Closure of skins and soft tissue defects is a mainstream procedure in the field of reconstructive plastic surgery. Nowadays plenty of reconstructive options exists in the armamentarium of the specialty. The “keystone island perforator flap” is a relatively new conception which consists of taking skin and superficial fascia in a keystone pattern adjacent to the defect that needs to be covered. This technique is based on the most contemporary knowledge of the vascularization and three-dimensional vascular architecture of the skin and soft tissue overlying the bones - the so called angiosomes and perforasomes concepts. In the present article a brief review of the main keystone fl ap types and on their predecessor - the Bezier flap, was made. Two clinical cases with difficult defects on the limbs are presented and discussed in order to illustrate the application of that approach. The keystone perforator island flaps is a sophisticated and relatively easy option for defect closure. However, this surgical concept still remains unpopular in the Bulgarian practice and science of plastic surgery. To the best of our knowledge this paper is the first one focused on the topic.
The current review reveals the seven subclasses of CD4+ T helper cells, i.e. Th1, Th2, Th9, Th17, Th22, regulatory T cells and Tfh, the cytokines produced by them and their role in tumor microenvironment. Main attention was paid to IL-17 and Th17 cells. IL-17-producing cells were described, among which were Treg17 cells and Tc17 cells. The transcription factors, engaged in the activation of Th17 cell differentiation were reviewed. It was shown that Th17 cells might possess regulatory functions in tumor microenvironments that directs toward immunosuppression. The reciprocity between Treg and Th17 cells is realized when the production of a large amount of TGF-β in tumors causes Treg cell differentiation, and the addition of IL-6 shifts the differentiation of naïve T cells to Th17 cells. The main pro-tumor role of IL-17 is the promotion of tumor angiogenesis through stimulation of fibroblasts and endothelial cells. The antitumor functions of IL-17 are associated with enhancement of cytotoxic activity of tumor specific CTL cells and with angiogenesis that provide channels through which immune cells might invade tumor and promote antitumor immunity.
The aim of the present study was to provide alternative means of measurement and evaluation of muscle strength in rehabilitation practice and diagnostics. In the last few years many electronic devices for evaluation of muscle strength have developed. Contemporary studies have shown that in addition to the standard manual muscle testing muscle strength can be assessed more objectively and analytically using electronic dynamometers and equipment. The strain gauges are used as a tool of precision in the industry that allows measurement of mechanical loads by dynamometers. By using these tools is possible to obtain continuous digital measurement and recording of muscle strength.
Copper (Cu) and zinc (Zn) are essential for life. Body Cu and Zn content depends on variety of factors - age, gender, and diet, type of drinking water, geographical location and genetic predisposition. Copper status becomes even more relevant not only in rare genetic disorders such as Wilson disease but in diseases such as cardiovascular ones, impaired glucose tolerance and neuro-degenerative and tumor diseases. The study aimed to examine the distribution of serum Cu and Zn in a representative group of the Bulgarian population and to describe factors which influence metal content. It also aimed to describe the link between serum Cu levels and the frequency of Alzheimer’s disease (AD) in Bulgarians. Cu and Zn in serum were measured in 379 individuals (172 males and 207 females) from 5 different regions in Bulgaria by flame atomic absorption using AAnalyst 400, Perkin Elmer. Statistical analyses were performed by SPSS, 19. Median and inert-quartile range (IQR) for blood Cu were 15.89 (13.87-7.89) μmol/L and for Zn - 13.00 (11.7-14.68) μmol/L in the examined group. Higher Cu levels in females than in males were found (p < 0.001). Decrease of Zn with aging was established (p > 0.05). Significant difference (p < 0.05) was found in serum Cu between young people (< 30 year old) and adults over 61 year old. Statistically significant difference in Cu and Zn was observed (p < 0.05) in respect of residences. Difference without significance was measured between serum lipids and serum Cu (p = 0.541) and Zn (p = 0.741).
The aim of the study is to compare the diagnostic capabilities of three different diagnostic methods: Quantitative Laser Fluorescence (QLF) − DIAGNOdent Classic (DD), Light-Induced Fluorescence (LIF) − SoproLife daylight and blue fluorescence, and their relevance to ICDAS II system in detection of fissure caries lesions in permanent molars. Permanent molars (n = 45) are divided in two groups: 1) third molars, n = 35; 2) first and second molars, n = 10. They are examined by 2 examiners with and without magnification x5 using ICDAS II, SoproLife “day light” and “blue light” (405nm), LIF, DIAGNOdent Classic − emitting laser light on 655nm, QLF. The results are proven with histological bucco-lingual or mesio-distal sections through the body of the lesion with diamond blade rinsed with water. Photos of all occlusal surfaces of the molars are taken before and after the sections. The lowest overdiagnosis rate is found with SoproLife camera. When visual examination is applied overdiagnoses are fewer than with DD. DD is not capable to differentiate white and brown spots from a caries lesion. Soprolife is not capable to differentiate brown spots from a caries lesion. The most accurate method in this in vitro study for diagnosis of fissure caries is LIF (SoproLife) − 75.6% of the teeth are correctly diagnosed, followed by ICDAS (57.8%) and QLF (DIAGNOdent) (40%).
Vitamin D deficiency is fequently observed in chronic kidney disease. We conducted this study to determine the concentration of the above-mentioned parameters and the correlation between them in order to optimize therapy with vitamin D in patients with end-stage renal disease (ESRD) on hemodialysis. In 53 patients on hemodialysis due to ESRD, vitamin D [Calcidiol (25(OH)D], parathyroid hormone (PTH), calcium, phosphorus, albuminuria, albumin:creatinine ratio (ACR) and other parameters have been followed up. Analysis of the levels of vitamin D has been carried out by High Performance Liquid Chromatography (HPLC), the PTH is determined by the system Centaur XP, Siemens Diagnostic, Electro-chemiluminescence immunoassay (ECLIA), and for albumin in urine we used immunological method [Miltigent microalbumin assay (Abbott Laboratories Diagnostics). We found out deficiency and insufficiency of vitamin D in 56.6% and 37.7%, as well as average 4.5 times increase in the PTH, hyperphosphatemia, hypocalcemia, albuminuria (A2 or A3), over 10 times increase in the ACR, secondary hyperparathyroidism. We registered a negative correlation between vitamin D and PTH. We confirmed the increase in creatinine and cystatin C in the patients on hemodialysis. There are few literature data for patients on hemodialysis, however, regarding the extent of the vitamin deficiency and its relationship with PTH, albuminuria, calcium, phosphorus, etc. Our data have indicated that patients on hemodialysis due to ESRD are associated with high incidence of vitamin D insufficiency or deficiency.
According to the World Health Organization there are almost two billion people worldwide who consume alcohol on a regular basis. It’s a common abuse and almost 80 million are diagnozed with “alcohol abuse disorders” (WHO 2002, 2004). Excessive alcohol consumption is related to more than 60 different medical conditions, as suicide, homicide and different forms of accidents. Some conditions are acute, while other conditions such as liver cirrhosis, chronic pancreatitis, haemorrhagic stroke and various forms of cancer, are chronic consequences. Non-carious destructions of teeth like dental erosion are also associated with frequent alcohol consumption, because of precipitation of salivary proline-rich proteins caused by polyphenols present in most alcoholic drinks. The high concentration of organic and inorganic acids and the habit of keeping the alcoholic drink in the mouth can cause chronic inflammations of the soft tissues in the mouth and can increase the negative side effects from metals of crowns, bridges, orthodontic devises and various restorations. A literature review has been made due to the authors clinical observations and experiences.
Diarrhea is the most common gastrointestinal symptom in HIV-infected patients. The incidence and severity of diarrhea increase with progression of the immune defi ciency. In the literature, 30-60% of the patients with diarrhea among HIV-infected individuals remain without specified etiological agent. The aim of this article is to present the incidence of enterocolitis among hospitalized HIV-infected patients over a 3-year period and the degree of etiological clarifi cation of the cause. The results of our analyses showed that 63% of the hospitalized HIV-infected patients for this period were with enterocolitis. Only in 30% of these patients etiological agent was isolated. The reasons for this are mainly financial constraints and, therefore, virological investigations and further endoscopic and histopathological examination of the patients with negative for bacteria and parasites stool samples, were not performed. In the cases with isolated pathogen, an etiological treatment was carried out in parallel with highly active antiretroviral therapy, while in unsubstantiated cases an empirical treatment was carried out. Advanced immune defi ciency was associated with more severe course and worse prognosis of the enterocolitis. The treatment with highly active antiretroviral therapy, which leads to improvement of the immune status of the patients, is essential for the output of enterocolitis in HIV-infected patients.
Oral/perioral piercing may provide an ideal environment for adhesion and colonization of microorganisms. The aim of this study is to perform an “in vitro” research on the capabilities of adhesion of Candida albicans on oral piercings made of plastic and metal. Acrylic and metal piercings were incubated with Candida albicans and then were observed using scanning electron microscopy under different magnifications. A lot of irregularities and roughness were observed on the surface of the plastic piercing unlike the surface of the metal one, which is not so rough. Nevertheless, the number of Candida albicans colonies was considerably larger on the scanned metal surface in comparison to the plastic surface. In vitro the metal surface of the piercing creates better environment for the adhesion and colonization of microorganisms than the acrylic. This could be attributed to the electrostatic forces that most likely attract Candida albicans to the metal piercing in the early stages of biofilm formation.
The rate of musculoskeletal disorders is increasing in white collar workers and often is discussed in relation to ergonomic and work organization issues. The aim of the study was to follow the rate and determinants of musculoskeletal disorders in broadcasting engineers under shift work. Job analysis and ergonomic evaluation of the workplaces of 168 broadcasting engineers, working different shift work schedules, was carried. The self reported working conditions, psychosocial and ergonomic factors were followed. Questioning for distribution and localization of musculoskeletal complaints and diagnosed musculoskeletal disorders was carried. Data were analyzed with variation, correlation and regression analysis. A lot of ergonomic and work organization problems, simultaneous work on two monitors, changes of workplace during the shift were found. More than 50% of the employees were not content with shift work schedules, 38.7% worked often under time pressure and 23.8% in non-ergonomic work posture. A high incidence of musculoskeletal complaints mainly in the region of the back and neck was found. 35.1% of the employee reported musculoskeletal disorders, determined by non-ergonomic work posture, problems in shift work schedules, lack of control and decision making in a highly significant model. Measures for improving workplace ergonomics and work organization were proposed in order to reduce stress, fatigue and health risks in broadcasting staff.