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1.
J Surg Oncol ; 120(3): 540-549, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31267571

RESUMO

BACKGROUND AND OBJECTIVES: Isolated limb perfusion (ILP) and infusion (ILI) are treatment modalities for unresectable melanoma in-transit metastases and extremity soft tissue sarcomas (STS). We sought to characterize the national trend in their utilization in the context of novel melanoma therapies introduced in 2011. METHODS: Using the National Inpatient Sample (2005-2014), patients with a primary diagnosis of limb melanoma or STS who underwent ILP/ILI were identified by diagnosis and procedure codes. Annual percent change (APC) in ILP/ILI procedures was determined. RESULTS: From 2005 through 2014, 670 and 130 ILP/ILI procedures were performed for melanoma and STS, respectively. Mean age was 64 (SD 15) years for melanoma and 59 (SD 18) years for STS. Over time, procedures for melanoma decreased with an APC of -17 (P = .019). Comparing 2005-2010 and 2011-2014, the mean number of procedures for melanoma decreased from 91 to 32 per year (P = .007). In contrast, there was no change for STS (APC 6.5, P = .39; mean 11 and 16 per year in 2005-2010 and 2011-2014, respectively, P = .46). CONCLUSIONS: ILI/ILP utilization has decreased for melanoma, but not for STS. Whether trends for ILP and ILI differed could not be determined. ILP/ILI remains an important option to consider for regional disease control.


Assuntos
Quimioterapia do Câncer por Perfusão Regional/métodos , Melanoma/tratamento farmacológico , Sarcoma/tratamento farmacológico , Adulto , Idoso , Extremidades , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
2.
Bone Joint J ; 101-B(6): 739-744, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31154835

RESUMO

AIMS: The aim of this study was to identify factors that determine outcomes of treatment for patients with chondroblastic osteosarcomas (COS) of the limbs and pelvis. PATIENTS AND METHODS: The authors carried out a retrospective review of prospectively collected data from 256 patients diagnosed between 1979 and 2015. Of the 256 patients diagnosed with COS of the pelvis and the limbs, 147 patients (57%) were male and 109 patients (43%) were female. The mean age at presentation was 20 years (0 to 90). RESULTS: In all, 82% of the patients had a poor response to chemotherapy, which was associated with the presence of a predominantly chondroblastic component (more than 50% of tumour volume). The incidence of local recurrence was 15%. Synchronous or metachronous metastasis was diagnosed in 60% of patients. Overall survival was 51% and 42% after five and ten years, respectively. Limb localization and wide surgical margins were associated with a lower risk of local recurrence after multivariable analysis, while the response to chemotherapy was not. Local recurrence, advanced patient age, pelvic tumours, and large volume negatively influenced survival. Resection of pulmonary metastases was associated with a survival benefit in the limited number of patients in whom this was undertaken. CONCLUSION: COS demonstrates a poor response to chemotherapy and a high incidence of metastases. Wide resection is associated with improved local control and overall survival, while excision of pulmonary metastases is associated with improved survival in selected patients. Cite this article: Bone Joint J 2019;101-B:739-744.


Assuntos
Neoplasias Ósseas/cirurgia , Condrossarcoma/cirurgia , Extremidades/cirurgia , Osteossarcoma/cirurgia , Neoplasias Pélvicas/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias Ósseas/patologia , Criança , Pré-Escolar , Condrossarcoma/patologia , Terapia Combinada , Extremidades/patologia , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/patologia , Osteossarcoma/patologia , Neoplasias Pélvicas/patologia , Estudos Retrospectivos , Resultado do Tratamento
3.
Zhen Ci Yan Jiu ; 44(5): 335-40, 2019 May 25.
Artigo em Chinês | MEDLINE | ID: mdl-31155865

RESUMO

OBJECTIVE: To observe the therapeutic effect of electroacupuncture (EA) of "Zusanli" (ST36) and "Ashi"-point on the healthy side (opposing needling) on muscular injury and expression of myogenin (myoG) and fast myosin skeletal heavy chain (Fast MyHC) proteins in the gastrocnemius muscle (GM) tissues in skeletal muscle contusion rats,so as to explore its mechanism underlying improvement of skeletal muscle injury. METHODS: A total of 54 male SD rats were divided into normal control (n = 6),model (n=24) and opposing needling (EA, n=24) groups. The latter two groups were further randomized into 3, 5, 7 and 14 d subgroups (n=6 per subgroup). The skeletal muscle contusion model of the hind-limb was established by using a self-made striking device. EA (1 Hz/3 Hz,1-2 mA) was applied to ST36 and "Ashi"-point on the uninjured side of the hind-limb for 15 min every time, once a day for 3, 5, 7 and 14 days, respectively. The injured GM was harvested on the 3rd, 5th, 7th and 14th day after muscular contusion. The morphological changes of the injured GM and the mean cross-sectional areas (CSAs) of the neonatal muscle cells were observed by microscope after H.E. staining. The immunoactivity of desmin protein (myogenic marker protein of myoblast cell) of GM was detected by immunofluorescence stain on the 7th day after injury, and the expression levels of myoG (on the 3rd and 5th day after injury) and fast MyHC protein of GM tissues (on the 7thand 14th day after injury) were detected by Western blot. RESULTS: H.E. staining of GS tissue showed fewer neuronal myocytes with disordered arrangement at different sizes, and appearance of some collagenous fibers among the mesenchyme on day 7 and 14 after muscular contusion, which was relatively milder in the EA group. In the EA group, the CSA values of the neonatal muscle cells were significantly larger than those in the model group on the day 7th (P<0.05), 14th (P<0.001) after injury. On day 7 after muscular contusion, the desmin was found to express on the cellular membrane of GM in the normal control group, while in the model group, the desmin expressed mainly in the cellular plasma in the model group, and on the cellular membrane of neonatal myocytes in the EA group, respectively. The desmin positive myocytes showed disordered arrangement and different sizes after muscular contusion, whereas the situations of the EA group were close to those of the normal control group. Desmin expression was up-regulated in the EA group compared with the model group which was not significant difference (P>0.05). On the 3rd and 5th day after muscular contusion, the expression level of myoG protein was significantly up-regulated in the model group compared with the normal control group (P<0.001), and significantly up-regulated in the EA group than that in the model group (P<0.001). On the 7th and14th day after contusion, the expression level of fast MyHC protein was significantly down-regulated in the model group relevant to the normal control group (P<0.001), and markedly up-regulated in the EA group relevant to the model group (P<0.01).. CONCLUSION: EA of ST36 and "Ashi"-point on the contralateral limb can up-regulate the expression of myoG and fast MyHC proteins of GM in acute skeletal muscle contusion rats, which may contribute to its effect in promoting the repair of skeletal muscle injury.


Assuntos
Contusões , Eletroacupuntura , Pontos de Acupuntura , Animais , Extremidades , Humanos , Músculo Esquelético , Ratos , Ratos Sprague-Dawley
4.
BMC Surg ; 19(1): 57, 2019 May 30.
Artigo em Inglês | MEDLINE | ID: mdl-31146705

RESUMO

BACKGROUND: However, the application of limb salvage with joint preservation is controversial. The purpose of this study is to propose a selection strategy of joint-sparing operative procedures for humeral malignancies based on tumor origin, site and bone strength. METHODS: The medical data of 28 patients with humeral malignancies treated at our institute from January 2010 to December 2016 were analyzed retrospectively. The patients had a median age of 51 years (range, 8-82 years). Bone strength scoring system was utilized to evaluated bone strength of the tumor. Four joint-sparing surgical methods were performed on selected patients. Evaluation of limb function was based on the Musculoskeletal Tumor Society scoring system. Two-sample t-test was used to compare patient group data such as bone strength score and postoperative Musculoskeletal Tumor Society score. RESULTS: The mean follow-up period for the 7 patients with primary malignancies was 45 months (range, 15-66 months). One patient died due to recurrence and lung metastasis, while the remaining 6 patients (6/7, 85.7%) survived without recurrence. For the 21 patients with metastases, 5 survived with tumors, with an average survival time of 25.8 months (range, 9-48 months). The rest died from progression of the primary tumors. The mean bone strength score for the biological reconstruction group and non-biological reconstruction group was respectively 9.7 ± 1.3 and 12.9 ± 1.2. A significant difference between the 2 groups (p < 0.05) was found. Mean postoperative Musculoskeletal Tumor Society score was respectively 27.2 ± 1.8 and 26.1 ± 1.7 for the 2 groups. There was no significant difference between the 2 groups (p > 0.05). Non-oncological complications included fracture (1), aseptic loosening (1) and radial nerve injury (1). CONCLUSIONS: Alcohol devitalized autograft replantation is applicable for diaphyseal humeral primary malignancies, with a good response to chemotherapy and a low bone strength score (≤10). In situ microwave ablation is suitable for diaphyseal and (or) metaphyseal low-grade malignant bone tumors or metastases with a low bone strength score (≤10). Intercalary prosthetic reconstruction is preferred for diaphyseal metastases with a high bone strength score (> 10).


Assuntos
Neoplasias Ósseas/cirurgia , Úmero/cirurgia , Salvamento de Membro/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Diáfises/cirurgia , Extremidades , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/cirurgia , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
5.
Zoology (Jena) ; 134: 16-26, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31146904

RESUMO

Segmentation gives rise to the anterior-posterior axis in many animals, and in vertebrates this axis comprises serially arranged vertebrae. Modifications to the vertebral column abound, and a recurring, but functionally understudied, change is the elongation of the body through the addition and/or elongation of vertebrae. Here, we compared the vertebral and axial kinematics of the robustly limbed Fire skink (Riopa fernandi) representing the ancestral form, the limbless European glass lizard (Ophisaurus apodus), and the Northern water snake (Nerodia sipedon). We induced these animals to traverse through channels and peg arrays of varied widths and densities, respectively, using high-speed X-ray and light video. We found that even though the snake had substantially more and shorter vertebrae than either lizard, intervertebral joint angles did not differ between species in most treatment levels. All three species decreased the amplitude and wavelength of their undulations as channels narrowed and the lizard species increased wave frequency in narrower channels. In peg arrays, both lizard species decreased wave amplitude, while the snake showed no differences. All three species maintained similar wavelengths and frequencies as peg density increased in most cases. Our results suggest that amplitude is decoupled from wavelength and frequency in all three focal taxa. The combination of musculoskeletal differences and the decoupling of axial kinematic traits likely facilitates the formation of different undulatory waves, thereby allowing limbless species to adopt different modes of locomotion.


Assuntos
Extremidades , Articulações/anatomia & histologia , Lagartos/anatomia & histologia , Serpentes/anatomia & histologia , Coluna Vertebral/anatomia & histologia , Animais , Fenômenos Biomecânicos , Lagartos/classificação , Locomoção , Serpentes/classificação
6.
J Surg Oncol ; 120(3): 332-339, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31172536

RESUMO

OBJECTIVE: Our aim was to compare outcomes in patients who underwent unplanned excisions (UE) of soft-tissue sarcomas (STS) against patients with planned excisions (PE). METHODS: The retrospective 7-institution US Sarcoma Collaborative database was used. Patients with curative-intent resection of truncal/extremity STS between 2000 and 2016 were included. Propensity score weighting analysis (PSWA) was performed. Endpoints were locoregional recurrence-free survival (LRFS), distant metastasis-free survival (DMFS), and disease-specific survival (DSS). RESULTS: One thousand five hundred and ninety-six patients were included. Eighty-two percent (n = 1315) underwent PE and 18% (n = 281) underwent UE. Compared with PE, patients with UE were younger with smaller tumors with similar tumor grade. Unmatched analysis revealed PE was associated with worse DMFS (hazard ratio [HR] 1.95, P = .009) and DSS (HR 1.78, P = .039), but not LRFS compared with UE. On PSWA, UE had earlier LRFS (3-year LRFS: 80.5% vs 89.8%, P = .039), but not DMFS or DSS. By grade, patients with high-grade tumors and UE had worse LRFS (1-year LRFS: 90% vs 94%, P = .015), but similar DMFS and DSS compared with PE. In low-grade patients, UE and PE had similar LRFS, DMFS, or DSS. CONCLUSIONS: UE of STS is not associated with worse prognosis compared to PE, though UE is associated with earlier locoregional recurrence in patients with high-grade tumors. Multimodality therapy is needed to achieve improved outcomes in these patients.


Assuntos
Sarcoma/cirurgia , Estudos de Coortes , Procedimentos Cirúrgicos de Citorredução/métodos , Extremidades/patologia , Extremidades/cirurgia , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Pontuação de Propensão , Estudos Retrospectivos , Sarcoma/patologia , Tronco/patologia , Tronco/cirurgia , Resultado do Tratamento
7.
J Surg Oncol ; 120(3): 366-375, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31236956

RESUMO

BACKGROUND: Desmoid tumors are rare locally invasive, benign neoplasms that develop along aponeurotic structures. Current treatment is complicated by associated morbidity and high recurrence rates. METHODS: A retrospective, single-institution review identified 23 patients (age: 16-77) with extra-abdominal desmoid tumors who received CT-guided percutaneous cryoablation as either a first-line (61%) or salvage (39%) treatment in 30 sessions between 2014 and 2018. Median maximal lesion diameter was 69 mm (range: 11-209). Intent was curative in 52% and palliative in 48%. Contrast-enhanced cross-sectional imaging was obtained before and after treatment in addition to routine clinical follow-up. RESULTS: Technical success was achieved in all patients. The median follow-up was 15.4 months (3.5-43.4). Symptomatic improvement was demonstrated in 89% of patients. At 12 months, the average change in viable volume was -80% (range -100% to + 10%) and response by modified response evaluation criteria in solid tumors (mRECIST) was CR 36%, PR 36%, and SD 28% No rapid postablation growth or track seeding was observed. Four patients underwent repeat cryoablation for either residual or recurrent disease. Two patients sustained a major procedural complication consisting of significant neuropraxia. CONCLUSION: Cryoablation for desmoid tumors demonstrates a high degree of symptom improvement and local tumor control on early follow-up imaging with relatively low morbidity.


Assuntos
Criocirurgia/métodos , Fibromatose Agressiva/cirurgia , Parede Abdominal/diagnóstico por imagem , Parede Abdominal/patologia , Parede Abdominal/cirurgia , Adolescente , Adulto , Idoso , Extremidades/diagnóstico por imagem , Extremidades/patologia , Extremidades/cirurgia , Feminino , Fibromatose Agressiva/diagnóstico por imagem , Fibromatose Agressiva/patologia , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Parede Torácica/diagnóstico por imagem , Parede Torácica/patologia , Parede Torácica/cirurgia , Tomografia Computadorizada por Raios X , Adulto Jovem
8.
Naturwissenschaften ; 106(7-8): 38, 2019 Jun 17.
Artigo em Inglês | MEDLINE | ID: mdl-31209559

RESUMO

Xiphosurida-crown group horseshoe crabs-are a group of morphologically conservative marine chelicerates (at least since the Jurassic). They represent an idealised example of evolutionary stasis. Unfortunately, body fossils of horseshoe crabs seldom preserve appendages and their associated features; thus, an important aspect of their morphology is absent in explorations of their conservative Bauplan. As such, fossil horseshoe crab appendages are rarely considered within a comparative framework: previous comparisons have focussed almost exclusively on extant taxa to the exclusion of extinct taxa. Here, we examine eight specimens of the xiphosurid Tachypleus syriacus (Woodward, 1879) from the Cenomanian (ca 100 Ma) Konservat-Lagerstätten of Lebanon, five of which preserve the cephalothoracic and thoracetronic appendages in exceptional detail. Comparing these appendages of T. syriacus with other fossil xiphosurids highlights the conserved nature of appendage construction across Xiphosurida, including examples of Austrolimulidae, Paleolimulidae, and Limulidae. Conversely, Belinuridae have more elongate cephalothoracic appendages relative to body length. Differences in appendage sizes are likely related to the freshwater and possible subaerial life modes of belinurids, contrasting with the primarily marine habits of other families. The morphological similarity of T. syriacus to extant members of the genus indicates that the conserved nature of the generic lineage can be extended to ecological adaptations, notably burrowing, swimming, possible diet, and sexual dimorphism.


Assuntos
Evolução Biológica , Fósseis/anatomia & histologia , Caranguejos Ferradura/anatomia & histologia , Caranguejos Ferradura/classificação , Adaptação Fisiológica , Animais , Ecossistema , Extremidades/anatomia & histologia , Filogenia , Especificidade da Espécie
9.
J Spec Oper Med ; 19(2): 41-47, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31201750

RESUMO

BACKGROUND: To investigate questions about application of emergency tourniquets in very young children, we investigated practices of Combat Application Tourniquet (C-A-T) use on a simulated infant-sized limb to develop ways to improve readiness for caregiving. METHODS: This study was conducted as investigations of C-A-Ts used by two individuals in deliberate practice. The practice setup simulating a limb of infants aged 3-5 months included a handrail (circumference, 5.25 in.). This setup needed a specific modification to the instructions for use to adhere the band between the clips. Each user performed 100 practices. RESULTS: With accrual of experience, application time was shorter for each user, on average in a power law of practice, and more ease was associated when less time was taken to apply the tourniquet. The ease of use was associated with accrued experience through deliberate practice of a tourniquet user while under coached learning. A check of tourniquet fit on a 4.25-in. limb also entailed the modification used in the 5.25-in. limb. However, an additional modification of wrapping the band in a figure-8 pattern around the rod was needed because the rod and clip could not meet. The fit on a 3.25-in. limb was impracticable for a workaround. Tourniquet use was harder for smaller limbs (i.e., 4.25 in. and 3.25 in.). A map of tourniquet fit was sketched of which sized limbs were too big, too small, within the fit zone, or at its borders. CONCLUSION: C-A-Ts mechanically fit the simulated limbs of infants aged 3-5 months, and C-A-T use was practicably easy enough to allow experienced users to fit tourniquets to limbs well using a specific modification of the routine technique. The findings and knowledge generated in this study are available to inform researches and developments in best preparation practices for instructing first aid.


Assuntos
Primeiros Socorros , Hemorragia/prevenção & controle , Torniquetes , Simulação por Computador , Desenho de Equipamento , Extremidades , Humanos , Lactente
10.
Pathologe ; 40(4): 431-435, 2019 Jul.
Artigo em Alemão | MEDLINE | ID: mdl-31240451

RESUMO

Soft-tissue sarcomas are rare malignant tumors. Surgery remains the most important treatment modality. Neoadjuvant and/or adjuvant chemo- and radiotherapy may be administered to improve the local and systemic outcome. Advances in oncological and reconstructive surgery, combined with the use of multimodal therapies, have made mutilating surgery rare events in extremity sarcomas. In retroperitoneal sarcomas, local recurrences are life-threatening events and multivisceral resection has become the standard surgical procedure. The subjects of this review are diagnostics, multimodal therapy, and resection strategy from a surgical point of view.


Assuntos
Neoplasias Retroperitoneais , Sarcoma , Neoplasias de Tecidos Moles , Terapia Combinada , Extremidades , Humanos , Recidiva Local de Neoplasia , Neoplasias Retroperitoneais/patologia , Neoplasias Retroperitoneais/cirurgia , Sarcoma/cirurgia , Neoplasias de Tecidos Moles/cirurgia
11.
Anticancer Res ; 39(5): 2459-2466, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31092440

RESUMO

BACKGROUND/AIM: This study aimed to identify the prognostic factors and outcomes of osteosarcoma (OS) located in proximal versus distal extremity long bones. PATIENTS AND METHODS: A nationwide cohort comprising all Norwegian high-grade OSs in extremity long bones between 1982 and 2009 was investigated. RESULTS: The univariate analysis results identified no significant differences in survival between patients with OS in proximal long bones (101 cases) as a group in comparison to patients with OS in the distal part of these bones (120 cases). However, proximal femur and primary metastasis were both independent adverse prognostic factors for sarcoma-specific survival in multivariate analyses, while elevated LDH and secondary OS were inferior prognostic factors for event-free survival. Adequate surgery and chemotherapy had a positive impact on survival. CONCLUSION: OS of the proximal femur had an unfavorable outcome in comparison to OS in other anatomical locations in extremity long bones.


Assuntos
Neoplasias Ósseas/epidemiologia , Neoplasias Ósseas/fisiopatologia , Extremidades/fisiopatologia , Osteossarcoma/fisiopatologia , Prognóstico , Adolescente , Adulto , Estudos de Coortes , Intervalo Livre de Doença , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Noruega , Osteossarcoma/epidemiologia , Adulto Jovem
12.
Zhonghua Shao Shang Za Zhi ; 35(4): 253-260, 2019 Apr 20.
Artigo em Chinês | MEDLINE | ID: mdl-31060172

RESUMO

Objective: To establish a method for repairing extremities with extensively deep burn using large piece of fresh allogeneic scalp spliced by Meek glue combined with autologous microskin and observe its effect. Methods: Medical records of two male patients with extremely extensive deep burn admitted to our hospital from May to November in 2018 were retrospectively analyzed. Two patients aged 44 and 25 years respectively, with total burn area of 90% and 97% total body surface area (TBSA) and full-thickness burn area of 85% and 70% TBSA, respectively. Preoperatively, the surgical area on the extremities was calculated to estimate the necessary amount of allogeneic scalp and Meek miniature skin. The large piece of fresh allogeneic scalp spliced by Meek glue combined with autologous microskin was prepared according to the methods described as follows. Thin medium-thickness fresh scalps with 3% TBSA and 0.30-0.35 mm in depth were harvested from each donor and spliced into a large piece with epidermis upward by spraying Meek glue. Then the spliced scalp was punched after covered with a single-layer gauze. Autologous microskin was transported onto the dermis of fresh large piece of allogeneic scalp by traditional floating method. Bilateral extremities with full-thickness burn of two patients were selected for self-control. The left upper extremity was denoted as treatment group while the right upper extremity was denoted as control group in Patient 1. The right lower extremity was denoted as treatment group while the left lower extremity was denoted as control group in Patient 2. Wounds in the treatment group were treated with fresh large piece of allogeneic scalp spliced by Meek glue and autologous microskin with expansion ratio of 1∶15 after escharectomy, while wounds in control group received grafting of Meek miniature skin with expansion ratio of 1∶6 and or 1∶9 after escharectomy. The donors of allogeneic scalp were 32 males who were the relatives or friends of the patients, aged 21-50 years, with scalp area of (548±48) cm(2). The healing conditions of donor sites of scalp were observed on post operation day 10, and were followed up within 3 months after operation to observe whether forming alopecia and hypertrophic scar or not. Wound healing condition was evaluated during follow-up in post operation week (POW) 2-5 and 4 months after operation. Wound coverage rates were calculated in both treatment and control groups in POW 2, 3, 4, and 5. Results: The donor sites of all allogeneic scalp of donors healed completely on post operation day 10. There was no alopecia or hypertrophic scar within 3 months after operation for follow-up. In POW 2, allogeneic scalp grafts basically survived in treatment group without obvious exudation, and most of the Meek miniature skin survived in control group with obvious exudation. Part of allogeneic scalp grafts dissolved and detached in treatment group in POW 3, and the surviving grafts scabbed. The eschar detached and new epithelium was observed in treatment group in POW 4 and 5. In POW 3-5, surviving Meek miniature skin in control group creeped and was incorporated, and the wounds shrank. Hypertrophic scar was observed in both treatment and control groups 4 months after operation, without obvious difference in scar as a whole. The wound coverage rates were respectively 84%-98% and 76%-92% in treatment group of two patients in POW 2-5, close to or higher than those of control group (35%-97% and 28%-81%, respectively). Conclusions: The study establishes a novel method for splicing fresh allogeneic scalps into a large piece as the covering of microskin, which has good effect for repairing extensively deep burn wounds. Considering that allogeneic skin is scarce, this method may be a new option in clinical treatment for extensively deep burn patients.


Assuntos
Queimaduras/cirurgia , Couro Cabeludo , Transplante de Pele/métodos , Cicatrização , Adulto , Extremidades , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Pele/patologia , Transplante Autólogo , Resultado do Tratamento , Adulto Jovem
13.
Medicine (Baltimore) ; 98(18): e15406, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31045795

RESUMO

BACKGROUND: Traumatic vascular injury is caused by explosions and projectiles (bullets and shrapnel); it may affect the arteries and veins of the limbs, and is common in wartime, triggering bleeding, and ischemia. The increasing use of high-energy weapons in modern warfare is associated with severe vascular injuries. METHODS: To summarize the current evidence of diagnosis and treatment for traumatic vascular injury of limbs, for saving limbs and lives, and put forward some new insights, we comprehensively consulted literatures and analyzed progress in injury diagnosis and wound treatment, summarized the advanced treatments now available, especially in wartime, and explored the principal factors in play in an effort to optimize clinical outcomes. RESULTS: Extremity vascular trauma poses several difficult dilemmas in diagnosis and treatment. The increasing use of high-energy weapons in modern warfare is associated with severe vascular injuries. Any delay in treatment may lead to loss of limbs or death. The development of diagnose and treat vascular injury of extremities are the clinical significance to the tip of military medicine, such as the use of fast, cheap, low invasive diagnostic methods, repairing severe vascular injury as soon as possible, using related technologies actively (fasciotomy, etc). CONCLUSION: We point out the frontier of the diagnosis and treatment of traumatic vascular injury, also with a new model of wartime injury treatment in American (forward surgical teams and combat support hospitals), French military surgeons regarding management of war-related vascular wounds and Chinese military ("3 districts and 7 grades" model). Many issues remain to be resolved by further experience and investigation.


Assuntos
Medicina de Emergência/métodos , Extremidades , Medicina Militar/métodos , Lesões do Sistema Vascular/diagnóstico , Lesões do Sistema Vascular/terapia , Amputação/métodos , Índice Tornozelo-Braço , Traumatismos por Explosões/diagnóstico , Traumatismos por Explosões/terapia , Prótese Vascular , Descompressão Cirúrgica/métodos , Fasciotomia/métodos , Fraturas Ósseas/terapia , Humanos , Militares , Estudos Retrospectivos , Transplante de Pele/métodos , Fatores de Tempo , Índices de Gravidade do Trauma , Estados Unidos , Procedimentos Cirúrgicos Vasculares/métodos , Lesões do Sistema Vascular/diagnóstico por imagem
14.
J Surg Oncol ; 120(2): 193-199, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31042013

RESUMO

BACKGROUND: While survival after surgical treatment of extremity soft tissue sarcoma (STS) is traditionally reported as actuarial survival, conditional survival (CS) may be more clinically relevant as it accounts for time already survived. We compared actuarial survival and CS of STS patients. MATERIALS AND METHODS: We analyzed 567 patients who underwent surgery for localized extremity STS. Actuarial survival was estimated using the Kaplan-Meier method. Cox proportional hazards model was used to evaluate factors associated with disease-specific survival. Five-year CS (CS5) estimates at "χ" year(s) after surgery were calculated as CS5 = S(χ + 5)/S(χ). RESULTS: Whereas actuarial survival decreased over time, CS5 increased. The postsurgical 1-, 3-, and 5-year CS5 values were 84.5%, 90.0%, and 93.8%, respectively, whereas the 6-, 8-, and 10-year actuarial survival rates were 82.0%, 79.4%, and 78.5%, respectively. The calculated CS5 exceeded actuarial survival especially in patients with risk factors such as large tumor size and Federation Nationale des Centers de Lutte Contre le Cancer (FNCLCC) grades 2 and 3 tumors. Patients with tumor size ≥5 cm had an actuarial survival of 73.9% at 10 years compared to a CS5 of 95.4% in patients alive at 5 years. Likewise, patients with FNCLCC grade 3 tumors had an actuarial survival of 71.1% at 10 years compared to a CS5 of 96.0% in patients alive at 5 years. CONCLUSIONS: Survival estimation by determination of CS can be dynamic and accurate especially in high-risk patients. CS can be useful for survival prediction and clinical decision making in extremity STS patients.


Assuntos
Extremidades , Sarcoma/mortalidade , Sarcoma/cirurgia , Neoplasias de Tecidos Moles/mortalidade , Neoplasias de Tecidos Moles/cirurgia , Análise Atuarial , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Taxa de Sobrevida
15.
Niger J Clin Pract ; 22(5): 642-647, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31089018

RESUMO

Aim: We aimed to compare the epidemiological data, general characteristics, laboratory findings, and outcomes of burn patients with ≤18 and >18 years of age. By this way, we also aimed to determine the effective preventive measures appropriate for different age groups. Subjects and Methods: The data of 630 consecutive patients admitted to our hospital with 2nd or 3rd degree burn injuries were retrospectively investigated. The patients were grouped into two regarding their ages as ≤18 (group 1) and >18 (group 2) years. Data of age, gender, cause of injury, location of injury, total burn area, length of hospital stay, laboratory data, and outcome of treatment were recorded. Results: We determined that although burn injury is more common in males compared with the females, male predominance is more commonly determined in older age group than children. Extremities are most commonly affected areas in both groups. In children, the most common etiological agent was hot beverages while in older age group electrical burns, and work accidents were more common (P < 0.001). Among children, patients younger than 3 years of age were compromising 62.4% of all cases. In adult group, total burned body surface area %, operation or intensive care unit requirement, hospitalization period, blood transfusion, or fresh frozen plasma requirement and the number of patients expired were all significantly higher compared with the children. Regarding the admission laboratory data, renal and liver function tests were significantly worse in older age group. However, neutrophile percentage was significantly higher in older group which may be a sign of augmented inflammatory response. Conclusion: Especially clinicians and public health providers should be aware of the clinical findings and outcomes of burn victims in order to drive more effective preventive measures.


Assuntos
Queimaduras/epidemiologia , Queimaduras/terapia , Neutrófilos , Traumatismos Ocupacionais/epidemiologia , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Bebidas , Superfície Corporal , Queimaduras/fisiopatologia , Queimaduras por Corrente Elétrica/epidemiologia , Criança , Pré-Escolar , Extremidades/lesões , Feminino , Humanos , Lactente , Unidades de Terapia Intensiva , Rim/fisiopatologia , Tempo de Internação , Contagem de Leucócitos , Fígado/fisiopatologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores Sexuais , Turquia/epidemiologia , Adulto Jovem
16.
Int J Mol Sci ; 20(9)2019 May 02.
Artigo em Inglês | MEDLINE | ID: mdl-31052504

RESUMO

Modelling is essential for a better understanding of microcirculatory pathophysiology. In this study we tested our hyperoxia-mouse model with healthy and non-healthy mice. Animals (n = 41) were divided in groups-a control group, with 8 C57/BL6 non-transgenic male mice, a diabetic group (DB), with 8 C57BLKsJ-db/db obese diabetic mice and the corresponding internal controls of 8 age-matched C57BLKsJ-db/+ mice, and a cardiac hypertrophy group (CH), with 9 FVB/NJ cα-MHC-NHE-1 transgenic mice prone to develop cardiac failure and 8 age-matched internal controls. After anesthesia, perfusion data was collected by laser Doppler flowmetry (LDF) during rest (Phase 1), hyperoxia (Phase 2), and recovery (Phase 3) and compared. The LDF wavelet transform components analysis (WA) has shown that cardiorespiratory, myogenic, and endothelial components acted as main markers. In DB group, db/+ animals behave as the Control group, but WA already demonstrated significant differences for myogenic and endothelial components. Noteworthy was the increase of the sympathetic components in the db/db set, as in the cardiac overexpressing NHE1 transgenic animals, reported as a main component of these pathophysiological processes. Our model confirms that flow motion has a universal nature. The LDF component's WA provides a deeper look into vascular pathophysiology reinforcing the model's reproducibility, robustness, and discriminative capacities.


Assuntos
Vasos Sanguíneos/fisiopatologia , Hiperóxia/fisiopatologia , Animais , Modelos Animais de Doenças , Extremidades/irrigação sanguínea , Extremidades/fisiopatologia , Hiperóxia/genética , Masculino , Camundongos Endogâmicos C57BL , Camundongos Transgênicos , Fluxo Sanguíneo Regional , Vasoconstrição
17.
J Dairy Sci ; 102(7): 6508-6517, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31079904

RESUMO

Dairy cow lying behavior is useful in determining the cow's level of welfare, as well as in determining how her environment may affect her comfort and ease of movement. In tiestall systems, cows usually remain in a stall for the duration of their lactation. The dry period offers a unique opportunity to provide alternative housing to the cow with minimal effects on farm housing and management. Our objective was to determine whether housing tiestall cows in deep-bedded pens over an 8-wk dry period altered lying time, lying and rising ability, or lying postures. At dry-off, 20 cows, paired by parity and calving date, were randomly assigned to a deep-bedded loose pen (LP) or a tiestall (TS). Leg-mounted pedometers measured lying time. Rising and lying ability were measured using 6 events of rising and lying from 24-h video recordings taken once a week per cow. Sequenced images (1/min) from the 24-h recordings were used to document lying postures and locations for each cow. Data were analyzed for the early (first week of dry-off), mid, and late (week before calving) terms of the dry period. Lying time did not differ between LP and TS but was numerically higher for LP than TS cows (14.4 vs. 13.0 h/d, respectively). Contact with stall or pen confines when lying down was 5 times higher in TS than LP. The increased contact, coupled with a higher occurrence of hindquarter shifting in the late term, led to higher overall abnormal lying behaviors in TS. Contact with the stall upon rising increased in the late term for TS cows. Cows housed in loose pens also exhibited greater variation in hind-leg postures, keeping legs tucked 20% less often in favor of alternative postures. Stall hardware (e.g., tie rail, dividers) may have affected the ease of transition between lying and standing, leading to higher levels of contact with the stall. Loose-pen cows are able to assume more postures than TS cows when provided more space, possibly allowing them to orient themselves in ways that provide greater comfort. Lying surface in the deep-bedded loose pen may ease the cow's lying-down and rising movements and lead to the higher lying time found with LP cows. Overall, aspects of the stall largely contributed to differences in lying behaviors, warranting further study into whether freestall systems would yield similar outcomes. Improving our concept of ease of movement related to lying and quality of rest in dairy cows, through evaluating lying behaviors in different housing systems, allows for better recommendations on viable alternative housing options.


Assuntos
Bovinos/fisiologia , Animais , Comportamento Animal , Extremidades/fisiologia , Feminino , Abrigo para Animais , Lactação , Paridade , Postura , Gravidez , Descanso
18.
Biomed Res Int ; 2019: 8329306, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31080830

RESUMO

Background: Inconsistent data have been reported for the effectiveness of intramuscular botulinum toxin type A (BTXA) in patients with limb spasticity after stroke. This meta-analysis of available randomized controlled trials (RCTs) aimed to determine the efficacy and safety of BTXA in adult patients with upper and lower limb spasticity after stroke. Methods: An electronic search was performed to select eligible RCTs in PubMed, Embase, and the Cochrane library through December 2018. Summary standard mean differences (SMDs) and relative risk (RR) values with corresponding 95% confidence intervals (CIs) were employed to assess effectiveness and safety outcomes, respectively. Results: Twenty-seven RCTs involving a total of 2,793 patients met the inclusion criteria, including 16 and 9 trials assessing upper and lower limb spasticity cases, respectively. For upper limb spasticity, BTXA therapy significantly improved the levels of muscle tone (SMD=-0.76; 95% CI -0.97 to -0.55; P<0.001), physician global assessment (SMD=0.51; 95% CI 0.35-0.67; P<0.001), and disability assessment scale (SMD=-0.30; 95% CI -0.40 to -0.20; P<0.001), with no significant effects on active upper limb function (SMD=0.49; 95% CI -0.08 to 1.07; P=0.093) and adverse events (RR=1.18; 95% CI 0.72-1.93; P=0.509). For lower limb spasticity, BTXA therapy was associated with higher Fugl-Meyer score (SMD=5.09; 95%CI 2.16-8.01; P=0.001), but had no significant effects on muscle tone (SMD=-0.12; 95% CI -0.83 to 0.59; P=0.736), gait speed (SMD=0.06; 95% CI -0.02 to 0.15; P=0.116), and adverse events (RR=1.01; 95% CI 0.71-1.45; P=0.949). Conclusions: BTXA improves muscle tone, physician global assessment, and disability assessment scale in upper limb spasticity and increases the Fugl-Meyer score in lower limb spasticity.


Assuntos
Toxinas Botulínicas Tipo A/efeitos adversos , Toxinas Botulínicas Tipo A/uso terapêutico , Extremidades/fisiopatologia , Espasticidade Muscular/tratamento farmacológico , Espasticidade Muscular/etiologia , Acidente Vascular Cerebral/complicações , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Espasticidade Muscular/fisiopatologia , Tono Muscular/efeitos dos fármacos , Tono Muscular/fisiologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Acidente Vascular Cerebral/fisiopatologia , Resultado do Tratamento
19.
Am J Vet Res ; 80(5): 461-468, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31034268

RESUMO

OBJECTIVE: To evaluate recovery of limb function by use of gait force analysis after tibial plateau leveling osteotomy (TPLO) in dogs with unilateral cranial cruciate ligament (CrCL) rupture. ANIMALS: 19 dogs with unilateral CrCL rupture treated with TPLO. PROCEDURES: Force plate gait analysis was performed before and 1, 2, 4, and 7 months after TPLO. Ground reaction forces (GRFs; which comprised peak vertical force [PVF], vertical impulse [VI], peak braking force, braking impulse, peak propulsion force [PPF], and propulsion impulse), time to switching from braking to propulsion, and vector magnitude at PVF in the forelimbs and hind limbs were evaluated. RESULTS: GRFs in the affected hind limb were significantly lower than in the contralateral hind limb before TPLO. These variables, except for PPF, were not significantly different 7 months after TPLO. Time to the switching point in the affected hind limb was significantly less from before to 2 months after TPLO. Vector magnitude at PVF had a similar pattern as PVF and VI during the recovery process. The PVF in the ipsilateral forelimb was significantly higher than in the contralateral forelimb before TPLO. CONCLUSIONS AND CLINICAL RELEVANCE: A similar pattern was detected between PVF or VI and craniocaudal force during recovery of dogs that underwent TPLO. Rupture of he CrCl resulted in a decrease in GRFs in the affected hind limb as well as in the switching point and PVF of limbs. However, weight distribution for the craniocaudal force was normalized before PVF or VI. Vector magnitude at PVF might be effectively evaluated by combining vertical force and craniocaudal force.


Assuntos
Lesões do Ligamento Cruzado Anterior/veterinária , Ligamento Cruzado Anterior/cirurgia , Cães/lesões , Extremidades/fisiologia , Análise da Marcha/veterinária , Osteotomia/veterinária , Animais , Lesões do Ligamento Cruzado Anterior/cirurgia , Cães/cirurgia , Feminino , Membro Anterior , Análise da Marcha/métodos , Membro Posterior , Masculino , Ruptura/veterinária , Tíbia/cirurgia
20.
J Surg Oncol ; 119(8): 1087-1098, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30977916

RESUMO

BACKGROUND: As the U.S. population ages, differences in oncologic outcomes among the elderly have been recognized. Our objective was to analyze the clinical, pathologic, and treatment outcomes for elderly soft tissue sarcoma (STS) patients, hypothesizing significant differences in the management and response to therapy. METHODS: Using the National Cancer Database, we identified 33 859 patients with nonmetastatic extremity STS. We defined elderly as ≥74 years in age and compared patient and treatment variables between adult and elderly patients. Cox-proportional hazards analysis was used to determine predictors of overall survival (OS). RESULTS: We identified 8504 elderly patients. Significant differences in histologic subtype, grade, and facility type between elderly and nonelderly patients (P < 0.05) exist. Elderly patients were less likely to undergo R0 resection (P = 0.001) and had a higher 90-day mortality (P = 0.001). Surgical elderly patients experienced superior OS compared with nonsurgical patients (P = 0.001). Among elderly patients, younger age, and female sex, lower Charlson-Deyo score, lower grade, smaller tumors, surgical resection, negative surgical margins, and radiation therapy were associated with better OS. CONCLUSIONS: Key differences exist in elderly extremity STS patients, including a narrower benefit/risk ratio with surgical management. These data highlight that elderly patients represent a distinct cohort for whom more careful selection appears indicated.


Assuntos
Sarcoma/terapia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Extremidades/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Sarcoma/mortalidade , Sarcoma/patologia , Estados Unidos/epidemiologia
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