Three-dimensional computed tomography analysis of frontoethmoidal cells: A critical evaluation of the International Frontal Sinus Anatomy Classification (IFAC).

OBJECTIVES: Two major classifications of frontoethmoidal cells, Lee and Kuhn and the IFAC (International Frontal Sinus Anatomy Classification), distinguish anterior, posterior and medial cells. The European anatomical position paper includes also lateral cells. According to the IFAC, anterior cells push the frontal sinus drainage pathway (FSDP) medially, posteriorly or posteromedially. Posterior cells push the FSDP anteriorly. The only medial cell, pushing the FSDP laterally is the frontal septal cell, which is attached to or located in the interfrontal sinus septum. The aim of this study was to verify the IFAC and characterise cells, which are inconsistent with this classification. DESIGN: A radioanatomic analysis. SETTING: Tertiary university hospital. PARTICIPANTS: One hundred and three Caucasian adult patients with no inflammatory changes in paranasal sinuses CT. MAIN OUTCOMES MEASURE: Results of assessment of multiplanar reconstruction of thin slice CT. RESULTS: Two types of cells that cannot be classified using the IFAC were found: (a) Lateral cells extending between the skull base and the anterior buttress, pushing the FSDP anteromedially or medially, present in 34 (16.5%) of the sides, (b) Paramedian cells: medially based, not adjacent to the interfrontal septum, pushing the FSDP laterally and posteriorly, present in 33 (16%) of sides. Suprabulla cells and suprabulla frontal cells were found to push the FSDP in directions other than anterior 28% and 31% of the time respectively. CONCLUSIONS: Neglecting lateral and paramedian cells may lead to inconsistent results between radioanatomical studies and impede communication between surgeons. They should be included in existing classifications of frontoethmoidal cells.

Measurement of the inflammatory response in the early postoperative period after hip and knee arthroplasty.

BACKGROUND: The aim of this study was to identify an inflammatory marker with fast and predictable kinetics to enable future discrimination between normal postoperative inflammation and potential infection after total hip and knee arthroplasty cases. METHODS: Changes in serum levels of C-reactive protein (CRP), interleukins (IL) 1ß, 6 and 8 and NT-proCNP peptide were measured before and during first 5 postoperative days in 100 patients undergoing total hip or knee arthroplasty. We also compared two methods to describe the magnitude of inflammation--applying separate two sample tests at each time point, and summary measures--area under the curve (AUC). RESULTS: IL-6 showed a similar kinetics pattern to the CRP in response to surgical trauma. Significantly greater level changes in all markers but NT-proCNP were observed in knee patients. Persisting high levels of CRP, but not other markers, were observed in obese hip patients. IL-6 was found to be an adjunct to routine CRP use. CONCLUSIONS: IL-6 has faster kinetics and is less influenced by patient weight, therefore it seems to be more useful in clinical practice. Summary measures describe the inflammatory response well and are easier to analyze than multiple analyses of single time points.

Factors associated with employment of powered wheelchair users.

Purpose: To identify correlations between demographic, health-related, environmental factors and the employment status of power wheelchair (PWC) users.Method: We retrospectively analysed semi-structured interviews with 128 participants, their assistants or family members, and the participant's provided medical records. Participants were adult PWC users who applied for grants in purchasing a new PWC for gaining or keeping employment between 2019-2021 in Mazovian Province, Poland.Results: Forty-six PWC users (35.9%) were employed while applying for the financial support programme. Fischer's Exact Test of Independence identified positive correlations between employment and education level (p < 0.001), residing in an urban area (p = 0.02), being employed before starting PWC use (p < 0.001), having vocational rehabilitation (p < 0.001), and living in a relationship (p = 0.002). There were no associations between employment status and sex, age at study entry, age at disability onset, living alone or with others, duration of PWC use, or full or part-time PWC use. Our findings indicate that PWC users are at risk of non-employment and financial hardship. This research may support policies for PWC provision that would support gainful employment. The results show that access to quality education, vocational rehabilitation, and perhaps the physical/emotional support from others in close relationships matter. These aspects should be considered in educational policies, transportation, and physical environmental accessibility for PWC users, supporting their gainful employment.

Paid employment is recognised for its positive impact on the financial situation, health, and overall life satisfaction of power wheelchair users. Rehabilitation professionals can play a crucial role in facilitating the attainment and maintenance of employment throughout the clinical process.Educating power wheelchair users with factors conducive to supporting their employment, such as pursuing advanced education, utilising vocational rehabilitation services, residing in urban areas, fostering meaningful social relationships, and drawing upon previous employment experiences, may improve outcomes.Sex, age, disability cause, duration of disability, and reliance on a power wheelchair as the primary mode of mobility were found to be unrelated to employment status among power wheelchair users.Further investigation into the needs of the power wheelchair user population in their pursuit of gainful employment is justified.

Sphenomaxillary Plate: Landmine or Landmark?

OBJECTIVES: Sphenomaxillary plate (SMP) is an inconstant bony septum separating the maxillary and sphenoid sinuses. Neglecting the SMP during endoscopic sinus surgery may lead to mistaking the sphenoid sinus for the posterior ethmoid cell with potentially dangerous consequences. However, its proper identification may allow planned sphenoidotomy through the posterior wall of the maxillary sinus or to enlarge transnasal or transethmoidal sphenoidotomy. The aim of this study was to evaluate (1) the incidence and morphology of the SMP and (2) possibility and safety of trans-SMP sphenoidotomy. METHODS: In the radioanatomical part of the study multiplanar reconstruction analysis of 117 consecutive paranasal sinus CT scans was conducted. In the clinical part of the research, trans-SMP sphenoidotomy was performed in consecutive patients operated on for chronic rhinosinusitis. RESULTS: The SMP was found in 25% of sides (34% of patients). It was constantly located superolateral to the posterior insertion of the middle turbinate. The SMP formed the prominence on the posterior wall of the maxillary sinus that could be identified using volume rendering in 11% of sides (19% of patients). 30 trans-SMP sphenoidotomies were performed in 18 patients. The SMP prominence was identified in 15 sides. In absence of SMP prominence, identification of the SMP was still possible using other anatomical landmarks. CONCLUSIONS: The SMP is present in over 30% Caucasian subjects at least on one side. Sphenoidotomy through the SMP is feasible and safe.

What do physiotherapists and physiotherapy students know about autonomic dysreflexia?

CONTEXT/OBJECTIVE: Autonomic dysreflexia (AD) is an emergency condition typical for individuals with spinal cord injury (SCI). Adequate health professionals' knowledge of AD is important for the effective and safe rehabilitation of persons with SCI. The purpose of the study is to assess the knowledge of AD in undergraduate and postgraduate physiotherapists. The data gained will be useful for better addressing of AD in clinical practice. DESIGN: An observational study. SETTING: Rehabilitation College in Warsaw, Medical University of Warsaw, Poland. PARTICIPANTS: 52 undergraduate and 68 postgraduate physiotherapists. INTERVENTION: AD knowledge testing. OUTCOME MEASURES: A test assessing knowledge of causality and consequences of AD created at the Medical University of Warsaw. RESULTS: No significant differences in test scores between under- and postgraduates were found (P = 0.09). Higher scores were noted in physiotherapy masters as compared to bachelors (P = 0.01), in participants who have an in-patient practice (P = 0.04), a practice longer than 5 years (P = 0.02) and those who see patients with SCI more frequently (P = 0.01). A self-assessed knowledge of AD was admitted as poor or none by 96.2% of undergraduates and 86.8% of postgraduates. CONCLUSION: In the studied population the knowledge of causality and consequences of AD presented by undergraduate and postgraduate physiotherapists was low. Lower test scores were associated with a lower level of professional education achieved, having an outpatient practice only and having fewer patients with spinal cord injury. Efforts should be made to improve undergraduate and postgraduate education on AD of physiotherapists.

The Effect of Anti-aging Peptides on Mechanical and Biological Properties of HaCaT Keratinocytes.

Atomic force microscopy (AFM) and fluorescence microscopy was applied to determine the influence of the anti-aging peptides on the morphology and the mechanical properties of keratinocytes. Immortalized human keratinocytes (HaCaT) were treated with two anti-aging bioactive peptides: Acetyl Tetrapeptide-2 and Acetyl Hexapeptide-50 (Lipotec). The AFM measurement of the keratinocyte stiffness were carried after 48 h exposure at an indentation depth of 200 nm. AFM analysis showed increase of the cell stiffness for cells treated with Acetyl Tetrapeptide-2 (P1) in concentration range. Acetyl Hexapeptide-50 (P2) at concentration of 0.05 µg/ml also increased the stiffness of HaCaT cells but at higher concentrations 0.5 and 5 µg/ml cell stiffness was lower as compared to untreated control. Fluorescence microscopy revealed remodeling of actin filaments dependent on the concentration of P2 peptide. The mechanical response of HaCaT cells treated with P2 peptide corresponds to change of transcription level of ACTN1 and SOD2 which activity was expected to be modulated by P2 treatment.

Neutrophil-to-lymphocyte ratio shows faster changing kinetics than C-reactive protein after total hip and knee arthroplasty.

BACKGROUND: Total hip arthroplasty (THA) and total knee arthroplasty (TKA) induce inflammatory reactions, which can be described by changes in the neuroendocrine, cellular, protein, and cytokine systems. The aim of this study was to document the normal distribution pattern of the neutrophil-to-lymphocyte ratio (NLR) after THA and TKA and to compare it with postoperative C-reactive protein (CRP) patterns. METHODS: Changes in serum CRP levels, neutrophil count, and lymphocyte count were measured before and during the first 5 postoperative days in a prospective study performed on 387 patients undergoing total hip or knee arthroplasty. RESULTS: Mean CRP levels in patients undergoing THA were 7.7 mg/L, 184.8 mg/L, and 115.9 mg/L, respectively, at Days 0, 3 and 5. The mean NLR of patients undergoing THA was 2.9, 3.6, and 2.7, respectively, at Days 0, 3, and 5. Mean CRP levels in patients undergoing TKA were 7.8 mg/L, 192.6 mg/L, and 108.6 mg/L, respectively, at Days 0, 3 and 5. The mean NLR of patients undergoing TKA was 2.8, 3.4, and 2.6, respectively, at Days 0, 3, and 5. When comparing the preoperative value and the Day 3 value, CRP levels increased more than the NLR (almost a 24-fold increase in mean CRP values vs. a 1.2-fold increase in mean NLR values). In both groups, the NLR returned to preoperative values by the 5th postoperative day. CONCLUSIONS: The present study demonstrated a significant elevation in CRP levels and the NLR following THA and TKA. In both groups, the NLR showed a faster kinetics pattern than CRP levels in response to surgical trauma.The translational potential of this article: We describe results of the use of the NLR, as compared to a routinely used marker, CRP, as advantageous in clinical setting due to faster dynamics of change. Integrating the NLR in clinical practice seems easy and without extra cost.

The effect of polymeric membrane surface on HaCaT cell properties.

The control of the surface properties is an important issue for applicability of polymer membranes interacting with cells. In this work, the influence of surface roughness and stiffness of two polymer membranes on viability and mechanical properties of keratinocytes was studied. Terpolimer polyglicolide, polycaprolactone and polylactide, (PGA-PCL-PLA) and copolymer polycaprolactone, polyglicolide (PGA-PCL) substrates were used for membranes fabrication. Surface modification - the hydrolysis of the obtained membranes was carried out. The analysis of membranes' surface properties revealed that RMS surface roughness and roughness factor of PGA-PCL-PLA membrane decreased after hydrolysis while its stiffness increased. In contrast, the PGA-PCL membrane stiffness was only slightly affected by NaOH treatment. Immortalized human keratinocytes (HaCaT) were grown under standard conditions on the surface of the studied membranes and characterized by means of atomic force microscopy and fluorescence microcopy. The results showed the substrate-dependent effect on cells' properties.

The effect of delphinidin on the mechanical properties of keratinocytes exposed to UVB radiation.

The usage of active compounds of dietary phytochemicals in prevention of UV-induced skin diseases is increasingly gaining attention in the development of skin care products. The purpose of this study was to measure the influence of delphinidin (as a botanical agent) on the cell mechanical properties evaluated by the atomic force microscopy (AFM) technique in the immortalized human keratinocyte cell line (HaCaT) exposed to UVB radiation. The cells were treated with various doses of UVB radiation with and without pre and post-treatment with selected concentrations of delphinidin. The measurements of the elastic properties revealed that the exposure of HaCaT cells to high dose of the UVB radiation (100mJ/cm2) caused a decrease in the cell elastic modulus. It was accompanied by the decrease of metabolic activity, rearrangement of actin cytoskeleton and disappearance of the cell repair marker 53BP1. Both pre-treatment and post-treatment with delphinidin at non-cytotoxic concentrations (5 or 10µM), restored the elastic modulus of irradiated keratinocytes. A direct AFM analysis showed that the UVB-mediated decrease of the cell stiffness was restored more effectively when cells were treated with delphinidin after the UVB irradiation. The results demonstrate the regenerative effect of delphinidin on the mechanical properties of cells exposed to UVB radiation (100mJ/cm2), which may be due to antioxidant and inhibitory effect on matrix metalloproteinases activation.