Approximate surface development of the left side half-trunk by a free-formed model

The approximate surface development, skin length, and surface area of the left side of the trunk of 51 female students were compared with regard to static and stretched postures. The data for each subject were obtained from geometrical models generated by moiré topography with a computer. When the chest was stretched, the anterior surface, the shoulder line, and the arm-base line were transformed from concave to convex, and a gap oriented toward the nipple widened out. The skin elongated vertically and transversely, except at the side of the waistline, where the skin contracted. The area at the top of the trunk decreased about 25%, while the other parts of the trunk increased 8-15%. The total anterior area was 1.20 m2 for the static posture and 1.29 m2 for the stretched posture. When the posterior surface was stretched, the shoulder line changed from convex to concave, the side line from quasi-straight to concave, and gaps oriented toward the chest line disappeared. The skin elongated most at the infrascapular region (20-35%), while the neck base line contracted (-11%). The center of the back and the lower arm base areas enlarged the most (25%) and the lumbar area enlarged the least (12%). The total posterior area was 1.26 m2 in the static posture and 1.37 m2 in the back-stretched posture. In conclusion, the back skin elongated and enlarged more when stretched than the frontal skin.     

Reliability of inferior pedicle reduction mammaplasty in burned oversized breasts

Heavy pendulous breasts cause physical and psychological trauma. Postburn deformity of breasts results in significant asymmetry, displacement of nipple-areola complex, due to burn scar contracture, and significant scarring; these factors add more psychological discomfort and subsequent behavioral changes. The use of the inferior pedicle procedure in burned breasts can solve many problems. The technique reduces the size of the large breast, eliminates the scar tissue by excising both medial and lateral flaps, and brings the mal-located nipple and areola to a normal position. This study stresses the possibility of harvesting the inferior dermal pedicle flap from within the postburn scar tissue without necrosis of the nipple and areola, because of the excellent flap circulation. Acceptable aesthetic appearance and retainment of nipple viability and sensitivity can be achieved with the inferior pedicle technique even with postburn deformity of the breast. The study was conducted on 11 women, all of whom had sustained deep thermal burns to the breasts and anterior torso and whose breasts were hypertrophied and pendulous.     

Physical and psychosocial symptoms among 88 volunteer subjects compared with patients seeking plastic surgery procedures to the breast

In an investigation of the relationship between macromastia and physical and psychosocial symptoms, 88 female university students, 21 augmentation mammaplasty patients, and 31 breast reduction patients graded somatic and psychosocial symptoms. The intent of the study was to discover which complaints were most common among women presenting for reduction mammaplasty and to determine whether height/weight index and brassiere chest measurement and cup size might affect their symptoms. Both the student group and the augmentation mammaplasty patients differed significantly from the breast reduction patients. Eighty-one percent of the reduction patients complained of neck and back pain. Seventy-seven percent complained of shoulder pain, 58 percent complained of chafing or rash; 45 percent reported significant limitation in their activity; and 52 percent were unhappy with their appearance (p < 0.001 compared with augmentation and student groups). Physical symptoms were related to height/weight index and bra chest and cup sizes in each of the three participating groups. It was found that patients who present for symptom-related reduction mammaplasty have a disease-specific group of physical and psychosocial complaints that are more directly related to large breast size than to being overweight.     

Leukotoxin,a linoleate epoxide: Its implication in the late death of patients with extensive burns

Burn death based on circulatory shock is often encountered after recovery from primary shock in patients with deep and extensive burns,i.e., late death. Several toxic substances have been proposed, however, the responsible substance remains obscure. Since we have found leukotoxin, a highly cytotoxic linoleate epoxide biosynthesized by neutrophils, in the burned skin, in the present study we determined plasma leukotoxin concentrations in various degree of 30 burn patients. C-reactive protein and circulatory white blood cells were also measured. A significantly high mortality rate of patients with extensive burns (burn surface area over 70%) was observed compared with that in patients with burn surface area under 70%, and significantly high leukotoxin concentrations were observed within a week, and 3 weeks after the thermal injury in patients with extensive burns compared with those in patients with burn surface area under 70%. There were two peaks of plasma leukotoxin concentrations,i.e., the early phase (within 1 week) and the late phase (over 1 week) in patients with extensive burns. Plasma leukotoxin concentrations significantly correlated with burn surface area in the early phase, and similar correlations were observed in the late phase. A significantly high mortality rate (61%) of patients with peak leukotoxin concentrations over 30 nmol/ml was observed compared with 8% for those below 30 nmol/ml. Plasma leukotoxin concentration correlated significantly to C-reactive protein concentration, log (leukotoxin nmol/ml)=0.042×C-reactive protein (mg/dl)+0.74, (r=0.83,P<0.01) in the late phase. From these results, it is concluded that leukotoxin is produced in patients with burns particularly in the late phase of extensive burns, and leukotoxin might play an important role in the tissue destructive procedure associated with severe burns.     

Is torso soft tissue motion really an artefact within breast biomechanics research?

For rigid body POSE estimation, any relative movement of the tracking markers on a segment is often referred to as an artefact; however this may be an important part of the signal within breast biomechanics. This study aimed to quantify differences in breast range of motion when calculated relative to the torso segment using either direct or segment optimised POSE estimation algorithms. Markers on the torso and right nipple were tracked using infrared cameras (200 Hz) during five running gait cycles in three breast support conditions (no bra, everyday bra and sports bra). Multiplanar breast range of motion was calculated relative to the torso segment using two POSE estimation algorithms. First, the torso segment was defined using direct POSE estimation (direct). Second, while standing stationary in the anatomical position; the positional data of the torso markers were used to construct the torso using segment optimised POSE estimation (optimised). The torso segment length defined using direct POSE estimation changed significantly by 3.4 cm compared to that of the segment optimisation POSE estimation in the no bra condition. Subsequently, superioinferior breast range of motion was significantly greater (p<0.017) when calculated using direct POSE estimation, within each of the three breast support conditions. Segment optimisation POSE estimation is recommended to minimise any differences in breast motion associated with intra segment deformation between physical activity types. However, either algorithm is recommended when evaluating different breast support garments, as a correctly fitted bra does not cause the torso markers to move relative to each other.     

Improving the accuracy of burn-surface estimation

A user-friendly computer-assisted method of calculating total body surface area burned (TBSAB) has been developed. This method is more accurate, faster, and subject to less error than conventional methods. For comparison, the ability of 30 physicians to estimate TBSAB was tested. Parameters studied included the effect of prior burn care experience, the influence of burn size, the ability to accurately sketch the size of burns on standard burn charts, and the ability to estimate percent TBSAB from the sketches. Despite the ability for physicians of all levels of training to accurately sketch TBSAB, significant burn size over-estimation (p less than 0.01) and large interrater variability of potential consequence was noted. Direct benefits of a computerized system are many. These include the need for minimal user experience and the ability for wound-trend analysis, permanent record storage, calculation of fluid and caloric requirements, hemodynamic parameters, and the ability to compare meaningfully the different treatment protocols.     

Diagnosis of Pericardial Effusion by Ultrasound

A reliable method of determining the presence of a pericardial effusion has been evolved. Ultrasonic waves reflected from the posterior part of the anterior chest wall and from the anterior surface of the anterior myocardium and pericardium produce echoes separated from each other by a bare area. This bare area varies in width and the variation has the same periodicity as the cardiac cycle.     

Coping with severe burns in the early stage after burn injury

This study examined the relationship between coping strategies, anxiety and depression levels and burn injury characteristics in the early phase of the treatment in burn-injured patients. Seventy patients with severe burns were interviewed within two weeks of their burn trauma. Coping strategies were measured by the coping with burns questionnaire (CBQ). Anxiety and depression levels were assessed with the Beck Depression Inventory and the Beck Anxiety Inventory. There were no statistically significant gender differences in various coping strategies. Avoidance was associated with higher levels of anxiety, depression and hopelessness. The percentage of total body surface area (TBSA) and localization of burns were not associated with coping patterns. Implications for the assessment and management of burn injured patients were discussed.     

Can fabric sensors monitor breast motion?

To establish whether conducting polymer-coated fabric sensors could be used to monitor breast motion, vertical breast motion of two large breasted women (C+ bra cup) was simultaneously monitored using an OPTOTRAK 3020 motion analysis system (200 Hz) and polymer-coated fabric sensors linked to a custom-made Bluetooth telemetry system (100 Hz) as the subjects walked and ran on a treadmill (7-10 km h(-1)). Sensor strain, change in resistance and vertical breast displacement relative to trunk movement were output for analysis. It was concluded that, although polymer-coated fabric sensors may exhibit a small response lag due to textile geometry changes, they were able to accurately and reliably represent changes in the amplitude of vertical breast displacement during treadmill gait.     

Longitudinal assessment of breast development in adolescent female patients with burns involving the nipple-areolar complex

Long-term follow-up of breast development in adolescent female patients with burns of the anterior chest wall is poorly documented. Between 1971 and 1976, 28 female patients with photographic documentation of burns to the anterior chest wall involving the nipple-areolar complex were reviewed. All patients were followed at least until their early teens. The mean age at the time of thermal injury was 5.9 +/- 2.5 years, with a mean follow-up time of 8.9 +/- 2.6 years. Thirteen patients (46 percent) were admitted to the Shriners Burns Institute in Galveston for acute care of their burns. Fifteen patients (54 percent) were referred for long-term follow-up or specific reconstructive procedures following care of the acute burns. In spite of significant thermal injury to the anterior chest wall with involvement of the nipple-areolar complex, no patient failed to develop breasts. Twenty patients (71 percent) required releases of the anterior chest wall to assist breast development. All anterior chest wall releases were accomplished with the use of skin grafts or local skin flaps.     

The spatial control of Torso RTK activation: a C-terminal fragment of the Trunk protein acts as a signal for Torso receptor in the Drosophila embryo

Regulated activation of receptor tyrosine kinases depends on both the presence of the receptors at the cell surface and on the availability of their ligands. In Drosophila, the torso tyrosine kinase receptor is distributed along the surface of the embryo but it is only activated at the poles by a diffusible extracellular ligand generated at each pole that is trapped by the receptor, thereby impeding further diffusion. Although it is known that this signal depends on the activity of several genes, such as torso-like and trunk, it is still unclear how is generated. The identification of the signal responsible for the torso receptor activation is an essential step towards understanding the mechanism that regulates the local restriction of torso signalling. Here we report that a fragment containing the carboxy-terminal 108 amino acids of the trunk protein retains trunk activity and is sufficient to activate torso signalling. We also show that this fragment bypasses the requirements for the other genes involved in the activation of the torso receptor. These results suggest that a cleaved form of the trunk protein acts as a signal for the torso receptor. We therefore propose that the restricted activation of the torso receptor is defined by the spatial control of the proteolytic processing of the trunk protein.     

A kinetic and electromyographic comparison of the standing cable press and bench press

This study compared the standing cable press (SCP) and the traditional bench press (BP) to better understand the biomechanical limitations of pushing from a standing position together with the activation amplitudes of trunk and shoulder muscles. A static biomechanical model (4D Watbak) was used to assess the forces that can be pushed with 2 arms in a standing position. Then, 14 recreationally trained men performed 1 repetition maximum (1RM) BP and 1RM single-arm SP exercises while superficial electromyography (EMG) of various shoulder and torso muscles was measured. The 1RM BP performance resulted in an average load (74.2 +/- 17.6 kg) significantly higher than 1RM single-arm SP (26.0 +/- 4.4 kg). In addition, the model predicted that pushing forces from a standing position under ideal mechanical conditions are limited to 40.8% of the subject's body weight. For the 1RM BP, anterior deltoid and pectoralis major were more activated than most of the trunk muscles. In contrast, for the 1RM single-arm SP, the left internal oblique and left latissimus dorsi activities were similar to those of the anterior deltoid and pectoralis major. The EMG amplitudes of pectoralis major and the erector muscles were larger for 1RM BP. Conversely, the activation levels of left abdominal muscles and left latissimus dorsi were higher for 1RM right-arm SP. The BP emphasizes the activation of the shoulder and chest muscles and challenges the capability to develop great shoulder torques. The SCP performance also relies on the strength of shoulder and chest musculature; however, it is whole-body stability and equilibrium together with joint stability that present the major limitation in force generation. Our EMG findings show that SCP performance is limited by the activation and neuromuscular coordination of torso muscles, not maximal muscle activation of the chest and shoulder muscles. This has implications for the utility of these exercise approaches to achieve different training goals.     

Knee moments during run-to-cut maneuvers are associated with lateral trunk positioning

Non-contact anterior cruciate ligament (ACL) injuries account for approximately 70% of ACL ruptures and often occur during a sudden change in direction or pivot. Decreased neuromuscular control of the trunk in a controlled perturbation task has previously been associated with ACL injury incidence, while knee abduction moments and tibial internal rotation moments have been associated with ACL strain and ACL injury incidence. In this study, the association between movement of the trunk during a run-to-cut maneuver and loading of the knee during the same activity was investigated. External knee moments and trunk angles were quantified during a run-to-cut maneuver for 29 individuals. The trunk angles examined were outside tilt (frontal plane angle of the torso from vertical), angle between the ground reaction force (GRF) and the torso in the plane containing the GRF and shoulders (torso-GRF_shoulders); and angle between GRF and torso in the plane containing the GRF and pelvis (torso-GRF_pelvis). Significant positive associations were found between torso angles and peak knee abduction moments (outside tilt, p=0.002; and torso-GRF_shoulders, p=0.036) while a significant negative association was found between peak tibial internal rotation moment and outside tilt (p=0.021). Because the peaks of these moments occur at different times and minimal axial rotation moment is observed at peak knee abduction moment (-0.29±0.46%BW*ht), the positive association between peak knee abduction moment and torso lean suggests that increasing torso lean may increase ACL load and risk of injury.     

Hypertonic saline dextran after burn injury decreases inflammatory cytokine responses to subsequent pneumonia-related sepsis

The present study examined the hypothesis that hypertonic saline dextran (HSD), given after an initial insult, attenuates exaggerated inflammation that occurs with a second insult. Adult rats (n = 15 per group) were divided into groups 1 (sham burn), 2 [40% total body surface area burn + 4 ml/kg isotonic saline (IS) + 4 ml.kg(-1).% burn(-1) lactated Ringer solution (LR)], and 3 (burn + 4 ml/kg HSD + LR), all studied 24 h after burns. Groups 4 (sham burn), 5 (burn + IS + LR), and 6 (burns + HSD + LR) received intratracheal (IT) vehicle 7 days after burns; groups 7 (burn + IS + LR) and 8 (burn + HSD + LR) received IT Streptococcus pneumoniae (4 x 10(6) colony-forming units) 7 days after burn. Groups 4-8 were studied 8 days after burn and 24 h after IT septic challenge. When compared with sham burn, contractile defects occurred 24 h after burn in IS-treated but not HSD-treated burns. Cardiac inflammatory responses (pg/ml TNF-alpha) were evident with IS (170 +/- 10) but not HSD (45 +/- 5) treatment vs. sham treatment (80 +/- 15). Pneumonia-related sepsis 8 days after IS-treated burns (group 7) exacerbated TNF-alpha responses/contractile dysfunction vs. IS-treated burns in the absence of sepsis (P < 0.05). Sepsis that occurred after HSD-treated burns (group 8) had less myocyte TNF-alpha secretion/better contractile function than IS-treated burns given septic challenge (group 7, P < 0.05). We conclude that an initial burn injury exacerbates myocardial inflammation/dysfunction occurring with a second insult; giving HSD after the initial insult attenuates myocardial inflammation/dysfunction associated with a second hit, suggesting that HSD reduces postinjury risk for infectious complications.     

Anterior thoracic hypoplasia: a separate entity from Poland syndrome

SUMMARY: Women presenting with anterior thoracic depression, breast hypoplasia, and subsequent asymmetry are often diagnosed with Poland syndrome regardless of pectoralis involvement, or are placed in the generic category of breast asymmetry or skeletal dysplasias. Recently, though, the term "sunken chest" has been used to describe forms of chest wall depression that previously may have fallen under generic skeletal dysplasias. The authors believe that, combined with hypoplasia of the ipsilateral breast, superior location of the nipple-areola complex compared with the contralateral side, and normal pectoralis muscles, this represents a previously undefined and real condition called anterior thoracic hypoplasia. During the past 4 years, the authors have treated eight women who have presented with a diagnosis of Poland syndrome or pectus excavatum, all of whom share the same characteristics-unilateral sunken anterior chest wall, hypoplasia of the breast, superiorly placed nipple-areola complex, normal pectoralis muscle, and normal sternal position. All of the patients underwent correction of breast asymmetry and unilateral anterior thoracic hypoplasia with augmentation mammaplasty, a method that when tailored for each side yields good aesthetic results. The average age of the patients was 31 years and the average chest size was 34. Cup size, as measured by the patient's standard bra, was a B on the nonaffected side in all patients and an A on the affected side in all patients except one. Of the eight patients, seven had the right anterior chest and breast involved, whereas one patient had involvement on the left. For all of the patients, the nipple and areola of the hypoplastic side were smaller and in a more superior position compared with the contralateral side on visual inspection. In the eight patients, a total of 19 augmentations (15 primary augmentations and four revisions) and one mastopexy were performed. Ten inframammary-fold approaches and nine periareolar approaches were used, and all of the implants were placed in a partial submuscular position, except for two implants placed in a subglandular position that were converted to partial submuscular positions in a secondary setting. In all the women, the sternal head of the pectoralis muscle was present and the pectoralis muscle appeared to be equal in size compared to the contralateral side. Nine different types of implants were used. Average implant fill volume measured 412 cc on the hypoplastic side and 257 cc on the contralateral side. In follow-up, all of the patients were satisfied with their operation and rated their aesthetic outcome as very good to excellent. The authors believe that anterior thoracic hypoplasia is a real, previously misdiagnosed and undescribed condition, and that both chest wall and breast deformities can be corrected safely and with excellent results using proper augmentation planning and implant selection.     

Prediction of body density in young and middle-aged women.

The purpose of this investigation was to predict body density of young and middle-aged women and to determine if the use of a greater variety of variables, particularly those for fat in the bust and hip regions, increases the predictability of body density. Body density determined by the hydrostatic technique (dependent variable) was obtained from 83 volunteer young women and 60 middle-aged women ranging from 18 to 22 and 33 to 50 yr of age, respectively. Independent variables included 8 skinfold, 13 girth, and 7 diameter measures; age; height; weight; and bra and cup sizes. Mean body density for young women was 1.043 g/ml (SD plus or minus 0.014) and percent fat, 24.8 (SD plus or minus 6.4); 1.031 g/ml (SD plus or minus 0.015) and 29.8% (SD plus or minus 6.7) for middle aged subjects. Percent fat was calculated by the formula of Siri. Factor analysis was used to examine the dimensions measured by the independent variables as a function of age. A multiple regression model was used to develop predictions of body density from the independent variables. The best combination of four variables for predicting body density was skinfold thigh, skinfold suprailiac, cup size, skinfold suprailiac, girth waist, and skinfold thigh (R = 0.89) for middle-aged women. The data showed that the highest predictons were found by using combinations of skinfold, girth, and diameter variables; cup size also supported the need for different regression equations for different age groups.     

健侧C7 神经移位经椎体前通路的解剖学研究及经颈椎后入路 解剖学探讨

目的:为临床上开展健侧C7神经移位经椎体前通路治疗臂丛损伤提供解剖学基础。方法:选取10具20侧正常成人尸体颈段标本,将双侧臂丛充分显露,远端向C7神经根前后股进行干支分离,在前后股加入外侧束及后束前将其切断,近端向椎间孔处游离,测量C7神经根从椎间孔至分股处的长度及C7神经至前后股长度,测量并记录C7神经根及前后股经椎体前通路、颈前皮下通路到对侧臂丛上、下干的距离。结果:C7神经根的长度(58.62±8.70)mm,C7神经前、后股的长度(70.03±10.79)mm,(65.15±9.11)mm,C7神经根经颈前皮下、椎体前通路至对侧上下干的缺损长度分别是(98.18±10.18)mm,(107.14±9.88)mm;(32.10±11.49)mm,(37.28±10.01)mm两组相比有统计学差异。结论:从解剖学角度而言,健侧C7神经移位经椎体前通路能明显缩短移植神经长度,在临床上具有可操作性。     

小鼠Ⅲ度烧伤模型的复制及皮肤病理形态改变的动态观察

目的利用近交系小鼠建立方法简便、效果稳定的Ⅲ度烧伤模型,对其皮肤病理改变进行动态观察,为烧伤实验治疗研究提供资料。方法小鼠实验前备毛,乙醚麻醉固定小鼠四肢,苏醒后于备毛部覆盖自制控制烧伤面积硬纸片,滴加95%酒精,点燃计时;烧伤早期和远期取皮肤进行病理检查,用Ki67抗体免疫组化观察细胞增殖。结果按本方法建立小鼠Ⅲ度烧伤模型,面积准确,深度一致,操作简便易行。小鼠烧伤皮肤病理改变与人类基本一致,但有其特点：小鼠Ⅲ度烧伤包括表皮至脂膜肌,烧伤后炎性渗出较晚,约需2 d;创面周围毛发生长活跃,倾向创面,Ki67抗体阳性细胞集中于毛囊底部。结论为利用小鼠烧伤模型进行实验治疗的研究提供了有实用价值的资料。     

Elevation of plasma gastrin and pancreatic polypeptide by electrical vagal stimulation in sheep: effects of sequential stimulation

Gastrin and pancreatic polypeptide (PP) are released into the circulation by vagal stimulation. The individual effects of the anterior and posterior vagal trunks on the release of these peptides are unknown. Four sheep were anaesthetized and studied acutely: both vagi were dissected at the hiatus and the trunks divided. In two sheep, the distal ends of the anterior trunks were stimulated for 5 min with an 8 V, 1 ms impulse at 10 Hz. After 1 h the posterior trunks were stimulated similarly. In the other two sheep, the posterior trunk was stimulated and after 1 h the anterior vagal trunk was stimulated. The anterior and posterior trunk equally stimulated the release of both gastrin and PP in four animals. The second stimulation in these four animals resulted in an 18-fold greater integrated response of gastrin and 20-fold greater response of PP. This potentiation to the second stimulus was observed in further experiments even when the same trunk, posterior or anterior, was stimulated twice. The similarity of influence of the anterior and posterior trunks for the release of PP suggests the existence of mechanisms for vagally stimulated PP release other than branches direct from the vagal trunks.