Breast Vascularization and Its Implication in Breast Reduction and Mastopexy Surgery: Anatomical Study

(1) Background: Breast reduction is one of the most frequently performed plastic surgeries in women worldwide. The Wise pattern breast reduction is one of the most frequent skin designs for this surgery. One key point of the surgery is to preserve a well-vascularized NAC by using different surgical pedicles. This study aims to test and update the anatomical knowledge of breast vascularization, the topographic and anatomical basis of the different surgical vascular pedicles, and the differences between the right and left sides. (2) Methods: A descriptive observational anatomical study was carried out on 15 breasts from 10 cryopreserved body donors. A dissection was performed by quadrants to know the affected arteries' origin in the different patterns. (3) Results: The largest and most frequently dissected internal mammary perforator artery was in the second intercostal space. A total of 44.9% of the dissected perforators are located in the upper inner quadrant, compared to 53.5% in the lower quadrants. (4) Conclusions: The upper inner quadrant alone has the most arterial perforators. In contrast, the sum of the two lower quadrants represents the greatest vascularization of the breast, with a small difference between both

Efectividad del abordaje específico de la región suboccipital en pacientes con cervicalgia mecánica crónica con déficit de rotación

Introducción: La cervicalgia mecánica es la tipología más frecuente de dolor cervical. La mayoría tiene su origen en factores mecánicos: movimientos repetitivos, ausencias de pausas en el trabajo, cargas estáticas y posturas mantenidas con la cabeza y/o los brazos. La incidencia anual de episodios de cervicalgia mecánica atendidos por los médicos de Atención Primaria se calcula en 12 por cada 1.000 sujetos que acuden a la consulta, y constituye uno de los principales problemas de salud atendidos en las unidades de fisioterapia de Atención Primaria. Las dos tecnicás manuales de la región suboccipital de este estudio, presenta una buena evidencia clínica, pero no se han realizado estudios en la cervicalgia mecánica crónica,Objetivo: Evaluar la efectividad de la técnica de inhibición suboccipital por presión mantenida (TISPM) y la movilización de deslizamiento translatorio dorsal de la articulación occipito-atloidea en grado III (MDTD), produce una mejoría adicional en la sintomatología en comparación con el tratamiento fisioterápico convencional, en sujetos con cervicalgia mecánica crónica y déficit de la rotación cervical superior.Material y Métodos: Se diseño un estudio Ensayo clínico aleatorizado, doble ciego. El estudio fue aprobado por el CEIC del IDIAP Jordi Gol, llevado a cabo en un servicio público de Atención Primaria. Registrado previamente en Clinicaltrials NCT02832232. Se reclutaron 78 pacientes con cervicalgia mecánica crónica que se repartieron en tres grupos. Grupo Control con tratamiento protocolizado consistente en IR, autotracciones, autoestiramientos y flexibilización de la columna dorsal, más charlas educativas; Grupo TISPM con tratamiento protocolizado más técnica de inhibición suboccipital por presión mantenida y Grupo MDTD con tratamiento protocolizado más técnica de movilización de deslizamiento translatorio dorsal de la articulación occipito-atloidea en grado III. Se valoró Intensidad de dolor, Rango de movilidad columna cervical global, Rango de movilidad columna cervical superior, discapacidad cervical, intensidad de cefaleas, evaluación palpatoria de los músculos suboccipitales y la apreciación subjetiva del cambio clínico. Las valoraciones se realizaron al inicio, final de tratamiento y 3 meses postratamiento.Resultados: Los grupos eran homogéneos al inicio. En la movilidad de la columna cervical global el grupo MDTD ofrece mejores resultados a corto plazo y el Grupo TISPM ofrece mejores resultados a medio plazo, en la variable de la movilidad de la columna cervical superior a corto y medio plazo el grupo MDTD es el que ofrece mejores resultados. En la variable intensidad del dolor el grupo MDTD ofrece mejores resultados a corto y medio plazo siendo el grupo TISPM el de mayor ganancia, en la intensidad de la cefalea ambos grupos de la técnica manual presentan diferencias estadísticamente significativas a corto y medio plazo siendo el grupo TISPM el de mayor ganancia, en la variable discapacidad cervical el grupo MDTD ofrece mejores resultados a corto y medio plazo, en la evaluación palpatoria el grupo MDTD ofrece mejores resultados a corto y medio plazo y el grupo TISPM a medio plazo. Los dos grupos de las técnicas manuales ofrece más caso de mejoría clínica siendo el grupo MDTD el que presentaba mas caso a corto y medio plazo más del 50%, el 69,2% a corto plazo y el 81% a medio plazo dejaron de tener un test de flexión rotación restringido en el grupo MDTD.Conclusiones: Añadir 6 sesiones de 5 minutos, con la MDTD, al protocolo de fisioterapia de Atención Primaria propuesto; produce mayor ganancia en discapacidad cervical y en el umbral de dolor a la presión a corto y medio plazo, y a corto plazo en la intensidad del dolor; mientras que añadir la TISPM al tratamiento de fisioterapia presenta mejores resultados en la intensidad del dolor a medio plazo y en la intensidad de la cefalea tanto a corto como medio plazo, en sujetos con cervicalgia mecánica crónica y déficit de rotación cervical superior.Añadir 6 sesiones de 5 minutos, con la MDTD, al protocolo de fisioterapia de Atención Primaria propuesto; produce mayor ganancia en la movilidad de la columna cervical global a corto plazo, mientras que a medio plazo añadir la TISPM al tratamiento de fisioterapia, presenta mejores resultados en sujetos con cervicalgia mecánica crónica y déficit de rotación cervical superior.Añadir 6 sesiones de 5 minutos, con la técnica de movilización de deslizamiento translatorio dorsal de la articulación occipito-atloidea, al protocolo de fisioterapia de Atención Primaria propuesto; produce mayor ganancia en la movilidad de la columna cervical superior tanto a corto como medio plazo en sujetos con cervicalgia mecánica crónica y déficit de rotación cervical superior.<br /

Effect of scapular fixation on lateral movement and scapular rotation during glenohumeral lateral distraction mobilisation

Background: Glenohumeral lateral distraction mobilisation (GLDM) is used in patients with shoulder mobility dysfunction. No one has examined the effect of scapular fixation during GLDM. The aim was to measure and compare the lateral movement of the humeral head and the rotational movement of the scapula when three different magnitudes of forces were applied during GLDM, with and without scapular fixation. Methods: Seventeen volunteers were recruited (n = 25 shoulders). Three magnitudes of GLDM force (low, medium, and high) were applied under fixation and non-fixation scapular conditions in the open-packed position. Lateral movement of the humeral head was assessed with ultrasound, and a universal goniometer assessed scapular rotation. Results: The most significant increase in the distance between the coracoid and the humeral head occurred in the scapular fixation condition at all three high-force magnitudes (3.72 mm; p &lt; 0.001). More significant scapular rotation was observed in the non-scapular fixation condition (12.71°). A difference in scapula rotation (10.1°) was observed between scapular fixation and non-scapular fixation during high-force application. Conclusions: Scapular fixation resulted in more significant lateral movement of the humeral head than in the non-scapular fixation condition during three intensities of GLDM forces. The scapular position did not change during GLDM with the scapular fixation condition

Changes over time in the strain on the inferior iliofemoral ligament during a sustained 5-minute high-force long-axis distraction mobilization: a cadaveric study

Objective To analyze the changes over time in the strain on the inferior iliofemoral (IIF) ligament when a constant high-force long-axis distraction mobilization (LADM) was applied over 5 minutes. Design A cross-sectional laboratory cadaveric study. Setting Anatomy laboratory. Participants Thirteen hip joints from 9 fresh-frozen cadavers (mean age, 75.6±7.8 years; N=13). Interventions High-force LADM in open-packed position was sustained for a period of 5 minutes. Main Outcome Measure(s) Strain on IFF ligament was measured over time with a microminiature differential variable reluctance transducer. Strain measurements were taken at every 15 seconds for the first 3 minutes and every 30 seconds for the next 2 minutes. Results Major changes in strain occurred in the first minute of high-force LADM application. The greatest increase in strain on the IFF ligament occurred at the first 15 seconds (7.3±7.2%). At 30 seconds, the increase in strain was 10.1±9.6%, the half of the total increase at the end of the 5-minute high-force LADM (20.2±8.5%). Significant changes in strain measures were shown to occur at 45 seconds of high-force LADM (F=18.11; P<.001). Conclusions When a 5-minute high-force LADM was applied, the major changes in the strain on IIF ligament occurred in the first minute of the mobilization. A high-force LADM mobilization should be sustained at least 45 seconds to produce a significant change in the strain of capsular–ligament tissue

Correlation between Power Elbow Flexion and Physical Performance Test: A Potential Predictor for Assessing Physical Performance in Older Adults

Correlation; Functional tests; Muscle power; Older adultsCorrelación; Pruebas funcionales; Poder muscular; Personas mayoresCorrelació; Proves funcionals; Potència muscular; Gent granBackground: With the increasing number of older adults and their declining motor and cognitive function, it is crucial to find alternative methods for assessing physical functionality. The Short Physical Performance Battery (SPPB), the Time Up and Go (TUG) test, the 4 Meter Walk Test and the Barthel Index (BI) have been used to evaluate mobility and fragility and predict falls. But some of these functional test tasks could be difficult to perform for frail older adults or bedridden patients that cannot ambulate. This study aimed to evaluate the relationship between these functional tests and the power elbow flexion (PEF test). Material and methods: A correlation study was designed with 41 older adults over 65 years of age. The upper limb muscle power was measured using a linear encoder (VITRUBE VBT) with the flexion of the elbow. Results: Strong correlations were found between the PEF test and the 4mWT (rho = 0.715, p = 0.001) and TUG (rho= -0.768, p = 0.001), indicating that the greater the upper limb muscle power is, the greater physical performance will be. Moderate correlations were also found between the PEF and Barthel Index (rho = 0.495, p = 0.001) and SPPB (rho = 0.650, p < 0.001). Conclusions: There is a strong correlation between PEF and the functional tests, proving that older adults that have greater upper limb muscle power have better physical performance. Upper limb muscle power and PEF could be an interesting tool for the assessment of physical performance in bedridden older adults

Central venous-catheter related bacteremia: incidence and risk factors in a hospital in western Mexico

AbstractBackgroundCentral venous catheters (CVC) are needed for monitoring and treatment of critically ill patients; however, their use increases the risk of bacteremia. The aim of the study was to quantify the incidence of central venous catheter-related bacteremia (CVCRB) and to identify factors associated with this infection.MethodsA prospective cohort study was conducted in a concentration hospital of western Mexico. The association of CVCRB and study variables was investigated using multivariate Cox regression analysis.ResultsTwo hundred and four patients with CVC were studied. The mean age was 4.6 years; 66.2% were male. Insertion sites of the catheters were subclavian vein 72.5% (n = 148), jugular vein 20.1% (n = 41) and femoral vein 7.4% (n = 15). CVCRB incidence was 6.5 events/1,000 catheter-days; microorganisms identified were gram-positive cocci 37.5% (n = 6), gram-negative bacilli 37.5% (n = 6) and Candida albicans 25% (n = 4). It was observed that the increase in catheter manipulations per day was associated with bacteremia (HR 1.14, 95% CI 1.06–1.23), whereas the use of intravenous antibiotics showed a protective effect (HR 0.84, 95% CI 0.76–0.92).ConclusionsIn addition to the strategies of maximum caution when placing or manipulating the catheter, we recommend decreasing, as much as possible, disconnects between the CVC and the infusion line. Antibiotics showed a protective effect, but the outcome is uncertain and the promotion of antimicrobial resistance should be considered

Heterogeneidad en el uso de los medios de pago y la banca online: un análisis a partir de la encuesta financiera de las familias (2002-2020)

In recent years, the banking system has been going through an intensive process of digitalisation that has affected, inter alia, the way in which citizens relate to financial entities. Even though this process brings benefits to society in the medium and long run, its short term effects depend, for example, on how familiar households are with the use of bank cards and online banking to access the financial services they need. This paper uses micro data from the Spanish Survey of Household Finances (EFF) for the period 2002-2020 to analyse how patterns in bank card ownership and use, as well as online banking usage, by Spanish households have changed over time. The richness of the EFF data makes it possible to characterise these patterns for different groups of the population according to their age, education level and income. In addition, the availability of information over such a long period of time for several birth cohorts allows these households’ decisions to be analysed over their entire life cycle. The results of the analysis are as follows. First, bank card ownership and use by households have spread throughout the period considered, growing especially among households with lower education levels and incomes. However, even in 2020, several groups of the population have been identified as still having relatively limited access to this specific means of payment, especially those who are older and have lower education levels and lower incomes. Indeed, for example, in 2020, around 20% of those households with a lower education level did not have any bank cards or, if they did have one, did not use it (around 1,760,000 households). Secondly, the use of online banking has increased generally for all households between 2002 and 2020, such that, even among those with an education level below secondary, about half use this way of interacting with banks at least occasionally. However, the spread of this instrument among households exhibits a high degree of heterogeneity according to the year of birth of the household head. For example, slightly more than 80% of those households whose head was born before 1944 did not use online banking in 2020 (around 2,130,000 households). Finally, this paper examines to what extent the patterns observed in bank card ownership and use, as well as in the use of online banking, according to household education level, income and birth year still persist when comparing households with similar demographics and geographical location. This additional analysis, which includes more household characteristics, shows, in line with the previous results, that the differences in bank card ownership and use by household income and education level have decreased between 2002 and 2020 (although bank card ownership is still more limited among households in the lower income quartile and among those whose head has a lower education level). Conversely, the differences among households in the use of online banking by income, age and education level have increased during this period.En los últimos años, el sistema bancario se encuentra inmerso en un intenso proceso de digitalización que ha afectado, entre otras dimensiones, a la forma en la que los ciudadanos se relacionan con las entidades financieras. Aunque a medio y largo plazo este proceso presenta beneficios para la sociedad, sus efectos a corto plazo dependen de cuán familiarizados estén los hogares, por ejemplo, con el uso de las tarjetas bancarias o de la banca online para acceder a los servicios financieros que demandan. Este documento utiliza datos desagregados de la Encuesta Financiera de las Familias (EFF) entre 2002 y 2020 para analizar cómo han cambiado los patrones de tenencia y uso de las tarjetas bancarias de los hogares españoles, así como el uso de la banca online. La riqueza de datos de la EFF permite caracterizar estos patrones para distintos grupos de población según su edad, nivel educativo y renta. Además, la disponibilidad de información a lo largo de un período prolongado para individuos nacidos el mismo año permite examinar la evolución de su uso de tarjetas y de la banca online a lo largo del ciclo vital. Los resultados del análisis sugieren, en primer lugar, que la tenencia de tarjetas bancarias y su uso se ha extendido a lo largo del período considerado, y ha crecido especialmente entre los hogares de menor nivel educativo y renta. No obstante, en 2020 aún se identifican algunos grupos de población que tienen acceso a este medio de pago de modo relativamente limitado, sobre todo los de mayor edad, menor nivel educativo y menor renta. Así, por ejemplo, en 2020, alrededor de un 20 % de los hogares con menor nivel educativo no tenían tarjeta bancaria o, teniéndola, no la utilizaban (en torno a 1.760.000 hogares). En segundo lugar, se observa que el uso de la banca online ha aumentado para todos los hogares entre 2002 y 2020, de modo que, incluso entre quienes tienen un nivel educativo inferior a Bachillerato, la mitad utiliza al menos ocasionalmente este modo de relacionarse con la banca. No obstante, el grado de difusión de este instrumento presenta una gran heterogeneidad según el año de nacimiento del cabeza de familia. Así, por ejemplo, en 2020, algo más del 80 % de los hogares con un cabeza de familia nacido antes de 1944 no utilizan la banca online (en torno a 2.130.000 hogares). Finalmente, este trabajo examina en qué medida estos patrones observados en la tenencia y el uso de tarjetas, así como en el uso de banca online, por educación, renta o año de nacimiento, se mantienen cuando se comparan hogares con composición demográfica y localización geográfica similares. Este análisis adicional, que tiene en cuenta más características relevantes de las familias, muestra, en línea con los resultados anteriores, que las diferencias en la tenencia y uso de tarjetas bancarias según la renta y el nivel educativo de los hogares se han reducido entre 2002 y 2020 —aun así, la tenencia de tarjetas sigue siendo más limitada en el cuartil inferior de renta y entre las familias con menor nivel educativo—. Por su parte, las diferencias entre hogares en el uso de la banca online según su renta, edad y educación han aumentado entre 2002 y 2020

Thermal and non-thermal effects of capacitive–resistive electric transfer application on different structures of the knee: A cadaveric study

Capacitive–resistive electric transfer therapy is used in physical rehabilitation and sports medicine to treat muscle, bone, ligament and tendon injuries. The purpose is to analyze the temperature change and transmission of electric current in superficial and deep knee tissues when applying different protocols of capacitive–resistive electric transfer therapy. Five fresh frozen cadavers (10 legs) were included in this study. Four interventions (high/low power) were performed for 5 min by a physiotherapist with experience. Dynamic movements were performed to the posterior region of the knee. Capsular, intra-articular and superficial temperature were recorded at 1-min intervals and 5 min after the treatment, using thermocouples placed with ultrasound guidance. The low-power protocols had only slight capsular and intra-capsular thermal effects, but electric current flow was observed. The high-power protocols achieved a greater increase in capsular and intra-articular temperature and a greater current flow than the low-power protocols. The information obtained in this in vitro study could serve as basic science data to hypothesize capsular and intra-articular knee recovery in living subjects. The current flow without increasing the temperature in inflammatory processes and increasing the temperature of the tissues in chronic processes with capacitive–resistive electric transfer therapy could be useful for real patients

Short-Term Effects of Three Types of Hamstring Stretching on Length, Neurodynamic Response, and Perceived Sense of Effort—A Randomised Cross-Over Trial

Background: Stretching techniques for hamstring muscles have been described both to increase muscle length and to evaluate nerve mechanosensitivity. Aim: We sought to evaluate the short-term effects of three types of hamstring stretching on hamstring length and report the type of response (neural or muscular) produced by ankle dorsiflexion and perceived sense of effort in asymptomatic subjects. Methods: A randomised cross-over clinical trial was conducted. A total of 35 subjects were recruited (15 women, 20 men; mean age 24.60 ± 6.49 years). Straight leg raises (SLR), passive knee extensions (PKE), and maximal hip flexion (MHF) were performed on dominant and non-dominant limbs. In addition, the intensity of the applied force, the type and location of the response to structural differentiation, and the perceived sensation of effort were assessed. Results: All stretching techniques increased hamstring length with no differences between limbs in the time*stretch interaction (p &lt; 0.05). The perceived sensation of effort was similar between all types of stretching except MHF between limbs (p = 0.047). The type of response was mostly musculoskeletal for MHF and the area of more neural response was the posterior knee with SLR stretch. Conclusions: All stretching techniques increased hamstring length. The highest percentage of neural responses was observed in the SLR stretching, which produced a greater increase in overall flexibility