Training charter in epilepsy surgery added competence

The present Training Charter in Epilepsy Surgery Added Competence constitutes the third stage of a program initiated by the European Society for Stereotactic and Functional Neurosurgery (ESSFN) and substantiated in close collaboration with the Union Européennedes Médecins Spécialists (UEMS) and the European Association of Neurosurgical Societies (EANS). This program aims to raise the standards of clinical practice by guiding education and quality control concepts. The particular sections of this Charter include: definitions and standards of added competence training, relations of the Epilepsy Unit with the Neurosurgical Department, duration of epilepsy surgery fellowship, institution and training program director requirements, operative totals for epilepsy surgery, educational program, individual requirements, and evaluation and qualification of the trainees. The specification of all these requirements is expected to improve harmonisation and quality of epilepsy surgery practice across Europe, and enhance the clinical activity and the scientific productivity of existing neurosurgical centres.     

Cytokine response to diabetic ketoacidosis (DKA) in children with type 1 diabetes (T1DM)

It has been suggested that cytokine release during DKA may result in capillary perturbation and thus may contribute to the development of its acute clinical complications (i.e.cerebral or pulmonary edema). We studied in 38 newly diagnosed T1DM children with DKA, aged 7.68±3.07 years, plasma levels of cytokines IL-1β (interleukin-1β), IL-2, IL-6, IL-8, IL-10, TNF-α (tumour necrosis factor-α) and also WBC (white blood cell count), hs-CRP (high sensitivity C-reactive protein), GH (growth hormone) and cortisol, prior to, during and 120h after DKA management, with the aim to monitor their levels at different time-points and in different degrees of DKA severity. Prior to DKA management the levels of IL-6, IL-8, IL-10, WBC and cortisol were elevated, but were all reduced within 120 h after DKA management. Then the patients were divided into two groups: a. moderate/severe: pH≤7.2, b. mild DKA: pH>7.2. In the group with moderate/severe DKA (ph≤7.2), IL-10 levels were the highest of all cytokines, but were significantly decreased after 6h (91.76 vs 18.04 pg/mL, p=0.008), with no further change, while IL-6 levels were decreased at 120 h (28.32 vs 11.9 pg/mL, p=0.003). The above were not observed in the group with mild DKA. In conclusion, in the children with DKA of our study, in the group with moderate/severe DKA the IL-10 levels were prematurely reduced at 6 hours, while the IL-6 levels remained high and were reduced at 120 hours after the DKA management. These changes may be responsible for increased capillary perturbation, which could lead to the subsequent development of acute DKA complications.     

Surgical management of rectal prolapse

Purpose

Rectal prolapse is uncommon; however, the true incidence is unknown because of underreporting, especially in the elderly population. Full-thickness rectal prolapse, mucosal prolapse and internal prolapse are three different clinical entities, which are often combined and constitute rectal prolapse. The aim of the study is to present our experience in the surgical management of rectal prolapse.

Methods

In a 6-year period (2004–2010), 27 patients were surgically treated for rectal prolapse. The majority of patients were women (25 women, two men) and their mean age was 72.36 years. The operations performed were two Delorme’s procedures, five STARR (Stapled TransAnal Rectal Resection), 14 Wells procedures, two Wells combined with Thiersch, one Altemeier, one sigmoid resection combined with Wells and two Thiersch.

Results

An emergency sigmoidostomy was performed on a patient after Wells operation due to obstructive ileus. One death occurred on the 5th postoperative day due to pulmonary embolism. Two recurrences observed 8 months postoperatively, one in a patient after STARR operation and one in a patient after Thiersch technique. The great majority of patients are completely relieved of symptoms.

Conclusions

The application of different modalities in the treatment of rectal prolapse is attributed to the fact that cause, degree of prolapse and symptoms, vary from one patient to another. Successful approach depends on many factors, including the status of a patient’s anal sphincter muscle before surgery, whether the prolapse is internal or external and the overall condition of the patient.

     

Serum paraoxonase/arylesterase activities in phenylketonuric patients on diet

AIM: To compare serum paraoxonase/arylesterase (PON-aryl) activities in phenylketonuric (PKU) patients with high and low phenylalanine (Phe) blood concentration. PATIENTS AND METHODS: Seventeen poorly controlled PKU children (off diet) underwent clinical and laboratory examinations before and after 30 days adhering to their special diet (on diet), whereas controls (N=24) were examined once. Lipid, lipoprotein levels and paraoxonase (PON 1) activities were measured with the Bayer Advia 1650 Clinical Chemistry System. Apolipoprotein AI (Apo AI) levels were determined by the Dade Behring BN ProSpec nephelometer, whereas total antioxidant capacity (TAC), PON-aryl and Phe levels were measured spectrophotometrically. RESULTS: Phe significantly differed among the groups. Lipids and lipoproteins, except high-density-lipoprotein-cholesterol (HDL-C) and Apo AI, were higher when off diet than those on diet. HDL-C and Apo AI were similar in patients and controls. TAC (0.99+/-0.19 mmol/l) was significantly lower when the patients were off diet than when they adhered to diet and controls (1.71+/-0.20 and 1.81+/-0.20 mmol/l P<0.001 respectively). PON 1 and PON-aryl activities (68+/-2 U/min/ml, 88+/-26 KU (min/ml) in children with high Phe were reduced as compared with those with low blood Phe levels (152+/-41 U/min/ml, 107+/-23 KU/min/ml P<0.001) and controls (146+/-43 U/min/ml, 109+/-41 KU/min/ml P<0.001). The enzyme activities positively correlated with HDL-C and Apo AI when PKU patients were on diet and controls as well as with TAC in all the groups, whereas negatively correlated with Phe levels. CONCLUSIONS: PON-aryl activities are strongly related to the dietary control of PKU patients.     

The effect of diet on Paraoxonase 1/Arylesterase activities in patients with disorders of galactose metabolism

OBJECTIVE: To investigate the effects of diet on the antiatherogenic enzyme Paraoxonase 1/Arylesterase (PON1/Aryl) activities in patients with disorders of galactose metabolism. PATIENTS AND METHODS: Eleven poorly dietary controlled children with classical galactosaemia (GALT deficiency), 7 with epimerase deficiency and 12 with duarte 1 variant 'off diet' underwent clinical and laboratory investigations before and after 10 days on galactose restricted diet whereas controls (N = 20) were examined once. Serum lipids, lipoproteins and apolipoprotein A1 (ApoA1) were measured with routine methods, PON1/Aryl activities and total antioxidant status (TAS) spectrophotometrically, and galactose-1-phosphate (Gal-1-P) enzymatically. RESULTS: Lipids, lipoproteins, ApoA1, PON1/Aryl, TAS remained unaltered in all groups, except in those with classical galactosaemia pre- versus postdiet. In patients with classical galactosaemia, TAS, PON1, Aryl (0.98 +/- 0.2 mmol/l, 60 +/- 12 U/min/ml, 56 +/- 16 KU/min/ml, respectively) were significantly reduced prediet as compared with those postdiet (1.63 +/- 0.2 mmol/l, 136 +/- 15 U/min/ml, 112 +/- 18 KU/min/ml, respectively; P < 0.001) and controls. The enzyme activities positively correlated with TAS (r = 0.56, P < 0.001) in all groups and negatively with Gal-1-P (r = -0.54, P < 0.001) in group with GALT deficiency. CONCLUSIONS: Low TAS and high Gal-1-P levels may reduce PON1/Aryl activities. Patients with classical galactosaemia, when on strict diet, may benefit with a generous antiatherogenic capacity.     

Renal involvement in paroxysmal nocturnal hemoglobinuria: an update on clinical features,pathophysiology and treatment

Objectives: The present review summarizes the available knowledge regarding acute and chronic kidney dysfunction in patients with paroxysmal nocturnal hemoglobinuria (PNH) focusing on its clinical features, pathophysiology and treatment.

Methods: A thorough PubMed search was performed using as main keywords: ‘paroxysmal nocturnal hemoglobinuria’, ‘acute kidney injury’, ‘chronic kidney disease’ and ‘eculizumab’.

Results: PNH’s etiopathogenesis is based on acquired mutations that lead to the reduction or absence of CD55 and CD59 complement regulators, which are responsible for some of the disease’s major clinical features, like intravascular hemolysis, cytopenias and thrombosis. PNH is often underdiagnosed, mainly due to its occasional mild manifestations and to its ability to mimic other severe clinical conditions. Various mechanisms have been proposed for the kidney damage attributed to the release of cell-free heme and free iron, including inflammatory response, oxidative stress, nitric oxide depletion, renal ischemia, membrane damage and apoptosis. Eculizumab, a terminal complement inhibitor, provides a safe and effective treatment option, especially when it is initiated early in the presence of kidney damage.

Discussion: Kidney injury is a poorly investigated clinical feature of PNH that affects a significant portion of patients. Increased awareness is needed by physicians to recognize the early signs and symptoms of acute and chronic renal insufficiency, so as to initiate the necessary therapy. It is also important to re-evaluation of PNH-specific treatments during the course of the disease.

Conclusion: Understanding the difficult but at the same time impressive mechanisms behind PNH remains a challenge for treating physicians.     

Dental pulp stem cells in chitosan/gelatin scaffolds for enhanced orofacial bone regeneration

Objective

Biomimetic chitosan/gelatin (CS/Gel) scaffolds have attracted great interest in tissue engineering of several tissues. However, limited information exists regarding the potential of combining CS/Gel scaffolds with oral cells, such as dental pulp stem cells (DPSCs), to produce customized constructs targeting alveolar/orofacial bone reconstruction, which has been the aim of the present study.

Circulating levels of adhesion molecules and markers of endothelial activation in acute inflammation induced by prolonged brisk exercise

OBJECTIVES: To investigate circulating levels of adhesion molecules and markers of endothelial activation in acute inflammation induced by prolonged brisk exercise. DESIGN AND METHODS: The circulating levels of adhesion molecules E-, L- and P-selectins, intercellular and vascular adhesion molecule-1 (ICAM-1 and VCAM-1), along with those of thrombomodulin (TM), N-terminal pro-brain natriuretic peptide (NT-pro-BNP) and cardiac troponin T, were measured before, at the end of and at 48 h post-race, in athletes participating in this extreme physical stress paradigm. RESULTS: Levels of L- and P-selectins remained the same before and at the end of the "Spartathlon" race, presenting a similar decline at 48 h post-race. E-Selectin, ICAM-1 and TM reached a maximum value at the end of the race and returned to normal 48 h after the race. A similar profile was observed for VCAM-1 and NT-pro-BNP, with a tendency for a decrease at 48 h post-race, while troponin T was not detected. CONCLUSIONS: The indices of endothelial activation are strongly affected during "Spartathlon" race, suggesting that, although prolonged brisk exercise activates the endothelium, it rapidly recovers.     

Low versus high volume of culture medium during embryo transfer: a randomized clinical trial

Purpose

The aim of this prospective randomized control trial was to evaluate if the use of two different volumes (20–25 vs 40–45 μl) of media used for embryo transfer affects the clinical outcomes in fresh in vitro fertilization (IVF) cycles.

Methods

In total, 236 patients were randomized in two groups, i.e., “low volume” group (n?=?118) transferring the embryos with 20–25 μl of medium and “high volume” group (n?=?118) transferring the embryos with 40–45 μl of medium. The clinical pregnancy, implantation, and ongoing pregnancy rates were compared between the two groups.

Results

No statistically significant differences were observed in clinical pregnancy (46.8 vs 54.3%, p?=?0.27), implantation (23.7 vs 27.8%, p?=?0.30), and ongoing pregnancy (33.3 vs 40.0%, p?=?0.31) rates between low and high volume group, respectively.

Conclusion

Higher volume of culture medium to load the embryo into the catheter during embryo transfer does not influence the clinical outcome in fresh IVF cycles.Trial registration number: NCT03350646