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1.
N Engl J Med ; 383(7): 630-639, 2020 08 13.
Artigo em Inglês | MEDLINE | ID: mdl-32786188

RESUMO

BACKGROUND: Chronic edema of the leg is a risk factor for cellulitis. Daily use of compression garments on the leg has been recommended to prevent the recurrence of cellulitis, but there is limited evidence from trials regarding its effectiveness. METHODS: In this single-center, randomized, nonblinded trial, we assigned participants with chronic edema of the leg and recurrent cellulitis, in a 1:1 ratio, to receive leg compression therapy plus education on cellulitis prevention (compression group) or education alone (control group). Follow-up occurred every 6 months for up to 3 years or until 45 episodes of cellulitis had occurred in the trial. The primary outcome was the recurrence of cellulitis. Participants in the control group who had an episode of cellulitis crossed over to the compression group. Secondary outcomes included cellulitis-related hospital admission and quality-of-life assessments. RESULTS: A total of 183 patients were screened, and 84 were enrolled; 41 participants were assigned to the compression group, and 43 to the control group. At the time of a planned interim analysis, when 23 episodes of cellulitis had occurred, 6 participants (15%) in the compression group and 17 (40%) in the control group had had an episode of cellulitis (hazard ratio, 0.23; 95% confidence interval [CI], 0.09 to 0.59; P = 0.002; relative risk [post hoc analysis], 0.37; 95% CI, 0.16 to 0.84; P = 0.02), and the trial was stopped for efficacy. A total of 3 participants (7%) in the compression group and 6 (14%) in the control group were hospitalized for cellulitis (hazard ratio, 0.38; 95% CI, 0.09 to 1.59). Most quality-of-life outcomes did not differ between the two groups. No adverse events occurred during the trial. CONCLUSIONS: In this small, single-center, nonblinded trial involving patients with chronic edema of the leg and cellulitis, compression therapy resulted in a lower incidence of recurrence of cellulitis than conservative treatment. (Funded by Calvary Public Hospital Bruce; Australian and New Zealand Clinical Trials Registry number, ACTRN12617000412336.).


Assuntos
Celulite (Flegmão)/prevenção & controle , Bandagens Compressivas , Edema/complicações , Idoso , Celulite (Flegmão)/epidemiologia , Celulite (Flegmão)/etiologia , Doença Crônica , Edema/terapia , Feminino , Seguimentos , Hospitalização/estatística & dados numéricos , Humanos , Incidência , Estimativa de Kaplan-Meier , Perna (Membro) , Masculino , Pessoa de Meia-Idade , Educação de Pacientes como Assunto , Qualidade de Vida , Prevenção Secundária/métodos
2.
Medicine (Baltimore) ; 99(32): e21608, 2020 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-32769918

RESUMO

BACKGROUND: Venous leg ulcers (VLUs) are common throughout the world, which seriously affects the patient's work and life. Relevant researches suggested that sclerosing foam (SF) has potential benefits for VLUs. However, there is no consistent conclusion. The purpose of our study is to assess whether SF is effective and safe for VLUs. METHODS: Relevant clinical randomized controlled trials will be obtained from a search of 8 databases (with no language restrictions) from their inception to May 2020: PubMed, the Cochrane Library, EMBASE, Web of Science, China National Knowledge Infrastructure Database, Wanfang Database, China Science and Technology Journal Database, and Chinese Biological Medicine. Data will be analyzed using RevMan 5.3 after literature screening and data extraction according to predefined inclusion and exclusion criteria. Cochrane Collaboration Risk of bias Tool will be applied in evaluating the quality of enrolled articles. The primary outcome is Closure of venous leg ulcers, ulcer healing rate, adverse events related to SF. The secondary outcomes include ulcer healing time, ulcer recurrence rate, pain. Risk ratio will be used for categorical data; mean differences will be used for measurement data. Where possible and appropriate, meta-analysis will be performed for each outcome. RESULTS: To clarify whether Sclerosing foam can be safe and efficient on treating venous leg ulcers. CONCLUSION: Our review will provide useful information to judge whether Sclerosing Foam is an effective and safe intervention for patients with venous leg ulcers.


Assuntos
Bandagens/normas , Protocolos Clínicos , Células Espumosas , Soluções Esclerosantes/uso terapêutico , Úlcera Varicosa/terapia , Humanos , Perna (Membro)/anormalidades , Perna (Membro)/irrigação sanguínea , Perna (Membro)/fisiopatologia , Metanálise como Assunto , Soluções Esclerosantes/normas , Revisões Sistemáticas como Assunto
3.
BMC Infect Dis ; 20(1): 618, 2020 Aug 24.
Artigo em Inglês | MEDLINE | ID: mdl-32831039

RESUMO

BACKGROUND: Vibrio cholerae are oxidase-positive bacteria that are classified into various serotypes based on the O surface antigen. V. cholerae serotypes are divided into two main groups: the O1 and O139 group and the non-O1/non-O139 group. O1 and O139 V. cholerae are related to cholera infection, whereas non-O1/non-O139 V. cholerae (NOVC) can cause cholera-like diarrhea. A PubMed search revealed that only 16 cases of necrotizing fasciitis caused by NOVC have been recorded in the scientific literature to date. We report the case of a Japanese woman who developed necrotizing fasciitis caused by NOVC after traveling to Taiwan and returning to Japan. CASE PRESENTATION: A 63-year-old woman visited our hospital because she had experienced left knee pain for the past 3 days. She had a history of colon cancer (Stage IV: T3N3 M1a) and had received chemotherapy. She had visited Taiwan 5 days previously, where she had received a massage. She was diagnosed with septic shock owing to necrotizing fasciitis. She underwent fasciotomy and received intensive care. She recovered from the septic shock; however, after 3 weeks, she required an above-knee amputation for necrosis and infection. Her condition improved, and she was discharged after 22 weeks in the hospital. CONCLUSIONS: With the increase in tourism, it is important for clinicians to check patients' travel history. Clinicians should be alert to the possibility of necrotizing fasciitis in patients with risk factors. Necrotizing fasciitis caused by NOVC is severe and requires early fasciotomy and debridement followed by intensive postoperative care.


Assuntos
Fasciite Necrosante/terapia , Vibrioses/complicações , Vibrioses/terapia , Vibrio cholerae não O1/patogenicidade , Amputação , Cuidados Críticos , Diarreia/complicações , Fasciite Necrosante/diagnóstico , Feminino , Humanos , Japão , Perna (Membro)/cirurgia , Pessoa de Meia-Idade , Fatores de Risco , Choque Séptico/etiologia , Choque Séptico/microbiologia , Choque Séptico/terapia , Taiwan , Viagem , Vibrioses/diagnóstico
5.
J Investig Med High Impact Case Rep ; 8: 2324709620944091, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32720827

RESUMO

COVID-19 (coronavirus disease-2019) infection is a highly prothrombotic state, resulting from a dysregulation of the coagulation cascade. Therefore, thromboprophylaxis is strongly recommended in these patients, with some experts even advocating for therapeutic dosing to prevent thromboembolic events. Heparin-induced thrombocytopenia (HIT) is a well-known complication of heparin therapy. In this article, we report a case of HIT in a patient with COVID-19. A 63-year-old male presented with 1 week of dry cough and diarrhea. He had a positive nasopharyngeal COVID-19 reverse-transcriptase-polymerase chain reaction. On admission, the platelet count and liver function tests were within normal limits. During his hospitalization, he developed a right femoral deep venous thrombosis and was started on therapeutic anticoagulation. Due to worsening respiratory failure, he was intubated and mechanically ventilated. Between days 11 and 12 of hospitalization, platelet count dropped from 304 000 to 96 000 cells/µL. He had a high pretest probability for HIT with a 4T score of 6 and a positive anti-PF4/heparin antibody. Heparin drip was discontinued and was switched to argatroban. The serotonin release assay eventually returned positive, which confirmed the diagnosis of HIT. We also discuss potential overdiagnosis of HIT in COVID-19 through 4 cases with false-positive HIT antibodies.


Assuntos
Anticoagulantes/efeitos adversos , Infecções por Coronavirus/complicações , Heparina/efeitos adversos , Pneumonia Viral/complicações , Trombocitopenia/induzido quimicamente , Trombose Venosa/tratamento farmacológico , Trombose Venosa/etiologia , Betacoronavirus , Humanos , Perna (Membro)/irrigação sanguínea , Masculino , Pessoa de Meia-Idade , Pandemias
8.
Surg Clin North Am ; 100(4): 807-822, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32681878

RESUMO

Peripheral arterial disease (PAD) affects many individuals worldwide and is associated with increased morbidity and mortality. Controversy exists on whether or not to screen asymptomatic patients. Further complicating this is that many patients with a chronic lower extremity wound are often asymptomatic. PAD and traditional noninvasive vascular studies may be inaccurate in providing a correct diagnosis. A review of current and novel vascular assessment modalities along with their benefits and limitations are presented here. A combination of these vascular assessments may help improve accuracy in diagnosis, providing timely care to those patients in need.


Assuntos
Perna (Membro)/irrigação sanguínea , Doença Arterial Periférica/fisiopatologia , Índice Tornozelo-Braço , Monitorização Transcutânea dos Gases Sanguíneos/métodos , Pressão Sanguínea/fisiologia , Determinação da Pressão Arterial/métodos , Humanos , Pele/irrigação sanguínea , Dermatopatias Vasculares/fisiopatologia , Espectroscopia de Luz Próxima ao Infravermelho/métodos , Sístole/fisiologia , Cicatrização/fisiologia
9.
PLoS One ; 15(7): e0235686, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32658907

RESUMO

Previous research found that below-knee prosthesis users proactively increase their lateral margin-of-stability on their impaired side in anticipation of an impending perturbation when the timing is predictable and potentially directed toward the impaired limb. While knowledge of perturbation timing and direction influences proactive strategies, the consequences of such knowledge and anticipatory behavior on recovery from perturbations is unclear. This study characterized center-of-mass (CoM) dynamics of below-knee prosthesis users and non-impaired controls following a lateral perturbation when the perturbation direction is known but a priori knowledge of the timing of perturbation is either known or unknown. Across groups, CoM displacement during perturbation exposure increased when directed towards the impaired or non-dominant limb with no influence of timing knowledge. In addition, peak CoM displacement was less with known timing irrespective of the perturbation direction. Generally, the CoM displacement during perturbation exposure correlated well with the CoM medial-lateral velocity during unperturbed walking, supporting evidence that human response dynamics to lateral perturbations are influenced by the instantaneous state of the body's momentum.


Assuntos
Membros Artificiais/psicologia , Equilíbrio Postural , Caminhada/fisiologia , Adulto , Fenômenos Biomecânicos , Estudos de Casos e Controles , Feminino , Humanos , Perna (Membro)/fisiologia , Masculino , Adulto Jovem
10.
Angiol Sosud Khir ; 26(2): 34-40, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32597883

RESUMO

AIM: The study was aimed at comparing the efficacy of implantation of autologous bone marrow cells with that of revascularizing osteotrephination in treatment of lower limb chronic critical ischaemia in patients with a poor distal vascular bed. PATIENTS AND METHOD: We analysed the results of comprehensive examination and treatment of a total of 60 patients presenting with lower limb chronic critical ischaemia due to atherosclerotic lesions of the femoropopliteal-tibial segment. According to the technology of treatment, the patients were divided into two statistically homogenous groups of 30 people each. Group One patients underwent standard revascularizing osteotrephination and Group Two patients in accordance with the original technique received intramuscular implantation of 40 ml of autologous bone marrow cells, with this volume distributed in 2-ml injections to 20 points of the muscles of the crus and femur along the internal and external surface. RESULTS: The use of the original technique of treatment made it possible to achieve the clinical status in the form of moderate or minimal improvement 6 months after bone marrow cells implantation in 29 (96.7%) patients and after 12 months in 28 (93.3%) patients, whereas after revascularizing osteotrephination in 25 (83.3%) and 20 (66.7%) patients, respectively. In the remote period after 12 months, the limb was saved in 28 (93.3%) and 26 (86.7%) patients in Group Two and Group One, respectively. The patients of the second group as compared with those of the first group after 12 months demonstrated a statistically significant increase in the physical health component by 19.8% and the mental health component by 9.8%. CONCLUSION: Implantation of autologous bone-marrow cells in chronic critical limb ischaemia is pathogenetically substantiated and makes it possible to optimize the results of treatment of patients.


Assuntos
Isquemia/etiologia , Doenças Vasculares Periféricas , Transplante de Medula Óssea , Humanos , Perna (Membro) , Extremidade Inferior , Transplante Autólogo , Resultado do Tratamento , Procedimentos Cirúrgicos Vasculares
12.
PLoS One ; 15(6): e0233706, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32502157

RESUMO

Equinus deformity is one of the most common gait deformities in children with cerebral palsy. We examined whether estimates of gastrocnemius length in gait could identify limbs likely to have short-term and long-term improvements in ankle kinematics following gastrocnemius lengthening surgery to correct equinus. We retrospectively analyzed data of 891 limbs that underwent a single-event multi-level surgery (SEMLS), and categorized outcomes based on the normalcy of ankle kinematics. Limbs with short gastrocnemius lengths that received a gastrocnemius lengthening surgery as part of a SEMLS (case limbs) were 2.2 times more likely than overtreated limbs (i.e., limbs who did not have short lengths, but still received a lengthening surgery) to have a good surgical outcome at the follow-up gait visit (good outcome rate of 71% vs. 33%). Case limbs were 1.2 times more likely than control limbs (i.e., limbs that had short gastrocnemius lengths but no lengthening surgery) to have a good outcome (71% vs. 59%). Three-fourths of the case limbs with a good outcome at the follow-up gait visit maintained this outcome over time, compared to only one-half of the overtreated limbs. Our results caution against over-prescription of gastrocnemius lengthening surgery and suggest gastrocnemius lengths can be used to identify good surgical candidates.


Assuntos
Paralisia Cerebral/complicações , Pé Equino/etiologia , Pé Equino/cirurgia , Marcha , Músculo Esquelético/cirurgia , Criança , Humanos , Perna (Membro)/cirurgia , Avaliação de Processos e Resultados em Cuidados de Saúde , Estudos Retrospectivos
13.
Medicine (Baltimore) ; 99(22): e20332, 2020 May 29.
Artigo em Inglês | MEDLINE | ID: mdl-32481409

RESUMO

BACKGROUND: There is a continued discussion on which is the best sclerosant to treat lower extremity varicose veins. Therefore, we did this meta-analysis to determine that foam sclerotherapy versus liquid sclerotherapy, which could perform better in the treatment of lower extremity varicose veins. MATERIALS AND METHODS: We independently searched 5 databases from inception to February 1, 2019, for randomized controlled trials and prospective controlled trials for comparing foam sclerotherapy and liquid sclerotherapy for the treatment of lower extremity varicose veins. The Newcastle-Ottawa Scale (NOS) was used to assess the quality of studies. The primary outcome and secondary outcomes were analyzed using stata 15.0. This meta-analysis was performed according to Cochrane Handbook. RESULTS: There were significant differences in effective rate (P < .001, odd ratios = 5.64, 95% confidence interval = 3.93-8.10) and incidence rate of pain (P = .030, odd ratios = 1.52, 95% confidence interval = 1.04-2.21) between foam sclerotherapy and liquid sclerotherapy. And there were no significant differences among local inflammation (P = .896, rate difference = 0.00, 95% confidence interval = -0.03 to 0.03), thrombophlebitis (P = .90, rate difference = 0.00, 95% confidence interval = -0.02 to 0.02) and hyperpigmentation (P = .336, rate difference = 0.05, 95% confidence interval = -0.05 to 0.14). CONCLUSIONS: Although foam sclerotherapy has a higher incidence rate of complications, it could achieve a more stable clinical efficacy in the treatment of lower extremity varicose veins than liquid sclerotherapy.


Assuntos
Soluções Esclerosantes/uso terapêutico , Escleroterapia/métodos , Varizes/tratamento farmacológico , Ensaios Clínicos como Assunto , Humanos , Incidência , Perna (Membro) , Estudos Prospectivos , Recidiva , Projetos de Pesquisa , Soluções Esclerosantes/administração & dosagem , Soluções Esclerosantes/efeitos adversos
14.
J Sports Med Phys Fitness ; 60(7): 992-998, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32597616

RESUMO

BACKGROUND: The rest interval between sets can affect the responses to resistance training. Thus, the purpose of this study was to compare the effects of different rest intervals (RI) on volume, density, and rating of perceived exertion (RPE) when adopting a crescent pyramid (CP) system. METHODS: Twenty young women (21.1±2.6 years, 1.59±0.06 m, 58.5±9.3 kg) participated in this study. All participants performed three experimental sessions of the leg press exercise in 5 sets until voluntary muscular failure at 60%, 65%, 70%, 75%, and 80% of one-repetition maximum (1RM). A randomized and crossover design was used so that in each session one of three RI (RI-1 = 1 min, RI-2 = 2 min, and RI-3 = 3 min) was tested. RESULTS: The participants performed a significantly larger volume in the RI-3 (12820±3134 kg) when compared to RI-1 (10367±3053 kg) condition (P<0.05). The volume did not differ between RI-2 and RI-3 (P>0.05). The density was higher (P<0.05) in RI-1 (43.1±12.7 kg/s) when compared RI-2 (25.6±5.8 kg/s) and RI-3 (17.7±4.3 kg/s). The RI-2 presented higher density compared to RI-3 condition (P<0.05). The RPE was not different between the three conditions (P>0.05). CONCLUSIONS: The use of 2 minutes of rest between sets allowed the performance of a high volume-load and density of the session in young women. In addition, the three experimental sessions provided a high perception of effort.


Assuntos
Percepção/fisiologia , Esforço Físico/fisiologia , Treinamento de Resistência/métodos , Levantamento de Peso/fisiologia , Adulto , Estudos Cross-Over , Feminino , Humanos , Perna (Membro)/fisiologia , Descanso/fisiologia , Fatores de Tempo , Adulto Jovem
15.
Proc Natl Acad Sci U S A ; 117(26): 14645-14656, 2020 06 30.
Artigo em Inglês | MEDLINE | ID: mdl-32522873

RESUMO

Focusing waves inside inhomogeneous media is a fundamental problem for imaging. Spatial variations of wave velocity can strongly distort propagating wave fronts and degrade image quality. Adaptive focusing can compensate for such aberration but is only effective over a restricted field of view. Here, we introduce a full-field approach to wave imaging based on the concept of the distortion matrix. This operator essentially connects any focal point inside the medium with the distortion that a wave front, emitted from that point, experiences due to heterogeneities. A time-reversal analysis of the distortion matrix enables the estimation of the transmission matrix that links each sensor and image voxel. Phase aberrations can then be unscrambled for any point, providing a full-field image of the medium with diffraction-limited resolution. Importantly, this process is particularly efficient in random scattering media, where traditional approaches such as adaptive focusing fail. Here, we first present an experimental proof of concept on a tissue-mimicking phantom and then, apply the method to in vivo imaging of human soft tissues. While introduced here in the context of acoustics, this approach can also be extended to optical microscopy, radar, or seismic imaging.


Assuntos
Processamento de Imagem Assistida por Computador/métodos , Ultrassonografia/métodos , Acústica , Análise de Fourier , Humanos , Perna (Membro)/diagnóstico por imagem , Imagens de Fantasmas , Espalhamento de Radiação
16.
Anticancer Res ; 40(6): 3423-3427, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32487640

RESUMO

BACKGROUND: Neurofibromatosis type 1 (NF1) is an autosomal dominant hereditary disease with complete penetrance and a very variable phenotype. Recent research has shown that postzygotic NF1 gene mutations occur to a far greater extent than previously thought. The phenotype of affected individuals reflects the time of somatic mutation and the phenotype is correspondingly diverse. This report describes histological and genetic findings in a case of mosaic NF1, the clinical control of which documents almost stationary skin findings over a period of 9 years. CASE REPORT: The 55-year-old female first presented for advice on a strip of nodular skin tumours of the calf skin. She had no hallmarks of NF1. It was only 9 years later that she had the skin tumours removed, all of which were partially diffuse and partially plexiform neurofibroma. The genetic examination showed an atypical large deletion of the NF1 gene in the skin tumours, but not in overlying skin or blood. CONCLUSION: Segmental NF1 is a distinct type of mosaic/somatic NF1 mutation. The phenotype of diffuse and plexiform skin neurofibromas can resemble cutaneous neurofibroma. Surgical therapy for segmental neurofibromatosis does not differ from the concepts for treating nerve sheath tumours in NF1 patients with a germline NF1 mutation.


Assuntos
Mosaicismo , Neurofibroma Plexiforme/diagnóstico , Neurofibroma Plexiforme/genética , Neurofibromatose 1/diagnóstico , Neurofibromatose 1/genética , Neoplasias Cutâneas/diagnóstico , Neoplasias Cutâneas/genética , Biópsia , Feminino , Estudos de Associação Genética , Predisposição Genética para Doença , Testes Genéticos , Humanos , Perna (Membro)/patologia , Pessoa de Meia-Idade
17.
Muscle Nerve ; 62(2): 219-225, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32362001

RESUMO

INTRODUCTION: In this study we collected reference values for the across-tarsal-tunnel conduction of the motor tibial nerve (mTN). METHODS: The mTN compound muscle action potentials (CMAPs) from the abductor hallucis muscle were obtained by stimulating below/above the malleolus and the popliteal fossa. The effect of weight, height, body mass index (BMI), foot and leg length, sex, and age were evaluated using univariate and multivariate correlation analyses, and predictive equations for each mTN conduction parameter were developed. RESULTS: On the basis of data from 185 subjects, there were differences between women and men in all anthropometric parameters and for some nerve conduction values. Through multivariate analysis, age, but not sex, was found to have a significant impact. Height affected both distal and proximal conduction velocity. BMI affected CMAP amplitude. DISCUSSION: mTN conduction is influenced by various demographic and anthropometric factors. For all intrinsic factors, height demonstrated the greatest effect on mTN conduction across the tarsal tunnel.


Assuntos
Potenciais de Ação/fisiologia , Estatura , Índice de Massa Corporal , Condução Nervosa/fisiologia , Nervo Tibial/fisiologia , Fatores Etários , Idoso , Peso Corporal , Eletrodiagnóstico , Feminino , Pé/anatomia & histologia , Humanos , Perna (Membro)/anatomia & histologia , Masculino , Pessoa de Meia-Idade , Tamanho do Órgão , Valores de Referência , Fatores Sexuais
19.
BMC Infect Dis ; 20(1): 348, 2020 May 15.
Artigo em Inglês | MEDLINE | ID: mdl-32414336

RESUMO

BACKGROUND: Besides the considerable role of blackflies to the transmission of many disease agents, these flies considered as annoying biting pests of wildlife, livestock, poultry, and humans. There are few literature reports of blackfly fever following Simulium spp. This study describes a case of blackfly fever and dermatitis following blackflies numerous bites in Iran. CASE PRESENTATION: The present report describes a 25-year-old man that was attacked by numerous flies while fishing and camping near Namrood river in Firuzkuh County, Tehran Province, Iran. Pruritic dermatitis with marked edema appeared mainly on the hands and legs and subsequently, the patient's condition worsened with swollen lymph nodes, joints aching, and 40 °C fever. The patient's clinical signs and symptoms were alleviated by injection of intramuscular Dexamethasone Phosphate (DEXADIC®) 8 mg/2 ml after 24 h. CONCLUSIONS: This study reported a human case with blackfly fever and dermatitis following numerous bites of Simulium kiritshenkoi, for the first time in Iran.


Assuntos
Dermatite/etiologia , Febre/etiologia , Mordeduras e Picadas de Insetos/complicações , Simuliidae , Adulto , Animais , Dermatite/tratamento farmacológico , Dexametasona/análogos & derivados , Dexametasona/uso terapêutico , Edema/tratamento farmacológico , Edema/etiologia , Feminino , Mãos , Humanos , Mordeduras e Picadas de Insetos/tratamento farmacológico , Irã (Geográfico) , Perna (Membro) , Masculino , Simuliidae/anatomia & histologia , Simuliidae/fisiologia
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