Superior Limb Research Articles

Results from a comparative study to evaluate the treatment effectiveness of a nonpneumatic compression device vs an advanced pneumatic compression device for lower extremity lymphedema swelling (TEAYS study)

ObjectiveAdvanced pneumatic compression devices (APCDs) have been shown to be effective in treatment of lower extremity lymphedema in the home setting. However, adherence to self-care has been poor, and APCDs require patients to remain immobile during treatment. We evaluated the safety and efficacy of a novel nonpneumatic compression device (NPCD) for treating lower extremity lymphedema vs an APCD. MethodsA randomized, crossover head-to-head study was performed at nine sites in 2023. Patients were randomized to either the NPCD or a commercially available APCD. Patients used the randomly assigned initial device for 90 days with a 4-week washout period before a comparable 90-day use of the second device. ResultsA total of 71 patients (108 affected limbs) with lower extremity lymphedema were analyzed. Compared with the APCD, the NPCD was associated with a greater mean decrease in limb edema volume (a mean limb volume decrease of 369.9 ± 68.19 mL [P < .05] vs 83.1 ± 67.99 mL [P < .05]). Significant improvement in Quality of Life was achieved for NPCD and but not for APCD treatment (score improvement of 1.01 ± 0.23 [P < .05] for NPCD vs 0.17 ± 0.18 [P > .05] for APCD). Patients reported greater adherence (81% vs 56%; P < .001) and satisfaction with the NPCD (78% vs 22%) compared with APCD. No device-related adverse events were reported. ConclusionsThe novel NPCD is an effective treatment for decreasing limb volume in patients with lower extremity lymphedema. The NPCD was more effective than an APCD and resulted in superior limb volume decrease, greater improved quality of life, adherence, mobility, and patient satisfaction.

Lipodystrophy in HIV/AIDS: a comparison between physically active, and inactive HIV-infected vs. uninfected men.

Exercise training may reduce whole-body fat mass and percentage. However, whether exercise improves fat distribution assessed by fat mass ratio (FMR) and regional fat percentage in men living with HIV (MLHIV) is still unclear. The aim of this study was to compare the FMR and total and regional body fat between physically active and inactive MLHIV and HIV-uninfected men. Using a cross‑sectional design, total and regional body fat assessed by dual x-ray absorptiometry (DXA) were compared between 19 MLHIV (ACT-MLHIV, 52±7 y, 23.8±4.1 kg.m-2) enrolled in a multimodal training program (aerobic, strength and flexibility exercises) for at least 12 months (60‑min sessions; 3 times/wk with moderate intensity) vs. 19 inactive MLHIV (IN-MLHIV, 51±7 y, 25.9±3.3 kg.m-2) and 19 HIV-uninfected men (HIV-, 51±8 y, 26.0±3.3 kg.m-2). FMR was calculated as the ratio between the percentage of fat in the trunk and the lower limbs. The ACT-MLHIV showed a lower trunk fat percentage (24.1±17.9% vs. 34.4±11.9%; P=0.02) and FMR (1.5±0.6 vs.1.9±0.5; P=0.02) than the IN-MLHIV, with no difference between them in lower limbs fat percentage (IN-MLHIV: 16.3±5.9 vs. ACT-MLHIV: 15.9±9.6%; P=0.98). HIV- showed a lower FMR (1.2±0.2; P<0.02) and superior lower limb fat percentage (24.1±8.0%; P<0.0001) than IN-MLHIV and ACT-MLHIV, as well as a higher total fat percentage than ACT-MLHIV (27.3±6.2 vs. 21.8±6.9%; P=0.02). Physical exercise seems to attenuate HIV-associated lipodystrophy by reducing trunk fat percentage while preserving lower limb fat mass. FMR and total fat percentage should not be used alone as markers of exercise-induced changes in lipodystrophy.

Absense of superior limbs in a fetus of a mother exposed to Topiramate

El topiramato es un agente farmacológico antiepiléptico de nueva generación, empleado para el tratamiento de crisis parciales y tónico-clónicas primarias en adultos y niños, en monoterapia o en combinación con otros fármacos, y como profilaxis de la migraña en adultos, así como para el alcoholismo, la obesidad, y el trastorno bipolar entre otros. En los últimos años, han sido publicados numerosos casos de malformaciones congénitas y retraso de crecimiento intrauterino en neonatos de madres expuestas a este fármaco durante la gestación. Se presenta el caso de un feto con agenesia de ambos miembros superiores en una madre expuesta a topiramato durante el primer trimestre, sin otros factores asociados ni otro posible agente causal detectado.

Engineering M2-type macrophages with a metal polyphenol network for peripheral artery disease treatment

Functional cell treatment for critical limb ischemia is limited by cell viability loss and dysfunction resulting from a harmful ischemic microenvironment. Metal-polyphenol networks have emerged as novel cell delivery vehicles for protecting cells from the detrimental ischemic microenvironment and prolonging the survival rate of cells in the ischemic microenvironment. M2 macrophages are closely related to tissue repair, and they secrete anti-inflammatory factors that contribute to lesion repair. However, these cells are easily metabolized in the body with low efficiency. Herein, M2 macrophages were decorated with a metal‒polyphenol network that contains copper ions and epigallocatechin gallate (Cu-EGCG@M2) to increase cell survival and therapeutic potential. Cu-EGCG@M2 synergistically promoted angiogenesis through the inherent angiogenesis effect of M2 macrophages and copper ions. We found that Cu-EGCG@M2 increased in vitro viability and strengthened the in vivo therapeutic effect on the ischemic hindlimbs of mice, which promoted the recovery of blood and muscle regeneration, resulting in superior limb salvage. These therapeutic effects were ascribed to the increased survival rate and therapeutic period of M2 macrophages, as well as the ameliorated microenvironment at the ischemic site. Additionally, Cu-EGCG exhibited antioxidant, anti-inflammatory, and proangiogenic effects. Our findings provide a feasible option for cell-based treatment of CLI.

Reconstruction of oncologic upper extremity defects with fibula free flaps has high union rates and excellent functional outcomes.

Limb salvage has better functional outcomes than amputation in the upper extremity. This can however be challenging after bony tumor resections. This is a retrospective case series of patients who underwent humerus, ulna, or radius reconstruction with a fibula free flap. Data were collected on demographics, oncologic history, surgical details, and complications. Functional outcome measures included the patient's ability to perform activities of daily living (ADL), presence of pain, and musculoskeletal tumor society (MSTS) score. Over a 25-year period, 38 reconstructions were performed. The flap success rate was 97.5%. Bony union was obtained in 19 of 19 (100%) forearm reconstructions and in 15 of 19 (79%) humerus reconstructions (p = 0.10). All 19 forearm reconstruction patients and 18/19 humerus reconstruction patients were able to perform ADLs with no pain or only occasional pain. The MSTS scores were not significantly different between the humerus and forearm cohorts (27.1 vs. 27.3, p = 0.68). Functional outcomes were significantly better in limbs that achieved union (p < 0.001). Recipient and donor site complications occurred in 10 (26.3%) and 5 (13%) patients, respectively. Oncologic upper-extremity reconstruction with fibula free flaps has excellent functional outcomes. Bone union is a predictor of superior limb function.

Electromyographic signals analysis to assess the response of a proprioceptive neuromuscular facilitation pattern execution.

Proprioceptive Neuromuscular Facilitation is a rehabilitation technique that consists of the stimulation of a healthy muscle in one extremity of the body to produce an activation effect of a damaged muscle in another extremity, laterally or contralaterally. The use of the analysis of the electromyographic response during the process allows us to describe and evaluate if the damaged muscle produces an activation. This paper presents the progress of the results of a clinical protocol where PNF is explored in healthy subjects, manipulating the upper limb, and recording the electromyographic response of the lower limbs in three different muscles in both inferior limbs. Four activation patterns (movement sequence) with three different stages with different intensities of resistance are considered. Lateral plane video recording analysis is performed to extract the trajectory of the manipulated limb and correlate this information with electromyography signals. The electromyography signals are analyzed in their temporal response by integrating the rectified and smoothed signal according to the beginning and end of the trajectory of the manipulated superior limb. Additionally, the spectrogram analysis of the signals is performed. The partial results of the protocol allow us to establish that the response in the most distal muscles to the manipulated upper limb has been non-significant for the subjects, compared to the response of the proximal muscles, where a relationship with activation and trajectory of the arm is observed. particularly in the process with greater resistance. The observed changes in signal frequency across the spectrogram correspond to low-frequency changes in the 15 to 20Hz band.Clinical Relevance- This work presents a strategy to assess the rehabilitation process based on proprioceptive neuromuscular facilitation by analyzing the time and time-frequency response of the electromyographic signal.

Buerger's Disease - A Clinical Case.

Buerger's disease is a distal segmental nonatherosclerotic vasculopathy that involves the inferior and superior limbs of smoker males younger than 45 years old. This article aims to describe a clinical case and revise the literature about Buerger's disease. A 45-year-old smoker male repeatedly visited the emergency department for refractory pain and inflammatory signs in the right hallux. After developing ulcers in the right foot, Doppler ultrasonography revealed segmental occlusion of distal arteries of that limb. It was also observed in arteriography "corkscrew" collaterals. Autoimmune, thrombophilic and cardiovascular diseases were excluded. Analgesia, antibiotics and alprostadil were implemented. As a result, the patient stopped smoking and was submitted to minor amputation with complete healing, after which he remained asymptomatic. Buerger's disease is a diagnosis of exclusion. Therefore, smoking cessation is the most effective treatment and is crucial to prevent disease progression.

Scoping review of atherectomy and intravascular lithotripsy with or without balloon angioplasty in below-the-knee lesions

We evaluated how contemporary data on infrapopliteal vessel preparation have been reported to identify knowledge gaps and opportunities for future research. A literature search was performed on Web of Science, PubMed, and Google Scholar to identify clinical research studies reporting on the outcomes of vessel preparation in below-the-knee lesions between 2006 and 2021. Studies were excluded if they were case reports or case series with a sample size of<10. A total of 15 studies comprising 5450 patients were included in this review, with vessel preparation performed in 2179 cases (40%). Of the 15 studies, 2 were randomized controlled trials, 6 were prospective cohort studies, and 7 were retrospective studies. Only 2 of the 15 studies evaluated intravascular lithotripsy devices, and 6 were noncomparative studies. The mean diameter stenosis treated was 86.7%± 12.6%, and the lesion length was 71.7± 55.3mm. Large heterogeneity was found in the choice and definitions of end points and lesion characterization. Procedural success ranged between 84% and 90%, and bailout stenting was performed in 0.8% to 15% of cases. Of the five studies comparing procedural success of atherectomy with or without balloon angioplasty to balloon angioplasty alone, only one was in favor of the former (99% vs 90%; P< .001). The remaining studies did not show any statistically significant differences. Similarly, atherectomy had a significantly superior limb salvage rate in only one of seven studies (91% vs 73%; P= .036). In contrast, the seven studies evaluating target lesion revascularization reported conflicting outcomes, with two in favor of atherectomy, two against atherectomy, and three reporting similar outcomes between atherectomy and balloon angioplasty alone. None of the studies evaluating intravascular lithotripsy was comparative. The current body of evidence on vessel preparation in tibial arteries is largely based on observational studies with a large amount of heterogeneity and a number of inconsistencies. Further clinical and experimental studies with more robust study designs are warranted to investigate the comparative efficacy and safety of vessel preparation in calcified tibial arteries.

P113 TRANSCATHETER CORRECTION OF RESIDUAL INFERIOR SINUS VENOSUS DEFECT AFTER SURGICAL CLOSURE

Abstract A 21–year old male who underwent surgical closure of an isolated inferior type sinus venosus atrial septal defect (SV–ASD) at 6 years of age was admitted to our institute for acute superior limb hypotonia and dysarthria, with brain computed tomography scan positive for an ischaemic event. The contrast transcranial Doppler (CTD) was positive for right–to–left shunt (RLS). The transesophageal echocardiogram (TOE) revealed a small ASD (3.8 mm) near the inferior vena cava (IVC) with a small baseline left–to–right shunt and severe RLS after Valsalva’s Manovre (&amp;gt;20 bubbles) (fig.A–B). No clear intra–cardiac source of embolization was detected on workup. After a multidisciplinary discussion, percutaneous closure of residual ASD was planned. The main challenge was represented by inadequate inferior–posterior rim towards the IVC (&amp;lt;5 mm). A Figulla Flex II ASD Occluder with the smallest waist of 4 mm was implanted with no evidence of residual intraprocedural shunt; no intraprocedural complications were observed (fig.C). The 1 month follow–up CTD was negative for RLS. Conclusions Residual ASD is a rare late complication after surgical closure of the ASD(1). We describe the case of a successful transcatheter closure of a small ASD in the presence of a deficient posterior–inferior rim which, in general, is considered an unfeasible anatomy for percutaneous procedure (2). The appropriate choice of treatment for a residual ASD should be carefully considered on a case–by–case basis. Reference 1) S. Ogura;Y.Takaya1; T. Akagi; K. Nakagawa; H. Ito.Percutaneous closure of residual atrial septal defect after surgical closure. Cardiovascular Intervention and Therapeutics (2021) 36:256–259 2) M. Chessa; G. Butera; A. Giamberti; R. M. Bini; M.Carminati. Transcatheter Closure of Residual Atrial Septal Defects After Surgical Closure. Journal of Interventional Cardiology vol.15, No. 3,2002

Airway Management of a Patient with Montgomery T-tube in situ undergoing Neurosurgery

This article stipulates the airway management in a patient requiring cranial debridement and cranioplasty with a Montgomery T-tube (MTT) in situ. Anesthetic techniques that have been previously described for surgeries with MTT in situ which can be managed by applying a laryngeal mask or intubating a trachea tube easily. The airway management of patients with an MTT in situ, requiring a supine position with the head rightly tilted and flexed, has not yet been addressed. In this article, we explored some possible approaches to cope with this arising problem. We present how we managed to intubate a double-lumen endotracheal tube onto the superior tracheal limb of the T-tube since the 5.0 mm ID tracheal tube (equivalent to a 6.9 mm ED) could not pass through the tube readily. This technique could possibly be considered for patients in similar clinical scenarios.

Corticobasal syndrome as a focal variant of Alzheimer’s disease

We present A 60-year-old woman with a 2-year history of progressive anterograde memory deficit, with a A 18F-FDG PET/CT and 11C-PIB PET/CT studies performed. In the follow-up she presented a typical corticobasal syndrome with extrapyramidal signs and left superior limb dystonia. These clinical and imaging features are consistent with a focal presentation of AD.

Latissimus Dorsi Tendon Repair

Background: Latissimus dorsi tendon ruptures are rare injuries that can occur in overhead or throwing motions and are almost always sports related. Indications: Latissimus dorsi tendon ruptures are largely treated nonoperatively, although surgical repair is indicated for the young active patient looking to return to a high level of sport and for those with complete avulsion injuries or mid-substance tendon tears. Technique Description: Depending on the degree of tendon retraction, anteroinferior or posteroinferior axillary incision is made. After the tendon is mobilized, sutures are placed in a Krackow fashion through the bulk of the tendon, and the tendon footprint is prepared by gently decorticating the surface of the humerus, just anterior and inferior to the teres major insertion point. Two Arthrex Pec Buttons are then loaded into the superior and inferior limbs of the suture tape and 2 unicortical holes are drilled into the footprint of the insertion site. The superior button is placed first and then tensioned to allow the latissimus dorsi to be pulled to the bone. Next, the second button is placed, though this is not tensioned until later at the time of the biceps tenodesis. Finally, the procedure is visualized and well inspected to ensure appropriate location of the tendon and securing hardware. Results: After an appropriate rehabilitation protocol is followed for up to 6 months postoperatively, acute repair of a ruptured latissimus dorsi tendon allows for near to complete restoration of patient functionality and strength, with return to full activity possible within 6 to 8 months. Conclusion: Surgical repair of a ruptured latissimus dorsi tendon is effective in restoring upper extremity strength and functionality and is associated with high patient satisfaction. The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

A Rare And Severe Complication Of SLE: Bullous Systemic Lupus Erythematous

Bullous systemic lupus erythematosus (BSLE) is a rare antibody-mediated blistering eruption of subepidermal tissues in patients with underlying SLE. We report a case of a 19 years old Indian unconscious male who presented with acute generalized blistering lesion and widespread tense vesicles and Bullae at the superior trunk, proximal superior limbs, and face(lips) with the symmetrical distribution. Bullae contained haemorrhagic fluid and bleeding was also seen on the ruptured site. The lesions are also seen on mucosal areas such as perioral, pharyngeal, laryngeal, and genital areas. Multiple erosions and crusting lesions are also seen over the body. Multiple scalp plaque erythematous peeling lesions with foul smells. Blood investigation showed leucocytosis and metabolic acidosis with a diagnosis of septic shock secondary to infected BSLE. He was treated with IV hydrocortisone 200mg, analgesic, and IV Ceftriaxone. Unfortunately, he collapsed 24 hours later and passed away. This case report highlights the importance of early detection of BSLE as an acute skin complication in patients with underlying SLE and its management steps.

A Rare And Severe Complication Of SLE: Bullous Systemic Lupus Erythematous

Bullous systemic lupus erythematosus (BSLE) is a rare antibody-mediated blistering eruption of subepidermal tissues in patients with underlying SLE. We report a case of a 19 years old Indian unconscious male who presented with acute generalized blistering lesion and widespread tense vesicles and Bullae at the superior trunk, proximal superior limbs, and face(lips) with the symmetrical distribution. Bullae contained haemorrhagic fluid and bleeding was also seen on the ruptured site. The lesions are also seen on mucosal areas such as perioral, pharyngeal, laryngeal, and genital areas. Multiple erosions and crusting lesions are also seen over the body. Multiple scalp plaque erythematous peeling lesions with foul smells. Blood investigation showed leucocytosis and metabolic acidosis with a diagnosis of septic shock secondary to infected BSLE. He was treated with IV hydrocortisone 200mg, analgesic, and IV Ceftriaxone. Unfortunately, he collapsed 24 hours later and passed away. This case report highlights the importance of early detection of BSLE as an acute skin complication in patients with underlying SLE and its management steps.

Image-Guided Stereotactic Radiosurgery for the Treatment of Spasticity and Pain: A Preliminary Experience.

BackgroundSpasticity is a major health problem worldwide. Response to current medical and rehabilitation treatments is often poor. Surgical treatment is available only for a very limited number of patients.AimWe recently reported the application of stereotactic radiosurgery as a treatment option for spasticity and related pain. This paper describes a larger experience using image-guided stereotactic radiosurgery targeting the cervical or lumbar spinal roots to relieve spasticity and pain in four patients.MethodsAll the patients had refractory spasticity and related pain, one patient had additional paroxystic neuralgic pain. The cause of spasticity and pain was a traumatic brain and/or spinal cord injury, brain and/or spinal cord surgery, and stroke. Symptoms affected the right superior limb in one patient, and the inferior limbs in three patients (unilaterally in two, bilaterally in one). According to the symptoms, one patient was treated at the cervical level (C7 right sensory root) and three patients at lumbar level (right L4, left S1, and L2 roots bilaterally). The target was selected on constructive interference in steady-state (CISS) MR, focusing the irradiation on the postganglionic sensory segment of the cervical root or the intra-foraminal dorsolateral sensory portion of the lumbar roots. Appropriate spasticity and pain scales were used to assess the patient’s status after the treatment.ResultsThe treatments were tolerated well. Marked symptomatic relief was found in all the treated patients. Improvements in spasticity and pain scales were observed up to the latest follow-up. After 2 years, the mean reduction of the visual analog scale (VAS) and Modified Ashworth Scale (MAS) was 64.3% and 43.7%, respectively, while the median reduction of MAS score was 50%.ConclusionsExcept for a previous case report, this is the first study describing a novel noninvasive technique based on image-guided radiosurgery to treat severe spasticity and pain due to brain and spinal cord injury. This novel technique appears to be safe and effective and deserves to be studied further.

Frontal eye fields in macaque monkeys: prefrontal and premotor contributions to visually guided saccades.

Neuronal spiking was sampled from the frontal eye field (FEF) and from the rostral part of area 6 that reaches to the superior limb of the arcuate sulcus, dorsal to the arcuate spur when present (F2vr) in macaque monkeys performing memory-guided saccades and visually guided saccades for visual search. Neuronal spiking modulation in F2vr resembled that in FEF in many but not all respects. A new consensus clustering algorithm of neuronal modulation patterns revealed that F2vr and FEF contain a greater variety of modulation patterns than previously reported. The areas differ in the proportions of visuomotor neuron types, the proportions of neurons discriminating a target from distractors during visual search, and the consistency of modulation patterns across tasks. However, between F2vr and FEF we found no difference in the magnitude of delay period activity, the timing of the peak discharge rate relative to saccades, or the time of search target selection. The observed similarities and differences between the 2 cortical regions contribute to other work establishing the organization of eye fields in the frontal lobe and may help explain why FEF in monkeys is identified within granular prefrontal area 8 but in humans is identified within agranular premotor area 6.

How I do it: horizontal fissure approach to the middle cerebellar peduncle.

The horizontal fissure approach is a workhorse for brainstem lesions in the central and dorsolateral pons and middle cerebellar peduncle (MCP). The cerebellopontine fissure is a V-shaped fissure with a superior and inferior limb between the cerebellum, pons, and MCP. The horizontal or petrosal fissure is at the apex of the cerebellopontine fissure and extends laterally to divide the petrosal surface of the cerebellum into superior and inferior parts. Splitting this fissure exposes the posterolateral aspect of the MCP without excessive retraction or transgression of the cerebellum. We demonstrate and describe the horizontal fissure operative approach to the middle cerebellar peduncle for resection of a pontine cavernoma with illustrative figures and operative video. Splitting the horizontal (petrosal) fissure of the cerebellum brings the middle cerebellar peduncle into view behind the root entry zone of the trigeminal nerve, providing an expanded, safe corridor to the central and dorsolateral pons.

Impact and safety outcomes of an intradialytic physical exercise program

IntroductionPatients undergoing hemodialysis (HD) are characterized by a poor physical condition and a substantial sedentary profile. The implementation of physical exercise programs in the hemodialysis units is usually limited by the inherent safeness and the lack of appropriate resources. ObjectivesWe aimed to evaluate the impact and safety outcomes of the implementation of an intradialytic physical exercise program (IPE) by a multidisciplinary team (physiotherapist and nursing assistant) in the physical condition of the patients. Material and methodsThis six months single-centre and experimental pre-post prospective study was carried out in 34 patients. A two day-week combined IPE intervention was implemented. The cardiopulmonary capacity (6MWT), muscular strength (HG, leg dynamometry and 10STS), body composition (bioimpedance) and coordination capacity (Timed Up and Go test) was assessed at the beginning and at the end of the study. Safety was evaluated by means of the number of issues regarding the vascular access, the hemodynamic stability as well as the vascular refilling profile (RBV) in each session. The adhesion to the program was also registered. Additionally, analytical parameters were recorded. ResultsThe adhesion to an IPE program was high (70.8%). A significant improvement of the cardiopulmonary capacity (6MWT average increase 47 m; p < 0.001), superior limbs (HG average increase of 1.6 kg; p = 0.007) as well as the lower extremities (10STS; p = 0.003; dynamometry p < 0.05). Regarding safeness, there were no incidences neither significant difference in the RBV. ConclusionsA combined IPE may contribute to the improvement of the physical condition of the patients as well as ensures a safe development of the HD treatment. We suggest a multidisciplinary team in order to efficiently establish an IPE program.

ROS-scavenging hybrid hydrogel for genetically engineered stem cell delivery and limb ischemia therapy

Stem cell therapy is a promising strategy for the treatment of ischemic diseases such as critical limb ischemia (CLI). The major obstacle is the poor survival rate and low efficiency of the implanted stem cells. Biomimetic scaffolds such as injectable hydrogels have shown the ability to promote cell retention and survival. However, the local ischemic microenvironment especially the high level of reactive oxygen species (ROS) usually induces cell loss and dysfunction, thereby leading to unsatisfactory therapeutic outcomes. Herein, we developed a new injectable hybrid hydrogel composed of natural type I collagen and melanin nanoparticles (MeNPs) for the delivery of Gremlin1 (Grem1)-overexpressed mesenchymal stem cells (Grem1-MSCs) and CLI therapy. After local injection of this cell delivery system into the ischemic limbs of mice, the thermal-triggered in situ gelation of collagen could maintain Grem1-MSCs at the injection site and MeNPs entrapped in the hydrogel framework could modulate the ischemic microenvironment via scavenging ROS to promote the survival of implanted stem cells. With this improved cell retention and survival, Grem1-MSCs could constantly secrete high concentration of Grem1, a newly discovered proangiogenic factor that can promote angiogenesis by activating the phosphoinositide 3-kinase (PI3K)-AKT signaling pathway, thereby leading to improved blood perfusion in the ischemic limbs and superior limb salvage. The strategy developed herein offers a promising therapeutic option for the effective cell-based treatment of ischemic diseases.

COVID-19 Changed the Incidence and the Pattern of Pediatric Traumas: A Single-Centre Study in a Pediatric Emergency Department

The first wave of COVID-19 spread worldwide from March to May 2020. Italy was one of the countries in the world where the lockdown period was most prolonged and restrictive. To date, the impact of prolonged lockdown on pediatric traumas has not fully investigated. This paper aimed to analyze, and compare to 2019, the incidence and the fracture pattern in patients admitted to our pediatric hospital during the total lockdown period. A single-center retrospective study was performed. The data were gathered from the Pediatric Emergency Department (PED) of the Bambino Gesù Children Hospital of Rome (Palidoro). This PED is the pediatric referral center for Rome and the hub for pediatric traumas of the region. Any admission diagnosis for fracture, trauma, sprains and dislocation during the lockdown period (10 March–4 May) were included. The demographic data, diagnosis, type of treatment, fracture segment, bone involvement and time interval between trauma and presentation to the PED were recorded. In 2020, a reduction of total traumas and fractures, compared to 2019 (p < 0.001), occurred (81%). Superior limb and inferior limb fractures decreased in 2020 compared to 2019 (p < 0.05). The identification of pediatric traumas and fractures trend could be useful to reorganize the PED. Epidemiological data from the previous lockdown could be helpful to prepare the healthcare system for new pandemic waves. Moreover, sharing national statistics and correlating those to other countries’ protocols, could be helpful to solve problems in case of worldwide emergency situations.