Measurement of the

^{140}Ce(n,γ) is a key reaction for slow neutron-capture (s-process) nucleosynthesis due to being a bottleneck in the reaction flow. For this reason, it was measured with high accuracy (uncertainty ≈5%) at the n_TOF facility, with an unprecedented combination of a high purity sample and low neutron-sensitivity detectors. The measured Maxwellian averaged cross section is up to 40% higher than previously accepted values. Stellar model calculations indicate a reduction around 20% of the s-process contribution to the Galactic cerium abundance and smaller sizeable differences for most of the heavier elements. No variations are found in the nucleosynthesis from massive stars.

[Arthroscopic Subtalar Distraction Arthrodesis in Post-Traumatic Indications]. / Artroskopická subtalární distrakcní artrodéza v poúrazových indikacích.

PURPOSE OF THE STUDY: This manuscript aims to present the method of arthroscopic assisted subtalar arthrodesis and to evaluate the benefi ts of this surgery on our study population. MATERIAL AND METHODS: In the period from 9/2007 to 1/2020, a total of 33 subtalar arthrodesis were performed in 31 patients aged 19-66 years (mean 48 years, median 50 years). The indication for arthrodesis was subtalar arthritis causing pain and gait disorders, or hindfoot deformities (most commonly after a calcaneus bone fracture). The arthroscopic assisted subtalar arthrodesis was performed with autologous tricortical bone block graft harvesting from the pelvis, supplemented by autologous cancellous bone graft. Stabilization was achieved by cannulated screws inserted in neutral ankle position. Patients in our retrospective study were followed up for a mean of 48 months (range, 24-130 months). The patients were evaluated preoperatively and at 2 years after surgery. The hindfoot angles and height (TCA - talocalcaneal angle, CIA - calcaneal inclination angle, TCH - talocalcaneal height) were evaluated on radiographs, bone union was assessed on radiographs and CT scans. The clinical assessment was performed using the ankle-hindfoot scale (AHS) of AOFAS (AOFAS score). RESULTS: The preoperative AOFAS score was 35-68 points (mean 52, median 54), the postoperative AOFAS score at 2 years after arthrodesis was 58-94 points (mean 82, median 82). Both the mean and median values of AOFAS score showed a signifi - cant progress from the poor result to the good and excellent result. After 2 years the TCA value decreased in 18 patients (56%) by no more than 3°. The CIA decrease observed in 21 patients (64%) was by 1° on average. The TCH decrease of 1-5 mm after 2 years since the surgery was seen in 16 patients. In 2 patients incomplete healing of arthrodesis was observed, manifested as a clinically asymptomatic non-union. No deep infection was reported. DISCUSSION: In agreement with the current literature, the arthroscopic subtalar arthrodesis has been confi rmed to be a safe method for the management of consequences of hindfoot fractures, with minimum complications and leading to accelerated bone fusion. Differences can be found in the approach, position, use of cancellous bone graft and surgical techniques. In recent years, prone position, posterior approaches, use of cancellous bone graft, distraction and fi xation with 2-3 screws divergently inserted into the bone prevail. The degree of healing of the bone fusion is generally an important factor. In our study population, non-healing was recorded in 2 patients, namely in the form of a clinically silent non-union. Neurological or early complications and/or osteosynthesis material failure occurred in up to a maximum of 10% of cases. The conclusive results of minimally invasive arthrodesis based on the AOFAS score have been confi rmed by us as well as by most authors. CONCLUSSIONS: Our study confi rmed that the arthroscopic assisted subtalar arthrodesis is a successful, reliable and safe minimally invasive method, with minimum complications, leading to stable arthrodesis. KEY WORDS: subtalar arthrodesis, subtalar arthroscopy.

Risk factors predicting cervical spine fracture on CT in craniocervical trauma - retrospective study.

INTRODUCTION: The study identifies risk factors predicting cervical spine fracture on CT based on information in the referral form. METHODS: All patients aged over 18 years with a CT scan of the head and cervical spine completed at the University Hospital Brno in the year 2019 to exclude any fresh trauma were included in the retrospective study. The analyzed potential risk factors included gender, age over 65 years, unconsciousness or impaired consciousness, mechanism of injury, paresthesia or plegia suspected to be associated with trauma, cervical spine pain, other neurological symptomatology, presence of cervical collar, presence of intracranial hemorrhage on head CT, and presence of skull fracture on head CT. RESULTS: In total, a cervical or upper thoracic spine fracture was described in 51 of 1177 patients (4.3%). Statistically significant risk factors for cervical spine fracture on CT scan were identified as mechanism of injury similar to car accident or jumping into water (OR 2.52; p=0.004), pain of the cervical spine (OR 1.81; p.

Rare Mucor circinelloides and Fusarium infection in latissimus free flap reconstruction after devastating foot injury in non-neutropenic patient.

Nowadays, free flap reconstruction in devastating lower limb trauma is a standard procedure in reconstructive surgery. The greatest factor directly affecting limb salvage is still the risk of infectious complications, whether local or systemic. Fungal wound infections are not among the most common infection complications in surgery, but their low incidence is compensated for by their fulminant and serious course, as well as severe local tissue destruction and strong angio-invasive potential together with the possibility of dissemination. In this case study, we present an example of a devastating lower leg injury, solved using latissimus free flap reconstruction, with subsequent difficult and prolonged healing, due to an invasive filamentous fungi infection. In the final part of the article, we focus briefly on the occurrence of similar cases in the literature.

[Importance of Skull X-ray in Head Trauma]. / Význam rtg lebky pri poraneních hlavy.

PURPOSE OF THE STUDY The aim of our study is to show the pitfalls of performing skull X-rays in patients with head injuries and the lack of accuracy of this examination nowadays, and to clarify the current trend in the MTBI investigation algorithm. MATERIAL AND METHODS A retrospective study of 3,950 patients treated for acute head injury at the Department of Trauma Surgery (University Hospital Brno) in the period from 2015 to 2016. Inclusion criteria were the following: mild brain injury (GCS = 15), primary skull X-ray design in head injury diagnosis. Patients with a positive skull X-ray finding underwent a head CT evaluation up to 24-hours from the injury except for the patients with an isolated nose bone fracture. A CT head scan was also performed in patients indicated by the neurologist at the initial examination based on the anamnestic data and an objective finding. RESULTS Inclusion criteria were met by 1,938 patients. In 1806 (93.2%) cases the X-ray was negative, in 132 (6.8%) patients the X-ray was positive, of which in 62% of patients a nasal fracture was detected. A skull fracture reported in 16 cases. Once the CT scan of the head was obtained, all of these cases were classified as false negative. After the CT scan of the head, intracranial bleeding was observed in 12 patients, in 4 cases accompanied by fractures of the skull, not visible on the X-ray images. After the statistical evaluation, the sensitivity and specificity of the X-ray examination compared to the CT scan of the head was determined to be 0.00 and 0.94, respectively. DISCUSSION The aim of MTBI diagnostics is primarily to detect serious intracranial lesions requiring neurosurgical intervention. A simple X-ray of the skull shows fractures only and does not allow to visualize both the brain and any traces of bleeding that would show an intracranial injury. Hofman, in his meta-analysis, points out that a simple X-ray image of the skull has only very little noticeable value when diagnosing MTBI. The prevalence of intracerebral hematoma (ICH) over MTBI is 0.083. The sensitivity of a radiographic finding of skull fracture in the diagnosis of ICH based on the CT verification is only 0.38 with a specificity of 0.95, which is consistent with our study where the sensitivity of the radiographic finding was 0.00 with a specificity of 0.94 relative to CT. Thus, the question is not whether to perform an X-ray of the skull in mild head injuries, but rather when to indicate a CT scan of the brain, when to admit the patient to the hospital for observation, and for how long or when the patient can be safely discharged into home care. The purpose of MTBI diagnostics, however, should not be a rashly decision to perform a brain CT scan, but to put into practice the CT indication criteria in MTBI applying and respecting the validated guidelines known worldwide. CONCLUSIONS Our study, in which no X-ray examination revealed possible intracranial bleeding, clearly shows that nowadays the plain radiograph of the skull does not bring any benefit in the diagnosis of minor traumatic brain injury. Key words:skull X-ray, CT of the head, head injury, minor traumatic brain injury.

[Ipsilateral Fractures of the Coracoid and Acromion Process of the Scapula Combined with the Distal Clavicle End Fracture, Treatment Options]. / Ipsilaterální zlomenina processus coracoideus a akromionu lopatky v kombinaci se zlomeninou laterální cásti klavikuly, terapeutická moznost resení.

Superior Shoulder Suspensory Complex (SSSC) is a bone and soft-tissue ring securing the connection of the upper extremity to the axial skeleton via the clavicle and sternoclavicular joint. An isolated injury to one component of SSSC is usually stable. An injury to 2 of its components is a potential source of shoulder girdle instability and requires surgical stabilisation. An injury affecting 3 and more components is extremely rare and surgical stabilisation should be indicated. Our study presents the case of a 50-year-old man who fell off the bicycle and sustained a direct blow to his left shoulder resulting in an ipsilateral fracture of the coracoid and acromion process combined with the fracture of the distal end of the clavicle. Following a standard clinical examination and a subsequent X-ray and a CT scan with three-dimensional shoulder reconstruction, an open reduction and stabilisation of all the injured SSSC components was performed. Later, early and gradual rehabilitation of the shoulder girdle was commenced. At 48 weeks after the surgery, almost full range of motion of the shoulder joint was achieved and the muscle strength of the operated upper extremity was comparable to that of the healthy one. Key words:Superior Shoulder Suspensory Complex, fracture, acromion, coracoid process, clavicle.

[Isolated Displaced Fracture of the Acromion - Case Report]. / Izolovaná dislokovaná zlomenina akromiálního výbezku lopatky - kazuistika.

UNLABELLED: Displaced fractures of the acromion are rare injuries. A 45-year-old lady presented with an isolated acromion fracture (type III, Kuhn classification) resulting from a direct blow to the top of her right shoulder in a fall while skiing. After standard clinical and radiological examination of the shoulder, an open reduction and internal plate fixation using a postero-superior approach to the scapula was performed. Early rehabilitation of the arm and shoulder was initiated. At 50 days after surgery the patient achieved a full range of motion in her right shoulder and muscle strength equal to that of the contralateral extremity. By 12 weeks radiographic union of the fracture was recorded. The final functional outcome after open reduction and internal plate fixation of the fracture was comparable with results reported in the literature and, in comparison with conservative treatment, the risk of non-union was significantly reduced. KEY WORDS: acromion fracture, scapula, osteosynthesis.

[Effect of Negative Pressure Wound Therapy on Infectious Complications in Grade III Open Fractures]. / Primární aplikace podtlakové terapie u otevrených zlomenin III. stupne a její vliv na vznik infekcních komplikací.

UNLABELLED: PURPOSE OF THE STUDY Grade III open fractures are associated with infectious complications in 25-66% of injuries. Negative pressure wound therapy (NPWT) applied to an injured soft tissue coverage provides an impermeable barrier between the injured structures and the external environment, in addition to early secretion draining and a positive effect on the site of application. All this also prevents secondary bacterial contamination. The objective of the study was to compare the results of treatment methods in view of infectious complications in patients with soft tissue injury in grade-III open fractures managed either by NPWT and primary closure or by covering with combined dressing fabric (COM) in combination with continual wound lavage. MATERIAL AND METHODS This retrospective study comprised 77 patients with 80 grade III open fractures treated in the years 2008-2012; of these, 39 patients with 41 fractures met the inclusion criteria and were finally evaluated. The patients were divided into two groups. The control group included 19 patients with 20 fractures treated by the standard surgical procedure using stabilisation with an external fixator or intramedullary nail, thorough soft tissue debridement, continual wound lavage and suture of skin lesions or using a primary coverage of the defect with COM. The trial group consisted of 20 patients with 21 fractures treated according to the same principle, but NPWT was applied to injured soft tissue coverage first and skin suture or any other type of skin defect coverage was carried out when the healing process was good and bacteriological findings were negative. The results of both methods were evaluated based on the following criteria: development of superficial or deep infection in the wound, interval to negative bacteriological findings and osteomyelitis rate. The results were analysed by Fisher's exact test and the Man Whitney U test. RESULTS Infectious complications were recorded in a total of 15 (37%) fractures: 11 (55%) in the control group and four (19.1%) in the trial group (p = 0.025). Recurrent infection was observed in five control group fractures (25%) and in none of the trial group fractures (p = 0.021). Osteomyelitis was found only in two control group fractures. The average interval before negative bacteriological results were obtained was 22 days in the control group and 12 days in the trial group (p = 0.001). DISCUSSION The NPWT use as a temporary coverage of soft tissue defects in open fractures results in a significant reduction of infectious complications, as shown by many relevant studies including this study. In comparison with Gopal's "fix and flap" concept, the NPWT in our patient group had slightly higher incidence of infectious complications (15.4% versus 19.1%). However, these results can be achieved only if a specialist in reconstructive surgery and appropriate technical facilities are readily available. If this is not possible, then the NPWT, in comparison with conventional methods, provides the best possible way of temporary protection for an injured soft tissue coverage. CONCLUSIONS Application of NPWT within the primary treatment of injured soft tissue coverage in grade III open fractures results in a statistically significant reduction of bacterial contamination at the site of injury, as well as a reduction of the subsequent incidence of infectious complications. Primary application of NPWT also significantly reduced the risk of recurrent infection. KEY WORDS: open fracture, negative pressure wound therapy, continual wound lavage, infection.

Fasciotomy closure using negative pressure wound therapy in lower leg compartment syndrome.

BACKGROUND: Fasciotomy wounds can be a major contributor to length of stay for patients as well as a difficult reconstructive challenge. OBJECTIVES: To evaluate lower leg fasciotomy wound closure outcomes comparing treatment with combined dressing fabric (COM) and negative pressure wound therapy (NPWT) in combination with elastic dynamic ligature (EDL). METHODS: Retrospective study of 63 patients who underwent lower leg fasciotomy due to injury treated from January 2008 to December 2015 at the Department of Trauma Surgery, University Hospital Brno. Of these fasciotomy wounds 42 received a NPWT treatment in combination with EDL, 21 were treated only with COM. Fasciotomy wounds were closed either with primary suture or in case of persisting oedema and skin retraction the defect was covered with split thickness skin graft. RESULTS: There was statistically significantly higher rate of primary wound closure using the NPWT versus traditional dressing (p = 0.015). Median time to definitive wound closure or skin grafting was shorter in the NPWT group. Number of dressing changes was lower in the NPWT group (p=0.008). CONCLUSION: NPWT combined with elastic dynamic ligature offers many advantages for fasciotomy wound closure in comparison with traditional techniques (Tab. 5, Fig. 3, Ref. 21).

Low-energy enhancement in the photon strength of 95Mo.

A new experimental technique is presented using proton-γ-γ correlations from (94)Mo(d,p)(95)Mo reactions which allows for the model-independent extraction of the photon strength function at various excitation energies using primary γ-ray decay from the quasicontinuum to individual low-lying levels. Detected particle energies provide the entrance excitation energies into the residual nucleus while γ-ray transitions from low-lying levels specify the discrete states being fed. Results strongly support the existence of the previously reported low-energy enhancement in the photon strength function.

Traumatic haemarthrosis of the knee -- indication to acute arthroscopy.

BACKGROUND AND AIMS: The most common mechanisms of the knee injuries are distortions and contusions. Fairly often they will result in hemarthrosis. The purpose of this study was to evaluate the findings in patients with acute traumatic hemarthrosis of the knee and based on these findings estimate the necessity of acute artroscopic examination with therapeutic procedure. MATERIAL AND METHODS: In the years 2007 and 2009 a total of 266 patients underwent acute arthroscopic examination in Department of Traumatology the Faculty Hospital Brno after the acute knee trauma. Patients with other intraarticular bone fractures were excluded. RESULTS: The ruptures of the ACL were the most common findings (52 %), meniscal tear (27 %), dislocation of the patella (11 %) and chondral or subchondral fractures were (13 %). In 224 (84 %) cases was performed artroscopic therapeutic procedure and in only 43 (16 %) case was performed routine arthroscopic examination. CONCLUSIONS: Based on our findings we believe that arthroscopic examination is necessary in patients with acute traumatic haemarthrosis of the knee and it is better methods like NMR examination because is provided to execute therapeutic procedure (Tab. 1, Fig. 2, Ref. 8). Full Text in PDF www.elis.sk.

[Early suture versus ligamentoplasty of scapholunate ligament injury: comparison of clinical results]. / Casná sutura versus ligamentoplastika léze skafolunátního vazu - srovnání klinických výsledku

PURPOSE OF THE STUDY: The aim was to evaluate subjective and objective criteria of wrist, hand and arm function in a group of patients with acute static scapholunate dissociation treated by acute suture or ligament reinsertion, and in a group of patients with chronic static scapholunate dissociation treated by ligament reconstruction using ligamentoplasty. MATERIAL AND METHODS: Of a total number of 70 patients treated surgically for scapholunate instability at the Department of Trauma Surgery, University Hospital in Olomouc and the Department of Trauma Surgery, University Hospital in Brno, from 2002 till the end of 2008, 37 patients with acute or chronic static scapholunate dissociation treated by suture, ligament reinsertion or ligamentoplasty were selected. Of them, 17 patients with chronic scapholunate dissociation and 10 patients with acute scapholunate dissociation appeared at the final follow-up. The assessment of subjective criteria was based on the Disabilities of the Arm, Shoulder and Hand Score, the Wrightington Wrist Function Score and the Visual Analogue Scale. The objective criteria included range of motion and grip strength, and radiographic parameters, such as scapholunate gap and scapholunate and scaphocapitate angles. Satisfaction of the patients and their return to work were also evaluated. The results were statistically analysed using the Chi-square, Mann-Whitney-U and Wilcoxon tests, with the level of significance a=0.05. RESULTS: In the group with acute static scapholunate dissociation, the objective criteria showed an improved range of flexion- extension. The range of radial and ulnar bending and grip strength were almost identical with those of the healthy wrist. In both evaluated groups the self-rated criteria had almost the same values in all three rating systems used. No statistically significant difference in any of the values compared was recorded. DISCUSSION: The results of subjective and objective assessments were comparable in the two groups. Paradoxically, some items of the subjective evaluation were better in the patients undergoing ligament reconstruction - ligamentoplasty. This can probably be explained by different subjective comparison of pre- and post-operative conditions in each group. Even though the subjective assessment was almost identical in both groups, we definitely find an advantage in acute treatment of a scapholunate ligament tear by suture. A technically easier procedure, a shorter period of restricted hand and arm function for the patient, no degenerative changes due to instability and a lower risk of complications - they all give support to this technique. Later conversion to another type of stabilisation if ligamentoplasty fails may bring problems and give much worse results than a failure of acute sutures CONCLUSIONS: An acute operative treatment of scapholunate ligament injury is regarded as a more suitable method for scapholunate dissociation. Ligamentoplasty, because of technical demands and risk of post-operative complications, can be used as a method of choice if the acute sutures of a torn scapholunate ligament fail or scapholunate dissociation is diagnosed at a late stage.

Anomalous fluctuations of s-wave reduced neutron widths of 192,194Pt resonances.

We obtained an unprecedentedly large number of s-wave neutron widths through R-matrix analysis of neutron cross-section measurements on enriched Pt samples. Careful analysis of these data rejects the validity of the Porter-Thomas distribution with a statistical significance of at least 99.997%.

[The Czech Republic Register of Injuries (URCR)--experience with the database management in the Brno Faculty Hospital]. / Urazový registr Ceské republiky--zkusenosti s vedením databáze ve FN Brno.

INTRODUCTION: Injuries are the leading cause of mortality in age group of people junior to 45 years. Central data collection is important to survey basic injury causation and trauma care quality. The Czech Trauma Registry was started in 2004. The aim of study was to discover valid statistic analysis from current data collection and its clinical practice contribution. PATIENTS AND METHODS: Doctors working in the Centre of trauma care (University hospital Brno) collect and enter data to the Trauma Registry. Data collection is practiced continuously through the hospitalization. Abbreviated Injury Scale and Injury Severity Score are used for injury severity determining. In the University hospital Brno 161 patients (159 patients met validity criterion) were entered in trauma registry. RESULTS: 159 patients were evaluated, Injury Severity Score was 16-75, demographically from 6 regions. Traffic accident was the most frequent cause of injury. Average inpatient age was 43 years. Mortality in our patient file was 10.7%. Investing sum for 1 patient who was returned to Trauma Registry was 209 019 Czech crowns. DISCUSSION: Authors confront their results with the German Trauma Registry, results in basic parameters are analogous. Data collection should be proceeding correctly. Czech Trauma Registry should be the instrument of quality management and is waiting for its statutory provision. CONCLUSION: Trauma registry is going to afford plenty information for pre-hospital and hospital care improvement.

Evidence for M1 scissors resonances built on the levels in the quasicontinuum of 163Dy.

Spectra of two-step gamma cascades following the thermal 162Dy(n,gamma)163Dy reaction have been measured. Distinct peaklike structures observed at the midpoints of these spectra are interpreted as a manifestation of the low-energy isovector M1 vibrational mode of excited 163Dy nuclei.

Neutron capture on (180)Ta(m): clue for an s-process origin of nature's rarest isotope.

The neutron capture cross section of (180)Ta(m) has been measured in the keV range, yielding a stellar average of 1465+/-100 mb at kT = 30 keV. Though the sample contained only 6.7 mg (180)Ta(m) (at an enrichment of 5.5%), the few capture events could be separated from much larger backgrounds by a unique combination of high efficiency, good energy resolution, and high granularity of the Karlsruhe 4 pi BaF(2) detector. A detailed s-process analysis based on this first experimental value indicates that (180)Ta(m) is predominantly of s-process origin.

Simulations of Gamma Cascades and Modelling Atomic Collision Chains.

A new method for simulation of nuclear γ cascades by the Monte Carlo technique is described. It makes it possible to generate artificially individual events of the γ-cascade decay of neutron capturing states in heavy nuclei. For the purpose of determination of lifetimes of nuclear levels by the GRID method the previously developed Mean Free Path Approach for modelling atomic collisions and their interplay with cascades has been generalized. Examples of the use of this generalization for determination of lifetimes of selected (150)Sm and (158)Gd levels are given and discussed.