A decrease in serum 1,25(OH)2D after elective hip replacement and during bone healing is associated with changes in serum iron and plasma FGF23.

OBJECTIVE: Although calcitriol is essential for bone healing, its serum concentrations are low after hip surgery, and they continue to decline during bone healing. This study aimed to test the hypothesis of an association of changes in calcitriol production with the status of fibroblast growth factor 23 (FGF23) and iron deficiency after elective hip replacement for coxarthrosis. METHODS: In this prospective study, we measured the biomarkers of 17 patients undergoing elective hip replacement on admission, on the first day after surgery, and at the regular check-up after 48 ± 8 days. The serum concentrations of 25-hydroxyvitamin D, 1,25-dihydroxyvitamin D, transferrin, ferritin, parathyroid hormone, intact plasma FGF23 (iFGF23) and C-terminal FGF23 (cFGF23) were determined. RESULTS: In our patients who underwent elective hip replacement, significant correlations existed between the percent change in the conversion rate of 25(OH)D to 1,25(OH)2D, plasma intact to C-terminal FGF23 ratio, and serum iron. CONCLUSIONS: The production of calcitriol is compromised after elective hip replacement surgery, leading to reduced levels of active vitamin D in the serum. Significant correlations between the percent change in the conversion rate of 25(OH)D to 1,25(OH)2D, plasma intact to C-terminal FGF23 ratio, and serum iron on the first day as well as 7 weeks after surgery could inspire future studies to determine whether and how calcitriol deficiency should be corrected, especially in fracture cases.

Decrease in serum calcitriol (but not free 25-hydroxyvitamin D) concentration in hip fracture healing.

OBJECTIVE: To assess the decrease in serum calcitriol concentrations after hip fracture. METHODS: Serum concentrations of calcitriol, 25(OH)D, parathyroid hormone (PTH), directly measured free 25(OH)D, and indices of bone formation were measured in elderly patients with hip fracture (HF) and patients with elective hip replacement (EHR) at admission and after 7 weeks. RESULTS: A total of 45 patients with HF and 17 patients with EHR completed this prospective study. Baseline serum calcitriol levels were ≤ 60 pmol/l in 26% of the HF patients. After 7 weeks, they significantly decreased (p < 0.001). In patients with EHR, serum calcitriol was within the reference range in all but one patient and did not change during the 7-week recovery phase. Seven weeks after HF, a significant positive relationship was observed between the change in calcitriol and serum 25(OH)D concentration (r = 0.385, p = 0.009) and free 25(OH)D (r = 0.296, p = 0.048), and a decrease in calcitriol during recovery was associated with a decrease in serum PTH (p = 0.038). Seven weeks after HF, changes in both serum PTH and serum 25(OH)D concentrations contributed to the prediction of changes in serum calcitriol (R2 = 0.190, p = 0.012). CONCLUSIONS: Unlike patients with EHR, subjects with HF had low serum 25(OH)D and low free 25(OH)D concentrations at admission, while their serum 1,25D levels were relatively elevated. Decreases in circulating calcitriol levels in the 7 weeks following hip surgery were associated with a resolution of secondary hyperparathyroidism and low availability of free 25(OH)D.

Global database of FRP-to-masonry bond strength tests.

Quantifying the bond strength between fibre-reinforced-polymer (FRP) composites and substrates is essential to the design of FRP retrofit systems. This paper collates a database of 1583 individual tests across 56 published experimental campaigns investigating the FRP-to-masonry bond strength through shear pull-tests. Included in the database is all available information characterizing the test arrangement, geometric and mechanical properties of the constituents, as well as the failure load and failure mode.

[Results of Surgically Treated Patients for Hip Fracture - Complications, Mortality]. / Výsledky po operacích zlomenin proximálního femuru ­ komplikace, letalita.

PURPOSE OF THE STUDY Our main objective was to evaluate the mortality and complications of patients following surgical treatment of hip fractures and to identify the associated risk factors for postoperative mortality. MATERIAL AND METHODS We retrospectively reviewed all patients over the age of 50 who underwent surgical treatment for femoral neck and peritrochanteric fractures at our institution in 2003 and 2013. Mortality was compared between subgroups classified by age, gender, fracture type, method of treatment. Correlation between mortality and postoperative complications, time to surgery, and blood transfusion need were evaluated. Chi-square was used for categorical variables and two-tailed student's t-test for continuous variables. Survival curves were compared by the log-rank test. Mortality rates were adjusted for patient age and compared to the mortality rates of Prague's population in the given years. RESULTS Altogether 425 patients were surgically treated for proximal femoral fracture in 2013, while 229 patients were treated in 2003. The overall 1-year mortality decreased by 10% over the study period (38% in 2003 and 28% in 2013), despite the higher average age in 2013. Survival was better in all subgroups broken down by diagnosis and method of treatment, statistically relevant in the subgroup of femoral neck fractures, notwithstanding the method of treatment and in the subgroup treated with total hip arthroplasty. The strongest prognostic factor for survival was the advanced age. The mortality rate rises significantly over the age of 75. The largest age group was between 85-89 years, with 1-year mortality rate of 32%. The annual mortality of the general population in Prague aged 85-89 years was 13% and has improved only by 1% in the decade. The reoperative rate was 4% and did not affect mortality. There was no significant relationship between mortality and complications or delay of surgery for up to 4 days. DISCUSSION The factors that might have contributed to better survival are the introduction of guidelines for hip fracture care to our unit, better prophylaxis of venous thromboembolism, improvement of surgical skills due to the growing volume of these cases, and a higher rate of discharges to aftercare units. CONCLUSIONS Mortality has significantly decreased between 2003 and 2013 (p < 0.001). We didn't find a correlation between mortality and delay of surgery up to 4 days. That means that a complicated operation such as hip arthroplasty could be postponed and operated in more comfortable conditions (in superaseptic OR) by orthopedic surgeons. Although we haven't identified any modifiable risk factor, we believe that the reasons for better survival are multifactorial as discussed. Key words: hip fracture, proximal femoral fracture, mortality, complications, time to surgery.

[Osteosynthesis of intracapsular femoral neck fractures by dynamic hip screw (DHS) fixation]. / Osteosyntéza intrakapsulárních zlomenin krcku stehenní kosti metodou DHS.

PURPOSE OF THE STUDY: The treatment of femoral neck fractures shows a relatively high number of poor outcomes, usually due to late complications, such as avascular necrosis of the femoral head or pseudoarthrosis. The latter may develop when the osteosynthesis of osteoporotic bone fails. The aim of this retrospective study was to evaluate a group of patients treated by osteo- synthesis for intra-capsular femoral neck fractures at our department, and to verify indication criteria and identify the therapeutic procedures that are best suited to our conditions. MATERIAL: In the 1997-2001 period, a total of 81 patients with intra-capsular femoral neck fractures were operated on. Of these, 64 treated by dynamic hip screw (DHS) fixation were followed up for at least 5 years. There were 33 women and 31 men; the average age was 21.5 years (range, 21 to 74 years). METHODS: The Garden classification was used to evaluate the displacement of femoral neck fractures. Preferably, osteosynthesis was carried out by closed reduction; only exceptionally was an extension device for the operating table used. A 135-degree sliding hip screw, with a short thread, directed to the head centre and a two-hole side plate were used most often.The average follow-up was 6.9 years. Evaluated were: the occurrence of late complications in relation to the length of time between injury and surgery, quality of fracture reduction, use of an anti-rotation screw and necessity of repeat surgery. RESULTS: Garden I or II fractures were diagnosed in 13 patients, 51 had Garden III or Garden IV fractures. Bone union without complications was achieved in 73.4 % of the patients within 12 months of surgery. Late complications were found in 26.6 %; of these, only one had Garden I fracture and the rest were Garden III and IV fractures. An anti-rotation screw was used in 39 patients (60.9 %) and its use had no effect on the development of late complications. Of the seven patients who developed pseudoarthrosis, the screw was used in four (57.1%); out of the nine patients with avascular necrosis, it was used in six (66.7 %). In the whole group, an unsatisfactory outcome of post-operative reduction was recorded in 29.7 %. In the patients with late complications this was found in 52.9 %, which was a statistically significant difference. Of the 17 patients with poor outcomes, 14 underwent total hip arthroplasty; in the patients with necrosis, arthroplasty was carried out at an average of 26 months post-operatively, in those with pseudoarthrosis it was at 7 months post-operatively. DISCUSSION: For the treatment of intra-capsular fractures of the femoral neck, surgery is the most frequent approach, but there are controversial views on various relevant issues. An important factor affecting the treatment outcome is the patient's bone quality. CONCLUSIONS: Our results show a direct relationship between the extent of fracture displacement and late complications, i.e., avascular necrosis and non-union. The quality of fracture reduction had a greater effect on fracture non-union than on the development of femoral head necrosis. The length of time between injury and surgery played a lesser role than it is believed. The use of an anti-rotation screw was not significantly related to the occurrence of late complications. The DHS method is economical and available, and provided sufficient results whose comparisons with the literature data show that this therapeutic approach is correct.

[Results of lumbar diskectomy]. / Výsledky bederních diskektomií.

PURPOSE OF THE STUDY: We evaluated the outcomes of lumbar discectomies in relation to the presence or absence of degenerative spinal lesions and the surgical treatment used in order to determine the extent to which these factors influence the result of treatment. MATERIAL: Patients who were treated by discectomy in the period from January 1, 1994, to July 7, 1998, were contacted. A total of 132 subjects received the Oswestry questionnaire (in two copies) in February 2002 and 100 of them, 62 men and 38 women, were included in the final evaluation. The average age of the patients at the time of surgery was 42.86 years (range, 15 to 69 years). The average follow-up period was 3.22 years. All patients underwent preoperative neurological check-up and examination by X-ray, contrast perimyelography, magnetic resonance imaging or computer tomography. The surgical procedure involved either microdiscectomy according to Caspar or conventional open discectomy. METHODS: The patients were allocated to four groups on the basis of the presence or absence of degenerative lesions shown by pre-operative or intra-operative findings and of the surgical treatment used. Each group was evaluated individually. Group 1 comprised 15 patients without degenerative lesions and group 2 included 19 patients with degenerative lesions; both groups were treated by the Caspar method. Groups 3 and 4 were treated by open discectomy and consisted of 32 patients without and 34 patients with degenerative lesions, respectively. The patients reported their pre- and post-operative complaints retrospectively, using a separate copy of the Oswestry Low Back Pain Disability Quiestionnaire, Version 1.0, for each period. RESULTS: In the whole sample, the average improvement estimated by the Oswestry Disability Index (ODI) was 30.32% in the year 2002, as compared with 54.15% before surgical treatment. The best outcome, improvement by 45.87%, was in group 1. Groups 2, 3 and 4 showed improvements by 31.95%, 30.35% and 22.38%, respectively. DISCUSSION: The Oswestry questionnaire has become a widely-used instrument for evaluation of complaints in patients with spinal disorders. Its universal application enabled us to compare the results of different studies. The presence of degenerative lesions was responsible for less successful outcomes of both the Caspar microdiscectomy and open discectomy. It remains to be answered to what extent these poorer outcomes in spines with degenerative lesions are related to the instability of the segments treated. However, it is apparent that the Caspar microdiscectomy improved the patients' conditions more than open discectomy. CONCLUSIONS: The average 30.32% decrease in ODI score from 54.15% before the surgical tree of intervertebral discs herniation, as evaluated at an average of 3.22 years after surgery, is regarded as a good outcome. The Oswestry questionnaire generally permits a reliable assessment of patient complaints. In this study, a Czech translation of Version 2.0 of this questionnaire is presented and recommended for use. The presence of serious degenerative spinal lesions makes the outcomes of discectomy less satisfactory. Prospects for the approach that combines discectomy with fusion can be assessed in patients whose indications are well defined and complaints exactly evaluated.

[Arthroscopic reconstruction of the anterior cruciate ligament using the transtibial technique and a graft from the patellar ligament--results after 5-6 years]. / Artroskopická rekonstrukce predního zkrízeného vazu transtibiální technikou stepem z lig. patellae--výsledky po 5 az 6 letech.

PURPOSE OF THE STUDY: Arthroscopic reconstruction of the anterior cruciate ligament (ACL) by transtibial technique with free graft from the patellar tendon fixed by interference screws is a commonly used procedure. The aim of this study is to evaluate the results 5 to 6 years after the surgery. MATERIAL: Fifty-two of 79 patients operated on in 1995 were checked in the period of 2000-2001. The average age of patients at the time of surgery was 26 years (range, 15-20 years), there were more men (62%), prevailing were injuries resulting from sports activities (92%). METHOD: We have used evaluation according to IKDC. We focused on the problems at the site from which the graft was harvested, on the difficulties in the kneeling position and walking on knees. Evaluation of the activity was based on the Tegner score. On radiographs we assessed the length of the patellar tendon, dilatation of the tibial canal and the incidence and degree of osteoarthritis. RESULTS: General evaluation according to IKDC was normal or nearly normal in 79% of patients. The difference of the anterior displacement of tibia between the operated on and non-operated on knee measured by arthrometer (KT 1000, 89N) was < 3 mm in 58% of patients and < or = mm in 95% of patients. Significant difficulties on the operated on side in the kneeling position and walking on knees were reported by 3 patients, slight difficulties were reported by 28 patients. Twenty patients reported slight difficulties also on the non-operated on side. Prior to the injury the average level of activity after Tegner was 7.9 (range, 6-10), prior to the operation 2.7 (range, 0-6) and at the time of check examination 7.0 (range, 4-10). The same level of activity as before the injury was reported by 61.5% of patients. Shortening of the patellar tendon on the operated on side > 5% (6 mm) was found out in 1 patient, shortening of < or = 5% (2-3 mm) in 30 patients. Tibial canal on the lateral projection 1 cm beneath the joint line was wider than 10 mm (dilated) in 6 patients. On the operated on knee osteoarthritis was found of the medial compartment of degree B and C in 42% of patients and on the non-operated knee in 19% patients. Aggravation of osteoarhritis of the medial compartment by one degree occurred after 5 to 6 years after the surgery in 4 out of 20 patients. All of them underwent meniscectomy. Eighty-six per cent (19 of 22) of patients with osteoarthritis of the medial compartment underwent medial meniscectomy. DISCUSSION: General results according to IKDC are compared with results published by Aglietti, Jomha and Patel. Dilatation of the tibial canal was found out in 6 patients and it was associated with the graft-tunnel mismatch. The relationship between meniscectomy and arthritis is well-know. In 31% of patients after medial meniscectomy there was found out narrowing of the joint line to 2-4 mm (degree C). In case of partial medial meniscectomy the posterior horn, i.e. the most important part of the meniscus, was in most cases removed. Worsening of the arthritis after resection of the minor radial lesions of the lateral meniscus or after leaving incomplete lesions of the posterior horn of the lateral meniscus untreated has not been observed. CONCLUSION: The surgery allows to improve the stability and extent of activity in most of the patients. The most frequent problem consists in the difficulties at the site of graft harvesting which may contribute to the decrease of subjective satisfaction. The relation between shortening of the patellar tendon and patellar difficulties was not proved. In the patients after medial meniscectomy osteoarthritis progresses even after ACL reconstruction.

[Histochemical analysis of enzymes in the rabbit cornea after LASIK surgery]. / Histochemické vysetrení aktivity nekterých enzymu v králicí rohovce po operaci LASIK.

The first experience with histochemistry of rabbit corneas after the operation LASIK is presented in this study. Activity of the following enzymes was assessed: alkalic phosphatase, acid phosphatase and dipeptidylpeptidase IV. No pathological activity of assessed enzymes was found in comparison with control corneas.

[Arthroscopic subacromial decompression.]. / Artroskopická subakromiální dekomprese.

Arthroscopic subacromial decompression is a generally recognized method of the treatment of the primary impingement sydrome and is one of the basic arthroscopic methods. The data in literature present 73-94 % of good and very good results. From May 1993 till June 1996 we treated at our clinic 40 patients with arthroscopic subacromial decompression of which 38 patients were followed up. The average period of follow-up is 3 years (2-5 years). All patients had clinical symptoms of impingement syndrome prior to operation. The patients who were indicated to resection of the lateral part of the clavicula and suture of the rotator cuff were not incorporated in the group. For the evaluation we used UCLA score after Ellman, the subjective satisfaction of patients was evaluated in detail. In 79 % the results after UCLA were good and very good (satisfactory). The most marked improvement was achieved in the evaluation of pain. 84 % of patients evaluated subjectively the result of the operation as good and very good. Worse evaluation on average was provided by patients who suffered the injury of the shoulder joint, patients already disabled before the surgery and women. The causes of unsatisfactory results in our group were the following: insuficient resection of acromion in 2 patients, persisting pain of acromioclavicular joint in 2 patients, non-diagnosed complete rupture of the rotator cuff in 1 patient, secondary impingement syndrome in 1 patient, CB syndrome in 1 patient and unclear cause of persisting complaints in 1 patient. Unsatisfactory results are caused by technical errors during the surgery and incorrect indications. The results can be improved by a careful clinical examination (acromioclavicular joint, stability, elimination of a secondary impingement), preliminary planning of the extent of resection of acromion according to radiographs (Y-projection, projections after Rockwood) and a correct evaluation of arthroscopic findings (lesion of labrum, SLAP, lesion of the rotator cuff). Key words: impingement syndrome, subacromial decompression, arthroscopy.

[LASIK--comparison of oscillating and rotating microkeratotomy using scanning electron microscopy]. / LASIK--srovnání oscilacní a rotacní mikrokeratotomie skeningovou elektronovou mikroskopií.

Scanning electron microscopy was used to evaluate the differences in the quality of the cut produced by oscilating microkeratome Flapmaker and Draeger rotating microkeratome. Higher quality of the edge of the cut was found with Flapmaker. Both microkeratomes produce uniform surface of the cut. Chatter is much less expressed with Flapmaker. No difference at the interface tissue was found with SEM three weeks postoperatively comparing the microkeratomes.

[Comparison of the diameter and thickness of the corneal lamella in LASIK surgery using the oscillating microkeratome]. / Porovnání prumeru a tloust'ky rohovkové lamely pro LASIK vytvorené oscilacním mikrokeratomem.

Corneal lamellas created by two different microkeratomes--oscillating and rotating are compared. Oscillating microkeratome Flapmaker (Refractive Technologies) and rotating Dreager microkeratome (Storz) were used for tis study. Diameter and thickness of the lamella were assessed. Rabbit lamella created by the same procedure as human differs significantly and this limits the interpretation of rabbit experiments to the human eyes. Oscillating microkeratome Flapmaker created more precise and standard lamella (standard deviation 4 times smaller) compared to rotating Storz on human eyes. Differences in lamella thickness in different topografical areas of the lamella were 3.3 times smaller with Flapmaker. We conclude that desired mean lamella thickness homogenity in different topografical areas of the lamella are much better with Flapmaker compared to Dreager microkeratome on human eyes.

[Comparison of the surface structure of the corneal stroma cut with a microkeratome using scanning and classical microscopy]. / Porovnání struktury povrchu rezu mikrokeratomem rohovkou ve skeningovém mikroskopu environmentálním a klasickém.

Surface of the corneal stroma after microkeratome cut was assessed by classical and environmental SEM. Environmental SEM allows magnification of tissue without it's previous drying. It is easy to prepare tissue for environmental SEM. Disadvantage of this leading technique is smaller scale of magnification and small angle of view. Classical SEM shows better the impact of LASIK on the cornea.

[Assessment of adhesion of the corneal lamella to the stroma in relation to the duration of the LASIK postoperative period]. / Merení adheze rohovkové lamely ke stromatu v závislosti na dobe od operace LASIK.

Adhesion of lamella created by two different microkeratomes was assessed during the healing period of 250 days. Oscillating microkeratome Flapmaker, Refractive Technologies and Draeger rotating microkeratome, Storz were used for this study. Increase of lamella adhesion during the healing period was found. The increase is little faster during the first weeks. The difference in adhesion between eyes operated by different microkeratome was not significant.

[Measurement of adhesion of the corneal lamella to the stroma in the early postoperative period after microkeratotomy]. / Merení adheze rohovkové lamely ke stromatu po rezu mikrokeratomem v casné pooperacní fázi.

The early postoperative adhesion of corneal lamella after LASIK was measured. The interface was washed by hypo, iso and hypertonic saline solution and the influence on the lamella adhesion was assessed. Drying the interface and the excimer laser ablation of epithelial cells along the edge of the lamella were assessed in terms of the influence on the adhesion. The term "phototerapeutic epithelectomy (PTE)" was proposed for the excimer laser ablation of corneal epithelial cells. Small insignificant influence of PTE was found. The clinical application of PTE to increase the early adhesion of lamella is not recommended because of the epithelial destruction along the lamella edge. The adhesion was increased significantly by means of drying the interface which is recommended for the clinical application. High variability od measurements between different eyes was found.