Polski Merkuriusz Lekarski最新文献

Objective: Aim: To evaluate the influence of the degree of detail of the nature of the pathomorphological changes in the osteoligamentous structures on the tactics of treating the patients with the traumatic damage to the thoracolumbar junction.

Patients and methods: Materials and Methods: A retrospective analysis of the treatment tactics was carried out in 96 patients with a traumatic injury of the thoracolumbar junction, both those who underwent a surgical treatment and those who underwent a conservative therapy. The lesions were classified using F. Magerl and AOSpine classifications; the neurological status was assessed according to the ASIA scale, the nature of the damage was specified using the McCormack criteria. The statistical data processing was performed using the Random Forest machine learning algorithm.

Results: Results: The nature of the injury makes it possible to unambiguously determine the optimal method of therapy when using the F. Magerl classification with a probability of 58.33%, while in relation to the AOSpine classification this figure is 55.21%. When building the models that include the nature of the damage, the level of the neurological disorders and the McCormack criteria, it was found that the use of the F. Magerl classification demonstrates an error in unambiguously determining the most effective treatment method at the level of 26.04%, while the use of AOSpine this figure was 21.88%.

Conclusion: Conclusions: The application of the AOSpine classification is more promising for the development of a multifactorial algorithm for the treatment of the traumatic injuries of the thoracolumbar junction.

Objective: . Aim: The purpose of the study was to identify the features of apoptotic and proliferative processes in experimental Staphylococcus aureus-infected radiation skin ulcer under conditions of photodynamic therapy and the use of platelet-rich plasma.

Patients and methods: Materials and Methods: An experimental study was conducted on 95 six-month-old male rats of the WAG population, which were divided into three groups. Group 1 included 25 animals that were simulated a radiation ulcer of the skin in the thigh area with subsequent application to its surface on the 7th day after irradiation with 0.2 ml of a suspension of the Staphylococcus aureus (ATCC 25923) reference strain (0.5 million microbial cells/cm2). Group 2 included 25 animals with Staphylococcus aureus-infected radiation skin ulcer, which were subjected to photodynamic therapy a day after infection. Group 3 included 45 animals with Staphylococcus aureus-infected radiation skin ulcers, which, 1 day after infection, received photodynamic therapy in the first half of the day, and in the second half of the day the periphery of the wound defect was injected with platelet-rich plasma. The material for the study was skin with underlying soft tissues from the area of radiation exposure. Histological, immunohistochemical, morphometric and statistical methods were used.

Results: Results: In cases of simultaneous use of photodynamic therapy and platelet-rich plasma, compared with photodynamic therapy alone, the processes ofapoptosis and proliferation were more balanced, active, with a shift in the proliferative-apoptotic ratio towards proliferation processes and met the needs of the regenerative process. From the 10th to the 22nd day of the experiment these processes increased, which indicated active healing processes, that, during survey microscopy on the 22nd day, were manifested by the complete filling of the wound cavity with granulation and connective tissues with the presence of an epithelial layer on the surface of the regenerate. From the 22nd to the 45th day of the experiment, a decrease in the rate of regeneration was recorded, as evidenced by a decrease in the intensity of apoptotic and proliferative processes. The intensity of the latter was sufficient, which led to the healing of Staphylococcus aureus-infected radiation skin ulcer on the 45th day with complete restoration of the original structure of the skin.

Conclusion: Conclusions: Photodynamic therapy in combination with the use of platelet-rich plasma balancedly activates apoptotic and proliferative processes with a predominance of the latter in granulation and connective tissues filling the lumen of Staphylococcus aureus-infected radiation skin ulcer, which on the 45th day of the experiment leads to wound healing with complete restoration of the original structure of the skin.

Objective: . Aim: To study the stability of surface-modified dental implants, with the usage of sandblasting/acid modification vs. photoactivation.

Patients and methods: Materials and Methods: In the observation were included 164 patients with dental defects. All patients had digital impressions taken by scanning the oral cavity with an intraoral scanner 3Shape TRIOSR. Group A (80 subjects) included implants whose surface was modified with a combination of sandblasting and acid. Group B (84 subjects) - implants after modification with photoactivation. The implant stability quotient was recorded using an Osstell MentorTM device.

Results: Results: The reliable effectiveness of the photoactivation method in complex treatment of the surface of dental implants in improving the stability of fixed dentures in the short and long-term periods of observation was proven. When assessing immediate clinical outcomes, there was no significant difference in the frequency of hyperemia, algesia, hyperthermia, soft tissue edema, regional lymphadenitis, depending on the classical method of treating the implant surface and the complex method with photoactivation. Of the long-term clinical outcomes with classical surface treatment, the absolute risk of implant failure was 1.2%, relative risk - 0,99 [CI%0,96-1,0]. The average value of the implant stability coefficient (ISQ) and the data of the Periotest study at the time of surgery probably did not differ in the observation groups, after 3 months, a higher index was proven in the treatment of the surface by the method of photoactivation and greater stability of the mandibular implants. At the time of implantation, there were no statistically significant differences in implant fixation between the groups, however, during prospective observation in group A, secondary stability indicators based on periotestometry results were significantly lower.

Conclusion: Conclusions: It was proved the reliable effectiveness of the photoactivation-method for surface modification in the short and long-term periods of observation for improving the results of orthodontically treatment.

Objective: Aim: The aim of the article is a comparative analysis of the main aspects of existing medical and diagnostic measures in patients with abnormal types of occlusal relationships and methods of mathematical and graphic reproduction of the shape of the dental arches, taking into account the individual characteristics of the maxillofacial area.

Patients and methods: Materials and Methods: The search for relevant publications related to the objective topic was carried out through scientific databases: Scopus, PubMed, BVS and Scielo.

Conclusion: Conclusions: The analysis of regression models of the reproduction of individual characteristics of the dental arch of the jaws will avoid errors that occur when comparing the actual sizes with their statistical norm, which will allow to correctly determine the proportionality and ratio of dif f erent departments of the dental and jaw system, the necessary amount of orthodontic measures in the treatment of anomalies of the dental arches.

Objective: Aim: The aim of the research is to study the cytokine prof i le (IL-1β, IL 6, TNF-α, IL-4, IL-10) in bronchoalveolar lavage of lungs in experimental APS and its correction with L-arginine and aminoguanidine.

Patients and methods: Materials and Methods: Antiphospholipid syndrome was modeled on white female BALB/c mice. L-arginine (25 mg/kg) and aminoguanidine (10 mg/kg) were used for its correction. The concentration of cytokines in bronchoalveolar lavage from the lungs was assessed using the ELISA test.

Results: Results: It was established that in cases of APS the concentration of proinf l ammatory cytokines IL-1β, IL-6 and TNF-a increased in 1.9, 2.3 and 6.6 times, respectively, compare to the control. At the same time a decrease of the IL-4 in 1.7 and IL-10 in 1.8 times was found in the APS group compare to the control. L-arginine reduced the level of proinf l ammatory cytokines IL-1β by 22%, IL-6 - by 36%, and TNF-α - by 23% compare to the animals with APS. At the same time, the level of anti-inf l ammatory cytokines increased: IL-4 - by 46%, IL-10 - by 57% compare to the APS animal group. Aminoguanidine, a selective iNOS inhibitor, did not cause any signif i cant decrease in pro-inf l ammatory cytokines but the level of anti-inf l ammatory cytokines IL-4 increased by 44% and IL-10 - by 49%.

Conclusion: Conclusions: The precursor of the NO synthesis L-arginine leads to a decrease in the concentrations of IL-1β, IL-6, TNF-a and an increase of IL-4 and IL-10 compare to the group of BALB/c mice with APS.

Objective: Aim: The analysis of dietary knowledge and habits of patients with aortic stenosis, both prior to and post valve implantation.

Patients and methods: Materials and methods: Patient with diagnosed moderate or severe aortic stenosis were included into the study. Telephonic dietary interview was performed. It was based on the standard KomPAN questionnaire developed and validated by the Behavioural Nutrition Team, Committee of Human Nutrition of Polish Academy of Sciences.

Results: Results: The analysis was conducted in 94 consecutive patients. The pro-health diet index was 4.87 points (3.7; 5.96), while the optimal level was defined as 20 points. The 12.8% of the respondents had low knowledge about nutrition, 79.8% - moderate and 7.4% - good. From 94 patients, 37 had the patientprosthesis mismatch and overweight. The 35.1% of patients with the patient-prosthesis mismatch and overweight considered their nutritional habits as bad, 62.2% as moderate and 2.7% as good. In a group of patients without the patient-prosthesis mismatch the self-opinion about diet was bad in 20.8%, moderate in 72.9% and good in 6.3%.

Conclusion: Conclusions: Dietary habits and nutritional knowledge in patients with aortic stenosis are inadequate. However, awareness of bad dietary habits in patients who are overweight and have patient-prosthesis mismatch is better compared to the remaining group of patients. The proper dietary education is needed in all patients with aortic stenosis.

Objective: Aim: To study the ultrastructural remodeling of atrial myoendocrine cells (AMC) of the atrial myocardium in streptozotocin-induced diabetes (SID) under chronic immobilization stress (CIS).

Patients and methods: Materials and methods: 40 sexually mature white male rats (body weight 150-180 g) were included in the study. Four groups were formed: group 1 - animals with comorbid pathology (SID and CIS), group 2 - animals with SID, group 3 - animals with CIS, group 4 - intact animals.

Results: Results: On the 14th day of the development of SID and CIS, an increase in the functional activity of AMC is noted, which is confirmed by hyperplasia and hypertrophy of the protein-synthesizing apparatus, an increase in the volume density of secretory granules (SG), especially diffusing ones, and indicates enhanced release of atrial natriuretic peptide (ANP) from cells during the experiment. On the 56th day of the experiment, in groups 1 and 2 of , destructive changes in AMC were noted, such as vacuolar and balloon dystrophy, colliquative and partial necrosis. At the same time, the functional activity of AMC of different regions of the myocardium significantly. In animals with CIS, the volume density of young and diffusing SG in AMC is decreased.

Conclusion: Conclusions: Therefore, in the early stages of the development of SID and CIS, an increase in the morpho-functional activity of AMC is noted. The long course of SID and its combination with CIS lead to destructive changes in AMC and to decrease in their secretory activity.

Objective: Aim: Multiple sclerosis (MS) is a chronic inflammatory neurodegenerative disease resulting in cognitive impairment, physical disabilities, and neurological symptoms. Ocrelizumab is an effective drug used in MS treatment. However, it causes a risk of hepatitis B reactivation in anti-HBc positive patients. We describe the impact of entecavir and tenofovir on HBV reactivation during treatment with ocrelizumab.

Patients and methods: Materials and methods: Our study included eight patients (aged 18-70 years) with positive anti-HBc antibodies who were diagnosed with MS based on the 2017 McDonald criteria. The subjects were treated with ocrelizumab and were given anti-HBV prophylaxis with nucleoside analogs. The mean time from the beginning of therapy with nucleoside analogs to the initiation of ocrelizumab treatment was 27.5 days. Patients were administered ocrelizumab and none of them was diagnosed with HBV reactivation.

Results: Results: None of the laboratory parameters worsened. No severe adverse effects were observed. These results suggest that entecavir and tenofovir are effective in HBV reactivation prophylaxis. Additionally, positive anti-HBc antibodies do not rule out treatment with ocrelizumab.

Conclusion: Conclusions: In patients with positive anti-HBc antibodies, nucleoside analogs, such as entecavir or tenofovir, should be administered before ocrelizumab administration to reduce the risk of viral reactivation. Further studies on simultaneous treatment with ocrelizumab and nucleoside analogs are required to confirm our findings.

Objective: Aim: To analyze the state of parameters of inflammation, endotoxicosis, and their influence on the functional capacity of the pancreas in the comorbid course of chronic pancreatitis and type 2 diabetes mellitus (DM2).

Patients and methods: Materials and methods: 115 patients with CP in the phase of mild therapeutic exacerbation in combination with DM2 in the stage of subcompensation were examined. To assess the impact of comorbid DM2 on the clinical condition of patients with CP, a comparison group of 25 patients with CP in the exacerbation phase was included in the study. The assessment of the presence and depth of pancreatic exocrine insufficiency (PEI) was carried out according to the "gold standard" - determination of the content of fecal α-elastase-1, which was determined by the method of enzyme immunoassay using standard kits. As the main criterion for diagnosis and monitoring of DM, the measurement of HbA1c was used, which was determined by the method of ion exchange chromatography. C-reactive protein (CRP) was determined by the immunoturbidometry method by photometric measurement of the antigen-antibody reaction to human CRP antibodies; reference values of CRP in blood serum are up to 3 mg/l. Endogenous intoxication (EI) was assessed based on the levels of medium-mass molecules (MMM) - MMM1 and MMM2 at wavelengths 254 and 280 nm. The level of circulating immune complexes (CIC) was determined by the method of selective precipitation in 3.75% ethylene glycol followed by photometry.

Results: Results: Moderate and moderate inverse correlations were established between CRP and fecal α-elastase in CP and CP-DM2 comorbidity (r=-0.423 and r=-0.565, p<0.05). This proved a reliable influence of the depth of inflammation according to the content of CRP on the increase in PEI according to the level of fecal α-elastase, which was higher in the CP-DM2 comorbidity compared to CP. A deeper level of secretory insufficiency of the pancreas was established in CP with concomitant DM2, which deepened when the CRP level increased, compared to that in isolated CP: an increase in the strength of reliable direct moderate HbA1c-CRP correlations in patients with CP in combination with DM2 was proved in relation to such cases isolated CP (respectively r=0.313 and r=0.410, p<0.05).

Conclusion: Conclusions: We proved a reliable influence of the index of endogenous intoxication on the level of PEI according to the level of fecal α-elastase, which was higher in the CP-DM2 comorbidity compared to isolated CP: moderate and medium-strength inverse correlations were established IEI-fecal α-elastase in patients with CP and CP-DM2 comorbidity (r=-0.471 and r=-0.517, p<0.05). An increase in the strength of reliable direct, moderate, and moderate correlations between the levels of HbA1c and the index of endogenous intoxication in patients with isolated CP and CP-DM2 comorbidity (

Informed patient consent to a medical procedure is a prerequisite for the treatment process to be legal. Actions taken for the good of a person are regulated by the Constitution of the Republic of Poland, international documents, and statutory law. The provisions of the Act on the Professions of Physician and Dentist or the Act on the Professions of Nurse and Midwife are significant here as well. Moreover, the issues of respect for the patient are tackled by the Act on the Patient's Rights and the Patient's Rights Ombudsman. As prescribed in the Medical Code of Ethics, the physician's mission is to protect human life and health, prevent diseases, treat the ill. It is a legal and deontological tool allowing selection of a medical procedure for the patient. Both law and medicine are predominated by the view that any action performed by the physician without the patient's consent is unlawful even if performed for a therapeutic purpose. The border of these two scientific fields is where a clash occurs between legally protected interests: life and health on the one hand, and the right to autonomy on the other. The provisions of Art. 192 of the Polish Penal Code protect the patient's right to self-determination in the scope of agreement to or rejection of therapeutic procedures, also in situations where their life or health are threatened. The paper aims to analyze possible issues related to consents to treatment of adults capable of expressing informed consents.