O-arm navigation versus C-arm navigation for guiding percutaneous long sacroiliac screws placement in treatment of Denis type Ⅱ sacral fractures / 中国修复重建外科杂志

OBJECTIVE@#To compare the effectiveness of O-arm navigation and C-arm navigation for guiding percutaneous long sacroiliac screws in treatment of Denis type Ⅱ sacral fractures.@*METHODS@#A retrospective study was conducted on clinical data of the 46 patients with Denis type Ⅱ sacral fractures between April 2021 and October 2022. Among them, 19 patients underwent O-arm navigation assisted percutaneous long sacroiliac screw fixation (O-arm navigation group), and 27 patients underwent C-arm navigation assisted percutaneous long sacroiliac screw fixation (C-arm navigation group). There was no significant difference in gender, age, causes of injuries, Tile classification of pelvic fractures, combined injury, the interval from injury to operation between the two groups ( P>0.05). The intraoperative preparation time, the placement time of each screw, the fluoroscopy time of each screw during placement, screw position accuracy, the quality of fracture reduction, and fracture healing time were recorded and compared, postoperative complications were observed. Pelvic function was evaluated by Majeed score at last follow-up.@*RESULTS@#All operations were completed successfully, and all incisions healed by first intention. Compared to the C-arm navigation group, the O-arm navigation group had shorter intraoperative preparation time, placement time of each screw, and fluoroscopy time, with significant differences ( P<0.05). There was no significant difference in screw position accuracy and the quality of fracture reduction ( P>0.05). There was no nerve or vascular injury during screw placed in the two groups. All patients in both groups were followed up, with the follow-up time of 6-21 months (mean, 12.0 months). Imaging re-examination showed that both groups achieved bony healing, and there was no significant difference in fracture healing time between the two groups ( P>0.05). During follow-up, there was no postoperative complications, such as screw loosening and breaking or loss of fracture reduction. At last follow-up, there was no significant difference in pelvic function between the two groups ( P>0.05).@*CONCLUSION@#Compared with the C-arm navigation, the O-arm navigation assisted percutaneous long sacroiliac screws for the treatment of Denis typeⅡsacral fractures can significantly shorten the intraoperative preparation time, screw placement time, and fluoroscopy time, improve the accuracy of screw placement, and obtain clearer navigation images.

Maternal mid-upper arm circumference as a predictor of low birth weight outcome among newborn deliveries of adolescents in a Tertiary Level Hospital

Background@#Maternal malnutrition is a major cause of low birth weight (LBW) newborn outcome especially among adolescent mothers. It is one of the key drivers of child stunting and initiates the vicious cycle of intergenerational malnutrition. The body mass index prior to pregnancy or at the initial trimester is currently being used to establish the desired weight gain throughout pregnancy. However, Filipino adolescents often delay their first antenatal visit at a later stage of pregnancy. Without a baseline weight, the establishment of appropriate weight gain and nutritional status is often challenging. Mid-upper arm circumference (MUAC) was proven to be a good proxy measure of acute malnutrition, however, there was no global consensus on what MUAC cut-off point to use to identify pregnant adolescents at risk for delivering LBW babies. Finding the optimal cut-off could facilitate early identification and intervention of pregnant adolescents who are nutritionally at risk and could eventually break the cycle of intergenerational malnutrition.@*Objectives@#The study aims to determine the association of maternal MUAC and the birth weight outcomes among newborn deliveries of adolescents in a tertiary hospital for a period of six months and to identify the optimal maternal MUAC cut-off point that can be used to predict low birth weight outcome among newborn deliveries of adolescents in a tertiary hospital. Methods. A cross-sectional study was conducted among adolescents ages 10 to 19 years who delivered babies in a tertiary hospital in the Philippines for a period of six months. Maternal MUAC and LBW outcome were documented, and their association was determined using a logistic regression analysis. To measure diagnostic accuracy, the sensitivity, specificity, and the area under the curve were taken for each MUAC point. A receiver operating characteristic (ROC) curve was used to aid the MUAC cut-off determination.@*Results@#Out of 237 newborn deliveries, 35% were noted with low birth weight while 65% had normal birth weight. Most of the mothers were in their late adolescence at 78%. The crude association for the MUAC cut-offs ≤23.00 cm, ≤23.50 cm, and ≤24.00 cm and LBW showed a significant value of 2.19, 2.25, and 2.39 at 95% CI, respectively. However, it is only the cut-off ≤24.00 cm that showed significant results for adjusted association by the logistic regression analysis. The MUAC cut-off ≤24.00 cm also showed a better trade-off value between the sensitivity and specificity. Furthermore, the optimal maternal MUAC measurement that predicts LBW newborn outcome points to ≤24.00 cm cut-off based on the ROC curve.@*Conclusion@#This study shows that the maternal MUAC is predictive of LBW outcome among adolescent deliveries.A MUAC cut-off of ≤24.00 cm was superior to lower cut-offs studied. The pregnant adolescents might need a higher MUAC cut-off than adults to allow timely intervention and prevention of poor neonatal outcomes. By doing this simple screening test, suspected pregnant adolescents can be easily identified and referred for further confirmatory testing.

Braquioplastia no paciente ex-obeso: proposta de classificação / Brachioplasty in ex-obese patients: proposed classification

Introdução: O tratamento cirúrgico da obesidade mórbida implicou na maior demanda por procedimentos reparadores das sequelas causadas pela perda ponderal. Braquioplastia trata o excesso de pele e lipodistrofia localizada nas regiões dos braços e axilas. Os procedimentos para correção de deformidade braquial são incompletos e resultam em cicatrizes insatisfatórias. Sendo assim, propomos uma classificação objetiva que sugere tratamento cirúrgico com vistas à obtenção de um contorno braquial adequado. O objetivo é propor classificação para avaliar lipodistrofia e flacidez cutânea na região dos braços e axilas no paciente ex-obeso e sugerir tratamento cirúrgico adequado. Método: Revisão da literatura e proposta de classificação que sugere opção de tratamento cirúrgico a partir do exame físico pré-operatório. Tal classificação é objetiva e abrangente, facilitando a padronização entre os cirurgiões plásticos. Resultados: A classificação LC se divide em 7 tipos. Tipo L - lipodistrofia sem flacidez; Tipo C1 - flacidez proximal sem lipodistrofia; Tipo C2 - flacidez até terço médio sem lipodistrofia; Tipo C3 - flacidez até terço distal sem lipodistrofia; Tipo LC1 - flacidez em terço proximal com lipodistrofia associada; Tipo LC2 - flacidez até terço médio com lipodistrofia; Tipo LC3 - flacidez até terço distal com lipodistrofia. Baseado na classificação, as denominadas "L" se beneficiam de lipoaspiração enquanto as denominadas "C" sugerem dermolipectomia cirúrgica. Conclusão: A classificação alinha deformidades preexistentes com a respectiva modalidade cirúrgica para correção de cada caso, portanto, a existência de uma classificação objetiva e prática facilita a comunicação e orienta o melhor tratamento, proporcionando ao paciente um contorno braquial adequado.

Introduction: Surgical treatment of morbid obesity has resulted in a greater demand for repairing procedures for sequelae caused by weight loss. Brachioplasty treats excess skin and localized lipodystrophy in the arm and armpit regions. Procedures for brachial deformity correction are incomplete and result in unsatisfactory scars. Therefore, we propose an objective classification that suggests surgical treatment intending to obtain an adequate brachial contour. The aim is to propose a classification to assess lipodystrophy and skin flaccidity in the arms and armpits in ex-obese patients and suggest adequate surgical treatment. Method: Literature review and classification proposal that suggests a surgical treatment option based on the preoperative physical examination. This classification is objective and comprehensive, facilitating standardization among plastic surgeons. Results: The LC classification is divided into 7 types. Type L - lipodystrophy without sagging; Type C1 - proximal flaccidity without lipodystrophy; Type C2 - sagging up to the middle third without lipodystrophy; Type C3 - flaccidity up to the distal third without lipodystrophy; Type LC1 - sagging in the proximal third with associated lipodystrophy; Type LC2 - sagging up to the middle third with lipodystrophy; Type LC3 - sagging up to the distal third with lipodystrophy. Based on the classification, those labeled "L" benefit from liposuction, while those labeled "C" suggest surgical dermolipectomy. Conclusion: The classification aligns preexisting deformities with the respective surgical modality for correction in each case; therefore, an objective and practical classification facilitates communication and guides the best treatment, providing the patient with an adequate brachial contour.

Influência da Gordura do Braço sobre Medida Indireta da Pressão Sanguínea: Uma Abordagem Estatística e de Machine Learning / Influence of Arm Fat on the Indirect Measurement of Blood Pressure: A Statistical and Machine Learning Approach

Resumo Fundamento A mensuração indireta da pressão sanguínea (PS) é sabidamente influenciada por diversos fatores como técnica, observador e equipamento, mas a influência da composição do braço ainda não foi investigada. Objetivo Identificar a influência da gordura do braço sobre a medida indireta da pressão sanguínea, utilizando modelos de inferência estatística e machine learning. Métodos Estudo transversal, com 489 adultos jovens saudáveis de 18 a 29 anos de idade. Foram medidos comprimento (COB), circunferência do braço (CB) e índice de gordura do braço (IGB). A PS foi mensurada em ambos os braços, simultaneamente. Os dados foram processados utilizando-se Python 3.0 e pacotes específicos para análise descritiva, regressão e clusterização. Um nível de significância de 5% foi adotado para todos os cálculos. Resultados A PS e as medidas antropométricas foram diferentes entre os hemicorpos. A pressão sanguínea sistólica (PAS), COB, e IGB foram maiores no braço direito (BD), enquanto CB foi similar em comparação ao braço esquerdo. COB e CB apresentaram correlação positiva com a PAS. Conforme o modelo de regressão, para determinado valor de CB e COB, a leitura da PAS poderá ter uma redução média de 1,80 mmHg no BD, e 1,62 mmHg no braço esquerdo, a cada 10% de aumento na IGB. A clusterização corroborou os resultados da regressão. Conclusão Foi encontrada uma influência significativa do IGB sobre a leitura da PS. A PAS teve correlação positiva com COB e CB, e correlação negativa com IGB, o que sugere a necessidade de mais investigações sobre a relação da PS com as frações de gordura e músculo do braço.

Abstract Background The indirect measurement of blood pressure (BP) is known to be influenced by many factors such as the technique, observer, and equipment; however, the influence of arm composition has not been investigated yet. Objective To identify the influence of arm fat on the indirect measurement of blood pressure using statistical inference and machine learning models. Methods Cross-sectional study, with 489 healthy young adults aged from 18 to 29 years old. Measurements of arm length (AL), arm circumference (AC) and arm fat index (AFI) were taken. BP was measured in both arms simultaneously. Data were processed using Python 3.0 and its specific packages for descriptive analysis, regression and cluster analysis. Significance levels: 5% for all calculations. Results BP and anthropometric measurements were different between the hemi-bodies. In the right arm, systolic blood pressure (SBP), AL and AFI were higher, while AC was similar compared with the left arm. AL and AC showed positive correlation with SBP. According to the regression model, for a fixed value of AC and AL, SBP readings could be reduced by a mean of 1.80 mmHg in the right arm, and 1.62 mmHg in the left arm for every 10% increase in AFI. Clustering analysis corroborated the regression results. Conclusion There was a significant influence of AFI on BP readings. SBP had a positive correlation with AL and AC, and a negative correlation with AFI, suggesting the need for further investigations on the relationship between BP and percentages of arm muscle and fat.

Clinical and laboratory differences between chromosomal and undefined causes of non-obstructive azoospermia: A retrospective study

ABSTRACT BACKGROUND: Knowledge of clinical and laboratory differences between chromosomal and undefined causes aids etiological research on non-obstructive azoospermia. OBJECTIVE: Compare clinical and laboratory differences between men with non-obstructive azoospermia due to chromosomal anomalies versus undefined causes DESIGN AND SETTING: A cross-sectional retrospective study conducted at a public university hospital in Campinas (Brazil) METHODS: All men aged 20-40 years with non-obstructive azoospermia were included in the analysis. RESULTS: The 107 cases included 14 with Klinefelter syndrome (KS) (13%), 1 with mosaic KS, 4 with sex development disorders (2 testicular XX, 1 NR5A1 gene mutation, and 1 mild androgen insensitivity syndrome) (4%), 9 with other non-obstructive azoospermia etiologies (8%), and 79 with undefined causes. The 22 chromosomal anomaly cases (14 KS, 1 mosaic KS, 2 testicular XX, 4 sex chromosome anomalies, and 1 autosomal anomaly) were compared with the 79 undefined cause cases. The KS group had lower average testicular volume, shorter penile length, and lower total testosterone levels but greater height, arm span, serum luteinizing hormone (LH) and follicle stimulating hormone (FSH) levels, and gynecomastia frequency (absent in the undefined group and affecting more than half of the KS group). Patients with testicular XX DSD had LH, FSH, and penile length data intermediate between the KS and undefined cause groups, testicular volume similar to the KS group, and other data similar to the undefined group. CONCLUSION: Clinical and laboratory data differentiate men with non-obstructive azoospermia and chromosomal anomalies, particularly KS and testicular XX, from those with undefined causes or other chromosomal anomalies.

Does the early phase of aging affect the morphology of biceps brachii and torque and total work of elbow flexors in healthy volunteers?

Upper and lower limbs can be affected by several diseases and changes related to current life habits, such as the sedentarism, technological advances, and even eating habits. This cross-sectional study investigated morphological adaptations of the biceps brachii muscle and the performance of the elbow flexors in healthy individuals in the early phase of aging. Thirty-two volunteers were separated according to age range (3rd, 4th, and 5th decades of life) and sex. Smaller diameters and subtypes of fibers were evaluated using muscle biopsies, and peak torque and total work were assessed using an isokinetic dynamometer. The variables were compared considering sex and decade, using mixed-effects linear models. The smaller diameter of all fiber types did not differ significantly between age groups for either sex. The proportion of oxidative fibers was reduced in male participants in the 4th (-20%) and 5th (-6%) decades of life compared to the 3rd decade, and there was an increase in the number of oxidative fibers in women from the 4th (+14%) to the 5th decade of life. There were no significant changes in the peak torque and total work between the analyzed age groups. The early phase of aging starts with alterations in the proportion of fibers, with a decrease in oxidative fibers in men and an increase in oxidative fibers in women. Smaller diameter, torque, and total work did not change over these decades of life.

Symptomatic Upper Extremity Deep Venous Thrombosis After Laser Lead Extraction

ABSTRACT Introduction: Laser lead extraction is a well-established method for removing unwanted leads with low morbidity and mortality. In this small series of cases, we documented our experience with venous thrombosis after laser lead extraction. Methods: Retrospective data of patients who underwent laser lead extraction with postoperative axillo-subclavian vein thrombosis between May 2010 and January 2020 were analyzed. Demographic, operative, clinical, and follow-up characteristics of those patients were collected from our medical database. Results: Six patients underwent percutaneous laser lead extraction. Mean age of the patients was 64±7 years. And four of them were male. A total of 11 leads with a mean age of 92±43.8 months were extracted. Patients presented with painful arm swelling postoperatively. Conclusion: Laser lead extraction may lead to symptomatic upper extremity deep venous occlusion.

Safety and efficacy of C-arm CT laser-guided percutaneous renal pelvic catheter drainage under DSA in the treatment of hydronephrosis caused by pelvic malignancy / 中华泌尿外科杂志

Objective:To investigate the safety and efficacy of C-arm CT laser-guided puncture combined with digital subtraction angiography (DSA)for percutaneous renal pelvic catheter drainage in the treatment of hydronephrosis caused by pelvic malignancy.Methods:A retrospective analysis was performed on the data of 56 patients with ureteral obstruction caused by pelvic malignancy admitted to the Affiliated Cancer Hospital of Zhengzhou University from February 2020 to August 2021, including 10 males and 46 females. The mean age of the patients was (54.0±10.1)years old. The causes were colorectal cancer (7 cases), bladder cancer (3 cases), cervical cancer (36 cases), endometrial cancer (3 cases), ovarian cancer (2 cases), pelvic metastasis of gastric cancer (4 cases) and pelvic sarcoma (1 case). There were 71 sides of renal pelvis dilation in 56 patients, with the degree of dilation ranging from 1.2cm to 5.0cm.The degree of hydronephrosis was mild on 36 sides, moderate on 27 sides, and severe on 8 sides. Preoperative blood urea nitrogen(9.90±6.22)mmol/L and creatinine (155.80±146.83)μmol/L.During the puncture and catheter drainage, the patient was placed in the prone position, the C-arm CT scan was used to plan the puncture path, and the laser positioning of the DSA flat panel detector was used to determine the skin puncture point. With local anesthesia, the puncture direction of the puncture needle was adjusted to make the skin puncture point, the tail of the puncture needle, and the laser fixation point present a state of "three-points in one-line" when the patient stopped breathing temporarily at the end of expiratory breath in a non-fluoroscopic state, so as to achieve the preset puncture angle. Subsequently, pyelocentesis was completed according to the planned puncture depth. After successful pyelocentesis, percutaneous external renal drainage tube insertion or ureteral stents were performed under DSA. The number of renal pelvis puncture, puncture time, radiation dose, deviation of external renal drainage tube insertion angle from puncture angle, as well as postoperative hemoglobin changes, renal function recovery and complications were recorded.Results:In this group, 56 cases of 71 sides of renal pelvis puncture and catheter drainage were successfully completed, and the success rate of the operation was 100.0% (71/71). The success rate of the first needle puncture was 97.2% (69/71). Those who failed the first needle puncture succeeded in the second puncture during the operation. The puncture time of renal pelvis was (1.9±1.8) min.The intraoperative radiation dose was (2.7±1.5) mSV. The external drainage tube of the renal pelvis was placed on 53 sides, and the external drainage tube was placed on 29 sides with the same angle as the preset angle, and 24 sides with a deviation within 3°.On the first day after operation, there was no significant difference in hemoglobin compared with that before operation, urea nitrogen (5.31±1.99) mmol/L and creatinine (62.25±16.72) μmol/L were re-examined after operation, and the differences were statistically significant compared with those before operation ( P=0.008, P=0.002). No serious surgery-related complications occurred in any patient. Conclusion:C-arm CT laser-guided puncture combined with DSA percutaneous renal pelvic catheter drainage could be safe and effective in the treatment of ureteral obstruction caused by pelvic malignancy.

Comparison of screw placement guided by O-arm navigation and ultrasound volume navigation in minimally invasive transforaminal lumbar interbody fusion / 中国修复重建外科杂志

OBJECTIVE@#To compare the effectiveness of O-arm navigation and ultrasound volume navigation (UVN) in guiding screw placement during minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) surgery.@*METHODS@#Sixty patients who underwent MIS-TLIF surgery for lumbar disc herniation between June 2022 and June 2023 and met the selection criteria were included in the study. They were randomly assigned to group A (screw placement guided by UVN during MIS-TLIF) or group B (screw placement guided by O-arm navigation during MIS-TLIF), with 30 cases in each group. There was no significant difference in baseline data, including gender, age, body mass index, and surgical segment, between the two groups ( P>0.05). Intraoperative data, including average single screw placement time, total radiation dose, and average single screw effective radiation dose, were recorded and calculated. Postoperatively, X-ray film and CT scans were performed at 10 days to evaluate screw placement accuracy and assess facet joint violation. Pearson correlation and Spearman correlation analyses were used to observe the relationship between the studied parameters (average single screw placement time and screw placement accuracy grading) and BMI.@*RESULTS@#The average single screw placement time in group B was significantly shorter than that in group A, and the total radiation dose of single segment and multi-segment and the average single screw effective radiation dose in group B were significantly higher than those in group A ( P<0.05). There was no significant difference in the total radiation dose between single segment and multiple segments in group B ( P>0.05), while the total radiation dose of multiple segments was significantly higher than that of single segment in group A ( P<0.05). No significant difference was found in the accuracy of screw implantation between the two groups ( P>0.05). In both groups, the grade 1 and grade 2 screws broke through the outer wall of the pedicle, and no screw broke through the inner wall of the pedicle. There was no significant difference in the rate of facet joint violation between the two groups ( P>0.05). In group A, both the average single screw placement time and screw placement accuracy grading were positively correlated with BMI ( r=0.677, P<0.001; r=0.222, P=0.012), while in group B, neither of them was correlated with BMI ( r=0.224, P=0.233; r=0.034, P=0.697).@*CONCLUSION@#UVN-guided screw placement in MIS-TLIF surgery demonstrates comparable efficiency, visualization, and accuracy to O-arm navigation, while significantly reducing radiation exposure. However, it may be influenced by factors such as obesity, which poses certain limitations.

Application of single-arm objective performance criteria/performance goal in acupuncture-moxibustion clinical trials / 中国针灸

Due to various constraints, such as clinical implementation conditions and unique characteristics of acupuncture-moxibustion, some randomized controlled trials (RCTs) of acupuncture-moxibustion still suffer from relatively low quality and limited applicability. The single-arm objective performance criteria/performance goal can be considered as an ideal supplementary and alternative research approach to RCTs. In this paper, the feasibility of applying the single-arm objective performance criteria/performance goal in acupuncture-moxibustion clinical research is explored from the limitations of conducting acupuncture-moxibustion RCTs, the principles, the essential design considerations and key statistical steps. In addition, illustrative examples are provided. The objective is to offer insights into resolving practical difficulties in acupuncture-moxibustion clinical research.

Epidemiological characteristics and risk assessment of occupational diseases caused by physical factors in Guangdong Province, 2013-2022 / 中国职业医学

Objective To analyze the epidemiological characteristics of occupational diseases caused by physical factors in Guangdong Province from 2013 to 2022, and to evaluate the key risk points of its incidence. Methods The data of newly diagnosed and suspected occupational diseases caused by physical factors in Guangdong Province from 2013 to 2022 were collected from the Occupational Diseases and Hazards Monitoring Information System under China Disease Prevention and Control Information System, and were analyzed retrospectively. The key risk points of occupational diseases caused by physical factors were evaluated. Results A total of 661 cases of occupational diseases caused by physical factors were reported in Guangdong Province from 2013 to 2022, showing an overall increasing trend, with an average annual growth rate of 29.6%. The major occupational diseases caused by physical factors were occupational hand-arm vibration disease and occupational heat stroke, accounting for 59.5% and 39.6%, respectively. The nine prefecture-level cities of Pearl River Delta region accounted for 98.5% of the new cases. The cases were distributed mainly in the manufacturing industry (77.0% of the cases). A total of 294 enterprises were involved in the analysis of newly diagnosed occupational diseases caused by physical factors. Occupational hand-arm vibration cases appeared to be significantly aggregated in specific enterprises, and other disease cases were mostly sporadic. The types of enterprise registration were mainly Hong Kong-, Macao-, and Taiwan-invested enterprises and domestic-funded enterprises, accounting for 53.1% and 41.4%, respectively. In terms of enterprise size, large-scale and small-scale enterprises accounted for 56.5% and 21.4% of cases, respectively. A total of 27.4% of workers with occupational diseases caused by physical factors were identified as suspected occupational diseases before be diagnosed as occupational diseases, all of which were hand vibration disease and heat stroke In the future, attention should be paid to the risks of mass events of occupational hand-arm vibration disease, outbreaks of occupational heat stroke, and missed diagnosis of suspected occupational hand-arm vibration disease. Conclusion Among all occupational diseases caused by physical factors in Guangdong Province, attention should be paid on occupational hand-arm vibration disease and occupational heat stroke. Occupational hand-arm vibration disease has a high risk of group morbidity. Construction workers and sanitation workers have a high potential risk of occupational heat stroke.

Effect of transcutaneous auricular vagus nerve stimulation combined with bilateral arm training on upper limb motor function of stroke patients / 中国康复理论与实践

ObjectiveTo investigate the effects of transcutaneous auricular vagus nerve stimulation (taVNS) combined with bilateral arm training (BAT) on upper limb motor function of hemiplegic stroke patients. MethodsFrom January, 2021 to January, 2022，105 stroke patients from Zhejiang Provincial People's Hospital were randomly divided into taVNS group (n = 35), BAT group (n = 35) and combined group (n = 35). All the patients received routine rehabilitation, while taVNS group received taVNS, BAT group received BAT, and the combined group received both taVNS and BAT, for eight weeks. The root mean square (RMS) of surface electromyography in deltoid, triceps brachii and extensor carpi was measured, and the scores of Box and Block Test (BBT), and Fugl-Meyer Assessment-Upper Extremities (FMA-UE) were obtained before and after treatment. ResultsThe RMS of all these muscles, and the scores of BBT and FMA-UE improved in all the three groups after treatment (|t| > 6.124, P < 0.001), and they were improved the most in the combined group (F > 18.162, P < 0.001). ConclusionBoth taVNS and BAT can enhance the muscle strength on the affected upper limb, increase the hand flexibility, and improve upper limb motor function of stroke patients, while the combination of both methods is more effective.

Reconstrução do braço com retalho miocutâneo do músculo grande dorsal após ressecção de sarcomas: relato de dois casos e descrição da técnica cirúrgica / Arm reconstruction with myocutaneous flap of the latissimus dorsi muscle after resection of sarcomas: report of two cases and description of the surgical technique

Os sarcomas de partes moles são neoplasias malignas raras originadas do mesênquima, mais comumente encontradas em membros. A ressecção cirúrgica com margens livres acima de 1cm é fundamental para obter a cura do paciente. A radioterapia pode ser combinada ao tratamento em casos selecionados. A reconstrução dos membros superiores após ressecções alargadas é um desafio. O retalho miocutâneo do músculo grande dorsal (RMGD) é uma opção em casos de lesões em membros superiores, sobretudo terço proximal e médio do braço, com preservação da função do membro e fechamento primário da área de ressecção. Relatamos dois casos de ressecção e reconstrução do braço utilizando RMGD com foco na descrição da técnica cirúrgica.

Soft tissue sarcomas are rare malignant neoplasms arising from the mesenchyme, most commonly found in the limbs. Surgical resection with free margins greater than 1 cm is essential to obtain a cure for the patient. Radiation therapy can be combined with treatment in selected cases. Reconstruction of the upper limbs after extended resections is a challenge. The latissimus dorsi myocutaneous flap (LDMF) is an option in injuries to the upper limbs, especially the proximal and middle thirds of the arm, with preservation of limb function and primary closure of the resection area. We report two cases of arm resection and reconstruction using LDMF, focusing on the surgical technique description.

Could mid-upper arm circumference be a valid proxy to the body mass index for elderly persons?

Introduction: In elderly persons, due to physiological, anatomical, and functional changes, body mass index (BMI) may not be suitable for the assessment of nutritional status. Mid-upper arm circumference (MUAC) can be a proxy indicator to identify underweight and overweight/obesity among elderly persons. This study aimed to estimate the correlation between MUAC and BMI, and the cutoffs for MUAC using receiver operating characteristic (ROC) analysis. Material and Methods: This survey was carried out in a resettlement colony of Delhi. The participants were residents of the area who were aged 60 years or older, and selected by a simple random sampling technique. The arm span, weight, and MUAC of the participants were measured. The correlation between MUAC and BMI for gender and age group was calculated. The ROC curve was also constructed. Results: A total of 946 eligible participants were enrolled. The correlation between MUAC and BMI was 0.67 (P < 0.001) and 0.76 (P < 0.001) among men and women, respectively. The MUAC cutoff for underweight was <25 cm with a sensitivity of 68.8% and specificity of 84.9%. The area under the curve (AUC) was 0.84 (0.80–0.88). The MUAC cutoff for overweight/obesity was ?27 cm with a sensitivity of 83.9% and specificity of 64.9%, and AUC was 0.78 (0.75–0.82). Conclusion: The MUAC of the participants increased as the BMI of the participants increased. MUAC cutoff was determined using the ROC curve for underweight and overweight/obesity among elderly persons.

Disability of Arm, Shoulder and Hand and Michigan Hand Outcomes Questionnaires: Exploring Responsiveness and Diagnostic Performance in a Sample of Outpatients with and without Hand and Wrist Complaints / Questionários Disability of the Arm Shoulder and Hand e Michigan Hand: Explorando a responsividade e performance diagnóstica em amostra de pacientes ambulatoriais com e sem queixas nas mãos e punho

Abstract Objective The present study aimed to verify whether, in an adult population with nontraumatic complaints in the upper limbs, (1) the Disability of the Arm, Shoulder and Hand (DASH) questionnaire and the Michigan Hand Outcomes Questionnaire (MHQ) are susceptible to a "ceiling effect" when compared with a sample of healthy subjects; and (2) to determine cutoff points for diagnostic performance and the intercorrelation for DASH and MHQ in both samples. Methods This was a prospective, comparative, nonrandomized study. In total, 150 subjects were included, with 75 in the case group (with disease) and 75 in the control group (without disease). This was a sample of patients recently admitted to a hand surgery outpatient clinic. Controls were matched to clinical cases according to inclusion. The ceiling effect was determined by a maximum response rate (> 15%); receiver operating characteristic (ROC) curves determined cutoff points for sickness definition, and DASH and MHQ sensitivity and specificity. Statistical significance was set at p < 0.05. Results The DASH and MHQ questionnaires had no ceiling effect for the case group. In this group, 18 (24%) patients had the maximum DASH score, but none (0%) had the maximum MHQ score. For the control group, 1 (1.33%) subject had the maximum DASH score, but none scored for MHQ. For case determination, DASH scores of 7.1 had 80% sensitivity and 60.3% specificity, whereas MHQ scores of 76.9 had 56.2% sensitivity and 97.3% specificity. Conclusion The DASH and MHQ questionnaires are reliable tools to measure the impact of hand and wrist morbidities on daily activities, and they are not susceptible to ceiling effects. The DASH questionnaire is more sensitive for patient identification, whereas the MHQ is more specific. As such, the MHQ seems more appropriate when a more specific functional increase is expected.

Resumo Objetivo Verificar se, em uma população adulta com queixa não traumática dos membros superiores, (1) os questionários Disability of the Arm, Shoulder and Hand (DASH, na sigla em inglês) e Michigan Hand Questionnaire (MHQ, na sigla em inglês) estão suscetíveis ao "efeito de teto", comparando com amostra de não-doentes; (2) determinar pontos de corte de performance diagnóstica e correlação interquestionários para DASH e MHQ em ambas as amostras. Método Estudo prospectivo, comparativo e não randomizado. Incluímos 150 pacientes, 75 no grupo caso (com doença) e 75 no grupo controle (sem doença). Trata-se de amostra de pacientes recém-admitidos em ambulatório de cirurgia da mão. Os controles foram pareados de forma balanceada de acordo com a inclusão dos casos. Determinamos a presença de efeito de teto por meio da taxa de respostas máximas (> 15%) e associamos curvas receiver operating characteristic (ROC, na sigla em inglês) para a determinação de pontos de corte para a determinação de doentes, associados a medidas de sensibilidade e especificidade. Consideramos p < 0.05 para significância estatística. Resultados Os questionários DASH e MHQ não demonstraram o efeito de teto para o grupo com doença. A porcentagem de pacientes do grupo caso com nota máxima foi de n = 18 (24%) no DASH e de 0% no MHQ. Para o grupo sem doença, 1 (1,33%) dos participantes pontuou com nota máxima para DASH, enquanto nenhum pontuou para o MHQ. Na determinação de casos, escores de DASH de 7,1 apresentam sensibilidade de 80% e especificidade de 60,3%. Para o MHQ, um escore de 76,9 apresenta sensibilidade de 56,2% e especificidade de 97,3%. Conclusão Os questionários DASH e MHQ são ferramentas confiáveis na mensuração do impacto das morbidades das mãos e dos punhos nas atividades diárias dos pacientes e não são suscetíveis a efeito de teto. O questionário DASH é mais sensível para a identificação de doentes, enquanto o MHQ é mais específico. Em situações nas quais se espera um incremento funcional mais discreto (ou mais específico), o MHQ parece mais adequado.

Referencias de índice de masa corporal. Precisión diagnóstica con área grasa braquial en escolares argentinos / Body mass index references. Diagnostic accuracy with the upper-arm fat area in Argentine schoolchildren

El índice de masa corporal (IMC) es una eficaz herramienta para detectar la sobrecarga ponderal en niños y adolescentes, asociado a la adiposidad corporal. Objetivo. Analizar la concordancia, sensibilidad y especificidad de tres referencias internacionales de IMC/edad (OMS, IOTF y CDC) para diagnosticar el exceso ponderal y conocer su precisión diagnóstica para identificar el exceso de adiposidad con relación al área grasa braquial (AGB) en población infanto juvenil de Argentina. Materiales y métodos. Se realizó un estudio multicéntrico, descriptivo-comparativo y transversal entre 2003 y 2008, en 22.658 niños y adolescentes argentinos de 4 a 13 años de edad. A partir del peso, talla, circunferencia del brazo y pliegue tricipital, se calcularon IMC y AGB. Se analizó la concordancia, sensibilidad y especificidad de referencias de IMC/edad (OMS, CDC, IOTF) y la precisión diagnóstica (curvas ROC) para identificar exceso de adiposidad, a partir del AGB, así como el punto de corte óptimo (PCO). Resultados. Las tres referencias tuvieron buena concordancia. La mayor sensibilidad correspondió a OMS y la mayor especificidad a IOTF. El área bajo la curva (ABC) fue mayor en Z-IMC/IOTF en varones y en Z-IMC/OMS en mujeres. Los PCO mostraron discrepancias, siendo mayores con OMS. Conclusión. Las tres referencias muestran similar precisión diagnóstica para detectar alta reserva calórica, con puntos de corte óptimo para las puntuaciones Z-IMC menores a 2 Z scores. Esto resulta relevante para la identificación de exceso de adiposidad en poblaciones, en relación con la implementación de políticas públicas de prevención de enfermedades crónicas no transmisibles(AU)

The body mass index (BMI) is an effective tool to detect weight overload in children and adolescents, associated with body adiposity. Objective. To analyze the concordance, sensitivity and specificity of three international BMI/age references (WHO, IOTF and CDC) to diagnose excess weight and to know their diagnostic accuracy to identify excess adiposity in relation to the brachial fat area (BFA) in Argentine child-youth population. Materials and methods. A multicenter, descriptive- comparative and cross-sectional study was carried out between 2003 and 2008 in 22.658 Argentine children and adolescents between aged 4 to 13 years. From the weight, height, arm circumference and tricipital fold, BMI and BFA were calculated. The concordance, sensitivity, and specificity of BMI / age references (WHO, IOTF, CDC,) were analyzed and the diagnostic precision (ROC curves) to identify excess adiposity, from the BFA, as well as the optimal cut-off point (OCP). Results. The three references had good agreement, the highest sensitivity corresponded to WHO and the highest specificity to IOTF. The area under the curve (AUC) was greater in Z-BMI/IOTF in men and in Z-BMI/WHO in women. The OCPs showed discrepancies, being higher with WHO. Conclusion. The three references show similar diagnostic accuracy to detect high caloric reserve, but with cut-off points for Z-BMI scores less than 2 Z scores. This is relevant for the identification of excess adiposity in populations in relation to the implementation of public policies for the prevention of chronic non-communicable diseases(AU)

Identification and preservation of arm lymphatics in axillary lymph node dissection to prevent arm lymphedema: a single center randomized controlled trial / 中华肿瘤杂志

Objective: To evaluate the feasibility of identification and preservation of arm lymphatics (DEPART) in axillary lymph node dissection (ALND) for breast cancer to prevent arm lymphedema. Methods: A randomized controlled study method was used. Two hundred and sixty-five patients who underwent breast cancer surgery at the Department of Thyroid and Breast Surgery, Zhongnan Hospital of Wuhan University from November 2017 to June 2018 were included, and the patients were randomly divided into ALND+ DEPART group (132 patients) and standard ALND group (133 patients) by random number table method. In the ALND+ DEPART group, indocyanine green and methylene blue were injected as tracers before surgery, and the arm sentinel nodes was visualized by staged tracing during intraoperative dissection of axillary lymph nodes. Partial frozen sections were made of arm lymph nodes >1 cm in length and hard and suspicious of metastasis, and arm lymph nodes and lymphatic vessels were selectively preserved. Patients in the standard ALND group underwent standard ALND. Objective and subjective indexes of arm lymphedema were evaluated by 5-point circumference measurement and Norman questionnaire. Results: Among 132 breast cancer patients in the ALND+ DEPART group, 121 (91.7%) completed DEPART. There were no statistically significant differences in age, body mass index, pathological type, dissection number of axillary lymph node, N stage, TNM stage, molecular typing, and regional radiotherapy between the ALND+ DEPART and standard ALND groups (P>0.05). At a median follow-up of 24 months, assessment by the 5-point circumference measurement showed that the incidence rates of lymphedema in the ALND+ DEPART and standard ALND groups were 5.0% (6/121) and 15.8% (21/133), respectively, with statistically significant differences (P=0.005). Assessment by the Norman questionnaire showed that the incidence rates of lymphedema in the ALND+ DEPART and standard ALND groups were 5.8% (7/121) and 21.8% (29/133), respectively, with a statistically significant difference (P<0.001). No local regional recurrence was observed in either group during the follow-up period. Conclusion: For breast cancer patients with positive axillary lymph nodes, the administration of DEPART during ALND can reduce or avoid the occurrence of arm lymphedema without compromising oncology safety.

Repair of soft tissue defect after digit degloving injury with free medial perforator flap of arm / 中华显微外科杂志

Objective:To explore the surgical technique and therapeutic effect of flap wrapping repair of soft tissue defect after digit degloving injury with free arm medial perforator flap.Methods:From October 2009 to December 2020, 15 patients with soft tissue defect after digit degloving injury were repaired with free arm medial perforator flaps. The patients were 9 males and 6 females aged 22 to 50 years old, with an average of 32 years old. Injury mechanism: 13 cases of machine strangulation and 2 cases of machine crushing. Plane of sleeve avulsion injury: at the distal metacarpophalangeal joint of thumb in 2 cases, at the middle and distal segment of single finger of 2nd to 5th fingers in 4 cases, and at distal metacarpophalangeal joint of 2nd to 5th fingers in 9 cases. Seven cases were in left hand and 8 in right hand. Emergency surgery was performed in 2 cases and scheduled surgery in 13 cases. The flap was designed in a shape of a long strip, and the size of the flap was 5.0 cm×2.5 cm-14.0 cm×3.5 cm. During the operation, the artery of the flap pedicle was anastomosed with the palmar digital proper artery or common digital artery of the recipient digit, the subcutaneous vein or the companion vein of the artery was anastomosed with the dorsal or palmar digital subcutaneous vein, and the medial brachial cutaneous nerve carried in the flap was anastomosed with the stump of palmar digital proper nerve. All the donor sites were directly sutured. After the surgery, follow-up visits were conducted regularly at outpatient clinic, or via telephone and WeChat review or by home visit. The flap appearance, sensation and function recovery of digital joints were observed together with the patient satisfaction. Results:All flaps survived successfully after surgery. Six patients with degloving defect of the whole digit had encountered poor wound healing caused by distal phalangeal necrosis. The second stage stump trimming was performed to keep the digit to the distal end of the middle segment. Two cases of thumb and 2 cases of middle finger suffered further burning and worn tears at 7-9 months after surgery and self-healed. The follow-up period was 6-28 (average 16) months. The flap was soft without bloating. The sensation recovered to S 2-S 3. The shape of fingers was good, and no secondary flap surgery was necessary. The overall movement of interphalangeal joints was poor. According to the evaluation standard of Michigan hand function questionnaire, 15 patients achieved very satisfactory with the overall appearance and function of hands. The linear scars at donor site were hidden without complications such as tenderness and contraction. Conclusion:The free medial perforator flap of the arm is easy to design and thin, hence does not affect the shape of a digit. So, it is ideal for the repair of soft tissue defect after digit degloving injury.

Rethinking the marketing strategy of anti-tumor drugs by single-arm trials supported / 中华肿瘤杂志

Single-arm trial refers to a clinical trial design that does not set up parallel control group, adopts open design, and does not involve randomization and blind method. These features, on the one hand, speed up the process of clinical trials, significantly shorten the time to market and meet the needs of patients with advanced malignancies, but also lead to the uncertainty of single-arm clinical trials themselves. Recently, the US Food and Drug Administration held a meeting of the oncologic drug advisory committee to discuss six tumor indications that have been accelerated approved, which once again triggered the discussion of single-arm trials. The basis of accelerated approval by single-arm trial is actually a compromise on the level of evidence-based medical evidence requirements after assessing the benefit risk. Therefore, the sponsor should strictly grasp the applicable conditions of single-arm trial in anti-tumor drugs and conduct single-arm trial scientifically. Post-marketing clinical trial should be implement as early as possible to ensure the benefit of patients. Based on the characteristics of single-arm trial, combined with two guidance relevant to single-arm trial issued by National Medical Products Administration recently, this article is supposed to propose and summarize the strategy of single-arm trial supporting the marketing of anti-tumor drugs.

Dosimetric effect of patient arm position on Cyberknife radiosurgery for spinal tumors / 北京大学学报(医学版)

OBJECTIVE@#To assess the potential dosimetric effects of arms movement in patients with Cyberknife spine tumors.@*METHODS@#In the study, 12 patients with thoracic and lumbar tumors were retrospectively selected respectively. The contour of the patient's arms was sketched and the CT density was modified to be equivalent to air in order to simulate the extreme case when the arm was completely removed from the radiation fields. The dose of simulated plan was re-calculated with the original beam parameters and compared with the original plan. The changes of V100, D95, and D90, conformity index (CI) and heterogeneity index (HI) in planning target volume (PTV), as well as Dmax, D1cc and D2cc in the spinal cord, stomach, esophagus, and intestines were analyzed by comparing with the original plans.@*RESULTS@#Compared with the original treatment plan, V100, D95, D90 and CI of PTV for the simulated plan was increased by 0.86%, 2.02%, 1.97% and 0.80% respectively, the difference was statistically significant (P < 0.05). Dmax, D1cc and D2cc of spinal cord was increased by 2.35%, 0.59% and 1.49% on average, compared with the original plan, the difference was statistically significant (P < 0.05). The difference was statistically significant only in average D2cc of stomach, which was increased by 1.70%, compared with the original plan (P < 0.05). There was no significant difference in dose change of eso-phagus and intestine between the original and simulated plans.@*CONCLUSION@#This study analyzed the most extreme arm position in spinal tumor of radiation therapy based on Cyberknife. It was found that the change of arm position had little effect on dosimetry. In addition, with the change of arm position, the dose in PTV and organ at risk (OAR) increased, but the increase was relatively small. Therefore, in some special cases where the patient really can't keep the arm position consistent during treatment, reasonable adjustment can be accepted. However, in order to ensure accurate radiotherapy, patient position should be as stable and consistent as possible.