Parental Satisfaction from Telemedicine in the Follow-up of Children Operated for Craniosynostosis during COVID-19 Pandemic.

OBJECTIVE: The current study aimed to evaluate the satisfaction level of parents from telemedicine use in the long-term follow-up of children operated for craniosynostosis during the COVID-19 pandemic. DESIGN: A cross-sectional 9-question survey analysis using Qualtrics survey software. SETTING: An institutional study carried out at a national, tertiary level academic center in the Slovak Republic. PATIENTS: All patients operated for non-syndromic and syndromic craniosynostosis in our department, who participated in the virtual postoperative follow-up consultations from March 23, 2020, through July 2, 2021, were included in our series. They were enrolled 498 patients, with the parents of 256 children being responding to the survey. INTERVENTIONS: The survey remained open until July 16, 2021, two weeks after the last virtual consultations. It was delivered to the parents by e-mail to generate closed 5-point Likert scale responses. RESULTS: Overall, 72.3% of parents were satisfied with the telemedicine program, and 67.2% found it convenient. Collectively, 89.1% reported that the received instructions were helpful to them. However, only 18.7% of them answered that they would prefer telemedicine consultations in the future. CONCLUSION: The results of this study showed a high satisfaction from the parents during the virtual follow-up of children operated for craniosynostosis. However, despite their positive experience with telemedicine, the vast majority of parents stated that they would prefer in-person visits in the future.

Rating nasolabial appearance on three-dimensional images in cleft lip and palate: a comparison with standard photographs.

BACKGROUND/OBJECTIVE: Judgement of nasolabial aesthetics in cleft lip and palate (CLP) is a vital component of assessment of treatment outcome. It is usually performed based on two-dimensional (2D) facial photographs. An increasing use of three-dimensional (3D) imaging warrants an assessment if 3D images can substitute 2D photographs during aesthetic evaluation. The aim of this study was to compare reliability of rating nasolabial appearance on 3D images and standard 2D photographs in prepubertal children. METHODS: Forty subjects (age: 8.8-12) with unilateral CLP treated according to a standardized protocol, who had 2D and 3D facial images were selected. Eight lay raters assessed nasal form, nasal deviation, vermilion border, and nasolabial profile on cropped 2D and 3D images using a 100-mm visual analogue scale (VAS). Additionally, raters answer two questions: 1. Do 2D or 3D images provide more information on nasolabial aesthetics? and 2. Is aesthetic evaluation easier on 2D or 3D images? RESULTS: Intrarater agreement demonstrated a better reliability of ratings performed on 3D images than 2D images (correlation coefficients for 3D images ranged from 0.733 to 0.857; for 2D images from 0.151 to 0.611). The mean scores showed, however, no difference between 2D and 3D formats (>0.05). 3D images were regarded more informative than 2D images (P = 0.001) but probably more difficult to evaluate (P = 0.06). LIMITATIONS: Basal view of the nose was not assessed. CONCLUSIONS: 3D images seem better than 2D images for rating nasolabial aesthetics but raters should familiarize themselves with them prior to rating.

The Oldest Bryophyte Herbarium Specimens from Central Europe, Collected by M. E. Boretius in 1717: Taxonomy, Nomenclature, Datation and Ethnopharmacology.

The WA Herbarium at the University of Warsaw houses a collection of plants created in 1717 by Matthew Ernest Boretius. They were gathered in former East Prussia, near Angerburg, now Wegorzewo (Poland). It is the oldest plant collection from this part of Europe. Boretius compiled the herbarium as a collection of all the surrounding plants, but their folk names (Polish and German) recorded in the herbarium confirm the ethnobiological or ethnopharmaceutical importance of some species. We identified bryophyte species and checked the accuracy of their original identifications recorded in the herbarium. We provided their Latin (scientific, pre-Linnaean) nomenclature together with German and Polish vernacular names. We contextualised this information within the history of the medicinal use of bryophytes around 1717, when the plant collection was created. We also investigated whether the specimens could have come from Northeastern Poland. Mosses and liverworts from the herbarium were identified nomenclaturally (by means of their original scientific polynomial names written on herbarium sheets) and taxonomically. The herbarium holds two species and one subspecies of liverwort and 27 species and one variety of moss. The accuracy of the original identifications was assessed, with a particular focus on the species considered medicinal at the time. We found that bryophytes were poorly known in the time of Boretius, which was the last period in bryology before the introduction of magnifying devices into this science (this crucial step was made by Dillenius in 1741). The vernacular names used in the herbarium were recorded for Marchantia polymorpha and Polytrichum commune-the only two species with confirmed medicinal use by the year 1717.

Short dental implants in microvascular free flap DCIA: A case report.

Placing dental implants in microvascular bone free flaps used for reconstructing the mandible or maxilla has been previously reported. However, there is scarce information available on the restorative protocol using short dental implants placed in a deep circumflex iliac artery (DCIA) microvascular free flap and the rationale behind it. This case report describes a 18-year-old patient referred to the hospital for numbness and dull pain of the left mandible, which she observed for three months. The patient underwent mandible resection and reconstruction using the DCIA free flap due to "giant cell lesion" on the left side of the mandibular angle. Short dental implants were placed and prosthetic reconstruction of the dentition involved in the resection was performed in a young patient with two integrated abutment crowns. The placement of short dental implants did not negatively affect the vascular pedicle and vitality of free flap. In our case report, two years after the healing, excellent aesthetic and function were accomplished with the DCIA flap followed by restoration with short implants.

Short and Extra Short Dental Implants in Osseous Microvascular Free Flaps: A Retrospective Case Series.

There is limited information regarding implant and prosthetic survival after osseous microvascular free flap (OMFF). This case series aims to describe the placement of short and extra short implants in osseous microvascular free flaps to support prostheses, and present an up to 40-month retrospective follow-up. Short and extra short dental implants were placed in six fibula free flaps (FFF) and in two microvascular deep circumflex iliac artery (DCIA) flaps. In total, 27 short and extra short dental implants have been placed into two different types of free flaps. Kaplan-Meyer (K-M) survival analyses were performed to evaluate the survival and success outcomes of implants and prostheses. Out of the eight patients reconstructed with free flap, five were rehabilitated with prostheses, one patient has a temporary prosthesis, and two patients are in the process of prosthetic rehabilitation. Twenty-seven implants were followed up for up to 40 months, and K-M analyses showed 100% implant survival probability (95% confidence interval: 100%), while the implant success probability was 91.0% (95% confidence interval: 68.6-97.7%). Short and extra short dental implants placed in OMFF presented high survival and success rates in a retrospective case series after up to 40 months.

Effects of Water-Ethanol Extracts from Four Sphagnum Species on Gene Expression of Selected Enzymes in Normal Human Dermal Fibroblasts and Their Antioxidant Properties.

Mosses (Bryophyta), particularly species of the genus Sphagnum, which have been used for centuries for the treatment of skin diseases and damage, are still not explored enough in terms of their use in cosmetics. The purpose of this study was to determine the antioxidant properties of water-ethanol extracts from four selected species of the genus Sphagnum (S. girgenshonii Russow, S. magellanicum Brid., S. palustre L., and S. squarrosum Crome) and their impact on the expression of genes encoding key enzymes for the functioning of the skin. In this study, the effects of Sphagnum extracts on the expression of genes encoding tyrosinase, collagenase, elastase, hyaluronidase and hyaluronic acid synthase in human dermal fibroblasts were determined for the first time in vitro. The extracts inhibited tyrosinase gene expression and showed antioxidant activity. The experiment showed an increase in the expression of some genes encoding collagenase (MMP1) or hyaluronidase (HYAL2, HYAL3 and HYAL4) and a decrease in the hyaluronan synthase (HAS1, HAS2 and HAS3) genes expression by the tested extracts. The obtained results suggest that using extracts from the tested Sphagnum species in anti-aging cosmetics does not seem beneficial. Further studies are needed to clarify their impact on the skin.

Natural Resources of Medicinal and Cosmetic Plants.

This Special Issue (SI) of Plants is devoted to medicinal and cosmetic plants [...].

Four Centuries of Medicinal Mosses and Liverworts in European Ethnopharmacy and Scientific Pharmacy: A Review.

(1) Medicinal use of bryophytes dates to ancient times, but it has always been marginal due to their small size, difficult identification, lack of conspicuous organs which would attract attention (flowers, fruits) and insipid taste of the herb. The earliest testimonies of their medical use come from the 1500s. The interest in medicinal bryophytes diminished considerably in the 1880s, except for Sphagnum spp., which became a source of dressing material. The second half of the 20th century saw the revival of the study of bryophyte chemistry. (2) Historical printed sources from 1616 to 1889 were queried. Bryophyte species found were taxonomically identified and presented against the background of their confirmed properties and ecology. The study was supplemented with historical vs. modern ethnomedicinal data. (3) In 26 publications, 28 species were identified. Modern usage was known for 10 of them. Medicinal properties of 16 species were confirmed. (4) Species of wide geographical distribution range were (or are still being) used in local folk medicines. Historical ethnobiological and ethnopharmaceutical uses of them are sometimes convergent with their confirmed properties, mostly external (as antimicrobial or cytotoxic remedies).

Side Effects of mRNA-Based COVID-19 Vaccine: Nationwide Phase IV Study among Healthcare Workers in Slovakia.

mRNA-based COVID-19 vaccines such as BNT162b2 have recently been a target of anti-vaccination campaigns due to their novelty in the healthcare industry; nevertheless, these vaccines have exhibited excellent results in terms of efficacy and safety. As a consequence, they acquired the first approvals from drug regulators and were deployed at a large scale among priority groups, including healthcare workers. This phase IV study was designed as a nationwide cross-sectional survey to evaluate the post-vaccination side effects among healthcare workers in Slovakia. The study used a validated self-administered questionnaire that inquired about participants' demographic information, medical anamneses, COVID-19-related anamnesis, and local, systemic, oral, and skin-related side effects following receiving the BNT162b2 vaccine. A total of 522 participants were included in this study, of whom 77% were females, 55.7% were aged between 31 and 54 years, and 41.6% were from Banska Bystrica. Most of the participants (91.6%) reported at least one side effect. Injection site pain (85.2%) was the most common local side effect, while fatigue (54.2%), headache (34.3%), muscle pain (28.4%), and chills (26.4%) were the most common systemic side effects. The reported side effects were of a mild nature (99.6%) that did not require medical attention and a short duration, as most of them (90.4%) were resolved within three days. Females and young adults were more likely to report post-vaccination side effects; such a finding is also consistent with what was previously reported by other phase IV studies worldwide. The role of chronic illnesses and medical treatments in post-vaccination side effect incidence and intensity requires further robust investigation among large population groups.

Oral Complications of ICU Patients with COVID-19: Case-Series and Review of Two Hundred Ten Cases.

BACKGROUND: The critically ill patients suffering from coronavirus disease (COVID-19) and admitted to the intensive care units (ICUs) are susceptible to a wide array of complications that can be life-threatening or impose them to long-term complications. The COVID-19 oral mucocutaneous complications require multidisciplinary management and research for their pathophysiological course and epidemiological significance; therefore, the objective of this study was to evaluate the prevalence and characteristics of the critically ill COVID-19 patients with oral complications. METHODS: We described the clinical and microbiological characteristics of the critically ill COVID-19 patients in our ICU department (Banska Bystrica, Slovakia). In addition, we reviewed the current body of evidence in Ovid MEDLINE®, Embase, Cochrane Library, and Google Scholar for the oral mucocutaneous complications of ICU patients with COVID-19. RESULTS: Three out of nine critically ill patients (33.3%) in our ICU department presented with oral complications including haemorrhagic ulcers and necrotic ulcers affecting the lips and tongue. The microbiological assessment revealed the presence of opportunistic pathogens, confirming the possibility of co-infection. On reviewing the current literature, two hundred ten critically ill patients were reported to have oral complications due to their stay in the ICU setting. Perioral pressure ulcers were the most common complication, followed by oral candidiasis, herpetic and haemorrhagic ulcers, and acute onset macroglossia. The prolonged prone positioning and mechanical ventilation devices were the primary risk factors for those oral complications, in addition to the immunosuppressive drugs. CONCLUSIONS: The multidisciplinary approach is strongly advocated for monitoring and management of COVID-19 patients, thus implying that dermatology and oral healthcare specialists and nurses should be integrated within the ICU teams.

The Slavcleft: a three-center study of the outcome of treatment of cleft lip and palate. Nasolabial appearance.

BACKGROUND: There is a multitude of protocols of treatment of cleft lip and palate (CLP) worldwide differing in number of operations, surgical techniques, and timings of surgeries. Despite, facial appearance in subjects with CLP is rarely ideal and residual stigmata are easy to notice in many patients irrespective of the protocol. The prospective controlled investigations are optimal for comparing effectiveness of treatment protocols. Because prospective studies are very challenging to perform in CLP field, it is reasonable to retrospectively assess different surgical protocols to identify the promising ones and then to test them in a prospective way. METHODS: Our objective was to assess the nasolabial appearance in a preadolescent Slavic population with unilateral cleft lip and palate (UCLP) by using the 0-200 numeric scale with reference photographs. Patients treated in Warsaw, Poland (n = 32), Prague, Czech Republic (n = 26) and Bratislava, Slovakia (n = 17) were included in this retrospective study. Each cleft center used a unique surgical protocol. Two panels of professional raters (n = 7) and laypeople (n = 10) scored blindly the nasolabial esthetics on cropped frontal and profile images with cropped reference photograph present on the same slide. Intra- and inter-rater agreement was assessed with Cronbach's alpha, intraclass correlation coefficients, t-tests, and Bland-Altman plots. Inter-group differences were evaluated with one-way ANOVA and regression analysis. RESULTS: The agreement within and between raters was acceptable. We found that patients treated in Warsaw, Prague, and Bratislava showed comparable nasolabial appearance on frontal and profile photographs when judged by both professional raters (p > 0.05) and laypeople (p > 0.05). Regression analysis did not identify influence of gender, group (i.e., Warsaw, Prague, and Bratislava), age at lip repair, surgeon, and age at photographic assessment on esthetic outcome (p > 0.05). CONCLUSION: This study showed that none of the surgical protocols showed superiority to produce good nasolabial appearance.

Central European ethnomedical and officinal uses of peat, with special emphasis on the Tolpa peat preparation (TPP): An historical review.

ETHNOPHARMACOLOGICAL RELEVANCE: Medical or hygienic uses of peat mosses dates back to the 18th century. Peat was used externally (as poultices) in the early 19th century. The peat preparation invented by Stanislaw Tolpa (Tolpa peat preparation, TPP) was patented in Poland in 1991; its concept had emerged in the 1980s. It raised high therapeutic expectations still being researched in the early 1990s. Profound expectations for peat, a natural product well known in Central European (and Polish) spas (for medicated baths and poultices), earned Tolpa's preparation great renown before any actual benefits (internal actions) were scientifically confirmed. AIM OF THE REVIEW: We study the origins of medical interest in peat in Polish science against the background of the historical ethnopharmacy of peat and Sphagnum moss in Central Europe. It is aimed at shedding a new light on the history of TPP, its connections with local ethnopharmacological traditions and inspirations for local medical studies on peat products and peat-derived drugs of the 1980s and early 1900s. MATERIALS AND METHODS: The literature on peat baths was found and reviewed including the information and data about the studies of TPP from published though unknown sources as well as from Polish patents, unpublished typescripts, press interviews and reports. RESULTS: Tolpa's research team missed the historical data about external and topical actions of Sphagnum peat or its preparations which were published in the 19th- and early 20th-century. This is strange because folk medicine based on peat emanated eastwards from ethnic Austria along the Vistula river and the Carpathians. Tolpa ignored balneotherapeutic (external) applications as well as the action of sphagnan from Sphagnum herb, and rejected this kind of peat as scientifically not promising, based on a single biological test on plants. The concept of an active principle in peat or its preparations evolved, and speculation concerning its nature was not followed by adequate basic research. The active principle was not found. Results concerning plant meristem growth were too readily applied in animal production and finally human medicine. The natural ingredient in TPP production was never defined botanically. Anti-cancer properties ascribed to the TPP on the basis of bio-stimulation tests stirred powerful social emotions. CONCLUSIONS: Topical peat cure originated in Austria in about 1820. It evolved as a whole branch of Central European balneotherapy which had been completely scientifically described by the 1950s. At that time an undefined peat extract was once successfully used in ear infections in paediatrics. Stanislaw Tolpa's research project to find any internal application of peat ignored the achievements of ethnobiology, balneotherapy, surgery and otorhinolaryngology known at that time. His strenuous and insistent efforts, carried out in isolation, crucially failed pre-clinical and clinical tests in any branch of his therapy. Three commercial drugs were allowed for 3 years before substantial clinical proofs of peat efficacy were achieved. Social impact was high and resulted in the birth of the Polish legend of Tolpa's marvellous drug.

Pattern of Morphological Variability in Unrepaired Unilateral Clefts With and Without Cleft Palate May Suggest Intrinsic Growth Deficiency.

In individuals with cleft lip and palate (CLP) an iatrogenic effect of operations on subsequent maxillary growth is well-known. Much less is known about the association between occurrence of CLP and intrinsic growth deficiency of the maxillofacial complex. The aim of this study was to compare morphological variability in subjects with unilateral cleft lip and alveolus/palate and unaffected controls using geometric morphometric methods. The research hypothesis was that if subjects with unrepaired unilateral CLP have intrinsic growth deficiency, the pattern of their craniofacial growth variation may differ from that in unaffected individuals. Lateral cephalograms were available of three groups of the same ethnic background (Proto-Malayid): (a) non-syndromic unrepaired unilateral complete cleft lip, alveolus, and palate (UCLP), N = 66, mean age 24.5 years (b) non-syndromic unrepaired unilateral complete cleft lip and alveolus (UCLA), N = 177, mean age 23.7 years, and (c) NORM (N = 50), mean age 21.2 years without a cleft. Using geometric morphometrics shape variability in groups and shape differences between groups was analyzed. Principal component analysis (PCA) was used to examine shape variability, while differences between groups and sexes were evaluated with canonical variate analysis. Sexual dimorphism was evaluated with discriminant function analysis (DA). Results showed that in comparison to NORM subjects, shape variability in UCLA and UCLP is more pronounced in the antero-posterior than in vertical direction. Pairwise comparisons of the mean shape configurations (NORM vs. UCLA, NORM vs. UCLP, and UCLA vs. UCLP) revealed significant differences between cleft and non-cleft subjects. The first canonical variate (CV1, 68.2% of variance) demonstrated that differences were associated with maxillary shape and/or position and incisor inclination, while in females, the CV1 (69.2% of variance) showed a combination of differences of "maxillary shape and/or position and incisor inclination" and inclination of the cranial base. Shape variability demonstrated considerable differences in subjects with UCLA, UCLP, and NORM. Moreover, in subjects with a cleft, within-sample variability was more pronounced in the antero-posterior direction, while in non-cleft subjects, within-sample variability was more pronounced in the vertical direction. These findings may suggest that subjects with unilateral clefts have intrinsic growth impairment affecting subsequent facial development.

Tangled history of the European uses of Sphagnum moss and sphagnol.

ETHNOPHARMACOLOGICAL RELEVANCE: Sphagnum mosses and peat could have been utilized as wound dressings for centuries, however reliable data on this subject are ambiguous; sometimes even no distinction between peat moss (Sphagnum spp.) and peat is made or these terms become confused. The first scientific account on surgical use of peat comes from 1882: a peat digger who successfully, by himself and in the way unknown to the then medicine, cured an open fracture of his forearm with peat. The peat, and very soon the peat moss itself (which is the major constituent of peat) drew attention of the 19th-century surgeons. AIMS OF THE WORK: We search for reliable information on: (1) inspirations for Sphagnum usage for medical purposes and its beginnings in the 19th century, (2) substances or products named sphagnol and their connections with (1); (3) on the origin of this name, (4) and on the occurrence of this name in medical sources. MATERIALS AND METHODS: We have identified and studied published sources on the uses of peat-based and Sphagnum-based preparations and products of any processing level (including herbal stock, distillate, isolated pure or impure active principle, or a mixture of such) in surgery, pharmacy or cosmetics. A special attention was paid to the name sphagnol, which appeared many a time, in more than one context since 1899. Source publications were critically analysed from the taxonomical, pharmacognostical and ethnopharmacological points of view. Gathered data were cross-checked with the modern knowledge of the biologically active principles of Sphagnum and the prospects of their medical use. RESULTS: The application of peat in surgery started 1882. The use of peat moss as dressings was developed in the 1880's. It returned to surgical practice during WW1. The name sphagnol has two meanings: (1) A chemical substance isolated from the cell walls of Sphagnum mosses in 1899. A post-1950 research showed it to be a mixture of phenols dominated by sphagnum acid. (2) A product of dry distillation of peat contains solid and liquid fractions and was applied in skin diseases due to antiseptic properties. It was added to ointments and medicated soaps manufactured up to the late 1960's. Today none of these two sphagnols is in use. CONCLUSIONS: Surgical application of peat had an ethnopharmacological origin: a case of wound treatment with peat as a remedy rather than a dressing (1880, published 1882) shortly shifted the surgeons' attention to peat moss as an absorptive dressing. The 1880's tests of antiseptic properties of peat and peat moss failed, the sterilization methods overrode the physiological effects of Sphagnum dressings. Sphagnan, a polysaccharide from Sphagnum cell walls, discovered 1983, inhibits microbial growth, tans the collagen and removes ammonia from microbial environments. Portions of raw peat could be sterile. The isolation of sphagnol (1899) from Sphagnum cell walls was not inspired by old surgery. Main component of sphagnol, the sphagnic acid, was used clinically during WW2, but was proved a weak antimicrobial agent. A homonymous name sphagnol appeared independently for a product of dry distillation of peat, introduced commercially probably about 1899, too, which gave rise to confusions: a) the commercial, "distilled" sphagnol was not the crystalline principle of Sphagnum cell walls. 2) the "distilled" sphagnol was hardly defined technologically or pharmacologically, never standardized in terms of the substrate (a variety of peat rather than Sphagnum herb) and the production process. This sphagnol, resembling pitch or tar, was an additive to medicated soaps and ointments for skin treatment and care. It must have been a low-scale product although advertised worldwide. Neither sphagnum acid nor sphagnan are used medicinally today.

DNA barcoding, ecology and geography of the cryptic species of Aneura pinguis and their relationships with Aneura maxima and Aneura mirabilis (Metzgeriales, Marchantiophyta).

Aneura pinguis is a thalloid liverwort species with broad geographical distribution. It is composed of cryptic species, however, the number of cryptic species within A. pinguis is not known. Five cpDNA regions (matK, rbcL, rpoC1, trnH-psbA and trnL-trnF) and the entire nuclear ITS region were studied in 130 samples of A. pinguis from different geographical regions. The relationships between the cryptic species of A. pinguis, A. maxima and A. mirabilis were analyzed. All of the examined samples were clustered into 10 clades corresponding to 10 cryptic species of A. pinguis (marked A to J). Aneura mirabilis and A. maxima were nested among different cryptic species of A. pinguis, which indicates that A. pinguis is a paraphyletic taxon. Subgroups were found in cryptic species A, B, C and E. As single barcodes, all tested DNA regions had 100% discriminant power and fulfilled DNA barcode criteria for species identification; however, the only combination detected in all subgroups was trnL-trnF with trnH-psbA or ITS2. The distances between cryptic species were 11- to 35-fold higher than intraspecific distances. In all analyzed DNA regions, the distances between most pairs of cryptic A. pinguis species were higher than between A. maxima and A. mirabilis. All cryptic species of A. pinguis clearly differed in their habitat preferences, which suggests that habitat adaptation could be the main driving force behind cryptic speciation within this taxon.

Central European medicinal bryophytes in the 16th-century work by Caspar Schwenckfeld, and their ethnopharmacological origin.

ETHNOPHARMACOLOGICAL RELEVANCE: Ubiquitous bryophyte species are reported from European, American and Asian ethnopharmacies. Some of their traditional medicinal uses are similar in distant and isolated cultures, and moreover, medicinal properties of some bryophytes are currently confirmed as justified by their chemical constituents. Aims of the work: we identify bryophytes listed in a medicinal and botanical work from 1600, and compare their medicinal applications (known in Europe between 1530-1600) with other ethnopharmacological data about these species and with modern pharmacological knowledge. This way we attempt to display origins of medicinal usage of bryophytes in Central Europe. MATERIALS AND METHODS: Bryophyte species in bibliographical sources printed in Central Europe (starting from O. Brunfels' Herbarum vivae Eicones... Argentorati, 1530) were identified according to old and recent taxonomical references. Caspar Schwenckfeld's scientific output from 1600 was treated here as a summary of 16th-century knowledge about medicinal bryophytes. RESULTS: Central European pharmacy about the year 1600 was familiar with the following bryophytes: Marchantia polymorpha L., Polytrichum commune Hedw., P. formosum Hedw. and Funaria hygrometrica Hedw. CONCLUSIONS: Between 1530-1600 in Central Europe the number of medicinal bryophytes increased from 2 (Lichen sive Hepatica and Polytrichon) to 4. Pharmaceutical usage of them was similar as in other, distant ethnopharmacies. Further 2-4 mosses (Rhytidiadelphus loreus and Rh. squarrosus; Thuidium tamariscinum and Th. delicatulum) were recognised as non-medicinal.

[Pediatric open heart surgery on cardiopulmonary bypass without the use of blood products]. / Operacje wrodzonych wad serca u dzieci w krazeniu pozaustrojowym bez uzycia krwi i preparatów krwiopochodnych.

Pediatric open heart surgery is associated with the usage of cardiopulmonary bypass. The circuit is primed with blood products because of risk of excessive hemodilution. The aim of the study was to prove the safety of open heart surgery on cardiopulmonary bypass without the use of blood products in the pediatric group. In this study, 78 patients with atrial septal defect (ASD type II) were enrolled and underwent elective atrial septal defect repair between the years of 1999 and 2003. The group I included 37 children aged from 3 to 16 years (8.79 +/- 4.45) who weighed from 13 to 68.8 kg (29.93 +/- 15.00). In this group, the transfusion of blood products during the surgery and postoperative course was avoided. Blood products were used in a control group (group II 4.1 patients) both during and after surgery. Children from this population ranged in age from 2.5 to 17 years (8.41+/- 4.18) and weighed from 11.5 to 59.7 kg (26.99 +/-12.95). For statistical analysis the t-Student test and U Mann Whitney test were used. The length of stay in the intensive care unit (1.18 +/- 0.47 vs 1.20 +/- 0.61 days) and total hospital stay (8.91 +/- 3.05 vs 10.05 +/- 4.28 days) did not differ statistically between the groups. Values of haematocrit and hemoglobin levels were statistically lower in group I during the postoperative course compared to the control group (intraoperative Hct: 19.43 +/- 4.93 vs 23.37 +/- 4.68%, p < 0.001), but these levels did not correlate with the occurrence of hypoxic, neurologic or coagulation complications. Directly after the surgery, group I had significantly higher platelet and leucocyte counts compared to the control group. There were no differences between the confronted populations in regard to postoperative bleeding (4.61 +/- 2.24 vs 4.76 +/- 1.75 ml/kg). The avoidance of using blood products in pediatric patients during open heart surgery with cardiopulmonary bypass is found to be safe, is not correlated with an increased surgical risk, and does not result in a prolonged hospital stay.

Medicinal mosses in pre-Linnaean bryophyte floras of central Europe. An example from the natural history of Poland.

ETHNOPHARMACOLOGICAL RELEVANCE: The paper presents information about the earliest botanical work from Poland, Warsavia physice illustrata which takes bryophytes into account. It was elaborated by a German physician Christian Heinrich Erndtel and issued in 1730 in Dresden. That time understanding of bryophytes was imprecise and in many cases they were confused with lichens and club mosses. MATERIALS AND METHODS: Bryophyte taxa polynomials (18 names) were identified using pre- and post-Linnaean botanical monographs from years 1590 to 1801. Their current names and pharmacological value are provided, as well as the old ethnobotanical data about bryophytes (cited from 18th-century sources). RESULTS: Altogether 18 bryophyte species were identified from the vicinity of Warsaw (17 mosses and 1 liverwort). Some of them are still abundant in this area (for example Climacium dendroides, Plagiomnium undulatum and Polytrichum juniperinum) while some other are rare or extinct (for example Neckera crispa and Rhodobryum roseum). CONCLUSIONS: Despite the technical ability to observe specific microscopic differences among bryophytes, physicians of 18th century were hardly interested in using any of them as medicinal stock. It may be concluded that the competences in pre-Linnaean bryology did not put into practice using moss-derived materia medica of 18th century (the only exceptions were Fontinalis antipyretica and Polytrichum spp.).

Consequences of right ventricle-to-pulmonary artery shunt at the first stage for the Fontan operation.

BACKGROUND: The evidence of the advantageous physiology associated with right ventricle-to-pulmonary artery (RV-PA) shunt in the early postoperative period after the Norwood procedure for hypoplastic left heart syndrome has been recently widely reported. We investigated the late consequences of this modification from the perspective of the third-stage palliation, the Fontan operation. METHODS: Between September 1995 and November 2006, a consecutive series of 50 children with hypoplastic left heart syndrome from a single institution underwent a fenestrated Fontan operation (lateral tunnel technique): group 1 (n = 19) after the modified Blalock-Taussig shunt, and group 2 (n = 31) after RV-PA shunt during the Norwood procedure. Hemodynamic, echocardiographic, electrocardiographic, and clinical operative and perioperative data were analyzed. RESULTS: Children after the RV-PA shunt were characterized by higher preoperative partial oxygen tension in pulmonary arteries (p = 0.018) and the aorta (p = 0.028), as well as lower systolic, diastolic, and mean aortic pressure (p = 0.005, p = 0.004, p = 0.019). After administration of 100% oxygen, this group additionally showed a lower value for systemic resistance (p = 0.013). The analyzed angiograms revealed a higher incidence of systemic-to-pulmonary collateral vessels (p = 0.003) in group 2. At the discharge after Fontan operation, children after the RV-PA shunt demonstrated higher arterial partial oxygen tension (p = 0.004). The two groups did not differ significantly with respect to the mortality, ventricular function, incidence of pleural effusions or rhythm disturbances, intensive care unit stay, and hospitalization time. CONCLUSIONS: The Norwood procedure with the RV-PA shunt provides satisfactory late hemodynamics. Children who underwent this method of palliation were more prone to the development of systemic-to-pulmonary arterial collaterals.