Structural connectivity-based predictors of cognitive impairment in stroke patients attributable to aging

Despite the rising global burden of stroke and its socio-economic implications, the neuroimaging predictors of subsequent cognitive impairment are still poorly understood. We address this issue by studying the relationship of white matter integrity assessed within ten days after stroke and patients' cognitive status one year after the attack. Using diffusion-weighted imaging, we apply the Tract-Based Spatial Statistics analysis and construct individual structural connectivity matrices by employing deterministic tractography. We further quantify the graph-theoretical properties of individual networks. The Tract-Based Spatial Statistic did identify lower fractional anisotropy as a predictor of cognitive status, although this effect was mostly attributable to the age-related white matter integrity decline. We further observed the effect of age propagating into other levels of analysis. Specifically, in the structural connectivity approach we identified pairs of regions significantly correlated with clinical scales, namely memory, attention, and visuospatial functions. However, none of them persisted after the age correction. Finally, the graph-theoretical measures appeared to be more robust towards the effect of age, but still were not sensitive enough to capture a relationship with clinical scales. In conclusion, the effect of age is a dominant confounder especially in older cohorts, and unless appropriately addressed, may falsely drive the results of the predictive modelling.

DESCRIPTION OF A SCHOOL SPORTS TRAINING PROGRAM FOR NOVICE GYMNASTS: THE LOAD DISTRIBUTION AND WELLBEING RESPONSES

The description of the training program structure and the measurement of dose-response for novice gymnasts at the scholarly level is still not elucidated in the literature. The study aimed to describe a rhythmic gymnastics training program for novices and to examine their perceptions of training load and wellbeing. Eight Brazilian gymnasts (10.6±0.5 years old), from a specific school, participated in a training program that lasted 26 weeks, and was separated into general preparation (1), specific preparation (2), intensification (3), tapering (4), competitive (5), and transitioning (6) phases. In each session, wellbeing and the internal training load (ITL) were measured by a Likert scale. The comparison of wellbeing and ITL during the program was performed by repeated-measure tests, with a significance of p< 0.05. A significant difference in ITL amongst the phases was found (x2= 110, p<0.001), with Phases 3, 4, and 5 presenting higher values compared to 2 and 6. Phase 6 had lower ITL compared to 2. Higher values of wellbeing were described during the program, however, Phase 6 presented a significantly higher score compared to Phases 2 and 5 (x2= 12.0, p=0.018). In conclusion, the rhythmic gymnastics training program developed for novice scholar participants seems to be adequate in terms of structure and training load distribution. In addition to the gymnasts reporting higher overall wellbeing during the program, attention should be paid to the competitive week, to avoid a decrease in wellbeing and possible negative effects on the gymnasts’ performance.

Spatio-Temporal Gait Parameters in Association with Medications and Risk of Falls in the Elderly

Purpose

The aim of this study was to analyze factors affecting spatio-temporal gait parameters in elderly people of both genders and different ages with different risks of fall, fall history, and medications.

Patients and Methods

A total of 210 community-dwelling older adults (156 females, 54 males; mean age 72.84±6.26 years) participated in this study. To assess the risk of falls, the Downton Fall Risk Index was used. An additional question about medication intake (all prescribed drugs) was asked. To assess the spatio-temporal gait parameters, the Zebris FDM platform was used. Gait parameters and Downton Fall Risk Index, stratified by participants’ history of falls, multiple medication use (0/1/2+), gender, age, and medication categories, were statistically analyzed using the Mann–Whitney U-test and Kruskal–Wallis test.

Results

When comparing different medication categories, a Downton Fall Risk Index score indicating a high risk of falls was observed in the psychotropic medication category (3.56±1.67). A gait velocity suggesting a higher risk of falls (≤3.60 km/h) was observed in the psychotropic (2.85±1.09 km/h) and diabetes (2.80±0.81 km/h) medication categories, in the age groups 70–79 years (3.30±0.89 km/h) and 80+ years (2.67±0.88 km/h), and in participants using two or more medications (3.04±0.93 km/h).

Conclusion

The results of this study confirm previous observations and show that higher age and multiple medication negatively affect the gait, and that the higher risk of falls is associated with psychotropic and diabetes medication use. These results provide important information for future fall preventive programs for the elderly that would be especially beneficial for elderly people taking psychotropic and diabetes medication.

EFFECTS OF DIFFERENT PHYSICAL EXERCISES ON GENERAL SELF-EFFICACY AND GLOBAL SELF-ESTEEM IN OLDER ADULTS

Maintaining a high quality of life and robust health as one grows older may be associated with higher general self-efficacy (GSE) and self-esteem (SEM). This study compares the effects of three types of exercise interventions (resistance training, proprioceptive training, and Nordic walking) on GSE and SEM. The final analysis included results of 34 adults (aged ≥ 65 years) who were not engaged in regular physical activity at least one year. Results indicate that physical exercise significantly positively affected GSE only in the resistance training group. No significant change of SEM occurred. The negative correlation between the initial level of GSE and the effect of physical exercise suggests that physical exercise may have a greater effect on people with low GSE. The positive correlation between the initial levels of GSE and SEM indicates the link between them. However, no association between changes in GSE and SEM over the intervention was found.

Comparison of methods used for evaluation of mutagenicity/genotoxicity of model chemicals - parabens

Growing worldwide efforts to replace (reduce) animal testing and to improve alternative in vitro tests which may be more efficient in terms of both time, cost and scientific validity include also genotoxicity/mutagenicity endpoints. The aim of the review article was to summarize currently available in vitro testing approaches in this field, their regulatory acceptance and recommended combinations for classification of chemicals. A study using the combination of Comet Assay performed on two cell lines and the Chromosomal Aberration test on human peripheral lymphocytes was performed with the aim to predict the genotoxic potential of selected paraben esters, serving as a model chemical group. Parabens are widely used in consumer products as preservatives and have been reported to exhibit inconclusive results in numerous genotoxicity studies. The Comet Assay identified Ethylparaben and Benzylparaben as potentially genotoxic. The Chromosomal Aberration test revealed weak genotoxic potential in case of Ethylparaben and positive genotoxicity in case of Butylparaben, Propylparaben and Isopropylparaben. The main reasons for variability seem to be limited water solubility of parabens, determining their bioavailability at the cellular level, and absence of metabolic activation in the Comet Assay. The results confirmed that the Comet Assay should serve as a screening test and should not be used as a stand-alone method for classification of genotoxicity. The weight of evidence approach in risk assessment should be supported with data generated with the use of human relevant in vitro methods based on cells / tissues of human origin.

The differences in postural stability between cross-country and Alpine skiers with intellectual disabilities

PURPOSE

The purpose of this study was to analyse differences in postural stability between athletes with ID competing in Alpine and Cross country (XC) skiing to assess the effect of special sports training on postural stability in persons with ID.

METHODS

Athletes with ID were divided into four groups by their discipline: Alpine skiers (n = 9), XC skiers 2.5 to 10 km (n = 10), XC skiers 500 to 1000 m (n = 18) and XC skiers 50 and 100 m (n = 10). All participants were asked to stand barefooted on the Zebris FDM platform (Medical GmbH, Germany) with their eyes open and closed. To compare differences between groups one-way ANOVA with Tukey HSD test was used. To compare the difference between the eyes open and closed, t-test was used.

RESULTS

Statistical analysis showed no significant differences between Alpine and XC skiers in analysed variables. The analysis of COP velocity showed superior postural stability in XC skiers 2.5 to 10 km compared to XC skiers 500 and 1000 m. In XC skiers 500 and 1000 m, XC skiers 2.5 to 10 km and Alpine skiers a significant increase in COP velocity was observed when having the eyes closed. In XC skiers 50 and 100 m, no statistically significant differences between the eyes open and closed conditions were observed.

CONCLUSIONS

Despite different sports training, no difference between Alpine and XC skiers in postural stability was observed. When comparing XC skiers, better postural stability was observed in skiers running longer distances, suggesting that this sports training enhances balance skills needed in everyday life.

The differences in postural stability between cross-country and Alpine skiers with intellectual disabilities

Purpose: The purpose of this study was to analyse differences in postural stability between athletes with ID competing in Alpine and Cross country (XC) skiing to assess the effect of special sports training on postural stability in persons with ID. Methods: Athletes with ID were divided into four groups by their discipline: Alpine skiers (n = 9), XC skiers 2.5 to 10 km (n = 10), XC skiers 500 to 1000 m (n = 18) and XC skiers 50 and 100 m (n = 10). All participants were asked to stand barefooted on the Zebris FDM platform (Medical GmbH, Germany) with their eyes open and closed. To compare differences between groups one-way ANOVA with Tukey HSD test was used. To compare the difference between the eyes open and closed, t-test was used. Results: Statistical analysis showed no significant differences between Alpine and XC skiers in analysed variables. The analysis of COP velocity showed superior postural stability in XC skiers 2.5 to 10 km compared to XC skiers 500 and 1000 m. In XC skiers 500 and 1000 m, XC skiers 2.5 to 10 km and Alpine skiers a significant increase in COP velocity was observed when having the eyes closed. In XC skiers 50 and 100 m, no statistically significant differences between the eyes open and closed conditions were observed. Conclusions: Despite different sports training, no difference between Alpine and XC skiers in postural stability was observed. When comparing XC skiers, better postural stability was observed in skiers running longer distances, suggesting that this sports training enhances balance skills needed in everyday life.

Cognitive effects of dance-movement intervention in a mixed group of seniors are not dependent on hippocampal atrophy

Dance-movement intervention (DMI) offers multi-component stimulation of cognitive functions, and it may ameliorate cognitive deficits in the elderly. We investigated the effects of intensive DMI on the cognitive performances of healthy seniors (HS) and patients with mild cognitive impairment (MCI). In addition, we evaluated whether the baseline MRI hippocampus-to-cortex volume (HV:CTV) ratio (i.e., a marker of a typical AD-specific brain atrophy and of distribution of neurofibrillary tangles in the brain) has any impact on the DMI-induced cognitive changes. The research cohort consisted of 99 subjects who were randomly assigned (in a 1:1 ratio) to a DMI group or to a control (life-as-usual) group. The DMI group consisted of 49 subjects with an average age of 69.16 years (SD = 5.36), of which 34 were HS (69.4%) and 15 had MCI (30.6%). The control group consisted of 50 subjects aged 68.37 years (SD = 6.10), of which 31 were HC (62%) and 19 (38%) had MCI. The DMI group underwent a 6-month intervention, which consisted of 60 lessons supervised by a qualified instructor. Statistical analysis yielded a significant improvement of the figural fluency task as measured by the five-point test in the DMI group as compared to the control group [t (97) = 2.72; p = 0.008]. The baseline HV:CTV ratio was not associated with cognitive changes on that task or with changes in any cognitive domain's Z scores. We observed DMI-induced effect on the test evaluating executive functions across the spectrum of HS and MCI, which was not dependent on the magnitude of AD-related brain pathology.

Advanced characterization of natural biofilm on nanofiber scaffold

Nanofiber scaffolds provide numerous advantages over common carriers engineered for microorganisms. The most important advantage is an increased speed of primary surface colonization (up to four times faster), which shortens the time required for the areal biofilm formation and optimum performance of attached microorganisms (higher efficiency of biological activity of up to twice as fast). Image analysis predicts early formation of biofilm even in beginning stages; analysis of biofilm reveals the different structures of bacterial colonies on both scaffolds (higher porosity, size, and number of bacterial colonies on nanofiber’s surface). The image analysis correlates well with determinations of dry matter (linear correlation of 0.96) and proteins (linear correlation of 0.89).

Diagnostic value of serum galactomannan, (1,3)-β-d-glucan, and Aspergillus fumigatus-specific IgA and IgG assays for invasive pulmonary aspergillosis in non-neutropenic patients

Detection of serum galactomannan (GM) and (1,3)-β-d-glucan (BG) is considered useful for non-culture diagnosis of invasive pulmonary aspergillosis (IPA) in neutropenic patients. Only few studies evaluated these seromarkers in non-neutropenic patients suspected of having IPA. The aim of this study was to evaluate both tests together with the Aspergillus fumigatus-specific serum IgG and IgA (IgAG) test for serological IPA diagnosis in non-neutropenic patients. Sera from 87 patients suspected of having IPA were retrospectively analysed. Patients were categorised into groups of proven IPA (n = 10), putative IPA (n = 31) and non-IPA colonisation (n = 46). When the GM, BG and IgAG assays were used for patients included in the study, the sensitivity/specificity/positive predictive value (PPV)/negative predictive value (NPV) were 48.8%/91.3%/83.3%/66.7%, 82.9%/73.9%/73.9%/82.9% and 75.6%/95.7%/93.9%/81.5%, respectively. Thus, the highest specificity and PPV were confirmed for the IgAG assay. Improvements in the sensitivity and NPV were achieved by "at least one positive" analysis with the GM and BG assays, with the sensitivity/specificity/PPV/NPV values being 85.0%/69.6%/71.4%/84.2%. Nevertheless, the highest sensitivity and NPV were achieved by the "at least one positive" analysis combining the GM, BG and IgAG tests (97.6% and 96.8%, respectively). The involvement of the IgAG assay could improve IPA diagnosis in non-neutropenic patients by increasing the sensitivity and NPV when combined with the GM or BG assays. Furthermore, improvement was achieved by combining the GM, BG and IgAG assays using the "at least one positive test" strategy, especially if doubt exists.

Nosocomial candidemia in the Czech Republic in 2012-2015: results of a microbiological multicentre study

  Background: Candidemia is a severe and often life-threatening infection frequently occurring in critically ill patients. During the last decade, new therapeutic and prophylactic strategies influenced (at least in some patient subgroups) the epidemiological situation and the spectrum of causative Candida strains. The present multicentre study aimed to assess the current epidemiological situation of Candida strains causing invasive candidiasis (IC) in patients of tertiary care hospitals in the Czech Republic.

MATERIAL AND METHODS

Clinical and microbiological data on patients with bloodstream yeast isolates collected in 11 tertiary care hospitals in the Czech Republic between 2012 and 2015 were analysed. The incidence of cases and species distribution were assessed by study year, age, and specialty. Moreover, an association with the Candida colonization and presence of toxigenic strains of Clostridium difficile in stool prior to blood culture positivity was analysed. For some of the strains, minimum inhibitory concentrations (MICs) of systemic antifungals were determined using standard methods.

RESULTS

A total of 886 episodes of candidemia (921 yeast strains) were identified during the study period. The overall incidence per 1000 admissions was 0.40 (range 0.21-1.22 depending on the hospital). Almost half of the isolates belonged to the species Candida albicans (49.7 %), followed by Candida glabrata (15.3 %) and Candida parapsilosis (11.2 %). Non-albicans species of Candida significantly predominated in oncology wards (71.6 %) as compared to surgery (40.4 %) or internal medicine (52.0 %) departments. More than 70.0 % of patients stayed in intensive care units at the time of positive culture; in 65.0 % of patients, colonization with the same yeast species preceded blood culture positivity. In only 5.1 % of all patients, the previous presence of toxigenic strains of Clostridium difficile in stool was found. Fifty-six of the 921 yeast strains were tested for antifungal susceptibility, with an increase in MICs to azoles being observed for C. glabrata.

CONCLUSION

The incidence of candidemia in the Czech Republic did not vary significantly between 2012 and 2015, and C. glabrata was the second most common yeast species after C. albicans isolated from blood.

[The prevalence of Candida pelliculosa, Candida utilis, and Candida fabianii in the Olomouc University Hospital: epidemiological study]

BACKGROUND

The aims of this study were to determine the prevalence of C. pelliculosa, C. utilis, and C. fabianii in clinical samples collected from patients hospitalized in the Olomouc University Hospital and compare their minimum inhibitory concentrations (MICs ) to nine systemic antifungals with respect to yeast species, patient age, gender, and site of infection.

MATERIAL AND METHODS

Identification was performed biochemically and using mass spectrometry (MALDI-TOF MS). MICs were determined by the broth dilution method.

RESULTS

Of a total of 163 clinical isolates, 119 were biochemically identified as C. pelliculosa and 44 as C. utilis. Using MALDI-TOF MS, 152 isolates were identified as C. fabianii, six as C. pelliculosa, three as C. utilis, and one as Ogataea polymorpha. The highest mean MICs were found in C. fabianii and in yeasts isolated from blood cultures and central venous catheters.

CONCLUSIONS

The MALDI-TOF MS found C. fabianii to be most prevalent in clinical samples as compared with the other studied species. The probable cause of discordant results between the two methods was the absence of C. fabianii in the database of the biochemical test kit which led to misidentification of this species. Higher MIC values in C. fabianii demonstrate the importance of the precise identification of this species.

The study of surface properties of an IgE-sensitive aptasensor using an acoustic method

We applied the acoustic transverse shear mode (TSM) method for study of the surface properties of a DNA aptasensor that specifically binds human immunoglobulin E (IgE). The biotinylated 45-mer DNA aptamers were immobilized on the surface of a self-assembled layer composed of a mixture of polyamidoamine dendrimers of the fourth generation with 1-hexadecanetiol covered by neutravidin. Using the TSM method, we studied the kinetics of changes of the series resonant frequency, f(s), and the motional resistance, R(m), of a quartz crystal transducer, used as a support for formation of the sensing layer. We have shown that attachment of the biotinylated DNA aptamers onto the surface covered by neutravidin results in a decrease of f(s), but in an increase of R(m). Similar changes of f(s) and R(m) were observed following addition of IgE. This suggests the contribution of friction forces to the crystal oscillation, which was taken into account in the calculation of the mass changes at the sensor surface following binding processes.

[Cryptogenic fibrotizing alveolitis]

Presented article deals with the pathogenesis of cryptogenic fibrotizing alveolitis (CFA), gives distinct histological types according ATS and ERS, considers clinical CFA picture and recommends examination program for this disease. The anti-inflammatory and immunosuppressive treatment is discussed together with other therapeutic approaches (long-lasting oxygenotherapy at home, transplantation and treatment of pulmonary hypertension). Final part deals with less frequent clinical manifestations.

[Tuberculosis in the Czech Republic]

Tuberculosis is a general infectious inflammatory disease caused by the bacillus (mycobacterium) tuberculosis. The disease originated when the bacillus was transmitted from affected cattle herds to humans. Genetic methods proved the existence of tuberculosis in mummies of the ancient Egypt. In the 19th and 20th century socio-economic conditions enabled pandemics of tuberculosis. The essential element for spreading of tuberculosis is the tuberculous patient. The disease develops in 10% of those who were infected. Tuberculosis manifests by long-lasting coughing, night sweating, tiredness, growing slim, febriles and loss of appetite. Diagnosis can be established on the basis of thoracic sciagram, confirmed by microscopic and cultivation examination of sputum. In the Czech Republic, an effective surveillance of tuberculosis was established with resulting good epidemiological situation.

Properties of mixed alkanethiol-dendrimer layers and their applications in biosensing

We studied the properties of mixed alkanethiol-dendrimer layers on a gold support and their application in biosensing. We showed that properties of glucose sensor can be modified using a different ratio of 1-hexadecanethiol (HDT) and poly(amidoamine) dendrimer of first generation (G1). The cyclic voltammetry in the presence of the redox couple, Fe(CN)(6)(3-)/Fe(CN)(6)(4-), was used for estimating how effectively the layer blocks the redox probe's access to the electrode surface. A scanning electrochemical microscope (SECM) was used to image the resulting distribution of the organic compounds. We found that with increasing content of dendrimers, the integrity of the layers was improved.

Activation and modulation of ligand-gated ion channels

Ligand-gated ionic channels are integral membrane proteins that enable rapid and selective ion fluxes across biological membranes. In excitable cells, their role is crucial for generation and propagation of electrical signals. This survey describes recent results from studies performed in the Department of Cellular Neurophysiology, Institute of Physiology ASCR, aimed at exploring the conformational dynamics of the acetylcholine, glutamate and vanilloid receptors during their activation, inactivation and desensitization. Distinct families of ion channels were selected to illustrate a rich complexity of the functional states and conformational transitions these proteins undergo. Particular attention is focused on structure-function studies and allosteric modulation of their activity. Comprehension of the fundamental principles of mechanisms involved in the operation of ligand-gated ion channels at the cellular and molecular level is an essential prerequisite for gaining an insight into the pathogenesis of many psychiatric and neurological disorders and for efficient development of novel specifically targeted drugs.

Effects of oxidation on changes of compressibility of bovine serum albumin

The methods of ultrasound velocity and density measurements were used to study the adiabatic compressibility of bovine serum albumin (BSA) during its oxidation by the prooxidants Cu2+ and 2,2'-azobis(2-amidinopropane) hydrochloride (AAPH). We did not find changes of compressibility of BSA in the presence of copper ions at rather high molar ratio Cu2+/BSA = 0.66 mol/mol. This can be explained by binding of the Cu2+ to the binding site of BSA and thus protecting the prooxidant action of the copper. However, AAPH-mediated oxidation of BSA resulted in an increase of its apparent specific compressibility (psik/beta0). These changes could be caused by the fragmentation of the protein.

[Lymphangioleiomyomatosis in a menopausal woman]

Lymphagioleiomyomatosis is a rare pulmonary disease which affects mainly women of childbearing age. An observation of lymphangiomyomatosis in a menopausal woman or in men is considered very unusual. We report a case of lymphagioleiomyomatosis in a 60-year-old woman.

[Interstitial pulmonary processes]

New classification of the idiopathic interstitial pneumonias on the basis of the structural characteristics is presented. The contemporary classification includes four types of disease, differing in the clinical symptomatology, reaction to therapy and prognosis.

Properties of glucose biosensors based on dendrimer layers. Effect of enzyme immobilization

The properties of glucose biosensors based on dendrimer layers on a gold support, which depend on the method of immobilization of glucose oxidase (GOX), were studied by amperometry. The kinetic parameters of enzymatic reactions, response time, sensitivity, detection limit, linear range, and enzyme turnover were determined. We showed that a more stable and sensitive sensor was obtained when GOX was immobilized on the dendrimer by crosslinking with glutaraldehyde in vacuum. This biosensor was stable for at least eight weeks. The response time was approximately 1.3 min, the detection limit of glucose was 25 micro M, and the apparent Michaelis-Menten constant was relative low ( K(m)=1.1+/-0.1 mM) in comparison with that for GOX in solution. The reason for these differences is discussed. The example of the application of the developed biosensors for the detection of mercury is also presented. The inhibitory effect of mercury on GOX activity was observed at mercury concentration of 100 nM.

Liposome aggregation in presence of the sweeteners cyclamate and saccharine

The interaction of the sweeteners saccharine and cyclamate with large unilamellar liposomes and planar bilayer lipid membranes (BLM) was studied. Application of the methods of light scattering and sound velocimetry showed that saccharine induces aggregation of liposomes, while cyclamate probably caused increase of the hydration of liposome surface. The sweeteners induced changes of BLM compressibility in a direction perpendicular to the membrane plane. The cyclamate induced considerably larger decreases in the elasticity module than saccharine. The obtained results show that both saccharine and cyclamate interacts with the surface of lipid bilayer and could modify the physical properties of lipid membranes.

[High-resolution computer tomography in the diagnosis of cryptogenic fibrosing alveolitis. Correlation with pulmonary function and bronchoalveolar lavage]

BACKGROUND

High resolution computed tomography (HRCT) revealed new findings as regards changes associated with cryptogenic fibrotizing alveolitis. So far views on changes suggesting activity of the disease are not uniform and they were not yet confronted with examinations of fluid obtained by bronchoalveolar lavage (BALT). The objective of the present work is to evaluate the contribution of HRCT to the assessment of the activity of the disease and compare the findings with the examination of BALT.

METHODS AND RESULTS

The authors evaluated the HRCT examination made in 52 patients with histologically confirmed cryptogenic fibrotizing alveolitis and in 39 of them the finding was confronted with the BALT examination. Signs of active inflammatory disease according to HRCT comprised a ground-glass increase of the density in 80.8%, centrilobular micronodules in 17.3% and a prominence of centrilobular structures in 32.7%. The suggested extent of affection of the pulmonary parenchyma assessed according to HRCT correlated well with the degree of dyspnoea, restrictive and obstructive ventilation disorder, pulmonary diffusion and with hypoxaemia. The authors confirmed also an inverse correlation between the grade assessed by HRCT and the percentage of lymphocytes in BALT.

CONCLUSIONS

The investigation confirmed the contribution of HRCT in the diagnosis of patients with cryptogenic fibrotizing alveolitis, it confirmed the complementary importance of HRCT and BALT examination when assessing the activity of the disease and its asset when monitoring patients during treatment.

[The clinical picture of pulmonary tuberculosis over the past 40 years]

Most patients with pulmonary tuberculosis present to their physician because of the symptoms of this disease. This study was aimed at finding out how the clinical picture of pulmonary tuberculosis diagnosed for the first time changes in the patients hospitalized at our department in the years 1948-1986. Furthermore, the percentage of asymptomatic patients, the frequency of detectable cavern and mycobacteria tuberculosis were established. During the time period studied a change in clinical picture of the disease occurred as seen on the 13 symptoms followed. The previously common haemoptysis is a rarer symptom of tuberculosis at present (17.5% in the 1948-1950 population compared to 5.0% in the 1983-1986 population). There is an increasing number of patients in which tuberculosis manifests itself by breathlessness (2.3% of the 1948-1950 population compared to 10.9% in the years 1979-1981). In the whole period studied patients with symptoms prevail, the difference between the 1948-1950 period (71.1%) and that of 1979-1986 (67.0%) is not statistically significant. The number of patients with cavernous tuberculosis is decreasing (75% of patients in the years 1948-1950, 37% of patients in the years 1983-1986), there is an increase in bacteriologically proven diseases (33.9% of the 1948-1950 population, 73.0% of that of 1983-1986). The change in the clinical picture of tuberculosis is connected with the improvement of social conditions of the whole population, introduction of compulsory BCG vaccination and effective therapy, as well as bovine tuberculosis elimination. The change in the clinical picture of the disease is also influenced by the ever increasing mean age of the patients.