The association between serum galectin-3 level and its placental production in patients with preeclampsia.

Galectin-3 is ß-galactoside-binding lectin, used in cardiology as a biomarker of heart failure. Available research suggest galectin-3 may play a role in the development of preeclampsia. Seventy seven women were included in the study: 39 with preeclampsia and 38 with uncomplicated pregnancy. Patients underwent blood sample analysis (galectin-3, N-terminal pro-brain natriuretic peptide (NT-proBNP), soluble fms-like tyrosine kinase-1 (sFlt-1), placental growth factor (PlGF), cystatin C, creatinine) and echocardiographic examination. After delivery, placental tissue samples were obtained for immunohistochemistry evaluation. In patients with preeclampsia, serum galectin-3 levels (11.8 versus 9.5 ng/ml; p = 0.004) and galectin-3 expression in placental tissue (immunoreactive score (IRS) in extravillous trophoblasts: 9 versus 5; p = 0.002; in syncytiotrophoblasts: 6 versus 2, p < 0.001) were significantly higher than in the control group. Serum NT-proBNP and sFlt-1 levels, sFlt-1/PlGF ratio, serum creatinine and cystatin C levels were significantly higher, whereas serum PlGF levels and estimated glomerular filtration rate (eGFR) were significantly lower in preeclamptic patients than in uncomplicated pregnancy. On echocardiography, preeclamptic women had significantly greater thickness of interventricular septum (IVS) and left ventricle posterior wall (PW) and significantly worse left ventricle diastolic function (higher E/e' values). Serum galectin-3 level did not correlate with any other biochemical parameters, as well as the vast majority of echocardiographic parameters. Significant correlation between serum galectin-3 and its placental expression in syncytiotrophoblasts (STB) was revealed. Renal function parameters and NT-proBNP correlated with antiangiogenic state. This study demonstrated increased serum galectin-3 levels and placental galectin-3 production in preeclamptic patients, in comparison to women with uncomplicated pregnancy. Myocardial dysfunction and worse renal function parameters in patients with preeclampsia were not related to galectin-3. The main source of galectin-3 in maternal blood was its placental production. In the development of preeclampsia, galectin-3 may act as a compensatory mechanism to impaired placentation in early pregnancy.

Variations in very preterm birth rates in 30 high-income countries: are valid international comparisons possible using routine data?

OBJECTIVE: Concerns about differences in registration practices across countries have limited the use of routine data for international very preterm birth (VPT) rate comparisons. DESIGN: Population-based study. SETTING: Twenty-seven European countries, the United States, Canada and Japan in 2010. POPULATION: A total of 9 376 252 singleton births. METHOD: We requested aggregated gestational age data on live births, stillbirths and terminations of pregnancy (TOP) before 32 weeks of gestation, and information on registration practices for these births. We compared VPT rates and assessed the impact of births at 22-23 weeks of gestation, and different criteria for inclusion of stillbirths and TOP on country rates and rankings. MAIN OUTCOME MEASURES: Singleton very preterm birth rate, defined as singleton stillbirths and live births before 32 completed weeks of gestation per 1000 total births, excluding TOP if identifiable in the data source. RESULTS: Rates varied from 5.7 to 15.7 per 1000 total births and 4.0 to 11.9 per 1000 live births. Country registration practices were related to percentage of births at 22-23 weeks of gestation (between 1% and 23% of very preterm births) and stillbirths (between 6% and 40% of very preterm births). After excluding births at 22-23 weeks, rate variations remained high and with a few exceptions, country rankings were unchanged. CONCLUSIONS: International comparisons of very preterm birth rates using routine data should exclude births at 22-23 weeks of gestation and terminations of pregnancy. The persistent large rate variations after these exclusions warrant continued surveillance of VPT rates at 24 weeks and over in high-income countries. TWEETABLE ABSTRACT: International comparisons of VPT rates should exclude births at 22-23 weeks of gestation and terminations of pregnancy.

Linking databases on perinatal health: a review of the literature and current practices in Europe.

BACKGROUND: International comparisons of perinatal health indicators are complicated by the heterogeneity of data sources on pregnancy, maternal and neonatal outcomes. Record linkage can extend the range of data items available and thus can improve the validity and quality of routine data. We sought to assess the extent to which data are linked routinely for perinatal health research and reporting. METHODS: We conducted a systematic review of the literature by searching PubMed for perinatal health studies from 2001 to 2011 based on linkage of routine data (data collected continuously at various time intervals). We also surveyed European health monitoring professionals about use of linkage for national perinatal health surveillance. RESULTS: 516 studies fit our inclusion criteria. Denmark, Finland, Norway and Sweden, the US and the UK contributed 76% of the publications; a further 29 countries contributed at least one publication. Most studies linked vital statistics, hospital records, medical birth registries and cohort data. Other sources were specific registers for: cancer (70), congenital anomalies (56), ART (19), census (19), health professionals (37), insurance (22) prescription (31), and level of education (18). Eighteen of 29 countries (62%) reported linking data for routine perinatal health monitoring. CONCLUSION: Research using linkage is concentrated in a few countries and is not widely practiced in Europe. Broader adoption of data linkage could yield substantial gains for perinatal health research and surveillance.

Pulmonary Function Abnormalities in Regard to Age at the Time of Diagnosis of Hypersensitivity Pneumonitis.

Hypersensitivity pneumonitis (HP) is a complex syndrome caused by exaggerated immune response to inhalation of a variety of organic particles in susceptible individuals. In this study we assessed the relationship between age at the time of diagnosis and the degree of functional and radiological changes in HP. The diagnosis of HP was made on the basis of a combination of clinical symptoms, medical history, serological tests, radiologic evidence of diffuse lung disease, and absence of other identifiable causes of lung disease. We reviewed the records of 111 patients (68 women) diagnosed with HP over a period of 18 years (1995-2013). The patients were stratified into 3 age-groups: <30, 30-49, and ≥50 years old. The commonest cause of HP was avian antigens (56.8 %). Dyspnea was present in 97.3 % of patients, weight loss in 54.7 % of patients, and respiratory insufficiency in 24.3 % of patients. Lung fibrosis in chest computed tomography was found in 35.1 % of patients. Lung function was impaired more seriously in the youngest age-group, with lung diffusing capacity for carbon monoxide (DLCO) <40 % in 69.2 % of these patients. Restrictive pattern was present in 92.3 % of patients in this group, as compared with the 41.0 % in the whole cohort. In this group, desaturation in the six minute walk test also was most notable, amounting to a median of 11 %. In conclusion, diagnosis of HP at young age is predictive of a more severe clinical course of disease, with lung fibrosis and higher disturbances in pulmonary function.

Decreased bone mineral density and alteration in biochemical bone metabolism markers in children affected by bone tumors after completion of therapy.

UNLABELLED: The aim of this study was to assess bone mineral density (BMD) and biochemical bone metabolism markers in patients with bone tumors after anti-cancer treatment. The study included 27 patients (median age 15 years) with malignant bone tumors and 27 healthy children. In all subjects, BMD and body composition were measured by dual-energy x-ray absorptiometry. Serum bone markers were determined by immunoenzymatic assays. After completion of treatment, patients with bone tumors had significantly decreased total and lumbar spine BMD. We observed lower calcium and vitamin D levels in patients and comparable values of bone turnover markers (carboxyterminal telopeptide of collagen type I - CTX, bone alkaline phosphatase - BALP and osteocalcin - OC) in both groups of children. However, the level of carboxylated osteocalcin (cOC) was significantly lower (p<0.01) and undercarboxylated OC (ucOC) was higher (p<0.05) in patients than in controls. Additionally, we observed similar values of anthropometric parameters in the subgroups of patients treated with methotrexate (MTX) or without MTX. In patients treated without MTX we found lower (p<0.05) ratio of cOC/ucOC, lower vitamin D level and higher CTX concentrations. Patients with bone tumors after anticancer treatment had decreased bone mineral density and alterations in bone metabolism markers with potential decrease in bone formation. KEYWORDS: bone cancer survivors, bone mineral density, bone formation markers, bone resorption markers, methotrexate.

Preoperative hypofractionated radiotherapy in the treatment of localized soft tissue sarcomas.

BACKGROUND: The primary treatment of soft tissue sarcomas (STS) is a radical resection of the tumor with adjuvant radiotherapy. Conventional fractionation of preoperative radiotherapy is 50 Gy in fraction of 2 Gy a day. The purpose of the conducted study was to assess the efficacy and safety of hypofractionated radiotherapy in preoperative setting in STS patients. METHODS: 272 patients participated in this prospective study conducted from 2006 till 2011. Tumors were localized on the extremities or trunk wall. Median tumor size was 8.5 cm, 42% of the patients had tumor larger than 10 cm, whereas 170 patients (64.6%) had high grade (G3) tumors. 167 patients (61.4%) had primary tumors. Patients were treated with preoperative radiotherapy for five consecutive days in 5 Gy per fraction, with an immediate surgery. Median follow up is 35 months. RESULTS: 79 patients died at the time of the analysis, the 3-year overall survival was 72%. Local recurrences were observed in 19.1 % of the patients. Factors that had a significant adverse impact on local recurrence were tumor size of 10 cm or more and G3 grade. 114 patients (42%) had any kind of treatment toxicity, vast majority with tumors located on lower limbs. 7% (21) of the patients required surgery for treatment of the complications. CONCLUSION: In this non-selected group of locally advanced STS use of hypofractionated preoperative radiotherapy was associated with similar local control (81%) when compared to previously published studies. The early toxicity is tolerable, with small rate of late complications. Presented results warrant further evaluation.

Ethnic variation in maternity care: a comparison of Polish and Scottish women delivering in Scotland 2004-2009.

OBJECTIVES: Birth outcomes in migrants vary, but the relative explanatory influence of obstetric practice in origin and destination countries has been under-investigated. To explore this, birth outcomes of Scots and Polish migrants to Scotland were compared with Polish obstetric data. Poles are the largest group of migrants to Scotland, and Poland has significantly more medicalized maternity care than Scotland. STUDY DESIGN: A population-based epidemiological study of linked maternal country of birth, maternity and birth outcomes. METHODS: Scottish maternity and neonatal records linked to birth registrations were analysed for differences in modes of delivery and pregnancy outcomes between Polish migrants and Scots, and compared with Polish Health Fund and survey data. RESULTS: 119,698 Scottish and 3105 Polish births to primiparous women in Scotland 2004-9 were analysed. Poles were less likely than Scots to have a Caesarean section and more likely to have a spontaneous vaginal or instrumental delivery. The Caesarean section rate in Poland is significantly higher and instrumental delivery rate lower than for either group of women in Scotland. CONCLUSIONS: Methodologically, comparing a large group of migrants from one country with the host population has advantages over grouping migrants from several countries into a single category, and allows more informed analysis of the effect of health services. Polish mothers' being slightly healthier explains some of their lower Caesarean section rate compared to Scots in Scotland. However, dominant models of obstetrics in the two countries seem likely to influence the differences between Poles delivering in Poland and Scotland. Further investigation of both is required.

Alterations in markers of bone metabolism and adipokines following a 3-month lifestyle intervention induced weight loss in obese prepubertal children.

BACKGROUND: Adipokines may influence bone metabolism in children, but this phenomenon is not well understood. Therefore, we studied the relationships between bone markers and adipokines during weight loss in obese children. MATERIALS AND METHODS: We determined serum leptin, soluble leptin receptor (sOB-R), adiponectin, BALP (bone alkaline phosphatase), CTX-I (C-terminal telopeptide of type I collagen), body composition and bone mineral density (by dual-energy X-ray absorptiometry) in 100 obese prepubertal children before and after 3 months of lifestyle intervention (low-energy diet, physical activity). The control group consisted of 70 non-obese children. RESULTS: Obese children had higher BALP activity by about 20% (p<0.001) and similar value of CTX-I compared with non-obese children. After weight loss (-0.96 BMI-SDS mean change), the BALP value in obese patients decreased (p<0.001), whereas CTX-I concentration was unchanged. Changes in BALP were positively correlated with changes in BMI (Body Mass Index) (r=0.352, p<0.001), but not associated with adipokine levels. Trend analysis using SDS-BMI subgroups showed that greater reduction of body mass was associated with a greater decrease of BALP (p=0.035) and leptin values (p<0.001), as well as a greater increase of sOB-R (p<0.003). CONCLUSIONS: Obesity during the prepubertal period is associated with an alteration in the adipokines profile and greater whole-body bone mass as a result of increased bone formation rather than reduced bone resorption. Changes in bone metabolism during lifestyle intervention seem to be related to weight loss but not to changes in adipokines. Further studies should elucidate the influence of long-term therapy on bone mass in childhood.

Preterm birth time trends in Europe: a study of 19 countries.

OBJECTIVE: To investigate time trends in preterm birth in Europe by multiplicity, gestational age, and onset of delivery. DESIGN: Analysis of aggregate data from routine sources. SETTING: Nineteen European countries. POPULATION: Live births in 1996, 2000, 2004, and 2008. METHODS: Annual risk ratios of preterm birth in each country were estimated with year as a continuous variable for all births and by subgroup using log-binomial regression models. MAIN OUTCOME MEASURES: Overall preterm birth rate and rate by multiplicity, gestational age group, and spontaneous versus non-spontaneous (induced or prelabour caesarean section) onset of labour. RESULTS: Preterm birth rates rose in most countries, but the magnitude of these increases varied. Rises in the multiple birth rate as well as in the preterm birth rate for multiple births contributed to increases in the overall preterm birth rate. About half of countries experienced no change or decreases in the rates of singleton preterm birth. Where preterm birth rates rose, increases were no more prominent at 35-36 weeks of gestation than at 32-34 weeks of gestation. Variable trends were observed for spontaneous and non-spontaneous preterm births in the 13 countries with mode of onset data; increases were not solely attributed to non-spontaneous preterm births. CONCLUSIONS: There was a wide variation in preterm birth trends in European countries. Many countries maintained or reduced rates of singleton preterm birth over the past 15 years, challenging a widespread belief that rising rates are the norm. Understanding these cross-country differences could inform strategies for the prevention of preterm birth.

What about the mothers? An analysis of maternal mortality and morbidity in perinatal health surveillance systems in Europe.

OBJECTIVE: To assess capacity to develop routine monitoring of maternal health in the European Union using indicators of maternal mortality and severe morbidity. DESIGN: Analysis of aggregate data from routine statistical systems compiled by the EURO-PERISTAT project and comparison with data from national enquiries. SETTING: Twenty-five countries in the European Union and Norway. POPULATION: Women giving birth in participating countries in 2003 and 2004. METHODS: Application of a common collection of data by selecting specific International Classification of Disease codes from the 'Pregnancy, childbirth and the puerperium' chapter. External validity was assessed by reviewing the results of national confidential enquiries and linkage studies. MAIN OUTCOME MEASURES: Maternal mortality ratio, with distribution of specific obstetric causes, and severe acute maternal morbidity, which included: eclampsia, surgery and blood transfusion for obstetric haemorrhage, and intensive-care unit admission. RESULTS: In 22 countries that provided data, the maternal mortality ratio was 6.3 per 100,000 live births overall and ranged from 0 to 29.6. Under-ascertainment was evident from comparisons with studies that use enhanced identification of deaths. Furthermore, routine cause of death registration systems in countries with specific systems for audit reported higher maternal mortality ratio than those in countries without audits. For severe acute maternal morbidity, 16 countries provided data about at least one category of morbidity, and only three provided data for all categories. Reported values ranged widely (from 0.2 to 1.6 women with eclampsia per 1000 women giving birth and from 0.2 to 1.0 hysterectomies per 1000 women). CONCLUSIONS: Currently available data on maternal mortality and morbidity are insufficient for monitoring trends over time in Europe and for comparison between countries. Confidential enquiries into maternal deaths are recommended.

[Relation between specific IgE antibodies to grass pollens and to wheat, rye, soya in children with allergic disease]. / Wzpólzaleznosc mieczy obecnoscia swoistych przeciwcial klasy ige dla pylków traw, pszenicy, zyta i soi u dzieci z choroba alergiczna.

The aim of this study was to investigate the relationship between the hypersensitivity to grass pollens (gxl) and to wheat (f4), rye ff5) and soya (fl 4) in children with allergic disease. Specific IgE was determined by the FEIA CAP- System. Hypersensitivity was expressed in classes from 1 to 6. Specific IgE antibodies against grass (gxl) in 944 children with allergic disease, aged from 6 months to 18 years were detected. At the same time in 532 of these children - specific IgE to wheat and rye and in 122 children specific IgE to soya were also estimated. We detected very high correlation between the hypersensitivity to grass and the presence of specific IgE to wheat, rye (r=0.96, p<0.01) and soya (r=0.90, p<0.05).

[Preliminary assessment of felbamate effect on the cerebral bioelectrical activity in children with refractory epilepsy]. / Wstepna ocena wplywu preparatu Felbamate na czynnosc bioelektryczna mózgu u dzieci z padaczka oporna na leczenie.

Influence Felbamate on the cerebral bioelectric activity (EEG) in the group of 31 children (18 with syndrome Lennox-Gastaut, 13 with partial epilepsy) with refractory epilepsy was investigated. In the waking EEG was visually analysed: 1. Abnormalities distribution and morphology with special consideration of slow waves, sharp elements and paroxysmal character of discharges. 2. Influence of Felbamate on the duration time of discharges. 3. Range dominant frequency and length of segments (with non-disturbed topographic differentiation) of background activity EEG. During therapy the results showed more often EEG improvement among children with syndrome Lennox-Gastaut (near 70%) than in children with partial refractory epilepsy (near 30%). The EEG results correlated positively with the clinical improvement. In the both group of epilepsy background activity improvement had a statistical significance. In sleep EEG any influence of Felbamate on the sleep spindles was observed. No observation about increase beta activity in waking and sleep EEG records was noted.

[Comparison of cost-effectiveness and efficacy of selected inhaled steroids in asthma treatment from budget perspective]. / Porównawnanie kosztów i skutecznosci leczenia astmy wybranymi glikokortykosteroidami wziewnymi z punktu widzenia budzetu.

Due to limited resources, when choosing among available treatment opportunities, it is necessary to include results of pharmaco-economic assessments. The aim of this study was to compare cost-effectiveness of Pulmicort Turbuhaler and Flixotide Rotadisc in asthma treatment. Result of randomised clinical study reported in Great Britain was used as a source of efficacy data. Costs of compared treatment options were calculated using the difference between full pharmacy price and patient's co-payment of consumed pharmaceuticals, as recorded in Warsaw open pharmacy shop in May 1999. It has been shown, statistically significant difference of cost-effectiveness in favour of Pulmicort Turbuhaler.

[Epidemiological studies in evaluation of effectiveness of health promotion programmes]. / Badania edpidemiologiczne w ocenie skutecznosci programów promocji zdrowia.

Basic characteristics of modern epidemiology and basic characteristics of epidemiological study are presented. First of all, the description of the model of randomised controlled trial is taken into account, because of its importance for evaluation of effectiveness of treatment. Consequences of main elements of randomised controlled trial for scientific inference is explained and the possibility of application of these elements to evaluation of health promotion programmes is discussed. The main points in the discussion on the possibility of application of epidemiological methods to evaluation of health promotion programmes are mentioned.

[Non-clinical factors in decision making about cesarean section]. / Pozakliniczne uwarunkowania w podejmowaniu decyzji o cieciu cesarskim.

Increasing cesarean-section rates have focused attention on variation in the use of this procedure that appear to be not only dependent of medical indication. This suggestion has been checked on the basis of newly implemented special forms in hospitals located in some areas of Poland in 1990. Documentation of 11.813 live births (almost 100% of live births in described area) has been analysed. It has been found 13.2% cesarean-section rate and 2.0% rate of other operative deliveries. Majority of cesarean sections have been medically indicated. But it has been also found that highest level of mothers education has been directly linked with higher rates of cesarean section. This linkage has been stronger than any other association (with age, parity etc.). Poland as a country, is divided for several regions subordinated to particular hospitals. It has been found that some of the patients have been admitted not to regional hospitals. We conclude that cesarean section rate among these patients was higher than this same ratio among all other patients admitted for deliveries in these hospitals. This association cannot be accounted for by differences in maternal age, parity, birth weight etc.

Frequency of Fra X syndrome among institutionalized mentally retarded males in Poland.

Results of cytogenetic studies, performed in a group of 201 institutionalized mentally retarded males, are presented. At least two cytogenetic methods for eliciting the Xq27.3 fragile site, recommended by the Fourth International Workshop on the Fra X Syndrome were used. A subgroup of 67 out of 201 studied males was also examined using molecular methods. In 6 (2.9%) males fra X syndrome was diagnosed. All cytogenetic positive results were confirmed by molecular analysis. Five patients had full expansion CGG repeats and one had both premutation and full mutation. Postulated frequency of fra X syndrome in Polish population being 0.2-0.4/1,000 males seems to be lower than it could be expected on the basis of previous literature data.

The widening gap in low birthweight rates between extreme social groups in Poland during 1985-90.

An attempt was made to identify the reasons for the increase in low birthweight (LBW) rates in Poland from 8.1% in 1985 to 8.4% in 1990. It was found that there was a differential increase in the LBW rates among the social groups. The highest increase was observed among the least educated mothers, especially in large cities. The LBW rate among the newborns of mothers who had finished their education at primary school level increased from 10.6% (in large cities from 14.7%) in 1985 to 12.5% (in large cities to 16.2%) in 1990. Controlling for maternal age, parity, education and place of residence did not change the significance of the increase in the LBW rate. The decline in birthweight was probably largely related to negative changes in socially differentiated levels of consumption of basic nutrients in Poland.

[Infant mortality and perinatal mortality in Poland in the eighties. II. Deaths by birthweight]. / Umieralnosc niemowlat i umieralnosc okoloporodowa w Polsce w latach osiemdziesiatych. Czesc II: Zgony wedlug masy urodzeniowej.

The dynamics of the changes in the level of the birthweight-specific infant mortality and perinatal mortality rates by age and cause during the eighties is presented. The strongest decline in the birthweight-specific infant and perinatal mortality rates is observed among the newborns weighing less than 2500 g. The level of the low birth weight (7.9% in 1989) and despite the decrease--the infant and perinatal mortality rates among the newborns weighing 1001-2500 g (100.5 and 109.4 respectively in 1989) and among the newborns weighing 601-1000 g (865.3 and 851.1 respectively in 1989) are high comparing to the developed countries.

[Social differentiation of increases in low birth weight in Poland--biological consequence of recession?]. / Spolecznie zróznicowany wzrost czestosci wystepowania niskiej masy urodzeniowej w Polsce--biologiczne skutki recesji?

The reasons of the increase in the LBW rate in Poland from 8.1% in 1985 to 8.4% in 1990 was investigated using the individual records from the birth certificates. There was differential increase of the low birth weight among the social groups. The highest increase was observed among the less educated mothers, especially in big cities. The LBW among the newborns delivered by mothers who had finished their education at the primary school level changed from 10.6% (in big cities from 14.7%) in 1985 to 12.5% (in big cities to 16.2%) in 1990.