Head trauma in sports - clinical characteristics, epidemiology and biomarkers.

Traumatic brain injury (TBI) is clinically divided into a spectrum of severities, with mild TBI being the least severe form and a frequent occurrence in contact sports, such as ice hockey, American football, rugby, horse riding and boxing. Mild TBI is caused by blunt nonpenetrating head trauma that causes movement of the brain and stretching and tearing of axons, with diffuse axonal injury being a central pathogenic mechanism. Mild TBI is in principle synonymous with concussion; both have similar criteria in which the most important elements are acute alteration or loss of consciousness and/or post-traumatic amnesia following head trauma and no apparent brain changes on standard neuroimaging. Symptoms in mild TBI are highly variable and there are no validated imaging or fluid biomarkers to determine whether or not a patient with a normal computerized tomography scan of the brain has neuronal damage. Mild TBI typically resolves within a few weeks but 10-15% of concussion patients develop postconcussive syndrome. Repetitive mild TBI, which is frequent in contact sports, is a risk factor for a complicated recovery process. This overview paper discusses the relationships between repetitive head impacts in contact sports, mild TBI and chronic neurological symptoms. What are these conditions, how common are they, how are they linked and can they be objectified using imaging or fluid-based biomarkers? It gives an update on the current state of research on these questions with a specific focus on clinical characteristics, epidemiology and biomarkers.

Cystatin C concentration is correlated with disease activity in rheumatoid arthritis patients.

OBJECTIVES: Rheumatoid arthritis (RA) is a systemic, inflammatory disease. Renal involvement worsens the course of RA and increases mortality. It is suggested that chronic inflammatory processes may contribute to renal impairment. The aim of this study was to investigate the impact of chronic inflammation and RA activity on glomerular filtration rate (GFR). METHODS: The study population consisted of 140 RA patients. High disease activity was observed in 42 patients (30%), and long-term RA (duration ≥ 10 years) in 64 (45.7%). Measures of renal function included: serum cystatin C, serum creatinine (SCr), and creatinine-based estimated GFR (eGFR) calculated by Cockcroft and Gault (CG) and Modification of Diet in Renal Disease (MDRD) formulas. RESULTS: The mean (SD) cystatin C concentration was 0.77 (0.2) mg/L, SCr 0.71 (0.23) mg/dL, eGFR(CG) 110.5 (37.8) mL/min/1.73 m², and eGFR(MDRD) 109.5 (34.5) mL/min/1.73 m². Cystatin C levels correlated positively with creatinine, and negatively with eGFR(CG) and eGFR(MDRD). Cystatin C concentration was significantly higher in patients with high disease activity, long-term RA, and hypertension, and in males. Patients currently being treated with biologics had non-significantly lower cystatin C levels than those treated with conventional modifying drugs. Cystatin C levels were significantly associated with markers of clinical, functional disease activity, and markers of inflammation. By contrast, there were no such correlations with other parameters of renal function. CONCLUSIONS: In patients with RA, cystatin C may be not only an indicator of GFR but also a marker of intensity of chronic inflammatory processes.

Seasonal patterns of traumatic brain injury deaths due to traffic-related incidents in the Slovak Republic.

Objective: Traumatic Brain Injuries (TBIs) are an important type of injury in terms of both morbidity and mortality. Road Traffic Incidents are one of the most frequent causes of TBI. This analysis seeks to quantify the number of such injuries occurring in the Slovak Republic, and examine patterns of TBI according to mode of transport and seasonality.Methods: Data concerning total numbers of TBIs occurring from the years 1996-2015 were obtained from the Statistical Office of the Slovak Republic. The events caused by road incidents were examined separately according the external cause stated on death certification. Events were classified into seasons according to the month of death. Summary statistics were produced concerning numbers of deaths according to sex, mode of transport and season. Analyses were performed to examine trends in TBI by season and type of road user.Results: During a period of 20 years from 1996, there were 17,047 recorded deaths involving TBI in the Slovak Republic. Of these, 5,370 were caused by road traffic incidents (RTIs). Age standardized rates tended to decrease from 8.3/100,000/year (1996) to 2.5/100,000/year (2015). Males made up approximately 79% of road traffic-caused TBIs. Summer and autumn showed significantly more events than any other season, with motorcyclists and cyclists in particular being more frequently injured at this time of year.Conclusions: The results show that Slovakia, like many countries, suffers a considerable burden of TBI and that RTIs are a major contributor to this, especially among young adults. Rates of TBI vary by season in Slovakia, and users of different modes of transport appear more or less likely to suffer such injury during different seasons. Considerable variability in rates of injury exists between road users and times of year. Improved understanding of the timing and sufferers of injuries may allow better planning of response and care services. Further research into transport modes and policies aimed at safer driving should be explored.

TrkA mediates developmental sympathetic neuron survival in vivo by silencing an ongoing p75NTR-mediated death signal.

Developmental sympathetic neuron death is determined by functional interactions between the TrkA/NGF receptor and the p75 neurotrophin receptor (p75NTR). A key question is whether p75NTR promotes apoptosis by directly inhibiting or modulating TrkA activity, or by stimulating cell death independently of TrkA. Here we provide evidence for the latter model. Specifically, experiments presented here demonstrate that the presence or absence of p75NTR does not alter Trk activity or NGF- and NT-3-mediated downstream survival signaling in primary neurons. Crosses of p75NTR-/- and TrkA-/- mice indicate that the coincident absence of p75NTR substantially rescues TrkA-/- sympathetic neurons from developmental death in vivo. Thus, p75NTR induces death regardless of the presence or absence of TrkA expression. These data therefore support a model where developing sympathetic neurons are "destined to die" by an ongoing p75NTR-mediated apoptotic signal, and one of the major ways that TrkA promotes neuronal survival is by silencing this ongoing death signal.

The p75 neurotrophin receptor mediates neuronal apoptosis and is essential for naturally occurring sympathetic neuron death.

To determine whether the p75 neurotrophin receptor (p75NTR) plays a role in naturally occurring neuronal death, we examined neonatal sympathetic neurons that express both the TrkA tyrosine kinase receptor and p75NTR. When sympathetic neuron survival is maintained with low quantities of NGF or KCl, the neurotrophin brain-derived neurotrophic factor (BDNF), which does not activate Trk receptors on sympathetic neurons, causes neuronal apoptosis and increased phosphorylation of c-jun. Function-blocking antibody studies indicate that this apoptosis is due to BDNF-mediated activation of p75NTR. To determine the physiological relevance of these culture findings, we examined sympathetic neurons in BDNF-/- and p75NTR-/- mice. In BDNF-/- mice, sympathetic neuron number is increased relative to BDNF+/+ littermates, and in p75NTR-/- mice, the normal period of sympathetic neuron death does not occur, with neuronal attrition occurring later in life. This deficit in apoptosis is intrinsic to sympathetic neurons, since cultured p75NTR-/- neurons die more slowly than do their wild-type counterparts. Together, these data indicate that p75NTR can signal to mediate apoptosis, and that this mechanism is essential for naturally occurring sympathetic neuron death.

Socioeconomic predictors of smoking behaviour among school-aged children, in the Slovakia.

OBJECTIVE: The aim of this study was to describe the relationship between smoking habits and socioeconomic determinants among adolescents. BACKGROUND: Tobacco use among young people is a formidable social health concern. The aim of this paper is to describe the situation in selected localities surveyed, and to elucidate the relations among experiments with tobacco in adolescent youth and behaviour of parents, friends and teachers and media influence. Thd objectives of this study are to describe patterns of self-reported smoking and to describe the association of trying smoking with other variables, such as social, or socio-demographics among a sample of young students. METHODS: Global Youth Tobacco Survey to track tobacco use among youth across countries using a common methodology and core questionnaire. In Slovakia, GYTS was carried out at the turn of 2002 to 2003. A total of 4.594 students participated in the study. RESULTS: The results indicate that the majority of the students (74.3%) have tried smoking where both parents are smokers. We found that gender, parents', friends' and teachers' smoking had a significant influence on whether the children ever tried smoking. A parent who smokes was found as a strong significant predictor for trying smoking in the group of students [OR = 1.6 (1.39-1.92)]. CONCLUSION: Predictors of smoking behaviour include parents', teachers' and friends' smoking. Public health interventions aim at conducting effective health promotion programs tailored to specific population groups and known predictors should be central to the design of such endeavours (Tab. 5, Ref. 18).

Clinical characteristics of Polish patients with ANCA-associated vasculitides-retrospective analysis of POLVAS registry.

OBJECTIVE: Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitides (AAV) are rare small to medium-size vessel systemic diseases. As their clinical picture, organ involvement, and factors influencing outcome may differ between countries and geographical areas, we decided to describe a large cohort of Polish AAV patients coming from several referral centers-members of the Scientific Consortium of the Polish Vasculitis Registry (POLVAS). METHODS: We conducted a systematic multicenter retrospective study of adult patients diagnosed with AAV between Jan 1990 and Dec 2016 to analyze their clinical picture, organ involvement, and factors influencing outcome. Patients were enrolled to the study by nine centers (14 clinical wards) from seven Voivodeships populated by 22.3 mln inhabitants (58.2% of the Polish population). RESULTS: Participating centers included 625 AAV patients into the registry. Their distribution was as follows: 417 patients (66.7%) with GPA, 106 (17.0%) with MPA, and 102 (16.3%) with EGPA. Male-to-female ratios were almost 1:1 for GPA (210/207) and MPA (54/52), but EGPA was twice more frequent among women (34/68). Clinical manifestations and organ involvement were analyzed by clinical phenotype. Their clinical manifestations seem very similar to other European countries, but interestingly, men with GPA appeared to follow a more severe course than the women. Fifty five patients died. In GPA, two variables were significantly associated with death: permanent renal replacement therapy (PRRT) and respiratory involvement (univariate analysis). In multivariate analysis, PRRT (OR = 5.3; 95% confidence interval (CI) = 2.3-12.2), respiratory involvement (OR = 3.2; 95% CI = 1.06-9.7), and, in addition, age > 65 (OR = 2.6; 95% CI = 1.05-6.6) were independently associated with death. In MPA, also three variables were observed to be independent predictors of death: PRRT (OR = 5.7; 95% CI = 1.3-25.5), skin involvement (OR = 4.4; 95% CI = 1.02-19.6), and age > 65 (OR = 6.3; 95% CI = 1.18-33.7). CONCLUSIONS: In this first multicenter retrospective study of the Polish AAV patients, we have shown that their demographic characteristics, disease manifestations, and predictors of fatal outcome follow the same pattern as those from other European countries, with men possibly suffering from more severe course of the disease.

On the use of biochemical markers in diagnostics of sudden cardiac death.

INTRODUCTION: Medical examiners frequently examine victims of sudden death. Most often sudden deaths have a cardiovascular cause. determine the diagnosis of sudden cardiac death based only on morphological findings may be often very difficult. Measurement of blood concentrations of cardiac troponin I (cTnl) and atrial natriuretic peptide (pro-ANP) is now in clinical use in adult patients with heart failure caused by myocardial damage. AIM: The aim of the study was the estimation wheather cTnl and/or pro-ANP could be markers of sudden cardiac death. PATIENTS AND METHODS: The study was carried out on 89 necroptic cases, of which 53 were concluded as cardiac-related sudden death, and 36 cases were used as a control group being other than cardiac death cases. Concentrations of markers were determined in blood taken from the left cardiac ventricle and from the right femoral vein. The dependence between the results of biochemical studies and death causes, results of histopathological examination of myocardium, time interval between the death and taking of samples, and resuscitation data was investigated. RESULTS: Concentrations of cTnl as determined in blood samples from the left ventricle were in most cases very high, largely exceeding the cut-off level, and so were concentrations of pro-ANP. The values of both parameters were significantly lower in peripheral blood. No statistically significant dependences were found between the levels of the studied markers and the cause of death, myocardial histopathological findings, time interval between the death and taking of samples, and resuscitation data. CONCLUSION: Based on the results obtained, the study can be concluded that blood is not a suitable medium for determination of biochemical markers of cardial troponin I and atrial natriuretic peptide for post-mortem diagnostics of myocardial damage and for determining the diagnosis of sudden cardiac death in a manner similar to diagnostics of myocardium damage in living patients.

The use of halloysite functionalized with isothiouronium salts as an organic/inorganic hybrid adsorbent for uranium(VI) ions removal.

Elimination of U(VI) from nuclear wastes and from the underground water near the uranium mines is the serious problem. Therefore search for new sorbents for U(VI) is still a big challenge for the scientists. This paper investigates of U(VI) ions sorption on halloysite modified with the isothiouronium salts: S-dodecaneisothiouronium bromide (ligand 1), S,S'-dodecane-1,12-diylbis(isothiouronium bromide) (ligand 2), S-hexadecaneisothiouronium chloride (ligand 3), S,S'-naphthalene-1,4-diylbis(methylisothiouronium) dichloride (ligand 4), and S,S'-2,5-dimethylbenzene-1,4-diylbis(methylisothiouronium) dichloride (ligand 5). It was established that halloysite modified by the ligands with four nitrogen atoms in their structure (ligand-5, 2 and 4) was characterized by higher sorption capacity compared with that modified by the ligands with two donor nitrogens (ligand-1 and 3). The maximum sorption capacity of halloysite-5 toward U(VI) was 157 mg U/g and this places the modified mineral among the most effective sorbents for U(VI) removal from wastes. As follows from ATR, XPS and thermal degradation spectra of the sorption products [R-S-C(NH)(NH2)]n = 1-2(UO22+) complexes are formed on the external surface of the halloysite whereas oligomeric hydroxy complexes (UO2)3(OH)5+ and (UO2)4(OH)7+ are present in the interior of halloysite structure and interact predominantly with aluminols.

Tetrad effect in the adsorption of the lanthanides on zeolite Y.

The adsorption of the lanthanides (except for Pm) on the zeolite Y was investigated under various solution conditions of nitrate ion concentration ([NO(-)(3)]: 0.001-2 mol/dm(3)) and total lanthanide concentration (from 0.0001 to 0.001 mol/dm(3)). The solutions of the lanthanide nitrates were equilibrated with the zeolite samples at 296 K. The concentrations of lanthanides in the initial and equilibrium solutions were determined by means of spectrophotometrical method with Arsenazo III reagent and distribution constants K(d) of the lanthanides between aqueous and zeolite phases were calculated. The evident concave tetrad effect in the change of logK(d) values (nitrate concentrations 0.4-2 mol/dm(3)) within the lanthanide series was noticed and an attempt at its explanation through the comparison of covalence in LnO bonds existing in triple bond AlO(1/3Ln)Si triple bond species in the zeolite phase and in Ln(NO(3))(2+) complexes forming in the aqueous phase was presented. The weak convex tetrad effect for equilibrium nitrate concentrations 0.001-0.32 mol/dm(3), manifesting in the change of logK(d) values and in the alteration of logK (adsorption constants), is evidence of the complexation of the tripositive lanthanide ions by the oxygens originating both from water molecules and from the zeolite framework.

Evidence of repair of DNA damage induced by 4-hydroxyaminoquinoline 1-oxide in guinea pig pancreatic slices in vitro.

In vitro exposure of guinea pig pancreatic slices to 4-hydroxyaminoquinoline 1-oxide (HAQO) resulted in increased [methyl-3H]thymidine ([3H]TdR) incorporation into DNA, both in the presence and absence of hydroxyurea (HU). Normal DNA replicative synthesis, but not DNA repair synthesis, was suppressed by HU. The increase in [3H]TdR incorporation into DNA damage induced by HAQO. Exposure of pancreatic slices to 10(-6) to 10(-5) M concentrations of HAQO did not significantly increase thymidine incorporation; however, a 15-min exposure to 10(-4) M HAQO induced a significant increase in HU-insensitive [3H]TdR incorporation into DNA. Kinetics of [3H]TdR incorporation suggests that most of the DNA repair synthesis occurs during the 2 hr following HAQO-induced DNA damage.

Management and outcome of traumatic epidural hematoma in 41 infants and children from a single center.

BACKGROUND: Traumatic brain injury (TBI) is a frequent cause of mortality and acquired neurological impairment in children. HYPOTHESIS: We hypothese that due to adequate treatment of EDH in children and adolescence excellent clinical and functional outcome can be reached. PURPOSE: To evaluate retrospectively our treatment process of EDH and to elucidate the relationship between trauma mechanism, injury pattern, radiological presentation, subsequent therapy and functional outcome. PATIENTS AND METHODS: Hundred and twenty infants and children with traumatic brain injuries (TBI) were treated between 1992 and 2009 at a single level-one trauma center. Data regarding accident, treatment and outcomes were collected retrospectively. To classify the outcomes the Glasgow Outcome Scale (GOS) scores at hospital discharge and at follow-up visits were used. EDH was classified according to the Rotterdam score. RESULTS: Finally, 41 cases were diagnosed with an EDH and therefore included in our study. Twenty-one cases were treated surgically; however of these in 11 patients delayed surgery was necessary. Twenty patients were treated conservatively. Two patients (5%) died within 24hours, 39 patients (95%) survived. One of the operatively treated patients (2%) presented in a vegetative state, another one had severe disability, and however, 32 patients (78%) showed good recovery at latest follow-up. DISCUSSION: Age, severity of TBI, and neurological status were the main factors influencing outcome after TBI due to acute EDH. We found that immediate as well as delayed surgical evacuation of EDH resulted in excellent outcomes in most cases. Conservative treatment was started in 76% of our cases - however needing in 35% delayed surgical intervention. Overall in all groups excellent final clinical and neurological outcomes could be reached.

The impact of body mass index on severity, patterns and outcomes after traumatic brain injuries caused by low level falls.

PURPOSE: Low level falls are a common cause of traumatic brain injuries (TBI) and are associated with significant mortality and disability. The aim of this study was to analyse whether BMI, height and weight of patients were related to severity, patterns and outcomes of TBI caused by low level falls. METHODS: Data on patients with TBI where cause of injury was a low level fall (fall < 3 m) with known body mass index (BMI) (N = 683) were analysed. Patients were categorized into underweight, normal, pre-obese and obese based on BMI and demographic characteristics, injury severity, patterns and outcomes were compared. In addition, physiological status, comorbidities and length of hospitalization were analysed in a subset of patients where this information was available. RESULTS: The median BMI was 25.6. About 1/10 of patients were obese. The mean age and proportion of male sex of patients was increasing with increasing BMI. The patients in all BMI groups were of similar injury severity and neurological status. There was also no difference in mortality and functional outcome based on patient's BMI. Obese and pre-obese patients required longer stay at ICU and in hospital. CONCLUSION: We found no associations between BMI and severity or outcome of TBI caused by low level falls. More detailed data and further studies are needed to fully elucidate these complex relationships.

Rate of Staphylococcus aureus nasal carriage in immunocompromised patients receiving haemodialysis treatment.

Specimens from the nose and throat were collected from 28 long-term haemodialysed patients. Staphylococcus aureus strains were isolated from sixteen patients who been on haemodialysis for over 113 months. Cytokine levels, as well as full blood cell differential counts and cell surface antigens were determined in these patients. The serum concentration of TGF-beta was significantly higher in patients carrying Staphylococcus aureus. CD14 and HLA-DR molecule expression on monocytes, as well as NK cell percentage was significantly different in S. aureus carriers. Our preliminary results suggest that immune status imbalance in haemodialysed patients could be related to the high incidence of S. aureus nasal carriage and infections.

Kinetics of continuous ambulatory peritoneal dialysis (CAPD) with four exchanges per day.

Fourteen patients who had no signs of peritonitis were studied during CAPD. Different exchange time schedules were used alternating exchanges with 1.5% and 2.6% glucose solutions. Usually longer exchanges followed shorter ones and vice versa. Total exchange time varied from 2--10 hours. Maximal ultrafiltration volumes were observed after 3 hours with 1.5% and 5 hours wit 2.6% glucose solutions. For small molecular weight solutes (urea, creatinine, sodium, potassium, and phosphate) dialyzate to plasma concentration ratios tended to be lower with 2.6% glucose solutions during the shorter exchanges. Equilibrium between plasma and dialyzate was attained for all these solutes by 10 hours total exchange time. The concentration ratios for inulin were similar with both types of solution, and did not achieve equilibrium by 10 hours. Protein concentrations and losses were higher with 2.6% glucose solution. Total protein and immunoglobulin losses per 24 hours were markedly lower than those reported for intermittent peritoneal dialysis. White blood cell counts increased slightly up to 5 hours and then remained constant up to 10 hours. Mononuclear cell counts were consistently higher than those of granulocytes. The efficiency of dialysis was not markedly influenced by uneven distribution of total exchange time. If 1.5% and 2.6% glucose solutions were used for particular time schedules, slightly higher dialysis efficiency could be obtained by using hyperosmolar solutions for the longer exchanges. Ultrafiltration volumes, protein and immunoglobulin losses, cell counts in dialyzate, and clearance of inulin varied among individual patients. Protein losses correlated positively with serum protein concentration and the body surface area of the patient. Clearances of insulin also correlated with body surface area but ultrafiltration volumes did not.

Plasma erythropoietin level and iron reserves in haemodialysis patients with and without acquired cystic kidney disease.

Concentration of erythropoietin (Epo) and iron reserves (IR) belong to the essential factors determining erythropoiesis in haemodialysis patients. Patients on dialysis with acquired kidney disease (ACKD+) can control anaemia better than patients without acquired kidney disease (ACKD-). Therefore we decided to check if plasma Epo levels and IR differ significantly in both groups of patients. Forty chronically haemodialyzed patients after ultrasound diagnosis were divided into 18 patients (45%) with ACKD+ and 22 (55%) without ACKD-. In both groups of patients we compared their plasma levels of Epo and IR. Plasma erythropoietin and ferritin levels were measured by enzymatic immunoassay. Iron reserves were estimated by the formula: IR = 400 x [ln (ferritin)-ln (50)]. In the ACKD+ group 72% of patients and in the ACKD- group 32% of patients did not require rHu Epo therapy. Plasma levels of erythropoietin and iron reserves did not differ significantly between ACKD+ and ACKD- patients. There must be also other factors than erythropoietin levels and iron reserves regulating erythropoiesis in these patients.

Relationship between some prognostic markers of HD patients and serum erythropoietin, insulin-like growth factor-1, leptin, parathormone and testosterone.

Iseki et al. [1] have shown that serum levels of albumin (Alb), creatinine (Cr) and BMI are significant predictors of death in haemodialyzed patients (HD pts). In our study we decided to assess the relationship between the levels of Alb, Cr, BMI and substances which have a known metabolic effect on nutritional status in HD pts: endogenous erythropoietin (Epo), insulin-like growth factor-1 (IGF-1), leptin (Lep), parathormone (PTH), and testosterone. The study was conducted in 53 (28M, 25F) stable HD pts. Serum levels of endogenous Epo and PTH were estimated by CLIA; IGF-1, Lep, testosterone, sex hormone binding globulin were estimated by RIA. The multiple regression analysis was done between Alb, Cr, BMI and Epo, IGF-1, PTH and Lep for all HD pts together and free androgen index (FAI) for men and women separately. Correlations: the level of serum albumin did not correlate significantly with any of the measured substances. Serum creatinine level significantly correlated only with the level of IGF-1 (p=0.02), BMI was significantly correlated with serum endogenous Epo (p<0.01), leptin (p=0.004) and FAI (p<0.005) both in men and women. We concluded that the higher concentrations of endogenous Epo, IGF-1 and testosterone could be correlated with a better prognosis in HD patients.

Influence of intraperitoneal gentamicin on peritoneal transport in IPD patients.

We have investigated the effect of intraperitoneal gentamicin on dialysis efficiency in 10 intermittent peritoneal dialysis (IPD) patients. The following parameters were measured: net ultrafiltration (UF); concentration ratios (D/P) of urea, creatinine, potassium; peritoneal clearances (ml/min) of urea, creatinine, potassium; mass transfer of sodium (MTNa); sodium sieving index (SCNa). It has been found that gentamicin significantly decreased D/P urea (p < 0.056) and D/P creatinine (p < 0.05). We found also a significant decrease of mean clearances of urea (p < 0.05) and creatinine (p < 0.05). The mean clearance of potassium did not significantly change. There was no significant change in UF, MTNa and SCNa. Our preliminary data suggest that gentamicin decreases the permeability of the peritoneum for certain low molecules in IPD patients, which may have a negative impact on dialysis efficiency.

Changes of endogenous erythropoietin level and iron status during a 30-month hemodialysis treatment of a group of patients.

In our earlier paper we found that among 50 hemodialysis patients (HD pts) 48% (24 pts) control anemia with hemoglobin (Hb) concentration >9.5 g/dl and hematocrit (Hct) >30% without recombinant human erythropoietin (rHuEpo) therapy. These HD pts had significantly higher mean endogenous erythropoietin (eEpo) level and lower iron reserves (IR) than HD pts who need rHuEpo therapy. The aim of this study was to judge whether the possibility to control anemia in pts not requiring rHuEpo therapy changes during a 30-month HD treatment. Serum eEpo and ferritin were measured every 6 months. After 30 months of HD treatment 18 pts remained in this group--5 pts died, 1 underwent transplantation. During the study period 4/18 pts permanently had a very low level of eEpo (under detection limit), 7/18 had the level of eEpo within normal range for healthy control, 7/18 pts had a high level of eEpo (up to 3 times higher than the mean for healthy control). Pts who had the highest level of eEpo had the lowest IR. After 30 months IR were significantly lower than at the beginning of observation (292 +/- 87 vs 143 +/- 127 mg). Important negative correlation between eEpo and IR was observed throughout the whole period of study: r = -0.4820, p < 0.02 at the start of the study, and r = -0.6126, p < 0.007 after 30 months of treatment. The study shows that the possibility to control anemia in pts not treated with rHuEpo did not change significantly during 30 months of HD treatment. Endogenous Epo level in HD pts not treated with rHuEpo varied between different pts: it was permanently low in some pts, permanently high in others and stayed normal in remaining pts.

Influence of some immune factors on the IL-6 and soluble IL-2 receptors in haemodialysed patients.

In respect to the immune deficiency state of long-term haemodialysed patients, both cytokines and their receptor disturbances have been taken into consideration. The purpose of our study was to evaluate the effect of uraemic and haemodialysis factors on the interleukin-6 and interleukin-2 soluble receptor levels and the reactivity after influenza vaccination. We have found that IL-6 and IL-2 receptor levels were statistically significantly elevated (98.8 +/- 39 pg/ml and 1557 +/- 544 U/ml, respectively) in serum of haemodialysed patients. The fact that increased immune complexes statistically correlated with soluble IL-2 receptor levels (p < 0.01) was very interesting for us. In order to study the immunological response after vaccination, 10 patients have been investigated after influenza vaccination. Plasma samples were collected before, as well as 1 and 4 weeks after vaccine administration. Antibody titres measured by haemagglutinin inhibition showed decreased antibody levels in haemodialysed patients. We conclude that the interleukin disturbance and the elevated interleukin-2 receptor levels together with the presence of circulating immune complexes can influence in some way the immune response of haemodialysed patients.