The main cellular source of reactive oxygen species (ROS) is mitochondrial respiratory chain and active NADPH responsible for "respiratory burst" of phagocytes. Whatsmore ROS are produced in endoplasmic reticulum, peroxisomes, with the participation of xanthine and endothelial oxidase and during autoxidation process of small molecules. Mitochondrial respiratory chain is the main cellular source of ROS. It is considered that in aerobic organisms ROS are mainly formed during normal oxygen metabolism, as byproducts of oxidative phosphorylation, during the synthesis of ATP. The intermembranous phagocyte enzyme - activated NADPH oxidase, responsible for the "respiratory burst" of phagocytes, which is another source of ROS, plays an important role in defense of organism against infections. The aim of this article is to resume actuall knowledge about structure and function of the mitochondrial electron transport chain in which ROS are the byproducts and about NADPH oxidase as well as the function of each of its components in the "respiratory burst" of phagocytes.

In autoimmune inflammatory diseases, including juvenile idiopathic arthritis (JIA), which leads to joint destruction, there is an imbalance between production of reactive oxygen species (ROS) and their neutralization which, as a consequence, leads to “oxidative stress.” The aim of the study was to assess the concentration of oxidative stress markers: nitric oxide (NO), a degree of lipid membrane damage, and total antioxidant plasma capacity in children with JIA. Thirty-four children with JIA were included into the study. A degree of lipid membrane damage (lipid peroxidation products) was estimated as thiobarbituric acid-reactive substances (TBARs), NO concentration as NO end-products: nitrite/nitrate (NO2−/NO3−) and total antioxidant plasma capacity as ferric reducing ability of plasma (FRAP). NO2−/NO3− serum concentration in children with JIA was statistically significantly higher than that in healthy children (p = 0.00069). There was no significant difference in TBAR levels between children with JIA and the control group. FRAP in sera of children with JIA was lower than that in healthy children, but the difference was not statistically significant. A statistically significant positive correlation was observed between NO end products and the 27-joint juvenile arthritis disease activity score (JADAS-27) and ESR, and a negative correlation was observed between FRAP and C-reactive protein (CRP) and white blood cell count (WBC). Our results confirm the increased oxidative stress in children with JIA. Overproduction of NO and decrease in the antioxidant plasma capacity may be involved in JIA pathogenesis.

Objective.The aim of the study was to investigate whether determination of anticitrullinated protein antibodies (ACPA) provides predictive information on severity of disease course and joint destruction in children with juvenile idiopathic arthritis (JIA).Methods.Sera from 74 children with JIA were examined for ACPA using the ELISA test. To assess joint destruction, plain radiographs of both hands were scored twice according to the Steinbrocker scale: at the beginning of observation and after 8.9 to 15.2 months (median 11.5 months) of the followup. Correlations between ACPA serum levels and the disease characteristics (type of JIA onset, disease activity, disease duration, radiological status) were investigated.Results.Twenty-six out of 74 examined children with JIA (35.0%) were ACPA-positive [> 5 relative units (RU)/ml]. ACPA were present in all types of JIA onset, including 36.6% of children with early stage JIA (disease duration < 6 months). All of the IgM-rheumatoid factor (RF)-positive children with polyarticular type of JIA onset were simultaneously positive for ACPA. ACPA levels correlated positively with disease activity at the beginning of the study (rho = 0.7196; p < 0.0001) and after followup (rho = 0.2485; p = 0.0486). Disease duration did not significantly affect ACPA serum levels. ACPA levels correlated positively with radiological joint destruction in children with JIA, both at the beginning of the study (rho = 0.4599; p = 0.0004) and after the followup period (rho = 0.5523; p < 0.0001).Conclusion.ACPA were superior to IgM-RF in diagnosing JIA and provided predictive information on severity of disease course and radiological outcome.

IntroductionResection of manubrium or body of the sternum is associated with a necessity of chest wall reconstruction. Large sternal defects require the use of different types of implants to ensure acceptable esthetic effect for the patient and chest stabilization.AimThe purpose of this case report is to present a novel method of reconstruction of manubrium removed due to renal cancer metastasis to the sternum.CaseWe present the case of a patient, who had underwent right nephrectomy for clear cell kidney cancer, diagnosed with a metastatic tumor in the sternum resulting in destruction of manubrium. The patient undergone tumor resection with primary reconstruction with an individual prosthesis. Sternal defect was filled with a personalized, computed tomography scan-based 3D-milled implant made of polyethylene.ResultsSternal reconstruction was uneventful. The patient endured surgery well, and has been under surveillance in outpatient clinic, without any respiration disorders, implant movement or local recurrence.ConclusionCustom-designed sternal implants created by 3D technique constitute an interesting alternative for previous methods of filling defects after resection of a tumor in this location.

Background: One of serious problems in the management of health care units is rational management of financial resources allocated by the government for health care. This management is significantly influenced by the valuation tariff of health care services, including surgical procedures. The assessment of the costeffectiveness of a particular service has a key role in the selection of procedures performed in a given health care unit. The aim of the study is to assess the costs of lobectomy via thoracotomy and video-assisted thoracoscopic surgery (VATS) in terms of the impact on the overall hospitalization cost and the answer to the question whether differences in hospitalization costs depending on the access are large enough to justify different valuation tariffs for surgery via traditional and minimally invasive access. Methods: This is a retrospective analysis of data on the costs of treatment of patients who underwent lobectomy via traditional access or VATS due to non-small cell lung cancer. Data concerning valuation of the procedure and hospitalization were compared with general costs of hospital treatment of these patients. Results: The study has proven that duration of the procedure (VATS: 145 min, thoracotomy: 143 min) and total value of hospitalization costs depending on the type of access (VATS: €2,235, thoracotomy: €1,500) were similar-the differences did not show statistical significance (P=0.96 and 0.05118). In contrast, the average time of patient stay in the hospital after surgery and the average cost of surgery were significantly different (3.69 for VATS vs. 5.71 days for thoracotomy with P=0.0000084 and €1,705 for VATS and €682 for thoracotomy with P=0.0114). Conclusions: The total cost of patient hospitalization after lobectomy via VATS is similar to the cost of hospitalization after thoracotomy. Similar costs of both treatments with well-known benefits of VATS including shorter hospitalization and better quality of life of the patient speak in favor of a wider use of minimally invasive access with a good effect in the form of economical use of financial resources.