Key Messages for a Frailty Prevention and Management Policy in Europe from the ADVANTAGE JOINT ACTION Consortium.

In the 2015 Ageing Report, the European Commission (EC) and the Economic Policy Committee stated that coping with the challenge posed by an ageing population will require determined policy action in Europe, particularly in reforming pension, health care and long-term care systems. The concern for this situation motivated the EC, the Parliament and many of the Member States (MS) to co-fund, in the 2015 call of the Third European Health Programme of the European Union 2014-2020, the first Joint Action (JA) on the prevention of frailty. ADVANTAGE JA brings together 33 partners from 22 MSs for 3 years. It aims to build a common understanding on frailty to be used in the MSs by policy makers and other stakeholders involved in the management, both at individual and population level, of older people who are frail or at risk for developing frailty throughout the European Union (EU). It is a formidable challenge but also a great opportunity for concerted action resulting in fostering effective and successful policies in frailty prevention and management in the participating MS. The Consortium has 2 years of hard work ahead to contribute to the needed change for frailty related disability free Europe. The first practical step towards this aim was the preparation of a document: the State of the Art on Frailty Report to support an overview of evidence of what works and what does not work on frailty prevention and management. Subsequently, this will be reflected in the advice that the JA will give to policy makers at MS level. Overall, these messages intend to be an instrument of added value to advocate for policy driven decisions on frailty prevention and management in the JA participating MSs and subsequently towards a frailty related disability free older population in Europe. The aim of this paper is to describe ADVANTAGE JA general structure, approach and recommendations towards a European health and social policy which will support frailty prevention in the participating MS.

Telomerase activity in transthoracic fine needle biopsy aspirates as a marker of peripheral lung cancer.

BACKGROUND: A study was undertaken to evaluate the usefulness of telomerase activity assay in transthoracic fine needle biopsy (TFNB) aspirates collected from peripheral tumours of the lung in predicting the malignant aetiology of lung infiltrations. METHODS: 100 patients with a peripheral infiltration of the lung underwent TFNB of the focal lesion. The aspirates were subjected to standard cytological evaluation. Telomerase activity in the specimens was determined with the PCR-ELISA PLUS method. The sensitivity, specificity, accuracy and predictive value of TFNB were calculated for cytological examination of aspirates alone and cytological examination with additional telomerase activity assessment. RESULTS: Lung cancer was newly diagnosed in 84 subjects and benign peripheral lesions were found in 16. During the first TFNB, lung cancer was identified in 56 cases of cancer (66.7%) while increased telomerase activity was found in 61 cancer aspirates (72.6%). No subject with a benign infiltration had a false positive result from cytological examination, but in one case (6.25%) increased telomerase activity was observed. The diagnostic sensitivity, accuracy and negative predictive value of the combination of cytological examination and telomerase activity assay in TFNB specimens were significantly higher than for cytological examination alone (89.3% vs 66.7%, p = 0.0004; 90% vs 72%, p = 0.001; 62.5% vs 36.4%, p = 0.039), but a combination of the two examinations was associated with a lower specificity of TFNB (96.9% vs 100%, p = 0.002). CONCLUSION: Detection of telomerase activity in aspirates taken during TFNB of a peripheral lung infiltration should be considered as an indication of the risk of malignancy in cases with false negative cytological results.

Serum thymus and activation-regulated chemokine, macrophage-derived chemokine and eotaxin as markers of severity of atopic dermatitis.

BACKGROUND: Expression of CCR4 ligands, such as thymus and activation-regulated chemokine (TARC) and macrophage-derived chemokine (MDC), leads to preferential influx of T-helper (Th) 2-type lymphocytes to the lesional skin in atopic dermatitis (AD). Eotaxin, like the CCR3 ligand, is an important contributor of eosinophils recruitment in the course of AD. These chemokines are assumed to play an important role in the pathomechanism of AD. METHODS: In this study, the serum concentration of TARC, MDC, eotaxin and total immunoglobulin E (IgE) in AD patients and healthy people were compared. Correlation between the studied indices and activity of AD was established. Severity of AD was assessed according to the SCORAD score. The study comprised 44 healthy people and 43 patients with AD. The serum concentrations of TARC, MDC, eotaxin and IgE were measured with the use of enzyme-linked immunosorbent assay kits. RESULTS: The serum levels of TARC, MDC, eotaxin and IgE appeared to be significantly higher in patients with AD than in healthy people. A strong positive correlation was revealed between the levels of TARC, MDC, total IgE in serum of patients with AD and SCORAD. In contrast, no significant relationship was found for the serum eotaxin concentration and TARC, MDC, IgE or disease severity. CONCLUSION: Our findings indicate that TARC and MDC are actively involved in the pathogenesis of AD and their expression, opposite to that of eotaxin, is strongly associated with clinical picture of atopic dermatitis.

Influence of age and gender on serum eotaxin concentration in healthy and allergic people.

BACKGROUND: Eotaxin is one of the important chemokines that modulate allergic inflammation. In many studies a correlation between an elevated serum concentration of eotaxin, allergen exposure and allergic symptoms has been confirmed. Influence of other factors on eotaxin concentration is feebly recognized. We made an attempt to assess the influence of age and gender on the serum eotaxin level in healthy people and in patients with intermittent IgE-mediated rhinoconjunctivitis (AR). METHODS: The serum eotaxin level was measured in 245 healthy people and 241 patients with AR before the pollen season with the ELISA technique (KITS, R&D USA, pg/ml). The parametric tests and linear regression analysis were used in statistical calculations. RESULTS: There were no differences between the allergic group and the healthy one in the mean age (accordingly: 31.3 +/- 11.6 yrs. vs. 31.6 +/- 12.5 yrs.; p=0.1) and the mean serum eotaxin content (118.1 +/- 44.9 pg/ml vs. 116.3 +/- 34.8 pg/ml; p=0.3). A significant relationship between the serum eotaxin level, gender and age was revealed in both groups and regression models were derived. A linear correlation between age (semi-partial correlation beta = 0.47, p = 0.0000001) and gender (semi-partial correlation beta = 0.3, p = 0.0000001), on the one side, and the serum eotaxin level, on the other, was found for the allergic people. In the control group a similar relationship between the serum eotaxin level and age (semi-partial correlation coefficient beta = 0.63, p = 0.0000001) and gender (semi-partial correlation factor beta = 0.23, p = 0.000006) was observed. CONCLUSIONS: Age and sex significantly influence the serum eotaxin content in healthy people and patients with IgE-mediated rhinoconjunctivitis.

Cc-chemokine eotaxin as a marker of efficacy of specific immunotherapy in patients with intermittent IgE-mediated allergic rhinoconjunctivitis.

BACKGROUND: Allergen-specific immunotherapy (SIT) is believed to be a valuable remedy in several allergic diseases; however, an accurate immunological marker of the efficacy of this treatment method has not been found yet. Cc-chemokine eotaxin, owing to its selective action on eosinophils, seems to play an important role in the pathophysiology of allergic response. The purpose of this study was to assess the usefulness of eotaxin in monitoring of SIT efficacy in patients with IgE-mediated allergic rhinoconjunctivitis. METHODS: One hundred and twenty-two patients with seasonal IgE-mediated allergic rhinoconjunctivitis due to tree- (birch, n = 42; hazel/alder, n = 14) or grass/cereal- (n = 66) pollen received allergen-specific immunotherapy. Serum eotaxin levels were determined four times in every patient, shortly before immunotherapy (Evaluation 0), immediately after the treatment (Evaluation 1), in the height of pollen season (Evaluation 2) and at least 2 weeks after the pollen season (Evaluation 3). Serum eotaxin levels were simultaneously measured in 59 healthy people from the control group. Changes in serum eotaxin levels were assessed in the healthy and allergic groups. Clinical symptoms of IgE-mediated rhinoconjunctivitis were evaluated and compared with serum eotaxin concentration changes. RESULTS: Mean values of eotaxin concentrations in serum during Evaluations 0-3 did not significantly differ in the healthy subjects and the patients with IgE-mediated rhinoconjunctivitis (P > 0.05). Moreover, no statistically significant differences in the serum eotaxin levels between the visits were observed in the patients who received immunotherapy (P > 0.05); however, immediately after immunotherapy (Evaluation 1) the mean serum level of eotaxin was lowest and closest to the serum eotaxin concentration in the control group at the same visit. No significant correlation between the mean value of the serum eotaxin level in the height of pollen season (r = -0.12, P > 0.05) or mean changes of the eotaxin levels between Evaluations 2 and 1 (r = -0.03, P > 0.05), on the one hand, and the cumulative score of symptoms and drug, on the other, were found. CONCLUSIONS: The results allow to conclude that although eotaxin plays a significant role in the mechanism of antigen-specific immunotherapy, its serum expression remains a poor marker of SIT efficacy.

[Evaluation of the influence of tobacco smoking on pulmonary function in youg men]. / Ocena wplywu palenia tytoniu na czynnosc ukladu oddechowego u mlodych mezczyzn.

UNLABELLED: According to WHO estimates in the early 1990s there were around 1.100 million smokers in the world, about one third of the global population over 15 years of age. The aim of the study was to evaluate tobacco influence on pulmonary function tests in young healthy men. The study was performed on 3004 subjects 18-23 years old. The subjects were divided into two groups, smokers (S n = 1726) and non-smokers (NS n = 1278). Each subject had spirometry and body pletysmography done. The analysis of influence of smoking on pulmonary function tests showed statistically significant decrease of TLC, FEV1, FEV1%/VC, PEF and FEF50 in the smokers' group. Percentage of people with airflow limitation (FEV1%VC < 85% N, FEV1 < 80% N, FEF50 < 70% N) was two times higher than in the non-smokers' group. IN CONCLUSION: smoking significantly increases the number of subjects with airflow limitation among healthy young males in Poland.

[Efficacy of the FLUTTER VRP1 device for physiotherapy patients with chronic pulmonary disease]. / Przydatnosc przyrzadu flutter VRP1 w rehabilitacji chorych na przewlekle choroby ukladu oddechowego.

Respiratory physiotherapy is essential to the treatment of all acute or chronic respiratory disorders which expectoration difficulties are major problem. The Flutter VRP1 is an easy to use physiotherapy device; combines safe endobronchial positive expiratory pressure with vibratory effects. Flutter is a useful device for sputum expectoration and markedly improvement of lung parameters.

[The role of inflammation mediators in bronchial asthma and chronic obstructive pulmonary disease]. / Rola niektórych mediatorów reakcji zapalnej w astmie oskrzelowej i przewleklej obturacyjnej chorobie pluc.

Bronchial asthma and chronic obstructive pulmonary disease (COPD) are chronic inflammatory diseases of the bronchial tree. Some products of eosinophils, neutrophils and other cells have been implicated in causing bronchial mucosal damage and may play important role in monitoring degree of airway inflammation and differentiation between bronchial asthma and COPD. The author described some of them.

[Local treatment with tumor necrosis factor alpha in a patient with lung cancer]. / Miejscowe leczenie czynnikiem martwicy nowotworów-alpha u chorej z guzem pluca.

Tumor Necrosis Factor alfa (TNFa) is a cytokine with cytolytic and cytotoxic properties. First clinical trials in which TNF was administered parenterally date back to early 70-ties. Soon it was noticed that when administered strictly to the tumor mass TNF exhibits high anti-tumor efficacy, exemplified by total or at least substantial regression of the tumor mass while producing minor and controllable symptoms. In this paper the case of local administration of the recombinant TNFa directly into the tumor mass constricting the bronchus was presented.

[Tumor necrosis factor-alpha--biological and immunologic properties]. / Czynnik martwicy nowotworów-alpha--wlasciwosci biologiczne i immunologiczne.

The studies investigating antitumor efficacy of bacterial infections, started by Coley, resulted in isolation of tumor necrosis factor (TNF-alpha), released by activated macrophages. It was hoped that direct and indirect cytotoxic, cytostatic and immunomodulatory effects of TNF-alpha would prove helpful in obtaining an effective antitumor drug. In this paper, we describe biologic and immunologic activity of cachectin as well as pre-clinical trials of TNF application in antitumor therapy.

[Tumor necrosis factor-alpha--phase I and phase II clinical trials]. / Czynnik martwicy nowotworów-alpha badania kliniczne I i II fazy.

Not fully successful therapy of carcinomas makes us search for new methods of antitumor treatment. Beside radiotherapy and chemotherapy, immunotherapy is the method we put our hopes on. Since its isolation in mid 70s TNF-alpha has been the subject of careful studies investigating its clinical usefulness. In phase I and II clinical trials dose- and manner of administration-dependent side effects were observed, which considerably limited the use of TNF-alpha in clinical practice. Topical (intratumoral) therapy eliminated most systemic side effects. Synergic antitumor efficacy of TNF-alpha, cytokines, such as interferon-gamma (IFN-gamma) and interleukin-2 (IL-2), and cytostatic drugs (etoposide, cyclophosphamide) was proved.