Salvia officinalis L. exerts oncostatic effects in rodent and in vitro models of breast carcinoma

Introduction: Based on extensive data from oncology research, the use of phytochemicals or plant-based nutraceuticals is considered an innovative tool for cancer management. This research aimed to analyze the oncostatic properties of Salvia officinalis L. [Lamiaceae; Salviae officinalis herba] using animal and in vitro models of breast carcinoma (BC). Methods: The effects of dietary administered S. officinalis in two concentrations (0.1%/SAL 0.1/and 1%/SAL 1/) were assessed in both syngeneic 4T1 mouse and chemically induced rat models of BC. The histopathological and molecular evaluations of rodent carcinoma specimens were performed after the autopsy. Besides, numerous in vitro analyses using two human cancer cell lines were performed. Results and Conclusion: The dominant metabolites found in S. officinalis propylene glycol extract (SPGE) were representatives of phenolics, specifically rosmarinic, protocatechuic, and salicylic acids. Furthermore, the occurrence of triterpenoids ursolic and oleanolic acid was proved in SPGE. In a mouse model, a non-significant tumor volume decrease after S. officinalis treatment was associated with a significant reduction in the mitotic activity index of 4T1 tumors by 37.5% (SAL 0.1) and 31.5% (SAL 1) vs. controls (set as a blank group with not applied salvia in the diet). In addition, salvia at higher doses significantly decreased necrosis/whole tumor area ratio by 46% when compared to control tumor samples. In a rat chemoprevention study, S. officinalis at a higher dose significantly lengthened the latency of tumors by 8.5 days and significantly improved the high/low-grade carcinomas ratio vs. controls in both doses. Analyses of the mechanisms of anticancer activities of S. officinalis included well-validated prognostic, predictive, and diagnostic biomarkers that are applied in both oncology practice and preclinical investigation. Our assessment in vivo revealed numerous significant changes after a comparison of treated vs. untreated cancer cells. In this regard, we found an overexpression in caspase-3, an increased Bax/Bcl-2 ratio, and a decrease in MDA, ALDH1, and EpCam expression. In addition, salvia reduced TGF-β serum levels in rats (decrease in IL-6 and TNF-α levels were with borderline significance). Evaluation of epigenetic modifications in rat cancer specimens in vivo revealed a decline in the lysine methylations of H3K4m3 and an increase in lysine acetylation in H4K16ac levels in treated groups. Salvia decreased the relative levels of oncogenic miR21 and tumor-suppressive miR145 (miR210, miR22, miR34a, and miR155 were not significantly altered). The methylation of ATM and PTEN promoters was decreased after S. officinalis treatment (PITX2, RASSF1, and TIMP3 promoters were not altered). Analyzing plasma metabolomics profile in tumor-bearing rats, we found reduced levels of ketoacids derived from BCAAs after salvia treatment. In vitro analyses revealed significant anti-cancer effects of SPGE extract in MCF-7 and MDA-MB-231 cell lines (cytotoxicity, caspase-3/-7, Bcl-2, Annexin V/PI, cell cycle, BrdU, and mitochondrial membrane potential). Our study demonstrates the significant chemopreventive and treatment effects of salvia haulm using animal or in vitro BC models.

Significance of flavonoids targeting PI3K/Akt/HIF-1α signaling pathway in therapy-resistant cancer cells - A potential contribution to the predictive, preventive, and personalized medicine

BACKGROUND

Cancer management faces multiple obstacles, including resistance to current therapeutic approaches. In the face of challenging microenvironments, cancer cells adapt metabolically to maintain their supply of energy and precursor molecules for biosynthesis and thus sustain rapid proliferation and tumor growth. Among the various metabolic adaptations observed in cancer cells, the altered glucose metabolism is the most widely studied. The aberrant glycolytic modification in cancer cells has been associated with rapid cell division, tumor growth, cancer progression, and drug resistance. The higher rates of glycolysis in cancer cells, as a hallmark of cancer progression, is modulated by the transcription factor hypoxia inducible factor 1 alpha (HIF-1α), a downstream target of the PI3K/Akt signaling, the most deregulated pathway in cancer.

AIM OF REVIEW

We provide a detailed overview of current, primarily experimental, evidence on the potential effectiveness of flavonoids to combat aberrant glycolysis-induced resistance of cancer cells to conventional and targeted therapies. The manuscript focuses primarily on flavonoids reducing cancer resistance via affecting PI3K/Akt, HIF-1α (as the transcription factor critical for glucose metabolism of cancer cells that is regulated by PI3K/Akt pathway), and key glycolytic mediators downstream of PI3K/Akt/HIF-1α signaling (glucose transporters and key glycolytic enzymes).

KEY SCIENTIFIC CONCEPTS OF REVIEW

The working hypothesis of the manuscript proposes HIF-1α - the transcription factor critical for glucose metabolism of cancer cells regulated by PI3K/Akt pathway as an attractive target for application of flavonoids to mitigate cancer resistance. Phytochemicals represent a source of promising substances for cancer management applicable to primary, secondary, and tertiary care. However, accurate patient stratification and individualized patient profiling represent crucial steps in the paradigm shift from reactive to predictive, preventive, and personalized medicine (PPPM / 3PM). The article is focused on targeting molecular patterns by natural substances and provides evidence-based recommendations for the 3PM relevant implementation.

Could temporary external fixation after reduction of displaced acetabular fractures prevent posttraumatic heterotopic ossification?

OBJECTIVES

To recommend appropriate immobilization after the initial reduction of acetabular displaced fractures in order to minimize the risk of heterotopic ossification formation.

DESIGN

Retrospective study of patients treated in our surgical department during the years 2005-2018.

MATERIALS AND METHODS

There were 94 patients included in statistical analysis. The factors of injury severity, course of surgery and hospitalization and incidence of complications were recorded. The functional and X-ray results were evaluated at least one year after surgery.

RESULTS

The patients were divided into the two groups according to the type of fixation after closed reduction, the external fixation (EF) and the skeletal traction (ST) group. According to the type of fracture there were 33 patients with central displacement and 61 patients with posterior displacement. Ossification grade III. And IV. Occur in 20% of our sample. There was greater incidence of Brooker grade III. And IV. Ossification in the ST group, but statistically insignificant, p = 0.57. There was no statistically significant difference in the occurrence of ossifications regarding the severity of the head injury, p = 0.11, or to the severity of the injury p = 0.54. The combination of posterior displacement and ST results in higher risk for ossifications, specifically in our group at 11.48% compared to the combination of posterior displacement and EF where it is 8.2%.

CONCLUSION

Skeletal traction for posterior displaced acetabular fracture appears to be a more risky procedure for the development of ossifications than external fixation.

Antithrombotic and antiplatelet effects of plant-derived compounds: a great utility potential for primary, secondary, and tertiary care in the framework of 3P medicine

Thromboembolism is the third leading vascular disease, with a high annual incidence of 1 to 2 cases per 1000 individuals within the general population. The broader term venous thromboembolism generally refers to deep vein thrombosis, pulmonary embolism, and/or a combination of both. Therefore, thromboembolism can affect both – the central and peripheral veins. Arterial thromboembolism causes systemic ischemia by disturbing blood flow and oxygen supply to organs, tissues, and cells causing, therefore, apoptosis and/or necrosis in the affected tissues. Currently applied antithrombotic drugs used, e.g. to protect affected individuals against ischemic stroke, demonstrate significant limitations. For example, platelet inhibitors possess only moderate efficacy. On the other hand, thrombolytics and anticoagulants significantly increase hemorrhage. Contextually, new approaches are extensively under consideration to develop next-generation antithrombotics with improved efficacy and more personalized and targeted application. To this end, phytochemicals show potent antithrombotic efficacy demonstrated in numerous in vitro, ex vivo, and in vivo models as well as in clinical evaluations conducted on healthy individuals and persons at high risk of thrombotic events, such as pregnant women (primary care), cancer, and COVID-19-affected patients (secondary and tertiary care). Here, we hypothesized that specific antithrombotic and antiplatelet effects of plant-derived compounds might be of great clinical utility in primary, secondary, and tertiary care. To increase the efficacy, precise patient stratification based on predictive diagnostics is essential for targeted protection and treatments tailored to the person in the framework of 3P medicine. Contextually, this paper aims at critical review toward the involvement of specific classes of phytochemicals in antiplatelet and anticoagulation adapted to clinical needs. The paper exemplifies selected plant-derived drugs, plant extracts, and whole plant foods/herbs demonstrating their specific antithrombotic, antiplatelet, and fibrinolytic activities relevant for primary, secondary, and tertiary care. One of the examples considered is antithrombotic and antiplatelet protection specifically relevant for COVID-19-affected patient groups.

Anti-breast cancer effects of phytochemicals: primary, secondary, and tertiary care

Breast cancer incidence is actually the highest one among all cancers. Overall breast cancer management is associated with challenges considering risk assessment and predictive diagnostics, targeted prevention of metastatic disease, appropriate treatment options, and cost-effectiveness of approaches applied. Accumulated research evidence indicates promising anti-cancer effects of phytochemicals protecting cells against malignant transformation, inhibiting carcinogenesis and metastatic spread, supporting immune system and increasing effectiveness of conventional anti-cancer therapies, among others. Molecular and sub-/cellular mechanisms are highly complex affecting several pathways considered potent targets for advanced diagnostics and cost-effective treatments. Demonstrated anti-cancer affects, therefore, are clinically relevant for improving individual outcomes and might be applicable to the primary (protection against initial cancer development), secondary (protection against potential metastatic disease development), and tertiary (towards cascading complications) care. However, a detailed data analysis is essential to adapt treatment algorithms to individuals’ and patients’ needs. Consequently, advanced concepts of patient stratification, predictive diagnostics, targeted prevention, and treatments tailored to the individualized patient profile are instrumental for the cost-effective application of natural anti-cancer substances to improve overall breast cancer management benefiting affected individuals and the society at large.

Synthesis of C-prenylated analogues of stilbenoid methyl ethers and their cyclic dihydrobenzopyranyl derivatives as potential anti-inflammatory agents

An efficient and versatile synthesis of the naturally occurring C-prenylated stilbenoid methyl ethers and synthetic analogs has been developed.

Metabolism of Selected 2-Arylbenzofurans in a Colon In Vitro Model System

2-arylbenzofurans represent a small group of bioactive compounds found in the plant family Moraceae. As it has not been investigated whether these substances are stable during passage through the gastrointestinal tract, their biological effects may be altered by the metabolism of intestinal microbiota or cells. The aim of the present study was to investigate and compare mulberrofuran Y (1), moracin C (2), and mulberrofuran G (3) in an in vitro model of human intestinal bacterial fermentation and in an epithelial model using the Caco-2 cell line. The analysis of compounds by LC-MS-Q-TOF showed sufficient stability in the fermentation model, with no bacterial metabolites detected. However, great differences in the quantity of permeation were observed in the permeability assay. Moreover, mulberrofuran Y (1) and moracin C (2) were observed to be transformed into polar metabolites by conjugation. Among the test compounds, mulberrofuran Y (1) was mostly stable and accumulated in endothelial cells (85.3%) compared with mulberrofuran G (3) and moracin C (2) (14% and 8.2%, respectively). Thus, only a small amount of mulberrofuran Y (1) was conjugated. Moracin C (2) and mulberrofuran G (3) were metabolized almost completely, with only traces of the unchanged molecule being found on the apical and cellular sides of the system. Only conjugates of mulberrofuran Y (1) and moracin C (2) were able to reach the basolateral side. Our results provide the basic description of bioavailability of these three compounds, which is a necessary characteristic for final evaluation of bio-efficacy.

Flavonoids Targeting HIF-1: Implications on Cancer Metabolism

Tumor hypoxia is described as an oxygen deprivation in malignant tissue. The hypoxic condition is a consequence of an imbalance between rapidly proliferating cells and a vascularization that leads to lower oxygen levels in tumors. Hypoxia-inducible factor 1 (HIF-1) is an essential transcription factor contributing to the regulation of hypoxia-associated genes. Some of these genes modulate molecular cascades associated with the Warburg effect and its accompanying pathways and, therefore, represent promising targets for cancer treatment. Current progress in the development of therapeutic approaches brings several promising inhibitors of HIF-1. Flavonoids, widely occurring in various plants, exert a broad spectrum of beneficial effects on human health, and are potentially powerful therapeutic tools against cancer. Recent evidences identified numerous natural flavonoids and their derivatives as inhibitors of HIF-1, associated with the regulation of critical glycolytic components in cancer cells, including pyruvate kinase M2(PKM2), lactate dehydrogenase (LDHA), glucose transporters (GLUTs), hexokinase II (HKII), phosphofructokinase-1 (PFK-1), and pyruvate dehydrogenase kinase (PDK). Here, we discuss the results of most recent studies evaluating the impact of flavonoids on HIF-1 accompanied by the regulation of critical enzymes contributing to the Warburg phenotype. Besides, flavonoid effects on glucose metabolism via regulation of HIF-1 activity represent a promising avenue in cancer-related research. At the same time, only more-in depth investigations can further elucidate the mechanistic and clinical connections between HIF-1 and cancer metabolism.

Polyketide Derivatives in the Resistance of Gerbera hybrida to Powdery Mildew

Powdery mildew is a common disease affecting the commercial production of gerbera flowers (Gerbera hybrida, Asteraceae). Some varieties show a certain degree of resistance to it. Our objective was to identify biomarkers of resistance to powdery mildew using an ¹H nuclear magnetic resonance spectroscopy and chemometrics approach in a complex, fully factorial experiment to suggest a target for selection and breeding. Resistant varieties were found to differ from those that were susceptible in the metabolites of the polyketide pathway, such as gerberin, parasorboside, and gerberinside. A new compound probably involved in resistance, 5-hydroxyhexanoic acid 3-O-β-D-glucoside, was described for the first time. A decision tree model was built to distinguish resistant varieties, with an accuracy of 57.7%, sensitivity of 72%, and specificity of 44.44% in an independent test. Our results suggest the mechanism of resistance to powdery mildew in gerbera and provide a potential tool for resistance screening in breeding programs.

Rhus coriaria L. (Sumac) Demonstrates Oncostatic Activity in the Therapeutic and Preventive Model of Breast Carcinoma

Comprehensive scientific data provide evidence that isolated phytochemicals or whole plant foods may beneficially modify carcinogenesis. The aim of this study was to evaluate the oncostatic activities of Rhus coriaria L. (sumac) using animal models (rat and mouse), and cell lines of breast carcinoma. R. coriaria (as a powder) was administered through the diet at two concentrations (low dose: 0.1% (w/w) and high dose: 1 % (w/w)) for the duration of the experiment in a syngeneic 4T1 mouse and chemically-induced rat mammary carcinoma models. After autopsy, histopathological and molecular analyses of tumor samples in rodents were performed. Moreover, in vitro analyses using MCF-7 and MDA-MB-231 cells were conducted. The dominant metabolites present in tested R. coriaria methanolic extract were glycosides of gallic acid (possible gallotannins). In the mouse model, R. coriaria at a higher dose (1%) significantly decreased tumor volume by 27% when compared to controls. In addition, treated tumors showed significant dose-dependent decrease in mitotic activity index by 36.5% and 51% in comparison with the control group. In the chemoprevention study using rats, R. coriaria at a higher dose significantly reduced the tumor incidence by 20% and in lower dose non-significantly reduced tumor frequency by 29% when compared to controls. Evaluations of the mechanism of oncostatic action using valid clinical markers demonstrated several positive alterations in rat tumor cells after the treatment with R. coriaria. In this regard, histopathological analysis of treated tumor specimens showed robust dose-dependent decrease in the ratio of high-/low-grade carcinomas by 66% and 73% compared to controls. In treated rat carcinomas, we found significant caspase-3, Bax, and Bax/Bcl-2 expression increases; on the other side, a significant down-regulation of Bcl-2, Ki67, CD24, ALDH1, and EpCam expressions and MDA levels. When compared to control specimens, evaluation of epigenetic alterations in rat tumor cells in vivo showed significant dose-dependent decrease in lysine methylation status of H3K4m3 and H3K9m3 and dose-dependent increase in lysine acetylation in H4K16ac levels (H4K20m3 was not changed) in treated groups. However, only in lower dose of sumac were significant decreases in the expression of oncogenic miR210 and increase of tumor-suppressive miR145 (miR21, miR22, and miR155 were not changed) observed. Finally, only in lower sumac dose, significant decreases in methylation status of three out of five gene promoters-ATM, PTEN, and TIMP3 (PITX2 and RASSF1 promoters were not changed). In vitro evaluations using methanolic extract of R. coriaria showed significant anticancer efficacy in MCF-7 and MDA-MB-231 cells (using Resazurin, cell cycle, annexin V/PI, caspase-3/7, Bcl-2, PARP, and mitochondrial membrane potential analyses). In conclusion, sumac demonstrated significant oncostatic activities in rodent models of breast carcinoma that were validated by mechanistic studies in vivo and in vitro.

Implications of flavonoids as potential modulators of cancer neovascularity

PURPOSE

The formation of new blood vessels from previous ones, angiogenesis, is critical in tissue repair, expansion or remodeling in physiological processes and in various pathologies including cancer. Despite that, the development of anti-angiogenic drugs has great potential as the treatment of cancer faces many problems such as development of the resistance to treatment or an improperly selected therapy approach. An evaluation of predictive markers in personalized medicine could significantly improve treatment outcomes in many patients.

METHODS

This comprehensive review emphasizes the anticancer potential of flavonoids mediated by their anti-angiogenic efficacy evaluated in current preclinical and clinical cancer research.

RESULTS AND CONCLUSION

Flavonoids are important groups of phytochemicals present in common diet. Flavonoids show significant anticancer effects. The anti-angiogenic effects of flavonoids are currently a widely discussed topic of preclinical cancer research. Flavonoids are able to regulate the process of tumor angiogenesis through modulation of signaling molecules such as VEGF, MMPs, ILs, HIF or others. However, the evaluation of the anti-angiogenic potential of flavonoids within the clinical studies is not frequently discussed and is still of significant scientific interest.

Genoprotective activities of plant natural substances in cancer and chemopreventive strategies in the context of 3P medicine

Severe durable changes may occur to the DNA structure caused by exogenous and endogenous risk factors initiating the process of carcinogenesis. By evidence, a large portion of malignancies have been demonstrated as being preventable. Moreover, the targeted prevention of cancer onset is possible, due to unique properties of plant bioactive compounds. Although genoprotective effects of phytochemicals have been well documented, there is an evident lack of articles which would systematically present the spectrum of anticancer effects by phytochemicals, plant extracts, and plant-derived diet applicable to stratified patient groups at the level of targeted primary (cancer development) and secondary (cancer progression and metastatic disease) prevention. Consequently, clinical implementation of knowledge accumulated in the area is still highly restricted. To stimulate coherent co-development of the dedicated plant bioactive compound investigation on one hand and comprehensive cancer preventive strategies on the other hand, the current paper highlights and deeply analyses relevant evidence available in the area. Key molecular mechanisms are presented to detail genoprotective and anticancer activities of plants and phytochemicals. Clinical implementation is discussed. Based on the presented evidence, advanced chemopreventive strategies in the context of 3P medicine are considered.

Metabolism of cis- and trans-Resveratrol and Dihydroresveratrol in an Intestinal Epithelial Model

Trans-resveratrol, a well-known plant phenolic compound, has been intensively investigated due to its association with the so-called French paradox. However, despite its high pharmacological potential, trans-resveratrol has shown relatively low bioavailability. Trans-resveratrol is intensively metabolized in the intestine and liver, yielding metabolites that may be responsible for its high bioactivity. The aim of this study was to investigate and compare the metabolism of trans-resveratrol (tRes), cis-resveratrol (cRes) and dihydroresveratrol (dhRes) in an in vitro epithelial model using Caco-2 cell lines. Obtained metabolites of tRes, cRes and dhRes were analyzed by LC/MS Q-TOF, and significant differences in the metabolism of each compound were observed. The majority of tRes was transported unchanged through the Caco-2 cells, while cRes was mostly metabolized. The main metabolite of both cis- and trans-resveratrol observed as a result of colon microbial metabolism, dhRes, was metabolized almost completely, with only traces of the unchanged molecule being found. A sulphate conjugate was identified as the main metabolite of tRes in our model, while a glucuronide conjugate was the major metabolite of cRes and dhRes. Since metabolism of simple phenolics and polyphenols plays a crucial role in their bioavailability, detailed knowledge of their transformation is of high scientific value.

Metabolism of Stilbenoids by Human Faecal Microbiota

Stilbenoids are dietary phenolics with notable biological effects on humans. Epidemiological, clinical, and nutritional studies from recent years have confirmed the significant biological effects of stilbenoids, such as oxidative stress protection and the prevention of degenerative diseases, including cancer, cardiovascular diseases, and neurodegenerative diseases. Stilbenoids are intensively metabolically transformed by colon microbiota, and their corresponding metabolites might show different or stronger biological activity than their parent molecules. The aim of the present study was to determine the metabolism of six stilbenoids (resveratrol, oxyresveratrol, piceatannol, thunalbene, batatasin III, and pinostilbene), mediated by colon microbiota. Stilbenoids were fermented in an in vitro faecal fermentation system using fresh faeces from five different donors as an inoculum. The samples of metabolized stilbenoids were collected at 0, 2, 4, 8, 24, and 48 h. Significant differences in the microbial transformation among stilbene derivatives were observed by liquid chromatography mass spectrometry (LC/MS). Four stilbenoids (resveratrol, oxyresveratrol, piceatannol and thunalbene) were metabolically transformed by double bond reduction, dihydroxylation, and demethylation, while batatasin III and pinostilbene were stable under conditions simulating the colon environment. Strong inter-individual differences in speed, intensity, and pathways of metabolism were observed among the faecal samples obtained from the donors.

Effect of Selected Stilbenoids on Human Fecal Microbiota

Dietary phenolics or polyphenols are mostly metabolized by the human gut microbiota. These metabolites appear to confer the beneficial health effects attributed to phenolics. Microbial composition affects the type of metabolites produced. Reciprocally, phenolics modulate microbial composition. Understanding this relationship could be used to positively impact health by phenolic supplementation and thus create favorable colonic conditions. This study explored the effect of six stilbenoids (batatasin III, oxyresveratrol, piceatannol, pinostilbene, resveratrol, thunalbene) on the gut microbiota composition. Stilbenoids were anaerobically fermented with fecal bacteria from four donors, samples were collected at 0 and 24 h, and effects on the microbiota were assessed by 16S rRNA gene sequencing. Statistical tests identified affected microbes at three taxonomic levels. Observed microbial composition modulation by stilbenoids included a decrease in the Firmicutes to Bacteroidetes ratio, a decrease in the relative abundance of strains from the genus Clostridium, and effects on the family Lachnospiraceae. A frequently observed effect was a further decrease of the relative abundance when compared to the control. An opposite effect to the control was observed for Faecalibacterium prausnitzii, whose relative abundance increased. Observed effects were more frequently attributed to resveratrol and piceatannol, followed by thunalbene and batatasin III.

Anti-inflammatory Natural Prenylated Phenolic Compounds - Potential Lead Substances

Background:

Natural phenolics are secondary plant metabolites, which can be divided into several categories with the common structural feature of phenolic hydroxyl. The biological activity of phenolics is often modified and enhanced by prenylation by prenyl and geranyl; higher terpenoid chains are rare. The type of prenyl connection and modification affects their biological activity.

Objective:

This review summarizes information about prenylated phenols and some of their potential sources, and provides an overview of their anti-inflammatory potential in vitro and in vivo.

Method:

The literature search was performed using SciFinder and keywords prenyl, phenol, and inflammation. For individual compounds, an additional search was performed to find information about further activities and mechanisms of effects.

Result:

We summarized the effects of prenylated phenolics in vitro in cellular or biochemical systems on the production and release of inflammation-related cytokines; their effects on inhibition of cyclooxygenases and lipoxygenases; the effects on production of nitric oxide, antiradical and antioxidant activity; and the effect on the inhibition of the release of enzymes and mediators from neutrophils, mast cells and macrophages. The information about the antiphlogistic potential of prenylated phenolics is further supported by a review of their action in animal models.

Conclusion:

Almost 400 prenylated phenols were reviewed to overview their antiinflammatory effect. The bioactivity of several prenylated phenols was confirmed also using in vivo assays. A pool of natural prenylated phenols represents a source of inspiration for synthesis, and prenylated phenols as components of various medicinal plants used to combat inflammation could be their active principles.

Identification of key structural characteristics of Schisandra chinensis lignans involved in P-glycoprotein inhibition

The aim of the present study was to determine the structural requirements for dibenzocyclooctadiene lignans essential for P-glycoprotein inhibition. Altogether 15 structurally related lignans isolated from Schisandra chinensis or prepared by modification of their backbone were investigated, including three pairs of enantiomers. P-Glycoprotein inhibition was quantified using a doxorubicin accumulation assay in human promyelotic leukemia HL60/MDR cells overexpressing P-glycoprotein. A preliminary quantitative structure-activity relationship analysis revealed three main structural features involved in P-glycoprotein inhibition: a 1,2,3-trimethoxy moiety, a 6-acyloxy group, and the absence of a 7-hydroxy group. The most effective inhibitors, (-)-gomisin N (1) and (+)-deoxyschizandrin [(+)-2], were selected for further evaluation of their effects. Both these lignans restored the cytotoxic effect of doxorubicin in HL60/MDR cells and when combined with a subtoxic concentration of this compound increased the proportion of G2/M cells significantly, which is a usual response to treatment with this anticancer drug.

Bioassay-guided isolation of the antinociceptive compounds motiol and beta-sitosterol from Scorzonera latifolia root extract

Scorzonera latifolia (Asteraceae) is a plant widely distributed in Central and East Anatolia. A mastic, named yaki sakizi, is prepared from the latex and roots of S. latifolia and similar species. This latex is used in Turkish folk medicine for its analgesic activity, as anthelmintic and against infertility. The aim of this study was to isolate the compounds responsible for the antinociceptive activity of S. latifolia using bioassay-guided fractionation. The methanolic extract of the S. latifolia roots was prepared and subjected to chromatographic purification. Isolated active compounds were identified by means of MS and NMR techniques. Writhing and tail-flick tests were used to determine antinociceptive activity. Motiol and beta-sitosterol were isolated as compounds with promising antinociceptive activity. It is suggested that antinociceptive activity of the plant extract is probably caused by the synergic interaction of the isolated compounds.

Molecular mechanisms of antiproliferative effects induced by Schisandra-derived dibenzocyclooctadiene lignans (+)-deoxyschisandrin and (-)-gomisin N in human tumour cell lines

A different behavior of the two dibenzocyclooctadiene lignans (+)-deoxyschisandrin (1) and (-)-gomisin N (2), from Schisandra chinensis fruits, was observed against two human tumour cell lines, (2008 and LoVo). These lignans inhibited cell growth in a dose-dependent manner on both cell lines, but inducing different types of cell death. In particular, (+)-deoxyschisandrin (1) caused apoptosis in colon adenocarcinoma cells (LoVo) but not in ovarian adenocarcinoma cells (2008), while (-)-gomisin N (2) induced apoptosis on both the cell lines used. Mitochondrial-mediated pathway was not involved in apoptotic stimuli. Both compounds caused G2/M phase cell growth arrest correlated with tubulin polymerization.

Selected natural phenolic compounds - potential treatment for peripheral neuropathy?

Neuropathic pain is a syndrome comprising pain caused by a lesion or dysfunction of the nervous system, or resulting from lesions or diseases of the somatosensory system. Neuropathic pain is often connected with adverse effects of chemotherapy administered because of cancer, infiltration of the nervous tissue with cancer cells, neurodegeneration and diabetes mellitus. Disbalance in the production of various cytokines plays an important role in the pathogenesis of many of the diseases connected with neuropathies. These cytokines comprise in particular interleukins IL-1β, IL-15, and IL-6, tumour necrosis factors, and prostaglandins. The biochemistry of the production of cytokines is directed by nuclear factors, which affect the expression of the mRNA for the respective cytokines or enzymes metabolizing the cytokines. The main nuclear factor which regulates the expression of cytokines is NF-κB. Because of insufficient effectiveness or adverse effects of the pharmacological treatment of peripheral neuropathy, many patients seek supportive or adjuvant therapy. Natural compounds which modulate the production of inflammatory cytokines may reduce the symptoms of neuropathies. Many natural phenolic compounds belong to substances affecting the activity of NF-κB and consequently the activity of cytokines which are regulated by this substance. The aim of this mini-review is to present information about three natural phenols which are potentially usable for the treatment of neuropathies: curcumin, resveratrol and mangiferin, and bring attention to the practical usability thereof. Curcumin and mangiferin are active constituents of plants; they have been used for centuries in traditional medicine. Biological effects of resveratrol have been known for a relatively short time; since the discovery of the so-called French paradox, attention has been focused on resveratrol. This summary includes particularly the information related to the influence on the activity of NF-κB, expression of anti-inflammatory cytokines, and antiradical activity, because imbalance between the creation and degradation of free radicals plays an important role in the activation of NF-κB and in inflammatory processes. It also briefly summarizes basic information concerning bioavailability, metabolism and practical application of the aforementioned substances.

KEYWORDS

phenols curcumin mangiferin NF-κB peripheral neuropathy resveratrol.

[Surgical treatment of humeral diaphyseal fractures]

PURPOSE OF THE STUDY

The aim of the study was to compare two surgical methods of treating diaphyseal fractures of the humerus.

MATERIAL AND METHODS

A prospective randomised study on the surgical treatment of humeral diaphyseal fractures was carried out between September 2009 and January 2013. The patients indicated for surgical treatment fell into two groups according to the technique used as follows: minimally invasive plate osteosynthesis (MIPO) with a locking compression plate (LCP; Synthes, Switzerland); depending on the fracture type and course of fracture line, either a straight narrow or a Philos or a metaphyseal LCP was used (group 1); and intramedullary nailing (EHN, Synthes, Switzerland) (group 2). A total of 49 patients were entered into the study. The men-to-women ratio was about 1:1 and the average age was 52 years (18 to 83). Of them, 45 patients with 46 humeral fractures were followed up and evaluated. The injury was caused by a fall from standing or while walking (n=21), traffic accident (n=16), sports activity (n=3) or work-related activity (n=5). A single injury was treated in 72% and multiple trauma in 28% of the patients. Using the AO classification, fractures were diagnosed as types A, B and C in 25, 10 and 11 patients, respectively. The patients were randomised into the groups using a computer programme allowing for the maintenance of group homogeneity. Each patient received information on the method to be used in a sealed envelope.

RESULTS

The average injury-surgery interval was 6 days (range, 0 to 26). The average operative time was 128 minutes (80 to 200). The average intra-operative exposure to X-ray was 8 minutes (3 to 20). The average hospital stay was 20 days (4 to 100) The average rehabilitation time till functional recovery was 17 weeks (3 to 37), the time of bone union by radiographic assessment was 20 weeks (12 to 40). The functional outcome was assessed using the Constant-Murley (CM) and Liverpool Elbow Score (LES) systems. The relative CM/LES score, as compared with the healthy extremity, was 95/100. Excellent and good results were achieved in 89% and complications were recorded in 26% of the patients. The most frequent complication was impingement syndrome or prolonged rehabilitation both in the patients with proximal humerus fractures managed with the Philos locking plate and in those treated by intramedullary nailing, although this was not necessarily due to a technical error, i.e., osteosynthetic material protrusion. Iatrogenic radial nerve injury was found only in one patient treated by intramedullary nailing and was associated with traction during reduction and nail insertion. Pseudoarthrosis was recorded in one patient of each group and there were no infectious complications.

DISCUSSION

Intramedullary nailing has not yet shown such good outcomes in humeral as in tibial fractures. The results of metaanalysis have indicated that humeral fractures treated by plate osteosynthesis have fewer complications and require repeat surgery less frequently. However, as shown by most recent studies, this difference is getting smaller. The MIPO technique was adopted at our department several years ago and the aim was to compare our results with those of other centres. The studies so far published have show that MIPO and conventional open plate osteosynthesis give comparable outcomes. CONCLUSIONS The statistical evaluation using the unpaired t-test did not show any significant differences in either the functional results or the number of complications between the two methods. Both achieved about 90% of excellent and good results and had 26% of complications. The only significant difference was found in the length of operative time (136 min in MIPO versus 117 min in EHN). With use of the Chi-Square test, a significant correlation between AO fracture type and treatment outcome in the MIPO group was found, i.e., no poor result was recorded for type A fractures, as assessed by the CM/LES score. No such correlation between the fracture type and the functional outcome was seen in the EHN group.

A new triterpene from Scorzonera latifolia (Fisch. and Mey.) DC

A novel triterpene 1 (3-β-hydroxy-fern-7-en-6-one-acetate) together with four known compounds, urs-12-en-11-one-3-acetyl (2), 3-β-hydroxy-fern-8-en-7-one-acetate (3), olean-12-en-11-one-3-acetyl (4) and leucodin (5) were obtained from the S. latifolia roots. All compounds were isolated from the n-hexane extract of S. latifolia roots using several chromatographic techniques. The structure of the isolated compounds was elucidated on the basis of (1)H-NMR, (13)C-NMR and 2D NMR data (HMBC, HMQC, COSY, TOCSY, NOESY, DEPT) as well as GC EITOF-HRMS.

Geranylated flavanone tomentodiplacone B inhibits proliferation of human monocytic leukaemia (THP-1) cells

BACKGROUND AND PURPOSE

Paulownia tomentosa is a rich source of geranylated flavanones, some of which we have previously shown to have cytotoxic activity. To identify members of this class of compounds with cytostatic effects, we assessed the effects of the geranylated flavanone tomentodiplacone B (TOM B) on cell cycle progression and cell cycle regulatory pathways of THP-1 human monocytic leukaemia cells.

EXPERIMENTAL APPROACH

Cell viability was measured by dye exclusion and proliferation by WST-1 assays; cell cycle was monitored by flow cytometry. Regulatory proteins were assessed by immunoprecipitation and kinase assays, and Western blotting.

KEY RESULTS

Tomentodiplacone B had no effect during the first 24 h of cell growth at concentrations between 1 and 2.5 µM, but inhibited cell growth in a dose-dependent manner at concentrations of 5 µM or higher. Growth inhibition during the first 24 h of exposure to TOM B was not accompanied by cytotoxicity as cells were accumulated in G1 phase dose-dependently. This G1 phase accumulation was associated with down-regulation of cyclin-dependent kinase 2 activity and also protein levels of cyclins E1 and A2. However, key stress-related molecules (γ-H2AX, p53 and p21) were not induced, suggesting that TOM B acts by directly inhibiting the cyclin-dependent kinase 2 signalling pathway rather than initiating DNA damage or cellular stress.

CONCLUSIONS AND IMPLICATIONS

Our study provides the first evidence that TOM B directly inhibits proliferation of human monocytic leukaemia cells, and thus is a potential anticancer agent, preventing leukaemia cells from progressing from G1 phase into DNA synthesis.

[Surgical treatment for proximal humerus fracture]

PURPOSE OF THE STUDY

The aim of the study was to compare the medical aspects of alternative surgical methods for treatment of proximal humerus fractures in specific indications (two- and three- fragment fractures).

MATERIAL AND METHODS

A prospective randomised study on surgical treatment of two- and three-fragment fractures of the proximal humerus was carried out at the Department of Surgery, University Hospital in Hradec Králové, from January 2006 till January 2010. The study comprised patients with proximal humerus fractures indicated for surgical treatment. Study inclusion criteria were as follows: informed consent, AO fracture types A2, A3, B1 or C1, age between 18 and 80 years, and patient compliance. Exclusion criteria included open fracture, associated injury (AIS . 2), open growth plates, or such state of the patient's health that would limit the extent of surgery. Two groups were compared. One included patients treated by the Zifko method of minimally invasive osteosynthesis with intramedullary K-wire insertion (MIO group) and the other (ORIF group) consisted of patients undergoing open reduction with angle-stable osteosynthesis using a Philos plate (Synthes, Switzerland). The patients were randomised to the groups by a computer programme which facilitates the maintenance of homogeneity of the groups compared. The procedure in each patient was based on the sealed-envelope method.

RESULTS

The ORIF group comprised 28 patients. It took them an average of 27.2 weeks (9-72) to regain normal upper limb function. The final CM score was 86.6% (64-100%) as compared with the healthy limb. Excellent and good results were achieved in 89% of the patients; complications were recorded in 39% of them. The MIO group included 27 patients. The fractures healed in all of them. Normal upper limb function was regained at an average of 21.4 weeks (13-36). The final CM score was 87.5% (52-100%) in comparison with the healthy limb. Excellent and good results were achieved in 89% and complications developed in 33% of the patients.

CONCLUSIONS

The statistical evaluation of the results, using the unpaired t-test, did not show any significant differences either in functional outcomes or the number of complications between the two groups. The only significant difference was found in operative times (117 min and 72 min in ORIF and MIO groups, respectively). The difference in time needed to regain limb function (27 and 21 weeks) was at a marginal level of statistical significance. With both methods 89% of excellent and good results were achieved, and a similar number of patients had complications (11 and 9).

Evaluation of cytotoxic activity of Schisandra chinensis lignans

Using exhaustive chromatographic separation we have isolated (-)-tigloyl-deangeloyl-gomisin F as a novel dibenzocyclooctadiene lignan from schisandra chinensis. With the help of HPLC, we further isolated (+)-schisandrin, (+)-deoxyschisandrin, (+)-γ-schisandrin, (-)-gomisin J, (+)-gomisin A, (-)-gomisin N, (-)-tigloyl-gomisin P, (-)-wuweizisu C, (-)-gomisin D, rubrisandrin A, (-)-gomisin G, (+)-gomisin K (3) and (-)-schisantherin C. A full NMR description of (-)-schisantherin C was carried out with the aim to confirm previous reports of its structure. Compounds isolated were identified on the basis of UV, IR, (1)H- and (13)C-NMR and MS. The cytotoxicity of lignans was tested for the BY-2 cell line alone and as a synergistic effect with the cytotoxic agent camptothecin. Lignans showed various toxicity and synergistic and antagonistic effects on camptothecin-induced cytotoxicity. Cytotoxicity against colon cancer cell line LoVo was also tested.

Analgesic compounds from Scorzonera latifolia (Fisch. and Mey.) DC

ETHNOPHARMACOLOGICAL RELEVANCE

A traditional mastic named yaki sakizi prepared from the roots of Scorzonera latifolia (Fisch. and Mey.) DC. is used as a folk remedy for treatment of pain in Turkish folk medicine.

AIM OF THE STUDY

To isolate and identify the compounds responsible for the antinociceptive activity of S. latifolia using bioassay-guided fractionation.

MATERIALS AND METHODS

The methanolic extract of the S. latifolia roots was prepared and subjected to isolation procedures such as solvent-solvent partitioning and column chromatography. Writhing and tail-flick tests were used to determine the antinociceptive activity.

RESULTS

The n-hexane fraction of the S. latifolia root methanolic extract showed potent antinociceptive activity in both writhing and tail-flick tests. Three compounds were isolated from n-hexane fraction using bioassay-guided chromatographic purification. Isolated compounds were the triterpene taraxasteryl myristate, taraxasteryl acetate, and fern-7-en-3-beta-one, structures were elucidated by means of MS and NMR techniques. Both taraxasterol derivatives showed promising antinociceptive activity when compared to reference compounds.

CONCLUSION

Results of the present study support the usage of S. latifolia in Turkish folk medicine. Both plant root extract and the isolated compounds showed promising antinociceptive activities. Our results suggested that antinociceptive activity of the plant extract is probably caused by the synergistic interaction of the isolated compounds.

[Successful urgent thoracotomy in a patient with penetrating heart injury--case report]

The case of a patient with a penetrating cardiac injury successfully treated by thoracotomy is reported. In a suicidal attempt, he suffered a self-inflicted thoracic stub wound penetrating the left ventricle. During transport to the hospital, he developed circulatory instability. He was admitted to the emergency department with no signs of life and bilateral non-responding mydriasis. Immediately, urgent anterolateral thoracotomy at the left 5th rib was performed. The pericardium was opened, cardiac tamponade was evacuated and the stab wound in the right ventricle was sutured. The subsequent ventricular fibrillation was treated using defibrillation with an electric discharge of 200 J. After sinus rhythm had resumed, the patient was transferred to the operating theatre for the finishing of thoracic exploration. No more injury was found. Intermittent myoclonus had persisted since admission, and a CT scan showed diffuse cerebral oedema due to post-hypoxic brain damage. During the following hospitalisation, the patient underwent the SSEP examination (evoked potentials) and no signs of decortication were found. At four weeks after injury, the patient was transported to his regional hospital he was afebrile, with stable circulation, spontaneous ventricular function and the GCS of 8 to 9.

[Expert Tibial Nail (ETN) for treatment of diaphyseal tibial fractures in current and extended indications: technique and clinical results]

PURPOSE OF THE STUDY

To present the authors' technical experience with the use of the Expert Tibial Nail (ETN) technique and its clinical results.

MATERIAL AND METHODS

Between December 2005 and the end of 2007, the ETN technique was used in 41 patients to treat 41 diaphyseal tibial fractures. All patients were followed-up prospectively.

RESULTS

The injury Severity Score (ISS) was in the range of 4 to 25 (average, 5.9). Eight patients suffered multiple trauma, 33 had isolated injuries. Of the 41 fractures, 31 were closed and 10 were open injuries. The fracture types according to the Tscherne classification were as follows: closed 0 type (n=10); closed type I (n=18); closed type II (n=3); open type I (n=3); open type II (n=5); open type III (n=2). The injury-to-surgery interval ranged from 1h and 50 min to 25 h and 12 min (median, 8 h and 52 min).The operative time ranged from 50 to 170 min (average, 87 min). Infectious complications or a secondary loss of reduction were not recorded. Three cases of insufficient primary reduction underwent repeat surgery during the first stay in hospital. Full weight-bearing with no pain was reported in the range of 10 to 24 weeks (average, 18 weeks) after surgery.

DISCUSSION

A choice of the nail diameter in relation to the marrow cavity width can be made during surgery with no loss of reduction (guidewire; undreamed/reamed nail). Because of a shorter straight lower part of the nail (compared to a UTN), a very steep position of the nail is necessary at its insertion in a short proximal metaphyseal fragment. The blunt lower ETN end can produce fracture line distraction when an effort is made to drive the nail as deep as possible into the short distal meta- physeal block, if this has not been reamed.

CONCLUSIONS

The ETN provides sufficient stability of diaphyseal tibial fractures including those involving the metaphysis. However, in some instances, poler screws are still indispensable. Sufficient reduction is necessary before nail insertion.

Nanofiber micro-dispersed oxidized cellulose as a carrier for topical antimicrobials: first experience

BACKGROUND

Micro-dispersed oxidized cellulose, already used for hemostasis, might be helpful for introduction of an antimicrobial drug.

AIM

To examine the effect of topically applied gentamicin attached to a new biodegradable carrier formed by micro-dispersed oxidized cellulose in microfiber and nanofiber form for treatment of acute wound infection and to assess the influence of this carrier on healing.

MATERIALS AND METHODS

A model of a full-thickness infected dermal wound was created in 12 female domestic pigs. The effectiveness of topical gentamicin delivered with micro-dispersed oxidized cellulose carrier was tested in acute wound infections caused by Staphylococcus aureus, Pseudomonas aeruginosa, or Escherichia coli.

RESULTS

The effectiveness of nanofiber micro-dispersed oxidized cellulose with gentamicin was proved according to culture findings. When assessed macroscopically, 100% of wounds treated by the nanofiber product had no signs of local infection. When microfiber micro-dispersed oxidized cellulose was used, cultures demonstrated residual bacteria in 94.4% of treated incisions despite the absence of clinically recognized infection.

CONCLUSIONS

Micro-dispersed oxidized cellulose carrier with a sufficient concentration of an attached antibiotic appears to be effective for the treatment of full-thickness skin infections. The positive influence of the product on the healing of a dermal incision was shown, and a good hemostatic effect was confirmed.

Cytotoxic activities of several geranyl-substituted flavanones

Nine geranylated flavanones isolated from the fruits of Paulownia tomentosa (4-12) and two from the roots of Morus alba (13 and 14) were examined for cytotoxicity to selected human cancer cell lines and normal human fibroblasts. Cytotoxicity was determined in vitro using a calcein AM cytotoxicity assay. Cytotoxicity for the THP-1 monocytic leukemia cell line was tested using erythrosin B cell staining. The geranylated compounds tested were compared with the known simple flavanone standards taxifolin (1), naringenin (2), and hesperetin (3) and with the standard anticancer drugs olomoucine II, diaziquone, and oxaliplatin and the antineoplastic compound camptothecin, and showed different levels of cytotoxicity. The effects of structural changes on cytotoxic activity, including geranyl substitution of the flavanone skeleton and the oxidation pattern of ring B of the flavanones, are discussed.

Effect of diplacone on LPS-induced inflammatory gene expression in macrophages

Flavonoids are commonly studied for their anti-inflammatory effects; however, this is the first paper describing the possible antiphlogistic activity of a geranylated flavanone. This study focused on the ability of diplacone to modulate the gene expression of pro-inflammatory tumour necrosis factor alpha and monocyte chemoattractant protein 1, and of anti-inflammatory zinc finger protein 36. The action of diplacone was also compared with that of conventional drug indomethacin. Human monocyte-derived macrophages of the human monocytic leukaemia cell line were pretreated with diplacone or indomethacin. Subsequently, inflammatory reaction was induced by lipopolysaccharide, and changes of tumour necrosis factor alpha, monocyte chemoattractant protein 1 and zinc finger protein 36 gene expression at the transcriptional level were measured. In this model, diplacone significantly down-regulated the expression of tumour necrosis factor alpha and monocyte chemoattractant protein 1 and up-regulated the zinc finger protein 36 expression. This makes diplacone a promising molecule for treatment of the inflammatory stage of diseases. The effect of diplacone in decreasing lipopolysaccharide-induced inflammatory gene expression is in many ways similar to that of the conventional drug indomethacin.

[Minimally invasive plate osteosynthesis (MIPO) in the humeral diaphysis fractures]

INTRODUCTION

Most of the humeral shaft fractures can be successfully treated conservatively. Due to increasing number of multiple and high-energy injuries, necessity of patient's compliance and restriction of his selfcare is conservative treatment in background. Humeral shaft fractures indicated to operation treatment are mostly solved by closed reposition and internal fixation with intramedullar nail (CRIF) or open reposition and internal fixation (ORIF).

AIM

The aim is to prove that miniinvasive plate osteosynthesis (MIPO) of the humeral shaft fractures combines advantages of the both currently used methods. In other words, to use a plate osteosynthesis with minimal invasiveness and to exclude unexpected complications of radical operation approach by open reposition and problems related to nailing.

MATERIAL AND METHOD

From March 2007 to August 2008 we operated on 20 patients with humeral shaft fractures using MIPO technique. Fractures were classified according to AO-classification: A - 9x, B - 5x, C - 6x. There were monotraumas and multiple injuries, as well.

RESULTS

The results were evaluated by Constant-Murley test and Liverpool elbow scoring system. The mean value was 92/9.1 points. In 75% of patients we have reached good and excellent results. Complications were observed in 5 patients (20%). All patients have been healed.

CONCLUSION

In spite of the limited number of patients in case serie our results are in accordance with current published data. Minimally invasive plate osteosynthesis is in our opinion safe and effective operation method for humeral shaft fractures treatment.

[Post-traumatic hypoglossal nerve paresis due to occipital condyle fracture]

The authors describe the case of a patient, a 33-year-old man, who presented with paresis of the hypoglossal nerve following an occipital condyle fracture. The patient, as a driver, was involved in a car accident and from the beginning he complained of neck pain. The diagnosis was established by CT examination as late as 72 hours after injury on the basis of clinical presentation (difficulty in swallowing, chewing and speaking due to impaired mobility of the left half of the tongue, with the left half showing a marked hypotrophy and muscle weakness). A conservative treatment was used - application of a rigid cervical collar for 3 months, which resulted in gradual neurological improvement.

Cholinesterase inhibitory activities of some flavonoid derivatives and chosen xanthone and their molecular docking studies

Flavonoids are one of the largest classes of plant secondary metabolites and are known to possess a number of significant biological activities for human health. In this study, we examined in vitro acetylcholinesterase (AChE) and butyrylcholinesterase (BChE) inhibitory activities of four flavonoid derivatives--quercetin, rutin, kaempferol 3-O-beta-D-galactoside and macluraxanthone. The in vitro results showed that quercetin and macluraxanthone displayed a concentration-dependant inhibition of AChE and BChE. Macluraxanthone showed to be the most potent and specific inhibitor of both the enzymes having the IC(50) values of 8.47 and 29.8 microM, respectively. The enzyme kinetic studies revealed that quercetin inhibited both the enzymes in competitive manner, whereas the mode of inhibition of macluraxanthone was non-competitive against AChE and competitive against BChE. The inhibitory profiles of the compounds have been compared with standard AChE inhibitor galanthamine. To get insight of the intermolecular interactions, the molecular docking studies of these two compounds were performed at the active site 3D space of both the enzymes, using ICM-Dock module. Docking studies exhibited that macluraxanthone binds much more tightly with both the enzymes than quercetin. The calculated docking and binding energies also supported the in vitro inhibitory profiles (IC(50) values). Both the compounds showed several strong hydrogen bonds to several important amino acid residues of both the enzymes. A number of hydrophobic interactions could also explain the potency of the compounds to inhibit AChE and BChE.

Cholinesterase inhibitory effects of the extracts and compounds of Maclura pomifera (Rafin.) Schneider

We have investigated anticholinesterase potential of the methanol extracts from the leaf, wood, flower, twig, and stem bark of the female and male individuals and rhizodermis and fruit from the female tree of Maclura pomifera (Rafin.) Schneider (Moraceae) along with its major isoflavonoids; osajin and pomiferin as well as their semi-synthetic derivatives; iso-osajin and iso-pomiferin. Anticholinesterase activity was determined by Ellman method using ELISA microplate reader. Osajin and pomiferin had a noticeable inhibition of AChE with IC(50) values of 2.239 and 0.096 mM, respectively, while their iso-derivatives were found to display less inhibition towards AChE. The extracts and compounds did not inhibit BChE. The extracts were analyzed for osajin and pomiferin contents by LC-DAD-MS and only the fruits and female flowers contained osajin (fruit: 8.87%, female flowers: 0.19%, w/w) and pomiferin (fruit: 13.6%, female flowers: 0.36%, w/w).

[Operation treatment of the humeral shaft fractures]

INTRODUCTION

Nowadays the humeral shaft fractures represent about 4% of all fractures. Most of them can be treated conservatively. In this type of treatment the cooperation of the patient is necessary, treatment is long lasting and needs the extremity to be immobilized. That's why still more fractures are indicated for the operation treatment, which enables an early rehabilitation and selfcare of the patient.

AIM

The aim of our work was to assess the functional and clinical results in patients after the operation of the humeral shaft fractures treated by closed reposition and intramedullary fixation or by open reposition and plate osteosynthesis (ORIF).

DESIGN

Retrospective descriptive study--case serie

MATERIAL AND METHODS

In our department within the years 2001-2006 we operated on 101 patients with humeral shaft fractures. 65 patients came to be checked, the follow up rate--65%. Fractures were classified according AO: A--50%, B--29%, C--21%. The ORIF was used in 18 patients, closed reduction and locked intramedullary nail in 21 patients, and closed reduction and K-wires bundle (Hackethal) in 26 patients.

RESULTS

The resulting conditions we evaluated by Constant-Murley and Liverpool elbow scoring system. The mean value reached 86/8.9. In 82% of patients we have reached good to excellent results. Complications were noted in 34

CONCLUSION

In spite of limited number of patients in our study the results of ours generally are not in contradiction to the current literature data. The best results were achieved by ORIF. On the contrary, the worst outcomes with greatest number of complications were in Hackethal group.

Cytotoxic activity of C-geranyl compounds from Paulownia tomentosa fruits

The newly discovered 5,7-dihydroxy-6-geranylchromone ( 1) was isolated from PAULOWNIA TOMENTOSA fruit and subsequently characterized. The structure of the isolated compound was elucidated on the basis of extensive NMR experiments including HMQC, HMBC, COSY, and NOESY, as well as HR-MS, IR, and UV. The cytotoxicity of 1 was evaluated using a plant cell model represented by tobacco BY-2 cells. The other phytoconstituents ( 2 - 8) previously isolated from P. TOMENTOSA were similarly evaluated together with the known flavanones 10 and 11. The cytotoxicity (human erythro-leukaemia cell line K562) and activity on erythroid differentiation of compounds 2 - 9 and 12 and 13 have also been evaluated. Acteoside ( 2) was determined to be the most toxic of the compounds tested on BY-2 cells, diplacone ( 6) on the K562 cell line. Some aspects of the relationship between the flavanone skeleton substitution and the metabolic activation necessary for a toxic effect are discussed.

Ischemic affection of the spinal cord as a result of the blunt thoracic trauma--a case report

Authors present the case of a patient who suffered the blunt thoracic trauma. In the clinical picture there dominated the paraplegia of both the lower extremities. Due to the weakened breathing on the right side the urgent thoracic drainage was performed. For circulation instability and amount of blood passing out of the drain an urgent thoracotomy was indicated even prior to the CT or MRI. During the operation bleeding from the Adamkiewicz's artery was spotted and sanated. After the postoperative stabilization the CT and MRI investigations proved the spinal cord ischemia as a cause of the local damage.

Antibacterial C-geranylflavonoids from Paulownia tomentosa Fruits

Eight C-6-geranylflavonoids ( 1- 8) were isolated from an ethanol extract of Paulownia tomentosa fruits. Tomentodiplacone ( 1), 3'- O-methyl-5'-hydroxydiplacone ( 2), 3'- O-methyl-5'- O-methyldiplacone ( 3), and tomentodiplacone B ( 4) were obtained as new compounds, and 3'- O-methyldiplacol ( 5) was isolated for the first time from a natural source. The structures of these new compounds were determined by using mass spectrometry (including HRMS) and 1D and 2D NMR spectroscopy, and the absolute configurations of the compounds were determined by circular dichroism. The antibacterial activities of 1- 8 against seven bacteria and yeast were evaluated.

[Surgical management of proximal humeral fractures using the Hackethal (Zifko) method--a case review]

BACKGROUND

Fractures of the proximal humerus actually represent 5% of all fractures and 45% of all humeral fractures with the highest incidence in women over 60 years of age. The outcomes of the greatest concern at these patients (pain, function of the shoulder and activities of daily living) get worse with age, osteoporosis, grading of fracture type and of initial fracture displacement. According to the literature (Evidence Based Medicine--EBM level II-III) operative treatment of displaced fractures reduces pain and need for assistance in activities of daily living, but open reduction with internal fixation by conventional screws and plates was connected with implant loosening, infection and avascular necrosis, whereas closed reduction with different methods of miniinvasive percutaneous stabilisation is threatened by primary malreduction.

AIM

Evaluation of clinical and functional outcomes and analysis of results of proximal humerus fractures treated by closed or percutaneous reduction and intramedullary fixation by means of bundle of Kirschner wires after Zifko.

DESIGN

Retrospective descriptive study--case serie.

MATERIAL AND METHODS

Within January 1, 2005 - December 31, 2005 there were 87 patients with 87 two- and three-fragments fractures of proximal humerus (according to Neers classification) operated at our institution, from which 76 by the method after ZiFko. 36 patients from these 76 came to final evaluation (follow-up rate 47%). AO fracture types were: A2-36%, A3-33%, B1-19%, C1-12%.

RESULTS

The resulting Constant-Murley (CM) score reached in mean 89 points with 89% of excellent--good functional results. Complications were recorded in 30% of cases and were represented mainly by proximal migration of K-wires. Avascular necrosis of humeral head occured in two cases (5.5%).

CONCLUSION

In spite of low follow-up rate we conclude, that the method of closed reduction and intramedullary fixation of two- and three-part fractures of proximal humerus after Zifko offers above-average final results with acceptable rate of complications, mostly not severe ones. The essential pre-condition of good result is proper reduction--closed of percutaneous one. On the contrary, suboptimal results correlate with primary and secondary malreductions. The incidence of latter increases in intraarticular fracture types with small fragment of head and thus with insuficient implant retention. To evaluate the merit of the method in relation to angle-stable extra-/or intramedullary implants, the prospective trials are needed.

[Rupture of the interventricular septum after the blunt trauma of thorax]

Authors present the case of little patient with the dissection, pseudoaneurysm and finally a rupture of the interventricular septum after the blunt thracic injury. The patient was smitten as a pedestrian by a car and during the whole period of her stay in the hospital she was showing signs of circulatory instability. Due to the current intraabdominal injuries this circulatory decompensation was first assigned to hemoperitoneum, for which the girl was operated on about 3 hours after admission. Nevertheless, even after the abdminal cavity check, after the treatment of supreficial liver lacerations and intensive volume resuscitation the patient showed signs of insufficiency. Diagnosis was finally determined on the base of the transthoracic echocardiography (TTE), which proved the traumatic rupture of interventricular septum. The operation followed correcting the defect, which was performed with a good result according to the TTE postoperatively. Nevertheless, 27 hours after the admission the patient died due to the electromechanical dissociation. In the discussion the authors then evoke a number of papers concerning the same topic.

[Sacral nerve stimulation in the treatment of anal incontinence]

Anal incontinence is defined as the loss of control of defecation. An estimated prevalence is about 20%, it increases with age and women are affected more frequently. Sacral nerve stimulation is a new treatment method with success rate nearly of 80%. It consists of two phases, temporary percutaneous nerve evaluation and permanent stimulation. The best results may be achieved in patients with anatomically intact sphincters, although indication criteria are still not uniform. Mechanism of action remains also unclear. Authors summarise aetiology of anal incontinence, describe the method of sacral nerve stimulation, indications and bring present published results of this method. The aim of this paper is to inform about the new treatment option which has not been yet used in the Czech Republic.

C-geranyl compounds from Paulownia tomentosa fruits

Five geranylflavonoids, one prenylated flavonoid, and a simple flavanone were isolated from an ethanolic extract of Paulownia tomentosa fruit. Tomentodiplacol (1), 3'-O-methyl-5'-methoxydiplacol (2), 6-isopentenyl-3'-O-methyltaxifolin (3), and dihydrotricin (4) are reported from a natural source for the first time and 3'-O-methyldiplacone (6) for the first time from the genus Paulownia. The structures of the compounds were determined by mass spectrometry, including HRMS, and by 1D and 2D NMR spectroscopy. The cytotoxicity and DPPH (2,2-diphenyl-1-picrylhydrazyl)-quenching activity of some of these compounds were tested, with diplacone proving to be the best antioxidant, although the most cytotoxic compound.

Antiradical activity of Paulownia tomentosa (Scrophulariaceae) extracts

Paulownia tomentosa is a large indecidous tree planted mostly for its fast growing wood and decorative purposes. The tree is also used in traditional Chinese medicine. As a part of our study of natural polyphenols, the fruits of Paulownia tomentosa were extracted by EtOH and than subjected to liquid/liquid extraction. Fractions were analysed by TLC and HPLC to determine presence of phenolic substances. We identified and quantified acteoside (1) and isoacteoside (2) in the EtOAc and n-BuOH extracts; mimulone (3) and diplacone (4) in the MeOH extract. To determine the antiradical activity of extracts we used the anti DPPH and peroxynitrite assays. The activity was expressed as Trolox C equivalents, IC50 for DPPH scavenging and a time dependency course was established. The polyphenols content was determined; results were expressed as gallic acid equivalents. Using these methods we found the fractions of the n-BuOH, EtOAc and MeOH extracts that display antiradical activity, which could be exploited as potential pharmaceuticals.

[Traumatic pseudoaneurysm of arteria femoralis profunda--the case report]

Authors present the case report of the pseudoaneurysm of deep femoral artery caused by the injury of the vessel wall during the open femur fracture. This fracture was primarly treated by repoisition and stabilization by the external fixator (Rohr system, Synthes GmbH, Switzerland), which was nine days later converted into the intramedullar osteosynthesis by the unreamed nail UFN (Synthes GmbH, Switzerland). The first clinical signs of the pseudoaneurysm occurred several days after the patient had been dismissed. In the clinical picture there dominated the painful swelling of thigh but no perfusion or innervation disorders in the periphery of the extremity were noticed and the finding was concluded as myositis ossificans. Proper diagnosis was set only 6 weeks later on the basis of the ultrasound and angiographic investigations. The situation was then solved by the angiographic embolization of pseudoaneurysm. In the discussion also other opinions from the literature are presented.

Delayed splenic rupture: an unusual cause of acute surgical abdomen

Authors describe an unusual case of acute abdomen after the traffic injury. They remind correct diagnosis of delayed splenic rupture and compare it with other literature findings.

Importance of the anorectal manometry in chronic anal fissure

This publication presents the results of postoperative manometric investigations of 77 patients with anal fissure treated within the time span 1985-1997 by lateral sphincterotomy (LS). Results of manometric investigations are compared with digital anal examinations and subjective complaints of patients. Digital anal examination correlated with manometry results in 52 cases (68%). The correspondence between these two results was proved in 48 cases when normal finding was present. An increased sphincter tonus was found in 3 patients, all of them having the anal fissure recurrences. A marked sphincters insufficiency, which had been manifested by stool and gas incontinence was found in one case. When searching for the reason of this complication we found out that this operation procedure had been performed by an unexperienced team of surgeons. In 25 cases (32%) the digital anal assessment and manometric measurement were different. Nevertheless, the clinical symptoms in this group of patients were rather poor. To conclude we may state that manometry provides important data for preoperative evaluation of anal sphincter function and should be performed prior to lateral sphincterotomy operation at least in women.

Immunoscintigraphy and intra-operative radioimmunodetection in the treatment of colorectal carcinoma

PURPOSE

Intra-operative radioimmunodetection of malignant involved lymph nodes follows the pre-operative immunoscintigraphy in the treatment of patients with colorectal carcinoma. The aims of this clinical study were to determine the sensitivity of the method, to compare the results in study when using Oncoscint and CEA-Scan and to evaluate the importance of the method of surgery and postoperative adjuvant therapy.

PATIENTS AND METHODS

121 patients with colorectal tumours (106 primary and 15 recurrent) were operated on using radioimmunoguided surgery (RIGS). The study compared results of pre-operative immunoscintigraphy, intra-operative radioimmunodetection and postoperative histological examination. Histological investigation used classical H&E staining. In histologically negative and RIGS positive cases the immunohistochemical investigation was supplemented. Two radiopharmaceuticals were used Oncoscint CR 103 (MAb B72.3, Satumomab Pendetide), labelled with 111In in 56 patients and CEA-Scan (IMMU 4-Fab' fragments MAb against CEA, Arcitumomab), labelled with 99mTc in 65 patients.

RESULTS

The relationship between RIGS positive results and histological examination was statistically assessed after 38 operations and the most acceptable RIGS evaluating index was determined. All subsequent results were evaluated by this index. Immunoscintigraphy of tumour was positive in 112 cases (92.6%). Fifty-five RIGS positive cases of malignant infiltrated lymph nodes were confirmed by 43 histologically positive examinations (78%). In this group 9 cases were discovered only by immunohistochemistry. Sixty-six remaining RIGS negative results were confirmed in 62 (94%) cases by negative histology.

CONCLUSIONS

Both immunoscintigraphy and RIGS enable one to make a more accurate diagnosis. While treating the primary disease the use of RIGS may help in assessment of necessary extent of operation performance and in staging of the disease by revealing occult lymph nodes involved. Pre-operative immunoscintigraphy seems to be a useful diagnostic method for detection of tumour recurrence. When comparing two radiopharmaceuticals used, CEA-Scan seems to be more suitable for diagnostic studies, but using the Oncoscint for tumour recurrence detection had some specific benefit, too.

[Role of peroperative coloscopy]

The authors focus attention on the method of preoperative endoscopy which is useful in some operations of the digestive tract and evaluate retrospectively its contribution in their own department. They compare data on this method in the professional literature and consistent with them they recommend preoperative endoscopic examination in indicated cases as a safe, rapid and effective method for improving the standard of surgical care of patients and recommend this method in the algorithm of treatment.