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Pulse wave velocity (PWV) is commonly used for assessing arterial stiffness and it is a useful and accurate cardiovascular mortality predictor. Currently, many techniques and devices for PWV measurement are known, but they are usually expensive and require operator experience. One possible solution for PWV measurement is photoplethysmography (PPG), which is convenient, inexpensive and provides continuous PWV results. The aim of this paper is validation of a new device for PPG sensor-based measurement of multi-site arterial PWV using a SphygmoCor XCEL (as the reference device) according to the recommendations of the Artery Society Guidelines (ASG). In this study, 108 subjects (56 men and 52 women, 20–91 years in 3 required age groups) were enrolled. The multi-site PWV was simultaneous measured by 7 PPG sensors commonly used in pulse oximetry in clinical settings. These sensors were placed on the forehead, and right and left earlobes, fingers and toes. Pulse transit time (PTT) was measured offline as the difference of time delay between two onsets of the pulse wave determined by the intersecting tangent method. The PWV was calculated by dividing the distance between PPG sensors by PTT. During PPG signals measurement, reference carotid to femoral PWV (cfPWV) was performed with a SphygmoCor XCEL system. The Pearson correlation coefficient (r) between the obtained PWV results was calculated. The Bland-Altman method was used to establish the level of agreement between the two devices. Mean difference (md) and standard deviation (SD) were also calculated. The multi-site PWV was highly correlated with accuracy at the ASG-defined level of “Acceptable” (md

Abstract In Poland, no statistical data are available concerning the analysis of the incidence of pneumonia in inpatient children. The requirement for these data results mainly from the need to prepare systemic and economic solutions. Aim This study aimed to use reported data for evaluating pneumonia incidence rates among hospitalised children and other parameters in various age groups. Subject and methods A detailed analysis was performed as part of the Operational Programme Knowledge Education Development co-financed by the European Social Fund. Services reported to the National Health Fund in 2014 were considered, including pneumonia incidence among hospitalised children and mortality in specific age groups. Results In 2014, a total of 68,543 children were hospitalised for pneumonia (68% of all hospitalisations for acute respiratory diseases). Within each of the analysed age groups, boys were hospitalised more frequently. Irrespective of the place of residence, infants were most commonly hospitalised. It was observed that there was a significant difference between the incidence rate of pneumonia among hospitalised children in all analysed groups depending on the province. The average length of stay was 7.29 days, with infants requiring the longest stays (7.96 days), and 1.8% of children were rehospitalised within 30 days due to recurrence of pneumonia. The most commonly coded pathogens responsible for pneumonia included Mycoplasma pneumoniae, Streptococcus pneumoniae and Chlamydia spp. A total of 19 inpatient hospital deaths in the course of pneumonia were reported. Conclusions Based on our findings, it is warranted to utilize epidemiological knowledge for the planning of an appropriate level of service commissioned both in outpatient and inpatient facilities as well as for the estimation of institutional and staff needs necessary to secure these services.

Chronic leg ulceration is a frequent condition in elderly patients. Chronic wounds that are nonresponsive to 3-month therapy affect approximately 6.5 million people in the United States with a prevalence of 1% and costs estimated at 25 billion dollars per year. Although the main causes are venous insufficiency, lower extremity arterial disease and diabetes, in many cases the etiology is multi-factorial. Approximately 20–23% of non-healing wounds that are refractory to vascular intervention have other etiologies including vasculitis, rheumatoid arthritis and Sjögren syndrome. Adverse drug interactions are the least commonly considered, especially those which involve disease-modifying anti-rheumatic drugs. The authors present a report on a female patient with reported Sjögren syndrome, multiple morbidities and non-healing lower limb ulceration that developed during treatment with methotrexate, and no significant improvement after discontinuation of the drug and after vascular surgery. Microvascular deterioration caused by beta-blockers was considered decisive. Calcium-blocker replacement brought complete healing in the follow-up.

Introduction: Statistical data on the structure of acute respiratory diseases incidence in the paediatric population are still scarce. The demand for such data results mainly from the need to constantly implement new systemic and economic solutions. The aim of the study was to attempt to use reported data for an assessment of the incidence of acute respiratory diseases in various age groups. Material and methods: An analysis of selected acute respiratory diseases was conducted in relation to diagnoses reported from 1 January to 31 December 2014 to the National Health Fund (NFZ, Narodowy Fundusz Zdrowia) in accordance with the codes of the International Statistical Classification of Diseases and Related Health Problems, 10th Revision. The study was conducted under the Knowledge Education Development operational programme co-funded by the European Social Fund. Results: A total of 101,000 children were hospitalised due to acute respiratory diseases, which amounted to 1,554 hospitalisa-tions per 100.000. The most common causes of hospitalisation were pneumonia and bronchitis/bronchiolitis. Boys were hospital-ised more often in each age group. The shortest average length of stay (ALOS) was 5.21 days and concerned hospitalisation due to bronchitis. The longest length of stay for children was due to tuberculosis (14.3 days). The highest age average of a child was recorded in pleural diseases (10.51 years) and the lowest in bronchitis (2.93 years). Rehospitalisation was necessary in children in whom tuberculosis or pleural diseases were diagnosed (1.43 vs 1.34). A total of 67 inpatient deaths were recorded, of which 19 were due to pneumonia or its complications. Conclusions: Epidemiological data reported to the National Health Fund (NFZ) seem quite reliable and do not differ significantly from those reported in other European countries. The analysed data may be useful in estimating health needs in paediatrics.

Sarcoidosis is a systemic multisystem inflammatory disease of unknown etiology. The disease is characterized by formation of non-caseating granulomas. The most common presentation is bilateral hilar lymphadenopathy and lung infiltration, but the disease is very heterogeneous, with an unpredictable clinical course. Musculoskeletal manifestations are common. Bone involvement is less frequent, and usually occurs in patients with chronic multisystem course of the disease. They are most commonly found in the phalanges of hands and feet, and are usually bilateral. The skull, long bones, ribs, pelvis, and axial skeleton may also be affected. Osseous involvement may be asymptomatic but in some cases can cause a severe disability. Imaging techniques are important for diagnosis. Radiological investigations revealed sclerotic or destructive lesions (involving also joints), cystic and punched out lesions and cortical abnormalities. Biopsy is required for differential diagnosis with respect to malignancy. Treatment is a part of systemic therapy and is not needed in all cases. Glucocorticoids and TNF-a antagonists are used for management.

Auscultation of the respiratory system – a key system in a human body – is a complicated procedure and it requires a doctor to have good perception skills and profound experience. During auscultation, specific sounds are identified by the doctor who then associates the acoustic phenomena heard with pathological processes. This article is an attempt at developing a classification system, using wavelet packets, a genetic algorithm, and a Support Vector Machine (SVM), which distinguishes between healthy patients and patients with crackles caused by pneumonia, pulmonary fibrosis, Heart Failure (HF) or Chronic Obstructive Pulmonary Disease (COPD). The system is elaborated and tested over a dataset consisting of 62 healthy (166 recordings) and 58 sick patients (187 recordings). A reliable system is described, consisting of 5 wavelet classifiers, featuring approx. 95 % sensitivity and 91 % specificity, applying 10-fold cross-validation.

In October 2016 a new independent disease called sarcopaenia (according to ICD-10 classification) appeared. According to the recommendation of the European Working Group on Sarcopenia in Older People (EWGSOP), sarcopaenia is defined as abnormally low muscle mass plus low skeletal muscle strength or low physical performance. Sarcopaenia, as a primary disease, is mainly observed in older people, but it can also appear in younger adults in the course of many clinical chronic conditions. One of the most frequent chronic diseases associated with chronic inflammation and functional limitation of skeletal system is rheumatoid arthritis. In the present article, current knowledge on the epidemiology of sarcopaenia and its association with rheumatoid arthritis is presented.

Objectives We conducted a study on usefulness of the tuberculin skin test (TST) and the Quantiferon-TB Gold IT (QFT) tests as predictors of radiological changes after contact with tuberculosis. Materials and Methods The study group consisted of TB-exposed HCWs working in the Military Institute of Medicine (Warsaw, Poland). The usefulness of TST, QFT, and a combination of both tests was assessed for prediction of silent radiological findings. Results 83 previously TB-exposed participants were recruited. None of the participants had a history of active tuberculosis. Positive TST results were reported in 72 (86.8 %) participants, and positive QFTs were observed in 27 (32.5 %) cases. Chest radiographs revealed 23 findings specific for non-active tuberculosis in 18 (21.7 %) participants. The results of the QFTs were associated with the highest negative predictive value, positive predictive value, and positive likelihood ratio of silent chest X-ray findings suggestive of latent tuberculosis infection. Positive QFT was the only statistically significant variable that increases the odds ratio (OR–8.3) of the presence of typical of tuberculosis radiological changes in the lung. Conclusion A positive QFT result in an individual with no TB history who was exposed to tuberculosis in the past is associated with a significantly higher risk of clinically silent parenchymal lesions in lungs suggestive of previous tuberculosis.

Introduction For many years, Poland has had a mandatory vaccination program against tuberculosis, which recommended repeated vaccinations from birth to adulthood. Therefore, the clinical value of the tuberculin skin test (TST) in diagnosing latent tuberculosis infection (LTBI) in Poland remains unclear. Objectives We conducted a study on the usefulness of the TST and QuantiFERON®-TB test (QFT) for the evaluation of the prevalence and risk factors of L TBI among Polish health care workers. Patients and methods The study group consisted of the Polish health care workers. TST and QFT were performed in each participant. The usefulness of TST and QFT was tested in relation to occupational risk factors. Results A total of 305 participants were included. A positive TST result was observed in 149 cases (48.9%) and a positive QFT result was observed only in 27 cases (8.9%). In the subgroup that declared contact with tuberculosis (n = 44), positive QFT and TST results were found in 20.5% and 63.3% cases, respectively. Past contact with tuberculosis was the only significant variable associated with a positive TST result. Independent variables associated with positive QFT results were older age, lower education level, longer period of work in health care, and previous contact with tuberculosis. Conclusions The QFT has a higher diagnostic value than the TST in the assessment of LTBI in Polish health care workers.

W pierwszym numerze “Pneumonologii i Alergologii Polskiej” z 2014 roku ukazała się kazuistyczna praca autorstwa Pani mgr Dagmary Borkowskiej i wsp [...]

Summary Purpose Evaluation of relationships between survival time of patients with advanced, non-resectable non-small cell lung cancer (NSCLC) and telomerase activity in aspirates, collected from primary lung tumours, and serum p53 protein levels. Material and methods The study group consisted of 52 patients with advanced (stage IIIB and IV) non-small cell lung cancer. In all of them, transthoracic fine-needle biopsy (TFNB) of focal pulmonary lesion was performed. The aspirates were subjected to telomerase activity by the PCR–ELISA PLUS method and serum levels of p53 protein were determined by the ELISA method. Additionally, clinical advancement of cancer and the time period of survival were assessed in the studied group. Kaplan–Meyer method and Cox analysis were used for statistical evaluation of survival prognosis. Results Increased telomerase activity was observed in 42 (81%) of the patients with non-resectable non-small cell lung cancer. Elevated concentrations of serum p53 protein were found in 28 (54%) of the participants. The following death rates were noted during the entire study period: twenty-three (23) (62%), out of 37 patients with increased telomerase activity, 7 (47%), out of 15 without detectable telomerase activity in primary lung tumour, 16 (57%), out of 28 subjects with increased serum levels of p53 protein and 14 (58%), out of 24 with no increased serum levels of p53. A significant relationship was observed in Cox hazard analysis between the time of survival and telomerase activity, while no such relationship was observed between the survival time period and serum p53 protein levels or sex, age, primary lung tumour size, lymph node status or development of distant metastases. Conclusion Telomerase activity in advanced primary non-small cell lung cancer is a better predictor of patients' survival than serum levels of p53 protein. The assessment of telomerase activity supplements in the prognosis of survival in the course of non-resectable NSCLC.

Acoustocerebrography is a novel, non-invasive, transcranial ultrasonic diagnostic method based on the transmission of multispectral ultrasound signals propagating through the brain tissue. Dedicated signal processing enables the estimation of absorption coefficient, frequency-dependent attenuation, speed of sound and tissue elasticity. Hypertension and atrial fibrillation are well known factors correlated with white matter lesions, intracerebral hemorrhage and cryptogenic stroke numbers. The aim of this study was to compare the acoustocerebrography signal in the brains of asymptomatic atrial fibrillation patients with and without hypertension. The study included 97 asymptomatic patients (40 female and 57 male, age 66.26 ± 6.54 years) who were clinically monitored for atrial fibrillation. The patients were divided into two groups: group I (patients with hypertension) n = 75, and group II (patients without hypertension) n = 22. Phase and amplitude of all spectral components for the received signals from the brain path were extracted and compared to the phase and amplitude of the transmitted pulse. Next, the time of flight and the attenuation of each frequency component were calculated. Additionally, a fast Fourier transformation was performed and its features were extracted. After introducing a machine learning technique, the ROC plot of differentiations between group I and group II with an AUC of 0.958 (sensitivity 0.99 and specificity 0.968) was obtained. It can be assumed that the significant difference in the acoustocerebrography signals in patients with hypertension is due to changes in the brain tissue, and it allows for the differentiating of high-risk patients with asymptomatic atrial fibrillation and hypertension.

Background: Expression of CCR4 ligands, such as thymus and activation-regulated chemokine (TARC) and macrophage-derived chemokine (MDC), leads to preferential influx of T-helper (Th) 2-type lymphocytes to the lesional skin in atopic dermatitis (AD). Eotaxin, like the CCR3 ligand, is an important contributor of eosinophils recruitment in the course of AD. These chemokines are assumed to play an important role in the patomechanism of AD. Methods: In this study, the serum concentration of TARC, MDC, eotaxin and total immunoglobulin E (IgE) in AD patients and healthy people were compared. Correlation between the studied indices and activity of AD was established. Severity of AD was assessed according to the SCORAD score. The study comprised 44 healthy people and 43 patients with AD. The serum concentrations of TARC, MDC, eotaxin and IgE were measured with the use of enzyme-linked immunosorbent assay kits. Results: The serum levels of TARC, MDC, eotaxin and IgE appeared to be significantly higher in patients with AD than in healthy people. A strong positive correlation was revealed between the levels of TARC, MDC, total IgE in serum of patients with AD and SCORAD. In contrast, no significant relationship was found for the serum eotaxin concentration and TARC, MDC, IgE or disease severity. Conclusion: Our findings indicate that TARC and MDC are actively involved in the pathogenesis of AD and their expression, opposite to that of eotaxin, is strongly associated with clinical picture of atopic dermatitis.

The aim of the study was to compare humoral response to influenza vaccinations in healthy people and patients with bronchial asthma or COPD. Ninety-one subjects (20 with COPD, 21 with bronchial asthma and 45 healthy) were vaccinated with a single dose of influenza subunit vaccine. Antibody response to haemagglutinin (HI) and neuraminidase (NI) glycoproteins and pulmonary function were measured before and after vaccination. Influenza-like symptoms and intensity of COPD or asthma complaints after vaccination were also recorded. A significant increase of geometric mean titres of HI and NI antibodies was observed in all three vaccinated groups. No significant differences between the COPD, asthma and healthy groups were observed in mean fold increase of HI and NI antibodies and response rate to vaccination or proportion of subjects with the sufficient protection level of HI. No change in intensity of asthma or COPD symptoms was found. There were no differences between the groups in the proportion of subjects who experienced influenza-like symptoms. The results suggest that in patients with bronchial asthma or COPD humoral response to influenza vaccine and safety of vaccinations are comparable to those in healthy individuals.

Background: Allergen-specific immunotherapy (SIT) is believed to be a valuable remedy in several allergic diseases; however, an accurate immunological marker of the efficacy of this treatment method has not been found yet. Cc-chemokine eotaxin, owing to its selective action on eosinophils, seems to play an important role in the pathophysiology of allergic response. The purpose of this study was to assess the usefulness of eotaxin in monitoring of SIT efficacy in patients with IgE-mediated allergic rhinoconjunctivitis. Methods: One hundred and twenty-two patients with seasonal IgE-mediated allergic rhinoconjunctivitis due to tree- (birch, n = 42; hazel/alder, n = 14) or grass/cereal- (n = 66) pollen received allergen-specific immunotherapy.Serum eotaxin levels were determined four times in every patient, shortly before immunotherapy (Evaluation 0), immediately after the treatment (Evaluation 1), in the height of pollen season (Evaluation 2) and at least 2 weeks after the pollen season (Evaluation 3). Serum eotaxin levels were simultaneously measured in 59 healthy people from the control group. Changes in serum eotaxin levels were assessed in the healthy and allergic groups. Clinical symptoms of IgE-mediated rhinoconjunctivitis were evaluated and compared with serum eotaxin concentration changes. Results: Mean values of eotaxin concentrations in serum during Evaluations 0–3 did not significantly differ in the healthy subjects and the patients with IgE-mediated rhinoconjunctivitis (P > 0.05). Moreover, no statistically significant differences in the serum eotaxin levels between the visits were observed in the patients who received immunotherapy (P > 0.05); however, immediately after immunotherapy (Evaluation 1) the mean serum level of eotaxin was lowest and closest to the serum eotaxin concentration in the control group at the same visit. No significant correlation between the mean value of the serum eotaxin level in the height of pollen season (r = −0.12, P > 0.05) or mean changes of the eotaxin levels between Evaluations 2 and 1 (r = −0.03, P > 0.05), on the one hand, and the cumulative score of symptoms and drug, on the other, were found. Conclusions: The results allow to conclude that although eotaxin plays a significant role in the mechanism of antigen-specific immunotherapy, its serum expression remains a poor marker of SIT efficacy.

Background: A study was undertaken to evaluate the usefulness of telomerase activity assay in transthoracic fine needle biopsy (TFNB) aspirates collected from peripheral tumours of the lung in predicting the malignant aetiology of lung infiltrations. Methods: 100 patients with a peripheral infiltration of the lung underwent TFNB of the focal lesion. The aspirates were subjected to standard cytological evaluation. Telomerase activity in the specimens was determined with the PCR-ELISA PLUS method. The sensitivity, specificity, accuracy and predictive value of TFNB were calculated for cytological examination of aspirates alone and cytological examination with additional telomerase activity assessment. Results: Lung cancer was newly diagnosed in 84 subjects and benign peripheral lesions were found in 16. During the first TFNB, lung cancer was identified in 56 cases of cancer (66.7%) while increased telomerase activity was found in 61 cancer aspirates (72.6%). No subject with a benign infiltration had a false positive result from cytological examination, but in one case (6.25%) increased telomerase activity was observed. The diagnostic sensitivity, accuracy and negative predictive value of the combination of cytological examination and telomerase activity assay in TFNB specimens were significantly higher than for cytological examination alone (89.3% vs 66.7%, p = 0.0004; 90% vs 72%, p = 0.001; 62.5% vs 36.4%, p = 0.039), but a combination of the two examinations was associated with a lower specificity of TFNB (96.9% vs 100%, p = 0.002). Conclusion: Detection of telomerase activity in aspirates taken during TFNB of a peripheral lung infiltration should be considered as an indication of the risk of malignancy in cases with false negative cytological results.

Evaluation of the relationship between telomerase activity in transthoracic fine-needle biopsy (TFNB) aspirates collected from peripheral non-small cell lung cancer (NSCLC), cancer advancement, risk of death and free of cancer recurrence survival.The study group consisted of 93 patients with peripheral infiltration of the lung. All of them had TFNB of the focal pulmonary lesion performed. The aspirates were subjected to standard cytological evaluation. Telomerase activity in the specimens was determined with the PCR-ELISA PLUS method. Cancer advancement, manner of treatment and survival were assessed in patients with NSCLC.A benign lesion of the lung was recognised in 14 cases. NSCLC was newly diagnosed in 79 subjects. Nobody with benign infiltration had a detectable level of telomerase in lung infiltration. Increased telomerase activity was observed in 56 (70.9%) patients with lung cancer. It was significantly more often detected in patients with non-operable NSCLC (clinical stage IIIB plus IV) and patients with distant metastases (stage IV alone). Cox hazard analysis revealed that presence of telomerase activity in primary NSCLC is an independent prognostic factor of survival. Increased telomerase activity in TFNB aspirates was related to 7 times higher relative risk of death during the study [RR=6.9 (CI: 1.8-26.8); p0.05] and 2.5 times higher risk of cancer recurrence after radical treatment [RR=2.5 (CI: 0.3-9.3); p0.05].Telomerase activity in aspirates collected through TFNB of primary peripheral NSCLC could be a helpful independent prognostic factor of distant metastases and risk of death or cancer recurrence.

Dear Editor, An interesting article by Heederik D et al. was published in a recent number of Ann Agric Environ Med. (2014, vol. 21, no 1, 5–10) concerning the relationship between, on the one hand, concentration of soy allergens in the proximity of a factory producing soy oil and intensity of respiratory symptoms, daily changes of peak expiratory flow (PEF) and bronchodilator utilization [1]. The authors tested daily changes of PEF, bronchodilator use and respiratory symptoms in two groups of people: those living in the vicinity of the soy oil factory and habitants living in the control area located about 5 km from the factory. They found positive skin prick tests (SPTs) to common allergens among 81% of participants and positive results of SPTs to soy in 11–12% examined people. The authors concluded that sensitization to soy allergen was not increased among the people living in the proximity of the factory; however, the soy-sensitized individuals living in the surroundings of the factory reported more respiratory symptoms, greater bronchodilator utilization, and lower PEF after having been downwind of the factory. Peak expiratory flow measurements, above all, are a useful method of evaluation of asthma control. Daily variability of PEF of more than 20% can be a symptom of pathological bronchial tree hyperresponsiveness (BHR) and bad asthma control [2]. BHR is an individual feature and is not directly correlated with the concentration of aeroallergens. Among people with allergic rhinoconjunctivitis and without bronchial asthma and/or BHR, the daily variability of PEF could be slight and may be comprised in the normal value for healthy people. The authors found positive results of allergic skin prick tests in the majority of participants from both groups (81%). Unfortunately, they did not report the percentage of people with asthma in both groups. This is important information, insofar as, for example, a higher incidence of bronchial asthma and BHR among participants from the study group may have influence on the greater variability of PEF, respiratory symptoms and bronchodilator consumption. Additionally, on the other hand, the lack of people with bronchial asthma in the control group could result in small daily PEF changes, scant other symptoms. It is also worth considering the smoking status of the participants in the statistical analysis. In the study group, the percentage of current smokers was higher than in the control; obviously, tobacco addiction has a significant influence on bronchial hyperresponsiveness and value of spirometric function tests [3].

BACKGROUND: One of the most promising markers of allergic inflammation is eotaxin, which has a selective influence on the migration of eosinophils. Its serum content significantly correlates with the intensity of allergic symptoms, so it might be interesting to know whether vaccination has any influence on serum expression of this chemokine. AIMS: Comparison of the humoral response to influenza vaccine and post-vaccination changes in the serum eotaxin level in patients with allergic bronchial asthma and healthy controls. METHODS: Forty-two asthmatics and 45 healthy individuals were vaccinated with a single dose of influenza subunit vaccine (Influvac). The serum eotaxin level and the antibody response to haemagglutinin (HI) and neuraminidase (NI) glycoproteins were measured before and after vaccination. RESULTS: A significant increase of geometric mean titres of HI and NI was observed in both groups. There were no significant differences between the groups in meanfold increase of HI and NI titres, response rate and protective level of HI. After vaccination, a significant decrease of the mean serum eotaxin value was observed in patients with asthma (149.4 +/- 71.0 versus 125.1 +/- 67.0, p= 0.0017), while no similar effect was present in healthy individuals (153.4 +/- 56.9 versus 159.3 +/- 54.4, p= 0.5). CONCLUSIONS: The results indicate that in patients with allergic bronchial asthma influenza vaccinations assure efficient protective antibody level and modulate the serum level of eotaxin.