Temporal changes in regulatory T cell subsets defined by the transcription factor Helios in stroke and their potential role in stroke-associated infection: a prospective case-control study.

BACKGROUND: Regulatory T cells (Tregs) are involved in the systemic immune response after ischemic stroke. However, their role remains unclear, and the effect appears to be both neuroprotective and detrimental. Treg suppressor function may result in immunodepression and promote stroke-associated infection (SAI). Thus we assume that the bidirectional effects of Tregs may be in part attributed to the intracellular transcription factor Helios. Tregs with Helios expression (H+ Tregs) constitute 70-90% of all Treg cells and more frequently than Helios-negative Tregs (H- Tregs) express molecules recognized as markers of Tregs with suppressor abilities. METHODS AND RESULTS: We prospectively assessed the circulating Treg population with flow cytometry in 52 subjects on days 1, 3, 10 and 90 after ischemic stroke and we compared the results with those obtained in concurrent age-, sex- and vascular risk factor-matched controls. At all studied time points the percentage of H+ Tregs decreased in stroke subjects-D1: 69.1% p < 0.0001; D3: 62.5% (49.6-76.6), p < 0.0001; D10: 60.9% (56.5-72.9), p < 0.0001; D90: 79.2% (50.2-91.7), p = 0.014 vs. controls: 92.7% (81.9-97.0) and the percentage of H- Tregs increased accordingly. In patients with SAI the percentage of pro-suppressor H+ Tregs on post-stroke day 3 was higher than in those without infection (p = 0.03). After adjustment for confounders, the percentage of H+ Tregs on day 3 independently correlated with SAI [OR 1.29; CI 95%: 1.08-1.27); p = 0.02]. Although the percentage of H+ Tregs on day 3 correlated positively with NIHSS score on day 90 (rS = 0.62; p < 0.01) and the infarct volume at day 90 (rS = 0.58; p < 0.05), in regression analysis it was not an independent risk factor. CONCLUSIONS: On the first day after stroke the proportion of H+ vs. H- Tregs changes in favor of pro-inflammatory H- Tregs, and this shift continues toward normalization when assessed on day 90. A higher percentage of pro-suppressive H+ Tregs on day 3 independently correlates with SAI and is associated positively with NIHSS score, but it does not independently affect the outcome and stroke area in the convalescent phase of stroke.

Isolated internal carotid artery dissection in a long-distance runner.

We present a case of internal carotid artery dissection (ICAD) in the precranial segment, which caused binocular visual impairment in a 49-year-old man during a marathon race. The incident lasted 3 h, after which the symptoms resolved. Imaging tests showed internal carotid artery dissection. No ophthalmologic changes were identified. After 6 weeks of ineffective non-invasive treatment the patient underwent vascular surgery - stent implantation into the damaged artery. Detailed diagnostic tests and adequate treatment allowed us to achieve a good clinical result. Upon the suspicion of ICAD it is recommended to extend standard Doppler ultrasound performed with a linear transducer and evaluate the proximal segment of the internal carotid artery with a curved transducer as well.

Accuracy of the anthropometric measurements of skeletonized skulls with corresponding measurements of their 3D reconstructions obtained by CT scanning.

BACKGROUND: The anthropometric measurements of the skeletonized skull are crucial in the investigation of human remains, mostly for personal identification. The images of the skull are used if the superimposition or approximation of the facial appearance is to be performed. The aim of the study was to compare the accuracy of the anthropometric measurements of skeletonized skulls with corresponding measurements of their 3D reconstructions obtained by CT scanning. METHODS: Ten skeletonized skulls and their 3D digital reconstructions were measured according to standard anthropometric procedures. The results were compared and statistical analysis was performed. RESULTS: The statistical analysis revealed that the 3D reconstruction is absolutely reliable for any measurements within the skull. The results of the measurements obtained from the CT image were accurate and comparable to the results of the anthropometric analysis of the skeletonized skull. The correlation between the anthropometry of the skeletonized skulls and the CT reconstructions was strong. CONCLUSIONS: It is relevant that 3D reconstructions of the skull can be used in forensic anthropology for personal identification.

Development of the maxillary sinus from birth to age 18. Postnatal growth pattern.

OBJECTIVES: Anatomical and developmental descriptions of the maxillary sinus may be of great clinical importance. An understanding of age-related changes in the dimensions and volume of the normal maxillary sinus may help in the evaluation of radiographs and identification of sinus abnormalities. The aim of the present study was to define growth patterns of maxillary sinuses in children up to the age of 18 years and evaluate the correlation between normal age-related changes in dimensions and volume. METHODS: The research sample consisted of CT scans of 170 patients subdivided into 17 groups based on age. Normal developmental changes were investigated and linear dimensions measured. RESULTS: The maxillary sinus, present at birth, increases in size until the end of the 18th year. The growth pattern includes changes in vertical, horizontal and antero-posterior directions. No bilateral dimorphism was observed, but gender-related differences were found in children over the age of 8 years. The most extensive period of growth occurs during the first 8 years and by the end of the 16th year the maximal values of all diameters and volume are reached. CONCLUSIONS: A CT study of developing maxillary sinuses allowed a precise evaluation of age-related changes in all diameters and volume to be made.

Microencapsulated sodium butyrate administered to patients with diverticulosis decreases incidence of diverticulitis--a prospective randomized study.

BACKGROUND: Microencapsulated sodium butyrate (MSB) has been previously associated with anti-inflammatory and regenerative properties regarding large bowel mucosa. We aimed to examine a role of MSB in patients with diverticulosis, hypothesizing its potential for reduction of diverticulitis episodes and diverticulitis prevention. METHODS: Seventy-three patients with diverticulosis (diagnosed in colonoscopy or/and barium enema or/and CT colography) were recruited for the study and randomized. The investigated group was administered MSB 300 mg daily; the control group was administered placebo. After 12 months, a total of 52 patients completed the study and were subject to analysis (30 subjects and 22 controls). During the study, the number of episodes of diverticulitis (symptomatic diagnosis with acute pain, fever, and leukocytosis), hospitalizations, and surgery performed for diverticulitis were recorded. Additionally, a question regarding subjective improvement of symptoms reflected changes in quality of life during the analysis. RESULTS: After 12 months, the study group noted a significantly decreased number of diverticulitis episodes in comparison to the control group. The subjective quality of life in the study group was higher than in the control group. There were no side effects of the MSB during the therapy. CONCLUSIONS: MSB reduces the frequency of diverticulitis episodes, is safe, and improves the quality of life. It can play a role in the prevention of diverticulitis.

Difficulties in personal identification caused by unreliable dental records.

This paper demonstrates a case of personal identification that initially seemed straightforward, mainly because complete and comprehensive antemortem dental records of a missing person were made available for analysis. Skeletal remains were found and the skull (most crucial for human identification) was delivered for analysis. Comparative analysis of antemortem and postmortem dental records excluded identification, while the results of superimposition (simultaneously performed by another team member) revealed sufficient concordant points to establish identity. The results caused confusion and additional information was required. The need for more evidence resulted in delivery of elements of the postcranial skeleton. Identification was finally achieved when concordant points were established in a comparison of antemortem X-rays and the humerus. Team members concluded that the dental records were in fact not adequate and that mistakes in numbering the teeth (superior canine instead inferior canine and right and left premolars) were considered to be the initial reason a positive identification had not been made. The authors conclude that a multidisciplinary approach is crucial to making a positive identification and that caution should be exercised when carrying out personal identification from dental records alone. The need to adequately train police officers to collect and preserve dental evidence is also emphasized.

Body mass estimation in modern population using anthropometric measurements from computed tomography.

Forensic anthropologists are able to estimate the stature of a skeleton, its sex and biological age at death, with a relatively high degree of accuracy. Body mass estimation from the stature and bi-iliac (maximum pelvic) breadth and femoral head breadth can be useful in forensic investigations involving unidentified skeletal remains. Predicting the body mass of skeletal remains always involves significant inaccuracy, however when body mass extremes are disregarded average figures provide the best estimation. The aim of the study was to investigate whether the methods usually used in body mass estimation are accurate in different BMI ranges. The usefulness of these methods in forensic anthropology was discussed. The study was performed using CT images of widely differing body types of modern central European populations. Maximum pelvic breadth and anteroposterior femoral head breadth were measured directly from the appropriate CT scan slices for each individual. Body mass index was established for each individual. Four different methods of body mass estimation were applied. The statistical analysis showed that body mass prediction methods based on the bi-iliac breadth with known stature and the femoral head breadth show strong correspondence. The results of body mass estimation using different methods were in high correlation with normal BMI. The accuracy of body mass prediction of underweight and obesity cases (BMI extremes) showed significant inaccuracy. Body mass estimation methods can provide important information for forensic anthropological investigation and personal identification. However, one should be aware of the discrepancies and should apply the equations carefully as they can carry significant errors.

The conclusive role of postmortem computed tomography (CT) of the skull and computer-assisted superimposition in identification of an unknown body.

Computed tomography is commonly used in modern medicine, and thus, it is often helpful for medicolegal purposes, especially as part of the antemortem record. The application of postmortem computed tomography and 3D reconstruction of the skull in challenging cases is reported, and its valuable contribution to positive identification is discussed. This paper presents a case in which the body of an unknown individual is identified. Positive identification had not been possible despite a multidisciplinary examination. The postmortem use of computerized tomography and 3D reconstruction of the skull followed by the comparison of individual morphological characteristics of the viscerocranium showed the concordant points between the deceased and a missing person. Finally, superimposition using a 3D-reconstructed skull instead of the skeletonized skull demonstrated an adequate degree of morphological consistency in the facial images of the analyzed individuals that lead to positive identification. It was concluded that where other methods of personal identification had failed, the use of postmortem computed tomography had proved to be instrumental in the positive identification of the deceased.

[Examination of the skull of Stanislaw Papczynski (1631-1701)--the founder of the fraternity of Marian Priests]. / Badania czaszki Stanislawa Papczyniskiego (1631-1701)--zalozyciela zgromadzenia ksiezy Marianów.

Procedures of identifying an individual on the basis of skeletal remains are of interest to anthropologists, anatomists, morphologists, physicians and criminologists. The results of such procedures are immensely significant, both from the cognitive point of view, as they allow for determining the range of variability of human traits, and from the practical standpoint, in forensic-medical procedures. The methodical aspect of the procedures represents an important problem since the reliability of the employed identification techniques determines the probability with which we can reconstruct the intravital appearance of an individual. The theoretical grounds for the criteria used for person's identification on the basis of skeletal remains are provided by the results of studies on variability of anatomic and morphologic structures and on reciprocal relations between the soft tissues and bony sublayer on which the soft tissues are distributed. Following the process of exhumation on February 12, 2007, in March, we received the skull of Father Stanislaw Papczynski, the founder of the fraternity of Marian Priests, with the objective of performing an anthropological examination and reconstructing his face. The examinations were commissioned in association with the ceremony of his beatification planned for September 2007. We used the "POL-SIT Rekonstrukcja" computer-assisted system of intravital face reconstruction, which represents a universal human face reconstruction system, based on the skull pattern introduced to the computer. Computed tomography CT was performed employing a Siemens tomograph Somatom Sensation 64. The 3 D reconstruction of the skull was achieved using the "In Space" software.