[Pelvic Ring Fractures - in extremis Patients]. / Zlomeniny pánevního kruhu ­ pacienti in extremis.

PURPOSE OF THE STUDY This study aims to analyse a subpopulation of patients with severe haemorrhagic shock and a concurrent unstable pelvic ring fracture. MATERIAL AND METHODS This manuscript is a retrospective study of prospectively collected data on trauma patients over a period of 10 years, namely between 2010 and 2019. These patients, primarily (after injury) referred to the trauma centre of the University Hospital Hradec Králové, were diagnosed with an unstable pelvic ring fracture as a part of multiple injuries. RESULTS The total number of patients with a pelvic ring fracture and concurrent acute phase of decompensated haemorrhagic shock in the period from 2010 to 2019 was 112. After excluding 25 patients with AIS 4 and 5 (Abbreviated Injury Scale) severe head trauma and another two patients who died of late-stage SIRS (systemic infl ammatory response syndrome) complications, the group consisted of 85 patients. Subsequently, the subpopulation of patients "in extremis" evaluated by the study included a total of 22 patients with the baseline systolic pressure below 70 mm Hg and/or baseline haemoglobin level below 80 g/l. CONCLUSIONS Prior to the evaluation of this study population, our department had no single algorithm developed to treat such patients. Slow blood circulation stabilisation or death were usually associated with inadequate haemostatic algorithm. The patients leaving the operating room and being handed over to the ICU presented the signs of a decompensated shock. Oftentimes, the pelvis was merely stabilised, with no further intervention to stop the bleeding. The extraperitoneal pelvic packing was performed in very few cases only. The extravasation of contrast media during the initial CT scan does not necessarily have to be detected due to vasospasm or hypotension with reduced blood fl ow. In such cases, only the size of haematoma is a sign of arterial bleeding. It is also risky to rely solely on vasography when stopping the bleeding which will certainly fail to stop venous bleeding. However, venous bleeding always accompanies arterial bleeding. Stabilisation of both segments of the pelvis is essential to stop bleeding in haemodynamically unstable patients with a pelvic ring injury. It is followed by extraperitoneal pelvic packing and in the case of continuing haemodynamic instability also vasography, namely even if there is a negative fi nding of the initial CT scan or if no initial CT scan was performed. This procedure has become the core of our single haemostatic algorithm. Key words: pelvic ring injury, patients in extremis, haemostatic algorithm.

Novel Method for Detecting the Stage of Arthrosis and Femoroacetabular Impingement Using a Gyroscopic Sensor and Neural Networks.

PURPOSE OF THE STUDY Femoroacetabular impingement syndrome is a complex, often post-traumatically developing impairment of the hip joint, characterized by ambiguous symptomatology, which makes early diagnosis diffi cult, especially in the early stages. Experimental retrospective study was carried out to evaluate the usability of a triaxial gyroscopic sensor in routine practice as an additional indication criterion for operative versus conservative treatment procedures. MATERIAL AND METHODS 92 patients were included in the retrospective study, and 62 completed the investigation. All patients signed informed consent. A gyroscopic sensor was placed on the right side of the pelvis above the hip joint, and the patients walked approximately 15 steps. Furthermore, an evaluation of the data during stair climbing and a complete clinical examination of the dynamics and physiological movements in the joint was carried out. Data measured with a gyroscopic sensor were processed using differential geometry methods and then evaluated using spectral analysis and neural networks. The proposed technique of diagnosing FAI using gyroscope measurement is a fast, easy-to-perform method. RESULTS Our approach in processing gyroscopic signals used to detect the stage of arthrosis and post-traumatically developing FAI could lead to more accurate early detection and capture in the early stages. CONCLUSIONS The obtained data are easily evaluated, interpretable and benefi cial in diagnosing the early stages of FAI. The results of the conducted research showed this approach to more accurate early detection of arthrosis and post-traumatically developing FAI. Key words: wearable sensors; osteoarthritis; mathematical biophysics; telemedicine.

Systemic toxic effects of Mesocain® in routine surgical practice upon iatrogenic overdose requiring cardiopulmonary resuscitation - case report.

This case report of a patient with a traumatic head injury provides an example of a systemic toxic reaction to a local anesthetic. Clinical signs of a systemic toxic reaction and hemorrhagic shock may initially be similar: tachycardia, hypotension and unconsciousness. The purpose is thus to remind that even the treatment of a minor injury can develop into a life-threatening condition. When a skin wound is treated using suture under local or regional anesthesia, the annual incidence rate of systemic toxic reactions is 1:3,000 and that of death is 1:30,000.

[Descending Thoracic Aortic Injury in Flail Chest]. / Poranení sestupné hrudní aorty pri blokové zlomenine zeber.

The authors present a case of 74-year-old female patient who suffered a flail chest in motor vehicle accident. First day after injury a descending thoracic aorta was injured, most likely during manipulation with the patient. This injury was verified by operation, which was indicated 26 hours after the hospital admission, because of a sudden decrease of blood pressure with blood loss over 600 ml through the chest tube. The female patient died during surgery despite all efforts. Due to our experience with this rare case and after literature studying, we would recommend to consider early surgical revision. Based on the close contact of severely displaced sharp edges of ribs to the descending aorta, which was visible on the CT scan. Even through the absence of clear leak of contrast in the CT examination. We could resect these parts of ribs. Key words: flail chest, descending thoracic aortic injury.

[Surgical Treatment of Clavicle Midshaft Fractures - Prospective Randomized Trial]. / Operacní lécba zlomeniny diafýzy klícní kosti ­ prospektivní randomizovaná studie.

PURPOSE OF THE STUDY Comparison of the outcomes of clavicle midshaft fractures using two different surgical techniques, namely intramedullar osteosynthesis using elastic stable intramedullary nailing (ESIN) with medial cap and extramedullar plate osteosynthesis. MATERIAL AND METHODS The prospective randomized trial was conducted at the Department of Trauma Surgery of the Department of Surgery of the University Hospital Hradec Králové in the Czech Republic at the Level I Trauma Center between 2014 and 2018 and compared two types of osteosynthesis of clavicle midshaft fractures. 60 patients were enrolled in the study and were randomly assigned to one of the two groups. In Group 1, the participants were treated by ESIN and in Group 2 by plate osteosynthesis. The operative technique was chosen by the sealed envelope method. According to the randomization list created by a specialised statistical company, every envelope was marked with a unique number and contained the intramedullar "IM", or the extramedullar "EM" sign. RESULTS The observation of statistical parameters by unpaired t test detected significantly different results: a shorter incision using ESIN osteosynthesis (median = 2.9 cm) compared with plate osteosynthesis (median 14 cm, p < 0.001), longer X-ray exposure using ESIN (median = 325 s) compared with plate osteosynthesis (median = 16.5 s, p < 0.001) and radiation dose using ESIN (median = 996 cGy/cm2) compared with plate osteosynthesis (median = 4 cGy/cm2, p < 0.001). The difference in other parameters such as operative time, in-patient length of stay and duration of rehabilitation was not statistically significant. The time to clavicle fracture repair was comparable in both the surgical arms, i.e. approximately 3 months. Also, the duration of incapacity for work was not statistically different. Functional Constant Shoulder Score at a one-year followup is comparable in both the two arms (p = 0.268). The Dunn s method necessitated a longer operative time when treating multifragmental midshaft clavicle fracture by the ESIN compared to simple fractures. No statistically significant difference was detected in the operative time of different procedures and in the number of bone fragments. The functional outcome was excellent in 25 patients (83%) in each method. DISCUSSION Most midshaft clavicle fractures are still treated non-operatively with good outcomes. The indication for surgical treatment is the dislocation of fragments greater than the width of the clavicle bone, the shortening of fragments greater than 2 cm and the angulation of more than 30°. Patient after operative treatment profits from bone healing by absolute or relative stability. In recent years, new intramedullar techniques other than open plate reduction and fixation have emerged. For example, elastic stable intramedullary titan nailing. Both the methods are full-fledged without functional differences in longterm follow-up. CONCLUSIONS We consider the intramedullar osteosynthesis to be the most appropriate surgical approach for simple midshaft spiral, oblique and transverse clavicle fractures and also wedge oblique fractures. Plate osteosynthesis is useful for all types of fractures. No statistically significant difference in the rate of bone healing was observed after intramedullar or extramedullar ostesynthesis, but multifragmentary fractures healed faster when plate osteosynthesis was used. The determining factor for the received radiation dose is solely the surgical method, not the type of fracture. There is a statistically significant difference in shorter X-ray exposure and lower received radiation dose in plate fixation and reduction. The complication rate is comparable in both the methods. Key words: elastic stable intramedullary nailing, midshaft clavicle fracture, ESIN, TEN, titan elastic nail, clavicle plate osteosynthesis, 3.5 LCP clavicular plate, indication for midshaft fracture treatment.

[Role of Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) to Save Life in Bleeding in a Patient with a Pelvic Ring Injury]. / Role balonové endovaskulární okluze aorty (REBOA) pri záchrane zivota u pacientu s krvácením z pánve.

The author presents a case study of the use of resuscitative endovascular balloon occlusion (REBOA) as a suitable alternative to thoracotomy and clamping of the descending aorta to control retroperitoneal bleeding in a patient with a pelvic injury. The patient who suffered multiple trauma after car accident, type C pelvic injury and retroperitoneal bleeding among other things, was following the pre-hospital ambulance care transported to the department of emergency medicine, with catecholamine infusion to support the blood flow. After the primary survey following the ATLS principles, the patient was taken for a CT scan. The CT examination revealed also multiple sources of retroperitoneal bleeding. Subsequently, the patient was brought to the operating room, where endovascular balloon occlusion of the descending aorta was performed to temporarily control retroperitoneal bleeding, which provided more time to treat the patient in line with the damage control surgery principles. In bleeding patients who suffered blunt torso traumas and serious haemorrhagic shock, or patients "in extremis", the survival after emergency thoracotomy ranges only around 1%. The to date results of REBOA technique applied in same indications are very promising globally. The survival rate increases multiple times especially in hypotensive patients, without the necessity of their immediate cardiopulmonary resuscitation. Key words:resuscitative balloon occlusion of the aorta, REBOA, haemorrhagic shock, retroperitoneal bleeding.

[Extracapsular Proximal Femoral Fractures - Retrospective Evaluation of a Group of Patients with a Focus on Complications of Treatment]. / Extrakapsulární zlomeniny proximálního femuru ­ retrospektivní vyhodnocení souboru pacientu se zamerením na komplikace lécby.

PURPOSE OF THE STUDY The purpose of this study is to retrospectively evaluate the treatment and the complications in patients with extracapsular proximal femoral fractures. MATERIAL AND METHODS The evaluation focused on a group of patients who underwent a surgery at the authors department in the period from 1 January 2011 to 31 December 2013. The inclusion criteria were a simple fall and a monotrauma. The injury-to-surgery interval, course of the surgery and hospital stay, occurrence of early and late complications were assessed. RESULTS In the respective period 286 patients underwent surgery, with the mean age of 79 years (36-101). A basicervical fracture was suffered by 20 patients, a pertrochanteric fracture by 228 patients and 38 patients sustained a subtrochanteric fracture. Osteosynthesis using the DHS was applied in 113 patients, in 110 patients PFNA osteosynthesis was performed and in 51 patients osteosynthesis using an Ender nail was conducted. Yet another type of plate osteosynthesis was opted for in 12 patients. The most frequent postoperative complication was delirium, which was reported in a total of 38 patients. Non-infectious early seroma and hematoma type collection was observed in 6 patients. An infection occurred in one patient. Apart from 8 patients who died during the primary hospital stay, the fracture healing was followed up in 252 patients (91% of 278). The length of healing was 15 weeks on average, delayed healing was reported in five patients. Primary malposition was seen in 9 patients (3%) and secondary malposition occurred in five patients (2%). There were five cases of non-union (2% of 278) in our group of patients. In the followed-up period, a total of 86 patients (30 % of 286) died within one year after the injury. In cases of death, the follow-up was 100% thanks to the data obtained from the Institute of Health Information and Statistics of the Czech Republic (UZIS). Death as a direct consequence of proximal femur fracture occurred in 66 patients (23% of 286). DISCUSSION The results of complications in our group (infection, delayed healing, malposition and non-union) are comparable to those identified by other authors, with the exception of one-year lethality, which is lower in the presented group. CONCLUSIONS The occurrence of complications after proximal femur surgeries is affected by multiple factors. The most important are the choice of a suitable implant, technically correct execution of osteosynthesis and intensive postoperative treatment, including the continuity of care after hospital discharge. Key words:extracapsular proximal femoral fractures, complications.

[Impaired Healing after Surgery for Femoral Fractures]. / Poruchy hojení po operacní lécbe zlomenin stehenní kosti.

PURPOSE OF THE STUDY: The aim of the study was to analyse causes of impaired bone healing in femoral fractures and to present options of their management. MATERIAL AND METHODS: This is a retrospective study of the data on complications prospectively collected between 2008 and 2013. The patients admitted for primary treatment at the Trauma Centre of the Faculty of Medicine in Hradec Kralove from January 2008 to December 2013 included 1186 patients with injury severity scores (ISS) > 15 and 1340 patients with new injury severity scores (NISS) >15, all older than 16 years. With the exception of two patients, the primary treatment involved the application of an external fixator as part of damage control surgery. Definitive surgery, regardless of the site of fracture, was performed using unreamed femoral nails (UFN) in 51, distal femoral nails (DFN) in 33, plates in 26, long proximal femoral nail antirotation (PFNA-long) in 14 and nails combined with dynamic hip screw (DHS) plates in five fractures. The analysis revealed both mechanical and biological causes of poor bone healing. RESULTS: Of the 124 patients whose multiple injuries included a fracture of the femur, 11 died within 24 hours in spite of intensive resuscitation. In the remaining 113 patients there were 16 bilateral fractures, 20 fractures of the proximal femur (extraarticular), 72 diaphyseal femur fractures and 26 distal femur fractures. Nine patients sustained segmental femoral shaft fractures. Ten diaphyseal and 14 distal femur injuries were open fractures (13.5% and 54%, respectively). Pseudarthrosis developed in a total of 12 fractures (9.3%); six (7.2%) were diaphyseal fractures, of which three were initially open fractures, and six (21.4%) were distal femur fractures with two initially open injuries. All proximal femur fractures healed completely. DISCUSSION: The frequency of non-union femoral diaphyseal fractures in our patients treated by unreamed intra-medullary nailing is in agreement with the literature data. The frequency of non-union distal femur fractures in our group was slightly higher than is published in the literature. This can be accounted for by the characteristics of our group consisting of patients with multiple severe injuries in whom fractures are due to high-energy trauma; the overall severity of injuries negatively affects the biological potential of a human organism for bone healing. CONCLUSIONS: A successful outcome of femoral fracture repair is based on an understanding of the biomechanical principle, i.e., correct fracture reduction and stable osteosynthesis fitting the morphology of the fracture. Comminuted femoral fractures heal well with the use of a narrow long nail whose working length allows for even distribution of movement at a fracture line amongst the fragments and thus fracture motion load does not exceed 20%. On the other hand, short oblique and transverse fractures are examples of problematic fractures which require maximum possible stability provided by a thick nail with a short working length; this is achieved by reaming the medullary cavity or adding lag screws. In our group of patients these fractures were also the most problematic ones. Generally, nailing remains the golden standard in the management of femoral fractures.

Bioassay-guided isolation of the antinociceptive compounds motiol and beta-sitosterol from Scorzonera latifolia root extract.

Scorzonera latifolia (Asteraceae) is a plant widely distributed in Central and East Anatolia. A mastic, named yaki sakizi, is prepared from the latex and roots of S. latifolia and similar species. This latex is used in Turkish folk medicine for its analgesic activity, as anthelmintic and against infertility. The aim of this study was to isolate the compounds responsible for the antinociceptive activity of S. latifolia using bioassay-guided fractionation. The methanolic extract of the S. latifolia roots was prepared and subjected to chromatographic purification. Isolated active compounds were identified by means of MS and NMR techniques. Writhing and tail-flick tests were used to determine antinociceptive activity. Motiol and beta-sitosterol were isolated as compounds with promising antinociceptive activity. It is suggested that antinociceptive activity of the plant extract is probably caused by the synergic interaction of the isolated compounds.

[Surgical treatment of humeral diaphyseal fractures]. / Operacní lécba zlomenin diafýzy humeru.

PURPOSE OF THE STUDY: The aim of the study was to compare two surgical methods of treating diaphyseal fractures of the humerus. MATERIAL AND METHODS: A prospective randomised study on the surgical treatment of humeral diaphyseal fractures was carried out between September 2009 and January 2013. The patients indicated for surgical treatment fell into two groups according to the technique used as follows: minimally invasive plate osteosynthesis (MIPO) with a locking compression plate (LCP; Synthes, Switzerland); depending on the fracture type and course of fracture line, either a straight narrow or a Philos or a metaphyseal LCP was used (group 1); and intramedullary nailing (EHN, Synthes, Switzerland) (group 2). A total of 49 patients were entered into the study. The men-to-women ratio was about 1:1 and the average age was 52 years (18 to 83). Of them, 45 patients with 46 humeral fractures were followed up and evaluated. The injury was caused by a fall from standing or while walking (n=21), traffic accident (n=16), sports activity (n=3) or work-related activity (n=5). A single injury was treated in 72% and multiple trauma in 28% of the patients. Using the AO classification, fractures were diagnosed as types A, B and C in 25, 10 and 11 patients, respectively. The patients were randomised into the groups using a computer programme allowing for the maintenance of group homogeneity. Each patient received information on the method to be used in a sealed envelope. RESULTS: The average injury-surgery interval was 6 days (range, 0 to 26). The average operative time was 128 minutes (80 to 200). The average intra-operative exposure to X-ray was 8 minutes (3 to 20). The average hospital stay was 20 days (4 to 100) The average rehabilitation time till functional recovery was 17 weeks (3 to 37), the time of bone union by radiographic assessment was 20 weeks (12 to 40). The functional outcome was assessed using the Constant-Murley (CM) and Liverpool Elbow Score (LES) systems. The relative CM/LES score, as compared with the healthy extremity, was 95/100. Excellent and good results were achieved in 89% and complications were recorded in 26% of the patients. The most frequent complication was impingement syndrome or prolonged rehabilitation both in the patients with proximal humerus fractures managed with the Philos locking plate and in those treated by intramedullary nailing, although this was not necessarily due to a technical error, i.e., osteosynthetic material protrusion. Iatrogenic radial nerve injury was found only in one patient treated by intramedullary nailing and was associated with traction during reduction and nail insertion. Pseudoarthrosis was recorded in one patient of each group and there were no infectious complications. DISCUSSION: Intramedullary nailing has not yet shown such good outcomes in humeral as in tibial fractures. The results of metaanalysis have indicated that humeral fractures treated by plate osteosynthesis have fewer complications and require repeat surgery less frequently. However, as shown by most recent studies, this difference is getting smaller. The MIPO technique was adopted at our department several years ago and the aim was to compare our results with those of other centres. The studies so far published have show that MIPO and conventional open plate osteosynthesis give comparable outcomes. CONCLUSIONS The statistical evaluation using the unpaired t-test did not show any significant differences in either the functional results or the number of complications between the two methods. Both achieved about 90% of excellent and good results and had 26% of complications. The only significant difference was found in the length of operative time (136 min in MIPO versus 117 min in EHN). With use of the Chi-Square test, a significant correlation between AO fracture type and treatment outcome in the MIPO group was found, i.e., no poor result was recorded for type A fractures, as assessed by the CM/LES score. No such correlation between the fracture type and the functional outcome was seen in the EHN group.

Crossover external fixator for acetabular fractures: a cadaver study.

BACKGROUND: Dislocated acetabular fractures in polytraumatized patients are very challenging cases to deal with. Temporary stabilization by skeletal traction is difficult in these patients. A more effective solution can be an external fixation. OBJECTIVE: The authors designed a new crossover external fixation frame for acetabular fracture. The aim of this study is the biomechanical testing of this frame on human cadavers. METHODS: This study is an experiment on ten human cadavers. The acetabular fracture C2.2 was created. The stabilization effect of external fixation was compared with stabilization by large distractor. Femoral heads' shifts caused by standardized manipulation with the cadaver were obtained from X-ray pictures. RESULTS: The mean total shift in stabilization technique by external fixation was 2.56 (1-4) mm. In stabilization by large distractor, the mean of the total shift after cadaver manipulation was 5.11 (0-10) mm. No significant differences were found between stabilization by external fixation and by large distractor (p = 0.066). CONCLUSIONS: The stabilization of acetabular fracture C2.2 by a crossover external fixator is as effective as large distractor. The crossover external fixation could be a suitable solution for the temporary stabilization of acetabular fractures in polytraumatized patients. Subsequent studies including clinical trials are necessary to confirm the authors' suggestion.

Reamed versus unreamed nail in the treatment of tibia shaft fractures.

PURPOSE: The aim of the prospective randomized study was to compare the results of the treatment of tibia shaft fractures (TSF) by reamed or unreamed intramedullar nail. METHODS: There were 103 patients with 104 TSF enrolled in the study within the period from December 2005 to June 2010. Seven patients were excluded from the study. Factors of injury severity, course of surgery and hospitalization, and incidence of early and delayed complications were recorded. X-ray was performed every 4 weeks until the fracture was healed. Functional results were evaluated at least 1 year after the surgery. Closed fractures were classified according to Tscherne classification and the open ones according to Gustilo classification. RESULTS: Forty-eight patients with 49 TSF were treated by unreamed tibial nail. There were 15 women and 33 men in this group. Injury severity score (ISS) ranged from 4 to 25 (ø 6.63). There were 45 closed fractures (0 16; I 22; II 7) and four open fractures (I 2; II 1; IIIA 1). In the reamed nail group there were 48 TSF. ISS ranged from 4 to 18 (ø 6.13). There were 35 closed (0 17; I 13; II 5) and 13 open (I 5; II 5; IIIA 3) fractures in this group. The time of operation was on average 15 min shorter in the unreamed nail group. X-ray healing was the same in both groups (18.12 versus 17.92 weeks). We had four patients in the unreamed nail group and six patients in the reamed nail group with delayed healing (28-44 weeks). We recorded no infection, loss of reduction or re-operation in both groups. Follow-up of functional results was 90 %. CONCLUSIONS: There was no statistically significant difference in clinical and functional results between the groups. We suggest that both methods are comparable.

Tomentomimulol and mimulone B: two new C-geranylated flavonoids from Paulownia tomentosa fruits.

Two new discovered C-geranylated flavonoids tomentomimulol (1) and mimulone B (2) were isolated from the methanol extract of Paulownia tomentosa (Thunb). Steud. (Paulowniaceae) fruits by exhaustive chromatographic separation together with one known compound tanariflavanone D (3). The identification of compounds and structure elucidation was carried out using 1D and 2D NMR experiments, as well as mass spectroscopy, ultra-violet, infra red and CD experiments.

A new triterpene from Scorzonera latifolia (Fisch. and Mey.) DC.

A novel triterpene 1 (3-ß-hydroxy-fern-7-en-6-one-acetate) together with four known compounds, urs-12-en-11-one-3-acetyl (2), 3-ß-hydroxy-fern-8-en-7-one-acetate (3), olean-12-en-11-one-3-acetyl (4) and leucodin (5) were obtained from the S. latifolia roots. All compounds were isolated from the n-hexane extract of S. latifolia roots using several chromatographic techniques. The structure of the isolated compounds was elucidated on the basis of (1)H-NMR, (13)C-NMR and 2D NMR data (HMBC, HMQC, COSY, TOCSY, NOESY, DEPT) as well as GC EITOF-HRMS.

[Surgical treatment for proximal humerus fracture]. / Operacní lécba zlomenin proximálního humeru.

PURPOSE OF THE STUDY: The aim of the study was to compare the medical aspects of alternative surgical methods for treatment of proximal humerus fractures in specific indications (two- and three- fragment fractures). MATERIAL AND METHODS: A prospective randomised study on surgical treatment of two- and three-fragment fractures of the proximal humerus was carried out at the Department of Surgery, University Hospital in Hradec Králové, from January 2006 till January 2010. The study comprised patients with proximal humerus fractures indicated for surgical treatment. Study inclusion criteria were as follows: informed consent, AO fracture types A2, A3, B1 or C1, age between 18 and 80 years, and patient compliance. Exclusion criteria included open fracture, associated injury (AIS . 2), open growth plates, or such state of the patient's health that would limit the extent of surgery. Two groups were compared. One included patients treated by the Zifko method of minimally invasive osteosynthesis with intramedullary K-wire insertion (MIO group) and the other (ORIF group) consisted of patients undergoing open reduction with angle-stable osteosynthesis using a Philos plate (Synthes, Switzerland). The patients were randomised to the groups by a computer programme which facilitates the maintenance of homogeneity of the groups compared. The procedure in each patient was based on the sealed-envelope method. RESULTS: The ORIF group comprised 28 patients. It took them an average of 27.2 weeks (9-72) to regain normal upper limb function. The final CM score was 86.6% (64-100%) as compared with the healthy limb. Excellent and good results were achieved in 89% of the patients; complications were recorded in 39% of them. The MIO group included 27 patients. The fractures healed in all of them. Normal upper limb function was regained at an average of 21.4 weeks (13-36). The final CM score was 87.5% (52-100%) in comparison with the healthy limb. Excellent and good results were achieved in 89% and complications developed in 33% of the patients. CONCLUSIONS: The statistical evaluation of the results, using the unpaired t-test, did not show any significant differences either in functional outcomes or the number of complications between the two groups. The only significant difference was found in operative times (117 min and 72 min in ORIF and MIO groups, respectively). The difference in time needed to regain limb function (27 and 21 weeks) was at a marginal level of statistical significance. With both methods 89% of excellent and good results were achieved, and a similar number of patients had complications (11 and 9).

Effect of diplacone on LPS-induced inflammatory gene expression in macrophages.

Flavonoids are commonly studied for their anti-inflammatory effects; however, this is the first paper describing the possible antiphlogistic activity of a geranylated flavanone. This study focused on the ability of diplacone to modulate the gene expression of pro-inflammatory tumour necrosis factor alpha and monocyte chemoattractant protein 1, and of anti-inflammatory zinc finger protein 36. The action of diplacone was also compared with that of conventional drug indomethacin. Human monocyte-derived macrophages of the human monocytic leukaemia cell line were pretreated with diplacone or indomethacin. Subsequently, inflammatory reaction was induced by lipopolysaccharide, and changes of tumour necrosis factor alpha, monocyte chemoattractant protein 1 and zinc finger protein 36 gene expression at the transcriptional level were measured. In this model, diplacone significantly down-regulated the expression of tumour necrosis factor alpha and monocyte chemoattractant protein 1 and up-regulated the zinc finger protein 36 expression. This makes diplacone a promising molecule for treatment of the inflammatory stage of diseases. The effect of diplacone in decreasing lipopolysaccharide-induced inflammatory gene expression is in many ways similar to that of the conventional drug indomethacin.

[Expert Tibial Nail (ETN) for treatment of diaphyseal tibial fractures in current and extended indications: technique and clinical results]. / Diafyzární zlomeniny bérce--technika a klinické výsledky s pouzitím Expert Tibial Nail (ETN) v klasických a rozsírených indikacích.

PURPOSE OF THE STUDY: To present the authors' technical experience with the use of the Expert Tibial Nail (ETN) technique and its clinical results. MATERIAL AND METHODS: Between December 2005 and the end of 2007, the ETN technique was used in 41 patients to treat 41 diaphyseal tibial fractures. All patients were followed-up prospectively. RESULTS: The injury Severity Score (ISS) was in the range of 4 to 25 (average, 5.9). Eight patients suffered multiple trauma, 33 had isolated injuries. Of the 41 fractures, 31 were closed and 10 were open injuries. The fracture types according to the Tscherne classification were as follows: closed 0 type (n=10); closed type I (n=18); closed type II (n=3); open type I (n=3); open type II (n=5); open type III (n=2). The injury-to-surgery interval ranged from 1h and 50 min to 25 h and 12 min (median, 8 h and 52 min).The operative time ranged from 50 to 170 min (average, 87 min). Infectious complications or a secondary loss of reduction were not recorded. Three cases of insufficient primary reduction underwent repeat surgery during the first stay in hospital. Full weight-bearing with no pain was reported in the range of 10 to 24 weeks (average, 18 weeks) after surgery. DISCUSSION: A choice of the nail diameter in relation to the marrow cavity width can be made during surgery with no loss of reduction (guidewire; undreamed/reamed nail). Because of a shorter straight lower part of the nail (compared to a UTN), a very steep position of the nail is necessary at its insertion in a short proximal metaphyseal fragment. The blunt lower ETN end can produce fracture line distraction when an effort is made to drive the nail as deep as possible into the short distal meta- physeal block, if this has not been reamed. CONCLUSIONS: The ETN provides sufficient stability of diaphyseal tibial fractures including those involving the metaphysis. However, in some instances, poler screws are still indispensable. Sufficient reduction is necessary before nail insertion.

[Successful urgent thoracotomy in a patient with penetrating heart injury--case report]. / Uspesná emergentní torakotomie u pacienta s penetrujícím poranením srdce: kazuistika.

The case of a patient with a penetrating cardiac injury successfully treated by thoracotomy is reported. In a suicidal attempt, he suffered a self-inflicted thoracic stub wound penetrating the left ventricle. During transport to the hospital, he developed circulatory instability. He was admitted to the emergency department with no signs of life and bilateral non-responding mydriasis. Immediately, urgent anterolateral thoracotomy at the left 5th rib was performed. The pericardium was opened, cardiac tamponade was evacuated and the stab wound in the right ventricle was sutured. The subsequent ventricular fibrillation was treated using defibrillation with an electric discharge of 200 J. After sinus rhythm had resumed, the patient was transferred to the operating theatre for the finishing of thoracic exploration. No more injury was found. Intermittent myoclonus had persisted since admission, and a CT scan showed diffuse cerebral oedema due to post-hypoxic brain damage. During the following hospitalisation, the patient underwent the SSEP examination (evoked potentials) and no signs of decortication were found. At four weeks after injury, the patient was transported to his regional hospital he was afebrile, with stable circulation, spontaneous ventricular function and the GCS of 8 to 9.

Cholinesterase inhibitory activities of some flavonoid derivatives and chosen xanthone and their molecular docking studies.

Flavonoids are one of the largest classes of plant secondary metabolites and are known to possess a number of significant biological activities for human health. In this study, we examined in vitro acetylcholinesterase (AChE) and butyrylcholinesterase (BChE) inhibitory activities of four flavonoid derivatives--quercetin, rutin, kaempferol 3-O-beta-D-galactoside and macluraxanthone. The in vitro results showed that quercetin and macluraxanthone displayed a concentration-dependant inhibition of AChE and BChE. Macluraxanthone showed to be the most potent and specific inhibitor of both the enzymes having the IC(50) values of 8.47 and 29.8 microM, respectively. The enzyme kinetic studies revealed that quercetin inhibited both the enzymes in competitive manner, whereas the mode of inhibition of macluraxanthone was non-competitive against AChE and competitive against BChE. The inhibitory profiles of the compounds have been compared with standard AChE inhibitor galanthamine. To get insight of the intermolecular interactions, the molecular docking studies of these two compounds were performed at the active site 3D space of both the enzymes, using ICM-Dock module. Docking studies exhibited that macluraxanthone binds much more tightly with both the enzymes than quercetin. The calculated docking and binding energies also supported the in vitro inhibitory profiles (IC(50) values). Both the compounds showed several strong hydrogen bonds to several important amino acid residues of both the enzymes. A number of hydrophobic interactions could also explain the potency of the compounds to inhibit AChE and BChE.

Cholinesterase inhibitory effects of the extracts and compounds of Maclura pomifera (Rafin.) Schneider.

We have investigated anticholinesterase potential of the methanol extracts from the leaf, wood, flower, twig, and stem bark of the female and male individuals and rhizodermis and fruit from the female tree of Maclura pomifera (Rafin.) Schneider (Moraceae) along with its major isoflavonoids; osajin and pomiferin as well as their semi-synthetic derivatives; iso-osajin and iso-pomiferin. Anticholinesterase activity was determined by Ellman method using ELISA microplate reader. Osajin and pomiferin had a noticeable inhibition of AChE with IC(50) values of 2.239 and 0.096 mM, respectively, while their iso-derivatives were found to display less inhibition towards AChE. The extracts and compounds did not inhibit BChE. The extracts were analyzed for osajin and pomiferin contents by LC-DAD-MS and only the fruits and female flowers contained osajin (fruit: 8.87%, female flowers: 0.19%, w/w) and pomiferin (fruit: 13.6%, female flowers: 0.36%, w/w).