Nanosilver-loaded PMMA bone cement doped with different bioactive glasses - evaluation of cytocompatibility, antibacterial activity, and mechanical properties.

Nanosilver-loaded PMMA bone cement (BC-AgNp) is a novel cement developed as a replacement for conventional cements. Despite its favorable properties and antibacterial activity, BC-AgNp still lacks biodegradability and bioactivity. Hence, we investigated doping with bioactive glasses (BGs) to create a new bioactive BC characterized by time-varying porosity and gradual release of AgNp. The BC Cemex was used as the base material and modified simultaneously with the AgNp and BGs: melted 45S5 and 13-93B3 glasses with various particle sizes and sol-gel derived SiO2/CaO microparticles. The effect of BG addition was examined by microscopic analysis, an assessment of setting parameters, wettability, FTIR and UV-VIS spectroscopy, mechanical testing, and hemo- and cytocompatibility and antibacterial efficiency studies. The results show that it is possible to incorporate various BGs into BC-AgNp, which leads to different properties depending on the type and size of BGs. The smaller particles of melted BGs showed higher porosity and better antibacterial properties with the moderate deterioration of mechanical properties. The sol-gel derived BGs, however, displayed a tendency for agglomeration and random distribution in BC-AgNp. The BGs with greater solubility more efficiently improve the antibacterial properties of BC-AgNp. Besides, the unreacted MMA monomer release could negatively influence the cellular response. Despite that, cements doped with different BGs are suitable for medical applications.

Influence of several biodegradable components added to pure and nanosilver-doped PMMA bone cements on its biological and mechanical properties.

Acrylic bone cements (BC) are wildly used in medicine. Despite favorable mechanical properties, processability and inject capability, BC lack bioactivity. To overcome this, we investigated the effects of selected biodegradable additives to create a partially-degradable BC and also we evaluated its combination with nanosilver (AgNp). We hypothesized that using above strategies it would be possible to obtain bioactive BC. The Cemex was used as the base material, modified at 2.5, 5 or 10 wt% with either cellulose, chitosan, magnesium, polydioxanone or tricalcium-phosphate. The resulted modified BC was examined for surface morphology, wettability, porosity, mechanical and nanomechanical properties and cytocompatibility. The composite BC doped with AgNp was also examined for its release and antibacterial properties. The results showed that it is possible to create modified cement and all studied modifiers increased its porosity. Applying the additives slightly decreased BC wettability and mechanical properties, but the positive effect of the additives was observed in nanomechanical research. The relatively poor cytocompatibility of modified BC was attributed to the unreacted monomer release, except for polydioxanone modification which increased cells viability. Furthermore, all additives facilitated AgNp release and increased BC antibacterial effectiveness. Our present studies suggest the optimal content of biodegradable component for BC is 5 wt%. At this content, an improvement in BC porosity is achieved without significant deterioration of BC physical and mechanical properties. Polydioxanone and cellulose seem to be the most promising additives that improve porosity and antibacterial properties of antibiotic or nanosilver-loaded BC. Partially-degradable BC may be a good strategy to improve their antibacterial effectiveness, but some caution is still required regarding their cytocompatibility. STATEMENT OF SIGNIFICANCE: The lack of bone cement bioactivity is the main limitation of its effectiveness in medicine. To overcome this, we have created composite cements with partially-degradable properties. We also modified these cements with nanosilver to provide antibacterial properties. We examined five various additives at three different contents to modify a selected bone cement. Our results broaden the knowledge about potential modifiers and properties of composite cements. We selected the optimal content and the most promising additives, and showed that the combination of these additives with nanosilver would increase cements` antibacterial effectiveness. Such modified cements may be a new solution for medical applications.

Epidemiology of meningococcal meningitis and changes in the surveillance system in Poland, 1970-2006.

The objective of this study was to describe the general features of meningococcal meningitis epidemiology in 1970-2006 in Poland, in the context of changes made in surveillance system methods. Because of limited availability of case-based data, a more detailed analysis was performed only for the period 1994-2006 with special focus on case-fatality and diagnostic certainty. The reported annual number of meningococcal meningitis cases reached its peak of 416 (incidence 1.2 per 100,000) in 1981, after which it decreased to 76 cases in 2003 (incidence 0.2), and then increased to 151 cases in 2006 (incidence 0.4 per 100,000). The observed decrease was consistent with the decline in the number of live births and the drop in mortality from meningococcal disease observed using an independent reporting of death certificates. In 1994-2006, 1,677 cases of meningococcal meningitis were registered, with annual incidence varying between 0.2 and 0.5 per 100,000 inhabitants. Median age of patients was 4 years and 73% of cases were under 18 years of age. The majority of cases were caused by group B meningococci, but a trend towards increasing proportion of serogroup C has been identified. Meningococcal meningitis only was reported in 79% of cases, and meningitis with concomitant septicaemia in 21%. The overall case fatality was 3.7% - 4.5% in cases of meningitis only, and 7.1% in cases of meningitis with septicaemia. Based on the case definition introduced in 2005, 88.1% of the cases would be classified as confirmed and 4.8% as probable, whereas 7.1% would not fulfil the criteria of the case definition. Although diagnostic certainty of reported cases has improved in recent years, it is still problematic. Further efforts are needed to increase the proportion of serogrouped cases and assess the burden of meningococcal disease in Poland.

Evaluation of tickborne encephalitis case classification in Poland.

Central European tickborne encephalitis (TBE) is a viral disease of the central nervous system. Despite a surveillance system for TBE existing in Poland since 1970, there are no standardised case definitions and different diagnostic tests are used in various regions. The purpose of this study was to summarise four years of surveillance data using standardised case definitions. From 1999 to 2002, 607 cases of TBE were reported to Poland's national surveillance system: 386 (63.6%) were males, 331 (54.5%) lived in rural areas, and 186 (30.6%) were between 30 and 50 years old. Of 606 diagnosed cases, 453 (74.7%) had aseptic meningitis, 109 (18.0%) had meningoencephalitis, and 44 (7.3%) had meningoencephalomyelitis. Of the 607 reported cases, 602 (99.2%) could be classified: 153 (25.4%) as confirmed, 343 (57.0%) as probable, and 106 (17.6%) as possible cases. There was a significant difference in classified cases by gender: 28.6% of male cases were classified as confirmed, compared with 19.7% of female cases (chi2= 10.48, p=0.0053). There was a significant difference in case classification by clinical diagnosis: 32.4% of cases with meningoencephalitis were classified as confirmed cases, compared with 24.7% of cases with aseptic meningitis (chi2=11.79, p=0.019). There were also significant differences in the distribution by case definition group across geographical regions. For appropriate monitoring of TBE, a uniform and valid case definition should be used in European countries. With only 25% of reported cases meeting the definition for confirmed cases, there is a need for more complete follow-up and standardised testing of suspect cases.

Plasma immunoreactive proopiomelanocortin peptides and cortisol in normal dogs and dogs with Addison's disease and Cushing's syndrome: basal concentrations.

We measured basal plasma concentrations of the immunoreactive (IR) proopiomelanocortin (POMC)-derived peptides ACTH, beta-lipotropin (beta LPH), beta-endorphin (beta END), and alpha MSH in 160 normal dogs, 32 dogs with Addison's disease, 42 dogs with adrenocortical tumors causing Cushing's syndrome, and 169 dogs with pituitary-dependent Cushing's disease. In normal dogs, plasma IR-POMC peptide levels were similar to those in man, except that IR-alpha MSH, a pars intermedia POMC product, was readily detected. In Addisonian dogs, plasma cortisol was decreased, and the IR-POMC peptides were increased, except for IR-alpha MSH, which was normal. In 7 Addisonian dogs given dexamethasone, elevated plasma IR-ACTH, beta LPH, and beta END levels fell dramatically. In dogs with Cushing's syndrome due to adrenal tumors, plasma IR-ACTH, beta LPH, and beta END were decreased, and cortisol was increased, but IR-alpha MSH was normal. Dogs with Cushing's disease due to pars distalis tumors had elevated plasma IR-ACTH, beta LPH, beta END, and cortisol, but normal IR-alpha MSH; their plasma cortisol was suppressed by dexamethasone. There appeared to be 2 types of pars intermedia tumors causing Cushing's disease: 1 dexamethasone nonsuppressible and with disproportionately high plasma IR-alpha MSH levels, the other relatively dexamethasone suppressible and with normal to slightly elevated IR-alpha MSH levels. These 2 pars intermedia tumor types may arise from 2 distinct normal canine pars intermedia cell types. Canine Cushing's disease may provide a useful model for variants of the disorder in man.

A Y-maze test reveals the positively reinforcing properties of electrical stimulation of the mesencephalic central gray area.

Animals stimulated in the dorsal part of the mesencephalic central gray area (CG) are able, as are animals stimulated in the lateral hypothalamus, to discriminate between the reinforced and the non-reinforced arm of an Y-maze to trigger a continuous electrical stimulation. This result clearly demonstrates that stimulation of the dorsal part of CG has an appetitive component.

Self-stimulation of an 'aversive' brain structure: the mesencephalic central gray area.

Four experiments were performed in BALB/c mice implanted either in the lateral hypothalamus (LH) or in the dorsal part of the mesencephalic central gray area (CG) or both in LH and CG. In the first 3 experiments the animals were placed in a Y-maze where they could successively trigger and turn off continuous electrical stimulation. Expt. 1 showed that mice stimulated in CG (like animals stimulated in LH) are able to discriminate between the reinforced and the non-reinforced arm of the Y-maze in order to self-administer the stimulation. This behavior was observed whether the experimental situation was a simple spatial discrimination or a more complex light-dark discrimination. During the second experiment, the animals could choose between stimulation of low intensity (in one arm) or high intensity (in the other arm). We observed that, like LH animals, CG implanted mice chose the higher stimulation, despite its strong aversive component. On the other hand, Expt. 3 showed that when the animals could chose between CG stimulation, whose intensity was progressively increased, and LH stimulation whose intensity remained constant (low) they preferred the latter. When the mice were placed in a lever-press box where they could obtain 0.2 s of electrical stimulation (last experiment), LH animals showed vigorous self-stimulation behavior, whereas CG animals showed only a weak response rate. These results show that, in spite of its aversiveness, dorsal CG stimulation has an appetitive component whose magnitude may vary under different experimental conditions.

A comparative study on basophil histamine release and skin testing in children with allergic rhinitis.

Skin tests and histamine release from basophils induced by the same allergens in children with allergic rhinitis were compared. A qualitative correlation between these two tests was found. Basophil histamine release either spontaneous or allergen-induced during the period of developed allergic symptoms was markedly higher as compared with that in a period of clinical remission. It is concluded that basophil histamine release might be a valuable diagnostic method for detection of allergen(s) responsible for symptoms of allergic rhinitis.

A comparative immunological study of vasomotor rhinitis and pollinosis.

Differentiation between pollinosis and vasomotor rhinitis creates great diagnostic difficulties. The aim of this study was to conduct comparative immunological clinical studies contrasting these two distinct diseases. Thirty-one subjects with untreated pollinosis and 29 subjects with untreated symptoms of rhinitis were tested, determining their T and B lymphocyte counts and the counts of their subpopulations, the levels of immunoglobulin A, M, G, D and E, both separately and in total, and levels of both basal and whole histamine. The control group was comprised of 30 healthy subjects. The results of this study show that these two diseases differ from each other (p < 0.05) in the recorded levels of basal histamine, total IgE, and IgG, IgM and IgD, as well as the count of T-RFC lymphocytes, T lymphocytes with receptors for Fc IgG and B lymphocytes with superficial receptors for IgG. The most useful laboratory methods for diagnosing the difference between pollinosis and vasomotor rhinitis appear to be the determination of levels of basal histamine and IgD in the blood.

Specific immunotherapy in pollinosis: I. Valuation of certain cytoimmunological indicators over the course of four years of immunotherapy in pollinosis.

The aim of this study was to identify, based on a wide range of cytoimmunological and immunological tests in combination with clinical valuations, the changes which occurred in pollinosis over the course of specific immunotherapy after the first, second, third and fourth years of treatment. Further tests were also conducted in order to demonstrate which of the indicators tested for correlated to a clinical improvement and might thus be helpful in determining the effectiveness of treatments for pollinosis. A group of 167 individuals, including subjects who had just completed their first, second, third and fourth year of desensitization treatments were tested. Levels of IgA, IgM, IgG, IgD, total and specific IgE, T-RFC, B-EAC, T-FcM-EN and T-FcG-BG lymphocyte counts, and concentrations of basal, total and specifically released blood histamine were all determined and noted. It was ascertained that the indicators best correlating to a clinical improvement over 4 years of desensitization in pollinosis were specific and total IgE, as well as the percentage of specifically released histamine present in the blood, with the level of basal histamine in the blood being constant during the entire course of the treatment. The remaining indicators which were tested did not undergo any characteristic changes over the course of 4 years of immunotherapy.

Specific immunotherapy in pollinosis: II. Forecasting changes in certain cytoimmunological indicators after four years of immunotherapy in pollinosis.

The determination of an appropriate period of duration for specific immunotherapy presents an important problem in the treatment of allergic diseases. The aim of this paper was to conduct a prognostic study of certain immunological indicators after 4 years of desensitization, and to determine which of the tested indicators are characteristic for an evaluation of the clinical condition. Individuals with pollinosis were tested after the first, second, third and fourth year of desensitization using the pollen allergen. The B and T-lymphocyte counts, the levels of immunoglobulins A, M, G, and total and specific E, and the volume of basal, total and specifically released histamine were all measured. Furthermore, the clinical condition of the patient was defined using a score method (0-3 points), taking into account the results of testing and the basic symptoms of the disease. Following this, a prediction of results after the fifth year of desensitization was made, using Brown's method of exponential smoothing. The majority of the data obtained from the forecasting study indicate that in the subsequent fifth year of desensitization, the indicators studied should undergo further changes in values, offering a strong argument for the necessity of extending the period of immunotherapy in pollinosis beyond three years. In the results of the regression function estimates it was determined that, among the indicators studied, those which are helpful in monitoring treatment are: T-RFC, T-FcG-BG, T-FcM-EN and B-EAC lymphocyte counts, levels of IgA, IgM and specific IgE, and the percentage of specifically released histamine.

Two-stage surgical treatment for male transsexuals.

A plan for complex treatment of male-to-female transsexuals is presented. On the basis of our experience in the management of 15 patients, two-stage surgical treatment aiming at the change of external genitals, as well as the obtained cosmetic and functional results are described.

Congenital blepharoptosis: Part I. Evaluation of the results of surgical treatment for congenital blepharoptosis.

A retrospective clinical analysis of 69 of 118 patients with congenital blepharoptosis aged from 2 to 48, who underwent surgical corrections at the Department of Plastic Surgery of Lódz between 1977 and 2001, was reviewed. Included cases were analysed on the base of the type of primary defect, degree of ptosis, and surgical method. The aim of this study was to estimate aesthetic and functional results of surgical treatment in 39 patients corrected by Mustarde's modified method, in 17 by Mustarde's method, in 7 by Everbusch's method, in 4 by Blascovic's method, and in 2 by frontalis suspension. Comparable acceptable results of Mustarde's modified and Mustarde's method were achieved. Postoperatively 13 patients (18.8%) exhibited lagophthalmos.

Congenital blepharoptosis: Part II. Visual disorders coexisting with congenital blepharoptosis.

A retrospective ophthalmic analysis 44 of 118 patients with congenital blepharoptosis aged from 2 to 48, who underwent surgical correction at the Department of Plastic Surgery of Lódz between 1977 and 2001, was reviewed. Patients with congenital blepharoptosis were investigated by ophthalmologists in the pre and postoperative period, and their medical ophthalmological notes were also analysed. The aim of this study was to assess the presence, type, and severity of visual disorders coexisting with ptosis. We found in 42 patients (95%) ophthalmologic disorders, of which we noted amblyopia in 19, astigmatism in 30, anisometropia in 5, and strabismus in 30 cases.

Drugs used for cognitive symptoms of Alzheimer's disease.

AD is a devastating disease that is increasing in real numbers as our population ages. The toll on individuals, families, health care, and society will continue to escalate unless more effective treatment approaches are developed. To date, the most effective treatments are those that increase brain ACh levels by retarding the enzymatic breakdown of this neurotransmitter. These agents have proved modestly effective but are far from being the answer to AD. Further, when these drugs are withdrawn, patients rapidly decompensate to the state of disability suffered by those receiving placebo, indicating the deteriorative process continues unabated. The long-term effects on cognition of these drugs also is not known, but most clinicians are not overly optimistic. Other pharmacologic approaches include vitamin E, ginkgo biloba, estrogen, and the nonsteroidal anti-inflammatory drugs. Clinical trials do not robustly support their efficacy at this time, but there are numerous anecdotal reports to promote any or all of these approaches. Newer strategies under study include antiamyloid agents and nootropics (which enhance neuronal metabolic activity). The value of these approaches remains to be confirmed.

[Neurologic syndromes in patients with HIV infections. I. Diseases of peripheral nerves and skeletal muscles associated with HIV infection]. / Zespoly neurologiczne u osób zakazonych HIV. Czesc I. Choroby nerwów obwodowych i miesni szkieletowych zwiazane z infekcja HIV.

It is a review of the most common neuropathies observed in HIV infected people. The authors present the basic clinical and neuropathological features of the: distal peripheral neuropathy, chronic inflammatory, demyelinating polyneuropathy, progressive ascending polyradiculopathy-myelopathy, mononeuropathy multiplex, and autonomic neuropathy. Mentioned are neuropathies observed as adverse reactions to drugs used for people with AIDS. HIV related myopathy is included in the review.

[Clinical assessment of calvarial reconstruction with autogenic bone graft or implants of acrylate and polypropylene-polyester knitted fabric]. / Ocena kliniczna rekonstrukcji sklepienia czaszki autogennymi przeszczepami kosci oraz wszczepami z akrylu i dzianin polipropylenowo-poliestrowych.

During the period between 1972-1992 32 patients with calvarial bone defects were treated by 35 reconstructions. The paper presents early and late results of various methods of reconstructions. Very good late results were achieved in all 5 patients in whom the defects were reconstructed with autogenic split cranial bone graft. There were equally good results in 19 from 22 patients in whom acrylic and propylene-polyester implants were applied. Total resorption of autogenic split iliac and split rib bone graft were observed in all 5 patients in whom skull defects were filled with this tissue.

[Neurological syndromes in HIV patients. Part III -- HIV-related diffuse diseases of the central nervous system]. / Zespoly neurologiczne u osób zakazonych HIV. Czesc III-Nieogniskowe choroby osrodkowego ukladu nerwowego zwiazane z zakazeniem HIV.

The last part of the review of the neurological syndromes observed among people who are HIV-infected deals with AIDS Dementia Complex, viral (CMV, HSV, VZV) encephalitides and cryptococcal meningitis and other less frequent diseases. Clinical presentation, neuropathology, diagnostic procedures and treatments are described. Diagnostic algorithm for central nervous system diseases in people with HIV is included. The main purpose of the present reviews is to pursue the common ground regarding treatment and diagnostic procedures with consulting neurologists and neurosurgeons for future cooperation in a growing area of HIV related neurology.

[Selective mechanical dilatation of brain arteries: intracranial angioplasty]. / Wybiórcze mechaniczne poszerzenie tetnic mózgowych--wewnatrzczaszkowa angioplastyka.

Intracranial vascular stenosis of haemodynamic significance is underappreciated both clinically and diagnostically. It is thought to be the cause of cerebral ischaemia in 8% of patients. Now it is possible to perform dilatation of the intracranial arterial stenosis by modern intraarterial angioplasty. Two cases are presented of successful dilatation of middle cerebral artery trunk stenosis. Diagnostic problems, follow up and pharmacological treatment as well as technique of intravascular treatment is described.