Successful limb salvage through staged bypass combined with free gracilis muscle transfer for critical limb ischemia with osteomyelitis after failed endovascular therapy

Abstract Background Critical limb ischemia with osteomyelitis is so difficult to treat that even appropriate revascularization and wound therapy cannot achieve limb salvage because of uncontrollable infection. It is still difficult to judge the possibility of limb salvage before revascularization. Case presentation A 73-year-old male complained of a small ulcer on his left toe, which was treated with multiple endovascular therapy. After failed endovascular therapy, he suffered extensive tissue loss with tibial osteomyelitis. We carried out staged surgery that was composed of dual bypass to the sural artery and posterior tibial artery. After intensive debridement and wound care, insertion of a subsequent free gracilis muscle flap to cover the exposed tibial bone was performed, achieving functional limb salvage. Conclusion Even in the threatened limb with extensive tissue loss and osteomyelitis, intensive and multidisciplinary treatment with staged revascularization, muscle transfer, and appropriate wound care achieved functional limb salvage

Inter-individual differences in working memory improvement after acute mild and moderate aerobic exercise.

Many studies have shown that aerobic exercise improves cognitive function and maintains brain health. In particular, moderate-intensity exercise is effective for improving cognitive performance. However, there is no strong consensus on whether a single exercise session improves working memory (WM) function, as it does inhibitory function. It is possible that these discrepancies involve inter-individual differences in WM function. Therefore, we investigated whether acute mild and moderate aerobic exercise improve WM, and whether there exist inter-individual differences in improvements in WM. Thirty healthy subjects were recruited and participated in three experimental conditions (control, mild-intensity exercise, and moderate-intensity exercise). Subjects performed 10 min of exercise on a cycle ergometer with an individualized load. Their pedaling rate was maintained at 60 rpm. In the control condition, subjects rested on the cycle ergometer instead of performing exercise. The N-back task (2-back and 0-back task) was performed to assess WM function before, 5 min, and 15 min after the 10-min exercise session. In this study, to elucidate the effect of an acute bout of mild or moderate exercise on WM, the "2-back- 0-back" contrast, which is assumed to represent WM function, was calculated. The Two-Dimensional Mood Scale was adopted to measure changes in psychological mood states efficiently. The results revealed that working memory function was not improved by acute mild or moderate exercise. However, baseline working memory function was significantly associated with any change in working memory function following exercise, and this was independent of exercise intensity. Subjects with the lowest working memory function at baseline responded the most favorably. The results revealed that improvements in working memory function after a single session of aerobic exercise depend on baseline working memory function