Wczesne wyniki leczenia skolioz idiopatycznych z zastosowaniem gorsetu dynamicznego SpineCor

Wstęp: Skolioza idiopatyczna to trójpłaszczyznowa deformacja kręgosłupa. Leczenie uzależnione jest od wielu czynników, spośród których wielkość skrzywienia i stopień dojrzałości kostnej wydają się być najbardziej istotne. W przypadku progresujących skrzywień o kącie <40° zalecane jest stosowanie gorsetu. Dostępnych jest wiele rodzajów gorsetów, najczęściej o sztywnej konstrukcji. Gorset dynamiczny SpineCor to system elastycznych taśm, które po założeniu bezpośrednio korygują deformację kręgosłupa nieograniczając jego ruchomości. Cel pracy: Celem pracy jest przedstawienie wczesnych wyników leczenia skolioz idiopatycznych z zastosowaniem gorsetu dynamicznego SpineCor. Materiał i metodyka: Kryterium rozpoczęcia leczenia gorsetem była obecność progresującego skrzywienia kręgosłupa u chorych z dojrzałością kostną według Rissera 0-3. Aplikacja gorsetu odbywało się według założeń metody. Badaną grupę stanowiło 42 chorych, 36 dziewcząt i 6 chłopców. Wiek w chwili rozpoczęcia leczenia wynosił średnio 11,9 lat. Okres obserwacji wynosił średnio 11 miesięcy. Wyjściowy kąt skrzywienia w odcinku piersiowym wynosił średnio 33,1°, zaś w odcinku lędźwiowym 29,4°. Badana grupa została podzielona na podgrupy na podstawie: wielkości wyjściowego skrzywienia, lokalizacji skrzywienia, płci. Wyniki oceniano jako korekcję (zmniejszenie kąta o >=5°), stabilizację (zmiana kąta +/- 5°) lub progresję (zwiększenie kąta o >=5°). Wyniki: Wielkość kąta skrzywienia w ostatniej kontroli w odcinku piersiowym wyniosła średnio 29,7°, zaś w odcinku lędźwiowym 25,5°. U 21 chorych skrzywienie uległo korekcji (50%), 14 osiągnęło stabilizację (33,3%) a 7 progresję (16,6%). Najlepsze wyniki osiągnięto w grupie chorych z wyjściowym kątem <25° (p < 0,05) - 60% chorych z korekcją. Przeciwnie w grupie chorych z wyjściowym kątem >45° tylko 37,5% osiągnęło korekcję. Nie zanotowano znaczących różnic w wynikach leczenia w zależności od płci. Wnioski: Gorset SpineCor stanowi dobrą alternatywę dla sztywnych gorsetów, zwłaszcza w przypadkach małych skrzywień. Pozwala on na zachowanie ruchomości kręgosłupa. Tego typu gorset jest dobrze akceptowalny przez młodych chorych. Niezbędne są dalsze długofalowe obserwacje celem ostatecznych wniosków.Introdcution: Idiopathic scoliosis is a three-dimensional deformation of the spine. Treatment of this condition depends on many factors, with curve magnitude (Cobb angle) and skeletal maturity (Risser sign) being the most important indices. In progressing curves of <40°, bracing is recommended. Different types of braces are available, most of them are of a rigid type. The SpineCor dynamic brace is a system of elastic bands designed to directly correct the spinal column deformity without restricting motion of the spine. Aim of the paper: The aim of this paper is to present early results of adolescent idiopathic scoliosis treatment with the SpineCor brace. Material and methods: Inclusion criteria for brace the application included the presence of a progressing curve in a skeletally immature child (Risser 0 - 3). The SpineCor brace was applied according to the principles of the method. The study group comprised 42 patients: 36 girls, 6 boys. The mean age at brace application was 11.9 years. The mean follow-up was 11 months. The mean initial curve size in the whole group was 33.1° in the thoracic spine and 29.4° in the lumbar spine. The evaluated group was subsequently divided into different subgroups depending on: initial curve size, curve type and sex. Results were classified as correction (decrease of curve size of >=5°), stablisation (curve change +/- 5°) or progression (increase of curve size of >=5°). Results: Mean curve size at the final follow-up was 29.7° in the thoracic spine and 25.5° in the lumbar spine. Twenty one patients improved (50%), 14 had curve stabilisation (33.3%) and 7 progressed (16.6%). The best results were achieved in curves lower than 25° Cobb angle (p < 0.05) - 60% of patients improved. In contrast, in the over-45° group, only 37.5% of patients improved. No significant differences were found between treatment results with regard to sex. Conclusion: SpineCor brace seems to be a good alternative for rigid braces, especially in minor curves. It enables preservation of motion of the spine. This type of brace is easily accepted by young patients. Further follow-up is needed to present long-term results

Surgical management of moderate adolescent idiopathic scoliosis with ApiFix® : a short peri- apical fixation followed by post-operative curve reduction with exercises

Surgery in adolescent idiopathic scoliosis (AIS) is a major operative intervention where 10-12 vertebrae are instrumented and fused. A smaller motion preserving surgery would be more desirable for these otherwise healthy adolescents. The ApiFix® system is a novel less invasive short segment pedicle screw based instrumentation inserted around the apex of the main curve. The system has a ratchet mechanism that enables gradual postoperative device elongation and curve correction. The ratchet is activated by performing specific spinal exercises. The unique features of the device allow curve correction without fusion. The system which has a CE approval was employed in adolescents with main thoracic curves. More than a dozen of ApiFix surgeries have been performed so far. The preoperative Cobb angle was 45° ± 8, and 25° ± 8 at final follow up. The following is a report on three adolescent females aged 13–16 years with curves between 43°-53° and Risser sign of 1-4 who underwent surgery with ApiFix®. Two pedicle screws were inserted around the curve apex and the ratchet based device with polyaxial ring connectors was attached to the screws. No fusion attempt was made. Operative time was around one hour. Two weeks after surgery the patients were instructed to perform Schroth like daily exercises with the aim of rod elongation and gradual curve correction. Patients were followed between 6 months to 2 years. Curves were reduced and maintained between 22- 33°. Patients were pain free and were able to perform their spinal exercises. Postoperative gradual elongation of the device was observed. No screw loosening or rod breakage were observed. No adding on or curve progression was seen. Three factors may contribute to the ApiFix® success: polyaxial connections that prevent mechanical failure, gradual curve correction by spinal motion and spinal growth modulation. The ApiFix® system allows managing moderate AIS with a simple and minor surgical intervention. Recovery is rapid with negligible motion loss. It allows gradual and safe curve correction with high patient satisfaction. It may also serve as an internal brace for AIS

Different cultures, different values: The role of cultural variation in public’s WTP for marine species conservation

Understanding the cultural variation in public preference for marine species is a necessary pre-requisite if conservation objectives are to include societal preferences in addition to scientific considerations. We report the results of a contingent study undertaken at three case-study sites: Azores islands (Portugal), Gulf of Gdansk (Poland) and Isles of Scilly (UK). The study considered species richness of five specific marine taxa (mammals, birds, fish, invertebrates and algae) as proxies of marine biodiversity and the aim of analysis was to estimate from a multi-site perspective public’s willingness to pay (WTP) to avoid increased levels of species loss (reduction of species richness) for different marine taxa. Results, based on 1502 face-to-face interviews, showed that income, education and environmental awareness of the respondents were significant predictors of WTP for marine species conservation. Results also indicated that respondents in each of the European locations had different preferences for marine taxa. In the Azores, although mammals and fish were valued highly, small differences occurred in the WTP among different taxa. Respondents in the Isles of Scilly put a relatively low value on fish while algae and marine mammals were highly valued. In Gdansk, respondents defined a clear order of preference for marine mammals>fish>birds>invertebrates and algae. These findings suggested that cultural differences may be important drivers of valuation and undermines the commonly held premise that charismatic/likeable taxa consistently have a disproportionately strong influence on WTP for biodiversity conservation. We conclude that conservation policy must take account of cultural diversity alongside biological diversity

Palaemon elegans - a new component of the Gulf of Gda&#324;sk macrofauna

The present paper reports on the occurrence of the prawn Palaemon elegans Rathke in the coastal waters of the Gulf of Gda&#324;sk in the years 2002-2003, and in other regions of the Baltic Sea as recorded by various authors

Support for Perimeter Border Protection Using Unmanned Ground Vehicle UGV

W artykule poruszono najważniejsze aspekty projektowania pojazdu bezzałogowego do realizacji zadań obserwacyjnych przy ochronie perymetrycznej granicy państwa. Przedstawiona została analiza warunków terenowych koniecznych do pokonywania przez pojazd bezzałogowy oraz opis kluczowych podzespołów pojazdu HUNTeR odpowiedzialnych za możliwość pracy w tego typu warunkach. Zawarto też wyniki badań weryfikujących założenia podstawowe projektu w zakresie pracy z maksymalną prędkością przejazdu.The article concerns the most important issues of designing an unmanned vehicle for the implementation of observation tasks in the protection of the perimeter of the state border. An analysis of the terrain conditions necessary for the unmanned vehicle to overcome and a description of the key components of the HUNTeR vehicle responsible for the ability to work in such conditions was presented. Also included were tests verifying the basic assumptions of the project in the field of operation at the maximum speed of travel

How to measure the economic value of ecosystem functions and processes and link such value to the MSP?

The paper aims at answering questions on implications of the economic valuation of regulatory ecosystem service in maritime spatial planning. The biogeochemical processes that occur in marine sediments such as denitrification, contribute indirectly, though significantly, benefits to human wellbeing. Such direct and indirect benefits are called ecosystem services. According to the Common International Classification of Ecosystem Services (CICES V5.1) for the Integrated Environmental and Economic Accounting, the case study: ecosystem service lies within the: Section - Regulation & Maintenance (Biotic); Division - Transformation of biochemical or physical inputs to ecosystems; Group - Mediation of wastes or toxic substances of anthropogenic origin by living processes and Class - Bio-remediation by micro-organisms, algae, plants, and animals (Code 2.1.1.1). Marine sediments are economically evaluated mainly as sources of providing services (sand and gravel extraction or space for potential industrial use). Their regulatory function is often neglected in such studies. Therefore, we employed the methodology from the field of ecological economics and assessed the economic value of denitrification of the Gulf of Gdansk. This paper suggests the possible implications of using such data in MSP and discusses the competition sea uses in order to determine the final benefits for society