Conjoint bicondylar Hoffa fracture in a child: a rare variant treated by minimally invasive approach

A case of conjoint Hoffa-type fracture in a child is presented. Hoffa fracture, i.e., coronal slice fracture of the condyles of the femur, is rare in adults and even rarer in the pediatric population. To date, no case of conjoint bicondylar Hoffa fracture has been reported in the literature. The presented case was successfully treated by arthroscopically assisted internal fixation

Transcript levels of Toll-Like receptors 5, 8 and 9 correlate with inflammatory activity in Ulcerative Colitis

<p>Abstract</p> <p>Background</p> <p>Dysregulation of innate immune response by Toll-Like Receptors (TLRs) is a key feature in Ulcerative Colitis (UC). Most studies have focused on <it>TLR2, TLR3</it>, and <it>TLR4 </it>participation in UC. However, few studies have explored other TLRs. Therefore, the aim of this study was to evaluate the mRNA profiles of <it>TLR1 to 9 </it>in colonic mucosa of UC patients, according to disease activity.</p> <p>Methods</p> <p>Colonic biopsies were taken from colon during colonoscopy in 51 patients with Ulcerative Colitis and 36 healthy controls. mRNA levels of <it>TLR1 to 9, Tollip</it>, inflammatory cytokines <it>IL6 </it>and <it>TNF </it>were assessed by RT-qPCR with hydrolysis probes. Characterization of <it>TLR9 </it>protein expression was performed by Immunohistochemistry.</p> <p>Results</p> <p>Toll-like receptors <it>TLR8, TLR9</it>, and <it>IL6 </it>mRNA levels were significantly higher in the colonic mucosa from UC patients (both quiescent and active) as compared to healthy individuals (p < 0.04). In the UC patients group the <it>TLR2, TLR4, TLR8 </it>and <it>TLR9 </it>mRNA levels were found to be significantly lower in patients with quiescent disease, as compared to those with active disease (p < 0.05), whereas <it>TLR5 </it>showed a trend (p = 0.06). <it>IL6 </it>and <it>TNF </it>mRNA levels were significantly higher in the presence of active disease and help to discriminate between quiescent and active disease (p < 0.05). Also, <it>IL6 </it>and <it>TNF </it>mRNA positively correlate with TLRs mRNA with the exception for <it>TLR3</it>, with stronger correlations for <it>TLR5, TLR8</it>, and <it>TLR9 </it>(p < 0.0001). <it>TLR9 </it>protein expression was mainly in the lamina propria infiltrate.</p> <p>Conclusions</p> <p>This study demonstrates that <it>TLR2, TLR4, TLR8</it>, and <it>TLR9 </it>expression increases in active UC patients, and that the mRNA levels positively correlate with the severity of intestinal inflammation as well as with inflammatory cytokines.</p

Detection of epithelial apoptosis in pelvic ileal pouches for ulcerative colitis and familial adenomatous polyposis

<p>Abstract</p> <p>Background</p> <p>Ileal pouch-anal anastomosis (IPAA) is the surgical procedure of choice for patients with refractory ulcerative colitis (UC) and for familial adenomatous polyposis (FAP) with many rectal polyps. Pouchitis is one of the more frequent complications after IPAA in UC patients; however, it is rare in FAP.</p> <p>Objective</p> <p>Evaluate pro-apoptotic activity in endoscopically and histological normal mucosa of the ileal pouch in patients with UC and FAP.</p> <p>Methods</p> <p>Eighteen patients (nine with UC and nine with FAP) with J pouch after total rectocolectomy were studied. Biopsies were obtained from the mucosa of the pouch and from normal ileum. The specimens were snap-frozen and the expressions of Bax and Bcl-2 were determined by immunoblot of protein extracts and by immunohistochemistry analysis. FADD, Caspase-8, APAF-1 and Caspase-9 were evaluated by immunoprecipitation and immunoblot.</p> <p>Results</p> <p>Patients with UC had significantly higher protein levels of Bax and APAF-1, Caspase-9 than patients with FAP, but were similar to controls. The expressions of Bcl-2 and FADD, Caspase-8 were similar in the groups. Immunohistochemistry for Bax showed less intensity of immunoreactions in FAP than in UC and Controls. Bcl-2 immunostaining was similar among the groups.</p> <p>Conclusion</p> <p>Patients with FAP present lower levels of pro-apoptotic proteins in all methods applied, even in the absence of clinical and endoscopic pouchitis and dysplasia in the histological analysis. These findings may explain a tendency of up-regulation of apoptosis in UC patients, resulting in higher rates of progression to pouchitis in these patients, which could correlate with mucosal atrophy that occurs in inflamed tissue. However, FAP patients had low pro-apoptotic activity in the mucosa, and it could explain the tendency to low cell turn over and presence of adenomas in this syndrome.</p

Update of complications and functional outcome of the ileo-pouch anal anastomosis: overview of evidence and meta-analysis of 96 observational studies

Item does not contain fulltextOBJECTIVE: The objective of this study is to provide a comprehensive update of the outcome of the ileo-pouch anal anastomosis (IPAA). DATA SOURCES: An extensive search in PubMed, EMBASE, and The Cochrane Library was conducted. STUDY SELECTION AND DATA EXTRACTION: All studies published after 2000 reporting on complications or functional outcome after a primary open IPAA procedure for UC or FAP were selected. Study characteristics, functional outcome, and complications were extracted. DATA SYNTHESIS: A review with similar methodology conducted 10 years earlier was used to evaluate developments in outcome over time. Pooled estimates were compared using a random-effects logistic meta-analyzing technique. Analyses focusing on the effect of time of study conductance, centralization, and variation in surgical techniques were performed. RESULTS: Fifty-three studies including 14,966 patients were included. Pooled rates of pouch failure and pelvic sepsis were 4.3% (95% CI, 3.5-6.3) and 7.5% (95% CI 6.1-9.1), respectively. Compared to studies published before 2000, a reduction of 2.5% was observed in the pouch failure rate (p = 0.0038). Analysis on the effect of the time of study conductance confirmed a decline in pouch failure. Functional outcome remained stable over time, with a 24-h defecation frequency of 5.9 (95% CI, 5.0-6.9). Technical surgery aspects did not have an important effect on outcome. CONCLUSION: This review provides up to date outcome estimates of the IPAA procedure that can be useful as reference values for practice and research. It is also shows a reduction in pouch failure over time.1 juli 201

Polycaprolactone-based block copolymers. I - Synthesis by anionic-coordination type catalysts

Bimetallic µ-oxalok oxides are very active anionic coordination type catalysts in the living polymerization of t-caprolactone. These compounds have a well-defined composition which can be systematically modified. It is proposed that at least half the alkoxy groups of these catalysts are replaced by carboxylate ones and the remaining alkoxy groups by any hydroxyl-terminated polymer PX. These new polymer PX-supported catalysts are powerful tools in tailoring poly(ε-capro1actone) block copolymers with well controlled molecular parameters

Polycaprolactone‐based block copolymers. II. Morphology and crystallization of copolymers of styrene or butadiene and ε‐caprolactone

Three series of amorphous semicrystalline poly(styrene‐b‐ε‐caprolactone)s have been synthesized with polystyrene blocks of 6000 (series A), 40000 (series B), and 70000 (series C) molecular weight, respectively. In these materials, the polymer miscibility evolves from a situation where a diffuse interphase involves the major part of the volume of the copolymer (series A) to a sharp phase separation as observed for copolymers with the longest PS block (series C). The crystallization of PCL blocks is mainly governed by the phase morphology. In copolymers of series A, the crystallization rate of PCL blocks is slowed down the more as the miscibility with PS increases, and ultimately the degree of crystallinity Xc decreases significantly. When phase separation is sharp, Xc changes dramatically at the phase inversion and decreases when PS forms the continuous phase. At the inversion Xc depends on the mean size of the PCL microdomains as compared with the thickness of the crystalline lamellae. The periodicity of the phase morphology as observed by TEM is influenced by the solvent used in casting films, whereas monolamellar monocrystals can be obtained by a self‐seeding technique. Copyright © 1989 John Wiley & Sons, Inc

Polycaprolactone-Based Block Copolymers. 3. Mechanical Behavior of Diblock Copolymers of Styrene and ∊-Caprolactone

Poly(styrene-block-∊-caprolactone) copolymers (PS-PCL) exhibit a two-phase morphology that dictates their mechanical behavior. The dependence of the isochronous torsion modulus on the copolymer composition clearly shows that a phase inversion takes place at ca. 45 wt % PCL. Although the stress-strain curves are governed by the nature of the continuous phase, the minor component influences the values of stress and strain in each deformation region. At least at compositions close to the phase inversion, the minor component forms semicontinuous phases as supported by electron microscopy and by the mechanical hysteresis of a completely amorphous PS-polyester copolymer comprising 55 wt % polyester. Although brittle at 77 K, a PS-PCL copolymer containing 56 wt % PCL exhibits a ductile fracture when extended by 300%, i.e., when the PCL spherulites are transformed into a microfibrillar structure. © 1989, American Chemical Society. All rights reserved

Polycaprolactone-based block copolymers: 4. Interfacial activity in poly(vinyl chloride) containing polyblends

The substantial difference in the Tg of poly(vinyl chloride) (PVC) and poly(ε-caprolactone) (PCL) offers a sensitive method of locating a polystyrene (PS)-PCL diblock in PVC or in PS/PVC polyblends. When mixed with PVC, these diblocks are dispersed as individual molecules in equilibrium with micelles. The equilibrium position depends on the composition of the diblock; when PCL is the major component, molecular dissolution in PVC is enhanced. A 50 50 PS-PCL diblock, each block of which is of a higher molecular weight than the related homopolymer, is located mainly at the PS/PVC interface, as shown by the essentially unchanged Tg of the PVC matrix and a sub-Tg assigned to the external layer of the PVC phases plasticized by the PCL blocks of the copolymer. Blocks longer than the associated homopolymer chain clearly enhance the mutual anchoring of the PS and PVC phases. Since PS and PVC are intrinsically brittle polymers, their melt blending in the presence of properly designed PS-PCL diblocks gives rise to fragile materials. © 1990