Chronic, acute and protocol-dependent effects of exercise on psycho-physiological health during long-term isolation and confinement.

Exercise could prevent physical and psychological deteriorations, especially during pandemic times of lock-down scenarios and social isolation. But to meet both, the common exercise protocols require optimization based on holistic investigations and with respect to underlying processes. This study aimed to explore individual chronic and acute effects of continuous and interval running exercise on physical and cognitive performance, mood, and affect and underlying neurophysiological factors during a terrestrial simulated space mission. Six volunteers (three females) were isolated for 120 days. Accompanying exercise training consisted of a continuous and interval running protocol in a cross-over design. Incremental stage tests on a treadmill were done frequently to test physical performance. Actigraphy was used to monitor physical activity level. Cognitive performance, mood (MoodMeter®), affect (PANAS), brain-derived neurotrophic factor (BDNF), insulin-like growth factor 1 (IGF-1), vascular-endothelial growth factor (VEGF), and saliva cortisol were investigated prior to, four times during, and after isolation, pre- and post-exercise on two separate days, respectively. As a chronic effect, physical performance increased (and IGF-1 tended) in the course of isolation and training until the end of isolation. Subjective mood and affect state, as well as cognitive performance, basal BDNF and VEGF levels, were well-preserved across the intervention. No acute effects of exercise were detected, besides slower reaction time after exercise in two out of nine cognitive tests, testing sensorimotor speed and memory of complex figures. Consistently higher basal IGF-1 concentrations and faster reaction time in the psychomotor vigilance test were found for the continuous compared to the interval running protocol. The results suggest that 120 days of isolation and confinement can be undergone without cognitive and mental deteriorations. Regular, individual aerobic running training supporting physical fitness is hypothesized to play an important role in this regard. Continuous running exercise seems to trigger higher IGF-1 levels and vigilance compared to interval running. Systematic and prolonged investigations and larger sample size are required to follow up on exercise-protocol specific differences in order to optimize the exercise intervention for long-term psycho-physiological health and well-being.

Comparison of clinical and laboratory parameters in patients with end-stage renal failure in the outcome of chronic glomerulonephritis and patients with end-stage renal failure in the outcome of other diseases.

BACKGROUND: frequent complications of hemodialysis treatments are coagulation disorders. This is due to activation of the coagulation of blood flow in the interaction with a dialysis membrane material vascular prostheses and extracorporeal circuit trunks. In addition, in hemodialysis patients receiving heparin for years, there is depletion of stocks in endothelial cells in tissue factor inhibitor, inhibits the activity of an external blood clotting mechanism. AIM: the aim of our study was to evaluate the hemostatic system parameters in patients with end-stage renal failure, depending on the cause of renal failure. MATERIAL AND METHODS: to evaluate the hemostatic system parameters in patients with end-stage renal failure, depending on the cause of renal failure and hemodialysis treatment duration conducted a study that included 100 patients observed in the department of chronic hemodialysis and nephrology hospital №1 Republican National Medical Center in the period of 2013-2016. RESULTS: in patients with end-stage renal failure in the outcome of chronic glomerulonephritis, a great expression of activation of blood coagulation confirm increased the mean concentration of fibrinogen, whereas in the group, which included patients with end-stage renal failure in the outcome of other diseases, such is not different from the norm, and a higher rate of hyperfibrinogenemia, identified in 2/3 patients in this group. CONCLUSIONS: it was revealed that the state of homeostasis in patients with end-stage renal failure in increasingly characterizes the level of fibrinogen and the activation of the hemostatic markers: soluble fibrin monomer complexes, D-dimers.

Eye lens exposure to medical staff during endoscopic retrograde cholangiopancreatography.

The paper presents a study of the radiation doses to eye lens of medical staff during endoscopic retrograde cholangiopancreatography (ERCP) procedures performed in a busy gastroenterology department. For each procedure the dose equivalent to the eye, exposure time, dose rate, Kerma Area Product and fluoroscopy time were recorded. Measurements were performed for a period of two months in four main positions of the operating staff, and then extrapolated to estimate annual doses. The fluoroscopy time per ERCP procedure varied between 1.0 min and 28.8 min, with a mean value of 4.6 min. The calculated mean eye dose per procedure varied between 34.9 µSv and 93.3 µSv. The results demonstrated that if eye protection is not used, annual doses to the eye lens of the gastroenterologist performing the procedure and the anesthesiologist can exceed the dose limit of 20 mSv per year.

Optimisation of paediatric chest radiography.

The purpose of this work is to present the algorithm for the optimisation of paediatric chest radiography aimed to reduce patient doses at keeping adequate image quality. Optimal tube voltage, tube current and exposure time, use of automatic or manual exposure control and use of antiscatter grid were recommended for different age groups and depending on the patient size. The optimised protocols and radiography technique resulted in decrease in Entrance surface air kerma and effective dose values in a factor of between 1.5 and over 5 for different age groups. Image quality was assessed to be of sufficient diagnostic quality.

Risk of radiation exposure to medical staff involved in interventional endourology.

The aim is to estimate the possibility the new annual dose limit for eye lens to be exceeded and to study the impact of protective shield. Radiation exposure to medical personnel was evaluated with EDD-30 dosemeter in positions of operating surgeon, assisting doctor and nurse. At the operator's typical position for diagnosis and treatment of the urinary tract, the lens dose rates were 0.9 mSv h(-1) and 0.06 mSv h(-1) without and with lead shield. At the operator's position typical for percutaneous intervention dose rates were 1.9 and 0.02 mSv h(-1), respectively. At typical workload, the annual eye lens dose to the main operator without protective screen was estimated to be 29 mSv. With lead screen, operator lens dose can be reduced by a factor of 15-95 according to the procedure. Installation and use of lead screen and use of lead glasses were recommended to the endourology medical team.

Multiple myeloma in association with second malignancy.

PURPOSE: To look at the frequency of second primary malignancies (SECMAL) in patients with multiple myeloma (MM). METHODS: The medical files of 332 patients with MM (whole group), diagnosed and treated at the University Multiprofile Hospital for Active Treatment "Sv. Georgi" and the Comprehensive Oncology Hospital (Plovdiv) for a 20-year period (1990-2010) were retrospectively analyzed. MM patients with SECMAL constituted the study group. A control group comprised patients with solid tumors associated with SECMAL. This group derived from a sample of 21768 patients with solid tumors. RESULTS: In the study group, SECMAL was diagnosed in 4.52% (N=15) of the patients, while in the control group this figure was 5.09% (N=1108) (p>0.05). The diagnosis of MM preceded the occurrence of SECMAL in 35.71% of the study group patients, the median interval being 6.6 years (range 5-14). More frequently the diagnosis of the solid tumor preceded the occurrence of MM (66.67%). Breast cancer and gastric cancer were encountered with the highest frequency (26.67% each). The median survival (77.2 months, range 44-129) was significantly longer in the group with MM and SECMAL compared to the whole group with MM (median 38.6 months, range 10-58; p<0.05). CONCLUSION: The rate of MM with other malignant diseases is comparable with the frequency of SECMAL in other lymphoproliferative disorders and solid tumors. The occurrence of SECMAL during the clinical course of MM is not a frequent event and is expected in the rare cases with longer survival.

From Virchow's triad to metastasis: circulating hemostatic factors as predictors of risk for metastasis in solid tumors.

Tumor growth is characterized by disturbances of hemostatic mechanisms towards subclinical activation of coagulation. In cancer patients there is an increased risk up to 4-6 fold for developing idiopathic thrombosis due to the tumor-associated prothrombotic status. The molecular basis for the interrelationship between malignant phenotype and hemostatic disbalance includes several specific properties of tumor cells such as production of proinflammatory and proangiogenic cytokines, exhibition of procoagulant / fibrinolytic activities by tumor cells themselves and direct cell-to-cell interactions between tumor cells and cellular components of the hemostatic system. Aberrant tissue factor (TF) expression is a hallmark of human cancers and has been linked to their metastatic potential and neoangiogenesis. TF is a multifunctional molecule which controls the pro-/antiangiogenic balance in tumor tissue both by its procoagulant properties and via coagulation-independent mechanism inducing production of angiogenic cytokines by tumor cells. Components of the fibrinolytic system urokinase plasminogen activator (uPA) and urokinase plasminogen activator receptor (uPAR) facilitate targeted proteolysis of the basement matrix in order neovascularization to occur. Overexpression of these factors in tumor tissue has been identified as prognosticator for metastatic spread and overall survival in many human cancers, including breast, gastrointestinal, lung, urological and gynecological malignancies. Measurement of circulating TF and the soluble isoform of uPAR in plasma may be useful for evaluating the risk of cancer metastasis, monitoring for tumor recurrence and prediction of response to cancer therapy.

Non-Hodgkin lymphomas and carrier state of viral hepatitis B and C.

PURPOSE: To establish the characteristics and prognosis of newly diagnosed patients with non-Hodgkin lymphoma (NHL), who were carriers of hepatitis B (HBV) and C (HCV) viral infection. METHODS: 542 patients with NHL, diagnosed and treated in the University Hospital "Sv. Georgi", Plovdiv, were retrospectively analysed. Two NHL patient groups were created - the study group, consisting of 33 patients with NHL positive for HBV and HCV, and the control group, consisting of 40 randomly assigned patients with NHL and negative serology for hepatitis. Study and control groups were compared for basic characteristics and survival. RESULTS: The prevalence of hepatitis B surface antigen (HBsAg) among newly diagnosed patients was 5.72% and of HCV 1.84 %. Association with hepatitis viruses was more frequent in indolent than in aggressive NHLs (p=0.044). Liver dysfunction was registered more often in the study group (p=0.002). Reactivation of HBV infection was registered in 5 patients (12.19%) from the study group. There was no statistically significant difference between survival rate of patients in the study group and in the control group (p=0.738). CONCLUSION: Hepatitis virus carrier state did not alter significantly the clinical course and disease prognosis (remission rates and survival) in our patient group. We recommend the routine testing for hepatitis infection in patients newly diagnosed with NHL in order to collect more data needed for the establishment of a possible causal relationship between hepatitis viruses and NHL. Since antiviral prophylaxis could positively impact the course of lymphoma treatment, national guidelines for the management of patients with hepatitis infection and NHL will prove to be necessary for the clinical practice.

Electrophoretic finding of bisalbuminemia.

BACKGROUND: Bisalbuminemia or alloalbuminemia is a rare inherited or acquired condition characterized by the presence of two albumin fractions during electrophoretical separation of serum proteins. METHODS: Bisalbuminemia was incidentally detected by agarose gel electrophoresis (AGE) during standard laboratory investigation of a 36-year old female patient, referred to our laboratory with the diagnosis of immune thrombocytopenia. RESULTS: The electrophoregram showed dysproteinemia with the presence of two distinct albumin bands. This initiated testing of other family members - mother, father, and son of the patient. CONCLUSIONS: We report a case of inherited bisalbuminemia in a Bulgarian family with two affected members of four investigated. This is the first report of inherited bisalbuminemia in the Plovdiv region and could be of great interest to laboratory practitioners and clinicians providing some new data on the protein evolution and the clinical approach.

Intraperitoneal perfusion chemotherapy with hyperthermia in some malignant ascites.

Intraperitoneal administration of chemotherapeutic drugs with hyperthermia (HIPEC) increases their local effect on malignant peritoneal diseases and reduces systemic cytotoxicity. The most commonly used are cisplatin, doxorubicin, and mitomycin C. A major disadvantage of intraperitoneal chemotherapy is limited penetration of the drug in the tumor lesion depth (1-3 mm). Extended exposure and increased pressure in the abdominal cavity solution increases penetration of the agent into the tumor and hyperthermia has synergy with cytostatic agent on the permeability of cell membranes and metabolism of the drug. Real clinical hyperthermia is achieved at 41 degrees C. Of greatest importance is the concentration of the drug, but crucial for the prognosis is complete cytoreductive surgery. A major disadvantage of the closed technique is the uneven distribution of the perfusion solution in the peritoneal cavity, and the main advantage is better control of the perfusion, keeping of constant hyperthermia of the solution and regular repetition of manipulation, like intravenous chemotherapy. Laparoscopy determines the stage of the tumor process, refines the indications and preoperative selection for HIPEC, monitors the effects of treatment and determines locations for introducing catheters. In the review the results of the inraperitoneal chemotherapy with hyperthermia in gastric, colorectal, ovarian and other cancers are discussed as well as in diffuse malignant peritoneal mesothelioma and others.

Potential for optimisation of paediatric chest X-ray examination.

The purpose of this study was to compare the important aspects of paediatric radiological practice and the patient doses from chest X-ray examinations performed in three hospitals in Bulgaria. Data from 163 paediatric patients were recorded using a standardised form. Entrance surface air kerma (ESAK) to patient was calculated from the air-kerma air product (KAP) and field size measurements. Large variations were found for KAP and ESAK. Inappropriate film size and insufficient collimation were often used. Inappropriate use of automatic exposure control and antiscatter grid was found. In most cases, no attention was paid to reduce dose to sensitive organs by means of shielding or proper collimation. Recommendations were given to the hospitals on how to reduce patient doses in paediatric chest radiography.

Exposure to patient during interventional endourological procedures.

The purpose of this work is to study doses to patients undergoing interventional endourological procedures. The study was performed in a modern Clinic of Endourology and Shockwave Lithotripsy, equipped with two dedicated X-ray systems. The following information was recorded for each patient: type of the procedure, patient age, fluoroscopy time, number of images acquired and patient dose in air kerma-area product, P(KA), measured with KAP-meters integrated in the X-ray units. Eleven types of procedures were included. From the collected sample of 429 patients for all procedures, the mean fluoroscopy time varied between 0.2 and 4 min. The highest values of mean P(KA) 457 and 590 cGy cm(2) were found for percutaneous nephrolithotripsy and ureteroscopy, respectively. The mean values of P(KA) for rest of the procedures investigated were between 58 and 398 cGy cm(2). Individual patient doses varied between 2 and 2440 cGy cm(2) and fluoroscopy time--between 0.1 and 13.7 min. The first study in interventional endourology in Bulgaria demonstrated big variations in patient doses depending on the type and the complexity of procedure, operator's experience and exposure modes.

Changes of serum prohepcidin, iron status and zinc-protoporphyrin in a random group of patients with malignant diseases.

PURPOSE: To investigate the changes in the serum levels of prohepcidin (pHp) and markers of iron homeostasis for gathering more data on the pathogenesis of anemia in malignancies. METHODS: In 84 patients with advanced solid malignant tumors, but without iron or vitamin B12 and folate deficiency anemia, we measured serum pHp levels and common markers of iron status, erythropoiesis and inflammation. Two months later the same tests were repeated to determine possible changes in the levels of the measured parameters. RESULTS: The first blood sample characterized the group with a moderately low hemoglobin (Hb) and high CRP levels, suggesting anemia in some patients. Two months later higher levels of serum iron (sFe), total iron binding capacity (TIBC), transferrin saturation, ferritin and zinc-protoporphyrine (ZPP) in erythrocytes were found, along with lower pHp and high sensitivity C-reactive protein (hs-CRP). The correlation coefficient (R) between the values of iron-containing substances and pHp were low (R=0.244). Allocations by sex, Hb concentration and pHp showed that the changes in each group were similar, keeping the trend of increased sFe, ferritin and ZPP, decreased hs-CRP and pHp, at a stable hematological state. CONCLUSION: Because of low correlation between sFe and pHp, it seems more likely that the positive two-month change of iron-containing substances in the serum of the studied patients is a result of treatment, impaired liver function or malignant intoxication, rather than of decreased pHp.

[Postoperative survival in patients with inoperable lung cancer].

UNLABELLED: Despite the advances in treatment in the last two decades, the prognosis in lung cancer remains infavourable. Only 20-25% of the patients are suitable for operative treatment. Almost 75% of the patients are inoperable at the time of diagnosis. MATERIAL AND METHODS: We present 148 patients, who underwent non-radical operation for the period 01.01.1997 - 31.12.2005 - 129 men (87.16%) and 19 women (12.84%), age range - 29-65 years (53.67 +/- 0.60). RESULTS: The mean time of survival for the group submitted to radiotherapy is 13.74 months, while for the group without postoperative radiotherapy is 9.31 months. The mean time of survival for the group submitted to chemotherapy is 9.99 months, while for the group without adjuvant chemotherapy is 10.27 months. CONCLUSIONS: The radiotherapy significantly improves the survival in the patients with inoperable lung cancer, while the chemotherapy don't increase the survival.

[Stage of disease as a prognostic factor in radically operated patients with non-small cell lung cancer].

UNLABELLED: Despite the better diagnostic and therapeutic opportunities, lung cancer is still the major cause for cancer mortality. The surgical-pathological TNM-stage is known as the most reliable prognostic factor for survival in patients with lung cancer. MATERIAL AND METHODS: We present 440 patients with non-small cell lung cancer, radically operated in the Clinic of Thoracic and abdominal surgery of University Hospital "St.George" - Plovdiv for the period 01.01.1997 - 01.09.2004 - 378 men (85.91%) and 62 women (14.09%), age range 23-82 years. RESULTS: The mean time of survival according to the stage is as follows: IA - 77 months, IB - 67, IIA - 55, IIB - 42, IIIA - 33 IIIB - 14, IV - 27 months. CONCLUSIONS: The stage of the disease is an important prognostic factor for patients with lung cancer. We found the lowest survival in stage IIIB. For selected patients in stage IV, the operative treatment leads to good results.

[Extent of resection as a prognostic factor in patients with non-small cell lung cancer].

UNLABELLED: Despite the new methods of treatment during the last two decades, prognosis in lung cancer remains unfavourable. Only 20-25% of the patients are suitable for surgery, and the surgical resection is the unique alternative with curable intent. The extent of resection is an important prognostic factor in lung cancer patients. MATERIAL AND METHODS: We present 440 patients with non-small cell lung cancer, radically operated in the Clinic of Thoracic and abdominal surgery of University Hospital "St.George" - Plovdiv for the period 01.01.1997 - 01.09.2004.191 underwent lobectomy, 12 - limited resection, 39 - bilobectomy, and 198 - pneumonectomy. RESULTS: 63 patients underwent lobectomy for stage I, and the 5-year survival was 63.49%. For the 12 patients with limited resection we found mean time of survival of 50 months, and the 5-year survival was 50%.331 of our patients were in stage II and III. 123 of them underwent lobectomy--the 5-year survival was 28.46%. 208 patients underwent bilobectomy and pneumonectomy--the 5-year survival in this group was 17.79%. CONCLUSIONS: In conclusion we found that the extent of resection is an important prognostic factor for lung cancer patients in stage I. The patients submitted to lobectomy have better survival compared with those submitted to limited resection. The survival is better for the group of patients who underwent lobectomy,compared with the one for the group with bilobectomy and pneumonectomy, which is probably due to the earlier stage of the disease.

Risk index score for bacteremia in febrile neutropenic episodes in children with malignancies.

PURPOSE: To prospectively determine risk factors for bacteremia in febrile neutropenic children with malignancies. PATIENTS AND METHODS: We studied 199 episodes of febrile neutropenia in 80 children with malignancies, treated by conventional chemotherapy for a 4-year period (2000 - 2004). A standardized computer database with a set of variables for each febrile neutropenic episode was used. C-reactive protein (CRP) was measured at the first febrile episode and on the 3rd and 5th day from the beginning of antibiotic therapy by immunoturbidimetric method. Blood cultures were taken at the onset of fever and before initiation of antibiotic therapy. RESULTS: Multivariate logistic regression analysis determined 5 variables as independent risk factors for bacteremia: the underlying malignant disease (leukemia, non - Hodgkin's lymphoma / NHL, stage IV), chills, perianal cellulitis, presence of central venous catheter and CRP rise >or=34.5 mg/L between the onset of fever and the 3rd day of empiric antibiotic therapy. Thus we identified a low-risk group for bacteremia of 19.1%. CONCLUSION: Serial measurement of CRP allows for definite risk stratification of febrile neutropenic episodes on the 3rd day from the onset of fever. The low-risk group could be eligible for sequential empiric antibiotic therapy.

Therapy-related acute promyelocytic leukemia after treatment with radioiodine for thyroid cancer: case report with literature review.

Therapy-related acute promyelocytic leukemia (t-APL) is a rare but known complication of chemotherapy and/or radiation therapy. Approximately 200 cases of t-APL have been reported in the literature up until now. The development of t-APL after radioiodine therapy is very rare, keeping in mind the very low doses of radiation exposure of the patient. We present a case of a 47-year-old woman with t-APL t15;17(q22;q21) developed after radioiodine treatment for thyroid carcinoma. The patient was treated with chemotherapy and achieved complete response lasting for 3(+) years. The patient's excellent response to treatment supports the data of the relevant literature that t-APL is associated with a better therapeutic result than the other subtypes of secondary acute myeloid leukemia (AML).

Blood biochemical parameters in women during long-term simulated hyperoxic diving up to 8 ATA.

Nowadays an increasing number of women are participating in recreational diving. A special recompression treatment table for delayed pulmonary barotrauma or decompression sickness was developed by V.V. Smolin in the Institute for Biomedical Problems (IBMP, Russia). The aim of our study was to investigate the effect of simulated dives (similar to this recompression treatment table) on biochemical parameters of healthy women. Three healthy female volunteers participated in long-term simulated diving to 8 ATA (0.8 MPa). Blood samples for determination of the biochemical substrate levels and activity of blood enzymes using a Reflotron analyzer were obtained at the control period, at the beginning of decompression and at the post dive period. No significant changes of serum levels of glucose, triglycerides, cholesterol, HDL cholesterol and urea were found during this experimental period or in comparison with the predive values. There were no significant changes in ALT activity in two volunteers but there was some tendency for an insignificant decrease in AST activity. One of the volunteers had a considerable increase in AST and ALT activities 15 h after the dive, probably due to a modified diet outside the experiment conditions. Thus, the long-term simulated diving recompression treatment table did not lead to a shift in the woman's serum biochemical status. However, it remains necessary to consider probable dysfunction of liver due to hyperbaric exposure.

The prognostic value of clinical and laboratory parameters in patients with chronic lymphocytic leukemia.

PURPOSE: Chronic lymphocytic leukemia (CLL) is heterogeneous in its clinical course. The aim of the present study was to identify some clinical and laboratory parameters with prognostic value in relation to survival of patients with CLL. PATIENTS AND METHODS: One hundred thirty one patients with CLL, treated in the Clinic of Hematology, Plovdiv, between 1992 and 2003 were studied. The patients' survival was analyzed by using the Kaplan-Meier method. Log-rank test was used to compare cumulative survival functions between different groups of patients. The parameters studied were: age, sex, Rai clinical stage, ECOG Performance status (PS), FAB morphological type, mediastinal lymphadenopathy, abdominal nodal mass, extranodal localization, absolute lymphocyte count, autoimmune hemolytic anemia, and response to therapy. RESULTS: The mean survival of patients was 76 months (95% Confidence Interval, 64-87). The following factors were found to carry significant prognostic value in relation to survival: Rai clinical stage, ECOG PS, mediastinal lymphadenopathy, extranodal localization, FAB morphological type and response to initial standard treatment. CONCLUSION: The prognostic factors identified in the present study can be easily applied in the clinical practice and may be used as a basis for creating mathematical prognostic models.