D-Dimers Variability in the Perioperative Period of Breast Cancer Surgery Helps to Predict Cancer Relapse: A Single-Centre Prospective Study.

BACKGROUND: The importance of D-dimers (DD) assessment in the diagnostic algorithm of venous thromboembolic (VTE) disease is well known. Increase of DD concentration may be also associated with neoplastic disease. Many studies documented that high concentration of DD before solid tumour surgery indicates more advanced disease and poor life expectancy. The prognostic value of the DD concentration variability in the perioperative period, in women undergoing breast cancer surgery, has not been analysed so far. Thus, the aim of the present prospective study was to assess whether the trend of DD concentration changes in the perioperative period may predict cancer recurrence in women undergoing breast cancer surgery. MATERIALS AND METHODS: 189 consecutive women with histopathological diagnosis of breast cancer (BC) referred for surgical treatment were included. DD concentration was measured twice in each patient: at the time of admission to hospital and at the time of discharge home. Enoxaparin in standard dose of 40 mg daily s. c. was used as primary VTE prophylaxis in all of the patients. RESULTS: The recurrence of BC, within 1 year observation time, occurred in 13 patients (6.8%), in 11 (5.8%) patients with DD increase after surgery and only in 2 (1.1%) without an increase in DD, P = .0179. Increase in DD concentration after BC surgery was an independent positive predictor of disease relapse (OR 8.600, LCI 1.451, UCI 96.80, P = .0371) together with the lack of postoperative radiotherapy (OR 6.009, LCI 1.305, UCI 31.95, P = .0245), whereas the lack of postoperative chemotherapy predicted no BC relapse (OR .07355, LCI .0056, UCI .58, P = .0245). CONCLUSIONS: Increase of DD in the early postoperative period may be considered as additional independent predictor of recurrence of BC within 1 year.

Statistical Analysis of Graph-Theoretic Indices to Study EEG-TMS Connectivity in Patients With Depression.

AIM: The objective of this work was to demonstrate the usefulness of a novel statistical method to study the impact of transcranial magnetic stimulation (TMS) on brain connectivity in patients with depression using different stimulation protocols, i.e., 1 Hz repetitive TMS over the right dorsolateral prefrontal cortex (DLPFC) (protocol G1), 10 Hz repetitive TMS over the left DLPFC (G2), and intermittent theta burst stimulation (iTBS) consisting of three 50 Hz burst bundle repeated at 5 Hz frequency (G3). METHODS: Electroencephalography (EEG) connectivity analysis was performed using Directed Transfer Function (DTF) and a set of 21 indices based on graph theory. The statistical analysis of graph-theoretic indices consisted of a combination of the k-NN rule, the leave-one-out method, and a statistical test using a 2 × 2 contingency table. RESULTS: Our new statistical approach allowed for selection of the best set of graph-based indices derived from DTF, and for differentiation between conditions (i.e., before and after TMS) and between TMS protocols. The effects of TMS was found to differ based on frequency band. CONCLUSION: A set of four brain asymmetry measures were particularly useful to study protocol- and frequency-dependent effects of TMS on brain connectivity. SIGNIFICANCE: The new approach would allow for better evaluation of the therapeutic effects of TMS and choice of the most appropriate stimulation protocol.

The impact of WWTP size and sampling season on the prevalence of antibiotic resistance genes in wastewater and the river system.

There is a growing concern about the fate of antibiotic resistance genes (ARGs) during wastewater treatment and their potential impacts on the receiving water bodies. We hypothesised that the quantity of ARGs in effluents may be related to the size of wastewater treatment plants (WWTPs) and sampling season. To date, only several attempts have been made to investigate the impact of the above factors at the catchment scale. Therefore, the goal of the present study was to explore possible differences in the quantity of ARGs in treated wastewater from small, medium-sized and large WWTPs in the catchment of the Pilica River (9258 km2). The impact of treated wastewater on the concentration of ARGs was also determined along the river continuum from upland to lowland segments to the point of confluence with the Vistula (342 km). Treated effluent was sampled in 17 WWTPs, and river water was sampled in 7 sampling sites in four seasons. The concentrations of blaTEM, tet(A), ermF, sul1 and aac(6')-Ib-cr genes, the integrase gene intI1 and the 16S rRNA gene were analysed by quantitative PCR. The physical and chemical parameters and nutrient concentrations (23 various parameters) in the analysed samples were determined. The highest absolute concentrations of the studied genes were noted in effluent samples from small WWTPs (p < 0.01). The concentration of ARGs (gene copies/mL) peaked in winter and spring samples (p < 0.04). The results of statistical analyses indicate that in small WWTPs, the absolute concentration of ARGs can be predicted based on the biochemical oxygen demand, in routine water analyses. However, none of the studied parameters supported predictions of ARG abundance in medium-sized and large WWTPs or in river water.

Efficacy of ciclesonide in the treatment of patients with asthma exacerbation.

INTRODUCTION: Progressing deterioration of the lung function, dyspnoea, cough, wheezing and chest tightness are the main features of asthma exacerbations. The first step in the prevention of severe asthma exacerbations is to intensify the anti-inflammatory treatment with high doses of inhaled corticosteroids (ICS). AIM: To assess the efficacy of ciclesonide in patients who have been losing control of asthma despite being treated with medium doses of inhaled corticosteroids and long-acting ß2-agonists (LABA) as the second controller. MATERIAL AND METHODS: The study was conducted in a group of 74 asthmatic patients who have been losing control of their asthma. Subjects entering the study received the following anti-inflammatory interventions: high doses of ciclesonide (1280 µg) or 640 µg of ciclesonide added to a current dose of ICS or a doubled dose of current ICS. RESULTS: Treatment options containing ciclesonide have shown statistically and clinically important advantages (improvement of Asthma Control Test score, reduction in rescue medication consumption, reduction in day and night symptoms score, improvement in spirometry parameters, decrease in exhaled nitric oxide, and no necessity of oral corticosteroids treatment) in comparison to patients for whom medium doses of the previously used inhaled corticosteroid were doubled. CONCLUSIONS: Treating with high doses of ciclesonide is characterised by a quick and potent anti-inflammatory effect as well as prompt clinical improvement along with the proper safety profile in patients experiencing asthma exacerbations.

The use of a hybrid Sequential Biofiltration System for the improvement of nutrient removal and PCB control in municipal wastewater.

This article aims to evaluate the efficiency of an innovative hybrid Sequential Biofiltration System (SBS) for removing phosphorus and nitrogen and polychlorinated biphenyls (PCBs) from original municipal wastewater produced by a Wastewater Treatment Plant under authentic operating conditions. The hybrid SBS was constructed with two barriers, a geochemical (filtration beds with limestone, coal and sawdust) and a biological barrier (wetlands with Glyceria, Acorus, Typha, Phragmites), operating in parallel. Significant differences were found between inflow and outflow from the SBS with regard to wastewater contaminant concentrations, the efficiency of removal being 16% (max. 93%) for Total Phosphorus (TP), 25% (max. 93%) for Soluble Reactive Phosphorus (SRP), 15% (max. 97%) for Total Nitrogen (TN), 17% (max. 98%) for NO3-N, and 21% for PCB equivalency (PCB EQ). In the case of PCB EQ concentration, the highest efficiency of 43% was obtained using beds with macrophytes. The SBS removed a significant load of TP (0.415 kg), TN (3.136 kg), and PCB EQ (0.223 g) per square meter per year. The use of low-cost hybrid SBSs as a post-treatment step for wastewater treatment was found to be an effective ecohydrological biotechnology that may be used for reducing point source pollution and improving water quality.

Analysis of the accuracy of the Wells scale in assessing the probability of lower limb deep vein thrombosis in primary care patients practice.

BACKGROUND: The clinical picture of deep vein thrombosis (DVT) is nonspecific. Therefore assessment of the probability of occurrence of DVT plays a very important part in making a correct diagnosis of DVT. The aim of our prospective study was to assess the accuracy of the Wells scale in primary care setting in diagnostic procedure of suspected deep vein thrombosis. METHODS: In the period of 20 - months (from 2007 to 2009) a group of residents from one of the urban districts of Warsaw, who reported to family doctors (22 primary care physicians were involved in the study) with symptoms of DVT were assessed on the probability of occurrence of deep vein thrombosis using the Wells scale. Family doctors were aware of symptoms of DVT and inclusion patients to this study was based on clinical suspicion of DVT. Patients were divided into three groups, reflecting probability of DVT of the lower limbs. To confirm DVT a compression ultrasound (CUS) test was established. We analyzed the relationship between a qualitative variable and a variable defined on an original scale (incidence of DVT versus Wells scale count) using the Mann-Whitney test. Chi-square test compared rates of DVT events in all clinical probability groups. Patient were follow up during 3 months in primary care setting. RESULTS: In the period of 20 months (from 2007 to 2009) a total number of 1048 patients (male: 250 , female: 798 mean age: 61.4) with symptoms suggestive of DVT of the lower extremities entered the study. Among the 100 patients classified in the group with a high probability of DVT of the lower extremities, 40 (40%) patients (proximal DVT - 13; distal DVT - 27) were diagnosed with it (95% CI [30.94% -49.80%]). In the group with a moderate probability consisting of 302 patients, DVT of the lower extremities was diagnosed in 19 (6.29%) patients (95% CI [4.06% -9.62%]), (proximal DVT - 1; distal DVT - 18). Of the 646 patients with a low probability of DVT of the lower extremities distal DVT was diagnosed in 1 (0.15%) patient (95% CI [0.03% -0.87%]). CONCLUSION: The Wells scale used in primary care setting demonstrated a high degree of accuracy.

Hierarchy of factors exerting an impact on nutrient load of the Baltic Sea and sustainable management of its drainage basin.

The aim of the paper was to evaluate 23 catchment factors that determine total phosphorus and total nitrogen load to the Baltic Sea. Standard correlation analysis and clustering were used. Both phosphorus and nitrogen loads were found to be positively related to the number of pigs and the human population associated with wastewater treatment plants (WWTPs) per km(2), while the number of cattle and agricultural area were found to influence nitrogen rather than phosphorus load, and the area of forests is negatively related to loads of both nutrients. Clustering indicates an overall north-south pattern in the spatial co-occurrence of socio-ecological factors, with some exceptions discussed in the paper. Positive steps in the Baltic Sea region have already been taken, but much remains to be done. The development of coherent response policies to reduce eutrophication in the Baltic Sea should be based on a comprehensive knowledge base, an appropriate information strategy and learning alliance platform in each drainage river catchments.

Role of environmental factors and toxic genotypes in the regulation of microcystins-producing cyanobacterial blooms.

The aim of this study was to understand: (1) how environmental conditions can contribute to formation of Microcystis-dominated blooms in lowland, dam reservoirs in temperate climate-with the use of quantitative molecular monitoring, and (2) what is the role of toxic Microcystis genotypes in the bloom functioning. Monitoring of the Sulejow Reservoir in 2009 and 2010 in two sites Tresta (TR) and Bronislawow BR), which have different morphometry, showed that physicochemical conditions were always favorable for cyanobacterial bloom formation. In 2009, the average biomass of cyanobacteria reached 13 mg L(-1) (TR) and 8 mg L(-1) (BR), and in the second year, it decreased to approximately 1 mg L(-1) (TR and BR). In turns, the mean number of toxic Microcystis genotypes in the total Microcystis reached 1% in 2009, both in TR and BR, and in 2010, the number increased to 70% in TR and 14 % in BR. Despite significant differences in the biomass of cyanobacteria in 2009 and 2010, the mean microcystins (MCs) concentration and toxicity stayed at a similar level of approximately 1 µg L(-1). Statistical analysis indicated that water retention time was a factor that provided a significant difference between the two monitoring seasons and was considered a driver of the changes occurring in the Sulejow Reservoir. Hydrologic differences, which occurred between two studied years due to heavy flooding in Poland in 2010, influenced the decrease in number of Microcystis biomass by causing water disturbances and by lowering water temperature. Statistical analysis showed that Microcystis aeruginosa biomass and 16S rRNA gene copy number representing Microcystis genotypes in both years of monitoring could be predicted on the basis of total and dissolved phosphorus concentrations and water temperature. In present study, the number of mcyA gene copies representing toxic Microcystis genotypes could be predicted based on the biomass of M. aeruginosa. Moreover, MCs toxicity and concentration could be predicted on the basic of mcyA gene copy number and M. aeruginosa (biomass, 16S rRNA), respectively. Present findings may indicate that Microcystis can regulate the number of toxic genotypes, and in this way adjust the whole bloom to be able to produce MCs at the level which is necessary for its maintenance in the Sulejow Reservoir under stressful hydrological conditions.

Automatic detection and analysis of the EEG sharp wave-slow wave patterns evoked by fluorinated inhalation anesthetics.

OBJECTIVE: The aim of this study was to develop a method for the automatic detection of sharp wave-slow wave (SWSW) patterns evoked in EEG by volatile anesthetics and to identify the patterns' characteristics. METHODS: The proposed method consisted in the k-NN classification with a reference set obtained using expert knowledge, the morphology of the EEG patterns and the condition for their synchronization. The decision rules were constructed and evaluated using 24h EEG records in ten patients. RESULTS: The sensitivity, specificity and selectivity of the method were 0.88 ± 0.10, 0.81 ± 0.13 and 0.42 ± 0.16, respectively. SWSW patterns' recruitment was strictly dependent on anesthetic concentration. SWSW patterns evoked by different types of anesthetics expressed different characteristics. CONCLUSIONS: Synchronization criterion and adequately selected morphological features of "slow wave" were sufficient to achieve the high sensitivity and specificity of the method. SIGNIFICANCE: The monitoring of SWSW patterns is important in view of possible side effects of volatile anesthetics. The analysis of SWSW patterns' recruitment and morphology could be helpful in the diagnosis of the anesthesia effects on the CNS.

[Diagnostic value of induced sputum in interstitial lung disease]. / Znaczenie diagnostyczne indukowanej plwociny w chorobach sródmiazszowych pluc.

BACKGROUND: Induced sputum (IS) has been recently used to investigate pulmonary inflammation in patients with interstitial lung disease (ILD), but still little attention has been paid to its efficacy in diagnosing sarcoidosis and other ILD. The aim of this study was to evaluate the diagnostic value of IS differential cell count and CD4+/CD8+ ratio in sarcoidosis (SA) and nonsarcoidosis ILD (NSA ILD). MATERIAL AND METHODS: We studied prospectively newly diagnosed 59 patients: 36 SA and 23 NSA ILD [16 hypersensitivity pneumonitis (HP) and 7 idiopathic pulmonary fibrosis (IPF)]. IS was performed by inhaling a 5% NaCl solution for 4 periods of 5 minutes. Giemsa stained cytopreps were differentially counted and T-lymphocyte subsets were analyzed by flow cytometry method. The k-nearest neighbour rule (k-NN) or predictive value of CD4+/CD8+ ratio were used to discriminate between SA and NSA ILD. The variables of IS used in k-NN rule were: cells viability, total cell count, percentages of alveolar macrophages, lymphocytes, neutrophils, eosinophils, CD4+ and CD8+ subsets, and CD4+/CD8+ ratio. RESULTS: 33 patients were able to produce an adequate sputum sample (SA-15, HP-11, IPF-7). A CD4+/CD8+ ratio>2.6 had a sensitivity of 100% and a specificity of 72% with 84% of correctly classified cases in distinguishing SA from NSA ILD. However, using k-NN rule the probability of correct classification was 79% (classification error rate-21%). CONCLUSION: To distinguish SA from NSA ILD cut off CD4+/CD8+ ratio>2.6 alone was superior to k-NN rule using all the parameters of IS.

Electron spectra line shape analysis of highly oriented pyrolytic graphite and nanocrystalline diamond.

The X-ray excited Auger electron spectroscopy (XAES), X-ray photoelectron spectroscopy (XPS) and elastic peak electron spectroscopy (EPES) methods were applied in investigating samples of nanocrystalline diamond and highly oriented pyrolytic graphite of various C sp(2)/sp(3) ratios, crystallinity conditions and grain sizes. The composition at the surface was estimated from the XPS. The C sp(2)/sp(3) ratio was evaluated from the width of the XAES first derivative C KLL spectra and from fitting of XPS C 1s spectra into components. The pattern recognition (PR) method applied for analyzing the spectra line shapes exhibited high accuracy in distinguishing different carbon materials. The PR method was found to be a potentially useful approach for identification, especially important for technological applications in fields of materials engineering and for controlling the chemical reaction products during synthesis.

A fuzzy-classifier system to distinguish respiratory patterns evolving after diaphragm paralysis in the cat.

We applied the fuzzy "k-nearest neighbor" (k-NN) classifier of the pattern recognition theory to fathom the abnormal way of breathing resulting from diaphragm paralysis and to distinguish the dominant component, tidal or frequency, of the breathing pattern on which ventilatory compensation relies in such a pathological state. We addressed this issue in the experimental model of diaphragm paralysis as a result of bilateral phrenicotomy in anesthetized, spontaneously breathing cats. Of several variables recorded, we selected two features, minute ventilation and arterial CO(2) tension, that were used for the k-NN analysis. The results demonstrate that the ability to maintain ventilation critically depended on the increase in frequency of breathing. Other breathing pattern strategies were ineffective. The k-NN evaluation with the two selected features discerned the prevailing pattern of breathing with sufficient probability. Such an evaluation may be a useful tool in predicting the development of compensatory strategies in disordered patterns of breathing.