BACKGROUND: Control of humeral torsion can present a challenge, especially intraoperatively during closed reduction and fixation of humeral shaft fractures or 2-part surgical neck fractures of the proximal humerus. The objective of this study is to develop and validate an indirect method for the assessment of humeral torsion using an index that is linearly correlated with rotational arm position and can be derived from only a single plain radiographic image of the proximal humerus.
METHODS: The Humeral Head Offset Index (HHOI) is calculated as the ratio of the medial and lateral offset of the humeral head measured from the outer cortices of the shaft on a plain radiographic or fluoroscopic image. The relationship of HHOI with humeral torsion was first verified on a sawbone model with radiopaque characteristics under fluoroscopic control. Different degrees of retroversion were simulated through manual rotation of the humerus with a digital protractor in 5° increments until 40° internally rotated and then in 5° increments until 40° externally rotated from the neutral position. The same procedure was subsequently performed digitally on Digitally Reconstructed Radiographs (DRRs) from computed tomography (CT) dataset of the sawbone. Next, the HHOI index was applied to eight randomly selected patients with total humerus CT using the same method. Spearman\'s rho was calculated for the bivariate analysis of correlation between the simulated degree of retroversion and the HHOI. Strength of correlation was classified according to Koo and Li. Interrater and intrarater reliability of three blinded observers with repetition of measurement after three months were analyzed by assessing the intraclass correlation coefficient (ICC).
RESULTS: Both in the sawbone model and in DRRs, we demonstrated a high to very high significant linear correlation between simulated retroversion and the HHOI. ICC values demonstrated excellent interrater reliability and excellent intrarater reliability for measurement of the HHOI.
CONCLUSIONS: The HHOI is a new, simple, reliable index that has a linear relationship to the rotation of the humerus and can therefore allow an indirect control of humeral torsion in comparison to the contralateral side.

Pulmonary sequestration with torsion is a rare condition. We describe a seven-month-old baby presenting excessive crying for pulmonary sequestration with torsion. Contrast-enhanced chest computed tomography demonstrated an oval-shaped mass in the posteromedial right lower chest, no systemic arterial supply was evident. The edge of the mass showed slight linear reinforcement, and its interior had no reinforcement. Thoracoscopic segmentectomy was carried out and histology confirmed pulmonary sequestration with torsion.

Torsion and rupture are life-threatening emergencies in rudimentary horn pregnancy, an extremely rare type of ectopic pregnancy. This case report aims to share the diagnosis and treatment of a patient, with torsion and ruptured horn pregnancy in a setting, with limited resources. It highlights the challenges faced and the strategies employed to ensure appropriate care. A 38-year-old woman, gravida 2, para 1, presented to the Obstetric and Gynaecology (OBGYN Department of Hiwot Fana University Hospital with a diagnosis of uterine rupture after she presented with a complaint of pushing down pain of 1 h, decreased fetal movement of 1-day duration, and with sudden and severe lower abdominal pain and distension. Conservative management was chosen, but deteriorating symptoms necessitated an emergency laparotomy, confirming a ruptured rudimentary horn pregnancy and surgically excising the horn. Ruptured rudimentary horn pregnancy with torsion is an extremely uncommon and perilous obstetric emergency that necessitates swift diagnosis and surgical intervention. For advanced primitive horn pregnancy, laparotomy combined with horn removal continues to be the gold standard of therapy. Healthcare providers can improve patient outcomes and alleviate the burden of life-threatening conditions by promoting multidisciplinary collaboration and embracing innovative, technologically advanced techniques.

Current clinical examination of low back pain (LBP) patients primarily relies on static clinical examinations, which rarely represent the dynamic postures patients adopt during daily activities. To gain an overview on the dynamic kinematics-kinetics changes over a day, the lumbar back kinematics of asymptomatic individuals and LBP patients were measured over 24 h, and the passively resisted bending and torsional moments were estimated. 208 asymptomatic subjects (115 females) and 116 LBP patients (71 females) were analysed. Compared to static upright standing, the mean lumbar lordosis of asymptomatic subjects drops significantly by 21° during everyday life (p < 0.01). Maximum bending moments of 44.0-50.6 Nm were estimated at the L2-L3. LBP patients showed significantly lower (p < 0.01) lumbar flattening during daily life of about 16°. Maximum bending moments of 27-52 Nm were found at the L3-L4. The initial static upright lumbar lordosis was significantly lower in LBP population (by 6°) resulting in almost similar average lumbar shapes during daily activities in both groups. The torsional movements were with 2.2° greatest in L1-L2 independent of sex (p = 0.19) and LBP (p = 0.54) with moments of 6-16 Nm. The lumbar profile and associated internal moments during daily life differ substantially from those recorded during clinical examinations. LBP patients demonstrates significantly lower lordosis at the snapshot assessment and significantly lower movement variations and internal moments during daily life. Only the dynamic long-term assessments unravelled a less flexed posture in LBP population. Apparently, such a reduced dynamic flexed posture indicates a compensatory habit for pain relief.

UNASSIGNED: Torsion of the right middle lobe following right upper lobectomy is a rare but potentially fatal complication. To prevent this, fixation of the right middle lobe has been suggested. This study was performed to examine the impact of right middle lobe fixation on postoperative outcomes and bronchial changes.
UNASSIGNED: We enrolled patients who underwent curative-intent video-assisted thoracic surgery (VATS) right upper lobectomy for lung cancer from 2019 to 2022. Participants were grouped based on whether they did or did not receive right middle lobe fixation. Bronchial angles were measured using preoperative and postoperative chest computed tomography images, and postoperative outcomes and bronchial changes were compared between the 2 groups.
UNASSIGNED: The study included a total of 50 patients, with 17 (34%) undergoing right middle lobe fixation. All procedures were performed using VATS. No significant differences between groups were observed in preoperative characteristics or postoperative outcomes. After surgery, both groups exhibited a significant increase in the right bronchus intermedius angle and a significant decrease in the branch angle. The postoperative right bronchus intermedius angle was significantly larger in the group without right middle lobe fixation compared to the group with fixation (47.38°±10.98° vs. 39.41°±9.21°, p=0.014). Three cases of atelectasis occurred in the group that did not undergo fixation while no cases were observed in the fixation group; however, this difference was not statistically significant.
UNASSIGNED: Fixation of the right middle lobe reduced postoperative angulation of the right bronchus intermedius, which may help prevent postoperative atelectasis.

UNASSIGNED: Wandering spleen (WS), characterized by abnormal mobility due to laxity of its ligaments, is a rare condition often presenting diagnostic challenges. Its complications, such as torsion and infarction, necessitate prompt recognition and management to prevent life-threatening outcomes.
METHODS: We report a case of a 45-year-old female presenting with acute abdominal pain, constipation, and a palpable mass in the right iliac fossa. Imaging revealed a torsion of a wandering spleen, a rare occurrence exacerbated by delayed diagnosis despite a decade of symptoms.
UNASSIGNED: Diagnostic imaging, including abdominal ultrasound and CT scan, played a crucial role in confirming the ectopic spleen and guiding surgical intervention. Immediate laparotomy revealed a twisted spleen necessitating splenectomy due to non-viability post-detorsion attempt.
CONCLUSIONS: This case underscores the importance of considering wandering spleen in the differential diagnosis of acute abdominal pain, especially in patients with chronic intermittent symptoms. Surgical intervention remains the definitive treatment, emphasizing the risks associated with conservative management in preventing complications.

BACKGROUND: Retroperitoneal leiomyomas (RLs) are rare benign tumours that can occur in the pelvic and/or abdominal parietal retroperitoneum. Once torsion occurs, it causes acute abdominal pain and can even lead to serious consequences such as gangrene, peritonitis, haemoperitoneum and shock if not identified and treated promptly. Therefore, a better understanding of the characteristics of RL torsion is needed. Here, we present a case of acute pedicle torsion of an RL in the posterior peritoneum followed by a literature review.
METHODS: Herein, we report the case of a 42-year-old woman with RL torsion. The patient visited our hospital complaining of lower abdominal pain for 6 d. Pelvic examination revealed a tender mass superior to the uterus. Pelvic magnetic resonance imaging (MRI) revealed an anterior uterine mass, multiple uterine fibroids and slight pelvic effusion. MRI suggested the possibility of a subserosal myoma of the anterior uterine wall with degeneration. Intraoperative exploration revealed a 10 cm pedunculated mass arising from the posterior peritoneum, with the pedicle torsed two times. Pathological examination confirmed a torsed RL.
CONCLUSIONS: In the case of a pelvic mass complicated with acute abdomen, the possibility of torsion should be considered.

BACKGROUND: Leiomyoma torsion is an incredibly rare entity. Diagnosis is frequently intraoperative due to poor correlation between clinical symptoms and radiological findings. We report a case of a twisted uterine leimyoma diagnosed intraoperatively.
METHODS: Our patient was 46 years old, nulliparous woman, presented to the emergency department with three days of acute pelvic pain. On physical examination, a firm and tender pelvic mass was palpable, extending below the umbilicus, suggestive of uterine origin. Laboratory investigations revealed an inflammatory response. Ultrasound identified a large abdomino-pelvic mass adherent to the right side of the uterus, with no detectable blood flow on Doppler examination. Given the diagnostic uncertainty, exploratory laparoscopy was performed. The diagnosis of a pedunculated Leiomyoma torsion with acute appendicitis was confirmed. Initially we performed a fibroid detorsion then a myomectomy and appendectomy were performed.
UNASSIGNED: The torsion of the vascular pedicle of a subserous leiomyoma can lead to ischemic gangrene and peritonitis, which can cause mortality. The risk factors that contribute to the fibroid torsion include the size, the stalk of the pedunculated myoma that must be thin and long in order for it to undergo rotation and torsion. There are no specific clinical signs or imaging modalities that reliably indicate the diagnosis. A diagnostic laparoscopy is most often indicated in case of diagnostic doubt. Surgery may consist in myomectomy or hysterectomy.
CONCLUSIONS: It is important to consider the possibility of torsed leiomyoma in the differential diagnosis in any woman presenting with an intra-abdominal and pelvic mass with acute abdomen.

In this case report, we present an unusual clockwise torsion of left colon around mesenteric root in a 10-month-old Arab filly, highlighting the clinical presentation, diagnostic approach and successful surgical intervention. A 10-month-old Arab filly weighing approximately 250 kg was referred with signs of acute abdominal pain. The history revealed anorexia, restlessness and severe abdominal pain that had begun the previous day. The local practitioner had previously administered flunixin meglumine, an analgesic, but it proved ineffective in relieving the pain. Upon physical examination, the filly exhibited sweating, a body temperature of 38.5°C, tachycardia (65 beats per minute) and tachypnea (25 breaths per minute). Due to the severity of the colic and the lack of response to the conservative treatments, surgical intervention was deemed necessary. An exploratory midline celiotomy was performed to evaluate the abdominal organs. During the examination, no obvious primary lesions were identified in the evaluated organs. However, a restriction in exteriorizing the left colon\'s length was observed. Further examination revealed an unusual clockwise torsion of the left colon that displaced in left to the right side around the mesenteric root; thereby, pelvic flexure was located in the normal anatomical position with a short length. To the best of our knowledge, this is the first reported case of clockwise torsion and an atypical displacement of the left colon in horses. The surgical correction of the displacement was successfully performed. The filly showed improvement post-surgery and did not exhibit any complications during the recovery period.

The design space of two-dimensional materials is undergoing significant expansion through the stacking of layers in non-equilibrium configurations. However, the lack of quantitative insights into twist dynamics impedes the development of such heterostructures. Herein, we utilize the lateral force sensitivity of an atomic force microscope cantilever and specially designed rotational bearing structures to measure the torque in graphite and MoS2 interfaces. While the extracted torsional energies are virtually zero across all angular misfit configurations, commensurate interfaces of graphite and MoS2 are characterized by values of 0.1533 and 0.6384 N-m/m2, respectively. Furthermore, we measured the adhesion energies of graphite and MoS2 to elucidate the interplay between twist and slide. The adhesion energy dominates over the torsional energy for the graphitic interface, suggesting a tendency to twist prior to superlubric sliding. Conversely, MoS2 displays an increased torsional energy exceeding its adhesion energy. Consequently, our findings demonstrate a fundamental disparity between the sliding-to-twisting dynamics at MoS2 and graphite interfaces.