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BMJ Case Reports Jun 2024This brief report discusses the diagnosis, management and surgical intervention of a man in his 30s presenting with a rare traumatic sternal manubrium dislocation...
This brief report discusses the diagnosis, management and surgical intervention of a man in his 30s presenting with a rare traumatic sternal manubrium dislocation following a motorcycle crash, accompanied by multiple concomitant rib fractures. The severity and complexity of the patient's injuries necessitated an operative approach for his sternomanubrial dislocation, emphasising the importance of multidisciplinary coordination, accurate diagnosis and prompt surgical intervention. The report provides valuable insights into the successful application of open reduction and internal fixation with plating in a real-world setting, which resulted in positive patient outcomes, despite the rarity and severity of this type of trauma. It further underscores the need for additional research to advance best practices for managing traumatic sternal manubrium dislocations in the context of high-impact injuries.
Topics: Humans; Male; Accidents, Traffic; Rib Fractures; Motorcycles; Joint Dislocations; Fracture Fixation, Internal; Adult; Manubrium; Sternum
PubMed: 38925669
DOI: 10.1136/bcr-2023-258312 -
Journal of the American Academy of... Jun 2024Simultaneous Multifrequency (SiMFy) is a time-saving and reliable stimulus to determine the frequency tuning of ocular vestibular-evoked myogenic potential (oVEMP);...
BACKGROUND
Simultaneous Multifrequency (SiMFy) is a time-saving and reliable stimulus to determine the frequency tuning of ocular vestibular-evoked myogenic potential (oVEMP); however, the absence of 4000 Hz in SiMFy potentially makes it a less potent tool for the diagnosis of Superior semicircular canal dehiscence, a pathology with an ever-increasing prevalence. Further, SiMFy was validated using only the infra-orbital (IO) electrode montage. However, the recordings obtained using the IO montage might be susceptible to reference contamination introduced by a small separation between the recording electrodes, and also susceptible to reflex impurity due to the spatially displaced reference electrode from the inferior oblique muscle (IOM), rendering it vulnerable to picking up responses from other muscles. Nonetheless, little is known about the similarities/differences between the SiMFy-induced oVEMPs using alternate montages [belly-tendon (BT), chin-reference (CR), and sternum-reference (SR)] and the non-simultaneous multifrequency oVEMPs (NSM-oVEMPs) using the IO montage.
PURPOSE OF THE STUDY
To develop a modified SiMFy stimulus and investigate its effects on frequency tuning of oVEMP using various electrode montages.
RESEARCH DESIGN
Within-subject experimental design.
STUDY SAMPLE
Thirty-three healthy adults aged 20-30 years.
DATA COLLECTION AND ANALYSIS
Tone bursts of octave and mid-octave frequencies from 250 Hz to 4000 Hz were generated and concatenated to create the modified SiMFy stimulus. All participants underwent non-simultaneous multifrequency oVEMPs and modified SiMFy oVEMPs using BT, CR, SR, and IO montages simultaneously. The response rate, peak-to-peak amplitude, and frequency tuning were compared between NSM-oVEMP and modified SiMFy oVEMP and also between the electrode montages.
RESULTS
BT montage recorded the largest amplitude among the montages in non-simultaneous multifrequency stimulation and modified SiMFy stimulation. Although the response rates were comparable, the modified SiMFy produced significantly lower oVEMP amplitudes than the non-simultaneous multifrequency stimulation within each electrode montage (p < 0.05). A moderate-to-strong agreement on frequency tuning existed between the non-simultaneous multifrequency stimuli and modified SiMFy stimulus for all the montages, except for the SR montage.
CONCLUSIONS
Although the modified SiMFy produces smaller amplitude oVEMPs than the non-simultaneous multifrequency stimulation for the respective montages, its use in combination with the BT montage yields higher response rates and larger peak-to-peak amplitudes than the non-simultaneous multifrequency recording using IO montage.
PubMed: 38925160
DOI: 10.1055/a-2353-2797 -
Nurse Education Today Jun 2024Evidence supporting the benefits of autonomous learning of basic life support, such as rapid outcomes and cost-effectiveness, is increasing. Reports supporting the...
BACKGROUND
Evidence supporting the benefits of autonomous learning of basic life support, such as rapid outcomes and cost-effectiveness, is increasing. Reports supporting the autonomous learning of cognitive skills in basic life support exist. However, there is currently no report supporting the autonomous learning of psychomotor skills in basic life support.
AIM
This study aimed to assess how using a research-developed pillow-made mannequin affects autonomous learning of psychomotor skills in basic life support training.
DESIGN
Randomized controlled trial.
SETTING
This study was conducted in a nursing school in Turkey.
PARTICIPANTS
Sixty-one (n = 61) third-year formal science undergraduate students.
METHODS
At XXX University, 61 nursing students were divided into Intervention (n = 31) and Control Groups (n = 30). Students in both groups received basic life support training, including live demonstrations. Intervention Group students practiced with the mannequin for 15 days. Skill assessments were conducted by two independent evaluators using a real mannequin 15 days later and six months later. Researchers used a checklist to assess psychomotor skills.
RESULTS
The sociodemographic characteristics of both student groups were similar. There was no significant difference in cognitive knowledge levels after the blended training (p > 0.05). However, at both post-intervention assessments, after 15 days and after 6 months, significant skill differences emerged in "placing the index finger on the ends of the sternum," "combining the thumbs in the middle," "defining the lower sternum as a massage point," "placing the base of the chest" "placing the weaker hand at the massage point," "placing the body perpendicular to the ribcage," and "performing 30 compressions." Cohen's kappa value was calculated as 0.932.
CONCLUSION
Use of the mannequin facilitates autonomous learning of psychomotor skills and promotes accurate application.
TRIAL REGISTRATION
ClinicalTrials.gov ID: NCT05346003, 08/02/2022.
PubMed: 38924976
DOI: 10.1016/j.nedt.2024.106273 -
Pediatric Critical Care Medicine : a... Jun 2024Current European guidelines for pediatric cardiopulmonary resuscitation (CPR) recommend the lower half of the sternum as the chest compression point (CP). In this study,...
OBJECTIVES
Current European guidelines for pediatric cardiopulmonary resuscitation (CPR) recommend the lower half of the sternum as the chest compression point (CP). In this study, we have used thoracic CT scans to evaluate recommended and optimal CP in relation to cardiac anatomy and structure.
DESIGN
Analysis of routinely acquired thoracic CT scans acquired from 2000 to 2020.
SETTING
Single-center pediatric department in a German University Hospital.
PATIENTS
Imaging data were obtained from 290 patients of 3-16 years old.
INTERVENTIONS
None.
MEASUREMENTS AND MAIN RESULTS
We measured and analyzed 14 thoracic metrics in each thoracic CT scan. In 44 of 290 (15.2%) scans, the recommended CP did not match the level of the cardiac ventricles. Anatomically, the optimal CP was one rib or one vertebral body lower than the recommended CP, that is, the optimal CP was more caudal to the level of the body of the sternum in 67 of 290 (23.1%) scans. The recommended compression depth appeared reasonable in children younger than 12 years old. At 12 years old or older, the maximum compression depth of 6 cm is less than or equal to one-third of the thoracic depth.
CONCLUSIONS
In this study of thoracic CT scans in children 3-16 years old, we have found that optimal CP for CPR appears to be more caudal than the recommended CP. Therefore, it seems reasonable to prefer to use the lower part of the sternum for CPR chest compressions. At 12 years old or older, a compression depth similar to that used in adults-6 cm limit-may be chosen.
PubMed: 38921055
DOI: 10.1097/PCC.0000000000003553 -
Journal of Cardiothoracic Surgery Jun 2024First rib tumors are extremely rare. Its compression of neurovascularity can easily lead to severe complications such as thoracic outlet syndrome, so early surgical... (Review)
Review
BACKGROUND
First rib tumors are extremely rare. Its compression of neurovascularity can easily lead to severe complications such as thoracic outlet syndrome, so early surgical resection is crucial. However, there is no standardized approach to surgery.
CASE PRESENTATION
A previously healthy 18-year-old Chinese male undergoes a chest computed tomography (CT) scan that incidentally reveals a raised calcified mass on the right first rib, which is most likely an osteochondroma when combined with magnetic resonance imaging (MRI). We achieved excellent results with resection and thoracic reconstruction by adopting an inverse L-shaped incision in the anterior chest and a longitudinal split of the sternum.
CONCLUSIONS
Our practice provides great reference for the surgical management of first rib tumors.
Topics: Humans; Male; Ribs; Osteochondroma; Adolescent; Bone Neoplasms; Tomography, X-Ray Computed; Magnetic Resonance Imaging; Manubrium
PubMed: 38915107
DOI: 10.1186/s13019-024-02902-9 -
Diabetes, Metabolic Syndrome and... 2024Autonomic nervous system dysfunction (ANSD), for which presently no treatment exists, has a negative impact on prognosis in people with type 2 diabetes (T2D). Periosteal... (Clinical Trial)
Clinical Trial
New Diabetic Treatment by Alleviation of Autonomic Nervous System Dysfunction Measured as Periosteal Pressure Sensitivity at Sternum Improves Empowerment, Treatment Satisfaction, and Self-Reported Health of People with Type 2 Diabetes: A Randomized Trial.
PURPOSE
Autonomic nervous system dysfunction (ANSD), for which presently no treatment exists, has a negative impact on prognosis in people with type 2 diabetes (T2D). Periosteal pressure sensitivity (PPS) on sternum may be a measure of autonomic nervous system dysfunction (ANSD). We tested if a non-pharmacological PPS-feedback-guided treatment program based on non-noxious sensory nerve stimulation, known to reduce PPS, changed empowerment, treatment satisfaction, and quality of life in people with T2D, compared to usual treatment.
PATIENTS AND METHODS
Analysis of secondary endpoints in a single center, two-armed, parallel-group, observer-blinded, randomized controlled trial of individuals with T2D. Participants were randomized to non-pharmacological intervention as an add-on to treatment as usual. Endpoints were evaluated by five validated questionnaires: Diabetes specific Empowerment (DES-SF), Diabetes Treatment Satisfaction (DTSQ), quality of life (QOL) (WHO-5), clinical stress signs (CSS), and self-reported health (SF-36). Sample size calculation was based on the primary endpoint HbA1c.
RESULTS
We included 144 participants, 71 allocated to active intervention and 73 to the control group. Active intervention compared to control revealed improved diabetes-specific empowerment (p = 0.004), DTSQ (p = 0.001), and SF-36 self-reported health (p=0.003) and tended to improve quality of life (WHO-5) (p = 0.056). The findings were clinically relevant with a Cohen's effect size of 0.5 to 0.7.
CONCLUSION
This non-pharmacological intervention, aiming to reduce PPS, and thus ANSD, improved diabetes-specific empowerment, treatment satisfaction, and self-reported health when compared to usual treatment. The proposed intervention may be a supplement to conventional treatment for T2D.
PubMed: 38910915
DOI: 10.2147/DMSO.S455216 -
International Journal of Molecular... May 2024Derived from axial structures, Sonic Hedgehog (Shh) is secreted into the paraxial mesoderm, where it plays crucial roles in sclerotome induction and myotome...
Derived from axial structures, Sonic Hedgehog (Shh) is secreted into the paraxial mesoderm, where it plays crucial roles in sclerotome induction and myotome differentiation. Through conditional loss-of-function in quail embryos, we investigate the timing and impact of Shh activity during early formation of sclerotome-derived vertebrae and ribs, and of lateral mesoderm-derived sternum. To this end, Hedgehog interacting protein (Hhip) was electroporated at various times between days 2 and 5. While the vertebral body and rib primordium showed consistent size reduction, rib expansion into the somatopleura remained unaffected, and the sternal bud developed normally. Additionally, we compared these effects with those of locally inhibiting BMP activity. Transfection of Noggin in the lateral mesoderm hindered sternal bud formation. Unlike Hhip, BMP inhibition via Noggin or Smad6 induced myogenic differentiation of the lateral dermomyotome lip, while impeding the growth of the myotome/rib complex into the somatic mesoderm, thus affirming the role of the lateral dermomyotome epithelium in rib guidance. Overall, these findings underscore the continuous requirement for opposing gradients of Shh and BMP activity in the morphogenesis of proximal and distal flank skeletal structures, respectively. Future research should address the implications of these early interactions to the later morphogenesis and function of the musculo-skeletal system and of possible associated malformations.
Topics: Animals; Hedgehog Proteins; Ribs; Spine; Gene Expression Regulation, Developmental; Mesoderm; Quail; Somites; Bone Morphogenetic Proteins; Carrier Proteins
PubMed: 38891790
DOI: 10.3390/ijms25115602 -
Sudebno-meditsinskaia Ekspertiza 2024Identification of a person by general group characteristics does not lose its relevance over a long period. An analysis of publications (2000-2023) devoted to the... (Review)
Review
Identification of a person by general group characteristics does not lose its relevance over a long period. An analysis of publications (2000-2023) devoted to the possibilities of using the sternum to determine gender and age showed a fairly large amount of work on this topic, with very promising results. The trend in the development of this area is the use of modern methods of medical imaging. This becomes the starting point for conducting such studies on the territory of the Russian Federation and developing a methodology that includes the Russian population, taking into account their population characteristics.
Topics: Sternum; Humans; Forensic Anthropology; Age Determination by Skeleton; Sex Determination by Skeleton; Female; Male; Russia
PubMed: 38887074
DOI: 10.17116/sudmed20246703160 -
Journal of Bodywork and Movement... Jul 2024The 'StretchPole' foam roller product is mainly used to loosen muscle groups and joints in the deeper layers of the body that are normally inaccessible to the human...
The 'StretchPole' foam roller product is mainly used to loosen muscle groups and joints in the deeper layers of the body that are normally inaccessible to the human hand, and to realign the skeletal structure by lying on the pole and performing exercises. It is also used to strengthen the core, which plays an important role in postural maintenance and stability. The purpose of this study was to determine the effects of the 'Solacon' exercise routine using a StretchPole on shoulder joint range of motion. Forty healthy participants performed Solacon exercises using a StretchPole. The specific method of Solacon comprises six movements: (1) chest slide, (2) crescent, (3) cone, (4) twister, (5) shoulder alternating rotation, and (6) chin-in exercise. The joint range of motion of the bilateral shoulder joint flexion, abduction, horizontal abduction, and external rotation (1st and 2nd) were measured before and after the exercises. All measures were significantly higher after exercise compared to before exercise. Solacon exercises improve thoracic spine and scapular mobility and stretch the anterior thoracic muscle groups. The shoulder joint in the broad sense consists of the humerus, scapula, clavicle, sternum, and ribs. These in turn constitute the scapulohumeral joint, acromioclavicular joint, sternoclavicular joint, scapulothoracic joint and functional second shoulder joint. In addition, costovertebral joints and intervertebral joints are also involved because of the added motion of the ribs and the spine. We considered that the ranges of motion of shoulder joint flexion, abduction, horizontal abduction, and external rotation measured in this study were expanded.
Topics: Humans; Range of Motion, Articular; Shoulder Joint; Male; Female; Adult; Young Adult; Exercise Therapy; Muscle Stretching Exercises
PubMed: 38876696
DOI: 10.1016/j.jbmt.2024.02.011