Recent Advances in the Use of Stem Cells in Tissue Engineering and Adjunct Therapies for Tendon Reconstruction and Future Perspectives.

Due to their function, tendons are exposed to acute injuries. This type of damage to the musculoskeletal system represents a challenge for clinicians when natural regeneration and treatment methods do not produce the expected results. Currently, treatment is long and associated with long-term complications. In this review, we discuss the use of stem cells in the treatment of tendons, including how to induce appropriate cell differentiation based on gene therapy, growth factors, tissue engineering, proteins involved in regenerative process, drugs and three-dimensional (3D) structures. A multidirectional approach as well as the incorporation of novel components of the therapy will improve the techniques used and benefit patients with tendon injuries in the future.

The effect of plasma cytokines on the expression of adiponectin and its receptors in the synovial membrane of joints and the infrapatellar fat pad in patients with rheumatoid arthritis and osteoarthritis.

BACKGROUND: Rheumatoid arthritis (RA) is an autoimmune inflammatory disease that leads to joint destruction. Numerous pro-inflammatory mediators, including adipokines, play an important role in the pathogenesis of RA. OBJECTIVE: The aim of the study was to investigate the relationships between selected plasma cytokines and expression of adiponectin and its receptors in the synovium and the infrapatellar fat pad in patients with RA and osteoarthritis (OA). METHODS: Blood, synovium and fat pad samples from 18 patients with RA and 18 with OA were collected during joint replacement surgery. Spearman rank correlations between plasma concentrations of selected cytokines (IL-1ß, IL-2, IL-4, IL-6, IL-7, IL-8, IL-10, IL-12 p40, IL-13, IL-17, G-CSF and GM-CSF) and the expression of adiponectin and its receptors were determined. Plasma levels of cytokines were determined using a magnetic bead-based multiplex assay, mRNA expression of adiponectin and its receptors were determined by real-time PCR. RESULTS: In OA patients, there were significant positive correlations between adiponectin expression in the synovial membrane and plasma levels of IL-1ß, IL-4, G-CSF and GM-CSF, as well as a significant positive correlation between adiponectin expression in the fat pad and plasma levels of GM-CSF. In addition, OA patients showed significant negative correlations between AdipoR1 and AdipoR2 expression in the synovial membrane and plasma IL-6 levels, as well as between AdipoR2 expression in the synovial membrane and plasma MCP-1 and TNF-α levels. In patients with RA, there were no significant correlations between adiponectin expression in the synovial membrane and infrapatellar fat pad and plasma levels of the cytokines studied. In addition, RA patients showed a statistically significant negative correlation between AdipoR1 expression in the synovial membrane and plasma levels of TNF-α, IL-7, IL-12 and IL-13, and a significant negative correlation between AdipoR1 expression in the infrapatellar fat pad and plasma levels of IL-1ß. CONCLUSIONS: Adiponectin and its receptors showed the correlations with several plasma cytokines, however, a thorough understanding of the role of adiponectin in RA and OA requires further investigation.

The Role of Omentin-1 in Cancers Development and Progression.

Adipose tissue serves as an energy store and is also an active endocrine organ, exerting activity that influences obesity-related processes through the production of regulatory proteins called adipokines or adipocytokines. Adipokines play important direct and indirect roles in the pathogenesis of insulin resistance, the regulation of local and systemic inflammatory processes, and related metabolic complications. There have been an increasing number of studies showing the relationship between some adipokines and carcinogenesis. This work reviews the current literature concerning the effects of omentin-1 on carcinogenesis.

The Role of Adipokines in the Pathogenesis of Psoriasis.

Psoriasis is a chronic and immune-mediated skin condition characterized by pro-inflammatory cytokines and keratinocyte hyperproliferation. Dendritic cells, T lymphocytes, and keratinocytes represent the main cell subtypes involved in the pathogenesis of psoriasis, while the interleukin-23 (IL-23)/IL-17 pathway enhances the disease progression. Human adipose tissue is an endocrine organ, which secretes multiple proteins, known as adipokines, such as adiponectin, leptin, visfatin, or resistin. Current evidence highlights the immunomodulatory roles of adipokines, which may contribute to the progression or suppression of psoriasis. A better understanding of the complexity of psoriasis pathophysiology linked with adipokines could result in developing novel diagnostic or therapeutic strategies. This review aims to present the pathogenesis of psoriasis and the roles of adipokines in this process.

The effect of unilateral carpal tunnel release on the non-operated contralateral hand.

BACKGROUND: Carpal tunnel syndrome (CTS) is often (60-90%) a bilateral condition. It has been suggested that patients with bilateral disease may benefit in the non-operated hand after unilateral surgery. OBJECTIVES: To investigate the effect of unilateral carpal tunnel release on the non-operated contralateral hand. MATERIAL AND METHODS: In 186 patients with bilateral CTS, a number of measurements were performed prior to surgery. The patients were scheduled for surgery on the other hand operation 3 months after the first. Upon admission, the same measurements were performed on the still unoperated hand. RESULTS: All subjective variables were significantly better in the hand scheduled for operation as compared to the second one. Pain intensity was lower by a mean of 0.8 on a numeric rating scale (NRS); Levine symptom and function scores were lower by a mean of 0.7 and 0.3, respectively. Digital sensibility and grip strength were also better, but the changes were without clinical or statistical significance. Asked directly about the status of the non-operated hand, 109 patients (64%) reported improvement, 40 (23%) noted no change and 21 (13%) deterioration. CONCLUSIONS: Regardless of the reasons for improvement, this study demonstrates that 64% of patients feel partial relief in the non-operated hand after unilateral carpal tunnel release.

Multi-organ trauma with rupture and Stanford type B dissection of thoracic aorta. Management sequence. Current possibilities of medical treatment.

A case of a 46-year-old car driver struck with great force by a tram through the driver's door is presented. The main trauma consisted in chest injury with multi-rib fracture along with rupture and dissection of the thoracic aorta. Immediate medical rescue actions consisted only in procedures necessary to support vital functions; the patient survived owing to being promptly transported to the Emergency Department to undergo thoracotomy and laparotomy with massive blood transfusion. Polytrauma angio-CT scan revealed a posttraumatic thoracic aorta lesion which in turn was treated by deployment of an endovascular thoracic stent graft. This way, the immediate risk of death was averted, and the remaining traumatic lesions and conditions could be treated. Patient was discharged to a Rehabilitation Center on the 49th day of treatment. The authors stress that trauma resulting from accidents with this particular mechanism, i.e. lateral car crash on the driver's side with the driver's door being staved in by the tram, should be managed by immediate transport of the patient to the Emergency Center. In such cases early drainage of the pleural cavity can deteriorate patient's status by increasing the bleeding from the ruptured aorta.

Bilateral carpal tunnel syndrome - A review.

Carpal tunnel syndrome (CTS) is the most common upper extremity compressive neuropathy, with a prevalence of 3%-5% in the general population, and 6% in the group of females over the age of 40. It occurs about five times more common in females, with 2 peaks observed, in the 6th and 8th decades of life. Bilateral manifestation is more common than unilateral (60%), but significantly more often begins or is more strongly expressed in the dominant hand. Possible anatomical abnormalities underlying the development of CTS account for about 5% of cases. More and more scientific data confirm the significant role of central nervous system processes (including central sensitization) in the development of carpal tunnel syndrome, and changes in central nervous system body somatotopic representation, resulting from prolonged median nerve pathology, are described in consistence with the brain plasticity concept. This central involvement of bilateral CTS may explain that a proportion of patients following surgery for one hand experience improvement also in the non-operated hand.

Pneumopericardium as a non-small-cell lung carcinoma complication.

Below we present a case of a young man with symptoms of progressive weakness, fever, cough, rapid decrease in body weight and the presence of a tumor in the left axillary region. The chest radiography and echocardiography revealed gas bubbles in the pericardium. The more detailed diagnostics and computed tomography of the chest showed an infiltration of the left lung cavity and a fistula among the bronchus, pleural and pericardial cavities. Further diagnostics demonstrated that the pneumopericardium (diagnosed by means of chest radiograph and echocardiography) was a complication of a primary non-small-cell lung carcinoma.

Veno-venous extracorporeal membrane oxygenation in a patient with severe acute respiratory failure - case report.

Acute respiratory failure resistant to conventional pulmonary therapy often requires intensive medical care. In rare cases, ventilator therapy proves insufficient, and only the option of employing veno-venous extracorporeal membrane oxygenation (ECMO V-V) remains. The present article describes the case of a 23-year-old patient who experienced severe acute respiratory distress syndrome with associated multiple organ failure. The patient was admitted to the pulmonary ward of the Alfred Sokolowski Regional Pulmonary Hospital in Szczecin-Zdunowo with suspected pneumonia of unknown etiology. After the initial 5 days of diagnostics at the pulmonary ward, the patient required a further 97 days of hospital treatment and spent 63 days at the Intensive Care Unit. There, he underwent ECMO V-V therapy lasting 22 days, which resulted in the improvement of his arterial blood gas parameters and clinical condition.

[Primary pulmonary mucosa-associated lymphoid tissue lymphoma: a case report]. / Chloniak typu MALT o lokalizacji plucnej - opis przypadku.

Primary pulmonary lymphoma accounts only 0,5% of all primary lung neoplasms. Mucosa-associated lymphoid tissue (MALT) lymphoma is a low grade B-cell extranodal lymphoma. It is a quite infrequent entity, however it constitutes from 72% to 90% of all pulmonary lung lymphomas. Long-term stimulation of bronchus-associated lymphoid tissue by antigens, smoking, inflammatory disorders or autoimmune diseases are thought to be leading to the development of MALT lymphoma. We present the case of primary pulmonary mucosa-associated lymphoid tissue lymphoma. A 76-year-old man with a history of heavy smoking (22.5 pack years) was admitted to the hospital for a further diagnostics of an abnormal finding in the right lung visualized on the chest X-ray. The diagnostic process, including imagining studies did not reveal the etiology of a lesion in the right lung. The patient was qualified for surgical diagnostics. The histological finding confirmed extranodal marginal low-grade B-cell lymphoma of mucosa -associated lymphoid tissue.

Single lung transplantation in a patient with retrospective positive cross-match.

Lung transplantation is a method useful in such non-malignant end-stage parenchymal and vascular diseases as: chronic obstructive pulmonary disease (COPD), idiopathic interstitial pulmonary fibrosis, cystic fibrosis, or primary pulmonary hypertension. The main aim of this procedure is to extend the patient's lifespan and quality of life. However, the availability of the operation is limited by organ access. In this paper we present the case of a 58-year-old female in the fourth stage of COPD, who was classified to have a single lung transplantation. Because of some technical problems it was decided to transplant a left donor lung in the right recipient lung locus. Positive cross match was demonstrated retrospectively, and we applied five courses of plasmapheresis. Human immunoglobulin and rituximab treatment were performed to decrease the impact of lymphocytotoxic antibodies. The patient survived 498 days after transplantation, 271 in the hospital.

Exposure of the surgeon's hands to radiation during hand surgery procedures.

BACKGROUND: The objective of the study was to assess the time of exposure of the surgeon's hands to radiation and calculate of the equivalent dose absorbed during surgery of hand and wrist fractures with C-arm fluoroscope guidance. MATERIAL AND METHODS: The necessary data specified by the objective of the study were acquired from operations of 287 patients with fractures of fingers, metacarpals, wrist bones and distal radius. 218 operations (78%) were percutaneous procedures and 60 (22%) were performed by open method. Data on the time of exposure and dose of radiation were acquired from the display of the fluoroscope, where they were automatically generated. These data were assigned to the individual patient, type of fracture, method of surgery and the operating surgeon. RESULTS: Fixations of distal radial fractures required longer times of radiation exposure (mean 61 sec.) than fractures of the wrist/metacarpals and fingers (38 and 32 sec., respectively), which was associated with absorption of significantly higher equivalent doses. Fixations of distal radial fractures by open method were associated with statistically significantly higher equivalent doses (0.41 mSv) than percutaneous procedures (0.3 mSv). Fixations of wrist and metacarpal bone fractures by open method were associated with lower equivalent doses (0.34 mSv) than percutaneous procedures (0.37 mSv),but the difference was not significant. Fixations of finger fractures by open method were associated with lower equivalent doses (0.13 mSv) than percutaneous procedures (0.24 mSv), the difference being statistically non-significant. Statistically significant differences in exposure time and equivalent doses were noted between 4 surgeons participating in the study, but no definitive relationship was found between these parameters and surgeons' employment time. CONCLUSIONS: 1. Hand surgery procedures under fluoroscopic guidance are associated with mild exposure of the surgeons' hands to radiation. 2. The equivalent dose was related to the type of fracture, operative technique and - to some degree - to the time of employment of the surgeon.

[AN ANALYSIS OF THE CAUSES OF REFUSAL OF ADMISSION TO PATIENTS WITH SEVERE INJURIES AND AMPUTATIONS OF THE HAND REFERRED TO THE REPLANTATION SERVICE]. / ANALIZA PRZYCZYN ODMÓW PRZYJECIA PACJENTÓW Z ROZLEGLYMI RANAMI I AMPUTACJAMI RAK, ZGLASZANYCH DO SERWISU REPLANTACYJNEGO.

INTRODUCTION: Total or partial upper limb amputation significantly reduces ability of normal functioning in the society. Development of microsurgical skills enabled to replantation of the amputated limb (or part) and to regain its partial or sometimes full function. MATERIAL AND METHODS: The study analyses the causes of refusal of admission to 55 of 141 patients referred to the replantation service of the Department of General and Hand Surgery PUM, over the period 2012-2013. RESULTS: The causes of denied admission included: injury without compromise of blood supply to the limb (35%), distal amputations (27%), crush injuries (11%), single finger amputation (9%), severe damage of the amputated part (9%) and lower limb amputations (5%). The age of the patient had no significant influence on the decision to refuse admission. The distance between the referring hospital and the replantation centre was statistically significantly shorter in accepted cases (252 km vs 496 km, p < 0.05). CONCLUSION: Our outcomes show a variety of causes of refusal. of admission to patients with severe trauma and amputation of the hand. The main factors influencing decision making regarding admission or denial were associated with the actual danger to the survival of the involved limb, and estimation/calculation of the chance for limb saving.

[Replantation and reconstruction vs terminalization in the treatment of amputation of the digits]. / Porównanie wyników replantacji lub rekonstrukcji i terminalizacji w leczeniu amputacji palców rak.

MATERIAL AND METHODS: This study records the outcomes of the treatment of 21 patients, 19 men and two women, who sustained an amputation of the total of 35 digits (27 fingers and eight thumbs). Eleven patients received replantation or reconstruction maintaining the length of the digit, whereas ten had their digits terminalized. RESULTS: The results were assessed at a mean of 5 years after injury. Patients with finger stumps had stronger grip than those with replanted digits (72% vs 48% of strength of the healthy hand). Hand function as assessed by quickDASH score (29 vs 33), quality of life as assessed by SF-36 score (63 vs 67) and number of patients experiencing cold sensitivity (7 vs 7) were similar in both groups. Patients after terminalization returned to work significantly earlier than those after replantation or reconstruction (6 vs 12 months). CONCLUSIONS: These results show that - considering function of the hand - replantation or advanced reconstruction offers the patient less benefit than simple terminalization.