Location of the narrowest area of the pharynx regarding body mass index and obstructive sleep apnoea severity

BACKGROUND

Among authors studying morphological determinants of the obstructive sleep apnoea (OSA) controversies exist on the location of the narrowest area within the pharynx, critical for development of obstruction. Those disagreements primarily revolve around differences between obese and nonobese OSA patients. Determination whether the location and size of the narrowest area within the pharynx differentiates the obese and nonobese OSA patients.

MATERIALS AND METHODS

A population of 55 subjects was investigated after being diagnosed with OSA in the Polysomnography Laboratory of the Department and Clinic of Otolaryngology in the Medical University of Warsaw, Poland. Additionally a head computed tomography (CT) was performed in all the subjects. The CT images were used to do several crucial measurements which described the geometry of the facial skeleton as well as soft tissues of the head. The obtained results were correlated with apnoea-hypopnoea index (AHI) and body mass index (BMI) values. The data were statistically analysed.

RESULTS

The distance between the hard palate and posterior pharyngeal wall parallel to the horizontal plane as well as the shortest distance between the soft palate and posterior pharyngeal wall significantly differentiated patients in the subgroups by AHI but not by BMI.

CONCLUSIONS

Pharyngeal obstruction at the level of the hard and soft palate differentiates patients with severe OSA from patients with mild and moderate OSA regardless of BMI.

Biocompatibility of electrospun human albumin: a pilot study

Albumin is rarely used for electrospinning because it does not form fibres in its native globular form. This paper presents a novel method for electrospinning human albumin from a solution containing pharmaceutical grade protein and 25% polyethylene oxide (PEO) used as the fibre-forming agent. After spontaneous cross-linking at body temperature, with no further chemicals added, the fibres become insoluble and the excess PEO can be washed out. Albumin deposited along the fibres retains its native characteristics, such as its non-adhesiveness to cells and its susceptibility for degradation by macrophages. To demonstrate this we evaluated the mechanical properties, biocompatibility and biodegradability of this novel product. After subcutaneous implantation in mice, albumin mats were completely resorbable within six days and elicited only a limited local inflammatory response. In vitro, the mats suppressed cell attachment and migration. As this product is inexpensive, produced from human pharmaceutical grade albumin without chemical modifications, retains its native protein properties and fulfils the specific requirements for anti-adhesive dressings, its clinical use can be expedited. We believe that it could specifically be used when treating paediatric patients with epidermolysis bullosa, in whom non-healing wounds occur after minor hand injuries which lead to rapid adhesions and devastating contractures.

Persistence of immune responses to the HPV-16/18 AS04-adjuvanted vaccine in women aged 15-55 years and first-time modelling of antibody responses in mature women: results from an open-label 6-year follow-up study

OBJECTIVE

Evaluation of the long-term HPV-16/18 AS04-adjuvanted vaccine immunogenicity persistence in women.

DESIGN

Multicentre, open-label, long-term follow-up (NCT00947115) of a primary phase-III study (NCT00196937).

SETTING

Six centres in Germany and Poland.

POPULATION

488 healthy women (aged 15-55 years, age-stratified into groups: 15-25, 26-45, and 46-55 years) who received three vaccine doses in the primary study.

METHODS

Immune responses were evaluated in serum and cervicovaginal secretion (CVS) samples 6 years after dose 1. Anti-HPV-16/18 geometric mean titres (GMTs) were measured by enzyme-linked immunosorbent assay (ELISA), and were used to fit the modified power-law and piecewise models, predicting long-term immunogenicity. Serious adverse events (SAEs) were recorded.

MAIN OUTCOME MEASURES

Anti-HPV-16/18 seropositivity rates and GMTs 6 years after dose 1.

RESULTS

At 6 years after dose 1, all women were seropositive for anti-HPV-16 and ≥97% were seropositive for anti-HPV-18 antibodies. GMTs ranged from 277.7 to 1344.6 EU/ml, and from 97.6 to 438.2 EU/ml, for anti-HPV-16 and anti-HPV-18, respectively. In all age groups, GMTs were higher (anti-HPV-16, 9.3-45.1-fold; anti-HPV-18, 4.3-19.4-fold) than levels associated with natural infection (29.8 EU/ml). A strong correlation between serum and CVS anti-HPV-16/18 levels was observed, with correlation coefficients of 0.81-0.96 (anti-HPV-16) and 0.69-0.84 (anti-HPV-18). Exploratory modelling based on the 6-year data predicted vaccine-induced anti-HPV-16/18 levels above natural infection levels for at least 20 years, except for anti-HPV-18 in the older age group (piecewise model). One vaccine-related and two fatal SAEs were reported.

CONCLUSIONS

At 6 years after vaccination, immune responses induced by the HPV-16/18 AS04-adjuvanted vaccine were sustained in all age groups.

Mutations in Pol gene of hepatitis B virus in patients with chronic hepatitis B before and after therapy with nucleoside/nucleotide analogues

Chronic hepatitis B (CHB) is one of the most common infections worldwide. Currently approved treatments of CHB include nucleoside/nucleotide analogues (NAs). However, long-term NA therapy is associated with accumulation of resistant mutations within the hepatitis B virus (HBV) polymerase gene. The incidence of naturally occurring HBV mutations leading to primary antiviral resistance has not been fully elucidated yet. The objective of present study was to detect the frequency of mutations within the HBV polymerase gene in 263 patients naïve to nucleoside/nucleotide analogues. Prevalence of HBV Pol gene mutations secondary to NA treatment in patients without pre-existing antiviral resistance mutations was also examined. Retrospective analysis showed that HBV Pol gene mutations were present in 7 out of 263 patients prior to the treatment. Mutations observed in NA-naïve CHB patients were associated only with resistance to lamivudine and adefovir. Compensatory mutations were observed as well. In the course of antiviral treatment, HBV Pol gene mutations were identified in 65 out of the remaining 256 CHB patients (25.39%), while no mutations of any type were detected in 160 patients (62.5%). The profiles of detected mutations were comparable to those observed in other studies that focused on the analysis of clinically relevant NA-resistant mutations. In conclusion, we found out that antiviral resistance mutations may pre-exist in the overall viral population present in untreated patients, although the incidence of HBV Pol gene mutations in NA-naïve CHB patients was low and reached only up to 2.66%. However, possible circulation and transmission of NAs-resistant HBV mutants in human population should be taken into account.

Randomised, controlled trial of concomitant pneumococcal and meningococcal conjugate vaccines

A randomised, open-label study compared the immunogenicity and safety of 7-valent pneumococcal conjugate vaccine (PCV7) and meningococcal C conjugate vaccine (MnCC vaccine) administered concomitantly and individually. Infants received PCV7+MnCC vaccine (n=265), PCV7 alone (n=268) or MnCC vaccine alone (n=178). PCV7 was administered at 2, 3½, 6 and 12 months, and MnCC vaccine at 2, 6 and 12 months. For the 7 pneumococcal serotypes tested (4, 6B, 9V, 14, 18C, 19F and 23F), proportions of subjects with pneumococcal serotype-specific immunoglobulin G (IgG) antibody concentrations ≥0.35 μg/mL post-infant series were non-inferior for the PCV7+MnCC vaccine (91.5-99.6%) and PCV7 (89.0-99.6%) groups. Proportions of subjects achieving serogroup C meningococcal serum bactericidal assay titres ≥1:8 post-infant series were non-inferior for the PCV7+MnCC vaccine (99.6%) and MnCC vaccine groups (98.8%). Pneumococcal IgG antibody levels were similar in the PCV7+MnCC vaccine and PCV7 groups at each time point. Post-infant and post-toddler meningococcus C serum bactericidal assay titres and IgG levels were similar in the PCV7+MnCC vaccine and MnCC groups, although pre-toddler, the levels were lower in the PCV7+MnCC vaccine group than the MnCC vaccine group. Immune response rates to diphtheria antigen approached 100% for all vaccine groups. Local reactions were mostly similar among the treatment groups. The MnCC vaccine group had lower rates of some systemic events than the PCV7+MnCC vaccine group. Immune responses to PCV7+MnCC vaccine were non-inferior compared with those seen with each vaccine administered alone.

Topographical anatomy and morphometry of the temporal bone of the macaque

Based on the dissections of 24 bones of 12 macaques (Macaca mulatta), a systematic anatomical description was made and measurements of the chosen size parameters of the temporal bone as well as the skull were taken. Although there is a small mastoid process, the general arrangement of the macaque's temporal bone structures is very close to that which is observed in humans. The main differences are a different model of pneumatisation and the presence of subarcuate fossa, which possesses considerable dimensions. The main air space in the middle ear is the mesotympanum, but there are also additional air cells: the epitympanic recess containing the head of malleus and body of incus, the mastoid cavity, and several air spaces on the floor of the tympanic cavity. The vicinity of the carotid canal is also very well pneumatised and the walls of the canal are very thin. The semicircular canals are relatively small, very regular in shape, and characterized by almost the same dimensions. The bony walls of the labyrinth are relatively thin.

A novel combined Hib-MenC-TT glycoconjugate vaccine as a booster dose for toddlers: a phase 3 open randomised controlled trial

OBJECTIVE

To study the immunogenicity and reactogenicity of a combined Haemophilus influenzae type b and Neisseria meningitidis serogroup C tetanus toxoid conjugate vaccine (Hib-MenC-TT) when administered as a booster dose in combination with a measles, mumps and rubella vaccine (MMR).

DESIGN

A phase 3 open randomised controlled trial.

SETTING

One centre in Oxford, UK and nine centres in Poland.

SUBJECTS

12-15-month-old healthy children.

INTERVENTIONS

In the primary stage of the study 500 healthy 6-12-week-old infants were randomised in a 3:1 ratio to receive Hib-MenC-TT+DTPa-IPV or MenC-CRM197 vaccine+DTPa-IPV-Hib. In the booster stage, 476 participants (190 in the UK and 286 in Poland) were vaccinated with Hib-MenC-TT and MMR.

MAIN OUTCOME MEASURES

The proportion of children with protective serum antibody levels against MenC and Hib 6 weeks following a Hib-MenC-TT booster dose.

RESULTS

The co-primary objectives were met: the Hib-MenC-TT booster dose induced protective antibody titres in children vaccinated with Hib-MenC-TT+DTPa-IPV or MenC-CRM197+DTPa-IPV-Hib at 2, 3 and 4 months of age. 94.8% (lower limit of (LL) 95% CI 92.4) of participants had rSBA-MenC >or=1:128 and 100% (LL 95% CI 99.2) achieved anti-PRP concentrations >or=1.0 microg/ml. The percentage of toddlers with a post boost rSBA-MenC of 1:128 was significantly higher after priming with Hib-MenC-TT (97.7%) than after MenC-CRM197 (86%) (difference: 11.7%; 95% CI 6.2 to 19.4).

CONCLUSION

The waning antibody titres against Hib and MenC following primary immunisation can be boosted to protective levels by administering the Hib-MenC-TT vaccine at 12-15 months of age, supporting the recent introduction of this vaccine in the UK immunisation schedule to sustain protection of children against Hib and MenC disease.

TRIAL REGISTRATION NUMBER

NCT00258700. Study ID: 103974 (http://clinicaltrials.gov).

The size of venous foramina and skull capacity in man and selected vertebrate species

In many experiments it was proved that brain cooling systems in mammals and birds depend on the flow of the cool venous blood into the cranial cavity through a well-developed system of foramina. In order to investigate the anatomical basis of this mechanism a morphological study was undertaken. On 10 species of mammals and birds, a correlation between the skull capacity and the size of its main venous foramina was determined. A computer system of image analysis was used. In man the skull that was the largest, however consisted venous foramina of the smallest size. Moreover, the asymmetry of the foramina and the concentration of the outflow in one dominant foramen was the greatest. Probably the dominance of only one venous foramen on each side of the human skull provides the reduction of flow resistance and creates more advantageous conditions for blood outflow from the skull, and therefore, better conditions for brain cooling.

Topographical anatomy and measurements of selected parameters of the rat temporal bone

On the basis of dissection of 24 bones of 12 black rats a systematic anatomical description was made and measurements of selected size parameters of the temporal bone were taken. Besides the main air space in the middle ear, the tympanic bulla, there are also additional air cells, namely the anterior and posterior epitympanic recesses, containing the head of the malleus and the body of the incus. On the side of the epitympanic recesses the following are easily accessible: the malleus head and the core of the incus, the superior and lateral semicircular canals and the facial nerve. On the side of the ventral tympanic bulla it is easy access to both windows and the cochlea. The semicircular canals are relatively large, the lateral canal being the largest and the posterior the smallest. The length of the spiral canal of the cochlea does not exceed 11 mm. It is worth mentioning that both the vertical and horizontal dimensions of the scala vestibuli and scala tympani do not even exceed 0.7 mm in the basal turn, and are significantly decreased to tenths of a millimetre in further turns. This needs to be taken into consideration during all experiments requiring the introduction of examining instruments into the cochlear scala.

ACE2 inhibition worsens glomerular injury in association with increased ACE expression in streptozotocin-induced diabetic mice

Angiotensin converting enzyme 2 (ACE2) is localized to the glomerular epithelial cells. Since ACE2 promotes the degradation of angiotensin II, a decrease in ACE2 activity could lead to the development of glomerular injury. We gave a specific ACE2 inhibitor, MLN-4760, for 4 weeks to mice rendered diabetic with streptozotocin. The urinary albumin/creatinine ratio was increased along with expansion of the glomerular matrix in diabetic mice treated with the inhibitor compared to the vehicle-treated mice. Glomerular staining of ACE was increased in the diabetic group and was further significantly increased in the diabetic group treated with MLN-4760. In renal vessels, ACE expression was also increased in the diabetic mice and, again, further increased in those diabetic mice treated with the ACE2 inhibitor. Our study shows that chronic pharmacologic ACE2 inhibition worsens glomerular injury in streptozotocin-induced diabetic mice in association with increased ACE expression.

The size of selected human skull foramina in relation to skull capacity

An anatomical study was undertaken in order to investigate whether the sizes of selected human skull foramina with significant venous compartments correlated significantly with skull capacity. A total of 100 macerated human skulls were examined to determine the diameter of the foramina and the skull capacity. Measurements of the surface area of the foramina were made using a computerised digital analysis system. Only the size of the hypoglossal canal and jugular foramen were found to correlate significantly with the capacity of the skull. This correlation, together with the considerable size of the hypoglossal canal, indicated its important role in the venous drainage of the brain. There was considerable centralisation of venous outflow from the brain, with 60% of the area of all venous foramina of the skull occupied by jugular foramina. Asymmetry between the right and left jugular foramina was identified, with an average ratio of 1.6 (ranging between 1 and 3.47). In the case of right-sided domination the correlation between the skull capacity and the size of both jugular foramina was negative (the larger the skull cavity, the less the asymmetry), while in the case of left-sided domination the correlation was positive. Perhaps the left-sided domination is less advantageous for the haemodynamics of blood outflow, as the left brachiocephalic vein is longer and is often compressed by the sternum and aortic arch.

The anatomy of the tympanic sinus

The tympanic sinus is one of the most important structures of the human temporal bone. Located in its vicinity are the round window, posterior semicircular canal and facial nerve. The study was performed on 30 temporal bones taken from adult cadavers of both sexes. After the tympanic sinus had been identified, its morphological features were evaluated. The sinus was then measured using a graticule with an accuracy of 0.05 mm. Also measured were the shortest distances from the tympanic sinus to the neighbouring structures (the lateral and posterior semicircular canal, the facial nerve canal and the jugular fossa). The measurements were performed under a surgical microscope with eye-piece graduation of 0.05 mm accuracy. Four main morphological types of fossa of the tympanic sinus and two main developmental forms, a deep sinus and a shallow sinus, were distinguished. The existence of a deep sinus was associated with absence of the bridge and the sinus was shallower when the bridge was prominent. The very deep sinuses were located close to the facial canal, in some cases penetrating deep in its vicinity (in some cases even going beyond two thirds of the canal's circumference), which poses a real risk of facial nerve damage during surgical removal of a lesion located in close proximity to the nerve. In most cases the tympanic sinus is elliptical in shape and its long diameter lies in the vertical plane (mean value: 2.73 x 2.23 mm). The mean distances from the tympanic sinus to the facial nerve canal, lateral semicircular canal, posterior semicircular canal and jugular fossa were 1.5 mm, 2.1 mm, 1.59 mm and 5.5 mm respectively. No correlation was observed between the measurement results and either sex or side.

The occurrence, variations and diameter of the human condylar canal in relation to the jugular foramen

In medical practice, especially in analysis of radiograms and computed tomography scans, it is very important to be familiar with the anatomy of the skull base, not only the normal and typical anatomical structures but also the variations and anomalies. One of the important venous foramina of the human skull is the condylar canal. This structure is described as the most stable and permanent venous emissary, with a prevalence of up to 100%. In our study, based on 100 human macerated skulls, this canal was encountered in 81% of cases. In several it was double. We have not encountered any information on this in the available literature. We found that the condylar canal in humans could be double and that the size of the external opening of this canal is not crucial in relation to the size of the jugular foramen. There was no significant correlation between the jugular foramen and the condylar canal in our specimens.

Abdominal radiation exposure elicits inflammatory responses and abscopal effects in the lungs of mice

An inflammatory reaction is a classical feature of radiation exposure and appears to be a key event in the development of the acute radiation syndrome. We have investigated the radiation-induced inflammatory response in C57BL6/J mice after total abdominal or total-body irradiation at a dose of 15 Gy. Our goal was to determine the radiation-induced inflammatory response of the gut and to study the consequences of abdominal irradiation for the intestine and for the lungs as a distant organ. A comparison with total-body irradiation was used to take into account the hematopoietic response in the inflammatory process. For both irradiation regimens, systemic and intestinal responses were evaluated. A systemic inflammatory reaction was found after abdominal and total-body irradiation, concomitant with increased cytokine and chemokine production in the jejunum of irradiated mice. In the lungs, the radiation-induced changes in the production of cytokines and chemokines and in the expression of adhesion molecules after both abdominal and total-body irradiation indicate a possible abscopal effect of radiation in our model. The effects observed in the lungs after irradiation of the abdomino-pelvic region may be caused by circulating inflammatory mediators consequent to the gut inflammatory response.

Differential qualitative and temporal changes in the response of the hypothalamus-pituitary-adrenal axis in rats after localized or total-body irradiation

Stress such as exposure to ionizing radiation is able to activate the hypothalamus-pituitary-adrenal axis. The present study sought to examine the effects of different configurations of a 10-Gy gamma irradiation in rats on the hypothalamus-pituitary-adrenal axis to understand the mechanism of negative feedback by glucocorticoids induced by ionizing radiation. Specifically, we determined adrenocorticotropin and corticosterone levels in plasma as well as corticotrophin-releasing factor expression in the paraventricular nucleus of the hypothalamus by in situ hybridization from 6 h to 4 days after total-body, abdominal or head irradiation. In this study, we found an activation of the hypothalamus-pituitary-adrenal axis after radiation exposure. Plasma adrenocorticotropin and corticosterone levels were significantly increased after total-body and abdominal irradiation 3 days after exposure, in parallel with decreased labeling of corticotrophin-releasing factor mRNA in the parvocellular region of the paraventricular nucleus of the hypothalamus. Our results suggest that ionizing radiation activates the neuroendocrine system to protect the organism from the occurrence of radiation-induced inflammation.

Effects of micronized fenofibrate on insulin resistance in patients with metabolic syndrome

BACKGROUND AND OBJECTIVE

Metabolic syndrome is characterized by insulin resistance (IR) as well as dyslipidemia, ventral overweight, hypertension and elevated fasting plasma glucose. Since diabetic and prediabetic states are commonly associated with hypertriglyceridemia, fenofibrates have been used in such patients. The aim of this pilot open trial was to study the influence of micronized fenofibrate on insulin resistance and plasma insulin levels in prediabetic and diabetic patients.

SUBJECTS

From 114 dyslipidemic patients, 31 with dyslipidemia and insulin resistance were selected to take part in the study. Of the 31 patients, 20 were nondiabetic and only 11 had noninsulin-dependent diabetes mellitus. Eighteen dyslipidemic patients acted as controls.

METHODS

Insulin resistance was assessed in a short-term insulin tolerance test. Plasma insulin, antiinsulin antibodies, lipid parameters and the insulin sensitivity index (ISI) were measured at entry and after a 3-month therapy with 200 mg micronized fenofibrate daily.

RESULTS

Three-month therapy with micronized fenofibrate resulted in significant ISI increase and was accompanied by a decrease in plasma insulin levels in dyslipidemic patients with metabolic syndrome. ISI also improved in patients with type 2 diabetes mellitus and there was an unexpected increase in plasma insulin levels. Antiinsulin antibodies were unchanged throughout the trial. Reductions in plasma triglycerides and total cholesterol exceeding 50% and 20%, respectively, were observed in patients with metabolic syndrome. These changes were accompanied by an increase in mean levels of plasma high-density lipoprotein (HDL) cholesterol (above 35%).

CONCLUSIONS

Micronized fenofibrate is an effective drug in normalizing lipid-lipoprotein levels in patients with metabolic syndrome. After a 3-month fenofibrate therapy, insulin resistance was reduced in a group of patients with dyslipidemia and metabolic syndrome.

Screening of a large panel of gastrointestinal peptide plasma levels is not adapted for the evaluation of digestive damage following irradiation

The aim of this study was to assess the potential of gastrointestinal peptide plasma levels as biomarkers of radiation-induced digestive tract damage. To this end, plasma levels of substance P, GRP, motilin, PYY, somatostatin-28, gastrin, and neurotensin were followed for up to 5 days in pigs after a 16-Gy whole-body X-irradiation, completed by a histopathological study performed at 5 days. Each peptide gave a specific response to irradiation. The plasma levels of GRP and substance P were not modified by irradiation exposure; neither were those of motilin and PYY. Concerning gastrin, a 2-3-fold increase of plasma concentration was observed in pig, which presented the most important histological alterations of the stomach. The plasma levels of somatostatin, unchanged from 1 to 4 days after irradiation, was also increased by 130% at 5 days. In contrast, a diminution of neurotensin plasma levels was noted, firstly at 1 day (-88%), and from 3 days after exposure (-50%). The present study suggested that changes in gastrin and neurotensin plasma levels were associated with structural alterations of the stomach and ileum, respectively, indicating that they may be relevant biological indicators of radiation-induced digestive damage to these segments.

Transmission of HCV infection among long-term hospitalized onco-haematological patients

Hepatitis C virus (HCV) infection is becoming a substantial problem in long-term hospitalized patients. Onco-haematological patients undergoing chemotherapy are especially prone to HCV infection. These patients are usually immunosuppressed and therefore antibodies to HCV are not produced despite the presence of HCV RNA in peripheral blood. The aim of the study was to see how often long-term hospitalized patients acquired HCV infection, and what were the possible sources and routes of virus transmission. The study involved 129 children with lymphoproliferative diseases, 36 patients with solid tumours, and 61 healthcare workers from onco-haematological wards. All were HCV RNA and anti-HCV negative at the time of first hospitalization. During a two and a half-year follow-up study among 165 onco-haematological patients, HCV RNA appeared in 87 in subsequent hospitalizations. The majority of infections were (82/87) were 1a genotype, 2 were 1b, 1 was 1a + 1b and 1 was 1a + 3a. In an attempt to establish the origin of HCV infection, healthcare workers were screened for HCV genotyping. All HCV-infected staff working on wards had the same genotype (1a). None of the staff was infected with 1b genotype. As the most prevalent genotype in Polish blood donors is 1b, HCV infection in onco-haematological patients is most likely due to horizontal transmission, probably involving genotype 1a, and potential horizontal transmission of HCV is implied by the presence of 1a genotype of HCV in saliva and urine of selected patients. Spread of hospital HCV infection among children may be facilitated by micro-injury of the skin and mucosa. Early detection of HCV RNA is important in such immunosuppressed patients, as they are not able to produce anti-HCV antibodies. This may enable the introduction of prophylactic steps to prevent the spread of HCV infection by horizontal transmission.

Expression of mRNA for cytokines (TNF-alpha and IL-1alpha) in human cytomegalovirus (HCMV) and hepatitis B virus (HBV) infections

The study was aimed at detecting cellular sources of transcripts for two cytokines, TNF-alpha and IL-1alpha in infection with human cytomegalovirus (HCMV) or hepatitis B virus (HBV). The studies were performed on paraffin sections of organs (liver, pancreas, spleen, lungs) obtained upon autopsy from a child deceased due to acute inborn HCMV infection, on paraffin sections of liver biopsy, obtained from a child with HCMV-induced chronic hepatitis, and of liver biopsies obtained from children with chronic type B hepatitis (n = 13). The classical in situ hybridization was applied with digoxygenin-labeled probes and amplification by the ImmunoMax technique. In HCMV infection, the most pronounced expression of mRNA for TNF-alpha and Il-1alpha was detected in pancreatic islets (mainly in beta cells) and, then, in a decreasing sequence, in liver (in macrophages and sinusoidal endothelial cells) and in lungs (in alveolar macrophages). No expression of the two cytokines was detected in the spleen. In HBV infection, weak expression of TNF-alpha and more intense expression of IL-1alpha in the liver were observed, mainly in sinusoidal endothelial cells and in macrophages as well as in hepatocytes. These results were confirmed by immunocytochemical experiments.

Effect of heavy ions on neuro-endocrine regulations

During American and Russian short and long-term space flights neuroimmune dysregulations have been observed in man and rats for up to three months after the return. During Extra-Vehicular Activity, radiation exposure risk is greater to elicit short and/or long-term deleterious effects on the functional capacity of the neuroimmune system. In order to assess the effects of high LET events on neuroimmune networks, our preliminary ground-based study was to investigate brain inflammatory responses in mouse after low dose radiation exposure with high LET particles (12C, 95MeV/u, 42 mGy). Plasma corticosterone levels were rapidly (6 hours) increased by two-fold, then decreased 24 hours post-irradiation. At 3 days plasma corticosterone and ACTH concentrations were also two- to three-fold increased. Plasma ACTH levels were still elevated up to seven days to two months. Furthermore immune functions are under current assessment. The results of this study should allow a greater understanding of the effects of high LET particles on neuroimmune system.

Significance of molecular identification of hepatitis C virus RNA in diagnosis of cryptogenic hepatitis in children

Viral etiology of hepatitis is routinely proved by standard immunological tests detecting specific antibodies. However, identification of specific antibodies cannot always be conclusive. Since specific hepatitis C virus (HCV) antibodies may appear after some months of the infection, identification of HCV RNA and/or hepatitis G virus (HGV) RNA should clarify the etiology of hepatitis. The aim of this study was to diagnose etiologically unknown hepatitis by a reverse transcription-polymerase chain reaction (RT-PCR) testing of the presence of HCV RNA and HGV RNA. The study involved 33 children with histologically proved hepatitis. The presence of HCV and any signs of autoimmune disease were not observed at the beginning of the follow-up study. During 2.5 years of the follow-up HCV-RNA was found in the blood and liver biopsies in 17 patients. Eight of them became HCV antibodies-positive during the follow-up. None of them eliminated the virus from the blood during the follow-up. In two other patients HCV-RNA was found only in the liver. HGV infection in all cryptogenic patients was excluded by PCR testing. Identification of HCV RNA RT-PCR allowed to diagnose 19 out of 33 (57.6%) patients with cryptogenic hepatitis. The etiology of the hepatitis in remaining 12 patients has to be established.

Hepatitis G virus co-infection may affect the elimination of hepatitis C virus RNA from the peripheral blood of hemodialysis patients

Hemodialysis patients are at risk for hepatitis C virus (HCV) and hepatitis G virus (HGV) infection. The aim of this study was to investigate the possible influence of HGV co-infection on HCV RNA elimination from the peripheral blood of hemodialysis patients. The study involved 144 persons, all with HCV antibodies and HCV RNA. Among 144 patients 24 (16.7%) were positive for HGV RNA. After 2.5 years of observation 80 patients (55.6%) were still HCV RNA-positive. In the latter group 18 patients were co-infected with HGV and 62 were HGV RNA-negative. During 2.5 years of the follow-up study 64 patients eliminated HCV RNA from the serum. In this group only 6 patients were HGV co-infected. None of the HGV-positive patients eliminated HGV RNA from the serum. The higher incidence of HGV co-infection in the group of patients who remained HCV RNA-positive (18/80, 22.5%), in comparison to the group of HCV antibodies-positive patients who lost HCV in the blood (6/64, 9.4%, P < 0.0001) suggests, that the co-infection with HGV may delay the spontaneous elimination of HCV RNA from the blood.

[Human immunodeficiency virus in the work environment]

This paper addresses the problem of occupational risk assessment of HIV infections and presents current data on HIV prevention. The risk of HIV infection is much lower than the probability of other infectious diseases that create an important medical problem in Poland. Nevertheless, it is a real hazard, involving not only medical, but also psychological, educational and social aspects. As yet there has been no documented case of occupational HIV infection in Poland, but health care workers should be aware of the HIV infection risk and should apply all possible preventive measures.

[Viral hepatitis as a disease with occupational etiology]

This paper reviews the literature and discusses the occupational background and conditions of hepatitis. There are known three hepatitis viruses (HAV, HBV and HCV) with proved transmission through occupational contacts. In addition, occupation-related infections HDV and HGV, are probable or possible. Current diagnostic and epidemiological data as well as suggestions concerning the prevention of occupational hepatitis are also presented. A concept of work ability of health-care workers infected with HBV and HCV is discussed.

Dimensions of the vestibular and tympanic scalae of the cochlea in selected mammals

The spiral shaped organ of hearing occurs only in mammals. This shape creates good conditions for the acoustic wave inside the cochlea. There are various forms of the cochlea in different species of mammal: the number of turns ranges from 1.5 to 4.5, a fact for which there seems no obvious explanation. In order to become more familiar with the geometry of the cochlear scalae in animals, a microanatomical study was carried out on 40 temporal bones, obtained from four common species of mammal: cat, dog, cattle and macaca. The bones were dissected with the aid of an operation microscope using standard otosurgical equipment, in which their perilymphatic spaces were filled with latex and further prepared in a formalin stain. Each of the rubber molds was removed from the osseous matrix and subsequently manually cut into 1 mm segments. The results, presented in diagrams, indicate that the vestibular and tympanic scalae present alternate dominance in their width and height, as was previously found in a study of humans. The change of this alternation domination appears two to five times on their entire length. The dimensions of the cochlear scalae are to a certain extent proportional to the weight of the animal: the largest were found in cattle and the smallest in the macaca.

Absence of protective role of afferent nerves in early intestinal mucosal alterations induced by abdominal irradiation in rats

PURPOSE

To assess the early effects of primary afferent nerve suppression by systemic treatment with the neurotoxin capsaicin in an acute model of abdominal irradiation in rats (10Gy, gamma).

MATERIALS AND METHODS

Changes in myeloperoxidase (MPO) activity, calcitonin gene-related peptide (CGRP) tissue content, number of mast cells and apoptotic cells were determined in jejunum and ileum in four groups of rat male Wistar (vehicle sham-irradiated, vehicle irradiated, capsaicin sham-irradiated and capsaicin irradiated) at 1 and 3 days post-irradiation.

RESULTS

In vehicle irradiated rats, CGRP was significantly increased from the first day after irradiation in jejunal mucosa; MPO activity increased in both segments at day 3 but not at day 1 after irradiation; the number of detectable mucosal mast cells dropped to nearly zero on days 1 and 3, while the apoptotic cells in the intestinal mucosa were significantly increased at day 1. Similar results were obtained for mast cells and apoptosis in capsaicin irradiated rats as compared to capsaicin sham-irradiated rats, while MPO activity was significantly increased and CGRP concentration in jejunal mucosa significantly decreased from the first day in these rats in comparison with capsaicin sham-irradiated rats.

CONCLUSIONS

Intestinal sensory innervation seems not to have a major protective role against a radiation-induced intestinal inflammatory reaction.

Intestinal and colonic motor alterations associated with irradiation-induced diarrhoea in rats

Localized application of ionizing radiation to the gastrointestinal tract frequently elicits responses, which include diarrhoea. The origin of this symptom is not clear but has been attributed to loss of epithelial integrity, together with alterations in motility and increased secretion. The purpose of this study was to examine whether a 10 Gy abdominal gamma irradiation leads to an inflammatory reaction, and to compare intestinal and colonic motility in controls and abdominally irradiated rats 1, 3 and 7 days after irradiation, using an electromyographic technique. The motility parameters analysed were the frequency and velocity of propagation of migrating myoelectric complexes (MMC) in the jejunum and colonic spike activity (long spike bursts; LSB) per 10 min in fasted rats. The MMC frequency was significantly reduced on days 1 and 7 after irradiation and the MMC pattern was markedly disrupted on day 3. The frequency of colonic LSB was significantly reduced on days 1, 3 and 7. Mouth to anus transit was significantly accelerated on day 3 only and diarrhoea was observed at this time. Myeloperoxidase activity in the jejunum and colon was also increased on this day only. It is concluded that irradiation-induced diarrhoea occurs contemporaneously with disruption of MMC in the small intestine.

Detection of DNA, mRNA and early antigen of the human cytomegalovirus using the immunomax technique in autopsy material of children with intrauterine infection

The present study focuses on the immunomax technique in association with the avidin-biotin-peroxidase complex (ABC) technique and a non-isotopic variation of in situ hybridisation (ISH) for optimal microscopical detection of human cytomegalovirus (HCMV). The studies were performed on an archival paraffin material originating from five children deceased due to intrauterine infection. The results of immunocytochemical and hybridocytochemical studies, with or without amplification using biotinylated tyramine, were compared with the routine histopathological results and results obtained using the polymerase chain reaction (PCR). Early antigen (EA)-HCMV was demonstrated in approximately twice as many cells as detected in the routine staining and also in cells that seemed morphologically intact. The hybridocytochemical studies confirmed the presence of HCMV DNA in cells that were positive in the immunocytochemical tests and, in addition (using the ISH-immunomax technique), in cell nuclei of intact myocardial myocytes. In general, fewer cells manifested the presence of HMCV mRNA than the presence of HCMV DNA. The immunomax technique was found to be more sensitive than the techniques of classical immunocytochemistry or of ISH. The former technique permitted the documentation of a higher number of HCMV replication sites than could be detected using the latter techniques. However, the clinical course of HCMV infection or the cause of death of the children was not directly related to the intensity of HCMV expression in tissues.

[Active infection with Epstein-Barr virus in two children with non-Hodgkin's lymphoma]

Epstein-Barr virus is common in environment. It has an organothropy to lymphoid tissue and liver tissue and the acute infection causes a mononucleosis. The aim of this study was to present two cases in children. In postmortal examination a non-Hodgkin lymphoma was diagnosed. In the first case the course was acute and in the second was chronic. In both cases the unique ethiologic factor was Epstein-Barr virus.

Studies on tissue expression of HBV in children with chronic hepatitis type B using Immunomax technique

The study aimed at employing the Immunomax technique to detect the markers of HBV replication (HBcAg and HBV-DNA) in liver biopsy material, obtained from children with chronic hepatitis type B. In line with the currently modified classification of chronic hepatitis and with the increasing potential of antiviral therapy it seemed purposeful to supplement routine staining techniques with studies at the molecular level. Our studies demonstrated the effective detection of both the core antigen and HBV-DNA in liver tissue in children using immunocytochemical techniques and in situ hybridization, amplified with the Immunomax technique. HBcAg was detected in 26 out of 27 liver biopsies from patients with chronic hepatitis type B and with replication of the virus. HBV-DNA was detected in all study children with HBV infection and in 2 out of 5 cases of chronic hepatitis of a distinct etiology. No significant relationships could be found between the detection of tissue HBV markers on the one hand and the intensity of inflammatory lesions or severity of fibrosis on the other.

Dimensions of the human vestibular and tympanic scalae

The cochlear scalae provide a practical access route for the insertion of cochlear implant electrodes. A microanatomical study was carried out on 25 human temporal bones obtained from cadavers. These bones were dissected with the aid of an operation microscope, in which their perilymphatic spaces were filled with coloured latex and further prepared in a formalin stain. Each of the rubber moulds was removed from the osseous matrix using standard otosurgical equipment, and subsequently cut into 1 mm segments. The height and width of the vestibular and tympanic scalae were measured. The results, presented in diagrams, indicate that the vestibular scala is less prominent than the tympanic scala in the basic and middle coil of the cochlea and in the upper coil, they display greater dimensions which could serve as a place for electrode insertion in cochlear implant procedures. In addition, the vestibular and tympanic scalae present alternate dominance in their width and height as corroborated by the calculated coefficients. The results obtained in this study supplement our knowledge of the anatomy of the cochlea thus far lacking a full investigation of the scalae, and could serve as a basis for other studies dealing with the physiology of the organs of hearing.

[Variability of magnitude of the human jugular foramen in relation to conditions of the venous outflow after ligation of the internal jugular vein]

The jugular foramina of the human skull, which are the main route of the venous outflow from the skull, are characterized by laterality. It is based upon predominance of one of the sides. This event presents considerable variability in human population. These differences are probably responsible for various results of ligation of the internal jugular vein, which is performed in some clinical situations in various patients. In order to appreciate the degree of this predominance much more precisely than it is presented in the available literature, a morphological study was carried out on 78 adult human cadavers. With an aid of digital image analysing system we measured a cross-section areas of the jugular foramina of non-macerated skull. We stated that parameters of the jugular foramina didn't differ significantly in respect to age, sex and body side. Predominance of one of the jugular foramina appeared in 83% of cases, and in remaining 17% was absent (it wasn't greater than an error of measurement). If it is present, the predominance of the left and the right side are equally probable. Laterality coefficient was also calculated. It was a ratio between cross-section area of the two jugular foramina: the greater one and the smaller one. Its amount was 1.62 in men and 1.59 in women, however this difference wasn't statistically significant. The range of the laterality was rather considerable because the coefficient differed from 1.02 to 3.6. When the degree of the laterality is high, ligation of the jugular vein on the greater side could by risky. We stated that in our material here were about 2.5% of such cases.

[Cochleostomy during the intracochlear implantation. Anatomical conditions in children and adults]

Cochleostomy is an opening of the perilymphatic spaces of the cochlea. It is the most important moment in intracochlear implant surgery. There are contradictory opinions in the available literature regarding this surgical intervention. Cochleostomy is performed through the round window, the oval window, the promontory or through the apical turn of the cochlea. A microanatomical study was performed to evaluate which kind of cochleostomy would be most effective and safe for the main structures of the temporal bone. The distances between round window and round window niche structures, the jugular bulb, internal acoustic meatus, posterior semicircular canal, internal carotid artery and cochlear canalicule were measured. It was stated that all the dimensions were smaller in children of up to four years of age and the differences were statistically significant. Cochleostomy through the promontory, especially using the "soft" technique of endosteum opening is safe for all the structures, and in children it also protects the cochlear canalicule.

[Comparative analysis of surgical approaches used during intracochlear implantation with reference to their safety for the important structures of the temporal bone]

A comparative analysis was made of three operative approaches used in cochlear implantations, regarding their safety for main structures of the temporal bone, simplicity and versatility. Anatomical and clinical data from literature were worked out. It was stated that the posterior tympanotomy approach is best because of its allows for good view on the round window niche and its risk for the facial nerve damage is not greater than that of the other routes. The posterior tympanotomy approach is safe for small children because the space between the facial nerve and tympanic ring is not smaller in them than in adults. This route to the tympanic cavity creates also possibilities for widening of the operating area if it is necessary, for example in obstructed and obliterated cochleas. The anterior tympanotomy approach is dangerous for children because of a great risk for facial nerve and jugular bulb. The mastoidotomy-tympanotomy approach is on the other hand very complex, requires special equipment and is not more protective for the facial nerve than posterior tympanotomy approach.

[The multiple promontory bridge]

Anatomical investigations of one hundred human temporal bones revealed a significant variability of the promontory bridge (ponticulus promontorii). In twelve bones double and in two-triple promontory bridge was observed. The triple promontory bridge had not been previously described in available literature. In all the cases the double or triple promontory bridges were observed only on the temporal bones obtained from cadavers of up to four years of age. It confirms previous statements suggesting that development of this structure is connected with the process of pneumatization of the statements suggesting that development of this structure is connected with the process of pneumatization of the temporal bone, which obviously starts in 3-4 year of life.

Mastoid emissary in Indian skulls

Two hundred and eleven Indian skulls originating from medieval times, South of Peru, were studied in respect to variability of the mastoid emissary. Occurrence and localisation of the external orifice of the mastoid emissary were studied in three distinct and well-separated populations, living in the three different places: Villa el Salvador, Tablada de Lurin and Paracas. Most of the skulls presented considerable degree of artificial deformation. External orifice of the mastoid emissary was multiple in most of the skulls, especially in Villa el Salvador and Paracas populations. Mastoid emissaries in Indian were situated generally higher than in European, especially regarding the Paracas population. Significant sex differences were present in this material, regarded as a whole (summarized results for the three populations), what is in agreement with previous observations on European skulls. It indicates that even in cases of relatively deep deformation, some characteristic features of sex dimorphism of the human skull are noticeable. Additionally, the three studied populations, which were well separated from each other and lived alone, differed significantly regarding localization of the mastoid emissaries.