Long-term radiocarbon variation studies in the air and tree rings of Slovakia

Fifty-five years of radiocarbon variation studies are reviewed with an emphasis on a better understanding of the impacts of the Bohunice nuclear power plant and fossil fuel CO2 on the atmosphere and biosphere of Slovakia. The maximum Δ14C levels in the air up to about 1200‰ were observed during the 1970s at the Žlkovce monitoring station, which after 2005 decreased to <30‰. A relative decrease in the atmospheric Δ14C levels due to increasing levels of fossil CO2 in the atmosphere has also been significant, for example, in Bratislava down to about -330‰, but after 2005 they were only <50‰ below the Jungfraujoch European clean-air level. The tree-ring data, averaging the annual Δ14C levels for several stations in Slovakia, have been in agreement with the atmospheric data, as well as with the newly established clean-air station at Jasná in central Slovakia. Future 14C levels will depend strongly on fossil CO2 levels in the atmosphere, which will change the bomb 14C era to the fossil CO2 era. New investigations of 14C variations in the atmosphere-biosphere-hydrosphere compartments represent a great challenge for radiocarbon science, important for better understanding of environmental processes, climate change, and impacts of human activities on the total environment. This new era of radiocarbon research will also need new developments in radiocarbon analytical technologies, as further progress in accuracy and precision of results (<1‰) will be needed to meet the new radiocarbon challenges.

Pediatric Inflammatory Multisystem Syndrome (PIMS) - Potential role for cytokines such Is IL-6

COVID-19 is a transmissible respiratory disease caused by coronavirus SARS-CoV-2, which is similar to SARS or MERS. Its increased severity was noted in aged patients usually over 65 years of age. Children and young people have an asymptomatic or mild course of the disease.Unfortunately, the number of children with problems after mild or asymptomatic COVID-19 recovery is increasing and their troubles resemble Kawasaki disease, although the laboratory findings seem to be different. This condition is called pediatric inflammatory multisystem syndrome (PIMS), and it is a new disease seen in children directly influenced by previous SARS-CoV-2 infection. The literature reports that PIMS typically follows 2-4 weeks after SARS-CoV-2 infection. The clinical symptoms of the affected children are extremely complex, ranging from gastrointestinal to cardiovascular problems with frequent skin and mucosal manifestations, and without intensive treatment they can be fatal. The exact causes of PIMS are recently unknown, however, it is explained as hyperactivation of immunity.In this minireview, we summarize data on the prominent role of the IL-6-IL-6R-STAT3 axis in PIMS aetiopathogenesis. Therapeutic manipulation of IL-6 or IL-6 receptor could be an approach to the treatment of children with severe PIMS.

Creatine Kinase and Myoglobin Levels as Indicators of Perioperative Muscle Damage during Open- and Mini-Invasive Stabilization of Thoracic and Lumbar Spine Fracture - a Prospective Randomized Study

PURPOSE OF THE STUDY In this randomized prospective study, we monitored and compared perioperative changes in skeletal muscle enzymes blood levels in open and mini-invasive stabilization of thoracolumbar spine fractures. The established hypothesis was to confirm higher blood levels of muscle enzymes in open stabilization. MATERIAL AND METHODS This study included 38 patients with the mean age of 46.4 years. 19 injuries were managed in an open procedure and 19 procedures were mini-invasive. Venous blood was taken intermittently at short intervals to determine the levels of skeletal muscle enzymes. The catalytic concentration of creatine kinase was determined via an enzymatic UV-test, and the concentration of myoglobin via electro-chemiluminescent immunoassay. Enzyme levels were processed statistically. The Wilcoxon test was used. RESULTS The median increase in the values of both enzymes is higher in the mini-invasive method than in the open method in both the surgery phase for the injury and in the extraction phase. The median increase in the values of both enzymes is higher in both methods for the primary procedure phase compared to the extraction phase. All results are statistically significant at p of <0.05. All tests were calculated using the MATLAB Statistics Toolbox. DISCUSSION A very surprising finding, when testing the hypothesis of the levels increasing mainly in open stabilization, was confirming the opposite. Both enzymes were higher in the mini-invasive approach to stabilising the spine after the injury, but also after the extraction. This contradicts the available literature. However, this can be explained by the methodology of enzyme levels determination in the previously published studies. We believe that this phenomenon can be partially caused by an iatrogenic mini-compartment of muscles in the postoperative period, absence of wound drainage, but also by higher muscle contusion when inserting bolts through the tubes via small incisions, when the tubes penetrate to the entry points relatively violently and the muscles in this area are affected more than in the classical skeletization. CONCLUSIONS Analysis of biochemical changes in open and mini-invasive surgery did not confirm the hypothesis that levels of creatine kinase and myoglobin enzymes increase especially in open stabilization. On the contrary, they were statistically significantly higher in mini-invasive procedures. Key words: creatine kinase, myoglobin, muscle enzymes, spine fracture, spine surgery, miniinvasive surgery.

Effect of shock waves combined with cytostatics on the growths of tumors in vivo

Based on their field of application, the physical parameters of shock waves differ. Experiments referred to in this article used tandem shock waves generated on the surface of a composite anode. There, individual pores of the anode produce multichannel discharges. The composite anode may have a variety of shapes, which, consequently, influence the arrangement of the entire apparatus and the area of their application. Experiments referred to in this article utilise an anode divided into two parts that generated tandem shock waves. The previously conducted experiments have clearly shown that the effect of a tandem shock wave can be very well localized in the focal area, causing necrosis and apoptosis of the tumor cells, and enhancing the effect of cytostatics. This study investigated the effect of tandem shock waves with concomitantly administered cytostatics. We conducted our experiments on Lewis rats. The rats were injected with syngeneic sarcoma tumor cells intradermally and caudally on both the right and left sides. The highest rate of tumor growth inhibition was observed in the cisplatin-treated group that was subsequently treated with shock waves. The effect of shock waves on cell membranes is well described as they increase their permeability due to sonodynamic effect induced by cavitation. The results of experiments referred to in this article conducted in vivo in experimental animals enable us to note that the shock wave increases the effect of chemotherapy administered.

Geant4-based electromagnetic background model for the CRESST dark matter experiment

The CRESST (Cryogenic Rare Event Search with Superconducting Thermometers) dark matter search experiment aims for the detection of dark matter particles via elastic scattering off nuclei in CaWO 4 crystals. To understand the CRESST electromagnetic background due to the bulk contamination in the employed materials, a model based on Monte Carlo simulations was developed using the Geant4 simulation toolkit. The results of the simulation are applied to the TUM40 detector module of CRESST-II phase 2. We are able to explain up to ( 68 ± 16 ) % of the electromagnetic background in the energy range between 1 and 40 keV .

5162Novel insights into desminopathy in the era of next generation sequencing

Aims

The pleomorphic clinical presentation makes the diagnosis of desminopathy difficult. This disease of intermediate filaments causes not only a contractile dysfunction in cardiomyopathy and skeletal myopathy, but also a secondary mitochondrial dysfunction. We aimed to describe prevalence, phenotypic expression and mitochondrial function in desmin mutation carriers identified in a large cohort of patients with unexplained cardiomyopathy.

Methods and results

A representative cohort of 327 Czech patients with unexplained cardiomyopathy underwent whole exome sequencing. The cohort consisted of cases with familial and sporadic dilated cardiomyopathy (81%), left ventricular noncompaction cardiomyopathy (LVNC) (13%), and less frequently of restrictive (3%) or arrhythmogenic cardiomyopathy (3%). Clinical and laboratory data of desmin mutation carriers were collected. Morphology, desmin expression and mitochondrial function were studied in available myocardial and skeletal muscle specimens.

Rare, conserved and possibly pathogenic desmin variants were identified in 6 (1.8%) probands. Two desmin mutations previously classified as variants of uncertain significance (p.K43E, p.S57L), one novel desmin variant (p.A210D) and two known pathogenic desmin mutations (p.R406W, p.R454W) were in affected individuals associated with characteristic pathological desmin aggregates in myocardial and/or skeletal biopsy samples. The individual with the novel desmin variant p.Q364H had decreased myocardial expression of desmin with absent desmin aggregates in myocardial/skeletal biopsy and presented with familial left ventricular non-compaction cardiomyopathy, a novel phenotype of desminopathy. Assessment of mitochondrial function in four carriers of desmin mutations with fresh-frozen skeletal and/or myocardial muscle specimens confirmed decreased metabolic capacity of mitochondrial respiratory chain complexes, which was in case of myocardial succinate respiration more profound than in end-stage heart failure of other etiologies. Genetic testing corrected an inappropriate clinical diagnosis in two probands previously diagnosed with mitochondrial disease and inflammatory cardiomyopathy. During a median follow-up of 56 months, 5 (83%) probands developed end-stage heart failure.

Conclusions

Desminopathy is a rare cause of cardiomyopathy and/or skeletal muscle myopathy with a pleomorphic clinical presentation and poor prognosis. The presence of desminopathy should be considered also in individuals with left ventricular non-compaction cardiomyopathy, and in the differential diagnosis of mitochondrial diseases and inflammatory cardiomyopathy.

Acknowledgement/Funding

Research grant of the Ministry of Health, Czech Republic [MZ 15-27682A], No. 00023001 (IKEM, Prague, CZ), the Czech Science Foundation [14-36804G].

[Outcomes of Treatment of Calcaneal Fractures Using Locking Compression Plate with or without Augmentation]

PURPOSE OF THE STUDY The retrospective study aims to compare the outcomes of augmentation of neutral triangle formed after the calcaneal fracture reduction with osteosynthesis using the locking compression plate with the outcomes of osteosynthesis without augmentation. MATERIAL AND METHODS In the period from 2005 to January 2011, 98 patients with 114 calcaneal fractures were treated by open reduction and internal fixation (ORIF) method with the use of calcaneal plate. The group included 15 women (15.3%) and 83 men (84.7%), with the mean age of 39.2 years (12-62 years). There were 16 cases of bilateral calcaneal fractures, of which 2 in women (12.5%) and 14 in men (87.5%). The fractures were classified based on the Sanders classification as Type I -IV. The patients with Type II and III fracture according to the Sanders classification were indicated for surgical treatment with ORIF using the calcaneal LCP. The defect in the region of neutral triangle of the calcaneus was filled with the injectable hydroxyapatite cement. The cohort of operated patients was evaluated based on the AOFAS (American Orthopaedic Foot and Ankle Society) Clinical Rating System. The bilateral fractures were not evaluated. This group shows a substantially higher occurrence of associated injuries, which causes strong distortion of results. RESULTS The cohort of 82 operated patients with Sanders Type II and III fractures were evaluated. In 20 fractures (24.4%) the defect in the calcaneus body was filled with hydroxyapatite cement. In osteosynthesis without defect augmentation an excellent result was achieved in 21 patients (33.9%). A good result was reported in 24 patients (38.7%), a satisfactory result in 12 patients (19.4%) and a poor result in 5 patients (8.0%). In patients with osteosynthesis of the calcaneus with augmentation, an excellent result was achieved in 6 cases (30%), a good result in 5 cases (25%), a satisfactory result in 7 cases (35%) and a poor result in 2 cases (10%). Early postoperative complications were observed in a total of 13 patients (15.8%). In osteosynthesis without defect augmentation, there were 2 cases of wound dehiscence (3.2%), 3 cases of marginal skin necrosis (4.8%), 4 cases of superficial wound infection (6.4%) and 1 case of deep wound infection (1.6%). In patients with performed augmentation, wound dehiscence was seen in 1 case (5%), superficial wound infection in 1 case (5%) and superficial marginal skin necrosis in 1 case (5%). Deep wound infection was not reported in this group. DISCUSSION A question frequently discussed is the filling of defect in the diaphysis of calcaneus. Brodt et al. state a statistically higher stability of the calcaneus in osteosynthesis with augmentation, but he does not use the locking plate. Longino in his study compares the results of calcaneal osteosynthesis with spongioplasty with a graft from pelvis and without it and does not observe any major differences in the final outcome in his cohort. Elsner evaluates the results in 18 patients, in whom calcium phosphate cement augmentation was used for osteosynthesis. Over the period of three years he did not observe a higher rate of complications. Schildhauer assesses the early load of the calcaneus with tricalcium phosphate cement augmentation. After three weeks of full loading no loss of reduction was found. Thordarson evaluates 11 operated patients with Sanders type II and III calcaneal fracture. The defect of the calcaneus was filled by calcium phosphate cement. In this small group 1 case of serious infection complication and 1 loss of reduction with full load at six weeks after the surgery were observed. In our group no differences were observed between the outcomes of patients with performed or not performed defect augmentation in the neutral triangle site. A higher percentage of complications in patients with filled defect of the calcaneus was not observed either. CONCLUSIONS The operative treatment of displaced intra-articular fractures consisting of open reduction from extended lateral approach and internal calcaneal LCP fixation brings good results. We concluded that there is no statistically significant difference in the results of osteosynthesis with a locking plate alone and combined with augmentation of diaphyseal defect of the calcaneus. Filling of the diaphyseal defect in the calcaneus is not necessary, it neither accelerates the healing, nor brings better treatment outcomes Key words: calcaneal fracture, cement augmentation of defect, locking plate, extended lateral approach.

Stable COX17 Downregulation Leads to Alterations in Mitochondrial Ultrastructure, Decreased Copper Content and Impaired Cytochrome c Oxidase Biogenesis in HEK293 Cells

Cox17 is an assembly factor that participates in early cytochrome c oxidase (COX, CcO) assembly stages. Cox17 shuttles copper ions from the cytosol to the mitochondria and, together with Sco1 and Sco2, provides copper ions to the Cox1 and Cox2 mitochondrially encoded subunits. In Saccharomyces cerevisiae, Cox17 also modulates mitochondrial membrane architecture due to the interaction of Cox17 with proteins of the MICOS complex (mitochondrial contact site and cristae organizing system). There is currently no data regarding the impact of long-term Cox17 deficiency in human cells. Here, we present construction and characterization of three stable COX17 shRNA-downregulated HEK293 cell lines that have less than 10 % of the residual Cox17 protein level. Cox17-depleted cell lines exhibited decreased intramitochondrial copper content, decreased CcO subunit levels (Cox1, Cox4 and Cox5a) and accumulation of CcO subcomplexes. Similarly to yeast cells, mitochondria in Cox17-downregulated HEK293 cell lines exhibited ultrastructural changes including cristae reduction and mitochondrial swelling. Characterization of the molecular pathogenesis of long-term Cox17 deficiency complements our knowledge of the mitochondrial copper metabolism and assembly of cytochrome c oxidase in human cells.

Changes in transcription pattern lead to a marked decrease in COX, CS and SQR activity after the developmental point of the 22(nd) gestational week

Tissue differentiation and proliferation throughout fetal development interconnect with changes in the oxidative phosphorylation system (OXPHOS) on the cellular level. Reevaluation of the expression data revealed a significant increase in COX4 and MTATP6 liver transcription levels after the 22(nd) gestational week (GW) which inspired us to characterize its functional impact. Specific activities of cytochrome c oxidase (COX), citrate synthase (CS), succinate-coenzyme Q reductase (SQR) and mtDNA determined by spectrophotometry and RT-PCR were studied in a set of 25 liver and 18 skeletal muscle samples at 13(th) to 29(th) GW. Additionally, liver hematopoiesis (LH) was surveyed by light microscopy. The mtDNA content positively correlated with the gestational age only in the liver. The activities of COX, CS and SQR in both liver and muscle isolated mitochondria significantly decreased after the 22(nd) GW in comparison with earlier GW. A continuous decline of LH, not correlating with the documented OXPHOS-specific activities, was observed from the 14(th) to the 24(th) GW indicating their exclusive reflection of liver tissue processes. Two apparently contradictory processes of increasing mtDNA transcription and decreasing OXPHOS-specific activities seem to be indispensable for rapid postnatal adaptation to high energy demands. The inadequate capacity of mitochondrial energy production may be an important factor in the mortality of children born before the critical developmental point of the 22(nd) GW.

Buccal Respiratory Chain Complexes I and IV Quantities in Huntington's Disease Patients

Alterations in mitochondrial parameters are an important hallmark of Huntington's disease (HD). The ubiquitous expression of mutant huntingtin raises the prospect that mitochondrial disturbances can also be detected and monitored through buccal epithelial cells. In a group of 34 patients with Huntington's disease and a group of 22 age-related healthy volunteers, respiratory complex I and IV protein quantities in buccal epithelial cells were measured using the dipstick immunocapture assay. The protein quantity of respiratory complex I correlates with age (r = 0.427, P = 0.026, FWE-P = 0.156) in the patient group, but not in the group of healthy subjects. Our non-invasive approach allows us to obtain valuable information for the studies of mitochondrial biochemical parameters in patients with neurodegenerative diseases and could also be useful in epidemiological studies.

[Comparison of Two Methods of Minimally Invasive Osteosynthesis for Proximal Radius Fractures in Paediatric Patients]

PURPOSE OF THE STUDY The presented study was construed as a retrospective multicentric clinical study focused on paediatric skeletal injuries of the proximal radius. As a general rule, the Type I displaced fractures (Judet classification) are treated conservatively, with no reduction. In the case of Type II-IV displacement, the fracture necessitates reduction or is also transfixed by a Kirschner wire (K-wire) or a Prevot nail (P-nail) where subsequent fragment instability occurs. The comparison aimed to ascertain whether there is a statistically significant difference between the two methods. No difference was expected by the authors, therefore a null hypothesis was set. MATERIAL AND METHODS The patients were treated at the Clinic of Paediatric Surgery, Orthopaedics and Traumatology (CPSOT) of the Faculty of Medicine of the Masaryk University and at the Clinic of Orthopaedics and Traumatology of the Musculoskeletal System of the University Hospital in Pilsen in the period from 2006 to 2015. Two methods of closed reduction and minimally- invasive osteosynthesis were evaluated. The first method was the elastic stable intramedullary nailing (ESIN) with a P-nail, the second method was an osteosynthesis using a K-wire. In the clinical part of the study, comparisons were made based on the monitoring of the same parameters - final restriction of movement, time to full weight bearing of the extremity and incidence of serious complications. RESULTS The final group comprised a total of 31 patients, of whom 7 boys and 24 girls aged 3-16 years with the median of 9-10 years. Some restriction of movement following the treatment occurred in a total of seven patients (44%) with the K-wire and in four patients (27%) with the P-nail. When comparing the movement at 5% level of significance using the Chi-Square tests, no significant difference was found (p = 0.446). When evaluating the serious complications at 5% level of significance using the Chi-Square tests, the difference between the two methods of treatment was again insignificant (p = 0.365). When the full weight bearing was compared (median K-wire 8 weeks, median P-nail 10 weeks), a statistically significant difference was obtained at 5% level of significance using the Fischer exact test (p = 0.003). DISCUSSION In these fractures, usually the metaphysis or the physis are involved in the injury, in which case the fractures are classified according to Salter and Harris, with the most frequent occurrence of SHII epiphyseal separation and rare SHIII and SHIV epiphyseal fractures. The radial head fractures are mostly caused by valgus force. Therefore, the individuals with a higher elbow valgosity are more prone to injuries. The girls strongly prevail (77%) also in our study. In general, our results as well as the literature have proven that as the displacement increases, the necessity of closed reduction and osteosynthesis grows. The post-treatment complications in our group were observed in 35.5% of patients, namely most often in the form of limited movement. The literature refers to complications in 26.5-53% of patients. CONCLUSIONS The clinical results clearly show that when comparing the complications after the radial head fracture in children there is no statistically significant difference between the methods of osteosynthesis. This study shall serve as a starting point for the currently ongoing prospective multicentric study evaluating the modified ESIN technique using a pre-bent Kirschner wire. Key words:children, fracture, radius, proximal, osteosynthesis.

[Verification of the Necessity for the Open Reduction and Tension Band Wiring of the Displaced Olecranon Fracture in Younger Children]

PURPOSE OF THE STUDY Olecranon fractures in skeletally immature patients are rather rare and represent up to 7% of elbow skeletal injuries. Although the majority of olecranon fractures is constituted by undisplaced fractures treated conservatively with good outcomes, a few of them require surgery. The aim of the study was to compare two different approaches of surgical treatment - the open reduction with tension band wiring - cerclage (ORCe) and the closed reduction and percutaneous pinning (CRPP). MATERIAL AND METHODS 37 patients (28 boys, 9 girls) were included in the retrospective multicentric study. The patients were treated at two different institutions (the Clinic of Paediatric Surgery, Orthopaedics and Traumatology, the University Hospital Brno and the Department of Paediatric Surgery and Traumatology, the University Hospital Hradec Králové, Czech Republic). 17 patients underwent the ORCe procedure, while 20 patients were treated using the CRPP method. Different parameters were statistically compared in the groups (demographic data, data concerning the course of the therapy, outcome of the therapy in terms of movements' restrictions and complications such as osteosynthesis failure and infection). RESULTS Both the groups were comparable in terms of demographic data because no statistically significant difference was observed in terms of the age (p = 0.082), the affected site (p = 1.000) and the gender (p = 0.462). Statistically significant difference between these two groups was found in the interval between the implementation and the removal of the osteosynthetic material (p < 0.001) and in the length of cast immobilisation (p = 0.047). The number of patients with movement restriction up to 10° was statistically significantly higher in patients who underwent the CRPP procedure (p = 0.040), but no statistically significant difference was seen between these two groups in terms of movement restriction more than 10° (p = 0.609). One revision surgery was performed in the CRPP group, however with no statistical significance (p = 0.350). DISCUSSION The multicentric study included 37 children, who underwent surgical treatment of a displaced olecranon fracture. Compared to the studies dealing with this topic the number of patients included in this study is relatively high. It advocates the possibility of using the CRPP method as a good alternative to the gold-standard ORCe technique because no difference in terms of the number of revision surgeries and the clinically important movement restriction of more than 10° were seen. It also brings along advantages such as a simple surgical technique, good functional and cosmetic effects, reducing the risk of ischemic insult of growth plate and the possibility of osteosynthetic material removal at an outpatient department with no need for general anaesthesia. The risk of a higher radiation exposure of both the patient and the surgical team should be considered as a disadvantage of the closed method. CONCLUSIONS The mini-invasive CRPP appears to be a good alternative option to the ORCe method for the treatment of isolated olecranon fractures in children offering the advantages such as avoiding extensive open procedure and simple implants removal. Key words:children, olecranon, fracture, tension band wiring - cerclage, percutaneous pinning, elbow.

Genotype-phenotype correlation in 44 Czech, Slovak, Croatian and Serbian patients with mucopolysaccharidosis type II

Mucopolysaccharidosis type II (Hunter syndrome, MPS II, OMIM 309900) is an X-linked lysosomal storage disorder caused by deficiency of iduronate-2-sulfatase (IDS). We analyzed clinical and laboratory data from 44 Slavic patients with this disease. In total, 21 Czech, 7 Slovak, 9 Croatian and 7 Serbian patients (43 M/1 F) were included in the study (median age 11.0 years, range 1.2-43 years). Birth prevalence ranged from 1:69,223 (Serbia) to 1:192,626 (Czech Rep.). In the majority of patients (71%), the disease manifested in infancy. Cognitive functions were normal in 10 patients. Four, six and 24 patients had mild, moderate, and severe developmental delay, respectively, typically subsequent to developmental regression (59%). Residual enzyme activity showed no predictive value, and estimation of glycosaminoglycans (GAGs) had only limited importance for prognosis. Mutation analysis performed in 36 families led to the identification of 12 novel mutations, eight of which were small deletions/insertions. Large deletions/rearrangements and all but one small deletion/insertion led to a severe phenotype. This genotype-phenotype correlation was also identified in six cases with recurrent missense mutations. Based on patient genotype, the severity of the disease may be predicted with high probability in approximately half of MPS II patients.

Molecular Diagnostics of Copper-Transporting Protein Mutations Allows Early Onset Individual Therapy of Menkes Disease

Menkes disease is a severe X-linked recessive disorder caused by a defect in the ATP7A gene, which encodes a membrane copper-transporting ATPase. Deficient activity of the ATP7A protein results in decreased intestinal absorption of copper, low copper level in serum and defective distribution of copper in tissues. The clinical symptoms are caused by decreased activities of copper-dependent enzymes and include neurodegeneration, connective tissue disorders, arterial changes and hair abnormalities. Without therapy, the disease is fatal in early infancy. Rapid diagnosis of Menkes disease and early start of copper therapy is critical for the effectiveness of treatment. We report a molecular biology-based strategy that allows early diagnosis of copper transport defects and implementation of individual therapies before the full development of pathological symptoms. Low serum copper and decreased activity of copperdependent mitochondrial cytochrome c oxidase in isolated platelets found in three patients indicated a possibility of functional defects in copper-transporting proteins, especially in the ATPA7 protein, a copper- transporting P-type ATPase. Rapid mutational screening of the ATP7A gene using high-resolution melting analysis of DNA indicated presence of mutations in the patients. Molecular investigation for mutations in the ATP7A gene revealed three nonsense mutations: c.2170C>T (p.Gln724Ter); c.3745G>T (p.Glu1249Ter); and c.3862C>T (p.Gln1288Ter). The mutation c.3745G>T (p.Glu1249Ter) has not been identified previously. Molecular analysis of the ATOX1 gene as a possible modulating factor of Menkes disease did not reveal presence of pathogenic mutations. Molecular diagnostics allowed early onset of individual therapies, adequate genetic counselling and prenatal diagnosis in the affected families.

[Clinical Results of Endoscopic Treatment of Greater Trochanteric Pain Syndrome]

PURPOSE OF THE STUDY This retrospective study aims to present short-term clinical outcomes of endoscopic treatment of patients with greater trochanteric pain syndrome (GTPS). MATERIAL AND METHODS The evaluated study population was composed of a total of 19 patients (16 women, 3 men) with the mean age of 47 years (19-63 years). In twelve cases the right hip joint was affected, in the remaining seven cases it was the left side. The retrospective evaluation was carried out only in patients with greater trochanteric pain syndrome caused by independent chronic trochanteric bursitis without the presence of m. gluteus medius tear not responding to at least 3 months of conservative treatment. In patients from the followed-up study population, endoscopic trochanteric bursectomy was performed alone or in combination with iliotibial band release. The clinical results were evaluated preoperatively and with a minimum follow-up period of 1 year after the surgery (mean 16 months). The Visual Analogue Scale (VAS) for assessment of pain and WOMAC (Western Ontario MacMaster) score were used. In both the evaluated criteria (VAS and WOMAC score) preoperative and postoperative results were compared. Moreover, duration of surgery and presence of postoperative complications were assessed. Statistical evaluation of clinical results was carried out by an independent statistician. In order to compare the parameter of WOMAC score and VAS pre- and post-operatively the Mann-Whitney Exact Test was used. The statistical significance was set at 0.05. RESULTS The preoperative VAS score ranged 5-9 (mean 7.6) and the postoperative VAS ranged 0-5 (mean 2.3). The WOMAC score ranged 56.3-69.7 (mean 64.2) preoperatively and 79.8-98.3 (mean 89.7) postoperatively. When both the evaluated parameters of VAS and WOMAC score were compared in time, a statistically significant improvement (p<0.05) was achieved postoperatively. The mean duration of surgical procedure was 68 minutes. Moreover, in peritrochanteric space apart from chronic bursitis also another pathology was found in a total of 14 cases (74%). In six cases (32%) it was a mild degeneration of m. gluteus medius (treated only with debridement) and in eight patients who underwent surgery (42%) the dorsal third of tractus iliotibialis was hypertrophic and protruding into bursa (treated with an incision of the hypertrophied part of the band). No serious neurovascular or thromboembolic complications were recorded. Only minor postoperative complications in a total of 7 patients who underwent surgery (37%) occurred. DISCUSSION There are lots of studies in literature presenting the results of endoscopic treatment of GTPS either using an independent trochanteric bursectomy or its combination with iliotibial band release. In our study we succeeded in achieving similar clinical results as those achieved by the other authors engaged in this area. CONCLUSIONS It has been proven in this retrospective study that the technique of endoscopic trochanteric bursectomy in patients with greater trochanteric pain syndrome yields statistically significant improvement of clinical results with the concurrent minimum incidence of postoperative complications. Key words: greater trochanteric pain syndrome, peritrochanteric space, recalcitrant trochanteric bursitis, hip arthroscopy, endoscopic trochanteric bursectomy, iliotibial band release.

Analysis of expression profiles of genes involved in F(o)F(1)-ATP synthase biogenesis during perinatal development in rat liver and skeletal muscle

During the process of intra-uterine mammalian fetal development, the oxygen supply in growing fetus is low. A rapid switch from glycolysis-based metabolism to oxidative phosphorylation (OXPHOS) must proceed during early postnatal adaptation to extra-uterine conditions. Mitochondrial biogenesis and mammalian mitochondrial F(o)F(1)-ATP synthase assembly (complex V, EC 3.6.3.14, ATPase) are complex processes regulated by multiple transcription regulators and assembly factors. Using RNA expression analysis of rat liver and skeletal tissue (Rattus norvegicus, Berkenhout, 1769), we describe the expression profiles of 20 genes involved in mitochondrial maturation and ATP synthase biogenesis in detail between the 16th and 22nd day of gestation and the first 4 days of life. We observed that the most important expression shift occurred in the liver between the 20th and 22nd day of gestation, indicating that the fetus prepares for birth about two days before parturition. The detailed mechanism regulating the perinatal adaptation process is not yet known. Deeper insights in perinatal physiological development will help to assess mitochondrial dysfunction in the broader context of cell metabolism in preterm newborns or neonates with poor adaptation to extra-uterine life.

Muscular dystrophies and myopathies: the spectrum of mutated genes in the Czech Republic

Inherited neuromuscular disorder (NMD) is a wide term covering different genetic disorders affecting muscles, nerves, and neuromuscular junctions. Genetic and clinical heterogeneity is the main drawback in a routine gene-by-gene diagnostics. We present Czech NMD patients with a genetic cause identified using targeted next-generation sequencing (NGS) and the spectrum of these causes. Overall 167 unrelated patients presenting NMD falling into categories of muscular dystrophies, congenital muscular dystrophies, congenital myopathies, distal myopathies, and other myopathies were tested by targeted NGS of 42 known NMD-related genes. Pathogenic or probably pathogenic sequence changes were identified in 79 patients (47.3%). In total, 37 novel and 51 known disease-causing variants were detected in 23 genes. In addition, variants of uncertain significance were suspected in 7 cases (4.2%), and in 81 cases (48.5%) sequence changes associated with NMD were not found. Our results strongly indicate that for molecular diagnostics of heterogeneous disorders such as NMDs, targeted panel testing has a high-clinical yield and should therefore be the preferred first-tier approach. Further, we show that in the genetic diagnostic practice of NMDs, it is necessary to take into account different types of inheritance including the occurrence of an autosomal recessive disorder in two generations of one family.

The phenotypic spectrum of fifty Czech m.3243A>G carriers

BACKGROUND

Mitochondrial myopathy, Encephalopathy, Lactic Acidosis and Stroke-like episodes syndrome (MELAS) is a common mitochondrial disorder with varying multisystemic clinical manifestation. We present a comprehensive clinical picture of 50 Czech m.3243A>G carriers with emphasis on the sequence of symptoms in symptomatic patients.

RESULTS

Symptoms developed in 33 patients (66%) and 17 carriers remained unaffected (34%). The age of onset varied from 1month to 47years of age, with juvenile presentation occurring in 53% of patients. Myopathy was the most common presenting symptom (18%), followed by CPEO/ptosis and hearing loss, with the latter also being the most common second symptom. Stroke-like episodes (SLE) occurred in fourteen patients, although never as a first symptom, and were frequently preceded by migraines (58%). Rhabdomyolysis developed in two patients. The second symptom appeared 5.0±8.3years (range 0-28years) after the first, and the interval between the second and third symptom was 2.0±6.0years (range 0-21years). Four of our patients remained monosymptomatic up to 12years of follow-up. The sequence of symptoms according to their time of manifestation was migraines, myopathy, seizures, CPEO/ptosis, SLE, hearing loss, and diabetes mellitus. The average age at death was 32.4±17.7years (range 9-60years) in the juvenile form and 44.0±12.7years (range 35-53years) in the adult form. Some patients with SLE harboured very low heteroplasmy levels in various tissues. No threshold for any organ dysfunction could be determined based on these levels.

CONCLUSIONS

Sufficient knowledge of the timeline of the natural course of MELAS syndrome may improve the prediction and management of symptoms in patients with this mitochondrial disease.

X-Chromosome Inactivation Analysis in Different Cell Types and Induced Pluripotent Stem Cells Elucidates the Disease Mechanism in a Rare Case of Mucopolysaccharidosis Type II in a Female

Mucopolysaccharidosis type II (MPS II) is an X-linked lysosomal storage disorder resulting from deficiency of iduronate-2-sulphatase activity. The disease manifests almost exclusively in males; only 16 symptomatic heterozygote girls have been reported so far. We describe the results of X-chromosome inactivation analysis in a 5-year-old girl with clinically severe disease and heterozygous mutation p.Arg468Gln in the IDS gene. X inactivation analysed at three X-chromosome loci showed extreme skewing (96/4 to 99/1) in two patient's cell types. This finding correlated with exclusive expression of the mutated allele. Induced pluripotent stem cells (iPSC) generated from the patient's peripheral blood demonstrated characteristic pluripotency markers, deficiency of enzyme activity, and mutation in the IDS gene. These cells were capable of differentiation into other cell types (cardiomyocytes, neurons). In MPS II iPSC clones, the X inactivation ratio remained highly skewed in culture conditions that led to partial X inactivation reset in Fabry disease iPSC clones. Our data, in accordance with the literature, suggest that extremely skewed X inactivation favouring the mutated allele is a crucial condition for manifestation of MPS II in females. This suggests that the X inactivation status and enzyme activity have a prognostic value and should be used to evaluate MPS II in females. For the first time, we show generation of iPSC from a symptomatic MPS II female patient that can serve as a cellular model for further research of the pathogenesis and treatment of this disease.

[Traumatic Thrombosis of the Renal Artery following Seat-Belt Injury]

Renal artery thrombosis is a rare complication of blunt abdominal injury. It occurs most frequently in car accidents in which sudden deceleration results in multiple internal injuries. Renal artery occlusion occurs rarely as an isolated blunt trauma. This report presents a case of traumatic occlusion of the left renal artery with complete ischaemia of the left kidney in a haemodynamically stable girl who suffered multiple seat-belt injuries in a car crash. Ambiguous findings on a CT scan of the abdominal cavity indicated surgical inspection of the abdomen and, since the injury-to-surgery interval was short, an attempt at revascularisation of the left kidney was made. This was performed using laparotomy through a lateral left-side incision, as an uncommon approach to the injured organs. A seat-belt fracture of the L2/3 spine was stabilised at secondstage surgery. Key words: renal artery thrombosis, seat-belt fracture of the lumbar spine.

[Augmentation of the Anterior Cruciate Ligament in Patients with Symptomatic Isolated Tear of Anteromedial or Posterolateral Bundle: Evaluation of Two-Year Clinical Results]

PURPOSE OF THE STUDY

We present the results of a prospective study of patients with symptomatic partial ACL tears comparing the pre-operative findings with the clinical results at two years after anterior cruciate ligament (ACL) augmentation.

MATERIAL AND METHODS

A total of 29 patients (7 women, 22 men; average age, 27.8 years) who were diagnosed with an isolated tear of the posterolateral (PL) bundle (18 patients) or the anteromedial (AM) bundle (11 patients) at 9 to 24 weeks after injury, and underwent ACL augmentation by isolated PL or AM bundle replacement, were evaluated. The characteristics assessed before surgery and at two years after it included the Lysholm and subjective IKDC scores and knee laxity measurement with a GNRB arthrometer (at 134 N and 250 N) and its assessment by the Lachman, anterior drawer and pivot shift tests. In addition, the presence of cyclop syndrome, graft failure and post-operative complications were evaluated.

RESULTS

The patients with isolated reconstruction of the PL bundle showed post-operatively statistically significant improvement in the degree of rotational knee laxity (p < 0.05) and the ventral knee laxity assessed by the Lachman test (p < 0.05). Postoperative improvement in the anterior drawer test results was not statistically significant (p = 0.07). The median value of side-to-side difference in knee laxity measured with the GNRB arthrometer decreased at 134 N from 1.7 mm pre-operatively to 0.8 mm at two years post-operatively (p < 0.05) and, at 250 N, from 2.8 mm to 1.5 mm (p < 0.05). The median Lysholm score increased from 74 to 91 points at two post-operative years and the median IKDC score improved from 76 to 92 points (p < 0.05). Graft failure was reported in one patient (5.6%) and 14 subjects (77.8%) reported return to pre-injury sports activities. The patients undergoing isolated reconstruction of the AM bundle achieved, at two years after surgery, a statistically significant decrease in positivity of the Lachman and anterior drawer tests (p < 0.05), while the results of the pivot shift test did not improve significantly (p = 0.09). The decrease in median values of side-to-side difference in knee laxity measured with the GNRB arthrometer was from pre-operative 3.1 mm to 1.2 mm at 134 N (p < 0.05) and from 6.2 mm to 1.9 mm at 250N (p < 0.05). The median Lysholm and IKDC scores increased from 68 to 92 points and from 70 to 94 points, respectively (p < 0.05). Nine patients (81.9%) reported return to pre-injury participation in sports. Apart from early wound bleeding in one patient, no complications were recorded.

DISCUSSION

By permitting maintenance of a healthy bundle and replacement of only a torn one, ACL augmentation provides several benefits. It allows for accelerated revascularization and re-innervation of the graft through mechanoreceptors of the healthy portion; it enables the surgeon to get a good anatomical orientation and achieve precise tunnel reaming; in addition the healthy bundle provides protection for the graft in the early post-operative period. Thus rehabilitation can be faster and also return to sports activities.

CONCLUSIONS

Our results show that ACL augmentation using isolated replacement of either the AM or the PL bundle brings about statistically significant improvement of all subjective and most of the objective criteria by two years after surgery.

Novel mutations in the TAZ gene in patients with Barth syndrome

Barth syndrome is an X-linked recessive disorder that is caused by mutations in Taffazin gene (TAZ), leading to severe cardiolipin deficiency which results in respiratory chain dysfunction. Barth syndrome is characterized by cardiomyopathy, neutropenia, skeletal myopathy, growth deficiency and 3-methylglutaconic aciduria. In this paper, we present clinical, biochemical and molecular data of the first four Czech patients from four unrelated families diagnosed with this rare disease. The mean age of onset was 5.5 ± 3.8 months. One child suffered from sudden cardiac death at the age of 2 years, the age of living patients is between 3 and 13 years. Muscle hypotonia was present in all four patients; cardiomyopathy and growth retardation in three and neutropenia in two of them. Two patients manifested a dilated and one patient a hypertrophic cardiomyopathy. A characteristic laboratory abnormality was the intermittently increased excretion of 3-methylglutaconic acid. Three novel hemizygous mutations in the TAZ gene were found (c.584G>T; c.109+6T>C; c.86G>A). We conclude that Barth syndrome should be included in differential diagnosis of cardiomyopathy in childhood, especially in the cooccurrence of dilated cardiomyopathy and 3-methylglutaconic aciduria.

[Surgical treatment of intra-articular calcaneal fractures in children]

Fractures of the heel bone are frequent injuries and they may interfere with the patient's common daily activities for quite a long time. They are most frequently caused by falls and jumps from a height, and occur most often in middle-aged persons; they account for about 2% of all fractures in adults. In children, calcaneal fractures indicated for surgery are rare. The report presents two cases of intra-articular fracture in children treated by open reduction from the extended lateral approach and by osteosynthesis with an angular stable plate. The surgical procedure, reduction, implant and post-operative care were the same as used in adults. A paediatric calcaneal fracture regularly occurs due to a high-energy impact and presents a serious injury. Therefore, it is recommended to treat such fractures at institutions with medical staff experienced in their management.

Lipoprotein lipase deficiency: clinical, biochemical and molecular characteristics in three patients with novel mutations in the LPL gene

Lipoprotein lipase (LPL) deficiency, caused by mutations in the LPL gene, is a rare autosomal recessive disorder manifesting in early childhood with recurrent abdominal pain, hepatosplenomegaly, acute pancreatitis, lipaemia retinalis and eruptive xanthomas. Typical laboratory findings are lactescent serum, extreme hypertriglyceridaemia and hypercholesterolaemia. The diagnostics is based on postheparin serum LPL assay and DNA analyses of the LPL gene. We report clinical, biochemical and molecular data of three children with LPL deficiency. One child manifested since the first week of life with recurrent abdominal pain (Patient 1), the second with abdominal distension and hepatosplenomegaly since the second month of life (Patient 3) and patient 2, asymptomatic younger brother of patient 1, was diagnosed in the first week of life. Lipaemia retinalis and splenomegaly were present in two symptomatic children, hepatomegaly in patient 3 and acute pancreatitis in patient 1. All children had lactescent serum, profound hypertriglyceridaemia (124 ± 25 mmol/l; controls < 2.2), hypercholesterolaemia (22.8 ± 7.3 mmol/l, controls < 4.2) and their LPL immunoreactive mass in serum did not increase after heparin injection. Molecular analyses revealed that both siblings are homozygous for novel mutation c.476C > G in the LPL gene changing the conserved amino acid of the catalytic centre. The third patient is a compound heterozygote for mutations c.604G>A and c.698A>G in the LPL gene, both affecting highly conserved amino acids. We conclude that LPL deficiency must be considered in neonates and young infants with abdominal pain and hypertriglyceridaemia because early treatment might prevent development of life-threatening acute pancreatitis.

Non-invasive screening of cytochrome c oxidase deficiency in children using a dipstick immunocapture assay

Cytochrome c oxidase (CIV) deficiency is among the most common childhood mitochondrial disorders. The diagnosis of this deficiency is complex, and muscle biopsy is used as the gold standard of diagnosis. Our aim was to minimize the patient burden and to test the use of a dipstick immunocapture assay (DIA) to determine the amount of CIV in non-invasively obtained buccal epithelial cells. Buccal smears were obtained from five children with Leigh syndrome including three children exhibiting a previously confirmed CIV deficiency in muscle and fibroblasts and two children who were clinical suspects for CIV deficiency; the smear samples were analysed using CI and CIV human protein quantity dipstick assay kits. Samples from five children of similar age and five adults were used as controls. Analysis of the controls demonstrated that only samples of buccal cells that were frozen for a maximum of 4 h after collection provide accurate results. All three patients with confirmed CIV deficiency due to mutations in the SURF1 gene exhibited significantly lower amounts of CIV than the similarly aged controls; significantly lower amounts were also observed in two new patients, for whom later molecular analysis also confirmed pathologic mutations in the SURF1 gene. We conclude that DIA is a simple, fast and sensitive method for the determination of CIV in buccal cells and is suitable for the screening of CIV deficiency in non-invasively obtained material from children who are suspected of having mitochondrial disease.

[Anatomical ACL reconstruction by a double- versus a single-bundle technique. Prospective randomised study of short-term clinical results]

PURPOSE OF THE STUDY

The aim of the study is to present a comparison of short-term results of double- versus single-bundle anatomical reconstruction of the anterior cruciate ligament (ACL) using hamstring endons and their fixation with absorbable interference screws.

MATERIAL AND METHODS

A total of 110 patients with an isolated ACL lesion and the healthy contralateral knee who met the indication criteria for ACL double bundle reconstruction (TISL, 14 mm; ICNW, 12 mm) were intra-operatively allocated at random to either double-bundle group (DB, n=55) or single-bundle group (SB, n=55). At 12 months after surgery, 97 patients (DB group, n=49; SB group, n=48), comprising 68 men and 29 women, were evaluated; the average age was 29.1 years and the injury-to-surgery interval was 15.9 weeks. Pre- and post-operative subjective criteria involved the IKDC and Lysholm score. Objectively, the occurrence of graft failure, range of motion deficit, return to pre-injury sports activity, side-to-side difference in anterior laxity of both knees in 20° flexion on a GNRB laximeter at an applied pressure of 124 N and 250 N, and pivot shift phenomenon were assessed.

RESULTS

No statistically significant difference was found in pre-operative values between the two groups. Post-operatively, there were no significant differences in the occurrence of complete graft failure (p=0.0755; DB group, n=0; SB group, n=3), range-of-motion deficit (p=0.2277-0.9788) or return to pre-operative sports activity (p=0.2322). In the DB group, side-to-side anterior tibial shifts at a pressure of 124 N (medians=1.3 mm and 2.1 mm for DB and SB groups, respectively; p=0.0007) and at a pressure of 250 N (DB group =2.1 mm; SB group = 3.1 mm; p<0.0001) were significantly different from the corresponding values in the SB group. Positive results for the pivot shift test (PST) were significantly less frequent in the DB than the SB group (Chi-square test =0.0112). The SB group patients had a 2.9-times (odds ratio, 2.8704) higher risk of positive postoperative PST results than the DB group patients. In both groups, a comparison of pre- and post-operative criteria showed significant improvement in both the subjective and the objective results.

DISCUSSION

The results of this study, in accordance with other authors' conclusions, suggest that the double-bundle technique provides better control over rotational and anterior knee laxity and therefore restores knee biomechanics better. However, other literature data do not confirm any significantly better outcomes of this method. Since only short-term results have been obtained so far, the study will continue because only the long-term results can provide conclusive evidence of an advantage of one technique over the other.

CONCLUSIONS

Our study showed significantly better restoration of knee rotational and anterior laxity in the patients undergoing anatomical reconstruction of the ACL by the double-bundle technique. The other evaluated criteria did not differ in relation to the technique used.

Compact low resolution spectrograph, an imaging and long slit spectrograph for robotic telescopes

The COmpact LOw REsolution Spectrograph (COLORES) is a compact and lightweight (13 kg) f/8 imaging spectrograph designed for robotic telescopes, now installed and operating on the TELMA, a rapid-slewing 60 cm telescope of the BOOTES-2 observatory in Málaga (Spain). COLORES is a multi-mode instrument that enables the observer to seamlessly switch between low-dispersion spectroscopy and direct imaging modes during an observation. In this paper, we describe the instrument and its development, from the initial scientific requirements through the optical design process to final configuration with theoretical performance calculations. The mechanical and electronic design is described, methods of calibration are discussed and early laboratory and scientific results are shown.

Association of minor and trace elements with mineralogical constituents of urinary stones: a hard nut to crack in existing studies of urolithiasis

The role of metals in urinary stone formation has already been studied in several publications. Moreover, urinary calculi can also be used for assessing exposure of humans to minor and trace elements in addition to other biological matrices, for example, blood, urine, or hair. However, using urinary calculi for biomonitoring of trace elements is limited by the association of elements with certain types of minerals. In this work, 614 samples of urinary calculi were subjected to mineralogical and elemental analysis. Inductively coupled plasma mass spectrometry and thermo-oxidation cold vapor atomic absorption spectrometry were used for the determination of major, minor, and trace elements. Infrared spectroscopy was used for mineralogical analysis, and additionally, it was also employed in the calculation of mineralogical composition, based on quantification of major elements and stoichiometry. Results demonstrate the applicability of such an approach in investigating associations of minor and trace elements with mineralogical constituents of stones, especially in low concentrations, where traditional methods of mineralogical analysis are not capable of quantifying mineral content reliably. The main result of this study is the confirmation of association of several elements with struvite (K, Rb) and with calcium phosphate minerals, here calculated as hydroxylapatite (Na, Zn, Sr, Ba, Pb). Phosphates were proved as the most important metal-bearing minerals in urinary calculi. Moreover, a significantly different content was also observed for Fe, Zr, Mo, Cu, Cd, Se, Sn, and Hg in investigated groups of minerals. Examination of such associations is essential, and critical analysis of mineral constituents should precede any comparison of element content among various groups of samples.

[Type AO/ASIF B3 fractures of the thoracic and lumbar spine]

PURPOSE OF THE STUDY

Type B3 thoracic and lumbar fractures are often found in spines with previous hyperossification processes such as ankylosing spondylarthritis (AS) or diffuse idiopathic skeletal hyperostosis (DISH). They occur most frequently due to high-energy trauma in a healthy spine and as fall-related domestic injury in a spine affected by hyperossification. Generally, they are less frequent than type B3 cervical spine fractures. In this retrospective study involving two centres, the incidence of these fractures, their characterisation, therapy and complications associated with them were investigated.

MATERIAL AND METHODS

Between March 2003 and March 2012, 21 patients with type B3 injuries (Magerl classification) were treated in our centres. The thoracic spine was involved in 14 and the lumbar spine in seven patients. The patients' average age was 61.8 years, with a range of 33 to 87 years. There were three women and 18 men. Six fractures occurred in previously healthy spines, five and 10 were in AS- and DISH-affected spines, respectively. The evaluation included the mechanism of injury, patient's weight and height, neurological findings, type of treatment and its result, outcome after treatment termination, complications and associated diseases and injuries.

RESULTS

The mechanism of injury differed between the healthy and disease-affected spines. All five AS patients suffered low-energy fractures while patients with previously healthy spines had high-energy injuries. The DISH patients had both low- and high-energy fractures. Type B3.1.1 fractures were diagnosed in two AS patients and six DISH patients, and in no previously healthy patient. Type B3.1.2 fractures were found in one AS patient, two DISH patients and one previously healthy patient. Type B3.2 fracture occurred in one patient with a previously healthy spine, in two AS and two DISH patients. Type B3.3 fractures were in four patients with previously healthy spines. Neurological deficit was found in five injured patients, four of whom had complete paraplegia (Frankel grade A) which did not improve. One AS patient in whom the spinal fracture was associated with Frankel grade C injury improved to Frankel D after surgery. All patients had an elevated BMI, ranging from 25.1 to 41.9; the average value was 32.2, which is within grade 1 obesity. Associated injuries were found in 11 patients, mostly in those with high-energy trauma. Seventeen patients were treated surgically, four conservatively. Posterior stabilisation was carried out in 10 patients who had either AS or DISH conditions; seven patients had a short spinal stabilisation. Complications included early infection in two patients, cerebrospinal fluid fistula in one, urinary tract infection in one and confused state of mind in two patients. All patients healed well but for one patient who died at 4 months after injury due to multiple complications.

DISCUSSION

In the majority of relevant publications these injuries are reported in patients suffering from hyperossification disorders such as AS or DISH. In patients with healthy spines they occur less frequently and the traumatic hyperextension mechanism must have great intensity. Fractures of a hyperossified spine are related to obesity and this was also confirmed by our study in which all patients were overweight or obese. This factor plays an important role in the hyperextension mechanism that produces a sudden overcoming of the resistance of a spinal segment to force, resulting in a type B3 fracture.

CONCLUSION

A different approach to these fractures is required in comparison with other spinal fractures. Type B3 fractures have some features common with type C fractures and are frequent in spines affected by spinal disease. In hyperossification disorders, paradoxically associated with advanced osteoporosis, fracture treatment requires long instrumentation. In healthy spines, fractures are treated with short instrumentation. In AS and DISH patients, the diagnosis may be delayed because these patients suffer from chronic spine pain and the pain due to fracture may be attributed to an accelerated chronic condition.

[Open reduction and plate fixation (ORIF LCP) for treatment of bilateral calcaneal fractures]

PURPOSE OF THE STUDY

Calcaneal fractures are frequent injuries which may interfere with the patient's daily activities for a long time. They usually occur as the result of an axial load causing impaction of the talus into the calcaneus. They can also be bilateral. Falls and jumps from height are the most frequent causes.

MATERIAL AND METHODS

Between August 2005 and December 2011, the method of open reduction and internal fixation (ORIF) with a calcaneal locking compression plate (LCP) was used to treat 98 patients with 114 calcaneal fractures. Of these, 16 were bilateral fractures found in two women and 14 men. In each patient, plain lateral and axial X-ray films of the calcaneus were taken on the day of injury. Computer tomography (CT) scans in the sagittal, transverse and coronary planes were obtained. Based on these, the fractures were classified as type I to type IV according to the Sanders system. The patients with type II and type III calcaneal fractures were indicated for ORIF treatment. The results were evaluated using the Rowe score.

RESULTS

The most frequent cause of fracture was a fall or a jump from height, which was recorded in 81 patients. Bilateral fractures were found in 16 patients. Of the 98 patients, excellent results were in 31, good in 39, satisfactory in 20 and poor in eight patients, as assessed with the Rowe score. Unilateral fractures achieved excellent results in 28, good in 35, satisfactory in 15 and poor in four patients. The results in bilateral fractures were excellent in three, good in four, satisfactory in five and poor in four patients. Early post-operative complications were recorded in a total of 24 patients, of whom 13 had unilateral and 11 had bilateral fractures.

DISCUSSION

The Sanders classification based on CT examination is used as an indication scheme in our department. Type II and type III fractures are indicated for ORIF treatment. A calcaneal LCP and an extended lateral approach are preferred. This allows for an almost perfect view of the fracture, an accurate reduction of the subtalar and calcaneocuboid joints and a stable internal fixation. In the patients with bilateral fractures, the occurrence of complications, multiple trauma and associated injuries was significantly higher. Also, they had less satisfactory results than the patients with unilateral fractures.

CONCLUSIONS

The surgical treatment of intra-articular fractures using open reduction from the extended lateral approach and internal fixation with a calcaneal LCP has achieved good results. CT scans are necessary for the diagnosis, fracture classification and indication for a surgical procedure. The timing of surgery plays a decisive role. Open fractures and fractures associated with severe soft tissue injury are treated urgently, other fractures at an appropriate time. Our results showed a significantly higher rate of complications in the patients with bilateral calcaneal fractures, as compared with the patients with unilateral fractures, as well as less satisfactory outcomes. High-energy trauma resulting in bilateral fractures predisposes to comminuted fractures with dislocation, which leads to more serious damage to subtalar joint function.

Novel Mutations in the Tyrosine Hydroxylase Gene in the First Czech Patient with Tyrosine Hydroxylase Deficiency

Tyrosine hydroxylase deficiency manifests mainly in early childhood and includes two clinical phenotypes: an infantile progressive hypokinetic-rigid syndrome with dystonia (type A) and a neonatal complex encephalopathy (type B). The biochemical diagnostics is exclusively based on the quantitative determination of the neurotransmitters or their metabolites in cerebrospinal fluid (CSF). The implementation of neurotransmitter analysis in clinical praxis is necessary for early diagnosis and adequate treatment. Neurotransmitter metabolites in CSF were analyzed in 82 children (at the age 1 month to 17 years) with clinical suspicion for neurometabolic disorders using high performance liquid chromatography (HPLC) with electrochemical detection. The CSF level of homovanillic acid (HVA) was markedly decreased in three children (64, 79 and 94 nmol/l) in comparison to age related controls (lower limit 218–450 nmol/l). Neurological findings including severe psychomotor retardation, quadruspasticity and microcephaly accompanied with marked dystonia, excessive sweating in the first patient was compatible with the diagnosis of tyrosine hydroxylase (TH) deficiency (type B) and subsequent molecular analysis revealed two novel heterozygous mutations c.636A>C and c.1124G>C in theTHgene. The treatment with L-DOPA/carbidopa resulted in the improvement of dystonia. Magnetic resonance imaging studies in two other patients with microcephaly revealed postischaemic brain damage, therefore secondary HVA deficit was considered in these children. Diagnostic work-up in patients with neurometabolic disorders should include analysis of neurotransmitter metabolites in CSF.

[Surgical treatment for factures of the neck and body of the talus]

PURPOSE OF THE STUDY

To present a retrospective evaluation of the results of our method of open reduction and internal fixation.

MATERIAL AND METHODS

A total of 35 patients were surgically treated for talar fractures at our department between 2004 and 2008. There were 27 men and eight women, with an average age of 31 years (range, 21 to 65). Talar neck fractures were recorded in 21 and talar body fractures in 14 patients. The most frequent cause of injury was a fall from height (77%); motorcar accidents were less frequent (14%). Open fractures were found in 8.5% of the patients, and talar fractures as a single trauma were recorded in 80% of them. Indication criteria for surgery included displaced talar neck (Hawkins type II to type IV) and body fractures, with a displacement exceeding 1 mm. The traction screw osteosynthesis used was combined with plate fixation in some patients. .Full weight-bearing of the extremity was allowed from 12 post-operative months. The patients were followed up at 6 weeks, 3, 6 and 12 months and then at yearly intervals. The American Orthopaedic Foot and Ankle Society (AOFAS) scores were used to evaluate the results.

RESULTS

Of the 35 fractures, 16 (45.7%) were treated surgically on the day of injury and 19 (54.3%) on subsequent days. The injury-surgery interval ranged from 0 to 12 days (average, 8 days). Primary bone union was recorded in 34 patients (97%) within 16 weeks of surgery; pseudoarthrosis developed in one patient. The results were excellent in eight (23%), good in 11 (31%) and satisfactory in seven (20%) patients. Poor outcome including function was reported by nine (26%) patients. The poor results were mostly due to associated tibial pilon fractures or because of arthrodesis necessary to be performed for management of necrosis or arthritis. Complications were recorded in 22 patients (63%) and included avascular necrosis in six (17%), traumatic arthritis of the tibiotalar and subtalar joints in 14 (40%) patients and pseudoarthrosis in one (3%) patient. This was treated by corticocancellous graft implantation and repeated osteosynthesis, and bone union occurred within 6 months. Traumatic arthritis was managed by arthrodesis in seven patients.

DISCUSSION

Dislocated talar neck and body fractures are always indicated for surgery. The surgical procedure used depends on the patient's injury, surgeon's experience and skills, surgical department's system and fracture type. The timing of surgery is related to the type of injury and soft tissue disturbance. The primary demand is to reduce the fracture as soon as possible; a definite treatment may be postponed. Open fractures require urgent management. The treatment should be completed by an experienced surgeon after subsidence of soft tissue oedema when there is no longer the risk of compartment syndrome development. Injury brings about blood flow disturbance, with its extent relative to the type of injury, which may result in avascular necrosis. However, the timing of surgical treatment plays no role in the development of complications such as avascular necrosis or traumatic arthritis.

CONCLUSIONS

Surgical management of dislocated talar neck and body fractures by open reduction and osteosynthesis does not achieve very good results. The definitive treatment should be carried out by an experienced surgeon and at a department with routine performance of these procedures. The results show that a delayed treatment by open reduction and stable osteosynthesis has better long-term outcomes than a rash acute operation done by an incomplete or less experienced operating team.

[Lumbar total disc replacement. Short-term results]

PURPOSE OF THE STUDY

Motion-preservation technologies for spinal disorders have evolved and come into use in the last decade. Three principal systems are currently available: total disc replacement, posterior neutralisation transpedicular system and interspinous implants. The aim of this retrospective study was to evaluate our group of lumbar total disc replacements at a follow-up of 2 years.

MATERIAL AND METHODS

A total of 42 disc prostheses were implanted in 37 patients. Of these, 31 with 35 artificial discs were followed up for 2 years. There were 11 men and 20 women with an average age of 42.9 years (range, 21 to 61 years). The indication for surgery was lumbar disc pain without radicular syndrome and contraindications included advanced degenerative facet joint disease and obesity with a body mass index over 30. Surgery was carried out through the pararectal retroperitoneal approach. Early and late complications were recorded. The group evaluation was based on radiological outcomes, and VAS and ODI scores reported by the patients at 6 weeks, and 3, 6, 12 and 24 months after surgery.

RESULTS

The average operative time was 68 minutes (range, 36 to 120 min) for single-level lumbar total disc replacement and 92 minutes (range, 72 to 130 min) for two-level procedures. The average hospital stay was 5.2 days (range, 3 to 12). Both keels of the prosthesis were in the exact center in 25 cases, they were shifted laterally in nine cases up to 2 mm and in one case more than 2 mm. Horizontal rotation of the prosthesis was seen in two patients, but not more than 5 degrees to the left. There was no disc loosening or subsidence, and no acceleration of adjacent segment degeneration. Two patients showed heterotopic ossification. Subjective evaluation was recorded as marked improvement in 15, partial improvement in 11 and no change in five patients. None of the patients reported deterioration. Low back pain assessed by the VAS score had an average value of 66.3 before surgery and 14.1 at 2 years after surgery. The average pre-operative ODI value was 48.9 and that at 2 years post-operatively was 24.5.

DISCUSSION

Pain relief evaluated by the VAS score in our study is comparable with or slightly better than is reported by the other authors. Some recorded average values for lumbago were 74 before surgery and 35 at 2 years of follow-up, or 62.3 before and 25.4 at 2 years after surgery, while our patients had the average VAS score of 66.3 before surgery and that of 18.4 at 2 years after surgery. The ODI values in our group were similar to those of other authors. When we compare this group with the group of our patients who were treated by spinal fusion surgery, the outcomes at 1 year are better in the total disc replacement group, as shown by the VAS for lumbago of 17.8 and ODI of 24.5 in the former versus the respective values of 18.1 and 29.0 in the latter group.

CONCLUSION

Based on the results it can be concluded that total disc replacement is an efficient method of treating degenerative intervertebral disc disease of the lumbar spine in young, active and motivated patients with no posterior spinal structure degeneration.

[Corneal ulceration complicating surgical correction of ptosis in patient with Kearns-Sayre syndrome--a case report]

The aim is to report a rare complication of surgical ptosis correction in a patient with Kearns Sayre syndrome and the therapeutic possibilities of its treatment.

METHODS

Exposure corneal ulceration caused by lagophtalmos developed gradually in a 30-year-old woman after an upper eyelid ptosis surgery of the right eye performed at another eye clinic. During an examination a limited movement of both eyes and retinal pigmentary changes (salt-pepper-like appearance) were diagnosed. A suspicion of the Kearns Sayre syndrome was expressed according to the clinical picture, the diagnosis was confirmed by molecular analyses in muscle biopsy, which revealed 5.2 kb deletion of mitochondrial DNA.

RESULTS

Corneal ulceration was treated by partial external tarsorrhaphy and frequent instillation of lubricants. The upper eyelid ptosis of the left eye was treated with a spectacle with ptosis support.

CONCLUSION

During the correction of upper eyelid ptosis in patients with progressive external ophtalmoplegia it is necessary to be aware of the risk of surgical exposure keratopathy and corneal ulceration due to the atony of musculus orbicularis oculi muscle and only slightly expressed Bell's phenomenon.

A Study of Band Alignment in GaAs/GaInP(Partially Ordered) Heterostructures with High Pressure

In this paper we review the use of high pressure techniques to investigate the optical properties of partially ordered GalnP epitaxial layers grown on GaAs substrates. In particular, we demonstrate the ability of high pressure to modify the band alignment at the GalnP/GaAs interface and hence to alter the optical properties of heterostructures fabricated from partially ordered GalnP on GaAs.

Effects of tandem shock waves combined with photosan and cytostatics on the growth of tumours

Shock waves, pressure waves manifested as a sharp increase in positive pressure followed by a decrease and the negative part of the wave, are not only used to treat concrements in medicine. Recently, research has been focused on the possibility of their use for damaging the tumour tissue. In contrast to concrements, which are different from the surrounding tissue by their acoustic impedance, the tumour tissue has the same acoustic impedance as the surrounding soft tissue. Therefore, we have developed a new source of shock waves, which is based on the principle of multichannel discharge. This new source generates two successive shock waves (tandem shock waves). The first shock creates acoustic non-homogeneity and cavitations in the tissue, and the second shock is damped in it. In this work we demonstrated the effect of tandem shock waves on the muscle tissue in depth. The damage is shown on the images from the magnetic resonance imaging and histological sections. In the further part of the experiment, we investigated the in vivo effects of tandem shock waves in combination with Photosan and cisplatin on the tumour tissue. The application of tandem shock waves resulted in the inhibition of tumour growth, compared with controls, in both parts of the experiment. The largest inhibition effect was observed in the groups of tandem shock waves combined with Photosan and in the second part with cisplatin.

Two patients with clinically distinct manifestation of pyruvate dehydrogenase deficiency due to mutations in PDHA1 gene

The most common cause of pyruvate dehydrogenase complex (PDHc) deficiency is the deficit of the E1α-subunit. The aim of this study was to describe distinct course of the disease in two boys with mutations in PDHA1 gene and illustrate the possible obstacles in measurement of PDHc activity. Clinical data and metabolic profiles were collected and evaluated. PDHc and E1α-subunit activities were measured using radiometric assay. Subunits of PDHc were detected by Western blot. PDHA1 gene was analysed by direct sequencing. In patient 1, the initial hypotonia with psychomotor retardation was observed since early infancy. The child gradually showed symptoms of spasticity and arrest of psychomotor development. In patient 2, the disease manifested by seizures and hyporeflexia in the toddler age. The diagnosis was confirmed at the age of seven years after attacks of dystonia and clinical manifestation of myopathy with normal mental development. Brain MRI of both patients revealed lesions typical of Leigh syndrome. Enzymatic analyses revealed PDHc deficiency in isolated lymphocytes in the first but not in the second patient. The direct measurement of PDH E1-subunit revealed deficiency in this individual. In patient 1, a novel hemizigous mutation c.857C>T (Pro250Leu) was detected in the X-linked PDHA1 gene. Mutation c.367C>T (Arg88Cys) was found in patient 2. We present first two patients with PDHc deficit due to mutations in PDHA1 gene in the Czech Republic. We document the broad variability of clinical symptoms of this disease. We proved that normal PDHc activity may not exclude the disease.

[Vertebral body augmentation using a vertebral body stent]

PURPOSE OF THE STUDY

Osteoporotic vertebral fractures can be treated by minimally invasive percutaneous vertebral augmentation with bone cement using vertebroplasty or balloon kyphoplasty. Transcutaneous reduction and vertebral body stenting has been the most recent principle. In contrast to balloon placement in kyphoplasty, the stent remains in the vertebral body and supports both the vertebral body and cement filling. In this retrospective study we present the essential information on the method and our first results.

MATERIAL AND METHODS

The method of vertebral body stent placement was used in 22 patients treated at 29 levels. Of these, 19 patients with 26 segments followed up for 3 months were evaluated. The group included 12 women and seven men with an average age of 68.3 years (12 to 83). The patients assessed their subjective complaints on the visual analogue scale (VAS) before surgery, and then at 1, 6 and 12 weeks post-operatively. The value of vertebral body reduction was obtained by measurement of anterior, middle and posterior vertebral body heights (AVBH, MVBH and PVBH, respectively) and a change in the vertebral body kyphotic angle (VBKA).

RESULTS

Twenty-four vertebrae were treated for osteoporotic fracture and two as preventive stenting in metastatic breast cancer. In 24 fractures, the stents extended fully in 20 vertebrae, i.e., 40 stents. These fractures evidently were not older than 3 months. In four segments, a total of eight stents did not extend at all or did only slightly. The 20 stabilised vertebral bodies had an average AVBH value of 19.41 mm pre-operatively and that of 22.775 mm post-operatively, which is an average increase by 3.365 mm in absolute numbers and by 17.34 %. The average pre- and post-operative MVBH values were 16.625 mm and 23.065 mm, which was improvement by 6.41 mm or by 38.56 %. The average PVBH values pre- and post-operatively were 26.835 mm and 28.31 mm, which meant improvement by 1.475 mm or by 5.5 %. The average correction of the kyphotic angle was 4.58°, i.e., 35.2 %, from a VBKA of 11.71° pre-operatively to 7.13° post-operatively. There were five cases (22.7 %) of cement leakage, i.e., two of ventral leakage, one of lateral leakage, one of dorsal leakage through a canal left in the pedicle by cannula insertion, and a dorsal leakage in metastatic disease. No neurological findings were recorded. The average VAS scores were as follows: 81.4 before surgery, 30.6 at 1 week, 16.3 at 6 weeks and 15.4 at 12 weeks after surgery.

DISCUSSION

Two experimental and one clinical study on vertebral body stenting only have been available in the recent relevant literature. In comparison with their results as well as with those of previous reports on vertebroplasty and kyphoplasty, our results showed high quality fracture reduction in all vertebrae. The rapid decrease in pain intensity in our group is comparable with all available groups treated by any method of vertebral body augmentation by cement injection; and cement leakage was recorded in even fewer cases.

CONCLUSIONS

The novel method of vertebral body stenting with cement augmentation provides a rapid pain relief, gives stability to fracture reduction and has a low rate of cement leakage. However, care must be taken not to indicate cases with a damaged posterior corticalis of the vertebral body.

Placental tissue as model for pilot study focused on RNA analysis from human foetal tissue

Early neonatal adaptation to extrauterine life is i.a. dependent on effective mitochondrial biogenesis during foetal development. Understanding of mitochondrial biogenesis is limited, because only scarce data are available from prenatal studies including RNA analyses in human foetal tissues. Aims of the study were focused on the factors affecting RNA quality in human placental tissue (HPT) including temperature, time period before HPT freezing and the Apgar score. In addition, optimal reference genes for mRNA quantification by real-time PCR in HPT were studied. Samples of HPT were obtained after the birth of 20 term neonates. Seven HPT were used for the time-course study of RNA degradation in two different temperatures (0 °C and 24 °C). Various instruments NanoDrop (NanoDrop Technologies), Experion (Bio-Rad Laboratories), Agilent 2100 Bioanalyzer (Agilent Technologies) were used for analysis of RNA integrity, purity and yield. Identification of suitable reference genes was achieved by analysing six candidate genes (ATP5O, SDHA, TBP, HPRT, PMBS, ATP6) for their expression stability (GeNorm application). The results showed that the HPT samples for RNA analyses must be frozen immediately after birth in -80 °C or stored at 0 °C maximally for 1 hour. The reference genes ATP50 and SDHA were the most stable for mRNA quantification in HPT. Human placenta represents easily obtainable source of foetal tissue for studies concerning mitochondrial biogenesis. We demonstrated that the critical limit for optimal storage and handling of HPT are the temperature and the time period before freezing of the samples.

Oligodendroglia from ADSL-deficient patient produce SAICAribotide and SAMP

Succinylpurines accumulate in the body fluids of patients with adenylosuccinate lyase (ADSL) deficiency but their source in the cerebrospinal fluid remains obscure. Study based on the incorporation of 13C-stable isotope-labeled glycine into cultured oligodendroglia from ADSL-deficient patient and the measurement of labeled products by LC/MS/MS showed total intracellular concentrations of succinylpurines from 45 to 99μmol/l and so these results suggest that these cells can be the source of the compounds in vivo.