Could the use of butyric acid have a positive effect on microbiota and treatment of type 2 diabetes?

OBJECTIVE: This review focuses on the role of butyrate as one of the key metabolites of gut microbiota. Butyrate along with other short-chain fatty acids, acetate and propionate, is one of the most important regulators of human metabolism. In this review, we discuss how changes in gut microbiota triggered by type 2 diabetes mellitus and its treatment (e.g., metformin) affect butyrate synthesis, how to increase butyrate production and whether there is robust evidence for the positive effects of sodium butyrate in the treatment of diabetes mellitus. MATERIALS AND METHODS:  Literature review was conducted by all authors. Studies published until 27/03/2020 were included. Search words were: ("butyric acid" OR "butyrate") AND ("type 2 diabetes "OR "T2DM"). The articles selected for the study were not chosen in a systematic manner, so the evidence may not be comprehensive. RESULTS: Butyrate was found to effectively reduce inflammation and plays a prominent role in the function of the intestinal barrier. To date the use of sodium butyrate in the treatment of patients with T2DM is not very popular. Meanwhile, butyric acid can beneficially modulate intestinal functions, counteracting the negative effects of the disease as well as the drugs used to treat diabetes. CONCLUSIONS: T2DM is a widespread chronic disease. Understanding role of microbiota in type 2 diabetes and the mechanisms connecting T2DM and alterations in gut microbiota could be the key to improved treatment of T2DM.

Catechol-oxide-methyltransferase (COMT rs4680:G>A) gene polymorphism does not affect analgesics' demand after elective hip replaceme.

Pain in patients with hip osteoarthritis appears long before surgery, and requires effective management as it affects patient comfort and daily activities. Therefore, the search for factors influencing response rate to analgesics is mandatory. In recent years, increasing attention has been paid to genetic factors underlying pain threshold and treatment efficacy. Polymorphic gene of catechol-oxide-methyltransferase (COMT) is a candidate gene associated with pain pathology and treatment response. The aim of the study was to evaluate association between the COMT rs4680:G>A polymorphism and demand for analgesics in patients subjected to elective hip replacement. The study included 196 patients after hip replacement surgery. Opioid demand was recorded and analgesic efficacy was scored using a four-level verbal pain intensity scale. COMT rs4680:G>A polymorphism was analysed by PCR-RFLP method. The studied COMT genotypes did not influence opioid administration in the studied patients from the day of surgery till day 6 afterwards. The distribution of the COMT rs4680:G>A in the studied subjects was as follows: GA­52.04%, AA­23.98% and GG­23.98%. It can be concluded that the COMT rs4680:G>A polymorphism is not associated with opioid demand in patients after elective hip replacement.

First metatarsophalangeal joint replacement with modular three-component press-fit implant. Preliminary report.

PURPOSE OF THE STUDY: The aim of this retrospective study was to assess functional and radiographic results of the first metatarsophalangeal joint replacement with use of unconstrained, modular, three components, porous titanium and hydroxyapatite coated, press-fit METIS® prosthesis. According to author's knowledge, results of that type of prosthesis have never been published before. MATERIAL AND METHODS: 25 prosthesis were implanted in 24 patients between February 2009 and May 2011. American Orthopaedic Foot and Ankle Society Hallux Metatarsophalangeal Interphalangeal scoring system (AOFAS-HMI) was used to assess functional results. Patients were also asked if they would undergo procedure again or recommend it to other people. Weight bearing radiographs ware made at final follow up and analyzed for presence of osteolysis and radiolucencies. In 8 patients total joint replacement was introduced as a salvage after failure of previous surgery like Keller resection arthroplasty, failed arthrodesis, avascular necrosis and postoperative arthritis. In 11 patients the reason for prosthetic replacement were hallux rigidus, in 4 cases rheumatoid arthritis and gout in one patient. In two patients additional procedures like Akin phalangeal osteotomy and in one case fifth metatarsal osteotomy, was performed. There were 20 females and 4 males in presented group. The mean age at the operation was 56 years. The average follow up period was 18 months (from 12 to 36 months). RESULTS: The median postoperative value of AOFAS-HMI scores was 88 points (from 75 to 95 points). First metatarsophalangeal joint motion (dorsiflexion plus plantarflexion) was classified according to AOFAS-HMI ranges as: moderately restricted (between 30 to 70 degrees) in 19 patients 80% (20 prosthesis) and severely restricted (less then 30 degrees) in 5 patients (20%). 15 (64%) patients were completely satisfied, 5 (20%) reported moderate satisfaction and (16%) 4 were totally disappointed and would not undergo this procedure again. A limited hallux dorsiflexion was the main dissatisfaction reason. Partial radiolucent line was seen in one patient (4%). Authors noticed two serious complications. In one patient, with rheumatoid arthritis, deep infection occurred 12 months after prosthesis implantation. In second case phalangeal implant was revised due to misalignment. CONCLUSIONS: METIS® metatarsophalangeal joint replacement allows alleviate of pain relating to hallux rigidus and partial restoration of joint movement, even in patients after failures of primary metatarsophalangeal joint surgery. AOFAS-HMI results are better than previously reported in the literature in assessment of the first metatarsophalangeal joint replacement. Radiographic results imply satisfactory bone ingrowth into the cementless implants.

Computed tomographic angiography and perfusion in the diagnosis of brain death.

INTRODUCTION: According to Polish brain death (BD) criteria, instrumental confirmatory tests should be used in certain clinical situations, particularly any case for which clinical examinations seem inadequate. Electrophysiological tests are often unavailable. Therefore, cerebral perfusion testing is the method of choice with four-vessel digital subtraction angiography (DSA), the gold standard. Unfortunately, DSA is an expensive and invasive examination that requires an experienced neuroradiologist and the availability of an angiography suite. Recently, multirow computed tomographic devices became available, even in smaller hospitals in Poland. Despite this fact, computed tomographic angiography (CTA) and computed tomographic perfusion (CTP) are not accepted in BD diagnosis protocols in Poland because of limited experience and a lack of widely accepted criteria. In this situation, we started a multicenter trial to determine the accuracy of CTA and CTP to confirm BD. METHODS: We examined 24 patients who fulfilled standard clinical BD criteria. We recognized the absence of brain perfusion in CTA examination following the criteria proposed by the French Society of Neuroradiology, namely, the absence of opacification of M4 middle cerebral artery segments (M4-MCA) and of deep cerebral veins. RESULTS: In all of our patients, CTA showed absence of opacification of M4 segments and of deep cerebral veins. In addition, three patients had CTA showing weak opacification of A2 segments of the anterior cerebral artery (A2-ACA) and M2 or M3-MCA. Opacification of the basilar artery or of the posterior cerebral arteries was not noted in any case. In all patients, CTP revealed zero values of regional cerebral blood volume and regional cerebral blood flow. Conventional angiography confirmed cerebral circulatory arrest in all 24 cases. CONCLUSION: CTA and CTP seem to be promising radiological examinations for the diagnosis of BD. They may be noninvasive alternatives to conventional cerebral angiography, and to the other instrumental confirmatory tests, that are unavailable or inadequate.

Reversal to whole-brain death criteria after 15-year experience with brain stem death criteria in Poland.

Polish brain-death criteria, similar to the original Harvard criteria, were published in 1984. In 1990, they were converted to brainstem death criteria, and were revised twice, in 1994 and in 1996. However, they could not be used in many complicated clinical situations such as intoxication, metabolic alterations, major facial injury, infratentorial lesions, and cervical spinal cord injury. The new Polish Transplant Act, passed by the Polish Parliament in 2005, recommends implementation of criteria for whole-brain death for brain-death diagnosis. In 2007, the Polish Ministry of Health Commission outlined new Polish brain-death criteria. Optional use of instrumental confirmatory tests was implemented in the new Polish national code of practice for the diagnosis of brain death in adults. In children up to age 2 years, instrumental tests are obligatory. Initially, there were problems in understanding the new, slightly more complicated classifications of primary and secondary brain injuries, infratentorial and supratentorial processes, modified apnea test. A broad commentary that addressed the most frequently asked questions was published in Anesthesiology and Intensive Therapy, the official journal of the Polish Society of Anaesthesiology and Intensive Therapy. This article dealt with most of the problems associated with implementation of the new criteria for diagnosis of brain death.

Unusual movements, "spontaneous" breathing, and unclear cerebral vessels sonography in a brain-dead patient: a case report.

A patient with a brain injury fulfilled all clinical criteria for brainstem death diagnosis. Two standard sets of tests were performed; according to Polish regulations, the patient could be declared brain dead. However, shortly after the completion of the tests and before the final brain death declaration, 6 triggered "assisted" breaths/min were noticed. After careful analysis of the ventilator settings, it was concluded that low trigger sensitivity and airway pressure oscillations during heart contractions were the reasons. Additionally, a few minutes later, spontaneous jerking movements of lower limbs and clonic movements of neck muscles secondary to painful stimuli were noticed. The situation became confusing; therefore, cerebral Doppler sonography was performed, showing circulatory arrest in both of the internal carotid, middle cerebral, and left vertebral arteries. The basilar artery was not visualized. Forward flow with increased pulsatility was recorded in extracranial and intracranial segments of the right vertebral artery. Cerebral circulatory arrest was still uncertain; therefore, the diagnostic procedures were completed with conventional cerebral angiography, which showed a lack of cerebral blood flow. Finally, the patient was declared brain dead; kidneys and bones were harvested. Cardiogenic oscillations associated with incorrect low ventilator trigger settings may falsely suggest persistence of breathing efforts in a brain-dead patient. In the case of any unusual events during brain death diagnosis, cerebral perfusion tests should be performed with cerebral angiography as the "gold standard."

Is retrieval of bone material from multiorgan donors effective enough to cover demand for biostatic bone tissue grafts in Poland?

In Poland there is growing demand for biostatic allogeneic bone transplantation mostly for traumatologic operations and orthopedic reconstructions. The bone material is primarily harvested during postmortem examinations in forensic and pathology laboratories. Nevertheless, the collected amounts are not sufficient, so that material needs to be acquired from alternative sources, such as multiorgan donors. Between 1998 and 2003, 2331 potential donors were registered by the Transplantation Coordinating Center in Warsaw, which was adjusted to 1794 donors who would have been accepted as donors of the bone tissue. Unfortunately, due to denials from family members and public prosecutors, the sample was only 1416 donors, which would cover about 40% of the clinical orthopedic demand in Poland.

Factors determining the contamination of bone tissue procured from cadaveric and multiorgan donors.

There is an increasing demand for bone allografts that are widely used in orthopedic reconstructive procedures. The bone tissue may be harvested from two sources: cadavers and multiorgan donors. Providing safe and valuable bone allografts is of paramount importance. Contamination of allografts during bone retrieval seems to be one of the most important problems since pathogenic microorganisms might be responsible for postoperative infections and complications in the healing process. The purpose of our study was to identify all factors contributing to bacteriological contamination of harvested bones. Therefore, we have considered factors such as harvesting environment, explantation techniques, storage and preparation of allografts, number of preceding procurements from the same donor, procurement duration, and time interval between death and tissue procurement. The microbiological evaluation of allografts has been performed by taking cultures from all collected bones. Our study revealed significantly greater contamination rates of bone allografts harvested from morgue than from multiorgan donors. According to this observation, we suggest that orthopedic surgeons should pay particular attention to obtain more bones of the highest quality, personally participating in multiorgan procurements.

[HIV infection in the operating room conditions]. / Zakazenie HIV w warunkach pracy bloku operacyjnego.

Several cases of occupational HIV transmission during surgical procedures have been reported all over the world in the last few years. Orthopaedic surgeons are at particularly high risk for blood contamination and skin injuries. This article addresses the risk of HIV transmission in the surgical setting with a focus on specific risk factors: the prevalence of the infection in general population, the stage of the disease, virulence, inoculum size, the nature and frequency of blood contacts. It also shows how the last two factors depend on surgical specialty, duration and kind of the procedure, role of each person, number of needles used and amount of blood loss. The recommended safer surgical techniques as well as personal protective equipment are presented as the strategy to prevent health care worker--to patient transmission. The importance of compliance with universal precautions is pointed as a way to achieve a successful outcome in preventing infection with HIV.

[Current methods of thromboprophylaxis in total hip arthroplasty]. / Wspólczesne metody profilaktyki przeciwzakrzepowej w alloplastykach calkowitych stawów biodrowych.

The paper presents a review of methods of thromboprophylaxis, with regard given to both pharmacological and physiotherapeutic means in patients who underwent a total hip replacement procedure. Routine procedure should involve proper assertion of indications for surgical treatment, appropriate preoperative planning, surgery carried out in conduction anaesthesia, in the shortest possible time and as atraumatically as possible. Several weeks' of pharmacological treatment involving use of low molecular weight heparins in unison with mechanical means e.g. elastic stockings should follow surgical intervention. Quick mobilization of the patient following the surgical procedure along with intensive physiotherapy results in a decrease of the risk of thrombosis. In order to increase the efficiency of thromboprophylaxis different preventive methods should be applied simultaneously.

[HIV-testing of patients and operating room staff: myths and facts]. / Badania pacjentów i czlonków zespolu operacyjnego w kierunku przeciwcial anty-HIV--mity i fakty.

Orthopedic surgeons are at risk of acquiring HIV. Multi-center studies have estimated the risk of infection related with exposure to blood and other body fluids. New discussion concerning mandatory testing of patients who require invasive procedures has arisen as several reports on occupationally acquired HIV infections have been published. The case of the French surgeon highlighted the high risk of infection by blood-born pathogens related to certain surgical techniques. Cases of patients infected by HIV by medical personnel (by an American dentist and the mentioned before French surgeon) are also discussed. Basing on these two cases, the procedures with the highest infection risk are discussed, along with HIV testing policies towards surgeons of health care authorities in different countries. The importance of preventive measures, considering no cure for HIV infections is available is also stressed.

An atypical surgical solution in a hangman's fracture: case report.

Anyone who is familiar with the pathomechanism of hangman's fractures will surely think twice before considering this type of injury to be relatively safe, on the grounds that a fracture of the C2 arches creates the conditions for decompressing the spinal cord, while the fact that the entire posterior complex is maintaining the ligament connection means that the fracture is relatively stable. Doe to the complexity of the pathomechanism involved in fractures, it is difficult to set the displacement non-surgically, and it may be dangerous to do so in the event of uncontrolled spine distraction. This article describes the surgical solution used to treat patient with a hangman's fracture using the anterior and posterior approaches simultaneously. The surgical procedure described here made it possible to decompress the spinal cord, perform a solid fixation, mobilize the patient quickly after surgery, and initiate effective rehabilitation.

[Factors influencing bone mineral density around the femoral stem after cementless total hip arthroplasty]. / Wybrane czynniki wplywajace na gestosc mineralna kosci wokól trzpienia endoprotezy po bezcementowej alloplastyce stawu biodrowego.

Factors influencing bone mineral density around the femoral stem after PM cementless total hip arthroplasty were evaluated in longitudinal study of 18 hips in 18 patients who had undergone surgery due to unilateral hip osteoarthritis. Bone mineral density in the femoral neck was determined by dualenergy X-ray absorptiometry measurement performed preoperatively and in periprosthetic femoral Gruen's zones prospectively 2 weeks, 3, 6, 12 and 24 months after surgery. The concentrations of calcium, magnesium and fluoride were measured in cortical and trabecular bone samples taken from resected femoral head and neck. At 12 and 24 months after the operation the regional bone mineral density measurement showed significant, maximum decrease but after 12 months bone mineral density appeared to be stabilized. The analysis of preoperative femoral neck density and fluoride content in trabecular bone proved that osteopenia and lower fluoride concentrations correlated significantly with greater bone density decrease after total hip arthroplasty. No other factors (age, sex, weight, calcium and magnesium concentrations in bone and fluoride concentration in cortical bone) showed significant associations.

[The evaluation of the effect of sodium fluoride concentration on the mechanical strength of the femoral bone in growing rats]. / Ocena wytrzymalosci kosci udowych u rosnacych szczurów otrzymujacych fluorek sodu w róznych stezeniach.

The aim of the study was to investigate the effects of different natrium fluoride concentrations on mechanical strength of femoral bone in young growing rats. Forty 6-weeks-old female Wistar rats were randomised into four groups. One group served as a control group receiving distilled water and the other three groups received fluoridated water with NaF at different doses (8, 30 and 60 mg F-/1). All rats were sacrificed after six weeks. The femoral bones were obtained from each rat, and bending strength of the femoral shaft and failure load of the femoral neck were assessed. Bending strength of the femoral shaft decreased significantly after fluoride therapy. The group receiving 8 mg F-/1 showed the highest failure load of the femoral neck, in comparison to the control group and groups receiving 30 and 60 mg F-/1.

[Hardness of bone tissue in growing rats treated by fluoride of various concentration]. / Twardosc tkanki kostnej zbitej u rosnacych szczurów otrzymujacych fluorki w róznych stezeniach.

The aim of the study was to investigate the effect of fluoride exposure on both bone fluorine content and bone hardness in rats. Twenty eight 6-weeks-old female rats were divided in four groups. One group served as a control group and received distilled water to drink, and the other three groups received fluoridated water at different doses (8, 30 and 60 mg F-/l). The rats were followed for 6 weeks. Both femoral bones were obtained from each rat, and changes in cortical bone fluoride content and Vickers microhardness in distal femoral diaphysis were assessed. Fluoride concentration in bone increased significantly with the fluoride intake through the water supply. Microhardness values were significantly greater in groups receiving fluoridated water, with maximum values in the 30 mg F-/l treated group. The results of this study show the usefulness of Vickers microhardness tests in examining mechanical changes in cortical bone after experimental exposure to fluoride.

[Aneurysmal bone cyst and solitary cyst of bone]. / Torbiele tetniakowate i samotne kosci.

Results of treatment of 7 cases of aneurysmal bone cysts and 12 cases of solitary bone cysts in 19 patients treated in our Department between 1991 and 1996 are presented. Changes were found in the humerus, femur, tibia and fibula. Curettage or excision was the mode of treatment. Recurrence of the condition has been noted in 4 cases. Excision of the change and filling of the defect with autologous or homologous bone graft is more efficient than curettage alone.

[The use of fluoride in the treatment of osteoporosis]. / Zastosowanie fluoru w leczeniu osteoporozy.

Fluorides salts are used in the treatment for osteoporosis for 30 years, since their anabolic action on trabecular bone is well documented, but safety and efficacy of this treatment is still debated. Fluoride administration results in increased number and level of activity of osteoblasts leading to thicker trabeculae. The highest fluoride concentration and activity can be found within newly formed osteoid. Recommended dose is 15-25 mg per day, that is 33-55 mg of sodium fluoride or 140-190 of Na2FPo3. Calcium and vitamin D should be prescribed to all patients concurrently. Most frequent side effects include bone pain and dyspeptic problems.

[The effect of sodium fluoride on selected biochemical markers of bone turnover in ovariectomized rats]. / Wplyw fluorku sodu podawanego droga pokarmowa na wybrane markery przebudowy kosci u szczurów poddanych owariektomii.

The aim of the study was to investigate the effect of fluoride on selected biochemical markers of bone remodelling in young growing rats and after ovariectomy performed on 12-weeks-old female Wistar rats. Seventy 6-weeks-old female Wistar rats were randomized into seven groups. The first baseline control group was sacrificed before the beginning of the experiment. Two groups served as controls receiving distilled water and the other groups received fluoridated water at different doses (two received 8 and two received 60 mgF-/l). 30 rats (ten from each group) were sacrificed after 6 weeks. Serum was then collected for measurement of fluoride concentration, serum total alkaline phosphatase activity (ALP) and concentration of telopeptide of rat type I collagen (ICTP). Last three groups (ten rats each) were ovariectomized and received than only distilled water to drink. After following six weeks all rats were sacrificed. After six weeks of experiment the group receiving 8 mg F-/l showed the lowest ICTP values and the smallest decrease of serum ALP activity compared to the baseline control group. The rats with higher plasma fluoride concentrations after ovariectomy demonstrated lower ICTP concentrations and higher ALP activity than animals with lower fluoride concentrations.

[Diclofenac for treatment of postoperative pain after hip arthroplasty in older patients]. / Diklofenak w leczeniu bólu pooperacyjnego po alloplastykach stawów biodrowych u chorych w podeszlym wieku.

Efficacy of diclofenac in pain relief after hip alloplasty was investigated in 35 patients aged 61-73 (mean 66). We compared "diclofenac group" to similar group of patients treated with i.m. morphine Complications and side effects of both therapies have been analyzed. Diclofenac therapy decreased opioids demand thus reduced its side effects. Patient's comfort has been improved also at non-operated sites.