A follow-up study on respiratory outcomes, quality of life and performance perception of SARS-CoV-2 primary and reinfection in elite athletes: A 9-month prospective study.

The prolonged consequences of SARS-CoV-2 on young elite athletes recovering from primary and reinfection are unclear. This study aimed to assess inspiratory/expiratory muscle strength and respiratory function at the time of spontaneous recovery at 3, 6, and 9 months after SARS-CoV-2 primary and reinfection in elite athletes. The study enrolled 25 elite male judoists, including 11 primary infection cases, five reinfection cases, and nine controls from the Türkiye Olympic Preparation Center. Inspiratory/expiratory muscle strength and respiratory function were measured, including maximal inspiratory pressure (MIP), maximal expiratory pressure (MEP), forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), FEV1/FVC, and peak expiratory flow (PEF) before and up to 9 months after SARS-CoV-2 infection in the early pre-competition preparation phases. The most common symptoms reported by reinfection cases were fatigue (80%), dyspnea (60%), and muscle/joint pain (60%), while primary infection cases reported fatigue (73%), muscle/joint pain (45%), and headache (45%). MIP decreased by -14% and MEP decreased by -13% following the SARS-CoV-2 infection in reinfection cases. Likewise, FEV1 and FVC decreased by -5% and -8%, respectively; consequently, FEV1/FVC increased by 3%. Inspiratory/expiratory muscle strength and respiratory function improved rapidly after 9 months of SARS-CoV-2 infection in primary cases, whereas dysfunction persisted in reinfection cases. PEF was unaffected throughout the 9-month follow-up period. Reinfection may lead to further alterations in respiratory system relative to the primary infection, with a suspected restrictive pattern that remains dysfunctional in the third month; however, it improves significantly during a 9-month follow-up period.

An atypical anatomical variation of the petrosphenoidal ligament in a newborn cadaver.

PURPOSE: To report an atypical anatomical variation of the petrosphenoidal ligament in a newborn cadaver and to discuss its clinical significance. METHODS: During a study of ten newborn cadavers, the skull base was dissected to reveal the anatomy of the petrosphenoidal ligament and its relationship with the abducens nerve. An atypical anatomical variation was observed, and this is described. The length of the right and left ligaments to the point where it splits into two arms, the joint length of the two ligaments at the junction of the clivus, the length of the ligament proceeding to the posterior clinoid process, and the abducens nerve's diameter as it passes below the ligament were measured on ImageJ software. RESULTS: The petrosphenoidal ligaments were y-shaped, and the attachment of the proximal ligaments was bifid. In the midline above the clivus, some ligament bundles joined the contralateral petrosphenoidal ligament, whilst another group of bundles originated at the posterior clinoid process. At the entry to Dorello's canal, the abducens nerve had a diameter of 0.59 mm on the left and 0.65 mm on the right. The part of the ligaments converging on the clivus in the midline after dividing into two arms was 10.68 mm. CONCLUSIONS: We think that this case report will provide useful information for surgical procedures to the petroclival region, transnasal surgical approaches, and surgical interventions involving the carotid artery.

Respiratory muscle strength and pulmonary function in unvaccinated athletes before and after COVID-19 infection: A prospective cohort study.

PURPOSE: We investigated abnormalities and recovery in respiratory function after COVID-19 infection in an unvaccinated elite athlete population. METHODS: Measurements included maximal inspiratory pressure (MIP), maximal expiratory pressure (MEP), forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), and peak expiratory flow (PEF). RESULTS: The most frequent reported symptoms were fatigue with 80% and muscle/joint pain and headache with 50%, whereas only 10% reported dyspnoea and 30% cough. During follow-up, MIP was up to 13% and MEP up to 8% lower following COVID-19 infection. Likewise, FEV1 was up to 2% and FVC up to 5% lower. While MEP and FEV1 rapidly normalised, MIP and FVC still remained abnormal after 52 days of COVID-19 infection, thereby leading to a restrictive ventilatory pattern. PEF seemed unaffected during follow-up. CONCLUSIONS: COVID-19 decreases respiratory function in unvaccinated athletes despite reporting few respiratory symptoms and having mild disease. An initiative aimed at reducing the long-term adverse effects following COVID-19 infection seems warranted, which perhaps may be avoided through vaccination.

Golden ratio for the foramen magnum on CT images: a morphological and morphometrical study / Proporción áurea para el foramen magnum en imágenes de TC: un estudio morfológico y morfométrico

SUMMARY: The foramen magnum (FM) is a transition zone between the spine and skull. There is a study in the literature showing the golden ratio (4.62) and harmony between both FM and the anteroposterior and transverse diameters of the skull. The aim of this study is to examine the existence of this ratio on CT images and to investigate whether this ratio changes according to the FM shape types. In this study, 402 adult CT images belonging to the Turkish population were examined. Maximum cranial length (MCL), maximum cranial width (MCW) and the FM length (FML) and FM width (FMW) were measured. The different shapes of the FM were macroscopically classified. The number and incidence of each type in the studied skull was registered. In the 402 CT images used in the study, 12 FM shapes were detected. Three of the shape types observed in our study have not been reported in the literature until now, and were found in our study for the first time. In addition, our data supported that by using the ratio of 4.62, there was a great harmony between the skull and FM. The results obtained from the research show that there is a ratio of 4.62 between the basic cranial measurements and FM dimensions in all shapes except triangular shape. It is thought that repeating the calculated coefficients over more different FM shapes will contribute to the effectiveness of the proposed golden ratio.

RESUMEN: El foramen magno (FM) es una zona de transición entre la columna y el cráneo. Existe un estudio en la literatura que muestra la proporción áurea (4,62) y la armonía entre el FM y los diámetros anteroposterior y transversal del cráneo. El objetivo de este estudio fue examinar la existencia de esta relación en las imágenes de TC e investigar si esta relación cambia según los tipos de forma del FM. Se examinaron 402 imágenes de TC de adultos pertenecientes a la población turca. Se midieron la longitud craneal máxima, el ancho craneal máximo y la longitud del FM y la anchura del FM. Las diferentes formas del FM se clasificaron macroscópicamente. Se registró el número e incidencia de cada tipo en el cráneo estudiado. En las 402 imágenes de TC utilizadas en el estudio, se detectaron 12 formas de FM. Tres de los tipos de formas observados en nuestro estudio no se han reportado en la literatura consultada describiéndose por primera vez. Además, nuestros datos respaldaron que al usar la proporción de 4,62, había una armonía importante entre el cráneo y el FM. Los resultados obtenidos de la investigación muestran que existe una relación de 4,62 entre las medidas craneales básicas y las dimensiones de la FM en todas las formas excepto en la triangular. Se cree que la repetición de los coeficientes calculados en más formas de FM diferentes contribuirá a la eficacia de la proporción áurea propuesta.

Variations of the superficial peroneal nerve and its terminal branches in the Turkish newborn fetuses.

AIM: The topography of the superficial peroneal nerve (SPN) and its terminal branches were studied, with the aim of providing further anatomical details for leg and foot in the Turkish newborn fetuses. MATERIAL AND METHODS: Limbs from twenty newborn cadavers were dissected. The course of the SPN on the leg and its terminal branches on the foot were investigated. RESULTS: The SPN was lateral (75%), anterior (15%), or branched in both areas (10%) of the cases. The SPN in the dorsum of the feet branched further into medial dorsal cutaneous nerve (MDCn) and intermediate dorsal cutaneous nerve (IDCn). In 82.5% of the cases the MDCn and the IDCn split into three and two branches, respectively. In 10% of the cases, the MDCn gave off three, and the IDCn one terminal branches. In 7.5% of the cases, the MDCn had three while the IDCn had two branches that communicated with the lateral dorsal cutaneous nerve. CONCLUSION: The course of SPN on the anterolateral surface of the leg and its terminal branches on the dorsal surface of the foot were quite different. This unusual variant location will enable the surgeon to find and preserve the SPN and its terminal branches.

A stereological study of MRI and the Cavalieri principle combined for diagnosis and monitoring of brain tumor volume.

In this study, we aimed to describe the application of the Cavalieri principle for the assessment of tumor volume using MRI without an over-projection/estimation effect. For this purpose, the volume of a patient's brain and the brain tumor volume, or the volume of the former tumor region, were estimated preoperatively and postoperatively using a combination of the Cavalieri principle and MRI. The previously described formula was modified for MRI measurements to eliminate the over-estimation effects of imaging. The total brain and tumor volumes estimated using the MRI of a representative patient with glioblastoma multiforme were: preoperative, 1562.46 cm³ and 81.59 cm³, respectively; and postoperative, 1571.72 cm³ and 86.92 cm³, respectively. The mean time to count points for an estimation of brain and tumor volume (or the volume of the former tumor region) were 14 minutes and 3 minutes, respectively. The coefficients of the errors of the estimates for brain and tumor volume (former tumor volume, postoperative) measurements were: preoperative 0.01 and 0.02; and postoperative 0.01 and 0.03, respectively. Our results show that the combination of MRI and the Cavalieri principle can provide an unbiased, direct and assumption-free estimate of the regions of interest. Therefore, the presented method could be applied efficiently without any need for special software, additional equipment or personnel other than that required for routine MRI in daily use.

Volumetric evaluation of the paranasal sinuses in normal subjects using computer tomography images: a stereological study.

OBJECTIVE: The size and shape of paranasal sinuses are especially relevant when considering endoscopic sinus surgery. For this reason, the size of the paranasal sinuses has been the subject of many studies, none of which has used stereological methods to estimate the volume. In the present stereological study, we estimated the volume of paranasal sinuses of normal males and females. MATERIAL AND METHODS: We used a combination of the Cavalieri principle and computer tomography scans taken from 39 male and 38 female patients to estimate the volumes of frontal, maxillary, ethmoidal and sphenoidal sinuses. RESULTS: The mean volumes of frontal, maxillary, ethmoidal and sphenoidal sinuses were estimated bilaterally, producing mean volumes of 11.6+/-0.8, 35.9+/-1.3, 11.8+/-0.4 and 13.6+/-0.7 cm(3), respectively. When the correlations between estimated volumes were analyzed statistically a positive relation was found for the paranasal sinuses. The size of the sinuses tends to decrease with age. CONCLUSION: The findings of the present study using the stereological methods could provide data for the evaluation of normal and pathological volumes of the paranasal sinuses.

The average values of the nasal anthropometric measurements in 108 young Turkish males.

OBJECTIVE: The aim of the study was to describe the average values of the nasal anthropometric measurements in young Turkish male population. METHODS: Study group consisted of 108 volunteer young Turkish males whose age were 18-30 years (mean age 22.31 year). All subjects were students in Yasar Dogu School of Physical Education and Sport of University of Ondokuz Mayis. RESULTS: The means total length and nasal bridge length of the nose were 56.92 and 55.26 mm, respectively. The means of the nasal bridge width and morphologic nose width were 29.74 and 33.63 mm, respectively. The mean width of the anatomic nose was 23.14 mm. The mean width of the nostril floor was 11.00 mm. The means length and width of the ala were 19.93 and 4.81 mm, respectively. The means of length and width of the columella were 9.34 and 5.34 mm, respectively. The mean frontonasal angle was 134.96 degrees and the mean nasolabial angle was 90.32 degrees. CONCLUSION: The nose was the dominant feature in the facial region. Anthropometric measurements related with the nose measured were compared with the available literature. Average values of the nose in this population may be used as a landmark for guidance to plan corrective surgery of the nose.

A new approach for the estimation of intervertebral disc volume using the Cavalieri principle and computed tomography images.

This study was carried out to describe a simple, accurate and practical technique for estimating the volume of intervertebral disc (ID) by the combination of the Cavalieri principle and computed tomography (CT) images. Total eight lumbar IDs from two cadavers were CT scanned in axial, sagittal and coronal sections. The consecutive sections with 5 and 3mm thickness were used to estimate the volume of the IDs by the Cavalieri principle. Three investigators estimated the volume of IDs independently to evaluate inter-observer differences. When the results were compared to the real volumes of IDs measured by the fluid displacement technique, there was no significant difference between the real volume measurements and the Cavalieri estimation results of ID volumes (P > 0.05). Moreover, findings of three investigators did not show significant variations (P > 0.05). Our results indicate that the section thickness and the section planes did not affect the accuracy of the disc volume estimation. Thus the combination of CT scanning with the Cavalieri principle may be used as a direct and reliable technique to estimate the volume of IDs with a mean of 4 min workload per ID.

Estimation of breast prosthesis volume by the Cavalieri principle using magnetic resonance images.

BACKGROUND: The purpose of this study was to search the accuracy and reproducibility of the Cavalieri method for the estimation of the breast prosthesis volume on magnetic resonance images (MRI). METHODS: Nine breast prostheses were scanned in axial and coronal section planes by MRI. The consecutive sections in 5-mm thickness were taken, after which the volumes of the prostheses were measured and estimated by means of the fluid displacement technique and three-dimensional postprocessing software, respectively. The volumes of the prostheses also were estimated by three performers using the Cavalieri principle to check the accuracy and interobserver interrelation of the suggested technique RESULTS: There were no significant differences between the Cavalieri estimate and the real volumes of the breast prostheses (p > 0.05), nor between the performers's volume estimates (p > 0.05). The orientation of the section planes did not affect the accuracy of the estimates (p > 0.05) CONCLUSIONS: This report describes a rapid, simple, accurate, and practical technique for estimating the volume of the breast prostheses without changing the routine process in the clinics. It was concluded that the combination of MRI with the Cavalieri principle is a direct and accurate technique that can be applied safely for estimating the volume of the breast prosthesis in 4 min and 34 s per prosthesis.

Rapid estimation of the vertebral body volume: a combination of the Cavalieri principle and computed tomography images.

OBJECTIVE: The exact volume of the vertebral body is necessary for the evaluation, treatment and surgical application of related vertebral body. Thereby, the volume changes of the vertebral body are monitored, such as infectious diseases of vertebra and traumatic or non-traumatic fractures and deformities of the spine. Several studies have been conducted for the assessment of the vertebral body size based on the evaluation of the different criteria of the spine using different techniques. However, we have not found any detailed study in the literature describing the combination of the Cavalieri principle and vertebral body volume estimation. MATERIALS AND METHODS: In the present study we describe a rapid, simple, accurate and practical technique for estimating the volume of vertebral body. Two specimens were taken from the cadavers including ten lumbar vertebras and were scanned in axial, sagittal and coronal section planes by a computed tomography (CT) machine. The consecutive sections in 5 and 3 mm thicknesses were used to estimate the total volume of the vertebral bodies by means of the Cavalieri principle. Furthermore, to evaluate inter-observer differences the volume estimations were carried out by three performers. RESULTS: There were no significant differences between the performers' estimates and real volumes of the vertebral bodies (P>0.05) and also between the performers' volume estimates (P>0.05). The section thickness and the section plains did not affect the accuracy of the estimates (P>0.05). A high correlation was seen between the estimates of performers and the real volumes of the vertebral bodies (r=0.881). CONCLUSION: We concluded that the combination of CT scanning with the Cavalieri principle is a direct and accurate technique that can be safely applied to estimate the volume of the vertebral body with the mean of 5 min and 11 s workload per vertebra.

The phrenic ganglion in man.

During educational dissections we observed a phrenic ganglion on the nerve of the phrenic artery originating from the upper pole of the right coeliac ganglion, which accompanied the right inferior phrenic artery on a female cadaver at the age of 34. In our case the left coeliac ganglion, the inferior phrenic artery, the right and left greater, lesser and least splanchnic nerves were present and normal. However, the left nerve of the phrenic artery and the phrenic ganglion were absent. We consider that this rarely reported neural formation may be of importance for anatomists and clinicians.

A deep femoral artery passing in front of the femoral vein.

It is known that a different ramification pattern can occur as a function of the development of the arteries of the lower limb. During a routine dissection, a variation of the deep femoral artery was found passing in front of the femoral vein in the left lower limb of a 43-year-old male cadaver. This case is reported because of its rare occurrence in the literature. The variation is discussed on the basis of the possible embryological development of the lower limb arteries.

Unbiased estimation of the liver volume by the Cavalieri principle using magnetic resonance images.

OBJECTIVE: It is often useful to know the exact volume of the liver, such as in monitoring the effects of a disease, treatment, dieting regime, training program or surgical application. Some non-invasive methodologies have been previously described which estimate the volume of the liver. However, these preliminary techniques need special software or skilled performers and they are not ideal for daily use in clinical practice. Here, we describe a simple, accurate and practical technique for estimating liver volume without changing the routine magnetic resonance imaging scanning procedure. MATERIALS AND METHODS: In this study, five normal livers, obtained from cadavers, were scanned by 0.5 T MR machine, in horizontal and sagittal planes. The consecutive sections, in 10 mm thickness, were used to estimate the whole volume of the liver by means of the Cavalieri principle. The volume estimations were done by three different performers to evaluate the reproducibility. RESULTS: There are no statistical differences between the performers and real liver volumes (P > 0.05). There is also high correlation between the estimates of performers and the real liver volume (r = 0.993). CONCLUSION: We conclude that the combination of MR imaging with the Cavalieri principle is a non-invasive, direct and unbiased technique that can be safely applied to estimate liver volume with a very moderate workload per individual.