Expression of circular RNAs in myelodysplastic neoplasms and their association with mutations in the splicing factor gene SF3B1

Mutations in the splicing factor 3b subunit 1 (SF3B1) gene are frequent in myelodysplastic neoplasms (MDS). Because the splicing process is involved in the production of circular RNAs (circRNAs), we investigated the impact of SF3B1 mutations on circRNA processing. Using RNA sequencing, we measured circRNA expression in CD34+ bone marrow MDS cells. We defined circRNAs deregulated in a heterogeneous group of MDS patients and described increased circRNA formation in higher-risk MDS. We showed that the presence of SF3B1 mutations did not affect the global production of circRNAs; however, deregulation of specific circRNAs was observed. Particularly, we demonstrated that strong upregulation of circRNAs processed from the zinc finger E-box binding homeobox 1 (ZEB1) transcription factor; this upregulation was exclusive to SF3B1-mutated patients and was not observed in those with mutations in other splicing factors or other recurrently mutated genes, or with other clinical variables. Furthermore, we focused on the most upregulated ZEB1-circRNA, hsa_circ_0000228, and, by its knockdown, we demonstrated that its expression is related to mitochondrial activity. Using microRNA analyses, we proposed miR-1248 as a direct target of hsa_circ_0000228. To conclude, we demonstrated that mutated SF3B1 leads to deregulation of ZEB1-circRNAs, potentially contributing to the defects in mitochondrial metabolism observed in SF3B1-mutated MDS.

Specific immune response to mRNA vaccines against COVID-19 in patients receiving allogeneic stem cell transplantation for myeloid malignancy was altered by immunosuppressive therapy

BACKGROUND

Allogeneic hematopoietic stem cell transplant (allo-HSCT) recipients are at high risk of complications associated with COVID-19 infection due to dysfunction of their immune system. Vaccination can protect from the adverse consequences of COVID-19. However, studies on the efficacy of COVID-19 vaccines in HSCT recipients with insufficient post-HSCT immune reconstitution are still scarce. In our study, we determined how immunosuppressive medication and the reconstitution of the cellular immune system influenced T cell responses specific for the surface glycoprotein of SARS-CoV-2 virus (S antigen) after two doses of mRNA vaccine against COVID-19 in patients with myeloid malignancies treated with HSCT.

METHODS

Vaccination outcomes were followed in 18 (allo-HSCT) recipients and 8 healthy volunteers. The IgG antibodies against SARS-CoV-2 spike (S) and nucleocapsid (NCP) protein were determined in ELISA and S-specific T cells were detected using a sensitive ELISPOT-IFNγ based on in vitro expansion and restimulation of T cells in pre- and post-vaccination blood samples. Multiparametric flow cytometry analysis of peripheral blood leukocyte differentiation markers was employed for determination of reconstitution of the main subpopulations of T cells and NK cells at month 6 after HSCT.

RESULTS

S- specific IgG antibody response detected in 72% of the patients was lower than in healthy vaccinees (100%). Vaccine-induced T-cell responses to S1 or S2 antigen were significantly reduced in HSCT recipients, which were treated with corticosteroids in dose 5 mg of prednisone- equivalents or higher during the vaccination period or in preceeding 100 days in comparison with recipients un-affected with corticosteroids. A significant positive correlation was found between the level of anti-SARS-Cov-2 spike protein IgG antibodies and the number of functional S antigen-specific T cells. Further analysis also showed that the specific response to vaccination was significantly influenced by the interval between administration of vaccine and transplantation. Vaccination outcomes were not related to age, sex, type of mRNA vaccine used, basic diagnosis, HLA match between HSC donor and recipient, and blood counts of lymphocytes, neutrophils, and monocytes at the time of vaccination. Multiparametric flow cytometry analysis of peripheral blood leukocyte differentiation markers showed that good humoral and cellular S-specific immune responses induced by vaccination were associated with well-reconstituted CD4⁺ T cells, mainly CD4⁺ effector memory subpopulation at six months after HSCT.

CONCLUSIONS

The results showed that both humoral and cellular adaptive immune responses of HSCT recipients to the SARS-CoV-2 vaccine were significantly suppressed by corticosteroid therapy. Specific response to the vaccine was significantly affected by the length of the interval between HSCT and vaccination. Vaccination as early as 5 months after HSCT can lead to a good response. Immune response to the vaccine is not related to age, gender, HLA match between HSC donor and recipient, or type of myeloid malignancy. Vaccine efficacy was dependent on well-reconstituted CD4⁺ T cells, at six months after HSCT.

Characterization of the input material quality for the production of tisagenlecleucel by multiparameter flow cytometry and its relation to the clinical outcome

Tisagenlecleucel (tisa-cel) is a CD19^-specific CAR-T cell product approved for the treatment of relapsed/refractory (r/r) DLBCL or B-ALL. We have followed a group of patients diagnosed with childhood B-ALL (n = 5), adult B-ALL (n = 2), and DLBCL (n = 25) who were treated with tisa-cel under non-clinical trial conditions. The goal was to determine how the intensive pretreatment of patients affects the produced CAR-T cells, their in vivo expansion, and the outcome of the therapy. Multiparametric flow cytometry was used to analyze the material used for manufacturing CAR-T cells (apheresis), the CAR-T cell product itself, and blood samples obtained at three timepoints after administration. We present the analysis of memory phenotype of CD4/CD8 CAR-T lymphocytes (CD45RA, CD62L, CD27, CD28) and the expression of inhibitory receptors (PD-1, TIGIT). In addition, we show its relation to the patients' clinical characteristics, such as tumor burden and sensitivity to prior therapies. Patients who responded to therapy had a higher percentage of CD8⁺CD45RA⁺CD27⁺ T cells in the apheresis, although not in the produced CAR-Ts. Patients with primary refractory aggressive B-cell lymphomas had the poorest outcomes which was characterized by undetectable CAR-T cell expansion in vivo. No clear correlation of the outcome with the immunophenotypes of CAR-Ts was observed. Our results suggest that an important parameter predicting therapy efficacy is CAR-Ts' level of expansion in vivo but not the immunophenotype. After CAR-T cells' administration, measurements at several timepoints accurately detect their proliferation intensity in vivo. The outcome of CAR-T cell therapy largely depends on biological characteristics of the tumors rather than on the immunophenotype of produced CAR-Ts.

OMIP-080: 29-Color flow cytometry panel for comprehensive evaluation of NK and T cells reconstitution after hematopoietic stem cells transplantation

This 29-color panel was developed and optimized for the monitoring of NK cell and T cell reconstitution in peripheral blood of patients after HSCT. We considered major post-HSCT complications during the design, such as relapses, viral infections, and GvHD and identification of lymphocyte populations relevant to their resolution. The panel includes markers for all major NK cell and T cell subsets and analysis of their development and qualitative properties. In the NK cell compartment, we focus mainly on CD57 + NKG2C+ cells and the expression of activating (NKG2D, DNAM-1) and inhibitory receptors (NKG2A, TIGIT). Another priority is the characterization of T cell reconstitution; therefore, we included detection of CD4+ RTEs based on CD45RA, CD62L, CD95, and CD31 as a marker of thymus function. Besides that, we also analyze the emergence and properties of major T cell populations with a particular interest in CD8, Th1, ThCTL, and Treg subsets. Overall, the panel allows for comprehensive analysis of the reconstituting immune system and identification of potential markers of immune cell dysfunction.

Inducible secretion of IL-21 augments anti-tumor activity of piggyBac-manufactured chimeric antigen receptor T cells

BACKGROUND

The efficiency of chimeric antigen receptor (CAR) T-cell-based therapies depends on a sufficient expansion of CAR T cells in vivo and can be weakened by intra-tumoral suppression of CAR T cell functions, leading to a failure of therapy. For example, certain B-cell malignancies such as chronic lymphocytic leukemia are weakly sensitive to treatment with CAR T cells. Co-expression of proinflamatory cytokines such as IL-12 and IL-18 by CAR T cells have been shown to enhance their antitumor function. We similarly engineered CAR T cell to co-express IL-21 and studied the effects of IL-21 on CAR T cells specific to CD19 and prostate-specific membrane antigens using an in vitro co-culture model and NSG mice transplanted with B-cell tumors.

RESULTS

IL-21 enhanced the expansion of CAR T cells after antigenic stimulation, reduced the level of apoptosis of CAR T cells during co-culture with tumor cells and prevented differentiation of CAR T cells toward late memory phenotypes. In addition, induced secretion of IL-21 by CAR T cells promoted tumor infiltration by CD19-specific CAR (CAR19) T cells in NSG mice, resulting in reduced tumor growth. By co-culturing CAR19 T cells with bone-marrow fragments infiltrated with CLL cells we demonstrate that IL-21 reduces the immunosupressive activity of CLL cells against CAR19 T cells.

CONCLUSIONS

CAR19 T cells armed with IL-21 exhibited enhanced antitumor functions. IL-21 promoted their proliferation and cytotoxicity against chronic lymphocytic leukemia (CLL). The results suggest that arming CAR T cells with IL-21 could boost the effectiveness of CAR T-mediated therapies.

A new approach to CAR T-cell gene engineering and cultivation using piggyBac transposon in the presence of IL-4, IL-7 and IL-21

BACKGROUND AIMS

Clinical-grade chimeric antigenic receptor (CAR)19 T cells are routinely manufactured by lentiviral/retroviral (LV/RV) transduction of an anti-CD3/CD28 activated T cells, which are then propagated in a culture medium supplemented with interleukin (IL)-2. The use of LV/RVs for T-cell modification represents a manufacturing challenge due to the complexity of the transduction approach and the necessity of thorough quality control.

METHODS

We present here a significantly improved protocol for CAR19 T-cell manufacture that is based on the electroporation of peripheral blood mononuclear cells with plasmid DNA encoding the piggyBac transposon/transposase vectors and their cultivation in the presence of cytokines IL-4, IL-7 and IL-21.

RESULTS

We found that activation of the CAR receptor by either its cognate ligand (i.e., CD19 expressed on the surface of B cells) or anti-CAR antibody, followed by cultivation in the presence of cytokines IL-4 and IL-7, enables strong and highly selective expansion of functional CAR19 T cells, resulting in >90% CAR⁺ T cells. Addition of cytokine IL-21 to the mixture of IL-4 and IL-7 supported development of immature CAR19 T cells with central memory and stem cell memory phenotypes and expressing very low amounts of inhibitory receptors PD-1, LAG-3 and TIM-3.

CONCLUSIONS

Our protocol provides a simple and cost-effective method for engineering high-quality T cells for adoptive therapies.

Intraperitoneal onlay mesh - an analysis of the patients cohort

INTRODUCTION

Incisional hernias represent one of the most complex and widely discussed issues of abdominal wall surgery. 10-20% of the cases occur following abdominal surgery. The aim of this study is to describe our surgical experience and determine whether the intraperitoneal onlay mesh (IPOM) procedure is suitable for hernia surgery with minimal postoperative complications.

METHOD

The paper focuses on patients operated on by the IPOM technique between 2015 and 2016. The group involved 53 patients with median or paramedian defects after acute or elective abdominal surgery. In patients with comorbidities, thorough preoperative examination was completed including abdominal ultrasound, colonoscopy and spirometry. In the postoperative period, we evaluated pain using the visual analogue scale, wound healing, relapses and patient´s satisfaction with functional as well as aesthetic outcomes of the surgery.

RESULTS

Our group comprised 53 patients operated on using the IPOM technique. They were 4879 years old with a body mass index exceeding 30 kg/m2. 18 patients had a paramedian hernia and 35 patients median hernia. 4 patients suffered a perioperative iatrogenic injury of the intestine, 8 cases developed postoperative paralytic ileus. Wound infection or infection of the mesh was not recorded. 2 patients with hernia recurrence were followed up for one year.

CONCLUSIONS

Incisional hernias represent an important surgical issue. Management is often complex. IPOM as the treatment of choice for patients with incisional hernias appears to be beneficial. However, it requires careful patient selection, patient preparation for surgery and their compliance, the surgeons extensive experience as well as excellent postoperative care with limited postoperative pain. The success rate of this method is high in carefully selected patients. Key words: IPOM - incisional hernia - patient compliance.

Reconstitution of cytomegalovirus-specific T-cell response in allogeneic hematopoietic stem cell recipients: the contribution of six frequently recognized, virus-encoded ORFs

BACKGROUND

The reactivation of human cytomegalovirus (HCMV) in immunosuppressed patients is associated with significant morbidity. Testing HCMV-specific T-cell responses can help determine which patients are at high risk of HCMV disease. We optimized selection of HCMV antigens for detection of T-cell response of patients after allogeneic hematopoietic stem cell transplantation (HSCT) with the aim of identifying patients with insufficient control of HCMV reactivation.

METHODS

T-cell immune response to HCMV was monitored in 30 patients during the first year after HSCT. The HSCT recipients were classified according to their anti-HCMV T-cell response and the presence of HCMV DNA in the blood.

RESULTS

We observed an inverse relationship between the magnitude of HCMV-specific T-cell responses against CMV lysate, phosphoprotein (pp) 65, immediate early-1 (IE-1), UL36, and UL55, but not to US3 and US29 detected by interferon-gamma (IFNγ)- ELISPOT and the level of HCMV DNA in the blood of patients during the 30 days following sampling. The study has revealed that patients who received a graft from a seronegative donor have a lower T-cell response against HCMV and increased probability of HCMV reactivation in comparison to the patients who had received their graft from a seropositive donor.

CONCLUSION

The individual peptide pools and native HCMV antigens were useful for monitoring the time course of the anti-HCMV response by IFNγ-ELISPOT, which proved to have a prognostic value. Besides widely employed peptide pools of pp65 and IE-1, the use of antigens UL36 and UL55, but not US3 or US29, increased sensitivity of the test.

Seroprevalence rates of HPyV6, HPyV7, TSPyV, HPyV9, MWPyV and KIPyV polyomaviruses among the healthy blood donors

Human polyomaviruses HPyV6, HPyV7, TSPyV, HPyV9, MWPyV, and KIPyV have been discovered between 2007 and 2012. TSPyV causes a rare skin disease trichodysplasia spinulosa in immunocompromised patients, the role of remaining polyomaviruses in human pathology is not clear. In this study, we assessed the occurrence of serum antibodies against above polyomaviruses in healthy blood donors. Serum samples were examined by enzyme-linked immunoassay (ELISA), using virus-like particles (VLPs) based on the major VP1 capsid proteins of these viruses. Overall, serum antibodies against HPyV6, HPyV7, TSPyV, HPyV9, MWPyV, and KIPyV were found in 88.2%, 65.7%, 63.2%, 31.6%, 84.4%, and 58%, respectively, of this population. The seroprevalence generally increased with age, the highest rise we observed for HPyV9 and KIPyV specific antibodies. The levels of anti-HPyV antibodies remained stable across the age-groups, except for TSPyV and HPyV9, where we saw change with age. ELISAs based on VLP and GST-VP1 gave comparable seroprevalence for HPyV6 antibodies (88.2% vs.85.3%) but not for HPyV7 antibodies (65.7% vs. 77.2%), suggesting some degree of crossreactivity between HPyV6 and HPyV7 VP1 proteins. In conclusion, these results provide evidence that human polyomaviruses HPyV6, HPyV7, TSPyV, HPyV9, MwPyV, and KIPyV circulate widely in the Czech population and their seroprevalence is comparable to other countries.

[The ONSTEP inguinal hernia repair technique]

The ONSTEP (Open New Simplified Totally Extraperitoneal) inguinal/femoral hernia repair technique is an innovative procedure presented by Portuguese surgeons Augusto Lourenço and Rui Soares da Costa within the EHS/AHS Congress in March 2012. The first institutions to perform this kind of hernia surgery in the Czech Republic are the Department of Surgery at Prostejov Hospital and the Department of Surgery at Frydlant Hospital. The ONSTEP technique represents a minimally traumatizing frontal approach to inguinal hernia repair using a special self-expanding mesh patch (an oval, anatomically-shaped moderate-pore polypropylene mesh with the circumferential memory-ring consisting of polyethylene terephthalate). The main advantages of this method are: short duration of surgery, the possibility of performing the procedure under local anaesthesia, short recovery time and rapid return to daily activities, low incidence of chronic post-operative groin pain, low recurrence rate, short hospital stay, good cosmetic effect and a low price. It is suitable for institutions performing outpatient surgery.

Flexible hard nanocomposite coatings

The article reports on flexible hard nanocomposite coatings prepared by magnetron sputtering.

Planktonic or non-planktonic food in young-of-the-year European perch Perca fluviatilis in ponds

Higher biomass especially of some aquatic macrophyte species offered a higher density of phytophilous zoobenthos, but did not increase the proportion of non-planktonic to planktonic prey in young-of-the-year perch Perca fluviatilis. Both abundance and biomass of non-planktonic prey dominated over planktonic prey in the pond with lower biomass of aquatic macrophytes and lower food. Survival of P. fluviatilis was lower (20%) in the pond with lower food than in the other pond (34%), however, specific growth rate (1.3% day(-1) ) and final Fulton's condition factor of P. fluviatilis were similar in both ponds.

Nitrites and nitrates in exhaled breath condensate in cystic fibrosis: relation to clinical parameters

OBJECTIVES

To evaluate correlation of exhaled breath condensate (EBC) nitrite and nitrate concentrations with disease severity in cystic fibrosis (CF) patients.

BACKGROUND

Nitrites and nitrates are products of oxidative metabolism of nitric oxide. Impaired metabolism of nitric oxide plays a role in pathogenesis of CF.

METHODS

EBC was collected from 46 stable CF patients and from 21 healthy controls. EBC concentrations of nitrites and nitrates were correlated with parameters of lung disease and nutritional status and with systemic inflammatory markers.

RESULTS

EBC nitrates concentrations in CF patients were lower than in healthy subjects (5.8 vs 14.3 μmol/l, p<0.001). They correlated positively with FEV1 (p=0.025) and serum albumin values (p=0.016) and negatively with chest radiograph Northern score (p=0.015) and serum C-reactive protein values (p=0.005). EBC nitrites concentrations in CF patients did not differ from those in healthy subjects and were not correlated to any studied parameter.

CONCLUSIONS

EBC nitrates concentrations correlate with disease severity in CF patients and are lower than in healthy subjects (Tab. 4, Fig. 1, Ref. 48).

Probably the oldest patient with the diagnosis of medullar conus teratoma

BACKGROUND

Authors present a case report of a 60 year old patient suffering from several movement and sensitivity disorders lasting for several months. On magnetic resonance scans a huge extramedular intradural structure was described. Patient underwent three operations and the same number of histological investigations. Furthermore we have performed bacteriological investigations because of the presence of suspicious pus during the surgery.

RESULTS

Even after the third investigation the evidence of mature teratoma has been established. After successful passing of three surgeries, the patient has no sphincter disorders and she is able to walk with the sticks and she has only small sensitivity deterioration.

CONCLUSION

All forms of teratoma are chemo- and radioresistent, so beside total extirpation we have no relevant possibilities to cure this tumour. The size of the extirpation is mostly limited by the time of appearance, the size of the tumour and by the potential damages of the normal spinal cord tissue, which could be protected by using neurophysiology (Fig. 3, Ref. 9).

[Twenty years of care for cystic fibrosis adults in Czech Republic]

INTRODUCTION

Most of cystic fibrosis (CF) patients survive now into adulthood and they are transferred to pulmonologist care.

AIMS

An overview of progress in care for CF adults in Czech Republic and evaluation of relationship of pulmonary function, nutritional status and airway colonization.

METHODS

All adult CF patients followed in pulmonary departments from December 1987 to December 2007 were included into study. Data about survival status, pulmonary function, nutritional status, airway colonization and other pulmonary and extrapulmonary manifestations of CF were collected from patients' records.

RESULTS

Total of 206 patients (96 females) were followed. Pancreatic insufficiency was present in 175 (85.0%), liver disease in 61 (29.6%) and insulin treatment in 58 (28.2%) patients. Bone disease was found in 70 (46.7%) from 150 examined patients. Sixty-two patients (23 females) died at mean age 25.4 +/- 5.5 years (median 24.3 years). Worse survival was recorded in patients with Burkholderia cepacia complex (BCC) airway colonization (24.4 +/- 4.0 vs 28.5 +/- 7.0 years, p = 0.012). One hundred forty-four living patients were followed to date of the 31st December 2007 with mean age 27.5 +/- 6.5 years (median 26.5 years), FEV1 64.4 +/- 28.5% pred. and BMI 20.9 +/- 3.1 kg/m2. Worse pulmonary function was present in patients with BCC colonization (FEV1 58.8 +/- 21.9 vs 67.8 +/- 27.3% pred., p = 0.041) and in malnourished patients (FEv1 49.5 +/- 18.5 vs 69.7 +/- 25.9% pred., p < 0.0001). BCC colonization was found in 54 (37.5%), Pseudomonas aeruginosa (PA) colonization in 92 (63.9%) and colonization without BCC or PA in 40 (27.8%) patients, respectively. Malnutrition (BMI < 19.0 kg/m2) was recorded in 38 (26.4%) patients.

CONCLUSION

This study confirms growing number of CF adults in Czech Republic, close relationship of pulmonary function and nutritional status and also unfavourable influence of BCC colonization.

Two-Functional Direct Current Sputtered Silver-Containing Titanium Dioxide Thin Films

The article reports on structure, mechanical, optical, photocatalytic and biocidal properties of Ti-Ag-O films. The Ti-Ag-O films were reactively sputter-deposited from a composed Ti/Ag target at different partial pressures of oxygen pO(2) on unheated glass substrate held on floating potential U(fl). It was found that addition of ~2 at.% of Ag into TiO(2) film has no negative influence on UV-induced hydrophilicity of TiO(2) film. Thick (~1,500 nm) TiO(2)/Ag films containing (200) anatase phase exhibit the best hydrophilicity with water droplet contact angle (WDCA) lower than 10° after UV irradiation for 20 min. Thick (~1,500 nm) TiO(2)/Ag films exhibited a better UV-induced hydrophilicity compared to that of thinner (~700 nm) TiO2/Ag films. Further it was found that hydrophilic TiO(2)/Ag films exhibit a strong biocidal effect under both the visible light and the UV irradiation with 100% killing efficiency of Escherichia coli ATCC 10536 after UV irradiation for 20 min. Reported results show that single layer of TiO(2) with Ag distributed in its whole volume exhibits, after UV irradiation, simultaneously two functions: (1) excellent hydrophilicity with WDCA < 10° and (2) strong power to kill E. coli even under visible light due to direct toxicity of Ag.

High-rate low-temperature dc pulsed magnetron sputtering of photocatalytic TiO2films: the effect of repetition frequency

The article reports on low-temperature high-rate sputtering of hydrophilic transparent TiO2thin films using dc dual magnetron (DM) sputtering in Ar + O2mixture on unheated glass substrates. The DM was operated in a bipolar asymmetric mode and was equipped with Ti(99.5) targets of 50 mm in diameter. The substrate surface temperature Tsurfmeasured by a thermostrip was less than 180 °C for all experiments. The effect of the repetition frequency frwas investigated in detail. It was found that the increase of frfrom 100 to 350 kHz leads to (a) an improvement of the efficiency of the deposition process that results in a significant increase of the deposition rate aDof sputtered TiO2films and (b) a decrease of peak pulse voltage and sustaining of the magnetron discharge at higher target power densities. It was demonstrated that several hundreds nm thick hydrophilic TiO2films can be sputtered on unheated glass substrates at aD = 80 nm/min, Tsurf < 180 °C when high value of fr = 350 kHz was used. Properties of a thin hydrophilic TiO2film deposited on a polycarbonate substrate are given.

[Treatment principle of the chronic obstructive pulmonary disease (COPD) exacerbation]

COPD is often accompanied with acute symptoms exacerbations. Patients in Ist stage: slide grade of COPD and IInd stage: middle grade of COPD suffer exacerbations accompanied with increased dyspnoea often together with increased cough and increased production of sputum. Patients in IIIrd stage (serious) and IVth stage (very serious) experience during exacerbations development of respiration insufficiency or its worsening and thus are usually treated in hospital. The most frequent causes of exacerbations are tracheobronchial tree infections and air pollution. The cause of approximately one third of serious exacerbations is not disclosed. Conditions which can resemble acute exacerbation are pneumonia, congestive heart failure, pneumothorax, pleural exudation, pulmonary embolism, and arrhythmia. Exacerbation treatment is symptomatic. Obstruction symptoms are treated with bronchodilatants and corticosteroids administration, hypoxemia with oxygen administration and signs of bacterial infection with antibiotics.

[Pathogenesis of the chronic obstructive pulmonary disease (COPD)]

An inflammation in the bronchial wall is usually present already in an early stage of the disease. An inflammatory infiltration cause predominantly mononuclear cells in the mucous membrane and neutrophiles in the phlegm produced by airways. Also eosinophiles can participate in the inflammation. Lymphocytes distribution is different from asthma because there is mainly submucosa infiltrated in COPD. Metaplasia of goblet cells appears. Chronic bronchial obstruction characterizing COPD is induced by conjunction of small airways disease (obstructive bronchiolitis) and a destruction of pulmonary parenchyma (emphysema) which both contribute to an impairment and differ form person to person. Chronic inflammation is a cause of remodeling and narrowing of small airways. Destruction of pulmonary parenchyma and the inflammation cause loss of alveolar connection with small airways and elastic pulmonary stress decreases. Two theories try to explain COPD--a theory of imbalance between proteinases and antiproteinases and a theory of oxidation stress.

[Lead systems in orthogonal electrocardiography]

The paper deals with evaluating quality of some orthogonal and pseudoorthogonal electrocardiographic lead systems as Frank lead system, signals derived from standard electrocardiographic leads by Levkov's transform and some signals of the standard 12 lead system that roughly fulfill condition of geometrical orthogonality. The signals of the lead systems were assessed by means of a mathematical criterion of two vector orthogonality which was originally proposed for purposes of electrocardiography and proved by Netusil. Experiments done with signals of the CSE database of short-time rest ECG records have revealed that the best ECG lead orthogonality has been found for signal sets of I-aVF-V2, and I-III-V2 leads, resp. Unfortunately nearly the worst results were obtained for the widely used Frank orthogonal lead system. It means that this lead system can lead (under some specific conditions) to missing diagnostically important information.

[A simple stereotaxic surgical apparatus]

A simple apparatus based on the classical stereotactic method of surgery offers the opportunity to master miniinvasive procedures in neurosurgery and neurotraumatology. This device is particularly helpful in evacuation of intracerebral spontaneous and traumatic haematomas and in stereobiopsies, i.e. the most frequent operations in clinical practice, without the need of general anaesthesia, craniotomy and interference with cerebral tissue. The reliability of the stereotactic apparatus was positively evaluated by three independent surgeons. The apparatus was registered for use in the health services.

[Is nebulized ipratropium bromide effective in the treatment of exacerbations of chronic obstructive pulmonary disease?]

The author administrated to 20 patients hospital on account of exacerbation of chronic obstructive pulmonary disease nebulized ipratropium bromide 0.5 mg on admission. Nebulized was repeated, using the same dose after 30 mins. The PEF value increased significantly after the first and second nebulization. After the two nebulizations dyspnoea was alleviated. The value of the respiration rate was significantly lower after both nebulizations as compared with the value before treatment. PaO2 increase significantly as compared with the value before treatment. PaO2 and the pulse rate did not change. An undesirable effect was recorded in one patient. Ipratropium bromide administration in effective and safe.

Acute effects of using a mobile phone on CNS functions

Twenty volunteers participated in two experiments exploring the acute effects of using the mobile phone Motorola GSM 8700 on the functions of the CNS. When speaking (5 minutes reading a text from daily newspapers) the electromagnetic fields from the mobile apparatus did not affect the visual evoked potentials. Also a 6-min exposure did not reveal any effect of electromagnetic fields on the results in two tests (memory and attention) performed while speaking into the mobile. On the other hand the phone call itself strongly influenced the performance in a secondary task applying a test of switching attention which is a good model for driving a car. The response and decision speed were significantly worse. This is a proof that even a slight psychological stress involved in calling while driving can be a great risk.

[The effect of ambulatory nutritional intervention using defined enteral nutrition on the nutritional status of selected adult patients with cystic fibrosis]

The prevalence of mild and serious nutritional disorders in patients with cystic fibrosis is high. One of the possible ways how to supplement the necessary nutrients is the administration of defined supplementary enteral nutrition. The objective of the presented work is to evaluate the effect of supplementary domiciliary enteral nutrition in adult patients with cystic fibrosis. To eight patients with cystic fibrosis, mean body weight 51.77 +/- 10.63 kg, mean age 24.7 +/- 1.9 years for a period of 6 +/- 1 months enteral nutrition was administered (containing 40 and 55.1% energy as fat) with a caloric density of 10 kcal/kg as supplementary domiciliary nutrition. The mean body weight increased from 51.77 +/- 10.63 to 53.13 +/- 10.59 kg (p < 0.02), the mean skinfold thickness increased from 7.98 +/- 6.04 to 8.65 +/- 6.30 mm (p < 0.05) and the mean serum albumin concentration increased from 33.66 +/- 0.97 to 37.29 +/- 3.33 g/l (p < 0.05). No undesirable side-effect associated with the administration of enteral nutrition were observed. The nutritional intervention by domiciliary enteral nutrition produced no undesirable side-effects and led to a statistically significant improvement of parameters of the nutritional status.

[What dosage is sufficient in combined inhalation therapy (fenoterol + ipratropium bromide) in patients with exacerbation of chronic obstructive lung disease?]

The authors compared in a prospective study the bronchodilatating and undesirable effects of combined inhalation treatment (phenoterol + ipratropium bromide) in the treatment of patients with exacerbation of chronic obstructive pulmonary disease, using different dosages. The patients were divided at random into two groups--group one inhaled berodual sol 3.5 ml/day (i.e. 1.75 mg phenoteroli + 0.875 mg ipratropii bromidium), the second group had a dose of double size. During the trial the authors monitored the peak expiration rate, the heart and respiration rate, blood gases and the subjective state of dyspnoea, using a 10 cm line. By comparison of bronchodilatating and undesirable effects they reached the conclusion that a daily dose of 3.5 ml berodual sol. is sufficiently effective. Increasing the daily dose to 7 ml did not produce a greater therapeutic effect nor increase the risk of undesirable effects.

[10 years' of care of adult patients with cystic fibrosis]

The authors summarized the results of ten years care of adult patients with cystic fibrosis (CF). They treated a total of 45 patients incl. 26 men and 19 women. Nineteen patients (42%) died. The most frequent cause of admission to hospital was respiratory infection (84%), planned antibiotic treatment (6.5%), pneumothorax (6%) and haemoptysis (4%). In all patients impaired ventilation of the obstructive type was found. The mean annual decline of FEV1 was 0.173 +/- 0.194 l, VC 0.303 +/- 0.323 l. The authors did not find a significant difference between live and dead patients. The mean annual increase of PaCO2 was 0.5 +/- 0.87 kPa, the mean annual decrease of PaO2 was 0.6 +/- 0.96 kPa. The difference of values in dead and live patients was significant. CF still remains an incurable disease. It is, however, possible by comprehensive treatment to prolong the patients life and to improve its quality.