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Background and Aims: Before performing any surgical or endovascular procedure, the anatomical classification of the patient is essential for treatment planning. Computed Tomographic Angiography (CTA) is a standard method to evaluate thoracic aortic anatomy and associated variations. Methods: This cross-sectional, descriptive study was performed among adult participants without any peripheral vascular diseases undergoing thoracic CTA. Demographic data were collected along with factors retrieved from the patients CTA, such as the type of aortic arch, length, and diameter of ascending and descending aorta, the diameter of the main branches and the distance between branches, the angles by which the main arteries rise from their origins, and left anterior oblique angle of the aortic arch. Results: 164 patients, with a mean age of 57 ± 19.3 years, entered the study. 53 (33.8%) had a bovine arch, which was mostly observed among males. A decrease in the frequency of type I arch and also an increase in the frequency of type 2 and 3 arches was observed with the increase in age (p < 0.001). The BCT diameter had a direct association with both left common carotid artery diameter (r = 0.478, p < 0.001) and left subclavian artery diameter (r = 0.470, p < 0.001). The length of the descending aorta had a direct correlation (r = 0.294, p < 0.001) with the length of the ascending aorta. Conclusion: Complex endovascular interventions are vital method in treating aorta, head, and neck pathologies. Accurate knowledge of thoracic aortic anatomy is becoming crucial for diagnosis and intervention planning.

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Introduction: Activity-based therapy is effective at improving trunk control in children with spinal cord injury. A prototype sensorized rocking chair was developed and confirmed as an activity that activates trunk muscles. This study uses data collected from the chair to predict muscle use during rocking. Methods: The prototype rocking chair included sensors to detect forces, accelerations, as well child and chair movement. Children with spinal cord injury and typically developing children (2-12 years), recruited under an approved IRB protocol, were observed rocking while sensor and electromyography data were collected from arm, leg, and trunk muscles. Features from sensor data were used to predict muscle activation using multiple linear regression, regression learning, and neural network modeling. Correlation analysis examined individual sensor contributions to predictions. Results: Neural network models outperformed regression models. Multiple linear regression predictions significantly correlated (p < 0.05) with targets for four of eleven children with SCI, while decision tree regression predictions correlated for five children. Neural network predictions correlated for all children. Conclusions: Embedded sensors capture useful information about muscle activation, and machine learning techniques can be used to inform therapists. Further work is warranted to refine prediction models and to investigate how well results can be generalized.

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Vascular variations of the coeliac trunk are relatively common, with documented occurrences including trifurcation of the common hepatic artery (CHA) and the presence of accessory and replaced hepatic arteries. This case report describes a novel variation wherein the CHA trifurcates into the proper hepatic artery (PHA), gastroduodenal artery, and accessory PHA (APHA). This particular trifurcation pattern has not been previously recorded. The APHA further branches into two arteries that supply the right lobe of the liver. Additionally, a middle hepatic artery (MHA), originating from the PHA, was identified alongside the right and left hepatic arteries. The MHA serves as a hilar artery that drains segment IV of the liver. This anatomical variant does not conform to any existing coeliac trunk classifications. Understanding this unique arterial pattern is crucial for liver transplantation, as well as procedures involving the pancreas, duodenum, and gallbladder, and for interventional techniques such as transcatheter arterial chemoembolization and transarterial radionuclide therapy.

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[Purpose] This study aimed to clarify the changes in the scapulothoracic joint and upper trunk angles and postural control during right-left hand-behind-back (HBB) movement. [Participants and Methods] The participants were 20 healthy right-handed men. We measured the HBB movement while standing using a three-dimensional motion capture system. Changes in the internal rotation angle of the scapulothoracic joint, upper trunk rotation angle, and center of pressure (COP) were examined to assess potential right-left differences between the analyzed positions. [Results] As the thumb touched the buttocks, upper trunk contralateral and scapulothoracic joint internal rotations were observed and the COP on the non-HBB side was significantly displaced laterally. There were no right-left differences in the changes between the analyzed positions for all measures. [Conclusion] Upper trunk contralateral rotation and postural control were conducted without right-left differences during HBB movement. These results suggest that upper trunk movement and standing postural control are involved in HBB movement. Therefore, it is useful to focus on the scapulothoracic joint angle, upper trunk rotation angle, and standing postural control during physical therapy evaluation and treatment with HBB movement.

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Studies reported the existence of instability catch (IC) during trunk flexion in patients with chronic low back pain (CLBP). However, different movement speeds can cause different neuromuscular demands resulting in altered kinematic patterns. In addition, kinematic characterization corresponding to clinical observation of IC is still limited. Therefore, this study aimed to determine (1) the association between movement speed and kinematic parameters representing IC during trunk flexion and (2) the differences in kinematic parameters between individuals with and without CLBP. Fifteen no low back pain (NoLBP) and 15 CLBP individuals were recruited. Inertial measurement units (IMU) were attached to T3, L1, and S2 spinous processes. Participants performed active trunk flexion while IMU data were simultaneously collected. Total trunk, lumbar, and pelvic mean angular velocity (T_MV, L_MV, and P_MV), as well as number of zero-crossings, peak-to-peak, and area of sudden deceleration and acceleration (Num, P2P, and Area), were derived. Pearson's correlation tests were used to determine the association between T_MV and L_MV, P_MV, Num, P2P, and Area. An ANCOVA was performed to determine the difference in kinematic parameters between groups using movement speed as a covariate. Significant associations (P < 0.05) were found between movement speed and other kinematic parameters, except for Area. Results showed that L_MV significantly differed from the P_MV (P = 0.002) in the CLBP group, while a significant between-group difference (P = 0.037) was found in the P_MV. Additionally, significant between-group differences (P < 0.05) in P2P and Area were observed. The associations between movement speed and kinematic parameters suggest that movement speed changes can alter kinematic patterns. Therefore, clinicians may challenge lumbopelvic neuromuscular control by modifying movement speed to elicit greater change in kinematic patterns. In addition, the NoLBP group used shared lumbar and pelvic contributions, while the CLBP group used less pelvic contribution. Finally, P2P and Area appeared to offer the greatest sensitivity to differentiate between the groups. Overall, these findings may enhance the understanding of the mechanism underlying IC in CLBP.

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BACKGROUND: Trunk lean angle is an underrepresented biomechanical variable for modulating and redistributing lower extremity joint loading and potentially reducing the risk of running-related overuse injuries. The purpose of this study was to systematically alter the trunk lean angle in distance running using an auditory real-time feedback approach and to derive dose-response relationships between sagittal plane trunk lean angle and lower extremity (cumulative) joint loading to guide overuse load management in clinical practice. METHODS: Thirty recreational runners (15 males and 15 females) ran at a constant speed of 2.5 m/s at 5 systematically varied trunk lean conditions on a force-instrumented treadmill while kinematic and kinetic data were captured. RESULTS: A change in trunk lean angle from -2° (extension) to 28° (flexion) resulted in a systematic increase in stance phase angular impulse, cumulative impulse, and peak moment at the hip joint in the sagittal and transversal plane. In contrast, a systematic decrease in these parameters at the knee joint in the sagittal plane and the hip joint in the frontal plane was found (p < 0.001). Linear fitting revealed that with every degree of anterior trunk leaning, the cumulative hip joint extension loading increases by 3.26 Nm·s/kg/1000 m, while simultaneously decreasing knee joint extension loading by 1.08 Nm·s/kg/1000 m. CONCLUSION: Trunk leaning can reduce knee joint loading and hip joint abduction loading, at the cost of hip joint loading in the sagittal and transversal planes during distance running. Modulating lower extremity joint loading by altering trunk lean angle is an effective strategy to redistribute joint load between/within the knee and hip joints. When implementing anterior trunk leaning in clinical practice, the increased demands on the hip musculature, dynamic stability, and the potential trade-off with running economy should be considered.

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Stroke is a disease with high mortality and morbidity that not only causes weakness in the extremities, loss of balance, and disturbances in trunk and postural control, but also affects respiratory function. The aim of this study was to investigate the relationship between trunk and postural control and pulmonary function in subacute stroke patients. Herein, 32 volunteer patients who were diagnosed with hemiplegia by a competent physician after unilateral hemorrhagic or ischemic stroke and who met the inclusion criteria participated in the study. Functional independence of the participants was evaluated using the Modified Rankin Scale (mRS) and their cognitive function was assessed with the Standardized Mini Mental State Examination. Respiratory function was evaluated with spirometric measurements, inspiratory muscle strength was evaluated with intraoral pressure measurements, trunk control was evaluated using the Trunk Impairment Scale (TIS), postural control was evaluated using the Postural Assessment Scale for Stroke Patients (PASS-T), computerized postural sway evaluation, and static posture analysis. A significant correlation was found between the TIS scores and inspiratory muscle strength (p < 0.05). A significant correlation was also found between the PASS-T scores and inspiratory muscle strength and pulmonary function (p < 0.05). All of the COP parameters measured were significantly correlated with the PEF(L/s) and FEF25-75 (L/s) (p < 0.05). In conclusion, this study showed that trunk and postural control are associated with inspiratory muscle strength and pulmonary function. It is recommended that evaluation of trunk and postural control and respiratory functions, as well as exercise training to improve these parameters, should be included in rehabilitation programs for individuals with stroke.

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PURPOSE: To compare trunk flexor, extensor, and lateral flexor muscle endurance between women with moderate to severe disability due to chronic neck pain (CNP) and asymptomatic women. DESIGN: Observational case-control study. METHODS: Thirty women with CNP and Neck Disability Index scores ranging from 30% to 70% and 28 asymptomatic women were included. The visual analog scale was used to assess neck pain intensity at rest and during activity. To assess trunk muscles endurance, trunk flexor endurance test, Sorensen test, and side bridge endurance test were performed. RESULTS: Analysis of covariance indicated that neck pain group had lower body mass index-adjusted endurance times of trunk flexor, extensor, and lateral flexor muscles with large effect sizes (p < .001, η2 = 0.378-0.696). Trunk flexor endurance time showed a moderately negative correlation with neck pain intensity at rest and a weakly negative correlation with neck disability score (r = -460 and -365, p < .05). CONCLUSIONS: Women with moderate to severe disability due to CNP exhibited decreased trunk muscle endurance, which may be a predisposing factor for low back pain. Also, trunk flexor endurance was related to neck pain complaints. A holistic approach, addressing the entire spine rather than focusing solely on the cervical region, might be useful for managing CNP. CLINICAL IMPLICATIONS: The findings of reduced endurance in trunk muscles should consider incorporating interventions in the management of CNP to effectively address pain and disability.

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Presenting this video tutorial, we want to demonstrate a step-by-step surgical approach to acute intramural haematoma of the thoracic aorta without a definite entry tear. Limited by the aortic valve proximally, the intramural haematoma involved the aortic root, ascending aorta, aortic arch, including adjacent parts of supra-aortic branches, and descending aorta extending to the diaphragmatic level. The operative strategy involved urgent total aortic arch replacement with the frozen elephant trunk technique and anatomical reimplantation of the three supra-aortic vessels. The direct open over-the-wire technique was used to cannulate the right axillary artery, and standard venous cannulation was performed while brain protection was achieved with bilateral selective antegrade cerebral perfusion.

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The external carotid artery (ECA) is a major branched artery that supplies head and neck structures. An undocumented variation of the ECA was discovered during cadaveric dissection of the anterolateral cervical region, in which a common origin for the ascending pharyngeal, facial, and lingual arteries was identified. In addition, bilateral, duplicate ascending pharyngeal arteries (APAs) were identified at the aforementioned common trunk and the bifurcation of the external and internal carotid arteries. Anatomical knowledge regarding the location of the APA is essential to physicians, as this vessel is a primary supply source for many skull base tumors and vascular lesions. Furthermore, such anatomical knowledge is essential to physicians, as there have been cases of misdiagnosis regarding APA anomalies as an internal carotid artery (ICA) dissection. In this cadaver, both ECAs exhibited typical branching into the superior thyroid artery (STA), occipital artery, posterior auricular artery, maxillary artery, and superficial temporal artery.

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Nutrients and water are important ecophysiological components for apples' development and productivity. The combination of high-density plantation, drip irrigation, and weekly fertigation not only conserves irrigation water, but also reduces cultivation costs compared to conventional methods. Leaf nutrient analysis provides insight into nutrient levels and assists in determining irrigation and fertigation schedules. We conducted the current research over two years (2021-22 and 2022-23) to evaluate different drip-fertigation effects on leaf nutrient status, vegetative growth, and yield of high-density apples. The experimental study employed a factorial randomised block design, replicating 16 different treatment combinations three times each. Each replication consisted of three plants, and the treatments included four irrigation levels (100 %, 80 %, 60 %, and control) and four fertigation levels (absolute control, 100 %, 75 %, and 50 % of the recommended NPK dosage). Analysis of the leaves indicated that IR1 (Drip irrigation at 100 % ETc) showed notably higher levels of nitrogen at (3.06 %), phosphorus at (0.48 %) and potassium at (2.07 %) compared to other treatments. Regarding fertigation levels, FN1 [100 % (AD) NPK] showed the highest nitrogen (3.12 %), phosphorus (0.50 %), and potassium (2.09 %) content. Parameters related to vegetative growth, including tree height, plant spread in both east-west (EW) and north-south (NS) directions, trunk girth, annual extension growth, and leaf area showed significant increases with higher irrigation and fertigation levels, surpassing conventional irrigation (IR4) by 6.17 percent, 7.78 percent (EW), 8.62 percent (NS), 10.49 percent, 4.53 percent and 1.96 percent, respectively. Among fertigation, FN1- 100 % AD (NPK) registered a maximum increase in growth parameters. Our analysis demonstrated that combining irrigation and fertigation improved leaf nutrient status and vegetative growth characteristics, which are critical determinants of fruit yield.

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The teleost kidneys are anatomically divided into head kidney and trunk kidney, each performing distinct physiological functions. Although previous research has elucidated the role of the head kidney in immune responses, there is a paucity of literature on the comparative studies of the head and trunk kidney response to bacterial infection. Therefore, an Edwardsiella ictaluri infection model of yellow catfish was constructed to investigate and compare the immune responses between the two kidney types. The findings indicated that E. ictaluri infection induced significant pathological changes in both the head and trunk kidney. Despite variances in structure, both the head and trunk kidney of yellow catfish exhibit robust immune responses following E. ictaluri infection. Unexpectedly, the up-regulation level of IgM was found to be higher in the trunk kidney compared to the head kidney. Additionally, both the IgM+ and IgD+ B cells were increased after bacterial infection. This research elucidates the parallels and distinctions in immune functions between both the head and trunk kidney in fish, enriching the immune theory of the fish kidney, and also providing a theoretical basis for the immune response of teleost kidney against bacterial infections.

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Pine nuts, the edible seeds of pines (Family: Pinaceae, Pinus spp.), are popular worldwide, particularly those from the Korean pine tree (Pinus koraiensis), which is economically significant and widely exported. The spread of pine wilt disease (PWD) caused by pinewood nematodes (PWNs) has necessitated the use of trunk injections of pesticides in Korea, raising concerns about pesticide residues in edible pine nuts. This study investigated the concentration of pesticide residues in pine nuts from trunk-injected trees and assessed their potential health risks to consumers. After Korean pine tree was trunk-injected with pesticide, the pine nuts were subsequently harvested and analyzed for pesticide residues using LC‒MS/MS. Short- and long-term risk assessments of trunk-injected pesticides in pine nuts were conducted. Abamectin and emamectin benzoate were not detected, while acetamiprid and sulfoxaflor were detected, but their levels were below the maximum residue limits (MRLs) set by Korea, the EU, and the US. The short-term and long-term risk assessments indicated negligible health risks for consumers from these residues. Despite the low risk, we recommend continued monitoring of pesticide residues in pine nuts intended for sale to ensure consumer safety.

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This multicenter observational study aimed to assess how pain reduction, induced by local anesthesia, affects the relative angular contributions of the shoulder girdle and trunk to the maximal angular performance during a semi-constrained overhead reach task in patients with ongoing shoulder pain. Twenty-nine individuals (age 59.0 SD 12.8 years;16-male) with symptomatic shoulders were administered corticosteroid and lidocaine injections by their attending orthopedic surgeon. Immediately before and after the injections, participants reached for a target on the ceiling ten times as high as possible while their pain levels, shoulder, and trunk movements were recorded. The analysis revealed that there was a significant reduction in pain following the injections. However, there were no significant differences in maximum shoulder and trunk inclination angles between the pre- and post-injection conditions. Notably, there were slight but statistically significant alterations in humeroscapular kinematics during the initial phase of arm elevation following the injections. In conclusion, acute pain relief following local anesthetics is not associated with immediate alterations in maximum shoulder girdle and trunk inclination angles during a semi-constrained overhead reach task in patients with ongoing shoulder pain. However, there are signs of small alterations in humeroscapular kinematics during the initial phase of arm elevation.

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Forest soils are the largest terrestrial sink of methane, but CH4 produced in tree trunks by methanogenic archaea and emitted into the atmosphere can significantly offset CH4 oxidation in the soil. However, our mechanistic understanding of CH4 accumulation in tree trunks, in relation with CH4 emission from the trunk surface, is still limited. We characterised temporal variations in the molar fraction of CH4 in the heartwood of trees ([CH4]HW) of four different species in a mountain forest and addressed the relationship between [CH4]HW and emission from the surface of the trunk (${F}_{CH_4}$), in connection with the characteristics of the wood. [CH4]HW were measured monthly for 15 months using gas-porous tubes permanently inserted into the trunk. [CH4]HW were above ambient CH4 molar fraction for all trees, lower than 100 ppm for seven trees, higher for the nine other trees and greater than 200,000 ppm (> 20%) for two of these nine trees. [CH4]HW varied monthly but were not primarily determined by trunk temperature. Heartwood diffusive resistance for CH4 was variable between trees, not only due to heartwood characteristics but probably also related to source location. ${F}_{CH_4}$were weakly correlated with [CH4]HW measured a few days after. The resulting apparent diffusion coefficient was also variable between trees suggesting variations in the size and location of the CH4 production sites as well as resistance to gas transport within the trunk. Our results highlight the challenges that must be overcome before CH4 emissions can be simulated at the tree level.

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Bike positional configuration changes strongly affect cycling performance. While consensus has emerged on saddle height optimisation, there is none for the relationship between other bike positional variables and cycling performance. Accordingly, this systematic review examines the effect of all major positional variables on performance in cycling, assessing differences between cycling disciplines and sex where possible. The systematic review, conducted per PRISMA guidelines, searched databases including Embase, Web of Science, Medline, and CINAHL, screening 16,578 studies. Of these, 47 were fully analysed. Study quality assessment using the NIH tool revealed none rated "good", 5 "fair" and 33 "poor". The analysis involved 724 participants (90 female, 454 male, 180 sex unstated). Studies focused on trunk angle/upper body position, handlebar height, Q factor, foot position, saddle fore-aft/height, seat tube angle and crank length. Participant cycling disciplines were often unspecified and few papers address women cyclists specifically. Key findings were associated with changing saddle height, trunk angle and saddle fore-aft. For trunk angle, accounting for the biomechanical and physiological effects as well as aerodynamic changes is important. Saddle fore-aft affects the hip angle and trunk angle. There are no clear recommendations for crank length, handlebar height, Q factor or cleat position.

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Objective The intended effect of this investigation is to quantify the efficacy of a four-week program of diagonal pattern exercises in managing trunk impairments and improving gait difficulties in hemiplegic stroke subjects. The study aims to measure changes in trunk stability and gait parameters post-intervention, providing insights into the potential therapeutic benefits of these exercises for stroke rehabilitation. Methodology This experimentation approach encompassing before and the follow-up test evaluations was implemented in this investigation. It was conducted at Madha College of Physiotherapy, Chennai, using convenience sampling to recruit 20 stroke subjects meeting specific inclusion criteria. Participants underwent pre-test evaluations for trunk control and gait. They were then divided equally into two groups for a four-week intervention comprising diagonal pattern exercises or single-plane training. Treatment sessions were administered five days per week for 45 minutes each. Posttest evaluations assessed changes in trunk control using the Trunk Impairment Scale (TIS) and gait parameters via the Timed Up and Go (TUG) test. Results Pretest analysis indicated no substantial baseline variations among the experimental and control groups, affirming their suitability for comparison. Posttest analysis of intervention at a 5% significance level revealed that the experimental group demonstrated a statistically significant improvement in trunk control, as measured by the TIS and TUG test, compared to the control group. The paired t-test results showed significant differences in pre- and posttest values within each group, while the unpaired t-test confirmed the superiority of the experimental group's outcomes, with a P-value < 0.05. This improvement is likely due to the effectiveness of the diagonal pattern exercise in enhancing trunk muscle activity and coordination. Conclusions This study concludes that diagonal pattern training is more beneficial for improving trunk musculature control and locomotory ability in chronic cerebrovascular accident subjects. The exercise program's simplicity, minimal risks, and ease of home application after initial therapist supervision make it a promising therapeutic approach.

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BACKGROUND: Pulmonary artery trunk aneurysm (PATA) is a rare and complex vascular anomaly characterized by the abnormal dilation of the initial portion of the pulmonary artery, posing significant diagnostic and therapeutic challenges. PURPOSE: This clinical case report aims to describe the follow-up of a patient with PATA, emphasizing the role of imaging in diagnosis and monitoring, as well as discussing potential associations with other conditions. RESEARCH DESIGN: The study is designed as a clinical case report, detailing the longitudinal follow-up of a single patient with PATA. STUDY SAMPLE: The subject of this study is a 48-year-old female patient with a history of idiopathic hypertension who developed a PATA. Data Collection and/or Analysis: Since 2010, the patient underwent various imaging exams, including echocardiography, computed tomography, and catheter angiography, to detect and evaluate the aneurysm at different stages. RESULTS: The imaging results indicated a progression of the aneurysm over time, underscoring the importance of imaging in the early identification and monitoring of PATA. The report also explores the possible association of PATA with conditions such as pulmonary hypertension, Behçet's disease, and Hughes-Stovin syndrome, highlighting the diagnostic complexity. CONCLUSIONS: Imaging diagnosis is crucial for the detection, characterization, and monitoring of PATA, providing essential information for selecting appropriate treatment options and achieving a satisfactory prognosis. An individualized treatment approach, considering both medical and surgical options, is necessary based on the clinical characteristics of each patient.

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OBJECTIVE: During total arch replacement (TAR) using frozen elephant trunk (FET) technique with Frozenix for true thoracic aortic aneurysm (tTAA), oversized FET tends to be chosen similar to the endovascular devise selection. However, the oversized FET is considered a risk factor for intimal injury. The appropriate size selection of FET remains insufficiently understood. METHODS: Between October 2014 and March 2022, a total of 49 patients underwent TAR using Frozenix for tTAA. Out of 49 patients, four patients planned to staged surgery were excluded, 19 patients were operated on with an undersized Frozenix compared with the descending aorta (undersized FET group) and in 26 patients an equal or oversized Frozenix was used (oversized FET group). Clinical outcomes and postoperative diameter changes were investigated. RESULTS: In-hospital mortality was 0%. The mean diameter of Frozenix and the descending aorta was 30.7 mm and 28.8 mm, respectively, in the oversized FET group, and 26.7 mm and 30.1 mm in the undersized FET group. Postoperative computed tomography (CT) demonstrated no endoleaks not only in the oversized FET group but also in the undersized FET group. CT also revealed that undersized FET had expanded more than the original diameter in all cases except for two, with an average of 2.47 ± 1.53 mm. Additionally, the descending aorta covered with Frozenix shrank in 10 patients (53%). Postoperative adverse aortic events were not observed. CONCLUSIONS: Undersized Frozenix tightly fit the descending aorta and resulted in complete sealing without endoleaks. Oversized FET is not strictly necessary considering the size-related adverse complications.

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In contrast to Western countries, traditional floor-seating cultures are prevalent in Korea, Japan, the Middle East, and Africa, where sitting on the floor in static positions such as squatting, kneeling, or sitting cross-legged is common. Most studies on sitting posture have predominantly focused on chair sitting in Western cultures, resulting in a cultural bias. This study aimed to investigate the effects of different cushion types (floor and traditional cushions of 3-cm, 5-cm, and 8-cm thickness) and seating postures (cross-legged, mother's leg, and kneeling) on measures of postural stability, trunk muscle activity, rotational spinal stability, and subjective postural stability in an Asian population. Forty right-hand and right-foot-dominant volunteers who did not experience activity-limiting back pain in the past 12 months were recruited. Multivariate analyses of variance (MANOVA) and ANOVA with a repeated-measures design were employed to assess the within-subject effects of the cushion type and seating posture. An alpha value of 0.05 was set for statistical significance. The results of this study suggest that preventing lordosis posture, seating on the floor, and maintaining a kneeling posture may reduce the loss of balance and trunk muscle fatigue. These results emphasize the need for additional ergonomic studies that focus on the seating traditions of Asian cultures.