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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 -
Plastic and Reconstructive Surgery.... Jun 2024Waist reduction by ultrasound-guided monocortical fracture (RibXcar), usually performed on floating ribs, may show limitations when performed on false ribs (9 and 10)...
BACKGROUND
Waist reduction by ultrasound-guided monocortical fracture (RibXcar), usually performed on floating ribs, may show limitations when performed on false ribs (9 and 10) because of the stress force exerted on the anterior fixation point (cartilage union to sternum). Hence, we introduced a procedure for conversion from false to floating ribs to improve the final result of the treatment of false ribs through a rib treatment scheme.
METHODS
Forty-nine female patients undergoing rib surgery were recruited. Waist measurements and angular variations were compared between two groups of patients, the first (26 patients) consisting of patients who underwent RibXcar with conversion surgery (ribs 9 and 10) and the second (23 patients) consisting of patients who underwent RibXcar without conversion surgery (ribs 9 and 10).
RESULTS
The waist measurements taken after 6 months showed a mean decrease of 8.70 cm in the group where only RibXcar was performed, whereas a statistically significant mean reduction of 17.04 cm was observed in the group where RibXcar was performed with rib conversion surgery.
CONCLUSIONS
The false-to-floating-rib conversion technique combined with RibXcar demonstrated more reduction in waist circumference and a more efficient rib angulation compared with RibXcar alone.
PubMed: 38872990
DOI: 10.1097/GOX.0000000000005900 -
Internal mammary artery perforator flap for repair of an upper thoracic tracheo-oesophageal fistula.Annales de Chirurgie Plastique Et... Jun 2024Tracheoesophageal fistulas (TOF) following esophagectomy for esophageal cancer are rare but potentially fatal. There is no consensus on treatment between stenting and...
Tracheoesophageal fistulas (TOF) following esophagectomy for esophageal cancer are rare but potentially fatal. There is no consensus on treatment between stenting and surgical repair, although the latter is associated with better distant survival. In surgical repair, the interposition of a flap improves healing by providing well-vascularized tissue and reinforcing the repair zone. The flaps described are usually muscular and decaying. We present the case of a malnourished fifty-year-old man who underwent intrathoracic surgical repair of symptomatic recurrent TOF using a skin flap based on the perforators of the internal thoracic artery (IMAP). The perforator flap was completely de-epidermized and tunneled under the sternum by a proximal and limited resection of the 3rd costal cartilage and placed at the posterior aspect of the trachea, with the excess tissue rolled up on either side. At 9 months, the patient showed no recurrence and improved general condition. The de-epidermized IMAP tunneled under the sternum intrathoracically is a reliable alternative to the conventional muscle flaps described in TOF management and an attractive additional tool in the plastic surgeon's surgical arsenal.
PubMed: 38866678
DOI: 10.1016/j.anplas.2024.05.005 -
Journal of Surgical Case Reports Jun 2024Necrotizing fasciitis, a rare, potentially life-threatening infection, often necessitates urgent medical intervention and surgical excision of the affected tissue. We...
Necrotizing fasciitis, a rare, potentially life-threatening infection, often necessitates urgent medical intervention and surgical excision of the affected tissue. We present a 55-year-old male patient with a progressively enlarging lump in the left breast that was diagnosed as a breast carcinoma. Post-modified radical mastectomy, histopathological examination revealed Grade II invasive ductal carcinoma with neuroendocrine features. Due to financial constraints, the patient missed post-operative follow-ups and did not complete the prescribed radiotherapy sessions. Three months later, the patient returned with fever, swelling alongside sharp pain in the left arm and oozing blood. A clinical diagnosis of necrotizing fasciitis was made, leading to urgent surgical debridement. While the wound progressively healed, a contracture developed restricting elbow movement. An Orthopedic Review and Bone scintigraphy revealed metastasis of breast carcinoma to the sternum. This case report highlights the multi-disciplinary management required in such financially constrained rare cases in low- and middle-income countries.
PubMed: 38863962
DOI: 10.1093/jscr/rjae412 -
Wounds : a Compendium of Clinical... May 2024Complex deep surgical site infection in the cardiothoracic surgery patient that reaches the sternum and even the mediastinum, causing osteomyelitis and mediastinitis, is...
BACKGROUND
Complex deep surgical site infection in the cardiothoracic surgery patient that reaches the sternum and even the mediastinum, causing osteomyelitis and mediastinitis, is associated with high rates of morbidity and mortality. Negative pressure wound therapy (NPWT) can aid in achieving favorable outcomes in patients with complex surgical site infections by promoting wound healing and shortening the hospital stay. NPWT is widely recognized for its advantages and has recently been used in both cardiothoracic and non-cardiothoracic settings.
OBJECTIVE
To evaluate the efficacy of NPWT in the management of complex deep surgical site infection after cardiothoracic surgery.
MATERIALS AND METHODS
A retrospective chart review of all complex cardiothoracic cases admitted to the cardiac and thoracic surgery divisions for surgical intervention to treat postoperative surgical wound infections.
RESULTS
A total of 18 patients were included, with a male-to-female ratio of 5:4. The mean (SD) age was 48.7 (16.5) years. The cases reviewed were complex, and the duration of the NPWT application ranged from 4 days to 120 days, with an average hospital stay of 62.8 days. Seventy-eight percent of patients required antibiotics (or had positive wound cultures); in 55.6% of these patients, polymicrobial infection was detected. No major complications were related to NPWT.
CONCLUSION
The study findings show that using NPWT in complex deep sternal and thoracic infections can enhance wound healing, shorten the hospital stay, and decrease morbidity and mortality secondary to wound infection in cardiothoracic patients.
Topics: Humans; Negative-Pressure Wound Therapy; Male; Female; Surgical Wound Infection; Middle Aged; Retrospective Studies; Wound Healing; Treatment Outcome; Adult; Aged; Cardiac Surgical Procedures; Length of Stay; Mediastinitis; Thoracic Surgical Procedures; Osteomyelitis; Anti-Bacterial Agents
PubMed: 38861213
DOI: 10.25270/wnds/23133 -
Ecology and Evolution Jun 2024The size and growth patterns of nestling birds are key determinants of their survival up to fledging and long-term fitness. However, because traits such as feathers,...
The size and growth patterns of nestling birds are key determinants of their survival up to fledging and long-term fitness. However, because traits such as feathers, skeleton and body mass can follow different developmental trajectories, our understanding of the impact of adverse weather on development requires insights into trait-specific sensitive developmental windows. We analysed data from nestling Alpine swifts in Switzerland measured throughout growth up to the age of 50 days (i.e. fledging between 50 and 70 days), for wing length and body mass (2693 nestlings in 25 years) and sternum length (2447 nestlings in 22 years). We show that the sensitive developmental windows for wing and sternum length corresponded to the periods of trait-specific peak growth, which span almost the whole developmental period for wings and the first half for the sternum. Adverse weather conditions during these periods slowed down growth and reduced size. Although nestling body mass at 50 days showed the greatest inter-individual variation, this was explained by weather in the two days before measurement rather than during peak growth. Interestingly, the relationship between temperature and body mass was not linear, and the initial sharp increase in body mass associated with the increase in temperature was followed by a moderate drop on hot days, likely linked to heat stress. Nestlings experiencing adverse weather conditions during wing growth had lower survival rates up to fledging and fledged at later ages, presumably to compensate for slower wing growth. Overall, our results suggest that measures of feather growth and, to some extent, skeletal growth best capture the consequences of adverse weather conditions throughout the whole development of offspring, while body mass better reflects the short, instantaneous effects of weather conditions on their body reserves (i.e. energy depletion vs. storage in unfavourable vs. favourable conditions).
PubMed: 38855314
DOI: 10.1002/ece3.11491 -
Journal of Clinical Anesthesia Jun 2024The mid point-transverse process to pleura block (MTPB) is a new variant of thoracic paravertebral block (TPVB). This study aimed to compare TPVB and MTPB with respect...
Ultrasound-guided mid point-transverse process to pleura block versus thoracic paravertebral block in pediatric open-heart surgery: A randomized controlled non-inferiority study.
STUDY OBJECTIVE
The mid point-transverse process to pleura block (MTPB) is a new variant of thoracic paravertebral block (TPVB). This study aimed to compare TPVB and MTPB with respect to intraoperative attenuation of the hemodynamic stress response to surgery and postoperative analgesia in pediatric open heart surgery with midline sternotomy.
DESIGN
A single-center, randomized, controlled, double-blind, non-inferiority study.
SETTING
Tertiary care children's university hospital.
PATIENTS
We recruited 83 children aged 2-12 years of both sexes with American Society of Anesthesiologists (ASA) physical status class II who were scheduled for elective open cardiac surgeries with midline sternotomy for the repair of simple noncyanotic congenital heart defects.
INTERVENTIONS
Eligible participants were randomized into either the TPVB or MTPB groups at a ratio of 1:1. In the TPVB group, patients were bilaterally injected with 0.4 ml/kg of 0.25% bupivacaine in the paravertebral space at T4 and T5. In the MTPB group, patients were bilaterally injected with 0.4 ml/kg of 0.25% bupivacaine mid-transverse process and pleura just posterior to superior costotransverse ligament at the level of T4 and T5.
MEASUREMENTS
The primary outcome was the hemodynamic responses to sternotomy incision, including heart rate (HR) and invasive mean arterial pressure (MAP), recorded before and after the induction of anesthesia, after skin incision, after sternotomy, 15 min after cardiopulmonary bypass (CPB), and after the closure of the sternum. The secondary outcomes were time needed to perform the bilateral block, intraoperative fentanyl consumption, postoperative fentanyl consumption, modified objective pain score (MOPS) measured at 1, 2, 6, 12, 18, and 24 h after extubation, extubation time, intensive care unit (ICU) discharge time, and the incidence of non-surgical complications (postoperative pruritus, postoperative vomiting, pneumothorax, hematoma or local anesthetic toxicity).
MAIN RESULTS
There were no significant differences in HR and MAP in the TPVB group compared with the MTPB group at the following time points: baseline, after induction, after skin incision, after sternotomy, 15 min after CPB, and after sternal closure. Intergroup comparisons of HR and MAP did not reveal significant differences between the groups. The median (IQR) time needed to perform bilateral MTPB (7[6-8] min) was significantly (p < 0.001) shorter than that of TPVB (12[10-13] min). Intraoperative fentanyl consumption and fentanyl consumption in the first postoperative 24 h after extubation were similar in the TPVB and MTPB groups (4[2-4] vs 4[2-4] and 4.66 ± 0.649 vs 4.88 ± 1.082 μg/kg), respectively. Extubation time and ICU discharge time were comparable in the TPVB and MTPB groups (2[1-3] vs 2[1-3] h and 21.2 ± 2.5 vs 20.8 ± 2.6 h), respectively. Measurements of MOPS pain scores at 1, 2, 6, 12, 18, and 24 h after extubation were similar in both groups. The incidence of nonsurgical complications was similar in both groups.
CONCLUSIONS
MTPB is non-inferior to TPVB in attenuating the intraoperative hemodynamic stress response to noxious surgical stimuli and in reducing perioperative opioid consumption, extubation time, and ICU discharge time. Moreover, MTPB is technically easier than TPVB and requires less time to perform. Clinical trial registration number The clinical trial registration was prospectively performed at the Pan African Clinical Trials Registry (PACTR202204901612169, approval date 01/04/2022, URL https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=22602).
PubMed: 38852396
DOI: 10.1016/j.jclinane.2024.111507