Deroofing: A safe, effective and well-tolerated procedure in patients with hidradenitis suppurativa.

INTRODUCTION: Hidradenitis suppurativa (HS) is a recurrent, debilitating, chronic disorder of the pilosebaceous unit. Although advances in HS treatment have been made, more than 45% of patients remain dissatisfied with systemic treatment, and more than one-third are dissatisfied with surgical procedures. OBJECTIVES: A prospective, observational study on the deroofing procedures in HS with special attention paid to patient satisfaction and complications. METHODS: HS lesions were assessed clinically and by the use of ultrasound. Patients reported outcomes, including pain, itch and satisfaction, were measured at 24 h post-surgery by a numeric rating scale (NRS) ranging from 0 to 10. Additionally, the timeline of objective wound closure reported by patients in (weeks), in addition to the need for any analgesics use, were both evaluated. RESULTS: The mean closure time of the post-deroofing wound was assessed as 4.4 ± 1.9 weeks. A statistically longer time was necessary for complete closure in males than in females (4.9 ± 2.2 weeks and 3.9 ± 1.6 weeks, respectively; p = 0.046). The closure time correlated positively yet weakly with the HS tunnel's width (r = 0.27, p = 0.016) and length (r = 0.228, p = 0.044). Patients assessed mean pain at 24 h post-op as mild with 0.7 ± 1.2 points according to NRS, with no differences between sexes. Similarly, itch in the first 24 h was assessed as mild with 1.8 ± 1.1 points, without differences between sexes. No pain, itch or adverse events were reported after 1 week following deroofing. Moreover, no cases of wound infection were reported. An overall patient satisfaction was assessed as 9.9 ± 0.4 points (range 9-10 points). CONCLUSION: Deroofing is an easy, effective and safe dermatosurgical procedure that does not require surgical experience or operating theatre. It is associated with no complications and very low post-op pain and should be part of holistic HS management.

Opioid receptors expression in the skin of haemodialysis patients suffering from uraemic pruritus.

BACKGROUND: Uraemic pruritus is a common symptom in patients with chronic kidney disease undergoing haemodialysis (HD) treatment. Etiopathogenesis of uraemic pruritus is complex and not fully explained, but there are reports indicating a possible role of peripheral opioid system in its pathomechanism. OBJECTIVES: This study was undertaken to analyse the expression of mu- and kappa-opioid receptors in the skin of HD patients with and without uraemic pruritus. METHODS: Forty patients suffering from chronic kidney disease, treated with haemodialysis (21 pruritic and 19 non-pruritic), were included. The expression of mu- and kappa-opioid receptors in their skin was evaluated with immunohistochemistry. RESULTS: The significant (P < 0.02) decrease in kappa-opioid receptor expression was shown in the skin of pruritic patients in comparison with the skin of those without itch (1.07 ± 0.62 and 1.66 ± 0.85, respectively). Moreover, there was a significant negative correlation between intensity of pruritus and expression of kappa-opioid receptors (r = -0.63, P = 0.002). There was no difference in the expression of mu-opioid receptor expression in the skin of pruritic and non-pruritic HD patients. CONCLUSIONS: This study indicates that changes in peripheral opioid system may play an important role in the uraemic itch pathogenesis and that future studies are necessary to fully understand this mechanism.

rs3827440, a nonsynonymous single nucleotide polymorphism within GPR174 gene in X chromosome, is associated with Graves' disease in Polish Caucasian population.

Recently Chu et al. conducted a two-stage genome wide association study in Chinese that identified a novel X-linked Graves' disease (GD) susceptibility marker at rs3827440 - a nonsynonymous (P162S) nucleotide transition (519C

Verification of the anatomy and newly discovered histology of the G-spot complex.

OBJECTIVES: To expand the anatomical investigations of the G-spot and to assess the G-spot's characteristic histological and immunohistochemical features. DESIGN: An observational study. SETTING: International multicentre. POPULATION: Eight consecutive fresh human female cadavers. METHODS: Anterior vaginal wall dissections were executed and G-spot microdissections were performed. All specimens were stained with haematoxylin and eosin (H&E). The tissues of two women were selected at random for immunohistochemical staining. MAIN OUTCOME MEASURES: The primary outcome measure was to document the anatomy of the G-spot. The secondary outcome measures were to identify the histology of the G-spot and to determine whether histological samples stained with H&E are sufficient to identify the G-spot. RESULTS: The anatomical existence of the G-spot was identified in all women and was in a diagonal plane. In seven (87.5%) and one (12.5%) of the women the G-spot complex was found on the left or right side, respectively. The G-spot was intimately fused with vessels, creating a complex. A large tangled vein-like vascular structure resembled an arteriovenous malformation and there were a few smaller feeding arteries. A band-like structure protruded from the tail of the G-spot. The size of the G-spot varied. Histologically, the G-spot was determined as a neurovascular complex structure. The neural component contained abundant peripheral nerve bundles and a nerve ganglion. The vascular component comprised large vein-like vessels and smaller feeding arteries. Circular and longitudinal muscles covered the G-complex. CONCLUSION: The anatomy of the G-spot complex was confirmed. The histology of the G-spot presents as neurovascular tissues with a nerve ganglion. H&E staining is sufficient for the identification of the G-spot complex.

Standard clinical computed tomography fails to precisely visualise presence, course and branching points of deep cerebral perforators.

BACKGROUND: Standard computed tomography (CT) images have earned a well-established position in neuroimaging. Despite that, CT is somehow limited by its resolution, which does not enable to distinctively visualise structures smaller than 300 µm in diameter. Perforating arteries, most of which measure 100-400 µm in diameter, supply important subcortical structures (thalamus, basal ganglia, internal capsule). Consequently, pathologies affecting these vessels (e.g. lacunar strokes) can have a devastating clinical outcome. The aim of our study was to assess standard CT's ability to visualise perforators and compare it with microscopic and micro-CT pictures. MATERIALS AND METHODS: We have obtained 6 brainstem and 17 basal ganglia specimens. We infused them with barium sulphate contrast medium administered into either vertebral or internal cerebral artery. After that, the specimens were fixed in formalin and subsequently a series of CT, micro-CT and microscopic examinations were performed. RESULTS: The median number of visualised perforators in brainstem and basal ganglia specimens was 8 and 3, respectively for CT and 18 and 7 for micro-CT (p < 0.05). Standard CT failed to clearly visualise branching points and vessels smaller than 0.25-0.5 mm (1-2 voxels) in diameter. Parallel vessels, like lenticulostriate arteries could not be differentiated in standard CT due to their proximity being smaller that the resolution. CONCLUSIONS: Basing on our results, we infer that CT is a poor modality for imaging of the perforators, presenting both quantitative and qualitative flaws in contrast with micro-CT.

The replication of the association of the rs6832151 within chromosomal band 4p14 with Graves' disease in a Polish Caucasian population.

Recently Chu et al. conducted a genome-wide association study in a Chinese Han population and identified two novel Graves' disease (GD) susceptibility loci within 4p14 (rs6832151) and 6q27 (rs9355610). Our purpose was to replicate these associations in a Polish Caucasian population. We analyzed rs6832151 and rs9355610 genotypes in a case-control study based on 560 GD patients and 1475 unrelated controls using TaqMan assays. Our study had the power of 0.8 and 0.6 to detect the effects originally reported for rs6832151 and rs9355610, respectively. We found an association between GD and the rs6832151 G allele (odds ratio OR = 1.27, P = 0.002). Analysis of model of inheritance suggested that the dominant model should be preferred (P(fit) = 0.938, OR = 1.39, P = 0.001). For rs9355610 a formally significant effect was observed assuming a recessive model (OR = 1.24, P = 0.028), whereas analysis of allele distribution showed a trend for association (OR = 1.14,95%, P = 0.082). Our findings are the first to show that rs6832151 and possibly rs9355610 contribute to GD pathogenesis also in Caucasians.

Differential association of juvenile and adult systemic lupus erythematosus with genetic variants of oestrogen receptors alpha and beta.

Oestrogens acting via nuclear receptors (encoded by ESR1 or ESR2) are important for pathogenesis of systemic lupus erythematosus (SLE). rs2234693 and rs4986938 are two single nucleotide polymorphisms (SNPs) whose C and A variants increase transcription of ESR1 and ESR2, respectively. The T allele of rs2234693 was associated with early onset SLE, whereas the role of rs4986938 in SLE was not reported. Our aim was to examine the role of rs2234693 and rs4986938 in conferring susceptibility to juvenile and adult SLE (jSLE and aSLE). Genotype distribution of both SNPs was analysed in 84 jSLE, 112 aSLE patients and 1001 controls. Allele C of rs2234693 was associated with jSLE (OR = 1.87, p = 0.006, p(corrected) = 0.02), whereas allele A of rs4986938 showed an association with aSLE (OR = 1.46, p = 0.008, p(corrected) = 0.03). In jSLE, rs2234693 C had lower frequency in patients with central nervous system involvement (OR = 0.39, p = 0.005, p(corrected) = 0.04) and showed a trend for increase among males, patients with renal involvement and those without DR2/3 (p < 0.05, p(corrected) > 0.05). Whereas our results are consistent with a role of ESR1 variation in jSLE, more studies are needed since the direction of association was the opposite of that reported previously. The association between rs4986938 (ESR2) and aSLE is a novel finding, consistent with our recent report associating this variant with Graves' disease.

Menisco-fibular ligament - an overview: cadaveric dissection, clinical and magnetic resonance imaging diagnosis, arthroscopic visualisation and treatment.

BACKGROUND: Injury to the menisco-fibular ligament (MFiL) is not commonly recognised. The anatomy of the lateral meniscus is complex and structure-function relationships are only partly understood. The purpose of the present study was to evaluate the MFiL, an anatomic structure rarely discussed that stabilises the lateral meniscus at the level of the hiatus popliteus and may have a crucial role in pathology of lateral meniscus injury. MATERIALS AND METHODS: The MFiL was dissected from its attachment at the lateral meniscus to its insertion on fibular head in 12 human normal cadaver knees. The dimensions were determined and its anatomic position visualised throughout a 90° range of motion. Findings were documented on digital photographs and on video. Results were compared against the magnetic resonance imaging (MRI) appearance of the injured MFiL in 20 patients. Concomitant knee injuries in those patients were also analysed to determine the most frequent pattern of injuries. RESULTS: The normal MFiL showed an inverted trapezoid-shape with a mean width proximally of 13 mm, mean width distally of 8.5 mm and a mean length of 18.4 mm. MRI visualisation of the ligament was possible even in regular sequences; however, additional radial plane sequences were also used. Arthroscopic visualisation and manipulation was optimal when the camera was inserted into the postero-lateral gutter with full knee extension. CONCLUSIONS: The MFiL stabilises the postero-lateral knee in concert with the menisco-femoral ligaments. Injury to the MFiL can be a cause of chronic postero-lateral pain syndrome with associated instability. Further anatomical and biomechanical studies are needed in order to fully evaluate its importance.

Validation of environmental transfer models and assessment of the effectiveness of countermeasures using data on (131)I releases from Chernobyl.

The studies undertaken by the (131)I Working Group, part of the International Atomic Energy Agency's EMRAS (Environmental Modelling for Radiation Safety) programme, were focused primarily on evaluating the predictive capability of environmental models. Particular emphasis was placed on applying models to evaluate the effectiveness of countermeasures.

A nicked duplex decamer DNA with a PEG(6) tether.

A dumbbell double-stranded DNA decamer tethered with a hexaethylene glycol linker moiety (DDSDPEG), with a nick in the centre of one strand, has been synthesised. The standard NMR methods, E.COSY, TOCSY, NOESY and HMQC, were used to measure (1)H, (31)P and T:(1) spectral parameters. Molecular modelling using rMD-simulated annealing was used to compute the structure. Scalar couplings and dipolar contacts show that the molecule adopts a right-handed B-DNA helix in 38 mM phosphate buffer at pH 7. Its high melting temperature confirms the good base stacking and stability of the duplex. This is partly attributed to the presence of the PEG(6) linker at both ends of the duplex that restricts the dynamics of the stem pentamers and thus stabilises the oligonucleotide. The inspection of the global parameters shows that the linker does not distort the B-DNA geometry. The computed structure suggests that the presence of the nick is not disturbing the overall tertiary structure, base pair geometry or duplex base pairing to a substantial extent. The nick has, however, a noticeable impact on the local geometry at the nick site, indicated clearly by NMR analysis and reflected in the conformational parameters of the computed structure. The (1)H spectra also show much sharper resonances in the presence of K(+) indicating that conformational heterogeneity of DDSDPEG is reduced in the presence of potassium as compared to sodium or caesium ions. At the same time the (1)H resonances have longer T:(1) times. This parameter is suggested as a sensitive gauge of stabilisation.

Human skull translucency: post mortem studies.

Measurements of optical translucency of human skulls were carried out. An incandescent light source and a CCD camera were used to measure the distribution of light transmitted through the skull in 10 subjects post-mortem. We noticed that intra-individual differences in optical translucency may be up to 100 times but inter-individual translucency differences across the skull reach 105 times. Based on the measurement results, a "theoretical" experiment was simulated. Monte-Carlo calculations were used in order to evaluate the influence of the differences in optical translucency of the skull on results of NIRS measurements. In these calculations a functional stimulation was done, in which the oxyhemoglobin and deoxyhemoglobin concentrations in the brain cortex change by 5µM and -5µM respectively. The maximal discrepancies between assumed hemoglobin concentration changes and hemoglobin concentration changes estimated with Monte-Carlo simulation may reach 50% depending of the translucency of the skull.

Model testing using data on 131I released from Hanford.

The Hanford test scenario described an accidental release of 131I to the environment from the Hanford Purex Chemical Separations Plant in September 1963. Based on monitoring data collected after the release, this scenario was used by the Dose Reconstruction Working Group of BIOMASS to test models typically used in dose reconstructions. The primary exposure pathway in terms of contribution to human doses was ingestion of contaminated milk and vegetables. Predicted mean doses to the thyroid of reference individuals from ingestion of 131I ranged from 0.0001 to 0.8 mSv. For one location, predicted doses to the thyroids of two children with high milk consumption ranged from 0.006 to 2 mSv. The predicted deposition at any given location varied among participants by a factor of 5-80. The exercise provided an opportunity for comparison of assessment methods and conceptual approaches, testing model predictions against measurements, and identifying the most important contributors to uncertainty in the assessment result. Key factors affecting predictions included the approach to handling incomplete data, interpretation of input information, selection of parameter values, adjustment of models for site-specific conditions, and treatment of uncertainties.

Model testing using data on 137Cs from Chernobyl fallout in the Iput River catchment area of Russia.

Data collected for 10 years following the Chernobyl accident in 1986 have provided a unique opportunity to test the reliability of computer models for contamination of terrestrial and aquatic environments. The Iput River scenario was used by the Dose Reconstruction Working Group of the BIOMASS (Biosphere Modelling and Assessment Methods) programme. The test area was one of the most highly contaminated areas in Russia following the accident, with an average contamination density of 137Cs of 800,000 Bq m-2 and localized contamination up to 1,500,000 Bq m-2, and a variety of countermeasures that were implemented in the test area had to be considered in the modelling exercise. Difficulties encountered during the exercise included averaging of data to account for uneven contamination of the test area, simulating the downward migration and changes in bioavailability of 137Cs in soil, and modelling the effectiveness of countermeasures. The accuracy of model predictions is dependent at least in part on the experience and judgment of the participant in interpretation of input information, selection of parameter values, and treatment of uncertainties.

The quality of heart valve tissue for homograft transplantation.

BACKGROUND AND AIM OF THE STUDY: The results of heart valve replacement surgery may be improved by refining surgical techniques and/or developing new heart valve transplants. The aim of this study was to examine the effect of age on the presence of cholesterol clefts and lipid deposits in the cusp base and sinus wall of aortic homografts. METHODS: Seventy-one valves were obtained at autopsy from donors (aged 15- 40 years) with no history of illness or evidence of serious illness. Trauma was the predominant cause of death among patients. The valves were examined using an osmium-vaporization technique. RESULTS: Osmiophilic deposits were detected in the cusp base in 28 cases (42%), and in the sinus wall in 49 cases (69%). Cholesterol crystals in the cusp base were found in 16 cases (24%), and sinus wall cholesterol clefts in 26 cases (38%). The model-predicted probability of cusp base lipid deposits existing was 76% in 40-year-old donors, 36% in 30-years-olds, and 11% in 20-year-olds; the probability of cusp base cholesterol clefts existing was 45%, 21% and 8% in these age groups, respectively. The influences of immunological reactions, biochemical changes (centers of calcification) and acceleration of atherosclerotic processes are discussed. CONCLUSION: The microscopic study of heart valves demonstrated the presence of lipid deposits in subjects of an unexpectedly young age. Among our study material, 58% of valves obtained from donors aged 11-40 years were unsuitable for transplantation. Our results confirmed the need for macroscopic inspection of heart valves before their being transplanted.

Electrophoretic seed globulin patterns and species relationships in the genus Lens Miller.

SDS-PAGE analysis of seed globulins covered 200 accessions of the following Lens taxa: L. culinaris subsp. culinaris, L. culinaris subsp. orientalis, L. odemensis, L. ervoides, L. nigricans, L. lamottei and L. tomentosus. The number of polypeptide bands detected in particular taxa varied from 22 in L. lamottei to 35 in L. ervoides. All the taxa under study showed variation due to differences among accessions and individual variation. Electrophoretic data were subjected to statistical analysis by the UPGMA method based on Euclidean distances. In the case of L. culinaris subsp. culinaris, some distinctness of the microsperma accessions from southern and central Asia was found. As to relationships among the studied taxa, the obtained results showed that L. culinaris subsp. culinaris appeared to be most closely allied to L. odemensis, while L. culinaris subsp. orientalis was found to be the closest relative of L. tomentosus. The four taxa formed one cluster separated from L. lamottei and L. ervoides. L. nigricans was shown to be the most divergent taxon.

Radiocesium in diet and humans in northeastern Poland after the Chernobyl accident.

137Cs and 134Cs concentrations were determined in the daily diet and foodstuffs in northeastern Poland in the fourth through sixth years after the Chernobyl accident. Intakes, body burdens, and dose equivalents were evaluated in the consecutive years. The data from this and previous work were used for the calculation of the effective half-time of radiocesium in humans. The effective half-time for 137Cs (1.94 y) was similar to that observed after nuclear weapons tests. The effective half-time for 134Cs was 0.98 y. Taking these half-times into account, the whole-body committed dose equivalent for the adult population was estimated to be 256 microSv; it was about 50% higher than that after the nuclear weapons tests.

[Analysis of factors affecting HBV and HCV infections in premature children]. / Analiza czynników sprzyjajacych zakazeniom HBV i HCV u dzieci przedwczesnie urodzonych.

Premature children with the very low birth weight, who need a long hospital treatment after the birth, belong to the group of the highest risk of HBV and HCV infections. The study includes 32 premature children, 14 girls and 18 boys, who were born between 26 and 35 week of pregnancy with the birth weight from 800 to 2400 g. Chronic hepatitis were found in these children; 11 children had HBV infection, 10 children had HCV infection, and both HBV and HBC infections were found in 11 children. Blood transfusions, parenteral nutrition, parenteral antibiotics, surgical treatment and other medical interventions were considered as the most important factors affecting HBV/HBC infections. All these factors should be taken into consideration in efforts to reduce the frequency of HBV and HBC infections in premature children.

[Evaluation of equivalent body burden in the thyroid for the people of Poland on results of 131I absorption after the disaster in Czernobyl. Determination of thyroid blockade with potassium iodide]. / Ocena równowazników dawek obciazajacych w tarczycy dla ludnosci Polski w wyniku wchloniec 131I po awarii w Czarnobylu. Okreslenie efektu blokady tarczycy jodkiem potasu.

An assessment of effectiveness of the administering of single dose of stable iodine in Poland on the reduction of 131I doses in thyroid has been performed. 5-compartment model of metabolism of iodine developed by Johnson has been used to evaluate predicted levels of stable iodine and 131I content in thyroid and commitment dose equivalent H50 for different doses of stable iodine and various age and sex group population. The measured values of 131I concentration in air and in milk and standard values for milk and food consumption and inhalation rate as well as metabolic parameters were used. Theoretical calculations showed that administering of stable iodine on 1986-04-28, 1986-04-29, 1986-04-30 and 1986-05-01 could have reduced committed dose equivalent H50 form ingestion with inhalation pathway by about 44%, 40%, 26%, 12% respectively. On the basis of measured 131I activity in the thyroid for inhabitants from different districts in Poland (1400 measurement) committed dose equivalents were determined and analysis of radiation hazard from 131I were performed. In the most contaminated regions of Poland average H50 doses for children 1-5 and 5-10 years old are close to 50 mSv (permissible level for population) and maximal doses exceed this limit four times. These maximal doses occurred for about from 5% inhabitants from these area. In the moderate and low contaminated regions of Poland the average doses are fivefold and tenfold less respectively.