Bacteriophage-based approach for treatment of urinary tract infections: a quick outlook

Urinary tract infections (UTIs) are among the most common bacterial infections affecting millions worldwide. The increasing emergence of antibiotic-resistant bacteria has become a serious concern in managing UTIs. Therefore, there is a growing interest in using bacteriophages as an alternative or adjunct therapy for UTIs. Bacteriophages are viruses that infect and kill bacteria, making them a promising tool for treating UTIs caused by antibiotic-resistant bacteria. This article provides a quick outlook on using bacteriophages to treat UTIs. We summarize the current understanding of the biology of bacteriophages, the challenges associated with developing phage-based therapies, and the promising results of several case reports and clinical trials. We also highlight the potential of phage therapy as a valuable tool in the fight against antibiotic-resistant UTIs. This quick outlook on a bacteriophage-based approach for treating UTIs offers a timely and informative summary of the current research in this field.

Audiometric Outcomes of Ventilation Drainage Treatment for Otitis Media with Effusion in Children: Implications for Speech Development and Hearing Loss

BACKGROUND Otitis media with effusion is the most commonly recognized condition in childhood. Chronic otitis media with accompanying hearing loss is particularly unfavorable in the first years of the child's life because it can not only permanently damage the structure of the middle ear, but also adversely affect speech development and intellectual abilities in the child. MATERIAL AND METHODS This study, from a single center in Poland, included 201 children (372 ears) requiring surgical treatment due to otitis media with effusion. The condition was diagnosed by an ear, nose, and throat specialist, and each patient had a hearing test performed. The control group consisted of 21 patients (42 ears) with negative outcomes following an audiological interview. RESULTS Among all of the patients enrolled in the study, a normal tympanometry result was found in 60.6% of ears, and otoemission occurred in 63.3% of ears. The average hearing threshold in the study group was 22.01 Hz in the 500 Hz frequency range, while they were 16.76 Hz, 12.72 kHz, and 14.78 kHz for the corresponding 1 kHz, 2 kHz, and 4 kHz ranges, respectively. CONCLUSIONS Ventilation drainage is an effective treatment for otitis media with effusion. The presence of genetic disease has the greatest impact on the course of otitis media. These patients most often require reinsertion of a ventilation tube.

Analytics, Properties and Applications of Biologically Active Stilbene Derivatives

Stilbene and its derivatives belong to the group of biologically active compounds. Some derivatives occur naturally in various plant species, while others are obtained by synthesis. Resveratrol is one of the best-known stilbene derivatives. Many stilbene derivatives exhibit antimicrobial, antifungal or anticancer properties. A thorough understanding of the properties of this group of biologically active compounds, and the development of their analytics from various matrices, will allow for a wider range of applications. This information is particularly important in the era of increasing incidence of various diseases hitherto unknown, including COVID-19, which is still present in our population. The purpose of this study was to summarize information on the qualitative and quantitative analysis of stilbene derivatives, their biological activity, potential applications as preservatives, antiseptics and disinfectants, and stability analysis in various matrices. Optimal conditions for the analysis of the stilbene derivatives in question were developed using the isotachophoresis technique.

Comparison of Safety and Efficacy of Hydrus and iStent Combined with Phacoemulsyfication in Open Angle Glaucoma Patients: 24-Month Follow-Up

The paper presents the results of a 24-month-long observation comparing the effectiveness and safety of two micro-invasive glaucoma surgery (MIGS) devices: Hydrus Microstent and iStent Trabecular Bypass in combination with cataract phacoemulsification in the treatment of open-angle glaucoma. We also analyzed the impact of preoperative factors on achieving surgical success in both surgical methods. The prospective, comparative, non-randomized study included 65 glaucoma surgeries. In 35 patients (53.8%), an iStent implant procedure was performed, while 30 patients (46.2%) underwent a Hydrus implant procedure. The demographic data was similar in both treatment groups. At 24 months after surgery, the mean IOP in the iStent group was 15.9 ± 3.0 mmHg and in the Hydrus group 16.2 ± 1.8 mmHg. The difference between the mean iStent vs Hydrus after two years of treatment was -0.3 (p = 0.683). At the 24 month follow-up, the average change in the number of antiglaucoma medications used was 71.7% in the iStent group and 79.6% in the Hydrus group. The difference in mean percentage change between groups was 7.9% in favor of Hydrus. Patients under the age of 70 may benefit from a greater risk reduction in the Hydrus group (HR = 0.81), while those over the age of 70 may benefit from a risk reduction in the iStent group (HR = 1.33). IOP cases with >18 mmHg before the surgery have a better chance of surgical success with the Hydrus method (HR = 0.28), and with IOP < 18 mmHg in the iStent group (HR = 1.93). Cases with more drugs (≥3 drugs) are more favorable in the Hydrus group (HR = 0.23), while those with a maximum of two drugs have a better prognosis in the iStent group (HR = 2.23). The most common postoperative complication was the presence of erythrocytes in the anterior chamber (AC), found in 40.0% of operated eyes in the Hydrus group. The profile of observed complications and significant improvement in visual acuity allows us to consider both implants as a safe way of treating patients with early or moderate glaucoma and co-existing cataracts.

Correction: Naked and necked gold nanoparticles prepared by submerged alternating current arc discharge in water

[This corrects the article DOI: 10.1039/D2RA06050G.].

The Influence of Hydrodynamic Conditions in a Laboratory-Scale Bioreactor on Pseudomonas aeruginosa Metabolite Production

Hydrodynamic conditions are critical in bioprocessing because they influence oxygen availability for cultured cells. Processes in typical laboratory bioreactors need optimization of these conditions using mixing and aeration control to obtain high production of the desired bioproduct. It could be done by experiments supported by computational fluid dynamics (CFD) modeling. In this work, we characterized parameters such as mixing time, power consumption and mass transfer in a 2 L bioreactor. Based on the obtained results, we chose a set of nine process parameters to test the hydrodynamic impact on a selected bioprocess (mixing in the range of 0-160 rpm and aeration in the range of 0-250 ccm). Therefore, we conducted experiments with P. aeruginosa culture and assessed how various hydrodynamic conditions influenced biomass, pyocyanin and rhamnolipid production. We found that a relatively high mass transfer of oxygen (k_La = 0.0013 s^-1) connected with intensive mixing (160 rpm) leads to the highest output of pyocyanin production. In contrast, rhamnolipid production reached maximal efficiency under moderate oxygen mass transfer (k_La = 0.0005 s^-1) and less intense mixing (in the range of 0-60 rpm). The results indicate that manipulating hydrodynamics inside the bioreactor allows control of the process and may lead to a change in the metabolites produced by bacterial cells.

Necked gold nanoparticles prepared by submerged alternating current arc discharge in water

The article presents the method of producing gold nanoparticles using a high voltage arc discharge of alternating current with a frequency of 50 Hz in distilled water. The equipment necessary to carry out the process is described, including the construction of the reactor and the power source of a very simple design necessary to generate a high-voltage arc discharge between the electrodes. Arc discharge processes were carried out two times for 2 and 5 minutes, respectively, in ambient conditions without thermostating the reactor, at medium temperature varying in the range of 25-70 °C. The obtained gold nanoparticles were examined by means of various analytical techniques such as UV-vis spectroscopy, zeta potential measurement, energy dispersive X-ray analysis (EDS), X-ray diffraction (XRD). The morphology, surface, and size of the obtained nanoparticles were carried out using transmission electron microscopy (HRTEM) and dynamic light scattering (DLS). The concentration of the obtained colloids were determined using the mass spectrometry ICP-MS technique. The results show that high-voltage AC arc discharge is a simple and effective way to obtain stable gold nanoparticles under environmentally friendly conditions at relatively low production costs, and can be considered as an alternative to arc discharge nanoparticles synthesis by means of direct current (DC) methods.

PhageScore-based analysis of Acinetobacter baumannii infecting phages antibiotic interaction in liquid medium

The growing interest in bacteriophages and antibiotics' combined use poses new challenges regarding this phenomenon's accurate description. This study aimed to apply the PhageScore methodology to assess the phage-antibiotic combination activity in liquid bacterial culture. For this purpose, previously described Acinetobacter infecting phages vB_AbaP_AGC01, Aba-1, and Aba-4 and antibiotics (gentamicin, ciprofloxacin, meropenem, norfloxacin, and fosfomycin) were used to obtain a lysis curve of bacteriophages under antibiotic pressure. The experimental data were analyzed using the Fractional Inhibitory Concentration Index (FICI) and PhageScore methodology. The results obtained by this method clearly show differences between phage lytic activity after antibiotic addition. Thus, we present the potential use of the PhageScore method as a tool for characterizing the phage antibiotic synergy in liquid culture. Further, the optimization of the PhageScore for this purpose can help compare antibiotics and their outcome on bacteriophage lytic activity.

Schlemm's canal: the outflow 'vessel'

In a healthy eye, the aqueous humour (AH) flows via the ciliary body and trabecular meshwork into the collector channels, which carry it to the episcleral veins. In glaucoma, a heterogeneous group of eye disorders affecting approximately 60 million individuals worldwide, the juxtacanalicular meshwork offers greater resistance to the outflow of the AH, leading to an increase in outflow resistance that gradually results in elevated intraocular pressure (IOP). The present review comprehensively covers the morphology of Schlemm’s canal (SC) and AH pathways. The path of the AH from the anterior chamber through the trabeculum into suprascleral and conjunctival veins via collector channels is described, and the role of SC in the development of glaucoma and outflow resistance is discussed. Finally, channelography is presented as a precise method of assessing the conventional drainage pathway and facilitating localization of an uncollapsed collector and aqueous veins. Attention is also given to the relationship between aqueous and episcleral veins and heartbeat. Possible directions of future research are proposed.

Basic physiology of Pseudomonas aeruginosa contacted with carbon nanocomposites

Experiments describing properties of nanomaterials on bacteria are frequently limited to the disk diffusion method or other end-point methods indicating viability or survival rate in plate count assay. Such experimental design does not show the dynamic changes in bacterial physiology, mainly when performed on reference microorganisms (Escherichia coli and Staphylococcus aureus). Testing other microorganisms, such as Pseudomonas aeruginosa, could provide novel insights into the microbial response to nanomaterials. Therefore, we aimed to test selected carbon nanomaterials and their components in a series of experiments describing the basic physiology of P. aeruginosa. Concentrations ranging from 15.625 to 1000 µg/mL were tested. The optical density of cultures, pigment production, respiration, growth curve analysis, and biofilming were tested. The results confirmed variability in the response of P. aeruginosa to tested nanostructures, depending on their concentration. The co-incubation with the nanostructures (in concentration 125 µg/mL) could inhibit the population growth (in most cases) or promote it in the case of graphene oxide. Furthermore, a specific concentration of a given nanomaterial could cause contradictory effects leading to stimulation or inhibition of pigmentation, an optical density of the cultures, or biofilm formation. We have found that particularly nanomaterials containing TiO2 could induce pigmentation in P. aeruginosa, which indicates the possibility of increased virulence. On the other hand, nanocomposites containing cobalt nanoparticles had the highest anti-bacterial potential when cobalt was displayed on the surface. Our approach revealed changes in respiration and growth dynamics that can be used to search for nanomaterials’ application in biotechnology.

The influence of nanomaterials on pyocyanin production by Pseudomonas aeruginosa

Pseudomonas aeruginosa is a bacterium producing industrially utile metabolites, such as rhamnolipids, biopolymers, and pigments. Pyocyanin, the most studied example of pigments, is a virulence factor that also shows the potential for application in, e.g., agriculture, anticancer therapy, and energy production. Therefore, potential inhibitors and stimulants of pyocyanin production by P. aeruginosa should be studied, and nanomaterials may cause both effects. The study aimed to examine the influence of zinc oxide and multi-walled carbon nanotubes (pristine or dispersed with alginic acid) on pyocyanin production by P. aeruginosa. First, the influence of different concentrations of nanomaterials (500.00–0.06 µg/mL) on culture optical density and biofilm formation was studied. These results helped select concentrations for further tests, i.e., growth curves and fluorescence measurements. Pyocyanin production was assessed by the chloroform–hydrochloric acid method. SEM analysis was conducted to assess the influence of nanomaterials on the cell's integrity and biofilm structure. Pristine multi-walled carbon nanotubes exhibited a stimulative effect on pigment production when applied in high concentrations (500.00 µg/mL), while dispersed material enhanced the production in lowered dosages (125.00 µg/mL). On the other hand, high concentrations of zinc oxide inhibited pyocyanin production, while minor increased bioproduct production. The research indicates the potential to use nanomaterials as the modulators of pyocyanin production and other metabolites.

Application of Magnetically Assisted Reactors for Modulation of Growth and Pyocyanin Production by Pseudomonas aeruginosa

Pseudomonas aeruginosa is a producer of desired secondary metabolites, including pyocyanin. Potential uses of this pigment urge a search for improved production methods. Recent trends in bioprocessing show the potential of the use of electromagnetic fields (EMFs) to influence the growth of microorganisms and even modulate the concentration of bioproducts. Here, we aimed at assessing the influence of rotating magnetic field (RMF) and static magnetic field (SMF) on pyocyanin production, growth rate, and respiration of P. aeruginosa. Moreover, exposure time to EMFs (2, 6, and 12 h) and culture volume (10 and 50 ml) were initially assessed. P. aeruginosa was cultivated in magnetically assisted reactors with 5 and 50 Hz RMF (magnetic induction of 24.32 and 42.64 mT, respectively) and SMF (−17.37 mT). Growth kinetics was assessed with Gompertz equation. The viability was tested using resazurin assay, whereas pyocyanin production by chloroform-HCl methodology. The growth of P. aeruginosa was slightly stimulated by exposure to a RMF with 50 Hz (108% related to the control) and significantly by SMF (132% related to the control), while RMF 5 Hz exposure prolonged the time of inflection (in comparison to RMF 50 Hz and SMF). The 6-h exposure to EMFs resulted in the highest pyocyanin production in comparison to the control, indicating a relationship between exposure time and product concentration. Moreover, cultures led in smaller volumes produced more pyocyanin. Our findings show that the use of different EMF types, frequency, and exposition time and volume could be used interchangeably to obtain different bioprocess aims.

Microinvasive glaucoma surgery: a review and classification of implant-dependent procedures and techniques

The aim of this article is to discuss how physiology and anatomical background affect the effectiveness of implant‐dependent microinvasive glaucoma surgery (MIGS). First, we provide a micro view of aqueous outflow and tissue behaviour. Second, we review studies exploring the mechanisms of the pressure‐lowering effect of MIGS, as well as tissue behaviour during aqueous flow and tissue motion. We also describe and classify microinvasive surgical procedures and the most important types of implants, as well as their mechanisms of action, implantation techniques and efficacy. Further, we summarize the indications and surgical results presented in recent studies, providing an evidence‐based update on novel and emerging MIGS techniques for the treatment of open‐angle glaucoma. These data can help surgeons to personalize the management of glaucoma and to choose the best MIGS option for individual glaucoma patients.

Development of an Autochthonous Microbial Consortium for Enhanced Bioremediation of PAH-Contaminated Soil

The main objectives of this study were to isolate bacteria from soil chronically contaminated with polycyclic aromatic hydrocarbons (PAHs), develop an autochthonous microbial consortium, and evaluate its ability to degrade PAHs in their native contaminated soil. Strains with the best bioremediation potential were selected during the multi-stage isolation process. Moreover, to choose bacteria with the highest bioremediation potential, the presence of PAH-degrading genes (pahE) was confirmed and the following tests were performed: tolerance to heavy metals, antagonistic behavior, phytotoxicity, and antimicrobial susceptibility. In vitro degradation of hydrocarbons led to the reduction of the total PAH content by 93.5% after the first day of incubation and by 99.22% after the eighth day. Bioremediation experiment conducted in situ in the contaminated area resulted in the average reduction of the total PAH concentration by 33.3% after 5 months and by over 72% after 13 months, compared to the concentration recorded before the intervention. Therefore, this study implicates that the development of an autochthonous microbial consortium isolated from long-term PAH-contaminated soil has the potential to enhance the bioremediation process.

XEN Glaucoma Implant for the Management of Glaucoma in Naïve Patients versus Patients with Previous Glaucoma Surgery

This retrospective study analyzed the surgical and refractive outcomes of a XEN Gel Implant (Allergan, Abbvie Company, Irvine, CA, USA) in naïve patients versus those with previous glaucoma surgery. We evaluated the efficacy of XEN implantation in 86 glaucoma patients during a long-term follow-up period. Patients were divided into two groups: naïve patients (Group 1) and patients with previous glaucoma surgery (Group 2). Eyes that received a XEN Gel Stent placement from December 2014 to October 2019 were included. Intraocular pressure (IOP) change, corrected distance visual acuity (CDVA), change in glaucoma medications, frequency of slit lamp revision procedures, and frequency of secondary glaucoma surgeries were the primary outcomes. In Group 1, the mean IOP before surgery was decreased significantly from 25.00 ± 7.52 mmHg to 16.83 ± 5.12 mmHg by the end of the study. In Group 2, the mean IOP decreased significantly from 25.35 ± 7.81 mmHg to 17.54 ± 5.34 mmHg. The mean IOP decrease from baseline was 29% in Group 1 and 27% in Group 2 (p = 0.567). There were no significant differences between the groups in the IOP baseline level, the final level, or the change between preoperative and final levels. The qualified success rate for Group 2 was 68.7% versus 76.5% for Group 1 for the initial procedure and 15.4% vs. 20.2%, respectively, for complete success rate (p > 0.05). However, at the end of the follow-up, more patients achieved an IOP < 18 mmHg in Group 1 than in Group 2. Despite the need for more anti-glaucoma medications, repeat XEN Gel implantation appears to show promising results in patients with previously failed anti-glaucoma procedures, owing to its minimal invasiveness.

Fabrication of Paper Sheets Coatings Based on Chitosan/Bacterial Nanocellulose/ZnO with Enhanced Antibacterial and Mechanical Properties

Here, we designed paper sheets coated with chitosan, bacterial cellulose (nanofibers), and ZnO with boosted antibacterial and mechanical activity. We investigated the compositions, with ZnO exhibiting two different sizes/shapes: (1) rods and (2) irregular sphere-like particles. The proposed processing of bacterial cellulose resulted in the formation of nanofibers. Antimicrobial behavior was tested using E. coli ATCC® 25922™ following the ASTM E2149-13a standard. The mechanical properties of the paper sheets were measured by comparing tearing resistance, tensile strength, and bursting strength according to the ISO 5270 standard. The results showed an increased antibacterial response (assigned to the combination of chitosan and ZnO, independent of its shape and size) and boosted mechanical properties. Therefore, the proposed composition is an interesting multifunctional mixture for coatings in food packaging applications.

Microinvasive Glaucoma Surgery: A Review of Schlemm's Canal-Based Procedures

Microinvasive glaucoma surgery has gained popularity over the past decade. It can be performed using three different mechanisms. In the present review, we focused on Schlemm’s canal (SC)-based surgery, which increases aqueous humor (AH) outflow into the aqueous veins by either removal of the trabecular meshwork (TM) or an increase in the tension in the TM. In primary open-angle glaucoma (POAG), the TM is the most likely region for increased AH outflow resistance. Theoretically, removal of the TM can improve the AH outflow; hence, glaucoma specialists focus on microsurgical dissection of the TM. In this review, we analyzed the available literature to examine SC-related microsurgical modalities based on the histopathological proofs of the localization of resistance of the AH outflow. First, we considered the role, anatomy, and physiology of the TM and SC. We referred to studies that describe the mechanisms and potential pathways, related to increased intraocular pressure in the POAG, that are targeted using the SC-related microsurgical interventions. Next, we took a closer look at the gonioscopic tools necessary for an ab-interno approach and explored incision canal surgery: ab-interno trabeculectomy using different instrumentation (Trabectome^®, Kahook Dual Blade) and variations of the technique. Thereafter, we discussed ab-interno canaloplasty, explaining the technique and reviewing its effectiveness. Finally, we presented the scope for future research in the field. Although the iStent also targets SC by bypassing it, this device has been reviewed extensively elsewhere.

The Response of Pseudomonas aeruginosa PAO1 to UV-activated Titanium Dioxide/Silica Nanotubes

Pseudomonas aeruginosa is a bacterium of high clinical and biotechnological importance thanks to its high adaptability to environmental conditions. The increasing incidence of antibiotic-resistant strains has created a need for alternative methods to increase the chance of recovery in infected patients. Various nanomaterials have the potential to be used for this purpose. Therefore, we aimed to study the physiological response of P. aeruginosa PAO1 to titanium dioxide/silica nanotubes. The results suggest that UV light-irradiated nanomaterial triggers strong agglomeration in the studied bacteria that was confirmed by microscopy, spectrophotometry, and flow cytometry. The effect was diminished when the nanomaterial was applied without initial irradiation, with UV light indicating that the creation of reactive oxygen species could play a role in this phenomenon. The nanocomposite also affected biofilm formation ability. Even though the biomass of biofilms was comparable, the viability of cells in biofilms was upregulated in 48-hour biofilms. Furthermore, from six selected genes, the mexA coding efflux pump was upregulated, which could be associated with an interaction with TiO2. The results show that titanium dioxide/silica nanotubes may alter the physiological and metabolic functions of P. aeruginosa PAO1.

Determination of Mercury Content in Surface Waters Using an Environmentally Non-Toxic Terminating Electrolyte

The paper presents results of the research on the dynamics of changes in the concentration of mercury in surface waters. The importance of mercury as an environmental pollutant results from specific properties of this metal, many sources of contamination, volatility, mobility, stability and high toxicity of its specific chemical forms. Samples of surface water collected from three rivers: the Bug, the Liwiec and the Muchawka were analysed. The Muchawka River flows into the Liwiec River, which in turn is a tributary of the Bug River. The technique of isotachophoresis was employed, using a solution of a biodegradable and environmentally non-toxic derivative of electrostatically stabilised silanates as the terminating electrolyte. The highest average mercury concentration of 0.89 μg/dm³ was determined in water samples collected from the Bug River in January, whereas the lowest concentration of 0.42 μg/dm³ was recorded in water collected from the Muchawka River in September.

The challenge of separating and determining biologically active electrostatically stabilized silanates using the high-performance liquid chromatography technique

We present the results of research on the optimal conditions for the separation and determination of newly obtained hypercoordinated compounds, which belong to the group of electrostatically stabilized silanates. The research involved five stationary and four mobile phases. The best selectivity was obtained using the graphite phase and the mobile phase consisting of acetonitrile/water (80/20). The maximum selectivity of the determined electrostatically stabilized silanates was 1.13 and 1.06 for (1), (2), (3); 1.10 and 1.15 for (4), (5), (6); and 1.12 and 1.15 for (7), (8), (9). The octadecyl phase (which is recommended as standard) did not yield satisfactory results.

Determination of the elemental composition and antioxidant properties of dates (Phoenix dactyliferia) originated from different regions

Due to the growing interest in running a healthy life, including the diet a special interest has been put in searching for products that are rich in nutrients, macro and micronutrients and vitamins. Dates are the fruits that meet these requirements and show multidirectional pro-health effects. These fruits are a source of potassium and other macro- and micronutrients. They have antioxidant properties thanks to the content of flavonoids and polyphenols. The elemental composition (Al, Ca, Cu, Fe, K, Mg, Mn, P, Sr and Zn) and antioxidant properties (total equivalent antioxidant capacity, total polyphenol content, total flavonoid content) of various dates from different regions of the world was determined. The results have shown that the peel and flesh of dates differ significantly in chemical composition. The peel is significantly richer in chemical components of biological importance. Discriminant analysis of the results obtained for dates originated from various regions indicated that the main factor determining the tested chemical composition is the place of cultivation, not the variety.

Hepatopathy of unknown etiology - is liver biopsy a good tool in differential diagnosis?

INTRODUCTION

Liver biopsy is a well-known method for the diagnosis and evaluation of chronic diffuse liver diseases, especially among patients with "hepatopathy of unknown origin".

MATERIAL AND METHODS

In the years 2014-2015 we performed 259 liver biopsies in 28 patients (22 females, 6 males, aged 18-65 years, mean: 45 years) with an initial diagnosis of "hepatopathy of unknown origin". The liver biopsies of these 28 patients were revised by two independent pathologists.

RESULTS

Histopathological features of autoimmune conditions were found in 11 cases, steatohepatitis with/without Mallory bodies in 7, simple steatosis without inflammation in 2 cases. In the other 8 cases the histopathological features were non-specific but pointed to vanishing bile duct syndrome, hemochromatosis, acute inflammation or fibrosis without inflammation. Surprisingly, only mild fibrosis without inflammatory infiltrates was present in one patient with a high titer of antinuclear antibodies (ANA > 1 : 3200). Mild cholestasis with bilirubinostasis was found in 4 cases. One patient had prominent lobular iron deposits and is now under observation for hemochromatosis. Vanishing bile duct syndrome as ductopenia without any signs of inflammation was found in one patient with suspicion of primary biliary cirrhosis. In one liver biopsy specimen we found normal liver architecture without inflammation or steatosis in a patient with elevated ALT and GGT, negative for viral antibodies and autoantibodies.

CONCLUSIONS

Liver biopsy - despite the increasing access to new, non-invasive methods - remains a useful method in the differential diagnosis of liver diseases.

Analytics and Application of Biologically Active Pentacoordinate Electrostatically Stabilized Silanates

The objective of this study was to synthesize information on the analytics, using two separation techniques, and the application of electrostatically stabilized silanate derivatives. They are biologically active, water-soluble, hydrolytically stable and biodegradable. Some of these compounds are used as plant growth regulators, while others, with higher molecular mass and lower electrophoretic mobility, are used in the form of terminating electrolytes in isotachophoresis, which is regarded as one of the green chemistry techniques. Two compounds were successfully used in the form of terminating electrolyte solutions, i.e. 4,4'-bis{1-(perhydroazepiniomethyl)[spirobi(1-sila-2,5-dioxacyclopentane-3-on)]at}, and 4,4'-bis{1-[(N,N-dimethyl)aminiomethyl]spirobi(1-sila-2,5-dioxacyclopentane-3-on)at} to isolate organic ionic substances with high molecular mass, e.g. derivatives of quinoline, stilbene and electrostatically stabilized silanates (ES-silanates). Establishing the best conditions for the analysis of these derivatives extends the possibilities of conducting research on their biological activity and miscellaneous applications. Furthermore, the terminating electrolytes used in the form of solutions of electrostatically stabilized silanates allow the analysis of both cationic and anionic forms.

Expression of programmed cell death protein 1 and T-cell immunoglobulin- and mucin-domain-containing molecule-3 on peripheral blood CD4+CD8+ double positive T cells in patients with chronic hepatitis C virus infection and in subjects who spontaneously cleared the virus

Chronic hepatitis C virus (HCV) infection is characterized by increased proportion of CD4+CD8+ double positive (DP) T cells, but their role in this infection is unclear. In chronic hepatitis C, immune responses to HCV become functionally exhausted, which manifests itself by increased expression of programmed cell death protein 1 (PD-1) and T-cell immunoglobulin- and mucin-domain-containing molecule-3 (Tim-3) on T cells. The aim of our study was to determine PD-1 and Tim-3 phenotype of DP T cells in subjects with naturally resolved and chronic HCV infection. Peripheral blood mononuclear cells from 16 patients with chronic infection and 14 subjects who cleared HCV in the past were stained with anti-CD3, anti-CD4, anti-CD8, anti-PD-1 and anti-Tim-3 antibodies and, in 12 HLA-A*02-positive subjects, MHC class I pentamer with HCV NS3₁₄₀₆ epitope. In chronic and past HCV infection, proportions of total DP T cells and PD-1+ DP T cells were similar but significantly higher than in healthy controls. DP T cells were more likely to be PD-1+ than either CD4+ or CD8+ single positive (SP) T cells. HCV-specific cells were present in higher proportions among DP T cells than among CD8+ SP T cells in both patient groups. Furthermore, while the majority of HCV-specific DP T cells were PD-1+, the proportion of HCV-specific CD8+ T cells which were PD-1+ was 4.9 and 1.9 times lower (chronic and past infection, respectively). PD-1 and Tim-3 were predominantly expressed on CD4^high CD8^low and CD4^low CD8^high cells, respectively, and co-expression of both markers was uncommon.

Mild hyperbilirubinemia as a marker of oesophageal varices in HCV-related compensated cirrhotic patients

The natural course of compensated liver cirrhosis caused by chronic hepatitis C virus (HCV) infection is still a very interesting problem in hepatology. The prognostic usefulness of the Child-Pugh and MELD score in compensated liver cirrhosis is still debated. Consequently, several attempts have been made to determine parameters other than included in the Child-Pugh score, which could be helpful in the prognosis of compensated liver cirrhosis assessment.

AIM

The aim of study was to identify a clinical or laboratory markers correlated with higher risk of liver decompensation among HCVinfected patients with compensated liver cirrhosis and presence or absence of esophageal varices.

MATERIALS AND METHODS

The study included 176 HCV-infected patients with compensated liver cirrhosis (74 women and 102 men) registered in the Clinical Database of Patients with Liver Cirrhosis - e-Hepar. All patients were monitored during 252 weeks for the occurrence of liver failure symptoms and the development of hepatocellular carcinoma (HCC).

RESULTS

The presence of esophageal varices was significantly associated with total bilirubin ≥2.0 mg/dl, platelets ≤110.0 G/L and 6 points in Child-Pugh score (p<0.05). The cumulative 252 weeks incidence of clinical decompensation was higher in patients with varices in comparison to patients without them (p<0.05). Variceal hemorrhages were observed in 9 cases (23.1%). During the follow-up period 9 patients died due to HCC complications.

CONCLUSIONS

Our findings underline the prognostic value of serum bilirubin (even mild elevation) and platelet count in HCV-infected patients with compensated liver cirrhosis. We have confirmed that liver decompensation is more frequent and more rapid in patients with compensated liver disease and concomitant oesophageal varices.

Cryoglobulinemia and its correlation with clinical extrahepatic manifestations in chronic hepatitis C

Cryoglobulinemia is a condition with a confirmed relationship with HCV infection, but many other extrahepatic symptoms are also present in hepatitis C. Aim: The aim of this study was to assess the incidence and type of extrahepatic manifestations and cryoglobulinemia as well as their correlation with clinical symptoms in Polish patients. Material and methods: 246 consecutive patients with hepatitis C were studied. Clinical symptoms were assessed by anamnesis and a clinical investigation. Cryoglobulins were estimated by a method basing on their ability to reverse precipitation in temperature +4ºC. Monoclonality of cryoglobulins was estimated by agarophoresis immunotyping – capillary electrophoresis and immunofixation. The presence of classical rheumatoid factor (RF-IgM) was tested using ELISA. Anti-nuclear antibodies (ANA) were tested using the indirect immunofluorescence method. Anti-CCP, anti-SSA, anti-α-fodrin antibodies, RF IgG, IgM and IgA were assessed using commercial enzymatic tests. Statistical methods were: Fisher exact test, generalized additive models, odds ratios with 95% confidence intervals, aid of spline curve, SAS system version 9.4. Results: Cryoglobulins were found in 93 persons (37.8%). Type II cryoglobulinemia was detected in 28 persons. Patients with cryoglobulinemia were elder (p<0.0004). 54 patients (21.95%) manifested clinical extrahepatic symptoms. Arthralgia was found in 27 cases (10.98%). Skin changes were found in 22 patients (8.94%). 12 persons had glomerulonephritis (4.88%). 11 patients (4.47%) had sicca syndrome. 6 patients developed peripheral polyneuropathy (2.4%). 4 persons developed B cell lymphoma (1.63%). There was no correlation between presence of symptoms and grading, staging, age, HCV genotype, and the presence of autoantibodies. Extrahepatic manifestations were present more frequently in women (p<0.0008).

Neuroimaging and genetic correlates of cognitive dysfunction in multiple sclerosis

Cognitive impairment occurs in 40-70% of patients with multiple sclerosis (MS). It is observed even at the early stage of disease, including clinically isolated syndrome (CIS). Cognitive dysfunction develops irrespectively of the physical disability. Affected domains include: information processing speed, visuospatial abilities, attention, verbal memory and executive functions. Cognitive deficits have relevant implication because of their impact on daily living, quality of life and increased risk of conversion from CIS to MS. In the recent years the issue of cognitive impairment in MS became an important research problem. The fundamental aim is to understand the neurobiological substrates of these mental symptoms. As we know neurodegenerative process associated with the disease, pathology of cerebral cortex and damage to the normal appearing brain tissue are potentially involved in the development of cognitive symptoms. Better assessment of these cerebral changes is possible through the improvement of magnetic resonance imaging techniques. Influence of genetic profile on the course of MS, including cognitive dysfunction, is still under evaluation. Despite using the new neuroimaging methods, the substrate of cognitive impairment in MS has not been clearly defined so far. Understanding the mechanisms underlying cognitive symptoms may extend our knowledge of the pathophysiology of the disease and also contribute to the development of new strategies and objectives for treatment. This paper provides a summary of the results obtained from the application of conventional and modern magnetic resonance imaging techniques to assess structural pathologies occurring in MS as well as genetic factors and their association with cognitive dysfunction.

Symptomatic co-infection with Babesia microti and Borrelia burgdorferi in patient after international exposure; a challenging case in Poland

The report presents a well-documented case of symptomatic co-infection of Babesia microti and Borrelia burgdorferi in a Polish immunocompetent patient after travelling to Canada and the USA.

Absolute quantification reveals the stable transmission of a high copy number variant linked to autoinflammatory disease

BACKGROUND

Dissecting the role copy number variants (CNVs) play in disease pathogenesis is directly reliant on accurate methods for quantification. The Shar-Pei dog breed is predisposed to a complex autoinflammatory disease with numerous clinical manifestations. One such sign, recurrent fever, was previously shown to be significantly associated with a novel, but unstable CNV (CNV_16.1). Droplet digital PCR (ddPCR) offers a new mechanism for CNV detection via absolute quantification with the promise of added precision and reliability. The aim of this study was to evaluate ddPCR in relation to quantitative PCR (qPCR) and to assess the suitability of the favoured method as a genetic test for Shar-Pei Autoinflammatory Disease (SPAID).

RESULTS

One hundred and ninety-six individuals were assayed using both PCR methods at two CNV positions (CNV_14.3 and CNV_16.1). The digital method revealed a striking result. The CNVs did not follow a continuum of alleles as previously reported, rather the alleles were stable and pedigree analysis showed they adhered to Mendelian segregation. Subsequent analysis of ddPCR case/control data confirmed that both CNVs remained significantly associated with the subphenotype of fever, but also to the encompassing SPAID complex (p < 0.001). In addition, harbouring CNV_16.1 allele five (CNV_16.1|5) resulted in a four-fold increase in the odds for SPAID (p < 0.001). The inclusion of a genetic marker for CNV_16.1 in a genome-wide association test revealed that this variant explained 9.7 % of genetic variance and 25.8 % of the additive genetic heritability of this autoinflammatory disease.

CONCLUSIONS

This data shows the utility of the ddPCR method to resolve cryptic copy number inheritance patterns and so open avenues of genetic testing. In its current form, the ddPCR test presented here could be used in canine breeding to reduce the number of homozygote CNV_16.1|5 individuals and thereby to reduce the prevalence of disease in this breed.

Spouse-to-Spouse Transmission and Evolution of Hypervariable Region 1 and 5' Untranslated Region of Hepatitis C Virus Analyzed by Next-Generation Sequencing

Hepatitis C virus (HCV) transmission between spouses remains poorly characterized, largely due to the limited availability of samples from the early stage of infection, as well as methodological constraints. A fifty-eight year-old male developed acute hepatitis C infection and his 53-year old spouse has been HCV-positive for over 10 years. Serum samples were collected from both at the time of acute hepatitis C diagnosis in male (baseline) and then at 9 and 13 months. Hypervariable region 1 (HVR1) and 5’ untranslated region (5’UTR) sequences were amplified and subjected to next generation sequencing (NGS) using a pyrosequencing platform. Genetic variants were inferred by Shorah reconstruction method and compared by phylogenetic and sequence diversity analysis. As the sequencing error of the procedure was previously determined to be ≤ 1.5%, the analysis was conducted with and without the 1.5% cut-off with regard to the frequency of variants. No identical HVR1 variants were identified in spouses at baseline and follow-up samples regardless whether the cut-off was applied or not. However, there was high similarity (98.3%) between a minor baseline donor variant (1.7% frequency) and the most abundant baseline recipient variant (62.5% frequency). Furthermore, donor and recipient strains clustered together when compared to 10 control subjects from the same area and infected with the same HCV subtype. There was an increase in HVR1 complexity (number of genetic variants) over time in both spouses. In contrast, the 5'UTR region was stable and of low complexity throughout the study. In conclusion, intrafamilial HCV transmission may be established by a very minor variant and investigation of this phenomenon requires high-sensitivity assays, such as NGS.

The correlation between pretreatment cytokine expression patterns in peripheral blood mononuclear cells with chronic hepatitis C outcome

Backgroud

Cytokine response against hepatitis C virus (HCV) is likely to determine the natural course of infection as well as the outcome of antiviral treatment. However, the role of particular cytokines remains unclear. The current study analyzed activation of cytokine response in chronic hepatitis C patients undergoing standard antiviral treatment.

Methods

Twenty-two patients were treated with pegylated interferon and ribavirin. Twenty-six different cytokine transcripts were measured quantitatively in peripheral blood mononuclear cells (PBMC) before and after therapy and correlated with therapy outcome as well as with clinical and liver histological data.

Results

We found that patients who achieved sustained virological response (SVR) showed higher pretreatment cytokine response when compared to subjects in whom therapy was unsuccessful. The differentially expressed factors included IL-8, IL-16, TNF-α, GM-CSF, MCP-2, TGF-β, and IP-10. Serum ALT activity and/or histological grading also positively correlated with the expression of IL-1α, IL-4, IL-6, IL-10, IL-12, IL-15, GM-CSF, M-CSF, MCP-2 and TGF-β.

Conclusion

Pretreatment activation of the immune system, as reflected by cytokines transcripts upregulation, positively correlates with treatment outcome and closely reflects liver inflammatory activity.

Detection of hepatitis C virus (HCV) negative strand RNA and NS3 protein in peripheral blood mononuclear cells (PBMC): CD3+, CD14+ and CD19+

Background

Although hepatitis C virus (HCV) is primarily hepatotropic, markers of HCV replication were detected in peripheral blood mononuclear cells (PBMC) as well as in ex vivo collected tissues and organs. Specific strains of HCV were found to be capable to infect cells of the immune system: T and B cells and monocytes/macrophages as well as cell lines in vitro. The direct invasion of cells of the immune system by the virus may be responsible for extrahepatic consequences of HCV infection: cryoglobulinemia and non-Hodgkin’s lymphoma.

The aim of the present study was to determine the prevalence of markers of HCV infection: negative strand HCV RNA and non-structural NS3 protein in PBMC subpopulations: CD3⁺, CD14⁺ and CD19⁺. The presence of virus and the proportion of affected cells within a particular PBMC fraction could indicate a principal target cell susceptible for HCV.

Methods

PBMC samples were collected from 26 treatment-free patients chronically infected with HCV. PBMC subpopulations: CD3⁺, CD14⁺, CD19⁺ were obtained using positive magnetic separation. The presence of negative strand RNA HCV and viral NS3 protein were analyzed by strand-specific RT-PCR and NS3 immunocytochemistry staining.

Results

Negative strand HCV RNA was detectable in 7/26 (27%), whereas NS3 protein in 15/26 (57.6%) of PBMC samples. At least one replication marker was found in 13/26 (50%) of CD3⁺ cells then in 8/26 (30.8%) of CD14⁺ and CD19⁺ cells. The highest percentage of cells harboring viral markers in single specimen was also observed in CD3⁺ (2.4%), then in CD19⁺ (1.2%), and much lower in CD14⁺ (0.4%) cells.

Conclusions

Our results indicate that CD3⁺ cells are a dominant site for extrahepatic HCV replication, although other PBMC subpopulations may also support virus replication.

Hepatitis C virus (HCV) infection of peripheral blood mononuclear cells in patients with type II cryoglobulinemia

OBJECTIVES

Type II cryoglobulinemia is a common extrahepatic manifestation of chronic hepatitis C virus (HCV) infection. The mechanisms behind its development are unclear, but could be related to direct infection of the immune cells.

METHODS

Peripheral blood mononuclear cells from 18 patients with type II cryoglobulinemia were separated into CD3+ (T cells), CD19+ (B cells) and CD14+ (monocytes) and analyzed for the presence of negative strand HCV RNA, which is a viral replicative intermediate, and for the presence of HCV non-structural protein 3 (NS3). Control group consisted of 182 consecutive chronic hepatitis C patients prior to initiation of antiviral therapy.

RESULTS

Negative strand HCV RNA was detected in PBMC from six (33.3%), patients and in 15 (8.2%) controls (p < 0.01). Negative strand was most frequently detected in B cells (3 patients), followed by T cells (2 patients), and monocytes (2 patients). One patient was positive both in CD3+ and CD14+ cells. NS3 protein was detected in six (33.3%) patients; five were positive in T cells, three in B cells, and another three were positive in monocytes. Two patients were positive in all analyzed cell subpopulation and one patient was positive in CD14+ and CD19+ cells, but not in CD3+ cells. Altogether, 11 patients (61.1%) were positive either for the negative strand HCV RNA or NS3 protein in at least one of the analyzed cell compartments.

CONCLUSION

Our findings of common presence of viral replication in cells of the immune system suggest that direct HCV infection could play a role in the etiology of cryoglobulinemia.

Comparison of two different immunohistochemical algorithms identifying prognostic subgroups of DLBCL

In this study we analyzed the prognostic value of single and combined immunohistochemical markers, according to algorithms proposed by Hans et al. and Muris et al. in 66 de novo diffuse large B-cell lymphoma (DLBCL) cases. The main aim of our study was to compare usefulness of these two immunohistochemical algorithms for the subdivision of DLBCL into prognostically relevant subgroups. Cases classified as germinal centre B-cell (GCB) had a significantly lower risk of death (p = 0.008) compared with the non-GCB group. The 5-year overall survival (OS) rate was 85% for the GCB group and only 30% for the non-GCB group (p = 0.003). Furthermore, division into the GCB and non-GCB group predicted prognosis in cases with low International Prognostic Index (IPI) (p = 0.03). GCB patients with a low IPI score had a significantly better OS than those from the non-GCB group (93% versus 45%) (p = 0.02). Although the 5-year OS of favourable group 1 from Muris algorithm was slightly better than in group 2, the difference was not significant (p = 0.241). In summary, our results indicate that the algorithm of Hans et al. has a significantly better prognostic value. By using immunohistochemistry and this algorithm, we can subclassify DLBCL into prognostically distinct subgroups and further refine the prognosis based on IPI.

[Toll-like receptors in viral hepatitis]

Toll-like receptors (TLRs) are part of the innate immune system. They recognize some protein, lipid, and nucleic structures that are common in microorganisms such as bacteria and viruses but not present in the human body. The stimulation of TLRs initiates the activation of an intracellular signaling network which results in the secretion of proinflammatory cytokines, mainly type I interferons, TNF-alpha, and IL-6. TLR2, TLR3, TLR4, TLR8, and TLR9 take part in the recognition of viral infections, four of them by discerning nucleic acids, with TLR3 recognizing dsRNA, TLR7 and TLR8-ssRNA, and TLR9-DNA. The role of TLRs in the development of infections and other inflammatory states, neoplasms, and autoimmune disorders is under investigation. The importance of TLRs in the natural course of hepatitis B and C and in the treatment of these diseases are the subject of particular interest. Attempts to apply TLR7 and TLR9 agonists in the treatment of chronic hepatitis type C are underway. A better understanding of the role of TLRs in the complex immunological phenomena accompanying viral hepatitis might put the therapeutic possibilities in these infections into a new perspective.

Solitary fibrous tumour of the tongue of an adolescent--a case report with immunohistochemical studies

Solitary fibrous tumour (SFT) is a rare, spindle-cell, mesenchymal neoplasm with haemangiopericytoma-like branching vascular pattern. The tumour has been reported in various locations but the oral cavity is a distinctly uncommon region. We describe a case of solitary fibrous tumour (SFT) in the tongue of a 15-year-old girl. Microscopically it had features characteristic for SFT and a common immunohistochemical profile but uncommonly increased mitotic count.

[Difficulties in treatment of kidney diseases related to HCV infection]

Membranoproliferative glomerulonephritis is a typical manifestation of HCV infection, in most cases connected with cryoglobulinemia. Efficiacy of antiviral treatment with interferon and ribavirine in this group of patients is lower compared to the population without kidney disease. Another options of treatment are: use of rituximab (monoclonal antibody destroying lymphocytes B), low-antigen containing diet, plasmapheresis and immunosupressive treatment. Recommendations of antiviral treatment in HCV-infected patients with concomitant renal failure were presented.

[Anti-HCV and HCV RNA in patients with the primary Sjögren syndrome]

The subject of study were 104 patients with the primary Sjögren Syndrome (p. Sj. s.) in whom markers of hepatitis C infection were investigated. All the patients fulfilled the criteria of the European Expert Group of the Sjögren Syndrome. Antibodies anti-HCV were found in 20 patients (19.2%) and HCV-RNA found in 5 patients (4.8%). These data were compared with those observed in several European countries and Japan. The following percentages of anti-HCV were observed until now in p.Sj.s. patients: Swedish--2%, Hungarian--6%, Japanese--12%, French--17%, Polish--19% and Spanish--26%. Our patients in whom liver data were available, showed only minor elevations of ALT and AST. International team of experts postulated the delineation of the disease entity: 'HCV-related primary Sjögren syndrome', separate from the p.Sj.s. itself. If this will be substantiated, we can put forward the hypotesis that 'HCV-related p.Sj.s.' may develop in a special subgroup of persons, perhaps genetically predisposed, and is a part of extrahepatic manifestations of HCV infection.

[The efficacy of tympanopunction in children with OMS]

INTRODUCTION

Otitis media with effusion is the most frequent cause of conductive hearing impairement (HL) at pediatric age. This entity can be asymptomatic for an important period of time (silent OME). There is a surgical and a nonsurgical approach for OME. In case of failure of conservative treatment of OME the ventilation tube insertion (VT) with adenoidectomy alone or combined with tonsillectomy should be choosed. If the hearing loss is less than 20 dB children are candidates for conservative treatment and myringotomy.

MATERIAL AND METHODS

From 1999 to 2003, 50 children with bilateral and 9 with unilateral OME underwent the surgical treatment in our ENT Department. Mean age of patient population was 6,8 years. Clinical evaluation of the OME treatment outcome was done in 2004. Surgical procedure involved myringotomy, aspiration of the middle ear effusion, middle ear irrigation with soline solution 0.9 % Sodium Chloride (NaCl) followed by suction of diluted glue. Depo-Medrol (methylprednisolone acetate) was administrated into the middle ear. Our procedure included the management of the upper airways obstruction.

RESULTS

Good long-term outcomes after surgical treatment of OME were obtained in 30 patients (79%). In this group of children the upper airways management included adenoidectomy and partial tonsillectomy. 8 children presented poor response to the treatment. In this group the surgical procedure consisted of adenoidectomy and inferior turbinate reduction. Two children presented acute otitis media and improved after conservative treatment. Other children with poor outcome were: a boy who underwent multiple surgical procedures due to laryngotracheal stenosis, a girl who suffered from chondrodysplasia. Remaining two patients presented few months ago aggravation of conductive hearing loss. According to positive familial history they underwent allergical examinations. One boy was planned for readenoidectomy and laser myringotomy, a girl already operated at the age of tree years, was planned for ventilation tubes insertion and readenoidectomy in another ENT Department.