The position of pulmonary carcinoids within the spectrum of neuroendocrine tumors of the lung and other tissues

Bronchopulmonary carcinoids comprise 25% of all human carcinoids. The World Health Organization divides them into typical (TC) and atypical forms (ATC), distinguished by differences in mitotic counts lower or higher than 2/2 mm(2) and the presence or absence of necrosis. The reproducibility of this classification with respect to the borderline cases with 1-2 mitotic counts/2 mm(2) has been questioned. We have analyzed 15 TCs and 20 ATCs by comparative genomic hybridization. Loss of 11q was the most frequent aberration in ATC (55%), but was observed only twice in TC (13%). Deletions of 3p were seen only in ATC (25%). Meta-analysis of our data and data from 218 neuroendocrine tumors and 50 non-small-cell lung carcinomas obtained from the literature revealed differences between carcinoids and carcinomas. For example, loss of 5q is frequent in lung carcinomas (75%) but is rarely seen in carcinoids (1.4%). Deletions of 11q are less frequent in neuroendocrine lung carcinomas than in ATC. To obtain a more objective survey of the relationship of pulmonary carcinoids to other neuroendocrine tumors and lung carcinomas, we created a hierarchical clustering dendrogram. This statistical approach resulted in a clear separation of carcinoids and carcinomas, which both built up different clusters. In summary, this study demonstrates the benefit of chromosomal analysis supplementary to the diagnosis of bronchopulmonary carcinoids. We also identified the feasibility of hierarchical clustering to get some clues on relationship between different tumor types. This study further argues against a transition of ATC to high-grade neuroendocrine lung carcinoma.     

Escherichia coli biofilm formation and dispersion under hydrodynamic conditions on metal surfaces

The aim of this study was to analyze the impact of hydrodynamic forces on the multiplication of E. coli, and biofilm formation and dispersion. The experiments were provided in a flow chamber simulating a cleaning-in-place system. Biofilm biomass was measured using a crystal violet dye method. The results show that hydrodynamic forces affect not only biofilm formation and dispersion but the multiplication of E. coli in the first place. We found more biofilm biomass on the rough surface than on the smooth one. The results of the biofilm formation test show that laminar flow promotes the biofilm growth over 72 h, meanwhile turbulent flow after 48 h causes decrease in biomass. The results of the biofilm dispersion test, in contrast, show that laminar flow removed less biofilm from both materials that turbulent flow did. Therefore, taking into account these findings in cleaning-in-place technology can substantially reduce E. coli multiplication and biofilm formation.     

Clinical Assessment of Spasticity in People With Spinal Cord Damage: Recommendations From the Ability Network,an International Initiative

A thorough assessment of the extent and severity of spasticity, and its effect on functioning, is central to the effective management of spasticity in persons with spinal cord damage (SCD). These individuals however do not always receive adequate assessment of their spasticity. Inadequate assessment compromises management when the effect of spasticity and/or need for intervention are not fully recognized. Assessment is also central to determining treatment efficacy. A barrier to spasticity assessment has been the lack of consensus on clinical and functional measures suitable for routine clinical practice. To extend on existing work, a working group of the Ability Network identified and consolidated information on possible measures, and then synthesized and formulated findings into practical recommendations for assessing spasticity and its effect on function in persons with SCD. Sixteen clinical and functional measures that have been used for this purpose were identified using a targeted literature review. These were mapped to the relevant domains of the International Classification of Functioning, Disability and Health to assess the breadth of their coverage; coverage of many domains was found to be lacking, suggesting a focus for future work. The advantages, disadvantages, and usefulness of the measures were assessed using a range of criteria, with a focus on usefulness and feasibility in routine clinical practice. Based on this evaluation, a selection of measures suitable for initial and follow-up assessments are recommended. The recommendations are intended to have broad applicability to a variety of health care settings where people with SCD are managed.     

FIVE YEARS AFTER DEVELOPMENT OF THE NATIONAL DISABILITY,HEALTH AND REHABILITATION PLAN FOR UKRAINE: ACHIEVEMENTS AND CHALLENGES

In 2015, technical consultation to support development of the National Disability, Health and Rehabilitation Plan in Ukraine was carried out by the Rehabilitation Advisory Team of the International Society of Physical and Rehabilitation Medicine. Recommendations for actions and projects to improve rehabilitation services within the healthcare system in Ukraine were developed, proposed and implemented. The achievements in the subsequent 5 years include establishing, training and enabling employment at healthcare facilities for new rehabilitation professionals (physical and rehabilitation medicine physicians, physical therapists, occupational therapists), commencing implementation of the International Classification of Functioning, Disability and Health (ICF), and increasing rehabilitation knowledge among Ukrainian communities and decision-makers. The main challenges include inappropriate healthcare legislation for developing modern rehabilitation services, gaps in the clinical environment and quality control for training rehabilitation professionals, and the slow pace of implementation of the ICF. A general facilitator is the ongoing healthcare reform in Ukraine, especially its continuation to secondary and tertiary healthcare levels. Future high-priority activities will include amendments to basic healthcare legislation, and introducing a bio-psycho-social approach for the provision of rehabilitation services at all healthcare levels and all rehabilitation treatment phases, starting with the most debilitating health conditions. It will be important to continue the collaboration with European and international partners. LAY ABSTRACTUkraine developed a National Disability, Health and Rehabilitation Plan (NDHRP) in 2015. Since then, the recommended actions and projects have been implemented in the country. Some achievements can be seen, including the establishment of new rehabilitation professions (i.e. physical and rehabilitation medicine (PRM) physician and ergotherapist (the Ukrainian terminology for occupational therapist); implementation of the International Classification of Functioning, Disability and Health (ICF); and commencement of implementation of rehabilitation at different levels of healthcare. However, some challenges still need to be addressed, including the introduction of legislation to enable the delivery of effective and safe rehabilitation services, continuing education for rehabilitation professionals, and raising awareness of the ICF implementation, which is based on introducing a biopsycho-social model into the entire clinical process of rehabilitation. With the support of international partners, including European PRM bodies and other international organizations, the outlook for improvement in the field of rehabilitation in Ukraine is very positive. Key words: rehabilitation system, rehabilitation service, rehabilitation profession, rehabilitation service situation analysis, Ukraine, National Disability, Health and Rehabilitation Plan

Since Soviet times Ukraine’s healthcare system has retained a healthcare model with centralized funding, financing “for beds at hospitals”, paper medical records, and wide practice of out-of-pocket payments (1). A further problem is the systemic mistranslation and misuse of the term “healthcare” as “medical care”, starting from the level of legislation, and resulting in misunderstanding of healthcare by many generations of healthcare workers and the general public. At the same time, Ukraine had an inherited rehabilitation system, which was based predominantly on a bio-medical model of disability. Existing rehabilitation legislation in Ukraine still only covers populations with a certified disability (the Ukrainian term “invalidity” is assigned after special assessment by the Medical and Social Examination Commissions (MSECs)). The majority of rehabilitation measures focus on compensation of functional deficits and different kinds of social support provided through so-called invalidity groups. Since 2014 the armed conflict in eastern Ukraine has resulted in numerous injuries among military service personnel and civilians, and thus has greatly increased demands for rehabilitation services. For these reasons, the existing system of “medical rehabilitation” has collapsed, and the need for development of the National Disability, Health and Rehabilitation Plan (NDHRP) for Ukraine has become undeniable. The Ukrainian government (in particular the Ministry of Health of Ukraine; MoH) decided to implement the principles of the World Health Organization (WHO) Global Disability Action Plan 2014–2021 (GDAP; 2) by initiating a technical consultation to support development of the NDHRP in Ukraine. This was carried out by the Rehabilitation Advisory Team (RAT) of the International Society of Physical and Rehabilitation Medicine (ISPRM) in 2015 (3). The mission was based on the principles of the United Nations (UN) Convention on the Rights of Persons with Disabilities (4) and the World Report on Disability (WRD; 5). The goalsetting was derived from the WHO GDAP’s “Better Health for All People with Disabilities” (2), and the mission used the specially developed Rehabilitation Service Assessment Tool (RSAT; 6).The main findings from this mission included the absence of essential rehabilitation professionals in the country, a bio-medical approach to rehabilitation delivery, a complete discrepancy in meanings/translations and application of international rehabilitation-related terminology, and a lack of intersectoral coordination between the governing bodies responsible for the provision of rehabilitation services.     

The - 429 T/C and - 374 T/A gene polymorphisms of the receptor of advanced glycation end products gene are not risk factors for diabetic retinopathy in Caucasians with type 2 diabetes

OBJECTIVE: The aim of this study was to look for a relationship between the - 429 T/C and the - 374 T/A gene polymorphisms of the receptor of advanced glycation end products (RAGE) gene and the development of diabetic retinopathy in Caucasians with type 2 diabetes. MATERIALS AND METHODS: One hundred and sixteen subjects with type 2 diabetes and diabetic retinopathy were compared to 70 diabetic subjects without diabetic retinopathy. Additionally, 76 subjects with proliferative diabetic retinopathy (a subgroup of diabetic retinopathy) were compared to 70 diabetic subjects without diabetic retinopathy. RESULTS: The - 429 T/C and the - 374 T/A RAGE gene distributions in patients with diabetic retinopathy (- 429 T/C: CC 0.9%, TC 25.9%, TT 73.2%; - 374 T/A: AA 9.5%, TA 47.4%, TT 43.1%) were not significantly different from those of diabetic subjects without retinopathy (- 429 T/C: CC 0%, TC 25.7%, TT 74.3%; - 374 T/A: AA 15.7%, TA 42.9%, TT 41.4%). Moreover, the - 429 T/C and the - 374 T/A RAGE gene distributions in patients with proliferative diabetic retinopathy were not statistically significantly different from those in diabetic subjects without retinopathy. CONCLUSION: Our study failed to demonstrate an association between either - 429 T/C or - 374 T/A gene polymorphism of the RAGE gene and diabetic retinopathy in Caucasians with type 2 diabetes. Additionally, we failed to demonstrate an association between either - 429 T/C or - 374 T/A gene polymorphism of the RAGE gene and proliferative diabetic retinopathy in Caucasians with type 2 diabetes.     

Glaucoma, ocular hypertension and diabetic retinopathy

71 out of 4803 diabetics attending the special outpatient clinic for diabetic eye complications at the 1st Eye Department of the University of Vienna were found to be suffering from glaucoma. Ocular hypertension was observed in 717 cases. Neither the course of diabetic retinopathy nor the correlation between duration of diabetes mellitus and the manifestation of retinal changes differed from the findings in diabetics with normal ocular pressure. The hypothesis that increased ocular pressure in response to the topical application of steroids might be of beneficial influence on the course of diabetic retinopathy was not confirmed by these observations.