Colgajo de Mustardé como tratamiento de un carcinoma basocelular. A propósito de un caso

Introducción: El carcinoma basocelular es actualmente el cáncer de piel más frecuente, siendo su principal factor de riesgo la exposición a radiación ultravioleta. Su tratamiento es la resección quirúrgica, según riesgo de recurrencia. La reconstrucción facial posterior a la resección se enfrentará según la unidad estética de la cara, lo cual determinará la técnica quirúrgica a utilizar. Material y Método: El siguiente caso clínico aborda la resección de un carcinoma basocelular nodular morfeiforme ubicado en mejilla y ala nasal, y posterior reconstrucción mediante el uso de un Colgajo de Mustardé, con resultado exitoso. Resultados: Evolución favorable, con reseccion completa de la lesion tumoral y vitalidad del colgajo postoperatorio. Cursó con una leve desviación nasal que cedió con masaje de la cicatriz. Se puede plantear una plastía de retoque del ala nasal a futuro. Conclusión: Presentamos un caso clínico de un carcinoma basocelular facial con alto riesgo de recurrencia que fue tratado en forma segura y efectiva con un colgajo de Mustardé.

Introduction: Basal-cell carcinoma is currently the most frequent type of skin cancer, its main risk factor being exposure to ultraviolet radiation. Treatment consists of surgical resection, according to recurrence risk. Post-resection facial reconstruction should be faced according to the aesthetic unit of the face, which will determine the surgical technique. Material and Method: The following clinical case presents the resection of a morpheiform nodular basal-cell carcinoma located on the cheek and nasal wing, and subsequent reconstruction using a Mustarde flap, with successful results. Results: Favorable evolution with complete resection of the tumor lesion and postoperative vitality of the flap. The patient presented a slight nasal deviation that resolved with scar massage. A nasal wing plasty can be considered in the future. Conclusion: We present a facial basal-cell carcinoma clinical case that was safely and effectively treated with a Mustarde flap.

Description of the S-Apple mixed rotation and transposition flap: preliminary note / Descrição do retalho misto de rotação e transposição S-Apple: nota prévia

Introduction: The flaps, whose function is to reduce or redirect tension during a closure, are classified based on their primary movement: transposition, advancement, and rotation, each with its characteristics, indications, and peculiarities. Combining the qualities of the transposition flaps with those of rotation, which make up the S-Apple flap, makes it more versatile and with better aesthetic results than the bilobed flap, which denotes the archetype for the appearance of the S-Apple. Method: Having the rotation and transposition flaps as an archetype, four flaps are made in the S-Apple flap, which are rotated and transposed to close the defect. This is excised in a circular format for the oncological safety of margins. The "S" of the flap is traced at a 30º angle in relation to the defect. The arm dimension must be the same diameter as the defect, with the flaps transposed as in a z-plasty, and the flap rotated to cover the defect, resulting from the exeresis of the lesion. Results: No necrosis, infection, dehiscence, recurrences, trapdoor scars, or rotation point elevation were observed. The scars were classified as satisfactory and extremely satisfactory. Conclusion: The S-Apple flap proved versatile and easy to mark with excellent aesthetic and functional results.

Introdução: Os retalhos, com função de reduzir ou redirecionar a tensão durante um fechamento, são classificados com base em seu movimento primário: transposição, avanço e rotação, cada um com suas características, indicações e peculiaridades. O arregimentar das qualidades dos retalhos de transposição com os de rotação, que compõem o retalho S-Apple, tornam-no mais versátil e com melhores resultados estéticos em relação ao retalho bilobado, que denota o arquétipo para o surgimento do S-Apple. Método: Tendo como arquétipo os retalhos de rotação e transposição, no retalho S-Apple são confeccionados quatro retalhos, que são rotacionados e transpostos para fechamento do defeito. Este é excisado em formato circular para segurança oncológica de margens. O "S" do retalho é traçado em um ângulo de 30º em relação ao defeito. A dimensão do braço deve ser do mesmo diâmetro do defeito, sendo os retalhos transpostos como em uma zetaplastia e o retalho rotacionado para cobrir o defeito, resultante da exérese da lesão. Resultados: Não foram observadas necroses, infecção, deiscências, recidivas, cicatrizes em alçapão e elevação em ponto de rotação. As cicatrizes foram classificadas como satisfatórias e extremamente satisfatórias. Conclusão: O retalho S-Apple se mostrou um retalho versátil de fácil marcação com excelentes resultados estéticos e funcionais.

Research progress on position stability and visual quality changes in the eye after implantable collamer lens implantation / 国际眼科杂志(Guoji Yanke Zazhi)

Implantable collamer lens(ICL)and toric ICL(TICL)are clinically common types of posterior chamber phakic intraocular lenses, they are mainly used to correct high myopia and low-to-moderate myopia of eyes whose corneal conditions are not suitable for corneal laser surgery. Accurate preoperative measurement, safe intraoperative implantation and appropriate postoperative location of lenses are critical to ensure the outcome of ICL implantable, and the appearance of V4c ICL with a central hole ensures the safety of this surgery to a greater extent. However, the intraocular position of both ICL and TICL is not invariable. Some studies have shown that the vault has a trend of decreasing year by year after ICL surgery, but its reason is unknown. And spontaneous rotation may occur after the TICL surgery, thereby causing visual loss, which is one of the main causes of TICL replacement. And postoperative changes in the position of the central hole also need attention. In addition, the visual quality of the operated eye will change after ICL/TICL implantation, but whether the change of intraocular positions of implanted lenses will affect the postoperative visual quality is also a problem that needs to be paid attention to and explored. Therefore, this paper reviewed the postoperative changes in vault, TICL axis, position of the central hole and their causes, as well as the effects of these changes on postoperative visual quality, offering valuable clinical guidance for accurate preoperative selection of ICL/TICL and surgical design, so as to improve the effectiveness and stability of ICL implantation in correction of myopic refractive error.

Advances in anterolateral ligament reconstruction: clinical practice and controversy / 中华骨科杂志

Rupture of the anterior cruciate ligament (ACL) is one of the most frequent forms of knee sports injuries. Nowadays, ACL reconstruction is commonly performed to help patients restore their rotational stability. However, in patients with high risk factors, the risk of ACL reconstruction failure remains high, primarily because of continuous postoperative anterolateral rotational instability. This rotational instability after ACL reconstruction has prompted researchers to focus on the anterolateral complex of the knee, such as iliotibial tract and anterolateral ligament (ALL). Among them, ALL has remained largely unappreciated for more than a century since its discovery in 1879. Even though it is still controversial, most studies in recent years have supported the anterolateral ligament as an independent ligament and a crucial anatomical component for preserving the rotational stability of the knee joint. Although augmentation of the anterolateral complex has experienced twists and turns, the anatomic ALL reconstruction, which can be performed minimally invasively and has a low risk of complications and minimal injury, is reappearing as a key strategy to address this problem. Currently, the majority of scholars believe that the need for combined ALL reconstruction during ACL reconstruction should be taken into account when there is severe rotational instability present, such as high-grade pivot shift test preoperatively, ACL revision surgery, and high requirements for rotational stability, such as age less than 25 years and the need to participate in pivoting sports. The corresponding suggested criteria are also put forth in the authoritative consensus of both domestic and foreign sources. However, the surgical indications chosen by different experts based on their individual experiences are not all consistent. Due to conflicting reports on the actual impact of ALL reconstruction on improving rotational stability and whether it will excessively restrict knee's internal rotation function, there is still much debate among researchers regarding whether ALL reconstruction and ACL reconstruction should be combined. Currently, there are two main reconstruction techniques: ALL single bundle reconstruction and Y-construct ALL double bundle reconstruction. Y-construct ALL double bundle reconstruction has a better ability to restore the original anatomy and is recommended in the consensus, but there is still a lack of randomized controlled trials between the two techniques. Therefore, the combination of ALL reconstruction at the time of ACL reconstruction has been clinically started in recent years for patients who are susceptible to failure after ACL reconstruction, which also raises many controversies.

Growth patterns of lateral abdominal muscles in adolescent baseball players / 体力科学

The purpose of this study was to determine the differences in the growth patterns of the external oblique (EO), internal oblique (IO), and transversus abdominis (TrA) muscles in adolescence baseball players. The subjects were 17 elementary school students (ES), 56 junior high school students (JS), and 21 high school students (HS) who played baseball. The EO, IO, and TrA muscle thicknesses were imaged using an ultrasound imaging device and analyzed separately on the dominant and non-dominant sides. Curve regression estimation of the relationship between EO, IO, and TrA and chronological age was used to read inflection points. An analysis of covariance was also performed, using body weight as a covariate for comparison with each of the EO, IO, and TrA grades. The inflection point readings showed that TrA was 11.26 years old (p<0.01, R2=0.45) for the dominant side and 10.10 years old (p<0.01, R2=0.46) for the non-dominant side, earlier than the inflection points of EO and IO. Analysis of covariance showed no significant difference in EO between any of the grades. IO showed significantly higher values for muscle thickness as the grade increased, both on the dominant and non-dominant side. TrA was higher for JS among ES and JS and higher for HS among ES and HS on both the dominant and non-dominant sides. EO may growth with increasing body size, while IO is interpreted to increase with increasing age due to the movement of baseball. TrA may grow earlier than EO and IO.

A Case of Forearm Rotation Contracture Improved Using a Simple Dynamic Splint / The Japanese Journal of Rehabilitation Medicine

Post-injury rotation contractures of the forearm significantly interfere with various activities of daily living, such as washing the face, receiving change, or wiping a desk, and cause distress to patients. The Colello-Abraham dynamic pronation-supination splint is useful for rotation contractures of the forearm；however, the device includes several small parts and a complicated structure, and assembling the appliance requires technical expertise. Here, we report a case of rotation contracture of the forearm that improved following the use of a simple dynamic splint.

A Case of Forearm Rotation Contracture Improved Using a Simple Dynamic Splint / The Japanese Journal of Rehabilitation Medicine

Post-injury rotation contractures of the forearm significantly interfere with various activities of daily living, such as washing the face, receiving change, or wiping a desk, and cause distress to patients. The Colello-Abraham dynamic pronation-supination splint is useful for rotation contractures of the forearm；however, the device includes several small parts and a complicated structure, and assembling the appliance requires technical expertise. Here, we report a case of rotation contracture of the forearm that improved following the use of a simple dynamic splint.

Effect of couch rotation angle on non-coplanar static intensity-modulated radiotherapy plan for gastric cancer / 中国辐射卫生

Objective To investigate the effect of couch rotation angle on non-coplanar static intensity-modulated radiotherapy (IMRT) plan for gastric cancer and to provide a reference for clinical planning. Methods A retrospective analysis was conducted on patients who recently underwent postoperative IMRT for gastric cancer. Twenty patients who received radiotherapy in the centre of Radiation Oncology of Huanggang Central Hospital from August 2022 to January 2023 were selected. That were selected to receive a seven-field coplanar static IMRT plan based on a couch rotation angle of 0° as the control group. Then, based on the coplanar IMRT plan, only the couch rotation angle of gantry angles 30° and 330° was changed to 10°, 20°, 30°, 40°, 50°, 60°, 70°, 80°, and 90°, respectively, and nine different non-coplanar plans were established. The homogeneity index (HI), conformity index (CI) of the target volume, and monitor unit (MU), as well as Dmean, V20, and V30 of the left and right kidneys, Dmax, Dmean, V10, V20, and V30 of the spinal cord, and Dmax, Dmean, V10, V20, V30, and V40 of the small intestine and liver were compared among the 10 plans. The MU and the dosimetric parameters of the target volumes and When the couch rotation angle was 60°, the minimum HI and maximum CI of the target volume were 0.0714±0.0089 and 0.9271±0.0108, respectively, and the minimum MU was 438±26, with the best homogeneity and conformity in the target volume and the shortest machine treatment time (P＜0.05). When the couch rotation angle was 10°, the Dmax of the small intestine was lowest, being (4620.73±99.27) cGy. When the couch rotation angle was 60°, the Dmean of the left and right kidneys was lowest, being (1246.30±130.35) cGy and (1001.52±103.33) cGy, respectively; the V20 of the left and right kidneys was lowest, being 22.87±6.29 and 19.69±1.84, respectively; the V10 and V30 of the spinal cord were lowest, being 40.08±4.92 and 1.68±0.34, respectively (P＜0.05). Conclusion The couch rotation angle has some influence on the postoperative treatment planning for patients with gastric cancer. In the design of non-coplanar plan for gastric cancer, the couch rotation angle of 60° contributes to establishing a better radiotherapy plan.

Effect of motor imagery therapy on hand function and motor imagery ability of patients after stroke / 中国康复理论与实践

ObjectiveTo observe the effect of motor imagery therapy on hand function and motor imagery ability of stroke patients. MethodsFrom March, 2018 to March, 2020, 41 stroke patients in Beijing Bo'ai Hospital were selected and randomly divided into control group (n = 20) and observation group (n = 21). Both groups received conventional rehabilitation training, and the observation group received motor imagery therapy in addition, for four weeks. Before and after training, the scores of Fugl-Meyer Assessment-Hand (FMA-H) and Kinesthetic and Visual Imagery Questionnaire-10 (KVIQ-10), and the accuracy of mental rotation task were compared between two groups. ResultsOne patient in the observation group dropped down. Before training, there was no significant difference in the scores of FMA-H and KVIQ, and the accuracy of mental rotation task between two groups (P > 0.05). After training, all the indexes improved in both groups (t > 6.611, P < 0.001), and the scores of FMA-H (t = 3.742, P < 0.001) and KVIQ (t = 4.122, P < 0.001), and the accuracy of mental rotation task (t = 2.075, P < 0.05) were higher in the observation group than in the control group. ConclusionMotor imagery therapy could facilliate the recovery of hand dysfunction and improve the motor imagery ability of stroke patients.

Imaging measurement and analysis of related indexes of variation of femoral head rotation center / 中国骨伤

OBJECTIVE@#To provide guidance for hip replacement by analyzing the variation of femoral head rotation center in different hip diseases.@*METHODS@#A total of 5 459 patients were collected from March 2016 to June 2021, who took positive and proportional plain films of both hips for various reasons. The relative position between the rotation center of the femoral head and the apex of the greater trochanter was measured. The positive variation is more than 2 mm above the top of the great trochanter, and the negative variation is more than 2 mm below the top of the great trochanter. A total of 831 patients with variation of femoral head rotation center were collected and were divided into 4 groups according to different diseases, and the variation was counted respectively. There were 15 cases in the normal group involving 10 cases of positive variation and 5 cases of negative variation. There were 145 cases of avascular necrosis of femoral head involving 25 cases of positive variation and 120 cases of negative variation. There were 346 cases of congenital hip dysplasia involving 225 cases of positive variation(including 25 cases of typeⅠ, 70 cases of type Ⅱ, 115 cases of type Ⅲ and 15 cases of type Ⅳ), and 121 cases of negative variation(including 50 cases of crowe typeⅠ, 60 cases of typeⅡ, 10 cases of type Ⅲ and 1 case of type Ⅳ). There were 325 cases of hip osteoarthritis group involving 45 cases of positive variation and 280 cases of negative variation.@*RESULTS@#There was significant difference in variation of femoral head rotation center among the four groups(P<0.05). There was significant difference in variation of femoral head rotation center among different types of congenital hip dysplasia(P<0.05). There were significant differences in cervical trunk angle and eccentricity among different variations of femoral head rotation center(P<0.05).@*CONCLUSION@#The variation of femoral head rotation center is related to cervical trunk angle and eccentricity. The variation of femoral head rotation center is an important factor in hip diseases. The variation of femoral head rotation center is different in different hip diseases. Avascular necrosis of the femoral head and osteoarthritis of the hip were mostly negative variations. With the aggravation of congenital hip dysplasia, the variation of femoral head rotation center gradually changed from negative variation to positive variation.The variation of femoral head rotation center should be paid attention to in the preoperative planning of hip arthroplasty. It is of great significance to select the appropriate prosthesis and place the prosthesis accurately.

Implications of occlusal plane in diagnosis and treatment of malocclusion / 浙江大学学报·医学版

Occlusal plane (OP) is one of the essential factors affecting craniofacial morphology and function. The OP not only assists in diagnosing malocclusion but also serves as an important reference for making treatment plans. Patients with different types of malocclusions have different forms of OP. Compared with patients with standard skeletal facial type, the occlusal plane of patients with skeletal class Ⅱ and high angle is steeper, while that of patients with skeletal class Ⅲ and low angle is more even. In orthodontic treatment, adjusting and controlling the OP can promote the normal growth and development of the mandible in most patients with malocclusion during the early stage of growth, while causing favorable rotation of the mandible in some adults with mild-to-moderate malocclusion. For moderate-to-severe malocclusion, the OP rotation by orthodontic-orthognathic treatment can achieve better long-term stability. This article reviews the evolution of the definition of OP and its implications for diagnosing and the guiding treatment of malocclusion.

Effects of transcranial direct current stimulation on event-related potentials of mental rotation / 生物医学工程学杂志

There are few researches on the modulation effect of transcranial direct current stimulation(tDCS) on complex spatial cognition. Especially, the influence of tDCS on the neural electrophysiological response in spatial cognition is not yet clear. This study selected the classic spatial cognition task paradigm (three-dimensional mental rotation task) as the research object. By comparing the changes in behavior and event-related potentials in different modes of tDCS before, during and after the application of tDCS, this study analyzed the behavioral and neurophysiological effects of tDCS on mental rotation. The comparison between active-tDCS and sham-tDCS showed no statistically significant difference in behavior between different stimulation modes. Still, the changes in the amplitudes of P2 and P3 during the stimulation were statistically significant. Compared with sham-tDCS, the amplitudes of P2 and P3 in active-tDCS mode showed a greater decrease during the stimulation. This study clarifies the influence of tDCS on the event-related potentials of the mental rotation task. It shows that tDCS may improve the brain information processing efficiency during the mental rotation task. Also, this study provides a reference for an in-depth understanding and exploration of the modulation effect of tDCS on complex spatial cognition.

Comparison of passive torque during shoulder internal rotation before and after a pitching in college baseball pitchers / 体力科学

Previous study reported that baseball pitchers had a decreased shoulder internal rotation (IR) range of motion after pitching. However, whether the decreased range of motion associated with pitching is caused by tightness of the posterior shoulder has not been clarified yet. The joint stiffness in the passive torque can be compared with posterior shoulder tightness before and after pitching. Hence, this study aimed to compare shoulder IR stiffness based on passive torque before and after pitching in baseball pitcher. Eleven health male collage baseball pitchers were recruited. Passive torque during IR (max IR, peak torque and stiffness) of dominant and non-dominant arms was measured using an isokinetic dynamometer. Measurements were taken before, after, and post 24 hours after pitching (105 pitches). It was observed that after pitching, max IR and peak torque were significantly decreased compared to those before pitching. However, there was no difference in the stiffness of passive torque among three measurements. In conclusion, healthy college baseball pitchers have a decreased IR range of motion after pitching. However, this result is not due to posterior shoulder tissue tightness, but because of altered stretch tolerance.

Influence of axial rotation on measurement of medial proximal tibial angle / 中国骨伤

OBJECTIVE@#To measure and compare medial proximal tibial angle (MPTA) of lower limbs under different axial rotation angles(neutral position, 30° internal rotation, 30° external rotation) on the load position radiographs, and explore changes and significance of MPTA measured within and between groups of tibia at different axial rotation positions.@*METHODS@#From January 2018 to December 2018, 40 patients with knee osteoarthritis (KOA) were selected, with a total of 80 limbs, including 12 males and 28 females, aged from 29 to 73 years old with an average of (59.6±12.7) years old. Full length radiographs of the lower limbs were taken on neutral tibia position, 30° internal rotation and 30° external rotation, respectively. MPTA was measured and the results were compared between groups and within groups.@*RESULTS@#MPTA measured on the left lower extremity of neutral tibia, 30° internal rotation and 30° external rotation were (86.08±2.48) °, (88.62±2.94) ° and (83.47±3.10) °, respectively. MPTA measured on the right lower limb were (86.87±1.97) °, (89.02±2.39) ° and (83.80±2.77) °, respectively, and there were no significant difference in MPTA measured between rotation angle group (P>0.05). While there were statistical difference in MPTA on the same limb between groups (P<0.05). On 30° internal rotation, MPTA of left and right lower limbs increased by (2.54±1.74) ° and (2.15±1.78) ° compared with tibia neutral position. On 30° external rotation, MPTA of left and right lower limbs decreased (2.61±2.03) ° and (3.07±1.75) ° compared with tibial neutral position.@*CONCLUSION@#When a full-length X-ray film is taken on the weight-bearing position of both lower limbs, if there is axial rotation or external rotation of tibia, MPTA will increase or decrease compared with neutral position, which may cause a certain degree of deviation in clinical operation based on the accurate measurement of MPTA. However, the extent to which this bias affects the clinical operation effect remains to be verified. In addition, limited by the total number of samples and the number of measurement groups, whether there is a linear relationship between MPTA deviation and tibial axial rotation needs to be further studied.

Conservative treatment of supination and external rotation for type Ⅲ and Ⅳankle fracture by bone setting / 中国骨伤

OBJECTIVE@#To explore curative effect of conservative treatment of supination-lateral rotation (SER) with type Ⅲ and Ⅳ ankle fracture by bone setting technique.@*METHODS@#From January 2017 to December 2019, 64 patients diagnosed with SER with type Ⅲ and Ⅳ ankle fracture were treated with manipulative reduction and conservative treatment (manipulation group) and surgical treatment with open reduction and internal fixation (operation group), 32 patients in each group. In manipulation group, there were 17 males and 15 females, aged from 15 to 79 years old with an average of (51.42±13.68) years old;according to Lauge-Hansen classification, there were 8 patients with supination external rotation type Ⅲ and 24 patients with type Ⅳ. In operation group, there were 13 males and 19 females, aged from 18 to 76 years old with an average of (47.36±15.02) years old;7 patients with type Ⅲ and 25 patients with type Ⅳ. Displacement of ankle fracture was measured by Digimizer software, and compared before treatment, 3 and 12 months after treatment between two groups. Lateral medial malleolus displacement, lateral medial malleolus displacement, lateral malleolus displacement, lateral malleolus displacement, lateral malleolus contraction displacement and posterior malleolus displacement were measured and compared between two groups. Mazur score was used to evaluate ankle joint function.@*RESULTS@#All patients were followed up from 12 to 36 months with an average of (17.16±9.36) months. There were statistical differences in lateral medial malleolus displacement, lateral medial malleolus displacement, lateral malleolus displacement, lateral malleolus displacement, lateral malleolus contraction displacement and posterior malleolus displacement in manipulation group before and after reduction(P<0.05). Compared with operation group, there were no statistically significant differences in lateral malleolus shift, lateral malleolus shift, lateral malleolus contraction shift(P>0.05), while there were statistically significant differences in lateral malleolus shift, posterior malleolus shift up and down (P<0.05). Mazur scores of ankle joint at 3 months after treatment in manipulation group and operation group were 68.84±13.08 and 82.53±7.31, respectively, and had statistical differences(P<0.05), while there was no difference in evaluation of clnical effect(P>0.05). There were no differences in Mazur score and evaluation of clnical effect between two groups at 12 months after treatment (P>0.05).@*CONCLUSION@#Bone setting technique could effectively correct lateral displacement of medial malleolus, lateral displacement of medial malleolus, lateral displacement of lateral malleolus and lateral contraction displacement of lateral malleolus in supination lateral rotation type Ⅲ and Ⅳ ankle fracture, and has good long-term clinical effect, which could avoid operation for some patients and restore ankle function after fracture.

Torsión uterina causada por miomatosis: reporte de un caso / Uterine torsion caused by myomatosis: A case report

Resumen ANTECEDENTES: La torsión uterina es una rotación del útero sobre su eje mayor de más de 45°; por lo general sucede en torno del istmo uterino. Los leiomiomas son el factor predisponente más frecuente en úteros no grávidos. OBJETIVO: Reportar el caso de una paciente con torsión uterina cervical y miomatosis de grandes elementos. CASO CLÍNICO: Paciente de 42 años, nuligesta, con antecedente de miomatosis uterina de grandes elementos de 27 x 27 cm. Los síntomas se iniciaron con síndrome doloroso abdominal intenso, tipo cólico, localizado en el hipogastrio y la fosa iliaca. En la exploración física el abdomen se percibió doloroso a la palpación superficial y profunda, con una tumoración cercana a la cicatriz umbilical (25 cm), móvil y dolorosa. En la laparotomía exploradora se encontró líquido peritoneal hemorrágico y se observó una torsión uterina (una vuelta) cerca del cuello del útero, además de un mioma subseroso en la cara posterior, de 27 x 27 cm. El útero, los anexos y las salpinges se advirtieron con datos francos de daño vascular, con áreas de isquemia. Por lo anterior se decidieron la histerectomía total abdominal y la salpingooforectomia bilateral. El informe histopatológico reportó: útero con cambio isquémico extenso panmural, sin evidencia de neoplasia maligna. CONCLUSIONES: El dolor abdominal es el síntoma más común de la torsión uterina que puede variar de leve a agudo. El diagnóstico preoperatorio rápido y preciso de torsión uterina es decisivo y se justifica la intervención quirúrgica de urgencia.

Abstract BACKGROUND: Uterine torsion is a rare entity that is defined as a rotation of the uterus on its major axis of more than 45°, generally occurring at the level of the uterine isthmus. Leiomyomas are the most frequent predisposing factor in non-gravid uterus. OBJECTIVE: Report of a case of a gynecological patient with uterine torsion at the cervical level in a uterus with uterine myomatosis of large elements. CLINICAL CASE: A 42-year-old patient, nulliparous, with a history of uterine myomatosis with large elements of 27 x 27 cm. The symptoms began with intense abdominal pain syndrome, colic type, located in the hypogastrium and the iliac fossa. On physical examination, the abdomen was perceived as painful on superficial and deep palpation, with a mobile and painful tumor close to the umbilical scar (25 cm). In the exploratory laparotomy, hemorrhagic peritoneal fluid was found and a uterine torsion (one turn) was observed near the cervix, as well as a subserous myoma on the posterior face, measuring 27 x 27 cm. The uterus, the annexes and the salpinges were noted with frank data of vascular damage, with areas of ischemia. Therefore, total abdominal hysterectomy and bilateral salpingo-oophorectomy were decided. The histopathological report reported: uterus with extensive panmural ischemic change, without evidence of malignancy. CONCLUSIONS: In uterine torsion, abdominal pain is the most common symptom and can range from mild to severe abdominal symptoms. Therefore, a prompt and accurate preoperative diagnosis of uterine torsion is crucial and urgent surgical intervention is warranted.

Posterior polar cataract: Hydrodissection and nucleus rotation in manual small-incision cataract surgery not a taboo with proper fluidics

A posterior polar cataract is a discoid posterior polar plaque-like cataract with a thin and fragile to absent posterior capsule with adherent acellular opacity to the capsule reported in the literature. It is a stationary or slowly progressive opacity. A higher risk of complications such as posterior capsular tear and nucleus drop makes this a challenging surgery. The techniques described in the literature include bimanual irrigation aspiration, leaving the plaque for later Yag, bimanual micro phaco, Lambda technique with dry aspiration, Phaco if opacity <4 mm and soft nucleus, pars plana vitrectomy (PPV), pars plana lensectomy (PPL) if opacity >4 mm and soft nucleus, intra-capsular cataract extraction (ICCE) and scleral fixated intraocular lens (IOL) if opacity >4 mm with the hard nucleus, viscodissection, 3 ports PPL, PPV, low parameters phaco, modified epinucleus removal, inverse horse-shoe technique, standard phacoemulsification, chip and flip for soft cataracts, stop and chop for hard cataracts, layer-by-layer phacoemulsification, standard lens aspiration, pars plicata posterior vitrecto-rhexis, manual small-incision cataract surgery, and conventional extracapsular extraction. A posterior capsule rupture rate of 0 to 36% is reported in different series for cataract extraction. To prevent this dreaded complication, surgeons used many modifications. Minimal hydrodissection in posterior polar cataract extraction was described by Fine et al. The authors describe a technique of low flow manual small-incision cataract surgery with minimal hydrodissection and nucleus rotation with no associated posterior capsule rent. This demonstrates that if the fluidics is understood and corrected, then minimal hydrodissection and nucleus rotation is not taboo in posterior polar cataract extraction by manual small-incision cataract surgery.

TO FIND CORRELATION OF CORE STRENGTH AND THORACIC ROTATION WITH SPEED OF THROWING IN CRICKETERS

Cricket is one of the most popular games which is played all over the world and its popularity has ever been increasing in the last decade. Fielding is an important dimension of the game as is batting and bowling. With the game being so fast with the introduction of 20 overs game fielding has had an increased demand in the sport. Throwing is considered one of the major and main activities of fielding. Throwing motions involve moving objects spatially using body segments, in particular, hand and arm segments, which can be classified into overarm throws, sidearm throws and underarm throws and divided into throwing objects quickly, accurately and far away. Aim of this study was to find The Correlation of Core Strength and Thoracic Rotation with Speed of Throwing in Cricketers. 31 Cricketers were assessed for their core strength with side rotational medicine ball throws and distance measured, Thoracic rotation in lumbar locked sitting position and measuring with universal goniometer and speed of throws with a BUSHNELL Speed gun. Results of this study showed that Core Strength and Speed of Throws showed a positive, strong and significant correlation whereas Thoracic Rotation and Speed of Throws also showed a positive and significant correlation. Core Strength showed greater clinical and statistical correlation with Speed of Throws than Thoracic Rotation. This study will not only help in preventing throwing injuries but also will help to train and enhance throwing abilities and overall performance

¿Efectividad de la técnica de liberación miofacial en el aumento del rango articular en restricción glenohumeral? Una comparación con la kinesioterapia tradicional / Effectiveness of the myofascial release technique in increasing joint range in glenohumeral restriction? A comparison with traditional kinesiotherapy

OBJETIVO: comparar la kinesioterapia tradicional con la técnica miofacial en pacientes con restricción articular interna glenohumeral. MÉTODO: estudio comparativo de 8 pacientes en un grupo de intervención (GI) y kinésico (GC), durante 8 semanas. Se comparó el pre y post test del ROM interno glenohumeral en ambos grupos mediante t de student. RESULTADOS: el grupo de la técnica miofascial demostró una amento significativo de ROM interno glenohumeral de 15,2º (p < 0,001), mientras que el grupo control no fue significativo (p > 0,05) sólo de de 6,4º. CONCLUSIONES:Un tratamiento de terapia con la Técnicas Liberación Miofascial en pacientes con déficit rotacional interno de hombro es más eficaz para aumentar el rango de movimiento articular de rotación interna glenohumeral que una técnica tradicional y conservadora.

OBJETIVE: to compare traditional kinesiotherapy with myofacial technique in patients with glenohumeral internal joint restriction. METHODS: comparative study of 8 patients in an intervention (IG) and kinesiotherapy (CG) group for 8 weeks. The pre- and post-test of glenohumeral internal ROM in both groups was compared using Student's t-test. RESULTS: the myofascial technique group showed a significant increase in glenohumeral internal ROM of 15.2º (p < 0.001), while the control group was not significant (p > 0.05) only 6.4º. CONCLUSIONS: A therapy treatment with Myofascial Release Techniques in patients with shoulder internal rotational deficit is more effective in increasing glenohumeral internal rotational joint range of motion than a traditional, conservative technique.

Crop succession and its reflections on soybean performance

The fluctuations in yield and consequently in production occurred due to climatic adversities in the main producing states of Brazil. Farming has changed over time, and past scenarios have shown high exploitation of natural resources focusing on soil tillage and conventional seeding methods. This study aimed to determine the yield performance of soybean grown under 10 consolidated crop succession systems. The experiment was conducted during the 2018/2019 crop season, before the research project entitled "Sustainable production systems with better use of biological and natural resources, with treatments arranged in a randomized block design and four replications". The treatments consisted of the following predecessor crops: Avena sativa, Avena strigosa, Triticum aestivum, Secale cereale, Brassica napus, Raphanus sativus, Avena strigosa + Raphanus sativus + Vicia sativa, Fallow, Avena strigosa + Lolium multiflorum, and Triticum aestivum ­ Fodder. Soybean was subsequently sown across winter crops. The succession that showed superior yield was Avena strigosa + Lolium multiflorum. This attribute was established by associating taller plants with the maximization of the number of grains per pod, hundred-grain mass, grain mass, and plant dry mass; in contrast, there was a lower emphasis on plant residue. The determining attributes for soybean yield were plant stand, plant height, the number of pods per plant, and total grain mass, with contrasts among groups composed of the succession of Avena sativa, Avena strigosa, Triticum aestivum, Secale cereale, and Brassica napus, distanced from Raphanus sativus, Avena strigosa + Raphanus sativus + Vicia sativa, Fallow, Avena strigosa + Lolium multiflorum, and Triticum aestivum - Fodder.