RENEB Inter-Laboratory Comparison 2021: The Dicentric Chromosome Assay.

After large-scale radiation accidents where many individuals are suspected to be exposed to ionizing radiation, biological and physical retrospective dosimetry assays are important tools to aid clinical decision making by categorizing individuals into unexposed/minimally, moderately or highly exposed groups. Quality-controlled inter-laboratory comparisons of simulated accident scenarios are regularly performed in the frame of the European legal association RENEB (Running the European Network of Biological and Physical retrospective Dosimetry) to optimize international networking and emergency readiness in case of large-scale radiation events. In total 33 laboratories from 22 countries around the world participated in the current RENEB inter-laboratory comparison 2021 for the dicentric chromosome assay. Blood was irradiated in vitro with X rays (240 kVp, 13 mA, ∼75 keV, 1 Gy/min) to simulate an acute, homogeneous whole-body exposure. Three blood samples (no. 1: 0 Gy, no. 2: 1.2 Gy, no. 3: 3.5 Gy) were sent to each participant and the task was to culture samples, to prepare slides and to assess radiation doses based on the observed dicentric yields from 50 manually or 150 semi-automatically scored metaphases (triage mode scoring). Approximately two-thirds of the participants applied calibration curves from irradiations with γ rays and about 1/3 from irradiations with X rays with varying energies. The categorization of the samples in clinically relevant groups corresponding to individuals that were unexposed/minimally (0-1 Gy), moderately (1-2 Gy) or highly exposed (>2 Gy) was successfully performed by all participants for sample no. 1 and no. 3 and by ≥74% for sample no. 2. However, while most participants estimated a dose of exactly 0 Gy for the sham-irradiated sample, the precise dose estimates of the samples irradiated with doses >0 Gy were systematically higher than the corresponding reference doses and showed a median deviation of 0.5 Gy (sample no. 2) and 0.95 Gy (sample no. 3) for manual scoring. By converting doses estimated based on γ-ray calibration curves to X-ray doses of a comparable mean photon energy as used in this exercise, the median deviation decreased to 0.27 Gy (sample no. 2) and 0.6 Gy (sample no. 3). The main aim of biological dosimetry in the case of a large-scale event is the categorization of individuals into clinically relevant groups, to aid clinical decision making. This task was successfully performed by all participants for the 0 Gy and 3.5 Gy samples and by 74% (manual scoring) and 80% (semiautomatic scoring) for the 1.2 Gy sample. Due to the accuracy of the dicentric chromosome assay and the high number of participating laboratories, a systematic shift of the dose estimates could be revealed. Differences in radiation quality (X ray vs. γ ray) between the test samples and the applied dose effect curves can partly explain the systematic shift. There might be several additional reasons for the observed bias (e.g., donor effects, transport, experimental conditions or the irradiation setup) and the analysis of these reasons provides great opportunities for future research. The participation of laboratories from countries around the world gave the opportunity to compare the results on an international level.

Technical considerations depending on the level of vascular ligation in laparoscopic rectal resection.

AIM: In addition to ischemia there is also anastomotic ends tension proven to be a risk factor for anastomotic leak. HT vascular ligation is accepted as a rule, in attempt to achieve tension-free anastomosis. LT is a preferred option, based on the more accurate preservation of proximal intestinal segment microperfusion and lower risk of damage to the hypogastric plexus. The aim of this study is evaluation of comparative indicators in high tie (HT) and low tie (LT) laparoscopic rectal resections. METHODS: A prospective nonrandomized comparative cohort study of patients in our department with cancer of the rectum in clinical stage I-III, operated on in laparoscopic approach over a 6-years period. RESULTS: For the period 2015-2020, a number of 208 laparoscopic surgeries have been done for rectal cancer. Patients were divided into three groups-group A with HT vascular ligation 116 pts. (69%), group B-53 pts. (25%), underwent low ligation-LT and group C-39pts. (19%) low tie plus lymph node dissection of the apical LN group (LT-appic LND). The distribution was made without randomization, based on the operators' expertise. Anastomotic leaks were 3.8% in group A, 3.0% in group B and 2.9% in group C (p > 0.05) with no significance difference. There is no significant difference in the number of lymph nodes obtained in group A and group B, while in group C the number of the harvested lymph nodes was higher (p < 0.05). The indicators for intestinal / defecation dysfunction, as well as for urinary/sexual dysfunction, according to our data, are significantly more favorable in patients with LT, in contrast to the other two groups. CONCLUSION: HT vascular ligation attempts to achieve tension-free anastomosis and more harvested lymph nodes. However, LT could be a preferred option, based on the lack of significant evidence for a difference in specific oncological survival and due to more accurate preservation of proximal intestinal segment microperfusion to prevent anastomosis dehiscence, also for its lower risk of damage to the hypogastric plexus. Splenic flexure mobilization provides elongation of the proximal intestinal segment, but has no proven effect on anastomotic leakage incidence. It increases surgical duration and is in fact necessary in up to 30% of the cases. At the present moment there is no precise data whether LT has an advantage in terms of prevention of autonomic nervous and urogenital dysfunction. New prospective randomized and highly probative studies are needed to standardize the procedures in specific clinical situations.

Difficulties in achieving and maintaining the goal of measles elimination in Bulgaria.

Measles is a disease with almost a hundred year history of existing registration in Bulgaria and has been subject to mass immunization since 1969. In 2017, after a three-year period with a low number of measles cases registered, an epidemic upsurge has been recorded affecting 3 of the total 28 regions in the country. The purpose of this study was to analyze the changes of measles morbidity in Bulgaria over the period of 1921-2017 and focus on the epidemiological characteristics of the last outbreak in the region of Plovdiv in 2017. For the whole period (1921-2017) the average measles morbidity amounts to 157.69%ооо, decreasing from 525.02%ооо in 1921 to 2.32%ооо in 2017, with 99.5% rate of reduction. In the period prior to vaccination the average morbidity was 247.14%ооо while in the vaccination period it was 70.08%ооо. The ARIMA model could be used as a short-term forecast to predict the morbidity rate. Against the background of the downward tendency in morbidity this study reports a small measles outbreak in Plovdiv, involving 141 cases, after three years of no local virus transmission in the country. An unvaccinated child who returned from abroad probably imported the disease. The measles cases were mainly Roma children and a large number of them were infants. The low intensity and prolong course of the outbreak was indicative of relatively high vaccination coverage of the population. To achieve measles elimination goals, efforts must be made to strengthen surveillance and increase the vaccination coverage, targeting children and especially Roma children.

Clinical and prognostic significance of pathological and inflammatory markers in the surgical treatment of locally advanced colorectal cancer.

BACKGROUND: Locally advanced colorectal cancer (CRC) may vary in its clinical and pathological appearance. It is now accepted that progression of disease in patients with locally advanced CRC is determined not only by local tumor characteristics but also by the immune system and inflammatory response in the body. METHODS: We investigated patients with confirmed CRC who were treated in the surgical clinic at the University Hospital Alexandrovska over a 10-year period and retrospectively evaluated the histological features of the preoperative biopsies and operative specimens removed during radical multivisceral resections. We also collected prospective data for serum C-reactive protein levels and Jass-Klintrup score, Petersen Index score, and Glasgow Prognostic Score in patients with locally advanced CRC. RESULTS: Of 1,105 patients with CRC, 327 (29.6%) were diagnosed with locally advanced disease. In total, 108 combined multivisceral resections (79 for primary tumors and 29 for recurrent tumors) were performed. Overall survival was 34 months for pR0 cases and 12 months for pR1 cases (P<0.05). Our data confirmed that C-reactive protein is a prognostic marker of overall survival. Data for 48 patients with histologically confirmed locally advanced tumors showed significantly increased survival with a higher Jass-Klintrup score (P=0.037). In patients with node-negative disease, 5-year survival was 49%. However, where there were high-risk pathological characteristics according to the Petersen Index, survival was similar to that for node-positive disease (P=0.702). Our data also showed a significant difference in survival between groups divided according to whether they had a modified Glasgow Prognostic Score of 1 or 2 (P=0.031). CONCLUSION: In order to maintain a reasonable balance between an aggressive approach and so-called meaningless "surgical exorbitance", we should focus on certain histopathological and inflammatory markers that can be identified as additional factors for planning the type and volume of surgical treatment.

[Reproductive problems in women with PCOS, the impact of PAI-1 carriers of 4G PAI-1 polymorphism and BMI].

Approximately 7-12% of women in reproductive age are affected by PCOS[2] and 40 to 70 percent of them are overweight contributing to the clinical picture of PCOS and increased reproductive and metabolic disorder. In order to investigate the role of PAl-1 as a possible risk factor for the development of PCOS a group of 67 women with polycystic ovarian disease and 70 healthy controls were investigated for levels of PAl-1 and carriage of the promoter polymorphism 675 4G/5G in gene of PAI-1. The correlation with BMI was checked. The results of the DNA analysis showed a high carriage of polymorphism 675 4G/4G in promoter of PAl-1 gene in women with PCOS but not significant (OR = 1.655; p = 0.141), as well in the total group of the patient (OR =1.474; p>0.05). Serum levels of PAI-1 were significantly higher in total group of patients compared to controls. The levels of PAI-1 is correlated with carriage of 675 4G/5G polymorphism in the gene for PAI-1 (r=0.534; p=0.03) as well as with BMI, like correlation coefficients were higherin the group with PCOS (0.572; p=0.04). Data from the disease history showed a higher percentage of women with reproductive problems: early pregnancy loss 48.5% and infertility 23.2%, significantly higher in the group with PCOS (58.1% compared to 32.4%). The carriers of polymorphism 4G are at greater risk for early pregnancy loss than those with 5G (61.45% as compared to 36.8%), which confirms that carriage of the polymorphism 4G/5G 675 gene PAl-1 has a specific in multifactorial pathogenesis and expression of PCOS.

[Reproductive problems in women with PCOS, the impact of PAL-1 CARRIERS OF 4G PAI -1 polymorphism and BMI].

Approximately 7-12% of women in reproductive age are affected by PCOS[2] and 40 to 70 percent of them are overweight contributing to the clinical picture of PCOS and increased reproductive and metabolic disorder. In order to investigate the role of PAl-1 as a possible risk factor for the development of PCOS a group of 67 women with polycystic ovarian disease and 70 healthy controls were investigated for levels of PAI-1 and carriage of the promoter polymorphism 675 4G/5G in gene of PAl-1. The results of the DNA analysis showed a high carriage of polymorphism 675 4G/4G in promoter of PAI-1 gene in women with PCOS but not as significant (OR = 1.6645, p = 0.141). Serum levels of PAI-1 were significantly higher in total group of patients compared to controls. The levels of PAI-1 is correlated with carriage of 675 4G/5G polymorphism in the gene for PAI-1 (R = 0.534, p = 0.03) as well as wih BMI, like correlation coefficients were higher in the group with PCOS (0.572, p = 0.04). Data from the disease history showed a higher percentage of women with reproductive problems: 61.5% (early pregnancy loss and infertility) significantly higher in the group with PCOS (70.1% compared to 54.1%). The carriers of polymorphism 4G are at greater risk for early pregnancy loss than those with 5G (61.45% as compared to 36.8%), which confirms that carriage of the polymorphism 4G/5G 675 gene PAI-1 has a specific in multifactorial pathogenesis and expression of PCOS.

ANESTHESIA CHARACTERISTICS OF A PATIENT WITH HYPERKALEMIC PERIODIC PARALYSIS--CASE REPORT.

We report a case of a successfully conducted anesthesia, without complications of a patient with hyperkalemic periodic paralysis who underwent elective laparoscopic cholecystectomy for chronic calculous cholecystitis. The perioperative considerations, the characteristics of anesthesia, and the factors that can lead to complications in this rare genetic disorder are discussed.

Non-Hodgkin lymphomas and carrier state of viral hepatitis B and C.

PURPOSE: To establish the characteristics and prognosis of newly diagnosed patients with non-Hodgkin lymphoma (NHL), who were carriers of hepatitis B (HBV) and C (HCV) viral infection. METHODS: 542 patients with NHL, diagnosed and treated in the University Hospital "Sv. Georgi", Plovdiv, were retrospectively analysed. Two NHL patient groups were created - the study group, consisting of 33 patients with NHL positive for HBV and HCV, and the control group, consisting of 40 randomly assigned patients with NHL and negative serology for hepatitis. Study and control groups were compared for basic characteristics and survival. RESULTS: The prevalence of hepatitis B surface antigen (HBsAg) among newly diagnosed patients was 5.72% and of HCV 1.84 %. Association with hepatitis viruses was more frequent in indolent than in aggressive NHLs (p=0.044). Liver dysfunction was registered more often in the study group (p=0.002). Reactivation of HBV infection was registered in 5 patients (12.19%) from the study group. There was no statistically significant difference between survival rate of patients in the study group and in the control group (p=0.738). CONCLUSION: Hepatitis virus carrier state did not alter significantly the clinical course and disease prognosis (remission rates and survival) in our patient group. We recommend the routine testing for hepatitis infection in patients newly diagnosed with NHL in order to collect more data needed for the establishment of a possible causal relationship between hepatitis viruses and NHL. Since antiviral prophylaxis could positively impact the course of lymphoma treatment, national guidelines for the management of patients with hepatitis infection and NHL will prove to be necessary for the clinical practice.

[Medical abortion for first-trimester termination of the pregnancy].

Abstract. Medical abortion is an alternative to surgical vacuum aspiration for first-trimester termination of pregnancy. It is essential to introduce officially this method in Bulgaria including actualization of the respective legislation, registration of the needed medicinal products and education of the specialists.

[Efficiency of Cikatridina spray for healing of episiotomy and perineal ruptures].

UNLABELLED: Episiotomy is the most common surgical intervention during childbirth. Cikatridina spray allows treatment of this primary contaminated surgical wound and assist its primary healing. The aim of this study is to determine the effectiveness of aid healing of episiotomy, and spontaneous perineal ruptures after normal and operative vaginal delivery. MATERIAL AND METHODS: The study included 90 women after spontaneous or operative vaginal delivery with episiotomy or a spontaneous perineal rupture treated with Cikatridina spray. Control group of 90 women was used to compare the efficency. The status of the wound was determined on the first, third, fifth and 30th day after birth, according to presence of the following symptoms: redness, swelling, pain, exudation, epithelization, open wound. RESULTS: Symptoms of redness, swelling and pain in the group treated with Cikatridina spray after normal birth resolved on the third postpartum day in 100% of cases. Same symptoms after operative vaginal birth persist in average 9% of women and resolved on the 5th day When comparing treated patients with Cikatridina spray with perineal ruptures and the control group in 100% were reported no symptoms in the study group compared with the control group where the redness, swelling persist in 20% and 85.7% epithelization is showing at 5 postpartum day. There was one open episiotomy of a patient from a control group after operative vaginal birth healed in 26 days. CONCLUSIONS: Cikatridina spray effectively eliminates symptoms of redness, swelling and pain regardless of perineal trauma and the method of delivery. There is an earlier epithelization after using the Cikatridina spray. Open and infected perineal wounds are treated with conventional medicines.

MHC Class II Binding Prediction by Molecular Docking.

Proteins of the Major Histocompatibility Complex (MHC) bind self and nonself peptide antigens or epitopes within the cell and present them at the cell surface for recognition by T cells. All T-cell epitopes are MHC binders but not all MCH binders are T-cell epitopes. The MHC class II proteins are extremely polymorphic. Polymorphic residues cluster in the peptide-binding region and largely determine the MHC's peptide selectivity. The peptide binding site on MHC class II proteins consist of five binding pockets. Using molecular docking, we have modelled the interactions between peptide and MHC class II proteins from locus DRB1. A combinatorial peptide library was generated by mutation of residues at peptide positions which correspond to binding pockets (so called anchor positions). The binding affinities were assessed using different scoring functions. The normalized scoring functions for each amino acid at each anchor position were used to construct quantitative matrices (QM) for MHC class II binding prediction. Models were validated by external test sets comprising 4540 known binders. Eighty percent of the known binders are identified in the best predicted 15 % of all overlapping peptides, originating from one protein.

[Frequency and characteristics for forceps delivery].

AIM: To establish the incidence of vaginal operative deliveries by extraction of the fetus with forceps and the degree of prematurity of newborns in which it is applied, to specify the type of forceps which is imposed. MATERIAL AND METHODS: The study included 672 births, completed by extraction of the fetus with forceps in the period 1994-2008 year in University hospital "Maichin dom" Sofia. The total number of births was 47,130, of which 32,924 have become per vias naturalis. Age of birth was from 13 to 42 years. The study was done prospectively and retrospectively. RESULTS: The incidence of forceps extraction of the total number of births for the period is 1.43%, as seen following the trend - in the first years of the period 1994 - 1995 is more than 2% of total births, in the period 1996 to 2003 years and then fluctuated between 1 and 2%, and after 2004 has decreased below 1%. There could be noticed slight and gradual reduction in the incidence of operative vaginal delivery by forceps. The general incidence of forceps extraction compared to vaginal births was 2.04% for the entire period, at the beginning is 3.5% and then fell between 2.5 and 2% for the period 1995 to 2003 years, then in 2004 was between 1 and 2%. In 94.8% of cases forceps was applied to term fetuses and 5.2% of cases in preterm fetuses (respectively 3.78% in premature fetuses 1-st degree, 1.10 percent premature fetuses II-nd degree and 0.31% in premature fetuses III-grade). In 74.65% of the cases was outlet forceps and 25.35% was low forceps. CONCLUSIONS: Forceps remains an irreplaceable tool for operative vaginal birth, but there is a tendency to reduce its use. In preterm fetuses forceps is the only method for vaginal operative delivery. Today only outlet and low forceps have their role in modern obstetrics, but there is a trend to reduce the incidence of the rotational forceps in comparison to increase of the use of outlet forceps.

[Indications for vaginal delivery with forceps application].

UNLABELLED: The aim of the study was to establish indications for operative vaginal delivery by extraction of the fetus with forceps in modern obstetrics. MATERIAL AND METHODS: This is a retro- and prospective study which includes 672 forceps deliveries in the period of 1994-2008 in Maternity hospital Sofia. Simpson and Kielland were used for extractions subject to appropriate indications and conditions, regardless of the gestational week of pregnancy. RESULTS: The most frequent indication for forceps application is fetal asphyxia (78.1%) and considering the frequency for 15 years it is the permanent, leading indication for forceps in modern obstetrics. Arrest of the head in the same plane of the pelvis was the indication in 23.6% of the cases it varies and is rarely primary through the 15 year period. Ineffective uterine contractions and/or pushes (16.7%) tends to decrease its frequency. Avoiding maternal efforts in the second stage of labor (8.5%) and in 50% of the cases was indicated for women with cardiovascular diseases. Malpositions (7.7%) increases through the years probably secondary to epidural analgesia. Indication preeclampsia-eclampsia is described in 1.3% of cases, followed by genital bleeding by 1.9% and prolapse of the umbilical cord by 0.6% and they are more incidentally reasons for application of forceps. CONCLUSION: Asphyxia of the fetus is the most common and a leading indication for extraction of the fetus with forceps. Ineffective uterine contractions and the arrest of the head in the same plane of the pelvis are consistent in their occurrence and lead to prolonged labor. In certain critical conditions (genital bleeding, prolapse of the umbilical cord and eclampsia) extraction of the fetus with forceps remains the only way for fast vaginal delivery.

[Epidural analgesia for vaginal delivery. Influence over the delivery, fetal presentation, the method of delivery and lactation].

Epidural anaesthesia is the most efficient and widespread in developed countries method of pain reduction. The effects of epidural analgesia over uterine activity, duration of first, second and third period of labor, frequency of operative delivery--vaginal and abdominal, as like as its effects of breastfeeding are established in this review.

[Epidural analgesia for vaginal delivery].

Epidural anaesthesia is the most efficient method of pain reduction. The effect of pain over physiological mother's and fetuse's process; indications, contraindications and conditions for epidural analgesia for vaginal delivery, as like as side effects and complications of epidural analgesia are established in this review.

Spatial Epidemiology Risk Assessment for Rehabilitated Former Asbestos Mining Areas in Limpopo Province; South Africa; Using Remote Sensing and Conventional Analytical Methods

The aim of this study was to conduct a comparative analysis using remote sensing and conventional sample analysis to assess asbestos pollution in rehabilitated former asbestos mining areas. The study focused on the Mafefe and Mathabatha areas of Limpopo Province; South Africa. Field-based remote sensing techniques were used to spectrally differentiate various types of asbestos minerals in order to determine their efficacy in assessing asbestos pollution. X-ray diffraction and scanning electron microscopy were employed for the identification and characterisation of traces of asbestos minerals in soil and water samples collected from the rehabilitated areas. The samples were also examined using in situ remote sensing. An Analytical Spectral Devices field spectrometer was used for spectral analysis of asbestos minerals and that of soil and water samples to compare and validate reflectance spectroscopy findings with laboratory results. Results show that in situ remote sensing techniques are able to reveal traces of asbestos minerals on rehabilitated dry surface areas; suggesting that they can play a significant role in monitoring the distribution of the asbestos minerals for epidemiological risk assessment. However; the spectral characteristics of asbestos minerals in the water medium were not as distinct as compared to laboratory methods. Overall; the results show potential for using remote sensing techniques in spatial epidemiology studies

Spatial Epidemiology Risk Assessment for Rehabilitated Former Asbestos Mining Areas in Limpopo Province; South Africa; Using Remote Sensing and Conventional Analytical Methods

Abstract:The aim of this study was to conduct a comparative analysis using remote sensing and conventional sample analysis to assess asbestos pollution in rehabilitated former asbestos mining areas. The study focused on the Mafefe and Mathabatha areas of Limpopo Province; South Africa. Field-based remote sensing techniques were used to spectrally differentiate various types of asbestos minerals in order to determine their efficacy in assessing asbestos pollution. X-ray diffraction and scanning electron microscopy were employed for the identification and characterisation of traces of asbestos minerals in soil and water samples collected from the rehabilitated areas. The samples were also examined using in situ remote sensing. An Analytical Spectral Devices field spectrometer was used for spectral analysis of asbestos minerals and that of soil and water samples to compare and validate reflectance spectroscopy findings with laboratory results. Results show that in situ remote sensing techniques are able to reveal traces of asbestos minerals on rehabilitated dry surface areas; suggesting that they can play a significant role in monitoring the distribution of the asbestos minerals for epidemiological risk assessment. However; the spectral characteristics of asbestos minerals in the water medium were not as distinct as compared to laboratory methods. Overall; the results show potential for using remote sensing techniques in spatial epidemiology studies

[Preoperative anxiety and its influence over the postoperative nausea and vomiting].

Preoperative anxiety has been suggested as a predictor of postoperative nausea and vomiting, but supporting data are lacking. The aim of this study was to evaluate the influence of preoperative anxiety on the risk of early postoperative nausea and vomiting. 30 patients participated in the study. The investigated factors--predictors and potential predictors--were: age, gender, smok ing history and preoperative anxiety. The anxiety was measured by the State--Trait Anxiety Inventory S--form (STAI S-form) and the Visual Analogue Scale for anxiety (VAS). The outcome was the occurrence of nausea and vomiting 12 h after surgery. 14 patients were with nausea and vomiting postoperatively and all of them were with a high preoperative anxiety. The most risk group for postoperative nausea and vomiting in this study is: young men, non smokers with high preoperative anxiety. There is an association between high level of preoperative anxiety and early postoperative nausea and vomiting.

[Psychological aspects of preoperative anxiety].

Admission to hospital for surgery is universally accepted as a stressful situation, provoking a certain level of anxiety in all patients. Anxiety is an unpleasant emotion and may cause patients to avoid planned operation. It also may adversely influence anesthetic induction and patient recovery. Many studies are performed to identify and quantify the risk factors of preoperative anxiety. A multitude of research has shown a positive correlation between preoperative anxiety and postoperative pain. Preoperative anxiety has been suggested as a predictor of postoperative nausea and vomiting. Preoperative anxiety is a great challenge for the anesthesiologist. There are many opened questions about the identification certain patient characteristics that predispose to high anxiety and description the quantity and quality of anxiety that patients experience preoperatively.