Projections of temperature-attributable mortality in Europe: a time series analysis of 147 contiguous regions in 16 countries

BACKGROUND

Europe has emerged as a major climate change hotspot, both in terms of an increase in seasonal averages and climate extremes. Projections of temperature-attributable mortality, however, have not been comprehensively reported for an extensive part of the continent. Therefore, we aim to estimate the future effect of climate change on temperature-attributable mortality across Europe.

METHODS

We did a time series analysis study. We derived temperature-mortality associations by collecting daily temperature and all-cause mortality records of both urban and rural areas for the observational period between 1998 and 2012 from 147 regions in 16 European countries. We estimated the location-specific temperature-mortality relationships by using standard time series quasi-Poisson regression in conjunction with a distributed lag non-linear model. These associations were used to transform the daily temperature simulations from the climate models in the historical period (1971-2005) and scenario period (2006-2099) into projections of temperature-attributable mortality. We combined the resulting risk functions with daily time series of future temperatures simulated by four climate models (ie, GFDL-ESM2M, HadGEM2-ES, IPSL-CM5A-LR, and MIROC5) under three greenhouse gas emission scenarios (ie, Representative Concentration Pathway [RCP]2.6, RCP6.0, and RCP8.5), providing projections of future mortality attributable fraction due to moderate and extreme cold and heat temperatures.

FINDINGS

Overall, 7·17% (95% CI 5·81-8·50) of deaths registered in the observational period were attributed to non-optimal temperatures, cold being more harmful than heat by a factor of ten (6·51% [95% CI 5·14-7·80] vs 0·65% [0·40-0·89]), and with large regional differences across countries-eg, ranging from 4·85% (95% CI 3·75-6·00) in Germany to 9·87% (8·53-11·19) in Italy. The projection of temperature anomalies by RCP scenario depicts a progressive increase in temperatures, more exacerbated in the high-emission scenario RCP8.5 (4·54°C by 2070-2099) than in RCP6.0 (2·89°C) and RCP2.6 (1·67°C). This increase in temperatures was transformed into attributable fraction. Projections consistently indicated that the increase in heat attributable fraction will start to exceed the reduction of cold attributable fraction in the second half of the 21st century, especially in the Mediterranean and in the higher emission scenarios. The comparison between scenarios highlighted the important role of mitigation, given that the total attributable fraction will only remain stable in RCP2.6, whereas the total attributable fraction will rapidly start to increase in RCP6.0 by the end of the century and in RCP8.5 already by the middle of the century.

INTERPRETATION

The increase in heat attributable fraction will start to exceed the reduction of cold attributable fraction in the second half of the 21st century. This finding highlights the importance of implementing mitigation policies. These measures would be especially beneficial in the Mediterranean, where the high vulnerability to heat will lead to an imbalance between the decreasing cold and increasing heat-attributable mortality.

FUNDING

None.

AB0990 SECONDARY SUBACUTE ARTHRITIS IN CHILDREN WITH DIASTROPHIC DYSPLASIA AND RMED

Background:

Progressive osteoarthritis is common in skeletal dysplasias. In the most of these disorders progress is relatively slow and acute pain with severe disability secondary to osteoarthritis is rare during childhood. Diastrophic dysplasia and rMED are quite unique among other skeletal dysplasias for secondary subacute arthritis (SSA). Protracted course of SSA can mimic JIA.

Objectives:

To analyse incidence and features of SSA in group of patients with DD/rMED.

Methods:

We retrospectively analysed for SSA our series of 39 patients with DD/rMED. Clinical, radiological and laboratory data were collected. Clinical assessment included pain (VAS), ROM (range of motion) and postural/walking disturbances. Radiological type by Yasunaga classification, neck-shaft angle (NSA) and articulo-trochanteric distance (AT distance) were estimated. MRI data regarding cartilage damage, joint effusion and bone marrow condition were noticed. Biomarkers of inflammation and immune response (ANA, RF, vimentin antibodies) were assessed in blood samples.

Results:

We identified 17 patients with hip joint SSA among 39 patients with DD/rMED (43%). Bilateral involvement was identified in 13 children with asynchronous appearance in all cases (from 2 to 18 months before the symptoms on the other side). Trauma (including iatrogenic damage during physiotherapy) preceded SSA in 9 cases. Pain, limited range of motion, limping and antalgic posture throughout the day were noticed in all the cases. Duration of these symptoms was from 4 weeks to 9 months. Progressive phase (increasing symptoms) took from 2 weeks to 4 months. General laboratory data were normal or indicated moderate inflammatory response without any specific changes. Radiolodgical data shows predictive sighs like NSA<110o, AT distance <10mm, fair or poor congruency by Yasunaga classification. Also radiological data demonstrated progressive subluxation with narrowing of articular space, osteoporosis, subchondral cysts.

MRI revealed pseudo-erosive damaged cartilage in contact area with joint effusion and bone marrow oedema. Total cartilage matrix also visualized like intermittent and multi-layered = erosive-like chondrolysis (defective articular hyaline cartilage) in 11 patients (65%).

Management included bed rest or partial weight bearing. NSAID were prescribed for 2-4 weeks with following usage according to the symptoms. Physical therapy to maintain range of motion was provided. One patient was operated (containment surgery for subluxation). In follow-up (2-7 years) 12 patients were painless at the daily life. 4 patients had intermittent pain and one patient (operated) - daily moderate pain. Range of motion was restored in 11 patients. Those patients who underwent in-hospital rehabilitation immediately after appearing of the symptoms demonstrated better outcome.

Conclusion:

SSA is typical for DD/rMED and leads to remarkable disability. Early recognition and non-surgical management are important for recovery. The quick reversibility of the clinical picture arthritis against the background of a short course of NSAIDs and rehabilitation is a characterized of non-autoimmune secondary inflammatory process (SSA). SSA not requiresanti-rheumatic treatment in childrenwith DD/rMED.

References:

[1]Al Kaissi, A., Kenis, V., Melchenko, E., Chehida, F. B., Ganger, R., Klaushofer, K., & Grill, F. (2014). Corrections of lower limb deformities in patients with diastrophic dysplasia.Orthopaedic surgery,6(4), 274-279.

[2]Baindurashvili A.G., Kenis V.M., Melchenko E.V., Grill F., Al-Kaissi A. Complex orthopaedic management of patients with skeletal dysplasias.Traumatology and Orthopedics of Russia. 2014;(1):44-50. doi.org/10.21823/2311-2905-2014-0-1-44-50

Disclosure of Interests:

None declared

Ageing of Polymer Frictional Interfaces: The Role of Quantity and Quality of Contact

When two objects are in contact, the force necessary for one to start sliding over the other is larger than the force necessary to keep the sliding motion going. This difference between static and dynamic friction is thought to result from a reduction in the area of real contact upon the onset of slip. Here, we resolve the structure in the area of contact on the molecular scale by means of environment-sensitive molecular rotors using (super-resolution) fluorescence microscopy and fluorescence lifetime imaging. We demonstrate that the macroscopic friction force is not only controlled by the area of real contact but also controlled by the "quality" of that area of real contact, which determines the friction per unit contact area. We show that the latter is affected by the local density of the contacting surfaces, a parameter that can be expected to change in time at any interface that involves glassy, amorphous materials.

Climate services for health: predicting the evolution of the 2016 dengue season in Machala, Ecuador

BACKGROUND

El Niño and its effect on local meteorological conditions potentially influences interannual variability in dengue transmission in southern coastal Ecuador. El Oro province is a key dengue surveillance site, due to the high burden of dengue, seasonal transmission, co-circulation of all four dengue serotypes, and the recent introduction of chikungunya and Zika. In this study, we used climate forecasts to predict the evolution of the 2016 dengue season in the city of Machala, following one of the strongest El Niño events on record.

METHODS

We incorporated precipitation, minimum temperature, and Niño3·4 index forecasts in a Bayesian hierarchical mixed model to predict dengue incidence. The model was initiated on Jan 1, 2016, producing monthly dengue forecasts until November, 2016. We accounted for misreporting of dengue due to the introduction of chikungunya in 2015, by using active surveillance data to correct reported dengue case data from passive surveillance records. We then evaluated the forecast retrospectively with available epidemiological information.

FINDINGS

The predictions correctly forecast an early peak in dengue incidence in March, 2016, with a 90% chance of exceeding the mean dengue incidence for the previous 5 years. Accounting for the proportion of chikungunya cases that had been incorrectly recorded as dengue in 2015 improved the prediction of the magnitude of dengue incidence in 2016.

INTERPRETATION

This dengue prediction framework, which uses seasonal climate and El Niño forecasts, allows a prediction to be made at the start of the year for the entire dengue season. Combining active surveillance data with routine dengue reports improved not only model fit and performance, but also the accuracy of benchmark estimates based on historical seasonal averages. This study advances the state-of-the-art of climate services for the health sector, by showing the potential value of incorporating climate information in the public health decision-making process in Ecuador.

FUNDING

European Union FP7, Royal Society, and National Science Foundation.

Sensitivity of El Niño intensity and timing to preceding subsurface heat magnitude

Despite extensive ongoing efforts on improving the long-term prediction of El Niño-Southern Oscillation, the predictability in state-of-the-art operational schemes remains limited by factors such as the spring barrier and the influence of atmospheric winds. Recent research suggests that the 2014/15 El Niño (EN) event was stalled as a result of an unusually strong basin-wide easterly wind burst in June, which led to the discharge of a large fraction of the subsurface ocean heat. Here we use observational records and numerical experiments to explore the sensitivity of EN to the magnitude of the heat buildup occurring in the ocean subsurface 21 months in advance. Our simulations suggest that a large increase in heat content during this phase can lead to basin-wide uniform warm conditions in the equatorial Pacific the winter before the occurrence of a very strong EN event. In our model configuration, the system compensates any initial decrease in heat content and naturally evolves towards a new recharge, resulting in a delay of up to one year in the occurrence of an EN event. Both scenarios substantiate the non-linear dependency between the intensity of the subsurface heat buildup and the magnitude and timing of subsequent EN episodes.

Real life clinical study design supporting the effectiveness of extra-fine inhaled beclomethasone/formoterol at the level of small airways of asthmatics

BACKGROUND

In an attempt to establish how treatment with inhaled extra-fine beclomethasone/formoterol (I-EF-BDP/F) formulation differs from other combinations of inhaled corticosteroid (ICS) and long acting beta-agonist (LABA), we studied lung function and markers of airway inflammation upon switching to the extra-fine formulation and after 8 weeks of treatment with it.

METHODS

We carried out a real-life clinical observation of undercontrolled asthmatic patients switched over from dry powder inhalers of fluticasone/salmeterol and budesonide/formoterol to I-EF-BDP/F (Foster(®), Chiesi Farmaceutici S.p.A., Italy). The effects of 8-weeks of treatment were documented by means of visual analog scale (VAS), quality of life by Asthma Quality of Life Questionnaire (AQLQ), spirometry and markers of airway or systemic inflammation: exhaled breath temperature (EBT), blood eosinophils (Eos), and high sensitivity C-reactive protein (CRP). Before/after treatment differences between forced vital capacity percent of predicted (%FVC), a simple indicator of small airways involvement, were calculated and subjects were ranked accordingly to reflect the magnitude of the therapeutic response. Subjects above the 75th percentile (n = 15), "top responders", were then compared with those below the 25th percentile (n = 15) "poor responders".

RESULTS

On average, the 59 patients completing the study (mean age ± SD 51 ± 12 years, 38 women) had significant improvement in VAS and QLQ scores at the end of the treatment period (49.1 ± 2.4 vs. 73.1 ± 2.05 and 146.1 ± 2.7 vs. 176.7.1 ± 3.4 respectively, P < 0.001), but not in the inflammatory indicators (EBT, CRP and Eos). However, when comparing the "top responders" with the "poor responders", significant improvement in these inflammatory indicators was observed: EBT significantly decreased from 34.04/mean/± 0.30/s.e.m./[°C] to 33.57 ± 0.33, P = 0.003, Eos in blood fell from 381.7 ± 91.2 [cells/μL] to 244.2 ± 43.2, P = 0.02. Before/after treatment differences in hsCRP decreased significantly in the top responders compared with the poor responders (Mann-Whitney test, P = 0.04).

CONCLUSION

Asthmatic subjects who had the most improvement in FVC after transition to I-EF-BDP/F from other combined ICS/LABA preparations also demonstrated a significant decrease in some indicators of airway/systemic inflammation. These results support the notion that I-EF-BDP/F exerts an effect also at the level of the small airways through a reduction of the level of air trapping. Patients in whom inflammation of the small airways plays an important clinical role are the ones to derive most benefit from this small airways tailored treatment. However, improved compliance due to the "promise of a new drug" effect should also be considered as contributing to the treatment results.

[Gastroesophageal reflux disease in pregnancy]

The incidence of GERD is high during pregnancy. Hormonal and mechanical factors in pregnancy alter the structure and function of the normal physiological barriers to reflux of gastric contents into the oesophagus. Most of the patient benefit from lifestyle changes, but require pharmacological treatment for full alleviation of their symptoms. Collaboration between obstetricians and gastroenterologists is recommended, with primary focus on the safety of the mother, fetus and neonate. It is recommended to initiate treatment with lifestyle changes and antacids. As a second line histamine-2 receptor antagonists (H2RA) and proton pump inhibitors (PPI) are tried. Careful discussion of the risks and benefits of the therapy with the patient should precede treatment with any of these medications. In patients with no history of GERD, the symptoms usually resolve after delivery.

[Endocrinology of in vitro maturation of oocytes]

In-vitro maturation (IVM) of oocytes is an alternative to conventional in-vitro fertilization (IVF) treatment. Significant progress has been made to improve pregnancy and implantation rates from in-vitro matured oocytes. However oocyte maturation in vitro is profoundly affected by culture conditions. Most IVM protocols supplement gonadotropins--folicle stimulating hormone (FSH) and luteinizing hormone (LH) into a culture medium for oocyte maturation. The addition of these hormones, as well as some growth factors is based on their physiological role in oocyte maturation in vivo. However, it is possible, they not to play the same role in promoting oocyte maturation in vitro. The aim of this survey is to examine the hormones and growth factors, which participate in oocyte maturation in vivo and to summarize briefly the available information about the effect they have on the in vitro maturation. The researches on effects of these endocrine factors on oocyte maturation and subsequent fertilization, as well as on early embryonal development proceed.

Ferroic nanoclusters in relaxors: the effect of oxygen vacancies

Single crystals of PbSc(0.5)Ta(0.5)O(3) with suppressed and enhanced oxygen deficiencies and different degrees of long-range B-site ordering were studied by Raman spectroscopy in order to clarify the significance of the different factors for the formation and growth of ferroic clusters in relaxors. It is shown that the presence of oxygen vacancies impacts more strongly on the incipient ferroic clustering than the degree of long-range B-site ordering. The oxygen deficiency hinders the formation of ferroelectric crystalline-type nanoregions, regardless of the presence/absence of long-range B(')/B('')-ordered regions. The low degree of defects in the O system enhances the long-range ferroelectric ordering, even in entirely B-site-disordered materials.

[Genetic counseling, surgical prophylaxis and treatment for familial adenomatous polyposis and hereditary nonpolyposis colorectal cancer]

FAP is an autosomal dominant disorder characterized by the appearance of thousands of adenomatous polyps. FAP is associated with a deletion of chromosome 5q21 (known as the APC gene). Surgical prophylaxis in FAP consists of resection of the entire large bowel, to prevent malignant transformation. Hereditary Nonpolyposis Colorectal Cancer(HNPCC), like FAP, is an autosomal dominant disorder. In contrast to FAP, HNPCC is associated with an unusually high frequency of cancers in the proximal large bowel. If an adenoma or adenocarcinoma of the colon is identified, total abdominal colectomy with an ileorectal anastomosis is recommended.

Purification and properties of individual collagenases from Streptomyces sp. strain 3B

Streptomyces strain 3B constitutively secreted collagenolytic enzymes during the post-exponential growth phase. Purification is described here leading to two collagenases (I and II) with specific activity of 3350 and 3600 U/mg, respectively, the highest activity obtained as yet for any streptomycete collagenase. Analysis of the purified enzymes by the method of zymography revealed that both I and II were homogeneous, with molar mass 116 and 97 kDa, respectively. Both collagenases were identical in their pH (7.5) and temperature optimum (37 degrees C). The inhibition profile of the enzymes by EDTA and 1,10-phenanthroline confirmed these enzymes to be metalloproteinases. By testing the activity with insoluble collagen, acid soluble collagen, gelatin, casein, elastin and Pz-PLGPR it was established that I and II are very specific for insoluble collagen and gelatin, showing a high activity toward acid soluble collagen and Pz-PLGPR. However, collagenases I and II failed to hydrolyze casein and elastin; they belong to true collagenases and resemble the clostridial enzymes.

Phytoplankton community and hydrochemical characteristics of the Western Black Sea

Since the early 1990s the persistent reports about the irreversibly degrading Black Sea have started to disappear. A large set of data, reflecting the temporal and spatial variability of microalgae and hydrochemical parameters in Western Black Sea waters (WBS), collected in 2001-2002 (EU 5th FP project "daNubs"), allows us to compare the present-day ecosystem functioning to previous ones and to certainly conclude on positive signs of relaxation. The years 2001 and 2002 were without ample, negative biological and hydrochemical events in the WBS. Nutrient general trend was a decreasing one since the late 1980s, and inorganic phosphorus and nitrogen concentrations were frequently below the method detection limits during summer autumn periods of 2001-2002. The shelf waters were properly oxygenated. The phytoplankton community was producing biomass in a decreasing tendency, especially obviously since 1995. Simultaneously, there was an increase in Si:P and Si:N molar ratios and concurrent increase in the diversity of mass algal species (mainly diatoms) but only a few of them generated exceptional blooms. Reduction of the ratios between phytoplankton and zooplankton biomasses became evident. The observed ecological status in 2001-2002 confirms that the Black Sea is no longer a reference point for progressive water quality deterioration.

Tissue Microarray Analysis of Cyclin D1 Gene Amplification and Gain in Colorectal Carcinomas

Colorectal cancer is one of the most common neoplastic diseases and one of the leading causes of cancer-related deaths. Elevated beta-catenin levels in colorectal cancer result in the binding of beta-catenin to LEF-1 and increased transcriptional activation of the CCND1 gene. Overexpression of cyclin D1 is observed in one third of colorectal tumors. CCND1 amplification is the main cause of protein overexpression in numerous human carcinomas. In colorectal cancer, however, no CCND1 amplification has been reported so far. The aim of this study was to determine the frequency of CCND1 amplifications and gains in a large number of colorectal carcinomas, arranged in a tissue microarray, in order to assess their role in colorectal cancer development. The copy number changes, detected by fluorescence in situ hybridization, were predominantly gains (7.6%) and only rarely amplifications (2.5%). In colorectal cancer, the CCND1 copy number increase was neither associated with the tumor phenotype (stage and grade) nor with the tumor localization (colon, rectum or sigmoid colon). In conclusion, even in a small number of colorectal tumors, CCND1 gene amplification is a possible mechanism for the increase in cyclin D1 oncoprotein.

[Congestive heart failure--some current problems]

The congestive heart failure (CHF) has become one of the most common syndromes afflicting the population. The long-term prognosis of these patients is bad. The CHF shows a tendency toward fast progressive development. The aim of our study was a retrospective investigation on CHF patients, a determination of CHF functional class by NYHA and its type, a determination of the most important diseases leading to heart decompensation and of the reasons for dead in these patients. For a 6-year period we investigated 6428 patients. 1095 (17.03%) of them were with a different degree of CFH. More of them were with II and III functional class of CHF by NYHA. In the age decade from 61 to 70 years the frequency of CHF increased significantly. The most important diseases leading to CHF syndrome were chronic ischemic disease, arterial hypertension, COPD with chronic cor pulmonale and valve diseases. The average age of deceased CHF patients was 67.8 +/- 7.4 years. After the manifestation of the first group of symptoms the mean life duration of CHF patients was 13.2 +/- 4.1 years.

[Cytokines and the liver in health and disease]

Cytokines are a group of proteins with autocrine, paracrine and endocrine activities which provide communication among hepatic cells and other cells and tissues of the man. Active in minute quantities, the cytokines activate and regulate homeostasis and cellular repair through effects on cell growth, differentiation and receptor expression and cell-mediated immunity. Cytokines--IL-1, IL-2, IL-6, IL-8 IL-10, IL-12, TNF-alfa, PDGF and others, modulate liver metabolism in health and disease, physiological and pathologic liver functions and the evolution of liver inflammation and injury to hepatic fibrosis and liver cirrhosis. Data concerning the use of a recombinant form of Interleukin-10 and Interleukin-12 in the treatment of chronic liver disease (chronic viral hepatitis, fibrosis, cirrhosis, alcoholic liver disease) and cell-mediated immunity regulation are widely discussed in the review.

[Sodium in clinics and complications of liver cirrhosis]

The changes in sodium homeostasis most frequently are expression of water-electrolyte balance disturbances in patients with liver cirrhosis. Hyponatremia of water excess is found in 35% of the patients with cirrhosis and ascites. This disturbance is most frequently connected with raised antidiuretic hormone (vasopressin) secretion and is realized by including of nonosmotic stimulating mechanisms. The vasopressin plays a leading role in pathogenesis of disturbed water metabolism in the liver cirrhosis. Some patients with hepatorenal syndrome are established with highest plasma vasopressin concentrations. Gene expression of the regulation of kidney vasopressin-sensitive water channels (aquaporin-2 proteins) is also raised in the liver cirrhosis. Using in practice vasopressin-type 2 (V-2) receptor antagonists gives hopeful results in medical treatment of water-electrolyte disturbances in patients with advanced liver cirrhosis.

[Early hemodynamic changes in chronic obstructive pulmonary disease with initial respiratory failure]

The chronic hypoxemia seems to play an important role in the pathogenesis of hemodynamic disorders in chronic obstructive pulmonary disease (COPD). The aim of the study was to follow-up the changes in pulmonary hemodynamics in COPD with mild respiratory failure. 78 COPD patients with Ist and IId degree of respiratory failure were investigated. The following investigations were carried out: two--dimensional echocardiography, spirometry, arterial blood gases and acid-base balance. In 18 of COPD patients a right heart catheterization was performed and the following indices were determined: mean pulmonary arterial (PA) pressure, pulmo-capillary resistance, teledyastolic right ventricular volume. The echocardiography showed significantly higher mean PA pressure values, an initial right ventricular dilatation and right ventricular wall hypertrophy. The indices of right heart catheterization were changed, too. The pulmo-capillary resistance was significantly increased. It was the most sensitive early parameter. The mean PA pressure was increased. There was no significant difference between the mean PA pressure determined by echocardiography and by right ventricular catheterization. A relationship between the degree of hypoxemia and the hemodynamic changes was found. The long development of COPD with mild respiratory failure leads to disorders in lung microcirculation and early changes in pulmonary hemodynamics. This process worsens the prognosis of COPD and the early prevention in the complex therapy of the disease is necessary.

[The immunological changes and prognosis of cholestatic jaundice in choledocholithiasis]

Fifty-six patients presenting choledocholithiasis are covered by the study. They are distributed in groups according to total serum bilirubin values, as follows: with total serum bilirubin < 20 mumol/l--17; 20 to 50 mumol/l--13; 50 to 80 mumol/l--9; and > 80 mumol/l--17 cases. Sixty healthy, sex and age matched individuals serve as controls. The immunocompetent cells are determined flow cytometrically with FACS TAR (BECTON DICKINSON). A panel of monoclonal antibodies (Becton Dickinson) is used, including: Leu4 (anti-CD3+)--T-lymphocytes; Leu3a (anti-CD4+)--helper/inducer lymphocytes; Leu2a (anti-CD8+)--suppressor/cytotoxic cells; Leu11a (anti-CD16+)--cells with a natural killer activity; Leu12 (anti-CD19+)--B-lymphocytes. As shown by the obtained results there are no changes in cell-mediated immune response among choledocholithiasis patients with normal values of total serum bilirubin. Parallel to increasing the degree of cholestatic jaundice (ChJ) severity, the absolute values of lymphocytes and their subpopulations decrease. The deficit is most clearcut in patients presenting the highest degree cholestasis, as compared to healthy individuals ((Ly: 1690 +/- 174/2277 +/- 186; CD3+: 956 +/- 119/1793 +/- 67; CD4+: 607 +/- 83/988 +/- 80; CD8+: 239 +/- 52/639 +/- 85; CD16+: 146 +/- 38/367 +/- 55; CD19+: 181 +/- 33/200 +/- 13. In 11 cases with early restored biliary drainage (by the 21st day of ChJ), total serum bilirubin decreases within 10 days after the operation (choledochoduodenoanastomosis), whereas lymphocytes and their subpopulations show an increase in absolute values. Two months after choledochoduodenoanastomosis, the total serum bilirubin and the lymphocyte subpopulations being examined regain their normal values. In two instances with rather late biliary drainage recovery (30 days after ChJ) the total serum bilirubin and lymphocyte subpopulations under study show no tendency whatsoever towards normalization at 10 days postoperatively. The results of the study demonstrate that the poor prognosis among ChJ patients is also related to inhibition of the cell-mediated immune response. The early biliary drainage recovery (at 21 days of ChJ) exerts a more favourable effect on the immune system, and improves the prognosis of the clinical course run by the pathological process.

[The extrahepatic manifestations in hepatitis C virus (HCV) infection]

The hepatitis C virus (HCV) infection could affect not only the liver, but also other tissues, organs and systems. The number of the reported in the literature extrahepatic lesions by HCV incessantly increases. A reliable association between the infections by HCV and the mixed cryoglobulinaemias, membrano-proliferative glomerulonephritis and porphyria cutanea tarda is confirmed. The participation of HCV in the pathogenesis of some diseases of the thyroid gland, the lymphocytic sialadenitis, lichen planus, diabetes mellitus, thrombocytopenia, antiphospholipid syndrome, etc., is assumed. The extrahepatic lesions by HCV are probably connected with the participation of the immune system, but they may be as well due to the replicating virus in the affected tissues, organs and systems. The pathogenetic mechanisms of the extrahepatic and autoimmune manifestations of the infection with HCV are not elucidated, which poses difficult therapeutic problems regarding the choice of interferon and/or corticosteroid hormones.

[The systemic and local immune responses in patients with alcoholic liver cirrhosis depending on hepatitis C viral infection (HCV)]

The systemic and local immune response was studied in patients with alcoholic liver cirrhosis and the significance of the combined infection with HCV. To investigation were submitted 23 patients (16 males and 7 females) aged between 29 and 61 years with alcoholic liver cirrhosis. Of them 14 were anti-HCV(+) and 9 anti-HCV(-). As controls were used 36 clinically healthy individuals, matched by sex and age to the patients. The flow cytometric analysis of the lymphocyte (Ly) populations from the peripheral venous blood and of cells from liver aspirate obtained by blind liver biopsy according to Menghini, was performed with FacsTAR (Becton Dickinson). In the anti-HCV(-) patients, as compared to the controls (patients/controls) the Ly subpopulations were increased: CD3+/mm3:2010 +/- 738/1440 +/- 388; CD4+/mm3:1350 +/- 441/991 +/- 442; IL-2R+/mm3:133 +/- 78.5/31 +/- 20. In the anti-HVC(+) patients we established increased IL-2R+/mm3: 170 +/- 126 as compared with the controls and anti-HCV(-) patients. The suppressor/cytotoxic (CD8+) Ly with their suppressor (CD8+CD11b+) and cytotoxic (CD8+CD11b-) subpopulations and natural killers (CD16+) had a tendency to diminution in the anti-HCV(+) patients. In both examined groups the B (CD19+) Ly were non-significantly increased. The flow cytometric analysis of the cells from the liver specimen in 9 patients of whom 3 anti-HCV(-) and 6 anti-HCV(+) revealed that CD3+ on the average were 32.8% +/- 20.4% (from 9.2% to 65.1%); CD4+ were 21.1% +/- 7.4% (from 12.0% to 34.5%); CD8+ 22.6% +/- 11.8% (from 4.7% to 39.8%) and their values were higher in the anti-HCV(+) patients; the correlation CD4+/CD8+ = 1/1.09 +/- 0.6; CD16+ were 12.9% +/- 10.1% (from 1.9% to 34.8%); CD19+ varied from 3.2% to 27.8%; monocytes (CD14+) were 7.69% +/- 5.65 (from 2.0% to 15.8%) from the cells of the aspirate and their percentage contents was higher in the anti-HCV(+) patients. The results of out study revealed that in patients with alcoholic liver cirrhosis changes in the cell immune response were also observed and that they were more marked in infection with HCV.