Incomplete Excision of Cutaneous Squamous Cell Carcinoma; Systematic Review of the Literature

The treatment of choice for cutaneous squamous cell carcinoma is complete surgical excision. Incomplete excision of cutaneous squamous cell carcinoma has an increased risk of local recurrence, deep subclinical progression, and metastasis. This study aimed to investigate the proportion and risk factors of incomplete excised cutaneous squamous cell carcinoma. A systematic review of the literature was performed. Incomplete excision rates for cutaneous squamous cell carcinoma ranged from 0.4% to 35.7%. The pooled incomplete excision risk estimate was 13% (95% confidence interval 9-17%). Risk factors noted in more than one study for incomplete excision included tumor depth and size, type of operator, head and neck localization, and former incomplete excision. We found an overall incomplete excision rate of 13% for cutaneous squamous cell carcinoma. Risk factors should be taken into account in the management of cutaneous squamous cell carcinoma surgical treatment

Gait Initiation in Children with Rett Syndrome

Rett syndrome is an X-linked neurodevelopmental condition mainly characterized by loss of spoken language and a regression of purposeful hand use, with the development of distinctive hand stereotypies, and gait abnormalities. Gait initiation is the transition from quiet stance to steady-state condition of walking. The associated motor program seems to be centrally mediated and includes preparatory adjustments prior to any apparent voluntary movement of the lower limbs. Anticipatory postural adjustments contribute to postural stability and to create the propulsive forces necessary to reach steady-state gait at a predefined velocity and may be indicative of the effectiveness of the feedforward control of gait. In this study, we examined anticipatory postural adjustments associated with gait initiation in eleven girls with Rett syndrome and ten healthy subjects. Muscle activity (tibialis anterior and soleus muscles), ground reaction forces and body kinematic were recorded. Children with Rett syndrome showed a distinctive impairment in temporal organization of all phases of the anticipatory postural adjustments. The lack of appropriate temporal scaling resulted in a diminished impulse to move forward, documented by an impairment in several parameters describing the efficiency of gait start: length and velocity of the first step, magnitude and orientation of centre of pressure-centre of mass vector at the instant of (swing-)toe off. These findings were related to an abnormal muscular activation pattern mainly characterized by a disruption of the synergistic activity of antagonistic pairs of postural muscles. This study showed that girls with Rett syndrome lack accurate tuning of feedforward control of gait

Near-Infrared Fluorescence with Indocyanine Green to Assess Bone Perfusion: A Systematic Review

Background: Adequate perfusion of a bone flap is essential for successful reconstruction of osseous defects. Unfortunately, complications related to inadequate bone perfusion are common. Near-infrared fluorescence (NIRF) imaging enables intraoperative visualization of perfusion. NIRF has been investigated in reconstructive surgery to aid the surgeon in clinical perioperative assessment of soft tissue perfusion. However, little is known on the beneficial use of NIRF to assess bone perfusion. Therefore, the aim of this review was to search for studies evaluating NIRF to assess bone perfusion. Methods: A systematic review, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline, was performed. Studies up to October 2021 were included. We extracted data regarding the study population, size and design, reported objective fluorescence parameters and the methodology used for fluorescence imaging and processing. Results: Ten articles were included. Studies reported unevenly on the protocol used for NIRF imaging. Five studies reported objective parameters. Absolute and relative perfusion parameters and parameters derived from maximum fluorescence were reported. The clinical significance of these parameters has not been evaluated in humans. Conclusion: The evidence on bone perfusion as measured with NIRF is limited. More clinical studies are required

Kinematic measurements.

<p>AP = Antero-posterior; ML = Medio-materal. Imb. = Imbalance; Unl. = Unloading; FL = foot length; BH = body height; SWto = Heel-off of the swing foot. p values refers to Wilcoxon-Mann-Whitney U Test.</p

Demographic and clinical characteristics.

<p>Demographic and clinical characteristics.</p

EMG recordings (RMS).

<p>Imb. = Imbalance; Unl. = Unloading; SOL = Soleus muscle; TA = Tibialis anterior muscle; p values refers to Wilcoxon-Mann-Whitney U Test.</p

Recorded data at gait initiation.

<p>Centre of pressure (CoP, black line) and centre of mass (CoM, dashed line) displacement in a healthy subject (<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0092736#pone-0092736-g001" target="_blank">figure 1</a> left) and child with RTT (<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0092736#pone-0092736-g002" target="_blank">figure 2</a> left) with corresponding EMG activity of tibialis anterior (TA) and soleus muscles (SOL) of swing and stance foot (<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0092736#pone-0092736-g001" target="_blank">figure 1</a> right and 2 right). The dotted line (in <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0092736#pone-0092736-g001" target="_blank">figure 1</a> left and 2 left) shows CoP-CoM distance at toe-off of the swing foot (SWto). In <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0092736#pone-0092736-g001" target="_blank">figure 1</a> (right), arrows indicate bilateral suppression of the tonic activity of SOL which, together with the subsequent activation of TA, is responsible for the backward displacement of the CoP. This synergistic activity of pairs of postural muscles (i.e. TA and SOL) is not present in RTT girls (<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0092736#pone-0092736-g002" target="_blank">figure 2</a> right). <i>Imbalance phase</i>, from the instant APAonset, at which the CoP start moving backward, to the instant of heel-off of the swing foot (SWho). <i>Unloading phase</i>, from SWho to toe-off of the swing foot (SWto). STto is the instant of toe-off of the stance foot.</p