Raman Optical Activity of 1T-TaS2

Measurements of optical activity can be readily performed in transparent matter by means of a rotation of transmitted light polarization. In the case of opaque bulk materials, such measurements cannot be performed, making it difficult to assess possible chiral properties. In this work, we present full angular polarization dependencies of the Raman modes of bulk 1T-TaS₂, which has recently been suggested to have chiral properties after pulsed laser excitation. We found that a mechanical rotation of the sample does not alter polarization-resolved Raman spectra, which can only be explained by introducing an antisymmetric Raman tensor, frequently used to describe Raman optical activity (ROA). Raman spectra obtained under circularly polarized excitation demonstrate that 1T-TaS₂ indeed shows ROA, providing strong evidence that 1T-TaS₂ is chiral under the used conditions of laser excitation. Our results suggest that ROA may be used as a universal tool to study chiral properties of quantum materials.

How are countries supporting health workers? Data from the COVID-19 Health System Response Monitor

Background

Health workers have been at the forefront of treating and caring for patients with COVID-19. They were often under immense pressure to care for severely ill patients with a new disease, under strict hygiene conditions and with lockdown measures creating practical barriers to working. This study aims to explore the range of mental health, financial and other practical support measures that 36 countries in Europe and Canada have put in place to support health workers and enable them to do their job.

Methods

We use data extracted from the COVID-19 Health Systems Response Monitor (HSRM). We only consider initiatives implemented outside of clinical settings where COVID-19 patients are treated, and therefore exclude workplace provisions such as availability of personal protective equipment, working time limits or mandatory rest periods.

Results

We show that countries have implemented a range of measures, ranging from mental health and well-being support initiatives, to providing bonuses and temporary salary increases. Practical measures such as childcare provision and free transport and accommodation have also been implemented to ensure health workers can get to their workplace and have their children looked after. Other initiatives such as offering continuing professional development credits for knowledge learnt during the crisis were also offered in some countries, albeit less frequently.

Conclusions

While a large number of initiatives have been introduced, often as ad-hoc measures, their effectiveness in helping staff is unknown in most countries. The effectiveness of these initiatives should be evaluated to inform future crisis responses and strategies for health workforce development.

Neuromorphic Binarized Polariton Networks

The rapid development of artificial neural networks and applied artificial intelligence has led to many applications. However, current software implementation of neural networks is severely limited in terms of performance and energy efficiency. It is believed that further progress requires the development of neuromorphic systems, in which hardware directly mimics the neuronal network structure of a human brain. Here, we propose theoretically and realize experimentally an optical network of nodes performing binary operations. The nonlinearity required for efficient computation is provided by semiconductor microcavities in the strong quantum light-matter coupling regime, which exhibit exciton-polariton interactions. We demonstrate the system performance against a pattern recognition task, obtaining accuracy on a par with state-of-the-art hardware implementations. Our work opens the way to ultrafast and energy-efficient neuromorphic systems taking advantage of ultrastrong optical nonlinearity of polaritons.

The Kidneys and the Liver as the Organs Regulating the Fibrinolytic System of the Circulating Blood

In experiments on rabbits it was shown by means of interruption and reestablishment of hepatic and renal circulation that these organs play an essential role in the regulation of the fibrinolytic system of the circulating blood. The kidneys are the source of the plasminogen activator secreted in the blood whereas the liver is responsible for the inactivation of the fibrinolytic system.

International Nosocomial Infection Control Consortium report, data summary of 50 countries for 2010-2015: Device-associated module

BACKGROUND

We report the results of International Nosocomial Infection Control Consortium (INICC) surveillance study from January 2010-December 2015 in 703 intensive care units (ICUs) in Latin America, Europe, Eastern Mediterranean, Southeast Asia, and Western Pacific.

METHODS

During the 6-year study period, using Centers for Disease Control and Prevention National Healthcare Safety Network (CDC-NHSN) definitions for device-associated health care-associated infection (DA-HAI), we collected prospective data from 861,284 patients hospitalized in INICC hospital ICUs for an aggregate of 3,506,562 days.

RESULTS

Although device use in INICC ICUs was similar to that reported from CDC-NHSN ICUs, DA-HAI rates were higher in the INICC ICUs: in the INICC medical-surgical ICUs, the pooled rate of central line-associated bloodstream infection, 4.1 per 1,000 central line-days, was nearly 5-fold higher than the 0.8 per 1,000 central line-days reported from comparable US ICUs, the overall rate of ventilator-associated pneumonia was also higher, 13.1 versus 0.9 per 1,000 ventilator-days, as was the rate of catheter-associated urinary tract infection, 5.07 versus 1.7 per 1,000 catheter-days. From blood cultures samples, frequencies of resistance of Pseudomonas isolates to amikacin (29.87% vs 10%) and to imipenem (44.3% vs 26.1%), and of Klebsiella pneumoniae isolates to ceftazidime (73.2% vs 28.8%) and to imipenem (43.27% vs 12.8%) were also higher in the INICC ICUs compared with CDC-NHSN ICUs.

CONCLUSIONS

Although DA-HAIs in INICC ICU patients continue to be higher than the rates reported in CDC-NSHN ICUs representing the developed world, we have observed a significant trend toward the reduction of DA-HAI rates in INICC ICUs as shown in each international report. It is INICC's main goal to continue facilitating education, training, and basic and cost-effective tools and resources, such as standardized forms and an online platform, to tackle this problem effectively and systematically.

Ambulatory physical activity during the initial training phase in a Naval Commando Unit

BACKGROUND

There is a positive correlation between the volume of physical activity performed and the incidence of lower extremity overuse injuries. Difficulty in evaluating the amount of activity in which highly specialised military units are engaged has prevented the implementation of a strict training programme designed to minimise overuse injuries.

PURPOSE

To quantify the ambulatory physical activity performed by trainees during the initial training phase in a Naval Commando Unit, with a view to developing more exact physical performance guidelines for the unit and the Israel Defense Forces, in general.

METHODS

Twenty-four accelerometers were worn by two teams each day. Trainees were instructed to wear the device on their non-dominant wrist 24 h a day, during all types of activities. Twice a week, the devices were collected, checked for damage and recharged, and the data were transferred to a computer.

RESULTS

Six trainees failed to complete the 9-week training period. Of the total 1512 accelerometer-days, 1075 readings (71%) were included in the study data. Trainees ambulated on average a distance of 15.5±8.61 km/day and 95.5 km/week. Accelerometer readings (estimated distances) were averaged each week for the two teams. The total distance measured over the 9-week study period was 911.15 km in team A and 808.38 km in team B. The total distance measured in both teams was, thus, almost double the planned 440 km (p=0.001).

CONCLUSIONS

Trainees greatly exceeded the planned safe distance. High variability was observed between trainees from the same team.

Characterization of novel CD55 isoforms expression in normal and neoplastic tissues

CD55 (decay-accelerating factor, DAF) is overexpressed in several types of cancer, including colorectal cancer. Because of its inhibitory effect on the complement system, it has been suggested as a possible target for cancer immunotherapy. However, CD55 is also expressed in normal tissues, body fluids and stroma, limiting the use of anti-CD55 therapeutic antibodies. Two novel CD55 splice variants or isoforms have recently been identified. These have been shown to contain part or all of intron 7 (CD55(int7+)), in contrast to the previously identified splice variants (CD55(wt)), which do not contain intron 7. Our aim was to determine the pattern of expression of the CD55(int7+) isoforms in normal and cancer tissues and to compare it to CD55(wt). We found that while CD55's isoforms levels vary directly, CD55(wt) is much more abundant (on average 48 times more) than CD55(int7+). Moreover, colon cancers that express high CD55(wt) mRNA levels tend to upregulate CD55(int7+) to a further extent. Finally, we compared the protein levels of CD55(int7+) to CD55(wt) by immunohistochemistry in various colorectal pathological conditions including neoplasia, and found that the levels of both isoforms were elevated in all types of colonic pathology. These results show that the levels of CD55(int7+) in normal tissue are much lower than CD55(wt), while in tumors it is restricted to the epithelial structures unlike CD55(wt). Thus, CD55(int7+) may be a more suitable target for cancer immunotherapy.

Peritoneal carcinomatosis from colorectal cancer: Not a lost cause

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Background: Patients who present with peritoneal carcinomatosis (PC) from colorectal cancer are considered terminal, with an expected median survival of 6-8 months. Therapy is often considered palliative and aggressive treatments are nihilistically ignored. This study investigates the clinicopathologic characteristics and clinical outcomes of CRC patients who present with PC.

Methods: This is a retrospective review of all patients who presented with stage IV CRC from 1/2000-12/2008 to a single, tertiary care institution. Patients with PC at the time of presentation were identified. Demographic data, clinicopathologic characteristics, treatment and survival data were collected and analyzed.

Results: 591 patients who presented with stage IV colorectal cancer were identified. Complete data was available on 216 patients. PC was confirmed in 106 patients (17.9%). PC was the only site of metastatic disease in 40 patients (6.7%). Compared with patients who did not have PC, patients with PC had significantly more right-sided primary tumors (28% vs 47%) and more mucinous tumors (7% vs 22%). The median overall survival for patients with isolated PC was 11.1 months as compared with 9.1 months for PC patients with extraperitoneal metastases (p = 0.5).

Conclusions: Patients with right-sided and mucinous primary colon cancers are at increased risk of developing PC. Despite a lack of aggressive therapy, patients with isolated PC achieved a 11 month median survival. Treating PC patients and patients at-risk for PC with optimal oncologic therapy, including cytoreduction and intraperitoneal chemotherapy, will improve survival and should be considered early in the management of PC patients.

No significant financial relationships to disclose.

Fatty acid composition of meat and adipose tissue from Krškopolje pigs and commercial fatteners in Slovenia

Abstract. The fatty acid composition of meat and subcutaneous adipose tissue of the indigenous Slovenian pig breed (Krškopolje, KP), which is raised extensively, was compared with that of commercial fatteners (CP) from intensive farms. Commercial fatteners were divided into three groups according to lean meat percentage: meaty, normal and fatty. The m. longissimus dorsi of Krškopolje pigs contained less C18:0 fatty acids than that of commercial fatteners and less C16:0 than that of the fatty group. The proportions of long chain fatty acids C20:4 n-6, C20:5 n-3 and C22:5 n-3 in the Krškopolje pigs and fatty groups were also significantly different. The highest proportion of essential C18:2 n-6 and C18:3 n-3 fatty acids were found in the meaty and normal groups. Intramuscular fat content of the m. longissimus dorsi did not differ between the Krškopolje pigs, and the fatty and normal groups. The Krškopolje pigs had the lowest proportion of saturated fatty acids (SFAs), while both the Krškopolje pigs and the fatty group have a lower proportion of polysaturated fatty acids (PUFAs) than the meaty group. The fatty group had a lower polyunsaturated : saturated fatty acid ratio than the meaty and normal groups. In the subcutaneous adipose tissue, Krškopolje pigs had the highest proportion of C18:1 n-9 and differed from the normal group in C18:0 content, from the fatty group in C16:1 n-7 and from the meaty and fatty groups in C18:2 n-6. Furthermore, the Krškopolje pigs had the highest monounsaturated fatty acids (MUFAs), and lower PUFAs and n-6 PUFAs proportions than the fatty group. The meaty group had a higher n-6 : n-3 PUFA ratio than the Krškopolje pigs.

White matter hyperintensities are significantly associated with cortical atrophy in Alzheimer's disease

BACKGROUND AND OBJECTIVE

Methodological variability in the assessment of white matter hyperintensities (WMH) in dementia may explain inconsistent reports of its prevalence and impact on cognition. We used a method of brain MRI segmentation for quantifying both tissue and WMH volumes in Alzheimer's disease (AD) and examined the association between WMH and structural and cognitive variables.

METHODS

A consecutive series of 81 patients meeting NINCDS-ADRDA criteria for probable AD was studied. Nineteen healthy volunteers of comparable age served as the control group. Patients had a complete neurological and neuropsychological evaluation, and a three dimensional MRI was obtained. Images were segmented into grey matter, white matter, and cerebrospinal fluid. WMH were edited on segmented images, and lobar assignments were based on Talairach coordinates.

RESULTS

Mild and moderate to severe AD patients had significantly more WMH than controls (p<0.05). WMH preferentially involved the frontal lobes (70%), were inversely correlated with grey matter cortical volume (R(2) = 0.23, p<0.001), and were significantly associated with vascular risk factors and with a worse performance on memory tasks.

CONCLUSION

Objective measurements of tissue volumes in AD demonstrated that WMH are significantly related to cortical atrophy and neuropsychological impairment.

Association between intensity of chlorhexidine use and micro-organisms of reduced susceptibility in a hospital environment

The potential for emergence of resistance to biocides has been a concern in recent years. This study tested whether an association exists between the intensity of chlorhexidine use and chlorhexidine susceptibility of micro-organisms isolated from patients in different clinical areas in an acute-care general hospital. Organisms frequently involved in nosocomial infections in the hospital were chosen for study over a six week period: Staphylococcus aureus (60 isolates), coagulase-negative staphylococci (48), Klebsiella pneumoniae (32), Pseudomonas aeruginosa (60), Acinetobacter baumannii (16) and Candida albicans (35). An index of chlorhexidine exposure for each clinical unit was derived for the year preceding organism collection. Chlorhexidine susceptibility was evaluated using agar incorporation minimum inhibitory concentrations (MICs) and disk diffusion. A statistically significant inverse correlation was shown between intensity of chlorhexidine use and the overall susceptibility of all study organisms taken together. There was no association when individual taxa were considered. These findings must be interpreted with caution considering that greater use of chlorhexidine is likely to occur in difficult clinical disciplines where antibiotic use, invasive procedures and other intensive care-related procedures, cross-infection and immunosuppression are all potential confounding factors. There was an excellent correlation between MICs and disk testing, suggesting that disk diffusion might be useful in studies involving more than one biocide.

Novelty enhances retrieval: molecular mechanisms involved in rat hippocampus

Rats exposed to a novel environment just prior to or 1-2 h, but not 4 or 6 h, before retention testing exhibited an enhanced retrieval of a one-trial inhibitory avoidance training. The bilateral intrahippocampal infusion of PD098059, an inhibitor of mitogen-activated protein kinase (MAPK), the specific upstream activator of p42 and p44 MAPKs, given 10 min before the exposure to the novel environment, blocked the enhancing effect of novelty on memory retrieval. In addition, prenovelty infusion of DL-2-amino-5-phosphonovalerate (APV), an antagonist of glutamate NMDA receptors, produced similar effects. The exposure to the novel environment is associated with an activation of p42 and p44 MAPKs and an increase in the phosphorylation state of the transcription factor cAMP response element binding protein (CREB). No changes were observed in cAMP-dependent protein kinase (PKA) activity or in alpha-CAMKII activation. Taken together, our results indicate that novelty activates hippocampal MAPKs, which are necessary, along with glutamate NMDA receptors, for the enhancing effect of novelty on retrieval.

Phosphorylated cAMP response element-binding protein as a molecular marker of memory processing in rat hippocampus: effect of novelty

From mollusks to mammals the activation of cAMP response element-binding protein (CREB) appears to be an important step in the formation of long-term memory (LTM). Here we show that a 5 min exposure to a novel environment (open field) 1 hr after acquisition of a one-trial inhibitory avoidance training hinders both the formation of LTM for the avoidance task and the increase in the phosphorylation state of hippocampal Ser 133 CREB [phosphorylated CREB (pCREB)] associated with the avoidance training. To determine whether this LTM deficit is attributable to the reduced pCREB level, rats were bilaterally cannulated to deliver Sp-adenosine 3', 5'-cyclic monophosphothioate (Sp-cAMPS), an activator of PKA. Infusion of Sp-Adenosine 3',5'-cyclic monophosphothioate Sp-cAMPS to CA1 region increased hippocampal pCREB levels and restored normal LTM of avoidance learning in rats exposed to novelty. Moreover, a 5 min exposure to the open field 10 min before the avoidance training interferes with the amnesic effect of a second 5 min exposure to the open field 1 hr after avoidance training and restores the hippocampal levels of pCREB. In contrast, the avoidance training-associated activation of extracellular signal-regulated kinases (p42 and p44 mitogen-activated protein kinases) in the hippocampus is not altered by novelty. Together, these findings suggest that novelty regulates LTM formation by modulating the phosphorylation state of CREB in the hippocampus.

Role of hippocampal signaling pathways in long-term memory formation of a nonassociative learning task in the rat

Long-term habituation to a novel environment is one of the most elementary forms of nonassociative learning. Here we studied the effect of pre- or posttraining intrahippocampal administration of drugs acting on specific molecular targets on the retention of habituation to a 5-min exposure to an open field measured 24 h later. We also determined whether the exposure to a novel environment resulted in the activation of the same intracellular signaling cascades previously shown to be activated during hippocampal-dependent associative learning. The immediate posttraining bilateral infusion of CNQX (1 microg/side), an AMPA/kainate glutamate receptor antagonist, or of muscimol (0.03 microg/side), a GABA(A) receptor agonist, into the CA1 region of the dorsal hippocampus impaired long-term memory of habituation. The NMDA receptor antagonist AP5 (5 microg/side) impaired habituation when infused 15 min before, but not when infused immediately after, the 5-min training session. In addition, KN-62 (3.6 ng/side), an inhibitor of calcium calmodulin-dependent protein kinase II (CaMKII), was amnesic when infused 15 min before or immediately and 3 h after training. In contrast, the cAMP-dependent protein kinase (PKA) inhibitor Rp-cAMPS, the mitogen-activated protein kinase kinase (MAPKK) inhibitor PD098059, and the protein synthesis inhibitor anisomycin, at doses that fully block memory formation of inhibitory avoidance learning, did not affect habituation to a novel environment. The detection of spatial novelty is associated with a sequential activation of PKA, ERKs (p44 and p42 MAPKs) and CaMKII and the phosphorylation of c-AMP responsive element-binding protein (CREB) in the hippocampus. These findings suggest that memory formation of spatial habituation depends on the functional integrity of NMDA and AMPA/kainate receptors and CaMKII activity in the CA1 region of the hippocampus and that the detection of spatial novelty is accompanied by the activation of at least three different hippocampal protein kinase signaling cascades.

p53 gene mutation and protein expression in operable non-small cell lung cancer in Poland

We investigated the association of p53 abnormalities (gene mutations by DNA sequencing and protein over-expression by immunostaining) with clinical data and prognosis in 74 patients with resected non-small cell lung cancer (NSCLC). DNA analysis of exons 5-8 of the p53 gene showed 34 mutations in 74 resected primary NSCLC (45.9%). Immunohistochemical study of the p53 protein revealed that 41 of 74 (55.4%) samples had positive staining. We found strong agreement between the results of the p53 protein expression test (p53-PE) and the p53 gene mutation test (p53-M) (Cohen's kappa = 0.65, 95% CI 0.48-0.82). Joint distribution of the results (analysed using the bivariate Dale model) was mainly influenced by, histological type of tumour. A positive result for the p53-PE test significantly increased (estimated odds ratio 84.5; 95% CI 8.89-803.03) the odds of observing a positive result in the p53-M test. In the univariate analysis (log rank test), positive results in the p53-M test and the p53-PE test were significantly associated with overall survival (P < 0.001 and P = 0.005, respectively). In the multivariate analysis (Cox's proportional hazard model), a positive result for the p53-M test significantly increased relative risk for overall survival (RR 9.56; 95% CI 2.62-34.87; P < 0.001). When the result of the p53-M test was accounted for, a positive result for the p53-PE test did not offer any additional prognostic information due to the strong dependence of results of the tests. However, when the result of the p53-M test was removed from the model, a positive result for the p53-PE test became a significant unfavourable prognostic factor (P = 0.009). We conclude that p53 gene mutation and protein expression analyses are in a strong agreement. Joint distribution of the results depends mainly on histological type of tumour. When considered separately, both tests are unfavourable prognostic factors in NSCLC. When the result of the p53-M test is taken into account, the p53-PE test does not offer any additional prognostic information.

Involvement of hippocampal PKCbetaI isoform in the early phase of memory formation of an inhibitory avoidance learning

Several evidences demonstrate that protein kinase C (PKC) is involved in hippocampal long-term potentiation (LTP) and in different forms of learning, including inhibitory avoidance training in rats. Here, we evaluated the levels of conventional PKC isozymes (alpha, betaI, betaII, gamma) in synaptic plasma membrane (SPM) fractions isolated from hippocampus of rats subjected to a one-trial inhibitory avoidance paradigm. At 0, 30 and 120 min after training, there was a significant increase in the total amount of PKCbetaI. Densitometric analysis of the immunoblots showed an increase of 142+/-11% at 0 min, 193+/-16% at 30 min and 156+/-6% at 120 min after training relative to shocked control values. No changes were found in PKCbetaI levels in SPM fractions of the shocked animals relative to naive control values. No training-specific increments in the levels of PKCalpha, betaII and gamma were observed at any time point tested. However, an increase in PKCgamma levels was found in trained and shocked animals sacrificed 120 min after each experimental procedure. In addition, bilateral microinjections of a fairly selective inhibitor of PKCbetaI isozyme into the CA1 of the dorsal hippocampus produced amnesia when given 10 min before training, or 50, 110, but not 170 min, after training. Thus, the present findings demonstrate the participation of PKCbetaI in the early synaptic events responsible for the acquisition and consolidation of an inhibitory avoidance learning, and suggest a putative role of this presynaptic isozyme on the enhanced PKC-dependent B-50/GAP-43 phosphorylation previously detected by us during this associative learning.

Expression of bcl-2 protein in non-small cell lung cancer: correlation with clinicopathology and patient survival

Molecular genetic studies have revealed mutations in a number of oncogenes and tumor suppressor genes in lung cancer. The bcl-2 gene product (bcl-2 protein) is implicated in oncogenesis by its ability to prolong cell death through the inhibition of apoptosis. We investigated expression of bcl-2 in 84 resected human non-small cell lung cancers (NSCLC) and correlated this phenomena with clinicopathology and survival. Immunohistochemical analysis with a monoclonal antibody specific for bcl-2 (Clone 124; Dako) was used to detect the protein in tumor samples. Overall, bcl-2 was detectable in 39 of 84 (46%) NSCLC. The percentage of bcl-2 positive cases varied according to the histological type. Positive bcl-2 immunostaining was observed in 27 of the 46 squamous cell carcinomas (59%), 7 of the 25 adenocarcinomas (28%) and 5 of the 13 large cell carcinomas (38%). The frequency of positive bcl-2 expression in squamous cell carcinomas was significantly higher than that in other histological two types (p = 0.037). Statistical comparisons between the patients' clinical characteristics and bcl-2 status revealed no significant differences in the frequency of bcl-2 expression with respect to sex, T and N factors, as well as TNM stage. The relationship between bcl-2 protein expression and postoperative survival was analyzed in 84 patients. Patients with bcl-2 negative tumors showed significantly shorter survival times than those with bcl-2 positive tumors. In univariate analysis of various potential prognostic factors only TNM stage and bcl-2 test were significant prognostic factors (p < 0.009 and p < 0.008, respectively). In multivariate analysis (Cox proportional hazard model), bcl-2 status (negative test) was independent unfavorable prognostic factor (p = 0.017). In conclusion, this set of observations suggests that assessment of the expression status of bcl-2 by tumors may provide prognostic information on the clinical behavior of NSCLC.

Preoperative CYFRA 21-1 level as a prognostic indicator in resected nonsmall cell lung cancer

Cytokeratin 19 is particularly abundant in carcinoma of the lung. The CYFRA 21-1 assay has recently been developed for detection of a cytokeratin 19 fragment in serum. In the current study, the prognostic information provided by the CYFRA 21-1 assay in operable nonsmall cell lung cancer (NSCLC) was analysed. Serum levels of CYFRA 21-1 were measured using an immunoradiometric assay (DiaSorin) in 94 patients with operable NSCLC. Survival and disease-free survival curves related to initial levels of this marker were estimated using the Kaplan-Meier method. Elevated preoperative CYFRA 21-1 levels were identified in 42% of patients with NSCLC. The number of patients with elevated levels of this marker increased with tumour node metastasis (TNM) stage (p=0.02). In univariate analysis elevated levels of CYFRA 21-1 were significantly associated with poor overall survival (p<0.001) and with disease-free survival (p<0.001). The results remained significant when the comparisons were adjusted, using the stratified log-rank test, for patient's TNM stage (p<0.001 for both overall and disease-free survival). Elevated preoperative levels of CYFRA 21-1 decreased the probability of survival or surviving without recurrence 15 months or more after the operation. This was confirmed by the results of the multivariate analysis. In conclusion, CYFRA 21-1 may be an independent prognostic parameter of survival and tumour relapse in nonsmall cell lung cancer and may be useful in identifying resected cancer patients at high risk for treatment failure.

Prognostic value of serum p53 antibodies in patients with resected non-small cell lung cancer

BACKGROUND

Serum antibodies against p53 protein (p53-Abs) have been detected in some cancer patients. The significance and use of p53-Abs as a marker of the clinical behavior of lung cancer is currently under investigation.

PURPOSE

In this study, we measured the serum p53-Abs in 84 patients with operable non-small cell lung cancer (NSCLC) and evaluated potential association between the presence of these antibodies and prognosis.

METHODS

Enzyme-linked immunosorbent assay (ELISA) was used to detect p53-Abs in serum. Survival and disease-free survival curves related to initial p53-Abs status were estimated using the Kaplan-Meier method.

RESULTS

At the time of diagnosis 19 (22.6%) of 84 analyzed patients had positive result from the serum p53 antibodies (p53-Abs) test. No association was found between p53-Abs, histological types of tumors and clinical stage of disease. We found that patients with a positive result from the p53-Abs test had lower probability of overall and disease-free survival. The unfavorable effect was significant both in the univariate analysis, as well as in the multivariate analysis (after adjustment for sex, histopathological type of tumor. TNM stage).

CONCLUSION

The results of the present study indicate that serum p53 antibodies may be an independent prognostic factor in NSCLC, especially in the squamous cell carcinoma (SqCC) patients and may be useful in identifying resected lung cancer patients at high risk for treatment failure.

CD161 (NKR-P1A) costimulation of CD1d-dependent activation of human T cells expressing invariant V alpha 24 J alpha Q T cell receptor alpha chains

A population of human T cells expressing an invariant V alpha 24 J alpha Q T cell antigen receptor (TCR) alpha chain and high levels of CD161 (NKR-P1A) appears to play an immunoregulatory role through production of both T helper (Th) type 1 and Th2 cytokines. Unlike other CD161(+) T cells, the major histocompatibility complex-like nonpolymorphic CD1d molecule is the target for the TCR expressed by these T cells (V alpha 24(invt) T cells) and by the homologous murine NK1 (NKR-P1C)+ T cell population. In this report, CD161 was shown to act as a specific costimulatory molecule for TCR-mediated proliferation and cytokine secretion by V alpha 24(invt) T cells. However, in contrast to results in the mouse, ligation of CD161 in the absence of TCR stimulation did not result in V alpha 24(invt) T cell activation, and costimulation through CD161 did not cause polarization of the cytokine secretion pattern. CD161 monoclonal antibodies specifically inhibited V alpha 24(invt) T cell proliferation and cytokine secretion in response to CD1d+ target cells, demonstrating a physiological accessory molecule function for CD161. However, CD1d-restricted target cell lysis by activated V alpha 24(invt) T cells, which involved a granule-mediated exocytotic mechanism, was CD161-independent. In further contrast to the mouse, the signaling pathway involved in V alpha 24(invt) T cell costimulation through CD161 did not appear to involve stable association with tyrosine kinase p56(Lck). These results demonstrate a role for CD161 as a novel costimulatory molecule for TCR-mediated recognition of CD1d by human V alpha 24(invt) T cells.

[Use of intraoperative fiber-esophagoscopy in surgical treatment of rare esophageal diseases]

The aim of our study is to discuss our observations concerning surgical treatment of rare diseases of the oesophagus. 10 patients were operated on, 6 cases with benign tumours (including leiomyoma, Abrikossoff tumour, polyp of oesophageal mucose), 2 with intramural bronchogenic cysts of the oesophagus, 1 with benign stricture after inflammation and 1 with stricture of oesophagogastric anastomosis after Akiyama operation. In 6 cases tumour was resected without opening of the oesophageal lumen (enucleation), in 4 patients with tumours located on one of the walls, the wedge resection, transversely to the long oesophageal axis was performed. In cases with tumour located in mucose (Abrikossoff tumour, polyp, post-inflammatory scar), intraoperative fiber-esophagoscopy was conducted simultaneously to enable the exact localisation of tumour and evaluation of radical resection. There were no postoperative complications and dysphagia showed regression. The remote results (from 1 year to 6 years) have been found to be satisfactory.

CONCLUSIONS

1. The procedure of choice in the treatment of the intramural cysts and benign tumour of the oesophagus is enucleation and wedge resection with suture in layers in the tumour located in mucose. 2. Intraoperative fiber-esophagoscopy enables the exact lesion localisation and evaluation of radical resection.

[Esophagogastric bypass anastomosis for benign stricture of cardia]

The aim of the study is to discuss our observations concerning oesophagogastric bypass anastomosis in cases with scar stricture of cardia in long-term achalasia (megaoesophagus). The Heller operation is ineffective in such patients and the resection of cardia with oesophagogastric anastomosis is a large and controversial operation. 16 patients were operated (6 of them after ineffective cardiomyotomy). In all cases long-term dysphagia, big loss of weight and large, S-shaped oesophagus lying on the diaphragm were found. The left side thoracotomy was performed and fundus of the stomach was dislocated to the chest through dilatatored oesophageal hiatus and with the oesophagus above the cardia. There were no postoperative complications. However, dysphagia regressed. The remote results (from 1 year to 7 years) in 11 patients were analysed. The general condition was satisfactory. No dysphagia and gastrooesophageal reflux was revealed. Anastomosis was efficient in X-ray examination. Our observations indicate that oesophagogastric anastomosis is a procedure of choice in the treatment of long-term achalasia with stricture of cardia and megaoesophagus.

[Usefulness of computed tomography and scintigraphy in diagnosis of emphysematous bullae in the lung]

The x-ray examinations usually do not reveal morbid changes after lung expansion in the treatment of spontaneous pneumothorax. In our observation computed tomography (CT) and scintigraphy enable not only the exact determination of the extent of changes but also they disclose bullae invisible in conventional chest radiographs. 15 patients with cured spontaneous pneumothorax and 10 patients with radiographic evidence of a bulla or bullae were examined. CT scans showed bullae from 3 to 18 cm in diameter involving predominantly the upper lobes. 4 patients had additionally subpleural or intraparenchymal bullae of various degrees. In all patients with cured spontaneous pneumothorax, CT scans revealed intraparenchymal bullae, and in 6 cases bilateral intraparenchymal bullae were revealed. Only in sites of large bullae, no isotopic marker or its low elimination was shown in perfusion and inhalation scintigraphy. 10 patients with giant bullous emphysema were operated; in 6 patients enucleation of bullae, in 3 lobectomy and in one patient bullectomy were performed.

CONCLUSION

CT is a method of choice in the diagnosis of lung emphysematous bullae and it enables the detection of the changes undetectable in chest radiographs. Perfusion and inhalation scintigraphy is helpful in the diagnosis of large emphysematous bullae and postoperative follow-up examination.

[Granulocyte macrophage-colony stimulating factor (GM-CSF) in diagnosis and monitoring of non-small cell lung cancer]

Serum tumor markers may be helpful in early diagnosis of cancer, in the initial assessment of the extent of the disease, and in monitoring the tumor growth or tumor volume reduction once cancer has been diagnosed and treatment started. Recent studies have focused on a new family of markers -hematopoietic growth factors, especially on granulocyte-macrophage colony-stimulating factor (GM-CSF). A number of investigations have shown autologous production of GM-CSF in various human cell lines derived from melanoma, gastric or ovarian cancer, and in certain tumors of nonhematopoietic origin. In this study serum level of GM-CSF was measured using a sensitive sandwich ELISA system in 34 patients with non-small cell lung cancer (NSCLC) before and 10, 30, 90, 180 and 270 days after surgical operation. Additionally common accepted tumor markers such as CEA and CYFRA 21.1 were also assayed. Preoperative level of GM-CSF was significantly increased in cancer patients relative to the normal sera (p < 0.02). Concentration of GM-CSF and CYFRA 21.1 were decreased on 10th day, but CEA on 30th day after surgical treatment, although upon comparison of pre- and postoperative tumor markers serum levels significant difference was observed for CYFRA 21.1 (p < 0.05). Levels of GM-CSF were increased in 85%, CEA in 62% and CYFRA 21.1 in 51%. The diagnostic sensitivity and serum levels of GM-CSF were related to the stage of the disease and the combined use of two markers increased the sensitivity compared with the use of only one. These results suggest that GM-CSF, especially in the combination with CYFRA 21.1., may be useful in the diagnostic and monitoring of patients with NSCLC.

Cancer procoagulant (CP) in lung cancer

Lung cancers (squamous cell carcinoma, microcellular carcinoma, macrocellular carcinoma and adenocarcinoma) show procoagulant activity. It mainly depends on the presence of cancer procoagulant (CP) in lung cancer cells.

Activity and tissue localization of cathepsin G in non small cell lung cancer

Activity and tissue localization of cathepsin G were examined in tumors deriving from 73 patients with non small cell lung cancer. Activity of cathepsin G was highest in adenocarcinoma, lower in planoepitheliale cancer, the lowest in macrocellular cancer. In all histological types of tumors cathepsin G activity in supernatants was lower than in sediments. The enzyme immunohistochemically was localized in neutrophils. There is evident correlation between neutrophil numbers and cathepsin G activity in examined cancer types. Result of our examinations indicate a relationship between cathepsin G activity, grade of tumor differentiation and particular clinical stages of disease.

Immunohistochemical analysis of tissue localization of cytokeratin 19 in lung cancer

Cytokeratins (CK) are one of the main families of intermediate filaments which make up the cytoskeleton. CK19 is strongly expressed by normal simple bronchial and respiratory epithelium as well as by their malignant counterpart. Although CK19 is a part of the cytoskeleton, a soluble fragment of this polypeptide can be released and assayed in the blood as CYFRA 21-1, new sensitive and valuable marker of non small cell lung cancer. In some cases, however, discrepancies between the serum level of CYFRA 21-1 and presence of tumor and its histological type have been observed. We studied immunohistochemically tissue localization of CK19 in tumors and non invaded lung parenchyma in a series of 34 patients surgically treated due to lung cancer. CK 19 was detected in cancer cells as well as in non neoplastic epithelium covering bronchial tree and alveolar surfaces. We found a different expression of CK19 in different histological type of tumors. The most intensive expression revealed squamous cell carcinomas and adenocarcinomas. Small cell cancer revealed poor expression of CK19. In non invaded parts of the resected lungs we found the strong expression of CK19 in the cytoplasm of regenerative II type pneumocytes occurring in large quantity in the cases of interstitial lung fibrosis concomitant with some tumors. We suggest it may be a cause of unexpectedly elevated serum levels of CYFRA 19-21 in some not oncological patients or patients with small cell lung cancer.

Activity and tissue localization of cathepsin D in non small cell lung cancer

Activity and tissue localization of cathepsin D were examined in tumors deriving from 80 patients with non small cell lung cancer. Activity of the enzyme was higher in sediments and supernatants of tumors than in non invaded lung parenchyma. In all histological types of tumors cathepsin D activity in sediments was three times lower and in lung parenchyma five times lower than in supernatants. The immunohistochemical technique was used for enzyme localization. We observed seemingly the lack of correlation between activity of cathepsin D examined in tumors and immunohistochemical reaction intensity in neoplasm cells. Different numbers of macrophages and quantity of tumor stroma could explain this effect in examined histological types of cancer. Results of our explanations indicates for relations between cathepsin D activity versus histological type and degree of tumor differentiation. We did not observe correlation between cathepsin D activity versus lymph node metastases and clinical stages.

Acute maduramicin toxicity in calves

A herd of 277 beef-breed calves in three age groups was mistakenly given the poultry coccidiostat maduramicin in a total mixed ration. It caused an acute toxicosis in which sudden death was the sole clinical finding in most cases. One group of 212 calves aged five to eight months suffered a mortality of 51 per cent in eight days and a total mortality of 56 per cent during the 40 days in which mortality was recorded. Mortality of only 3 per cent was recorded in two other groups of calves aged nine to 16 months in eight days and a total mortality of 11 per cent over the 40-day period.

Activity of cancer procoagulant (CP) in serum of patients with cancer of lung, breast, oesophagus and colorectum

Activity of cancer procoagulant (CP) was studied in blood serum of 90 patients with cancer of lung, breast, oesophagus and colorectum, and of 15 healthy people. The activity of CP was determined by the coagulation method. Sera of patients with cancer showed higher mean activity of CP than sera of healthy control. Of the 90 cancer patients 78 were identified correctly by this test as having cancer (sensitivity 85%). In the case of lung and colorectal cancers the higher CP activity was observed the more advanced was the clinical stage of cancer, and the test was positive in 100%. After radical removal of malignant tumor of lung, decreased CP activity was found.

Activity of cancer procoagulant (CP) in serum of patients with cancer of lung, breast, oesophagus and colorectum

Activity of cancer procoagulant (CP) was studied in blood serum of 90 patients with cancer of lung, breast, oesophagus and colorectum, and of 15 healthy people. The activity of CP was determined by the coagulation method. Sera of patients with cancer showed higher mean activity of CP than sera of healthy control. Of the 90 cancer patients 78 were identified correctly by this test as having cancer (sensitivity 85%). In the case of lung and colorectal cancers the higher CP activity was observed the more advanced was the clinical stage of cancer, and the test was positive in 100%. After radical removal of malignant tumor of lung, decreased CP activity was found.

Preoperative CYFRA 21-1 level as a prognostic indicator in resected primary squamous cell lung cancer

The CYFRA 21-1 assay is a test that has been developed recently for detection of a cytokeratin 19 fragment in serum. A diagnostic role for CYFRA 21-1 has already been proposed. The question of whether this marker is prognostically significant is important in clarifying the role of CYFRA 21-1 in clinical practice. The aim of this study was to evaluate the prognostic significance of elevated preoperative CYFRA 21-1 levels in patients with resected primary squamous-cell lung cancer (SqCC). Serum levels of CYFRA 21-1 were measured using an immunoradiometric assay (CIS bio) in 91 patients with operable SqCC. Survival and disease-free survival curves related to initial levels of this marker were estimated using the Kaplan-Meier method. In the univariate analysis the log-rank test and the log-rank test for trend were used. In the multivariate analysis the stratified log-rank test and the proportional hazard model were used. Elevated preoperative CYFRA 21-1 levels were identified in 55% of patients with SqCC. The number of patients with elevated levels of this marker increased with TNM stage (P = 0.0001). In univariate analysis elevated levels of CYFRA 21-1 were significantly associated with poor overall survival (P < 0.00005) and with disease-free survival (P < 0.00005). In multivariate analysis elevated levels of this marker were also found to be associated with poor overall and disease-free survival (P = 0.01 and P = 0.003 respectively). In conclusion, CYFRA 21-1 may be an independent prognostic parameter of survival and tumour relapse in SqCC and may be useful in identifying resected SqCC patients at high risk of treatment failure.

Expectant management of post-term patients: observations and outcome

Post-term pregnancy is associated with increased perinatal mortality. In a retrospective study based on our post-term protocol from 1990 until May 1995 1,798 post-term pregnant women with reliable dating were evaluated for expectant management. A group of 2,633 pregnant women who delivered between 37 and 41 weeks during 1994 served as a control group. The perinatal mortality (0.56 per 1,000 vs. 0.75 per 1,000 in the control group) was similar in both groups. The incidence of induction of labor (7.45% vs. 7% in the control group), meconium of more than +1 (5.2% vs. 4% in the control group), shoulder dystocia (0.33% vs. 0.19%), high birthweight (> 4,500 g) (1% vs. 1%), and cesarean section rates (7.5% vs. 7% in the control group) were similar. However the fetal distress rates (11.6% vs 16%; P = .004), instrumental deliveries (10.1% vs. 13%, P = .002), and the rate of 5-minute Apgar score of less then 7 (1.1% vs. 5%, P = .000001) were found to be significantly lower in the post-date group than in the control group. We conclude that the expectant management and our intensive observation and follow-up in post-term is indicated for both mother and fetus.

The role of endoscopic retrograde cholangiopancreatography and cholangiography in the laparoscopic era

OBJECTIVE

The authors reviewed the results of endoscopic retrograde cholangiopancreatography (ERCP) and intraoperative cholangiography in a series of patients who underwent laparoscopic cholecystectomy.

SUMMARY BACKGROUND DATA

The indications for preoperative and postoperative ERCP and intraoperative cholangiography as adjuncts to laparoscopic cholecystectomy are evolving. The debate regarding the use of selective or routine intraoperative cholangiography has intensified with the advent of laparoscopic cholecystectomy.

METHODS

The authors reviewed the records of 343 consecutive patients who underwent laparoscopic cholecystectomy during a 1-year period. Historical, biochemical, and radiologic findings for the patients who underwent ERCP and intraoperative cholangiography were analyzed.

RESULTS

Three hundred forty- three patients underwent laparoscopic cholecystectomy during the period reviewed. Preoperative ERCP was performed in 42 patients. Twenty-seven of these patients (64%) had common bile duct (CBD) stones, which were cleared with a sphincterotomy. Intraoperative cholangiography was performed for 101 patients (29%). Three cholangiograms had false- positive results (3%), leading to two CBD explorations, in which no CBD stones were found, and one normal ERCP. Six patients underwent postoperative ERCP, three for the removal of retained CBD stones (0.9%), all of which were cleared with a sphincterotomy. Fifteen patients had gallstone pancreatitis, six of whom had CBD stones (40%) that were cleared by ERCP. There were 33 complications (10%) and no CBD injuries.

CONCLUSION

The use of routine intraoperative cholangiography is discouraged in view of its low yield and the significant rate of false positive cholangiogram results.

"Grievous bodily harm:" gamma hydroxybutyrate abuse leading to a Wernicke-Korsakoff syndrome

Gamma-hydroxybutyrate (GHB) is a naturally occurring GABA-like drug used illicitly by bodybuilders. Although there are reports of several cases of GHB abuse, with a variety of nervous system complications, we present the first case associated with a Wernicke-Korsakoff syndrome.

CYFRA 21-1 determination in patients with non-small cell lung cancer: clinical utility for the detection of recurrences

The aim of this study was to evaluate serial determinations of CYFRA 21-1 in the follow-up of patients treated surgically for non-small cell lung cancer in order to predict the risk of tumour recurrence. Serum levels of CYFRA 21-1 were measured using an immunoradiometric assay (CIS bio) in 57 patients with operable non-small cell lung cancer (NSCLC): 25 with squamous cell carcinoma (SqCC), 20 with adenocarcinoma (AC), 12 with large cell carcinoma (LCC) and 30 with non-malignant lung diseases. Elevated preoperative CYFRA 21-1 levels were identified in 44% of all patients with NSCLC. The diagnostic specificity of the assay was 97%. Positive CYFRA 21-1 levels was observed in 30% of stage I, 33% of stage II, and 55% of stage IIIa. Statistically significant differences were obtained between stages I and IIIa, II and IIIa, but not between stages I and II. During follow-up recurrence was observed in 19 of 57 (33%) NSCLC patients. Recurrence-free survival probability for patients with elevated serum CYFRA 21-1 levels before surgery was 52% (13/25), versus 81% (26/32) for patients with normal serum CYFRA 21-1 levels (p < 0.01). In 15 patients with increased trend for CYFRA 21-1, elevated serum CYFRA 21-1 levels preceded (13 patients) or coincided (2 patients) with the clinical detection of tumour recurrence, providing a predictive value of an increased trend of 87%. In the multivariate analysis the association of the increase of CYFRA 21-1 level with a higher risk of recurrence is statistically significant (p < 0.001).

Clinical tumour markers in lung cancer

Within the past few years, the measurement of serum and tissue markers has had an increasing influence on clinical decisions about initial treatment and follow-up. Lung cancer illustrates the types and importance of these various markers. This review presents data concerning the most studied and interesting markers in non-small cell (NSCLC) and small cell lung cancer (SCLC). CEA, TPA, SCC-Ag, CYFRA 21-1, ferritin, CA19-9, CA50, CA242, H-K-N-ras mutations and p53 mutation seem to be the most prolific in NSCLC, while NSE, BN/GRP, CK-BB, NCAM, IL-2R, IGF-I, transferrin, ANP, mAb (cluster 5), Le-y and c-N-L-myc mutation are markers in SCLC patients. Some of these serum markers might be useful adjuncts for monitoring response to therapy, including early detection of tumour reactivation to allow curative therapy and rapid detection of treatment failure to allow change of the regimen. The study of these markers also may lead to a better understanding of the biological characteristics of lung cancer. The information derived from these biological studies represents the most promising avenue towards new treatment strategies, as well as attempts at secondary prevention.

CYFRA 21-1 as a tumour marker for bronchogenic carcinoma

Despite extensive research, the role of the commonly employed tumour markers in the diagnosis of lung carcinoma is yet to be clarified. The utility of a new marker, CYFRA 21-1, in the preoperative evaluation of patients with bronchogenic carcinoma was investigated. CYFRA 21-1 was determined with a radiometric assay in serum of 280 patients with lung cancer and 208 patients with various nonmalignant lung diseases. The levels of the marker were significantly higher in lung cancer patients. Among benign lung diseases, elevated CYFRA 21-1 levels were found in pulmonary fibrosis. Using a cut-off of 3.2 ng.ml-1 (95th percentile of levels obtained in benign lung disease), the total sensitivity of the marker was 48%. The best sensitivity was obtained in squamous cell lung cancer (60%). The highest values of CYFRA 21-1 were found in metastatic lung cancer, and the marker sensitivity was more elevated in stage IIIb and IV. On the other hand, 40% of patients with surgically resectable lung cancer had CYFRA 21-1 levels above the cut-off. We conclude that CYFRA 21-1 may be satisfactorily employed in the differential diagnosis between malignant and benign lung diseases in association with other clinical and radiological data.

Diagnostic and prognostic value of the new tumour marker CYFRA 21-1 in patients with squamous cell lung cancer

We wanted to investigate the diagnostic and prognostic significance of serum CYFRA 21-1, especially in predicting the risk of recurrence in patients with operable squamous cell lung cancer. Serum levels of CYFRA 21-1 were measured using an immunoradiometric assay (CIS bio) in 76 patients with squamous cell lung cancer (64 operable and 12 with unresectable tumours), 22 with other non-small-cell type (12 with adenocarcinoma and 10 with large-cell type) and 45 with nonmalignant lung diseases. Elevated preoperative CYFRA 21-1 levels were identified in 63% of patients with squamous cell type (SqCC), 33% with adenocarcinoma, and 30% with large-cell carcinoma type. The diagnostic specificity of the assay was 96%. Positive CYFRA 21-1 levels were observed in 33% of stage I, 52% of stage II, 76% of stage IIIa and 83% of stage IIIb patients with SqCC type. Statistically significant differences were obtained between stages I and II and between II and IIIa, but not between stages IIIa and IIIb. Recurrence-free survival probability for patients with elevated serum CYFRA 21-1 levels before surgery was 63% (24/38) versus 92% (24/26) for patients with normal serum CYFRA 21-1 levels. However, the difference was not statistically significant when adjusted for the TNM stage (primary tumour, regional lymph node involvement, occurrence of distant metastasis). In 9 of the 10 patients with increased trend for CYFRA 21-1 during follow-up, elevated serum CYFRA 21-1 levels preceded (7) or coincided (2) with the clinical detection of tumour recurrence, providing a predictive value of an increased trend of 90%.(ABSTRACT TRUNCATED AT 250 WORDS)

Salmonella typhi iron uptake mutants are attenuated in mice

Iron starvation interferes drastically with the multiplication and virulence of Salmonella typhi mutants defective in enterochelin synthesis or enterochelin transport. Growth of these mutants is inhibited in the presence of human sera and unsaturated transferrin and is restored by fully saturated transferrin. The mutants exhibit decreased ability to grow in HeLa cell monolayers and are attenuated in mice. These findings are consistent with the S. typhi enterochelin system playing a role in the pathogenesis of typhoid fever.