INTRODUCTION: This study aimed to assess the impact of midline lumbar fusion with cortical bone trajectory screws (MIDLF/CBT) on the multifidus muscles, focusing on the evaluation of their postoperative atrophy. CLINICAL RATIONALE FOR THE STUDY: MIDLF/CBT is a relatively new technique increasingly used to treat spinal instability. Despite its reduced invasiveness compared to traditional posterior lumbar interbody fusion with traditional pedicle screws (PLIF/TP), concerns remain about potential damage to the multifidus muscles that are crucial for spinal stability. Understanding the extent of muscular atrophy post-MIDLF/CBT is vital for improving surgical outcomes, and potentially patient rehabilitation strategies. MATERIAL AND METHODS: This study retrospectively analysed preoperative and postoperative MRI scans of patients who underwent MIDLF/CBT for degenerative segmental spondylolisthesis. The bilateral width of the multifidus muscles at the operated segment and adjacent segments was measured using axial T2-weighted MRI scans. Statistical comparisons were made using a paired t test, with significance set at p < 0.05. RESULTS: The study included 16 patients with an average age of 57 ± 10 years, 10 of whom (62.5%) were women, and featured a mean follow-up period of 37 ± 25 months. Postoperative measurements showed a significant reduction in the width of the multifidus muscles at the operated segment (mean difference -3.3mm, p = 0.02) and the inferior adjacent segment (-7.4 mm, p < 0.01). A decrease in muscle width at the superior adjacent segment was also observed, although this was not statistically significant. CONCLUSIONS AND CLINICAL IMPLICATIONS: Our study concluded that MIDLF/CBT results in significant multifidus muscle atrophy at and below the operated segment, potentially impacting postoperative rehabilitation and recovery. These findings highlight the need for further research comparing MIDLF/CBT to other spinal stabilisation techniques. Additionally, incorporating functional electromyographic assessments of paraspinal muscles could provide deeper insights into the long-term consequences of spinal surgeries and helpdevelop new approaches and strategies to mitigate paravertebral muscles atrophy, thus enhancing patient outcomes.

• MeSH
• Lumbar Vertebrae * surgery   diagnostic imaging   MeSH
• Spinal Fusion * methods   MeSH
• Paraspinal Muscles * diagnostic imaging   pathology   MeSH
• Cortical Bone surgery   diagnostic imaging   MeSH
• Middle Aged MeSH
• Humans MeSH
• Magnetic Resonance Imaging MeSH
• Pedicle Screws MeSH
• Postoperative Complications diagnostic imaging   MeSH
• Retrospective Studies MeSH
• Aged MeSH
• Spondylolisthesis * surgery   diagnostic imaging   MeSH
• Muscular Atrophy * etiology   diagnostic imaging   MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH

INTRODUCTION: A comparison of body composition assessments using military circumferences to bioelectrical impedance analysis (BIA) and the reference standard dual-energy X-ray absorptiometry (DEXA) can gauge effectiveness of assessments. High-frequency (500 KHz) direct segmental multifrequency bioelectrical impedance analysis (DSM-BIA) accurately calculates total water mass and body fat% (BF%), but it is unknown whether higher frequencies (1,000 KHz) increase measurement accuracy. The purpose was to compare DSM-BIA 500, DSM-BIA 1000, the DoD Circumference Method (CM), and the reference-standard DEXA. MATERIALS AND METHODS: Design: Cross sectional, observational study. Participants/Setting: A total of 62 participants from the military healthcare system (n = 25 males, 38.8 ± 11.4 years, n = 37 females 43.7 ± 15.95 years) were measured in an outpatient clinic setting. Statistical Analysis: BF% was estimated via DEXA, DSM-BIA 500, DSM-BIA 1000, and CM to identify the relationship between methods using Pearson correlation, intraclass correlation coefficients (ICCs), and Bland-Altman plots. The study was approved by the IRB from Walter Reed National Military Medical Center at Bethesda and Concordia University Chicago. RESULTS: Circumference Method BF% was moderately correlated with DSM-BIA 500 (males r = 0.63, ICC = 0.76; females r = 0.77, ICC = 0.85), DSM-BIA 1000 (males r = 0.59, ICC = 0.74; females r = 0.77, ICC = 0.85), and DEXA (males r = 0.62, ICC = 0.62; females r = 0.73, ICC = 0.82). DSM-BIA 500 BF% was strongly correlated with DSM-BIA 1000 (males r = 0.99, ICC = 0.99; females r = 0.99, ICC = 0.99) and DEXA (males r = 0.93, ICC = 0.94; females r = 0.89, ICC = 0.89). Lastly, DSM-BIA 1000 BF% was also strongly correlated with DEXA (males r = 0.93, ICC = 0.94; females r = 0.84, ICC = 0.90) (P for each reported r < 0.01). Bland-Altman analysis confirmed an overall mean bias of -1.72% CM vs. DEXA in females, indicating the tendency of CM to underestimate BF% compared to DEXA limits of agreement from -14.24 to 10.8. There was an upward slope of the linear relationship between the bias and mean of the measures (Beta = 0.34, P = 0.01). In the full cohort, there was an overall mean bias of 1.14% of CM vs. DSM BIA 1000, with CM tending to overestimate BF% compared to DSM BIA 1000 with limits of agreement -11.13 to 13.41%. There is an upward slope line of the linear relationship between the bias and the mean of the measures (Beta = 0.17, P = .03). CONCLUSION: This study found that CM BF% was moderately correlated with DSM-BIA 500 kHz, DSM-BIA 1,000 kHz BIA, and DEXA. Both DSM-BIA 500 and DSM-BIA 1,000 kHz strongly correlated well with DEXA implying that there was no further increase in correlation with increased frequency. Additionally, there was proportional bias in BF% in the female group between CM and DEXA and in the total group between CM and DSM BIA 1000.

• MeSH
• Absorptiometry, Photon * methods   statistics & numerical data   MeSH
• Adult MeSH
• Electric Impedance * MeSH
• Body Mass Index MeSH
• Middle Aged MeSH
• Humans MeSH
• Cross-Sectional Studies MeSH
• Body Composition * physiology   MeSH
• Adipose Tissue diagnostic imaging   physiology   MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Observational Study MeSH
• Comparative Study MeSH

BACKGROUND: Pulmonary hernia is a rare condition characterized by the protrusion of lung tissue through a chest wall defect. Trauma and thoracic surgery are the most common causes of acquired lung hernias. We present an unusual case of (sequential) bilateral lung herniation with parenchymal infarction after bilateral lobar lung transplantation. CASE PRESENTATION: A 50-year-old female, wait-listed as high-urgency candidate, with a body mass index (BMI) of 29 kg/m2 underwent a bilateral lobar lung transplantation for pulmonary fibrosis through a clamshell thoracotomy approach. Due to a size mismatch, stapler resection of the segment 3 and the middle lobe of the right lung, as well as an upper left lobectomy was required. The chest was closed with 3 braided non-absorbable pericostal sutures on each side. Sternal osteosynthesis was performed with a titanium sternal splint along with 7 self-tapping screws with a length of 18 mm. On the posttransplant day (PTD) 18, patient's clinical condition deteriorated. Physical examination didn't reveal any palpable subcutaneous chest resistance. However, a computed tomography (CT) scan showed a herniation of the segment 6 of the right lung. During acute surgical revision, perioperative finding revealed posterior pericostal suture failure. Therefore, a stapler resection was performed due to the infarction of the herniated segment. On the PTD 36, herniation of the left lung parenchyma was detected by acute CT scan. The protruding vital parenchyma was surgically repositioned without necessity of resection. Two posterior pericostal sutures were broken, and distal part of sternal splint detached. Thoracotomy was closed using 5 braided non-absorbable sutures. Sternum was re-osteosynthesized with the STRATOSTM system. After 3 months of intensive postoperative care, the patient was transferred to the rehabilitation department. She was discharged on the PTD 99. After 20 months of follow-up, lung function remains stable without the need for oxygen support. CONCLUSION: Clamshell incision remains ultimate approach in thoracic surgery. However, pulmonary herniation after clamshell thoracotomy is a rare complication and may manifest as acute respiratory distress syndrome with an inflammatory response. In these cases, CT scan should be always considered, even if no palpable pathology of chest is present.

• MeSH
• Hernia * etiology   MeSH
• Infarction etiology   surgery   MeSH
• Middle Aged MeSH
• Humans MeSH
• Herniorrhaphy methods   adverse effects   MeSH
• Lung diagnostic imaging   MeSH
• Lung Diseases surgery   etiology   MeSH
• Tomography, X-Ray Computed MeSH
• Postoperative Complications surgery   MeSH
• Thoracotomy * methods   MeSH
• Lung Transplantation * adverse effects   MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Case Reports MeSH

CXCL12 and CXCR4 proteins and mRNAs were monitored in the dorsal root ganglia (DRGs) of lumbar (L4-L5) and cervical (C7-C8) spinal segments of naïve rats, rats subjected to sham operation, and those undergoing unilateral complete sciatic nerve transection (CSNT) on post-operation day 7 (POD7). Immunohistochemical, Western blot, and RT-PCR analyses revealed bilaterally increased levels of CXCR4 protein and mRNA in both lumbar and cervical DRG neurons after CSNT. Similarly, CXCL12 protein levels increased, and CXCL12 mRNA was upregulated primarily in lumbar DRGs ipsilateral to the nerve lesion. Intrathecal application of the CXCR4 inhibitor AMD3100 following CSNT reduced CXCL12 and CXCR4 protein levels in cervical DRG neurons, as well as the length of afferent axons regenerated distal to the ulnar nerve crush. Furthermore, treatment with the CXCR4 inhibitor decreased levels of activated Signal Transducer and Activator of Transcription 3 (STAT3), a critical transforming factor in the neuronal regeneration program. Administration of IL-6 increased CXCR4 levels, whereas the JAK2-dependent STAT3 phosphorylation inhibitor (AG490) conversely decreased CXCR4 levels. This indicates a link between the CXCL12/CXCR4 signaling axis and IL-6-induced activation of STAT3 in the sciatic nerve injury-induced pro-regenerative state of cervical DRG neurons. The role of CXCR4 signaling in the axon-promoting state of DRG neurons was confirmed through in vitro cultivation of primary sensory neurons in a medium supplemented with CXCL12, with or without AMD3100. The potential involvement of conditioned cervical DRG neurons in the induction of neuropathic pain is discussed.

• MeSH
• Benzylamines MeSH
• Chemokine CXCL12 * metabolism   MeSH
• Cyclams pharmacology   MeSH
• Heterocyclic Compounds pharmacology   MeSH
• Interleukin-6 metabolism   MeSH
• Rats MeSH
• Sciatic Neuropathy metabolism   MeSH
• Sensory Receptor Cells * metabolism   MeSH
• Sciatic Nerve * injuries   metabolism   MeSH
• Rats, Sprague-Dawley MeSH
• Receptors, CXCR4 * metabolism   MeSH
• Nerve Regeneration * MeSH
• Signal Transduction * MeSH
• Ganglia, Spinal * metabolism   MeSH
• STAT3 Transcription Factor * metabolism   MeSH
• Animals MeSH
• Check Tag
• Rats MeSH
• Male MeSH
• Animals MeSH
• Publication type
• Journal Article MeSH

BACKGROUND: Large femoral defects after trauma, femoral non-unions, fractures complicated by osteomyelitis or defects after bone tumour resection present high burden and increased morbidity for patient and are challenging for reconstructive surgeons. Defects larger than 6 cm and smaller defects after failed spongioplasty are suitable for reconstruction using a free, eventually a pedicled vascularised bone flap. The free fibular flap is preferred but an iliac crest free flap or a pedicled medial femoral condyle flap can be also used. These vascularised flaps are ideal for bridging defects of long bones and can be also used as osteocutaneous or osteomuscular flaps for coverage of soft tissue defect if present. The patients and their families were informed that data will be submitted for publication and they gave their written informed consent prior to the submission. The study was approved by the institutional ethic committee. METHODS: We analysed a group of eight patients with large diaphyseal or distal metaphyseal femoral defects. A free fibular flap was used in six patients, a pedicled medial ipsilateral femoral condyle flap was used in two patients and a defect in one patient was reconstructed using an iliac crest free flap. RESULTS: All flaps healed completely in all patients and no fracture of the flap was detected during the study period. In one patient, a locking plate broke and was replaced by a compression plate. At the last check-up all patients were able to step on the reconstructed limb with full weight. DISCUSSION: Although our study comprises a heterogeneous group of cases, they all have been successfully treated by a similar technique, adapted in each case specifically to the needs of the patient. A major limitation parameter of reconstruction by a free vascularised flap is the size of bone defect needed to be reconstructed. In case of a bone defect longer than 6 cm and a concomitant soft tissue disruption, a vascularised double-barrel fibula is the preferred. CONCLUSION: Large femoral defects can be successfully reconstructed with good long-term results using suitable free or pedicled vascularised bone flaps, especially preferring the free fibular flap.

• MeSH
• Surgical Flaps * MeSH
• Adult MeSH
• Femur * surgery   transplantation   MeSH
• Fibula transplantation   surgery   injuries   MeSH
• Femoral Fractures surgery   MeSH
• Middle Aged MeSH
• Humans MeSH
• Young Adult MeSH
• Retrospective Studies MeSH
• Aged MeSH
• Bone Transplantation * methods   MeSH
• Free Tissue Flaps transplantation   MeSH
• Treatment Outcome MeSH
• Plastic Surgery Procedures * methods   MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Young Adult MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH

Pánevní endometrióza je dobře známým klinickým rizikovým faktorem pánevního zánětu a srůstů. Prezentujeme zde komplikovaný případ ženy po císařském řezu, kdy tradiční řez na předním dolním děložním segmentu nebyl možný z důvodu městnavé pánve. Novorozenec byl porozen pomocí řezu zadní stěny dělohy s rotací okrouhlého vazu.

Pelvic endometriosis is a well-known clinical risk factor for pelvic inflammation and adhesions. We present a complex case of a woman undergoing a cesarean section where the traditional incision on the anterior lower uterine segment was not possible due to a congested pelvis. The newborn was delivered using a posterior uterine wall incision with rotation of the round ligament.

• MeSH
• Tissue Adhesions surgery   etiology   MeSH
• Cesarean Section MeSH
• Adult MeSH
• Endometriosis * surgery   diagnosis   complications   MeSH
• Obstetric Labor Complications etiology   MeSH
• Humans MeSH
• Magnetic Resonance Imaging MeSH
• Pelvis pathology   MeSH
• Pregnancy MeSH
• Check Tag
• Adult MeSH
• Humans MeSH
• Pregnancy MeSH
• Female MeSH
• Publication type
• Case Reports MeSH

In this study, we investigated the mechanism underlying electrocardiogram (ECG) alterations in a rabbit model of acute pulmonary thromboembolism (PTE). Twelve healthy adult New Zealand white rabbits were used, with eight in the experimental group (PTE group) and four in the control group. After developing the rabbit model of acute PTE, ECG and coronary angiography were performed. HE staining was conducted on the right and left ventricular tissues, and polymerase chain reaction (PCR) was used to determine brain natriuretic peptide (BNP), tumor necrosis factor-alpha (TNF-?), and Troponin I (TNI) mRNA expression in the myocardium. There were considerable changes in the ST segment of the ECG in the PTE group. Coronary angiography revealed the absence of spasm, stenosis, and occlusion. In the plasma of the PTE group, the levels of D-dimer, BNP, TNF-?, and TNI were significantly elevated, and these changes were statistically significant (P<0.05). PCR analysis of ventricular myocardial tissue indicated significantly higher levels of BNP, TNF-?, and TNI mRNA in the PTE group than in the control group. These differences were statistically significant (P<0.05). The ST-T variations on the ECG of rabbits with acute PTE correlate strongly with the temporary changes in right heart volume caused by acute PTE. Keywords: Animal model of pulmonary embolism, B-type natriuretic peptide, Electrocardiogram, Pulmonary thromboembolism, Troponin I, Tumor necrosis factor-alpha.

• MeSH
• Acute Disease MeSH
• Electrocardiography * MeSH
• Rabbits MeSH
• Disease Models, Animal * MeSH
• Natriuretic Peptide, Brain blood   MeSH
• Pulmonary Embolism * physiopathology   blood   MeSH
• Tumor Necrosis Factor-alpha blood   metabolism   genetics   MeSH
• Troponin I blood   metabolism   MeSH
• Animals MeSH
• Check Tag
• Rabbits MeSH
• Male MeSH
• Animals MeSH
• Publication type
• Journal Article MeSH

KEY CLINICAL MESSAGE: In the anatomically complex terrain of the head and neck, the use of 3D intraoperative models serves as an effective verification tool, determining the size, shape, and number of foreign bodies. This allows the main operator to maximize their capacities for careful wound revision and receive real-time information about the remaining content of the sought-after bodies. ABSTRACT: Penetrating foreign bodies of various origins in the head and neck are uncommon, but potentially hazardous injuries. Complete removal of foreign bodies from soft tissues is essential for optimal healing, minimizing complications, and significantly reducing the risk of the need for reoperation. Despite various technological systems and safeguards available, unintentionally retained surgically placed foreign bodies remain difficult to eliminate completely. A 34-year-old female patient with a cut on the right side of her face who was initially treated with sutures at a general surgical clinic presented for a follow-up examination. A foreign body was verified subcutaneously on the anterior-posterior x-ray image on the right side. Computed tomography confirmed a total of 7 foreign bodies with a density corresponding to dental enamel, distributed subcutaneously, subfascially, and intramuscularly in the right temporal region. As part of the preoperative preparation and analysis, the bone segment of the right temporal fossa with the zygomatic bone and the glass fragments were segmented from the CT data and printed on an SLA printer. The physical 3D models were autoclave sterilized and present during surgery. The position, shape, and number of each individual glass fragment was compared with 3D-printed one. The benefits of producing 3D models of foreign bodies are undeniable, particularly in their perioperative comparison with the removed foreign bodies from wounds.

• Publication type
• Journal Article MeSH
• Case Reports MeSH

Souhrn: Flossing je poměrně novou kompresivní terapeutickou technikou využívanou především ve fyzioterapii a sportovní medicíně. Tato metoda využívá aplikace speciálně navržených elastických pásků cirkulárně kolem jednotlivých segmentů těla. Terapeutický efekt techniky spočívá především v krátkodobé kompresi měkkých tkání a kloubů, které se během aplikace flossingového pásku nacházejí přímo v zóně ošetření, s následným uvolněním komprese segmentu. Mezi nejčastější indikace techniky řadíme: zlepšení mobility měkkých tkání, podpora regenerace, zlepšení cirkulace, urychlení hojících se procesů, zrychlení svalové kontrakce, zlepšení pohybové koordinace či redukce bolesti. Hlavním cílem příspěvku je poukázat na možnosti a limity této relativně nové fyzioterapeutické metody s přehledovým shrnutím relevantních informací z dostupné odborné literatury. Součástí sdělení jsou i vybrané kazuistiky pacientů po traumatickém poranění ruky.

Summary: Flossing is a relatively new compressive therapeutic technique, used mainly in physiotherapy and sports medicine. This method uses the application of specially designed elastic bands circularly wrapped around individual body segments. The therapeutic effect of the technique consists primarily in the short-term compression of soft tissues and joints, which are located directly in the treatment zone during the application of the flossing tape, with subsequent release of segment compression. The most common indications of the technique include: improvement of soft tissue mobility, support of regeneration, improvement of circulation, acceleration of healing processes, acceleration of muscle contraction, and improvement of movement coordination and reduction of pain. The main goal of the paper is to point out the possibilities and limits of this relatively new physiotherapeutic method with an overview of relevant information from the available literature. Selected case reports of patients after traumatic hand injury are also included.

• Keywords
• flossing,
• MeSH
• Adult MeSH
• Wrist Fractures diagnosis   therapy   MeSH
• Kinesiology, Applied methods   MeSH
• Humans MeSH
• Finger Injuries diagnosis   therapy   MeSH
• Hand Injuries * diagnosis   rehabilitation   MeSH
• Aged MeSH
• Physical Therapy Modalities MeSH
• Check Tag
• Adult MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Case Reports MeSH

Endometrióza je chronické zánětlivé onemocnění, které je charakterizováno výskytem endometriální tkáně mimo děložní dutinu. Postihuje 6 % až 10 % žen v reprodukčním věku a je diagnostikováno až u 50 % žen s neplodností. Patofyziologie endometriózy je stále neúplně objasněna. Diagnostika je založena na anamnéze, gynekologickém vyšetření, vaginálním ultrazvuku, magnetické rezonanci, někdy až operační revizi. Terapie endometriózy se zaměřuje na úlevu od bolesti, zlepšení kvality života a léčbu neplodnosti. Léčba může být pouze symptomatická (analgetika), hormonální nebo operační. Chirurg se s endometriózou setká nejčastěji při postižení rektosigmoidea. Při symptomatickém postižení máme k dispozici 3 možnosti: shaving, diskoidní resekci a segmentální resekci. Každý z těchto chirurgických přístupů má svá pozitiva a negativa. Segmentální resekce je nejradikálnějším zákrokem, s nižším výskytem recidiv, ale také vyšším rizikem komplikací. Celkově lze konstatovat, že si léčba tohoto komplexního onemocnění zasluhuje centralizaci, neboť zahrnuje složité rozhodování gynekologa a chirurga ohledně rozsahu chirurgického zákroku a jeho dopadů na pacientku, s níž musí být řádně prodiskutována.

Endometriosis is a chronic inflammatory condition characterized by the presence of endometrial tissue outside the uterine cavity. It affects 6% to 10% of women in reproductive age and is diagnosed in up to 50% of women with infertility. The pathophysiology of endometriosis is still not fully understood. Diagnosis is based on medical history, gynecological examination, vaginal ultrasound, magnetic resonance imaging and sometimes surgical revision. The therapy for endometriosis focuses on pain relief, improving the quality of life and treating infertility. Treatment options include symptomatic relief (analgetics), hormonal therapy, or surgery. Surgeons commonly encounter endometriosis when it affects the rectosigmoid region. When symptomatic, three surgical approaches are available: shaving, discoid resection, and segmental resection. Each of these surgical approaches has its pros and cons. Segmental resection is the most radical procedure, with a lower recurrence rate but also a higher risk of complications. Overall, the treatment of endometriosis involves complex decision-making by gynecologists and surgeons regarding the extent of surgical intervention and its impact on the patient, which must be thoroughly discussed.