Prolonged Compression Research Articles

Cosmetic iris implants - double edge sword.

Iris implants were originally described as an option to treat photophobia and glare associated with aniridia, coloboma, corectopia or any other causes of acquired or congenital iris defects. They are not designed to be used in healthy phakic eyes and not approved by regulatory bodies anywhere in the world for cosmesis. However, widespread publicity and the compulsive need for beautification has popularised the use of these implants illicitly. Implantation into phakic eyes causes mechanical irritation of angle structures leading to chronic inflammation, pigment dispersion, prolonged endothelial cell loss and compression of the trabecular meshwork. The consequences are dire, leading to presentation of such patients with serious complications involving the cornea, angle, and lens. Here we give an extensive review of available literature on cosmetic iris implants and also describe a case with bilateral cosmetic iris implants (New-ColorIris). The patient presented with corneal decompensation, glaucoma, and cataract in both eyes, seven years after the implantation and was successfully managed with explantation of the device followed by a DMEK Triple procedure.

Crush syndrome: a review of current knowledge and treatment strategies

Crush syndrome is a severe systemic manifestation resulting from the breakdown of muscle cells leading to the release of toxic substances into the bloodstream. This condition can occur when a part of the body experiences a significant amount of pressure for an extended period. Crush syndrome presents with severe metabolic disruptions such as acute kidney injury, electrolyte disturbances, and cardiovascular collapse. It is essential to understand the pathophysiology and clinical features of crush syndrome for effective management and prevention of potentially devastating outcomes. The act of crushing and rupturing muscular cells generates a mechanical force that triggers the discharge of myoglobin. Subsequently, myoglobin undergoes a conversion into metmyoglobin and acid hematin, which are subsequently released into the systemic circulation. The muscular tissue harbors a variety of electrolytes and enzymes, which may attain toxic levels upon entry into the circulation in excessive quantities. The release of sodium, calcium, and fluids due to regional ischemia leads to increased muscle volume and tension, depletion of creatine kinase (CK) and ATP, and muscle vasodilation, further exacerbating hypotension. Crush syndrome can also lead to cardiovascular instability and renal failure due to vasomotor and nephrotoxic factors. Elevations in serum CK levels exceeding 1000 IU/l, along with accompanying clinical features, are widely recognized as indicative of crush syndrome. Diagnostic investigations commonly involve assessing serum levels of aldolase, myoglobin, and myoglobin degradation products. Progressive increases in serum levels of lactic acid, aspartate aminotransferase (AST), alanine aminotransferase (ALT), and lactate dehydrogenase (LDH) are observed, while levels of serum urea and creatinine exhibit a steep rise, particularly following prolonged compression, and serve as valuable predictors of renal failure. The treatment of crush syndrome requires a multidisciplinary approach that addresses the metabolic, cardiovascular, and renal complications associated with this condition. The mainstay of treatment includes early release of the affected limb or compartment, fluid resuscitation, correction of electrolyte abnormalities, and alkalinization of urine. Additionally, renal replacement therapy and hyperbaric oxygen therapy may be beneficial in managing acute kidney injury and tissue hypoxia, respectively. Crush syndrome, albeit infrequent, represents a potentially fatal medical condition that demands a thorough comprehension of its underlying pathophysiology, clinical manifestations, and treatment modalities. Early recognition and appropriate management of this condition can significantly r,educe morbidity and mortality associated with crush syndrome.

Update of the Natural History, Pathophysiology, and Treatment Strategies of Degenerative Cervical Myelopathy: A Narrative Review.

Cervical myelopathy is a clinical syndrome resulting in symptoms of neurologic deficits due to prolonged spinal cord compression or ischemia in the cervical spine. Spinal cord compression can be caused by ossification of the posterior longitudinal ligament and hypertrophy of ligamentun flavum in addition to degenerative cervical spondylosis, degenerative disc disease, and progressive cervical kyphosis. Degenerative cervical myelopathy (DCM) is a series of disease entities caused by spinal cord compression by various nontraumatic and non-infectious causes. The pathophysiology of DCM includes spinal cord structure and function abnormalities caused by both static and dynamic factors. Surgical decompression for patients with moderate to severe cervical myelopathy not only inhibits the progression of neurological deterioration, but also improves functional status, pain, and quality of life. However, the role of nonsurgical treatment in patients with mild spinal cord compression is controversial. In general, patients with cervical myelopathies who do not undergo surgery have a poor prognosis. Appropriate surgical treatment is recommended when spinal cord compression is confirmed on image study in patients with reasonable symptoms of cervical myelopathy. The patient's overall health, degree of compression, presence of concurrent cervical radiculopathy, and cervical spine alignment, in addition to lesion location and etiology, should be considered when determining an appropriate surgical procedure. This review covers the updated issues, including pathophysiology, clinical manifestations, differential diagnosis, and available treatments for DCM.

Elevated creatinine kinase levels amongst Dutch adolescents with acute alcohol intoxication

This study aims to explore the prevalence of creatinine kinase elevation amongst a sample of Dutch adolescents admitted for acute alcohol intoxication. The data on all admitted adolescents < 18 years old with acute alcohol intoxication between 2008 and 2021 were collected from a Dutch major district general hospital, Reinier de Graaf Gasthuis, in Delft. Overall, 495 adolescents who were treated for symptoms of acute alcohol intoxication during this period were included in the study. When evaluating the blood samples of the included patients, elevated creatinine kinase levels were found in 60% of the cases, with a mean of 254 U/I (normal value ≤ 145 U/I). A confirmed diagnosis of rhabdomyolysis (increase in CK > fivefold the upper limit of normal) was present in 4.4% of cases. Moreover, using a linear regression this study found that a higher blood alcohol concentration was associated with higher creatinine kinase levels, when adjusted for positive drug screenings amongst the adolescents with acute alcohol intoxication (p = 0.027; β = 66.88; 95% CI 7.68 − 126.08). Conclusions: This is the first study focusing on how acute alcohol intoxication affects adolescents’ muscle tissue. The results could potentially help to prevent alcohol use within the sports world. It could also aid understanding of how acute alcohol intoxication influences the breakdown of adolescents’ muscle tissue.What is Known:• Alcohol, alongside pharmaceutical agents and illicit drugs, is a significant cause of rhabdomyolysis (increase in creatinine kinase > fivefold the upper limit of normal).• Creatinine kinase elevation in alcohol intoxicated patients may be as a result of direct “muscular” toxicity” (myotoxicity) or from prolonged immobilization and ischemic compression induced by coma.What is New:• Our retrospective cohort study is a pioneer in addressing the effect of acute alcohol intoxication amongst adolescents (< 18 years) upon muscle tissue (creatinine kinase level) within a large population. When evaluating the blood samples of the included population, elevated creatinine kinase levels were found in 60% of the cases, with a mean of 254 U/I (normal value ≤ 145 U/I).• There is an association between alcohol intoxication and elevated creatinine kinase levels amongst adolescents. Future research is needed to further understand the pathophysiology and causality of this interaction.

Multi-objective Optimization of Multi-cells Foam Mattress

Body pressure dispersion mattresses are useful tools for preventing pressure ulcers in patients with limited mobility who experience prolonged body weight-related compression loads at their body contact areas over time. The objective of this study is to propose and optimize a multicell finite element (FE) model of foam mattress to prevent patients from developing pressure ulcers (bed sores), by improving the contact pressure distribution on the upper mattress surface and immersion in the mattress. The NSGA-II multi-objective genetic algorithm was used to predict different configurations of cell materials to provide a more comfortable sleep. Our mattress model contains many cells (50 × 50 × 50), each of which can contain one of the nine different foam firmnesses. The NSGA-II algorithm attempts to combine the properties of soft and firm foams into a single mattress. however, the complexity and intersection of the fitness function objectives and the high number of possible chances forced the optimal solutions set to extend into the area under the result of foams that have a compressive strength between soft and firm. Based on the overall optimization results, the standard deviation ranged from 0.00325 to 0.00175 MPa and the maximum mattress immersion ranged from 50 mm to less than 20 mm. Mattresses with optimal configurations disperse body pressure smoothly to fit the patient's body shape.

The Key to a Successful PBC in Treatment of Trigeminal Neuralgia.

As a minimally invasive treatment of trigeminal neuralgia, percutaneous balloon compression (PBC) has become increasingly popular worldwide. Because it is simple and straightforward, it does not need a complicated apparatus only a fluoroscope plus an operator's experience. Therefore, the surgical technique seems to be essential and worth further addressing. The paper stresses that the target of PBC should be the semilunar ganglion (the soma of neurons) rather than the rootlets (axons) because the latter is renewable. To obtain a sufficient pressure against the ganglion, Meckel's cave should be covered utterly by an inflating balloon, which fluoroscopically appears in a pear shape. To attain a proper balloon position, it is suggested to make a tunnel with a blunt stylet in a proper penetrative angle before inserting a soft catheter. Too large a pear is unnecessary, hence injecting should be stopped when growth becomes apparently slow. To avoid an unacceptable postoperative paresthesia, a prolonged compression is not encouraged.

Compressão pneumática prolongada e guiada por ultrassom de um pseudoaneurisma da artéria radial após intervenção coronariana percutânea: solução simples e eficaz para um problema raro e desafiador

Abstract Transradial access is associated with fewer access site-related complications, earlier patient mobilization, and greater postprocedural comfort. Pseudoaneurysms are an extremely rare complication after transradial procedures and the radial artery itself is the most atypical arterial site of occurrence. We report a case in which a non-surgical, non-invasive, simple, and effective solution (prolonged pneumatic compression) was used to manage a radial artery pseudoaneurysm, a very rare and challenging complication of transradial procedures.

1163: QUALITY IMPROVEMENT INITIATIVES REDUCE CHEST COMPRESSION PAUSES DURING PEDIATRIC ECPR

Introduction: Prolonged chest compression (CC) pauses in cardiopulmonary resuscitation (CPR) are associated with worse survival during in-hospital cardiac arrests. Procedures necessary to gain access for extracorporeal CPR (ECPR) can potentially prolong CC pauses during extracorporeal membrane oxygenation (ECMO) cannulation. Implementation of targeted quality improvement initiatives to improve team communication may reduce CC pauses during pediatric ECPR. Methods: Baseline data from a pediatric intensive care unit (PICU) in a tertiary care children’s hospital demonstrated significantly longer CC pauses and lower CC fraction (CCF) during ECMO cannulation when compared to similar metrics pre-cannulation. An intervention designed to improve CC metrics during ECPR was implemented, including: 1. Sharing of baseline CC data with ECPR stakeholders 2. Standardization of counting CC pauses out loud to improve team awareness of pause length 3. Creation of a reporting aid to assist with ECPR documentation and 4. Interdisciplinary ECPR simulation sessions every other month to practice communication during cannulation. CC pause characteristics were compared pre- and post- intervention using unpaired t-tests. Results: Eleven ECPRs were analyzed pre-intervention and five ECPRs post-intervention. CC pause characteristics (mean duration of pauses, individual longest pause, and CCF) improved in both pre- and during ECMO cannulation epochs post-intervention when compared to their pre-intervention counterparts. During ECMO cannulation, mean length of CC pauses was 30 seconds (pre-intervention) vs 13 seconds (post-intervention) (p < 0.02). The longest CC pause during ECMO cannulation was 337 seconds (pre-intervention) compared with 69 seconds (post-intervention) (p = 0.03). CCF during ECMO cannulation pre-intervention and post-intervention was 68% vs 83% respectively (p = 0.03). Conclusions: CC pause metrics during the cannulation phase of pediatric ECPR improved significantly after quality improvement interventions including baseline CC data review, verbal communication of CC pause length and interdisciplinary ECPR simulations. Future aims include correlating CC pause characteristics with clinical outcomes.

Percutaneous Atrial Septal Defect (ASD) closure technique in case of association with an azygos continuation of the inferior vena cava “case report”

Introduction: Atrial Septal Defect (ASD) is the most common congenital heart disease, accessible to percutaneous closure in 90% of cases. The closure procedure is performed usually under local anesthesia and TTE by femoral access. The association of OS-ASD with an azygos continuation of the inferior vena cava is very rare (&lt; 0.1/1000 births) making femoral access impossible. Only a few cases are mentioned in the literature, here we describe the procedure as faithfully as possible. Important clinical finding: We present a case of a 32-years-old female candidate for percutaneous closure of OS-ASD with right cavity dilatation who present during her procedure an unusual guidewire path suspecting an azygos continuation of the inferior vena cava, confirmed by CT angiography, making impossible the closure via the femoral approach. Therapeutic intervention: After being confronted with the categorical patient refusal of the surgery, we performed successfully the procedure; one month later; under general sedation by internal jugular approach. We finished with manual compression before extubating the patient. Outcomes: The follow-up was favorable at the cost of a hematoma at the puncture site and brachial plexus compression, which regressed after 3 days. Conclusion: We opted for general anesthesia and intubation to guide the procedure by TEE. We placed it in the aorta, which gave us good stability to continue successfully the procedure. We underestimated the risk of complication at the puncture site, which could have been avoided by using a vascular suture device or more prolonged compression. Main takeaway lesson: Percutaneous closure is the reference treatment for OS-ASD. In case of is associated with an azygos continuation of the inferior vena cava, the right internal jugular vein remains a reasonable approach; it requires discussion and rigorous preparation by the whole team. The management of the puncture site in this situation remains delicate and requires great concentration.

Controversies in the management of proximal deep vein thrombosis.

Controversies in the management of proximal deep vein thrombosis.

Significance of oxidative endotoxemia and hypoxia in the pathogenesis of testicular insufficiency in patients with inguinal hernia

Aim. To determine the level of “oxidative stress” and hypoxia markers in the blood and venous blood flowing from the testicle in inguinal hernias and the postoperative period after inguinal hernioplasty.Materials and Methods. 34 patients with inguinal hernias were under the observation in Istiqlol health complex of Dushanbe. The age of patients ranged from 18 to 30 years old. The patients were divided into 3 groups: 14 patients with long (5 or more years) inguinal hernia combined with varicocele, 12 patients with infertility, and 8 patients with inguinal herniotomy. The content of LPO products and hypoxia markers in the blood flowing from the testicle was studied in 34 patients with various groups of inguinal hernias.Results and discussion. An analysis of the level of “oxidative” toxemia and hypoxia indices in the studied groups of patients showed their increased levels in the peripheral blood. The levels of DA and MDA in peripheral blood in Group I patients reached 1.3±0.02 units pg/ml and 2.4±0.09 nmol/ml, which was caused by prolonged compression of the spermatic cord elements by the hernial sac; the presence of ischemia was confirmed by increased blood lactate level. Marked pathophysiological changes result in the disturbance of hormonal background and spermatogenesis disorder.Conclusion. Increased content of LPO products in the testicular parenchyma further results in the branching of chain reactions and final LPO products with high damaging activity followed by the development of systemic damage to cellular structures of the contralateral testis with subsequent progression and development of testicular insufficiency.

Delayed diagnosis of blunt thoracic aortic injury due to thoracic vertebral fracture: A case report and literature review.

Blunt vascular injury of the aorta combined with thoracolumbar fracture is rare. Delayed diagnosis may have a catastrophic outcome. We present a case of blunt thoracic aortic injury combined with a vertebral body fracture at T10 after a fall from height in which the diagnosis was delayed. After consultation with the vascular and spinal surgeons, we performed a thoracic endovascular aortic repair. When the patient's condition had stabilized, the fractures were reduced using posterior vertebral instrumentation. Prolonged compression of the thoracic aorta resulted in extensive necrosis of muscle tissues in the right lower leg. Fortunately, clinical and radiological examinations performed 7 months and 1 year later did not reveal any further damage. Cases of thoracic vertebral fracture with concomitant blunt thoracic aortic injury reported in the literature are reviewed. Thoracic endovascular aortic repair is a feasible, safe, and effective minimally invasive treatment for aortic injury when combined with thoracic vertebral fracture.

ПАТОГЕННЫЙ ПОТЕНЦИАЛ БАКТЕРИЙ ГРУППЫ ESKAPE, ВЫДЕЛЕННЫХ ИЗ РАН: ХАРАКТЕРИСТИКА ФЕНОИ ГЕНОТИПИЧЕСКИХ МАРКЕРОВ И ВОЗМОЖНОСТЬ ИХ ПРАКТИЧЕСКОГО ПРИМЕНЕНИЯ

Backgroud. Evaluation of the biological properties of isolates obtained from the clinical samples of patients will increase the informative value of the microbiological study and optimize the interpretation of the culture results in order to substantiate further wound treatment tactics. Aim. To analyze the phenotypic and genotypic properties of ESKAPE bacteria and to determine the possibility of practical use of the parameters characterizing the bioprofile of the isolate when interpreting the results of microbiological culture of the wound swabs. Material and methods. Pheno- and genotypic markers of the pathogenic potential of ESKAPE isolates were analyzed: Enterococcus faecalis (n=93), Staphylococcus aureus (n=177), Klebsiella pneumoniae (n=7), Acinetobacter baumannii (n=32), Pseudomonas aeruginosa (n=45), Enterobacterales (Proteus mirabilis, n=26). Microorganisms were isolated from the wound swabs of patients with acute and chronic wounds, who were admitted to the burn department of the Gomel City Clinical Hospital No. 1 for specialized medical care during the period 2012-2020. Integumentary tissue defects were represented by post-traumatic wounds (mechanical trauma, thermal burns), postnecrotic wounds (after purulent-inflammatory diseases of the skin and underlying tissues), trophic ulcers (on the stumps of the lower extremities after prolonged wearing of the prosthesis; neurotrophic ulcers after mechanical trauma to peripheral nerves); pressure ulcers stage III after prolonged tissue compression. When describing the isolates, the duration of the wounds and the presence of clinical signs of infectious inflammation were taken into account. Results. The relationship between the clinical state of the wound (no signs of inflammation, critical colonization, infection) and the bioprofile of the isolate obtained from the wound swabs was determined. Potentially pathogenic S. aureus, possessing colonization, invasive and cytotoxic properties, was found in wounds with a minimum duration of up to 4 days, but the absence of clinical manifestations of infection suggested contamination. Biofilm formation, persistent properties, genetic markers of pathogenicity in S. aureus and E. faecalis in combination with pathological changes in fine-grained granulations in the wound indicated colonization. The inflammatory status of the wounds (critical colonization and infection according to NERDS&amp;STONEES criteria) from which P. aeruginosa and A. baumannii were isolated, the presence of genetic virulence markers, and antibiotic resistance indicated the clinical significance of these isolates as etiological agents of the infectious process. P. mirabilis isolated from critically colonized and infected wounds did not have the full range of virulence markers in all cases, especially in associations. K. pneumoniae was isolated only from the wounds showing signs of inflammation and demonstrated various combinations of genetic determinants of virulence, variability in capsular polysaccharide overproduction and biofilm formation. Conclusion. An algorithm has been developed for interpreting the results of microbiological culture of wound swabs with the use of pheno- and genotypic markers, which are recommended for determining the leading pathogen that colonizes the wound and disrupts the healing process. The algorithm allows assessing the etiological significance of mixed cultures isolated from critically colonized and infected wounds, which will determine the further tactics of treating patients.

Common Peroneal Injury mistaken as Neuraxial Analgesia Complication after Normal Vaginal Delivery

In obstetrics, commonly involved lower limbs neuropathies are peroneal, sciatic and femoral nerves but peroneal nerve palsy is the most common. Causes of peroneal nerve injury during childbirth include, but not limited to, instrument-assisted delivery, prolonged external knee compression from stirrups or hand positioning, knee hyperflexion, prolonged squatting and sometimes neuraxial anaesthetic technique. We present a case of unilateral common peroneal neuropathy in a vaginal delivery patient under epidural technique.

Modified method of cervical conization with hybrid use of a cold knife and an electric knife for high-grade squamous intraepithelial lesions.

ObjectiveTo evaluate the feasibility and surgical outcome of the modified method of cervical conization with hybrid use of a cold knife and an electric knife.MethodsA retrospective analysis of cervical conization for high-grade squamous intraepithelial lesions was performed between January 2020 and December 2020. Traditional cold knife conization and modified conization were used. The clinical characteristics and surgical outcomes were compared between these methods.ResultsNinety-two patients with high-grade squamous intraepithelial lesions were included. Traditional conization was performed in 46 patients, and the modified method was used in 46 patients. There were no differences in clinical characteristics, such as age, menopausal status, and conization height, between the methods. Intraoperative blood loss with the modified method was significantly lower than that with traditional conization (27.6 ± 4.7 vs 51.3 ± 18.3 mL). Postoperative vaginal bleeding requiring emergent measures, such as prolonged gauze compression, sutures, or electrocautery, was significantly less with the modified method than with traditional conization (4.3% vs 17.4%). A median follow-up of 10.2 months showed no significant difference in persistence or recurrence between the methods.ConclusionsThe modified method of cervical conization with hybrid use of cold and electric knives may be a good alternative to traditional cold knife conization.

Association between partial thrombosis of the corpus cavernosum, partial priapism, and hard flaccid syndrome: A scoping review.

To describe the association between partial thrombosis of the corpus cavernosum, partial priapism, and hard flaccid syndrome. A scoping review was performed according to the recommendations of the Joanna Briggs Institute. Moreover, we performed a search strategy using the MEDLINE, EMBASE, and CENTRAL databases. We included the available information, evaluating the conditions of partial thrombosis of the corpus cavernosum, partial priapism, and hard flaccid syndrome, and their molecular and physiological mechanisms and clinical presentation. We identified 207 articles and chose eight studies published between 2001 and 2021. The total number of patients was 34, and their mean age was 28.2 years. Moreover, in 84% of the studies, the pathophysiology of the events was related to microtrauma or prolonged perineal compression. Additionally, 94.2% of the patients had some degree of erectile dysfunction. In addition, out of all patients, 94% underwent magnetic resonance imaging (MRI). However, patients with hard flaccid syndrome did not show relevant findings in these studies. Conversely, MRI showed asymmetry in the proximal corpora cavernosa, thrombosed corpus cavernosum segments, and mainly cavernous fibrous septum in patients with partial cavernous thrombosis and partial priapism. Partial thrombosis of the corpus cavernosum, partial priapism, and hard flaccid syndrome occurred more frequently in young patients, possibly related to microtraumas that generate cavernous fibrosis and trigger alterations in the erection of the distal portion of the penis. Additionally, they cause proximal hardening of the pelvis, perineal pain, painful ejaculations, and cavernous asymmetry. Moreover, the imaging characteristics are similar in patients with partial priapism and partial cavernous thrombosis.

A pressure ulcers assessment system for diagnosis and decision making using convolutional neural networks

Pressure ulcers are a common problem in hospital care and long-term care. Pressure ulcers are caused by prolonged compression of soft tissues, which can cause local tissue damage and even lead to serious infections. This study uses a deep learning algorithm to construct a system that diagnoses pressure ulcers and assists in making treatment decisions, thus providing additional reference for first-line caregivers. We performed a retrospective research of medical records to find photos of patients with pressure ulcers at National Taiwan University Hospital from 2016 to 2020. We used photos from 2016 to 2019 for training and after removing the photos which were vague, underexposed, or overexposed, 327 photos were obtained. The photos were then labeled as "erythema" or "non-erythema" for the first classification task and "extensive necrosis", "moderate necrosis" or "limited necrosis" for the second, by consensus of three recruited physicians. An Inception-ResNet-v2 model, a kind of Convolutional Neural Network (CNN), was applied for training these two classification tasks to construct an assessment system. Finally, we tested the model with the photos of pressure ulcers taken from 2019 to 2020 to verify its accuracy. For the task of classification of erythema and non-erythema wounds, our CNN model achieved an accuracy of about 98.5%. For the task of classification of necrotic tissue, our model achieved accuracy of about 97%. Our CNN model, which was based on Inception-ResNet-v2, achieved high accuracy when classifying different types of pressure ulcers, making it applicable in clinical circumstances.

An Artificial PVA-BC Composite That Mimics the Biomechanical Properties and Structure of a Natural Intervertebral Disc.

Disc herniation is one of the most ubiquitous healthcare problems in modern cities—severe patients eventually require surgical intervention. However, the existing operations—spinal fusion and artificial disc replacement—alter the biomechanics of the spine, leaving much room for improvement. The appropriateness of polyvinyl alcohol (PVA) for biomedical applications has been recognised due to its high water content, excellent biocompatibility, and versatile mechanical properties. In this study, a newly-designed PVA–bacterial cellulose (PVA-BC) composite was assembled to mimic both the biomechanics and annular structure of natural intervertebral discs (IVDs). PVA-BC composites of various concentrations were fabricated and tested under unconfined compression and compressive creep in order to acquire the values of the normalised compressive stiffness and whole normalised deformation. The normalised compressive stiffness increased considerably with an increasing PVA concentration, spanning from 1.82 (±0.18) to 3.50 (±0.14) MPa, and the whole normalised deformation decreased from 0.25 to 0.13. Formulations of 40% PVA provided the most accurate mimicry of natural human IVDs in normalised whole deformation, and demonstrated higher dimensional stability. The biocompatible results further confirmed that the materials had excellent biocompatibility. The novel bionic structure and formulations of the PVA-BC materials mimicked the biomechanics and structure of natural IVDs, and ensured dimensional stability under prolonged compression, reducing the risk of impingement on the surrounding tissue. The PVA-BC composite is a promising material for third-generation artificial IVDs with integrated construction.

Dijagnostički modaliteti i fizikalna terapija kod pacijenata sa sindromom karpalnog tunela

Carpal tunnel syndrome (CTS) represents one of the most common compressive peripheral neuropathies on the upper extremities, and is characterized by compression of the medial nerve on its way through the carpal tunnel area. The first changes experienced by patients with CTS are sensory and occur mainly at night, and if they are not recognized and treated in time, they progress and become continuously present. Prolonged compression of the medial nerve in the region of the carpal tunnel can lead to permanent damage to this nerve, which can result in the patient losing the ability to distinguish between hot and cold, as well as atrophy of the thenar muscles and difficulty in palmar abduction of the thumb. The diagnosis of CTS is generally made based on the patient's symptoms, clinical history and anamnesis, as well as electrodiagnostic tests. In addition to these methods, provocative tests, nuclear magnetic resonance (NMR) and ultrasound examinations are used in the evaluation of CTS. In patients with CTS, a large number of treatment methods, both surgical and non-surgical, are used in clinical practice. Myofascial massage, ultrasound, interference currents, continuous short-wave diathermy, extracorporeal shock wave therapy (ESWT) have been shown to be beneficial in reducing pain and symptoms or improving function in patients with CTS in the short and medium term. It was also pointed out that there are no firm conclusions about optimal doses and therapeutic parameters. A better understanding of the etiology and pathophysiological mechanisms of CTS, as well as the effects of certain therapeutic modalities in the treatment of this condition, will contribute to further understanding of the origin and progression of CTS, as well as the possibilities of prevention and treatment of these patients in order to improve the quality of their life and the functionality of the affected limb.

A Case of Functional Testicular Torsion Caused by Incarcerated Inguinal Hernia in a Newborn

Testicular torsion in neonates is a urologic emergency with an incidence of 6.1 per 100,000 live births. Incarcerated inguinal hernia is also an emergency with an incidence of approximately 6% to 31% in children with inguinal hernia. Functional testicular torsion from an incarcerated inguinal hernia is a rare event in children, often not considered in the initial evaluation. A 19-day-old newborn boy was admitted to our neonatal intensive care unit after visiting a primary clinic. He presented with inconsolable crying and right scrotal swelling. Upon initial physical examination, a hard palpable mass and swelling was found in the inguinoscrotal region, accompanied with redness and warmth of the scrotum. Scrotal ultrasound with color Doppler showed inguinal hernia with strangulation and scanty blood flow to the testis. The patient underwent a right orchiectomy and partial resection of the affected small bowel. Surgical findings confirmed a testicular torsion and incarcerated inguinal hernia with testis with small bowel necrosis. Here, we report a rare case of a newborn with functional testicular torsion as a result of prolonged spermatic cord compression due to incarcerated inguinal hernia.