Management of an Entrapped Patient with a Field Amputation

Background

Emergency surgical amputations are rare and resource-intensive lifesaving interventions. Most emergency medical services (EMS) lack a formal protocol to manage these high-risk but low-occurrence events. There has been limited attention in the EMS community to address this issue. Without a literature-based approach, the EMS community has been offered little guidance on managing surgical field amputations.

瑞替普酶治疗下肢深静脉血栓形成的临床观察

目的：探讨下肢深静脉血栓（DVT）的有效治疗方法。方法对该院60例下肢DVT患者进行回顾性分析,32例予瑞替普酶溶栓治疗（瑞替普酶溶栓组）,与随机选取同期予重组链激酶溶栓治疗28例（重组链激酶溶栓组）作对比。治疗期间观察患肢变化和有无不良反应,对疗效进行评价。结果两组患者临床全部达到有效,愈显率相比瑞替普酶溶栓组高于重组链激溶栓组,差异有统计学意义（P＜0．05）。不良反应比较,瑞替普酶溶栓组低于重组链激溶栓组,但两组差异无统计学意义（P＞0．05）。随访期间两组均未见复发病例。结论瑞替普酶治疗下肢深静脉血栓形成是有效的、安全的。     

毁损肢体严重程度评分与保肢指数在儿童截肢应用中的回顾分析

目的：回顾分析该院76例创伤截肢与保肢的病例,为儿童临床截肢手术适应证提供参考。方法回顾总结分析该院1996年7月至2013年5月收治的38例外伤性截肢患儿（试验组）,同期38例严重创伤而未截肢的患儿38例（对照组）,采用毁损肢体严重程度（MESS）以及保肢指数（LSI）评分重新评估,统计分析两种评分系统与截肢术的吻合度。结果 MESS与 LSI两种评分系统均对儿童截肢术有很高的区分度。结论 M ESS与LSI均可作为儿童截肢参考系统,但LSI评分系统较M ESS更适用于儿童。     

Manual aspiration thrombectomy for acute and subacute inferior vena cava thrombosis and lower extremity deep venous thrombosis

Deep vein thrombosis (DVT), which can lead to pulmonary embolism (PE), is a major contributor to the global disease burden and is the third most common cardiovascular pathology after coronary artery disease and stroke. Venous thromboembolic disease, which encompasses the disease entities of DVT and PE, affects up to 10 million cases every year and represents a serious and potentially life-threatening condition. Standard anticoagulation therapy alone is ineffective at promoting deep venous system thrombus removal. Many patients develop postthrombotic syndrome (PTS) despite being on adequate anticoagulation therapy. Aggressive therapy for rapid thrombus removal is important to prevent the development of PTS. Besides impeding the onset of PTS, rapid clearance of the thrombus is also required in the treatment of phlegmasia cerulea dolens, an uncommon but life-threatening complication of acute DVT that can lead to arterial insufficiency, compartment syndrome, venous gangrene, and limb amputation. Manual aspiration thrombectomy (MAT) can provide rapid and effective therapy that could be compared to the open surgical thrombectomy approach with minimal risk of morbidity, mortality, or recurrence after surgery. Though many devices have been developed to date for pharmacomechanical thrombolysis, the cost of the treatment using these devices is very expensive. MAT is simple to perform, easy to learn, inexpensive, and rapid. This review will outline and dissect several studies and case reports, sourced from the PubMed database, on the subject of the use of MAT in treating inferior vena cava thrombosis and lower extremity DVT, including in patients with compression of the iliac vein and phlegmasia cerulea dolens.     

Upper extremity movement reliability and validity of the Kinect version 2

Purpose: Studies have shown that marker-less motion detection systems, such as the first generation Kinect (Kinect 1), have good reliability and potential for clinical application. Studies of the second generation Kinect (Kinect 2) have shown a large range of accuracy relative to balance and joint localization; however, few studies have investigated the validity and reliability of the Kinect 2 for upper extremity motion. This investigation compared reliability and validity among the Kinect 1, Kinect 2 and a video motion capture (VMC) system for upper extremity movements.

Design: One healthy, adult male performed six upper extremity movements during two separate sessions. All movements were recorded on the Kinect 1, Kinect 2 and VMC simultaneously. Data were analyzed using MATLAB (Natick, MA), Microsoft Excel (Redmond, WA), and SPSS (Armonk, NY).

Results: Results indicated good reliability for both Kinects within a day; results between days were inconclusive for both devices due to the inability to exactly repeat the desired movements. Range of motion (ROM) magnitudes for both Kinects were different from the VMC, yet patterns of motion were very highly correlated for both devices.

Conclusion: Simple transformations of Kinect data could bring magnitudes in line with those of the VMC, allowing the Kinects to be used in a clinical setting.

• Implications for Rehabilitation

• The clinical implications of the investigation support the notion that the Kinects could be used in the clinical setting if an understanding of their limitations exists.

• Using the Kinects to make assessments with a given data collection session is acceptable. Using the Kinects to make comparisons across different days such as before or after an intervention should be approached with caution.

• The Kinect 2 provides a more cost effective option compared to the VMC. Additionally, the Kinect is more portable, requires less time to set-up, and takes up less space, thus increasing its overall usability compared to the VMC.

     

童年中期双生子下肢长相关指标的遗传学分析

目的分析遗传与环境因素对童年中期双生子儿童下肢长相关指标的影响,并分析其中年龄和性别的作用。方法对呼和浩特市和包头市5~8岁171对双生子儿童下肢长相关指标进行测量,使用Mx软件拟合最佳模型,计算校正年龄前后各指标遗传与环境方差组分。结果各指标最佳拟合模型均为ACES,校正年龄后遗传度分别为:身高:男43%,女60%);坐高:男62%,女62%;下肢长:男50%,女62%;下肢长指数:男18%,女36%。身高、下肢长和下肢长指数的遗传度存在一定性别差异。结论童年中期下肢长相关指标发育受环境因素的影响较大,应通过加强营养与锻炼及控制相关疾病等改善下肢长度发育,促使儿童生长发育潜力得到更好的发挥。     

An ergonomics study on the evaluation of carpal tunnel syndrome among Chikan embroidery workers of West Bengal,India

Background:

Chikan embroidery is a popular handicraft in India that involves hand-intensive stitching while seated in a static posture with the upper back curved and the head bent over the fabric. Women perform most Chikan embroidery.

Objectives:

The aim of this study was to analyze the repetitive nature of this work among female Chikan embroiderers by measuring the prevalence of upper extremity discomfort and carpal tunnel syndrome (CTS).

Methods:

The Nordic musculoskeletal questionnaire was used to analyze the extent of upper extremity pain symptomology. The repetitive nature of Chikan embroidery work was evaluated using the Assessment of Repetitive Tasks of the upper limbs tool (ART). Motor nerve conduction studies of median and ulnar nerves were performed with embroidery workers and a control group to determine the risk of CTS.

Results:

Among embroidery workers, the prevalence of wrist pain was 68% and forearm pain was 60%. The embroiderers also commonly reported Tingling and numbness in the hands and fingertips. The ART analysis found that Chikan embroidery is a highly repetitive task and nerve conduction studies showed that the embroidery workers were more likely to experience CTS than women in the control group.

Conclusions:

Chikan embroidery is a hand-intensive occupation involving repetitive use of hands and wrists and this study population is at risk of experiencing CTS. Future research should explore the potential benefits of ergonomics measures including incorporating breaks, stretching exercises, and the use of wrist splints to reduce repetitive strain and the probability of developing CTS.     

游离皮瓣修复下肢缺损时受区血管的选择

目的探讨游离皮瓣修复下肢缺损时受区血管的选择。方法采用游离皮瓣移植修复下肢缺损共29例,其中膝部创面3例,小腿10例,足、踝部15例,膝下至足背严重撕脱1例;背阔肌瓣移植16例,股前外侧瓣8例,肩胛皮瓣4例,腹直肌瓣1例。用作受区的血管有旋股外侧血管(2例)、膝降血管(1例)、胫前血管(11例)、胫后血管(10例)、腓血管(2例)、足背血管(1例)和腓肠肌内、外侧血管(各1例)。结果术后3例发生血管危象,行血管探查后,2例解除危象、移植组织成活,1例失败。23例患者平均随访13(6~24)个月,下肢均恢复行走功能,除3例皮瓣外形臃肿影响穿鞋而二期行皮瓣修薄术外,其余皮瓣外形基本满意。结论下肢受区血管选择对皮瓣游离移植成功修复相当重要,必要时伤肢腓肠肌内、外侧血管或旋股外侧血管、膝降血管可作受区吻合血管。     

中西医结合治疗下肢静脉炎的分析

目的：观察与分析中西医结合治疗下肢静脉炎的效果。方法：选取符合条件的60例下肢静脉炎患者且将其分为两组,即中西医结合治疗组和单纯西医治疗组,同时给予两组患者相应治疗措施且对其进行观察与相关数据统计和分析。结果：中西医结合治疗组临床疗效明显优于单纯西医治疗组,且中西医结合治疗组患者生活质量也好于单纯西医治疗组患者（^P〈O．05）。结论：中西医结合治疗下肢静脉炎效果确切。     

通络消肿方治疗乳腺癌术后上肢淋巴水肿的临床研究

目的:观察通络消肿方对乳腺癌术后上肢淋巴水肿患者的临床疗效。方法:将126例乳腺癌术后上肢淋巴水肿患者分为两组,治疗组(通络消肿方组)63例和对照组(安体舒通组)63例,测量并记录治疗前后患肢臂围,对两组患者的临床效果观察对比。结果:治疗组总有效率82.5%,对照组总有效率55.6%,治疗组较对照组有显著差异(P<0.05)。结论:通络消肿方对乳腺癌术后上肢淋巴水肿有较好临床疗效。