Multiple endocrine neoplasia type 1 in Poland: a two-centre experience

Introduction: Multiple endocrine neoplasia type 1 (MEN1) has been causing problems for clinicians since it was first described in 1954 by Wermer. Not only its rarity, but also its variable clinical manifestations and lack of genotype-phenotype correlation make it hard to establish evidence-based guidelines for the management of this syndrome. Nationwide registers and population-based research are the best means to improve knowledge about this rare disease. As yet, there is no example of such research in the Polish population of MEN1 patients. Material and methods: We performed a retrospective analysis of clinical and genetic data of patients diagnosed with MEN1 syndrome and followed-up in two polish referral centres in the years 1994–2018. Results: We analysed 79 patients, of whom the majority were women. The mean age of the patient population was 43 years, mean age at MEN1 diagnosis was 37.95 years, and mean interval from initial symptoms to MEN1 diagnosis was 6.93 years. Primary hyperparathyroidism (PHP), gastroenteropancreatic neuroendocrine tumour (GEP-NET), and pituitary adenoma (PA) developed in 90%, 52%, and 47% of patients, respectively. The dominance of insulinoma with low prevalence of gastrinoma is the most vivid difference, when compared to previously described populations. Moreover, we found 3.5-fold higher risk of developing a pituitary tumour in patients with a frameshift mutation with the STOP codon of the MEN1 gene.  Conclusions: The Polish population of patients with MEN1 is different than previously described European and Asian populations, primarily in prevalence of functional NETs. A frameshift mutation with the STOP codon of the MEN1 gene significantly increases the risk of PA. Further studies with a larger cohort of patients are needed to fully describe the Polish population and improve diagnosis and management of the syndrome

How long to provide special care after emergency department admission in three most common non-traumatic diseases?

INTRODUCTION: The first hours after the admission of patients, and proper medical care is administered in the emergency department [ED], are of decisive importance in protecting them from unexpected death. Medical staff and researchers are not consistent in the period to follow up on deaths after admission to the emergency department and they analyze arbitrarily different time intervals without any justification for the chosen period. In this study, we will conduct an epidemiological data analysis to determine the range of the most dangerous (elevated) risk (hazard) of death for patients within one month of observation from an ED admission using modern survival modeling and software. MATERIAL AND METHODS: Epidemiological data analysis of the three most common non-traumatic diseases (neoplasms, circulatory, and endocrine) was carried out in this study. Using the 2016–2019 sample of 14,904 first-visit ED patients at the Multi-Specialistic Hospital in Gorzów Wielkopolski, Poland, we determined the range of the most dangerous (elevated) risk (hazard) of death within one month of observation, based on a Royston–Parmar (RP) regression with spline functions (assuming non-constant hazard over time). RESULTS: The results show that in the three most common non-traumatic diseases (neoplasms, circulatory, and endocrine) for the first 72 hours, patients should be under special supervision of medical personnel to avoid an excess of unexpected deaths. Moreover, within a month from ED admission, the hazard ratio [HR] of death was almost half as high [HR = 1.47, 95% confidence interval (CI) = 1.07 to 2.02] in diagnosed circulatory patients and over twice as high (HR = 2.25, 95% CI = 1.58 to 3.20) in neoplastic diseases as compared to reference endocrine patients. Moreover, the estimated RP hazards (probabilities of death) increased until the third day after admission, reaching 1.0% (95% CI = 0.8% to 1.4%) of endocrine patients, 1.5% (95% CI = 1.3% to 1.6%) of circulatory patients, and 2.2% (95% CI = 1.8% to 2.6%) for neoplasms, and then dropped radically with the time of observation. CONCLUSIONS: In view of the care of patients in the three most non-traumatic clinical diagnoses (endocrine diseases, circulatory diseases, and neoplasms), special attention should be paid to the first three days after admission to the ED (after this time, in the first month of observation, the risk of death of these patients decreases significantly)

The influence of physiotherapy on the concentration of interleukin-8 in patients suffering from chronic obstructive pulmonary disease

Wstęp: Interleukina-8, chemokina produkowana przez makrofagi i komórki nabłonka, silny chemoatraktant dla neutrofili, odgrywa zasadniczą rolę w aktywacji neutrofilów i eozynofilów w drogach oddechowych u chorych na POChP i może służyć jako marker nasilenia reakcji zapalnej. Zapalenie to w przypadku pacjentów z POChP może charakteryzować się zwiększoną liczbą neutrofilów w plwocinie, a także podwyższonym stężeniem interleukiny-8. Celem niniejszej pracy było określenie wpływu fizjoterapii na stężenie interleukiny-8 w indukowanej plwocinie u chorych na POChP. Materiał i metody: Badaniami objęto 44 chorych (21 mężczyzn, 23 kobiety, średnia wieku 56,47 &#177; 9,52) leczonych w SP ZOZ Szpitalu Specjalistycznym MSWiA w Głuchołazach, usprawnianych w Dziale Usprawniania Leczniczego, z rozpoznaną POChP (wskaźnik FEV1%VC < 65%), z niezmieniającym się leczeniem farmakologicznym w trakcie fizjoterapii. U wszystkich chorych przed fizjoterapią przeprowadzono test wydolnościowy na bieżni ruchomej według zmodyfikowanego protokołu Bruce&#8217;a oraz dokonano oceny duszności na podstawie 20-punktowej skali Borga w celu kwalifikacji do fizjoterapii. U wszystkich chorych zastosowano kompleksową 3-tygodniową fizjoterapię pulmonologiczną, której podstawą był trening wydolnościowy na ergometrze rowerowym. Wielkość obciążeń treningowych dobierano indywidualnie dla każdego chorego na podstawie oceny tolerancji wysiłku. Standardowy program fizjoterapii obejmował również ćwiczenia mięśni oddechowych, ze szczególnym uwzględnieniem mięśni brzucha i przepony, inhalacje z roztworu izotonicznego NaCl, drenaż ułożeniowy z oklepywaniem klatki piersiowej, relaksację oraz spacery. U wszystkich chorych oznaczono stężenie IL-8 w indukowanej plwocinie przed rozpoczęciem kompleksowej fizjoterapii i po jej zakończeniu. Stężenie IL-8 określono za pomocą testu ELISA. Wyniki: Wykazano, że stężenie interleukiny-8 było istotnie niższe po 3-tygodniowej fizjoterapii. Interleukina-8 w plwocinie spadła od 18,91 &#177; 25,2 do 9,69 &#177; 14,06 ng/ml (p = 0,0215). Największy spadek stężenia IL-8 dotyczył chorych z jej najwyższym wyjściowym stężeniem. Wnioski: Obniżenie stężenia IL-8 w indukowanej plwocinie po kompleksowej fizjoterapii chorych na POChP wskazuje na obniżenie aktywności neutrofilów, co może być jedną z przyczyn poprawy stanu klinicznego pacjentów. Pneumonol. Alergol. Pol. 2011; 79, 3: 184&#8211;188Background: Interleukin-8 (IL-8, CXCL8), chemokine produced by macrophages and epithelium cells, plays a major role in activating neutrophils and eosinophils in the airways of patients with COPD and might act as a stimulator of inflammatory process. The aim of the research was to assess whether pulmonary physiotherapy influences the concentration of IL-8 in the induced sputum of patients with COPD. Material and methods: The study included 44 patients (21 males, 23 females, average age 56.47 &#177; 9.52) with COPD treated in Physiotherapy Department of MSWiA Hospital in Glucholazy, with unchanged pharmacological treatment for the duration of the therapy. Before treatment, efficiency treadmill test by Bruce modified protocol and dyspnea assessment with the modified 20-point Borg scale was given to qualify each patient for physiotherapy. All patients participated in a 3-week multi-treatment pulmonary physiotherapy programme based on efficiency training on a cycloergometer. The physical workload was determined individually for each patient based on the assessment of individual exercise tolerance. Standard physiotherapy programme also included respiratory muscles&#8217; training with particular emphasis on training of abdominal muscles and diaphragm, inhalations with isotonic saline, drainage, chest clapping, relaxations and walking. IL-8 concentration in each patient&#8217;s induced sputum was collected prior to complex physiotherapy, and after it has been completed. IL-8 concentration was determined with the use of the ELISA test. Results: It was found that the concentration of IL-8 was significantly lower in patients with COPD after a 3-week physiotherapy programme. It fell from 18.91 &#177; 25.2 to 9.69 &#177; 14.06 ng/ml (p = 0.0215). The most significant IL-8 concentration decrease was observed in patients with the highest initial level of IL-8. Conclusions: The study shows that multi-treatment pulmonary physiotherapy causes decrease of IL-8 level in the induced sputum in patients with COPD, what can suggest decrease activity of neutrophils, which may be one of the factors leading to the improvement in patients&#8217; clinical condition. Pneumonol. Alergol. Pol. 2011; 79, 3: 184-18

Overall and GTV subvolumes tumour control probability (TCP) for head and neck cancer treated by 3D-IMRT with inhomogeneous dose distribution

Introduction.  In this study, an original model has been developed to estimate the real TCP that is a product of the TCPs calculated for GTV subvolumes of head and neck cancer based on 3D-IMRT dose planning. Material and methods.  Retrospective pilot group consist of 16 cases of oropharyngeal cancer in stage T1–2N0 previously treated with 3D-IMRT with at least 3-year follow-up. The total dose (TD) was 60–70 Gy in 2.0 Gy fractions delivered over 42–49 days. Within GTV two subvolumes were marked out: SVA with the planned 100% TD, and underdosed (90–95%) SVB. The TCP for both was calculated using the original formula developed by Withers and Maciejewski. Results.  During 3-year follow-up, 8 local recurrences (LR) occurred. In about 70% of SVB “dose cold spots” encompassed more than 50% GTV volume. This resulted in the TCPSVB decrease to 60%. Thus, the real overall TCP was much lower than a priori predicted, and in these cases local recurrences occurred. Discussion.Both cold spot SVB volumes and their dose deficit strongly correlated with a high risk of LR. Conclusions.In conclusion the magnitude of dose deficit and the size of cold subvolume within GTV have an indepen­dent negative impact on real TCP and demand dose re-planning

The taxonomy statistic uncovers novel clinical patterns in a population of ischemic stroke patients.

In this paper, we describe a simple taxonomic approach for clinical data mining elaborated by Marczewski and Steinhaus (M-S), whose performance equals the advanced statistical methodology known as the expectation-maximization (E-M) algorithm. We tested these two methods on a cohort of ischemic stroke patients. The comparison of both methods revealed strong agreement. Direct agreement between M-S and E-M classifications reached 83%, while Cohen's coefficient of agreement was κ = 0.766(P < 0.0001). The statistical analysis conducted and the outcomes obtained in this paper revealed novel clinical patterns in ischemic stroke patients. The aim of the study was to evaluate the clinical usefulness of Marczewski-Steinhaus' taxonomic approach as a tool for the detection of novel patterns of data in ischemic stroke patients and the prediction of disease outcome. In terms of the identification of fairly frequent types of stroke patients using their age, National Institutes of Health Stroke Scale (NIHSS), and diabetes mellitus (DM) status, when dealing with rough characteristics of patients, four particular types of patients are recognized, which cannot be identified by means of routine clinical methods. Following the obtained taxonomical outcomes, the strong correlation between the health status at moment of admission to emergency department (ED) and the subsequent recovery of patients is established. Moreover, popularization and simplification of the ideas of advanced mathematicians may provide an unconventional explorative platform for clinical problems

Od liczby przestępstw niewykrytych do innych statystyk kryminalnych: obserwacje opolskiej policji z wykorzystaniem modeli bayesowskich

Niewykrywalność przestępstw jest dużym problemem w utrzymaniu porządku publicznego, a analizując doniesienia naukowe na ten temat wydaje się, że go można nawet uznać za „wstydliwy”. Z tego powodu w niniejszej pracy podjęliśmy się oceny niniejszego zjawiska kryminalistycznego, dostosowując nowoczesne metody geostatystyczne. W opracowaniu wykorzystaliśmy wszystkie zgłoszone do Komendy Wojewódzkiej Policji w Opolu przestęp-stwa popełnione w województwie w okresie pięciu lat 2015–2019 i zbudowaliśmy modele przestrzenno-czasowe wskaźników niewykrytej przestępczości. Ich roczne pięcioletnie stopy wzrostu oparte są na populacji referencyjnej przy użyciu hierarchicznego modelowania bay-esowskiego. Kombinacje tych poziomów porównaliśmy z prawdopodobieństwem liczby wykrytych i niewykrytych przestępstw. Analiza statystyczna została rozszerzona o powierzch-nię kwadratową i surowe wskaźniki zgłoszonych statystyk przestępczości względem popu-lacji referencyjnej. Stwierdziliśmy, że stopień wykrywalności przestępstw jest bezpośrednio związany z liczebnością populacji referencyjnej, co może również sugerować zasadność prze-prowadzenia szczegółowej analizy w zakresie dostosowania odpowiedniej obsady personelu policji w jednostkach administracyjnych. Wyraźny był również wpływ powierzchni jednostek administracyjnych na liczbę niewykrytych przestępstw. Ponadto ogólne wskaźniki zgłaszanej przestępczości oraz wahania w czasie w obrębie samych jednostek terytorialnych implikowały istotniejsze zmiany statystyk kryminalistycznych, niż różnice pomiędzy nimi i zostały ustalone jedynie na podstawie liczby przestępstw niewykrytych. Zastosowanie metod bayesowskich (pomimo statystycznego zaawansowania, jednakże prostej aplikacji komputerowej) pozwala na analizę danych geostatystycznych (niezależnie od rodzaju) i nowe możliwości wniosko-wania naukowego. Przy obecnej technice oprogramowania, wszystkie prezentowane wyniki statystyczne są dość łatwe do osiągnięcia, niemniej wymagają współpracy zainteresowanych profesjonalnych organów policyjnych i statystycznych oraz komplementarnych analiz nauko-wych. Na koniec warto podkreślić, że metody bayesowskie pozwalają na otwarcie zupełnie nowych horyzontów poznawczych w badaniach kryminalistycznych.The non-detectability of crimes is a big problem for maintaining public order, and by reviewing scientific reports on this subject it seems that this problem can even be considered ‘shameful’. For this reason, we undertook in this study an assessment of this forensic phenomenon adapting modern geostatistical methods. This study uses all reported incidences of crimes to the Opole Provincial Police Headquarters committed in the Opole region over a five year period 2015–2019. Spatio-temporal patterns of undetected crime rates were built. Their annual five-year growth rates are based on the reference population using hierarchical Bayesian modeling. The combinations of these levels were compared with the odds of detected to undetected crime numbers. The statistical analysis was extended with square area and crude rates of the reported crime statistics per reference population. We found that the degree of crime detection is directly related to the reference population size which may also suggest the validity of a detailed analysis in terms of adjusting the appropriate staffing of police personnel in administrative units. Furthermore, the influence of the area of administrative territories on the number of undetected crimes was also evident. Additionally, overall reported crime rates and the fluctuations in time within territorial units themselves implicated more important changes in criminal statistics than the differences between them and were established using unsolved crime statistics only. The use of Bayesian methods (despite the fact that they are statistically advanced, is simple in a computer application) allows for the unfolding of geostatistical data (regardless of the type) and new possibilities of scientific inference. All these statistical results are quite easy to achieve with the current programming technique, nevertheless they require the cooperation of interested professional forensic and statistical bodies and further scientific explanations. Finally, it is worth emphasizing that Bayesian methods allow brand-new cognitive horizons to be opened in forensic research

Overlapped Bayesian spatio-temporal models to detect crime spots and their possible risk factors based on the Opole Province, Poland, in the years 2015–2019

Abstract Geostatistical methods currently used in modern epidemiology were adopted in crime science using the example of the Opole province, Poland, in the years 2015–2019. In our research, we applied the Bayesian spatio-temporal random effects models to detect ‘cold-spots’ and ‘hot-spots’ of the recorded crime numbers (all categories), and to ascertain possible risk factors based on the available statistical population (demographic), socio-economic and infrastructure area characteristics. Overlapping two popular geostatistical models in the analysis, ‘cold-spot’ and ‘hot-spot’ administrative units were detected which displayed extreme differences in crime and growth rates over time. Additionally, using Bayesian modeling four categories of possible risk factors were identified in Opole. The established risk factors were the presence of doctors/medical personnel, road infrastructure, numbers of vehicles, and local migration. The analysis is directed toward both academic and police personnel as a proposal for an additional geostatistical control instrument supporting the management and deployment of local police based on easily available police crime records and public statistics