CLINICAL SCIENCE
Variation of the Anthropometric Index for pectus excavatum relative to age, race, and sex
Eduardo Baldassari RebeisI,
, Jose Ribas Milanez de CamposI, Luis Felipe Pinho MoreiraI, Antonio Carlos PastorinoII, Paulo Manuel Pêgo-FernandesI, Fabio Biscegli JateneI
Corresponding author
I Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Instituto do Coração (HCFMUSP-INCOR), Departamento de Cardiopneumologia, Ambulatório do Serviço de Cirurgia Torácica, São Paulo/SP, Brazil
II Instituto da Criança do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Pediatria, São Paulo/SP, Brazil
Read
1090
Timeswas read the article
364
Total PDF
726
Total HTML
Share statistics
array:24 [ "pii" => "S1807593222016246" "issn" => "18075932" "doi" => "10.6061/clinics/2013(09)07" "estado" => "S300" "fechaPublicacion" => "2013-09-01" "aid" => "1624" "copyright" => "CLINICS" "copyrightAnyo" => "2013" "documento" => "article" "crossmark" => 0 "licencia" => "https://creativecommons.org/licenses/by-nc/3.0/" "subdocumento" => "fla" "cita" => "Clinics. 2013;68:1215-9" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "itemSiguiente" => array:19 [ "pii" => "S1807593222016258" "issn" => "18075932" "doi" => "10.6061/clinics/2013(09)08" "estado" => "S300" "fechaPublicacion" => "2013-09-01" "aid" => "1625" "copyright" => "CLINICS" "documento" => "article" "crossmark" => 0 "licencia" => "https://creativecommons.org/licenses/by-nc/3.0/" "subdocumento" => "fla" "cita" => "Clinics. 2013;68:1220-4" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">CLINICAL SCIENCE</span>" "titulo" => "Thymosin ß<span class="elsevierStyleInf">4</span> expression in colorectal polyps and adenomas" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "1220" "paginaFinal" => "1224" ] ] "contieneResumen" => array:1 [ "en" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig1" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1182 "Ancho" => 755 "Tamanyo" => 273221 ] ] "descripcion" => array:1 [ "en" => "<p id="spara10" class="elsevierStyleSimplePara elsevierViewall">Hyperplastic and serrated hyperplastic polyps: A), B) No immunoreactivity for Tβ<span class="elsevierStyleInf">4</span> was observed in hyperplastic and serrated hyperplastic glands of the polyps analyzed. Scattered mast cells showed an intense and granular positivity for Tβ<span class="elsevierStyleInf">4</span> (OM X250 and X 100). Adenoma with low-grade dysplasia: C) at low magnification, the diffuse cytoplasmic immunoreactivity for Tβ<span class="elsevierStyleInf">4</span> was restricted to the dysplastic crypt epithelium (OM x100); D) at higher magnification, three main patterns of reactivity for Tβ<span class="elsevierStyleInf">4</span> were observed in the dysplastic glands: perinuclear spots, cytoplasmic granules and homogeneous cytoplasmic immunostaining (OM x400); adenoma with high-grade dysplasia: E) at low magnification, intense cytoplasmic immunoreactivity for Tβ<span class="elsevierStyleInf">4</span> was observed in the cytoplasm of dysplastic cells (OMX100); F) at higher magnification, diffuse and homogeneous Tβ4 immunoreactivity was observed in the cytoplasm of dysplastic glands (OMx400); adenocarcinoma: G) at higher magnification, peri-nuclear spot-like reactivity for Tβ4 was observed in the cytoplasm of the neoplastic nest (OMx400); H) perinuclear spot-like reactivity for Tβ4 was observed in the cytoplasm of the infiltrating tumor glands. Fine granular immunoreactivity was detected in the stroma surrounding the infiltrating tumor glands (OMx250).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Sonia Nemolato, Tiziana Cabras, Angelo Restivo, Luigi Zorcolo, Eliana Di Felice, Daniela Fanni, Clara Gerosa, Irene Messana, Massimo Castagnola, Gavino Faa, Giuseppe Casula" "autores" => array:11 [ 0 => array:2 [ "nombre" => "Sonia" "apellidos" => "Nemolato" ] 1 => array:2 [ "nombre" => "Tiziana" "apellidos" => "Cabras" ] 2 => array:2 [ "nombre" => "Angelo" "apellidos" => "Restivo" ] 3 => array:2 [ "nombre" => "Luigi" "apellidos" => "Zorcolo" ] 4 => array:2 [ "nombre" => "Eliana" "apellidos" => "Di Felice" ] 5 => array:2 [ "nombre" => "Daniela" "apellidos" => "Fanni" ] 6 => array:2 [ "nombre" => "Clara" "apellidos" => "Gerosa" ] 7 => array:2 [ "nombre" => "Irene" "apellidos" => "Messana" ] 8 => array:2 [ "nombre" => "Massimo" "apellidos" => "Castagnola" ] 9 => array:2 [ "nombre" => "Gavino" "apellidos" => "Faa" ] 10 => array:2 [ "nombre" => "Giuseppe" "apellidos" => "Casula" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1807593222016258?idApp=UINPBA00004N" "url" => "/18075932/0000006800000009/v1_202212010704/S1807593222016258/v1_202212010704/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S1807593222016234" "issn" => "18075932" "doi" => "10.6061/clinics/2013(09)06" "estado" => "S300" "fechaPublicacion" => "2013-09-01" "aid" => "1623" "copyright" => "CLINICS" "documento" => "article" "crossmark" => 0 "licencia" => "https://creativecommons.org/licenses/by-nc/3.0/" "subdocumento" => "fla" "cita" => "Clinics. 2013;68:1210-4" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">CLINICAL SCIENCE</span>" "titulo" => "Acute effects of physiotherapeutic respiratory maneuvers in critically ill patients with craniocerebral trauma" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "1210" "paginaFinal" => "1214" ] ] "contieneResumen" => array:1 [ "en" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig1" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1334 "Ancho" => 797 "Tamanyo" => 67868 ] ] "descripcion" => array:1 [ "en" => "<p id="spara10" class="elsevierStyleSimplePara elsevierViewall">Design and flow of participants through the clinical trial.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Manoel Luiz de Cerqueira Neto, Álvaro Vieira Moura, Telma Cristina Fontes Cerqueira, Esperidião Elias Aquim, Álvaro Reá-Neto, Mirella Cristine Oliveira, Walderi Monteiro da Silva Júnior, Valter J. Santana-Filho, Rosana Herminia Scola" "autores" => array:9 [ 0 => array:2 [ "nombre" => "Manoel Luiz" "apellidos" => "de Cerqueira Neto" ] 1 => array:2 [ "nombre" => "Álvaro Vieira" "apellidos" => "Moura" ] 2 => array:2 [ "nombre" => "Telma Cristina Fontes" "apellidos" => "Cerqueira" ] 3 => array:2 [ "nombre" => "Esperidião Elias" "apellidos" => "Aquim" ] 4 => array:2 [ "nombre" => "Álvaro" "apellidos" => "Reá-Neto" ] 5 => array:2 [ "nombre" => "Mirella Cristine" "apellidos" => "Oliveira" ] 6 => array:2 [ "nombre" => "Walderi Monteiro" "apellidos" => "da Silva Júnior" ] 7 => array:2 [ "nombre" => "Valter J." "apellidos" => "Santana-Filho" ] 8 => array:2 [ "nombre" => "Rosana" "apellidos" => "Herminia Scola" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1807593222016234?idApp=UINPBA00004N" "url" => "/18075932/0000006800000009/v1_202212010704/S1807593222016234/v1_202212010704/en/main.assets" ] "en" => array:20 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">CLINICAL SCIENCE</span>" "titulo" => "Variation of the Anthropometric Index for <span class="elsevierStyleItalic">pectus excavatum</span> relative to age, race, and sex" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "1215" "paginaFinal" => "1219" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Eduardo Baldassari Rebeis, Jose Ribas Milanez de Campos, Luis Felipe Pinho Moreira, Antonio Carlos Pastorino, Paulo Manuel Pêgo-Fernandes, Fabio Biscegli Jatene" "autores" => array:6 [ 0 => array:4 [ "nombre" => "Eduardo Baldassari" "apellidos" => "Rebeis" "email" => array:1 [ 0 => "eb.rebeis@usp.br" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">I</span>" "identificador" => "aff1" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor1" ] ] ] 1 => array:3 [ "nombre" => "Jose Ribas Milanez" "apellidos" => "de Campos" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">I</span>" "identificador" => "aff1" ] ] ] 2 => array:3 [ "nombre" => "Luis Felipe Pinho" "apellidos" => "Moreira" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">I</span>" "identificador" => "aff1" ] ] ] 3 => array:3 [ "nombre" => "Antonio Carlos" "apellidos" => "Pastorino" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">II</span>" "identificador" => "aff2" ] ] ] 4 => array:3 [ "nombre" => "Paulo Manuel" "apellidos" => "Pêgo-Fernandes" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">I</span>" "identificador" => "aff1" ] ] ] 5 => array:3 [ "nombre" => "Fabio Biscegli" "apellidos" => "Jatene" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">I</span>" "identificador" => "aff1" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Instituto do Coração (HCFMUSP-INCOR), Departamento de Cardiopneumologia, Ambulatório do Serviço de Cirurgia Torácica, São Paulo/SP, Brazil" "etiqueta" => "I" "identificador" => "aff1" ] 1 => array:3 [ "entidad" => "Instituto da Criança do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Pediatria, São Paulo/SP, Brazil" "etiqueta" => "II" "identificador" => "aff2" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor1" "etiqueta" => "*" "correspondencia" => "Tel.: 55 11 2661–5926" ] ] ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig2" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 487 "Ancho" => 664 "Tamanyo" => 33765 ] ] "descripcion" => array:1 [ "en" => "<p id="spara20" class="elsevierStyleSimplePara elsevierViewall">Measurement B) The lowest depth of the defect, using the highest point of the anterior chest wall and the deepest point of the pre-sternum region at the DT as reference points.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="cesec10" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle60">INTRODUCTION</span><p id="para10" class="elsevierStylePara elsevierViewall">Among all of the congenital deformities of the thoracic wall, <span class="elsevierStyleItalic">pectus excavatum</span> (PEX) is the most common. It is characterized by a depressed sternal region relative to the frontal rib cage (<a class="elsevierStyleCrossRef" href="#bib1">1</a>).</p><p id="para20" class="elsevierStylePara elsevierViewall">Treatment of PEX is based on functional (<a class="elsevierStyleCrossRef" href="#bib2">2</a>), aesthetic (<a class="elsevierStyleCrossRef" href="#bib3">3</a>) psychological (<a class="elsevierStyleCrossRef" href="#bib4">4</a>), and quality of life (<a class="elsevierStyleCrossRef" href="#bib5">5</a>) considerations. Treatment can be either conservative (<a class="elsevierStyleCrossRef" href="#bib6">6</a>) or surgical (<a class="elsevierStyleCrossRef" href="#bib7">7</a>), involving pre-sternum filling without bone mobilization or bone mobilization with prosthetics (<a class="elsevierStyleCrossRef" href="#bib1">1</a>,<a class="elsevierStyleCrossRef" href="#bib8">8</a>–<a class="elsevierStyleCrossRef" href="#bib10">10</a>) or without (<a class="elsevierStyleCrossRef" href="#bib1">1</a>,<a class="elsevierStyleCrossRef" href="#bib11">11</a>).</p><p id="para30" class="elsevierStylePara elsevierViewall">Consensus has not been obtained regarding the methods used to assess this deformity, and evaluation remains subjective (<a class="elsevierStyleCrossRef" href="#bib7">7</a>) or objective (<a class="elsevierStyleCrossRef" href="#bib12">12</a>–<a class="elsevierStyleCrossRef" href="#bib16">16</a>). The Anthropometric Index (AI) for PEX (<a class="elsevierStyleCrossRef" href="#bib15">15</a>,<a class="elsevierStyleCrossRef" href="#bib17">17</a>–<a class="elsevierStyleCrossRef" href="#bib19">19</a>) purports to provide the physician with a method for clinically verifying PEX. The AI is a quickly administered and low-cost clinical assessment, which does not induce adverse effects and is not vulnerable to environmental influences.</p><p id="para40" class="elsevierStylePara elsevierViewall">We compared the AI to the Haller index (HI) (<a class="elsevierStyleCrossRef" href="#bib14">14</a>) and the lower vertebral index (VI) (<a class="elsevierStyleCrossRef" href="#bib13">13</a>). The operational characteristics that were drawn from our data bank produced highly accurate curves and superimposable values for the three indices, relative to the diagnosis of PEX. The AI, HI, and VI cut-off points that differentiated PEX patients from healthy subjects were 0.12, 3.1, and 0.25, respectively. The AI was thus validated, although the HI and VI were once considered among surgeons the gold standards informing the treatment of this illness (<a class="elsevierStyleCrossRef" href="#bib15">15</a>). However, previous reports have not examined differences in the results due to age, race, or sex; such inferences would not be appropriate given the sample sizes of these studies. Thus, the purpose of the present study was to consider effects of age, race, and sex on AI.</p></span><span id="cesec20" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle70">OBJECTIVE</span><p id="para50" class="elsevierStylePara elsevierViewall">The objective of this study was to determine variations in the IA for PEX due to age, race, and sex in individuals who were free of congenital defects of the thoracic wall.</p></span><span id="cesec30" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle80">METHODS</span><p id="para60" class="elsevierStylePara elsevierViewall">The period of this investigation was 2002 through 2012. The study was undertaken at Ambulatório de Cirurgia Torácica and Ambulatório de Alergias do Instituto da Criança do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Ambulatório de Cirurgia Torácica da Prefeitura de Piracicaba, Instituto Formar de Piracicaba.</p><p id="para70" class="elsevierStylePara elsevierViewall">The subjects were male and female patients, both Caucasian and of African descent, belonging to the following age ranges: 3 – 10 years old; 11 – 20 years old; and 21 – 40 years old (<a class="elsevierStyleCrossRef" href="#bib20">20</a>).</p><p id="para80" class="elsevierStylePara elsevierViewall">This study was approved by the Comissão de Ética para Análise de Projetos de Pesquisa do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo under #658/01 and #0122/06.</p><p id="para90" class="elsevierStylePara elsevierViewall">The inclusion criteria were: a) absence of congenital or acquired defects of the thoracic wall; b) aged between 3 and 40 years old; and c) body mass index (BMI) less than 25.</p><p id="para100" class="elsevierStylePara elsevierViewall">The exclusion criteria were: a) individuals with breast implants; b) lactation; and c) presence of any condition that might interfere with the normal architecture of the thorax, such as trauma leading to alteration of the chest, kyphosis and/or lordosis, cardiopathy, and pneumopathy.</p><p id="para110" class="elsevierStylePara elsevierViewall">Clinical measurements were obtained with the patient lying in the supine position on a flat table parallel to the floor during deep inhalation. The measurement instruments were: a) an articulated square; b) a rigid ruler coupled to a level (the measuring device); c) a pinned limiting device; and d) a conventional ruler.</p><p id="para120" class="elsevierStylePara elsevierViewall">Two clinical measurements were recorded: <span class="elsevierStyleBold">measurement A</span> and <span class="elsevierStyleBold">measurement B.</span> Measurement A was the longest measured anteroposterior distance from the tangential coronal plane relative to the dorsal region and the tangential coronal plane to the highest point of the chest at the distal third of the sternum (DT). This measurement was obtained with the patient in the supine position, while laying over one of the segments of the articulated square. Measurement A was defined as the intersection between the vertical scale of the other segment of the articulated square and the rigid ruler (the measuring instrument), coupled to the level running tangentially over the highest point of the anterior chest wall at the DT (<a class="elsevierStyleCrossRef" href="#fig1">Figure 1</a>).</p><elsevierMultimedia ident="fig1"></elsevierMultimedia><p id="para130" class="elsevierStylePara elsevierViewall">Measurement B, or the deepest point of the chest defect, was defined as the distance between the tangential plane and the highest point of the anterior chest wall and the plane over the deepest point of the pre-sternum region at the DT, when both planes were parallel to each other. This measurement was obtained with the rigid ruler (the measuring instrument) coupled to the level running tangentially over the highest point of the chest. The vertical shaft was then introduced through the center of the ruler until the tip touched the skin over the sternum at the DT. The segment of shaft from the pre-sternum region to the ruler indicated the vertical distance (<a class="elsevierStyleCrossRef" href="#fig2">Figure 2</a>).</p><elsevierMultimedia ident="fig2"></elsevierMultimedia><p id="para140" class="elsevierStylePara elsevierViewall">In addition, a metric tape measure was used to assess the circumference of the thorax at the DT.</p><p id="para150" class="elsevierStylePara elsevierViewall">In these individuals, the Anthropometric Index for PEX (AI) (<a class="elsevierStyleCrossRef" href="#bib15">15</a>,<a class="elsevierStyleCrossRef" href="#bib17">17</a>) was defined as measurement B divided by measurement A (AI = B/A). Weight, height, and thorax circumference at the DT were statically analyzed using Prism software, version 5.2 (Graphpad Prism, USA).</p><p id="para160" class="elsevierStylePara elsevierViewall">'The normality of the sample distribution was tested using the Shapiro-Wilk test. Correlations were assessed via Spearman's rank-order correlation test, and comparisons between sexes and races were performed using the Mann-Whitney U test. Comparisons between sexes and age groups were conducted via ANOVA. <span class="elsevierStyleItalic">p</span>-values<0.05 indicated statistical significance.</p></span><span id="cesec40" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle90">RESULTS</span><p id="para170" class="elsevierStylePara elsevierViewall">Between 2002 and 2012, 166 individuals with normal chest morphology were assessed. The group of subjects was enrolled by the Ambulatório de Cirurgia Torácica and the Ambulatório de Alergias do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, the Ambulatório de Cirurgia Torácica da Prefeitura de Piracicaba, and the Instituto Formar de Piracicaba/São Paulo.</p><p id="para180" class="elsevierStylePara elsevierViewall">Of the 166 subjects, 114 were male (13 of whom were between 3 and 10 years of age, 52 were between 11 and 20 years of age, and 49 were between 21 and 40 years of age), and 52 were female (8 of whom were between 3 and 10 years of age, 22 were between 11 and 20 years of age, and 22 were between 21 and 40 years of age). One hundred eighteen of the 166 individuals were Caucasian, and 48 individuals were of African descent.</p><p id="para190" class="elsevierStylePara elsevierViewall">The results of the Shapiro-Wilk test for AI values indicated that the sample was normally distributed. Spearman's test found no correlations between the AI for PEX and weight, height, or thoracic circumference. However, the AI values were significantly different between male and female subjects as evidenced by results of the Mann-Whitney test (<span class="elsevierStyleItalic">p</span><0.0001). The AI values between Caucasian individuals and those of African descent were not significantly different (<span class="elsevierStyleItalic">p</span> = 0.311). We compared the sexes within each age group using ANOVA; the mean values and standard deviations for the 3- to 10-year-old, 11- to 20-year-old, and 21- to 40-year-old groups are displayed in <a class="elsevierStyleCrossRef" href="#tbl1">Tables 1</a>, <a class="elsevierStyleCrossRef" href="#tbl2">2</a>), and <a class="elsevierStyleCrossRef" href="#tbl3">3</a>), respectively. These values exhibited large variability in the female subjects belonging to the 11- to 20-year-old and the 21- to 40-year-old groups, which was evident both in their means and corresponding standard deviations (<a class="elsevierStyleCrossRef" href="#fig3">Figure 3</a>).</p><elsevierMultimedia ident="tbl1"></elsevierMultimedia><elsevierMultimedia ident="tbl2"></elsevierMultimedia><elsevierMultimedia ident="tbl3"></elsevierMultimedia><elsevierMultimedia ident="fig3"></elsevierMultimedia><p id="para200" class="elsevierStylePara elsevierViewall">When assessing the AI according to age group we observed that:<ul class="elsevierStyleList" id="celist10"><li class="elsevierStyleListItem" id="celistitem10"><span class="elsevierStyleLabel">a)</span><p id="para210" class="elsevierStylePara elsevierViewall">There was no difference among male subjects from the 3- to 10-year-old, 11- to 20-year-old, and 21- to 40-year-old groups (<span class="elsevierStyleItalic">p</span>>0.05).</p></li><li class="elsevierStyleListItem" id="celistitem20"><span class="elsevierStyleLabel">b)</span><p id="para220" class="elsevierStylePara elsevierViewall">There was no difference between female subjects from the 11- to 20-year-old and 21- to 40-year-old groups (<span class="elsevierStyleItalic">p</span>>0.05).</p></li><li class="elsevierStyleListItem" id="celistitem30"><span class="elsevierStyleLabel">c)</span><p id="para230" class="elsevierStylePara elsevierViewall">There were differences between the female subjects aged 3 – 10 years old and those aged 11 – 20 years old or 21 – 40 years old (<span class="elsevierStyleItalic">p</span><0.01 and <span class="elsevierStyleItalic">p</span><0.0001, respectively).</p></li></ul></p></span><span id="cesec50" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle100">DISCUSSION</span><p id="para240" class="elsevierStylePara elsevierViewall">A number of methods by which to assess PEX have been reported in the literature. Didactically, these methods can be classified as objective or subjective. Among the objective methods, which were the focus of the present investigation, clinical methods and those that use imagery are the most effective.</p><p id="para250" class="elsevierStylePara elsevierViewall">Our sample exhibited significantly different AI values between male subjects of all age groups and female subjects of all age groups (<span class="elsevierStyleItalic">p</span><0.0001). We believe that the breasts accounted for this difference, because measurements A and B were collected using gauging devices that run across the chest. This belief is supported by no difference being found between male and female subjects of preteen ages (3–10 years of age) (<a class="elsevierStyleCrossRef" href="#fig3">Figure 3</a>), when the breasts have not yet developed.</p><p id="para260" class="elsevierStylePara elsevierViewall">Knutson (<a class="elsevierStyleCrossRef" href="#bib21">21</a>), who also conceived a clinical method of evaluating PEX based on the topography of the chest, reported difficulty in applying his method in women due to increased breast tissue. Similarly, Horst et al. (<a class="elsevierStyleCrossRef" href="#bib22">22</a>) found differences between men and women when gauging the chest by means of his optical methodology and Moiré's topography. Using this approach to measure the thorax, Horst et al. did find differences between the sexes, but they were not so large as to prevent differentiating PEX patients from non-PEX patients among both men and women. This study also validated the AI, despite significant differences between sexes, it and effectively and objectively differentiated patients with PEX from those without PEX among both men and women (<a class="elsevierStyleCrossRef" href="#bib15">15</a>).</p><p id="para270" class="elsevierStylePara elsevierViewall">Daunt et al. (<a class="elsevierStyleCrossRef" href="#bib23">23</a>) electronically calculated the HI in 275 men and 282 women, according to what Haller et al. proposed in 1987. The HI was defined as being the ratio between the longest latero-lateral distance and the anteroposterior distance to the surface of the board of the sternum, relative to the anterior portion of the vertebral body at the DT, as measured by computerized tomography of the thorax (<a class="elsevierStyleCrossRef" href="#bib14">14</a>). Daunt et al. recorded higher values in female subjects than in male subjects who were aged either between 0 and 6 years old or between 12 and 18 years old. Our results differ from those of Daunt's 0- to 6-year-old group; we found no significant differences between our male and female 3- to 10-year-old individuals. We must consider, however, that the age groups between these two studies do not completely coincide and that the sample size of our 3- to 10-year-old group was small (13 boys and 8 girls). The results obtained by Daunt et al. for the 12-to 18-year-old group were similar to ours; our female 11- to 20-year-old group had higher AI values than male subjects of the same ages.</p><p id="para280" class="elsevierStylePara elsevierViewall">Nakahara et al. (<a class="elsevierStyleCrossRef" href="#bib24">24</a>) examined PEX patients and normal individuals and conceived a measurement for chest depression in PEX. It was defined as the ratio between the anteroposterior internal distance of the left parietal pleura and the parietal pleura at the level of the greatest deformity and the distance from the surface of the sternum board to the anterior portion of the vertebral body at the same level. In Nakahara's investigation, the degree of chest depression in normal individuals was lower in patients over 15 years of age. These results differed from ours; we did not find any significant difference in male subjects across all of the age groups. That the formula for the degree of depression does not account for any soft tissue must be considered. Still, the results remain controversial in light of the findings reported by Backer et al. (<a class="elsevierStyleCrossRef" href="#bib12">12</a>) and Derveaux et al. (<a class="elsevierStyleCrossRef" href="#bib13">13</a>), who did not observe alteration of the VI from the age of 6 years old or 10 years old, respectively. Regardless, the IV, like the depression degree, measures the internal architecture of the thorax.</p><p id="para290" class="elsevierStylePara elsevierViewall">Backer et al. (<a class="elsevierStyleCrossRef" href="#bib12">12</a>) examined 88 subjects with PEX and 445 normal individuals, and Derveaux et al. (<a class="elsevierStyleCrossRef" href="#bib13">13</a>) examined 54 subjects with PEX and 250 normal individuals. They calculated VI similarly as the ratio between the vertebral diameter and the thoracic sagittal diameter of the posterior portion of the vertebral body, relative to the posterior board of the sternum, both of which were measured using simple X-rays of the profile of the thorax at the DT. Backer et al. (<a class="elsevierStyleCrossRef" href="#bib12">12</a>) did not find any significant differences between sexes. This finding is compatible with the AI if the increase in AI values in women is attributable to increased breast tissue; the VI calculation does not account for soft tissue, whereas the AI does because it is calculated using measurements of the external part of the thorax. Regarding age, both authors demonstrated that there was no variation from the age of 6 years old (<a class="elsevierStyleCrossRef" href="#bib12">12</a>) or 10 years old (<a class="elsevierStyleCrossRef" href="#bib13">13</a>), which supports our hypothesis that the internal anteroposterior architecture of the thorax does not change until at least 10 years of age. Therefore, changes in the AI (external architecture) between men and women should be attributed to breast growth beginning at approximately 11 years of age.</p><p id="para300" class="elsevierStylePara elsevierViewall">Male and female subjects aged 3 to 10 years old had lower mean AI values, which were statistically different from those of female subjects aged 11 to 40 years old. There was no significant difference between the mean AI values of Caucasians and subjects of African descent.</p></span><span id="cesec60" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle110">AUTHOR CONTRIBUTIONS</span><p id="para310" class="elsevierStylePara elsevierViewall">Rebeis EB developed the study protocol, formulated the measurements used for all of the study subjects at all of the clinics, created the database, performed the literature review, statistical analyses, and discussion of the study results, devised the scientific methodology of the second study, and edited the current report for language. Campos JR reviewed the study protocol, realized the measurements in the sample of the Clinic of Thoracic Surgery of the HCFMUSP, and discussed the results and study goals. Moreira LF performed the statistical analyses and database generation and maintenance. Pastorino AC obtained approval of the study protocol at the Children's Institute and the HCFMUSP, participated in the measurements performed at the Clinic of Allergy at the same institution, and participated in discussion of the pediatric study. Pêgo-Fernandes PM discussed the theoretical basis of the study and participated in the final review of the manuscript. Jatene FB discussed the study design and participated in the final review of the manuscript.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:9 [ 0 => array:2 [ "identificador" => "xpalclavsec1581236" "titulo" => "KEYWORDS" ] 1 => array:2 [ "identificador" => "cesec10" "titulo" => "INTRODUCTION" ] 2 => array:2 [ "identificador" => "cesec20" "titulo" => "OBJECTIVE" ] 3 => array:2 [ "identificador" => "cesec30" "titulo" => "METHODS" ] 4 => array:2 [ "identificador" => "cesec40" "titulo" => "RESULTS" ] 5 => array:2 [ "identificador" => "cesec50" "titulo" => "DISCUSSION" ] 6 => array:2 [ "identificador" => "cesec60" "titulo" => "AUTHOR CONTRIBUTIONS" ] 7 => array:2 [ "identificador" => "xack638797" "titulo" => "ACKNOWLEDGMENTS" ] 8 => array:1 [ "titulo" => "REFERENCES" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2013-02-22" "fechaAceptado" => "2013-04-22" "PalabrasClave" => array:1 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "KEYWORDS" "identificador" => "xpalclavsec1581236" "palabras" => array:3 [ 0 => "Anthropometry/Methods" 1 => "Thoracic Wall/Abnormalities" 2 => "Funnel Chest/Diagnosis" ] ] ] ] "tieneResumen" => true "resumen" => array:1 [ "en" => array:2 [ "resumen" => "<span id="ceabs10" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle10">OBJECTIVES</span><p id="spara70" class="elsevierStyleSimplePara elsevierViewall">To determine possible variations in the Anthropometric Index for <span class="elsevierStyleItalic">pectus excavatum</span> relative to age, race, and sex in individuals free of thoracic wall deformities.</p></span> <span id="ceabs20" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle20">METHODS</span><p id="spara80" class="elsevierStyleSimplePara elsevierViewall">Between 2002 and 2012, 166 individuals with morphologically normal thoracic walls consented to have their chests and the perimeter of the lower third of the thorax measured according to the Anthropometric Index for <span class="elsevierStyleItalic">pectus excavatum</span>. The participant characteristics are presented (114 men and 52 women; 118 Caucasians and 48 people of African descent).</p></span> <span id="ceabs30" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle30">RESULTS</span><p id="spara90" class="elsevierStyleSimplePara elsevierViewall">Measurements of the Anthropometric Index for <span class="elsevierStyleItalic">pectus excavatum</span> were statistically significantly different between men and women (11–40 years old); however, no significant difference was found between Caucasians and people of African descent. For men, the index measurements were not significantly different across all of the age groups. For women, the index measurements were significantly lower for individuals aged 3 to 10 years old than for individuals aged 11 to 20 years old and 21 to 40 years old; however, no such difference was observed between women aged 11 to 20 years old and those aged 21 to 40 years old.</p></span> <span id="ceabs40" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle40">CONCLUSION</span><p id="spara100" class="elsevierStyleSimplePara elsevierViewall">In the sample, significant differences were observed between women aged 11 to 40 years old and the other age groups; however, there was no difference between Caucasian and people of African descent.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "ceabs10" "titulo" => "OBJECTIVES" ] 1 => array:2 [ "identificador" => "ceabs20" "titulo" => "METHODS" ] 2 => array:2 [ "identificador" => "ceabs30" "titulo" => "RESULTS" ] 3 => array:2 [ "identificador" => "ceabs40" "titulo" => "CONCLUSION" ] ] ] ] "NotaPie" => array:1 [ 0 => array:1 [ "nota" => "<p class="elsevierStyleNotepara" id="cenpara10">No potential conflict of interest was reported.</p>" ] ] "multimedia" => array:6 [ 0 => array:7 [ "identificador" => "fig1" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 442 "Ancho" => 664 "Tamanyo" => 28565 ] ] "descripcion" => array:1 [ "en" => "<p id="spara10" class="elsevierStyleSimplePara elsevierViewall">Measurement A) The maximum anteroposterior measurement at the level of the distal third of the sternum.</p>" ] ] 1 => array:7 [ "identificador" => "fig2" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 487 "Ancho" => 664 "Tamanyo" => 33765 ] ] "descripcion" => array:1 [ "en" => "<p id="spara20" class="elsevierStyleSimplePara elsevierViewall">Measurement B) The lowest depth of the defect, using the highest point of the anterior chest wall and the deepest point of the pre-sternum region at the DT as reference points.</p>" ] ] 2 => array:7 [ "identificador" => "fig3" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 505 "Ancho" => 764 "Tamanyo" => 50792 ] ] "descripcion" => array:1 [ "en" => "<p id="spara30" class="elsevierStyleSimplePara elsevierViewall">This figure presents the mean AI values and their corresponding confidence intervals for male and female subjects aged 3–10 years old, 11–20 years old, and 21–40 years old.</p>" ] ] 3 => array:7 [ "identificador" => "tbl1" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "<p id="TFN01t01" class="elsevierStyleSimplePara elsevierViewall">NOTE: n = number of individuals; SD = standard deviation.</p><p id="TFN02t01" class="elsevierStyleSimplePara elsevierViewall">Mean = average value of the AI for PEX.</p>" "tablatextoimagen" => array:1 [ 0 => array:1 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="top" scope="col">Sex \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="top" scope="col">n \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="top" scope="col">Mean \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="top" scope="col">SD \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="top">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="top">13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="top">0.035 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="top">0.015 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="top">Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="top">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="top">0.030 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="top">0.019 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spara40" class="elsevierStyleSimplePara elsevierViewall">The number of individuals, means, and standard deviations of female and male subjects aged 3–10 years old.</p>" ] ] 4 => array:7 [ "identificador" => "tbl2" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "<p id="TFN01t02" class="elsevierStyleSimplePara elsevierViewall">NOTE: n = number of individuals; SD = standard deviation.</p><p id="TFN02t02" class="elsevierStyleSimplePara elsevierViewall">Mean = average value of the AI for PEX.</p>" "tablatextoimagen" => array:1 [ 0 => array:1 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="justify" valign="top" scope="col">Sex \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="top" scope="col">n \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="top" scope="col">Mean \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="top" scope="col">SD \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="justify" valign="top">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="top">52 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="top">0.031 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="top">0.012 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="justify" valign="top">Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="top">22 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="top">0.057 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="top">0.026 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spara50" class="elsevierStyleSimplePara elsevierViewall">The number of individuals, means, and standard deviations of female and male subjects aged 11 – 20 years old.</p>" ] ] 5 => array:7 [ "identificador" => "tbl3" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "<p id="TFN01t03" class="elsevierStyleSimplePara elsevierViewall">NOTE: n = number of individuals; SD = standard deviation.</p><p id="TFN02t03" class="elsevierStyleSimplePara elsevierViewall">Mean = average value of the AI for PEX.</p>" "tablatextoimagen" => array:1 [ 0 => array:1 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="justify" valign="top" scope="col">Sex \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="top" scope="col">n \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="top" scope="col">Mean \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="top" scope="col">SD \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="justify" valign="top">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="top">49 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="top">0.033 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="top">0.012 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="justify" valign="top">Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="top">22 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="top">0.063 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="top">0.027 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spara60" class="elsevierStyleSimplePara elsevierViewall">The number of individuals, means, and standard deviations of female and male subjects aged 21 – 40 years old.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "REFERENCES" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "cebibsec10" "bibliografiaReferencia" => array:24 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Anthropometric Index for <span class="elsevierStyleItalic">pectus excavatum</span> as a method of diagnosis and preoperative and postoperative evaluation: a comparative analysis with the Haller Index and the Lower Vertebral Index (thesis)" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => """ Eduardo Baldassari Rebeis \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:3 [ "fecha" => "2005" "editorial" => "Faculdade de Medicina of the Universidade de São Paulo" "editorialLocalizacion" => "São Paulo" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib2" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Tórax infundibular e carinado" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => """ NF Trench \n \t\t\t\t\t\t\t\t """ 1 => """ R Saad \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "LibroEditado" => array:5 [ "editores" => "NFTrench, RSaad" "titulo" => "Cirurgia torácica" "paginaInicial" => "81" "paginaFinal" => "124" "serieFecha" => "1983" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib3" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The seagull wing self retaining prosthesis in the surgical treatment of <span class="elsevierStyleItalic">pectus excavatum</span>" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => """ GMA Dato \n \t\t\t\t\t\t\t\t """ 1 => """ M Cavaglià \n \t\t\t\t\t\t\t\t """ 2 => """ E Ruffini \n \t\t\t\t\t\t\t\t """ 3 => """ A Dato \n \t\t\t\t\t\t\t\t """ 4 => """ M Mancuso \n \t\t\t\t\t\t\t\t """ 5 => """ A Parola \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Cardiovasc Surg" "fecha" => "1999" "volumen" => "40" "numero" => "1" "paginaInicial" => "139" "paginaFinal" => "146" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib4" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Funnel chest. Psychological and psychosomatic aspects in children youngsters and young adults" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => """ E Einsiedel \n \t\t\t\t\t\t\t\t """ 1 => """ A Clausner \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Cardivasc Surg" "fecha" => "1999" "volumen" => "40" "numero" => "5" "paginaInicial" => "733" "paginaFinal" => "736" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib5" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A pilot study of the impact of surgical repair on disease-specific quality of life among patients with <span class="elsevierStyleItalic">pectus excavatum</span>" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => """ ML Lawson \n \t\t\t\t\t\t\t\t """ 1 => """ TF Cash \n \t\t\t\t\t\t\t\t """ 2 => """ R Akers \n \t\t\t\t\t\t\t\t """ 3 => """ E Vasser \n \t\t\t\t\t\t\t\t """ 4 => """ B Burke \n \t\t\t\t\t\t\t\t """ 5 => """ M Tabangin \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/s0022-3468(03)00123-4" "Revista" => array:7 [ "tituloSerie" => "J Pediatr Surg" "fecha" => "2003" "volumen" => "38" "numero" => "6" "paginaInicial" => "916" "paginaFinal" => "918" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12778393" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib6" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Preliminary results of orthotic treatment of pectus deformities in children and adolescents" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => """ SA Haje \n \t\t\t\t\t\t\t\t """ 1 => """ R Bowen \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/01241398-199211000-00018" "Revista" => array:7 [ "tituloSerie" => "J Pediatr Orthop" "fecha" => "1992" "volumen" => "12" "numero" => "6" "paginaInicial" => "795" "paginaFinal" => "800" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1452753" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib7" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "<span class="elsevierStyleItalic">Pectus excavatum</span> late results with and without operation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => """ GHII Humphreys \n \t\t\t\t\t\t\t\t """ 1 => """ A Jaretzki III \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Thorac Cardiovasc Surg" "fecha" => "1980" "volumen" => "80" "numero" => "5" "paginaInicial" => "686" "paginaFinal" => "695" ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib8" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Silicone implant of <span class="elsevierStyleItalic">pectus excavatum</span>: indications and refinement in technique" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => """ MW Marks \n \t\t\t\t\t\t\t\t """ 1 => """ LC Argenta \n \t\t\t\t\t\t\t\t """ 2 => """ DC Lee \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/00006534-198407000-00007" "Revista" => array:7 [ "tituloSerie" => "Plast Reconstr Surg" "fecha" => "1984" "volumen" => "74" "numero" => "1" "paginaInicial" => "52" "paginaFinal" => "58" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/6739600" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib9" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Casting the implant for reconstruction of <span class="elsevierStyleItalic">pectus excavatum</span>" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => """ G Hougaard \n \t\t\t\t\t\t\t\t """ 1 => """ H Svensson \n \t\t\t\t\t\t\t\t """ 2 => """ KG Holmqvist \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Scand J Plast Reconstr Hand Surg" "fecha" => "1995" "volumen" => "29" "numero" => "3" "paginaInicial" => "227" "paginaFinal" => "231" ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib10" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "<span class="elsevierStyleItalic">Pectus excavatum</span>: exceptional surgical correction using silicone prosthesis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => """ LM Ferreira \n \t\t\t\t\t\t\t\t """ 1 => """ LEF Abla \n \t\t\t\t\t\t\t\t """ 2 => """ JM Andrews \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Rev Hosp São Paulo Esc Paul Med" "fecha" => "1995" "volumen" => "6" "paginaInicial" => "26" "paginaFinal" => "29" ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib11" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "<span class="elsevierStyleItalic">Pectus excavatum / pectus carinatum</span>: tratamento cirúrgico" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => """ MS Coelho \n \t\t\t\t\t\t\t\t """ 1 => """ WS Stori \n \t\t\t\t\t\t\t\t """ 2 => """ LDV Pizarro \n \t\t\t\t\t\t\t\t """ 3 => """ SA Zanin \n \t\t\t\t\t\t\t\t """ 4 => """ JL Gonçalves \n \t\t\t\t\t\t\t\t """ 5 => """ N Bergonse \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Rev Col Bras Cir" "fecha" => "2003" "volumen" => "30" "paginaInicial" => "249" "paginaFinal" => "261" ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib12" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The surgical treatment of funnel chest: initial and follow-up results" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => """ OG Backer \n \t\t\t\t\t\t\t\t """ 1 => """ S Brünner \n \t\t\t\t\t\t\t\t """ 2 => """ V Larsen \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Acta Chir Scand" "fecha" => "1961" "volumen" => "121" "paginaInicial" => "253" "paginaFinal" => "256" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/13685690" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib13" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Preoperative and postoperative abnormalities in chest X-ray indices and in lung function in pectus deformities" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => """ L Derveaux \n \t\t\t\t\t\t\t\t """ 1 => """ I Clarysse \n \t\t\t\t\t\t\t\t """ 2 => """ I Ivanoff \n \t\t\t\t\t\t\t\t """ 3 => """ M Demedts \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1378/chest.95.4.850" "Revista" => array:7 [ "tituloSerie" => "Chest" "fecha" => "1989" "volumen" => "95" "numero" => "4" "paginaInicial" => "850" "paginaFinal" => "856" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2924614" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib14" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Use of CT scans in selection of patients for <span class="elsevierStyleItalic">pectus excavatum</span> surgery: a preliminary report" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => """ JA Haller \n \t\t\t\t\t\t\t\t """ 1 => """ SS Kramer \n \t\t\t\t\t\t\t\t """ 2 => """ A Lietman \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Pediatr Surg" "fecha" => "1987" "volumen" => "22" "numero" => "10" "paginaInicial" => "904" "paginaFinal" => "906" ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib15" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Anthropometric index for <span class="elsevierStyleItalic">pectus excavatum</span>" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => """ EB Rebeis \n \t\t\t\t\t\t\t\t """ 1 => """ JRM Campos \n \t\t\t\t\t\t\t\t """ 2 => """ A Fernandez \n \t\t\t\t\t\t\t\t """ 3 => """ LFP Moreira \n \t\t\t\t\t\t\t\t """ 4 => """ FB Jatene \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1590/s1807-59322007000500011" "Revista" => array:7 [ "tituloSerie" => "Clinics" "fecha" => "2007" "volumen" => "62" "numero" => "5" "paginaInicial" => "599" "paginaFinal" => "606" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17952321" "web" => "Medline" ] ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib16" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Spontaneous evolution of pectus excavatum deformity in children: a five-year prospective study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => """ I Milovitsh \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ "tituloSerie" => "Srp Arh Celok Lek" "fecha" => "2001" "volumen" => "129" "numero" => "1" "paginaInicial" => "32" "paginaFinal" => "35" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15637988" "web" => "Medline" ] ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib17" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Índice antropométrico para classificação quantitativa do <span class="elsevierStyleItalic">pectus excavatum</span>" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => """ EB Rebeis \n \t\t\t\t\t\t\t\t """ 1 => """ MS Samano \n \t\t\t\t\t\t\t\t """ 2 => """ CTS Dias \n \t\t\t\t\t\t\t\t """ 3 => """ A Fernandez \n \t\t\t\t\t\t\t\t """ 4 => """ JRM Campos \n \t\t\t\t\t\t\t\t """ 5 => """ FB Jatene \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Bras Pneumol" "fecha" => "2004" "volumen" => "30" "numero" => "6" "paginaInicial" => "501" "paginaFinal" => "507" ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib18" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Application of the anthropometric index for the assessment of <span class="elsevierStyleItalic">pectus excavatum</span> in patients submitted to the Nuss technique: two cases" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => """ RR Brigato \n \t\t\t\t\t\t\t\t """ 1 => """ JRM Campos \n \t\t\t\t\t\t\t\t """ 2 => """ FB Jatene \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1590/s1806-37132007000300018" "Revista" => array:7 [ "tituloSerie" => "J Bras Pneumol" "fecha" => "2007" "volumen" => "33" "numero" => "3" "paginaInicial" => "347" "paginaFinal" => "350" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17906798" "web" => "Medline" ] ] ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib19" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "<span class="elsevierStyleItalic">Pectus excavatum</span>: evaluation of Nuss technique by objective methods" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => """ R Brigato \n \t\t\t\t\t\t\t\t """ 1 => """ JRM Campos \n \t\t\t\t\t\t\t\t """ 2 => """ FB Jatene \n \t\t\t\t\t\t\t\t """ 3 => """ LFP Moreira \n \t\t\t\t\t\t\t\t """ 4 => """ EB Rebeis \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1510/icvts.2008.184580" "Revista" => array:7 [ "tituloSerie" => "Interact Cardiovasc Thorac Surg" "fecha" => "2008" "volumen" => "7" "numero" => "6" "paginaInicial" => "1084" "paginaFinal" => "1088" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18772264" "web" => "Medline" ] ] ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib20" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Crianças, adolescentes e atividade física: aspectos maturacionais e funcionais" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => """ H Tourinho \n \t\t\t\t\t\t\t\t """ 1 => """ LSPR Tourinho \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Rev Paul Educ Fis" "fecha" => "1998" "volumen" => "12" "numero" => "1" "paginaInicial" => "71" "paginaFinal" => "83" ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib21" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Mensurement of thoracic deformities. A new technique giving objective and reproducible results" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => """ U Knutson \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3109/14017436709131846" "Revista" => array:7 [ "tituloSerie" => "Scand J Thorac Cardiovasc Surg" "fecha" => "1967" "volumen" => "1" "numero" => "1" "paginaInicial" => "76" "paginaFinal" => "79" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/6078798" "web" => "Medline" ] ] ] ] ] ] ] ] 21 => array:3 [ "identificador" => "bib22" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Objective shape measurement of anterior chest wall with moire topography. Methods and deduction of non dimensional index numbers for the estimation of funnel chest" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => """ M Horst \n \t\t\t\t\t\t\t\t """ 1 => """ D Albrecht \n \t\t\t\t\t\t\t\t """ 2 => """ B Drerup \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1055/s-2008-1045162" "Revista" => array:7 [ "tituloSerie" => "Z Orthop" "fecha" => "1885" "volumen" => "123" "numero" => "3" "paginaInicial" => "357" "paginaFinal" => "364" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/4050048" "web" => "Medline" ] ] ] ] ] ] ] ] 22 => array:3 [ "identificador" => "bib23" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Age-related normal ranges for Haller index in children" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => """ SW Daunt \n \t\t\t\t\t\t\t\t """ 1 => """ JH Cohen \n \t\t\t\t\t\t\t\t """ 2 => """ SF Miller \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Pediatr Radiol" "fecha" => "2004" "volumen" => "34" "numero" => "4" "paginaInicial" => "326" "paginaFinal" => "330" ] ] ] ] ] ] 23 => array:3 [ "identificador" => "bib24" "etiqueta" => "24" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "An evaluation of operative outcome in patients with funnel chest diagnosed by means of the computed tomogram" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => """ K Nakahara \n \t\t\t\t\t\t\t\t """ 1 => """ K Ohno \n \t\t\t\t\t\t\t\t """ 2 => """ S Miyoshi \n \t\t\t\t\t\t\t\t """ 3 => """ H Maeda \n \t\t\t\t\t\t\t\t """ 4 => """ Y Monden \n \t\t\t\t\t\t\t\t """ 5 => """ Y Kawashima \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ "tituloSerie" => "J Thorac Cardiovasc Surg" "fecha" => "1987" "volumen" => "93" "numero" => "4" "paginaInicial" => "577" "paginaFinal" => "582" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3561006" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:4 [ "identificador" => "xack638797" "titulo" => "ACKNOWLEDGMENTS" "texto" => "<p id="para320" class="elsevierStylePara elsevierViewall">We are thankful to the individuals who participated in this study and whose measurements were essential to this work. We would also like to express our gratitude to the Instituto Formar de Piracicaba, Ambulatório de Cirurgia Torácica da Prefeitura de Piracicaba, Ambulatório de Alergias do Instituto da Criança do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo and Ambulatório de Cirurgia Torácica do Hospital das Clínicas (HCFMUSP-INCOR), Disciplina de Cirurgia Torácica do Departamento de Cardiopneumologia da Faculdade de Medicina da Universidade de São Paulo.</p>" "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/18075932/0000006800000009/v1_202212010704/S1807593222016246/v1_202212010704/en/main.assets" "Apartado" => null "PDF" => "https://static.elsevier.es/multimedia/18075932/0000006800000009/v1_202212010704/S1807593222016246/v1_202212010704/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1807593222016246?idApp=UINPBA00004N" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 7 | 0 | 7 |
| 2024 October | 57 | 31 | 88 |
| 2024 September | 35 | 27 | 62 |
| 2024 August | 50 | 26 | 76 |
| 2024 July | 28 | 16 | 44 |
| 2024 June | 46 | 19 | 65 |
| 2024 May | 59 | 13 | 72 |
| 2024 April | 65 | 20 | 85 |
| 2024 March | 31 | 12 | 43 |
| 2024 February | 37 | 17 | 54 |
| 2024 January | 36 | 15 | 51 |
| 2023 December | 29 | 21 | 50 |
| 2023 November | 29 | 22 | 51 |
| 2023 October | 29 | 37 | 66 |
| 2023 September | 17 | 26 | 43 |
| 2023 August | 32 | 14 | 46 |
| 2023 July | 38 | 21 | 59 |
| 2023 June | 31 | 14 | 45 |
| 2023 May | 8 | 3 | 11 |
| 2023 April | 6 | 3 | 9 |
| 2023 March | 8 | 0 | 8 |
| 2023 February | 16 | 3 | 19 |
| 2023 January | 3 | 0 | 3 |
| 2022 December | 29 | 4 | 33 |
Show all