Zespół tylnej odwracalnej encefalopatii — opis przypadku

Zespół tylnej odwracalnej encefalopatii (posterior reversible leukoencephalopathy syndrome) po raz pierwszy opisano stosunkowo niedawno, bo około 20 lat temu, głównie na podstawie charakterystycznego obrazu mózgowia w badaniu rezonansu magnetycznego (MR). W odróżnieniu od zmian stwierdzanych w badaniach neuroobrazowych zakres objawów klinicznych w badaniu przedmiotowym może być bardzo szeroki, co może utrudniać ustalenie rozpoznania. Do najczęstszych objawów należą: bóle i zawroty głowy, zaburzenia widzenia, jakościowe i ilościowe zaburzenia świadomości. Rzadziej obserwuje się niedowład połowiczy lub zespół móżdżkowy. Za główną przyczynę PRES uznaje się wysokie wartości ciśnienia tętniczego, a także schorzenia mogące się przyczynić do jego wysokich wartości — wśród nich ostre i przewlekle choroby nerek oraz schorzenia autoimmunologiczne. Poza badaniami podmiotowym i przedmiotowym pierwszoplanowe znaczenie w ustaleniu rozpoznania ma badanie MR mózgowia, w którym stwierdza się charakterystyczne obszary o hiperintensywnym sygnale w obrazowaniu T2-zależnym. Patologia ta dotyczy głównie płatów potylicznych, ale zmiany mogą być także stwierdzane w innych częściach mózgowia. W leczeniu najważniejszą rolę odgrywa normalizacja wysokich wartości ciśnienia tętniczego. Przy prawidłowym leczeniu farmakologicznym obraz kliniczny i radiologiczny ulegają całkowitej normalizacji w ciągu kilku lub kilkunastu tygodni

TP53 polymorphism in plasma cell myeloma

Introduction. Significant and accessible predictive factors for bortezomib treatment in plasma cell myeloma (PCM) are still lacking. TP53 codon 72 polymorphism (P72R) results in proline (P) or arginine (R) at 72 amino acid position, which causes synthesis of proteins with distinct functions. The aims of our study were to: 1) analyze whether this polymorphism is associated with an increased risk of PCM; 2) study whether the P72R polymorphism affects overall survival (OS) among PCM patients; 3) assess the possible association of the P72R polymorphism with sensitivity to bortezomib in cell cultures derived from PCM patients. Material and methods. Genomic DNA from newly diagnosed 59 patients (without IgVH gene rearrangements and TP53 deletions) and 50 healthy blood donors were analyzed by RFLP-PCR to identify TP53 polymorphism. Chromosomal aberrations were detected by use of cIg-FISH. The lymphocyte cell cultures from a subgroup of 40 PCM patients were treated with bortezomib (1, 2 and 4 nM). Results. The P allele of the P72R polymorphism was more common than the R allele in PMC patients compared to controls (39% vs. 24%), and the difference was significant (p = 0.02). The PP and PR genotypes (in combina­tion) were more frequent among cases than in controls (65% vs. 42%, OR = 2.32, p = 0.04). At the cell culture level and 2 nM bortezomib concentration the PP genotype was associated with higher necrosis rates (10.5%) compared to the PR genotype (5.7%, p = 0.006) or the RR genotype (6.3%, p = 0.02); however, no effect of genotypes was observed at bortezomib concentrations of 1 and 4 nM. The shortest OS (12 months) was observed in patients with the PP genotype compared to patients with the PR or RR genotypes (20 months) (p = 0.04). Conclusions. The results suggest that P72R polymorphisms may be associated with an increased PCM risk and may affect OS of PCM patients. However, we saw no consistent results of the polymorphism effect on apoptosis and necrosis in cell cultures derived from PCM patients. Further studies are need in this regard

External quality monitoring facilitates improvement in already well-performing stroke units: insights from RES-Q Poland

Introduction. The Registry of Stroke Care Quality (RES-Q) is used in Poland for quality monitoring by numerous hospitals participating in the Angels Initiative. Our aim was to assess the degree of improvement in highly stroke-oriented centres that report cases to the RES-Q each year. Material and methods. This retrospective analysis included Polish stroke units that from January 2017 to December 2020 contributed to the RES-Q at least 25 patients annually. Results. Seventeen out of 180 Polish stroke units reported patients each year (2017, n = 1,691; 2018, n = 2,986; 2019, n = 3,750; 2020, n = 3,975). The percentage of ischaemic stroke patients treated with alteplase remained stable (26%, 29%, 30% and 28%, respectively). The door-to-needle time progressively decreased, from a median 49 minutes to 32 minutes. The percentage of patients treated ≤ 60 minutes and ≤ 45 minutes significantly increased (from 68% to 86% and from 43% to 70%, respectively), with no change observed between 2019 and 2020. Despite a general improvement in dysphagia screening (81%, 91%, 98% and 99%), screening performed within the first 24h from admission became less frequent (78%, 76%, 69% and 65%). In-hospital mortality significantly increased (11%, 11%, 13% and 15%), while the proportion of patients discharged home remained stable. Conclusions. Quality-oriented projects facilitate the improvement of stroke care, even in centres demonstrating good baseline performance. Polish stroke units that consistently reported cases to the RES-Q demonstrated improvement in terms of door-to- -needle time and dysphagia screening. However, there is still a need to shorten the time to dysphagia screening, and carefully monitor stroke unit mortality following the COVID-19 pandemic

Programmed Death-1 and Its Ligand Are Novel Immunotolerant Molecules Expressed on Leukemic B Cells in Chronic Lymphocytic Leukemia

Programmed death-1 (PD-1) is an immunoreceptor predominantly expressed on exhausted T cells, which through an interaction with its ligand (PD-L1), controls peripheral tolerance by limiting effector functions of T lymphocytes. qRT-PCR for PD-1, PD-L1 and their splicing forms as well as flow cytometric assessment of surface expression was performed in a cohort of 58 chronic lymphocytic leukemia (CLL) patients. In functional studies, we assessed the influence of the proliferative response of leukemic B-cells induced by IL-4 and CD40L on PD-1 transcripts and expression on the protein level. The median level of PD-1, but not PD-L1, transcripts in CLL patients was higher in comparison to healthy volunteers (HVs, n = 43, p = 0.0057). We confirmed the presence of PD-1 and PD-L1 on the CLL cell surface, and found the expression of PD-1, but not PD-L1, to be higher among CLL patients in comparison to HVs (47.2% vs. 14.8%, p<0.0001). The Kaplan-Meier curves for the time to progression and overall survival in groups with high and low surface expression of PD-1 and PD-L1 revealed no prognostic value in CLL patients. After stimulation with IL-4 and CD40L, protein expression of PD-1 was significantly increased in samples that responded and up-regulated CD38. PD-1, which is aberrantly expressed both at mRNA and cell surface levels in CLL cells might represent a novel immunotolerant molecule involved in the pathomechanism of the disease, and could provide a novel target for future therapies

Przetoki szyjno-jamiste; postępowanie diagnostyczno-terapeutyczne na przykładzie przypadków klinicznych o różnej etiologii

Przetoka szyjno-jamista to nieprawidłowe połączenie między tętnicami szyjnymi a zatoką jamistą. Pierwszy opis przypadku przetoki szyjno-jamistej powstał w 1930 roku. W 1985 roku Barrow wraz z zespołem stworzyli powszechnie dziś stosowaną klasyfikację przetok szyjno-jamistych na podstawie obrazów angiograficznych. Zgodnie z tym podziałemwyodrębnia się 4 typy pr zetok: bezpośrednie (typ A) i pośrednie (typy B, C, D). P rzetoki typu A stanowią 70–90%przypadków. Są to najczęściej urazy oraz pęknięcie tętniaka tętnicy szyjnej wewnętrznej w odcinku jamistym. Wśródprzyczyn typów B, C, D, które stanowią 10–30% przypadków, wymienia się czynniki prowadzące do osłabienia ściannaczyń: nadciśnienie tętnicze, miażdżycę oraz choroby układowe tkanki łącznej.Klasyczna triada objawów przetoki szyjno-jamistej obejmuje: obrzęk i przekrwienie gałki ocznej, wytrzeszcz i tętniącyszum naczyniowy. Ponadto mogą występować: opadanie powiek, zaburzenia gałkoruchowe (uszkodzenie nerwów III,IV, VI), ubytki w polu widzenia oraz bóle twarzy w zakresie unerwienia pierwszej i drugiej gałęzi nerwu V. Diagnostykajest zazwyczaj złożona, prowadzona zarówno przez neurologów, jak i okulistów. Badaniem diagnostycznym z wyborujest cyfrowa angiografia subtrakcyjna. Zazwyczaj wykonuje się r ównież tomografię komputerową (CT, computedtomography) głowy, angiografię metodą rezonansu magnetycznego mózgowia, CT oczodołów, badanie okulistyczne(obejmujące ocenę: ostrości wzroku, dna oka, ciśnienia śródgałkowego, ultrasonografię gałki ocznej). W zależnościod typu pr zetoki stosuje się leczenie zachowawcze lub inwazyjne (endowask ularne — embolizacja pr zetoki lubklasyczny zabieg neurochirurgiczny). Autorzy przedstawili trzy przypadki przetok szyjno-jamistych o różnej etiologiiobrazujących różnorodność objawów klinicznych oraz trudności diagnostyczno-terapeutyczne

Assessment of the Level of Physical Activity and Body Mass Index of Soldiers of the Polish Air Force

Level of physical activity positively affects health condition, correlates highly with level of physical fitness and contributes to the efficient performance of military tasks. The aim of the study was to assess the level of physical activity and body mass index of the Polish Air Force soldiers. A total of 543 professional soldiers (men) doing military service in military units of the Polish Air Force underwent the examination. The average age of examined soldiers amounted to 34.8 &plusmn; 9.0 years. In order to carry out the research, the long version of the International Physical Activity Questionnaire was used. Out of the total of 477 questionnaires that qualified for the analysis, a high level of physical activity was found among 81.1% of subjects, moderate 10.5% and low 8.4%. Average MET values were obtained in the following: job-related, relocation (transportation), housekeeping, recreation (leisure activities and sport). The average MET values were 4173 &plusmn; 5306 MET; 2371 &plusmn; 2725 MET; 2455 &plusmn; 4843 MET; 2421 &plusmn; 2802 MET, respectively. The average level of body mass index amounted to 25.98 &plusmn; 3.38 kg/m2. The tested Air Force soldiers were generally characterized by a high and moderate level of physical activity. Generally, there was no difference in the level of physical activity between the flight crew and the ground staff

Positive Impact on Physical Activity and Health Behaviour Changes of a 15-Week Family Focused Intervention Program: “Juniors for Seniors”

The promotion of physical activity (PA) in children and their parents requires effective planning and sometimes even interventions. This study shows the effect of PA during a 15-week intervention program “Junior for Seniors” by applying a socioecological model to the interpretation of the data. This comprehensive approach emphasizes the fact that health promotion should focus not only on intrapersonal factors but also on the multilevel factors that might be determinants and modulators of increased PA. In 2015, 24 children (“juniors,” 14 girls and 10 boys, aged M=7.96±0.69) and 22 parents (“seniors,” 14 mothers aged M=38.86±2.96 and 8 fathers aged M=37.38±2.97) were voluntarily enrolled in a study spread across three primary schools in the city of Poznań, Poland. The effectiveness of the intervention was determined according to postintervention behavioural changes in PA in comparison to preintervention levels, as reported by the parents and children. Overall, the study found increases in PA levels and reductions in sedentary time. Although the changes are modest, there are some unrecognized benefits of the intervention which may have occurred, such as improved sport and motor skills, more frequent family social behaviours (walks, meals, and visiting relatives), or simply improved quality of “do-together” leisure time PA

Prognostic Potential of Galectin-9 mRNA Expression in Chronic Lymphocytic Leukemia

Galectin-9 (Gal-9), very poorly characterized in chronic lymphocytic leukemia (CLL), was chosen in our study to examine its potential role as a CLL biomarker. The relation of Gal-9 expression in malignant B-cells and other routinely measured CLL markers, as well as its clinical relevance are poorly understood. Gal-9 mRNA expression was quantified with RT-qPCR in purified CD19+ B-cells of 100 CLL patients and analyzed in the context of existing clinical data. Our results revealed the upregulation of Gal-9 mRNA in CLL cells. High Gal-9 mRNA expression was closely associated with unfavorable prognostic markers. In addition, Gal-9 expression in leukemic cells was significantly elevated in CLL patients who did not respond to the first-line therapy compared to those who did respond. This suggests its potential predictive value. Importantly, Gal-9 was an independent predictor for the time to treatment parameters. Thus, we can suggest an adverse role of Gal-9 expression in CLL. Interestingly, it is possible that Gal-9 expression is induced in B-cells by EBV infection, so we determined the patients’ EBV status. Our suggestion is that EBV coinfection could worsen prognosis in CLL, partly due to Gal-9 expression upregulation caused by EBV

High M-MDSC Percentage as a Negative Prognostic Factor in Chronic Lymphocytic Leukaemia

In the current study, we analysed the role and prognostic value of myeloid-derived suppressor cells (MDSC) in chronic lymphocytic leukaemia (CLL). The frequency of circulating monocytic MDSC (M-MDSC; defined as CD14+CD11b+CD15-HLA-DR-/low cells) was assessed in correlation with clinical and laboratory parameters characterising the disease activity and patient immune status. Samples of peripheral blood from untreated CLL patients and healthy volunteers were stained with monoclonal antibodies for flow cytometry analysis. CLL patients with M-MDSC percentages above 9.35% (according to the receiver operating characteristic (ROC) analysis) had a shorter time-to-treatment and shorter survival time than the group with a lower percentage of M-MDSC. The M-MDSC percentage was higher in patients with adverse prognostic factors (i.e., 17p and 11q deletion and CD38 and ZAP-70 expression). A high M-MDSC percentage was linked to significantly lower expression of the CD3&zeta; in T cells. Furthermore, an analysis of immune regulatory molecules (arginase 1 (ARG1), nitric oxide synthase (NOS2), indoleamine 2,3-dioxygenase (IDO), transforming growth factor beta (TGF-&beta;), and interleukin (IL)-10) was performed. By the means of flow cytometry and RT-qPCR, we showed an overexpression of three of them in M-MDSC of CLL patients. M-MDSC cells seem to be an important factor in the immunosuppressive microenvironment of CLL and seem to be a good and novel prognostic facto