Agreement between Accelerometer-Assessed and Self-Reported Physical Activity and Sedentary Behavior in Female Breast Cancer Survivors

An accurate quantitative assessment of physical activity and sedentary lifestyles enables a better understanding of their relationship with the health records of cancer survivors. The objective of this study was to compare the subjective and objective methods of physical activity measurement in female breast cancer survivors. Materials and methods: In total, 135 female breast cancer survivors at the Holycross Cancer Center, Kielce, Poland, were included in this study. A shortened version of the International Physical Activity Questionnaire (IPAQ) was used to subjectively assess the participants' physical activity (PA), and an ActiGraph GT3X-BT accelerometer was used for an objective assessment. In total, 75% of the studied women did not report any vigorous PA, irrespective of the measurement method. The average values of moderate PA and moderate-to-vigorous PA (MVPA) measured with IPAQ compared with the accelerometer were sevenfold and tenfold higher, respectively. Conversely, the sedentary behavior values measured with the accelerometer were almost three times higher than those measured with IPAQ. The PA and sedentary behavior measurements were significantly different. Irrespective of PA intensity, the accelerometer-based measurements produced significantly lower results than IPAQ, while higher results were observed for sedentary behavior. The measurement differences between these two methods increased as the average differences grew. Regardless of the measurement method, a negative association was observed between moderate PA with general adiposity and adipose tissue distribution, whereas sedentary behavior demonstrated an opposite trend. This indicates the detrimental role of obesity in limiting PA.

Global survival trends for brain tumors, by histology: analysis of individual records for 556,237 adults diagnosed in 59 countries during 2000-2014 (CONCORD-3)

BACKGROUND

Survival is a key metric of the effectiveness of a health system in managing cancer. We set out to provide a comprehensive examination of worldwide variation and trends in survival from brain tumors in adults, by histology.

METHODS

We analyzed individual data for adults (15-99 years) diagnosed with a brain tumor (ICD-O-3 topography code C71) during 2000-2014, regardless of tumor behavior. Data underwent a 3-phase quality control as part of CONCORD-3. We estimated net survival for 11 histology groups, using the unbiased nonparametric Pohar Perme estimator.

RESULTS

The study included 556,237 adults. In 2010-2014, the global range in age-standardized 5-year net survival for the most common sub-types was broad: in the range 20%-38% for diffuse and anaplastic astrocytoma, from 4% to 17% for glioblastoma, and between 32% and 69% for oligodendroglioma. For patients with glioblastoma, the largest gains in survival occurred between 2000-2004 and 2005-2009. These improvements were more noticeable among adults diagnosed aged 40-70 years than among younger adults.

CONCLUSIONS

To the best of our knowledge, this study provides the largest account to date of global trends in population-based survival for brain tumors by histology in adults. We have highlighted remarkable gains in 5-year survival from glioblastoma since 2005, providing large-scale empirical evidence on the uptake of chemoradiation at population level. Worldwide, survival improvements have been extensive, but some countries still lag behind. Our findings may help clinicians involved in national and international tumor pathway boards to promote initiatives aimed at more extensive implementation of clinical guidelines.

Is ERCC1 a prognostic biomarker for urothelial cancer following radical cystectomy? A long-term analysis

INTRODUCTION

Excision repair cross-complementation 1 protein (ERCC1) plays a vital role in cancer cells enabling DNA repair via nucleotide excision repair. Thus, we hypothesized whether expression of this protein may be utilized as a prognostic marker in patients after radical cystectomy.

MATERIAL AND METHODS

The final analysis involved 123 patients with urothelial bladder carcinoma who underwent radical cystectomy with bilateral lymphadenectomy. The median follow-up time was equal to 853 days. ERCC1 status was evaluated immunohistochemically with the application of tissue microarrays.

RESULTS

Positive ERCC1 expression was noted in 46% of the studied cases. Among the analyzed clinical and pathological factors, we could not establish a statistically significant correlation with ERCC1. Similarly, survival curves were statistically indifferent in patients with tumors categorized according to both expression categories. We did not confirm a prognostic value of ERCC1 in the multivariate regression analysis.

CONCLUSIONS

ERCC1 expression does not influence the overall survival of patients with urothelial bladder carcinoma after radical cystectomy.

[Rectourethral fistula treatment using the modified York Mason technique: Failure factors assessment]

OBJECTIVES

To assess surgical outcomes and failure factors in the management of rectourethral fistulas treated surgically with the modified York Mason technique based on our center's 25 years of experience.

METHODS

From 1997 to 2021, in a single center study, a total of 35 consecutive patients, underwent rectourethral fistula cure, using the modified York Mason technique. Preoperative patient data, surgical outcomes and failure factors were assessed.

RESULTS

Of the 35 patients, 28 were successfully managed without the need of further intervention (80%). Median age was 67 years (IQR 62-72) and median follow-up time was 71 months (IQR 30-123). There was no significant difference between the patients that had recurrence or not after the first York Mason.

CONCLUSIONS

The modified York Mason technique offers a high success rate for the cure of iatrogenic rectourethral fistulas. No predictive factor of failure, after a first cure of recto-uretral fistula by modified York-Mason technique was reported.

LEVEL OF EVIDENCE

3.

Two-year follow-up cohort study focused on gender-specific associations between socioeconomic status and body weight changes in overweight and obese middle-aged and older adults

OBJECTIVE

As overall spread of obesity in populations is generally acknowledged to result from unhealthy lifestyles rather than individual genetic makeup, this study aimed to gain specific insights into its determinants through assessing the prevalent associations between individual socioeconomic status (SES) and weight loss in overweight and obese men and women.

METHODS

A prospective, 2-year follow-up study covered 3362 (38.0% men) respondents, aged 43-64 years, body mass index ≥25 kg/m2. Changes in body weight were estimated as a percentage of initial weight. Three categories of changes were defined: gained ≥3%, stable (gained <3% or lost <3%), lost ≥3%. Body weight loss was determined against three categories: lost ≥3 to <5%, lost ≥5 to <10%, lost ≥10%. Select SES variables (ie, gender, age, education, marital status, occupational activity and income) were determined in line with the Health Status Questionnaire. The associations between SES and body weight changes were analysed with the aid of logistic regression models. The results were presented as ORs with 95% CIs.

RESULTS

Only 18% of the respondents had complied with the medical recommendations on weight loss. Significant differences were encountered between the gender, age and occupational activity variables and the weight loss one. Multifactorial models were used to determine the following gender-specific associations between SES and weight loss. Men with moderate income had significantly higher odds for weight loss (≈75%), as compared with the higher earners, whereas women with low income, occupationally inactive, had significantly higher odds (≈30% and ≈50%, respectively), as compared with the high earners and occupationally active ones.

CONCLUSIONS

Lower education, male gender, lower income per household, older age and unemployment status were the established factors predisposing to obesity. While aiming to ensure effectiveness of the measures specifically aimed at preventing obesity, population groups deemed most at risk of potential weight gain must prior be identified.

Evaluation of Complete Pathological Regression after Neoadjuvant Chemotherapy in Triple-Negative Breast Cancer Patients with BRCA1 Founder Mutation Aided Bayesian A/B Testing Approach

The aim of this study was to evaluate the probability of pathologic complete regression (pCR) by the BRCA1 gene mutation status in patients with triple-negative breast cancer (TNBC) treated with neoadjuvant chemotherapy. The study involved 143 women (mean age 55.4 ± 13.1 years) with TNBC. The BRCA1 mutation was observed in 17% of the subjects. The most commonly used (85.3%) chemotherapy regimen was four cycles of adriamycine and cyclophosphamide followed by 12 cycles of paclitaxel (4AC + 12T). The differences between clinico-pathological factors by BRCA1 status were estimated. Odds ratios and 95% confidence intervals for pCR vs. non-pCR were calculated using logistic regression. The probability distribution of pCR based on BRCA1 status was estimated using beta distributions. The presence of T3-T4 tumours, cancer in stages II and III, lymphovascular invasion, and the use of chemotherapy schedules other than 4AC + 12T significantly decreased the odds of pCR. It was established that there was a 20% chance that pCR in patients with the BRCA1 mutation was 50% or more times as frequent than in patients without the mutation. Thus, the BRCA1 mutation can be a predictive factor for pCR in patients with TNBC.

Assessment of Age-Induced Changes in Body Fat Percentage and BMI Aided by Bayesian Modelling: A Cross-Sectional Cohort Study in Middle-Aged and Older Adults

Background

Loss of fat-free mass (FFM) and gain in body fat (BF) are the key disability risk factors, also instrumental in perpetuating already existing functional disorders. Obesity construed in terms of body mass index (BMI) values, in view of undesirable gain in BF, is a risk factor for cardio-metabolic disorders. Both detrimental processes clearly evidence a scope of involutionary changes characteristic of an aging population, also standing for one of its greatest burdens.

Purpose

The present study aimed to assess the changes in body composition (BC), in conjunction with the relationship between BF% and BMI, for defining overweight and obesity status in middle-aged and older adults, against the select indicator variables under study.

Materials and Methods

The study involved 4799 individuals (33.7% men), PONS Project participants, aged 43-64 years. BF% was measured with the aid of bioelectrical impedance analysis (BIA) method. Age-induced changes in BC were determined against BF%, fat mass (FM), FFM, BMI, fat mass index (FMI), and fat-free mass index (FFMI). The relationship between BF% and BMI was established with the aid of Bayesian regression models, adjusted for gender and age.

Results

In both genders, BF% increased with age at a similar annual rate. The reduction of FFM was noted mainly in men, which in conjunction with BF% gain ensured BMI stability. The increase in BF% in women with stable FFM affected an increase in BMI. Regardless of the BMI threshold, the anticipated (predicted) BF% increased with age in both genders.

Conclusion

Monitoring of BC is of particular importance in older adults, in view of appreciably better characteristics of both the short- and long-term health predictors, as well as overall potential for developing specifically targeted, effective health interventions.

Competing Risks of Cancer and Non-Cancer Mortality When Accompanied by Lifestyle-Related Factors-A Prospective Cohort Study in Middle-Aged and Older Adults

Background

The study aimed to identify the association between the lifestyle-related factors and the cancer-specific, or non-cancer-specific mortality, when accompanied by a competing risk. Two statistical methods were applied, i.e., cause-specific hazard (CSH), and sub-distribution hazard ratio (SHR). Their respective key advantages, relative to the actual study design, were addressed, as was overall application potential.

Methods

Source data from 4,584 residents (34.2% men), aged 45–64 years, were processed using two different families of regression models, i.e., CSH and SHR; principal focus upon the impact of lifestyle-related factors on the competing risk of cancer and non-cancer mortality. The results were presented as hazard ratios (HR) with 95% confidence intervals (95% CI).

Results

Age, smoking status, and family history of cancer were found the leading risk factors for cancer death; the risk of non-cancer death higher in the elderly, and smoking individuals. Non-cancer mortality was strongly associated with obesity and hypertension. Moderate to vigorous physical activity decreased the risk of death caused by cancer and non-cancer causes.

Conclusions

Specific, lifestyle-related factors, instrumental in increasing overall, and cancer-specific mortality, are modifiable through health-promoting, individually pursued physical activities. Regular monitoring of such health-awareness boosting pursuits seems viable in terms of public health policy making.

Optimal cut-off values for anthropometric measures of obesity in screening for cardiometabolic disorders in adults

Excessive accumulation of body fat (BF) promotes obesity, whilst posing a significant health hazard. There being no agreed, optimal quantifying methods, application of BF variable in clinical practice is not deemed an effective assessment option. The study, involving 4,735 patients (33.6% men), aged 45-64, aimed to identify optimal cut-off values for anthropometric indicators of obesity to evaluate cardiometabolic risk. A minimum P-value approach was applied to calculate the cut-offs for BF%. Threshold values for body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), and waist-to-height (WHTR) ratio, facilitating optimal differentiation of cardiometabolic risk, were based on BF%, expressed as a binary classifier. The newly estimated cut-off values for predicting cardiometabolic risk, based on BMI, were lower than the referential obesity thresholds, whereas the threshold values of WC, WHR, and WHTR were higher. Apart from dyslipidemia, the odds of cardiometabolic disorders were higher, when the anthropometric indicators under study exceeded the cut-off points in both sexes. The proposed cut-offs proved instrumental in predicting cardiometabolic risk, whilst highlighting diagnostic and clinical potential of BF%, whereas BMI boasted the highest predictive potential. Cardiometabolic risk also proved significantly higher even in the overweight patients.

Optimal Body Fat Percentage Cut-Off Values in Predicting the Obesity-Related Cardiovascular Risk Factors: A Cross-Sectional Cohort Study

BACKGROUND

Reliable obesity assessment is essential in evaluating the risk of cardiovascular risk factors (CRFs). Non-availability of clearly defined cut-offs for body fat percentage (BF%), as well as a widespread application of surrogate measures for obesity assessment, may result in incorrect prediction of cardio-metabolic risk.

PURPOSE

The study aimed to determine optimal cut-off points for BF%, with a view of predicting the CRFs related to obesity.

PATIENTS AND METHODS

The study involved 4735 (33.6% of men) individuals, the Polish-Norwegian Study (PONS) participants, aged 45-64. BF% was measured with the aid of bioelectrical impedance analysis (BIA) method. The gender-specific cut-offs of BF% were found with respect to at least one CRF. A P-value approach, and receiver operating characteristic curve analyses were pursued for BF% cut-offs, which optimally differentiated normal from the risk groups. The associations between BF% and CRFs were determined by logistic regression models.

RESULTS

The cut-offs for BF% were established as 25.8% for men and 37.1% for women. With the exception of dyslipidemia, in men and women whose BF% was above the cut-offs, the odds for developing CRFs ranged 2-4 times higher than those whose BF% was below the cut-offs.

CONCLUSION

Controlling BF% below the thresholds indicating an increased health hazard may be instrumental in appreciably reducing overall exposure to developing cardio-metabolic risk.

Age-Dependent Disparities in the Prevalence of Single and Clustering Cardiovascular Risk Factors: A Cross-Sectional Cohort Study in Middle-Aged and Older Adults

Background

Cardiovascular diseases (CVDs) are the leading cause of mortality worldwide; with age acknowledged as an independent cardiovascular risk factor (CRF) in adults. Appreciating the association between age and classic CRFs is believed to boost all potential benefits of prevention.

Purpose

Assessment of the prevalence of single and clustered CRFs and their association with age.

Patients and Methods

The survey involved 4735 people (33.6% men) who were PONS project attendees aged 45-64. The study protocol comprised the Health Status Questionnaire, general medical examination, anthropometric measurements, and blood and urine sampling. The prevalence of single and clustered CRFs (hypertension, dyslipidemia, diabetes mellitus, and obesity) in the incrementally split age groups was calculated. The incidence rate of CRFs, against their absence, was determined by Poisson regression models with robust standard errors.

Results

The prevalence of CRFs was established in 90% of the respondents. Except dyslipidemia and ≥1 CRFs, prevalence of risk factors increased with age, although this trend was the weakest in men. In the total group, and in women, prevalence of dyslipidemia and ≥1 CRFs was unrelated to age, whereas in men, it was on the rise in the younger age groups. The incidence rate of CRFs was strongly related to age, and, with the exception of dyslipidemia, was higher in the older age groups.

Conclusion

Cardiovascular risk factors are common in the adult population, while their prevalence and clustering are more prevalent in seniors. Apart from dyslipidemia, the risk of CRFs is appreciably age-related, and higher in seniors.

Partitioning of mesophyll conductance for CO2 into intercellular and cellular components using carbon isotope composition of cuticles from opposite leaf sides

We suggest a new technique for estimating the relative drawdown of CO₂ concentration (c) in the intercellular air space (IAS) across hypostomatous leaves (expressed as the ratio c_d/c_b, where the indexes d and b denote the adaxial and abaxial edges, respectively, of IAS), based on the carbon isotope composition (δ¹³C) of leaf cuticular membranes (CMs), cuticular waxes (WXs) or epicuticular waxes (EWXs) isolated from opposite leaf sides. The relative drawdown in the intracellular liquid phase (i.e., the ratio c_c/c_bd, where c_c and c_bd stand for mean CO₂ concentrations in chloroplasts and in the IAS), the fraction of intercellular resistance in the total mesophyll resistance (r_IAS/r_m), leaf thickness, and leaf mass per area (LMA) were also assessed. We show in a conceptual model that the upper (adaxial) side of a hypostomatous leaf should be enriched in ¹³C compared to the lower (abaxial) side. CM, WX, and/or EWX isolated from 40 hypostomatous C₃ species were ¹³C depleted relative to bulk leaf tissue by 2.01-2.85‰. The difference in δ¹³C between the abaxial and adaxial leaf sides (δ¹³C_AB - ¹³C_AD, Δ_b-d), ranged from - 2.22 to + 0.71‰ (- 0.09 ± 0.54‰, mean ± SD) in CM and from - 7.95 to 0.89‰ (- 1.17 ± 1.40‰) in WX. In contrast, two tested amphistomatous species showed no significant Δ_b-d difference in WX. Δ_b-d correlated negatively with LMA and leaf thickness of hypostomatous leaves, which indicates that the mesophyll air space imposes a non-negligible resistance to CO₂ diffusion. δ¹³C of EWX and 30-C aldehyde in WX reveal a stronger CO₂ drawdown than bulk WX or CM. Mean values of c_d/c_b and c_c/c_bd were 0.90 ± 0.12 and 0.66 ± 0.11, respectively, across 14 investigated species in which wax was isolated and analyzed. The diffusion resistance of IAS contributed 20 ± 14% to total mesophyll resistance and reflects species-specific and environmentally-induced differences in leaf functional anatomy.

WHO recommendations on physical activity versus compliance rate within a specific urban population as assessed through IPAQ survey: a cross-sectional cohort study

OBJECTIVE

The study was designed to address the following three key areas, that is, (1) evaluate overall level of physical activity in the residents of a mid-sized, Central-European city, (2) compliance level with WHO's recommendations on physical activity in leisure time and (3) actual impact of select socioeconomic factors on the physical activity level within the study population.

METHODS

Assessment of the source data collected for 4619 participants (1532 men and 3087 women, aged 45-65 years; mean age 56.41±5.31 years) was completed. Three levels of physical activity, and compliance level with pertinent WHO recommendations was evaluated, based on International Physical Activity Questionnaire (long form). Multilevel logistic regression models of socioeconomic factors associated with moderate-level, high-level physical activity, and WHO recommendations were developed.

RESULTS

Data analyses revealed that 6.19% of the study participants (n=286) engaged in low-level physical activity, 48.86%-in moderate-level activity, while high-level activity was reported in 44.94% of them. Compliance with pertinent WHO recommendations was higher in men aged 44-55 years, boasting upper-level education, living without a partner and in the persons with a net income over €1140 per household.

CONCLUSIONS

Overall level of physical activity in the residents of a mid-sized, Central-European city was established as moderate. Pertinent WHO recommendations on physical activity were met by 4.2% of the subjects only.

Identifying predictive motor factors for falls in post-menopausal breast cancer survivors

OBJECTIVE

Breast cancer treatment, including radical surgery, is also pursued as late as the 7th - 8th decade of women's lives. Standard physical rehabilitation procedures offered to those women are predominantly focused on attenuating specific functional deficits of the upper limb and trunk. Seldom do they entail any regimens specifically aimed at recovering overall functionality, and reducing exposure to falls-risk. The study aimed to assess potential interrelationships between the self-reported falls, individual functional capabilities and appreciably reducing exposure to falls-risk in a group of post-menopausal, post-surgical breast cancer survivors.

METHODS

The study recruited 102 women (aged 65-79; mean age 70.2), post-surgical breast cancer survivors. The subjects were stratified by age into three groups: Group 1 (65-69 years); Group 2 (70-74 years), and Group 3 (75-79 years). Individual functional capabilities were assessed with Eight-foot up & go test (8UG), chair stand test (CST), and 2-minute step test (2ST). Tinetti POMA test was applied to assess gait and balance disorders. Self-reported falls in the past year were ascertained through a questionnaire.

RESULTS

Assessment of individual aerobic endurance (2ST) also demonstrated a clear deficit in the mean scores category in all respective age sub-groups, as compared against the reference values. The deficits ranged from 4.86 to 15.90 steps less than the normative values; the oldest subjects demonstrating the largest deficit. The aerobic endurance tests results significantly impacted the ultimate assessment of an individual falls-risk in the oldest group. The analysis of the number of falls sustained within the recent year indicated that 43.67% of the subjects fell victim of such incidents.

CONCLUSION

An individual exposure to falls-risk was found to be appreciably more dependent upon individual aerobic endurance rather than overall strength of the lower part of the body in the breast cancer survivors over 75.

IL33 Promotes Colon Cancer Cell Stemness via JNK Activation and Macrophage Recruitment

The expression and biological role of IL33 in colon cancer is poorly understood. In this study, we show that IL33 is expressed by vascular endothelial cells and tumor cells in the human colon cancer microenvironment. Administration of human IL33 and overexpression of murine IL33 enhanced human and murine colon cancer cell growth in vivo, respectively. IL33 stimulated cell sphere formation and prevented chemotherapy-induced tumor apoptosis. Mechanistically, IL33 activated core stem cell genes NANOG, NOTCH3, and OCT3/4 via the ST2 signaling pathway, and induced phosphorylation of c-Jun N terminal kinase (JNK) activation and enhanced binding of c-Jun to the promoters of the core stem cell genes. Moreover, IL33 recruited macrophages into the cancer microenvironment and stimulated them to produce prostaglandin E₂, which supported colon cancer stemness and tumor growth. Clinically, tumor IL33 expression associated with poor survival in patients with metastatic colon cancer. Thus, IL33 dually targets tumor cells and macrophages and endows stem-like qualities to colon cancer cells to promote carcinogenesis. Collectively, our work reveals an immune-associated mechanism that extrinsically confers cancer cell stemness properties. Targeting the IL33 signaling pathway may offer an opportunity to treat patients with metastatic cancer. Cancer Res; 77(10); 2735-45. ©2017 AACR.

[Laparoscopic pyeloplasty in adults--mid-term results in 32 laparoscopic pyeloplasties during 2003-2008]

Pyeloureteric iunction obstruction is the most common inborn error of the upper urinary pathways. In the time of routine prenatal ultrasound examination, this disease is discovered in the child's age, when it is treated most frequently. Publication summarizes the results of modern laparoscopic management in the adults, who had not been diagnosed previously and symptoms occurred many years after their birthdate. The surgical treatment has been changed in the approach, but not the goal of desobtruction. The results in the adults are influenced not only by the operation technique, but also by the length of time the obstruction lasted and by the number and severity of the inflammatory changes.

[Outcomes of transperitoneal laparoscopic nephrectomy for renal adenocarcinoma]

Laparoscopic radical nephrectomy (LRN) is method of choice in malignant renal tumors (RCC) stage T1-3. Procedure has proved to be technically safe with low post-operative morbidity and standard oncological results, provided the patients are secondaries free in the time of surgery, and there was no positive margin in resected tissue. There was no recurrence even after 6 years of follow-up. The most influential variables regarding the survival of patients postoperatively were: presence of metastases in the time of surgery p <0.0001, pathological grade p < 0.001, stage p < 0.018 and p < 0.046, respectively, if the tumors were 4 cm and bigger. It could be concluded, that laparoscopic way of removing the tumor with the kidney has proved the same oncological results even in the mid-term follow-up, if compared with classical open surgery done lege artis.

[Analysis of results of percutaneous nephrolithotomies]

BACKGROUND

Percutaneous nephrolithotomy is an effective less invasive method for the treatment of nephrolithiasis. Authors retrospectively analysed results of this procedure performed in a single centre (Department of Urology, General University Hospital, Prague) from January 2005 till June 2007.

METHODS AND RESULTS

Patients were acquired by an analysis of operating reports performed over a period January 2005 till June 2007 and subsequently a retrospective analysis of electronic and paper patient's records was carried out. Percutaneous nephrolithotomy was performed in 150 patients. Of those, 117 (78%) patients underwent primary and 33 (21.3%) secondary procedure. Analysed group consisted of 85 (56.7%) men and 65 (43.3%) women. Right-sided procedure was performed in 46% (69 times) and left-sided in 54% (81 times) of cases. Mean patient's age was 52.9 years (SD +/- 16.3). Mean stone size was 18.3 (SD +/- 9.5) mm. Staghorn calculi were present in 19 (12.7%) patients and 77 (51.3%) patients had more than 1 stone. Intracorporeal lithotripsy was necessary in 82 (54.7%) cases. Seventy eight (52.9%) patients were stone free after the procedure. There were 24 (16%) patients with an anatomic abnormality of upper urinary tract. The most common (in 64.3%) component in analysed stones was a calcium oxalate.

CONCLUSIONS

The amount of stone free patients is rather lower compared to the literature results. However, definitive results are always affected by auxiliary procedures (mainly extracorporeal shock wave lithotripsy), which are not included in the analysis.

[Progress of laparoscopic surgery in adults at the Department of Urology of the First Faculty of Medicine and General Teaching Hospital]

Laparoscopy is the most modern operative technique, the main advantage of which is the least invasivity. In urology, the laparoscopy has won its yield only in nineties of 20th century, but it was in urology, where the robots were launched as first, and nowadays using them it is possible to perform ablative/reconstructive surgery in a tiny intracorporeal space. The price of laparoscopic operations is high and has been the only limit up to now, but technical approaches and indications have already been fixed.

Cytotoxic Activity of a Tumor Protease-Activated Pore-Forming Toxin

Equinatoxin II is a pore forming toxin produced by the sea anemone Actinia equina. It is able to kill very unspecifically most cell types by the membrane-perturbing action of an amphiphilic alpha-helix located at its N-terminal. A normally active N-terminal mutant, containing one single cys in the amphiphilic alpha-helix, becomes totally inactive when it is bound to avidin via a biotinylated linker. By choosing, as a linker, a peptide containing a tumor protease cleavage site, we were able to construct an enzymatically activable conjugate which should be selective for tumor cells. The introduced cleavage site was designed in order to be digested by both cathepsin B and matrix metalloproteases (MMPs). We confirmed that this conjugate could be activated in vitro by cathepsin B and MMPs. After having measured the enzymatic activity of fibrosarcoma and breast carcinoma cells, we analyzed the cytotoxic effect of the conjugate on the same lines and on human red blood cells (HRBC) as controls. We found that the conjugate was activated, at least in part, by the tumor cell lines used, whereas it was inactive on HRBC. That the activation process was dependent on the enzymatic action of cathepsin B and MMPs, was indicated by three lines of evidence: (1) binding occurred normally on all type of cells including HRBC which however were insensitive being devoid of enzymes; (2) the cytotoxic effect correlated with the amount of cathepsin B activity expressed by the cells; (3) conjugate activation was reduced by specific inhibitors of cathepsin B and MMPs. These results demonstrate the possibility of tumor cell killing by a pore-forming toxin conjugate specifically activated by tumor proteases.

[Chlamydia infections in urogenital tract--application of direct immunofluorescence in the diagnostics of Chlamydia trachomatis in the East Bohemian Region of Czech Republic during 1997-2003]

OBJECTIVE

The aim of the study was an evaluation of results of Chlamydia trachomatis antigen detection by means of direct immunofluorescence in samples from patients suspected from this infection.

DESIGN

Retrospective study.

SETTING

Institute of clinical microbiology, University Hospital and Medical Faculty of Charles University, Hradec Králové.

METHODS

Samples from females were swabs from uterine cervix, vagina and urethra, from male urethral swabs; moreover conjunctival swabs, bronchoalveolar irrigation, lower respiratory tract aspirates and sputum. Samples were fixed and "dyed" with monoclonal specific antibody labeled by fluorescent dye in the lab with a commercial diagnostic kit and they were evaluated microscopically after adding a drop of glycerol and covering with a top slide.

RESULTS

Within a group of 6126 samples from patients suspected from Chlamydia infection we have found positivity in 14.4%. Of this subgroup 14.1% in samples from genitourinary tract of females and 15.2% in males, 14.1% from conjunctival swabs and 3.7% from lower respiratory tract. According to an age differentiation, positive samples in individual life-decades from genitourinary tract were 0-13-14.4-13.9-13.9 and in females over 60 13.9%. In males the corresponding walues were 0-21.4-15.1-16-13.4 and those over 60 years 16%. So, the highest positivity in our region has been detected in samples from young men aged 20-30, where it is nearly two-fold higher comparison to age-matched females.

CONCLUSION

Direct detection of Chlamydia trachomatis antigen with immunofluorescence method still remains a reliable diagnostic tool. But for a control or confirmation of disputable results it is inconditionally necessary to have at least one more method available, e.g. PCR.

[Asynchronous occurrence of three neoplastic diseases: chronic B-cell lymphatic leukemia, renal carcinoma and prostatic adenocarcinoma]

Authors present a case of three asynchronous malignancies in man working life-long in chemical industry. Course of diseases and their treatment are described: B chronic lymphatic leukaemia (B-CLL) (age of 55), conventional clear cell renal carcinoma (CRCC) (age of 61) and adenocarcinoma of prostate (CaP) (age of 72). B-CLL treatment was chlorambucil for 2 years and follow-up subsequently. CRCC treatment was radical transperitoneal nephrectomy. Due to locally advanced CaP bilateral orchiectomy and radical external beam radiotherapy were performed. Patients is alive 30 months without any signs of any malignity. Incidence of multiple malignancies and particularly triplicities are discussed in this article. Authors point out pertinence of radical therapeutic approach also in multiple malignancies and oncological screening not only in patients with heamatological malignancy, but considering it in all tumours.

[Fournier's gangrene]

The authors present their own experiences with diagnostics and treatment of men with necrotising fasciitis of the scrotum (Fournier's gangrene). During 1995-2001 8 men were treated for the above diagnosis at the Clinic of Urology, Faculty Hospital in Hradec Králové. Six cases were patients with diabetes type II, in one patient we found during basic examinations a large tumour of the sigmoid and one patient was 7 days after total scrotal orchiectomy (because of prostatic adenocarcinoma). Repeated open revision under general anaesthesia was performed in all men with necessary necrectomy, testicles were intact (except a patient after orchiectomy). The infection was spread into the hypogastric area in two patients and in one patient spontaneous rupture of bulbar urethra occurred. By a combination of antibiotic therapy and repeated necrectomies, open wound healing and wet compresses we achieved cure of infection and granulations, which made final scrotal plastic surgery possible. From microbiological point of view it was mixed aerobic and anaerobic flora.

Characterization of parazoanthoxanthin A binding to a series of natural and synthetic host DNA duplexes

Parazoanthoxanthin A is a fluorescent yellow nitrogenous pigment of the group of zoanthoxanthins, which show a broad range of biological activity. These include, among others, the ability to bind to DNA. In this study we have used a variety of spectroscopic (intrinsic fluorescence emission and UV-spectroscopy) and hydrodynamic techniques (viscometry) to characterize in more detail the binding of parazoanthoxanthin A to a variety of natural and synthetic DNA duplexes in different buffer conditions. Our results reveal the following five significant features: (i) Parazoanthoxanthin A exhibits two modes of DNA binding: One binding mode exhibits properties of intercalation, while the second binding mode is predominantly electrostatic in origin. (ii) The apparent binding "site size" for parazoanthoxanthin A near physiological salt concentration (100 mM NaCl) is in the range of 7 +/- 1 base pairs for natural genomic DNA duplexes (calf thymus and salmon testes DNA) and alternating synthetic polynucleotides (poly[d(AT)]. poly[d(AT)] and poly[d(GC)]. poly[d(GC)]). A slightly larger apparent binding site size of 9 +/- 1 bp was obtained for parazoanthoxanthin A binding to the synthetic homopolymer poly[d(A)]. poly[d(T)]. (iii) Near physiological salt concentration (100 mM NaCl) parazoanthoxanthin A binds with the same approximate binding affinity of 2-5 x 10(5) M(-1) to all DNA polymers studied. (iv) At low salt concentration, parazoanthoxanthin A preferentially binds alternating poly[d(AT)]. poly[d(AT)] and poly[d(GC)]. poly[d(GC)] host duplexes. (v) Parazoanthoxanthin A inhibits DNA polymerase in vitro.

Antibacterial and anticholinesterase activities of aplysamine-4, a bromotyrosine-derived metabolite of a Red Sea marine sponge

Aplysamine-4, a metabolite of likely bromotyrosine biogenesis, was isolated from an unidentified verongid sponge from the Red Sea. The compound was identified by heteronuclear magnetic resonance experiments, and by electrospray ionization tandem mass spectrometry. The compound exhibited moderate inhibitory activity on several Gram positive and Gram negative bacteria, and was also found to be a non-competitive reversible inhibitor of acetylcholinesterase. At pH 7.4, a Ki value of 16 and 2 microM was determined with electric eel and insect recombinant acetylcholinesterase, respectively. A deprotonated form of aplysamine-4 was obtained by alkaline treatment of the natural compound and it was shown to be less active than the protonated form.

[Comparison of 2 methods of diagnosis of changes in transplanted kidneys in the early postoperative period: biopsy vs dynamic scintigraphy of the graft]

Renal transplantation is at present a standard therapeutic method in chronic renal insufficiency. For a favourable development of the graft some investigated criteria are of basic importance: basic diagnosis which led to renal failure, period of dialyzation treatment, high standard collection and perfusion and early diagnosis of the rejection episode. Non-invasive diagnostic methods of the rejection episode are always indirect and correlate with histologically confirmed rejection, depending on the period of transplantation in 10-90% patients. Indirect diagnosis is based in particular on a rise of the creatinemia, decline of glomerular filtration, fluid retention variations of blood pressure and increase of the Doppler assessed index of resistance (IR) in the peripheral veins of the graft [1]. For many years the role of nuclear diagnostics are tested. The disadvantage of direct diagnosis--biopsy--is increased haemorrhage and loss of the graft [1, 2, 3, 4]. The greatest problem is the differentiation of acute (cellular) rejection as compared with acute tubular necrosis during the initial days after transplantation. The authors describe their experience with 81 biopsies in the course of 3 years in patients during the first 10 days after transplantation, comparison with dynamic scintigraphy of the graft. Their attention is focused on the technique and risks of renal biopsy.

[Aspergillosis--a rare complicating disease in patients after renal transplantation]

The authors submit a detailed analysis of the death of a 42-year-old man after a second renal transplantation. The patient died with symptoms of cardiac failure in a septic condition of obscure etiology where even detailed examination did not provide a timely answer as regards the lethal pathogen. Aspergillus fumigatus is a rare lethal pathogen. Despite this it is, as all opportune infections, for patients with immunosuppressive therapy a serious life threatening infection [1, 2]. In a group of 650 transplantations performed since 1961 in Hradec Králové it is the first death caused by generalized Aspergillus infection.

Crystal structure of the soluble form of equinatoxin II, a pore-forming toxin from the sea anemone Actinia equina

BACKGROUND

Membrane pore-forming toxins have a remarkable property: they adopt a stable soluble form structure, which, when in contact with a membrane, undergoes a series of transformations, leading to an active, membrane-bound form. In contrast to bacterial toxins, no structure of a pore-forming toxin from an eukaryotic organism has been determined so far, an indication that structural studies of equinatoxin II (EqtII) may unravel a novel mechanism.

RESULTS

The crystal structure of the soluble form of EqtII from the sea anemone Actinia equina has been determined at 1.9 A resolution. EqtII is shown to be a single-domain protein based on a 12 strand beta sandwich fold with a hydrophobic core and a pair of alpha helices, each of which is associated with the face of a beta sheet.

CONCLUSIONS

The structure of the 30 N-terminal residues is the largest segment that can adopt a different structure without disrupting the fold of the beta sandwich core. This segment includes a three-turn alpha helix that lies on the surface of a beta sheet and ends in a stretch of three positively charged residues, Lys-30, Arg-31, and Lys-32. On the basis of gathered data, it is suggested that this segment forms the membrane pore, whereas the beta sandwich structure remains unaltered and attaches to a membrane as do other structurally related extrinsic membrane proteins or their domains. The use of a structural data site-directed mutagenesis study should reveal the residues involved in membrane pore formation.

Acid- and base-induced conformational transitions of equinatoxin II

We have investigated the acid- and base-induced conformational transitions of equinatoxin II (EqTxII), a pore-forming protein, by a combination of CD-spectroscopy, ultrasonic velocimetry, high precision densimetry, viscometry, gel electrophoresis, and hemolytic activity assays. Between pH 7 and 2, EqTxII does not exhibit any significant structural changes. Below pH 2, EqTxII undergoes a native-to-partially unfolded transition with a concomitant loss of its rigid tertiary structure and the formation of a non-native secondary structure containing additional alpha-helix. The acid-induced denatured state of EqTxII exhibits a higher intrinsic viscosity and a lower adiabatic compressibility than the native state. Above 50 degrees C, the acid-induced denatured state of EqTxII reversibly denatures to a more unfolded state as judged by the far UV CD spectrum of the protein. At alkaline pH, EqTxII undergoes two base-induced conformational transitions. The first transition occurs between pH 7 and 10 and results in a partial disruption of tertiary structure, while the secondary structure remains largely preserved. The second transition occurs between pH II and 13 and results in the complete loss of tertiary structure and the formation of a non-native, more alpha-helical secondary structure. The acid- and base-induced partially unfolded states of EqTxII form water-soluble oligomers at low salt, while at high salt (> 350 mM NaCl), the acid-induced denatured state precipitates. The hemolytic activity assay shows that the acid- and base-induced denatured states of EqTxII exhibit significantly reduced activity compared to the native state.

Suppression of red cell diffusional water permeability by lipophilic solutes

The inhibitory effect of a series of neutral lipophilic solutes (methanol, ethanol, n-propanol, iso-propanol, n-butanol, iso-amylalcohol, n-hexanol, diethylether, nitrobenzene, and pyridine) on the diffusional water permeability (Pd, tot) of bovine erythrocyte membrane at 25 degrees C was studied in comparison to that of p-chloromercuri benzoate (pCMB). Permeability data were obtained by measuring the transmembrane diffusional water exchange time tau(exch) using an 1H-T2 NMR technique. Maximal inhibition by approximately 50% of Pd, tot was produced by 2 mM pCMB which completely blocked the membrane water channels in 20 min, hence suggesting the channel-to-lipid diffusional water permeability ratio of about 1:1. Furthermore, the maximal inhibitory effect of pCMB in combination with the lipophilic solutes was lower than that of pCMB alone. As pCMB does not interfere with the lipid bilayer, and provided that it blocks the water channels in solute presence as well, this confirms that the solutes induce an increase in the lipid-mediated background water permeability contribution (Pd, lipid) by the formation of aqueous leaks in the membrane hydrophobic barrier. However, faster but less efficient in permeability inhibition than pCMB (either alone or combined with solutes) were the lipophilic solutes alone. Taken together, the results indicate that the lipophilic solutes suppress the membrane total permeability Pd, tot by two opposing effects: a reduction of its channel-mediated part (Pd, channel) to the extent exceeding that of a simultaneous Pd, lipid increase. The inhibitory potency of the solutes tested appears to be correlated with their solubility in the membrane medium.

Decreasing risk of viral transfusion-transmitted diseases in Croatia

AIM

To assess the risk of viral transfusion-transmitted infections in Croatia.

METHODS

The following parameters were analyzed: frequency of blood donations repeatedly reactive for HBsAg and anti-HCV (1993-1999); blood donations confirmed positive for HBsAg and anti-HCV (1997-1999), anti-HIV1/2, and syphilis reactivity (1993-1999); number of registered patients with hepatitis B and C; transfusion-associated hepatitis B and hepatitis C; and frequency of HBV, HCV and HIV markers in patients with congenital bleeding disorders (1993-1998).

RESULTS

The frequency of repeatedly reactive HBsAg and anti HCV markers and confirmed positive HBsAg, anti-HCV, and syphilis markers in donors blood decreased during the study, whereas the frequency of anti-HIV1/2 positivity did not change. The frequency of confirmed positive donors in 1999 was 0.068% for HBsAg, 0.035% for anti HCV, 0.002% for anti HIV1/2, and 0.0056% for syphilis. The number of patients with hepatitis B, hepatitis C, and transfusion-associated hepatitis B and C steadily decreased during the 1993-1998 period. The number of transfusion-associated hepatitis patients leveled off in 1997. From the beginning of the follow-up of AIDS patients in 1987, only 7 (2%) of hemophiliacs have been HIV-infected, all before 1990 and due to non-inactivated coagulation factor concentrates. There were no cases of transfusion-associated HIV2 infection in patients with congenital bleeding disorders or transfusion-associated HIV1 infection through transfusion of labile blood components.

CONCLUSION

The safety of transfusion therapy in Croatia has improved, and the present risks of viral transfusion transmitted diseases are very low.

A common motif in proparts of Cnidarian toxins and nematocyst collagens and its putative role

In Cnidarians, cnidoblast cells contain organelles called cnidocysts, which are believed to be the product of an extremely complex regulated secretory pathway. When matured, these stinging organelles are capable of storing and delivering toxins. We hypothesized that translated nematocyst proteins might comprise specific sequences serving as signals in sorting to the organelle. A sodium channel neurotoxin from the sea anemone Actinia equina was cloned and the toxin precursor sequence was compared to those of nematocyst collagens, pore-forming toxins and ion channel neurotoxins. It was found that all the analyzed sequences possess a highly conserved stretch of nine amino acid residues ending with Lys-Arg N-terminally of the mature region.

Lysine 77 is a key residue in aggregation of equinatoxin II, a pore-forming toxin from sea anemone Actinia equina

Among eighteen point mutants of equinatoxin II produced in E. coli, containing a single cystein substitution at variable position, EqtIIK77C was chosen for its peculiar properties. It was almost 100 times less hemolytic than the wild-type, but its hemolytic activity could be restored by chemical modification of the thiol group, provided that a positive charge was reintroduced. This indicates that a positive charge at this position is necessary for toxin activity. The mutant formed larger pores as compared to the wild type, but displayed the same cation selectivity. The pores reverted to normal size upon reintroduction of the positive charge. The conformation of EqtIIK77C and its binding to lipid membranes, either vesicles or red blood cells, was almost normal. However the kinetics of calcein release from lipid vesicles was substantially slower than that of the wild-type. Taken together with the different size of the pore formed, this is an indication that mutation of Lys77 --> Cys influences the normal development of the aggregate which is required for assembling the functional pore.

AFM imaging of surface adsorbed polymeric 3-alkylpyridinium salts from the marine sponge Reniera sarai

Bioactive 3-alkylpyridinium polymers (poly-APS) have recently been isolated from the marine sponge Reniera sarai. Previous results have shown that these molecules in aqueous solutions form supramolecular aggregates with an average hydrodynamic radius of 23 +/- 2 nm. To obtain additional evidences about the shape and the dimensions of poly-APS aggregates, we used atomic force microscopy (AFM) operating in tapping mode. The images clearly showed adsorbed aggregates with a lateral dimension of approximately 40 nm and a thickness of the order of approximately 1 nm. The distribution of volumes of the adsorbed aggregates is very similar to the distribution of hydrodynamic radii as obtained from the dynamic light scattering experiments. The volume distribution of these aggregates shows a maximum at 1750 nm3, which corresponds to a sphere with a radius of 7.5 nm.