Correction: MeltMan: Optimization, Evaluation, and Universal Application of a qPCR System Integrating the TaqMan qPCR and Melting Analysis into a Single Assay

[This corrects the article DOI: 10.1371/journal.pone.0151204.].

Estimating the Baseline Incidence of a Seasonal Disease Independently of Epidemic Outbreaks

In epidemiology, it is very important to estimate the baseline incidence of infectious diseases, but the available data are often subject to outliers due to epidemic outbreaks. Consequently, the estimate of the baseline incidence is biased and so is the predicted epidemic threshold which is a crucial reference indicator used to suspect and detect an epidemic outbreak. Another problem is that the "usual" incidence varies in a season dependent manner, i.e. it may not be constant throughout the year, is often periodic, and may also show a trend between years. To take account of these factors, more complicated models adjusted for outliers are used. If not adjusted for outliers, the baseline incidence estimate is biased. As a result, the epidemic threshold can be overestimated and thus can make the detection of an epidemic outbreak more difficult. Classical Serfling's model is based on the sine function with a phase shift and amplitude. Multiple approaches are applied to model the long-term and seasonal trends. Nevertheless, none of them controls for the effect of epidemic outbreaks. The present article deals with the adjustment of the data biased by epidemic outbreaks. Some models adjusted for outliers, i.e. for the effect of epidemic outbreaks, are presented. A possible option is to remove the epidemic weeks from the analysis, but consequently, in some calendar weeks, data will only be available for a small number of years. Furthermore, the detection of an epidemic outbreak by experts (epidemiologists and microbiologists) will be compared with that in various models.

Estimating the Baseline and Threshold for the Incidence of Diseases with Seasonal and Long-Term Trends

In epidemiology, it is very important to estimate the baseline incidence of infectious diseases. From this baseline, the epidemic threshold can be derived as a clue to recognize an excess incidence, i.e. to detect an epidemic by mathematical methods. Nevertheless, a problem is posed by the fact that the incidence may vary during the year, as a rule, in a season dependent manner. To model the incidence of a disease, some authors use seasonal trend models. For instance, Serfling applies the sine function with a phase shift and amplitude. A similar model based on the analysis of variance with kernel smoothing and Serfling's higher order models, i.e. models composed of multiple sine-cosine function pairs with a variably long period, will be presented below. Serfling's model uses a long-term linear trend, but the linearity may not be always acceptable. Therefore, a more complex, long-term trend estimation will also be addressed, using different smoothing methods. In addition, the issue of the time unit (mostly a week) used in describing the incidence is discussed.

MeltMan: Optimization, Evaluation, and Universal Application of a qPCR System Integrating the TaqMan qPCR and Melting Analysis into a Single Assay

In the present work, we optimised and evaluated a qPCR system integrating 6-FAM (6-carboxyfluorescein)-labelled TaqMan probes and melting analysis using the SYTO 82 (S82) DNA binding dye in a single reaction. We investigated the influence of the S82 on various TaqMan and melting analysis parameters and defined its optimal concentration. In the next step, the method was evaluated in 36 different TaqMan assays with a total of 729 paired reactions using various DNA and RNA templates, including field specimens. In addition, the melting profiles of interest were correlated with the electrophoretic patterns. We proved that the S82 is fully compatible with the FAM-TaqMan system. Further, the advantages of this approach in routine diagnostic TaqMan qPCR were illustrated with practical examples. These included solving problems with flat or other atypical amplification curves or even false negativity as a result of probe binding failure. Our data clearly show that the integration of the TaqMan qPCR and melting analysis into a single assay provides an additional control option as well as the opportunity to perform more complex analyses, get more data from the reactions, and obtain analysis results with higher confidence.

The Relationship of Kynurenine and Neopterin Levels and Their Association with a Selection of Other Immune Markers in Chronic Myeloid Leukaemia Patients

Among malignant diseases, chronic myeloid leukaemia (CML) is one of the best suited candidates for immunotherapy. For this purpose it is necessary to broaden the present knowledge on the immunology of this disease. As a part of such a project, the levels of kynurenine (KYN) and neopterin (NPT) were studied in 28 CML patients and in the same number of healthy subjects. At diagnosis, both KYN and NPT levels were found to be elevated in a significant portion of the patients and dependent on their leukocyte count. As in the case of KYN, increased NPT levels dropped after achieving remission. When correlating KYN and NPT levels with a selection of other markers tested, significant association was revealed only in the case of CRP and IL-6. However, there were several patients with increased KYN levels in whom NPT was not detected, and vice versa. The relapse of the disease observed in two patients was accompanied by an increased level of NPT in both cases, but by an increased level of KYN in only one of them. No significant correlation was found between KYN and NPT levels in sera taken at diagnosis. However, when the whole set of sera was taken into consideration, the association became statistically significant. Although the data obtained revealed a number of similarities between KYN and NPT production in CML patients, it also suggested a difference in the kinetics of these two biomarkers' production.

The effect of different doses and different routes of acetylsalicylic acid administration on platelet aggregation in healthy volunteers and ischemic stroke patients

The purpose was to assess the effect of different doses and different routes of acetylsalicylic acid (ASA) administration on platelet aggregation and the comparison between platelet aggregation after the single and the repetitive administration of ASA in healthy individuals and in patients after ischemic stroke. The study group consists of 22 healthy individuals and 30 patients with documented ischemic stroke. Platelet aggregation was measured in healthy individuals: (a) twice before ASA and (b) 2 h after different single doses and different routes of ASA administration-(b1) 500 mg orally, (b2) 500 mg intravenously, and (b3) 100 mg orally. We measured aggregability in healthy individuals after five consecutive days of 100 mg of ASA q.d. and in patients on chronic ASA 100 mg q.d. The VerifyNow was used with results expressed in aspirin reaction units (ARU). In healthy individuals, the dose-(b1) 500 mg orally-reduced the aggregability to mean (SD) 392 (36) ARU (p < 0.001), (b2) 500 mg intravenously to 428 (46) (p < 0.001) and (b3) 100 mg orally to 460 (76) (p < 0.001). The suppression of aggregation after 500 mg was (p = 0.029) higher after the oral compared to intravenous administration, and the same is true for the suppression after single dose of 500 mg orally and 100 mg orally (p = 0.011). Oral dose 100 mg for 5 days in healthy individuals reduced aggregation to 405 (37) and in post-stroke patients to 433 (54). All doses of ASA, both orally and intravenously, have produced a significant reduction of platelet aggregation. Preference of the parenteral to oral application has not been established.

[Effect of the liquid milk nutritional supplement with enhanced content of whey protein on the nutritional status of the elderly]

AIM

The aim of this study was to evaluate the effect of long-term administration of liquid nutritional supplement with increased amounts of whey protein and reduced amounts of lactose, produced in accordance with a new recipe "Nutrisen" on the elderly living in institutionalized care.

METHODS

The study was carried out from May to July, 2013, on 47 retirement home residents, living in Prague, all of which were 65 years or older. Supplemented group (n = 23) consumed (200 ml) milk drinks with three different flavours on a daily basis for eight weeks. The reference group was on a normal diet. There was no significant difference in baseline characteristics between participants in both groups. Anthropometric and biochemical indicators of nutritional status and tolerance of the nutritional supplement during long-term use were evaluated.

RESULTS

Both compliance (daily intake program) and tolerance of the nutritionally defined supplement were very good. For the supplemented group, there was an average weight increased of 700 grams after the 8 week nutritional supplement test period. Average levels of albumin and prealbumin increased significantly (from the beginning to the end of the program), 35.5 ± 4.52 g/l vs 36.19 ± 4.1 g/l and 0.160 ± 0.05 vs 0.174 ± 0.04 g/l (p < 0.05), vitamin D levels increased from 31.2 ± 16.4 nmol/l to 36.8 ± 17.7 nmol/l (p < 0.001) and HDL-cholesterol levels increased from 1.29 ± 0.33 mmol/l to 1.35 ± 0.35 mmol/l (p < 0.001).

CONCLUSION

The specific nutritionally defined milk drink (Nutrisen), used in this study, was well tolerated by the elderly study participants, over the eight-week clinical study. We observed a positive effect on the participants weight, serum albumin, prealbumin, vitamin D and HDL-cholesterol.

Alcohol consumption and marijuana use in young adult Czechs

OBJECTIVES

The main objective of the study is to explore associations between alcohol consumption and marijuana use in young adults and to discuss the opportunities for brief intervention.

METHODS

Face to face structured interviews were carried out with 2,221 young adult Czechs (mean age 29.9, sd. 5.8 years). 51.4% were males. Alcohol consumption was calculated using beverage specific quantity frequency method. Alcohol-related problems were assessed using the Czech version of the AUDIT. Frequency of marijuana use in the last twelve months was asked as well.

RESULTS

The overall alcohol consumption was 9.2 litres of pure alcohol per person and year. The last year prevalence of marijuana use was 21.8%. The use of marijuana positively correlated with the frequency of beer drinking (r = 0.27), frequency of heavy episodic drinking [HED] (r = 0.32) and with the summary score in AUDIT (r = 0.39). Harmful or problem drinkers (AUDIT score > or = 16) reported marijuana use more frequently than moderate drinkers (60% compared to 18.8%; OR = 6.54; 95% CI = 4.7; 9.1). OR for marihuana use in heavy episodic drinkers was 4.3 (95% CI = 3.3; 5.6).

DISCUSSION

The results suggest that frequent HED and harmful drinking are closely associated with marijuana use in younger adults. Since marijuana use (including heavy use) is rather common in the Czech Republic, it would be recommendable to also extend screening and brief intervention to reduce the use of cannabis. The existing guidelines for brief intervention should be modified in order to cover marijuana consumption as well.

Nutritional status assessment of institutionalized elderly in Prague, Czech Republic

BACKGROUND

There are few studies in the Czech Republic describing and evaluating the nutritional status of institutionalized elderly.

METHODS

Data were collected from 659 women and 156 men aged 65 years and older and living in retirement homes in and around Prague. Data included: a Mini-Nutritional Assessment (MNA questionnaire), anthropometric measurements and biochemical evaluations.

RESULTS

According to the MNA questionnaire, 10.2% of these elderly individuals were malnourished and 39.4% were at risk of malnutrition. More women than men were malnourished (OR = 0.59 and 95% CI 0.42-0.86). Mean BMI values were 25.5 for females and 27.5 for males. MNA was positively correlated mostly with immobility (r = 0.63; p < 0.001), BMI (r = 0.57; p < 0.001) and mid-arm circumference (r = 0.56; p < 0.001). Serum albumin levels were <28 g/l in 1.3% (1.3% of the women and 1.36% of the men) and between 29.0 - 34.0 g/l in 21% (22.5% of the women and 14.4% of the men). Statistically significant differences between groups according to MNA scores were found for albumin, prealbumin, transferrin and creatinine. Prevalence of smoking was significantly higher among males.

CONCLUSION

The study results confirmed that institutionalized elderly, especially women, should be considered a nutritionally vulnerable population group that needs attention.

Ulnar nerve at the elbow - normative nerve conduction study

Introduction

A goal of our work was to perform nerve conduction studies (NCSs) of the ulnar nerve focused on the nerve conduction across the elbow on a sufficiently large cohort of healthy subjects in order to generate reliable reference data.

Methods

We examined the ulnar nerve in a position with the elbow flexion of 90^o from horizontal. Motor response was recorded from the abductor digiti minimi muscle (ADM) and the first dorsal interosseous muscle (FDI).

Results

In our sample of 227 healthy volunteers we have examined 380 upper arms with the following results: amplitude (Amp)-CMAP(wrist) for ADM 9.6 ± 2.3 mV, MNCV at the forearm 60.4 ± 5.2 m/s, MNCV across the elbow 57.1 ± 5.9 m/s.

Discussion

Our study showed that motor NCSs of the ulnar nerve above elbow (AE) and below elbow (BE) in a sufficiently large cohort using methodology recommended by AANEM gave results well comparable for registration from FDI and ADM.

Long-term changes in prevalence of overweight and obesity in Czech 7-year-old children: evaluation of different cut-off criteria of childhood obesity

The objective of this paper was an evaluation of change in prevalence of overweight and obesity in Czech children, and a comparison of cut-off points for body mass index references from the Czech Republic (CzR), International Obesity Task Force and WHO. The authors conducted a survey in 7-year-old children, and compared data from 1951, 1981, 1991, 2001 and 2008 (WHO cut-offs). 2008 data were evaluated according to different cut-offs. Results showed that since 1951 in boys, overweight prevalence increased from 13.0% in 1951 to 26.8% in 2001, in girls from 10.9% to 22.9%. Obesity increased in boys from 1.7% to 8.3%, in girls from 1.7% to 6.9%. From 2001 to 2008 obesity in boys increased; obesity in girls and overweight in both genders decreased. In 2008 cohort the following values were found: overweight and obesity: CzR criteria, percentage was lowest (14.8% boys and 11.1% girls); WHO criteria, highest prevalence (23.5% boys and 19.5% girls); obesity: lowest ratio International Obesity Task Force criteria (4.4% boys, 3.3% girls), highest ratio boys WHO criteria (10.0%), girls CzR criteria (5.0%). Overweight and obesity prevalence increased in 7-year-old Czech children since 1951; since 2001 prevalence is plateauing with exception of boys. Using different body mass index references resulted in marked differences in overweight and obesity prevalence.

HPV involvement in tonsillar cancer: prognostic significance and clinically relevant markers

The association of high-risk human papillomaviruses (HR HPVs) with tonsillar cancer (TC) has been documented. Because patients with HPV-associated tumors show better survival rates, modification of their treatment regimen is being considered. It is therefore crucial to find markers for the identification of patients whose tumors are linked to viral infection. A cohort of 109 patients with primary TC was screened for HPV DNA presence in the tumor tissues and HPV-specific antibodies in sera. Data regarding risk factors and clinical parameters were collected. Forty-five specimens were analyzed for the expression of viral E6 and E2-region mRNA, and the p16 and p53 protein expression status was assessed by immunohistochemistry. The overall prevalence of HPV DNA in TC tissues was 65.1%. Ninety-three percent of HR HPV DNA-positive samples expressed E6*I mRNA. E2-region mRNA expression was detected in 36% of positive samples, which implies that the virus is integrated in 64% of HPV DNA/RNA-positive tumors. p16 overexpression and the presence of antibodies specific to HPV16 E6/E7 oncoproteins correlated well with HPV DNA and RNA presence. The disease-specific survival rate of patients with HPV DNA-positive tumors was significantly higher than that of HPV DNA-negative patients. In addition to providing further evidence of the involvement of HPV infection in the etiopathogenesis of a proportion of TC cases, our study demonstrates that p16 immunostaining and anti-E6/E7 antibodies as surrogate markers of HPV involvement represent specific, sensitive and clinically accessible assays for the identification of TC patients who have a considerably better prognosis.

[Fractures of the L5 transverse process in pelvic ring injury]

PURPOSE OF THE STUDY

The aim of the study was to record the frequency of L5 transverse process fractures associated with pelvic injuries and to find out whether in unstable pelvic fractures the frequency is significantly higher.

MATERIAL AND METHODS

The group evaluated comprised 106 patients (38 women and 68 men; average age, 43.4 years; range, 16 to 95 years) treated for pelvic ring fractures at two trauma centres in the period from January 1 to December 31, 2007. Their radiographs and CT scans were retrospectively reviewed in order to identify fractures of the L5 transverse processes and to obtain exact descriptions of injuries to the dorsal pelvic structures. The results were statistically analysed using the Chi-square test with a 5 % level of significance.

RESULTS

The evaluation of radiographs and CT scans identified L5 process fractures in 21 patients; none of these had type A pelvic fracture. An L5 transverse process fracture was found in 10 (15 %) of 69 patients with type B pelvic fracture and in 11 (73 %) of 15 patients with type C pelvic fracture, i.e., only in the patients with unstable injury to the pelvis classified as type C or type B. The occurrence of L 5 transverse process fractures was significantly higher in completely unstable, type C pelvic trauma than in partially unstable, type B pelvic injury (p < 0.001).

DISCUSSION

Our results showed that evaluation of the radiographs was not sufficient for the identification of L5 transverse process fractures and trauma to the dorsal pelvic structures. The reason was either poor quality or incorrect positioning. This gives support to the recommendations of many authors that CT scans should be the standard method for identification of all pelvic injuries. The study also confirmed that L5 transverse process fractures are associated with unstable pelvic injuries. Their significantly high occurrence is in agreement with other relevant studies which, however, have reported the results without statistical evaluation.

CONCLUSIONS

The study shows a significantly higher occurrence of L5 transverse process fractures in patients with unstable pelvic ring injuries. The finding of such a fracture should focus attention to looking for trauma to the dorsal pelvic structures.

[Pressure ulcer and mortality risk after surgical treatment of proximal femoral fractures in the elderly]

PURPOSE OF THE STUDY

We aimed to determine the incidence of pressure sores and their effect on survival in patients older than 70 years who underwent surgery for hip fracture, and to identify the factors which were associated with an increased risk of pressure sores.

MATERIAL AND METHODS

The group comprised 269 patients (219 women and 50 men) older than 70 years who underwent surgery for proximal femoral fractures in the Trauma center between January 2003 and June 2005. Follow-up ranged from 12 to 18 months. In a prospective study we assessed relevant medical history, demographic and clinical data, pre-, intra-, and post-operative factors and the presence, location and depth of pressure sores. Statistical significance at a 5 % level of probability was determined by testing null hypotheses for qualitative and quantitative variables, using multivariate analysis adjusted for selected baseline characteristics.

RESULT

The average age of the patient group was 81 years (range, 70-99). Pressure ulcers developed in 92 patients (34.2 %); their presence in the post-operative period significantly reduced patient survival (p=0.037). In terms of location, pressure ulcers in the calcaneal region had a more significant effect on patient mortality (p=0.011) than those in the sacral region (p=0.130). Age was not significantly associated with pressure ulcer development (p=0.547), in contrast to male gender (p=0.007). A lower mobility score before injury was a significant risk factor (p=0.007). Co-morbidities adjusted for age and gender had a significant effect (p=0.003). The factors that did not significantly increase the risk of pressure ulcers were as follows: the patient's living environment before injury (p=0.113), AO type of fracture (p=0.653), type of anaesthesia (p=0.702), surgical procedure used (p=0.946), morbidity before injury (p=0.267) and time to surgery (p=0.180). The presence of acute complications was of boundary significance (p=0.083). DISCUSSION The study included only the patients with proximal femoral fractures who underwent surgery. It was the authors' view that, by excluding conservatively treated patients, a more homogenous group was achieved. There is only sparse information in the literature concerning the effect of pressure ulcers on reduced patient survival, and the significance of pressure ulcer location has not been evaluated at all. Similarly, the effect of pre-morbidity on pressure ulcer development has not been reported in any of the studies available. In contrast to other studies, the authors did not find age to be a risk factor for increased ulcer development. They believe that the quality and quantity of the input data (prospective data collection, large sample size, long follow-up) guarantee the validity of the results obtained in this study. The incidence of pressure sores is in agreement with the results of relevant studies involving large numbers of patients and prolonged follow-up.

CONCLUSIONS

In patients older than 70 years undergoing surgery for hip fracture, the development of pressure ulcers had a significant effect on reduced survival, with the highest significance for ulcers in the calcaneal region. Factors significantly increasing the risk of ulcer development were male gender, morbidity before injury and pre-existing chronic complications. The presence of acute complications was of boundary significance. The study did not show any significant effect of age, pre-morbidities, time to surgery, patient's living environment before injury, fracture type, type of anaesthesia or surgical procedure used on the incidence of pressure ulcers.

[Genotyping of viral glycoprotein B (gB) in hematopoietic stem cell transplant recipients with active cytomegalovirus infection: analysis of the impact of gB genotypes on the patients' outcome]

AIM OF THE STUDY

Genetic variation of CMV strains may correlate with their pathogenicity for immunocompromised patients. On the basis of sequence variation in the UL55 gene encoding the most abundant viral envelope glycoprotein gB, CMV can be classified into four major gB genotypes. The aim of the study was the analysis of the distribution of gB genotypes in a cohort of haematopoietic stem cell transplant (HSCT) recipients and of the correlation of genetic polymorphisms with clinical outcomes and manifestation of CMV infection.

MATERIAL AND METHODS

Archived DNA isolates from consecutive blood samples of 53 adult allogeneic HSCT recipients with active CMV infection, transplanted in 2004-2005, were used for the genetic analysis. HCMV gB genotyping was performed by restriction fragment length polymorphism (RFLP) analysis and sequencing of the central variable region of UL55. The association of gB genotypes with selected clinical parameters was assessed by multivariate analysis after adjustment for graft donor type, HLA-matching and anti-thymocyte immunoglobulin (ATG) therapy.

RESULTS

gB1, gB2, gB3, and gB4 genotypes were detected in 30%, 17%, 26% and 4% of the patients, respectively. An atypical gB genotype was found in one patient. Co-infection with two or more gB genotypes was revealed in 17% of the patients. The distribution of gB genotypes did not vary in time, despite the fact that the patients transplanted in 2005 had more severe CMV infection with higher viral loads in the blood than those transplanted in 2004. gB1 was associated with a lower viral load (p = 0.046) and a milder course of symptomatic CMV infection, but with a higher rate of acute graft versus host disease (OR 3.4; p = 0.067). Pancytopenia was less frequent in the patients infected with gB3 (OR 0.09; p = 0.075). In contrast, gB2-infected patients had a worse outcome of CMV infection with a higher rate of organ involvement and were less responsive to antiviral therapy (OR 6.65 and 0.18; p = 0.15 and 0.12, respectively). The prognostic impact of co-infection with two or more gB genotypes was not shown.

CONCLUSIONS

gB genotype may have an impact on the course of CMV infection and its complications in HSCT recipients. Nevertheless, these results need to be tested on a larger group of patients in the context of genetic variability of other functionally important viral genes. The characterization of viral genetic factors determining CMV pathogenesis will be of relevance to the treatment of patients at high risk of CMV infection.

[Reproductive outcome after laparoscopic myomectomy--retrospective analysis 1994-2007]

The aim of the study was to analyse the reproductive outcome after laparoscopic myomectomy (LM) in infertile patients. Between the years 1994-2007 were 351 infertile women operated in our department. The average age of the patients was 33.5. The total number of extirpated fibroids was 643, with the average of 1.7 per patient and the average size of 3.3 cm. 171 women (48.7%) became pregnant after LM. There were 119 deliveries, 16 spontaneous abortions and 6 ectopic pregnancies in this group. The caesarean section (CS) rate was 46.2% . Intramural localisation of the fibroid significantly correlated with the termination of pregnancy by CS. I. and II. trimester pregnancy loss correlated significantly with deep coagulation when conception occurred during 12 months after surgery. No uterine rupture was observed during pregnancy.

[Mortality risk factors in the elderly with proximal femoral fracture treated surgically]

PURPOSE OF THE STUDY To assess the effects of medical history, fracture type, method of treatment and complications on the risk of death in elderly patients treated for proximal femoral fracture. MATERIAL AND METHODS The group comprised of 269 patients (219 women and 50 men) older than 70 years who underwent surgery for proximal femoral fracture at the Level I Traumacentre between January 2003 and June 2005. The follow-up ranged from 12 to 38 months. In a prospective consecutive manner the following was recorded: age, gender, serious internal diseases, pre-injury level of mobility, place of living before injury, fracture type (AO classification), time between injury and surgery, anaesthesia, surgical technique, complications and death. Statistical significance at the 95% level was ascertained using null-hypothesis tests for qualitative and quantitative variables by means of multivariate analysis. RESULTS The average age of the patients was 81 years (range, 70 to 99 years). The higher the age, the shorter the time of survival (p=0.015) as each additional year reduced survival by 4.6%. The women to men ratio was 4.2:1. The male gender had a significantly shorter time of survival (p=0.007). Two and more serious internal diseases in the patient's medical history, as compared with a single one, also made survival significantly shorter (p<0.001). When, before injury, a patient moved without walking support, survival was significantly longer than in a patient using a walking cane/crutch (p=0.022) or two canes/crutches or a walker (p<0.001), or in a bedridden patient (p=0.014). The fact that, before injury, a patient was living in a pensioner's home had no effect on a shortened time of survival (p=0.136). Similarly, the fracture type (31A or 31B and subgroups) was not significant for the length of survival (p=0.903). The interval between injury and surgery was not a risk factor for survival (p=0.269). No effect of the type of anaesthesia on survival was found (p=0.450). Neither the surgical technique nor the type of implant was significant for survival time. When general internal complications occurred, they affected the length of survival significantly (p<0.001). Also, pressure sores developing in the post-operative period significantly shortened the time of survival (p=0.037). Early complications did not result in shorter survival (p=0.867), but late deep infection in ive patients significantly shortened their lives (p=0.008). Failed osteosynthesis and consequent revision surgery shortened survival time only when it occurred during the primary treatment (p=0.003); after the primary hospitalization was terminated, it had no effect on the length of survival (p=0.398). DISCUSSION The study focused attention only to elderly patients with proximal femoral fracture treated surgically. The authors suggest that, by excluding patients treated conservatively, the group became more homogeneous and a more exact assessment of each factor's effect on death risk was possible. The investigated factors were recorded only during the first year following injury; however, death was recorded by the end of the study. Using the assessment of cumulative survival, this allowed for a more accurate statistical evaluation of the effect of each factor on the risk of death. CONCLUSIONS In patients over 70 years, a significantly shorter time of survival following the surgical treatment of proximal femoral fracture was found to be related to high age, male gender, multiple morbidity in the patient's medical history, poor patient's mobility before injury, general complications, development of pressure sores post-operatively, failed osteosynthesis requiring revision surgery and deep infection of the affected hip. No relation to significantly shorter survival was found for the following factors: living in a pensioner's home before injury, fracture type, time between injury and surgery, type of anaesthesia and operative technique. Key words: hip fracture, surgical treatment, mortality, risk factors.

Health behaviors, nutritional status, and anthropometric parameters of Roma and non-Roma mothers and their infants in the Czech Republic

OBJECTIVE

To compare maternal health behaviors, maternal nutritional status, and infant size at birth of Romas and non-Romas in the Czech Republic.

DESIGN

Maternal interviews and food frequency questionnaire, maternal blood samples, physical measurements of mothers and infants.

SETTING

Hospital, maternal/child care center; 2-4 days postpartum.

PARTICIPANTS

76 Roma mothers and 151 mothers from the majority population.

MAIN OUTCOME MEASURES

Infant length/weight; maternal height/weight; weight gain during pregnancy; duration of pregnancy; maternal smoking habits; dietary intake; use of food supplements during pregnancy; and maternal blood levels of folate, beta-carotene, retinol, and alpha-tocopherol.

ANALYSIS

Comparison of ethnic groups by 2-sample Wilcoxon test, chi-square, Fischer's exact test, relative risk, and analysis of variance (ANOVA).

RESULTS

Pregnancy duration was about 1 week shorter in Roma women (P < .001), and their infants had lower birth weight (P < .001) and shorter length (P < .001). Prevalence of smoking was significantly higher among Roma mothers (P < .001). Roma women used food supplements less frequently than non-Roma women (P < .001) and had significantly lower mean blood concentrations of folate (P < .001), beta-carotene (P < .001), retinol (P < .02), and alpha-tocopherol (P < .02).

CONCLUSIONS AND IMPLICATIONS

The nutritional status of Roma mothers is worse than that of mothers from the majority Czech population. The dietary and smoking habits of pregnant Roma women should be of special concern to family doctors, obstetricians, nutrition educators, and social workers.

Cortisol levels in cerebrospinal fluid correlate with severity and bacterial origin of meningitis

Introduction

Outcomes following bacterial meningitis are significantly improved by adjunctive treatment with corticosteroids. However, little is known about the levels and significance of intrathecal endogenous cortisol. The aim of this study was to assess cortisol as a biological and diagnostic marker in patients with bacterial meningitis.

Methods

Forty-seven consecutive patients with bacterial meningitis and no prior treatment were evaluated. For comparison, a group of 37 patients with aseptic meningitis and a group of 13 healthy control individuals were included.

Results

The mean age of the bacterial meningitis patients was 42 years, and the mean Glasgow Coma Scale, Acute Physiology and Chronic Health Evaluation II, and Sequential Organ Failure Assessment scores on admission were 12, 13 and 4, respectively. Altogether, 40 patients (85%) were admitted to the intensive care unit, with a median (interquartile range) length of stay of 8 (4 to 15) days. A bacterial etiology was confirmed in 35 patients (74%). The median (interquartile range) cortisol concentration in cerebrospinal fluid (CSF) was 133 (59 to 278) nmol/l. CSF cortisol concentrations were positively correlated with serum cortisol levels (r = 0.587, P < 0.001). Furthermore, CSF cortisol levels correlated with Acute Physiology and Chronic Health Evaluation II score (r = 0.763, P < 0.001), Sequential Organ Failure Assessment score (r = 0.650, P < 0.001), Glasgow Coma Scale score (r = -0.547, P < 0.001) and CSF lactate levels (r = 0.734, P < 0.001). CSF cortisol was only weakly associated with intrathecal levels of IL-6 (r = 0.331, P = 0.02) and IL-8 (r = 0.296, P < 0.05). CSF cortisol levels in bacterial and aseptic meningitis significantly differed (P < 0.001). The CSF cortisol concentration of 46.1 nmol/l was found to be the optimal cutoff value for diagnosis of bacterial meningitis.

Conclusion

CSF cortisol levels in patients with bacterial meningitis are highly elevated and correlate with disease severity. Moreover, our findings also suggest that intrathecal cortisol may serve as a valuable marker in discriminating between bacterial and aseptic meningitis.

Smoking attributable hospital treatment, treatment costs and smoking attributable mortality in the Czech Republic in 2002

OBJECTIVES

The main objective of this work is to quantify the number of hospitalizations caused by smoking, estimate the costs of hospital treatment and to estimate contribution of smoking to mortality in the Czech Republic (CR) in 2002.

METHODS

The estimate of the proportion by which smoking contributed to hospitalizations and to mortality in the CR was computed using the method of smoking-attributable fractions (SAF). The SAF was computed from relative risks established in the American study Cancer Prevention Study II and from estimates of the prevalence of smoking in the CR from a nationwide study conducted in 2002.

RESULTS

In 2002, based on data provided by the General Health Insurance Company, there were 145,336 hospitalizations, and the total cost of hospital treatment was estimated as 4.727,612 (in thousands) CZK. The total number of deaths caused by smoking was 20,550 (95% CI: 18,851-22,262), 14,525 in men and 6,025 in women. Deaths caused by smoking represented 19% of the total nationwide mortality for 2002. Earlier estimates were published by Peto and Lopez for 1995 (22,300 deaths caused by smoking) and 2000 (17,746 deaths). The estimate arrived by authors using the SAF method for 2002 corresponds quite well with that by Peto and Lopez for 2000.

CONCLUSIONS

The high morbidity and mortality rate related to smoking is directly connected to high prevalence of smoking in the Czech Republic. An effective tobacco control policy, including restrictive measures on availability of tobacco products combined with preventive programmes and smoking cessation programmes, could contribute to the reduction of smoking and save lives and treatment costs caused by smoking.

Adiponectin as a potential marker of prostate cancer progression: studies in organ-confined and locally advanced prostate cancer

Serum levels of adiponectin were measured in patients with benign prostatic hyperplasia and prostate cancer of pT2 and pT3 stage. Adiponectin ELISA assay, immunohistochemistry, and selected metabolic and biochemical parameters measurement was performed in 25 patients with benign prostatic hyperplasia and 43 with prostate cancer (17 patients with organ-confined and 26 patients with locally advanced disease). Serum adiponectin levels did not differ between prostate benign hyperplasia and cancer clinical stage T2, but was significantly higher in pT3 relative to pT2 group (14.51+/-4.92 vs. 21.41+/-8.12, P = 0.003). Tissue immunohistochemistry showed enhanced staining in neoplastic prostate glands and intraepithelial neoplasia relative to benign prostatic hyperplasia without distinction between disease grade and stage. Serum adiponectin levels are higher in locally advanced relative to organ-confined prostate cancer and may thus serve as an auxiliary marker providing further improvement for discrimination between pT2 and pT3 stages.

Iodine Saturation of Roma Neonates in Prague Is Not at an Optimum Level

AIM

The purpose of our study was to determine urinary iodine as an indicator of iodine supplementation in Roma (Gypsy) neonates compared to majority population neonates.

METHODS

The groups studied were formed by 30 full-term Roma neonates and 151 majority population neonates. Iodine was determined from samples of urine collected on the 4th day after delivery, after alkaline ashing, using the Sandell-Kolthoff method.

RESULTS

The median of urinary iodine in Roma neonates was 92.15 microg/l urine and in neonates from majority population mothers it was 109.20 microg/l urine. The mean of urinary iodine in Roma neonates was 114.55 microg/l urine (SD 71.68 microg/l) and in neonates from majority population mothers it was 141.86 microg/l urine (SD 87.42 microg/l). The difference was not statistically significant. Majority population mothers more frequently consumed nutrition supplements containing iodine as well as fish.

CONCLUSIONS

Compared to older data, supplementation of neonates with iodine is higher. However, it does not reach optimum levels. The urinary iodine median in Roma neonates lies in the mild iodine deficiency band.

Characteristics of Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis and Staphylococcus aureus isolated from the nasopharynx of healthy children attending day-care centres in the Czech Republic

Nasopharyngeal carriage of potential pathogens was studied in 425 healthy 3- to 6-year-old children attending 16 day-care centres (DCCs) in nine Czech cities during the winter 2004-2005. The overall carriage of pathogens was 62.8% (Streptococcus pneumoniae, 38.1%; Haemophilus influenzae, 24.9%; Moraxella catarrhalis, 22.1%; Staphylococcus aureus, 16%). An age-related downward trend was observed for colonization with respiratory pathogens in contrast to Staph. aureus whose carriage was significantly higher among older children. The following serotypes of colonizing S. pneumoniae were the most predominant: 23F (20.6%), 6A (15.1%), 6B (12.7%), 18C (7.8%), 15B and 19F (6% each). The majority (94.3%) of H. influenzae isolates were non-typable; among capsulated isolates, serotype b was not found. Decreased susceptibility to penicillin was determined in 3% of pneumococci; 4.6% of H. influenzae strains and 85.1% of M. catarrhalis strains produced beta-lactamase. As for non-beta-lactam antibiotics, pneumococci resistant to trimethoprim-sulphamethoxazole were the most common (15.7%) among the attendees.

[Comments to statistical methods in medical disciplines]

Statistical methods are nowadays one of the main tools for the evidence based medicine. This paper mentions some of the basic ideas necessary for the reader to understand usage of statistical methods.

[Prevalence of GBV-C/HGV (HGV) in HIV-infected patients and potential influence of co-infection on the course of the disease.]

AIM OF THE STUDY

Assessment of prevalence of GBV-C/HGV infection in HIV-infected patients and evaluating of a possible influence of GBV-C/HGV on the course of HIV infection by assessment of immunological and virological markers of progression of HIV infection.

MATERIALS AND METHODS

We have investigated serum samples of 273 HIV- infected patients from AIDS Center of the University Hospital Na Bulovce Prague during 2002-2003. Our target was to assess the presence of markers of GBV-C/HGV infection by semiquantitative HGV RNA evaluation and anti-E2 antibodies by ELISA testing. 271 of serum samples were tested for HGV RNA and 269 samples were tested for anti-E2 antibodies. HIV viral load and CD4 count were tested concurrently. We used Spearmans test to rule out the dependency of CD4 count and HIV viral load on HGV infection.

RESULTS

89 (33,3 %) of patients were positive in HGV RNA test and 101 (38,5 %) of patients were positive in anti E2-ELISA. No statistically significant effect of GBV-C/HGV infection was observed on CD4 count and HIV viral load in our cohort of patients.

CONCLUSIONS

The effect of GBV-C/HGV infection on predictive laboratory markers of HIV infection was not confirmed in our study. Further investigations regarding this subject seem to be necessary.

Standardized parenteral alanyl-glutamine dipeptide supplementation is not beneficial in autologous transplant patients: a randomized, double-blind, placebo controlled study

We conducted a controlled, double-blind study of parenteral glutamine supplementation in an unselected group of consecutive autologous transplant patients. Patients received 30 g of alanyl-glutamine dipeptide (Dipeptiven; Fresenius-Kabi, Bad Homburg, Germany) or glutamine-free amino acid solution i.v. from day +1 to day +14 or to discharge. All patients were assessed for clinical status, mucositis, blood counts, oral intake and immune reconstitution. Parenteral nutrition was administered according to predefined guidelines. Forty patients were randomized; 21 into the glutamine and 19 into the placebo arm. Glutamine patients had less days with diarrhoea (3.3 +/- 4.0 vs 4.3 +/- 3.0, P = 0.03), but they had more severe oral mucositis (mean 4 +/- 4.7 vs 1.4 +/- 2.3 days of mucositis score >13, P = 0.04), spent more days on opioids (mean 3.5 +/- 4.2 vs 1.2 +/- 2.2 days, P = 0.03) and left hospital later than placebo patients (mean 13.5 +/- 3.1 vs 11.7 +/- 2.4 days after transplant, P = 0.06). There were more relapses (P = 0.02) and deaths (P = 0.05) in the glutamine group. The cost of supportive care (mean 2960 +/- 1694 vs 1534 +/- 513 Euro, P = 0.002) was also greater for glutamine patients, mainly due to the cost of glutamine dipeptide itself. The described mode and dosage of glutamine administration did not produce meaningful benefit in our autologous transplant patients and it was certainly not cost-effective.

[Parenteral glutamine does not improve the nutritional status in patients during high-dose chemotherapy and autologous peripheral stem cell transplantation]

BACKGROUND AND AIM

High-dose chemotherapy is aggressive treatment modality adversely affecting both energy/protein demands and oral intake/resorption of nutrients. Aminoacid glutamine is known for its' proteoanabolic effect and as an energy source for enterocytes and immune system. Nutritional parameters have been studied in a controlled, randomised, double-blinded trial of parenteral glutamine supplementation of autologous stem cell transplant patients.

METHODS

Forty consecutive patients with haematological and solid cancer and multiple sclerosis were treated from 1999 to 2001 by high-dose chemotherapy with autologous stem cell transplantation. Patients were randomly assigned either for parenteral administration of 30 g of alanyl-glutamine dipeptide (Dipeptiven, Fresenius-Kabi) or isonitrogenous glutamine-free amino acid solution from day +1 to day +14 or to discharge from hospital. Patients were closely monitored from admission to day +100. Nutritional parameters included: oral dietary intake, body weight, body composition, energy expenditure, concentration of serum proteins and nitrogen balance. Parenteral nutrition in dose of 26.5 kcal/kg and 1 g of aminoacid/kg was given to patients who did not reach adequate oral intake for 5 days and withheld after three consecutive days of adequate intake.

RESULTS

Nutritional assessment on admission differed according to the method used but no parameter of nutrition predicted the clinical course of treatment. Inadequate oral intake period lasted (mean +/- SD) 6.8 +/- 5.9 days, average length of stay being 17.5 +/- 3.9 days. Patients were unable to use sipping of enteral feed. Resting energy expenditure neither on admission nor in critical period differed from predicted value. Serum protein concentrations significantly decreased on discharge with normalisation as soon as to day +28, correlating inversely with changes in extracellular water content. Nitrogen urine loss was 10-16 g/day. Only 42.5% of patients were treated with parenteral nutrition. Cumulative nitrogen balance at day +9 was -30.7 +/- 24.1 g N. Body weight at day +28 significantly decreased (-2.94 +/- 4.4 kg), mostly consisting of loss of pure body cell mass. Glutamine supplementation did not improve any of the listed nutritional parameters.

CONCLUSIONS

High-dose chemotherapy with autologous stem cell transplantation causes proteocatabolism of medium severity. Nutritional status of patients cannot be improved by the mode and dosage of parenteral glutamine used in our study. Optimal nutritional monitoring and treatment for this group of patients is suggested.

Lipid metabolism and neuropsychological follow-up study of workers exposed to 2,3,7,8- tetrachlordibenzo- p-dioxin

OBJECTIVE

More than 35 years ago, during 1965-1968, in the former Czechoslovakia, approximately 80 persons became ill due to occupational exposure to 2,3,7,8-tetrachlordibenzo- p-dioxin (2,3,7,8-TCDD). The objective of this study was to investigate the incidence of disorders related to occupational exposure to 2,3,7,8-TCDD.

METHODS

Most subjects in the group of 12 former 2,3,7,8-TCDD workers (mean age 56.8 years, exposure 10 days to 23 months) still suffer from disturbances of lipid metabolism, psychic disorders, chloracne, and/or nervous system lesions. All workers were given internal, neuropsychological and ophthalmological examinations. Blood cholesterol and triglycerides were measured, and the common carotid artery was examined by ultrasound (B-mode), with the intima-media thickness (IMT) also being measured. Findings were compared with the 2,3,7,8-TCDD level in 1996.

RESULTS

Nine of the 12 previously exposed workers had elevated plasma lipids, and hyperlipidaemia was statistically more frequent in patients with higher 2,3,7,8-TCDD levels ( P=0.03). Subject 1, with the highest 2,3,7,8-TCDD plasma level, had 80% stenosis of the diameter of the carotid artery, which needed acute surgery. Besides him, seven persons had atherosclerotic plaques in the carotid arteries. The mean IMT in the group was 0.85 mm (SD+/-0.19); the normal value is 0.62 mm. Eight subjects had degenerative changes of the ocular fundus. Chloracne was still present in two persons. Neuropsychological findings were assessed as normal only in three persons with lower 2,3,7,8-TCDD plasma levels in 1996. Mean 2,3,7,8-TCDD plasma level in 1996 was 256 pg g(-1) fat (range 14-760).

CONCLUSION

Hyperlipidaemia, atherosclerotic plaques, increased IMT, ischaemic heart disease and neuropsychological disturbances were frequent in this group of former 2,3,7,8-TCDD workers. Hyperlipidaemia might have played an important role in most of these disorders. The level of 2,3,7,8-TCDD correlated with the highest level of triglycerides ( P=0.02) and cholesterol ( P=0.01) that was found during the 35-year follow-up. This group belongs to the most heavily 2,3,7,8-TCDD-exposed groups of workers, because the mean estimated concentration at the time of intoxication was approximately 5000 pg g(-1) plasma fat.

Biochemical, neuropsychological, and neurological abnormalities following 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) exposure

Presented herein are the results of follow-up examinations of 13 workers performed in 1996--30 yr following 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) intoxication in a herbicide production plant. In these workers, the current mean plasma level of 2,3,7,8-TCDD, measured by high-resolution gas chromatography/high-resolution mass spectrometry, was 256 pg/gm lipid (range = 14-760 pg/gm lipid). This mean value corresponded to an estimated concentration of approximately 5,000 pg/gm plasma fat that existed about 30 years ago. Such a mean plasma level indicates that this group was one of the most heavily exposed groups to 2,3,7,8-TCDD described in the literature. Patients with persistent chloracne had significantly higher plasma levels of 2,3,7,8-TCDD than persons without chloracne. A significant, positive correlation was found between plasma levels of 2,3,7,8-TCDD in 1996 and levels of cholesterol and plasma lipids that existed since 1974. During 1996, there was a significant positive correlation between 2,3,7,8-TCDD and levels of beta-lipoproteins, cholesterol, and triglycerides. Also in 1996, significant correlations were found between neuropsychological variables and plasma levels of 2,3,7,8-TCDD. Other significant correlations were observed between neuropsychological variables and (1) the highest levels of triglycerides (i.e., since the year 1989), (2) levels of triglycerides in 1996, (3) levels of cholesterol at the first examination (i.e., 1969-1970), (4) highest level of cholesterol since the year 1969, and (5) cholesterol levels in 1996. Such correlations are biologically plausible, and they provide evidence of impaired cognitive performance (i.e., memory first), with a concurrent increase of plasma lipid levels. Abnormal electromyography, electroencephalography, and visual evoked potentials were observed in 23%, 54%, and 31 %, respectively, of former workers. Abnormal electroencephalography findings occurred more frequently in workers who had 2,3,7,8-TCDD blood levels that exceeded 200 pg/gm plasma fat than in workers with 2,3,7,8-TCDD values lower than 200 pg/gm plasma fat (p < .025). Frequency of polyneuropathic EMG abnormalities decreased from 38% in the 1970s to 23% in 1996. Improvement of conduction velocity in the tibial nerve was statistically significant (p < .05).

Serum cartilage oligomeric matrix protein reflects the presence of clinically diagnosed synovitis in patients with knee osteoarthritis

OBJECTIVE

Cartilage oligomeric matrix protein (COMP) is a component of articular cartilage whose serum levels show a strong correlation with radiographic osteoarthritis (OA) status. It has recently been found, however, that COMP is also produced in synovium. To assess the hypothesis that synovitis affects serum COMP levels in patients with knee OA, we collected sera for COMP simultaneous with a clinical examination for synovitis.

DESIGN

Sera were collected from OA patients who fulfilled the American College of Rheumatology criteria for knee OA. Radiographs were classified according to the grading system of Kellgren and Lawrence. Synovitis was diagnosed clinically by joint tenderness plus swelling and/or increased warmth over the joint. COMP levels in sera were measured by inhibition ELISA with monoclonal antibody (mAb) 17-C10.

RESULTS

Serum COMP levels were significantly correlated with age, synovitis and an interaction of synovitis and OA severity. Synovitis showed the strongest effect on COMP levels (R=0.1587, P< 0.01), in contrast to C-reactive protein, duration of OA and OA severity score which showed no significant effect on COMP levels. Individual signs of synovitis, namely, joint tenderness and warmth had a significant effect on serum COMP levels while swelling alone did not.

CONCLUSION

Synovitis exerts a significant effect on serum COMP levels measured with mAb 17-C10 in OA patients. These findings underscore the importance of the clinical joint examination to assess for synovitis, when attempting to apply objective measures, such as COMP, to the clinical setting.

[GBV-C/HGV, a new virus as one possible cause of hepatitis of unknown etiology]

For etiologically obscure (some 4%) viral hepatitis agents are sought and tested to make elucidation of their cause possible. One of the candidates is since 1995 the newly discovered virus GBV-C/HGV. Despite intense research its relationship to viral hepatitis of obscure origin (VHN) has not been elucidated so far. In the submitted paper the authors attempted to contribute to the elucidation of etiological associations of GBV-C/HGV infection and VHN by comparing the dynamics of markers of the infection in a group of 59 patients with VHN, two control groups exposed to a high risk of parenteral operations and a third comparative group. The first control group comprised 64 patients in a long-term haemodialyzation programme (HD), the second group was formed by 82 patients with haematooncological disease (BD). The third comparative group comprised 22 patients coinfected (CI) with virus of hepatitis C (VHC), or possibly hepatitis B (VHB). The patients with VHN were HBsAg, anti HCV and anti HEV negative. In the majority in the first blood sample transaminases were elevated which was one of the main reasons for examination of GBV-C/HGV RNA. Prevalence of GBV-C/HGV infection, proved by the presence of at least one of the two markers of current or past infection (GBV-C/HGV RNA, antiGBV-C/HGV) was in the compared VHN, HD and BD groups as follows: 88.1%, 59.4% and 43.9%. The frequency of GBV-C/HGV positivity was highest in VHN-76.3%. In control groups HD and BD GBV-C/HGV RNA positivity was substantially lower, 18.8% and 25.6% resp. Long-term continuous viraemia was recorded in patients with VHN in 18.6%. In groups HD and BD it was half that value: 9.3% and 9.18%. In patients with VHN surprisingly after 6.5 months a marked rise of negative findings occurred (5.6x) without the expected increase of antibodies. A similar finding was recorded also in the other groups (HD and BD), incl. CI patients. Disappearance of viraemia was observed most frequently in VHN (55.9%). In groups HD and BD GBV-C/HGV RNA disappeared only in 7.8% and 12.1% resp. In treated patients of the CI group viral RNA was present in 45.5% and it disappeared in 36.4%. On the other hand, seroconversion to antibodies was comparable in VHN, HD and BD (11.9%, 9.4%, 8.5%), only in group CI it was higher (18.2%), obviously in conjunction with treatment of concurrent HCV or HBV infection. Disappearance of viraemia without subsequent seroconversion occurs in GBV-C/HGV infection frequently, the highest rate was observed by the authors in patients with VHN. Disappearance of viraemia does not necessarily imply clearance of GBV-C/HGV but may be due to a change of GBV-C(HGV into a state of persistence without positive laboratory markers of the infection. Persistence of the virus could also be the reason of the assumed conditioned pathogenicity of the virus, and the effect of frequent disappearance of both markers could explain some controversial epidemiological observations when in studies only static data without dynamic associations were used.

Antiemetic efficacy of three serotonin antagonists during high-dose chemotherapy and autologous stem cell transplantation in malignant lymphoma

The aim of this study was to compare antiemetic efficacy of three serotonin antagonists, granisetron, tropisetron and ondansetron, during conditioning for autologous stem cell transplantation (ASCT). Forty-five malignant lymphoma patients (mean age 38 years, M:F 30:15), undergoing the highly emetogenic regimen BEAM prior to ASCT, were randomized to receive IV granisetron (G) 3 mg once a day, IV tropisetron (T) 5 mg once a day, or IV ondansetron (0) 8 mg twice daily, for six days. The treatment groups were comparable with respect to age, sex and previous experience of nausea and/or vomiting. Nausea and/or emesis control failure was defined as a nausea lasting > or = 4 hours and/or > or = 3 episodes of vomiting/24 h, emesis control failure as > or = 3 episodes of vomiting/24 h. Both the period of chemotherapy (6 days) and the whole period of observation (10 days) were evaluated. Nausea and/or emesis control failure occurred in 24% of patients during the period of chemotherapy and in 51% of patients throughout the whole period of observation, while emesis control failed in 2% and 27% of patients, respectively. The efficacy of three serotonin antagonists was comparable during the chemotherapy period (5 patients with nausea and/or emesis control failure in the granisetron group, 2 in the tropisetron group and 4 in the ondansetron group,p = 0.40). When evaluating the whole period of observation, the antiemetic response to G and T was significantly better than to O, nausea and/or emesis control failure having occurred in 7 (47%) patients treated with G, 5 (33%) patients treated with T, and 12 (80%) patients treated with O, p = 0.03. The results concerning emesis control failures were similar, G 4 (27%), T 1 (7%), O 7 (47%), p = 0.04. Headache was the only frequent side effect of serotonin antagonists (30% incidence). All three serotonin antagonists sufficiently controlled nausea and vomiting during high-dose chemotherapy (BEAM) administration in 67-87% of patients. In comparison with ondansetron, both tropisetron and granisetron proved to be more effective after ASCT, when emetogenic factors other than chemotherapy alone participated.

Study of the genotoxicity of toluene

Chromosome analysis was conducted for peripheral lymphocytes of 23 printers exposed to toluene concentrations of 590 mg/m3 in a rotary machine workshop and to rotogravure printing inks. The percentages of aberrant cells were 2.30 in the printers and 1.46 in the control group (n = 22) (p < .05). The concentration of hippuric acid in printers was significantly higher than in the control group (p < .01), and the level of blood toluene at the end of the workshift was 0.500 mg/l. The authors also examined rotogravure printing inks-considered a potential source of genotoxic polycyclic aromatic hydrocarbons because they contained carbon black-their use in printing plants, and previous documentation of increased chromosomal aberrations in rotogravure printers. Only milligrams of fluorene and phenanthrene per gram of the printing inks were found; no polycyclic aromatic hydrocarbons with carcinogenic properties were discovered in the inks. The authors used Salmonella typhimurium indicator strains TA 98, TA 100, TA 1537, and YG 1041 in spot tests and indicator strains TA 98 and TA 100 in plate-incorporation assays to determine that there was no bacterial mutagenicity of all four colors of rotogravure inks. Urinary mutagenicity, which was evaluated with a microsuspension assay containing YG 1041 indicator strain both in the presence and absence of metabolic activation, was also studied. No significant difference in bacterial mutagenicity was found between the exposed and control groups. The increased percentage of aberrant cells in printers can be explained by exposure to genotoxicants that are not excreted in urine. Toluene was the most likely cause of the aberration.

[Prognostic factors and markers of activity in multiple myeloma (results of the Cooperative Group for Diagnosis and Treatment of Multiple Myeloma)]

BACKGROUND

Multiple myeloma (MM) is mostly fatal neoplastic disorder, however, the median survival of 30-40 months does not adequately express the wide spectrum courses of the disease. Therefore better prognostic factors are needed.

METHODS AND RESULTS

We analyzed the value of both standard clinical features and cytokines for differential diagnosis, assessment of myeloma activity, prediction of overall survival and duration of remission in a group of 124 patients with MM and in 156 with various monoclonal gammapathies, respectively. The initial levels of Ca2+, LD, Hb, albumin, IL-6, PO4- and creatinine were useful for differentiation of monoclonal gammapathy of undetermined significance from MM. Serum IL-6 correlated with the stage and activity of MM, sIL-6R levels were significantly higher only in stage III and in newly diagnosed myeloma. We did not found the correlation between IL-6 and CRP levels. The usefulness of some standard features for prediction of survival was confirmed (Ca2+, Hb, clinical stage and subclassification A/B according to Durie-Salmon, SB2M > 4 mg/ml, creatinine, LD, ALP) as well as sIL-6R serum level determined both at time of diagnosis and during the course of disease. The prognosis of patients with reversible renal failure and those with intact renal function was not significantly different. Among other features, only serum sIL-6R, measured at time of diagnosis or during the course of disease, had significant predictive value for the assessment of duration of event-free survival in patients with MM.

CONCLUSION

Due to short follow-up possible association of high levels of IFN-gamma with better prognosis of MM could not be stated.

[Administration of interferon alpha as post-transplantation immunotherapy in malignant lymphoma. Case control study]

BACKGROUND

A possible cause of relapses in patients with malignant lymphomas after autologous transplantation of haematopoietic cells is among others the absence of an immune reaction. The objective of the present study was to assess the effect of long-term interferon alpha administration after autologous transplantation in malignant lymphomas.

METHODS AND RESULTS

A total of 16 patients were followed up (9 men and 6 women, mean age 44 years) 14 with non-Hodgkin's lymphoma and two with Hodgkin's disease where after high-dose transplantation with autologous transplantation of haematopoietic cells immunotherapy was started by administration of IFN alpha 3 MU three time per week. The treatment was well tolerated, only in two patients (12.5%) the doses had to be reduced or temporarily discontinued. The results were compared with a control group (16 subjects, 12 men, 4 women, mean age 43 years and similar other characteristics as the followed up group) who were not given IFN alpha after transplantation. The controls were paired with regard to the condition after transplantation, grade of pretreatment, diagnosis and age. In the group treated with IFN alpha five relapses developed and two deaths occurred, in the control group four relapses and three deaths. The probability of survival without signs of progression (PFS) and total survival (OS) within 18 months is in the treated group 67.4% and 88.9%, in the control group 86.5% and 93.8%. The results are not statistically significant.

CONCLUSIONS

The authors confirmed in their study the feasibility of long-term administration of IFN alpha after transplantation. On a preliminary basis it may be stated that the results did not differ in the treated and not treated patients, nevertheless the impact of this type of immunotherapy or its modification will have to be evaluated in a randomized study.

[Monitoring markers of bone turnover in multiple myeloma]

PURPOSE

To assess the efficacy of bone turnover markers monitoring for prediction of overall survival and event-free survival in patients with multiple myeloma. To determine the value of initial measurement for differential diagnosis and evaluation of myeloma stage and activity.

METHODS AND RESULTS

We evaluated 79 consecutive, previously untreated patients with myeloma and 24 with monoclonal gammopathy of undetermined significance. Urine excretion rates of pyridinoline (PYR) and deoxypyridinoline (DPYR) as markers of bone resorption and serum osteocalcin (OC) as marker of bone formation were measured at diagnosis and further repeatedly during the course of disease. High-performance liquid chromatography (HPLC) was used to measure urinary excretion rates of PYR and DPYR, serum OC levels was analysed using RIA method. Significant correlation was found between PYR and DPYR levels (p < 0.001) and between DPYR and OC (p < 0.05). Significantly higher urine PYR and DPYR (p < 0.001 and p < 0.01, respectively), but not serum OC, were found in myeloma comparing MGUS. In patients with MM PYR and DPYR levels were significantly higher in stage III vs. I and II (p < 0.01), the correlation with disease activity was not found. The grade of bone involvement according to RTG (osteolysis, osteoporosis, absence of bone lesions) was not reliable as a prognostic factor in our study. Univariate overall survival analysis showed prognostic significance for initial PYR (p < 0.05) but not for DPYR and/or OC. Rapid decrease of PYR (after 1 month of chemotherapy) was associated with the shortest median survival (608 days), however, significant difference was observed only comparing the patients in which PYR decreased 12 months after start of chemotherapy. In the univariate analysis increase of DPYR was the only variable significant for event-free survival (p < 0.05), increase of PYR tend to be significant (p < 0.1).

CONCLUSIONS

We confirmed possible contribution of pyridinium cross-links for differential diagnosis of MM and MGUS and the correlation with advanced stage of MM. Initial measurement of PYR and monitoring of both PYR and DPYR during the course of myeloma could be helpful for prediction of overall survival and event-free survival. According to our experience OC is not useful for diagnosis, assessment of disease stage and activity and prediction of survival of patients with MM.

[Evaluation of time trends in the weekly count of diseases]

In routine systems investigating the morbidity according to diagnosis it is very useful to analyse the development in time (for example the development of weekly reports). This paper is concerned with the methodology of such analyses. In practice it appears that the number of cases depends on season. It stands to reason, that it is necessary to consider also long-term trends. In this paper two different approaches are discussed--the Box-Jenkins analysis, which describes the random error and the Method of Trend Decomposition which spread the number of cases into the systematic component (long term trend and seasonal effect) and random variability. The authors describe the method of smoothing the estimate of the time series by kernel estimate. In both approaches they use weekly reports from the whole Czech Republic of diagnoses viral hepatitis A, rubella and salmonellosis.

Using a screen filter positively influences the physical well-being of VDU operators

Sixty full-time VDU workers participated in a field study concerned with the effects of antiglare screen filter on the occurrence, duration, and intensity of eye and physical complaints. Forty of them were given a screen filter, the remaining 20 worked without filter. Two types of questionnaires were administered both prior to the installation of filters, and after one month of their use. The first inquired about the occurrence and duration of complaints during the last month, the other one measured their intensity on three days in the morning, before lunch and at the end of the working day. The intensity scores were corrected for hours worked at VDU on the day concerned. The filter and control group did not differ in age, gender, years of work experience at VDU, type of work task, self-reported overall health, eye conditions, and ergonomic layout of the workstation. The differences between the initial and final measurement were processed for each group separately by applying t-tests for paired samples, and both groups were compared by an analysis-of-variance test. Whereas the control group did not show any significant change, the participants in filter group reported less occurrence, shorter duration, and less intensive eye and musculoskeletal complaints after one month of filter use. It may be concluded that screen filters improve the conditions for the visual perception of the VDU, thus relieving eye strain, and that they positively influence the working posture and help relieve musculoskeletal complaints as well.

[Interleukin-6, tumor necrosis factor alpha and their soluble receptors in Bence-Jones nephropathy. Possible role in pathogenesis andthe importance in the determination of prognosis in renal insufficiency]

BACKGROUND

Bence-Jones nephropathy, the most serious form of which is renal failure, is one of the frequent complications in multiple myeloma (MM). Precise pathogenetic mechanism of renal injury remains unclear. Experimental study points to the possible role of some cytokines in the development of this type of nephropathy. We have investigated the levels of interleukin-6 (IL-6), tumour nekrosis factor alpha (TNF-alpha) and their soluble receptors in patients with plasmocytoma.

METHODS AND RESULTS

The group comprised 49 patients with plasmocytoma, mostly with MM. Significantly higher levels of IL-6 were found in patients with irreversible renal insufficiency and/or failure (group A-median 13.3 pg/ml, range 3.6-33.3) comparing patients with reversible impairment (group B-median 3.1-range 1.8-38.4) (p < 0.01) and those with normal renal functions (group C-median 2.3-range 0.97-7.41) (p < 0.01). Significant difference was also found between the groups B and C (p < 0.05). Analysis of variance with the use of various factors showed that the correlation between IL-6 and prognosis of renal disease was stronger (p < 0.001) than the correlation between cytokine levels and the clinical phase of MM (p < 0.05). The difference of IL-6 levels between various clinical stages of MM was not significant. The levels of sIL-6R were significantly increased in patients with both reversible and irreversible renal insufficiency comparing the group with unaffected renal functions (p < 0.05 and p < 0.01 respectively). TNF-alpha levels did not differ between all 3 groups of patients, however, significantly increased values of sTNF-R II were observed in group A vs B and group B vs C (p < 0.05).

CONCLUSIONS

We conclude, that some cytokines, especially IL-6/sIL-6R, could play an important role in development of renal insufficiency in MM or other monoclonal gammapathies. We suggest that IL-6 levels could be predictive factor for renal insufficiency recovery.

[Urinary excretion of neopterin and plasma levels of interferon gamma in patients with multiple myeloma]

Neopterin, a pteridine derivate, is produced and released by lymphocytes and monocytes/macrophages after stimulation by T-cell derived interferon (IFN) gamma. The urinary excretion of neopterin and plasma IFN-gamma levels were measured in 35 patients with multiple myeloma (MM) and 21 patients with other monoclonal gammapathies (MG). Significantly higher excretion of neopterin was found in patients with MM in the time of diagnosis and/or progressive phase of disease (median 963,7 mumol/mol creatinine, range 183,9-2 376,3) comparing the patients in stable phase of MM (median 407,4, range 184,3-826,4), monoclonal gammapathy of undetermined significance (406,2, 226,9-1 689,3) and other MG (452,5, 240, 4-913,6) (p < 0,05). Elevation of urinary neopterin levels preceded changes of other parameters of disease activity by several months, persistent high urinary excretion was associated with refractory disease respectively. The differences of neopterin levels between patients of various clinical stages of MM was observed in newly diagnosed and progressive disease (III. vs. I and II. clinical stage, p < 0.05), but not in stable phase of MM. The plasma concentration of IFN-gama were insignificantly higher in MM than in health controls, however, the difference between all groups of patients was not found. We conclude, that neopterin is a good marker of disease activity in patients with MM. The plasma levels of its regulatory cytokine, IFN-gama, did not correlate with urine neopterin levels in our study.

Somatosensory evoked potentials in workers exposed to toluene and styrene

Somatosensory evoked potentials (SEPs) were used to evaluate possible subclinical impairment of the nervous system due to occupational exposure to toluene and styrene. A group of 36 rotogravure printers with severe exposure to toluene, 20 workers with severe exposure to styrene in a glass laminate manufacturing plant, and a comparison group of healthy subjects were studied. The severity of exposure was documented by measurements of toluene and styrene concentrations in breathing zone air, by hippuric acid concentration in urine in the group exposed to toluene, and by urinary mandelic acid concentration in the group exposed to styrene. Somatosensory evoked potentials were measured by stimulation of the median nerve at the wrist and the tibial nerve at the ankle. Peripheral conduction velocities (CVs) in both extremities and central conduction time (CCT) after tibial nerve stimulation were significantly decreased in both exposed groups. Significantly prolonged latencies of peripheral and cortical SEPs to median nerve stimulation as well as cortical SEPs to tibial nerve stimulation were found in workers exposed to styrene. Some abnormalities in SEPs at peripheral or spinal and cortical levels were found in eight workers exposed to toluene and six workers exposed to styrene. Of these, in three workers exposed to toluene and two to styrene increased CCT and delayed latencies of cortical responses at normal conduction values in the periphery were found. A trend for increased frequency of abnormal SEPs with duration of exposure to toluene and styrene and alcohol abuse was found. Abnormalities in SEPs in the exposed groups are most probably of multifactorial origin. Central SEP abnormalities in both exposed groups could indicate early signs of subclinical dysfunction at spinal and cortical levels and could be due to toluene or styrene exposure probably potentiated by alcohol consumption in the group exposed to toluene.

The patterns of complex and partially purified mycobacterial antigens in macrophage migration inhibition testing

In rabbits immunized intratarsally by M. tuberculosis, M. kansasii and M. avium the responses to homologous and heterologous antigens were assessed by direct and indirect macrophage migration inhibition tests. Complex cytoplasmic antigens were obtained by disruption of bacterial mass and by ultracentrifugation of the supernatants. The partially purified antigens were prepared by gel chromatography of the complex antigens on a Sephadex G 150 column. The middle fraction (260/280 ratio approx. 1, molecular weight approx. 32 KD) was employed as partially purified antigen. In the direct tests the migration activity of immune spleen macrophages was significantly reduced by homologous complex and partially purified antigens (MI = 0.63 to 0.72) and it differed significantly from responses obtained with heterologous antigens (MI = 0.75 to 0.92); however, these were still lower than those in nonimmunized control animals where MI ranged from 0.89 to 1.01. In the indirect tests, the strongest responses were recorded again with homologous complex and partially purified antigens (MI = 0.43 to 0.53). The responses in heterologous systems differed even more markedly than in direct tests (MI = 0.65 to 0.81); and, these were again still significantly lower than in control animals (MI = 0.89 to 0.98). In both direct and indirect tests, the complex and partially purified antigens did not vary substantially in their immunogenic capacity. The presence of cross-reacting responses in heterologous systems can be explained by a close relatedness of mycobacteria used in the immunization schedule and by the presence of common epitopes in complex and purified testing antigens.

In vitro cellular immune response to homologous and heterologous antigens in rabbits sensitized by five species of Mycobacterium and Nocardia asteroides

Rabbits were sensitized with killed Mycobacterium tuberculosis, M. kansasii, M. avium, M. scrofulaceum, M. fortuitum, and Nocardia asteroides, and their response to homologous and heterologous antigens was assessed in vitro by direct and indirect macrophage migration inhibition tests. The antigens were obtained by disintegration of bacterial mass and by purification of the supernatants by ultracentrifugation. In the direct test, hypersensitivity to homologous antigen was most marked with M. tuberculosis, M. kansasii, and M. avium (migration indices [MI] = 0.42 to 0.50), but was significantly weaker with organisms possessing a lower degree of pathogenic activity (MI for M. fortuitum and N. asteroides = 0.70 and 0.72, respectively). Reactivity to heterologous antigens was also highest in animals sensitized with strongly pathogenic species, approximating normal values in rabbits sensitized with weak pathogens. In the indirect test, the strongest responses were obtained again to homologous antigens (MI = 0.42 to 0.67), and they differed more markedly from reactions to heterologous antigens than in the direct test. The weakest activity of heterologous antigens was again found with M. fortuitum and N. asteroides, where MIs were 0.82 to 0.93.