Phagocytosis of latex beads by a human monocytic Mono Mac 6 cell line and effects of low-frequency electromagnetic field interaction

Some studies have shown that electromagnetic fields (EMFs) may impact immune response cells and their functions. The first stage of the defense from pathogens is innate immunity encompassing phagocytosis and phagocytosis-related intracellular effects. Our work aimed to determine the influence of a low-frequency electromagnetic field (7 Hz, 30 mT_rms) on the phagocytosis process of latex beads (LBs), the production of reactive oxygen species (ROS), and viability changes in a human monocytic Mono Mac 6 (MM6) cell line as an experimental model of the phagocytosing cells in in vitro cell culture conditions. For these purposes, cells were firstly activated with infectious agents such as lipopolysaccharide (LPS), Staphylococcal enterotoxin B (SEB), or the proliferatory agent phytohaemagglutinin (PHA), and then a phagocytosis test was performed. Cell viability and range of phagocytosis of latex beads by MM6 cells were measured by flow cytometry, and the level of ROS was evaluated with the use of a cytochrome C reduction test. The obtained results revealed that applied EMF exposure mainly increased the necrosis parameter of cell death when they were pre-stimulated with SEB as an infectious factor and subsequently phagocytosed LBs (P=0.001). Prestimulation with other agents like LPS or PHA preceding phagocytosis resulted in no statistically significant changes in cell death parameters. The level of ROS depended on the used stimulatory agent, phagocytosis, and/or EMF exposure. The obtained effects for EMF exposure indicated only a slight decrease in the ROS level for cells phagocytosing latex beads and being treated with SEB or PHA, while the opposite effect was observed for LPS pre-stimulated cells (data not statistically significant). The results concerning the viability of phagocytosing cells, the effectiveness of the phagocytosis process, and the level of radical forms might result from applied EMF parameters like signal waveform, frequency, flux density, and especially single EMF exposure.

Effects of water ingestion on autonomic activity and gastric motility in patients with celiac disease

The pathogenesis of celiac disease is associated with an autoimmune process. The disease causes chronic inflammation of the small intestinal mucosa, which may affect the brain-gut axis. The activation of visceral receptors (gastrointestinal mechanoreceptor and osmoreceptor) in response to stomach distension caused by water ingestion has not been studied before. Our results showed reduced responsiveness of the autonomic nervous system to water ingestion in patients with celiac disease, which may lead to disturbances of gastric myoelectrical activity and depends on baseline autonomic activity. Water intake can induce gastric distension and motility response, without changes in gastrointestinal hormones. It can also increase the activity of the autonomic nervous system. On the other hand, inflammation in celiac disease (CeD) can alter visceral perception (increase sensitization), leading to autonomic dysfunction. We aimed to investigate the effect of water ingestion on autonomic activity measured as heart rate variability (HRV) and gastric myoelectrical activity measured by electrogastrography (EGG) in patients with CeD. The study included 53 patients with CeD and 50 healthy controls: mean (SD) age, 43.4 (14.8) years and 44.1 (9.2) years, respectively. Electrocardiography with HRV analysis and simultaneous 4-channel EGG was performed before and after the water load test (WLT) ingestion 500-ml water over 5 minutes. We found that compared with controls, at fasting, patients with CeD showed a reduced percentage of normogastria (P=0.045) and an average percentage of slow wave coupling (P<0.01) with increased dominant power (DP) (P<0.001). Moreover, water ingestion in CeD patients reduced the percentage of gastric arrhythmia (P<0.01) and increased the percentage of normogastria (P<0.01) and DP (P<0.01). Finally, in the CeD group, water ingestion increased HRV indices: low frequency by 116.9% (P<0.001), high frequency by 125.3% (P<0.01), but they did not reach the values of the control group. Patients with CeD showed a smaller increase in parasympathetic autonomic activity after the WLT than controls. Altered autonomic responsiveness may contribute to the disturbances of gastric myoelectrical activity and depends on baseline autonomic activity.

The role of cardiovascular magnetic resonance imaging with T1 and T2 mapping in sudden cardiac death survivors

Background

Sudden cardiac death (SCD) in the adult population is poorly studied, although determining its etiology is crucial for management and prognosis [1]. Cardiovascular magnetic resonance imaging (CMR) is being increasingly utilized in SCD survivors [1,2]. The role of late gadolinium enhancement (LGE) imaging in patients with recent SCD and no significant coronary artery disease (CAD) is well established, but there is no data on the additive role of T1 and T2 mapping [1–3].

Purpose

This is a retrospective study to assess the role of CMR including T1 and T2 mapping in SCD survivors.

Methods

Between 01/2016 and 12/2019, we retrospectively analyzed patients who underwent CMR on a Siemens Magnetom Avanto 1.5 T scanner within 4 weeks of SCD. CMR protocol included cine imaging, T1 and T2 mapping, and LGE imaging. Native and post-contrast myocardial T1 values were measured within the septum on the mid short axis (SAX) and extracellular volume fraction was calculated using the standard formula. T2 values were measured in six mid segments on the mid SAX map. Additional measurements were performed if long axis T2 maps were available. Clinical data, electrocardiography (ECG), transthoracic echocardiography (TTE), coronary computed tomography angiography (CCTA), and left heart catheterization (LHC) were reviewed from the electronic health record. An ischemic evaluation was performed in 33 (94%) of patients.

Results

A total of 35 patients who underwent CMR for SCD were included for analysis (mean age 46.9±14.1 years; 20 (57%) male). SCD etiology was established based on clinical data, ECG, TTE, CCTA, and LHC in 9 (26%) patients. CMR provided the most probable SCD etiology in an additional 20 (57%) patients with T1 and T2 mapping abnormalities seen in 18 (51%) patients. Diagnoses determined by CMR included myocarditis (35%), hypertrophic cardiomyopathy (CMP) (20%), left ventricular non-compaction CMP (15%), dilated CMP (10%), takotsubo CMP (5%), and myocardial infarction with non-obstructive CAD (15%) (Table, Figure). Elevated native T1 was seen in 15 (43%) (mean T1 1069±60 ms; site specific normal &lt;1080 ms), elevated ECV in 16 (46%) (30±7%; site specific normal &lt;29%), and elevated native T2 in 22 (63%) patients (65±10 ms; site specific normal &lt;60 ms). LGE was present in 31 (89%) patients. The etiology of SCD remained unknown in 6 (17%) patients despite extensive testing including CMR.

Conclusions

CMR has significant diagnostic and prognostic value in assessing SCD etiology compared to non-CMR based evaluation. Myocarditis is a common underdiagnosed cause of SCD in adult patients well seen in a CMR protocol with T1 and T2 mapping. Myocardial inflammation monitoring in SCD survivors with serial CMRs using T1 and T2 mapping could influence clinical decision making by justifying pharmacotherapy modification and timing of ICD implantation. To conclude, CMR with T1 and T2 mapping provides high diagnostic yield in the investigation of SCD etiology.

Funding Acknowledgement

Type of funding sources: None.

Rapid cardiovascular magnetic resonance protocol utilizing compressed sensing real-time imaging during the COVID-19 pandemic

Funding Acknowledgements

Type of funding sources: None.

Background

Coronavirus Disease 2019 (COVID-19) poses many workflow challenges for healthcare systems. Elective cardiovascular magnetic resonance (CMR) exams were postponed until safety protocols were instituted. Since reopening, imaging labs are managing COVID-19 safety triaging, exam backlog, and increased referrals, thus innovative solutions for process improvement are needed.

Purpose

An accelerated compressed sensing (CS) real-time (RT) technique offers dynamic cardiac imaging with high spatial and temporal resolution without image degradation. We sought to evaluate the efficiency of a rapid RT CMR protocol with a goal to decrease scan time without compromising study quality and comprehensiveness.

Methods

We retrospectively evaluated 219 CMRs (Siemens Magnetom Sola 1.5T) performed 09/01/2020 - 10/15/2020. After excluding 81 exams due to heterogeneous protocols (Figure 1), we analyzed 138 CMR exams using standard cardiomyopathy or myocarditis protocols. CMR studies utilized either a rapid RT short axis (SAX) cine (spatial resolution of 2.5 mm2 or better and temporal resolution of 55 ms or better) or standard breath-held (BH) SAX cine protocol (Figure 2).  Protocols were chosen by the interpreting physician. Previous internal quality control demonstrated similar volumetric quantification between RT and BH SAX cines. RT cines were reconstructed inline using a CS-based method.  We analyzed the length of time needed to complete each protocol and the number of series performed. Statistical analysis included student t-test with p value &lt;0.05 considered significant.

Results

Of 138 analyzed CMR exams, there were 23 rapid protocols and 115 standard protocols performed. The mean image acquisition time for the rapid protocol was significantly shorter at 26 ± 6 minutes (range 18-44 min) vs 33 ± 6 minutes (range 22-49 min) for the standard protocol, p &lt; 0.001. This represents a mean relative reduction in scan time of 21%. More time was saved in rapid myocarditis (scan time 25 ± 6 min vs 34 ± 6 min, p = 0.01; relative time reduction 26%) vs rapid cardiomyopathy protocols (scan time 27 ± 6 min vs 31 ± 6 min, p = 0.04; relative time reduction 13%). There was no significant difference in the number of series performed (62 ± 14 series in rapid vs 67 ± 11 series in standard protocols, p = 0.09).  T1 and T2 maps constituted the same percentage of acquired images regardless of protocol used (T1 maps 1.8% vs 1.7% for cardiomyopathy, 1.4% vs 1.4% for myocarditis in standard vs rapid protocols respectively; T2 maps 1.8% vs 1.7% for cardiomyopathy, 5.6% vs 5.8% for myocarditis in standard vs rapid protocols respectively).

Conclusions

A rapid CMR protocol utilizing a CS-based RT imaging is significantly shorter as compared to the standard protocol with adequate diagnostic quality. Rapid CMR protocols are an effective tool for process improvement during the COVID-19 pandemic.

The effect of visceral reception activation (water load test) on autonomic activity and gastric myoelectric activity in gastrointestinal malignancies

OBJECTIVES

The aim of this study was to analyze the effect of water load test (WLT) on heart rate variability (HRV), blood pressure variability (BPV), hemodynamic parameters and gastric myoelectric activity in gastrointestinal (GI) cancer patients.

BACKGROUND

WLT activates gastrointestinal mechanoreception and osmoreception, and hence, can indirectly modulate autonomic activity.

METHODS

Eighty patients (mean age 61.2 years) were enrolled, along with the group of healthy controls. HRV, BPV and electrogastrography (EGG) were recorded at rest (in a fasted state) and after water uptake at 100 ml/min.

RESULTS

WLT contributed to an increase in the percentages of normogastria time, from 37.3 % to 50.0 % (p=0.02) and from 42.3 % to 47.7 % (p=0.01), respectively in colon and rectal cancer. Cancer patients presented lower values of HRV indices determined on linear analysis at rest and after WLT.

CONCLUSIONS

A slight predominance of the sympathetic component was observed in response to WLT, which was reflected by changes in hemodynamic parameters. The response to WLT is a consequence of GI mechanoreception and osmoreception activation and resultant pressure reaction. This effect was disrupted by the neoplastic process within the GI tract, especially in gastric and colon malignancies, but not in rectal cancer (Tab. 2, Fig. 12, Ref. 40). Text in PDF www.elis.sk Keywords: autonomic nervous system, gastric myoelectric activity, water uptake, heart rate variability, blood pressure variability, gastrointestinal cancer.

Urinary neutrophil gelatinase-associated lipocalin, kidney injury molecule-1, uromodulin, and cystatin C concentrations in an experimental rat model of ascending acute kidney injury induced by pyelonephritis

Recent evidence suggests that neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule-1 (KIM-1), cystatin C (CysC), uromodulin (UMOD), and some interleukins (IL-6 and IL-18) can be considered as diagnostic markers of acute kidney injury (AKI). The aim of this study was to verify the applicability of four urinary (u) markers, namely uNGAL, uKIM-1, uCysC, and uUMOD, for the diagnosis of ascending AKI induced by bacterial pyelonephritis. The study included 30 female rats that were divided into three groups (n = 10 each) and were inoculated transurethrally with various doses of Escherichia coli to induce isolated pyelonephritis (group 1, 10⁵ CFU/ml), pyelonephritis-induced AKI (group 2, 10⁷ CFU/ml), or AKI and urosepsis (group 3, 10⁹ CFU/ml). The inoculate contained a highly virulent E. coli strain isolated from a patient with pyelonephritis. Urine samples were obtained prior to the inoculation and 7, 14, and 21 days thereafter. The concentrations of all assessed proteins were determined in the urine samples by ELISA. All the study groups showed elevated concentrations of uNGAL and uCysC at all study time points. The concentrations of uKIM-1 in group 1 were the same as that at the baseline, whereas it was elevated in groups 2 and 3 at all study time points. The concentrations of uUMOD in groups 1 and 2 tended to decrease with the time from inoculation, whereas it rapidly increased in group 3 at 21 days postinfection. uKIM-1 seems to be the only marker of ascending AKI associated with urinary tract infection. Elevated concentrations of uNGAL, uCysC, and uUMOD were found in both AKI and isolated pyelonephritis. Thus, it can be concluded that none of these markers can be used as a single diagnostic marker of ascending AKI, as it may produce false-negative results, leading to incorrect diagnosis, lack of adequate treatment, and increased mortality risk.

Changes in viability of rat adipose-derived stem cells isolated from abdominal/perinuclear adipose tissue stimulated with pulsed electromagnetic field

Previous experiments demonstrated that low-frequency electromagnetic field (LF-EMF) may activate cellular death pathways in proliferating cells. Therefore, we hypothesized that LF-EMF may also influence viability of highly proliferating undifferentiated adipose-derived stem cells. Obesity is classified as a civilization disease; its etiopathogenesis is presumed to include both genetic predisposition and influence of modified environmental factors, such as unbalanced diet with excess calories and/or too low physical activity. Obesity may lead to a number of metabolic disorders, including type 2 diabetes mellitus, cardiovascular diseases (associated with atherosclerosis) related to primary hypertension and ischemic heart disease, myocardial infarction and other complications. The aim of this study was to verify if LF-EMF alters viability parameters of adipose-derived stem cells (ADSCs) isolated from rats, cultured in vitro and exposed to pulsed electromagnetic field (PEMF; 7 Hz, 30 mT). ADSCs were obtained from healthy rats and animals with experimentally-induced obesity, both males and females, pups and adults. The animals were fed with chow with either low (LF diet) or high fat content (HF diet) for 21 days. Then, ADSCs were isolated from extracted adipose tissue and used to establish cell cultures. ADSCs from the first passage were exposed to PEMF three times, 4 hours per exposure, at 24-h intervals (experimentally developed protocol of PEMF stimulation). 24 hours after the last exposure to PEMF, viability parameters of ADSCs were analyzed by flow cytometry (FCM). The study demonstrated that LF diet exerted a protective effect on PEMF-exposed ADSCs, especially in the case of male and female pups. In turn, the proportion of early apoptotic cells in PEMF-treated ADSC cultures from adult female rats maintained on HF diet turned out to be significantly higher than in other experimental groups.

Interstitial cells of Cajal - systematic review

This paper reviews the distribution of interstitial cells of Cajal (ICC) in the human gastro-intestinal (GI) tract, based on ultrastructural and immunohistochemical evidence. The distribution and morphology of ICC at each level of the normal GI tracts is addressed from the perspective of their functional significance. Alterations of ICC reported in as well as in GI stromal tumours are reviewed, with emphasis on the place of ICC in the pathophysiology of disease.

Type of desmin expression in cardiomyocytes - a good marker of heart failure development in idiopathic dilated cardiomyopathy

AIM

The aim of this study was to determine whether remodelling of the desmin (DES) cytoskeleton affects myocardial function and whether it could be a useful marker of disease progression in patients with idiopathic dilated cardiomyopathy (IDCM).

MATERIAL AND METHODS

Endomyocardial biopsy was performed in 195 IDCM patients, and five to six specimens were collected from the left ventricle. DES expression was evaluated using tissue immunostaining and Western blotting. The study population was assigned to four groups according to DES expression type: I, normal DES staining at Z-lines giving a regular pattern of cross-striation (n = 57); IIA, increased DES staining with a regular pattern of cross-striation (n = 40); IIB, increased DES staining with an irregular pattern of cross-striation and/or the presence of aggregates (n = 56); and III, decreased/lack of DES staining (n = 42). Fibrosis, cardiomyocyte hypertrophy and ultrastructure were assessed for the four types of DES expression.

RESULTS

The pathological types of DES expression (IIB or III) were associated with pathological changes in mitochondria and the contractile apparatus. Cardiomyocyte diameter and level of fibrosis were both significantly affected. DES expression type correlated with NYHA class, left ventricular end-diastolic diameter, left ventricular ejection fraction and the level of N-terminal pro-brain natriuretic protein.

CONCLUSION

The type of immunohistochemical DES expression correlated with the level of myocardial injury at the cellular and organ levels. This correlation was similar to that observed between DES expression and the well-established biochemical, echocardiographic and clinical parameters of heart failure (HF). DES expression type could be used as an important diagnostic feature of HF development.

Functional, histological structure and mastocytes alterations in rat urinary bladders following acute and [corrected] chronic cyclophosphamide treatment

Neurogenic inflammation is linked to urinary bladder overactivity development. Cyclophosphamide (CYP) damages all mucosal defence lines of urinary bladder and induces cystitis with overactivity. The aim of this study was to estimate the effect of CYP on rat urinary bladder function, histological structure and mastocytes numbers following acute and chronic CYP treatment. Fourty two female rats were divided into four groups: I (control), II (acute cystitis), III (chronic cystitis), IV (sham group). Acute and chronic cystitis were induced by CYP in single dose and four doses (1(st), 3(rd), 5(th), 7(th) day), respectively. In group I-III the cystometric evaluation was performed. Sections of the bladder were stained with HE and toluidine blue for the detection of mastocytes. The severity of inflammation was examined according to mucosal abrasion, haemorrhage, leukocyte infiltration and oedema. Acute and chronic CYP treatment caused inflammatory macroscopic and microscopic changes (mucosal abrasion, haemorrhage, oedema) and increased infiltration of inflammatory cells in urinary bladder. Acute treatment induced the infiltration of mastocytes within bladder wall contrary to chronic one decrement. Acute treatment caused more severe mucosal abrasion, whereas chronic one revealed more developed haemorrhage changes. Additionally, cystometric evaluation revealed urinary bladder overactivity development in both types of cystitis. Basal pressure and detrusor overactivity index after acute treatment increased considerably in comparison with the increase obtained after chronic one. Our results proved that acute model of CYP-induced cystitis in rats is more credible for further evaluation of neurogenic inflammation response in pathogenesis of overactive bladder as compared to chronic one.

Physiological and morphological effects of long-term vagal stimulation in diet induced obesity in rats

Some previous studies have shown suppressive effect of the vagal nerve stimulation (VNS) on long - term feeding regulation in rats. We assessed body weight, interstitial cells of Cajal (ICC), myenteric plexus neurons, mast cells in the stomach, duodenum and colon and c-Fos expression in nodose vagal ganglia in the rats with VNS. Male Wistar rats were implanted with microchip (MC) and kept during the whole study (100 days) on high calorie diet. Left vagal nerve was stimulated by electrical pulses (10ms, 200mV, 0.05Hz) generated by MC. After finishing the experiments tissue samples (stomach, duodenum, colon and nodosal vagal ganglia) were taken. Mast cells were toluidine blue stained and counted in mucosa, muscularis externa and serosa. For immunostaining, antibodies for ICC (CD117), myenteric plexus neurons (PGP9.5) and c-Fos were used. Positive cells were assessed by image analysis. Chronic microchip vagal stimulation significantly decreased epididymal fat pad weight, meal size with effect on decreased weight gain in VNS rat. VNS significantly increased mast cells number in all examined parts of the gastrointestinal wall, mainly in the muscularis. There were no significant differences in ICC and myenteric plexus neurons between VNS and control. Expression of c-Fos in nodosal ganglia was higher in VNS group. The effects observed during long-term VNS concern predominantly mast cells. These data support the theory that VNS can increase vagal afferent satiety signals leading to reduced food intake and body weight gain and mast cells are involved in this process.

Magnetically induced vagus nerve stimulation and feeding behavior in rats

Vagus nerve (VN) contribute to the bidirectional communication between the gastrointestinal tract and the central nervous system. Stimulation of the VN by a magnetically-driven solenoid with parameters similar to those during food-induced stomach distension has been thought to mimic short-term signaling of satiety and suppress food intake. In this study, the determination of optimal parameters of vagal neuro-modulation to achieve decreased food intake with a resulting reduction in body mass of rats is explored as therapy to treat obesity. The experimental design consisted of three groups of obese adult male Wistar rats: Group 1: VEMF - with solenoid's electrodes placed on the left VN in the magnetic field exposure (MFE); Group 2: EMF - without solenoid's electrodes on the VN in MFE; Group 3: CON - without solenoid's electrodes on the VN outside the MFE. This study suggests that the rats with solenoid's electrodes placed on the left VN significantly decreased their food intake, weight gain and serum leptin concentrations when compared to that of the CON group. PP levels were found to be higher in the VEMF group when compared to the controls groups. It was found that the most effective parameters of vagal stimulation on eating behavior were 3631, 7861, 14523 A(2) x h/m(2). The magnetic field by unknown mechanisms also influences feeding behavior. This study suggests that vago-vagal reflexes are involved in the feeding homeostasis and that neuromodulation might be an effective method for managing obesity. Further studies are required to confirm these effects in humans.

The vagal afferents discharge and myoelectrical activity in the gastric hyperalgesia model in rats

A long term exposure of the gastric mucosa to inflammatory factors is suspected to alter the normal stomach motility. The consequence of it is an abnormal sensomotor response to food causing dyspeptic symptoms. Our study aimed to investigate the vagal afferents activity and the gastro-duodenal slow wave response to the mild gastric mucosa inflammation in rats. The gastric mucosal inflammation was induced by addition iodoacetamide to drinking water for 5 days. The gastro-duodenal slow wave, vagal nerve recordings and the gastric mucosa examination were performed on 6th day. The iodoacetamide irritated gastric mucosa presented the minimal inflammatory infiltration with mast cells. The vagal afferent activity was significantly increased after iodoacetamide treatment from 0.3 +/- 0.1 to 1.9 +/- 0.58 Hz, (p<0.05). The gastric slow wave accurate frequencies extracted from the fast Fourier transform spectra accelerated from 0.08 +/- 0.01 to 0.1 +/- 0.02 Hz (p<0.05). The duodenal frequencies remained unchanged (from 0.64 +/- 0.02 to 0.59 +/- 0.1 Hz). These results suggest that mild gastric mucosa irritation sensitizes vagal afferents and alters gastric but not duodenal pacemaker activity which may contribute to dyspeptic sensations.

Melatonin and serotonin effects on gastrointestinal motility

The gastrointestinal tract represents the most important extra pineal source of melatonin. Presence of melatonin (M) suggests that this hormone is somehow involved in digestive pathophysiology. Release of GI melatonin from serotonin-rich enterochromaffin EC cells of the GI mucosa suggest close antagonistic relationship with serotonin (S) and seem to be related to periodicity of food intake. Food deprivation resulted in an increase of tissue and plasma concentrations of M. Its also act as an autocrine and paracrine hormone affecting not only epithelium and immune system but also smooth muscle of the digestive tract. Low doses M improve gastrointestinal transit and affect MMC. M reinforce MMCs cyclic pattern but inhibits spiking bowel activity. Pharmacological doses of M delay gastric emptying via mechanisms that involve CCK2 and 5HT3 receptors. M released in response to lipid infusion exerts a modulatory influence that decreases the inhibitory effects of the ileal brake on gastric emptying. On isolated bowel S induces dose dependent increase in tone and reduction in amplitude of contraction which is affected by M. M reduced the tone but not amplitude or frequency of contraction. M is a promising therapeutic agent for IBS with activities independent of its effects on sleep, anxiety or depression. Since of its unique properties M could be considered for prevention or treatment of colorectal cancer, ulcerative colitis, gastric ulcers and irritable bowel syndrome.

Vacuum and forceps training in residency: experience and self-reported competency

OBJECTIVE

Determine chief residents' experience with vacuum and forceps deliveries and self-perceived competencies with the procedures.

STUDY DESIGN

Study 1: A written questionnaire was mailed to all fourth year residents in US RRC approved Ob/Gyn programs. Study 2: The study was replicated using a web-based survey the following year. Data were analyzed with chi (2) and Wilcoxon Signed Rank tests using SPSS.

RESULTS

Surveys were received from 238 residents (20%) in Study 1 and 269 residents in Study 2 (23%, representing 50% of all residency programs). In both studies, residents reported performing significantly less forceps than vacuum deliveries. Virtually all residents wanted to learn to perform both deliveries, indicated attendings were willing to teach both, and felt competent to perform vacuum deliveries (Study 1, 94.5%; Study 2, 98.5%); only half felt competent to perform forceps deliveries (Study 1, 57.6%; Study 2, 55.0%). The majority of residents who felt competent to perform forceps deliveries reported that they would predominately use forceps or both methods of deliveries in their practice (Study 1, 75.8%; Study 2, 64.6%). The majority of residents who reported that they did not feel competent to perform forceps deliveries reported that they would predominately use vacuum deliveries in their practice (Study 1, 86.1%; Study 2, 84.2%).

CONCLUSION

Current training results in a substantial portion of residents graduating who do not feel competent to perform forceps deliveries. Perceived competency affected future operative delivery plans.

Effect of long-term vagal stimulation on food intake and body weight during diet induced obesity in rats

Regulation of food intake and body weight is accomplished by several mechanisms. CNS receives information from periphery and modifies food intake mainly by vagal nerves that provide the major neuroanatomical link between gastrointestinal sites stimulated during food intake and CNS sites that control feeding behavior and metabolism. Gastric mechanoreceptors and jejunal chemoreceptors activated by food or vagal nerve stimulation (VNS), which mimic the physiological input, suppress feeding within short-term regulation. Our research was aimed on determination the role of electrical VNS in long-term control of food intake and body weight in diet induced obesity fed rats. Food intake, body weight and epididymal fat pad were assessed in male Wistar rats divided into three groups (controls vs. VNS). Rats were implanted with microchip and kept during the whole study (100 days) on diet induced obesity. Vagal nerve was stimulated by electrical rectangular pulses duration 10 ms, amplitude 200 mV, frequency 0.05 Hz generated by microchip. In control group surgery produced no significant changes in meal size and body weight gain as compared to intact group. In contrast, significantly decreased epididymal fat pad weight, decreased meal size with effect on decreased weight gain was observed in VNS rats. Data support theory that VNS can increase vagal afferent signal conduct to CNS and mimics the satiety signals leading to reduce food intake and body weight gain.

Patient characteristics influencing quality of life in gynecologic cancer

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Background: The Functional Assessment of Cancer Therapy general (FACT) questionnaire was developed to assess disease and treatment specific issues affecting patients’ quality of life (QoL). Factors other than cancer and its treatment, such as age, general physical and emotional health, and socio-economic status, may have significant effects on QoL and patients’ response to treatments. This study examined the effect of these variables on the domains of the FACT in gynecologic oncology patients undergoing surgery for pelvic mass suspected to be malignant or endometrial cancer. Methods: Demographic information and patient characteristics were obtained pre-operatively. Patients also completed the FACT and the SF-36, a general health questionnaire that measures physical and mental well-being but is not designed to be sensitive to the detection of small treatment effects. Correlation and multiple regression analysis were used to assess the effect of diagnosis, age, body mass index (BMI), educational level, marital status, smoking status, physical (PCS) and mental (MCS) summary scores of the SF-36 on FACT domain scores. Results: Data were collected on 157 women at their pre-operative visit (endometrial cancer, n=45; benign masses, n=79; ovarian cancer, n=33). PCS, MCS and age were positively correlated with scores on the FACT, while BMI and smoking were negatively correlated ( Table ). Educational level was negatively correlated with scores on the social domain but positively correlated with physical scores on the FACT. PCS and MCS accounted for a significant amount of the variance (R2) in regression models for each of the FACT domains ( Table ). Conclusion: Patients’ QoL, as measured by a questionnaire that is sensitive to their disease and treatment, is affected by their baseline characteristics. As treatment options become more complex, these variables are likely to be of increasing importance in evaluating QoL.

[Table: see text]

No significant financial relationships to disclose.

Peripheral mechanisms of intestinal dysmotility in rats with salsolinol induced experimental Parkinson's disease

Gastrointestinal dysmotility in Parkinson's disease (PD) has been attributed in part to peripheral neurotoxine action. Our purpose was the evaluation of the salsolinol effect on intramuscular interstitial cells of Cajal (ICC), duodenal myoelectrical activity (DMA) and vagal afferent activity (VAA) in rats with experimental PD. Twenty rats were divided into 2 equal groups. Experimental PD was produced in one group by 3 weeks of the intraperitoneal salsolinol injections (50 mg/kg/day), whereas the 2-nd group served as control. DMA and VAA were recorded in both groups during fasting and stepwise--gastric distension (GD) of 10 ml. Subsequently fragments of duodenum were removed and intramuscular ICC were assessed as c-Kit antigen percentage in the duodenal muscular zone. Analyses of the fasting DMA and VAA recordings didn't reveal differences between the compared groups. During GD increase of DMA dominant frequency (p=0.04) and VAA frequency (p<0.01) was observed in the controls whereas in the salsolinol group both parameters remained unchanged. Image analysis of duodenum revealed decreased c-Kit expression in the salsolinol-injected animals (p=0.05). The results of our study may suggest the direct effect of salsolinol on both ICC and neuronal pathways of gastro-duodenal reflexes.

Peripheral mechanisms of intestinal dysmotility in the morphine tolerant and dependent rats

Changes of intestinal motility and transit produced by tolerance to and dependence upon morphine have been partly attributed to peripheral mechanisms. We evaluated the effect of chronic peripheral morphine administration and peripheral mu-receptor blockade on vagal afferent activity (VAA) and c-Kit positive intramuscular cells of Cajal (ICCs). Ten rats were subjected to chronic subcutaneous morphine infusion for 72 h with subsequent VAA recording. Potential frequency was evaluated within recordings before and after mu receptor blockade by (D)-Phe -Cys -Tyr -(D)-Trp -Orn -Thr -Phe -Thr (CTOP) i.p. injections. Afterwards the rats were sacrificed and intramuscular c-Kit antigen expression was assessed by image analysis within removed fragments of duodenum and ascending colon. An equal group of rats served as a control for VAA and c-Kit expression. Analysis of VAA revealed similar frequencies of potentials in morphine tolerant / dependent rats before CTOP and in the controls. CTOP increased potential frequency in the morphine group which effect was visible mostly within the first 20 minutes (p=0.01). The morphine infused animals presented also higher c-Kit expression in both the duodenum (p<0.001) and the ascending colon (p<0.001) in comparison to the control group. Results of our study may indicate the involvement of both the intestinal wall and the long vago-vagal reflexes in tolerance to and dependence upon opioids.

Loss of interstitial cells of Cajal after pulsating electromagnetic field (PEMF) in gastrointestinal tract of the rats

Exposure to the magnetic field has remarkably increased lately due to fast urbanization and widely available magnetic field in diagnosis and treatment. However, biological effects of the magnetic field are not well recognized. The myoelectric activity recorded from the gastrointestinal and urinary systems is generated by specialized electrically active cells called interstitial cells of Cajal (ICCs). Thus it seems rational that ICC have significant vulnerability to physical factors like an electromagnetic field. The aim of this study was to evaluate the influence of pulsating electromagnetic field (PEMF) (frequency 10 kHz, 30ms, 300 muT burst, with frequency 1Hz) on ICCs density in the rat gastrointestinal tract. Rats were divided into two groups (n=32). The first group was exposed to PEMF continuously for 1, 2, 3, and 4 weeks (n = 16), and the second group (n=16) served as a control. Tissue samples of the rat stomach, duodenum and proximal colon were fixed and paraffin embedded. The tangential sections of 5 microm thickness were stained immunohistochemically with anti-c-Kit (sc-168) antibody and visualized finally by DAB as chromogen (brown end product). C-Kit positive branched ICC-like cells were detected under the light microscope, distinguished from the c-kit-negative non-branched smooth muscle cells and from the c-kit positive but non-branched mast cells and quantitatively analyzed by MultiScan computer program. Apoptosis detection was performed with rabbit anti-Bax polyclonal antibody (Calbiochem, Germany) and LSAB 2 visualization system. The surface of c-Kit immunopositive cells decreased after exposure to PEMF in each part of the gastrointestinal tract. Reduced density of ICCs was related to exposure time. The most sensitive to PEMF were ICCs in the fundus of the stomach and in the duodenum, less sensitive were ICCs in the colon and pacemaker areas of the stomach. No marked changes in ICC density in the pyloric part of the stomach were observed. We demonstrate that the PEMF induced apoptosis dependent decrease in ICC expression.

The nomographic design approach to recycled water reatment by the nitritation process

The side-stream generated recycled water in the wastewater treatment plants is characterized as high in both nitrogen concentration and fluctuation of load. Thus, the design approach for recycle water management became an important part of the biological nutrient removal system design. The application of nitrogen removal from recycled water using the nitritation process has recently been increased due to economical reasons associated with an effective carbon allocation as well as the minimization of aeration cost. The concept of nitritation reactor design related to an inhibition of nitrite oxidizer has not been fully practiced in reality because of the limited field experiences. In this paper, a new approach has been proposed to determine reactor size and oxygen requirement in nitritation process design. The SRT-based design approach has been examined based on a series of laboratory experiments.

[Reproduction of the bird Mimus gilvus (Passeriformes: Mimidae) in Maracaibo, Venezuela]

Four pairs of the poorly understood tropical mockingbird Mimus gilvus were captured and color banded at a grassland in Maracaibo, Venezuela in June 1997. Throughout the following 8 months, individuals were observed two days per week for 4 hours each. We recorded courtship behaviour, nest construction, incubation, parental care, territory defense and timing of reproductive cycle. Pairs lived in defined territories defended primarily by the male. Both sexes participated in nest building which began at the start of two rainy seasons: April and October. Between April and June, 80% of nests were parasited by the shiny cowbird (Molothrus bonariensis). No parasitism was recorded in the later nesting season. Consequently, breeding success for the April and October seasons was 20% and 83% respectively. Only the female incubated and the mean clutch size was 2.2 eggs.

[Measurement of vascular density in proliferative lesions of the thyroid gland]

In the present study vascular density was measure in histopathological slides of the simple goiter (15 cases) and of the same proliferative condition of the thyroid gland (113 cases) including adenoma (29 cases) and carcinoma (16 cases). Epithelial antibody CD31 and vWF identified vessels with the help of semiautomatic image analysis system. It has been shown that the highest values were typical for neoplastic tumors. However significant overlap has been shown. Statistically significant differences were very weakly seen between neoplasm's and thyroid hyperfunction. Also differences between carcinomas and adenomas were of low significance. Probably this is because of great heterogeneity of carcinomatosus neoplasms included in this study. Unexpectedly there were also no statistically significant differences between simple goiter, hyperplasia and thyroid hyperfunction.

[Cytoimmunologic changes in material obtained from bronchoalveolar lavage (BAL) in asymptomatic individuals chronically exposed to silica dust]

The aim of this study was to determine and to evaluate silica induced lung cell reactivity--if any--in bronchoalveolar space, before clinical changes develop. Bronchoalveolar lavage (BAL) was carried out in 15 nonsmoking individuals with chronic professional silica exposure, free of lung signs and symptoms. Controls were healthy nonsmokers. Routine BAL cytology (HE, MGG) was completed by mast cell staining (toluidine blue). BAL lymphocyte subsets were phenotyped by direct two- and three-color immunofluorescence (applied DAKO A/S monoclonal antibodies: anti-CD3, CD4, CD8, CD11b, CD14, CD15, CD16 + 56, CD19, CD25, CD45, HLA-DR). Parallel staining was performed in peripheral blood. In individuals with chronic silica exposure we found: significant increase in alveolar macrophage (362 +/- 45 vs 160 +/- 33 x 10(3) cells/ml, p < 0.05), lymphocyte (61 +/- 9 vs 24 +/- 5 x 10(3) cells/ml, p < 0.05) and BAL total cell (415 +/- 76 vs 187 +/- 34 x 10(3) cells/ml, p < 0.05) numbers; significant increase in mast cell (0.4 +/- 0.1 vs 0.2 +/- 0.1, p < 0.05), NK cell (7.0 +/- 1.8 vs 3.6 +/- 1.0, p < 0.05) and Th early activated lymphocyte percent (CD4 + CD25+ calculated as percentage of CD4+ cells: 15.1 +/- 1.5 vs 7.8 +/- 1.6, p < 0.01). All results were presented as median +/- SEM. Bronchoalveolar space of people with chronic silica exposure usually shows pathological reaction (especially macrophagic alveolitis), although they are free of manifested pulmonary disease. Th early activated lymphocytes, NK cells and mast cells seem to play important role in the early interstitial lung tissue reaction to silica.

[Morphometric analysis of cell nuclei and regional lymph node status with patients suffering from laryngeal carcinoma]

We analysed 61 patients suffering from squamous cell carcinoma of larynx, who were treated in the Department of Otolaryngology, Collegium Medicum, Jagiellonian University, Cracow. Seven parameters of the cell nuclei and their variance were studied with the aid of a computer-assisted system of image analysis. The slides were viewed with a high-resolution black and white camera (Mintron) connected to the computer with the frame graber card (512 x 512 pixels with 256 gray levels, Vist software) at x630 magnification with an Axiophot microscope. It was established that high values of nuclear area, perimeter, density, long or shot nuclear axis carry an increased risk of metastases to regional lymph nodes.

Extracellular polymeric substances in relation to nutrient removal from a sequencing batch biofilm reactor

Experimental investigations were performed to determine the possibility of simultaneous biological nitrogen and phosphorus removal during various biofilm processes in conjunction with biofilm characterisation, especially extracellular polymeric substance (EPS). Since biologial nitrogen removal requires an alternating exposure of anaerobic-anoxic-oxic conditions in the bulk liquid that surrounds the biofilm growth media, a sequencing batch reactor (SBR)-type operation was used. Various materials including expanded clay, polystyrene, polyurethane, and acrylic materials were used as the biofilm growth support medium. Simultaneous nitrogen and phosphorus removal was possible with SBR, but it was postulated that nutrient removal efficiencies varied with film thickness. Thinner biofilm promoted nitrification and phosphorus removal, but thicker biofilm enhanced denitrification and reduced phosphorus removal. EPS contents were similar regardless of support media types or biofilm configuration, but EPS contents gradually increased as the film growth continued after backwashing. EPS contents were increased with increased nitrogen removal, but it was difficult to define its relation with phosphorus removal. In addition, suspended solids removal was correlated well with the EPS content in the biofilms.

[Efficiency of artificial neural networks for prediction of regional lymph node metastasis]

A retrospective study of 90 patients suffering from laryngeal carcinoma who were surgically treated in the Department of Otolaryngology, Collegium Medicum, Jagiellonian University, Cracow, Poland, has been performed. In 26 patients metastases in regional lymph nodes has been found. Various clinical, histopathological and kariometric factors have been subject to analysis. The artificial neural networks techniques have been used for prediction of presence of metastases in lymph nodes. The artificial neural networks exhibit an ability to generalize, i.e. they can learn from exemplary sets of data. Therefore the patients data have been divided at random into two sets forming a learning set (70 patients) and a test set (20 patients). A series of simulations have been carried out, using networks of various architectures and experimentally selected learning parameters, giving the prediction results between 71% and 96% of correct recognitions. The best prediction results have been achieved for the network of triple layer perceptron type including 6 neurons in the hidden layer. The evaluation of factors related to the presence of metastases in lymph nodes has been also carried out using logistic regression method for several groups of patients including various numbers of cases. The data sets of the remaining patients have been used for testing the reliability of that statistical method, giving between 56% and 64% of correct recognitions. Therefore the possibilities of prediction of metastases presence in lymph nodes are better for the artificial neural networks method (up to 96% of correct classifications) i.m. comparison to the logistic regression method (only up to 64% of correct classifications for the same data sets).

Nuclear morphometry for the prediction of regional lymph nodes metastases in patients with cancer of the larynx

The changes in cell nuclei reflect their activity. Quantitative morphometric analyses of tumor nuclei could be instrumental in providing prognostic information. We studied whether, and if so, which specific nuclear parameters and histoclinical factors in patients with cancer of the larynx could be related to the lymph node metastases. Specimens were taken from 61 patients surgically treated in the Department of Otolaryngology, Jagiellonian University, Cracow, Poland, between 1987 and 1988. The period between the onset of the first symptoms and the actual commencement of the treatment spanned no more than 9 months. The follow-up period was no shorter than 5 years. Histologically confirmed metastases in the regional lymph nodes were found in 16 patients. The histologic grading and tumor front grading was pursued in all cases. Fourteen parameters of the nuclei were studied with the aid of a computer-assisted system of image analysis. The morphometric parameters and the histoclinical factors were analyzed by the chi(2) test and the stepwise logistic regression. It was established that nuclear area > or =66 microm (P = 0.042), perimeter > or =32 microm (P = 0.087), optical density > or =22,500 (P = 0.027), long axis > or =10.15 microm (P = 0.025), short axis > or =7.3 microm (P = 0.003), TFG assessed (> or =15 points) and tumor advancement (T3, T4) were related to more frequent metastases to the lymph nodes. The morphometric parameters of the greatest significance were short axis and optical density. The quantitative morphometric analysis could prove a useful tool in predicting metastases to the lymph nodes.

[Changes in lymphocyte subsets in bronchoalveolar lavage fluid in patients with systemic sclerosis]

The aim of this study was to estimate if alterations of lymphocyte subsets obtained by broncholaveolar lavage (BAL) were related to clinical data observed in nonsmoking patients with systemic sclerosis (SSc). Clinical examination included chest X-rays, spirometry and arterial blood gasometry. Patients were divided into group A (pulmonary changes present, n = 15) and B (without any changes, n = 7). Healthy subjects constituted the control group (n = 10). BAL lymphocytes were phenotyped using monoclonal antibodies coupling CD4, CD8 (both in coexpression with CD25), CD19 and HLA-DR human antigens and flow cytometer FACStar (Becton-Dickinson). Parallel staining was performed in peripheral blood. BAL lymphocyte typing was completed by BAL routine cytology. In SSc patients we found increased BAL total cell number, percentage of neutrophils, eosinophils and macrophage giant cells, as well as high percent of CD25+ and HLA-DR+ lymphocytes. In the group A neutrophilic alveolitis was observed in nearly half of cases: total lymphocyte number (per 1 ml of BAL fluid) and significantly reduced CD4/CD8 ratio were found. In the group B, as compared with controls, we found significantly elevated lymphocyte total cell number per 1 ml of BAL fluid (including particular subsets: CD3+, CD4+, CD8+). Also significantly high CD4+25+ lymphocyte percent was observed. Summing up, cytological and/or immunological alterations were observed in all examined SSc patients. The intensity of these alterations seems to be related to the clinical data. A decreased value of CD4/CD8 ratio may play a role in the local appearance of pulmonary changes in the course of systemic sclerosis.

The use of nuclear morphometry for the prediction of survival in patients with advanced cancer of the larynx

We examined retrospectively whether the quantitative morphometric analysis of nuclear shapes in patients with advanced cancer of the larynx could be used as a prognostic factor. In all, specimens were taken from 90 patients treated by surgery in the Department of Otolaryngology, Jagiellonian University, Cracow, Poland, between 1987 and 1988. The follow-up period was no shorter than 5 years. In the group examined there were 59 patients with T3 tumors and 31 with T4 tumors. A neck dissection was performed on one or both sides in each case. Metastases in regional lymph nodes were found in 26 patients. Histologic grading was assessed in all cases. Fourteen parameters of nuclear shape were studied using a computer-assisted system of image analysis. Morphometric data were compared with patients' survival rates. The worse survival rates were found to be linked with a nuclear area (NA) > or = 64.82 micron 2 and its standard deviation (SDNA) > or = 20.10 micron 2, a nuclear perimeter (NP) > or = 32.45 microns and its variation (SDNP) > or = 4.77 microns, nuclear density (ND) > or = 22,215.63 and its variation (SDND) > or = 6930.85 and nuclear roundness (NR) > or = 0.76. By using multivariate Cox regression analysis the SDND, presence of metastases in lymph nodes and low tumor differentiation were found to be independent prognostic factors. No statistically significant correlation was found between the parameters examined, lymph node status and tumor differentiation.

Influence of initial medium content (pH, serum and Ca++ concentration) on leukocyte migration test

The aim of the study was to check to what extent inhibition of leukocyte migration in capillary tubes depends on alteration in pH, serum content and Ca++ concentration in medium in which the test is started. We found that relatively wide variations of pH (between 6.4 and 8.2) did not influence the final result. The best conditions for leukocyte migration were created by addition of 5% calf foetal serum, whereas a contamination of medium with autologous serum made a proper interpretation of the test difficult because of a resulting dispersion of cells. Neither removal nor addition of Ca++ ions had a significant effect on migration of leukocytes, unless combined with a simultaneous presence of calcium ionophore A 23187 in 0.5 microM concentration.