Superior Trunk Research Articles

Clinical and neuroelectrophysiological characteristics of primary peripheral nerve hyperexcitability syndrome

Objective: To investigate the clinical and neuroelectrophysiological characteristics of patients with primary peripheral nerve hyperexcitability syndrome (PNHS). Methods: The clinical data of 20 patients who were diagnosed with PNHS in Beijing Tiantan Hospital from April 2016 to January 2023 were retrospectively collected. All patients underwent neuroelectrophysiological examinations. Clinical and electrophysiological characteristics were compared between the antibody positive and antibody negative groups, according to serum and cerebrospinal fluid anti-contactin-associated protein-like 2 (CASPR2) and/or anti-leucine-rich glioma-inactivated protein 1 (LGI-1) antibodies. Results: There were 12 males and 8 females, with a mean age of (44.0±17.2) years and the disease course of [M (Q1, Q3)] 2.3 (1.1, 11.5) months. Motor symptoms included fasciculations, myokymia, muscle pain, cramps, and stiffness. These symptoms were commonly seen in the lower limbs (17 patients), followed by upper limbs (11 patients), face (11 patients) and trunk (9 patients). Nineteen (19/20) patients had sensory abnormalities and/or autonomic dysfunction, 13 patients had central nervous system involvement, and 5 patients had concomitant lung cancer or thymic lesions. The characteristic spontaneous potentials on needle electromyography (EMG) were myokymia potential (19 patients), fasciculation potential (12 patients), spastic potential (3 patients), neuromyotonic potential (1 patients), etc, which were commonly seen in the lower limb muscles, especially the gastrocnemius muscle(12 patients). After-discharge potential was found in 8 patients, and 7 were in the tibial nerve. Seven patients had positive serum anti-CASPR2 antibodies, and 3 of them had concomitant anti-LGI1 antibodies. And 1 patient had positive serum anti-LGI1 antibody alone. Compared with patients in the antibody negative group (n=12), the patients who had anti-VGKC complex antibodies (n=8) had a shorter course of disease [M (Q1, Q3): 1.8 (1, 2) months vs 9.5 (3.3, 20.3) months, P=0.012], higher incidence of after-discharge potential (6/8 vs 2/12, P=0.019). The immunotherapy regimen (multi-dru, single-drug, no immunotherapy: 6, 2, 0 patients) in antibody-positive patients was different from the antibody-negative group (3, 6, 3 patients, U=21.00, P=0.023). Conclusions: The symptoms of motor nerve hyperexcitation, characteristic EMG spontaneous potentials and after-discharge potentials in PNHS patients are most commonly seen in the lower limbs. Attention should be paid to concomitant sensory and autonomic nerve hyperexcitation. PNHS patients with positive serum anti-CASPR2 antibodies may require immunotherapy with multiple drugs.

Anatomical distribution and clinical significance of middle cerebral artery M2 segment vessel occlusions and its cortical branches in acute ischaemic stroke patients

BackgroundCharacterisation of anatomical distribution and the clinical impact of middle cerebral artery M2 (MCA-M2) segment occlusion and its subsequent cortical branches (CBs) in acute ischaemic stroke patients (AIS).MethodsRetrospective, monocentric study...

Assessment of the Effectiveness of Jalaukavacharana (Leech therapy) and Shalmali Kantaka Lepa in a Mukhadushika (Acne Vulgaris): A Case Study

ABSTRACT Mukhadushika (acne vulgaris) has been described in the context of Kshudra roga in Ayurvedic classics. It occurs due to the vitiation of Vata and Kapha dosha and Rakta as important Dushyas. Acharya Sushruta has described Mukhadushika as a thorn-like eruption on the face. In the modern system, it can be called as acne vulgaris. It is a chronic inflammatory disease, characterized by papules, pustules, and often scarring, mainly on face, upper trunk, and back. Acne vulgaris is a nearly universal skin disorder affecting 79%–95% population of youths. In the current era, diet and lifestyle changes, stress, increasing pollution, and hormonal changes increases the problem of acne vulgaris. In the present case, the patient was treated with Shalmali Kantaka Lepa once in a day for 21 days and Jalaukavacharana (leech therapy) in four settings during 21 days with 7-day intervals. At the end of the therapy, patients had significant improvement in clinical features. From this case study, it can be concluded that seeks the attention of researchers to carry out the same therapeutic measures on lager sample sizes for fruitful clinical output.

Multi-segment bioimpedance in the evaluation of treatment for secondary lower limb lymphedema: Gynecological cancer

<b>Aim</b>: The present aimed study was to report the mobilization of body fluids after five days of intensive treatment for secondary lower limb lymphedema.<br /> <b>Materials and methods</b>: A crossover clinical trial was conducted involving the analysis of changes in intracellular and extracellular fluids in all extremities and the trunk in women with lower limb lymphedema secondary to treatment for gynecological cancer. Evaluations were performed with multi-segment bio impedance analysis before and after intensive treatment using Godoy Method® eight hours per day for five days. Comparisons were made using Wilcoxon signed-ranks test.<br /> <b>Results</b>: Significant changes in intracellular and extracellular fluids were found in all extremities and the trunk (p<0.0001 for all comparisons).<br /> <b>Conclusion</b>: Intensive Godoy Method® leads to important changes in the distribution of body fluids in the treatment of lower limb lymphedema following treatment for gynecological cancer, with a significant increase in fluids in the upper limbs and trunk as well as significant reductions in the lower limb and in intracellular and extracellular water.

Effect of Neck and Upper Trunk Exercises in the Management of Mechanical Low Back Pain

Effect of Neck and Upper Trunk Exercises in the Management of Mechanical Low Back Pain

Superior Trunk Block: Ultrasound Guided Novel Approach for Shoulder Surgery

Superior Trunk Block: Ultrasound Guided Novel Approach for Shoulder Surgery

The Evolution of the Reconstructive Strategy for Elbow Flexion for Acute C5, C6 Brachial Plexus Injuries over Two Decades.

Over the course of the past two decades, improved outcomes following brachial plexus reconstruction have been attributed to newer nerve transfer techniques. However, key factors aside from surgical techniques have brought improved consistency to elbow flexion techniques in the latter decade. One-hundred seventeen patients who underwent brachial plexus reconstruction from 1996 to 2006 were compared with 120 patients from 2007 to 2017. All patients were evaluated preoperatively and postoperatively to assess the recovery time and of elbow flexion strength. In the first decade, nerve reconstruction methods included proximal nerve grafting, intercostal nerve transfer, and Oberlin-I transfer. In the second decade, newer methods such as double fascicular transfer and ipsilateral C7 division transfer to the anterior division of upper trunk were introduced. About 78.6% of the first decade group versus 87.5% of the second decade group were able to reach M3 flexion strength (p = 0.04), with shorter time recovery to reach M3 in the 2nd decade. About 59.8% of the first decade group versus 65.0% of the second decade group were able to reach M4 (p = 0.28), but no significant difference in time of recovery. In both groups, the double fascicular nerve transfer had the highest impact when introduced in the second decade. More precise magnetic resonance imaging (MRI) techniques helped to diagnose the level of injury, the roots involved and evaluate the health of the donor nerves in preparation for intraplexus transfer. In addition to modified techniques in nerve transfers, (1) MRI-assisted evaluation and surgical exploration of the roots with (2) more judicious choice of donor nerves for primary nerve transfer were factors that ensured reliable and outcomes in the second decade.

Effect of the physical rehabilitation program based on self-care ability in patients with acute ischemic stroke: a quasi-experimental study

IntroductionIt is the most practical goal of limb rehabilitation for stroke patients to make the upper limb, trunk, and lower limb joints link together as a whole and restore the ability to self-care. However, many previous studies focused on the single joint or single muscle group movement of stroke patients and did not integrate self-care ability training into the whole process of rehabilitation, which lacks accuracy, integrity, and systematization.MethodsA quasi-experimental study was conducted in a tertiary hospital. Eligible patients were recruited according to the inclusion criteria and exclusion criteria and then divided into an experimental group (n = 80) and a control group (n = 80) by the medical district. The control group received the routine physical rehabilitation intervention. The experimental group adopted the physical rehabilitation program based on self-care ability led by the nurses specializing in stroke rehabilitation to carry out the multi-joint coordinated exercise based on the control group. The training time and frequency were the same in both groups (45 min per session, one session per day for three consecutive months). The primary outcome was myodynamia. Secondary outcomes were the modified Barthel Index (MBI) and Stroke Specific Quality of Life Scale (SS-QOL). The primary and secondary outcomes were assessed before the intervention and at 1 and 3 months of intervention. In this study, the TREND checklist was followed for non-randomized controlled trials.ResultsA total of 160 participants completed the study. The physical rehabilitation program based on self-care ability was better than the routine rehabilitation program. With the prolongation of intervention time, all outcomes improved gradually in the experimental group (P < 0.05), and the myodynamia of lower limbs recovered faster than that of upper limbs. In the control group, the myodynamia of the affected limb was not significantly improved (P > 0.05), with only a small increase in MBI and SS-QOL scores (P < 0.05).ConclusionThe physical rehabilitation program based on self-care ability after stroke was beneficial for acute ischemic stroke patients and improved the patient's myodynamia, quality of life, and self-care ability within the third month.

Key points of development of motor skills in childhood embodied in gait parameters

ObjectiveTo observe changes of correlations of gait parameters of four sets of body in children aged 3–6. DesignA cross-sectional observational study. SettingDong Gang kindergarten in Suzhou, China. ParticipantsA total of 89 children between 3 and 6 years old. Main outcome measuresA total of 37 three-dimensional (3-D) gait parameters assessed with a wearable gait analysis system in 2-min walking test, for 3 times. ResultsThere were significant differences in gait speed, stride length and sagittal range of motion (ROM) of trunk among children of 3–6 years old (P < 0.05). The left and right toe out angle, sagittal ROM of waist, coronal ROM of trunk and arm swing velocity of male were significantly greater than those of female children (P < 0.05). Most gait parameters were symmetrical (P < 0.01). Canonical correlations of Upper Limbs Set vs. Trunk and Waist Sets increased by ages (P < 0.05). Canonical correlation of Trunk Set vs. Waist Set decreased by ages. Canonical correlations of Lower Limbs Set to any other sets were not significant (P > 0.05). ConclusionsValues and symmetry of gait parameters cannot reflect the development of motor skill during ages of 3–6. Proper trunk movement coordinating with upper limbs and isolating from waist is the key point of development of motor skill in walking. It is built during preschool period and girls develop better. Before the preschool period, lower limbs’ isolating movements from the other segments have already developed well. These key points of motor skills in walking should be considered when motor tasks for segment isolation and coordination are given to children with motor dysfunction.

Frequency, facilitators, and barriers for range of motion to prevent shoulder contracture in brachial plexus birth injury: A pilot study.

This pilot study investigated the efficacy of passive range of motion (PROM) during the first year of life to prevent development of shoulder contractures in children with brachial plexus birth injury (BPBI) and identified facilitators and barriers to caregiver adherence with daily PROM. Five caregivers of children with upper trunk BPBI participated in retrospective interviews about the frequency with which they performed PROM during their child's first year of life including facilitators and barriers to daily adherence. Medical records were reviewed for documentation of caregiver-reported adherence and documented evidence of shoulder contracture by age one. Three of the five children had documented shoulder contractures; all three had delayed initiation or inconsistent PROM in the first year of life. Two without shoulder contractures received consistent PROM throughout the first year of life. Making PROM part of the daily routine was a facilitator to adherence while family contextual factors were barriers. Absence of shoulder contracture may be related to consistent PROM throughout the first year of life; decreased frequency of PROM after the first month of life did not increase the risk of shoulder contracture. Consideration of family routines and context may facilitate adherence with PROM.

Accessory Subscapularis muscle compressing posterior division of upper trunk: A rare presentation

Presence of additional or accessory muscles near the axilla can lead to compression of vital structures of the axilla. Opposite conventional thoughts, it seems that the subscapularis muscle (SM) is the most variable muscle of the rotator cuff group. Accessory Subscapularis muscle is one of the rare variants of the Subscapularis muscle. Presence of this variant (ASsm) can cause abnormal clinical presentation. During routine dissection of the axilla in a female cadaver in the Department of Anatomy, Muzaffarnagar Medical College, we found an additional slip or accessory subscapularis muscle, arising from the anterolateral part of the Subscapularis and running upward and medially, finally attached to the coracoid process (palpated tip). During its course, it passed through the Brachial plexus and caused compression of the posterior division of the Upper trunk. This type of accessory slip or accessory subscapular muscle can cause compression neuropathy, or this accessory slip can be used during the repair of a ruptured Subscapularis or any other adjacent muscle. Keywords: Accessory Subscapularis Muscle, Rotator Cuff Variants, Brachial Plexus Compression

Bilateral Becker’s Nevus Over the Scalp: A Rare Encounter

ABSTRACT Becker’s nevus is a cutaneous smooth muscle hamartoma characterized by a unilateral, hyperpigmented, and hypertrichotic patch that commonly affects the upper trunk. It most commonly presents during puberty and sometimes it may be present since birth. We, hereby, report a case of late onset bilateral Becker’s melanosis over the scalp which is an unusual site.

A 63-Year-Old Female Presenting to the Emergency Department with Massive Facial Swelling and Dyspnea

A 63-year-old woman presented to the emergency department with acute dyspnea and progressive swelling of the face (Figure 1), neck, and upper trunk [...]

Successful management of Australian patients with locally advanced keratinocyte cancer (KC) and/or extensive skin field cancerization (ESFC), using widefield volumetric arc radiation therapy (VMAT): Report with 24-month follow-up.

9586 Background: Keratinocyte cancer (KC) diagnoses are associated with an elevated risk of developing new skin lesions. Patients with extensive skin field cancerization (ESFC) have large areas (generally ≥50cm2) of actinic keratoses and often, frequent keratinocyte cancers, necessitating repeated interventions. Volumetric modulated arc radiation therapy (VMAT) can precisely target large, complex surfaces with modulated doses, as required, leading to its increasing application to ESFC +/- KC. This is a follow-up 24-month report on the efficacy, safety, cosmetic, and quality of life outcomes of VMAT in the management of patients with ESFC +/- KC at Australian facilities. Methods: Two hundred and twenty-four fields for 194 patients with ESFC +/- KC have been prescribed widefield VMAT and prospectively enrolled in the National (Australian) Dermatology Radiation Oncology Registry (NDROR). One hundred and six fields are now beyond 24-months post-treatment. Over 80% of patients had received up to 4 prior non-radiotherapy interventions. Fields included lower and upper limb, face, scalp, or trunk regions. 3-, 6-, 12-, 18-, and 24-month follow-up assessments rated the percentage of field clearance, lesion response, new lesion events, cosmesis using the Lovett’s scale, toxicity based on CTCAE, and quality of life as assessed using a EQ-5D-5L visual analogue scale (VAS). Results: Median dose delivered to ESFC-only and ESFC + KC fields were 45 Gy (16.2-60 Gy) and 47 Gy (22-60 Gy), respectively, in 25 daily fractions (7-30) across 7 weeks (2-13). At 24-month follow-up of 106 fields, 96% and 94% of ESFC-only and ESFC + KC fields, respectively had clinical success, defined as &gt; 90% field clearance. Cosmesis was graded excellent or good in 98% of fields. The incidence of new KC within the field out to 24-months was 11%. Grade 1-2 radiation dermatitis was induced in all fields during treatment, but resolved by 3-month follow-up. Six percent of fields exhibited grade 3 dermatitis. Twelve percent of patients discontinued treatment due to acute toxicities (Median 88% dose delivered). The most common persistent toxicity at 24-month follow-up was localized grade 1-2 xerosis (51%), alopecia (43%), and/or pruritis (8%). Quality of life was sustainably improved in patients at 24-month follow-up (3.67; p= 0.026). Conclusions: Widefield VMAT has a promising profile of clinical efficacy, safety, and cosmesis in patients with ESFC +/- KC for whom other therapies had failed. Treatment was also associated with significant and durable improvements in quality of life. While long-term follow-up of patients continues, these results provide further support for widefield VMAT as a suitable option for patients with increasingly unmanageable presentations of ESFC and locally-advanced KC. Clinical trial information: ACTRN12618000627257 .

Association between the primary site of disease and the stage at diagnosis for merkel cell carcinoma: A population-based analysis.

e21600 Background: Merkel cell carcinoma [MCC] is a rare, aggressive skin cancer with a high rate of recurrence, metastasis, and poor prognosis. It commonly involves the head and neck (HN) region (41% of diagnosed cases), followed by the upper and lower extremities and trunk in decreasing frequency. We used the Survival, Epidemiology, and End Results [SEER] November 2021 database to assess the incidence, cause-specific survival, and the association between the primary site of disease and the stage at diagnosis for primary MCC. Methods: Using the SEER-November 2021 (17 registry) database, a retrospective analysis was performed on the 4120 cases of pathologically confirmed MCC (ICD-O-3 code 8247), diagnosed between 2004-2015. Baseline characteristics were assessed using the Chi-squared test and the Kruskal-Wallis test. Multivariate multinomial logistic regression was performed to evaluate the association, with alpha at 0.05. Analysis was performed using SEERStat and SAS 9.4. Results: The overall age-adjusted incidence rate (IR) of MCC was 0.4 cases per 100,000 with an observed 5-year survival [OS] of 47.8% and cause-specific 5-year survival [CSS] of 68.7%. The median age at diagnosis was 79 years (interquartile range - 66,83) with a male preponderance (60.4%). At baseline, males had higher odds of being diagnosed at stages III or IV (p &lt; 0.001). The odds of being diagnosed at stages II, III, or IV were significantly higher in patients with the trunk as the primary site compared to the HN region with an OR 3.8 (p &lt; 0.001), 2.4 (p &lt; 0.001), and 2.2 (p = 0.001), respectively. For patients with the upper limb as the primary site, the odds of being diagnosed at stage II were 1.4 times higher than the HN region (p = 0.0095), and stage IV was 0.4 times (p = 0.03) higher. For the lower limb and hip, the odds of being diagnosed at stages II, III, or IV were significantly higher than the HN region with an OR 2.6 (p &lt; 0.001), 1.6 (p &lt; 0.0005), and 1.5 (p = 0.04), respectively. Conclusions: While less prevalent than the MCC of the HN region, patients with MCC of the trunk, upper or lower extremities had a higher probability of being diagnosed with an advanced-stage malignancy compared to the former. Additional prospective studies are required to investigate this association further and explore its significance in site-specific treatment approaches and survival factors. [Table: see text]

A novel recognition of artificial intelligence in regional anaesthesia

Mechanised analysis of algorithms for problem solving, object recognition and decision-making assistance defines the general concept underlining artificial intelligence (AI).[1] The former presents notable applications in perioperative medicine across diverse situations like depth of anaesthesia monitoring, closed-loop anaesthesia delivery, risk-predictive models, pain-management through objective analgo-scoring, operating-room planning logistics and, guidance of perioperative ultrasonography. The recent Food and Drug Administration (FDA) approval[2] of the Scan Nav™ Anatomy Peripheral Nerve Block (PNB) system (Intelligent Ultrasound Group, Cardiff, United Kingdom)[3] only emerges as a novel recognition of the potential of AI in regional anaesthesia. Worthwhile to mention, Hemmerling et al.[4] described an encouraging seminal use of the robotic ultrasound-guided nerve block system or the Magellan system, almost a decade ago. Employing the same system, Morse et al.[5] went on to compare the performance parameters (learning curve and success rates) and subjective performance variability of manual versus robot-assisted ultrasonographic nerve blocks in a phantom model. The authors found that assistance of nerve blocks, enabled significant faster needle guidance (1.8 [1.6] seconds vs. 0.3 [0.3] seconds; P = 0.007), than for manual blocks. Inter-subject performance variability was also found to be considerably attenuated. Specific to the context of the recently FDA approved software medical device, ScanNav™ Anatomy PNB system uses deep-learning AI technology. During performance of a peripheral nerve block the ScanNav™ system identifies and grades a live ultrasound image using this technology. A distinctive colour overlay of the key sono-anatomical structures during a live ultrasound scan is a characteristic valuable attribute of the system.[3] This enhances standardisation and accuracy of the ultrasound image interpretation. This device colour highlights anatomy of 10 vital regions relevant to ultrasound-guided regional anaesthesia namely Interscalene, Supraclavicular, Axillary and Superior Trunk Brachial plexus of the upper limb; Erector Spinae Plane, Rectus Sheath and Supra-inguinal Fascia Iliaca sheath of truncal structures; and Femoral Nerve, Adductor canal and Popliteal nerve sheath of the lower limb. Furthermore, a 3-dimension inbuilt reference material provides a review of the relevant anatomy, probe-positioning technique; and demonstrates a virtual scan of the selected anatomical region. The system enables adjustments in the intensity of coloured highlighting according to user preference and allows for viewing the unmodified and highlighted images side-by-side for better comprehension of the sono-anatomy. The use of ScanNav™ system thereby facilitates as a labelling device alongside real-time anatomy visualisation during regional anaesthesia. The system also has inbuilt virtual scans that assist the clinician functioning as a 3D reference material of the relevant PNB anatomy scanned. Notably so, the software is compatible with the general-purpose ultrasound systems in addition to being a stand-alone device. Talking of the literature relevant to the ScanNav™ Anatomy PNB system, Bowness et al.[6] compared 240 ultrasound scans performed across 15 expert versus non-expert regional anaesthesia providers on evaluating its' role in promoting the uptake and generalisability of ultrasound-guided regional anaesthesia. The authors outlined that non-experts were more likely to submit positive feedback and less likely to submit negative reviews than the experts (P = 0.001). Positive feedbacks were obtained on the role of the device in training (37/60, 61.7%) and utility for teaching (30/60, 50.0%). Meanwhile the non-experts appreciated the anatomic structure identification and learning, as the contextual benefits, some nonexperts and experts thought the device could decrease the scanning confidence. Additionally, expert providers reported a potentially increased, yet insignificant, risk in 12/254 (4.7%) vs. 8/254 (3.1%, P = 0.362) scans for needle trauma to “safety” structures. The discussion elaborates the tremendous opportunity AI has to offer in guiding regional anaesthesia, awaiting prospective validation outside the core 10 block areas. The utility of this device can be further extended to sympathetic blocks like the stellate-ganglion, celiac-plexus and other blocks for treatment of chronic pain syndromes like complex regional pain syndrome. The times might not be distant when perioperative physicians have routine access to ultrasound machines integrated with AI-assisted colour reframing for anatomical landmark “coding” side by side with the present B-mode, M-mode and colour/pulse Doppler profiling.

Tackle direction and preferred side affect upper body loads and movements in rugby union tackling

ABSTRACT Tackling in Rugby Union is associated with most match injuries. New tackle regulations have been explored to reduce injuries, but limited quantitative evidence is available to inform any law changes. Using a novel tackle simulator, we investigated upper body loading under different tackling conditions: direction of approach (0° - frontal, 45° and 90° to the ball carrier direction) and side of body (dominant vs. non-dominant). Peak impact force between tackler and simulator , and head and upper trunk segment motions were measured from 10 male players. Impact load averages were 17% higher at (0°) compared with (90°), across the two different tackling sides (p = 0.093), with the highest impact force measured during dominant-side shoulder tackles at 0° (5.63 ± 1.14 kN). Trunk resultant accelerations were higher (+19%, p = 0.010) at 0° compared with 90°, with the highest resultant acceleration measured in frontal tackles with the dominant shoulder (17.52 ± 3.97 g). We observed higher head lateral bending around the impact when tackling with the non-dominant shoulder at 45° (p = 0.024) and 90° (p = 0.047). Tackling from an offset angle from frontal may be safer. Deficiencies in tackling techniques on the non-dominant side should be reduced.

The effect of reclined seatback angles on the motion of booster-seated children during lateral-oblique low-acceleration impacts

Belt-positioning boosters (BPB) may prevent submarining in novel seating configurations such as seats with reclined seatbacks. However, several knowledge gaps in the motion of reclined child occupants remain as previous reclined child studies only examined responses of a child anthropomorphic test device (ATD) and the PIPER finite element (FE) model in frontal impacts. The aim of this study is to investigate the effect of reclined seatback angles and two types of BPBs on the motion of child volunteer occupants in low-acceleration far-side lateral-oblique impacts.Six healthy children (3 males, 3 females, 6–8 years, seated height: 66±3.2 cm, weight: 25.2±3.2 kg) were seated on two types of low-back BPB (standard and lightweight) on a vehicle seat and restrained by a 3-point simulated-integrated seatbelt on a low-acceleration sled. The sled exposed the participants to a low-speed lateral-oblique (80° from frontal) pulse (2 g). Three seatback recline angles (25°, 45°, 60° from vertical) with two BPB (standard and lightweight) were tested. A 10-camera 3D-motion-capture system (Natural Point Inc.) was used to capture peak lateral head and trunk displacements and forward knee-head distance. Three seat-belt load cells (Denton ATD Inc) captured peak seatbelt loads. Electromyography (EMG, Delsys Inc) recorded muscle activation. Repeated Measure 2-way ANOVAs were performed to evaluate the effect of seatback recline angle and BPB on kinematics. Tukey’s post-hoc test for pairwise comparisons was used. P-level was set to 0.05.Peak lateral head and trunk displacement decreased with the increasing seatback recline angle (p < 0.005, p < 0.001, respectively). Lateral peak head displacement was greater in the 25° compared to the 60° condition (p < 0.002) and in the 45° condition compared to the 60° condition (p < 0.04). Lateral peak trunk displacement was greater in the 25° condition than the 45° condition (p < 0.009) and the 60° condition (p < 0.001), and in the 45° condition than the 60° condition (p < 0.03). Overall peak lateral head and trunk displacements and knee-head forward distance were slightly greater in the standard than the lightweight BPB (p < 0.04), however these differences between BPBs were small (∼10 mm).Shoulder belt peak load decreased as the reclined seatback angle increased (p < 0.03): the shoulder belt peak load was statistically greater in the 25° condition than the 60° condition (p < 0.02). Muscle activation from the neck, upper trunk, and lower legs showed great activation. Neck muscles activation increased with the increase in seatback recline angle. Thighs, upper arms, and abdominal muscles showed small activation and no effect of conditions.Child volunteers showed decreased displacement suggesting that reclined seatbacks placed the booster-seated children in a more favorable position within the shoulder belt in a low-acceleration lateral-oblique impact, compared to nominal seatback angles. BPB type seemed to minimally influence the children’s motion: the small differences found may have been due to the slight difference in heights between the two BPBs. Future research with more severe pulses is needed to better understand reclined children’s motion in far-side lateral-oblique impacts.

The differential effects of upadacitinib treatment on skin rashes of four anatomical sites in patients with atopic dermatitis

BackgroundUpadacitinib is an oral Janus kinase (JAK) 1 inhibitor approved in Japan for moderate-to-severe atopic dermatitis (AD), and it provides a high therapeutic efficacy.ObjectivesWe compared the therapeutic effects of upadacitinib on skin rashes of individual anatomical sites, head and neck, upper limbs, lower limbs, and trunk in patients with AD.MethodsFrom August 2021 to December 2022, 65 Japanese patients with moderate-to-severe AD (aged ≥ 12 years) were treated with oral once daily upadacitinib 15 mg plus twice daily topical corticosteroids of moderate-to-strongest classes.ResultsThe eczema area and severity indexes (EASIs) of individual sites decreased significantly at weeks 4, 12, and 24 compared to those at week 0 in parallel to total (whole body) EASI. The achievement rates of EASI 75 at week 24 and of EASI 90 at week 12 of lower limbs were significantly higher than those of trunk. The percent reductions of EASI of lower limbs at weeks 12 and 24 were significantly higher than those of head and neck and of trunk.ConclusionsAmong the four anatomical sites, the treatment responsiveness to upadacitinib in lower limbs appeared the highest, while those in trunk and in head and neck appeared relatively lower.

Sweet Syndrome - A Review of Pathogenesis, Clinical Features, Diagnosis and Treatment

Sweet syndrome is a rare, inflammatory, non-infectious skin disorder characterized by an acute onset of skin leasions such as painful, erythematous plaques, nodules and papules, most frequently located on the upper extremities, trunk, neck and face. Generally, dermatological symptoms are accompanied by fever, headaches, arthralgia and leukocytosis. The syndrome belongs to the group of febrile neutrophilic dermatoses. Skin biopsy reveals a diffuse, neutrophilic infiltrate in the upper dermis. Sweet syndrome presents in three clinical subtypes: classical, malignancy-associated and drug-induced. The etiology of this disease still remains unclear, but it seems that can be associated with dysfunction of the immune system, genetic predispostion and neoplastic process. Sweet syndrome has been reported in relation to pregnancy, drug administration, vaccinaton and infection of the respiratory or digestive system. Systemic glucocorticosteroids still remain the first line treatment for most patients, nevertheless new therapeutic options against reccurent Sweet syndrome have been investigated.