Conservative versus surgical treatment of displaced midshaft clavicle fracture in adolescents.

INTRODUCTION: Midshaft clavicle fractures are common in childhood and their conservative treatment predominates. The indication for surgical treatment of adolescents with significantly displaced fractures remains controversial. The aim of this study was to compare the results of conservative or surgical treatment (intramedullary nailing) of these fractures. METHODS: Retrospective clinical study of patients aged 1117 years with significantly displaced clavicle fractures treated at the Department of Pediatric Surgery and Traumatology, University Hospital Hradec Králové in 20112020. RESULTS: In this period, 696 patients with a clavicle fracture (excluding neonatal fractures) were treated. Of these, only 90 (13%) adolescent patients had significantly displaced diaphyseal fractures. Conservative approach was adopted in 52 (58%) of them; the remaining patients underwent a surgical procedure, while an intramedullary inserted and fixed titanium nail (TEN) was used in 20 (22%) cases. Supportive fixation was necessary in 4 of the operated patients. The duration of supportive fixation (basic therapeutic procedure for conservative treatment) was significantly shorter in operated patients (18 vs. 29 days, p=0.0001). No statistically significant difference was found in terms of the time interval of complete healing and return to full activity (74 vs. 85 days, p=0.051). There was one complication in the healing of the surgical wound; all patients healed without sequelae. CONCLUSION: According to the study, intramedullary osteosynthesis using a fixed titanium nail reduced the need for supportive fixation and allowed to shorten its time. Overall cosmetic and functional results were comparable to the conservative procedure. Therefore, this method can be recommended, especially for active adolescents.

Health literacy on HIV infection among adolescents in the Czech Republic: a case study of two Czech cities Plzeň and České Budějovice.

Despite health literacy being an important assumption for maintaining a healthy population, there are not many studies focusing on health literacy concerning HIV infection among adolescents in the Czech Republic and among Czech authors. In contrast, there are plenty of scientific papers and researches focused on awareness and susceptibility of adolescents in most affected regions of the world, Sub-Saharan Africa and India particularly. Adolescents belong to a high-risk group of the population. Education is one of the most important factors that influence the level of risk of HIV infection. However, increasing health literacy is only implemented in some types of secondary schools in the Czech Republic. The goal of this study is to verify health literacy concerning HIV infection among adolescents in two types of Czech secondary schools (grammar school and vocational school) in two Czech regional cities (Plzeň and České Budějovice). To determine the level of health literacy of HIV infection, a questionnaire (13 open and 9 closed questions) was compiled. A descriptive cross-sectional study was implemented among students (N = 1 942) of 16 chosen schools in two cities of the Czech Republic in 2015. The questionnaire was pre-tested and it took about 15 minutes to complete. The association was tested by a chi-square test, the averages were then compared with an independent t-test, the p-value (0,05) was used in all tests. Most of the students (67,3%) had good health literacy about HIV/AIDS, statistically significant differences were found between students of grammar schools and vocational schools (p = 0,012). Differences were also found between men and women (p = 0,037). The respondents showed the best knowledge about transmission (94,3%), the poorest about epidemiological questions (18,3%). Gender and the type of school had a statistically significant influence on the level of knowledge (gender x2; p = 0,042, types of a school x2; p = 0,031). In this cross-sectional study, women studying at grammar schools had the best knowledge of HIV/AIDS. In contrast, the lowest level of knowledge was found in men studying in vocational schools. The school types and gender had a statistically significant influence on the level of knowledge. However - knowledge is not enough. To reduce infection risk potential will mean to help adolescents to transform knowledge into diminishing of their risky behaviour. The implementation of prevention in all types of schools is crucial for the reduction of exposure from HIV infection. We consider educating adolescents about sexually transmitted diseases important. Despite that our research showed differences among schools and gender. Those differences can make a particular group be more at risk of being infected. Based on the findings, it would be suitable to unify and improve the approach to the education of this topic in all types of schools and to target preventive and educational techniques to boys more, since men are the biggest group of the HIV positive people in the Czech Republic.

Foreign body ingestion in children.

INTRODUCTION: Evaluation of results of the group of paediatric patients treated for swallowed foreign bodies in the digestive tract. METHODS: Retrospective analysis of patients treated for foreign bodies in the digestive tract, managed at the University Hospital of Hradec Králové between 2011-2018. RESULTS: 365 patients (182 boys, 183 girls) with a foreign body in the digestive tract have been evaluated. The mean age was 2.4 years. Most of the children were treated as outpatients (280 children, 76.7%) and only 85 children (23.3%) were hospitalized. The most commonly swallowed frequent bodies included coins (26%) and batteries (14.5%); sharp objects occurred in 5.2%. Unusual foreign bodies were noticed, too. We can mention for example a pen or a plant nutrition product. In 302 cases (82.7%) the foreign bodies passed easily per vias naturales. Endoscopy was necessary in 63 cases (17.2%) - in 51 children the object had to be removed from the oesophagus and in 12 children the object had to be removed from the stomach. None of the swallowed bodies caused complications such as digestive tract perforation or bowel obstruction. No patient in the group was indicated for laparotomy to remove the foreign body. CONCLUSION: Foreign bodies entrapped in the oesophagus have to be removed endoscopically. In most cases, foreign bodies in the stomach require only observation in the outpatient setting because they leave the stomach easily, without complications, per vias naturales. If a battery remains at the same place of the digestive tract for more than 24 hours, endoscopic removal is indicated at our department. In addition, endoscopy is done in cases of swallowed multiple magnets or bodies that are too large and remain in stomach for several weeks or months. Surgical removal of foreign bodies should be reserved only for complicated cases.

[Verification of the Necessity for the Open Reduction and Tension Band Wiring of the Displaced Olecranon Fracture in Younger Children]. / Overení nutnosti otevrené repozice a tahové cerkláze u dislokované zlomeniny okovce u mensích detí.

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

[HIV/AIDS epidemics in sub-Saharan regions in the 2010s: Regional analysis of UNAIDS data]. / Epidemie HIV/AIDS v subsaharských regionech na pocátku druhé dekády 21. století: regionální specifika na pozadí analýzy dat UNAIDS.

Of all HIV-positive people worldwide, more than two thirds live in Sub-Saharan Africa. Using updated data from UNAIDS, this article analyses whether there is still a signi-ficant increase in HIV in this region or whether national and international programmes and campaigns have successfully contributed to slowing down the epidemic or even reversing its trend. The historical context of the global pandemic of HIV/AIDS is discussed and regional specificities of the HIV spread in the UNAIDS African macro-regions are outlined. The issue of the key factors in the battle against HIV across the Sub-Saharan countries in the second decade of the 21st century is also considered.Key words: HIV/AIDS - Sub-Saharan Africa - regions - ART - history of the spread of HIV/AIDS - pandemics.

[Geography of the HIV/AIDS pandemic: analysis of selected available papers and studies]. / Geografie pandemie HIV/AIDS: rozbor vybraných dostupných clánku a studií.

The article discusses selected papers of foreign geographers who seek correlation between biomedical characteristics of the HIV/AIDS pandemic in various parts of the world and socioeconomic factors that either fuel or prevent the spread of infection. It also points out the benefit from the interconnection between medical sciences, epidemiology and geography and outlines the research areas in which the Czech Republic could participate in the future.

[Invasive streptococcal infections]. / Invazivní streptokokové infekce.

The severity of streptococcal infections depends upon different virulence of individual strains of its causative agent. The most important species are beta-haemolytic group A streptococci (GAS). Clinical manifestations include skin affections, respiratory tract infections and, in particular, serious systemic invasive infections. The pathogenicity of GAS is derived from cell wall components and extracellular products, especially toxins with properties of the so-called superantigens. Less invasive forms of the disease are include necrotizing fasciitis, myositis, pneumonia, sepsis without focus, arthritis, meningitis, puerperal sepsis, streptococcal toxic shock syndrome (STSS) and severe course of erysipelas and cellulitis with blood culture positive for GAS. In most cases, soft tissue infections dominate, often accompanied by chronic diseases of lower extremities in elderly patients. The other clinical forms are rather rare. In children, the condition is clearly frequently related to chickenpox. The generally accepted therapeutic management comprises comprehensive intensive care, early administration of penicillin in combination with clindamycin, and surgical intervention. The use of intravenous immunoglobulins (IVIG), elimination methods and hyperbaric oxygen are under discussion. The slight increase in cases and ineffective prevention require rapid assessment of diagnosis and adequate treatment as a protracted course of the condition is connected with a high mortality rate.

Loss of Cited2 affects trophoblast formation and vascularization of the mouse placenta.

Cited2 is widely expressed in the developing embryo and in extraembryonic tissues including the placenta. Gene expression can be induced by a number of factors; most notably by the hypoxia inducible transcription factor, HIF1, under low oxygen conditions. Cited2 encodes for a transcriptional co-factor that in vitro can act as both a positive and negative regulator of transcription. This function is due to its interaction with CBP/p300 and appears to depend on whether Cited2 enables CBP/p300 to interact with the basic transcriptional machinery, or if its binding prevents such an interaction from occurring. Here, we report a novel function for Cited2 in placenta formation, following gene deletion in mouse. In the absence of Cited2 the placenta and embryo are significantly small from 12.5 and 14.5 dpc respectively, and death occurs in utero. Cited2 null placentas have fewer differentiated trophoblast cell types; specifically there is a reduction in trophoblast giant cells, spongiotrophoblasts and glycogen cells. In addition, the fetal vasculature of the placenta is disorganised and there are fewer anastomosing capillaries. Given that Cited2 is expressed in both trophoblasts and the fetal vasculature, the observed defects fit well with the sites of gene expression. We conclude that Cited2 is required for normal placental development and vascularisation, and hence for embryo viability.

Elevated serum levels of TNF-alpha, sTNF-RI and sTNF-RII in murine schistosomiasis correlate with schistosome oviposition and circumoval granuloma formation.

Levels of circulating tumour necrosis factor (TNF-alpha) and its soluble receptors are elevated in chronic human schistosomiasis. However, the kinetics of TNF-alpha production and release of its soluble receptors have not been studied in humans or animals. Here we report on increased levels of TNF-alpha and its soluble receptors in murine schistosomiasis, beginning with schistosome oviposition and circumoval granuloma formation. TNF-alpha, sTNF-RI and sTNF-RII were measured in sera of mice infected with Schistosoma mansoni each week for 10 weeks postinfection. TNF-alpha levels increased gradually in all mice during the first 3 weeks. From 6th week postinfection, TNF-alpha levels in infected mice increased steadily, whereas those of uninfected mice remained essentially unchanged. sTNF-RI levels fluctuated in all mice during the first 3 weeks, and increased in infected mice during the following 5 weeks. sTNF-RII levels were similar in all mice for the first 4 weeks but increased in infected mice throughout the remainder of the experimental period. These data may be helpful in understanding pathogenesis in schistosomiasis as TNF-alpha plays a crucial role in circumoval granuloma formation and adversely affects schistosome fecundity.

The marks, mechanisms and memory of epigenetic states in mammals.

It is well recognized that there is a surprising degree of phenotypic variation among genetically identical individuals, even when the environmental influences, in the strict sense of the word, are identical. Genetic textbooks acknowledge this fact and use different terms, such as 'intangible variation' or 'developmental noise', to describe it. We believe that this intangible variation results from the stochastic establishment of epigenetic modifications to the DNA nucleotide sequence. These modifications, which may involve cytosine methylation and chromatin remodelling, result in alterations in gene expression which, in turn, affects the phenotype of the organism. Recent evidence, from our work and that of others in mice, suggests that these epigenetic modifications, which in the past were thought to be cleared and reset on passage through the germline, may sometimes be inherited to the next generation. This is termed epigenetic inheritance, and while this process has been well recognized in plants, the recent findings in mice force us to consider the implications of this type of inheritance in mammals. At this stage we do not know how extensive this phenomenon is in humans, but it may well turn out to be the explanation for some diseases which appear to be sporadic or show only weak genetic linkage.

[Significance of the radial artery pulse in dislocated supracondylar fractures of the humerus in children]. / Význam pulzace arteria radialis u dislokované suprakondylické zlomeniny humeru u detí.

The importance of palpable or non-palpable pulsation of the radial artery in children with supracondylar fractures of the humerus is still not correctly appreciated either in the practice or in the literature. Despite the relatively frequent occurrence both the diagnostic and therapeutic procedures are not yet uniform. The objective of this study was to evaluate retrospectively the importance of the pulsation of the radial artery in children with this injury treated in author's departments. Impaired pulsation was recorded in 24 of 244 children (9.8%). In all of 7 patients with impaired pulsation in the years 1984-1992 a vascular operation was made. On the other hand, during the period from 1993 till June 30, 1999, only 4 patients were thus operated on for this reason. In other 7 children pulsation was restored immediately after reposition and percutaneous pinning, while in the remaining 6 children with obstruction of the brachial artery confirmed by triplex Doppler examination pulsation was restored within 1-18 days, always without complications and sequelae. Based on their own results and data in the literature, the authors draw attention to the relative independence of the feared Volkmann's contracture on palpable or non-palpable pulsation of the radial artery and to the minor importance of urgent vascular reconstruction if the collateral circulation is satisfactory. In the case of patent circulation in the hand and forearm muscles a minimal invasive (closed) approach to treatment is possible in spite of concurrent obliteration of the brachial artery, just with reduction and percutaneous pinning of the displaced fracture with K-wires.

[Volkmann's contracture and suprcondylar fractures of the humerus in children]. / Volkmannova kontraktura a suprakondylická zlomenina humeru u detí.

The most frequent cause of the compartment syndrome with subsequent Volkmann's contracture of the upper extremity in children is a supracondylar fracture of the humerus. Often it is being associated by some with the concurrent injury and obliteration of the brachial artery. In the majority of cases of Volkmann's contracture in children with dislocated supracondylar fractures of the humerus, described in the available literature, the development of Volkmann's contracture was preceded by reduction of the fracture and fixation with bandage or in cast with the elbow in flexion. The aim of this study work was to evaluate the impact of specific methods of treatment on the development of Volkmann's contracture. No Volkmann's contracture was observed in a group of 257 patients with displaced supracondylar fracture of the humerus at the authors department from 1984 till 1999 while 7 children with obliteration of the brachial artery were successfully treated without an operation. The development of Volkmann's contracture can be successfully prevented for patients with the displaced supracondylar fracture of the humerus. Minimal elbow flexion, careful manipulation during closed reduction, stabilisation of fragments by percutaneous pinning and careful clinical follow-up are the crucial factors in the prevention of compartment syndrome in this context.

Complex patterns of inheritance of an imprinted murine transgene suggest incomplete germline erasure.

Here we report a transgenic mouse line that exhibits significant deviations from a classic pattern of parental imprinting. When the transgene is passed through the female germline, it is completely silenced in some offspring while in others expression is reduced. This variable expressivity does not appear to be the result of differences in the presence of unlinked modifiers. Female transmission of the transgene is associated with hypermethylation. The transgene is generally reactivated on passage through the male germline. Extended pedigrees reveal complex patterns of inheritance of the phenotype. The most likely explanation for this result is that the imprint is not completely erased and reset when passed through the germline of either sex. FISH analysis reveals that the transgene has integrated into chromosome 3 band E3, a region not known to carry imprinted genes, and the integration site shows no sign of allele-specific differential methylation. These findings, in conjunction with other recent work, raise the possibility that the introduction of foreign DNA into the mammalian genome, either through retrotransposition or transgenesis, may be associated with parental imprinting that is not always erased and reset during meiosis.

Structural-functional relationships in pig heart AMP-deaminase in the presence of ATP, orthophosphate, and phosphatidate bilayers.

The secondary structure of pig heart AMP-deaminase (AMP-d) in the absence and in the presence of orthophosphate or dioleoyl phosphatidic acid (DOPA) or ATP was investigated by FT-IR spectroscopy. While the latter substance activates the enzyme, orthophosphate is a well-known negative allosteric effector and DOPA exerts a noncompetitive inhibition on AMP-deaminase. Small changes in the secondary structure of AMP-d were induced by the above mentioned substances. Only DOPA reduced the thermal stability of AMP-d and avoided protein intermolecular interactions suggesting structural-functional relationships in AMP-d in the presence of the above substances and a possible role of phosphatidic acid in the subtle regulation of AMP-d activity by temporary binding of the enzyme to cellular membranes.

[Disorders of intestinal rotation and fixation in older children]. / Poruchy strevní rotace a fixace u vetsích detí.

The authors discuss five older children where malrotation of the gut was diagnosed. The youngest child was three years old, the oldest 16 years. In three children the malrotation was diagnosed from clinical symptoms and examination by imaging methods, in two it was detected by chance during operation. In the two children where the impaired rotation of the gut was detected on operation, non-rotation was involved. In the remaining three children twice a left side paraduodenal hernia was diagnosed and once an external stenosis of the duodenum by Ladd's bands.

[Diagnosis and therapy of post-traumatic hemobilia]. / Príspevek k diagnostice a lécbe poúrazové hemobilie.

The submitted case-history deals with a successfully diagnosed and treated case of post-traumatic hemobilia in a 13-year-old girl. Hemobilia was manifested clinically by the typical Sandblom triad of symptoms. It was due to a pseudoaneurysm of the peripheral arteriole of the hepatic artery diagnosed by selective liver angiography. In treatment selective intraarterial embolization of the supplying artery proved useful.

[Adnexal torsion in childhood]. / Torze adnex v detském veku.

During the 7-year period (1987-1993) the authors treated nine girls on account of torsion of the adnexa. In six girls torsion of primarily unaltered adnexa occurred, in one girl torsion of an ovary enlarged by a cyst and in two torsion of the ovary affected with a benign tumour, a coetaneous teratoma. In seven instances the organ affected with ischaemic necrosis had to be resected. In two girls detorsion of the ovary was performed, according to a sonographic control examination, however, in one the affected ovary atrophied. In the discussion the authors deal with the diagnosis of torsion of the adnexa and the method of treatment. The authors consider ultrasonic examination of organs of the abdominal cavity and retroperitoneum a very suitable method in all cases of abdominal pain in childhood, as this method can greatly contribute to the diagnosis of acute abdominal and gynaecological attacks. During surgery they recommend to preserve adnexa with a doubtful vitality because there is certain hope that they will be saved. During the postoperative period they recommend the long-term follow up of girls clinically and by ultrasonographic checks. If pathological changes are detected on the preserved adnexa, they recommend early re-operation and elimination of the risk factor (cysts etc.). The operation should be supplemented by prophylactic fixation of the preserved adnexa if this fixation was not done already during the primary operation.

[Comparison of the results of conservative and surgical therapy of dislocated supracondylar fractures of the humerus in children]. / Porovnání výsledku konzervativní a operacní lécby dislokovaných suprakondylických zlomenin humeru u detí.

The authors evaluate retrospectively in a group of 121 children with a dislocated supracondylar fracture in 1984-1993 the results of different therapeutic methods. The highest percentage of excellent and satisfactory results was recorded in children treated by closed reposition with percutaneous pinning with Kirschner wires (88%). In open reposition with Kirschner wires 60% of the results were excellent of satisfactory. The lowest percentage of excellent and satisfactory results was recorded when fixation with a plaster bandage was used (48%). The highest percentage of poor results was observed in surgical reposition with internal fixation (37%). The cause of failure in the majority of patients is according to the authors inadequate reposition of fragments. The authors discuss different types of treatment. They recommend non-surgical reposition with percutaneous pinning, even for less dislocated extension supracondylar fractures of the humerus as well as for fractures complicated by vascular injuries.