Upper-limb Research Articles

One-Stage Surgical Resection and Functional Reconstruction for Upper Limb Soft Tissue Sarcoma.

Currently, the gold standard of treatment for extremity soft tissue sarcoma (STS) is limb-sparing surgery. When the upper extremity is involved, the functional outcome is frequently poor. A 1-step resection and functional reconstruction would be advisable to obtain a fast recovery. Our study aims at retrospectively analyzing our case series of immediate nerves and tendons reconstructions of the upper limb after STS resection, while combining a review of the literature. A retrospective review was conducted on a consecutive series of patients who underwent an immediate functional reconstruction after STS resection of the upper limb between 2015 and 2022 among the IRCCS Foundation "Istituto Nazionale dei Tumori." The Disabilities of the Arm, Shoulder and Hand (DASH) score was considered the primary outcome. The obtained DASH scores were compared through groups that underwent different reconstructive procedures. The literature review was conducted according to the PRISMA (Preferred Reporting Items for Systematic review and Meta-Analysis) criteria among 3 databases (PubMed, EMBASE, and Cochrane) using the search parameters "(((upper extremity) OR (upper limb)) AND (functional reconstruction) AND (soft tissue sarcoma)." Between 2015 and 2022, 52 patients required a functional reconstruction. The mean follow-up time was 49.63 months. The DASH score analysis reported a mean value of 44.1 ± 26.7. A statistically significant difference was found between groups who underwent different reconstruction techniques, whereas no difference was found regarding exposure to neoadjuvant radiation therapy. The literature review reported few articles focusing on immediate functional reconstruction after STS resection, and only 6 articles were included in the review. Our review aimed at reporting our case series of immediate functional reconstructions after STS of the upper extremity, which is currently the most substantial one reported in literature to set an effective baseline for further studies in the field.

TouchMark: Partial Tactile Feedback Design for Upper Limb Rehabilitation in Virtual Reality.

The use of Virtual Reality (VR) technology, especially in medical rehabilitation, has expanded to include tactile cues along with visual stimuli. For patients with upper limb hemiplegia, tangible handles with haptic stimuli could improve their ability to perform daily activities. Traditional VR controllers are unsuitable for patient rehabilitation in VR, necessitating the design of specialized tangible handles with integrated tracking devices. Besides, matching tactile stimulation with corresponding virtual visuals could strengthen users' embodiment (i.e., owning and controlling virtual bodies) in VR, which is crucial for patients' training with virtual hands. Haptic stimuli have been shown to amplify the embodiment in VR, whereas the effect of partial tactile stimulation from tangible handles on embodiment remains to be clarified. This research, including three experiments, aims to investigate how partial tactile feedback of tangible handles impacts users' embodiment, and we proposed a design concept called TouchMark for partial tactile stimuli that could help users quickly connect the physical and virtual worlds. To evaluate users' tactile and comfort perceptions when grasping tangible handles in a non-VR setting, various handles with three partial tactile factors were manipulated in Study 1. In Study 2, we explored the effects of partial feedback using three forms of TouchMark on the embodiment of healthy users in VR, with various tangible handles, while Study 3 focused on similar investigations with patients. These handles were utilized to complete virtual food preparation tasks. The tactile and comfort perceptions of tangible handles and users' embodiment were evaluated in this research using questionnaires and interviews. The results indicate that TouchMark with haptic line and ring forms over no stimulation would significantly enhance users' embodiment, especially for patients. The low-cost and innovative TouchMark approach may assist users, particularly those with limited VR experience, in achieving the embodiment and enhancing their virtual interactive experience.

Bimanual Arm Trainer Versus Traditional Occupational Therapy Services in Upper Extremity Function.

Upper extremity (UE) dysfunction resulting from stroke significantly affects a person's ability to complete self-care activities, consequently diminishing functional independence. Effective interventions that improve UE function in persons with stroke are needed. To explore the effectiveness of the Bimanual Arm Trainer (BAT) compared with traditional occupational therapy treatment sessions (i.e., a control group) on improving UE function after acute ischemic stroke. Clinical trial, two-group, nonrandomized repeated-measures design. Inpatient rehabilitation facility. Twenty-seven persons with ischemic stroke and an Action Research Arm Test (ARAT) score ≤17. Minimum of three 10-min sessions on the BAT. ARAT, Upper Extremity Fugl-Meyer Assessment of Motor Recovery after Stroke (FMA-UE). Both the intervention and control groups showed significant improvement on the ARAT from evaluation to discharge (main effect of time: p = .02). There was no statistically significant main effect of group and no significant Time × Group interaction (p = .63). FMA-UE scores also improved significantly in the intervention group from evaluation to discharge (p < .001). FMA-UE scores were not available for the control group. Both the intervention and control groups demonstrated significant improvements in UE function from evaluation to discharge. There were no statistically significant differences between groups, indicating that the BAT results in similar improvements in UE function, as would be expected in traditional occupational therapy. Further research is warranted to examine additional BAT programs, use different outcome measures, and assess participants over a longer time span. Plain-Language Summary: The Bimanual Arm Trainer (BAT) is a novel device that can be used in occupational therapy to improve arm function among stroke patients. There is limited research on BAT's effectiveness in improving arm function among stroke patients. In an acute inpatient rehabilitation setting, we compared outcome scores of patients who received traditional occupational therapy services with those who also used the BAT. Both groups achieved significant improvements in arm function from evaluation to discharge. We found that the addition of the BAT interventions did not significantly affect the outcome measure scores for either group. We conclude that more research is needed to examine additional BAT programs, use different outcome measures, and assess participants over a longer period of time.

Osseointegration: A new approach to improve functional performance of prostheses – a systematic review of the literature

Background: Individuals with amputations experience functional limitations in their daily activities, depending on the level of their injuries. They often encounter problems with socket-based prostheses. Osseointegration is a new method in prosthetic rehabilitation that aims to enhance the performance of amputees and reduce the issues associated with current prostheses. The objective of this review was to assess the advantages and disadvantages of this novel approach in the rehabilitation of amputees. Method: A search was conducted in various databases, including Google Scholar, PubMed, ISI Web of Knowledge, Embase, and Scopus. The search terms used were “osseointegration,” “prosthesis,” and “amputation.” The quality of the studies was evaluated using the Down and Black tool. Results: The search using the aforementioned keywords yielded 18 papers. Out of these, 10 papers focused on the use of osseointegration for lower limb amputations, while 5 papers focused on upper limb amputations. Additionally, 3 papers examined the occurrence of stump infections associated with this method. The quality of the studies ranged from 15 to 20. Conclusion: Based on the available literature, osseointegration addresses some of the challenges associated with socket-based prostheses. Furthermore, it improves the performance of prostheses. However, there are several issues with this method, including high costs, stump infections, and the need for extensive expertise to insert the implant. Further large-scale studies are necessary to determine the various limitations and advantages of this approach for different levels of amputations.

Lower urinary tract symptoms in children with Duchenne muscular dystrophy: An evaluation in terms of functional level, posture, and muscle strength.

To examine factors associated with lower urinary tract symptoms (LUTS) and lower urinary tract dysfunction (LUTD) in children with Duchenne muscular dystrophy (DMD). This cross-sectional study included 45 individuals diagnosed with DMD between the ages of 5 and 18 years. LUTS were evaluated with the Dysfunctional Voiding and Incontinence Scoring System, functional levels with the Brooke Upper Extremity Functional Classification and the Vignos Scale, lumbar lordosis angle with a bubble inclinometer, pelvic inclination angles with a digital inclinometer, and muscle strength with a hand-held dynamometer. The mean age of the children was calculated as 9.00 ± 3.32 years, body weight as 31.10 ± 12.59 kg, and height as 125.87 ± 18.46 cm. LUTD was detected in 20 children (44.44%). There was an association between high LUTD severity and low strength of the following muscles: bilateral hip flexor (Dominant: r = -0.338, p = 0.023; nondominant: r = -0.411, p = 0.005), quadriceps femoris (Dominant: r = -0.445, p = 0.002; nondominant: r = -0.504, p < 0.001), elbow flexor (Dominant: r = -0.461, p = 0.001; nondominant: r = -0.455, p = 0.002), and elbow extensor (Dominant: r = -0.442, p = 0.002; nondominant: r = -0.450, p = 0.002). Upper extremity functionality level was significantly higher in the LUTD-negative group (p = 0.004). There was no relationship between lumbar lordosis and pelvic inclination angles and LUTS symptoms (p > 0.05). To provide the adequate care for bladder health in children with DMD, it is essential to focus on parameters that will increase functionality and independence in this population.

A Cable-Driven Exosuit for Bidirectional Upper Limb Resistance Exercises

A Cable-Driven Exosuit for Bidirectional Upper Limb Resistance Exercises

Changing Horses in Midstream: Modern Pentathlon After the 2024 Olympic Games.

The decision of the Union Internationale de Pentathlon Moderne to replace horse riding with Obstacle after the 2024 Olympic Games challenges training, testing, and recovery management in Modern Pentathlon. This commentary discusses physiological, technical, and tactical effects of rule changes in the 5 disciplines with a specific focus on the new discipline Obstacle. Modern Pentathlon requires athletes to develop specific endurance capacities relying on both the aerobic and anaerobic systems while simultaneously increasing lower- and upper-body strength capabilities. In addition, movements must be repeatedly executed in an explosive and precise manner. Running and swimming must be fast but economical. Swapping from horse riding to Obstacle will prioritize the explosive strength of the upper extremities and core while keeping high levels of endurance and precision in swimming, fencing, and shooting. Moreover, condensing the Modern Pentathlon competition to a 90-minute television-friendly format enables more competitions in the future. Athletes and coaches will thus also need to develop and maintain effective individual peri-exercise routines (before, during, and after the competition) to successfully meet the resulting tactical and physical challenges of the new format. This commentary aims to stimulate the discussion on the effect of the Union Internationale de Pentathlon Moderne's decisions to replace riding with the new Obstacle discipline and implement a more television-friendly format with a focus on physiological, technical, and tactical aspects.

Analysis of clinical characteristics and factors affecting treatment responses in patients with pyoderma gangrenosum: a multicenter study of 239 patients☆

BackgroundPyoderma Gangrenosum (PG) is a chronic disease characterized by recalcitrant skin ulcers. ObjectiveWe aimed to evaluate the demographic, clinical characteristics, treatments and factors affecting the treatment responses of patients with PG. MethodsWe performed a multicenter study of 12 tertiary care centers. We analyzed the data of the patients who were followed up with a diagnosis of PG between the years 2012‒2022 retrospectively. ResultsWe included a total of 239 patients of whom 143 were female and 96 were male, with an average age of 54.2 ± 17.4 years. The most common treatment was systemic steroids (n = 181, 75.7%). Among these patients, 50.8% (n = 92) used systemic steroids as the sole systemic agent, while 49.2% (n = 89) used at least one adjuvant immunosuppressive agent. The independent factors determined in regression analysis to influence response to systemic steroids positively were disease onset age ≥ 30-years, negative pathergy, absence of leukocytosis, negative wound culture, presence of a single lesion, and absence of upper extremity involvement. Biological agents were used in 18.4% (n = 44) of the patients in the present study. We also analyzed pathergy positive PG and early onset (onset age < 30) PG separately due to their distinct clinical features which were revealed during statistical analysis. Study limitationsRetrospective nature of the present study. ConclusionsAnalyses of the factors influencing treatment responses are addressed in this study. Also, we concluded that investigation for accompanying autoinflammatory diseases of pathergy positive PG and early onset PG is necessary and the patients in these two groups are more resistant to treatment, necessitating more complicated treatments.

Breaststroke and butterfly intercycle kinematic variation according to different competitive levels with Statistical Parametric Mapping analysis

Breaststroke and butterfly are complex swimming techniques requiring refined motor skills to perform successfully, with coordinated and consistent interaction between propulsive and resistive forces being decisive when considering swimmers expertise. The current study analysed those techniques intercycle kinematic variation in two swimmers cohorts. Twenty elite and 15 national level swimmers performed one 25 m breaststroke and one 25 m butterfly sprints, with an underwater camera recording images at 120 Hz in the sagittal plane. Mean velocity, maximum and minimum velocities, stroke rate and length, intracycle velocity variation and phases relative duration were calculated for consecutive cycles (elite: five breaststroke/butterfly, national level: eight breaststroke/seven butterfly). The two highest peaks and the lower peak in between in breaststroke were also addressed. Intercycle and inter-groups analysis were performed using ANOVA, ANCOVA and Statistical Parametric Mapping. Elite and national level differed regarding breaststroke mean and maximum velocities, 1st and 2nd peaks and minimum between peaks (1.30 ± 0.02 vs 1.15 ± 0.02 m/s, 2.13 ± 0.05 vs 1.88 ± 0.06 m/s, 1.63 ± 0.05 vs 1.48 ± 0.05 m/s, 2.13 ± 0.05 vs 1.86 ± 0.05 m/s, 1.33 ± 0.04 vs 1.23 ± 0.04 m/s), and butterfly mean, maximum and minimum velocities, stroke rate and intracycle velocity variation, respectively (1.65 ± 0.01 vs 1.50 ± 0.01 m/s, 2.20 ± 0.04 vs 2.09 ± 0.04 m/s, 1.12 ± 0.04 vs 0.79 ± 0.04 m/s, (57.9 ± 0.9 vs 54.9 ± 1.0cycles/min, 18.4 ± 1.3 vs 23.7 ± 1.3 %). Elite and national level swimmers showed consistent breaststroke intercycle kinematic variation, but a butterfly mean velocity decay, with the upper limbs release and recovery, and the outsweep phases originating variability between butterfly cycles. Skill levels contrasted in technical and strategic features at sprint breaststroke and butterfly but showed similar velocity variability between consecutive swimming cycles.

‘When nature breaks the rules’: Guillain-barré syndrome presenting with descending paralysis

Guillain-Barré Syndrome (GBS) typically presents with ascending paralysis, but we report an atypical case involving descending paralysis in a 36-year-old male. The patient experienced upper limb weakness and respiratory muscle involvement, progressing to respiratory distress. Initial cerebrospinal fluid (CSF) analysis and nerve conduction studies (NCS) were normal, delaying the diagnosis. Treatment with intravenous immunoglobulin (IVIG) led to partial recovery. This case highlights the diagnostic challenges of atypical GBS presentations and the importance of early intervention.

Trends in Upper Extremity Saw Injuries From 2003 to 2022.

Saws are a common source of upper extremity injury. There have been several commercial and government-mandated safety mechanisms designed to reduce the number of saw injuries. We aim to assess the trends in the incidence and impact of saw-related upper extremity injuries over the last 2 decades. The National Electronic Injury Surveillance System database was queried from January 2003 to December 2022 for upper extremity injuries caused by saws. Summary statistics for primary body part injured and diagnosis were calculated. Linear regression was performed to evaluate trends in the number of injuries over time. An estimated 1.38 million injuries (weighted) presenting to emergency departments were reported from January 2003 to December 2022. Patients had a mean age of 50.5 ± 18.1. Digits (82.2%) accounted for most injuries, followed by hands (11.9%). The lower arm (3.4%), wrist (1.66%), shoulder (0.3%), elbow (0.2%), and upper arm (0.2%) accounted for fewer injuries. There was a downtrend in number of saw injuries over the study period (R = 0.83, R2 = 0.69, p < .001). Subgroup analysis showed decreases in number of injuries to fingers (R = -0.82, R2 = 0.67, p < .001) and wrists (R = -0.61, R2 = 0.37, p = .004). The most common diagnoses were lacerations (69.7%), fractures (12.6%), and amputations (9.9%). Upper extremity saw injuries have significantly decreased over the last 20 years. The fingers and hands account for the vast majority of saw injuries, resulting most commonly in lacerations, fractures, and amputations. IV.

At-home wearable-based monitoring predicts clinical measures and biological biomarkers of disease severity in Friedreich’s Ataxia

BackgroundFriedreich ataxia (FRDA) results in progressive impairment in gait, upper extremity coordination, and speech. Currently, these symptoms are assessed through expert examination at clinical visits. Such in-clinic assessments are time-consuming, subjective, of limited sensitivity, and provide only a limited perspective of the daily disability of patients.MethodsIn this study, we recruited 39 FRDA patients and remotely monitored their physical activity and upper extremity function using a set of wearable sensors for 7 consecutive days. We compared the sensor-derived metrics of lower and upper extremity function as measured during activities of daily living with FRDA clinical measures (e.g., mFARS and FA-ADL) and biological biomarkers of disease severity (guanine-adenine-adenine (GAA) and frataxin (FXN) levels), using Spearman correlation analyses.ResultsThe results show significant correlations with moderate to high effect sizes between multiple sensor-derived metrics and the FRDA clinical and biological outcomes. In addition, we develop multiple machine learning-based models to predict disease severity in FRDA using demographic, biological, and sensor-derived metrics. When sensor-derived metrics are included, the model performance enhances 1.5-fold and 2-fold in terms of explained variance, R², for predicting FRDA clinical measures and biological biomarkers of disease severity, respectively.ConclusionsOur results establish the initial clinical validity of using wearable sensors in assessing disease severity and monitoring motor dysfunction in FRDA.

A Method to Improve the Accuracy for the Comparison of Consecutively Determined Upper Limb Cross-Sectional Area Profiles of Test Subjects: Impact on (Segmental) Limb Volume and Local Limb Circumference.

Background: Chronic edema management depends on measuring small volume changes over time. Therefore, a highly sensitive, accurate, and reliable technique is needed to objectively judge sequential measurements. Methods and Results: The prototype of the Peracutus Aqua Meth (PAM), a new volumetric measuring device, was used in an experimental study. Thirty-nine healthy test subjects were measured three times. The measuring principle of the PAM is based on obtaining a profile of cross-sectional areas along the length of an object or limb. Besides total arm volumes, the volume of any chosen segment can be determined. The utmost tip of the middle finger appeared to be an unreliable reference point. Instead, the concept of "hand median" was introduced to align and compare profiles of cross-sectional areas of sequential measurements. Using the hand median strongly improved the measuring accuracy, rendering standard deviation values of 0.4%-1.3% for (segmental) volume determination. Conclusions: Measurements with the PAM show that accurate local/segmental volume determination of a limb is possible. Standard deviations of less than 1.3% are easily obtained for cross-sectional area and volume determination.

Corticospinal Tract Sparing in Cervical Spinal Cord Injury

Disruptions in the brain’s connections to the hands resulting from a cervical spinal cord injury (cSCI) can lead to severe and persistent functional impairments. The integrity of these connections is an important predictor of upper extremity recovery in stroke and may similarly act as a biomarker in cSCI. In this perspective article, we review recent findings from a large cohort of individuals with cSCI, demonstrating the predictive value of corticospinal tract (CST) integrity in cSCI—CST sparing. This research underscores that, akin to stroke, the integrity of brain-to-hand connections is crucial for predicting upper extremity recovery following cSCI. We address the limitations of commonly used metrics, such as sacral sparing and the concept of central cord syndrome. Furthermore, we offer insights on emerging metrics, such as tissue bridges, emphasizing their potential in assessing the integrity of brain connections to the spinal cord.

Higher systolic blood pressure in left not right upper limb is associated with all-cause mortality risk in a community-based population

Abstract Background and Purpose Previous studies have shown that elevated inter-arm systolic blood pressure difference (SBPD) is a valuable indicator for assessing the risk of all-cause mortality. However, no research currently reports that the different impact of higher SBP in which upper limb on all-cause mortality risk. This study investigates which side of the upper limbs has a higher SBP that is more associated with all-cause mortality risk in a community population. Methods The subjects were from the a Atherosclerosis Cohort of the Department of Cardiology of our University First Hospital from 2012 to 2021, and those with missing data of brachial-ankle pulse wave velocity and a history of myocardial infarction or stroke in the baseline survey were excluded. The endpoint was defined as all-cause mortality. SBPD was defined as the difference between the systolic blood pressure of the right arm minus the systolic blood pressure of the left arm by the noninvasive arteriosclerosis detection device BP-203RPEIII (Omron, Japan). SBPD was categorized into four groups: 0-10 mmHg (right arm higher &amp;lt;10mmHg), ≥ 10 mmHg (right arm higher ≥ 10 mmHg ), -10 to &amp;lt; 0 mmHg (left arm higher ≤10 mmHg), and &amp;lt; -10 mmHg (left higher &amp;gt; 10mmHg). The relationship between SBPD and all-cause mortality risk was determined by multivariable Cox proportional hazards regression after adjusting for covariates (age, body mass index, gender, current smoking, current drinking, estimated glomerular filtration rate, diabetes, hypoglycemic treatment, total cholesterol, triglycerides, lipid-lowering treatment, and antihypertensive treatment). Results Totally, 8628 participants were included, with a mean age of 56.58 ± 8.97 years old, and 64.51% (5566) were female. Among them, 380 (4.40%) had an SBPD ≥ 10 mmHg, and 409 (4.74%) had an SBPD &amp;lt; -10 mmHg. During a median follow-up of 9.87 years, 442 cases of all-cause mortality (5.19%) occurred. The Kaplan-Meier curve suggested that the greater the difference in SBPD, the higher the cumulative risk of all-cause mortality. The Log-rank test showed a significant statistical difference (P= 0.0115). Compared to right arm higher &amp;lt;10mmHg group, the risk of all-cause mortality was not significantly elevated in right arm higher ≥ 10 mmHg (adjusted HR=1.17, 95% CI: 0.74-1.84, P=0.507) or left arm higher ≤10 mmHg group (adjusted HR=0.90, 95%CI: 0.74-1.11, P=0.329). However, the risk of all-cause mortality significantly increased by 59% in left higher &amp;gt; 10mmHg Group (adjusted HR=1.59, 95% CI: 1.10-2.30, P=0.013). The results remained significant after adjusting for peripheral right arm SBP (adjusted HR=1.56, 95% CI: 1.08-2.24, P=0.018). Conclusion This study found that a higher SBP in the left arm is associated with a higher risk of all-cause mortality in a Beijing community-based population, and they should be monitored and intervened more intensively.Hazard Ratios for all-cause mortalitySurvival curves for SBPD groups

Alcohol intake and patterns of multi-site musculoskeletal pain in the British Whitehall II study

Abstract Background Patterns of multi-site musculoskeletal (MSK) pain and its relationship with alcohol drinking among white-collar employees and retirees remain unclear compared to blue-collar workers. This study aimed to examine the relationship between alcohol drinking and MSK pain through latent class analysis (LCA) in current and retired white-collar employees. Methods We used the data from the 7th phase (2000-2002, n = 6,967, response rate 71.6%) of the British Whitehall II study, chosen for its availability of MSK items and approximately 1:1 ratio of employees to retirees, allowing for an evaluation of the relationship between alcohol drinking and MSK pain by employment status. LCA was used to distinguish patterns of multi-site MSK pain. A multinomial logistic regression model was used to examine the association between alcohol drinking and the identified pain patterns, with analyses conducted separately for employees and retirees. Results We identified five latent classes for pain (back/cervical: 7.1%, cervical: 28.9%, upper limb: 29.4%, combined LBP/upper limb/cervical: 13.2%, and LBP alone: 21.5%). Increased alcohol intake might be associated with elevated odds of upper limb pain in current drinkers, but this could not be statistically confirmed (OR: 1.04, 95% CI: 0.99-1.09). Employment status may modify the association with a significant interaction found between alcohol intake and retirement (p-value: 0.043). Every 7-unit increase in alcohol intake is associated with 18% and 12% higher odds of pain in LBP/UBP/cervical and upper limbs, respectively (95% CI: 1.02-1.37; 1.02-1.23). Conclusions Increased alcohol intake was associated with pain patterns only among retired white-collar employees but not the current ones. Interventions on alcohol consumption could help confirm if, reducing alcohol intake or avoiding hazardous drinking, for white-collar retirees prevents not only upper limb pain but also more complex pain patterns. Key messages • Musculoskeletal pain in white-collar employees and retirees contributes to the cervical and upper extremities, differing from low back/neck pain studies among general or blue-collar workers. • The association between alcohol drinking and pain patterns may differ across employment status. Reducing alcohol intake might be advised to retired drinkers for preventing multi-site pain.

Upper and Lower Limb Training Evaluation System Based on Virtual Reality Technology

Upper and lower limb rehabilitation training is essential for restoring patients’ physical movement ability and enhancing muscle strength and coordination. However, traditional rehabilitation training methods have limitations, such as high costs, low patient participation, and lack of real-time feedback. The purpose of this study is to design and implement a rehabilitation training evaluation system based on virtual reality to improve the quality of patients’ rehabilitation training. This paper proposes an upper and lower limb rehabilitation training evaluation system based on virtual reality technology, aiming to solve the problems existing in traditional rehabilitation training. The system provides patients with an immersive and interactive rehabilitation training environment through virtual reality technology, aiming to improve patients’ participation and rehabilitation effects. This study used Kinect 2.0 and Leap Motion sensors to capture patients’ motion data and transmit them to virtual training scenes. The system designed multiple virtual scenes specifically for different upper and lower limbs, with a focus on hand function training. Through these scenes, patients can perform various movement training, and the system will provide real-time feedback based on the accuracy of the patient’s movements. The experimental results show that patients using the system show higher participation and better rehabilitation training effects. Compared with patients receiving traditional rehabilitation training, patients using the virtual reality system have significantly improved movement accuracy and training participation. The virtual reality rehabilitation training evaluation system developed in this study improves the quality of patients’ rehabilitation and provides personalized treatment information to medical personnel through data collection and analysis, promoting the systematization and personalization of rehabilitation training. This system is innovative and has broad application potential in the field of rehabilitation medicine.

Double arch technique - a novel surgical procedure for the hypoplastic aortic arch syndrome

Abstract Background The hypoplastic aortic arch syndrome was defined as a combination of hypoplastic aortic arch and complex proximal descending aortic anomalies (such as aortic aneurysm, aortic coarctation, aortic tortuosity, or aortic dissection). In this study, we proposed a novel 'double arch' technique as a simple surgical procedure to treat the hypoplastic aortic arch syndrome, which could eliminate the requirement for cardiopulmonary bypass. Purpose This study aimed to investigate the surgical outcomes of patients who underwent the 'double arch' technique, and further evaluate the effectiveness and safety of this novel technique. Methods Briefly, J-shaped mini-sternotomy and left posterolateral thoracotomy were both performed in this technique. The ascending aorta, aortic arch, and proximal descending aorta were dissociated. After that, the ascending aorta was occluded using a side-biting clamp, followed by an end-to-side anastomosis between the proximal end of vascular graft and the ascending aorta. Similarly, the thoracic descending aorta was occluded with two aortic clamps beyond the opening of the left subclavian artery, and was then transected between the clamps, followed by an end-to-end anastomosis between the distal end of vascular graft and the distal descending aorta, while the proximal descending aorta was closed with sutures. The transection site of the aorta could be adjusted according to the extent of the lesions, and the vascular graft was placed in the left thoracic cavity. The operation was performed at room temperature. The primary endpoint was early mortality, which referred to in-hospital death and/or death within 30 days after surgery (including intraoperative death), whichever is longer. Critical secondary endpoints included aortic reoperation, newly developed aneurysms, and the blood pressure difference between the upper and lower extremities. Results Twelve patients with hypoplastic aortic arch syndrome were enrolled from December 2015 to February 2022. Patients were diagnosed using computed tomography. The median age (interquartile range, IQR) was 26.5 (17.0, 39.0) years (ranging from 12.0 to 55.0), and 8 patients were female (66.7%). The median operation time (IQR) was 4.7 (3.8, 5.5) hours (ranging from 2.8 to 7.3). All patients survived to discharge and completed the follow-up. The median follow-up time (IQR) was 5.42 (3.25, 5.97) years (ranging from 0.02 to 6.25). During the follow-up, no patient died or was required for reoperation. In addition, no newly developed aneurysm was found, and no severe adverse event was recorded. The median blood pressure difference (IQR) between the upper and lower extremities was 9 (4, 17) mmHg (ranging from 3 to 27). Conclusions The 'double arch' technique is a viable alternative surgical treatment for the hypoplastic aortic arch syndrome. This technique is expected to significantly simplify the surgical procedure and improve the long-term prognosis of patients.Diagram of the 'double arch' techniqueCT scans of pre- and post-operation

Klippel-Trénaunay-Weber Syndrome: Prenatal Diagnosis and Review of the Literature.

Klippel-Trénaunay-Weber syndrome (KTW) is a rare congenital disease, representing a challenge in prenatal diagnosis due to overlapping characteristics with other syndromes and no specific genetic markers known to date. We have collected all the cases present in the literature on the prenatal diagnosis of KTW, emphasizing common ultrasound findings that can guide the clinician and genetics to the prenatal counseling. Thus, we collected all the information about the postnatal prognosis and the necessity for treatment. Our review of 44 cases highlights the typical common features: hemihypertrophy, predominantly affecting the right leg, with cystic lesions extending to the trunk or upper limbs and rare internal organ involvement. Prenatal complications, including hydrops and polyhydramnios, emphasize the need for a careful ultrasound follow-up. Despite no identified genetic mutation, genetic counseling and invasive testing are recommended. Mortality rate due to a severe complication known as Kasabach-Merritt syndrome, underlines the importance of early diagnosis and accurate management strategies. Prenatal diagnosis of KTW, guided by ultrasound findings and genetic counseling, could help with informed decision-making and optimal care planning.

Degloving soft tissue injuries of upper limbs and their management in Khartoum- Sudan: Cross-sectional study

Degloving soft tissue injuries of upper limbs and their management in Khartoum- Sudan: Cross-sectional study