A Two-Stage Approach Integrating Provisional Biomaterial-Mediated Stabilization Followed by a Definitive Treatment for Managing Volumetric Muscle Loss Injuries.

Treatment of volumetric muscle loss (VML) faces challenges due to its unique pathobiology and lower priority in severe musculoskeletal injury management. Consequently, a need exists for multi-stage VML treatment strategies to accommodate delayed interventions owing to comorbidity management or prolonged casualty care in combat settings. To this end, polyvinyl alcohol (PVA) was used at concentrations of 5%, 7.5%, and 10% to generate provisional muscle void fillers (MVFs) of varying stiffness values (1.125 kPa, 3.700 kPa, and 7.699 kPa) to stabilize VML injuries as part of a two-stage approach. These were implanted into a rat model for a duration of 4 weeks, then explanted and either left untreated (control) or treated through minced muscle grafting (MMG). Additional benchmarks included acute MMG and unrepaired groups. At the MVF explant, the 7.5% PVA group exhibited superior neuromuscular function compared to the 5% and 10% PVA groups, the least fibrosis, and the largest median myofiber size among all groups at the 12-week endpoint. Despite the 7.5% PVA's superiority amongst the two-stage treatment groups, neuromuscular function was neither improved nor impaired relative to acute treatment benchmarks. This suggests that the future success of a two-stage VML treatment strategy will necessitate a more effective definitive intervention.

Beyond the Ordinary: An Atypical Guillain-Barré Syndrome Case With Unique Characteristics.

We present a patient with pharyngeal-cervical-brachial Guillain-Barré syndrome (PCB-GBS) that progressed to a severe state followed by a quick recovery after treatment. This unique clinical course has not been documented previously and provides a potentially invaluable description of a novel GBS variant. A 42-year-old man arrived at the emergency department with a 24-hour history of dysphagia, weakness in his right arm, and bilateral shoulder weakness. Nerve conduction velocity testing revealed bilateral sensory and motor polyneuropathy, leading to the diagnosis of GBS with the PCB variant. Timely diagnosis and plasmapheresis treatment contributed to a complete recovery of muscle strength and reflexes. In cases resembling ours, it is imperative to contemplate the existence of rare Guillain-Barré variants. This case underscores the necessity of recognizing and addressing rare Guillain-Barré variants in clinical settings with similar presentations.

Validación de un instrumento para evaluar la carga del cuidador en parálisis cerebral / Validation of an instrument to assess caregiver burden in cerebral palsy cases

Objetivo Desarrollar y validar una escala para evaluar la carga del cuidador del niño con parálisis cerebral (PC) de niveles funcionales GMFCS (Gross Motor Function Classification System) IV y V. Materiales y Métodos Se llevó a cabo un estudio de validación de escalas mediante la aplicación de un cuestionario a 108 cuidadores de niños con PC. La primera fase del estudio consistió en la generación del cuestionario y la realización de una prueba piloto. La segunda fase comprendió la aplicación de la escala. Finalmente, la tercera fase correspondió al análisis psicométrico (validez de constructo y de criterio, consistencia interna, y confiabilidad temporal) y a la determinación de la utilidad de la escala. Para el test-retest se repitió la encuesta a 62 pacientes. Resultados Se construyó una escala con 10 items pertenecientes a dos dominios. En el estudio de la validez de criterio se obtuvo un coeficiente de correlación de Pearson de 0,71 al comparar la escala del cuidador con los niveles funcionales GMFCS. La consistencia interna fue muy buena con un coeficiente alfa de Crombach total de 0,87. En el estudio de la confiabilidad test retest se encontró un coeficiente de correlación de Pearson mayor a 0,87 para cada uno de los ítems. Conclusiones La “Escala del Cuidador” es un instrumento con una validez, confiabilidad y utilidad aceptables para medir la dificultad en el cuidado de niños con PC severa en nuestro medio.(AU)

Objective To develop and validate a scale for assessing the difficulties of daily care of children with severe cerebral palsy (CP) at functional levels IV and V on the GMFCS (Gross Motor Function Classification System). Materials and Methods A validation study was performed by means of a questionnaire to 108 caregivers of children with CP. The first phase of the study aimed to develop the questionnaire and conduct a pilot experiment. The second phase covered the application of the scale. Finally, the third phase consisted of a psychometric analysis (construct and criterion-related validity, internal consistency) and the determination of the scale's utility. For the retest, the questionnaire was applied to 62 patients. Results A scale was developed with 10 items from two domains. The internal consistency was very good with a Cronbach's alpha of 0.87. For the criterion-related validity, a Pearson's correlation coefficient of 0.71 was obtained when the scale was compared to the GMFCS´s functional levels. For the reliability retest, a Pearson's correlation coefficient higher than 0.87 for each of the items was found. Conclusions The “Caregiver Scale” is a valid and reliable instrument. Its usefulness for measuring the difficulties in the care of children with severe CP is acceptable.(AU)

[Validation of an instrument to assess caregiver burden in cerebral palsy cases]. / Validación de un instrumento para evaluar la carga del cuidador en parálisis cerebral.

Objective To develop and validate a scale for assessing the difficulties of daily care of children with severe cerebral palsy (CP) at functional levels IV and V on the GMFCS (Gross Motor Function Classification System). Materials and Methods A validation study was performed by means of a questionnaire to 108 caregivers of children with CP. The first phase of the study aimed to develop the questionnaire and conduct a pilot experiment. The second phase covered the application of the scale. Finally, the third phase consisted of a psychometric analysis (construct and criterion-related validity, internal consistency) and the determination of the scale's utility. For the retest, the questionnaire was applied to 62 patients. Results A scale was developed with 10 items from two domains. The internal consistency was very good with a Cronbach's alpha of 0.87. For the criterion-related validity, a Pearson's correlation coefficient of 0.71 was obtained when the scale was compared to the GMFCS´s functional levels. For the reliability retest, a Pearson's correlation coefficient higher than 0.87 for each of the items was found. Conclusions The "Caregiver Scale" is a valid and reliable instrument. Its usefulness for measuring the difficulties in the care of children with severe CP is acceptable.