BACKGROUND: Spasticity is a common feature in patients with disruptions in corticospinal pathways. However, the term is used ambiguously. Here, spasticity is defined as enhanced velocity-dependent stretch reflexes and placed within the context of deforming spastic paresis encompassing other forms of muscle overactivity. OBJECTIVE: This scoping review aims at evaluating the clinimetric quality of clinical outcome assessments (COAs) for spasticity across different pathologies and to make recommendations for their use. METHODS: A literature search was conducted to identify COAs used to assess spasticity. An international expert panel evaluated the measurement properties in the included COAs. Recommendations were based on the MDS-COA program methodology based on three criteria: if the COA was (1) applied to patients with spastic paresis, (2) used by others beyond the developers, and (3) determined to be reliable, valid, and sensitive to change in patients with spasticity. RESULTS: We identified 72 COAs of which 17 clinician-reported outcomes (ClinROs) and 6 patient-reported outcomes (PROs) were reviewed. The Tardieu Scale was the only ClinRO recommended for assessing spasticity. One ClinRO-Composite Spasticity Index-and two PROs-Spasticity 0-10 Numeric Rating Scale and 88-Item Multiple Sclerosis Spasticity Scale-were recommended with caveats. The Ashworth-derived COAs were excluded after evaluation due to their focus on muscle tone rather than spasticity, as defined in this review. CONCLUSIONS: The Tardieu Scale is recommended for assessing spasticity, and two PROs are recommended with caveats. Consistent terminology about the various types of muscle overactivity is necessary to facilitate their assessment and treatment. © 2024 The Author(s). Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.

• MeSH
• Outcome Assessment, Health Care * standards   MeSH
• Humans MeSH
• Muscle Spasticity * physiopathology   diagnosis   etiology   MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH
• Review MeSH

The sacroiliac joint (SIJ) exhibits significant variation in auricular surface morphology. This variation influences the mechanics of the SIJ, a central node for transmitting mechanical energy from upper body to lower limbs and vice versa. The impact of the auricular surface morphology on stress and deformation in the SIJ remains poorly understood to date. Computed tomography scans obtained from 281 individuals were included to extract the geometry of the pelvic ring. Then, the auricular surface area, SIJ cartilage thickness, and total SIJ cartilage volume were identified. Based on these reconstructions, 281 finite element models were created to simulate SIJ mechanical loading. It was found that SIJ cartilage thickness only weakly depended on age or laterality, while being strongly sex sensitive. Auricular surface area and SIJ cartilage volume depended weakly and non-linearly on age, peaking around menopause in females, but without significant laterality effect. Larger SIJs, characterized by greater auricular area and cartilage volume, exhibited reduced stress and deformation under loading. These findings highlight the significant role of SIJ morphology in its biomechanical response, suggesting a potential link between morphological variations and the risk of SIJ dysfunction. Understanding this relationship could improve diagnosis and targeted treatment strategies for SIJ-related conditions.

• MeSH
• Finite Element Analysis MeSH
• Biomechanical Phenomena physiology   MeSH
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Stress, Mechanical MeSH
• Adolescent MeSH
• Young Adult MeSH
• Tomography, X-Ray Computed * MeSH
• Sacroiliac Joint * anatomy & histology   physiology   diagnostic imaging   MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Adolescent MeSH
• Young Adult MeSH
• Male MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH

Idiopatická skolióza je komplexní deformita páteře s multifaktoriální etiopatogenezí zahrnující biomechanické, neurologické, genetické, endokrinní a environmentální faktory. Tento článek se zaměřuje na propojení biomechanických a neurologických faktorů u pacientů s idiopatickou skoliózou, přičemž klíčovými biomechanickými aspekty jsou svalové dysbalance a posturální asymetrie. Neurologicko-funkční aspekty zahrnují senzorické dysfunkce a dyspraxii, které souvisí s centrálním nervovým systémem a jeho schopností správně zpracovávat a integrovat informace z periferie. Specifické klinické testy umožňují přesnou diagnostiku těchto dysfunkcí, což je klíčové pro sestavení efektivních terapeutických plánů zohledňujících individuální motorické a senzorické poruchy. Včasná diagnostika a intervence přispívá k prevenci komplikací spojených s progresí skoliózy a zlepšuje nejen fyzický stav, ale i psychickou pohodu pacientů. Rehabilitace hraje významnou roli v propojení biomechanických a neurologicko-funkčních přístupů, poskytuje komplexní rámec pro optimalizaci terapie a reflektuje důraz na multidisciplinární spolupráci v léčbě skoliózy, čímž nabízí perspektivní cestu pro začlenění recentních diagnostických a terapeutických postupů do klinické praxe zaměřené na pacienty s idiopatickou skoliózou.

BACKGROUND: Proximal Femoral Focal Deficiency (PFFD) is the most proximal manifestation of a syndrome involving Congenitally Shortened lower Limbs (CSL), which also affects the fibula and midline metatarsals. This pattern of congenital human long bone deficiencies corresponds, in a time dependent manner, to the failed ingrowth pathways of new blood vessels of the growing embryonic limb. The distal femoral condyles are, in contrast, served by an alternative vascular supply from around the knee joint, and so remain resistant to the CSL deficiency. AIM: We hypothesize that embryonic vascular dysgenesis causes PFFD, as well as the cardinal features of the Femoral, Fibular and midline Metatarsal deficiencies (FFM) syndrome. RESULTS: Arteriography of CSL with PFFD reveals diminution or failed formation of the Femoral Artery (FA), which corresponds to downstream skeletal reductions. It may also reveal preservation of the primitive Axial Artery (AA) of the embryonic limb. The combination of missing and retained primitive vessels inform the time, place, and nature of the etiologic vascular events. This suggests that PFFD is the visible expression of a normally prefigured cartilaginous scaffold of the femur, which develops in conformity with the available pattern of blood vessels present. The teratogen thalidomide, known to affect the forming embryonic vasculature, also produces PFFD indistinguishable from the naturally occurring entity. CONCLUSION: The entire spectrum of PFFD, including phocomelia, fibular, and metatarsal dystrophisms, should thus be regarded as downstream skeletal results of embryonic arterial dysgeneses.

• MeSH
• Femoral Artery * abnormalities   embryology   MeSH
• Femur * abnormalities   blood supply   embryology   MeSH
• Fibula abnormalities   blood supply   MeSH
• Humans MeSH
• Metatarsal Bones abnormalities   MeSH
• Lower Extremity Deformities, Congenital * embryology   MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH
• Review MeSH

Background: Complex nasal defects most often arise due to oncological resection or severe trauma. Traditional methods of two-stage nose reconstruction using a forehead flap with a skin graft have often resulted in collapse and deformity of the nose with a very compromised outcome over time. These techniques were gradually replaced by new procedures consistently reconstructing the intranasal lining, most often with flaps from the nasal septum. These methods reconstruct the cartilaginous and bony support of the nose as well, while the skin cover of the nose is, nowadays, in large defects, reconstructed in three stages. Evaluation of the topic: The options for intranasal lining reconstruction are as follows: a composite graft, a turnover flap covered with a local flap, advancement of the residual lining (bipedicle vestibular mucosa flap), a folded forehead flap, a prelaminated forehead flap, the use of another local flap (a forehead, nasolabial, facial artery myomucosal flap), a hinged turnover flap, a septal mucoperichondrial hinged flap, a composite septal chondromucosal pivot flap, a turbinate flap and microvascular free flaps (a radial forearm flap, a helix free flap, a kite flap, a dorsalis pedis free flap, a temporoparietal free flap, a postauricular free flap). Thanks to the abundant vascular supply of the face, the risk of ischemia and infection is mitigated, allowing most complex nasal defects to be reconstructed by using local flaps to restore all layers of the nose. Local tissues retain ideal quality, coloration, and texture, are reliable, and usually result in esthetically acceptable morbidity of the donor area. If the inner lining defect is extensive, it must be reconstructed by free microvascular tissue transfer. If other than intranasal flaps are used in the reconstruction of the internal lining, it is preferable to postpone the reconstruction of the supporting framework until the second stage while thinning the flaps used; otherwise, there is a high risk of obturation of the nasal airways. Conclusion: The results of modern reconstruction dramatically improved after the introduction of three-stage nasal reconstruction and emphasizing the reconstruction of all layers of the nose. Therefore, a quality inner lining is the basis for the construction of the new nose.

Příručka, která se zaměřuje na podiatrickou péči o pacienty se syndromem diabetické nohy. Určeno odborné veřejnosti.

• MeSH
• Diabetic Foot MeSH
• Skin Care MeSH
• Publication type
• Handbook MeSH

• Conspectus
• Patologie. Klinická medicína
• NML Fields
• podiatrie
• diabetologie
• NML Publication type
• kolektivní monografie

Pulmonary artery banding is a surgical procedure performed when there is a shunt between the left and right ventricle. Its aim is to constrict the lumen of the pulmonary artery by using a band to reduce blood flow to the lungs. In this study, we report the results of investigating the mechanical properties of a composite composed of poly(L-lactide-co-ε-caprolactone) layers and a collagen matrix (PLCL-COLL). PLCL layers were obtained by electrospinning, impregnated with collagen solution, and finally cross-linked to increase the stiffness of the material. Bands of PLCL-COLL were implanted into a rat peritoneum and explanted after 1, 3, and 6 months in vivo. The mechanical properties of the material before and after implantation were determined using uniaxial tensile tests. The same was done with samples of strips prepared from GORE-TEX material. By comparing the results of tensile tests before implantation and after explantation, it was found that PLCL-COLL degrades in the rat's body and that it exhibits a mechanical response showing of elastic modulus values that correspond well to arterial biomechanics (elastic modulus measured in the initial linear region of the deformation was found to be: 4.14 MPa ± 1.11 MPa, 2.34 MPa ± 1.02 MPa, 1.11 MPa ± 0.77 MPa, and 0.88 MPa ± 0.60 MPa before implantation, and 1, 3, and 6 months after implantation respectively). Similar to the elastic modulus, the strength of the PLCL-COLL composite decreased during in vivo exposure (1.32 ± 0.32 MPa, 0.60 ± 0.26 MPa, 0.44 ± 0.11 MPa, and 0.46 ± 0.28 MPa before implantation, and 1, 3, and 6 months after implantation respectively). In our experiments, PLCL-COLL material was always more compliant than GORE-TEX (elastic modulus 34.7 MPa ± 2.06 MPa before implantation, and 9.35 MPa ± 6.80 MPa after implantation). The results suggest that PLCL-COLL could be a suitable candidate for the development of artery banding tapes, and also for further use in cardiovascular surgery.

• MeSH
• Pulmonary Artery * surgery   MeSH
• Biocompatible Materials chemistry   MeSH
• Biomechanical Phenomena MeSH
• Collagen * chemistry   metabolism   MeSH
• Rats MeSH
• Mechanical Phenomena * MeSH
• Peritoneum * surgery   MeSH
• Tensile Strength MeSH
• Polyesters * chemistry   metabolism   MeSH
• Materials Testing MeSH
• Animals MeSH
• Check Tag
• Rats MeSH
• Male MeSH
• Animals MeSH
• Publication type
• Journal Article MeSH

The Bonebridge (BB) was the first active transcutaneous implantation system for bone conduction. The main indications are conductive or mixed hearing loss and single-sided deafness. Treacher-Collins syndrome (TCS) is a rare genetic disease that affects craniofacial development. The disorder results in deformations of facial structure including ear malformations, especially microtia and ear canal atresia. These patients suffer from conductive hearing loss. CT scans often show unfavorable temporal bone anatomy making placement of an implant difficult. For implantable hearing rehabilitation, patients may decide for conduction implants, such as a BAHA, a Ponto, a Vibrant Soundbridge, or a Bonebridge. In this case report, we present 2 patients with TCS implanted with the Bonebridge system, their audiological results, and quality of life.

• MeSH
• Prosthesis Implantation * methods   MeSH
• Bone Conduction MeSH
• Quality of Life MeSH
• Humans MeSH
• Mandibulofacial Dysostosis * complications   MeSH
• Hearing Loss, Conductive * surgery   etiology   rehabilitation   MeSH
• Hearing Aids * MeSH
• Treatment Outcome MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH
• Case Reports MeSH

Permeability is an important molecular property in drug discovery, as it co-determines pharmacokinetics whenever a drug crosses the phospholipid bilayer, e.g., into the cell, in the gastrointestinal tract, or across the blood-brain barrier. Many methods for the determination of permeability have been developed, including cell line assays (CACO-2 and MDCK), cell-free model systems like parallel artificial membrane permeability assay (PAMPA) mimicking, e.g., gastrointestinal epithelia or the skin, as well as the black lipid membrane (BLM) and submicrometer liposomes. Furthermore, many in silico approaches have been developed for permeability prediction: meta-analysis of publicly available databases for permeability data (MolMeDB and ChEMBL) was performed to establish their usability. Four experimental and two computational methods were evaluated. It was shown that repeatability of the reported permeability measurement is not great even for the same method. For the PAMPA method, two different permeabilities are reported: intrinsic and apparent. They can vary in degrees of magnitude; thus, we suggest being extra cautious using literature data on permeability. When we compared data for the same molecules using different methods, the best agreement was between cell-based methods and between BLM and computational methods. Existence of unstirred water layer (UWL) permeability limits the data agreement between cell-based methods (and apparent PAMPA) with data that are not limited by UWL permeability (computational methods, BLM, intrinsic PAMPA). Therefore, different methods have different limitations. Cell-based methods provide results only in a small range of permeabilities (-8 to -4 in cm/s), and computational methods can predict a wider range of permeabilities beyond physical limitations, but their precision is therefore limited. BLM with liposomes can be used for both fast and slow permeating molecules, but its usage is more complicated than standard transwell techniques. To sum up, when working with in-house measured or published permeability data, we recommend caution in interpreting and combining them.

• MeSH
• Madin Darby Canine Kidney Cells MeSH
• Caco-2 Cells MeSH
• Blood-Brain Barrier metabolism   MeSH
• Humans MeSH
• Liposomes * chemistry   MeSH
• Membranes, Artificial MeSH
• Cell Membrane Permeability physiology   MeSH
• Permeability * MeSH
• Dogs MeSH
• Animals MeSH
• Check Tag
• Humans MeSH
• Dogs MeSH
• Animals MeSH
• Publication type
• Journal Article MeSH
• Meta-Analysis MeSH

Souhrn Úvod: Lumbální kýla v dětském věku je extrémně vzácná diagnóza a vyžaduje specifický diagnostický a léčebný přístup. Kazuistika prezentuje první popsaný případ v České republice. Popis případu: Dvacetidvouměsíční chlapec byl vyšetřen na chirurgické ambulanci pro měkkou, volně reponibilní rezistenci v pravé bederní oblasti, která byla dle matky přítomna od narození. Ultrazvukové vyšetření prokázalo defekt v oblasti odpovídající trigonum lumbale superius (Grynfeltti seu Lesshafti) velikosti 17 × 11 mm s herniací střevní kličky. Chlapec podstoupil RTG skeletu a ultrazvuk břicha k vyloučení přidružených vad a následně byl indikován k otevřené hernioplastice. Vzhledem k velikosti defektu byla zvolena primární plastika bez použití síťky. Pooperační průběh byl bez komplikací a při plánovaných kontrolách byl pacient bez známek recidivy kýly a bez vývojové asymetrie. Závěr: Lumbální kýla u dětí je vrozená a často se objevuje v souvislosti s dalšími přidruženými malformacemi, které je nutné vyloučit. Typ operace závisí na velikosti defektu a cílem je zajistit plastiku bez napětí.

Summary Introduction: Lumbar hernia in the pediatric population is an extremely rare diagnosis and therefore requires specific diagnostic and therapeutic approaches. This case report describes the first published case of a pediatric lumbar hernia in the Czech Republic. Case description: A 22-month-old boy was examined at a pediatric surgical clinic due to a soft reducible mass in the right lumbar region, which, according to his mother, has been present from birth. An ultrasound scan confirmed a defect in the anatomical localization of the superior lumbar triangle (the triangle of Grynfeltt-Lesshaft) measuring 17 × 11 mm with a bowel loop herniation. The patient underwent a skeletal X-ray and an abdominal ultrasound in order to rule out associated malformations, following which he was scheduled for an open hernioplasty. Given the small size of the defect, a primary closure without mesh hernioplasty was performed. The postoperative course was uneventful and at clinical follow-ups the patient showed no signs of hernia recurrence or growth asymmetry. Conclusion: Lumbar hernia in children is congenital and frequently occurs with other associated malformations, which must be ruled out. The type of operation depends on the size of the defect and its purpose is to provide a tension-free closure.

• Keywords
• lumbální kýla,
• MeSH
• Hernia * diagnosis   pathology   MeSH
• Infant MeSH
• Humans MeSH
• Herniorrhaphy methods   MeSH
• Congenital Abnormalities MeSH
• Check Tag
• Infant MeSH
• Humans MeSH
• Male MeSH
• Publication type
• Case Reports MeSH