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Background: Local high-frequency percussive (HFP) massage has recently found widespread application in physical therapy. Although HFP massage reportedly improves range of motion (ROM), the mechanism underlying its action has not yet been proven. This study aimed to clarify whether a 5-minute percussive massage regimen affects muscular or connective tissues, such as the deep fascia and deep intermuscular fascia and the change in joint ROM. Method: The study sample was calculated using G*Power analysis program, and this study enrolled 15 healthy men who underwent 5-minute HFP massage to the medial gastrocnemius muscle. Shear-wave elastography was used to measure tissue stiffness in the deep fascia, muscle, and deep intermuscular fascia through shear-wave velocity as well as the ROM of the volunteers' ankle joint dorsiflexion before and after the HFP massage. A value of P < .05 was used to declare statistical significance, and post hoc was used to calculate the effect size using G*Power. Results: Shear-wave velocity revealed a significant change in the deep fascia (P = .003; shear-wave velocity: -0.7 m/s) and significant increase in ROM of ankle dorsiflexion (P = .002; increase in ROM: 3.0°) after 5 minutes of HFP massage. However, the muscle and deep intermuscular fascia did not exhibit any significant changes. Conclusions: HFP massage for 5 minutes modified the stiffness of the deep fascia and concurrently improved the ankle joint-dorsiflexion ROM. This method can be used as an intervention to decrease stiffness of the deep fascia and increase the ROM efficiently. [ABSTRACT FROM AUTHOR]

Background: Low-intensity resistance exercise therapy (LIRET) based on myofascial chains, applied to both affected and nonlocal joints, is an effective method for knee osteoarthritis (OA) rehabilitation. This study applied LIRET in a comparison of prevalues and postvalues of lower-limb tension in female patients with knee OA and asymptomatic participants. Methods: Twenty-four female participants with knee OA and 20 asymptomatic women took part in a 3-month long application of LIRET. Participants' ankle passive torque and ankle range of motion in the sagittal plane were assessed with an isokinetic dynamometer. The collected values were used to estimate the sagittal-plane lower-limb tension. Results: Compared with the asymptomatic group, participants with knee OA presented decreased maximum ankle dorsiflexion (P <.001), decreased ankle plantar flexion range (P =.023), ankle resting position more inclined to dorsiflexion (P =.017), increased ankle dorsiflexion stiffness (P =.005), and lower ankle plantar flexion stiffness (P =.034). After exercise intervention, the knee OA group self-reported less knee pain (P <.001), improved physical function (P <.001), increased maximum dorsiflexion (P =.021), and increased plantar flexion range (P <.001). While plantar flexion stiffness increased (P =.037), dorsiflexion stiffness decreased (P =.015) and ankle resting position moved toward dorsiflexion (P =.002). Results suggest possible decreased anterior leg tension and possible increased posterior leg tension in patients with knee OA. Conclusions: The results supported that knee OA patients present imbalanced myofascial tension of lower limbs. LIRET based on myofascial chains appears to decrease pain, and stiffness, and improve physical function of patients with knee OA and change their lower-limb tension. [ABSTRACT FROM AUTHOR]

Background: Chronic non-specific low back pain (CNSLBP) is prevalent among firefighters and may negatively affect their job performance. Alterations in the thoracolumbar fascia (TLF) structure are associated with CNSLBP. Percussive massage therapy (PT) has demonstrated potential in modifying fascial properties and alleviating pain. However, its effects on TLF structure in CNSLBP patients have not been thoroughly investigated. This study evaluates the effects of 6 weeks of PT on TLF echo intensity, thickness, pain, and disability in firefighters with CNSLBP, utilizing ultrasound imaging as a primary assessment tool. Methods: This six-week randomized controlled trial involved 38 firefighters with CNSLBP. Participants were randomly assigned 1:1 to either the PT group (receiving PT and core stability exercise) or the control group (receiving only core stability exercise). TLF echo intensity and thickness were measured using ultrasound imaging, and disability was assessed using the Roland-Morris Disability Questionnaire (RMQ) at baseline and post-intervention. Pain was measured using the Visual Analog Scale (VAS) at baseline, immediately after the first intervention, three weeks post-intervention, and post-intervention. Paired t-tests were conducted to analyze within-group changes in RMQ and ultrasound data, while ANCOVA was used to assess between-group differences, and repeated measures ANOVA for VAS scores. Results: Participants in the PT and control groups were aged 26.6±4.1 and 23.6±1.7 years, respectively, with BMI of 23.1±1.8 and 21.8±1.2 kg/m². The PT group showed significant reductions in bilateral TLF echo intensity post-intervention (left side: mean difference -6.4, 95% CI -9.7 to -3.1, p < 0.001, effect size 0.67; right side: mean difference -7.6, 95% CI -11.8 to -3.3, p < 0.01, effect size 0.60). Changes in TLF thickness were not statistically significant (p > 0.05). The PT group demonstrated significantly lower VAS scores than the control group (mean difference - 0.626, 95% CI -1.087 to -0.165, p = 0.009, effect size 0.63). RMQ scores decreased by -1.3 (95% CI -2.1 to -0.4, p < 0.01, effect size 0.5). Conclusion: Six weeks of percussive massage therapy significantly reduced thoracolumbar fascia echo intensity, alleviated pain, and improved functional disability in firefighters with chronic non-specific low back pain, but was not effective in altering fascia thickness. Percussive massage therapy emerges as an effective and safe strategy for managing chronic non-specific low back pain in firefighters. Trial registration: Retrospectively registered in Thai Clinical Trials Registry (TCTR20221223001) on December 22, 2022. [ABSTRACT FROM AUTHOR]

The fascial system has gained recognition for its integral role in connecting skin, superficial and deep fasciae, and underlying muscles. However, consensus on its microstructure depending on its topography remains elusive as well as its implications in clinical practices, such as reconstructive surgery and physiotherapy techniques. This study focuses on the iliotibial tract (ITT) implicated in the iliotibial band syndrome. The goal is to describe microstructural characteristics using classical 2D histology and cryogenic contrast‐enhanced microcomputed tomography (cryo‐CECT) such as the total thickness, number of layers, layer thickness, fibre orientation and tortuosity, according to the specific topography. The total thickness of the ITT varied across topographic regions, with the superior part being on average thicker but non‐significantly different from the other regions. The inferior part showed heterogeneity, with the anterior region (AI) being the thinnest and the posterior one (PI) the thickest. The ITT exhibited 1–3 layers, with no significant differences among regions. Most commonly, it consisted of two layers, except for the antero‐superior (AS) and antero‐middle (AM) regions, which sometimes had only one layer. The posterior regions frequently had 2 or 3 layers, with the PI region having the highest mean (2.7 layers). The intermediate layer was the thickest one, varying from the AI region (0.368 mm ± 0.114) to the PI region (0.640 mm ± 0.305). The superficial layer showed regional variability, with the AS region being the thinnest. The deep layer appeared thinner than the superficial one. Fibre orientation analysis indicated that the intermediate layer mainly consisted of oblique longitudinal fibres, orientated downward and forward, while the superficial and deep layers had transversal or oblique transversal fibres. Cryo‐CECT 3D observations confirmed these findings, revealing distinct orientations for different layers. Fibre tortuosity exhibited differences based on orientation. Transversal fibres (>65°) were significantly less tortuous than longitudinal fibres (<25°) and oblique intermediate fibres (25°–65°), aligning with 3D plot observations. This quantitative study highlights various microstructural characteristics of the ITT, offering insights into its regional variations. The analysis accuracy is increased due to the novel technology of cryo‐CECT which emerges as a valuable tool for precise assessment of 3D fibre orientation and tortuosity. These findings contribute to a deeper understanding of the ITT structure, useful in clinical practices, such as reconstructive surgery and physiotherapy, and future research endeavours. [ABSTRACT FROM AUTHOR]

Musculoskeletal infections in the ER are not an uncommon presentation. The clinical context is critical in determining the suspicion for infection and degree of tissue involvement which can involve all layers from the skin to bones. The location, extent, and severity of clinically suspected infection directly relate to the type of imaging performed. Uncomplicated cellulitis typically does not require any imaging. Localized and superficial infections can mostly be evaluated with ultrasound. If there is a diffuse site (an entire extremity) or suspected deeper involvement (muscle/deep fascia), then CT is accurate in diagnosing, widely available, and performed quickly. With potential osseous involvement, MRI is the gold standard for diagnosing acute osteomyelitis; however, it has the drawbacks of longer scan times, artifacts including patient motion, and limited availability. [ABSTRACT FROM AUTHOR]

Background: Given the growing concerns regarding objective measures of clinical outcomes, attention has recently been devoted to the establishment of clinically significant outcome (CSO) thresholds for patient-reported functional scores after rotator cuff surgery. Purpose: To retrospectively compare patient-reported outcome (PRO) measures (PROMs) and radiographic data between patients who underwent arthroscopic superior capsular reconstruction (SCR) with and without long head of the biceps tendon (LHBT) augmentation. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 43 patients receiving arthroscopic SCR between 2016 and 2020 were enrolled, including a biceps augmentation group (n = 27) and a nonaugmentation group (n = 16). Patients were asked an anchor question regarding their satisfaction and perception of improvements. PROMs of American Shoulder and Elbow Surgeons (ASES), Constant score, Single Assessment Numeric Evaluation (SANE), and visual analog scale (VAS) for pain scores and radiographic data including magnetic resonance imaging and plain radiographs were collected and compared between the 2 groups. Anchor questions in CSO analysis for deriving the minimal clinically importance difference (MCID), substantial clinical benefit (SCB), Patient Acceptable Symptom State (PASS), and maximal outcome improvement (MOI) values were applied ≥2 years postoperatively. Results: Based on satisfaction responses, 17 patients were classified as satisfied, 16 as unsatisfied, and 10 as fair. Additionally, 13 patients felt they were improved, 14 changed, and 16 unchanged. Intergroup comparison based on patients' satisfaction and perception of change or improvement exhibited significant differences in all 4 functional scores in favor of the satisfied and improved patients. However, there was no significant difference in the ΔVAS scores between the groups. CSO analyses showed no significant difference in percentage of patients achieving MCID, SCB, and PASS thresholds for the ΔASES, ΔConstant, and ΔSANE scores between patients undergoing arthroscopic SCR with or without LHBT augmentation. A significant difference was found in the percentage of patients achieving the MOI for ΔASES score with 70.4% in the augmented group and 37.5% in the nonaugmented group, respectively. The mean acromiohumeral distance (AHD) differed significantly between augmentation (8.1 ± 2.2 mm) and nonaugmentation (7 ± 1.9 mm) groups. The graft tear rate did not differ significantly. Conclusion: There was no significant difference in PROs and percentage of patients achieving MCID, SCB, and PASS between isolated and augmented SCR groups. A higher percentage of patients achieving MOI and slightly greater AHD were found in the augmented group. Further evaluation is required to determine if there is any long-term benefit to LHBT augmentation of SCR. [ABSTRACT FROM AUTHOR]

Studies on the muscular-deep fascial system which connects the upper eyelid, brow, and glabella, are lacking. This study aimed to explore the fine anatomy of the muscular-deep fascial system in the region between the eyebrow and the superior orbital margin. We included eight formalin–phenol-embalmed cadavers (16 sides of specimens), and categorized them into anatomical dissections and histological sections. Five cadavers (10 sides) were dissected for gross anatomical observation, whereas all soft tissues of the other three cadavers (6 sides) were dissected for tissue sectioning and histological analysis. Three tissue blocks and 16 strips in each block were trimmed, numbered, and sliced into these specimens. Hematoxylin–Eosin and Masson's Trichrome staining were performed. In the region between the eyebrow and the superior orbital margin, the frontalis was covered by the orbicularis oculi. Fibers of the frontalis muscle penetrated into the orbicularis oculi muscle bundles, and crosslinked around the eyebrow level. Both the frontalis and the orbicularis oculi were attached to the thickened multilayered deep fascia in this region, which could be regarded as the muscular-deep fascial system. The muscular-deep fascial system connects the frontalis deep fascia and deep forehead compartments down to the orbicularis-supporting ligament. The precise anatomy of the muscular-deep fascial system in the region between the eyebrow and the superior orbital margin may provide a valuable reference for soft-tissue fixation and suspension in facial surgery. [ABSTRACT FROM AUTHOR]

Introduction: The rupture of the plantar fascia is a rare but significant injury that predominantly affects athletes and individuals engaged in high-impact activities. Sudden increases in physical activity, direct trauma, corticosteroid injections, and chronic degeneration from plantar fasciitis can predispose individuals to rupture. It can involve a complete or partial tear of the plantar fascia fibers, leading to a loss of structural integrity and functional support. The tear may occur at the origin, mid-portion, or insertion of the fascia. Spontaneous ruptures of the plantar fascia (occurring without any predisposing factors) are rarely observed in clinical practice. No guidelines or other unequivocal recommendations are available for this pathological condition. Method: A healthy 35-year-old male who works in an office setting and is a recreational cyclist with a silent clinical anamnesis experienced a spontaneous rupture of the plantar fascia of the left foot with no history of trauma. He exhibited significant localized tenderness and swelling in the medial arch of the left foot with difficulty bearing weight on the affected foot. An MRI confirmed a partial rupture of the medial cord of the plantar fascia accompanied by surrounding inflammation. The patient underwent conservative treatment, which included rest, immobilization, physiotherapy (ultrasound therapy, high-power laser therapy, and transcutaneous electrical nerve stimulation), rehabilitation, and a gradual return to activity. Results: At the 12-week follow-up, the patient reported a significant reduction in pain and marked improvement in functional mobility (as confirmed by VAS and Foot Function Index scores). Physical examination showed no tenderness, and the patient could bear full weight on the foot without discomfort. A follow-up ultrasound demonstrated complete resolution of the plantar fascia rupture and no residual inflammation. Discussion: This case underscores the effectiveness of an integrated rehabilitative approach and provides a framework for managing similar cases in clinical practice. [ABSTRACT FROM AUTHOR]

Background • Thoracolumbar fascia (TLF) is crucial for stabilization and load distribution. Individuals with non-specific low back pain (NSLBP) and hyperlordosis present with trigger points (TrPs) and tight TLF. Instrument-assisted percussion therapy (IAPT) is a form of vibration therapy used for the release of fascia. However, the effect of IAPT has not been well understood on TrPs in TLF and its effect on posture. Primary Study Objective • To determine the effect of IAPT on hyperlordotic posture, pelvic inclination, TrPs, and disability in NSLBP. Another aim was to evaluate the tangible effect of IAPT on TrPs. Methods/Design • Double-blinded placebo-controlled trial conducted on NSLBP patients with lumbar hyperlordosis. Participants • Thirty-two participants with NSLBP were randomly allocated into IAPT and placebo groups. Intervention • The Interventional group (n = 16) underwent IAPT and the placebo group (n = 16) underwent sham IAPT along with interferential therapy (IFT) and cryotherapy for alternate days over two weeks. Primary Outcome Measures • Pre- and post-intervention (2 weeks) both the groups were evaluated for TrPs using a pressure algometer, diagnostic USG to assess dimensions of TrPs on TLF, Index of lumbar lordosis (ILL), Lumbar lordosis curve (LLC) using flexicurve, pelvic tilt (PT) angle using bubble inclinometer, and Modified Oswestry Disability Index (MODI). Results • Upon between-group comparison, for PT (P = .0009), ILL (P = .0001), LLC (P = .0033), length (P = .0007), and breadth of TrPs (P = .0004), the improvements were significantly better in IAPT group than the control group except for PPT (P = .2834) and MODI (P = .0135) where both the groups were equally effective. Conclusion • IAPT is an effective method of releasing TrPs and correcting hyperlordotic lumbar and pelvic posture in individuals with NSLBP. Further, the study created confirmatory evidence that IAPT is effective for treating TrPs and is not merely a placebo effect. [ABSTRACT FROM AUTHOR]

Background: This study aims to delineate anatomical landmarks crucial for complete mesocolic excision, focusing on Gerota's fascia, which guides surgical dissection in right-sided colon cancer, forming the posterior limit. Employing a multimodal approach, the research aims to understand the fascial anatomy and its variations under pathological conditions. Methods: Three methods were applied: a pilot dissection on an embalmed cadaver for clear anatomical presentation of prerenal fascia, Mimics segmentation of the fascia and its relationship with the colon, and a retrospective analysis of MDCTA scans from 196 patients (mean age 65.73 y, 118 F/78 M). Systematic measurements of fascial thickness were taken at key renal levels—upper pole, hilum, lower pole, and infra-renal. Covariates analyzed included Body Mass Index, age, and sex. Results: The pilot dissection revealed the renal fascia of Gerota as the only true retrocolic compact connective tissue and the fusion fascia of Toldt as a mesh of strands of loose connective tissue and fat lobules. MDCTA showed clearer visualization of Gerota's fascia at the hilum and inferior renal pole, predominantly on the left. There were significant differences in fascial thickness between sides (1.30 mm on the right and 1.34 mm on the left) and a positive correlation with BMI, whereas age and sex showed no significant effects. Conclusion: Gerota's fascia is a critical anatomical landmark in CME for right colon cancer. This study highlights the fascia's structural integrity, unaffected by the tumor, underscoring its importance in surgical navigation. [ABSTRACT FROM AUTHOR]

Context: The concept of anatomical fascial trains and myofascial release are heavily researched topics independently. However, few studies have determined if myofascial release of remote areas can cause lengthening throughout more distal aspects of these fascial trains. Clinical Question: In healthy individuals, what is the effect of myofascial release on the plantar aspect of the foot in improving flexibility and hamstring length as determined by a sit-and-reach test? Clinical Bottom Line: The usage of myofascial release on the plantar aspect of the foot via a firm object has been shown to improve sit-and-reach distance. Each article included for analysis utilized similar methods of instructing self-myofascial release with regard to time as well as type of object used for the intervention. Though this was consistent between studies, the authors should have implemented secondary outcome measures. Despite the limitations to each of the studies analyzed, there is a Strength of Recommendation Taxonomy (SORT) Level B evidence to support the implementation self-myofascial release to the plantar fascia. This intervention should be considered a concurrent option for individuals with range of motion deficits or fascial restrictions in the upper thigh. [ABSTRACT FROM AUTHOR]

Purpose: Manual reconstruction (MR) of the vastus lateralis (VL) muscle cross-sectional area (CSA) from sequential ultrasound (US) images is accessible, is reproducible, and has concurrent validity with magnetic resonance imaging. However, this technique requires numerous controls and procedures during image acquisition and reconstruction, making it laborious and time-consuming. The aim of this study was to determine the concurrent validity of VL CSA assessments between MR and computer vision--based automated reconstruction (AR) of CSA from sequential images of the VL obtained by US. Methods: The images from each sequence were manually rotated to align the fascia between images and thus visualize the VL CSA. For the AR, an artificial neural network model was utilized to segment areas of interest in the image, such as skin, fascia, deep aponeurosis, and femur. This segmentation was crucial to impose necessary constraints for the main assembly phase. At this stage, an image registration application, combined with differential evolution, was employed to achieve appropriate adjustments between the images. Next, the VL CSA obtained from the MR (n = 488) and AR (n = 488) techniques was used to determine their concurrent validity. Results: Our findings demonstrated a low coefficient of variation (CV) (1.51%) for AR compared with MR. The Bland--Altman plot showed low bias and close limits of agreement (+1.18 cm², -1.19 cm²), containing more than 95% of the data points. Conclusions: The AR technique is valid compared with MR when measuring VL CSA in a heterogeneous sample. [ABSTRACT FROM AUTHOR]

Background: Biomaterials and surgical techniques for reconstructive tympanic membrane surgery are under development. Objectives: The objective of this study is to analyze the functional and surgical outcomes of a novel fascia with cartilage reinforcement technique for anterior tympanic membrane perforation in tympanoplasty. Methods: Records of 198 patients with anterior tympanic membrane perforation who underwent tympanoplasty between August 2018 and March 2021 were prospectively reviewed. Patients with dry anterior quadrant perforations of the tympanic membrane were included and underwent tympanoplasty using two methods: Type 1 tympanoplasty with temporalis fascia only, and tympanoplasty with fascia and cartilage reinforcement. Postoperative functional and surgical outcomes were analyzed. Results: Comparing the pre-operative and post-operative air conduction levels and air-bone gaps showed significant improvement in both groups (P < 0.001). Additionally, no significant difference was observed between air-bone gap closure (P = 0.316) and increase in air conduction levels (P = 0.222) according to graft type. Conclusions: Both temporalis muscle fascia and temporalis muscle fascia with cartilage reinforcement revealed satisfactory functional and surgical outcomes. Furthermore, the novel combined cartilage-fascia technique had a comparable graft take rate and hearing results in anterior perforations, with no significant change in tympanic membrane vibratory properties. [ABSTRACT FROM AUTHOR]

Aim: The internet and social media are becoming integral to our lives today. YouTube was founded in 2005 and can be helpful in health matters by providing quick and easy access to medical information. However, the reliability of medical videos on YouTube could be improved. Many videos on YouTube about interfascial plane blocks are widely used for analgesic purposes in anesthesia practice. In order to avoid causing incorrect and incomplete information and to prevent information pollution, interfascial plan block videos on YouTube should be examined. Therefore, this study evaluated the educational content and preparation quality of the interfascial plan block videos on YouTube. Material and Method: Educational videos of eight different interfascial plane block types on YouTube were evaluated using two surveys. Each survey consists of 14 questions. Each question receives a score between 0 and 5. Each video receives a total score between 0 and 70 for each survey. Material and Method: Educational videos of eight different interfascial plane block types on YouTube were evaluated using two surveys. Each survey consists of 14 questions. Each question receives a score between 0 and 5. Each video receives a total score between 0 and 70 for each survey. Conclusion: Although YouTube contains medical training videos, their reliability is questioned. Therefore, it is more accurate and reliable for researchers to obtain medical information from reliable sources, academic articles, or publications of official medical institutions. [ABSTRACT FROM AUTHOR]

Neurology and connective tissue are intimately interdependent systems and are critical in regulating many of the body’s systems. Unlocking their multifaceted relationship can transform clinical understanding of the mechanisms involved in multisystemic regulation and dysregulation. The fascial system is highly innervated and rich with blood vessels, lymphatics, and hormonal and neurotransmitter receptors. Given its ubiquity, fascia may serve as a “watchman,” receiving and processing information on whole body health. This paper reviews what constitutes fascia, why it is clinically important, and its contiguous and interdependent relationship with the nervous system. Unquestionably, fascial integrity is paramount to human locomotion, interaction with our environment, bodily sense, and general physical and emotional wellbeing, so an understanding of the fascial dysregulation that defines a range of pathological states, including hypermobility syndromes, autonomic dysregulation, mast cell activation, and acquired connective tissue disorders is critical in ensuring recognition, research, and appropriate management of these conditions, to the satisfaction of the patient as well as the treating practitioner. [ABSTRACT FROM AUTHOR]

Background: Massive irreparable rotator cuff tears (MIRCTs) are among the most challenging shoulder conditions to treat surgically. Supraspinatus tendon reconstruction (STR) is a recently introduced technique for MIRCTs based on fascia lata-muscle interface healing, which completely differs from the classic bridging technique with fascia lata-tendon interface healing. However, histological and biomechanical comparisons of the fascia-muscle and fascia-tendon interfaces have not been performed. Purpose: To investigate the histological and biomechanical healing of the fascia-bone interface and fascia-muscle interface after chronic MIRCTs in a rat model using different surgical methods. Study Design: Controlled laboratory study. Methods: The authors established a chronic MIRCT model in the right shoulder of rats and then repaired it using the STR or bridging repair technique. Evaluations were performed at 2, 4, 8, and 12 weeks, including histological, imaging, biomechanical, and functional analyses. Results: Both techniques resulted in good fascia-bone interface healing based on the histological results. The STR group had significantly more cartilage formation at 8 and 12 weeks and higher Modified Tendon Maturity Score after 12 weeks at the fascia-bone interface compared with the bridging repair group and formed the typical 4-layered structure. Collagen fibers in the fascia-muscle and fascia-tendon interfaces exhibited normal muscle-tendon interface characteristics at 12 weeks. However, the STR group had more improvement in fatty infiltration compared with the bridging repair group. The ultimate failure load and stiffness did not differ between the STR and bridging repair groups 4 weeks postoperatively in both the fascia-bone interface and supraspinatus muscle-fascia-bone integrity. Movement distance and grasp time were significantly longer in the STR group than in the bridging repair group at 12 weeks and attached the level in the normal control groups. Conclusion: These results suggest that the fascia-muscle interface from the STR technique is histologically and functionally better than the fascia-tendon interface. Moreover, this study provides a theoretical basis for the clinical use of the STR technique. Clinical Relevance: The fascia-muscle interface and fascia-tendon interface were the key points of the STR and bridging techniques, respectively. The fascia-muscle interface is histologically and functionally superior to the bridging technique, and the STR technique might be a better choice for the treatment of MIRCTs. [ABSTRACT FROM AUTHOR]

Fascia is a specialized connective tissue system that encapsulates and interconnects between tissues and organs throughout the body. The fascia system regulates pain sensation, organ inflammation, trauma, and fibrotic diseases. This mini-review summarizes recent findings from animal models, which reveal the inter-dependency between tissues/organs and the fascia system. Special mechanisms are explored of fascia response to skin inflammatory processes and fibrotic microenvironments in trauma models. We highlight the functionally diverse communities of its fascia-born fibroblasts and the significance of their stage-specific differentiation and communication to disease progression. Understanding the molecular mechanisms and cellular processes within the fascia microenvironment may serve as a basis for future clinical translation. [ABSTRACT FROM AUTHOR]

Radial dysplasia (RD) is a congenital upper limb birth defect that presents with changes to the upper limb anatomy, including a shortened or absent radius, bowed ulna, thumb malformations, a radially deviated hand and a range of muscle and tendon malformations, including absent or abnormally shaped muscle bundles. Current treatments to address wrist instability caused by a shortened or absent radius frequently require an initial soft tissue distraction intervention followed by a wrist stabilisation procedure. Following these surgical interventions, however, recurrence of the wrist deviation remains a common, long‐term problem following treatment. The impact of the abnormal soft connective tissue (muscle and tendon) anatomy on the clinical presentation of RD and the complications following surgery are not understood. To address this, we have examined the muscle, fascia and the fascial irregular connective tissue (ICT) fibroblasts found within soft connective tissues, from RD patients. We show that ICT fibroblasts isolated from RD patients are functionally abnormal when compared to the same cells isolated from control patients and secrete a relatively disordered extracellular matrix (ECM). Furthermore, we show that ICT fibroblast dysfunction is a unifying feature found in RD patients, even when the RD clinical presentation is caused by distinct genetic syndromes. [ABSTRACT FROM AUTHOR]

Background. Male circumcision (MC) is a practice involving the surgical excision of the foreskin to expose the glans and it is often performed for religious reasons. Ritual circumcision is frequently carried out by unqualified practitioners in inadequate settings, which can also lead to the death of the individual. Case Report. A 28-day-old infant was undergoing circumcision by a man that performed the circumcision using a razor blade. During the same day, the child experienced continuous bleeding from the wound and, finally, died after about 20 hours. At autopsy, a cutaneous sharp injury was revealed with ablation of the foreskin and part of the penile body. The lesion had irregular and jagged margins, with diffuse hemorrhagic infiltration. The glans and upper fascia of the penis appeared edematous and hyperemic and there were abundant hemorrhagic infiltrations in the frenulum area. The child's death was attributed to hemorrhagic shock in a child undergoing genital mutilation surgery. The finding of a significant hemorrhagic infiltration of the frenulum region indicated that the frenular artery had been severed. Conclusions. Around 35% of ritual male circumcisions are performed clandestinely in Italy, and typically by unqualified practitioners. In such events, the forensic investigation of the injuries inflicted on the victim allows for determining whether the procedure was performed appropriately or not, to verify the existence of a causal link between the procedure itself and the death of the individual. [ABSTRACT FROM AUTHOR]

Background: In physiotherapy, the classic muscle–bone concept is used to translate basic and clinical anatomy. By defining the anatomical structures from superficial to deeper layers which frame the ArthroMyoFascial complex, our aim is to offer clinicians a comprehensive concept of within the muscle–bone concept. Method: This study is a narrative review and ultrasound observation. Results: Based on the literature and ultrasound skeletonization, the ArthroMyoFascial complex is defined. This model clarifies fascial continuity at the joint level, describing anatomical structures from skin to deeper layers, including superficial fascia, deep fascia, myofascia including skeletal muscle fibers, and arthrofascia all connected via connective tissue linkages. This model enhances the understanding of the muscle–bone concept within the larger ArthroMyoFascial complex. Conclusion: The ArthroMyoFascial complex consists of multiple anatomical structures from superficial to deeper layers, namely the skin, superficial fascia, deep fascia, myofascia including muscle fibers, and arthrofascia, all linked within a connective tissue matrix. This model indicates that it is a force-transmitting system between the skin and the bone. This information is crucial for manual therapists, including physiotherapists, osteopaths, chiropractors, and massage therapists, as they all work with fascial tissues within the musculoskeletal domain. Understanding fascia within the muscle–bone concept enhances clinical practice, aiding in therapeutic testing, treatment, reporting, and multidisciplinary communication, which is vital for musculoskeletal and orthopedic rehabilitation. [ABSTRACT FROM AUTHOR]

Background: Designed to help treat pain and loss of function after rotator cuff repair, allograft spacer procedures utilize a graft to act as a spacer in the subacromial space, decreasing pain from impingement of the greater tuberosity on the acromion at the extremes of overhead motion. Purpose: To evaluate the biomechanical characteristics of secured versus unsecured tensor fascia lata allografts used in an allograft spacer procedure. Study Design: Controlled laboratory study. Methods: A total of 8 fresh-frozen cadaveric shoulder specimens were used. There were 4 conditions tested: (1) intact rotator cuff, (2) stage III rotator cuff tear (complete supraspinatus tendon and superior one-half of the infraspinatus tendon), (3) unsecured tensor fascia lata graft, and (4) secured tensor fascia lata graft. Both superior and posterior translation of the humeral head were calculated in each condition. A 4-cm × 5-cm × 6-mm tensor fascia lata graft was used in the subacromial space to act as a spacer. Grafts were secured at the lateral edge of the native rotator cuff footprint with 2 knotless anchors. Results: With unbalanced loading, both secured and unsecured grafts varied in their ability to limit superior and posterior translation at various rotation angles back to levels seen with intact rotator cuffs at 0° and 20° of abduction. During balanced loading, both unsecured and secured grafts limited superior and posterior translation more than those seen in the rotator cuff–deficient condition (P <.01) and similar to those seen in the intact condition (P >.05). The secured and unsecured grafts allowed similar amounts of translation at every position with both unbalanced and balanced loading (P >.05). Finally, total graft motion was <7 mm in all positions. Conclusion: Unsecured tensor fascia lata grafts were biomechanically equivalent to secured grafts when used during allograft spacer procedures. Clinical Relevance: While both grafts were successful at limiting superior and posterior translation of the humeral head during early range of motion, the unsecured graft represents a cheaper, easier option to utilize during allograft spacer procedures. [ABSTRACT FROM AUTHOR]

The fascia of the pancreatic head is referred to as the retropancreatic fascia of Treitz, and that of the body and tail of the pancreas is named the retropancreatic fascia of Toldt. However, the spatial relationship between the nerves, fascia, and the distribution of the fascia on the dorsal side of the pancreas remains unclear. Therefore, this study aimed to explore the distribution of these fasciae and elucidate the spatial relationship between the nerves and arteries connecting the retroperitoneal space and the peritoneal organs by studying eight cadavers using macroscopic anatomical examination, wide‐range serial sectioning, and three‐dimensional reconstruction. The fasciae of Treitz and Toldt converge caudally to the root of the superior mesenteric artery (SMA), forming a narrower gap around the roots of the celiac trunk and SMA than in the celiac plexus. The fasciae eventually get closer to each other, and the boundary between them becomes obscured, providing coverage to the anterior surface of the aorta between the SMA and the inferior mesenteric artery. The celiac plexus does not penetrate the fascia but converges before spreading into the pancreas. Similarly, the arteries pass through this gap in the fasciae. Our findings suggest that the retroperitoneal space and peritoneal organs are connected through a narrow no‐fascia area, with the distribution of the fascia relating to nervous and vascular pathways. Our findings reveal that the distribution of the avascular plane may provide a crucial anatomical foundation for abdominal digestive organ surgery by reducing bleeding volume and determining the dissection region. [ABSTRACT FROM AUTHOR]

We present a comprehensive neural network to model the deformation of human soft tissues including muscle, tendon, fat and skin. Our approach provides kinematic and active correctives to linear blend skinning [Magnenat-Thalmann et al. 1989] that enhance the realism of soft tissue deformation at modest computational cost. Our network accounts for deformations induced by changes in the underlying skeletal joint state as well as the active contractile state of relevant muscles. Training is done to approximate quasistatic equilibria produced from physics-based simulation of hyperelastic soft tissues in close contact. We use a layered approach to equilibrium data generation where deformation of muscle is computed first, followed by an inner skin/fascia layer, and lastly a fat layer between the fascia and outer skin. We show that a simple network model which decouples the dependence on skeletal kinematics and muscle activation state can produce compelling behaviors with modest training data burden. Active contraction of muscles is estimated using inverse dynamics where muscle moment arms are accurately predicted using the neural network to model kinematic musculotendon geometry. Results demonstrate the ability to accurately replicate compelling musculoskeletal and skin deformation behaviors over a representative range of motions, including the effects of added weights in body building motions. [ABSTRACT FROM AUTHOR]

Conservative treatments for plantar fasciitis have different levels of effectiveness, so it is necessary to personalize the therapeutic modality that improves the patients' symptoms. Methods: A double-blinded randomized clinical trial was designed to evaluate the short-term efficacy of a physical treatment in chronic plantar fasciitis, namely iontophoresis, compared with radial shockwave therapy. Heel pain, health status using the EuroQol-5D questionnaire, and fascia thickness measured with ultrasound were evaluated. In total, 127 patients were randomly selected for group A and treated with iontophoresis therapy (lidocaine 0.4% and dexamethasone 0.5%), or for group B, in which they were treated with radial shockwave therapy (EWST). Measurements were taken at baseline and at follow-up during the 5 weeks of the study. Results: Statistically significant differences were observed to the shockwave therapy group in respect to the final fascia thickness, and the VAS scale (p = 0.001). The differences between groups A and B showed that the shockwave group follow-up after 3 weeks experienced complete pain remission (1.0 ± 0.9; 95%CI 0.8–1.2) and after the 6-week follow-up, complete pain remission of plantar fasciitis was observed for both therapies. Patients had a better perception of the use of EWST at the end of the treatment, although in both groups it was satisfactory (p = 0.001). Conclusions: The results of this study showed a shorter-term effectiveness of shockwave treatment compared with the use of iontophoresis. However, both techniques were effective in satisfactorily reducing pain in this short period. [ABSTRACT FROM AUTHOR]

The temporal fascia is a double lamina sandwiching a thick fat layer above the zygomatic bony arch. To characterize each lamina, their developmental processes were examined in fetuses. We observed histological sections from 22 half-heads of 10 mid-term fetuses at 14–18 weeks (crown-rump length, 95–150 mm) and 12 near-term fetuses at 26–40 weeks (crown-rump length, 215–334 mm). The superficial lamina of the temporal fascia was not evident at mid-term. Instead, a loose subcutaneous tissue was attached to the thin, deep lamina of the temporal fascia covering the temporalis muscle. At near-term, the deep lamina became thick, while the superficial lamina appeared and exhibited several variations: i) a monolayered thick membrane (5 specimens); ii) a multi-layered membranous structure (6) and; iii) a cluster of independent thick fasciae each of which were separated by fatty tissues (1). In the second and third patterns, fatty tissue between the two laminae was likely to contain longitudinal fibrous bands in parallel with the deep lamina. Varying proportions of the multi-layered superficial lamina were not attached to the zygomatic arch, but extended below the bony arch. Whether or not lobulation or septation of fatty tissues was evident was not dependent on age. The deep lamina seemed to develop from the temporalis muscle depending on the muscle contraction. In contrast, the superficial lamina developed from subcutaneous collagenous bundles continuous to the cheek. Therein, a difference in development was clearly seen between two categories of the fasciae. [ABSTRACT FROM AUTHOR]

Study objective We report a novel block technique aimed to provide lumbosacral, abdominal, and hip analgesia: The quadro-iliac plane (QIP) block. Design A cadaveric examination that evaluates the spread of QIP block. Setting Cadaver laboratory. Patients One unembalmed cadaver. Interventions Bilateral ultrasound-guided QIP blocks on cadavers with 40 mL of methylene blue %0.5 each side. Measurements Dye spread in cadaver. Main results There was staining in the deep interfascial plane of the erector spinae muscles. Extensive staining of the interfascial plane corresponding to the posterior aspect of the quadratus lumborum muscle (QLM) was observed. There was extensive staining on the anterior surface of the QLM. There was spread of dye traversing along the transversalis fascia and significantly infiltrating retroperitoneal fat tissue. Bilateral staining of the ilioinguinal and iliohypogastric nerves was observed. On the right, there was minimal staining over the subcostal nerve. There was dye present bilaterally within the deep regions of the transverse processes. The lumbar plexus was stained on both sides. Conclusion The local anesthetic applied from a place where the QLM reaches its largest volume and the fascial plane creates a closed gap in the caudal area may exhibit a more rounded and extensive spread. Quadro-iliac plane block, involves the administration of local anesthetic to the posterior aspect of the QLM at its origin from the iliac crest. According to our cadaver study, this technique may be a promising option for alleviating acute and chronic pain in the lumbosacral, lower abdominal, and hip regions. [ABSTRACT FROM AUTHOR]

The purpose of this study was to examine the differences in thoracolumbar fascia (TLF) and lumbar muscle modulus in individuals with and without hamstring injury using shear wave elastography (SWE). Thirteen male soccer players without a previous hamstring injury and eleven players with a history of hamstring injury performed passive and active (submaximal) knee flexion efforts from 0°, 45° and 90° angle of knee flexion as well as an active prone trunk extension test. The elastic modulus of the TLF, the erector spinae (ES) and the multifidus (MF) was measured using ultrasound SWE simultaneously with the surface electromyography (EMG) signal of the ES and MF. The TLF SWE modulus was significantly (p < 0.05) higher in the injured group (range: 29.86 ± 8.58 to 66.57 ± 11.71 kPa) than in the uninjured group (range: 17.47 ± 9.37 to 47.03 ± 16.04 kPa). The ES and MF modulus ranged from 14.97 ± 4.10 to 66.57 ± 11.71 kPa in the injured group and it was significantly (p < .05) greater compared to the uninjured group (range: 11.65 ± 5.99 to 40.49 ± 12.35 kPa). TLF modulus was greater than ES and MF modulus (p < 0.05). Active modulus was greater during the prone trunk extension test compared to the knee flexion tests and it was greater in the knee flexion test at 0° than at 90° (p < 0.05). The muscle EMG was greater in the injured compared to the uninjured group in the passive tests only (p < 0.05). SWE modulus of the TLF and ES and MF was greater in soccer players with previous hamstring injury than uninjured players. Further research could establish whether exercises that target the paraspinal muscles and the lumbar fascia can assist in preventing individuals with a history of hamstring injury from sustaining a new injury. [ABSTRACT FROM AUTHOR]

Neck infections are often prone to being underestimated and can manifest insidiously. The spread of infection can lead to translocation into thoracic areas, causing descending necrotizing mediastinitis (DNM). However, the application of the post-mortem approach in such cases is not well-described in the literature. A literature review was carried out according to the PRISMA methods. Nine papers were included in the final review, revealing different levels of involvement of neck layers that can be linked to different causes. Expertise with respect to the anatomy of the fasciae and spaces of the neck enables an understanding of the pathogenesis of DNM. However, a clear autoptic description was not provided in any of the articles. Therefore, we also employed a practical post-mortem approach to cases of death due to DNM. It is fundamental for pathologists to identify the exact head and neck structures involved. Providing dissectors with support from an otolaryngologist could be useful. This paper could help address such difficult cases. [ABSTRACT FROM AUTHOR]

SUMMARY This case series describes an emerging and ongoing lameness condition observed in broiler breeder males in flocks owned by a broiler integrator in the United States between February 2021 and April 2023. The lameness is characterized by an upright, penguin-like posture and gait. Affected flocks are typically 12–22 wk of age at presentation, but birds with similar stance and gross lesions can be observed as early as 1 day of age. Male mortality associated with this condition ranges from 0.01% to 6% per flock. The condition is infrequently observed in pullets from the female line but has not been observed in males (sex slips) from the female line. On postmortem examination, affected birds have bilateral hemorrhage due to a tearing of the iliotibialis muscles and fascia. In one case, a higher proportion of affected birds had unilateral lesions concurrently with broken legs or severe inguinal vaccine reaction. In this case, the affected leg was the weight-bearing leg. Histopathology confirmed the presence of hemorrhage in fascial sheaths surrounding major muscles, in addition to muscle fiber necrosis, edema, fibroplasia, and dissociation of tendon collagen. Bacteriology, histopathology, and clinical presentation identified no factors that were suggestive of an infectious etiology for this condition. No etiology has been established, but a suggested pathogenesis involves excessive biomechanical force resulting in tendon structural stress, leading to separation of tendon collagen fibers and associated muscle fiber stretching, separation, necrosis, and hemorrhage. The condition has been reported in multiple genetic lines, but the role of inheritance in the condition has not been fully evaluated. RESUMEN Miotendinopatía de etiología desconocida en machos reproductores pesados. Esta serie de casos describe una condición de cojera emergente y recurrente observada en parvadas de machos reproductores pesados propiedad de un integrador de pollo de engorde en los Estados Unidos entre febrero del 2021 y abril del 2023. La cojera se caracteriza por una postura y desplazamientos corporales en forma erguida, parecidos a los de los pingüinos. Las parvadas afectadas suelen tener entre 12 y 22 semanas de edad en el momento de la presentación, pero se han podido observar aves con similar postura corporal y lesiones macroscópicas tan temprano como al primer día de edad. La mortalidad de los machos asociada con esta condición oscila entre el 0.01% y el 6% por parvada. La condición se observa con poca frecuencia en pollitas de la línea hembra, pero no se ha observado en machos provenientes de la misma línea hembra (errores de sexado). En el examen post mortem, las aves afectadas presentan hemorragia bilateral debido a un desgarramiento de los músculos iliotibiales y la fascia. En un caso, una mayor proporción de aves afectadas tuvieron lesiones unilaterales simultáneamente con patas rotas o una reacción postvacunal severa en la región inguinal. En este caso, la pierna afectada era la misma que soportaba peso. La histopatología confirmó la presencia de hemorragia en las vainas fasciales que rodean los músculos principales, además de necrosis de fibras musculares, edema, fibroplasia y disociación del colágeno del tendón. Mediante la bacteriología, la histopatología y la presentación clínica no se identificaron factores que sugirieran una etiología infecciosa para esta afección. No se ha establecido una etiología, pero una patogénesis sugerida implica una fuerza biomecánica excesiva que produce estrés estructural del tendón, lo que lleva a la separación de las fibras de colágeno del tendón y al estiramiento, separación, necrosis y hemorragia de las fibras musculares asociadas. La afección se ha informado en múltiples líneas genéticas, pero no se ha evaluado completamente el papel de la genética en esta condición. [ABSTRACT FROM AUTHOR]

Background: Ultrasound-guided fascia iliaca compartment block $US6FICB% is an important procedure for minimising opioid use during perioperative pain management for the expanding demographic of elderly patients with hip fractures. Nurse anaesthetists with specialised skills are emerging as valuable assets for the efficient delivery of this nerve block. Despite the growing implementation of US6FICB, studies have not yet detailed how its pain relief effects differ between men and women, or the differentiation of the effect on pain at rest and with movement. This study aims to evaluate the analgetic effect of US6FICB administered by nurse anaesthetists in patients with hip fractures, with a specific focus on variations based on the patient's sex and the intensity of pain at rest and during movement. Design: Prospective observational study involving systematic data collection to observe the effects of US6FICB in a clinical setting. Method: Pain intensity at rest and with movement was recorded on a numeric rating scale $0710%. Then, nurse anaesthetists administered a US6FICB. After 60 minutes, pain intensity at rest and during movement were recorded once more. A decrease of 1.5 points was deemed clinically significant. Results: Of the 33 patients with complete datasets, the mean pain reduction after US6FICB was 1.4 $95% CII 0.572.4% for pain at rest and 2.6 points $95% CII 1.873.5% for pain during movement. Clinically significant pain relief was noted in 17 patients $51.5%% at rest and 23 patients $69.7%% during movement. A high initial pain intensity at rest was a statistically significant predictor for the procedure's effect (odds ratio 1.6; 95% CII 1.172.3; p<0.01%. The study did not reveal significant sex-based differences, but the sample size may not have been adequate for this determination. No serious adverse effects were recorded. Conclusion: Nurse anaesthetist-delivered US6FICB can offer notable pain alleviation for hip fracture patients, particularly for movement-induced pain and for patients initially reporting high pain intensities. [ABSTRACT FROM AUTHOR]

The degenerative cycle of recurrent leg ulcers is extremely costly to the NHS. Contradictory guidelines have fostered a risk adverse culture, which delays timely management and allows deterioration. Effective treatment of leg ulcers has also been hindered due to ignorance about their pathophysiology. Once deemed solely due to arterial/venous insufficiency, then arterial/venous and lymphatic in origin, the role of the myofascial system in interstitial stasis, ulcer formation and wound healing has never been discussed. Lymphascial Kinesiology Taping (LKT) offers a low-risk, cost-effective intervention, which can improve outcomes at any stage of degeneration or frailty. The concepts of a myofascial interstitium, bio-tensegrity, proprioception and mechano-transduction are considered, in relation to the mechanism of action of LKT on the skin, and how it influences and improves interstitial stasis and tissue necrosis. Due to a paucity of literature for venous and arterial leg ulcers, presented case studies reveal how deoxygenated tissue necrosis is avoided in traumatic injury, oncology and post-surgical settings to illustrate the theory and promote the use of LKT for tissue health and wound recovery. [ABSTRACT FROM AUTHOR]

Objective: To evaluate and discuss the plastic surgery treatment of asymmetric crying face. Methods: From 2019 to 2022, 60 patients with asymmetric crying face were treated by fascia lata grafting. We evaluated the postoperative improvement, summarized experiences and reviewed literatures about the treatment of asymmetric crying face. Results: 59 patients showed varying degrees of improvement in the movement of the affected corner of mouth, and no complications were found during the follow-up period of 6 months to 24 months. Conclusions: The cause of asymmetric crying face is still uncertain. Fascia lata grafting has shown a certain effect in the treatment of asymmetric crying face. This study evaluated this method with quite large sample. More researches are needed to explore the most appropriate treatment for asymmetric crying face. [ABSTRACT FROM AUTHOR]

Background: Evidence suggests the plantar fascia and its interphase with the flexor digitorum brevis muscle can play a relevant role in plantar heel pain. Needling interventions could offer an appropriate treatment strategy to addressing this interface. Objective: We compared the accuracy and safety of ultrasound-guided versus palpation-guided procedures for the proper targeting of the interface between the plantar fascia and the flexor digitorum brevis with a solid needle. Methods: A crossover cadaveric study was conducted. Five experienced therapists performed a series of 20 needle insertions each (n = 100 in total, 10 landmark-guided and 10 ultrasound-guided) on 10 anatomical samples. The therapists were instructed to accurately place the needle on the interface between the plantar fascia and the flexor digitorum brevis muscle. The distance of the tip of the needle to the identified target (accuracy), the surrounding sensitive structures targeted (safety), the time needed for the procedure, the number of needle passes, and the needle length outside the skin were assessed. Results: The ultrasound-guided technique was associated with a significantly higher accuracy (p < 0.001) but without differences in safety (p = 0.249) as compared to the palpation-guided procedure. Conclusion: Our results suggest that ultrasound-guided insertion exhibits greater accuracy but not greater safety than palpation-guided insertion when targeting the interface between the plantar fascia and the flexor digitorum brevis. [ABSTRACT FROM AUTHOR]

Hollow temples are not typically considered aesthetically pleasing, and hollowness worsens with the aging process. When filling this region with fillers, there are several anatomical considerations, with injection techniques varying depending on the layer targeted. Specifically, injections between the superficial temporal fascia and the superficial layer of the deep temporal fascia are performed using a cannula, while periosteal layer injections involve the use of a needle to reach the bone before inserting fillers. Detailed anatomical insights encompass the boundaries of the temporal fossa and cautionary notes regarding blood vessels, supported by specific studies on veins and arteries in the temporal region. Complications, including vessel injuries, are discussed alongside an exploration of various injection techniques. This review provides a comprehensive exploration of anatomical considerations and the specific methodologies employed in temple augmentation with fillers. [ABSTRACT FROM AUTHOR]

Background and Objectives: This study aims to compare the neuromuscular structure of the vagina in women with posterior vaginal wall prolapse with the neuromuscular structure of the vagina in women without prolapse, to determine the difference, and to demonstrate the role of neuromuscular structure in the physiopathology of prolapse. Materials and Methods: In this prospective study, women aged between 40 and 75 years who had not undergone any vaginal surgery and had not undergone any abdominal prolapse surgery were included. Thirty-one women diagnosed with rectocele on examination were included in the study group. Thirty-one patients who underwent vaginal intervention and hysterectomy for reasons other than rectocele (colposcopy, conization, etc.) without anterior or posterior wall prolapse were included in the control group. Biopsy material was obtained from the epithelium of the posterior wall of the vagina, including the fascia that fits the Ap point. Immunohistochemical staining with Protein Gene Product 9.5 and smooth muscle α-actin was performed in the pathology laboratory. The epithelial thickness measurement and smooth muscle density parameters obtained with these immunohistochemical stainings were compared between the two groups. The collected data were analyzed using the SPSS 23 package program. p values less than 0.05 were considered statistically significant. Results: In the control group, muscle thickness and the number of nerves per mm2 of fascia were statistically significantly higher than in the study group (p < 0.05). Conclusions: We found that smooth muscle tissue and the number of nerves per mm2 of fascia were decreased in posterior vaginal wall prolapse compared to the general population. Based on the correlation coefficients, age was the parameter that most affected the degree of prolapse, followed by parity, number of live births, and number of vaginal deliveries. [ABSTRACT FROM AUTHOR]

Mastectomy serves as the main surgical treatment for both invasive and in situ breast carcinoma and large phyllodes tumors. It is associated with skin necrosis, seroma, and surgical site infection in up to 30% of patients. In the present trial, we compared the complications in patients undergoing skin flap elevation by one of the 4 techniques: thick skin flap raised by scalpel(group1), thin skin flap raised with scalpel (group 2), thick skin flap raised with diathermy (group 3), and thin skin flap raised with diathermy (group 4). A randomized trial with superiority hypothesis and 2 × 2 factorial design was conducted at All India Institute of Medical Sciences New Delhi. Mastectomy skin flap necrosis (MSN) was recorded as the main outcome of interest. MSN was noted in 2.5% in group1, 10% in group 2, 7.5% in group 3, and 30% in group 4. MSN was observed in 5% cases with thick flap compared to 20% cases with a thin skin flap (p = 0.007). Raising the flap with scalpel was associated with MSN in 6.25% compared to 18.75% in the diathermy group (p = 0.029). We conclude that raising a thick flap with scalpel is associated with lowest risk of skin flap necrosis. Trial Registration: Clinical Trial Registry- India CTRI/2014/09/004978 [ABSTRACT FROM AUTHOR]

Objective We aimed to evaluate the effectiveness of ultrasound-guided facia iliaca compartment (FIC) and erector spinae plane (ESP) blocks in managing postoperative pain after total hip arthroplasty surgery. Methods A total of 60 patients were randomized into 2 groups (n  = 30): one that received FIC blocks and one that received ESP blocks. FIC and ESP blocks were performed with 30 mL 0.25% bupivacaine at the end of the surgery. The patients received intravenous tramadol and patient-controlled postoperative analgesia. The pain scores, opioid consumption, and adverse events were recorded. Results The dynamic pain scores on movement in the postoperative first hour were significantly lower in the ESP block group than in the FIC block group (3 [2–4] vs 4 [2–5], respectively; P  = .035). Data are expressed as median (25th–75th percentiles). Postoperative opioid consumption within the first postoperative 8 hours was significantly higher in the FIC block group than in the ESP block group (80 mg [61–100] vs 100 mg [80–120], respectively; P  = .010). The adverse effects of opioids did not differ between the 2 groups. Conclusion ESP and infrainguinal FIC blocks provided similar postoperative analgesia 24 hours after total hip arthroplasty. The ESP block is more beneficial than the FIC block in terms of pain scores and opioid consumption in the early hours of the postoperative period. Trial registration www.ClinicalTrials.gov (ID: NCT05621161). [ABSTRACT FROM AUTHOR]

Background. Kyphosis is a prevalent condition in older women that can significantly impact their mobility. Various therapeutic approaches and modalities can be used to treat hyperkyphosis. Cervicothoracic fascia stretching reduces kyphotic angle, decreases cervical pain, and improves various dimensions of thoracic mobility. Purpose of the study. The aim of this study is to evaluate the effect of the cervicothoracic fascia stretch on the thoracic mobility of older women. Subjects and methods. Sixty older women with non-specific neck discomfort, whose ages ranged from 60 to 70, were recruited from the outpatient clinics at Heliopolis University. The recruited patients were randomly divided into two groups of equal numbers of subjects: Group A included 30 patients who underwent cervicothoracic fascia stretching, and 30 patients were included in Group B who underwent diaphragmatic breathing exercises three times a week for four weeks. The neck pain was assessed utilizing the Neck Pain and Disability Scale (NPAD), while thoracic kyphosis was assessed utilizing a flexion curve ruler. Moreover, thoracic circumference excursion was measured using tape, while transverse and latero-lateral dimensions of the thorax were assessed using a chest depth caliper. Results. The comparison between pre- and post-study results showed a significant enhancement in all measured variables, including neck pain, thoracic circumference, chest width dimension, chest depth dimension, and kyphotic angle in both groups. Our findings indicated a statistically significant decrease in neck pain and kyphotic angle. Conversely, there was a statistically significant increase in thoracic circumference and chest width dimension for the cervicothoracic stretch group after treatment. Conclusions. Both interventions, such as intrathoracic fascia stretch and diaphragmatic breathing exercises exhibited extraordinary effectiveness in the management of reduced thoracic mobility and neck pain in older women with better results in favor of cervicothoracic stretch. [ABSTRACT FROM AUTHOR]

Background: This study aimed to investigate the thickness changes of the heel fat pad and the plantar fascia associated with loading and unloading in healthy individuals and patients with heel pain and reveal the differences between them. Methods: The study included adult male participants with (n = 9) and without (n = 26) heel pain. The participants placed their right foot on an evaluation apparatus with a polymethylpentene resin board (PMP), while their left foot was positioned on a weighing scale used to adjust the loading weight. The heel fat pad was differentiated into superficial Microchamber and deep Macrochamber layers. These layers and plantar fascia thickness were measured using an ultrasonographic imaging device at loading phase ranging from 0% to 100% of their body weight and unloading phase from 100% to 0%. Additionally, the study examined the thickness change ratios of the superficial and deep heel fat pad layers when the load increased from 0% (unload) to 100% (full load). Results: In healthy individuals and patients with heel pain, no significant thickness changes were observed in the Microchamber layer of the heel fat pad or the plantar fascia during loading and unloading evaluations. However, significant thickness changes were observed in the Macrochamber layer of the heel fat pad, and the pattern of change differed between the loading and unloading phases. Additionally, patients with heel pain showed differences in the thickness change and thickness change ratios of the microchamber and macrochamber layers of the heel fat pad during both loading and unloading phases. The thickness of the plantar fascia did not show significant differences between both groups. Conclusion: Compared with healthy individuals, in our relatively small study, patients with heel pain had greater deep fat pad compression in loading and less recovery after load removal. This finding suggests that these patients have different intrinsic fat pad function and related morphology than those without heel pain. [ABSTRACT FROM AUTHOR]

This article discusses a case study of a 60-year-old patient who developed a deep neck infection as a complication of esophageal cancer. The patient underwent a biopsy and later presented with symptoms of a deep neck infection. The article highlights the importance of clinical evaluation, imaging, and active management for successful outcomes in deep neck infections. It also discusses the symptoms, diagnosis, and treatment options for these infections, emphasizing the need for prompt surgical drainage. The article also mentions the risk factors, microbiology, and potential complications associated with deep neck infections. [Extracted from the article]

Skin perceives and reacts to external mechanical forces to create resistance against the external environment. Excessive or inappropriate stimuli of pressure may lead to cellular alterations of the skin and the development of both benign and malignant skin disorders. We conducted a comprehensive literature review to delve into the pressure-induced and aggravated skin disorders and their underlying pressure-related mechanisms. Dysregulated mechanical responses of the skin give rise to local inflammation, ischemia, necrosis, proliferation, hyperkeratosis, impaired regeneration, atrophy, or other injurious reactions, resulting in various disease entities. The use of personal devices, activities, occupations, weight bearing, and even unintentional object contact and postures are potential scenarios that account for the development of pressure-related skin disorders. The spectrum of these skin disorders may involve the epidermis (keratinocytes and melanocytes), hair follicles, eccrine glands, nail apparatuses, dermis (fibroblasts, mast cells, and vasculature), subcutis, and fascia. Clarifying the clinical context of each patient and recognizing how pressure at the cellular and tissue levels leads to skin lesions can enhance our comprehension of pressure-related skin disorders to attain better management. [ABSTRACT FROM AUTHOR]

Background: Arthroscopic superior capsular reconstruction (ASCR) and reverse shoulder arthroplasty (RSA) have both shown favorable outcomes in patients with irreparable rotator cuff tears (IRCTs). Purpose: To (1) compare the clinical outcomes of ASCR versus RSA in patients aged ≥65 years with IRCTs and (2) compare serial changes in clinical outcomes between treatment groups. Study Design: Cohort study; Level of evidence, 3. Methods: This study included patients with IRCTs without glenohumeral osteoarthritis who underwent either ASCR or RSA between March 2013 and December 2020 and had at least 2 years of follow-up data. We assessed active range of motion, a visual analog scale (VAS) pain score, the American Shoulder and Elbow Surgeons (ASES) score, and the Single Assessment Numeric Evaluation (SANE) score at the preoperative, short-term (postoperative 6-12 months), and final follow-up times. Results: In total, 64 patients (ASCR, 31 patients; RSA, 33 patients) were included. The mean age of patients was 71.3 ± 4.4 and 72.9 ± 4.1 years, and the mean final follow-up duration was 42 ± 21.8 and 37.7 ± 21.7 months in the ASCR and RSA groups, respectively. At the short-term follow-up, RSA achieved significant improvements in all clinical outcomes, except for internal rotation (IR), while ASCR only showed significant improvements in VAS pain, ASES, and SANE scores. Compared with the preoperative period, both ASCR and RSA achieved significant improvements in all clinical outcomes, except for IR in the RSA group at the final follow-up. The ASCR group achieved better IR and ASES scores at the final follow-up, while the time taken to recover from pseudoparalysis was shorter after RSA. The ASCR group showed a 67.8% graft healing rate at the 1-year follow-up, while the RSA group showed 12.1% of scapular notching at the final follow-up. No other postoperative complications were observed in either group. Conclusion: ASCR and RSA achieved favorable clinical outcomes in the study cohort. At the short-term follow-up, RSA showed significant improvements in all clinical outcomes, except for IR, while ASCR only showed significant improvements in VAS pain, ASES, and SANE scores. At the final follow-up, however, ASCR had better IR and ASES scores compared with RSA. [ABSTRACT FROM AUTHOR]

In ultrasound diagnostics, acoustic absorbers block unwanted acoustic energy or prevent the reception of echo signals from structures outside the target area. Non-metallic absorbers provide a low-echoic signal that is suitable for observing the anatomy of the area to which the absorber is attached. In this study, we aimed to evaluate the effect of a polyurethane film absorber (PU) on ultrasound diagnostic imaging and investigate its effectiveness in improving the image contrast between the fascia and muscle structures. Twenty-six healthy men in their twenties participated in this study. The experiment was performed with the participant in the supine position and with an ultrasound transducer probe placed at the center of the measurement area on the abdomen. Images of the rectus abdominis (RA; muscle) and rectus sheath, e.g., fascia including superficial fascia (SF) and deep fascia (DF), obtained after attaching a PU, were compared with those obtained without the absorber (No_PU). The thickness was measured using brightness mode ultrasound imaging. To analyze the quantitative differences in the fascia and muscle images depending on the presence of the absorber, the signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were derived from the signal intensities measured in the target areas. The thickness of the fascia and muscle was similar in all regions of interest, regardless of the absorber; therefore, the existing diagnostic value was maintained. Overall, the signal intensity decreased; however, the SNRs of the RA, SF, and DF differed significantly. The SNR of the RA decreased in the PU but increased for the SF and DF. The CNRs for SF-RA and DF-RA significantly increased with the PU. In this study, we demonstrated that the PU behaved similarly to previously used metallic absorbers, reducing the signal from the attachment site while accurately indicating the attachment site in the ultrasound images. Furthermore, the results showed that the PU efficiently distinguished fascia from surrounding tissues, which could support studies requiring increased signal contrast between fascia and muscle tissue and aid the clinical diagnosis of fascial diseases. [ABSTRACT FROM AUTHOR]

This article provides a step-by-step guide to forelimb amputation in companion animals, specifically focusing on the preferred method of amputation via removal of the scapula. The article discusses the indications for forelimb amputation, potential complications, patient preparation and positioning, surgical approach, and postoperative considerations. It emphasizes the importance of meticulous surgical technique and haemostasis to reduce the risk of complications such as infection. The article concludes with take-home messages, including the high reported infection rates following limb amputation and the need for careful surgical technique to minimize complications. [Extracted from the article]

Chest wall reconstruction poses significant challenges. One of those challenges is choosing the correct material for reconstruction. There is debate on using prosthetic materials versus autologous tissues and rigid versus nonrigid materials. This article showcases the novel use of fascia lata for chest wall reconstruction in children. [ABSTRACT FROM AUTHOR]

This article discusses the use of volumizing thread lifts as a treatment for subzygomatic arch depression, a condition that can occur in both elderly and younger individuals. The study explores the use of hyaluronic acid (HA) filler injections and volumizing thread lifts to correct the depression and enhance facial contours. The article presents a successful case study of a 45-year-old patient who underwent the procedure and expressed satisfaction with the results. The authors highlight the potential advantages of incorporating volumizing thread lifts into the treatment and emphasize the need for further research to assess the long-term safety and effectiveness of the procedure. [Extracted from the article]

Context: Plantar fasciitis (PF) is a common and devastating disease. Despite different treatments, there is no clear evidence for the effect of these treatments on PF. One of the therapy methods used in physiotherapy is dry needling (DN). So the purpose of this study is to investigate the effect of DN on the pain and range of motion of the ankle joint and plantar fascia thickness in subjects with PF who are suffering from the trigger points of the gastrocnemius and soleus muscles. Methods: In this study, 20 volunteer females with PF were randomly assigned into DN treatment and control groups. Measurements were range of motion in dorsiflexion and plantar flexion, plantar fascia thickness, and visual analog scale measured before, immediately, and 1 month after the end of the intervention in both groups. Results: There were significant differences in the plantar fascia thickness and visual analog scale between the 2 groups. Plantar fascia thickness (P = .016) and visual analog scale (P = .03) significantly decreased in the treatment group. However, there was no significant difference in plantar flexion (P = .582) and dorsiflexion range of motion (P = .173) between groups. Conclusion: The result of this study showed that DN can reduce pain and plantar fascia thickness in women with PF who are suffering from trigger points of the gastrocnemius and soleus muscles. Level of evidence: Level 1, randomized controlled trial. [ABSTRACT FROM AUTHOR]