Negative pressure wound therapy as a „bridge” for the final reconstruction of tissue defect following a degloving injury of the forearm – a case report

Degloving injuries are traumatic avulsions usually resulting in large areas of soft tissue defects. The injury involves separation of skin and subcutaneous tissue from fascia and muscles. The complex nature of these injuries requires a patient-oriented multidisciplinary surgical approach and a wide variety of therapeutic options. Negative pressure wound therapy can be of benefit at every stage of the long-lasting treatment. In this paper, we present a case of a 29-year-old male after an occupational accident with a conveyor belt leading to a degloving injury of the right forearm treated in the Department of Plastic Surgery of the Medical University in Gdańsk. The use of NPWT, hyperbaric oxygen therapy, dermal regeneration templates, skin grafting, and early rehabilitation resulted in an excellent functional and aesthetic outcome

Polymorphism of the FTO

The objective was to compare the impact of clinical and genetic factors on body mass index (BMI) in children with type 1 diabetes (T1DM) without severe obesity. A total of 1,119 children with T1DM (aged 4–18 years) were qualified to take part in the study. All children were genotyped for variants of FTO, MC4R, INSIG2, FASN, NPC1, PTER, SIRT1, MAF, IRT1, and CD36. Results. Variants of FTO showed significant association with BMI-SDS in the T1DM group. The main factors influencing BMI-SDS in children with T1DM included female gender (P=0.0003), poor metabolic control (P=0.0001), and carriage of the A allele of the FTO rs9939609 gene (P=0.02). Conclusion. Our research indicates, when assessing, the risk of overweight and obesity carriage of the A allele in the rs9939609 site of the FTO gene adds to that of female gender and poor metabolic control. This trial is registered with ClinicalTrials.gov (NCT01279161)

Ocena prawdopodobieństwa urodzenia dziecka z niezrównoważonym kariotypem oraz ryzyka wystąpienia rożnych patologii ciąży w rodzinach nosicieli translokacji chromosomowych wzajemnych angażujących chromosom 7

Introduction: Carriership of reciprocal chromosomal translocation (RCT) may be the reason the occurrence of congenital malformations in the offspring, early neonatal death, stillbirth, and recurrent miscarriages due to unbalanced karyotype of gametes. The probability rate for individual categories of unfavorable outcomes depends on the kind of chromosome involved and is individually variable. Objectives: The aim of study was to estimate the probability rates for unbalanced offspring and to evaluate the risk for different categories of unfavorable pregnancy outcomes, depending on the size of chromosomal segment with differentiation between maternal/paternal origin of the reciprocal chromosomal translocations involving chromosome 7p (RCT-7p) and 7q (RCT-7q). In addition, the use of the obtained results has been illustrated by the example of a family with unique RCT t(7;9)(p21.3,p23). Material and methods: Empirical and cytogenetic data on 341 pregnancies and offspring of 133 carriers were collected from 69 pedigrees of carriers of RCT-7p and RCT-7q at risk for a single 7 segment imbalance. The probability rates of particular form of pregnancy pathology have been calculated according to the method of Stengel-Rutkowski and Stene, including all forms of meiotic segregation and their survival rates after fertilization to term childbirth. Results: The probability rates for unbalanced offspring for carriers of RCT-7p after 2:2 disjunction and adjacent-1 segregation were calculated as 5.5%±2.2% (6/108); for maternal (MAT) and paternal (PAT) carriers were aboutCel pracy: Celem pracy było opracowanie wskaźników prawdopodobieństwa urodzenia dziecka z niezrównoważonym kariotypem oraz wskaźników ryzyka różnych patologii ciąży w rodzinach nosicieli translokacji chromosomowych wzajemnych angażujących segmenty chromosomu 7 (TCW-7), w zależności od długości pojedynczych segmentów krótkich (TCW-7p) i długich (TCW-7q) ramion chromosomu 7, z uwzględnieniem rodzicielskiego pochodzenia nosicielstwa. Na przykładzie rodziny z nosicielstwem unikatowej t(7;9)(p21.3;p23) zaprezentowano, w jaki sposób praktycznie można wykorzystać uzyskane wskaźniki udzielając porady genetycznej. Materiał i metody: Analizę segregacyjną przeprowadzono w grupie 69 rodowodów nosicieli TCW-7 zawierających dane kliniczne i cytogenetyczne 341 ciąż i urodzeń potomstwa w sześciu grupach oddzielnie w zależności od długości segmentu 7p i 7q wyznaczonej przez położenie punktu złamania TCW: 7p21→pter, 7p14…p15→pter, 7p11…p12…p13→pter oraz 7q33…q34…q35→qter, 7q32 →qter, 7q11…q21.. q22…q31→qter z uwzględnieniem rodzicielskiego pochodzenia TCW. Wyniki: Prawdopodobieństwo urodzenia dziecka z niezrównoważonym kariotypem w przypadku nosicielstwa TCW-7p wynosiło 5.5±2.2% (6/108) (w tym matczyne MAT

Polymorphism of the FTO Gene Influences Body Weight in Children with Type 1 Diabetes without Severe Obesity

The objective was to compare the impact of clinical and genetic factors on body mass index (BMI) in children with type 1 diabetes (T1DM) without severe obesity. A total of 1,119 children with T1DM (aged 4-18 years) were qualified to take part in the study. All children were genotyped for variants of FTO, MC4R, INSIG2, FASN, NPC1, PTER, SIRT1, MAF, IRT1, and CD36. Results. Variants of FTO showed significant association with BMI-SDS in the T1DM group. The main factors influencing BMI-SDS in children with T1DM included female gender ( = 0.0003), poor metabolic control ( = 0.0001), and carriage of the A allele of the FTO rs9939609 gene ( = 0.02). Conclusion. Our research indicates, when assessing, the risk of overweight and obesity carriage of the A allele in the rs9939609 site of the FTO gene adds to that of female gender and poor metabolic control. This trial is registered with ClinicalTrials.gov (NCT01279161)

A comprehensive molecular study on Coffin-Siris and Nicolaides-Baraitser syndromes identifies a broad molecular and clinical spectrum converging on altered chromatin remodeling

Chromatin remodeling complexes are known to modify chemical marks on histones or to induce conformational changes in the chromatin in order to regulate transcription. De novo dominant mutations in different members of the SWI/SNF chromatin remodeling complex have recently been described in individuals with Coffin-Siris (CSS) and Nicolaides-Baraitser (NCBRS) syndromes. Using a combination of whole-exome sequencing, NGS-based sequencing of 23 SWI/SNF complex genes, and molecular karyotyping in 46 previously undescribed individuals with CSS and NCBRS, we identified a de novo 1-bp deletion (c.677delG, p.Gly226Glufs*53) and a de novo missense mutation (c.914G>T, p.Cys305Phe) in PHF6 in two individuals diagnosed with CSS. PHF6 interacts with the nucleosome remodeling and deacetylation (NuRD) complex implicating dysfunction of a second chromatin remodeling complex in the pathogenesis of CSS-like phenotypes. Altogether, we identified mutations in 60% of the studied individuals (28/46), located in the genes ARID1A, ARID1B, SMARCB1, SMARCE1, SMARCA2, and PHF6. We show that mutations in ARID1B are the main cause of CSS, accounting for 76% of identified mutations. ARID1B and SMARCB1 mutations were also found in individuals with the initial diagnosis of NCBRS. These individuals apparently belong to a small subset who display an intermediate CSS/NCBRS phenotype. Our proposed genotype-phenotype correlations are important for molecular screening strategie

The ARID1B spectrum in 143 patients: from nonsyndromic intellectual disability to Coffin–Siris syndrome

Purpose: Pathogenic variants in ARID1B are one of the most frequent causes of intellectual disability (ID) as determined by large-scale exome sequencing studies. Most studies published thus far describe clinically diagnosed Coffin–Siris patients (ARID1B-CSS) and it is unclear whether these data are representative for patients identified through sequencing of unbiased ID cohorts (ARID1B-ID). We therefore sought to determine genotypic and phenotypic differences between ARID1B-ID and ARID1B-CSS. In parallel, we investigated the effect of different methods of phenotype reporting. Methods: Clinicians entered clinical data in an extensive web-based survey. Results: 79 ARID1B-CSS and 64 ARID1B-ID patients were included. CSS-associated dysmorphic features, such as thick eyebrows, long eyelashes, thick alae nasi, long and/or broad philtrum, small nails and small or absent fifth distal phalanx and hypertrichosis, were observed significantly more often (p < 0.001) in ARID1B-CSS patients. No other significant differences were identified. Conclusion: There are only minor differences between ARID1B-ID and ARID1B-CSS patients. ARID1B-related disorders seem to consist of a spectrum, and patients should be managed similarly. We demonstrated that data collection methods without an explicit option to report the absence of a feature (such as most Human Phenotype Ontology-based methods) tended to underestimate gene-related features

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Technological value of winter durum wheat cv. Komnata as dependent on chemical plant protection

W pracy oceniono wpływ sposobu chemicznej ochrony roślin na właściwości ziarna i mąki ozimej pszenicy twardej odmiany Komnata. W latach 2005–2008 w RZD Pawłowice, należącym do Uniwersytetu Przyrodniczego we Wrocławiu przeprowadzono ścisłe doświadczenie polowe w 4 powtórzeniach, na glebie kompleksu pszennego dobrego, w stanowisku po rzepaku ozimym. W doświadczeniu polowym zastosowano trzy sposoby chemicznej ochrony roślin oraz poziom kontrolny, w którym nie stosowano środków ochrony roślin przeciwko patogenom wywoływanym przez grzyby. Uzyskane ziarno oceniono pod względem cech fizycznych, przemiałowych oraz cech jakościowych mąki, według metodyki obowiązującej w przetwórstwie pszenicy twardej. Uzyskane wyniki badań wykazywały znacznie większy wpływ warunków pogodowych na cechy ziarna i mąki ozimej pszenicy twardej niż sposobu chemicznej ochrony roślin. Ziarno o najkorzystniejszych cechach jakościowych otrzymano w 2006 roku, w którym w lipcu, podczas dojrzewania pszenicy odnotowano bardzo niską sumę opadów (12 mm), a temperatura przekraczała o prawie 5°C średnią wieloletniej z lat 1976–2005. Wartość współczynnika Sielinianova (k) dla tego okresu wyniosła tylko 0,16. Sposób chemicznej ochrony roślin, polegający na zaprawianiu ziarna siewnego i dwukrotnym stosowaniu fungicydów, sprzyjał uzyskaniu ziarna o najlepszych cechach jakościowych za wyjątkiem wartości wskaźnika wielkości cząstki. Wpływ badanego czynnika na cechy przemiałowe ziarna za wyjątkiem wydajności mąki śrutowej i wymielności kaszek był nieistotny, natomiast w odniesieniu do cech jakościowych mąki powodował jedynie obniżenie rozpływalności glutenu.The influence of chemical plant protection on properties of grain and flour was determined in winter durum wheat (T. durum L.) cv. Komnata. The field experiment was carried out in the years 2005–2008 at the Agriculture Experimental Station in Pawłowice, in vicinity of Wrocław, Poland, on lessive soil developed from silty clay, after winter oilseed rape forecrop. The 16.5 m2 plots were arranged in randomized replicate blocks.In the experiment three ways of chemical plant protection were applied together with the control, without chemical plant protection. Physical and milling properties of the obtained grain and milling properties and quality features of flour were estimated according to the current methodology used in hard wheat technology. The results show greater influence of weather conditions than that of chemical plant protection on the grain and flour features. The best grain was harvested in 2006 when, during maturation, the lowest rainfall was recorded (12 mm) and temperature was higher, about 5°C in comparison to means from the years 1976–2005. The value of Sielinianov coefficient for this period was only 0.16. The best grain, excluding particle size index, was obtained from plants cultivated from the treated seed and twice sprayed with fungicides. Influence of the estimated factor on milling properties, excluding break flour and middling extraction, was not important. Chemical plant protection decreased considerably only flowingness of gluten

Mercury Exposure from the Consumption of Dietary Supplements Containing Vegetable, Cod Liver, and Shark Liver Oils

Vegetable and fish oils constitute a significant part of all dietary supplements. Due to increasing environmental pollution, the raw materials used for their production may be contaminated with toxic substances, including metals. The aim of the present study was to determine the mercury (Hg) content in vegetable oils, shark liver oils, and cod liver oils. The tests conducted were to help determine the level of mercury contamination of the tested preparations and the related potential threat to human health. The amount of Hg in the tested dietary supplements was compared, and the amount of the metal consumed at various times of use was determined. A total of 36 preparations of dietary supplements available on the Polish market were used for the study. The method of atomic absorption spectrometry using the amalgamation technique was used for the determinations (AMA 254, Altec, Czech Republic). Among the sample of all of the tested preparations, the Hg concentration ranged from 0.023 to 0.427 &micro;g/kg, with an average of 0.165 &micro;g/kg. Differences in Hg content in the various tested preparations (shark liver oil, cod liver oil, and vegetable oils) were statistically significant. The average concentration of Hg in the vegetable oils (0.218 &micro;g/kg) was more than twice that of the cod liver oils (0.106 &micro;g/kg) and shark liver oils (0.065 &micro;g/kg). In none of the tested preparations did the amount of Hg exceed the acceptable standard for dietary supplements (0.10 mg/kg). The analysis showed that the Hg content in vegetable oils, shark liver oils, and fish oils from the Polish market is at a low level, guaranteeing the safety of their use, and as such, they do not pose a threat to health

Foot drop in children with newly diagnosed type 1 diabetes: three case reports

The etiology of foot drop is diverse from various diseases to mechanic injuries and includes neuropathy of the peroneal nerve. Peroneal neuropathy might also be one of the forms of diabetic neuropathy, very rarely reported as the first sign of diabetes. We describe three cases of children with newly diagnosed type 1 diabetes (TID) who developed unilateral peroneal nerve palsies and tibial nerve palsies, presenting clinically as a foot drop. In two of our cases, the symptoms of foot drop occurred shortly after starting treatment for severe diabetes ketoacidosis. In the third patient, food drop was a reason for the initial medical consultation, but eventually, TID was diagnosed. The presented cases highlight that neuropathy can be observed not only as a chronic complication of T1D, but it can also appear at the time of disease manifestation. The incorrect position of the lower limb during a keto coma may contribute to the development of neuropathy