Effect of menopause, anthropometry, nutrition and lifestyle on bone status of women in the northern mediterranean / Efecto de la menopausia, la antropometría, la nutrición y el estilo de vida sobre la condición ósea de las mujeres en el mediterráneo norte

OBJECTIVE: The purpose of this study was to explore the influence of age, menopause, anthropometry, nutrition and lifestyle on bone status of women of the Northern Mediterranean Region of Croatia, which is considered the Adriatic Coast of Southeast Europe. METHODS: Quantitative ultrasound measurement was performed on the women's right heel and the values of the primary parameters (the Broad Ultrasonic Attenuation and the Speed of Sound [BUA and SOS]) were obtained. Dietary data were assessed with specially designed semi-quantitative food frequency questionnaire. Multiple regression analysis was employed to examine the influence of age and anthropometry, as well as hormonal and nutritional factors on BUA and SOS. RESULTS: In all female subjects, both primary parameters were predicted by menopause. Among nutrition and lifestyle factors, carbohydrates were significant predictors for BUA (β= -0.151, p < 0.05), and smoking is significant predictor for SOS (β= -0.113, p < 0.05). In premenopausal women, BUA is significantly predicted by body height (β= 0.71, p < 0.05) and body mass index (β= 1.44, p < 0.05). In postmenopausal women, both primary parameters are strongly predicted by age and anthropometric parameters. Besides, SOS is significantly predicted by smoking (β= -0.18, p < 0.01) and alcohol (β= -0.13, p < 0.05). Besides, SOS is significantly predicted by smoking (β= -0.18, p < 0.01) and alcohol (β= -0.13, p < 0.05). CONCLUSION: Bone quality in women from the Croatian Mediterranean Region mostly depends on their hormonal status. When the effect of menopause is controlled, bone status becomes dependent on age and anthropometry.

OBJETIVO: El propósito de este estudio fue explorar la influencia de la edad, la menopausia, la antropometría, la nutrición y el estilo de vida en la condición ósea de las mujeres de la región mediterránea norteña de Croacia, que es considerada la Costa Adriática del Sudeste de Europa. MÉTODOS: Se realizó una medicación cuantitativa mediante ultrasonido en el talón derecho de las mujeres y se obtuvieron los valores de los parámetros primarios (la atenuación del ultrasonido de banda ancha y la velocidad del sonido [AUB y VDS]). Los datos dietéticos fueron evaluados mediante un cuestionario semi-cuantitativo de frecuencia de alimentos, especialmente diseñado. Se empleo el análisis de regresión múltiple para examinar la influencia de la edad y la antropometría, así como los factores hormonales y nutritivos sobre AUB y VDS. RESULTADOS: En todas las sujetos hembras, ambos parámetros primarios fueron predichos por la menopausia. Entre los factores nutrición y estilo de vida, los carbohidratos fueron predictores significativas de para AUB (β= -0.151, p < 0.05), y fumar es el predictor significativo para VDS (β= -0.113, p < 0.05). En las mujeres premenopáusicas, la AUB es predicha significativamente por la altura del cuerpo (β= 0.71, < 0.05) y el indice de masa corporal (β= 1.44, p < 0.05). En las mujeres postmenopáusicas, ambos parámetros primarios son fuertemente predichos por la edad y los parámetros antropométricos. Además, la VDS es predicha significativamente por el hábito de fumar (β= -0.18, p < 0.01) y el alcohol (β= -0.13, p < 0.05). CONCLUSIÓN: La calidad ósea de las mujeres de la región mediterránea croata depende principalmente de su estado hormonal. Cuando el efecto de la menopausia se controla, la condición ósea se hace dependiente de la edad y la antropometría.

Effect of menopause, anthropometry, nutrition and lifestyle on bone status of women in the northern Mediterranean.

OBJECTIVE: The purpose of this study was to explore the influence of age, menopause, anthropometry, nutrition and lifestyle on bone status of women of the Northern Mediterranean Region ofCroatia, which is considered the Adriatic Coast of Southeast Europe. METHODS: Quantitative ultrasound measurement was performed on the women's right heel and the values of the primary parameters (the Broad Ultrasonic Attenuation and the Speed of Sound [BUA and SOS]) were obtained. Dietary data were assessed with specially designed semi-quantitative food frequency questionnaire. Multiple regression analysis was employed to examine the influence of age and anthropometry, as well as hormonal and nutritional factors on BUA and SOS. RESULTS: In all female subjects, both primary parameters were predicted by menopause. Among nutrition and lifestyle factors, carbohydrates were significant predictors for BUA (beta = -0.151, p < 0.05), and smoking is significant predictor for SOS (beta = -0.113, p < 0.05). In premenopausal women, BUA is significantly predicted by body height (beta = 0.71, p < 0.05) and body mass index (beta = 1.44, p < 0.05). In postmenopausal women, both primary parameters are strongly predicted by age and anthropometric parameters. Besides, SOS is significantly predicted by smoking (beta = -0.18, p < 0.01) and alcohol (beta = -0.13, p < 0.05). Besides, SOS is significantly predicted by smoking (beta = -0.18, p < 0.01) and alcohol (beta = -0.13, p < 0.05). CONCLUSION: Bone quality in women from the Croatian Mediterranean Region mostly depends on their hormonal status. When the effect of menopause is controlled, bone status becomes dependent on age and anthropometry.

Short-term exposure of mice to gasoline vapor increases the metallothionein expression in the brain, lungs and kidney.

Environmental airborne pollution has been repeatedly shown to affect multiple aspects of brain and cardiopulmonary function, leading to cognitive and behavioral changes and to the pronounced inflammatory response in the respiratory airways. Since in the cellular defense system the important role might have stress proteins-metallothionein (MT)-I and MT-II, which are involved in sequestration and dispersal of metal ions, regulation of the biosynthesis and activities of zinc-dependent transcription factors, as well as in cellular protection from reactive oxygen species, genotoxicity and apoptosis, in this study we investigated their expression in the brain, lungs and kidney, following intermittent exposure of mice to gasoline vapor. Control groups consisted of intact mice and of those closed in the metabolic chamber and ventilated with fresh air. The data obtained by immunohistochemistry showed that gasoline inhalation markedly upregulated the MTs expression in tissues which were directly or indirectly exposed to toxic components, significantly increasing the number of MT I+II positive cells in CNS (the entorhinal cortex, ependymal cells, astroglial cells in subventricular zone and inside the brain parenchyma, subgranular and CA1-CA3 zone of the dentate gyrus in hippocampus and macrophages-like cells in perivascular spaces), in the lungs (pneumocytes type I and type II) and in the kidneys (parietal wall of Bowman capsule, proximal and distal tubules). The data point to the protective and growth-regulatory effects of MT I + II on places of injuries, induced by inhalation of gasoline vapor.

Influence of tumor thickness and vascularity on survival in cutaneous melanoma.

Eighty-eight cases of cutaneous melanoma (CM) were analyzed in order to elucidate the relationship between thickness, angiogenesis, and prognosis. The thickness of the tumor was measured according to the Breslow method, and the microvessels were identified by an immunohistochemical study using anti-factor VIII monoclonal antibody on specimens from 40 patients with superficial spreading melanoma (SSM), and 48 with nodular type (NM). Microvessels were counted in the area of highest density. The overall survival and disease-free period were analyzed retrospectively. The proportion of patients with thicker CMs (> 1.5 mm) increased with age in both sexes. Mean vascular count was statistically significant different only between thinner and thicker tumors in the SSM group (P < 0.05). Prognosis was correlated with the thickness of CM (P = 0.0002), mean vascular count alone (P = 0.004), mean vascular count in association with CM thickness less than 1.5 mm (P = 0.0005), and with mean vascular count in NM (P = 0.02). These findings suggest that increasing microvessel density indicates a worsening prognosis.

Marinacci communication. Case report.

Marinacci or reverse Martin-Gruber communication is a rare anatomical variation. Until now, in all reported cases the branch was diagnosed using electrophysiological studies but not substantiated anatomically. The authors report a case of ulnar-median nerve communication in the distal forearm that was discovered during carpal tunnel release surgery and confirmed postoperatively on electromyographic studies.

Brachial plexus gunshot injury in an infant.

We present the case of an infant with a gunshot lesion in the brachial plexus. Intraoperative nerve action potential recordings suggested posterior cord neurolysis and medial and lateral cord grafting. After 3 years' follow-up complete recovery of motor and sensory function was seen as a result of immense nerve regeneration capability and brain plasticity. According to our knowledge this is the first reported case of such a mechanism of injury in an infant.

Hook-rod with pedicle screw fixation for unstable spinal fracture. Technical note.

A technique is described in which spinal fracture repositioning, decompression, and stabilization are achieved by a combination of hook-rod and pedicle screw fixation. This straightforward technique is useful for performing acute decompression in patients with partial neurological deficits and multisystem injuries. A laminectomy allows for placement of a stiffer fixation system, and it improves the insufficient canal clearance obtained when performing annulotaxis alone.

The anatomy of the Berrettini branch: implications for carpal tunnel release.

OBJECT: Dissections were performed in 100 fresh cadaver palms to determine the frequency with which superficial palmar communication between the median and ulnar nerves occurs and to what extent it might incur iatrogenic injury during endoscopic carpal tunnel release. METHODS: Superficial palmar communication between the median and ulnar nerves was present in 81% of the dissected hands. Superficial palmar communication, also known as the Berrettini branch, has been classified into four distinct types by Ferrari and Gilbert. Twelve hands were classified as Group 1 (communication in an oblique course from the ulnar to the median nerve originating >4 mm above the distal margin of the transverse carpal ligament [TCL]), 16 hands were classified as Group 2 (communication parallel to the distal margin of the TCL), and 53 hands were classified as Group 3 (communication in an oblique course from the ulnar nerve to the third common digital nerve, originating below the distal margin of the TCL). No hand fit the Group 4 classification (atypical communication). CONCLUSIONS: The Berrettini branch can be considered a normal anatomical finding. In 28% of the hands in this study, the branch was proximal to the edge of the distal ligament and, therefore, prone to iatrogenic injury in both one-portal and two-portal endoscopic surgery.

Evaluation of functional nerve recovery shows that allogeneic nerve graft treated with ICAM-1 and LFA-1 mAbs can be good alternative to syngeneic graft.

The objective of the study is to establish recovery results of tibial nerve defects reconstructed using allogeneic and xenogeneic graft, in host immunosuppressed with Intercellular Adhesion Molecule-1 (ICAM-1) and Lymphocyte Function Antigen-1 (LFA-1) monoclonal antibodies (mAbs). A pilot study was conducted in fifteen Fischer rats by forming a 1 cm right tibial nerve gap, then reconstructing it with 1.2 cm long grafts, namely, Wistar allogeneic, Black mouse xenogeneic, and syngeneic (n = 5/group). The main study included forty-eight rats allocated to the following groups (n = 12/group): 1) Allograft without treatment as control group. 2) Allograft with intraperitoneal ICAM-1 and LFA-1 mAbs treatment. 3) Allograft preserved in Belzers' solution including ICAM-1 mAbs plus standard intraperitoneal treatment. 4) Syngraft as benchmark. At 3, 6 and 9 weeks postengraftment walking track analysis was performed and expressed as Tibial Functional Index (TFI). Motor and compound nerve action potential across the graft conduction velocities were measured at week 10. Xenograft did not show any functional recovery and was therefore excluded from main study. However, pilot and main study results showed recovery results in both treated allogeneic groups and were comparable to benchmark syngraft. Therefore, allogeneic nerve graft could be an alternative in peripheral nerve reconstruction and spinal cord grafting.

The value of an operating microscope in peripheral nerve repair. An experimental study using a rat model of tibial nerve grafting.

The aim of this study was to test the hypothesis that the use of an operating microscope improves the results of peripheral nerve repair. Tibial nerve grafting was carried out on 48 Fischer rats divided into 2 groups: in one, a loupe was used, and in the other a surgical microscope. At 5 months after grafting, recovery was evaluated by functional, electromyographic, and morphometric tests. The mean motor nerve conduction velocity was 26.77 +/- 9.37 m/sec in the group where the loupe was used compared with 44.19 +/- 11.36 m/s when the microscope group was used. The soleus muscle weight and the diameter of myelinated fibres also confirmed better regeneration in the microscope group. These results clearly indicate that it is essential to use the microscope for peripheral nerve repair.

Electromyographic evaluation of experimental nerve grafts suggests better recovery with microscope assistance.

Controversy surrounds the value of optic magnification for peripheral nerve surgery. The aim of this study was to compare the loupe magnification with microscope-assisted techniques in a rat tibial nerve graft model. The parameters studied included motor nerve conduction velocity (MNCV), clinical test equivalent (CTE), soleus muscle weight (SMW) and morphometric nerve indices. In the loupe and microscope groups MNCV mean was 26.77 +/- 9.37 m/sec and 44.19 +/- 11.36 m/sec respectively. MNCV results suggest better regeneration in the microscope group, as confirmed by CTE, SMW and myelinated fibre (MF) diameter.

The role of interfascicular nerve grafting after gunshot wounds. A report of 44 cases.

In this study the authors present the results of 44 patients with 49 interfascicular nerve grafting procedures necessitated by gunshot wounds. The aim was to establish the effectiveness of microsurgical interfascicular nerve grafting for war injuries. The 49 interfascicular nerve grafting procedures were performed between July 1991 and January 1993. All but one were performed within 6 months of injury. Nerve recovery was assessed independently by a neurologist. The M/S scale was used for median, ulnar and radial nerves, and the grading scale recommended by Millesi was used for the sciatic, tibial and peroneal nerves. Follow-up was for between 2.5 and 3.5 years. Patients scoring at least M3/S3+, or Grade 2 on the Millesi scale, were considered to have useful functional recovery which occurred in high median (0 out of 1), low median (4 out of 9), high ulnar (0 out of 2), low ulnar (5 out of 11), high radial (4 out of 6), low radial (2 out of 2), sciatic (5 out of 9), peroneal (4 out of 7), and tibial (2 out of 2). The extent of recovery correlated inversely with the patient's age and the length of the graft, but was independent of the time between injury and surgery and of presumed projectile energy. Our results suggest that microsurgical interfascicular nerve grafting is of value in the management of wartime nerve injuries.

Prognostic validity of different classifications in assessment of war inflicted nerve injury.

In this study, the relation of postoperative peripheral nerve recovery following war inflicted nerve injuries and the injury classification according to the projectile energy, Abbreviated Injuries Scale, 1985 revision, as well as the fracture and metallic bodies criteria (Red Cross Wound Classification), was investigated. During the war against Croatia, the authors followed-up 137 wounded people, suffering a total of 147 various war nerve injuries that were surgically treated. The prospective classification of all wounded based on the projectile energy data and retrospective classification based on the Abbreviated Injury Scale and Red Cross Wound Classification were performed. The recovery was independently evaluated by a neurologist according to the British Medical Research Council for arm and Millesi scale for leg nerve injuries. A statistically significant relation was obtained between the peripheral nerve function recovery, Abbreviated Injury Scale and fracture criteria from the Red Cross Wound Classification. There was no significant influence on the projectile energy and presence of metallic body criteria on the nerve function recovery. The Abbreviated Injury Scale was concluded to be the most valid prognostic classification in the assessment of war inflicted peripheral nerve injuries. The fracture criteria were also found to be an additional valuable source of information.

The effects of air pollution on ventilatory lung functions.

The prevalence of chronic bronchitis was studied among female subjects aged 18-63 years from three areas with different ambient air quality: Bakar and Krasica with SO2 concentrations above the WHO guideline and Viskovo where the SO2 concentrations were below the guideline. The subjects were examined and administered a questionnaire. Differences in their ventilatory lung functions were tested and related to air quality. The subjects from the two regions to air quality. The subjects from the two regions with a higher pollution level had lower FVC and FEV1 values than those from the Viskovo region. However, no statistically significant differences in the prevalence of chronic bronchitis between the subjects from regions with different ambient air quality were found. The same applies to the occurrence of pathological restrictive ventilation disturbances. In the Krasica region the occurrence of pathological obstructive ventilatory disturbances was significantly higher than in the Viskovo and Bakar regions; a correlation between the duration of residence and ventilatory lung function was also observed.

Surgical treatment of sympathetic ophthalmia.

We report the case of a 12-year-old girl who was hospitalized for bilateral uveitis that occurred 2 years after a penetrating injury of the left eye. On admission, all clinical signs of sympathetic ophthalmia were present with visual function reduced to light perception and intact projection in the right eye and light perception without intact projection in the left. Ultrasonography confirmed that the retina was in its proper place in both eyes. Since abrasion of the corneal epithelium and decalcification of the cornea with ethylene diamine tetra-acetic acid had been performed on the right eye, it was decided to proceed with pars-plana lensectomy and vitrectomy in the same (better preserved) eye. The surgery was performed as planned, with an uneventful postoperative course. Three years later, the eye operated upon had no signs of inflammation, and the visual acuity achieved with the aphakic correction was 0.8.

Acute aseptic panophthalmitis caused by a copper foreign body.

Enucleation was performed on a 10-year-old boy after an eye injury from the explosion of a dynamite cartridge. Amaurosis was noted 48 h after the injury upon admission to our clinic. The clinical picture of panophthalmitis comprised bulbus protrusion with limited movement and hypopion; total retinal detachment was demonstrated by ultrasonography. Intensive pain was present. A histochemical investigation was performed, showing purulent exudation in the anterior chamber, choroid, and retina. Copper stained with rubeanic acid was positive. Electrogravimetrically, the foreign body was found to be 94% copper and approximately 40 mm2 in size.