Natalija Stefanović

Peculiarities of the sural nerve complex morphologic types in human fetuses

The sural nerve is the most frequently used sensory nerve in nerve transplantation. It can be transplanted alone or together with the other elements of the neurovascular stalk within the superficial sural flap. The aim of this study was to define the morphologic types of the sural nerve complex, as well as to describe their specific characteristics. Microdissection was performed on 100 human fetuses (200 calves) after 10% formalin fixation. Five morphologic types of sural nerve complex with different incidence were defined. Two morphologic types dominated: type I (58.5%) in which the sural nerve was formed by merging of a fibular communicating branch and the medial sural cutaneous nerve, and type III (26%) in which the medial sural cutaneous nerve took over the function of the sural nerve. Other morphologic variations were less common.

Progression of kidney damage in Balkan endemic nephropathy: a 15-year follow-up of patients with kidney biopsy examination.

Progression of kidney damage was studied in 18 patients with Balkan endemic nephropathy (BEN), with a mean 15-year follow-up after renal biopsy. According to kidney function, estimated by 99mTc-DTPA clearance, patients were divided into three groups: with apparently normal kidney function (clearance 103.5 ± 21.3 mL/min/1.73 m2), with incipient renal failure (clearance 65.5 ± 11.3), and with advanced renal failure (clearance 28.0 ± 6.2). The mean yearly decrease of glomerular filtration rate was 2.74 mL/min. In two patients, an increase of kidney function was recorded. Six patients become dialysis dependent, two from the group with incipient renal failure, but all four from the group with advanced renal failure. Three patients died after 8 to 12 years of follow-up, one from causes unrelated to kidney disease and two from end-stage renal failure. This study has shown that BEN is characterized by a slow course and prolonged evolution, modified by medical supervision and treatment.

Morphometric Analysis of Connective Tissue Sheaths of Sural Nerve in Diabetic and Nondiabetic Patients

One of the most common complications of diabetes mellitus is diabetic neuropathy. It may be provoked by metabolic and/or vascular factors, and depending on duration of disease, various layers of nerve may be affected. Our aim was to investigate influence of diabetes on the epineurial, perineurial, and endoneurial connective tissue sheaths. The study included 15 samples of sural nerve divided into three groups: diabetic group, peripheral vascular disease group, and control group. After morphological analysis, morphometric parameters were determined for each case using ImageJ software. Compared to the control group, the diabetic cases had significantly higher perineurial index (P < 0.05) and endoneurial connective tissue percentage (P < 0.01). The diabetic group showed significantly higher epineurial area (P < 0.01), as well as percentage of endoneurial connective tissue (P < 0.01), in relation to the peripheral vascular disease group. It is obvious that hyperglycemia and ischemia present in diabetes lead to substantial changes in connective tissue sheaths of nerve, particularly in peri- and endoneurium. Perineurial thickening and significant endoneurial fibrosis may impair the balance of endoneurial homeostasis and regenerative ability of the nerve fibers. Future investigations should focus on studying the components of extracellular matrix of connective tissue sheaths in diabetic nerves.

Hemodialysis Treatment in Patients with Balkan Endemic Nephropathy: An Epidemiological Study

Aim. To analyze hemodialysis (HD) treatment of patients with Balkan endemic nephropathy (BEN) from five endemic villages in the South Morava Region of Serbia. Analyses of patterns of incidence may generate hypotheses about the underlying causes of BEN, and prevalence data provide information on the current and likely future burden on health services for managing BEN. Methods. A total of 143 end-stage kidney disease patients (ESKD) with BEN were admitted to the renal replacement program from 1974 to 2004: 121 to HD, 15 peritoneal dialysis, and 7 kidney transplantation. As a control group, 117 patients with other kidney disease (chronic pyelonephritis, glomerulonephritis, and ischemic nephropathy) admitted to HD at the time of BEN patients and matched by age and gender were studied. Results. Most of the BEN patients (93.4%) treated by HD were born from 1917 to 1941. The majority of patients (79.3%) started HD from 1977 to 1991 (period of 15 years). The mean age of BEN patients starting HD treatment was 49.1 years in the period from 1974 to 1978, and increased steadily in the following years, being 72.5 years in the last period of study (2004–2006) The mean survival time of BEN males was 4.70 (95% CI 3.66–5.75) and for females was 5.02 (95% CI 1.47–4.53). Difference between males and females was not statistically significant (log rank 0.14, p = 0.7, P > 0.5). Mean survival times of 4.84 (95% CI 3.97–5.70) in BEN patients and 3.1 (95% CI 2.78–3.84) in other kidney disease patients were found. Difference between BEN patients and controls was statistically significant (log rank 8.38, p = 0.0038, P < 0.01). Conclusion. The population of endemic villages around the South Morava River admitted to HD treatment after 1974 was exposed to environmental toxicant(s) from 1917 to 1941. The most intense effect of environmental exposure was in that period, with ESKD in patients in their forties. The exposure to environmental toxicants has diminished, so ESKD of BEN has become less frequent and manifested in the older age, mean 72.5 in the period from 2004 to 2006. Different type of exposure was registered in some other endemic regions in Serbia and abroad.

Analysis of Fascicular Structure and Connective Tissue Sheaths in Sural Nerve during Aging

Summary The aim of our study was to analyze the changes of connective tissue sheaths of epi-, peri- and endoneurium of sural nerve during aging. The study was conducted on sural nerve samples of 10 cases aged 9-80 years. The specimens were embedded in paraffin using standard procedures, after which 5-μm-thick cross-sections of nerve trunks were made and stained using Masson’s trichrome staining. After morphological analysis of fascicular structure and connective sheaths of the nerve, morphometric analysis was conducted using the software for digital image analysis “ImageJ”. Each investigated case was analyzed for total neural, epineurial and fascicular cross-section area, mean values of perineurial index, volume density of myelinated axons and of endoneurial content. To test the difference in mean values for statistical significance we used the Student’s T-test for small independent sample. The number of fascicles was 5-13, while the majority of the nerves had less than 10 fascicles. Fascicular structure, which included the number of fascicles and epifascicular/fascicular area ratio, did not show significant changes during aging. Perineurial thickness /fascicle size ratio statistically significantly increased in the older investigated group (p<0.05). Myelinated fibres were of smaller diameter, with more irregular form and markedly less frequent in older cases. Quantitative analysis showed statistically significant decrease in volume density of myelinated fibres in the older group. As results of applied investigation methods we found thickening of perineurial sheath of sural nerve during aging, as well as endoneurial fibrosis. Future investigations of age-related changes should focus on analysis of the components of extracellular matrix within perineurium and endoneurium.

Longitudinal striae of the human fornix: shape, relations and variations

BackgroundTwo pairs of sagittal longitudinal striae, medial and lateral, are slender bundles of fibers located on the dorsal surface of corpus callosum, situated deeply in the longitudinal fissure of telencephalon. Imbedded in the structure of tiny gyrus, indusium griseum, they are, in fact, supracallosal fibers of the fornix, previously called fornix longus.MethodsLongitudinal striae were investigated in 25 fixed human brains obtained from autopsies. Macrodissection and morphometric methods were used in order to find out and analyze the appearance and gross morphological variability of longitudinal striae, as well as their inter-individual relations.ResultsLateral longitudinal striae were located along the sulci of corpus callosum. Medial striae were positioned along the sagittal midline and they were mostly individual. However, they were at times connected, spanned or duplicated. Longitudinal striae make a characteristic pattern on the dorsal surface of corpus callosum. A classification of striae is made on the basis of their appearance.ConclusionsAlthough similar at first sight the striae, especially medial ones, have some individual features which make the pattern variable. Medial striae are more variable than the lateral ones. Perhaps functional neuroimaging and DT MRI will disclose the enigma of these striae.

Morphometric analysis of somatotropic cells of the adenohypophysis and muscle fibers of the psoas muscle in the process of aging in humans.

The aim of this research was to quantify changes of the adenohypophyseal somatotropes and types 1 and 2 muscle fibers with aging, as well as to establish mutual interactions and correlations with age. Material was samples of hypophysis and psoas major muscle of 27 cadavers of both genders, aged from 30 to 90 years. Adenohypophyseal and psoas major tissue sections were immunohistochemically processed and stained by anti-human growth hormone and anti-fast myosin antibodies, respectively. Morphometric analysis was performed by ImageJ. Results of morphometric analysis showed a significant increase in the somatotrope area, and significant decrease in somatotrope volume density and nucleocytoplasmic ratio with age. Cross-sectional areas of types 1 and 2, and volume density of type 2 muscle fibers decreased significantly with age. One Way ANOVA showed that the latter cited changes in the somatotropes and types 1 and 2 muscle fibers mostly become significant after the age of 70. Significant positive correlation was observed between the area of the somatotropes and volume density of type 2 muscle fibers. A significant negative correlation was detected between the nucleocytoplasmic ratio of the somatotropes and cross-sectional areas of types 1 and 2 muscle fibers. So, it can be concluded that after the age of 70, there is significant loss of the anterior pituitarys somatotropes associated with hypertrophy and possible functional decline of the remained cells. Age-related changes in the somatotropes are correlated with the simultaneous atrophy of type 1, as well as with the atrophy and loss of type 2 muscle fibers.

Parahippocampal corpora amylacea and neuronal lipofuscin in human aging

The aim of this research was to quantify the number of corpora amylacea and lipofuscin-bearing neurons in the parahippocampal region of the brain. Right parahippocampal gyrus specimens of 30 cadavers were used as material for histological and morphometric analyses. A combined Alcian Blue and Periodic Acid-Schiff technique was used for identification and quantification of corpora amylacea and lipofuscin-bearing neurons. Immunohistochemistry was performed using S100 polyclonal, neuron-specific enolase and glial fibrillary acidic protein monoclonal antibodies for differentiation of corpora amylacea and other spherical inclusions of the aging brain. Cluster analysis of obtained data showed the presence of three age groups (median age: I = 41.5, II = 68, III = 71.5). The second group was characterized by a significantly higher numerical density of subcortical corpora amylacea and number of lipofuscin-bearing neurons than other two groups. Values of the latter cited parameters in the third group were insignificantly higher than the first younger group. Linear regression showed that number of parahippocampal lipofuscin-bearing neurons significantly predicts numerical density of subcortical corpora amylacea. The above results suggest that more numerous parahippocampal region corpora amylacea and lipofuscin-bearing neurons in some older cases might represent signs of its’ neurons quantitatively-altered metabolism.

Evaluation of Some Anatomical and Anthropometric Characteristics of the Chest Based on the Analysis of Digital Images of the Anterior Aspect of Trunk in Top Athletes

Evaluation of Some Anatomical and Anthropometric Characteristics of the Chest Based on the Analysis of Digital Images of the Anterior Aspect of Trunk in Top Athletes The aim of this research was to assess the size and shape of the chest in students and top athletes. The research involved 23 first-year students of the Faculty of Sport and Physical Education, and 23 top athletes of the Athletic Federation of Serbia. The digital images of the frontal trunk aspect were made and further analyzed in ImageJ program. The vertical and horizontal distances and as well as the angles were determined: the infrasternal angle and the angle of umbilicus (sides of the angle connect the points on the left and right). Both students and athletes were divided into three height groups (I - 165-174 cm; II - 175-184 cm; III - 185-194 cm). BMI and BI were determined (shoulder width). No statistical differences in height, weight and BMI among the groups of students and top athletes were found, which pointed to the homogeneity of the groups. All the parameters determined, the vertical and horizontal ones, except AAD, were significantly higher in top athletes (p ≤ 0.05) compared to the same parameters obtained in students of all three height groups. Acromial distance increases with height, but not statistically significantly. The above mentioned indicates a significantly better development of the bone-joint-muscle system of the chest in top athletes. The infrasternalni angle correlates with the angle of the umbilicus and it can be used to assess the shape of the chest. In our researches, analysing the individual cases, the presence of normasthenic, asthenic (elongated) and barrel-shaped chest was determined. The program ImageJ is very precise, objective and easily applicable for determining the lenghtwise parameters and angles in anatomic and anthropometric measurements. The method does not require anthropometric equipment, digital images can be made quickly and efficiently. Therefore, we consider it particularly suitable for measurements in childhood and athletes. Procena nekih anatomskih i antropometrijskih karakteristika grudnog koša analizom digitalne slike prednjeg aspekta trupa kod vrhunskih atletičara Cilj istraživanja bio je da se proceni veličina i oblik grudnog koša kod studenata i vrhunskih atletičara. Istraživanja su sprovedena na 23 studenta prve godine Fakulteta sporta i fizičkog vaspitanja i 23 vrhunskih atletičara Atletskog saveza Republike Srbije. Načinjene su digitalne fotografije frontalnog aspekta trupa, koje su analizirane u ImageJ programu. Određivane su vertikalne i horizontalne distance i uglovi: infrasternalni i ugao sa temenom kod umbilikusa (kraci ugla spajaju akromijalne tačke levo i desno). I studenti i atletičari podeljeni su u tri visinske grupe (I: 165-174cm; II: 175-184cm; III: 185-194 cm). Određivan je BMI i BI (širina ramena). Nema statističkih razlika u visini, težini i BMI između grupa kod studenata i kod vrhunskih atletičara, što ukazuje na homogenost grupa. Svi određivani parametri, vertikalni i horizontalni, osim AAD, su kod vrhunskih atletičara statistički značajno veći (p 0,05) u odnosu na iste parametre kod studenata u sve tri visinske grupe. Akromijalno-akromijalna distanca se povećava sa visinom, ali ne statistički značajno. Napred navedeno ukazuje na značajno bolju razvijenost koštanozglobno-mišićnog sistema grudnog koša kod vrhunskih atletičara. Infrasternalni ugao korelira sa uglom kod umbilikusa, te se može koristiti za procenu oblika grudnog koša. U našim istraživanjima, analizom pojedinačnih slučajeva, utvrđeno je prisustvo normosteničnog, asteničnog i bačvastog oblika grudnog koša. Program ImageJ je veoma precizan, objektivan i lako primenljiv za određivanje dužinskih parametara i uglova u anatomskim i antropometrijskim merenjima. Metoda ne zahteva antropometrijsku opremu, a digitalne slike se mogu brzo i efikasno uraditi, te smatramo da je posebno pogodna kod merenja u dečijem uzrastu i kod sportista.