Status of retained deciduous second molars in subjects with agenesis of second premolars in relation to age.

AIM: To evaluate the presence and status of retained DM2 without permanent successors in relation to age. BACKGROUND: Preservation of retained deciduous second molars (DM2) can be applied to treat congenital absence of second premolars (PM2). However, the consequences of caries and progressing root resorption or infraocclusion may affect their survival. METHODS: Panoramic radiographs of individuals >10 years of age with agenesis of at least one PM2 were evaluated and divided into three groups according to age. The presence and location of retained DM2, caries/restorations, infraocclusion and root resorption were investigated. RESULTS: A total of 131 subjects with PM2 agenesis were included (mean age: 13 years 11 months). The majority were missing one or two PM2. In total, 174 retained DM2 were present (33%), and their incidence was higher in the younger age groups. Caries/restorations were found in 88 (50.6%) and infraocclusion in 21 (12%) retained DM2. The roots were resorbed mostly for ½ of the root length (35%). CONCLUSION: Long-term prognosis of retained DM2 without permanent successors seems uncertain, especially within the younger age group. In individuals older than 17 years, the prognosis for a healthy DM2 is favorable, if no distinct infraocclusion or extensive root resorption is present.

Computed tomography with positron emission tomography is more useful in local than systemic infectious process related to cardiac implanted electrotherapy device: a prospective controlled multicenter diagnostic intervention PET-Guidance Trial.

Assess the diagnostic value of 18-F FDG PET/CT in cardiac implantable electronic devices (CIED) infections in facilitating diagnostic process and optimizing decision-making process.Study group (n = 21) patients with initial suspected diagnosis of CIED-related infection or fever of unknown origin and patients referred for device removal due to infection. Control group (n = 13) patients with implanted CIED, who underwent PET/CT due to other non-infectious indications and had no data for infectious process in follow-up.PET/CT scan showed pocket infection in 12 patients (including 1 in whom infection was not finally diagnosed-the examination was performed early after the implantation procedure-1.5 months), increased tracer uptake in intravascular lead part in 3 patients, and increased uptake in intracardiac part in 5 patients.We found that sensitivity, specificity, positive predictive value, and negative predictive value of the diagnosis made by PET/CT in generator pocket infection was 91.7%, 70%, 78.6%, 87.5% and in lead-dependent intracardiac infection 100%, 47.1%, 35.7%, 100% respectively. PET/CT scan enabled reclassification of diagnosis from possible to definite CIED-related infection in 6 out of 9 patients, and to excluded in 3 out of 9.Establishing diagnosis of device related infections may be challenging due to non-specific symptoms. Incorporation of PET/CT scan in the diagnostic schema can improve accuracy and timing of the diagnosis and help to assess the extent of infection. PET/CT is more useful in local than systemic infectious process related to cardiac implanted electrotherapy device.Trial registration Consent of the bioethics committee nr IK-NP.-0021-85/1465/14. Registration in the www.clinicaltrials.gov database: NCT02196753.

Diffusion tensor imaging findings in the multiple sclerosis patients and their relationships to various aspects of disability.

BACKGROUND: The aim of the study was to assess microstructural changes within strategic brain regions in multiple sclerosis (MS) patients, using diffusion tensor imaging (DTI), with regard to various aspects of disability. MATERIAL AND METHODS: The study comprised 50 patients with relapsing-remitting MS (37 women, 13 men, mean age 36.4 yrs) and 27 age- and sex-matched controls. Using DTI, fractional anisotropy (FA) and apparent diffusion coefficient (ADC) values were obtained within corpus callosum (CC), both thalami (TH) and middle cerebellar peduncles (MCP). Disability was assessed using Expanded Disability Status Scale (EDSS), MS Functional Composite (MSFC), Symbol Digit Modalities Test (SDMT) and Fatigue Severity Scale (FSS). DTI indices were compared between the patients and controls and in the MS group - referred to disability measures. RESULTS: Significant decrease in FA and increase in ADC within CC and both TH were found in MS patients compared to the controls. DTI indices within CC and TH correlated significantly with SDMT score, and within TH and MCP - with MSFC manual dexterity measure. CONCLUSIONS: Changes in DTI measures in normal appearing white and grey matter in the MS patients indicate subtle alterations of the tissue integrity. An occult damage to the strategic brain regions may contribute to various aspects of disability due to MS.

Effect of Selective Antibiotic Pressure on the MLS-B Phenotype in Methicillin-Resistant Staphylococcus aureus Strains Originating From Patients From Transplantation Wards: 24 Years of Observations.

INTRODUCTION: Staphylococcus aureus infection, and health care-associated-methicillin resistant S aureus (HA-MRSA) in particular, is a serious risk for patients treated with organ transplantation. The frequent combined resistance of these bacteria to macrolides, lincosamides, and streptogramin-B (MLS-B) limits the use of these drugs in therapy. AIM: Evaluation of the mechanism of MLS-B resistance among HA-MRSA strains derived from patients treated in surgical-transplantation wards, over a 24-year period, and assessment of correlation of clindamycin use and resistance phenotype. MATERIALS AND METHODS: One hundred and twelve HA-MRSA strains from patients in surgical-transplantation wards (clinical hospital, Warsaw), hospitalized in the period from 1991 to 2014. Methicillin-resistance was determined using phenotypic and genetic methods by detecting the mecA gene. Erythromycin/clindamycin resistance was determined by E-test, the iMLS-B (inductive) and cMLS-B (constitutive) phenotypes by the D-test method. The number of defined daily doses (DDD), statistically per 1000 person-days, was calculated in accordance with the WHO guidelines. RESULTS: Resistance to erythromycin/clindamycin in MRSA strains increased from 1991 to 2004-2007 from 64.7/11.8% to 100/76.9%, respectively. The frequency of the cMLS-B phenotype in the years 1991/2010-2011/2012 was 5.9%/76.9%/69.7%, respectively, and correlated with the increased use of clindamycin in the examined wards. In 2012, the percentage of MLS-B-sensitive isolates increased from 3.9 to 21.7%, while constitutive resistance decreased to 69.7%, which correlated with a decrease in the use of clindamycin. CONCLUSIONS: The proportion of cMLS-B to iMLS-B phenotypes in HA-MRSA is related to the amount of clindamycin used in hospital wards. Limiting the selection pressure of antibiotics can lead to complete loss of resistance or return to the inductive mechanism of its regulation.

Characteristics of the expression of KAI1/CD82 and PDGFRß and their impact on glioma progression.

The biological features of glioma cells may define their clinical outcome. Little is known about the interactions between KAI1/CD82 metastatic suppressor protein and PDGFR in gliomas. The aim of the study was to examine KAI1/CD82 and PDGFR expression in gliomas in order to find the impact of these proteins on progression of the tumors. PDGFR, KAI1/CD82 protein expression and mRNA of genes were evaluated on eighty four paraffin-embedded tissue of gliomas using immunohistochemical staining and RT-PCR analysis. The PDGFR expression was higher in IV/III than in I/II glioma grades (p = 0.0004). The level of mRNA PDGFR was associated with the degree of PDGFR immunoreactivity. Downregulation of KAI1/CD82 was associated with tumor malignancy (p = 0.007). The increased level of KAI1/CD82 gene expression (3-4-fold) was found in gliomas with strong KAI1/CD82 immunoreactivity. The parallel KAI1/CD82 and PDGFR expression was more significantly associated with cases in a group graded as III and IV than in a group graded as I/II (p = 0.002). We found that a loss of KAI1/CD82 and an increase in PDGFR expression in gliomas relate to a progressive tumor growth. The correlation between PDGFR and KAI1 expression in high grade gliomas suggests that a direct or indirect interaction between these proteins might have an impact on cell motility and invasive behavior of the tumor.

ALCAM and CD6--multiple sclerosis risk factors.

ALCAM and CD6 may play an important role in the pathogenesis of multiple sclerosis (MS), since they are involved in the transmigration of leukocytes across the blood-brain barrier. In this study, we confirmed our previous findings about the association of the ALCAM gene with risk, development and progression of MS. Additionally, we showed that in the case of the CD6 gene (encoding receptor of ALCAM) not only polymorphisms but also mRNA expression level are associated with MS. Our analysis revealed that the risk of the disease for AA individuals in rs12360861 was almost 3.0-fold lower in comparison to GG individuals (OR=0.34; CI95%=0.12; 0.81). Moreover, we observed lower expression of CD6 mRNA in patients than in healthy individuals (T(2)2,74=6.678; p=0.002).

Investigation of gene-gene interactions between CD40 and CD40L in Polish multiple sclerosis patients.

CD40-CD40L interaction is necessary for the activation of both humoral and cellular immune response and has been suggested to play a role in the pathogenesis of multiple sclerosis (MS). Therefore, we analyzed the combined influence of the CD40 and CD40L variants on MS susceptibility and progression on well-defined Polish population. Our investigation revealed that CT individuals in rs1883832 locus of CD40 possessed almost 1.5-fold higher risk for MS than CC individuals (OR = 1.44; 95%CI = 1.03-2.1; p = 0.032), while this risk for TT individuals was almost 2.5-fold higher (OR = 2.36; 95%CI = 1.19-4.78; p = 0.014). Moreover, for the first time, we observed the association of CD40 gene with MS development and progression. We observed that for the rs1883832CC individuals the age at diagnosis was on average 2 years lower than for the rs1883832CT and rs1883832TT individuals (CI95% = -3.69-(-0.29); p = 0.023). Additionally, we detected that individuals with TT and CT genotypes showed lower risk of developing secondary progressive course in comparison to those with CC genotype. For rs1883832TT individuals this risk was 4-fold lower (HR = 0.24; CI95% = 0.10-0.53; p = 0.00062). Despite the fact that CD40-CD40L pathway plays a key role in development of autoimmune diseases, we were not able to detect gene-gene interactions between CD40 and CD40L polymorphisms associated with multiple sclerosis.

Stimulated peripheral production of interferon-gamma is related to fatigue and depression in multiple sclerosis.

OBJECTIVES: The aim of the study was to evaluate the stimulated production of interferon-gamma (IFNγ) by peripheral CD3+CD4+ T lymphocytes in patients with multiple sclerosis (MS) with regard to the degree of fatigue, and to investigate relationships between immunological parameters, level of depression and clinical variables. METHODS: Forty MS patients (30 women, 10 men, aged 22-60 years): 20 fatigued and 20 non-fatigued were involved in the study. Fatigue was evaluated using the Fatigue Severity Scale (FSS) and Modified Fatigue Impact Scale (MFIS), depression level - using Beck Depression Inventory (BDI). Production of IFNγ by stimulated peripheral blood CD3+CD4+ T lymphocytes, assessed using flow cytometry, was compared between MS patients with different levels of fatigue and controls. Correlations were searched out between immunological findings and BDI, age, duration and course of MS, relapse rate, disability (assessed in Expanded Disability Status Scale - EDSS) and its progression. RESULTS: Stimulated production of IFNγ by CD3+CD4+ T lymphocytes was higher in severely fatigued patients in comparison with non-fatigued ones and controls, tended to correlate with FSS and MFIS, and correlated with BDI. No relationships were found between immunological findings and disease-related variables. CONCLUSION: Stimulated production of IFNγ by peripheral CD3+CD4+ T lymphocytes is related to fatigue and depression in MS patients.

Peripheral nerve changes assessed by conduction velocity distribution in patients with primary Raynaud's phenomenon and dysautonomia.

AIM: Different mechanisms (neural and intravascular) are thought to be important in the pathogenesis of Raynaud's phenomenon (RP). In a previous study we confirmed autonomic nervous system impairment in patients with primary RP, but the pathogenic role of peripheral nerves remained unclear. The aim of the current study was an electrophysiological analysis of peripheral nerves using both standard conduction velocity and the conduction velocity distribution (CVD) in patients with primary RP in order to investigate the causes of dysautonomia. METHODS: We examined 34 patients with primary RP and dysautonomia and 31 sex- and age-matched controls. Standard motor and sensory conduction tests in ulnar and peroneal (sural) nerves and a CVD test in the same nerves were performed. RESULTS: Clinically, none of the patients had motor symptoms, while 35.3% of them presented sensory neuropathy. Standard neurographic tests were within the normal limits except for the significant prolongation of mean sensory latency in both examined nerves. CVD revealed significant slowing of motor conduction velocity in all the conduction values, e.g. in the 10th, 50th, and 90th percentiles of velocity. There were no differences in the width of the velocity distribution in the patient group and controls. CONCLUSION: The results of CVD indicated the presence of generalized subclinical peripheral motor nerve impairment (subclinical polyneuropathy) in patients with primary RP and dysautonomia. Based on the present and previous studies, we conclude that the mechanism of autonomic dysfunction in primary RP is mixed, resulting from both central and peripheral neural abnormalities.

Association of the HLA-G gene polymorphism with multiple sclerosis in a Polish population.

Summary In this study, three polymorphic sites in the HLA-G gene: -725C>G>T, -716T>G and 14bp(indel) were genotyped. Significant differences were found between patients and controls in the alleles and genotypes for -725C>G>T and in three-point haplotypes. We observed also a significant difference in the age of disease onset between patients positive and negative for 14bp(ins). The results suggest that single nucleotide polymorphisms in the promoter of the HLA-G gene (mainly -725C>G>T), and 14bp(indel), or some genetic marker in tight linkage disequilibrium with them are associated with multiple sclerosis.

Autonomic dysfunction in primary Raynaud's phenomenon.

AIM: The pathogenesis of Raynaud's phenomenon is still unclear. Neural and intravascular mechanisms are thought to be involved in the pathological process. The role of the autonomic nervous system is continually discussed, with particular attention to over-reactivity of the sympathetic part. The aim of this study was the clinical and electrophysiological analysis of autonomic nervous system function in patients with primary Raynaud's phenomenon. METHODS: Thirty four patients with primary Raynaud's phenomenon and 31 sex and age-matched controls were examined. Neurological examination, modified Low's Questionnaire, orthostatic and sustained handgrip tests, conduction velocity study in three nerves, sympathetic skin response (SSR), and heart rate variability (HRV) during deep breathing and at rest with the fast Fourier transform were performed. RESULTS: In the clinical examinations, 35.3% of the primary Raynaud's patients presented sensory neuropathy, but this was not confirmed in the standard conduction velocity tests. The modified Low's Questionnaire revealed dysautonomy in 82% of the patients. Autonomic regulation during the orthostatic and handgrip tests were within the normal limits. HRV at rest and the E/I ratio were significantly lower in the patient group than in the controls, while HRV spectrum analysis revealed the predominance of the low-frequency band in the patients. CONCLUSIONS: These results indicate the presence of sympathetic dysregulation and impairment of parasympathetic modulation of heart function in primary Raynaud's patients. The different cardiovascular and sudomotor functions are not affected to the same degree. These observations might support the theory of a central impairment of autonomic function in primary Raynaud's phenomenon. Peripheral nerve lesion as a coexisting cause of the observed dysautonomy remains uncertain.

Different patterns of activation markers expression and CD4+ T-cell responses to ex vivo stimulation in patients with clinically quiescent multiple sclerosis (MS).

Patients with relapsing-remitting (RR) and secondary progressive (SP) forms of multiple sclerosis (MS), although in long-term clinical remission, showed different patterns of increased expressions of the activation markers: CD69, CD40L, and both membrane/surface and cytoplasmic CTLA-4 (mCTLA-4 and cCTLA-4, respectively) in freshly isolated peripheral blood (PB) CD4+ T cells compared with controls. Also observed were dysregulated responses to ex vivo stimulation in both groups of MS patients accompanied by increased IFN-gamma synthesis. Our findings may suggest that the mechanisms leading to each clinical form of the disease may be heterogeneous.

Progression of multiple sclerosis is associated with exon 1 CTLA-4 gene polymorphism.

OBJECTIVES: Multiple sclerosis (MS) is a chronic demyelinating disease of the central nervous system which is widely believed to have a T-cell-mediated etiology. The cytotoxic T-lymphocyte antigen-4 (CTLA-4) antigen molecule plays a key role in the downregulation of T-cell responses. To examine the genetic association of the CTLA-4 gene locus with MS, we analyzed an exon 1 (A49G) transition. MATERIAL AND METHODS: One hundred and fifty-two MS patients and 154 controls were examined. The A/G transition was genotyped by a polymerase chain reaction followed by labeling with a SNaPshot kit and detection using a capillary genetic analyzer. RESULTS: The genotype, allele and phenotype frequencies did not differ significantly between MS patients and controls. Those MS patients with AA and AG genotypes had 4.36 times greater risk of progressing from the relapsing-remitting to the secondary progressive form of the disease than those with the GG genotype. CONCLUSION: The results of our study indicate that CTLA-4 (A49G) exon 1 polymorphism is associated with MS progression.

Fas expression on T cells and sFas in relapsing-remitting multiple sclerosis.

OBJECTIVES: To investigate the proportions of peripheral blood CD4+/Fas+ and CD8+/Fas+ cells and serum sFas levels in relapsing-remitting multiple sclerosis (RRMS) patients with relapses (active RRMS), those without relapses (stable RRMS), and controls over 1 year. MATERIAL AND METHODS: Sixteen RRMS patients and 10 controls were tested monthly. Cells were analyzed by dual immunofluorescence and the sFas levels by ELISA. There were 14 relapses which occurred 1223 days after the last control visits. The measurements performed at these visits in the active RRMS patients were considered as relapse-related, while the rest were regarded as relapse-unrelated. RESULTS: In active RRMS patients the median of CD4+ Fas+ to total CD4+ and CD8+ Fas+ to total CD8+ from relapse-related measurements were higher than the median from relapse-unrelated measurements (P=0.003, 0.004, respectively). The median of CD4+ Fas+ to total CD4+ from relapse-unrelated measurements in active RRMS was higher compared with stable RRMS (P = 0.005) and controls (P = 0.004). The sFas level from relapse-unrelated measurements was also higher in active RRMS than in stable RRMS (P = 0.04) and in controls (P = 0.004). CONCLUSIONS: We suggest that increased expression of Fas antigen on CD4+ subset and increased serum sFas level are valuable markers of clinical activity in MS.

[Clinical course and changes of soluble interleukin-2 receptor and soluble forms of intercellular adhesion molecule-1 (ICAM-1) in serum of multiple sclerosis patients]. / Przebieg kliniczny a stezenie rozpuszczalnego receptora interleukiny-2 i rozpuszczalnej formy miedzykomórkowej czasteczki adhezyjnej (ICAM-1) w surowicy krwi w stwardnieniu rozsianym.

UNLABELLED: Changes were assessed in serum levels of soluble interleukin-2 receptor (sIL-2R alpha) and soluble intercellular adhesion molecule-1 (sICAM-1), indirect indices of activation of immunological system, in the course of multiple sclerosis (ms). 12 patients (av. age 39.2 +/- 9.4 y.) with the first relapse that fulfilled criteria of clinical probable ms acc. to Poser Committee were included into the study. Blood samples were taken at the beginning of the relapse and then every 2-month periods. Simultaneously, neurological impairment (EDSS scale) was assessed. When the next relapse occurred examination was repeated from the beginning. The total time of observation was between 12 and 18 months. The levels of both soluble molecules were examined with ELISA test. In relapse mean serum levels of sIL-2R alpha and sICAM-1 were significantly elevated in comparison to the results obtained in remission (respectively: p < 0.001 and p = 0.03). Changes in serum level of both soluble molecules during the first 2 months after relapse were significantly higher than in subsequent 2-month periods (p < 0.001). Each relapse was accompanied by elevation of serum levels of sIL-2R alpha and sICAM-1. There was no obtainable correlation between improvement in EDSS scale and changes in sIL-2R alpha level during the whole time of observation. Improvement in EDSS scale was correlated with lowering of sICAM-1 but only during the first two months after relapse. CONCLUSIONS: Serum level of sIL-2R alpha and sICAM-1 in ms patients during relapse is significantly higher in comparison to the results obtained during remission. Each relapse is accompanied by elevation of sIL-2R alpha and sICAM-1 in serum, during remission serum levels of both molecules do not changed significantly.

Expression of Fas antigen on T cell subpopulations in peripheral blood of patients with relapsing-remitting multiple sclerosis.

BACKGROUND: During the relapse of multiple sclerosis, the activation of T cells, autoreactive to myelin antigens in blood, enhanced and maintained as a result of anomalous mechanisms of their earlier elimination, leads on para- and autocrine basis to the activation of antigen- non-specific cells of immune system. In consequence, activated cells secrete a range of proinflammatory cytokines and display activation antigen expression on their surface, which results in blood-brain barrier damage. The differentiation of lymphocytes into effector cells in blood during MS relapse is to increase the number of cells supporting inflammatory reactions and simultaneously to reduce the number of cells which play a role of suppressors. Fas antigen is present among activation antigens found on T cells. Once this antigen has been combined with the ligand, it transmits apoptic signal to the cell. The presence of Fas antigen on activated peripheral blood T cells may enable us to estimate their activation and it may also indicate a potential to eliminate those cells from blood. The aim of the study was to provide a quantitative assessment of the subpopulations of CD3, CD4 and CD8 lymphocytes in peripheral blood and to investigate Fas antigen expression on these subsets in patients with relapsing-remitting multiple sclerosis, in relation to clinical activation of the disease. MATERIAL AND METHODS: Thirty-five patients participated in the study, including 14 patients finding themselves in clinical relapse of the disease and 21 patients in the state of remission. Additionally, 21 healthy subjects were included. Quantitative assessment of individual subpopulations and Fas co-expression was carried out with the use of monoclonal antibodies anti CD3, CD4 and CD8 as well as anti CD95 antibodies, and flow cytometer Pas/Dako Galaxy. RESULTS: The differences in the percentage of particular lymphocytes between 3 groups proved insignificant. Patients in the relapse of the disease showed significantly greater Fas expression on subpopulations CD3 and CD4 when compared to the results obtained from remission patients and control subjects. This difference was not observed for Fas expression on subset CD8. CONCLUSIONS: The investigation of Fas receptor expression may be useful in order to monitor clinical course of the disease, which is characterised by the periods of exacerbation and remission.

[Multimodal evoked potentials in malabsorption syndrome]. / Multimodalne potencjaly wywolane w zespolach zlego wchlaniania.

The multimodal evoked potentials (visual, somatosensory and auditory brainstem) in 23 patients with malabsorption syndrome of different origin were investigated. The diagnosis of the disease was confirmed on the basis of histological examination and result of D-ksyloza test. The control group consisted of 30 healthy persons. Examination of visual evoked potentials revealed significant prolongation of latency of P 100 component in examined group in comparison with controls. Latency of N13 and N20 of somatosensory evoked potentials in patients with malabsorption syndrome were also significantly prolonged when compared to controls, otherwise transit time to cortex (TTC) was merely prolonged. Auditory brainstem potentials were also abnormal. Changes involved prolongation of latency of I, III and V responses and prolongation of interpeak latencies of I-III, III-V, I-V as well. The amplitudes of the examined evoked potentials between patients and controls did not differ significantly. On the basis of obtained results in was pointed out that different specific afferent systems are affected in patients with malabsorption syndrome what seems to be connected with vitamin's deficiency, especially B12 and E. Authors conclude that multimodal evoked potentials examinations are useful in the diagnosis and monitoring of the disease, specially in subclinical cases.

Delayed attenuation of myocardial ischemia with repeated exercise in subjects with stable angina: a possible model for the second window of protection?

AIMS: A delayed myocardial protection extends between 24 and 96 h after ischemic preconditioning in animals. To test for this phenomenon in humans, subjects with stable angina were subjected to exercise test-induced myocardial ischemia and the effect of this "preconditioning" ischemic insult on the exercise-induced myocardial ischemia with the re-exercise after 24-96 hours was studied. METHODS AND RESULTS: Forty-eight males with a history of infarction and positive exercise test were recruited to the study. After baseline symptom-limited exercise test, the subjects were randomized to four experimental groups (n = 12/group). The groups were allowed to recover for 24 h, 48 h, 72 h or 96 h before performing the second exercise test. Variables analyzed were heart rate-systolic blood pressure product at 1 mm ST segment depression, time to 1 mm ST segment depression, maximum ST segment depression, exercise duration, and the total ischemic time. There were no intergroup differences in baseline values for these variables. All variables were significantly improved at 24 h, the improvement peaked usually at 48 h (maximum increase in the variables by 31-46%), and the variables returned to baseline by 96 h after the first test. CONCLUSIONS: The exercise-induced ischemia caused transient attenuation of myocardial ischemia with re-exercise. Although the time-window and the time-course of this effect shows striking resemblance to those of the delayed preconditioning in animals, its mechanism remains speculative. The most probable mechanisms that may be involved include increased myocardial perfusion and/or some adaptive changes in the myocardium, the delayed preconditioning being one possibility.

[The incidence of neuropathy in patients with diabetes type 1]. / Wystepowanie neuropatii u pacjentów z cukrzyca typu 1.

The aim of the study was to evaluate the incidence of diabetic neuropathy. The examined group consisted of 32 patients (14 boys, 18 girls) 16 to 19 years old with diabetes duration of 5 till 17 years, treated actually with multiple injections of human insulin. Diabetic neuropathy was observed in 56% of patients. The incidence of neuropathy was higher after 15 years of diabetes duration, in patients with bad metabolic control - HbA1c>8%, multiple ketoacidosis (p=0.003) and higher total cholesterol levels (p=0.003), with microalbuminuria (64.3%) and macroalbuminuria (83.3%) and in patients with systolic and diastolic blood pressure equal and/or above 90 % percentyle.

[Clinical-electrophysiological characteristics of Alzheimer's dementia and cerebrovascular dementia based on determination of cerebral refraction time]. / Kliniczno-elektrofizjologiczna charakterystyka otepienia alzheimerowskiego i naczyniopochodnego w oparciu o badanie czasu refrakcji mózgowej.

The aim of the study was an electrophysiologic assessment of cerebral refractory period in relation to chosen clinical parameters, EEG and CT in patients with dementia of various origin. The study included 30 patients (11 female, 19 male) aged 50-75: 15 with dementia of Alzheimer type (DAT) and 15 with vascular dementia (VD), and 15 age-matched healthy controls. Cerebral refractory period (CRP) was assessed by means of somatosensory evoked potentials with the use of paired stimulation with varying interstimulus interval, applied to the median nerve. Interstimulus interval, with which one somatosensory response was obtained to paired stimuli, was determined as absolute refractory period. CRP was significantly prolonged in demented patients, when compared to the control group, with no significant difference between groups with DAT and VD. CRP correlated negatively with age and positively with Mini Mental State Examination results, assessing the degree of mental deterioration. Prolonged CRP was noted in patients with vast lesions shown in CT. No relationship between CRP and EEG changes was found. CRP is a sensitive parameter, which may contribute to electrophysiological assessment of cerebral function.