The utility of the predictive scores in polytrauma with abdomino-pelvic injuries: a series of 38 patients.

UNLABELLED: Trauma is the principal cause of mortality among the population under 40 years. The aim of our study was to compare predictive trauma scores and demonstrate their utility in the evaluation of the quality of care in polytrauma. MATERIAL AND METHODS: A retrospective study was performed between 2000-2011 including polytrauma patients with abdominal lesions and pelvic fracture who under went emergency laparotomy. We calculated ISS, GCS, RTS,TRISS, ASCOT trauma scores and W score for evaluation of treatment quality. RESULTS: We obtained the necessary data to calculate the predictive scores in 38 cases. Comparing the scores of the survivals and non-survivals we noted the following regarding mortality predictive scores: GCS 13.74 vs. 6.13 (p 0.0001),ISS 28.52 vs. 35 (p=0.0169), RTS 6.96 vs. 3.07 (p 0.0001),TRISS 84.67% vs. 28.7% (p 0.0001), ASCOT 10.34% vs.64.32% (p 0.0001). The W score in TRISS and ASCOT methodology was -2.05 (p=0.7997) and -7.81 (p=0.336),respectively. There was no statistically significant difference between actual and predicted mortality, the former being 39.47%. CONCLUSION: We did not observe differences between the two methodologies TRISS and ASCOT in mortality prediction (p=0.5401). Both of them can be used to predict polytrauma patient evolution. The W score is useful in treatment quality assessment.

Clinical findings, treatment and outcome of trapped neutrophil syndrome in Border Collies: 12 cases (2011-2022).

OBJECTIVES: This study aimed to evaluate clinical signs, diagnostic findings, treatment administered and short- (survival to 28 days) and long-term prognosis (survival >6 months) in dogs diagnosed with trapped neutrophil syndrome. MATERIALS AND METHODS: Medical records of 12 dogs (10 Border Collies and two Border Collie Crossbreeds) homozygous for VPS13B gene mutation causing trapped neutrophil syndrome from seven veterinary institutions between January 2011 and June 2022 were evaluated retrospectively. RESULTS: The most common clinical signs at the time of diagnosis were pyrexia, abnormal gait and gastrointestinal signs. Concurrent metaphyseal osteopathy and immune-mediated polyarthritis were common. Seven dogs had a segmented neutrophil count below, four dogs within and one dog above the analyser reference interval at presentation. Two dogs had a septic source identified and both were additionally identified to be homozygous mutant positive on DNA testing by polymerase chain reaction (PCR) for canine cyclic neutropenia. All dogs received at least one antimicrobial agent and 10 dogs received treatment with prednisone or prednisolone (median starting dose 1 mg/kg/day; range 0.5 to 2.5 mg/kg/day). Nine dogs were alive at 28 days and six dogs were alive at 6 months post-diagnosis. CLINICAL SIGNIFICANCE: Trapped neutrophil syndrome should be suspected in young Border Collies with pyrexia, lameness and gastrointestinal signs. Neutropenia may not always be present and long-term survival is possible. A septic focus was not commonly identified in our population; however, our results suggest that if identified, testing for concurrent canine cyclic neutropenia should be considered.

Association between PNPLA3[G]/I148M variant, steatosis and fibrosis stage in hepatitis C virus - genetic matters.

There is an established correlation between the PNPLA3 rs738409 C > G single nucleotide polymorphism (SNP) and hepatic steatosis and fibrosis in hepatitis C virus (HCV) infected patients. However not all data is convergent regarding the exact impact of this SNP on the pattern of disease progression in different clinical settings. In this study, we aimed to further bridge the knowledge gap on this topic by investigating the role of the G allele in promoting steatosis, fibrosis and disease progression in relation to other metabolic and anthropometric host factors. Two hundred and fifty consecutive patients, previously diagnosed with chronic hepatitis C (CHC) underwent liver biopsy. Histology was assessed using the Metavir scoring system. Transient elastography was used for follow-up. Ninety-eight patients were genotyped for PNPLA3 rs738409 and followed up for fibrosis progression. PNPLA3 rs738409[G] allele was significantly correlated with severe steatosis (P = 0.04), severe fibrosis at the time of enrollment (P = 0.0005) and fibrosis progression with an OR of 10.31 (95% CI 1.06 - 99.59, P = 0.04), after a mean follow-up time of 62.85 (95%CI: 52.21 - 76.15) months. Severe steatosis at the time of enrollment had an OR of 11.02 (95% CI 1.48 - 82.09, P = 0.01) for the association with fibrosis progression. The HOMA-IR index was also positively correlated with severe fibrosis (P = 0.03) and fibrosis progression on univariate analysis (P = 0.02). PNPLA3 rs738409[G] allele is a reliable predictor for steatosis and fibrosis in CHC. The presence of G allele, along with severe steatosis and insulin resistance are significant predictors for fibrosis progression.

[The action of silymarin on Galactosamine-induced hepatitis in the rat (author's transl)]. / Die Wirkung von Silymarin auf die experimentelle Galaktosamin-Hepatitis bei der Ratte

The hepatoprotective action of Silymarin was studied in 65 male Wistar rats, prior to and following D-galactosamine intoxication. There was a marked reduction in the histological and ultrastructural changes in the nucleolus, nuclear membrane, mitochondria, granular and agranular endoplasmic reticulum and lysosomes of the liver cell and also in the Kupffer stellate cells. The reduction in glycogen and RNA loss was determined biochemically. The activities of many enzymes were kept constant (oxidoreductases, NADH2 diaphorase, G-6-phosphatase, Mg++ and K+/Na+-dependent ATPases, acid phosphatases).

Helicobacter-like organisms in gastroduodenal diseases.

The incidence of the Helicobacter-like organisms (HLO) was investigated on biopsy specimens of antral gastric mucosa, stained by the Wayson technique, in 509 patients with various gastric and duodenal diseases. The incidence of HLO was: 72.8 percent in gastric ulcer, 69.6 percent in duodenal ulcer, 69.2 percent in bulbitis, 61.0. percent in chronic gastritis, 37.5 percent in the postoperative stomach, 50 percent in gastric cancer, and 34.3 percent on healthy controls. The HLO were present over the whole year, with a peak in March. Sex and age had little influence on the HLO incidence. The Wayson staining technique proved to be a good technique of detection of HLO on gastric mucosa smears.

Separation of creatine-kinase isoenzymes on ion-exchange mini-columns for diagnostic purposes.

For diagnostic purposes, creatine-kinase (CK) isoenzymes were separated on mini-columns of DEAE Sephadex A50 from the serum of 55 patients with myocardial infarction or cerebral disturbances and from 45 normal subjects. The optimum conditions of separation were determined by separation of CK isoenzymes (CK--MM, CK--MB, CK--BB) from human organ homogenates (skeletal muscle, myocardium, brain). In the patients with myocardial infarction the CK-MB isoenzyme activity amounted to more than 6% of the total enzyme value. The chromatogram in these cases was similar to that of human myocardium homogenate. The CK-BB isoenzyme was found only in patients with severe cerebral disturbances (cerebral hemorrhage). In such cases the chromatogram was similar to that of human brain homogenate. Therefore, by associating the assay of serum CK total activity with the separation of CK isoenzymes it was proved that the CK--MB and CK--BB isoenzymes can supply a useful test in differential diagnosis.

Study of serum ceruloplasmin and of the copper/zinc ratio in cardiovascular diseases.

The serum copper and zinc concentration, the Cu/Zn ratio and ceruloplasmin activity have been studied in 400 subjects divided into 4 groups of study: 50 normal subjects (controls), 100 patients with ischemic heart disease, 100 subjects with myocardial infarction in the past history and 150 patients with acute myocardial infarction. It was observed that in normal subjects the Cu/Zn ratio is about 1, in acute myocardial infarction it reaches 2.5 but it returns to normal during convalescence. In the patients with ischemic heart disease the ratio decreases to 0.8 and in the subjects with infarction in the past history it is about 1.6 (almost normal). The variation of these ratio is due to the serum zinc concentration which in ischemic heart disease presents values over the upper normal limit and in acute myocardial infarction below the lower normal limit. In the subjects with acute infarction ceruloplasmin (copper depending enzyme) the activity was observed to be inversely proportional to the Cu/Zn ratio in the first 4 days after the onset of the disease. The quick normalization of one or of both parameters is a sign of positive evolution of the disease.

Theoretical investigation of an artificial joint with micro-pocket-covered component and biphasic cartilage on the opposite articulating surface.

This paper presents a theoretical investigation of a geometrically idealized artificial joint with micro-pocket-covered component and biphasic cartilage on the opposite articulating surface. The fluid that exudes from the biphasic cartilage fills and pressurizes the micro-pockets. In this way, a poro-elasto-hydrodynamic regime of lubrication is developed. Assuming that lower friction would result in lower adhesive wear, and neglecting the fatigue as well as the abrasive wear, the proposed bearing system hypothetically could reduce the amount of wear debris. Equations of the linear biphasic theory are applied for the confined and unconfined compression of the cartilage. The fluid pressure and the elastic deformation of the biphasic cartilage are explicitly presented. The effective and equilibrium friction coefficients are obtained for the particular configuration of this bearing system. The micro-pockets geometrical parameters (depth, radius, surface distribution and edge radius) must be established to reduce the local contact stresses, to assure low friction forces and to minimize the biphasic cartilage damage. The influence of the applied pressure, porosity of the micro-pocket-covered component, filling time, cartilage elasticity, permeability and porosity upon the micro-pockets depth is illustrated. Our results are based upon the previously published data for a biphasic cartilage.

Variations of zinc, calcium and magnesium in normal subjects and in patients with neoplasias.

The serum zinc, calcium and magnesium concentration as well as the possible relationship between these elements was determined by means of atomic absorption spectrophotometry in 150 patients with prostatic, lung, liver and breast neoplasms as well as with chronic leukemia, and in 80 normal subjects. These determinations showed that zinc concentration is increased in almost all the forms of cancer except prostatic and lung cancer in which the zinc values were below the lowest normal limits. From this study it also resulted that high zinc values favour the development of cancer. The antagonic relationship between zinc and calcium or magnesium in neoplasias proves the protective role played by the latter elements in the forms of cancer in such cases.

[The mechanism of action of phenobarbital on the metabolism of 131J-B.S.P. in cholestasis induced by ANIT in isolated and perfused rat liver (author's transl)]. / Die Wirkung von Phenobarbital auf die 131J-Bromsulfalein-Aufnahme bei isolierter Perfusion der durch alpha-Naphthylisothiozyanat cholostatischen Rattenleber.

In order to establish whether the increased B.S.P. secretion in the bile following phenobarbital administration is the consequence of change in the bile output or represents a consequence of the enzymatic induction, the dynamics of the elimination of 131J-B.S.P. was studied in animals treated with ANIT and Phenobarbital in the conditions of isolated perfused liver. At the same time the levels of the conjugation enzyme of B.S.P. were also determined. It was noted that after Phenobarbital the biliary elimination of 131J-B.S.P. is in correlation with the important increase of the output; in the animals treated with ANIT, on the other hand, the biliary excretion of B.S.P. is minimal. The biliary elimination is directly proportional to the increased of the bile output and reflects the changes found in the perfusate. Our findings allow us to assume that the increased of the bile output and in a smaller extent the result of the stimulation B.S.P. conjugation with Gluthation.

Gallstones--mineralogical and chemical investigations.

A comparative study of the mineralogical-structural characteristics and chemical composition of gallstones was performed on stone samples removed intraoperatively from the gallbladders of 12 patients. The study included all the types of gallstones. Their chemical components determined were: bilirubin, cholesterol, phospholipids, calcium, proteins. The stones were examined physically (size, number, shape, color) and the radial or concentric disposition of the layers was estimated on cross-sections. Thin sections (2 X 10(-2)mm) were obtained and examined by polarizing microscope in order to observe the inner structural characteristics. The crystallographic analysis of all the types of stones studied is reported. In all the samples, a perfect concordance was found between the mineralogical structure and the chemical composition of the gallstones. The results obtained are valuable premises for further research in the formation of stones, since a mineralogical study offers the possibility to estimate variations of crystal aggregation, according to the local changes of the gallbladder (inflammation, bacterial growth, pH, etc.).

Diagnostic value of serum bile acid determination in chronic hepatitis and liver cirrhosis.

Fasting and postprandial total bile acid measurements were performed by an enzymatic method in the serum of 12 patients with chronic persistent hepatitis, 8 with chronic active hepatitis, 14 with cirrhosis and 10 with cholestatic chronic hepatitis, as well as in that of 22 normal controls. The results indicated a rise of serum bile acid concentration concomitant with the degree of morphologic liver injury. A significant rise of the fasting concentration of bile acids as compared to the control started with chronic active hepatitis. As postprandial bile acid level was significantly higher in all types of chronic hepatitis and cirrhosis and correlated significantly with most of the usual biochemical liver tests, it could be considered as a test of major diagnostic significance for chronic liver diseases.

Possible correlation between the zinc and copper concentrations involved in the pathogenesis of various forms of anemia.

The concentrations of three trace elements (iron, copper and zinc) involved in hematopoiesis were studied in 200 patients with iron-deficit anemia, hemolytic anemia and Biermer's anemia, in comparison with a group of normal subjects. The method used was atomic absorption spectrophotometry. The results obtained showed that in iron-deficit anemia resistant to iron therapy the copper and ceruloplasmin serum concentrations are at the lowest limit of normal. This copper deficit has a negative effect on the disease by preventing hemoglobin synthesis. In iron-deficit anemias responding to iron therapy the relatively low (about 90 gamma %) zinc values have a negative effect by blocking the iron in the iron reserve. In hemolytic anemia the very high zinc serum concentrations (over 200 gamma %) may lead to a shortening of the erythrocytes life span due to its "entatic state". In Biermer's anemia zinc by its high concentration has a positive role owing to carbonic anhydrase which eliminates more rapidly carbon dioxide from the organism.

Model for the alignment of actin filaments in endothelial cells subjected to fluid shear stress.

Cultured vascular endothelial cells undergo significant morphological changes when subjected to sustained fluid shear stress. The cells elongate and align in the direction of applied flow. Accompanying this shape change is a reorganization at the intracellular level. The cytoskeletal actin filaments reorient in the direction of the cells' long axis. How this external stimulus is transmitted to the endothelial cytoskeleton still remains unclear. In this article, we present a theoretical model accounting for the cytoskeletal reorganization under the influence of fluid shear stress. We develop a system of integro-partial-differential equations describing the dynamics of actin filaments, the actin-binding proteins, and the drift of transmembrane proteins due to the fluid shear forces applied on the plasma membrane. Numerical simulations of the equations show that under certain conditions, initially randomly oriented cytoskeletal actin filaments reorient in structures parallel to the externally applied fluid shear forces. Thus, the model suggests a mechanism by which shear forces acting on the cell membrane can be transmitted to the entire cytoskeleton via molecular interactions alone.

Study of the relationship between the granulocyte LDH, alkaline phosphatase and Zn at the level of the leukocyte in patients with chronic myeloid leukemia.

Mixed leukocyte suspensions were prepared from heparinized blood collected from healthy subjects and from patients with chronic myeloid leukemia (CML). In all the suspensions determinations were made for: zinc, by atomic absorption; granulocyte alkaline phosphatase (GAP), using the method with p-nitrophenylphosphatase; granulocyte LDH, by means of the enzymatic autoanalyser LKD 8,600. In the patients with CML, the values of zinc and of granulocyte alkaline phosphatase activity were very low while the granulocyte LDH values were higher than normal. The chromatogram of the granulocyte LDH isoenzymes on DEAE-Sephadex A50 minicolumn (0.5 X 12 cm) showed an "alpha type abnormality" revealed by the increased activity of the isoenzymes with high electrophoretic mobility LDH2 and LDH1 specific for tissues with intense oxidative phosphorylation. In the normal subjects the chromatogram of the leukocyte LDH isoenzymes showed a type M (skeletal muscle) prevalence denoting intense anaerobic glycolysis. Therefore the low zinc concentrations (0.55 micrograms mg N2 as compared with the normal 1.24 micrograms mg N2) in these patients cause the decrease of GAP activity by the lack of zinc in the active center of the enzyme and the decrease of cellular permeability thus allowing the extracellular release of granulocyte LDH.