Differential diagnosis of thyroid orbitopathy - diseases mimicking the presentation or activity of thyroid orbitopathy.

Thyroid orbitopathy (TO) is the most common cause of orbital tissue inflammation, accounting for about 60% of all orbital inflammations. The inflammatory activity and severity of TO should be diagnosed based on personal experience and according to standard diagnostic criteria. Magnetic resonance imaging (MRI) of the orbit is used not only to identify swelling and to differentiate inflammatory active from non-active TO, but also to exclude other pathologies, such as orbital tumours or vascular lesions. However, a group of diseases can mimic the clinical manifestations of TO, leading to serious diagnostic difficulties, especially when the patient has previously been diagnosed with a thyroid disorder. Diagnostic problems can be presented by cases of unilateral TO, unilateral or bilateral TO in patients with no previous or concomitant symptoms of thyroid disorders, lack of symptoms of eyelid retraction, divergent strabismus, diplopia as the only symptom of the disease, and history of increasing diplopia at the end of the day. The lack of visible efficacy of ongoing immunosuppressive treatment should also raise caution and lead to a differential diagnosis of TO. Differential diagnosis of TO and evaluation of its activity includes conditions leading to redness and/or swelling of the conjunctiva and/or eyelids, and other causes of ocular motility disorders and eye-setting disorders. In this paper, the authors review the most common diseases that can mimic TO or falsify the assessment of inflammatory activity of TO.

Transanal total mesorectal excision (TaTME) in rectal cancer treatment within an expert center.

The objective of this study was to evaluate treatment outcomes in patients who underwent the TaTME procedure for cancer of the middle and low rectum in an expert center. Prospective analysis of the outcomes of all consecutive patients treated using the TaTME technique for cancer of the middle and distal rectum at the our medical center between March 1, 2015, and March 31, 2022. A total of 128 patients (34 women, 94 men; mean age 66.01 [38-85] years) with cancer of the middle and distal rectum qualified for TaTME. TaTME procedures were performed in 127/128 (99.22%) patients. Complications of surgery were observed in 22/127 (17.32%) patients. Negative proximal and distal margins were confirmed in all 127 patients. Complete (R0) resection of the mesorectum was confirmed in 125/127 (98.43%) and nearly complete (R1) resection was confirmed in 2/127 (1.57%) patients. The average follow-up period was 795 days (296-1522) days. Local recurrence was detected during the follow-up period in 2/127 (1.57%) patients. This study showed that the TaTME procedure is an effective and safe method for the minimally invasive treatment of middle and low rectal cancers, particularly within an expert center setting.

Taste perception and food preferences in patients with diabetic foot ulcers before and after hyperbaric oxygen therapy.

OBJECTIVE: The aim of the study was to evaluate the effect of hyperbaric oxygen therapy (HBOT) on taste perception and food preferences in patients with diabetic foot ulcers. METHODS: The study involved 75 healthy people (Group C) and 23 patients with diabetic foot ulcers before HBOT (Group Db) and after 25-30 HBOT treatments (Group Da) (2.5 ATA, 87 min). The sip and spit method was used to examine the taste perception for 5 basic flavours. Food preferences were studied using photographs of dishes. RESULTS: The recognition thresholds in Group C were lower than in Group Db for 5 basic flavours. The taste intensity in Group C was higher than in Group Db for: 0.1% and 1.0% monosodium glutamate, 0.02% citric acid, and 0.002% quinine hydrochloride. The hedonic response in Group C was more negative than in Group Db for: 0.18% sodium chloride, 0.3% monosodium glutamate and 0.1% citric acid. The pleasure derived from eating in Group C was lower than in Group Db for sour and salty products. The recognition thresholds in Group Db were higher than in Group Da for umami and sour. The taste intensity in Group Db was lower than in Group Da for: 0.1%, 0.3% and 1.0% monosodium glutamate. The pleasure derived from eating in Group Db was higher than in Group Da for chocolate and crisps. CONCLUSIONS: In people with diabetic foot ulcers, an impaired all 5 basic tastes occurred with different food preferences compared to healthy people. HBOT causes beneficial changes resulting in increased sensitivity to umami and sour taste as well as a decrease in the pleasure derived from eating chocolate and crisps.

[Optimization of the treatment of moderate to severe and active thyroid orbitopathy considering the recommendations of the European Group on Graves' Orbitopathy (EUGOGO) [Optymalizacja leczenia umiarkowanej do ciezkiej i aktywnej orbitopatii tarczycowej z uwzglednieniem zalecen European Group on Graves' Orbitopathy (EUGOGO)]].

Graves' disease (GB), also known as Basedow's disease, is the most common cause of hyperthyroidism, and thyroid orbitopathy (TO) is its most common non-thyroid manifestation with an incidence of 42.2/million people/year. Based on the guidelines of the European Graves' Orbitopathy Group (EUGOGO), certain management standards presented in our publication should be used to optimize and improve the efficacy of TO treatment. Deciding on the optimal treatment for both hyperthyroidism and TO requires a cooperative team of specialists: endocrinologist, ophthalmologist, radiation therapist, and surgeon, as well as consideration of the risk of relapse and possible complications of the treatment method. The inflammatory activity and severity of TO should be diagnosed based on the investigator's own experience and according to standard diagnostic criteria. Assessment of the inflammatory activity of TO can be performed using the clinical activity score (CAS) and using imaging methods - mainly MRI. The severity of TO is assessed using a seven-grade NOSPECS classification and a three-grade EUGOGO scale. In moderate to severe and active TO, i.v. methylprednisolone pulses are the treatment of choice. It is important to maintain the standard and regimen of treatment. The recommended standard as first-line treatment in most patients with moderate to severe and active TO is the combined use of methylprednisolone i.v. (cumulative dose of 4.5 g over 12 weeks) with concurrent administration of mycophenolate sodium 0.72 g per day for 24 weeks. In more severe forms of moderate to severe and active TO, a higher cumulative dose of methylprednisolone i.v. is recommended as an alternative first-line treatment (7.5 g) as monotherapy starting with a dose of 0.75 g once a week for 6 weeks and 0.5 g for a further 6 weeks. EUGOGO guidelines recommend that in cases of no clinical response after 6 weeks of first-line treatment with i.v. methylprednisolone and mycophenolate, after 3-4 weeks, a second course of i.v. methylprednisolone monotherapy should be started with a higher cumulative dose of 7.5 g. Other second-line treatment options are orbital radiotherapy with or without oral or i.v. systemic glucocorticosteroid therapy, cyclosporine, or azathioprine in combination with p.o. glucocorticosteroid, methotrexate monotherapy, and a group of biologic drugs rituximab, tocilizumab, teprotumumab). Keeping in mind that TO is a sight-threatening disease, we expect, through the treatment applied, to maintain full visual acuity, pain relief, single vision in the useful part of the visual field, and a positive cosmetic effect.

Comparison of Physicochemical, Mechanical, and (Micro-)Biological Properties of Sintered Scaffolds Based on Natural- and Synthetic Hydroxyapatite Supplemented with Selected Dopants.

The specific combinations of materials and dopants presented in this work have not been previously described. The main goal of the presented work was to prepare and compare the different properties of newly developed composite materials manufactured by sintering. The synthetic- (SHAP) or natural- (NHAP) hydroxyapatite serves as a matrix and was doped with: (i) organic: multiwalled carbon nanotubes (MWCNT), fullerenes C60, (ii) inorganic: Cu nanowires. Research undertaken was aimed at seeking novel candidates for bone replacement biomaterials based on hydroxyapatite-the main inorganic component of bone, because bone reconstructive surgery is currently mostly carried out with the use of autografts; titanium or other non-hydroxyapatite -based materials. The physicomechanical properties of the developed biomaterials were tested by Scanning Electron Microscopy (SEM), Dielectric Spectroscopy (BSD), Nuclear Magnetic Resonance (NMR), and Differential Scanning Calorimetry (DSC), as well as microhardness using Vickers method. The results showed that despite obtaining porous sinters. The highest microhardness was achieved for composite materials based on NHAP. Based on NMR spectroscopy, residue organic substances could be observed in NHAP composites, probably due to the organic structures that make up the tooth. Microbiology investigations showed that the selected samples exhibit bacteriostatic properties against Gram-positive reference bacterial strain S. epidermidis (ATCC 12228); however, the property was much less pronounced against Gram-negative reference strain E. coli (ATCC 25922). Both NHAP and SHAP, as well as their doped derivates, displayed in good general compatibility, with the exception of Cu-nanowire doped derivates.

Tirzepatide - a dual GIP/GLP-1 receptor agonist - a new antidiabetic drug with potential metabolic activity in the treatment of type 2 diabetes.

The incretin hormones glucagon-like peptide 1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP) are responsible for up to 65% of postprandial insulin secretion. Tirzepatide, developed by Eli Lilly, is a dual GIP/GLP-1 receptor agonist in the form of a synthetic linear peptide; its acylation technology allows it to bind to albumin, thus making it possible to dose the drug once a week. This review summarizes the key characteristics and pharmacokinetics of tirzepatide. The authors present the results of a phase 1, 2, and 3 clinical trial on the effects of tirzepatide on glycaemic and lipid control and the beneficial effects on body weight in a dose-dependent manner in patients with type 2 diabetes mellitus (T2DM). Tirzepatide has the ability to reduce glycaemic levels, improve insulin sensitivity, reduce body weight, and improve lipid metabolism, which is critically important in T2DM. Tirzepatide administered by weekly subcutaneous injections appears to be a promising drug for the treatment of T2DM as well as cardiometabolic disorders. The mechanism of action and safety profile of tirzepatide potentially fills important gaps in the current treatment of T2DM.

Imeglimin: a new antidiabetic drug with potential future in the treatment of patients with type 2 diabetes.

Imeglimin (IMEG) is the first drug of the "glimin" group. Glimin is a new group of hypoglycaemic drugs for the treatment of patients with type 2 diabetes mellitus (T2DM). The chemical structure and action mechanism of the drug are presented in the paper. Imeglimin is unique and different in action compared to other hypoglycaemic drugs. Imeglimin has been shown to have a beneficial effect on 3 key pathogenetic elements of T2DM, i.e., 1. increased gluconeogenesis, 2. inadequate glucose-induced insulin secretion by beta cells, and 3. peripheral insulin resistance. The peak effect on fasting plasma glucose (FPG) and glycated haemoglobin (HbA1c) levels of IMEG is reached after 16 weeks of treatment. Subjects receiving IMEG at 1000- and 1500-mg doses twice daily also achieved significantly greater reductions in fasting plasma glucose (FPG) levels at week 24 compared to the placebo group (IMEG in humans causes increased insulin secretion as well as reductions in fasting plasma glucose and glycated haemoglobin). This paper also presents the pharmacokinetics of IMEG action, clinical evidence for its efficacy, results of phase II and III clinical trials, and drug tolerability. Our paper seems to show that IMEG, with its novel mechanism of action, has a chance to improve treatment results in a larger population of T2DM patients.

Preliminary Research on the Effect of Hyperbaric Oxygen Therapy in Patients with Post-COVID-19 Syndrome.

Negative consequences and medical complications of COVID-19 can persist for up to several months after initial recovery. These consequences can include stroke, diabetes, decreased lung diffusing capacity, sleep apnea, pulmonary fibrosis, arrhythmia, myocarditis, fatigue, headaches, muscle aches, heart rate fluctuations, sleep problems, memory problems, nervousness, anxiety, and other neurological disorders. Thirty-one patients who reported symptoms related to previous COVID-19 disease of both sexes were enrolled in the initial program. The patients underwent compression sessions in a multiplace hyperbaric chamber. Each patient underwent a cycle of 15 compressions. Before the first session, each participant completed a venous blood gas test, a Fullerton test, and two spirometry tests (one before the Fullerton test and one after the test). Patients completed psychotechnical tests, a questionnaire on quality of life (Polish version of EQ-5D-5L), and a questionnaire on specific symptoms accompanying the disease and post-infection symptoms. The results showed significant improvements in areas such as quality of life, endurance and strength, some spirometric parameters, the anion gap and lactate levels, working memory, and attention in the group of treated patients. In contrast, there were no changes in pH, pO2, pCO2, glucose, and excess alkaline values. A follow-up interview confirmed that the beneficial effects were maintained over time. Considering the results obtained, including the apparent improvement in the patient's clinical condition, it can be concluded that the use of 15 compression sessions was temporarily associated with a noticeable improvement in health and performance parameters as well as improvement in certain blood gas parameters.

Polymeric Microfiltration Membranes Modification by Supercritical Solvent Impregnation-Potential Application in Open Surgical Wound Ventilation.

This study investigated supercritical solvent impregnation of polyamide microfiltration membranes with carvacrol and the potential application of the modified membranes in ventilation of open surgical wounds. The impregnation process was conducted in batch mode at a temperature of 40 °C under pressures of 10, 15, and 20 MPa for contact times from 1 to 6 h. FTIR was applied to confirm the presence of carvacrol on the membrane surface. In the next step, the impact of the modification on the membrane structure was studied using scanning electron and ion beam microscopy and cross-filtration tests. Further, the release of carvacrol in carbon dioxide was determined, and finally, an open thoracic cavity model was applied to evaluate the efficiency of carvacrol-loaded membranes in contamination prevention. Carvacrol loadings of up to 43 wt.% were obtained under the selected operating conditions. The swelling effect was detectable. However, its impact on membrane functionality was minor. An average of 18.3 µg of carvacrol was released from membranes per liter of carbon dioxide for the flow of interest. Membranes with 30-34 wt.% carvacrol were efficient in the open thoracic cavity model applied, reducing the contamination levels by 27% compared to insufflation with standard membranes.

Cellulose Acetate Membranes Modification by Aminosilane Grafting in Supercritical Carbon Dioxide towards Antibiofilm Properties.

The study explores the grafting of cellulose acetate microfiltration membranes with an aminosilane to attain antibiofilm properties. The grafting reaction was performed in the supercritical carbon dioxide used as a transport and reaction medium. The FTIR analyses and dissolution tests confirmed the covalent bonding between the aminosilane and polymer. The membranes' microstructure was investigated using a dual-beam SEM and ion microscopy, and no adverse effects of the processing were found. The modified membranes showed a more hydrophilic nature and larger water permeate flow rate than the neat cellulose acetate membranes. The tests in a cross-filtration unit showed that modified membranes were considerably less blocked after a week of exposure to Staphylococcus aureus and Escherichia coli than the original ones. Microbiological investigations revealed strong antibiofilm properties of the grafted membranes in experiments with Staphylococcus aureus, Listeria monocytogenes, Escherichia coli, and Salmonella Enteritidis.

The Effect of Immunosuppression on Selected Antioxidant Parameters in Patients with Graves' Disease with Active Thyroid-Associated Orbitopathy.

BACKGROUND AND STUDY AIMS: Thyroid-associated orbitopathy, the most common extrathyroidal manifestation of Graves' disease, is an autoimmune inflammation of orbital soft tissue. We report the study assessing the effect of immunosuppressive treatment with methylprednisolone on selected antioxidant parameters in patients with Graves' disease with active thyroid-associated orbitopathy. PATIENTS AND METHODS: Activity and serum levels of selected antioxidant parameters as well as lipid peroxidation products were determined in a group of 56 patients with active thyroid-associated orbitopathy at three time-points: at baseline, after the discontinuation of intravenous methylprednisolone treatment and at 3 months after the discontinuation of additional oral methylprednisolone treatment. A control group consisted of 20 healthy age- and sex-matched volunteers. RESULTS: We found an increased activity of superoxide dismutase and glutathione peroxidase and increased serum levels of uric acid, malondialdehyde and conjugated dienes, as well as a reduced activity of paraoxonase-1 and reduced serum vitamin C level in the study group at baseline. Systemic intravenous and oral methylprednisolone therapy led to normalization of activity and concentration of the most studied parameters. CONCLUSION: Results of our study confirmed that oxidative stress is one of the factors involved in the pathogenesis of thyroid-associated orbitopathy and the methyloprednisolone treatment is effective in reducing both clinical symptoms and oxidative stress in patients with this disease.

The effect of thyroid hormone status on selected antioxidant parameters in patients with Graves' disease and active thyroid-associated orbitopathy.

INTRODUCTION: Oxidative stress has been implicated in the pathogenesis of thyroid-associated orbitopathy (TAO) in patients with Graves' disease (GD). This study assessed the effect of thyroid hormone abnormalities on selected antioxidant parameters in patients with active TAO. MATERIAL AND METHODS: The study group consisted of 56 patients with GD and active TAO treated with antithyroid medication. Depending on the thyroid hormone level, they were subdivided into two groups: Group 1 - hyperthyroid patients (n = 34) and Group 2 - euthyroid patients (n = 22). The total oxidant status expressed as the ferric reducing ability of plasma (FRAP) as well as selected enzymatic and nonenzymatic components of the antioxidant system, including the activity of superoxide dismutase (SOD), glutathione peroxidase (GPx), and paraoxonase 1 (PON-1), as well as the levels of vitamin C, uric acid, and lipid peroxidation products: malondialdehyde (MDA) and conjugated dienes (CD) were assessed in all enrolled participants. RESULTS: The FRAP values in Group 1 were significantly higher than in controls. The FRAP values in Group 2 were lower than in Group 1 and higher than in controls. However, the differences were not significant. In Group 1, the activity of SOD and GPx, as well as serum levels of uric acid, MDA, and CD, were significantly higher than in controls. At the same time, serum PON-1 activity and vitamin C levels were significantly lower in Group 1 than in controls. In Group 2, the SOD activity as well as MDA and CD levels were non-significantly lower than in Group 1 and non-significantly higher than in controls. The activity of GPx in euthyroid patients with TAO was significantly higher than in controls. CONCLUSIONS: Hyperthyroidism is a significant contributor to oxidative stress in patients with active TAO, which manifests as upregulated lipid peroxidation and antioxidant system activation. Euthyroid state restoration leads to a relative reduction in activity and levels of most studied antioxidant parameters, which still remain above the normal values. The autoimmune inflammation of the orbital tissue seems to be a thyroid hormone status-independent modifier of oxidative stress.

Selected adipose tissue hormones in the blood of patients with ischaemic cerebral stroke.

INTRODUCTION: Despite considerable progress in knowledge, ischaemic stroke is still a disease that causes serious clinical problems. A role in its pathogenesis can be attributed to i.a. adipose tissue hormones. The aim of this paper is to assess the blood levels of selected adipocytokines in patients during the acute phase of ischaemic stroke as compared to healthy persons, and an attempt to indicate a correlation between their blood concentrations and the level of stroke severity and its outcomes. MATERIAL AND METHODS: The study included 46 patients with fresh ischaemic stroke (27 females, 19 males, average age 67.6 years). All patients had a CT scan of the head, their neurological condition was assessed using a stroke severity scale, and their blood levels of resistin, chemerin, and visfatin were tested. The control group consisted of 32 patients (16 females, 16 males, average age 64.1 years) who had never suffered cerebrovascular diseases. RESULTS: Elevated levels of both resistin and chemerin were found in the group of patients with ischaemic stroke (9.17 ± 2.95 ng/mL vs. 6.55 ± 2.01 ng/mL for resistin and 265.0 ± 59.3 ng/mL vs. 191.0 ± 43.6 ng/mL for chemerin). It was also found that the blood concentration of chemerin was higher in females than in males with stroke. However, no difference was found in visfatin blood concentration between the group with ischaemic stroke and the control group (1.65 ± 1.09 ng/mL vs. 1.5 ± 1.39 ng/mL). CONCLUSIONS: Higher resistin and chemerin blood concentrations significantly increase the risk of ischaemic stroke. The level of stroke severity at the moment of its occurrence and during its course do not depend on the concentrations of adipocytokines under analysis.

Evaluation of retinal function improvement in neovascular age-related macular degeneration after intravitreal aflibercept injections with the use of the assessment of retinal sensitivity: The use of the assessment of retinal sensitivity in anti-VEGF treatment - a STROBE-compliant observational study.

This study compares 2 methods of macular function evaluation: the microperimetric examination (mean central retinal sensitivity and fixation stability) and the distance best-corrected visual acuity (BCVA) examination, which is the most frequently used method of assessing macular function in patients with newly diagnosed wet age-related macular degeneration (AMD) who have been treated with anti-vascular endothelial growth factor (VEGF) drug (aflibercept).Prospective analysis was conducted on 44 eyes of 44 patients treated with intravitreal injection of anti-VEGF (aflibercept) because of newly diagnosed neovascular AMD. According to the research protocol, all patients had a 6-month follow-up. The response to treatment was monitored functionallybyMP-1 microperimetry, fixation, and distance BCVA assessment after injection. Improvement of retinal sensitivity and BCVA was found under aflibercept treatment. There was statistically significant improvement in retinal sensitivity in the MP-1 study 3 and 6 months from the beginning of anti-VEGF therapy. Moreover, a significant improvement in retinal sensitivity between 3 and 6 months of observation was demonstrated. At the same time, up to 3 months from the beginning of treatment, BCVA improved significantly compared to the baseline value. In the 6th month of the study BCVA remained stable without further significant improvement.Microperimetric examination with medium sensitivity and fixation stability assessment is a very valuable test determining the retinal function. It is clear that examining the macular morphology itself in modern diagnostics is not enough to assess retinal function. Microperimetry technique is a valuable tool for functional long-term evaluation of retinal function (also for a period of more than 3 months).

Assessment of selected adipocytokines in obese women with postmenopausal osteoporosis.

INTRODUCTION: Osteoporosis and obesity are considered civilisation diseases. Menopause is a time of increased bone resorption and increased mass of adipose tissue. Adipocytokines secreted by the adipose tissue are believed to be a potential factor in the pathogenesis of osteoporosis. MATERIAL AND METHODS: The aim of this research was to assess leptin, adiponectin, and resistin secretion in obese postmenopausal women with osteoporosis and determine whether obesity might be a factor mitigating the risk of osteoporosis. The study involved 80 postmenopausal women with osteoporosis divided into groups: I with BMI of 30.0 34.9, obese; and II with BMI of 18-24.9, normoweight. Leptin, adiponectin and resistin concentrations were assessed, and bone mineral density (BMD) was measured in the L1-L4 section of the spine using the DXA densitometric method. RESULTS: The results of the comparison of the two groups indicate a statistically significant dependence in groups regarding leptin secretion; the group of obese women demonstrated significantly higher concentrations. No differences between the groups were demonstrated for adiponectin or resistin secretion. CONCLUSIONS: Higher leptin concentration and a positive correlation with BMI was confirmed in obese postmenopausal women with osteoporosis. It was also demonstrated that BMD increases with growing BMI. No effect of obesity on the secretion of adiponectin or resistin in women with postmenopausal osteoporosis was found. From among the investigated adipocytokines, only leptin can be considered a bone tissue protective factor in postmenopausal women.

Fibroblast and keratinocyte crosstalk: the effect of a poly(tri[ethylene glycol] ethyl ether methacrylate) thermoresponsive surface on short-term co-culture.

The treatment of difficult-to-treat wounds can be challenging. Although a number of approaches have been investigated, the healing process may be slow and unsatisfactory. An alternative approach is the use of a continuous sheet of skin cells applied over a wound which may improve cell implantation and patient recovery. To analyse the gene expression profile of fibroblast/keratinocyte co-culture on poly(tri[ethylene glycol] ethyl ether methacrylate) (P[TEGMA-EE]), a thermoresponsive biocompatible surface. Cultures were grown for 72 hours as a continuous layer on P(TEGMA-EE). Assays for genotoxicity, cell morphology, and fluorescence-assisted flow cytometry were performed to exclude adverse effects. A gene expression profile related to the extracellular matrix was investigated by microarray analysis. For fibroblast monocultures and fibroblast/keratinocyte co-cultures maintained for 72 hours on P(TEGMA-EE), no change in morphology or specific surface markers, or DNA damage (comet assay) was observed, relative to control surface. Moreover, no detrimental impact was ascertained based on microarray analysis. In response to lowered temperature, the detachment of a continuous cell layer sheet from the thermoresponsive surface was observed. When gene expression was compared between fibroblasts cultured alone and co-cultured with keratinocytes on P(TEGMA-EE), 10 genes were shown to be differentially expressed. Of these genes, six were significantly differentially expressed between cultures grown on P(TEGMA-EE) and human skin samples. Our results indicate that P(TEGMA-EE) is fully biocompatible and is therefore a suitable surface for successful preparation and recovery of two-layered fibroblast/keratinocyte co-culture as a continuous sheet of cells.

TaTME: 2 Years of Experience of a Single Center.

INTRODUCTION: Concomitant transanal and transabdominal access has shown potential benefits for patients with lower and medial rectal cancers and led to better short-term and medium-term outcomes, a better quality of surgical specimen and a lower number of positive radial margins. MATERIALS AND METHODS: Between 2015 and 2017, 36 patients with rectal cancer underwent transanal total mesorectal excision (TaTME) surgery. The group included 21 males and 16 females. The mean age of the patients was 68.7 years and ranged from 41 to 83 years. In all cases, concomitant transanal and laparoscopic access via abdomen were used. Transanal access was achieved with the use of GelPoint Path Transanal Access Platform (Applied Medical). The lower rectum was visualized with the use of Lone Star retractor (Lone Star Medical Products Inc.). RESULTS: In 35 cases R0 resection was reported and R1 in 1 case (2.7%). Mean number of lymph nodes in the specimen was 13.7 (8 to 20 nodes). The mesorectal quality was graded as complete in 34 cases (94.4%) and nearly complete in 2 cases (5.6%). Symptoms of anastomotic leak were observed in 6 cases with 3 patients (8.3%) requiring reoperation. CONCLUSIONS: TaTME seems to be a promising method of treatment for patients with lower and middle rectal cancer. Short-term outcomes show an advantage of TaTME over laparoscopic total mesorectal excision.

Does the transplantation of keratinocytes really reduce the risk of death? Survival analysis of patients hospitalized at the Dr Stanislaw Sakiel Centre for Burns Treatment in 2008-2015.

BACKGROUND: Keratinocyte transplantation is an adjuvant procedure in the extensive burn therapy method. However, it must be taken into consideration that clinical results of keratinocyte transplantation are ambiguous and progress achieved in this method is still being verified, especially due to the high cost of cultured epithelial autograft (CEA) transplants. OBJECTIVES: The aim of this study was to verify the impact of cultured keratinocyte application on patients' survival. This study included a group of patients with the highest chance for a successful outcome of the therapy and excluded patients with no compelling reason to apply for such an expensive therapy. MATERIAL AND METHODS: This study included all the patients with burns diagnosed between January 1, 2008 and January 1, 2016, who were treated with cultured skin cells. Patients' age and gender, percentage of total body surface area (TBSA) affected, percentage of burn depth of the 3rd/4th degree, number of days between admission and surgery, and need for rehabilitation were analyzed. RESULTS: The cultured cell application did not significantly affect the risk of death (p > 0.05). CONCLUSIONS: Keratinocytes should be applied as an adjunctive method for the treatment of burns with at least 40% TBSA affected, but with a maximal burn depth of the 2nd degree. In the group of patients below 50 years of age, a higher number of transplants with a cell population above 20 million/mL and a significantly lower mortality rate were observed, which means that in the mentioned age group, this graft was more effective. It has been suggested that patients older than 50 years of age with burns deeper than of the 2nd degree should be treated with more advanced methods like, e.g., the application of stem cells.

Thermal imaging and planimetry evaluation of the results of chronic wounds treatment with hyperbaric oxygen therapy.

BACKGROUND: One of the methods to treat chronic wounds is the use of hyperbaric oxygen (HBO). Objective measurement of the wound surface is an important element in the process of monitoring and predicting the progress of treatment. OBJECTIVES: The aim of the study was to evaluate the effect of hyperbaric oxygen therapy (HBOT) on ulcer wound healing in patients with chronic venous insufficiency ulcers and diabetic foot syndrome using thermal imaging and computerized planimetry. MATERIAL AND METHODS: During a 3-year period, 284 digital computer planimetry measurements were gathered from 142 patients treated for leg ulcers caused by chronic venous insufficiency and ulcers from diabetic foot syndrome at HBOT Unit of the Dr Stanislaw Sakiel Centre for Burns Treatment in Siemianowice Slaskie (Poland). Each patient took 30 HBOT sessions using a Haux multiplace HBO chamber at a pressure of 2.5 atmospheres absolute (ATA). The results of the treatment were monitored by thermovision and computerassisted planimetry measurements performed before and after HBOT. RESULTS: Both groups of patients exhibited a reduction in the surface and perimeter of the wound after HBOT. The treatment effects were also confirmed by thermal imaging. The areas calculated from thermal imaging and planimetry are different but correlated. CONCLUSIONS: It seems that a combination of thermal imaging and planimetry may enhance the diagnosis as well as provide the physician with more information about therapy effects.

Computerized planimetry evaluation of hyperbaric oxygen therapy in the treatment of diabetic foot.

BACKGROUND: Diabetic foot ulcer is one of the major complications of diabetes mellitus in adults. OBJECTIVES: The aim of the study was to conduct a planimetry evaluation of the effectiveness of hyperbaric oxygen therapy (HBOT) in the treatment of patients with vascular disorders caused by diabetic foot. MATERIAL AND METHODS: The study included 94 patients, 30 females (32%) and 64 males (68%), aged 33-76 years, with diabetes lasting 1.5-32 years, who underwent HBOT due to diabetic foot. All patients from that group underwent vascular procedures prior to HBOT. In qualifying patients for hyperbaric oxygen therapy, transcutaneous oximetry method was applied (30-60 exposures in hyperbaric oxygen at pressure of 2.5 ATA). Progress in wound healing was evaluated by computerized planimetry system IRIS 4. RESULTS: In 26 patients the wounds were completely closed and in 37 patients the topical state was significantly improved - the wound surface decreased by 34% in average. During the treatment, in 11 patients amputation of fingers and metatarsal necrotic bones was performed, while in 9 patients amputation was prevented. CONCLUSIONS: A planimetry evaluation showed that the application of HBOT in the treatment of diabetic foot enhances foot ulcer healing, reduces tissue damage, contributes to the reduction of complications related to soft tissue and bone infections.