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1.
Sensors (Basel) ; 21(19)2021 Sep 29.
Artigo em Inglês | MEDLINE | ID: mdl-34640836

RESUMO

Low-back pain has a high impact on the world population, and solutions are in demand. The behavior of specific physiological processes has been modified using magnetic fields, whether for pain relief, bone consolidation, or improvement of vascularization. The use of tape with magnetic properties could help in these cases. A double-blind randomized clinical trial was designed to use Magnetic Tape® versus placebo Kinesio tape. Blood flow variables were evaluated using pulsed power Doppler ultrasound. Resistance index, pulsatility index, systolic velocity, and diastolic velocity were measured. The pressure pain threshold was measured using algometry in 22 subjects. The results reveal significant differences between the groups for the pulsation index variable (8.06 [5.16, 20.16] in Magnetic Tape® versus 5.50 [4.56, 6.64] in Kinesio tape) and lower (0.98 [0.92, 1.02] for Magnetic Tape® versus 0.99 [0.95, 1.01] for Kinesio tape) in the resistance index variable. The pressure pain threshold variable presented significant differences at multiple levels. The application of Magnetic Tape® causes immediate effects on blood flow and pain and could be a technique of choice for pain modulation. Further studies would be necessary.


Assuntos
Fita Atlética , Dor Lombar , Extremidades , Hemodinâmica , Humanos , Dor Lombar/diagnóstico por imagem , Dor Lombar/terapia , Fenômenos Magnéticos
2.
Anticancer Res ; 41(10): 4665-4672, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34593414

RESUMO

BACKGROUND/AIM: The surgical treatment of patients with bone metastasis of the extremities poses a set of unique challenges. We aimed to highlight common hazards when treating pathological fractures as well as hazards surrounding assumptions on metastatic status and life expectancy. MATERIALS AND METHODS: This systematic literature review includes studies published from January 1, 1985 to May 7, 2021. Published articles were surveyed using PubMed. Of 99 studies, 32 original articles were found to meet the inclusion criteria. The PRISMA guidelines were used to select articles. RESULTS: Current literature reports a variety of common pitfalls. In order to avoid pitfalls, it is essential to secure the diagnosis. Furthermore, life expectancy must be given consideration when planning surgical therapy. In addition, a well-functioning multidisciplinary team is needed to coordinate further options such as radiation or embolization. CONCLUSION: Despite the fact that the surgical principles for treating bone metastases of the extremities are often to the point, incorporating all the nuances of treatment is a meticulous procedure.


Assuntos
Neoplasias Ósseas/secundário , Neoplasias Ósseas/terapia , Extremidades/patologia , Neoplasias Ósseas/diagnóstico , Neoplasias Ósseas/patologia , Gerenciamento Clínico , Extremidades/lesões , Extremidades/cirurgia , Fraturas Espontâneas/diagnóstico , Fraturas Espontâneas/patologia , Fraturas Espontâneas/cirurgia , Humanos , Comunicação Interdisciplinar , Expectativa de Vida
3.
Arthroscopy ; 37(9): 2934-2936, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34481631

RESUMO

Operative repair of Achilles tendon rupture significantly decreases the rerupture rate, regardless of type of surgical suture technique. Likewise, regarding repair of either the quadriceps or patellar tendon, surgical repair technique does not significantly influence the generally excellent outcomes achieved, whereas too-early mobilization should be avoided. In terms of the use of suture versus suture tape, load to failure is similar. Many factors impact tendon rupture repair success, including postoperative care, the quality of the tendon, underlying medical issues, and patient compliance, but suture type or technique has little influence on outcome after acute lower-extremity tendon rupture.


Assuntos
Tendão do Calcâneo , Traumatismos dos Tendões , Tendão do Calcâneo/cirurgia , Extremidades , Humanos , Ruptura/cirurgia , Técnicas de Sutura , Suturas , Traumatismos dos Tendões/cirurgia
4.
J Egypt Natl Canc Inst ; 33(1): 27, 2021 Sep 27.
Artigo em Inglês | MEDLINE | ID: mdl-34568989

RESUMO

BACKGROUND: On account of extremity wide range of movements and difficulty of reproducibility during irradiation of extremity sarcomas, assorted immobilization strategies are employed to eliminate setup errors. The study purpose was to compare the setup errors of the commonly used immobilization tools and to define planning target volume (PTV) margins for each device. METHODS: A retrospective review comparing Vac-Loc™ and thermoplastic cast (Tcast) was conducted. On radiotherapy treatment, portal imaging was matched with the pre-treatment simulation imaging for both fixation tools. The isocenter shifts and total vector error (TVE) were compared. Random (σ) and systemic errors (Σ) were computed and PTV margins were defined. RESULTS: Three hundred seven shifts in each direction measured in 14 patients. Mean displacements for the Vac-Loc™ and Tcast, respectively, were as follow: vertical; -0.01 cm vs. 0.02 cm, longitudinal; 0.03 cm vs. 0.04; lateral; 0.04 cm vs. 0.00 cm and TVE; 0.15 cm vs. 0.17 cm with no significant statistical difference. Random and systemic errors were comparable for both devices. The lateral displacement and rotational random errors were higher Vac-Loc™ compared to Tcast. Overall measured PTV margins were marginally lower for Tcast compared to Vac-Loc™. CONCLUSION: Vac-Loc™ and Tcast are valid options for immobilization with no clear superiority of either device. The marginal advantage of Tcast warrants further prospective studies.


Assuntos
Planejamento da Radioterapia Assistida por Computador , Sarcoma , Extremidades , Humanos , Estudos Prospectivos , Dosagem Radioterapêutica , Reprodutibilidade dos Testes , Estudos Retrospectivos , Sarcoma/radioterapia
5.
Tidsskr Nor Laegeforen ; 141(2021-12)2021 09 07.
Artigo em Norueguês | MEDLINE | ID: mdl-34505491

RESUMO

For locally advanced soft tissue sarcomas and metastases from melanoma located in the extremities, mutilating surgery or amputation may be necessary to achieve local control. Isolated limb perfusion with high-dose chemotherapy may represent an alternative to amputation for this patient group.


Assuntos
Sarcoma , Neoplasias de Tecidos Moles , Quimioterapia do Câncer por Perfusão Regional , Extremidades , Humanos , Perfusão , Sarcoma/tratamento farmacológico , Neoplasias de Tecidos Moles/tratamento farmacológico
6.
Neuron ; 109(18): 2981-2994.e5, 2021 09 15.
Artigo em Inglês | MEDLINE | ID: mdl-34534455

RESUMO

The role of the cerebellum in predictive motor control and coordination has been thoroughly studied during movements of a single body part. In the real world, however, actions are often more complex. Here, we show that a small area in the rostral anterior interpositus nucleus (rAIN) of the mouse cerebellum is responsible for generating a predictive motor synergy that serves to protect the eye by precisely coordinating muscles of the eyelid, neck, and forelimb. Within the rAIN region, we discovered a new functional category of neurons with unique properties specialized for control of motor synergies. These neurons integrated inhibitory cutaneous inputs from multiple parts of the body, and their activity was correlated with the vigor of the defensive motor synergy on a trial-by-trial basis. We propose that some regions of the cerebellum are organized in poly-somatotopic "action maps" to reduce dimensionality and simplify motor control during ethologically relevant behaviors.


Assuntos
Piscadela/fisiologia , Núcleos Cerebelares/química , Núcleos Cerebelares/fisiologia , Extremidades/fisiologia , Movimento/fisiologia , Animais , Núcleos Cerebelares/citologia , Cerebelo/química , Cerebelo/citologia , Cerebelo/fisiologia , Previsões , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Camundongos Transgênicos , Optogenética/métodos , Gravação em Vídeo/métodos
7.
Nat Commun ; 12(1): 5533, 2021 09 20.
Artigo em Inglês | MEDLINE | ID: mdl-34545091

RESUMO

LMX1B haploinsufficiency causes Nail-patella syndrome (NPS; MIM 161200), characterized by nail dysplasia, absent/hypoplastic patellae, chronic kidney disease, and glaucoma. Accordingly in mice, Lmx1b has been shown to play crucial roles in the development of the limb, kidney and eye. Although one functional allele of Lmx1b appears adequate for development, Lmx1b null mice display ventral-ventral distal limbs with abnormal kidney, eye and cerebellar development, more disruptive, but fully concordant with NPS. In Lmx1b functional knockouts (KOs), Lmx1b transcription in the limb is decreased nearly 6-fold, indicating autoregulation. Herein, we report on two conserved Lmx1b-associated cis-regulatory modules (LARM1 and LARM2) that are bound by Lmx1b, amplify Lmx1b expression with unique spatial modularity in the limb, and are necessary for Lmx1b-mediated limb dorsalization. These enhancers, being conserved across vertebrates (including coelacanth, but not other fish species), and required for normal locomotion, provide a unique opportunity to study the role of dorsalization in the fin to limb transition. We also report on two NPS patient families with normal LMX1B coding sequence, but with loss-of-function variations in the LARM1/2 region, stressing the role of regulatory modules in disease pathogenesis.


Assuntos
Extremidades/fisiopatologia , Proteínas com Homeodomínio LIM/metabolismo , Síndrome da Unha-Patela/metabolismo , Fatores de Transcrição/metabolismo , Animais , Sequência de Bases , Galinhas , Cromatina/metabolismo , Feminino , Deleção de Genes , Genes Reporter , Homozigoto , Humanos , Masculino , Camundongos , Especificidade de Órgãos , Linhagem , Fenótipo
8.
Bone Joint J ; 103-B(9): 1541-1549, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34465152

RESUMO

AIMS: While a centralized system for the care of patients with a sarcoma has been advocated for decades, regional variations in survival remain unclear. The aim of this study was to investigate regional variations in survival and the impact of national policies in patients with a soft-tissue sarcoma (STS) in the UK. METHODS: The study included 1,775 patients with a STS who were referred to a tertiary sarcoma centre. The geographical variations in survival were evaluated according to the periods before and after the issue of guidance by the National Institute for Health and Care Excellence (NICE) in 2006 and the relevant evolution of regional management. RESULTS: There had been a significant difference in survival between patients referred from the North East, North West, East Midlands, West Midlands, South West, and Wales in the pre-NICE era (five-year disease-specific survival (DSS); South West, 74% vs North East, 47% (p = 0.045) or West Midlands, 54% (p = 0.049)), which was most evident for patients with a high-grade STS. However, this variation disappeared in the post-NICE era, in which the overall DSS for high-grade STS improved from 47% to 68% at five years (p < 0.001). Variation in the size of the tumour closely correlated with the variation in DSS, and the overall size of the tumour and incidence of metastasis at the time of diagnosis also decreased after the national policies were issued. CONCLUSION: The survival of patients with a STS improved and regional variation corrected after the introduction of national policies, as a result of a decreasing size of tumour and incidence of metastasis at the time of diagnosis, particularly in patients with a high-grade STS. This highlights the positive impact of national guidelines on regional variation in the presentation, management, and outcome in patients with a STS. Cite this article: Bone Joint J 2021;103-B(9):1541-1549.


Assuntos
Extremidades , Política de Saúde , Sarcoma/mortalidade , Neoplasias de Tecidos Moles/mortalidade , Neoplasias Torácicas/mortalidade , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Humanos , Incidência , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Gradação de Tumores , Metástase Neoplásica , Características de Residência , Estudos Retrospectivos , Medicina Estatal , Taxa de Sobrevida , Reino Unido/epidemiologia
9.
Acta Chir Orthop Traumatol Cech ; 88(4): 321-324, 2021.
Artigo em Tcheco | MEDLINE | ID: mdl-34534063

RESUMO

Large unresectable STS presents a therapeutic challenge. Several options are being explored to avoid amputation without compromising the oncological outcome. Neoadjuvant chemotherapy delivers inconsistent and rather unsatisfactory results, preoperative radiotherapy compromises healing, hence it can impede adjuvant systemic treatment. We present a case report of neoadjuvant use of isolated limb perfusion with TNF-alfa and Alkeran (Melphalan) in a patient with initially unresectable large myxoid liposarcoma of the thigh. We achieved 55% reduction in size of the tumor that allowed for wide resection with a safe margin. Pathology confirmed 99% tumor necrosis. The patient has a full function of his extremity and is disease-free at one year follow-up. ILP should be considered as a treatment option which, in selected cases, can contribute to limb sparing surgery. Key words: sarcoma, soft tissue, regional perfusion, chemotherapy, surgery, orthopedic, limb salvage.


Assuntos
Lipossarcoma Mixoide , Terapia Neoadjuvante , Adulto , Quimioterapia do Câncer por Perfusão Regional , Extremidades , Humanos , Salvamento de Membro , Lipossarcoma Mixoide/diagnóstico por imagem , Lipossarcoma Mixoide/tratamento farmacológico , Lipossarcoma Mixoide/cirurgia , Perfusão , Coxa da Perna
10.
BMC Musculoskelet Disord ; 22(1): 750, 2021 Aug 31.
Artigo em Inglês | MEDLINE | ID: mdl-34465336

RESUMO

BACKGROUND: Reconstruction of the skeletal defects resulting from the resection of bone tumors remains a considerable challenge and one of the possibilities is the orthotopic replantation of the irradiated bone autograft. One technical option with this technique is the addition of a vital autologous fibular graft, with or without microvascular anastomosis. The aim of our study was to evaluate the clinical results of the treatment of our patient cohort with a specific view to the role of fibular augmentation. METHODS: Twenty-one patients with 22 reconstructions were included. In all cases, the bone tumor was resected with wide margins and in 21 of them irradiated with 300 Gy. In the first case, thermal sterilization in an autoclave was used. The autograft was orthotopically replanted and stabilized with plates and screws. Fifteen patients underwent an additional fibular augmentation, 8 of which received microvascular anastomoses or, alternatively, a locally pedicled fibular interposition. RESULTS: the most common diagnosis was a Ewing sarcoma (8 cases) and the most common location was the femur (12 cases). The mean follow-up time was 70 months (16-154 months). For our statistical analysis, the one case with autoclave sterilization and 3 patients with tumors in small bones were excluded. During follow-up of 18 cases, 55.6% of patients underwent an average of 1.56 revision surgeries. Complete bony integration of the irradiated autografts was achieved in 88.9% of cases after 13.6 months on average. In those cases with successful reintegration, the autograft was shorter (n.s.). Microvascular anastomosis in vascularized fibular strut grafts did not significantly influence the rate of pseudarthrosis. CONCLUSIONS: the replantation of extracorporeally irradiated bone autografts is an established method for the reconstruction of bone defects after tumor resection. Our rate of complications is comparable to those of other studies and with other methods of bone reconstruction (e.g. prosthesis). In our opinion, this method is especially well suited for younger patients with extraarticular bone tumors that allow for joint preservation. However, these patients should be ready to accept longer treatment periods.


Assuntos
Neoplasias Ósseas , Autoenxertos , Neoplasias Ósseas/diagnóstico por imagem , Neoplasias Ósseas/radioterapia , Neoplasias Ósseas/cirurgia , Transplante Ósseo , Extremidades , Fíbula/diagnóstico por imagem , Fíbula/cirurgia , Humanos , Reimplante , Estudos Retrospectivos , Resultado do Tratamento
11.
Unfallchirurg ; 124(9): 704-719, 2021 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-34427698

RESUMO

Pathological fractures of the extremities frequently lead to uncertainty with respect to the treatment strategy and timing. The origin of metastases is typically breast, bronchial, renal and prostate cancer and myelomas. Primary bone tumors play a subordinate role. The majority affect the femur, humerus and occasionally the tibia. Surgery is typically the first line treatment as healing under conservative treatment is unlikely. The most important goal is to relieve pain and the preservation or restoration of function. For correct assessment of indications, analysis of the fracture pattern and oncological aspects including dignity, entity, prognosis, metastatic status and the general condition of the patient need to be taken into consideration. Based on all these aspects the surgical approach can be chosen. Treatment options range from osteosynthetic stabilization and augmentation osteosynthesis up to endoprosthesis replacement. The treatment is carried out in an interdisciplinary procedure as additional measures need to be addressed in addition to the surgical treatment.


Assuntos
Neoplasias Ósseas , Fraturas Espontâneas , Neoplasias Ósseas/cirurgia , Extremidades , Fêmur , Fixação Interna de Fraturas , Fraturas Espontâneas/cirurgia , Humanos , Úmero , Masculino , Estudos Retrospectivos , Resultado do Tratamento
13.
Zoology (Jena) ; 148: 125947, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34333369

RESUMO

The role of COX-2 induced PGE2 in the site-specific regulation of inflammatory mediators that facilitate disparate wound healing in the tail and limb of a lizard was studied by analysing their levels during various stages of healing. The activity of COX-2 and concentration of PGE2 surged during the early healing phase of tail along with the parallel rise in EP4 receptor. PGE2-EP4 interaction is corelated to early resolution (by 3 dpa) of inflammation by rising the antiinflammatory mediator IL-10. This likely causes reduction in proinflammatory mediators viz., iNOS, TNF-α, IL-6, IL-17 and IL-22. Conversely, in the limb, COX-2 derived PGE2 likely causes rise in inflammation through EP2 receptor-based signalling, as all the proinflammatory mediators stay elevated through the course of healing (till 9 dpa), while expression of IL-10 is reduced. This study brings to light the novel roles of IL-17 and IL-22 in programming wound healing. As IL-17 reduces in tail, IL-22 behaves in reparative way, causing conducive environment for scar-free wound healing. On the contrary, synergic elevation of both IL-17 and Il-22 form a micro-niche suitable for scarred wound healing in limb, thus obliterating its regenerative potential.


Assuntos
Ciclo-Oxigenase 2/metabolismo , Citocinas/metabolismo , Extremidades , Lagartos , Cauda , Cicatrização/fisiologia , Animais , Ciclo-Oxigenase 2/genética , Citocinas/genética , Feminino , Regulação da Expressão Gênica/fisiologia , Masculino
14.
Unfallchirurg ; 124(10): 782-788, 2021 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-34379162

RESUMO

A reliable reconstruction of soft tissue defects of the lower extremities especially in the distal third of the leg is still a special challenge for reconstructive surgeons. The possibility of salvaging the leg has to be evaluated in the setting of an interdisciplinary team and the timing of the operation(s) with respect to the safety of the patient and a systematic approach with the selection of a suitable flap have to be defined. Traditionally local muscle flaps or free flaps have been established for coverage of defects of the lower extremities. Recently perforator-based flaps have gained popularity for reconstruction of lower extremity defects. Furthermore, new surgical techniques and developments in association with the demographic change have led to a paradigm shift.


Assuntos
Retalhos de Tecido Biológico , Retalho Perfurante , Procedimentos Cirúrgicos Reconstrutivos , Lesões dos Tecidos Moles , Extremidades , Humanos , Extremidade Inferior/cirurgia , Terapia de Salvação , Lesões dos Tecidos Moles/cirurgia
15.
Clin Imaging ; 79: 300-313, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34388683

RESUMO

The coronavirus disease 2019 (COVID-19) pandemic caused by the novel severe acute respiratory syndrome coronavirus (SARS-CoV-2) has affected almost every country in the world resulting in severe morbidity, mortality and economic hardship, altering the landscape of healthcare forever. Its devastating and most frequent thoracic and cardiac manifestations have been well reported since the start of the pandemic. Its extra-thoracic manifestations are myriad and understanding them is critical in diagnosis and disease management. The role of radiology is growing in the second wave and second year of the pandemic as the multiorgan manifestations of COVID-19 continue to unfold. Musculoskeletal, neurologic and vascular disease processes account for a significant number of COVID-19 complications and understanding their frequency, clinical sequelae and imaging manifestations is vital in guiding management and improving overall survival. The authors aim to provide a comprehensive overview of the pathophysiology of the virus along with a detailed and systematic imaging review of the extra-thoracic manifestation of COVID-19. In Part I, abdominal manifestations of COVID-19 in adults and multisystem inflammatory syndrome in children will be reviewed. In Part II, manifestations of COVID-19 in the musculoskeletal, central nervous and vascular systems will be reviewed.


Assuntos
COVID-19 , Adulto , Aorta , Criança , Extremidades , Humanos , Neuroimagem , SARS-CoV-2 , Síndrome de Resposta Inflamatória Sistêmica
16.
Biomed Res Int ; 2021: 2106972, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34395610

RESUMO

Leiomyosarcoma is an uncommon soft tissue sarcoma that composed of malignant mesenchymal cells with distinct features of the smooth muscle lineage. Typically affects the uterus and gastrointestinal tract, it can rarely be seen in large blood vessels, lymphatic and glandular duts, the mesentery, the omentum, retroperitoneum, and limbs. Occurrence is particularly rare in the limb region. Retrospective study based on patient records and postoperative pathological histological features. Four patients with limb leiomyosarcoma that were operated between 2016 and 2020 were included, three of them arising in the subcutis of the thigh region and one in cubitus. Extend resection with satisfactory outcomes is reported. Pathological examination showed that masses were composed of a fascicular arrangement of hyperchromatic spindle-shaped cells, characterized by the proliferation of epithelioid cells with eosinophilic cytoplasm for epithelioid leiomyosarcoma. Leiomyosarcomas that arise in the soft tissue, although rare, should be differentiated from other lesions, such as neurilemoma, neurofibroma, liomyoma,lipomyoma, synoviosarcoma, rhabdomyosarcoma, malignant fibrous histiotoma, and malignant neurinoma.


Assuntos
Extremidades/patologia , Leiomiossarcoma/cirurgia , Neoplasias de Tecidos Moles/cirurgia , Adulto , Idoso , Extremidades/diagnóstico por imagem , Extremidades/cirurgia , Feminino , Humanos , Leiomiossarcoma/diagnóstico por imagem , Leiomiossarcoma/patologia , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Neoplasias de Tecidos Moles/diagnóstico por imagem , Neoplasias de Tecidos Moles/patologia , Resultado do Tratamento , Adulto Jovem
17.
BMC Cancer ; 21(1): 916, 2021 Aug 13.
Artigo em Inglês | MEDLINE | ID: mdl-34388968

RESUMO

BACKGROUND: Acute Limb Ischemia (ALI) carries a high morbidity and mortality rate that is compounded in the cancer patient. Though it is a relatively uncommon event, it is of extremely high adverse impact and carries poor awareness among clinicians. METHODS: Retrospective review of electronic medical records was performed of cancer patients presenting with acute limb ischemia (ALI) to the tertiary cancer center's urgent care center or as inpatient between January 1, 2014 and January 1, 2020. RESULTS: Out of the 29 cancer patients with ALI, 12 (41%) died within 3 month and 9 (31%) patients died within 1 months of ALI diagnosis. 65% had long term adverse outcome after ALI - 31% with death in 1 month, 2 (7%) with an amputation, 5 (17%) with lifestyle-limiting claudication, and 3 (10%) with subsequent wound ulceration or gangrene. Patients not eligible for standard of care (12 patients, 41%) (RR 2.33 95% CI [1.27-4.27], p <  0.01) and heparin administration ≥6 h from presentation (19 patients, 65%) (RR 2.81 [1.07-7.38], p = 0.04) were at increased risk of adverse outcome. Atypical/confounded presentation of ALI (13 patients, 45%) (RR 1.84 95% CI [1.03-3.29], p = 0.04), pulse exam not documented (12 patients, 41.4%) (RR 1.95 [95% CI [1.14-3.32], p = 0.01), and patients with services other than a vascular specialist initially consulted (8 patients, 27.6%) (RR 1.91 95% CI [1.27-2.87], p <  0.01) were significant risk factors for heparin administered ≥6 h from presentation. CONCLUSIONS: ALI is devastating in cancer patients, with a high number presenting with atypical/confounded signs and symptoms which delays treatment. Heparin administered ≥6 h from presentation is associated with adverse outcome.


Assuntos
Extremidades/irrigação sanguínea , Extremidades/patologia , Isquemia/epidemiologia , Neoplasias/epidemiologia , Doença Aguda , Idoso , Feminino , Humanos , Isquemia/etiologia , Isquemia/mortalidade , Masculino , Pessoa de Meia-Idade , Morbidade , Mortalidade , Neoplasias/complicações , Neoplasias/mortalidade , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Centros de Atenção Terciária
18.
Microsurgery ; 41(6): 513-521, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34390277

RESUMO

INTRODUCTION: Active smoking is known to impair wound healing following free tissue transfer for reconstruction due to its vasoconstrictive effect on the microcirculation. The aim of this study was to evaluate the impact of flap selection on flap loss, in nonelective, traumatic extremity-free soft tissue transfer in active smokers. METHODS: All patients undergoing a free tissue transfer for acute trauma of the extremity at a level I trauma center from 2011 to 2017 were identified. Breast reconstruction and osseous/osseocutaneous flaps were excluded. The study population was divided in two groups based on the type of flap used (muscle versus perforator flap). Factors known to be associated with impaired wound healing were extracted from the database. Primary outcome was major smoking related complications (complete/partial flap loss). Secondary outcomes included minor flap-related complications (infection, dehiscence) and donor site complications. The impact of smoking was assessed for the different type of flaps using multivariate analyses. RESULTS: A total of 118 flaps were identified during the study period. Out of those, 52 were perforator-based fasciocutaneous flaps, while 66 were muscle flaps. Active smoking status resulted in a statistically significant increase in the incidence of major and minor complications in the perforator flap group (36% vs. 4%, adjusted odds ratio, AOR [95%CI]: 2.31[1.48,19.30], adj-p = 0.021 and 32% vs. 17%, AOR [95% CI]: 1.23[1.11,14.31], adj-p = 0.034) but had no impact in the muscle group. CONCLUSIONS: The present study suggests a higher incidence of flap related complications in smokers when a perforator flap was selected but no impact when a muscle flap was utilized.


Assuntos
Retalhos de Tecido Biológico , Mamoplastia , Retalho Perfurante , Procedimentos Cirúrgicos Reconstrutivos , Estudos de Casos e Controles , Extremidades , Humanos , Músculos , Estudos Retrospectivos , Fumar/efeitos adversos , Resultado do Tratamento
19.
Hum Mov Sci ; 79: 102861, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34392188

RESUMO

We investigated the control of upright standing in individuals with unilateral transtibial amputation (TTA) by assessing the inter-limb coupling and the coupling between the center of pressure beneath both limbs combined (COPNET) and the center of pressure (COP) beneath the prosthetic limb and the intact limb. Twenty-one adults with TTA and eighteen unimpaired adults completed 90 s of standing on two parallel force plates. The inter-limb coupling and the coupling between the COP beneath each limb and the COPNET were assessed by quantifying the synchronization of the COP signals. This included the number of epochs with synchronized signals, the total duration of signal synchronization and the relative phase and deviation phase between the signals. Additionally, magnitude and temporal characteristics of the COP displacements were quantified. Individuals with TTA exhibited looser inter-limb coupling in the anterior-posterior direction, characterized by more shifts between epochs with synchronized signals, shorter total duration of signal synchronization, less in-phase coordination patterns and a higher deviation phase between the two limbs, compared to unimpaired individuals. This coincided with a larger and more irregular postural sway in the TTA group. No group difference was observed in the mediolateral direction. The coupling between the COPNET and the COP beneath the individual limbs was similarly direction dependent, and tighter for the intact side, suggesting that an intact limb-driven strategy was utilized.


Assuntos
Amputação , Equilíbrio Postural , Adulto , Extremidades , Humanos , Posição Ortostática , Fatores de Tempo
20.
Proc Biol Sci ; 288(1956): 20211168, 2021 08 11.
Artigo em Inglês | MEDLINE | ID: mdl-34344178

RESUMO

Chelicerate arthropods exhibit dynamic genome evolution, with ancient whole-genome duplication (WGD) events affecting several orders. Yet, genomes remain unavailable for a number of poorly studied orders, such as Opiliones (daddy-long-legs), which has hindered comparative study. We assembled the first harvestman draft genome for the species Phalangium opilio, which bears elongate, prehensile appendages, made possible by numerous distal articles called tarsomeres. Here, we show that the genome of P. opilio exhibits a single Hox cluster and no evidence of WGD. To investigate the developmental genetic basis for the quintessential trait of this group-the elongate legs-we interrogated the function of the Hox genes Deformed (Dfd) and Sex combs reduced (Scr), and a homologue of Epidermal growth factor receptor (Egfr). Knockdown of Dfd incurred homeotic transformation of two pairs of legs into pedipalps, with dramatic shortening of leg segments in the longest leg pair, whereas homeosis in L3 is only achieved upon double Dfd + Scr knockdown. Knockdown of Egfr incurred shortened appendages and the loss of tarsomeres. The similarity of Egfr loss-of-function phenotypic spectra in insects and this arachnid suggest that repeated cooption of EGFR signalling underlies the independent gains of supernumerary tarsomeres across the arthropod tree of life.


Assuntos
Aracnídeos , Animais , Aracnídeos/genética , Extremidades , Genes Homeobox , Genoma , Insetos
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