Anatomical Study of the Superficial Musculoaponeurotic System in Relation to the Zygomaticus Major.

BACKGROUND: The superficial musculoaponeurotic system (SMAS) is crucial for the structural integrity and dynamics of facial expressions and is a particularly important consideration during facelift surgeries. This study investigated the anatomical structure and continuity of the SMAS at the site where the zygomaticus major (Zmj) originates, which is where the SMAS extends from the lateral to the anterior aspects of the face. Knowledge of these aspects is crucial for understanding the mechanics of facial movements and also the aging process. METHODS: Dissections of 66 specimens and histological analyses were used to explore the intricate relationships and attachments between the SMAS and facial muscles. RESULTS: The findings indicated that at the Zmj origin site, the SMAS-connected to the inferior margin of the orbicularis oculi-covered the superficial surface of the Zmj fibers. As it tracked downward, the SMAS was observed to split into two layers lateral to the Zmj fibers, enveloping them both superficially and deeply. Additionally, as the SMAS continued forward, it ceased to be distinctly visible in the buccal area. CONCLUSIONS: These results provide a deeper understanding of the complex layering and interconnectivity of the SMAS, which supports facial dynamics and structural integrity. This information could be particularly useful in surgical and aesthetic procedures in the midfacial area.

Consensus document on the implications of standardization of BCG supply in the management of patients with non-muscle-invasive bladder cancer.

Patients with non-muscle-invasive bladder cancer (NMIBC) in the intermediate and high-risk groups must receive adjuvant treatment with intravesical Bacillus Calmette-Guérin (BCG) following transurethral resection (TUR), as it reduces the risk of recurrence and presumably the risk of progression as well. Optimization of BCG efficacy is achieved by administering maintenance therapy. However, since many immunological aspects of the mechanism of action of BCG in the bladder remain unknown, the implementation of the optimal dose, number of instillations, strains and adequate maintenance regimen over the last decades has been heterogeneous. Additionally, this has hindered the interpretation of efficacy in terms of oncologic outcomes. This, together with the shortages of BCG in recent years, have forced scientific societies to adapt their clinical practice guidelines and modify their protocols of adjuvant treatment with BCG. This includes changes to strains, doses, and maintenance during this period of time. This consensus document evaluates the current status of adjuvant BCG treatment and the implications of BCG supply availability in the treatment of patients with NMIBC. It also addresses the implementation of novel therapies that will improve cancer prognosis and the quality of life of patients with NMIBC in the future.

Associação de dinapenia, sarcopenia, aptidão física e capacidade funcional em adultos fisicamente ativos no Brasil / Association of dynapenia, sarcopenia, physical fitness and functional capacity in physically active adults in Brazil

Contexto e objetivo: O envelhecimento está associado a diversas alterações fisiológicas que podem afetar a aptidão física e a capacidade funcional, como a sarcopenia e a dinapenia. O presente estudo teve como objetivo descrever e comparar aspectos físicos e funcionais de adultos em relação aos critérios de sarcopenia e dinapenia. Desenho e local: Os participantes faziam parte do Projeto Misto Longitudinal de Aptidão Física e Capacidade Funcional de São Caetano do Sul, que busca avaliar e acompanhar a saúde e o desempenho físico de idosos na região. A amostra foi composta por 1480 participantes com idade acima de 50 anos e média de 66,5 anos. Métodos: Para a classificação da sarcopenia e dinapenia, foram adotados os critérios do Asian Working Group for Sarcopenia e do European Working Group on Sarcopenia in Older People. Uma análise estatística foi realizada utilizando a análise de covariância ANCOVA não paramétrica, ajustada pelo sexo, idade e índice de massa corporal (IMC), buscando comparar a capacidade funcional entre os grupos. Foi adotado um nível de significância de P < 0,05 e o software utilizado para as análises foi o SPSS versão 25. Resultados: A prevalência de sarcopenia na amostra foi de 3% e de dinapenia, 62,3%. Foram identificadas diferenças estatisticamente significativas nas variáveis de aptidão física e capacidade funcional. Conclusão: A massa muscular isoladamente pode não ser um critério adequado para definir sarcopenia em adultos, pela não-linearidade da relação entre massa muscular e capacidade físico-funcional.

Effect of oral supplementation with whey protein on muscle mass in adults with type 2 diabetes mellitus: a systematic review of randomized controlled trials.

OBJECTIVE: To investigate the overall effect of whey protein supplementation on skeletal muscle mass in adults with type 2 diabetes mellitus (T2DM). METHODS: Systematic review of reports on corporal muscle mass from clinical trials that assessed the use of whey protein supplementation by means of validated techniques in patients with T2DM. PubMed, SCOPUS, Web of Science, LILACS, and SciELO databases were searched up to April 2022. Risk of bias was assessed by the Cochrane Collaboration Risk of Bias tool. We conducted a qualitative synthesis of information. RESULTS: Four studies (424 participants) that met the selection criteria were identified out of 1,787 records. Of these, 3 studies assessed the total muscle mass using dual-energy X-ray absorptiometry (DXA), and 1 reported changes to the transverse diameter of the vastus lateralis muscle with ultrasound imaging. In the intervention groups, DXA assessments demonstrated an increase in total muscle mass in 3 studies and in the appendicular muscle mass in 2. Changes to the proportion of muscle mass were not seen in the DXA studies and only a discrete difference was seen in the comparative groups studied by ultrasound imaging. CONCLUSION: Following the administration of whey protein supplementation in patients with T2DM, a partially positive effect was seen in skeletal muscle mass gain with a moderate certainty of evidence.

Muscle Synergy Analysis as a Tool for Assessing the Effectiveness of Gait Rehabilitation Therapies: A Methodological Review and Perspective.

According to the modular hypothesis for the control of movement, muscles are recruited in synergies, which capture muscle coordination in space, time, or both. In the last two decades, muscle synergy analysis has become a well-established framework in the motor control field and for the characterization of motor impairments in neurological patients. Altered modular control during a locomotion task has been often proposed as a potential quantitative metric for characterizing pathological conditions. Therefore, the purpose of this systematic review is to analyze the recent literature that used a muscle synergy analysis of neurological patients' locomotion as an indicator of motor rehabilitation therapy effectiveness, encompassing the key methodological elements to date. Searches for the relevant literature were made in Web of Science, PubMed, and Scopus. Most of the 15 full-text articles which were retrieved and included in this review identified an effect of the rehabilitation intervention on muscle synergies. However, the used experimental and methodological approaches varied across studies. Despite the scarcity of studies that investigated the effect of rehabilitation on muscle synergies, this review supports the utility of muscle synergies as a marker of the effectiveness of rehabilitative therapy and highlights the challenges and open issues that future works need to address to introduce the muscle synergies in the clinical practice and decisional process.

Programa de gimnasia laboral para los moldeadores manuales metalúrgicos

Los trastornos músculo-esqueléticos relacionados con el trabajo constituyen motivo de preocupación para la comunidad científica, avalado por su efecto negativo en la vida de los trabajadores y la productividad de las empresas. En el proceso de fundición de metales, los moldeadores manuales con pisón neumático exteriorizan manifestaciones de estas afecciones. Ello indujo a realizar una investigación que tuvo como objetivo elaborar un programa de Gimnasia Laboral para contribuir a la atención de los trastornos músculo-esqueléticos en los moldeadores manuales metalúrgicos. Para recopilar, analizar y procesar los datos se emplearon métodos teóricos, empíricos y matemático-estadísticos, entre ellos el histórico-lógico, analítico-sintético, inductivo-deductivo, sistémico-estructural-funcional, la observación participante, encuesta, entrevista, revisión documental, el experimento, criterio de usuarios y la estadística descriptiva e inferencial. La población objeto de estudio estuvo conformada por 19 moldeadores manuales metalúrgicos, seleccionados de forma intencional. El diagnóstico y la sistematización teórica alcanzada posibilitaron elaborar un programa de Gimnasia Laboral, en correspondencia con los requerimientos del proceso de moldeo, cuya efectividad fue constatada.

As lesões músculo-esqueléticas relacionadas com o trabalho são motivo de preocupação para a comunidade científica, sustentadas pelos seus efeitos negativos na vida dos trabalhadores e na produtividade das empresas. No processo de fundição do metal, os moldadores manuais com compactador pneumático externalizam as manifestações dessas condições. Isso originou uma pesquisa que teve como objetivo desenvolver um programa de Ginástica Laboral para contribuir no cuidado de lesões osteomusculares em moldadores manuais metalúrgicos. Para coletar, analisar e tratar os dados foram utilizados métodos teóricos, empíricos e matemático-estatísticos, incluindo histórico-lógico, analítico-sintético, indutivo-dedutivo, sistêmico-estrutural-funcional, observação participante, levantamento, entrevista, revisão documental, o experimento, critérios de usuário e estatísticas descritivas e inferenciais. A população em estudo foi composta por 19 modeladores manuais metalúrgicos, selecionados intencionalmente. O diagnóstico e a sistematização teórica conseguidos permitiram desenvolver um programa de Ginástica Laboral, em correspondência com as exigências do processo de moldagem, cuja eficácia foi verificada.

Work-related musculoskeletal disorders are a cause of concern for the scientific community, supported by their negative effect on the lives of workers and the productivity of companies. In the metal casting process, manual molders with pneumatic tamper externalize manifestations of these conditions. This led to carrying out a research that aimed to develop a Labor Gymnastics program to contribute to the care of musculoskeletal disorders in metallurgical manual shapers. To collect, analyze and process the data, theoretical, empirical and mathematical-statistical methods were used, including historical-logical, analytical-synthetic, inductive-deductive, systemic-structural-functional, participant observation, survey, interview, documentary review, the experiment, user criteria and descriptive and inferential statistics. The population under study was made up of 19 metallurgical manual shapers, intentionally selected. The diagnosis and theoretical systematization achieved made it possible to develop a Labor Gymnastics program, in correspondence with the requirements of the molding process, whose effectiveness was verified.

Impact of Kinesiotherapy Rehabilitation on Quadriceps Femoris Muscle Strength and Functionality in Total Hip Arthroplasty Patients / Impacto de la Rehabilitación con Kinesioterapia en la Fuerza y Funcionalidad del Músculo Cuádriceps Femoral en Pacientes con Artroplastía Total de Cadera

SUMMARY: The objective was measure quadricep strength after Total Hip Arthroplasty (THA) and kinetic treatment and then determine its impact on the functional recovery of patients with hip osteoarthritis. A total of 79 (25 were male and 54 were female) patients with THA. Exclusion criteria were previous extra-system kinetic treatment, operated on for hip fracture, not completing the treatment. Maximum Isometric Strength (MIS), Time Up and Go (TUG), Modified Harris Hip Score. There was a significant increase in the MIS of the post-treatment operated knee extension in both men and women (p < 0.0001 SE = 0.43; p < 0.0001 SE = 1.22, respectively). In the TUG, the execution time was significantly lower post-treatment in both men and women (p < 0.0001 SE = 0.77; p < 0.0001 SE = 0.94, respectively). The final Harris score increased significantly post-treatment in male and female (p < 0.0001 SE = 2.90; p < 0.0001 SE = 1.96, respectively). the association between MIS and the Harris score, it was noted that, for a 1 kg increase in this measure compared to the initial assessment, the Harris score, after 12 weeks of treatment, increased by 0.179 points (β = 0.179; p = 0.050). The conclusions were Indicate an increase in knee extension MIS of the operated hip after treatment in both sexes. At the same time, functionality increased post-treatment in both male and female.

El objetivo del estudio fue medir la fuerza del músculo cuádriceps femoral después de la artroplastia total de cadera (THA, por sus siglas en inglés) y el tratamiento kinésico, para determinar su impacto en la recuperación funcional de pacientes con osteoartritis de cadera. En el estudio participaron 79 pacientes con THA (25 hombres y 54 mujeres). Se excluyeron quienes tuvieron tratamiento Kinésico previo fuera del hospital, operación por fractura de cadera y no completar el tratamiento. Las principales medidas tomadas fueron: Fuerza Máxima Isométrica (MIS), Time UP and GO (TUG), Puntuación Modificada de Harris de Cadera. Hubo un aumento significativo en la MIS de la extensión de rodilla del lado operado después del tratamiento tanto en hombres (p<0,0001, EE=0,43) como en mujeres (p<0,0001, EE=1,22). En el TUG, el tiempo de ejecución fue significativamente menor después del tratamiento en hombres (p<0,0001, EE=0,77) y mujeres (p<0,0001, EE=0,94). La puntuación final de Harris aumentó significativamente después del tratamiento en hombres (p<0,0001, EE=2,90) y mujeres (p<0,0001, EE=1,96). En cuanto a la asociación entre MIS y la puntuación de Harris, se observó que por cada aumento de 1 kg en esta medida en comparación con la evaluación inicial, la puntuación de Harris aumentó en 0,179 puntos después de 12 semanas de tratamiento (β=0,179; p=0,050). En conclusión se observó un aumento en la MIS de la extensión de rodilla del lado operado después del tratamiento en ambos sexos. Al mismo tiempo, la funcionalidad aumentó después del tratamiento tanto en hombres como en mujeres.

Adjunct role of potassium-rich vegetarian diet and a novel potassium food supplement to improve pain in chronic rheumatoid arthritis on supervised standard care: a randomised controlled study.

Introduction: An earlier food survey showed dietary potassium deficiency in rheumatoid arthritis (RA). Objective: To evaluate an adjunct role of oral potassium to reduce joint pain in RA. Methods: 172 consenting eligible symptomatic patients (median duration 6.5 years) on standard care were randomised into an assessor blind, parallel efficacy, controlled, prospective, multiarm single-centre study (80% power, drug trial design) of 16 weeks duration-arm A (potassium-rich vegetarian diet), arm B (arm A plus novel potassium food supplement) and arm C (control, regular diet). Standard efficacy (American College of Rheumatology recommendation) and safety and diet intake (3-day recall) were assessed at monthly intervals (protocol). Standard soft-ware package (SPSS V.20) was used for statistical analysis; analysis of variance), Mann-Whitney statistic and χ2 test.; significant p<0.05, two sided). Study arms were found matched at baseline. Background RA medication remained stable. Preset target for increased potassium intake (India standards) were mostly achieved and participants remained normokalemic. Results: 155 patients (90.1%) completed the study and several showed improvement (maximum improved measures in arm B). Potassium intervention was safe and well tolerated. Adverse events were mild; none caused patient withdrawal. On comparison, the mean change in pain visual analogue scale (-2.23, 95% CI -2.99 to -1.48) at week 16 (primary efficacy) from baseline was significantly superior in arm B (per protocol analysis). A high daily potassium intake (5-7.5 g, arm B) was significantly associated with low pain (study completion); OR 2.5 (univariate analysis), likelihood ratio 2.9 (logistic regression). Compliance (intervention), diet record and analysis, RA medication and absence of placebo were potential confounders. Conclusion: High oral potassium intake, based on a suitable vegetarian diet and food supplement, reduced joint pain and improved RA. It was a safe adjunct to standard care, Further validation studies are required. Trial registration: CTRI/2022/03/040726; Clinical Trial Registry of India.

New anatomical findings in the mandibular body region: Two parts that make up bucco-mandibular space.

Soft tissue spaces not only enable gliding by contraction of the facial muscles, but they also cause drooping of the superficial fat due to gravity in the upright position. This study was performed to clarify the structures around the bucco-mandibular space (BMS) and to apply this anatomical knowledge to clinical practice. Four sides of the face were dissected using a conventional gross anatomical dissection technique, and 10 sides (5 horizontal and 5 frontal sections) of the removed semi-facial soft tissue were dissected using the stretched tissue dissection (STD) method. Histological examination of the mandible was performed on two sides to confirm the findings of conventional gross anatomical dissection and STD. In all cases, both gross dissection and STD revealed that the BMS was composed of two parts. The superficial part was filled with adipose tissue containing nerves and vessels, including the marginal mandibular branch of the facial nerve, facial artery, facial vein, and mental nerve. We named this part the adipo-neuromandibular part. By contrast, the deep part was separated from the adipo-neurovascular part by facial deep fascia and composed of loose connective tissue. We named this deep part the loose connective tissue part. The STD method enabled us to obtain detailed anatomical findings of the mandibular region and elucidate two parts of the BMS in which the neurovasculature is distributed. We believe that these findings provide new insights into facial anatomy by resolving existing anatomical uncertainties and will contribute to safer surgical treatment in the facial region.

Perioperative chemotherapy and immunotherapy to optimize cystectomy outcomes in the curative intent of non-metastatic muscle-invasive bladder cancer: A systematic review and meta-analysis.

INTRODUCTION: Perioperative systemic treatments play a crucial role in the comprehensive management of muscle-invasive bladder cancer. While neoadjuvant platinum-based chemotherapy has a proven efficacy, administering adjuvant chemotherapy can be challenging in patients with multiple comorbidities. Although immunotherapy has shown success in metastatic settings, its effectiveness in both neoadjuvant and adjuvant settings remains under investigation. This study aims to conduct a systematic literature review and meta-analysis to assess the impact of chemotherapy and/or immunotherapy in neoadjuvant and/or adjuvant settings. METHODS: A systematic review and meta-analysis were conducted by consulting the PubMed, Scopus, and ClinicalTrial.gov databases for the period from 1994 to 2023. The analysis utilized Forest Plots for key points of interest: overall survival/pathologic response for neoadjuvant chemotherapy (NAC) and overall survival/disease-free survival for adjuvant chemotherapy (AC), employing random or fixed models. RESULTS: The systematic review included 26 articles, and 14 were incorporated into the meta-analysis. For NAC, five studies assessed overall survival, yielding an overall hazard ratio (HR) of 0.84 [0.75-0.94]; P=0.002. Pathologic response under NAC was evaluated in five studies, resulting in an overall odds ratio (OR) of 0.3 [0.2-0.4]; P<0.001 compared to cystectomy and 0.86 [0.65-1.13]; P=0.28 for MVAC vs. GC. Regarding AC, six studies investigated overall survival, revealing an overall HR of 0.93 [0.77-1.12]; P=0.46. Disease-free survival under AC was examined in seven studies, with an overall OR of 0.58 [0.44-0.78]; P<0.001. Meta-analysis was not conducted for immunotherapy due to limited phase II studies in the neoadjuvant setting and only two available studies in the adjuvant setting. CONCLUSION: This study reaffirms the efficacy of platinum-based chemotherapy in neoadjuvant and adjuvant scenarios, enhancing overall survival in muscle-invasive bladder cancer patients. Immunotherapy exhibits promising outcomes in tumor downstaging in the neoadjuvant setting and in disease-free survival, in the adjuvant setting.

Miopatías RYR1 en la infancia: correlación fenotipo-genotipo e incidencia / RYR1 myopathies in childhood: phenotype-genotype correlation and incidence

Introducción: Las miopatías relacionadas con el receptor de rianodina de tipo 1 (RYR1-RM) constituyen la categoría más frecuente de miopatías congénitas. La introducción de técnicas genéticas ha cambiado el paradigma diagnóstico y sugiere la prioridad de estudios moleculares sobre biopsias. Este estudio busca explorar las características clinicoepidemiológicas de pacientes con variantes del gen RYR1 en un hospital pediátrico de tercer nivel con el objetivo de ampliar la comprensión de la correlación genotipo-fenotipo en las RYR1-RM. Pacientes y métodos: Estudio observacional, descriptivo y transversal, de pacientes menores de 14 años con síntomas miopáticos y variantes potencialmente patógenas del gen RYR1 entre enero de 2013 y diciembre de 2023, considerando variables como sexo, edad, desarrollo motor, variantes genéticas, patrón de herencia y otras manifestaciones. Todas las variables fueron tabuladas frente a la variante genética. Resultados: De los nueve pacientes incluidos, la incidencia estimada fue de aproximadamente 1/10.000 nacidos vivos. La mediana en el momento del diagnóstico fue de 6 años, con una variabilidad fenotípica significativa. Se observaron síntomas comunes, como debilidad y retraso del desarrollo motor. Las variantes genéticas afectaron al gen RYR1 de manera diversa, y hubo cinco variantes previamente no descritas. La biopsia muscular se realizó en cinco pacientes, en dos de ellos de tipo miopatía central core; en uno, multiminicore; en uno, desproporción congénita de fibras; y en otro, de patrón inespecífico. Conclusiones: Las RYR1-MR de nuestra serie ofrecieron variabilidad fenotípica y de afectación, con una incidencia en nuestra área de en torno a 1/10.000 recién nacidos. La mayoría de los casos fueron varones, de variantes missense dominantes. Aportamos cinco variantes genéticas no descritas con anterioridad.(AU)

Introduction: Ryanodine receptor type 1-related myopathies (RYR1-RM) represent the most prevalent category of congenital myopathies. The introduction of genetic techniques has shifted the diagnostic paradigm, suggesting the prioritization of molecular studies over biopsies. This study aims to explore the clinical and epidemiological characteristics of patients with RYR1 gene variants in a tertiary pediatric hospital, intending to enhance the understanding of the genotype-phenotype correlation in RYR1-RM. Patients and methods: An observational, descriptive, and cross-sectional study was conducted on patients under 14 years old with myopathic symptoms and potentially pathogenic RYR1 gene variants from January 2013 to December 2023. Variables such as gender, age, motor development, genetic variants, inheritance pattern, and other manifestations were considered. All variables were tabulated against the genetic variant. Results: Of the nine included patients, the estimated incidence was approximately 1 in 10,000 live births. The median age at diagnosis was six years, with significant phenotypic variability. Common symptoms such as weakness and delayed motor development were observed. Genetic variants affected the RYR1 gene diversely, including five previously undescribed variants. Muscle biopsy was performed in five patients, revealing central core myopathy in two, multiminicore in one, congenital fiber-type disproportion in one, and a nonspecific pattern in another.(AU)

Orbital trochleitis: Literature review.

Trochleitis is clinically and/or radiologically evidenced inflammation of the trochlea or orbital pulley. Clinically it is characterized by pain and hypersensitivity in the superomedial orbital angle, which is increased or triggered by direct palpation of the area and/or eye movements. During the REM (rapid eye movements) phase of sleep, patients with trochleitis suffer from nocturnal micro-awakenings that impede their rest, and pain is often associated with visual symptoms (diplopia or Brown's syndrome). The lack of common guidelines for diagnosis and treatment of this disease, its low prevalence and the lack of knowledge of the different entities associated with trochlear pain, leads to underdiagnosis or misdiagnosis. It is essential to know the characteristics of this pathology and to diagnose it correctly, differentiating it from other trochlear pain entities, in order to be able to carry out an adequate therapeutic and prognostic approach. The lack of consensus on the therapeutic protocol means that various treatments are used, in different order and often with a combination of several without a firm scientific basis. This comprehensive review of previous studies concludes that nonsteroidal anti-inflammatory drugs (NSAIDs) achieve an overall complete cure rate of 77%, although this rate decreases to 30% in case of motility restriction or diplopia. Intratrochlear corticosteroid injection achieves an overall complete cure rate of 86%, even in the worst prognosis trochleitis, being the only effective option in NSAID-refractory trochleitis and currently being questioned as the first treatment option.

The value of multi-modal ultrasound in the assessment of sarcopenia in maintenance hemodialysis patients.

INTRODUCTION: Sarcopenia is one of the common complications in maintenance hemodialysis (MHD) patients and is associated with poor prognosis. We aimed to study the validity and reliability of ultrasound in the assessment of sarcopenia in MHD patients. METHODS: MHD patients were categorized into the sarcopenia group and the non-sarcopenia group according to the diagnostic criteria of the Asian Working Group on Sarcopenia (AWGS) 2019. Ultrasonography of the left medial head of the gastrocnemius muscle was performed in MHD and healthy controls to obtain muscle thickness (MT), pinnation angle (PA), fascicle length (FL), cross-sectional area (CSA), echo intensity (EI), elastic modulus (E), shear wave velocity (SWV), and microvascular velocity (MV). Compare the differences in ultrasound parameters among different groups, and determine the cut-off values suitable for diagnosing sarcopenia in MHD patients. RESULTS: The MT, CSA, PA, and MV in the sarcopenia group were lower than those in the non-sarcopenia group and the control group; while the EI was higher, the FL of the sarcopenia group was lower than that of the non-sarcopenia group, while the E and SWV of the sarcopenia group were higher than those of the control group. Receiver operating characteristic curve analyses indicated that ultrasound combined index had a good diagnostic value, model Y = 13.511-0.121*MT-0.609*CSA-0.172*PA+0.011*EI-2.205*MV(P < 0.05), with a cut-off value of 0.69. CONCLUSIONS: Multi-modal ultrasound is a safe, non-invasive, and real-time imaging examination method, and can provide information on muscle structure, stiffness, and perfusion, which is expected to be a promising potential tool for predicting sarcopenia in MHD patients.

Morphology and Morphometry of the Dorsal Interosseous Muscles of the Hand: Laterality and Sexual Dimorphism / Morfología y Morfometría de los Músculos Interóseos Dorsales de la Mano: Lateralidad y Dimorfismo Sexual

SUMMARY: The dorsal interosseous muscles (DIM) are intrinsic muscles of the hand located dorsally between metacarpal bones, which play a role in finger abduction. Anatomical variations of these muscles in terms of form and length have been well documented, but variations regarding sex and laterality are underexplored. The aim of this study was to investigate the morphology and morphometry of the DIM of the hand regarding sexual dimorphism and laterality. Twenty human cadavers belonging to the white individuals (n = 40 hands) with known sex and laterality were used for this study. DIMs were dissected and observed for morphology. Also, a digital calliper was used to measure the midpoint length of the DIM. The origin and insertion of all the DIM were normal with the left hand having no additional, supernumerary, and absent muscles in each compartment. The variations were only found on the right side and predominant in females: 2 out of 11 (18.18%) hands containing a space with a supernumerary muscle; 1 out of 11 (9.09%) hands having a space with a double muscle; and 1 out of 11 (9.09%) hands having a compartment with a unipennate muscle. In males, 1 out of 9 (11.11%) hands had a compartment with a supernumerary muscle. The mean midpoint length of each muscle in females and males in both hands from the first to the fourth muscle, respectively, was documented. In females on the left: 46.79 ± 3.56; 42.62 ± 3.57; 49.02 ± 4.21; 41.66 ± 2.15 and right: 47.30 ± 2.49; 39.27 ± 4.14; 45.69 ± 4.64; 38.12 ± 4.08. In males, it was on the left: 50.01 ± 3.95; 41.98 ± 3.79; 47.90 ± 4.83; 41.79 ± 4.25, and on the right: 46.65 ± 2.09; 39.01 ± 4.25; 47.47 ± 3.41; 38.31 ± 4.40. The mean midpoint length of the DIM was relatively higher on the left hand compared to the right hand in both females and males. In this study, variations regarding the supernumerary muscle, double interosseous space, and unipennate muscles were only observed on the right-hand side and predominantly in females, an insight that may guide in the treatment of fractures, stiffness of the hand, and compartment syndromes.

Los músculos interóseos dorsales (DIM) son músculos intrínsecos de la mano ubicados dorsalmente entre los huesos metacarpianos, que desempeñan un papel en la abducción de los dedos. Las variaciones anatómicas de estos músculos en términos de forma y longitud están bien documentadas, pero las variaciones con respecto al sexo y la lateralidad están poco exploradas. El objetivo de este estudio fue investigar la morfología y morfometría de los DIM de la mano con respecto al dimorfismo sexual y la lateralidad. Para este estudio se utilizaron veinte cadáveres humanos pertenecientes a individuos blancos (n = 40 manos) con sexo y lateralidad conocidos. Los DIM se diseccionaron y observaron para determinar su morfología. Además, se utilizó un calibrador digital para medir la longitud del punto medio del DIM. El origen y la inserción de todos los DIM fueron normales y la mano izquierda no tenía músculos adicionales, supernumerarios y ausentes en cada compartimento. Las variaciones se encontraron sólo en el lado derecho y predominaron en el sexo femenino: 2 de 11 (18,18%) manos contenían un espacio con un músculo supernumerario; 1 de cada 11 (9,09%) manos presentando un espacio con doble músculo; y 1 de cada 11 (9,09%) manos presentaba un compartimento con músculo unipenate. En los hombres, 1 de cada 9 (11.11%) manos tenía un compartimento con un músculo supernumerario. Se documentó la longitud media del punto medio de cada músculo en mujeres y hombres en ambas manos desde el primer al cuarto músculo, respectivamente. En mujeres de izquierda: 46,79 ± 3,56; 42,62 ± 3,57; 49,02 ± 4,21; 41,66 ± 2,15 y derecha: 47,30 ± 2,49; 39,27 ± 4,14; 45,69 ± 4,64; 38,12 ± 4,08. En los varones fue hacia la izquierda: 50,01 ± 3,95; 41,98 ± 3,79; 47,90 ± 4,83; 41,79 ± 4,25, y a la derecha: 46,65 ± 2,09; 39,01 ± 4,25; 47,47 ± 3,41; 38,31 ± 4,40. La longitud media del punto medio del DIM fue relativamente mayor en la mano izquierda en comparación con la derecha tanto en mujeres como en hombres. En este estudio, las variaciones con respecto al músculo supernumerario, el doble espacio interóseo y los músculos unipennados sólo se observaron en el lado derecho y predominantemente en el sexo femenino, un conocimiento que puede guiar en el tratamiento de fracturas, rigidez de la mano y síndromes compartimentales.

Surco del Músculo Iliopsoas y su Relación Clínica con la Cadera. Una Revisión / Groove of the Iliopsoas Muscle and its Clinical Relationship with the Hip. A Review

El músculo iliopsoas es el principal flexor de la cadera siendo un rotador lateral accesorio de ésta, sus fibras discurren posteriores al ligamento inguinal, cruzando anteriormente a la pelvis. Este trayecto ocurre en un surco que se localiza entre la eminencia iliopúbica, medialmente y la espina iliaca anteroinferior, lateralmente. Si bien existen antecedentes de este surco, no se encuentra expresado en la terminología anatómica internacional (TAI) como un surco relevante dentro de los relieves óseos pélvicos. Este surco se encuentra asociado al tendón en diferentes disfunciones de cadera, como la cadera en resorte (coxa saltans). El objetivo de la investigación es ampliar el conocimiento clínico y anatómico de este surco y su inclusión en la terminología anatómica internacional. Dentro de los criterios de inclusión se seleccionaron artículos publicados en español e inglés que aludieron referencia al surco y/o palabras claves como, "músculo iliopsoas", "músculo psoas ilíaco", "surco iliopsoas" "surco coxal", "groove iliopsoas" y "iliopsoas muscle" "surco coxal". Los motores de búsqueda utilizados fueron Pubmed, Google Académico y Springer Link. La relevancia del surco del músculo iliopsoas abre una puerta a las discusiones respecto a su forma y profundidad, así como también un punto de referencia asociada a diferentes situaciones clínicas relacionada con este surco y probables predisposiciones a lesiones o chasquidos que ocurren en cadera. Finalmente, el conocimiento del surco para el músculo iliopsoas es importante tenerlo en consideración en investigaciones que aborden esta región, así como su terminología anatómica, relaciones anatómicas, clínicas y quirúrgicas.

SUMMARY: The iliopsoas muscle is the main hip flexor being an accessory lateral rotator of this, its fibers run posterior to the inguinal ligament, crossing anterior to the pelvis. This course occurs in a groove located between the iliopubic eminence medially and the anterior inferior iliac spine laterally. Although there are antecedents of this groove, no relevant comments are found in international anatomical terminology (IAT) as a groove within the pelvic bone reliefs. This groove is associated with the tendon in different hip dysfunctions, such as the hip snap (coxa saltans). The objective of the research is to expand the clinical and anatomical knowledge of this groove and its inclusion in international anatomical terminology. Within the inclusion criteria, articles published in Spanish and English were selected that referred to the groove and/or keywords such as "iliopsoas muscle", "iliopsoas muscle", "iliopsoas groove", "coxal groove", "iliopsoas groove". and "iliopsoas muscle" "coxal groove". The search engines used were Pubmed, Google Scholar and Springer Link. The relevance of the iliopsoas muscle groove gives way to discussions regarding its shape and depth, as well as a point of reference associated with different clinical situations related to this groove and probable predispositions to injuries or snaps that occur in the hip. Finally, knowledge of the groove for the iliopsoas muscle is important to consider in research that addresses this region, as well as its anatomical terminology, anatomical, clinical, and surgical relationships.

In vitro 3D co-culture model of human endothelial and smooth muscle cells to study pathological vascular remodeling. / Modelo de cocultivo 3D in vitro de células endoteliales y vasculares de músculo liso humanas para el estudio del remodelado vascular patológico.

Pathological vascular remodeling of the vessel wall refers to the structural and functional changes of the vessel wall that occur in response to injury that eventually leads to cardiovascular disease. The vessel wall is composed of two main types of cells, endothelial cells and vascular smooth muscle cells, whose communication is crucial in both the development of the vasculature and the homeostasis of mature vessels. Changes in the dialogue between endothelial cells and vascular smooth muscle cells are associated with various pathological states that triggers remodeling of the vascular wall. For many years, considerable efforts have been made to develop effective diagnoses and treatments for these pathologies by studying their mechanisms in both in vitro and in vivo models. Compared to animal models, in vitro models can provide great opportunities to obtain data in a more homogeneous, economical and massive way, providing an overview of the signaling pathways responsible for these pathologies. The implementation of three-dimensional in vitro co-culture models for the study of other pathologies has been postulated as a potentially applicable methodology, which determines the importance of its application in studies of cardiovascular diseases. In this article we present a method for culturing human endothelial cells and vascular smooth muscle cells, grown under non-adherent conditions, that generate three-dimensional spheroidal structures with greater physiological equivalence to in vivo conditions. This in vitro modeling could be used as a study tool to identify cellular and molecular mechanisms involved in the pathological processes underlying vascular remodeling.

Sonographic diagnosis of radiographically undetectable bennet fracture.

Intra-articular fractures of the base of the first metacarpal (Bennet fractures) are prone to dislocation and require surgical reduction and fixation to prevent secondary degenerative joint disease and chronic dysfunction. Therefore, a prompt diagnosis is necessary, mostly achieved by conventional roentgenograms. We report the case of a 62-year-old man in whom a Bennet fracture was highly suspected on ultrasound (US) examination realized after a fall. Standard radiographs, obtained after US to confirm the diagnosis, were interpreted as normal. A computed tomography was then performed showing a typical Bennet fracture. This case report demonstrates that a careful assessment of bones must be an integral part of any routine musculo-skeletal US examination, particularly in post-traumatic patients. US can detect bone fractures where radiograph is not discriminating.

Malnutrition: muscle wasting, inflammation, RDW, and their relation with adverse outcomes.

OBJECTIVE: The objective of the study was to explore red cell distribution width (RDW) as a surrogate marker of inflammation, alone and in conjunction with muscle wasting to predict malnutrition-related adverse outcomes. METHODS: This was a single-center observational study including adult hospitalized patients. Demographic variables, malnutrition criteria, and RDW were captured within 24 hours of hospital admission. Correlation tests and regression models were performed between these variables (RDW and muscle wasting) and adverse outcomes (in-hospital mortality and unplanned transfer to critical care areas (CCA). RESULTS: Five hundred and forty-five patients were included in the final analysis. Muscle wasting showed an independent association with adverse outcomes in every regression model tested. RDW alone showed fair predictive performance for both outcomes' significance and the adjusted model with muscle wasting showed association only for unplanned transfer to CCA. CONCLUSION: RDW did not improve the prediction of adverse outcomes compared to muscle wasting assessed by physical examination and simple indexes for acute and chronic inflammation. Malnourished patients presented higher RDW values showing a possible metabolic profile (higher inflammation and lower muscle). It is still unknown whether nutrition support can influence RDW value over time as a response marker or if RDW can predict who may benefit the most from nutritional support.

OBJETIVO: Explorar el ancho de distribución eritrocitaria (ADE) como un marcador subrogado de inflamación, individualmente y en conjunto con el desgaste muscular, para predecir resultados adversos asociados a la desnutrición. MÉTODO: Estudio unicéntrico, observacional, incluyendo pacientes adultos hospitalizados. Se capturaron variables demográficas, criterios de desnutrición y el ADE en las primeras 24 horas de ingreso. Se realizaron pruebas de correlación y modelos de regresión entre dichas variables (ADE y desgaste) y resultados adversos (mortalidad hospitalaria y traslado no planeado a áreas críticas). RESULTADOS: Se incluyeron 545 pacientes. El desgaste muscular mostró asociación independiente con los resultados adversos en cada modelo. El ADE individualmente mostró un desempeño aceptable para la predicción de ambos resultados, y en modelos ajustados con desgaste muscular mostró asociación únicamente con traslado no planeado a áreas críticas. CONCLUSIONES: El ADE no mejoró la predicción de resultados adversos comparado con el desgaste muscular por exploración física e índices simples de inflamación. Los pacientes con desnutrición presentaron mayores valores de ADE, mostrando un posible perfil metabólico (mayor inflamación y menos músculo). Aún se desconoce si el soporte nutricional puede influenciar el ADE como un marcador de respuesta o si puede predecir una respuesta favorable al soporte nutricional.

Low handgrip strength is related to elevated echogenicity in patients with chronic kidney disease: A pilot, cross-sectional and exploratory study.

OBJECTIVES: Evaluate associations between triceps braqui muscle ultrasound measures (TB US) and handgrip strength (HGS), and the sensibility of TB US for low HGS in non-dialysis-dependent chronic kidney disease (nd-CKD) patients. PARTICIPANTS AND METHODS: This pilot, cross-sectional, and exploratory study evaluated TB cross-sectional images from A-mode US and processed by FIJI-Image J to obtain muscle thickness (MT), echogenicity (EI), cross-sectional area (CSA), pennation angle (PA), and fascicle length (Lf) associating them with absolute HGS by simple and, multiple linear regression. The HGS was normalized to body mass index (BMI) and separated into low HGS (HGS/BMI≤10p according to sex and age) and adequate HGS (HGS/BMI>10p) groups. The body composition was from multifrequency bioimpedance. ROC analysis verified the TB US diagnostic accuracy to low HGS. RESULTS: Were included 42 (21M/21F) adults with 65.5 (60-70) y median age, 47.22% in 3b CKD stage. The low HGS group (45.23%) showed a higher fat mass (FM), TB muscle medium head's PA, and EI than adequate HGS (p<0.05). In crude model, a pixels increase in EI was associated with a 0.452kgf HGS reduction (p=0.019); adjusted for sex, age, and FM, a one-unit increase in EI was associated with a 0.510kgf HGS reduction (p=0.011). The EI also showed moderate diagnostic accuracy (AUC=0.730; CI 95%=0.589; 0.919) to low HGS and a sensitivity of 86.9% (cutoff≥13.52 pixels). CONCLUSION: In nd-CKD patients, of all measurements from US, the EI was the most associated with HGS, and the only one sensitive to low HGS diagnosis.

Pharmacological treatments for the correction of presbyopia.

Presbyopia affects between 1.7 and 2 billion people worldwide. Presbyopia significantly impacts productivity and quality of life in both developed and developing countries. During accommodation, the human eye changes its dioptric power by altering the shape of the lens, but the exact nature of this change has not been fully explained. Recently, topical treatments have been marketed for the treatment of presbyopia and others are under investigation. In order to prepare a review of these novel therapies, we searched the major biomedical search engines. We found 15 randomized clinical trials and 12 reviews that met our review criteria. There are two different strategies for this purpose, the pinhole effect that increases depth of focus and "crystalline lens relaxation" for which parasympathetic mimetics and lens oxidation intermediates have been used. The results are generally favorable in terms of improvement of near visual acuity, although the follow-up period of the studies is short. These are novel strategies in the early stages of research that could be useful in the treatment of presbyopia.