Immunological findings in cigarette smokers

The aim of our study was to assess the effects of cigarette smoking on selected indices of immunity. The study comprised 116 men divided into three groups: 37 subjects smoking for not more than 10 yr, 39 subjects smoking for more than 10 yr, and control group consisting of 40 age-matched men who never used to smoke. The following parameters were studied: total number of lymphocytes, B-cells, T-cells subpopulations: (CD3+)T-, (CD4+)T-helper, (CD8+)T-cytotoxic and (CD16+)natural killer (NK)-cells and serum concentration of immunoglobulins A, D, G and M, C3c and C4 complement components, acute phase proteins: alpha(1)-acid glycoprotein, haptoglobin, ceruloplasmin and lysozyme. The (CD4+)/(CD8+) ratio was also calculated. The suppressive effect of tobacco smoke on human immunity was seen as decreased serum concentration of immunoglobulins and lysozyme, especially in men smoking for more than 10 yr, decreased (CD16+)NK-cells absolute number and elevated population of (CD8+)T-cytotoxic lymphocytes entailing a decrease in CD4+/CD8+ ratio.     

Emergence of Klebsiella pneumoniae coproducing KPC-2 and 16S rRNA methylase ArmA in Poland

A Klebsiella pneumoniae epidemic strain that coproduced carbapenemase KPC-2 (K. pneumoniae carbapenemase 2) and 16S rRNA methylase ArmA has emerged in Poland. Four nonduplicate isolates from patients in a hospital in Warsaw, Poland, were found to carry the bla(KPC-2) and armA genes on ca. 50-kb and 90-kb plasmids, respectively. Tn4401 with a 100-bp deletion in the variable region was detected in all the isolates. XbaI pulsed-field gel electrophoresis (PFGE) revealed 93.2% similarity of the isolates. All the isolates were resistant to carbapenems and 4,6-disubstituted 2-deoxystreptamines.     

Forphenicinol enhances the antitumor effects of cyclophosphamide in a model of squamous cell carcinoma

We examined the interaction between forphenicinol (FPL) and cyclophosphamide (CPA) or ionizing radiation (IR) on the growth of murine squamous cell carcinoma tumors SCCVII. Primary tumors were established in C3H mice by injecting SCCVII tumor cells subcutaneously into the right hind limb. FPL (100 mg/kg for 8 days) and/or CPA (25 mg/kg twice) were administered by intraperitoneal injection. Tumors were irradiated to a total dose of 40 Gy (eight 5-Gy fractions). SCCVII tumor growth was inhibited by FPL (P=0.054), IR (P=0.003) and CPA (P<0.001) compared with control. The combination of FPL and CPA inhibited tumor growth additively compared with either treatment alone in both small- and large-volume tumors. FPL did not significantly enhance the antitumor effects of IR, however, when CPA+FPL were combined with IR, significant tumor growth inhibition was observed compared with FPL alone (P<0.001), CPA alone (P=0.002) and IR alone (P=0.002). Due to its low toxicity profile, FPL may be combined with CPA, IR and other cytotoxic therapies to potentially enhance the therapeutic ratio.     

An increase in non-toxigenic Corynebacterium diphtheriae infections in Poland — molecular epidemiology and antimicrobial susceptibility of strains isolated from past outbreaks and those currently circulating in Poland

ObjectivesAn increase in non-toxigenic Corynebacterium diphtheriae infections – mainly invasive infections – has been observed in countries with high vaccination coverage. However, reasons for this situation are unknown. In this study we characterized and compared human clinical isolates of non-toxigenic C. diphtheriae strains isolated from infections that have occurred over recent years and C. diphtheriae strains isolated from diphtheria cases from past outbreaks in Poland.MethodsWe determined biotypes, genotypes, the occurrence of plasmids, and antimicrobial susceptibilities of 19 clinical C. diphtheriae strains. Genotypes were determined using pulsed-field gel electrophoresis (PFGE) and enterobacterial repetitive intergenic consensus polymerase chain reaction (ERIC-PCR) techniques.ResultsThe non-toxigenic C. diphtheriae strains isolated over the last few years were found to belong to biotype gravis and were genetically indistinguishable using PFGE and ERIC-PCR techniques. No plasmids were detected in the strains. All tested strains were susceptible to penicillin and erythromycin, as well as to imipenem, vancomycin, daptomycin, gentamicin, tetracycline, clindamycin, trimethoprim/sulfamethoxazole, rifampin, quinupristin/dalfopristin, and linezolid. Of the strains tested, 47% were intermediate for cefotaxime.ConclusionsThe genetic similarity of non-toxigenic C. diphtheriae strains causing infection suggests that the strains represent a single clone. They may possess additional virulence genes in a chromosome, related with higher pathogenicity and invasiveness. The genetic changes have not been followed by resistance to antibiotics.     

Calcanisation of tibia using Ilizarov fixator in crush injuries of hindfoot: a new method

Crush injuries of the foot are one of the most difficult and challenging tasks for a trauma surgeon to manage in terms of limb salvage and provision of a painless functional foot. Injuries to the foot, especially the hindfoot, account for almost 24.6% of all the warfare injuries in Afghanistan, of which more than 70% end in amputation for various reasons. We devised a method using the principles of Ilizarov's distraction osteosynthesis to salvage limbs with bony defects in the hindfoot which otherwise were candidates for amputation. The procedure is done in two stages. Initially, the ring fixator is applied for the soft tissue reconstruction and infection control, and the next stage consists of percutaneous "inverted L"-shaped osteotomy in the posterior half of the lower tibia. The study included 32 patients with hindfoot crush injuries involving talus, calcaneum, a combination of both, or even involving the adjacent tarsal bones. All these crush injuries were classified using the Gustilo and Anderson classification. The postoperative functional assessment of the feet was done using the Maryland Foot Score system with a minimum follow-up of four years. We had good results in 53%, fair in 34% and failure in 13% of our cases. The complications of this procedure were the same as with the use of the ring fixator elsewhere in the body. This method provides a technique to salvage the foot and produce a painless, stable, fused foot in one of the most difficult settings of a hindfoot crush injury.     

18F-FLT and 18F-FDOPA PET kinetics in recurrent brain tumors

Purpose

In this study, kinetic parameters of the cellular proliferation tracer ¹⁸F-3′-deoxy-3′-fluoro-l-thymidine (FLT) and the amino acid probe 3,4-dihydroxy-6-¹⁸F-fluoro-l-phenylalanine (FDOPA) were measured before and early after the start of therapy, and were used to predict the overall survival (OS) of patients with recurrent malignant glioma using multiple linear regression (MLR) analysis.

Methods

High-grade recurrent brain tumors in 21 patients (11 men and 10 women, age range 26 – 76 years) were investigated. Each patient had three dynamic PET studies with each probe: at baseline and after 2 and 6 weeks from the start of treatment. Treatment consisted of biweekly cycles of bevacizumab (an angiogenesis inhibitor) and irinotecan (a chemotherapeutic agent). For each study, about 3.5 mCi of FLT (or FDOPA) was administered intravenously and dynamic PET images were acquired for 1 h (or 35 min for FDOPA). A total of 126 PET scans were analyzed. A three-compartment, two-tissue model was applied to estimate tumor FLT and FDOPA kinetic rate constants using a metabolite- and partial volume-corrected input function. MLR analysis was used to model OS as a function of FLT and FDOPA kinetic parameters for each of the three studies as well as their relative changes between studies. An exhaustive search of MLR models using three or fewer predictor variables was performed to find the best models.

Results

Kinetic parameters from FLT were more predictive of OS than those from FDOPA. The three-predictor MLR model derived using information from both probes (adjusted R ²?=?0.83) fitted the OS data better than that derived using information from FDOPA alone (adjusted R ²?=?0.41), but was only marginally different from that derived using information from FLT alone (adjusted R ²?=?0.82). Standardized uptake values (either from FLT alone, FDOPA alone, or both together) gave inferior predictive results (best adjusted R ²?=?0.25).

Conclusion

For recurrent malignant glioma treated with bevacizumab and irinotecan, FLT kinetic parameters obtained early after the start of treatment (absolute values and their associated changes) can provide sufficient information to predict OS with reasonable confidence using MLR. The slight increase in accuracy for predicting OS with a combination of FLT and FDOPA PET information may not warrant the additional acquisition of FDOPA PET for therapy monitoring in patients with recurrent glioma.