Tissue Inhibitors of Metalloproteinase 1 (TIMP-1) and 3 (TIMP-3) as New Markers of Acute Kidney Injury After Massive Burns.

BACKGROUND Acute kidney injury (AKI) is a common and serious complication after massive burn injury. One of the postulated etiologies is destruction of the extracellular matrix of nephrons, caused by a local imbalance between matrix metalloproteinases (MMPs) and specific inhibitors. The aim of this study was to analyze the dynamics of tissue inhibitors of metalloproteinases (TIMPs) during the first 5 days after massive thermal injury and the relationship with the risk of AKI. MATERIAL AND METHODS Thirty-three adults (22 men, 11 women) with severe burns were enrolled in the study. The values of TIMPs 1 to 4 were measured in blood serum and urine using the multiplex Luminex system. The associations between TIMPs and the risk of AKI were analyzed by using the generalized linear mixed models for repeated measurements. RESULTS Significant changes in serum and urine activities of TIMPs were confirmed, especially during the first 2 days after burn injury. Almost half of patients presented renal problems during the study. Significant differences between values of TIMPs in AKI and non-AKI status were also observed. However, a significant relationship between concentration of TIMPs and risk of AKI was confirmed only for urine TIMP-1 and serum TIMP-3. CONCLUSIONS The evaluation of TIMPs in the early stage after burn injury has potential benefits. The important roles of urine TIMP-1 and serum TIMP-3, as novel markers of the risk of AKI development, were confirmed. Other parameters require further analysis.

Archetype analysis and the PHATE algorithm as methods to describe and visualize pregnant women's levels of physical activity knowledge.

The knowledge of physical activity (PA) recommended for pregnant women and practical application of it has positive impact on the outcome. Nevertheless, it is estimated that in high-income countries over 40% of pregnant women are insufficiently physically active. One of the reasons is insufficient knowledge pregnant women have about allowed effort during pregnancy and both recommended and not recommended physical activities. Description of knowledge about physical activity the women have and distinguishing patterns of their knowledge is becoming an increasingly important issue. A common approach to handle survey data that reflect knowledge involves clustering methods or Principal Component Analysis (PCA). Nevertheless, new procedures of data analysis are still being sought. Using survey data collected by the Institute of Mother and Child Archetypal analysis has been applied to detect levels of knowledge reflected by answers given in a questionnaire and to derive patterns of knowledge contained in the data. Next, PHATE (Potential of Heat-diffusion for Affinity-based Trajectory Embedding) algorithm has been used to visualize the results and to get a deeper insight into the data structure. The results were compared with picture derived from PCA. Three archetypes representing three patterns of knowledge have been distinguished and described. The presentation of complex data in a low dimension was obtained with help of PHATE. The formations revealed by PHATE have been successfully described in terms of knowledge levels reflected by the survey. Finally, comparison of PHATE with PCA has been shown. Archetype analysis combined with PHATE provides novel opportunities in examining nonlinear structure of survey data and allows for visualization that captures complex relations in the data. PHATE has made it possible to distinguish sets of objects that have common features but were captured neither by Archetypal analysis nor PCA. Moreover, for our data, PHATE provides an image of data structure which is more detailed than interpretation of PCA.

Archetypal Analysis and DEA Model, Their Application on Financial Data and Visualization with PHATE.

One of the goals of macroeconomic analysis is to rank and segment enterprises described by many financial indicators. The segmentation can be used for investment strategies or risk evaluation. The aim of this research was to distinguish groups of similar objects and visualize the results in a low dimensional space. In order to obtain clusters of similar objects, the authors applied a DEA BCC model and archetypal analysis for a set of companies described by financial indicators and listed on the Warsaw Stock Exchange. The authors showed that both methods give consistent results. To get a better insight into the data structure as well as a visualization of the similarities between objects, the authors used a new approach called the PHATE algorithm. It allowed the results of DEA and archetypal analysis to be visualized in a low dimensional space.

Prognostic factors in patients undergoing lymphadenectomy for squamous cell carcinoma of the penis.

INTRODUCTION: Penile cancer is rare, and data on prognostic factors of the disease are scarce. The aim of the study was to assess prognostic factors in patients undergoing lymphadenectomy for penile cancer. MATERIAL AND METHODS: Ninety-eight men who underwent lymphadenectomy for penile cancer were enrolled in the study. Progression-free survival and overall survival were assessed. RESULTS: Five-year progression-free survival and overall survival were 0.6651 (95% CI: 0.5151-0.7783) and 0.5516 (95% CI: 0.4412-0.6488), respectively. Multivariate analysis showed that the factors that reduce progression-free survival include delay of lymphadenectomy by more than 3 months after diagnosis (p = 0.045) and involvement of non-inguinal lymph nodes (N0 vs. affected lymph nodes other than superficial inguinal, p = 0.0004; superficial inguinal vs. others, p = 0.001). Factors deteriorating overall survival include high grade (G1 vs. G2, p = 0.0072, and G1 vs. G3, p = 0.0347), more than one lymph node affected (p = 0.001) and crossing the lymph node capsule (p = 0.034). CONCLUSIONS: The factors worsening the prognosis in patients with penile cancer after lymphadenectomy include delayed lymphadenectomy, involvement of lymph nodes other than the superficial inguinal, involvement of more than one lymph node, crossing the lymph node capsule, and high grade.

[Assessment the efficacy of postoperative radiotherapy in the patients with non-small cell lung cancer. Retrospective study]. / Ocena wyników pooperacyjnej radioterapii u chorychna niedrobnokomórkowego raka pluca. Badanie retrospektywne.

INTRODUCTION: The basic method of therapy of non-small cell lung cancer is surgery. For a number of years a discussion has gone concerning the indications for postoperative radiotherapy in the case of non-radical surgical treatment. At present, in many centers, the postoperative radiotherapy is recommended for patients with confirmed metastases to mediastinal lymph nodes (pN2) and in case of microscopic or macroscopic features of incomplete surgical margins. The aim of this retrospective study was to assess the results of adjuvant radiotherapy after surgical treatment of non-small cell lung cancer. MATERIAL AND METHODS: From December 1993 to October 2005 in the Department of Radiotherapy Centre of Oncology at Wawelska St. in Warsaw, 366 patients (pts) were radically irradiated after surgery. In 192 pts radiotherapy was performed due to incomplete surgical margins, in 174 pts - due to metastases to mediastinal lymph nodes - in 26 pts both indications coexisted. First and second clinical stage was found in 96 pts: (I - 9 pts: 2.4%; II - 87 pts: 24%). Stage IIIA was found in 252 pts (69%) and IIIB in 18 pts (5%). Performance status according to Zubrod scale was: 0 - in 302 pts (82.5%), 1 - in 54 pts (14.8%) and 2 - in 10 pts (2.7%). Retrospective analysis of the treatment results was carried out. Survival time and time of occurrence of a local progression were assessed. Survival probability was calculated with the Kaplan-Meier method. Multidimensional analysis of prognostic factors was carried out with the D.R. Cox proportional risk model. RESULTS: In the studied group, one year survival was 78.02 ± 2%, two years, survival was 54.14 ± 2%, an five years, survival was 31.03 ± 2%. The two years, local control was estimated as 45.62% ± 4% and the five years, local control was 27.37 ± 4%. Probability of survival was significantly higher in the pts with better performance status - median survival in the groups with Zubrod stage 0 and 1 + 2 were 3.2 and 1.3 years respectively). Patients who received 〉 50 Gy of irradiation had significantly better life expectancy than others - median survival in the groups 〉 50 Gy and ≤ 50 Gy were 4.42 and 2.25 years respectively). Frequency of local recurrence was lower in the group of pts who received 〉 50 Gy of irradiation, than in remaining pts. Local recurrences were not observed in the pts treated with 3D radiotherapy regimen, but this group of pts received also higher dose of irradiation than others. Multiple survival analysis revealed that dose of irradiation ≤ 50 Gy, worse performance status and older age of the patient were independent adverse prognostic indicators. CONCLUSIONS: 1. The results of postoperative radiotherapy in his retrospective study were strongly influenced by the dose of irradiation, patients' age and performance status. Total radiotherapy dose ≤ 50 Gy, older age of the patients and worse performance status (1 + 2) were negative survival indicators. 2. 3D technique of irradiation was combined with the best regional control of the disease.

Bipolar cemented hip hemiarthroplasty in patients with femoral neck fracture who are on hemodialysis is associated with risk of stem migration.

BACKGROUND AND PURPOSE: Femoral neck fractures are considerably more common in patients on hemodialysis than in the general population. We determined the outcome of bipolar hemiarthroplasty for hip fracture in patients with long-term hemodialysis and compared it with that of a matched-paired group of patients with intact renal function. METHODS: We analyzed 26 bipolar hemiarthroplasties in 23 hemodialysed patients with a mean age of 56 (41-78) years who were followed for mean 3.6 (1-8) years. These cases were matched for age, sex, and BMI with 26 patients with femoral neck fractures and normal renal function. The mean follow-up time in the control group was 7 (5-10) years. As primary surgery for their femoral neck fracture, all patients had a bipolar hemiarthroplasty with a 28-mm metal-polyethylene internal articulation and a cemented stem. RESULTS: The mortality rate was 21% in the hemodialysed group and 4% in the control group (p = 0.005). The bipolar head migrated in 1 patient in the hemodialysed group but in none of the patients in the case-matched group. In the hemodialysed group, 8 stems migrated and 3 of these were revised, whereas in the control group 3 stems migrated and 2 were revised. The stem migration in the hemodialysed group was not preceded by the development of osteolysis or radiolucent lines at the bone-cement interface. The cumulative survival for prosthesis migration as endpoint was 44% at 5 years in the hemodialysed group and 96% in the control group (p = 0.03). INTERPRETATION: The main mode of failure of cemented bipolar hemiarthroplasties in hemodialysed patients is stem migration, due to failure of the bone-cement interface.