Are military fitness tests safe for members with a total hip arthroplasty?

INTRODUCTION: Canadian Armed Forces (CAF) members must complete an annual fitness evaluation. Members with a total hip arthroplasty (THA) may be at risk of injury during these strenuous tests. To inform CAF policy, we sought expert consensus on the safety of fitness testing for members with a THA. METHODS: We conducted a three-round Delphi study with a panel of hip arthroplasty experts to determine the safety of CAF operational fitness evaluations for members with a THA. The experts evaluated videos of the 10 individual tasks included in the evaluations. RESULTS: All individual tasks were judged to be safe by consensus. One task, which involves digging with a shovel, was considered safe provided that participants avoid deep hip flexion. The nine other tasks were judged to be safe without modifications or interventions. The experts also supported a policy recommendation that would allow members to perform military fitness evaluations if they (1) have a primary THA, (2) had no episodes of instability, (3) are at least 12 months postoperatively and (4) have been cleared by an orthopaedic surgeon and a physiatrist/physiotherapist. CONCLUSION: A panel of arthroplasty experts concluded, based on video analysis, that CAF fitness evaluations are generally safe for members with a THA.

Transtraumatic Epidural Electrostimulation of the Spinal Cord in a Pig Model.

The effect of transtraumatic epidural electrostimulation (TEES) above (T5) and below (L2) spinal cord injury in the lower thoracic region (T8-T9) in combination with treadmill exercise in pigs was evaluated using electrophysiological examination methods and behavioral tests. Two weeks after spinal cord injury, motor evoked potentials of m. soleus were recorded during electrostimulation at the level of T5 and L2 segments, which indicated activation of spinal cord structures above and below the focus of injury. After 6 weeks of TEES in combination with physical training, restoration of the characteristics of M-response and H-reflex of the soleus muscle in response to stimulation of the sciatic nerve, improvement of joint mobility, and appearance of voluntary motor activity in the hindlimbs were observed. Neuromodulation with TEES had been proven to be an effective way to stimulate posttraumatic spinal cord regeneration and can be used in the development of a neurorehabilitation protocol for patients with spinal cord injury.

Technical considerations depending on the level of vascular ligation in laparoscopic rectal resection.

AIM: In addition to ischemia there is also anastomotic ends tension proven to be a risk factor for anastomotic leak. HT vascular ligation is accepted as a rule, in attempt to achieve tension-free anastomosis. LT is a preferred option, based on the more accurate preservation of proximal intestinal segment microperfusion and lower risk of damage to the hypogastric plexus. The aim of this study is evaluation of comparative indicators in high tie (HT) and low tie (LT) laparoscopic rectal resections. METHODS: A prospective nonrandomized comparative cohort study of patients in our department with cancer of the rectum in clinical stage I-III, operated on in laparoscopic approach over a 6-years period. RESULTS: For the period 2015-2020, a number of 208 laparoscopic surgeries have been done for rectal cancer. Patients were divided into three groups-group A with HT vascular ligation 116 pts. (69%), group B-53 pts. (25%), underwent low ligation-LT and group C-39pts. (19%) low tie plus lymph node dissection of the apical LN group (LT-appic LND). The distribution was made without randomization, based on the operators' expertise. Anastomotic leaks were 3.8% in group A, 3.0% in group B and 2.9% in group C (p > 0.05) with no significance difference. There is no significant difference in the number of lymph nodes obtained in group A and group B, while in group C the number of the harvested lymph nodes was higher (p < 0.05). The indicators for intestinal / defecation dysfunction, as well as for urinary/sexual dysfunction, according to our data, are significantly more favorable in patients with LT, in contrast to the other two groups. CONCLUSION: HT vascular ligation attempts to achieve tension-free anastomosis and more harvested lymph nodes. However, LT could be a preferred option, based on the lack of significant evidence for a difference in specific oncological survival and due to more accurate preservation of proximal intestinal segment microperfusion to prevent anastomosis dehiscence, also for its lower risk of damage to the hypogastric plexus. Splenic flexure mobilization provides elongation of the proximal intestinal segment, but has no proven effect on anastomotic leakage incidence. It increases surgical duration and is in fact necessary in up to 30% of the cases. At the present moment there is no precise data whether LT has an advantage in terms of prevention of autonomic nervous and urogenital dysfunction. New prospective randomized and highly probative studies are needed to standardize the procedures in specific clinical situations.

Etiology and therapy indication for cochlear implantation in children with single-sided deafness : Retrospective analysis.

OBJECTIVE: The characteristics of children with single-sided deafness (SSD) who become candidates for unilateral cochlear implantation (uCI) were identified. STUDY DESIGN: In all, 118 children with SSD presenting from 2013-2019 to a tertiary pediatric children's hospital were retrospectively assessed regarding candidacy for uCI. RESULTS: Of the 118 children, 103 had completed uCI candidacy assessment, while 15 were undergoing this assessment at the time of review. More than half of children did not go on to implantation (63/103, 61%), with the 2 main reasons being (1) half (31/63) did not meet candidacy criteria for implantation, most commonly due to cochlear nerve aplasia/hypoplasia (31/82 who were assessed with MRI, 38%) and (2) families (30/103; 29%) declined participation in the surgical arm of the trial. The most common etiologies of SSD in the 37/103 (36%) children who both met candidacy and consented to implantation were congenital cytomegalovirus (cCMV; 16/37, 43%), unknown (6/37, 16%), cochleovestibular anomaly and trauma (each 5/37, 14%). CONCLUSIONS: Many children with SSD who present for implant candidacy assessment do not ultimately receive uCI. Major factors contributing to noncandidacy are cochlear nerve aplasia and parental acceptance of the intervention. While approximately half of children with SSD in our cohort were candidates for implantation, only 1/3 of the total cohort proceeded with implantation with the main predictors of acceptability of this intervention being an etiology (i.e., cCMV) that carries risk of progressive deterioration in the better hearing ear or SSD that was sudden in onset. These findings provide important insight into this new population of cochlear implant users and the emerging acceptance of intervention in children with SSD.

Measurements of electron density profile by frequency modulated continuous wave reflectometer in the T-10 tokamak using high magnetic field side probing and extraordinary mode lower cutoff.

A new, previously unused combination of the high magnetic field side probing and the lower extraordinary mode cutoff was used in the T-10 tokamak for the electron density profile measurements by using a frequency modulation continuous wave reflectometer. This scheme has a significant advantage for large fusion machines where flat electron density profiles and high electron temperatures are expected. The reflectometer design is based on a common scheme with voltage controlled oscillators, active multipliers, and in-phase/quadrature signal detection. Iterative procedures were applied to calibrate a microwave source frequency and compensate the dispersion of probing signals in the conventional rectangular waveguides used as the transmission lines. About 0.2% stability of the beating frequency was reached after the calibration procedure had been finished. An advanced finite-difference scheme was proposed for the reconstruction of the electron density profile to reduce errors and improve the overall performance of the algorithm. Reconstructed electron density profiles demonstrate good agreement with conventional T-10 diagnostic data. Some specific technical and physical aspects of the diagnostic were also discussed on the basis of T-10 operation experience.

Bioluminescent Study of the Distribution of High-Molecular-Weight Protein Fraction of Cellex Daily Preparation in the Brain after Intranasal Administation.

Permeability of the blood-brain barrier for protein fractions 50-100 kDa (PF50-100) of Cellex Daily preparation labeled with fluorescent tracer FITC and non-conjugated FITC were compared after intranasal administration of the preparations to healthy rats. Fluorimetrical analysis of the serum and cerebrospinal fluid samples showed that Cellex Daily PF50-100-FITC administered intranasally penetrated into the blood and cerebrospinal fluid with maximum accumulation in 2 h after administration and persists in the circulation for 24 h probably due to binding with plasma proteins. The differences in the kinetic profile of PF50-100-FITC and free FITC indirectly suggest that the major part of the preparation is not degraded within 24 h and FITC is probably not cleaved from the protein components of the preparation. In vivo fluorescence analysis showed significant fluorescent signal in the olfactory bulbs in 6 h after intranasal administration; hence, the preparation administered via this route can bypass the blood-brain barrier. Scanning laser confocal microscopy of rat brain sections confirmed penetration of the high-molecular weight protein fraction PF50-100-FITC into CNS structures. The most pronounced accumulation of the labeled drug was observed in the olfactory bulb in 6 and 12 h after administration. In contrast to free FITC administered in the control group, significant accumulation of PF50-100-FITC in the olfactory cortex and frontal cortex neurons with functionally active nuclei was observed in 6, 12 and 24 h after intranasal administration.

Hyphenated techniques in speciation analysis of polyoxometalates: identification of individual [PMo12-xVxO40]-3-x (x = 1-3) in the reaction mixtures by high performance liquid chromatography and atomic emission spectrometry with inductively coupled plasma.

Unambiguous identification of polyoxometalate (POM) species generated in self-assembly reactions in solution is rather problematic due to close similarity of their properties such as solubility and spectral characteristics. The situation is made more complex by protonation equilibria (which can change their analytical signals) and the lack of individual compounds to serve as standards for individual members of these mixtures. In the present work a new approach to the study of such POMs has been suggested, taking molybdovanadates [PMo12-xVxO40]-3-x as a model. The key feature of this approach consists of generation of so-called "conditional model systems" that include most of the expected components of a mixture formed by self-assembly, tracked down by reliable detection techniques, e.g., 51V NMR-spectroscopy in this particular case. Then the proposed composition of the mixture is verified and corrected by means of high-performance liquid chromatography coupled with inductively coupled plasma atomic emission spectrometry (HPLC-ICP-AES).

[Cognitive disorders in stroke patients: the possibilities of pharmacological correction].

OBJECTIVE: To determine the efficacy and safety of cellex in treatment of cognitive disorders in acute ischemic stroke (IS). MATERIAL AND METHODS: The study involved 246 patients with acute IS. Patients were randomly divided into two groups depending on the use of cellex or placebo along with basic treatment during 10 days. The dynamics of neuropsychological status was evaluated. RESULTS AND CONCLUSION: In IS patients, treatment with cellex have led to more rapid and marked reduction of mild and moderate cognitive disorders.

Trapping molecular bromine: a one-dimensional bromobismuthate complex with Br2 as a linker.

The reaction between solid (NMP)n{[BiBr4]}n (1) (NMP = N-methylpyridinium) and Br2, generated in situ in HBr solution, results in the formation of (NMP)3[Bi2Br9]·Br2 (2). In the structure of 2, dibromine molecules connect discrete binuclear [Bi2Br9](3-) anions into an extended network. Complex 2 is thermally stable (up to 150 °C).

[Inguinal endometriosis: two case reports and literature review].

Endometriosis is a common gynecological disease that is characterized by the presence of endometrial glands and stroma outside the uterus. Ectopic endometrial tissue can be localized in all organs of the human body, but it affects most often organs in the pelvis. The localization in the inguinal canal is extremely rare - 0.3% -0.6% of all cases of endometriosis. We report two cases of inguinal endometriosis in patients with a history of previous surgery in the pelvis. Both patients is formation in the inguinal region of increasing volume, accompanied by severe pain especially in the premenstrual period. The diagnosis was based on an exact medical history and histological examination. The main methods of treatment of inguinal endometriosis is radical surgical excision of the lesion. We recommend hormone therapy as an adjunct to treatment.

[Novelties in the Treatment of Colorectal Diseases - An Echo from the 10-th ESCP Congress].

Treatment of colorectal pathology stands continuous development. One of the promotional leaders of the new therapeutic approaches is the European Society of Coloproctology (ESCP). The annual congress of the organization held in Dublin, Ireland and it unites the elite of European Community countries. The most advanced scientific knowledge of the diseases of the colon and rectum, anal canal and perineum was presented.

[Possibilities of the treatment of speech impairment in the acute stage of ischemic stroke using neuroprotective therapy]. / Vozmozhnosti korrektsii rechevykh rasstroĭstv v ostrom periode ishemicheskogo insul'ta s pomoshch'iu neĭroprotektivnoĭ terapii.

AIM: To estimate an effect of cellex on the dynamics and time of speech functions recovery in the acute stage of ischemic stroke. MATERIAL AND METHODS: A multicenter, randomized, double-blind, placebo controlled clinical study included 8 Russian clinical sites. Four hundred eighty patients were involved. During the standard base therapy, cellex (or placebo) was introduced subcutaneously in dose 0,1 mg once a day in the first 10 days from the beginning of hospitalization. RESULTS AND CONCLUSION: The rapid and complete regress of aphasia, especially in cases of severe and middle to severe clinical course, was observed.

PRIMARY RETROPERITONEAL EXTRA-ORGAN TUMORS (PRET) - SURGICAL TACTICS.

INTRODUCTION: Retroperitoneal tumors, in general, are rare tumors which histopathological characteristics and biological behavior can be considered as benign or malignant. They originate from various tissue elements located in the retroperitoneal space. They often cover Anatomical structures of varying importance - mainly retroperitoneal vessels and organs, which determines the type of surgery - radical or palliative. They are composed of adipose tissue, vascular elements, smooth and striated muscle, neural elements germline structures. There are three main types of retroperitoneal tumors: mesodermal, neurogenic and teratosarcomas. As mentioned above each can be either benign and malignant. In most cases there are no specific symptoms except general weakness, heaviness in the abdomen, loss of appetite, progressive weight loss, headache and fever. The pain is most often located in the lumbosacral area. The tumor can also cause disturbances in urination. In patients with advanced stage can be observed significantly symmetrical or asymmetrical tumor growth in the abdominal area. The most commonly used techniques for the diagnosis of the disease are X-ray, CT-scan and MRI. MATERIAL AND METHODS: Retrospective study involving 112 cases operated in the clinic for 14-years period (2000-2014) - 101 patients, 11 of them were operated on twice in a different time interval on the occasion of relapsed malignant process. RESULTS: Out of all operated cases, 42% are males (47 cases) and 58% - women (65 cases). In most cases (72% - 81 cases) tumors are malignant. All patients were treated surgically. There were followed up a total of 89 patients over a period of 3 months to 8 years (96 months) as of the studied malignant cases 3 year survival was observed in 21 patients, and one patient has survived 96 months after total extirpation of fibrosarcoma. Early postoperative mortality (till 20th postoperative day) was registered in 3 patients - 2.67% of all operated cases. DISCUSSION: About 80% of primary retroperitoneal extra-organ tumors are generally malignant. People of all ages are affected equally and no statistically significant difference in the number of men and women is detected. There are many theories about the emergence of retroperitoneal tumors, but currently none of them has not been fully proven. Treatment depends on the type of the lesion. Surgery is the main approach and it should be applied to both benign and malignant lesions. In the case of malignancy other methods than surgical are chemo- and radiotherapy but they are less effective.

Clinical and prognostic significance of pathological and inflammatory markers in the surgical treatment of locally advanced colorectal cancer.

BACKGROUND: Locally advanced colorectal cancer (CRC) may vary in its clinical and pathological appearance. It is now accepted that progression of disease in patients with locally advanced CRC is determined not only by local tumor characteristics but also by the immune system and inflammatory response in the body. METHODS: We investigated patients with confirmed CRC who were treated in the surgical clinic at the University Hospital Alexandrovska over a 10-year period and retrospectively evaluated the histological features of the preoperative biopsies and operative specimens removed during radical multivisceral resections. We also collected prospective data for serum C-reactive protein levels and Jass-Klintrup score, Petersen Index score, and Glasgow Prognostic Score in patients with locally advanced CRC. RESULTS: Of 1,105 patients with CRC, 327 (29.6%) were diagnosed with locally advanced disease. In total, 108 combined multivisceral resections (79 for primary tumors and 29 for recurrent tumors) were performed. Overall survival was 34 months for pR0 cases and 12 months for pR1 cases (P<0.05). Our data confirmed that C-reactive protein is a prognostic marker of overall survival. Data for 48 patients with histologically confirmed locally advanced tumors showed significantly increased survival with a higher Jass-Klintrup score (P=0.037). In patients with node-negative disease, 5-year survival was 49%. However, where there were high-risk pathological characteristics according to the Petersen Index, survival was similar to that for node-positive disease (P=0.702). Our data also showed a significant difference in survival between groups divided according to whether they had a modified Glasgow Prognostic Score of 1 or 2 (P=0.031). CONCLUSION: In order to maintain a reasonable balance between an aggressive approach and so-called meaningless "surgical exorbitance", we should focus on certain histopathological and inflammatory markers that can be identified as additional factors for planning the type and volume of surgical treatment.

[Differentiation of mesenchymal stem cells of adipose tissue].

Experimental investigation were conducted with the objective to determine a stem cells, capacity to differentiate in adipogenic direction, if they were obtained from adipose tissue. The investigation results have witnessed, that the cells, obtained from adipose tissue, are capable for a tissue-speciphic differentiation in osteogenic, chondrogenic, and, principally--in adipogenic direction, what confirms a multypotent nature of mesenchymal stem cells of adipose tissue. Adipose tissue constitutes an alternative to the bone marrow, as a source of multipotent mesenchymal stem cells, which may be applied in further investigations, concerning determination of their defense possibility for the transplanted autologous adipose tissue from the tissue resorption, made in a lipophiling way.

Platinum polyoxoniobates.

Reaction of [Nb6O19](8-) with [Pt(OH)4(H2O)2] upon heating yielded first characterized platinum polyniobates. A dimeric complex [Nb6O19{Pt(OH)2}]2(12-) (1) is produced in a 1 : 1 molar ratio. Increasing the Pt/Nb6 molar ratio to 1 : 2 yields a mixture of 1 and a sandwich-type complex [Pt(Nb6O19)2](12-) (2).

Grafting {Cp*Rh}(2+) on the surface of Nb and Ta Lindqvist-type POM.

New hybrid POM based on Lindqvist-type polyoxometalates [M6O19](8-) (M = Nb, Ta) and organometallic fragment {Cp*Rh}(2+) have been isolated and characterized. X-ray quality crystals of K4[(Cp*Rh)2Nb6O19]·20H2O () and Cs4[(Cp*Rh)2Ta6O19]·18H2O () were obtained from solutions with {Cp*Rh} : [M6O19](8-) stoichiometry 2 : 1. The solution behavior of the hybrid polyoxoanions was studied with ESI-MS and (1)H DOSY NMR. Amongst the poorly investigated chemistry of polyoxotantalates, complex is the first complex bearing a grafted organometallic fragment. The formation of 1 : 1 complexes was detected by ESI-MS techniques.

Coordination-induced condensation of [Ta6O19](8-): synthesis and structure of [{(C6H6)Ru}2Ta6O19](4-) and [{(C6H6)RuTa6O18}2(µ-O)](10-).

Reaction of [(C6H6)RuCl2]2 and Na8[Ta6O19] gives two new hybrid organometallic POM complexes, Na10[{(C6H6)RuTa6O18}2(µ-O)]·39.4H2O (Na10-1) and Na4(trans-[{(C6H6)Ru}2Ta6O19]·20H2O (Na4-2). In both cases the half-sandwich fragments {(C6H6)Ru}(2+) are coordinated as additional vertices to the {Ta3(µ2-O)3} triangles of the hexatantalate. According to NMR and ESI-MS data, the dimeric complex [{(C6H6)RuTa6O18}2(µ-O)](10-) dissociates in water with the formation of monomeric [(C6H6)RuTa6O19](6-) species (1a). X-ray structural characterization and aqueous speciation of the complexes by (13)C, (1)H, and DOSY NMR; ESI-MS; and capillary electrophoresis (CE) have been carried out.

[Assurance of intestinal transplant quality].

Issues of preservation of function and the intestinal transplant quality, security for a recipient, prophylaxis of rejection reaction, immunosuppressive therapy were enlighted.

Peutz-Jeghers syndrome--a rare case and a literature review.

The Peutz-Jeghers syndrome is inherited condition, characterized by hamartomatous gastrointestinal polyposis and with mucocutaneous pigmentation. We have experienced a case with typical clinical features, diagnosed before complication's development. In order to prevent cancer setting it is recommended to perform aggressive screening and high-technological procedures.