Quantification of Gardnerella vaginalis, Atopobium vaginae and Lactobacillus spp. in bacterial vaginosis.

INTRODUCTION: The aim of the study was to investigate prevalence of bacteria most frequently associated with bacterial vaginosis using Amsel's criteria as well as to quantify these bacteria by real-time PCR and to explore the difference in their quantity between healthy and bacterial vaginosis samples. METHODOLOGY: For classification of vaginal discharge samples Amsel's criteria have been used. To detect and quantify Gardnerella vaginalis Atopobium vaginae, Lactobacillus spp. and total vaginal microbiome, real-time PCR has been applied. RESULTS: According to results of our study Amsel's criteria matched well with real-time PCR diversification of healthy women and women with BV. Nevertheless, real-time PCR has been more sensitive in diagnosis of bacterial vaginosis. DNA quantification of bacteria demonstrated that mutual abundance of G.vaginalis and A. vaginae was good bacterial vaginosis marker . On the contrary, Lactobacillus spp. was present in high amount in both healthy and bacterial vaginosis samples, but ratio of investigated bacteria was different between them. In fact, G. vaginalis and A. vaginae comprised only 0.1% of total microbiome in healthy, whereas Lactobacillus spp. took 99.3% of it. Nonetheless, in bacterial vaginosis, G. vaginalis and A. vaginae made up 34.4% of total microbiome, while Lactobacillus spp. was 21.6%. CONCLUSIONS: According to the results of our study real-time PCR analysis was more sensitive in diagnosis of bacterial vaginosis than Amsel's method, as well as it represented fine tool in making a difference between microbial entities in healthy and bacterial vaginosis samples.

Effects of Focal Vibration and Robotic Assistive Therapy on Upper Limb Spasticity in incomplete Spinal Cord Injury.

Vibration stimulation seems to be an affordable easy-to-use rehabilitation tool. Focal muscle vibration (FV) has potential to reduce spasticity and enhance muscle strength and performance. Combined with robotic assisted movement therapy, the rehabilitation can benefit from improvement of more than one aspect. For example, FV could firstly decrease abnormally increased muscle tone and joint rigidity by tackling volitional control for easier robotic movement exercise. Exactly this approach is evaluated within a clinical trial presented in this paper. FV were applied to relaxed spastic wrist flexor and extensor muscles for 15min. Subsequently, the wrist was engaged in a robotic-assisted game-playing. Results from two cases who completed the trial showed short-term decrease in wrist stiffness as assessed by clinical spasticity measurement Modified Ashworth Scale (MAS). Active range of motion (AROM) and engineering joint stiffness (JS) measurements were estimated using a robotic apparatus and the results complemented previous observations. The AROM increased and JS decreased for both cases when compared at the beginning and at the end of each interventional session. These results are a part of an ongoing clinical trial but show promise for reducing repercussions of spasticity in incomplete spinal cord injury.

VIBROfocus: Design of a focal vibro-tactile robotic-assistive system for spasticity rehabilitation.

The main focus of spasticity treatment is to alleviate pain, improve function and reduce risk of additional complications. In this paper the design of a robotic system with enhanced focal vibro-tactile stimulation for the treatment of spasticity in the upper limbs is presented. Building on emerging evidence on the use of vibrations in the treatment of spasticity, we propose a new integrated approach. Our design combines the use of vibro-tactile stimulation of the high tone muscle with robotic movement assistance to augment rehabilitation outcomes in patients with spasticity in the upper limbs.

Analysis of cervical resistance during continuous controllable balloon dilatation: controlled clinical and experimental study.

BACKGROUND: Hydraulic dilatation is a novel method of cervical dilatation that is based on continuous controllable dilatation (CCBD) by the pumping of fluid into the balloon extension of the system. The main advantage of this procedure is that it allows control of and insight into the process of cervical dilatation. METHODS: For the purposes of our research, we created a new and upgraded system for CCBD which consists of a programmed hydrostatic pump connected to a balloon extension. With regard to our aim to precisely measure and determine the location of the cervical resistance, we placed two pressure-measuring films, one on the top and one on the bottom of the balloon extension. This study included 42 patients in whom cervical resistance was measured before suction curettage. RESULTS: Cervical dilatation and measurement of cervical resistance were successful in all patients. The analysis of the pressure-measuring films showed that the points of highest resistance were located in the zone of the internal cervical os and that these values were much higher than those in the zone of the external cervical os (0.402 versus 0.264 MPa at the upper pressure-sensitive film; 0.387 versus 0.243 MPa at the lower pressure-sensitive film). This study also showed that an increase in cervical resistance in the zone of the internal cervical os was followed by an increase in cervical resistance in the zone of the external cervical os. CONCLUSIONS: During CCBD, the internal cervical os is the centre of cervical resistance, and the values do not decline with the number of miscarriages or the number of previous births. TRIAL REGISTRATION NUMBER: ISRCTN Registry identifier: ISRCTN30949871 . Date of registration: 13 May 2015.

Computer simulation of cervical tissue response to a hydraulic dilator device.

BACKGROUND: Classical mechanical dilators for cervical dilation are associated with various complications, such as uterine perforation, cervical laceration, infections and intraperitoneal hemorrhage. A new medical device called continuous controllable balloon dilator (CCBD) was constructed to make a significant reduction in all of the side effects of traditional mechanical dilation. METHOD: In this study we investigated numerically the cervical canal tissue response for Hegar and CCBD using our poroelastic finite element model and in-house software development. Boundary conditions for pressure loading on the tissue for both dilators in vivo were measured experimentally. Material properties of the cervical tissue were fitted with experimental in vivo data of pressure and fluid volume or balloon size. RESULTS: Obtained results for effective stresses inside the cervical tissue clearly showed higher stresses for Hegar dilator during dilation in comparison with our CCBD. CONCLUSION: This study opens a new avenue for the implementation of CCBD device instead of mechanical dilators to prevent cervical injury during cervical dilation.

[Breech presentation at term: caesarean section or vaginal delivery?].

INTRODUCTION: Term breech presentation occurs in 3-4% of all deliveries. Most obstetricians are completely sure how to end delivery when the foetus is in breech presentation, by caesarean section as the only option. OBJECTIVE: The main goal of the paper was to present the method of delivery for term breech presentation analyzed at the Hospital of Gynaecology and Obstetrics and Clinical Centre in Kragujevac, and parameters that influenced the decision on the method of choice to perform delivery with the foetus in breech position. METHODS: During a three-year prospective study, the course and outcome of all term breech deliveries were under followup. The study involved only deliveries in breech presentation, with a trial of labour ending by vaginal delivery, while elective caesarean section due to breech presentation of the foetus was not included in the study. The following parameters were compared: body mass, newborn's first minute Apgar score and head circumference, gestational maturity, gestational age, delivery duration, maternal level of education and maternal parity. RESULTS: Of total 6,470 deliveries, 653 (10.10%) were finalized by caesarean section. Of these, there were 202 (3.12%) term breech presentations, of which 72 (35.64%) women had caesarean and 130 (64.36%) vaginal delivery. A difference was detected in newborn's body mass and head circumference, delivery duration, maternal level of education and parity between pregnancies terminated surgically in comparison to vaginal delivery, while pregnancy duration, maternal age, first minute Apgar score, and most significantly, perinatal morbidity did not show any difference regardless of the method of delivery for term breech presentation. CONCLUSION: With respect of all known parameters, vaginal delivery in breech presentation is also accepted.

Ovarian endometroid adenocarcinoma in pregnancy.

BACKGROUND: Ovarian cancer is very rare in pregnancy. It is mainly of epithelial origin, low grade and low malignant potential. CASE REPORT: We presented a patient in which ultrasound confirmed the presence of clearly limited tumor in the left ovary when she was eight weeks pregnant. The results of 4D Color Doppler showed a central type of tumor vascularisation with resistance index (IR) less than 0.5. The Consultancy Board in Gynecology of the Institute for Oncology and Radiology of Serbia decided to remove the patient's left adnexa and intensively monitor the pregnancy period. The operation (Adnexectomia lateralis sinistra) was performed at 18th week of gestation. Histopathological analysis showed adenocarcinoma invasivum, endometroid well-differentiated type (histological grade I, nuclear grade 2). In 37th week of gestation, the patient gave birth to a male child by cesarean section. In the next 3 years the patient had no subjective interference, laboratory tests and ultrasonographic findings were normal. CONCLUSION: Ovarian cancer in pregnancy is usually asymptomatic and diagnosed during routine clinical and ultrasound examination. The color Doppler technique have particular importance in the diagnosis of pathological blood supply in tumors and in indication of malignant ovarian mass.

Cartilage oligomeric matrix protein - inflammation biomarker in knee osteoarthritis.

Chondrocytes and synovial cells synthesize Cartilage Oligomeric Matrix Protein (COMP) when activated by proinflammatory cytokines. The aim of this study was to analyze and compare ultrasound parameters of joint inflammation, effusion and synovitis with the levels of COMP in the serum of patients with primary osteoarthritis. Ultrasound was done and the concentration of COMP (ng/mL was examined in 88 patients. 75% of patients had effusion (size 10.13±4.35 mm), 62.5% had effusion in lateral recessus (LR), 28.4% (size 8.53±2.27 mm) in suprapatelar (SR), and 27.3% (size 11.38±4.44 mm) in medial (MR). 67% of patients had synovitis size 4.84±3.57 mm in SR, 3.15±1.86 mm in MR; and 6.09±2.80 mm in LR. 17.0% of patients had nodular type of synovitis, 30.7% had diffusive, and 19.3% nodular - diffusive. There was a significant link between the size of synovitis and effusion in SR (r = 0.966, p = 0.000), MR (r = 0.812, p = 0.009) and LR (r = 0.886, p = 0.003). The median of COMP concentration was 54 (44.5-58) ng/mL in patients without effusion. In those with effusion it was 57 (48.75-64.25) ng/mL (p = 0.030). Without synovitis it was 52 (45.5-58) ng/mL, with synovitis 58 (50-66) ng/mL, (p = 0.006), diffusion type synovitis 60 (50-67) ng/mL, nodular 57 (50-62) ng/mL, nodular-diffusion 54 (44.5-66.5) ng/mL (p = 0.014). With longer osteophytes the median of COMP was 56 (48-64) ng/mL, with shorter osteophytes 55 (46.5-59) ng/mL (p = 0.000). Cartilage oligomeric matrix protein has a moderate significance in the assessment of disturbance of the metabolism of synovial and cartilage tissue in patients with knee osteoarthritis (sensitivity = 59%; specificity = 50%; cut off = 53.5 ng/mL).

Cytosolic pro-apoptotic SPIKE induces mitochondrial apoptosis in cancer.

Proteins of the BCL-2 family are important regulators of apoptosis. The BCL-2 family includes three main subgroups: the anti-apoptotic group, such as BCL-2, BCL-XL, BCL-W, and MCL-1; multi-domain pro-apoptotic BAX, BAK; and pro-apoptotic "BH3-only" BIK, PUMA, NOXA, BID, BAD, and SPIKE. SPIKE, a rare pro-apoptotic protein, is highly conserved throughout the evolution, including Caenorhabditis elegans, whose expression is downregulated in certain tumors, including kidney, lung, and breast. In the literature, SPIKE was proposed to interact with BAP31 and prevent BCL-XL from binding to BAP31. Here, we utilized the Position Weight Matrix method to identify SPIKE to be a BH3-only pro-apoptotic protein mainly localized in the cytosol of all cancer cell lines tested. Overexpression of SPIKE weakly induced apoptosis in comparison to the known BH3-only pro-apoptotic protein BIK. SPIKE promoted mitochondrial cytochrome c release, the activation of caspase 3, and the caspase cleavage of caspase's downstream substrates BAP31 and p130CAS. Although the informatics analysis of SPIKE implicates this protein as a member of the BH3-only BCL-2 subfamily, its role in apoptosis remains to be elucidated.

[The ultrasonographic diagnosis of fetal encephalocele at 13th gestational week].

BACKGROUND: Encephalocele presents a rare anomaly of central nervous system, developed as a consequence of neural tube closing defect during early embrional development, and it is described by a baggy formation which prolaborates through the pores of the scull, filled with brain tissue, cerebrospinal liquor and entwined with meninges. According to literature search, until this day, the earliest it can be ultrasonically detected is the 13th gestation week, with the appliance of three-dimensional ultrasound. CASE REPORT: We presented 25 years old patient, ultrasonically diagnosed with occipital fetal encephalocela at the 13th gestation week. A gestation sack was located in the right uteral corn of the two-corned uterus with one cervix. The diagnosis was confirmed also by trippled value of alpha-fetoprotein in maternal serum: 75.98 IU/mL. CONCLUSION: Ultrasonic examination is the method of choice for prenatal detection of a fetal anomaly. It is possible to diagnose encephalocele if it prominates above the limits of the scull.

[Histochemical and immunohistochemical analysis of ruptured atherosclerotic abdominal aortic aneurysm wall].

BACKGROUND/AIM: The main complication of the atherosclerotic abdominal aortic aneurysm (AAA) is her rupture that begins with lesion in intima and rupture. The purpose of this work was to determine immunocytochemical and morphofunctional characteristics of the cells in aortic wall in ruptured atherosclerotic abdominal aortic aneurysm. METHOD: During the course of this study, 20 samples of atherosclerotic AAA were analyzed, all of them obtained during authopsy. The samples were fixed in 4% formalin and embedded in paraffin. Sections of 5 microm thickness were stained histochemically (of Heidenhain azan stain and Periodic acid Schiff--PAS stain) and immunocytochemically using a DAKO LSAB+/HRP technique to identify alpha-smooth muscle actin (alpha-SMA), vimentin, myosin heavy chains (MHC), desmin, S-100 protein, CD45 and CD68 (DAKO specification). RESULTS: The results of our study showed that ruptured atherosclerotic AAA is characterized by a complete absence of endothelial cells, the disruption of basal membrane and internal elastic lamina, as well as a presence of the remains of hypocellular complicated atherosclerotic lesion in intima. On the plaque margins, as well as in the media, smooth muscle cells (SMCs) are present, which express a alpha-SMA and vimentin (but without MHC or desmin expression), as well as leukocyte infiltration, and a large number of foam cells. Some of the foam cells show a CD68- immunoreactivity, while the others show vimentin- and S-100 protein-immunoreactivity. Media is thinned out with a disorganized elastic lamellas, while adventitia is characterized by inflammatory inflitrate (infection). CONCLUSION: Rupture of aneurysm occurs from the primary intimal disruption, which spreads into thinned out media and adventitia. Rupture is caused by unstable atherom, hypocellularity, loss of contractile characteristics of smooth muscle cells in intima and media, neovascularization of the media, as well as by the activity of the macrophages in the lesion.

[Treatment of surgical wounds on the uterus after laparoscopic myomectomy].

INTRODUCTION: The advantages of laparoscopic removal of a myoma over classical surgical technique are shorter hospital stay, rapid recovery and less pain after surgery, as well as a lower frequency of ileus and thromboembolic complications. The surgical technique of laparoscopic removal of myoma involves four basic stages: incision on the wall of the uterus, separation of the myoma from the healthy uterine tissue, to stop bleeding and removal of the myoma from the abdomen. Apart from these four basic stages, it is also necessary to establish a new integrity of the uterine wall, especially in women planning pregnancy. OBJECTIVE: The aim of the paper is to present the procedures used in the treatment of uterine wall defect during the laparoscopic removal of the myoma. METHODS: We analysed 96 patients who were indicated for laparoscopic myomectomy. All patients were divided into four groups according to the type of the technique of haemostasis and treatment of the defect on the uterine wall: electrocoagulation, electrocoagulation with application of argon plasma, a single suture and extended suture. RESULTS: In order to stop bleeding, we most often used electrocoagulation by monopolar electricity, i.e. in 39.6% of the patients. To stop bleeding and treat the defect of the uterine wall, we used a single suture in 21.9% and in 11.4% patients we used the extended suture. The manner of uterine wall treatment did not have a statistically significant influence on the results of haematological parameters (p > 0.05), consumption of carbon dioxide (p > 0.05) and the duration of surgical procedure (p > 0.05). The increased use of antibiotics (p < 0.05) in the group of patients in whom we treated the defect by sutures on the uterus, the length of postsurgical hospitalisation and absence from work (p < 0.01) was statistically significant. CONCLUSION: To achieve a better reconstruction of the uterus, it is recommended to use sutures with laparoscopic removal of myoma.

[Arthrosonography and biomarkers in the evaluation of destructive knee cartilage osteoarthrosis].

INTRODUCTION: Knee osteoarthrosis (OA) is a degenerative disease with progressive loss of cartilage of joints and bone destruction. During this process, the release of fragments of connective tissue matrix is detected in the biological fluids such as human cartilage glycoprotein (YKL-40), cartilage oligomeric matrix protein (COMP) and collagen type I C terminal telopeptid (CTX-I). OBJECTIVE: The aim of the study was to determine the degree of connection cartilage thickness measured by ultrasound with serum concentrations of biomarkers YKL-40, COMP and CTX-I in patients with primary knee OA. METHODS: The analysis included 88 patients with the diagnosis of knee OA. Ultrasound examination of knees were done by two rheumatologists. The analysis of serum samples determined the concentration of COMP, YKL-40 and CTX-I by the ELISA method. RESULTS: The average age of patients was 69.97 +/- 9.37 years and the duration of knee OA 6.46 +/- 6.73 years. The average cartilage thickness of the femoral condyle was 1.33 +/- 0.20 mm; of the medial condyle (MC) (front access) 1.30 +/- 0.23 mm, (rear access) 1.30 +/- 0.29 mm and lateral condyli (LC) (front access) 1.39 +/- 0.27 mm. The average cartilage thickness of MC (front access) was 1.27 mm (0.98-1.42 mm), (rear access) 1.27 mm (0.84-1.46 mm) and LC (front access) 1.36 mm (1.01-1.57 mm) (p = 0.002). There was a significant connection in the negative direction between the patients' age and the cartilage thickness of MC (front and rear access) and LC (front access) (r = -0.253; p = 0.017). There was a significant negative direction of interrelationship between the cartilage thickness of MC (front access) (r = -0.259; p = 0.015) and LC (front access) and the disease duration (r = -0.259; p = 0.015). In patients with knee OA lasting for 5 years the measured cartilage thickness was 1.27 mm (1.16-1.49 mm), and 0.99 mm (0.94-1.23 mm) (p = 0.007) in those lasting for 20 years. There was a significant relationship in a negative direction between the concentration of YKL-40 and cartilage thickness of MC (front access) (r = -0.249; p = 0.019). CONCLUSION: The progressive loss of cartilage during the long-term evolution of osteoarthrosis is most extensive in the femoral MC. The increased serum levels of YKL-40 can be a good indicator of joint cartilage destruction.

A MR compatible mechatronic system to facilitate magic angle experiments in vivo.

When imaging tendons and cartilage in a MRI scanner, an increase in signal intensity is observed when they are oriented at 55 degrees with respect to Bo (the "magic angle"). There is a clear clinical importance for considering this effect as part of the diagnosis of orthopaedic and other injury. Experimental studies of this phenomenon have been made harder by practical difficulties of tissue positioning and orientation in the confined environment of cylindrical scanners. An MRI compatible mechatronic system has been developed to position a variety of limbs inside the field of view of the scanner, to be used as a diagnostic and research tool. It is actuated with a novel pneumatic motor comprised of a heavily geared down air turbine, and is controlled in a closed loop using standard optical encoders. MR compatibility is demonstrated as well as the results of preliminary trials used to image the Achilles tendon of human volunteers at different orientations. A 4 to 13 fold increase in signal at the tendon is observed at the magic angle.

[Influence of metal-ceramic fixed dental restorations on the occurrence of discoloration of gingiva].

BACKGROUND: Adverse effects of dental cast alloys on the health of patients are the problem in clinical practice. The aim of this paper was to describe the case of a patient with discolorated gingivae in the presence of fixed dental restorations and used diagnostic and therapeutic procedures. CASE REPORT: A 30-year old pacient, presented with the complaints about unsatisfactory esthetic of his fixed dental restorations. He complained about the greyish discoloration of gingivae, inappropriate color of the crowns, and a larger space between the central incisors. Both discolorated and normal gingivae around the fixed dental restorations were taken by excision and the samples of gingivae were examined histopathologically, and by using the Atomic Absorption Spectrophotometry test (AAS). Histopathological examination of the discolorated gingivae showed the presence of non-specific inflammation with a foreign body. AAS revealed the presence of various metals in the samples and the higher metal contents in the samples of discolorated gingivae as compared with the samples of normal gingivae. New metal-ceramic crowns were made for the patient. CONCLUSION: A main cause of greyish discoloration of gingivae was presence of a metal in gingival tissue. After the excision of discolorated gingivae old metal-ceramic crowns should be replaced with new crowns.

A one degree of freedom haptic system to investigate issues in human perception with particular application to probing tissue.

This paper presents the results of several early studies relating to human haptic perception sensitivity when probing a virtual object. A 1 degree of freedom (DoF) rotary haptic system, that was designed and built for this purpose, is also presented. The experiments were to assess the maximum forces applied in a minimally invasive surgery (MIS) procedure, quantify the compliance sensitivity threshold when probing virtual tissue and identify the haptic system loop rate necessary for haptic feedback to feel realistic.

Ensuring the usability of a knee arthroscopy simulator.

There is limited research considering the usability of medical virtual environments. Usability evaluation is an essential validation phase that considers the extent to which a product achieves its specific goals, with effectiveness, efficiency and satisfaction. A four-stage iterative approach is adopted to enhance usability in the development of a knee arthroscopy training system. This process has drawn attention to issues that may impede system usability for example non-conformity to platform conventions, and visibility of the system status. The process highlights features that computer scientists can overlook when working closely with a system but that are essential to user acceptance and effective application.

Novel force resolver designs for a haptic surgery simulator.

This paper presents the results of an investigation into the design of low cost, four degree of freedom force/torque resolvers for use in compact haptic devices for surgical training. Two designs using piezo-resistive sensors are described and one using strain gauges. The advantages and disadvantages of each approach are stated and conclusions presented.

Effect of a low-dose ethinylestradiol and gestodene in combination on the frequency of micronuclei in human peripheral blood lymphocytes of healthy women in vivo.

BACKGROUND: Since most oral hormonal contraceptives contain a fixed combination of ethinylestradiol and gestodene as an estrogenic/progestogenic component, we decided to evaluate the possible mutagenic effect of a low-dose contraceptive pills containing 20 microg ethinylestradiol and 75 microg gestodene. METHODS: A total of 30 healthy women received hormonal contraception during six consecutive menstrual cycles. A single daily dose was 20 microg ethinylestradiol and 75 microg gestodene. The pills were taken orally in a monthly cycle of 3 weeks on and 1 week off. In the investigation of the mutagenic effect of these contraceptive pills in vivo, the cytokinesis block micronucleus (CBMN) test was used, and the frequency of micronuclei (MN) in peripheral blood lymphocytes was determined. RESULTS: Average MN frequency in women before therapy was 7.40 +/- 0.75 MN/1000 analyzed cells, and after therapy was 7.37 +/- 0.59 MN/1000 analyzed cells (p > 0.05). CONCLUSION: Our data suggest that oral contraception with 20 microg ethinylestradiol and 75 microg gestodene in combination during six consecutive menstrual cycles does not induce micronuclei in peripheral blood lymphocytes of women.