Report on the Effect of the Implementation of an Early Detection and Prevention of Cancer Program on Families at High Hereditary Risk-Concentrating on Patients Undergoing Genetic Diagnostics and Counseling in Central Poland.

Over a 46-month period, the objectives of the National Cancer Control Program (NCCP, pol. Narodowy Program Zwalczania Chorób Nowotworowych), coordinated by the Ministry of Health, were pursued by conducting genetic diagnostics on individuals at high risk of developing cancer. A total of 1097 individuals were enrolled in the study, leading to the identification of 128 cases of germline mutations. The implementation of the NCCP led to the identification of genetic mutations in 4.43% of the patients qualified for BRCA1 and BRCA2 screening tests, in 18.18% of those qualified for a comprehensive next-generation sequencing (NGS) panel in cases of breast and ovarian cancer, and in 17.36% of cases of colorectal and endometrial cancer. The research conducted allowed us to establish individualized preventive and therapeutic approaches for mutation carriers. However, the results prove that liberalizing the inclusion criteria for high-throughput diagnostics and the use of broad gene panels could significantly increase the percentage of detected carriers. This publication serves as a summary and discussion of the results obtained from the implementation of the NCCP as well as of the role of genetic consulting in personalized medicine.

Tell Me, What Do You See?-Interpretable Classification of Wiring Harness Branches with Deep Neural Networks.

In the context of the robotisation of industrial operations related to manipulating deformable linear objects, there is a need for sophisticated machine vision systems, which could classify the wiring harness branches and provide information on where to put them in the assembly process. However, industrial applications require the interpretability of the machine learning system predictions, as the user wants to know the underlying reason for the decision made by the system. We propose several different neural network architectures that are tested on our novel dataset to address this issue. We conducted various experiments to assess the influence of modality, data fusion type, and the impact of data augmentation and pretraining. The outcome of the network is evaluated in terms of the performance and is also equipped with saliency maps, which allow the user to gain in-depth insight into the classifier's operation, including a way of explaining the responses of the deep neural network and making system predictions interpretable by humans.

Comparative analysis of 13 HPV genotypes diagnosed in urine sediment cells vs. desquamated cervical epithelial cells

INTRODUCTION: The human papilloma virus (HPV) belongs to double-stranded, DNA circular viruses which infect the epithelial cells. The highest incidence of HPV is identified in malignant processes which affect the uterine cervix, as well as vulvar, penile, rectal and pharyngeal regions. GOAL OF STUDY: An attempt to find correlations between HPV incidence rates in urine sediment cells and in desquamated epithelial cells of the uterine cervix in a group of patients with frequent, recurrent cystitis. MATERIALS AND METHODS: HPV presence was studied, both in urine sediment cells and in uterine cervix epithelial cells of 77 patients. RESULTS: An analysis of urinary sediments brought a total of twenty (25.97%) positive and 57 (74.03%) negative results. In turn, an evaluation of uterine cervix material samples revealed 17 (22.08%) positive and 60 (77.92%) negative results. CONCLUSIONS: The study enabled a comparison between HPV prevalence rates in urine sediment cells and in uterine cervix epithelial cells of an examined patient. The performed observations are likely to trigger a further analysis of the studied issue; however, the obtained results provide arguments for different natural histories of the infection processes.

The presence of staphylococcal superantigens in nasal swabs and correlation with activity of granulomatosis with polyangiitis in own material.

OBJECTIVES: Nasal carriage of Staphylococcus aureus and its superantigens (SAg) seem to be a risk factor disease exacerbation in granulomatosis with polyangiitis (GPA). We investigated the association between the presence of SAg in nasal swabs and activity of disease in GPA patients also taking into account correlation with an antimicrobial treatment. METHODS: In a prospective study of a total of 150 GPA patients hospitalised in the period 2009-2016, nasal swabs were examined for the presence of Staphylococcus aureus and SAg. Subsequently, the association with disease activity was assessed. RESULTS: Of 362 Staphylococcus aureus-positive nasal swab cultures from 115 of the 150 patients, the presence of at least one SAg in 126 samples (34.8%) from 56 patients (48.7%) was found. Among the 17 patients with limited to subglottic stenosis (SGS) disease, SAg were detected in 6 cases (35.3%). We did not find a significant correlation between the presence of SAg and disease activity (p=0.986), although when individual SAg were analysed separatively, SED and TSST-1 were more frequently present in active disease. Additionally, the results of the analysis demonstrated a protective effect of trimethoprim/sulfamethoxazole (T/S) treatment (0R 0.52, p<0.0092) in GPA patients. Interestingly, GPA limited to SGS appeared as an unfavourable factor associated with disease activity (0R 1.84, p=0.05). CONCLUSIONS: The association between staphylococcal SAg in nasal swabs and GPA activity is not evident. Multiple mechanisms that may lead to disease activation still need to be investigated.

Causes of deaths in COPD patients in primary care setting--a 6-year follow-up.

INTRODUCTION: COPD is one of the most frequent respiratory diseases responsible for patients' disability and mortality. In 2005 a single primary care practice, COPD was diagnosed in 183 out of 1,960 eligible subjects ≥ 40 years (9.3%). The aim of this study was to assess mortality rate and causes of deaths in this group after 6 years. MATERIAL AND METHODS: In 2011 we invited all 183 patients with COPD recognised in 2005. We performed spirometry, physical examination, questionnaire of respiratory symptoms, smoking habits, concomitant diseases and treatment. Information about deaths was taken from primary care register, furthermore, family members were asked to deliver medical documentation or death certificate. RESULTS: In 2011 we studied only 74 subjects (40.4%), 43 subjects died (23.5%) and 66 subjects were lost from the follow-up (36.1%). Cardiovascular diseases were the most frequent causes of deaths - 21 subjects (48.8%) (heart attack - 8 patients and stroke - 8 patients). Respiratory failure in the course of COPD exacerbation was the cause of 10 deaths (23.3%). Neoplastic diseases lead to 9 deaths (20.9%) (lung cancer 7 patients). Renal insufficiency was responsible for one death (2.325%), and the causes of 2 deaths remained unknown (4.65%). Subjects who died (predominantly males) were older, had higher MRC score and lower FEV1. CONCLUSIONS: Study performed six years after COPD diagnosis revealed that 23.5% of subjects died. The main causes of deaths were the following: cardiovascular diseases (mainly heart attack and stroke), COPD exacerbations and lung cancer (more than 75%). Death risk in COPD patients was associated with age, male sex, dyspnoea and severity of the disease.

Pilot program on distance training in spirometry testing - the technology feasibility study.

INTRODUCTION: Office spirometry has been widely used in recent years by general practitioners in primary care setting, thus the need for stricter monitoring of the quality of spirometry has been recognized. MATERIAL AND METHODS: A spirometry counseling network of outpatients clinics was created in Poland using portable spirometer Spirotel. The spirometry data were transferred to counseling centre once a week. The tests sent to the counseling centre were analyzed by doctors experienced in the analysis of spirometric data. In justified cases they sent their remarks concerning performed tests to the centres via e-mail. RESULTS: We received 878 records of spirometry tests in total. Data transmission via the telephone was 100% effective. The quality of spirometry tests performed by outpatients clinics was variable. CONCLUSIONS: The use of spirometers with data transfer for training purposes seems to be advisable. There is a need to proper face-to-face training of spirometry operators before an implementation of any telemedicine technology.

[Evaluation of genomic imbalance in endometrial hyperplasia and carcinoma]. / Ocena niezrównowaienia genomu w przypadkach rozrostu oraz raka endometrium.

OBJECTIVE: The main goal of our study was to identify the earliest and specific genetic changes which could be associated with an increased risk of neoplastic transformation in a group of patients with endometrial hyperplasia. Another goal was to characterize genetic changes associated with advanced forms of cancer. MATERIAL AND METHODS: The study involved forty-four (44) female patients, including five (5) patients with no histopathologically confirmed hyperplastic features, twenty-six (26) patients with histopathologically confirmed endometrial hyperplasia, and thirteen (13) patients with diagnosed carcinoma of the endometrium. The study was conducted using a custom-made 4x180 K microarray of BlueGnome. RESULTS: Copy number variations (CNV) were found in the cases without endometrial hyperplasia. Such changes occur with varying frequency in the genome of healthy female population. Significant genome imbalance was identified in the twenty-six (26) (100%) patients with diagnosed hyperplasia and in eleven (11) subjects (84.6%) with diagnosed endometrial cancer. Other not yet reported, changes localized in characteristic regions of the genome were also found.

Methotrexate as a single agent for treating pulmonary sarcoidosis: a single centre real-life prospective study.

INTRODUCTION: The first-line therapy in chronic sarcoidosis, according to WASOG/ATS/ERS recommendations, is GCS. This therapy is associated with significant adverse effects and finally does not alter the natural history of the disease. The objective of our study was to evaluate the efficacy and safety of monotherapy with MTX, as an alternative to GCS, in progressive pulmonary sarcoidosis. MATERIAL AND METHODS: An open prospective real-life, single-centre trial was performed on 50 patients with biopsy proven sarcoidosis, 28M and 22F, mean age 45.55 ± 8.9 years. The average duration of disease before MTX therapy was 12.34 ± 20.49 years, GCS therapy in the past was applied in 41 patients. All patients received MTX (10 mg or 15 mg weekly) between 2004 and 2013 because of chronic progressive pulmonary sarcoidosis. Therapy was planned for 24 months. Patients underwent regular clinical evaluation, pulmonary function assessment, exercise ability testing (6MWT), and chest radiography for therapy effectiveness every six months and side effects monitoring every 4-6 weeks. Forty-nine patients were included for statistical analysis of treatment efficacy. They were retrospectively allocated to "MTX responder" group if an improvement of 10% of FEV1, FVC, TLC, or 15% of DLCO from the initial value was documented for at least one parameter or "non-responders" if the patient did not meet the above-mentioned criteria. RESULTS: Duration of treatment ranged from 6 to 24 months, mean time 60.75 ± 34.1 weeks. For the whole cohort significant improvement after MTX therapy was observed for minimal SaO2 (%) (p = 0.043) and for decrease of DSaO2 (%) (p = 0.048) in six-minute walk test. The results were significantly better for patients treated with 15 mg than for those treated with 10 mg weekly and for those who obtained a greater total amount of MTX during therapy. Significant difference of DLCO%pred was observed after six months of MTX therapy between groups treated 15 mg vs 10 mg weekly (73.27 ± 12.7% vs. 63.15 ± 16.4%, p = 0.03). Twenty-five patients (55%) met the criteria of "MTX responders" group. Patients who responded well to treatment had significantly lower TLC and FVC initial values comparing to "MTX non-responders". After treatment the only significant difference in PFT between groups was noted for DLCO%pred. Eleven patients (22%) stopped the treatment due to adverse events of MTX, mild hepatic abnormalities were observed in ten patients (20%), and concomitant infection was found in four patients. There were no patients with a fatal outcome. CONCLUSIONS: MTX as a single agent in the treatment of sarcoidosis has proved to be a safe and effective steroid alternative. Selected patients with chronic pulmonary sarcoidosis experience definite PFT improvements after MTX treatment. There is need to search for predictors of MTX treatment effectiveness.

Fatal clinical outcome in a patient with sarcoidosis-lymphoma syndrome.

A 62-year-old female suspected of malignant disease underwent a splenectomy that revealed noncaseating granulomas in the histological specimen. Chest X-ray (CXR) and lung CT scans suggested sarcoidosis stage II. TBLB showed noncaseating granulomas. A diagnosis of sarcoidosis was made. Initially no treatment was needed as partial remission on CXR and normal lung function were observed. During the follow up she underwent open lung biopsy and axillary lymph node biopsy because of radiological progression with presence of CXR opacities imitating metastases and recurrent lymphadenopathy. No malignant cells were found. Spontaneous partial resolution of disseminated changes on the CXR was observed. Because of progressive deterioration in lung function and the clinical course of the disease strongly suggesting the progression of systemic sarcoidosis, the patient was given steroid treatment, which initially resulted in partial remission of pulmonary disseminated changes, peripheral lymphadenopathy and improvement in lung function test. Eight months later severe deterioration in general condition, anaemia, leukocytosis, hypoxemia, massive hepatomegaly and recurrence of general lymphadenopathy along with progression of disseminated changes were found. She died before the final diagnosis was established. Post-mortem examination showed a nodal marginal zone B-cell lymphoma with monocytoid B-cells, according to WHO classification. The malignant cells were found in the jugular, mediastinal, paratracheal, paragastric, paraintestinal and retroperitoneal lymph nodes and they infiltrated the lungs, pleura, liver, thyroid gland and pancreas. No sarcoid granulomas were found in the autopsy.

The influence of comorbidities on mortality in bronchiectasis: A prospective, observational study.

BACKGROUND: Bronchiectasis is a progressive chronic disease associated with an increased risk of mortality. OBJECTIVES: To identify the prevalence of comorbidities in patients with bronchiectasis and the impact of these comorbidities on mortality. MATERIAL AND METHODS: A cohort of 93 patients with computed tomography (CT)-confirmed bronchiectasis admitted consecutively to a tertiary teaching hospital was observed over a period of 5 years. All patients were carefully observed for comorbidities and mortality. RESULTS: A total of 43 men (46.2%) and 50 women (53.8%) with a median age of 66.0 years (interquartile range (IQR) 59.7-74.0 years), and a median of 3 comorbidities at baseline (IQR 1-5) were observed. The mortality rate during the observation period was 16%. The median number of comorbidities was significantly higher in the group of non-survivors (5 (IQR 3-5.75)) compared with survivors (3 (IQR 1-4); p = 0.0100). The burden of comorbidities was associated with an increased hazard of death: having 4 or more comorbidities was associated with an increased risk of death compared to patients with 2 or 3 coexisting illnesses (hazard ratio (HR) = 1.35 (95% confidence interval (95% CI) [0.41, 4.41]); p = 0.0494). The Bronchiectasis Aetiology Comorbidity Index (BACI) was a significant predictor of death in patients with severe bronchiectasis. CONCLUSION: We found a significant number of comorbidities in patients with bronchiectasis. In these patients, the comorbidity burden has an impact on mortality. The BACI is a useful tool for the clinical assessment of patients with severe bronchiectasis.

The Usefulness of Cell-Based and Liquid-Based Urine Tests in Clarifying the Diagnosis and Monitoring the Course of Urothelial Carcinoma. Identification of Novel, Potentially Actionable, RB1 and ERBB2 Somatic Mutations.

Bladder cancer is one of the most common cancers in global statistics. One of the issues associated with this disease is the high incidence of cases with delayed diagnosis and what factors correlate with worse treatment outcomes. A possible reason for this may be the rather limited availability of non-invasive diagnostic tools. This short communication presents a case of a 68 year old male patient after an ineffective therapy, carried on for several years with symptoms commonly associated with prostate overgrowth that masked a carcinoma in situ of the urinary bladder. Implementation of several diagnostic techniques, including urine sediment cytology, immunocytochemistry, the fluorescence in situ hybridisation technique, the Bladder EpiCheck test and whole-genome sequencing, enabled the establishment of a correct diagnosis, implementation of appropriate treatment and provision of patient-friendly monitoring. The described case emphasises the usefulness of cell-based and liquid-based urine tests in bladder cancer diagnostic procedures.

[Evaluation of motivation to quit smoking in outpatients attending smoking cessation clinic]. / Ocena motywacji do rzucenia palenia u pacjentów poradni antynikotynowej.

INTRODUCTION: The success in smoking cessation depends not only on a method of treatment but also on patient motivation. The aim of this study was to estimate the motivation and the main reason to quit smoking among outpatients attending smoking cessation clinic. MATERIAL AND METHODS: One hundred and eleven patients (50 men and 61 women), mean age 58, filled in a motivation test, nicotine dependence test and a questionnaire of the clinic. RESULTS: The main motivation to quit was for the health reasons (83%). Mean motivation test result was 6.93; mean nicotine addiction evaluated in dependence test was 5.49. Eighty seven percent of patients were ready to quit smoking during one month (36% in 24 hours; 23% in one week; 28% in four weeks). There was no significant difference between men and women. CONCLUSIONS: The main motivation to quit smoking were the health reasons as well among men as women. There was no correlation between the readiness to quit smoking determined as time to quit attempt and the motivation test.

Evolution of upper airway resistance syndrome.

The question of whether upper airway resistance syndrome (UARS) is a distinct disease or an initial feature of obstructive sleep apnoea syndrome is still a matter of debate. We evaluated a retrospective group of UARS patients to determine the evolution of UARS over time and the relationship between clinical evolution and subjects' phenotype. Investigations were performed in 30 patients, in whom UARS was diagnosed between 1995 and 2000 by the use of full polysomnography (PSG) without oesophageal pressure (Pes) measurement. The time between initial and follow-up investigations was 6.6 +/- 2.6 years. All subjects had full PSG with Pes measurement and completed a sleep questionnaire, including the Epworth Sleepiness Scale. In 19 subjects, PSG results were compatible with UARS. In nine subjects, obstructive sleep apnoea-hypopnoea syndrome (OSAHS) was diagnosed. In two subjects, PSG did not demonstrate breathing abnormalities. The mean +/- SD apnoea-hypopnoea index in the UARS group was 1.5 +/- 1.7 h(-1) and 25.2 +/- 19 h(-1) in the OSAHS group (P < 0.01). The increase in body mass index (BMI) between initial and follow-up investigations in the UARS group was from 29.4 +/- 4 to 31 +/- 5.7 kg m(-2) (P = 0.014) and in the OSAHS group from 30 +/- 4.1 to 32.4 +/- 4.7 kg m(-2)(P = 0.004). Amplitude of Pes swings during respiratory events was significantly higher in OSAHS than that in UARS (P = 0.014). Our results suggest that UARS is part of a clinical continuum from habitual snoring to OSAHS. Progression from UARS to OSAHS seems to be related to an increase in the BMI.

[Smoking habits in a family physician's practice]. / Palenie tytoniu wsród podopiecznych lekarza rodzinnego.

INTRODUCTION: Poland is the one of the countries in the European Union with the highest prevalence of smokers. The involvement of family physicians in smoking cessation activity could improve this situation. The aim of this study was to estimate smoking habits, their intensity and nicotine dependence in a family physician's practice (urban and rural population). An additional aim was to estimate smoking habits in relation to the presence of smoking-related disease, gender, location and motivation to stop smoking. MATERIAL AND METHODS: This study was part of an investigation into the prevalence and severity of chronic obstructive pulmonary disease (COPD) in the same population. Statistical analysis of questionnaires about smoking and history of respiratory diseases, Fagerström's nicotine dependence test and a motivation to quit test were performed. RESULTS: Questionnaires were filled in by 1960 subjects (87% of those eligible). There were 29.6% current smokers, 24.9% ex-smokers, and 45.5% never-smokers. There were 39.4% current smokers among men, and 23.3% among women. Current smokers were more numerous in the rural population. 54% of women urban dwellers and 73% of women from rural population never smoked. There were no significant differences in the motivation to stop smoking or in the nicotine dependence among smokers with and without COPD nor according to the severity of COPD. CONCLUSIONS: Smoking habits among the studied population were comparable with national and regional data. The intensity of smoking habits among female town dwellers is especially alarming.

Does bronchiectasis affect COPD comorbidities?

INTRODUCTION: COPD and bronchiectasis, chronic inflammation disorders of the bronchial tree through the mechanism of 'spill-over' of inflammatory mediators, may lead to systemic manifestations of illness of the respiratory system and comorbidities. The aim of the study was to evaluate the frequency of coexisting chronic obstructive pulmonary disease and bronchiectasis and influence of bronchiectasis on COPD comorbid diseases. MATERIAL AND METHODS: A post-hoc cross-sectional analysis of cohort study of 288 consecutive patients hospitalized due to acute exacerbation of COPD was performed. RESULTS: 177 males (61.5%) and 111 females (38.5%) with mean age = 71.0 8 ± 8.9 yrs, FEV1 % pred. = 34.6 ± 16.8 with COPD diagnosis were studied. In this group, 29 (10.1%) patients presented with bronchiectasis confirmed by HRCT scan. COPD patients with and without bronchiectasis had similar Charlson index results (2.5 vs 2.1, p=0.05). COPD patients with bronchiectasis required longer hospitalization during exacerbation. COPD patients with bronchiectasis significantly more often than patients without this comorbidity revealed the features of colonization with P. aeruginosa (OR = 4.17, p = 0.02). CONCLUSIONS: Bronchiectasis is a relatively common comorbidity in COPD patients. COPD patients with bronchiectasis are more frequently colonized with P. aruginosa comparing to non-bronchiectasis COPD patients. We did not confirm the influence of bronchiectasis on COPD comorbidities.

Methotrexate treatment efficacy in sarcoidosis might be related to TNF-α polymorphism: real life preliminary study.

INTRODUCTION: Methotrexate therapy improves lung function in selected sarcoidosis patients. Variation in TNF gene was associated with response to treatment. Aim: To determine the predictive role of-308 G/A, -857C/T, -863 C/A and -1031 T/C TNF-α polymorphism in the efficacy of MTX for progressive pulmonary sarcoidosis. MATERIAL AND METHODS: Twenty-eight sarcoidosis patients treated with MTX (6-24 months) were genotyped for TNF-α polymorphisms: -1031 T/C, -857C/T, -308 G/A and -863 C/A. Pulmonary function test (PFT) were performed every 6 months to determine treatment response, until the drug withdrawal. RESULTS: No correlation between the initial clinical presentation of sarcoidosis and TNF α polymorphisms was found, neither for every allele nor for combined genotypes distribution. According to PFT evaluation we have discovered 3 types of response to MTX: early (ER), late (LR) and No-response (NR). TNF-α-308 A allele carriers have got significantly higher chance to be LR, p=0.02, RRI:83%. TNF-α-308 GG genotype transferred the 3-fold higher probability of early vs late response to MTX, p=0.02. Combined genotyping allowed to distinguish LR from ER and NR groups. ER and NR patients are genetically similar (-857CC-308GG). LR are "genetically" different group of patients (-857C/T-308GG or -857CC-308A/G) with 5-fold greater probability to be LR than TNF-α-857CC-308GG patients, p=0,005 sensitivity 85%, specificity: 43%, PPV 58%, NPV 75%. TNF-α-308GG-857CC patients have significantly lower chance to be LR comparing to other response type p=0.03 OR=0,075 95% CI=0.07-0.08. CONCLUSION: Two types of positive response to MTX therapy (early and late) in chronic respiratory sarcoidosis are associated with polymorphic changes in TNF gene.

Sleep-disordered breathing in a middle-aged and older Polish urban population.

Obstructive sleep apnoea syndrome (OSAS) is a frequent disorder; however, the prevalence of sleep-disordered breathing is not well known in many countries. The aim of our investigation was to assess the prevalence of sleep-disordered breathing (SDB) in a representative sample of the population of Warsaw. We studied 676 subjects (57.1% of the randomised cohort from the Monica II study). The sample comprised 356 males (52.7%) and 320 females (47.3%), whose mean age was 56.6 +/- 8.2 years (range 41-72 years). Mean number of apnoeas and hypopnoeas per hour of time in bed (AH) in males was 7 +/- 9.5 and in females 3.9 +/- 6.6 (P < 0.001). SDB (cut-off point AH > 5 or >10) was identified in 188 subjects (27.8%) and 97 subjects (14.3%), respectively. SDB was established twice as frequently in males as in females (respectively 36.5 versus 18.5%; P < 0.001 for AH > 5 and 19.8 versus 8.5%; P < 0.001 for AH > 10). A diagnosis of OSAS AH > 10 and Epworth Sleepiness Score > or =11 points was established in 51 subjects (7.5%). The prevalence of OSAS was nearly four times higher in males (40 subjects, 11.2%) than in females (11 subjects, 3.4%; P < 0.001). The severity of OSAS was similar in both sexes (AH: males 32.3 +/- 14.9 and females 31.4.1 +/- 15.4). Older age and male sex were predictors of SDB. SDB and OSAS were independent predictors of coronary artery disease after adjusting for age, sex, body mass index, neck circumference and smoking habit.

[Influence of neck circumference and body mass index on obstructive sleep apnoea severity in males]. / Wplyw obwodu szyi i wskaznika masy ciala na zaawansowanie obturacyjnego bexdechu sennego u mezczyzn.

INTRODUCTION: Obesity and male gender are the main risk factors for the development of obstructive sleep apnoea (OSA); however, some epidemiological data has shown that neck circumference (NC) > or = 43 cm is a better predictor of obstructive event frequency than body mass index (BMI). The aim of this study was to assess the relation between NC and BMI on OSA severity in males. MATERIAL AND METHODS: The subjects completed a sleep questionnaire and Epworth sleepiness scale before the sleep study (full polysomnography or PolyMesam study). Authors studied 133 consecutive males with confirmed OSA (AHI/RDI > 10, Epworth score > 9 points). Chest X-ray, spirometry, arterial blood gases, ECG, blood morphology and biochemistry were performed during treatment trial with autoCPAP. RESULTS: Subjects presented with obesity--BMI = 35.8 +/- 6.1 kg/m2, NC = 46 +/- 3.4 cm and severe disease--AHI/RDI = 45.3 +/- 23.6. Mean age was 52.7 +/- 11.3 years. The majority of subjects had NC > or = 43 cm (116 pts, 87.2% - group 1), 17 pts (12.8% - group 2) had NC < 43 cm had 17 pts. Comparison of both groups showed significant differences only for BMI (group 1 - 36.8 +/- 5.7, group 2 - 28.6 +/- 3.7; p < 0.0001). Linear regression analysis revealed significant correlation between NC and AHI/RDI (R2 = 0.07, r = 0.26; p = 0.003); however, the correlation between BMI and AHI/RDI was stronger (R2 = 0.14, r = 0.37; p < 0.0001). In multiple linear regression analysis we found significant correlation between AHI/RDI and age (beta = -0.31, p = 0.003) and BMI (beta = 0.34, p = 0.02). CONCLUSIONS: The strongest correlation between AHI/RDI, younger age and BMI. Correlation between neck circumference and AHI/RDI was significant but less when compared to BMI.

[Six-minute walk test in obstructive sleep apnoea]. / Test 6-minutowego chodu u chorych na obturacyjny bezdech senny.

INTRODUCTION: The aim of this study was to assess results of 6MWT in non-selected group of obstructive sleep apnoea (OSA) patients. In healthy adult subjects 6-minute walking distance (6MWD) range from 400 to 700 m. Obesity, the main symptom of OSA, is one of the factors associated with reduction of 6MWD (another common factors: older age, shorter height, female sex, pulmonary, cardiovascular and musculoskeletal diseases). MATERIAL AND METHODS: Subjects completed sleep questionnaire and Epworth sleepiness scale before sleep studies (full polysomnography [PSG] or PolyMesam study [PM]). Consecutive OSA subjects (AHI/RDI >10, Epworth score > 9 points) were evaluated. The 6MWT, chest X-ray, spirometry, arterial blood gases, ECG, blood morphology and biochemistry were performed during trial treatment with autoCPAP. RESULTS: We studied 151 subjects (119 males - 78.8% and 32 females - 21.2%), mean age 53.4 +/- 10.5 years. Subjects were obese - BMI = 35.7 +/- 6.2 kg/m(2) and presented severe OSA - AHI/RDI = 42.4 +/- 23.2. To assess relations between 6MWD and AHI/RDI, BMI, age and concomitant diseases we divided subjects in two groups: 1(st) with 6MWD > or = lower limit of normal (LLN) (123 pts; 81.5%) and 2(nd) with 6MWD < LLN (28 pts; 18.5%). Significant differences between groups were found for BMI, FVC (% of predicted) and Borg dyspnea scale before and after 6MWT. In multiple linear regression analysis we found significant correlation between 6MWD and BMI (beta = 0.41, p < 0.0001) and arterial hypertension (beta = -0.16, p = 0.04). Females had significantly shorter 6MWD than males (401.1 +/- 83.6 m and 451.8 +/- 107 m, respectively; p = 0.01). Difference was significant after adjustment for BMI and age (analysis of covariance) - R = 0.61, R2 = 0.38 (p < 0.0001). CONCLUSIONS: BMI, female sex, arterial hypertension and lower FVC (% of predicted) were related to shorter 6-minute walking distance in OSA patients.

[Failure of uvulopalatopharyngoplasty (UPPP) in severe obstructive sleep apnoea (OSA)]. / Uwulopalatofaryngoplastyka (UPPP) jako zabieg nieskuteczny w leczeniu ciezkiego obturacyjnego bezdechu sennego (OBS).

INTRODUCTION: Uvulopalatopharyngoplasty (UPPP) is the most frequent surgical procedure in obstructive sleep apnoea (OSA) treatment. The aim of this study was to assess effects of UPPP in OSA subjects admitted to our Sleep Laboratory. MATERIAL AND METHODS: We studied 22 mostly obese males (mean BMI = 33.1 +/- 4 kg/m(2)) in mean age 51.7 +/- 9.7 years. Polysomnography or polygraphy (Poly-Mesam) was performed 28.5 +/- 30.5 month after UPPP. RESULTS: Sleep studies after UPPP revealed severe OSA in most of the patients - mean AHI/RDI = 53 +/- 33.2, mean overnight SaO(2) = 88.1 +/- 5.3%. Subjects spent near half night in desaturation below 90% (T90 = 46.8 +/- 33.8%) and presented daytime somnolence (Epworth score: 14.3 +/- 4.8 points). Only in 3 subjects (13.6%), UPPP was successful (AHI/RDI < or = 10). CONCLUSIONS: Our study confirmed previous data that UPPP is ineffective in majority of obese subjects with severe OSA.