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Byline: V. Sramek (1), I. Novak (1), M. MatAjovic (1), R. Rokyta (1), M. Nalos (1), P. Hora (1), H. Pittrova (1) Keywords: Citrate anticoagulation; Hemofiltration; Hypercalcemia; Thrombocytopenia; Multiple myeloma; Acute renal failure Abstract: A 72-year-old patient with multiple myeloma was admitted to the intensive care unit because of hypercalcemic crisis and acute renal failure. After 7 days of comprehensive therapy including diuretics, steroids, calcitonin, and intermittent hemodialysis (IHD) with low-calcium dialysate, calcium still reached high levels between IHD treatments and thrombocytopenia developed after chemotherapy. CWHDF with calcium-free bicarbonate dialysate was started. Anticoagulation with 2.2 % citrate was performed in order to chelate calcium, and thus treat the hypercalcemia, and to provide regional anticoagulation, and thus reduce the risk of bleeding due to thrombocytopenia. CWHDF with citrate anticoagulation was continued for 6 days, and standard heparin anticoagulation was started when the hypercalcemia and thrombocytopenia abated. Author Affiliation: (1) ICU, Medical Department I, Charles University Hospital Plzen, Alej Svobody 80, 30460, Plzen, Czech Republic Article History: Registration Date: 23/03/2009 Received Date: 03/07/1997 Accepted Date: 04/12/1997

A repeated soil survey (1995 and 2006) on 66 ICP Forests pair plots in the Czech Republic revealed a significant relationship between modeled nitrogen deposition and nitrogen concentration in the soil. Nitrogen deposition was modeled for the years 1995, 2004 and 2006. We found a more significant relationship between deposition data in 2004 and soil data in 2006 than between deposition and soil data from the same year 2006. Concentration of total nitrogen in forest soil increased from 1995 to 2006. Forest soil showed effects of increased nitrogen input from the humus layer to around 20 cm depth of mineral soil. The occurrence and cover of nitrophilous species in the herb layer increased from 1995 to 2006 in 25% of the analyzed plots, which corresponds to the nitrogen increase in forest soil. The results suggest that nitrogen deposition still represents a threat for Czech forest ecosystems.

The immune response crucially determines the survival of patients with malignant tumors including breast carcinoma. The aim of the present study was to evaluate retrospectively an association of peripheral blood cell count (PBC)-derived ratios and urinary neopterin concentration with prognosis in breast cancer patients. Urinary neopterin, neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR) and platelet-to-lymphocyte ratio (PLR) were retrospectively analyzed in a cohort of 474 breast cancer patients. NLR and PLR correlated positively with each other and negatively with LMR, but no correlation between neopterin concentrations and PBC-derived ratios was observed. Increased urinary neopterin concentration was a significant predictor of poor survival in patients with active disease, but PLR, NLR or LMR were not significantly associated with survival in multivariate analysis. In conclusion, increased urinary neopterin was a significant predictor of poor survival in patients with breast cancer and active disease.

The aim of the present study was to evaluate the correlations of peripheral blood cell count (PBC)-derived ratios with neopterin concentration and biomarkers of atherosclerosis risk in patients with history of breast cancer. Neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR) and platelet-to-lymphocyte ratio (PLR) were calculated in three cohorts of patients with a history of breast cancer and in controls. Significant differences were observed between PBC-derived ratios obtained from automated and manual counts. NLR and PLR were significantly higher and LMR was significantly lower in patients. NLR and PLR correlated positively with each other and negatively with LMR. NLR exhibited a significant correlation with age, glucose and C-reactive protein (CRP) concentrations, whereas LMR correlated negatively with CRP. With the exception of a correlation between LMR and urinary or serum neopterin concentrations in controls, no other correlation between neopterin concentrations and PBC-derived ratios was observed. NLR ≥3 was a significant predictor of poor survival, but neither urinary neopterin ≥205 μmol/mol creatinine, NLR ≥150 nor LMR ≥4.25 was significantly associated with survival. In conclusion, no consistent correlation was observed between urinary and serum neopterin concentrations and any of the PBC-derived ratios. In a cohort of breast cancer patients, a higher NLR predicted poor survival.

The aim of the present study was to evaluate the association between changes in peripheral blood cell count and neopterin concentrations in patients with a history of breast cancer. Peripheral blood cell count, serum ferritin, serum neopterin and urinary neopterin concentrations were determined in 61 patients with a history of breast cancer and 74 control subjects. Hemoglobin, relative lymphocyte count and absolute lymphocyte count were lower, and relative neutrophil count, ferritin and serum neopterin concentrations were significantly higher in breast cancer patients than in controls. Compared to controls, the difference in hemoglobin concentration was statistically significant only in patients with active disease. Significant negative correlations were observed between urinary neopterin and hemoglobin as well as between serum neopterin and relative lymphocyte counts in breast cancer patients. Increased ferritin concentrations were associated with a history of hypertension, but higher absolute lymphocyte counts were associated with hypertension only in subjects without history of cancer. In conclusion, in patients with a history of breast cancer, anemia is associated with disease activity and systemic immune activation. Ferritin concentrations are increased in subjects with hypertension.

The aim of the present study was to evaluate the prevalence of the risk factor of atherosclerosis in patients with history of breast cancer. C-reactive protein, lipoprotein (a), cholesterol, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein cholesterol, triglycerides, homocysteine, fibrinogen, glucose, magnesium, uric acid, and urinary albumin were determined by routine methods in 61 patients with history of breast cancer and 74 control subjects. Urinary neopterin and creatinine concentrations were measured by high-performance liquid chromatography, and intima-media thickness was determined sonographically. Breast cancer patients were significantly older and also had higher systolic blood pressure, glycosylated hemoglobin, lipoprotein (a), serum neopterin, and intima-media thickness. Serum HDL cholesterol and magnesium concentrations were significantly higher in controls compared with patients. Differential patterns of associations between the risk factors of atherosclerosis were observed in patients with history of breast cancer compared with controls. In conclusion, the prevalence of risk factors of atherosclerosis is high in patients with history of breast cancer. Differential associations between risk factors suggest possible differences in the pathogenesis of atherosclerosis in breast cancer patients and controls.

Monocytes/macrophages are thought to play a fundamental role in the development of vascular lesions in atherosclerosis. In the present study, we evaluated circulating CD14+CD16+ monocytes, laboratory parameters of the risk of atherosclerosis, including serum cholesterol, homocysteine and C-reactive protein, urinary neopterin, serum a-tocopherol and retinol along with carotid intima-media thickness in patients with breast carcinoma. A significant correlation was observed between the absolute numbers of CD14+CD16+ monocytes, serum HDL cholesterol and triglyceride concentrations. In conclusion, present data extend the observation of an association between peripheral blood CD14+CD16+ monocyte counts and lipid metabolism to cancer patients. No correlation of CD14+CD16+ monocyte counts with urinary neopterin concentrations was observed.

Increased serum or urinary concentrations of neopterin have been described in patients with tumors of different primary locations, but reports on neopterin in patients with esophageal carcinoma are scanty. We have studied serum neopterin, retinol and alpha-tocopherol in 45 patients with carcinoma of the esophagus or gastroesophageal junction. Serum neopterin was determined using radioimmunoassay. Retinol and alpha-tocopherol were determined by high-performance liquid chromatography. Serum neopterin in patients with carcinoma of the esophagus was significantly increased while retinol and alpha-tocopherol were significantly decreased compared to controls. No correlation of neopterin with hemoglobin or peripheral blood cell counts was observed. During chemoradiation, neopterin increased significantly, while retinol and alpha-tocopherol did not change. In conclusion, the present study demonstrates increased serum neopterin and decreased retinol and alpha-tocopherol concentrations in patients with esophageal carcinoma. Chemoradiation induced a further increase of serum neopterin concentrations.

Increased serum or urinary concentrations of neopterin have been described in patients with tumors of different primary locations, but reports on neopterin in patients with melanoma are scanty. We have studied serum neopterin and a melanoma marker, S-100-beta, in 41 patients with melanoma. Serum neopterin and S-100-beta were determined by immunoassay. Neopterin concentrations were significantly increased compared to controls only in patients with active disease, but not in patients without evidence of disease activity. Serum neopterin and S-100-beta in patients with active disease were higher than in patients without evidence of disease activity. In patients a significant correlation existed between neopterin and S-100-beta (rs = 0.33, p