Frequency of thyroid pathologies in the central Black Sea Region: Ultrasound-based field study.

Background: Thyroid pathologies are very common diseases. The most common thyroid pathologies are goiter and thyroid nodules. Thyroid ultrasonography is the most widely used examination method in the evaluation of thyroid pathologies. The aim of this field study is to determine the frequency of thyroid pathologies in the province of Tokat and to evaluate its relationship with some factors such as gender and dietary habits. Materials and Methods: In this population-based prospective study, thyroid US examination was performed on a total of 822 patients. The examination procedure was carried out by one radiologist with at least 10 years of experience. During the examination, thyroid dimensions, parenchyma echo, presence of nodule, echo if any, number, size, and localization were evaluated. The relationships between thyroid pathologies and age, gender, body mass index (BMI), and chronic diseases in the participants were evaluated. Results: Up to 45.2% (n = 372) of the participants were male and 54.8% (n = 417) were female. The ages of the participants ranged from 20 to 87 years. The mean age of the participants was 47.2. Up to 9.8% of the participants had an increase in thyroid size, defined as goiter. Parenchyma was homogeneous in 72.1% of the participants and heterogeneous in 27.9%. Thyroid nodules were present in the thyroid gland in 40.8% of the participants. There was a statistically significant relationship between thyroid pathologies and female gender, age, and obesity. Conclusion: Thyroid diseases show regional differences. Older age, female gender, and obesity increase the frequency of thyroid pathologies.

The course of Autoimmune Thyroiditis in WOMEN.

Context: Although, many studies have been made on the clinical course of autoimmune thyroiditis, this study focused on women and the factors effecting the natural course such as Selenium. Objective: The study aimed to determine Hashimoto's thyroiditis (HT) clinical course in adults and the factors that could affect it. Design: The study was in a retrospective manner between 2010-2018. Subjects and Methods: 101 patients with HT were followed for 60.7±32.7 months. Biochemical and ultrasonographic data were collected. We investigated whether the age at diagnosis, family history, smoking habits, levothyroxine replacement therapy, and serum selenium (Se) levels influenced the disease course. Results: No relationship was observed between age and thyroid functions, thyroid volumes (TV), and autoantibody (Ab) levels at diagnosis. Ab levels were irrelevant with TV, echogenicity, and nodularity at diagnosis. However, initial TSH levels were significantly associated with anti-TPO levels (p=0.028, r=0.218). In the untreated group, thyroid functions seemed to be stable. TV decreased significantly in both treated and untreated patients (p<0.001). The decrease in TV was significantly higher in the treatment group (p=0.002). In euthyroid and subclinical hypothyroid patients, levothyroxine therapy did not affect the decrease in TV. Ab levels remained stable in untreated patients, but anti-TPO levels significantly decreased in treated patients (p<0.001). Smoking seemed to increase only anti-Tg levels (p=0.009). Family history was not associated with any of the studied parameters. Serum Se level was negatively correlated only with thyroid echostructure and only in treated patients. TV showed a "Gaussian distribution" in all patients at the diagnosis and at the end, independent of levothyroxine treatment. Conclusions: Most euthyroid patients remained euthyroid during five years of follow-up. The decrease in TV was significantly prominent with LT4 treatment. Importantly, TV followed a normal distribution instead of the bimodal distribution that is classically described.

Effects of the dopamine D3 receptor agonist 7-hydroxy-2-(di-N-propylamino) tetralin in hyperthyroidism-induced premature ejaculation rat model.

Various factors are involved in the aetiology of premature ejaculation (PE). Hyperthyroidism is one of the causes of acquired PE, but the exact mechanism by which it causes the disorder is not yet understood. The aim of this study was to evaluate the role of the dopaminergic system in hyperthyroidism-induced PE by the intracerebroventricular microinjection of the preferentially active dopamine receptor agonist 7-hydroxy-2-(di-N-propylamino) tetralin (7-OH-DPAT) in a rat model of this disorder. Wistar rats were randomly divided into hyperthyroid and control groups, and ejaculation was induced by the ICV administration of 7-OH-DPAT. To evaluate the emission and expulsion phases of ejaculation, measurements of seminal vesicle pressure (SVP) and electromyographic recordings of the bulbospongiosus muscle were taken. The interval between the 7-OH-DPAT administration and the first ejaculation was significantly less in the hyperthyroid group (p < .01) than in the control group, and the maximum amplitude of the SVP values revealed a statistically significant difference between the groups (p < .01). The intervals between contractions of the seminal vesicle and bulbospongiosus muscles were also significantly less in the hyperthyroid group (p = .0187) than in the control group. No other results differed significantly between the groups. This study determined that hyperthyroidism altered only the emission phase of ejaculation.

Economic growth leads to increase of obesity and associated hepatocellular carcinoma in developing countries.

 Hepatocellular carcinoma (HCC) is the most common type of primary liver cancer and the third leading cause of cancer related death worldwide. In recent years, the prevalence of HCC has increased in both developing and developed countries. Most HCC cases develop in the presence of advanced chronic liver disease related to viral hepatitis. In particular hepatitis B virus and hepatitis C virus infections are considered as major HCC risk factors worldwide. However, current studies provide strong evidence for increasing numbers of HCC in nonalcoholic fatty liver disease (NAFLD). NAFLD represents the hepatic manifestation of metabolic syndrome which is based on obesity and insulin resistance. Epidemiologic data clearly demonstrates that NAFLD and obesity-related disorders are significant risk factors for tumor development in general and HCC in particular. As a consequence of life style changes towards higher calorie intake and less exercise, obesity and metabolic syndrome are spreading all over the world. Due to this increase in obesity and metabolic syndrome NAFLD-related HCC will become a major health care problem in the future. In conclusion, better understanding of the impact of NAFLD and obesity in the development of HCC will improve our treatment strategies of HCC and allow preventive measures.

[Intraocular pressure, ocular blood flow, and corneal biomechanics changes after LASIK surgery for myopia]. / Vliyanie operatsii LASIK pri miopii na pokazateli oftal'motonusa, ob''emnogo glaznogo krovotoka i «biomekhaniki¼ rogovitsy.

AIM: to study changes in intraocular pressure (IOP), volumetric ocular blood flow (OBF) rate, and biomechanical properties of the cornea after excimer laser ablation in patients with myopia of different degrees. MATERIAL AND METHODS: A total of 16 patients (32 eyes) with myopia ranging from 2.75 to 9.0 D were examined before and after LASIK. Ocular Blood Flow Analyzer (OBFA) was used to measure IOP and OBF as well as pulse amplitude and volume. Ocular Response Analyzer (ORA) was also employed to provide the following data: Goldmann-equivalent IOP, corneal compensated IOP, corneal hysteresis, and corneal resistance factor. The eyes were then divided into two groups: group 1 - 15 eyes with less than 70-µm deep ablation of the cornea and group 2 - 17 eyes with more than 70-µm deep ablation. RESULTS: Group 1 demonstrated a statistically reliable decrease in IOP values provided by either method and biomechanical parameters of the cornea (p<0.005), but no difference in pre- and postoperative OBF, or pulse amplitude, or pulse volume (p>0.05). In group 2, all the parameters changed reliably, except for the pulse volume (p>0.05). In particular, a decrease was recorded for IOP (with no dependence to the method of measurement; p<0.001), pulse amplitude (p<0.01), corneal hysteresis (p<0.001), and corneal resistance factor (p<0.001); an increase - for OBF (p<0.05). CONCLUSION: One should allow for possible mismeasurement of IOP and OBF as well as biomechanical parameters of the cornea in post-LASIK patients, keeping in mind that the extent of error depends on the depth of ablation. Shallow ablation (no more than 70-µm deep) has no statistically significant effect on OBF readings, while IOP seems to decrease considerably. In deep ablation (more than 70-µm deep), both parameters are reliably lower than at baseline.

[Tomography findings in optic nerve head and retina in differential diagnosis between normal-tension glaucoma and ischemic optic neuropathies].

AIM: to determine tomography findings in optic nerve head (ONH) and retinal nerve fiber layer (RFNL) that may be valuable for differential diagnosis between normal-tension glaucoma (NTG) and ischemic optic neuropathy (ION) outcome. MATERIAL AND METHODS: Group 1 consisted of 17 patients (32 eyes) with NTG, group 2--17 patients (24 eyes) with ION outcome. The control group included 22 patients (22 eyes) with no sighs of optic neuropathy. Optic nerve head and retina assessment included scanning laser ophthalmoscopy (HRT 111) and optical coherence tomography (Stratus OCT 3000). Statistical analyses were performed using Statistica 10 software suite. RESULTS: Statistically significant changes in HRT parameters, namely, the mean RNFL thickness, retinal height variation along the contour line, and RB discriminant function, were observed in both study groups as compared to the controls. NTG patients also showed lower rim indices, larger cups, smaller values of the FSM discriminant function, and lower GPS (glaucoma probability score) than both ION patients and the controls. OCT findings included a statistically significant decrease in RNFL thickness in both study groups as compared to the controls. As for the difference between the groups, it was unreliable. Quadrant comparisons of RNFL thicknesses revealed that lower quadrant RNFL thinning was more significant in NTG patients, while temporal quadrant RNFL thinning--in ION patients. CONCLUSION: Both conditions are associated with a similar degree of RNFL thinning, as confirmed by OCT, however, HRT changes are much more pronounced in NTG than in ION patients.

[Effects of blood flow properties on ocular hemodynamics].

AIM: to study the effects of blood rheology on ocular blood flow (OBF) parameters and estimated individual normal range of intraocular pressure (IOP). MATERIAL AND METHODS: A total of 15 patients (15 eyes) taking warfarin were enrolled. Volumetric parameters and linear velocity of OBF under warfarin treatment and after its cessation were obtained by means of flowmetry (Paradigm's Blood Flow Analyzer) and color Doppler flow mapping (Voluson 730), respectively. On the basis of flowmetry results an individual normal range of IOP was calculated in all patients. RESULTS: Pulsatile OBF does not appear to correlate with warfarin-induced changes in blood rheology (p = 0.09), however, depends on IOP fluctuations (p = 0.02). Resistance index of retinal vessels is found to rise significantly with increasing blood viscosity (p < 0.05). CONCLUSION: The use of warfarin, an indirect thrombin inhibitor, has no effect on estimated individual normal range of IOP, which is crucial for glaucoma diagnosis and monitoring.

[Ocular blood flow and carotid artery malfunction].

AIM: to evaluate ocular hemodynamics and informativity of estimated individual normal range of intraocular pressure (IOP). MATERIALS AND METHODS: A total of 12 patients (22 eyes) with carotid artery malfunction were examined. Ocular blood flow (OBF) and IOP were measured with Ocular Blood Flow Analyzer. Actual OBF was then compared with what is considered normal for a given axial length (AL). Individual normal range of IOP was calculated according to an original formula (described in previous publications). Doppler imaging of ocular vessels enabled blood flow velocity measurement. Morphological parameters and functional status of the retina and optic nerve were judged on automated perimetry (Octopus 900) and optical coherence tomography (Cirrus HD-OCT) findings. Statistical analyses were performed using Statistica 10 software. RESULTS: Generally, OBF showed no correlation with the grade of carotid artery stenosis (p < 0.05), however, was significantly reduced as compared to its AL-dependent norm in patients with greater than 85% narrowing of the internal carotid artery, which can cause misestimating of their individual normal range of IOP. A negative relationship was established between the blood flow velocity in short posterior ciliary arteries and the grade of internal carotid artery stenosis (p < 0.005). Ocular blood flow deficit relative to the AL-dependent norm correlated with ophthalmic artery resistance index. CONCLUSION: OBF-based estimation of individual normal range of IOP is inexpedient in patients with greater than 80% carotid artery stenosis due to its possible influence on ocular hemodynamics. In most cases of less than 80% carotid artery stenosis OBF is adequate or slightly reduced as compared to its AL-dependent norm and thus, has no significant impact on estimated individual normal range of IOP.

Protective effect of vitamin B5 (dexpanthenol) on cardiovascular damage induced by streptozocin in rats.

OBJECTIVES: This study investigated whether Dexpanthenol (DEX) improves diabetic cardiovascular function and cardiac performance by regulating total oxidant and antioxidant status. METHODS: Diabetes was induced by a single intraperitoneal injection of Streptozocin (50 mg/kg in 1 ml of saline) and treatment groups received DEX (300 mg/kg/day) for 6 weeks. Endothelium (in)dependent relaxation responses were assessed in thoracic aortic rings and coronary vasculature together with alpha receptor and voltage dependant contractile responses of aorta. Myocardial contractility has been recorded by an intra ventricular latex balloon. Total oxidant and antioxidant status were measured from the serum samples. RESULTS: Induction of diabetes resulted in an apparent body weight loss, high blood glucose, endothelial dysfunction and increased serum oxidant status. DEX supplementation restored the endothelial dysfunction, antioxidant status and body weight whereas decreasing blood glucose level. CONCLUSION: Along with the standard therapy of diabetes, DEX can be used as a safe and economical way of adjuvant therapy to diminish the burden of the disease (Tab. 3, Fig. 3, Ref. 30).

[Determination of the individual normal range of intraocular pressure in differential diagnosis between pseudonormal tension glaucoma and ischemic optic neuropathies].

The study investigated the relation between the actual intraocular pressure (IOP) and its individual normal range in normal-tension glaucoma (NTG) and ischemic optic neuropathy (ION) outcome. A total of 39 patients (61 eyes) were examined. Group 1 included 19 patients (35 eyes) with newly diagnosed NTG, group 2--20 patients (26 eyes) with the ION outcome. Besides conventional tests, the ophthalmic assessment in all patients included determination of the individual normal range of IOP and evaluation of biomechanical properties of the cornea. It is showed that determination of the individual normal range of IOP may play a key role in confusing cases of differential diagnosis between NTG and ION. The average actual IOP in patients with NTG generally exceeds the individual normal range by 40% (more than 5 mmHg), whereas in patients with the ION outcome--by only 11.7% (less than 5 mmHg - buffer range). No statistically significant difference in IOP measurements by different tonometry methods was found in either NTG or ION patients with corneal compensated IOP less than 21 mmHg.

[Intraocular pressure and ocular blood flow features intravitreal infection of anti-vascular endothelial growth factor agents].

OBJECTIVE: to investigate intraocular pressure (IOP) and ocular blood flow (OBF) changes as well as the individual normal range of IOP in patients with age-related macular degeneration (AMD) with or without concomitant glaucoma after intravitreal anti-vascular endothelial growth factor (VEGF) therapy. MATERIAL AND METHODS: Group 1 included 34 patients (34 eyes) with AMD and no glaucoma, group 2-34 patients (34 eyes) with both AMD and glaucoma. In all patients the IOP and OBF were measured (with Ocular Blood Flow Analyzer) and the individual normal range of lOP calculated before the treatment, on the third day after the injection and at the 1-month follow-up visit. Statistical analysis was performed by STATISTICA 10. RESULTS: In group 1 there were no significant changes in ocular blood flow at different times after ranibizumab injection. In group 2 a considerable decrease in OBF was detected 1 month after the injection (p<0.001). In group 1 the intraocular pressure was at the same level before and after the treatment. In group 2 the IOP significantly decreased on the third day after the anti-VEGF injection (p=0.03) but was back to the initial level in 1 month. The individual normal range of lOP, when calculated on the third day after the injection, appeared to be much lower than before due to a moderate decrease in both IOP and OBF. At the 1-month follow-up the individual normal range of IOP was back to initial values in non-glaucoma patients but remained low in the glaucoma group due to reduced OBF. CONCLUSION: The established decrease in the individual normal range of IOP in the late period after an anti-VEGF injection should be taken into account when managing patients with both AMD and glaucoma.

[Differentiation of concomitant glaucomatous optic neuropathy in optic disc drusen].

Characteristics of ocular blood flow (OBF) in primary open-angle glaucoma (POAG) in eyes with optic disc drusen have been investigated. The study enrolled 21 patient (35 eyes) with optic disc drusen, of which 7 (8 eyes) were diagnosed with POAG. Besides the standard tests, the ophthalmological assessment included evaluation of OBF (flowmetry) and an individual normal range of intraocular pressure (IOP). The results showed that optic disc drusen are not associated with OBF changes. Concomitant POAG might be suspected in a patient with optic disc drusen whose OBF is significantly decreased and IOP is above the individual normal range. Differentiation of morphofunctional changes in chronic optic neuropathy, which might be due to either glaucomatous optic neuropathy or optic disc drusen, is complicated when actual IOP lies within the average normal range. Ocular blood flow evaluation by means of flowmetry with calculation of an individual normal range of IOP has been demonstrated as a highly effective predictor of concomitant POAG in patients with optic disc drusen.

[Peculiarities of ocular blood flow in ischemic optic neuropathy and normal tension glaucoma].

Characteristics of ocular hemodynamics in ischemic optic neuropathy (ION) outcome and normal tension glaucoma (NTG), the conditions that are difficult to be differentially diagnosed, have been investigated. The study enrolled 32 patients (40 eyes) with ION outcome, 26 patients (46 eyes) with NTG, and 20 patients (32 eyes) with no ocular pathology. Besides the standard ophthalmological examination, color Doppler imaging of ocular vessels, evaluation of ocular blood flow volume and individual normal range of intraocular pressure (flowmetry) were performed in all cases. The results showed that an excess of the actual intraocular pressure (IOP) over the individual normal range was much higher in patients with NTG than in patients with ION (39% and 14.5% correspondingly). It was also found that NTG is associated with a more significant decrease of ocular blood flow volume (30.1% in average) in comparison to ION outcome (11%). In both conditions a decrease in velocity parameters of the blood flow in main ocular vessels was registered, however, ocular hemodynamics changes appeared to be more severe in patients with glaucomatous optic neuropathy. A statistically reliable correlation between volumetric and velocity parameters of ocular blood flow has been discovered.

[Hemodynamic changes in myopia of different degrees].

A total of 78 patients (143 eyes) with low, medium and high degree myopia were assessed. Apart from standard ophthalmological tests, flowmetry and duplex ultrasound of ocular vessels were performed in all cases to evaluate volumetric and velocity parameters of ocular blood flow in relation to the length of anterior-posterior axis and the degree of myopia. It is found that both parameters of regional blood flow progressively decrease as the anterior-posterior axis increases.

Efficacy of Kinesio® tapes in obstetrical brachial plexus injury: a randomized controlled trial.

OBJECTIVES: The purpose of this study was to investigate the effectiveness of Kinesio® tape application associated to exercise in patients with obstetric brachial plexus injury (OBPI). MATERIALS AND METHODS: Ninety patients with Erb-Duchenne palsy secondary to OBPI participated in a 3-month study, in 2 groups; study group (n = 50) and control group (n = 40). Both followed the same physical therapy program, while the study group also received Kinesio® taping over the scapula and forearm. The patients were evaluated, pre- and post-treatment, using the Modified Mallet Classification (MMC), Active Movement Scale (AMS), and active range of motion (ROM) of the plegic side. RESULTS: There were no statistically significant intergroup differences in age, gender, birth weight or plegic side (p > 0.05), or in pre-treatment MMC and AMS scores (p > 0.05). There were significant differences in favor of the study group for Mallet 2 (external rotation) (p = 0.012), Mallet 3 (hand on the back of the neck) (p < 0.001), Mallet 4 (hand on the back) (p = 0.001) and total Mallet score (p = 0.025), and for AMS shoulder flexion (p = 0.004) and elbow flexion (p < 0.001). ROM results before and after treatment (within groups) showed significant improvement in both groups (p < 0.001). CONCLUSION: Since this a was a preliminary study, the results should be interpreted with caution in terms of clinical efficacy. The results suggest that associating Kinesio® taping to conventional treatment helps functional development in patients with OBPI.'

Elective bladder preservation with multimodality treatment for bladder cancer.

PURPOSE: To observe the outcome of maximal transurethral resection of bladder tumor (TURBT) followed by induction chemotherapy and concurrent chemoradiotherapy in medically inoperable patients with bladder cancer. METHODS: This study included 30 patients with stage T 2-4 bladder cancer. The patients were first treated with TURBT, and then received 2 cycles of induction chemotherapy with gemcitabine and cisplatin, followed by concurrent chemoradiotherapy with gemcitabine. RESULTS: Median follow up was 28.9 months. Radiologically, complete and partial response rates were 60 and 36.7%, while cystoscopically they were 40 and 30%, respectively. Local progression (4 cases) and distant metastasis (11 cases) were noted. Median overall survival and progressionfree survival were 32 and 21 months, respectively. One -and 2-year overall survival and progression-free survival rates were 97.60% and 83.49%, respectively. CONCLUSION: The multimodal treatment performed in this study was well tolerated and achieved a high rate of bladder preservation in selected patients with bladder cancer.

[Comparative analysis of several morphometric parameters received using optic coherent tomography and scanning laser ophthalmoscopy in initial glaucoma diagnosis].

Retinal morphometric parameters received using confocal scanning laser ophthalmoscopy and optic coherent tomography (OCT) are compared. OCT was performed using Stratus OCT 3000 ("Carl Zeiss Meditec"), and for confocal scanning laser ophthalmoscopy we used Heidelberg retinal tomography HRT 3.0 ("Heidelberg Engineering"). A total of 81 patients (158 eyes) were enrolled into the study: 34 patients (64 eyes) with suspected glaucoma (diagnosis of early open angle glaucoma was proven after ophthalmologic examination) and 47 healthy adults aged from 38 till 72 years old. OCT was found to reveal significant decrease of retinal nerve fiber layer (RNFL) thickness in peripapillary zone in patients with suspected glaucoma as compared with healthy subjects, whereas no significant difference in morphometry of neuroretinal rim and PNFL was found using confocal scanning laser ophthalmoscopy (HRT).

[Diagnostic value of macular morphometry in patients with primary open-angle glaucoma].

In this article the results of practical use of central retinal zone (CRZ) tomography in primary open-angle glaucoma (POAG) measured with RTA (Retinal thickness Analyzer, Talia Technology Ltd., Israel) are presented. 460 patients (790 eyes) aged 45-85 years old were included into the study. Significant decrease of CRZ minimal thickness and perifoveal region thickness (p < 0.05 and p = 0.01 respectively) was revealed in patients with POAG compared with control group. Morphometric data showed correlation with decrease of light sensitivity and visual field defects detected with static perimetry. This fact confirms information value of central retinal morphometric changes for glaucoma diagnosis.

[Results of clinical evaluation of a new screening method for determining the individual normal level of intraocular pressure].

The paper presents the results of practical application of a new screening method for determining tolerant intraocular pressure (TIOP) on a Blood Flow Analyzer (Paradigm, USA). Studies were conducted on 331 eyes (205 subjects). Group 1 consisted of 80 patients (126 eyes) without glaucoma being found, with intraocular pressure (IOP) in the average normal range, but with a TIOP excess of 1-8 mm Hg (a risk group); Group 2 included 15 subjects (20 eyes) without glaucoma with normal IOP in whom TIOP exceeded the existing IOP by 1-7 mm Hg; Group 3 comprised 110 patients (185 eyes) with Stage I-III primary open-angle glaucoma (POAG) with compensated IOP. Morphofunctional studies revealed glaucoma in 95 (75%) eyes in the risk group: Stages II and I in 61 and 30%, respectively; and advanced glaucoma in 9%. At the same time, there was a close correlation of the probable detection of glaucoma with the existing degree of a TIOP excess. No cases of glaucoma were observed in Group 2. The determination of TIOP and morphofunctional changes over time in Group 3 revealed a stable glaucomatous process in 99% of cases in which IOP was lower than or equal to TIOP, as well as progressive glaucomatous neuropathy in 91% in which compensated LOP exceeded TIOP. The results of the study in Group 3 suggest that the index TIOP may be used as a guide of IOP in the treatment and monitoring of POAG. The presented data indicate that the determination of the level of TIOP is a required element of both standard ophthalmological examination and monitoring of glaucoma.

Novel Approach and Interpretation for the Determination of Electromagnetic Forming Limits.

A new method to determine electromagnetic forming limits curves (EM-FLCs) for sheet metals is proposed. The different strain paths (between uniaxial and biaxial tension) are achieved by specific tool coil and specimen designs. It is ensured that the apex of the specimen deforms on a constant strain path, and excess bending at the apex is avoided. This is done so that the determined EM-FLCs are comparable to their quasi-static counterparts. The method determines the EM-FLCs for the aluminum alloys AA-1050a-H24 and EN AW-5083-H111 and the magnesium alloy Mg AZ31-O. Overall, it is observed that the necking limits in electromagnetic forming (EMF) are higher compared to quasi-static forming. The fracture surfaces of electromagnetically deformed specimens are examined to reveal the existence of out-of-plane shear stresses. A numerical analysis corroborates this observation and their variation with strain rate. The presence of such stresses is proposed as a possible reason for the increased necking limits in EMF. As reasons for higher forming limits, previous research has identified inertial stabilization, strain rate hardening, die impact, and change in deformation mechanism. The current study reaffirms the positive effect of inertial stabilization and makes key observations in the increase of twinning in EMF of Mg AZ31-O.