Efficacy of partial and complete resuscitative endovascular balloon occlusion of the aorta in the hemorrhagic shock model of liver injury / 世界急诊医学杂志（英文）

@#BACKGROUND: Resuscitative endovascular balloon occlusion of the aorta (REBOA) can temporarily control traumatic bleeding. However, its prolonged use potentially leads to ischemia-reperfusion injury (IRI). Partial REBOA (pREBOA) can alleviate ischemic burden; however, its security and effectiveness prior to operative hemorrhage control remains unknown. Hence, we aimed to estimate the efficacy of pREBOA in a swine model of liver injury using an experimental sliding-chamber ballistic gun. METHODS: Twenty Landrace pigs were randomized into control (no aortic occlusion) (n=5), intervention with complete REBOA (cREBOA) (n=5), continuous pREBOA (C-pREBOA) (n=5), and sequential pREBOA (S-pREBOA) (n=5) groups. In the cREBOA and C-pREBOA groups, the balloon was inflated for 60 min. The hemodynamic and laboratory values were compared at various observation time points. Tissue samples immediately after animal euthanasia from the myocardium, liver, kidneys, and duodenum were collected for histological assessment using hematoxylin and eosin staining. RESULTS: Compared with the control group, the survival rate of the REBOA groups was prominently improved (all P<0.05). The total volume of blood loss was markedly lower in the cREBOA group (493.14±127.31 mL) compared with other groups (P<0.01). The pH was significantly lower at 180 min in the cREBOA and S-pREBOA groups (P<0.05). At 120 min, the S-pREBOA group showed higher alanine aminotransferase (P<0.05) but lower blood urea nitrogen compared with the cREBOA group (P<0.05). CONCLUSION: In this trauma model with liver injury, a 60-minute pREBOA resulted in improved survival rate and was effective in maintaining reliable aortic pressure, despite persistent hemorrhage. Extended tolerance time for aortic occlusion in Zone I for non-compressible torso hemorrhage was feasible with both continuous partial and sequential partial measures, and the significant improvement in the severity of acidosis and distal organ injury was observed in the sequential pREBOA.

Balón de resucitación aórtico endovascular (REBOA) para el control de la hemorragia no compresible de torso. Revisión de la evidencia

La hemorragia no compresible de torso continúa siendo unas de las principales causas de mortalidad del paciente víctima de trauma. El control de este tipo de sangrado requiere de procedimientos invasivos como la toracotomía de reanimación, la cual se realiza en el paciente in extremis. La utilización de REBOA se re-introduce desde el 2011, como una forma de oclusión endovascular de la aorta y con el tiempo ya forma parte de los implementos con que cuenta un centro de trauma nivel I. Actualmente REBOA se utiliza dentro del proceso de reanimación, mientras se realiza el control definitivo de un sangrado en el torso, con el fin de aumentar la perfusión de órganos como cerebro y corazón, existiendo dos zonas principales de oclusión a nivel aórtico. Múltiples investigaciones se han realizado para encontrar las indicaciones y beneficios de REBOA dentro de la atención integral de un paciente con trauma grave, estando aun estas en desarrollo. La utilización en un paciente con trauma grave se encuentra protocolizada en diferentes pasos que van desde el acceso arterial hasta el seguimiento de la extremidad post retiro del introductor. Por este último punto, REBOA se encuentra dentro de los implementos importantes de la reanimación, sin embargo, no reemplaza conceptos básicos como atención integral del paciente politraumatizado, control precoz del sangrado y el control de daños resucitativo. Su implementación requiere de un centro altamente protocolizado y con equipos de trauma establecidos con el objetivo de disminuir las complicaciones y optimizar la supervivencia.

Non compressible torso hemorrhage continues to be one of the main causes of mortality in trauma victims. The control of this type of bleeding requires invasive procedures such as resuscitation thoracotomy, that is performed on the patient "in extremis". The use of REBOA has been reintroduced since 2011, as a form of endovascular occlusion of the aorta and over time it is has already part of the implements that a level I trauma center. REBOA is used within the resuscitation process, while definitive control of bleeding in the torso is carried out, in order to increase the perfusion of organs such as the brain and heart, with two main areas of occlusion at the aortic level. Multiple investigations have been carried out to find the indications and benefits of REBOA within the comprehensive care of a patient with severe trauma, and these are still under development. Its use in a patient with severe trauma is protocolized in different steps that go from arterial access to follow-up of the extremity after removal of the sheath. For this last point, REBOA is among the important implements of resuscitation, however, it does not replace basic concepts such as comprehensive care of the polytraumatized patient, early control of bleeding and resuscitative damage control. Its implementation requires a highly protocolized center with established trauma teams with the aim of reducing complications and optimizing survival.

Effect of torso training on unstable surface on lower limb motor function in patients with incomplete spinal cord injury / 浙江大学学报·医学版

OBJECTIVES@#To investigate the effect of torso training on unstable surface on lower limb motor function in patients with incomplete spinal cord injury.@*METHODS@#A total of 80 patients with incomplete spinal cord injury caused by thoracolumbar fracture admitted in Ningbo Yinzhou No.2 Hospital from April 2020 to December 2021 were randomly divided into control group and study group, with 40 cases in each group. In addition to routine training, the control group received torso training on stable surface and the study group received torso training on unstable surface. The gait, lower limb muscle strength, balance function, lower limb function, mobility and nerve function of the two groups were compared.@*RESULTS@#After treatment, the stride length, stride frequency and comfortable walking speed improved in the two groups (all P<0.05), and the improvements in study group were more significant (all P<0.05). The muscle strength of quadriceps femoris, gluteus maximus, hamstring, anterior tibialis and gastrocnemius were improved in the two groups (all P<0.05), and the improvements in study group were more significant (all P<0.05); the total trajectories of static eye opening and static eye closing gravity center movement in the two groups were significantly shorter (all P<0.05), and the improvements in the study group were more significant (all P<0.05). The dynamic stability limit range and the American Spinal Injury Association (ASIA) lower extremity motor score, Berg balance scale, modified Barthel index scale in the two groups were significantly higher (all P<0.05), and these scores in study group were significantly higher than those in the control group (all P<0.05). Both groups showed a significant improvement in ASIA grade (all P<0.05), and the improvement in the study group was significantly better (P<0.05).@*CONCLUSIONS@#Torso training on unstable surface can effectively improve the gait and lower limb muscle strength of patients with incomplete spinal cord injury and improve the lower limb motor function.

Use of REBOA in the universe of magical realism: a real-world review / Uso de REBOA en el universo del realismo mágico: revisión de vida real

Abstract While reading the novella "Chronicle of a Death Foretold" by the Colombian Nobel Laureate Gabriel García-Marquez, we were surprised to realize that the injuries sustained by the main character could have been successfully treated had he received modern trauma care in which REBOA may have been considered. This is a discussion of Mr. Nasar's murder to explore whether he could have been saved by deploying REBOA as a surgical adjunct to bleeding control and resuscitation. In reading García-Marquez's novel we noted the events that unfolded at the time of Santiago Nasar's murder. To contextualize the claim that Mr. Nasar could have survived, had his injuries been treated with REBOA, we explored and illustrated what could have done differently and why. On the day of his death, Mr. Nasar sustained multiple penetrating stab wounds. Although he received multiple stab wounds to his torso, the book describes seven potentially fatal injuries, resulting in hollow viscus, solid viscus, and major vascular injuries. We provided a practical description of the clinical and surgical management algorithm we would have followed in Mr. Nasar's case. This algorithm included the REBOA deployment for hemorrhage control and resuscitation. The use of REBOA as part of the surgical procedures performed could have saved Mr. Nasar's life. Based on our current knowledge about REBOA in trauma surgery, we claim that its use, coupled with appropriate surgical care for hemorrhage control, could have saved Santiago Nasar's life, and thus prevent a death foretold.

Resumen Leyendo la novela "Crónica de una muerte anunciada" del Nobel de Literatura Gabriel García Márquez, nos sorprendió reconocer que las heridas provocadas al personaje principal se habrían podido tratar exitosamente en un centro de trauma moderno donde hubieran optado por REBOA. Hacemos referencia al asesinato del señor Nasar para explorar la posibilidad de que se hubiera podido salvar de haberse utilizado REBOA como adyuvante de la cirugía para reanimación y control de la hemorragia. En la lectura de la novela de García Márquez tomamos nota de los sucesos que tuvieron lugar en el momento del asesinato de Santiago Nasar. Para contextualizar la afirmación de que Nasar habría podido sobrevivir si le hubieran manejado sus heridas con REBOA, exploramos e ilustramos lo que habría podido hacerse de otra manera y porqué. El día en que murió, el señor Nasar sufrió múltiples heridas por arma blanca y si bien muchas de ellas fueron en el torso, el libro describe siete heridas mortales que comprometieron los órganos sólidos, además de lesiones vasculares mayores. Presentamos una descripción práctica del algoritmo para el manejo clínico y quirúrgico que habríamos seguido en el caso del señor Nasar. Este algoritmo incluye el uso de REBOA para el control de la hemorragia y la reanimación, el cual, como parte de los procedimientos quirúrgicos realizados, habría podido salvarle la vida a la víctima. Basados en nuestro conocimiento actual acerca del uso de REBOA en la cirugía de trauma, planteamos que, junto con la atención quirúrgica apropiada para controlar la hemorragia, este procedimiento habría podido salvarle la vida a Santiago Nasar y, por tanto, evitar una muerte anunciada.

Hemodynamically unstable non-compressible penetrating torso trauma: a practical surgical approach / Guía práctica para el abordaje quirúrgico del trauma penetrante del torso en paciente hemodinámicamente inestable

Abstract Penetrating torso trauma is the second leading cause of death following head injury. Traffic accidents, falls and overall blunt trauma are the most common mechanism of injuries in developed countries; whereas, penetrating trauma which includes gunshot and stabs wounds is more prevalent in developing countries due to ongoing violence and social unrest. Penetrating chest and abdominal trauma have high mortality rates at the scene of the incident when important structures such as the heart, great vessels, or liver are involved. Current controversies surround the optimal surgical approach of these cases including the use of an endovascular device such as the Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) and the timing of additional imaging aids. This article aims to shed light on this subject based on the experience earned during the past 30 years in trauma critical care management of the severely injured patient. We have found that prioritizing the fact that the patient is hemodynamically unstable and obtaining early open or endovascular occlusion of the aorta to gain ground on avoiding the development of the lethal diamond is of utmost importance. Damage control surgery starts with choosing the right surgery of the right cavity in the right patient. For this purpose, we present a practical and simple guide on how to perform the surgical approach to penetrating torso trauma in a hemodynamically unstable patient.

Resumen El trauma penetrante del torso representa la segunda causa de muerte de origen traumático después del trauma craneoencefálico. En países desarrollados existe mayor prevalencia de trauma cerrado, asociado principalmente a accidentes de tránsito o caídas de grandes alturas. Mientas, que en países en vía de desarrollo el trauma penetrante es más prevalente con heridas por arma de fuego o por arma blanca asociado a la violencia y las desigualdades sociales. El trauma penetrante torácico y abdominal pueden presentar altas tasas de mortalidad en la escena del trauma si se comprometen estructuras importantes como el corazón, los grandes vasos o el hígado. Actualmente, existen controversias sobre el adecuado abordaje quirúrgico con la implementación o no de dispositivos endovasculares como el balón de resucitación endovascular de oclusión aórtica (Resuscitative Endovascular Balloon Oclussion of the Aorta - REBOA) y la realización de ayudas imagenológicas. El objetivo de este artículo es presentar el conocimiento sobre este tema, basado en la experiencia adquirida durante los últimos 30 años con el manejo del trauma, cirugía general y cuidado crítico. Sostenemos que en un paciente hemodinámicamente inestable se debe realizar una temprana oclusión aórtica endovascular o abierta con el objetivo de evitar el desarrollo o propagación del rombo de la muerte. Con este propósito, presentamos una guía práctica y sencilla sobre el abordaje quirúrgico del paciente hemodinámicamente inestable con trauma penetrante del torso.

Clinical diagnosis, treatment, and outcomes of seven neonates with deep venous thrombosis of the extremities and torso / 中华围产医学杂志

Objective:To analyze the diagnosis, treatment, and outcomes of neonates with deep venous thrombosis (DVT) of the extremities and torso.Methods:The clinical diagnosis, treatment and outcomes of seven neonates with DVT of the extremities and torso admitted to Beijing Children's Hospital, Capital Medical University from March 2016 to March 2020 were retrospectively analyzed. Paired t test and paired rank sum test were used to compare the difference of coagulation indexes before and after the anticoagulant therapy. Results:Among the seven neonates with DVT of the extremities and torso, six were male and five were term infants, with the gestational age of (37.9±2.5) weeks and birth weight of (2 989±619) g. The median age at admission was 2.0 d and the age at diagnosis was 3.0 d. Except for one case of left common femoral vein thrombosis with limb swelling on the affected side, the other cases were all found with DVT by routine abdominal ultrasound examination after admission. Six cases received heparin treatment with the median duration of 8.5 d (1.8-28.8 d), including four cases of thrombosis in the portal venous, one in the postcava and renal venous, and one in the left common femoral vein. Among the six cases, the thrombus disappeared in five cases, which were confirmed by vascular ultrasound examination during follow-up, and in another case, the thrombus was shrinked significantly but remained. After the treatment, the platelet count [(464.5±128.9)×10 9/L vs (142.5±104.2)×10 9/L, t=－5.019, P=0.004] and antithrombin-Ⅲ level [(67.08±28.87)% vs (46.05±12.60)%, Z=－2.201, P=0.028] were increased and the D-dimers was decreased [0.392 mg/L(0.250-0.884 mg/L) vs 2.511 mg/L(0.755-14.033 mg/L), Z=－2.201, P=0.028] with no reports of heparin-related side-effect. One case with advanced postcaval thrombosis did not receive heparin anticoagulant therapy, but the thrombosis disappeared 270 d after diagnosis during follow-up. Conclusions:DVT of the extremities and torso may have no specific symptoms during the neonatal period and the overall prognosis is good. Heparin anticoagulant therapy is recommended until thrombosis disappears for patients with large thrombosis or significantly high level of D-dimer. The course of heparin treatment varies greatly among individuals, and close monitoring is required.

Optimization Design of Emergency Quick Fixation Device Based on ANSYS Workbench / 中国医疗器械杂志

OBJECTIVE@#A rapid fixation device is developed to solve the problems of emergency fixation and transportation of patients with spinal injury.@*METHODS@#Through the analysis of the function,3D modeling design, finite element analysis and optimization design based on ANSYS Workbench, tensile strength verification experiment, we produced the prototype, and tested it, conducted a simulated rescue experiment.@*RESULTS@#The fixation device designed can meet the demand of spinal injury patients for safe rescue after accidents, and the quality of the rapid fixation device was lighten by about 30% without reducing the intensity.@*CONCLUSIONS@#The method based on optimal design can obviously improve the structure design, and has reference significance for other related rescue equipment design.

Management of non-compressible torso hemorrhage: An update / 中华创伤杂志(英文版)

With the widespread adoption of advanced tourniquets, the mortality rate of limb wound hemorrhage has decreased significantly, and non-compressible torso hemorrhage has gradually occupied the leading position of potentially preventable death, both in military and civilian circumstances. With the emergence of novel hemostatic devices and materials, strategies for the management of non-compressible torso hemorrhage have changed significantly. This review summarizes the current treatment strategies and types of equipment for non-compressible torso hemorrhage and suggests future research directions, hoping to provide a comprehensive review for the medical personnel and researchers engaging in this field.

REBOA as a New Damage Control Component in Hemodynamically Unstable Noncompressible Torso Hemorrhage Patients / El REBOA como nuevo actor en el control de daños del paciente hemodinámicamente inestable con hemorragia no compresible del torso

Abstract Noncompressible torso hemorrhage is one of the leading causes of preventable death worldwide. An efficient and appropriate evaluation of the trauma patient with ongoing hemorrhage is essential to avoid the development of the lethal diamond (hypothermia, coagulopathy, hypocalcemia, and acidosis). Currently, the initial management strategies include permissive hypotension, hemostatic resuscitation, and damage control surgery. However, recent advances in technology have opened the doors to a wide variety of endovascular techniques that achieve these goals with minimal morbidity and limited access. An example of such advances has been the introduction of the Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA), which has received great interest among trauma surgeons around the world due to its potential and versatility in areas such as trauma, gynecology & obstetrics and gastroenterology. This article aims to describe the experience earned in the use of REBOA in noncompressible torso hemorrhage patients. Our results show that REBOA can be used as a new component in the damage control resuscitation of the severely injured trauma patient. To this end, we propose two new deployment algorithms for hemodynamically unstable noncompressible torso hemorrhage patients: one for blunt and another for penetrating trauma. We acknowledge that REBOA has its limitations, which include a steep learning curve, its inherent cost and availability. Although to reach the best outcomes with this new technology, it must be used in the right way, by the right surgeon with the right training and to the right patient.

Resumen La hemorragia no compresible del torso es una de las principales causas de muerte prevenibles alrededor del mundo. Una evaluación eficiente y apropiada del paciente traumatizado con hemorragia activa es la esencia para evitar el desarrollo del rombo de la muerte (hipotermia, coagulopatía, hipocalcemia y acidosis). Actualmente, las estrategias de manejo inicial incluyen hipotensión permisiva, resucitación hemostática y cirugía de control de daños. Sin embargo, los recientes avances tecnológicos han abierto las puertas a una amplia variedad de técnicas endovasculares que logran esos objetivos con una morbilidad mínima y un acceso limitado. Un ejemplo de estos avances ha sido la introducción del balón de resucitación de oclusión aortica; REBOA ( Resuscitative Endovascular Balloon Occlusion of the Aorta , por sus sigla en inglés ), el cual, ha tenido gran provecho entre los cirujanos de trauma alrededor del mundo debido a su potencial y versatilidad en áreas como trauma, ginecología y obstetricia, y gastroenterología. El objetivo de este artículo es describir la experiencia lograda en el uso del REBOA en pacientes con hemorragia no compresible del torso. Nuestros resultados muestran que el REBOA puede usarse como un nuevo actor en la resucitación de control de daños del paciente con trauma severo, para este fin, nosotros proponemos dos nuevos algoritmos para el manejo de pacientes hemodinámicamente inestables: uno para trauma cerrado y otro para trauma penetrante. Se reconoce que el REBOA tiene sus limitaciones, las cuales incluye un periodo de aprendizaje, su costo inherente y la disponibilidad. A pesar de esto, para lograr los mejores resultados con esta nueva tecnología, el REBOA debe ser usado en el momento correcto, por el cirujano correcto con el entrenamiento y el paciente correcto.

Evaluation of the organs at risk doses for lung tumors in gated and conventional radiotherapy

Purpose: The purpose of this study was to evaluate the organs at risk (OARs) doses for lung tumors in gated radiotherapy (RT) compared to conventional RT using the four-dimensional extended cardiac-torso (4D-XCAT) digital phantom in a simulation study. Materials and Methods: 4D-XCAT digital phantom was used to create 32 digital phantom datasets of different tumor diameters of 3 and 4 cm, and motion ranges (MRs) of 2, 2.5, 3, and 3.5 cm and each tumor was placed in four different lung locations (right lower lobe, right upper lobe, left lower lobe, and left upper lobe). XCAT raw binary images were converted to the digital imaging and communication in medicine format using an in-house MATLAB-based program and were imported to treatment planning system (TPS). For each dataset, gated and conventional treatment plans were prepared using Planning Computerized RadioTherapy-three dimensional (PCRT-3D) TPS with superposition computational algorithm. Dose differences between gated and conventional plans were evaluated and compared (as a function of 3D motion and tumor volume and its location) with respect to the dose-volume histograms of different organs-at-risk. Results: There are statistically significant differences in dosimetric parameters among gated and conventional RT, especially for the tumors near the diaphragm (P < 0.05). The maximum reduction in the mean dose of the lung, heart, and liver were 6.11 Gy, 1.51 Gy, and 10.49 Gy, respectively, using gated RT. Conclusions: Dosimetric comparison between gated and conventional RT showed that gated RT provides relevant dosimetric improvements to lung normal tissue and the other OARs, especially for the tumors near the diaphragm. In addition, dosimetric differences between gated and conventional RT did generally increase with increasing tumor motion and decreasing tumor volume

Identification, molecular structure and expression characteristics of Torso like gene in Anopheles dirus / 中国血吸虫病防治杂志

ObjectiveTo characterize Torso-like (tsl) gene and investigate its expression characteristics in Anopheles dirus, so as to provide a theoretical basis for subsequent functional studies of the tsl gene. MethodsAccording to the coding sequences of Drosophila melanogaster and An. gambiae tsl genes, the complete genome of An. dirus was retrieved and the An. dirus tsl gene was characterized. Specific primers were designed and the target gene was amplified using PCR and reverse-transcription PCR assays. The physicochemical properties, signal peptide, transmembrane structure, secondary structure and tertiary structure of the encoded protein TSL were analyzed using bioinformatics tools, and a phylogenetic analysis was performed. In addition, the specific expression of the tls gene was detected in various tissues of An. dirus using a quantitative real-time PCR assay. Results The An. dirus tsl gene was 16 751 bp in length with a CDS region of 1 134 bp, encoding 377 amino acids, and the encoded TSL protein was a stably hydrophilic protein. The TSL protein was predicted to be a secretory protein that was located in extra-membrane regions containing signal peptides. The secondary structure of the TSL protein contained α-helix (51.72%), extended strand (12.20%), β-bridge (4.78%) and random coil (31.30%) in the secondary structure, and a 3D homology model was generated using 5cj9.1.A as a template. Phylogenetic analysis revealed a close genetic relationship in the TSL protein between An. dirus and An. farauti. In addition, quantitative real-time PCR assay detected the tsl gene expression in the head, chest, abdomen and foot of An. dirus, with the highest expression in the head and low expression in the foot. Conclusions The tsl gene is characterized in An. dirus at a genomic level, and the prediction of the TSL protein structure and the elucidation of the tissue-specific tsl gene expression in An. dirus provide a basis for the further studies on the gene functions.

A Torso Simulator Design for Implantable Nerve Stimulator Test / 中国医疗器械杂志

This paper introduces ISO 14708-3:2017, the new edition of the international standard for implantable neurostimulator, and emphasizes the new requirements in the clause of protection from RF electromagnetic interference. To meet this new requirements, this paper presents a design of torso simulator for the testing of implantable neurostimulator. The design includes volume conductor, electrodes and grids, which can simulate the actual operating environment of implantable neurostimulator in RF electromagnetic interference testing. The torso simulator is verified by performance in the last part of the paper.

Versão brasileira da Segmental Assessment of Trunk Control (SATCo) / La versión brasileña de la Segmental Assessment of Trunk Control (SATCo) / Brazilian version of the Segmental Assessment of Trunk Control (SATCo)

RESUMO Traduziu-se e adaptou-se para o português do Brasil o teste Segmental Assessment of Trunk Control (SATCo). Dois profissionais proficientes na língua inglesa traduziram, independentemente, a escala original para o português do Brasil (T1 e T2). Em seguida, gerou-se a versão traduzida de consenso (TU). Dois tradutores realizaram duas versões em inglês (RT1 e RT2) da versão TU. Um novo processo de consenso entre tradutores e pesquisadores resultou em uma versão em inglês (RTfinal), que foi comparada com a versão original, com vistas a possíveis diferenças semânticas. A versão do instrumento em português do Brasil (TU), denominada "Avaliação Segmentar do Controle de Tronco", foi revisada pela comissão de especialistas, composta por três fisioterapeutas, para verificação do conteúdo e gerou a segunda versão de concordância (Tfinal). Tfinal foi encaminhada a uma das autoras da escala original para verificar o entendimento da versão em português do Brasil. Após essa etapa, 20 fisioterapeutas aplicaram a escala em crianças com paralisia cerebral. Parte dos fisioterapeutas indica a necessidade de complementação de informação na descrição das instruções e na descrição da pontuação.

RESUMEN Se tradujo y se adaptó al portugués de Brasil la prueba Segmental Assessment of Trunk Control (SATCo). La escala original fue traducida de forma independiente por dos expertos en lengua inglesa al portugués de Brasil (T1 y T2). Después se produjo una versión traducida en acuerdo (TU). De esta versión, fueron realizadas dos versiones en lengua inglesa por dos traductores (RT1 y RT2). Se formó un nuevo consenso entre traductores e investigadores del cual generó una versión en lengua inglesa (RTfinal), en que se comparó al original para encontrar diferencias semánticas. La versión del instrumento en portugués brasileño (TU) se llamó Avaliação Segmentar do Controle de Tronco (Evaluación Segmentaria de Control del Tronco) y fue corregida por un conjunto de expertos, constituido de tres fisioterapeutas, para chequear el contenido, siendo que al final generó una segunda versión por consenso (Tfinal). Esta segunda versión la mandaron a una de las autoras de la escala original para chequear la comprensión de la versión en portugués de Brasil. Tras esta etapa, veinte fisioterapeutas aplicaron esta escala a niños con parálisis cerebral. Una parte de los fisioterapeutas señalan que es necesario complementar informaciones sobre la descripción de las instrucciones y de los puntajes.

ABSTRACT The Segmental Assessment of Trunk Control (SATCo) test was translated and adapted to Brazilian Portuguese. Two English language proficient professionals independently translated the original scale for the Brazilian Portuguese (T1 and T2). Following, the translated version of consensus was generated (TU). Two translators performed two versions in English (BT1 and BT2) of the TU version. A new process of consensus between translators and researchers resulted in an English version (BTfinal) that was compared with the original version, aiming to detect possible semantic differences. The version of the instrument in Brazilian Portuguese (TU), called Segmental Assessment of Trunk Control, was revised by the experts' committee, composed of three physical therapists for content checking and the second version of agreement was generated (Tfinal). Tfinal was submitted to one of the original scale authors to check the understanding of the Brazilian Portuguese version. After this step, 20 physical therapists applied the scale in children with Cerebral Palsy. Part of the physical therapists indicates the need for complementary information in the description of instructions and score.

Adult Stature Estimation by Multiple Parameters of Body Torso Segment / 法医学杂志

Objective T o prom ote the further research on body stature estim ation and the innovative ap-plications based on the distances betw een the anatom ical landm arks on body torso surface. Methods A specification for the collection of distances betw een the anatom ical landm arks on body torso surface w as established. T he data of 933 cases of adult population in Y angtze R iver D elta region w ere collected. M ultiple linear regression m ethod w as used to statistical analyse and establish the regression equation of stature estim ation. Results A regression equation about 5 variables including gender (x1), cervical verte-brae-coccyx line (x2), sterna-pubis line (x3), distance betw een acrom ion and iliospinale anterius (x4) and shoulder breadth (x5), and stature (y) w as established, y=105.406+5.414 x1+0.436 x2+0.286 x3+0.225 x4+0.193 x5. Conclusion T he m ethod is suitable for the rapid, sim ple and accurate estim ation of stature for the forensic experts.

Adult Stature Estimation by Multiple Parameters of Body Torso Segment / 法医学杂志

OBJECTIVES@#To promote the further research on body stature estimation and the innovative applications based on the distances between the anatomical landmarks on body torso surface.@*METHODS@#A specification for the collection of distances between the anatomical landmarks on body torso surface was established. The data of 933 cases of adult population in Yangtze River Delta region were collected. Multiple linear regression method was used to statistical analyse and establish the regression equation of stature estimation.@*RESULTS@#A regression equation about 5 variables including gender （x₁）, cervical vertebrae-coccyx line （x₂）, sterna-pubis line （x₃）, distance between acromion and iliospinale anterius （x₄） and shoulder breadth （x₅）, and stature （y） was established, y=105.406+5.414 x₁+0.436 x₂+0.286 x₃+0.225 x₄+ 0.193 x₅.@*CONCLUSIONS@#The method is suitable for the rapid, simple and accurate estimation of stature for the forensic experts.

Dinamometria lombar: um teste funcional para o tronco / Lumbar dynamometry: a functional test for the torso

Contexto: A força muscular é a principal valência física. Sua avaliação clínica é realizada utilizando-se testes manuais. Esses testes, embora reprodutíveis, são muito subjetivos e pouco precisos. A avaliação do tronco vem sendo realizada por meio da dinamometria lombar (DL). Essa informação é valiosa nos exames admissionais e periódicos de colaboradores que atuam em tarefas que exigem esforço repetitivo e manejo de cargas de levantamento e transferência. Objetivos: Como a literatura não possui valores referenciais para esse teste, buscamos apresentar valores que podem ser utilizados como referência para futuros estudos de valores normativos. Métodos: O estudo foi conduzido com 691 participantes saudáveis de ambos os sexos, praticantes e não praticantes de atividade física regular, todos com índice de massa corporal (IMC) normal. A faixa etária variou entre 18 e 45 anos, sendo 382 homens, com idade média de 27,1 anos (±7,5), e 309 mulheres, com idade média 28,2 anos (±8,1). Foi utilizado um sistema de dinamometria digital portátil composto por uma plataforma, conectada a uma célula de carga por meio de uma corrente, e um indicador digital. Resultados: O valor médio de força medido com o sistema de DL, em homens, foi 114,0 kgf (±25,4), e 48,5 kgf (±18,8) nas mulheres. Portanto, a amplitude de força exercida pelos homens foi 235,1% superior à exercida pelas mulheres. Conclusão: Esse estudo apresenta uma contribuição inicial para o estabelecimento de valores normativos desse teste dinamométrico; porém, outros estudos são necessários, uma vez que as medições realizadas são preliminares e específicas para a região geográfica estudada.

Context: Muscle strength is the main physical valence. Clinical evaluation is performed using manual tests. But, these tests, although reproducible, are very subjective and imprecise. The torso evaluation has been performed by means of the the lumbar dynamometry (LD). This information is valuable in admission and periodic examinations of employees working on tasks that require repetitive effort, lifting, and transfer of loads. Objectives: As literature does not have reference values for this test, the objective of this research was to present values that can be used as reference for future study of normative values. Methods: The study was conducted with 691 healthy participants of both the genders and practitioners that do not practice regular physical activity, all with normal body mass index (BMI). Their ages ranged between 18 and 45 years, 382 were men, with an average age of 27.1 years (±7.5), and 309 women, with an average age of 28.2 years (±8.1). A portable digital system is composed of a dynamometer connected to a load cell and platform, and a digital indicator. Results: The average value of force measured in men with the LD system was 114.0 kgf (±25.4), and 48.5 kgf (±18.8) in women. Men had 235,1% more strength than women. Conclusion: This study presents an initial contribution to establish normative values for this dynamometer test, but further studies are needed, given the fact that the measurements are preliminary and specific to the geographic region studied.

Braquio-dorso-mamoplastia: cirurgia do contorno corporal da região superior do tronco após grandes perdas ponderais / Brachial-dorsal mammoplasty: body contour surgery of the upper region of the trunk after major weight loss

INTRODUÇÃO: No Brasil foram realizadas 88 mil cirurgias bariátricas em 2014. Após o emagrecimento, ocorre desinsuflação de todo o tronco, com flacidez e dobra de excesso cutâneo das mamas à região dorsal posterior. Por isso, propomos procedimento cirúrgico que trate a região superior toda do tronco, incluindo mamas, dorso lateral e posterior e braços. OBJETIVO: Mostrar a experiência pessoal em cirurgias de braquio-dorso-mamoplastia. MÉTODO: Foram operados 13 pacientes no período de 2007 a 2014, sendo 11 mulheres e dois homens. RESULTADOS: A média de idade foi de 41,9 anos. A braquio-dorso-mamoplastia foi realizada em todos os pacientes. Em três casos, foi realizada braquio-dorso-mamoplastia em L, devido à menor deformidade latero-posterior. A duração média das cirurgias foi de 4 horas e 30 minutos. O Índice de Massa Corporal (IMC) médio, antes da cirurgia bariátrica, foi de 53,5 kg/m2. As perdas ponderais variaram de 47 a 114 kg. O IMC pré-operatório variou de 23 a 39 kg/m2. Não houve casos de infecção, grandes deiscências ou seroma. Duas pacientes evoluíram com hematoma, necessitando de nova intervenção para drenagem. CONCLUSÃO: As deformidades da região torácica no paciente com perda ponderal maciça são variáveis, sendo necessários diversos tratamentos cirúrgicos que deverão abordar o tórax inteiro como área anatômica única. É importante compreender a deformidade que cada paciente apresenta e adequar a abordagem cirúrgica em conformidade. A indicação principal para uma braquio-dorso-mamoplastia é a queda lateral do sulco inframamário.

INTRODUCTION: In Brazil, 88000 bariatric surgeries were performed in 2014. After weight loss, deflation occurs around the trunk, with sagging and folding of excess skin of the breasts in the posterior dorsal region . We, therefore, propose a surgical procedure to treat upper region of the entire trunk, including breasts, side and rear back, and arms. OBJECTIVE: To present a personal experience in brachial-dorsal mammoplasty surgeries. METHOD: We operated 13 patients from 2007 to 2014, 11 women and two men. RESULTS: The average age was 41.9 years. The brachial-dorsal mammoplasty was performed in all patients. In three cases, L-brachial-dorsal mammoplasty was performed, due to lower latero-posterior deformity. The average surgery duration was 4 hours and 30 minutes. The average Body Mass Index (BMI), before bariatric surgery, was 53.5 kg/m2. Weight loss ranged from 47 to 114 kg. The pre-surgery BMI ranged from 23 to 39 kg/m2. There were no cases of infection, large dehiscence or seroma. Two patients developed hematoma, requiring a new intervention for drainage. CONCLUSION: Deformities of the thoracic region in patients with large weight loss are variable, requiring several surgical treatments that should address the entire chest as a single anatomical area. It is important to understand the deformity that each patient presents and adapt the surgical approach accordingly. The main indication for a brachial-dorsal mammoplasty is lateral drop of the inframammary fold.

Complementary exams in blunt torso trauma. Perform only radiographs and fast: is it safe? / Exames complementares na condução do trauma contuso do tronco. É seguro realizar apenas radiografias e fast?

ABSTRACTObjective:to evaluate effectiveness of using chest X-ray (CXR), pelvis X-ray (RXP) and FAST (Focused Abdominal Sonography on Trauma) to exclude significant lesions of the body in blunt trauma.Methods:a prospective study involving 74 patients whom made the three tests (CXR, RXP and FAST) during the initial evaluation between October 2013 and February 2014. The results were compared to the tomography of the same patients or clinical outcome. If the patient did not have alterations on the CT scans or during the observation time, the initial workup was considered safe. All patients were evaluated at the Hospital João XXIII, Belo Horizonte, Brazil.Results:of the 74 patients studied the average age was 33 years, RTS: 6.98, ECG: 12. From 44 (59.45%) patients with exams (radiographs and FAST) unchanged, three had significant injuries (two splenic injuries and one liver injury) diagnosed by clinical monitoring. The remaining patients - 30 (40.55%) - had at least one alteration in conventional tests. Of these group 27 (90%) had significant injuries and three (10%) minor injuries. The sensitivity of all three tests for screening considerable lesions was 90% and the specificity was 93%. The negative predictive value was 93% and the positive predictive value 89%.Conclusion:this research showed that all the three exams - chest X-ray, pelvis and FAST - are safe to lead with the blunt trauma if well used and associated with clinical examination.

RESUMOObjetivo:avaliar a efetividade do uso da radiografia de tórax (RxT), pelve (RxP) e FAST (Focused Abdominal Sonography on Trauma) em excluir lesões significativas do tronco no trauma contuso.Métodos:estudo prospectivo envolvendo 74 pacientes no período de outubro de 2013 a fevereiro de 2014 que fizeram, durante a avaliação inicial, os três exames (RxT, RxP e FAST). Os resultados destes exames foram comparados à tomografia de tronco do mesmo paciente ou com a sua evolução clínica com base no tempo de observação protocolado pelo hospital. Todos os pacientes foram atendidos no Hospital João XXIII, Belo Horizonte/MG, Brasil.Resultados:Dos 74 pacientes estudados, a média de idade foi 33 anos, RTS: 6,98, Escala de Coma de Glasgow (ECG): 12. Desses, 44 (59,45%) possuíram os exames (radiografias e FAST) sem alterações, porém três pacientes desse grupo apresentaram lesões importantes (duas lesões esplênicas e uma hepática) suspeitadas através do acompanhamento clínico e definidas pela tomografia posterior. O restante dos pacientes, 30 (40,55%), tiveram pelo menos uma alteração nos exames convencionais, sendo que, dentro desse grupo, 27 (90%) apresentaram lesões significativas e três (10%) lesões leves. A sensibilidade do conjunto dos três exames para triagem de lesões significativas foi 90% e sua especificidade, 93%. O valor preditivo negativo encontrado foi 93% e o valor preditivo positivo, de 89%.Conclusão:O estudo demonstrou que o conjunto dos três exames (radiografia de tórax, pelve e FAST) é seguro para conduzir o trauma contuso do tronco, se for bem utilizado, associado ao exame clínico.

Asymmetry of the Isokinetic Trunk Rotation Strength of Korean Male Professional Golf Players

OBJECTIVE: To determine whether there is side to side difference of the trunk rotation muscle in Korean male professional golf players. Healthy controls who did not play golf were also evaluated and compared with professional golf players. METHOD: Fifty-one professional golf players and 50 healthy controls participated in this study. Bilateral isokinetic trunk rotation strength that represented the aiming side and non-aiming side trunk rotator function in a golf swing and other parameters were evaluated using the Biodex System III Isokinetic Dynamometer at angular velocities of 30, 60, and 120 degree per second. RESULTS: The professional golf players' peak torque and total work on their aiming sides were significantly higher than on their non-aiming side at all angular velocities. Additionally, the golf players' peak torque on their aiming side was significantly higher than those of the healthy controls only at the 60 degree per second angular velocity, but there was a slight and consistent trend in the others. Finally, the difference between the aiming side and the non-aiming side of the professional golf players and the healthy controls was also significant. CONCLUSION: The aiming side rotation strength of the male professional golf players was higher than that of non-aiming side. The controls showed no side-to-side differences. This finding is attributed to the repetitive training and practice of professional golf players. A further study is needed to investigate if the strengthening of the trunk rotation muscle, especially on the aiming side, could improve golf performance.

Finite element analysis on mechanical responses of human torso with body armor to non penetrating ballistic impact / 医用生物力学

ObjectiveTo develop a finite element computational model of the torso for the numerical simulation of mechanical responses of human torso to non-penetrating ballistic impact. MethodsBased on the CT data of a Chinese adult man, the finite element model of human torso was created by using the medical image processing software Mimics and the finite element pre-processing software HyperMesh. The pressure and acceleration response of the human torso outfitted with soft body armor to the ballistic impact from 9 mm ammunition at a velocity of 360 m/s was calculated numerically by the explicit finite element code LS-DYNA. ResultsThe finite element model of human torso including thoracic skeletal structure, organs, mediastinum and muscle/skin was established. The pressure response of heart, lung, liver and stomach, as well as the acceleration response of sternum were obtained by numerical calculation. It was found that the peak pressure and its time phase were dependent on the distance between the impact point and the measured point wherever in various organs or different position of an organ. Conclusions The finite element computational model of human torso outfitted with soft body armor is available for the simulation of human response to non-penetrating ballistic impact, and the simulated response can be used as evidence for the investigation on mechanism and protection of behind armor blunt frauma.