Thoracic osteophyte as a cause of symptomatic greater splanchnic nerve compression. Case report.

Thoracic osteophytes are a common feature of degenerative spine disease. However, it is rare that osteophytes overgrowth on the anterior surface of thoracic spine results in the compression of vital structures and causes symptoms. A 39-year old man with a two-year history of thoracic and upper abdominal pain was admitted to the neurosurgery ward after having been seen by several specialists. Thoracic spine MRI and CT scans were analyzed. Osteophytes were identified on the anterolateral right side at level T8-T9 and were indicated as a possible cause of the symptoms. After obtaining patient consent, surgery was performed with transthoracic access to the anterolateral surface of the spine. Intraoperatively, the greater splanchnic nerve was released by osteophyte removal. The patient reported improvement of the preoperative symptoms at the six-month and two-year follow-up visit. Postoperative MRI indicated complete osteophyte excision. To the best of our knowledge, this is the first report of symptomatic sympathetic trunk branch compression by thoracic osteophytes.

Oxidative stress reduction related to the efficacy of n-3 polyunsaturated fatty acids in first episode schizophrenia: Secondary outcome analysis of the OFFER randomized trial.

Intervention studies of n-3 polyunsaturated fatty acids (n-3 PUFA) as add-on therapy in patients with schizophrenia have not examined changes in oxidative stress. A randomized placebo-controlled trial of a 26-week intervention composed of 2.2g/day of n-3 PUFA was found to reduce symptom severity in first-episode schizophrenia patients. The present study is an extension of our previous report, whose secondary aim was to assess the association between the clinical effect of n-3 PUFA and changes in oxidative stress indices. Seventy-one patients aged 16-35 were enrolled in the study and randomly assigned to the study arms. Total plasma antioxidant capacity and 8-epi-isoprostane F2α content were assessed at baseline and at weeks 8 and 26 of the study as secondary outcome measures. Significant changes in oxidative stress indices favouring the intervention group were observed: decreases in 8-isoprostane F2α (p<0.001) and increases in total plasma antioxidant capacity (p<0.001). Significant correlations between changes in clinical scores relevant to symptom severity and changes in oxidative indices were observed. The results of the present study hence suggest that the efficacy of a six-month intervention with n-3 PUFA observed in first-episode schizophrenia may be related to improvement in oxidative stress indices.

The association between polyunsaturated fatty acid consumption and the transition to psychosis in ultra-high risk individuals.

PUFA deficiencies in cellular membranes have been observed in ultra-high risk (HR) individuals and in early schizophrenia. It is uncertain whether dietary PUFA consumption can be associated with the risk of transition to psychosis in HR individuals. The aim of the study was to assess PUFA consumption and confirm whether dietary habits are related to the risk of transition to full-threshold psychosis in HR individuals during a 12-month follow-up. PUFA consumption during the previous year was analyzed in 62 h individuals and 33 healthy controls (HC) at the beginning of the follow-up period using a validated Food-Frequency Questionnaire and the Polish Food Composition Tables. Fifteen HR individuals converted into psychosis (C-HR) during the 12-month follow-up. C-HR individuals reported significantly higher consumption of n-6 fatty acids (linoleic acid, LA and arachidonic acid, AA) in comparison with individuals who did not develop psychosis (NC-HR). The C-HR group reported a significantly higher AA/(EPA+DHA) consumption ratio than the NC-HR group. HC reported significantly higher consumption of most n-3 PUFA and lower consumption of all n-6 PUFA than both groups of HR individuals. The results suggest that dietary patterns of PUFA consumption may play a role in the conversion to psychosis of HR individuals.

Hepatitis C virus 5' untranslated region variability correlates with treatment outcome.

Hepatitis C virus (HCV) variability affects viral-host interactions. We analysed HCV 5'untranslated region (5'UTR) in sera and peripheral blood mononuclear cells (PBMC) from chronic hepatitis C patients undergoing antiviral treatment. We studied 139 patients treated with pegylated interferon and ribavirin. The primary endpoint was a sustained virological response (SVR) defined as negative HCV RNA level 24 weeks after the end of therapy. 5'UTR was analysed by single-strand conformational polymorphism (SSCP) and sequencing. The pretreatment SSCP pattern in serum and PBMC differed in 26 (18.7%) patients. During therapy, the SSCP pattern remained stable in 65 (60.8%) patients, number of bands declined in 16 (15.0%), and in 18 (16.8%) patients, changes were qualified as 'shift' indicating change in band positions. In univariate analysis, there was a significant (P ≤ 0.05) positive association between SVR and pretreatment serum and PBMC dissimilarities, initial viral load <10(6) IU/mL, IL-28B CC genotype of the rs12979860 single nucleotide polymorphism and change in the SSCP band pattern (either 'shift' or decline) In multivariable analysis, only low initial viral load, IL-28B genotype, and changes in the SSCP band pattern were independent factors associated with SVR. In conclusion, stability of 5'UTR correlated with infection persistence, while changes correlated with SVR.

Seronegative hepatitis C virus infection in patients with lymphoproliferative disorders.

It has been reported that hepatitis C virus (HCV) RNA may be present in serum and/or lymphoid cells in the absence of specific circulating antibodies. The current study analysed seronegative HCV infection in patients with lymphoproliferative disorders. We studied 77 anti-HCV-negative patients (45 male and 32 female, mean age 54.8 ± 14.2 years) with various lymphoproliferative disorders. HCV-RNA was detected by RT-PCR in plasma, peripheral blood mononuclear cells (PBMC) and bone marrow. Furthermore, the presence of viral nonstructural protein 3 (NS3) was determined in PBMC and bone marrow by immunostaining. HCV-RNA was detectable in at least one compartment in 27 (35.1%) patients. Viral RNA was found in bone marrow in 22 patients (28.6%), in PBMC in 13 (16.9%) and in plasma in 10 (13%) patients. In nine patients, evidence of infection was confined to the bone marrow compartment. Viral load in HCV-RNA-positive plasma ranged from 15 to 1.17 × 10(3) IU/mL. NS3 was detected in all but two HCV-RNA-positive bone marrow samples and in all but one HCV-RNA-positive PBMC samples. All 27 HCV-RNA-positive patients remained anti-HCV-negative when tested again after 6-12 months, but only four remained HCV-RNA positive. In conclusion, among patients with lymphoproliferative disorders, HCV can be present in plasma, PBMC and bone marrow despite the lack of circulating specific antibodies. Further studies are required to analyse the phenomenon of seronegative infection and to determine whether such patients are infectious.

Variability of hepatitis C virus hypervariable region 1 (HVR-1) during the early phase of pegylated interferon and ribavirin therapy.

PURPOSE: Genetic variability of hepatitis C virus (HCV) is considered to be an important factor defining viral pathogenesis, persistence and resistance to treatment. The aim of the present study was to characterize HCV genetic heterogeneity within a hypervariable region 1 (HVR-1) before and during the early period of pegylated interferon alfa (PEG-IFN-α) and ribavirin treatment in correlation with treatment outcome. MATERIAL AND METHODS: The study involved 24 patients treated with PEG-IFN-α and ribavirin whose sera were collected before (baseline) and at 7, 14, 21 28 and 56 day of treatment. HCV HVR-1 region was amplified by nested RT- PCR and subjected to SSCP (single strand conformational polymorphism) analysis. SSCP changes of HCV HVR-1 over time in each patient were compared to treatment outcome results. RESULTS: In 2/11 (18%) SVR+ and 8/13 (62%) SVR- treated patients, HVR-1 genetic changes manifested by new SSCP bands (new genetic variants) and were significantly more frequent in nonresponders (P <0.05). CONCLUSIONS: Our results indicate that HCV HVR-1 variability during the early phase of PEG-IFN-α and ribavirin therapy may be predictive of treatment outcome.

Medium-term temporal stability of the helminth component community structure in bank voles (Clethrionomys glareolus) from the Mazury Lake District region of Poland.

The structure of helminth communities in wild rodents is subject to seasonal variation, and is dependent on host age within years. Although between-year variation has been monitored, seldom has it been assessed rigorously by appropriate multifactorial analysis with potentially confounding factors taken into account. In this study we tested the null hypothesis that despite seasonal, host age and sex effects, helminth communities should show relative stability between years. Over a period of 3 years (1998-2000) we sampled bank vole (Clethrionomys glareolus) populations (total n = 250) at 2 points in the year: in spring, at the start of the breeding season, and in autumn, after the cessation of breeding. In spite of seasonal differences and strong age effects, the between-year effects were surprisingly small. Measures of component community structure (Berger-Parker dominance index, the dominant species, S. petrusewiczi) did not vary, or varied only slightly from year to year. The majority of measures of infracommunity structure [Brillouin's index of diversity, prevalence of all helminths combined, prevalence and abundance of H. mixtum (the most prevalent helminth), mean species richness] did not differ significantly between years when other factors such as age, sex and seasonal variation had been taken into account. Some between-year variations were found (at the component community level, Simpson's index of diversity; at the infracommunity level, prevalence and abundance of S. petrusewiczi and abundance of all helminths combined), but even these were modest in comparison to seasonal and age differences, and were primarily attributable to S. petrusewiczi. We conclude that despite dynamic within-year fluctuations, helminth communities in bank voles in this region of Poland show relative stability across years. The sporadic occurrence of individual platyhelminths at low prevalence, makes little difference to the overall structure, which is largely maintained by the key roles played by the dominant intestinal nematodes of bank voles and the rarer species collectively.

Factors affecting the component community structure of haemoparasites in common voles ( Microtus arvalis) from the Mazury Lake District region of Poland.

The prevalence and abundance of infections with haemoparasites were studied over a 4-year period in Microtus arvalis (common vole, n =321) sampled from fallow grassland sites in north-eastern Poland. Total species richness was five (prevalence= Haemobartonella sp. 63.9%, Bartonella spp. 27.7%, Babesia microti 9.0%, Trypanosoma sp. 8.4% and and Hepatozoon lavieri 3.1%) with 76.9% of the voles carrying at least one species and a mean infracommunity species richness of 1.1. Variation in species richness was determined primarily by season and year, the interaction of these factors, and that of year with host age. The observed frequency distribution of infracommunity species richness did not differ from that predicted by a null model, suggesting that there were no marked associations between the species. Analyses of prevalence and abundance of infection with each species in turn, revealed that overall the principal causes of variation were temporal and seasonal, their interaction, and interactions with intrinsic factors (age and sex), the latter playing only a minor role in their own right. However, the relative importance of these combinations varied and was distinct for each of the species in the study. Prevalence data revealed eight sets of two- and three-way associations between species, mostly dependent to some extent on one of the intrinsic and extrinsic factors in the model. Analysis of quantitative associations suggested two sets of positive two-way interactions, none of which remained after controlling for the effect of extrinsic and intrinsic factors on the abundance of each species. These data are discussed in the context of the changing ecological profiles in this region of Eastern Europe and, in a wider context, in relation to current understanding of the factors that shape component community structures of haemoparasites in wild rodents.

Prevalence and abundance of Cryptosporidium parvum and giardia spp. in wild rural rodents from the Mazury Lake District region of Poland.

Prevalence and abundance of Cryptosporodium parvum and Giardia spp. were studied in 3 species of rodents from forests and abandoned agricultural fields in N.E. Poland (Clethrionomys glareolus n = 459; Microtus arvalis n = 274; Apodemus flavicollis n = 209). Overall prevalence was consistently higher in the voles compared with A. flavicollis (70.6, 73.0 and 27.8% respectively for C. parvum and 93.9, 96.3 and 48.3% respectively for Giardia spp.). Prevalence and abundance of infection also varied markedly across 3 years with 1998 being a year of higher prevalence and abundance with both species. Fewer older animals (especially C. glareolus and M. arvalis) carried infection with C. parvum and infections in these animals were relatively milder. Although seasonal differences were significant, no consistent pattern of changes was apparent. Host sex did not influence prevalence or abundance of infection with C. parvum, but made a small contribution to a 4-way interaction (in 5-way ANOVA) with other factors in the case of Giardia spp. The 2 species co-occurred significantly and in animals carrying both parasites there was a highly significant positive correlation between abundance of infection with each, even with between-year, seasonal, host age, sex and species differences taken into account. Quantitative associations were confined to the 2 vole species in the study. These results are discussed in relation to the importance of wild rodents as reservoir hosts and sources of infection for local human communities.

Factors affecting the component community structure of haemoparasites in bank voles (Clethrionomys glareolus) from the Mazury Lake District region of Poland.

The prevalence and abundance of infections with haemoparasites were studied over a 3 year period in Clethrionomys glareolus (bank vole, n = 420) sampled from forests in the NE of Poland. Total species richness was 5 (Prevalence = Haemobartonella sp. 63.1%, Bartonella grahamii 27.4%, Hepatozoon erhardovae 31.4%, Trypanosoma evotomys 15% and Babesia microti 1.0%) with 81.9% of the voles carrying at least 1 species and a mean infracommunity species richness of 1.4. Variation in species richness was determined primarily by season and year, and the interaction of these factors. The observed frequency distribution of infracommunity species richness did not differ from that predicted by a null model, suggesting that there were no marked associations between the species. Analyses of prevalence and abundance of infection with each species in turn, revealed that overall the principal causes of variation were temporal and seasonal and their interaction, intrinsic factors such as age and sex playing only a minor role. However, the relative importance of specific extrinsic, and rarely intrinsic, factors varied and was distinct for each of the species in the study. Prevalence data revealed 4 sets of 2-way associations between species, mostly varyingly dependent on combinations of intrinsic and extrinsic factors. Analysis of quantitative associations suggested 4 sets of positive 2-way interactions, 3 of which remained after controlling for the effect of extrinsic and intrinsic factors on the abundance of each species, but only one could be unequivocally accepted (Haemobartonella sp. +B. grahamii) after correction for multiple comparisons. These data are discussed in the context of the changing ecological profiles in this region of Eastern Europe and, in a wider context, in relation to current understanding of the factors which shape component community structures of haemoparasites in wild rodents.

[Co-infection of Borrelia garinii and B. afzelii in a population of wild rodents from woodland]. / Wspólwystepowanie Borrelia garinii i B. afzelii wsród populacji gryzoni lesnych.

The maintenance of Borrelia burgdorferi s.l. in the environment is dependent on the zoonotic cycle involving tick vectors and certain reservoir hosts. It is well known, that the same species of wild rodents, as well as the vector Ixodes ricinus, are often co-infected with at least two genomospecies of B. burgdorferi s.l.: B. afzelii and B. garinii. The ticks collected from two rodent species: Clethrionomys glareolus and Apodemus flavicollis were examined for the presence of B. burgdorferi s.l., as well as for B. garinii and B. afzelii. In this study, an immunofluorescent antibody assay (IFA) and polymerase chain reaction (PCR) protocols were used. The high level of infestation in rodents (90% for C. glareolus and nearly 100% for A. flavicollis) shows that wild rodents are important hosts of the immature stages of I. ricinus. A high percent of Borrelia positive ticks collected from bank voles and yellow necked mice; above 7% determined by IFA and 2% determined by PCR, clearly revealed that these species of animals are competent zoonotic reservoirs of B. burgdorferi s.l.

Prevalence of IgG antibodies response to Borrelia burgdorferi s.l. in populations of wild rodents from Mazury lakes district region of Poland.

Three rodent species: Clethrionomys glareolus, Apodemus flavicollis and Microtus arvalis from Mazury Lakes District of Poland were examined for antibodies to Borrelia burgdorferi by enzyme-labelled protein G assay (ELGA). C. glareolus had an exceptionally high prevalence of B. burgdorferi antibodies - 58%, but A. flavicollis and M. arvalis also showed significant prevalence of 16.6% and 10.5%, respectively. The ELGA method is highly specific with good reproducibility. Nevertheless, some differences of sensitivity of assessed samples were season dependent. However, high seroprevalence did not coincide with infestation rates of examined rodents by I. ricinus ticks. The results indicated that in Mazury Lakes District, naturally infected rodents play an important role as an animal reservoir host for B. burgdorferi, and these animals may increase the risk of human infections in some habitats used as recreation areas. Also, this study shows that ELGA method based on the affinity of protein G for IgG of wild animals may be widely used to determine the competent zoonotic reservoir of B. burgdorferi.