Lower Preoperative Verbal Memory Performance Is Associated with Delirium after Coronary Artery Bypass Graft Surgery: A Prospective Cohort Study

OBJECTIVE

Cognitive impairment constitutes one of the major risk factors of delirium after coronary artery bypass graft (CABG) surgery; however, it is unclear whether only patients with global cognitive decline are at increased risk for delirium or if individuals with preserved global cognitive functions but impairments in specific cognitive domains are also more vulnerable to developing delirium. Thus, this study aimed to analyze the neurocognitive status of patients scheduled for CABG surgery with the use of an advanced computerized cognitive battery (CNS Vital Signs) and to investigate possible associations between impaired performance in selective cognitive areas and the risk of postoperative delirium development.

METHODS

The study enrolled 127 participants with a median age of 67 years (IQR: 63-71). Postoperative delirium developed in 32 (25%) patients.Before surgery, the patients were screened for global cognitive impairment with the use of the Mini-Mental State Examination Test, and the individuals were asked to perform the CNS Vital Signs battery to investigate 12 specific cognitive domains. The Confusion Assessment Method and the Memorial Delirium Assessment Scale were used to screen for a diagnosis of delirium postoperatively.

RESULTS

In multivariate models, a lower score of verbal memory-assessed preoperatively was independently associated with the risk of postoperative delirium development. Other independent predictors of delirium included more advanced age, gender female, depression, postoperative pyrexia, and the presence of extracorporeal circulation.

CONCLUSIONS

As decreased verbal memory constitutes an independent risk factor for postoperative delirium, a verbal memory test may be a useful predictor of postoperative delirium development.

The astrophysical S-factor for dd-reactions at keV-energy range

The experimental results of measurements of the astrophysical S-factor for dd-reaction at keV-energy range collision energies using liner plasma technique are presented. The experiments were carried out at the high current generator of the Institute of High-Current Electronics in Tomsk, Russia. The measured values of the S-factors for the deuteron collision energies 1.80, 2.06 and 227 keV are S d d = ( 114 ± 68 ) , ( 64 ± 30 ) , ( 53 ± 16 ) b ⋅ k e V , ${{S}_{dd}}=(114\pm 68),(64\pm 30),(53\pm 16)b\cdot keV,$ respectively. The corresponding cross sections for dd-reactions, described as a product of the barrier factor and measured astrophysical S-factor, are σ d d n ( E c o l = 1.80 keV ) = ( 4.3 ± 2.6 ) . $\sigma _{dd}^{n}\left( {{E}_{col}}=1.80\text{keV} \right)=(4.3\pm 2.6).$ 10 − 33   c m 2 ; σ d d n ( E c o l = 2.06 keV ) = ( 9.8 ± 4.6 ) ⋅ 10 − 33   c m 2 ; σ d d n ( E c o l = ${{10}^{-33}}~c{{m}^{2}};\sigma _{dd}^{n}\left( {{E}_{col}}=2.06\text{keV} \right)=(9.8\pm 4.6)\cdot {{10}^{-33}}~c{{m}^{\text{2}}};\sigma _{dd}^{n}\left( {{E}_{col}}= \right.$

Oxidative stress and soluble receptor for advanced glycation end-products play a role in the pathophysiology of delirium after cardiac surgery

Coronary-artery bypass graft (CABG) surgery is known to improve cardiac function and decrease mortality, albeit, this method of treatment is also associated with a neuropsychiatric complications including postoperative delirium. The pathophysiology of delirium after cardiac surgery remains poorly understood. Thus, the purpose of this study was to investigate whether oxidative stress reflected by decreased preoperative and postoperative plasma antioxidant activity is independently associated with delirium after cardiac surgery. The second aim was to assess whether decreased antioxidant activity is stress-related or mediated by other pathologies such as major depressive disorder (MDD), anxiety disorders, and cognitive impairment. Furthermore, the putative relationship between pre- and postoperative soluble receptor for advanced glycation end-products (sRAGE) overexpression and plasma antioxidant capacity was evaluated. The patients cognitive status was assessed 1 day preoperatively with the use of the Mini-Mental State Examination Test and the Clock Drawing Test. A diagnosis of MDD and anxiety disorders was established on the basis of DSM-5 criteria. Blood samples for antioxidant capacity and sRAGE levels were collected both preoperatively and postoperatively. The Confusion Assessment Method for the Intensive Care Unit was used within the first 5 days postoperatively to screen for a diagnosis of delirium. Postoperative delirium was diagnosed in 34% (61 of 177) of individuals. Multivariate logistic regression analysis revealed that low baseline antioxidant capacity was independently associated with postoperative delirium development. Moreover, increased risk of delirium was observed among patients with a preoperative diagnosis of MDD associated with antioxidant capacity decreased postoperatively. According to receiver operating characteristic analysis, the most optimal cutoff values of the preoperative and postoperative antioxidant capacity that predict the development of delirium were 1.72 mM and 1.89 mM, respectively. Pre- and postoperative antioxidant capacity levels were negatively correlated with postoperative sRAGE concentration (Spearman's Rank Correlation − 0.198 and − 0.158, p < 0.05, respectively). Patients with decreased preoperative antioxidant activity and those with depressive episodes complicated with lower postoperative antioxidant activity are at significantly higher risk of delirium after cardiac surgery development. sRAGE overexpression may be considered as protective mechanism against increased oxidative stress and subsequent cell damage.

Extent of the frontal sinuses in the aspect of neurosurgical craniotomy approaches

BACKGROUND

Frontal sinuses within the frontal bone can be a potential obstacle in neurosurgical approach in this region. Their unintended opening during craniotomy is not beneficial due to the risk of brain infections by bacteria inhabiting the sinus mucosa. Therefore, such opening should be avoided whenever the surgical procedure does not involve the sinus itself. The aim of the study was the morphometric analysis of the frontal sinuses based on computed tomography imaging.

MATERIALS AND METHODS

The width, height, projection surface area and location of the highest and most lateral points of the sinuses were determined.

RESULTS

The vertical diameter of the sinuses was found to be greater in men compared with women. The most lateral point of the sinuses was located higher in men, and in men was located higher on the left side. The results obtained may indicate that the frontal sinuses tend to be larger in men and that air cells in men extend further in the upper-lateral direction on the left side of the frontal bone.

CONCLUSIONS

This may cause an increased risk of unintentional opening of the left frontal sinus during frontal craniotomy or pterional craniotomy with frontal extension.

Incremental processing of polymer materials using the INDUSTRY 4.0 network structure

The article presents the possibility of incremental processing of polymeric materials using the network structure of INDUSTRY 4.0. The selected network control systems for 3D printers processing polymer materials were analyzed in terms of software and hardware identification used in industrial conditions, science and education. Both solutions requiring continuous data exchange between the controlling computer and the 3D printer as well as systems dedicated to control with the use of a computer network were taken into account. The possibilities of adapting 3D printers to work in the remote control mode and control of the incremental process are presented. The possibilities of developing processes related to 3D printing based on remote control using network systems were also determined.

Methodology for the Quality Control Process of Additive Manufacturing Products Made of Polymer Materials

The objective of this publication is to present a quality control methodology for additive manufacturing products made of polymer materials, where the methodology varies depending on the intended use. The models presented in this paper are divided into those that are manufactured for the purpose of visual presentation and those that directly serve the needs of the manufacturing process. The authors also a propose a comprehensive control system for the additive manufacturing process to meet the needs of Industry 4.0. Depending on the intended use of the models, the quality control process is divided into three stages: data control, manufacturing control, and post-processing control. Research models were made from the following materials: RGD 720 photopolymer resin (PolyJet method), ABS M30 thermoplastic (FDM method), E-Partial photopolymer resin (DLP method), PLA thermoplastic (FFF method), and ABS thermoplastic (MEM method). The applied measuring tools had an accuracy of at least an order of magnitude higher than that of the manufacturing technologies used. The results show that the PolyJet method is the most accurate, and the MEM method is the least accurate. The findings also confirm that the selection of materials, 3D printing methods, and measurement methods should always account not only for the specificity and purpose of the model but also for economic aspects, as not all products require high accuracy and durability.

Elevated Monocyte Chemoattractant Protein-1 as the Independent Risk Factor of Delirium after Cardiac Surgery. A Prospective Cohort Study

BACKGROUND

The pathogenesis of postoperative delirium is largely unknown. The primary objective of this study is to assess whether increased levels of monocyte chemoattractant protein-1 (MCP-1) and high-sensitivity C-reactive protein (hsCRP) are associated with postoperative delirium in patients who have undergone cardiac surgery. The secondary objective is to investigate whether any association between raised inflammatory biomarkers levels and delirium is related to surgical and anesthetic procedures or mediated by pre-existing psychiatric conditions associated with raised pro-inflammatory markers levels.

METHODS

The patients were screened for cognitive impairment one day preoperatively with the use of the Mini-Mental State Examination Test and the Clock Drawing Test. A diagnosis of major depressive disorder (MDD) and anxiety disorders was established on the basis of Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria. Blood samples were collected pre- and postoperatively for hsCRP and chemokine levels.

RESULTS

Postoperative delirium developed in 34% (61 of 177) of patients. Both pre- and postoperative hsCRP, and preoperative MCP-1 levels were associated with postoperative delirium in univariate comparisons; p = 0.001; p < 0.001; p < 0.001, respectively. However, according to a multivariable logistic regression analysis, only a raised MCP-1 concentration before surgery was independently associated with postoperative delirium, and related to advancing age, preoperative anxiety disorders and prolonged intubation.

CONCLUSIONS

The present study suggests that an elevated preoperative MCP-1 concentration is associated with delirium after cardiac surgery. Monitoring of this inflammatory marker may reveal the cardiovascular disease (CVD) patients who are at risk of neuropsychiatric syndromes development.

Antioxidant capacity as a novel biomarker of delirium after cardiac surgery

Introduction

Coronary-artery bypass graft (CABG) surgery is known to improve cardiac function and decrease mortality, albeit, this method of treatment is associated with a high risk of postoperative delirium. The pathophysiology of delirium after cardiac surgery is largely unknown.

Objectives

To investigate whether oxidative stress reflected by decreased preoperative and postoperative plasma antioxidant capacity (AC) is independently associated with delirium after cardiac surgery. Furthermore, to assess whether the association between AC and the level of soluble receptor for advanced glycation end-products (sRAGE) exists.

Methods

The patients were examined 1 day preoperatively with the Mini International Neuropsychiatric Interview and MMSE test to screen for depression, anxiety disorders, and for cognitive impairment, respectively. Blood samples for AC and sRAGE levels were collected both preopertively and postoperatively. The CAM ICU and MDAS were used within the first 5 days postoperatively to screen for a diagnosis of delirium.

Results

Postoperative delirium developed in 34% (61 of 177) of participants. Multivariate stepwise logistic regression analysis revealed that patients with low baseline AC are at significantly increased risk of developing delirium. Moreover, preoperative AC levels were inversly correlated with postoperative sRAGE concentrations (Spearman’s Rank Correlation -0.198; p<0.05). The most optimal cutoff values of the preoperative and postoperative AC that predict the development of delirium were 1.720 mM and 1.893 mM, respectively.

Conclusions

Decreased plasma AC levels are associated with delirium after cardiac surgery and inversly correlated with post-surgery sRAGE concentration. This may be an important pathophysiological consideration in the increased risk of postoperative delirium seen in cardiac surgery patients.

Raised preoperative monocyte chemoattractant protein-1 as the independent predictor of delirium after cardiac surgery. A prospective cohort study

Introduction

Delirium is a frequent and serious complication of cardiac surgery. However, the knowledge regarding pathogenesis of postoperative delirium is limited.

Objectives

To investigate whether increased levels of monocyte chemoattractant protein-1 (MCP-1) and hyper-sensitive C-Reactive Protein (hsCRP) are associated with postoperative delirium in cardiac surgery patients.

Methods

Patients were examined and screened for major depressive disorder (MDD) and cognitive impairment one day preoperatively, using the Mini International Neuropsychiatric Interview and The Mini-Mental State Examination Test. Blood samples were collected pre- and postoperatively for hsCRP and chemokine levels. Following surgical interventions, the Confusion Assessment Method for the Intensive Care Unit and the Memorial Delirium Assessment Scale with the cut-off score 10 were used to diagnose delirium.

Results

Postoperative delirium screening was found positive in 34% (61 of 177) of patients. Both, pre- and postoperative hsCRP, and preoperative MCP-1 levels were associated with postoperative delirium in univariate comparisons; p=0.001; p=0.0004; p < 0.001, respectively. However, according to a multivariate stepwise logistic regression analysis only MCP-1 concentration raised before surgery was independently associated with postoperative delirium, and related to advancing age of participants (Spearman’s Rank Correlation 0.192; p=0.0103). According to ROC analysis, the most optimal cut-off for MCP-1 concentration in predicting the development of delirium was 371.81 ng/ml with sensitivity of 77.0% and specificity of 58.6%.

Conclusions

The present study suggests that raised preoperative MCP-1 concentration is independently associated with delirium after cardiac surgery. Preoperative monitoring of pro-inflammatory markers combined with regular surveillance may be helpful in the prediction and early detection of postoperative delirium in this patient group.

[Viral transfer of tumor necrosis factor-related apoptosis-inducing ligand (TRAIL) in gene therapy]

Tumor necrosis factor-related apoptosis-inducing ligand (TRAIL) selectively induces carcinoma cell death through the extrinsic pathway of apoptosis. Preclinical trials of gene therapy have been conducted using viral transfer of the TRAIL transgene into prostate, bladder, breast, kidney, liver, non-small cell lung cancer and also glioblastoma cells. Experiments in vitro demonstrated the extensive apoptosis of target cells as well as frequent disease regression or remission. TRAIL transfer did not show any side effects, opposite to chemotherapy. Encouraging results of TRAIL-related gene therapy were observed in rheumatoid arthritis and type 1 diabetes. Adenoviral vectors (AdV) encoding TRAIL are the most promising tool in anti-tumor therapy. They have undergone numerous modifications by increasing transfection efficiency and transgene expression in target cells. However, only one clinical phase I trial has been performed. AdV encoding the TRAIL transgene caused local inflammation and apoptosis in patients with prostate cancer.

Plasma antithrombin III and protein C levels in early recognition of late-onset sepsis in newborns

OBJECTIVE

The aim of this prospective, observational study was to establish the prognostic values of plasma antithrombin III (ATIII) and protein C (PC) functional levels, determined in 150 neonates with suspected late-onset sepsis.

OBSERVATIONS

Both the ATIII and PC concentrations were significantly lower in neonates with sepsis, either confirmed or not confirmed by blood culture, than data obtained in infants with excluded disease. The lowest values of plasma ATIII and PC were observed in neonates who had died in the course of sepsis. The differences between survivors and non-survivors were statistically significant (respectively, for ATIII P=0.003 and for PC P=0.00002). A highly statistically significant correlation (P=0.0016) between plasma PC functional level and risk of death was found in patients with sepsis. However, plasma ATIII concentration, evaluated in the same group of patients, did not correlate with the occurrence of death.

CONCLUSION

We concluded that the measurement of plasma ATIII and, especially, PC levels may facilitate the recognition of sepsis and, with respect to PC, may have a prognostic value. Plasma PC functional concentration below 10% might be the indication for supplementation of PC concentrate.

[Influence of ureaplasma infection on the clinical state of newborns]

The aim of this study was the analysis of the clinical state of newborns infected with various species of ureaplasma.

METHODS

50 prematurely born patients with respiratory disturbances and confirmed presence of ureaplasma in the respiratory tract were analyzed. Endotracheal aspirates were collected for examination. Presence of ureaplasma was confirmed by culture and a commercial test (Biomerieux), the ureaplasma species were identified using PCR.

RESULTS

In 40 examined newborns Ureaplasma parvum (U.p.) was found, in 10 Ureaplasma urealyticum (U.u.). Newborns infected with U.u. were subject to more frequent and longer therapeutic procedures supporting respiration (respirator, nCPAP), needed more frequent surfactant and antibiotic administration. In the mentioned group the mortality rate was 33%, while in newborns infected with U.p. it was 15%.

CONCLUSIONS

Initial results suggest worse clinical status and higher mortality of prematurely born infected with Ureaplasma urealyticum.

Association of stem cell factor expression in nasal polyp epithelial cells with aspirin sensitivity and asthma

Mast cells constitute a significant proportion of cells infiltrating nasal polyp tissue, and epithelial cells may release stem cell factor (SCF), a cytokine with chemotactic and survival activity for mast cells. We aimed to assess the expression of SCF in human nasal polyp epithelial cells (NPECs) as related to patients' clinical phenotypes. Nasal polyp tissues were obtained from 29 patients [including nine with aspirin (ASA)-hypersensitivity and 12 with bronchial asthma] undergoing polypectomy for nasal obstruction. Epithelial cells were obtained following 6-week culture of nasal polyps explants. The SCF released into the culture supernatant was assessed by enzyme-linked immunosorbent assay (ELISA) and total SCF mRNA in the polyp tissue was determined by semiquantitative reverse transcriptase polymerase chain reaction (RT-PCR). For the whole group of patients, the number of polypectomies correlated with expression of SCF mRNA (r = 0.62; P < 0.005), SCF protein in the NPECs supernatants (r = 0.39; P < 0.05) and with density of mast cells in epithelial layer (r = 0.37; P < 0.05) and stromal layer (r = 0.5; P < 0.01) of nasal polyps. The SCF/beta-actin mRNA ratios were significantly higher in ASA-hypersensitive (AH) asthmatics (median 0.97, range: 0.8-1.5) when compared with ASA-tolerant (AT) patients (median 0.5, range: 0.1-0.7; P < 0.001). The SCF protein concentration in NPEC supernatants was also significantly higher in AH asthmatics (median 1.10 pg/microg DNA, range: 0.4-1.9) when compared with AT patients (median 0.1 pg/microg DNA, range: 0.02-1.2; P < 0.001). In the subpopulation of ASA-sensitive asthmatics the number of polypectomies correlated also with the density of mast cells and eosinophils in the polyp tissue.

Serum tumor necrosis factor alpha receptors p55/p75 ratio and ovarian cancer detection

OBJECTIVE

Early ovarian cancer detection is still very difficult and patients are mostly in advanced stages, with obvious influence on poor prognosis.

METHOD

Fifty-one ovarian cancer patients and 16 healthy controls had the serum concentrations of TNF alpha receptor p55, p75 and CA-125 measured prospectively and preoperatively.

RESULT

Mean concentrations of TNF alpha receptor p55, p75 and CA-125 in patients with ovarian cancer were higher than in controls. The ratios of p55 and p75 receptor in ovarian cancer and controls were 0.73+/-0.38 and 0.55+/-0.06 respectively. The areas under ROC curve in detecting malignancy (all FIGO stages) were 0.73, 0.65, 0.88 and 0.85 for p55, p75, p55/p75 ratio and CA-125 respectively. The areas under ROC curve in detecting stage I of ovarian cancer were 0.52, 0.60, 0.84 and 0.66 for p55, p75, p55/p75 ratio and CA-125 respectively.

CONCLUSION

Serum TNF alpha p55/p75 ratio showed promising value in ovarian cancer detection.

Evaluation of soluble tumour necrosis factor alpha receptors p55 and p75 in ovarian cancer patients

PURPOSE

Evaluation of serum TNFalpha receptor 1 (p55) and 2 (p75) concentrations preoperatively in patients with ovarian masses.

METHODS

Estimation by ELISA assay in 51 women with ovarian cancer and 16 healthy controls. Mean values and correlations with CA-125, tumour volume index, morphological score, pathological finding and cytoreduction were estimated.

RESULTS

Mean concentrations of p55 and p75 in cancer patients were 2006 +/- 1030 pg/ml and 2849 +/- 1092 pg/ml, respectively, whereby for controls 1323 +/- 291 pg/ml and 2386 +/- 475 pg/ml, respectively. The area under the ROC curve for CA-125, p55 and p75 for cancer (FIGO Stages I-IV) were: 0.85 (95% CI 0.75-0.92), 0.73 (95% CI 0.60-0.83) and 0.65 (95% CI 0.50-0.77), respectively. Serum p55 correlated with morphological ultrasound score and CA-125 but not with FIGO stage, tumour grade or tumour volume index. No correlations of p75 with these parameters were observed.

CONCLUSION

Estimation of p55 and p75 provide little information in ovarian cancer patients and have poor detecting power.

Evaluation of soluble intracellular adhesion molecule-1 (sICAM-1) in benign and malignant ovarian masses

PURPOSE

To evaluate serum ICAM-1 levels preoperatively in patients with ovarian masses.

METHODS

Estimation by ELISA assay in 101 women with pelvic tumours and 16 healthy controls was performed. Correlations of sICAM-1 levels with CA-125, Tumour Volume Index, morphological score and pathological findings were studied.

RESULTS

Fifty-one ovarian tumours were malignant, five were borderline and 45 benign. Mean levels of sICAM-1 were respectively, 311.1 +/- 182.9 ng/ml, 172.6 +/- 40.1 ng/ml, 241.8 +/- 74.1 ng/ml and 195.6 +/- 68.7 ng/ml for controls. The area under ROC curve for sICAM-1 was 0.72 (95% CI 0.58-0.82), the cut-off 250 ng/ml, corresponding to 81.3% sensitivity and 52.9% specificity. Serum ICAM-1 correlated with morphological score (r = 0.51, p < 0.001), but not with FIGO stage, tumour grade, Tumour Volume Index and CA-125.

CONCLUSION

sICAM-1 concentrations are higher in patients with malignant tumours, but poorly correlate with clinical status. The clinical use alone in ovarian malignancy detection and tumour differentiation seems to have limited application. Combinations of CA-125 and sICAM-1 could improve the test characteristics.

[The assessment of food intake and declared satisfaction in medical students]

Proper nutrition is one of the basic factors of the external environment which substantially influence the assurance and upkeep of a one's good state of health until old age. For students of medicine, i.e. prospective doctors, acquisition of knowledge and clinical experience should be accompanied by raising qualifications in the field of preventive treatment so that in future they can not only cure but also promote health. The aim of the present study was to analyse students' nutrition habits and to evaluate the declared satisfaction with the way of feeding. In preparation of the present paper the author used anonymous questionnaire method employing an inquiry form. The research included 416 students of the 4th and 5th years of study of the Medicine Department and 3rd and 4th year students of the Stomatology Division in 2001-2002 years. In the female group one could observe a larger consumption of vegetables and fruit, dairy products, poultry, fish and seeds of leguminous plants. Men more often eat animal fat and red meat. The analysis of the number of meals eaten shows that majority of women eat only one hot meal a day and do not eat supper. Whereas men twice as often do not eat breakfasts, they eat two or more hot meals a day and 70% of them declare they eat supper. Every second questioned person eats sweetmeats even several times a day, and only 7.7% of the population does not have the habit of intermittent eating. Analysis of the research material allowed to draw the following conclusions: 1. There is a statistically significant interdependence between the amount and quality of consumed food and the sex. 2. Women's nutritious habits are more adequate than men's nutrition habits to the dietetic prescriptions of the Institute of Food and Nutrition]. 3. Most of the men are satisfied with their nutritious habits, and the dissatisfied group is dominated by women. 4. The obtained results point to a necessity to work out and implement pro-health education within the field of young people's nutrition.

Differential distribution of estrogen receptor-beta and estrogen receptor-alpha in the porcine ovary

Steroids act on the follicle through autocrine and paracrine mechanisms to regulate follicular growth and steroidogenesis. Estradiol plays a significant role in determining the fate of the developing follicle and acts via specific receptors which are nuclear transcription factors. It has been established that besides classical estrogen receptor-alpha (ER alpha) novel forms termed ER beta exist. In species studied to date these two types of ERs exhibit different tissue localisation patterns and levels of expression. The present study was performed to determine whether ER alpha and ER beta are differentially expressed in the porcine ovary. Immunohistochemical studies using antibodies to ER alpha and ER beta, established the predominance of ER beta over ER alpha in the porcine ovary. Cyclical changes in estrogen receptor-beta expression were observed. The immunostaining was present in all types of follicles, and decreased in corpus luteum while it regressed. In the contrary estrogen receptor-alpha staining was seen only in large preovulatory follicle and in early corpora lutea.

[Current knowledge among students of the Silesian Medical Academy about the importance and role of medical care funds]

The purpose of this research was verification and comparison of the present state of knowledge among the students of different departments and years of study. The questions concerned the role of Medical Care Funds in the up-to-now healthcare system and the patient's rights as far as the students' future professions as doctors, dentists, healthcare managers and medical rescuers is concerned. The questionnaire included 15 questions referring to the problem of functioning of the medical care institutions after the reform of healthcare services introduced in 1999. Distinct from most of the published works of this kind, the authors adopted a uniform "assessment" method following the principles of didactic measurement. The researchers calculated: Range, Modal, Mediana, Arithmetic Average, Variance, Standard Deviation, Easiness of the Task, Difficulty of the Task, Skip Fraction, the Task's Differentiating Power, Reliability Coefficient of the Test. The calculation was conducted with the use of the Excel programme modified by the researchers to suit the needs of didactic measurement. The survey included 104 students of the 3rd year of Dental Department, 116 of the students 4th year of Dental Department, 31 students of Bachelor's Medical Rescue Studies by the Medical Department in Zabrze, 18 students of Post-Graduate Management and Administration in Healthcare by the Medical Department in Zabrze and Silesian Technical University, 151 4th year students of the Medical Department in Zabrze and 121 6th year students of the Medical Department in Zabrze. It has been proved that between the particular groups there are significant differences as far as the students' knowledge is concerned ("the healthcare managers" demonstrated quite a high knowledge ratio). And that the questions were at different difficulty levels depending on the branch and year of study represented by the respondents.

[Self-assessment of nutritinal status in medical students and objective measures of estimating somatic development]

Problem of "obesity epidemic" is still very common, but the knowledge about this is limited and it develops very slowly. Probably it even concerns medical students who are in touch with health problems every day and who will watch over society's health in the future. Available literature estimating people's health is mainly connected with negative measures of human health condition. Positive measures are rarely used, although they are simply in use and accessible (including financial accessibility). This kind of measures should be used in widest range to epidemiological investigation of obesity. The aim of the study was to estimate the level of medical student's obesity and to compare declared self-assessment expressed by BMI. In the research 416 III-VI year students of Medical University of Silesia were involved. We used a number of anonymous questionnaires to receive required information. We analyzed objective value of BMI, fat tissue capacity, student's self-assessment and student's satisfaction of their state of nutrition. Statistic analyzes were done using Epi Info v.5.01b program. Distribution of abnormal body weight among students under research was following: underweight--10.3% of the students, overweight--12% and II degree obesity--1.9% of investigated population. Among people with confirmed obesity only 100% of women realized this fact and 44.2% of men found their overweight as normal. Student's satisfaction of state of nutrition independently if it was proper or not, was significantly higher among men. It is necessary to teach students how to properly estimate the state of nutrition.

[Differentiation of students's knowledge of civilization-related diseases]

The goal of the study was to check and compare the current condition of students' knowledge on civilization-related diseases in relation to their future career as doctors, dentists, health care managers. The questionnaire consisted of 15 closed questions concerning civilization-related diseases. As opposed to majority of studies referring to this problem uniform method of assessment in accordance with the principles of didactic measurement was applied. The following test components were measured: Range, Mode, Median, Arithmetic Mean, Variance, Standard Deviation, Task Simplicity, Task Complexity, Reliability. Calculations were carried out using our own updated Excel programme. Study group consisted of 104 III year students of Division of Dentistry, 116 students of IV year Division of Dentistry, 31 students of Licentiate Faculty of Emergency Medicine in Zabrze, 18 students of Postgraduate Course in Management and Administration in Health Care Medical Faculty in Zabrze and Technical University in Gliwice, 151 IV year students of Medical Faculty in Zabrze and 121 VI year students of Medical Faculty in Zabrze. Significant differences between individual groups (surprisingly low level among future managers of health care) as well as different degree of difficulty of questions depending on the faculty and the year of study.

In comparison to progenitor platelets, microparticles are deficient in GpIb, GpIb-derived carbohydrates, glycerophospholipids, glycosphingolipids, and ceramides

Activated blood platelets shed microparticles with procoagulant activity that probably participate in normal hemostasis. We have isolated spontaneously formed microparticles from human blood and analysed them for ultrastructure, antigenic profile, and biochemical composition. In transmission electron microscopy microparticles appeared as regular vesicles with a mean diameter of 300 nm (50-600 nm). In flow cytometry almost all microparticles reacted with fluorescein isothiocyanate (FITC) labeled antibody to platelet glycoprotein complex IIb-IIIa (GpIIb-IIIa) and with FITC-annexin V but only 40-50% of microparticles reacted with FITC-antibody to platelet glycoprotein Ib (GpIb). The latter result was confirmed by double labeling of microparticles with FITC-antibody to GpIIb-IIIa and phycoerythrin (PE) labeled antibody to GpIb. Large microparticles reacted better with anti-GpIb than the small ones. A decreased level of GpIb was also demonstrated by SDS/polyacrylamide gel electrophoresis of microparticles. Compositional studies indicated, that in terms of cholesterol and protein contents, microparticles resembled platelets rather than platelet membranes as previously thought. They are, however, deficient in certain components. Thus, in comparison to platelets, microparticles had reduced contents of sialic acid (by 56.4%), galactosamine (by 48.2%), glucosamine (by 22.4%), galactose by (11.8%) and fucose (by 21.6%). Mannose content was increased by 11.8%. Total phospholipids in microplatelets were lower by 17.8%. Glycerophospholipids only were affected with phosphatidylserine being decreased as much as by 43.2%. Neutral glycosphingolipids, gangliosides and ceramides in microparticles were reduced by half.

Contents of total and protein-bound carbohydrates are low in leukemic leukocytes from patients with acute myelogenous leukemia

Leukemic leukocytes from 12 patients with acute myelogenous leukemia (AML) and two patients with chronic myelogenous leukemia (CML) were isolated by centrifugations in Percoll gradients, and examined for total carbohydrates. In leukemic leukocytes from 10 of these patients ceramide-bound carbohydrates were also determined. Protein-bound carbohydrates were calculated by subtraction of ceramide-bound carbohydrates from total carbohydrates. In all samples analysed the contents of total and protein-bound carbohydrates were much lower in leukemic leukocytes than in normal neutrophils, irrespective whether the results were expressed relative to protein, DNA, cell number or dry mass. For immature leukemic cells of M0-M1 phenotype differences up to 10-fold were observed. Contents of ceramide-bound carbohydrates, i.e. those of neutral and acidic glycosphingolipids (GSLs) were also low in leukemic cells. However, when GSL carbohydrates were calculated as percentage of total carbohydrates, GSLs in leukemic leukocytes were elevated in half of the AML patients but depressed in the other half. The results are discussed in the light of the hypothesis on GSL function by one of us (Kościelak J., 1986, Glycoconjugate J. 3, 95-108). According to one element of the hypothesis, during cell differentiation newly synthesized glycoproteins (GPs) that perform specific functions are added to house-keeping GPs that are present in plasma membranes of all types of cells. Thus, during differentiation, the GP content of the cell membrane should increase and that of the so called "membrane packing" glycosphingolipids should decrease.

In comparison to progenitor platelets, microparticles are deficient in GpIb, GpIb-derived carbohydrates, glycerophospholipids, glycosphingolipids, and ceramides

Activated blood platelets shed microparticles with procoagulant activity that probably participate in normal hemostasis. We have isolated spontaneously formed microparticles from human blood and analysed them for ultrastructure, antigenic profile, and biochemical composition. In transmission electron microscopy microparticles appeared as regular vesicles with a mean diameter of 300 nm (50-600 nm). In flow cytometry almost all microparticles reacted with fluorescein isothiocyanate (FITC) labeled antibody to platelet glycoprotein complex IIb-IIIa (GpIIb-IIIa) and with FITC-annexin V but only 40-50% of microparticles reacted with FITC-antibody to platelet glycoprotein Ib (GpIb). The latter result was confirmed by double labeling of microparticles with FITC-antibody to GpIIb-IIIa and phycoerythrin (PE) labeled antibody to GpIb. Large microparticles reacted better with anti-GpIb than the small ones. A decreased level of GpIb was also demonstrated by SDS/polyacrylamide gel electrophoresis of microparticles. Compositional studies indicated, that in terms of cholesterol and protein contents, microparticles resembled platelets rather than platelet membranes as previously thought. They are, however, deficient in certain components. Thus, in comparison to platelets, microparticles had reduced contents of sialic acid (by 56.4%), galactosamine (by 48.2%), glucosamine (by 22.4%), galactose by (11.8%) and fucose (by 21.6%). Mannose content was increased by 11.8%. Total phospholipids in microplatelets were lower by 17.8%. Glycerophospholipids only were affected with phosphatidylserine being decreased as much as by 43.2%. Neutral glycosphingolipids, gangliosides and ceramides in microparticles were reduced by half.

Contents of total and protein-bound carbohydrates are low in leukemic leukocytes from patients with acute myelogenous leukemia

Leukemic leukocytes from 12 patients with acute myelogenous leukemia (AML) and two patients with chronic myelogenous leukemia (CML) were isolated by centrifugations in Percoll gradients, and examined for total carbohydrates. In leukemic leukocytes from 10 of these patients ceramide-bound carbohydrates were also determined. Protein-bound carbohydrates were calculated by subtraction of ceramide-bound carbohydrates from total carbohydrates. In all samples analysed the contents of total and protein-bound carbohydrates were much lower in leukemic leukocytes than in normal neutrophils, irrespective whether the results were expressed relative to protein, DNA, cell number or dry mass. For immature leukemic cells of M0-M1 phenotype differences up to 10-fold were observed. Contents of ceramide-bound carbohydrates, i.e. those of neutral and acidic glycosphingolipids (GSLs) were also low in leukemic cells. However, when GSL carbohydrates were calculated as percentage of total carbohydrates, GSLs in leukemic leukocytes were elevated in half of the AML patients but depressed in the other half. The results are discussed in the light of the hypothesis on GSL function by one of us (Kościelak J., 1986, Glycoconjugate J. 3, 95-108). According to one element of the hypothesis, during cell differentiation newly synthesized glycoproteins (GPs) that perform specific functions are added to house-keeping GPs that are present in plasma membranes of all types of cells. Thus, during differentiation, the GP content of the cell membrane should increase and that of the so called "membrane packing" glycosphingolipids should decrease.

Culture of human nasal epithelial cells from nasal polyps on collagen matrix

Epithelial cell cultures became an experimental model employed for both animal and human studies. We established a modified method of culture of human nasal epithelial cells from nasal polyps using serum-free, hormonally supplemented Ham's F-12 medium and Vitrogen 100 collagen matrix. Cells reached confluent monolayer structures in 5 to 7 days (mean time 6 +/- 0.89 days) of culture. The confluent cultures consisted of pure epithelial cells, which was confirmed by light and electron microscopy, and immunohistochemical staining with anticytokeratin antibody. The success ratio of cultures was 61.5%. The culture system described is efficient enough to provide pure epithelial cells for further functional studies.

[Treatment of condylomata acuminata of the male reproductive organs with CO2 laser under colposcopic control]

The first results of laser therapy in treatment of condylomata acuminata of male reproductive organs are reported. Between November 1991 and December 1993 in Department of Reproduction, Institute of Gynecology and Obstetrics, Karol Marcinkowski University School of Medical Sciences, Poznań in nine patients with condylomatous changes of reproductive organs CO2-laser therapy under colposcopic control was done. In 7 of them the healing was achieved. In two patients second laser therapy was done. All patients are still under control in Department of Reproduction and there was no recurrence diagnosed.

[Use of CO2 laser in the treatment of condylomata acuminata of the anogenital region in pregnant women]

The first results of treatment of condylomata acuminata of anogenital region in 11 pregnant women were presented. The analysis were made in Department of Reproduction, Institute of Gynecology and Obstetrics, Academy of Medicine, Poznań. All patients were treated between 28 and 35 week of pregnancy. After first laser-therapy the healing achieved in 9 women. The second lasertherapy was required in 2 patients. It was done after 3 weeks. Complete destruction of pathological changes was obtained. All women had vaginal delivery and no complications (connected with HPV infection) in their newborns were found. The authors said that CO2-lasertherapy under colposcopic control is a reliable method for treatment of condylomata acuminata in pregnant women.

[Point CO2 laser vaporization in treatment of superficial endometriosis of the uterine cervix]

The study showed the treatment of superficial endometriosis of the uterine cervix in 54 women between November 1991 and January 1994. After first vaporisation 43 patients were cured successfully. In 8 cases vaporisation should be repeated and in 3 women the operation should be performed for the third time. All patients are still under control in our department and there is no recurrence observed.

[Erosion of the uterine cervix in women with primary infertility treated with CO2 laser]

The authors described the results of treatment of erosions of the uterine cervix in 78 women with primary sterility with CO2-laser vaporisation in Department of Reproduction, Institute of Gynecology and Obstetrics, Academy of Medicine, Poznań. The results were estimated through clinical, cytological and colposcopical examinations in the term of 6 weeks and 3 months after therapy. The Insler's cervical mucus test was done in all women after 3 months. In all women the healing was achieved and five of them were needed for second laser therapy because of superficial endometriosis. The authors think that CO2-laser vaporisation (under colposcopical control) of erosions of the uterine cervix in women with primary sterility is the reliable method. The wound's healing after laser therapy is quick and without any complications. Laser therapy causes no trauma of the cervix structure and does not disturb in excretion of mucus by cervical glands.

[Hysteroscopy in the diagnosis and treatment of residua after evacuation of hydatidiform mole]

The authors showed the case of 23 years old multipara treated in Department of Reproduction, Institute of Gynecology and Obstetrics, Academy of Medicine, Poznań because of hydatidiform mole using the exhaustion of uteri. After 8 weeks the hysteroscopy was done in order to explain the reasons of elevated serum beta hCG levels. During the hysteroscopy the polypoid lesion was recognized and removed using the electric resectoscope. After this endoscopic operation the normalization of serum beta hCG levels was achieved.

[Hysteroscopic evaluation of the uterine tubal opening]

The hysteroscopic evaluation of uterine openings in 23 sterile women was described. The attention was paid to morphological features of obliterated uterine openings. The hysteroscopic examination of structural changes located in uterine openings seems to be a reliable method for evaluation of potency of oviducts. This procedure may help in choosing the proper way of therapy--microsurgery or IVF.

Late toxic effects of long-term exposure to lindane in peripheral blood cells in rabbits. II. Erythrocyte changes

After lindane administration in daily doses of 0.1 LD50 for one month (total dose 2.0 LD50) changes in the erythrocytes were found persisting for up to 4 months after withdrawal of the pesticide. A significant increase in the number of echinocytes, a greater per cent of reticulocytes, significantly raised level of denatured haemoglobin, and an increased number of erythrocytes of higher sensitivity to oxidating factors in relation to control group was observed.

Changes in serum and internal organs during increased accumulation of gamma-hexachlorocyclohexane in adipose tissue of rabbits

The effect of Lindan (gamma-HCH) on liver and kidney structure and serum calcium level was studied in rabbits. It was found that Lindan 7 mg/kg daily given for 4 weeks caused changes of tissue structure in the studied organs not only during its administration but also during 16 weeks after its withdrawal.

[Cytotoxic effect of fenarimol on peripheral blood cells and organs]

The effect of fenarimol in blood cells and changes in liver and kidneys in rats were investigated. Fenarimol applied in doses 25 mg/ml intragastrically during 5 days, at 24h after the last doses caused functional and structural changes of blood cells and organs. The decreases of osmotic fragility of erythrocytes and phagocytic activity of neutrophils, and the increase of the percentage of lymphocytes without detectable lysosomes accompanied by the minor decrease of the number of blood cells was observed in the peripheral blood. The indistinctness of the structure of the hepatic lobules and of liver laminae and the vacuolized hepatic cells with pycnotic nuclei were visible in the liver. The abnormally enlarged cortical Malphighian++ glomeruli in kidney were found. The observed changes indicate the cytotoxic effect of fenarimol in strongly intoxicated rats. The impaired phagocytic activity of neutrophils may cause the growth of susceptibility to bacterial infection.