Ultra-sound Shear Wave Elastography Tissue Stiffness and Thickness Assessment After Adjuvant Radiotherapy for Breast Cancer Treatment; An Exploratory Study.

Purpose: This research investigated the feasibility of using B-mode ultrasound with shear-wave elastography (SWE) to evaluate the structural and mechanical properties of multiple tissue layers in the pectoral region of women with chronic radiation fibrosis following breast cancer treatment. Method: Nine women between one and five years post unilateral conventional fractionated radiotherapy were evaluated. Both ultrasound and SWE were used to examine the thickness and stiffness of skin, subcutaneous adipose tissue, fascia and muscle in both their irradiated and non-irradiated sides. Linear mixed models were conducted to examine statistical differences in tissue thickness and stiffness between irradiated and non-irradiated sides with the arm resting by the side and also in abduction. Results: Significant differences were found between irradiated and non-irradiated tissues. Irradiated skin was significantly thicker (p=0.020) and stiffer (p<0.001) with the arm by the side. Irradiated subcutaneous adipose tissue was significantly thinner (p<0.001). Irradiated fascia and muscles thinned significantly with the arm moved out to abduction position. Irradiated pectoral muscle was significantly stiffer (p=0.004), this stiffness amplified with arm abduction (p<0.001) where the muscle thinned significantly (P<0.001).Conclusion: Ultrasound with SWE shows potential to provide novel objective evaluation of radiation induced soft tissue fibrosis at multiple tissue layers in the pectoral region. Tissue thickness changes in irradiated tissue were evident in ultrasound images. Quantifying these tissue changes supports research development and introduction of clinical interventions to ameliorate the symptoms of morbidity that is currently considered irreversible.

A Cadaveric study on Rectus Sternalis muscle and its clinical significance in Western part of Tamilnadu state (Kongunadu region)

Background: Rectus sternalis is considered as an unusual accessory or supernumerary muscle which appears either unilateral or bilateral in the anterior thoracic wall of human beings. It varies in length, breadth, thickness and incidence among different races and in both sexes. Regarding its origin and insertion still a clear conclusion has not been reached because some authors says it originates and ascends for insertion while some of them opines it originates and descends for insertion. Clinically, its presence also leads to false diagnosis such as Breast tumours, lipoma etc. Aim of the study: To find out the presence of Rectus sternalis muscle in the anterior chest wall during routine dissection. Materials and Methods: 37 well embalmed and preserved cadavers of both sexes which is used for routine dissection to Phase-I MBBS students were taken into condideration. The pectoral region on either side of sternum was dissected in layers and visualised for the presence of Rectus sternalis. Results: Among 37 cadavers dissected, Rectus sternalis was found in the pectoral region of a male and a female cadaver. In male it appeared bilateral, whereas in female it is unilateral. In both the cases it lie superficial to pectoralis major. Conclusion: The incidence of Rectus sternalis reported from our study was 5.4%. In the earlier days it lead to misdiagnosis and made great challenge to radiologists and surgeons, but now-a days with advancement in imaging techniques its presence can be detected clearly thus avoiding unnecessary expenditure and invitro techniques. Clinically it is also used as pedicle flap in breast reconstructive surgeries. KEY WORDS: Cadaver, Dissection, Pectoral region, Rectus sternalis, sternocleidomastoid.

Impact of acute fonofos exposure on skeletal muscle of zebrafish: Histopathological and biometric analyses

It is widely known that pesticides generally do not show target specificity, and off-target species are strikingly affected by these chemicals. In the current work, histological changes in skeletal muscles of zebrafish (Danio rerio) caused by fonofos, an acetylcholinesterase (AChE) inhibitor organophosphate insecticide, were examined. Zebrafish were treated with 1 mg/L, 2 mg/L and 4 mg/L of fonofos for 96 hours. Skeletal muscle samples were removed from the pectoral region and embedded in paraffin. Sections were stained with Mayer's Hematoxylin and Eosin, Gomori's Trichrome and Periodic Acid Schiff techniques. Histopathological alterations were investigated by light microscopy. Fibrosis, intramyofibrillar vacuoles, disintegrated myofibrils, splitting of myofibers, atrophic and disappeared fibers, histoarchitectural loss, necrosis and progressive decrement in glycogen content were noted. Muscle fiber diameter measurements were also performed. Statistical analysis showed that measured fiber diameters of all fonofos exposed groups were significantly different from the control group, and they decreased in a concentration-dependent manner. These results suggested that fonofos caused significant myoarchitectural impairments in non-target freshwater zebrafish.

Thoracobrachialis- A Cadaveric Study of a Morphological Variation of Pectoralis Major with a Novel Nomenclature and Classification of the Chondroepitrochlearis Muscle

Background: Anatomical variations are not uncommon in the pectoral region but the chondroepitrochlearis muscle has been of special interest in history owing to its rarity. Chondroepitrochlearis is a muscular slip that arises from the lower ribs, the inferolateral aspect of the pectoralis major, or the aponeurosis of the external oblique muscle and crosses the axilla to insert on the medial intermuscular septum or the medial epicondyle of the humerus. Multiple variants of this muscle exist including chondroepitrochlearis, chondrofascialis, costoepitrochlearis, thoracoepicondylaris, chondrohumeralis, etcetera. The objectives is to article aims to simplify and standardize the reporting of the chondroepitrochlearis muscle by proposing a novel nomenclature and classification. In this paper, we also present and discuss a case of chondroepitrochlearis. Subjects and Methods : A prospective study was conducted from 2012 to 2020 in the Department of Anatomy, ESIC MC and PGIMSR, Rajajinagar, to identify anatomical variations in the pectoral region. Results: During routine dissection of a male cadaver, an unusual slip was found on the right side and was identified as chondroepitrochlearis. Conclusion: Since the reporting of this rare muscle has been increasing in live patients, taking into consideration the variability in the presentation of the same anatomical structure, to avoid confusion, we propose a novel, blanket nomenclature- “Thoracobrachialis”. We also propose a clinically relevant classification that is based on the level of insertion of the muscle and the possible neurovascular structures involved.

The Rare Five Finger Pectoralis Nerves: A Case Report

The brachial plexus is a complex network of nerve tissue in the human body that has been reported to vary from person to person. We describe a very rare variation of the brachial plexus found on a routine cadaveric dissection. On the left side of the chest, we identified two lateral pectoral nerves arising from the lateral cord and innervating the pectoralis major muscle; two medial pectoral nerves (MPNs) arising from the medial cord that innervates both pectoral muscles and a communicating branch that connects the lateral and MPN. In addition, this communicating branch had a nerve that innervated the pectoralis minor muscle. Knowing the variations of branching of the pectoral nerves is critical when performing any medical procedure in the pectoral region, such as plastic breast reconstruction surgery after modified radical mastectomy in breast cancer, removal of the pectoral muscles, anesthetizing the brachial plexus, or axillary dissection.

Combined Effects of Water Depth and Velocity on the Accelerometric Parameters Measured in Horses Exercised on a Water Treadmill

Horse trainers often claim that exercise on a water treadmill (WT) leads to a greater muscle power and development compared to terrestrial locomotion, because of the greater viscosity of water compared to air. This research assesses locomotor changes measured with accelerometers fixed in the pectoral region and in the sacrum midline in six horses subjected to exercise sessions of 40 min duration on a WT without water (DT), and with water at the depth of fetlock (FET) and carpus (CAR) with velocities of 6 km/h and at the depth of stifle (STF) at 5 km/h. Another five horses performed the same exercise sessions but always with a velocity of 5 km/h. Total power increased from DT to FET and CAR, without significant differences between CAR and STF depths when the velocity was the same. However, a significant decrease was found when the velocity was reduced. The greater total power with water was distributed mainly to the dorsoventral axis, with significant increases in dorsoventral displacement and dorsoventral power. Both parameters were significantly affected by velocity and water depth. In conclusion, total and dorsoventral powers increased with velocity and water depth, leading to reduction in longitudinal and mediolateral power, during exercise on a WT.

Capacitive resistive electric transfer modifies gait pattern in horses exercised on a treadmill

Background Capacitive resistive electric transfer (CRET), a radiofrequency at 448 kHz, resulted in increased superficial and deep temperature and hemoglobin saturation, faster elimination of metabolic and inflammatory products and enhanced sport performance in humans. This research aims to investigate whether the application of CRET affects the locomotor pattern in horses and to assess whether an accumulative effect appears when two CRET sessions are applied two consecutive days. Methods Nine horses were subjected to two CRET sessions applied in both right and left sides of neck, shoulder, back and croup. The horses were exercised on a treadmill, at walk and at trot, before CRET application and at 2, 6 and 12 h after. A second CRET session was applied next day, and the animals were evaluated again at the same times (i.e. at 26, 30 and 36 h after the first session). Between 5 and 7 days later, the same horses were subjected to a sham procedure and they were evaluated in the same times as in the CRET experiment. During treadmill exercise, locomotor parameters were measured with a triaxial accelerometer fixed in the pectoral region and in the sacrum midline. Results The sham procedure did not affect any of the accelerometric variables studied. CRET applications resulted in greater total powers, which resulted in absolute increased dorsoventral, mediolateral and longitudinal powers. However, a reduction in dorsoventral power expressed as a percentage of total power was found. Stride regularity increased. The greater total power resulted in longer stride length and because the velocity was kept fixed on the treadmill, stride frequency decreased. An accumulative effect of CRET application was only found in stride length and frequency. Conclusions It appears that CRET is a useful technique to enhance power and to elongate the stride at defined walk and trot velocities. The effect of these changes on performance should be studied for horses competing in different sport disciplines.

Use of Calender Extract Cream in Equine Lacerate Wound

Background: Wounds and lacerations are constant in the clinical routine of horses. The treatment of wounds by the second intention is the most common in the equine clinic; it consists in addition to surgical debridement, the use of allopathic or phytotherapeutic healing. In this context, several phytotherapics used in folk medicine have been used with promising results in the equine species, especially marigold (Calendula officinalis L.), recognized by the German scientific committee as antiseptic and healing. The objective of this study was to evaluate the efficacy of the nonionic cream of Calendula officinalis at 2% in an extensive lacerating wound in an equine.Case: A 6-month-old female Quarter Horse, weighing 160 kg, a lacerating wound in the pectoral region of unknown traumatic origin, was treated in the large animal sector of the Veterinary Hospital of Universidade Paranaense (UNIPAR). Clinical examination revealed an exudative wound in the pectoral region, complicated by the presence of environmental organic matter and myiasis, involving transverse pectoral and descending pectoral muscles, with a large tissue separation and exposure of part of the first sternum. After an initial evaluation, a trichotomy was performed around the wound, removal of myiasis and sanitization of the wound with water and PVP-I, which was filled with sterile dressings and covered with a dressing using a tubular mesh. Antibiotic therapy was instituted, along with anti-inflammatory medication and antitetanic serum (5,000 IU). Due to the need for surgical debridement, after previous fasting and general anesthesia followed by site antisepsis, surgical debridement was performed, followed by reduction of dead space with application of standard "Wolf" sutures, for re-approximation of the wound edges was applied suture in Wolf pattern captonated with segments of equipment. In the post-surgical period, topical treatment with nitrofurazone ointment and crystal sugar was instituted. However, after five days of the surgical procedure, there was dehiscence of the wound, at which time another intervention was chosen. After sedation remaining in standard anatomical position, sutures of the same pattern and wire were applied, but captonated with polyester buds and wound dressing was instituted, followed by the application of nonionic cream of marigold (C. officinalis) extract, in the concentration of 2%, twice a day until complete healing of the wound.Discussion: The use of nonionic marigold cream (C. officinalis) 2% showed a significant efficacy, in the case reported, corroborating with literature data that marigold presented an advantage in the inflammatory phase of the healing process, when compared to the other two substances, favored epithelization and demonstrated bactericidal action. This activity is reported to the substances present in C. officinalis, especially the flavonoids, which are phenolic compounds derived from the secondary metabolism of plants. In addition to phenolic compounds such as triterpenes, faradiol esters and taraxasterol are considered responsible for antioxidant, anti-inflammatory, antimicrobial and angiogenic activities, actions that contribute directly or indirectly to the healing process. The present report contributes positively to the use of alternative treatments in wounds as the phytotherapeutic in question, since it proved feasible, besides avoiding the use of allopathic ones with higher associated costs and environmental impact in its production and use, as well as the emergence of bacterial resistance.

Development of Respiration Measuring Robot

In this study, we developed and tested a monitoring robot to measure the respiration of a person. Upon detecting any abnormality, such as a subject falling down of a person, the monitoring robot moves closer to the person. Subsequently, it automatically extracts the pectoral region from the images and determines the respiration using the measured pectoral movements. We demonstrated that our monitoring robot can automatically perform this series of operations.