Trend change analysis in the assessment of body balance during posture adjustment in reaction to anterior-posterior ground perturbation.

Postural adjustments (PA) occur to counteract predictable perturbations and can be impaired as a result of musculoskeletal and neurological dysfunctions. The most common way to detect PA is through electromyography measurements or center of pressure (COP) position measurements, where analysis in time domain and frequency domain are the most common. Aim of the research was to determine whether a new method of analyzing stabilographic measurements-the COP trend change analysis (TCI) of temporary posture corrections- can expand understanding of changes in balance strategy connected with PA. The study group involved 38 individuals (27women, 11men) aged 23±2.6 years. Measurements were performed using a stabilographic platform placed on a perturbation platform. The tests involved three measurements with forward and backward momentary movements of the platform. Participants were tested in three conditions-knowing the nature, time and direction of perturbation (Tr3), knowing only the nature of perturbation (Tr2) and without any information about the perturbation (Tr1). Statistically significant differences were revealed in the last second of Tr3 for the mean velocity of COP (p<0.05) and for two TCI parameters-TCI_dV (p<0.05) and TCI_dS (p<0.01). The increase in TCI_dV was related to the increase in the mean distance between trend changes (TCI_dS) and constant value of the mean time between trend changes (TCI_dT). The increase of the mean value of TCI_dS was the result of smaller number of posture corrections with the distance 0-2 mm and lager number with the distance 4-6 mm. Obtained results proved that the TCI analysis is a method enabling an extended analysis of PA, indicating the nature of changes occurring in posture corrections-longer momentary jumps of COP-related to a change in the strategy of maintaining balance before a known disorder, which has not been analyzed in this type of research so far.

Atrial septum anatomy as a predictor of ischemic neurological episodes in patients with a patent foramen ovale.

BACKGROUND: The correlation between atrial septum anatomy and the risk of ischemic neurological events remains underexplored. AIMS: This study aimed to examine both the functional and anatomical attributes of the atrial septum and identify predictors of stroke and/or transient ischemic attack (TIA) in patients diagnosed with patent foramen ovale (PFO). METHODS: A total of 155 patients diagnosed with PFO, with a cardiological cause of neurological events, were enrolled. Transesophageal echocardiography was utilized to assess the anatomy of the PFO canal, size of the right-to-left shunt, thickness of the primary and secondary atrial septum, presence of atrial septum aneurysm, and anatomical structures of the right atrium. RESULTS: Regression analysis showed that factors such as female sex, hypercholesterolemia, PFO canal width, and a large right-to-left shunt were significantly associated with stroke and/or TIA. Receiver operating characteristic analysis indicated that the width of the PFO canal holds a relatively weak, although significant predictive, value for ischemic neurological episodes (area under the curve = 0.7; P = 0.002). A PFO canal width of 4 mm was associated with 70% sensitivity and 55% specificity for predicting stroke and/or TIA. CONCLUSIONS: The atrial septum's anatomy, especially the dimensions of the PFO canal and the magnitude of the right-to-left shunt, combined with specific demographic and clinical factors, are linked to ischemic neurological incidents in PFO patients.

Computer-assisted preoperative planning of reduction of and osteosynthesis of scapular fracture: A case report.

INTRODUCTION: Reports on the use of computer-assisted trauma surgery of comminuted scapula fracture are still quite rare. In this article, we present a case of comminuted scapula fracture, the surgical reconstruction of which was pre-operatively planned using a complex software solution. MATERIALS AND METHODS: For surgical planning of the fracture, we used the TraumaTech software facilitating virtual reconstruction (both manual and automatic), surgery planning, design of the implant, planning of screw placement and lengths, and production of a 3D print model of the fracture and the implant. The software also supported ordering such custom-made plate from a plate producer who was capable of fast and precise production of the plate. RESULTS: The surgery using the custom-ordered plate was successful. The actual used screw lengths did not differ from the planned ones by more than 2 mm. One year after the surgery, the patient was capable of more demanding activities and doing sports activities. CONCLUSION: This approach provides a great way to prevent complications of the surgery and to shorten its duration. To the best of our knowledge, this is the first description of the treatment of a scapula comminuted fracture utilizing computer-assisted preoperative planning.

Impact of percutaneous patent foramen ovale closure on migraine headaches in patients with history of ischemic neurological events.

INTRODUCTION: Observational studies have shown that migraine has been associated with patent foramen ovale (PFO). Whilst studies investigating PFO closure for the treatment of migraine have been neutral, there is some evidence that symptoms of migraine may improve if the PFO was closed after ischemic stroke. AIM: To establish whether closure of PFO in patients with stroke or transient ischemic attack (TIA) is associated with reduction in the severity of co-existent migraine headaches. MATERIAL AND METHODS: Patients with ischemic stroke or TIA, PFO suitable for percutaneous closure and migraine, were given migraine severity questionnaires prior to PFO closure. These were followed up at 6 and 12 months after closure with the same questionnaire. The primary endpoint was change in migraine severity using the Migraine Severity Scale (MIGSEV). Migraine episode frequency, disability (using the MIDAS scale), and pain intensity were also assessed. RESULTS: Sixty-two patients were included in the analysis. MIGSEV scores reduced from 7 (7-8) at baseline to 4 (3.25-6) at 6-month follow-up, and 3 (0-4) at 12-month follow-up (p < 0.001). Other measures of migraine headache were also improved at both 6- and 12-month follow-up. Twenty-four (38%) patients were rendered migraine free at 12 months. CONCLUSIONS: PFO closure for stroke or TIA prevention in patients with migraine was associated with a reduction in markers of migraine headache severity.

Early stage of atherosclerosis in aortocoronary saphenous vein grafts: intravascular ultrasound study

Abstract Introduction: Angiographically visible plaques in patent vein grafts are usually detected years after surgery. Our aim was to examine early plaque formation in vein grafts. Methods: Bypass angiography and intravascular ultrasonography (IVUS) examination were performed on 77 aortocoronary saphenous vein grafts (SVGs) implanted in 36 patients during the first 2 years after CABG. In each graft, a good quality 25 mm ultrasound image was analyzed. We measured: plaque area, lumen area, external elastic membrane (EEM) area, graft area and wall area. For the comparative assessment of SVGs, the index plaque area/EEM area was calculated. Data were analyzed for the following 4 time periods: I - 0-4 months (22 grafts), II - 5-8 months (23 grafts), III - 9-12 months (19 grafts) and IV - 13-16 months (13 grafts) after CABG. Student's t and Fisher-Snedecor tests were used for the purpose of statistical analysis in this retrospective study. Results: In period I, plaque formation (neointimal) was observed in 10 grafts (45%), with a mean plaque area of 1.59 mm., in 6 grafts (26%) in period II, with a mean plaque area of 1.03 mm. and in 15 grafts (71%) in period III, with a mean plaque area of 1.41 mm., and in all (100%) grafts in period IV, with mean plaque area of 2,3 mm.. Average index plaque area/EEM area in periods I, II, III and IV were 0.12, 0.08, 0.13 and 0.22. We have showed a significant plaque increase between periods II and IV(P=0.038). Conclusion: IVUS showed plaque in about 40% of venous grafts during the first year after CABG. Between 13-16 months plaque was visible in all studied grafts.

Early Stage of Atherosclerosis in Aortocoronary Saphenous Vein Grafts: Intravascular Ultrasound Study.

INTRODUCTION: Angiographically visible plaques in patent vein grafts are usually detected years after surgery. Our aim was to examine early plaque formation in vein grafts. METHODS: Bypass angiography and intravascular ultrasonography (IVUS) examination were performed on 77 aortocoronary saphenous vein grafts (SVGs) implanted in 36 patients during the first 2 years after CABG. In each graft, a good quality 25 mm ultrasound image was analyzed. We measured: plaque area, lumen area, external elastic membrane (EEM) area, graft area and wall area. For the comparative assessment of SVGs, the index plaque area/EEM area was calculated. Data were analyzed for the following 4 time periods: I - 0-4 months (22 grafts), II - 5-8 months (23 grafts), III - 9-12 months (19 grafts) and IV - 13-16 months (13 grafts) after CABG. Student's t and Fisher-Snedecor tests were used for the purpose of statistical analysis in this retrospective study. RESULTS: In period I, plaque formation (neointimal) was observed in 10 grafts (45%), with a mean plaque area of 1.59 mm., in 6 grafts (26%) in period II, with a mean plaque area of 1.03 mm. and in 15 grafts (71%) in period III, with a mean plaque area of 1.41 mm., and in all (100%) grafts in period IV, with mean plaque area of 2,3 mm.. Average index plaque area/EEM area in periods I, II, III and IV were 0.12, 0.08, 0.13 and 0.22. We have showed a significant plaque increase between periods II and IV(P=0.038). CONCLUSION: IVUS showed plaque in about 40% of venous grafts during the first year after CABG. Between 13-16 months plaque was visible in all studied grafts.

The first identification of nesfatin-1-expressing neurons in the human bed nucleus of the stria terminalis.

Neuropeptides are involved in various brain activities being able to control a wide spectrum of higher mental functions. The purpose of this concise structural investigation was to detect the possible immunoreactivity of the novel multifunctional neuropeptide nesfatin-1 within the human bed nucleus of the stria terminalis (BNST). The BNST is involved in the mechanism of fear learning, integration of stress and reward circuits, and pathogenesis of addiction. Nesfatin-1-expressing neurons were identified for the first time in several regions of the BNST using both immunohistochemical and fluorescent methods. This may implicate a potential contribution of this neuropeptide to the BNST-related mechanisms of stress/reward responses in the human brain.

Biomechanical analysis of the durability of a modified S1 vertebrae transpedicular screws insertion technique.

BACKGROUND: One of the most important elements of the transpedicular screw implantation technique, which enables a strong screw-bone interface, is the precise choice of the site of screw insertion and the screw's trajectory. Due to the complex biomechanics of the lumbosacral interface and different shape of the sacrum, fixation of this segment remains a challenge for surgeons. Because of this, Kubaszewski et al. proposed a modified technique in which the entry point for screw insertion in the S1 vertebra is changed. METHODS: Six human cadaver specimens of the S1 vertebrae were examined. Two transpedicular screws were inserted into the body of each examined vertebra using two implantation methods with different screw entry points and trajectories. The screws were subjected to cyclic preloading, followed by the pull-out test. The ultimate pull-out force, displacement, stiffness, and failure energy were measured. FINDINGS: The average pull-out force obtained for the standard method of implantation was 498 N (SD 201), whereas for the modified technique, it was 1308 N (SD 581). Displacement of the inserted screws in the new method was 36% higher than in the case of the standard method. This method is also characterized by the greater stiffness of the obtained interface and greater failure energy than the normally used technique. INTERPRETATION: The obtained results demonstrate that the use of the new technique of implantation significantly increases the strength of the obtained screw-bone interface. It should also increase the success rate of the performed fixations and increase the safety of such fixations in clinical practice.

Female and male orbit asymmetry: Digital analysis.

BACKGROUND: Standard anthropometric methods applied to measurements of the skull differentials are laden with mistakes stemming from the way the measuring devices are built and from a lack of experience on the part of the researchers. To increase objectivity, digital imaging measurements via computer systems were introduced. OBJECTIVES: The aim of this research was to assess the asymmetry of the male and female orbit with the application of the new graphic methods: raster graphics and vector graphics. MATERIAL AND METHODS: The examination was conducted on 184 well-preserved skulls. The photos were taken by a digital camera with high definition. Orbit asymmetry was examined by determining the distance between the centers of gravity of both orbits and the frontal median line d1 and d2. Then angles α and ß were appointed. They are defined as angles between the line that runs through craniometrical points mf and ek on the right side (angle α) and on the left side (angle ß), and the frontal median line at their crossing point. Distances r2 and r1, which are allocated points between the frontal median lines (LPP), were also set. RESULTS: Angles α and ß were also analyzed while comparing the skulls of both genders. Statistically significant differences were only observed in male skulls. However, differences for both genders were noted in parameters d1 and d2. No statistically significant differences were discovered between men and women for parameters r1 and r2. The groups of women and men were merged, being treated as a population; which resulted in the conclusion that there are no statistically significant differences between these parameters. CONCLUSIONS: The skull's asymmetry connected to gender and the asymmetry of the right and left sides of examined craniums can be used in criminal examinations as well as in facial reconstructive surgeries.

Neointima development in externally stented saphenous vein grafts.

INTRODUCTION: The main limitation of coronary artery bypass grafting (CABG) is rapid neointimal hyperplasia leading to graft failure. AIM: To assess plaque formation in saphenous vein grafts (SVG) covered by an external Dacron stent in comparison with the classical technique. MATERIAL AND METHODS: In the study group vein grafts covered by external stent mesh made of Dacron were implanted. An intravascular ultrasonography (IVUS) study was performed in 35 aorto-coronary SVG covered by an external Dacron stent and in 64 normal SVG during the first year after CABG. In each SVG 25 mm of good quality IVUS image, volumes of lumen, plaque (neointima), outer border of the vein graft (external SVG) and adventitia were calculated in three time periods: 0-130 days, 130-260 days and 260-390 days. RESULTS: Between the first and second time period, lumen volume (mm3) was reduced from 10.33 ±4.4, to 6.80 ±2.23 in the second period and 5.69 ±1.26 in the third one. This effect was much less marked in normal grafts. The corresponding lumen volume (mm3) was: 10.90 ±3.9, 9.15 ±2.94 and 8.92 ±2.93 in consecutive time periods. Plaque volume (mm3) did not change in control grafts during the course of the study, but it increased very significantly in stented grafts from 0.86 ±1.24 in the first period to 2.70 ±1.58 in the second and 3.29 ±2.66 in the third one. CONCLUSIONS: The experimental technique of implanting SVG covered with an external elastic Dacron stent seems to be inferior to traditional ones. This is probably due to the more complicated process of vein implantation and higher micro-injury occurrence during the surgery.

Feasibility and accuracy of new insertion technique of S1 transpedicular screw. Computed tomography-based morphometric analysis.

OBJECTIVE: To assess feasibility and accuracy of a new insertion technique of S1 transpedicular screw. SUMMARY OF BACKGROUND DATA: Transpedicular stabilization in the first sacral vertebra (S1) is a technically demanding surgical procedure with inherent risk of loosening of the implant. A modification of the technique was recently proposed, along with the analytical verification which was performed based on the available literature. In the study, we performed radiological assessment of screws inserted into the S1 using the classical and modified techniques. METHODS: The analysis was performed in two parts. The first part was performed on eight cadaver specimens after implantation of the screws. In the second part, we used computed tomography images of patients with degenerative disk disease with a superimposed representation of screws. The thickness of the posterior cortex adherent to the screws, screw trajectory and their position with regard to the spinal canal was measured. The area of posterior cortex in contact with the screws was also calculated. RESULTS: The contact length and area was found to be two times greater for screws introduced with the modified technique. The convergence angle was comparable between the techniques, despite the shift of entry point. There was no canal breach, although with the modified technique the screws passed closer to the spinal canal. CONCLUSIONS: The modified technique is considered safe. In this technique, the screws pass through a thicker portion of the posterior cortex compared to the classical technique that aims at improving the stability of the fixation.

"Mortui vivos docent" or who gives his body to science? The analysis of the personal questionnaires of Polish donors in the Conscious Body Donation Program.

The Conscious Body Donation Program conducted since 2003 by the Department of Human Anatomy, Medical University of Silesia in Katowice was the first innovative project aimed at obtaining informed donors' bodies for the purpose of teaching anatomy in Poland. The aim of this prospective study was to determine the declared donors' characteristics and to establish the possible motivation for body donation. A total of 244 application files were reviewed and the following information was analyzed: donor's age, age at which the decision to donate the body was made, donor's place of residence and declared nationality, family background, education and profession, family structure and religion. Our results showed that mainly elderly people decided to donate their bodies (68.5 ± 11.84 years), living mostly in large and medium-sized cities. Men--donors often lived in small towns. Most of the donors were of blue-collar parentage, completed secondary education and at the time of taking decision to donate where married and retired. Widows were more likely to make the decision to donate than widowers. Most of our donors were Catholic. Our analysis of the profile of Polish donors may be useful to understand better for which groups of people death is not to be perceived as the end, and may become a value, which can be beneficial to living people.

Orbital Opening Shape and Its Alphanumerical Classification.

BACKGROUND: Orbit is the one of the most complicated areas of the facial part of cranium. The anthropological analysis of the orbits comprises basic measurement characterizing their shape: width and height. Classic anthropometric methods used to measure the skull variability are burdened with mistakes resulting from construction of measuring devices as well as from researcher's experience. OBJECTIVES: The purpose of our research was to introduce a metric classification of the orbital opening. MATERIAL AND METHODS: The study was carried out on 184 skulls. In our study we suggest introducing a classification of the orbital opening shape by calculating a functional for the 15 categories of the orbit shape. Shape categories have been arranged following the increasing value of the functionals. Each shape category of the orbital opening, according to the Piasecki's descriptive classification, was assigned a letter from the alphabet. RESULTS: We have observed a greater number of symmetrical skulls in the female group (29.11%) than in the male (23.81%). In both groups the symmetry type AA was the most frequent, it corresponds to the value of functional comprised in the interval from 0 to 1,30. According to the Piasecki's descriptive classification it was the oval elongated type. CONCLUSIONS: Our alphanumerical classification based on the value of functional and on the orbit outline assigned to the value is an objective and useful method of the orbital opening shape analysis.

Transcatheter closure of patent foramen ovale using the internal jugular venous approach.

Transcatheter closure of patent foramen ovale is routinely performed using the transfemoral approach, which is safe and technically easy. Our case represents the rare situation where the procedure needs to be performed using the right internal jugular venous approach. According to our best knowledge this is the first report of a patent foramen ovale closure procedure with access through the internal jugular with necessity to advance the guide wire and transseptal sheath into the left ventricle. Developing alternative techniques of transcatheter patent foramen ovale closure seems to be especially important in rare cases where transfemoral access is unavailable.

Nasal region dimensions in children: a CT study and clinical implications.

Atresias of nasal cavity, especially in young children, pose an essential problem in children's otolaryngology. Only a few morphometric studies of nasal cavity concerning healthy neonates and young infants without nasal stenosis are available. Multislice computed tomography is a perfect tool enabling a precise evaluation of anatomic structures. The aim of this study was a complex morphometric evaluation of clinically important bone and mucosal structures of nasal cavity and examination of their dependence on age and sex in children up to 3 years of age. 180 children, age range 0-3 years, were divided into 5 age groups, and measurements of 18 distances between skeletal structures and between mucosal structures of nasal cavity were performed on their CT scans. A correlation between the widths of selected bone structures was examined. There were no statistically significant differences in analyzed morphometric parameters between adjacent age groups. The differences were statistically significant only between extreme age groups. There was a correlation between evaluated structures and age. Our results are a valuable supplement of nasal cavity morphometric data of young children. They may be useful in setting reference values of evaluated parameters in children and in diagnosis and planning of surgical treatment in children's otolaryngology.

Cephalic index in the first three years of life: study of children with normal brain development based on computed tomography.

Cephalic index is a highly useful method for planning surgical procedures, as well as assessing their effectiveness in correcting cranial deformations in children. There are relatively very few studies measuring cephalic index in healthy Caucasian young children. The aim of our study was to develop a classification of current cephalic index for healthy Caucasian children up to 3 years of age with normal brain development, using axial slice computer tomography performed with very thin slices (0.5 mm) resulting in more accurate measurements. 180 healthy infants (83 females and 97 males) were divided into 5 age categories: 0-3, 4-6, 7-12, 13-24, and 25-36 months. The average value of cephalic index in children up to 3 years of age amounted to 81.45 ± 7.06. The index value in case of children under 3 months was 80.19, 4 to 6 months was 81.45, 7 to 12 months was 83.15, in children under 2 years was 81.05, and in children under 3 years was 79.76. Mesocephaly is the dominating skull shape in children. In this study, we formulated a classification of current cephalic indices of children with normal brain development. Our date appears to be of utmost importance in anthropology, anatomy forensic medicine, and genetics.

Digital analysis of the orbit using the non-referring method.

INTRODUCTION: Anthropological analysis of the orbits using classic anthropometric instruments based on width and height measurements as well as orbital index allows for classification of orbits in terms of their shape, yet it has poor clinical application. Nowadays computer graphics enables a precise research technique implementing the latest achievements in digital technology and data recording. The aim of the study was to compare in let parameters of left and right orbits in male and female skulls by means of digital analysis techniques. MATERIAL AND METHODS: The analysis was carried out on 184 early medieval well-preserved skulls. The examined crania were fixed into Molisson's craniost at in the author's own modification. They were directed in space towards the Frankfurt plane and photographed in a frontal norm. Parameters describing the plane structure of the orbits were obtained through computer analysis, integrating raster and vector graphics of mathematical recordings of craniofacial structures. RESULTS: The research demonstrated some differences between male and female skulls. Parameters of right orbit like area, circumference, radius, excavation, circularity deviation and functional were statistically significant higher values in male skull. The following parameters of left orbit: area, circumference, reference circle radius, parameter describing height between two point (mf-ek), maximal width, maximal excavation in relation to median and mean, circularity deviation and functional were statistically significant higher parameter in the male group. CONCLUSIONS: Orbit shape variability, and especially variability of the orbit in let, are highly important features for anthropologists and maxillofacial surgeons, hence the usefulness of the in let orbit shape digital analysis.

Nanosilver - does it have only one face?

Silver nanoparticles (NPs) have at least one dimension of a particle smaller than 100 nm and contain 20-15,000 silver atoms. Due to its antibacterial activity nanosilver (NS) is used for medical purposes. NS particles can be obtained by various methods. Potentially, the best method of the NS synthesis for medical purposes is based on a brief flow of electric current between two silver electrodes placed in deionized water. It is accepted that the major antibacterial effect of silver is its partial oxidation and releasing silver ions, which interact with thiol groups of peptidoglicans of bacterial cell wall, and proteins of the cell membrane causing cell lysis. Silver ions can also bind to bacterial DNA preventing its replication and stopping synthesis of bacterial proteins. The rise in exposure to silver NPs has spurred interest into their toxicology. NS undergoes a set of biochemical transformations including accelerated oxidative dissolution in gastric acid, binding to thiol groups of serum and tissue proteins, exchange between thiol groups, sulfides and selenides, binding to selenoproroteins and photoreduction in skin to zerovalent metallic silver. Animal studies have shown that exposure to NS may lead to liver and spleen damage. NS can also stimulate an increased secretion of proinflammatory cytokines by monocytes. As a spectrum of NS applications is still growing, the complex evaluation of a safety of its use becomes an important task. This requires an elucidation of not only the influence of NS on human cells and organism, but also its biotransformation in organism and in environment.

Clinical significance of knowledge about the structure, function, and impairments of working memory.

A review of contemporary research on the working memory system (WMS) is important, both due to the need to focus the discussion on further necessary investigations on the structure and function of this key part of the human brain, as well as to share this knowledge with clinicians. In our introduction we try to clarify the actual terminology and provide an intuitively understandable model for 3 basic cognitive operations: perception, recognition, imagery, and manipulation of recalled mental images. We emphasize the importance of knowledge of the structure and function of the WMS for the possibility to demonstrate the links between genetic polymorphisms and the prevalence to some mental disorders. We also review current knowledge of working memory dysfunction in the most common diseases and specific clinical situations such as maturation and aging. Finally, we briefly discuss methods for assessment of WMS capacity. This article establishes a kind of compendium of knowledge for clinicians who are not familiar with the structure and operation of the WMS.