Natural history of eosinophilic esophagitis: a systematic review of epidemiology and disease course.

Eosinophilic esophagitis is a chronic immune-mediated esophageal disorder. For its timely diagnosis, clinicians must recognize common symptoms, and understand differences in symptoms across patient groups. The aim of this study is to systematically review the epidemiology and natural history of eosinophilic esophagitis. The MEDLINE, Embase, and Cochrane databases were searched from 1974 to February 2017 for studies describing the epidemiology and natural history of eosinophilic esophagitis. Congress abstracts from 2014 to 2016 were also searched. Search results were screened against predetermined inclusion/exclusion criteria by two independent reviewers, and data extraction was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Of 1376 articles identified, 47 met the inclusion criteria: 20 on epidemiology and 27 on natural history. Incidence and prevalence of eosinophilic esophagitis varied widely across North America and Europe, and increased over time. Incidence increased 131-fold in the Netherlands (1996-2010), 20-fold in Denmark (1997-2006), and 5.1-fold in Calgary, Canada (2004-2008). The most commonly reported symptoms were emesis and abdominal pain in children, and dysphagia and food impaction in adults. Age at diagnosis was 5.9-12.0 years in children, and approximately 30 years in adults. Time between symptom onset and diagnosis was 1.2-3.5 years in children and 3.0-8.0 years in adults. Diagnostic delay was associated with an increased risk of endoscopic features of fibrostenosis. Symptoms of eosinophilic esophagitis differed significantly by age and race. In conclusion, there is an increasing incidence and prevalence of eosinophilic esophagitis. The considerable delay between symptom onset and diagnosis suggests that clinicians do not readily recognize the disease, which may have important clinical ramifications.

How complement activation influences the development of chronic synovitis in a mouse model of rheumatoid arthritis.

OBJECTIVES: Chronic synovitis is the main characteristic of rheumatoid arthritis (RA), defined by the proliferation of synovial lining cells, an important source of chemokines and cytokines associated with inflammation. The aim of this study was to examine the influence of complement functional activity on the development of chronic synovitis. METHOD: The experiments were conducted in zymosan-induced arthritis (ZIA) provoked by intra-articular injection of 180 µg zymosan. Mice were treated with 10 ng/g body weight (bw) cobra venom factor (CVF) on days -3 and -2 or with 10 ng/g bw CVF on days 7, 12, and 17 of ZIA. The percentage of neutrophils (CD11b+Ly6G+), macrophages (F4/80), and complement 5 anaphylatoxin receptor (C5aR)-positive cells in the synovial fluid (SF) were determined by flow cytometry and the expression of C5aR and C3aR in the synovium was detected immunohistochemically. RESULTS: The induction of ZIA in the absence of complement activity strongly inhibited the development of synovitis. By contrast, complement activation during ZIA exacerbated chronic synovitis through an increase in macrophage infiltration, C5aR and C3aR expression in the joints, and C5aR expression on SF cells. Levels of C5a and soluble receptor activator of nuclear factor kappa B ligand (sRANKL) in the SF were elevated whereas neutrophil infiltration and levels of tumour necrosis factor (TNF)-α and interleukin (IL)-6 in the SF were unchanged. CONCLUSIONS: Our findings indicate an important role for functional complement activity in the maintenance of chronic synovitis in a model of RA. Antagonizing complement activation represents new possibilities for the amelioration of synovitis symptoms.

Validity of reported data in the Swedish Cardiac Arrest Register in selected parts in Sweden.

AIM: To describe differences and similarities between reported and non-reported data in the Swedish Cardiac Arrest Register in selected parts in Sweden. METHODS: Prospective and retrospective data for treated OHCA patients in Sweden, 2008-2010, were compared in the Swedish Cardiac Arrest Register. Data were investigated in three Swedish counties, which represented one third of the population. The recording models varied. Prospective data are those reported by the emergency medical service (EMS) crews, while retrospective data are those missed by the EMS crews but discovered afterwards by cross-checking with the local ambulance register. RESULT: In 2008-2010, the number of prospectively (n=2398) and retrospectively (n=800) reported OHCA cases was n=3198, which indicates a 25% missing rate. When comparing the two groups, the mean age was higher in patients who were reported retrospectively (69 years vs. 67 years; p=0.003). There was no difference between groups with regard to gender, time of day and year of OHCA, witnessed status or initial rhythm. Bystander cardiopulmonary resuscitation (CPR) was more frequent among patients who were reported prospectively (65% vs. 60%; p=0.023), whereas survival to one month was higher among patients who were reported retrospectively (9.2% vs. 11.9%; p=0.035). CONCLUSION: Among 3198 cases of OHCA in three counties in Sweden, 800 (25%) were not reported prospectively by the EMS crews but were discovered retrospectively as missing cases. Patients who were reported retrospectively differed from prospectively reported cases by being older, having less frequently received bystander CPR but having a higher survival rate. Our data suggest that reports on OHCA from national quality registers which are based on prospectively recorded data may be influenced by selection bias.

BALF-derived fibroblasts differ from biopsy-derived fibroblasts in systemic sclerosis.

Growth of fibroblasts from bronchoalveolar lavage fluid (BALF) in patients with systemic sclerosis (SSc) has previously been described. The purpose of the present study was to characterise fibroblasts from BALF and bronchial biopsies from SSc patients with alveolitis and from controls, to analyse fibroblast proliferation, migration, stress fibres and proteoglycan production. BALF and bronchial biopsies were collected from 10 patients with SSc and alveolitis and from 15 controls. Outgrowth of fibroblasts was observed from the BALF of four patients, particularly in those with a markedly increased percentage of eosinophils in BALF, but not in any member of the control group. Increased levels of granulocyte-macrophage colony-stimulating factor, correlating with the percentage of eosinophils in BALF, were found in patients when compared with controls. Fibroblasts from BALF showed an elongated, mobile phenotype and increased proteoglycan production compared to the corresponding biopsy fibroblasts. In conclusion, outgrowth of fibroblasts with an altered phenotype is reported from bronchoalveolar lavage fluid in systemic sclerosis patients with alveolitis and an increased percentage of eosinophils in the bronchoalveolar lavage fluid. These findings indicate a possible role for eosinophil-fibroblast interaction in pulmonary fibrosis in systemic sclerosis.

Weaning from long-term mechanical ventilation: a nonpulmonary weaning index.

OBJECTIVE: Despite the extensive investigations in the area of weaning, clinicians are still struggling with the question of when to begin the process of weaning. Clinical weaning indices designed to predict the weaning potential are most frequently based on pulmonary factors. However, many physiological, respiratory, and mechanical factors also have impact on weaning, but are often overlooked. We suggest a new "nonpulmonary weaning index" (NPWI), which assesses the influence of factors such as blood albumin and total blood protein on the weaning success. METHODS: We assess the information value of 17 clinical and paraclinical indices in a retrospective study covering 151 patients on a long-term (at least 7 days) mechanical ventilation. The most informative of those 17 indices are used in the formulation of NPWI. Its threshold differentiates the successful from the unsuccessful weaning trials. RESULTS: From all 17 indices the most significant are: total blood protein, blood albumin, PaO2, hematocrit, lactate, the ratio PaO2/FiO2, hemoglobine, and RUE. The proposed index uses only two of them: blood albumin and total blood protein. It is easily calculated and can easily be tracked in time. It has high sensitivity and specificity. CONCLUSIONS: The results of this study suggest that in the decision whether to attempt weaning from long-term mechanical ventilation, more attention should be paid to the nonpulmonary factors.

[Clinical importance of macroscopic hematuria]. / Klinichno znachenie na makroskopskata khematuriia.

The authors established macroscopic hematuria in 13,8 per cent of the examined 1618 renal patients. It is most often met in patients with chronic calculus pyelonephritis and nephrolithiasis (45,2%). In 9,0 per cent of the patients with chronic glomeruloneshrihs and in 14,9 per cent of those with acute glomerulonephritis the painless macroscopic hematuria is the initial clinical manifestation of the disease. The latter is a frequent symptom (40,6%) in patients with congenital kidney anomalies. In 5,8 per cent of the patients with macroscopic hematuria -- the reason is not elucidated.

[Incidence and characteristics of the hypertension syndrome in chronic glomerulonephritis]. / Chestota i osobenosti na khipertonichniia sindrom pri khronichnite glomerulonefriti.

The authors share their results from the studies on the incidence and characteristic of hypertonic syndrome in 132 patients with chronic glomerulonephritis (ChGN). In that random group, 65.1 per cent had renoparenchymal hypertension (RPH), 34.8 per cent of the patients had RPH among the patients with normal renal function, and with various degrees of chronic renal insufficiency (ChRI) - 95.4 per cent. In 69 patients, the diagnosis was confirmed by puncture biopsy, with a predomination of membranous, membranous-proliferative, IgA and endoproliferative ChGN. With the exception of IgA nephritis, RPH in the rest is found relatively often even in the absence of ChRI. The symptomatics of RPH was relatively poor--most frequently the patients complained of headache--in 48 per cent but patients with ChGN without RPH also had the same complaints--26 per cent. Complaints as dizziness, tinnitus and insomnia were rare. The hypertension was with a short duration (according to anamnestic data)--in 2/3 less than three years and 40 per cent of the patients had hypertonic crises or/and acute left cardiac insufficiency in spite of the relatively little alterations in ECG and fundus of the eye. Those were mainly patients with advanced ChRI. The authors lay stress upon the necessity of complex treatment of renal insufficiency and of hypertension with a view to the improvement of the prognosis of those patients.

[Clinical characteristics of the anemic syndrome in chronic renal diseases]. / Klinichna kharakteristika na anemichniia sindrom pri khronichnite bubrechni zaboliavaniia

The results from the study of the anemia syndrome in 1100 patients are reported (881 with chronic pyelonephritis, 147 with chronic glomerulonephritis and 72 with endemic nephropathy). Out of them 663 were with preserved renal function, 160 - with compensated and 274 - with decompensated nitrogen retention. Anemia was found in 98.7 per cent of the patients with endemic nephropathy, in 59.2 per cent of the patients with chronic glomerulonephritis and in 56.8 per cent of the patients with chronic pyelonephritis. Anemia precedes the manifestations of renal insufficiency in endemic nephropathy. In 36 per cent of the patients with endemic nephropathy it is severe or very severe. Light anemia was found in 44,6 per cent of the patients with chronic pyelonephritis and in those with preserved renal function. Only in the patients with chronic pyelonephritis the values of serum iron are under the normal. The administration of iron preparations in those patients is with good results. In the stage of decompensated renal insufficeincy effect was obtained by often blood transfusions.

[Lysogeny in Escherichia coli isolated from birds and the spectrum of the lytic action of isolated phage]. / Vurkhu lizogeniiata pri Escherichia coli, izolirani ot ptitsi, i spektura na litichnoto deistvie na izoliranite fagi.

Studies was the lysogenicity in a total of 70 strains of Escherichia coli isolated from birds. As many as 19 lysogeneic strains were isolated, yielding 19 phages that had the signature of lysogenic strains. Two serologic groups of phages were established by means of the neutralization reaction. It was found that phages 30 and 229, representing the two serologic groups of bacteriophages could lyse up to 44 per cent of the E. coli strains isolated from birds, 7 per cent of those isolated from calves, and 4 per cent of those from pigs. Out of 74 Salmonella strains, belonging to ten species, the same phages lysed two strains of Salmonella newport and 1 strain of Salmonella anatum. It is believed that phage lysis could be used to establish the source of infection and to evaluate the effectiveness of the prophylactic measures applied, incl. disinfection.

[Immunological reactivity in a radiation microclimate]. / Imunologichna reaktivnost v usloviiata na radiatsionen mikroklimat.

Bearing in mind the complexity of the radiation factor in industrial conditions the aim of work was to investigate the immunological reactivity in the conditions of glass production. The following methods were used: bactericide properties of skin, quantity of deep microflora of the skin, lysosome activity of the saliva, phagocytic activity of neutrophils in blood, bactericide properties of serum and serum complement. A decrease in the immunological reactivity of the organism was established which was most strongly expressed in relation to the bactericide properties of the skin, lysosome activity of the saliva and the phagocyte activity of the neutrophils in blood.

[Direct bacteriological studies of patients with calculous pyelonephritis]. / Direktni bakteriologichni prouchvaniia pri bolni s kalkulozen pielonefrit.

The authors report their observations on the bacteriological studies in 115 patients with chronic calculous pyelonephritis. Intraoperatively, pelvic urine and biopsic material was taken from the pyelonephritis changed areas of the kidney and directly inoculated upon enriched nutrient medium "Difco" Later, inoculations were carried out on solid nutrient media. A total of 225 bacteria of 8 species were isolated. Bacteria were present in pelvic urine or in kidney punched-out material of all patients with calculous pyelonephritis, often--in both places. In 52.2% of the cases the bacteria established in both the places were identical, and in the rest of the cases--different or association of the same with another bacterium. An attempt was made to explain that phenomenon. E. coli, Pr. mirabilis and Staph. aureus were most frequently isolated. Consideration given to the observations, the authors recommend active uroantiseptic therapy in case of clinic of exacerbated chronic calculous pyelonephritis evan in case of sterile urine, as well as not very strict observation of the requirements of antibiogram with bacteriuria established. The experience of the inclusion of antistaphylococcal treatment is indicated in case of a picture of urosepsis in patients with chronic calculous pyelonephritis even in the absence of the isolated Staph. aureus from urine.

[Diagnostic significance of lysozymuria in chronic pyelonephritis]. / Diagnostichno znachenie na lizozimuriiata pri khronichniia pielonefrit.

Lysozymuria was studied in 70 patients with chronic pyelonephritis with preserved renal function and two groups of 18 patients each with pyelonephritis, with chronic renal insufficiency (CRI) and glomerulonephritis without CRI. Elevated value of lysozyme in urine was obtained in 40% of the patients with chronic pyelonephritis with preserved renal function and in 66.6% of those with chronic pyelonephritis in the stage of a chronic renal insufficiency. Lysozyme level in urine is in a correlation dependence on serum creatinine level. Lysozymuria is more frequent among patients with pyelonephritis with significant bacteriuria as well as among patients not treated with uroantiseptics. Lysozymuris is present in two patients with nephrotic syndrome from the patient group with glomerulonephritis and in two with probable not complicated chronic pyelonephritis.

Plasma renin activity in patients with renovascular hypertension.

Changes of plasma renin activity (PRA) were studied in 45 patients with renovascular hypertension. Peripheral PRA was assayed by Serebovskaya's modification of Pickens' biological method; in 13 patients it was additionally assayed in blood samples taken from both renal veins. In some of the patients who were not surgically treated PRA was followed up over a period of 1 to 5 years. The interrelation between PRA and the sex and age of the patients, the duration and the severity of the disease, the clinical and the morphological type of renovascular hypertension, as well as uni- or bilateral involvement of the renal artery is discussed. PRA was increased during the early stage of renovascular hypertension, while later it became normal. PRA of renal vein blood samples, from the kidney with a constricted renal artery, reflects more exactly the dynamics of the changes in the pressor system of the kidney. The assay of PRA is of special importance in the evaluation of the indications for surgical treatment and of the effect of reconstructive surgery.

[131-I-hippuran clearance and isotopic nephrography in patients with endemic nephropath]. / 131J-khipuranov kliruns i izotopna nefrografiia pri bolni s endemichna nefropatiia

The authors carried out investigations on renal function with isotope nephrogram and 131J-hippuran clearance in 30 patients with endemic nephropathy - three with and 27 without nitrogen retention. In all patients, especially in advanced stages, a considerable decrease of the effective renal plasma flow was established. The radioisotope nephropathy also provides evidence for diffuse bilateral and symetric alterations in the complete renal function. The statement was confirmed that in the course of endemic nephropathy, all renal structures are gradually involved, but the functions of tubules and interstitial tissues are especially severly disturbed.

[Results of treatment of chronic exacerbated pyelonephritis with unroantiseptics under clinical conditions]. / Rezultati ot lechenieto na khronichniia izostren pielonefrit s uroatiseptitsi v klinichni usloviia

The results are reported from the carried out 701 shortterm therapeutic courses in 527 patients with exacerbated chronic pyelonephritis. The results are considered as "very good" in realization of a full clinical remission (normalization of temperature and ESR), disappearance of leucocyturia and bacteriuria), "good" - in normalization of three of those indices and "withfut effect". Co-trimoxazol (88.3 per cent of the patients), gentamycin (61.7%), ampicillin (58.8%), nelidix acid (57.4%), nitrfuran (55.0%) and choloramphenicol (53.1%) have manifested the highest effectiveness (very good and good effect). In a small number of the treated patients with cephalosporins effect was obtained in 50.0 per cent, with urovalidin - 44.4 per cent and with carbenicillin - 62.5 per cent. According to the authors' opinion the therapeutic schemes for a long-term treatment must include chlorampheniacal, nelidix acid, co-trimoxazol and nitrofuran sometives -amplicillin. Gentamycin, ampicillin and cephalosporins and with indications - some other uroantiseptics must be used in the coping with severe exacerbation of the disease. The authors recommend the chronic intermittent uroantiseptic treatment.

[A study of renal function using radioisotope methods in patients with diabetic nephropathy]. / Prouchvane na bubrechnata na bubrechnata funktsiia s pomoshtta na radioizotopni metodi pri bolni ot diabetna nefropatiia

An earlier and more manifested affect of glomerular function was established during the examination of 35 patients with diabetic nephropathy, 14 of them in a stage of renal insufficiency, with the help of radioisotope clearance methods (of EDTA, labelled with 169Yb for the determination of glomerular function and of hippuran, labelled with 131J for the determination of the renal plasma flow). The renal plasma flow is affected to a considerably more restricted extent. The combination of diabetic nephropathy with chronic pyelonephritis, found in 10 patients, does not affect substantially the mentioned functions of the kidney, but additional investigations were considered necessary in that field. Bilateral symmetric alterations are more frequently the secretory and excretory segmentsmthe establishment of unilateral alterations may speak of the presence of chronic pyelonephritis of uropathic character. The radioisotope methods, because of their accessibility and less possibilities for errors are recommended for renal functional investigations.

[I-131-hippuran clearance and isotope nephrography in chronic pyelonephritis]. / 131-J-hipuranov kliruns i izotopna nefrografiia pri khronichen pielonefrit

The results from the complex radioisotope and clinical examination of 105 patients with chronic pyelonephritis are presented. 131J-hippuran clearance was performed according to the single injection method. The obtained average value 583--166 ml/min 1,73 m2 for the patients in renal compensated stage is lower than the normal. The average value for renal plasma flow is 229.58--127 ml/min/1,73 m2 for patients in renal decompensated stage. The filtration fraction--FF showed decreased values both in renal compensated (0,14) and in decompensated patients (0,09). That gives us sufficient grounds to assume some changes in the glomerular function even in the compensated stage of chronic pyelonephritis and during the decompensated stage it considerably decreases due to manifested morphological changes, addecting also the glomerular apparatus. Isotope nephrogram was made to 71 of the patients, which proved normal in those in the compensated stage or with slight alteration, predominatly unilaterally, while in the cases with decompensated stage--the changes were strongly manifested, most frequently in the three segments, bilaterally.

[Microclimatic and air ionization problems in electronic telecommunication centers]. / Mikroklimatichni i aeroionizatsionni problemi v elektronni telekomunikatsionni tsentrali.

The electronic automatic telegraph stations are up-to-date telecommunicative equipment. There is no information in literature for hygiene characteristic of the working conditions in this type of modern industrial activity. The study shows, that the basic hygiene problems are related to the microclimate and ionization of the air of the working premises. The climatic installation creates extremely static microclimate during all the periods of the year and systematic aero-ionic insufficiency of the air. Possibilities for regulating the climatic installation regime are discussed in view of establishing physiologically sound and well-grounded microclimate and aero-ionic conditions.