Comparison of volarly and dorsally displaced distal radius fracture treated by volar locking plate fixation.

INTRODUCTION: In case of distal radius fractures (DRF) the distal fragment generally displaces either dorsally or volarly. Scientific literature however, seldom differentiates between volarly and dorsally displaced DRFs when reporting results. It is no clear, if the direction of displacement has an influence on the clinical and radiological outcome. This study was intended to evaluate the influence of displacement direction in adult patients with surgically treated Colles or Smith type fractures. PATIENTS AND METHODS: After a mean follow up (FU) time of above 5 years, 50 patients who underwent open reduction and internal fixation for DRFs (25 Smith type fractures, 25 Colles type fractures) were included. Upon FU, standard X-rays and a clinical evaluation as well as evaluation scores were raised and analysed. RESULTS: Clinical evaluation showed no difference between the Colles and the Smith group. Radiologic and clinical results for the Colles group showed diminished flexion compared to the healthy wrist, decreased radial inclination and dorsal tilt during FU and progression of osteoarthritis. For the Smith group decreased grip strength compared to the healthy wrist and osteoarthritis-progression was found. For both groups there was no correlation between radiologic values, grip strength, arthrosis grading, disability of arm, shoulder and hand score and patient rated wrist evaluation score. DISCUSSION: Decreased flexion in combination with a decreased dorsopalmar tilt might hint towards a mechanical inhibition in the Colles group. Altogether, the study showed good clinical outcome with satisfactory radiological result. As all patients showed arthrosis progression, the fracture per se is to be seen as a prearthrotic factor. It still remains unclear which measures could be taken to prevent this.

LIPOPROTEIN ASSOCIATED PHOSPHOLIPASE A2 AS A MARKER OF VULNERABLE ATHEROSCLEROTIC PLAQUE IN PATIENTS WITH INTERNAL CAROTID ARTERY STENOSIS.

The aim of this study was to compare the concentration of inflammatory vascular markers and morphological structure of atherosclerotic plaque in symptomatic and asymptomatic patients with the stenosis of internal carotid artery (ICA). The research was carried out in 70 patients with hemodynamically significant stenosis of ICA out of which 40 (57%) were asymptomatic patients and 30 (43%) were symptomatic patients, of which 20 patients (66%) have had a stroke, or transient ischemic attack (TIA), 10 patients (33%). All the patients were indicated to carotid endarterectomy as a surgical prevention of stroke. All the patients were taken their blood for biochemical testing (T-Chol, LDL, HDL, TG, Fibrinogen, CRP and specific markers IL-4 and Lp-PLA2) early morning prior to surgery. The highest concentrations of T-Chol, LDL, HDL, CRP and Fibrinogen were measured in symptomatic patients, however, these did not feature a significant difference compared with the group of asymptomatic patients (P>0.05). Significant difference was found in IL-4 (P<0.001) and in Lp-PLA2 (P<0.001). When evaluating concentration of tracked parameters in patients with soft atherosclerotic plaque and patients with calcified atherosclerotic plaque, significant differences were found in these markers: TG (P<0.05), CRP (P<0.01), IL-4 (P<0.001) and Lp-PLA2 (P<0.001). The paper deals with higher concentrations of Lp-PLA2 in patients with a soft atherosclerotic plaque. Higher concentration of Lp-PLA2 and systemic inflammatory markers (CRP, IL-4) could be used along with ultrasonography to detect mainly asymptomatic patients who are in urgent need of surgical or endovascular treatment as a prevention of stroke.

FEATURES OF FORMATION OF COLLATERAL CIRCULATION IN PATIENTS WITH SUBCLAVIAN STEAL SYNDROME.

To date in patients with subclavian steal syndrome diagnosis is only grade of stenosis or localization of occlusion described. Authors recommend to take into account also type of a collateral compensation of cerebral circulation for selection of an optimal treatment The objective of the research was to study the features of formation of collateral circulation in patients with subclavian steal syndrome. The authors described changes in the direction of blood flow in the extracranial vessels of 42 patients with subclavian steal syndrome. Latent subclavian steal syndrome was detected in 26.2% of patients, transient subclavian steal syndrome was found in 54.8% of patients, and a persistent course of the disease was observed in 19.9% of patients. Symptoms of vertebrobasilar insufficiency were detected in 26.6% of patients, and combination of chronic upper extremity ischemia and vertebrobasilar insufficiency was diagnosed in 73.8% of patients. When analyzing the features of collateral circulation in 64.3% of patients the extracranial compensatory mechanism was observed being provided by three main groups of collateral hemodynamic reallocation: the occipito-vertebral hemodynamic mechanism of compensation was detected in 38.1% of cases, the thyroid compensatory mechanism was found in 16.7% of cases, and the brain stem-occipital compensatory mechanism was observed in 9.5% of cases. In 35.7% of patients the intracranial compensatory mechanism was observed being provided by two main groups of collateral hemodynamic reallocation: the vertebro-vertebral compensatory mechanism was found in 21.4% of cases and cerebrobasilar compensatory mechanism was detected in 14.3% of cases. Consideration of the features of collateral circulation in patients with subclavian steal syndrome may serve as a prognostic criterion for selecting an optimal treatment tactics.Each of compensatory mechanisms has its own hemodynamic peculiarities. The occipito- vertebral compensatory mechanism has the most positive influence on the compensationof hemodynamic failure of the vertebrobasilar basin.

17-ß-estradiol Decreases Neutrophil Superoxide Production through Rac1.

Neutrophil granulocytes form the biggest free radical producing system of the human body. The importance of this system in atherosclerotic plaque formation and other free radical mediated disorders is confirmed by both in vivo and in vitro studies. Estrogen's effect on free radical production involves multiple estrogen receptors and occurs both on transcriptional and on protein phosphorylational level. Estrogen decreases the superoxide production of neutrophil granulocytes in such a short time frame it is unlikely to be mediated by transcription regulation. We investigated the underlying mechanism through which the mentioned estrogen effect takes place using an immunabsorption-based method. Phosphorylation data of 43 different messenger proteins were used for pathway analysis. The newly identified pathway involved largely second messengers from previously described non-genomic estrogen effects and affected superoxide production via Rac1 - an important regulator of free radical production and chemotaxis. Selective inhibition of the participating second messengers altered superoxide production in the predicted direction confirming that this pathway is at least partly responsible for the effect of 17-ß-estradiol on chemoattractant induced superoxide production.

Retrospective Study of the Hungarian National Transplant Team's Cardiorespiratory Capacity.

The low availability of donor organs requires long-term successful transplantation as an accepted therapy for patients with end-stage renal and liver diseases. The health benefits of regular physical activity are well known among healthy individuals as well as patients under rehabilitation programs. Our aim was to describe the cardiorespiratory capacity of the Hungarian National Transplant Team. Twenty-five kidney (n = 21) or liver (n = 4) transplant athletes participated in this study. Maximal cardiorespiratory capacity (VO2max) was measured on a treadmill with the use of gas analysis. After a resting pulmonary function test, subjects completed a vita maxima test until exhaustion. Aerobic capacity of transplant athletes was higher than the age- and sex-predicted cardiorespiratory fitness (VO2max, 109.9 ± 21.7% of the predicted values; P = .0101). Resting respiratory function indicators exceeded 80% of predicted age- and sex-matched normal values. There were positive correlations between VO2max and workload (r(2) = 0.40; P = .0463), metabolic equivalent (r(2) = 0.72; P < .0001), and oxygen pulse (r(2) = 0.30; P = .0039). However, age showed negative correlation with VO2max (r(2) = 0.32; P = .0031), and there was no significant correlation between graft age and maximal oxygen consumption (r(2) = 0.15; P = .4561). Although the small amount of participants can not represent the general kidney and liver transplant population, the excellent cardiorespiratory performance suggests that a normal level of physical capacity is available after transplantation and can be even higher with regular physical activity. This favorable physiologic background leads to a state that provides proper graft oxygenization, which is an important factor in long-term graft survival.

Linear spin wave theory for single-Q incommensurate magnetic structures.

Linear spin wave theory provides the leading term in the calculation of the excitation spectra of long-range ordered magnetic systems as a function of 1/√S. This term is acquired using the Holstein-Primakoff approximation of the spin operator and valid for small δS fluctuations of the ordered moment. We propose an algorithm that allows magnetic ground states with general moment directions and single-Q incommensurate ordering wave vector using a local coordinate transformation for every spin and a rotating coordinate transformation for the incommensurability. Finally we show, how our model can determine the spin wave spectrum of the magnetic C-site langasites with incommensurate order.

The immediate response of jejunal mucosa to small bowel heterotopic allotransplatation in rats.

The course of histopathological alterations within jejunal graft architecture during the initial adaptation phase in the host body was investigated. Graft tissues were compared to the intestinal tissues of the recipients. This study demonstrates: (1) renewal of intestinal epithelial lining in the graft biopsies during initial hours after transplantation is more likely caused by migration and extension of remaining epithelial cells than by their increased mitotic division. (2) Distinct decrease in histopathological injury was observed in transplanted grafts after 6h, but the morphometrical parameters, particularly villus height and wall thickness, remained altered. (3) Significant decrease in apoptotic cell death in the epithelial lining within 6h of graft recirculation was accompanied by no effect on apoptosis levels of the cells in lamina propria connective tissue. (4) Although the apoptosis level in the connective tissue cells was not modulated in the grafts within the first hour after transplantation, caspase-3 dependent apoptosis was decreased significantly.

Magnetic soft modes in the distorted triangular antiferromagnet α-CaCr2O4.

In this Letter, we explore the phase diagram and excitations of a distorted triangular lattice antiferromagnet. The unique two-dimensional distortion considered here is very different from the "isosceles"-type distortion that has been extensively investigated. We show that it is able to stabilize a 120° spin structure for a large range of exchange interaction values, while new structures are found for extreme distortions. A physical realization of this model is α-CaCr(2)O(4), which has a 120° structure but lies very close to the phase boundary. This is verified by inelastic neutron scattering which reveals unusual rotonlike minima at reciprocal space points different from those corresponding to the magnetic order.

Selective imaging of active pharmaceutical ingredients in powdered blends with common excipients utilizing two-photon excited ultraviolet-fluorescence and ultraviolet-second order nonlinear optical imaging of chiral crystals.

Second order nonlinear optical imaging of chiral crystals (SONICC) and two-photon excited fluorescence measurements [both autofluorescence and two-photon excited UV-fluorescence (TPE-UVF)] were assessed for the selective detection of APIs relative to common pharmaceutical excipients. Active pharmaceutical ingredients (APIs) compose only a small percentage of most tabulated formulations, yet the API distribution within the tablet can affect drug release and tablet stability. Complementary measurements using either UV-SONICC (266 nm detection) or TPE-UVF were shown to generate signals >50-fold more intense for a model API (griseofulvin) than those produced by common pharmaceutical excipients. The combined product of the measurements produced signals >10(4)-fold greater than the excipients studied. UV-SONICC or TPE-UVF produced greater selectivity than analogous measurements with visible-light detection, attributed to the presence of aromatic moieties within the API exhibiting strong one and two photon absorption at ~266 nm. Complementary SONICC and fluorescence measurements allowed for the sensitive detection of the three-dimensional distribution of tadalafil within a Cialis tablet to a depth of >140 µm.

Alterations of epithelial layer after ischemic preconditioning of small intestine in rats.

Ischemic-reperfusion (IR) injury of the small intestine makes a serious complications associated with various surgical procedures and is related to changes in motility, secretory activity and structural alterations. Preconditioning can reduce range of this damage. The aim of the experimental study was to determine the influence of ischemic preconditioning (IPC) on IR injury on jejunal epithelial layer. Wistar rats (n = 56) were divided in two experimental groups. IR group was subjected to 60 min ischemia of cranial mesenteric artery and followed by reperfusion periods: 1,4,8,24 h (IR1, IR4, IR8, IR24). Group with ischemic preconditioning (IPC+IR) was subjected to two subsequent ischemic attacks (12 min) with 10 min of reperfusion between them, and after 2nd attack ischemia was induced for 60 min followed by relevant reperfusion period. IPC showed the protective impact on the jejunal tissue architecture after 1 h reperfusion, when in IR1 group the highest and significant damage was observed (p < 0.001) in contrast to IPC+IR1 group. Histopathological damage of the intestine in pretreated groups was postponed to 4 h of reperfusion. Protective effect of IPC together with later accumulation of injury signs were confirmed by weaker impact on goblet cell (p < 0.001) and Paneth cell populations (p < 0.05).The increased cells proliferation in preconditioned groups came later, but stronger after 8 h of reperfusion (p < 0.001) and after 24 h of reperfusion still remained at the high activity level (p < 0.001). Our experimental results on the histopathological changes in the jejunum during ischemic preconditioning proved that IPC may have a positive effect on maintaining intestinal barrier function.

NADPH-diaphorase expression in the rat jejunum after intestinal ischemia/reperfusion.

The purpose of this study was to analyze the nicotinamide adenine dinucleotide phosphate - diaphorase (NADPH-d) activity in the rat jejunum after a mesenteric ischemia/reperfusion injury. Nitric oxide, synthetised from L-arginine by the enzyme nitric oxide synthase, is a nonadrenergic noncholinergic relaxant neurotransmitter of the intestinal smooth muscle. It plays an important role in the process of plasticity after the ischemia/reperfusion injury. Experimental animals were divided in two groups: the control group and the ischemic/reperfusion group, with different period of the reperfusion. The NADPH-d histochemical method has been used as a marker for the nitric oxide synthase. NADPH-d activity has been rapidly decreased in the neurons of both enteric nervous systems in plexuses of the jejunum after 1 h mesenteric ischemia and 1 h reperfusion. Differences were predominantly detected in the myenteric plexus; they were seen in change of the neuronal shape, in the arrangement of neurons and in intensity of their staining. The NADPH-d positivity was absent in the intestinal crypts. After 1 h ischemia and 24 h reperfusion, the NADPH-d activity was gradually increased, but it was lower in comparison with the control group. On the 30th day following the ischemia/reperfusion there were no changes in NADPH-d positivity compared with the control animals. These results indicated that the jejunal ischemia/reperfusion has affected the neurons of the enteric nervous system of adult rats and resulted in the early decrease of NADPH-d positivity 1 h of the reperfusion insult. The gradual increasing of NADPH-d activity in 24 h following the reperfusion could be considered as a result of the plasticity process. On the 30(th) day after the ischemia/reperfusion all histochemical changes were returned to the control levels.

Histochemical detection of monoamine oxidases in rat female genital organs during preimplantation period of pregnancy.

OBJECTIVE: Localization of monoamine oxidases (MAO) in rat female gonads during preimplantation period of pregnancy was determined. MATERIAL AND METHODS: Pregnant females were killed on their first, third, and fifth days of pregnancy and animals were transcardially perfused with PBS and fixative solutions. Ovaries, oviducts and uteri were immediately removed and they served for the determination of MAO localization employing the method of enzymatic histochemistry. RESULTS: MAO-A activity in ovary was visible in corpora lutea and in interstitial gland cells while MAO-B was detected predominantly in blood vessels. Both MAO enzymes were seen in the smooth muscle fibers of the ovarian hilum. The presence of MAO enzymes was however not detected in follicles at any stage of their development. In oviduct and uterus, both MAO enzymes were visible in similar places, namely in smooth muscle fibers, mast cells and blood vessels, with no MAO presence seen in the epithelium. CONCLUSIONS: Potential physiological importance of MAO localization in different cells of female reproductive organs during early period of pregnancy is proposed (Fig. 6, Ref. 29).

The significance of the circumaortic left renal vein and other venous variations in laparoscopic living donor nephrectomies.

Among the several vascular variation those concerning the venous system of the kidneys show the most significant variability. They often play an important role when it comes to choosing the kidney to be removed for transplantation. Based on our prior studies, we have surveyed these variations. When performing a laparoscopic living donor nephrectomy owing to the limited field of vision and the restricted possibilities for preparation, preoperative radiologic planning is of utmost importance. We evaluated 55 donors who underwent laparoscopic nephrectomies using the 16-section multidetector-row computed tomography angiography. Among the donors who underwent surgeries we observed circumaortic veins (CAV) in three cases, retroaortic veins in 6 cases, multiple renal veins in 10 cases, and a lumbar vein draining into the left renal vein (RV) in 30 cases. In the 2 cases wherein CAVs were discovered, the team decided to use the other kidney. In 1 case, due to a short right RV, we chose the left kidney. The complex development of the CAV that is sometimes difficult to reconstruct in 3D poses a challenge for both the radiologist and the surgeon.

Volumetric hemodynamic changes and postoperative complications in hypothermic liver transplanted patients.

INTRODUCTION: Hepatic diseases decrease the liver's involvement in thermoregulation. Removal of the liver during transplantation increases the incidence of hypothermia during the surgery. The aims of the present study were to analyze the hemodynamic changes among hypothermic liver transplantations and to determine its relationship to postoperative complications. METHODS: Conventional and volumetric hemodynamic monitoring and intramucosal pH measurements were performed during 54 liver transplantations. According to the core temperature until graft reperfusion, patients were classified into group A, hypothermic patients (temperature < 35 °C; n=25) versus group B, normothermic patients (temperature > 36 °C; n=29). We examined the relationships between central venous pressure (CVP), intrathoracic blood volume index, cardiac index (CI), and oxygen delivery index, oxygen consumption index, as well as the fluctuation of the mean arterial pressure (MAP) and gastric intramucosal pH and activated clotting time. We recorded prolonged ventilation time, vasopressor and hemodialysis requirements, occurrence of infections, and intensive care days. RESULTS: There were no significant differences in the MELD scores. More Child-Pugh class C patients (P<.01) showed significantly higher APACHE II scores (P<.02) among group A. During hepatectomy and at the same intrathoracic blood volumes, the hypothermic group showed significantly higher CVP levels (P<.02). During the anhepatic and postreperfusion phases, the decreased CI levels (P<.05) were associated with increased MAP values (P<.05). Without differences in oxygen delivery, the oxygen consumption was lower in group A (P<.05). The intramucosal pH levels were the same in the both groups during the whole examination period. More instances of infection, intensive care, and hemodialysis treatment days, were observed as well as significantly longer vasopressor requirements and coagulopathy among the hypothermic group (P<.007).

Genistein induces phosphorylation of cAMP response element-binding protein in neonatal hypothalamus in vivo.

We investigated the effect of the phytoestrogen, genistein and 17beta-oestradiol on cAMP response element-binding protein (CREB) phosphorylation in the neonatal female rat hypothalamus in vivo using western blot analysis and immunohistochemistry. Although CREB expression was insensitive to the compounds we tested, administration of genistein and 17beta-oestradiol induced rapid CREB phosphorylation (< 15 min) in the hypothalamus and its level remained elevated at 4 h. Quantitative immunohistochemical analysis showed that genistein and 17beta-oestradiol had no effect on CREB phosphorylation in the magnocellular subdivision of paraventricular nucleus. By contrast, genistein induced a dose-dependent increase in CREB phosphorylation in the medial preoptic area (mPOA) and anteroventral periventricular nucleus (AVPV). Administration of 17beta-oestradiol also caused a rapid, dose-dependent increase in CREB phosphorylation in the hypothalamus, mPOA and AVPV. These results demonstrate that genistein induces oestrogen-like rapid action on CREB phosphorylation in the neonatal central nervous system in vivo.

Adult Respiratory Distress Syndrome and alveolar epithelium apoptosis: an histopathological and immunohistochemical study.

Adult Respiratory Distress Syndrome results from a variety of different initial insults, including trauma, sepsis, pneumonia and aspiration, and represents a severe form of acute lung injury. The lung samples of a 20-year-old man who had suffered a serious motorbike accident were obtained for histological examination. He died on the seventh day as a consequence of respiratory failure. The typical histopathological features of syndrome overlapping the first exudative phase into the second proliferate phase were observed. The apoptotic index of the early apoptotic phase evaluated using M30CytoDEATH was 3.4+/-0.2. The average number of apoptotic cells in the intermediate and late phases measured using the TUNEL method was 9.8+/-0.7. Our findings indicate that alveolar epithelium apoptosis seems to be less important during the early phases of Adult Respiratory Distress Syndrome.

Elevated CREB activity in embryonic fibroblasts of gene-targeted histamine deficient mice.

OBJECTIVES: Histamine is a known inducer of cAMP-responsive element binding protein (CREB), which plays a key role in initiation of adipogenesis. Our present goal was to study how histamine deficiency impacts CREB signalling and adipogenesis. METHODS: We used a histidine-decarboxylase gene-targeted (HDC KO) mice model lacking endogenous histamine. We measured CREB activity and expression by EMSA, Western blot and real-time RT-PCR, as well as cAMP levels by ELISA in primary embryonic fibroblasts derived from WT and HDC KO mice. The ability of these cells to form adipocytes was also tested in preliminary experiments. RESULTS: We found that in the absence of the histamine, cells show higher constitutive CREB activity and greatly increased intracellular cAMP levels, as well as that in contrast to WT cells, HDC KO fibroblasts are more prone to differentiate into adipocytes. CONCLUSION: These data suggest a newly recognised inhibitory role for histamine in CREB activity and draws attention to the potential role of histamine in adipocyte differentiation.

Endobronchial actinomycosis presenting as haemoptysis.

Actinomycosis is an infrequent chronic progressive granulomatous and suppurative disease caused by Actinomyces israelii, a natural inhabitant of the gastrointestinal tract. We report a rare case of a 68-year-old man with primary endobronchial actinomycosis who presented in the emergency respiratory ward with massive hemoptysis and dyspnea. An urgent fiberoptic bronchoscopy revealed hypertrophic mucosa and a narrowed lingular bronchus with a pale extruding exophyt. Diffuse bleeding from the mucosa adjacent to the exophyt was present. Histopathologic evaluation revealed chronic inflammation with abscess formation and clusters of Actinomyces colonies. Therapy with clindamycin maintained for 7 weeks prevented recurrence of the disease. In the light of our case and the review of literature we conclude that early recognition of primary endobronchial actinomycosis associated with hemoptysis and proper antibiotic treatment are essential to prevent undesirable complications including unwarranted surgery (Fig. 2, Ref. 30). Full Text (Free, PDF) www.bmj.sk.

Periodic heterogeneity-driven resonance amplification in density fingering.

Periodic heterogeneity is introduced in experiments with thin solution layers where downward propagating planar autocatalytic fronts are hydrodynamically unstable and cellular patterns develop. The evolution of fingers is greatly affected by the spatial heterogeneity when the wave number associated with it falls in the vicinity of the most unstable mode of the reference system with uniform thickness. The imposed heterogeneity will drive the instability by amplifying the modes with the matching wave numbers as indicated by the experimentally constructed dispersion curves.