CD105 and placental growth factor--potent prognostic factors in childhood acute lymphoblastic leukaemia

The studies aimed at identifying a prognostic significance of angiogenesis-related factors: CD105 and placental growth factor (PlGF) in a course of acute lymphoblastic leukaemia (ALL). Research protocol was based on detection of RNA and protein expressions in bone marrow blasts using quantitative PCR and immunocytochemical assays respectively. Kaplan-Meier statistics revealed CD105 and PlGF expression as managed separately do not correlate with relapse-free time in ALL patients. On the other hand, an associated analysis of CD105 and PlGF demonstrated a significantly shorter progression-free time in children who were CD105+ and PlGF+ or CD105- and PlGF+ at the moment of ALL diagnosis.     

Usefulness of the antisense and triplex anti-IGF-1 techniques for postoperative cellular gene therapy of malignant gliomas expressing IGF-1

BACKGROUND AND PURPOSE: The aim of the study was to estimate the usefulness of the antineoplastic vaccination in treatment of malignant brain tumors. According to medical knowledge there is no cure for this kind of tumors. MATERIAL AND METHODS: Between 2001 and 2005, ten patients suffering from malignant glial tumors were treated. There were 5 male and 5 female individuals, aged from 17 to 76 (mean age: 40.8 years). The histopathological examination showed 4 cases of glioblastoma and 6 cases of anaplastic astrocytoma. Initially, patients were operated on with dissection of 1 cm(3) of the most representative part of tumor. The neoplasm cells were cultured, transfected with episomal pMT EP vector (expressing alternatively oligonucleotide sequence forming triple helix with IGF-I gene or antisense against IGF-1 mRNA), re-cultured, irradiated and resuspended in medium to prepare antineoplastic vaccine. The patients were vaccinated subcutaneously. We examined peripheral blood lymphocyte subsets to assess the immunological response of the patients. RESULTS: We observed prolongation of the survival time to 21.7 months compared to 9-11 months observed in literature. The patients were additionally treated oncologically with radiotherapy and chemotherapy (temozolomide) according to the reasonable indications. Therefore, the comprehensive assessment of the genotherapy as the supplemental monotherapy was impossible. CONCLUSIONS: The method of treatment used in this study prolongs the survival time of patients with high-grade gliomas of the central nervous system. This gene therapy needs further investigations as a method of oncological monotherapy of brain malignant gliomas.     

Estimation of patient eligibility for thrombolysis in acute ischaemic stroke based on a hospital stroke registry in Warsaw

BACKGROUND AND PURPOSE: Thrombolysis for acute ischaemic stoke was introduced and licensed in Poland in 2003. The aim of the study was to assess the potential eligibility of patients for intravenous recombinant tissue plasminogen activator (rt-PA). We also investigated whether widespread information about stroke and organisational changes in the 2nd Department of Neurology influenced eligibility and the number of treated patients. MATERIALS AND METHODS: An analysis of the 2nd Department of Neurology of the Institute of Psychiatry and Neurology database of stroke patients admitted in the years 1995-2003 and 2003-2005 was performed. Eligibility for rt-PA treatment was assessed using the criteria outlined by the SITS (Safe Implementation of Thrombolysis in Stroke) protocol. The number of patients eligible for thrombolysis was estimated and then compared with the number of treated patients. RESULTS: A total of 1541 patients with ischaemic stroke were admitted between 1 June 1995 and 1 November 2003, 18.7% within 2 hours of onset, 78% aged under 80. 4.6% of patients were found eligible for rt-PA. 552 ischaemic stroke patients were admitted between 1 November 2003 and 30 September 2005, 19.2% within 2 hours from onset, 71.6% under 80 years old. 6.9% were eligible for rt-PA, and 8.6% were treated. CONCLUSION: Age and time from onset to admission were the most common exclusion criteria. The number of actually treated patients was higher than estimated. After providing the information about stroke symptoms there was a trend in decreasing time from onset to admission. Organizational changes increased the number of treated patients.     

Functional imaging in movement disorders

Parkinsonian syndromes in the early stage are often misdiagnosed in the general practice. Neuroimaging brings information about changes in the anatomical structure of the brain, which are not typical of movement disorders. The introduction of a functional imaging with the use of presynaptic tracers of the dopaminergic system enables proving nigrostriatal degeneration and supporting the clinical diagnosis of Parkinsonism even in the early phase of the disease. Availability of the single photon emission computer tomography (SPECT) imaging in the nuclear medicine departments gives an opportunity to introduce this neuroimaging method in Poland. In this review we present methods of functional imaging of the brain, particularly of the dopaminergic pathway with the use of SPECT tracers. The role of functional imaging in movement disorders workup for the neurologist is discussed.     

An evaluation of the accessibility of early post-stroke comprehensive rehabilitation in Poland

BACKGROUND AND PURPOSE: According to the European Stroke Initiative recommendations every stroke patient should undergo rehabilitation; its program should be tailored according to the individual needs of the patient. The aim of our study was to evaluate the accessibility of comprehensive early stroke rehabilitation at neurological departments in Poland. MATERIALS AND METHODS: We have sent a questionnaire evaluating neurological and rehabilitation departments in Poland, where stroke patients are treated and undergo early rehabilitation. We divided them into 5 categories -- classes from A to F: class A -- having comprehensive rehabilitation (kinesitherapy minimum 60 minutes/day, speech therapy minimum 30 minutes for 5 days a week and rehabilitation of other cognitive impairments and group kinesitherapy at rehabilitation departments); B -- having the possibility of all types of therapy, but is done less frequently; C -- kinesitherapy and speech therapy; D -- kinesitherapy and cognitive rehabilitation; E -- only kinesitherapy. We also separated neurological departments without trained rehabilitation staff. RESULTS: We obtained responses from 191 of 215 (88.8%) neurological departments. According to criteria: 26 class A, 38 class B, 50 class C, 2 class D, 73 class E, 2 without specialized rehabilitation staff. We received filled questionnaires from 115 of 172 (66.9%) rehabilitation departments. According to criteria: 11 class A, 31 class B, 28 class C, 4 class D and 41 class E. CONCLUSION: Only 14% of all neurological departments and 10% of rehabilitation departments administered comprehensive early stroke rehabilitation in Poland. Improvement of comprehensive rehabilitation accessibility in Poland is necessary for lowering the number of disabled post-stroke patients.     

Prostate Cancer Mortality Reduction by Prostate-Specific Antigen–Based Screening Adjusted for Nonattendance and Contamination in the European Randomised Study of Screening for Prostate Cancer (ERSPC)

Background

Prostate-specific antigen (PSA) based screening for prostate cancer (PCa) has been shown to reduce prostate specific mortality by 20% in an intention to screen (ITS) analysis in a randomised trial (European Randomised Study of Screening for Prostate Cancer [ERSPC]). This effect may be diluted by nonattendance in men randomised to the screening arm and contamination in men randomised to the control arm.

Objective

To assess the magnitude of the PCa-specific mortality reduction after adjustment for nonattendance and contamination.

Design, setting, and participants

We analysed the occurrence of PCa deaths during an average follow-up of 9 yr in 162 243 men 55–69 yr of age randomised in seven participating centres of the ERSPC. Centres were also grouped according to the type of randomisation (ie, before or after informed written consent).

Intervention

Nonattendance was defined as nonattending the initial screening round in ERSPC. The estimate of contamination was based on PSA use in controls in ERSPC Rotterdam.

Measurements

Relative risks (RRs) with 95% confidence intervals (CIs) were compared between an ITS analysis and analyses adjusting for nonattendance and contamination using a statistical method developed for this purpose.

Results and limitations

In the ITS analysis, the RR of PCa death in men allocated to the intervention arm relative to the control arm was 0.80 (95% CI, 0.68–0.96). Adjustment for nonattendance resulted in a RR of 0.73 (95% CI, 0.58–0.93), and additional adjustment for contamination using two different estimates led to estimated reductions of 0.69 (95% CI, 0.51–0.92) to 0.71 (95% CI, 0.55–0.93), respectively. Contamination data were obtained through extrapolation of single-centre data. No heterogeneity was found between the groups of centres.

Conclusions

PSA screening reduces the risk of dying of PCa by up to 31% in men actually screened. This benefit should be weighed against a degree of overdiagnosis and overtreatment inherent in PCa screening.     

Elevated D-dimer concentration identifies patients with incomplete recanalization of pulmonary artery thromboemboli despite 6 months anticoagulation after the first episode of acute pulmonary embolism

BACKGROUND: Despite long-term anticoagulation in some patients after acute pulmonary embolism (APE) pulmonary thrombi are not completely resolved. We hypothesized that elevated D-dimer concentration reflecting increased endogenous fibrinolysis may indicate incomplete pulmonary thrombi resolution after the first episode of PE. METHODS: 55 patients aged 54.7+/-18.6 years were anticoagulated for 6 months with acenocumarol (74.5% patients) or low molecular weight heparin (25.5% patients) when control spiral computed tomography (sCT), lung perfusion scintigraphy and D-dimer assessment were performed. RESULTS: Incomplete recanalization of pulmonary circulation was found in 39 (70.9%) patients - thrombi at sCT and/or > or =1 wedge-shaped perfusion defect at scintigraphy. Age, sex, rate of unprovoked APE, malignancies, thrombolysis in the acute phase and type of long-term anticoagulation were similar in patients without and with complete recanalization. D-dimer at follow-up but not on admission was higher in patients with then without incomplete recanalization (median 340 (80-2280) vs 160 (60-390) ng/mL, p=0.02). All 11 (20%) patients with D-dimer level >500 ng/mL at follow-up did not resolve thromboemboli completely. ROC analysis showed that D-dimer at follow-up identified patients with incomplete recanalization (AUC 0.709, 95% CI (0.560-0.831), p=0.007). Multivariable analysis confirmed that D-dimer >350 ng/mL at follow-up and right ventricle dysfunction at the diagnosis were independent predictors of incomplete recanalization (OR 18.58 (95% CI 1.97-175.19) and 7.03 (95% CI 1.43-34.6), respectively, p=0.0006). CONCLUSION: Elevated D-dimer after 6 months anticoagulation and right ventricular dysfunction at the diagnosis predict incomplete recanalization of pulmonary circulation after first episode of APE.