Digit ratios and their asymmetries as risk factors of developmental instability and hospitalization for COVID-19.

COVID-19 presents with mild symptoms in the majority of patients but in a minority it progresses to acute illness and hospitalization. Here we consider whether markers for prenatal sex hormones and postnatal stressors on developmental instability, i.e. digit ratios and their directional and unsigned asymmetries, are predictive of hospitalization. We focus on six ratios: 2D:3D; 2D:4D; 2D:5D; 3D:4D; 3D:5D; 4D:5D and compare hospitalized patient and control means for right, and left ratios, directional asymmetries (right-left) and unsigned asymmetries [|(right-left)|]. There were 54 patients and 100 controls. We found (i) patients differed in their digit ratios from controls (patients > controls) in all three ratios that included 5D (2D:5D, 3D:5D and 4D:5D) with small to medium effect sizes (d = 0.3 to 0.64), (ii) they did not differ in their directional asymmetries, and (iii) patients had greater |(right-left)| asymmetry than controls for 2D:4D (d = .74) , and all ratios that included 5D; 2D:5D (d = 0.66), 3D:5D (d = .79), 4D:5D (d = 0.47). The Composite Asymmetry of the two largest effects (2D:4D + 3D:5D) gave a patient and control difference with effect size d = 1.04. All patient versus control differences were independent of sex. We conclude that digit ratio patterns differ between patients and controls and this was most evident in ratios that included 5D. Large |(right-left)| asymmetries in the patients are likely to be a marker for postnatal stressors resulting in developmental perturbations and for potential severity of COVID-19.

The significance of DNA methylation profile in metastasis-related genes for the progression of colorectal cancer.

DNA methylation, an epigenetic modification plays a role in the pathogenesis of colorectal cancer (CRC). CRC cases, both sporadic and familial, are often characterized by abnormal pattern of the cytosine methylation in CpG dinucleotides in regulatory regions of genes important for cancer transformation. Also genes mutated in CRC can have their epigenetic pattern altered and we suggest that changes in DNA methylation array can be important for CRC metastatic potential ‒ the main reason of CRC-associated mortality. These genes are: KRAS, genes of the Rho family of GTPases, MACC1, Met, MTA1 and RASSF1A. In addition, genes encoding miRNA important for epithelial mesenchymal transition and other metastasis-related effects, such as mir-9, miR-34 and miR-210 can be good candidates for associating their DNA methylation profiles with CRC metastasis. Analysis of DNA methylation profile in various stages of CRC along with other genetic/epigenetic changes specific for all main stages of CRC transformation could help in anti-metastatic therapy immediately after CRC diagnosis. However, targeting DNA methylation pattern in CRC therapy is a conception, which requires further work to precisely change DNA methylation array, without affecting genes, whose expression should not be changed.

[Benign bone tumors]. / Gutartige Knochentumoren.

Benign bone tumors are neoplasms which have their origin in bone and lack criteria of malignant tumors, i.e. infiltrative growth pattern and distant metastases. They are classified according to the WHO criteria concerning the tumor matrix (osseous, cartilaginous, fibrous etc.). Traditionally there are also some non-neoplastic bone lesions which are classified as benign bone tumors and belonging to the group of tumor-like bone lesions. For the physician it is important to know those entities which are harmless, as well as those which can tend to re-occur or which ones can be locally destructive. Finally, some tumors are at risk of becoming malignant (large and proximal enchondromas or multiple tumors within a syndromal disease). Treatment is in most cases uncomplicated and can range between observation, curettage and sometimes extensive resection with complex defect reconstruction.

[Benign soft tissue tumors in orthopedics]. / Gutartige Weichteiltumoren in der Orthopädie.

For the most part soft tissue tumors are benign. However, the clinical presentation, including radiological aspects, is not always clear. Therefore, a biopsy is necessary in some cases to detect malignant tumors at an early stage. The course of even benign tumors is sometimes complicated. A not insignificant group of local, aggressive or intermediary tumors tend to recur and in exceptional cases can be fatal. Benign soft tissue tumors are subdivided according to the current WHO classification from 2002. They are classified by the tissue they mimick. In clinical practice they are additionally grouped according to aggressiveness. Some benign soft tissue tumors occur in the context of a syndrome, leading to multiple tumors. In these cases there is the threat of a tumor becoming malignant (neurofibromatosis, Maffucci syndrome).

Inhibition of osteosarcoma cell proliferation by the Hedgehog-inhibitor cyclopamine.

Osteosarcomas (OS) are the most frequent primary malignant bone tumors in humans. Even though OS are chemosensitive, about 30% of patients must be considered poor responders and consequently have a dismal long term prognosis. The Hedgehog (Hh) gene is crucial in the signalling pathways of proliferation and differentiation during embryonic development. There is evidence that uncontrolled activation of this pathway results in specific types of cancer and that inhibition of Hh signalling is able to suppress tumour growth and to induce apoptosis of neoplastic cells. This study investigates the impact of the steroidal alkaloid and Hh-inhibitor cyclopamine on osteosarcoma cells. Thus we demonstrate the drug's impact on cellular proliferation, cell cycle cell death as well as the cells' metabolism. We here demonstrate that cyclopamine exhibits a high efficacy against the osteosarcoma cell lines HOS, SaOS and OS-KA, a self-established primary osteosarcoma cell line. In particular, cyclopamine is able to inhibit proliferation and to promote cell death. Our results provide evidence for the potency of the Hh-inhibitor cyclopamine as a future treatment of osteosarcomas.

[Good results with a cemented titanium stem after 7-9 years]. / Zementierter Titan-Schaft erbringt gute Ergebnisse nach 7-9 Jahren.

AIM: Because of partially ver y controversial results in cemented hip stem replacements made of titanium alloy we investigated in our own patients the mid-term survival of the "Euroform"-stem. This stem is anatomically designed for cemented fixation, made of Ti (6)Al (4)V. METHOD: Within a period between 1990 and 2000 we implanted 2,141 Euroform-prostheses. The course of 103 patients which were operated between April 1990 and April 1992 was followed up. 9 patients died in the meantime and 8 could not be reached. Of the remaining 86 patients we could examine 73 patients with 79 prostheses (87 %). Investiagtion included a questionnaire and clinical and radiological examination to create the Harris-hip-score. The follow-up was 7-9 years, with an average of 94 months. RESULT: Of those 79 prostheses, revision surgery was performed for septic loosening in three cases and for aseptic loosening in two cases. Radiologically one stem was found to be loosen. This means that for aseptic loosening we had a revision rate for aseptical femoral loosening of 2.5 % after 94 months with a mean Harris-hip-score of 84 points. Good or excellent results were found in 82 %, fair results in 9 % and poor results in 9 %. CONCLUSION: The "Euroform" prosthesis is a cemented titanium alloy stem that has in contrary to some other published studies good mid- to long-term results.

[Diagnostics and minimally invasive therapy for chronic low back pain]. / Diagnostik und minimal-invasive Therapie bei chronischen Lumbalgien.

Chronic low back pain is one of the most frequent causes for seeking medical help in Germany. Many factors play a causal role in its pathogenesis. This is where the dilemma resides in narrowing down the diagnosis and deciding on subsequent therapeutic intervention. There is overall agreement on the concept of when it is expedient to initiate further diagnostic measures. With the exception of clear pathomorphological findings and the presence of cardinal symptoms or warning signs, so-called "red flags", primary back pain should not be subjected to any specific diagnostic tests and therapy during the first 3 months. We present well-established techniques for blockade, discography, and minimally invasive treatment options such as cryotherapy, procedures for thermal ablation, and intradiscal electrotherapy. Vertebroplasty, currently a frequently applied method, is also included in the discussion of minimally invasive treatment for chronic low back pain.

[Multiple pathological fractures within the scope of DeToni-Debre-Fanconi syndrome after fumarate therapy in psoriasis]. / Multiple pathologische Frakturen im Rahmen eines DeToni-Debré-Fanconi-Syndroms nach Fumarattherapie bei Psoriasis.

We report about a rare case of a pathological fracture of the shank following earlier pathological fractures at other locations in a comparatively young female patient with no history of trauma. There were no known diseases other than psoriasis. The shank fracture was treated surgically by osteosynthesis. Osteoporosis, myeloma, or malignancy as causative factors of this fracture could be excluded. Scintigraphy showed an enhancement, especially at the extremities. Other than reactive bone growth, histological examination revealed no further aspects. Laboratory analysis indicated a massive lack of vitamin D3. After transferring the patient to the internal department of our hospital, long-term medication with fumaric acid was determined to be the reason for the osteomalacia of a Fanconi's syndrome. Three months after cessation of these medicaments and treatment with active vitamin D3 metabolites, the patient was free of complaints. The radiographs showed an essential improvement of the demineralization.

[Modified collateral ligament reconstruction with the tendon of the abductor pollicis tendon in treatment of chronic radial instability of the basal thumb joint]. / Modifizierte Seitenbandplastik mit der Sehne des M. abductor pollicis brevis zur Behandlung der chronischen radialen Instabilität des Daumengrundgelenkes.

Injuries to the radial collateral ligament of the MP joint of the thumb occur much less frequently than injuries to the ulnar collateral ligament. Ligament injury is usually a result of direct trauma. The resultant instability to the thumb usually impairs hand function. In acute lesions to the radial collateral ligament, direct repair is often possible. In cases of chronic radial joint instability, secondary ligament reconstruction with a free tendon graft, most commonly the palmaris longus tendon, is usually recommended. We describe another technique using the tendon insertion of the abductor pollicis brevis muscle. The tendon inserting distally can be used as a stable ligament after dividing it at the border to the muscle and attaching it to the head of the metacarpal bone with a wire. The follow-up for six patients treated by this method showed good and painless stability and function of the thumb in a time span of one year.

99mTc-HEPIDA plasma clearance as a diagnostic tool. Total plasma v. specific hepatic clearance.

BACKGROUND: (99m)Tc-HEPIDA total plasma clearance has been used for assessment of hepatic parenchyma damage. However, the radiopharmaceutical used is being partly cleared from plasma also by the urinary tract. As the share of the latter route in total elimination of the compound is not well known, the aim of the study was to investigate the percentage of (99m)Tc-HEPIDA eliminated by the kidneys and by the liver. MATERIAL AND METHODS: To this aim total plasma clearance of the compound and urinary part were determined by the methods employed here in 117 patients and in 16 healthy volunteers. The pure hepatic clearance was calculated as the difference between total plasma and the urinary clearance of (99m)Tc-HEPIDA. RESULTS: The urinary clearance in patients amounted from 2.6 to 78% of total clearance; in the healthy volunteers the corresponding range was from 8.6 to 28%. Pronounced spread of the urinary clearance (coefficient of variation = 35%) and lack of correlation between the urinary and total clearance make it necessary to take account of urinary elimination in each patient in whom reasonably accurate assessment of hepatic clearance is required. CONCLUSION: Further studies on the diagnostic efficacy of pure hepatic clearance and its change with age in healthy patients appear necessary.

Recurrent chondroblastoma of the upper thoracic spine. A case report and review of the literature.

A very rare case of recurrent chondroblastoma of the upper thoracic spine with a follow-up of more than 20 years is presented and discussed with a review of the literature.

[Epidemiologic-clinical analysis of purulent meningitis in adults: material from the Clinic of Infectious Diseases AM in Lodz in the years 1990-1991]. / Analiza epidemiologiczno-kliniczna ropnego zapalenia opon mózgowo-rdzeniowych u doroslych: material Kliniki Chorób Zakaznych AM w Lodzi w latach 1990-1991.

Authors have presented 81 cases of bacterial meningitis in adult patients (pts) treated in the Clinic for Infectious Diseases in the years 1990-1991. The aim of the study was the clinical and epidemiological analysis of the bacterial meningitis. Clinical symptoms, time between first symptoms and onset of hospitalisation and treatment, coexisting diseases and their influence on the course of the disease were considered in the analysis. The aetiological agent was found in 21% of cases. In the study group 75.3% were pts 26-65 years old. 77.8% were male pts. In 65.4% pts delay in hospitalisation and therapy exceeded 24 hours, 41.9% was longer than 48 hours. 18% of pts were afebrile. In the study group only 34.6% of pts were free of coexisting diseases.

[Treatment outcome of purulent meningitis in adults from material of the Clinic of Infectious Diseases AM in Lodz in the years 1990-1991]. / Wyniki leczenia ropnego zapalenia opon mózgowo-rdzeniowych u doroslych w materiale Kliniki Chorób Zakaznych AM w Lodzi w latach 1990-1991.

81 patients (pts) with bacterial meningitis hospitalised in the Clinic for Infectious Diseases in the years 1990-1991 were treated according to two therapeutic schedules. First: young pts (under 40 years), without coexisting diseases obtained Penicillin G and aminoglycoside and/or synthetic penicillin. Second: pts over 40 years old with coexisting diseases or cases of recurrent meningitis were treated with third-generation cephalosporins and aminoglycoside and/or synthetic penicillin. The mortality was 16% in the study group. 11 of 13 pts with coexisting diseases died. Neurologic sequelae were found in 23% of pts. The complete recovery was obtained in 34% of pts, more often (35.9%) in a group treated with third--generation cephalosporins comparing to 29.4% with other antibiotic therapy.