Background: Acute flaccid myelitis (AFM) is a debilitating illness that is defined by the sudden onset of flaccid paralysis in the extremities with spinal magnetic resonance imaging (MRI) demonstrating a longitudinal lesion confined to the gray matter. The purpose of this study was to report the types of upper-extremity palsy and outcomes of surgical reconstruction in patients with AFM. Methods: Eight patients with a median age at onset of 3.8 years (range, 2.3 to 9.9 years) were identified. There was loss of shoulder abduction and external rotation in all patients, loss of elbow flexion in 5 patients, complete or partial loss of hand function in 3 patients, and spinal accessory nerve palsy in 2 patients. All patients underwent surgical reconstruction, which was categorized into 3 main groups: nerve transfer, secondary muscle transfer, and free muscle transfer. Results: The median follow-up period was 39 months (range, 30 to 94 months). Four patients obtained ≥90° of shoulder abduction whereas the other 4 patients had shoulder abduction of ≤70°. The 5 patients who received free muscle transfer or nerve transfer to restore elbow function obtained ≥140° of elbow flexion. Two patients treated with free muscle transfer to restore finger function obtained satisfactory total active motion of the fingers (180°). Conclusions: The patterns of paralysis and the strategy and outcomes of surgical reconstruction for patients with AFM differed from those for traumatic and obstetric brachial plexus palsy. All patients had loss of shoulder abduction, and 2 had spinal accessory nerve palsy. Restoration of shoulder function was unpredictable and depended on the quality of the donor nerves and recovery of synergistic muscles. Restoration of elbow and hand function was more consistent and satisfactory. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete list of levels of evidence.

Abstract:We have developed a visualized 3-D model of a City Sustainability Index (CSI) based on our original concept of city sustainability in which a sustainable city is defined as one that maximizes socio-economic benefits while meeting constraint conditions of the environment and socio-economic equity on a permanent basis. The CSI is based on constraint and maximization indicators. Constraint indicators assess whether a city meets the necessary minimum conditions for city sustainability. Maximization indicators measure the benefits that a city generates in socio-economic aspects. When used in the policy-making process, the choice of constraint indicators should be implemented using a top-down approach. In contrast, a bottom-up approach is more suitable for defining maximization indicators because this technique involves multiple stakeholders (in a transdisciplinary approach). Using different materials of various colors, shapes, sizes, we designed and constructed the visualized physical model of the CSI to help people evaluate and compare OPEN ACCESSSustainability 2015, 7 12403 the performance of different cities in terms of sustainability. The visualized model of the CSI can convey complicated information in a simple and straightforward manner to diverse stakeholders so that the sustainability analysis can be understood intuitively by ordinary citizens as well as experts. Thus, the CSI model helps stakeholders to develop critical thinking about city sustainability and enables policymakers to make informed decisions for sustainability through a transdisciplinary approach.

Case: A 7-year-old boy presented with left femoral and obturator nerves (ONs) palsy after an asthmatic attack with a viral prodrome, and his right lower limb was unaffected. He was diagnosed with acute flaccid myelitis (AFM) after positive spinal magnetic resonance imaging findings. After contralateral ON to femoral nerve transfer (CONFNT), his left quadriceps was reinnervated at 5.5 months, full knee extension was recovered at 14 months, and good functional outcomes were achieved at 31 months. Conclusions: This first clinical report on CONFNT demonstrated a feasible good alternative in treating young patients with AFM with unilateral L2-L4 palsy and short duration of deficit.

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Background: The purpose of this study was to evaluate the long-term outcome of successful fingertip replantations with more than 10 years of follow-up after surgery. Methods: A total of 34 successfully replanted digits in 31 patients with a mean period to follow-up of 16.5 years were included in this study. The main outcome measures were time to return to work, pain, cold intolerance, sensory recovery, nail deformity, grip strength, range of motion of the thumb interphalangeal or finger distal interphalangeal joint, fingertip atrophy, nonunion, bone shortening, use in activities of daily living, and patient satisfaction. Results: None of the patients reported chronic pain. No cold intolerance was experienced in 32 digits. Semmes-Weinstein monofilament testing showed recovery of protective sensation in 27 digits. The moving two-point discrimination test showed excellent or good recovery in 91 percent of the patients. Sensory recovery was satisfactory, and there was no significant difference regardless of nerve repair or injury type. Moderate to severe nail deformity was found in six digits. Fingertip atrophy was evaluated by comparing the volume of the replanted fingertip with the contralateral digit. The volume was 82 ± 17 percent of the contralateral normal side. There was no significant difference in the volume comparing the level of amputation, injury type, or incidence of postoperative vascular complication. Ninety-seven percent of the patients were satisfied with the results. Conclusion: Long-term outcome of fingertip replantation more than 10 years after surgery was found to be favorable.