Illness tracking in SARS-CoV-2 tested persons using a smartphone app: a non-interventional, prospective, cohort study

There are few data on the range and severity of symptoms of SARS-CoV-2 infection or the impact on life quality in infected, previously healthy, young adults such as Swiss Armed Forces personnel. It is also unclear if an app can be used to remotely monitor symptoms in persons who test positive. Using a smartphone app called ITITP (Illness Tracking in Tested Persons) and weekly pop-up questionnaires, we aimed to evaluate the spectrum, duration, and impact of symptoms reported after a positive SARS-CoV-2 test according to sex, age, location, and comorbidities, and to compare these to responses from persons who tested negative. We followed up 502 participants (57% active participation), including 68 (13.5%) positive tested persons. Hospitalisation was reported by 6% of the positive tested participants. We found that positives reported significantly more symptoms that are typical of COVID-19 compared to negatives. These symptoms with odds ratio (OR > 1) were having difficulty breathing (OR 3.35; 95% CI: 1.16, 9.65; p = 0.03), having a reduced sense of taste (OR 5.45; 95% CI: 1.22, 24.34; p = 0.03) and a reduced sense of smell (OR 18.24; 95% CI: 4.23, 78.69; p < 0.001). Using a random forest model, we showed that tiredness was the single symptom that was rated as having a significant impact on daily activities, whereas the other symptoms, although frequent, had less impact. The study showed that the use of an app was feasible to remotely monitor symptoms in persons infected with SARS-CoV-2 and could be adapted for other settings and new pandemic phases such as the current Omicron wave.

A Review of Total Hip Arthroplasty Comparison in FNF and OA Patients

BACKGROUND

Worldwide, total hip arthroplasty (THA) has become one of the most commonly performed surgical procedures. Femoral neck fracture (FNF) and osteoarthritis (OA) are two of the medical conditions necessitating a hip replacement, most frequently carried out. The preoperative and postoperative pathways for patients suffering from these two diseases differ, yet worldwide, many national healthcare systems underestimate or misinterpret the (more than nuanced) care plan differences of the two. Factors and Criteria. Analyzed material was gathered from studies published between 2013 and 2019. Various strands of data demographics, comorbidities, and complications, as well as treatment outcomes, were tabulated to compare and contrast THA patients suffering from FNF and OA to collate their findings. Outcomes were cross-checked and validated for reliability and then were presented in a table format.

RESULTS

All five retrospective cohort studies fitted the required criteria for inclusion in this work, four US-based study groups and one European-based study group. Data were gathered from three separate databases. The "average" FNF patient is 76.8 years old. There was a 68.96% female probability. The "average" OA patient is 69.15 years old. There was a 5.24% female probability. 59.57% operated for athrosis, and only 34.63% operated for fracture which received grade lower than the third in the American Society of Anaesthesiologist (ASA) classification. There was more than 3 times higher prevalence of complications in the trauma group. FNF patients' hospitalization was approximately 3 days longer. On average, 3.7% of patients operated for trauma and 1.5% of patients with elective THA required a second surgery. 6.57% FNF and 2.93% OA patients had unplanned readmission.

CONCLUSIONS

In general, patients who suffer a femoral neck fracture are an extremely fragile group. They require additional perioperative and postoperative care. To meet these desired expectations, more FNF cost-comprehensive systems need to be initiated.

Acquired immune deficiency syndrome (AIDS) and late presentation in Poland - data from Test and Keep in Care (TAK) Polska project

OBJECTIVES

Late presentation (LP) at HIV diagnosis is associated with worse prognosis and an increase in the number of new infections. We analyse the proportion of patients diagnosed late and factors related to LP in Poland in 2016-2017.

METHODS

Data were obtained from 13 out of 17 HIV centres in Poland from 2016 and 2017, including date of diagnosis, age, sex, transmission route, anti-hepatitis C virus (anti-HCV), Venereal Diseases Research Laboratory (VDRL) antibodies, AIDS diagnosis, baseline HIV viral load and CD4 count.

RESULTS

Out of 1522 patients, 88.9% were male with median age of 33.6 years. Men who have sex with men (MSM) comprised 69.4% of all new infections, heterosexual route of transmission (HTX) 18.2% and injecting drug use (IDU) 4.7%. Late presenters comprised 44.8% of the study group. Factors associated with LP were female sex [odds ratio (OR) = 1.5, 95% confidence interval (95% CI): 1.09-2.08], older age (OR = 1.59, 95% CI: 1.42-1.79 per decade), route of transmission (HTX: OR = 1.96, 95% CI: 1.50-2.56; IDU: OR = 3.17, 95% CI: 1.92-5.37), positive HCV results (OR = 1.90, 95% CI: 1.23-2.95) and syphilis diagnosis (OR = 2.06, 95% CI: 2.29-3.31). Adjusting for these factors, the only independent factors associated with LP were age (OR = 1.52, 95% CI: 1.35-1.71) and route of transmission (HTX: OR = 1.73, 95% CI: 1.23-2.44; IDU: OR = 2.24, 95% CI: 1.25-4.10).

CONCLUSIONS

Late presentation in Poland follows European trends. A total of 44.8% of all newly diagnosed patients in Poland continue to present late or at the AIDS stage. Independent factors associated with LP/AIDS were older age, IDU and HTX. Patients from these groups should be targeted to improve early diagnosis and medical care.

Increased expression of the TNF superfamily member LIGHT/TNFSF14 and its receptors (HVEM and LTßR) in patients with systemic sclerosis

OBJECTIVES

This study aimed to assess the potential role of the TNF superfamily member lymphocyte T-related inducible ligand that competes for glycoprotein D binding to herpesvirus entry mediator on T cells (LIGHT) in SSc through evaluation of: skin expression of LIGHT and its receptors, herpesvirus entry mediator and lymphotoxin ß-related receptor, and serum concentration of LIGHT in SSc patients.

METHODS

Expression of LIGHT and its receptors was investigated by immunohistochemistry and evaluated semi-quantitatively in skin biopsies from 19 SSc patients and 9 healthy controls. Serum levels of LIGHT were measured using ELISA in 329 patients with SSc and 50 control subjects.

RESULTS

Expression of LIGHT and both receptors was higher in SSc patients compared with controls (P < 0.05 for all comparisons). Patients with early SSc (⩽ 3 years from the first non-Raynaud's phenomenon symptom) showed higher expression of LIGHT and herpesvirus entry mediator compared with patients with longer disease duration (P < 0.05 for both comparisons). The mean serum concentration of LIGHT was significantly higher in SSc patients compared with the controls (P < 0.05). High serum concentration of LIGHT was associated with male sex, presence of digital ulcers, muscle involvement (defined by elevated serum creatine kinase levels), steroid treatment and lack of ACA. However, in multivariate regression analysis only presence of digital ulcers and creatine kinase elevation were independently associated with serum concentration of LIGHT.

CONCLUSION

These data provide the first evidence of overexpression of LIGHT and its receptors in SSc and suggest that the LIGHT axis might contribute to the pathogenesis of SSc. Increased serum concentrations of LIGHT seem to reflect vascular injury in SSc.

Potential role for Streptococcus gordonii-derived hydrogen peroxide in heme acquisition by Porphyromonas gingivalis

Streptococcus gordonii, an accessory pathogen and early colonizer of plaque, co-aggregates with many oral species including Porphyromonas gingivalis. It causes α-hemolysis on blood agar, a process mediated by H₂ O₂ and thought to involve concomitant oxidation of hemoglobin (Hb). Porphyromonas gingivalis has a growth requirement for heme, which is acquired mainly from Hb. The paradigm for Hb heme acquisition involves the initial oxidation of oxyhemoglobin (oxyHb) to methemoglobin (metHb), followed by heme release and extraction through the actions of K-gingipain protease and/or the HmuY hemophore-like protein. The ability of S. gordonii to mediate Hb oxidation may potentially aid heme capture during co-aggregation with P. gingivalis. Hemoglobin derived from zones of S. gordonii α-hemolysis was found to be metHb. Generation of metHb from oxyHb by S. gordonii cells was inhibited by catalase, and correlated with levels of cellular H₂ O₂ production. Generation of metHb by S. gordonii occurred through the higher Hb oxidation state of ferrylhemoglobin. Heme complexation by the P. gingivalis HmuY was employed as a measure of the ease of heme capture from metHb. HmuY was able to extract iron(III)protoporphyrin IX from metHb derived from zones of S. gordonii α-hemolysis and from metHb generated by the action of S. gordonii cells on isolated oxyHb. The rate of HmuY-Fe(III)heme complex formation from S. gordonii-mediated metHb was greater than from an equivalent concentration of auto-oxidized metHb. It is concluded that S. gordonii may potentially aid heme acquisition by P. gingivalis by facilitating metHb formation in the presence of oxyHb.

High serum sCD163/sTWEAK ratio is associated with lower risk of digital ulcers but more severe skin disease in patients with systemic sclerosis

INTRODUCTION

Systemic sclerosis (SSc) is an autoimmune disease characterized by chronic inflammation, vascular injury and excessive fibrosis. CD163 is a scavenger receptor which affects inflammatory response and may contribute to connective tissue remodelling. It has recently been demonstrated that CD163 can bind and neutralize the TNF-like weak inducer of apoptosis (TWEAK), a multifunctional cytokine which regulates inflammation, angiogenesis and tissue remodelling. We aimed to investigate the relationships between serum levels of soluble CD163 (sCD163) and soluble TWEAK (sTWEAK) in relation to disease manifestations in SSc patients.

METHODS

This study included 89 patients with SSc who had not received immunosuppressive drugs or steroids for at least 6 months and 48 age- and sex-matched healthy controls (HC) from four European centres. Serum concentrations of sTWEAK and sCD163 were measured using commercially available ELISA kits.

RESULTS

The mean serum concentrations of sTWEAK were comparable between SSc patients (mean +/- SD: 270 +/- 171 pg/mL) and HC (294 +/- 147pg/mL, P >0.05). Concentration of sCD163 and sCD163/sTWEAK ratio were significantly greater in SSc patients (984 +/- 420 ng/mL and 4837 +/- 3103, respectively) as compared to HC (823 +/- 331 ng/mL and 3115 +/- 1346 respectively, P <0.05 for both). High sCD163 levels and a high sCD163/sTWEAK ratio (defined as > mean +2SD of HC) were both associated with a lower risk of digital ulcers in SSc patients (OR, 95%CI: 0.09; 0.01, 0.71, and 0.17; 0.06, 0.51, respectively). Accordingly, patients without digital ulcers had a significantly higher sCD163 concentration and sCD163/sTWEAK ratio as compared to SSc patients with digital ulcers (P <0.01 for both) and HC (P <0.05 for both). A high sCD163/sTWEAK ratio, but not high sCD163 levels, was associated with greater skin involvement.

CONCLUSIONS

The results of our study indicate that CD163-TWEAK interactions might play a role in the pathogenesis of SSc and that CD163 may protect against the development of digital ulcers in SSc. Further studies are required to reveal whether targeting of the CD163-TWEAK pathway might be a potential strategy for treating vascular disease and/or skin fibrosis in SSc.

Recent advances in the diagnosis and treatment of systemic sclerosis

Systemic sclerosis (SSc) is a multisystem autoimmune disease characterized by widespread vascular injury and progressive fibrosis of the skin and internal organs. The involvement of internal organs results in significant morbidity and mortality of SSc patients with cardiopulmonary involvement being the leading cause of SSc‑related deaths. The management of SSc patients remains a challenge because therapeutic options are rather limited and no therapy has definitively shown a disease‑modifying effect. A significant progress that has recently been made in the understanding of the SSc pathogenesis contributed to the introduction of new therapeutic options. Preliminary clinical studies have yielded promising results for mycophenolate mofetil, anti‑CD20 antibodies, and stem‑cell in the treatment of SSc. Multicenter cohort studies help understand the natural history of SSc, which leads to improvement in the care of SSc patients. The major objective of those studies is to establish the screening strategies for early diagnosis and, subsequently, to introduce appropriate management concerning specific organ involvement in SSc as well as to formulate specific treatment recommendations.

[Treatment of foot drop in orthopaedic practice]

Foot drop is a symptom of many diseases and leads to an unaesthetic limping gait, falls and injuries. The most common cause of foot drop is injury to the common peroneal nerve, which innervates ankle joint and foot extensors. Other causes of foot drop include: sciatic nerve injury, lumbar plexopathies, L4/L5 radiculopathy, central nervous system related neuropathies (anterior horn cell disease, brain tumor). Also compartment syndromes of the lower leg can lead to foot drop deformity. Ankle-foot orthoses (AFO) are helpful in the treatment of paralyzed extensor muscles of the foot. The surgical treatment should be connected with the etiology of the foot drop and can include: neurolysis of the nerve, "end to end" repair, autogenous nerve graft procedures, nerve transfers, direct neuromuscular neurotization and tendon transfers. In proximal sciatic nerve lesions, nerve transfers and one-stage nerve repair with concomitant tendon transfer are valuable methods of the treatment of drop foot. The aim of the paper is to present pathogenesis and modes of treatment of foot drop deformity encountered in any orthopedic unit.

[The importance of rehabilitation after operative treatment of Dupuytren's disease]

Postoperative hand therapy in patients after surgery for Dupuytren's contracture is common in medical practice. Through an effective splinting and exercise program, the surgical outcome can be enhanced. The treatment plan must take into account the wide range of reactions to surgery. The management plan must be flexible, more than in most areas of hand surgery. The most important points in hand therapy after surgery for Dupuytren's disease include: 1) early detection of potential postoperative complications--including disturbances in wound healing; 2) edema control; 3) scar management; 4) maintenance of surgical correction; 5) restoration of finger flexion to the degree of preoperative range of motion. The postoperative program of hand rehabilitation depends on type of surgery, and therapist's education. The hand therapist should see all patients initially on removal of the operative dressing and provide advice on a program of active mobilization. Thereafter, patients should be seen routinely at weekly intervals to ensure that recovery of motion is progressing.

Increased production of a proliferation-inducing ligand (APRIL) by peripheral blood mononuclear cells is associated with antitopoisomerase I antibody and more severe disease in systemic sclerosis

OBJECTIVE

A proliferation-inducing ligand (APRIL), a member of the tumor necrosis factor (TNF) family, plays a crucial role in the survival of peripheral B cells, and may contribute to the pathogenesis of systemic sclerosis (SSc) through upregulation of autoantibody production and maintenance of autoimmune phenomena. We evaluated the capacity of peripheral blood mononuclear cells from patients with SSc (SSc-PBMC) to produce APRIL; and investigated correlations between production of APRIL by SSc-PBMC and clinical and laboratory features of the disease.

METHODS

PBMC from 20 patients with SSc and 14 healthy subjects were incubated in fetal calf serum-supplemented RPMI medium. APRIL levels were determined in cell culture supernatants by ELISA.

RESULTS

PBMC from patients with SSc produced significantly more APRIL (961 ± 151 pg/ml/10⁵ cells) than control PBMC (798 ± 219 pg/ml/10⁵ cells; p < 0.01). In patients with SSc, increased production of APRIL was associated with the presence of diffuse skin involvement, scleroderma lung disease, peripheral vasculopathy, greater capillary damage on capillaroscopy, and presence of anti-topoisomerase I (anti-topo I) antibodies. Multivariate regression analysis revealed anti-topo I antibodies as the only independent predictor of high production of APRIL by PBMC.

CONCLUSION

Production of APRIL is increased in SSc-PBMC and is associated with the presence of anti-topo I antibodies and more severe disease. Targeting the APRIL pathway might represent a therapeutic possibility for treatment of patients with SSc, in particular those with anti-topo I antibodies.

Interbody fusion and transpedicular fixation in the treatment of spondylolisthesis

BACKGROUND

This is a retrospective analysis of long-term results of treatment of dysplastic, isthmic and degenerative spondylolisthesis with interbody fusion and transpedicular screw fixation.

MATERIAL AND METHODS

Twenty-one patients underwent interbody fusion with the "Bialstab" transpedicular system. Anterior lumbar interbody fusion (ALIF) was subsequently performed in 2 patients. In the remaining patients, posterior lumbar interbody fusion (PLIF) was performed following interbody fusion in the same session. Mean follow up was 22.4 months. Results were evaluated on the basis of a physical examination, the Oswestry questionnaire and the VAS back pain score. Radiologic assessment was based on targeted lateral radiographs to the stabilized segment.

RESULTS

The post-operative wound healed without complications in all patients. Clinical outcomes at follow-up were rated as good (10), quite good (9) and poor (2). The average Oswestry score was 14 (range 0-30). The mean VAS score at follow-up was 2.9 (range 0-8). Anatomical slip reposition was performed in 2 patients, partial reposition in 11 patients, and 8 patients were treated with in situ fusion. Radiological evaluation revealed fusion in 17 patients.

CONCLUSIONS

1. Transpedicular fixation with interbody fusion is an effective technique for the treatment of spondylolisthesis. 2. Partial reposition of spondylolisthesis with neural decompression makes it possible to avoid neurological complications. 3. The "Bialstab" fixation system fulfills the criteria for good transpedicular stabilization.

[Applying the posterior fasciocutaneous thigh flap in bed sores treatment]

The paper presents the possibilities of applying the posterior thigh flap in the treatment of ischial pressure sores. Between 2000 and 2004 the flap was used in three cases treated in the Orthopaedics and Traumatology Department of the Medical Universtity in Bialystok. The indications, contraindications, operative technique and advantages of the posterior thigh flap are described. In all three cases the ischial bed sores healed well without recurrences. The posterior fasciocutaneous pedicled flap is a good method of treatment for not too extensive bed sores in the ischial region. This flap can be applied in recurrences found after primary bed sore treatment with another method. However the fasciocutaneous flap has a limited range of transposition as compared with cutaneous flaps.

[New methods of hand mobilization after operative treatment of flexor tendon injuries]

The paper presents various methods of physiotherapy after operative treatment of lacerated flexor tendons of the hand. Early physiotherapy is a very important factor in the essential treatment of a patient after tendon injury. The goal of treatment is to restore an optimal range of motion of the injured finger which enables the patient to have unrestricted finger motion. There are various rehabilitation programs. They are based on passive, active or both of these kinds of finger movements. Each of these methods requires a different position of the hand. The choice of physiotherapy method depends on: type of surgical treatment of the lacerated tendon, the presence of other hand injuries, the level of education of the surgeon and physiotherapist, the patient's age and the possibility of cooperation with the patient.

Distally based sural artery flap in soft tissue defects of the heel region

Background. The coverage of tissue defects caused by decubitus ulcers in the remains a challenge for reconstructive surgery. In this article we describe our own experience with the use of the distally-based superficial sural artery flap. Material and methods. Between 1997 and 2004 we used distally-based superficial sural artery island flaps in 8 patients. In all cases the tissue was prepared as a fasciocutaneous flap. Results. All the flaps have survived. The advantages offered by this flap include constant and reliable blood supply, easy dissection, minimal morbidity of donor site, and preservation of the major arteries in the leg. We observed venous congestion and edema in three flaps, and marginal necrosis in one flap. Conclusions. The distally based sural artery flap is a good method for the treatment of soft tissue defects in the heel region. The procedure is short and can be performed in a single stage without microsurgery. This flap has the potential for reinnervation in demanding patients.

[Sacral pressure sores and their treatment]

INTRODUCTION

Sacral bed sores still present a serious problem in most surgery departments. They occur mainly in elderly patients of limited mobility. The treatment of such sores extends over long periods of time and therefore involves considerable costs.

MATERIAL AND METHODS

The material consisted of 11 sacral pressure ulcers treated surgically. The sores occurred in 4 severely disabled patients suffering from proximal third femur fractures, 4 patients with traumatic brain injury (treated in the Intensive Care Unit), and 3 patients suffering from bed sores after spinal cord injury. In 6 patients a fasciocutaneous flap was applied to the sores and in 5 cases a pedicled musculocutaneous gluteus maximus flap. The end results were assessed using Seiler's criteria.

RESULTS

Complications of the "seroma" type were observed in 3 patients, and in 2 marginal necrosis. In all our patients complete healing was achieved within 2-4 weeks.

CONCLUSIONS

On analysing our experience to date in surgical treatment of bed sores we are of the opinion that even extensive sacral sores can be covered with unilateral pedicled flaps provided that they are appropriately planned. Deep sores of the 4th degree sometimes with concomitant osteomyelitis require pedicled muscle flaps or in some cases musculocutaneous flaps to improve local circulation. The preparation of the patient for reconstruction surgery is just as important as the operation itself and therefore such preparation should never be neglected.

The Oxford II medial unicompartmental knee replacement. A minimum 10-year follow-up study

Background. The first clinical results from unicondylar knee arthroplasty (UKA), which was introduced in the early seventies, were non-conclusive. The development and modernization of unicompartmental implants (mobile bearing models, such as Oxford II), and also stricter qualification criteria for UKA brought about significant improvement in long term outcome. The aim of our study was to assess the long-term outcome of UKA using Oxford II implants, and also to verify the inclusion criteria. Material and methods. The authors present an analysis of long-term outcome in unicompartmental knee arthroplasty in 42 patients, qualified for treatment according to the criteria of Kozin and Scott, and also the designers of the implant. The follow-up assessment was performed a minimum of 10 years after surgery (11.2 years average). Results. The results were assessed using the 100-point HSS scale. Excellent results were achieved in 10 cases, good results in 22 cases, fair results in 6 cases, and poor results in 4 cases. The implant survival rate was 86%. There were some complications related to surgical error or lack of strict compliance with the qualification criteria. Conclusion. UKA late results are comparable to those achieved in TKA, given proper qualification. Also, this procedure can be considered as a definitive solution in older patients.

The radiological outcomes of total knee arthroplasty using computer assisted navigation ORTHOPILOT

Comprehensive radiographic analysis of total knee arthroplasty performed traditionally and with the use of Computer Assisted Navigation (CAN) is presented. The aim of this study was to compare the precision of implant alignment considering two operating techniques. The analyzed material consisted of 100 radiograms of patients operated on traditional way and 100 knee joint radiograms of patients operated on with a use of CAN. Assessment of postoperative radiograms was carried out in order to analyze coronal mechanical axis and sagittal orientation of both femoral and tibial components. Measurements were taken precisely up to 1 degrees and therefore results were classified as good (0-2 degrees deviation due to mechanical axis), satisfactory (2-4 degrees) and poor (over 4 degrees). The radiological outcome allows to present the following conclusions: CAN allows to minimize the risk of incorrect prosthesis alignment and therefore significantly improves the radiological outcome of total knee arthroplasty. This improvement can lead to better long time "survival" of implant components. The only price one pays for this improvement is 15-20 minute surgery delay, however it needs further studies to determine other possible disadvantages.

Osteochondral defects of the talus treated by mesenchymal stem cell implantation--early results

The purpose of this study was to present early results of talus cartilage defects treatment with autologous mesenchymal stem cells CD34+ implantation technique. Nine (9) patients were treated, due to IV degree chondromalation (by ICRS). The applied standard procedure included: clinical examination, AP and lateral x-ray, MRI, preoperative, as well as during control examination. The surgical procedure consisted of the defect's debridement, harvesting and fixation of the periosteal flap and CD34+ implantation. Clinical results were assessed after 6 months to 3 years by clinical examination, Magee score and MRI. Good and very good clinical results were obtained and confirmed by MRI in 8 cases. In one case, cartilage hypertrophy was noted. There were no delamination and infection signs.

A comparative morphological study of direct nerve implantation and neuromuscular pedicle methods in cross reinnervation of the rat skeletal muscle

PURPOSE

The study was undertaken to evaluate the recovery of rat skeletal muscles reinnervated by crossed direct nerve implantation and crossed neuromuscular pedicle graft.

MATERIAL AND METHODS

The animals (157) were divided into 3 groups. In the first group--direct nerve implantation --(DNI) 52 animals, the peroneal nerve was transected and implanted into the gastrocnemius muscle of the hind limb of the rats. In the second group (53 animals)--the neuromuscular pedicle (NMP) of the peroneal nerve was elevated and transferred to the gastrocnemius muscle. The third group consisted of 52 healthy animals. Muscle function was examined by electrophysiological methods (evoked electromyography and muscle isometric tetanic tension) and by morphological methods (reinnervated muscle weight, microscopic examinations, morphometric and histochemical examinations).

RESULTS

The weight of reinnervated muscles in the first 3 weeks decreased. The lowest values of muscle weights were noted at 4 weeks. At the end of the experiment muscle weight in the first group was 64.3% of the control group and in the second group 65.2%. Morphometric, histological and histochemical analysis were performed after 12 and 36 weeks. At 12 weeks of the experiment the diameter of reinnervated muscle fibers in the second group was statistically higher than in the first group. At that time the process of reinnervation was more advanced than in the first group. At 36 weeks there were no statistical differences between the two groups. An increase in the number of muscle fibers was noted as the processes of reinnervations progressed. At the site of nerve (or pedicled nerve-muscle) implantation new motor end plates were formed.

CONCLUSIONS

We consider that reinnervation of the experimentally paralyzed muscle is possible after crossed DNI and after NMP neurotization. The reinnervation with the NMP technique is quicker than with the DNI. Based on the morphological examinations--both methods guarantee only a partial recovery of the function of the paralyzed muscle.

[Maternal plasma and amniotic fluid interleukin-6 and tumor necrosis factor-alpha levels in imminent preterm labor]

DESIGN

Our purpose was to investigate the maternal plasma and amniotic fluid interleukin-6 and tumor necrosis factor-alpha levels in women with imminent preterm labour.

MATERIAL AND METHODS

The present study was designed to evaluate IL-6 and TNF-alpha levels in 93 pregnant women with threatened preterm labour and 40 women with normal pregnancy. Maternal blood samples were collected by routine forearm venipuncture at admission during routine laboratory tests. Amniotic fluid was collected through hysterectomy during caesarean delivery from women at term but not in labour and by amniotomy or hysterectomy from women with preterm labour.

RESULTS

Maternal plasma and amniotic fluid IL-6 and TNF-alpha concentrations were significantly elevated in women with preterm labour (premature rupture of membranes and uterine contractions) compared to gestationally matched, non-labouring controls.

[Efficacy of amnioinfusion in anhydramnios at term before induction of labor and newborn outcome]

Oligohydramnios complicates about 0.5-5% of pregnancies and is associated with an increased rate of perinatal morbidity and mortality. Our purpose was determine the effectiveness of amnioinfusion before induction of labour in reducing the incidence of fetal distress in pregnancies with anhydramnios at term. The rate of cesarean sections performed for fetal distress was higher in the control group (57.1%) than in the amnioinfused group (20.3%). Anhydramnios was associated with an increased abnormalities fetal heart rate. Amnioinfusion is effective option for the prevention of fetal distress in anhydramnios at term.

[Maternal plasma and amniotic fluid interleukin-6 levels in imminent preterm labor]

Our purpose was to investigate the maternal plasma and amniotic fluid interleukin-6 levels in women with preterm labour. The present study was designed to evaluate IL-6 levels in 93 pregnant women with threatened preterm labour and 40 normal pregnant. Maternal blood samples were collected by routine forearm venipuncture at admission during routine laboratory tests. Amniotic fluid was collected during hysteretomy during caesarean delivery from women at term but not in labour and by amniotomy or hysteretomy from women with preterm labour. Maternal plasma and amniotic fluid IL-6 concentrations were significantly elevated in women in preterm labour (premature rupture of membranes and uterine contractions) compared to gestationally matched, non-laboring controls.

[N-acetyl-beta-glucosaminidase (NAG) activity in parturients with placental insufficiency in postmature pregnancy and with EPH-gestosis]

NAG activity evaluation was carried out in parturients' blood and placental homogenates in regular pregnancies (n = 46) and complicated with biological postmaturity (n = 30) and EPH-gestosis (n = 24). It was revealed that in the blood of parturients with pregnancy complicated with gestosis there was considerable increase of NAG activity (2.43 +/- 1.02 microKat/kg). Lower activity level was found in parturients with entopic pregnancy (1.93 +/- 0.87 microKat/kg), and the lowest in those with postmature pregnancy (1.78 +/- 0.56 microKat/kg). The placental homogenates presented statistically significant differences--the highest in postmature pregnancy (6.37 +/- 2.01 mKat/kg), lower in pregnancy complicated with gestosis (4.85 +/- 1.52 mKat/kg) and the lowest in normal pregnancy (3.52 +/- 1.21 mKat/kg). The elevated activity in blood serum of parturient with gestosis may indicate kidney damage in the course of disease. High activity in homogenate may indicate the processes of placental degradation in postmature pregnancy. There is no evidence of correlation between NAG activity in blood and activity in placental tissue.

[The role of endothelium in normal pregnancy and pregnancy complicated by preeclampsia]

Endothelial cell dysfunction is thought to play a role in preeclampsia and the reduced production by vascular endothelial cells of the antiaggregatory and vasodilatory factors is well documented. The present study was designed to evaluate endothelial cells function in preeclamptic and healthy pregnant subjects. The nitric oxide plasma concentration in women with preeclampsia was significantly lower as compared with normotensive pregnant women. A significant increase in ET concentration was found in preeclamptic women as compared with normal pregnant patients and normal non-pregnant. The plasma concentrations of von Willebrand factor were significantly increased in healthy pregnancy as compared with preeclamptic patients. The results of our study demonstrate a significant endothelial cells damage in preeclamptic patients. Whether these observations contribute to the vascular pathophysiologic features of preeclampsia remains to be proved.

[The role of nitric oxide and blood platelets in pathogenesis of preeclampsia]

The aim of this study was to evaluate the concentration of nitric oxide and the platelet function in preeclamptic and normal pregnant women. The patients with preeclampsia had new hypertension (diastolic blood pressure consistently > or = 90 mmHg with previously lower readings), new proteinuria and generalized oedema that subsequently regressed after delivery. Blood was collected by routine forearm venipuncture before delivery. The following parameters were evaluated: nitric oxide, beta-TG and PF4. The nitric oxide plasma concentration in women with preeclampsia was significantly lower compared with normotensive pregnant women. beta-TG and PF4 concentrations were significantly increased in patients with preeclampsia. Whether these observations contribute to the vascular pathophysiologic features of preeclampsia remains to be proved.

[Epidemiological analysis of congenital infections in newborns]

The aim of this study was to review 2567 deliveries in the District Hospital in Białystok in 1997. In 2388 term labours and 179 preterm ones we noticed the congenital infections; in 90 (3.8%) and in 58 (32.4%) newborns respectively. The main etiologic factors of infections were Escherichia coli and Staphylococcus epidermidis in term newborns and Staphylococcus epidermidis and Escherichia coli in preterm babies. Clinical signs of the urinary tract infection were most frequent in mature infants, whereas the sepsis was quite common in premature newborns.

C-reactive protein concentration in the sera of pregnant women with imminent premature parturition and preterm amniorrhea

C-reactive protein (CRP) levels were evaluated during spontaneous labour, in imminent premature parturition (IPP) and after preterm rupture of oocyst membranes (PROM). Increasing CRP level during spontaneous labour was found in 16.6% parturients. Elevated CRP level in patients with IPP makes it impossible to predict premature labour. In parturients with PROM, increase in CRP level makes further infection predictable only in a few cases.

[Meigs syndrome--diagnostic difficulties]

Meigs' syndrome in 68 years woman with pleural effusion and ovarian tumour was described. The cause of the pleural liquid in Meigs' syndrome is still not clear. New views on the pathogenesis and diagnostic methods of pleural liquids causes were presented.

[Pulmonary alveolar proteinosis--diagnostic problem]

A case of a 37 years old woman with suspicion of sarcoidosis is presented. However, the course of disease was not typical for sarcoidosis. The previous diagnosis was verified. The results of bronchoalveolar lavage and histological examination of lung biopsy sample revealed features characteristic for pulmonary alveolar proteinosis. The diagnostic methods, clinical course of disease and the ways of treatment are presented.

Activity alterations of chosen parameters of cord blood hemostasis in newborns from complicated pregnancies with premature ablation of placenta

The study was carried out on 20 newborns with diagnosed premature ablation of placenta of 0,I,II clinical degree. In comparison to healthy newborns (n = 30) statistically significant differences were proved in: ATIII activity-48% (65%), plasminogen concentration-50% (63%), alpha 2antyplasmin activity 53% (67%); euglobulin clot fibrinolysis time 70 (95) min., and fibrinogen concentration 1.4 (1.8) g/l. The presented differences prove increased coagulation system activation in newborns from mothers with symptoms of premature ablation of placenta. Activity changes of hemostasis system in cases of premature ablation of placenta have the features of disorders accompanying intrauterine fetal anoxia.

[Prophylaxis of puerperal infections using the Gyno-Pevaryl 150 preparation]

The authors estimated the biocenosis of vagina in women before delivery. The examination were made upon 50 women between 28 and 40 week of pregnancy and on the third day after delivery; comparing the results of estimation the purity of vagina and bacterial inoculations in two groups of pregnant women:-control group (without G-P 150 treatment) and in group with G-P 150 application. The authors proved the entire disappearance of mycotic infection (candida albicans) in women treated with G-P 150. The also stated that potential pathogenic bacterial flora during puerperium occurs much more rarely.

Attentional effects of caffeine in man: comparison with drugs acting upon performance

The aim of this study was to observe if a method useful for measuring attentional effects could be applied in testing the differential effects of caffeine, the beta-stimulant salbutamol, and the beta-blocker propranolol. Caffeine (300 mg) was administered to a sample of 19 normal subjects compared to two samples of 40 controls. Caffeine was found to increase attention and vigilance by augmenting the number of repetitions of responses to a verbal stimulus in a free word association test. This pattern was also seen with salbutamol and propranolol, but to a lesser degree.

Effects of naloxone on cardiovascular responses to static exercise and behavior in conscious cats

Conscious cats performing static (isometric) exercise were studied before and after administration of the opiate antagonist naloxone in order to evaluate the possible role of endogenous opiates in regulating cardiovascular responses to static exercise. Intravenous administration (0.4 mg/kg) of naloxone had no effect on resting left ventricular systolic pressure or on heart rate. In addition, similar increases in left ventricular systolic pressure and heart rate occurred during static exercise both before and after naloxone. However, naloxone reduced the number of exercise events the cats would perform per day. We conclude that moderate doses of naloxone do not modulate the cardiovascular responses to moderate static exercise in conscious cats. The results do indicate that endogenous opiates are involved in regulating the number of exercise bouts the cats will perform per day.

Responses of parkinsonian patients to a successive free word-association test

28 Parkinsonian patients matched with 28 normal controls took a free word-association test. Three variables were measured: the commonness of the responses, their latencies, and their repetitions. Comparison of the two samples showed the same magnitudes of intercorrelations among these variables. But, if commonness and latency remained the same, repetition increased significantly for patients. These data were discussed in relation to results on the absence of cognitive slowing.

Effects of alpha-adrenergic blockade on cardiovascular responses to static exercise in cats

Static exercise performed by conscious cats elicits increases in heart rate (HR), left ventricular systolic pressure (LVSP), and the maximal rate of left ventricular pressure development [LV(dP/dt)max]. The increased HR is mediated primarily by withdrawal of parasympathetic tone, whereas a beta-adrenergic mechanism is responsible for the LV(dP/dt)max increase. In the present study the cardiovascular responses to static exercise in awake cats was recorded before and after alpha-adrenergic blockade. Pressure transducers were implanted into the left ventricle of cats who had been trained operantly to perform static exercise. Significant increases in LVSP, LV(dP/dt)max and HR occurred in all cats during static exercise before blockade. In contrast, alpha-adrenergic blockade (phentolamine, 2.5 mg/kg iv) abolished the exercise-induced increase in LVSP but did not prevent increases in HR and LV(dP/dt)max. The cats performed fewer exercise bouts per day during alpha-blockade than when unblocked. We conclude that an alpha-adrenergic mechanism mediates the increase in LVSP in response to static exercise in conscious cats.