Serological responses to Cryptosporidium antigens in inhabitants of Hungary using conventionally filtered surface water and riverbank filtered drinking water.

In this study the putative protective seroprevalence (PPS) of IgG antibodies to the 27-kDa and 15/17-kDa Cryptosporidium antigens in sera of healthy participants who were and were not exposed to Cryptosporidium oocysts via surface water-derived drinking water was compared. The participants completed a questionnaire regarding risk factors that have been shown to be associated with infection. The PPS was significantly greater (49-61%) in settlements where the drinking water originated from surface water, than in the control city where riverbank filtration was used (21% and 23%). Logistic regression analysis on the risk factors showed an association between bathing/swimming in outdoor pools and antibody responses to the 15/17-kDa antigen complex. Hence the elevated responses were most likely due to the use of contaminated water. Results indicate that waterborne Cryptosporidium infections occur more frequently than reported but may derive from multiple sources.

The utility of the predictive scores in polytrauma with abdomino-pelvic injuries: a series of 38 patients.

UNLABELLED: Trauma is the principal cause of mortality among the population under 40 years. The aim of our study was to compare predictive trauma scores and demonstrate their utility in the evaluation of the quality of care in polytrauma. MATERIAL AND METHODS: A retrospective study was performed between 2000-2011 including polytrauma patients with abdominal lesions and pelvic fracture who under went emergency laparotomy. We calculated ISS, GCS, RTS,TRISS, ASCOT trauma scores and W score for evaluation of treatment quality. RESULTS: We obtained the necessary data to calculate the predictive scores in 38 cases. Comparing the scores of the survivals and non-survivals we noted the following regarding mortality predictive scores: GCS 13.74 vs. 6.13 (p 0.0001),ISS 28.52 vs. 35 (p=0.0169), RTS 6.96 vs. 3.07 (p 0.0001),TRISS 84.67% vs. 28.7% (p 0.0001), ASCOT 10.34% vs.64.32% (p 0.0001). The W score in TRISS and ASCOT methodology was -2.05 (p=0.7997) and -7.81 (p=0.336),respectively. There was no statistically significant difference between actual and predicted mortality, the former being 39.47%. CONCLUSION: We did not observe differences between the two methodologies TRISS and ASCOT in mortality prediction (p=0.5401). Both of them can be used to predict polytrauma patient evolution. The W score is useful in treatment quality assessment.

Better cardiorespiratory fitness associated with favourable metabolic control and health-related quality of life in youths with type 1 diabetes mellitus.

OBJECTIVE: to explore the relationship among health-related quality of life (HRQoL), clinical variables, anthropometric measures, physical activity and cardiorespiratory fitness in children and adolescents with type 1 diabetes.Furthermore, we aimed to find predictors of HRQoL and metabolic control. METHODS: A total of 106 patients (sex ratio: 1:1) with mean HbA1c of 8.55 (± 1.44) % and diabetes duration of 5.15 (± 3.24) years were assessed. The average age was 13.22 (± 3.08) years. RESULTS: We observed statistically significant negative medium correlation between HbA1c and VO2max (r = ­ 0.343; p = 0.000). There was statistically significant small positive correlation between the HRQoL and the maximal oxygen consumption (r = 0.208; p = 0.032). We found no significant correlation between the HbA1c and the patients' HRQoL. In the multiple linear regression analysis both the better metabolic control and the HRQoL was predicted by the VO2max, other variables had no effect. Physical activity level did not explain the HRQoL. Boys had significantly better HRQoL and less skinfold thickness than girls. CONCLUSION: Better cardiorespiratory fitness associated with both favourable metabolic control and better HRQoL of diabetic youths.Regular aerobic exercise improves the young patients' physical fitness and overall health status, and perception of health-related quality of life, respectively.

Evidence for a bound H dibaryon from lattice QCD.

We present evidence for the existence of a bound H dibaryon, an I=0, J=0, s=-2 state with valence quark structure uuddss, at a pion mass of m(π)∼389 MeV. Using the results of lattice QCD calculations performed on four ensembles of anisotropic clover gauge-field configurations, with spatial extents of L∼2.0, 2.5, 3.0, and 3.9 fm at a spatial lattice spacing of b(s)∼0.123 fm, we find an H dibaryon bound by B(∞)(H)=16.6±2.1±4.6 MeV at a pion mass of m(π)∼389 MeV.

[Spleno-renal distal and proximal shunts for hypersplenism due to hepatic cirrhosis]. / Suntul spleno-renal distal si proximal pentru hipersplenismul datorat cirozei hepatice.

The secondary hypersplenism appears from 30-50% in liver cirrhosis with portal hypertension. The mechanism of the complication is the splenic congestion as the result of the progress of the portal hypertension. Between 1997-2005, 16 patients with hypersplenism due to liver cirrhosis were operated in the service. The aim of the operation was to decompress the portal hypertension, by spleno-renal shunt (Warren), in 6 patients, truncular shunts in 2 patients, and splenectomy with spleno-renal shunts in 8 patients. No postoperative death was noted on the series. The platelets number and the white blood cells, destroyed by the reticuloendothelial system of the spleen, were counted in the first month and the first year, as well as the spleen volume. In patients with non-splenectomy operations the improvement of the blood elements number was remarked in the first week, but the volume of the spleen remained increased during 1-6 month. In patients with splenectomy the platelets and the white cells dramatically increased, with the risk of coagulation disfunction. The survival rate at five years was 12 patients.

[Cervical anastomotic fistula in surgery of the esophagus]. / Fistulele anastomozelor cervicale din chirurgia esofagului.

Cervical anastomotic fistula are reported in the surgical literature in 10-30% of the patients, providing a much longer hospitalisation, a higher morbidity and in some cases even mortality. Between 1997-2003, 91 patients underwent surgical treatment for esophageal cancers and 14 patients for chemical burns. In the cancer group the rate of resection was 67,03% (61 patients). In 8 patients with non-resection tumours a retrosternal esophageal by-pass with stomach was carried out. Cervical anastomosis were performed in 68 patients, by hand sutures. Anastomotic fistula were noted in 9 patients (13,24%). In 6 cases temporarily fistula occurred, with spontaneous healing by local treatment, in 8-28 days. 2 patients required reoperation and one patient a definitive feeding jejunostomy. Most common causes of fistula are technical problems, ischemic gastric or colonic tube, postoperative respiratory failure, with prolonged hypoxia. An anastomosis in the neck results in less postoperative complications than one of the lower level.

Organic hydroperoxide-induced chemiluminescence of follicular fluid and blood serum samples obtained from women pretreated for in vitro fertilization.

The organic hydroperoxide-induced chemiluminescence of follicular fluid obtained from in vitro fertilized patients and its differently separated fractions were evaluated. Peroxidative stress causes a different photo-emission in the samples which alludes to some factors playing a role in the maintenance of the pro-oxidant/antioxidant balance. Interactions between the protein compounds of the samples and the organic hydroperoxide associate with formation of excited species contributing to the distinctive light emission processes. The technique offers a special re-interpretation of the scavenger state relating to the components of follicular fluid.

Issues to debate on the Women's Health Initiative: estrogen: an instrument or the conductor of the orchestra?

Although it is well known that cyclic production of sex hormones is essential to establish reproductive function and female characteristics, distant impacts of the activity of the female endocrine system result from a concert of delicate mechanisms. Estrogen is rather an instrument than a conductor in this physiological orchestra of the female. Thus, controversies in the explanation of results from studies on hormone replacement therapy (HRT) and cardiovascular disease (CVD) prevention might be eliminated, if we analyse not only the role of estrogen but a broader spectrum of factors leading to CVD. Authors would like to hypothesize that haemorheological changes in women around menopause, such as increased blood and plasma viscosity, haematocrit and fibrinogen, are largely responsible for the increased mortality in the post-menopausal life period. We believe that a cyclic withdrawal bleeding establishes a more favourable haemorheological condition, thus, sequentially administered estrogen might be protective in post-menopausal women. Nevertheless, other factors, that decrease blood viscosity, such as daily exercise, intake of ample amount of fluids as well as ideal nutrition, are equally important. We are confident that sequential HRT, as well as healthy life style and risk prevention programmes have their proper place in the management of this issue.

[The surgical treatment of the parastomal hernia using prolene mesh]. / Tratamentul chirurgical a eventratiilor parastomale cu plasa prolen.

UNLABELLED: Parastomal herniation is a frequent complication in enterostomy. The therapeutic strategy consists in three approaches: local fascial repair, relocation of the stoma, local repair of the parietal defect using nonabsorbable meshes. In our clinic between 1997-2002 we used monofilament meshes placed in sublay position at four patients with parastomal herniation. At three patients we used midline laparotomy placing the mesh round the colostomy on preperitoneal space, after preparing the hernia sack. The size of the mesh goes beyond the parastomal parietal defect with 3-5 cm. At the fourth patient we placed the mesh round the preperitoneal segment of the colon using a combined intraperitoneal and parastomal procedure, the size of the mesh going beyond parastomal parietal defect in this case too with 3-5 cm. The immediately and delayed results was favorable. CONCLUSIONS: The parastomal herniation's surgical repair applying prolen mesh can be a therapeutic alternative with good results.

[Longitudinal Wirsung gastrostomy in the surgical management of chronic pancreatitis]. / Wirsungo-Gastrostomia longitudinala în tratamentul chirurgical al pancreatitei cronice.

UNLABELLED: The longitudinal pancreatico-jejunostomy is a commonly used procedure in the management of the chronic pancreatitis with dilated pancreatic duct (Wirsung), however the drainage of the dilated pancreatic duct is realizable with longitudinal Wirsungo-gastrostomy to. We present one clinical case of chronic pancreatitis with dilated pancreatic duct, where the pancreatic drainage was realized with an anastomosis between the dilated Wirsung duct and the posterior wall of the stomach (longitudinal Wirsungo-gastrostomy). RESULTS: One year after Wirsungo-gastrostomy (postoperative reevaluation of the patient) a general well condition without subjective accuses, ponderal increase and stabile glucidic metabolism was found. CONCLUSION: The Wirsungo-gastrostomy could represent an alternative procedure in the management of the chronic pancreatitis with dilated pancreatic duct.

The effect of catecholamines, acetylcholine and histamine on progesterone release by human granulosa cells in a granulosa cell superfusion system.

There are experimental data demonstrating the presence and actions of various neurotransmitters in the ovary, thus supporting the view that they might play a role in intraovarian regulatory mechanisms, although their exact function in the regulation of ovarian hormone secretion is unclear. The objective of the present study was to investigate the direct action of catecholamines, acetylcholine and histamine on progesterone secretion of human granulosa cells in a superfused cell system. Human granulosa cells were isolated from preovulatory follicular fluid using a Percoll gradient centrifugation method. Approximately 2 x 10(6) cells were mixed with Sephadex G-10 and were transferred into two chambers of the superfusion apparatus. The system was perfused with a culture medium and test materials were added to the system at a dose of 100 pmol/ml. The progesterone concentration of samples was measured using an (125)I radioimmunoassay. Administration of epinephrine (adrenaline), norepinephrine (noradrenaline), dopamine and histamine had no effect on progesterone release. However, acetylcholine produced a significant progesterone release, which could be blocked by atropine. The observed effect of acetylcholine on progesterone release of superfused human granulosa cells may reflect a physiological role of acetylcholine in the regulation of granulosa cell function during the menstrual cycle.

Modulatory effect of acetylcholine on gonadotropin-stimulated human granulosa cell steroid secretion.

The aim of this study was to explore the direct action of acetylcholine on gonadotropin-stimulated progesterone (P) and estradiol (E(2)) secretion of human granulosa cells (GCs) cultured in serum-free medium. Human GCs were isolated from preovulatory follicular fluid aspirated from 22 women undergoing in vitro fertilization at the University Women's Hospital of Tübingen. The production of progesterone and E(2) was measured in the presence and absence of acetylcholine, carbachol, atropine, luteinizing hormone (LH) or follicle-stimulating hormone (FSH) using radioimmunoassay. Statistical analysis of the data was performed by ANOVA and Newman-Keuls test. Administration of acetylcholine or carbachol (10(-5) M) resulted in a significant increase in P and E(2) secretion. This response was specifically blocked by the muscarinic receptor antagonist atropine. Similarly, carbachol resulted in a significant increase in P and E(2) output, though the response to it was somewhat reduced when compared to that evoked by acetylcholine. Acetylcholine did not show any additive effect on LH-stimulated P secretion, while it augmented the stimulatory effect of FSH on P release. In contrast, carbachol markedly diminished the stimulatory effect of LH on P secretion, while it caused no change in FSH-induced P output. When administered together, acetylcholine did not modify the stimulatory effect of FSH on E(2) secretion, however, it markedly elevated LH-induced E(2) output. Similar to this, carbachol significantly increased LH-induced E(2) release, however it decreased FSH-stimulated E(2) secretion. We suggest that acetylcholine has a direct modulatory effect on gonadotropin-stimulated steroid production of GCs, an effect that is mediated via muscarinic receptors. This effect may have a physiological role in the regulation of GC function during the menstrual cycle.

Influence of melatonin on basal and gonadotropin-stimulated progesterone and estradiol secretion of cultured human granulosa cells and in the superfused granulosa cell system.

The aim of this study was to explore the direct action of melatonin (Me) on basal and gonadotropin-stimulated progesterone (PG) and estradiol (E2) secretion of human granulosa cells (GCs) cultured in serum-free medium and in a superfused GC system. Human GCs were isolated from preovulatory follicular fluid aspirated from 34 women undergoing in vitro fertilization at the University Women's Hospital of Tübingen. PG and E2 production was measured in the presence and absence of Me, propranolol, LH or FSH using radioimmunoassay. Statistical analysis of the data was performed by ANOVA and Newman-Keuls test. Me stimulated E2 secretion in a dose-dependent manner. Propranolol did not cause any change in E2 secretion, and when given with Me, it only partially blocked but could not entirely prevent E2 output. There was no statistically significant effect of Me on PG production when Me was administered at concentrations between 10(-4) and 10(-8) M. However, at 10(-3) M Me significantly suppressed PG output of granulosa cells. LH and FSH significantly stimulated the secretion of both steroid hormones. Me significantly reduced LH- and FSH-induced E2 secretion, as well as LH-stimulated PG output, while it caused only a slight, yet significant decrease in PG secretion. In the superfused GC system, FSH and LH resulted in a significant stimulatory effect on PG release. Me did not modify the stimulatory effect of FSH on PG, while it caused some delay in LH-stimulated PG release. Propranolol and Me had no stimulatory effect on PG release. On the basis of our results we suggest that Me has a direct modulatory effect on basal E2 and gonadotropin-stimulated E2 and PG secretion of human GCs. The observed effect may play a physiological role in the regulation of GC function during the menstrual cycle.

A dynamic in vitro investigation of the characteristics of the granulosa cells hormone secretion.

OBJECTIVE: Basic characteristics of ovarian steroid production has largely been clarified by the use of human granulosa cell cultures in vitro. This technique made also possible to test different stimulatory and blocking hormones and chemicals in the cell cultures to clarify regulatory mechanisms of the granulosa cells. However, these cell cultures are static systems that do not give information about the dynamics of steroid production of the granulosa cells. Therefore, in the present study we have tried to establish a dynamic model using the so called superfusion method. METHODS: Granulosa cells were isolated from follicular fluid obtained by aspiration from patients undergoing in vitro fertilization program. The granulosa cells were packed into a closed Sephadex G10 column which was continuously kept at 37 degrees C and washed with McCoy's 5A culture medium. Samples of the medium leaving the column were collected in every 30 minutes with a fraction collector. Stimulation with LH and blocking with cycloheximide were carried out by adding the materials into the perfusing culture medium. Progesterone levels of the samples were measured by RIA-s. RESULTS: We found that the basal progesterone secretion is pulsatile even in the absence of any stimulation. After stimulation with LH there is a rapid, but a slight increase in the steroid levels, followed by a delayed and also pulsatile definite increase of progesterone levels starting at about 30 minutes. CONCLUSIONS: From the data obtained it is clear that human granulosa cells are storing progesterone in a small quantity that is LH releasable. The delayed progesterone increase is due to de novo synthesis of the hormones after the gonadotropin stimulation, which takes about 60 minutes.

Early recognition of pregnancy by the maternal immune system.

PROBLEM: Immunologic recognition of pregnancy is important for normal gestation. Successful pregnancy is characterized by a Th2 dominance, whereas there is a Th1 dominance in failed pregnancies. We assume that a signal given by the fertilized ovum induces a Th2 shift, necessary for a normal outcome. In vitro fertilization provides a tool for testing this possibility. METHOD OF STUDY: Phytohemagglutinin-stimulated lymphocytes were incubated for 48 hr in the presence of culture media from in vitro fertilized eggs, as well as in follicular fluid (FF) and control supernatants. Total RNA was isolated from the lymphocytes by the guanidine-isothiocyanate method and interleukin (IL)-10 mRNA expression was detected by reverse transcription-polymerase chain reaction. RESULTS: Ten percent of the activated lymphocytes incubated with FF expressed IL-10 mRNA, whereas 88% of the lymphocytes activated with supernatants of sperm + oocytes gave a positive signal. Significantly (P < 0.05) fewer (50%) lymphocytes stimulated in the presence of control supernatants also expressed mRNA for IL-10. In supernatants of activated lymphocytes incubated with the culture medium of spermia + oocytes, the concentration of IL-10 was significantly higher than in the lymphocytes incubated with FF. CONCLUSION: These data suggest that the presence of the fertilized ovum induces a Th2 shift, which enables pregnancy to proceed to term.