Effect of weight loss on cardiometabolic risk factors in obese patients

Background

Central obesity and dyslipidemia are a cardinal features of the metabolic syndrome and represents increased cardiometabolic risk. It has been shown that weight loss is capable to improve insulin sensitivity and lipid parameters. The aim of our study was to analyze the effect of a weight-lowering program (diet and physical activity) on LDL- and HDL-cholesterol subfractions and cardiometabolic risk factors (waist circumference, blood pressure, insulin sensitivity, physical fitness).

Methods

We studied 2 groups of obese subjects, group A composed of 43 patients with obesity grade 1 and 2 (30F/13M; age: 43.2 ±12.4 years; BMI 31.3 ± 6.1 kg/m2); group B composed of patients with obesity grade 3 (6F/7M; age: 34.7 ±9.8 years; BMI 51.7 ± 7.9 kg/m2). The weight loss interventional program (NCT02325804) in duration of 8-week (group A) or 24 weeks (group B) consisted of hypocaloric diet and physical activity. Body composition, physical fitness, blood lipids profile (using the Lipoprint system (Quantimetrix Corp., CA, USA), and insulin sensitivity were measured.

Results

The average weight loss was 7.3±1.9 kg in group A and 35.3±16.0 kg in group B. Systolic, diastolic blood pressure (BP) as well as heart rate decreased in group A, in group B only systolic BP. Fasting plasma glucose and insulin decreased as well as insulin sensitivity and physical fitness has been improved after intervention. Total, LDL2, HDL2 cholesterol, as well as triglycerides (TG) decreased with weight in group A and total, LDL, TG, VLDL, LDL2 large, and small HDL subfractions decreased and intermediate HDL increased in group B.

Conclusions

Short term life style intervention (diet and physical activity) in patients with obesity lead to notable improvement of cardiometabolic parameters (decreased body fat mass, improved insulin sensitivity, lipid profile) as well as atheroprotective changes in LDL subfractions.

Funding

Supported by grants APVV 17-0099; VEGA 2/0129/20; VEGA 2/0072/18

Key messages

Short term life style intervention in patients with obesity lead to notable improvement of cardiometabolic parameters. Weight-lowering program (diet and physical activity) lead to positive changes in LDL- and HDL-cholesterol subfractions.

Signal protein-functionalized gold nanoparticles for nuclear targeting into osteosarcoma cells for use in radiosensitization experiments

The standard therapy for malignant primary bone tumors such as osteosarcoma involves major surgeries. For tumors located in difficult regions such as the pelvis, surgical intervention could lead to serious side effects for example loss of a limb and/or function, loss of bowel, bladder and sexual function as well as problems with wound healing and surgical complications. Therefore, exploring other approaches that can improve or complement current surgical techniques is important. Hence, sensitizing primary bone tumors to radiation could offer an additional strategy that could complement surgery and significantly improve survival and quality of life. Gold nanoparticles (AuNPs) have been shown to enhance radiosensitivity by increasing the local dose of radiation inside tumors. Therefore, the referred procedure of preparation and functionalization of gold nanoparticles may be used for investigation whether DNA repair inhibition in the presence of AuNPs leads to an effective radiosensitizing strategy for primary bone tumor cells and explore the mechanism of how this may be happening. In our work, we prepared gold nanoparticles and verified the relation between the size of the AuNPs and their uptake in tumor 143B cells and also investigated whether the optimal size of the AuNPs should not be smaller than the size of nuclear envelope pores (20-50 nm). Hence, two different AuNPs systems were prepared: the first one with AuNPs core size of about 5 nm (BS) and the second one with AuNPs core size of about 50 nm (ZA). For cellular AuNPs uptake enhancement, we functionalized the AuNPs with signaling peptides. For this purpose we prepared PEG-coated AuNPs functionalized with signal peptides for targeted transport into the cytoplasm (CPP) and into the cell nucleus (CPP + NLS). The toxicity of the AuNPs systems was assessed by MTS assay. We prepared stable functionalized AuNPs systems of both sizes. With the functionalizing of the AuNPs using signal peptides (CPP, NLS), the AuNPs penetrated into the cell nucleus. The referred procedure of preparation and functionalization of gold nanoparticles may be used for investigating inhibition of DNA repair in the presence of AuNPs and it could lead to new understanding in overcoming radioresistance in primary bone tumor cells.

1.5 μm photoluminescence and upconversion photoluminescence in GeGaAsS:Er chalcogenide glass

The paper reports on ≈1.5 μm Stokes photoluminescence (PL) emission and upconversion photoluminescence (UCPL) emission in the visible and near-infrared spectral region in Er3+-doped Ge25Ga8As2S65 chalcogenide glasses at pumping wavelengths of 980 and 1550 nm. The ≈1.5 μm PL emission spectra are broadened with increasing concentration of Er ions which is discussed in terms of radiation trapping and UCPL dynamics affecting the Er3+: 4 I 13/2 level lifetime. The UCPL emission was observed at ≈530, ≈550, ≈660, ≈810 and ≈990 nm and its overall intensity as well as red-to-green UCPL emission intensity ratio increases with increasing Er concentration. To explore the UCPL dynamics we measured double logarithmic dependency of green (≈550 nm) and red (≈660 nm) UCPL emission versus pump power at pumping wavelength of 975 nm. Moreover, we measured quadrature frequency resolved spectroscopy (QFRS) on green UCPL emission (≈550 nm) using 975 nm pumping wavelength and various excitation powers. The QFRS spectra on green UCPL were analyzed in term of QFRS transfer function for three-level model from which we deduced energy transfer upconversion rate w 11 (s−1) originating from Er3+: 4 I 11/2, 4 I 11/2→4 F 7/2, 4 I 15/2 transitions.

Nitric oxide as an indicator for severity of injury in polytrauma

BACKGROUND

Patients with injuries to multiple organs or organ systems are in a serious risk of shock, multiorgan failure and death. Although there are scoring systems available to assess the extent of polytrauma and guide the prognosis, their usefulness is limited by their considerably subjective nature. As the production of nitric oxide (NO) by many cell types is elevated in tissue injury, we hypothesized that serum concentration of NO (and its oxidation products, NOx) represents a suitable marker of polytrauma correlating with prognosis. We wanted to prove that nitric oxide could serve as an indicator for severity of injury in polytrauma.

METHODS

We measured serum NOx and standard biochemical parameters in 93 patients with various degrees of polytrauma, 15 patients with minor injuries and 20 healthy volunteers.

RESULTS

On admission, serum NOx was higher in patients with moderate polytrauma than both in controls and patients with minor injury, and it was even higher in patients with severe polytrauma. Surprisingly, NOx on admission was normal in the group of patients that required cardiopulmonary resuscitation or died within 48 hours after admission. In the groups, where it was elevated on admission, serum NOx dropped to normal values within 12 hours. Blood lactate levels on admission were elevated in proportion to the severity of subsequent clinical course.

CONCLUSION

Elevated serum NOx and blood lactate in patients with polytrauma are markers of serious clinical course, while normal NOx combined with a very high lactate may signal a fatal prognosis (Fig. 4, Ref. 8).

Assessment of silver nanoparticle toxicity for common carp (Cyprinus carpio) fish embryos using a novel method controlling the agglomeration in the aquatic media

Formation of agglomerates and their rapid sedimentation during aquatic ecotoxicity testing of nanoparticles is a major issue with a crucial influence on the risk assessment of nanomaterials. The present work is aimed at developing and testing a new approach based on the periodic replacement of liquid media during an ecotoxicological experiment which enabled the efficient monitoring of exposure conditions. A verified mathematical model predicted the frequencies of media exchanges which checked for formation of agglomerates from silver nanoparticles AgNP with 50 nm average size of the original colloid. In the model experiments, embryos of common carp Cyprinus carpio were exposed repeatedly for 6 h to AgNPs (5-50 μm Ag L(-1)) either under semistatic conditions (exchange of media after 6 h) or in variants with frequent media exchanges (varying from 20 to 300 min depending on the AgNP colloid concentration and the desired maximum agglomerate size of 200 or 400 nm). In contrast to other studies, where dissolved free metals are usually responsible for toxic effects, our 144-h experiments demonstrated the importance of AgNP agglomerates in the adverse effects of nanosilver. Direct adsorption of agglomerates on fish embryos locally increased Ag concentrations which resulted in pronounced toxicity particularly in variants with larger 400 nm agglomerates. The present study demonstrates the suitability of the novel methodology in controlling the conditions during aquatic nanomaterial toxicity testing. It further provided insights into the mechanisms underlying the effects of AgNP, which rank on a global scale among the most widely used nanomaterials.

Cardiovascular and sympathetic responses to a mental stress task in young patients with hypertension and/or obesity

Present study was aimed to investigate sympathetic responses to mental stress with hypothesis that the presence of obesity in patients with hypertension has a modifying effect. Young male subjects, 8 with hypertension grade I, with BMI 25 kg/m(2) (HT), 10 with hypertension grade I, and BMI 30 kg/m(2) (HT OB), 14 healthy controls with BMI 30 kg/m(2) (OB), and 13 healthy controls with BMI 25 kg/m(2) (C) underwent the Stroop test. ECG was recorded continuously to evaluate heart rate variability (HRV). Blood pressure (BP) and catecholamine concentrations were measured at baseline, at the end of mental stress test and 15 min thereafter. Patients with HT demonstrated increased adrenaline concentrations and enhanced stress-induced noradrenaline release compared to that in healthy controls. In obese subjects, stress-induced increase of systolicBP was lower compared to lean individuals. Stress exposure induced a significant rise in the low frequency power component of HRV, however the increase was lower in the HT OB group compared to C. Obesity in patients with hypertension did not lead to a different reaction in comparison with lean hypertensive subjects. The present data demonstrate higher sympathoadrenal activity in early-stage of hypertension. Obesity is connected with higher resting systolicBP and modifies the HRV response to mental stress.

Genetics of neuroendocrine factors in rheumatoid arthritis

Inadequate production of cortisol related to inflammation and decrease in adrenal androgen production are hallmarks of hypothalamic-pituitary-adrenal (HPA)-related endocrine findings in rheumatoid arthritis (RA). In particular, lower dehydroepiandrosterone sulfate (DHEAS) levels were consistently found in a subset of premenopausal RA females. Recently, several new gene variants have been identified in association with serum DHEAS concentrations, such as in SULT2A1 and HHEX genes. These DHEAS-related genes and other variants involved in HPA regulation may play a role in the adrenal androgen deficiency in RA. The aim of our study was to review involvement of genetic mechanisms of HPA regulation, with focus on adrenal androgens, in the context of RA pathophysiology. Although, effects of the DHEAS-related gene variants appear to be relatively small compared to other well-known factors such as age, complex interactions between DHEAS-associated genotypes and adrenal androgen hypofunction phenotype may exist in RA. Further studies analyzing specific neuroendocrine phenotype/genotype in RA are needed.

Mathematical modelling for the comparison of plate and intramedullary osteosynthesis stability in intraarticular distal radius fractures

BACKGROUND

A comparison between plate and intramedullary osteosynthesis techniques in terms of the biomechanical stability of distal radius fracture fixation.

METHODS

Mathematical modelling was used to simulate distal radius fractures, type C1 and type C2, and to compare the stability of osteosynthesis in both techniques under several wrist joint load conditions: axial compressive loading of the radius, bending loads in volar and dorsal flexion and radial and ulnar deviation, and axial torsional loading of the forearm.

RESULTS

For both type C1 and type C2 fractures, the stability of intramedullary osteosynthesis was comparable with plate osteosynthesis in dorsal flexion. Plate osteosynthesis proved to be more stable only in ulnar deviation. The intramedullary X-screw technique provided more stability when loads were applied in volar flexion, radial deviation, pronation and supination, and in axial loading of the radius.

CONCLUSIONS

The result of mathematical simulations was comparable for both types of fracture. It showed a higher stability of intramedullary osteosynthesis. Although when lower force intensity was applied, both techniques were comparable (Fig. 8, Ref. 16).

Determinants of adrenal androgen hypofunction in premenopausal females with rheumatoid arthritis

The aim of our study was to investigate adrenocortical function in the context of disease activity and inflammatory status in premenopausal RA females. Adrenal glucocorticoid and androgen responses to the 1 microg ACTH 1-24 test were investigated in 23 premenopausal RA and in 15 age- and BMI-matched healthy females. Twelve RA patients were on low-dose prednisone (<8.5 mg/day). Patients with DAS28>3.2 had lower (p<0.05) total plasma cortisol, 17-hydroxyprogesterone, dehydroepiandrosterone and androstenedione responses in the ACTH test compared to healthy controls. Patients with DAS28>3.2 had lower (p<0.05) dehydroepiandrosterone response in the ACTH test compared to patients with DAS28</=3.2. C-reactive protein (CRP), DAS28, and interleukin (IL)-6 negatively correlated with androstenedione response to ACTH 1-24. Responses of all measured adrenal steroids were lower (p<0.05) in patients on low-dose glucocorticoids compared to healthy controls. RA patients not treated with glucocorticoids had lower total cortisol response (p=0.038) but did not differ in free plasma cortisol in the ACTH test. The results indicate an association of increased disease activity with a decrease in adrenal androgen production in RA and normal cortisol bioavailability in patients not treated with glucocorticoids.

The role of endocrine mechanisms in ventilator-associated lung injury in critically ill patients

The critically ill subjects are represented by a heterogeneous group of patients suffering from a life-threatening event of different origin, e.g. trauma, cardiopulmonary failure, surgery or sepsis. The majority of these patients are dependent on the artificial lung ventilation, which means a life-saving chance for them. However, the artificial lung ventilation may trigger ventilation-associated lung injury (VALI). The mechanical ventilation at higher volumes (volutrauma) and pressure (barotrauma) can cause histological changes in the lungs including impairments in the gap and adherens junctions and desmosomes. The injured lung epithelium may lead to an impairment of the surfactant production and function, and this may not only contribute to the pathophysiology of VALI but also to acute respiratory distress syndrome. Other components of VALI are atelectrauma and toxic effects of the oxygen. Collectively, all these effects may result in a lung inflammation associated with a subsequent profibrotic changes, endothelial dysfunction, and activation of the local and systemic endocrine responses such as the renin-angiotensin system (RAS). The present review is aimed to describe some of the pathophysiologic aspects of VALI providing a basis for novel therapeutic strategies in the critically ill patients.

Ag-Sb-S Thin Films Prepared by RF Magnetron Sputtering and Their Properties

One of the recent applications of thin chalcogenide films is rewritable optical data recording. This technology is based on reversible phase transition between crystalline and amorphous state and vice versa. Dominant materials for rewritable optical recording are Ge Sb Te and Ag In Sb Te alloys. Material research still continues due to need of increasing storage capacity and data rates. Thin Ag Sb S films were prepared by RF magnetron sputtering as potential candidates for rewritable optical data storage films.

There were prepared polycrystalline bulks of AgSbS2. Composition and homogeneity of these bulks were checked by scanning electron microscopy with energy dispersive analysis (SEM EDX) structure and bonding relations were studied by Raman spectroscopy and × ray diffraction (XRD).

Targets for RF magnetron sputtering were prepared from pulverized bulks by hot pressing technique. Targets were characterized the same way as bulks.

Composition and homogeneity of prepared thin films were characterized by SEM EDX, character (amorphous/crystalline) was studied by XRD. Optical properties (spectral dependence of refractive index) were evaluated on basis of UV Vis NIR spectroscopy and variable angle spectral ellipsometry (VASE).

Crystallization abilities were traced by thermal dependence of optical transmission of prepared thin films.

[Evaluation of 11beta-hydroxysteroid dehydrogenase type 1 activity in female patients with rheumatoid arthritis]

INTRODUCTION

Cortisol levels in patients with rheumatoid arthritis (RA) are considered inadequate to ongoing inflammation. One possible mechanism ofthe relative cortisol deficit can be decreased 11beta-hydroxysteroid dehydrogenase type 1 (11BHSD1) activity, an enzyme that converts inactive cortisone to active cortisol. The aim of the study was to determine systemic and local activity of 11 BHSD1 in female patients with RA.

METHODS

Six female RA patients without glucocorticoid therapy (age 29 +/- 2 years, BMI 21 +/- 1 kg/m2) and six healthy women (age 30 +/- 2 years, BMI 21 +/- 1 kg/m2) were studied. Endogenous cortisol production was suppressed by dexamethasone. 11BHSD1 activity was evaluated by changes in concentrations of total plasma, free plasma, salivary and cortisol in subcutaneous adipose tissue after cortisone acetate administration (25 mg per os).

RESULTS

Concentrations of total plasma, free plasma, salivary, and tissue cortisol increased significantly, however there was no significant difference between RA patients and controls.

CONCLUSION

The result suggests comparable systemic and adipose tissue conversion of cortisone to cortisol. Despite chronic inflammation, systemic activity of 11BHSD1 is not responsible for relative adrenal deficiency in RA. Changes in local activity of the enzyme in tissues affected by inflammatory process cannot be excluded.

[Cardiovascular diseases in rheumatoid arthritis]

Risk of cardiovascular diseases is significantly higher in patients with rheumatoid arthritis (RA) than in normal population, leading to higher mortality of these patients. An accelerated atherosclerosis has been considered a basis for the increased cardiovascular risk in RA. Besides classical atherosclerosis risk factors, systemic inflammation plays a substantial role. Indirect mechanisms such as insulin resistance and dyslipidemia may play a role, however, inflammation probably causes direct damage to blood vessels. Thus, systemic inflammation has a primary role and other factors accelerate this process. An adequate anti-inflammatory therapy can have a positive effect also on cardiovascular diseases in RA.

Effect of timing of second prostaglandin F 2 alpha administration in a 5-day, progesterone-based CO-Synch protocol on AI pregnancy rates in beef cows

The objective was to compare the timed AI pregnancy rate of Angus-cross beef cows synchronized with a 5-d CO-Synch + CIDR (a progesterone-releasing intravaginal insert) protocol and given two doses of PGF(2 alpha) (PGF), with the first dose in conjunction with CIDR withdrawal on Day 5, and the second dose given either early or late relative to the first dose. All cows (N = 1782) at 16 locations received 100 microg of GnRH + CIDR on Day 0. Cows received 25 mg of PGF concurrent with removal of the CIDR on Day 5, and were randomly allocated within locations to receive a second PGF either early (N = 881; from 0.5 to 3.9 h) or late (N = 901; from 4.5 to 8.15 h) relative to the first PGF treatment. On Day 8 (72 h after CIDR removal), all cows were inseminated and concurrently given 100 microg of GnRH. Cows were fitted with a pressure-sensitive mount detection device (Kamar) at CIDR removal. Cows were observed twice daily through Day 7 and at the time of AI on Day 8 for estrus and Kamar status (estrus - red, partial and lost Kamar versus no estrus - white Kamar) was recorded. Accounting for location, season, AI sire, cow observed in estrus or not at or before timed AI, and treatment by cows observed in estrus interaction, timed AI pregnancy rates were greater for the late (6.45 +/- 0.03 h) than the early (2.25 +/- 0.05 h) interval, 57.2 vs. 52.7%, respectively (P < 0.05). In conclusion, cows that received the second PGF late after the first PGF on the day of CIDR removal in a 5 d CO-Synch + CIDR synchronization protocol had significantly higher timed AI pregnancy rates than those receiving the second PGF early after the first PGF.

[Management of diaphyseal forearm fractures using LCP angle- stable fixation devices and intramedullary nailing]

AIM OF THE STUDY

The aim of this study is to assess treatment outcomes of diaphyseal radial and ulnar fractures using angle- stable LCP device (Synthes, Svýcarsko), compared to ForeSight intramedullary nailing (Smith&Nephew, USA).

MATERIAL AND METHODS

The prospective study included 80 patients with 115 forearm fractures, assigned to two equal groups, based on the fixation method. The group included 53 males and 27 females, the mean age was 36.6 years of age (range 18-77). the mean folow up period was 18 months (range 12-32 months). The patients were repetitevely x-rayed and their functional assessment was performed at the same time. Furthermore, treatment- related complications were also evaluated.

RESULTS

Two cases of prolonged healing were recorded in the LCP device treatment group. Four cases of prolonged healing were recorded in the intramedullary nailing group, which healed within 18 months and did not require reoperation. The mean fracture healing time was 20.5 weeks (range 9-80 weeks) in the group with intramedullary nailing, and 19.0 weeks (range 12-46 weeks) in the LCP group. No significat differences in surgery time, healing time, postoperative pain scores or final 1-year functional outcomes were detected between the both treatment groups. Statistically significant prolonged healing was demonstrated in the intramedullary nailing group in cases, where fragment dislocation exceeded 3 mm, compared to a group of patients with anatomical repositioning and dislocation of less than 2 mm (p = 0.015; Anova). No cases of deep infections were recorded. Complications, recorded in the intramedullary nailing group, included the following: partial migration of securing nails in two subjects and incomplete synostosis in two subjects. Complications, recorded in the LCP device group, included: early re-fracturing in the original fracture location in a single subject (3 weeks after extraction).

DISCUSSION

The results correspond with outcomes of other recent studies. Although open repositioning and internal fixation is considered a standard treatment method in forearm diaphyseal fractures, recently changing opinion on the use of nails in this indication is apparent. Considering ongoing improvements of these implants, the trend of nailing should be more widely accepted.

CONCLUSION

Although their concept of fracture fixation is different, the both implants appear indicated for the management of forearm diaphyseal fractures.

Effects of endogenous and exogenous hypercortisolemia on low-dose adrenocorticotropin test outcome in humans

BACKGROUND

The results of low-dose ACTH testing may be impaired during endogenous or exogenous hypercortisolemia in various clinical situations.

AIM

The hypothesized inhibitory effects of hypercortisolemia on adrenal responsiveness to low-dose ACTH were tested in two model situations in healthy humans.

SUBJECTS AND METHODS

Nine young healthy women underwent low-dose ACTH test in 5 modifications. In ACTH-ACTH test, ACTH (1 microg iv) was given at 09:00 h and 10:00 h. Two control tests consisted of single ACTH bolus at 09:00 h or at 10:00 h. In hydrocortisone (HC)-ACTH test, HC (20 mg po) was given at 08:30 h and ACTH was injected at 10:00 h. Control test consisted of single HC administration at 08:30 h.

RESULTS

Cortisol response after the 2nd ACTH test was significantly lower vs the 1st ACTH bolus (Deltamax: 166+/-32 nmol/l vs 276+/-15 nmol/l, p<0.05) in ACTH-ACTH test. Responses of other steroids after both ACTH injections were comparable. ACTH bolus during HC-induced hypercortisolemia caused a slight increase in cortisol level and prevented its decrease, seen after HC administration alone. Adrenal cortisol production in response to ACTH bolus under different incipient conditions (baseline, physiological, and pharmacological hypercortisolemia; 180+/-16, 173+/-21, and 177+/-53 nmol.min.l-1, respectively) did not significantly differ (p=0.8).

CONCLUSIONS

Endogenous and exogenous hypercortisolemia did not influence adrenal cortisol response to low-dose ACTH test indicating lack of its negative feedback at adrenal level.

Adrenomedullary response to hypoglycemia in first-degree relatives of patients with rheumatoid arthritis

Our recent studies showed blunted adrenomedullary responses to insulin-induced hypoglycemia in premenopausal females with rheumatoid arthritis (RA) and systemic sclerosis, suggesting dysregulation of the adrenomedullary hormonal system (AMHS). Since no relationship has been found between degree of AMHS dysfunction and clinical or inflammatory parameters in those patients, we hypothesize the presence of an inherited perturbation of the AMHS. To test this hypothesis, we evaluated adrenomedullary responses to insulin-induced hypoglycemia (0.1 IU/kg) in premenopausal female subjects: 17 glucocorticoid-naïve RA patients, 15 healthy first-degree family members (FDR), and 18 age- and body mass index-matched healthy controls. Our results demonstrate that when compared to controls, RA patients had lower baseline epinephrine levels (P= 0.01) and lower area under response curve (AUC) levels of norepinephrine (P < 0.001) and epinephrine (P < 0.003). In contrast, FDR had lower (P= 0.001) AUC levels of norepinephrine compared to controls and higher (P= 0.033) AUC levels of epinephrine compared to RA patients. There were no significant differences in epinephrine response between FDR and controls. Although we found lower norepinephrine responses to hypoglycemia in FDR of RA patients, adrenomedullary responses to hypoglycemia does not appear to be altered to the degree found in RA patients.

[Six-month functional and X-ray outcomes of distal radius fractures managed using multidirectional locking plates]

INTRODUCTION

Distal radius fractures remain the commonest fractures in the human body. Developed countries have recorded increasing rates of these fracures.

MATERIAL AND METHODS

The authors assess results of distal radius osteosynthesis procedures using the Aptus Radius 2.5 mm (Medartis, Schweiz) system, consisting of 18 types of multidirectional, locking plates, designated for osteosyntheses and corrective osteotomies of the distal radius. The authors evaluate six-month results in 66 patients operated from January to September 2007. All AO types of fractures were included in the study group.The mean age of the patients was 49.5 years.

RESULTS

According to X-ray, the mean healing time was 7 weeks. 6 moths following the procedure, the radius length was +0.4 mm (ranging from +4 mm to -4 mm), the radial inclination was 21 degrees (ranging from 13 degrees to 29 degrees) and the palmar tilt of the articular surface was 7 degrees (ranging from 0 degrees to 10 degrees of the palmar tilt). The range of motion, compared to the other extremity, was as follows: palmar flexion 87.5%, dorsal flexion 91.5%, radial duction 90.5%, ulnar duction 88.2%, pronation 98.1% and supination 94.3%. The mean grip strength reached 85% of that of the contralateral extremity.

DISCUSSION

Fragment-specific fixation using the Aptus radius system, provides enough stability to prevent secondary loss of correction. Functional and radiological outcomes were similar to those with other types of locking plates. The results obtained from this study correspond to data presented in other recent studies assessing multidirectional locking plates.

CONCLUSION

Central, targeted fixation of the fracture fragments and introduction of locking screws provide stability, which minimizes duration of additional fixation and facilitates early rehabilitation. It can be used for osteosynthesis of all types of fractures according to AO classification and, in particular, optimizes fixation of the C.2. and C.3. fracture types.

Interlocking nailing of forearm fractures

AIM OF THE STUDY

The aim of this retrospective study is to evaluate the results after treating diaphyseal fractures of the radius and ulna with an interlocking intramedullary nail.

MATERIALS AND METHODS

Between 2001 and 2005, 78 patients with 118 fractures were treated using the ForeSight intramedullary nail (Smith & Nephew, Memphis, USA). The average patient age was 37.02 years. In the postoperative period, early and late complications were evaluated through radiological and functional methods. The average period of follow-up was 25 months (range: 12-58 months).

RESULTS

The average length of time to demonstrated bone healing was 14.2 weeks. Four cases of prolonged healing were observed. Pseudo-arthrosis formation did not occur. Assessment of function according to Anderson gave the following results: full range of movement in 88.6% of patients; mild restriction of movement in 10.1%; severe restriction of movement in 1.3% of patients. The implanted material was extracted from 27 patients. Refractures did not occur. Postoperative complications included: 1 superficial infection, 3 cases of incomplete radio-ulnar synostosis; one case of compartment syndrome.

CONCLUSIONS

Upon comparing the techniques of using plates with those of nailing in the treatment of forearm fractures, we have achieved comparable results with nailing. We therefore regard it as advantageous, in particular for treating open, serial and grossly comminuted fractures of the forearm bones.

Compromising bradycardia: management in the emergency department

AIM OF THE STUDY

Bradycardia may represent a serious emergency. The need for temporary and permanent pacing is unknown.

METHODS

We analysed a registry for the incidence, symptoms, presenting rhythm, underlying mechanism, management and outcome of patients presenting with compromising bradycardia to the emergency department of a university hospital retrospectively during a 10-year period.

RESULTS

We identified 277 patients, 173 male (62%), median age 68 (IQR 58-78), median ventricular rate 33 min(-1) (IQR 30-40). The leading symptoms were syncope [94 (33%)], dizziness [61 (22%)], collapse [46 (17%)], angina [46 (17%)] and dyspnoea/heart failure [30 (11%)]. The initial ECG showed high grade AV block [134 (48%)], sinus bradycardia/AV block [46 (17%)], sinuatrial arrest [42 (15%)], bradycardic atrial fibrillation [39 (14%)] and pacemaker-failure [16 (6%)]. The underlying mechanisms were primary disturbance of cardiac automaticity and/or conduction [135 (49%)], adverse drug effect [58 (21%)], acute myocardial infarction [40 (14%)], pacemaker failure [16 (6%)], intoxication [16 (6%)] and electrolyte disorder [12 patients (4%)]. In 107 (39%) patients bed rest resolved the symptoms. Intravenous drugs to increase ventricular rate were given to 170 (61%) patients, 54 (20%) required additional temporary transvenous/transcutaneous pacing. Two severely intoxicated patients could be stabilised only by cardiopulmonary bypass. A permanent pacemaker was implanted in 137 patients (50%). Mortality was 5% at 30 days.

CONCLUSION

In our cohort, about 20% of the patients presenting with compromising bradycardia required temporary emergency pacing for initial stabilisation, in 50% permanent pacing had to be established.

[Treatment of diaphyseal forearm fractures with locking intramedullary nail]

INTRODUCTION

The aim of this study is to evaluate the results after treating diaphyseal fractures of the forearm with an inter-locking intramedullary nail.

METHODS

Between 2003 and 2005, 45 patients with 68 fractures were treated using the ForeSight intramedullary nail (Smith&Nephew, Memphis, USA). The average patient age was 34.12 years. In the postoperative period, early and late complications were evaluated through radiological and functional methods.

RESULTS

The average length of time to demonstrated bone healing was 13.2 weeks. 3 cases of prolonged healing were observed, and pseudoarthrosis formation did not occur. Assessment of function according to Anderson gave the following results: full range of movement in 86.9% of patients; mild restriction of movement in 10.9%; and severe restriction of movement in 2.2% of patients. Postoperative complications included: I superficial infection, 2 cases of incomplete radioulnar synostosis; and one case of compartment syndrome.

CONCLUSIONS

Upon comparing the techniques of using plates with those of nailing in the treatment of forearm fractures, we have achieved comparable results with nailing, and we therefore regard it as advantageous foremost for treating open, serial and grossly comminuted fractures of the forearm bones.

Multiple organochlorine pollution and the thyroid

OBJECTIVE

Although the biological effects of major persistent organochlorinated pollutants (POPs) appear to be essentially similar, some effects which would be specific for certain substance cannot be excluded. We attempted to study the thyroid volume and thyrotropin level in the population living in the area with multiple pollution by polychlorinated biphenyls (PCBs) and pesticides (DDE and hexachlorobenzene - HCB).

METHODS

A total of 454 adults was examined within the pilot field survey in 1998. Among them were 237 males (age range 19-78 years, median 47) and 227 females (age range 19-78 years, median 48). Fifteen environmentally prevalent congeners of polychlorinated biphenyls and also p,p-DDE (2,2-bis(4-chlorophenyl)-1,1-dichloroethylene), p,p-DDT (2,2-bis(4-chlorophenyl)- 1,1,1-trichloro-ethane), hexachlorobenzene (HCB) as well as alpha-, beta- and gamma-hexachlorocyclohexane (HCH) were determined in serum by high resolution gas chromatography using microelectron capture detector and microcapillary column. Thyroid volume (ThV) was measured by real time sonography using the ellipsoid method with the aid of sonographic instrument Sonoline SI-400 (Siemens, Germany). The level of TSH was estimated by supersensitive immunoradiometric method using commercial kits by Immunotech (Marseille, France). Pearsons correlation coefficients after logarithmic transformation of values and Spearmans correlation coefficients were used for statistical evaluation.

RESULTS

Significant positive association (p<0.01) was found between DDE and PCB, DDE and HCB, while that between PCB and HCB was not significant. Similar positive association (p<0.01) was also found between each individual organochlorine and their sum. Significant negative association (p<0.01) was found between ThV and TSH. When using categorical PCB values either >2000 (N=208) or >3000 (N=127) ng/g lipid, significant positive association (p<0.05 and p<0.01, respectively) was found between the sum of all organochlorines (PCB+DDE+HCB) and ThV, while that between PCB and ThV (p<0.01) was found only at the PCB levels >3000 ng/g lipid. When using Spearmans correlation coefficients, significant negative association appeared between PCB and TSH (p<0.05), sum of organochlorines and TSH (p<0.05) and ThV and TSH (p<0.01).

CONCLUSIONS

Although several significant positive and negative associations were found, this study, like several others, could not exactly define the participation level of individual POPs in their common toxic effects, but possibly contributed to the recognition and elucidation of some problems related to this task.

Synthesis and Characterization of New Calcium Phenylphosphonates and 4-Carboxyphenylphosphonates

Three new calcium phenylphosphonates, CaC(6)H(5)PO(3).2H(2)O, Ca(3)(C(6)H(5)PO(3)H)(2)(C(6)H(5)PO(3))(2).4H(2)O, and CaC(6)H(5)PO(3).H(2)O, and two calcium 4-carboxyphenylphosphonates, Ca(HOOCC(6)H(4)PO(3)H)(2) and Ca(3)(OOCC(6)H(4)PO(3))(2).6H(2)O, were prepared. It was found that CaC(6)H(5)PO(3).2H(2)O transformed into previously known Ca(C(6)H(5)PO(3)H)(2) via Ca(3)(C(6)H(5)PO(3)H)(2)(C(6)H(5)PO(3))(2).4H(2)O in the presence of phenylphosphonic acid, and vice versa, Ca(C(6)H(5)PO(3)H)(2) turned into CaC(6)H(5)PO(3).2H(2)O in a weak basic medium. A similar relationship was found between Ca(HOOCC(6)H(4)PO(3)H)(2) and Ca(3)(OOCC(6)H(4)PO(3))(2).6H(2)O; i.e., Ca(3)(OOCC(6)H(4)PO(3))(2).6H(2)O transformed into Ca(HOOCC(6)H(4)PO(3)H)(2) in the presence of 4-carboxyphenylphosphonic acid. On the contrary, Ca(3)(OOCC(6)H(4)PO(3))(2).6H(2)O is formed from Ca(HOOCC(6)H(4)PO(3)H)(2) in the presence of ammonium as a weak base. The structure of Ca(HOOCC(6)H(4)PO(3)H)(2) was solved from X-ray powder diffraction data by an ab initio method using a FOX program. The compound is monoclinic, space group C2/c (No. 15), a = 49.218(3) A, b = 7.7609(4) A, c = 5.4452(3) A, beta = 128.119(3) degrees , and Z = 4. Its structure is one-dimensional with [Ca(2)(HOOCC(6)H(4)PO(3)H)(4)](infinity) ribbons forming basic building blocks. The ribbons are held together by hydrogen bonds between carboxylic groups.

[Small mammals at community refuse dumps as reservoirs of pathogens and parasites]

Five-year studies (1981-1986) were performed to investigate a total number of 2589 small mammals of 18 species. Refuse dumps are marked for highly specific conditions. The difference between refuse dumps and natural habitats consists in more sufficient quantity of food, better sheltering possibilities and in highly specific microclimate particularly. As a result of aerobic and anaerobic decompositions of organic materials, temperature in dumps is approximately 50 degrees C. From ecological point of view mammalian populations in refuse dumps could be classified in three groups according to the degree of their adaptation to this specific habitat: 1. permanent, abundant species, well-adapted to and closely connected with the habitat of dumps (Crocidura suaveolens, Mus musculus, Rattus norvegicus, Apodemus sylvaticus, Microtus arvalis), 2. permanent, common species which are, however, loosely connected with this habitat (Sorex araneus, Mustela nivalis), 3. rare species whose occurrence in this habitat is largely accidental.(ABSTRACT TRUNCATED AT 250 WORDS)

[Adiaspiromycosis in small mammals in large capacity pigsties in the Trebon basin]

From 1977 to 1979 a study on the occurrence of adiaspiromycosis was performed on three animal farms in South Bohemia. In 113 examined small mammals from the farms and their neighbourhoods adiaspiromycosis was detected in M. arvalis living both in the fields in the precincts (7/613, i. e. 1.14%) and in the grassy areas inside the three animal farms (5/221, i. e. 2.3%). By that time no adiaspiromycosis was found in small mammals living in the farm buildings. The obtained results were compared with the results achieved at the control locality Klec, in the same geographical region, where adiaspiromycosis had been followed for 15 years. At the control locality adiaspiromycosis was found in further four species of small mammals: Talpa europaea, Erinaceus europaeus, Apodemus sylvaticus and Ondatra zibethica. The occurrence of adiaspiromycosis inside the farms is a serious epizootological finding. From the viewpoint of maintaining and circulation of pathogen is on the studied farms undoubtedly of major importance M. arvalis, forming here permanently living residential populations.