Pontos de corte para diagnóstico de sarcopenia em idosos a partir da força muscular de membros superiores e inferiores com ajustes alométricos

A presente tese defende a normalização da força e da massa muscular pelo tamanho corporal como estratégia eficiente para minimizar o viés das dimensões corporais sobre a funcionalidade de idosos. A tese foi composta de três objetivos específicos respondidos em quatro estudos originais. O primeiro objetivo foi propor expoentes alométricos para normalizar a força de membros superiores e inferiores pelo tamanho corporal e gerar pontos de corte para a fraqueza muscular de idosos, respondido em dois estudos originais. No Estudo I (Identification of muscle weakness in older adults from normalized upper and lower limbs strength: A cross-sectional study), que envolveu 94 idosos (IC 95%: 68,2 a 73,9 anos) de ambos os sexos, foram obtidas medidas de força muscular (preensão manual, extensão de joelhos dinâmica e isocinética), do tamanho corporal (antropometria, dimensões e índices) e mobilidade. Foram aplicadas estratégias de normalização (força/tamanho corporal) e alometria (força/tamanho corporalb; sendo b o expoente alométrico) associado à mobilidade dos idosos. Foram gerados 49 modelos válidos para identificar fraqueza muscular. A normalização aumentou a precisão dos pontos de corte em mulheres, mas não em homens. Todavia os ajustes nos homens também tornaram a força muscular independente do tamanho corporal, reduzindo o enviesamento para casos extremos. Isso implicou em menor risco de atribuir um diagnóstico falso-positiva/negativo à fraqueza muscular. E no Estudo II (Allometrically adjusted grip strength to identify low strength from 13,235 older adults of low- and middle-income countries), que envolveu idosos de ambos os sexos oriundos de seis países em desenvolvimento, a normalização da força muscular por dimensões corporais foi replicada em diferentes populações. Os métodos foram similares ao Estudo I, mas envolveu somente medidas da força de preensão manual, estatura e massa corporal. A relação não linear entre força e massa corporal foi confirmada, exceto para estatura. Os ajustes alométricos tornaram a força muscular independente do tamanho corporal e sua variabilidade destacou a necessidade de pontos de corte específicos para cada país. Os valores dos expoentes alométricos gerados para cada país foram muito próximos, confirmando a efetividade universal dessa estratégia. Nosso segundo objetivo foi aplicar comparativamente os expoentes alométricos propostos no Estudo I e outros relatados na literatura, a testar sua eficácia em normalizar a força e identificar fraqueza muscular. Assim, no Estudo III (Foreign allometric exponents adequately normalize isokinetic knee extension strength to identify muscle weakness and functional limitation in Portuguese older adults: A cross-sectional study) 132 idosos portugueses de ambos os sexos realizaram testes de mobilidade, força isocinética de extensão do joelho e medidas das dimensões corporais para normalizar a força (força/tamanho corporalb). Foram definidos pontos de corte para fraqueza muscular (curva ROC) a partir da força de extensão isocinética do joelho normalizada, ou não, identificado pelo menor quartil de mobilidade. Os pontos de corte da força absoluta, mostraram acurácia insuficiente (AUC<0.70). Expoentes alométricos, ainda que estrangeiros (três brasileiros e um norte americano), melhoraram a acurácia diagnóstica de fraqueza muscular. Concluímos que normalizar a força muscular isocinética de extensão do joelho, mesmo com o uso de expoentes alométricos estrangeiros é melhor do que nenhum ajuste. Nosso terceiro objetivo foi buscar uma estratégia simplificada para identificar a baixa massa muscular de idosos, baseada na limitação funcional para o risco de sarcopenia. Assim, para o Estudo IV (Normalizing Calf Circumference to identify low Skeletal Muscle Mass in Older Women: A Cross-sectional Study) foram propostos pontos de corte para o perímetro da panturrilha, normalizado pelo tamanho corporal, para identificar baixa massa muscular esquelética em mulheres idosas. Valores do perímetro da panturrilha de mulheres jovens (n=78) foram utilizados como referencia dos pontos de corte de baixa massa muscular (-2 desvio padrão). Os resultados mostraram que o perímetro da panturrilha normalizado pelo IMC identificou baixa massa muscular com maior acurácia do que os valores absolutos. A normalização retirou o costumeiro viés da relação de U invertido com a mobilidade (6MWT), geralmente observado em valores absolutos. A precisão obtida suportou o uso de PP·IMC-1 para identificar baixa massa muscular em mulheres idosas. Por conclusão, A estratégia alométrica proposta evita erros na classificação da baixa força muscular de idosos, decorrentes do viés causado pelo tamanho corporal. Possivelmente, isso reduz consideravelmente as chances de diagnósticos de casos falso positivos e negativos de sarcopenia em dimensões corporais de idosos com valores extremos. Palavras-chave: ajuste, alometricamente normalizado, avaliação, incapacidade, fragilidade, funcionalidade/estado funcional, medida, sarcopeniaThis thesis defends the normalization of strength and muscle mass by body size as an efficient strategy to minimize the bias of body dimensions on the functionality of the older adults. The thesis consisted of three specific objectives answered in four original studies. The first objective was to propose allometric exponents to normalize the strength of upper and lower limbs by body size and generate cutoff points for muscle weakness in the older adults, which was answered in two original studies. In Study I (Identification of muscle weakness in older adults from normalized upper and lower limbs strength: A cross-sectional study), which involved 94 older people (95% CI: 68.2 to 73.9 years) of both sexes, were muscle strength measurements were obtained (hand grip, dynamic and isokinetic knee extension), body size (anthropometry, dimensions, and indexes) and mobility. Strategies for normalization (strength/body size) and allometry (strength/body sizeb; b being the allometric exponent) associated with the mobility of the older adults were applied. Were generated 49 valid models to identify muscle weakness. Normalization increased the precision of the cut-off points in women but not in men. However, adjustments in men also made muscle strength independent of body size, reducing the bias for extreme cases. This implied a lower risk of attributing a falsepositive/ negative diagnosis to muscle weakness. And in Study II (Allometrically adjusted grip strength to identify low strength from 13,235 older adults of low- and middle-income countries), which involved older adults of both sexes from six developing countries, the normalization of muscle strength by body dimensions was replicated in different populations. The methods were like Study I, but only involved measurements of handgrip strength, height, and body mass. The non-linear relationship between strength and body mass was confirmed, except for height. Allometric adjustments made muscle strength independent of body size, and their variability highlighted the need for country-specific cutoff points. The values of allometric exponents generated for each country were very close to, confirming the universal effectiveness of this strategy. Our second objective was to comparatively apply the allometric exponents proposed in Study I and others reported in the literature, to test their effectiveness in normalizing strength and identifying muscle weakness. Thus, in Study III (Foreign allometric exponents suitably normalize isokinetic knee extension strength to identify muscle weakness and functional limitation in Portuguese older adults: A cross-sectional study) 132 Portuguese older adults of both genders performed tests of mobility, isokinetic strength of breast extension. knee and body dimension measurements to normalize strength (strength/body sizeb). Cutoff points for muscle weakness (ROC curve) were defined based on the normalized isokinetic knee extension strength, or not, identified by the lowest mobility quartile. The absolute strength cut-off points showed insufficient accuracy (AUC<0.70). Allometric exponents, although foreign (three Brazilians and one North American), improved the diagnostic accuracy of muscle weakness. We conclude that normalizing isokinetic knee extension muscle strength, even with the use of foreign allometric exponents, is better than no adjustment. Our third objective was to seek a simplified strategy to identify low muscle mass during aging, based on functional limitation for the risk of sarcopenia. Thus, for Study IV (Normalizing Calf Circumference to identify low Skeletal Muscle Mass in Older Women: A Cross-sectional Study) cut-off points were proposed for the calf perimeter, normalized by body size, to identify low skeletal muscle mass in older women. Calf circumference values for young women (n=78) were used as a reference for low muscle mass cutoff points (-2 standard deviation). The results showed that the calf perimeter normalized by BMI identified low muscle mass with greater accuracy than the absolute values. Normalization removed the usual bias of the inverted U-to-mobility ratio (6MWT), usually seen in absolute values. The accuracy obtained supported the use of PP·BMI-1 to identify low muscle mass in older women. In conclusion, the proposed allometric strategy avoids errors in the classification of low muscle strength in the older adults, resulting from the bias caused by body size. Possibly, this considerably reduces the chances of diagnosing false positive and negative cases of sarcopenia in body dimensions of older people with extreme values

Total ankle replacement : Clinical, radiological, and biochemical assessment with special reference to osteolysis

End-stage ankle arthritis may be managed surgically with either ankle fusion or total ankle replacement (TAR). The results of total ankle replacement have improved over the recent decades, but challenges remain. Peri-implant osteolysis has been major problem, as it compromises the stability of the implant components and can lead to aseptic loosening and implant failure. For this retrospective study, 164 ankles (34 Scandinavian Total Ankle Replacement (STAR) and 130 Ankle Evolutive System (AES)) operated on in single institution during 1997–2008 were followed clinically and radiologically. Histological samples were collected from ankles revised due to periprosthetic osteolysis. Analysis from the data covering the years 1997–2006 of the Finnish Arthroplasty Registry was conducted. The peri-implant osteolysis was quite common in the AES total ankle implants: 70% of the ankles exhibited osteolysis at the latest follow-up. Dual-coating of the implant was associated with a 3.1-fold risk of osteolysis and of significantly earlier development of osteolysis compared to single-coating. Histology revealed a foreign-body reaction characterized by extensive soft and bone tissue necrosis. RANK/RANKL-mediated osteoclast and multinuclear foreign body giant cells contributed to peri-implant osteolysis, and there was increased expression of danger signals in the peri-implant tissues, suggesting an auto-inflammation mechanism behind osteolysis. The annual incidence of TAR according to the Finnish Arthroplasty Registry was 1.5 per 105 inhabitants and overall implant survival was 83% at 5 years when any revision was the end point. The most common reasons for revision were aseptic loosening (39%) and instability (39%). In the registry study, there was no difference in the survival rates between the STAR and AES designs, nor was there any association between age, gender, diagnosis, or hospital volume and TAR survival. The survival of the STAR implant was satisfactory, 93.8% (95% CI 77.5% to 98.4%) at 5 years, and 87.2% (95% CI 69.4% to 95.0%) at 10 and 15 years. There was no statistically significant association between implant survival and patient age, gender, BMI, or diagnosis. The overall rate of revisions was 44%, which includes all postoperative revisions for osteolysis, component and insert exchanges, and conversions to arthrodesis. The survival of the AES implant was strongly affected by osteolysis and malalignment, and inferior compared to previously published results. The 5-year survival was 87.3% (95% CI 80.0% to 92.0%), and the 10-year survival 74.9% (95% CI 65.4% to 82.2%). Postoperative alignment of ≥10º of varus predicted a poorer outcome and was statistically significant for implant survival (p=0.0005). The revision rate for all revisions was 57% including all postoperative revisions for osteolysis, component exchanges, and conversions to arthrodesis. Osteolysis was the main reason for revisions and failure. The survival of the STAR total ankle replacement was satisfactory in the long-term, but the results of the AES total ankle implants were strongly influenced by aggressive and early-emerging osteolysis. Future studies should focus on examining the mechanism behind the osteolytic process in TAR to avoid similar problems for implant development in the future.Nilkan tekonivel: Kliininen, radiologinen ja biokemiallinen seuranta Ylemmän nilkkanivelen loppuvaiheen nivelrikkoa voidaan hoitaa nilkan luudutus- tai tekonivelleikkauksella. Viime parinkymmenen vuoden aikana nilkan tekonivelleikkaus tuhoutuneen ylemmän nilkkanivelen hoidossa on yleistynyt. Hankalin nilkan tekonivelen komplikaatio on viime vuosien aikana ollut osteolyysi eli luun liukeneminen tekonivelen ympäriltä, joka saattaa johtaa tekonivelen irtoamiseen. Tässä takautuvassa tutkimuksessa analysoitiin yhdessä sairaalassa laitetun 164 nilkan tekonivelen (34 Scandinavian Total Ankle Replacement (STAR) ja 130 Ankle Evolutive System (AES)) kliiniset ja radiologiset seurantatulokset. Kudosnäytteet saatiin nilkoista, jotka oli jouduttu uusintaleikkaamaan osteolyysin vuoksi. Lisäksi analysoitiin Suomen Endoproteesirekisterin dataa ajalta 1997–2006 koskien nilkan tekoniveliä. Osteolyysin määrä AES-nilkan tekonivelissä oli korkea, 70 % nilkoista viimeksi tehdyn analyysin mukaan. AES-tekonivelen kaksoispinnoite aiheutti yli kolminkertaisen riskin osteolyysin kehittymiselle sekä merkitsevästi aikaisemmin ilmaantuvaa osteolyysiä yksinkertaiseen pinnoitteeseen verrattuna. Mikroskooppitutkimuksessa todettiin vierasesinereaktio ja runsaasti kudoskuoliota. Suomen Endoproteesirekisteriin perustuvassa tutkimuksessa nilkan tekonivelen vuosittainen ilmaantuvuus oli 1,5 tapausta 100.000 asukasta kohti. Nilkkaproteesin kokonaispysyvyys oli 83 % 5 vuoden aikana, kun päätetapahtumana oli mikä tahansa uusintaleikkaus. Uusintaleikkauksen yleisimmät syyt olivat aseptinen irtoaminen (39 %) ja epävakaus (39 %). Rekisteritutkimuksen mukaan implanttimallilla, potilaan iällä, sukupuolella, diagnoosilla tai sairaalan leikkausvolyymilla ei ollut yhteyttä implantin pysyvyyteen. STAR-nilkan tekonivelen pysyvyyden todettiin olevan erittäin hyvä, 93.8 % viiden vuoden ja 87,2 % kymmenen ja viidentoista vuoden aikana. Potilan iällä, sukupuolella, painoindeksillä tai diagnoosilla ei todettu yhteyttä tekonivelen pysyvyyteen. Uusintaleikkausten määrä oli 44 % sisältäen kaikki uusintaleikkaukset osteolyysin vuoksi, komponenttien vaihdot ja tekonivelen vaihdot luudutukseen. AES-nilkan tekonivelen pysyvyys oli huonoa, ja siihen vaikuttivat sekä runsas osteolyysin määrä että nilkan virheasento. Viiden vuoden pysyvyys oli 87.3 % ja kymmenen vuoden 74.9 %. Leikkauksen jälkeisen nilkan virhelinjauksen todettiin ennustavan tilastollisesti merkitsevästi huonompaa tulosta. Uusintaleikkausten määrä oli 57 % sisältäen kaikki uusintaleikkaukset osteolyysin vuoksi, komponenttien vaihdot ja tekonivelen vaihdot luudutukseen. Osteolyysi aiheutti suurimman osan uusintaleikkauksista ja epäonnistumisista. STAR-tekonivelen pysyvyys oli hyvä pitkällä aikavälillä, mutta AES-tekonivelen tuloksia huononsi merkitsevästi erittäin aikaisessa vaiheessa ilmaantunut aggressiivinen osteolyysi. Tulevaisuudessa tutkimusten tulisi keskittyä selvittämään tarkemmin osteolyysin mekanismeja, jotta vastaavat ongelmat voitaisiin jatkossa välttää tekonivelien kehitystyössä.Siirretty Doriast

Infrared Thermography for the Assessment of Lumbar Sympathetic Blocks in Patients with Complex Regional Pain Syndrome

[ES] El síndrome de dolor regional complejo (SDRC) es un trastorno de dolor crónico debilitante que suele afectar a una extremidad, y se caracteriza por su compleja e incomprendida fisiopatología subyacente, lo que supone un reto para su diagnóstico y tratamiento. Para evitar el deterioro de la calidad de vida de los pacientes, la consecución de un diagnóstico y tratamiento tempranos marca un punto de inflexión. Entre los diferentes tratamientos, los bloqueos simpáticos lumbares (BSLs) tienen como objetivo aliviar el dolor y reducir algunos signos simpáticos de la afección. Este procedimiento intervencionista se lleva a cabo inyectando anestesia local alrededor de los ganglios simpáticos y, hasta ahora, se realiza frecuentemente bajo el control de diferentes técnicas de imagen, como los ultrasonidos o la fluoroscopia. Dado que la termografía infrarroja (TIR) ha demostrado ser una herramienta eficaz para evaluar la temperatura de la piel, y teniendo en cuenta el efecto vasodilatador que presentan los anestésicos locales inyectados, se ha considerado el uso de la IRT para la evaluación de los BSLs. El objetivo de esta tesis es, estudiar la capacidad de la TIR como una técnica complementaria para la evaluación de la eficacia en la ejecución de los BSLs. Para cumplir este objetivo, se han realizado tres estudios implementando la TIR en pacientes diagnosticados de SDRC de miembros inferiores sometidos a BSLs. El primer estudio se centra en la viabilidad de la TIR como herramienta complementaria para la evaluación de la eficacia ejecución de los BSLs. Cuando se realizan los BSLs, la colocación correcta de la aguja es crítica para llevar realizar el procedimiento técnicamente correcto y, en consecuencia, para lograr los resultados clínicos deseados. Para verificar la posición de la aguja, tradicionalmente se han utilizado técnicas de imagen, sin embargo, los BSLs bajo control fluoroscópico no siempre aseguran su exacta ejecución. Por este motivo, se han aprovechado las alteraciones térmicas inducidas por los anestésicos locales y se han evaluado mediante la TIR. Así, cuando en las imágenes infrarrojas se observaron cambios térmicos en la planta del pie afectado tras la inyección de lidocaína, se consideró que el BSL era exitoso. El segundo estudio trata del análisis cuantitativo de los datos térmicos recogidos en el entorno clínico a partir de diferentes parámetros basados en las temperaturas extraídas de ambos pies. Según los resultados, para predecir adecuadamente los BSLs exitosos, se deberían analizar las temperaturas de las plantas de los pies durante los primeros cuatro minutos tras la inyección del anestésico local. Así, la aplicación de la TIR en el entorno clínico podría ser de gran ayuda para evaluar la eficacia de ejecución de los BSLs mediante la evaluación de las temperaturas de los pies en tiempo real. Por último, el tercer estudio aborda el análisis cuantitativo mediante la implementación de herramientas de machine learning (ML) para evaluar su capacidad de clasificar automáticamente los BSLs. En este estudio se han utilizado una serie de características térmicas extraídas de las imágenes infrarrojas para evaluar cuatro algoritmos de ML para tres momentos diferentes después del instante de referencia (inyección de lidocaína). Los resultados indican que los cuatro modelos evaluados presentan buenos rendimientos para clasificar automáticamente los BSLs entre exitosos y fallidos. Por lo tanto, la combinación de parámetros térmicos junto con de clasificación ML muestra ser eficaz para la clasificación automática de los procedimientos de BSLs. En conclusión, el uso de la TIR como técnica complementaria en la práctica clínica diaria para la evaluación de los BSLs ha demostrado ser totalmente eficaz. Dado que es un método objetivo y relativamente sencillo de implementar, puede permitir que los médicos especialistas en dolor identifiquen los bloqueos realizados fallidos y, en consecuencia, puedan revertir esta situación.[CA] La síndrome de dolor regional complex (SDRC) és un trastorn de dolor crònic debilitant que sol afectar una extremitat, i es caracteritza per la seua complexa i incompresa fisiopatologia subjacent, la qual cosa suposa un repte per al seu diagnòstic i tractament. Per a evitar la deterioració de la qualitat de vida dels pacients, la consecució d'un diagnòstic i tractament primerencs marca un punt d'inflexió. Entre els diferents tractaments , els bloquejos simpàtics lumbars (BSLs) tenen com a objectiu alleujar el dolor i reduir alguns signes simpàtics de l'afecció. Aquest procediment intervencionista es duu a terme injectant anestèsia local al voltant dels ganglis simpàtics i, fins ara, es realitza freqüentment sota el control de diferents tècniques d'imatge, com els ultrasons o la fluoroscopia. Atés que la termografia infraroja (TIR) ha demostrat ser una eina eficaç per a avaluar la temperatura de la pell, i tenint en compte l'efecte vasodilatador que presenten els anestèsics locals injectats, s'ha considerat l'ús de la TIR per a l'avaluació dels BSLs. L'objectiu d'aquesta tesi és, estudiar la capacitat de la TIR com una tècnica complementària per a l'avaluació de l'eficàcia en l'execució dels BSLs. Per a complir aquest objectiu, s'han realitzat tres estudis implementant la TIR en pacients diagnosticats de SDRC de membres inferiors sotmesos a BSLs. El primer estudi avalua la viabilitat de la TIR com a eina complementària per a l'analisi de l'eficàcia en l'execució dels BSLs. Quan es realitzen els BSLs, la col·locació correcta de l'agulla és crítica per a dur a terme el procediment tècnicament correcte i, en conseqüència, per a aconseguir els resultats clínics desitjats. Per a verificar la posició de l'agulla, tradicionalment s'han utilitzat tècniques d'imatge, no obstant això, els BSLs baix control fluoroscòpic no sempre asseguren la seua exacta execució. Per aquest motiu, s'han aprofitat les alteracions tèrmiques induïdes pels anestèsics locals i s'han avaluat mitjançant la TIR. Així, quan en les imatges infraroges es van observar canvis tèrmics en la planta del peu afectat després de la injecció de lidocaIna, es va considerar que el BSL era exitós. El segon estudi tracta de l'anàlisi quantitativa de les dades tèrmiques recollides en l'entorn clínic a partir de diferents paràmetres basats en les temperatures extretes d'ambdós peus. Segons els resultats, per a predir adequadament l'execució exitosa d'un BSL, s'haurien d'analitzar les temperatures de les plantes dels peus durant els primers quatre minuts després de la injecció de l'anestèsic local. Així, l'implementació de la TIR en l'entorn clínic podria ser de gran ajuda per a avaluar l'eficàcia d'execució dels BSLs mitjançant l'avaluació de les temperatures dels peus en temps real. El tercer estudi aborda l'anàlisi quantitativa mitjançant la implementació d'eines machine learning (ML) per a avaluar la seua capacitat de classificar automàticament els BSLs. En aquest estudi s'han utilitzat una sèrie de característiques tèrmiques extretes de les imatges infraroges per a avaluar quatre algorismes de ML per a tres moments diferents després de l'instant de referència (injecció de lidocaïna). Els resultats indiquen que els quatre models avaluats presenten bons rendiments per a classificar automàticament els BSLs en exitosos i fallits. Per tant, la combinació de paràmetres tèrmics juntament amb models de classificació ML mostra ser eficaç per a la classificació automàtica dels procediments de BSLs. En conclusió, l'ús de la TIR com a tècnica complementària en la pràctica clínica diària per a l'avaluació dels BSLs ha demostrat ser totalment eficaç. Atés que és un mètode objectiu i relativament senzill d'implementar, pot ajudar els metges especialistes en dolor a identificar els bloquejos realitzats fallits i, en conseqüència, puguen revertir aquesta situació.[EN] Complex regional pain syndrome (CRPS) is a debilitating chronic pain condition that usually affects one limb, and it is characterized by its misunderstood underlying pathophysiology, resulting in both challenging diagnosis and treatment. To avoid the patients' impairment quality of life, the achievement of both an early diagnosis and treatment marks a turning point. Among the different treatment approaches, lumbar sympathetic blocks (LSBs) are addressed to alleviate the pain and reduce some sympathetic signs of the condition. This interventional procedure is performed by injecting local anaesthetic around the sympathetic ganglia and, until now, it has been performed under different imaging techniques, including the ultrasound or the fluoroscopy approaches. Since infrared thermography (IRT) has proven to be a powerful tool to evaluate skin temperatures and taking into account the vasodilatory effects of the local anaesthetics injected in the LSB, the use of IRT has been considered for the LSBs assessment. Therefore, the purpose of this thesis is to evaluate the capability of IRT as a complementary assessment technique for the LSBs procedures performance. To fulfil this aim, three studies have been conducted implementing the IRT in patients diagnosed with lower limbs CRPS undergoing LSBs. The first study focuses on the feasibility of IRT as a complementary assessment tool for LSBs performance, that is, for the confirmation of the proper needle position. When LSBs are performed, the correct needle placement is critical to carry out the procedure technically correct and, consequently, to achieve the desired clinical outcomes. To verify the needle placement position, imaging techniques have traditionally been used, however, LSBs under radioscopic guidance do not always ensure an exact performance. For this reason, the thermal alterations induced by the local anaesthetics, have been exploited and assessed by means of IRT. Thus, the LSB procedure was considered successfully performed when thermal changes within the affected plantar foot were observed in the infrared images after the lidocaine injection. The second study deals with the quantitative analysis of the thermal data collected in the clinical setting through the evaluation of different temperature-based parameters extracted from both feet. According to the results, the proper LSB success prediction could be achieved in the first four minutes after the block through the evaluation of the feet skin temperatures. Therefore, the implementation of IRT in the clinical setting might be of great help in assessing the LSBs performance by evaluating the plantar feet temperatures in real time. Finally, the third study addresses the quantitative analysis by implementing machine learning (ML) tools to assess their capability to automatically classify LSBs. In this study, a set of thermal features retrieved from the infrared images have been used to evaluate four ML algorithms for three different moments after the baseline time (lidocaine injection). The results indicate that all four models evaluated present good performance metrics to automatically classify LSBs into successful and failed. Therefore, combining infrared features with ML classification models shows to be effective for the LSBs procedures automatic classification. In conclusion, the use of IRT as a complementary technique in daily clinical practice for LSBs assessment has been evidenced entirely effective. Since IRT is an objective method and it is not very demanding to perform, it is of great help for pain physicians to identify failed procedures, and consequently, it allow them to reverse this situation.Cañada Soriano, M. (2022). Infrared Thermography for the Assessment of Lumbar Sympathetic Blocks in Patients with Complex Regional Pain Syndrome [Tesis doctoral]. Universitat Politècnica de València. https://doi.org/10.4995/Thesis/10251/181699TESI

Papers on Anthropology XX

-M. Toomsalu, A. Arend. Medical Collections in Tartu Old Anatomical Theatre – from August Rauber’s anatomy museum to a multifunctional research and edutainment centre -H. Kaarma. A short overview of the work of anthropologists of the Old Anatomical Theatre -M. Viikmaa. Leiu Heapost – 75 -R. Allmäe. Human bones in Salme I boat-grave, the Island of Saaremaa; Estonia -N. Balciuniene, D. graf von Keyserlingk, A. Valanciute, I. Balnyte,A. Macas, A. Tamasauskas. Changes of the chicken chorioallantoic membrane and the behaviour of the transplanted glioblastoma -A. Barzdina, M. Pilmane, A. Petersons. Grap and NF expression in brain tissue in children and adults after fatal traumatic brain injury -D. Batulevicius, G. Skripkiene, V. Batuleviciene, V. Skripka, A. Dabuzinskiene, D. H. Pauza. Complexity of the frog intracardiac neurons. Intracellular injection study -A. Dabuzinskiene, A. Ratkevicius, D. Batulevicius, G. Skripkiene, V. Skripka, G. Liutkiene, U. A. Bagdonas, S. Razbadauskiene. Gender differences in the human cervicothoracic ganglia -C. Dogan, C. Raschka. Anthropometrical and sport constitutional comparison of German male soccer players and male students of sport sciences -D. Gudiene, I. Balnyte, J. Palubinskiene, A. Valanciute. Age related structural changes in human basilar artery -L. Heapost. Taste sensitivity to PTC and colour blindness in Estonians -P. Hussar, I. Tokin, G. Filimonova, I. Tokin, Ü. Hussar. Dexamethazone-induced T-lymphocyte apoptosis in different lymphoid organs -L. Kalichman, E. Kobyliansky. Hand osteoarthritis and aging: the results of large-scale cross-sectional study -S. Kana, T. Viik. Annual report of the Estonian Naturalists’ Society 2010 -B. Karmakar, E. Kobyliansky. Finger and palmar dermatoglyphics in Muzeina Bedouins from South Sinai: a qualitative traits -D. Kažoka, J. Vētra. Variations in some anthropometrical parameters of the women with the different iris colour in Latvia -J. Kasmel, T. Kasmel. Seventy years of the Anthropology Section of the Estonian Naturalists’ Society (Part III) -R. Kisenauskaite, D. Paskeviciene. The research of physical condition, physical activity and nutrition of teacher education students -R. Kleina, I. Franckevica, M. Sperga, D. Lutinska. The analysis of undiagnosed malignancies -G. Kolesova, J. Vētra. Sexual dimorphism of pelvic morphology variation in live humans -V. Kulvietis, V. Žalgeviečienė, J. Didžiapetriene,D. Bulotienė, R. Rotomskis. Distribution of nanoparticles in the pregnant rat:the morphologic and spectroscopic study -A. Kuzminienė, S. Šalomskaitė-Davalgienė, I. Balnyte, J. Palubinskienė, A. Valančiūte, V. Ulozas. Evaluation of the chicken embryo choriaollantoic membrane model for laryngeal tumor transplantation -J. Limbo. The tooth size in the end of the Estonian iron age -M. Lintsi, H. Kaarma, M. Aunapuu, A. Arend, R. Aule. Correlation between anthropometrical variables and body surface area -M. Matyk, C. Raschka. Body composition and somatotype of European top roller speed skaters -A. Miskova, M. Pilmane, D. Rezeberga. Immunochistochemical distribution of IGF-1, bFGF and their receptors in decidual embryonic and tubal human pregnancy tissue -E. Mozeika, M. Pilmane, J. Kisis. Distribution of human B-defensin 2,TNF-alpha, IL-1alpha, IL-6 and IL-8 in psoriatic skin -P. Männik, R. T. Kibur, A. Arend, M. Aunapuu. Trophinin and integrin β3 expression in the human endometrium. A pilot study -A. Namm, A. Arend, M. Aunapuu. Bone morphogenetic proteins as regulators of neural tube development -E. Pētersone-Gordina, G. Geshards. Dental disease in a 17th–18th century German community in Jelgava, Latvia -L. Pļaviņa. Assessment of the physical activity level for the staff military personnel -V. Russeva. Alternations of cervical vertebrae in two individuals from the Late Antiquty Necropolis from the “Big Mound” near Cabyle, Bulgaria -S. Skuja, V. Groma, R. Kleina. Chronic alcohol abuse is implicated in the oxidative stress and the changes in the neurotrophic factor receptor expression in the human CNS -R. Stamm, M. Stamm, N. Sorgina, S. Koskel. Training programme to develop young volleyballers’ jumping ability -G. Sumeraga, M. Pilmane. Distribution of neuropeptides in nasal and nasopharyngeal mucosa in patients with the post nasal drip syndrome -N. Szoldatits, B. L. Buda, G. A. Tóth. Body proportion changes of nursing home oligophrenics in western Hungary (1991–2011) -A. Valdovska, M. Pilmane. Relation between serum enzymes and liver histopathology in mink with hepatitis -G. Veldre, T. Kums, E. Salum, J. Eha. Relationship between soldiers’ body height-weight category and changes in their spinal column kyphotic curvature during a long-term military missio

Report of the Secretary of War; being part of the message and documents communicated to the two Houses of Congress at the beginning of the second session of the Fifty-fourth Congress, 1896

Annual Report of the Sec. of War. 24 Nov. HD 2, 54-2, v2-9, 5975p. (3478-3485] Pursuit of renegade Apaches; deportation of Canadian Crees; etc