Trunk Group Research Articles

False lumen thrombosis and aneurysmal transformation of the non-operated aorta after surgical treatment of proximal dissection

Background: One of the most feared long-term complications of surgical treatment of proximal aortic dissections is an aneurysm of the non-operated compartments of the aorta.Objective: To conduct a comparative analysis of different methods for surgical treatment of proximal aortic dissections in relation to false lumen thrombosis development in non-operated compartments.Methods: We conducted a simple observational retrospective multicenter study to study the effectiveness of the frozen elephant trunk technique compared with a standard surgical intervention (aggressive hemiarch anastomosis or total aortic arch replacement with a multibranched prosthesis). Our study included 101 patients grouped based on the method of treatment: group 1 for frozen elephant trunk (n = 31); group 2 for thoracic aorta reconstruction by the standard methods (control group, n = 70). Due to the retrospective nature of the study and the disparity of groups by certain characteristics, we used propensity score matching to increase the reliability of the results. All patient data were collected in the preoperative period, from the protocols of surgical interventions, in the postoperative and long-term periods (3-6 months, 1 year, 2 years, 3 years after surgery). All statistical calculations were conducted in the RStudio software, version 0.99.879 (RStudio Inc., Boston, USA).Results: The absence of false lumen thrombosis at the thoracic aorta level persisted after the surgical treatment in half of the patients in the control group (n = 13; 52%) and was not determined in the frozen elephant trunk group. Complete false lumen thrombosis at the thoracic aorta level (level of stent graft placement and distal to the diaphragm) was achieved in more than half of the patients in the frozen elephant trunk group and only in 3 (12%) control patients. Aneurysmal transformation of the non-operated aorta occurred in 12 (48%) patients from group 2 and was absent in group 1.Conclusion: The frozen elephant trunk technique reduces the frequency of aorto-related events to 0% within 3 years compared with the standard approach (32%, P < .005). Patients operated on for proximal aortic dissection using the frozen elephant trunk technique are significantly more likely to have false lumen thrombosis in the thoracic aorta (P = .004), significantly lower incidence of aneurysmal transformation or thoracic aorta growth rate of >5 mm per year in the long-term period (P = .016) compared with those who underwent the standard methods. Received 15 February 2023. Revised 31 July 2023. Accepted 4 August 2023. Funding: The study was carried out within the framework of the grant of the President of the Russian Federation НШ-5096.2022.3 (agreement No. 075-15-2022-823 dated 12.05.2022). Conflict of interest: The authors declare no conflict of interest. Contribution of the authorsConception and study design: A.M. Chernyavskiy, M.M. Lyashenko Data collection and analysis: M.M. Lyashenko, A.A. Shadanov, D.S. Panfilov, E.V. SkurikhinaStatistical analysis: M.M. LyashenkoDrafting the article: M.M. LyashenkoCritical revision of the article: A.M. Chernyavskiy, D.A. Sirota, B.N. KozlovFinal approval of the version to be published: A.M. Chernyavskiy, M.M. Lyashenko, D.A. Sirota, A.A. Shadanov, B.N. Kozlov, D.S. Panfilov, E.V. Skurikhina

Timing of computed tomography imaging in adult patients with severe trauma: A nationwide cohort study in Japan

PurposeComputed tomography (CT) has become essential for the management of trauma patients. However, appropriate timing of CT acquisition remains undetermined. The purpose of this study was to assess the relationship between time to CT acquisition and mortality among adult patients with severe trauma. MethodsWe conducted a retrospective cohort study using data from the Japan Trauma Data Bank, which had 256 participating institutions from all over Japan between 2004 and 2018. Patients were categorized upon arrival as either severe trunk trauma with signs of shock or severe head trauma with coma and separately analyzed. Cases were further divided into three groups based on time elapsed between arrival at hospital and CT acquisition as immediate (0–29 min), intermediate (30–59 min), or late (≥60 min). Primary outcome was mortality on discharge, and multivariate logistic regression with adjusting for confounders was used for evaluation. ResultsA total of 8467 (3640 in immediate group, 3441 in intermediate group, 1386 in late group) with trunk trauma patients and 6762 (4367 in immediate group, 2031 in intermediate group, 364 in late group) with head trauma patients were eligible for analysis included in the trunk and head trauma groups, respectively. The trunk trauma patients with shock on hospital arrival was 56.4% (4773/8467), and the head trauma patients with deep coma upon EMS arrival was 44.2% (2988/6762). Mortality rate gradually increased from 5.7% to 15.8% with prolonged time to CT imaging among trunk trauma patients. Multivariate logistic regression for death on discharge among trunk trauma patients yielded an adjusted odds ratio of 1.79 (95% confidence interval: 1.42–2.27) for the late group compared to the immediate group. In contrast, among head trauma patients, an adjusted odds ratio was 0.93 (95% confidence interval: 0.71–1.20) for the late group compared to the immediate group. ConclusionCT scan at or after 60 min was associated with increased death on discharge among patients with severe trunk trauma but not in those with severe head trauma.

Prognostic significance of variant left common pulmonary vein after transcatheter pulmonary vein isolation

Left common pulmonary vein is the most common anatomical variant of pulmonary veins that may affect the outcome of pulmonary vein isolation. Our aim was to compare procedural data and outcomes in patients with common trunk versus normal left atrial anatomy for radiofrequency and cryoballoon catheter ablation. Data from patients who underwent pulmonary vein isolation for atrial fibrillation and had a preprocedural cardiac CT scan at our Institution between 01. 10. 2019 and 10. 03. 2022 were retrospectively evaluated. We defined a common trunk where the left superior and inferior pulmonary vein merged at least 5 mm before the left atrial ostium. From the study population (n = 210), data from 42 patients with a left common trunk (LCPV group) and 60 patients with normal left atrial anatomy (control group) were examined. No significant differences were found between the common trunk and the control group in terms of demographic data. There was no significant difference between the two groups in procedural data for radiofrequency and cryoballoon ablation (procedure time, fluoroscopy time, left atrial dwelling time, radiation dose). After radiofrequency ablation, the success rate at 1-year follow-up was 72.0% in the common trunk group and 76.2% in the control group (p = 0.659). For cryoballoon ablation, the success rate was 64.7% and 69.2% for common trunk and normal anatomy, respectively (p = 0.641). There was no significant difference in the procedural parameters and clinical outcome between patients with left common pulmonary vein and those with normal left atrial anatomy. Both radiofrequency and cryoballoon ablation techniques are well suited for this population. Orv Hetil. 2023; 164(4): 140-147.

Comparison of the Effects of Skin Microneedling with Cupping Therapy and Microneedling Alone: An Experimental Study.

Microneedling promotes percutaneous collagen induction; cupping therapy creates negative pressure and leads to increased blood flow in the applied area. The addition of cupping therapy to microneedling is thought to contribute positively to microneedling's effects. This study was carried out to investigate the histologic effects of adding cupping therapy to microneedling. Thirty Wistar rats were divided into five groups, with six rats in each group. One control group and four experimental groups were formed, which are defined as follows: the control group; the single-session microneedling applied to the dorsal trunk group; the 15-minute cupping therapy added to the single-session microneedling group; the microneedling applied over a total of three sessions at 3-week intervals group; and the microneedling with cupping therapy applied over a total of three sessions at 3-week intervals group. Each animal was euthanized at the end of the fourth week following the last treatment, and skin samples were evaluated histologically with hematoxylin and eosin stain and type I and III collagen antibody immunostaining. The addition of cupping therapy to microneedling increased the thickness of the epidermis and dermis. A significant increase in type I collagen immunostaining and the type-I-to-type III collagen ratio was seen only in the single-session microneedling applied to the dorsal trunk group. Cupping therapy did not generate a significant difference in type I collagen immunostaining. No treatment was found to produce a significant increase in type III collagen immunostaining. Cupping therapy can be added to microneedling therapy and used to increase certain desired effects on skin. Microneedling is an easy and effective method to improve skin quality in clinical practice.

Outcomes of the Gore Excluder Iliac Branch Endoprosthesis for Japanese Patients With Aortoiliac Aneurysms: A Study Based on J-Preserve Registry

Purpose: To evaluate the clinical utility of the Gore Excluder iliac branch endoprosthesis (IBE) for Japanese patients with aortoiliac aneurysms. Materials and Methods: This was a multicenter retrospective cohort study (J-Preserve Registry). Patients undergoing endovascular aortic repair using the Gore Excluder IBE for aortoiliac aneurysms between August 2017 and June 2020 were enrolled. Data pertaining to the baseline and anatomical characteristics, technical details, and clinical outcomes were collected from each institution. The primary endpoints were technical success, IBE-related complications, and reinterventions. Secondary endpoints were mortality, aneurysm size change, and reintervention during follow-up. Technical success was defined as accurate deployment of the IBE without type Ib, Ic, or III endoleaks on the IBE sides on completion angiography. A change in aneurysm size of 5 mm or more was taken to be a significant change. Results: We included 141 patients with 151 IBE implantations. Sixty-five IBE implantations (43.0%) had at least one instruction for use violation. Twenty-two patients (15.6%) required internal iliac artery (IIA) embolization for external iliac artery extension on the contralateral side. Of 151 IBE implantations, 19 exhibited IIA branch landing zones due to IIA aneurysms. Mean maximum and proximal common iliac artery (CIA) diameters were 32.9±9.9 mm and 20.5±6.9 mm, respectively. The mean CIA length was 59.1±17.1 mm. The IIA landing diameter and length were 9.0±2.3 mm and 33.8±14.6 mm. The overall technical success rate was 96.7%. There were no significant differences in IBE-related complications (2.3% vs 5.3%, p=0.86) or IBE-related reinterventions (1.5% vs 5.3%, p=0.33) between the IIA trunk and IIA branch landing groups. The mean follow-up period was 635±341 days. The all-cause mortality rate was 5.0%. There were no aneurysm-related deaths or ruptures during the follow-up. Most patients (95.7%) had sac stability or shrinkage. Conclusion: The Gore Excluder IBE was safe and effective for Japanese patients in the midterm. Extending the IIA device into the distal branches of the IIA was acceptable, which may permit extending indications for endovascular aortic aneurysm repair of aortoiliac aneurysms to more complex lesions. Clinical Impact This study suggests clinical benefits of the Gore Excluder IBE for Japanese patients, despite 43% of the IBE implantations having at least one IFU violation.

71. Evaluation of Axonal Regeneration Across a Long Cross-face Nerve Graft in Rats

Purpose: Cross-face nerve grafting is a preferred technique in facial reanimation due to its capability in providing spontaneous action and symmetry to a patient following regeneration. The length of graft used is thought to be involved in differing functional outcomes. The present study evaluates changes in axonal regeneration at different lengths along a cross-face nerve graft. Methods: The sciatic nerve of sixteen adult Sprague Dawley rats was harvested as a 2-cm graft and coapted end-to-end to the proximal main trunk of the facial nerve. Thirteen weeks later, the graft site was re-exposed for sectioning. 5mm segments were taken from the native facial nerve trunk (Group 1), in the nerve graft, just distal to coaptation (Group 2), midway (Group 3), and just proximal to the distal end of the graft (Group 4). The nerve segments were preserved and embedded in paraffin, cut in 1um cross-sections, and stained with 1% toluidine blue for axon counting. After segmentation, the nerve stump was immersed in 4% Fluoro-Gold (FG) for one hour, returned to the head for retrograde labeling over one week. The brains were preserved in 4% PFA/30% sucrose, frozen in OCT, and sectioned in 40um cross-sections. Every third section was taken to avoid double-counting cells, and counter-stained with Fluoroshield PI (PI). Images were taken with a fluorescent microscope using a combined filter, and cells with double-positive stain were counted as regenerated motoneurons. Statistical analysis was performed using unpaired t-tests in GraphPad Prism7. Results: Analysis of the retrograde-labeled regenerated motoneuron counts showed no significant difference between the proximal portion of the graft (3,538 ± 1,969) and the facial trunk (4,128 ± 731) (p=0.67). However, the motoneuron count at the midway point of the graft (1,517 ± 335) and at the distal end (269 ± 293) were significantly lower than in the facial trunk (p=0.01 and 0.006, respectively). Analysis of the nerve biopsies along the length of the graft demonstrated no significant differences in myelinated axon count across the graft with a mean count of 6,207 ± 310 at the nerve trunk, and 6,606 ± 2399 (p=0.76), 6,405 ±2340 (p=0.88), and 7,179 ± 744 (p=0.07) moving farther down the graft segment.

Comparison of Isometric Strength of the Trunk and Hip Muscle Groups in Female Athletes with and without Low Back Pain: A Cross-Sectional Study.

Background: Low back pain (LBP) is a common musculoskeletal disorder in athletes. Reduced strength in hip and trunk muscles has been observed among non-athletes with low back pain. This study aimed to compare the strength of trunk and hip muscles between female athletes with and without LBP and to investigate strength association with disability level in female athletes with LBP. Methods: This cross-sectional study was conducted on 26 female athletes with LBP and 30 female athletes without LBP. The strength of the trunk and hip muscles was measured using a hand-held dynamometer and the impact of LBP on the sports activities and activities of daily living was measured using the Athletes Disability Index (ADI). Data analysis was done using an independent sample t test and the Pearson correlation coefficient. Results: There were no significant differences between groups for trunk and hip muscles strength (p > 0.05). A fair to moderate correlation was seen between the strength of the trunk, hip abductors, flexor and extensors muscles and the scores of the ADI questionnaire in the LBP group (r = -0.26 to -0.48). However, there was no significant correlation between the strength of hip adductor muscles and the scores on the ADI questionnaire. Conclusion: Based on the results, the strength of trunk and hip muscles was not different between athletes with and without LBP. It is recommended that athletes' training be done during functional tasks rather than strengthening a single muscle group.

Strength, Flexibility and Postural Control of the Trunk and Lower Body in Participants with and without Patellofemoral Pain

Patellofemoral pain (PFP) is a frequent knee condition. The aim of this study was to investigate strength, flexibility and postural control in people with and without PFP. Fifty-five participants between 14 and 54 years of age (PFP = 18, control group = 37) were included. Strength and flexibility for all trunk, hip, knee and ankle muscle groups were measured along with postural control outcomes. Analyses were conducted based on the “affected” and “non-affected” leg within-group and between-groups. Between-groups analysis demonstrated a statistically lower strength of trunk muscles (range: 35.8–29.3%, p < 0.001), knee extensors (20.8%, p = 0.005) and knee flexors (17.4%, p = 0.020) in PFP participants. Within-group analysis proved an 8.7% (p = 0.018) greater hip internal rotation strength and ankle extension flexibility (p = 0.032) of the “affected side” in PFP participants. This was, to our knowledge, the first study to investigate the strength of all trunk muscle groups. The results indicate that participants with PFP exhibit impaired strength of trunk muscle groups, along with knee muscle deficits, which may present a rehabilitation target. Clinicians should consider implementing trunk strengthening exercises into PFP programs along with knee-targeting exercise programs.

Рост клонов плюсовых деревьев сосны обыкновенной, отобранных в Нижегородской области по смолопродуктивности

The taxational indicators of clones of plus trees of Scots pine, selected by resin productivity, were studied in comparison with similar characteristics of plants, selected by linear parameters of the trunk. They are represented They are presented in the assortment of the forest seed plantation No. 10 in the Semenovsky forestry of the Nizhny Novgorod region, created in 1984 on a plot with the type of forest growing conditions — B2, and the type of forest — maynikovo-lingonberry pine. In the organization of the work, the principle of the only logical difference was observed, as well as the requirements for the typicality, suitability and expediency of the experience. As a test marker for checking the purity of the clonal composition of the plantation, the value of the angle of attachment of the first-order lateral branches to the trunk was used. The height and diameter of the trunk are taken into account in 571 trees with a continuous list. The distribution of the average values of the analyzed indicators in the vegetative offspring of plus trees compared with each other is not uniform. The highest height (16,70 ± 0,43 m) observed in clones of the K-011 plus tree selected by resin productivity is 2,65 m or 1,19 times higher than the lowest value (14,05 ± 0,44 m) inherent in clones of the K-113 plus tree selected by the same criteria, and 2,02 m or 1,14 times higher than the lowest value (14,23 ± 0,31 m) inherent in clones of the K-171 plus tree selected by the same criteria taxational indicators of the trunk. Differences in the taxational indicators of clones in the group of plus trees distinguished by resin productivity, as well as in the group of trunks distinguished by characteristics, correspond to the level of significant ones, which indicates the specificity of their genotypes. The degree of similarity of the plus trees in terms of trunk parameters is not the same, which indicates a different level of individual non-identity of each of the plus trees in relation to the others in their considered population.

Trunk Rotation Exercises Versus Sit-to-Stand Training with Step-Foot Position on Balance and Gait in Patients with Chronic Stroke

Context: Muscle weakness, decreased range of motion, abnormal muscle tone, incoordination, and multisensory disintegration in stroke patients can lead to balance disturbances, reduced mobility, and higher risk for falls. There is paucity in literature whether trunk rotation exercises or sit-to-stand training protocol would be more beneficial for stroke-related disability. Aims: The aim of this study is to determine the comparative effect of trunk rotation exercises and sit-to-stand training with step-foot position on balance and gait in patients with chronic stroke. Settings and Design: Experimental study was carried out at tertiary care center. Subjects and Methods: Thirty stroke patients were recruited and randomly included in one of the two study groups. Group A was given trunk rotation exercises and Group B received sit-to-stand training with step-foot position for 30 min, 3 times a week, for 4 weeks. Both the groups received conventional physiotherapy for another 30 min. Balance and gait were assessed before and postintervention using the Berg Balance Scale (BBS) and Dynamic Gait Index (DGI), respectively. Statistical Analysis Used: The Mann–Whitney U-test was applied for the comparison of group data. Results: When BBS and DGI were compared at pre-and postintervention time, results were statistically significant for both groups (P < 0.001). However, when between groups posttest scores were compared for BBS and DGI, results were statistically not significant (P > 0.05). Conclusion: Both trunk rotation exercises and sit-to-stand training with step-foot position were equally effective in improving balance and gait in chronic poststroke subjects.

The pedagogical concept «Jena-plan» of P. Petersen

At present, the educational concept «Jena-plan» of a German scholar Peter Petersen (1884-1952) has become widespread in the educational systems of some European countries. It is a technology that aims to change the approach to the organization of education and upbringing of children radically. Two tasks are solved in the issue: to reveal the less known biographical data of P. Petersen, and to characterize the most important features of the pedagogical concept put forward by him. The purpose of the study is to determine its significance in the history of European education. The following methods were used: biographical and retrospective analysis, direct observation in some schools in Germany and the Chech Republic, that use «Jena-Plan» in their practice, as well as an axiological approach. Main results. The concept «Jena-plan» has become quite widespread due to its didactic effectiveness, humanistic orientation and compliance with the age and individual characteristics of children. The technology of using the concept of Peter Petersen on the example of one of the schools in Germany is revealed in the issue. The method of applying the concept in practice, – on the example of «trunk group» and «trunk table» («Stammgruppe» and «Stammtisch» in German), – is shown. The main conclusion of the research is that «Jena-plan» has the prospect of further development in the modern European school. This statement is confirmed by the regular holding of conferences of the movement of adherents of the «Jena Plan», a significant number of schools that fully or partially use the provisions of this concept. Some positive features of this concept can also be used in domestic education.

Pathomechanism of Lower-level Discogenic Groin Pain and Clinical Outcomes of Percutaneous Endoscopic Discectomy for the Treatment of Discogenic Groin Pain

Groin pain can be induced by high-level (L1-L2 or L2-L3) lumbar disc herniation. However, 4.1% of patients with lower-level (L4-L5 or L5-S1) lumbar disc herniation also complained of groin pain. The pathomechanism of groin pain occurring due to lumbar disc herniation at and below the L4-5 levels is still unclear. To investigate the afferent pathways of lower-level lumbar disc herniation induced groin pain. And evaluate the clinical results of transforaminal endoscopic discectomy treatment for discogenic groin pain. This retrospective observational study used an experimental design (institutional review board: HROH 201-C2-100). The research took place in the Laboratory Research Center and spine center at The First Affiliated Hospital of Harbin Medical University. Firstly, 14 adult Wistar rats were randomly divided into 2 groups: control group (the paravertebral sympathetic trunks were preserved) and experimental group (the paravertebral sympathetic trunks were resected). All Wistar rats were intraperitoneally anesthetized, and then 1 (mu)L of fast blue was injected into the dorsal rami of L2 spinal nerves on the right side. Forty hours later, 2 (mu)L of nuclear yellow was injected into the right posterior portion of the L5-L6 intervertebral disc. The L1 and L2 spinal ganglia were sectioned 8 hours later to observe fluorescently double-labeled cells and the effect of paravertebral sympathetic trunk resection. Secondly, 14 adult Wistar rats were anesthetized, and the right posterior portion of the L5-L6 intervertebral disc was electrostimulated to observe potential changes in the genitocrural nerve in the ipsilateral inguinal region. To evaluate the clinical outcomes of transforaminal endoscopic discectomy for the treatment of discogenic groin pain, between September 2015 and May 2017, transforaminal endoscopic discectomy was performed on 30 patients with lower-level discogenic groin pain. Outcomes were analyzed utilizing the visual analog scale, Oswestry disability index, and MacNab Criteria. The total proportion of cells in the right L1 and L2 spinal ganglia with fast blue/nuclear yellow double labeling was 3.33% and 3.41% (48 and 56), respectively. The number of fluorescently double-labeled cells in the resected paravertebral sympathetic trunk group was significantly less (P < 0.01). Electrical stimulation of the right posterior portion of the L5-L6 intervertebral disc could elicit action potentials in the ipsilateral genitofemoral nerve. All patients were followed for 12 months, and the visual analog scale score at 1 week, 1 month, 3 months, 6 months, and 12 months after the operation was 0.79 ± 0.55, 0.54 ± 0.55, 0.47 ± 0.65, 0.51 ± 0.65, and 0.69 ± 0.55, respectively, showing a significant decrease compared with the preoperative visual analog scale score (P < 0.01). Based on the MacNab scoring system, the effective rate was 100%, and the rate of good and excellent results was 93.3%. A relatively small number of patients and a short follow-up period. Discogenic groin pain is transmitted by sympathetic nerves and appears in the area segmentally innervated by the anterior rami of the L1 and L2 spinal nerves. Posterolateral percutaneous transforaminal endoscopic discectomy and radiofrequency thermal annuloplasty are effective minimally invasive alternative treatments for discogenic groin pain.

The role of traditional growing rods in the era of magnetically controlled growing rods for the treatment of early-onset scoliosis.

To describe the clinical and radiographic profile of early-onset scoliosis (EOS) patients treated with traditional growing rods (TGR) during the magnetically-controlled growing rod (MCGR) era. A US multicenter EOS database was reviewed to identify (1) patients who underwent TGR after MCGR surgery was introduced at their institution, (2) patients who underwent MCGR during the same time period. Of 19 centers, 8 met criteria with all EOS etiologies represented. Clinical notes were reviewed to determine the indication for TGR. Patient demographics and pre-operative radiographs were compared between groups. A total of 25 TGR and 127 MCGR patients were identified. The TGR patients were grouped by indication into the sagittal plane profile (n = 11), trunk height (n = 6), co-morbidities/need for MRI (n = 4), and other (ex: behavioral issues, remaining growth). Four patients had a combination of sagittal profile and short stature with sagittal profile listed as primary factor. The TGR short trunk group had a mean T1-S1 length of 192mm vs 273mm for the MCGR group (p = 0.0002). The TGR sagittal profile group, had a mean maximal kyphosis of 61° vs 55° for the MCGR group (p = 0.09). TGR continues to have a role in the MCGR era. In this study, the most commonly reported indications for TGR were sagittal plane profile and trunk height. These results suggest that TGR is indicated in patients of short stature with stiff hyperkyphotic curves. As further experience is gained with MCGR, the indications for TGR will likely be refined.

Analysis of Qualitative Features of Beech and Oak Trunks as a Determinant of the Quality Assessment

Proper quality assessment of timber requires a certain level of knowledge and overview of technical conditions and correct identification and assessment of the qualitative features of trunks. The ratio of the highest quality classes is decreasing. Therefore, increasing the potential financial resources allocated to forest management could lead to the improvement and increase of this ratio. The objective of the study was to identify the frequency and occurrence of limiting features in the group of non-coniferous beech and oak trunks. A further objective was to classify major factors causing and increasing the frequency of occurrence of such limiting marks. Altogether, 969 beech and oak trunks were assessed in the University Forest Enterprise of the Technical University in Zvolen. The dependences of the size and occurrence of individual qualitative features on the selected factors were statistically assessed using the Pearson correlation coefficient and Cramer’s V; significance was established using χ2 test and a significance level α = 0.05. The most frequently occurring features were sweep, knots, and heart shakes. The results of the comparative and statistical analysis indicate that the management of forest stands and interventions carried out in the forest stands affect the occurrence of the negative features being analyzed the most. However, the conditions of the given site (soil, subsoil, and slope) also play a certain role and can affect the technological aspect of the harvest. The obtained results are valid for the conditions of the University Forest Enterprise of the Technical University in Zvolen; however, they can also be applied in a wider range of similar conditions of Central European forest stands.

Exercise for the intervertebral disc: a 6-month randomised controlled trial in chronic low back pain.

Muscle, bone and tendon respond anabolically to mechanical forces. Whether the intervertebral disc (IVD) can benefit from exercise is unclear. To examine whether exercise can beneficially affect IVD characteristics. This is a single-blinded 6-month randomised controlled trial (ACTRN12615001270505) in an exercise and physiotherapy clinic. Forty patients with chronic non-specific low back pain (NSCLBP) are included in this study. The primary outcome was lumbar IVD T2 time (MRI). Secondary outcomes included IVD diffusion coefficient and IVD expansion with short-duration lying. Twenty patients progressively loaded their lumbar IVDs (exercise) via an exercise programme involving progressive upright aerobic and resistance exercises targeting the trunk and major muscle groups and were compared to twenty patients who performed motor control training and manual therapy (control). Testing occurred at baseline, 3months and 6months. Seventeen exercise and fifteen control patients completed the interventions. There were no group-by-time differences in T2 time of the entire IVD (exercise 94.1 ± 10.0ms vs. control 96.5 ± 9.3ms, p = 0.549). Exercise patients had shorter T2 time in the posterior annulus at 6months (82.7 ± 6.8ms vs. 85.1 ± 8.0ms, p = 0.028). Exercise patients showed higher L5/S1 apparent diffusion coefficients and decreased IVD height at 3months (both p ≤ 0.050). After adjustments for multiple comparisons, differences lost statistical significance. Per-protocol and intent-to-treat analyses yielded similar findings. This trial found that 6months of exercise did not benefit the IVD of people with NSCLBP. Based on this index study, future studies could investigate the effect of exercise on IVD in different populations, with different types, durations and/or intensities of exercise, and using different IVD markers. These slides can be retrieved under Electronic Supplementary Material.

Outcomes of the Gore Excluder Iliac Branch Endoprosthesis Using Division Branches of the Internal Iliac Artery as Distal Landing Zones

Purpose: To evaluate the outcomes of the Gore Excluder Iliac Branch Endoprosthesis (IBE) using division branches of the internal iliac artery (IIA) as distal landing zones. Materials and Methods: Between January 1, 2014, and December 31, 2018, 74 patients (mean age 74±7 years; 72 men) treated for aortoiliac or common iliac artery aneurysms had an IBE deployed with distal landing of the side branch within the main trunk (n=60) of the internal iliac artery (IIA) vs within a division branch (n=25). Thirteen (17%) patients received bilateral IBE implantations for a total of 85 vessels evaluated. Early endpoints were technical success, 30-day mortality, 30-day major adverse events (MAEs), and 30-day major access complications. Late endpoints were survival, primary and secondary IIA patency, freedom from IIA branch instability, freedom from new-onset buttock claudication, and aneurysm sac diameter changes. Time-dependent outcomes were reported as Kaplan-Meier curves with differences assessed using the log-rank test. Estimates are presented with the 95% confidence interval (CI). Results: The overall technical success rate was 97%, with 1 technical failure per group (p=0.43). Two patients, one from each group, died within 30 days (p=0.43). No significant differences were seen in the rates of 30-day MAEs (7% vs 17%, p=0.35) or major access complications (9% vs 11%, p>0.99) for patients receiving distal landing in the main trunk vs a division branch, respectively. The mean follow-up for the entire cohort was 19±12 months. The overall 1-year survival rate was 94% (95% CI 74% to 99%). The primary and secondary patency rates at 1 year were 98% (95% CI 88% to 99%) vs 95% (95% CI 72% to 99%, p=0.72) and 98% (95% CI 88% to 99%) vs 100% (p=0.41) for the main trunk vs division branch groups, respectively. Freedom from IIA branch instability estimates were also similar at 1-year follow-up [93% (95% CI 82% to 97%) vs 90% (95% CI 66% to 97%), p=0.29], as were the freedom from new-onset buttock claudication estimates [98% (95% CI 86% to 99%) and 94% (95% CI 67% to 99%), respectively; p=0.62]. Mean sac diameter change was 5.4±5.3 mm, not significantly different between the groups (p=0.85). Conclusion: Use of the posterior or anterior division of the IIA as a distal landing zone for the Gore Excluder IBE was safe and efficacious in the midterm. This technique may permit extending indications for endovascular repair of aortoiliac aneurysms to cases with unsuitable anatomy within the IIA main trunk. Long-term assessment is needed to affirm the efficacy of this technique.

Radiotherapy in the treatment of extracranial hemangiopericytoma/solitary fibrous tumor: Study from the Rare Cancer Network

Background and purposeThe role of radiotherapy (RT) in the treatment of hemangiopericytoma/solitary fibrous tumor (HPC/SFT) is still under debate. We aimed at investigating whether radiotherapy can improve the results in patients operated for extracranial HPC/SFT. Materials and methodsData from patients with HPC/SFT, treated from 1982 to 2012, were retrospectively reviewed within the Rare Cancer Network framework. Actuarial local control (LC), disease-free survival (DFS), metastasis-free survival (MFS) and overall survival (OS) were calculated with Kaplan-Meyer method. Patient and tumor parameters were analyzed by univariate and multivariate analysis. ResultsOf 114 HPC/SFT, 58 (50.9%) occurred in the extremities/superficial trunk and 56 (49.1%) in intra-thoracic/retroperitoneum. Seventy-eight patients (68.4%) underwent surgery only (Sx), and 36 (31.6%) Sx and RT (Sx + RT). Median RT dose was 60 Gy (range 45–68.4 Gy) in 1.6–2.2 Gy fractions. In the extremities/superficial trunk group of patients, actuarial 5-year LC rates were 50.4% after Sx and 91.6% after Sx + RT (p < 0.0001) for LC, and 50.4% after Sx and 83.1% after Sx + RT (p = 0.008) for DFS. In the intra-thoracic/retroperitoneum group of patients, actuarial 5-year rates were 89.3% after Sx and 77.8% after Sx + RT (p = 0.99) for LC, and 73.8% after Sx and 77.8% after Sx + RT (p = 0.93) for DFS. At multivariate analysis, the addition of RT resulted in better LC and DFS in the whole series. The advantage was confirmed for LC in the group of patients affected by extremity/superficial trunk tumors. ConclusionAddition of RT to Sx could improve the prognosis, in terms of LC and DFS, essentially in patients with extremities/superficial trunk tumor locations.

Superior Trunk Block: A Phrenic-sparing Alternative to the Interscalene Block: A Randomized Controlled Trial.

Interscalene nerve blockade remains one of the most commonly used anesthetic and analgesic approaches for shoulder surgery. The high incidence of hemidiaphragmatic paralysis associated with the block, however, precludes its use among patients with compromised pulmonary function. To address this issue, recent studies have investigated phrenic-sparing alternatives that provide analgesia. None, however, have been able to reliably demonstrate surgical anesthesia without significant risk for hemidiaphragmatic paralysis. The utility of the superior trunk block has yet to be studied. The hypothesis was that compared with the interscalene block, the superior trunk block will provide noninferior surgical anesthesia and analgesia while sparing the phrenic nerve. This randomized controlled trial included 126 patients undergoing arthroscopic ambulatory shoulder surgery. Patients either received a superior trunk block (n = 63) or an interscalene block (n = 63). The primary outcomes were the incidence of hemidiaphragmatic paralysis and worst pain score in the recovery room. Ultrasound was used to assess for hemidiaphragmatic paralysis. Secondary outcomes included noninvasively measured parameters of respiratory function, opioid consumption, handgrip strength, adverse effects, and patient satisfaction. The superior trunk group had a significantly lower incidence of hemidiaphragmatic paralysis compared with the interscalene group (3 of 62 [4.8%] vs. 45 of 63 [71.4%]; P < 0.001, adjusted odds ratio 0.02 [95% CI, 0.01, 0.07]), whereas the worst pain scores in the recovery room were noninferior (0 [0, 2] vs. 0 [0, 3]; P = 0.951). The superior trunk group were more satisfied, had unaffected respiratory parameters, and had a lower incidence of hoarseness. No difference in handgrip strength or opioid consumption were detected. Superior trunk block was associated with lower worst pain scores on postoperative day 1. Compared with the interscalene block, the superior trunk block provides noninferior surgical anesthesia while preserving diaphragmatic function. The superior trunk block may therefore be considered an alternative to traditional interscalene block for shoulder surgery.

Effect of Kinesio taping on clinical symptoms in people with fibromyalgia: A randomized clinical trial.

Fibromyalgia syndrome (FMS) is a disorder characterized by chronic widespread pain and muscle soreness. Because of its high prevalence, many therapeutic approaches have been proposed with the aim of improving overall physical function and reducing pain. Since low adherence is one of the major limitations among these patients, treatments that do not interfere with their daily routines, such as KT, would be a feasible option. The main goal of this study was to analyze the effect of Kinesio Tape (KT) on pain, posture, body comfort and quality of life (QoL) in people with FMS. Thirty-five women (between 17 and 70 years of age) with FMS were randomly allocated to two treatment groups, depending on the location of the KT: "Upper trunk group" (UTG) (n= 18) and "Global trunk group" (GTG) (n= 17). The intervention period lasted 3 weeks. Pain, comfort, trunk posture and QoL were assessed before and after the intervention. Both KT treatments were effective in reducing pain and improving neck and shoulder comfort (p< 0.05). The GTG achieved a significant improvement in thoracic comfort (p< 0.05), whereas the UTG experienced a significant improvement in non-dominant side trunk posture and showed a significant improvement in the QoL score (p< 0.05). GT and UT KT applications have positive effects on patients with FMS and may be considered as a suitable treatment option among this population.

The Buffalo Trunk Technique for Aortic Arch Reconstruction

The frozen elephant trunk technique facilitates repair of aortic arch and proximal descending aortic pathologic processes. Commercially available hybrid grafts may simplify this approach by allowing for a single suture line, potentially streamlining the distal anastomosis and improving operative times. However, these devices are currently not readily available in United States. We developed a surgical technique, the Buffalo Trunk, to simplify the frozen elephant trunk procedure that obviates the need for a hybrid graft and decreases operating times. Our technique uses a soft-branched graft along with a stent graft to create a distal anastomosis that incorporates the aorta, stent graft, and soft graft in a zone 2 arch reconstruction. Patient characteristics, operative times, and perioperative outcomes were analyzed. A total of 37 patients underwent the Buffalo Trunk procedure compared with 29 patients who underwent the traditional frozen elephant trunk. Bypass and circulatory arrest times were 34 and 18 minutes shorter, respectively, in the Buffalo Trunk group. Total blood transfusions were lower in the Buffalo Trunk group. The stroke rate was 5% and 30-day mortality occurred in 2 patients. No difference was noted in end-organ dysfunction, morbidity, and mortality between the two techniques. The benefits of a hybrid approach to the frozen elephant trunk can be attained without the complex industry-available technology as presented by our technique, the Buffalo Trunk. Evolution of this approach has facilitated shorter circulatory arrest time and subsequently overall decreased operative times without compromising outcomes.