Relationship between EMG-detected and ultrasound-detected fasciculations in amyotrophic lateral sclerosis: A prospective cohort study

ObjectivesFasciculation potentials (FP) are an important consideration in the electrophysiological diagnosis of ALS. Muscle ultrasonography (MUS) has a higher sensitivity in detecting fasciculations than electromyography (EMG), while in some cases, it is unable to detect EMG-detected fasciculations. We aimed to investigate the differences of FP between the muscles with and without MUS-detected fasciculations (MUS-fas).MethodsThirty-one consecutive patients with sporadic ALS were prospectively recruited and in those, both needle EMG and MUS were performed. Analyses of the amplitude, duration, and number of phases of EMG-detected FPs were performed for seven muscles per patient, and results were compared between the muscles with and without MUS-fas in the total cohort.ResultsThe mean amplitude and phase number of FP were significantly lower in patients with EMG-detected FP alone (0.39 ± 0.25 mV and 3.21 ± 0.88, respectively) than in those with both FP and MUS-fas (1.22 ± 0.92 mV and 3.74 ± 1.39, respectively; p < 0.0001 and p = 0.017, Welch’s t-test).ConclusionSmall FP may be undetectable with MUS. MUS cannot replace EMG in the diagnostic approach for ALS.SignificanceClinicians should use a combination of EMG and MUS for the detection and quantitative analysis of fasciculation in ALS.     

Epidemiology of isolated adult lower limb burns over 15 years with a focus on preventable work-related injuries

Our aim was to describe the epidemiology of isolated adult lower limb burns presenting to the Pinderfields Regional Burns Centre, Wakefield, United Kingdom between 2003 and 2018. Data was obtained using our local records of the international Burn Injury Database (iBID).6059 patients were treated in our department during this period. 18.7% presented with isolated lower limb burns (n = 1133). 65.4% of patients were male (n = 741). Scald was the most common mechanism of injury. Work-related burns accounted for 23.4% of the injuries (n = 265).36% of patients were admitted (n = 408), and 11.7% underwent surgical intervention (n = 133).Isolated lower limb burns are common in patients in the working age group. Work-related injuries are preventable. Targeted education to highlight the risks, reduce the incidence, and improve awareness of first aid measures are recommended.     

Effects of dynamic lycra orthosis as an adjunct to rehabilitation after botulinum toxin-A injection of the upper-limb in adults following stroke: A single-blinded randomized controlled pilot study

ABSTRACT

Background

Dynamic lycra splints are proposed to modify hypertonicity due to their characteristics – neutral warmth, circumferential pressure, and creating a low-intensity prolonged stretch on hypertonic muscles – to contribute to increased sensory awareness of the involved limb.     

良肢体摆放与肢体功能运动对脑卒中偏瘫患者肢体并发症的影响

目的研究良肢体摆放与肢体功能运动对脑卒中偏瘫患者肢体并发症的影响。方法选取2018年8月-2020年10月我院接收的脑卒中偏瘫患者66例,随机分为对照组和观察组,各33例。对照组按常规护理。观察组早期进行良肢体摆放与肢体功能运动。比较两组Fugl-Meyer运动功能评分、并发症情况。结果观察组并发症总发生率为12.12%,低于对照组的39.39%(P<0.05)。两组护理前Fugl-Meyer运动功能评分比较差异无统计学意义(P>0.05);观察组护理半个月、1个月、3个月、6个月Fugl-Meyer运动功能评分高于对照组(P<0.05)。结论在脑卒中偏瘫患者护理中施予良肢体摆放与肢体功能运动,能够明显改善患者Fugl-Meyer运动功能,并减少各类并发症的发生。     

The keystone flap and its simplified version for malignant skin tumor defects of the lower limbs: A review of 25 cases

BackgroundSkin tumors commonly occur on the legs and are treated in first line by surgery. Several techniques are available to repair lower limb defects: secondary-intention healing, partial closure, primary closure with or without an s-plasty, or a skin graft. The lack of tissue laxity of the surrounding skin does not allow several local flaps (advancement, rotation, or transposition). Closing large skin defects at this site may be challenging.Patients and methodsWe retrospectively reviewed a series of consecutive patients undergoing malignant tumor wide excision on lower limbs, with a keystone flap or its simplified technique (releasing incision) for closure of a skin defect.ResultsTwenty-five patients, 17 women and 8 men, ranging from 19 to 95 years old (mean age: 70 years) were included. Keystone flap reconstruction on the lower limbs was performed in 19 cases and the simplified technique in 6. The excised tumors were as follows: squamous cell carcinoma (n = 6), basal cell carcinoma (n = 9), melanoma (n = 9) and Bowen's disease (n = 1). Three local complications were observed. No cases of recurrence were observed.ConclusionKeystone flap is a reliable surgical method for reconstruction of lower limb skin defects. Aesthetic results are better than when a skin graft is used, complications are uncommon, and prolonged operative time is avoided.     

四肢骨肉瘤保肢治疗与预后影响因素分析

目的探究四肢骨肉瘤保肢治疗与预后的危险因素。方法 89例四肢骨肉瘤患者行保肢治疗后随访3年,依据3年预后结局分为生存组(71例)与死亡组(18例),比较两组患者临床特征,分析死亡的相关因素,将相关因素代入Cox比例风险模型分析危险因素。结果生存组及死亡组四肢骨肉瘤患者Enneking分期及是否术后肺转移、治疗后病理性骨折、术前乳酸脱氢酶升高、完成化疗情况比较,差异均有统计学意义(P﹤0.05)。术后出现肺转移、未完成化疗及Enneking分期为Ⅱ期或Ⅲ期为四肢骨肉瘤保肢治疗后3年内死亡的危险因素(P﹤0.05)。结论尽早确诊、尽早治疗、积极预防病理性骨折、完成规范化疗及预防肺转移的发生能够辅助提高四肢骨肉瘤患者保肢治疗后的生存率。