Reconstrução mamária com TRAM: avaliação tomográfica abdominal / Breast reconstruction with TRAM: abdominal tomographic evaluation

Introdução: O retalho transverso do músculo reto abdominal (TRAM) é um método de reconstrução mamária com bons resultados estéticos e dispensa o uso de próteses de silicone para melhor contorno corporal. Foi originalmente descrito por Holmstrom em 1979, como uma elipse de pele e gordura com base em um músculo isolado no seu pedículo vascular. A reconstrução sistematizada do defeito da parede instalado após a transposição do retalho com o uso de tela de polipropileno foi descrita em estudo prévio por Cunha. O artigo tem como objetivo avaliar as alterações na parede abdominal, após a sistematização da colocação da tela de polipropileno durante a cirurgia de reconstrução com TRAM. Método: É um trabalho de coorte retrospectivo que avalia as possíveis alterações da parede abdominal de pacientes submetidos ao retalho TRAM com tomografia computadorizada de abdome pré e pós-operatórias. Resultados: Foi evidenciada uma redução do tamanho da cavidade abdominal de, em média, 14,5% e 14,2% na espessura da parede abdominal submetidas ao TRAM. A maior redução da espessura da parede abdominal foi de um paciente submetido ao retalho bipediculado, com 50,7%. As complicações apresentadas foram hérnia umbilical, seroma tardio, fibrose peritela e granuloma de fio. Conclusão: Nesse estudo, a tomografia após a cirurgia demonstrou a redução no volume da cavidade abdominal e espessura da parede abdominal, o que não influenciou estatisticamente no aparecimento de hérnia abdominal, abaulamentos, extrusão da malha ou outras deformidades.

Introduction: The transverse rectus abdominis muscle flap (TRAM) is a method of breast reconstruction with good aesthetic results and does not require the use of silicone implants for better body contouring. It was originally described by Holmstrom in 1979 as an ellipse of skin and fat based on an isolated muscle on its vascular pedicle. The systematic reconstruction of the wall defect installed after flap transposition using polypropylene mesh was described in a previous study by Cunha. The article aims to evaluate changes in the abdominal wall, after the systematization of polypropylene mesh placement during TRAM reconstruction surgery. Method: This is a retrospective cohort study that evaluates possible changes in the abdominal wall of patients undergoing the TRAM flap with preand postoperative abdominal computed tomography. Results: A reduction in the size of the abdominal cavity of, on average, 14.5% and 14.2% in the thickness of the abdominal wall subjected to TRAM was evidenced. The greatest reduction in abdominal wall thickness was in a patient who underwent a bipedicled flap, with 50.7%. The complications presented were umbilical hernia, late seroma, perithellal fibrosis, and thread granuloma. Conclusion: In this study, tomography after surgery demonstrated a reduction in the volume of the abdominal cavity and thickness of the abdominal wall, which did not statistically influence the appearance of abdominal hernia, bulging, mesh extrusion, or other deformities.

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.

Effect of external diaphragm pacing therapy combined with abdominal functional electrical stimulation on respiratory function for stroke patients / 中国康复理论与实践

ObjectiveTo explore the effect of external diaphragm pacing therapy combined with abdominal functional electrical stimulation on respiratory function for stroke patients. MethodsFrom October, 2020 to September, 2022, 54 stroke patients were randomly divided into control group (n = 18), external diaphragm pacing group (n = 18) and combined treatment group (n = 18). All the groups received breathing training, while the external diaphragm pacing group received external diaphragm pacing therapy, and the combined treatment group received external diaphragm pacing and abdominal functional electrical stimulation therapy, for two weeks. They were measured forced vital capacity (FVC), forced expiratory volume in first second (FEV1), ratio of forced expiratory volume in first second in forced vital capacity (FEV1/FVC), peak expiratory flow (PEF), maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) with pulmonary function instrument; measured diaphragmatic excursion (DE) and diaphragmatic thickness (DT) with ultrasound, before and after treatment. ResultsThree cases in the control group, two cases in the external diaphragm pacing group and one case in the combined treatment group dropped off. The FVC, FEV1, PEF, MIP, MEP and DE improved in all the groups (|t| > 3.366, P < 0.01) after treatment; and the FVC, FEV1, MIP and DE increased more in the combined treatment group and the external diaphragm pacing group than in the control group (P < 0.05); the FVC and FEV1 increased more in the combined treatment group than in the external diaphragm pacing group (P < 0.05). ConclusionExternal diaphragm pacing therapy may improve ventilation and inspiratory muscle strength, and increase diaphragm movement for stroke patients; while the ventilation improved more after combining with abdominal functional electrical stimulation.

Dose-effect relationship of compound lidocaine hydrochloride for TAP-RSB for postoperative analgesia in elderly patients undergoing laparoscopic radical colon cancer surgery with general anesthesia / 中华麻醉学杂志

Objective:To evaluate the dose-effect relationship of compound lidocaine hydrochloride for transverse abdominal plane-rectus abdominis sheath block (TAP-RSB) for postoperative analgesia in elderly patients undergoing laparoscopic radical colon cancer surgery with general anesthesia.Methods:Elderly patients of either sex, aged≥65 yr, with body mass index <30 kg/m 2, of American Society Anesthesiologists physical status Ⅰ-Ⅲ, undergoing elective laparoscopic radical colon cancer surgery with general anesthesia, were selected.After induction of general anesthesia, compound lidocaine hydrochloride was given under ultrasound guidance for bilateral TAP block (20 ml on each side) and for bilateral RSB (10 ml on each side), with the initial concentration of 0.4%.Each time the concentration increased/decreased in the next patient depending on whether or not the analgesia was effective.The ratio between the two successive concentrations was 1.00∶1.15.The analgesic effects were evaluated by the Numerical Rating Scale at 1 h intervals from the time of postoperative admission to the post-anesthesia care unit until 8 h after TAP-RSB (Numerical Rating Scale ≤ 3 was considered as effective analgesia). The probit method was used to calculate the half effective concentration (EC 50) and 95% effective concentration (EC 95) and 95% confidence interval of compound lidocaine hydrochloride. Results:The EC 50 and EC 95(95% confidence interval)of compound lidocaine hydrochloride for TAP-RSB were 0.289% (0.232%-0.352%) and 0.404% (0.345%-0.970%), respectively, when used for postoperative analgesia in elderly patients undergoing laparoscopic radical colon cancer surgery with general anesthesia. Conclusions:The EC 50 and EC 95 of compound lidocaine hydrochloride for TAP-RSB are 0.289% and 0.404%, respectively, when used for postoperative analgesia in elderly patients undergoing laparoscopic radical colon cancer surgery with general anesthesia.

Efficacy of dexmedetomidine combined with transversus abdominis plane block in laparoscopic radical resection of colorectal cancer and its effect on serum CXCL8 level / 肿瘤研究与临床

Objective:To investigate the efficacy of dexmedetomidine combined with transversus abdominis plane block in laparoscopic radical resection of colorectal cancer and its effect on serum CXCL8 level.Methods:A total of 72 patients who planned to undergo laparoscopic radical resection of colorectal cancer in Changzhou Hospital of Traditional Chinese Medicine from March 2017 to March 2021 were selected as the research subjects, and they were divided into transversus abdominis plane block anesthesia group (group A) and dexmedetomidine combined with transversus abdominis plane block anesthesia group (group B) by random number table method with 36 cases in each group. The operation time, intraoperative blood loss, fluid supplementation, visual analogue score (VAS) and Ramsay sedation score at different times after operation, and serum CXCL8 level after operation were compared between the two groups of patients. The adverse reactions of the two groups of patients were compared.Results:There was no significant difference in operation time and fluid supplementation between the two groups (both P > 0.05). The VAS scores of patients in group B at 4, 8 and 24 hours after operation were lower than those in group A [(2.8±0.6) points vs. (4.2±1.2) points, (2.1±1.0) points vs. (3.4±1.1) points, (1.8±0.4) points vs. (2.5±0.7) points, all P < 0.05], and the Ramsay sedation scores of patients in group B at 4, 8 and 24 hours after operation were higher than those in group A [(4.3±1.2) points vs. (2.7±0.7) points, (3.5±1.1) points vs. (2.2±1.0) points, (2.4±0.9) points vs. (1.6±0.6) points, all P<0.05]. Serum CXCL8 levels of patients in group B at 2, 24 and 48 hours after operation were lower than those in group A [(78±16) ng/ml vs. (87±19) ng/ml, (68±14) ng/ml vs. (75±15) ng/ml, (52±10) ng/ml vs. (61±13) ng/ml, all P<0.05]. The incidence rates of adverse reactions in group A and group B were 8.3% (3/36) and 13.9% (5/36), and the difference was not statistically significant ( P > 0.05). Conclusions:Dexmedetomidine infusion during laparoscopic radical resection of colorectal cancer under general anesthesia combined with transversus abdominis plane block can help reduce postoperative pain, increase sedative effect, and reduce serum CXCL8 level.

Effect of transcutaneous abdominal electrical stimulation in people with constipation due to spinal cord injuries: a pilot study / Efecto de la electroestimulación abdominal transcutánea sobre el estreñimiento en personas con lesión de la médula espinal: estudio piloto / Efeito da eletroestimulação abdominal transcutânea no quadro de constipação em pessoas com lesão medular: estudo piloto

ABSTRACT Objective: To evaluate the effect of abdominal electrical stimulation (EE) on bowel movement frequency and feces consistency and expelled amount in people with constipation due to spinal cord injuries (SCI). Method: This is an experimental, crossover, randomized pilot study with two treatment groups: conventional intestinal rehabilitation and conventional rehabilitation associated with EE via 8- and 20-Hz Functional Electrical Stimulation (FES) of the abdominal muscles. Both groups were followed for two weeks with daily 30-minute EE sessions. Participants were hospitalized in a rehabilitation institute in the municipality of São Paulo. Data were analyzed using descriptive and inferential statistics. Results: This study included 10 people with SCI, of which most were male (70%), with a mean age of 39 years (SD = 16.37). EE, associated with conventional treatment, was more effective in increasing defecation frequency (p = 0.029) and amount of feces expelled (p = 0.031). Conclusion: Abdominal EE, associated with conventional treatment, helped to increase defecation frequency and amount of feces expelled in people with constipation due to SCI. This pilot study will serve as the basis for a future clinical trial with greater sampling and statistical evidence.

RESUMEN Objetivo: Evaluar el efecto de la electroestimulación abdominal (EE) sobre la frecuencia de las evacuaciones, la consistencia y la cantidad de heces en personas con estreñimiento debido a una lesión de la médula espinal (LME). Método: Estudio piloto experimental de tipo crossover-aleatorizado en dos grupos de tratamiento: convencional rehabilitación intestinal y convencional asociado a EE con Functional Electrical Stimulation (FES) de 8 y 20 Hz aplicados a los músculos abdominales. Se realizó un seguimiento de ambos grupos durante dos semanas con 30 minutos de sesión diaria de EE. Los participantes estaban hospitalizados en un instituto de rehabilitación de la ciudad de São Paulo. Los datos se analizaron mediante estadística descriptiva e inferencial. Resultados: Diez personas con LME participaron en el estudio, la mayoría hombres (70%) con una edad media de 39 años (DE = 16,37). La EE asociada al tratamiento convencional demostró ser más eficaz en el aumento de la frecuencia de evacuación (p = 0,029) y la cantidad de heces (p = 0,031). Conclusión: La EE abdominal asociada al tratamiento convencional ayudó a aumentar la frecuencia de evacuación y la cantidad de heces en el contexto de estreñimiento en personas con LME. Este estudio piloto servirá de base para futuros ensayos clínicos con mayor muestreo y evidencia estadística.

RESUMO Objetivo: Avaliar o efeito da eletroestimulação (EE) abdominal sobre a frequência de evacuações, a consistência e a quantidade de fezes em pessoas com constipação decorrente da lesão medular (LM). Método: Estudo piloto experimental do tipo crossover-randomizado em dois grupos de tratamento: convencional de reabilitação intestinal e convencional associado à EE com Functional Electrical Stimulation (FES) de 8 e 20 Hz aplicados na musculatura abdominal. Ambos os grupos em seguimento por duas semanas, com 30 minutos de sessão diária de EE. Os participantes estavam internados em um instituto de reabilitação da cidade de São Paulo. Os dados foram analisados por meio de estatística descritiva e inferencial. Resultados: Participaram do estudo 10 pessoas com LM, a maioria do sexo masculino (70%), com média de idade de 39 anos (DP = 16,37). A EE, associada ao tratamento convencional, mostrou-se mais eficaz no aumento da frequência evacuatória (p = 0,029) e na quantidade de fezes (p = 0,031). Conclusão: A EE abdominal associada ao tratamento convencional auxiliou no aumento da frequência evacuatória e na quantidade de fezes no quadro de constipação em pessoas com LM. Este estudo piloto servirá como base para um futuro ensaio clínico com maior amostragem e comprovação estatística.

The effect of physical exercise on the rehabilitation quality of human waist dysfunction / O efeito do exercício físico na qualidade da reabilitação da disfunção da cintura humana / El efecto del ejercicio físico en la calidad de rehabilitación de la disfunción de la cintura humana

ABSTRACT Introduction Human motor dysfunction can affect the quality of life, especially waist dysfunction. And an effective means to improve muscle strength during exercise. Object This article compares and analyzes the effectiveness of human muscle exercise on the decline in quality of life caused by motor dysfunction. Method The article divides patients with motor dysfunction into trunk isokinetic training group (experimental group) and waist and abdominal muscle functional training group (control group), and comparative analysis of related indicators before and after treatment. Results Before treatment, the specific indicators of the two were different (P>0.05). After treatment, the patients' quality of life indicators and motor function indicators were significantly different (P<0.05). Conclusion Exercise has an obvious curative effect for patients with human motor dysfunction, and it is worthy of clinical promotion. Level of evidence II; Therapeutic studies - investigation of treatment results.

RESUMO Introdução A disfunção motora humana pode afetar a qualidade de vida, principalmente a disfunção da cintura. E um meio eficaz de melhorar a força muscular é o exercício. Objetivo este artigo compara e analisa a eficácia do exercício muscular humano no declínio da qualidade de vida causado por disfunção motora. Método O artigo divide os pacientes com disfunção motora em grupo treinamento isocinético de tronco (grupo experimental) e grupo treinamento funcional de cintura e músculos abdominais (grupo controle), e análise comparativa dos indicadores relacionados antes e após o tratamento. Resultados Antes do tratamento, os indicadores específicos dos dois eram diferentes (P> 0,05). Após o tratamento, os indicadores de qualidade de vida e indicadores de função motora dos pacientes foram significativamente diferentes (P <0,05). Conclusão O exercício tem um efeito curativo óbvio para pacientes com disfunção motora humana e é digno de promoção clínica. Nível de evidência II; Estudos terapêuticos - investigação dos resultados do tratamento.

RESUMEN Introducción La disfunción motora humana puede afectar la calidad de vida, especialmente la disfunción de la cintura. Y un medio eficaz para mejorar la fuerza muscular es el ejercicio. Objeto Este artículo compara y analiza la efectividad del ejercicio muscular humano sobre el deterioro de la calidad de vida causado por la disfunción motora. Método El artículo divide a los pacientes con disfunción motora en grupo de entrenamiento isocinético del tronco (grupo experimental) y grupo de entrenamiento funcional de cintura y músculos abdominales (grupo control), y análisis comparativo de indicadores relacionados antes y después del tratamiento. Resultados Antes del tratamiento, los indicadores específicos de los dos eran diferentes (P> 0.05). Después del tratamiento, los indicadores de calidad de vida de los pacientes y los indicadores de función motora fueron significativamente diferentes (P <0,05). Conclusión El ejercicio tiene un efecto curativo obvio para los pacientes con disfunción motora humana y es digno de promoción clínica. Nivel de evidencia II; Estudios terapéuticos: investigación de los resultados del tratamiento.

Neuromuscular injury method in different strength sports damage / Método de lesão neuromuscular em danos variados causados por esportes de força / Método de lesión neuromuscular em daños variados causados por deportes de fuerza

ABSTRACT Introduction: Sports muscle injury is a common phenomenon in sports, and most of it is caused by intense exercise done for a long time. Objective: The effect of high intensity mode (HI) speed endurance training on the muscle injury of athletes. Methods: 14 sprinters were recruited; the muscle injury indexes of the subjects were tested 15 min before and 24 h, 48 h and 72 h after speed endurance training in HV mode and HI mode (high volume mode and high intensity mode, respectively). Results: The results of this study showed that both high amount and HI mode speed endurance training caused a certain degree of injury to the subjects' muscles, but the injury caused by HI mode speed endurance training to the muscles was more serious than that caused by high amount (P < 0.05). Conclusions: HI mode speed endurance training causes a certain degree of injury to the subjects' muscle, but it causes more serious injury than high volume mode speed endurance training. Level of evidence II; Therapeutic studies - investigation of treatment results.

RESUMO Introdução: As lesões musculares são fenômenos comuns no esporte e a maioria são causadas por exercícios intensos praticados por um longo período. Objetivo: O efeito do treinamento de resistência de velocidade de alta intensidade (AI) nas lesões musculares de atletas. Métodos: 14 corredores foram recrutados; os índices de lesão muscular dos indivíduos foram testados 15 minutos antes e 24h, 48h e 72h após o treino de resistência de velocidade em AV e AI (modos alto volume e alta intensidade, respectivamente). Resultados: Os resultados deste estudo mostram que tanto os treinamentos de resistência de velocidade nos modos alto volume e AI causaram certo grau de lesão aos músculos dos indivíduos, mas a lesão ao músculo por treino de resistência de velocidade no modo AI foi mais severa do que aquela no modo alto volume (P < 0.05). Conclusões: O treinamento de resistência de velocidade no modo AI causa certo grau de lesão aos músculos dos indivíduos, mas causa danos mais sérios do que o treino de resistência de velocidade no modo alto volume. Nível de evidência II; estudos terapêuticos - investigação de resultados de tratamento.

RESUMEN Introducción: Las lesiones musculares son fenómenos comunes en el deporte y la mayoría es causada por ejercicios intensos practicados por un largo periodo. Objetivo: El efecto del entrenamiento de resistencia de velocidad de alta intensidad (AI) en las lesiones musculares de atletas. Métodos: Se reclutaron 14 corredores; se testaron los índices de lesión muscular de los individuos 15 minutos antes y 24h, 48h y 72h después del entrenamiento de resistencia de velocidad en AV y AI (modos alto volumen y alta intensidad, respectivamente). Resultados: Los resultados de este estudio muestran que tanto los entrenamientos de resistencia de velocidad en los modos alto volumen y AI causaron cierto grado de lesión a los músculos de los individuos, pero la lesión al músculo por entrenamiento de resistencia de velocidad en el modo AI fue más severa que aquella en el modo alto volumen (P<0.05) Conclusiones: El entrenamiento de resistencia de velocidad en el modo AI causa cierto grado de lesión a los músculos de los individuos, pero causa daños más serios que el entrenamiento de resistencia de velocidad en el modo alto volumen. Nivel de evidencia II; Estudios terapéuticos - investigación de resultados de tratamiento.

Phosphocreatine improves muscle microcirculation during exercise / A fosfocreatinina melhora a microcirculação muscular durante o exercício / La fosfocreatina mejora la microcirculación muscular durante el ejercicio

ABSTRACT Introduction: Phosphate (CP) its biosynthesis begins with the kidney. Glycocianine was synthesized from glycocianine, then methylated in the liver, and finally formed in each tissue. Objective: To study the effects of phosphatic acid in exercise training. Methods: This paper uses 50 pure male mice, 2 month old, weight at 22 ± 3 g, and mice per day, 5 minutes each time. After exercise training, dry dry with a towel and blow it with a hair dryer, and move it to the end of each other. Results: The average time of motion B mouse to give phosphate creatine is significantly longer than the average time of the non-administration of the A group, and the motion time is prolonged to extend 23.20%. Phosphate has improved motor endurance and promotes improvement in muscle microcirculation during exercise. Conclusions: Motion can be used to improve the maximum aerobic capacity of exercise in motion. Level of evidence II; Therapeutic studies - investigation of treatment results.

RESUMO Introdução: A biossíntese Its do fosfato começa no rim. Glicociamina foi sintetizado de glicocianina, e depois transformado em metilato no fígado; finalmente, desenvolve em cada tecido. Objetivo: Estudar os efeitos do ácido fosfato em treinamento de exercícios. Métodos: Este estudo usa 50 camundongos machos puros de dois meses de idade, pesando ± 3g aos 22 meses, e XXX camundongos por dia por cinco minutos cada vez. Após o treino, estes foram secos com uma toalha e secador de cabelo e colocados um do lado do outro. Resultados: O tempo médio de movimento para o grupo B de camundongos produzir fosfato de creatinina é consideravelmente mais longo do que o tempo médio do grupo A, onde não houve administração. O tempo de movimento se prolonga em 23,20%. O fosfato melhora a resistência motora e promove uma melhora na microcirculação durante o exercício. Conclusões: O movimento pode ser usado para melhorar a capacidade aeróbica máxima do exercício em movimento. Nível de evidência II; Estudos terapêuticos - investigação de resultados de tratamento.

RESUMEN Introducción: El biosíntesis del fosfato empieza en el riñón. La Glicociamina se sintetizó de Glicocianina, y después se transformó en metilato en el hígado; y finalmente, formó cada tejido. Objetivo: Estudiar los efectos del ácido fosfato en entrenamiento de ejercicios. Métodos: Este estudio utiliza 50 ratones machos puros de 2 meses de edad, pesando ± 3g a los 22 meses, y xxx ratones por día por 5 minutos cada vez. Tras el entrenamiento, se los secó con una toalla y secador de pelo y se los puso lado a lado. Resultados: El tiempo medio de movimiento para el grupo B de ratones producir fosfato de creatina es considerablemente más largo que el tiempo medio del grupo A, donde no hubo administración. El tiempo de movimiento se alarga en 23,20%. El fosfato mejora la resistencia motora y promueve una mejoría en la microcirculación durante el ejercicio. Conclusiones: El movimiento puede usarse para mejorar la capacidad aeróbica máxima del ejercicio en movimiento. Nivel de evidencia II; Estudios terapéuticos - investigación de resultados de tratamiento.

Therapeutic effect of two muscle strengthening programs in patients with patellofemoral pain syndrome. A randomized controlled clinical trial / Efecto terapéutico de dos programas de fortalecimiento muscular en pacientes con síndrome de dolor pátelofemoral. Ensayo clínico controlado aleatorizado

Abstract Introduction: Patellofemoral pain syndrome (PFPS) is one of the most common musculoskeletal disorders affecting the knee joint. Conservative treatment reduces pain and improves functional capacity in the short and medium-term. Objective: To determine the therapeutic effect of two muscle strengthening exercise programs in patients with PFPS from Bogotá, Colombia, aged between 15 and 40 years. Materials and methods: Experimental randomized controlled clinical trial conducted in 40 patients with PFPS from Bogotá, Colombia, aged 15-40 years, with a mild to moderate level of physical activity. Participants were randomly distributed into 2 intervention groups: Group A: 8-week-long core, hip and knee muscles strengthening exercises program; Group B: 8-week-long hip and knee muscles strengthening exercises program. The level of pain was measured using the Visual Analog Scale and the Kujala Anterior Knee Pain Scale. Results: The addition of core muscle strengthening exercises to the traditional treatment improved the quality of life of participants in the intervention group A, where a significant reduction of pain, with a statistically significant difference in the total score of the Kujala scale (p=0.025) was observed. Conclusions: Including core muscle strengthening exercises in the conservative management of PFPS increases its effectiveness to reduce pain and improve the quality of life of these patients. ClinicalTrials.gov Identifier: NCT04011436

Resumen Introducción. El síndrome de dolor pátelofemoral (SPF) es una de las alteraciones musculoesqueléticas más frecuentes que afectan la articulación de la rodilla. El tratamiento conservador reduce el dolor y mejora la capacidad funcional en el corto y mediano plazo. Objetivo. Establecer el efecto terapéutico de dos programas de ejercicios de fortalecimiento muscular en pacientes con SPF de Bogotá, Colombia, con edades entre 15 y 40 años. Materiales y métodos. Ensayo clínico controlado aleatorio experimental realizado en 40 pacientes con SPF de Bogotá, Colombia, con edades entre los 15 y 40 años, con nivel de actividad física leve a moderada y que fueron distribuidos de forma aleatoria en 2 grupos de intervención: Grupo A: programa de ejercicios de fortalecimiento de los músculos del core, la cadera y la rodilla con una duración de 8 semanas; Grupo B: programa de ejercicios de fortalecimiento de los músculos de la cadera y la rodilla con la misma duración. El nivel de dolor se midió a través de la Escala Visual Analógica y de la Escala de Kujala para dolor patelofemoral. Resultados. La adición de ejercicios de fortalecimiento de los músculos del core al tratamiento tradicional mejoró la calidad de vida de los participantes en el grupo de intervención A, donde se observó una reducción significativa del dolor con una diferencia estadísticamente significativa en la puntuación total de la escala Kujala (p=0.025). Conclusiones. Incluir ejercicios de fortalecimiento de los músculos del core al manejo conservador del SPF aumenta su efectividad para reducir el dolor y mejorar la calidad de vida de estos pacientes. ClinicalTrials.gov Identifier: NCT04011436

Improved efficacy of transversus abdominal plane-rectus sheath block combined with general anesthesia in patients undergoing laparoscopic pancreaticoduodenectomy / 中华麻醉学杂志

Objective:To evaluate the improved efficacy of transversus abdominal plane (TAP)-rectus sheath (RS) block combined with general anesthesia in the patients undergoing laparoscopic pancreaticoduodenectomy.Methods:Fifty-six American Society of Anesthesiologists physical status Ⅰ-Ⅲ patients of both sexes, aged 45-64 yr, with body mass index of 18-25 kg/m 2, scheduled for elective laparoscopic pancreaticoduodenectomy, were divided into 2 groups ( n=28 each) using a random number table method: general anesthesia group (group G) and TAP-RS block plus general anesthesia group (group TRG). In group TRG, after induction of general anesthesia, bilateral TAP-RS block was performed with 0.375% ropivacaine mixed with 0.5 μg/kg dexmedetomidine under ultrasound guidance, 20 ml was injected into the plane of bilateral transverse abdominis, and 10 ml was injected into the posterior sheath of the bilateral rectus abdominis, and the tube was placed on the plane of the transverse abdominis, and 5 ml/h was continuously pumped after operation.In both groups, anesthesia was induced with IV midazolam, sufentanil, etomiddate and cisatracurium besylate and maintained using combined intravenous-inhalational anesthesia, and patient-controlled intravenous analgesia (PCIA) was performed after operation.Pulmonary function indexes were measured before induction of anesthesia (T 0) and at 6, 12 and 24 h after removal of the tracheal tube (T 1-3). Blood gas analysis was performed at T 0, T 2 and T 3.The occurrence of high/low blood pressure, tachycardia/bradycardia, consumption of opioids, PACU stay time, pressing times of PCIA within 24 h after surgery, rescue analgesia, time of passing the first flatus, the first postoperative off-bed time, length of postoperative hospital stay, and 48 h quality of recovery-40 (QoR-40) were recorded.The occurrence of adverse reactions and nerve block-related complications were recorded within 48 h after operation. Results:Conversion to laparotomy during operation was found in 4 patients, changing the scope of resection in 2 patients, and a total of 50 patients were enrolled in this study.Compared with group G, the pressing times of PCIA was significantly reduced, the requirement for postoperative rescue analgesia was decreased, the intraoperative consumption of sufentanil and remifentanil was reduced, the incidence of intraoperative hypertension and tachycardia was decreased, the FEV1, FVC and PEFR were increased at T 2, 3, the 48 h QoR-40 score was increased, the time of passing the first flatus, the first postoperative off-bed time, and length of postoperative hospital stay were shortened, the incidence of nausea, agitation, somnolence, and hypoxemia was decreased ( P<0.05), and no significant change was found in the indicators of blood gas analysis at each time point in group TRG ( P>0.05). Nerve block-related complications were not found in group TRG. Conclusion:Compared with general anesthesia alone, TAP-RS block combined with general anesthesia is helpful in carrying out anesthetic model of low-consumption opioids and improving the quality of early postoperative recovery when used in the patients undergoing laparoscopic pancreaticoduodenectomy.

Application of transversus abdominis plane block combined with rectus sheath block in patients undergoing laparoscopic total hysterectomy / 中国医师进修杂志

Objective:To evaluate the effect of total intravenous anesthesia combined with transversus abdominis plane block (TAPB) and rectus sheath block (RSB) in patients undergoing laparoscopic total hysterectomy.Methods:One hundred and twenty patients who required a laparoscopic total hysterectomy under total intravenous anesthesia from April 2019 to June 2020 in General Hospital of Eastern Theater Command were selected. The patients were divided into 4 groups by random digits table method with 30 cases each: total intravenous anesthesia group (C group), total intravenous anesthesia combined with TAPB group (T group), total intravenous anesthesia combined with RSB group (R group) and total intravenous anesthesia combined with TAPB and RSB group (S group). The narcotic (propfol and remifentanil) dosage, changes of resting visual analogue score (VAS) within 48 h after operation, pressure number of analgesia pump within 48 h after operation, anesthesia satisfaction score and incidence of emergence agitation were compared among 4 groups.Results:The remifentanil dosage, propfol dosage and pressure number of analgesia pump within 48 h after operation in S group were significantly lower than those in T group, R group and C group: (1.09 ± 0.23) mg vs. (1.49 ± 0.21), (1.47 ± 0.26) and (1.48 ± 0.23) mg, (543.53 ± 41.78) mg vs. (618.96 ± 37.21), (598.67 ± 37.86) and (607.87 ± 36.93) mg, (3.52 ± 2.03) times vs. (5.47 ± 1.83), (6.63 ± 2.08) and (9.77 ± 2.16) times, the anesthesia satisfaction score was significantly higher than that in R group and C group: (18.13 ± 3.22) scores vs. (21.43 ± 2.42) and (21.44 ± 2.56) scores, and there were statistical differences ( P<0.05). The resting VAS extubation and 12, 24, 48 h after operation in S group was significantly lower than that in C group and R group, the resting VAS 12, 24 and 48 h after operation was significantly lower than that in T group, and there were statistical differences ( P<0.05). The incidence of emergence agitation in S group was significantly lower than that in C group: 6.67% (2/30) vs. 26.67% (8/30), and there was statistical difference ( P<0.05). Conclusions:TAPB combined with RSB can reduce the narcotic dosage, reduce the incidence of emergence agitation and relieve perioperative pain in patients undergoing laparoscopic total hysterectomy. The effect is better than that of total intravenous anesthesia and total intravenous anesthesia combined with TAPB or RSB.

Reabilitação abdominal no pós-parto / Abdominal rehabilitation after labor

Diversos processos fisiológicos, bem como alterações viscerais e osteomioarticulares, ocorrem durante a gestação e o parto e impactam de forma significativa o organismo feminino. A expansão do útero afeta a forma do abdome e a geometria dos músculos abdominais, os pesos do útero gravídico aumentam a pressão sobre a musculatura do assoalho pélvico com repercussões estéticas e funcionais. Objetivo: Revisar sistematicamente os estudos publicados nos últimos 10 anos a respeito das técnicas de reabilitação abdominal no pós-parto. Métodos: Foi realizada uma revisão sistemática da literatura, no período compreendido entre os anos de 2009 e 2019, nas bases de dados eletrônicas PubMed, BVS, Science Direct, PEDro. Resultados: Houve uma grande variabilidade em relação às intervenções utilizadas e aos desfechos analisados, sendo verificado estudos sobre flacidez abdominal, fibro edema gelóide, incontinência urinária persistente e tratamento para diástase do reto abdominal (DRA). Conclusão: De acordo com os resultados obtidos no presente estudo e baseados em estudos anteriores, conclui-se que os exercícios abdominais não apresentam mudança significativa para tratamento de IU; são necessários mais estudos para analisar quais tipos de exercícios são eficazes para tratamento de DRA; o aparelho que combina radiofrequência, infravermelho, massagem mecânica e endermologia tem influência positiva no tratamento de flacidez abdominal, fibro edema gelóide e lipodistrofia localizada. (AU)

Several physiological processes, visceral and osteomioarticular, occur during pregnancy and labor and impact significantly the female organism. The uterus expansion affects the abdomen shape and the abdominal muscles geometry, the pregnant uterus weight rises the pressure over the pelvic floor muscles with esthetic and functional repercussions. Objective: To review systematically studies published in the last 10 years about the techniques of abdominal rehabilitation on post childbirth. Methods: Systematic review of literature in the period between 2009 and 2019, on electronic data bases PubMed, BVS, Science Direct, PEDro. Results: There was a great variability in relation to the interventions used and the analyzed outcomes, being checked studies about abdominal flaccidity, fibrosis geloid edema, persistent urinary incontinence (UI) and abdominal rectus diastasis (ARD). Conclusion: According to the results obtained in the present study and based in previous studies, we conclude that abdominal exercises do not show significant change to UI treatment; more studies are necessary to analyze which exercises are effective to ARD treatment and if the machine that combines radiofrequency, infrared, mechanical massage and endermologie has positive influence on treatment for abdominal flaccidity, fibrosis geloid edema and localized lipodystrophy. (AU)

Tratamento da parede abdominal com plicatura em Crossbow / Abdominal wall treatment with plication using the crossbow technique

Introdução: A necessidade de oferecer resultados com maior definição nas abdominoplastias nos compele a evoluir tecnicamente. O objetivo deste trabalho é apresentar a técnica de plicatura em Crossbow com suas três variantes, reforçando o conceito de aproximação vertical e horizontal da aponeurose dos músculos retos e oblíquos abdominais ao mesmo tempo, promovendo dois vetores diferentes de tração, culminando em uma maior definição da parede abdominal, principalmente na região do hipogastro e fossas ilíacas. Métodos: No período entre janeiro de 2016 e fevereiro de 2018, foram realizadas 22 cirurgias exclusivamente com a técnica Crossbow em seus tipos l, ll e lll, tanto em pacientes estéticos como pós-bariátricos. Resultados: Os resultados foram favoráveis tanto do ponto de vista estético, com maior definição do hipogastro, como do ponto de vista clínico, uma vez que nenhum paciente apresentou sinais ou sintomas diferentes de técnicas convencionais. Conclusão: A técnica Crossbow é simples e reprodutível, sendo mais um agregante na armamentária para melhorar a estética abdominal. Apesar de promover o reforço da região hipogástrica, tanto para tratamento primário como secundário desta região, só o aumento da casuística poderá demonstrar as possíveis vantagens do método.

Introduction: Owing to the need to deliver results with greater definition in abdominoplasties, techniques must evolve. The objective of this study was to introduce the crossbow technique for plication along with its three variants that reinforces the concept of vertical and horizontal alignments of the aponeurosis of the rectus and oblique abdominis muscles at the same time, promotes 2 different traction vectors, and culminates in a greater definition of the abdominal wall, mainly in the hypogastrium and iliac fossa regions. Methods: From January 2016 to February 2018, 22 surgeries were performed exclusively with the types l, ll, or lll crossbow technique, both in esthetic surgery cases and post-bariatric patients. Results: The results were favorable both from the esthetic point of view, with greater definition of the hypogastrium, and from a clinical point of view, as none of the patients showed signs or symptoms different from those of the conventional techniques. Conclusion: The crossbow technique is a simple and reproducible tool in the medical armamentarium to improve abdominal esthetics. Although it promotes the strengthening of the hypogastric region, both for primary and secondary treatments of this region, only a sample size increase can demonstrate the possible advantages of the method.

Analysis of Recruitment Pattern of Related Muscles in Two Types of Active Straight Leg Raise / 中国康复理论与实践

Objective:To compare the rate of recruitment in two types of active straight leg raise (ASLR) and to investigate the activation patterns of the related muscles. Methods:From June to October, 2018, eleven healthy subjects were recruited. Surface electromyography (sEMG) signals of unilateral rectus femoris, bilateral rectus abdominis, internal oblique abdominis, external oblique abdominis and multifidus were recorded in normal ASLR (Action A) and raising leg for ten seconds (Action B). %maximal voluntary isometric contraction (MVIC) of these muscles was processed and analyzed. Results:%MVIC of ipsilateral internal oblique muscle and external oblique muscle were greater than the opposite side (t > 2.549, P < 0.05) in Action A; %MVIC of ipsilateral internal oblique muscle, external oblique muscle and rectus abdominis muscle were greater than the opposite side (t > 2.240, P < 0.05) in Action B; compared with action B, Action A had higher %MVIC of bilateral internal oblique and rectus femoris (t > 3.549, P < 0.05). Conclusion:The activation mode of ipsilateral dominance was shown in both actions, and the different motion control strategies may be adopted by the neuromuscular system in different ASLR.

Effects of ultrasound-guided transveses abdominis plane block on anesthesia and early postoperative patient-controlled analgesia in patients undergoing gynecological laparoscopic surgery / 中国基层医药

Objective To investigate the efficacy of ultrasound-guided transveses abdominis plane block ( TAP) on anesthesia and postoperative analgesia in patients undergoing gynecological laparoscopic surgery. Methods From January 2015 to July 2017,60 patients aged 46 -68 yeas,of American Society of Anesthesiologists (ASA) physical status I-II,scheduled for elective gynecological laparoscopic surgery in Nanxiang Hospital of Jiading District of Shanghai were randomly divided into control group( A group) and ultrasound-guided TAP group( B group) ,with 30 cases in each group,In B group,ultrasound-guided TAP was performed 30 min before induction of anesthesia. The patients in both two groups received patient-controlled intravenous analgesia ( PCIA) for 48 h started from 10 min before the end of surgery. The VAS score ≥4points,sufentanil 5μg was injected intravenously. The consumption of anesthesia drugs during operation,time of consciousness and extubation,the consumption of sufentanil per hour in 24h after operation,requirement for rescue medication,and the adverse reactions within 24h after surgery were also recor-ded. Results Compared with those in A group,the consumption of propofol[(210 ± 32) mg vs. (324 ± 45) mg], sufentanil[(31 ± 3. 6)μg vs. (42 ± 3. 8)μg] in operation and consumption of sufentanil per hour in 24h after operation [(3.2±0.5)μgvs.(5.4±0.7)μg?inBgroupweresignificantlylower(P<0.001).Thetimeofconsciousness [(12 ± 3)min vs. (20 ± 5)min]and extubation[(15 ± 4)min vs. (25 ± 7)min]were significantly reduced in B group (P<0. 001). The requirement for rescue medication(13％ vs. 40％) and the incidence rate of nausea(10％ vs. 33％) and vomiting(0％ vs. 10％) within 24h after surgery were significantly decreased in B group compared with those in A group (P<0. 05). Conclusion Ultrasound-guided TAP performed in patients undergoing gynecologicallaparoscopic surgery can reduce the consumption of anesthesia drugs in operation and optimize postoperative analgesia.

Efficacy of transversus abdominis plane block combined with butopenol PCIA for analgesia after cesarean section under general anesthesia / 中华麻醉学杂志

Objective To evaluate the efficacy of transversus abdominis plane (TAP) block combined with butopenol patient-controlled intravenous analgesia (PCIA) for analgesia after cesarean section under general anesthesia.Methods Ninety American Society of Anesthesiologists physical status Ⅰ or Ⅱ parturients,aged 18-42 yr,weighing 52-88 kg,at 38-42 weeks of gestation,scheduled for elective cesarean section under general anesthesia,were divided into 3 groups (n=30 each) using a random number table method:TAP block group (group TAP),butopenol PCIA group (group B) and TAP block plus butopenol PCIA group (group TB).In group TAP,bilateral TAP blocks were performed under ultrasound guidance at the end of surgery,and 0.375％ ropivacaine 20 ml was injected into each side.In group B,butopenol 1 mg was intravenously injected at 30 min before the end of operation,PCIA was performed at the end of surgery,PCIA solution contained butopenol 8 mg and ondansetron 8 mg (diluted to 100 ml in sodium chloride injection),and the PCIA pump was set up to deliver a 0.5 ml bolus dose with a 15-min lockout interval and background infusion at 2 ml/h.Butopenol 1 mg was intravenously injected at 30 min before the end of operation,and TAP block in combination with butopenol PCIA was performed at the end of operation in group TB.When the postoperative visual analog scale score was greater than or equal to 4 points,morphine 10 mg was intramuscularly injected as rescue analgesic.The requirement for morphine was recorded within 48 h after operation.The occurrence of agitation during emergence from anesthesia and adverse reactions within 48 h after operation were also recorded.Results No adverse reactions such as hematoma at the puncture site or local anesthetic intoxication were observed in TAP group and TB group.Compared with group TAP,the incidence of postoperative shivering and requirement for morphine were significantly decreased in group TB (P＜0.05).The incidence of postoperative nausea and v omiting and requirement for morphine were significantly lower in group TB than in group B (P＜0.05).Conclusion The combination of TAP block and butopenol PCIA exerts better efficacy for analgesia after cesarean section under general anesthesia than either alone.

Effect of transversus abdominis plane block on postoperative cognitive function in elderly patients undergoing laparoscopic surgery under general anesthesia / 中华麻醉学杂志

Objective To evaluate the effect of transversus abdominis plane (TAP) block on postoperative cognitive function in elderly patients undergoing laparoscopic surgery under general anesthesia.Methods Forty-eight male patients undergoing laparoscopic tension-free repair of inguinal hernia under general anesthesia,aged 65-75 yr,of American Society of Anesthesiologists physical status Ⅱ or Ⅲ,with body mass index of 20-28 kg/m2,were divided into 2 groups (n =24 each) using a random number table method:TAP block combined with general anesthesia group (group TG) and general anesthesia group (group G).Anesthesia was induced with midazolam,cisatracurium besylate,sufentanil and etomidate,and the patients were mechanically ventilated after laryngeal mask airway insertion.TAP block was performed through the anterior superior iliac spine approach,and 0.25％ ropivacaine 30 ml was injected in group TG.Anesthesia was maintained by target-controlled infusion of propofol and remifentanil and muscle relaxation by intravenously injecting cisatracurium.The occurrence of cerebral regional oxygen saturation (rSO2) and low rSO2 events (rSO2 ＜60％) was recorded at 1 min before anesthesia induction (T0),5 min after inserting the laryngeal mask airway (T1),at skin incision (T2),30 min after skin incision (T3),and at the end of surgery (T4).The consumption of propofol and remifentanil was recorded during surgery.Montreal Cognitive Assessment (MoCA) was used to evaluate the cognitive function of patients at 1 day before surgery and 7 days after surgery,and the development of postoperative cognitive dysfunction (POCD,MoCA scores＜ 26) was recorded.Results Compared with group G,the intraoperative consumption of propofol and remifentanil was significantly reduced,rSO2 was increased at T2~,and the incidence of low rSO2 events was decreased,MoCA scores were increased at 7 days after surgery,and the incidence of POCD was decreased in group TG (P＜0.05).Conclusion TAP block can reduce the incidence of POCD in elderly patients undergoing laparoscopic surgery under general anesthesia.

Comparison of ultrasound-guided transverse abdominis plane block on intraoperative and postoperative analgesia at different time points in total abdominal hysterectomy / 中国医师杂志

Objective To evaluate the influence of ultrasound-guided transverse abdominis plane (us-TAP) block on intraoperative and postoperative analgesia at different time points in total abdominal hysterectomy.Methods 46 patients undergoing total hysterectomy under general anesthesia were selected,randomly divided into two groups,group A and group B,with 23 cases in each group.Group A received bilateral us-TAP block after induction of general anesthesia and before operation;Group B received bilateral us-TAP block after operation and before anesthesia recovery.In both groups,the anesthesia was adjusted according to the bispect ral index (BIS) and hemodynamics.Sufentanil was used for patient-controlled intravenous analgesia (PCIA) after operation.The mean blood pressure (MBP),heart rate (HR) at T0(preanesthesia),T1 (skin incision),T2 (postoperation),T3 (tracheal extubation),T4 [leave the post anesthesia care unit (PACU)] in both two groups were recorded.The dosage of anesthetics during operation and the recovery time after operation were recorded.Visual analogue scores (VAS) at 2 h,6 h,12 h and 24 h after operation were observed in the resting and coughing state of the patients in the two groups.The total consumption of analgesics 24-h after surgery and the side effects of nausea and vomiting were recorded.Results MAP and HR in group A were significantly lower than that in group B at T1 (P ＜ 0.05),but there was no statistical difference at other time points (P ＜ 0.05).The dose of sufentanil used in group A was less than that in group B (P ＜ 0.05).The recovery time in group A was shorter than that in group B (P ＜ 0.05).At 2 h,6 h,12 h and 24 h post operation,there was no significant difference at rest and coughing VAS between the two groups (P ＜ 0.05).There was no difference in the consumption of analgesics 24 hours after operation between the two groups (P ＜ 0.05).The incidence of postoperative nausea and vomiting in group A was lower than that in group B (P ＜ 0.05).Conclusions In open hysterectomy,although the analgesic effect of us-TAP blockade before and after operation is not significantly different,preoperative TAP blockade under ultrasound can effectively reduce the amount of intraoperative general anesthetics and accelerate the recovery of patients,effectively reducing the incidence of postoperative nausea and vomiting.

Efficacy of transversus abdominis plane block with different doses of dexmedetomidine mixed with ropivacaine in pediatric patients undergoing laparoscopic surgery with general anesthesia / 中华麻醉学杂志

Objective To evaluate the efficacy of transversus abdominis plane block (TAPB) with different doses of dexmedetomidine mixed with ropivacaine in the pediatric patients undergoing laparoscopic surgery with general anesthesia.Methods Eighty patients of both sexes,aged 3-6 yr,weighing 10-30kg,scheduled for elective single-channel laparoscopic appendectomy,were divided into 4 groups (n =20each) using a random number table method:0.5 μg/kg dexmedetomidine plus ropivacaine group (group DR1),1.0 μg/kg dexmedetomidine plus ropivacaine group (group DR2),1.5 μg/kg dexmedetomidine plus ropivacaine group (group DR3),and ropivacaine group (R group).Bilateral TAPB was performed under ultrasound guidance after the end of anesthesia induction.In group TR,0.25％ ropivacaine 0.5 ml/kg was injected,the 0.5 ml/kg mixture of 0.5,1.0 and 1.5 μg/kg dexmedetomidine and ropivacaine at a final concentration of 0.25％ was injected in DR1,DR2 and DR3 groups.Anesthesia was maintained by intravenously infusing remifentanil and inhaling sevoflurane.Cisatracurium was intermittently injected to maintain muscle relaxation.Ibuprofen was taken orally to maintain postoperative FLACC score ＜4.The intraoperative consumption of remifentanil,tracheal extubation time,duration of anesthetic recovery room stay,requirement for ibuprofen,and occurrence of opioids-and TAPB-related complications were recorded.Results There was no significant difference in the intraoperative consumption of remifentanil or tracheal extubation time between four groups (P＞0.05).Compared with group R,the requirement for ibuprofen was significantly decreased in DR2 and DR3 groups,the duration of anesthetic recovery room stay was significantly prolonged in group DR3 (P＜0.05),and no significant change was found in the requirement for ibuprofen in group DR1 or in the duration of anesthetic recovery room stay in DR1 and DR2 groups (P＞0.05).Compared with group DR1,the duration of anesthetic recovery room stay was significantly prolonged,and the requirement for ibuprofen was decreased in group DR3,and the requirement for ibuprofen was significantly decreased (P＜0.05),and no significant change was found in the duration of anesthetic recovery room stay in group DR2 (P＞0.05).Compared with group DR2,the duration of anesthetic recovery room stay was significantly prolonged (P＜0.05),and no significant change was found in the other parameters in group DR3 (P＞ 0.05).No patients developed opioids-or TAPB-related complications.Conclusion TAPB with 1.0 μg/kg dexmedetomidine mixed with ropivacaine provides good efficacy for the pediatric patients undergoing laparoscopic surgery with general anesthesia.