Manejo terapéutico de actualidad de heridas complejas del tercio distal de la pierna en el Hospital de Trauma (Prof. Manuel Giagni) y en la Unidad de Cirugía Plástica de la Facultad de Ciencias Médicas - UNA / Current therapeutic management of complex wounds of the distal third of the leg in the Trauma Hospital (Prof. Manuel Giagni) and in the Plastic Surgery Unit of the Faculty of Medical Sciences - UNA

Introducción: La herida es una pérdida de continuidad de la piel o mucosa producida por algún agente físico o químico. Una herida es "compleja" cuando por su extensión, localización, profundidad o exposición de elementos nobles, necesita para su curación una terapéutica especial. Este es el caso de heridas con compromiso tisular que afecta a estructuras como músculos, fascias, tendones, huesos, vasos sanguíneos, nervios o las lesiones de lenta evolución como úlceras o escaras. Objetivos: Determinar el método de reconstrucción más utilizado en el manejo terapéutico de las heridas complejas del tercio distal de la pierna en los pacientes atendidos en el Hospital de Trauma y en la Unidad de Cirugía Plástica de la FCM - UNA. Materiales y métodos: Estudio de diseño observacional, tipo de estudio descriptivo y retrospectivo. Fueron incluidos pacientes de ambos sexos, mayores de edad, con heridas complejas en el tercio distal de la pierna, atendidos en el Hospital de Trauma y en la Unidad de Cirugía Plástica de la FCM - UNA, durante el periodo 2010 al 2019. Resultados: Se incluyó a 112 pacientes de los cuales el 80,36 % fue hombres y el 19,64 % mujeres. Las edades estaban comprendidas entre los 18 y los 73 años y una media de 33,8 ± 14 años. La edad más frecuente fue 18 años. La mediana de edad es de 30 años, lo que implica que la mitad de la muestra tuvo por lo menos dicha edad. En cuanto a la procedencia, el 41,07 % era del interior, el 30,36 % del departamento Central y el 28,57 % restante de Asunción. En cuanto al mecanismo de la lesión, se puede observar que el mecanismo más frecuente fue el accidente de tráfico, seguido por caída de altura, en un gran porcentaje. En cuanto a la evolución y complicaciones se puede ver que 92 individuos, o sea 82 % de los pacientes no tuvo ninguna evolución negativa o complicaciones. Lo más común fue la infección con 1,9% de prevalencia, la pérdida parcial del colgajo o piel representan el 2,4%, dehiscencia de la sutura el 0,9 %, hematoma 0,6 % y pérdida total del colgajo 0,54 %. En cuanto al tratamiento aplicado, se debe tener en cuenta que los pacientes pudieron haber recibido más de un tratamiento por lo que el tamaño de la muestra se refiere a las visitas. El tratamiento más frecuente fue el colgajo sural con 28,57%, tutor externo con el 20,19%, injerto de piel 16,46%, toillete 12,73% y colgajo fascio - cutáneo en 6,21%. Conclusión: La gran mayoría de los casos tratados corresponde a algún tipo de accidente de tránsito. Se necesita de un equipo multidisciplinario: ortopedistas, cirujanos plásticos, cirujanos vasculares, fisioterapeutas, etc. en trabajo coordinado para tratar estas graves lesiones de forma a obtener resultados favorables. Para la cobertura de la pierna traumatizada, con exposición ósea, recurrimos a los colgajos musculares, en el 1/3 proximal el gemelo, en el 1/3 medio el sóleo. Para la cobertura del 1/3 distal de la pierna utilizamos el colgajo neuro-veno-fascio-cutáneo (sural) a pedículo distal.

Introduction: The wound is a loss of continuity of the skin or mucosa produced by some physical or chemical agent. A wound is "complex" when due to its extension, location, depth, exposure of noble elements, it requires special therapy to heal. This is the case of wounds with tissue involvement that affects structures such as muscles, fascia, tendons, bones, blood vessels, nerves, or slowly evolving lesions such as ulcers or bedsores. Objectives: Determine the reconstruction method most used in the therapeutic management of complex wounds of the distal third of the leg in patients treated at the Trauma Hospital and the Plastic Surgery Unit of the FCM - UNA. Materials and methods: Observational, descriptive, and temporally retrospective study. Patients of both sexes, of legal age, with complex wounds in the distal third of the leg, treated at the Trauma Hospital and in the Plastic Surgery Unit of the FCM - UNA, during the period 2010 to 2019, were included. Results: 112 patients were included, of which 80.36% are men and 19.64% are women. The ages range from 18 to 73 years and an average of 33.8 ± 14 years. The most common age was 18 years. The median age is 30 years, which implies that half of the sample is at least that age. Regarding origin, 41.07% are from the interior, 30.36% from the Central department and the remaining 28.57% from Asunción. Regarding the mechanism of injury, the most frequent mechanism was a traffic accident, followed by a fall from a height, in a large percentage. Regarding the evolution and complications, 92, that is, 82% of the patients do not have any negative evolution or complications. The most common was infection with 1.9%, partial loss of the flap or skin represented 2.4%, suture dehiscence with 0.9%, hematoma 0.6%, and total loss of the flap 0.54. %. Regarding the treatment applied, it must be considered that patients may have received more than one treatment, so the sample size refers to visits. The most frequent treatment was the sural flap with 28.57%, external tutor with 20.19%, skin graft 16.46%, toilette 12.73% and fasciocutaneous flap in 6.21%. Conclusion: Most cases treated correspond to some type of traffic accident. A multidisciplinary team is needed: orthopedists, plastic surgeons, vascular surgeons, physiotherapists, etc. in coordinated work to treat these serious injuries to obtain favorable results. To cover the traumatized leg, with bone exposure, we resort to muscle flaps. In the proximal 1/3, the gastrocnemius. In the middle 1/3, the soleus. To cover the distal 1/3 of the leg we used the neuro-veno-fascio-cutaneous (sural) flap to the distal pedicle.

Arterialização venosa superficial com veia safena magna in situ: a experiência de um único centro / Superficial venous arterialization with the great saphenous vein in situ: a single-center experience

Resumo Contexto A arterialização do arco venoso dorsal do pé é uma técnica indicada em casos de isquemia crítica de membros inferiores sem leito distal adequado que possibilite tratamento convencional, como revascularização, angioplastia ou tratamento clínico. Objetivos O propósito do trabalho foi apresentar o resultado da arterialização do arco venoso do pé em 16 pacientes submetidos a essa técnica. Métodos Tratou-se de um estudo analítico descritivo retrospectivo transversal, baseado na revisão de prontuários de 16 pacientes submetidos à arterialização do arco venoso dorsal do pé para salvamento de membro, entre janeiro de 2016 a janeiro de 2021. Resultados Dos 16 pacientes submetidos à arterialização do arco venoso do pé, 25% (4) evoluíram para amputação maior durante a mesma internação, e 6,25% (1) pacientes evoluíram para amputação maior após 6 meses. Os demais pacientes (68,75%, 11) tiveram seus membros preservados, sendo que 10 foram submetidos a amputações menores (pododáctilos e antepé), e 1 paciente não necessitou de procedimento adicional. Conclusões A técnica de arterialização do arco venoso dorsal do pé deve ser considerada em casos selecionados. Trata-se de uma alternativa válida para a preservação do membro na impossibilidade de tratamento convencional.

Abstract Background Arterialization of the dorsal venous arch of the foot is a technique indicated in cases of critical lower limb ischemia that do not have a distal bed that is adequate to enable conventional treatment such as revascularization, angioplasty, or clinical treatment. Objectives The purpose of this study is to present the result of arterialization of the venous arch of the foot in 16 patients who underwent treatment with this technique. Methods This is a cross-sectional retrospective descriptive analytical study based on a review of the medical records of 16 patients who underwent arterialization of the dorsal venous arch of the foot for limb salvage from January 2016 to January 2021. Results Four (25%) of the 16 patients who underwent arterialization of the venous arch of the foot underwent a major amputation during the same hospital stay and one patient (6.25%) had a major amputation within 6 months. The other 11 patients (68.75%) had their limbs preserved, with 10 undergoing minor amputations (toes and forefoot) and one patient having no additional procedures. Conclusions We conclude that the technique of arterialization of the dorsal venous arch of the foot should be considered in selected cases. It is a valid alternative for limb salvage when conventional treatment is impossible.

Nursing interventions to empower the family caregiver of person with lower limb amputation: scoping review / Intervenções de Enfermagem para capacitar o cuidador familiar de uma pessoa com amputação de membro inferior: revisão de escopo / Intervenciones de enfermería para capacitar al cuidador familiar de una persona con amputación de miembro inferior: revisión de alcance

ABSTRACT Objectives: to map nursing interventions that empower the Family caregiver of the person with lower limb amputation for is role. Methods: scoping review guided by Joanna Briggs Institute methodology conducted in different databases (including gray literature). Results: six studies published between 2009 and 2021 were included. Interventions of counselling and support for patients and family; peer support interventions performed by a certified pair; involvement of caregivers or family members in support groups; and key interventions for patient and family caregiver psychological balance. Two studies discussed the importance of caregiver and amputee training and development of coping skills. Another study recommended Interventions of informative support for caregivers regarding care for the amputee and adaptation to home. Conclusions: results of this review allow the identification of recommendations (guidelines) for practice and recommendations/suggestions for interventions according with identified needs of family caregivers of patients with lower limb amputation.

RESUMO Objetivos: mapear intervenções de enfermagem que capacitem o cuidador familiar da pessoa com amputação de membro inferior para seu papel. Métodos: revisão de escopo orientada pela metodologia do Joanna Briggs Institute realizada em diferentes bases de dados (incluindo literatura cinzenta). Resultados: foram incluídos seis estudos publicados entre 2009 e 2021. Intervenções de aconselhamento e apoio para pacientes e familiares; intervenções de apoio de pares realizadas por uma dupla certificada; envolvimento de cuidadores ou membros da família em grupos de apoio; e intervenções-chave para o equilíbrio psicológico do paciente e do cuidador familiar. Dois estudos discutiram a importância do treinamento do cuidador e do amputado e do desenvolvimento de habilidades de enfrentamento. Outro estudo recomendou intervenções de suporte informativo para os cuidadores com relação aos cuidados com o amputado e à adaptação ao lar. Conclusões: os resultados dessa revisão permitem a identificação de recomendações (diretrizes) para a prática e recomendações/sugestões para intervenções de acordo com as necessidades identificadas dos cuidadores familiares de pacientes com amputação de membros inferiores.

RESUMEN Objetivos: mapear intervenciones de enfermería que capaciten al cuidador familiar de la persona con amputación de miembro inferior para su rol. Métodos: es una revisión de alcance guiada por la metodología del Instituto Joanna Briggs, llevada a cabo en diferentes bases de datos (incluyendo literatura gris). Resultados: se tuvieron en cuenta seis estudios publicados entre 2009 y 2021, a saber: intervenciones de asesoramiento y apoyo para pacientes y familiares; intervenciones de apoyo entre iguales realizadas por un par de profesionales certificados; participación de cuidadores o familiares en grupos de apoyo e intervenciones clave para el equilibrio psicológico del paciente y del cuidador familiar. Dos estudios analizaron la importancia de la formación del cuidador y del amputado y del desarrollo de habilidades de afrontamiento. Otro estudio recomendó intervenciones de apoyo informativo para los cuidadores en relación con el cuidado del amputado y su adaptación a la vida hogareña. Conclusiones: los resultados de esta revisión permiten identificar recomendaciones/directrices para la práctica y recomendaciones/sugerencias de intervenciones según las necesidades identificadas de los cuidadores familiares de pacientes con amputación de miembros inferiores.

Transcranial magnetic stimulation in the treatment of phantom limb pain: a systematic review / Estimulação magnética transcraniana no tratamento da dor do membro fantasma: uma revisão sistemática

Abstract Background Phantom limb pain (PLP) occurs after amputations and can persist in a chronic and debilitating way. Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive neuromodulation method capable of influencing brain function and modulating cortical excitability. Its effectiveness in treating chronic pain is promising. Objective To evaluate the evidence on the efficacy and safety of using rTMS in the treatment of PLP, observing the stimulation parameters used, side effects, and benefits of the therapy. Methods This is a systematic review of scientific articles published in national and international literature using electronic platforms. Results Two hundred and fifty two articles were identified. Two hundred and forty six publications were removed because they were duplicated or met the exclusion criteria. After selection, six studies were reviewed, those being two randomized clinical trials and four case reports. All evaluated studies indicated some degree of benefit of rTMS to relieve painful symptoms, even temporarily. Pain perception was lower at the end of treatment when compared to the period prior to the sessions and remained during patient follow-up. There was no standardization of the stimulation parameters used. There were no reports of serious adverse events. The effects of long-term therapy have not been evaluated. Conclusion There are some benefits, even if temporary, in the use of rTMS to relieve painful symptoms in PLP. High-frequency stimulation at M1 demonstrated a significant analgesic effect. Given the potential that has been demonstrated, but limited by the paucity of high-quality studies, further controlled studies are needed to establish and standardize the clinical use of the method.

Resumo Antecedentes A dor do membro fantasma (DMF) ocorre após amputações e pode persistir de forma crônica e debilitante. A estimulação magnética transcraniana repetitiva (EMTr) é um método de neuromodulação não invasivo capaz de influenciar a função cerebral e modular a excitabilidade cortical. Sua eficácia no tratamento da dor crônica é promissora. Objetivo Avaliar as evidências sobre a eficácia e segurança do uso da EMTr no tratamento da DMF, observando os parâmetros de estimulação utilizados, efeitos colaterais e benefícios da terapia. Métodos Trata-se de uma revisão sistemática de artigos científicos publicados na literatura nacional e internacional utilizando plataformas eletrônicas. Resultados Foram identificados 252 artigos. Duzentas e quarenta e seis publicações foram removidas por estarem duplicadas ou atenderem aos critérios de exclusão. Após a seleção, foram revisados seis estudos, sendo dois ensaios clínicos randomizados e quatro relatos de caso. Todos os estudos avaliados indicaram algum grau de benefício da EMTr no alívio dos sintomas dolorosos, mesmo que temporariamente. A percepção da dor foi menor ao final do tratamento quando comparada ao período anterior às sessões e permaneceu durante o acompanhamento do paciente. Não houve padronização dos parâmetros de estimulação utilizados. Não houve relatos de eventos adversos graves. Os efeitos da terapia a longo prazo não foram avaliados. Conclusão Existem alguns benefícios, mesmo que temporários, no uso da EMTr para alívio dos sintomas dolorosos na DMF. A estimulação de alta frequência em M1 demonstrou um efeito analgésico significativo. Dado o potencial demonstrado, mas limitado pela escassez de estudos de alta qualidade, são necessários mais estudos controlados para estabelecer e padronizar o uso clínico do método.

Correlação entre o índice de resistência vascular e a arteriografia na avaliação do leito arterial distal na isquemia crítica dos membros inferiores / Correlation between the vascular resistance index and arteriography for assessment of the distal arterial bed in chronic limb threatening ischemia

Resumo Contexto Pacientes com isquemia crítica (IC) dos membros inferiores (MMII) precisam de arteriografia para o planejamento da cirurgia de revascularização. A ultrassonografia Doppler (UD) não é invasiva e, através da aferição do índice de resistência (IR), pode fornecer informações sobre as artérias distais. Objetivos Correlacionar a Classificação Angiográfica de Rutherford com o IR na avaliação do leito arterial distal dos MMII. Métodos Estudo transversal, realizado em hospital público terciário, com 120 pacientes portadores de IC dos MMII, entre setembro de 2019 a abril de 2022. Foi comparado o IR das artérias da perna passíveis de serem receptoras de revascularização com a imagem obtida através da arteriografia dessas artérias em acordo com a Classificação Angiográfica de leito distal de Rutherford. Resultados Foram avaliados 120 MMII em 120 pacientes com idade média de 68,6 anos. A amostra foi composta de 50,0% de pacientes do sexo masculino. Na amostra, 90,0% pacientes encontravam-se na classe cinco de Rutherford. Os valores do IR encontrados para as artérias de perna apresentaram uma correlação positiva, estatisticamente significativa, quando comparados com a Classificação de Rutherford (tibial anterior, p< 0,01; tibial posterior, p = 0,012 e fibular, p = 0,034 e artéria dorsal do pé, p < 0,001). Conclusões Neste estudo, os IRs das artérias da perna obtidos através da ultrassonografia Doppler apresentaram uma correlação positiva quando comparados à classificação de Rutherford. Em pacientes com isquemia crítica, esse índice pode ser útil na avaliação do leito arterial distal dos membros inferiores.

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

Aspects médico-légaux de la réparation des amputations traumatiques de membres en milieu professionnel reçues au Centre des Urgences de Yaoundé / Medico-legal aspects of the repair of traumatic limb amputations in the workplace received at the Yaoundé Emergency Center

Objectif : Décrire les aspects médico-légaux de la réparation des amputations traumatiques de membres en milieu professionnel. Méthodologie : Etude descriptive retrospective réalisée au centre des urgences de Yaoundé (CURY) de Janvier 2017 à Decembre 2022. Etait inclus, tout patient consentant ayant subi une amputation de membre consécutive à un accident de travail durant la période d'étude. Résultats : Au total, 96 patients amputes de membres ont ete colliges. Les victimes étaient majoritairement de sexe masculin soit 70.8%, la tranche d'âge la plus representee était celle de 30 à 35 ans. La categorie professionnelle la plus representee etait la categorie H (transport et entreposage) soit 34.5%. L'ecrasement a constitué le type lésionnel le plus pourvoyeur d'amputation soit 46,9 %, les membres inferieurs etaient le plus souvent atteint (66,6%). La duree moyenne d'arrêt de travail etait de 90,5 jours et l'incapacité permanent partielle (IPP) moyen etait de 47.9 %. Des patients amputes, 47.9 % avaient beneficies d'un changement de poste de travail. Conclusion: Les amputations traumatiques de membres en milieu professionnel sont relativement fréquentes. Toutes les catégories socioprofessionnelles peuvent être concernees. Elles sont source de prejudices importants.

Objective : To describe the medico-legal aspects of repairing traumatic limb amputations in the workplace. Methodology : Retrospective descriptive study conducted at the Yaounde emergency centre (YEC) from January 2017 to December 2022. All consenting patients who underwent a limb amputation following a work-related accident during the study period were included. Results : A total of 96 patients with limb amputations were enrolled. The victims were predominantly male (70.8%), and the most common age group was between 30 and 35 years. The most common occupational category was H (transport and storage), at 34.5%. Crushing was the most common type of injury causing amputations (46.9%), with the lower limbs most often affected (66.6%). The average length of time off work was 90.5 days, and the average permanent partial disability (PPD) was 47.9%. Of the amputated patients, 47.9% had benefited from a change of workstation. Conclusion : Traumatic limb amputations in the workplace are relatively common. All socioprofessional categories may be affected. They are a source of significant prejudice

Effect of brain-computer interface based on visual, auditory and motor feedback combined with transcranial direct current stimulation on upper limb function in stroke patients / 中国康复理论与实践

ObjectiveTo explore the effect of brain-computer interface (BCI) based on visual, auditory and motor feedback combined with transcranial direct current stimulation (tDCS) on upper limb function in stroke patients. MethodsFrom March to October, 2023, 45 stroke inpatients in Xuzhou Rehabilitation Hospital and Xuzhou Central Hospital were divided into BCI group (n = 15), tDCS group (n = 15) and combined group (n = 15) randomly. All the groups received routine rehabilitation, while BCI group received BCI training, tDCS group received tDCS, while the combined group received tDCS and followed by BCI training immediately, for four weeks. They were assessed with Fugl-Meyer Assessment-Upper Extremities (FMA-UE), Action Research Arm Test (ARAT), modified Barthel Index (MBI) and delta-alpha ratio (DAR) and power ratio index (PRI) of electroencephalogram before and after treatment. ResultsThe scores of FMA-UE, ARAT and MBI increased in all the groups after treatment (|t| > 5.350, P < 0.001), and all these indexes were the best in the combined group (F > 3.366, P < 0.05); while DAR and PRI decreased in all the groups (|t| > 2.208 , P < 0.05), they were the best in the combined group (F > 5.224, P < 0.01). ConclusionBCI based on visual, auditory and motor feedback combined with tDCS can further improve the motor function of upper limbs and the activities of daily living of stroke patients.

Effect of virtual reality on upper limb function after stroke: a study of diffusion tensor imaging / 中国康复理论与实践

ObjectiveTo explore the effect of virtual reality on upper limb function in stroke patients through diffusion tensor imaging (DTI). MethodsFrom September, 2021 to March, 2023, 80 stroke patients in the Fuzhou Second General Hospital were randomly divided into control group (n = 40) and experimental group (n = 40). Both groups received routine rehabilitation, while the experimental group received virtual reality training additionally, for four weeks. They were assessed with Fugl-Meyer Assessment-Upper Extremities (FMA-UE) and Action Research Arm Test (ARAT) before treatment, after treatment and after four-week follow-up; and they were scaned with DTI to measure the fractional anisotropy (FA) and relative anisotropy (RA) of cerebral peduncle and posterior limb of inner capsule of the affected side before and after treatment. ResultsTwo cases dropped in each group. The FMA-UE and ARAT scores increased in both groups after treatment and follow-up (F > 2.790, P < 0.001), and increased more in the experimental group than in the control group (t > 2.297, P < 0.05). FA and RA in the posterior limb of inner capsule increased in both groups after treatment (t > 21.013, P < 0.001), and increased more in the experimental group (t > 2.006, P < 0.05). The d-value of FA of the posterior limb of internal capsule before and after treatment (ΔFA) was positively correlated with the d-value of FMA-UE score (r > 0.362, P < 0.05) in both groups, the ΔFA of the posterior limb of internal capsule was positively correlated with the d-value of ARAT score (r = 0.459, P < 0.01). ConclusionVirtual reality training can promote the recovery of upper limb function in stroke patients, which may associate with the conductivity of posterior limb of inner capsule.

Prognostic relevance of female gender on mortality after peripheral artery disease revascularization / Relevancia pronóstica del género femenino en la mor talidad luego de la revascularización de la enfermedad arterial periférica

Abstract Introduction : Lower limb peripheral artery disease (PAD) presents high morbidity and mortality. Women represent a small subgroup in different studies, with scarce evidence regarding the prognosis of this gender on PAD. The aim of the present work was to determine the prognostic impact of female gender on lower limb PAD revascularization. Methods : This was a retrospective, single-center study, including patients undergoing symptomatic lower limb PAD revascularization. Results : Among a total of 309 patients included in the study, 109 belonged to the female gender (35%). Women were older and presented lower prevalence of cardiovascular risk factors compared with the male gender. All-cause mortality (22% vs. 12%, p = 0.02) and re-hospitalizations for chronic limb-threatening ischemia (18% vs. 10%, p = 0.04) rates were significantly higher in women. In a multivariate regression model, female gender was independently associated with all-cause mortality (OR 2.19 [95% CI: 1.06-4.51], p = 0.03). The time-to-event showed that women exhibited 93% more risk of suffering death than men, after adjusting for clinically relevant variables (HR 1.93 [95% CI: 1.04-3.56], p = 0.04). Discussion : Women with symptomatic PAD revascu larization presented worse prognosis than men in terms of all-cause mortality and re-hospitalizations for chronic limb-threatening ischemia rates. Therefore, it is essen tial to achieve an adequate control of cardiovascular risk factors, as well as to optimize medical treatment in female patients.

Resumen Introducción : La enfermedad arterial de miembros inferiores (EAMI) presenta elevada morbimortalidad. Las mujeres constituyen un subgrupo minoritario en distin tos estudios, con escasa evidencia acerca del pronóstico por género en EAMI. Nuestro objetivo fue determinar el impacto pronóstico del género femenino en la revascu larización de EAMI. Métodos : Estudio de cohorte retrospectivo y unicén trico, que incluyó pacientes con EAMI sintomática y revascularizada. Resultados : Se incluyeron 309 pacientes, de los cuales 109 (35%) eran mujeres. Las mujeres fueron más añosas y presentaron menor prevalencia de factores de riesgo cardiovascular en comparación a los hombres. Las tasas de mortalidad por todas las causas (22% vs. 12%, p = 0.02) y de hospitalizaciones por isquemia crítica (18% vs. 10%, p 0.04) fueron significativamente mayores en mujeres. En el modelo de regresión multivariado, el sexo femenino se asoció de forma independiente con mortalidad por todas las causas (OR 2.19 [IC 95%: 1.06-4.51], p = 0.03). En el análisis de tiempo al evento, las mujeres tuvieron 93% más riesgo de morir que los hombres, luego de ajustar por variables clínicamente relevantes (HR 1.93 [IC 95%: 1.04-3.56], p = 0.04). Discusión : Las mujeres con EAMI sintomática y re vascularizada presentaron un peor pronóstico en com paración a los hombres en términos de tasas de mor talidad por todas las causas y de hospitalizaciones por isquemia crítica de miembros inferiores. Por lo tanto, es fundamental lograr un adecuado control de factores de riesgo cardiovascular, como así también, optimizar el tratamiento médico en el género femenino.

Bone Anatomy of the Thoracic Limb in the Common Hippopotamus (Hippopotamus amphibius) and White Rhinoceros (Ceratotherium simum)

SUMMARY: Although megaherbivores do not belong to the Brazilian fauna, they can be found in national zoos, which makes it important to know the anatomy of the locomotor apparatus to contribute to the clinical routine of zoos and veterinary rehabilitation centers. Thus, the aim of this study was to describe the anatomical structures of the thoracic limb bones in the common hippopotamus (Hippopotamus amphibius) and white rhinoceros (Ceratotherium simum) and to compare them with the bone structures described for other ungulates. The scapula had a triangular appearance in the common hippopotamus, whereas in the white rhinoceros it had a rectangular appearance. The acromion was observed only in the common hippopotamus scapula. The hippopotamus humerus did not have the intermediate tubercle, only the greater and lesser tubercles, unlike the rhinoceros which also has the intermediate tubercle. The two megamammals studied had an ulna not incorporated to the radius and seven carpal bones distributed in two bone rows. The common hippopotamus had four digits and four metacarpal bones, while the white rhino had three digits, hence three metacarpal bones. Although with some species-specific differences, the bone anatomy found in the studied megaherbivores was similar to that described for domestic ungulates, such as horses and cattle. The fact that the bones studied belong to articulated skeletons of the collection of the Museum of Anatomy made it difficult to identify some anatomical structures. This study can help veterinarians in bone health care, animal welfare and comfort of such species present in Brazilian zoological parks.

Aunque los megaherbívoros no pertenecen a la fauna brasileña, se pueden encontrar en zoológicos nacionales, lo que hace importante conocer la anatomía del aparato locomotor para contribuir a la rutina clínica de los zoológicos y de los centros de rehabilitación veterinaria. Por tanto, el objetivo de este estudio fue describir las estructuras anatómicas de los huesos de los miembros torácicos en el hipopótamo común (Hippopotamus amphibius) y el rinoceronte blanco (Ceratotherium simum) y compararlas con las estructuras óseas descritas para otros ungulados. La escápula tenía una apariencia triangular en el hipopótamo común, mientras que en el rinoceronte blanco tenía una apariencia rectangular. El acromion se observó sólo en la escápula del hipopótamo común. El húmero del hipopótamo no tenía el tubérculo intermedio, sólo los tubérculos mayor y menor, a diferencia del rinoceronte que también tiene el tubérculo intermedio. Los dos ejemplares de megamamíferos estudiados tenían una ulna no incorporada al radio y siete huesos del carpo distribuidos en dos filas óseas. En el hipopótamo común se observaron cuatro dedos y cuatro huesos metacarpianos, mientras que en el rinoceronte blanco se encontraron tres dedos, por lo tanto, tres huesos metacarpianos.A pesar de algunas diferencias específicas de cada especie, la anatomía ósea encontrada en los megaherbívoros estudiados fue similar a la descrita para los ungulados domésticos, tal como los caballos y el ganado. El hecho de que los huesos estudiados pertenezcan a esqueletos articulados de la colección del Museo de Anatomía dificultó la identificación de algunas estructuras anatómicas. Este estudio puede ayudar a los veterinarios en el cuidado de la salud ósea, el bienestar animal y el confort de las especies presentes en los parques zoológicos brasileños.

Deformidad congénita en dedos de manos y pies asociados a camptodactilia. Presentación de una familia afectada / Congenital deformity in fingers and toes associated with camptodactyly. Presentation of an affected family

Las deformidades de los dedos son alteraciones frecuentes y en ocasiones se asocian a camptodactilia. Estas pueden ser congénitas o adquiridas, estar asociadas a teratógenos durante la etapa prenatal o determinado por un gen heredado que provoque este defecto y manifestarse de forma aislada o en varios miembros de una misma familia, segregándose con un patrón de herencia autosómico dominante. Se presenta una familia con tres miembros afectados a partir de una progenitora con el defecto en los dedos de las manos y los pies, que tiene dos descendientes con las mismas deformidades, sin otras alteraciones. Se considera un defecto congénito con implicación estética, en la movilidad de todos los dedos en alguna medida. Resulta necesario el seguimiento multidisciplinario, en conjunto ortopédicos, psicólogos y genetista clínico, para brindar un adecuado asesoramiento genético a la familia, informar el posible tratamiento quirúrgico y la rehabilitación oportuna para elevar la calidad de vida de estos afectados.

Finger deformities are frequent alterations and are sometimes associated with camptodactyly. These can be congenital or acquired, and may be associated with teratogens during prenatal stage or determined by an inherited gene that causes this defect, as well as appear in isolation or in several members of the same family, segregating with an autosomal dominant inheritance pattern. We present a family with three affected members from a mother with a defect in fingers and toes, who has two descendants with the same deformities, without other alterations. It is considered a congenital defect with aesthetic implications, and repercussions, to some extent, on the mobility of all fingers. Multidisciplinary follow-up is necessary, together with orthopedics, psychologists, and clinical geneticists, to provide adequate genetic counseling to the family, inform possible surgical treatment, and timely rehabilitation to improve the quality of life of those affected subjects.

Clinical impact of the infrapatellar location in symptomatic peripheral arterial disease patients / Impacto clínico de la localización infrapatelar en pacientes con enfermedad arterial periférica sintomática

Abstract Background: Peripheral artery disease (PAD) frequently affects multiple segments of the limbs. Contradictory data have reported worse prognosis in aortoiliac lesions, nevertheless, diabetes and chronic limb ischemia frequently affects the infrapatellar territory. Our aim was to assess the impact of infrapatellar disease in cardiovascular outcomes. Methods: We performed a retrospective, observational cohort study at a university hospital in Argentina. Electronic health records were retrospectively reviewed including symptomatic PAD patients requiring revascularization. A multivariable regression model was performed to account for confounders. The primary endpoint was a composite of hospitalizations due to chronic limb threatening ischemia (CLTI) and major amputation events between infrapatellar and suprapatellar patients. Minor amputation events, all-cause death, myocardial infarction (MI), stroke, and major cardiovascular events (MACE) were secondary endpoints. Results: From January 2014 through July 2020, a total of 309 patients were included in the analysis. 151 patients had suprapatellar disease, and 158 had infrapatellar disease. The primary composite endpoint occurred in 35 patients (22.2%) in the infrapatellar patients and 18 patients (11.9%) in the suprapatellar patients (HR = 2.16; 95% confidence interval [CI] = [1.22-3.82]; p = 0.008). Both components of the primary outcomes occurred more frequently in infrapatellar patients. Minor amputation events were more prevalent in infrapatellar patients (HR = 5.09; 95% CI = [1.47-17.6]; p = 0.010). Death, MI, stroke, and MACE events were not different among groups (all p > 0.05). Conclusion: Infrapatellar disease was an independent factor for increased hospitalization of CLTI, major and minor amputations events, compared to suprapatellar disease in symptomatic revascularized PAD patients.

Resumen Objetivo: La enfermedad vascular periférica (EVP) afecta generalmente múltiples segmentos de los miembros. Existe información contradictoria con respecto al pronóstico de pacientes con enfermedad aortoilíaca, sin embargo, la diabetes y la enfermedad critica de miembros inferiores habitualmente afecta el territorio infrapatelar. Nuestro objetivo es determinar el impacto de la afectación infrapatelar en eventos cardiovasculares. Métodos: Estudio retrospectivo, observacional en un hospital universitario de Argentina. Se revisó la historia clínica electrónica de pacientes con EVP con requerimiento de revascularización. Se generó un modelo de regresión multivariado incluyendo variables clínicamente relevantes. El punto final primario fue un combinado de hospitalización por isquemia crítica y amputaciones mayores entre pacientes con afectación infrapatelar y suprapatelar. Amputaciones menores, muerte por todas las causas, infarto agudo de miocardio (IAM), accidente cerebrovascular (ACV) y un combinado de eventos cardiovasculares (MACE) fueron los puntos secundarios. Resultados: Se reclutó un total de 309 pacientes desde enero de 2014 hasta julio de 2020. 151 pacientes presentaron enfermedad suprapatelar y 158 infrapatelar. El punto final primario ocurrió en 35 pacientes (22.2%) en el grupo infrapatelar y en 18 pacientes (11.9%) en suprapatelares (HR 2.16; intervalo de confianza 95% [1.22-3.82]; p = 0.008). Ambos componentes ocurrieron con mayor frecuencia en pacientes con afectación infrapatelar. Los eventos de amputación menor fueron mas prevalentes en pacientes con afectación infrapatelar (HR 5.09; IC95% [1.47-17.6]; p = 0.010) La mortalidad por todas las causas, IAM, ACV y MACE no fueron diferentes entre los grupos (p > 0.05). Conclusión: La enfermedad infrapatelar fue un factor independiente para mayor riesgo de hospitalización por isquemia critica, amputación mayor y menor comparado con pacientes con afectación suprapatelar en EVP sintomática revascularizada.

Neonatal Tetanus: demographics, clinical management and outcomes of A Study of 7 Cases in Afghanistan

This study aims to study the demographics, treatment and outcome of neonatal tetanus patients managed at Nangarhar Regional Hospital Afghanistan from June 2019-January 2021. Seventeen neonates were studied. All presented with fever, poor sucking and limb stiffness, with a history of unsterile delivery and uncertain maternal tetanus immunity status. Low-resource settings continue to report high mortality from neonatal tetanus, due to lack of sophisticated management modalities like neuromuscular blockade and invasive ventilation [20-23].The age group of mothers 21-25 of admitted neonates shows high frequency i.e 42.85%. Education of mother of admitted neonates was Primary education i.e 57.14%. 71.42 % (5) mothers not vaccinated. The vaccination awareness should be implemented in community by organising various awareness camp town wise. Government should implement the education mandatory and free for below poverty class and females.

Trombo flotante en el arco aórtico, una causa poco frecuente de isquemia de miembros inferiores / Floating thrombus in the aortic arch, a rare cause of lower limb ischemia

Resumen La oclusión arterial aguda de los miembros inferio res es una urgencia médica y quirúrgica por su morbi mortalidad. Presentamos el caso de un hombre de 59 años que ingresó al servicio de urgencias por un dolor agudo y difuso del miembro inferior izquierdo causado por extensos coágulos obstructivos en las arterias del miembro inferior izquierdo. Siendo improbable la cau sa ateromatosa tras realización de la angioscopia de miembros inferiores, se sospechó un origen cardíaco. La ecografía cardiaca no mostró anomalías, sin embargo, la angiotomografía torácica reveló un trombo flotante en el arco aórtico. El paciente fue tratado quirúrgica mente con colocación de una endoprótesis aórtica sin complicaciones.

Abstract Acute arterial occlusion of the lower limbs is a medi cal and surgical emergency due to its morbi-mortality. We present the case of a 59-year-old man admitted to the emergency department for acute and diffuse pain in the left lower limb caused by extensive obstructive clots in the arteries of this limb. Since atheromatous cause was unlikely after angioscopy of the lower limbs, a car diac origin was suspected. Echocardiogram was normal, however, thoracic angiotomography revealed a floating thrombus in the aortic arch. The patient was treated surgically with placement of an aortic endoprosthesis without complications.

Upper limb nerve variations may alter clinical diagnosis: a scoping review / Las variaciones nerviosas del miembros superior pueden alterar el diagnóstico clínico: una revisión de alcance

SUMMARY: Upper limb nerve variations may be related to the absence of a nerve, an interconnection between two nerves or a variant course. The purpose of this review is to screen the existing literature on upper limb nerve variations that may alter the neurologic diagnostic process. A scoping review was performed following PRISMA for Scoping Reviews guidelines. Initially, 1331 articles were identified by searching Pubmed and Web of Science until the 22nd of October 2022. After screening, reading, and additional searching 50 articles were included in this review. Variations were divided into two categories: 1) variations causing a different innervation pattern involving sensory, motor, or both types of fibers, and 2) variations causing or related to compression syndromes. Two-thirds of the included articles were cadaver studies. Nine articles were diagnostic studies on symptomatic or healthy individuals involving medical imaging and/or surgery. Nerve variations that may cause a different innervation pattern concern most frequently their interconnection. The connection between the median and musculocutaneous nerve in the upper limb and the connection between the median and ulnar nerve in the forearm (Martin-Gruber) or hand (Riche-Cannieu) may be present in half of the population. Injury to these connections may cause compound peripheral neuropathies a result of variant sensory and motor branching patterns. Muscular, vascular, or combined anomalies in the forearm were reported as causes of entrapment neuropathies. These nerve variations may mimic classical entrapment syndromes such as carpal tunnel syndrome or compression at ulnar canal (Guyon's canal). Knowledge of frequent nerve variations in the arm may be important during the diagnostic process and examination. Variant innervation patterns may explain non-classical clinical signs and/or symptoms during provocative tests. Classical nerve compression syndromes in the arm may warrant for differential diagnosis, especially in the case of persistent or recurrent symptoms.

Las variaciones nerviosas del miembro superior pueden estar relacionadas con la ausencia de un nervio, una interconexión entre dos nervios o un curso variante. El objetivo de esta revisión fue examinar la literatura existente sobre las variaciones de los nervios de los miembros superiores que pueden alterar el proceso de diagnóstico neurológico. Se realizó una revisión de alcance siguiendo las pautas de PRISMA para revisiones de alcance. Inicialmente, se identificaron 1331 artículos mediante la búsqueda en Pubmed y Web of Science hasta el 22 de octubre de 2022. Después de la selección, la lectura y la búsqueda adicional, se incluyeron 50 artículos en esta revisión. Las variaciones se dividieron en dos categorías: 1) variaciones que causan un patrón de inervación diferente que involucra fibras sensoriales, motoras o de ambos tipos, y 2) variaciones que causan o están relacionadas con síndromes de compresión. Dos tercios de los artículos incluidos eran estudios de cadáveres. Nueve artículos fueron estudios de diagnóstico en individuos sintomáticos o sanos que involucraron imágenes médicas y/o cirugía. Las variaciones nerviosas que pueden causar un patrón de inervación diferente se refieren con mayor frecuencia a su interconexión. La conexión entre el nervio mediano y musculocutáneo en el miembro superior y la conexión entre el nervio mediano y ulnar en el antebrazo (Martin-Gruber) o la mano (Riche-Cannieu) puede estar presente en la mitad de la población. La lesión de estas conexiones puede causar neuropatías periféricas compuestas como resultado de patrones de ramificación variantes sensitivos y motores. Se informaron anomalías musculares, vasculares o combinadas en el antebrazo como causas de neuropatías por atrapamiento. Estas variaciones nerviosas pueden imitar los síndromes de atrapamiento clásicos, como el síndrome del túnel carpiano o la compresión en el canal ulnar. El conocimiento de las variaciones nerviosas frecuentes en el brazo puede ser importante durante el proceso de diagnóstico y examen. Los patrones de inervación variantes pueden explicar los signos y/o síntomas clínicos no clásicos durante las pruebas de provocación. Los síndromes clásicos de compresión nerviosa en el brazo pueden justificar el diagnóstico diferencial, especialmente en el caso de síntomas persistentes o recurrentes.

Precisión y fiabilidad de la medición del índice tobillo-brazo utilizando un dispositivo oscilométrico versus el método Doppler / Accuracy and reliability of ankle-brachial index measurement using an oscillometric device versus the Doppler method

Introducción: la medición del índice tobillo-brazo (ITB) es una prueba de primera línea y con alta precisión diagnóstica para detectar la enfermedad vascular periférica (EVP). El método Doppler, considerado el estándar de oro, requiere del dispositivo y de un operador capacitado, lo que limita su uso en la atención primaria. Como alternativa, un método oscilométrico que emplea un dispositivo de presión arterial automático es una prueba simple y accesible que podría minimizar los sesgos del observador y eliminar la necesidad de capacitación especial. Objetivos: validar la capacidad diagnóstica de un dispositivo oscilométrico automatizado frente al método Doppler para la medición del ITB. Materiales y métodos: se incluyeron pacientes con diabetes mellitus tipo 1 y 2 (DM1 y DM2), mayores de 50 años, con uno o más factores de riesgo cardiovascular. Luego de que los pacientes permanecieran 5 minutos acostados, se registró la presión arterial sistólica (PAS) con tensiómetro Welch Allyn DS 45-11 y Doppler Vascular Contec Sonoline B 8 Mhz en ambas arterias tibiales posteriores y en arteria braquial derecha. Posteriormente se realizaron los mismos registros con monitor de presión arterial automático modelo Omrom HEM-7130. Se calculó el ITB de cada miembro inferior y las capacidades diagnósticas (sensibilidad [S-, especificidad [E], concordancia por coeficiente kappa, valor predictivo positivo [VPP] y valor predictivo negativo [VPN]) del método oscilométrico para detectar un ITB patológico por Doppler (≤0,90). Resultados: se evaluaron 66 pacientes, 52 varones y 14 mujeres, 7 con DM1 y 59 con DM2, 69 años de edad (DS 9,8), con una antigüedad de la DM de 18,05 años (DS 12,01). La prevalencia de EVP detectada por Doppler (ITB ≤0,90) fue del 16,7% (IC 95% 9,9-23,4). El método oscilométrico para detectar un ITB ≤0,90 por Doppler mostró una S del 72,7% (IC 95% 51,8-93,6), una E del 96,3% (IC 95% 92,4-100), una concordancia del 92,4% (IC 95% 87,5-97,3), un VPP del 80,0% (IC 95% 59,9-100) y un VPN del 94,6% (IC 95% 90,0-99,3). Conclusiones: el alto VPN hallado (condición esencial para un método de screening) significa que si el método oscilométrico da un ITB >0,90, hay un 94,6% de posibilidad de que el ITB por Doppler no sea ≤0,90. El VPP de 80% encontrado significa que si el ITB oscilométrico es ≤0,90, hay un 80% de posibilidad de que el ITB Doppler sea verdaderamente ≤0,90. Por lo tanto, consideramos que la simple medición del ITB con el método oscilométrico podría recomendarse en la atención primaria, donde se requieren métodos rápidos, fáciles y confiables.

Introduction: the measurement of the ankle-brachial index (ABI) is a first-line test with high diagnostic accuracy for the detection of peripheral vascular disease. The Doppler method, considered the gold standard, requires the device and a trained operator, which limits its use in primary care. Alternatively, an oscillometric method using an automated blood pressure device is a simple and affordable test that could minimize observer bias and eliminate the need for special training. Objectives: to validate the diagnostic capacity of an automated oscillometric device against the Doppler method for ABI measurement. Materials and methods: diabetes mellitus type 1 and 2 (DM1 and DM2) patients older than 50 years with 1 or more cardiovascular risk factors were included. After 5 minutes lying down, SBP was recorded with a Welch Allyn DS 45-11 sphygmomanometer and Contec Sonoline B 8 Mhz Vascular Doppler in both posterior tibial arteries and in the right brachial artery. Subsequently, the same recordings were made with an Automatic Blood Pressure Monitor Model Omrom HEM-7130. The ABI of each lower limb and the diagnostic capabilities (sensitivity [S], specificity [E], concordance by kappa coefficient, positive predictive value [PPV] and negative predictive value [NPV] of the oscillometric method to detect a pathological ABI were calculated by Doppler (≤0.90). Results: 66 patients were evaluated, 52 men and 14 women, 7 DM1 and 59 DM2, 69 years old (SD 9.8) with a history of diabetes of 18.05 years (SD 12.01). The prevalence of PVD detected by Doppler (ABI ≤0.90) was 16.7% (95% CI 9.9-23.4). The oscillometric method to detect an ABI ≤0.90 by Doppler showed an S of 72.7% (95% CI 51.8-93.6), an E of 96.3% (95% CI 92.4-100), a concordance of 92.4% (95% CI 87.597.3), a PPV of 80.0% (95% CI 59.9-100) and a NPV of 94.6% (95% CI 90 .0-99.3). Conclusions: the high NPV found (essential condition for a screening method) means that if the oscillometric method gives an ABI >0.90, there is a 94.6% chance that the Doppler ABI is not ≤0.90. The PPV of 80% found means that if the oscillometric ABI is ≤0.90, there is an 80% chance that the Doppler ABI is truly ≤0.90. Therefore, we consider that the simple measurement of ABI with the oscillometric method could be recommended in primary care, where fast, easy and reliable methods are adequate.

Effect of video-based mirror therapy on lower limb motor function of stroke patients at recovery stage / 中国康复理论与实践

ObjectiveTo observe the effect of video-based mirror therapy on lower limb motor function, walking ability, and balance of stroke patients at recovery stage. MethodsFrom January to October, 2022, 43 stroke patients in Beijing Bo'ai Hospital were randomly divided into control group (n = 22) and mirror therapy group (n = 21). Both groups received routine rehabilitation, and the mirror therapy group received video-based mirror therapy additionally, for four weeks. They were assessed with Fugl-Meyer Assessment-Lower Extremities (FMA-LE), Functional Ambulation Category (FAC) and Berg Balance Scale (BBS) before and after treatment. ResultsAfter treatment, the scores of FMA-LE, FAC and BBS improved significantly in both groups (|t| > 6.205, P < 0.001), and the scores of FMA-LE and BBS were better in the mirror therapy group than in the control group (|t| > 2.164, P < 0.05). ConclusionCombining with video-based mirror therapy could facilitate to improve the lower limb motor function and balance ability of stroke patients at recovery stage.

Effect of transcutaneous auricular vagus nerve stimulation combined with robot-assisted therapy on upper limb function of stroke patients / 中国康复理论与实践

ObjectiveTo investigate the effect of transcutaneous auricular vagus nerve stimulation (taVNS) combined with robot-assisted therapy on upper limb function of subacute stroke patients. MethodsFrom March, 2022 to March, 2023, 60 subacute stroke patients from Dushu Lake Hospital and the First People's Hospital of Kunshan were randomly divided into control group (n = 20), robot group (n = 20) and combined group (n = 20). All the groups received conventional treatments including medication, physical therapy and occupational therapy; the robot group received sham taVNS combined with hand robot-assisted therapy; while the combined group received taVNS combined with hand robot-assisted therapy, for four weeks. They were assessed with Fugl-Meyer Assessment-Upper Extremities (FMA-UE) and hand part, the root mean square (RMS) electromyography of the extensor carpi radialis and extensor digitorum muscles during contraction, and the latency and amplitude of transcranial magnetic stimulation motor-evoked potential (TMS-MEP) before and after treatment. ResultsAfter treatment, the scores of FMA-UE and hand part, RMS of the extensor carpi radialis and extensor digitorum muscles, and latency and amplitude of TMS-MEP improved in all the groups (t > 2.099, P < 0.05); and they were the best in all indicators in the combined group (F > 9.106, P < 0.001). ConclusiontaVNS combined with robot-assisted therapy can promote central nervous system remodeling and further improve upper limb function in stroke patients.

Effect of repetitive peripheral magnetic stimulation on upper limb motor function of stroke patients after contralateral seventh cervical nerve transfer / 中国康复理论与实践

ObjectiveTo explore the effect of repetitive peripheral magnetic stimulation on upper limb motor function rehabilitation of stroke patients after contralateral seventh cervical nerve transfer (CC7). MethodsFrom May, 2020, to May, 2022, 34 stroke patients with hemiplegia underwent CC7 in Jing'an District Centre Hospital of Shanghai were randomly divided into control group (n = 17) and observation group (n = 17). Both groups received conventional rehabilitation. The observation group accepted repetitive peripheral magnetic stimulation, and the control group received sham stimulation, for eight weeks. They were assessed with Fugl-Meyer Assessment-Upper Extremities (FMA-UE) and Hua-Shan Grading of Upper Extremity (H-S grading) before and after treatment. ResultsTwo cases dropped down in each group. There was difference in gender between two groups (χ2 = 6.136, P < 0.05). After treatment, the scores of FMA-UE and H-S grading significantly improved in both groups (t > 4.000, P < 0.01), and the improvement was better in the observation group than in the control group (t > 2.362, P < 0.05). ConclusionRepetitive peripheral magnetic stimulation could improve the motor function of upper limb and hand of stroke patients with hemiplegia after CC7.

Relationship between symmetry of lower limb function and gait symmetry in patients with incomplete spinal cord injury / 中国康复理论与实践

ObjectiveTo observe the characteristics of gait symmetry and its influencing factors in patients with incomplete spinal cord injury (ISCI). MethodsFrom May, 2018 to November, 2021, 34 patients with ISCI in Beijing Bo'ai Hospital were divided into symmetrical injury of lower limb (SI) group and asymmetrical injury of lower limb (ASI) group according to the lower extremities motor score (LEMS). Three dimensional motion acquisition system and plantar pressure acquisition system were used for gait test. The symmetry indexes of step length, stance time and swing time were caculated. ResultsThe symmetry indexes of step length, stance time and swing time were significant lower in SI group than in ASI group (|t| > 2.619, P < 0.01). Stance time and swing time significantly correlated to the difference of bilateral LEMS in ASI group (r > 0.468, P < 0.01). Discriminant analysis showed that gait parameter equations were different for patients with different symmetry of lower limb injuries. ConclusionThe symmetry of lower limb motor function impacts gait symmetry for patients with ISCI, especially the difference value of bilateral total LEMS. Gait parameters can be used to determine the symmetry of lower limb injury in patients with ISCI.