Hematogenous infantile infection presenting as osteomyelitis and septic arthritis: a case report

The case of a 6-month old male infant presenting at the emergency department with fever and swelling at the left knee joint is discussed. Laboratory tests showed an inflammatory condition. Left knee plain radiograph demonstrated local soft tissue oedema. Percutaneous needle aspiration of articular fluid showed a positive culture for Staphylococcus aureus. The diagnosis of septic arthritis was confirmed. Because of inadequate response to treatment an MRI study was followed to evaluate possible abscesses. The presence of an abscess in the suprapatellar bursa was confirmed and an additional inflammatory process of the bone marrow was revealed, consistent with osteomyelitis. The pathophysiology, the imaging findings, the patient’s management and a review of septic arthritis and osteomyelitis coexistence are presented in this paper

A prospective dual-centre intra-individual controlled study for the treatment of burns comparing dermis graft with split-thickness skin auto-graft

Publisher Copyright: © 2022, The Author(s).To investigate if donor and recipient site morbidity (healing time and cosmesis) could be reduced by a novel, modified split-thickness skin grafting (STSG) technique using a dermal component in the STSG procedure (DG). The STSG technique has been used for 150 years in surgery with limited improvements. Its drawbacks are well known and relate to donor site morbidity and recipient site cosmetic shortcomings (especially mesh patterns, wound contracture, and scarring). The Dermal graft technique (DG) has emerged as an interesting alternative, which reduces donor site morbidity, increases graft yield, and has the potential to avoid the mesh procedure in the STSG procedure due to its elastic properties. A prospective, dual-centre, intra-individual controlled comparison study. Twenty-one patients received both an unmeshed dermis graft and a regular 1:1.5 meshed STSG. Aesthetic and scar assessments were done using The Patient and Observer Scar Assessment Scale (POSAS) and a Cutometer Dual MPA 580 on both donor and recipient sites. These were also examined histologically for remodelling and scar formation. Dermal graft donor sites and the STSG donor sites healed in 8 and 14 days, respectively (p < 0.005). Patient-reported POSAS showed better values for colour for all three measurements, i.e., 3, 6, and 12 months, and the observers rated both vascularity and pigmentation better on these occasions (p < 0.01). At the recipient site, (n = 21) the mesh patterns were avoided as the DG covered the donor site due to its elastic properties and rendered the meshing procedure unnecessary. Scar formation was seen at the dermal donor and recipient sites after 6 months as in the standard scar healing process. The dermis graft technique, besides potentially rendering a larger graft yield, reduced donor site morbidity, as it healed faster than the standard STSG. Due to its elastic properties, the DG procedure eliminated the meshing requirement (when compared to a 1:1.5 meshed STSG). This promising outcome presented for the DG technique needs to be further explored, especially regarding the elasticity of the dermal graft and its ability to reduce mesh patterns. Trial registration: ClinicalTrials.gov Identifier (NCT05189743) 12/01/2022.Peer reviewe

ЖЕЛУДОЧКОВЫЕ НАРУШЕНИЯ РИТМА ПРИ АРТЕРИАЛЬНОЙ ГИПЕРТЕНЗИИ: РОЛЬ БИОМАРКЕРОВ ВОСПАЛЕНИЯ В РАЗВИТИИ АРИТМИЙ

Arrhythmogenic role of proinflammatory cytokines is still unclear despite of wide discussion on inflammatory arrhythmogenic mechanisms. The main goal of study was to compare levels of tumor necrosis factor a, interleukin 6 and interleukin 4 in hypertensive patients with and without ventricular rhythm disturbances. The study included 100 cases, 50 of those had ventricular arrhythmias. Levels of tumor necrosis factor a, interleukin 6 and interleukin 4 were studied. Possible connections of above mentioned biomarkers with ventricular arrhythmias, blood pressure, echocardiography left ventricle data were evaluated. Higher level of biomarkers was associated with presence of ventricular arrhythmias; higher rate of ventricular extrasystoles was accompanied with insignificantly lower biomarker level. Теория воспаления в генезе аритмий активно изучается, но в ней по-прежнему существует ряд обсуждаемых вопросов. В частности, недостаточно изучена роль провоспалительных цитокинов в развитии аритмий. Целью настоящей работы было исследованиие содержания фактора некроза опухолей α, интерлейкинов 6 и 4 у пациентов с артериальной гипертензией в сочетании с желудочковыми нарушениями ритма сердца и определение их места в аритмогенезе. В исследование были включены 100 человек, из них у 50 диагностировали желудочковые аритмии, а еще 50 составили группу сравнения. У всех наблюдаемых были определены провоспалительные цитокины (фактор некроза опухолей α, интерлейкин 6) и противовоспалительный интерлейкин 4. Проанализировали их взаимосвязь с градацией желудочковых экстрасистолий, степенью повышения артериального давления, геометрией левых камер сердца. Наличие желудочковых нарушений ритма при артериальной гипертензии сопровождалось повышением концентрации провоспалительных цитокинов, а при частых желудочковых экстрасистолах наблюдалась тенденция к снижению содержания интерлейкина 4.

MicroRNA-155 mediates multiple gene regulations pertinent to the role of human adipose-derived mesenchymal stem cells in skin regeneration

Introduction: The role of Adipose-derived mesenchymal stem cells (AD-MSCs) in skin wound healing remains to be fully characterized. This study aims to evaluate the regenerative potential of autologous AD-MSCs in a non-healing porcine wound model, in addition to elucidate key miRNA-mediated epigenetic regulations that underlie the regenerative potential of AD-MSCs in wounds.Methods: The regenerative potential of autologous AD-MSCs was evaluated in porcine model using histopathology and spatial frequency domain imaging. Then, the correlations between miRNAs and proteins of AD-MSCs were evaluated using an integration analysis in primary human AD-MSCs in comparison to primary human keratinocytes. Transfection study of AD-MSCs was conducted to validate the bioinformatics data.Results: Autologous porcine AD-MSCs improved wound epithelialization and skin properties in comparison to control wounds. We identified 26 proteins upregulated in human AD-MSCs, including growth and angiogenic factors, chemokines and inflammatory cytokines. Pathway enrichment analysis highlighted cell signalling-associated pathways and immunomodulatory pathways. miRNA-target modelling revealed regulations related to genes encoding for 16 upregulated proteins. miR-155-5p was predicted to regulate Fibroblast growth factor 2 and 7, C-C motif chemokine ligand 2 and Vascular cell adhesion molecule 1. Transfecting human AD-MSCs cell line with anti-miR-155 showed transient gene silencing of the four proteins at 24 h post-transfection.Discussion: This study proposes a positive miR-155-mediated gene regulation of key factors involved in wound healing. The study represents a promising approach for miRNA-based and cell-free regenerative treatment for difficult-to-heal wounds. The therapeutic potential of miR-155 and its identified targets should be further explored in-vivo

Non-alcoholic fatty liver disease and gastroesophageal reflux disease as a model of a patient with a high cardiovascular risk

A high level of cardiovascular diseases and the increase in the number of patients with excessive body weight indicate eating disorders among the population not only of Russia, but also in the whole world. Rhetorical remains the question of determining the primary pathogenetic link. However, the understanding and control of cardiovascular risk will entail improving the quality of life of patients with multiple organ pathology and positive changes in the dynamics of statistical indicators of health. The aim of our study was to study the features of cardiovascular system in 20 patients with nonalcoholic fatty liver disease (NAFLD) and gastroesophageal reflux disease (GERD) aged 18 to 60 years. As a result, we demonstrated a high prevalence of modifiable and non-modifiable factors of cardiovascular risk in patients with NAFLD and GERD, the leading of which was an inherited family history, arterial hypertension, inadequate physical activity, nicotine dependence, excessive alcohol consumption.Высокий уровень сердечно-сосудистых заболеваний и увеличение численности пациентов с избыточной массой тела свидетельствуют о нарушениях пищевого поведения среди населения не только россии, но и в мире в целом. риторическим остается вопрос определения первичного патогенетического звена. однако, понимание и возможность управления кардиоваскулярными рисками, повлечет за собой повышение качества жизни пациентов с полиорганной патологией и положительные сдвиги в динамике статистических показателей здравоохранения. Целью нашего исследования было изучение особенностей состояния сердечно-сосудистой системы у 20 больных с неалкогольной жировой болезнью печени (НаЖБП) и гастроэзофагеальной рефлюксной болезнью (ГЭрБ) в возрасте от 18 до 60 лет. В результате, нами была продемонстрирована высокая распространенность модифицируемых и немодифицируемых факторов кардиоваскулярных рисков у больных НаЖБП и ГЭрБ, ведущими из которых были наследственная отягощенность, артериальная гипертензия, недостаточная физическая активность, никотиновая зависимость, избыточное употребление алкоголя

Результаты неинтервенционного наблюдательного многоцентрового исследования тактики ведения пациентов с аксиальным псориатическим артритом в условиях реальной клинической практики (NiSaXPA)

Psoriatic arthritis (PsA) is a chronic immunoinflammatory disease of the joints, spine and entheses from the group of spondyloarthritis, which is usually observed in patients with psoriasis. In recent years, the axial form of PsA (axPsA) has been actively researched. However, there is insufficient data on approaches to the diagnosis and treatment of patients with axPsA in real-life clinical practice. This article presents the results of an interim analysis of data from a non-interventional multicenter observational study on the treatment of patients with axPsA in real-life clinical practice (NiSaXPA) in Russian centers.Objective: to identify patients with axPsA, their characteristics and describe treatment tactics in real-life clinical practice.Material and methods. Patients with PsA who met the inclusion criteria were prospectively followed up during routine visits to a rheumatologist. Participants' axial radiographs were uploaded to a database in order for it to be confirmed the presence or absence of axPsA by two independent experts, a rheumatologist and a radiologist. Patients with a confirmed axPsA diagnosis participated in a further data collection phase (Visit 2, week 24).Results and discussion. Six hundred patients were enrolled into the study. At the time of analysis, 386 (64.3%) of them (209 men and 177 women) were screened for axPsA. The diagnosis of axPsA was confirmed in 241 (62.4%) cases; these patients formed the Per Protocol (PP) population. The mean age of patients with axPsA in the PP population was 46.30±12.6 years and the body mass index (BMI) was 27.4±5.2 kg/m2 . In 14.9% of patients, the duration of psoriasis was less than 1–5 years, in 21.5% – 5–10 years and in 63.6% – more than 10 years. The duration of PsA symptoms was less than 1–5 years in 31.2 % of patients, 5–10 years in 31.6 % and more than 10 years in 37.2 %. Low disease activity (BASDAI ˂ 4) was achieved in 33.3 % of patients with axPsA at visit 1 and in 64.3 % at visit 2; the BASDAI index declined on average from 4.67±1.95 to 3.31±1.89 points.In real-life clinical practice, patients were most frequently prescribed non-steroidal anti-inflammatory drugs (NSAIDs) – 88.7% and 71.7% (visits 1 and 2, respectively), and synthetic disease-modifying antirheumatic drugs (sDMARDs) –79.1% and 70.7%, respectively; therapy with biologic disease-modifying antirheumatic drugs (bDMARDs) was initiated in 40.2% and 60.6% of patients, respectively.Conclusion. The results of the interim analysis of this observational study showed that in 87.2% of patients who met the CASPAR criteria for PsA there was a suspicion of axial manifestations of PsA on the primary care level. However, only 62.4% of them had a confirmed diagnosis of axPsA on centralized expert assessment, which may indicate a possible overdiagnosis of axial lesions in real-life practice and emphasizes the importance of collaboration between a rheumatologist and a radiologist when analyzing the results of imaging studies. 33.3% of patients with axPsA had low disease activity according to BASDAI at baseline and 64.3% after 24 weeks, meaning that the disease was only adequately controlled in one third of cases despite therapy; the number of these patients doubled after a change in therapy. In real-world clinical practice, patients with axPsA are most commonly prescribed drugs from the NSAID and sDMARD groups; the frequency of use of biologic drugs varied between 40.2 and 60.6% by the end of the observation period.Псориатический артрит (ПсА) – хроническое иммуновоспалительное заболевание суставов, позвоночника и энтезисов из группы спондилоартритов, которое обычно наблюдается у больных псориазом. В последние годы активно изучается аксиальная форма ПсА (аксПсА). Вместе с тем данных о подходах к диагностике и ведению пациентов с аксПсА в реальной клинической практике недостаточно. В настоящей публикации представлены результаты промежуточного анализа данных неинтервенционного наблюдательного многоцентрового исследования тактики ведения пациентов с аксПсА в условиях реальной клинической практики (NiSaXPA) в российских центрах.Цель исследования – выявление пациентов с аксПсА, их характеристика и описание тактики ведения в условиях реальной клинической практики.Материал и методы. Во время плановых визитов к ревматологу проводилось проспективное наблюдение пациентов с ПсА, соответствовавших критериям включения. Аксиальные рентгенограммы участников были загружены в базу данных для подтверждения наличия или отсутствия аксПсА двумя независимыми экспертами – ревматологом и рентгенологом. Пациенты с подтвержденным диагнозом аксПсА участвовали в дальнейшей фазе сбора данных (визит 2, неделя 24).Результаты и обсуждение. В исследование включено 600 пациентов. На момент проведения анализа с целью выявления аксПсА обследовано 386 (64,3%) из них (209 мужчин и 177 женщин). Диагноз аксПсА подтвержден в 241 (62,4%) случае; эти больные составили популяцию по протоколу (PP, Per Protocol). У 145 (37,6%) пациентов аксПсА не выявлен. Возраст пациентов с аксПсА в популяции РР составил в среднем 46,30±12,6 года, индекс массы тела (ИМТ) – 27,4±5,2 кг/м2 . У 14,9% пациентов длительность псориаза была менее 1–5 лет, у 21,5% – 5–10 лет и у 63,6% – более 10 лет. Давность симптомов ПсА у 31,2% пациентов составляла менее 1–5 лет, у 31,6% – 5–10 лет и у 37,2% – более 10 лет. Низкой активности заболевания (BASDAI ˂ 4) к визиту 1 достигли 33,3% больных аксПсА, к визиту 2 – 64,3%; было отмечено снижение индекса BASDAI в среднем с 4,67±1,95 до 3,31±1,89 балла. В реальной клинической практике пациентам наиболее часто назначали нестероидные противовоспалительные препараты (НПВП) – 88,7% и 71,7% (визиты 1 и 2 соответственно) и синтетические базисные противовоспалительные препараты (сБПВП) – 79,1% и 70,7% соответственно; терапия генно-инженерными биологическими препаратами (ГИБП) была инициирована 40,2% и 60,6% больных соответственно.Заключение. Результаты промежуточной оценки данного наблюдательного исследования показали, что у 87,2% пациентов, отвечавших критериям CASPAR для ПсА, исходно при обследовании по месту жительства были заподозрены аксиальные проявления ПсА. Однако при центральной экспертной оценке диагноз аксПсА был верифицирован только у 62,4% из них, что может свидетельствовать о возможной гипердиагностике аксиального поражения в реальной практике и подчеркивает важность кооперации ревматолога и рентгенолога при анализе результатов визуализационных методов обследования. 33,3% пациентов с аксПсА имели низкую активность заболевания по BASDAI исходно и 64,3% – через 24 нед. Таким образом, несмотря на проводимую терапию, адекватно контролировать заболевание удавалось только в трети случаев, после смены терапии число таких пациентов увеличилось вдвое. В реальной клинической практике пациентам с аксПсА наиболее часто назначают препараты из группы НПВП и сБПВП, частота использования ГИБП варьировалась от 40,2 до 60,6% к концу наблюдения

Polyethylene/Polyhydroxyalkanoates-based Biocomposites and Bionanocomposites

The development of advanced polymer composite materials having superior mechanical properties has opened up new horizons in the field of science and engineering. Polyethylene (PE) is considered one of the most widely used thermoplastics in the world due to its excellent properties which have excellent chemical inertness, low coefficient of friction, toughness, near-zero moisture absorption, ease of processing and electrical properties. Polyhydroxyalkanoates (PHAs) are garnering increasing attention in the biodegradable polymer market because of their promising properties such as high biodegradability in different environments. This chapter covers polyethylene/polyhydroxyalkanoates-based biocomposites and bionanocomposites. It summarizes many of the recent research accomplishments in the area of PE/PHAs-based biocomposites and bionanocomposites such as state-of-the-art regarding different methods of their preparation. Also discussed are different characterization techniques and use of PE/PHAs-based biocomposites and bionanocomposites in biomedical, packaging, structural, military, coating, fire retardant, aerospace and optical applications, along with recycling and lifetime studies

Molecular origin of physical ageing and rejuvenation in glassy polystyrene

Molecular origin of physical ageing and rejuvenation in glassy polystyren