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Background: Detecting bone marrow edema (BME) as a sign of acute fractures is challenging on conventional computed tomography (CT). This study evaluated the diagnostic performance of a three-material decomposition (TMD) approach for detecting traumatic BME of the extremities on spectral computed tomography (SCT). Methods: This retrospective diagnostic study included 81 bone compartments with and 80 without BME. A TMD application to visualize BME was developed in collaboration with Philips Healthcare. The following bone compartments were included: distal radius, proximal femur, proximal tibia, distal tibia and fibula, and long bone diaphysis. Two blinded radiologists reviewed each case independently in random order for the presence or absence of BME. Results: The interrater reliability was 0.84 (p < 0.001). The different bone compartments showed sensitivities of 86.7% to 93.8%, specificities of 84.2% to 94.1%, positive predictive values of 82.4% to 94.7%, negative predictive values of 87.5% to 93.3%, and area under the curve (AUC) values of 85.7% to 93.1%. The distal radius showed the highest sensitivity and the proximal femur showed the lowest sensitivity, while the proximal femur presented the highest specificity and the distal tibia presented the lowest specificity. Conclusions: Our TMD approach provides high diagnostic performance for detecting BME of the extremities. Therefore, this approach could be used routinely in the emergency setting. [ABSTRACT FROM AUTHOR]

Objective: To identify trends in apparent diffusion coefficient (ADC) measurements from diffusion-weighted imaging (DWI) with respect to tumor type classification and other tumor characteristics whether common malignant soft tissue tumors can be distinguished. Materials and methods: A consecutive series of extremity malignant soft tissue tumors and soft tissue sarcomas (STS) among 78 adult patients with conventional MRI and DWI were included. Each case was evaluated with respect to T1/T2 signal alterations and heterogeneity, presence of peritumoral edema, necrosis, cystic changes, internal hemorrhage, and maximum longitudinal dimension blinded to the histology. The ADC mean and minimum were obtained using a free-hand region of interest of the whole tumor and the darkest (lowest signal area) ADC area of the tumor. Kruskal–Wallis and Wilcoxon Rank-Sum Tests were used to determine associations and significance between tumor subtypes. Intraclass correlation (ICC) and kappa calculations were utilized to assess inter-reader agreements for ADC values and reader diagnosis. Results: Liposarcomas showed more heterogenous T1W images with hyperintense T1W signal when compared to tumors not classified as liposarcoma (P = 0.046 and P = 0.010, respectively). Liposarcomas were relatively consistent in demonstrating an absence of hemorrhage (81.8%) while undifferentiated pleomorphic sarcomas consistently showed intralesional hemorrhage (90%). When comparing individual tumor classifications against the rest of the samples, lymphomas registered lower mean and minimum ADC values in the whole tumor and in the most hypointense area of the tumor for both readers (P < 0.05). The interobserver agreement between the two readers was good to excellent for all four ADC measurements (ICC = 0.65–0.98). Conclusion: Diffusion-weighted imaging generated ADC measurements are reproducible but currently offer limited insight in being able to differentiate among different malignant soft tissue tumor and sarcoma histologies. T1W and T2W signal characteristics also offer limited insight in differentiating between soft tissue malignancies. [ABSTRACT FROM AUTHOR]

Exercise training has the potential for inducing enhancements in peripheral circulation, which can play important preventive and therapeutic roles in peripheral circulatory diseases. However, the relevant published studies show conflicting and inconclusive results. Furthermore, useful or optimum ambient temperature for this purpose has not yet been established. Therefore, we investigated the acute responses in peripheral circulation from exposure of healthy subjects to treadmill exercise under different ambient temperatures; A total of 12 young adult volunteers (males 6, females 6) randomly underwent three sessions of treadmill exercise for 30 min under three different ambient temperatures (10°C, 20°C, and 30°C), at a predetermined exercise intensity. Before and after the intervention, leg skin blood flow (SBF) was measured by laser Speckle flowgraphy and hand skin temperature (ST), by digital thermometry; After the cessation of treadmill exercise, compared to the corresponding baseline values, a significant increase in SBF was observed under all ambient temperature conditions (P [ J Adv Biotechnol Exp Ther 2023; 6(1.000): 222-230]

Abstract Background War conflicts and terror-related injuries constitute a significant public health problem in Somalia. We aim to characterize and compare the injury characteristics of gunshot and blast injuries of the extremities. Methods The data of 333 patients with gunshot and blast injuries of the extremities over three years were retrospectively reviewed. The demographics, injury characteristics, and outcomes were analyzed. Results Most of the patients had injuries due to gunshot casualties compared with blast victims (n = 222, 66.7% vs. n = 111, 33.3%). Patients with gunshot wounds (GSW) had a more significant proportion of males than those with blast wounds (BW) (95.5% vs. 85.6%, P 2-week hospital stay in 31% vs. 19%, P

Objective:International classification of functioning, disability and health (ICF) was prepared by the World Health Organization to create a standard language for the definition and measurement of health and health-related states. ICF classification collects disease and disability situation sunder 3 titles as organ/system structure sand functions, activity limitations (daily and social life activities). The guide prepared by the American Medical Association (AMA guideline-6th edition) has been prepared based on ICF terminology. AMA guideline calculates the disability rating according to the effects of the person’s daily and social life activities.Methods:It is aimed to compare the regulations used in our country (The Regulation on Determination of Working Powerand Loss of Profitability in Profession-SGK and the Regulation on Disability Assessment for Adults-disabled) with the AMA guideline over the calculated disability rates. The disability rates of 315 cases who developed extremity injuries as a result of traffic accidents between 2018 and 2019 were calculated according to 3 regulations. The cases were analyzed in terms of gender, age at the time of the incident, type of accident, time between the incident and admission, injury sites, the clinics for which consultation was requested, whether the operation was performed and the complications that occurred.Results:81.9% of the cases were male, the mean age was 31.14 years, when we look at the disability rate values, the highest disability rates is calculateda according to the SGK Regulations and the lowest disability rates calculated according to AMA guideline.Conclusion:It is seen that active life activities are not included in the calculation of disability ratio in there gulations used in our country. AMA guideline has been prepared in detail and clearly for extremity disability calculation and we think that it should be in routine practice to prevent loss of rights.

Background: Validated self-reporting tools are required to evaluate the functional outcome and health-related quality of life (HRQOL) for those who had extremity bone sarcomas in their childhood or adolescence. Our study pursued cross-cultural adaptation and validation of the pediatric Toronto Extremity Salvage Score (pTESS) and Toronto Extremity Salvage Score (TESS) to assess the functional outcome for Egyptian children and adult survivors following surgeries of extremity bone sarcomas. In the modified versions of pTESS and TESS, mental domains were added to allow the evaluation of HRQOL using a specific instrument for childhood bone cancer. Methods: The internal consistency and test–retest reliability of the studied forms were assessed with Cronbach's alpha and Intra-class coefficients (ICC), respectively. For convergent validity, correlations between scores of the generic Pediatric Quality of Life Inventory (PedsQL 4.0) and pTESS /TESS scores were reported. Factor Analysis was feasible for pTESS-leg; due to the insufficient samples, only the average inter-item correlation coefficients were reported for the remaining versions. Results: Out of 233 participants, 134 responded to pTESS-leg, 53 to TESS-leg, 36 to pTESS-arm, and only 10 to TESS-arm. All versions showed excellent internal consistency (Cronbach's alpha >0.9), good test–retest reliability (ICC >0.8), moderate to strong correlations with PedsQL, and acceptable average inter-item correlation coefficients (≥0.3). Three factors were extracted for the pTESS-leg, in which all mental items were loaded on one separate factor with factor loadings exceeding 0.4. Active chemotherapy, less than one year from primary surgery, or tibial tumors were associated with significantly inferior pTESS/TESS scores in the lower extremity group. Conclusion: The Egyptian pTESS and TESS are valid and reliable self-reporting tools for assessing the functional outcome following surgeries for extremity bone sarcomas. The modified pTESS and TESS versions, which include additional mental domains, enabled the assessment of the overall health status of our population. Future studies should include a larger sample size and evaluate the ability of pTESS/TESS to track progress over time. [ABSTRACT FROM AUTHOR]

Vascular injuries of the extremities are associated with a high mortality rate. Conventionally, open surgery is the treatment of choice for peripheral vascular injuries. However, rapid development of devices and techniques in recent years has significantly increased the utilization and clinical application of endovascular treatment. Endovascular options for peripheral vascular injuries include stent-graft placement and embolization. The surgical approach is difficult in cases of axillo-subclavian or iliac artery injuries, and stent-graft placement is a widely accepted alternative to open surgery. Embolization can be considered for arterial injuries associated with active bleeding, pseudoaneurysms, and arteriovenous fistula and in patients in whom embolization can be safely performed without a risk of ischemic complications in the extremities. Endovascular treatment is a minimally invasive procedure and is useful as a simultaneous diagnostic and therapeutic approach, which serve as advantages of this technique that is widely utilized for vascular injuries of the extremities. [ABSTRACT FROM AUTHOR]

Merkel cell carcinoma (MCC) has a tendency for lymphatic spread and locoregional recurrence, although there is little data examining the risk factors for patients with lymph node-positive extremity lesions. The purpose of the current study was to examine the outcomes and risk factors associated with nodal metastasis in extremity MCC. We retrospectively reviewed the medical record of 120 patients with extremity MCC evaluated at our institution between 1994 and 2021. The mean age of this cohort was 71 years; 33% of patients were female; and 98% were Caucasian. Seventy-eight (65%) patients presented with localized disease. Thirty-seven (31%) patients had stage III disease, and five (4%) patients had stage IV disease. Treatment of primary lesions consisted primarily of margin-negative excision and adjuvant radiotherapy. Nodal metastases were most treated with adjuvant radiation or completion lymph node dissection. Five-year disease-specific survival in our series was 88% for patients with localized disease, 89% for stage IIIa disease, 40% for stage IIIb disease and 42% for stage IV. Factors associated with worse survival included immunosuppression and macroscopic nodal disease. In conclusion, extremity MCC has a low rate of local recurrence when treated with margin-negative excision and adjuvant radiation. However, treatment of nodal metastases remains a challenge with high rates of recurrence and mortality, particularly for patients who are immunosuppressed or who have macroscopic nodal disease. [ABSTRACT FROM AUTHOR]

The question of whether ability-related emotional intelligence (ability EI) predicts important life outcomes has attracted considerably more attention than the question of what ability EI consists of. In the present paper, the authors draw from the attitude and emotion literatures to suggest that the evaluation dimension of meaning is likely key in understanding how ability EI operates. Measures of ability EI predict the extent to which individuals can accurately evaluate words and measures of the latter type act as emotional intelligence measures. Extending this analysis, the paper reviews recent sources of data linking ability EI to attitudinal processes, such as those involved in attitude–behavior relationships and affective bipolarity. Individuals with high EI appear to experience their affect in more bipolar terms and they display evidence of greater decisiveness in their evaluations. Pursuing links of the present type will allow researchers to generate new predictions concerning the ability EI construct. [ABSTRACT FROM AUTHOR]

Evaluation for suspected inflammatory arthritis as a cause for chronic extremity joint pain often relies on imaging. It is essential that imaging results are interpreted in the context of clinical and serologic results to add specificity because there is significant overlap of imaging findings among the various types of arthritis. This document provides recommendations for imaging evaluation of specific types of inflammatory arthritis, including rheumatoid arthritis, seronegative spondyloarthropathy, gout, calcium pyrophosphate dihydrate disease (or pseudogout), and erosive osteoarthritis. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances in which peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation. [ABSTRACT FROM AUTHOR]

Objective The aim of the present study was to report a novel nomenclature system for extended latissimus dorsi musculocutaneous (LD) flaps. To evaluate the clinical application and surgical efficacy of the different extended LD flaps for large wounds in the extremities. Methods From January 2004 to December 2018, 72 consecutive patients who received extended LD flaps were retrospectively analyzed. Patients' ages ranged from 2 to 68 years with 37 males and 35 females. All wounds were extensive in either the upper or lower limbs, while the skin defect area ranged from 18 cm × 10 cm to 37 cm × 21 cm. Forty‐one wounds were located in the calf, 18 in the foot and ankle, six in the shoulder and upper arm, four in the thigh, and three at the knee joint. Twenty‐eight patients had fractures, and six of these patients with segmental bone defects (ranging in size from 3 to 7 cm) required secondary orthopaedic procedures. Single‐ and double‐wing extended LD flaps were designed and harvested according to the shape of the wounds. Results The flaps received consisted of 64 single‐wing and eight double‐wing extended LD flaps, and the mean flap harvest time was 56.2 min. The donor sites were closed primarily for all patients. Additional subcutaneous veins were anastomosed to the recipient's vessels in 14 patients. The venous crisis was noticed on the first postoperative day in four cases. Two flaps were salvaged after emergency re‐exploration, and another two patients' flaps were necrosed. In these two patients, lower limb amputation and extended LD flap on the other side were used, respectively, for the final treatment. The wounds healed well, providing reliable soft tissue coverage and good contour in the reconstructed areas. Six patients had segmental bone defects that required secondary orthopaedic procedures, two patients were repaired with vascularized iliac crest bone grafts, and another four patients were reconstructed by the Ilizarov technique. All the patients' bone defects achieved union and most patients achieved good functional recovery at the recipient site. The mean follow‐up was 15.7 months (range, 10–56 months). No significant donor site morbidities limiting patients' daily activities occurred during the follow‐up. Eight patients developed a donor site hypertrophic scar, three patients on the back, and five on the anterolateral thigh. Conclusion Single‐ and double‐wing extended LD flaps are simple and reliable methods for large skin and soft tissue defects in the extremity, with good functional and aesthetic results.

Background One of the most essential goals in managing complex limb defects is obtaining adequate soft tissue coverage with excellent functional and aesthetic outcomes. Free perforator skin flaps represent an optimal option for such defects. Therefore, our intention was to reconstruct these kinds of defects with thin fasciocutaneous flaps without the need for debulking. Herein, we define the legitimate use of the medial sural artery perforator (MSAP) flaps for small-moderate size defect coverage of the hand and foot. Patients and Methods Seven patients received MSAP flaps for reconstruction of different hand and foot defects, of which the majority were males (4/7). Age, sex, flap size, location, number of perforators, recipient vessel, type of anastomosis, technique of donor site closure, and postoperative morbidity were recorded. Patients' age ranged from 48 to 84 years. Results Single-stage debridement followed by reconstruction was performed. Flap sizes ranged from 6 to 18 cm in length and 4 to 10 cm in width. The pedicles of 6 flaps were anastomosed to the tibial artery system (three posterior tibial artery, three dorsalis pedis artery) and one to the ulnar artery. Conclusion MSAP flap can be a versatile option for single-stage reconstruction of small-moderate size defects of the extremities, where thin, soft tissue envelope is required. This flap has lower donor site morbidity, more tedious elevation process, and has a good reconstructive and aesthetic result without the need for debulking in the future.

This research article discusses feminine death in three short stories: The Little Match Girl (1906) by Hans Christian Andersen, Dead Men's Path (1972) by Chinua Achebe, and The Story of an Hour (1969) by Kate Chopin. It aims to reveal the existence of extremity and sacrifice in the death of a woman. This study used a qualitative-descriptive design to reveal and investigate the phenomena and forms, or modes, of women's deaths. The theory of feminine death from Elizabeth Bronfen (2017) is used to reveal the extremity and sacrifice of a woman, and the theory of philosophical death and female finitude from Linnell Secomb (1999) is used to reveal the mode and symbols of feminine death. Based on Spradley's theory and analysis, we argue that the three short stories all have extremity and sacrifice; in the short story by Hans Christian Andersen, there is a mode or form of death called "being-towards-death." Furthermore, in the work of Chinua Achebe, there is a mode of death called "the master-slave battle to the death." Lastly, Kate Chopin produced "dwelling-with-death". The three short stories can be found in extremity, sacrificing, and feminine modes of death. Thus, the identification can reveal the feminine death phenomenon in the short story.

Opinion statement: Extremity soft tissue sarcoma (ESTS) constitutes the majority of patients with soft tissue sarcoma (STS). Patients with localized high-grade ESTS > 5 cm in size carry a substantial risk of developing distant metastasis on follow-up. A neoadjuvant chemoradiotherapy approach can enhance local control by facilitating resection of the large and deep locally advanced tumors while trying to address distant spread by treating the micrometastasis for these high-risk ESTS. Preoperative chemoradiotherapy and adjuvant chemotherapy are often used for children with intermediate- or high-risk non-rhabdomyosarcoma soft tissue tumors in North America and Europe. In adults, the cumulative evidence supporting preoperative chemoradiotherapy or adjuvant chemotherapy remains controversial. However, some studies support a possible benefit of 10% in overall survival (OS) for high-risk localized ESTS, especially for those with a probability of 10-year OS < 60% using validated nomograms. Opponents of neoadjuvant chemotherapy argue that it delays curative surgery, compromises local control, and increases the rate of wound complications and treatment-related mortality; however, the published trials do not support these arguments. Most treatment-related side effects can be managed with adequate supportive care. A coordinated multidisciplinary approach involving sarcoma expertise in surgery, radiation, and chemotherapy is required to achieve better outcomes for ESTS. The next generation of clinical trials will shed light on how comprehensive molecular characterization, targeted agents and/or immunotherapy can be integrated into the upfront trimodality treatment to improve outcomes. To that end, every effort should be made to enroll these patients on clinical trials, when available. [ABSTRACT FROM AUTHOR]

The purpose of this study was to investigate fracture patterns due to pediatric firearm injuries. The data used was from the US Firearm Injury Surveillance Study 1993–2019. Over these 27 years, there were 19,033 children with fractures due to firearm activity with an average age of 12.2 years; 85.2% were boys and the firearm was a powder type in 64.7%. The finger was the most common fracture location, while the tibia/fibula was the most common location for those admitted to the hospital. Children ≤ 5 years of age sustained more skull/face fractures; most spine fractures occurred in the 11–15-year age group. The injury was self-inflicted in 65.2% of the non-powder and 30.6% of the powder group. The injury intent was an assault in 50.0% of the powder and 3.7% of the non-powder firearm group. Powder firearms accounted for the majority of the fractures in the ≤5 and 11–15 year-olds, non-powder firearms accounted for the majority of the fractures in the 6–10 year-olds. Injuries occurring at home decreased with increasing age; there was an increase in hospital admissions over time. In conclusion, our findings support the need for safe storage of firearms in the home away from children. This data will be helpful to assess any changes in prevalence or demographics with future firearm legislation or other prevention programs. The increasing acuity of firearm-associated injuries seen in this study is detrimental to the child, impacts familial wellbeing, and results in significant financial costs to society. [ABSTRACT FROM AUTHOR]

Background: Although an intensive care unit (ICU) admission is a risk factor for missed injury, there has been some disagreement on whether missed injuries in trauma ICU patients have a longer length of stay (LOS). With this in mind, these patients' frequency of missed injuries and related factors were investigated. Materials and methods: This was a prospective cohort study on multiple trauma injury patients in a tertiary referral trauma center's trauma intensive care unit (TICU) from March 2020 to March 2021. A tertiary survey was conducted in the TICU by attending physicians to find the types I and II missed injuries (any injury discovered after primary and secondary surveys during the hospital stay). A logistic regression model was designed for predictors of missed injuries in ICU-admitted multiple trauma patients. Results: Out of 290 study participants, 1,430 injuries were found, and of those injuries, 74 cases (25.5%) had missed injuries. In other words, there were 103 missed injuries, resulting in a missed injury detection rate of 7.2%. The most frequently missed injuries (43.4%) were concluded as extremities fractures. The regression model showed that the patients with missed injuries are prone to longer TICU LOS [odds ratio (OR) = 1.15; p = 0.033], and cases who underwent a computed tomography (CT) scan are less likely to have missed injuries (OR = 0.04; p < 0.001). The abbreviated injury scale (AIS) range was 1--3 in missed injuries. Conclusion: Our research underlines the importance of finding missed injuries and the necessity of CT scan to decrease them. In teaching centers, life-threatening injuries decrease with increasing visits and examination times. Although these missed injuries do not increase mortality, they cause longer TICU LOS and costs. [ABSTRACT FROM AUTHOR]

Dedifferentiated liposarcoma occurs predominantly in the retroperitoneum. Given the paucity of cases, information on the clinical characteristics of this entity in the extremities and trunk wall is quite limited. In particular, the significance of preoperative evaluation and principles of intraoperative management of the different components, i.e., well-differentiated and dedifferentiated areas, are still to be defined. Clinical characteristics, treatment outcomes, and risk factors for poor oncological outcomes in cases of dedifferentiated liposarcoma in the extremity or trunk wall were analyzed by a retrospective, multicentric study. A total of 132 patients were included. The mean duration from the initial presentation to dedifferentiation was 101 months in dedifferentiation-type cases. The 5-year local recurrence-free survival, metastasis-free survival, and disease-specific survival rates were 71.6%, 75.7%, and 84.7%, respectively. Among 32 patients with metastasis, 15 presented with extrapulmonary metastasis. A percentage of dedifferentiated area over 87.5%, marginal/intralesional margin, and R1/2 resection in the dedifferentiated area were independent risk factors for local recurrence. Dedifferentiated areas over 36 cm2, French Federation of Cancer Centers Sarcoma Group grade III, and intralesional or marginal resection were independent risk factors for metastasis. A dedifferentiated area over 77 cm2 and lung metastasis were independent risk factors for disease-specific mortality. The typical clinical characteristics of dedifferentiated liposarcoma in the extremity and trunk wall were reconfirmed in the largest cohort ever. The evaluation of the dedifferentiated area in terms of grade, extension, and pathological margin, together with securing adequate surgical margins, was critical in the management of this entity. ● The mean time to dedifferentiation was 101 months in dedifferentiation type. ● The 5-year local recurrence and metastasis-free survival were 71.6% and 75.7%. ● The 5-year disease-specific survival rate was 84.7%. ● Among 32 patients with metastasis, 15 presented with extrapulmonary metastasis. ● Grade, extension, and margin in the dedifferentiated area are critical to outcomes. [ABSTRACT FROM AUTHOR]

Individualized survival prognostic models for symptomatic patients with appendicular metastatic bone disease are key to guiding clinical decision-making for the orthopedic surgeon. Several prognostic models have been developed in recent years; however, most orthopedic surgeons have not incorporated these models into routine practice. This is possibly due to uncertainty concerning their accuracy and the lack of comparison publications and recommendations. Our aim was to conduct a review and quality assessment of these models. A computerized literature search in MEDLINE, EMBASE and PubMed up to February 2022 was done, using keywords: “Bone metastasis”, “survival”, “extremity” and “prognosis”. We evaluated each model’s performance, assessing the estimated discriminative power and calibration accuracy for the analyzed patients. We included 11 studies out of the 1779 citations initially retrieved. The 11 studies included seven different models for estimating survival. Among externally validated survival prediction scores, PATHFx 3.0, 2013-SPRING and potentially Optimodel were found to be the best models in terms of performance. Currently, it is still a challenge to recommend any of the models as the standard for predicting survival for these patients. However, some models show better performance status and other quality characteristics. We recommend future, large, multicenter, prospective studies to compare between PATHfx 3.0, SPRING 2013 and OptiModel using the same external validation dataset.

Abstract Background Sarcomas are a heterogeneous group of rare malignant tumors of mesenchymal origin in the musculoskeletal system. The main treatment is surgery often supplemented with pre-or postoperative radiotherapy. A retrospective study by Bedi et al. indicated that negative pressure wound therapy (NPWT) reduced the risk of postoperative wound complications in patients treated with preoperative radiation followed by surgical tumor removal of lower extremity soft tissue sarcomas (STS), and the use of NPWT was not associated with an increased risk of local recurrence. Previous studies have shown that NPWT can reduce postoperative complications. STS surgeries are a high-risk procedure concerning wound complications. Methods Non-blinded single-center randomized controlled trial comparing NPWT versus conventional wound dressing and postoperative wound complications after surgical removal of deep-seated high-malignant STS of the extremities or trunk wall Sample-size calculation: 154 STS patients (80% risk of avoiding type II error, 5% risk of type I error, and an 80% wound complication risk) Block randomization of 8 into: Group A: Conventional wound dressing Group B: NPWT (PREVENA PLUS™ Incision Management System) Inclusion criteria: Surgery for a deep-seated STS of an extremity or the trunk wall Exclusion criteria: Age

Background: War conflicts and terror-related injuries constitute a significant public health problem in Somalia. We aim to characterize and compare the injury characteristics of gunshot and blast injuries of the extremities. Methods: The data of 333 patients with gunshot and blast injuries of the extremities over three years were retrospectively reviewed. The demographics, injury characteristics, and outcomes were analyzed. Results: Most of the patients had injuries due to gunshot casualties compared with blast victims (n = 222, 66.7% vs. n = 111, 33.3%). Patients with gunshot wounds (GSW) had a more significant proportion of males than those with blast wounds (BW) (95.5% vs. 85.6%, P < 0.001). There were more open extremity fractures in GSW casualties (96.4% vs. 81.1%). The BW victims had significantly higher associated injuries (52.3% vs. 18.5%, P < 0.001). The BW group had a higher injury severity score (ISS ≥ 16 in 55%, P < 0.001). The need for an intensive care unit (ICU) admission was significantly higher in the BW patients (18% vs. 6.3%, P < 0.001); as well as the length of hospital stay (LOS) was higher in the BW group compared with the GW patients (> 2-week hospital stay in 31% vs. 19%, P < 0.04). About a 2.7% mortality rate was observed in BW (P < 0.014). Conclusion: Gunshot and explosion injuries comprise the majority of war and terror-related trauma of the extremities. These injury mechanisms differ in the body regions involved, the severity of the injury, duration of hospital stay, need for ICU admission, and mortality. Assessment and management of such devastating casualties require a complex and multidisciplinary approach. [ABSTRACT FROM AUTHOR]

Background: Histological analysis is used to distinguish between benign and malignant tumors, allowing for the definitive diagnosis of soft tissue sarcoma (STS). Objective: To evaluate the clinicopathological characteristics of extremity soft tissue sarcoma. Subjects and Methods: The present cross-sectional study included a total sample of 18 participants with soft tissue sarcoma planned for surgery according to their tissue biopsy. Results: Regarding the characteristics of STS in the present results, the mean size was 20.1± 10.6 cm, ten patients (55.6%) had STS on the right side and 44.4% had STS on the left side. Only five patients (27.8%) had superficial STS and 13 (72.2%) had deep STS. Regarding the stages of STS, 2 (11.1%) were stage IA, 3 (16.7%) were stage IB, 4 (22.2%) were stage IIA, 6 (33.3%) were stage IIB, 1 (5.6%) was stage IIIA and 2 (11.1%) were stage IIIB. Regarding the histopathological diagnosis of STS, 2 (11.1%) had undifferentiated pleomorphic sarcoma, 3 (16.7%) had liposarcoma, 7 (38.9%) had rhabdomyosarcoma, 3 (16.7%) had myxofibrosarcoma, and 3 (16.7%) had leiomyosarcoma. The comparison between males and females regarding characteristics and histopathological types of STS showed that there was no statistically significant difference. Conclusion: Males are more likely to be diagnosed with soft tissue sarcoma, while middle-aged people are disproportionately afflicted. The lower extremities are the most prevalent site of involvement, and rhabdomyosarcoma is the most common histologic subtype. The clinicopathological features of soft tissue sarcoma are not influenced by gender distribution. [ABSTRACT FROM AUTHOR]

This study examines the question of asymmetry/symmetry regarding the use of language in partisan media outlets in the US. Some research has suggested that conservatives and conservative media are unique in how they present information to their audience, positing that conservatives use simpler, more uncivil language. Others have noted that some of these matters, such as use of uncivil language, applies to both conservative and liberal outlets. The current study adds to this literature by examining whether the ideological leanings of news sources correlate with reading ease, level of negativity (sentiment), and level of formality (tone). Specifically, we examine whether only conservative outlets use simpler, negative, and less formal language or if these trends appear for media outlets across the ideological spectrum. Our findings find support for the symmetry hypothesis. Indeed, our findings suggest that ideological extremity and partisanship strength correlate with use of easier-to-read language. [ABSTRACT FROM AUTHOR]

James Joyce's neologism "debths" (Finnegans Wake) that Susan Howe elects for the title of her 2017 volume of poetry points to at least three semantic coordinates of "obligation," "trespass," and "demise," never--due to its implied transaction between the sound and the spelling--fully yielding to or being appropriated by any stable signification. In Debths, the end of life, writing, and, perhaps, literature are palpable, if overtly manifested, currents of poetic discourse. In my article, I advance the idea of recognizing this tripartite taxonomy as a variant of what Divya Victor calls "extremity." Within this context, I demonstrate the emergence of a dialogic, intertextual, and appropriative subjectivity of the poet. [ABSTRACT FROM AUTHOR]

In developing countries delayed presentation following major vascular injury is common due to limited vascular trauma units; delay in diagnosis and time lost in transit which pose a major challenge for limb salvage. Aim of this study was to assess limb survival and complications after delayed revascularization of extremity following major vascular injury. 20 patients, (19 males and 1 female, mean age 31.55 years) with major extremity vascular injury who presented >8 h after vascular trauma were included in this study. All patients had road traffic accidents as the cause of extremity injury. These patients were operated by primary vascular repairs, thrombectomy and/or interposition vein graft along with fixation of concomitant skeletal trauma. The commonest vessel injured was popliteal artery. The mean time of limb revascularization was 30.8 h. Limb salvage rate was 95% and there was no perioperative mortality. 9 patients developed postoperative complications including sloughing of leg muscles (4), foot drop (3) pseudo aneurysm (1) and reperfusion injury (1). At 6 months follow-up all the patients were able to walk with full weight bearing and there was no chronic ischemia, pain or sinuses. Limb salvage can be achieved with good results in patients with delayed revascularization in selected cases. However; delayed revascularization leads to long and protracted postoperative course with high chances of vascular and neurological complications. [ABSTRACT FROM AUTHOR]

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The media fulfil various functions in society. For the audience and for society, the priority of these functions may be different. In terms of importance for society, their socialisation function is also important. Socialisation through the media assumes its dominance when there is a dysfunction of primary socialisation or at certain stages of human development. From a societal perspective, their influence as a potential shaper of society's culture in the context of secondary socialisation is relevant. At present, audio-visual production in particular is dominant. It is attractive to all generations, as it provides both information and entertainment in a way that is convenient for the audience. Television offers different types of programmes with higher or lower value and quality of media content. Reality shows have a relatively significant presence in the programming structure. This television format on the border of non-fiction and fiction brings in different values, formulas and elements. The authors of the study analyse the various positive and controversial elements of reality shows. They focus on trash reality shows, which are more prominently represented in the autumn programming structure. In their interpretation, they not only draw on current findings, but also use their years of experience and knowledge from research in this field. The emphasis is on the potential impact on the socialisation of sensitive audience groups as well as on the culture of society as a whole. [ABSTRACT FROM AUTHOR]

Background Extremity replantation as well as allotransplantation aim to restore form and function of the amputated limb. Both approaches, however, are clearly limited by the ischemic time. Ex vivo perfusion (EVP), already well-established in the field of solid organ transplantation, represents a promising tool to overcome this restriction. Methods We have currently established the technical requirements to provide EVP to severed limbs in a clinical hospital setting and hereby report of a 48-hour hypothermic EVP (EVP48) of an upper extremity amputated at the level of the proximal humerus, followed by a 2-hour simulated reperfusion (2SR) with donor blood. Results Muscle biopsies revealed histopathologically well preserved, vital muscle tissue after EVP24, and partially grouped muscle fiber necrosis with predominantly vital muscle tissue after EVP48 and 2SR. Analyses of perfusate samples showed a marked decline of biochemical muscle damage markers during EVP48. Cytokine analysis disclosed an isolated increase of the proinflammatory cytokines, interleukine-6, monocyte chemotactic protein-1, and interferon-γ, during EVP and 2SR. Magnetic resonance imaging, performed after EVP48, indicated partial muscle necrosis of the intrinsic hand muscles only, while no signs for infection or inflammation were present. Conclusion Our single case experience shows the general feasibility of an amputated limb ex vivo salvage perfusion setting to allow for delayed replantation up to 24 hours. Nevertheless, an accurate prior planning is crucial to ensure successful implementation of EVP in the acute clinical setting.

IntroductionSchwannomas are the most common neoplastic lesions of the peripheral nerves when growing on the extremities, they usually have adverse effects on patients due to the exposed and functional nature of the region.MethodsIn the present single-center retrospective study, we included all patients with pathologically confirmed schwannoma located in extremities between 2011 and 2021 totaling 183 patients. Data on gender, age, duration history, clinical presentation, occurrence region, nerve affiliation, imaging data, modus operation, mass volume, immunohistochemistry, postoperative neurological function, and recurrence were collected.ResultsAs in previous studies, patients were predominantly middle-aged with a mean age of 49.5, without gender preference and a male-to-female ratio of 1.2:1. Most patients are first seen for this disease, and only five of them are recurrent. The majority presented with an isolated (91.26%), asymptomatic (37.7%) mass, with tenderness (34.97%) being the second frequent complaint. 60% of lesions occurred in the upper extremity, more commonly on the left side (55.26%) than the right. The average duration of onset was 47.50 months. MRI is more sensitive for neurogenic tumors than ultrasound, as it owns 78.93% correct. In immunohistochemistry, the top three markers for positive labeling schwannoma are S-100 (98.95%), Ki67 (98.68%) and β-Catenin. 98.36% of patients underwent complete resection of the lesion, of which 14.44% required partial sacrifice of the nerve fibers. Thanks to the application of intraoperative peripheral nerve microscopic operation, only 6 patients showed symptoms of postoperative nerve injury, and 3 of them received second surgery. Intraoperative microscopic manipulation, preservation of the main nerve, and the need for reconstruction of the affected nerve fibers are some of the points worth noting.DiscussionIn summary, the possibility of schwannoma should not be overlooked in the identification of masses that occur in the upper extremities of the middle-aged population. Preoperative ultrasound and MR are useful for determining the nature of the mass, and S100, Ki67, and β-Catenin are sensitive to it. Surgical resection can achieve satisfying functional results and a low risk of nerve injury.

Objective: The aim of this study was to examine the long-term impact of physiologic surgical options, including VLNT and LVB, on patients with secondary lymphedema of the upper or lower extremity (UEL/LEL). Summary Background Data: VLNT and LVB have become increasingly popular in the treatment of lymphedema. However, there is a paucity of long-term data on patient outcomes after use of these techniques to treat lymphedema. Methods: An analysis of prospectively collected data on all patients who underwent physiologic surgical treatment of secondary lymphedema over a 5.5-year period was performed. Patient demographics, surgical details, subjective reported improvements, LLIS scores, and postoperative limb volume calculations were analyzed. Results: Two hundred seventy-four patients with secondary lymphedema (197 upper, 77 lower) were included in the study. More than 87% of UEL patients and 60% of LEL patients had reduction in excess limb volume postoperatively. At 3 months postoperatively, patients with UEL had a 31.1% reduction in volume difference between limbs, 33.9% at 6 months, 25.7% at 12 months, 47.4% at 24 months and 47.7% at 4 years. The reduction in limb volume difference followed a similar pattern but was overall lower for LEL patients. Greater than 86% of UEL and 75% of LEL patients also had improvement in LLIS scores postoperatively. Fifty-nine complications occurred (12.9%); flap survival was >99%. Conclusions: Patients with secondary UEL/LEL who undergo VLNT/LVB demonstrate improved functional status and reduced affected limb volumes postoperatively. Patients with UEL seem to have a more substantial reduction in limb volume differential compared to LEL patients. [ABSTRACT FROM AUTHOR]

Objective: The aim of the present study was to report a novel nomenclature system for extended latissimus dorsi musculocutaneous (LD) flaps. To evaluate the clinical application and surgical efficacy of the different extended LD flaps for large wounds in the extremities. Methods: From January 2004 to December 2018, 72 consecutive patients who received extended LD flaps were retrospectively analyzed. Patients' ages ranged from 2 to 68 years with 37 males and 35 females. All wounds were extensive in either the upper or lower limbs, while the skin defect area ranged from 18 cm × 10 cm to 37 cm × 21 cm. Forty‐one wounds were located in the calf, 18 in the foot and ankle, six in the shoulder and upper arm, four in the thigh, and three at the knee joint. Twenty‐eight patients had fractures, and six of these patients with segmental bone defects (ranging in size from 3 to 7 cm) required secondary orthopaedic procedures. Single‐ and double‐wing extended LD flaps were designed and harvested according to the shape of the wounds. Results: The flaps received consisted of 64 single‐wing and eight double‐wing extended LD flaps, and the mean flap harvest time was 56.2 min. The donor sites were closed primarily for all patients. Additional subcutaneous veins were anastomosed to the recipient's vessels in 14 patients. The venous crisis was noticed on the first postoperative day in four cases. Two flaps were salvaged after emergency re‐exploration, and another two patients' flaps were necrosed. In these two patients, lower limb amputation and extended LD flap on the other side were used, respectively, for the final treatment. The wounds healed well, providing reliable soft tissue coverage and good contour in the reconstructed areas. Six patients had segmental bone defects that required secondary orthopaedic procedures, two patients were repaired with vascularized iliac crest bone grafts, and another four patients were reconstructed by the Ilizarov technique. All the patients' bone defects achieved union and most patients achieved good functional recovery at the recipient site. The mean follow‐up was 15.7 months (range, 10–56 months). No significant donor site morbidities limiting patients' daily activities occurred during the follow‐up. Eight patients developed a donor site hypertrophic scar, three patients on the back, and five on the anterolateral thigh. Conclusion: Single‐ and double‐wing extended LD flaps are simple and reliable methods for large skin and soft tissue defects in the extremity, with good functional and aesthetic results. [ABSTRACT FROM AUTHOR]

Background: A crush injury to the upper extremity with a MESS (Mangled Extremity Severity Score) more than or equal to 10 carries a poor salvage prognosis and functional outcome. Usually performing multiple staged surgeries in these patients make the follow up and rehabilitation regimen long and complicated. This means either the patient doesent return or fails to gain any function. In order to overcome this problem we have done a single stage functional reconstruction in a mangled upper extremity. Case: A young female presented with a crush injuiry of the upper limb where a functional reconstruction with an LD (Latissimus Dorsi) flap was done 48 hrs after limb salvage surgery. The flap provided cover to the shoulder and elbow joint and also acted as a motor for elbow flexion. Result: After 6 months following surgery, the patient had regained active motion in her elbow and shoulder joint, and at 1 year she was able to carry out activities of daily living without any external help. Conclusion: Our case demonstrates that the mangled upper extremity can have varied presentations but the surgeon should use every knowledge and technique at their disposal to achieve the maximum chance of autologous functional reconstruction. [ABSTRACT FROM AUTHOR]

BACKGROUND: Osteoarthritis (OA) is one of the most prevalent and disabling musculoskeletal diseases worldwide. There is preliminary evidence from experimental studies and consensus documents that chiropractic management may alleviate spine and/or extremity OA related pain in the short term. OBJECTIVE: This research explores the potential relationship of a pragmatic course of care, including soft tissue therapy, spinal manipulation, and other treatments commonly delivered by chiropractors, to spine and extremity pain in patients with OA. METHODS: A retrospective analysis of prospectively collected data from the chiropractic program at a publicly funded healthcare facility was conducted. The primary outcome measures for patients diagnosed with spine and/or extremity OA (n = 76) were numeric pain scores of each spinal and extremity region at baseline and discharge, and a change score was determined. RESULTS: Statistically significant improvements that exceed a clinically meaningful difference in pain numeric rating scale scores were demonstrated by point change reductions from baseline to discharge visits. Change scores exceeding a minimally clinically important difference of "2-points" were present in the sacroiliac (- 2.91), extremity (- 2.84), cervical (- 2.73), thoracic (- 2.61), and lumbar (- 2.59) regions. CONCLUSION: Patients diagnosed with OA in a socioeconomically disadvantaged community demonstrated reductions in mean pain scores in both a clinically meaningful and statistically significant manner concurrent with a course of chiropractic care. [ABSTRACT FROM AUTHOR]

Background: Acral location of melanomas is associated with poor survival. It can be due, at least in part, to the fact that acral lentiginous melanoma, a distinct melanoma subtype, has a particular biological profile and a bad clinical behavior. However, since almost 50% of acral melanomas are not of acral lentiginous melanoma subtype, the worse clinical behavior could also be attributable to the intrinsic characteristics of the location. Objective: This study aimed to investigate if melanomas of the lower limb excluding acral lentiginous melanoma differ by location. Methods: This retrospective, observational study recruited patients from an oncology referral center in Spain. We included 285 patients with superficial spreading and nodular melanomas of the lower limb. We compare melanomas by site, clinical and pathological characteristics, and the differences by location of disease-free and melanoma-specific survival by the Kaplan-Meier method and Cox proportional hazard method. Results: Patients with melanomas on the foot, compared to those on the rest of the limb, were older and reported having suffered less sunburns; the melanoma more frequently appeared in areas that had been rarely sun exposed, were more frequently of nodular type, presented thicker tumors, with more ulceration, less regression, and more advanced stage of the disease. Foot location increased the risk of relapse and decreased melanoma-specific survival. Conclusion: Melanoma development in foot is less related to sun exposure and is associated with pathological features that can account for the worse prognosis and poorer survival. [ABSTRACT FROM AUTHOR]

Abstract 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.

BackgroundThe Mangled Extremity Severity Score (MESS) was developed 25 years ago in an attempt to use the extent of skeletal and soft tissue injury, limb ischemia, shock, and age to predict the need for amputation after extremity injury. Subsequently, there have been mixed reviews as to the use of this score. We hypothesized that the MESS, when applied to a data set collected prospectively in modern times, would not correlate with the need for amputation.MethodsWe applied the MESS to patient data collected in the American Association for the Surgery of Trauma PROspective Vascular Injury Treatment registry. This registry contains prospectively collected demographic, diagnostic, treatment, and outcome data.ResultsBetween 2013 and 2015, 230 patients with lower extremity arterial injuries were entered into the PROspective Vascular Injury Treatment registry. Most were male with a mean age of 34 years (range, 4-92 years) and a blunt mechanism of injury at a rate of 47.4%. A MESS of 8 or greater was associated with a longer stay in the hospital (median, 22.5 (15, 29) vs 12 (6, 21); p = 0.006) and intensive care unit (median, 6 (2, 13) vs 3 (1, 6); p = 0.03). Of the patients' limbs, 81.3% were ultimately salvaged (median MESS, 4 (3, 5)), and 18.7% required primary or secondary amputation (median MESS, 6 (4, 8); p < 0.001). However, after controlling for confounding variables including mechanism of injury, degree of arterial injury, injury severity score, arterial location, and concomitant injuries, the MESS between salvaged and amputated limbs was no longer significantly different. Importantly, a MESS of 8 predicted in-hospital amputation in only 43.2% of patients.ConclusionTherapeutic advances in the treatment of vascular, orthopedic, neurologic, and soft tissue injuries have reduced the diagnostic accuracy of the MESS in predicting the need for amputation. There remains a significant need to examine additional predictors of amputation following severe extremity injury.Level of evidenceProspective, prognostic study, level III.

Neurofibromatosis type 1 (NF-1aa Neurofibromatosis type 1) is an autosomal dominant mutation on chromosome 17q11.2 which causes downregulation of the ras tumor suppressor oncogene as well as alteration in the production of the protein neurofibromin. These genetic changes commonly lead to unique phenotypes of neurofibromas, Lisch nodules, axillary freckling, and café au lait spots. Uncommonly seen in this condition are vascular anomalies leading to spontaneous hemorrhages. We present the case of a spontaneous thigh hematoma in a patient with NF-1. Since intra-operative findings did not reveal any obvious arterio-venous malformations, it was determined that the patient likely had arterial dysplasia with resultant rupture secondary to nearby invasion of a neurofibroma.

Puncture wounds with retained foreign bodies in the extremities constitute an important part of orthopedic emergency admissions. In this study, we aimed to retrospectively examine the epidemiological data of patients, as well as diagnostic and treatment methods applied and complications that occurred in patients who underwent surgery with the diagnosis of puncture wounds with retained foreign bodies in our clinic. In the present study, 95(44 female - 51 male) patients who underwent surgical intervention with the diagnosis of puncture wound with retained foreign body in our clinic were examined retrospectively. Of the patients, 44.21% were in the pediatric age group (0-17 years), and 55.79% were in the adult age group (18 years and above). The most common foreign body causing puncture wound was needle in 49 patients (51.58%). The most commonly affected anatomical area was the foot area, at a rate of 48.42%. In our patient group, 91.58% could be diagnosed by direct radiography. Ultrasound was required in 8.42% of the patients. Among anesthetic methods, local anesthesia was the most commonly used method (49.47%). Fluoroscopy was sufficient as the imaging method during the surgical procedure in 87.37% of the patients. Puncture wounds with retained foreign bodies requiring surgical intervention in the extremities affect the pediatric population as well as the adult population. The first imaging method to be applied is direct radiography, and if it is insufficient, ultrasound can be used. Although they are usually simple injuries, they may rarely cause complications such as infection, tendon injury, and vascular-nerve injury. [Med-Science 2021; 10(2.000): 416-21]