Turkey after the start of negotiations with the European Union - foreign relations and the domestic situation, Part II. OSW Report, July 2008

The Centre for Eastern Studies has decided to embark on the project entitled 'Turkey after the start of negotiations with the European Union - foreign relations and the domestic situation' for two major reasons: the start of the accession negotiations between Ankara and the European Union in October 2005, and the significant part which Turkey plays in western Eurasia (the Caucasus, the countries in the basins of the Black and Caspian Seas, the Middle East and the Balkans) which We wish to present our readers our second report discussing Turkey's relations with Central Asia, the Caucasus and Russia, the aspect of Turkish foreign policy regarding the Black Sea, and the role of Turkey as a transit country for oil and gas from the Middle East and the Caspian regions. The evaluation of Turkey's standpoint and potential regarding the aforementioned issues is especially important, considering the tensions existing in Turkey's relations with the EU and the USA, as well as the West's increasing engagement in the Caucasus, Central Asia and Black Sea regions. In this process, Ankara may play the role of a significant ally for the West. However, it may just as readily play the role of its rival, who could co-operate with other countries and may seriously frustrate the implementation of the EU and US' goals. The Report was developed between autumn 2006 and autumn 2007, over which time the project participants searched for publicly available documents in Poland, Turkey, EU countries and the USA, and went on five research trips to Central Asia, Russia, Turkey and Caucasus, where they met local analysts, officials and researchers

Hepatocyte growth factor in exhaled breath and BAL fluid in sarcoidosis

Wstęp: Wątrobowy czynnik wzrostu (HGF) jest silnym mitogenem stymulującym wzrost komórek nabłonka pęcherzyków płucnych. Wyższe stężenia HGF w różnych materiałach biologicznych stwierdzono między innymi w zespole ostrej niewydolności oddechowej (ARDS), u chorych po przebytym zapaleniu płuc i po pneumonektomii. Niekorzystnym zejściem sarkoidozy jest włóknienie płuc. Wątrobowy czynnik wzrostu mógłby być przydatny jako marker pozwalający na rozpoznanie chorych obarczonych ryzykiem włóknienia płuc. Celem pracy była ocena: 1) czy HGF jest wykrywalny w popłuczynach oskrzelowo-pęcherzykowych (BAL) i kondensacie powietrza wydechowego (EBC); 2) czy stężenia HGF w BAL-u i kondensacie chorych na sarkoidozę różnią się od stężeń osób zdrowych; 3) czy istnieją korelacje z parametrami aktywności i wybranymi czynnikami rokowniczymi. Materiał i metody: Zebrano kondensat od 64 i popłuczyny oskrzelowo-pęcherzykowe od 30 chorych na sarkoidozę. Grupę kontrolną stanowiły osoby zdrowe (n = 15 dla EBC, n = 9 dla BAL). Wątrobowy czynnik wzrostu oznaczono immunoenzymatycznie. Wyniki: Stężenia HGF w kondensacie przekroczyły próg detekcji u 62% badanych (56% chorych i 87% zdrowych) i we wszystkich próbkach BAL. Nie stwierdzono różnic w stężeniach w EBC i BAL pomiędzy osobami chorymi i zdrowymi. Nie stwierdzono korelacji pomiędzy HGF w EBC/BALF a stopniem radiologicznym, parametrami czynności płuc, czasem trwania choroby, liczbą nawrotów, odsetkiem limfocytów w BAL, stężeniem enzymu konwertującego angiotensynę i wapnia w surowicy, utratą dobową wapnia z moczem. Wnioski: Wątrobowy czynnik wzrostu jest wykrywalny w BAL i EBC. Jednak brak różnic pomiędzy chorymi na sarkoidozę i osobami zdrowymi oraz brak korelacji z markerami aktywności i czynnikami rokowniczymi uniemożliwiają jego zastosowanie w diagnostyce i monitorowaniu sarkoidozy.Introduction: Hepatocyte growth factor (HGF) is a strong mitogen stimulating lung epithelial cell growth. Elevated levels of HGF have been reported in various biological materials of patients with acute respiratory distress syndrome and in patients recovering from pneumonia or pneumonectomy. Sarcoidosis may be complicated by lung fibrosis. Consequently, HGF could be considered a new biomarker identifying patients with a higher risk of lung fibrosis. The aim of the study was to verify whether: 1. HGF is measurable in bronchoalveolar lavage fluid (BALF) and exhaled breath condensate (EBC); 2. HGF in BALF or EBC is impaired in sarcoidosis; and 3. HGF correlates with chosen activity and prognostic markers. Material and methods: Sixty-four EBC and 30 BALF of sarcoid patients, and 15 and 9 of healthy controls, respectively, were collected for the measurement of HGF using an ELISA test. Results: HGF was detectable in 62% of EBC samples (56% sarcoidosis and 87% of controls) and in all the BALF samples. EBC and BALF concentrations were not different in comparison to the controls. Moreover, no correlation was found between EBC/BALF concentrations and radiological stage, lung function tests, duration of disease, number of relapses, BALF lymphocytes, serum ACE, or serum and urine calcium concentrations. Conclusions: HGF is detectable in BAL and EBC. However, it does not distinguish sarcoidosis patients from healthy subjects. The above, as well as the lack of correlations with various parameters of disease activity and severity rule out EBC/ /BALF HGF as a biomarker for sarcoidosis monitoring

Diagnostic and treatment standards in idiopathic pulmonary fibrosis in the era of antifibrotic drugs in Poland: A real-world practice survey

Background Currently, only two drugs have been shown to modify the inevitable natural history of idiopathic pulmonary fibrosis (IPF). Changes in the reimbursement policy for antifibrotic drugs in Poland have led to the availability of pirfenidone from January 2017 and nintedanib from March 2018 for the treatment of Polish patients with IPF. This study aimed to evaluate the possible changes and shortcomings in the clinical practice standards in IPF in the era of access to antifibrotic therapy in Poland. Methods A real-world data survey was performed among physicians attending the Polish Respiratory Society Congress held in May 2018. The present survey was a follow-up to the previous survey undertaken in 2016, before the availability of antifibrotics in Poland. Results A total of 99 physicians participated in the survey, among which 80% were pulmonologists. The majority of participants (83%) represented hospital-based clinicians and most of them (93%) were involved in interstitial lung diseases (ILD) management. As many as 63% of the respondents elaborate the final diagnosis of IPF working with the expert radiologist routinely, 47% do that in the cooperation with other pulmonologists, and if a biopsy was performed 39% discuss its results with the expert pathologist. Bronchoalveolar lavage (BAL) and surgical lung biopsy (SLB) would never be recommended in the differential diagnosis of IPF by 9% and 16% of the respondents, respectively. Corticosteroids (CS) or a combination of CS and immunosuppressants (IS) is still recommended by 22% of participants. Proton pump inhibitors (PPI) in the case of symptomatic GERD are prescribed by 44% of the respondents, and 12% prescribe PPI regardless of GERD symptoms. Pirfenidone is used by 70%, and nintedanib by 48% of the respondents. Only 39% of the respondents refer patients with IPF to professional rehabilitation centers. Conclusions The level of cooperation between pulmonologists and other specialists in the diagnostic workup of IPF is unsatisfactory. IPF treatment practices in the era of access to effective drugs in Poland require immediate improvement. There is an urgent need to develop the local Polish practical guidelines to improve the management of IPF

Wyniki przesiewowych badań prenatalnych w materiale 2285 ciąż z rejonu Pomorza Zachodniego diagnozowanych w latach 2005-2006

Summary In the following paper we have presented the results of non-invasive and invasive prenatal diagnostic tests performed on 2285 pregnant women from the Western-Pomeranian Region between 2005 and 2006. Material and methods: Retrospective analysis of screening tests on 2285 pregnant women. Medical history, including age, weight, familial data pedigrees up to third degree relatives, accompanying diseases, gestational complications in the family, type, dosage and period of any drugs intake, was obtained. Sonographic screening and evaluation of maternal serum PAPP-A and betaHCG levels. Results: Screening tests identified 4.5% high-risk pregnancies in this group. 69% of the patients consented to invasive diagnosis. As a result, genetic anomalies were detected in 43.7% of cases. Significant differences in betaHCG levels correlated with oral gestagens intake and place of residence (coastal areas). Conclusion: Broad use of certified non-invasive methods of prenatal screening allow substansial reduction of invasive procedures with high levels of positive prediction. Medical drugs intake as well as place of inhabitation may influence on free betaHCG levels.Streszczenie Cel pracy: Celem pracy było przeanalizowanie wyników nieinwazyjnych i inwazyjnych badań prenatalnych przeprowadzonych w regionie zachodniopomorskim w latach 2005-2006. Materiał i metody: Analiza retrospektywna 2285 ciąż. Wywiad z uwzględnieniem 3 pokoleniowego rodowodu, badania ultrasonograficzne I trymestru wraz z testem podwójnym. Amniopunkcje ze standardową oceną kariotypu. Wyniki: Drogą badań przesiewowych wyłoniono 4,5% ciąż podwyższonego ryzyka, z których 69% poddało się amniopunkcji. Pozwoliło to na potwierdzenie w wysokim odsetku (43,7%) nieprawidłowości genetycznych. W badanej grupie ciężarnych zaobserwowano istotne zmiany w parametrach biochemicznych betaHCG zależne od przyjmowanych leków (gestageny) oraz od miejsca zamieszkania (okolice nadmorskie). Wnioski: Powszechne zastosowanie certyfikowanych nieiwazyjnych badań prenatalnych pozwala na ograniczenie liczby przeprowadzanych amniopunkcji przy utrzymaniu wysokiego wskaźnika predykcji. Doustne przyjmowanie niektórych leków oraz miejsce zamieszkania pacjentki może wpływać na poziomy wolnej podjednostki betaHCG

Prenatal diagnosis of Langer-Giedion Syndrome confirmed by bac s-on-beads technique

Langer-Giedion Syndrome (LGS), with characteristic phenotypic features including craniofacial dysmorphic signs, postnatal growth retardation and skeletal abnormalities, mental impairment, urogenital malformations and heart defects, is caused by partial deletions of the long arm of chromosome 8. We present a case of a female fetus with LGS. The diagnosis was molecularly proven with the BACs on Beads™ method at 32 weeks of gestation. To the best of our knowledge, prenatal recognition of that genetic defect had previously been made in only one case. Also, it has never been described before

Idiopathic pulmonary fibrosis (IPF) ― common practice in Poland before the “antifibrotic drugs era”

  INTRODUCTION: Idiopathic pulmonary fibrosis (IPF) is a chronic, progressive and debilitating lung disease with a median survival time of 3–5 years. For now, pirfenidone (PIR) and nintedanib (NTB) are the only drugs that can slow down the disease’s progression. In Poland, these drugs, although registered for legal use, had not been reimbursed for IPF patients until the end of the year 2016. Aim of the study was to assess what was common practice in terms of diagnosis and treatment in the period before antifibrotic drugs became available for IPF patients in Poland. MATERIAL AND METHODS: We performed a survey among participants of two nationwide pulmonological congresses held in 2016. RESULTS: One hundred and fifty physicians took part in the study. Only 55% of respondents would reach their final diagnosis in collaboration with a radiologist. Just 40% of those sending patients for surgical lung biopsy (SLB) would discuss the case directly with a pathologist. 22% would never refer the patient suspected of having IPF for SLB. 85% believed that bronchoalveolar lavage (BAL) may be useful for diagnosis. 41% of respiratory professionals would not use any drug for the treatment of IPF patients. 23% of physicians would prescribe corticosteroids in high doses (CS), either in monotherapy or in combination with other drugs. Only 43% of respondents would use antacid drugs in case of symptomatic gastro-oesophageal reflux disease (GERD), and only 11% would prescribe these drugs regardless of GERD diagnosis. CONCLUSIONS: The majority of Polish pulmonologists were not supported by radiologists and pathologists in the diagnostic process. Treatment standards were unsatisfactory, mostly due to a lacking of reimbursement regulations. Further education is necessary to improve management of IPF patients in Poland.

QuantiFERON-TB-GOLD In-Tube in patients with sarcoidosis

Introduction: Sarcoidosis and tuberculosis (TB) are the diseases that share many similarities. Mycobacterium tuberculosis (MTB) culture results are the gold standard for the diagnosis of TB, but false positive results are not rare. The aim was to evaluate the utility of QFT in detecting latent TB infection in a group of sarcoidosis patients with negative history of TB and negative culture/BACTEC results, and checking sarcoidosis activity influence on the QFT results. Additionally, we assessed if QFT negative result may strengthen the suspicion that positive culture/BACTEC results are false positive. Material and methods: 37 culture-negative and 6 culture-positive sarcoidosis patients were enrolled. On the basis of clinical and radiological data TB was considered unlikely (false-positive results). A control group consisted of age-matched subjects with excluded TB (n = 37). QuantiFERON-TB GOLD In-Tube (QIAGEN, USA) was used according to the manual. Test validity was checked basing on the results obtained from a low-risk (n = 21) and active TB group (n = 23). Results: The frequency of positive results tended to be higher in MTB(–) sarcoidosis (24.3% vs. 13.5% for the control group, p = 0.37), but was similar to the general population. None of culture-positive sarcoidosis patients was QFT-positive. The positive results were equally distributed among patients with active and inactive sarcoidosis. Conclusions: QFT has been found to be the useful test for the detection of latent TB infection in sarcoidosis patients. In addition, we confirm that sarcoidosis activity does not negatively influence the result of QFT. Moreover, QFT would be proposed as a cost-saving diagnostic test providing additional diagnostic information when false positive MTB culture result in the sarcoidosis patient is highly suspected. However, in each case clinical, radiological and epidemiological data should be considered before taking the therapeutic decision

Matter-Wave Interference versus Spontaneous Pattern Formation in Spinor Bose-Einstein Condensate

We describe effects of matter-wave interference of spinor states in the $^{87}$Rb Bose-Einstein condensate. The components of the F=2 manifold are populated by forced Majorana transitions and then fall freely due to gravity in an applied magnetic field. Weak inhomogeneities of the magnetic field, present in the experiment, impose relative velocities onto different $m_F$ components, which show up as interference patterns upon measurement of atomic density distributions with a Stern-Gerlach imaging method. We show that interference effects may appear in experiments even if gradients of the magnetic field components are eliminated but higher order inhomogeneity is present and the duration of the interaction is long enough. In particular, we show that the resulting matter-wave interference patterns can mimic spontaneous pattern formation in the quantum gas.Comment: 5 pages, 4 figures, version accepted in Phys. Rev.