The Influence of Polyphenol Compounds on Human Gastrointestinal Tract Microbiota

Polyphenols form a diverse group of compounds containing at least two hydroxyl groups in their chemical structure. Because of the common presence in plant kingdom, polyphenols are considered a significant component of food and an important group of compounds with antioxidant properties. The absorption of polyphenols present in food depends mostly on the activity of intestinal microflora. However, little is known about the processes and interactions responsible for such phenomenon in guts ecosystem. There are only few available publications that examine the effect on polyphenols on intestinal microbiota. Therefore, this work will focus on describing the relationship between polyphenol compounds present in food and bacteria colonizing the intestines, their mechanism, and impact on human’s health.

Impact of Vitamin D on Physical Efficiency and Exercise Performance-A Review

Vitamin D deficiency amongst athletes and the general population seems to be a prominent problem. The most recognized role of vitamin D is its regulation of calcium homeostasis; there is a strong relationship between vitamin D and bone health. Moreover, its concentrations are associated with muscle function and immune response in both the general and athletic populations. Vitamin D level is strongly connected with the presence of VDRs (vitamin D receptors) in most human extraskeletal cells. Expression of multiple myogenic transcription factors enhancing muscle cell proliferation and differentiation is caused by an exposure of skeletal muscles to vitamin D. The aim of this review is to summarize current understanding of the significance of vitamin D on exercise performance and physical efficiency, as well to analyze the impact of vitamin D on multiple potential mechanisms. More high-quality research studies, considering free 25(OH)D as a better marker of vitamin D status, the baseline level of 25(OH)D and multiple pathways of vitamin D acting and usage in athletes are required.

Analysis of risk factors for non-radical excision in patients with primary breast cancer undergoing breast conserving therapy: A single-center study

Introduction: Incomplete excision of the primary lesion is one of the most important causes of local recurrence in breast cancer patients undergoing breast conserving therapy (BCT). The aim of the study is to determine the factors that increase the risk of obtaining positive surgical margins after BCT. Material/Methods: Prospective analysis included 1,102 cases of invasive primary breast cancer treated with BCT (01/2015-12/2016). In the study group, we selected clinical-pathological factors, which have an impact on the excision rate of the primary lesion. It concerned identifiable features in pre-operative diagnostic procedures. Results: In 15.7% of patients after BCT, positive margins of primary tumor excision were obtained. These patients required secondary surgery (with conversion to mastectomy in 78 (45.1%) patients undergoing surgery). In other cases, the primary tumor was excised radically. Non-radical excision of the tumor was recorded in 21.4% of patients presenting lobular breast cancer (vs 7.4% in case of different histopathological types), lesions exceeding value of 2 cm and in event of positive HER2 receptor status (16.8% vs 11.4%). Among factors significantly increasing the rate of non-radical BCT operations, patients’ age and BMI (body mass index) value were specified (in uni- and multivariate analysis, with presence of statistically significant differences in case of every above mentioned factors). Conclusions: Several clinical and pathological factors contribute to significantly increased risk of the incomplete excision following BCT. Identification of such variables should influence the selection of the surgical method. It concerns especially risk factors, which presence is possible to record prior to surgical procedure.

Intraoperative diagnosis of sentinel lymph node metastases in breast cancer treatment with one-step nucleic acid amplification assay (OSNA)

INTRODUCTION

The aim of the study was to evaluate the clinical usefulness of a one-step nucleic acid amplification assay (OSNA) for intraoperative detection of metastases to sentinel lymph nodes (SLNs) in comparison to examination of frozen sections, and to summarize the results of previous studies.

MATERIAL AND METHODS

We enrolled 98 patients aged 58.13 ±10.74 years treated surgically for breast cancer, and 99 biopsies of SLNs were followed by analysis of 105 SLNs. The central 1 mm slice of SLN was used for examination of frozen sections, whereas 2 outer slices of SLNs were analyzed intraoperatively with OSNA. Detection of isolated tumor cells (ITC), micrometastases or macrometastases with OSNA extended surgery to axillary lymph node dissection. Congruency of results was assessed between OSNA and examination of frozen sections.

RESULTS

One-step nucleic acid amplification assay detected metastases in 29/105 SLNs in surgery of 27/99 breasts, including ITC in 3/29 SLNs, micrometastases in 12/29 and macrometastases in 14/29. One-step nucleic acid amplification assay detected significantly more metastases to SLNs than examination of frozen sections (p < 0.0001). All 8 inconsistent results were positive in OSNA and negative in examination of frozen sections; ITC were identified in 2/8 SLNs and micrometastases in 6/8 SLNs. Sensitivity for OSNA was calculated as 100%, specificity as 90.47%, and κ was 79.16%.

CONCLUSIONS

One-step nucleic acid amplification assay analysis allows rapid and quantitative detection of mRNA CK19 with high specificity and a low rate of false positives. One-step nucleic acid amplification assay is a reliable tool for intraoperative diagnosis of whole SLNs during surgery of breast cancer. One-step nucleic acid amplification assay minimizes the need for secondary surgery and avoids delays in the adjuvant treatment.

Intra-operative digital specimen radiology reduces re-operation rates in therapeutic mammaplasty for breast cancer

BACKGROUND

The aim of this study was to evaluate our experience with intra-operative imaging of therapeutic mammaplasty specimens at Edinburgh Breast Unit.

METHODS

A retrospective review was performed of patients who underwent therapeutic mammaplasty in Edinburgh Breast Unit between 2007 and 2013 who had intraoperative specimen radiography.

RESULTS

98 (100%) patients who underwent therapeutic mammaplasty for breast cancer had intra-operative imaging using the faxitron(®) system. 3 out of those 97 (3%) patients had a re-operation because of positive margins confirmed pathologically on cavity excision specimens, but only 1 out of 3 (1%) patients had residual breast cancer present within the re-excision specimen. None required mastectomy. Median age was 58 (range 34-81). Median follow up was 3.1 years (range 6 months - 5.5 years). There was no local recurrence or conversion to mastectomy in this group.

CONCLUSION

Complete excision rate in patients who had intra-operative imaging during therapeutic mammaplsty procedure was 97% in our group. Faxitron(®) system is a useful adjunct in helping to achieve low incomplete excision rates.

[Total upper and lower eyelid reconstruction using an expanded forehead flap supplied by the frontal branch of superficial temporal artery]

Eyelids form the protective eye apparatus. Loss of upper or lower eyelid can lead to infection, vision impairment or even blindness. Although there are many techniques for upper or lower eyelid reconstruction, there are only few articles to report simultaneous reconstruction of both eyelids. The aim of this study is to present a two-stage eyelid reconstruction method using the forehead flap. A 60-year-old woman was admitted to our Department with animal bite wounds in the left periorbital area. During the first operation, the eyelid defect was covered with forehead flap and in the second stage, horizontal incision was created in the flap above the eyeball to form a palpebral fissure. During this two-step surgical treatment, both eyelids of the left eye were reconstructed. The length and width of palpebral fissure were 30 mm and 14 mm, respectively. The patient was satisfied with the surgery outcomes. Reconstruction of both eyelids with forehead flap supplied by the frontal branch of the superficial temporal artery provides the elementary protection to the eyeball, enables vision preservation and offers good aesthetic result.

Co-existence of chronic non-communicable diseases and common neoplasms among 2,462 endocrine adult inpatients - a retrospective analysis

OBJECTIVE

To analyze the coexistence of chronic non-communicable diseases (NCDs) and common neoplasms among endocrine adult inpatients.

MATERIALS AND METHOD

The retrospective analysis was performed using clinical data of 2,462 adult patients (2,003 women and 459 men), hospitalized in the reference endocrine department. Diagnoses of 18 types of benign tumours and 16 types of malignant tumours, together with the most common 25 NCDs and demographic parameters, were all collected from the medical records. The most frequently found 6 types of benign tumours (of thyroid, pituitary, uterus, breast, adrenal and prostate) and 4 types of malignant tumours (of thyroid, breast, prostate and uterus) were taken for further statistical analyses.

RESULTS

Age predicted the existence of accumulated as well as individual types of benign and malignant tumours, whereas BMI predicted the occurrence of accumulated and some individual types of benign tumours. Accumulated as well as individual types of benign and malignant tumours coexisted more frequently with several NCDs, such as diabetes, hypertension, metabolic syndrome, osteoporosis, Graves' disease, coronary artery disease, state after cholecystectomy, thus being disorders usually resulting from excessive exposure to harmful environmental factors. The most distinct coexistence was found between breast cancer and metabolic syndrome, between breast cancer and Graves' disease, between cancer of the uterus and type 2 diabetes, between cancer of the uterus and metabolic syndrome, and between cancer of the uterus and dyslipidemia.

CONCLUSION

The results obtained indicate a significant relationship between the most common NCDs and several cancers in endocrine adult patients, which suggests that the prevention of the former may reduce the frequency of the latter.

TSH receptor antibodies have predictive value for breast cancer - retrospective analysis

Background

Associations between breast cancer and thyroid disorders are reported in numerous studies. Relationships between thyroperoxidase antibodies (TPOAb), thyroglobulin antibodies (TgAb) and breast cancer have been previously demonstrated. However, no analysis has been performed concerning an association between thyrotropin (TSH) receptor antibodies (TSHRAb) and breast cancer. The aim of the study was to evaluate the prevalence of breast cancer or benign breast tumors in patients with Graves’ disease and to analyze a possible relationship between Graves’ disease and these two groups of breast diseases with emphasis to epidemiology and laboratory findings.

Patients and methods

Clinical and laboratory details of 2003 women hospitalized for endocrine disorders were retrospectively analyzed, using an unpaired Student’s t-test, logistic regression analysis, χ² test of independence or the two-sided ratio comparison test.

Results

The coexistence of Graves’ disease and breast cancer was statistically significant. We observed TSHRAb and TgAb more frequently in patients with breast cancer. We found that TSHRAb is the only variable possessing predictive value for breast cancer.

Conclusions

The strong relationship between Graves’ disease and breast cancer is proposed. We suggest that TSHRAb could be described as a positive determinant of breast cancer. The present data call attention to the usefulness of screening for breast cancer in long-term follow-up of patients with autoimmune thyroid disorders, especially of those with Graves’ disease. Similarly, screening for autoimmune thyroid disorders should be performed in patients with nodular breast disease. Additionally, the article draws ideas for further research in order to develop targeted treatment for more successful outcome in patients with breast cancer.

Delayed two-stage breast reconstruction with implants: The authors' recent experience

BACKGROUND

Presently, breast cancer detection is delayed in Poland and, thus, the only other option for patients is amputation and breast reconstruction (immediate or delayed). Reconstructive methods are based on using the patient's own tissue (pedicled or free myocutaneous flaps) or implants (a tissue expander, which is later exchanged for a prosthesis or an expandable implant).

OBJECTIVE

To evaluate the aesthetic results of a delayed two-stage breast reconstruction with the use of implants (expander and prosthesis) in patients who have previously undergone cancer-related mastectomy.

METHODS

From 2006 to 2009, 54 patients (34 to 65 years of age) underwent reconstruction at least one year after their mastectomy and adjuvant chemotherapy; three women also received x-ray therapy. All women underwent a two-stage treatment with a tissue expander, which was later exchanged for a prosthesis.

RESULTS

Outcomes of the surgery (evaluated by the physician and the patient at least six months after all stages of reconstruction) were found to be very good in 42 patients and good in 12 patients. After amputation and x-ray therapy in two cases, a fistula developed, which necessitated implant removal.

CONCLUSIONS

After amputation, breast reconstruction with implants (expander and prosthesis) provides good aesthetic results. The method is mildly burdening to the patient and does not cause severe scarring. Symmetrization of the second breast is often recommended; however, the cost is not covered by the national health system. In principle, earlier x-ray therapy disqualifies the application of implants. Dividing reconstruction into two stages (expander and prosthesis) allows for possible correction of prosthesis placement.

Individual and ethnic aspects of preoperative planning for posttraumatic rhinoplasty

The aim of this study was to compare the aesthetic results of post traumatic rhinoplasty among Europeans with populations of healthy Caucasians described in earlier reports, and to collate correct parameters of nasal shape in healthy representatives of both sexes and various races for improvement in aesthetic results of surgery. 3-D scanning of the face was performed in 54 patients after posttraumatic septorhinoplasty. Analysis of 3D model was based on two indices of the nasal proportions and four angles of the region from 18 anthropological points. Parameters of the nasal shape in addition to gender were compared to average values of healthy Caucasian population, described before. Normal characteristics of the nose among individuals of three races from previous studies were also compared to one another. In females, mean height and width of the nose as well as length of both nostrils was smaller. Neither were there any significant differences in width of the nostrils and length of the nasal pyramid nor nasal prominence. Nasal proportions were similar in both sexes. Some of the nasal angles differed in addition to gender. Posttraumatic rhinoplasty resulted in correct shape of the nose similar to the healthy Caucasian population. The aesthetic nose differ among healthy individuals of the three races analysed. While preoperative planning is important, knowledge of the normal values of parameters characterising shape in both genders is equally important as the individual differences in relation to the whole face.

Are we aware of all complications following body piercing procedures?

BACKGROUND

The popularity of body piercing procedures is increasing around the world. Body piercing, depending on the age and social group, is believed to involve up to 51% of the general population. Complications following piercing procedures are variable.

OBJECTIVE

To present an unusual complication after lower lip piercing - embedding of a stud into the lip - and to determine why it occurred from the side of the mucous membrane and not from the side of the skin.

METHODS

A 21-year-old man presented to the plastic surgery outpatient clinic with embedding of piercing into the lower lip. Results In lateral X-ray film, a metallic shadow was observed in the area of the oral soft tissues. The length of the stick was only 8 mm. In this patient, a stick that was too short in relation to the thickness of the lip was used. In this situation, the ends of the stud pressed too strongly on the surrounding tissues. Consequently, this may have caused necrosis of the mucous membrane and embedding of the stud into the lip.

CONCLUSION

The observations described confirm a higher susceptibility to mechanical pressure of the mucous membrane than of the skin. An increasing rate of complications after body piercing reflects a lack of medical knowledge in individuals performing such procedures.

Aortic thrombosis and ulcerative colitis

Arterial thrombotic accidents in the course of inflammatory bowel disease are rare. They generally affect young adults whose disease is active. We observed a case of aortic and renal arterial thrombosis in a 40-year-old woman who was suffering from ulcerative colitis. Surgical thrombectomy ensured good postoperative results, without any ischemic or renal sequelae. Six days later the patient presented with distal thrombosis of the splenic artery, which receded under anticoagulant treatment. The physiopathology of thromboembolic events in the course of inflammatory bowel disease is uncertain. Such events result from a state of hypercoagulability of various mechanisms, which can be observed in active inflammatory bowel disease. This possibility of serious arterial thrombosis argues in favor of long-term anticoagulant treatment when inflammatory bowel disease is active.

Primary malignant tumors of the venous system in the lower extremities

Malignant tumors arising from venous walls in the lower extremity are uncommon. Histologically they are divided into two groups: hemangioendotheliomas of intermediate malignancy and leiomyosarcomas. This report describes a retrospective series of seven primary venous tumors observed in four men and three women with a mean age of 49.8 years (range: 18 to 64 years) who underwent surgical treatment between 1985 and 1995. The tumor was located in the superficial femoral vein in four patients, common femoral vein in two patients, and greater saphenous vein in one patient. A palpable tumor was present in five patients, localized pain in two patients, and metastasis in two patients. The histological diagnosis was leiomyosarcoma in six patients and hemangioendothelioma in one patient. Surgical treatment consisted of complete resection in six patients and partial excision in one patient. Venous reconstruction was performed in two patients and adjuvant radiation therapy in four patients. There was no operative morbidity/mortality. Median survival was 31 months. Four patients with leiomyosarcoma died from metastasis. Two patients with leiomyosarcoma and one with hemangioendothelioma are alive at 9 years, 16 months, and 9 months, respectively. Local recurrence was never observed after complete resection. The prognosis of venous leiomyosarcoma of the lower extremities is poor due to early occurrence of metastasis. Doppler ultrasound and MRI are useful to establish early diagnosis at the nontumoral stage. Improvement in the prognosis of leiomyosarcoma may justify perioperative chemotherapy before and after radical surgical excision.