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Loffi RG, Cruz TKF, Paiva GM, Souto DO, Barreto SR, Santana PAN, Nascimento AAAC, Costa FRM, Cota EB, Haase VG. Theoretical-Methodological Foundations for the Global Integration Method (Método de Integração Global-MIG) in the Treatment of Autism Spectrum Disorder. CHILDREN (BASEL, SWITZERLAND) 2024; 11:191. [PMID: 38397303 PMCID: PMC10887636 DOI: 10.3390/children11020191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 01/30/2024] [Accepted: 01/31/2024] [Indexed: 02/25/2024]
Abstract
Currently, there is no intervention model for autism spectrum disorder (ASD) that addresses all levels and factors of the International Classification of Functioning, Disability and Health (ICF, WHO). The most researched programs focus on naturalistic, developmental and behavioral approaches to socio-communication. Less attention has been paid to motor and environmental reactivity aspects (behavior/interest restriction and sensory reactivity). The evidence rationale for the Global Integration Method (MIG, "Método de Integração Global"), a model addressing sensorimotor reactivity in addition to socio-communication, is presented. MIG is an integrative, interdisciplinary, family-oriented intervention and naturalistic program that addresses all levels and moderating factors of ASD's impact. MIG's theoretical rationale is based on the predictive coding impairment and embodied cognition hypotheses. MIG incorporates both bottom-up (flexible therapeutic suit, social-motor synchronization) and top-down (schematic social information processing, narratives, imagery) strategies to promote the building and use of accurate, flexible and context-sensitive internal predictive models. MIG is based on the premises that predictive coding improves both socio-communication and environmental reactivity, and that the postural stabilization provided by the flexible therapeutic suit frees information processing resources for socio-cognitive learning. MIG builds on interdisciplinary, professionally and parentally mediated work based on behavioral principles of intensive training in a situated environment.
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Affiliation(s)
- Renato Guimarães Loffi
- Instituto de Neurodesenvolvimento, Cognição e Educação Inclusiva (INCEI), TREINITEC Ltda., Rua Carmélia Loffi 17, Justinópolis, Ribeirão das Neves 33900-730, MG, Brazil; (R.G.L.); (G.M.P.); (D.O.S.); (S.R.B.); (P.A.N.S.); (A.A.A.C.N.); (F.R.M.C.); (E.B.C.); (V.G.H.)
| | - Thalita Karla Flores Cruz
- Instituto de Neurodesenvolvimento, Cognição e Educação Inclusiva (INCEI), TREINITEC Ltda., Rua Carmélia Loffi 17, Justinópolis, Ribeirão das Neves 33900-730, MG, Brazil; (R.G.L.); (G.M.P.); (D.O.S.); (S.R.B.); (P.A.N.S.); (A.A.A.C.N.); (F.R.M.C.); (E.B.C.); (V.G.H.)
- Programa de Pós-Graduação em Neurociências, Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, MG, Brazil
| | - Giulia Moreira Paiva
- Instituto de Neurodesenvolvimento, Cognição e Educação Inclusiva (INCEI), TREINITEC Ltda., Rua Carmélia Loffi 17, Justinópolis, Ribeirão das Neves 33900-730, MG, Brazil; (R.G.L.); (G.M.P.); (D.O.S.); (S.R.B.); (P.A.N.S.); (A.A.A.C.N.); (F.R.M.C.); (E.B.C.); (V.G.H.)
- Programa de Pós-Graduação em Neurociências, Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, MG, Brazil
| | - Deisiane Oliveira Souto
- Instituto de Neurodesenvolvimento, Cognição e Educação Inclusiva (INCEI), TREINITEC Ltda., Rua Carmélia Loffi 17, Justinópolis, Ribeirão das Neves 33900-730, MG, Brazil; (R.G.L.); (G.M.P.); (D.O.S.); (S.R.B.); (P.A.N.S.); (A.A.A.C.N.); (F.R.M.C.); (E.B.C.); (V.G.H.)
| | - Simone Rosa Barreto
- Instituto de Neurodesenvolvimento, Cognição e Educação Inclusiva (INCEI), TREINITEC Ltda., Rua Carmélia Loffi 17, Justinópolis, Ribeirão das Neves 33900-730, MG, Brazil; (R.G.L.); (G.M.P.); (D.O.S.); (S.R.B.); (P.A.N.S.); (A.A.A.C.N.); (F.R.M.C.); (E.B.C.); (V.G.H.)
- Programa de Pós-Graduação em Ciências Fonoaudiológicas, Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, MG, Brazil
| | - Patrícia Aparecida Neves Santana
- Instituto de Neurodesenvolvimento, Cognição e Educação Inclusiva (INCEI), TREINITEC Ltda., Rua Carmélia Loffi 17, Justinópolis, Ribeirão das Neves 33900-730, MG, Brazil; (R.G.L.); (G.M.P.); (D.O.S.); (S.R.B.); (P.A.N.S.); (A.A.A.C.N.); (F.R.M.C.); (E.B.C.); (V.G.H.)
- Programa de Pós-Graduação em Neurociências, Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, MG, Brazil
| | - Amanda Aparecida Alves Cunha Nascimento
- Instituto de Neurodesenvolvimento, Cognição e Educação Inclusiva (INCEI), TREINITEC Ltda., Rua Carmélia Loffi 17, Justinópolis, Ribeirão das Neves 33900-730, MG, Brazil; (R.G.L.); (G.M.P.); (D.O.S.); (S.R.B.); (P.A.N.S.); (A.A.A.C.N.); (F.R.M.C.); (E.B.C.); (V.G.H.)
- Programa de Pós-Graduação em Neurociências, Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, MG, Brazil
| | - Fabiana Rachel Martins Costa
- Instituto de Neurodesenvolvimento, Cognição e Educação Inclusiva (INCEI), TREINITEC Ltda., Rua Carmélia Loffi 17, Justinópolis, Ribeirão das Neves 33900-730, MG, Brazil; (R.G.L.); (G.M.P.); (D.O.S.); (S.R.B.); (P.A.N.S.); (A.A.A.C.N.); (F.R.M.C.); (E.B.C.); (V.G.H.)
- Programa de Pós-Graduação em Psicologia: Cognição e Comportamento, Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, MG, Brazil
| | - Elisa Braz Cota
- Instituto de Neurodesenvolvimento, Cognição e Educação Inclusiva (INCEI), TREINITEC Ltda., Rua Carmélia Loffi 17, Justinópolis, Ribeirão das Neves 33900-730, MG, Brazil; (R.G.L.); (G.M.P.); (D.O.S.); (S.R.B.); (P.A.N.S.); (A.A.A.C.N.); (F.R.M.C.); (E.B.C.); (V.G.H.)
| | - Vitor Geraldi Haase
- Instituto de Neurodesenvolvimento, Cognição e Educação Inclusiva (INCEI), TREINITEC Ltda., Rua Carmélia Loffi 17, Justinópolis, Ribeirão das Neves 33900-730, MG, Brazil; (R.G.L.); (G.M.P.); (D.O.S.); (S.R.B.); (P.A.N.S.); (A.A.A.C.N.); (F.R.M.C.); (E.B.C.); (V.G.H.)
- Programa de Pós-Graduação em Neurociências, Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, MG, Brazil
- Programa de Pós-Graduação em Psicologia: Cognição e Comportamento, Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, MG, Brazil
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Granieri S, Sileo A, Altomare M, Frassini S, Gjoni E, Germini A, Bonomi A, Akimoto E, Wong CL, Cotsoglou C. Short-Term Outcomes after D2 Gastrectomy with Complete Mesogastric Excision in Patients with Locally Advanced Gastric Cancer: A Systematic Review and Meta-Analysis of High-Quality Studies. Cancers (Basel) 2023; 16:199. [PMID: 38201626 PMCID: PMC10778561 DOI: 10.3390/cancers16010199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 12/17/2023] [Accepted: 12/29/2023] [Indexed: 01/12/2024] Open
Abstract
Complete mesogastric excision (CME) has been advocated to allow for a more extensive retrieval of lymph nodes, as well as lowering loco-regional recurrence rates. This study aims to analyze the short-term outcomes of D2 radical gastrectomy with CME compared to standard D2 gastrectomy. A systematic review of the literature was conducted according to the Cochrane recommendations until 2 July 2023 (PROSPERO ID: CRD42023443361). The primary outcome, expressed as mean difference (MD) and 95% confidence intervals (CI), was the number of harvested lymph nodes (LNs). Meta-analyses of means and binary outcomes were developed using random effects models to assess heterogeneity. The risk of bias in included studies was assessed with the RoB 2 and ROBINS-I tools. There were 13 studies involving 2009 patients that were included, revealing a significantly higher mean number of harvested LNs in the CME group (MD: 2.55; 95% CI: 0.25-4.86; 95%; p = 0.033). The CME group also experienced significantly lower intraoperative blood loss, a lower length of stay, and a shorter operative time. Three studies showed a serious risk of bias, and between-study heterogeneity was mostly moderate or high. Radical gastrectomy with CME may offer a safe and more radical lymphadenectomy, but long-term outcomes and the applicability of this technique in the West are still to be proven.
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Affiliation(s)
- Stefano Granieri
- General Surgery Unit, ASST Brianza—Vimercate Hospital, 20871 Vimercate, Italy; (E.G.); (A.G.)
| | - Annaclara Sileo
- General Surgery Residency Program, University of Milan, 20122 Milan, Italy; (A.S.); (A.B.)
| | - Michele Altomare
- Trauma Center and Emergency Surgery, ASST Great Metropolitan Hospital Niguarda, 20162 Milan, Italy;
| | - Simone Frassini
- General Surgery Residency Program, University of Pavia, 27100 Pavia, Italy;
| | - Elson Gjoni
- General Surgery Unit, ASST Brianza—Vimercate Hospital, 20871 Vimercate, Italy; (E.G.); (A.G.)
| | - Alessandro Germini
- General Surgery Unit, ASST Brianza—Vimercate Hospital, 20871 Vimercate, Italy; (E.G.); (A.G.)
| | - Alessandro Bonomi
- General Surgery Residency Program, University of Milan, 20122 Milan, Italy; (A.S.); (A.B.)
| | - Eigo Akimoto
- Department of General Surgery, Juntendo University Nerima Hospital, Tokyo 177-8521, Japan;
| | - Chun Lam Wong
- Ruttonjee & Tang Siu Kin Hospital, Hong Kong, China;
| | - Christian Cotsoglou
- General Surgery Unit, ASST Brianza—Vimercate Hospital, 20871 Vimercate, Italy; (E.G.); (A.G.)
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Kurahashi Y, Tomita T, Nakamura T, Nakao E, Hojo Y, Kohno S, Ishida Y, Shinohara H. Proposal for T3 classification of esophagogastric junction carcinoma based on the interconnection of extramural anatomical structures. Esophagus 2023; 20:587-594. [PMID: 37470882 DOI: 10.1007/s10388-023-01023-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 07/14/2023] [Indexed: 07/21/2023]
Abstract
Classification of extramural invasion of esophagogastric junction carcinoma (EGJC) is not yet established. The anatomy surrounding the EGJ alters between the mediastinum and the abdominal cavity. This review proposed a T3 classification of EGJC based on anatomical continuity. Analysis of endoscopic ultrasound images, review of intraoperative images, and detailed observation of surgical specimens were followed by a review of the literature. In the EGJ, the muscularis propria of the esophagus is enclosed in mediastinal adipose tissue called the adventitia, which is surrounded by the diaphragmatic crus and contains the paraesophageal lymph nodes (LNs). After passing through the esophageal hiatus along with the vagus nerves and blood vessels, the adventitia joins the adipose tissue containing the paracardial LNs, which is covered by the peritoneum, and then further divides into the lesser and greater omentum. The connective tissue outside the muscularis propria of the stomach, including the adipose tissue of the omentum, is called the subserosa. According to the TNM classification, T3 esophageal and gastric cancer is defined as invasion of the adventitia and subserosa, respectively. Given that the adventitia is anatomically continuous with the subserosa, T3 tumors of the EGJ can be described as those that extend through the muscularis propria but do not invade the peritoneum or diaphragmatic crus. We propose classifying T3 EGJC as "tumor extends through muscularis propria" rather than using the separate terms "adventitia" and "submucosa". T4 could be "tumor perforates serosa or invades adjacent structures", as per the current gastric cancer classification.
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Affiliation(s)
- Yasunori Kurahashi
- Department of Gastroenterological Surgery, Hyogo Medical University, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Toshihiko Tomita
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Hyogo Medical University, Nishinomiya, Hyogo, Japan
| | - Tatsuro Nakamura
- Department of Gastroenterological Surgery, Hyogo Medical University, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Eiichiro Nakao
- Department of Gastroenterological Surgery, Hyogo Medical University, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Yudai Hojo
- Department of Gastroenterological Surgery, Hyogo Medical University, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Shugo Kohno
- Department of Gastroenterological Surgery, Hyogo Medical University, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Yoshinori Ishida
- Department of Gastroenterological Surgery, Hyogo Medical University, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Hisashi Shinohara
- Department of Gastroenterological Surgery, Hyogo Medical University, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan.
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Llewellyn J, Fede C, Loneker AE, Friday CS, Hast MW, Theise ND, Furth EE, Guido M, Stecco C, Wells RG. Glisson's capsule matrix structure and function is altered in patients with cirrhosis irrespective of aetiology. JHEP Rep 2023; 5:100760. [PMID: 37534230 PMCID: PMC10393548 DOI: 10.1016/j.jhepr.2023.100760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 03/14/2023] [Accepted: 03/31/2023] [Indexed: 08/04/2023] Open
Abstract
Background & Aims Glisson's capsule is the interstitial connective tissue that surrounds the liver. As part of its normal physiology, it withstands significant daily changes in liver size. The pathophysiology of the capsule in disease is not well understood. The aim of this study was to characterise the changes in capsule matrix, cellular composition, and mechanical properties that occur in liver disease and to determine whether these correlate with disease severity or aetiology. Methods Samples from ten control patients, and six with steatosis, seven with moderate fibrosis, and 37 with cirrhosis were collected from autopsies, intraoperative biopsies, and liver explants. Matrix proteins and cell markers were assessed by staining and second harmonic generation imaging. Mechanical tensile testing was performed on a test frame. Results Capsule thickness was significantly increased in cirrhotic samples compared with normal controls irrespective of disease aetiology (70.12 ± 14.16 μm and 231.58 ± 21.82 μm, respectively), whereas steatosis and moderate fibrosis had no effect on thickness (90.91 ± 11.40 μm). Changes in cirrhosis included an increase in cell number (fibroblasts, vascular cells, infiltrating immune cells, and biliary epithelial cells). Key matrix components (collagens 1 and 3, hyaluronan, versican, and elastin) were all deposited in the lower capsule, although only the relative amounts per area of hyaluronan and versican were increased. Organisational features, including crimping and alignment of collagen fibres, were also altered in cirrhosis. Unexpectedly, capsules from cirrhotic livers had decreased resistance to loading compared with controls. Conclusions The liver capsule, similar to the parenchyma, is an active site of disease, demonstrating changes in matrix and cell composition as well as mechanical properties. Impact and implications We assessed the changes in composition and response to stretching of the liver outer sheath, the capsule, in human liver disease. We found an increase in key structural components and numbers of cells as well as a change in matrix organisation of the capsule during the later stages of disease. This allows the diseased capsule to stretch more under any given force, suggesting that it is less stiff than healthy tissue.
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Affiliation(s)
- Jessica Llewellyn
- Department of Gastroenterology and Hepatology, School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Center for Engineering MechanoBiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Caterina Fede
- Department of Neuroscience, University of Padova, Padova, Italy
| | - Abigail E. Loneker
- Center for Engineering MechanoBiology, University of Pennsylvania, Philadelphia, PA, USA
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, USA
| | - Chet S. Friday
- Department of Orthopaedic Surgery, School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Michael W. Hast
- Department of Orthopaedic Surgery, School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Neil D. Theise
- Department of Pathology, New York University, School of Medicine, New York, NY, USA
| | - Emma E. Furth
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Maria Guido
- Department of Pathology, University of Padova, Italy
| | - Carla Stecco
- Department of Neuroscience, University of Padova, Padova, Italy
| | - Rebecca G. Wells
- Department of Gastroenterology and Hepatology, School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Center for Engineering MechanoBiology, University of Pennsylvania, Philadelphia, PA, USA
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, USA
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Fascia Layer-A Novel Target for the Application of Biomaterials in Skin Wound Healing. Int J Mol Sci 2023; 24:ijms24032936. [PMID: 36769257 PMCID: PMC9917695 DOI: 10.3390/ijms24032936] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 01/28/2023] [Accepted: 01/31/2023] [Indexed: 02/05/2023] Open
Abstract
As the first barrier of the human body, the skin has been of great concern for its wound healing and regeneration. The healing of large, refractory wounds is difficult to be repaired by cell proliferation at the wound edges and usually requires manual intervention for treatment. Therefore, therapeutic tools such as stem cells, biomaterials, and cytokines have been applied to the treatment of skin wounds. Skin microenvironment modulation is a key technology to promote wound repair and skin regeneration. In recent years, a series of novel bioactive materials that modulate the microenvironment and cell behavior have been developed, showing the ability to efficiently facilitate wound repair and skin attachment regeneration. Meanwhile, our lab found that the fascial layer has an indispensable role in wound healing and repair, and this review summarizes the research progress of related bioactive materials and their role in wound healing.
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O'Regan PW, Mhuircheartaigh JMN, Scanlon TG, Shelly MJ. Radiology of the Mesentery. Clin Colon Rectal Surg 2022; 35:328-337. [PMID: 35975110 PMCID: PMC9376046 DOI: 10.1055/s-0042-1744481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
The recent description and re-classification of the mesentery as an organ prompted renewed interest in its role in physiological and pathological processes. With an improved understanding of its anatomy, accurately and reliably assessing the mesentery with non-invasive radiological investigation becomes more feasible. Multi-detector computed tomography is the main radiological modality employed to assess the mesentery due to its speed, widespread availability, and diagnostic accuracy. Pathologies affecting the mesentery can be classified as primary or secondary mesenteropathies. Primary mesenteropathies originate in the mesentery and subsequently progress to involve other organ systems (e.g., mesenteric ischemia or mesenteric volvulus). Secondary mesenteropathies describe disease processes that originate elsewhere and progress to involve the mesentery with varying degrees of severity (e.g., lymphoma). The implementation of standardized radiological imaging protocols, nomenclature, and reporting format with regard to the mesentery will be essential in improving the assessment of mesenteric anatomy and various mesenteropathies. In this article, we describe and illustrate the current state of art in respect of the radiological assessment of the mesentery.
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Affiliation(s)
- Patrick W. O'Regan
- Department of Radiology, University Hospital Limerick, St. Nessan's Road, Dooradoyle, Limerick, Ireland
| | - Jennifer M. Ní Mhuircheartaigh
- Department of Radiology, University Hospital Limerick, St. Nessan's Road, Dooradoyle, Limerick, Ireland
- School of Medicine, University of Limerick, Limerick, Ireland
| | - Timothy G. Scanlon
- Department of Radiology, University Hospital Limerick, St. Nessan's Road, Dooradoyle, Limerick, Ireland
- School of Medicine, University of Limerick, Limerick, Ireland
| | - Martin J. Shelly
- Department of Radiology, University Hospital Limerick, St. Nessan's Road, Dooradoyle, Limerick, Ireland
- School of Medicine, University of Limerick, Limerick, Ireland
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Cui H, Cui JX, Zhang KC, Liang WQ, Li SY, Huang J, Chen L, Wei B. Can a single-port robot be safely used for robotic total gastrectomy for advanced gastric cancer? First experience using the da Vinci SP platform. Gastroenterol Rep (Oxf) 2022; 10:goac023. [PMID: 35686174 PMCID: PMC9172626 DOI: 10.1093/gastro/goac023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 05/03/2022] [Accepted: 05/04/2022] [Indexed: 11/13/2022] Open
Abstract
Background Many studies have shown the operative feasibility and safety of robotic gastrectomy. Surgeons are pursuing single-port (SP) surgery to leverage the advantages of minimally invasive gastrectomy. The purpose of this study was to describe technical considerations and short-term outcomes from the first reported SP robotic total gastrectomy (RTG) using the da Vinci SP platform. Methods A 75-year-old patient with a body-mass index of 19.8 kg/m2 and clinical stage III cancer (cT3N+M0) underwent SP RTG on 22 January 2022 at the Department of General Surgery, the Chinese PLA General Hospital. All procedures were performed successfully using the da Vinci SP robotic platform. Results The SP RTG was successfully performed with D2 lymphadenectomy including No. 10 lymph-nodes dissection and extracorporeal Roux-en-Y anastomosis. Except for subcutaneous emphysema, no severe adverse events occurred during the operation. According to a visual analogue scale (VAS), the subjective feeling of post-operative pain was given a VAS score of 3 of 10 on Post-Operative Day 1 (POD 1), 1 of 10 on POD 3, and 1 of 10 on POD 7. We removed the gastric tube on POD 2 and advised sipping water, a liquid diet, and a soft diet on PODs 2, 4, and 6, respectively. The patient was discharged without any complications on POD 8. Conclusion RTG is technically feasible and safe using the da Vinci SP robotic platform. To our knowledge, this is the first study using the da Vinci SP platform in RTG for advanced gastric cancer in elderly patients. To verify its superior operative outcomes, further clinical trials are needed.
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Affiliation(s)
- Hao Cui
- Department of General Surgery, The First Medical Center, Chinese PLA General Hospital , Beijing, P. R. China
- School of Medicine, Nankai University , Tianjin, P. R. China
| | - Jian-Xin Cui
- Department of General Surgery, The First Medical Center, Chinese PLA General Hospital , Beijing, P. R. China
| | - Ke-Cheng Zhang
- Department of General Surgery, The First Medical Center, Chinese PLA General Hospital , Beijing, P. R. China
| | - Wen-Quan Liang
- Department of General Surgery, The First Medical Center, Chinese PLA General Hospital , Beijing, P. R. China
| | - Shu-Yan Li
- Foreign Languages College, Shandong University of Traditional Chinese Medicine , Jinan, Shandong, P. R. China
| | - Jun Huang
- Department of General Surgery, The First Medical Center, Chinese PLA General Hospital , Beijing, P. R. China
- School of Medicine, Nankai University , Tianjin, P. R. China
| | - Lin Chen
- Department of General Surgery, The First Medical Center, Chinese PLA General Hospital , Beijing, P. R. China
- School of Medicine, Nankai University , Tianjin, P. R. China
| | - Bo Wei
- Department of General Surgery, The First Medical Center, Chinese PLA General Hospital , Beijing, P. R. China
- School of Medicine, Nankai University , Tianjin, P. R. China
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8
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Kobayashi N, Shinohara H, Haruta S, Udagawa H, Ueno M. Reducing the risk of postoperative pancreatic fistula in radical gastrectomy: pre-assessment with computed tomography for the diagnosis of pancreatic steatosis. Langenbecks Arch Surg 2021; 407:587-596. [PMID: 34559268 DOI: 10.1007/s00423-021-02337-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 09/20/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE To determine whether pancreatic steatosis (PS) is associated with the risk of postoperative pancreatic fistula (POPF) after radical gastrectomy, and if so, to investigate whether pre-assessment by diagnostic imaging can mitigate the risk. METHODS The clinical records of 276 patients with cStage I gastric cancer who underwent laparoscopic gastrectomy with D1 + lymphadenectomy between 2012 and 2015 were reviewed. In the first phase up to July 2013 (n = 138), PS was classified from computed tomography (CT) findings into type S (superficial fat deposition) or type D (diffuse fatty replacement) and examined for association with POPF. In the second phase (n = 138), the preoperative CT assessment of PS was routinized. Separate samples from pancreatoduodenectomy consistent with each type were histologically examined. RESULTS In the first phase, the incidence of POPF was significantly higher in group S, but not in group D, compared with normal pancreas (16.3% and 9.1% vs. 3.6%, respectively; P = 0.03). The drain amylase level was lowest in group D, reflecting exocrine insufficiency. Histologically, the loose connective-tissue space between the fat infiltrating the pancreas and the peripancreatic fat containing the lymph nodes was unclear in type D but conserved in type S. In the second phase, surgery was performed with more intention on accurately tracing the dissection plane and significantly lowered incidence of POPF in Group S (16.3% to 2.1%; P = 0.047). CONCLUSION Peripancreatic lymphadenectomy is more challenging and likely to cause POPF in patients with PS. However, the risk may be reduced using appropriate dissection techniques based on the CT pre-assessment findings.
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Affiliation(s)
- Nao Kobayashi
- Department of Surgery, Tsudanuma General Hospital, Narashino, Japan.,Department of Gastroenterological Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Hisashi Shinohara
- Department of Gastroenterological Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan. .,Department of Gastroenterological Surgery, Toranomon Hospital, Tokyo, Japan.
| | - Shusuke Haruta
- Department of Gastroenterological Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Harushi Udagawa
- Department of Gastroenterological Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Masaki Ueno
- Department of Gastroenterological Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
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9
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Suzuki K, Sasaki T, Miyagi Y, Mori K, Kishikawa H, Ishii Y, Sakamoto A, Nitta T. The Effect of Continuous Field Block through Intercostal Muscles after Atrial Septal Defect Closure via a Mini-Right Thoracotomy in Pediatric Patients. J NIPPON MED SCH 2021; 88:347-353. [PMID: 33250477 DOI: 10.1272/jnms.jnms.2021_88-507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Postoperative pain management in thoracotomy patients often is difficult. Furthermore, pediatric patients present more challenges because of their inability to effectively communicate their pain intensity. The purpose of this study was to evaluate the use of continuous field block through intercostal muscles as postoperative pain management in pediatric thoracotomy. METHODS Between 2014 and 2018, 11 patients underwent an ASD closure using a cardiopulmonary bypass via a mini-right thoracotomy through the fourth intercostal space. At the time of chest closure, a single-shot field block via the fourth intercostal muscles was performed with levobupivacaine (0.6 mg/kg). The first five patients were only given the single-shot field block (Single group). The remaining six patients were given levobupivacaine continuously (0.1 mg/kg/hr) through an indwelling catheter until the chest tube removal (Continuous group). The groups' vital signs, total amounts of acetaminophen used, postoperative courses were compared. RESULTS Although the heart rate did not differ between the groups, the respiratory rate was significantly higher in the Single group versus the Continuous group at 16 and 32 hr post-surgery (35.6 ± 9.7/min vs. 18.5 ± 4.7/min; p=0.007, 43.0 ± 10.4 vs. 25.3 ± 3.1; p=0.042, respectively). The accumulated dosage of acetaminophen given by postoperative day 2 was significantly higher in the Single group versus the Continuous group (55.3 ± 22.1 mg/kg vs. 7.8 ± 17.4 mg/kg; p=0.012). CONCLUSIONS Continuous field block via intercostal muscles after ASD closure via a mini-right thoracotomy in children was effective to stabilize the vital signs and reduce the analgesic medication use.
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Affiliation(s)
- Kenji Suzuki
- Department of Cardiovascular Surgery, Nippon Medical School
| | - Takashi Sasaki
- Department of Cardiovascular Surgery, Nippon Medical School
| | - Yasuo Miyagi
- Department of Cardiovascular Surgery, Nippon Medical School
| | - Keisuke Mori
- Department of Anesthesiology, Nippon Medical School
| | | | - Yosuke Ishii
- Department of Cardiovascular Surgery, Nippon Medical School
| | | | - Takashi Nitta
- Department of Cardiovascular Surgery, Nippon Medical School
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10
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Furnishing Wound Repair by the Subcutaneous Fascia. Int J Mol Sci 2021; 22:ijms22169006. [PMID: 34445709 PMCID: PMC8396603 DOI: 10.3390/ijms22169006] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 08/10/2021] [Accepted: 08/17/2021] [Indexed: 12/28/2022] Open
Abstract
Mammals rapidly heal wounds through fibrous connective tissue build up and tissue contraction. Recent findings from mouse attribute wound healing to physical mobilization of a fibroelastic connective tissue layer that resides beneath the skin, termed subcutaneous fascia or superficial fascia, into sites of injury. Fascial mobilization assembles diverse cell types and matrix components needed for rapid wound repair. These observations suggest that the factors directly affecting fascial mobility are responsible for chronic skin wounds and excessive skin scarring. In this review, we discuss the link between the fascia's unique tissue anatomy, composition, biomechanical, and rheologic properties to its ability to mobilize its tissue assemblage. Fascia is thus at the forefront of tissue pathology and a better understanding of how it is mobilized may crystallize our view of wound healing alterations during aging, diabetes, and fibrous disease and create novel therapeutic strategies for wound repair.
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11
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Byrnes KG, Walsh D, Walsh LG, Coffey DM, Ullah MF, Mirapeix R, Hikspoors J, Lamers W, Wu Y, Zhang XQ, Zhang SX, Brama P, Dunne CP, O'Brien IS, Peirce CB, Shelly MJ, Scanlon TG, Luther ME, Brady HD, Dockery P, McDermott KW, Coffey JC. The development and structure of the mesentery. Commun Biol 2021; 4:982. [PMID: 34408242 PMCID: PMC8373875 DOI: 10.1038/s42003-021-02496-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 07/26/2021] [Indexed: 01/07/2023] Open
Abstract
The position of abdominal organs, and mechanisms by which these are centrally connected, are currently described in peritoneal terms. As part of the peritoneal model of abdominal anatomy, there are multiple mesenteries. Recent findings point to an alternative model in which digestive organs are connected to a single mesentery. Given that direct evidence of this is currently lacking, we investigated the development and shape of the entire mesentery. Here we confirm that, within the abdomen, there is one mesentery in which all abdominal digestive organs develop and remain connected to. We show that all abdominopelvic organs are organised into two, discrete anatomical domains, the mesenteric and non-mesenteric domain. A similar organisation occurs across a range of animal species. The findings clarify the anatomical foundation of the abdomen; at the foundation level, the abdomen comprises a visceral (i.e. mesenteric) and somatic (i.e. musculoskeletal) frame. The organisation at that level is a fundamental order that explains the positional anatomy of all abdominopelvic organs, vasculature and peritoneum. Collectively, the findings provide a novel start point from which to systemically characterise the abdomen and its contents. Byrnes et al. reconstruct the developing mesentery from digitized embryonic datasets and human and animal cadavers using 3D digital and printed models. They confirm the mesentery remains a continuous organ in and on which all abdominal digestive organs develop and that at the foundation level, the abdomen comprises a mesenteric and non-mesenteric domain.
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Affiliation(s)
- Kevin G Byrnes
- Department of Surgery, University of Limerick Hospitals Group, Limerick, Ireland.,4iCentre for Interventions in Infection, Inflammation and Immunology, School of Medicine, University of Limerick, Limerick, Ireland
| | - Dara Walsh
- Department of Surgery, University of Limerick Hospitals Group, Limerick, Ireland.,4iCentre for Interventions in Infection, Inflammation and Immunology, School of Medicine, University of Limerick, Limerick, Ireland
| | - Leon G Walsh
- Department of Surgery, University of Limerick Hospitals Group, Limerick, Ireland.,4iCentre for Interventions in Infection, Inflammation and Immunology, School of Medicine, University of Limerick, Limerick, Ireland
| | - Domhnall M Coffey
- Department of Surgery, University of Limerick Hospitals Group, Limerick, Ireland.,4iCentre for Interventions in Infection, Inflammation and Immunology, School of Medicine, University of Limerick, Limerick, Ireland
| | - Muhammad F Ullah
- Department of Surgery, University of Limerick Hospitals Group, Limerick, Ireland.,4iCentre for Interventions in Infection, Inflammation and Immunology, School of Medicine, University of Limerick, Limerick, Ireland
| | - Rosa Mirapeix
- Department of Anatomy and Embryology, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jill Hikspoors
- Department of Anatomy and Embryology, Maastricht University, Maastricht, Netherlands
| | - Wouter Lamers
- Department of Anatomy and Embryology, Maastricht University, Maastricht, Netherlands
| | - Yi Wu
- Digital Medicine Department, Biomedical Engineering College, Third Military Medical University, Chongqing, China
| | - Xiao-Qin Zhang
- Digital Medicine Department, Biomedical Engineering College, Third Military Medical University, Chongqing, China
| | - Shao-Xiang Zhang
- Digital Medicine Department, Biomedical Engineering College, Third Military Medical University, Chongqing, China
| | - Pieter Brama
- School of Veterinary Medicine, Veterinary Science Centre, Dublin, Ireland
| | - Colum P Dunne
- 4iCentre for Interventions in Infection, Inflammation and Immunology, School of Medicine, University of Limerick, Limerick, Ireland
| | - Ian S O'Brien
- Department of Anatomy, National University of Ireland Galway, Galway, Ireland
| | - Colin B Peirce
- Department of Surgery, University of Limerick Hospitals Group, Limerick, Ireland
| | - Martin J Shelly
- Department of Radiology, University of Limerick Hospitals Group, Limerick, Ireland
| | - Tim G Scanlon
- Department of Radiology, University of Limerick Hospitals Group, Limerick, Ireland
| | - Mary E Luther
- Department of Surgery, University of Limerick Hospitals Group, Limerick, Ireland
| | - Hugh D Brady
- Department of Surgery, University of Limerick Hospitals Group, Limerick, Ireland
| | - Peter Dockery
- Department of Anatomy, National University of Ireland Galway, Galway, Ireland
| | - Kieran W McDermott
- 4iCentre for Interventions in Infection, Inflammation and Immunology, School of Medicine, University of Limerick, Limerick, Ireland
| | - J Calvin Coffey
- Department of Surgery, University of Limerick Hospitals Group, Limerick, Ireland. .,4iCentre for Interventions in Infection, Inflammation and Immunology, School of Medicine, University of Limerick, Limerick, Ireland.
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12
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Chin KJ, Versyck B, Elsharkawy H, Rojas Gomez MF, Sala-Blanch X, Reina MA. Anatomical basis of fascial plane blocks. Reg Anesth Pain Med 2021; 46:581-599. [PMID: 34145071 DOI: 10.1136/rapm-2021-102506] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 01/29/2021] [Accepted: 01/30/2021] [Indexed: 11/04/2022]
Abstract
Fascial plane blocks (FPBs) are regional anesthesia techniques in which the space ("plane") between two discrete fascial layers is the target of needle insertion and injection. Analgesia is primarily achieved by local anesthetic spread to nerves traveling within this plane and adjacent tissues. This narrative review discusses key fundamental anatomical concepts relevant to FPBs, with a focus on blocks of the torso. Fascia, in this context, refers to any sheet of connective tissue that encloses or separates muscles and internal organs. The basic composition of fascia is a latticework of collagen fibers filled with a hydrated glycosaminoglycan matrix and infiltrated by adipocytes and fibroblasts; fluid can cross this by diffusion but not bulk flow. The plane between fascial layers is filled with a similar fat-glycosaminoglycan matric and provides gliding and cushioning between structures, as well as a pathway for nerves and vessels. The planes between the various muscle layers of the thorax, abdomen, and paraspinal area close to the thoracic paravertebral space and vertebral canal, are popular targets for ultrasound-guided local anesthetic injection. The pertinent musculofascial anatomy of these regions, together with the nerves involved in somatic and visceral innervation, are summarized. This knowledge will aid not only sonographic identification of landmarks and block performance, but also understanding of the potential pathways and barriers for spread of local anesthetic. It is also critical as the basis for further exploration and refinement of FPBs, with an emphasis on improving their clinical utility, efficacy, and safety.
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Affiliation(s)
- Ki Jinn Chin
- Department of Anesthesiology and Pain Medicine, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Barbara Versyck
- Department of Anaesthesia and Pain Medicine, Catharina Ziekenhuis, Eindhoven, North Brabant, The Netherlands.,Department of Anaesthesia and Pain Medicine, AZ Turnhout, Turnhout, Belgium
| | - Hesham Elsharkawy
- Outcomes Research Consortium, Cleveland Clinic, Cleveland, Ohio, USA.,Department of Anesthesiology, Case Western Reserve University, MetroHealth Pain and Healing Center, Cleveland, Ohio, USA
| | | | - Xavier Sala-Blanch
- Anesthesiology, Hospital Clinic de Barcelona, Barcelona, Spain.,Human Anatomy and Embryology, University of Barcelona Faculty of Medicine, Barcelona, Spain
| | - Miguel A Reina
- Department of Anesthesiology, Madrid-Monteprincipe University Hospital, CEU-San-Pablo University School of Medicine, Madrid, Spain
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13
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Jiang HH, Liu HL, Li AJ, Wang WC, Lv L, Peng J, Pan ZH, Chang Y, Lin MB. Laparoscopic lateral lymph node dissection in two fascial spaces for locally advanced lower rectal cancer. World J Gastroenterol 2021; 27:3654-3667. [PMID: 34239276 PMCID: PMC8240048 DOI: 10.3748/wjg.v27.i24.3654] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 01/20/2021] [Accepted: 02/25/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The procedure for lateral lymph node (LLN) dissection (LLND) is complicated and can result in complications. We developed a technique for laparoscopic LLND based on two fascial spaces to simplify the procedure.
AIM To clarify the anatomical basis of laparoscopic LLND in two fascial spaces and to evaluate its efficacy and safety in treating locally advanced low rectal cancer (LALRC).
METHODS Cadaveric dissection was performed on 24 pelvises, and the fascial composition related to LLND was observed and described. Three dimensional-laparoscopic total mesorectal excision with LLND was performed in 20 patients with LALRC, and their clinical data were analyzed.
RESULTS The cadaver study showed that the fascia propria of the rectum, urogenital fascia, vesicohypogastric fascia and parietal fascia lie side by side in a medial-lateral direction constituting the dissection plane for curative rectal cancer surgery, and the last three fasciae formed two spaces (Latzko's pararectal space and paravesical space) which were the surgical area for LLND. Laparoscopic LLND in two fascial spaces was performed successfully in all 20 patients. The median operating time, blood loss and postoperative hospitalization were 178 (152-243) min, 55 (25-150) mL and 10 (7-20) d, respectively. The median number of harvested LLNs was 8.6 (6-12), and pathologically positive LLN metastasis was confirmed in 7 (35.0%) cases. Postoperative complications included lower limb pain in 1 case and lymph leakage in 1 case.
CONCLUSION Our preliminary surgical experience suggests that laparoscopic LLND based on fascial spaces is a feasible, effective and safe procedure for treating LALRC.
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Affiliation(s)
- Hui-Hong Jiang
- Department of General Surgery, Yangpu Hospital, Tongji University School of Medicine, Shanghai 200090, China
- Institute of Gastrointestinal Surgery and Translational Medicine, Tongji University School of Medicine, Shanghai 200090, China
| | - Hai-Long Liu
- Department of General Surgery, Yangpu Hospital, Tongji University School of Medicine, Shanghai 200090, China
- Institute of Gastrointestinal Surgery and Translational Medicine, Tongji University School of Medicine, Shanghai 200090, China
| | - A-Jian Li
- Department of General Surgery, Yangpu Hospital, Tongji University School of Medicine, Shanghai 200090, China
| | - Wen-Chao Wang
- Department of General Surgery, Yangpu Hospital, Tongji University School of Medicine, Shanghai 200090, China
| | - Liang Lv
- Department of General Surgery, Yangpu Hospital, Tongji University School of Medicine, Shanghai 200090, China
| | - Jian Peng
- Department of General Surgery, Yangpu Hospital, Tongji University School of Medicine, Shanghai 200090, China
| | - Zhi-Hui Pan
- Department of General Surgery, Yangpu Hospital, Tongji University School of Medicine, Shanghai 200090, China
| | - Yi Chang
- Department of General Surgery, Yangpu Hospital, Tongji University School of Medicine, Shanghai 200090, China
- Institute of Gastrointestinal Surgery and Translational Medicine, Tongji University School of Medicine, Shanghai 200090, China
| | - Mou-Bin Lin
- Department of General Surgery, Yangpu Hospital, Tongji University School of Medicine, Shanghai 200090, China
- Institute of Gastrointestinal Surgery and Translational Medicine, Tongji University School of Medicine, Shanghai 200090, China
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14
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Fede C, Petrelli L, Guidolin D, Porzionato A, Pirri C, Fan C, De Caro R, Stecco C. Evidence of a new hidden neural network into deep fasciae. Sci Rep 2021; 11:12623. [PMID: 34135423 PMCID: PMC8209020 DOI: 10.1038/s41598-021-92194-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 05/31/2021] [Indexed: 12/20/2022] Open
Abstract
It is recognized that different fasciae have different type of innervation, but actually nothing is known about the specific innervation of the two types of deep fascia, aponeurotic and epymisial fascia. In this work the aponeurotic thoracolumbar fascia and the epymisial gluteal fascia of seven adult C57-BL mice were analysed by Transmission Electron Microscopy and floating immunohistochemistry with the aim to study the organization of nerve fibers, the presence of nerve corpuscles and the amount of autonomic innervation. The antibodies used were Anti-S100, Anti-Tyrosine Hydroxylase and Anti-PGP, specific for the Schwann cells forming myelin, the sympathetic nerve fibers, and the peripheral nerve fibers, respectively. The results showed that the fascial tissue is pervaded by a rhomboid and dense network of nerves. The innervation was statistically significantly lower in the gluteal fascia (2.78 ± 0.6% of positive area, 140.3 ± 31.6/mm2 branching points, nerves with 3.2 ± 0.6 mm length and 4.9 ± 0.2 µm thickness) with respect to the thoracolumbar fascia (9.01 ± 0.98% of innervated area, 500.9 ± 43.1 branching points/mm2, length of 87.1 ± 1.0 mm, thickness of 5.8 ± 0.2 µm). Both fasciae revealed the same density of autonomic nerve fibers (0.08%). Lastly, corpuscles were not found in thoracolumbar fascia. Based on these results, it is suggested that the two fasciae have different roles in proprioception and pain perception: the free nerve endings inside thoracolumbar fascia may function as proprioceptors, regulating the tensions coming from associated muscles and having a role in nonspecific low back pain, whereas the epymisial fasciae works to coordinate the actions of the various motor units of the underlying muscle.
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Affiliation(s)
- Caterina Fede
- Department of Neurosciences, Institute of Human Anatomy, University of Padua, Via A. Gabelli 65, 35121, Padova, Italy.
| | - Lucia Petrelli
- Department of Neurosciences, Institute of Human Anatomy, University of Padua, Via A. Gabelli 65, 35121, Padova, Italy
| | - Diego Guidolin
- Department of Neurosciences, Institute of Human Anatomy, University of Padua, Via A. Gabelli 65, 35121, Padova, Italy
| | - Andrea Porzionato
- Department of Neurosciences, Institute of Human Anatomy, University of Padua, Via A. Gabelli 65, 35121, Padova, Italy
| | - Carmelo Pirri
- Department of Neurosciences, Institute of Human Anatomy, University of Padua, Via A. Gabelli 65, 35121, Padova, Italy
| | - Chenglei Fan
- Department of Neurosciences, Institute of Human Anatomy, University of Padua, Via A. Gabelli 65, 35121, Padova, Italy
| | - Raffaele De Caro
- Department of Neurosciences, Institute of Human Anatomy, University of Padua, Via A. Gabelli 65, 35121, Padova, Italy
| | - Carla Stecco
- Department of Neurosciences, Institute of Human Anatomy, University of Padua, Via A. Gabelli 65, 35121, Padova, Italy
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15
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Buscemi A, Campisi SS, Frazzetto G, Petriliggieri J, Martino S, Ambramo P, Rapisarda A, Maldonato NM, Di Corrado D, Coco M. What Does the Body Communicate With Postural Oscillations? A Clinical Investigation Hypothesis. Front Psychol 2021; 12:668192. [PMID: 34220640 PMCID: PMC8241913 DOI: 10.3389/fpsyg.2021.668192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 05/13/2021] [Indexed: 11/13/2022] Open
Abstract
The evolution of the foot and the attainment of the bipedia represent a distinctive characteristic of the human species. The force of gravity is dissipated through the tibial astragalic joints, and the movement of the ankle is manifested on a sagittal plane. However, this is in contrast with other studies that analyze the straight station in bipodalic support of the body. According to these studies, the oscillations of the body dissipated by the articulation of the ankle are greater on a frontal plane than on a sagittal plane. Probably, this can be deduced by analyzing the concept of "cone of economy (COE) and equilibrium;" a cone that has its base with the oscillations described by the 360° movement performed by the head and has its apex that supports polygon defined by the tibio-astragalic articulation. The purpose of this study was to evaluate a kind of communication between the oscillations of the COE and equilibrium and the main sphere of somatic dysfunction (structural, visceral, or cranial sacral), assessing the reliability of the "fascial compression test." The implications of this connection have been considered, while grounding the hypothesis in the ability of the human body to maintain its center of mass (COM) with minimum energy expenditure and with minimum postural influence. At the same time, the fascial compression test provides a dominant direction of fascial compartments in restriction of mobility.
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Affiliation(s)
- Andrea Buscemi
- Department of Research, Italian Center Studies of Osteopathy, Catania, Italy
| | - Santi Scirè Campisi
- Department of Research, Italian Center Studies of Osteopathy, Catania, Italy
| | - Giulia Frazzetto
- Department of Research, Italian Center Studies of Osteopathy, Catania, Italy
| | | | - Simona Martino
- Department of Research, Italian Center Studies of Osteopathy, Catania, Italy
| | - Pierluca Ambramo
- Department of Research, Italian Center Studies of Osteopathy, Catania, Italy
| | | | - Nelson Mauro Maldonato
- Department of Neuroscience and Reproductive and Odontostomatological Sciences, University of Naples Federico II, Naples, Italy
| | | | - Marinella Coco
- Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy
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16
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Cabanas-Valdés R, Toro-Coll MD, Cruz-Sicilia S, García-Rueda L, Rodríguez-Rubio PR, Calvo-Sanz J. The Immediate Effect of Informational Manual Therapy for Improving Quiet Standing and Bodily Pain in University Population. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18094940. [PMID: 34066393 PMCID: PMC8124965 DOI: 10.3390/ijerph18094940] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 04/30/2021] [Accepted: 05/02/2021] [Indexed: 12/25/2022]
Abstract
Background: The Informational Manual Therapy (IMT) is a therapeutic touch. This study aims to assess the effect of IMT on quiet standing, pain and health status in university population. Methods: An experiment was conducted on subjects utilizing a comparative paired analysis both before and after the intervention. One IMT session was performed on 57 healthy individuals aged from 18 to 65 years. The primary outcome was quiet standing assessed by the Satel 40 Hz stabilometric force platform. Secondary outcomes were bodily pain assessed by the 36-Item Short Form Survey (SF-36) and health status by EQ-5D-3L. The primary outcome was evaluated before and immediately after treatment. Results: The individuals were divided into 3 age groups, 18–35 (52.6%), 35–50 (29.8%) and 51–65 (17.6%). Statistically significant differences were immediately observed after the session ended when comparing the pre-post quiet stance scores in a number of length parameters: L, Lx, Ly and stabilometry amplitude on Y-axis with eyes open and closed. Significant differences were also found when testing bodily pain (SF-36) and anxiety (5Q-5D-3L). Conclusion: One session of IMT produced positive effects when testing quiet standing with eyes open and eyes closed, as well as a significant reduction in pain and anxiety for those tested. Further research is suggested.
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Affiliation(s)
- Rosa Cabanas-Valdés
- Physiotherapy Department, Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, 08195 Sant Cugat del Vallés, Spain; (M.D.T.-C.); (L.G.-R.); (P.R.R.-R.)
- Correspondence:
| | - Mª Dolores Toro-Coll
- Physiotherapy Department, Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, 08195 Sant Cugat del Vallés, Spain; (M.D.T.-C.); (L.G.-R.); (P.R.R.-R.)
| | | | - Laura García-Rueda
- Physiotherapy Department, Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, 08195 Sant Cugat del Vallés, Spain; (M.D.T.-C.); (L.G.-R.); (P.R.R.-R.)
| | - Pere Ramón Rodríguez-Rubio
- Physiotherapy Department, Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, 08195 Sant Cugat del Vallés, Spain; (M.D.T.-C.); (L.G.-R.); (P.R.R.-R.)
| | - Jordi Calvo-Sanz
- Physiotherapy Department, School of Health Sciences, Tecno Campus, Mataró-Pompeu Fabra University (TCM-UPF), 08302 Barcelona, Spain;
- Hospital Asepeyo Sant Cugat del Vallès, 08174 Barcelona, Spain
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17
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Gastric equivalent of the 'Holy Plane' to standardize the surgical concept of stomach cancer to mesogastric excision: updating Jamieson and Dobson's historic schema. Gastric Cancer 2021; 24:273-282. [PMID: 33387120 DOI: 10.1007/s10120-020-01142-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 11/14/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Surgery for curable gastric cancer has historically involved dissection of lymph nodes, depending on the risk of metastasis. By establishing the concept of mesogastric excision (MGE), we aim to make this approach compatible with that for colorectal cancer, where the standard is excision of the mesentery. METHODS Current advances in molecular embryology, visceral anatomy, and surgical techniques were integrated to update Jamieson and Dobson's schema, a historical reference for the mesogastrium. RESULTS The mesogastrium develops with a three-dimensional movement, involving multiple fusions with surrounding structures (retroperitoneum or other mesenteries) and imbedding parenchymal organs (pancreas, liver, and spleen) that grow within the mesentery. Meanwhile, the fusion fascia and the investing fascia interface with adjacent structures of different embryological origin, which we consider to be equivalent to the 'Holy Plane' in rectal surgery emphasized by Heald in the concept of total mesorectal excision. Dissecting these fasciae allows for oncologic MGE, consisting of removing lymph node-containing mesenteric adipose tissue with an intact fascial package. MGE is theoretically compatible with its colorectal counterpart, although complete removal of the mesogastrium is not possible due to the need to spare imbedded vital organs. The celiac axis is treated as the central artery of the mesogastrium, but is peripherally ligated by tributaries flowing into the stomach to feed the spared organs. CONCLUSION The obscure contour of the mesogastrium can be clarified by thinking of it as the gastric equivalent of the 'Holy Plane'. MGE could be a standard concept for surgical treatment of stomach cancer.
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18
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A Closer Look at the Cellular and Molecular Components of the Deep/Muscular Fasciae. Int J Mol Sci 2021; 22:ijms22031411. [PMID: 33573365 PMCID: PMC7866861 DOI: 10.3390/ijms22031411] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 01/26/2021] [Accepted: 01/27/2021] [Indexed: 12/16/2022] Open
Abstract
The fascia can be defined as a dynamic highly complex connective tissue network composed of different types of cells embedded in the extracellular matrix and nervous fibers: each component plays a specific role in the fascial system changing and responding to stimuli in different ways. This review intends to discuss the various components of the fascia and their specific roles; this will be carried out in the effort to shed light on the mechanisms by which they affect the entire network and all body systems. A clear understanding of fascial anatomy from a microscopic viewpoint can further elucidate its physiological and pathological characteristics and facilitate the identification of appropriate treatment strategies.
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19
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Byrnes KG, Khan JSA, Haroon UM, McCawley N, Cheema IA. Management of colon-invading renal cell carcinoma: Operative technique and systematic review. Urol Ann 2021; 13:1-8. [PMID: 33897156 PMCID: PMC8052896 DOI: 10.4103/ua.ua_86_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 09/12/2020] [Indexed: 01/04/2023] Open
Abstract
Invasion into adjacent organs by non-metastatic renal cell carcinoma (RCC) occurs in 1% of patients suitable for resection. Colonic invasion is rare and presents technical challenges. No prospective data exists to guide management of these patients. We present the first reported case of a colon-invading RCC managed with simultaneous open right radical nephrectomy and extended right hemicolectomy. PubMed, Scopus and EMBASE databases were searched for relevant case reports reporting management of colon-invading renal cell carcinoma. Case reports, case series and cohort studies were eligible. A chart review was performed on a patient who presented with right-sided colon-invading RCC. Four previously reported cases were identified. The current case was managed with simultaneous open radical nephrectomy and extended right hemicolectomy. The patient remains well six months postoperatively with no evidence of disease recurrence. Histopathological evaluation of the resected specimen confirmed a T4 clear cell RCC with sarcomatoid differentiation. Colon-invading RCC is rare. This is the first reported case of right-sided, colon-invading RCC treated with radical resection. The current case confirms radical resection is a feasible management strategy for similar presentations. En bloc resection of involved organs remains the only potentially curative option for locally advanced disease.
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Affiliation(s)
| | | | | | - Niamh McCawley
- Department of Colorectal Surgery, Beaumont Hospital, Dublin, Ireland
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20
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Abstract
The fascial system is a link between the various body systems. Understanding the embryonic formation of the fascial system contributes to understanding the development of the whole body, helping to understand clinical phenomena. The text presents the concept of the fascial system and its interactions with the neural system. We describe the formation of musculoskeletal fascia from somites and mesenchymal cells of the cranial neural crest. Differences in the formation of the head, neck, trunk, and limbs and their respective embryonic relationships are presented. We detail the formation of visceral fascia and their corresponding innervations, from the tongue to the final portion of the digestive tract; the development of the genitourinary system that occurs later in the celomic cavity; and the formation of the cardiocirculatory and respiratory systems, with the development of their respective envelopes, associated with the corresponding innervation. The text covers the embryology of neural fasciae, both at the level of the central and peripheral nervous system. Finally, the development of derme and pannicular fascia is presented.
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Affiliation(s)
- Leonardo Vieira
- Osteopathy, Brazilian Academy of Fascias, Belo Horizonte, BRA
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21
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Magyar CTJ, Nebiker CA. Hernia after retroperitoneoscopic adrenalectomy, case report. Gland Surg 2020; 9:442-446. [PMID: 32420271 DOI: 10.21037/gs.2020.01.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
We report the first case of a previously undocumented complication after posterior retroperitoneal adrenalectomy (PRA). Extensive diagnostic procedures for persisting abdominal pain led to diagnosis of an incisional hernia (IH) approximately 2.5 years after surgery for a pheochromocytoma of the right adrenal gland. Thus, IHs need to be recognized as a potential complication after PRA, particularly if the symptoms are non-specific. The differential diagnosis of an IH after PRA includes a type of spontaneous lumbar hernia due to a pre-existing weakness of the abdominal wall however the treatment for both type of hernias is similar by mesh repair. A possible risk factor for IH after PRA might be obesity, due to different factors including difficulties in closing the fascia in depth under subcutaneous tissue.
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Affiliation(s)
- Christian T J Magyar
- Resident in Surgery, Klinik für Viszeralchirurgie, Kantonsspital Aarau, Aarau, Switzerland.,Consultant Surgeon, Klinik für Viszeralchirurgie, Kantonsspital Aarau, Aarau, Switzerland
| | - Christian A Nebiker
- Resident in Surgery, Klinik für Viszeralchirurgie, Kantonsspital Aarau, Aarau, Switzerland.,Consultant Surgeon, Klinik für Viszeralchirurgie, Kantonsspital Aarau, Aarau, Switzerland
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22
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Weber P, Graf C, Klingler W, Weber N, Schleip R. The feasibility and impact of instrument-assisted manual therapy (IAMT) for the lower back on the structural and functional properties of the lumbar area in female soccer players: a randomised, placebo-controlled pilot study design. Pilot Feasibility Stud 2020; 6:47. [PMID: 32322406 PMCID: PMC7164264 DOI: 10.1186/s40814-020-00592-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 04/02/2020] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Myofascial (self-)treatments, such as foam rollers to therapeutic instruments in manual therapy, are utilized increasingly in prevention and therapy in healthy people, athletes, and patients suffering from chronic back pain. However, there is limited knowledge about the effectiveness of treatment and the underlying mechanisms of myofascial therapies, especially for instrument-assisted manual therapy (IAMT). Therefore, this pilot study will investigate the feasibility and impact of IAMT for the lumbar area compared with heat application and placebo treatment as a basis for calculating the sample size for further full studies. The primary outcomes will be a critical analysis of the feasibility of the measurement protocol in terms of time economy and expressiveness and of the short- and long-term effects on shear motion of the single tissue layers of the lower back obtained through ultrasound imaging. Secondary outcomes will include thickness and compressibility of the lumbar structures and flexibility of the dorsal structures, indentometry, and superficial skin temperature. METHODS A minimum of 60 healthy, competitive 15-35-year-old female soccer players will be recruited and randomised into three groups. Short-term effects of IAMT on thoracolumbar structures will be compared with heat application and pressure-less placebo treatment. Long-term effects in the IAMT group will be tested after nine further interventions over a 5-week period (2×/week) and compared with the placebo group, which will not receive further treatments but will serve as a control. Intermediate and final testing of both groups will occur in weeks three and five. DISCUSSION This pilot study will assess the feasibility and the impact of IAMT for the lower back particularly by examining the structural and functional properties of myofascial tissue using diagnostic ultrasound. These outcomes could evaluate the feasibility of the measurements used, shall build a basis for sample size calculation of further full studies, and might generate a greater understanding of myofascial therapies, especially IAMT, for the lower back and its benefits. If this approach proves to be practicable, next steps will be further full studies with soccer players, other sports, and patients with low back pain. TRIAL REGISTRATION German Clinical Trials Register (DRKS00012252) 20.06.2018; retrospectively registered.
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Affiliation(s)
- Patrick Weber
- Department Movement and Health Promotion, German Sport University Cologne, Cologne, Germany
| | - Christine Graf
- Department Movement and Health Promotion, German Sport University Cologne, Cologne, Germany
| | - Werner Klingler
- Anaesthesiology, SRH Hospitals Sigmaringen, Sigmaringen, Germany
- Experimental Anaesthesiology, Ulm University, Germany, Ulm, Germany
- Clinical Sciences, Queensland University of Technology, Brisbane, Australia
| | - Nadine Weber
- Department Cardiology, Aachen University, Aachen, Germany
| | - Robert Schleip
- Conservative and Rehabilitative Orthopaedics, Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
- Sports Medicine and Health Promotion, Friedrich-Schiller University Jena, Jena, Germany
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23
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Abstract
The aim of the study was to obtain information on the sensory functions of the thoracolumbar fascia (TLF). The types of nerve fibres present in the TLF were visualized with specific antibodies to neuropeptides and sympathetic fibres. Most data were obtained from the TLF in rats, but some findings from the human fascia are also included. The only receptive nerve ending found was the free nerve ending, i.e. no corpuscular receptors existed in our specimen. An exclusive innervation with free nerve endings speaks for a nociceptive function, but the TLF may also fulfill proprioceptive functions, since many of the free nerve endings have a low mechanical threshold. Most of the fibres could be visualized with antibodies to CGRP [calcitonin gene- related peptide (CGRP)] and SP [substance P (SP)]. The latter ones most likely were nociceptors. The TLF contained a great proportion of postganglionic sympathetic fibres, which may be vasoconstrictors. A comparison between an inflamed and intact fascia showed an increase of the CGRP- and SP-positive fibres in the inflamed TLF. This finding could be one explanation for the low back pain of many patients, since practically all lesions of the fascia are accompanied by a sterile inflammation.
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Affiliation(s)
- Siegfried Mense
- Department of Neurophysiology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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24
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López-Fernández P, Murillo-González J, Arráez-Aybar LA, de la Cuadra-Blanco C, Moreno-Borreguero A, Mérida-Velasco JR. Early stages of development of the alar fascia (human specimens at 6-12 weeks of development). J Anat 2019; 235:1098-1104. [PMID: 31418466 DOI: 10.1111/joa.13074] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2019] [Indexed: 12/22/2022] Open
Abstract
In recent years, there has been much discussion concerning the cervical fasciae. The aim of this study is to confirm and to describe the development of the alar fascia as well as its relationship with nearby structures. Histological preparations of 25 human embryos (6-8 weeks of development) and 25 human fetuses (9-12 weeks of development) were studied bilaterally using a conventional optical microscope. Our study confirms the existence of the alar fascia and permits three stages to be established during its development. The initial stage (1st), corresponding to the 6th week of development (Carnegie stages 18-19), is characterized by the beginning of the alar fascia primordium in the retroesophageal space at the level of C7-T1. In the formation stage (2nd), corresponding to the 7th and 8th weeks of development (Carnegie stages 20-23), the alar fascia primordium grows upwards and reaches the level of C2-C3. In the maturation stage (3rd), beginning in the 9th week of development, the visceral, alar and prevertebral fasciae can be identified. The alar fascia divides the retrovisceral space (retropharyngeal and retroesophageal) into two spaces: one anterior (between the alar fascia and the visceral fascia and extending from C1 to T1, named retropharyngeal or retroesophageal space according to the level) and the other posterior (between the alar fascia and the prevertebral fascia, named danger space). We suggest that this latter space be named the retroalar space. This study suggests that alar fascia development is related to mechanical factors and that the alar fascia permits the sliding of the pharynx and the oesophagus during swallowing.
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Affiliation(s)
- Pedro López-Fernández
- Division of Human Anatomy and Embryology, Department of Basic Health Sciences, Rey Juan Carlos University, Madrid, Spain.,Department of Surgery, University Hospital Rey Juan Carlos, Madrid, Spain
| | - Jorge Murillo-González
- Faculty of Medicine, Department of Human Anatomy and Embryology, Complutense University of Madrid, Madrid, Spain
| | - Luis Alfonso Arráez-Aybar
- Faculty of Medicine, Department of Human Anatomy and Embryology, Complutense University of Madrid, Madrid, Spain
| | - Crótida de la Cuadra-Blanco
- Faculty of Medicine, Department of Human Anatomy and Embryology, Complutense University of Madrid, Madrid, Spain
| | - Alicia Moreno-Borreguero
- Department of Nutrition and Endocrinology, University Hospital of Fuenlabrada, Rey Juan Carlos University, Madrid, Spain
| | - José Ramón Mérida-Velasco
- Faculty of Medicine, Department of Human Anatomy and Embryology, Complutense University of Madrid, Madrid, Spain
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25
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Byrnes KG, Walsh D, Dockery P, McDermott K, Coffey JC. Anatomy of the mesentery: Current understanding and mechanisms of attachment. Semin Cell Dev Biol 2019; 92:12-17. [DOI: 10.1016/j.semcdb.2018.10.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 10/10/2018] [Indexed: 01/10/2023]
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26
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Wang Y, Zhu L, Xia W, Wang F. Anatomy of lymphatic drainage of the esophagus and lymph node metastasis of thoracic esophageal cancer. Cancer Manag Res 2018; 10:6295-6303. [PMID: 30568491 PMCID: PMC6267772 DOI: 10.2147/cmar.s182436] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The lymphatic drainage of the inner layers (mucosa and submucosa) and the outer layers (muscularispropria and adventitia) of the thoracic esophagus is different. Longitudinal lymphatic vessels and long drainage territory in the submucosa and lamina propria should be the bases for bidirectional drainage and direct drainage to thoracic duct and extramural lymph nodes (LN). The submucosal vessels for direct extramural drainage are usually thick while lymphatic communication between the submucosa and intermuscular area is usually not clearly found, which does not facilitate transversal drainage to paraesophageal LN from submucosa. The right paratracheal lymphatic chain (PLC) is well developed while the left PLC is poorly developed. Direct drainage to the right recurrent laryngeal nerve LN and subcarinal LN from submucosa has been verified. Clinical data show that lymph node metastasis (LNM) is frequently present in the lower neck, upper mediastinum, and perigastric area, even for early-stage thoracic esophageal cancer (EC). The lymph node metastasis rate (LNMR) varies mainly according to the tumor location and depth of tumor invasion. However, there are some crucial LN for extramural relay which have a high LNMR, such as cervical paraesophageal LN, recurrent laryngeal nerve LN, subcarinal LN, LN along the left gastric artery, lesser curvature LN, and paracardial LN. Metastasis of thoracic paraesophageal LN seems to be a sign of more advanced EC. This review gives us a better understanding about the LNM and provides more information for treatments of thoracic EC.
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Affiliation(s)
- Yichun Wang
- Department of Radiation Oncology, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui, P.R. China, ;
| | - Liyang Zhu
- Department of Radiation Oncology, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui, P.R. China, ;
| | - Wanli Xia
- Department of Thoracic Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui, P.R. China
| | - Fan Wang
- Department of Radiation Oncology, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui, P.R. China, ;
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27
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Bordoni B, Marelli F, Morabito B, Castagna R. Chest pain in patients with COPD: the fascia's subtle silence. Int J Chron Obstruct Pulmon Dis 2018; 13:1157-1165. [PMID: 29695899 PMCID: PMC5903840 DOI: 10.2147/copd.s156729] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
COPD is a progressive condition that leads to a pathological degeneration of the respiratory system. It represents one of the most important causes of mortality and morbidity in the world, and it is characterized by the presence of many associated comorbidities. Recent studies emphasize the thoracic area as one of the areas of the body concerned by the presence of pain with percentages between 22% and 54% in patients with COPD. This article analyzes the possible causes of mediastinal pain, including those less frequently taken into consideration, which concern the role of the fascial system of the mediastinum. The latter can be a source of pain especially when a chronic pathology is altering the structure of the connective tissue. We conclude that to consider the fascia in daily clinical activity may improve the therapeutic approach toward the patient.
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Affiliation(s)
- Bruno Bordoni
- Foundation Don Carlo Gnocchi IRCCS, Department of Cardiology, Institute of Hospitalization and Care with Scientific Address, Milan, Italy
| | - Fabiola Marelli
- CRESO, School of Osteopathic Centre for Research and Studies, Gorla Minore, Italy
- CRESO, School of Osteopathic Centre for Research and Studies, Fano, Italy
| | - Bruno Morabito
- CRESO, School of Osteopathic Centre for Research and Studies, Gorla Minore, Italy
- CRESO, School of Osteopathic Centre for Research and Studies, Fano, Italy
- Department of Radiological, Oncological and Anatomopathological Sciences, Sapienza University of Rome, Rome, Italy
| | - Roberto Castagna
- CRESO, School of Osteopathic Centre for Research and Studies, Gorla Minore, Italy
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Early Intervention and Nonpharmacological Therapy of Myopia in Young Adults. J Ophthalmol 2018; 2018:4680603. [PMID: 29576878 PMCID: PMC5822817 DOI: 10.1155/2018/4680603] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2017] [Accepted: 12/13/2017] [Indexed: 02/08/2023] Open
Abstract
Myopia is a condition of the eye where parallel rays focus in front of, instead of on, the retina, which results in excessive refractive power of the cornea or the lens or eyeball elongation. Studies carried out in recent years show that the etiology of myopia is complex with genetic and environmental factors playing a role. Refraction defects decrease the quality of vision, while progressing myopia can lead to partial loss of vision, which can be particularly dramatic in young adults. Therefore, it is so crucial to take appropriate actions aimed at preventing myopia progression. This is a review of nonpharmacological therapeutic possibilities of refraction defect prevention in young adults, with special regard to myofascial therapy, osteopathy, and massage of acupuncture points surrounding the eye.
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29
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Bordoni B, Marelli F, Morabito B, Sacconi B, Caiazzo P, Castagna R. Low back pain and gastroesophageal reflux in patients with COPD: the disease in the breath. Int J Chron Obstruct Pulmon Dis 2018; 13:325-334. [PMID: 29403270 PMCID: PMC5777378 DOI: 10.2147/copd.s150401] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
COPD is a worsening condition that leads to a pathologic degeneration of the respiratory system. It represents one of the most important causes of mortality and morbidity in the world, and it is characterized by the presence of associated comorbidity. This article analyzes gastroesophageal reflux disease (GERD) and low back pain (LBP) in patients with COPD and tries to produce anatomo-clinical considerations on the reasons of the presence of these comorbidities. The considerations of the authors are based on the anatomic functions and characteristics of the respiratory diaphragm that are not always considered, from which elements useful to comprehend the symptomatic status of the patient can be deduced, finally improving the therapeutic approach. The information contained in the article can be of help to the clinician and for physiotherapy, and to all health professionals who gravitate around the patient’s care, improving the approach to the diaphragm muscle.
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Affiliation(s)
- Bruno Bordoni
- Foundation Don Carlo Gnocchi IRCCS, Department of Cardiology, Scientific Institute of Hospitalization and Care, Milan
| | - Fabiola Marelli
- Department of Fascial Osteopathic Research, CRESO, School of Osteopathic Centre for Research and Studies, Gorla Minore.,Department of Fascial Osteopathic Research, CRESO, School of Osteopathic Centre for Research and Studies, Fano
| | - Bruno Morabito
- Department of Fascial Osteopathic Research, CRESO, School of Osteopathic Centre for Research and Studies, Gorla Minore.,Department of Fascial Osteopathic Research, CRESO, School of Osteopathic Centre for Research and Studies, Fano
| | - Beatrice Sacconi
- Department of Radiological, Oncological and Anatomopathological Sciences, Sapienza University of Rome.,Department of Radiological, Oncological and Anatomopathological Sciences, Center for Life Nano Science@Sapienza, Istituto Italiano di Tecnologia, Rome
| | - Philippe Caiazzo
- Department of Osteopathic Research, AITOP, Italian Academy of Postural Osteopathic Therapy, Levizzano Rangone - Castelvetro, Italy
| | - Roberto Castagna
- Department of Fascial Osteopathic Research, CRESO, School of Osteopathic Centre for Research and Studies, Gorla Minore
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30
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Struller F, Weinreich FJ, Horvath P, Kokkalis MK, Beckert S, Königsrainer A, Reymond MA. Peritoneal innervation: embryology and functional anatomy. Pleura Peritoneum 2017; 2:153-161. [PMID: 30911646 DOI: 10.1515/pp-2017-0024] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 11/03/2017] [Indexed: 12/14/2022] Open
Abstract
The parietal peritoneum (PP) is innervated by somatic and visceral afferent nerves. PP receives sensitive branches from the lower intercostal nerves and from the upper lumbar nerves. Microscopically, a dense network of unmyelinated and myelinated nerve fibers can be found all over the PP. The unmyelinated fibers are thin and are ending just underneath the PP. The myelinated fibers can penetrate the PP to reach the peritoneal cavity, where they lose their myelin sheath and are exposed to somatic and nociceptive stimuli. PP is sensitive to pain, pressure, touch, friction, cutting and temperature. Noxious stimuli are perceived as a localized, sharp pain. The visceral peritoneum (VP) itself is not innervated, but the sub-mesothelial tissue is innervated by the autonomous nerve system. In contrast to the PP, the visceral submesothelium also receives fibers from the vagal nerve, in addition to the spinal nerves. VP responds primarily to traction and pressure; not to cutting, burning or electrostimulation. Painful stimuli of the VP are poorly localized and dull. Pain in a foregut structure (stomach, duodenum or biliary tract) is referred to the epigastric region, pain in a midgut structure (appendix, jejunum, or ileum) to the periumbilical area and pain from a hindgut source (distal colon or rectum) is referred to the lower abdomen or suprapubic region. Peritoneal adhesions can contain nerve endings. Neurotransmitters are acetylcholine, VIP, serotonin, NO, encephalins, CGRP and substance P. Chronic peritoneal pain can be exacerbated by neurogenic inflammation, e.g. by endometriosis.
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Affiliation(s)
- Florian Struller
- Department of General and Transplant Surgery, University Hospital Tübingen, Tübingen, Germany.,National Centre for Pleura and Peritoneum, University of Tübingen, Tübingen, Germany
| | - Frank-Jürgen Weinreich
- Department of General and Transplant Surgery, University Hospital Tübingen, Tübingen, Germany.,National Centre for Pleura and Peritoneum, University of Tübingen, Tübingen, Germany
| | - Philipp Horvath
- Department of General and Transplant Surgery, University Hospital Tübingen, Tübingen, Germany.,National Centre for Pleura and Peritoneum, University of Tübingen, Tübingen, Germany
| | - Marios-Konstantinos Kokkalis
- Department of General and Transplant Surgery, University Hospital Tübingen, Tübingen, Germany.,National Centre for Pleura and Peritoneum, University of Tübingen, Tübingen, Germany
| | - Stefan Beckert
- Department of General and Transplant Surgery, University Hospital Tübingen, Tübingen, Germany.,National Centre for Pleura and Peritoneum, University of Tübingen, Tübingen, Germany
| | - Alfred Königsrainer
- Department of General and Transplant Surgery, University Hospital Tübingen, Tübingen, Germany.,National Centre for Pleura and Peritoneum, University of Tübingen, Tübingen, Germany
| | - Marc A Reymond
- Department of General and Transplant Surgery, University Hospital Tübingen, Tübingen, Germany.,National Centre for Pleura and Peritoneum, University of Tübingen, Tübingen, Germany
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