https://www.clinsurggroup.us/journals/imaging-journal-of-clinical-and-medical-sciences A Peertechz Open Access Journal en-us 31 Dec, 2024 https://www.clinsurggroup.us/articles/IJCMS-11-242.php Introduction: This study aimed to describe the clinical, ultrasound, and biological correlation in the diagnosis of chronic renal failure at CIMED and the Donka National Hemodialysis Center. Materials and methods: This was a descriptive cross-sectional study lasting 16 months from November 1, 2021, to March 31, 2023. Study variables were sociodemographic, clinical, and paraclinical. Results: During the study period, 6943 ultrasound scans were performed, 48 of which showed CKD (0.7%). There was a predominance of males, with a sex ratio of 1.08. The mean age was 52, with extremes of 17 and 78. Blue-collar workers were the most common socio-professional group (33.3%). The edematous syndrome was the most frequent reason for consultation (33.3%). Severe CKD was the most common in our study (56.3%). Ultrasound stage III was the most frequent, accounting for 52.1% of cases. There was a correlation between a decrease in creatinine clearance and an increase in the ultrasound stage of CKD and an increase in the severity of CKD with an increase in the ultrasound stage. Conclusion: Our study made it possible to cross-reference clinical, ultrasound, and biological data of chronic renal failure, allowing us to observe significant trends by location which suggests a correlation between these different aspects in the diagnosis of chronic renal failure within the practice of medical imaging for exploration and diagnostics (CIMED) and at the Donka National Hemodialysis Center in Conakry. 27 Dec, 2023 https://www.clinsurggroup.us/articles/IJCMS-10-241.php Magnetic resonance imaging is recognized as a useful modality in breast imaging. Motion is considered the most relevant cause of artefacts in breast MRI leading to degraded image quality or rendering studies non-diagnostic. The important reason for patient motion is contrast administration. Contrast administration may lead to discomfort, feeling of tingling and warmth, and pain in the arm contrast was administered to. The aim of our study was to determine the influence of contrast agent injection side and improve communication with patients on motion artifacts on subtraction reconstructions in order to prove that unexpected events may cause non-physiological movement resulting in motion artifacts, and that well-timed warning may decrease such artifacts. 146 patients with breast MRI from July 2019 to May 2020 were included. 71 of them were warned before the dynamic sequence started, and 75 of them didn't receive any warning for contrast application. The pectoral shift, in millimeters in the anteroposterior and lateral-lateral directions, was measured. Pectoral shift showed to be larger in unwarned patients when compared to warned ones with high significance (p=0.001) -no artifacts were observed in 361 warned, and 267 in unwarned women. Furthermore, artifacts were significantly larger on the side contralateral to contrast administration (median value of 2mm for the same side, and 1mm on the opposite side). In conclusion, our study showed that if patients knew the exact time of contrast application, the motion artifacts would be less pronounced; and that we should apply the contrast agent on the side opposite to the breast pathology is expected in. 14 Nov, 2023 https://www.clinsurggroup.us/articles/IJCMS-10-240.php Introduction: This paper is centered around advancing brain image analysis through the introduction and evaluation of advanced methods. Methods: With the overarching goal of enhancing both image quality and disease classification accuracy, the paper sets out to address crucial aspects of modern medical imaging. The research's trajectory begins by laying a strong foundation through an in-depth exploration of the principles governing Magnetic Resonance Imaging (MRI) and Computed Tomography (CT). This understanding serves as a springboard for the subsequent phases, wherein image quality improvement takes center stage. Results: By employing cutting-edge image processing techniques, the research aims to reduce noise and enhance image clarity, thereby setting the stage for more reliable and precise analysis. The second phase involves segmentation, a pivotal step in brain image analysis. Various segmentation methods will be assessed to determine their efficacy in accurately identifying distinct brain structures. Finally, the paper delves into the realm of deep learning, particularly leveraging CNN, to classify brain images based on disease types. This sophisticated approach holds promise for refining disease identification accuracy by identifying nuanced patterns within the images. Conclusion: Overall, the research aspires to modernize and elevate the field of brain image analysis, ultimately contributing to improved medical diagnostics and insights. 06 May, 2023 https://www.clinsurggroup.us/articles/IJCMS-10-239.php Possible complications that may occur and how to solve them before surgery are essential. This case is of special interest for being a low-incidence pathology in a rare location. The case is of high interest because of the importance of evacuating the hemorrhage to prevent sequels and the complexity of its management and highlights the importance of considering the diagnosis of this event. 30 Sep, 2022 https://www.clinsurggroup.us/articles/IJCMS-9-238.php Introduction: Gadolinium deposition in the human brain, especially in the Globus Pallidus (GP) and the Dentate Nucleus (DN) has been reported after the administration of linear Gadolinium-Based Contrast Agents (GBCAs). This study aims to determine whether repeated injections of macrocyclic GBCA are associated with an increased Signal Intensity (SI) on T1-weighted sequences in the Globus Pallidus (GP) and Dentate Nucleus (DN) in oncologic pediatric patients. Materials and methods: This retrospective monocentric cohort study included consecutive children with at least two MRIs performed after administration of macrocyclic GBCAs. The SI measurements were determined on unenhanced T1-weighted images by drawing a circular region of interest (ROI) within GP and Thalamus (TH) and DN, Pons (P), at baseline, and at last MRI. SI ratios and the differences in ratios (GP/TH) and (DN/P) between the first and last MRI calculated. Results: Out of 413 consecutive children attending Leon Berard cancer center, 50 patients were included, and data analysis showed significantly increased GP/TH SI ratios between the first and the last MRI (p =0.0305). The DN/P SI ratios did not significantly differ between the first and the last MRI (p=0.2668). Conclusion: This study showed an increased SI in GP after several intravenous administrations of macrocyclic GBCAs but no increased SI was identified in the DN. Although no clinical adverse effects have been reported so far, the gadolinium deposits in the brain should be carefully monitored, especially in children who still undergo neurodevelopment. 29 Sep, 2022 https://www.clinsurggroup.us/articles/IJCMS-9-237.php The diagnostic criteria for the behavioral variant of frontotemporal dementia were revised recently. Distinguishing both disorders apart as brain imaging studies in patients with schizophrenia also demonstrate changes in the frontal and temporal lobes which can help in the diagnostic process. This paper highlights the challenges in diagnosing Treatment-Resistant Schizophrenia (TRS) with a differential diagnosis of Fronto-Temporal Dementia (FTD) from magnetic resonance imaging (MRI) imaging. From the diagnosis of the case study, it can be summarized that frontotemporal atrophy is often associated with FTD but it may also occur in a patient suffering from schizophrenia. This provides a challenge for medical practitioners to distinguish between FTD and schizophrenia as disinhibition and executive dysfunction may prominent in schizophrenia with (Frontotemporal Atrophy) FTA. 23 Sep, 2022 https://www.clinsurggroup.us/articles/IJCMS-9-236.php The purpose of this brief report is to stimulate further interest and to raise awareness in relation to the usefulness of assessing cardiac autonomic nerve function using heart rate variability (HRV). The paper outlines the mechanisms associated with HRV and the relationships between HRV, health, and athletic performance. The paper then summarizes the potential benefits of HRV in the assessment of health and exercise adaptations. The paper also provides suggestions about the practical implications of HRV measurement during data collection. We hope that the content provides useful information for the application of HRV for health evaluation and training adaptations. In addition, we hope the paper will provide a better understanding of how HRV measurements can be interpreted and used. Finally, the paper provides practical applications that are effective in the assessment of health and athletic training program outcomes. 07 Jul, 2022 https://www.clinsurggroup.us/articles/IJCMS-9-235.php Cemento-ossifying fibroma is a rare benign fibro-osseous neoplasm commonly involving the jaws majority of lesions occur in mandible bone. It can be discovered as an incidental finding in radiological imaging. Symptomatic patients are presented with a slowly growing mass involving the jaws commonly in mandible bone and can attain a large size with the passage of time. It can cause facial deformity if left untreated. We present such a case of Cemento-ossifying fibroma involving the right hemi-mandible bone, and its radiological imaging findings, including X-ray (OPG), CT scan, and Histopathology. 25 Mar, 2022 https://www.clinsurggroup.us/articles/IJCMS-9-234.php Background and aims: It was investigated whether there is a relationship between advanced atherosclerosis of the carotid artery and cancer. Method: The carotid Total Plaque Area (TPA), the maximum plaque thickness, and the cardiovascular risk based on Framingham calculator using body-mass-index were determined in healthy subjects using ultrasound. We compared the outcome in subjects with advanced atherosclerosis of the carotid artery (type III-IV b finding) with and without statin treatment. The follow-up was collected as part of occupational health check-ups. Result: In 4207 healthy men aged 35-65 years (50±8 years) we found 578 subjects with advanced atherosclerosis of the carotid artery (type III-IV b finding). A follow-up was available for 566 (97.9%) subjects. The average follow-up time was 48 months (range 0 to 139 months). Ten subjects were excluded because of missing data on treatment. A total number of 230 subjects was treated with a statin, 326 received no statin. Within the group of these subjects (54±6 years), 33 men died (15 cancer, 4 strokes, 11 heart attacks, 1 COPD, 1 sepsis, 1 cirrhosis of the liver). In the group with CVD death, two subjects were treated with a statin, 13 were untreated. In the group with cancer death, two subjects were treated with a statin, 13 were untreated. The death rate because of cancer and CVD was 1.7% for the treated subjects and 8.0% for the untreated subjects. In the group with low risk (n= 1890), six men died (2 traffic accidents, 1aneurysm bleeding, 2 cancer, 1 unclear, a follow-up examination has been completed for 43.9% (n= 830) of the subjects, mean follow-up time of 65 months (0-137 months). One man died (Parkinson) within the group with intermediate risk. In this group (n= 482) a follow-up examination has been completed for 55% (n= 265) with a mean follow-up time of 55 months (total range: 0-130 months). In the reference group (no atherosclerosis; n= 1257) follow-up has been completed in 38.3% (n= 482) with a mean follow-up time of 60 (0-145) months and nobody died. In 3203 healthy women aged 35-65 years nobody died of cancer. Conclusion: The development of cancer in men with advanced atherosclerosis of the carotid artery appears to be noticeable. The question of whether there is a causal relationship requires further investigations. 19 May, 2021 https://www.clinsurggroup.us/articles/IJCMS-8-233.php Tuberculosis is an infectious disease usually caused by the bacteria Mycobacterium tuberculosis. This study aimed to analyze the epidemiological profile of Tuberculosis in Cabo Verde from 2006 to 2016. This is an epidemiological, longitudinal and descriptive study in which the secondary data on Tuberculosis were obtained from the annual statistical reports of the Ministry of Health. Incidence, prevalence, mortality rate and percentage of new cases of Tuberculosis, were calculated by age group, gender and treatment for each year. During the study period, 3 282 new cases of all forms of Tuberculosis were registered. The average annual incidence rate was 59 / 100,000. It was observed a higher incidence of the disease among men in the age group of 25 to 34 years old. Pulmonary Tuberculosis was the most frequent form of tuberculosis. The mortality rate in this period remained stable. Although there are positive effects from Tuberculosis control measures in the country, there is the need for complementary measures by developing active surveillance, strengthening the laboratory diagnosis capacity in order to reduce the disease prevalence and prevent multi-drug-resistant Tuberculosis. Moreover, there is a need for complementary epidemiological studies. 21 Apr, 2021 https://www.clinsurggroup.us/articles/IJCMS-8-232.php Of a 72-year-old patient who was brought to our emergency room with fever and worsening condition for several weeks. Initial blood count showed a hemoglobin of 48g/L with a hematocrit of 0.14. 22 Jan, 2021 https://www.clinsurggroup.us/articles/IJCMS-8-231.php Nearly one year ago the world awoke to a new disease, COVID-19. National economies and the lives of almost every individual on the planet Earth were directly impacted. The initial political and medical successes were to “flatten the curve” with social distancing, wearing masks and “lock-down” of society, and then to race toward a safe and effective vaccine. Two vaccines have now been developed and approved in the United States and one in England. 14 Feb, 2020 https://www.clinsurggroup.us/articles/IJCMS-7-230.php Myocarditis in Arrhythmogenic Right Ventricular Dysplasia (ARVD) is characterized massive inflammatory cell infiltrates founded after acute myocardial necrosis in the early stages of the disease. This inflammatory response didn’t mean necessarily an infective process and could lead to changes in phenotype and to an abrupt progression of the disease. 18 Dec, 2019 https://www.clinsurggroup.us/articles/IJCMS-6-229.php Women with both dense breasts and breast implants present a special challenge for consideration due to the increased incidence of false-positives and false-negatives with mammography [1]. Molecular Breast Imaging [MBI] has provided limited proven benefit until recently, when improvements in camera calibration, enhancement and quantification [2,3], resulted in the ability to differentiate tissue based upon measurable changes in regional blood flow and metabolism [4]. 01 Nov, 2019 https://www.clinsurggroup.us/articles/IJCMS-6-228.php Endomyocardial fi brosis is a rare cause of restrictive cardiomyopathy which predominates in lowincome population living in tropical areas. It´s characterized by endomyocardial fi brous tissue deposition causing restrictive physiology with poor prognosis without proper management. 10 Oct, 2019 https://www.clinsurggroup.us/articles/IJCMS-6-227.php Objective: The main goal of this research is the assessment of sexual dysfunction in a group of OCD patients in Iran. 18 Sep, 2019 https://www.clinsurggroup.us/articles/IJCMS-6-226.php Arachnoid cysts are central nervous system lesions that infrequently occur in childhood. They can be mobile and produce partial or complete obstruction in the Cerebrospinal Fluid (CSF) circulation. They are usually present at birth and are asymptomatic, although sometimes the symptoms appear in adolescence or adulthood due to the growth acceleration [1,2]. 27 Aug, 2019 https://www.clinsurggroup.us/articles/IJCMS-6-225.php The leiomyomatosis peritonealis dissiminata (LPD) a histologically benign condition, but it can residivere and be metastatic. Since the macroscopically picture imitates diffuse peritoneal carsinosis, the risk of unnecessary drastic precautions are nearby. 16 Jun, 2019 https://www.clinsurggroup.us/articles/IJCMS-6-224.php The girl looks at you in the hope that you will help to cure spinal cord injury (and other diseases) in children. The picture was taken from the fairy tale film “Till Eulenspiegel”. In the film she (Jule Hermann) is hoping that her father wants her. 16 Jun, 2019 https://www.clinsurggroup.us/articles/IJCMS-6-223.php Poster of the Author Schalow G (Number 38) at the international conference IPBIS2018 in Belfast 2018: Pediatric acquired brain injury repair. The poster is not especially good because of lack of money. But the repair progress of the nervous system in children can clearly be seen It is also shown that human anatomy and physiology is needed for repair. 16 Jun, 2019 https://www.clinsurggroup.us/articles/IJCMS-6-222.php The SCI patient Nefeli during exercising only with the legs while playing/working with the iPhone (A) or singing and moving (B). While playing a bit crazy during CDT (B) is beneficial for repair because it keeps the patient in a good mood in spite of the SCI. Being addicted to the iPhone (A) is mostly not beneficial for repair. 16 Jun, 2019 https://www.clinsurggroup.us/articles/IJCMS-6-221.php Nefeli is watching the coordinated moving of the fins of fishes. 16 Jun, 2019 https://www.clinsurggroup.us/articles/IJCMS-6-220.php The spinal cord injury patient Nefeli during performing hula hoop and playing at the same time with the sister/Author with a balloon. B. Nefeli during hula hoop with two rings. C. With three rings, which was possible only for a few seconds. D,F,G. Nefeli during hula hoop and swinging additionally rings with the hands. 16 Jun, 2019 https://www.clinsurggroup.us/articles/IJCMS-6-219.php Running to improve pelvis positioning in a patient with a SCI at the level of Th10/11. A. During walking on knees, the pelvis is too much backwards mainly because of spasticity. B-E. During running the patient is able to bring the pelvis forward, especially in E. F. After running 10 times the distance of 6m the patient was exhausted but happy. Note that the patient is strongly using her arms to increase the running speed. A high-speed camera would have been needed to improve the quality of the pictures. 16 Jun, 2019 https://www.clinsurggroup.us/articles/IJCMS-6-218.php Improved running performance (A) of the SCI patient because of being able to flex and lift more the knees instead of swinging the leg outwards during walking (B) and running (C). 16 Jun, 2019 https://www.clinsurggroup.us/articles/IJCMS-6-217.php Jumping on springboard of the 11-year-old SCI patient Nefeli after 2.5 years of CDT. Jumping in anti-phase (A-C), in rotation (D,E) and in abduction-adduction (F,G). 16 Jun, 2019 https://www.clinsurggroup.us/articles/IJCMS-6-216.php Exercising on the special CDT device with coordinated support by the Author. The Author recognized with the left hand when Nefeli started to sweat in the leg first time after the SCI, which means that the sympathetic nervous system re-innervated the body below the injury level Th10. 16 Jun, 2019 https://www.clinsurggroup.us/articles/IJCMS-6-215.php The spinal cord injury patient Nefeli just after learning to ride a normal bicycle at an age of 12.5 years (A). She manages also to ride curves (slalom) (B). She still has problems to keep the feet on the pedals, but when she slips from pedals, she has no problems to keep the balance (C). Note that she has to concentrate very much to keep the feet on the pedals (A), seven years after the SCI injury. 16 Jun, 2019 https://www.clinsurggroup.us/articles/IJCMS-6-214.php Relearning to ride a bicycle (A-G) instead of riding wheel instruments in the lying position (H) of patients with spinal cord injury. In B the feet are fixed. In C Nefeli is demonstrating the improvement of trunk stability. In D through G the feet are not fixed. E. With support of the father, Nefeli can manage a bit to ride a normal bicycle. 16 Jun, 2019 https://www.clinsurggroup.us/articles/IJCMS-6-213.php Improvement of the low load coordination dynamics best values with therapy. 16 Jun, 2019 https://www.clinsurggroup.us/articles/IJCMS-6-212.php Natural standing of the SCI patient at school following 12 months of therapy (A). After 18 months of CDT she stands straighter during working in the kitchen (B). The patient prefers to be bare foot (B) or to wear socks to have more input from the soles of the feet for better balance because of the damage of the fasciculus gracilis. 16 Jun, 2019 https://www.clinsurggroup.us/articles/IJCMS-6-211.php Improvement of the straightness of the trunk during hula hoop. The treatment time is 12 months in A, 18 in C and 22 months in D. The improvement of straightness may not be characteristic for the improvement of her scoliosis. 16 Jun, 2019 https://www.clinsurggroup.us/articles/IJCMS-6-210.php Improvement of longest hula hoop exercising times in dependence on therapy. Note that the individual times varied much. 16 Jun, 2019 https://www.clinsurggroup.us/articles/IJCMS-6-209.php The arching of the back is impaired in the patient Nefeli (A). In the four-year-old brother the arch of the back is physiologic (B). 16 Jun, 2019 https://www.clinsurggroup.us/articles/IJCMS-6-208.php Nefeli during dancing at school. Disappointing is that 16 of the 18 pupils had over-weight. 16 Jun, 2019 https://www.clinsurggroup.us/articles/IJCMS-6-207.php Foot arches during supported walking. Note the right foot has in the stance phase (A, arrow) no foot arch. 16 Jun, 2019 https://www.clinsurggroup.us/articles/IJCMS-6-206.php Practical judgment of extensor spasticity. When the Author holds the patient Nefeli (SCI Th10), one can judge her extensor spasticity by the extension of her legs (A). Her present spasticity is medium strong. A physiologic leg position can be seen in B. The healthy seven-year-old sister has no spasticity and the legs are flexed. 16 Jun, 2019 https://www.clinsurggroup.us/articles/IJCMS-6-205.php Therapy-induced spasticity reduction in the short-term memory. The position of the ball represents the state of the system and the potential well, the attractor. The ball is attracted to the stable position in the deepness of the hole, called attractor state. The attractor layout, consisting of two attractive states of different stability, is changing upon exercising very coordinated rhythmic movements. Black ball = stable state, open ball = very unstable state, hatched ball = spasticity and movement co-exist. Variability of phase and frequency coordination not indicated. 16 Jun, 2019 https://www.clinsurggroup.us/articles/IJCMS-6-204.php Epigenetic regulation for repair by movement-based learning. CDT-induced stimulation of the pathways that regulate neural network repair is a proven therapeutic and preventive tool. Epigenetic mechanisms, stimulated by physiologic network activation, are likely key players within signaling networks, as DNA methylation, chromatin remodeling and small non-coding RNAs superfamily are required for the fine-tuning and coordination of gene expression during neural network repair by learning. Since the nervous system is involved in nearly all body functions, CDT will improve health. 16 Jun, 2019 https://www.clinsurggroup.us/articles/IJCMS-6-203.php Zones of Head and referred pain. 16 Jun, 2019 https://www.clinsurggroup.us/articles/IJCMS-6-202.php Ten-year-old Nefeli can move again the big toe separately four years after the accident and following 10.5 months of coordination dynamics therapy. In A she does not activate foot muscles and is relaxed. In B,C she concentrates and visualizes the task to activate the dorsal flexion of the big toe, which indicates that the spinal cord repair has reached with the activation of the halluces longus the spinal cord segment L5. 16 Jun, 2019 https://www.clinsurggroup.us/articles/IJCMS-6-201.php Ten-year-old Nefeli can move again the big toe separately four years after the accident and following 10.5 months of coordination dynamics therapy. In A she does not activate foot muscles and is relaxed. In B,C she concentrates and visualizes the task to activate the dorsal flexion of the big toe, which indicates that the spinal cord repair has reached with the activation of the halluces longus the spinal cord segment L5. 16 Jun, 2019 https://www.clinsurggroup.us/articles/IJCMS-6-200.php The 10-year-old SCI patient Nefeli during training with the hula hoop to improve trunk mobility/stability and balance. 16 Jun, 2019 https://www.clinsurggroup.us/articles/IJCMS-6-199.php The patient with a SCI learned to lift the knees and strike the ground first with the heel to induce the stepping automatism for SCI repair. Note, the arch of the foot is preserved in the left foot but not in the right foot during the stance phase. With the lifting of the knees, Nefeli became able to activate the quadriceps much more; the regeneration of the spinal cord had substantially reached the L4 segment. Nefeli is walking in the usual trot gait coordination. 16 Jun, 2019 https://www.clinsurggroup.us/articles/IJCMS-6-198.php Improvement of running and walking times when moving along a floor. The patient is using the arms also for keeping the balance. 16 Jun, 2019 https://www.clinsurggroup.us/articles/IJCMS-6-197.php Sclerotomes (B) and Dermatomes (A). 16 Jun, 2019 https://www.clinsurggroup.us/articles/IJCMS-6-196.php Coordination dynamics values over time of the SCI patient Nefeli. 16 Jun, 2019 https://www.clinsurggroup.us/articles/IJCMS-6-195.php Patient with SCI during exercising on the special CDT device different movement patterns to improve phase and frequency coordination of neuron firing. In A and B also trunk rotation is trained. When turning in the standing position (F), the performance of the right foot is pathologic (plantar flexed). 16 Jun, 2019 https://www.clinsurggroup.us/articles/IJCMS-6-194.php Two ways to get up from the floor after falling. In A through D mainly the arms are used for getting up and in E through H the legs. 16 Jun, 2019 https://www.clinsurggroup.us/articles/IJCMS-6-193.php Volitional dorsal flexion of the feet in a patient with 70% SCI. In ‘A’ plantar flexed and in ‘B’ dorsal flexed. To improve foot power, the hand grip is co-activated (clench her fists). 16 Jun, 2019 https://www.clinsurggroup.us/articles/IJCMS-6-192.php Automatic stepping in a newborn infant. A. The 5-day-old infant, Juliane, performing primary automatic stepping; slight backward posture. The heel of the right foot touched the ground first. B. Infant Juliane, 8-day-old, performing automatic stepping. 16 Jun, 2019 https://www.clinsurggroup.us/articles/IJCMS-6-191.php In spite of all the struggles the Author had with the patient Nefeli when pushing her to the limits of exercising, she wrote into the control book that she likes the Author. 16 Jun, 2019 https://www.clinsurggroup.us/articles/IJCMS-6-190.php Supported jumping in anti-phase of the 9.5-year-old Nefeli with SCI in comparison to other girls. Note, with the right small finger the therapist (Author) is trying to keep the right foot of Nefeli in a physiologic position. The progress in jumping is quantified by the increase of jumps per series. y = age in years. 16 Jun, 2019 https://www.clinsurggroup.us/articles/IJCMS-6-189.php Free walking on treadmill in the forward and backward direction of a patient with a SCI. Note the pathologic inward rotation of the left knee and the not straight upper body because of the scoliosis. 16 Jun, 2019 https://www.clinsurggroup.us/articles/IJCMS-6-188.php Improvement of free walking on treadmill of the 10-year-old patient Nefeli with a SCI. At the beginning a walking speed of 2.5km/h was only possible, later on a speed of 4km/h became possible. The patient walked without shoes to have a better sensory input and in this way a higher stability, which was the limiting factor of continuous walking. 16 Jun, 2019 https://www.clinsurggroup.us/articles/IJCMS-6-187.php Improvement of urinary bladder functioning quantified by the time from the urge/desire to void until micturition. 16 Jun, 2019 https://www.clinsurggroup.us/articles/IJCMS-6-186.php The girl Nefeli, who acquired a spinal cord injury at the levels Th10/11 during walking with sticks and free walking. Note the pathologic walking pattern in B. 16 Jun, 2019 https://www.clinsurggroup.us/articles/IJCMS-6-185.php The six-year-old Nefeli (sitting), who acquired a spinal cord injury, following 8-months-therapy in a rehabilitation center in Affoltern in Switzerland (one day costs approximately 2000 US Dollar). Note, Nefeli had problems to manage at school in the first class. 16 Jun, 2019 https://www.clinsurggroup.us/articles/IJCMS-6-184.php Severe scoliosis of the SCI patient Nefeli caused by the spinal cord injury and the cancer removal. With the removal of the neuroblastoma at least one intercostal was removed. 16 Jun, 2019 https://www.clinsurggroup.us/articles/IJCMS-6-183.php A. Posterior funiculus, containing the posterior columns fasciculus gracilis (medial, afferent fibers from the leg) and fasciculus cuneatus (lateral, afferent fibers from the arm). Afferent fibers sub-serving different sensory modalities traverse the root entry zone and enter the posterior horn (B). The type of myelin changes from peripheral to central, and the myelinating cells are no longer Schwann cells, but rather oligodendrocytes. The spinal cord injury at the level of Th10 is indicated. The afferent fibers from the arm join the cord at cervical levels and lie more laterally and dorsally to the spinal cord injury. The action potentials derived from receptors in muscles, tendons, fasciae, joint capsules and skin are conveyed in the distal processes of pseudo-unipolar neurons in the spinal ganglia. The central processes of the cells, in turn, ascend in the spinal cord and terminate in the nucleus gracilis of the medulla oblongata. The impulses derived from receptors in the leg are conveyed similarly to the caudal spinal cord. But in the spinal cord the central processes are mainly destroyed at the injury site and the action potentials cannot reach the second neurons in the nucleus gracilis of the medulla oblongata (dotted lines) (B). B. Central continuation of posterior column pathways. The posterior column nuclei contain the second neurons of the afferent pathway, which project their axons to the thalamus. Due to the spinal cord injury the second neurons in the nucleus cuneatus are partly de-afferented (dotted line). C. Pictured spinal cord injury site. Soled lines are functional, dotted lines not. To understand the regeneration of the human spinal cord, induced by coordination dynamics therapy, more knowledge of the regeneration in human is needed. 16 Jun, 2019 https://www.clinsurggroup.us/articles/IJCMS-6-182.php Neuron operating as a coincidence or coordination detector. A. Afferent input is reaching rather uncoordinated the cell soma. Only sometimes an action potential is generated, because the threshold of action potential generation is mostly not achieved. B. The action potentials in fibers 1 through 4 are reaching time-coordinated the dendrites or the cell soma. The postsynaptic potentials add up and the threshold is achieved at approximately –30mV, and action potentials are generated time-coordinated at the axon hillock. In the real CNS mostly, many more smaller postsynaptic potentials will contribute to the generation of an action potential and passive conduction from the dendrites to the cell soma has to be taken into account. Coordinated afferent input may thus induce or enhance (coordinated) communication between neuronal network parts following CNS injury. 16 Jun, 2019 https://www.clinsurggroup.us/articles/IJCMS-6-181.php Up and down movements of the trunk to arch the patient’s back and to activate neurogenesis at the SCI level Th10. The impaired arch is marked with SCI Th10. 16 Jun, 2019 https://www.clinsurggroup.us/articles/IJCMS-6-180.php Spinal cord cross section with indicated approximate injury (cross-hatched) and loss of interneuron (dotted area) of the patient Nefeli. Synapses of descending motor tracts onto anterior horn neurons are shown. 16 Jun, 2019 https://www.clinsurggroup.us/articles/IJCMS-6-179.php Primary motor areas (homunculus of the brain). Note that the toes are close to urinary bladder and rectum areas. 16 Jun, 2019 https://www.clinsurggroup.us/articles/IJCMS-6-178.php A-C. Volitional abduction and adduction of the toes becomes possible again in the SCI patient Nefeli. With the activation of the Mm. interrossei dorsales and plantares (C), the regeneration of the spinal cord has reached the S1 to S3 spinal cord segments. 16 Jun, 2019 https://www.clinsurggroup.us/articles/IJCMS-6-177.php Activation of the halluces longus muscle (C) when dorsal flexing the big toes separately (B). Spinal cord regeneration reached the L5 level. 16 Jun, 2019 https://www.clinsurggroup.us/articles/IJCMS-6-176.php Segment-indicating muscles of the L4, L5, S1, S2/S3 and S4/S5 spinal cord segments for measuring the level of spinal cord regeneration. A. Relation between spinal cord and vertebra segments. B. The spinal cord segment L4 indicating muscle is for example the quadriceps. The extensor halluces longus is characteristic for the L5 segment. C. The plantar muscles of the foot represent S1 to S3 spinal cord segments. D. The vesical and anal sphincters are activated from the S4/S5 spinal cord segments. The skeletal muscles of the leg are innervated by α1, α2 and α3-motoneurons, but the external bladder and anal sphincters are innervated only by α2-motoneurons. 16 Jun, 2019 https://www.clinsurggroup.us/articles/IJCMS-6-175.php MRI of the 10-year-old patient Nefeli with a spinal cord injury at the levels around Th10. Because of scoliosis, the spinal cord is not fully in the plane. The injury of the spinal cord is mainly from the dorsal site. 16 Jun, 2019 https://www.clinsurggroup.us/articles/IJCMS-6-174.php Salamander-crawling (C, D) in similarity salamander-walking (A, B) of the 10-year-old Nefeli with a spinal cord injury (Th10). In D the bending is disturbed because of the scoliosis and spasticity. 16 Jun, 2019 https://www.clinsurggroup.us/articles/IJCMS-6-173.php A, B. Possible rotational body movement of Tiktaalik, caused by alternately using one front limb for forward locomotion. C, D. This front limb movement is simulated by a patient with a spinal cord injury (Nefeli) by using alternately the right and left arm. Tiktaalik roseae is a lobe-finned fish from the late Devonian period, about 375 million years ago, having may be features akin to those of four-legged animals (tetrapods). Tiktaalik has a possibility of being a representative of the evolutionary transition from fish to amphibians. 16 Jun, 2019 https://www.clinsurggroup.us/articles/IJCMS-6-172.php Ten-year-old patient with an incomplete spinal cord injury at the Th10 level during creeping. Note, because of the severe scoliosis, the creeping is not symmetrical. The rotation to the left is limited because of the scoliosis. C. Training of right-left symmetry via the corpus callosum (D) when exercising on the special CDT device with crossed arms. 16 Jun, 2019 https://www.clinsurggroup.us/articles/IJCMS-6-171.php The 5.5-year-old Nefeli after suffering an incomplete spinal cord injury Th10 by medical malpractice. B. Nefeli after eight months of conventional children rehabilitation in Switzerland (Affoltern). Sticks and orthosis were needed. C,D. Ten-year-old patient Nefeli after six months of coordination dynamics therapy. At school she can walk again and can write at the white board. 16 Jun, 2019 https://www.clinsurggroup.us/articles/IJCMS-6-170.php Evolution of the attractor layout of bladder functioning induced by learning transfer from movements to bladder functions upon CDT. The region around each local minimum of the potential landscape acts like a well that weekly traps the system into a coordinated state. Black balls correspond to stable minima of the potential. With learning, the pattern ‘spasticity of the external bladder sphincter’ vanishes and the patterns for bladder functioning (‘synergy’ and dyssynergia’) appear anew and gain their physiologic stability (physiologic deepness of each basin of attraction). The corresponding attractor layout for physiologic bladder functioning is given. Fluctuation of pattern state (the black ball) (C), and their decrease (F), due to the impairment of phase and frequency coordination of neuron firing, is pictured in ‘C’ and ‘F’ by long and short arrows. Dotted and dashed lines indicate the re-occurrence of bladder sensation. Note that more than two years of optimal continuous CDT were needed for bladder repair. 16 Jun, 2019 https://www.clinsurggroup.us/articles/IJCMS-6-169.php Direct comparison of secondary muscle spindle afferent activity and motoneuron activity between the brain-dead human HT6 with a synergy of the bladder (A) and the paraplegic 9 with a dyssynergia of the bladder (B). A. Simultaneous measurements of activities of secondary muscle spindle afferents (a), parasympathetic preganglionic motoneurons (b) and oscillatory firing (high activity mode) of a sphincter motoneuron innervating the striated anal sphincter (c). Note that with the transient activity increase of the parasympathetic fibers (b) the secondary muscle spindle afferent fiber increased strongly its activity (a) for minutes, and the oscillatory firing sphincter motoneuron discontinued its oscillation (c) to reduce strongly its activity. bladder 3x = 3 times bladder catheter pulling. T ext. anal sphincter mot. = oscillation period of the sphincter α2-motoneuron innervating the anal sphincter. For further details, see Chapter V of [1]. 16 Jun, 2019 https://www.clinsurggroup.us/articles/IJCMS-6-168.php Comparison between changes in secondary muscle spindle afferent activity and detrusor pressure (measured before the surgery; for the implantation of a sacral anterior root stimulator). Paraplegic 9. A. Activity changes of the afferent fiber SP2(1) following bladder catheter pulling (Figure 37Ba). Approx. mean activity level is represented by a dashed line at 7.5 IIs/0.8s ((APs -1)/0.8s). The activity above the mean is cross-hatched and is proposed to be due to parasympathetic activation. Root vS4. B. Detrusor pressure (pressure difference) changes taken from ‘C’. Note that changes in the detrusor pressure show almost exactly the same time course as do the activated changes of the secondary muscle spindle afferent fiber SP2(1) of ‘A’. Corresponding peaks are correlated by arrows. C. Abdominal pressure (measured as rectal pressure), intravesical pressure (urinary bladder pressure) and detrusor pressure (pressure difference) during retrograde filling before the surgery. One transient detrusor pressure increase, marked ‘B’, is used, after enlargement in ‘B’, to compare with the spindle afferent activity. 16 Jun, 2019 https://www.clinsurggroup.us/articles/IJCMS-6-167.php Self-organization of premotor spinal *2-oscillator O1, which innervates the external urinary bladder sphincter (skeletal muscle). Brain-dead human HT6; recording from a dorsal S4 nerve root. A. Recordings from *2-motoneurons O1 and O2, firing in the oscillatory mode with impulse trains of 2 (upper recording) and 3 (lower recording) action potentials (APs). The durations of the oscillation periods were 110 (O1) and 164ms (O2). The interspike intervals of the impulse trains were 5.9ms (O1) and 4.6 and 7.4ms (O2). Motoneuron O1 conducted at 36 m/s; its recurrent fiber conducted at 21 m/s. The measurement layout is shown schematically. The inserts show the oscillatory firing modes; they have not been drawn to scale. 16 Jun, 2019 https://www.clinsurggroup.us/articles/IJCMS-6-166.php Location of receptors and muscles for the continence of the urinary bladder and the rectum, innervated by motoneurons the activities of which were recorded, in the brain-dead human HT6 (dS4 root), paraplegic 9 (vS4 root) and paraplegic 7 (nerve root S5). 16 Jun, 2019 https://www.clinsurggroup.us/articles/IJCMS-6-165.php Schematic diagram of the sympathetic and parasympathetic nervous system. Yellow = sympathetic, blue = parasympathetic. The recording from a sacral root shows single action potentials of preganglionic neurons (par) and a skin afferent fiber. 16 Jun, 2019 https://www.clinsurggroup.us/articles/IJCMS-6-164.php Clinical urinary bladder function test (Urodynamics). Improvement of the urinary bladder functions, quantified by urodynamics in a 30-year-old female patient. A. 3 months after the accident resulting paraplegia sub Th12 following spinal cord lesion. B. 12 months after the accident (lesion level lowered to sub L3). In A, the detrusor pressure (Pdet) is generated by the contracture of the bladder wall, as the pressure difference between abdominal pressure (Pabd, measured in the rectum) and the bladder pressure (Pves, measured in the bladder). Electromyographic recording obtained with surface electrodes from the sphincters and the pelvic floor (EMG) is shown; the external sphincters and the functionally correlated pelvic floor muscles show similar sEMG activity (the rhythmic pressure peaks in A do not originate in the bladder). In A, the detrusor shows nearly no activity with retrograde bladder filling at 25 ml/min; in B, the detrusor shows first activity at 360 ml bladder filling. A detrusor-sphincteric-dyssynergia occurs, because the detrusor pressure peaks occur at the same time as the sphincter EMG activity peaks (B) (bladder and sphincter contract at the same time, so that fluid can only emerge from the bladder at high bladder pressure; there is a danger of reflux through the ureter into the kidneys). The EMG peaks are a bit irregular, probably because the fluid, leaving the bladder, shunts transiently the EMG electrodes. Exact functional description of B: 2x coughing (B below) increases the EMG activity and passively the pressure in the abdomen and in the bladder (marked by the small arrows, physiologic). The bulbocavernosus reflex (induced by pressure applied to the clitoris) increased the EMG activity of the sphincters (physiologic). Conclusion: The reflex arch is in order; sacral nerve roots and nerves have not been damaged in the accident. I (bottom right): The patient feels an increase of unvolitional detrusor pressure (first feeling of bladder pressure at 360 ml). She tries to contract the sphincters to stop the bladder emptying. Shortly after the desire to empty the bladder, as the detrusor pressure decreases, fluid is leaving the bladder. II: Due to tapping onto the bladder, the bladder reflex is activated (detrusor activated, nearly no abdominal pressure); fluid is leaving the bladder. III: Due to the abdominal muscular pressure the pressure in the abdomen increases as does passively the pressure in the bladder (the detrusor is not activated); fluid left the bladder. With a delay, the detrusor was activated by the bladder reflex. - The urinary bladder of the patient is partly functioning. It has to be further improved by therapy induced reorganization of the CNS: (1) An earlier feeling of bladder filling, (2) an increase of the time difference between the feeling of the first bladder filling and the un-volitionally emptying of the bladder (for the time being, approx. 10 min, in dependence on whether the patient is physically active (such as walking) or not, (3) further learning how to activate the detrusor on volition, and (4) the physiologic coordination between the bladder and the external sphincter functioning (to stop the detrusor-sphincter-dyssynergia). 16 Jun, 2019 https://www.clinsurggroup.us/articles/IJCMS-6-163.php Relation of coordination dynamics values to therapy duration for a load of 20N and for exercising in the forward (lines and dots) and backward directions (20Nb; dashed line and crosses) in a patient with a SCI sub C5/6 (Kadri). Note that with no therapy the coordination dynamics values got worse (increased) and upon therapy they improved again. Upon metal removal the coordination dynamics values increased strongly. The transient coordination dynamics value increases (peaks) ‘1’ through ‘9’ fall together with the re-appearance of certain muscle functions or specific improvements of motor and autonomic functions and indicate therefore most likely small bits of regeneration. After the large peak ‘6’ of transient coordination dynamics value increase, urinary bladder functioning was re-learned. 16 Jun, 2019 https://www.clinsurggroup.us/articles/IJCMS-6-162.php Comparison between the development of an infant and repair of a cervical spinal cord injury upon CDT. Left penal, positioning upon 0.5 years of therapy and right penal after 5 years of therapy. 16 Jun, 2019 https://www.clinsurggroup.us/articles/IJCMS-6-161.php Comparison between development and the repair of an almost complete cervical spinal cord injury upon one year (A,C,G) (therapy started at an age of 15.5 years) and 5 years of coordination dynamics therapy (B,E,H) (CDT started with 17 years). The MRI of the SCI of the patient of the left panel is shown in ‘I’ and those one of the right panel in ‘K’. Trunk rotation (A,B,C), un-sustained sitting (D,E,F), and four-point kneeling (G,H,I) is compared between one year and 5 years of CDT and with the positioning of an infant. 16 Jun, 2019 https://www.clinsurggroup.us/articles/IJCMS-6-160.php Relation of coordination dynamics values to therapy length for increasing load between 20 and 150N. The loads for forward exercising (dots, 20N, 100N, 150N) are marked at the curves (20Nb = backward exercising (crosses) at 20N). Note that with no therapy the coordination dynamics values got worse and upon administering therapy again the values improved again even 2 years after the accident. After stopping therapy, the coordination dynamics values for 100 and 150N increased again (23.3.2008). When the patient (Sten) trained himself intensively (including running and jumping), he further improved his high-load CD values (8.9. and 23.9.2010). 16 Jun, 2019 https://www.clinsurggroup.us/articles/IJCMS-6-159.php Improvement of times for running 60 and 400m (A,B) and increase of jumps with a skipping-rope per single session (C) in relation to on-going therapy sessions. Therapy period = second half of 2006 (Next PDF No 160). 16 Jun, 2019 https://www.clinsurggroup.us/articles/IJCMS-6-158.php The outcome of a SCI repair depends strongly on the severance of the injury. A-D. MRI’s of approximately 99, 95 and 50% injury. C shows the 50% injury with titan fixation and B without. The severance of an injury can also be estimated with a fixation in place. G,H. In 50% injury, the patient can relearn walking, running and jumping. E,F. In 95% (and 99%) the patient cannot re-learn free walking and jumping. 16 Jun, 2019 https://www.clinsurggroup.us/articles/IJCMS-6-157.php A. Improvement of high-load coordination dynamics (CD) values in a patient with severe brain injury upon coordination dynamics therapy for several years. The high-load CD values were obtained by summing up the single CD values for forward and backward exercising, ∆ (high-load CD value) = ∆20N + ∆50N + 100N + ∆150N + 200N + ∆150N + ∆100N + ∆100N + ∆50N + ∆20N + ∆20N). B, C. For comparing the rate of repair, the improvement curves of the high-load coordination dynamics values of an athlete (C) and a healthy pupil (B) are inserted. Note that the brain-injured patient needed much more time to achieve similar good CD values. D. Continuation of therapy. The substantial improvement of the high-load CD values (lower values), in the middle of 2018, motivated the patient Sotiris to continue his therapy at the limit. 16 Jun, 2019 https://www.clinsurggroup.us/articles/IJCMS-6-156.php Layout for measuring coordination dynamics (arrhythmicity of exercising) between arm and leg movements, displayed on the laptop; for the intermediate coordination’s between pace and trot gait, the fluctuation of the network states is larger. The recording of sEMG activity (displayed on the oscilloscope) from the tibialis anterior and other muscles is also shown. The inset shows single motor unit action potentials on the lowest trace. The recordings are taken from a patient (Kadri) with a motoric complete cervical spinal cord injury C5/6 (95% injury). 16 Jun, 2019 https://www.clinsurggroup.us/articles/IJCMS-6-155.php The 11-year-old Nefeli with an incomplete spinal cord injury (SCI) during exercising coordinated arm, leg and trunk movements to improve the coordinated firing of neurons and sub-neural networks. This special CDT device for measuring and therapy (int.pat.) is produced by the firm: Giger Engineering, Martin Giger dipl.Ing.ETH/SIA, Herrenweg 1, 4500 Solothurn, Switzerland, www.g-medicals.ch. 16 Jun, 2019 https://www.clinsurggroup.us/articles/IJCMS-6-154.php The potential, V(φ), of the coordination dynamics for jumping on springboard (D, Nefeli) of a healthy (A) and injured CNS (B,C). The region around each local minimum acts like a well that weakly traps the system into a coordinated state. Behavioral changes are represented by the over-damped movement of a rolling ball in the potential “landscape”. High fluctuations (indicated by long arrows attached to the ball (network state)) in the stable state, due to high variability of phase and frequency coordination (in the injured case), will have a greater probability of “kicking” the system out of the basins of attraction (B,C) than for low fluctuations (short arrows) (A), due to small variability of phase and frequency coordination (in A). In B, only the in-phase jumping is stable, even though the fluctuation is high. In C there is only an attractor basin for the in-phase jumping, but the fluctuation is so high that there is a high probability that the system is kicked out of the basin of attraction. The patient can no longer jump in anti-phase and has difficulty with jumping in-phase. The stability of jumping depends on the motor program (deepness of basin of attraction) and the fluctuation of the pattern state (moving of the ball) caused by the increased variability of phase and frequency coordination due to the injury. 16 Jun, 2019 https://www.clinsurggroup.us/articles/IJCMS-6-153.php Trot gate crawling of a cerebral palsy girl in interpersonal coordination with the therapist. The crawling performance of the therapist is not optimal. The right arm is leading with respect to the left knee. The crawling performance of the patient is also not optimal; the knees are too much apart. 16 Jun, 2019 https://www.clinsurggroup.us/articles/IJCMS-6-152.php Motor program bursts in patients who suffered a spinal cord injury, structured with clonus activation and rhythmic firing of FF-type motor units A. EMG recording of a clonus (f = 5.3Hz) in the right tibialis anterior muscle of a patient who suffered a complete spinal cord injury sub Th5/7; the patient was not exercising. B, C. Motor programs of a patient who suffered an incomplete spinal cord injury sub Th4 upon exercising on the special coordination dynamics therapy device at 50 and 100N (medium to high load). In B, motor program bursts are structured by rhythmicity; frequencies of 5 and 7.3Hz are suggested. No motor program in the right tibialis anterior muscle; some motor program structure in the right gastrocnemius muscle. In C (faster sweep), there is no motor program in the right tibialis anterior muscle. Mainly clonus activity at a frequency of 4.5Hz can be seen in the right gastrocnemius muscle. Two physiologic motor program bursts can be seen in the left tibialis anterior muscle (not structured by rhythmicity). In the left gastrocnemius muscle a motor program burst can be seen which is structured by 5Hz rhythmicity (clonus frequency, see clonus in the right gastrocnemius muscle) and higher frequency rhythmicity (26 and 40Hz). 16 Jun, 2019 https://www.clinsurggroup.us/articles/IJCMS-6-151.php Phase and frequency coordination between oscillatory firing motor units (FF-type) during the generation of a motor program during exercise on the special coordination dynamics therapy device at loads increasing from 100 to 200N. Oscillation periods (T) and oscillation frequencies (f [Hz]) of oscillatory firing motor unit 1 are partly indicated. ‘A,B,D,E’ same recording situation as in Figure 23; ‘C,F’ soleus electrodes shifted to gluteus muscles to check early re-innervation upon therapy. The waveforms of the 3 identified FF-type motor unit potentials ‘1’, ‘2’, and ‘3’ are the same as in Figure 23; motor units ‘2’ and ‘3’ are partly marked. In ‘F’, some coordination’s between motor unit ‘3’ and ‘1’ are marked. 16 Jun, 2019 https://www.clinsurggroup.us/articles/IJCMS-6-150.php Correlation of muscle fiber types, motor nerve fiber types, and oscillatory firing spinal neuronal networks, based on histochemical, morphological and physiological properties. This figure provides a simplified correlation between muscle fiber, motoneuron and sacral oscillator types. No additional subtypes have been included. α = motoneuron, γ1, γ2 = dynamic and static fusimotors, parasympathetic = parasympathetic preganglionic motoneuron. S1, ST, S2 = stretch, tension and flow receptor afferents. 16 Jun, 2019 https://www.clinsurggroup.us/articles/IJCMS-6-149.php Touch (and pain)-stimulated afferent activity. Touch and pain activity, stimulated by pin-prick (A) and touch (Ea) of S5 or Co dermatomes and recorded extracellularly from a dorsal coccygeal root (brain-dead human HT6). T1, T2, T3, T4, P = mark action potentials (APs) from single touch and pain fibers. Subscripts 1, 2, 3 mark single fibers. 16 Jun, 2019 https://www.clinsurggroup.us/articles/IJCMS-6-148.php Classification scheme for human peripheral nerve fibers. Conduction velocities (V) and nerve fiber diameters (Ø) of afferent and efferent nerve fiber groups in normal humans and in patients with a traumatic spinal cord lesion for 0.5 to 6 years. The splitting of the α1-motoneurons into the 3 subgroups, α11, α12, α13, has not yet been confirmed. This is the only existing classification scheme for human nerve fibers! 16 Jun, 2019 https://www.clinsurggroup.us/articles/IJCMS-6-147.php Development of a classification scheme for human peripheral nerve fibers. Conduction velocities (V) and nerve fiber diameters (Ø) of afferent and efferent nerve fiber groups in normal humans and in patients with a traumatic spinal cord injury for 0.5 to 6 years. 16 Jun, 2019 https://www.clinsurggroup.us/articles/IJCMS-6-146.php Schematic splitting of the activity of several nerve fibres into simultaneous impulse patterns of single fibres by comparing waveforms, conduction velocities and reoccurring characteristic impulse patterns (rhythmic firing of sphincteric motoneurons). The different conduction times and waveforms were recognized on an expanded time scale. Stretch receptor and secondary muscle spindle afferents contribute to the drive of sphincteric motoneurons and form, together with other afferents, regulation units. 16 Jun, 2019 https://www.clinsurggroup.us/articles/IJCMS-6-145.php Layout of the recording of single-nerve fiber action potentials to measure the self-organization of neuronal networks of the human CNS under physiologic and pathophysiologic conditions. By recording with two pairs of wire electrodes (B) from sacral nerve roots (cauda equina, C), containing between 200 and 500 myelinated nerve fibers, records were obtained in which single-nerve fiber action potentials (APs) were identified from motoneuron axons (main action potential (AP) phase downwards) and afferents (main AP phase upwards). 16 Jun, 2019 https://www.clinsurggroup.us/articles/IJCMS-6-144.php Cervical spinal cord injury of an 18-year old man approximately 8 hours after a motor cycle accident (A) and one year later (B). 16 Jun, 2019 https://www.clinsurggroup.us/articles/IJCMS-6-143.php Caudal part of the human spinal cord from the dorsal side. Lig. dent. = denticulate ligament. Dissection of the Author. 16 Jun, 2019 https://www.clinsurggroup.us/articles/IJCMS-6-142.php Human spinal cord with dorsal (A) and ventral side (B,C). Intumescentia cervicalis and lumbosacralis are visible. The caudal ventral roots are thinner than the dorsal roots. The passage of the artery spinalis magna (Artery of Adamkiewicz) and the anterior spinal artery are indicated. The C5 and Th10 roots and the intercostal nerve Th12 are indicated. Dissection of the Author. 16 Jun, 2019 https://www.clinsurggroup.us/articles/IJCMS-6-141.php Spinal cord (A) and dermatome segments (B-D). The segmental innervation of the skin in B is according to Hansen-Schliack and in C after Keegan and Garret. The overlap of dermatomes (D) is according to Foerster. Note the different location of the T1 dermatome in B and C. There is variation of the segmental skin innervation especially in the lower sacral range. 16 Jun, 2019 https://www.clinsurggroup.us/articles/IJCMS-6-140.php A. Spinal cord segments and their relation to the vertebral bodies. Note the Ascensus of the spinal cord, giving rise to the long cauda equina nerve roots. B. Approximate segmental innervation of the skin. C. Below the spinal cord injury level there is loss of sensitivity and loss of connectivity to muscle and other functions. 04 Aug, 2018 https://www.clinsurggroup.us/articles/IJCMS-5-139.php A 45-year-old female came to our attention with a 6-month history of ulcerative mass in her right breast, cough, shortness of breath, nasal obstruction with hematic discharge, and hearing loss. The patient underwent excision biopsy of breast lesion. Definitive pathology (Figure A) documented the presence of a granulomatous mastitis with suppurative necrotic foci (*), giant multinucleated cells (circles), and normal breast ducts trapped by neutrophilic-eosinophilic infiltrate (arrowheads). 19 Apr, 2018 https://www.clinsurggroup.us/articles/IJCMS-5-138.php Fahr’s disease is a rare inherited or sporadic neurological disorder with a prevalence of <1/1,000,000, with a higher incidence reported among males and a typical age of onset in the 4th–6th 3rd-5th decade of life. 29 Mar, 2018 https://www.clinsurggroup.us/articles/IJCMS-5-137.php Stress is an inescapable fact of life. The perceived stress induces endocrine alterations characterized by the activation of hypothalamo-pituitary-adrenal axis and sympathetic adreno-medullary axis. The glucocorticoids and catecholamines which are secreted in response to stress induce variations in the physiology and behavior that help the individual to adapt to changing demands of the body. Glucocorticoids are known to play a central role in inducing the stress related pathophysiology. These hormones induce hypermetabolism in order to cope up with the increasing energy demands of the body. However when the stress is persistent the body adapts itself to continuous demands and starts regulating the metabolism at higher levels than the normal, termed as allostasis. This overwhelming load on the body will predispose the individual for the development of diseases. This mini-review focuses on long term chronic stress induced alterations in glucose metabolism and development of insulin resistance and glucose intolerance as a result of long term allostatic regulation. 15 Feb, 2018 https://www.clinsurggroup.us/articles/IJCMS-5-136.php In the current study, we have experimentally and comparatively investigated and compared malignant human cancer cells and tissues before and after irradiating of synchrotron radiation using Saturated Spectroscopy and Unsaturated Spectroscopy, respectively. 05 Dec, 2017 https://www.clinsurggroup.us/articles/IJCMS-4-135.php A 16 year old girl presented with severe congestive dysmenorrhea shortly after the onset of menarche at 14 years of age. Menstrual cycles were otherwise regular with normal fl ow pattern. She was prescribed multiple NSAIDS, which provided minimal relief. 29 Nov, 2017 https://www.clinsurggroup.us/articles/IJCMS-4-134.php The incidence of invasive yeast infections is rising in patients hospitalised in intensive care. Their early diagnosis is problematic, although predictive models (Pitt’s colonization index, Leon score and others) can be helpful when deciding to initiate treatment 19 Jun, 2017 https://www.clinsurggroup.us/articles/IJCMS-4-133.php Radioactive Iodine (RAI) has been an integral part of the identifi cation, surveillance, and treatment of the most common types of metastatic thyroid carcinoma since its fi rst use in 1941 30 Dec, 2016 https://www.clinsurggroup.us/articles/IJCMS-3-132.php Objective: Cardiopulmonary bypass (CPB) induces a systemic inflammatory response which is thought to be a significant cause of postoperative organ dysfunction and mortality. In this study we aimed to investigate the effect of ITGA2B (integrin alpha 2b, platelet glycoprotein IIb of IIb/IIIa complex) gene polymorphism on the magnitude of inflammatory response after CPB 21 Dec, 2016 https://www.clinsurggroup.us/articles/IJCMS-3-131.php Objective: To evaluate testicular volume, varicocelle, hydrocelle, microlithiasis, semen parameters and measure serum FSH, LH, and Testosterone concentrations in young male thalassemic patients. 19 Dec, 2016 https://www.clinsurggroup.us/articles/IJCMS-3-130.php Energy drinks have become readily available and are being utilized globally. However, the potential side effects of their use are not well understood. Most consumers use these beverages with the goal of increasing energy. 06 Dec, 2016 https://www.clinsurggroup.us/articles/IJCMS-3-129.php Human tissues and organs could be affected depending on pathological condition of diseases. Proteins are basic functioning molecules of cells accordingly to modification intensities. 29 Nov, 2016 https://www.clinsurggroup.us/articles/IJCMS-3-128.php Introduction. Recent studies that characterize the subventricular zone (SVZ) have identified the role that it represents for neurogenesis, neuromigration processes and the formation of cortical neural networks. There are two neurogenic niches in the adult human brain, the SVZ and the dentate gyrus of the hippocampus, where neural stem cells have a significant potential of differentiation to become glial cells and neurons. 25 Aug, 2016 https://www.clinsurggroup.us/Clinical-Medical-Sciences/IJCMS-3-127.php Placement of a ventriculoperitoneal shunt is an established procedure for treatment of hydrocephalus, however, complications can occur. The most common causes of shunt malfunction are catheter obstruction and infection. The incidence of Ventriculoperitoneal shunt related abdominal complications has been reported to be from 5% to 47% [1]. The most common distal ventriculoperitoneal shunt complications include shunt infection, subcutaneous collection of CSF, peritoneal pseudocyst, bowel perforation, intestinal volvulus, mesenteric pseudotumor, migration of the catheter into the pleural cavity and heart, and development of an incision hernia [2]. 13 Jul, 2016 https://www.clinsurggroup.us/Clinical-Medical-Sciences/IJCMS-3-126.php The patient was a 15-year-old girl with an established diagnosis of Alagille syndrome (AS) since early life. Her medical history was significant for systemic manifestations of AS including liver transplantation and pulmonary artery balloon dilation. She had an unusual triangular facies characterized by a broad overhanging forehead, deep set, hyperteloric eyes and small pointed chin. Her best-corrected visual acuity was 1.0 in both eyes. Slit-lamp examination was positive for posterior embryotoxon in both eyes. Funduscopy revealed diffuse choroidal hypopigmentation with increased visibility of the choroidal vessels and symmetric, well-circumscribed macular discoloration (Figure 1). A circumferential chorioretinal atrophy was also detected in the peripheral retina (Figure 1). 08 May, 2016 https://www.clinsurggroup.us/Clinical-Medical-Sciences/IJCMS-3-125.php Kp community-acquired pneumonia is rarely encountered. Its prevalence is higher in Asia, where a higher strain virulence was demonstrated [1,2]. It's a pyo-pneumothorax, which usually occurs on debilitated or immuno-compromised patients. It is a severe disease associated with high mortality. Here, we report the observation of a Kp community-acquired pneumonia occurring in a genetic disorder context. 07 Apr, 2016 https://www.clinsurggroup.us/Clinical-Medical-Sciences/IJCMS-3-124.php An elderly male presents to orthopedic clinic with severe back pain for fifteen days. He is unable to sit or stand. The pain remains persistent even while lying supine. He also complains of nausea, anorexia and cough with blood tinged sputum since ten days. He gives past history of grade II benign prostatic hyperplasia with nodule under prostate specific antigen monitoring. Examination reveals no significant finding. 06 Feb, 2016 https://www.clinsurggroup.us/Clinical-Medical-Sciences/IJCMS-3-123.php A 79-year-old man presented to our emergency department with sudden back pain. Laboratory results showed CK 2836 U/L (normal range 30-160), CK-MB 393 U/L (<25), D-dimer 1.4 µg/mL (<1), BNP 37.9 pg/mL (<19.5), cTnl 0.133ng/mL (<0.028) and electrocardiogram showed ST elevation in V1~6. Acute myocardial infarction (AMI) was suspected. Because of the back pain, acute aortic dissection (AAD) and pulmonary thromboembolism (PE) needed to be ruled out and contrast-enhanced computed tomography (CECT) was performed. CECT images showed no findings of AAD or PE. Instead, the images revealed the decreased enhancement in the interventricular septum and apex of the left ventricle (Figure A,B, arterial phase, Figure C,D, delayed phase). 25 Jan, 2016 https://www.clinsurggroup.us/Clinical-Medical-Sciences/IJCMS-3-122.php The inadvertent swallowing of foreign bodies is common, but results in perforation of the gastrointestinal tract in less than 1% of cases [1]. Because any site of the gastrointestinal tract may be perforated by a foreign body, the clinical presentation may vary and mimic diverse medical conditions. Presentation may be early in the form of peritonitis or late in the form of intra-abdominal abscess. Up to date no case of abdominal wall abscess was reported. 25 Jan, 2016 https://www.clinsurggroup.us/Clinical-Medical-Sciences/IJCMS-3-121.php Eight year-old child presented with two year history of dyspnoea on exertion. Clinical examination revealed a continuous murmur peaking in diastole. Two dimensional transthoracic echocardiography revealed a dilated left circumflex artery (LCX) in parasternal short axis view with enlarged right atrium (RA) and right ventricle (Figures 1A,B). Apical four chamber view demonstrated fistulous flow from LCX to RA (Figures 1C,D, arrows); flow travelled initially in left atrioventricular groove and then along inter-atrial septum before opening into RA near its superior wall (Movie 1). 07 Oct, 2015 https://www.clinsurggroup.us/Clinical-Medical-Sciences/IJCMS-2-120.php A patient of 55 years presented seven days ago a fever. Since 3 days he developed multiple nodular lesions. Dermatological examination revealed pruriginous pinkish and infiltrated plaques, nodules and papules, with firm consistency, disseminated on the trunk .There was no mucosal or nail lesions. The rest of the physical examination was normal. Histology was in favor of leukemia cutis witch correspond to cutaneous localization of acute leukemia. The study of skin lesions allowed a quick diagnosis of the etiology of fever. The care of his leukemia is accompanied by the disappearance of lesions. 24 Apr, 2015 https://www.clinsurggroup.us/Clinical-Medical-Sciences/IJCMS-2-119.php Airway management has made many advances in recent years. However, an unanticipated difficult airway can turn out to be a nightmare for anaesthesiologist. The various predictors include clinical assessment predictors, X-ray neck, conventional helical computed tomographic (CT) scan, indirect laryngoscopy, pulmonary function tests and fiberoptic bronchoscopy had been successfully used for delineation of airway anatomy [11. Pinsonneault C, Donati F (1999) Tracheal resection and reconstruction. Can J Anaesth 46: 439-455.]. The shortcomings of aforementioned techniques except for fiberoptic bronchoscopy are that they tell about static component without giving much information about dynamic component of airway. 22 Apr, 2015 https://www.clinsurggroup.us/Clinical-Medical-Sciences/IJCMS-2-118.php The squamous papilloma is a common benign oral epithelial neoplasm [11. Naik R, Nithin KP, Mujib BR, Rai KK (2014) An Unusual Presentation of Squamous Papilloma on the Buccal Mucosa. Indian Journal of Multidisciplinary Dentistry 4: 1015-18.]. Papilloma usually presents as an exophytic, painless papillary mass [22. Neville BW, Damm DD, Allen CM, Bouquot JE (2009) Oral and maxillofacial pathology. 3rd ed. Philadelphia. Elsevier p362-63.]. Oral Submucous Fibrosis is a premalignant condition [33. Auluck A, Rosin MP, Zhag L, Sumanth KN (2008) Oral Submucous Fibrosis, a Clinically Benign but Potentially Malignant Disease: Report of 3 Cases and Review of the Literature. J Can Dent Assoc 74: 735-40.]. A 45 year old female patient presented with growth in inner side of left cheek region. Patient had history of gutka chewing for past 6 years. On intra oral examination, the growth was pinkish, strawberry like in appearance with a papillary surface in the right buccal mucosa (Figure 1). Generalized blanching of oral mucosa was present (Figure 2). The growth was not tender on palpation and firm in consistency. The growth was pedunculated with no induration or bleeding on palpation. Palpable fibrotic bands were present in the buccal mucosa. 21 Mar, 2015 https://www.clinsurggroup.us/Clinical-Medical-Sciences/IJCMS-2-117.php Coloduodenal fistula is a very infrequent complication, which can arise from both benign and malignant diseases. It consists in a pathological communication between the lumen of the colon and duodenum. The onset of signs and symptoms is generally sub-acute, and the majority of the patients will present with a non-specific abdominal pain, diarrhoea, nausea and vomiting [1]. Nevertheless, the clinical presentation may vary significantly - depending on the site of fistulisation - and some cases may never be diagnosed. 18 Dec, 2014 https://www.clinsurggroup.us/Clinical-Medical-Sciences/IJCMS-2-116.php Hepatic hydrothorax (HH), variceal haemorrhage (VH) and portal vein thrombosis (PVT) are complications associated with hepatic cirrhosis (HC) and involve poor prognosis. HH occurs in 4%-17% of cirrhotic patients [1]. Atypical presentations include pleural effusion without ascites and left-sided only effusions. The pathophysiology is believed to involve defects in tendinous diaphragmatic portion. Usual treatment includes diuretics and thoracocentesis, and even transjugular intrahepatic portosystemic shunt (TIPS) and liver transplantation [2]. Among patients with cirrhosis, due to portal hypertension (PH), varices form quite frequently (10% a year, approximately), and about a third of patients with varices will develop VH. PVT is commonly developed in cirrhosis (ultrasonography studies have reported prevalence of 5 to 24 per cent), and is related to unbalanced haemostasis and slowing of portal flow. 13 Dec, 2014 https://www.clinsurggroup.us/Clinical-Medical-Sciences/IJCMS-2-115.php Gingival Recession 24 Nov, 2014 https://www.clinsurggroup.us/Clinical-Medical-Sciences/IJCMS-1-114.php 82-year-old male patient previously twice subjected to surgical intervention for peritonitis, and to two subsequent interventions for giant incisional hernia. After the final intervention, the meshpad was removed, due to infection, but the giant eventration persisted. Eight years later, when anaemia was observed, a gastroenterology examination was performed and sigmoid cancer diagnosed. Subsequent CT scans revealed a giant right renal cyst measuring 29 × 21 cm, within the evisceration. In response, a left hemicolectomy was performed, with resection and marsupialisation of the renal cyst, and repair of the incisional hernia. The patient evolved well and was discharged eight days after surgery. 17 Oct, 2014 https://www.clinsurggroup.us/Clinical-Medical-Sciences/IJCMS-1-113.php It's my privilege and honor to write the editorial of a newly enterprising title "Imaging Journal of Clinical and Medical Sciences (IJCMS)." "Peertechz" has done an excellent work again. We are already enamored by an overwhelming response from various authors throughout the globe. Again I will say it's just the beginning of a new endeavor. IJCMS is a peer-reviewed international journal, with the main purpose to provide a scientific platform for the publication of papers documenting recent advances and new developments in the field of radiology in medicine and biology, as well as regularly updating on existing modalities and scenarios. 29 Sep, 2014 https://www.clinsurggroup.us/Clinical-Medical-Sciences/IJCMS-1-112.php Emergent airway obstruction is a dreaded emergency among anesthesiologists. Classically has been managed with awake options, particularly fibreoptic intubation. Laryngoceles, if size and accessibility allows for it, can be evacuated by needle aspiration, postponing definitive management. 10 Sep, 2014 https://www.clinsurggroup.us/Clinical-Medical-Sciences/IJCMS-1-111.php A 45-year-old man presented to the emergency room with abdominal pain and distention, dyspnea and a scrotal mass with absence of a visible penis as shown in the figure 1 below. Abdominal circumference was 120 cm, scrotum circumference was 80 cm and the height of the scrotum was 35 cm. There were no signs of acute abdomen and preliminary routine laboratory labs were within normal except for minimally elevated transaminase levels. Physical examination showed that the patient has ascites along with a compressible painful scrotum and he is known to have Hepatitis C. There were no signs of acute gastrointestinal bleeding or encephalopathy. 08 Sep, 2014 https://www.clinsurggroup.us/Clinical-Medical-Sciences/IJCMS-1-110.php Airway management is the basic skill acquired and mastered by anesthesiologist and is their prime responsibility. Difficulties in optimal airway management can lead to serious adverse effects and failure can even lead to mortality. Due to these reasons, diligent efforts are continuously being undertaken to improve the care in form of introduction of various guidelines, audits, safe monitoring standards and newer airway gadgets. Conventional imaging includes x-rays, computed tomography (CT) or Magnetic resonance imaging (MRI). However these have risk of radiations hazards and do not provide real time imaging required during airway management. Ultrasound (US) is one such relatively recent adjunct to anaesthesiologist's armentarium. Since its inception in airway management, the list of applications of ultrasonography in perioperative, emergency and critical care settings is increasing exponentially. Its advantages include safety, simplicity, portability, non-invasiveness, cost effectiveness and reproducibility. Ample literature now exists to support its utility as well as efficacy. 08 Sep, 2014 https://www.clinsurggroup.us/Clinical-Medical-Sciences/IJCMS-1-109.php A 48-year-old man presented with exotropia of his left eye. The alternative prism cover test demonstrated there was 60 prism diopter exotropia. A 9 mm lateral rectus muscle recession and a 7 mm medial rectus muscle resection were performed in his left eye. Approximately one month later, a polypoid, red, smooth-surfaced mass arose from the area overlying the original insertion of lateral rectus muscle (Figure 1A). We diagnosed this mass as pyogenic granuloma. One month after administration with topical corticosteroid drops, this mass was completely resolved (Figure 1B). There was no recurrence during the 2 years after surgery. 28 Aug, 2014 https://www.clinsurggroup.us/Clinical-Medical-Sciences/IJCMS-1-108.php A 21-month old age girl presented with asymptomatic lesions on her right arm of 4 days duration. She denied sore throat, fever and cough and no lesions were found anywhere else including buccal mucosa. She had not taken any medications recently. 24 Jul, 2014 https://www.clinsurggroup.us/Clinical-Medical-Sciences/IJCMS-1-107.php Head trauma is a common cause of anosmia; however, the diagnosis is typically late, owing to greater attention being given to the more life-threatening sequelae of the injury. Studies have cited olfactory dysfunction as occurring in approximately 30% of all head traumas [1]. A 19-year-old woman presented with olfactory disturbance after suffering a cranial base fracture 2 months previously in a traffic accident. Examination by T&T olfactogram revealed that she had the condition of total anosmia. Brain magnetic resonance imaging (MRI) showed abnormal intensity due to cerebral contusion bilaterally in the orbitofrontal cortex, predominantly on the right side. In contrast, definite laterality was not detected at the olfactory tracts. From the above findings, we speculated that the anosmia in this patient may have been caused mainly by orbitofrontal cortex damage. 03 Jul, 2014 https://www.clinsurggroup.us/Clinical-Medical-Sciences/IJCMS-1-106.php Psoriasis is an immune mediated, chronic inflammatory, incurable condition of the skin that affects 2-3% of the population globally. It is associated with red, thick, scaly lesions [1], is more common in patients on higher latitudes, in Caucasians and may manifest itself with an underlying arthropathy. Psoriasis has a spectrum of presentations ranging from localized, mild disease to involvement of more than 90% of the body's surface called erythrodermic form [2]. In as many as 4% of the patients with psoriatic the first sign of disease involves changes to the nail, however, these nail changes are seen in about half patients at some point in the course of the disease. Arthropathy, specifically, Psoriatic arthritis is also seen in about 5-10% of this patient population [3]. 03 Jul, 2014 https://www.clinsurggroup.us/Clinical-Medical-Sciences/IJCMS-1-105.php Bilateral Congenital Colobomas and Vitiligo in a Blind Middle Aged Female 03 Jul, 2014 https://www.clinsurggroup.us/Clinical-Medical-Sciences/IJCMS-1-104.php Severe calcification of the pericardium with thickness measuring up to an impressive 1.2 cm leading to bi-atrial enlargement. The inter-ventricular septum is also straightened. All these findings are highly suggestive of constrictive pericarditis on the CT scan image shown above. 03 Jul, 2014 https://www.clinsurggroup.us/Clinical-Medical-Sciences/IJCMS-1-103.php Patient is a 30 year old male with no significant past medical history who repeatedly sought medical attention for debilitating right testicular pain. Initially he was symptomatically treated with non-steroidal anti-inflammatory medications for presumptive diagnosis of testicular trauma. A few months later he went to different emergency department and was treated with antibiotics for presumptive diagnosis of epididymitis. Finally at his third presentation he was hospitalized. Three testicular biopsies were taken and only the biopsy sample from the middle area of the right testes revealed polyarthritis nodosa. The Patient had no other signs and symptoms and this was likely isolated PAN of his right testes which is a very rare occurrence. 03 Jul, 2014 https://www.clinsurggroup.us/Clinical-Medical-Sciences/IJCMS-1-102.php he blue arrows point to the pleural calcification seen in this patient with asbestos exposure. Patient is a 76 year old male who suffered from severe asbestos exposure while working for the plumbing industry. He Presented to the emergency department after a motor vehicle accident and on workup was incidentally found to have bilateral pleural effusions and calcification of the pleura in the left lung consistent with Mesothelioma. 03 Jul, 2014 https://www.clinsurggroup.us/Clinical-Medical-Sciences/IJCMS-1-101.php Bilateral Congenital Colobomas leading to blindness in this middle aged female.