Serum anti-glycan antibodies in paediatric-onset Crohn's disease : association with disease phenotype and diagnostic accuracy

Introduction: Antibodies reacting with various microbial epitopes have been described in inflammatory bowel disease (IBD) and are associated with a specific diagnosis and clinical presentation. Aim: To evaluate the profile of new anti-glycan antibodies, their potential association with disease phenotype and diagnostic accuracy in paediatric Crohn’s disease (CD). Material and methods: Blood samples from 134 paediatric IBD patients (109 CD, 25 ulcerative colitis (UC)) and 67 controls were blindly analysed for anti-Saccharomyces cerevisiae (ASCA), anti-chitobioside carbohydrate (ACCA), anti-laminaribioside carbohydrate (ALCA), and anti-mannobioside carbohydrate (AMCA) antibodies using commercially available assays. The serological response to glycans was correlated with clinical disease characteristics. Results: At least one of the tested anti-glycan antibodies was present in 75% of CD patients. Despite the high frequency of reactivity to glycan epitopes, a limited overlap of serological markers was observed. In total, 49% of ASCA-negative patients presented with one of the following: ACCA, ALCA, or AMCA. The occurrence of one antibody from the anti-glycan panel was independently associated with complicated disease phenotype and ileocolonic disease location. A higher level of immune response as assessed by the quartile sum scores for ACCA, ALCA, and AMCA was linked with older age at diagnosis (10-17 years) and ileocolonic disease location. The ASCA had the greatest accuracy for diagnosis and differentiation of CD. Conclusions: Qualitative and quantitative serologicalal response to glycan epitopes was associated with distinct clinical presentation in paediatric CD patients. This raises the possibility for the use of these markers to differentiate subgroups of CD patients with more sever clinical presentation. The ASCA was the most accurate serological marker for CD; however, testing for the new anti-glycan antibodies may constitute an adjunctive tool in a specific group of patients to aid in the differentiation of CD with absent ASCA from ulcerative colitis

Comparison of continuous epidural block and continuous paravertebral block in postoperative analgaesia after video-assisted thoracoscopic surgery lobectomy: a randomised, non-inferiority trial

Background: Video-assisted (VATS) lung lobectomy can be associated with stronger postoperative pain than is commonly believed. It is generally accepted to introduce multimodal analgaesic strategies based on regional blockade, opioids and non-steroidal anti-inflammatory drugs. However, there is still no consensus regarding the optimal regional technique. The aim of this study was to compare the analgaesic efficacy of continuous thoracic epidural block (TEA) and percutaneous continuous paravertebral block (PVB) in patients undergoing video-assisted lung lobectomy. Methods: Fifty-one patients undergoing VATS lobectomy were enrolled in the present prospective, randomised clinical trial. The same analgaesic regimen in both groups included continuous infusion of 0.25% bupivacaine with epinephrine, intravenous ketoprofen and paracetamol. The doses of local anaesthetics were determined to achieve the spread of at least 4 segments in both groups. Postoperative static and dynamic visual analogue pain scores, as well as patient-controlled morphine usage, were used to compare the efficacy of analgaesia. Side effects and failure rates of both blocks were analysed. Results: Static and dynamic pain scores at 24 postoperative hours were significantly lower in the paravertebral group, as were the static pain score at 36 and 48 postoperative hours (P < 0.05). No difference between the treatment groups was identified regarding postoperative morphine usage. The failure rate was higher in the epidural group than in the paravertebral group. No complications were noted in either group, but side effects (urinary retention, hypotension) were more frequent in the epidural group (P < 0.05). Conclusions: Postoperative pain following VATS lung resection procedures is significant and requires the application of complex analgaesic techniques. Percutaneous paravertebral block is equally effective as thoracic epidural block in providing analgaesia in patients undergoing VATS lobectomy. Paravertebral block has a better safety profile than thoracic epidural block

What has happened to the females? : population trends in the Aesculapian snake at its northern range limit

Populations at the edge of their main range of distribution are often exposed to suboptimal environments. They therefore exhibit a greater susceptibility towards habitat changes and often clearly differ in their structure and dynamics from populations in the main range. Here we define population parameters of the Aesculapian snake Zamenis longissimus, a species endangered in Europe, at its northern range limit based on data obtained in the valley of the River San (Bieszczady Mts., SE Poland) in 2009-2013. We focus on the spatial and temporal sex ratio patterns by comparing data obtained in 2009-2013 with published records from 1990 to 1998 and five other northern populations (1 from the main range, 1 at the northern edge of its contiguous range, and 3 entirely isolated ones). Using the capture-mark-recapture (CMR) method, we estimated the population size to be about 230 snakes. Our data show that among adults the percentage of females (17.74%) in the San valley population was significantly lower than in those other five populations and the same population studied two decades earlier. Because of the male-biased sex ratio, we estimated the effective population size to be about 74 snakes. This disproportion between the sexes in adults may be interpreted as an early stage of the population extinction process at the northern range limit of this species’ distribution. It is probably due to the limited availability of egg-laying sites, compelling females to undertake longer movements, which may heighten the risk of mortality. Keywords: Zamenis longissimus, Population size, Sex ratio, Northern range limit, Extinctio

Predictors of sinus rhythm return during defibrillation testing in patients with permanent atrial fibrillation undergoing implantation of a cardioverter-defibrillator

Background: Atrial fibrillation (AF) is present in a significant proportion of patients treated with an implantable cardioverter-defibrillator (ICD). Defibrillation testing may lead to sinus rhythm (SR) restoration which may be hazardous due to the increased risk of thromboembolic complications in these patients. Aim: To identify predictors of SR restoration during defibrillation testing in patients with permanent AF undergoing ICD implantation. Methods: Permanent AF was present in 79 (12%) of 671 consecutive patients who received ICD in our institution between 2005 and 2010. In this group, 47 patients (mean age 64 &#177; 12 years, 38 males) underwent defibrillation testing during the implantation procedure and in the remaining 32 patients defibrillation testing was not performed due to various contraindications. Sinus rhythm was restored in 17 (36%) patients, while AF was still present after defibrillation testing in the remaining 30 patients. We analysed demographic, clinical, echocardiographic and electrophysiological parameters which could identify those patients in whom SR was restored, using univariate and multivariate analysis as well as constructing ROC curves. Results: Demographic parameters and clinical history were similar in both groups. Patients in whom SR was restored had smaller left atrial diameter (49.9 &#177; 5.9 vs 59.4 &#177; 6.1 mm, p < 0.001), more often received a double-coil defibrillation lead (83% vs 10%, p < 0.001), had less advanced heart failure as assessed using NYHA classification (p < 0.05), and were more frequently treated with amiodarone (47% vs 23%, p < 0.025). The chance of SR return was increased 11 times in patients receiving amiodarone, 6 times in patients with a double-coil lead, 2 times in patients with lower NYHA class, and 1.36 times in patients with smaller left atrium diameter (for each 1 mm increase). The ROC curves showed that using the cut-off value for the left atrial diameter of 47 mm, patients prone to SR restoration were identified with a sensitivity of 65%, specificity of 100%, positive predictive value of 83%, and negative predictive value of 90% (area under curve 0.904, 95% CI 0.809&#8211;1.0). Multivariate analysis showed that NYHA class, amiodarone usage, type of defibrillating lead and left atrial diameter were independent predictors of SR restoration. Conclusions: Atrial fibrillation was present in 12% of consecutive patients undergoing ICD implantation and was terminated by defibrillation testing in 36% of those who underwent this test. The NYHA class, amiodarone usage, type of defibrillating lead and left atrial diameter were independent predictors of SR restoration. Kardiol Pol 2011; 69, 1: 17-22Wstęp: Wśród pacjentów poddawanych zabiegowi implantacji kardiowertera-defibrylatora (ICD) są także chorzy z utrwalonym migotaniem przedsionków (AF). U tych osób istnieje możliwość niespodziewanego powrotu rytmu zatokowego (SR) podczas testu defibrylacji migotania komór (VF) wykonywanego w czasie wszczepiania ICD. Cel: Celem pracy była identyfikacja czynników determinujących powrót SR w czasie testu defibrylacji VF u chorych z utrwalonym AF poddanych wszczepieniu ICD w ramach prewencji wtórnej lub pierwotnej nagłego zgonu sercowego. Metody: W grupie 671 chorych (śr. wieku 62,3 roku, 501 mężczyzn) poddanych implantacji ICD u 79 (12%) osób rozpoznano utrwalone AF. W tej grupie u 47 pacjentów (śr. wieku 63,9 roku, 38 mężczyzn) wykonano test defibrylacji VF przy wszczepieniu ICD, natomiast u pozostałych 32 odstąpiono od wykonania tego testu z powodu przeciwwskazań. Podczas testu u 17 (36%) pacjentów (grupa A, śr. wieku 64,2 roku, 14 mężczyzn) stwierdzono powrót SR, a u pozostałych 30 chorych (grupa B, śr. wieku 63,5 roku, 24 mężczyzn) nadal rejestrowano AF. Obie grupy porównano pod względem wskazań i technicznych szczegółów implantacji, a także danych klinicznych echokardiograficznych, stosowanego leczenia i parametrów elektrofizjologicznych. Przeprowadzono analizę jednoczynnikową i wieloczynnikową w celu ustalenia, które parametry były niezależnie związane z powrotem SR oraz wykreślono krzywe ROC dla tych zmiennych. Wyniki: Wiek, czas trwania AF, rozkład głównych kardiologicznych schorzeń i towarzyszących chorób, wskazań do ICD, stosowanych leków (beta-adrenolityków, inhibitorów ACE, diuretyków, antykoagulacyjnych, antyagregacyjnych) oraz wartości parametrów elektrofizjologicznych (elektrycznych) nie różniły się znacząco między grupami A i B. U chorych z grupy A zarejestrowano istotnie niższe klasy niewydolności serca wg NYHA (p < 0,05), mniejszy wymiar lewego przedsionka (p < 0,001), częstsze stosowanie elektrody dwupierścieniowej (p < 0,001) oraz częstsze podawanie amiodaronu (p < 0,025). Szansa odzyskania SR przez osoby leczone amiodaronem była 10,77-krotnie większa niż przez osoby nieleczone, a przy stosowaniu elektrody dwukoilowej - 6,24-krotnie większa niż w przypadku elektrody jednokoilowej. Zmniejszenie klasy NYHA z III lub IV do II zwiększało szansę odzyskania SR 2,29-krotnie. Mniejszy o 1 jednostkę (1 mm) wymiar lewego przedsionka powodował zwiększenie szansy odzyskania SR 1,36-krotnie. W krzywej ROC optymalny punkt odcięcia dla wymiaru lewego przedsionka w celu identyfikacji chorych, u których AF ustąpiło podczas defibrylacji, wyniósł 47 mm. Wnioski: Wśród osób z ICD utrwalone AF stwierdzono u 12% chorych i u 36% z nich po teście defibrylacji obserwowano powrót SR. Czynnikami sprzyjającymi ustąpieniu AF były konfiguracja spiral elektrody defibrylującej, mniejszy wymiar lewego przedsionka, niższa klasa NYHA oraz stosowanie amiodaronu. Kardiol Pol 2011; 69, 1: 17-2

The influence of lung volume reduction with intrabronchial valves on the quality of life of patients with heterogeneous emphysema — a prospective study

Introduction: A heterogeneous emphysema is one of the most severe forms of chronic obstructive pulmonary disease (COPD). In some cases, besides the standard pharmacotherapy, a new treatment option of emphysema can be used — bronchoscopic lung volume reduction (BLVR) with the use of intrabronchial valves. Objectives: To examine the health-related quality of life (HRQoL) of patients with severe emphysema after intrabronchial valve (IBV) implantation for the treatment of one lung. Material and methods: From 2011 to 2013 a single center prospective observational study was performed. The study assessed the effect of the therapeutic BLVR intervention, measured by St. George Respiratory Questionnaire (SGRQ). A statistical analysis by use of Wilcoxon test for dependent variables was performed. Results: Twenty patients were enrolled to the study (mean age 63 ± 10 years old), all ex-smokers with tobacco exposure 38 ± 11.3 packyears. After 3 months of IBV treatment the average SGRQ score improved significantly in total (–12.8; p &lt; 0.001) and in domains and differences were for: “symptoms” (–8.5; p &lt; 0.001), “activity” (–13.9; p &lt; 0.001) and “influence on life”(–13.5; p &lt; 0.002). Conclusions: The presented study revealed the significant improvement of the quality of life measured by SGRQ after the IBV treatment for heterogeneous emphysema. For the first time our study showed the significant improvement of all three domains of SGRQ after IBV treatment.Introduction: A heterogeneous emphysema is one of the most severe forms of chronic obstructive pulmonary disease (COPD). In some cases, besides the standard pharmacotherapy, a new treatment option of emphysema can be used — bronchoscopic lung volume reduction (BLVR) with the use of intrabronchial valves. Objectives: To examine the health-related quality of life (HRQoL) of patients with severe emphysema after intrabronchial valve (IBV) implantation for the treatment of one lung. Material and methods: From 2011 to 2013 a single centre prospective observational study was performed. The study assessed the effect of the therapeutic BLVR intervention, measured by St. George Respiratory Questionnaire (SGRQ). A statistical analysis by use of Wilcoxon test for dependent variables was performed. Results: Twenty patients were enrolled to the study (mean age 63 ± 10 years), all ex-smokers with tobacco exposure 38 ± 11.3 packyears. After 3 months of IBV treatment the average SGRQ score improved significantly in total (–12.8; p &lt; 0.001) and in domains and the differences were for: “symptoms” (–8.5; p &lt; 0.001), “activity” (–13.9; p &lt; 0.001) and “influence on life”(–13.5; p &lt; 0.002). Conclusions: The presented study revealed a significant improvement of the quality in the life measured by SGRQ after IBV treatment for heterogeneous emphysema. For the first time our study showed the significant improvement of all three domains of SGRQ after IBV treatment

Endosonography-guided fine needle aspiration in the diagnosis of sarcoidosis : a randomized study

There are no widely accepted standards for the diagnosis of sarcoidosis. The aim of this study was to assess the relative diagnostic yield of endobronchial ultrasound fine-needle aspiration (EBUS‑FNA) and endoscopic ultrasound fine-needle aspiration (EUS‑FNA), and to compare them with standard diagnostic techniques such as endobronchial biopsy (EBB), transbronchial lung biopsy (TBLB), transbronchial needle aspiration (TBNA), and mediastinoscopy. This was a prospective randomized study including consecutive patients with clinical diagnosis of stage I or II sarcoidosis. EBB, TBLB, and TBNA were performed at baseline in all patients. Subsequently, patients were randomized to group A (EBUS‑FNA) or group B (EUS‑FNA). Next, a crossover control test was performed: all patients with negative results in group A underwent EUS‑FNA and all patients with negative results in group B underwent EBUS‑FNA. If sarcoidosis was not confirmed, mediastinoscopy was performed. We enrolled 106 patients, of whom 100 were available for the final analysis. The overall sensitivity and accuracy of standard endoscopic methods were 64% each. When analyzing each of the standard endoscopic methods separately, the diagnosis was confirmed with EBB in 12 patients (12%), with TBLB in 42 patients (42%), and with TBNA in 44 patients (44%). The sensitivity and accuracy of each endosonographic technique were significantly higher than those of EBB+TBLB+TBNA (P = 0.0112 vs P = 0.0134). The sensitivity and accuracy of EBUS‑FNA and EUS‑FNA are significantly higher than those of standard endoscopic methods. Moreover, the sensitivity and accuracy of EUS‑FNA tend to be higher than those of EBUS‑FNA

The size and shape of parasitic larvae of naiads (Unionidae) are not dependent on female size.

The naiads, large freshwater mussels (Unionida), have very long life spans, are large-bodied, and produce thousands to millions of larvae (glochidia) which typically must attach to host fish tissues to metamorphose into a juvenile mussel. Glochidia develop within a female's marsupial gill demibranch, thus their number is restricted by female size. However, larger mussels acquire more energy, which could be invested in either larger-sized glochidia, in a more glochidia, or a combination of both. The high level of host specialization seen in many naiads may constrain glochidial size and shape around a narrow optimum, while naiads that use a wide range of host fishes may be predicted to possess greater plasticity in glochidial morphology. In this paper, we investigated the relationship between maternal body size and progeny body size and shape, aided by modern digital microscopy. We analyzed the between- and within- species variation of glochidia size and shape relative to female size in four widespread species of European naiads: Anodonta anatina, Anodonta cygnea, Unio crassus and Unio tumidus. Whereas the total reproductive output is collinear with female body size, substantial differences between species in glochidia size were found within genus Anodonta, but not genus Unio where glochidial size is remarkably consistent. The glochidial shape, however, differed within both Unio and Anodonta. We interpret this constant within-species glochidial size in Unio as reflecting a constraint imposed by the likelihood of successful transmission onto and off from a narrow range of hosts, whereas their shape seems to be less constrained. The Anodonta species, inhabiting a wide spectrum of habitats and using more than twice the number of fish hosts than Unio spp., have larger glochidia with greater variation in size and shape. Our results suggest that measures of glochidial variability may also serve as an indicator of host specificity in other naiads

Characteristics of clinical presentation of 146 cases of newly diagnosed paediatric onset Crohn’s disease

Wstęp: Badania epidemiologiczne wyraźnie wskazują na zwię kszenie się liczby zachorowań na nieswoiste zapalenia jelit (NZJ), w szczególności na chorobę Leśniowskiego-Crohna (ChLC), wraz ze zmniejszeniem się wieku zachorowania w populacji pediatrycznej. Cel: Charakterystyka nowo rozpoznanej ChLC o początku w wieku pediatrycznym. Materiał i metody: Analizie poddano dane kliniczne i demograficzne pacjentów z nowo rozpoznaną przed ukończeniem 18. roku życia ChLC, uzyskane na podstawie prospektywnego rejestru i kwestionariusza. Wyniki: W grupie 146 pacjentów przeważali chłopcy (56%) i w momencie rozpoznania ChLC byli znamiennie młodsi w porównaniu z dziewczętami (11,25 ±4,48 roku vs 12,71 ±4,33 roku, p = 0, 04). Nie stwierdzono różnic między płciami w odniesieniu do średniego wieku wystąpienia objawów (9,98 ±4,69 roku vs 11,33 ±4,53 roku, p = 0,08) i czasu ich trwania (13,65 ±21,66 mies. vs 15,52 ±22,66 mies., p = 0,79). Dziewczęta znamiennie częściej cechowały się bardziej nasiloną aktywnością ChLC ocenianą na podstawie pediatrycznego indeksu aktywności ChLC (66,63% vs 40,74%, p = 0,028). Płeć żeńska zwiększała ryzyko zahamowania wzrostu oraz wystąpienia nieprawidłowych wyników stężenia hemoglobiny, albumin i odczynu Biernackiego. Wśród objawów przeważały bóle brzucha, biegunka i krwawienie z dolnego odcinka przewodu pokarmowego, chociaż ta klasyczna triada objawów była obecna tylko u 37% badanych. Dominowały postać zapalna (B1) ChLC i lokalizacja zmian w dystalnym odcinku jelita krętego z jednoczesnym zajęciem jelita grubego (L3). Wnioski: Wyniki wskazują na różnice między płciami w obrazie klinicznym, co może być uwarunkowane czynnikami genetycznymi i/lub hormonalnymi. Przeważało rozległe zajęcie przewodu pokarmowego (L3) z przewagą postaci zapalnej (B1). U większości pacjentów wartości badań laboratoryjnych były zgodne z zakresem referencyjnym, co ogranicza ich przydatność w diagnostyce różnicowej.Introduction: Epidemiological studies clearly indicate an increasing incidence of inflammatory bowel disease (IBD), especially in paediatric Crohn’s disease (CD), with decreasing age of the disease onset. Aim: To define the characteristics of newly diagnosed, paediatric onset CD patients. Material and methods: Demographic and clinical data of newly diagnosed CD patients under the age of 18, based on the prospective IBD patients registry and self-reported questionnaire, were compared. Results: In the entire group of 146 CD patients, males predominated (56%) and were significantly younger at the time of diagnosis (11.25 ±4.48 years vs. 12.71 ±4.33 years, p = 0.04). No differences were found for either the mean age of onset of symptoms (9.98 ±4.69 years vs. 11.33 ±4.53 years, p = 0.08) or for the lag time between CD-related symptoms and establishing the diagnosis (13.65 ±21.66 months vs. 15.52 ±22.66 months, p = 0.79). Significantly more frequently girls presented with more active CD as assessed by PCDAI (66.63% vs. 40.74%, p = 0.028) with a significantly higher risk for growth impairment and higher odds for a lower haemoglobin level, hypoalbuminaemia, and increased ERS. The most frequent symptoms were abdominal pain, diarrhoea and rectal bleeding; however, this classic triad of symptoms occurred in only 37% of patients. Inflammatory behaviour (B1) and ileocaecal localization (L3) were found the most frequently and no gender differences were found according to initial disease classification. Conclusions: These data revealed gender-related differences in paediatric onset CD; therefore genetic and/or hormonal factors could influence the disease clinical presentation at that age. Extensive disease location (L3) was expressed by most of the patients and inflammatory behaviour (B1) predominated. A high proportion of newly diagnosed paediatric CD patients presented with normal laboratory values which restricted their usefulness for the differential diagnosis