Presentation of the ATLETAS DA VOZ™ Conditioning Program

Objectives: To present a simple form of vocal and breathing conditioning for voice professionals based on concepts from vocal science. The vocal conditioning program called Voice Athletes Conditioning uses the principles of exercise physiology to gradually improve vocal and respiratory overload to achieve endurance, power, and flexibility. Methods: Due to our personal experience with high voice users, we synthesized a vocal conditioning program (AVCP) that combines voice science, exercise physiology, sports science and physical therapy principles. This is an 8-week program of daily vocal and breathing exercises with overload enhancement each week using different types of breathing devices and semi-occluded vocal tract exercises, designed and developed according to the specific requirements and performance of the voice professional. Reflections: Professional voice users often experience episodes of vocal fatigue that can directly affect their performance and vocal health. As with physical training for athletes, voice exercises can also contribute to improving vocal conditioning, preventing voice disorders, as well as helping to obtain better performance, greater tolerance to fatigue and shorter recovery time. Conclusions: AVCP is an approach that considers the principles of muscle training aimed objectively at the respiratory and vocal muscles, carried out with a variety of breathing devices and specific vocal exercises in search of greater performance time, less physiological stress, and shorter recovery time in the professional use of the voice.

Objetivos: Presentar una forma sencilla de acondicionamiento vocal y respiratorio para profesionales de la voz, basada en conceptos de la ciencia vocal. El programa de acondicionamiento vocal denominado Voice Athletes Conditioning utiliza los principios de la fisiología del ejercicio para mejorar gradualmente la sobrecarga vocal y respiratoria, con el fin de lograr resistencia, potencia y flexibilidad. Métodos: Debido a nuestra experiencia personal con usuarios de voz aguda, sintetizamos un programa de acondicionamiento vocal (AVCP) que combina principios de la ciencia de la voz, la fisiología del ejercicio, las ciencias del deporte y la fisioterapia. Se trata de un programa de 8 semanas de ejercicios vocales y respiratorios diarios con realce de sobrecarga cada semana utilizando diferentes tipos de dispositivos respiratorios y ejercicios semioclusivos del tracto vocal, diseñado y desarrollado de acuerdo con los requerimientos específicos y el rendimiento del profesional de la voz. Reflexiones: Los usuarios profesionales de la voz experimentan a menudo episodios de fatiga vocal que pueden afectar directamente su rendimiento y salud vocal. Al igual que ocurre con el entrenamiento físico de los deportistas, los ejercicios vocales también pueden contribuir a mejorar el acondicionamiento vocal, prevenir trastornos de la voz, además de ayudar a obtener un mejor rendimiento, una mayor tolerancia a la fatiga y un menor tiempo de recuperación. Conclusiones: El AVCP es un enfoque que considera los principios del entrenamiento muscular dirigido objetivamente a la musculatura respiratoria y vocal, realizado con diversos aparatos respiratorios y ejercicios vocales específicos en busca de un mayor tiempo de actuación, menor estrés fisiológico y menor tiempo de recuperación en el uso profesional de la voz.

Reconstrução mamária: Experiência de 10 anos / Breast reconstruction: 10 years experience

Introdução: A reconstrução mamária pós-tratamento cirúrgico do câncer de mama (um dos principais cânceres que acometem as mulheres) tem sido progressivamente mais indicada, haja vista o benefício da recuperação psicológica e da qualidade de vida, seja utilizando implantes e/ou tecidos autólogos. O presente trabalho visa demonstrar a experiência da equipe, discutir técnicas operatórias e complicações em relação aos dados da literatura mundial, além de verificar a aplicabilidade da técnica na prática clínica da equipe. Método: Estudo observacional retrospectivo desenvolvido em hospital universitário em Juiz de Fora a partir da revisão de prontuários de pacientes submetidas a mastectomia com reconstrução mamária entre 2010 e 2020. Resultados: Das 860 mamas abordadas, 84% foram imediatas à cirurgia oncológica e 16% foram tardias; o principal acesso ao tecido mamário foi a incisão de Stewart, seguido de incisões inframamárias estendidas, periareolares e T invertido; quanto às técnicas reconstrutoras, destaca-se 35% dos casos com retalho com músculo grande dorsal, 25% com prótese pré-peitoral, 20% com retalho miocutâneo transverso do músculo reto abdominal e 10% com retalho muscular local. As complicações mais incidentes foram deiscência de sítio cirúrgico, seguida de necrose cutânea, seroma, infecção de sítio cirúrgico e hematoma, além de outros menos comuns como dor crônica e ruptura de prótese após mamografia. Conclusão: A reconstrução mamária pós-mastectomia é indispensável para a recuperação física e emocional da mulher, sendo as técnicas utilizadas nos últimos dez anos consistentes, confiáveis, de baixa morbidade e com ótimos resultados estéticos quando bem indicadas.

Introduction: Breast reconstruction after surgical treatment for breast cancer (one of the main cancers that affect women) has been progressively more recommended, given the benefits of psychological recovery and quality of life, whether using implants and/or autologous tissues. The present work aims to demonstrate the team's experience, and discuss operative techniques and complications concerning data from the world literature, in addition to verifying the applicability of the technique in the team's clinical practice. Method: Retrospective observational study developed at a university hospital in Juiz de Fora based on a review of medical records of patients who underwent mastectomy with breast reconstruction between 2010 and 2020. Results: Of the 860 breasts treated, 84% underwent immediate oncological surgery and 16% were late; the main access to the breast tissue was the Stewart incision, followed by extended inframammary, periareolar, and inverted T incisions; regarding reconstructive techniques, 35% of cases used a latissimus dorsi muscle flap, 25% used a prepectoral prosthesis, 20% used a transverse rectus abdominis myocutaneous flap and 10% used a local muscle flap. The most common complications were surgical site dehiscence, followed by skin necrosis, seroma, surgical site infection, and hematoma, in addition to other less common complications such as chronic pain and prosthesis rupture after mammography. Conclusion: Postmastectomy breast reconstruction is essential for a woman's physical and emotional recovery, with the techniques used in the last ten years being consistent, reliable, with low morbidity, and with excellent aesthetic results when correctly indicated.

Reconstrução da região superior do dorso com retalho musculocutâneo do trapézio em V-Y baseado na artéria dorsal da escápula / Reconstruction of the upper region of the back with a V-Y trapezius musculocutaneous flap based on the dorsal artery of the scapula

Introdução: Defeitos na região superior do dorso geralmente são de difícil tratamento, especialmente nos casos de exposição de vértebras, meninge ou material de síntese. O fechamento primário com retalho muscular ou musculocutâneo é a melhor escolha, mas a área doadora para tratar grandes defeitos pode requerer enxertia. A preservação da artéria dorsal da escápula parece assegurar um território cutâneo maior do que o do retalho musculocutâneo do trapézio clássico baseado apenas na artéria cervical transversa. Método: Foi concebida uma ampla ilha triangular de pele sobre o músculo trapézio baseado na artéria dorsal da escápula com transferência por movimento pendular e um procedimento tipo V-Y em cinco pacientes após a extirpação de tumores malignos. Resultados: Os defeitos e as áreas doadoras foram fechados primariamente com total viabilidade dos retalhos e não foram observadas complicações além da ocorrência de seroma. Conclusão: O retalho musculocutâneo do trapézio baseado na artéria dorsal da escápula oferece segurança no tratamento de exposição óssea na região superior do dorso.

Introduction: Defects in the upper region of the back are generally difficult to treat, especially in cases of exposure of vertebrae, meninges, or synthetic material. Primary closure with a muscular or musculocutaneous flap is the best choice, but the donor area to treat large defects may require grafting. Preservation of the dorsal artery of the scapula appears to ensure a larger cutaneous territory than that of the classic trapezius musculocutaneous flap based only on the transverse cervical artery. Method: A wide triangular island of skin was designed over the trapezius muscle based on the dorsal scapular artery with pendulum transfer and a V-Y type procedure in five patients after the extirpation of malignant tumors. Results: The defects and donor areas were closed primarily with full viability of the flaps and no complications were observed other than the occurrence of seroma. Conclusion: The trapezius musculocutaneous flap based on the dorsal artery of the scapula offers safety in the treatment of bone exposure in the upper back region.

Striated Musculature: Embryonic and Fetal Development / Musculatura Estriada: Desarrollo Embrionario y Fetal

SUMMARY: The different embryological origins of striated muscle tissue make it an interesting tissue but at the same time difficult to understand, this is how the musculature of the face comes from the first pharyngeal arch, on the other hand. The muscles of the tongue derive from the somites. The muscles of the larynx come from the pharyngeal arches. The muscles of the spine come from the medial or internal myotome of the somite, while the muscles of the limbs and body wall come from the external myotome. The cardiac musculature originates from the lateral splanchnic mesoderm. In this work, the development of myoblasts in human, mouse and chicken fetuses was studied in the facial region, tongue, and spine, limbs, body wall and cardiac muscles using histological histochemical techniques and immunohistochemical technique. The objective of the work is to compare the histogenesis of striated muscle (skeletal, visceral and cardiac), indicating the differences in origin, evolution of the morphological characteristics in each of them and the signaling routes that are involved in its development.

Los distintos origenes embriológicos del tejido muscular estriado lo hace un tejido interesante, pero a la vez difícil de entender, es así como la musculatura de la cara proviene del primer arco faríngeo, en cambio, la musculatura de la lengua deriva de los somitos. La musculatura de la laringe proviene de los arcos faríngeos. La musculatura de la columna vertebral proviene del miotomo medial o interno del somito, en cambio la musculatura de los miembros y pared del cuerpo proviene del miotomo externo. La musculatura cardiaca se origina del mesoderma lateral esplácnico. En este trabajo se estudió el desarrollo de mioblastos en fetos humanos, de ratón y pollo, en la región facial, lengua, columna vertebral, miembros, pared del cuerpo y musculatura cardíaca mediante técnicas histológicas histoquímicas y técnica inmunohistoquímica. El objetivo del trabajo fue comparar la histogénesis del músculo estriado (esquelético, visceral y cardíaco), indicando las diferencias de origen, evolución de las características morfológicas en cada una de ellas y las rutas de señalización que se ven involucradas en el desarrollo del mismo.

Relationship between Botulinum Toxin and Temporomandibular Dysfunction: a Literature Review / Relação Entre Toxina Botulínica e Disfunção Temporomandibular: uma Revisão Bibliográfica

Temporomandibular dysfunction (TMD) encompasses several conditions affecting the temporomandibular joint and jaw muscles, leading to orofacial pain and other symptoms. Botulinum toxin is a potential therapy for relieving pain, improving jaw function, and reducing the use of analgesics. This study aims to systematically illustrate the application of botulinum toxin in the therapeutic context of TMD. This study took the form of a literature review, in which an analysis of knowledge repositories was conducted, including Medline (U.S. National Library of Medicine), accessed via PubMed, as well as Lilacs (Latin American and Caribbean Literature in Health Sciences), Scielo (Scientific Electronic Library Online), and Google Scholar. The selection involved the inclusion of studies published from 2015 to 2023. The literature review identified botulinum toxin as an effective and safe therapeutic alternative for TMD patients. The manifestation of side effects, when reported, was predominantly mild and transient in nature, granting botulinum toxin the prospect of establishing itself as a promising therapeutic option in refractory cases to conventional approaches. However, it is important to emphasize the need for further studies and clinical trials to further consolidate the efficacy and safety associated with the use of botulinum toxin as a treatment for TMD. (AU)

A disfunção temporomandibular (DTM) engloba várias condições que acometem a articulação e os músculos da mandíbula, causando dor orofacial e outros sintomas. A toxina botulínica é uma potencial terapia para aliviar a dor, melhorar a função mandibular e reduzir o uso de analgésicos. Este estudo visa ilustrar de forma sistemática a aplicação da toxina botulínica no contexto terapêutico da DTM. Este estudo assumiu a forma de uma revisão bibliográfica, na qual foi realziado uma análise de repositórios de conhecimento, incluindo o Medline (Biblioteca Nacional de Medicina dos Estados Unidos), acessado por meio do PubMed, assim como o Lilacs (Literatura Latino-Americana e do Caribe em Ciências da Saúde), o SciELO (Scientific Electronic Library Online) e o Google Scholar. A seleção envolveu a inclusão de estudos publicados no período de 2015 a 2023. A revisão bibliográfica identificou a toxina botulínica como uma alternativa terapêutica eficaz e segura para pacientes com DTM. A manifestação de efeitos colaterais, quando relatados, revelou-se predominantemente de natureza branda e transitória, outorgando à toxina botulínica a perspectiva de se consagrar como um recurso terapêutico promissor em situações refratárias às abordagens convencionais. No entanto, é importante enfatizar a necessidade de estudos prévios e ensaios clínicos para uma maior consolidação da eficácia e segurança associadas à utilização da toxina botulínica como tratamento para a DTM. (AU)

Reconstrução mamária com TRAM: avaliação tomográfica abdominal / Breast reconstruction with TRAM: abdominal tomographic evaluation

Introdução: O retalho transverso do músculo reto abdominal (TRAM) é um método de reconstrução mamária com bons resultados estéticos e dispensa o uso de próteses de silicone para melhor contorno corporal. Foi originalmente descrito por Holmstrom em 1979, como uma elipse de pele e gordura com base em um músculo isolado no seu pedículo vascular. A reconstrução sistematizada do defeito da parede instalado após a transposição do retalho com o uso de tela de polipropileno foi descrita em estudo prévio por Cunha. O artigo tem como objetivo avaliar as alterações na parede abdominal, após a sistematização da colocação da tela de polipropileno durante a cirurgia de reconstrução com TRAM. Método: É um trabalho de coorte retrospectivo que avalia as possíveis alterações da parede abdominal de pacientes submetidos ao retalho TRAM com tomografia computadorizada de abdome pré e pós-operatórias. Resultados: Foi evidenciada uma redução do tamanho da cavidade abdominal de, em média, 14,5% e 14,2% na espessura da parede abdominal submetidas ao TRAM. A maior redução da espessura da parede abdominal foi de um paciente submetido ao retalho bipediculado, com 50,7%. As complicações apresentadas foram hérnia umbilical, seroma tardio, fibrose peritela e granuloma de fio. Conclusão: Nesse estudo, a tomografia após a cirurgia demonstrou a redução no volume da cavidade abdominal e espessura da parede abdominal, o que não influenciou estatisticamente no aparecimento de hérnia abdominal, abaulamentos, extrusão da malha ou outras deformidades.

Introduction: The transverse rectus abdominis muscle flap (TRAM) is a method of breast reconstruction with good aesthetic results and does not require the use of silicone implants for better body contouring. It was originally described by Holmstrom in 1979 as an ellipse of skin and fat based on an isolated muscle on its vascular pedicle. The systematic reconstruction of the wall defect installed after flap transposition using polypropylene mesh was described in a previous study by Cunha. The article aims to evaluate changes in the abdominal wall, after the systematization of polypropylene mesh placement during TRAM reconstruction surgery. Method: This is a retrospective cohort study that evaluates possible changes in the abdominal wall of patients undergoing the TRAM flap with preand postoperative abdominal computed tomography. Results: A reduction in the size of the abdominal cavity of, on average, 14.5% and 14.2% in the thickness of the abdominal wall subjected to TRAM was evidenced. The greatest reduction in abdominal wall thickness was in a patient who underwent a bipedicled flap, with 50.7%. The complications presented were umbilical hernia, late seroma, perithellal fibrosis, and thread granuloma. Conclusion: In this study, tomography after surgery demonstrated a reduction in the volume of the abdominal cavity and thickness of the abdominal wall, which did not statistically influence the appearance of abdominal hernia, bulging, mesh extrusion, or other deformities.

Associação do retalho miocutâneo do músculo peitoral maior e da mamaplastia em T invertido para reconstrução de extenso defeito da parede torácica: relato de caso / Association of pectoralis major myocutaneous flap and inverted T mammoplasty for reconstruction of extensive chest wall defect: case report

Introdução: Em 1977, a partir dos estudos anatômicos de McCraw et al., passou-se a utilizar o músculo peitoral maior como retalho miocutâneo em ilha. O presente artigo descreve um caso de reconstrução de um defeito da parede anterior do hemitórax direito através do retalho miocutâneo peitoral maior em ilha ipsilateral. Relato do Caso: A.E.S., de 66 anos, sexo masculino foi submetido a ressecção ampla de um carcinoma basocelular infiltrativo recidivante de 13,0 x 8,0cm da região paraesternal direita. O retalho miocutâneo foi transposto através de tunelização subcutânea e as cicatrizes posicionadas em forma de mamaplastia em T invertido. Conclusão: A presente tática cirúrgica é de fácil execução para cirurgiões habituados com reconstrução mamária, apresenta tempo cirúrgico curto e resultado estético-funcional satisfatório.

Introduction: In 1977, based on anatomical studies by McCraw et al., the pectoralis major muscle began to be used as an island myocutaneous flap. The present article describes a case of reconstruction of a defect in the anterior wall of the right hemithorax using the pectoralis major myocutaneous flap in an ipsilateral island. Case Report: AES, 66 years old, male, underwent wide resection of a recurrent infiltrative basal cell carcinoma measuring 13.0 x 8.0 cm in the right parasternal region. The myocutaneous flap was transposed through subcutaneous tunneling and the scars were positioned in the shape of an inverted T mammoplasty. Conclusion: This surgical tactic is easy to perform for surgeons accustomed to breast reconstruction, has a short surgical time, and has satisfactory aesthetic-functional results.

Incremental Ramp Load Protocol to Assess Inspiratory Muscle Endurance in Healthy Individuals: Comparison with Incremental Step Loading Protocol

ABSTRACT Introduction: Protocols for obtaining the maximum threshold pressure have been applied with limited precision to evaluate inspiratory muscle endurance. In this sense, new protocols are needed to allow more reliable measurements. The purpose of the present study was to compare a new incremental ramp load protocol for the evaluation of inspiratory muscle endurance with the most used protocol in healthy individuals. Methods: This was a prospective cross-sectional study carried out in a single center. Ninety-two healthy individuals (43 men [22 ± 3 years] and 49 women [22 ± 3 years]) were randomly allocated to perform: (i) incremental ramp load protocol and (ii) incremental step loading protocol. The sustained pressure threshold (or maximum threshold pressure), maximum threshold pressure/dynamic strength index ratio, time until task failure, as well as difference between the mean heart rate of the last five minutes of baseline and the peak heart rate of the last 30 seconds of each protocol were measured. Results: Incremental ramp load protocol with small increases in the load and starting from minimum values of strength index was able to evaluate the inspiratory muscle endurance through the maximum threshold pressure of healthy individuals. Conclusion: The present study suggests that the incremental ramp load protocol is able to measure maximum threshold pressure in a more thorough way, with less progression and greater accuracy in the load stratification compared to the limited incremental step loading protocol and with a safe and expected cardiovascular response in healthy individuals.

Digital analysis of unilateral ptosis repair: external levator advancement vs. Müller's muscle conjunctival resection

ABSTRACT Purpose: Evaluation of lid contour and marginal peak point changes to compare outcomes of external levator advancement and Müller's muscle conjunctival resection surgery in unilateral ptosis. Methods: We reviewed the charts of unilateral ptosis patients who underwent external levator advancement or Müller's muscle conjunctival resection. Eyelid contour analysis was conducted on preoperative and 6-month postoperative digital images. This was performed with the multiple margin reflex distances technique, measuring the vertical distance from a line intersecting the center of the pupil to the eyelid margin at 10 positions at 2 mm intervals. The marginal peak point changes were analyzed digitally using the coordinates of the peak point according to the pupil center. Each position's mean distance was compared preoperatively, postoperatively, and with the fellow eyelid. Results: Sixteen patients underwent external levator advancement and 16 patients had Müller's muscle conjunctival resection. The mean margin reflex distance was improved by both techniques (1.46 vs. 2.43 mm and 1.12 vs. 2.25 mm, p=0.008 and p=0.0001 respectively) and approached that of the fellow eyelid (2.43 vs. 2.88 and 2.25 vs. 2.58 mm, p=0.23 and p=0.19, respectively). However, statistically significant lid margin elevation was limited to between the N6 and T6 points in the external levator advancement group. Whereas, significant elevation was achieved along the whole lid margin in the Müller's muscle conjunctival resection group. The marginal peak point was shifted slightly laterally in the external levator advancement group (p=0.11). Conclusions: Both techniques provide effective lid elevation, however, the external levator advancement's effect lessens toward the canthi while Müller's muscle conjunctival resection provides more uniform elevation across the lid margin. The margin reflex distance alone is not sufficient to reflect contour changes.

Efeitos da bandagem elástica na dor orofacial e nos movimentos mandibulares após 24 horas de uso: ensaio clínico randomizado / Effects of athletic tape on orofacial pain and jaw movements after 24 hours of use: a randomized clinical trial

RESUMO Objetivo Analisar a sensação de dor e amplitude dos movimentos mandibulares de indivíduos adultos com disfunção temporomandibular, antes e após aplicação da bandagem elástica por 24 horas. Método Trata-se de um ensaio clínico randomizado duplo-cego, do qual participaram 22 sujeitos adultos com disfunção temporomandibular, alocados aleatoriamente em dois grupos, sendo grupo A composto por 10 mulheres e um homem (média de idade de 28,2±8,3 anos) e grupo B por nove mulheres e dois homens (média de idade de 26,2±3,9 anos). Todos os participantes foram submetidos à aplicação do Diagnostic Criteria for Temporomandibular Disorders (DC/TMD). Foi realizada a avaliação do limiar da dor, com uso de um algômetro, para aplicação da pressão no masseter e temporal e medição dos movimentos mandibulares, com paquímetro. O grupo A foi submetido à aplicação da bandagem sobre o músculo masseter com estiramento de 40% e o grupo B sem estiramento. A colagem da bandagem foi realizada, com corte em "I", com ponto fixo sobre a inserção e ponto móvel sobre a origem do músculo masseter. Os participantes permaneceram com a bandagem por 24 horas e foram reavaliados. Resultados Houve alívio da dor no grupo A na articulação temporomandibular à direita e na origem do masseter à esquerda. O grupo B apresentou redução da dor em região de temporal anterior à esquerda. Não foram encontradas diferenças nos movimentos mandibulares após intervenção, bem como não houve diferença na comparação entre os grupos. Conclusão O uso da bandagem sobre o masseter, por 24 horas, com estiramento, produziu alívio da dor na origem do masseter direito e na região da articulação temporomandibular direita e, sem estiramento, no temporal anterior esquerdo. Não houve diferença na amplitude de movimentos mandibulares.

ABSTRACT Purpose To analyze the sensation of pain and the range of mandibular movements of adult individuals with temporomandibular disorder, before and after the application of the athletic tape. Method This is a double-blind randomized clinical trial, in which 22 adults with temporomandibular disorder participated, randomly allocated into two groups, with group A comprising 10 women and one man (mean age 28.2±8.3 years) and group B comprising nine women and two men (mean age 26.2±3.9 years). Group A was submitted to the application of the athletic tape on the masseter with 40% stretch and the group B to the application of the athletic tape on the masseter without stretching. All participants underwent the application of the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD). Pain threshold assessment was performed using an algometer to apply pressure to measurement points. The measurement of mandibular movements was performed using a caliper. The athletic tape was glued using the I technique, with a fixed point over the insertion and a movable point over the origin of the masseter muscle. Participants remained with the athletic tape for 24 hours and were re-evaluated. Results There was pain relief in the group A in the temporomandibular joint on the right and at the origin of the masseter on the left. The group B showed a reduction in pain in the left anterior temporal region. No differences were found in mandibular movements after intervention, as well as no difference was found in the comparison by groups. Conclusion The use of the athletic tape over the masseter muscle, with stretching, for 24 hours produced relief from the sensation of pain, on the origin of the right masseter and in the right temporomandibular joint, and, without stretching, in the left anterior temporal muscle. There was no difference in the range of mandibular movements.

Longitud muscular, dolor y funcionalidad en adultos jóvenes con disfunción de la articulación sacroilíaca

Introducción: La disfunción de la articulación sacroilíaca es un trastorno patomecánico, en la cual se pierde la estabilidad y se altera el funcionamiento de la cintura pélvica; también se modifica la capacidad de trasmitir y disipar fuerzas desde los miembros inferiores hacia la columna y viceversa. El acortamiento de músculos como el dorsal ancho, isquiotibiales y espinales lumbares puede alterar el control motor y generar lumbalgia. Objetivo: Evaluar la longitud muscular del dorsal ancho, los isquiotibiales, los espinales lumbares, el dolor y la funcionalidad en adultos jóvenes a partir de la comparación de tres grupos de estudio: dolor lumbar, disfunción de la articulación sacroilíaca y control. Métodos: Se realizó un estudio de corte transversal. Se incluyeron 114 personas de ambos sexos. La longitud muscular se evaluó a través de pruebas específicas para cada músculo. La escala visual análoga y el Oswestry se utilizaron para medir el dolor y la funcionalidad, respectivamente. Las diferencias de las variables entre los grupos de estudio se calcularon con la prueba de Chi2. Resultados: No se observaron diferencias en cuanto a longitud muscular en los grupos de estudio. El grupo con disfunción de la articulación sacroilíaca presentó más personas con dolor y limitación funcional moderada-severa. Conclusiones: Las retracciones del dorsal ancho, los isquiotibiales y los espinales lumbares no se relacionaron con el dolor lumbar o la disfunción de la articulación sacroilíaca; sin embargo, los adultos jóvenes de este grupo presentaron más molestias y discapacidad.

Introduction: Sacroiliac joint dysfunction is a pathomechanical alteration, in which stability is lost and the functioning of the pelvic girdle is altered; the ability to transmit and dissipate forces from the lower limbs to the spine and vice versa is also modified. The shortening of muscles such as the latissimus dorsi, hamstrings and lumbar spinal muscles can alter motor control and generate low back pain. Objective: To evaluate the muscle length of latissimus dorsi, hamstrings and lumbar spinal muscles, pain and functionality in young adults by comparing three study groups: pain, sacroiliac joint dysfunction and control. Methods: A cross-sectional study was carried out. A total of 114 subjects of both sexes were included. Muscle length was assessed through muscle-specific tests. The Visual Analog Scale and the Oswestry were used to measure pain and functionality, respectively. Differences in variables between study groups were calculated with the Chi2 test. Results: No differences in muscle length were observed in the study groups. The group with sacroiliac joint dysfunction presented more individuals with pain and moderate-severe functional limitation. Conclusions: Latissimus dorsi, hamstring and lumbar spinal retractions were not related to low back pain or sacroiliac joint dysfunction; however, young adults in this group presented more discomfort and disability.

Cirurgia de enucleação em decorrência de proptose do globo ocular em cadela: relato de caso / Enucleation surgery due to proptosis of the eyeball in a female dog: case report / Cirugía de enucleación por proptosis del globo ocular en una perra: informe de un caso

A proptose do globo ocular é uma das consequências comuns do trauma e a enucleação é um procedimento de escolha em caso de impossibilidade de reversão do quadro. Nota-se a infrequência de relatos de enucleação do globo ocular resultante de proptose traumática, o que torna importante a descrição deste caso, a qual objetiva fornecer relevantes informações e contribuições para o desenvolvimento da oftalmologia e clínica cirúrgica veterinária. Uma cadela filhote foi atendida no HVU - UFPI/CPCE, apresentando o globo ocular direito prolapsado. A enucleação foi selecionada em decorrência do intervalo prolongado entre a detecção da lesão e a busca por assistência médica, da presença de uma alta carga de corpos estranhos observados e da ausência de reflexos pupilares. A cirurgia iniciou-se com a cantotomia seguida da dissecação da musculatura do globo ocular. Foi realizado o pinçamento dos vasos sanguíneos e do nervo óptico, e fez-se a ressecção do globo ocular. Depois de uma ligadura invaginante e redução do espaço morto, removeu-se as bordas palpebrais e realizou-se a blefarorrafia. Cerca de 40 dias após a enucleação, a cadela apresentou-se estável e com uma evolução cicatricial satisfatória do ferimento cirúrgico. Esse procedimento, foi realizado de forma semelhante ao que é visto na literatura, embora, majoritariamente, seja recomendada a enucleação em decorrência de afecções diferentes da proptose traumática.(AU)

Proptosis of the eyeball is one of the common consequences of trauma and enucleation is the procedure of choice if it is impossible to reverse the condition. There are few reports of enucleation of the eyeball resulting from traumatic proptosis, which makes it important to describe this case, which aims to provide relevant information and contributions to the development of ophthalmology and veterinary surgical practice. A female puppy was seen at the HVU - UFPI/CPCE, presenting with a prolapsed right eyeball. Enucleation was selected due to the prolonged interval between detecting the lesion and seeking medical assistance, the presence of a high foreign body burden and the absence of pupillary reflexes. Surgery began with canthotomy followed by dissection of the eyeball muscles. The blood vessels and optic nerve were clamped and the eyeball was resected. After an invaginating ligature and reduction of the dead space, the eyelid edges were removed and blepharorrhaphy was performed. Around 40 days after enucleation, the dog was stable and had satisfactory healing of the surgical wound. This procedure was carried out in a similar way to that seen in the literature, although enucleation is mostly recommended for conditions other than traumatic proptosis.(AU)

La proptosis del globo ocular es una de las consecuencias comunes de los traumatismos y la enucleación es el procedimiento de elección si es imposible revertir la condición. Existen pocos relatos de enucleación del globo ocular resultante de proptosis traumática, lo que torna importante la descripción de este caso, que pretende proporcionar informaciones relevantes y contribuciones para el desarrollo de la oftalmología y de la práctica quirúrgica veterinaria. Una cachorra fue atendida en el HVU - UFPI/CPCE con prolapso del globo ocular derecho. Se optó por la enucleación debido al prolongado intervalo entre la detección de la lesión y la búsqueda de asistencia médica, la presencia de una elevada carga de cuerpo extraño y la ausencia de reflejos pupilares. La cirugía comenzó con una cantotomía seguida de la disección de los músculos del globo ocular. Se pinzaron los vasos sanguíneos y el nervio óptico y se resecó el globo ocular. Tras una ligadura invaginante y la reducción del espacio muerto, se retiraron los bordes de los párpados y se realizó una blefarorrafia. Unos 40 días después de la enucleación, el perro estaba estable y la herida quirúrgica había cicatrizado satisfactoriamente. Este procedimiento se llevó a cabo de forma similar a lo visto en la bibliografía, aunque la enucleación se recomienda sobre todo para afecciones distintas de la proptosis traumática.(AU)

Research progress on the application of botulinum toxin type A in the treatment of myogenous temporomandibular disorders / 口腔疾病防治

@#Myogenous temporomandibular disorder (M-TMD) is one of the main subtypes of temporomandibular disorder (TMD) and typically manifests as masticatory myofascial pain; the incidence of TMD has been increasing annually in recent years. Botulinum toxin type A (BTX-A) is a potent neurotoxin produced by Clostridium botulinum. BTX-A inhibits the release of acetylcholine from the presynaptic membrane, thereby blocking neuromuscular junction signaling. The noncosmetic application of BTX-A in the oral and maxillofacial regions is a prominent research topic. In recent years, an increasing number of studies have focused on the application of BTX-A in the treatment of M-TMD. The results of a literature review revealed that an appropriate dose (10-50 U unilaterally) of BTX-A administered in a single injection into the masticatory muscles can effectively treat myalgia over a period of 3-6 months. Common adverse effects, such as masticatory weakness and facial paralysis, are transient and can be avoided by standardized injection techniques. However, there is a lack of standardized guidelines for injection techniques in clinical practice.

Effects of dry swallowing and swallowing tasks of varying consistencies and volumes on the hyoid muscles in healthy adults / 中国组织工程研究

BACKGROUND:Modification of food consistency and volume is a commonly used method of swallowing compensation in clinical practice.Dry swallowing is a commonly used method of evaluation.The hyoid muscles are very important in swallowing.The effects of dry swallowing and swallowing tasks of different consistencies and volumes on hyoid muscle activation levels are still unclear. OBJECTIVE:To explore the effects of simple dry swallowing and swallowing tasks of different consistencies and volumes on the hyoid muscles in healthy adults. METHODS:A total of 44 healthy adults were included from April to August 2019,including 19 males and 25 females,with an average age of(21.7±2.8)years.They randomly performed dry swallowing and swallowing tasks of different consistencies(the International Dysphagia Diet Standardisation Initiative(IDDSI)frame levels 0-4)and volumes(5,10,20 mL),and the surface electromyogram signals of the hyoid muscles during each swallowing task were recorded.After processing the raw surface electromyogram signals,the activation levels of the hyoid muscles were compared between dry swallowing and swallowing tasks of different consistency and volume. RESULTS AND CONCLUSION:The mean amplitude values of the suprahyoid muscles corresponding to swallowing tasks of 20 mL for levels 0-4,10 mL for level 3,and 5 mL for level 4 were higher than those of dry swallowing(P＜0.05).The mean amplitude values of the suprahyoid muscles corresponding to the 20-mL swallowing tasks of different consistencies were higher than those of the 5-mL swallowing tasks of the corresponding consistencies,except for level 3(P＜0.05).The mean amplitude values of the suprahyoid muscles corresponding to the 20-mL swallowing tasks of different consistencies were higher than those of the 10-mL swallowing tasks of the corresponding consistencies,except for levels 2 and 3(P＜0.05).The mean amplitude values of the infrahyoid muscles corresponding to all swallowing tasks were higher than that of dry swallowing(P＜0.05).The mean amplitude values of the infrahyoid muscles corresponding to the 20-mL swallowing tasks of different consistencies were higher than that of the 5-and 10-mL swallowing tasks of the corresponding consistencies(P＜0.05).The mean amplitude values of the infrahyoid muscles corresponding to the 10-mL swallowing tasks of different consistencies were higher than those of the 5-mL swallowing tasks of the corresponding consistencies,except for level 3(P＜0.05).To conclude,in healthy adults performing swallowing tasks of different volumes and consistencies,the level of activation of the hyoid muscles is less susceptible to IDDSI frame levels 0-4 consistency and more susceptible to volume.The higher volume indicates the higher activation level of the hyoid muscles.

Effect of anterior quadratus lumborum block at the lateral supra-arcuate ligament on postoperative pulmonary function in patients undergoing robot-assisted laparoscopic radical prostatectomy under general anesthesia / 中华麻醉学杂志

Objective:To evaluate the effect of anterior quadratus lumborum block at the lateral supra-arcuate ligament on the postoperative pulmonary function in patients undergoing robot-assisted laparoscopic radical prostatectomy under general anesthesia.Methods:Seventy-two American Society of Anesthesiologists Physical Status classification Ⅰ-Ⅲ patients, aged 50-80 yr, with body mass index of 18.5-27.9 kg/m 2, scheduled for elective robot-assisted laparoscopic radical prostatectomy under general anesthesia, were divided into 2 groups ( n=36 each) using a random number table method: control group and observation group. After induction of general anesthesia, observation group underwent anterior quadratus lumborum block at the lateral supra-arcuate ligament under ultrasound guidance, with 20 ml of 0.375% ropivacaine administered on each side. Control group only received total intravenous anesthesia. Postoperative analgesia was provided by patient-controlled intravenous analgesia until 48 h after operation, and intravenous dezocine was administered as rescue analgesic when the visual analogue scale score at rest≥4. Pulmonary function was assessed at 1 day before surgery and 1-7 days after surgery. Forced vital capacity (FVC), forced expiratory volume in 1 s (FEV 1), maximal mid-expiratory flow rate (FEF 25%-75%), and time to recovery of 80% predicted pulmonary function were recorded. Arterial blood gas analysis was performed at 1 day before surgery and 1-3 days after surgery, and SpO 2, PaO 2 and PaCO 2 were recorded. The consumption of intraoperative remifentanil, effective pressing times of patient-controlled analgesia, and the number of patients required rescue analgesia were recorded. Postoperative pulmonary complications within 7 days after operation and re-hospitalization within 30 days were recorded. The time to first flatus, postoperative length of hospital stay and occurrence of adverse reactions (dizziness, nausea, vomiting) within 3 days after surgery were also recorded. Results:Compared with control group, FVC, FEV 1 and FEF 25%-75% were significantly increased postoperatively, the time to recovery of 80% FVC, FEV 1 and FEF 25%-75% was shortened, postoperative SpO 2 and PaO 2 were increased, postoperative PaCO 2 was decreased, the consumption of intraoperative remifentanil, effective pressing times of patient-controlled analgesia, and the number of patients required rescue analgesia were reduced, the postoperative time to first flatus and length of hospital stay were shortened, and the incidence of adverse reactions and pulmonary complications was decreased ( P<0.05). Conclusions:Anterior quadratus lumborum block at the lateral supra-arcuate ligament can improve postoperative pulmonary function, reduce adverse reactions, and promote early recovery for the patients undergoing robot-assisted laparoscopic radical prostatectomy under general anesthesia.

Masticatory muscle weakness as the main manifestation in a patient with Kennedy′s disease: a case report / 中华神经科杂志

Kennedy′s disease usually begins with limbs weakness, especially lower limbs weakness and atrophy, accompanied by tongue atrophy. A case of Kennedy′s disease with masticatory muscle weakness and atrophy as the first and main symptoms was reported. The patient was a middle-aged male who had been weak chewing for 7 years with progressive deterioration and needed to hold his jaw with his hand while chewing or speaking. There was no significant limbs weakness throughout the course. Physical examination showed strength of limbs grade Ⅴ, only mild tongue atrophy, but serious masticatory muscle atrophy and weak chowing. He was finally definitely diagnosed with Kennedy′s disease by genetic testing. Masticatory muscle atrophy and weak chowing as the main phenotype is rare in Kennedy′s disease. This case will help clinicians to strengthen the understanding of this rare clinical phenotype of Kennedy′s disease.

The effectiveness of different training modes of six-character qigong in improving respiratory muscle functioning after a stroke / 中华物理医学与康复杂志

Objective:To explore the impact of different six-character qigong training modes on respiratory muscle function early after a stroke.Methods:Sixty-six stroke survivors in the early stage of recovery were randomly divided into a control group, a modified training group, and an ancient training group, each of 22. In addition to routine rehabilitation training, the control group received conventional respiratory training. The modified training and ancient training groups were trained in modified six-character qigong or ancient six-character qigong, respectively, for two weeks. Before the treatment, after the two weeks and one month later, maximum inspiratory pressure (MIP) and maximum expiratory pressure (MEP), forced expiratory volume in one second, forced vital capacity, peak expiratory flow, maximum mid-expiratory flow, and peak inspiratory flow were measured. Diaphragm mobility during quiet inspiration and maximum inspiration were also quantified.Results:After 2 weeks of treatment and at 1 and 3 months after the end of the treatment, all three groups showed significant improvement in MIP, MEP and the pulmonary ventilation indicators, but the average improvement in the modified training group was significantly greater than in the other two groups. Their average diaphragm mobility was also significantly greater.Conclusion:Modified six-character qigong respiratory training is more effective than its ancient counterpart in improving respiratory muscle function, pulmonary ventilation, and diaphragm mobility early after a stroke, with effects which persist for at least one month.

Research progress on the molecular genetics and neuroscience of congenital cranial dysinnervation disorders / 国际眼科杂志(Guoji Yanke Zazhi)

Congenital cranial dysinnervation disorders(CCDDs)are a group of diseases with congenital non-progressive developmental abnormalities or absence of one or more cranial nerves, resulting in primary or secondary abnormalities of cranial nerves innervating the extraocular muscles. CCDDs can be sporadic or hereditary, and may be accompanied by systemic abnormalities. In recent years, with the research progress of neuropathology, neuroimaging, and genetics, it has not only been clarified that the cause of eye movement disorder in CCDDs is neurogenic, but also been found the pathogenic genes of CCDDs, including SALL4, HOXA1, KIF21A, PHOX2A, TUBB3, and HOXB1, etc. In this review, the relevant domestic and international literatures on the molecular genetics and neuroscience of CCDDs in recent years are reviewed, aiming to address how the causing gene mutations of CCDDs affect brain neural development and further lead to congenital abnormal cranial nerve innervation, in order to provide references for the clinical and basic research of CCDDs.

Effect of core muscles training based on spinal fine-tuning manipulation on lumbar spine function and quality of life in patients with lumbar facet joint disorders / 中国康复理论与实践

ObjectiveTo explore the effect of core muscles training based on spinal fine-tuning manipulation on lumbar facet joint disorders. MethodsFrom February, 2021 to February, 2022, 80 patients with lumbar facet joint disorders in Huadong Hospital Affiliated to Fudan University were randomly divided into control group (n = 40) and observation group (n = 40) randomly. Both groups received routine treatment and spinal fine-tuning manipulation, while the observation group received core muscles training in addition, for six weeks. They were assessed with Japanese Orthopaedic Association (JOA) scores, Short-Form of McGill Pain Questionnaire and World Health Organization Quality of Life-BREF before and after treatment. The recurrence rate was observed after three months follow-up. ResultsThe scores of all the scales improved after treatment (t > 5.751, P < 0.001), and improved more in the observation group than in the control group (t > 2.051, P < 0.05). After three months follow-up, the recurrence rate was 7.89% (3/38) in the observation group, less than 28.13% (9/32) in the control group (χ2 = 5.005, P = 0.025). ConclusionCombination of core muscles training may improve lumbar function, reduce lumbar pain, reduce recurrence and improve quality of life for patients with lumbar facet joint disorders.

Anatomic barriers to paraspinal blocks: a cadaver case series

Abstract The paraspinal space is intriguing in nature. There are several needle tip placements described in compact anatomical spaces. This has led to an incertitude regarding the appropriate anatomic locations for needle tip positions. Through our cadaver models we try to resolve the issues surrounding needle tip positions clarifying anatomical spaces and barriers. Further we propose an anatomical classification based on our findings in cadaveric open dissections and cross and sagittal sections.