Stabilization of the hypoplastic thumb type Blauth IIIB using a non-vascularized proximal interphalangeal joint from the toe as an alternative reconstruction when pollicization is not accepted: Description of the surgical technique.

BACKGROUND: A Blauth IIIB hypoplastic thumb is a significant functional and cosmetic problem for the developing hand in children. The gold standard in treatment is amputation and index pollicization. Despite the good functional results, some parents do not consent to the operation, mainly for cosmetic reasons. OBJECTIVES: The aim is to present a detailed description and features of the technique used in our department for stabilization of a hypoplastic thumb type Blauth IIIB with a non-vascularized proximal interphalangeal joint from the toe. This is the first description of this surgery for this kind of congenital defect, together with the largest group of patients analyzed compared to alternative techniques described in the literature. MATERIAL AND METHODS: Sixteen patients were included in the analysis. The mean age was 3 years (standard deviation (SD) ±2). In most cases, it was a unilateral and isolated defect. We described the surgical technique and postoperative management in detail and assessed intraoperative factors such as donor selection, operative time, technical problems, stabilization time, complication rate, and reoperations. Appropriate statistics were performed. RESULTS: Most often, the graft was taken from the 3rd toe. The average operation time was 59 ±17.5 min. No technical problems were found during the surgery. The Kirschner wire was removed after an average of 6.5 weeks. The complication rate was 25%, which included the destabilization of Kirschner wires or graft non-union, but it decreased to 6% after reoperation. Five patients underwent tendon transfers. CONCLUSIONS: The presented technique is based on principles such as vascularized metatarsophalangeal joint transplants. It may be an option for stabilizing a hypoplastic thumb if parents do not consent to pollicization. Having microsurgical skills is unnecessary. The operation and anesthesia times are significantly shorter, resulting in less burden on the child's body. The study will continue assessing long-term postoperative functions and the comparison to pollicization.

Hand and wrist - what the hand surgeon wants to know from the radiologist.

Hand surgeons, as unique specialists, appreciate the complexity of the anatomy of the hand. A hand is not merely a group of anatomic structures but a separate organ that works by feeling, sending information to the brain, and enabling a variety of movements, from precise skills to firm tasks. Acute and chronic problems interfere with complicated hand function and potentially influence work or daily life activities for a long time. Thus, the surgeon's role is to propose appropriate treatment with predictable results. This paper attempts to specify the preoperative considerations and their influence on the choice of surgical procedure and the assessment of results potentially influencing further treatment. We have divided the manuscript by anatomical structures, which is a natural surgical assessment and planning approach. The most common problems were highlighted to introduce the method of decision-making and surgical solutions.

End-to-Side vs. Free Graft Nerve Reconstruction-Experimental Study on Rats.

The long history of regeneration nerve research indicates many clinical problems with surgical reconstruction to be resolved. One of the promising surgical techniques in specific clinical conditions is end-to-side neurorrhaphy (ETS), described and then repeated with different efficiency in the 1990s of the twentieth century. There are no reliable data on the quality of recipient nerve regeneration, possible donor nerve damage, and epineural window technique necessary to be performed. This research attempts to evaluate the possible regeneration after end-to-side neurorrhaphy, its quality, potential donor nerve damage, and the influence of epineural windows on regeneration efficiency. Forty-five female Wistar rats were divided into three equal groups, and various surgical technics were applied: A-ETS without epineural window, B-ETS with epineural window, and C-free graft reconstruction. The right peroneal nerve was operated on, and the tibial nerve was selected as a donor. After 24 weeks, the regeneration was evaluated by (1) footprint analysis every two weeks with PFI (peroneal nerve function index), TFI (tibial nerve function index), and SFI (sciatic nerve function index) calculations; (2) the amplitude and latency measurements of motor evoked potentials parameters recorded on both sides of the peroneal and tibial nerves when electroneurography with direct sciatic nerve electrical stimulation and indirect magnetic stimulation were applied; (3) histomorphometry with digital conversion of a transverse semithin nerve section, with axon count, fibers diameter, and calculation of axon area with a semiautomated method were performed. There was no statistically significant difference between the groups investigated in all the parameters. The functional indexes stabilized after eight weeks (PFI) and six weeks (TFI and SFI) and were positively time related. The lower amplitude of tibial nerve potential in groups A and B was proven compared to the non-operated side. Neurophysiological parameters of the peroneal nerve did not differ significantly. Histomorphometry revealed significantly lower diameter and area of axons in operated peroneal nerves compared to non-operated nerves. The axon count was at a normal level in every group. Tibial nerve parameters did not differ from non-operated values. Regeneration of the peroneal nerve after ETS was ascertained to be at the same level as in the case of free graft reconstruction. Peroneal nerves after ETS and free graft reconstruction were ascertained to have a lower diameter and area than non-operated ones. The technique of an epineural window does not influence the regeneration result of the peroneal nerve. The tibial nerve motor evoked potentials were characterized by lower amplitudes in ETS groups, which could indicate axonal impairment.

The Usefulness of Motor Potentials Evoked Transvertebrally at Lumbar Levels for the Evaluation of Peroneal Nerve Regeneration after Experimental Repair in Rats.

Motor evoked potentials (MEPs) are used in neurology as part of a precise diagnostic method to study the transmission of efferent neural impulses at the central and peripheral levels of the nervous system. Previous attempts have been made to apply MEPs in animal studies for evaluating neural transmission at the motor cortex center level to the muscles of the forelimbs and hindlimbs. In clinical and experimental studies, little attention is focused on the significance of the magnetic stimulation of spinal cord structures with the direct recording of the evoked potentials from peripheral nerve motor fibers. The aim of this paper was to evaluate the usefulness of the motor potentials evoked transvertebrally at lumbar levels in the evaluation of experimental peroneal nerve regeneration in rats. The bilateral transmission of efferent impulses in the distal parts of the peroneal and tibial nerves was verified by recordings of evoked potentials following transvertebral magnetic stimulation at lumbar levels (MEPs) and the electrical stimulation of the sciatic nerve in classical electroneurographic (ENG) tests for comparison. Recordings were performed 24 weeks after grafts on surgically treated hindlimbs as well as on non-operated hindlimbs as controls. Both the MEP and ENG stimulations resulted in evoked potentials with larger amplitude values following the application of the magnetic pulses, with more being recorded on the non-operated hindlimbs than on the operated ones when recordings were taken from peroneal nerve branches. We observed statistically significant correlations between the MEP and ENG results for peroneal and tibial nerve amplitude on the non-operated side and peroneal nerve amplitude on the operated side. The recorded latencies of the evoked potentials were shorter in the ENG studies than in the MEPs for the non-operated side. The results demonstrated the phenomenon of regeneration in the motor fibers of the peroneal nerves 24 weeks after grafting in the experimental conditions. In this study, the MEPs were as useful as the ENG studies for evaluating regeneration in the motor fibers of hindlimb nerves in rats, although they were not significantly different. This paper discusses the clinical importance of transvertebral MEPs induced at the lumbosacral and cervical levels with a magnetic field for the diagnostic evaluation of efferent impulse transmission at different levels of the motor pathway.

Cost-effectiveness Analysis of Subcutaneous Infliximab for Inflammatory Bowel Diseases in Sequential Biologic Treatment.

BACKGROUND: Inflammatory bowel disease (IBD) guidelines recommend tumor necrosis factor-α inhibitors (TNFis) for patients who have not responded to conventional therapy, and vedolizumab in case of inadequate response to conventional therapy and/or TNFis. Recent studies have shown that vedolizumab may also be effective in the earlier treatment lines. Therefore, we conducted cost-effectiveness analyses to determine the optimal treatment sequence in patients with IBD. METHODS: A Markov model with a 10-year time horizon compared the cost-effectiveness of different biologic treatment sequences in patients with moderate to severe ulcerative colitis (UC) and Crohn's disease (CD) from the UK and French perspectives. Subcutaneous formulations of infliximab, vedolizumab, and adalimumab were evaluated. Comparative effectiveness was based on a network meta-analysis of clinical trials and real-world evidence. Costs included pharmacotherapy, surgery, adverse events, and disease management. RESULTS: The results indicated that treatment sequences starting with infliximab were less costly and more effective than those starting with vedolizumab for patients with UC in the United Kingdom and France, and patients with just CD in France. For patients with CD in the United Kingdom, treatment sequences starting with infliximab resulted in better health outcomes with incremental cost-effectiveness ratios (ICERs) near the threshold. CONCLUSIONS: Based on the ICERs, treatment sequences starting with infliximab are the dominant option for patients with UC in the United Kingdom, and patients with UC and CD in France. In UK patients with CD, ICERs were near the assumed "willingness to pay" threshold. These results reinforce the UK's National Institute for Health and Care Excellence recommendations for using infliximab prior to using vedolizumab in biologics-naïve patients.

A Markov model compared the cost-effectiveness of biologic treatment sequences in patients with moderate to severe inflammatory bowel diseases from a European perspective. The results indicated that treatment sequences starting with infliximab are the dominant option than those starting with vedolizumab.

Evaluation of the ulna lengthening by distraction osteogenesis in congenital radial deficiency.

PURPOSE: Publications evaluating the results of the ulna lengthening in congenital radial deficiency are based only on small groups of subjects which yield statistical studies of low scientific value. The aim was to examine the effectiveness of ulna lengthening in radial longitudinal deficiency and determine the number and quality of complications based on one of the most numerous study groups described in the literature. METHODS: The material consists of a study group with 31 upper limbs of unmatured patients diagnosed with type III and IV radial longitudinal deficiency. The study group was evaluated based on the parameters known from the literature. The difficulties during elongation were classified according to Paley's classification. RESULTS: The study group contained patients with a mean age of 9 years, and the number of boys and girls was comparable. Ulna length significantly increased after elongation compared to the initial bone length. The patient's age didn't affect the ulna lengthening, and the amount of elongation didn't significantly affect the total stabilization period. However, the total stabilization time increased with increasing patient age. Difficulties affected more than half of the cases. CONCLUSIONS: Ulna elongation in congenital radial deficiency results in significant lengthening of the ulna, and thus the entire forearm, compared to the initial bone length. This technique has a high percentage of difficulty, so its use should be considered after cautious discussion with the parents and patients.

Comparison of the Antioxidant Activity of Propolis Samples from Different Geographical Regions.

Propolis composition depends on several factors. The classification of propolis is based on its geographical location, color and agricultural characteristics. It is also classified according to the flora where the bees collect the resins, which represent the raw material for propolis production. Propolis possesses high antioxidant activity determined by its phenolic compounds. Due to diverse composition and possible impact on human health, eight samples of propolis were evaluated for their phenolic composition and antioxidant activity. Samples of Polish, Romanian, Turkish and Uruguayan origin propolis were used for phenolic spectrum determination using high performance liquid chromatography and photodiode array detection and in vitro DPPH and ABTS methods were used to determine the antioxidant activity of the extracts. PCA and HCA models were applied to evaluate the correlation between isolated polyphenols and antioxidant activity. The results confirmed variability in propolis composition depending on the geographical region of collection and the plant sources, and correlation between chemical composition and antioxidant activity. Results of PCA and HCA analyses confirm that Polish propolis is similar to that from different provinces of Romania, while Turkish and Uruguay are completely different. Polish and Romanian propolis belong to the poplar type. The assessed phenolic compounds of propolis samples used in the study are responsible for its antioxidant effect. The observed antioxidant activity of the analyzed samples may suggest directing subsequent research on prophylactic and therapeutic properties concerning cardiovascular, metabolic, neurodegenerative, and cancerous diseases, which are worth continuing.

The influence of shoulder arthrodesis on the function of the upper limb in adult patients after a brachial plexus injury: a systematic literature review with elements of meta-analysis.

Based on the literature, 294 shoulder arthrodeses after brachial plexus injury in adults were assessed, mostly male; the mean age of the patients was 33 years, and the mean follow-up time was 5.5 years. The most common cause of injury was a traffic accident, especially on a motorcycle.Arthrodesis position ranged from 15 to 40 degrees of flexion, 15 to 60 degrees of abduction, and 0 to 50 degrees of internal rotation with the predominance of position by the 30-30-30 rule. Plates, screws, and external fixation were used for stabilization. The complication rate was at the level of 28%, the most common complication being delayed union or nonunion.Active movements of flexion and abduction averaged 61 and 56 degrees, respectively, while reaching the hand to the mouth, front pocket, and buttock was feasible for 69%, 71%, and 38%, respectively, after surgery. Shoulder pain was present in 77% of patients, and 28% experienced no relevant pain reduction after surgery. The subjective satisfaction rate was 82% based on significant improvement and satisfaction reported by patients after arthrodesis.Arthrodesis of the shoulder, in adult patients after brachial plexus palsy, can reduce shoulder pain, increase stability, and result in a range of motion that increases the possibility of carrying out everyday activities. This affects the high level of subjective patient satisfaction after surgery. Cite this article: EFORT Open Rev 2021;6:797-807. DOI: 10.1302/2058-5241.6.200114.

Factors affecting the final outcomes after reconstruction of the median and ulnar nerve at the level of the forearm: Analysis of 41 patients.

BACKGROUND: Upper extremity injuries have a significant impact on social and professional life. They represent about 10% of visits to emergency departments. Nerve lacerations are one of the biggest problem because loss of innervation results in muscle atrophy, decreased sensibility, and therefore permanent dysfunction. Appropriate treatment is very important for patients to regain function. MATERIALS AND METHODS: The study included 41 patients, 30 men and 11 women who underwent nerve repair surgery in the middle and distal forearm level in the years 2001-2017. The patients' age ranged from 9 to 73 years with an average of 37 years. They were divided into 3 groups with repaired median, ulnar and both nerves. We determined time from injury to nerve repair, assessed sensitivity in index and little finger with a two-point discriminator, and muscle strength by measuring adduction of the little finger and palmar abduction of the thumb.Results were rated based on Medical Research Council Scale (MRC). In addition, general hand disability was assessed according to the Disabilities of the Arm, Shoulder and Hand Questionnaire (DASH). RESULTS: There was a statistically significant (p = 0.0197), positive correlation (r > 0) between the period from injury to surgery and the DASH score, and statistically significant difference (p = 0.0001) in return of muscular function between groups with median, ulnar and both nerves injury. Also correlation between patients age and score of DASH was statistically significant (p = 0.0140) with positive correlation (r > 0). There was no statistically significant difference in the return of sensitivity (p = 0.4337) and the DASH score (p = 0.3831) between these three groups. CONCLUSIONS: Patients with shorter time from injury to repair and at a younger age had better DASH results. The median nerve had the best motor function between the groups. There was no difference in sensitivity or DASH scores between groups.

Parkinson's disease with early motor complications: predicting EQ-5D- 3L utilities from PDQ-39 data in the EARLYSTIM trial.

BACKGROUND: A utility value is a health-related quality of life metric (HRQoL) metric used in a cost-effectiveness analysis. While utilities as outcomes in the treatment of advanced Parkinson's disease (PD) with deep brain stimulation (DBS) are available, they do not currently exist for PD with early motor complications. The objectives of this study were to predict utilities from observed disease-specific HRQoL data using two mapping algorithms, and investigate their performance in terms of longitudinal changes within and between treatment groups, and distribution by PD severity. METHODS: This is a post hoc analysis of data from the EARLYSTIM trial of DBS compared with best medical therapy (BMT) in PD patients with early motor complications We used two published algorithms comprising ordinal and multinomial regression models to map EQ-5D-3L utilities from observed PD-specific 39 item Questionnaire (PDQ-39) scores in EARLYSTIM. Utilities were calculated using the predicted functioning levels of EQ-5D-3L dimensions and the established EQ-5D-3L UK tariffs. Statistical analyses (analysis of variance, two-tailed Student's t-test) were used to test the change from baseline within groups and difference in change from baseline between groups in utilities. Boxplots were developed to investigate the distribution of predicted utilities by PD severity, measured using the Hoehn and Yahr scale. RESULTS: The change from baseline in predicted mean utilities was statistically significant at all visits up to 24 months for the DBS group (p < 0.001) with both algorithms, and statistically significant at 12 months only (p = 0.04) for the BMT group with one algorithm. With both algorithms, the between-groups difference in change from baseline in predicted mean utilities favored DBS at all follow-up visits (p < 0.001). Based on the Hoehn and Yahr scale, predicted utilities deteriorated with increasing disease severity. CONCLUSIONS: Among PD patients with early motor complications, utilities predicted by both mapping algorithms using PDQ-39 data demonstrated a statistically and clinically meaningful improvement with DBS compared with BMT. It was not possible to conclude if one algorithm was more responsive than other. In the absence of utilities collected directly from patients, mapping is an acceptable option permitting economic evaluations to be undertaken.

Bee Products in Dermatology and Skin Care.

Honey, propolis, bee pollen, bee bread, royal jelly, beeswax and bee venom are natural products which have been used in medicine since ancient times. Nowadays, studies indicate that natural bee products can be used for skin treatment and care. Biological properties of these products are related to flavonoids they contain like: chrysin, apigenin, kaempferol, quercetin, galangin, pinocembrin or naringenin. Several pharmacological activities of phenolic acids and flavonoids, and also 10-hydroxy-trans-2-decenoic acid, which is present in royal jelly, have been reported. Royal jelly has multitude of pharmacological activities: antibiotic, antiinflammatory, antiallergenic, tonic and antiaging. Honey, propolis and pollen are used to heal burn wounds, and they possess numerous functional properties such as: antibacterial, anti-inflammatory, antioxidant, disinfectant, antifungal and antiviral. Beeswax is used for production of cosmetics and ointments in pharmacy. Due to a large number of biological activities, bee products could be considered as important ingredients in medicines and cosmetics applied to skin.

RAPESEED PHOSPHATIDYLCHOLINE HYDROLYSIS TO PHOSPHATIDIC ACID USING PLANT EXTRACTS WITH PHOPSPHOLIPASE D.

Phosphatidic acid (PA) has a crucial role in cell membrane structure and function. For that reason it has a possible application in the treatment of some health disorders in humans, can be used as a natural and non toxic emulsifier and the component of drug carriers in pharmaceuticals and cosmetics as well as a component for synthesis of some new phospholipids. PA is short-lived in the cell and is difficult to extract directly from the biological material. PA may be easily prepared by hydrolysis of phospholipids, especially phosphatidylcholine (PC), using cabbage phospholipase D (PLD). Hydrolytic activity of purified by us PLD extracts from cabbage towards rapeseed phosphatidylcholine (RPC) was investigated. Hydrolysis was carried out in the biphasic system (water/diethyl ether) at pH 6,5 and temp 30°C. Influence of enzymatic extracts from three cabbage varieties, reaction time, Ca2+ concentration and enzyme extracts/PC ratio, on activity towards RPC resulting in rapeseed phosphatidic acid (RPA) formation were examined. Our study shows that the PLD extracts from savoy cabbage (PLDsc), white cabbage (PLDwc) and brussels sprouts (PLDbs) used in experiments exhibit hydrolytic activity towards RPC resulting in rapeseed RPA with different yield. The highest activity towards RPC shows PLD extract from PLDsc with the RPC conversion degree to RPA (90%) was observed at 120 mM Ca2+ concentration, reaction time 60 min and ratio of PLD extract to RPC 6 : 1 (w/w). Our study shows that purified by us PLDsc extracts exhibit hydrolytic activity towards RPC giving new RPA with satisfying conversion degree for use in pharmacy, cosmetics and as a standard in analytical chemistry.

Polyphenols from Bee Pollen: Structure, Absorption, Metabolism and Biological Activity.

Bee pollen constitutes a natural source of antioxidants such as phenolic acids and flavonoids, which are responsible for its biological activity. Research has indicated the correlation between dietary polyphenols and cardioprotective, hepatoprotective, anti-inflammatory, antibacterial, anticancerogenic, immunostimulating, antianaemic effects, as well as their beneficial influence on osseous tissue. The beneficial effects of bee pollen on health result from the presence of phenolic acids and flavonoids which possess anti-inflammatory properties, phytosterol and linolenic acid which play an anticancerogenic role, and polysaccharides which stimulate immunological activity. Polyphenols are absorbed in the alimentary tract, metabolised by CYP450 enzymes, and excreted with urine and faeces. Flavonoids and phenolic acids are characterised by high antioxidative potential, which is closely related to their chemical structure. The high antioxidant potential of phenolic acids is due to the presence and location of hydroxyl groups, a carboxyl group in the immediate vicinity of ortho-diphenolic substituents, and the ethylene group between the phenyl ring and the carboxyl group. As regards flavonoids, essential structural elements are hydroxyl groups at the C5 and C7 positions in the A ring, and at the C3' and C4' positions in the B ring, and a hydroxyl group at the C3 position in the C ring. Furthermore, both, the double bond between C2 and C3, and a ketone group at the C4 position in the C ring enhance the antioxidative potential of these compounds. Polyphenols have an ideal chemical structure for scavenging free radicals and for creating chelates with metal ions, which makes them effective antioxidants in vivo.

Structure and antioxidant activity of polyphenols derived from propolis.

Propolis is a potential source of natural antioxidants such as phenolic acids and flavonoids. Its wide biological effects have been known and used since antiquity. In the modern world natural substances are sought which would be able to counteract the effects of antioxidative stress, which underlies many diseases, such as cancer, diabetes and atherosclerosis. This paper aims to present the antioxidative activity of phenolic acids and flavonoids present in Polish propolis and the relationship between their chemical structure and antioxidative activity influencing its medicinal properties. Data concerning the biological activity of propolis are summarized here, including its antibacterial, anti-inflammatory, anticarcinogenic, antiatherogenic, estrogenic effects, as well as AIDS- counteracting and reparative-regenerative function.

Rapeseed lecithin hydroxylation by chlorine replacing with hydroxyl groups in chlorinated phospholipids.

Rapeseed lecithin ethanol soluble fraction (LESF) was hydroxylated with 30% hydrogen peroxide in the presence of acetic acid. The product was compared to the one obtained by method based on nucleophilic substitution reaction of phospholipids chlorine derivatives. In this approach, hydrogen chloride was added to double bonds in unsaturated acyl groups of phospholipids. Next, chlorine was replaced with hydroxyl groups via the alkaline hydrolysis of chlorine derivatives. The surface active properties of the products obtained with the usage of two methods of rapeseed LESF hydroxylation were determined. The minimal surface tension (eta(min), mN/m) and the critical micelle concentration (CMC, g/L) of LESF hydroxylated with hydrogen peroxide (20.2 mN/m, 6.0 g/L) and obtained by chlorine replacing with hydroxyl groups in chlorinated phospholipids (25.0 mN/m, 9.8 g/L) were compared to LESF (31.8 mN/m, 17.8 g/L). Hydroxylated LESF obtained by lecithin chlorination and chlorine replacing with hydroxyl groups in the chlorine derivatives has no peroxides and the good surface active properties. The product as an effective emulsifier can be used in pharmacy and cosmetics.

Antioxidant activity of ethanolic fractions of Polish propolis.

There is a great variation in the chemical composition of propolis of different origins. Likewise, the method of its extraction has significant impact on the content of biologically active compounds. Here we compared methods of propolis extraction for optimal antioxidant activities which were measured by means of beta-carotene discolouration, 1,1-diphenyl-2-picrylhydrazyl (DPPH) free radical scavenging, and 2,2'-azinobis-3-ethylbenzothiazoline-6-sulfonic acid (ABTS*+) radical cation decolouration assays. In the extracts, the contents of polyphenols and flavonoids were measured, and phenolic acids were identified and quantified by HPLC. A three-step extraction allowed obtaining large amounts of phenolic acids from propolis. The propolis fractions obtained had antioxidant properties comparable to those of alpha-tocopherol and butylated hydroxytoluene. Therefore, they may be used as effective natural antioxidants.