Operationalizing anthropological theory: four techniques to simplify networks of co-occurring ethnographic codes

The use of data and algorithms in the social sciences allows for exciting progress, but also poses epistemological challenges. Operations that appear innocent and purely technical may profoundly influence final results. Researchers working with data can make their process less arbitrary and more accountable by making theoretically grounded methodological choices. We apply this approach to the problem of simplifying networks representing ethnographic corpora, in the interest of visual interpretation. Network nodes represent ethnographic codes, and their edges the co-occurrence of codes in a corpus. We introduce and discuss four techniques to simplify such networks and facilitate visual analysis. We show how the mathematical characteristics of each one are aligned with an identifiable approach in sociology or anthropology: structuralism and post-structuralism; identifying the central concepts in a discourse; and discovering hegemonic and counter-hegemonic clusters of meaning. We then provide an example of how the four techniques complement each other in ethnographic analysis.

Patterns and drivers of cryptogam and vascular plant diversity in glacier forelands

Vascular and nonvascular plants are affected by environmental factors determining their distribution and shaping their diversity and cover. Despite the cryptogam commonness in Arctic communities, previous studies have often focused on limited number of factors and their impact on only selected species of vascular plants or cryptogams. Our study aimed to investigate in detail the differences in species diversity and cover of cryptogams and vascular plants in the glacier forelands and mature tundra on Svalbard. Furthermore, we determined the biotic and abiotic factors that affected diversity, cover and distribution of cryptogam and vascular plant species. In 2017, we established 201 plots in eight locations (each including habitat type of foreland and mature tundra) and surveyed species abundance, sampled soils and environmental data. Results revealed that diversity and cover of analysed groups differed significantly between locations and habitat types, except for cryptogam cover in mature tundra in terms of location. Distance to the glacier terminus, slope, soil conductivity, nutrient content, and clay content impacted both plant groups' diversity. In contrast, distance to the glacier terminus, nutrient content and soil pH affected their cover. In addition, for cryptogam diversity and cover, foreland location and vascular plant cover were also important, while for vascular plant cover time elapsed after glacier retreat was significant. Distribution of both groups' species in forelands was associated with time elapsed after glacier retreat, soil pH, and nutrient contents. Soil texture and distance to the glacier terminus additionally influenced cryptogam distribution. The positive impact of vascular plants on cryptogam diversity and cover indicates complex relationships between these groups, even in forelands' relatively simple communities. As the cryptogam diversity in the polar areas is high but still largely unknown, future studies on species ecology and climate change impact on vegetation should consider both vascular plants and cryptogams and interactions between these groups.

Lymphocyte subsets in haematological patients with COVID-19: Multicentre prospective study

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Patients with haematological malignancies and COVID-19 are characterized by T lymphopenia and reduction in NK cell numbers.

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T lymphopenia in haematological patients with COVID-19 include reduction in CD4+ T cells numbers and lowered CD4/CD8 ratio.

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Increase in activated T cells with low CD4/CD8 ratio are crucial for the early stages of COVID-19 in haematological patients.

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Low levels of both TCRγ/δ and CD3+CD25+ T cells may indicate impaired cellular response to COVID-19 in haematological patients.

The role of immune dysregulation in the course and prognosis of COVID-19 is not clearly established. In particular, immune status in specific populations such as haematological patients, who have an impaired immunological system, has not been described so far. Here, we performed a comprehensive analysis of peripheral blood lymphocyte subsets in 27 SARS-CoV-2-infected patients, including 16 patients with haematological malignancies. We identified T cell subpopulations, B cells, NK cells and TCR α/ß and ɣ/ƍ-expressing T cells during COVID-19 infection, with significant changes observed in immune profiles during the course of disease, especially in haematological patients. We observed an increase in activated T lymphocytes (CD3+HLA-DR+ and CD3+CD8+HLA-DR+) in the early stages of SARS-CoV-2 infection with a concomitant decrease in the CD4/CD8 ratio in haematological patients compared to non-haematological patients affected by COVID-19. We also found a decrease in ɣ/ƍ T cells in both studied groups of patients, with lower numbers of CD25+ T cells and CD16+CD56+ NK cells in haematological patients compared to non-haematological patients with COVID-19. Our findings demonstrate, for the first time, impaired adaptive immunity in patients with haematological malignancies infected with COVID-19, resulting in impaired cellular immune responses to SARS-CoV-2. This warrants further investigation of this disease group in COVID-19 patient cohorts

The application of nanotechnology in cancer immunotherapy

Targeted therapy is associated with the use of drugs designed against specific molecular targets. Their mechanism of action is based on the inhibition of specific signaling pathways in processes related to the development of cancer (proliferation, invasion, angiogenesis or metastasis). One of the most important methods of treatment is immunotherapy, which uses monoclonal antibodies. Their mechanism of action is based on inducing programmed cell death by inhibiting specific signal transduction processes. However, immunotherapy has a number of limitations, including side effects that may endanger the patient’s life. To overcome those obstacles immunoconjugates were developed, which combine a monoclonal antibody, or its fragment, with a drug using a stable linker. Their mechanism of action is based on the monoclonal antibody binding to a cell membrane receptor, their internalization, the degradation of the linker, and the release of the drug attached to the antibody, which then activates specific genes or proteins or induces apoptosis. Immunoconjugates represent a promising alternative for anticancer treatment used today, but their use is associated with some obstacles. Nanotechnology helps to solve these problems with a chemotherapeutics delivery system called immunonanoparticles. It uses chemotherapeutics encapsulated in nanoparticles in combination with monoclonal antibodies displaying the ability of selective recognition and binding with molecular targets on the surface of selected cancer cells. This review focuses on presenting the most important solutions used in targeted therapy, which combine traditional immunotherapy with modern nanotechnology.

Organic carbon accumulation in the glacier forelands with regard to variability of environmental conditions in different ecogenesis stages of High Arctic ecosystems

Recently deglaciated surfaces of glacier forelands are subjected to a variety of biotic and abiotic factors that lead to continuous soil formation. Until now, no attempt has been taken to analyse multiple factors that might affect soil development in the Arctic forelands. The main aim of this research was to determine the factors that influence soil development in the eight forelands of Svalbard. Moreover, the effects of both habitat type (glacier foreland and mature tundra) and geographical location on environmental variables treated as potential factors influencing soil formation were tested. In 2017, at each location a series of 1 m² plots was established; all 168 plots were investigated in terms of soil properties, spatial data, biological soil crusts (BSCs) properties, percent cover of BSCs and vascular plants. Stepwise multiple linear regression analysis using forward variable selection showed that soil development was significantly associated with six of fifteen analysed factors, i.e. BSC cover, carbon and nitrogen content in BSCs, soil pH, Topographic Wetness Index and foreland location. Two-way analysis of variance followed by Tukey's test revealed significant differences in studied environmental variables between habitat types and studied locations, showing that foreland soils still retain particular initial characters to differentiate them from tundra soil.

Differences in the courses of meningococcal and pneumococcal cerebrospinal meningitis

Neisseria meningitidis and Streptococcus pneumoniae are the most common pathogens causing cerebrospinal meningitis (CSM) in adults. The mortality rate and the number of complications remain high. In our study, retrospective evaluations were conducted on data concerning 98 adult patients with bacterial cerebrospinal meningitis caused by Neisseria meningitidis (n = 42) and Streptococcus pneumoniae (n = 56), hospitalised at the Regional Specialistic Hospital in Wroclaw (Poland) within the period 1998-2018. Compared to the group infected with S. pneumoniae, patients infected with N. meningitidis were younger and were less often affected by an additional disease burden; they presented more frequently with haemorrhagic rashes. Compared to the S. pneumoniae group, in patients with meningococcal CSM, cytosis in cerebrospinal fluid measuring < 1,000 cells/ mL was less frequent; intravascular coagulation syndrome appeared more frequently; the hospitalisation time was shorter and the rate of mortality was lower. Meningococcal meningitis occurs more frequently among young people with no history of disease. It is characterised by the rapid development of symptoms, which results in earlier diagnosis and more favourable prognosis compared to cases of S. pneumoniae. Irrespective of the pathogen, advanced age and a level of cytosis in cerebrospinal fluid of < 1,000 cells /μl indicate an unfavourable prognosis.

Effect of Land Use, Seasonality, and Hydrometeorological Conditions on the K+ Concentration-Discharge Relationship During Different Types of Floods in Carpathian Foothills Catchments (Poland)

The purpose of the study was to determine the role of land use, seasonality, and hydrometeorological conditions on the relationship between stream water potassium (K⁺) concentration and discharge during different types of floods-short- and long-duration rainfall floods as well as snowmelt floods on frozen and thawed soils. The research was conducted in small catchments (agricultural, woodland, mixed-use) in the Carpathian Foothills (Poland). In the woodland catchment, lower K⁺ concentrations were noted for each given specific runoff value for summer rainfall floods versus snowmelt floods (seasonal effect). In the agricultural and mixed-use catchments, the opposite was true due to their greater ability to flush K⁺ out of the soil in the summer. In the stream draining woodland catchment, higher K⁺ concentrations occurred during the rising limb than during the falling limb of the hydrograph (clockwise hysteresis) for all flood types, except for snowmelt floods with the ground not frozen. In the agricultural catchment, clockwise hystereses were produced for short- and long-duration rainfall floods caused by high-intensity, high-volume rainfall, while anticlockwise hystereses were produced for short- and long-duration rainfall floods caused by low-intensity, low-volume rainfall as well as during snowmelt floods with the soil frozen and not frozen. In the mixed-use catchment, the hysteresis direction was also affected by different lag times for water reaching stream channels from areas with different land use. K⁺ hystereses for the woodland catchment were more narrow than those for the agricultural and mixed-use catchments due to a smaller pool of K⁺ in the woodland catchment. In all streams, the widest hystereses were produced for rainfall floods preceded by a long period without rainfall.

Neuroendoscopic techniques in the treatment of arachnoid cysts in children and comparison with other operative methods

OBJECTIVE

The authors intended to evaluate the application of neuroendoscopic techniques for the treatment of arachnoid cysts in children and compare it with other operative methods.

METHODS

The analysis covered the results of treatment of 44 children with arachnoid cysts who were subjected to neuroendoscopic procedures and 62 patients who underwent other operations.

RESULTS

The neuroendoscopic treatment of arachnoid cysts was very effective because of low rate of reoperative treatment (six out of 44 patients), no need to change the operative method (40 effective out of total 44 operative procedures), and low rate of persistent worsening (none of 44 patients worsened).

CONCLUSIONS

Summing up all the mentioned aspects of neuroendoscopic techniques, the neuroendoscopic techniques were the most suitable operative procedures in the treatment of arachnoid cysts in the presented group of patients, providing that the connection between the lumen of the arachnoid cyst and the cerebrospinal fluid cisterns was of good quality.

Influence of neuroendoscopic third ventriculostomy on the size of ventricles in chronic hydrocephalus

Our intention was to compare the clinical outcome after surgical treatment of chronic hydrocephalus between patients who were subjected to neuroendoscopic third ventriculostomy and patients who underwent shunt implantation. At the Department of Neurosurgery of the Research Institute of Polish Mothers' Memorial Hospital from 1999 to 2001, 29 children, of an average age of 7 years (+/-7.1 years SD), underwent successful neuroendoscopic procedures, and from 1992 to 1994, 59 children, of an average age of 2 months (+/-1.9 months SD), underwent shunt implantation. The size of the ventricular system was described by the Frontal Horn Index and its change after operative procedures by the ratio of the final to the primary Frontal Horn Index. Head circumference was measured in percentiles according to the Kurniewicz-Witczakowa chart for Polish children. The reduction in head circumference after a neuroendoscopic procedure was, on average, significantly less than after a shunt implantation (0.39 percentiles +/-29.6 SD vs 17.93 percentiles +/-19.93 SD). Concerning the change in ventricular size after a neuroendoscopic procedure, it was noticed that the average ratio of the final to the primary Frontal Horn Index was 0.9. Meanwhile, the same parameter after a shunt implantation was 0.55. Based on the values of the Frontal Horn Indexes, it was observed that the ventricular system in infants after neuroendoscopic procedures was significantly larger than in other age groups (0.7 vs 0.5). After successful neuroendoscopic operations in a group of children suffering from Chiari II malformation, ventricular systems were slightly enlarged. The ratio of the final Frontal Index to the primary Frontal Horn Index was 1.31. In children suffering from chronic hydrocephalus, the average reduction in the size of the ventricular system and the rate of head circumference growth are lower after neuroendoscopic operations than after shunt implantations. Successful neuroendoscopic procedures are characterized by, on average, a higher rate of head circumference growth in infants than in neonates. In addition, the rate of head circumference growth after successful neuroendoscopic procedures could be higher than before the operation, which is clearly visible in children suffering from Chiari II malformation, but it does not mean a constant increase of that parameter during the postoperative period.

[Central nervous system tumors in pregnancy]

Central nervous system tumour in pregnancy constitutes a serious complication. Considering frequent difficulties in diagnostics and therapy, the aim of the study was to present our experience in management with pregnant women with brain and spinal cord tumours. Between 1988-2000, in The Research Institute Polish Mother's Memorial Hospital in Lodzi, 4 pregnant women had been diagnosed with brain and spinal cord tumours. The incidence of tumours complicating pregnancy was 1/11460. Two patients diagnosed at 29 weeks' gestation, underwent craniotomy and tumour resection during pregnancy. Two other women with central nervous system tumours diagnosed at 39 weeks' gestation, were operated in the postpartum period. The analysis of the postoperative period, gestation and/or postpartum period in all women and well-being of their new-borns confirm undertaken medical decisions.

Frequency of three BRCA1 gene founder mutations in breast/ovarian cancer families from the Pomerania-Kujawy region of Poland

A group of 63 families from the Pomerania-Kujawy region were analyzed for three BRCA1 gene Polish founder mutations, 5382insC, 300T>G, and 4153delA, because of breast (BrCa) and/or ovarian cancer (OvCa) history. The analysis was carried out by multiplex polymerase chain reaction method. BRCA1 mutation was revealed in nine (14%) families: in three (33%) of hereditary BrCa and OvCa families, in three (8%) of hereditary BrCa families, and in three (21%) of hereditary OvCa families. According to risk criteria, it was revealed in 45% of high-risk families with more than three cancers, 13% of moderate-risk families with two cancers, and 8% of families with sporadic OvCa. In six families, the mutation was found in a proband with BrCa or OvCa and in three families, the mutation was found in a healthy proband, first-degree relative of a patient deceased of BrCa or OvCa. 5382insC frameshift mutation accounted for 67% and 300T>G missense mutation for 33% of all identified familial mutations. 4153delA frameshift mutation was not found in analyzed sample of families. 5382insC mutation was found in 9% and 300T>G in 5% of all investigated families, and in 27 and 18%, respectively, of high-risk families. This underlines the importance of applying strict inclusion criteria to analyze mutation frequency in hereditary BrCa/OvCa families.

Effectiveness of neuroendoscopic procedures in the treatment of complex compartmentalized hydrocephalus in children

OBJECTIVE

The main object of the work is to assess the suitability of neuroendoscopic techniques for the treatment of complex compartmentalized hydrocephalus.

METHODS

For this purpose the authors compared two groups of children treated in the Research Institute of the Polish Mother's Memorial Hospital from March 1997 to January 2002. The first group of 47 children, treated using neuroendoscopic procedures, was compared with the second, which comprised 80 children treated conventionally by complicated shunt implantations.

RESULTS

The children treated neuroendoscopically needed on average 1.7660 procedures during the entire therapy, and 1.0232 operations a year. The same parameters in the conventionally-treated group were as follows: the total number of procedures was 7.050, and the rate of reoperation was 3.949 procedures a year. The proportion of patients who suffered from complications connected with operative treatment and who had a bad outcome was higher in the conventionally-treated group than in the neuroendoscopic one.

Assessment and prevalence of depression in women 45-55 years of age visiting gynecological clinics in Poland: screening for depression among midlife gynecologic patients

The aims of the Polish survey were to assess efficacy of screening for depression in gynecological practice and to estimate prevalence of depressive disorders in midlife women visiting gynecologists. The study included 2262 female outpatients aged 45-55, who were screened by 120 gynecologists throughout Poland. Patients completed the Beck's Depression Inventory (BDI) and were assessed by gynecologists to verify the presence of symptoms of a current Depressive Episode according to ICD-10 diagnostic criteria. Patients who obtained a score of 12 points or more on the BDI were referred for psychiatric evaluation, including the modified version of Mini International Neuropsychiatric Interview (MINI). The study showed that gynecologists in Poland are able to perform screenings for depression effectively in outpatient settings. Results also suggested that about 19% of women aged 45 to 55 years visiting gynecologists may suffer from depressive disorders.

[A comparison of neuro-endoscopic techniques with other surgical procedures in the treatment of arachnoid cysts in children]

The aim of the study was to evaluate the use of neuroendoscopic techniques (in comparison with other surgical procedures) in the treatment for arachnoid cysts in children. The analysis was performed on results of treatment 22 children with arachnoid cysts submitted to neuroendoscopic procedures. The group consisted of 6 girls and 16 boys, aged from 1 day to 18 years (mean age 5.3 years, SD +/- 5.6). The control group treated with other, non-endoscopic surgical procedures consisted of 61 patients (20 girls and 41 boys aged from 10 days to 17 years, mean age 7 years, SD +/- 6). Criteria of success varied according to the type of surgical treatment. In the case of procedures other than shunt implantation, the treatment was regarded as effective, if there was no need to change the surgical method, while shunt implantation was considered effective, if shunt revision was not necessary. The operative treatment outcome was assessed using the Glasgow Outcome Scale. Post-treatment changes in the clinical state were graded as improvement, no change, or deterioration. In terms of the assumed criteria of success in the treatment for arachnoid cysts, neuroendoscopic procedures and microsurgical cyst excisions were among the most effective methods. As many as 90.9% of neuroendoscopically treated children needed no other operation, in comparison with 92.6% of patients submitted to microsurgical procedures, who needed no change in the operative treatment. In the group of neuroendoscopically treated patients the effectiveness of neuroendoscopic operations varied according to the type of procedure used. Cystocysternostomies or cystoventriculostomies were successful in 100%. The analysis of clinical outcome has shown that deterioration was observed only in 13% of the patients with shunt implantation. Analyzing each type of arachnoid cyst separately, a statistically significant relationship was found between improvement of the clinical state and the use of craniotomy in the surgical treatment for cysts localized in the posterior fossa. Improvement in the case of neuroendoscopically treated children was related to a larger reduction in the cyst size after surgery and to a lower intensity of intraoperative bleeding. Neuroendoscopic techniques allowed to reduce the average period of hospitalization. Neuroendoscopic cystocysternostomy and cystoventriculostomy were the most effective techniques, besides microsurgical excision of arachnoid cysts. Neuroendoscopic treatment efficacy depends on the type of procedure used. The application of neuroendoscopic techniques allows to reduce the period of hospitalization.

[Changes in head circumference and ventricular system size after neuro-endoscopic third ventriculostomy in children]

The aim of the study was to compare changes in the head circumference ventricular system size after neuroendoscopic third ventriculostomy with those following shunt implantation in children suffering from chronic hydrocephalus. The data were analysed to establish criteria of success of neuroendoscopic procedures. In the years 1999-2001 neuroendoscopic third ventriculostomy was performed in 59 children at the Neurosurgery Department of the Research Institute of Polish Mothers' Memorial Hospital. However, the sample analysed in the paper consists of 29 children (16 boys, 13 girls aged from 18 days to 18 years, mean age 7.03, SD = 7.11 years) with chronic hydrocephalus successfully treated with neuroendoscopic procedures. The control group consists of 59 children (31 boys, 28 girls) selected out of 80 patients who underwent primary shunt implantation at the same Neurosurgical Department in the years 1992-1994. The control children (aged from 2 weeks to 9 months, mean age 2 months, SD = 1.92 months) did not need shunt revision during the clinical observation period. The ventricular system size was assessed in terms of the Frontal Index, while postoperative changes in the system size were expressed by the ratio of the Final Frontal Index to the Baseline Frontal Index. If the ventricular system size remained the same, the ratio was 1; if its size decreased after surgery, the ratio was less than 1, while any increases in the system size were reflected by a ratio over 1. Moreover, the head circumference (HC) was measured before and after surgery only in infants and neonates with non-communicating hydrocephalus. HC was expressed in centiles using the centile chart developed by Kurniewicz-Witczakowa for various age and sex groups of Polish children. The analysis included also post-surgery changes in HC over the observation period, in terms of the difference between the baseline HC value and HC measurements in relation to the observation period duration. A positive sign of this index evidenced a decrease in the rate of HC enlargement, while a negative sign--an increased rate of HC growth. The mean HC at the end of the observation period was 72.96 centile in the neuroendoscopy group and 52.36 centile in children after shunt implantation. The reduction of head circumference following neuroendoscopic procedures was significantly smaller than that after shunt implantation, as the average decrease in HC after neuroendoscopy was only 0.4 centile as compared to about 18 centiles after shunt implantation. In the neuroendoscopy group a relationship was found between HC and age: in newborns HC was significantly smaller than that in infants (20.25 and 82.55 centiles, respectively). An analysis of HC changes (in centiles) in relation to the time since the surgery in all the children aged under 1 year, successfully treated with neuroendoscopic procedures, indicated no tendency to a steady increase in the rate of HC enlargement, even though in many cases the HC after surgery was larger than that prior to the surgery. As regards changes in the ventricular system size, the average ratio of Final to Baseline Frontal Index was 0.9 in the neuroendoscopy group and 0.5 in the group after shunt implantation. The ventricular system turned out to be significantly larger in infants after neuroendoscopy than in other age groups (the mean Frontal Index values were 0.65 vs. 0.53, respectively). No tendency to constant enlargement of the ventricular system size after neuroendoscopy was found. In children with non-communicating hydrocephalus due to Chiarii II malformation a mild enlargement of the ventricular system was seen after successful neuroscopy (the ratio of the Final to Baseline Frontal Index amounted to 1.3).

CONCLUSIONS

The rate of head circumference (HC) enlargement in infants after succeeded neuroendoscopic procedures did not continually increase during the postoperative period, although their HC expressed in centiles could be higher than that before surgery. The average reduction of the ventricular system size was much smaller after neuroendoscopic ventriculostomy than than after shunt implantations. In children with Chiarii II malformation and in infants the ventricle system size may be somewhat increased in comparison to pre-operative levels. However, no tendency to a steady enlargement with time was found either in the HC or in the ventricle system size.

[Neuro-endoscopic techniques in the treatment of complex hydrocephalus in children]

The aim of the paper was to evaluate effectiveness of neuroendoscopic procedures in comparison to complex shunt systems implantation in the treatment of complex compartmentalized hydrocephalus in children. Neuroendoscopic techniques were applied in 47 patients (23 boys, 24 girls aged from 25 days to 18 years, mean age 3 years SD = 4.9 years). The shunt implantation comparison group consisted of 80 patients (47 boys and 33 girls aged from 1 day to 16 years, mean age 0.8 year, SD = 2 years). Every endoscopic procedure was planned individually, in accordance with the patient's type of complex hydrocephalus and level of deformity of his/her ventricular system. In cases of multiloculated hydrocephalus septostomy was generally performed to restore communication between separated parts of the ventricular system. In uniloculated hydrocephalus resulting from the foramen of Monro obliteration, septostomy of pellucid septi was performed to connect the isolated lateral ventricles. In cases of isolated ventricle III the foramen of Monro patency was restored to connect the ventricle with the whole ventricular system. Neuroendoscopic techniques allowed to significantly reduce the number of necessary surgical procedures. Complex hydrocephalus patients treated with the traditional shunt implantation required on the average 7 operations during the whole therapy, as compared to about 2 in those treated by means of neuroendoscopic techniques. An analysis of the number of necessary surgical interventions per year of clinical observation also indicated superiority of neuroendoscopy techniques over shunt implantation (1 vs. 4 operations per year, respectively). Neuroendoscopy allowed to simplify shunt systems in 33 children, i.e. 70.2% of those treated with neuroendoscopic techniques, while in the group treated with traditional methods of shunt implantation only 16 children (16.3%) had a simple shunt system (a shunt with one intraventricular drain). The outcome assessed according to the Glasgow Outcome Scale (GOS 1, 2) in children treated only by shunt implantation was significantly inferior to that in the neuroendoscopy group, both in terms of mortality rate (22.5 and 4.3%, respectively) and postoperative complications present in 42 (52.5%) of shunt implantation cases and 9 (19.1%) of endoscopically treated patients.

CONCLUSIONS

Neuroendoscopic techniques allowed to reduce the number of necessary operative procedures, to simplify shunt systems, to improve clinical outcome, and to reduce the risk of complications in the early postoperative period.

Polish consensus: procedure in case of estrogen deficiency in women after breast cancer therapy

Women surviving breast cancer in the postmenopausal period suffer from hormonal alternations with adverse effect on mental status and functioning of a number of organs and systems. Two thirds of these women had menopause before the diagnosis of breast cancer. In the remaining one-third ovarian failure is natural or induced by chemotherapy. Doctors cautiously approach the use of estrogen therapy in this group of patients. Their fears are not unsupported bearing in mind known epidemiological data exist linking breast cancer with the use of hormonal therapy. The purpose of this review is to evaluate current data on hormonal use and breast cancer risk.

[Application of IVF in women with endometriosis]

Application of IVF at women with endometriosis after pharmacological and surgical therapy hold out hopes to possession of child. Endometriosis occurs three times more often in the patients with primary sterility than in patients with secondary sterility. The presence of a small endometriosis does not reduce the success of the IVF therapy. The women with endometriosis who undergo IVF treatment have similar prospect in compensate with women with tubal sterility. IVF improve fertility in women with mild or minimal endometriosis. But at women after IVF the presence of endometriomas is associated with increased rates of early pregnancy losses. Women with endometriosis marking often antinuclear antibodies and antiphospholipid antibodies than women without endometriosis. To evaluate the 15% of infertile women have endometriosis.

[Evaluation of incidence of Chlamydia trachomatis infections among the group of infertile women diagnosed by laparoscopy, and based on properties of Chlamydia trachomatis in the cervical canal, peritoneal fluid and ovarian cyst puncture]

The number of 75 patients who underwent diagnostic et operative laparoscopy was analysed. The percentage of infection cases caused by Chlamydia Trachomatis was 9.33% investigations proved correlation between fallopian tube factor and infection. It seems that pelvic infection not always undergoes with infection of uterine cervix.

[Concentrations of MMP-1, TIMP-1, MMP-1/TIMP-1 and I CTP complexes in follicular fluid as related to fertilization rate in women treated with in-vitro fertilization]

OBJECTIVES

Metalloproteinases and their inhibitors appear to control connective tissue remodelling during follicular rupture. The aim of the study was to establish if oocytes fertilisation rate after ovulation induction depends on the concentrations of MMP-1, its inhibitor TIMP-1, MMP-1/TIMP-1 complex and I CTP in follicular fluid (FF).

MATERIAL AND METHODS

FF were collected from 37 infertile patients undergoing ovulation induction using either short or long protocol. FF was obtained 36 hours after administration of hCG (Pregnyl). The level of MMP-1, TIMP-1, MMP-1/TIMP-1 complex were measured using ELISA kits and I CTP, E2, FSH, LH, using RIA assay kits.

RESULTS

Statistically significant (p < 0.05) difference was found in TIMP-1, E2, and FSH concentration, being higher in the group with more than 75% fertilisation rate: TIMP-1 728.8 + 100.1 ng/ml vs 666.3 + 94.5 ng/ml; E2 477.3 +/- 160.0 ng/ml vs 368.0 +/- 190.0 ng/ml and FSH 7.27 +/- 1.45 mIU/ml vs 6.24 +/- 1.6 mIU/ml.

CONCLUSIONS

Statistically significant increase in TIMP-1 concentration observed among patients with fertilisation rate above 75% indicates an important role of this substance in ovulation process.

Blood selenium and glutathione peroxidases in miscarriage

OBJECTIVE

To investigate the selenium glutathione and glutathione peroxidase (glutathione-Px) levels in blood in women who experience miscarriage.

DESIGN

An observational study.

PARTICIPANTS

Forty women with miscarriage occurring in the first and second trimesters.

METHODS

Concentrations were measured in whole blood and plasma. Glutathione was measured in red cells and glutathione-Px activity was measured in the red cells and plasma. The results were compared with 36 women in the same period of viable pregnancy and 28 age-matched, healthy, non-pregnant controls.

RESULTS

The selenium concentrations in whole blood and plasma of women following abortion were the same as in viable pregnancy, but were significantly lower compared with controls. The glutathione levels were significantly higher in women with miscarriage compared with viable pregnancies and with non-pregnant women. Red cell and plasma glutathione-Px activities of women who had had a miscarriage were significantly lower than in both normal pregnancies and the control group.

CONCLUSION

The decreased activities of the antioxidant enzymes, red cell and plasma glutathione-Px, may play an important role in the aetrology of spontaneous abortion.

[Multiple pregnancy as a cause of premature delivery]

Authors analysed management, complications and outcome of 13 multifetal pregnancies (11 triplet and 2 quadruplet), their duration, the way of delivery, indications for cesarean section and perinatal mortality rate. A majority of the multifetal pregnancies were diagnosed before the end of 20 weeks gestation, and 69.2% of women had cervical cerclages. Tocolysis was used in 9 cases (69.2%). The mean gestational age at delivery was 32.8 weeks. Cesarean section was performed in nine cases (29 neonates). Of the 41 neonates there were 2 stillbirth (4.88%) and 3 neonatal death (7.31%). In 87.9% of cases, delivery occurred before the end of 37 weeks gestation. The most common maternal complications were toxemia (23.1%) and anemia (46.2%).

[The influence of delivery methods for twins on obstetric results]

The analysis covered 100 twin gestations over the years 1996-1998 in the material of Gynecology and Obstetrics Clinic in Bydgoszcz. The authors estimated the relations between the mode of delivery and presentations of the twins. Abnormal foetal presentation occurred in 68 pregnancies (68%), and was more often in the second twin (61.8%). The highest percentage of cesarean sections (29%) we have observed in the case of an abnormal presentation of the first twin. The condition of the twins in their first minute after the birth was estimated according to the birth weight, the gestational age, and the mode of surgical procedures performed. Better condition after the birth of the second twin with the birth weight above 1000 g comparing to the first twin was established in cesarean sections, not in other obstetrical procedures. There was no essential difference between the mortality rate of the first and the second twin. Early diagnosis of the twin pregnancy using USG helps us to choose a suitable management during pregnancy and an optimal mode of delivery.

[Evaluation of cGMP plasma concentration in women in normal pregnancy and labor]

Aim of our study was evaluation of cGMP plasma concentration in women in course normal pregnancy and labour. The investigations were performed in Department of Obstetrics and Gynaecology Medical Academy in Bydgoszcz. Following groups of patients were examined. 1. 12 non-pregnant women 2. 59 women with normal pregnancy 3. 31 women at term with spontaneous uterus contractions.

RESULTS

1. low concentrations cGMP in plasma in non-pregnant women in course of menstruation cycle 2, low concentration cGMP in the first half of pregnancy--with gradual increase from 25 to 33 gestation week and with rapid increase in last 7 weeks of pregnancy, 3.--significant higher cGMP concentration at term in relation to values observed in early pregnancy and to the period between 28 and 37 weeks of gestation 4. significant higher cGMP plasma concentration in women in labour in relation to cGMP concentrations at term without uterus contractions.

[Evaluation of using Levovist in the differential diagnosis of ovarian tumors]

The research on applying Levovist was carried out in the Department of Obstetrics and Gynaecology of Medical Academy in Bydgoszcz, Poland, in the years 1997-1998. Out of 118 hospitalised patients with preliminary diagnosis: tu. hypogastrii, tu. adnexorum, tu. ovarii, cystis ovari, due to the suspicious ultrasound result, and/or decreased parameters of arterial blood flow (PI < 1.0; RI < 0.6) and or presence of abdominal fluid, 32 women were included in the study. The changes in the Doppler image under the influence of Levovist and their correlation with histologic features were analysed. The time span between injection of Levovist and the enhancement of the Doppler image was not characteristic for any tumor. However, it was observed, that the mean return time i.e. from the enhancement of the Doppler signal to the initial pattern, was considerably longer in carcinomas than in other ovarian tumours. No signal enhancement was observed in benign lesions.

[The course of pregnancy and delivery among women with thrombocytopenia]

Between January 1987 and December 1997 in The Ludwik Rydygier Medical University in Bydgoszcz 10 pregnant woman with autoimmune or "gestational" thrombocytopenia and preeclampsia--associated thrombocytopenia were evaluated. All of the patients delivered naturally and one delivered by caesarean section for obstetric indications. Severe neonatal thrombocytopenia was observed in one of newborns.

[The evaluation of efficiency of PGE 1 (alprostadil) during intracavernous injection in the treatment of erectile dysfunctions]

We have investigated the influence of PGE1 (alprostandil--"Prostavasin"--Schwarz Pharma company) on the erection in the group of 34 men with erectile disfunction (28 with and 6 without diabetes mellitus) treated in period from 1996 to 1998. Other diseases were excluded in all patients. The concentrations of FSH, LH, T, PRL, T3 and T4 were in normal range. The applied dose of PGE 1 varied from 5 mg to 20 mg maximum three times a week. The effect of the treatment was estimated according to subjective symptoms. The effectiveness of the treatment varied from 50% to 67%. The most effective dose was the maximal one (20 mg). The minimal effective dose of alprostadil was 10 mg.

[Struma ovarii: rare ovarian neoplasm]

Authors of this research present 3 cases of struma ovarii diagnosed in postoperative histopathological examination in years 1994-1997. The first one was accidentally discovered during examination of a woman in menopausal period, the second was a case of 39-years old woman with hyperthyroidism and struma parenchymatoso-nodosa and the third was detected during examination of a young 21-years old woman with abdominal pain. In first two cases Doppler flowmetry revealed low RI and PI parameters (< 0.5 and < 0.7 respectively) in tumor structures.

[Evaluation of ovarian tumor vascularization by means of intravaginal ultrasonography with color Doppler]

53 cases of ovarian tumors were diagnosed and operated in the Clinic of Obstetrics and Gynecology of Medical Academy in Bydgoszcz in years 1996-1997. Retrospective analysis of 58 results of ultrasonographic examination with color-Doppler estimated flows and histopathological diagnoses in cases of ovarian tumor was performed. On the ground of sonographically estimated morphology, presence or absence of vascularization and pulsation and resistance indices (PI and RI respectively) an attempt to discriminate benign and malignant tumors was made. Values of RI > 0.6 and PI > 1.0 in absence of morphologically suspicious features in ultrasonographic examination correlated with benign forms of ovarian tumors in histological examination.

[Personal experience in rehabilitation of patients treated with Austin-Moore hip arthroplasty for femoral neck fracture]

Pre and post-operative rehabilitation protocol used in 76 patients with femoral neck fracture treated with Austin-Moore hip plasty is presented. The age of patients ranged from 68 to 91 years (mean 79 years). They were operated on average 5 days after admission (range 1-16 days). The authors emphasize role of rehabilitation leading to regaining of ambulating skills by the operated patient. It also decreases the number of pulmonary and psychoorganic complications, shortens hospital stay. Cardiac infarct and pulmonary vein embolism were causes of two fatalities in postoperative period. Mean hospital stay was 22 days.

[Relationship between erythropoietin activity in fetal blood and Liley's curve and bilirubin concentration in amniotic fluid in serologic conflict]

Authors analysed concentration of erythropoietin (EPO) in fetal blood from pregnancies complicated by serologic conflict. There was conducted the trial of settle correlation between EPO activity in fetal blood and bilirubin concentration in amniotic fluid and its optical density ratio obtained by amniopuncture in the same pregnancies.

[A model for medical care of gestational diabetes]

Our approach to taking care of 122 diabetic pregnant women was presented. At first, they were hospitalized in the Pathological Pregnancy Ward. An intensive insulin therapy (human insulin) was initiated and all the patients were educated. The pregnant appeared as an outpatient every fortnight within the first part of pregnancy and every seven to ten days in the second one. They were hospitalized for a few days in 12th and 24th week of pregnancy and from 36th/37th week until delivery. Unfortunately, their first arrival to our center was too late, usually with diabetes out of control. There were 3 miscarriages (2.4%), 111 newborns were in a satisfactory condition (91%), 4 died (3.3%), congenital malformations were found in four others (3.3%). A successful course of pregnancy was dependent upon a proper care taken of patients early enough, good cooperation with them and related with it satisfactory metabolic control of diabetes.

[Activity of cathepsin B and D in blood serum of women with uterine cervix neoplasms]

The activity of cathepsins B and D were determined in the serum in 98 patients with carcinoma of the cervix uteri and in 25 women with dysplasia of the cervix uteri. The clinical value of the examined enzymes was performed. The results show that the mean serum activity of cathepsins increase with progression of neoplastic disease. The elevation of at least one of two studied lysosomal hydrolases were estimated in 68 patients (69.5%) with carcinoma of the cervix uteri.

[Selected clinical and laboratory tests during specific immunotherapy of patients hypersensitive to insect bites]

The study aimed at determining selected immunologic parameters of the cellular histamine secretion and skin reactivity in the group of 9 patients hypersensitive to insect poison with effective immunotherapy following 2 years of maintenance treatment. It has been shown that the continuation of the specific immunotherapy for 2 years maintains and even increases favourable changes in humoral and cellular immunity induced already in the early phase of desensitization. An assay of the specific IgE and IgG4, cellular histamine secretion, and skin reactivity is of value in monitoring specific allergy to insect poison immunotherapy.

[Fertility of women after surgical intervention on organs of reproduction]

The research included 114 female patients treated at the Clinic of Obstetrics and Gynaecology in the years 1986-1991. Information was based on a questionnaire, with 40 (35%) answers. Basic parameters of fertility were evaluated in women, who underwent surgical intervention on reproductive organs and they were discussed in connection with other conditioning. It was ascertained that the decision concerning infertility treatment is taken up by young patients, up to 25 years of age, during the first 5 years of marriage. Duration of the treatment in the majority of patients lasts longer than 5 years. Routine surgical interventions in the area of reproductive organs do not increase significantly the possibility of conception. Whereas in this group we deal more often with ectopic pregnancy.

[Socio-medical conditioning of marital infertility]

An inquiry was carried out among 185 women diagnosed because of infertility. The questionnaires included personal data, obstetric information from the past and information concerning earlier attempts at diagnosing and treating both partners. Authors of this article are of the opinion that infertile couples, especially from the country, decide only too late to find out the causes of the infertility. Taking into consideration the range of present day knowledge, the authors point out that highly specialized centres should deal with diagnosing and treating infertility.

[Surgical treatment of polycystic ovary syndrome. B. Postoperative examinations]

After the wedge resection of the ovaries the authors obtained the normal menses in 100%, the reduction of total testosterone in blood of 41.8% and of 17-KS in urine of 20%, an increase of fertility of 62.5% and in hirsutism a correction only of 12%, the stopping of 12% and no correction of 76%. The authors conclude that the cause of the healing or of the correction is placed in the resection of 3/4 of the changed ovaries with cysts follicles with distinct thecal layer what is accompanied by the reduction of testosterone on average of 41.8%. On contrary a weak correction in hirsutism has the explanation that the existent hirsutism is supported even by the normal level of testosterone in organism.

[Surgical treatment of polycystic ovary syndrome. A. Preoperative examinations]

The aim to study was the determination the effect of operative treatment of 31 patients with polycystic ovary syndrome. Before the operation primarily the authors confirmed at the patients the presence of menstrual abnormalities in 96.8%, of infertility in 100%, of hirsutism I. in 9.7%, II. in 61.8%, III. in 29% and the average level of 17-ketosteroids 16.0 +/- 6.9, of DHEA 3.7 +/- 1.5 mg and of estrogens 39.0 +/- 15.1 mcg in 24 urine, of total testosterone 0.98 +/- 0.24, of FSH 3.4 +/- 1.5, of LH 44 +/- 2.4, of prolactin 11.4 +/- 5.4 and of estradiol 0.32 +/- 0.35 ng/ml in blood. On the basis of clinical, hormonal or/and ultrasonographic examinations the diagnosis of the polycystic ovarian disease was performed.

[Pharmacokinetic examination of theophylline in pregnancy in cases of fetal anoxia]

The purpose of the investigation was to determine the effects of pregnancy on theophylline pharmacokinetics and to clarify the clinical effect of theophylline treatment in cases of threatened anoxemia of foetus. The study was carried out in 15 pregnant women between 28 and 32 weeks of pregnancy with chronic anoxemia of the foetus. The women obtained Aminophyllinum "Polfa" 250 mg (201.3 mg of theophylline) every 12 hours for 4 days to achieve the steady-state of theophylline. After the first dose the drug concentration reached the level of theophylline in range of 12.05 +/- 4.57 micrograms/ml in 15 minutes to 3.62 +/- 0.74 micrograms/ml in 12 hours. The subsequent doses increased the concentration and in steady-state the concentration fluctuates between 21.48 +/- 10.00 micrograms/ml and 6.20 +/- 1.56 micrograms/ml, what coincides with established therapeutic range of theophylline (10-20 micrograms/ml). Elimination of the drug was characterised by calculation of the elimination rate constant and drug-clearance. Both parameters are higher after a single administration what suggest the accumulation of theophylline after multiple drug administration by the saturation of enzymes taking part in metabolism of the drug. Attention should be paid higher values of half-life in pregnancy in comparison with those obtained previously in healthy volunteers. Comparative investigations of the level of theophylline in amniotic fluid in relation to maternal blood in steady-state showed a high correlation between these two values (r = 0.7867, p < 0.006). The proportion of the concentration of theophylline in relation to that in maternal blood is about 60% (0.5978 +/- 0.1599).(ABSTRACT TRUNCATED AT 250 WORDS)

[Pharmacokinetic investigations of verapamil used as a concomitant drug in treatment of premature labor]

The study carried out on 35 pregnant women, who were threatened with fenoterol and verapamil by premature delivery. The pharmacokinetics of verapamil have been examined after single dose and in steady state using drug in a dose of 2 x 80 mg/day (15 women) and 3 x 40 mg/day (8 women). Verapamil in a dose of 2 x 80 mg/day induced average steady state concentration in range of 40.6 +/- 7.8 ng/ml to 134.2 +/- 56.9 ng/ml and in a dose of 3 x 40 mg/day 28.9 +/- 5.1 ng/ml to 69.8 +/- 11.2 ng/ml. Since most authors take as optimal therapeutic level of verapamil in blood the range of 100-200 ng/ml, it seems that dosage regimen of 2 x 80 mg/day can be recommended. Additionally, verapamil concentration in maternal blood and in amniotic fluid were determined simultaneously in a group of 12 pregnant women. Verapamil readily penetrates placenta reaching in amniotic fluid about 70% of the concentration observed in maternal blood.

[Level of specific IgE and IgG in blood serum of patients with hay fever after several cycles of desensitization with pollinex vaccine]

Blood serum specific IgE and IgG levels have been assayed in a group of 54 patients allergic to grass pollen during the long-lasting desensitization with Pollinex Depot vaccine. Specific IgE and IgG levels were determined with RAST and IgG-RAST technique whereas a titre of the blocking antibodies with RAST inhibition test. It was found that cyclic administration of Pollinex vaccine, repeated every 3-4 years, significantly influences patients' immunologic system manifested by a decrease in specific IgE, and an increase in both IgG level and the titre of the blocking antibodies.