Distribution of plantar pressures during gait in different zones of the foot in healthy children: the effects of laterality.

The objective was to determine whether gait is symmetric in healthy children 6-7 years of age and to assess the effects of laterality and the anatomical zone of the foot. 46 children were subjected to gait symmetry analysis in which the plantar and lateral pressures associated with kicking a ball, static balance, and dynamic support were measured. There were no significant differences in the average pressure exerted by the right and left feet based on the laterality of the child. Independent of each laterality test, a greater pressure on the right rearfoot was observed compared to the left rearfoot and on the left midfoot and forefoot compared to the right.

Barcelona consensus on supermicrosurgery.

The popularity of supermicrosurgery has increased dramatically over the past few years, but the lack of agreement regarding the name of the technique and its applications has caused misunderstandings among microsurgeons when trying to communicate and compare surgical procedures. We report the consensus reached on the name used to refer to supermicrosurgery techniques following the First European Conference on Supramicrosurgery held in Barcelona (Spain) on March 4-5, 2010. Present applications, advantages, and disadvantages of supermicrosurgery are discussed. It was agreed that supermicrosurgery was the most accurate name to reflect the essence of this extremely delicate technique. According to Koshima, supermicrosurgery is a technique of microneurovascular anastomosis for vessels of 0.3 to 0.8 mm and single nerve fascicles. The range of applications for this technique has increased rapidly and now includes lymphedema treatment, nerve reconstruction, replantation and reconstruction of amputated fingertips, microsurgical flap salvage, and new possibilities for free tissue transfer. Supermicrosurgery is a remarkably useful reconstructive tool that involves a great deal of skill and has a steep learning curve for the microsurgeon to master. Although it is currently performed by only a minority of microsurgeons, we consider it will be incorporated into conventional microsurgery in the near future.

Modified anterior intercostal artery perforator flap (AICAP) for autologous breast volume restoration after explantation.

Explantation of breast implants has become increasingly common. This study aimed to analyze breast auto-augmentation following implant explantation (using a laterally designed anterior intercostal artery perforator [AICAP] flap) in patients who did not need new implants and required volume preservation. Twenty-four patients (48 breasts) aged 31-67 years (mean, 52.4 years) with body mass index (BMI) between 24.43 and 29.34 (mean, 27.32) kg/m2 underwent this procedure. All patients had implant-related problems, such as recurrent capsular contracture (n=11), seroma (n=2), animation deformity (n=3), rupture-induced bleeding (n=5), and breast implant disease (n=3). Sizes of implants removed ranged from 215 to 355 ml. The mean flap size was 23.9 cm × 7.5 cm, and the average flap thickness was 2.3 cm (range, 2.0-3.2 cm). Flap survival was clinically examined postoperatively by ultrasonography. Pre- and postoperative final breast volumes were compared by direct patient observation and independent photograph observation by three plastic surgeons according to a 4-point scale (bad=1, regular=2, good=3, and excellent=4) and the brassiere size. All flaps were completely viable after harvesting. No postoperative signs of fat necrosis were observed, and independent plastic surgeon evaluation revealed good and excellent results in all cases. Patient satisfaction evaluated by BREAST-Q data was >90%. This new design, AICAP flap (with a lateral thoracic extension), can be safely used for breast volume restitution after breast implant explantation with high patient satisfaction. This flap exhibited reasonable potential of providing additional volume in patients who undergo implant explantation and require the preservation of similar volume.

Influence of organised sports practice during adolescence on health of adult women with special emphasis on participation in aesthetic sports.

This study aimed to assess the differences in psychosocial health and cardiometabolic risk during adulthood in women based on previously organised sport (OS) participation during adolescence and current activity levels, with emphasis on participation in aesthetic sports. The study included 1947 women aged 18-55 years who were categorised into four groups: 355 aesthetic athletes during adolescence, 494 non- aesthetic athletes during adolescence, 791 non-athletes during adolescence with similar current levels of physical activity (PA) to OS groups and 307 currently inactive non-athletes during adolescence. Participants answered questionnaires regarding sport participation, psychosocial health and cardiometabolic risk. The results show that non-athletes during adolescence who are currently inactive reported significantly lower psychosocial health and higher cardiometabolic risk scores. Women with currently homogenous PA levels (χ² = 0.514) reported similar physical quality of life (QoL), exercise addiction, anxiety and depression symptoms regardless of participation in OS during adolescence (P > .05), except aesthetic athletes who reported the worst sleep and mental QoL. Very high training volumes in aesthetic athletes did not influence psychological outcomes and cardiometabolic risk in adulthood compared to lower training volumes. In conclusion, the effects of PA during adulthood appear to be powerful enough to induce beneficial adaptations in health outcomes that match those observed in women who participate in OS during adolescence, except for aesthetic sports participants, who show a high risk of lower quality of sleep in adulthood. PA should be promoted in adults and especially women who have not participated in OS during adolescence.

Socio-economic impact on women diagnosed and treated for breast cancer: a cross-sectional study.

INTRODUCTION: The increase in breast cancer survival poses a challenge for patients to be able to rejoin their professional and social life in very similar conditions to those before diagnosis. The aim of this study is to assess short- and medium-term social, economic and professional impact of BC among women diagnosed with it. METHODS: A cross-sectional descriptive study using QLQ-C30, QLQ-BR23, and MOS-SSS instruments and a semi-structured interview in women diagnosed in years 2011, 2014, and 2016 in Hospital de la Santa Creu i Sant Pau in Barcelona (Spain). RESULTS: 175 patients were included with a mean age of 55. About 62.8% were married or coupled, 76% were living with their family unit, and 52.6% denied changes in their living situation. The mean Support Global Index was 74.7% and 78.8% before and after diagnosis, respectively. The mean global quality of life (QOL) was 67.3%, outstanding insomnia as the main symptom (X > 30%) and sexual function as the most affected dimension. At the moment of diagnosis, two-thirds of patients were working. After diagnosis, 87.5% stopped working, 39.4% were off work for 7-12 months, and only 50% returned to work. Multivariate analysis identified working as the most associated variable with a good QOL. CONCLUSIONS: QOL among women diagnosed with breast cancer is quite high and stable. Nevertheless, there are some very relevant aspects to QOL that need to be considered whilst caring for patients with BC to achieve rehabilitation as complete and comprehensive as possible.

Preoperative planning of lymphaticovenous anastomosis: The use of magnetic resonance lymphangiography as a complement to indocyanine green lymphography.

BACKGROUND: Lymphaticovenous anastomosis (LVA) is a surgical treatment for lymphedema that requires identification and mapping of functional lymphatic channels. This technique was performed blindly for years because of the lack of suitable methods of study. Progress in imaging techniques and the introduction of Indocyanine green lymphography (ICG-L) represented a significant advancement in lymphedema management. Magnetic resonance lymphangiography (MRL) has also helped improve knowledge about lymphedema anatomy and pathophysiology. We now present our protocol based on both ICG-L and MRL for optimal LVA preoperative planning. METHODS: A prospective study between April 2010 and June 2015 was conducted in 82 patients (77 females, mean age 45.5 years) with stage I (9.8%), II (73.2%), and III (17.0%) lymphedema. All patients underwent lymphedema surgical treatment with LVA. Surgery was planned based on preoperative information from ICG- L and MRL. RESULTS: We obtained a mean of 6.87 lymphatic locations per extremity from MRL and selected a mean of 4.04 for LVA. When MRL data coincided with ICG-L data, we found a functional lymphatic vessel in 96.9% of cases and performed LVA successfully in 91.4%. CONCLUSIONS: ICG-L and MRL are noninvasive techniques that provide images of the lymphatic system with sufficient temporal and spatial resolution to depict functional lymphatic vessels. Such knowledge is essential for preoperative planning of LVA microsurgery. We present our protocol for the approach of surgical treatment of lymphedema. This protocol represents a step forward in unifying patient selection criteria and achieving safe, effective, and rational surgery.

An analysis of resistance training based on the maintenance of mechanical power.

Resistance training techniques, that increase the global power output of an exercise, exercise set and continuous sets, can optimize neuromuscular adaptation and dynamic athletic performance. An observation that is apparent during traditional resistance training is the slowing of movement velocity as fatigue increases. To perform at maximum velocity, only repetitions that permit maintenance of the maximum power output are essential for increasing the global power output. This article reviews the available research which examines the pattern of velocity decrease with different load intensities. In addition, an analysis is performed of the possible advantages of resistance training based on the maintenance of the mechanical power versus traditional resistance training. Furthermore, a variety of fact-finding lines are proposed with the objective of answering the numerous open questions related to resistance training based on the maintenance of mechanical power.

[Human dignity and terminal situations]. / Dignidad humana y situaciones terminales.

Dignity should not be confused with the unbecoming conditions that a person can find himself in due to external situations or disease. The person/patient in a terminal situation has human dignity, which must be respected not because he/she is a terminal patient but simply because he/she is a person. But it is true that in terminal situations dignity can be particularly threatened. Nonetheless, one must not deduce from the criterion of respecting dignity the conclusion of prolonging biological life at all costs, but instead that of guaranteeing the best quality of living during the process of dying and of worthily accompanying the person who is approaching death by helping him to accept this.

Oncological safety of breast cancer patients undergoing free-flap reconstruction and lipofilling.

BACKGROUND: Autologous fat grafting is a widely accepted approach for breast reconstruction after mastectomy but its oncological safety has not been established. This study aimed to compare recurrence in patients who underwent fat-grafting procedures after autologous breast reconstruction and those who did not. PATIENTS AND METHODS: We retrospectively reviewed 207 consecutive patients, who underwent mastectomy and reconstruction using free flap surgery. We divide them in two groups: a study group of patients who underwent fat grafting procedure and a control group of patients who did not. Outcome regarding local and regional recurrence was compared between the two groups. Particularly, we studied recurrences from primary surgery to baseline (first lipofilling) and from baseline to most recent follow-up. RESULTS: Median follow-up was 60 months from surgery to baseline and 29 months from baseline to most recent follow-up. The overall observational period after mastectomy in the control group was 120 months. Local recurrence was observed in 6 patients from the study group, respectively 3 in the first observational period and 3 after the fat grafting procedure. The control group, as the study one, presented a total of 6 recurrences (p = 0.555; Hazard Ratio free flap and lipo vs only free flap: = 0.66; 95% CI 0.16-2.66). CONCLUSIONS: We found no significant differences in recurrence between patients who underwent fat grafting and those who did not. These encouraging findings support previous results but larger series of patients are required to confirm long-term oncological safety in these procedures.

Comparación entre Web of Science y Scopus: estudio bibliométrico de las revistas de anatomía y morfología / Comparison between Web of Science and Scopus: bibliometric study of anatomy and morphology journals

El objetivo de este trabajo es comparar los indicadores bibliométricos básicos del área de anatomía y morfología dentro de las bases de datos de Web of Science (en adelante WoS) y Scopus. La metodología llevada a cabo se basa en una búsqueda bibliométrica realizada en Web of Knowledge y Scopus. La muestra la conforman el conjunto de revistas indexadas en ambas bases de datos del área citada. Los resultados indican que el número de revistas fue mayor en Scopus que en WoS (42 vs. 21). El índice citas/artículo global es mayor en Scopus. Solamente hay dos revistas que permiten publicar sus artículos en un idioma diferente al inglés en WoS y tres en Scopus. En WoS, los valores de factor de impacto y del índice h tienen una correlación de 0,17, mientras que en la base de datos Scopus los valores de correlación entre el factor de impacto y del índice h, son muy superiores, tiene una correlación de 0,79. La mayoría de revistas están editadas en países anglosajones. Las conclusiones del estudio nos llevan a resaltar que existe un mayor número de revistas y citas en Scopus comparado con WoS. La utilización del factor de impacto para la evaluación de una revista parece ser un indicador más conveniente a corto plazo, siendo el índice h un indicador que refleja la influencia a largo plazo de una publicación y posiblemente refleja mejor la categoría científica de ésta. En la actualidad es conveniente aconsejar el uso de varios índices en la evaluación de la calidad de las revistas.

The aim of this study is to compare the basic bibliometric indicators in the area of anatomy and morphology inside the databases Web of Science and Scopus. The methodology carried out is based on a bibliometric search conducted in Scopus and Web of Knowledge. The sample comprises the set of journals indexed in both databases of the cited field. The results indicate that the number of journals was higher in Scopus than WoS (42 vs. 21). The overall reference / article index is higher in Scopus. There are only two journals that allow publication of papers in a language other than English, one in WoS and three in Scopus. In WoS, the impact factor value and h-index has a correlation of 0.17, while the Scopus database correlation values between the impact factor and h-index, are far superior, it has a correlation 0.79. Most journals are published in English-speaking countries. These findings lead us to highlight that there are a greater number of citations in Scopus journals compared with WoS. The use of the impact factor to evaluate a journal seems to be a more convenient short-term indicator, the h index is an indicator that reflects the long-term influence of a publication and could also better determine the article´s scientific category. Currently, the use of various indices is advisable in evaluating the quality of journals.

The validity of incremental exercise testing in discriminating of physiological profiles in elite runners.

The goal of this study was to determine whether traditional ergoespirometric incremental exercise testing carried out to the point of exhaustion could be useful in distinguishing the physiological profiles of elite runners that compete in races that lasted about 8 minutes versus those that lasted about 2 hours. Ten male marathon runners (performance time: 2:12:04, coefficient of variation (CV) = 2.33%) and 8 male 3000 m steeplechase runners (performance time: 8:37.83, CV = 2.12%) performed an incremental test on the treadmill (starting speed 10 km·h-1; increments, 2 km·h-1; increment duration, 3 min to exhaustion). Heart rate (HR), VO2, and lactate concentrations were measured at the end of each exercise level. At maximal effort, there were no differences between the groups regarding VO2max and maximal HR; however, the workload time, vVO2max and peak treadmill velocity were significantly higher in the 3000 m steeplechase group (p<0.05). At submaximal effort, there were no significant differences between groups for VO2 (ml·kg-1·min-1), HR, or lactate. Our results show that this type of testing was not sufficient for discriminating the physiological profiles of elite runners who competed in middle-distance versus long-distance events (e.g. in the marathon and the 3000 m steeplechase).

Multidetector-row computed tomography in the planning of abdominal perforator flaps.

An accurate preoperative evaluation of the vascular anatomy of the abdominal wall is extremely valuable in improving the surgical strategy in abdominal perforator flaps. The multidetector-row computer tomography offers thin slice coverage of extended volumes with an extremely high spatial resolution. From October 2003 to December 2004, 66 female patients had breast reconstruction surgery in our department using the deep inferior epigastric artery perforator flap. Our multidetector-row computer tomography studies were performed using a 16-detector-row computer tomography scanner. The image assessment was carried out using the following protocol: we first identified the best three perforators from each side of the abdomen. Then we conducted a three-dimensional reconstruction of the abdomen by identifying exactly where the three best perforators emerged from the rectus abdominis fascia. We then transferred the data obtained from the image to the patient using a coordinate system. In addition, we also placed the dominant perforators in the patient by using a conventional hand-held Doppler. During the operation we compared intra-operative findings, Doppler results and computer tomography outcomes. Neither false positive nor false negative results were found in the computer tomography outcome. Multidetector-row computer tomography provides us with an easy method of interpreting the virtual anatomic dissection in three dimensions. It has high sensitivity and specificity and provides a good quality evaluation of the perforator vessels. This information allows reduction of operating time and safer performance of surgery. The multidetector-row computer tomography is a highly effective tool in the preoperative study of abdominal perforator flaps.

Competitive and uncompetitive inhibitors simultaneously acting on an autocatalytic zymogen activation reaction.

The time course of the residual enzyme activity of a general model consisting of an autocatalytic zymogen activation process inhibited by an irreversible competitive inhibitor and an irreversible uncompetitive inhibitor has been studied. Approached analytical expressions which furnish the time course of the residual enzyme activity from the onset of the reaction depending on the rate constants and initial concentration have been obtained. The goodness and limitations of the analytical equations were checked by comparing with the results obtained from the numerical integration, i.e. with the simulated progress curves. A dimensionless parameter giving the relative contributions of both the activation and the inhibitions routes is suggested, so that the value of this parameter determines whether the activation or the inhibitions routes prevail or if both processes are balanced during the time for which the analytical expressions are valid. The effects of the initial zymogen, free enzyme and inhibitors concentrations are analysed. Finally an experimental design and kinetic data analysis is proposed to evaluate simultaneously the kinetic parameters involved and to discriminate between different zymogen activation processes which can be considered particular cases of the general model.