The role of negative pressure wound therapy in salvaging a six-year-old child's crushed foot - A case report.

Crushed extremity is an infrequent injury in children and represents a major challenge for the orthopaedic surgeon. Sometimes the decision making process, whether to amputate or save a limb, is very difficult. Several scoring systems have been developed in order to determine the fate of crushed extremities, but they are not always predictive when patients are children. In the past few years, advances in bone and soft tissue reconstruction techniques have improved outcomes, even in the most extreme cases. Negative Pressure Wound Therapy has become an accepted option in the treatment of crushed limbs. We report a 6-year-old child with a crushed left foot from the running chain of his father's motorcycle. Early revascularization and stabilization along with multiple debridement and the application of Negative Pressure Wound Therapy leaded to salvage of the child's limb. At the end of one year follow up, he presented a very good functional and aesthetic result. LEVEL OF CLINICAL EVIDENCE: "4".

Stimulation of natural killer cells by homoeopathic complexes: an in vitro and in vivo pilot study in advanced cancer patients.

The present study was designed in order to evaluate the effects of five homoeopathic complex preparations on functional activity natural killer cells (NKCs) in advanced cancer patients. We examined the effects of Coenzyme Compositum®, Ubichinon Compositum®, Glyoxal Compositum®, Katalysatoren® and Traumeel® on the functional activity of NKCs. Experimental procedures included in vitro and in vivo trials. The in vitro trials were performed in NKCs isolated from 12 healthy volunteers (aged 44 ± 4 years) and incubated with the five homoeopathic complex preparations. The in vivo trials were performed in 15 advanced cancer patients (aged 55 ± 12 years) supplemented for 3 months with the homoeopathic preparations. All five homoeopathic preparations significantly increased the cytotoxic activity of the NKCs at the lowest NKCs/target cell ratio 12:1 (p < 0·05). The order of activity was: Ubichinon Compositum® > Glyoxal Compositum® > Katalysatoren® > Traumeel® > Coenzyme Compositum®. In the advanced cancer patients, the homoeopathic preparation significantly increased NKCs cytotoxic activity (p < 0·05). The homoeopathic complex preparations tested in this study can be used as an adjuvant immunotherapy in advanced cancer patients.

Comparison of the Weil and Triple Weil Osteotomies: A Clinical Retrospective Study.

INTRODUCTION: The Weil and triple Weil osteotomies are two widely used procedures in the surgical treatment of metatarsalgia. The aim of this comparative retrospective study was to evaluate the functional results and determine the complications of the two types of osteotomies in a series of patients who underwent surgery due to third rocker metatarsalgia. MATERIAL AND METHODS: In this paper, 71 patients were included between September 2015 and October 2020. The average age was 58 years old (age range: 28-72). Of all the patients, 27 suffered from metatarsalgia due to systemic (extra-regional) or regional diseases were excluded. The remaining 44 patients, after six months of unsuccessful conservative treatment, underwent surgery. Based on the preoperative planning to restore the peripheral parabolic curve of the metatarsals, when a shortening of less than or equal to 3 mm was required, a Weil osteotomy was performed. However, when a shortening of more than 3 mm was required, a triple Weil osteotomy was performed. Therefore, two groups of patients were formed, and a total of 90 osteotomies were performed. During the postoperative period, all the patients were clinically and radiographically assessed. The American Orthopedic Foot and Ankle Society (AOFAS) score was used for the assessment of the functional result, while the pain was assessed using the Visual Analogue Scale (VAS). RESULTS:  The mean follow-up was 24 months. The average operative time for the Weil and the triple Weil osteotomies was 22.8 minutes and 31.5 minutes, respectively. In group A, preoperatively, the average AOFAS score was 31/100, and postoperatively, it was 89/100. In group B, the corresponding values were 30/100 and 93/100, respectively. In group A, the preoperative VAS score was 7.8/10, while the postoperative VAS score was 1.3/10. In group B, the corresponding values were 8.2/10 and 1.7/10, respectively. In group A, stiffness had a percentage equal to 60.9%, and a floating toe was noticed in 16 osteotomies. In group B, superficial infection represented the commonest complication, with an incidence of 25.6%. CONCLUSION: Both Weil and triple Weil osteotomies are effective procedures in the surgical treatment of patients who suffer from third-rocker metatarsalgia. In both cases, correct preoperative planning is of paramount importance for the outcome. However, in terms of the appearance of the floating toe, it seems that in cases where a ray's shortening of more than 3 mm is required, the triple osteotomy is superior to the Weil osteotomy.

Biomechanical Analysis of the Change of the Metatarsophalangeal Joint's Center of Rotation After Weil and Triple Weil Osteotomies: A Comparative Cadaveric Study.

Background The aim of the present biomechanical study on cadavers was to determine both the center of rotation of the metatarsophalangeal joints and the position of the tendons of the interosseous muscles after the Weil and triple Weil osteotomies, and to compare these parameters in order to clarify the pathogenesis of dorsal stiffness and floating toe. Materials and methods Seven fresh-frozen cadaveric feet were utilized. After completing the preparation of both the plantar and the dorsal surface, we performed the dissection of the entire second, third and fourth rays, and each ray was fixed to a wooden wall mounted on a movable frame. The biomechanical analysis was based on an equilibrium system made of pulleys, threads, and variable weights. Geometrical analysis of both osteotomies and fluoroscopy was used to determine the initial and final metatarsophalangeal joint's center of rotation, as well as the change of interosseous muscles position. Results On comparing the results of the findings, we noticed that after Weil osteotomy, the metatarsophalangeal joint's center of rotation was proximally and plantarly displaced by 3.5 mm compared to the control group, and by 3.7 mm in comparison to the triple Weil osteotomy group. In the latter, the center of rotation was displaced by 0.817 mm compared to the control group. Furthermore, after the Weil osteotomy, the position of the interossei tendon was above the metatarsal longitudinal axis. Conclusion In cases where a metatarsal shortening of 5 mm or greater is desired, the Weil osteotomy causes a statistically significant plantar displacement of the metatarsophalangeal joint's center of rotation, compared to cases where triple Weil osteotomy is performed.

Syncope without prodromes is associated with excessive plasma release of adenosine at the time of syncope during head-up tilt table test.

BACKGROUND: In syncopal patients without underlying structural disease, we sought to investigate the association of Adenosine Plasma Levels (ADP) with the clinical presentation of neurally mediated syncope (NMS) and the outcomes of Head-Up Tilt Table Test (HUTT) and Adenosine test (ADT). METHODS: We studied 124 patients with different clinical types of NMS, i.e., Vasovagal (VVS, n=58), non-prodromes (NPS, n=18), or situational syncope (SS, n=48), using a standard protocol including HUTT and ADT. During HUTT, ADP was measured in the supine position, at table tilting and in syncope. RESULTS: Baseline ADP did not differ among groups. ADP at syncope were higher in NPS (n=5) compared to VVS (n=20): 0.23 vs. 0.12 µΜ, p=0.03, and SS (n=22): 0.04 µΜ, p=0.02. In NPS, ADP increased from supine to syncope (n=5): 0.15 vs. 0.23 µΜ, p=0.04. In VVS, ADP increased only from supine to tilt position: 0.11 vs. 0.14 µΜ, p=0.02. In SS, ADP did not change during HUTT. In positive vasodepressor HUTT, ADP increased from supine to tilt position (p=0.002) and at syncope (p=0.01). In SS, 20.0% exhibited cardioinhibitory HUTT vs. 6.8% in other forms of syncope (p=0.04). In SS, 22.9% manifested positive ADT vs 6.6% in other types of syncope (p=0.012). CONCLUSION: The subset of NPS patients with positive HUTT, show excessive ADP release at the time of syncope. This may explain the lack of prodromes in this form of syncope. Such observations contribute to the understanding of distinct profiles of clinical forms of syncope and may differentiate the management approach accordingly.

Is polyploidy a persevering accident or an adaptive evolutionary pattern? The case of the brine shrimp Artemia.

Asexual organisms are confronted with substantial drawbacks, both immediate and delayed, threatening their evolutionary persistence. Yet, genetic associations with asexuality may refresh the gene pool promoting adaptation of clonal lineages; polyploidy is one of them. Parthenogenesis itself and/or polyploidy are responsible for the maintenance and spread of clones in Artemia, a sexual-asexual genus of halophilic anostracans. We applied flow cytometry, microsatellite genotyping, and mtDNA sequencing to 23 asexual populations. Artemia parthenogens have evolved multiple times either through hybridization or spontaneously. Nine out of 23 populations contained clones of mixed ploidy (2n, 3n, 4n). Most clones were diploid (20/31) while two and nine clones were triploid and tetraploid, respectively. Apomictic triploids and tetraploids formed two distinct groups of low genetic diversity compared with the more divergent automictic diploids. Polyploidy is also polyphyletic in Artemia, with triploids and tetraploids having independent origins from different sexual ancestors. We discern a pattern of geographical parthenogenesis with all clonal groups being more widespread than their closest sexuals. In favour of a specialist model, asexual diploids are restricted to single locations and are strikingly segregated from generalist triploids and tetraploids occupying a variety of sites. This is a rare pattern of mixed life-history strategies within an asexual complex.

Aggressive angiomyxoma to 57-year old man.

Aggressive angiomyxoma is a rare mesenchymal tumor occurring usually in women of reproductive age in pelvic-perineum region. These myofibroblastic tumors rarely affect men and non-pelvic-perineum anatomical sites. There are few literature references for aggressive angiomyxoma in men. We describe a case of a 57-year old male with aggressive angiomyxoma of the scrotum and its management.

Deficient Phagocytosis Among HIV-1 Infected Adults Over Time Even in HAART Setting.

BACKGROUND: Phagocytosis is regarded to be impaired in HIV-1 infected adults, leading to high frequency and severity of several infections in this population. Data is contradictory with regards to individual facets in HIV infection. OBJECTIVE: Aim of this study was to assess the phagocytic activity during the natural course of HIV infection. METHOD: It is a longitudinal study assessing natural course and impairment of neutrophil and monocyte phagocytosis in both naïve and HAART treated patients. RESULTS: A lower neutrophil phagocytic activity was recorded in naïve patients compared to treated patients. Interestingly, a downward trend of neutrophil phagocytic activity was recorded in both groups, irrespectively of HAART intake, within 48 weeks of observation. CONCLUSION: Defects of innate immunity appear to be present in HIV infected patients regarding phagocytic activity of monocytes and of neutrophils which seems to decline over time. These deficiencies are influenced by the levels of CD4 cell counts and viral load.

Antiretroviral naive and treated patients: Discrepancies of B cell subsets during the natural course of human immunodeficiency virus type 1 infection.

AIM: To evaluate alterations of memory B cell subpopulations during a 48-wk period in human immunodeficiency virus type 1 (HIV-1) patients. METHODS: Forty-one antiretroviral naïve and 41 treated HIV-1 patients matched for age and duration of HIV infection were recruited. All clinical, epidemiological and laboratory data were recorded or measured. The different B cell subsets were characterized according to their surface markers: Total B cells (CD19+), memory B cells (CD19+CD27+, BMCs), resting BMCs (CD19+CD27+CD21high, RM), exhausted BMCs (CD19+CD21lowCD27-, EM), IgM memory B (CD19+CD27+IgMhigh), isotype-switched BMCs (CD19+CD27+IgM-, ITS) and activated BMCs (CD19+CD21low+CD27+, AM) at baseline on week 4 and week 48. RESULTS: Mean counts of BMCs were higher in treated patients. There was a marginal upward trend of IgM memory B cell proportions which differed significantly in the treated group (overall trend, P = 0.004). ITS BMC increased over time significantly in all patients. Naive patients had of lower levels of EM B cells compared to treated, with a downward trend, irrespectively of highly active antiretroviral therapy (HAART) intake. Severe impairment of EM B cells was recorded to both treated (P = 0.024) and naive (P = 0.023) and patients. Higher proportions of RM cells were noted in HAART group, which differed significantly on week 4th (P = 0.017) and 48th (P = 0.03). Higher levels of AM were preserved in HAART naive group during the whole study period (week 4: P = 0.018 and 48: P = 0.035). HIV-RNA viremia strongly correlated with AM B cells (r = 0.54, P = 0.01) and moderately with RM cells (r = -0.45, P = 0.026) at baseline. CONCLUSION: HIV disrupts memory B cell subpopulations leading to impaired immunologic memory over time. BMC, RM, EM and ITS BMC were higher in patients under HAART. Activated BMCs (AM) were higher in patients without HAART. Viremia correlated with AM and RM. Significant depletion was recorded in EM B cells irrespectively of HAART intake. Perturbations in BMC-populations are not fully restored by antiretrovirals.

Could Somatostatin Enhance the Outcomes of Chemotherapeutic Treatment in SCLC?

PURPOSE: Somatostatin is a peptide with a potent and broad antisecretory action, which makes it an invaluable drug target for the pharmacological management of pituitary adenomas and neuroendocrine tumors. Furthermore, somatostatin (SST) receptors (SSTR1, 2A and B, 3, 4 and 5) belong to the G protein coupled receptor family and are overexpressed in tumors. Since, human small-cell lung cancer overexpresses somatostatin receptors (STTR), they could be legitimate targets for treating SCLC.The aim of this study was the evaluation of cytotoxicity of somatostatin in combination with several anticancer drugs in HTB-175 cell line (Small Cell Lung Cancer Cell line that expresses neuron specific enolase). METHODS: Docetaxel, Paclitaxel, Carboplatin, Cisplatin, Etoposide, Gemzar, Navelbine, Fluorouracil, Farmorubicin are the chemotherapeutic drugs that we used for the combination before and after adding somatostatin in SCLC cell culture. HTB-175 cell line was purchased from ATCC LGC Standards.At indicated time-point, 48h after the combination, cell viability and apoptosis were measured with Annexin V staining by flow cytometry. RESULTS: Flow cytometry showed that Docetaxel, Paclitaxel, Gemzar and Cisplatin induced apoptosis more when they were added before somatostatin, whereas etoposide induced apoptosis more after somatostatin treatment. Navelbine alone or in combination with somatostatin showed no differences in apoptosis. Farmorubicin showed equal toxicity in all combinations. Fluorouracil and Carboplatin induced apoptosis more when added alone in HTB-175 cell line. However, increased apoptosis was also observed when Carboplatin was administered before somatostatin in higher concentrations. CONCLUSION: Our results indicated that depending on the drug, somatostatin treatment before or after chemotherapeutic drugs increased apoptosis in small cell lung cancer cells. We suggest that long acting somatostatin analogues could be used as additive and maintenance therapy in combination to antineoplastic agents in SCLC patients.