DIFFERENCE IN PATIENT QUALITY OF LIFE AFTER HIP ARTHROPLASTY WITH A MINIMALLY INVASIVE APPROACH OR CLASSIC APPROACH.

The increasing rate of orthopedic procedures, hip arthroplasty in particular, requires improvement of surgical techniques, as well as of the respective rehabilitation protocols. The aim of the study was to assess differences in the quality of life and incidence of limping eight years after total hip arthroplasty performed with a minimally invasive or classic approach. This cross-sectional study included 68 patients, i.e. 32 operated with classic approach and 36 with minimally invasive approach during 2011. The following parameters were observed: anthropometric measurements, history of comorbidity, subjective assessment of limping, and SF-36 questionnaire (Short Form Survey Instrument). SF-36 testing, which consists of 8 domains, showed that 5 domains of the quality of life were statistically significantly better in the minimally invasive group (level of significance p<0.05). These domains were role of limitation due to physical health (p=0.01), energy (p=0.02), social functioning (p=0.02), pain (p=0.02) and general health (p=0.00). The minimally invasive group had a statistically significantly lower incidence of limping (p=0.032). Quality of life after hip replacement could be a decisive factor when choosing the type of orthopedic procedure. The higher number of limping patients in the classic approach group may have contributed to differences in the quality of life. In conclusion, the minimally invasive approach enables higher long-term quality of life and functional recovery.

THE ROLE OF PARAVERTEBRAL BLOCKS IN AMBULATORY SURGERY: REVIEW OF THE LITERATURE.

Ambulatory surgery often involves surgical procedures on the thorax, abdomen and limbs, which can be associated with substantial postoperative pain. The aim of this narrative review is to provide an analysis of the effectiveness of paravertebral block (PVB) alone or in combination with general anaesthesia, in this setting, with an emphasis on satisfactory postoperative analgesia in comparison to other modalities. We have conducted a search of current medical literature written in English through PubMed, Google Scholar and Ovid Medline®. Peer-reviewed professional articles, review articles, retrospective and prospective studies, case reports and case series were systematically searched for during the time period between November 2003 and February 2019. The literature used for the purpose of creating this review showed that utilisation of paravertebral block either alone or in combination with general anaesthesia, has a positive effect on satisfactory analgesia in ambulatory surgery. With a multimodal analgesic approach of PVB and other techniques of anaesthesia and analgesia there is a reduction in postoperative opioid consumption, fewer side effects, lower pain scores, decreased mortality, earlier mobilisation of patients and reduced hospital stay.

Comparative study of frequency of different lymphocytes subpopulation in peripheral blood of patients with prostate cancer and benign prostatic hyperplasia.

PURPOSE: Benign prostatic hyperplasia (BPH) and prostate cancer (PC) are the most common urologic diseases among men over fifty and, until recently, they were considered to be caused by the impaired immune response. Despite many studies designed to investigate T-cell-based antitumor immunity, the role of innate immune cells in BPH and PC is still poorly understood. In this study the frequency of different leukocytes subpopulation in peripheral blood of BPH, PC patients and in healthy volunteers was analysed and compared. METHODS: In a cross-sectional study 60 subjects were enrolled (20 patients with BPH or with PC and 20 healthy volunteers). Peripheral blood mononuclear cells (PBMC) were isolated and the percentage of T lymphocytes, natural killer (NK) and NKT cells, as well as subsets of T lymphocytes [CD3(+)CD56(-)CD4(+), T(regs) (CD4(+)CD25(+)FoxP3(+)) and CD3(+)CD56(-)CD8(+)] and NK cells (CD3(-)CD56(+dim) and CD3(-)CD56(+bright)) were analysed by flow cytometry. Intracellular content of interleukin-4 (IL-4) and interferon gamma (IFNγ in T lymphocytes, NK and NKT cells were also detected. RESULTS: The percentage of T lymphocytes and their subsets in peripheral blood lymphocytes did not differ among investigated groups, while the frequency of Tregs was the highest in PC patients. The percentage of NK cell and their subsets did not differ among investigated groups. Negative correlation between PSA value, percentage of T lymphocytes and NK cells was observed only in PC patients. Highly positive correlation between the PSA value and the percentage of Tregs was found in PC patients. CONCLUSION: Different frequencies in distinctly lymphocyte subpopulation in peripheral blood of healthy men, BPH and PC patients could be responsible for occurrence and progression of prostatic hyperplasia or tumour. Due to the ability of tumours to suppress the cognate T cell immune response, the cells of innate immunity (NKT and Tregs) may be playing a key role in the immunopathogenesis of PC and BPH.

Immunomodulation of cell-mediated cytotoxicity after chronic exposure to vapors.

Cytotoxic T lymphocytes and natural killer (NK) cells represent two major types of immune cytotoxic cells that have a crucial role in innate immunity. Urban air pollution represents a common and difficult problem in the majority of metropolises, which contain high levels of traffic congestion generating great amounts of genotoxic substances. Diesel exhaust particles act as adjuvant in the immune response and may lead to the enhancement of proinflammatory and proallergic response without exposure to allergen. The activities of diesel exhaust particles (DEPs) and their benzene extracts may cause the increasing respiratory mortality and morbidity. Since the lung inflammatory response to DEPs is compartmentalized, the importance of finding the suppressive substances, whose function will be to elucidate the DEPs effects, is fundamental. The objectives of this study were to examine the NK-mediated cytotoxicity against human NK-sensitive target, as well as the values of BTEX (benzene, toluene, ethylbenzene and xylene isomers) in urine in people from industrial area and those from rural fields. NK-mediated cytotoxicity of peripheral blood mononuclear cells was investigated against human NK-sensitive K-562 tumor cell line. BTEX were analyzed from urine by a HS-SPME method. All exposed individuals were demonstrated the significant decreased of NK-mediated cytotoxicity against human NK-sensitive target and increasing BTEX values. BTEX-analyze in urine and determination of NK-mediated cytotoxicity, as an important methods represent good markers in environmental monitoring, which contribute to the better protection of air pollutants and quicker diagnosis of environmental diseases.

Augmentation of regulatory T cells (CD4+CD25+Foxp3+) correlates with tumor stage in patients with colorectal cancer.

UNLABELLED: Recent evidence suggests that decline of regulatory T cells (Tregs) play a critical role in the prevalence of autoimmune diseases inhibiting the maintenance of peripheral self tolerance, while its augmentation leads to insufficient antitumor response, accompanied with poor prognosis in various malignancies. Increased number of Tregs (CD4+CD25+FoxP3+) were noticed in peripheral blood mononuclear cells (PBMCs), tumor-infiltrating lymphocytes (TILs) and/or regional lymph nodes lymphocytes (LNLs) of patients with gastrointestinal tumors. The aim of our study was to investigate the correlation between the percentage of Tregs in peripheral blood of patients with colorectal carcinoma, using flow cytometric technique and tumor stages, classified as Dukes' A, B, C or D and by stage of differentiation. Peripheral blood venous samples were obtained from 92 patients with colorectal cancer and from 30 healthy adult volunteers. STATISTICAL ANALYSIS: Linear regression equations were generated using a least-squares method and analyzed for differences of covariance. Statistical significance was calculated by Mann Whitney U-test. Our data has shown that 15% patients with colorectal cancer were classified as Dukes' A, 41% were Dukes' B, 35% were Dukes' C and 9% were Dukes' D. 54% patients with CRC were well differentiated, 11% were poorly differentiated, 20 were moderately differentiated, tage, 4% were mucinous carcinoma and rest of 11% were partly good differentiated with mucinous components. The increased percentage of Tregs in colorectal cancer patients correlates with tumor stage. These results indicate a possible involvement of regulatory T cells in disease progression. New strategies using inhibition or depletion of Tregs are necessary to elucidate the complexity of defective tumor immunity.