Medical sciences

Folia Medica Cracoviensia

Content

Folia Medica Cracoviensia | 2019 | vol. 59 | No 3 |

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Abstract

B a c k g r o u n d: Regulation of energy balance in patients with short bowel syndrome (SBS) is disturbed due to lack of significant part of the intestine. The goal of the research was to analyse the plasma concentrations of selected regulatory peptides — ghrelin, visfatin, and irisin — in children with SBS.

M e t h o d s: To achieve this aim we recruited study group consisted of 28 children with SBS fed parenterally for at least two weeks, mean age 14 ± 5 months and mean standardised body mass index (SDS-BMI) –1.26 ± 0.84. The control group was represented 25 healthy children of matching age and SDS-BMI. The plasma concentrations of peptides (ghrelin, visfatin, and irisin) were determined using immunoassays, and liver enzymes (AST, ALT, GGT) using an auto-analyser.

R e s u l t s: We observed lower visfatin and ghrelin levels in the study group as compared to controls (both P <0.0001). The lowest total ghrelin concentration was observed in SBS children after ileal resection (P = 0.0016). Irisin concentration did not differ between the groups. Most of the SBS children showed elevated liver enzymes activities at the first measurement and during one-year follow-up.

C o n c l u s i o n: Our findings showed that plasma ghrelin and visfatin themselves may play a role in the course of SBS, while a lack of disturbance in irisin might imply that it is neither playing any role nor it is affected by SBS itself.

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Authors and Affiliations

Julita Pabisek-Miernik
Barbara Kościelniak-Merak
Mikołaj Spodaryk
Przemysław J. Tomasik
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Abstract

Alcohol is a recognized teratogen that affects various aspects of fetal development. Tissue that is particularly susceptible to its teratogenicity is neuronal tissue. The effect of prenatal alcohol exposure (PAE) on the central nervous system has been extensively studied, yet the knowledge on the influence of PAE on the autonomic nervous system is scarce. The purpose of this article is to review the current state of knowledge about the impact of PAE on the autonomic nervous system. Studies conducted on the PAE animal model have shown that prenatal alcohol exposure is associated with significant alterations in the autonomic nervous system, but the mechanisms and consequences are not yet clearly defined. It was established that PAE causes decreased heart rate variability (HRV) in fetal cardiotocography. Several studies have revealed that later, in infancy and childhood, reduced parasympathetic activity with or without compensating sympathetic activity is observed. This may result in behavioral and attention disorders, as well as an increased predisposition to sudden infant death syndrome. Both animal and human studies indicate that the relationship between PAE and autonomic dysfunction exists, however large, well-designed, prospective studies are needed to confirm the causal relationship and characterize the nature of the observed changes.

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Authors and Affiliations

Michał Jurczyk
Katarzyna Anna Dyląg
Kamil Skowron
Krzysztof Gil
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Abstract

The anatomy of the human temporal bone is complex and, therefore, poses unique challenges for students. Furthermore, temporal bones are frequently damaged from handling in educational settings due to their inherent fragility. This report details the production of a durable physical replica of the adult human temporal bone, manufactured using 3D printing technology. The physical replica was printed from a highly accurate virtual 3D model generated from CT scans of an isolated temporal bone. Both the virtual and physical 3D models accurately reproduced the surface anatomy of the temporal bone. Therefore, virtual and physical 3D models of the temporal bone can be used for educational purposes in order to supplant the use of damaged or otherwise fragile human temporal bones.

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Authors and Affiliations

Janusz Skrzat
Matthew J. Zdilla
Paweł Brzegowy
Mateusz Hołda
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Abstract

I n t r o d u c t i o n: Hydronephrosis is an actual pediatric problem, affecting children in the anteand neonatal periods. Intrinsic stenosis is due to external obstruction and creates a pathophysiological basis of this urological pathology. Co-localization of ureter with a renal vasculature also could not be omitted from this point of view. Mesenchymal cells, partially telocytes, are important for local fibrosis development and hydronephrosis formation as well. In the current study, we focused on identification of telocytes in the human ureters to hypothesize their role in hydronephrosis pathophysiology.

M a t e r i a l a n d Me t h o d s: The samples were taken from 18 surgically treated patients with hydronephrosis (due to ureteral obstruction and crossing renal vessel). The control group consisted of 10 patients suffered from a non-obstructive disease of the urinary tract — predominantly renal tumors. Tissue samples from a ureter were stained for c-kit, tryptase, CD34 and PDGFRα to identify telocytes. Routine histology was performed to analyze tissue morphology, collagen deposits and mast cell’s profile.

R e s u l t s: Telocytes were detected in the ureteral wall. In patients with hydronephrosis we revealed decreasing density of telocytes, the prevalence of collagen, rise in mast cells amount and the ureteral wall thickening. In ureters with crossing renal vessels as a primary etiologic factor more telocytes have been observed in comparison with the obstructive hydronephrosis.

C o n c l u s i o n s: A declined density of telocytes accompanied hydronephrosis development. Increased number of mast cells in the ureteral wall reflects a local inflammation, while detailed observation of collagen/muscle deposits and density of telocytes reveal a difference depended on etiologic factor (obstruction or crossing vessel) in patients with hydronephrosis.

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Authors and Affiliations

Michał Wolnicki
Veronika Aleksandrovych
Anna Gil
Artur Pasternak
Krzysztof Gil
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Abstract

The musculocutaneous nerve (C5–C7) is a terminal branch of the lateral cord of the brachial plexus and provides motor innervation to the anterior compartment of arm muscles. Both the musculocutaneous and median nerve may show numerous anatomical variations. Keeping in mind possible aberrations in the course of the upper limb nerves may increase the safety and success rate of surgical procedures. The presented report is a detailed anatomical study of the fusion between the median and musculocutaneous nerve, supplemented by intraneural fascicular dissection. In the presented case, the musculocutaneous nerve was not found in its typical location in the axillary cavity and upper arm during the preliminary assessment. However, a careful intraneural fascicular dissection revealed that musculocutaneous nerve was fused with the median nerve and with its lateral root; Those nerves were surrounded by a common epineurium, however they were separable. The muscular branch to the biceps brachii muscle arose from the trunk ( fascicular bundle) dissected out from the median nerve and corresponding to the musculocutaneous nerve. Such variation may be of utmost clinical importance, especially during reconstructions of the brachial plexus or its branches.

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Authors and Affiliations

Edward Clarke
Grzegorz Wysiadecki
Robert Haładaj
Janusz Skrzat
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Abstract

I n t r o d u c t i o n: Fecal calprotectin (FC) rises significantly in intestinal inflammation accompanied by neutrophil activation — such as Clostridium diffi cile infection (CDI). The aim of the study was to evaluate the benefi t of FC testing in assessing the severity of CDI.

Ma t e r i a l s a n d M e t h o d s: The study group included 76 patients with CDI hospitalized in the Jagiellonian University Hospital in Krakow from July 2017 till January 2018. FC levels were measured using an EIA (Enzyme Immunoassay). Demographic, clinical information and blood tests were recorded using standardized data collection forms. The selection of patients into non-severe and severe groups was carried out in accordance with the ESCMID criteria (European Society of Clinical Microbiology and Infectious Diseases) and some modifications to those criteria were proposed.

R e s u l t s: The studied population included 76 patients (39 men and 37 women) with CDI aged from 24 to 98 years (mean: 72). Median calprotectin level was 739 (Q25–Q75: 612–799 μg/g), characteristic of patients with colitis. A statistically signifi cant diff erence in FC concentration in patients with severe vs non-severe CDI was observed (severe — 770 vs non-severe — 659 μg/g, p = 0.009). FC directly correlated with platelets level; however, no correlation between FC level and the blood parameters prognostic for CDI (leukocyte, neutrophil count, albumin, creatinine levels) was found.

C o n c l u s i o n: FC level is an indication of ongoing intestinal inflammation in CDI patients. FC level significantly correlated with CDI severity, which demonstrates that FC could serve as a predictive marker for assessing CDI severity.

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Authors and Affiliations

Mirosław Dróżdż
Grażyna Biesiada
Hanna Pituch
Dorota Wultańska
Piotr Obuch-Woszczatyński
Michał Piotrowski
Jolanta Kędzierska
Mateusz Michalak
Aleksander Garlicki
Jacek Czepiel
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Abstract

Incidence of colonic atresia in living infants ranges from 1:5,000 to 1:60,000 (average 1:20,000). It constitutes 1.8 to 15% of all cases of atresia of the gastrointestinal tract. In 58.56–75% of all cases is right-sided. We aim, through the presentation of two cases of colonic atresia which we encountered and after systematic research of the current literature, at addressing three major issues: diagnostic approach, operative strategy and management of the prognostic parameters of the colonic atresia. The common parameter in these two cases was the early diagnosis, which played a significant role in the uncomplicated postoperative course. The first case was a type I sigmoid atresia. Contrast’s escape during contrast enema examination due to accidental rupture of the distal part of the colon led to diagnosis. Side-to-side anastomosis, restoration of the rupture and a central loop sigmoidostomy were urgently performed. The second case was a type III atresia at the level of the ascending colon, which was early diagnosed via pregenital ultrasonography, in which colonic dilation was depicted. Restoration of the intestinal continuity early after birth was performed at a time. In conclusion, we believe that early diagnosis, selection of the appropriate operative strategy and prompt recognition of potential post-operative complications, especially rupture of the anastomosis, contribute to the optimization of the prognosis in patients with colonic atresia.

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Authors and Affiliations

Ioannis Patoulias
Thomas Feidantsis
Charalampos Doitsidis
Magdalini Mitroudi
Maria-Styliani Kalogirou
Dimitrios Patoulias
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Abstract

B a c k g r o u n d: Articular cartilage is highly-organized nonvascularized tissue which is responsible in humans for pressure absorption under load, as well as for the smoothness of the opposite tangential bone surfaces.

The purpose of our research is to study structural and functional features of articular cartilage at lightoptical level by using state-of-the-art research methods of bone-cartilage tissue.

M a t e r i a l a n d M e t h o d s: The study was conducted on samples of femoral heads. Hyperfine sections were subject to hematoxylin and eosin, Van Gieson’s and PAS staining. In order to identify the receptor profile of chondrocytes and the features of protein arrangement in extracellular matrix we undertook an immunohistochemical study.

R e s u l t s: An articular cartilage is quite organized tissue. As any other organ, it has parenchyma and stroma. Parenchyma is represented by one type of cells — chondrocytes, which, depending on how deep they are located in cartilage, have a different shape, size and functional features. The chondrocytes and extracellular matrix have different degrees of receptors expression.

C o n c l u s i o n s: Th e cartilage is being constantly self-renewed, what is manifested by means of a rather slow division of the surface-located chondrocytes and programmed death of dystrophic-modified cells. The features of extracellular matrix structure determine the originality of cell location in different areas of cartilage tissue. Due to synthesis of specific proteins, chondrocytes self-regulate properties of cartilage tissue.

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Authors and Affiliations

Mykola Lyndin
Nadegda Gluschenko
Vladyslav Sikora
Yuliia Lyndina
Natalia Hyryavenko
Gennadii Tkach
Victoria Kurochkina
Anatolii Romaniuk
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Abstract

I n t r o d u c t i o n: RANTES regulates leukocyte recruitment to areas affected by the inflammatory process. Microvesicles (MVs) belong to a subpopulation of extracellular vesicles and show proangiogenic potential by transferring bioactive molecules to target cells.

Obj e c t i v e s: The aim of this study was to determine the relationship between circulating proangiogenic factors (MVs and RANTES) and diabetes complications in patients with different severities of diabetic retinopathy (DR). CCR5 (CD195) receptors transported by annexin V-labeled MVs were also investigated. Patients and Methods: Diabetic patients (n = 61), among whom 35 had confirmed DR classified according to guidelines, and controls (n = 25) were included. MVs were isolated by centrifugation and analyzed using flow cytometry, RANTES was assessed by ELISA.

R e s u l t s: T h e study group diff ered from the control group with respect to BMI, age, heart rate and systolic blood pressure. Additionally, glucose and creatinine concentrations were signifi cantly increased: 5.30 [5.09–5.62] vs. 9.38 [7.48–11.55] (p<0.0001) mmol/l and 74.59 [64–84] vs. 89.00 [77.11–105.44] μmol/l (p = 0.0005), respectively. RANTES concentrations were significantly increased in diabetic patients compared to those of controls (15.5 (9.7–18.1) vs. 8.9 (0.9–14.6) μg/ml (p = 0.011)), and RANTES concentration significantly increased with respect to nonproliferative DR progression. Moreover, the number of CCR5-positive MVs was significantly increased in patients with heavy nonproliferative diabetic retinopathy (HNPDR) compared to those with soft nonproliferative DR (SNPDR): 1178 [836–2254] vs. 394 [275–799] counts/μl.

C o n c l u s i o n s: Correlation of RANTES concentrations with the stage of nonproliferative DR and the statistically significant dependence of CCR5-positive MVs with disease progression suggest that MVs and RANTES can be considered new biomarkers.

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Authors and Affiliations

Aleksandra Tokarz
Magda Konkolewska
Beata Kuśnierz-Cabala
Barbara Maziarz
Patryk Hanarz
Aleksander Żurakowski
Iwona Szuścik
Ewa Łucja Stępień
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Abstract

Significant impact factor and psycho-emotional stress in the etiology of dysfunction indicate the need of the routine approach in the treatment of patients with temporomandibular joint disorders to be changed. The aim of the study was to obtain data, documented test results as to the efficiency of progressive muscle relaxation in the treatment of pain caused by temporomandibular joint disorders, as a supplement to previous methods using occlusal splint and other physical therapies. The study included 100 patients of both sexes, aged from 20 to 35 years who were diagnosed with pain due to temporomandibular joint disorders accompanied with high muscle tension of musticatory muscles which were treatment by relaxation therapy. All patients underwent physical examination, specialized functional examination of the masticatory system in accordance with the Polish version of the study RDC/TMD (The Research Diagnostic Criteria of Temporomandibular Disorders, Axis I — physical assessment, Axis II — assessment of psychosocial status and pain — related disability) and assessment of psycho emotional factor and stress, based on the survey developed for their own purpose. The results of the research were obtained using specialized statistical package “R” i386 3.2.3. The results of examinations aft er relaxation therapy showed a signifi cant reduction in the intensity of myofascial pain in all patients. Progressive muscle relaxation can be successfully used as an supportive therapy treatment of patient with dysfunction.

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Authors and Affiliations

Ewa Ferendiuk
Joanna Marta Biegańska
Piotr Kazana
Małgorzata Pihut

Editorial office

KOMITET REDAKCYJNY

Redaktor Naczelny
Dr hab. Krzysztof Gil, prof. UJ

Zastępca Redaktora Naczelnego
Prof. Andrzej Surdacki

Sekretarz Redakcji
Prof. Beata Kuśnierz – Cabala

Członkowie
Prof. Benjamin Chain (London, UK),
Prof. Paul Enck (Tübingen, Germany),
Prof. Tomasz Grodzicki (Kraków, Poland),
Prof. Kalina Kawecka-Jaszcz (Kraków, Poland)
Prof. Maciej Małecki (Kraków, Poland),
Prof. Janusz Marcinkiewicz (Kraków, Poland),
Prof. Franz H. Messerli (New York, USA),
Prof. Jacek Musiał (Kraków, Poland),
Prof. Wiesław Pawlik (Kraków, Poland),
Prof. Jacek J. Pietrzyk (Kraków, Poland)
Prof. Władysław Sułowicz (Kraków, Poland)
Prof. Piotr Thor (Kraków, Poland)
Prof. Jerzy A. Walocha (Kraków, Poland)

Redaktor techniczny
Danuta Ambrożewicz

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