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Prognosis and Survivability in Surgically Treated Metastasis of the Long Bones

Abstract

Aim: To assess the clinical results after osteosynthesis with locked intramedullary nail in metastasis of the long bones. Material and methods. We designed a prospective study in which we included all the patients with metastasis of the long bones admitted and surgically treated in our department between 2013 and 2015. Data for 64 were available at the final check-up. Our cohort totalized a number of 69 fractures (2 long bones required surgical treatment in 5 patients). The mean follow-up for survivors was 37 months (limits: 18-49 months). The primary tumor was known in 51 patients (79,69%). For the remaining 13 cases (20,31%), the primary tumor was not known and the pathological fracture was the first sign of the malignant disease. In the last group, the tumor could be identified by imagistic methods in 6 cases, while in other 3 cases, a biopsy and histological examination (which were performed in all the remaining 7 cases) determined the source organ. Clinical and radiological check-ups were performed at every 3 months in the first year and at every 6 months after that. Results. Pain amelioration and mobilization of the involved limb were achieved in all the cases. In 3 patients, the osteosynthesis could not compensate the progressive bone loss and the permanent use of an external orthosis was mandatory. The survival rate was 82,81% at 6 months and 67,19% at 12 months. Conclusions. All patients could be mobilized. Two thirds of the patients will survive more than a year. The goals of osteosynthesis are the same, regardless the location of the fracture and implant used: pain amelioration, stability for immediate full weight bearing, durability for patient’s life expectancy.

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Assessment of the tumourigenic and metastatic properties of SK-MEL28 melanoma cells surviving electrochemotherapy with bleomycin

Assessment of the tumourigenic and metastatic properties of SK-MEL28 melanoma cells surviving electrochemotherapy with bleomycin

Background. Electrochemotherapy is a local treatment combining chemotherapy and electroporation and is highly effective treatment approach for subcutaneous tumours of various histologies. Contrary to surgery and radiation, the effect of electrochemotherapy on metastatic potential of tumour cells has not been extensively studied. The aim of the study was to evaluate the effect of electrochemotherapy with bleomycin on the metastatic potential of human melanoma cells in vitro.

Materials and methods. Viable cells 48 hours after electrochemotherapy were tested for their ability to migrate and invade through Matrigel coated porous membrane. In addition, microarray analysis and quantitative Real-Time PCR were used to detect changes in gene expression after electrochemotherapy.

Results. Cell migration and invasion were not changed in melanoma cells surviving electrochemotherapy. Interestingly, only a low number of tumourigenesis related genes was differentially expressed after electrochemotherapy.

Conclusions. Our data suggest that metastatic potential of human melanoma cells is not affected by electrochemotherapy with bleomycin, confirming safe role of electrochemotherapy in the clinics.

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Surviving history: Kate Chopin

Abstract

Bearing witness to the colonial and anti-feminist atmosphere of 19th-century America, Kate Chopin created her works against a background of all kinds of repression reigning over social life. Likewise, Désirée’s Baby focuses mainly on a young woman’s marital life and the social/familial problems she confronts because of her personal background and imperial and gender-based oppression surrounding her life. Through a new historicist reading, the story has several humane elements to be taken into account. Reflecting the periphery and the repressed, Désirée’s Baby is a significant anticanonical writing with an inspiring human touch and a historically excluded work which depicts the dramatic existential problems of the time

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SURVIVE: let the dead help the living—an autopsy-based cohort study for mapping risk markers of death among those with severe mental illnesses

Abstract

Background: Forensic autopsy strategies may improve differential diagnostics both post-mortem and ante-mortem and aid in clinical settings concerning preventive efforts for premature mortality. Excess mortality and reduced life expectancy affect persons with severe mental illnesses (SMI) for multi-faceted reasons that remain controversial. Somatic conditions, medical treatment and lifestyle diseases, which are primarily examined in the living, contribute to premature deaths. The underlying pathophysiological mechanisms are unclear, though, and the benefits of a focused, standardised autopsy remain unproven. We have developed and implemented an optimised molecular–biological autopsy for deceased persons with SMI. Our aim is to map the occurrence of 1) somatic diseases and organ changes; 2) metabolic syndrome; 3) use and abuse of alcohol, pharmaceuticals and psychoactive substances; 4) pharmacokinetic and pharmacodynamic factors in the metabolism of pharmaceuticals; and 5) genetic variations (acquired and/or congenital) in sudden cardiac death. Additionally, we hope to contribute to diagnostic treatments and preventive measures to benefit those living with SMI. Methods: SURVIVE: let the dead help the living is a prospective, autopsy-based study on 500 deceased persons with SMI subjected to forensic autopsies under the Danish Act on Forensic Inquests and Autopsy. The autopsies followed an extended, standardised autopsy protocol comprised of whole-body computed tomography scanning, magnetic resonance imaging of the heart and brain and an extended forensic autopsy, including a wide panel of analyses (toxicology, microbiology, genetics, histology and biochemical analysis). Additionally, post-mortem data were linked to ante-mortem health data extracted from Danish national health registers.

Discussion: The SURVIVE autopsy procedure, including tissue sampling and bio banking, has been shown to be effective. We expect that the SURVIVE study will provide unique opportunities to unravel the mechanisms and causes of premature death in persons with SMI. We also expect that identifying prognostic biomarkers for comorbidities will contribute to prevention of premature deaths and comorbidities in persons with SMI.

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Populations of Muscardinus avellanarius in north-western Europe can survive in forest poor landscapes, when there are enough hedges (Rodentia: Gliridae)

Abstract

The hazel dormouse (Muscardinus avellanarius) is a strictly arboreal species. In its European lowland range, the forest coverage was heavily reduced during historical times, e.g. down to ca. 4% in the northern German federal state of Schleswig-Holstein in the 18th century. This low forest cover remained for 200 years. According to habitat models, hazel dormice cannot survive in the long-term in habitats with low levels of forest cover (<5–10%). To answer the question, how hazel dormouse populations survived in almost deforested areas the recent species distribution map for north-west Europe was analysed with a GIS-overlay of different habitat data. Additionally, historical maps for north-west Germany were analysed to find crucial historical landscape elements. The history of a site apparently influences the present status of hazel dormice. Forest cover of younger woodlands is still of importance but less determinant. Habitat tradition and continuity are important for habitat suitability for the hazel dormouse and identifying historical hedgerow systems and historical woodlands can help to find places with hitherto unknown presence of hazel dormouse. Apparently, for the hazel dormouse the lack of forest habitats in north-western Europe was successfully compensated by the creation of a hedgerow network. Hedgerows function as a habitat by themselves, not just as a connecting structure. A density of 50 m continuous high quality and well-connected hedgerows per hectare seems to be a minimum for the survival of hazel dormice in northwest European landscapes. The preservation of ancient habitats and the restoration of new habitats as core habitats and connections is a key strategy to facilitate the long-term survival and re-colonisation of species.

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Human CD46, CD55 and CD59 expression influence on swine transgenic fetal fibroblasts’ survivability in the presence of human complement components

Abstract

Mechanisms regulating the activity of the complement system responsible for the rejection of transplant organs are balanced so that the attack is instantaneous but is restricted to the infected cells of the organism. The most important components regulating its activity comprise CD55 and CD46 factors as well as the CD59 anchored in the cell membrane. Hyperacute response of the immunological system appears to be the key in the xenotransplant rejection and the elaboration of methods preventing its occurrence will give a real chance for the development of xenotransplantation.

Gene constructs containing coding sequences of human CD46, CD55 and CD59 were prepared and used to transfect porcine fetal fibroblasts. Stable lines were molecularly characterized for an integration of transgenes by PCR. Lines with a stable integration of transgenes were subjected to further characterization of expression by RT-PCR and vitality test. Molecular characteristics of the transgenic cell lines obtained revealed a steadfast integration and, in the majority of cases, expression of the introduced transgenes. The performed cytotoxicity analysis demonstrated that transgenic lines were characterised by a higher survivability rate than non-transgenic cells in the presence of human serum which proved their protective influence in relation to the activity of the complement system.

Open access
Absent Pulmonary Valve Syndrome – Special Prenatal Care and Early Surgery in Obstetric/Cardiac Center - A New Hope for Postnatal Survivors?

Abstract

Introduction: APVS (Absent Pulmonary Valve Syndrome) is a rare congenital heart disease. Its incidence according to The Polish National Registry of Fetal Cardiac Pathology in years 2004 - 2016 was 0.6%.This disease is caused by the absence or the residual pulmonary artery valve resulting in significant dilation of the pulmonary trunk and its branches. In utero deaths are reported. After birth the major problem is respiratory failure and high preoperative and postoperative mortality. Material and methods: In 1995 to 2016, 11 fetuses with APVS were diagnosed in our unit, at the average 27,5 weeks of gestation (min. 18.5- max 37.1 weeks of gestation). Two groups were analysed in this series of cases: “Old one” by 2011 (n = 6) and “New one” since 2011 (n = 5) and perinatal care as well as survival were compared. We analysed the fetal echo results, perinatal care including transplacental digoxin and steroids treatment in NEW group, the longevity of the pregnancy and neonatal/infants outcome. Results: In Old group the average day of cardiac surgery was day 91st after birth (max. 161) and the survival was 50% . In the New group the average surgery day was 41st day and the postoperative survival was 60%, however there was no statistical significance ( p > 0,05). Conclusions: There is no single parameter from prenatal life in foetuses with APVS which may allow to predict the positive outcome meaning neonatal survival. However optimal perinatal care (early detection of defect, transplacental digoxin at least 3-4 weeks, steroids, no preterm delivery, on-time delivery, postnatal care in tertiary center) and relatively early cardiac surgery may have combined impact on the improvement of survival after prenatal diagnosis of APVS, however more data are necessary to prove this hypothesis.

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Sympathectomized tumor-bearing mice survive longer but develop bigger melanomas

Abstract

Objectives. Previously we have shown that 20 days after the tumor cells injection smaller melanomas have been developed in chemically sympathectomized mice in comparison with animals having intact sympathetic nervous system. However, it is known that chemical sympathectomy reduces the sympathetic neurotransmission only temporarily. In the present study, we monitored the survival of the sympathectomized mice with melanoma with an attempt to find out how long the suppressing effect of sympathectomy on the melanoma growth may endure.

Methods. The chemical sympathectomy was performed by intraperitoneal injection of neurotoxin 6-hydroxydopamine in male C57BL/6J mice. Seven days later, the animals were injected subcutaneously with B16-F10 melanoma cells. Then, melanoma development, survival of the tumor-bearing mice and weight of the developed tumor mass were analyzed.

Results. Sympathectomy delayed the development of the palpable tumors (18th day vs.14th day) and significantly prolonged the survival of the tumor-bearing mice (median 34 days vs. 29 days). However, the weight of the developed melanoma was significantly increased in the sympathectomized mice in comparison with the animals having intact sympathetic nervous system.

Conclusions. The data of the present study showed that effect of the chemical sympathectomy, performed before the tumor growth induction, persisted even at the time when sympathetic nerves started to regenerate that resulted in a prolonged survival of the mice with melanoma. However, comparing to our previous study, in which we have shown a reduced tumor mass in earlier stages of the tumor growth, specifically 20 days after melanoma cells injection, now we indicate that in later stages of the melanoma progression, the tumor mass was significantly increased in sympathectomized animals. These contra-intuitive findings may indicate that interventions affecting the sympathetic nervous system may exert complex effect on the tumor progression. Based on these data we may suggest that the potential therapeutic interventions affecting the sympathetic signaling in the tumor tissue and its microenvironment should attenuate the sympathetic neurotransmission not only temporarily but till the complete regression of the tumor tissue.

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Will Xerothermic Grasslands of the Ponidzie Region Survive?

Abstract

Xerothermic grasslands are veritable botanical gems of the Ponidzie region, located in the upland zone of Poland. Most of these exceptional plant communities have been formed as a result of deforestation, in habitats characterized by specific climatic, hydrological and soil conditions. The result of the natural reserve protection of the xerothermic grassland, however, is opposite to the desired result. The survival of the xerothermic grassland depends on the change in the approach to their protection. Xerothermic grasslands are an excellent example of the difficulties with maintaining very valuable, but semi-natural and anthropogenic communities, related to a large extent to traditional, extensive forms of agriculture. Similar problems occur in the case of gladiolus meadows in lower subalpine forest zones or of once-mown molinion meadows in river valleys.

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New classifications of prenatally diagnosed congenital heart defects and their influence of neonatal survivability

Abstract

Attempts to adapt the classifications of pediatric congenital heart defects (CHD) to prenatal cardiology have been lasting for many years. The paediatric cardiology CHD classifications are mainly based on anatomic details and/or pulmonary blood flow and are not always useful in fetal medicine. Because of these reasons and also many more, adaptation attempts of congenital heart defects of children, from pediatric to prenatal cardiology have not brought desired effects.Clinical course in utero and at delivery can now be predicted, and as a consequence, fetal medicine specialists are being asked to consider the fetus as a patient and the transition to postnatal life is an important part of care. The new prenatal classifications of CHD shows new particular group of CHD, requiring emergent procedure after birth. Thanks to organizing special delivery room with special team of specialist we can much more improve the outcome, especially in severest CHD.

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