The position statement of the Working Group on the treatment of post-traumatic stress disorders in adults

Post-traumatic stress disorder (PTSD) is a mental distress that occurs after participation in traumatic event such as the experience of natural disaster, car accident, terrorist attack or armed conflict, being a victim of sexual assault, tortured, physically abused, traumatized or being in any other life-threatening situation. The trauma victim does not always have to be in the position of the o directly threatened with physical harm. The disorder may be developed also as a result of an acute reaction to stress caused by participation in situation in which another person suffer so unimaginable that the further normal life of witness becomes impossible. Patients are often convinced that they lose previous ability to exist irretrievably. Globally PTSD is an increasingly recognized disorder. It can be predicted that in Europe, due to the ongoing war in Ukraine and the migration crisis, the frequency of severe disorders related to traumatic stress will systematically increase. In recent years, there has been a significant progress in knowledge and the development of methods for counteracting PTSD. The empirically confirmed forms of treatment include psychotherapeutic and pharmacotherapeutic interactions. The presented recommendations were developed by a team of experts in the field of psychiatry, clinical psychology, psychotherapy and primary care in order to proposed guidelines for therapeutic procedures in medical and psychological practice. The position statement of the working group have been developed in line with evidence-based practice as a part of three-stage procedure including: literature review, the issue discussion and development of the unified expert position.

The position statement of the Working Group on the diagnosis of the post-traumatic stress disorders in adults

Experiencing a situation of extreme danger can lead to serious stress disorders (such as PTSD) that can affect both the victims and the professional helpers. Military operations in Ukraine in the first half of 2022 started an ongoing migration crisis, resulting in the displacement of approximately 3.5 million people to Poland. It is indicated that post-traumatic stress disorders may affect up to one third of adult refugees. Exposure to traumatic stress related to assault, limitation of basic resources, fear, insecurity, death, and a sense of injustice affected the entire population of the country. As a result, refugees, healthcare professionals, uniformed services, volunteers, and NGO workers constitute a group at risk of developing stress-related disorders, including post-traumatic stress disorder (PTSD). The presented recommendations were developed by an interdisciplinary team of experts in the field of psychiatry, clinical psychology, psychotherapy, and family medicine to present systematic guidelines for diagnostic procedures in medical and psychological practice.

Anthropogenic radionuclides in Antarctic biota - dosimetrical considerations

The article presents results of the research on artificial radionuclides (¹³⁷Cs, ⁹⁰Sr, ²⁴¹Am) in the Antarctic environment. Samples of 12 species from the marine environment: Pygoscelis adeliae, Pygoscelis papua, Macronectes giganteus, Pagodroma nivea, Catharacta antarctica, Leptonychotes weddellii, Mirounga leonina, Harpagifer antarcticus, Chaenocephalus aceratus, Nacella concinna, Himantothallus grandifolius, Iridaea cordata (bones, feathers, soft tissues, eggs' shells of birds, bones, skin, fur of mammals, fish, mollusks' soft tissues and shells, algae) and samples of 4 species from the terrestrial environment: Sanionia uncinata, Usnea antarctica, Usnea aurantiaco-atra, Deschampsia antarctica (mosses, lichens, grass) were investigated. Differences in the accumulation of ¹³⁷Cs between marine and terrestrial ecosystem were shown, which are mostly due to conservatism of mosses and lichens and active removal of cesium by animal body. Furthermore discrepancy between mosses and lichens in the radioceasium accumulation was statistically proven with the additional use of Neutron Activation Analysis. Moreover, the internal weighted dose rates assessment was prepared using the ERICA Tool. The dose rates were relatively low, not exceeding several dozen nGy/h. Nonetheless, one species - Pagodroma nivea, was significantly outstanding due to the highest weighted dose rate it is burdened with.

18β-Glycyrrhetinic acid: its core biological properties and dermatological applications

Recently, attention has been focused on identifying natural herbal compounds with high biological activity, especially antioxidative, anti-inflammatory and antimicrobial properties, for preventing and controlling various skin conditions, including inflammation-related diseases such as atopic dermatitis and UV-induced skin photoaging. One key active plant ingredient is 18β-glycyrrhetinic acid (GA), the main metabolite of glycyrrhizin (GL), obtained from licorice root. The review examines the valuable biological properties of GA, particularly those playing key roles in the treatment of various dermatological disorders in humans. The review highlights the key anti-inflammatory, antioxidant and antimicrobial properties of GA and its toxicity towards normal cells lines. It also examines the physicochemical properties of GA and presents methods of increasing its penetration through the stratum corneum and bioaccumulation with the use of modern delivery systems such as liposomes and nanoemulsions.

Measurement of 131I activity in air indoor Polish nuclear medical hospital as a tool for an internal dose assessment

This paper presents results of 131I air activity measurements performed within nuclear medical hospitals as a tool for internal dose assessment. The study was conducted at a place of preparation and administration of 131I ("hot room") and at a nurse station. 131I activity measurements were performed for 5 and 4 consecutive working days, at the "hot room" and nurse station, respectively. Iodine from the air was collected by a mobile HVS-30 aerosol sampler combined with a gas sampler. Both the gaseous and aerosol fractions were measurement. The activities in the gaseous fraction ranged from (28 ± 1 Bq m-3) to (492 ± 4) Bq m-3. At both sampling sites, the activity of the gaseous iodine fraction trapped on activated charcoal was significantly higher than that of the aerosol fraction captured on Petrianov filter cloth. Based on these results, an attempt has been made to estimate annual inhalation effective doses, which were found to range from 0.47 mSv (nurse female) to 1.3 mSv (technician male). The highest annual inhalation equivalent doses have been found for thyroid as 32, 27, 13, and 11 mSv, respectively, for technician male, technical female, nurse male, and nurse female. The method presented here allows to fill the gaps in internal doses measurements. Moreover, because method has been successful used for many years in radioactive contamination monitoring of air in cases of serious nuclear accidents, it should also be used in nuclear medicine.

Survival of 86,690 patients with thyroid cancer: A population-based study in 29 European countries from EUROCARE-5

BACKGROUND

Incidence rates of thyroid cancer (TC) increased in several countries during the last 30 years, while mortality rates remained unchanged, raising important questions for treatment and follow-up of TC patients. This study updates population-based estimates of relative survival (RS) after TC diagnosis in Europe by sex, country, age, period and histology.

METHODS

Data from 87 cancer registries in 29 countries were extracted from the EUROCARE-5 dataset. One- and 5-year RS were estimated using the cohort approach for 86,690 adult TC patients diagnosed in 2000-2007 and followed-up to 12/31/2008. RS trends in 1999-2007 and 10-year RS in 2005-2007 were estimated using the period approach.

RESULTS

In Europe 2000-2007, 5-year RS after TC was 88% in women and 81% in men. Survival rates varied by country and were strongly correlated (Pearson ρ = 75%) with country-specific incidence rates. Five-year RS decreased with age (in women from >95% at age 15-54 to 57% at age 75+), from 98% in women and 94% in men with papillary TC to 14% in women and 12% in men with anaplastic TC. Proportion of papillary TC varied by country and increased over time, while survival rates were similar across areas and periods. In 1999-2007, 5-year RS increased by five percentage points for all TCs but only by two for papillary and by four for follicular TC. Ten-year RS in 2005-2007 was 89% in women and 79% in men.

CONCLUSIONS

The reported increasing TC survival trend and differences by area are mainly explained by the varying histological case-mix of cases.

Measurement of 131I activity in thyroid of nuclear medical staff and internal dose assessment in a Polish nuclear medical hospital

This paper presents results of 131I thyroid activity measurements in 30 members of the nuclear medicine personnel of the Department of Endocrinology and Nuclear Medicine Holy Cross Cancer Centre in Kielce, Poland. A whole-body spectrometer equipped with two semiconductor gamma radiation detectors served as the basic research instrument. In ten out of 30 examined staff members, the determined 131I activity was found to be above the detection limit (DL = 5 Bq of 131I in the thyroid). The measured activities ranged from (5 ± 2) Bq to (217 ± 56) Bq. The highest activities in thyroids were detected for technical and cleaning personnel, whereas the lowest values were recorded for medical doctors. Having measured the activities, an attempt has been made to estimate the corresponding annual effective doses, which were found to range from 0.02 to 0.8 mSv. The highest annual equivalent doses have been found for thyroid, ranging from 0.4 to 15.4 mSv, detected for a cleaner and a technician, respectively. The maximum estimated effective dose corresponds to 32% of the annual background dose in Poland, and to circa 4% of the annual limit for the effective dose due to occupational exposure of 20 mSv per year, which is in compliance with the value recommended by the International Commission on Radiological Protection.

The beneficial effect of insulin degludec on nocturnal hypoglycaemia and insulin dose in type 1 diabetic patients: a systematic review and meta-analysis of randomised trials

AIMS

Insulin degludec is a new-generation ultra-long-acting basal insulin which offers a significantly more predictable glucose-lowering effect than other long-acting insulin analogues. The aim of this study was to compare the effect of treatment with insulin degludec and long-acting insulin analogues glargine and detemir in type 1 diabetic (T1D) patients by means of a systematic review and meta-analysis.

METHODS

The following electronic databases were searched up to January 2014: MEDLINE, EMBASE and The Cochrane Library. Additional references were obtained from the reviewed articles. There were included randomised controlled trials of at least 12-week duration with basal-bolus regimen therapies in T1D patients.

RESULTS

Current analysis included four studies involving 1,846 T1D patients. The combined data from all trials showed a statistically significant reduction in the basal insulin dose (MD -0.042, 95 % CI -0.067 to -0.018, p = 0.001) and the total daily insulin dose (MD -0.072, 95 % CI 0.016 to -0.027, p = 0.002) in the degludec group compared to other long-acting analogues. There was also a significant reduction of nocturnal hypoglycaemia in the degludec group compared to the controls (rate ratio 0.697, 95 % CI 0.617-0.786, p = 0.000). There were no differences between the groups in terms of glycated haemoglobin values, fasting plasma glucose (FPG) and adverse events.

CONCLUSIONS

Basal-bolus treatment with insulin degludec was superior to long-acting insulin analogues detemir and glargine in reducing the rate of nocturnal hypoglycaemia. In comparison with other long-acting analogues, treatment with insulin degludec was safe and patients obtained similar metabolic control expressed by HbA1c and FPG levels with the added benefit of a reduced basal and total insulin dose.

Synthesis of novel halo and tosyloxy nortropane derivatives as efficient precursors for the one-step synthesis of the dopamine transporter PET ligand [(18)F]FECNT

The fluorine-18 labeled nortropane derivative 2β-carbomethoxy-3β-(4-chlorophenyl)-8-(2-fluoroethyl)-nortropane (FECNT) is a dopamine transporter (DAT) ligand. Currently, it is considered as reference for positron emission tomography imaging. Herein, the synthesis of novel precursors (N-tosyloxy-, chloro-, and bromo- analogues) for one-step radiosynthesis of [(18)F]FECNT is reported. Using the N-mesyloxy- precursor in a one-step radiosynthesis, the crude [(18)F]FECNT was obtained with the radiolabeling yield of 45 ± 10%, confirming the practical efficiency of this approach in the design of novel precursors for labeling.

Circulating CXCL9 and CXCL10 as markers of activity of Graves' orbitopathy during treatment with corticosteroids and teleradiotherapy

The aim of the study was to assess the usefulness of circulating chemokines CXCL9 and CXCL10 measurements as surrogate markers of GO activity and as a guideline in therapeutic decision-making. Forty-two individuals were divided into 4 groups: 1. 15 euthyroid patients with clinical symptoms of orbitopathy (GO) who underwent corticosteroid therapy consisting of intravenous infusions of methylprednisolone (MP) and teleradiotherapy (TR); 2. 10 patients with hyperthyroid GD (Gtx); 3. 10 patients with GD in euthyreosis (Geu); and 4. 7 healthy volunteers age and sex-matched to groups 1-3. The serum samples were collected 24 h before MP, 24 h after first dose of MP, before TR and at the end of therapy. Serum CXCL9 and CXCL10 were determined by ELISA and TSH-Rab by RIA. There were significant reductions in CXCL9 and CXCL10 serum concentrations during CS and TR treatment as compared both to control group and to basal values in GO patients. Moreover, CXCL9 concentration was significantly diminished in comparison to controls in GO patients who were identified later as corticosteroid-respondent (p<0.001). In this latter group of patients, CXCL9 was also found to be significantly reduced 24 h after first dose of MP as compared to non-respondents (p<0.02). The high-degree positive correlation between CXCL9 and CXCL10 was found (R=0.8; p<0.001). Our results suggest that the increased concentrations of CXCL9 (and CXCL10), at least in part, reflect the activity of orbital inflammation and therefore these chemokines could serve as a guideline in therapeutic decision-making in patients with Graves' orbitopathy.

Alexithymia and pain experience in depressive patients

Introduction

Alexithymia appears as an inhibition of recognizing and describing the mental conditions. It is often connected with psychosomatic illness or depression.

Aims

The aim of this study was to compare depressive patients with healthy persons in terms of the prevelence and level of the alexithymia and pain feeling.

Methods

The examined group (E) consists of 16 patients with diagnosed depression (11 women, 44,6±11,6 year old).The control group (C) consists of 14 randomly chosen persons (10 women, 40,0+/-15,3 year old) who achieved < 11 points in the Beck's Depression Inventory (BDI).The alexithymia level was examined with TAS - 26 questionnaire (difficulty of recognizing the feelings and somatic senses (ODR), concrete thinking (MK), difficulty of expressing the feelings (TRW) and the lack of imagination (U)). The intensity of pain was examined with the questionnaire SF-MPQ. The scale BPCQ was used to examine beliefs about pain control.

Results

No statistical differences about age, sex, the U feature in TAS-26 scale and the results of BPCQ test were shown. The differences beetween groups E and C appeared in the alexithymia intensity range (75,3 ± 14,4 v.62,4 ± 8,2pts, p = 007), the ODR feature (23,7 ± 6,7 v. 13,0 ± 4,1pts, p< 0,001), MK (18,9 ± 4 v.23,1 ± 5,3pts, p = 0,036) and TRW (13,4 ± 2,6 v. 9,6 ± 2,8pts, p = 0,001). The E group featured significantly higher pain intensity(p = 0,012).

Conclusions

The patients with depression suffer from alexithymia very often. The prevalence of upper difficulties and great intensity of pain could suggest a psychotomatic component of pain affections.

Induction of senescence in MYCN amplified neuroblastoma cell lines by hydroxyurea

Recently, it was shown that MYCN amplified cells spontaneously expulse extrachromosomally amplified gene copies by micronuclei formation. Furthermore, it was shown that these cells lose their malignant phenotype and start to age. We tested whether it is possible to encourage neuroblastoma tumor cells to enter the senescence pathway by low concentrations of the micronuclei-inducing drug hydroxyurea (HU). We studied the effect of HU on 12 neuroblastoma cell lines with extra- or intrachromosomally amplified MYCN copies and without amplification. Two extrachromosomally amplified neuroblastoma cell lines (with double minutes) were investigated in detail. Already after 3 weeks of HU treatment, the BrdU uptake dropped to 25% of the starting cells. After 4 weeks, enlarged and flattened cells (F-cells) and increased granularity in the majority of cells were observed. A drastic reduction of the MYCN copy number-down to one copy per cell-associated with CD44 and MHCI upregulation in up to 100% of the HU treated neuroblastoma cells was found after 5-8 weeks. Telomere length was reduced to half the length within 8 weeks of HU treatment, and telomerase activity was not detectable at this time, while being strongly expressed at the beginning. All these features and the expression of senescence-associated-beta-galactosidase (SA-beta-GAL) in up to 100% of the cells support the hypothesis that these cells entered the senescence pathway. Thus, low-dose HU is a potent senescence elicitor for tumor cells with gene amplification, possibly representing an attractive additional strategy for treatment of this subset of tumors.

Urinary incontinence in women as a health and social problem

PURPOSE

Urinary incontinence is a disease due to which women have suffered for many centuries. But there is some optimistic side to the problem, too; such illnesses can be treated and prevented. The aim of the work was to evaluate the frequency of occurring such cases among women and to evaluate the chosen risk factors influencing this illness.

MATERIAL AND METHODS

Results of studies carried through on 160 women in 2000 and 2001 at the 2nd Gynaecological Medical University of Lódź were presented here.

RESULTS

A high frequency of urinary incontinence among the tested group was found. Almost every five respondent claimed to hale had symptoms that would prove this illness.

CONCLUSIONS

Risk factors of occurrence of urinary incontinence among the patients were: birthweight over 4000 g, gynaecological or urological operations, big body mass and physical work were significant.

The prevalence of tobacco smoking among public health students at Medical University of Białystok

The rate of cigarettes' consumption in the world is regularly decreasing, although it remains high. In spite of the fashion for non-smoking, younger and younger people start to smoke. It is important that health related major students' behaviour is a social example. The aim of this study was to determine the number of smokers among public health major students at Medical University of Białystok, and to present the influence of socio-demographic features of respondents on their behaviour related to smoking. The results showed that among the examined students the prevalence of smoking was high--almost one-third of respondents smoked. The prevalence of smoking was significantly higher in men than in women students.

Factors influencing the maintenance of nicotine abstinence among the habitants of the region of Lódź and Kalisz in the years 1996-2003

The aim of the study was to determine the factors allowing non-smoking for the next 2 years after a 5-year period of non-smoking. A questionnaire study was performed in October 2003 among 449 of men and women chosen from among 1700 contest' 'Quit & Win' Competition participants, which was ending in 1996 2nd International Antinicotine Campaign "Quit & Win" in Poland in the region of Lódź and Kalisz. Chosen people were respondents, who during studies conducted in the years 1998 and 2001 stated that they were not smoking at all since their participation in the contest. Filled-in questionnaires were sent back by 296 people (65.9%). The analysis showed that the surveyed with elementary education more rarely than people with other level of education could preserve in non-smoking habit for the next 2 years after a 5-year period of non-smoking. Further maintenance of nicotine abstinence was not dependent on: age, sex, the place of living, the marital status and the source of income.

Cell cycle and cell size regulation in Down syndrome cells

Although the neuropathological features typical for Down Syndrome obviously result from deregulation of both, cell cycle control and differentiation processes, so far research focused on the latter. Considering the known similarities between the neuropathology of Down Syndrome and Alzheimer's disease and the knowledge, that in Alzheimer's disease neuronal degeneration is associated with the activation of mitogenic signals and cell cycle activation, it is tempting to investigate the consequences of an additional chromosome 21 on mammalian cell cycle regulation. We analysed the distribution of cells in different cell cycle phases on the flowcytometer and the cell size of human amniotic fluid cells with normal karyotypes and with trisomy 21. We could not detect any significant differences suggesting that the presence of an additional copy of the about 225 genes on human chromosome 21 does not trigger cell cycle effects in amniotic fluid cells. These data provide new insights into the cell biology of trisomy 21 cells.

Iodine-induced hyperthyroidism--an epidemiological survey several years after institution of iodine prophylaxis in Poland

In 1997, the obligatory model of iodine prophylaxis was introduced in Poland in order to correct the existing status of mild and/or moderate iodine deficiency. In order to monitor possible side-effects of increased iodine supply, studies on iodine-induced hyperthyroidism were initiated by establishing several regional registers of hyperthyroidism. In the present paper, the results of a two-year monitoring (2000-2001) have been summarized. There are no epidemiological data on hyperthyroidism prior to starting the iodine prophylaxis, but the obtained current data are comparable to observations in other countries, made after iodine supplementation. The incidence of iodine-induced hyperthyroidism did not exceed the acceptable level, thus confirming--together with previous observations on the effectiveness of iodine prophylaxis--the adequacy of applied dose of KI (30 microg/kg NaCl), used for salt iodization in Poland.

[Clinical-pathomorphologic preparation of patients after surgical treatment of differentiated thyroid cancer to adjuvant treatment with 131I]

Thyroid cancer treatment includes: surgery, radioiodine therapy, thyroxine therapy and radiotherapy. Selection of treatment's strategy depends on histopathological evaluation, age of patient and iodine uptake. The aim of the analysis was to verify how the medical documentation of patients treated by surgical treatment was prepared. All patients were directed to the Department of Endocrinology, Holycross Cancer Center in Kielce. Analysis encompassed 33 patients classified to 131I therapy for the first time. In each case patient's medical documentation and histopathological diagnosis made in Department of Tumor Pathology, Holycross Cancer Center, were compared.

RESULTS

A conformity with primary cancer diagnosis was obtained in all but one patient in whom pathological consultation did not confirm oxyphilic carcinoma. In four cases the type of cancer was changed as a result of repeated consultation. pTMN classification was stated in 23 primary pathologic examination cases. After consultation of slides and inspection of surgery protocol, total or partial pTNM stage was obtained in other 9 patients.

CONCLUSIONS

Establishment of diagnostic and therapeutic algorithm, accepted on Conference in Szczyrk, 1995 is inadequately executed in small centers. Routine consultation of histopathological slides creates a possibility to make a proper choice of treatment's strategy.

Genetic analysis in patients with familial and sporadic frontotemporal dementia: two tau mutations in only familial cases and no association with apolipoprotein epsilon4

We screened for tau gene mutations among 24 Japanese (6 familial and 18 sporadic cases) and 4 Polish patients with frontotemporal dementia (FTD) using PCR-SSCP analysis followed by DNA sequencing. We identified 2 missense mutations in exon 10: N279K and P301L in 2 Japanese patients with familial FTD. Additionally 3 DNA polymorphisms: 2 known (3' exon 3 + 9, A --> G and exon 7, codon 176, G --> A) and 1 new (exon 8, codon 185, T --> C) were identified in 1 Polish patient. Tau mutations were not found in subjects with a negative family history suggesting that tau mutations do not account for most sporadic cases of FTD. We also found no association of apolipoprotein E4 allele with FTD.

The suitability of DNA extracted from formalin-fixed, paraffin-embedded tissues for double differential polymerase chain reaction analysis

Formalin-fixed, paraffin-embedded (FFPE) tissues are one of the popular sources of diagnostic materials, the easiest to store and transport. They are often used as the source of nucleic acids for retrospective molecular analyses based on DNA amplification by polymerase chain reaction (PCR). However, it is known that nucleic acids from paraffin-embedded tissues are much worse templates than those recovered from fresh tissues. It is exceptionally important in a quantitative analysis, including double differential PCR (ddPCR). Therefore, a pilot study comparing quantity and quality of DNA extracted with various paraffin removal and DNA isolation procedures from FFPE tissues was conducted. Furthermore, the suitability of DNA isolated with optimized procedure for the assessment of erbB-2 average gene copy number (AGCN) was checked. Specimens for comparison of extraction and isolation procedures were generated from the same human normal thyroid tissue embedded in paraffin to eliminate variabilities in tissue processing and sample size. Three procedures of paraffin removal and three procedures of DNA extraction from deparaffinized tissue were compared. Only one procedure provided DNA, which was efficiently amplified in ddPCR. The material obtained with this optimized procedure was used to check the precision of ddPCR by evaluation of AGCN of erbB-2 oncogene. Low variability of obtained results close to expected AGCN value (AGCN=1) indicates high reproducibility of the method, as well as its high accuracy, if the normal value of erbB-2 AGCN in the examined tissue is assumed.

Familial frontotemporal dementia and parkinsonism with a novel mutation at an intron 10+11-splice site in the tau gene

We report a case of familial frontotemporal dementia and parkinsonism characterized by early onset with mental retardation. The patient died at the age of 54; neuronal loss was severe in the frontal and temporal cortices, globus pallidus, substantia nigra, red nucleus and dentate nucleus. Anti-tau-positive fibrillary changes were observed in neurons and glia in these regions. Although the patient had 2 novel point mutations of the tau gene, P301P (CCG to CCA) and an intron 10+11-splice site (T to C), exon trapping analysis indicated that the latter was pathogenic.

Thyroid gland dysfunctions during antiviral therapy of chronic hepatitis C

BACKGROUND

The aim of this study was assessment of the frequency of thyroid dysfunctions (TD) during antiviral treatment of chronic hepatitis C (CHC).

MATERIAL AND METHODS

Data obtained from 120 not treated before patients with CHC, confirmed by the liver biopsy, and with the correct initial thyroid function, was analyzed. 63 patients were treated with IFN-alpha, and 57 with IFN + ribavirin combined therapy. HCV genotype was determined in 80 patients, and alleles HLA DRB1 in 74. Both tests were carried out by the use of commercial assay InnoLipa (Innogenetics, Belgium). All the patients had TSH level regularly monitored every 4 weeks. If any abnormalities were observed, the whole set of tests was applied for diagnosis. Frequency of TD was analyzed according to patients' sex, therapy scheme, HCV genotype and HLA DBR1 alleles. Both groups, with TD and without TD were compared by the initial data, such as: patients' sex, age, ALT activity, and liver biopsy results.

RESULTS

TD occurred in 40 patients (33.3%): in 7 (5.8%) signs of hypothyroidism, and in 33 (27.5%) hyperthyroidism. In 14 patients (11.7%) autoimmunological thyroiditis was diagnosed, in 2 (1.7%) subacute thyroiditis, and in the rest of patients only temporary changes in TSH concentration, without any clinical manifestations, were observed. In 4 women, the antiviral treatment was withdrawn, because of thyreotoxicosis, and in 6 patients thyroid hormones supplementation was needed after termination of interferon application. Thyroid complications occurred significantly more often in women than in men. No significant differences according to the age, therapy scheme, ALT activity, fibrosis stage, nor HCV genotype were find in the TD frequency. Among 13 genotyped DRB1 alleles, differences were observed only in DRB*11 allele frequency: in 37.7% of patients with TD, and in 9.1% of patients without TD (p = 0.0093; Pc = 0.12).

CONCLUSIONS

Antiviral treatment induces more often latent and transient thyroid dysfunctions as well as autoimmunological, and subacute thyroidis. The last mentioned complication may be the indication for withdrawal of the treatment, or may cause persistent hypothyroidism. Regular monitoring of TSH concentration, in 4-weeks intervals, seems to be essential for early diagnosis of thyroid complications.

Ability of patients to accurately recall the severity of acute painful events

OBJECTIVE

Pain studies require prospective patient enrollment to ensure accurate pain assessment. The authors correlated pain assessments of an acute painful episode over a one-week period and determined the accuracy of patient pain severity recall over time.

METHODS

This was a prospective, descriptive, longitudinal study. Participants were a convenience sample of 50 emergency department patients with acute pain resulting from injuries or painful invasive procedures. A trained research assistant administered a structured pain survey containing demographic and historical features to all patients. Patients sequentially assessed their pain severity using a vertical 100-mm visual analog scale marked "most pain" at the top, a verbal numeric rating scale ranging from 0 to 100 from none to worst (NRS100), and a verbal numeric rating scale ranging from 0 to 10 from none to worst (NRS10). Patients were contacted by phone and asked to reassess their initial pain severity one and seven days later using the two verbal numeric rating scales. Analysis of pain assessments using the various scales at the three time intervals was performed with Pearson's and Spearman's coefficients and repeated-measures analysis of variance (ANOVA).

RESULTS

There were 50 patients with a mean age of 41 years. Correlation between initial pain assessments on the three scales ranged from 0.83 to 0.92. Correlations between the initial and 24-hour assessments were NRS100-0.98 and NRS10-0.98. Correlations between the initial and one-week assessments were NRS100-0.96 and NRS10-0.97. Repeated-measures ANOVA showed no significant change in pain assessments over time for both verbal numeric scales.

CONCLUSIONS

Pain severity assessments of acute painful events one and seven days later were similar and highly correlated with initial assessments using both verbal numeric scales. Patients accurately recall the severity of an acute painful episode for at least one week after its occurrence, which may allow retrospective pain assessments.

Two brothers with frontotemporal dementia and parkinsonism with an N279K mutation of the tau gene

OBJECTIVE

To characterize the clinical diagnostic features, neuropathologic phenotype of tau deposition, and subunit structure of tau filaments in patients who had an asparagine-to-lysine substitution at codon 279 (the N279K missense mutation) of the gene for microtubule-associated tau protein.

BACKGROUND

The N279K mutation is a causative genetic defect for pallidopontonigral degeneration in an American kindred that presents with frontotemporal dementia (FTD) and parkinsonism.

METHODS

The authors analyzed retrospectively the clinical symptoms of two Japanese brothers who carry this mutation. Postmortem neuropathologic and electron microscopic studies, and Western blot analysis of insoluble tau were performed to correlate tau-mediated lesions with neurologic deficits.

RESULTS

Both patients exhibited impairment in recent memory, parkinsonism, and corticospinal disturbances in addition to FTD. Parkinsonism in one patient was responsive temporarily to l-dopa. There was intense tau deposition in the medial temporal cortices and upper and lower motor neurons with accompanying corticospinal tract degeneration. Two distinct tau isoforms with four microtubule-binding repeats, in hyperphosphorylated forms, were the primary constituents of insoluble tau, which aggregated to the filamentous component, termed "paired tubules," in neurons, oligodendrocytes, and astrocytes. The elemental filaments were hollow tubules measuring 11 to 12 nm in diameter, two of which adhered to each other along their longitudinal axes to form "paired tubules."

CONCLUSIONS

Early memory loss and pyramidal signs, which are atypical of FTD, can be presenting symptoms in this disorder. The authors demonstrated that the subunit structure of tau filaments is a pair of hollow tubules despite the prevailing twisted ribbon model.

Familial frontotemporal dementia with a P301L tau mutation in Japan

We have reported the family line with frontotemporal dementia (FTD) in Japan. This family line has so far included four patients. Patient II-1 (man) had a 10 year history of slowly progressive personality and behavioral changes and died at the age of 56. His neuropathological examination showed severe atrophy of the bilateral frontal and temporal cortices with neuronal loss, gliosis and superficial spongiosis. Pick bodies were not found. The neuropathological diagnosis was atypical Pick's disease without Pick bodies or Pick-type in FTD. Patient III-2 is patient II-1's oldest daughter and was taken ill with personality change at the age of 52. She died at the age of 68. Patient III-4 is patient II-1's second daughter. Her onset with strange speech and behavior was at the age of 59. Patient III-5 is patient II-1's oldest son. He also had onset with personality change at the age of 54 and had the P301L mutation in tau. In all III generation cases CT/MRI revealed circumscribed frontotemporal atrophy. Patient III-5's PET/SPECT showed signs of hypoperfusion or hypometabolism in the bilateral frontotemporal areas. This is the first report of familial FTD with the P301L mutation in Japan.

[The value of radiological examination in the diagnosis of rotator cuff tear]

The aim of this paper was to evaluate the correlation between radiological changes on a-p radiograph of the shoulder and rotator cuff tear on the ground of analysis of 328 patients (360 shoulders) aged between 11 and 73 years suffering from different forms of periarthritis humeroscapularis. Sonographic examination revealed rotator cuff tear in 54 shoulders; 38 confirmed at surgery and 16 at arthrography. There was very strong correlation between rotator cuff tear and irregularities of greater tubercle, narrowing of the distance between humeral head and acromion to 5 mm or less, greater tubercle recession, osteophytes and reverse shape of acromion. Last 3 changes were very strongly correlated with medium and large size rotator cuff tear.

[Left ventricular diastolic function evaluated by Doppler echocardiography in coronary artery disease in relation to to systolic function]

The aim of the study was to assess the relationship between left ventricular (LV) diastolic dysfunction measured by Doppler mitral flow indices (D.m.f.i.) and LV systolic performance in coronary artery disease (CAD). 107 pts with confirmed CAD without or after MI in I, II NYHA class was divided into 2 groups according to ejection fraction (EF) value = 55%. 13 D.m.f.i. regarding to the time, velocity, flow volume and derivates were calculated. In the patient with CAD with normal EF, the diastolic dysfunction was characterised by the impaired relaxation. There were prolonged isovolumic relaxation time IVRT and deceleration time of early filling flow DT, reduced early filling fraction EFF and increased the atrial filling fraction AFF, decreased E/A ratio and E/A-VTI. The regression analysis revealed the positive correlation between EF and DT r = 0.35 and inverse correlation between wall motion score index WMSI and DT r = DT r = -0.33. The stepwise regression analysis revealed that EF and WMSI are independent factors influencing on DT. Our results confirm that diastolic dysfunction precedes the systolic dysfunction in CAD. The correlation between D.m.f.i. and LV systolic function parameters were obtained. The results suggest that the LV systolic function should be take to account in the Doppler mitral flow analysis.

Comparison of patient and practitioner assessments of pain from commonly performed emergency department procedures

STUDY OBJECTIVE

To compare patient and practitioner assessments of pain associated with commonly performed emergency department procedures and use of anesthetics before these procedures.

METHODS

This was a prospective, observational, cross-sectional study conducted at a university-based ED with a convenience sample of ED patients. Research assistants recorded the procedure performed and historical and demographic information on standardized data collection instruments. After each procedure, both the patient and practitioner independently recorded assessments of patient pain on a 100-mm visual analog scale (VAS). Use of preprocedure anesthetics and patient preferences regarding their use were also identified. Categorical variables were analyzed by chi(2) tests. Patient and practitioner VAS scores were compared using a paired t test; alpha was preset at .05. Correlation coefficients were calculated to assess correlation between patient and practitioner pain scores.

RESULTS

A total of 1,171 procedures were evaluated for the 15 most common procedures performed. The mean patient age was 42.8+/-18.7 years and 46.1% were male. Overall, the mean patient VAS was 20.8 mm+/-25.1 mm; the mean practitioner VAS was 23.5 mm+/-20.3 mm. The mean difference between groups was 3.0 mm (95% confidence interval [CI], 1.3 to 4.1). Correlation between patient and practitioner pain scores for individual procedures was poor to fair (r=.26 to.68). The most painful procedures according to patients in descending order were nasogastric intubation, abscess drainage, fracture reduction, and urethral catheterization. Local anesthetics were administered in 12.8% of procedures yet would be requested before similar future procedures by 17.1% of patients. Patients who would choose local anesthetics in the future gave higher pain scores than those who would not (43.3 mm versus 16.3 mm; mean difference=27.0 mm, 95% CI, 22.2 to 31.8 mm).

CONCLUSION

The most painful procedures for ED patients were nasogastric intubation, incision and drainage of abscesses, fracture reduction, and urethral catheterization. Although practitioners also identified these procedures as most painful, the correlation between patient and practitioner pain assessments in individual patients was highly variable. Overall use of anesthetics before these procedures was low. Practitioners should be attentive to their patients' individual anesthetic needs before performing painful procedures.

A Polish pedigree with Alzheimer's disease determined by a novel mutation in exon 12 of the presenilin 1 gene: clinical and molecular characterization

The presenilin 1 (PS-1) gene, recently identified on chromosome 14q24.3, is a major gene involved into the autosomal dominant forms of early onset Alzheimer's disease (EOAD). Mutations of the PS-1 gene are responsible for the majority of familial EOAD. We found a novel mutation in a Polish family with EOAD from the Poznań region. The mutation at codon 424 in exon 12 of the PS-1 gene leads to an amino acid substitution Leu-Arg in a transmembrane domain VIII of the presenilin 1 molecule. The change is predicted to have a drastic effect on the protein function because it is associated with a very early age of onset (a range of 30-35 years) and a quick progression (about a 4-5 years duration) of the disease.

Genetic variability of apolipoprotein E in a Polish population

Apolipoprotein E (apoE, protein; APOE, gene) is a component of very low density lipoprotein and high-density lipoprotein and plays an important role in lipoprotein metabolism. There are three common alleles of APOE (*2, *3, and *4), which encode the E2, E3, and E4 isoforms of the protein. Distribution of apoE isoforms shows marked variation among various ethnic groups. Direct phenotyping of human APOE in plasma was used to estimate APOE allele frequencies in 137 unrelated blood donors from 3 regions of Poland. The relative frequencies observed for the APOE*2, APOE*3, and APOE*4 alleles were 0.055, 0.839, and 0.106, respectively. The data have been compared with data found in other population groups. The frequency of the APOE*2 allele in Poles was among the lowest in Europe.

[Mutation of presenilin ++ genes and their role in pathogenesis of Alzheimer's disease]

A new family of presenilin genes involved in the pathogenesis of early-onset autosomal dominant Alzheimer's disease (AD) has been identified recently. Mutations in presenilin-1 and presenilin-2 genes have a full penetration and lead to AD. The presenilins are transmembrane proteins localized mainly within endoplasmatic reticulum and Golgi systems. Their biological function remains unknown. It has been suggested that the presenilins may be important for intracellular processes of protein trafficking and processing. Presenilin mutations play a direct role in the beta-amyloid precursor protein metabolism and cause increased production of amyloidogenic A beta 42(43) peptide.

Apolipoprotein E genotypes in sporadic early and late-onset Alzheimer's disease

Recent data have demonstrated that presence of apolipoprotein E (APOE) epsilon *4 allele is a major risk factor of Alzheimer's disease (AD). We determined the APOE genotypes in 64 patients with sporadic probable AD and 43 non-demented aged controls selected from Poznań region and the western part of Poland using the polymerase chain reaction (PCR) followed by the restriction fragment length polymorphism (RFLP) analysis. We confirmed a strong correlation of the APOE epsilon *4 allele with sporadic late-onset AD. In contrast to many previous reports we did not found an association between the APOE epsilon *4 allele and sporadic early-onset AD.

Syndromic foramina parietalia permagna

We report on a boy with unique somatic and skeletal manifestations. The syndrome consists of branchial and auricular fistulae, abnormal face, and skeletal abnormalities including foramina parietalia permagna.

Screening for presenilin-1 gene mutations by PCR-SSCP analysis in patients with early-onset Alzheimer's disease

The majority of early-onset familial Alzheimer's disease (EOAD) has been associated with mutations in a novel gene on chromosome 14 which has been termed presenilin-1 gene. We screened for mutations within the presenilin-1 gene in twenty patients with EOAD using a PCR-SSCP analysis. We found three aberrant (mutant?) band patterns for exons 4 and 7 in three unrelated patients.