The EXPOLIS study: implications for exposure research and environmental policy in Europe

Exposure analysis is a crucial part of effective management of public health risks caused by pollutants and chemicals in our environment. During the last decades, more data required for exposure analysis has become available, but the need for direct population based measurements of exposures is still clear. The current work (i) describes the European EXPOLIS study, designed to produce this kind of exposure data for major air pollutants in Europe, and the database created to make the collected data available for researchers (ii) reviews the exposure analysis conducted and results published so far using these data and (iii) discusses the implications of the results from the point of view of research and environmental policy in Europe. Fine particle (with 37 elements and black smoke), nitrogen dioxide, volatile organic compounds (30 compounds) and carbon monoxide inhalation exposures and exposure-related questionnaire data were measured in seven European cities during 1996-2000. The EXPOLIS database has been used for exposure analysis of these pollutants for 4 years now and results have been published in approximately 30 peer-reviewed journal papers, demonstrating the versatility, usability and scientific value of such a data set. The multipollutant exposure data from the same subjects in the random population samples allows for analyses of the determinants, microenvironments and sources of exposures to multipollutant mixtures and associations between the different air pollutants. This information is necessary and useful for developing effective policies and control strategies for healthier environment.     

Echinococcus multilocularis: An Emerging Pathogen in Hungary and Central Eastern Europe?

Echinococcus multilocularis, the causative agent of human alveolar echinococcosis, is reported for the first time in Red Foxes (Vulpes vulpes) in Hungary. This parasite may be spreading eastward because the population of foxes has increased as a consequence of human interventions, and this spread may result in the emergence of alveolar echinococcosis in Central Eastern Europe.     

Reactive microglia in aging and dementia: an immunohistochemical study of postmortem human brain tissue

Significantly increased up-regulation of HLA DR (major histocompatibility complex class II antigen) was seen using immunohistochemistry in postmortem brain tissue from demented patients with Alzheimer’s disease (AD) (73 cases, 61 females/12 males, mean age 84 ± 9 years) compared to controls (22 cases, 10 females/12 males, mean age 78 ± 9 years). The counts of HLA DR-expressing activated microglia were significantly higher in female AD patients compared to males, significantly higher in AD patients with the age at death greater than 75 years compared to those dying younger and higher, although not statistically significantly, in AD patients with the apolipoprotein E (ApoE) ɛ4 allele compared to those patients not carrying this allele. In contrast to the situation in AD patients, in the control cases the HLA DR expression was higher in males compared to females. Furthermore, in the very old non-demented patients (age at death > 80 years), a decrease in the up-regulation of HLA DR expression was observed. A significant correlation between activated microglia and neurofibrillary tangles was seen in female AD patients compared to males, in AD cases without ApoE ɛ4 allele compared to those with this allele, in sporadic cases compared to familial and in cases with senile rather than presenile onset of the disease. Our results indicate that there is an age- and/or sex-related variability in up-regulation of HLA DR expression of microglia and that the linkage between this up-regulation and AD lesions is significantly influenced by the ApoE ɛ4 allele, gender of subjects, age at onset and familiality of the disease. Received: 20 May 1998 / Revised: 5 August 1998, 4 October 1998 / Accepted: 21 October 1998     

Melkersson-rosenthal syndrome

Melkersson - Rosenthal syndrome was described by Melkersson and Rosenthal separately in the year 1928 and 1931 respectively. It is supposed to be a rare syndrome of bilateral alternating recurrent facial paralysis alongwith fissured tongue and oedema of the lips, face and eyelids. A case of Melkersson - Rosenthal syndrome is reported with all the classic findings which is a rarity. In this case there was alternating facial paralysis to begin with followed by bilateral paralysis third time, along with oedema of lips and face, fissured tongue, and dialation of sig-moid colon with absence of haustrations.     

Net reclassification index at event rate: properties and relationships

The net reclassification improvement (NRI) is an attractively simple summary measure quantifying improvement in performance because of addition of new risk marker(s) to a prediction model. Originally proposed for settings with well‐established classification thresholds, it quickly extended into applications with no thresholds in common use. Here we aim to explore properties of the NRI at event rate. We express this NRI as a difference in performance measures for the new versus old model and show that the quantity underlying this difference is related to several global as well as decision analytic measures of model performance. It maximizes the relative utility (standardized net benefit) across all classification thresholds and can be viewed as the Kolmogorov–Smirnov distance between the distributions of risk among events and non‐events. It can be expressed as a special case of the continuous NRI, measuring reclassification from the ‘null’ model with no predictors. It is also a criterion based on the value of information and quantifies the reduction in expected regret for a given regret function, casting the NRI at event rate as a measure of incremental reduction in expected regret. More generally, we find it informative to present plots of standardized net benefit/relative utility for the new versus old model across the domain of classification thresholds. Then, these plots can be summarized with their maximum values, and the increment in model performance can be described by the NRI at event rate. We provide theoretical examples and a clinical application on the evaluation of prognostic biomarkers for atrial fibrillation. Copyright © 2016 John Wiley & Sons, Ltd.