Changes in the scar tissue structure after cesarean section as a result of manual therapy

BACKGROUND

Available statistical data from 2015 show that 28% of pregnancies in developed countries end in cesarean section (CC). Discomfort associated with the scar after surgery is a common complication.

OBJECTIVES

This study aimed to evaluate the changes in the structure of the cesarean scar after the application of a scheme of manual therapy.

MATERIAL AND METHODS

The study included 15 women in the treatment group (TG) and 15 in the control group (CG). The scars were evaluated twice at 5-week intervals with the use of quantitative scales: the Vancouver Scar Scale (VSS), the Manchester Scar Scale (MSS) and the Patient and Observer Scar Assessment Scale (POSAS). During each examination, the scar was compared, using the specified criteria, to the physiological skin, i.e., the tissues directly bordering the incision. During therapy, 8 manual techniques were used during a 4-week program consisting of 30-minute sessions 3 times per week.

RESULTS

Patients in the TG showed a statistically significant improvement in all of the analyzed characteristics of the scar. A statistically significant difference was also observed between the results obtained during the 2nd examination (after the therapy) in the TG and the CG.

CONCLUSIONS

As a result of the therapy, the condition of the scar in the TG significantly improved. Onerous scar-related symptoms were alleviated. The vascularity, hyperpigmentation and distortion of the scar were reduced. The elasticity and pliability of the scar increased, and the height of the scar decreased. The texture, finish and contour of the scar improved. Obtained results suggest that manual therapy of the scar after CC should be a part of the treatment in women during the postpartum period.

Giant Intrathoracic Mass in a Young Woman With Acute Kidney Injury

CASE PRESENTATION

A 35-year-old woman without past medical history sought treatment for fatigue and dry cough of 3 weeks' duration. Basic laboratory tests revealed severe anemia. She had no history of bleeding, hemoptysis, dyspnea, or fever. The patient was admitted for RBC transfusion and more extensive diagnostics.

The utility of fluorescence in situ hybridization (FISH) in determining DNA damage-inducible transcript 3 (DDIT3) amplification in dedifferentiated liposarcomas - an important diagnostic pitfall

BACKGROUND AND OBJECTIVE

Dedifferentiated liposarcoma (DDLPS) is characterized by non-lipogenic sarcoma fields coexisting with adipocyte-rich well-differentiated areas. Amplification of the 12q13-15 region includes the MDM2 and DDIT3 genes. MDM2 amplification is considered a genetic hallmark of DDLPS, while DDIT3 is typically rearranged in myxoid liposarcoma. Recent studies showed that DDIT3 amplification is associated with myxoid liposarcoma-like (LPS-like) morphology in DDLPS. Our study aimed to evaluate the status of MDM2 and DDIT3 by FISH in DDLPS and correlate it with MLPS-like features.

MATERIAL AND METHODS

Six patients with MLPS-like morphology DDLPS were investigated pathologically, immunohistochemically, and genetically. The control groups of patients with classical DDLPS morphology and well-differentiated liposarcoma (WDLPS) were established and molecularly assessed as well. Fluorescence in situ hybridization (FISH) used in routine diagnostics was performed to determine the status of MDM2 and DDIT3 genes.

RESULTS

The patient's mean age was 64 (range from 43 to 85 years) with a 5:4 male to female ratio. Tumors were localized retroperitoneally (15) and extra-retroperitoneally (3). All cases demonstrated amplification of the 12q15 region containing MDM2 gene and co-amplification of the 5' DDIT3 FISH Probe representing DDIT3 telomeric tag. However, we did not find the relation of myxoid LPS-like morphology with DDIT3 amplification as previously reported.

CONCLUSIONS

The biopsy material from DDLPS with myxoid areas can be misclassified as myxoid liposarcoma. Indeed, according to the histological image, DDIT3 status may be evaluated first. In these cases, we show that the DDIT3 telomeric tag amplification assessed by FISH, is a common, nonspecific feature, which is also found in classical DDLPS and WDLPS. Therefore, we believe that co-amplification of DDIT3 and MDM2 may be considered a spectrum of the 12q13-15 region amplification due to the specification of FISH methodology.

Comparison of cognitive functioning of elders with late-life depression and patients with and without a history of depressive episodes: a cross-sectional study

Nowadays there are numerous studies on the occurrence of cognitive dysfunction in late-life depression (LLD). The role of executive dysfunctions in the psychopathology of depression is particularly emphasized and needs further examination. The aim was to assess cognitive functions and their relation to depressive symptoms in elders with LLD, previously depressed, and patients without the history of depressive episodes. The study consisted of 824 older adults who underwent a neuropsychological evaluation (97 currently depressed, 114 previously depressed and 613 patients without the history of depressive episodes). LLD patients performed poorer in ACE-III and AVLT and poorer in TMT-B than those previously depressed and never depressed. The LLD group also performed significantly poorer than the previously depressed on Digit Span Forward. Results of a multiple regression analysis indicated that performance on measures of executive functioning was associated with depression severity in LLD (β =.227, P =.024). The results of this study suggest that executive functions are the most impaired in the elderly with LLD. Furthermore, there is a relationship between executive dysfunction and the severity of depression in LLD. Executive dysfunction appears to be the core neurocognitive deficit in LLD.

[Clinical and demographic predictors of mild cognitive impairment - cross-sectional study]

OBJECTIVE

Introduction: Cognitive limitations are a serious health and social problem, which concerns elderly people. Effective prevention and treatment of cognitive dysfunction is one of the challenges of modern medicine. There is not enough consistent data in the literature to indicate to indicate the relationship between various clinical and demographic factors with cognitive functioning in different age ranges. The aim: To analyze clinical and demographic predictors of mild cognitive impairment by age group.

PATIENTS AND METHODS

Material and methods: The analysis included 817 participants (669 with normal cognitive function and 148 people with MCI). The evaluation of the level of depressive symptoms was measured by the Short Form Geriatric Depression Scale. All participants were screened for cognitive functioning using the Mini-Mental State Examination and Addenbrooke's Cognitive Examination-III. Different cognitive domains were evaluated with different neuropsychological tools: the Rey Auditory Verbal Learning test, Clock Drawing test, Verbal Fluency test, Digit Span Test and Trail Making test.

RESULTS

Results: It has been shown that independently associated with MCI ware age (OR = 1.09, 95% CI: 1.05-1.13) and level of education (OR = 0.75, 95% CI: 0.69-0.81). Depending on the age, it turned out that in the younger MCI group, age, education and depression were significant, and the age and level of education were significant in the older MCI group.

CONCLUSION

Conclusions: The identification of cognitive dysfunctions is an important element of the diagnostic and therapeutic process.

Nutritional therapy complications in children with ultra-short bowel syndrome include growth deficiency but not cholestasis

Aim

Children with ultra‐short bowel syndrome (USBS) have not been extensively studied to date because the condition is rare. The aim of the study was to assess the nutritional status of children with USBS receiving home parenteral nutrition, using citrulline serum concentration and cholestasis.

Methods

We studied 17 patients with USBS, with a median age of 6.6 years and median duration of parenteral nutrition of 6.6 years. The study was carried out at The Children's Memorial Health Institute, Warsaw, from January 2014 to January 2015.

Results

The median standard deviation score (SDS) was −1.2 for body mass according to chronological age, −1.72 according to height and −0.59 according to height for age. Patients requiring seven days per week parenteral nutrition had a citrulline concentration below 10 μmol/L. Decreased bone‐mineral density was observed in 87% of the patients. Low values of 25‐hydroxyvitamin D were found in 53% of the children. None of the patients had elevated conjugated bilirubin levels above 34.2 μmol/L.

Conclusion

Children with USBS were growth deficient according to their chronological age, with frequent abnormal bone mineralisation and vitamin D deficiency. Children requiring parenteral nutrition seven days a week had citrulline concentrations below 10 μmol/L. Cholestasis was not seen.

Profiles of empathic sensitivity in students of the last year of medicine

Developing the empathic attitude is one of the tasks of medical education as it affects the quality of therapeutic contact in the relationship between the doctor and the participant, conditioning the treatment process. According to Davis's concept, empathy is defined as an affective-cognitive reaction in the context of the other person's experience.

AIM

Analysis of profiles of empathic sensitivity in students of medicine. Group: Male and female students of the fifth year of medicine who agreed to participate in an anonymous study (n = 153; M = 57, F = 96; mean age: 23 years). Tools: The Empathetic Sensitivity Scale (EES), which is the Polish tool for Davis's Interpersonal Reactivity Index (IRI) was used. The ESS includes three sub-scales: Empathic Care (EC), Personal Distress (PD) and Adopting Perspective (AP).

RESULTS

The raw results were converted into sten scores and for sten scores for all three dimensions of empathetic sensitivity no differences were found between male and female students. Three clusters (1: n = 33%, 2: n = 39%, 3: n = 28%), which differ in terms of each distinguished indicator, were identified.

CONCLUSIONS

The first cluster characterizes empathetic people, both in the affective and cognitive spheres, and those dealing well with unpleasant emotions in situations difficult to others. The second cluster characterizes participants with the ability to recognize the needs of others and to take into account their perspectives; the third cluster includes participants with a tendency to focus on own experiences emerging in response to other people's suffering but with the ability to understand a situation and show empathic concern for the other person. The most favourable profile - for a future doctor as well as for his participants - is the first cluster because the doctor, with his empathic sensitivity directed towardsthe other man, can deal with his own unpleasant emotions.

An Assessment of the Number of Cariogenic Bacteria in the Saliva of Children with Chemotherapy-Induced Neutropenia

BACKGROUND

Anticancer therapy entails qualitative and quantitative changes in the physiological bacterial flora of the organism, including the oral microflora.

OBJECTIVES

The aim of the study was to assess the number of cariogenic bacteria - Streptococcus mutans and Lactobacillus spp. - in the saliva of children with chemotherapy-induced neutropenia, and the relationship between the dynamics of neutrophils in the blood and the number of cariogenic bacteria in the saliva.

MATERIAL AND METHODS

The study included 52 children aged 3-17.5 years, diagnosed with cancer and undergoing antineoplastic treatment. The control group comprised 52 generally healthy children matched for age and gender. Both groups underwent microbiological analysis of the saliva. The Dentocult SM Strip Mutans test (Orion Diagnostica, Espoo, Finland) was used to evaluate the number of Streptococcus mutans colonies in the saliva, while the Dentocult LB test (Orion Diagnostica) was used to assess the number of Lactobacillus spp. bacteria. The statistical analysis was carried out using STATISTICA 10 software (StatSoft Inc., Tulsa, USA).

RESULTS

The statistical analysis using Kendall's tau test showed a significant inverse correlation between the number of neutrophils in the blood and the number of the Streptococcus mutans and Lactobacillus spp. colonies in the saliva of the children undergoing anticancer therapy. The highest titres of cariogenic bacteria in the saliva were observed during severe neutropenia, which was frequently observed between day 7 and day 21 of the chemotherapy course.

CONCLUSIONS

A significant increase in the number of cariogenic bacteria in the saliva during episodes of chemotherapy-induced neutropenia suggests that the activity of dental caries increases in children undergoing antineoplastic treatment.

Muscle mitochondrial density after exhaustive exercise in dogs: prolonged restricted activity and retraining

The effect of exhaustive treadmill exercise on mitochondrial density (MD) and ultrastructural changes in quadriceps femoris muscle was studied in 7 normal, healthy, male mongrel dogs (2-4 years, 15-20 kg) before and after restricted activity (RA) (2 months for 5 dogs, 5 months for 2 dogs), and following a subsequent 2-month exercise retraining period (2-months group). Mean (+/- S.E.) time to exhaustion in the 2-month group decreased from 177 +/- 11 min before to 90 +/- 16 min (delta = -49%, p < 0.05) after RA; retraining increased tolerance to 219 +/- 36 min (delta = +24%, p < 0.05) above the pre-RA and 143% (p < 0.05) above the post-RA time. Post-RA exhaustion time in the 5-months group was 25 and 45 min (35 +/- 10 min). Muscle samples taken after RA showed abnormalities indicative of degeneration, which were reversed by retraining. Resting MD decreased (p < 0.05) from a control level of 27.8% to 14.7% (2 months) and 16.3% (5 months), and was restored to 27.1% (NS) after retraining. Exhaustive exercise caused an increase in MD under control conditions and after RA, but not following retraining. Disruption of mitochondria after exercise was evident after 5-months confinement. Factors causing mitochondrial changes and eventually their disruption during exercise after restricted activity are not related as much to the state of fatigue as to the pre-exercise quality of the muscle modified by disease or training.

Craviten effect on the metabolism of stored platelets

Craviten effect on platelets suspended in their own plasma was investigated by two methods of incubation with the drug: the fresh platelets were incubated for 18 h at 4 degrees C with Craviten added to plasma and platelets stored for 18 h at 4 degrees C without Craviten were incubated with Craviten at 37 degrees C for 1 h. For evaluation of the metabolic activity and function of the platelets, the levels of high-energy compounds ATP and ADP, the activity of hexokinase and pyruvate kinase and the amount of adenyl nucleotides released by the platelets after thrombin addition were measured, and the spontaneous aggregation of platelets and c-AMP were determined. The experiments demonstrated that Craviten prevented the fall of ATP level of the stored platelets, raised the activity of hexokinase and pyruvate kinase in the platelets, increased the amount of nucleotides released by the platelets in the release reaction. Craviten inhibited also increased spontaneous aggregation of stored platelets and raised c-AMP level.

[Effect of cytostatic agents on the metabolism and ultrastructure of blood platelets in man]

The effect of cytostatic drugs used in the treatment of haemopoietic system diseases: cerubidin, hydroxyurea. cytosine arabinoside and their combinations on the platelet count, platelet ultrastructure, metabolic activity and participation in the processes of haemostasis was investigated. The experiments were done using two concentrations of the drugs: clinical corresponding to the maximal single dose and a fivefold as high concentration, It was found that the investigated cytostatic agents and their cominations in the first concentration had no effect of the platelet count, level of free nucleotides, activity of glucose-6-phosphate dehydrogenase and lactic dehydrogenase, and on the reaction of adenine nucleotides release from the platelets induced with thrombin. Using the higher concentration of the drugs it was observed that cerubidin and the combination of cytostatic agents tested changed the shape and ultrastructure of the platelets.