Vertical Muscle Research Articles

Principles of Abdominal Muscles Training Aimed at their Visualization

Abdominal muscles have many vital anatomical and physiological functions, inclu­ding supporting the trunk and spine, allowing body movement and holding organs in place by regulating internal abdominal pressure. They can be divided into two groups: anterolateral, which include flat and vertical muscles, and posterior abdominal walls muscles. Due to the growing interest in physical activity, many people are looking for a recipe for strong and visible abdominal muscles. To achieve this, a combination of cardiorespiratory, strength, high intensity interval training (HIIT) and strict abdominal muscle exercises, with proper diet and lifestyle is required. The percentage of whole body fat and the level of visceral fat also play an important role in the process of visualization. Exercises for abdominal muscles should be diversified, based on various types of movement and engaging all major muscles. It is recommended to perform training regularly and modify it frequently, taking into account progression and increase in the difficulty level. The purpose of this review is to present the current state of knowledge on this topic in a clear and accessible manner, primarily addressed to those professionally involved in or interested in bodybuilding.

Laparoscopic pelvic surgery after reconstructive surgery with vertical rectus abdominis muscle flap: A case report.

IntroductionPatients who have experienced vertical rectus abdominis muscle (VRAM) flap reconstruction are under risk of the abdominal incisional hernia (donor site hernia), and laparotomy increases the risk.Presentation of the caseWe present the case of a 71-year-old nulliparous woman who experienced radical vulvectomy against extramammary Paget disease and reconstructive surgery with VRAM flap 7 years ago and developed right ovarian tumor. In this case, right ovarian tumor was removed with laparoscopic surgery, instead of laparotomy, and the risk of incisional hernia was successfully minimized.DiscussionIncisional (donor site) hernia after reconstructive surgery using VRAM flap has been reported in between 2 and 10%. While VRAM flap can fill larger amount of skin and subcutaneous tissue to recipient site, the risk of postoperative incisional hernia of abdominal wall is substantial.ConclusionReconstructive surgery of with VRAM flap is required for extramammary vulvar Paget disease expanding wide range, and develops the risk of incisional hernia.Laparoscopic surgery should be applied in patients who have experienced VRAM flap reconstruction and developed pelvic tumor for avoiding the risk of incisional hernia as long as it can be allowed on oncologic aspects such as recurrence.

Outcomes of half-width vertical rectus transposition augmented with posterior fixation sutures for sixth cranial nerve palsy

To describe the experience with half-width vertical muscles transposition (VRT) augmented with posterior fixation sutures. The clinical charts of all patients, who underwent half-width VRT augmented with posterior fixation sutures for sixth cranial nerve palsy from January 2003 to December 2018, were retrospectively reviewed. For each patient, pre- and post-operatively, the largest measured angle was used for the calculations, usually resulting with the angle for distance, except in young infants, where measurements were made at near fixation using the Krimsky test. Fifteen patients met the inclusion criteria for the study, of them 9 (60.0%) had also medial rectus muscle recession at the time of surgery. Mean follow-up period was 21.4±23.2mo (range 1.5-82mo). Preoperative mean esotropia was 51.3±19.7 prism diopter (PD; range 20-90 PD). Postoperative mean deviation on final follow-up was 7.7±20.2 PD (range -40 to 35 PD; P=0.018). In all patients with preoperative abnormal head position, improvement was noted. Ten (66.7%) patients had improvement in abduction and 10 (66.7%) patients reported improvement in their diplopia, by final follow-up. The addition of medial rectus recession was correlated with a larger change in postoperative horizontal deviation compared to baseline (P=0.026). Two (13.3%) patients developed a vertical deviation in the immediate postoperative period which had resolved in one of them. Half-width VRT augmented with posterior fixation suture, with or without medial rectus muscle recession, is an effective and safe procedure for esotropia associated with sixth cranial nerve palsy. A major improvement in the angle of deviation is expected. Most patients will have improvement in their abnormal head position and diplopia.

Risk Factors for Reoperation after Strabismus Surgery among Patients with Thyroid Eye Disease

To examine risk factors for strabismus surgery reoperation in patients with thyroid eye disease (TED). Retrospective cohort study. An insurance claims database was used to identify patients with TED who underwent at least one strabismus operation between 2003 and 2019. We recorded specific muscles operated on, as well as the timing and frequency of reoperations. Cox regressions were used to estimate associations between time to reoperation and patient and primary surgery characteristics. Of the 448 patients who met inclusion criteria, 111 (24.8%) underwent a reoperation. Patients were followed for an average of 5.4 ± 3.0 years after their initial strabismus surgery. The rates of reoperation among patients whose initial surgery involved horizontal muscles only, vertical muscles only, and horizontal and vertical muscles were 29 of 120 (24.2%), 33 of 169 (19.5%), and 49 of 159 (30.8%) respectively (P=.05). The number of muscles operated on initially was the only independent predictor for undergoing a strabismus surgery reoperation (odds ratio, 1.27; 95% confidence interval, 1.03-1.57; P=.03). The number of muscles operated on initially was also associated with shorter time to first reoperation (hazard ratio, 1.22; 95% confidence interval, 1.02-1.46; P=.03). Age at first surgery, time between diagnosis of TED and first strabismus surgery, gender, race, and use of adjustable sutures were not associated with time to reoperation. Approximately 1 in 4 patients with TED require reoperation after strabismus surgery. The number of muscles operated on was the only independent predictor for both undergoing a reoperation and time to first reoperation.

Thermoregulation of ocean sunfish in a warmer sea suggests their ability to prevent heat loss in deep, cold foraging grounds

During behavioural thermoregulation, it has been demonstrated that fish alter their heat exchange rates between warming and cooling. In the case of the ocean sunfish (Mola mola), there is a several-fold difference in the rate of heat exchange between foraging in the deep, cooler water and recovering body temperature at the warmer surface. Increased heat gain during warming has been suggested, but there is also the possibility of preventing heat loss during cooling. To examine this, we measured the vertical movement and muscle temperature of three captive sunfish that were released into the field under warmer conditions and compared them with previously reported sunfish that foraged in cooler deep water. The released sunfish vertically moved from near the surface, where the water temperature was 21–25 °C, to depths of 150–200 m, where the water temperature was 15–17 °C. All sunfish occasionally appeared on the sea surface and sometimes remained at the surface for <41 min. However, they reduced their muscle temperature by diving before their muscle temperature exceeded 21–22 °C, suggesting behavioural thermoregulation using the cooler water temperature at depth. In addition, the feeding events detected by video were limited to depths shallower than 60 m. This is in contrast from previously observed sunfish behaviour, in which fish were reported as recovering their body temperature using warmer temperatures at the surface after foraging in deep, cooler water. The heat-budget models indicated that the whole-body heat-transfer coefficients during warming in this study were similar to those of previously reported sunfish that had recovered their body temperature at the sea surface after foraging in deep, cooler water. In contrast, the heat-transfer coefficients at cooling in this study were higher than those of sunfish foraging in deep, cooler water. This suggests that ocean sunfish may have the ability to prevent heat loss in the physiological regulation of heat exchange rate during thermoregulation, while also indicating that sunfish have the ability to respond to changes in the temperature environment by altering their behaviour and heat exchange rate.

Types of Surgery Performed and Reoperation Rate for Congenital Superior Oblique Palsy: a Claims Database Study.

To investigate types of surgeries performed to treat a presumed congenital superior oblique palsy (SOP) and the reoperation rate. This was a population-based retrospective cohort study using claims data from the United States. Patients who underwent strabismus surgery for a presumed congenital SOP with ≥ 3 months of continuous enrolment after the initial surgery were included. We investigated age, surgical methods and the time interval between the initial surgery and reoperation. The hazard ratios for reoperation were estimated according to the surgical methods using Cox regression analysis. A total of 3,998 patients underwent surgery for presumed congenital SOP; 2,981 (74.6%) on only one vertical muscle (excluding superior oblique). Reoperation was performed on 427 patients (10.7%). Compared to patients who underwent unilateral surgery on one vertical muscle (excluding superior oblique muscle), patients who underwent surgery that included the superior oblique muscle (unilateral 2.08; 95% CI, 1.61-2.67, p < 0.001; bilateral 2.44; 95% CI, 1.40-4.28, p = 0.002) and two or more vertical muscles (excluding the superior oblique muscle) (unilateral 2.99; 95% CI, 2.00-4.49, p < 0.001; bilateral 1.68; 95% CI, 1.23-2.28, p = 0.001) had increased hazard ratios for reoperation. The median period between the initial surgery and reoperation was 168.0 [Q1-Q3 84.0-407.8] days and negatively correlated with patient age at initial surgery (r = -0.199, p < 0.001). The reoperation rate for presumed congenital SOP was 10.7%. Patients who underwent surgery on two or more vertical muscles or the superior oblique muscle had an increased risk of reoperation.

Overcorrection after vertical muscle transposition with augmentation sutures in sixth nerve palsy

To report a series of cases, who developed consecutive exodeviation after vertical muscle transposition (VRT) performed for sixth nerve palsy, describe their management and analyze their outcome.

The rate of superior oblique surgery in children and adolescents with Brown syndrome according to claims data

To determine the rate of superior oblique surgery and how often it is combined with surgery on other extraocular muscles or associated with subsequent strabismus surgeries in children and adolescents with Brown syndrome. This was a population-based retrospective cohort study using the Optum deidentified Clinformatics Data Mart Database (2004-2018) for patients ≤18years of age diagnosed with Brown syndrome who underwent superior oblique surgery as their first strabismus surgery and had at least 6months of continuous enrollment. We assessed sex, age, and the number of included patients by year and by age. Combined and subsequent strabismus surgeries were also investigated. Of 1,007 patients diagnosed with Brown syndrome, 115 (11.4%) underwent superior oblique surgery. The rate of superior oblique surgery was relatively constant between 2004 to 2018. The superior oblique surgery rate was highest in children ≤2years of age with a decreasing rate as age increased. In 45 of 115 patients (39.1%), other extraocular muscles were operated on in addition to the superior oblique muscle. Of 88 patients who underwent superior oblique surgery without concurrent vertical muscle surgery as the first operation, 11 patients (12.5%) subsequently underwent an additional vertical muscle surgery because of newly developed or worsening vertical misalignment. In this study cohort, superior oblique surgery was performed on 11.4% of children and adolescents with Brown syndrome. The number of patients with Brown syndrome and therate of superior oblique surgery decreased as age increased to age 10years.

A Review of Transposition Techniques for Treatment of Complete Abducens Nerve Palsy.

Purpose:To review various types of extraocular muscle transposition procedures for management of strabismus in sixth cranial nerve palsy with little lateral rectus (LR) muscle function, along with their pros and cons.Methods:We performed a comprehensive review of transposition procedures in sixth cranial nerve palsy, based on literature published anytime up to March 2021. A thorough search through PubMed and Cochrane databases was performed. All types of clinical studies on different transposition procedures in LR palsy, were included.Results:Eighty-six original articles in English, with full text or abstracts available, were included in the review, among which 16 are prospective studies, 48 retrospective, 3 review articles, 1 randomized clinical trial, 17 case reports, and 1 letter. Vertical rectus transposition has demonstrated promising results, especially in abduction improvement and expansion of binocular diplopia-free visual field, albeit the possible adverse effects such as anterior segment ischemia, especially in the presence of medial rectus contracture, and induced vertical deviation may become troublesome. Partial muscle transposition, single muscle transposition, and also transposition without tenotomy have all been introduced to reduce the risk of multiple muscle manipulation and ischemia. On the other hand, different adjustable transpositions are being utilized to manage concomitant or induced vertical deviations.Conclusion:Transposition procedures are highly effective in the treatment of esotropia caused by complete LR palsy. Various techniques for vertical muscle transposition have been proposed, with each of them having certain advantages and disadvantages.

Pelvic Reconstruction following Abdominoperineal Resection and Pelvic Exenteration: Management Practices among Plastic and Colorectal Surgeons.

Pelvic reconstruction with a muscle flap significantly improves postoperative outcomes following abdominoperineal resection (APR). Despite it being the gold standard, significant surgeon-selection bias remains with respect to the necessity of pelvic obliteration, flap choice, and ostomy placement. The objective of the study was to characterize management practices among colorectal surgeons (CSs) and plastic surgeons (PSs). Specialty-specific surveys were distributed electronically to CSs and PSs via surgical societies. Surveys were designed to illustrate geographic and specialty-specific differences in management. Of 106 (54 CSs and 52 PSs) respondents (58% Canada, 21% Europe, 14% the United States, and 6% Asia/Africa), significant interdisciplinary differences in practices were observed. Most respondents indicated that multidisciplinary meetings were not performed (74% of CSs and 78% of PSs). For a nonradiated pelvic dead space with small perineal defect, 91% of CSs and 56% of PSs indicated that flap reconstruction was not required. For a radiated pelvic dead space with small perineal defect, only 54% of CSs and 6% of PSs indicated that there was no need for flap reconstruction. With respect to ostomy placement, 87% of CSs and 21% of PSs indicated that stoma placement through the rectus was superior. When two ostomies were required, most CSs preferred exteriorizing ostomies through bilateral recti and requesting thigh-based reconstruction. PSs favored the vertical rectus abdominis muscle (VRAM; 52%) over the gracilis (23%) and inferior gluteal artery perforator (IGAP; 23%) flaps. Among PSs, North Americans favor abdominally based flaps (VRAM 60%), while Europeans favor gluteal-based flaps (IGAP 78%). A lack of standardization continues to exist with respect to the reconstruction of pelvic defects following APR and pelvic exenteration. Geographic and interdisciplinary biases with respect to ostomy placement, flap choice, and role for pelvic obliteration continues to influence reconstructive practices. These cases should continue to be approached on a case by case basis, driven by pathology, presence of radiation, comorbidities, and the size of the pelvic and perineal defect.

Wielding and evaluating the removal composition of common artefacts in EEG signals for driving behaviour analysis

Noninvasive EEG signals provide neural activity information at high resolution, of which human mental status can be properly detected. However, artefacts always exist in brain oscillatory EEG signals and thus impede the accuracy and reliability of relevant analysis, especially in real-world tasks. Moreover, the use of a mature artefact identification method cannot assure impeccable artefact separation; this leads to a trade-off between removing contaminated information and losing valuable information. This study addresses this problem by investigating a simulator-based driving behaviour analysis using a car-following scenario to correlate the EEG-based mental features with behavioural responses. The study develops an architecture for an artefact composition pool and proposes three integrated prediction models to evaluate the removal compositions of the EEG artefacts. Three errors (mean absolute, root mean square, mean absolute percentage) and R-squared index are considered for measuring the performance of the models. The results show that the best-performing composition outperformed the no-removal and all-removal cases by 11.75% and 4.28% improvements, respectively. Specifically, we investigate different common artefacts including eye blinks, horizontal eye movements, vertical eye movements, generic discontinuities and muscle artefacts. The gained knowledge on artefact removal, EEG spectral features and stimuli-response patterns can be further applied to properly manipulate real-world EEG signals and develop an effective brain-computer interface.

Inferior Oblique Recession with 5 mm Loop to Correct Vertical Deviation and Inferior Oblique Overaction Secondary to Superior Oblique Palsy

ABSTRACT Purpose: To evaluate the effect of augmented inferior oblique recession (recession +5 mm loop) on the vertical deviation in primary position (PP) and the inferior oblique overaction (IOOA) in patients with unilateral congenital or acquired superior oblique palsy. Patients and methods: The medical records of patients who underwent unilateral inferior oblique recession with 5 mm loop during 2012 and 2019 were retrospectively reviewed. All patients had small to moderate manifest or intermittent hypertropia in PP and overaction of the inferior oblique muscle of +2 or +3 in lateral gaze. Patients who had combined inferior rectus surgery of the contralateral eye or who had previous vertical muscle surgery were excluded. Results: A total of 26 patients were included. Of these, three patients had combined horizontal muscle surgery. In 22 patients, the superior oblique palsy was congenital or longstanding, in 4 it was acquired and stable for more than 9 months. The mean preoperative vertical deviation in PP at distance and near was 14.7Δ and 11.2Δ, respectively. The mean postoperative vertical deviation was 5.7Δ and 4.1Δ after a mean follow-up of 19 months. The IOOA improved in all patients, 16 patients had an improvement of +2 and 10 patients had an improvement of +1. Conclusion: Inferior oblique recession with a 5 mm loop is a simple and quick technique to correct small to moderate hypertropia in primary position and inferior oblique overaction in contralateral gaze in patients with congenital, longstanding or acquired superior oblique palsy without risk of overcorrection.

Safety analysis of early oral feeding after esophagectomy in patients complicated with diabetes

ObjectiveTo evaluate the safety of early oral feeding in patients with type II diabetes after radical resection of esophageal carcinoma.MethodsThe clinical data of 121 patients with type II diabetes who underwent radical resection of esophageal carcinoma in the department of cardiothoracic surgery of Jinling Hospital from January 2016 to December 2018 were retrospectively analyzed. According to the median time (7 days) of the first oral feeding after surgery, the patients were divided into early oral feeding group (EOF, feeding within 7 days after surgery, 67 cases) and late oral feeding group (LOF, feeding after 7 days, 54 cases). Postoperative blood glucose level, incidence of complications, nutritional and immune indexes, inflammatory indexes, normalized T12-SMA (the postoperative/preoperative ratio of vertical spinal muscle cross-sectional area at the 12th thoracic vertebra level) and QLQ-C30 (Quality Of Life Questionnaire) scores were recorded and compared in the two groups.ResultsThere was no statistical difference in preoperative nutritional index and postoperative complication rates between the EOF and LOF group (p > 0.05). The postoperative nutritional index (ALB, PA, TRF, Hb) and immune index (IgA, IgG, IgM) of the EOF group were higher than those of the LOF group (p < 0.05), and the inflammatory indicators (CRP, IL-6) of the EOF group were significantly lower than those of the LOF group (p < 0.05). Moreover, postoperative T12-SMA variation and QLQ-C30 scores of the EOF group were higher than those in LOF group (p < 0.05).ConclusionsEarly oral feeding is safe and feasible for patients with type II diabetes after radical resection of esophageal cancer, and it can improve short-term nutritional status and postoperative life quality of the patients.

Surgical strategy for third nerve palsy with aberrant regeneration: Harnessing the aberrant power.

Purpose:Our study aimed to evaluate the outcome of contralateral eye (CE) fixation duress squint surgery (FDSS) in third nerve palsy (3rd NP) with aberrant regeneration and compare the postoperative ptosis correction with preoperative ptosis improvement on adduction.Methods:Patients of 3rd NP with aberrant regeneration who underwent CE FDSS between December 2012-July 2015 in a tertiary-care eye hospital with a follow-up period of 1-year were retrospectively studied to analyze preoperative and postoperative details. Surgical success was defined as the correction of ptosis within 1 mm of preoperative ptosis improvement during maximal adduction of the affected eye, postoperative alignment ≤10Δ, and resolution of subjective diplopia in primary position.Results:A total of 14 eyes in 14 patients (mean age 23.6 ± 13.6 years) were included. Mean preoperative exotropia and ptosis in primary position in 14 patients was 53.4 ± 20pd and 4.89 ± 2.9 mm, respectively, and mean hypotropia in 6 patients was 23.67 ± 5.89pd. The mean improvement of ptosis on adduction and supraduction in all patients was 4.07 ± 2.64 mm and 2.89 ± 2.22 mm, respectively (P = 0.213). All patients underwent large recession of CE lateral rectus (mean 12.4 ± 2.7 mm), 9 patients underwent CE medial rectus resection/plication (mean 6.0 ± 0.9 mm) and 6 patients underwent CE superior rectus recession (mean 6.6 ± 0.67 mm). Postoperatively, mean ptosis and exotropia correction was 3.7 ± 2.4 mm (P = 0.000) and 15 ± 9.6pd (P = 0.000), respectively, and mean hypotropia was 2.17 ± 4.02pd (P = 0.000). Surgical success was achieved in 6 patients. Postoperative ptosis correction showed strong positive correlation with preoperative improvement of ptosis on adduction (r = 0.87; P = 0.00).Conclusion:Preoperative lid excursion on adduction in 3rd NP can be regarded as a prognostic sign of the success of CE FDSS which can simultaneously correct both ptosis and squint.

VRAM flap for locally advanced breast cancer

The authors presented a case of a patient with locally advanced breast cancer, with mammary and axillary localization, initially considered non-resectable, with good response after neoadjuvant chemotherapy. Due to the location of the lesion and the need for extensive resection, radical mastectomy was performed, associated with reconstruction with myocutaneous flap of the vertical rectus abdominis muscle. Different therapeutic options, the reasons that determine this choice, and local long-term control were discussed.

Fleur-de-Lys Myocutaneous Flap for Complex Sacral Reconstruction

INTRODUCTION: Massive sacral defect resulting from total sacrectomy presents a reconstructive challenge,1 and in some cases, the use of vertical or transverse Rectus Abdominis Muscle (RAM) flap may not provide enough soft tissue to reconstruct it. The use of Fleur-de-lys flap technique has been described in cases of autologous breast reconstruction and for thoracic wound defects.2,3 The aim of this study is to describe the surgical technique of the combination of Transversal Rectus Abdominis Muscle (TRAM) flap with the Vertical Rectus Abdominis Muscle (VRAM) flap, which assumes the form of a “Fleur-de-lys”, and to identify the population of patients reconstructed by this technique followed sacral resection. METHODS: A retrospective chart review was conducted on patients undergoing oncologic sacral resections followed by Fleur-de-lys myocutaneous flap for soft tissue reconstruction between December 2008 and December 2019. Demographics, clinical and surgical characteristics, postoperative outcomes, and complications were reviewed. RESULTS: Two patients underwent Fleur-de-lys myocutaneous flap to sacral reconstruction. A 44-year-old male and a 31-year-old female, both patients presented with a locally advanced sacropelvic chordoma requiring en bloc total sacrectomy and rectal resection. The mean tumor size was 2,139 cm3, and the soft tissue defect 13920 cm3. Patients underwent pelvic instrumentation with hardware and fibular grafts (1 patient bilateral free fibula flap; the other allograft fibular bone) for spine and pelvic reconstruction followed by pedicled Fleur-de-lys flap. The posterior abdominal wall was reconstructed in 1 patient with Alloderm to avoid bowel herniation. One patient developed a minor abdominal wound dehiscence, managed with dressing change, and wound vac. The other patient presented wound infection and minor dehiscence in the abdominal and sacral requiring surgical debridement with successful healing. The mean hospital stay was 74 days (63–85), and the follow-up was 13 months (7–19). One patient expired after 19 months of the initial surgery. CONCLUSION: The Fleur-de-lys myocutaneous flap obliterates massive soft tissue defects resulted from total sacral resections and avoids the need of other flaps with low morbidity associated. REFERENCES: 1. Kreutz-Rodrigues L, Banuelos J, Saleem HY, et al. The use of vertical rectus abdominis myocutaneous flap for pelvic reconstruction: what are the risk factors for complications? Plast Reconstr Surg Glob Open. 2019;7(8 Suppl):75–75. 2. Marshall DR, Ross DA. A Fleur de Lys modification of the TRAM flap for breast reconstruction. Br J Plast Surg. 1994;47:521–526. 3. Anthony JP, Foster RD. The reconstruction of complex thoracic wounds: a fleur-de-lys modification of the rectus abdominis myocutaneous flap. Plast Reconstr Surg. 2001;107:1229–1233.

Surgical treatment for small-angle vertical strabismus

ABSTRACT To assess the indications for and results obtained with partial vertical recti muscle recession in patients with diplopia and small-angle vertical strabismus. Retrospective study of patients who underwent partial temporal or nasal recession of the superior rectus (SR) or inferior rectus (IR). Outcome was considered favorable when diplopia had resolved in primary position and downward gaze at the end of the follow-up. A total of 17 cases were included. Mean age was 69.11 years (47% women). The diagnoses were fourth nerve paresis (6), hypertropia (3), incomplete third nerve paresis (3), sagging eye (1), age-related strabismus (1), ocular myasthenia gravis (1), and restrictive strabismus after retinal surgery (2). Mean preoperative vertical deviation was 6.11 pd in primary position, and postoperative vertical deviation was 2.05 (the mean difference was statistically significant, p < 0.001). Surgery was performed on the right eye in 29.41% of patients and on the left eye in 70.58%. The SR was treated in 11 cases (temporal pole in 7 and nasal in 4) and the IR in 6 (temporal pole in 3 and nasal in 3). Mean recession was 4.14 mm ± 0.42. Outcome was favorable in 76.47% of cases at the end of the follow-up (mean, 10 months), and the previous torsion was eliminated in 5. No overcorrections were recorded. Partial SR or IR recessions were successful in most cases of small-angle vertical strabismus. There were no overcorrections in primary position gaze.

The difference of surface electromyography data processing method based on simulated manal-lifting-task

Objective: To study the differences of different signal processing method of surface electromyography (sEMG) in judging muscle fatigue. Methods: From July to October 2019, based on the model of simulated manual lifting operation, the original sEMG signals from 13 volunteers of brachial radial muscle, brachial two-headed muscle, triangle muscle, left vertical spine muscle, right vertical spine muscle and lateral femoral muscle were collected in the operation activities. Three different electromyography signal processing methods (all signal from motion beginning to the end, peak signal and ehe specified motion signal) were used to analyze the original data in time domain (RMS) and frequency domain (MDF) , the data difference between different electromyography signal processing methods was analyzed by using Wilcoxon rank and sum test and nonlinear curve fitting method. Results: The age of the subjects of the simulated lifting operation was (24.31±2.02) years old, height (173.78±4.84) cm, weight (66.28±5.58) kg, body mass index (BMI) 21.94±1.58. The thickness of triceps skinfold was (14.08±4.86) mm, and the thickness of the skin fold under the scapula was (15.54±3.59) mm. After processing the original signal data by using different sEMG signal interception methods, the normality test, Levene's test, and the Wilcoxon test showed that, except for the MDF index of the brachial two-headed muscle, the differences in the RMS and MDF signals of the other muscles were statistically significant (P<0.016) . The all signal processing method dealed with data distribution dispersion better than other methods, and the rate of change of RMS signal slope was higher than other methods. Non-linear regression results showed that all signal processing method had low volatility in processing data, and the regression equation had a high degree of fit. Conclusion: Different electromyography signal processing methods have differences. The all signal processing method which intercepts from starting point to the end point of action cycle has the least data volatility, and electromyography time domain and frequency domain index with the highest sensitivity of time, which is suitable for the application of surface electromyography to judge muscle fatigue in dynamic and complex operations.

A Comparative Analysis of Rare Sternalis Muscles: A Case Report

The sternalis muscle is a rare variant in the anterior chest wall located anterior to the vertical muscle. It was found in two cadavers during routine cadaveric dissection of 20 bodies. This finding provided an opportunity to perform a comparative anatomical analysis between a unilateral sternalis muscle on a female versus a bilateral sternalis muscle on a male. Having a better understanding of the anatomical variants can be extremely useful, precisely to avoid misdiagnosing tumors and to assist in landmark identification during surgeries.

Surgical outcomes of three different weakening procedures of inferior oblique muscle in the treatment of unilateral superior oblique palsy

BackgroundTo compare surgical outcomes and complications of three inferior oblique weakening procedures; Inferior Oblique Myectomy (IOM), Inferior Oblique combined Resection-Anterior Transposition (IORAT) and Inferior Oblique Anterior Transposition (IOAT) in the management of unilateral Superior Oblique (SO) palsy.MethodsRetrospective review of medical records of all patients with unilateral SO palsy who underwent one of the aforementioned IO weakening procedures at Benha University hospital was performed. Patients were excluded if surgery was bilateral or combined with other vertical muscle surgery. Primary outcome parameters were improvement of Hypertropia (HT) in primary gaze, side gazes, on alternate head turn, Inferior Oblique Overaction (IOOA), Superior Oblique Underaction (SOUA), correction of head tilt and postoperative complications.ResultsThe review reveals a total of 65 patients with unilateral SO palsy; 54 congenital and 11 acquired, who met the study criteria and were classified into 3 groups; IOM group (24cases), IORAT group (19cases) and IOAT group (22cases). Compared with IOM, both IORAT and IOAT induced significant correction of HT in primary position, ipsilateral gaze, contralateral head tilt and IOOA. IORAT was significantly more effective than IOAT in correction of HT in ipsilateral gaze and contralateral head tilt while there was no statistical difference between the three groups in correction of HT in ipsilateral gaze, contralateral head tilt and SOUA. Postoperative Anti-elevation was significantly recorded following IORAT (6 cases, 31%) than IOAT (3 cases, 13%) and IOM (one cases, 4%).ConclusionsThe IORAT and IOAT were more superior to IOM in correction of IOOA and HT in the primary position and some other gaze positions. However, superiority of IORAT over the other two procedures should be weighed against its significant association with postoperative underaction of IO muscle and anti-elevation syndrome.