A new anatomical variation of the musculocutaneous and the median nerve anastomosis

Variations of the brachial plexus and its terminal branches are not uncommon.Therein, the anatomical variations of the musculocutaneous and the median nerve are classified into 5 types, while the communicating branches between the musculocutaneous and the median nerve are classified into 3 types, depending on their position related to the coracobrachial muscle. The case reviewed in this paper presents a variation similar to that of the second variety, but is significantly different due to the appearance of the proximal musculocutaneous nerve and its communicating branching, the site rising from the communicating branch (through the coracobrachial), and important clinical implications of this new variation. Despite the communicating branch being located in the upper third of the upper arm, it should not be considered as being a double lateral root of the median nerve

Morphometric characteristics of the optic canal and the optic nerve

Background: The optic nerve (ON), a major component of the visual system, is divided into four segments: the intrabulbar (IB), the intraorbital (IO), the intraca- nalicular (ICn) and the intracranial (ICr). The ICr ends with the two nerves partially decussating in the optic chiasm (OCh). The purpose of this study is to provide a detailed description of the dimensions of the OC (the diameter and the surface area of its foramina and the central segment, as well as the length of the OC and the thickness of its walls) as well as the ON (the length of the ON segments, the diameter of the ICn segment of the ON, the angle of decussation in the OCh, as well as the distance between the two ON at the cranial foramen of the OC).  Materials and methods: The acquired data was then used to estimate the volu- me of the OC and the ICn segment of the ON. The morphometric research was performed on 25 cadavers (17 male and 8 female) and 30 skulls.  Results: The surface area of the central segment of the OC was significantly smaller than the cranial foramen (p = 0.02) and the orbital foramen (p = 0.009). The inferior wall of the OC was significantly shorter than the other OC walls (p < 0.0001). The IO segment of the ON was the longest, where the difference to the ICn and ICr was statistically significant (p < 0.0001). The surface area of the ON at the cranial foramen was significantly larger than the surface area at the central segment of the OC (p = 0.02) and orbital foramen (p < 0.0001). The difference between the surface areas of the ON at the orbital foramen and the central segment of the OC was also statistically significant (p = 0.01). The estimated volume of the OC was calculated to be 190.72 mm3, and the volume of the ICn segment of the ON was estimated to be 50.25 mm3.  Conclusions: It is absolutely crucial to open the central segment of the OC when decompressing the ON, due to the narrowing of the OC in this segment.

Influence of admission glucose profile and hemoglobin A1c on complications of acute myocardial infarction in diabetic patients

Abstract. -BACKGROUND: Diabetic patients have a double higher short-term mortality rate after acute myocardial infarction (AMI) than nondiabetic ones. Admission glucose level has been already concerned as an independent risk factor for the long-term prognosis after myocardial infarction. The aim of this study is to evaluate the influence of admission glucose profile (AGP) and glycosylated hemoglobin (HbA1c) on complications of the AMI in patients with type 2 diabetes. PATIENTS AND METHODS: The study was based on 76 diabetic patients hospitalized with first-ever AMI. Admission glucose profile was estimated as mean value of the first six blood glucose values, since HbA1c was measured from the blood sampled in the first morning after the admission to hospital. All post-infarction complications are divided into electrical and mechanical ones. ROC curves are used to analyze predictive values of admission glucose profile and HbA1c for developing post-infarction complications. RESULTS: Admission glucose profile is a significant (p = 0.001) predictor of electrical complications with 12.25 mmol/L cut-off value (sensitivity 77.3%; specificity 64.5%), while it is not significant (p > 0.05) for mechanical complication (cut-off value 16.85 mmol/L; sensitivity 45.2%; specificity 77.8%). HbA1c is not enough good for the complication prediction (p > 0.05). Considering electrical and mechanical complications aggregately, AGP is even more significant (p = 0.000) with 14.85 mmol/L cut-off value (sensitivity 54.4%; specificity 94.7%), and HbA1c is significant, as well (p = 0.013, too with 9.07 % cut-off value (sensitivity 57.9%; specificity 78.8%). CONCLUSIONS: Comparing the predictability between AGP and HbA1c, in our sample, the first one seems to be the better one. Admission glucose profile and HbA1c should be the obligatory laboratory tests performed at the time of hospital admission after the heart attack

Bilateral anatomic variation in the relation of the upper trunk of the brachial plexus to the anterior scalene muscle

The brachial plexus represents a field of many anatomical variations with impor- tant clinical implications, especially in the diagnosis and treatment of the thoracic outlet syndrome (TOS). The case described in this paper presented a novel bilateral variation in the relation of the upper trunk of the brachial plexus to the anterior scalene muscle. The ventral rami of the C5 and C6 spinal nerves perforated the anterior scalene muscle simultaneously through a common opening, and joined to form the upper trunk. Previous literature reports described variations of the brachial plexus and the scalene muscles, as well as the embryological basis for their presence. The case reported herein helps to improve the comprehension of the TOS, as well as the diagnostic and therapeutical approach to this syndrome

Significance of anatomical variations of the lateral circumflex femoral artery for the tensor fasciae latae flapping

The tensor fasciae latae (TFL) muscle is commonly used in plastic and reconstructive surgery as a transpositional or a free flap, in order to repair different kinds of defects. In most cases its vascularisation is provided by an ascending branch of lateral circumflex femoral artery (LCFA), which gives different numbers of branches and enters the TFL muscle in different manners. The represented study deals with the arterial vascularisation of the TFL muscle: the entrance of the vascular stalk branches; variations of the LCFA bifurcation’s angle; and the skin area of vascularisation. The study was performed on both lower limbs of a 100 foetal and 10 adult cadavers. The LCFA was injected with micropaque solution, afterwards fixed and preserved in 10% formalin solution. Microdissection was performed under magnifying glass and surgical microscope. Analysis of adult cadavers was performed to determine the skin area vascularised by perforating blood vessels from the TFL muscle, by injecting methylene-blue dye into the artery, prior to which all branches of the LCFA, besides the ascending branch, were ligated. The research of a 100 foetal cadavers showed that the LCFA with its ascending branch ensured the blood supply to the muscle. In 85% it gave two branches, the ascending and the descending one, with the angle of bifurcation circa 90o in 73% of cases. The ascending branch can give 0 or more terminal branches, or even form an arterial net. Skin area affected with dye ranged from 18 × 22 cm to 23 × 28 cm and is in positive correlation with the LCFA length and diameter. The understanding of the presented variations have an exceptional significance in planning and applying the TFL flap, especially free flap, in successful repairing and covering the defects, as well as in preventing postoperative complications

Interchannel coupling effects in the spin polarization of energetic photoelectrons

Effects of the interchannel coupling on the spin polarization of energetic photoelectrons emitted from atomic Ne valence subshells are examined. Like previously obtained results for cross sections and angular distributions, the photoelectron spin polarization parameters too are found considerably influenced by the coupling. The result completes a series of studies to finally conclude that the independent particle description is inadequate for the {\em entire} range of photoionization dynamics over the {\em full} spectral energy domainComment: 7 pages, 5 figures, accepted in Phys. Rev.

Antibacterial, antioxidant and anti-proliferative properties and zinc content of five south Portugal herbs

Context: Crataegus monogyna L. (Rosaceae) (CM), Equisetum telmateia L. (Equisataceae) (ET), Geranium purpureum Vil. (Geraniaceae) (GP), Mentha suaveolens Ehrh. (Lamiaceae) (MS), and Lavandula stoechas L. spp. luisieri (Lamiaceae) (LS) are all medicinal. Objective: To evaluate the antioxidant, antiproliferative and antimicrobial activities of plant extracts and quantify individual phenolics and zinc. Material and methods: Aerial part extracts were prepared with water (W), ethanol (E) and an 80% mixture (80EW). Antioxidant activity was measured with TAA, FRAP and RP methods. Phenolics were quantified with a HPLC. Zinc was quantified using voltammetry. Antibacterial activity (after 48 h) was tested using Enterococcus faecalis, Bacillus cereus, Escherichia coli, Staphylococcus aureus, Pseudomonas aeruginosa and Listeria monocytogenes. Antiproliferative activity (after 24 h) was tested using HEP G2 cells and fibroblasts. Results: Solvents influenced results; the best were E and 80EW. GP had the highest antioxidant activity (TAA and FRAP of 536.90mg AAE/g dw and 783.48mg TE/g dw, respectively). CM had the highest zinc concentration (37.21 mg/kg) and phenolic variety, with neochlorogenic acid as the most abundant (92.91 mg/100 g dw). LS was rich in rosmarinic acid (301.71 mg/100 g dw). GP and LS inhibited the most microorganisms: B. cereus, E. coli and S. aureus. GP also inhibited E. faecalis. CM had the lowest MIC: 5830 mu g/mL. The antibacterial activity is explained by the phenolics present. LS and CM showed the most significant anti-proliferative activity, which is explained by their zinc content. Conclusion: The most promising plants for further studies are CM, LS and GP.FCT, Fundacao para a Ciencia e a Tecnologia of Portugal [SFRH/BSA/139/2014

A protocol for thoracic radiation therapy in patients with cardiac implantable electronic devices

Prolonged lifespan and improved diagnostic and treatment modalities have led to significant progress in the diagnosis and treatment of cardiovascular disease and cancer. A substantial number of patients with malignancies also have cardiovascular disease at the time of cancer treatment. Per literature, over one million implantable cardiac devices are inserted annually. Ionizing radiation, especially in the thoracic area is related to cardiac implantable electronic device (CIED) damage and malfunction. Besides that, CIED can interfere with radiotherapy planning and delivery, as well as patient motivation to undergo radiotherapy treatment. Management of oncology patients, undergoing radiotherapy, for any indication, with a CIED is essential, and safe radiotherapy practice requires minimizing the risk to patients as much as possible, from pretherapy planning to posttherapy follow-up. A collaborative multidisciplinary approach, tailor-made for every single radiotherapy center is imperative to provide effective and safe radiotherapy for these patients. A collaboration of radiation oncologists, medical physicists and cardiologists from the University Clinical Center Kragujevac has created a local protocol for radiotherapy treatment and follow-up for patients receiving radiotherapy at the Center for Radiation Oncology University C linical Center Kragujevac, which provides safe and efficient delivery of an adequate radiotherapy dose to target volumes with appropriate cardiac monitoring.Publishe

GSTM1 Modulates Expression of Endothelial Adhesion Molecules in Uremic Milieu

Deletion polymorphism of glutathione S-transferase M1 (GSTM1), a phase II detoxification and antioxidant enzyme, increases susceptibility to end-stage renal disease (ESRD) as well as the development of cardiovascular diseases (CVD) among ESRD patients and leads to their shorter cardiovascular survival. The mechanisms by which GSTM1 downregulation contributes to oxidative stress and inflammation in endothelial cells in uremic conditions have not been investigated so far. Therefore, the aim of the present study was to elucidate the effects of GSTM1 knockdown on oxidative stress and expression of a panel of inflammatory markers in human umbilical vein endothelial cells (HUVECs) exposed to uremic serum. Additionally, we aimed to discern whether GSTM1-null genotype is associated with serum levels of adhesion molecules in ESRD patients. HUVECs treated with uremic serum exhibited impaired redox balance characterized by enhanced lipid peroxidation and decreased antioxidant enzyme activities, independently of the GSTM1 knockdown. In response to uremic injury, HUVECs exhibited alteration in the expression of a series of inflammatory cytokines including retinol-binding protein 4 (RBP4), regulated on activation, normal T cell expressed and secreted (RANTES), C-reactive protein (CRP), angiogenin, dickkopf-1 (Dkk-1), and platelet factor 4 (PF4). GSTM1 knockdown in HUVECs showed upregulation of monocyte chemoattractant protein-1 (MCP-1), a cytokine involved in the regulation of monocyte migration and adhesion. These cells also have shown upregulated intracellular and vascular cell adhesion molecules (ICAM-1 and VCAM-1). In accordance with these findings, the levels of serum ICAM-1 and VCAM-1 (sICAM-1 and sVCAM-1) were increased in ESRD patients lacking GSTM1, in comparison with patients with the GSTM1-active genotype. Based on these results, it may be concluded that incubation of endothelial cells in uremic serum induces redox imbalance accompanied with altered expression of a series of cytokines involved in arteriosclerosis and atherosclerosis. The association of GSTM1 downregulation with the altered expression of adhesion molecules might be at least partly responsible for the increased susceptibility of ESRD patients to CVD