The legal and ethical framework governing body donation in Europe - 2nd update on current practice.

BACKGROUND: In 2008, members of the TEPARG provided first insights into the legal and ethical framework governing body donation in Europe. In 2012, a first update followed. This paper is now the second update on this topic and tries to extend the available information to many more European countries. METHODS: For this second update, we have asked authors from all European countries to contribute their national perspectives. By this enquiry, we got many contributions compiled in this paper. When we did not get a personal contribution, one of us (EB) searched the internet for relevant information. RESULTS: Perspectives on the legal and ethical framework governing body donation in Europe. CONCLUSIONS: We still see that a clear and rigorous legal framework is still unavailable in several countries. We found national regulations in 18 out of 39 countries; two others have at least federal laws. Several countries accept not only donated bodies but also utilise unclaimed bodies. These findings can guide policymakers in reviewing and updating existing laws and regulations related to body donation and anatomical studies.

Preoperative Left Ventricular Global Longitudinal Strain Identifies Aortic Stenosis Patients with Improved Postoperative Recovery of Left Ventricular Geometry: A Prospective Cohort Study.

INTRODUCTION: The left ventricular ejection fraction (LVEF) is commonly used as a marker of aortic stenosis (AS) disease severity and to indicate surgical intervention. However, an LVEF <50% identifies mainly advanced disease. Hence, earlier detection of subclinical LV systolic dysfunction may improve clinical decision-making. The global longitudinal strain (GLS) can identify subclinical systolic dysfunction at earlier stages of AS progression even in the presence of preserved LVEF. To this end, we evaluated the preoperative prognostic significance of the LVGLS to identify patients who will undergo a more extensive postoperative LV reverse remodeling as a surrogate marker for clinical recovery. METHODS: We performed a prospective observational study based on detailed pre- and postoperative 2D transthoracic echocardiographic examinations, including strain analysis with speckle tracking. We screened 60 consecutive patients with severe AS and a preoperative LVEF ≥50% indicated for surgery; 39 patients met the study entry criteria and consented to their participation. RESULTS: The median age was 67 (range 30-79) years; 56.4% were female. At baseline, the GLS was 61.64±7.22%. Surgery led to an improvement in the GLS; the mean difference was 3.23% [95% CI=1.96 to 4.49%] during a median follow up time of 5 (interquartile range 4-6) months. The preoperative GLS correlated with the postoperative LV mass index (LVMI) r=0.526, P=0.001 and the intraventricular septal thickness in diastole (IVSd) r=0.462, P=0.003. Furthermore, patients with a normal GLS (≤-18.9%) at baseline experienced a better recovery of their LV morphology and systolic function during the postoperative course compared to those with an abnormal GLS (>-18.9%). The effect size, hedges g, was at least >0.75 for the LVMI, IVSd, intraventricular septal thickness in systole (IVSs), left ventricular posterior wall thickness in diastole (LVPWd) and LVEF, suggesting a clinically significant difference between subgroups at follow-up. CONCLUSION: A normal preoperative left ventricular global longitudinal strain is associated with an improved left ventricular reverse remodeling and systolic function following surgery to resolve aortic stenosis.

Morphological alterations in the position of the mandibular foramen in dentate and edentate mandibles.

The technique of inferior alveolar nerve (IAN) block must be based on precise anatomical knowledge regarding the correct position of the mandibular foramen (MF). The aim of the investigation reported here was to determine the anatomic and topographic localization of the MF according to mandibular ramus anatomic landmarks and to identify morphological alterations in the position of the MF and size and shape of the ramus in terms of the impact of tooth socket loss in the molar and premolar region. Seventy-three dry human adult mandibles were divided into two groups according to dental status. These were measured to determine the distances from the anterior and posterior ramus border (AB, PB) to the midpoint of the MF fossa, and from the mandibular notch (MN) and inferior ramus border (IB) to the MF entering point. A number of relevant ramus anatomic features were analyzed, such as ramus width (RW), height (RH), and thickness (RT). The MF was closer to the PB and IB in edentate mandibles (right/left mean PB-MF 10.66 ± 1.84/11.06 ± 2.05 mm; right/left mean IB-MF 21.77 ± 3.23/21.8 ± 2.27 mm) compared to dentate mandibles (right/left mean PB-MF 11.87 ± 2.08/12.04 ± 1.94 mm; right/left mean IB-MF 22.94 ± 3.09/22.74 ± 3.74 mm). Edentate mandibles demonstrated reduced RW (right/left mean RW 26.03 ± 3.53/26.49 ± 3.90 mm), significantly reduced (p = 0.03) right RH (right/left mean RH 43.56 ± 4.74/45.43 ± 4.86 mm), and significantly reduced (p < 0.05) RT in the area of the MF fossa depression (right/left mean RT 5.52 ± 1.21/5.21 ± 0.91 mm) compared to dentate mandibles (right/left mean RW 27.34 ± 3.84/27.48 ± 3.80 mm; right/left mean RH 46.33 ± 4.52/47.40 ± 4.20 mm; right/left mean RT 7.86 ± 1.98/8.10 ± 1.92 mm). Alterations in MF position and mandibular ramus anatomic features in edentate mandibles increase the potential risk of complications and failure of IAN block.

Preoperative Left Ventricular Global Longitudinal Strain Identifies Aortic Stenosis Patients with Improved Postoperative Recovery of Left Ventricular Geometry: A Prospective Cohort Study

Abstract Introduction: The left ventricular ejection fraction (LVEF) is commonly used as a marker of aortic stenosis (AS) disease severity and to indicate surgical intervention. However, an LVEF <50% identifies mainly advanced disease. Hence, earlier detection of subclinical LV systolic dysfunction may improve clinical decision-making. The global longitudinal strain (GLS) can identify subclinical systolic dysfunction at earlier stages of AS progression even in the presence of preserved LVEF. To this end, we evaluated the preoperative prognostic significance of the LVGLS to identify patients who will undergo a more extensive postoperative LV reverse remodeling as a surrogate marker for clinical recovery. Methods: We performed a prospective observational study based on detailed pre- and postoperative 2D transthoracic echocardiographic examinations, including strain analysis with speckle tracking. We screened 60 consecutive patients with severe AS and a preoperative LVEF ≥50% indicated for surgery; 39 patients met the study entry criteria and consented to their participation. Results: The median age was 67 (range 30-79) years; 56.4% were female. At baseline, the GLS was 61.64±7.22%. Surgery led to an improvement in the GLS; the mean difference was 3.23% [95% CI=1.96 to 4.49%] during a median follow up time of 5 (interquartile range 4-6) months. The preoperative GLS correlated with the postoperative LV mass index (LVMI) r=0.526, P=0.001 and the intraventricular septal thickness in diastole (IVSd) r=0.462, P=0.003. Furthermore, patients with a normal GLS (≤-18.9%) at baseline experienced a better recovery of their LV morphology and systolic function during the postoperative course compared to those with an abnormal GLS (>-18.9%). The effect size, hedges g, was at least >0.75 for the LVMI, IVSd, intraventricular septal thickness in systole (IVSs), left ventricular posterior wall thickness in diastole (LVPWd) and LVEF, suggesting a clinically significant difference between subgroups at follow-up. Conclusion: A normal preoperative left ventricular global longitudinal strain is associated with an improved left ventricular reverse remodeling and systolic function following surgery to resolve aortic stenosis.

Prognostic factors of primary cutaneus melanoma.

INTRODUCTION: The purpose of this study was to identify tumor characteristics of primary malignant melanoma predictive of sentinel lymph node positive status, and then to determine whether sentinel lymph node status has an impact on recurrence and survival. MATERIAL AND METHODS: A total of 100 patients with primary malignant skin melanoma were analyzed. The prospective melanoma database identified patients with histologically confirmed cutaneus melanoma, clinically negative and clinically positive regional lymph nodes with no evidence of distant disease, who had undergone surgery between April 2001 and May 2012. Univariate and multivariate analyses were performed to assess factors that predict sentinel lymph node positive status, recurrence and survival. RESULTS: We identified Breslow's thickness and lymphocytic response as independent predictors of sentinel lymph node status in cutaneous melanoma patients. Sentinel lymph node status was a significant predictor of disease free survival. CONCLUSION: Despite the limitation, this study confirms Breslow's thickness and tumor lymphocytic infiltration as two factors predictive of sentinel lymph node metastasis in cutaneous melanoma patients. We also found sentinel lymph node status to be the most significant independent predictor of disease free survival and identified sentinel lymph node status as an important variable to consider when estimating the risk of regional recurrence.

Growth parameters and nutritional status in relation to socioeconomic status of Macedonian adolescents.

AIM: To assess the anthropometric parameters of growth and nutritional status in relation to socioeconomic status (SES) of Macedonian adolescents. METHODS: The study included 546 adolescents from urban regions of the Republic of Macedonia, aged 14 to 15 years. Participants were measured with standard equipment and measurement technique according to the International Biological Programme. The following anthropometric indices were calculated: height-for-age (BH), weight-for-age (BW) and BMI-for-age (kg/m2). For measuring family wealth, the Family Affluence Scale (FAS) has been used. Adolescents were grouped into three SES groups. RESULTS: Age-specific differences were found for body height and weight in favour of 15-year-old males (p<0.05). There were no significant differences in height and weight among different SES groups. Female participants were more overweight in the high SES group (13.2%) and middle SES group (10.8%), compared to those in the low SES group (6.7%). According to the obtained results in females, the prevalence of obese and underweight females is higher in those with low SES. CONCLUSIONS: Male adolescents were found to be taller and heavier than female adolescents. Both male and female adolescents were taller and heavier in high SES group than those in other SES groups. There were no SES differences in prevalence of underweight, overweight and obesity among Macedonian school adolescents living in urban areas, except among females, those in the low SES group had a significantly higher prevalence of obesity than did those in the MSES and HSES groups.

Morphometric analysis of the cervical spinal canal on MRI.

Two useful numerical values, called the Torg ratio and the spinal canal diameter (SC diameter) are widely accepted as reliable morphometric determinants of spinal stenosis. The aims of the study were to examine morphometric determinants of the cervical spinal canal on MRI in both sexes and analyse them as reliable indicators of spinal stenosis. Measurements were made on 50 MR images (sagittal T2 weighted images from C3 to C7) of the cervical spine of patients from the Emergency Centre who had undertaken MRI of the cervical spine in addition to CT for various diagnostic indications. Torg ratio, used in evaluation of the spinal canal stenosis on plain x-ray radiographs, cannot be used as a spinal canal stenosis indicator due to the gender differences in the vertebral bodies' width. Sagittal canal diameters were more spread out in males than in females. MRI enables the value of the space available for the spinal cord, (SAC) to be determined, by subtracting the sagittal diameter of the spinal cord from the sagittal diameter of the spinal canal. Not gender, but individual and level differences in the SAC values were evident (cervical cord enlargement). SAC values relied more on the spinal canal than on the spinal cord, so that the differences in the dimensions of the spinal cord accounted for less variability in the SAC values. MR imaging of the cervical spine provides more accurate cervical canal and spinal cord measurements that could serve as morphometric determinants of the cervical canal stenosis.

Guidelines for high quality mammography screening.

Mammography is a method of choice for breast screening characterized with great effectiveness in early detection of breast cancer. High quality mammography means the best image quality with minimal breast radiation. The aim of this review is to determine the factors that reduce the MGD (mean glandular dose) in order to achieve minimal breast radiation without compromising the image quality. The implementation of quality standards in mammography screening includes the following activities: technological improvements, optimal calibration of the equipment in mammography centers according to the breast thickness and tissue composition, adequate assessment of the mean glandular dose and elimination of the present causes for poor quality mammograms. These recommendations are dedicated to the medical staff in radiology centers, and to the physicians who have clinical practice with female population undergoing a regular mammography screening. Quality control in standard mammography screening examination can contribute to reducing the morbidity and mortality of breast cancer.