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UNIWERSYTET MIKOŁAJA KOPERNIKA w TORUNIU

COLLEGIUM MEDICUM im. LUDWIKA RYDYGIERA

W BYDGOSZCZY

MEDICAL AND BIOLOGICAL

SCIENCES

(dawniej ANNALES ACADEMIAE MEDICAE BYDGOSTIENSIS)

TOM XXIII/3 lipiec – wrzesień ROCZNIK 2009

R E D A K T O R N A C Z E L N Y E d i t o r - i n - C h i e f

Grażyna Odrowąż-Sypniewska

Z A S T Ę P C A R E D A K T O R A N A C Z E L N E G O C o - e d i t o r Jacek Manitius

S E K R E T A R Z R E D A K C J I S e c r e t a r y

Beata Augustyńska

R E D A K T O R Z Y D Z I A Ł Ó W A s s o c i a t e E d i t o r s

Mieczysława Czerwionka-Szaflarska, Stanisław Betlejewski, Roman Junik, Józef Kałużny, Jacek Kubica, Wiesław Szymański

K O M I T E T R E D A K C Y J N Y E d i t o r i a l B o a r d

Aleksander Araszkiewicz, Beata Augustyńska, Michał Caputa, Stanisław Dąbrowiecki, Gerard Drewa, Eugenia Gospodarek, Bronisław Grzegorzewski, Waldemar Halota, Olga Haus, Marek Jackowski, Henryk Kaźmierczak, Alicja Kędzia,

Michał Komoszyński, Wiesław Kozak, Konrad Misiura, Ryszard Oliński, Danuta Rość, Karol Śliwka, Eugenia Tęgowska, Bogdana Wilczyńska, Zbigniew Wolski, Zdzisława Wrzosek, Mariusz Wysocki

K O M I T E T D O R A D C Z Y A d v i s o r y B o a r d

Gerd Buntkowsky (Berlin, Germany), Giovanni Gambaro (Padova, Italy), Edward Johns (Cork, Ireland), Massimo Morandi (Chicago, USA), Vladimir Palička (Praha, Czech Republic)

A d r e s r e d a k c j i A d d r e s s o f E d i t o r i a l O f f i c e Redakcja Medical and Biological Sciences

ul. Powstańców Wielkopolskich 44/22, 85-090 Bydgoszcz Polska – Poland

e-mail: [email protected], [email protected] tel. (052) 585-3326

www.medical.cm.umk.pl

Informacje w sprawie prenumeraty: tel. (052) 585-33 26 e-mail: [email protected], [email protected]

ISSN 1734-591X

UNIWERSYTET MIKOŁAJA KOPERNIKA W TORUNIU COLLEGIUM MEDICUM im. LUDWIKA RYDYGIERA

BYDGOSZCZ 2009

Medical and Biological Sciences, 2009, 23/3

CONTENT p.

REVIEWS

W o j c i e c h P o s p i e c h , K r y s t y n a N o w a c k a , I w o n a G ł o w a c k a , D o r o t a

W ł o d a r c z y k - P r z y b y l s k a , M a g d a l e n a H a g n e r - D e r e n g o w s k a , K a t a r z y n a L a t a c k a , E w a K i t s c h k e – The influence of vocal and instrumental forms of Baroque music on the relaxation of patients undergoing oncological diagnosis . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . 5

W o j c i e c h P o s p i e c h , K r y s t y n a N o w a c k a , K a t a r z y n a L a t a c k a , M a g d a l e n a

H a g n e r - D e r e n g o w s k a , D o r o t a W ł o d a r c z y k - P r z y b y l s k a , I w o n a G ł o w a c k a , E w a K i t s c h k e – The influence of march and relaxation music on movement intensification and rest after effort . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

A d r i a n R e ś l i ń s k i , J o a n n a K w i e c i ń s k a , J a k u b S z m y t k o w s k i , E u g e n i a

G o s p o d a r e k , S t a n i s ł a w D ą b r o w i e c k i – Pro- and antiapoptotic properties of bacteria of the Chlamydiaceae family . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

E w a S t y c h n o , A n n a K s y k i e w i c z - D o r o t a – Emotional intelligence – the determinant

conditioning life satisfaction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 ORIGINAL ARTICLES M a ł g o r z a t a A n d r z e j e w s k a , B e r n a d e t a S z c z e p a ń s k a , D o r o t a Ś p i c a , J a c e k

J . K l a w e , M a r t a K u d ł a , J e r z y K a s p r z a k – Occurence of Campylobacter species in surface waters in Bydgoszcz region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27

M i r o s ł a w a C i e ś l i c k a , M a r e k N a p i e r a ł a – The somatic build of lightweight rowers . . . . . . . 33 A n n a G m e r e k , J a n S t y c z y ń s k i , A n n a K r e n s k a , R o b e r t D ę b s k i , M a r i u s z

W y s o c k i – Pneumonia in hematopoietic stem cell recipients during early post-transplant period . . 39 M a g d a l e n a H a g n e r - D e r e n g o w s k a , K r y s t y n a N o w a c k a , W o j c i e c h H a g n e r ,

M a g d a l e n a W i ą c e k - Z u b r z y c k a – Nordic Walking – new trend in rehabilitation . . . . . . . . 45 A l i c j a K ę d z i a , J o w i t a W o ź n i a k , K r z y s z t o f D u d e k – Metrological analysis of topo-

graphy of radial nerve in humeral segment during fetal period . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51 M a r i u s z K l i m c z y k , M i r o s ł a w a C i e ś l i c k a , M i r o s ł a w a S z a r k – Somatic characte-

ristic, strength and sport result in 12-19-year-old pole vault jumpers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59 M a r i u s z K l i m c z y k – Special fitness and a sport result in 19-year-old pole vault jumpers . . . . . . . . . . . 69 E w a K o p c z y ń s k a , R o m a n M a k a r e w i c z , M a c i e j D a n c e w i c z , J a n u s z

K o w a l e w s k i , H a n n a K a r d y m o w i c z , T o m a s z T y r a k o w s k i – The correlation between MMP-9, MMP-2, TIMP-1, VEGF serum concentrations in lung cancer . . . . . . . . . . . . . . . . . . 77

B a r b a r a R u s z k o w s k a , S ł a w o m i r M a n y s i a k , L i l i a n a B i e l i s , B e a t a M a ł e c k a ,

G r a ż y n a D y m e k , L i l l a S e n t e r k i e w i c z , D a n u t a R o ś ć , G r a ż y n a O d r o w ą ż - - S y p n i e w s k a – Fibrinogenolysis in postmenopausal women taking oral hormone replacement therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83

M o n i k a Z a w a d k a , S t a n i s ł a w K r a j e w s k i , W o j c i e c h H a g n e r , J o a n n a P a w l a k ,

K a r o l i n a W i ś n i e w s k a – The influence of Parkinson’s disease on balance disorders . . . . . . . . 89


SPIS TREŚCI str.

PRACE POGLĄDOWE W o j c i e c h P o s p i e c h , K r y s t y n a N o w a c k a , I w o n a G ł o w a c k a , D o r o t a

W ł o d a r c z y k - P r z y b y l s k a , M a g d a l e n a H a g n e r - D e r e n g o w s k a , K a t a r z y n a L a t a c k a , E w a K i t s c h k e – Wpływ wokalno-instrumentalnych form epoki baroku na relaksowanie pacjentów poddanych diagnozie onkologicznej . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . 5

W o j c i e c h P o s p i e c h , K r y s t y n a N o w a c k a , K a t a r z y n a L a t a c k a , M a g d a l e n a

H a g n e r - D e r e n g o w s k a , D o r o t a W ł o d a r c z y k - P r z y b y l s k a , I w o n a G ł o w a c k a , E w a K i t s c h k e – Wpływ muzyki marszowej na intensyfikację ruchu i relaksacyjnej na odpoczynek po wysiłku . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

A d r i a n R e ś l i ń s k i , J o a n n a K w i e c i ń s k a , J a k u b S z m y t k o w s k i , E u g e n i a

G o s p o d a r e k , S t a n i s ł a w D ą b r o w i e c k i – Właściwości pro- i antyapoptotyczne bakterii rodziny Chlamydiaceae . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

E w a S t y c h n o , A n n a K s y k i e w i c z - D o r o t a – Inteligencja emocjonalna – wyznacznik warun-

kujący satysfakcję życiową . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 PRACE ORYGINALNE M a ł g o r z a t a A n d r z e j e w s k a , B e r n a d e t a S z c z e p a ń s k a , D o r o t a Ś p i c a , J a c e k

J . K l a w e , M a r t a K u d ł a , J e r z y K a s p r z a k – Występowanie bakterii z rodzaju Campylobacter w wodach powierzchniowych powiatu bydgoskiego . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27

M i r o s ł a w a C i e ś l i c k a , M a r e k N a p i e r a ł a – Budowa somatyczna wioślarzy wagi lekkiej . . . . 33 A n n a G m e r e k , J a n S t y c z y ń s k i , A n n a K r e n s k a , R o b e r t D ę b s k i , M a r i u s z

W y s o c k i – Zapalenie płuc u biorców komórek hematopoetycznych we wczesnym okresie potransplantacyjnym . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39

M a g d a l e n a H a g n e r - D e r e n g o w s k a , K r y s t y n a N o w a c k a , W o j c i e c h H a g n e r ,

M a g d a l e n a W i ą c e k - Z u b r z y c k a – Nordic walking – nowy trend w rehabilitacji . . . . . . . . . 45 A l i c j a K ę d z i a , J o w i t a W o ź n i a k , K r z y s z t o f D u d e k – Analiza metrologii i topografii

nerwu promieniowego w odcinku ramieniowym w okresie prenatalnym . . . . . . . . . . . . . . . . . . . . . . . . . . 51 M a r i u s z K l i m c z y k , M i r o s ł a w a C i e ś l i c k a , M i r o s ł a w a S z a r k – Budowa somatyczna,

siła a wynik sportowy w skoku o tyczce u zawodników w wieku 12-19 lat . . . . . . . . . . . . . . . . . . . . . . . . 59 M a r i u s z K l i m c z y k – Sprawność specjalna a wynik sportowy u 19-letnich tyczkarzy . . . . . . . . . . . . . . 69 E w a K o p c z y ń s k a , R o m a n M a k a r e w i c z , M a c i e j D a n c e w i c z , J a n u s z

K o w a l e w s k i , H a n n a K a r d y m o w i c z , T o m a s z T y r a k o w s k i – Korelacja stężeń MMP-9, MMP-2, TIMP-1, VEGF w surowicy chorych na raka płuca . . . . . . . . . . . . . . . . . . . . . . . . . . . 77

B a r b a r a R u s z k o w s k a , S ł a w o m i r M a n y s i a k , L i l i a n a B i e l i s , B e a t a M a ł e c k a ,

G r a ż y n a D y m e k , L i l l a S e n t e r k i e w i c z , D a n u t a R o ś ć , G r a ż y n a O d r o w ą ż - - S y p n i e w s k a – Fibrynogenoliza u kobiet w okresie pomenopauzalnym stosujących hormonalną terapię zastępczą drogą doustną . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83

M o n i k a Z a w a d k a , S t a n i s ł a w K r a j e w s k i , W o j c i e c h H a g n e r , J o a n n a P a w l a k ,

K a r o l i n a W i ś n i e w s k a – Wpływ choroby Parkinsona na zaburzenia równowagi . . . . . . . . . . . 89 Regulamin ogłaszania prac w Medical and Biological Sciences . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95

Medical and Biological Sciences, 2009, 23/3, 5-7

REVIEW / PRACA POGLĄDOWA Wojciech Pospiech1, Krystyna Nowacka2, Iwona Głowacka3, Dorota Włodarczyk-Przybylska3, Magdalena Hagner-Derengowska2, Katarzyna Latacka2, Ewa Kitschke2

THE INFLUENCE OF VOCAL AND INSTRUMENTAL FORMS OF BAROQUE MUSIC

ON THE RELAXATION OF PATIENTS UNDERGOING ONCOLOGICAL DIAGNOSIS

WPŁYW WOKALNO-INSTRUMENTALNYCH FORM EPOKI BAROKU NA RELAKSOWANIE

PACJENTÓW PODDANYCH DIAGNOZIE ONKOLOGICZNEJ

1Chair and Department of Music Therapy, Nicolaus Copernicus University Collegium Medicum in Bydgoszcz Head: dr hab. Wojciech Pospiech, prof. UMK

2Chair and Clinic of Rehabilitation, Nicolaus Copernicus University Collegium Medicum in Bydgoszcz Head: dr hab. Wojciech Hagner, prof. UMK

3Chair and Clinic of Neurosurgery and Neurotraumatology, Nicolaus Copernicus University Collegium Medicum in Bydgoszcz

Head: dr hab. Wojciech Beuth, prof. UMK

S u m m a r y

Oncologically diagnosed patients have a wide range of needs. The state of their health, diagnosis, diagnostic and therapeutic procedures are events of great importance for each person. World reports confirm a positive impact of music on oncological patients. The principal and most characteristic feature for Baroque music is the contrast between the high and low notes, and a clearly marked basis

flowing in the background in which one can see harmony. An incredible precision, melodicity and the accumulation of contrast make one relaxed. It is therefore advised and highly justified to conduct further research as well as apply music therapy and Baroque music in therapy for oncologically diagnosed patients.

S t r e s z c z e n i e

Pacjenci diagnozowani onkologicznie mają szeroki zakres potrzeb. Stan zdrowia, diagnoza, postępowanie diagnostyczne i lecznicze są wydarzeniami o ogromnym znaczeniu dla każdego człowieka. Doniesienia światowe potwierdzają korzystny wpływ muzyki na pacjentów onkologicznych. Istotne zastosowanie ma tutaj muzyka barokowa. Cechuje ją kontrast pomiędzy wysokimi i niskimi

rejestracjami oraz wyraźnie zaznaczona płynąca w tle podstawa, w której widać harmonię. Niezwykła precyzja, melodyjność, nagromadzenie kontrastów odpręża i relaksuje. Wskazane są więc i głęboko uzasadnione badania i stoso-wanie muzykoterapii poprzez muzykę barokową u pacjentów diagnozowanych onkologicznie.

Key words: music, music therapy, relaxation music Słowa kluczowe: muzyka, muzykoterapia, relaksacja muzyką

Wojciech Pospiech et al.

6

Oncologically diagnosed patients have a wide range of needs. The state of their health, diagnosis, diagnostic and therapeutic procedures are events of great importance for each person. The situation becomes much more dramatic, if there is a suspicion of malignant neoplasm which, despite widespread public education, still causes concern and anxiety. The process of diagnosing disturbs the life rhythm of patients. The importance of the disease is subjective to each patient. The disease can be described according to Lazarus's theory of mind in the following manner:

a) as a threat – the patient treats the disease as an obstacle in fulfilling their own goals and objectives, an impediment to their future life and existence.

b) as a harm, a loss, for example a woman who has been diagnosed with breast cancer is afraid of losing her breast.

c) a challenge – it is the willingness to fight with obstacles and win the war against the disease

A patient who is suspected of having cancer reacts very emotionally in the first stage. Thinking about the disease causes such reactions as fear, anxiety, restlessness, depression, grief, sense of loss, nostalgia, indifference, aggression, sense of guilt. Patients who are in the process of being diagnosed spend hours outside doctor’s offices awaiting results or their interpretation. They need to take part in relaxation processes, to learn how to minimize negative emotions associated with the disease, which in the future will help them fight against the disease. Music as a form of therapy is of great help in such cases. It has accompanied humanity for thousands of years, always playing a substantial role in our lives. Music has a unique ability to evoke emotions, meets the need for expression, shows what is inside every individual and reaches the depths of our soul showing what is inside. It also reaches the subconscious, regulating physiological processes. Music changes, allows the listener to come closer to the therapist. Music therapy is a constantly evolving discipline and it is becoming increasingly involved in various types of therapies.

The situation of an oncologically diagnosed patient is extremely difficult. Oncological diagnosis entails such negative emotions as nostalgia, idealizing the past, sense of guilt, anxiety, uncertainty. The patient constantly asks the question “Why me? Why did it happen to me?” Suspected oncological disease reverses the course of life of these patients. Their therapy should be directed towards eliminating stress, achieving calmness, relaxation. Baroque music has

therapeutic qualities. Among patients listening to this type of music an improvement of psychic condition has been observed. World reports confirm a positive impact of music on oncological patients. Some authors mention minimizing the fear and pain in patients before and during mammography. Other examples demonstrate the improvement in patients’ moods, increased positive thinking, and reduced fear. Not all reports, however, show a positive effect of music on oncological patients. Kwekkeboom studies did not show significant differences in the elimination of stress between patients within the study group and in the control group. Currently, music therapy is included in the care and diagnosis programs for patients in numerous centers in the United States of America. Hospital employees confirm that music therapy changes their patients, changes their way of thinking into a positive one, they undergo transformation in the positive direction.

Research shows that listening to and composing music reduces the seriousness syndrome among patients with cancer. Other reports confirm the reduction of side effects of cancer treatment (4). Appropriate music for reducing stress associated with cancer diagnosis is Baroque music. Baroque as a period in music history was very colorful and multidimensional, initiated by Peri Jałopa with work entitled Daphne. The principal and most characteristic feature of Baroque music is the contrast between the high and low notes, and a clearly marked basis flowing in the background in which one can see harmony. An incredible precision, melodicity and the accumulation of contrast forces to reflect on the meaning of life. Baroque music also relaxes. Baroque music offered in the oncological ward is relaxing. It affects such parameters as muscle tension (decrease), cardiovascular system (increased pulse), affects the respiratory and gastrointestinal system, decreases the threshold of mental sensitivity. Baroque music offered to oncological patients, its rhythm and pace brings back positive associations and memories. Meetings between oncological patients and music therapists are held in an atmosphere of mutual understanding, openness, so that the patient becomes more open to and willing to cooperate with the therapist. During music therapy sessions, patient’s attention is also shifted from their disease and their mood improves. It is therefore advised and highly justified to conduct further research as well as apply music therapy and Baroque music in the therapy for oncologically diagnosed patients.

The influence of vocal and instrumental forms of baroque music on the relaxation of patients undergoing oncological diagnosis

7

REFERENCES 1. Beck S.L. (1991): The therapeutic use of music for

cancer-related pain. Oncology Nursing Forum, 18, 1327–1337.

2. Kerkvliet G.J. (1990): Music therapy may help control cancer pain. Journal of the NationalCancer Institute, 82, 350–352.

3. Cepeda MS et al: Music for pain relief Cochrane Database SystRev 2006;(2).

4. Michael M. Richardson BM, Adriana E. Babiak-Vazquez, MPH, Moshe A. Frenkel: Music Therapy in a Comprehensive Cancer Center Journal of the Society for Integrative Oncology, Vol 6, No 2 (Spring), 2008: p 76.

5. Abrams, Brian; Decker, Georgia M: Music, Cancer and Immunity Clinical Journal of Oncology Nursing.

6. Kronenberg M.: Muzykoterapia. Podstawy teoretyczne do zastosowania muzykoterapii w profilaktyce stresu, Mediator Sp. z.oo, Szczecin 2006.

Address for correspondence: Katedra i Zakład Muzykoterapii UMK w Toruniu Collegium Medicum im. Ludwika Rydygiera ul. Świętojańska 20 85-077 Bydgoszcz tel.: (052) 585 10 14 w. 109 e-mail: [email protected] Received: 24.03.2009 Accepted for publication: 07.04.2009


REVIEW / PRACA POGLĄDOWA Wojciech Pospiech1, Krystyna Nowacka2, Katarzyna Latacka2, Magdalena Hagner-Derengowska2,

Dorota Włodarczyk-Przybylska3, Iwona Głowacka3, Ewa Kitschke2

THE INFLUENCE OF MARCH AND RELAXATION MUSIC

ON MOVEMENT INTENSIFICATION AND REST AFTER AN EFFORT

WPŁYW MUZYKI MARSZOWEJ NA INTENSYFIKACJĘ RUCHU I RELAKSACYJNEJ NA ODPOCZYNEK PO WYSIŁKU

1Chair and Department of Music Therapy, Nicolaus Copernicus University Collegium Medicum in Bydgoszcz

Head: dr hab. Wojciech Pospiech, prof. UMK 2Chair and Clinic of Rehabilitation, Nicolaus Copernicus University Collegium Medicum in Bydgoszcz

Head: dr hab. Wojciech Hagner, prof. UMK 3Chair and Clinic of Neurosurgery and Neurotraumatology, Nicolaus Copernicus University

Collegium Medicum in Bydgoszcz Head: dr hab. Wojciech Beuth, prof. UMK

S u m m a r y

Music therapy, according to Natason, is a multi optional method which uses various effects of music on the human psychosomatic system. This results in growing interest in the therapy in the medical environment. Among many applications of different types of music, the influence of

march music on movement intensification and relaxation music on rest after an effort have been analyzed. This is still a subject of research currently conducted by the Chair and Clinic of Rehabilitation of Collegium Medicum in Bydgoszcz.


Muzykoterapia to według Natansona metoda wielostronnego postępowania, które wykorzystuje wieloraki wpływ muzyki na psychosomatyczny ustrój człowieka. Wywołuje to coraz większe zainteresowanie w środowisku medycznym. Wśród wielu zastosowań różnych rodzajów

muzyki ostatnio zaczęto zastanawiać się nad wpływem muzyki marszowej na intensyfikację ruchu i relaksacyjnej na odpoczynek po wysiłku. Stanowi to temat badań naukowych prowadzonych obecnie przez Katedrę i Klinikę Rehabilitacji Collegium Medicum w Bydgoszczy.

Key words: music, music therapy, relaxation music Słowa kluczowe: muzyka, muzykoterapia, relaksacja muzyką

Music has been accompanying people’s lives for

thousands of years but it was only in the last century that we observed its rise as a form of therapy. Music has been studied in terms of its influence on each sphere of human life. Not only does it move one’s heart, touches the soul, affecting one’s mental condition but also changes the somatic activities of our

body. As mentioned by Natanson music affects „the entire human psychosomatic system” [1].

This phenomenon is of great interest among doctors and therapists. The concept of music therapy by Lewandowska calls it "one of the forms of psychological and physical therapy" [2]. She also writes that so far “experimental and practical music

Wojciech Pospiech et al.

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therapy shows that music can change the activity of human nervous system, have an effect on certain changes in operations on the entire body, may alter muscle tension, speed up metabolism, change the speed of blood circulation, reduce the sensitivity threshold, influence internal secretion, have an impact on strength and rapidity of pulse, respiration, etc." [2]. These observations clearly justify using music therapy in such fields of medicine as anesthesiology, neurophysiology, gynecology, obstetrics, geriatrics, neuropsychology, especially in cases of delayed development, brain damage, in patients with early autism, behavior disorders, neurosis as well as in paralyzed, deaf and blind children and pediatrics for preventive purposes. One cannot ignore that it is also of great importance for the rehabilitation of the locomotor system, where mobility is also important for patients from all of the above mentioned clinics. The manner in which the music therapy is conducted cannot always be the same. It depends on the diagnosis, symptoms, treatment, and treatment period.

Although music therapy has been known in Poland since the 50’s, little has been said about it so far. In the Polish medical literature, few reports can be found on its healing qualities. It also proves still how little is its use in Polish hospitals, sanatoriums, various medical centers, in contrast to western countries. Implementation projects concerning music therapy have been created and will certainly bring a lot of good. The Chair and Clinic of Rehabilitation of the Collegium Medicum in Bydgoszcz undertook research to examine the impact of march music on the movement intensification and the influence of relaxation music after an effort.

March music as a form of music was born in the seventeenth century, along with the rise of stage forms and Baroque instruments. It is characterized by simple melodies with strong rhythm, supported with a three key theme, often inspired by a short sound played on a wind instrument. As early as in the ancient Rome march music accompanied cavalry parades therefore march has been often understood as military music. In Poland, ever since the reign of Jan III Sobieski, separate music ensembles have been formed which performed march music during military marches. At the turn of the eighteenth and nineteenth century, march music as a fully artistic form began to be included into suites, sonatas, symphonies, and later operas and ballets. The most important element of march music is rhythm. It has its most perfect

counterpart in the motion of a human, since it influences it most strongly. Moreover, it also influences human internal rhythms, which are often the driving force behind our actions and feelings. This represents a kind of unconditional stimulus for the movement which shows the purpose of linking it with the motion. This would explain the use of this type of music in order to intensify, stimulate or initiate movement. Rhythm was used in rehabilitation for the first time by Peter Egela in 1883. Due to its therapeutic qualities, march music is considered as activating music.

Relaxation music consists primarily of instrumental works with a slow pace, recognizable melody with a soft sound and small dynamics. According to Galinska it is characterized, (1981), among other things by: short duration (3 ÷ 10 min), slow pace, low volume and lack of dynamic contrasts, flow of melody and rhythm, prevalence of steady, "rocking", rhythms, presence of minor culmination points, allowing the patient to balance between tension and relaxation, the regularity of the course. Calm songs help relax. They include classical, popular and electronic music, as well as so recently popular sounds of the nature and animal world. Music therapy can certainly be used as an addition to rehabilitation. Using music seems very purposeful during rest after for example a series of physical exercise. Relaxing melodies help in breathing and relaxing exercises, may decrease pain, relieve from stress, depression and related diseases, bring relief, help fight obstacle, improve comfort, and restore internal harmony by stimulating the body's defense mechanism against disability. Recent scientific reports inform about the impact of works of Beethoven, Vivaldi and Strauss on the harmonization and integration of heart and brain rhythm. The differences in music sensitivity between particular individuals require however an appropriate selection of music and the way it is listened to.

Patients in rehabilitation centers fight for recovering their mobility. Great emphasis in their therapeutic program is put on the movement. It is important that the patient is properly activated to exercise. Daily exercise, however, involve fatigue and often stress associated with the difficulties that overcoming disability entails. Music therapy is a tool that can stimulate, calm or quieten the patient, depending on the need and the stage of kinetic-therapeutic session. It may make recovery time more comfortable and shorten it at the same time.

The influence of march and relaxation music on movement intensification and rest after an effort

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A development of this interesting topic should be expected upon completion of research undertaken in the Chair and Clinic of Rehabilitation. Let us hope that this also ensures that this unique tool- music therapy- is fully implemented. REFERENCES 1. Budziarek J.: Historia, www.muzykoterapia.cba.pl . 2. Dega W., Milanowska K.: Rehabilitacja medyczna.

PZWL, 1993. 3. Galińska E.: Diagnostyczne i terapeutyczne aspekty

stosowania muzyki w lecznictwie. Polski Tygodnik Lekarski, nr 26, 1981.

4. Kuch J.: Rehabilitacja. PZWL, Warszawa 1989. 5. Lewandowska K.: Muzykoterapia dziecięca. Studio

„NORMA”, Gdańsk 1996. 6. Milanowska K.: Kinezyterapia. PZWL, Warszawa 1999. 7. Natanson T.: Programowanie muzyki terapeutycznej.

Akademia Muzyczna im. K. Lipińskiego we Wrocławiu, Wroclaw 1992.

8. Nordoff P., Robbins C.: Terapia muzyką w pracy z dziećmi niepełnosprawnymi. Historia, metoda i praktyka. Oficyna Wydawnicza IMPULS, Kraków 2008.

9. Weiss M., Zembaty A.: Fizjoterapia. PZWL, Warszawa 1993.

Address for correspondence: Katedra i Zakład Muzykoterapii UMK w Toruniu Collegium Medicum im. Ludwika Rydygiera ul. Świętojańska 20 85-077 Bydgoszcz tel.: (052) 585 10 14 w. 109 e-mail: [email protected] Received: 24.03.2009 Accepted for publication: 07.04.2009


REVIEW / PRACA POGLĄDOWA Adrian Reśliński1, Joanna Kwiecińska2, Jakub Szmytkowski1, Eugenia Gospodarek2, Stanisław Dąbrowiecki1

PRO- AND ANTIAPOPTOTIC PROPERTIES OF BACTERIA

OF THE CHLAMYDIACEAE FAMILY

WŁAŚCIWOŚCI PRO- I ANTYAPOPTOTYCZNE BAKTERII RODZINY CHLAMYDIACEAE

1Chair and Clinic of General and Endocrine Surgery, Nicolaus Copernicus University, Collegium Medicum in Bydgoszcz, Poland

Head: dr hab. n. med. Stanisław Dąbrowiecki, prof. UMK 2Chair and Department of Microbiology Nicolaus Copernicus University,

Collegium Medicum in Bydgoszcz, Poland Head: dr hab. n. med. Eugenia Gospodarek, prof. UMK

S u m m a r y

Bacteria of the family Chlamydiaceae are obligate intracellular pathogens that are known to cause conjunctivitis, trachoma, pneumonia and the most common sexually transmitted diseases. The family Chlamydiaceae involves two genera: Chlamydia and Chlamydophila. The bacteria exist in two developmental forms: an infectious metabolically inactive elementary body (EB) and a noninfectious metabolically active reticulate body (RB).

Apoptosis (programmed cell death) is a process that plays an important role in the maintenance of homeostasis in multicellular organisms. It can be either initiated by an extrinsic or intrinsic pathway. Both pathways lead to the activation of caspases, a family of specific cysteine proteases.

Chlamydiaceae can induce caspase-independent apoptosis in infected and uninfected cells. The programmed

cell death requires the activation of the Bax proapoptotic protein, a member of the Bcl-2 family. There is evidence that Chlamydia-infected macrophages induce apoptosis of T cells by a humoral mechanism and direct cell-to-cell contact.

Chlamydiaceae can also inhibit programmed cell death. The bacteria inhibit apoptosis of infected cells by degradation of proapoptotic BH3-only proteins and sequestration of protein kinase Cδ (PKCδ) on the inclusion vacuole or in its immediate vicinity. Chlamydiaceae prevent programmed cell death by activation of the nuclear factor kappaB (NF-кB) and phosphatidylinositol-3-kinase/Akt (PI3K/Akt) pathway.

The mechanism of pro- and antiapoptotic bacterial activity is complex and not fully explained.


Bakterie rodziny Chlamydiaceae są bezwzględnymi patogenami wewnątrzkomórkowymi, powodującymi zapalenie spojówek, jaglicę, zapalenie płuc oraz choroby przenoszone drogą płciową. Rodzina Chlamydiaceae obejmuje dwa rodzaje: Chlamydia i Chlamydophila. Bakterie występują w dwóch formach rozwojowych: zakaźnego, metabolicznie nieaktywnego ciałka elementarnego (EB) oraz niezakaźnego, metabolicznie aktywnego ciałka siateczkowatego (RB).

Apoptoza (zaprogramowana śmierć komórki) jest procesem odgrywającym istotną rolę w utrzymaniu homeostazy w organizmach wielokomórkowych. Może być zapoczątkowana na drodze wewnątrz- i zewnątrzpochodnej. Zarówno droga wewnątrzpochodna, jak i zewnątrzpochodna prowadzą do aktywacji kaspaz, rodziny specyficznych proteaz cysteinowych.

Chlamydiaceae mogą indukować niezależną od kaspaz apoptozę w komórkach zakażonych oraz niezakażonych. Zaprogramowana śmierć komórek wymaga aktywacji

Adrian Reśliński et al.

14

proapoptotycznego białka Bax należącego do rodziny Bcl-2. Istnieją dowody, że makrofagi zakażone bakteriami rodzaju Chlamydia powodują apoptozę komórek T w mechanizmie humoralnym oraz w wyniku bezpośredniego kontaktu komórka-komórka.

Chlamydiaceae mogą także hamować zaprogramowaną śmierć komórek. Bakterie hamują apoptozę poprzez degradację proapoptotycznych białek BH3-only oraz

sekwestrację kinazy białkowej Cδ na wodniczkach lub ich bezpośredniej bliskości. Chlamydiaceae zapobiegają także zaprogramowanej śmierci komórek poprzez aktywację czynnika jądrowego NF-кB oraz szlaku obejmującego 3-kinazę fosfatydylinozytolu oraz kinazę Akt.

Mechanizm pro- i antyapoptotycznego działania bakterii rodziny Chlamydiaceae jest złożony i nie w pełni wyjaśniony.

Key words: Chlamydiaceae, apoptosis, programmed cell death Słowa kluczowe: Chlamydiaceae, apoptoza, zaprogramowana śmierć komórki INTRODUCTION

Bacteria of the Chlamydiaceae family are obligate intracellular pathogens. They belong to the order Chlamydiales, along with the following families: Parachlamydiaceae, Waddiaceae, Simkaniaceae as well as a group of unclassified chlamydias. The family Chlamydiaceae includes two genera: Chlamydia and Chlamydophila [1].

Chlamydia species include: Ch. trachomatis, Ch. suis, Ch. muridarum. The genus Chlamydophila consists in the following species: Chl. pneumoniae, Chl. pecorum, Chl. abortus, Chl. psittaci, Chl. felis, Chl. caviae [1].

The Chlamydiaceae family includes a few species being obligate human pathogens. These can cause diseases, transmitted in different ways depending on the species. Ch. trachomatis is the etiological factor of nongonococcal urethritis and cervicitis, transmitted sexually (sexually transmitted diseases, STD). Some strains cause chronic conjunctivitis and trachoma. The airborne Chl. pneumoniae is responsible for respiratory infections and asthma [2].

The life cycle of Chlamydiaceae includes two types of cells, the first being small cells (approx. 0.2-0.4 µm), known as elementary bodies (EB). This form is capable of infecting host cells. These cells have a rigid cell wall, with characteristic disulfide cross-bonds between the major outer membrane proteins (MOMP) and cystein – rich proteins. Another characteristic trait is the lack of peptidoglycan [2, 3].

Within an hour of infection, EBs transform into the second cell type, the reticulate bodies (RB). These are a few times larger than EBs and cannot exist independently outside the host cell. During the transformation of EBs into RBs, the cross-bonds are broken down, which increases the metabolic activity and ion transport into the cell [2, 3].

As a result of a complex rearrangement,

accompanied by DNA, RNA and protein synthesis, RBs transform into EBs. Within a few dozen hours, the infected cell lyses and EBs are released, ready to infect further cells [3].

Under certain circumstances, RBs may transform into noninvasive and nonreplicating persistent bodies (PB). This may be triggered by various factors, associated mainly with unfavorable environment. A lack of necessary nutrients slows down the replication cycle of the bacteria in the host cell [3].

Chlamydiaceae interfere with the infected cell’s life cycle in various ways, one of them being a decrease in the expression of the major histocompatibility complex (MHC) surface antigens, which helps avoid an immune reaction. A crucial role is played by the type three secretion system (TTSS), secreting numerous proteins contributing to the early phase of the bacteria’s life cycle [2]. Chlamydiaceae have been shown to both induce [4, 5, 6] and prevent apoptosis of the host cells [7, 8, 9].

APOPTOSIS

Apoptosis is a process ensuring proper development of organisms. Due to its unique regulatory mechanisms, it is also described as programmed cell death. Apoptosis occurs in cells which are deemed abnormal, expendable or harmful to the organism. Abnormalities in its course or regulation may lead to many pathologies and cause numerous diseases.

There are a few apoptotic pathways, all converging at the point of effector caspase activity. Caspases are cysteine proteases with an ability to break down certain cellular proteins. They are divided into two groups: initiator caspases – stimulated by various factors and effector caspases, responsible for the final

Pro- and antiapoptotic properties of bacteria of the Chlamydiaceae family

15

effect of apoptosis – the formation of apoptotic bodies [10].

Scientists assume that four pathways of apoptosis initiation exist. Two of those are activated by extracellular signals, such as Fas receptor ligands and granzymes. The remaining pathways respond to signals derived from within the cell, activating the release of proapoptotic molecules from the mitochondria or possibly related to the activation of endoplasmic reticulum [10].

The best known pathway of apoptosis initiation is the receptor pathway, activated by an extrinsic ligand binding to a surface receptor. These receptors belong to the family of transmembrane receptors for the tumor necrosis factor (tumor necrosis factor receptors, TNFR). Their specific trait is the presence of a unique death domain (DD), which oligomerises after the ligand binds with the extracellular portion of the receptor and activates adaptor molecules : the Fas-associated protein with death domain (FADD) or the TNF receptor-associated protein with death domain (TNFADD), as well as procaspase -8. This way, a death inducing signaling complex (DISC) is formed, which possesses the capacity for autocatalytic proteolysis of procaspase – 8 and probably procaspase-10, which activate effector caspases, predominantly caspase - 3 [10].

The other extrinsic mechanism of apoptotic induction is based on the interaction between grazyme particles and cell perforins. Granzymes are serine caspase – like proteases, released from the cytotoxic granules of NK cells and T lymphocytes. Five classes of human granzymes have been identified: A, B, H, K and M, B class being responsible for the initiation of apoptosis. It requires perforin activity, damaging the cellular membrane and allowing B granzyme to pass inside the cell. Once in the cell, B granzyme directly activates caspases-3, -7, -8 and -10, therefore initiating apoptosis [11].

The intracellular pathway of apoptotic initiation may include two cellular structures. The mitochondrial pathway has been best investigated. The factors initiating this pathway include: an increase in intracellular calcium ion concentration, the presence of reactive forms of oxygen, oxidative stress, disturbances in electrolyte transport or damage to genetic material. The inducing factor causes characteristic changes within the mitochondrial membrane, including altered polarization and new canal formation, enabling the escape of molecules within the mitochondrion. These

include: cytochrome C, apoptosis inducing factor (AIF), G endonuclease, Smac/DIABLO protein (second mitochondria derived activator of caspase/direct IAP binding protein with low IP) [12].

Of particular importance for the initiation of apoptosis is the release of cytochrome C, which binds in the cytoplasm with Apaf-1 and procaspase-9, with the participation of ATP, to create an apoptosome. This is a structure with the capability for the proteolysis of caspase – 9 zymogen to its active form, which can activate the caspase cascade [12].

The other cellular structure participating in apoptotic induction is the endoplasmic reticulum ( ER). The outer membrane of the ER is associated with procaspase-12, which is activated to caspase – 12, most likely being the initiating caspase. The exact mechanism of procaspase – 12 activation is unknown. Hypotheses include the role of m-calpain which displays the activity of a cystein protease or Apaf-1 – like protein [10].

Regardless of the pathway of apoptotic initiation, its next stage includes the activity of effector caspases, i.e.: -3, -7, -8. These caspases possess the capability to break down many proteins, the most important of those being poly(ADP-ribose)polymerase (PARP), apoptose inhibitors or DNases. Besides playing a role in the mechanism of apoptosis, they also serve many other purposes such as stopping the cell cycle and directing the cell to the DNA repair pathway [10].

As a result of structural alterations of numerous proteins and the fragmentation of DNA by DNases, characteristic changes occur in the morphology of the cell. These include the shrinking of cellular organelles, their fragmentation and formation of pores within the cellular membrane leading to the escape of cytoplasmic elements. The final effect is the formation of apoptotic bodies, containing fragmented DNA and parts of cellular structures. The cell dies and vanishes without a trace [10]. Figure 1 shows the activation of caspases during apoptosis.


16

Ryc. 1. Apoptoza – aktywacja kaspaz Fig. 1. Apoptosis – the activation of caspases APOPTOTIC INDUCTION

Bacteria of the Chlamydiaceae family have the capability to induce programmed cell death. As Ojcius et al. have shown in their research [4], Chl. psittaci induces caspase-independent apoptosis in macrophages and epithelial cells. Characteristic features of apoptosis appear 24 hours after infection both in the infected cells and in neighboring non-infected ones. According to the authors, the infected cells may secrete pro-apoptotic factors responsible for the programmed death of non-infected cells [4]. These might include tumor necrosis factor α (TNFα) or other cytokines [5]. According to Perfettini et al. [13] the apoptotic ativity of Chl. psittaci depends on the activity of Bax, a protein of the Bcl-2 family. In infected cells the Bax protein is activated and moves from the cytosol to the mitochondrion [13], where it induces the release of cytochrome c [14].

Caspase – independent programmed cell death may also be induced by Chl. pneumoniae. Apoptosis of human coronary artery endothelial cells (HCAECs) begins within two hours of infection, and is mediated by the Bax and AIF proteins [6]; AIF being a mitochondrial intermembrane flavoprotein. After release into the cytosol it moves to the nucleus, where it induces caspase – independent chromatin concentration and DNA fragmentation. It has also been

show to slow down cytochrome c release from the mitochondrion [15].

Macrophages infected with Ch. trachomatis induce T cell apoptosis [16]. The programmed death of these cells might be caused by direct cell –cell interaction or by the activity of humoral factors. The cell-cell mechanism of T cell apoptotic induction is not known, however it has been proven that apoptosis cannot be prevented by blocking the death receptors on

the surface of the lymphocyte.. According to researchers, TNFα secreted by infected macrophages is the humoral factor inducing the programmed death of T lymphocytes. As Jendro et al. have shown [16], it alone is insufficient to induce T cell apoptosis. There is likely another factor involved. Perhaps this other factor is the Chlamydia protein associating with death domain (CADD), which has been shown to induce caspase – dependent apoptosis in various types of mammalian cells. The CADD protein interacts with cytoplasmic death domains of the receptors of the TNF family, such as TNFR1, Fas, DR4 and DR5 [17]. Thus, it is possible that the CADD plays a role in the induction of apoptosis requiring a direct contact between the infected macrophage and the T cell, as it does not interact with receptors on the cell surface.

Chlamydia heat shock protein 60 (Chlamydia HSP60) is another factor capable of inducing apoptosis in cells infected with Ch. trachomatis. Acting via the Toll-like receptor, TLR4), it induces programmed death of human primary trophoblasts, placental fibroblasts and the JEG3 trophoblast cell line. It has been noted that the apoptosis of placental fibroblasts is caspase – dependent, whereas in JEG3 cells it occurs independently of these proteases [18].

ANTIAPOPTOTIC ACTIVITY

Bacteria of the Chlamydiaceae family have also been shown to have an antiapoptotic effect on host

I Faza inicjatorowa zewnątrzkomórkowa I The extracellular initiator phase

I Faza inicjatorowa wewnątrzkomórkowa I The intracellular initiator phase

II Faza efektorowa II The effector phase

III Faza destrukcji komórki III The destruction of cell phase

TNFR

DD

Prokaspaza-8

Białk

a ad

apto

row

e Perforyny

Granzym B Ligand

Kaspaza-7

Kaspaza-8 Kaspaza-3

Kaspaza-10? Kaspaza-8

Prokaspaza-12

Siateczka śródplazmatyczna

Kaspaza-12

Kaspaza-7

Kaspaza-9

Mitochondrium

Apoptosom


17

cells. It has been noted that the release of cytochrome c from the mitochondrion is blocked in infected cells [7, 19].

One of the mechanisms leading to the blockade of cytochrome c release from the mitochondria is the proteolytic degradation of BH3-only (Bcl-2 homology domain only) proteins, such as: Bim, Puma, Bad [7], Bmf, Noxa, tBid [20], and Bik [21]. BH3-only proteins are proapoptotic factors belonging to the family of Bcl-2 proteins. Under physiological conditions, their expression in the cell is low, or they appear in the cytoplasm in inactive forms. If apoptose – inducing stimuli are present, they become activated in various mechanism, such as: transcription induction (Puma, Noxa, Bim), release from sequestration sites (Bim and Bmf), dephosphorylation (Bad) and proteolytic modification (Bid). These protein then move to the mitochondrion, where they activate the Bax and Bak proteins, resulting in increased permeability of the outer mitochondrial membrane and release of cytochrome c, among others. BH3-only proteins also bind with antiapoptotic proteins of the Bcl-2 family, neutralizing them [22].

The proteolytic degradation of BH3-only proteins begins 16-24 hours after infection [7, 20]. According to Pirbhai et al. [23], the degradation in Ch. Trachomatis – infected cells is caused by the release of CPAF (Chlamydial protease/proteasome-like activity factor) into the cytosol.

Other species of the Chlamydiaceae family have been proven to possess antiapoptotic properties associated with the retardation of proapoptotic Bax and Bak protein activation. These include: Ch. muridarum, Chl. caviae and Chl. psittaci [8].

The retarding influence of Chlamydia on programmed cell death, resulting from a blockade of cytochrome c release, might also be associated with the sequestration of protein kinase Cδ (PKCδ) on the vacuoles or in their immediate vicinity [24]. PKCδ is a proapoptotic enzyme. After activation it moves to the mitochondrion, where it influences the release of cytochrome c [25]. As Tse et al. have shown [24], the separation of protein kinase Cδ from its target is caused by the binding of the enzyme’s C1 domain by diacylglycerol (DAG) present in the vacuoles.

The mechanism of the antiapoptotic activity displayed by bacteria of the genus Chlamydophila might be associated with NF-кB (nuclear factor-κB) [9, 26]. NF-кB regulates the expression of more than 100 genes. In the eukaryotic cell, NF-κB is composed of

Rel molecules: NF-κB1 (p105/p50), NF-κB2 (p100/p52), RelA (p65), c-Rel, RelB. The most common form of NF-κB is a dimer composed of RelA and NF-κB1 [27]. It is present in the cytoplasm as a complex with its inhibitor – IκB. Due to activation, in the case of bacteria or their products by way of the TLR receptors, IκB – kinases (IKK) are activated, which cause proteolytic degradation of IκB in an ubiquitin – dependent pathway. After being released from its inhibitor, NF-κB is transported to the nucleus, where it regulates the expression of certain genes, among them those associated with apoptosis [27].

As Wahl et al. have shown [26] in the Mono Mac 6 monocyte cells infected with Chl. pneumoniae an NF-кB –dependent expression of the c-IAP 2 (cellular inhibitor of apoptosis 2) occurs. The c-IAP 2 protein prevents apoptosis through binding and blocking caspase -3, -7 and -9 [28]. Paland et al. [9] have also documented that the blockade of programmed death of epithelial cells by Chl. pneumoniae requires NF-кB. Reports have also appeared, excluding NF- кB from apoptose prevention. According to Fischer et al. [19] the antiapoptotic effect of Chl. pneumoniae on HeLa cells, associated with the blockade of cytochrome c release and the activation of the caspase cascade that depends on it, does not depend on the NF-κB transcriptive factor.

The antiapoptotic activity of Ch. trachomatis is also related to the transmitter pathway including phosphatydylinositol 3-kinase (PI3K) and Akt kinase [29]. phosphatydylinositol 3-kinase is an enzyme which is responsible for the transformation of phosphatidylinositol 4,5-diphosphate to phosphatidylinositol 3,4,5-triphosphate, which changes the conformation of Akt kinase, enabling the activation of this enzyme. Akt kinase, known also as protein kinase B (PKB) regulates many of the intracellular processes, including apoptosis. It slows down programmed cell death, acting directly on proapoptotic factors such as: Bax, Bak, Bad. It phosphorylates caspase -9 and decreases its activity. The antiapoptotic activity of Akt kinase is also associated with the regulation of transcription factors (AFX, FKHR, FKHRL1, NF-кB, CREB) controlling pro – and antiapoptotic genes. Akt kinase has the capability to prevent apoptosis by altering cell metabolism [30].

According to the research of Verbeke et al. [29], infecting HeLa cells with Ch. trachomatis induces the activation of Phosphatidylinositol-3 kinase, which in turn causes the activation of Akt kinase. Active Akt


18

kinase phosphorylates the Bad protein. Phosphorylated proapoptotic Bad protein binds with the InG protein present in the membrane of cytoplasmic inclusion bodies via the 14-3-3β adaptor protein. Sequestration of Bad protein on the surface of the cytoplasmic inclusion body prevents it from migrating into the mitochondrion and releasing cytochrome c. The mechanism of PI3K activation in infected cells remains unknown. Perhaps the bacteria produce a proapoptotic factor which is moved into the cytosol via the TTSS. According to those authors, the activation of PI3K may be the effect of oxidative stress induced by the infection.

SUMMARY

Apoptosis is a process playing an important role in the pathogenesis of the diseases caused by bacteria belonging to the Chlamydiaceae family. Proapoptotic activity enables these microorganisms to leave the infected cells, eliminate phagocytes and stimulation of inflammatory response. Their antiapoptotic properties protect them from premature lysis of infected cells, providing the bacteria with a favorable environment.

The mechanisms of pro – and antiapoptotic activity of Chlamydiaceae is complex and has not been fully explained. Therefore, conflicting reports exist. Further research aimed at a better understanding of the influence of these bacteria on host cells is mandatory. BIBLIOGRAPHY 1. Pawlikowska M., Deptuła W.: Chlamydie środo-

wiskowe – nowe patogeny człowieka i zwierząt. Post. Mikrobiol. 2007; 46: 59-67.

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21. Dong F., Pirbhai M., Xiao Y. et al.: Degradation of the proapoptotic proteins Bik, Puma and Bim with Bcl-2 Domain 3 Homology in Chlamydia trachomatis-infected cells. Infect. Immun. 2005; 73: 1861-1864.

22. Shibue T., Taniguchi T.: BH3-only proteins: integrated control point of apoptosis. Int. J. Cancer 2006; 119: 2036-2043.

23. Pirbhai M., Dong F., Zhong Y. et al.: The secreted protease factor CPAF is responsible for degrading


19

proapoptotic BH-3-only proteins in Chlamydia trachomatis-infected cells. J. Biol. Chem. 2006; 281: 31495-31501.

24. Tse S.M., Mason D., Botelho R.J. et al.: Accumulation of diacyloglycerol in the Chlamydia inclusion vacuole: possible role in the inhibition of host cell apoptosis. J. Biol. Chem. 2005; 280: 25210-25215.

25. Majumder P.K., Pandey P., Sun X. et al.: Mitochondrial translocation of protein kinase Cδ in phorbol ester-induced cytochrome c release and apoptosis. J. Biol. Chem. 2000; 275: 21793-21796.

26. Wahl C., Maier S., Marre R. et al.: Chlamydia pneumoniae induces the expression of inhibitor of apoptosis 2 (c-IAP2) in human monocytic cell line by an NF-kappaB-dependent pathway. Int. J. Med. Microbiol. 2003; 293: 377-381.

27. Rutkowski R., Panacewicz S.A., Skrzydlewska E. et al.: Właściwości biologiczne czynnika transkrypcji jądrowej NF-κB. Alert. Astma Immun. 2005; 10: 125-131.

28. Deveraux Q.L., Reed J.C.: IAP family proteins – suppressors of apoptosis. Genes Dev. 1999; 13: 239-252.

29. Verbeke P., Welter-Stahl L., Ying S. et al.: Recruitment of Bad by the Chlamydia trachomatis vacuole correlates with host-cell survival. PLoS Pathogens 2006; 2: 408-417.

30. Song G, Ouyang G., Bao S.: The activation of Akt/PKB signaling pathway and cell survival. J. Cell. Mol. Med. 2005; 9: 59-71.

Corresponding author: Adrian Reśliński Chair and Clinic of General and Endocrine Surgery Nicolaus Copernicus University Collegium Medicum in Bydgoszcz ul. M. Skłodowskiej-Curie 9 85-094 Bydgoszcz tel.: (052) 585-47-30 Received: 4.09.2007 Accepted for publication: 23.03.2008


REVIEW / PRACA POGLĄDOWA Ewa Stychno, Anna Ksykiewicz-Dorota

EMOTIONAL INTELLIGENCE – THE DETERMINANT

CONDITIONING LIFE SATISFACTION

INTELIGENCJA EMOCJONALNA – WYZNACZNIK WARUNKUJĄCY SATYSFAKCJĘ ŻYCIOWĄ

Chair and Department of Management in Nursing Faculty of Nursing and Health Sciences

Medical University of Lublin Head: prof. dr hab. Anna Ksykiewicz-Dorota

S u m m a r y

According to some scientists, Intelligence Quotient by itself is not a very good predictor of job performance. Intelligence Quotient predicts less than 20% of career success. Research conducted over the recent 20 years has clearly shown that a leader’s emotional intelligence is more important than Intelligence Quotient. Emotional Quotient constitutes a factor conditioning career success and life-satisfaction .

Emotional Intelligence is the ability to identify and understand one’s emotions, allowing one to manage those emotions and hence one’s behavior more effectively.

Emotional Intelligence is increasingly relevant to organization’s development and development of its human resources, because the Emotional Intelligence principles provide a new way to understand and assess people's behaviors, attitudes, interpersonal skills, and potential. It is an important aspect in human resources planning, job profiling, recruitment and selection, management of workers’ development. Unlike Intelligence Quotient, Emotional Intelligence can be learned and developed.


Zgodnie z opinią niektórych naukowców, sama inteligencja ogólna nie wystarcza do osiągania dobrych wyników w pracy. Iloraz inteligencji zapewnia mniej niż 20% sukcesu zawodowego. Badania przeprowadzone w ciągu ostatnich 20 lat wyraźnie pokazały, że dla liderów ważniejsza od inteligencji ogólnej jest inteligencja emocjonalna. Ona warunkuje sukces w karierze i satysfakcję życiową.

Inteligencja emocjonalna to zdolność identyfikowania i rozumienia swoich emocji, umożliwiająca bardziej

efektywne zarządzanie tymi emocjami, a przez to i zachowaniem. Inteligencja emocjonalna jest coraz bardziej istotna dla rozwoju organizacji i jej zasobów ludzkich, ponieważ pozwala zrozumieć i ocenić zachowania ludzi, ich postawy, umiejętności interpersonalne i potencjał twórczy. Jest ona ważnym aspektem w planowaniu kadr, profilowaniu pracy, rekrutacji i selekcji, zarządzaniu rozwojem pracowników. W odróżnieniu od inteligencji ogólnej, inteligencji emocjonalnej można się nauczyć i ją rozwijać.

Key words: emotional intelligence, manager, medical team, life-satisfaction Słowa kluczowe: inteligencja emocjonalna, menedżer, zespół medyczny, satysfakcja życiowa

Ewa Stychno, Anna Ksykiewicz-Dorota

22

Modern science of administration and management brought about significant changes concerning the desired model of a manager. For many years it has been considered that a manager, in order to fulfil well the managing duties, should be primarily an intelligent person. Before taking the position of a manager, the candidate undergoes a number of tests for general intelligence. These tests investigated the skills of logical thinking and quick reasoning, which was a guarantee of achieving occupational success.

The studies by Mayer and Salovey showed that people with brilliant intelligence are not always successful at work and in their personal lives [1].

The intelligence quotient decides about life success and satisfaction only in 20%, and consequently, a high intelligence quotient does not guarantee success in all areas of life [2, 3, 4, 5].

The lack of possibilities to foresee the course of an occupational career on the basis of intelligence quotient inclined the researchers to change the method of examination of the premises of occupational success based on intelligence [6, 7].

It turned out that other factors play a considerably greater role than rational intelligence itself. These factors are defined as emotional intelligence.

Goleman analysed outstanding and average employees from the aspect of competence, and observed that in over 80%, irrespectively of the position occupied, they differed in competence derived from emotional intelligence [8].

While carrying out studies concerning the management skills of supervisors, the author noticed that intellectual skills are necessary to achieve success. Despite this, emotional intelligence turned out to be twice as important as other factors in the activity of a manager at each level. The role of this intelligence increased at higher levels, where the differences in technical skills are insignificant [8].

The objective of the presented study is an attempt to explain the problem of emotional intelligence, and the justification for its development at work and in everyday life.

Various definitions of emotional intelligence can be found in literature.

Salovey and Mayer define this concept as “the ability to monitor one's own and others' feelings and emotions, to discriminate among them, and to use this information to guide one's thinking and actions” [9].

According to Gardner, emotional intelligence is a set of non-intellectual abilities, competence and skills

affecting the capabilities of an individual to cope effectively with the expectations of the environment (inter- and intra-personal skills), stress, adaptation skills and general mood [10].

Goleman played the most important role in the dissemination of the idea of emotional intelligence, and defined it as an open and decisive expression of own opinions and emotions, execution of own rights and decision making [11].

According to Goleman, emotional intelligence consists of the following five domains:

- self-awareness; - self-regulation - motivation; - empathy; - social skills [11, 12]. The first three domains: self-awareness, self-

regulation and motivation, belong to “personal competence”, while empathy and social skills to “social competence”.

Self-awareness is self-confidence, understanding of faults, own emotional states, capabilities, and their effect on an individual and the environment [11].

Proper understanding of own emotional states is necessary in order to handle one’s behaviour appropriately [6].

People with strong self-awareness: – are honest with respect to themselves and others; – perceive in what way their feelings (e.g. anger)

affect them, others, and their success at work; – talk about their behaviour without inhibition; – expect and provide constructive criticism [12].

Self-regulation is controlling own emotions, which cannot be avoided, but which may be managed. Performing an occupation, e.g. as a nurse, requires a constant confrontation with a group of people or with an individual – these are a continuous series of complicated interpersonal relationships. In order to adapt to the changing circumstances one should skilfully manage own emotional responses. When one manages to understand and accept own emotions the best solution comes by itself [6].

Motivation is also a component of emotional intelligence. It means taking over initiative and constant improvement on the way to achieve the delineated goal.

People with strong internal motivation: – are rarely satisfied with their former

achievements, are willing to have achievements beyond expectations;

Emotional intelligence - the determinant conditioning life satisfaction

23

– are the motive power of transformation of good organization into an excellent one;

– establish standards, because they want their achievement to be measured by means of unequivocal criteria;

– do not ascribe success only to themselves, but also to others;

– assume full responsibility for poor results of the functioning of an organization, and never blame others, external factors or unfortunate coincidence;

– approach failures as new opportunities for learning [12].

The skill of motivating oneself allows to achieve occupational goals. People possessing low self-motivation, even those who are very intelligent and talented, will work below their capabilities, and therefore their work will be less effective [13].

Empathy is the ability to comprehend the situation and others’ points of view in order to make rational decisions. This is also the ability to approach the matters from someone else’s position [14].

Empathy is important in at least three situations: – organization of the task teams (i.e. big foci of

emotions); – growing globalisation and competition; – winning and keeping talented employees [12]. The final element of emotional intelligence are

social skills, i.e. skills which provide popularity, adequate fulfilment of the leading roles and effectiveness in interpersonal relationships [11].

These skills make an effective communication and constructive solving of conflicts possible [6].

Studies conducted by Kriegelewicz showed that there is a positive correlation between the level of emotional intelligence and the application of a constructive strategy in conflict solving, while a negative correlation occurs in the case of applying destructive strategies [15].

According to Gardner, people who possess social skills are able to:

– organize the work of a team; – solve interpersonal conflicts; – perform social analyses (i.e. produce familiarity

in interpersonal contacts) [16]. General intelligence and emotional intelligence are

two different sets of skills. There is, however, a certain relationship between the intelligence quotient and some aspects of emotional intelligence, but this

relationship is so weak that both types of intelligence seem to exist independently [11].

Cognitive intelligence is inborn and does not change within the whole life, while it is possible to learn emotional intelligence and achieve its high level through practice [6].

According to Konrad and Hendel, people need a high quotient of general and emotional intelligence to perform their best [17].

In Goleman’s opinion, due to the deficiency of emotional intelligence, “intellectually intelligent” people occupy a lower level in the social-occupational hierarchy than those who possess a lower level of general intelligence, but a higher level of emotional intelligence [11].

Behaviours and traits resulting from the level of general and emotional intelligence vary and are dependent on gender [18].

Females with a high general intelligence quotient are characterised, among other things, by: high intellectual skills, univocal expression of thoughts, wide scope of intellectual and aesthetic interests, anxiety, experiencing thoughts and feelings, unwillingness to show emotions, and are introvert.

People of the same gender and high emotional intelligence quotient are very self-confident, kind, open, sociable, express their feelings in a moderate way, are emotionally balanced and easily make contacts.

Males with a high general intelligence quotient are characterised by a wide scope of intellectual interests, ambition, productivity, responsibility, persistence, emotional coolness, criticism, protectionism, and poor flexibility of behaviours.

Males who have a high emotional intelligence quotient are sociable, open, kind, energetic, responsible, possess a rich emotional life with the lack of tendency towards worrying [18, 19].

Emotional intelligence is an indispensable factor activating and improving mental efficiency [20]. This type of intelligence affects the level of interpersonal relationships and skills of coping in the occupation chosen. It happens that even if an employee is a very intelligent person, possesses appropriate education and many-year period of occupational experience, will not be successful because his/her emotional intelligence is not suitable for the occupation chosen [21].

It is confirmed that people with a higher level of emotional intelligence: – are better workers;

Ewa Stychno, Anna Ksykiewicz-Dorota

24

– work more effectively; – have better contacts with others [10].

The level of emotional intelligence is especially important: − at managing the workplaces where the image of the

institution is shaped among employees; − at the workplaces directly associated with the

provision of services for a client/patient, where the image of the institution is shaped among services recipients [13]. Emotional intelligence, in a supervisor’s best form,

allows to exert an influence on the subordinates without manipulation and authority. It is based on the skill of observation, learning, novelty, and acting in a way that considers emotional valuation instead of concentrating on logic and technical analysis [20].

Emotionally intelligent individuals are especially desired, among other things, in medical professions, where one works with and on behalf of people.

Therefore, a good manager who manages a medical team, apart from occupational qualifications, should possess knowledge from the areas of psychology and sociology, and know the following: – what the psychological mechanisms of decision

making consist in; – in what way to intervene in problems of

a conflicted team; – how to provide subordinates with feedback

information [20]. An employee occupying a managing position who

has a high level of emotional intelligence implants an optimistic approach into the work of the team. Such a manager is able to reconcile various emotions of the subordinates and channel these emotions into a positive direction, and also abides by hes/her own values [22].

As each individual possesses his/her own emotional intelligence, a team of people also have a team emotional intelligence. This is the way in which a group of employees make decisions, they refer to one another, and function within the framework of a specified organization. Members of intelligent teams achieve better results at work and have a greater satisfaction with common work [6].

In teams where the level of emotional and social tensions is high, the employees cannot be fully effective [19].

The scope of issues associated with emotional intelligence is a new problem. There are few studies in this area, and those already existing clearly show that emotional intelligence is important in constructing an

occupational career, which means that it cannot be omitted in modern practice of managing human resources [20].

The achievement of success in occupational and personal life is not to the highest degree dependent on experience and intellect, but on the way one uses personal and social competencies contributing to emotional intelligence.

People who can appropriately use their skills are able to achieve success where others fail. One should be aware of the fact that emotional intelligence allows to control one’s own behaviour, cope with relations with others, and to make such decisions in life which bring about the anticipated effects [6].

One can learn emotional intelligence, understand one’s own emotions and recognize the feelings of others, and develop communication skills. By means of special techniques it is possible to elevate the level of emotional intelligence in order to overcome the barrier between emotions and reason, develop leadership abilities and skills of teamwork, as well as better realize oneself in personal life [3, 6].

Quoting the statement by Szczygieł: “Emotional illiterates will wander blind through life experiencing many frustrations and lack of fulfilment in relations with others” [23]. LITERATURE 1. Mayer J., Salovey P.: The intelligence of emotional

intelligence. Intelligence, 1993, 17, 433-442. 2. Santorski J.: Sukces emocjonalny. Wyd. Jacek

Santorski&Co, Warszawa 2004. 3. Sehr M.M.: Inteligencja emocjonalna. Testy EQ. Klub

Diogenes, Warszawa 1999. 4. Schmidt F.L., Hunter J.E.: The validity and utility of

selection methods in personnel psychology: Practical and theoretical implications of 85 years of research findings. Psychological Bulletin, 1998, 124, 262-274.

5. Gardner H., Kornhaber M.L., Wake W.K.: Inteligencja: wielorakie perspektywy. Wyd. Szkolne i Pedagogiczne, Warszawa 2001.

6. Brandberry T., Greaves J.: Podręcznik inteligencji emocjonalnej. Wyd. HELION, Gliwice 2006.

7. Terelak J.F.: Psychologia organizacji i zarządzania. Wyd. Difin, Warszawa 2005.

8. Worzer J.: 30 minut z inteligencją emocjonalną. Wyd. KOS, Katowice 1999.

9. Salovey P., Mayer J.D.: Emotional Intelligence. Imagination, cognition and personality, 1990, 9, 185-211.

10. Caban M. J., Rewerski T.: Inteligencja emocjonalna i kompetencje społeczne u osób pracujących i bez-robotnych. Polityka społeczna, 2005, 2, 8-11.

Emotional intelligence - the determinant conditioning life satisfaction

25

11. Goleman D.: Inteligencja emocjonalna. Media Rodzina of Poznań, Poznań 1997.

12. Wood R., Tolley H.: Jak obliczyć i podwyższyć iloraz inteligencji emocjonalnej. Wyd. Amber, Warszawa 2003.

13. Modrzejewska K.: Rozwijanie inteligencji emocjonalnej- krok na ścieżce kariery. Zarządzanie zasobami ludzkimi, 2005, 2, 57-65.

14. Salovey P., Bedell B.T., Detweiler J.B., Mayer J. D.: Aktualne kierunki badań nad inteligencją emocjonalną. W: Lewis M., Haviland-Jones J.M. (red.): Psychologia emocji. Gdańskie Wydawnictwo Psychologiczne, Gdańsk 2005, 634-656.

15. Kriegelewicz O.: Inteligencja emocjonalna partnerów a zadowolenie ze związku i strategie rozwiązywania konfliktów w małżeństwie. Przegl. Psychol., 2005, 4, 431-452.

16. Królik G.: Autoprezentacja. Wyd. AE, Katowice 2002. 17. Konrad S., Hendl C.: Inteligencja emocjonalna.

Videograf II, Katowice 2000. 18. Celińska-Nieckarz S.: Emocjonalny potrafi więcej.

Personel, 2000, 10, 24-25. 19. Szaban J.: Miękkie zarządzanie. Wydawnictwo WSzPiZ,

Warszawa 2003.

20. Cooper R.K., Sawaf A.: EQ. Inteligencja emocjonalna w organizacji i zarządzaniu. Wyd. Studio EMKA, Warszawa 2000.

21. Simmons S., Simmons J.C.: Jak określić inteligencję emocjonalną. Dom Wydawniczy REBIS, Poznań 2001.

22. www.serwishr.pl/att/Wywiady/Wywiad_z_R.Boyatzis. pdf 2007-09-01

23. Szczygieł D.: Zdolność czy cecha osobowości? Kontrowersje wokół definicji i pomiaru inteligencji emocjonalnej. W: Martynowicz E. (red.): Od poczucia podmiotowości do bycia ofiarą. Oficyna Wydawnicza „Impuls”, Kraków 2006, 85-110.

Address for correspondence: Katedra i Zakład Zarządzania w Pielęgniarstwie Uniwersytet Medyczny w Lublinie 20-059 Lublin Aleje Racławickie 1 tel. służbowy (0 81) 528 88 84 fax: (0 81) 528 88 85 e-mail: [email protected] Received: 4.09.2008 Accepted for publication: 25.04.2009


ORIGINAL ARTICLE / PRACA ORYGINALNA Małgorzata Andrzejewska1, Bernadeta Szczepańska1, Dorota Śpica1, Jacek J. Klawe1, Marta Kudła1,

Jerzy Kasprzak2

OCCURRENCE OF CAMPYLOBACTER SPECIES IN SURFACE WATERS IN BYDGOSZCZ REGION

WYSTĘPOWANIE BAKTERII Z RODZAJU CAMPYLOBACTER

W WODACH POWIERZCHNIOWYCH POWIATU BYDGOSKIEGO

1Chair and Department of Hygiene and Epidemiology, Nicolaus Copernicus University Collegium Medicum in Bydgoszcz

Head: dr hab. n. med. Jacek J. Klawe, prof. UMK 2Provincial Sanitary and Epidemiological Station in Bydgoszcz

Head: mgr inż. Jerzy Kasprzak

S u m m a r y

B a c k g r o u n d . Water in open basins is one of the transmission routes of Campylobacter spp. in the environment and the cause of Campylobacter spp. infection in humans and animals. The presence of Campylobacter in surface water testifies for a good adaptation of these bacteria to the aquatic environment. The main causes of occurrence of Campylobacter in water are contamination by municipal sewage and water birds.

M a t e r i a l s a n d m e t h o d s . 390 samples of surface water were analyzed by a membrane filtration. Detailed diagnosis was conducted by use of PCR multiplex. Water samples were taken from 10 public beaches, 4 ponds, 2 rivers and 5 fountains since April 2006 to April 2008.

R e s u l t s . The presence of Campylobacter was detected in 66 samples of surface water (16%). The results indicate, that 40,8% of water samples taken from fountains

were contaminated with Campylobacter. Bacteria of Campylobacter genus were also detected in 19,3% samples of ponds and 18% samples of rivers. The least frequent isolation,was discovered in samples taken from public beaches (3,3%). C. jejuni and C.coli dominated in positive samples.

C o n c l u s i o n s . 1. The high frequency of Campylobacter occurrence in water from fountains, can be caused by the contamination with birds feces, and brings about a danger for dogs drinking water straight from the fountains and children playing around. 2. Water from ponds and rivers in Bydgoszcz could be a risk factor of campylobacteriosis. 3. Water from public beaches in the Bydgoszcz region was only slightly contaminated with Campylobacter spp.


W s t ę p . Wody otwartych zbiorników wodnych stanowią jeden z nośników odpowiedzialnych za rozprzestrzenianie się bakterii z rodzaju Campylobacter w środowisku oraz są przyczyną zakażeń tymi pałeczkami u ludzi i zwierząt. Obecność tych drobnoustrojów w wodzie świadczy o ich doskonałych zdolnościach adaptacyjnych do środowisk wodnych, które są wykorzystywane przez te bakterie jako miejsce tymczasowego bytowania. Główną przyczyną pojawiania się Campylobacter spp. w wodzie są

zanieczyszczenia lądowe, w tym ścieki oraz odchody ptaków. Biorąc pod uwagę rolę wody, jako drogi przenoszenia i rozpowszechnienia bakterii w środowisku, podjęto badania, których celem było sprawdzenie, czy rzeki, stawy, kąpieliska i fontanny powiatu bydgoskiego mogą być rezerwuarem tych bakterii.

M a t e r i a ł i m e t o d y . Materiał do badań pobierano z 10 kąpielisk wyznaczonych w obrębie jezior z powiatu bydgoskiego, 4 stawów na terenach rekreacyjnych

Małgorzata Andrzejewska et al.

28

Bydgoszczy, 2 rzek (Brdy i Wisły) oraz 5 miejskich fontann w okresie od kwietnia 2006 do kwietnia 2008. Przebadano łącznie 390 prób wody, poddając je filtracji membranowej. Do szczegółowej diagnostyki gatunkowej wykorzystano reakcję multipleks PCR.

W y n i k i . Obecność bakterii z rodzaju Campylobacter stwierdzono w 66 próbach wody z 390 przebadanych, co stanowiło 16%. Największą częstość izolacji zaobserwowano w próbach wody pochodzących z miejskich fontann (40,8%). Częstość występowania Campylobacter w próbach wody pobranych ze stawów na terenach rekreacyjnych miasta wynosiła 19,3%, a w wodach z rzeki Brdy i Wisły 18%. Najmniejszą częstość izolacji stwierdzono w próbach wody

pobieranych z kąpielisk (3,3%). Najczęściej izolowanymi gatunkami były C. jejuni i C. coli.

W n i o s k i . 1. Wysoki odsetek izolacji bakterii z miejskich fontann może być wynikiem ich zanieczyszczeń odchodami ptaków i stanowić zagrożenie dla psów pijących z nich wodę oraz dzieci bawiących się przy fontannach. 2. Woda ze stawów na terenach rekreacyjnych Bydgoszczy oraz rzeki Brdy i Wisły może stanowić ryzyko zakażenia kampylobakteriozą. 3. Woda z przebadanych jezior powiatu bydgoskiego, przeznaczonych do kąpielisk, była w niewiel-kim stopniu zanieczyszczona bakteriami z rodzaju Campylobacter.

Key words: Campylobacter spp., surface waters, contamination Słowa kluczowe: Campylobacter spp., wody powierzchniowe, zanieczyszczenia INTRODUCTION

Microorganisms of the genus Campylobacter have been crucial in epidemiology of food poisoning for over 30 years. The most important within the genus Campylobacter are pathogenic species C. jejuni, C. coli and C. lari, first of which, implicated in about 90% of diseases, is a common pathogen in humans [1, 2].

Possible dangerous complications after infection with Campylobacter and the fact that the bacteria are prevailing in various environments make us afraid of infections with the microbe [3, 4].

Natural reservoirs of the bacteria are alimentary canals of numerous species of wild and domestic animals. The bacteria are therefore common in natural environment, e.g. surface waters. Campylobacter has been isolated from rivers, fresh water, seawater, as well as from groundwater and sediments [5]. Surface waters carry Campylobacter spp., are responsible for distributing the bacteria, and might cause occasional infections or even a widespread epidemic. Ingestion of contaminated water carries a great risk of getting infected with campylobacteriosis due to low minimal infecting dose – only 500 bacteria cells [2]. Untreated water, partially treated water or recontaminated drinking water is the most common source of mass infections by Campylobacter in humans. Over recent years the greatest focal infections transmitted by water were registered in Canada, Great Britain and South Wales [4, 6, 7, 8,]. The presence of Campylobacter spp. in surface waters is connected with water contamination by sewage, wild birds' faeces, and rainfall [3, 4]. Survivability of these microbes in water depends mainly on water temperature and is higher in lower temperatures. The bacteria are significantly more prevalent in water in the cold months of the year

and in the early spring than in the summer months. Increased UVB irradiance might be the reason why the bacteria are isolated less frequently in the summer months [9, 10].

In Poland, despite earlier reports on isolation of bacteria of the genus Campylobacter from surface waters, no research monitoring Campylobacter water contamination is routinely conducted. Taking into consideration all that has been stated above, there has been undertaken a research which aims to evaluate the occurrence of Campylobacter spp. in surface waters in the Bydgoszcz region such as: the Brda and Wisła rivers, popular public beaches, ponds and fountains. MATERIAL AND METHODS

A total of 390 water samples, taken since April 2006 to April 2008, from 10 public beaches from Bydgoszcz, 4 ponds, 2 rivers (Brda and Wisła) and 5 city fountains were included in this study (Table I.). The samples from popular public beaches in the Bydgoszcz region were taken with cooperation with Provincial Sanitary and Epidemiological Station in Bydgoszcz.

Membrane isolation of Campylobacter spp. To isolate Campylobacter bacteria from water, membrane filtration was performed [11]. Water samples were oozed using membrane filters (Millipore 0,45). Filters were put into 90 ml Bolton broth (Oxoid) and incubated in temperature 37°C for 48 h under micro-aerobic condition (Generbox microaer-BioMerieux). Next, bacterial suspension from Bolton broth was spread on the surface of Karmali Agar or Preston Agar plates (Oxoid). The plates were incubated in the

Occurence of Campylobacter species in surface waters in Bydgoszcz region

29

temperature of 41°C for 48 hrs under micro-aerobic condition.

Table I. Water sampling sites Tabela I. Lokalizacja punktów poboru prób wody do badań

Preliminary identification. Colonies suspected of being Campylobacter spp. were examined for cell morphology by Gram method coloring and catalase and oxydase reaction.

Species identification. Bacterial chromosomal DNA was isolated from 24-h culture on Karmali or Preston Agar by conventional boiling method. For species identification a PCR was performed using a method described by Wang et al. [12].

RESULTS

The occurrence frequency of Campylobacter in examined samples taken from surface waters of the Bydgoszcz region is summarized in Table II. 390 water samples in total were tested in this study, including 171 water samples from ponds, 50 from the Vistula and

Brda rivers, 49 from fountains and 120 from public beaches. The results indicate that 16% of surface water samples are contaminated with Campylobacter spp.

Table II. The frequency of occurrence of Campylobacter in

analysed samples taken from surface waters Tabela II. Częstość występowania bakterii z rodzaju Cam-

pylobacter w badanych wodach powierzchnio-wych

Samples with

Campylobacter spp./ Próby zawierające

Campylobacter spp.

Place of sampling /

Miejsce pobrania próbki

No. of samples /

Liczba pobranych

prób n %

Isolated species / Wyizolowane gatunki

Ponds / Stawy

171 33 19,3 C.jejuni (14), C.coli (9), C.lari (3), C.upsaliensis (3) C.fetus (2), C.sputorum (2),

Fountains / Fontanny

49 20 40,8 C.coli (5), C.jejuni (5), C.upsaliensis (4), C. lari (3), C.fetus (3)

Rivers / Rzeki

50 9 18 C.jejuni (5), C.coli (4)

Public beaches / Zbiornik

rekreacyjny

120 4 3,3 C.coli (4)

Total/ Ogółem

390 66 16 C.jejuni (24), C.coli (22), C.upsaliensis (7), C.lari (6), C.fetus (5), C.sputorum (2)

The occurrence frequency of Campylobacter in

examined samples taken from ponds was 19,3 %. A study of ponds showed that 33 of water samples were positive for thermotolerant Campylobacter with C. jejuni making up 14 of the isolates, C. coli 9. A total of 50 water samples from 2 rivers in Bydgoszcz were examined. Of 9 campylobacter-positive samples (18%), 5 were found to contain C. jejuni, 4 were found

to contain C. coli. Campylobacter spp. was isolated from 20 samples (40.8%) from fountains. The most often isolated genus was C. jejuni (5) i C. coli (5).

An important part of the research, considering possibility of infection during bath, was the occurrence of Campylobacter spp. in water from popular public beaches in the Bydgoszcz region. 120 water samples were included in this study. Campylobacter bacteria was found in only 4 of the samples (3,3%). Isolated microorganism was C.coli.

DISCUSSION

The detection of Campylobacter spp. in

environmental surface waters is important in order to identify possible sources of infection and for further understanding of the epidemiology of infection. The reported occurrence of Campylobacter spp. isolation

Lp Type of water body /

Typ zbiornika

Name and localization of water body / Nazwa i lokalizacja zbiornika

1. Public beaches / Zbiornik

rekreacyjny

Jezioro Borówno (Dobrcz)


rekreacyjny

Jezioro Jezuickie (Piecki)


rekreacyjny

Jezioro Jezuickie (Chmielniki)


rekreacyjny

Jezioro Lipkusz (Kregiel)


rekreacyjny

Jezioro Stoczek (Krówka Leśna)


rekreacyjny

Jezioro Wierzchucińskie Duże (Sicienko)


rekreacyjny

Zalew Koronowski (Pieczyska)


rekreacyjny

Zalew Koronowski (Romanowo)


rekreacyjny

Zalew Koronowski (Samociążek)


rekreacyjny

Zalew Koronowski (Sokole Kuźnica)

12. Pond / Staw Park im. Kazimierza Wielkiego(Bydgoszcz) 13. Pond / Staw Dolina Pięciu Stawów (Bydgoszcz) 14. Pond / Staw Balaton (Bydgoszcz) 15. Pond / Staw Leśny Park Kultury i Wypoczynku (Bydgoszcz) 16. River / Rzeka Brda 17. River / Rzeka Wisła 18. Fountain / Fontanna Park im. Wincentego Witosa (Bydgoszcz) 19. Fountain / Fontanna Stary Rynek (Bydgoszcz) 20. Fountain / Fontanna Park im. Kazimierza Wielkiego (Bydgoszcz) 21. Fountain / Fontanna Budynek NOT (Bydgoszcz) 22. Fountain / Fontanna ul. Słowackiego (Bydgoszcz)

Małgorzata Andrzejewska et al.

30

from environmental waters varies between 16.3 and 82.1% [13].

In our study of water samples from ponds, rivers and public beaches we indicate that respectively 19,3%, 18% and 3,3% of the samples were contaminated with bacteria of the genus Campylobacter. Similar results concerning contamination of river samples has been reported by Daczkowską–Kozon et al. [14]. The presence of this bacteria was confirmed in 19,4% samples from the Odra river. Hörman et al. [15] have identified Campylobacter spp. in 17,3% of examined samples from surface water in Finland.

Occurrence of Campylobacter spp. was studied in various waters in Northern Ireland by Moore et al [16]. Discussed microorganisms were found in 41,7% of recreational lakes and in 87% of specimen of rivers, which is definitely higher quantity than in our study. A similar percentage of Campylobacter bacteria in rivers was found by Rosef et al [17].

The low percentage of Campylobacter spp. occurrence in our studies may result from the fact that ponds and places of river water sampling were far from municipal sewage outlets which are often the cause of water contamination. The cause of low percentage of Campylobacter spp. isolation may be the fact that public beaches are of high cleanness category water and comply with sanitary requirements. Water samples from public beaches were also taken in the summer when most authors noticed lower frequency of isolations. Researches of most authors have generally found Campylobacter concentration in surface waters to be higher in the winter season, when lower water temperature and UV levels are thought to result in increased survival of Campylobacter in the environment.

In this study, we identified high level of Campylobacter isolation from the fountain water samples - 40,8%. In available literature there is no notification about Campylobacter isolation from fountains. However, many authors indicate increasing number of waterborne-disease outbreaks associated with recreational waters (fountains, swimming pools), amount of which has increased dramatically in the recent several years [19, 20]. High frequency of Campylobacter contamination in fountains water suggests that such waters may be important reservoir of these bacteria and there is a need for their increased control. Fountains in the city center are not only there for the esthetic purposes, they are often a source of

water for domestic animals and birds that can contaminate water with faces. Due to not- typical use of fountains, especially by children, they could be a Campylobacter infection risk factor.

CONCLUSIONS 1. Conatmination with birds faces can be the reason of

high frequency of Campylobacter spp. occurrence in water from fountains what brings danger on dogs drinking water directly from fountains and children playing around.

2. Water from ponds and rivers in Bydgoszcz could be a risk factor of campylobacteriosis.

3. Water from public beaches in Bydgoszcz region was only slightly contaminated with Campylobacter spp.

4. There is a necessity to include routine researches for identification of Campylobacter microorganism in water.

REFERENCES 1. Kwiatek K., Zasadny R., Wojdat E.: Występowanie

termotolerancyjnych drobnoustrojów z rodzaju Campylobacter na powierzchni tusz zwierząt rzeźnych. Przegl. Epidemiol. 2006; 60: 347-352.

2. Drzewiecka B., Sinkiewicz J.: Występowanie bakterii z rodzaju Campylobacter w wodach powierzchniowych wykorzystywanych na potrzeby komunalne na terenie województwa bydgoskiego. Roczniki PZH. 2000; 51(1): 53-61.

3. Daczkowska-Kozon E.: Woda – nośnik Campylobacter i przyczyna kampylobacterioz. Przemysł spożywczy. 2005; 12:20-21.

4. Jones K.: Campylobacters in water, sewage and the environment. Journal of Applied Microbiology. 2001; 90: 68-79.

5. Daczkowska-Kozon E.: Epidemiologia zakażeń wywoływanych przez pałeczki z rodzaju Campylobacter. Zbiorniki i organizmy wodne jako rezerwuar Campylobacter spp. Post.Mikrobiol. 2002; 41: 133-146.

6. Hanninen M.L. i wsp: Detection and typing of Campylobacter jejuni and Campylobacter coli and analysis of indicator organisms in three waterborne outbreaks in Finland. Appl. Env Microbiol. 2003; 69: 1391-1396.

7. Richardson C. at all.: A community outbreak of Campylobacter jejuni infection from a chlorinated public water supply. Epidemiology and Infection. 2007; 135: 1151-1158. Cambridge University Press.

8. Clifford G.C i wsp.: Characterization of Waterborne Outbreak–associated Campylobacter jejuni, Walkerton, Ontario. Emerging Infectious Diseases. 2003; 9(10).

Occurence of Campylobacter species in surface waters in Bydgoszcz region

31

9. Hudson J.A., Nicol C., Wright J. i wsp.: Seasonal variation of campylobacter types from human cases, veterinary cases, raw chicken, milk, water. J. Appl. Microbiol. 1999; 87: 115-124.

10. Nylen G. i wsp.: The seasonal distribution of Campylobacter infection in nine European countries and New Zealand. Epidemiol Infect. 2002; 128(3): 383-390.

11. Detection of Campylobacter species in water. (www.evaluations-standards.org.uk).

12. Wang i wsp.:Colony Multiplex PCR Assay for Identification and Differentiation of Campylobacter jejuni, C. coli, C. lari, C. upsaliensis, and C. fetus subsp. fetus. Journal of Clinical Microbiology. 2002; 40(12): 4744-4747.

13. Sails A. D., Bolton F. J., Fox A. J. i wsp.: Detection of Campylobacter jejuni and Campylobacter coli in Environmental Waters by PCR Enzyme-Linked Immunosorbent Assay. Appl Environ Microbiol. 2002; 68(3): 1319–1324.

14. Daczkowska-Kozon E., Brzostek-Nowakowska J.: Campylobacter spp. in waters of three main Western Pomerania water bodies. International Journal of Hygiene and Environmental Health. 2001; 203: 435-443.

15. Hörman A. i wsp.: Campylobacter spp., Giardia spp., Cryptosporidium spp., Noroviruses, and Indicator Organisms in Surface Water in Southwestern Finland, 2000-2001. Applied and Environmental Microbiology. 2004; 70(1): 87-95.

16. Moore J.E., Caldwell P.S., Millar B.C.: Occurrence of Campylobacter spp. in water in Northern Ireland: implications for public health. The Ulster Medical Journal. 2001; 70(2): 102-107.

17. Rosef O., Rettedal G., Lågeide L.: Thermophilic campylobacters in surface water: a potential risk of campylobacteriosis. International Journal of Environmental Health Research. 2001; 11(41) 321-327.

18. Eyles R. i wsp.: Spatial and Temporal Patterns of Campylobacter Contamination Underlying Public Health Risk in the Taieri River, New Zealand. J. Environ. Qual. 2003; 32: 1820-1828.

19. Kebabjian R.S.: Interactive water fountains: the potential for disaster. Journal of Environmental Health. 2003 (1) July.

20. Hoebe Christian. J.P.A. i wsp.: Norovirus Outbreak among Primary Schoolchildren Who Had Played in a Recreational Water Fountain. The Journal of Infectious Diseases. 2004; 189: 699–705.

Address for correspondence: mgr Małgorzata Andrzejewska Chair and Department of Hygiene and Epidemiology Nicolaus Copernicus University Collegium Medicum in Bydgoszcz ul. M. Skłodowskiej-Curie 9 85-094 Bydgoszcz, Poland tel.: 052 585 36 16 fax.: 052 585-35-89 email: [email protected] Received: 26.05.2009 Accepted for publication: 25.08.2009


ORIGINAL ARTICLE / PRACA ORYGINALNA Mirosława Cieślicka, Marek Napierała

THE SOMATIC BUILD OF LIGHTWEIGHT ROWERS

BUDOWA SOMATYCZNA WIOŚLARZY WAGI LEKKIEJ

Faculty of Physical Education, Kazimierz Wielki University in Bydgoszcz Head: dr Mariusz Zasada

S u m m a r y

Rowing is a sport discipline in which an obtained result is heavily dependent upon physiological factors and somatic characteristics of competitors. The study aimed to identify and highlight those somatic parameters which differentiate lightweight rowers and persons not involved in a competitive sport. This will allow to gain a more thorough understanding of specific determinant factors related with professional rowing.

M e t h o d s . The research was conducted in February 2009 (22 lightweight rowers and 41 students aged 19-23). The following somatic characteristics were measured: body height, hip width, length of upper limb, shoulder width, relaxed and flexed arm circumference, chest circumference at inhalation and respiration, thigh circumference, body weight (kg) and body composition (adipose tissue in %). A type of subjects’ body build was determined based on a typological system.

R e s u l t s . As regards the somatic build, some parameters were noted to differentiate lightweight rowers from students, the distinctions being statistically significant (0,05). They are as follows: lightweight rowers’ height, arm

circumference at relaxation, chest circumference at respiration were greater than those of students, whereas their body weight, percentage of adipose tissue and BMI were lower.

C o n c l u s i o n s . The dissimilarities in the somatic build of lightweight rowers and students (a comparative group) stem from the nature of a selection process for this sport discipline and specialized training of lightweight rowers. Competitors with strictly determined somatic parameters are exactly those who succeed in a lightweight category. The characteristic feature is a relatively great height at low body weight (necessity to maintain a weight limit during competitions), and hence, a leptosomatic body build. Characteristics of a rowing training bring about specific somatic changes such as low adipose tissue when compared with a control group. The differences can be observed in muscle tissue, which is revealed by the measurements of arm and chest circumference, the two being of a greater value in rowers despite their lower body weight and greater height.


W s t ę p . Wioślarstwo jest sportem, w którym uzyskiwany wynik zależy w poważnym stopniu od czynników fizjologicznych oraz właściwości somatycznych zawodników. Podjęto również próbę znalezienia i zwrócenia uwagi na te parametry somatyczne, które w największym stopniu różnią wioślarzy wagi lekkiej i osoby nieuprawiające sportu wyczynowo. Pozwoli to lepiej poznać specyficzne uwarunkowania związane z uprawianiem tej dyscypliny sportu.

M a t e r i a ł i m e t o d y . Badania przeprowadzono w lutym 2009 (22 wioślarzy wagi lekkiej i 41 studentów). Wiek badanych 19-23 lata. Dokonano pomiaru cech somatycznych: wysokość ciała, szerokość bioder, długość kończyny górnej, szerokość barków, obwód ramienia w spoczynku i w napięciu, obwód klatki piersiowej na wdechu i wydechu, obwód uda. Pomiaru masy (kg) oraz składu ciała (tkanka tłuszczowa w organizmie w %). Typ budowy ciała badanych określono na podstawie systemu typologicznego.

Mirosława Cieślicka, Marek Napierała

34

W y n i k i . Pod względem budowy somatycznej wioślarze wagi lekkiej różnią się istotnie statystycznie (0,05) od studentów: większą wysokością ciała, mniejszą masą ciała, mniejszą procentową zawartością tkanki tłuszczowej w organizmie, większym obwodem ramienia w spoczynku, większym obwodem klatki piersiowej na wydechu, mniejszym BMI.

W n i o s k i . Różnice w budowie somatycznej wioślarzy wagi lekkiej i studentów (grupa porównawcza) są spowodowane specyfiką doboru do tej dyscypliny sportu oraz specjalistycznym treningiem wioślarzy wagi lekkiej. Sukcesy w kategorii wagi lekkiej odnoszą zawodnicy o ściśle

ustalonych parametrach somatycznych. Cechami charakterystycznymi są: stosunkowo duży wzrost, przy niskiej masie ciała (konieczność utrzymania limitu wagowego podczas zawodów), a co za tym idzie leptosomatyczna budowa ciała. Również specyfika treningu wioślarskiego powoduje określone zmiany somatyczne. Jest to między innymi niska zawartość tkanki tłuszczowej w porównaniu z grupą kontrolną. Różnice widać również w masie tkanki mięśniowej, o czym mogą świadczyć pomiary obwodów ramienia i klatki piersiowej, ich wartości u wioślarzy wagi lekkiej są większe mimo mniejszej masy ciała i większego wzrostu.

Key words: rowing, somatic build Słowa kluczowe: wioślarstwo, budowa somatyczna

Rowing is a sport that requires the adequate preparation of a sportsman’s body to perform high-intensity physical effort during training sessions and at regattas. It is one of those sport disciplines for which specified physical parameters condition success. Knowledge of the sport and training is still under development, and limits of human capabilities are extended. These impressive achievements are an effect of a number of factors backed with hard and long-standing work. Currently, sport training is a complex process, in which, apart from technique and tactics, attention is paid to shape dominant motor features in a given discipline [1]. High level of achievements in present-day rowing excludes compensating for technical deficiencies with high physiological parameters, and vice versa: physiological deficiencies cannot be counterbalanced with even best rowing technique. Only when the most efficient technique, accompanied with optimal physiological “back-up”, is mastered, does rowing mastery become accessible. Ties between physiological processes and the processes of biomechanics should be applied at all stages of sport training. The basis for rowing technique is the ability to accomplish the breakpoints of a rowing cycle. A technical training is based upon the pursuit of absolute mastery (nearly automatic) of rowing technique, and at the same time maintaining the competitor’s ability to fully control the rowing speed and rhythm. Long-standing observations of competitors taking part in the Olympic Games led to the assumption that a sport result is, to a great extent, related with the somatic build and age of rowers. A result achieved in rowing is dependent upon a number of factors, such as: somatic build of competitors, fitness potential, level of tactical, technical and physical preparation, technological progress (construction of oars and shells), weather

conditions, optimization of a training process and, finally, nutrition. Apart from capacity-related predisposition, rowers should have a number of adequate somatic parameters (long upper and lower limbs, long torso). The present study attempted to demonstrate some basic somatic differences between lightweight rowers and students (comparative group). These somatic parameters that most explicitly differentiate lightweight rowers and individuals who do not practice any sport professionally were also sought. This will allow to gain the knowledge of some determinant factors related to this sport discipline.

The study aimed to: - gain basic information related to the somatic build

of lightweight rowers and a given comparative group, i.e. students in this particular study;

- determine the differences in the somatic build between lightweight rowers and the comparative group;

- identify factors that determine differences in the groups under study. MATERIALS AND METHODS

The research was conducted in February 2009 among 22 lightweight rowers training in the RTW Bydgostia sports club. The comparative group comprised 41 students chosen at random. Both groups were the students of the University of Economy (Wyższa Szkoła Gospodarki) in Bydgoszcz, aged 19 to 23.

Using an anthropometer, the following somatic traits were measured: body height, hip height, upper limb length, shoulder width. With an anthropometric tape, the following parameters were measured: relaxed and flexed arm circumference, chest circumference at inhalation and respiration, thigh circumference. Body

The somatic build of lightweight rowers

35

weight (kg) and composition (adipose tissue in body in %) were measured using medical scales “Tanita”. Additionally, the BMI index was determined (BMI= [body weight (kg)]/ [height (m)]2). The type of body build was determined on the basis of Kretschmer’s typological system applying the Rohrer’s ratio and Curtis’ key [3]. Some statistical methods were applied in the study in order to calculate the arithmetic average and standard deviation. Statistical verification was conducted using the “U” test, thus assessing the ratio of significance of differences between the group under study and the control group. Statistical research was conducted in accordance with the rules applied [4]. RESEARCH RESULTS

The analysis of Table I above shows that the parameter that differentiated the two groups most significantly, was body height. An average rower’s body height was 183.4 cm, while the same parameter for students was 179.48 cm. The difference above proved to be statistically significant (0.05). A similar level of statistical difference (0,05) was observed as regards body weight. The average body weight of students and rowers was 76.59 kg and 73.59 kg respectively. It should be emphasized that the body weight across the lightweight rowers’ group was stable, while in the comparative group the measurement results were often extremely different. A lower level of adipose tissue was characteristic of lightweight rowers. The average result was 7.24%. For the students under study the average adipose tissue content was 13.4%.

Table I. Numerical characteristics of selected somatic

features of lightweight rowers and students Tabela I. Charakterystyki liczbowe wybranych cech somatycz-

nych wioślarzy wagi lekkiej i studentów

Wioślarze wagi lekkiej (n=22)

Lightweight rowers (n=22)

Studenci (=41) Students (n=41)

Badana cecha

Studied feature

Średnia

arytmetyczna Arithmetic

average

Odchylenie standardowe

Standard deviation

Średnia arytmetyczna

Arithmetic average

Odchylenie standardowe

Standard deviation

Różnica średnich

Differences between averages

Istotność różnic „u”

Significance of „u”

differences

Wskaźnik Mollisona

Mollison Index

Body height (cm)

183.40 3.26 179.48 6.07 3.92 3.35* 0.65

Body weight (kg)

73.59 1.14 76.31 8.10 -2.72 2.11* -0.34

Adipose tissue (%)

7.24 0.89 13.40 2.58 6.16 15.40* 2.39

BMI 21.88 0.50 23.39 1.93 -1.51 4.72* -0.78

* statistically significant difference 0.05

Average results of both relaxed and flexed arm

circumference proved to be higher in lightweight

rowers (31.4 cm and 34.3 cm respectively) rather than in students (30.04 cm and 34 cm). It was noted that the differences in arm measurement were low in the group of rowers, whereas they were of significance in students. The average chest circumference (104.2 cm at inhalation and 99 cm at respiration), similarly to previous parameters was higher in lightweight rowers. It should also be noted that the results were similar across the whole group of rowers. When analyzing thigh measurement across the groups, the higher average value was observed in students (55.6 cm). In rowers’ group the result was 54.7 cm. Also in this case the discrepancy in results in the group of sportsmen was slight, unlike in the comparative group.

Fig. 1. Measurements of selected somatic features of lightweight rowers and students

Ryc. 1. Pomiary wybranych cech somatycznych wioślarzy wagi lekkiej i studentów

Fig. 2. Types of body build of lightweight rowers and students Ryc. 2. Typy budowy ciała wioślarzy wagi lekkiej i studentów

The figure above represents body build types of

lightweight rowers and control group, i.e. students. Among rowers, the dominant body build type was leptosomatic (90% of subjects), and only 10% of rowers were of the athletic type. However, 40% of students were of the leptosomatic type, 33% of them were of the pyknic type, and 27% of them were of the athletic type.

0% 20% 40% 60% 80% 100%

typ leptosomatycznyleptosomatic type

typ atletycznyathletic type

typ pikniczny picnic type

studenciwioś larze

0 20 40 60 80 100 120

szerokość barków / shoulder w idth

szerokość bioder / hip w idth

obw ód ramienia w spoczynku relaxed arm circumference

obw ód ramienia w napięciu f lexed arm circumference

obw ód klatki piersiow ej na w dechu chest circumference at inhalation

obw ód klatki piersiow ej na w ydechu chest circumference at respiration

obw ód uda / thigh circumference

cm

Serie2

Serie1

pyknic type


36

DISCUSSION

Rowing is a sport that requires an adequate preparation of a sportsman’s body to perform high-intensity physical effort during training and at regattas. A rowing competitor engages over 70% of muscle mass, which results in a very high energy expenditure [5]. Roth [6] suggested that during a simulated rowing race taking 7 minutes, 67% of energy is consumed from lactate energy metabolism, and the remaining 33% from non-lactate sources (21% non-lactate and 12% lactate). It was also concluded that 10-20% of energy expenditure comes from non-lactate sources, and the remaining 80-90% from lactate energy sources. Rowers need considerable muscle strength to apply speed to the shell at the start, and high maximum oxygen uptake (VO2 max) in order to maintain speed during a race [5]. A competitor performs over 200 full cycles when covering a classic distance of 2000 meters. This requires proper endurance-strength preparation, as well as high endurance parameters. Intense research in the field of rowing-related processes is still in progress and it contributes to an in-depth knowledge of a competitor. Rowing is one of those sport disciplines in which determined physical parameters are a prerequisite to success.

A sport training process comprises two phenomena, i.e. on the one hand the level of motoric capabilities, and, on the other hand, accommodation of rower’s body to specific types and intensity of physical effort, the function of which is a formation of a body build typical of a given sport discipline. Present day rowing analyzed as a great sport accomplishment, requires that a competitor be versatile, both in terms of high physical endurance, and high rowing technical abilities. Rowing is a sport in which an obtained result is largely dependent upon physiological factors and somatic traits of competitors [7]. A large input into the development of effort metabolism research conducted “on water” was provided by Di Prampero and associates [8]. The influence of rowers’ body build on achieved sport results is also worth noticing.

Halina Milicerowa and Zbigniew Drozdowski [9, 10] are among those who signaled the emergence of such dependencies. Body composition of male and female rowers was also under measurement. The observations of Morris and Payne showed that in a lightweight category, the gradual reduction of body weight in a training season occurs through the decrease in total energy and fat consumption. Fast weight loss

occurred through physical effort, nutritional restrictions and limitation of liquids consumption [11]. As the research conducted by Pawlaczyk suggests, rowers should be characterized with great height, lean frame, and large shoulders and hips. The confirmation of these research results was the analysis of results achieved by rowers, which proved to be better in the competitors with greater values of the above mentioned features [12]. According to Hernig, a rower should have long upper limbs, which would allow them to row within an optimal range at angle oar position. Another desired feature should be long lower limbs with their muscles being one of the main driving forces during a rowing cycle. A crucial parameter is height-weight related. In this respect, the parameters must be selected in such a manner so as to qualify a sportsman to a weight category [13]. In a sport training process two phenomena occur, i.e. on the one hand the compensation of level of motoric capabilities, and on the other hand, accommodation of rower’s body to specific types and intensity of physical effort, the function of which is a formation of a body build typical of a given sport discipline or competition [13]. Krupecki presented an analysis of competitors who took part in the Olympic Games. The author claims that between 1960 and 1992, the body build of rowers changed considerably. Rowers were taller than their predecessors by about 8 cm, their body weight was also greater by 8.5 kg. The analysis of body build related materials of competitors who took part in the Olympics in Atlanta and Sydney confirmed the above insight; body height increased by 1 cm, and body weight by 1.5 kg. At the Barcelona Olympics, it was 191.6±5.41 cm, in Atlanta: 190.4±5.14 cm and 192.8±5.47 cm in Sydney. Similar changes were related to the body weight of competitors; the average value at Barcelona Olympics was 89.95±6.38 kg, 91.3±5.77 kg in Atlanta, and 91.2±6.97 kg in Sydney [14]. Research conducted by Garay and associates [15], Piotrowski and associates [16, 17], Skład and associates [18] and Krupecki and associates [14] suggest that rowers can be distinguished from non-training individuals not only on the basis of body height and weight, but also: upper limb length (arm span), lower limb length (especially of the lower limb), shoulder width, large limb muscle circumferences (especially of the prearm), as well as proper proportions between tissue components. The analysis of research results leads to similar conclusions to those obtained by Piotrowski and associates in their studies

The somatic build of lightweight rowers

37

[17], namely: when compared to those peers who do not practice any sport competitively, rowers can be distinguished by high somatic indices.

CONCLUSIONS

In the light of the present research, the following conclusions can be drawn:

1. Lightweight rowers, when compared with students, are characterized by (statistically significant differences of 0,05): greater body height, lower body weight, lower percentage of adipose tissue in body, greater shoulder width, greater hip width, greater relaxed arm circumference, greater chest circumference at respiration, lower BMI.

2. Lightweight rowers are characterized by a leptosomatic body build in 90%, and only 10% of the group members have an athletic build. Students represent leptosomatic, pyknic, and athletic body build in 40%, 33% and 27% respectively.

3. The dissimilarities in the somatic build of lightweight rowers and students (comparative group) stem from the nature of a selection process for this sport discipline and specialized training of lightweight rowers. Competitors with strictly determined somatic parameters are precisely those who succeed in a lightweight category. The characteristic feature is a relatively great height at low body weight (necessity to maintain a weight limit during competitions), and hence, a leptosomatic body build. Characteristics of a rowing training bring about specific somatic changes such as low adipose tissue when compared with the comparative group. The differences can be observed in muscle tissue, which is revealed by the measurements of arm and chest circumference, the two being of a greater value in rowers despite their lower body weight and greater height. PIŚMIENNICTWO 1. Katarzyna Dmitruk, Mirosława Cieślicka, Błażej

Stankiewicz.: Charakterystyka zmian wytrzymałości ukierunkowanej oraz jej wskaźników w okresie przygotowawczym rocznego cyklu treningowego wioślarzy juniorów. Annales Universitas Marie Curie-Skłodowska sectio D 111 Medicina vol.LXII, supplXVIII, N.2 111 Lublin 2007; 83-85.

2. Ważny Z.: Kontrola efektów po treningowych. Koncepcja i propozycje rozwiązań praktycznych. RCMSz KfiS, Warszawa 1990; 54-59.

3. Drozdowski Z.: Antropologia w wychowaniu fizycznym, AWF Poznań 1998; 154-157.

4. Arska – Kotliska M., Bartz J.: Wybrane zagadnienia statystyki dla studiujących wychowanie fizyczne, AWF Poznań 1993. s.23-77.

5. Steinacker J. M.: Physiological aspects of training in rowing. “International Journal of Sports Medicine” nr 14 (Suppl.1); 1993 3-10.

6. Roth W i wsp.: Untersuchungen zur Dynamik der Energiebereisteklung wahrend maximaler Mittelzeitausdauerbelastungen. „Medizin und Sport“ 1983; 23/4; 107-114.

7. Hartmann U., Mader A., Wasser K., Klauer I.: Peak force, velocity and power during five and ten maximal rowing ergometer strokes by world class female and male rowers. „International Journal of Sports Medicine” 1994 Nr 14 (suppl 1); 42-45.

8. Di Prampero P. E., Mognoni P.: Maximal anaerobic power in man. (W:) Di prampero P.E., J. Poortmans (red).: Physiological chemistry of exercise and training. Basel-Munchen-Paris-London-New York-Sydney 1981; 112-118.

9. Milicerowa H.: Budowa somatyczna jako kryterium selekcji sportowej. Studia i monografie AWF Warszawa 1973; 6-21.

10. Drozdowski Z.; Antropologia a kultura fizyczna. AWF, Poznań 1996; 74-78.

11. Morris F. L., Pajne W. R.: Seasonal – variations in the body – composition of lightweight rowers. „ British Journal of Sports Medicine” 1996, 30: 301 – 304.

12. Sozański Z.: Kierowanie jako czynnik optymalizacji treningu. AWF Warszawa 1993; 73.

13. Hennig M.: Wioślarstwo, PZTW Warszawa 2003; 23-43; 133-134.

14. Krupecki K., Jaszczanin J.: Wpływ podstawowych cech somatycznych wioślarzy na osiągnięty wynik sportowy, na podstawie danych uczestników Igrzysk Olimpijskich w Atlancie w 1996 r. Didelio meistriskumu sportininku regimo valdymas. Vilnus, 1997; 27-29.

15. Garay A. A., Levine L., Lindsay I. E.: Genetic and anthropological studies olimpic athletes. New York- San Francisco- London, Academic Press 1974; 24.

16. Piotrowski J., Skład M., Krawczyk B., Majle B.: Somatic indices of junior rowers to their athletics exercise. Biology of Sport Nr 3; 1992; 117-125.

17. Piotrowski J., Skład M., Krawczyk B., Majle B.: Somatic indices of junior rowers as related to their athletic experience. Biology of sport a quarterly journal of sport and exercise sciences, Volume 9, Number 3, 1993; 239-243


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18. Skład M., Krawczyk B., Majle B.: Effects of an intense annual training on body components and other somatic traits in young male and female rowers. Biology of sport a quarterly journal of sport and exercise Nr 4, 1993; Volume 10.

Address for correspondence: Faculty of Physical Education Kazimierz Wielki University in Bydgoszcz dr Mariusz Zasada ul. Sportowa 2 85-091 Bydgoszcz tel/fax. 600945007 (052} 37 67 910 e-mail: [email protected] Received: 24.04.2009 Accepted for publication: 25.08.2009


ORIGINAL ARTICLE / PRACA ORYGINALNA Anna Gmerek*, Jan Styczyński, Anna Krenska, Robert Dębski, Mariusz Wysocki

PNEUMONIA IN HEMATOPOIETIC STEM CELL RECIPIENTS DURING EARLY POST-TRANSPLANT PERIOD

ZAPALENIE PŁUC U BIORCÓW KOMÓREK HEMATOPOETYCZNYCH

WE WCZESNYM OKRESIE POTRANSPLANTACYJNYM

Chair and Clinic of Pediatric Hematology and Oncology, Laboratory of Clinical and Experimental Oncology *Students’ Scientific Society, Nicolaus Copernicus University Collegium Medicum in Bydgoszcz

Head: prof. dr hab. n. med. Mariusz Wysocki

S u m m a r y B a c k g r o u n d . Despite fast improvement in

supportive therapy of hematopoietic stem cell transplantation (HSCT), the risk of death caused by pulmonary complications still remains very high. The objective of the study was to analyse the frequency and outcome of pneumonia in patients after HSCT in early post-transplant period.

P a t i e n t s . A total number of 91 transplants were performed in 87 patients (4 patients were retransplanted) between 2003-2008. There were 63 autologous and 28 allogeneic (from 20 related and 8 unrelated donors) transplantations. The source of hematopoietic stem cells were peripheral blood in 67 patients , bone marrow in 23 and cord blood in 1 patient .

M e t h o d s . Patients underwent standard prophylaxis and transplant procedures. Pulmonary complications were defined as new or persistent pulmonary infiltrates on chest radiograph or chest computed tomography scan, respiratory

symptoms, hypoxemia, or hemoptysis. Patients suspected for pneumonia were treated with empirical antibiotic therapy.

R e s u l t s . The total number of patients with pneumonia in the early post-transplant period was 10/91 (11.2%) patients, including two episodes in two patients. Antibiotic therapy and supportive therapy in transplant unit were efficient in 4/10 (40%) patients. Among 5 patients referred to Intensive Care Unit (ICU), 3 patients have eventually developed multi-organ failure (MOF) with death. Two deaths were connected with second episode of pneumonia, including patient with MOF. Broncho-alveolar lavage (BAL) was performed in most of patients treated in ICU, however microbiological analysis showed no etiologic agent.

C o n c l u s i o n s . Pneumonia is a serious complication in patients undergoing stem cell transplantation, with mortality rate 50%. Prophylaxis and empirical therapy remain the standard approach, however a need of a diagnostic improvement still exists.

S t r e s z c z e n i e W s t ę p . Pomimo ciągłego postępu w terapii

wspomagającej transplantacji komórek hematopoetycznych (TKH), ryzyko zgonu spowodowanego powikłaniami płucnymi ciągle pozostaje wysokie. Celem pracy była analiza częstości incydentów zapaleń płuc i zejść u pacjentów po TKH we wczesnym okresie potransplantacyjnym.

P a c j e n c i . Do badań włączono 91 transplantacji, przeprowadzonych u 87 pacjentów (4 pacjentów miało dwukrotne transplantacje) w latach 2003-2008. Wykonano 63 autologiczne i 28 allogenicznych (w tym 20 rodzinnych

i 8 niespokrewnionych) TKH. Źródłem komórek hematopoetycznych była krew obwodowa u 67 pacjentów, szpik kostny u 23 i krew pępowinowa u 1 pacjenta.

M e t o d y k a . Pacjentów poddano standardowym profilaktycznym procedurom transplantacyjnym. Powikłania płucne definiowano jako obecność nowych lub utrzymujących się nacieków w badaniu RTG/KT, z charakterystycznymi objawami płucnymi, hipoksemią lub krwiopluciem. Pacjentom, u których podejrzewano zapalenie płuc, wprowadzano antybiotykoterapię empiryczną.

Anna Gmerek et al.

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W y n i k i . Zapalenie płuc we wczesnym okresie poprzeszczepowym wystąpiło u 10/91 (11,2%) pacjentów, w tym dwukrotnie u dwojga pacjentów. Antybiotykoterapia i terapia wspomagająca prowadzone w oddziale przeszczepowym były efektywne u 4/10 (40%) pacjentów. Spośród 5 pacjentów przekazanych do Oddziału Intensywnej Terapii (OIT) u 3 pacjentów doszło do rozwoju niewydolności wielonarządowej i zgonu. Dwa zgony były spowodowane drugim incydentem zapalenia płuc. Płukanie

oskrzelikowo-pęcherzykowe (BAL) wykonano u większości pacjentów leczonych w OIT, jednakże nie wykazano obecności czynników etiologicznych.

W n i o s k i . Zapalenie płuc jest poważnym powikłaniem u pacjentów poddawanych TKH, ze śmiertelnością 50%. Profilaktyka i terapia empiryczna pozostaje standardowym postępowaniem, jednakże istnieje potrzeba ulepszenia procesu diagnostycznego.

Key words: hematopoietic stem cell transplantation, pneumonia, children Słowa kluczowe: transplantacje komórek hematopoetycznych, dzieci, zapalenia płuc INTRODUCTION

Since the early seventies hematopeietic stem cell transplantation (HSCT) has become a significant, widely used life-saving procedure among adults and children, for whom conventional therapy fails. HSCT is an important therapeutic option currently used in large spectrum of diseases such as: hematologic and nonhematologic malignancies, bone marrow failure, immunodeficiencies, hemoglobinopathies, metabolic and autoimmune diseases. Despite fast improvement, HSCT still remains limited by early and long-term side effects. Pulmonary complications with high range of pneumonia incidents are the major cause of morbidity and mortality among patients undergoing high-dose therapy and auto- or allogeneic transplantation [1, 2]. Pulmonary complications occur in 25% of children undergoing HSCT and increase the risk of death in the first year after HSCT [3].

The objective of the study was an analysis of the frequency and outcome of pneumonia incidents in patients after HSCT in early post-transplant period.

PATIENTS

This retrospective study refers to 91

transplantations performed in 87 patients (4 patients were retransplanted). The group included 42 female and 45 male aged 0.9-32 years (median age 11,8 years). Patients underwent high-dose therapy and hematopoietic stem cell transplantation between 2003-2008 in the Bone Marrow Transplant (BMT) Unit in the Chair and Clinic of Pediatric Hematology and Oncology in Bydgoszcz. Patients were treated for the following diseases: acute lymphoblastic leukemia (ALL, 15 patients), acute myeloblastic leukemia (AML, 9 patients), chronic myeloid leukemia (CML, 4 patients), Hodgkin disease (HD, 11 patients), non-Hodgkin lymphoma (NHL, 3 patients), severe aplastic

anemia (SAA, 4 patients), brain tumor (BT, 10 patients), neuroblastoma (NBL, 19 patients), Ewing sarcoma (ES, 6 patients), and other solid tumors (ST, 6 patients).

In 54 patients the transplantation was performed in first remission, in 29 cases in second remission and in 8 cases in third or fourth remission. Lansky Performance Score (for children up to 16) or Karnofsky Performance Score (for patients over 16) was over 80 in 83 patients and 80 or less in 8 patients. There were 63 autologous and 28 allogeneic (from 20 related and 8 unrelated donors) transplantations. The source of hematopoietic stem cells were peripheral blood in 67 patients (73.6%), bone marrow in 23 (25.3%) and cord blood in 1 patient (1.1%). METHODS Transplant procedures

Details concerning performed transplants including stem cell collection and conditioning regimens, as well as prophylaxis, diagnosis and therapy of acute graft-versus-host diseases (in allogeneic transplants) were published elsewhere [4]. Early post-transplant period was regarded up to day +30. Prophylaxis of infection

All analyzed patients received a low-germ diet and were treated in a separate transplantation ward in single rooms. Intensified hygiene measures in transplant unit included: masks, gloves and gowns for staff; water and air control; visitors were not allowed to enter the unit. Prophylactic antibiotics included ciprofloxacin and/or cotrimoxazole, acyclovir, and fluconazole (in patients undergoing allogeneic

Pneumonia in hematopoietic stem cell recipients during early post-transplant period

41

transplant) until neutrophil recovery or administration of antimicrobial therapy due to infection. Pulmonary complications

Pulmonary complications were defined as new or persistent pulmonary infiltrates on chest radiograph or chest computed tomography scan, respiratory symptoms, hypoxemia, or hemoptysis. Antimicrobial therapy

Patients suspected for pneumonia were immediately treated with empirical antibiotic therapy. First line treatment included three options of two-drug therapy: 1. third- or fourth-generation cephalosporine with aminoglycoside; 2. carbapenem with aminoglycoside. Vancomycin or clarithromycin was added, if symptoms persisted for 72 h. Amphotericin B was given empirically, if the patient did not respond to antibiotic therapy within 6 days. RESULTS

The total number of patients suffering from pneumonia in the early post-transplant period was 10/91 (11,2%) patients, including two episodes in two patients (Table 1). With respect to type of transplant, 5/63 (7.9%) patients after autologous transplantations, and 5/28 (17.8%) patients undergoing allogeneic transplantations developed pneumonia (ns, Fisher exact test). Two out of 8 patients after allogeneic transplants from unrelated donor and 3/20 (15%) recipients of stem cells from sibling donor experienced pneumonia (ns, Fisher exact test). Both patients with pneumonia after allogeneic transplants from unrelated donor died.

No significant influence on incidence of pneumonia was found for following factors: gender (6/45 male and 4/42 female patients), age below 12 years (6/46 vs 4/45 in adolescents and young adults; ns, Fisher exact test), CMV serostatus, graft-versus-host disease (in allo-HSCT) or initial diagnosis. Previous episodes of pneumonia (before transplant) had no impact on incidence of pneumonia in early post-transplant period.

Antibiotic therapy and supportive therapy in BMT unit were efficient in 4/10 (40%) patients. One patient died and five other patients were referred to Intensive Care Unit (ICU), including both patients with second episode of pneumonia. Two patients out of five, who were treated in ICU, were cured from pneumonia, however one died after second episode of pneumonia. Finally, two deaths were connected with second

episode of pneumonia and multi-organ failure (MOF). All patients who died from pneumonia in ICU, eventually developed MOF in spite of intensive supportive therapy. Broncho-alveolar lavage (BAL) was performed in most of patients treated in ICU, however microbiological analysis showed no etiologic agent. Table 1. Clinical details of patients with pneumonia after

hematopoietic stem cell transplantation Tabela 1. Dane kliniczne pacjentów z zapaleniem płuc po

transplantacji komórek hematopoetycznych

UPN – Unique Patient Number; GVHD – graft versus host disease; CMV – cytomegalovirus; M – male; F – female; ALL – acute lymphoblastic leukemia; AML – acute myeloid leukemia; CML – chronic myeloid leukemia; HD – Hodgkin disease; SAA – severe aplastic anemia; MOF – Multi-Organ Failure; IGIV – intravenous immunoglobulins; n/a – not applicable

DISCUSSION

Heamatopoietic stem cell transplantation is a modern and widely used therapeutic method for a large group of patients, however toxic and infectious complications still remain the main obstacle in successful therapy. Pulmonary complications following HSCT remain a significant source of morbidity and mortality in both the early and late HSCT period. More than half of pneumonia patients included in the present study eventually died, either from respiratory or multi-organ failure.

Part of patients responded to empirical therapy with broad spectrum antibiotics, however others developed either multi-organ failure or second episode of pneumonia. The question arises if it would be better if lung biopsy or broncho-alveolar lavage (BAL) were

PatientPacjent

UPNUPN

Gender

Płeć

AgeWiek

Primary disease Choroba podstawowa

Diagnosis of infection on day Początek infekcji (dzień)

Transplant type Rodzaj transplantacji

GVHD GVHD

CMV IgG serostatus Stan CMV

TreatmentLeczenie

Outcome Zejście

1 17 M 4 AML +12 Autologous n/a negative Antibiotic therapy

Alive

2 18 M 11 CML +9 Allogeneic (sibling donor)

No negative Antibiotic therapy

Cured from pneumonia

3 20 F 26 HD +10 Autologous n/a negative Antibiotic therapy + IGIV

Alive

-1 Antibiotic therapy


4 21 M 14 SAA

+22

Allogeneic (sibling donor)

Yes negative

Intensive Care Unit

MOF, death

5 51 M 9 Neuroblastoma +3 Autologous n/a positive Intensive Care Unit

Cured from pneumonia.

6 55 F 11 Ewing tumor +3 Autologous n/a negative Antibiotic therapy


7 59 F 2 Neuroblastoma +6 Autologous n/a negative Intensive Care Unit

MOF, death

8 68 F 2 ALL 0 Allogeneic, unrelated

No negative Antibiotic therapy

Death

9 79 M 20 ALL +23 Allogeneic, unrelated

No negative Intensive Care Unit

Renal failure, MOF, death

10 86 M 15 Ewing tumor +6 Autologous n/a positive Antibiotic therapy + Intensive Care Unit

Alive, but died after second episode of pneumonia

Anna Gmerek et al.

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introduced to these patients. Another issue is if selected antibiotic therapy would be more appropriate than broad spectrum antibiotics and if it is needed to diagnose potential pathogen. BAL has been a useful initial diagnostic tool in the evaluation of pulmonary complications post HSCT. However, it has been shown, that a BAL post HSCT in pediatric recipients will likely only yield a diagnosis 35% of the time compared to lung biopsy which had a 90% diagnostic yield. In the future a paradigm will be required to determine which pediatric HSCT recipients may benefit by having an initial lung biopsy and foregoing an initial BAL to diagnosis of pulmonary complications [5].

Diagnostic bronchoscopy and BAL did not enhance either 30- or 100-day survival [3]. This diagnostic procedure does not improve outcome in the immunosuppressed child with pulmonary symptoms [3], and also in pneumonia caused by other factors, such as immunological disorders, toxicity of chemotherapy, GVHD or epithelial apoptosis activation resulting in Idiopathic Pneumonia Syndrome (IPS). These cases with absence of active lower respiratory tract infection are still under experimental therapy. One of our patients underwent anti-cytokine therapy with TNFR2 (etanercept) application after an inconclusive BAL [6]. Significant improvement of the respiratory system was observed after this experimental treatment. The patient eventually died due to other complications and multi-organ failure. Although pathogen identification is difficult and it does not confer a survival advantage, rigorous, prospective screening may allow for earlier identification of pathogens and thereby provide a benefit to this uniquely vulnerable population.

Despite significant advances in critical care and transplantation medicine, non-infectious lung injury remains a major problem following autologous and allogeneic hematopoietic stem cell transplantation (HSCT) both in the immediate post-transplant period and in the months to years that follow. Historically, approximately 50% of all pneumonias seen after HSCT have been secondary to infection [7]. Although non-infectious lung injury occasionally occurs following autologous transplants, the allogeneic setting greatly exacerbates toxicity acutely and chronically. Pulmonary injury is associated with significant morbidity and mortality and responds poorly to standard therapies. Insights generated using animal models suggest that the immunologic mechanisms

contributing to lung inflammation after HSCT may be similar to those responsible for graft-versus-host disease (GVHD) after allogeneic HSCT [7].

Despite intensive prophylaxis of infection and high standard transplant procedures 10 out of 87 patients (including four retransplatations) developed pneumonia. The frequency remains the highest among patients undergoing allogeneic transplants from unrelated donors. However each kind of transplant brings the risk of pneumonia. Gender, age, CMV serostatus, graft-versus-host disease and initial diagnosis did not have a significant impact on incidence of pneumonia. The mortality among patients undergoing pneumonia in the present study was 50%. Most of the children with pneumonia cured in ICU eventually developed MOF or died after second episode of lung injury in spite of intensive diagnostic and supportive therapy, including BAL. Other 5 patients were eventually cured with empirical antibiotic therapy. Therefore, selective therapy with antibiotics seems to be inappropriate option in the cases where identification of the patogens does not confer a survival advantage or simply no patogens are identified. Finally, rigorous and prospective screening may enable earlier identification of pathogens and can lead to appropriate therapy before irreversible lung changes. REFERENCES 1. Savani BN, Montero A, Wu C, Nlonda N, Read E,

Dunbar C, Childs R, Solomon S, Barrett AJ: Prediction and prevention of transplant-related mortality from pulmonary causes after total body irradiation and allogeneic stem cell transplantation. Biol Blood Marrow Transplant 2005;11:223-230.

2. Kache S, Weiss IK, Moore TB: Changing outcomes for children requiring intensive care following hematopoietic stem cell transplantation. Pediatr Transplant 2006;10:299-303.

3. Eikenberry M, Bartakova H, Defor T, Haddad IY, Ramsay NK, Blazar BR, Milla CE, Cornfield DN: Natural history of pulmonary complications in children after bone marrow transplantation. Biol Blood Marrow Transplant 2005;11:56-64.

4. Styczynski J, Debski R, Krenska A, Gornicka H, Hulek E, Wojtylak P, Windorbska W, Drzewiecka B, Ostrowski K, Tujakowski J, Marciniak L, Kusza K, Goc M, Prokurat A, Chrupek M, Urasinski T, Peregud-Pogorzelski J, Ociepa T, Krawczuk-Rybak M, Leszczynska E, Balcerska A, Niedzwiecki M, Wysocki M: Transplantacje komórek hematopoetycznych w świetle 5-letnich doświadczeń. Med Biol Sci 2008;22:157-163.

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5. Cooney-Qualter E, Satwani P, van de Ven C, Baldinger L, Bye M, Bhatia M, Garvin J, George D, Bradley MB, Schwartz J, Wolownik K, Foley S, Hawks R, Kohl V, Cairo MS: Lung biopsy (Bx) has a significantly higher diagnostic yield compared to bronchoalveolar lavage (BAL) in pediatric hematopoietic stem cell transplant (HSCT) recipients. Biol Blood Marrow Transplant 2008;14:26 (abstract 64).

6. Piątkowska M, Styczynski J: Zastosowanie etanerceptu w terapii idiopatycznego zapalenia płuc u dziecka po transplantacji allogenicznych komórek hematopoetycznych. Med Biol Sci 2007;21:141-145.

7. Yanik G, Cooke KR: The lung as a target organ of graft-versus-host disease. Semin Hematol 2006;43:42-52.

Address for correspondence: dr hab. n. med. Jan Styczyński UMK w Toruniu Collegium Medicum im. Ludwika Rydygiera Katedra i Klinika Pediatrii, Hematologii i Onkologii ul. Curie-Skłodowskiej 9 85-094 Bydgoszcz e-mail: [email protected] tel: +52 585 4860. fax: +52 585 4867 Received: 17.03.2009 Accepted for publication: 7.04.2009


ORIGINAL ARTICLE / PRACA ORYGINALNA Magdalena Hagner-Derengowska, Krystyna Nowacka, Wojciech Hagner, Magdalena Wiącek-Zubrzycka

NORDIC WALKING – NEW TREND IN REHABILITATION

NORDIC WALKING – NOWY TREND W REHABILITACJI

Chair and Clinic of Rehabilitation of the Nicolaus Copernicus University Collegium Medicum in Bydgoszcz Head: dr hab. Wojciech Hagner, prof. UMK

S u m m a r y

Nordic Walking is a new outdoor form of exercise, but in easy way to describe it is traditional walking with specially designed poles, which are made of composit of carbon fibres.

This form of recreation is used as an alternative form of rehabilitation especially for patients with cardiologic problems, orthopedic disabilities and for patients with obesity.

Nordic Walking comes from Finland and it was involved as an alternative summer training for skiers. It is a perfect form of exercise for everyone, because it has three levels of training – basic for those people, whose level of physical activity is poor or they need to encourage; fitness and sport for those people who are looking for new form of physical activity.

Nordic Walking is recommended for everyone not only seniors and patients, but also for healthy people as a form of prevention and promotion of healthy lifestyle.

Nordic Walking is a form of training, which uses more than 90 % of body muscles and helps to develop motor functions such as strength, mobility and coordination. Moreover Nordic Walking compared with regular walking shows greater energy consumption by organism during Nordic walking training. Nordic Walking helps to improve physiological functions of heart, muscles and respiratory system, also it is worth to mention that Nordic Walking is used to improve muscle endurance and strength and joint mobility range and it is perfect for those, who have posture problems.

In conlusion Nordic Walking is a new form of recreation and rehabilitation that helps to promote healthy lifestyle.


Nordic walking jest nową formą ćwiczeń na powietrzu. Jest połączeniem tradycyjnego marszu z pracą górnej części ciała oraz kończyn górnych, poprzez użycie specjalnie zaprojektowanych do tej formy ruchu kijków z kompozytu włókna węglowego, polegające na odpychaniu się nimi od podłoża.

Ta forma rekreacji ruchowej jest stosowana jako alternatywna forma ćwiczeń w rehabilitacji, szczególnie dla pacjentów kardiologicznych, ze schorzeniami ortopedycz-nymi oraz pacjentów z otyłością.

„Nordic walking” pochodzi z Finlandii i był alternatywną formą treningu letniego dla narciarzy biegowych, jako ”cho-dzenie z kijkami”. Ta forma ruchu rozwijała się i doskona-liła, a w 1997 roku przyjęła nazwę „nordic walking”.

Omawiana forma treningowo-rehabilitacyjna jest perfekcyjną formą ruchu praktycznie dla każdego, ponieważ trening „nordic walking” może odbywać się na trzech poziomach intensywności, poziomie basic, czyli podsta-wowym dla wszystkich osób z niską wydolnością fizyczną oraz dla pacjentów wymagających zachęty fitness i sport jest rekomendowany dla osób bardziej wytrenowanych, o wyższym poziomie wydolności i tych, którzy szukają urozmaicenia w innych formach treningowych.

„Nordic walking” jest polecany dla każdego, nie tylko dla seniorów i pacjentów, ale również dla osób zdrowych, które chcą promować zdrowy tryb życia i stosować tę formę ruchu jako profilaktykę zdrowotną. Nordic walking jest formą treningową angażujacą 90% mięśni naszego organizmu, wspomaga rozwój głównych funkcji

Magdalena Hagner-Derengowska et al.

46

motorycznych, takich jak siła, mobilność i koordynacja ruchowa.

Porównując „nordic walking” z treningiem chodu bez kijków wykazuje się znaczną przewagę korzyści zdrowotnych treningu „nordic walking”, tj wzrost wydatku energetycznego podczas treningu. Wg wielu autorów „nordic walking” ma korzystny wpływ na układ krwionośny, oddechowy, a także aparat ruchu, ponieważ odciąża stawy,

czyli jest znacznie bezpieczniejszy od joggingu. Rekomendowany jest również dla tych osób, które mają problem z prawidłową postawą ciała.

Reasumując, „nordic walking” jest doskonałą formą ćwiczeń na świeżym powietrzu zalecaną przez lekarzy i fizjoterapeutów jako rehabilitacja i rekreacja ruchowa w celu promocji zdrowia.

Key words: Nordic Walking, recreation, rehabilitation, health promotion Słowa kluczowe: „nordic walking”, rekreacja, rehabilitacja, promocja zdrowia INTRODUCTION

Nowadays, computers, television and fast food have dominated our lives to such an extent that, it is difficult to encourage the society to do any kind of physical activity. The reason for this is our sedentary lifestyle which, in consequence, leads to obesity, and various systemic diseases ranging from diabetes to problems with the motor apparatus. After work we usually sit down in front of our TV and the only exercise that we get is using the remote control to zap through channels. Still, it takes so little to change our habits. Walking is the most natural and healthy form of movement. Fast walking or cross-country walking, for instance, keep us fit. Nordic Walking (NW), on the other hand, combines walking with a technique of pushing yourself from the ground with special poles. When walking with such poles we follow the path of the Finns who invented the name of NW in 1997. NW has been practised in Finland, the Netherlands, Germany, Switzerland and the USA and more than 7 million people around the world do it – now it’s time for Poland. It is not difficult; all we need is two poles and some motivation.

HISTORY

In the 80s and at the beginning of 90s jogging and

cross-country walking were the most popular sports. Yet, those two types of outdoor exercises are not entirely beneficial or healthy as far as rehabilitation is concerned. They strain joints and do not use the upper part of our body. An effective form of rehabilitation which gradually substitutes jogging and walking in Europe is Nordic Walking, the roots of which go back to the 30s, when Finnish langlauf skiers started to walk along a beach with poles. The modern form of NW was introduced and made popular in 1997 in Finland, yet its origins may be found in medieval times

when pilgrims used poles during long wanderings. However, in modern times, NW was introduced as summer training for skiers and with time it evolved into a set of exercises increasing and improving efficiency among various social groups, starting from healthy persons who want to get or keep fit, through sportsmen who do training, children and teenagers, elderly persons, obese persons who wish to lose excessive weight, and, finally, patients of rehabilitation clinics who suffer from various ailments, mainly connected with the locomotor system. This is possible thanks to diverse levels and techniques of walking with poles. NW is a new form of motor recreation in the tourist industry, and it is the tourists who were the first ones to learn how to use the poles while mountain trekking – poles were used as useful tools that made walking easier. Poles are also used by sportsmen during long summer sessions as tools that help them to build up endurance and strengthen muscles. Attempts to promote NW were made every year. Still, the influence of marketing was only noticed in the 90s, when this form of recreation aroused enthusiasm and interest. In the USA NW was introduced as Power Walk, and the poles were used to increase the effectiveness of walking [3, 7]. WHO CAN DO NORDIC WALKING?

Nordic Walking was created for persons of any age and of any physical or health efficiency. The only requirement is that a patient has to be able to walk without anyone’s help. NW is advisable for persons who, from the medicine-related point of view, are contraindicated to do any jogging or walking. It can be clearly stated that walking with poles is simply more effective than walking without them. It is a perfect solution for those who are looking for something new and different as far as their daily trainings are

Nordic Walking - new trend in rehabilitation

47

concerned. Additionally, it may be practised by persons who would like to have pulse beat characteristic for training, but do not wish to quicken it. Anyone can increase their efficiency by regular training and improve not only their muscle strength and endurance, but also flexibility. For this reason NW is a good way of spending time actively especially when it comes to elderly persons, persons with balance disorders, or obese persons who need to increase their energy expenditure, but their movement speed is limited or there are some health contraindications to do regular exercises [7]. WHO SHOULD WE WALK WITH?

In 2000 the International Nordic Walking Association (INWA) was founded in Finland. It is an international organization, authorised by the founders of NW to promote, develop and protect the rules and characteristics of NW around the world. NW-related training methods and education programs are created in cooperation with professionals dealing with sport, health and fitness. The best way to learn how to walk while doing NW is to enrol for classes organized by certified instructors, for instance INWA instructors, who will help you to master the technique and who will create an effective and pleasurable training program for you. An up-to-date list of INWA instructors is available on the Internet [3, 11].

HEALTH ASPECTS

NW is a form of training which helps us use all

muscles and develop main motor functions such as mobility, strength, coordination and endurance. NW may be introduced when strength or muscle endurance need to be improved. Moreover, it leads to greater energy use, and better vascular flow. During NW training we burn approx. 400 kcal/1h (depending on the speed) and during regular walking only approx. 280 kcal/1h. [7, 8]. Compared with regular walking, the ratio of burnt calories is 20:40 %. Latest research showed that as far as omalgia, a widely spread ailment in contemporary world full of computers, is concerned NW produces positive results. It is effective because it annihilates pain and muscle tension in the neck and shoulder area and improves mobility of upper backbone segments. What is more, depending on the force and intensity of pole-strikes, it increases oxygen intake by 20-60 percent, and the heart beat, which is

increased to the cardio level, stimulates the respiratory and the cardiovascular system [9, 12]. Walking with poles makes us use the upper body part muscles; it intensifies shoulder joint movement and increases blood circulation, which then gives an impression that our muscles are more relaxed than during regular walking. Supporting oneself with poles improves our balance and requires an extension in our hip joint during the 3rd phase, i.e. during supporting oneself on toes [3, 7, 12].

When training systematically the energy use increases and, as a consequence, we lose weight effectively, our rest blood pressure is lowered, our body becomes slimmer, stress and depression disappear, endorphins are secreted and our mood is better. Thanks to the poles NW is a form of training during which knees and hips are mildly strained, and while we do pole-strikes hips and knees are relieved even by 5 kg. According to the research that has been conducted it can be stated that the poles relieve our motor apparatus by 30 percent. Each pole-strike makes us use 90 percent of our body’s muscles - this makes training highly effective. NW can be trained almost everywhere and at any time of the year. As far as chronic states, for example arthrosis or pain, are concerned, specialist exercises are used to improve muscle strength, endurance, joint mobility and general joint movement. Systematic exercises which take place 3-5 times a week, and last 20-30 minutes, improve our health without the risk of joint strain which can be observed during jogging or running. Thanks to NW we improve the physiological functions of our heart, muscles, neural and joint system. Due to the fact that various substances are secreted during a given period of time, exercises may reduce inflammatory reactions and myogen pain. Nordic Walking training is very intensive for all body parts. It strengthens flexor and extensor muscles of the forearm, pectoral muscles, stomach and back muscles, posterion arm and shoulder muscles, gluteal muscles, hip and thigh muscles. A significant aspect of this type of training is that it does not strain joints, but strengthens bones and reduces the risk of osteoporosis. Contrary to regular walking, NW is more effective because all muscles are involved, including the upper body part, shoulders and arms. All in all, Nordic Walking training is an effective method of outdoor rehabilitation, as it improves our form and helps us concentrate. It removes stress, teaches coordination and balance, and, what is important as far as elderly patients are concerned, it


48

gives a sense of confidence and balance while walking [3, 7, 12]. Training – short description

NW can be practised at three different levels – for health, fitness and sport. • The health-related technique is perfect for

persons who suffer from health limitation connected with karyology, orthopaedics, neurology (balance and coordination disorders), and rheumatology. It is also for those who would like to work on their health and fitness in a not so intensive, tiresome, yet effective way [3, 7].

• Healthy individuals who would like to improve their form are advised to take up the next level of NW training – the fitness technique - which is a technique involving all muscles (it is a systemic form of exercise). The energy use increases by 46 percent and heart rate is faster than rest heart beat by 10-17 beats. A person who does NW at this level may feel the positive effects of exercises after the very first training session [5, 8].

• Individuals who are very fit and have great physical efficiency should try the sport training. Persons who like challenge will find NW of particular interest and will soon find out that this is much more than just walking with poles [7, 8].

Fig. 1. Correct walking technique

In order to make NW training effective it should be done systematically, several times a week and it should last 30 minutes to 2 hours. The walking pace should be constant, and heart beat should reach 120-150 beats per minute [1, 4, 5, 12].

Fig. 2. Training

Nordic Walking training requires one-piece (the safest and the most efficient) poles made of carbon fibre impregnated with resin. Thanks to the fact that they are elastic, durable, rigid (as far as the best models are concerned) and lightweight, our bodies are in balance while walking and our regular walking is much more interesting. Poles require us to maintain correct body posture, slightly bent forward, which activates our back muscles [1, 9]. One should start NW training once he/she is well acquainted with the walking technique, which should be practised under a qualified Nordic Walking trainer’s supervision (as far as patients are concerned, they should be trained by a physiotherapists). Every person who starts to train NW should adapt the walking speed to their physical abilities, and move their arms in turns [9]. Choosing the right poles is not only a matter of convenience, but also of safety and effective training. Their length is determined by the height of the person who is going to use them multiplied by 0.68. This way we get the right length of poles (in cm). We can say that the poles were chosen correctly if the angle between the forearm and arm is 90º. The pelvis should be slightly lifted upwards, posture muscles should be tense, and the torso should be bent forward intensifying the work of back, pectoral and stomach muscles. Moreover, the poles help to maintain the optimal centre of gravity and much better balance while walking [3, 7, 11].

This supports rehabilitation connected with arthrosis, especially of knee joints, or lower limb fractures. One should also warm up before starting the training in order to stretch the muscles and prepare the body for strain [3, 4, 7].

\

Nordic Walking - new trend in rehabilitation

49

3. 4.

5. 6.

7.

8. 9. Fig. 3, 4, 5, 6, 7, 8, 9. Warm up and exemplary relaxing and

stretching exercises CONCLUSIONS

Nordic Walking is extremely helpful as far as rehabilitation of patients is concerned - especially when their posture is incorrect due to inaccurate therapy. It is recommended as a method of rehabilitation because it can be practised at any time of

the year. Outdoor exercises improve health, form and physical endurance, and help the person who trains NW feel great satisfaction in everyday life. REFERENCES 1. Aigner A. (at all): Effekte von Nordic Walking –

Normalen Gehen auf Herzfrequenz und arterialie

Laktatkonzentration. Osterrichisches Journal fur

Sportsmedizin, 2004, 34, 32-36.

2. Borodulin K. (at all): Associations of self-rated fitness

and different types of leisure time physical activity with

predicted aerobic fitness in 5346 Finnish adults. Journal

of Physical Activity and Health 2004, 1, 142-153.

3. Church T., Earnest J., Morss A.: Field testing of

physiological responses associated with Nordic Walking.

Res. Quart. Exerc. Sports 2002, 73, 296-300.

4. Cleindeist F. i wsp.: Comparsion of kinematic and

kinetic paramethrs between the locomotion patients in

Nordic Walking and running. Orthop. and Traum. Sport

Medicine. 2006, tom.20, s.25-30.

5. Haugan A., Sollesnes B.: Does submaximal oxygen

uptake increase when using Nordic Walking poles?

Academic degree study. Fjordane University College,

Faculty of Teacher Education, Sogndal, Norway 2003.

6. Koskinen J., Karki M., Virtanen M.: Poweroad balance

from Nornic Walking – effects of regular NW to

muscular strength and postural control of egeing

employers who are unaccustomed to regular physical

exercise. Bachelor of Physiotherapy degree. Helsinki

Polytechnic, Health Care and Social Services, Helsinki

2003.

7. Laukkanen R.: Scientific evidence on Nordic Walking.

INWA Helsinki 2004.

8. Mukka M.: Estimating of selfrequided Nordic Walking

and walking training intensity in 50-60 years old

women. Doctor Thesis ,University of Jyvaskyla 2004.

9. Morss A. (at all): Field test comparing the metabolic cost

of normal walking versus walking with Nordic Walking.

Med. Sci. Sports Exerc. 2001, 33, 23-30.

10. Parkatti T., Wacker P., Andrews N.: Functional capacity

from Nordic Walking among elderly people. Seminar

presentation, University of Jyvaskyla, Finland 2002.

11. Schmidt A. (at all): Nordic Walking – an analysis of

target groups and perspectives. IX-th Annual Congress

of the European College of Sport Science, Clermont-

Ferrand, France 2004.


50

12. Rogers C. i wsp.: Energy expenditure during

submaximal walking with exerstriders. Med. Sci. Sports

and Exerc.1995, tom 27; s. 607-611.

Address for correspondence: Katedra i Klinika Rehabilitacji UMK w Toruniu Collegium Medicum im. Ludwika Rydygiera ul. M. Skłodowskiej-Curie 9 tel./fax: (052) 585 40 42 e-mail: [email protected] Received: 30.06.2009 Accepted for publication: 2.09.2009


ORIGINAL ARTICLE / PRACA ORYGINALNA Alicja Kędzia1, Jowita Woźniak1, Krzysztof Dudek2

METROLOGICAL ANALYSIS OF TOPOGRAPHY OF RADIAL NERVE IN HUMERAL SEGMENT DURING FETAL PERIOD

ANALIZA METROLOGII I TOPOGRAFII NERWU PROMIENIOWEGO

W ODCINKU RAMIENIOWYM W OKRESIE PRENATALNYM

1 Department of Normal Anatomy, Medical University of Wrocław Head: prof. dr hab. Alicja Kędzia

2 Institute of Machines Design and Operation, Technical University of Wrocław Head: dr hab. inż. Tomasz Nowakowski, prof. PWr.

S u m m a r y

The paper aimed at metrological analysis and topography of radial nerve within humeral segment during foetal period in order to fill up the gap in available literature. The surveys were characteristic for their cognitive character as the knowledge of foetal structures may have practical meaning in potential reparative procedures after brachial plexus damage or humeral bone fractures. Morphological analysis included 140 preparations of upper extremities, 70 foetuses within morphological age between 15 and 28 week with crown-rump lengths (CRL): 90-255 mm, 34 female ones (47.9%). Methods applied comprised: morphological and preparational analysis, digital acquisition of images with the help of digital camera, computer measurement systems Scion Image for Windows 4.0.3.2 Alpha, as well as statistical analysis (program STATISTICA: Shapiro-Wilk test, Kolmogorov-Smirnov test, U Mann-Whitney test, Wilcoxon signed-rank test and MANOVA analysis). Symmetry and sex dimorphism

as well as dynamics of growth of length of humerus, width and length of radial nerve, profunda brachii artery, medial collateral artery, width of heads of triceps brachii muscles. At the level p < 0.05 there is no statistical difference in values of examined dimensions at left and right sides (with single exception of length of profunda brachii artery at back side of shoulder, left one was noticeably longer). Majority of dimensions of female foetuses was greater than male foetuses (p <0.05). This reflects the fact that female foetuses were bigger and older. The profunda brachii artery within 15-28 week evolves in a steady way which is proved by the constant value of Wtg indicator. In contrast, the speed of growth of radial nerve was lower than its transversal dimension which is proved by weak (but statistically important at the level p < 0.05) negative correlation of indicator with age of foetuses.


Celem pracy była analiza metrologii i topografii nerwu promieniowego (nervus radialis) w odcinku ramieniowym w okresie życia płodowego, w celu uzupełnienia luki w piśmiennictwie. Badania miały charakter poznawczy, znajomość płodowych struktur może mieć znaczenie praktyczne dla ewentualnych zabiegów naprawczych przy uszkodzeniach splotu ramiennego oraz przy złamaniach kości ramiennej. Analizie morfometrycznej poddano 140 preparatów kończyn górnych 70 płodów w wieku morfologicznym między 15 a 28 tygodniem, w przedziale

długości v-tub: 90-255 mm. Wiek morfologiczny płodów określono na podstawie zależności opisanej przez Scammona i Calkinsa. Płodów żeńskich (F) było 34 (47,9%).

W pracy posługiwano się metodami: antropologiczną, preparacyjną, akwizycją obrazu za pomocą Scione Image for Windows oraz metodami statystycznymi (pakiet programu Statistica: test Shapiro-Wilka, test U Manna-Whitneya). W badaniach uwzględniono przyrosty tygodniowe długości kości ramieniowej (humerus), średnicy i długości: nerwu promieniowego: (nervus radialis), tętnicy głębokiej ramienia

Alicja Kędzia et al.

52

(arteria profunda brachii), tętnicy pobocznej środkowej (arteria collateralia media), szerokości głowy długiej, bocznej i przyśrodkowej mięśnia trójgłowego ramienia (musculus triceps brachii). Analizowano symetrię i dymorfizm płciowy, nie zaobserwowano (na poziomie p<0,05) statystycznie istotnej różnicy w wartościach analizowanych wymiarów po lewej i prawej stronie (poza wyjątkiem długości tętnicy głębokiej ramienia na tylnej powierzchni ramienia Itg po stronie lewej była istotnie dłuższa (ryc. 3). Występowanie dymorfizmu płciowego

weryfikowano testem U Manna-Whitneya. Większość wymiarów płodów żeńskich była istotnie większa od płodów męskich (p> 0,05). Tętnica głęboka ramienia w okresie od 15 do 28 tygodnia rozwija się równomiernie, o czym świadczy stała wartość wskaźnika Wtg. Natomiast tempo wzrostu długości nerwu promieniowego i długości głowy przyśrodkowej mięśnia trójgłowego ramienia jest niższe od ich wymiarów poprzecznych, o czym świadczy słaba (ale istotna statystycznie na poziomie p < 0,05) ujemna korelacja odpowiednich wskaźników z wiekiem płodów.

Key words: foetus, upper limb, radial nerve, profunda brachii artery, triceps brachii muscle, medial collateral artery Słowa kluczowe: płód, nerw promieniowy, tętnica głęboka ramienia, mięsień trójgłowy ramienia INTRODUCTION

Knowledge of normal foetus evolution is important in evaluation of hypotrophy of foetus [1]. Examinations of length of upper extremities by Woźniak and Bruska [2], Jeanty [3], Chen at al. [4], Bareggi et al. [5], Gray and Gardner [6] were done for this purpose. Lewis [7] describe topographic relations between humerus and scapula during embryonic evolution before approaching 20 mm. Observations of Morales-Rosello [8] indicated good oxygen supply of blood flowing through humeral vessels and their subsequent branching. These vessels have high index of flow resistance. Author examined flow in vessels with the help of sonograph in humeral for 71 foetuses. In the available literature there is no research devoted to this area for foetuses. The paper of Karabulut et al. [9] is an exception. He has examined 200 humeral plexuses and he has proved that it is formed before 13 week of fetal life. Rodriguez-Niederfuehr et al. [10] analysed variants of vessels of upper limb for 192 dead adults. They have also presented their own classification of deviations due to literature. Subsequent papers [11, 12] of these authors include interesting observation about theory of appearance of morphological variants of vessels during embryonic period. Authors examined 112 embryos between 12 and 23 stage of evolution (CRL: 3.5-30 mm). At the stage 13 (CRL: 5-6 mm) of embryonic evolution the vessel plexus begins to mature according to increase and differentiate in various directions. This remodelling begins from aorta and it is continued from proximal to distant parties. At the stage 15 (CRL: 7.5-9 mm), differentiation approaches armpit vessels and under clavicle vessels. At the stage 17 (CRL: 13-15 mm), it approaches elbow, but at stage 18 (CRL: 13.5-16.5 mm) it approaches forearm. During 21 stage (CRL: 22-24 mm), the final pattern of vessels of upper limb is formed in a way which can be observed

postnatally. Carlan et al. [13] and Bono et al. [14] examined length and shape of radial nerve of adults. Morphological variants of humeral vessel and its branches are the main topic of the papers by Coskun et al. [15] and Patnaik et al. [16], Peştemalci et al. [17], Lim et al. [18]. Modifications of triceps brachii muscles were examined by Tubbs et al. [19], Merin et al. [20] and Fabrizio [21] et al. Results of rare variants of triceps brachii types were discussed by Manske [22]. Relations between vessels and nerves for patients with paralysis of radial nerve resulted from broken humerus were described by Bodner et al. [23]. Solzi et al. [24] analyzed cases of injuries resulting from clinic treatment and post-injection damage of radial nerve. Analysis of available literature indicated lack of studies devoted to triceps brachii muscle morphology, radial nerve and corresponding profunda brachii artery during fetal period. Fulfillment of this gap constitutes the main purpose of this paper. MATERIAL AND METHODS

Examinations comprised 140 arms of 70 foetuses between 15 and 28 week of life (34 females). The whole of the material was stored in formaldehyde solution and at present, it is impossible to conciliate any new one. The foetuses used in the surveys were preserved in similar time range so the agent influence was similar in the case of all the examined structures. The whole of examined material originated from the reservoir of the Department of Normal Anatomy, Wrocław University of Medicine. Morphological age of foetuses was determined according to the dependence described by Scammona and Calkins [25]. Applied methods include: preparations, antrophology, image acquisition with the help of digital camera as well as statistical analysis. Mean, standard deviations, median, minimum and maximum values were

Metrological analysis of topography of radial nerve in humeral segment during fetal period

53

calculated for all quantitative variables. All variables were not-normally distributed (Shapiro-Wilk test) and therefore differences between two independent groups (F vs. M) were tested by Mann-Whitney test and differences between two related groups (left vs. right side) were checked by Wilcoxon signed-rank test. Spearman's rank correlation coefficient was used to take the dependence force between all the analyzed sizes. After scatter plot analysis, regression non linear analysis was applied to describe the changes of radial nerve basic measurements. Hyperbolic tangent function proved to fit the measurements results best .

Measurements were done under computer system Scion Image for Windows 4.0.3.2 Alpha. Photos were prepared with the help of Gimp 2.2 and Bimp 1.43. The paper aimed at metrological and topography analysis of radial nerve in the humeral segment during fetal life, evaluation of sex dimorphism, symmetry and growth rate. All the specimens were photographed with millimeter scale which enabled pixels to millimeters rescaling. Scion Image is a computer program reading linear sizes from digital photographs to within 0.01 mm. All sizes measurements were taken three times avoiding exposure of such valuable fetal material to any damage. Scion Image for Windows computer system has not been applied, so far, to morphometric examinations of radial nerve. RESULTS

Two kinds of measurements were done, somatic features CRL, v-pl, body mass (Table I) and ones depicting morphometry of back area of humerus for 70 foetuses thus for 140 extremities (Table II and III, Fig. 1). The age of examined material is best visualized in Fig. 2 histogram. Foetuses aged 17-24 weeks were most numerously represented in the material.

Table I. Somatic characteristics of examined foetuses and

results of comparison

Sex Examined feature of foetus

Female Male Total

p value

Age [day]: Mean x Standard deviation SD Median xmed Minimal value xmin Maximal value xmax

151 24 160 107 193

155 30 160 102 198

153 27 160 102 260

0.381

Length CRL [mm]: Mean x Standard deviation SD Median xmed Minimal value xmin Maximal value xmax

177 45 186 99 265

174 44 180 90 235

175 44 182 90 265

0.789

Mass [g]: Mean x Standard deviation SD Median xmed Minimal value xmin Maximal value xmax

393 214 442 70 815

400 249 375 50 842

396 231 410 50 842

0.921

Table II. Characteristics of parameters of humeruses of examined foetuses and results of comparison

Sex Parameters

Female Male Total p

valueLenght of humerus Lkr [mm]

Mean x Standard deviation SD Median xmed Minimal value xmin Maximal value xmax

47.4 11.0 49.2 25.6 67.5

44.9 11.5 45.7 24.0 72.2

46.1 11.3 46.6 24.0 72.2

0.143

Distance Ann [mm] Mean x Standard deviation SD Median xmed Minimal value xmin Maximal value xmax

13.3 3.5 13.6 6.5 23.1

12.3 3.4 12.0 5.1 19.9

12.8 3.5 12.5 5.1 23.1

0.118

Width of long head triceps brachii Bgd [mm]


6.3 2.2 6.1 2.4 13.2

5.8 2.1 5.5 1.4 13.0

6.0 2.2 5.9 1.4 13.2

0.185

Width of medial head triceps brachii Bgp [mm]


4.8 1.6 4.9 1.5 9.2

4.4 1.8 4.0 1.8 10.1

4.6 1.7 4.4 1.5 10.1

0.065

Width of lateral head triceps brachii Bgb [mm]


6.4 1.9 6.6 2.7 10.5

5.9 2.1 5.7 2.2 11.9

6.1 2.0 6.1 2.2 11.9

0.101

Width of radial nerve Dnp [mm]


1.1 0.3 1.1 0.5 1.8

1.0 0.3 0.9 0.4 1.7

1.0 0.3 1.0 0.4 1.8

0.073

Distance Ant [mm] Mean x Standard deviation SD Median xmed Minimal value xmin Maximal value xmax

0.7 0.5 0.6 0.1 2.3

0.5 0.4 0.4 0.1 1.7

0.6 0.4 0.5 0.1 2.3

0.085

Dimension Caption Lkr Length of humerus, [mm] Dnp Width of radial nerve in its half length, [mm] Ant Distance between radial nerve and profunda brachii artery in the half length of humerus,

[mm] Abp Distance between lateral head and medial head triceps brachii in medial line of

humerus, [mm] Dtg Width of profunda brachii artery in the half length of vessel, [mm] Dtp Width of medial collateral artery in the branching from profunda brachii artery, [mm] Lnp Length of radial nerve at the back surface of shoulder, [mm] Ltg Length of profunda brachii artery at the back surface of shoulder, [mm] Ann Distance between lateral epicondyle humerus and the place of outgoing of radial nerve

in lateral facies humerus, [mm] Bgd Width of long head triceps brachii in half length of humerus, [mm] Bgp Width of medial head triceps brachii in half length of humerus, [mm] Bgb Width of lateral head triceps brachii in half length of humerus, [mm] Fig 1. Denotation of analysed geometrical dimensions of

shoulder


54

Table III. Characteristics of morphometric parameters and topography of radial nerve and results of comparison

Sex Parameters

Female Male Total p-

valueDistance Abp [mm]


2.4 0.7 2.2 0.9 5.4

2.0 0.8 2.0 0.2 4.8

2.2 0.8 2.1 0.2 5.4

0.022

Width of profunda brachii artery Dtg [mm]


0.6 0.2 0.6 0.3 1.1

0.6 0.3 0.5 0.2 1.3

0.6 0.2 0.6 0.2 1.3

0.469

Width of medial collateral artery Dtp [mm]


0.4 0.1 0.4 0.2 0.7

0.4 0.1 0.4 0.2 0.7

0.4 0.1 0.4 0.2 0.7

0.217

Length of radial nerve Lnp [mm]


16.1 3.7

16.2 8.7

22.8

15.4 4.1

15.2 7.1

27.2

15.7 3.9

16.0 7.1

27.2

0.210

Length of profunda brachii artery Ltg [mm]


14.2 5.0

13.6 5.7

30.5

13.0 3.9

13.1 5.9

24.6

13.6 4.5

13.3 5.7

30.5

0.322

Fig. 2. Examined material histogram against the background of normal distribution

Coincidence of analysed empirical distributions

with theoretical normal distribution was verified with the help of Shapiro-Wilk test and Kolmogorov-Smirnov test. The value p = 0.05 was accepted as the critical one. In separate groups of age empirical distribution does not coincide with normal distribution. According to this fact, the importance of differences between left and right sides were examined with the help of Wilcoxon signed-rank test and appearance of sex dimorphism was examined with U Mann-Whitney test. Analysis of growth rate was carried for week

periods of time. The mean length of humerus (Lkr) was 2 mm greater for female foetuses, which is proved by the material chosen. Distance between radial nerve and profunda brachii artery is greater for female than male foetuses (approximately 0.3 mm). Distance between medial and lateral head triceps brachii Atp of female foetuses is 0.4 mm greater comparing to male one. Width of radial nerve Dnp of female foetuses is 0.4 mm greater comparing to male one in mean approximately 0,4 mm. Mean length of right profunda brachii artery Ltg in posterior facies humerus is 1.2 mm greater comparing to left one.

This difference is statistically important at the level p < 0,05 (Fig. 3).

Fig. 3. Comparison of length of profunda brachii artery (Ltg) in the back surface of left and right shoulder as well as results of Wilcoxon signed-rank test

Correspondences between analysed features are

depicted by correlation matrix (Table IV, Fig. 3). All parameters grow in linear manner, which is presented in Fig. 4. Strong linear correlation was observed between radial nerve width and humeral bone length both on the left and right side which stands for their gradual growth in the whole analysed foetal period.

Table IV. Matrix of Spearman’s rank correlation coefficients

between measured features Parameters Ant Abp Dtg Dtp Lnp Ltg Ann Lkr Bgd Bgp Bgb Dnp [mm] 0.369 0.431 0.676 0.654 0.770 0.647 0.737 0.796 0.609 0.675 0.609

Ant [mm] 0.251 0.354 0.317 0.374 0.355 0.453 0.351 0.229 0.319 0.258

Abp [mm] 0.347 0.380 0.489 0.348 0.465 0.464 0.390 0.375 0.370

Dtg [mm] 0.648 0.625 0.503 0.604 0.627 0.488 0.541 0.469

Dtp [mm] 0.586 0.511 0.603 0.635 0.573 0.565 0.561

Lnp [mm] 0.735 0.688 0.800 0.596 0.706 0.658

Ltg [mm] 0.647 0.706 0.587 0.667 0.609

Ann [mm] 0.778 0.561 0.611 0.550

Lkr [mm] 0.727 0.705 0.742

Bgd [mm] 0.575 0.697

Bgp [mm] 0.557

Important correlation coefficients are listed at the level p < 0.05

0

5

10

15

20

25

30

35

40

No

of o

bs

Wilcoxon testZ = 2,084; p = 0,037

left right

Shoulder

0

5

10

15

20

25

30

35

Ltg

[mm

]


55

Fig. 4. Exemplary correlation diagrams of humerus length (Lkr) and width of radial nerve (Dnp) with humerus length (Lkr) and length of radial nerve (Lnp), as well as regression models and regression coefficients

Correlation coefficients of all analysed geometrical

parameters (with exception of correlation Ann – the distance between radial nerve and lateral epicondyle with Lkr – the length of humerus) differ noticeably from zero, which enables estimation of mutual correlation among examined parameters. The increase of analysed dimensions x of shoulder is depicted by hyperbolic function tangent:

( )( )cGAbax −⋅⋅= tanh

where: GA – the week of foetal life; a, b and c – parameters estimated according to mean square method (Table V). The level of coincidence with experimental results is evaluated with the help non linear correlation coefficient R. The dynamics of growth of length alike dimensions is depicted in Fig. 5. The growth ratio during the first period is greater, humerus grows most rapidly (3.2 mm/week), radial nerve develops more slowly (1.3 mm/week) with accompanying profunda brachii artery (0.7 mm/week). During the final period (27 – 28 week) the increase of humerus length slows down to 1.3 mm/week, the length of radial nerve to 0.3 mm/week and increases of length of profunda brachii

artery have the same value (0.7 mm/week). The following length-width like parameters are defined to describe the growth rate in two directions:

index of radial nerve: DnpLnpWnp = ;

index of profunda brachii artery: DtgLtgWtg =

where: Lnp – length of radial nerve, Dnp – width of radial nerve, Ltg – length of profunda brachii artery, Dtg - width of profunda brachii artery. Profunda brachii artery develops steadily between 15 and 28 week, which is proved by the constant value of Wtg index (Fig. 6). In contrast growth rate of radial nerve is smaller than its transversal dimensions, which is proved by weak (but statistically important, at the level p < 0.05) negative correlation of suitable index with foetuses age. The relative increase of nerve length during discussed period was smaller than the increase of width. Table V. Parameters of mathematical model of growth for

analysed elements of humerus ( )( )cGAbaX −⋅⋅= tanh

Dimension X xmin xmax Sex a b c 25.32 68.38 Female 69.1 0.0687 6.59 Lkr 23.77 72.41 Male 129.3 0.0174 1.59 7.66 23.39 Female 24.6 0.0580 8.04 Lnp 6.82 28.68 Male 19.0 0.0830 7.78 0.43 1.90 Female 63.9 0.0011 7.07 Dnp 0.31 1.82 Male 63.3 0.0008 3.14 5.19 30.47 Female 238.8 0.0038 6.62 Ltg 5.94 25.10 Male 27.3 0.0264 2.70

Dtg 0.16 1.34 Total 9.8 0.0032 4.13 0.05 2.60 Female 63.8 0.0006 5.37 Ant 0.06 1.90 Male 63.4 0.0004 3.63 0.64 5.69 Female 60.1 0.0017 -0.73 Abp 0.20 5.03 Male 25.5 0.0030 -3.89 0.15 0.76 Female 0.5 0.1243 10.84 Dtp 0.12 0.91 Male 4.8 0.0037 0.18 6.01 23.72 Female 37.2 0.0225 5.36 Ann 4.96 20.23 Male 25.0 0.0241 0.00 2.36 13.95 Female 8.6 0.0914 11.16 Bgd 1.29 13.24 Male 142.8 0.0021 3.40 1.32 10.65 Female 7.0 0.0780 10.76 Bgp 1.66 11.00 Male 28.8 0.0067 -0.36 2.50 11.18 Female 8.4 0.0861 9.50 Bgb 1.84 12.00 Male 127.2 0.0022 1.05

Fig. 5. The dependence of humerus length (Lkr), radial nerve (Lnp) and profunda brachii artery (Ltg) on foetus age

Lkr [mm] = 18.51 + 26.685 * Dnp [mm]r = +0.796

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Fig 6. Correlation diagrams of length – width like indices with foetus age. Wnp – index for radial nerve, Wtg -

index for profunda brachii artery DISCUSSION

Analysis of available literature discussing radial nerve development in foetal period revealed complete lack of elaborations including results of measurements defining this nerve geometry. This paper aimed at filling this gap up.

According to presented results it has been found that the length of humerus increases faster between 15 and 21 week than in the subsequent period 21 – 28 week of foetal life. This part of research was compared with data from literature. The week growth rate of humerus amounts above 3.1 mm in 15 week and decreases to 1.3 mm during 28 week. Obtained results are higher than the ones coming from ultrasonography [4]. This fact has very important clinical meaning especially in evaluation of hypotrophy of foetus [1]. Application of Scion Image for Windows appears especially profitable and it allowed repetition of measurements with high precision but without any damage of foetus. It should be noticed that in measurements of foetus structures in another examination the computer method Scion Image for

Windows was applied [26, 27, 28]. In the available literature there is no data about morphometry of radial nerve in shoulder during foetal period. According to our results the profunda brachii artery develops steadily between 15 and 28 week. Damages of humerus plexus appear most frequently during shoulder dystocia (Erb – Duchene palsy entailing injury roots of the brachial plexus (from C5 to C6), Klumpke’s paralysis is the result of injury of the lower roots of the brachial plexus (from C8 to T1)) [29]. Fleming et al. [30] elaborated dependence between layout of radial nerve and risk of injury during surgical operation in the area of back humerus while examining dead adults. CONCLUSIONS

The full symmetry of development of radial nerve and profunda brachii artery has been noticed as well as absence of sex dimorphism. Development of profunda brachii artery is regular within 15-28 week whereas the development of radial nerve becomes irregular with domination of longitudinal dimensions. REFERENCES 1. Mazur A.: Characteristics of terminal wisps of placentas

in foetal hypotrophy. Doctor thesis, Wroclaw; 2005. p 9-19.

2. Woźniak W, Bruska M.: The lenght of the humerus in human embryos at developmental stages 18- 23. Folia Morphol. 2006; 65(2): 136-139.

3. Jeanty P.: Fetal limb biometry. Radiology. 1983; 147(2): 601-602.

4. Chen M, Lee YH, Lam YH, Ou CQ, Tang MH.: First-trimester fetal limb biometry in Chinese population. Prenat Diagn. 2007; 27(2): 133-138.

5. Bareggi R, Grill V, Zweyer M, Sandrucci MA, Narducci P, Forabosco A.: The growth of long bones in human embryological and fetal upper limbs and its relatonship to other developmental patterns. Anat Embryol (Berl). 1994; 189(1): 19-24.

6. Gray DJ, Gardner E.: The prenatal development of the human humerus. Am J Anat. 1969; 124(4): 431-446.

7. Lewis WH. The development of the arm in man. Am J Anat. 1901/1902; 1(2): 145-183.

8. Morales-Rosello J.: Doppler Sonographic study of fetal brachial and umbilical artery blood flow during pregnancy. J Clin Ultrasound. 2001; 29(3): 152-156.

9. Karabulut KA, Ziylan T, Büyükmumcu M, Seker M, Uysal II.: Brachial plexus variations in human fetuses. Neurosurgery. 2003; 53: 676-684.

10. Rodriguez-Niedenfuehr M, Vazquez T, Nearn L, Ferreira B, Parkin I, Sanudo JR.: Variations of the arterial pattern in the upper limb revisited: a morphological and statistic

Wnp = 22,231 - 0,2787 * GAr = -0,280

14 16 18 20 22 24 26 28 30

GA [wks]

5

10

15

20

25

30

35

40

Wnp

Wtg = 27,0r = 0

14 16 18 20 22 24 26 28 30

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0

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study, with a review of the literature. J Anat. 2001; 199: 547-566.

11. Rodriguez-Niedenfuehr M, Burton G J, Deu J, Sanudo JR.: Development of the arterial pattern in the upper limb of staged human embryos: normal development and anatomic variations. J Anat. 2001; 199: 407-417.

12. Rodriguez-Niedenfuehr M, Vazquez T, Parkin I G, Sanudo JR.: Arterial patterns of the human upper limb: update of anatomical variations and embryological development. Eur J Anat. 2003; Suppl 1: 21- 28.

13. Carlan D, Pratt J, Patterson J M, Weiland AJ, Boyer MI, Gelberman RH.: The radial nerve in the brachium: an anatomic study in human cadavers. J Hand Surg (Am). 2007; 32(8): 1177- 182.

14. Bono Mc Ch, Grossman MG.: Radial and axillary nerves anatomic considerations for humeral fixation. Clin Orthop Relat Res. 2000; 373: 259-264.

15. Coskun N, Sarikcioglu L, Donmez BO, Sindel M.: Arterial, neural and muscular variations in the upper limb. Folia Morphol. 2005; 64(4): 347-52.

16. Patnaik VVG, Kalsey G, Singla R.: Branching pattern of brachial artery – a morphological study. J Anat Soc India. 2002; 51(2): 176-186.

17. Peştemalci T, Ince Y, Yildirim M, Kopuz C, Yildiz Z, Kesmezacar F, Aydin E, Corumlu U, Demir T.: A study of variable origins of arteries in arm. Eur J Plast Surg. 2007; 30: 133-117.

18. Lim AY, Pereira BP, Kumar VC.: The long head of the triceps brachii as a free functioning muscle transfer. Plast Reconst Surg. 2001; 107(7): 1746-1752.

19. Tubbs SR, Salter EG, Oakes JW.: Triceps brachii muscle demonstrating a fourth head. Clin Anat. 2006; 19: 657-660.

20. Merin MT, Soubhagya RN, Ashwin K, Madhan KS, Latha VP, Vasudha S.: Four-headed biceps and triceps brachii muscles with neurovascular variation. Anat Sci Int. 2008; 83(2): 107-111.

21. Fabrizio P A, Clemente RF.: Variations in the triceps brachii muscle. Clin Anat. 1997; 10: 259- 263.

22. Manske PR.: Compression of the radial nerve by the triceps muscle: a case report. J Bone Joint Surg Am. 1977; 59: 835-836.

23. Bodner G, Buchberger W, Schocke M, Bale R, Huber B, Harpf Ch, Gassne E, Jaschke W.: Radial nerve palsy associated with humerus shaft fracture: evaluation with IS-initial experience. Radiology. 2001; 3: 811-816.

24. Solzi P, Lotem M, Fried A, Levy M, Najenson T, Nathan H.: Radial palsy following muscular effort. A nerve compression syndrome possibly related to a fibrous arch of the lateral head of the triceps. J Bone and Joint Surg. 1971; 53B(3): 500- 506.

25. Carlson BM.: Human embriology and developmental. Mosby St Louis; 1999. p. 450.

26. Derkowski W, Kędzia A.: Application of image procesing system Scion for Windows 98 and Elf in evaluation of development of fossa anterior cranial during fetal period. VIII Conference on computer aided scientific research. Wroclaw; 2001. p. 65-71.

27. Glonek M, Kędzia A.: Evaluation of effectiveness of programs Elf and Scion for Windows 98 in morphological analysis of human lateral ventricles during fetal period. VIII Conference on computer aided scientific research. Wroclaw; 2001. p. 59-65.

28. Kędzia A, Derkowski W, Glonek M.: Structure and function of skull on the basis of computer image analysis during fetal period. XIII Conference on Computer Aided Scientific Research. Wroclaw; 2006. p. 241-246.

29. Higier J, Wiernicka S.: Clavicle fracture during delivery. Ginecol Pol. 1957; 28(2): 149-160.

30. Fleming P, Lenehan B, Sankar R, Folan-Curran J, Curtin W.: One- third, two-thirds: relationship of the radial nerve to the lateral intermuscular septum in the arm. Clin Anat. 2004; 17: 26-29.

Address for correspondence: Alicja Kędzia Department of Normal Anatomy Medical University of Wrocław ul. Chałubińskiego 6a, 50-368 Wrocław; Poland tel: +48 71 784 00 80 e-mail: [email protected] Received: 11.08.2009 Accepted for publication: 2.09.2009


ORIGINAL ARTICLE / PRACA ORYGINALNA Mariusz Klimczyk, Mirosława Cieślicka, Mirosława Szark

SOMATIC CHARACTERISTICS, STRENGTH AND SPORT RESULT

IN 12-19-YEAR-OLD POLE VAULT JUMPERS

BUDOWA SOMATYCZNA, SIŁA A WYNIK SPORTOWY W SKOKU O TYCZCE

U ZAWODNIKÓW W WIEKU 12-19 LAT


S u m m a r y

I n t r o d u c t i o n . Proper muscle strength is a fundamental component in accomplishing acts of movement specific to a given sport discipline (these movements are highly complex in one of track and field events, i.e. pole vault). It is a critical factor in efficient movements, maintaining stability in joints and minimizing muscle-bone injuries. The present paper discusses changes in somatic characteristics, strength and sport result in 12-19-year-old pole vault jumpers in a single annual training cycle, and the percentage of dependencies between parameters (monitors), including a sport result.

M a t e r i a l s a n d m e t h o d s . The study conducted in February of 2007 and 2008 included seven 12-19-year-old pole vault jumpers from the “Zawisza” Bydgoszcz sports club. In order to assess the physical development of jumpers, the measurements of somatic characteristics such as length, width, circumference and body weight were analysed. An index of somatic characteristics according to Rohrer, based on the ratio of body weight to body height, was used.

The studies were conducted using a large sliding caliper, medical scales and metric tape. In order to develop fitness tests that would evaluate strength parameters of young jumpers comprehensively, the dynamic strength of arm and shoulder girdle, as well as explosive leg power were taken into consideration. All tests were carried out under identical conditions.

R e s u l t s . The analysis of tests results of jumpers’ somatic development revealed progression or, in some cases, slowdown in the growth of individual indices. Overall, the greatest growth in the above parameters was observed in the youngest jumpers, where the average was 11.1% in J.R.,

whereas in the oldest jumpers it was 2.01% (W.P) and 1.54% (K.B.).

The analysis of individual physical fitness development of subjects revealed, aside from few exceptions, a decisive increase in indices. The greatest improvement was again observed in the youngest jumpers: J.R., P.R. and O.S. (34.27%, 39.35% and 35.42% respectively), whereas in the oldest jumpers it was only 17.47% (W.P.) and 22.8% (K.B).

Upon analyzing changes in the somatic characteristics and the level of strength capabilities development in individual subjects, the relations between them were shown on the basis of a percentage difference. The average growth in somatic traits in the oldest jumpers, i.e. W.P and K.B. was 2.01% and 1.54% respectively, and the average growth in strength capabilities 17.47% and 22.8%, whereas a sport result of W.P. was 4.1% and no progress was observed in K.B. In turn, in the youngest subject (12-13 years old) the average of somatic traits increased by 11.1%, strength capabilities by 34.27%, and a pole vault jump result by 11.11%.

C o n c l u s i o n s . The analysis of study results demonstrated the growth rate of individual parameters, where the most significant increase in somatic traits was observed in the sportsmen between 12 and 16. In the oldest jumpers (at the first stage of research aged 18, and after a year – 19 /K.B., W.P./), a clear slowdown in the growth of the trait described was noted. Similarly, as regards strength capabilities, the least significant growth was demonstrated in the oldest jumpers, whereas the greatest in the youngest jumpers. The most noticeable increase in a sport result was displayed in O.S, and the most moderate in W.P.

Mariusz Klimczyk et al.

60

Such a small number of subjects prevents from any generalizations to be made as regards study results, yet the jumpers with the smallest growth in somatic traits and strength capabilities (W.P and K.B) achieved the smallest progress in sport results. In younger subjects the growth in somatic parameters, strength capabilities and sport result was

considerable. In the case of the youngest jumper and a year older colleague, smaller improvement in a sport result was caused by absence from training sessions (this was brought about by, among other things, an injury), which affected mastering the jumping technique.


Wstęp. Stosowna siła mięśniowa jest niezbędnym elementem umożliwiającym zawodnikom realizowanie specyficznych dla danej dyscypliny sportowej aktów ruchowych (bardzo złożonych w konkurencji lekkoatletycznej - skok o tyczce). Jest ona niezastąpionym czynnikiem sprawnego poruszania się, utrzymania odpowiedniej stabilności w obrębie stawów, jak również zminimalizowania kontuzji mięśniowo-szkieletowych. Praca dotyczy analizy zmian budowy somatycznej, siły i wyniku sportowego w skoku o tyczce 12-19-letnich tyczkarzy w jednym rocznym cyklu treningowym, jak również procentu wspólnych zależności wskaźników kontrolnych, łącznie z wynikiem sportowym.

M a t e r i a ł i m e t o d y . Badaniom, które przeprowadzono w miesiącu lutym 2007 i 2008 roku poddanych zostało siedmiu 12-19-letnich zawodników uprawiających skok o tyczce w klubie „Zawisza” Bydgoszcz. Do oceny rozwoju fizycznego wykorzystano pomiary budowy somatycznej dotyczące cech długościowych, szerokościo-wych, obwodów oraz masy ciała. Dokonano obliczenia wskaźnika budowy somatycznej wg. Rohrera na podstawie określenia stosunku masy ciała do jego wysokości.

Badania wykonano posługując się cyrklem kabłąkowym dużym, wagą lekarską i taśmą metryczną. Do skonstruowania prób sprawnościowych, które by możliwie wszechstronnie oceniły parametry siłowe młodocianych skoczków o tyczce, wzięto pod uwagę siłę dynamiczną ramion i obręczy barkowej, a także siłę eksplozywną nóg. Wszystkie próby zostały przeprowadzone w tych samych warunkach.

W y n i k i b a d a ń . Przeprowadzona analiza wyników badań rozwoju somatycznego badanych skoczków o tyczce ukazała progresję lub w nielicznych przypadkach spowolnienie tempa wzrostu poszczególnych wskaźników. Generalnie, największy wzrost powyższych parametrów nastąpił u najmłodszych sportowców, gdzie u J.R. ich średnia wzrosła o 11,1%, natomiast u najstarszych W.P. i K.B. odpowiednio 2,01% i 1,54%.

Analiza poziomu rozwoju indywidualnej sprawności fizycznej poddanych badaniom młodych tyczkarzy wykazała poza nielicznymi wyjątkami, zdecydowany wzrost poszczególnych wskaźników. Największą poprawę średniej

ich wartości zauważyć można ponownie u najmłodszych tyczkarzy J.R., P.R. i O.S. (odpowiednio o 34,27%, 39,35% i o 35,42%), gdzie u najstarszych W.P. o 17.47% i K.B. o 22,8%.

Przeprowadzając analizę zmian w budowie somatycznej, poziomie rozwoju zdolności siłowych u poszczególnych badanych na podstawie różnicy procentowej wykazano występujące pomiędzy nimi relacje. Średnia wartość wzrostu parametrów somatycznych u najstarszych sportowców W.P. i K.B. wzrosła odpowiednio o 2,01%, 1,54%, a średnia rozwoju zdolności siłowych o 17,47%, 22,8%, natomiast wynik sportowy u W.P. 4,1%, a u K.B. jego progresja nie wystąpiła. Z kolei u najmłodszego poddanego badaniom skoczka o tyczce (12-13 lat) średnia cech somatycznych wzrosła o 11,1%, zdolności siłowych o 34,27%, a rezultat w skoku o tyczce o 11,11%.

W n i o s k i . Analiza wyników badań pozwoliła wykazać tempo wzrostu poszczególnych wskaźników kontrolnych, gdzie największy przyrost parametrów somatycznych zauważyć można u zawodników w przedziale wiekowym pomiędzy 12 a 16 rokiem życia. U najstarszych sportowców (w pierwszym etapie badań 18, a po upływie roku 19 lat /K.B., W.P.) nastąpiło wyraźne spowolnienie w powiększeniu opisywanej cechy. Podobnie w przypadku zdolności siłowych, najmniejszy ich przyrost zauważyć można u najstarszych tyczkarzy, a największy u najmłodszych. Najbardziej zauważalne powiększenie wyniku sportowego dostrzega się u O.S, a najmniejsze u W.P.

Przy tak małej liczbie badanych trudno jest uogólnić wyniki badań, jednakże tyczkarzy, u których wzrost procentowy parametrów somatycznych i zdolności siłowych jest najmniejszy (W.P. i K.B.), charakteryzuje również najmniejsza progresja wyniku sportowego. Natomiast u młodszych zawodników nastąpiła widoczna zwyżka zarówno parametrów somatycznych, jak i zdolności siłowych oraz wyraźny progres wyniku sportowego. W przypadku najmłodszego tyczkarza i jego o rok starszego kolegi mniejsza poprawa wyniku sportowego jest spowodowana dużą absencją na zajęciach treningowych (z powodu kontuzji), co miało wpływ na opanowanie techniki skoku o tyczce.

Key words: somatic build, pole vault, training Słowa kluczowe: budowa somatyczna, skok o tyczce, trening

Somatic characteristics, strength and sport result in 12-19-year-old pole vault jumpers

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INTRODUCTION

Proper muscle strength is a fundamental component in accomplishing acts of movement specific to a given sport discipline (these movements are highly complex in one of track and field events, i.e. pole vault). It is a critical factor in efficient movements, maintaining stability in joints and in minimizing muscle-bone injuries. Muscle strength enables a man to perform effort in a 24-hour cycle without excessive tiredness. It also contributes to full and effective participation in physical activity, at the same time playing an important role in bone mass building, since it prevents the reduction of bone mineral density (osteoporosis) and falls at later age. The impact of strength training on human body is tremendous: it can help lower blood pressure, control adiposity level and prevent lower back pain syndromes. These are just some of the reasons why a steady increase in the number of persons working out, irrespective of their experience and age, can be observed [1].

A number of experts point out that the observations of ontogenetic variability of strength capabilities are hindered due to a great quantity of those capabilities (static and dynamic strength, relative and absolute strength, etc.), and research methods applied (dynamometers, tensometric platforms and motor tests) [2, 3, 4, 5, 6]. Wolański and Parizkova [7], in the research on explosive power measured by means of a countermovement jump, demonstrated that improvement in girls’ results can be observed up to the age of 14, whereas in men it is up to 27. The explosive power of 22-year old women equaled that of 6-year old girls, and 27-year old men equaled 12-year old boys in their power.

Fidelus [8], Kubica [9], Sozański [10] and Kochanowicz [11] indicate that there are differences in the morphology of fibers adapted for dynamic and static contractions. Dynamic contractions arise as a result of the operation of fast twitch fibers, i.e. white fibers, whereas in static contractions red fibers take part. A possibility of morphological remodeling of muscle fibers opens up by performing appropriate exercises. On the basis of research it was concluded that dynamic power training brings about changes in the arrangement of microfibrils, number of nuclei and shape of muscle fibers to the advantage of white fibers, while isometric training produces changes to the advantage of red fibers. It can be concluded from the above that the nature of an

activity models, to some extent, morphological structure and the form of activity of muscles being trained.

Quantitative and qualitative indicators of strength capabilities are dependent on a number of factors. According to Ljach [12], Kubica [9], Kozłowski [2] and Costtilla [13], they encompass morphological (bone-muscle), nervous, attitudinal and other factors.

Among morphological factors, the following can be distinguished:

• Characteristics of muscle contractions, conditioned by the ratio of slow-twitch to fast-twitch fibers;

• Power of anaerobic mechanisms conditioning muscle work process;

• Proportions of bone leverages, mass of long bones, structure of bone tissue;

• Physiological cross-section and mass of muscles; • Activity of enzymes taking part in muscle

contractions; • Quality of intramuscular coordination, etc. Acknowledged experts emphasize the need to apply

advanced dynamometers that make it possible to take measurements of muscle groups a researcher is interested in during standard exercises in which the following parameters are determined:

• Force impulse – integral characteristics of mechanical force displayed by a sportsman during the act of movement;

• Force gradient – time at which an exercising person achieves maximum force [9, 4].

Numerous researchers, among others Szopa J., Mleczko E., Żak S. [14], Ważny Z. [6], claim that an absolute size of human’s static strength is strictly related with body weight and in a factor analysis it is distinguished as an element independent of relative strength, absolute strength, dynamic strength and explosive strength.

In order to control the scope and direction of adaptive changes in sport process management developed by H. Sozański [15], test instruments that enable strength measurement in static and dynamic conditions, also during work, are used.

In strength level control, the following parameters have a basic value according to K. Fidelus [8] and H. Sozański [15]: • Strength values recorded in slow movements are not

significantly different from strength indicators recorded in isometric conditions;


62

• During yielding work strength is at its peak value, significantly higher than isometric strength indicators;

• During fast moves strength decreases as speed increases;

• No dependencies were found between maximum isometric strength and dynamic strength in fast moves. It is recommended that a speed-strength index is

used to evaluate explosive power. The index shows the ratio of maximum force value (Fmax) to the time of its occurrence (tmax) [F/t – force impulse]. As sportsman’s capabilities increase, the strength increases as well in inverse ratio to time. This method can be applied in pole vault jumpers strength testing, and in all sport disciplines [5, 16].

The present study aimed to reveal the relations between the somatic characteristics, strength capabilities development level and sport result of 12-19-year old jumpers.

MATERIAL AND METHODS

The material presented in the study is a part of research on theoretical foundations of sport training process management with an example of pole vault. The research that was conducted in February 2007 and 2008 included seven 12-19-year-old pole vault jumpers training in the “Zawisza” Bydgoszcz sports club.

The subjects pursued school education curriculum. One of the boys was in his fifth grade and the other in sixth grade in elementary school. Three of them were gymnasium (lower secondary school) students (one in his first year, two in their second year). Two sportsmen were high school students. Minor sportsmen attending elementary schools had their trainings three times per week. The remaining ones had their trainings four to five times a week. A training unit length was 60-90 minutes. At school, the boys had three lessons of physical education classes per week, with the emphasis on developing general physical fitness.

While the sportsmen executed training objectives, they underwent research aimed at determining body reaction towards training stimuli applied.

The following methods and research instruments were utilized in the study: • Assessment of physical development, • Physical fitness training, • Sport results recording, • Statistical methods.

In order to evaluate physical development, the measurements of somatic characteristics related to length, width, circumference and body weight were taken.

1) Body height (basis-vertex), 2) Body weight, 3) Torso length (suprasternale-symphysiom), 4) Lower limb length (basis-symphysion), 5) Upper limb length (acromion-daktylion III), 6) Shoulder length (acromion-acromion), 7) Pelvis width (iliocristale-iriocristale), 8) Thigh circumference, 9) Lower limb circumference, 10) Shoulder circumference, 11) Chest circumference at inhalation, 12) Chest circumference at exhalation, 13) Chest extension (volume difference between the

inhalation and exhalation). The somatic build index according to Rohrer based

on the ratio of body weight to body height was calculated. (body weight (g) x 100) : body height (cm)3

The research was conducted using a large sliding caliper, medical scales and metric tape.

In order to develop fitness tests that would evaluate strength parameters of young jumpers comprehensively, the dynamic strength of arm and shoulder girdle, as well as explosive legs power were taken into consideration. All tests were conducted under identical conditions.

The following measurements were taken: 1. Standing long jump: the jumper stands at a line and

then takes off and lands using both feet. 2. Long jump with a 35-metre run-up: 20 meters of

approach run, last 15 meters of maintaining rhythm and entering the jump.

3. Feet lifting to a hung pole – exercises (quantity). 4. Feet lifting to a fixed bar with arms straight 5x in

a set time (s). 5. Pull-ups using a fixed bar (quantity). 6. Rope climbing (3-meter long rope). 7. Vaulting box jump over a crossbar ( cm). 8. Overhead shot put throw, 4-kilo shot (m). 9. Pole vault ( cm).

Directly prior to particular tests, young sportsmen were informed in detail on the procedures used in the tests. The tests were preceded with a 15-minute warm-up led by a coach.

Control competitions records (in pole vault) were used for the analysis of sport results.

The collected material underwent a statistical analysis with consideration given to the percentage of difference between initial and final tests, average, minimum and maximum values.


63

RESULTS

A visible manifestation of human biological development is a body build that allows performing acts of movement.

The analysis of somatic development of subjects revealed progress or, in few cases, slowdown in growth of individual parameters (See Table 1). As regards body height, the most visible progress was observed in young pole vault jumpers between 12 and 13 years of age (J.R.), 13 and 14 (P.R.) and 14 and 15 (O.S.) equaling 6.67% (10 cm), 4.64% (7 cm) and 4.1% (7 cm) respectively, whereas in an 18-year old jumper who turned 19 over the study period (K.B.), the value of the parameter under question did not increase. The greatest body weight growth was again observed in the same sportsmen between 12 and 15, as well as in the jumper who was 15, and later on 16 (A.K.). The growth in this parameter was as follows: 25.71% (9 kg), 13.89% (5 kg), 21.3% (11.5 kg), and 16.36% (9 kg). The smallest growth was noted in K.B. since it equaled 1.37% (1 kg).

Table I. Results of physical development tests of 12-19-year-

old pole vault jumpers Tabela I. Wyniki badań rozwoju fizycznego 12-19 letnich

tyczkarzy

It. Examined Examination Examined subjects

parameters W. P. K.B. B.M. A.K. O. S. P.R. J.R. 1 body height 1 187 185 182 180 171 151 150 ( cm) 2 188 185 184 185 178 158 160

% 0.53 0 1.1 2.78 4.1 4.64 6.67 2 body weight 1 74 73 61 55 54 36 35 ( kg) 2 76 74 66 64 65.5 41 44

% 2.7 1.37 8.2 16.36 21.3 13.89 25.71 3 shoulder girdle width 1 41 40 38 35 37 33 32 ( cm) 2 41 40.9 39 39.5 38.5 34 33.5

% 0 2.25 2.63 12.86 4.05 3.03 4.69 4 pelvic girdle width 1 34 30 32 28 29 25 22 ( cm) 2 34 31 32.5 28.5 29.5 25.5 23

% 0 3.33 1.56 1.79 1.72 2 4.55 5 lower limb length 1 96 94 92 93 87 84 82 ( cm) 2 96.5 94.5 93 96 91 88 87

% 0.52 0.53 1.1 3.23 4.6 4.76 6.1 6 upper limb height 1 84 83 78 75 76 68 63 ( cm) 2 84 83.5 79.5 78 76.5 69 68

% 0 0.6 1.92 4 0.66 1.47 7.94 7 thigh circumference 1 50 52 46 45 46 38 39 ( cm) 2 49.5 53.5 45 47 47.5 39 40

% 1 2.88 2.17 4.44 3.26 2.63 2.56 8 lower limb 1 34.5 38 33 34 36 29 29 circumference 2 36.5 39 33 36.5 38.5 31 33

( cm) % 5.8 2.63 0 7.35 6.94 6.9 13.79 9 shoulder 1 27 29.5 25 24 25 20 19 circumference ( cm) 2 29.5 30.5 27 27.5 27 21 22

% 9.26 3.39 8 14.58 8 5 15.79 10 chest circumference 1 101 103 92 86 85 77 73 at inhalation ( cm) 2 104 104 97 89 90 79 78

% 2.97 0.97 5.43 3.49 5.88 2.6 6.85 11 chest circumference 1 91 92 85 79 80 70 68 at exhalation ( cm) 2 94 93 89 82 85 72 71

% 3.3 1.1 4.71 3.8 6.25 2.86 4.41 12 chest expansion 1 10 11 7 7 5 7 5 ( cm) 2 10 11 8 7 5 7 7

% 0 0 14.29 0 0 0 40

13 torso length 1 55 55 53 53 50 40 41 ( cm) 2 55 55.5 54 55 52 42 43

% 0 0.91 1.89 3.77 4 5 4.88

The biggest growth in shoulder girdle width was observed in A.K. (15 and 16 years of age), namely 12.86% (4.5 cm), whereas it did not change in the oldest subject (W.P.) who was between 18 and 19. When analyzing the growth of pelvic girdle, it can be noted that the biggest growth was in the youngest jumper (J.R.) – 4.55% (1 cm), while this parameter did not change in W.P. The comparison between the first and second measurement of lower limb length shows that this parameter changed most notably in the youngest sportsman (J.R.) by 6.1% (5 cm), while in the oldest subjects (W.P., K.B.) the growth was the least visible, equaling 0.52% (0.5 cm) and 0.53% (0.5 cm) respectively. The next parameter that underwent scrutiny was upper limb length, where the biggest growth was again observed in the youngest jumper: 7.94% (5 cm), while it was non-existent in W.P. A large majority of the remaining parameters were noted to improve.

When comparing jumpers’ body height with the results of M. Napierała’s [17] studies that included the Kujawsko-Pomorskie province, it becomes apparent that the present subjects exceeded their peers as regards body height, even though the results were slightly lower in beginner jumpers (12 and 13 years old) (Marek Napierała: 12,5 yrs - 155,23 cm – 13,5 yrs – 161,07 cm; 13,5 yrs – 161,07 cm and 14,5 yrs – 168,33 cm; 14,5 yrs – 168,33 cm – 15,5 yrs – 172,22 cm; 15,5 yrs – 172,22 cm and 16,5 yrs – 175,64 cm; 18,5 yrs - 178,69 cm and 19,5 yrs – 179,01 cm). A similar relation can be noted between body height of the subjects and body height of the boys examined in national research by R. Przewęda and J. Dobosz [18]: (12,5 yrs – 155,00 cm, 13,5 yrs – 162,14 cm.; 13,5 yrs - 162,14 cm, a 14,5 yrs - 168,20 cm; 14,5 yrs – 168,20 cm, a 15,5 yrs – 173,81 cm; 15,5 yrs – 173,81 cm and 16,5 yrs – 176,49 cm; 18,5 yrs – 178,82, 19,5 yrs – 178,32 cm).

The comparison of body weight of pole vault jumpers who were studied by M. Napierała [17] in the Kujawsko-Pomorskie province with national studies by R. Przewęda and J. Dobosz [18] reveals the following: 12,5-year-old, and after a year 13,5-year old (J.R.) was characterized by lower body weight than his peer from Napierała’s and Przewęda’s research (M. Napierała: 12,5 yrs – 46,23 kg, 13,5 yrs – 49,54 kg) (R. Przewęda, J Dobosz: 12,5 yrs - 44,98 kg, a 13,5 yrs – 50,54 kg). Another young sportsman (13,5 and then 14,5-year-old) (P.R.) had also lower body weight than his peers (M. Napierała: 13,5 yrs – 49,54 kg and 14,5 yrs – 54,21 kg), (R. Przewęda, J. Dobosz: 13,5 yrs – 50,54 kg, a 14,5 yrs


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– 56,13 kg). In turn, a 14,5 and then 15,5-year-old boy (O.S.) was characterized with slightly lower body weight as a 14,5-year old sportsman than those examined by Napierała and Przewęda, whereas at the age of 15,5 his body weight was bigger when compared with M. Napierała’s, R. Przewęda’s and J. Dobosz’s research (M. Napierała: 14,5 yrs – 54,21 kg and 15,5 yrs – 59,64 kg), (R. Przewęda, J. Dobosz: 14,5 yrs – 56,13 kg, 15,5 yrs – 62,34 kg). Another two 15,5-year old and then 16,5-year-old sportsmen (B.M., A.K.) differed in body weight, namely: one of them had lower (A.K.) weight and the other one (B.M.) bigger than the average value for boys examined by M. Napierała (M. Napierała: 15,5 yrs – 59,64 kg, 16,5 yrs – 65,27 kg). Then, when comparing this to the results obtained by R. Przewęda and J. Dobosz, both sportsmen had lower weight (R. Przewęda, J. Dobosz: 15,5 yrs – 62,34 kg, 16,5 yrs – 66,49 kg). Also, one of two 18,5 and then 19,5-year-old sportsmen (K.B. and W.P.), namely W.P. was characterized with lower weight than the average obtained by M. Napierała, whereas for K.B. the weight was bigger at the age of 18,5 and lower at the age of 19,5 (M. Napierała: 18,5 yrs – 71,89 kg, 19,5 yrs – 74,1 kg), while when their body weight was compared to the results of R. Przewęda and J. Dobosz studies, it turned out to be lower (R. Przewęda, J. Dobosz: 18,5 yrs – 70,75 kg, 19,5 yrs – 71,83 kg).

The analysis of body weight to body height ratio revealed that these values differ among individual sportsmen. The tendency of the above indicator is determined by an average value for all subjects, where a slight growth is observed (See Table II).

Table II. Body build indicator of subjects according to Rohrer Tabela II. Wskaźnik budowy ciała badanych tyczkarzy wg

Rohrera Subject Rohrer's index % difference

I exam. II exam. W.P. 1.13 1.14 0.88 K.B. 1.21 1.23 1.65 B.M. 1.01 1.06 4.95 A.K 0.94 1.01 7.45 O.S. 1.08 1.16 7.41 P. 1.05 1.04 0.95 J. 1.04 1.07 2.88

M (average) 1.07 1.1

The analysis of individual physical development

level of subjects revealed that, aside from few exceptions, the indicators had a growing tendency (Table III). The most remarkable progress in a standing long jump was observed in an 18-year old jumper K.B., i.e. by 9,16% (24 cm), while the smallest was

demonstrated in O.S. (15 years), i.e. by 0,81% (2 cm). In a long jump, the biggest progress was noted in a 14-year-old jumper (P.R.), i.e. by 27.35% (102 cm), the smallest in A.K. (16 lat) 8.15% (44 cm). The next task was to lift feet to a crossbar. In this case, as many as five subjects improved their result by 100%, where K.B. and B.M. lifted their feet two times more, and O.S., P.R. and J.R. did it one time more, whereas A.K. did not improve his result. As regards rope climbing, the best progress was noted in P.R., namely by 47.25% (6.02 s), while in K.B. the lowest (19 years) by 2.49% (0.07 s). The next test were pull-ups using a fixed bar. Here, the biggest improvement was observed in O.S., i.e. by 66.67% (4 times), and the lowest was in B.M. 6.67% (once). As far as vaulting box jump over crossbar is concerned, the most considerable progress was observed in O.S., i.e. by 50% (15 cm), and the lowest improvement was noted in the oldest jumper, W.P. who improved his result by 7.63% (9 cm). In the test of an overhead 4-kilo shot put, the most notable headway was noted in J.R., i.e. by 62.18% (4.34 m), whereas O.S. improved his result by 6.68% (0.74 m), which was the smallest advancement. As regards pole vault, the greatest step forward was demonstrated in O.S., i.e. by 31.03% (90 cm), while K.K. showed a lack of progress in his result.

Table III. Individual physical fitness development of 12-19-

year-old jumpers Tabela III. Poziom rozwoju indywidualnej sprawności

fizycznej 12-19 letnich tyczkarzy

Examined parameters Exams. Subjects It. W. P. K.B. B.M. A.K. O.S. P.R. J.R. 1 1 273 262 249 250 247 228 225 standing long jump (cm) 2 296 286 266 268 249 231 234

% 8.42 9.16 6.83 7.2 0.81 1.32 4 2 1 537 520 515 540 426 373 382 long jump (cm) 2 626 568 589 584 516 475 473

% 16.57 9.23 14.37 8.15 21.13 27.35 23.823 feet lifting to a hung pole 1 4 2 2 3 1 1 1 (number of lifts) 2 6 4 4 3 2 2 2

% 50 100 100 0 100 100 100 4 feet lifting to a fixed bar 1 5.73 5.93 5.94 11.72 6.38 8.97 9.07 5x in a set time (s) 2 5.63 5.26 5.72 6.09 6.43 7.95 8.02

% 1.75 11.3 3.7 48.04 0.78 11.37 11.585 3-metre rope climbing (s) 1 5.28 2.81 5.53 10.04 9.69 12.74 13.01 2 4.03 2.88 3.86 6.93 6.08 6.72 8.21

% 23.67 2.49 30.2 30.98 37.25 47.25 36.896 pull-ups using a fixed bar 1 10 16 15 9 6 10 14 (quantity) 2 12 18 16 11 10 16 17

% 20 12.5 6.67 22.22 66.67 60 21.437 vaulting box jump 1 118 50 50 50 30 30 35 over crossbar (cm) 2 127 65 70 60 45 40 40

% 7.63 30 40 20 50 33.33 14.298 overhead shot put throw 1 16.04 15.81 13.35 12.16 11.08 7.81 6.98 4-kilo shot (m) 2 17.92 17.03 14.45 16.07 11.82 10.48 11.32

% 11.72 7.72 8.24 32.15 6.68 34.19 62.189 1 490 400 360 315 290 295 270 pole vault (cm) 2 510 400 410 360 380 315 300

% 4.08 0 13.89 14.29 31.03 6.78 11.11

When comparing one of individual physical fitness

development indicators, i.e. standing long jump, with average results obtained by boys from the Kujawsko-


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Pomorskie province studied by M. Napierała [17] and R. Przewęda and J. Dobosz [18], it can be noted that all present study jumpers vastly outperformed their peers (M. Napierała: 12,5 yrs – 166,35 cm; 13,5 yrs – 174,54 cm; 14,5 yrs – 189,12 cm; 15,5 yrs – 202,89 cm; 16,5 yrs – 204,12 cm; 18,5 yrs – 230,56 cm; 19,5 yrs – 225,69 cm. R. Przewęda, J. Dobosz: 12,5 yrs – 164,55 cm; 13,5 yrs – 177,72 cm; 14,5 yrs – 190,33 cm; 15,5 yrs – 204,97 cm; 16,5 yrs – 212,97 cm; 18,5 yrs – 223,14 cm; 19,5 yrs – 222,22 cm).

The analysis of somatic characteristics and strength capabilities level changes showed some relations discussed below. In the oldest jumpers (W.P. and K.B.), somatic parameters did not grow (body height, shoulder girdle width, pelvic girdle width, chest expansion and torso length), whereas the most remarkable increase was noted in shoulder circumference, i.e. by 9.26% (A.P.) (See Table I). Nevertheless, the increase in strength indicators was observed, varying from 1.75% (feet lifting to a fixed bar /W.P./) up to 100% (feet lifting to a pole /K.B./) (See Table II). The average growth value of somatic parameters in W.P. and K.B. was 2.01%, 1.54% respectively, and the average growth of strength capabilities was by 17.47%, 22.8%. The sport result in (W.P.) increased by 4.1%, whereas no progress was observed in K.B. (See Table IV). For 15-year-old sportsmen (first stage of research) and then 16-year-old (second stage), i.e. B.M. and A.K., the progress was much higher as regards individual somatic traits, up to 16.36% (body weight - /A.K./). The average value of somatic traits development was 4.1% in B.M., and 6.03% in A.K. Moreover, strength capabilities measured by feet lifting to a pole increased by 100% in B.M. The average value of strength capabilities progress was 26.25% in B.M., and 21.1% in A.K., whereas a sport result 13.89% and 14.29% respectively. Then, in O.S. (14-15 yrs) the chest expansion did not change, yet, body weight increased by 21.3%. Nonetheless, strength indicators were noted to have increased, varying from 0.78% (feet lifting to a fixed bar) up to 100% (feet lifting to a pole). It should be noted that the average of somatic traits increased by 5.44%, strength capabilities by 35.42%, and a pole vault jump by 31.03%. For young pole vault jumpers, i.e. P.R. (13-14 yrs), one somatic trait did not change (chest expansion), and body weight increased by 13.89%, while strength capabilities of this sportsman increased by 1.32% (standing long jump) up to 100% (feet lifting to a pole). The average values of somatic traits and strength capabilities increased by 4.21% and 39.35% respectively, whereas a

sport result by 6.78%. In the youngest subject (12-13 years), the following growth of somatic traits can be observed: from 2.56% (thigh circumference) up to 25.71% (body weight), whereas the growth in strength capabilities fluctuates from 4% (standing long jump) up to 100% (feet lifting to a pole). At the same time, the average of somatic traits increased by 11.1%, strength capabilities by 34.27%, and a pole vault jump result by 11.11%.

Table IV. Somatic parameters, strength capabilities and sport

result growth rate (research: February 2007 – February 2008)

Tabela IV. Tempo wzrostu parametrów somatycznych, zdolności siłowych I wyniku sportowego (badania luty 2007-luty 2008)

% growth Subjects

Age of subjects Somatic

parameters Strength capabilities

Sport result

W.P. K.B. B.M. A.K. O.S. P.R. J.R.

18-19 18-19 15-16 15-16 14-15 13-14 12-13

2.01 1.54 4.1 6.03 5.44 4.21 11.1

17.47 22.8 26.25 21.1 35.42 39.35 34.27

4.1 0 13.89 14.29 31.03 6.78 11.11

CONCLUSIONS

The analysis of test results displayed the growth rate of individual parameters, where the most significant growth in somatic parameters was observed in subjects between 12 and 16 (J.R., P.R, O.S., A.K., and B.M.). In the oldest subjects (in the first stage of research – 18, and after a year – 19 /K.B., W.P./) a visible slowdown in the growth of traits in question was observed. Likewise, the smallest growth of strength capabilities was demonstrated in the oldest jumpers, whereas the biggest in the youngest ones. The most noticeable increase in a sport result was noted in O.S, and the smallest in W.P.

Such a small number of subjects makes it problematic to generalize research results, yet the pole vault jumpers who are characterized with the smallest percentage growth of somatic parameters and strength capabilities (W.P. and K.B.), are also characterized with the smallest progress in a sport result. Then, in the youngest sportsmen there was a notable growth in somatic parameters, strength capabilities and visible progress in a sport result. In the case of the youngest jumper and a year older colleague, smaller improvement of a sport result was caused by absences from training sessions (resulting from, among other things, an injury), which affected the overall pole vault technique.


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LITERATURE

1. Osiński W. (2000): Antropomotoryka. AWF, Poznań. 2. Kozłowski S. (1986): Granice przystosowania. Wiedza

Powszechna, Warszawa. 3. Klimek A. (1986): Dynamika zmian cech motoryki,

wydolności aerobowej, funkcji układu oddechowego i krążeniowego oraz równowagi kwasowo-zasadowej w zależności od obciążenia wysiłkiem fizycznym 8-15 letnich chłopców. Wydawnictwo monograficzne nr 12, Wyd. II, AWF, Kraków.

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11. Kochanowicz K. (2006): Podstawy kierowania procesem szkolenia sportowego w gimnastyce. AWFiS, Gdańsk.

12. Ljach W.J. (2003): Kształtowanie zdolności motorycznych. Biblioteka trenera. COS, Warszawa.

13. 13. Costill D.L. (1985): Practical problems in exercise physiology research. Research Quarterly for exercise and sport, v. 56, nr 4, p. 378-384.

14. Szopa J., Mleczko E., Żak S. (1996): Podstawy antropomotoryki. PWN, Warszawa-Kraków.

15. Sozański H. (red.), (1999): Podstawy teorii treningu sportowego. AWF, Warszawa.

16. Raczek J. (1986): Motoryczność człowieka, poglądy, kontrowersje i koncepcje. W: Motoryczność dzieci i młodzieży – aspekty teoretyczne oraz implikacje metodyczne (red. J. Raczek) AWF, Katowice cz. I.

17. Napierała M. (2008): Środowiskowe uwarunkowania somatyczne i motoryczne a wiek rozwojowy dzieci i młodzieży na przykładzie województwa kujawsko-pomorskiego. Wydawnictwo Uniwersytetu Kazimierza Wielkiego, Bydgoszcz.

18. Przewęda R, J. Dobosz (2003): Kondycja fizyczna polskiej młodzieży. Studia i Monografie nr 98, AWF, Warszawa.

Address for correspondence: Faculty of Physical Education Kazimierz Wielki University in Bydgoszcz Kierownik: dr Mariusz Zasada ul. Sportowa 2 85-091 Bydgoszcz tel,/fax. 663089733 (052} 37 67 910 e-mail: [email protected] Received: 24.04.2009 Accepted for publication: 25.08.2009


ORIGINAL ARTICLE / PRACA ORYGINALNA Mariusz Klimczyk

SPECIAL FITNESS AND A SPORT RESULT IN 19-YEAR-OLD POLE VAULT JUMPERS

SPRAWNOŚĆ SPECJALNA A WYNIK SPORTOWY U 19-LETNICH TYCZKARZY


S u m m a r y

I n t r o d u c t i o n . The improvement in sport performance causes a necessity to engage a number of experts from a variety of scientific fields to coach the youth. New factors affecting the functioning of theory and practice require an in-depth synthesis, especially in the field of theoretical bases of a sport training.

Technique and teaching methodology of pole vault, psycho-physical preparation of jumpers in all stages of sport proficiency, as well as the nature of competitions force a researcher to consider development trends (both domestic and international), new technologies, as well as individual predispositions of athletes. This paper presents the growth dynamics of special fitness indices based on a two-stage research, and the influence of these indices on a sport result in pole vault.

M a t e r i a l s a n d m e t h o d s . The study included five 19-year old pole vault jumpers who underwent a specialized training in the sports clubs: “Zawisza” Bydgoszcz, “Gwardia” Piła and “Śląsk” Wrocław. The subjects went through examinations twice, i.e. in February 2008 and June 2008, with the aim of analysing speed-strength and coordination parameters characteristic of pole vault. All tests were conducted using the following methods and research tools: testing special fitness, recording of sport results and methods of statistical data analysis.

S t u d y r e s u l t s . The analysis of respective special fitness tests revealed the dynamics throughout the tests. The greatest growth of average and minimum value was observed in 3-metre rope climbing, i.e. by 5.66% and 11.66% in the first and second test respectively, maximum in feet lifting to a fixed bar (7.59%), whereas the standard deviation changed most significantly in pole vault, i.e. by 31.01%. As far as individual results are concerned, the greatest growth in indices was observed in W.P. in a rope climbing test

(11.66%), and two athletes had lower results in feet lifting to a fixed bar, namely 2.4% (W.P.) and 0.97% (K.S.).

The analysis of correlation of motor fitness results in 19-year-old pole vault jumpers in the first stage of tests revealed varied interdependence between the capabilities. The greatest correlation in the first stage of tests was noted between standing long jump and overhead 4-kilo shot put throw (0.9668). In the second stage of tests, a remarkable correlation was still observed in strength-based tests, i.e. rope climbing and feet lifting to a fixed bar (0.9279), standing long jump and overhead 4-kilo shot put throw (0.9183). Upon analyzing the progress of dependencies of respective tests with a sport result in pole vault it can be observed that the most significant improvement, when comparing first and second stage of research, was revealed in long jump with a run-up and rope climbing, i.e. 0.7995 and 0.5833 respectively.

S u m m a r y . When juxtaposing research results it can be noted that, despite improvement in the majority of special fitness indices of 19-year-old jumpers, the polarity is visible. It becomes especially visible in long jump with a run-up and vaulting box jump over a crossbar. Then, the greatest progress in indices under the study was noted in running tests and lifting feet to a fixed crossbar with arms straight.

The analysis of test results highlighted the dynamics of physical development of 19-year-old jumpers, and made it possible to determine the extent to which respective indices of special fitness and sport results correlated.

The strongest correlations between pole vault jump and vaulting box jump over a crossbar were found in both stages of the study, i.e. 0.9047 and 0.8729 respectively. It was observed that the greatest progress of the dependencies of certain special fitness tests and pole vault jump result, upon comparison between both stages of the study, occurred in long jump with a run-up and rope climbing. It is curious why

Mariusz Klimczyk

68

such a correlation showed no progress with feet lifting to a fixed bar.

A b s t r a c t . The objective of the present study was to analyse certain special fitness tests, individual results and a mutual correlation between motor fitness and other tests

with a sport result of 19-year-old jumpers. The subjects attend high schools where they have four hours of physical education with particular attention paid to shaping general fitness.


W s t ę p . Nieustanny wzrost wyników sportowych, powoduje potrzebę zaangażowania do pracy szkoleniowej z młodzieżą powiększającej się stale grupy znawców z poszczególnych dziedzin nauki. Nowe uwarunkowania w zakresie działania teorii i praktyki zmuszają do gruntownej syntezy, szczególnie w zakresie teoretycznych podstaw treningu sportowego.

Technika wykonania, metodyka nauczania skoku o tyczce, przygotowanie psychofizyczne tyczkarzy na wszystkich etapach zaawansowania sportowego, jak również specyfika uczestnictwa w zawodach sportowych, zmusza do uwzględnienia tendencji rozwojowych (zarówno na arenie krajowej, jak i międzynarodowej), nowych technologii, a także indywidualnych predyspozycji sportowców. W pracy przedstawiono dynamikę wzrostu wskaźników sprawności specjalnej na podstawie dwóch etapów badań, jak również ich wpływ powyższych wskaźników na wynik sportowy w skoku o tyczce.

M a t e r i a ł i m e t o d y . Badaniami objęto pięciu 19-letnich tyczkarzy, na etapie szkolenia specjalistycznego, uprawiających skok o tyczce w klubie sportowym „Zawisza” Bydgoszcz, Gwardia Piła i Śląsk Wrocław. Sportowcy badaniom zostali poddani dwukrotnie, tj. w lutym 2008 roku i w czerwcu 2008 roku. Uwzględniono w nich parametry szybkościowo-siłowe i koordynacyjne specyficzne dla konkurencji, jaką jest skok o tyczce. Wszystkie próby zostały przeprowadzone w tych samych warunkach. W pracy posłużono się następującymi metodami i narzędziami badań: testowanie sprawności specjalnej, rejestracja wyników sportowych, metody statystycznego opracowania.

W y n i k i b a d a ń . Przeprowadzona analiza wyników badań poszczególnych prób sprawności specjalnej wykazała ich zróżnicowaną dynamikę. Największy wzrost średniej i minimalnej wartości wystąpił w próbie wspinania po trzymetrowej linie odpowiednio o 5,66%, 11,66%, maksymalnej w unoszenia stóp do drążka (7,59%), natomiast odchylenie standardowe największej zmianie uległo o 31,01% w skoku o tyczce. Indywidualnie największy wzrost wyników wystąpił u zawodnika W.P. w próbie polegającej na wspinaniu po linie (11,66%), z kolei dwóch sportowców pogorszyło swoje rezultaty w unoszeniu stóp do drążka W.P. o 2,49%, a K.S. o 0,97%.

Analiza korelacji wyników sprawności motorycznej skoczków o tyczce w wieku 19 lat na pierwszym etapie badań wykazała zróżnicowaną współzależność pomiędzy jej zdolnościami.

Największa współzależność w pierwszym etapie badań wystąpiła pomiędzy skokiem w dal z miejsca a rzutem kulą (4 kg) w tył ponad głową (0,9668). W drugim etapie badań duża współzależność nadal występuje pomiędzy próbami o charakterze siłowym: wspinaniem po linie a unoszeniem stóp do drążka (0,9279), skokiem w dal z miejsca a rzutem kulą czterokilogramową w tył ponad głową (0,9183). Przeprowadzając analizę porównawczą postępu zależności poszczególnych prób z wynikiem sportowym w skoku o tyczce dostrzega się, że największa poprawa pomiędzy pierwszym i drugim etapem badań wystąpiła w przypadku próby skoku w dal z rozbiegu i wspinania po linie (odpowiednio 0,7995, 0,5833).

P o d s u m o w a n i e . Zestawiając wyniki badań należy stwierdzić, że mimo poprawy w przypadku większości wskaźników sprawności specjalnej 19-letnich tyczkarzy zauważa się znaczne ich zróżnicowanie. Szczególnie widoczne jest to w próbie polegającej na skoku w dal z rozbiegu i skoku ze skrzyni przez poprzeczkę. Natomiast najwyższe tempo badanych parametrów odnotowano w próbach biegowych i w unoszeniu stóp do drążka w zwisie o prostych ramionach.

Analiza wyników badań przyczyniła się do wykazania dynamiki rozwoju sprawności fizycznej tyczkarzy w wieku 19 lat, określenia stopnia współzależności pomiędzy poszczególnymi wskaźnikami sprawności specjalnej i wynikami sportowymi.

Najwyższe korelacje wyniku skoku o tyczce dostrzega się, zarówno na pierwszym, jak i drugim etapie badań, ze skokiem ze skrzyni przez poprzeczkę, odpowiednio 0,9047 i 0,8729. Największy postęp zależności pomiędzy poszcze-gólnymi próbami sprawności specjalnej a wynikiem w skoku o tyczce na podstawie porównania dwóch etapów badań wystąpił w przypadku próby skoku w dal z rozbiegu i wspinania po linie. Zastanawiające jest, dlaczego nie wzrosła zależność w przypadku próby polegającej na unoszeniu stóp do drążka.

Key words: somatic build, pole vault, training Słowa kluczowe: budowa somatyczna, skok o tyczce, trening

Special fitness and a sport result in 19-year-old pole vault jumpers

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INTRODUCTION

The improvement in sport performance causes a necessity to engage a number of experts from a variety of scientific fields to coach the youth. New factors affecting theory and practice require an in-depth synthesis, especially in the field of theoretical bases of sport training.

Technique and teaching methodology of pole vault, psycho-physical preparation of jumpers in all stages of sport proficiency, as well as the nature of competitions force a researcher to consider development trends (both domestic and international), new technologies and individual predispositions of sportsmen. This paper presents the growth dynamics of special fitness indices based on a two-stage research, and their influence on a sport result in pole vault.

Pole vault jump is a constantly developing event. Maintaining a jumper-oriented individual training approach, the elements and methods of which are varied, makes training process increasingly effective. The means should be suitable for a proper motor development, physiological capabilities and mental preparation of sportsmen [1, 2, 3, 4, 5].

One of a highly important criterion of sportsmen’s predispositions is a physical fitness growth rate. This issue has attracted wide attention in the field, and the importance of respective motor capabilities in different sport disciplines has been highlighted [6, 7, 8, 9, 10].

Study of the dynamics of motor capabilities development, indispensable for the execution of fitness and functional requirements in pole vault, are of a great importance in the training stage under the study. It is helpful in optimizing the sport training process.

The research into physical fitness and training results of jumpers will make it possible to optimise training loads in accordance with individual capabilities of sportsmen and determine their development predictions.

The greater improvement in a sport result, the more attention is paid to special fitness.

The objective of the study was to assess the level

of special fitness of 19-year-old pole vault jumpers, based on a two-stage research. CHARACTERISTICS OF RESEARCH MATERIAL

The study included five 19-year-old pole vault jumpers who underwent a specialized training in the sports clubs: “Zawisza” Bydgoszcz, “Gwardia” Piła and “Śląsk” Wrocław. The sportsmen were tested twice, i.e. in February 2008 and June 2008. The jumpers had their training session in the club 5-6 times

per week, each training unit equalling 90-120 minutes. The jumpers attended high schools where they had 4 PE lessons weekly, with particular focus on general physical fitness. RESEARCH METHODS

As the sportsmen executed training objectives, they were subjected to the tests twice, i.e. in February 2008 and in June 2008, focusing on speed-strength and coordination parameters specific to pole vault. The following research methods and tools were applied: • Special fitness testing; • Recording sport result; • Methods of statistical data analysis.

CONTROL OF SPECIAL FITNESS

When developing special fitness tests, a system of monitors specific to pole vault requirements in a given stage of research was accounted for. The following measurements were taken:

- running speed at the distance of 15 metres out of a 20-metre approach run;

- running speed at the distance of 15 metres out of a 20-metre approach run with a pole;

- explosive power measured by a long jump with a 20-metre run-up and maintaining rhythm at the distance of 15 metres;

- power measured by a standing long jump; - power measured by an overhead 4-kilo shot put

throw; - strength of muscles of the back and shoulder

girdle measured by feet lifting to a fixed bar with arms straight 5x in a set time (s);

- strength of shoulder girdle and shoulder muscles measured by a 3-metre rope climbing;

- coordination measured in a jump over a crossbar with a somersault through hand standing (starting on a vaulting box or mattress);

- a pole vault jump test RECORDING SPORT RESULTS

The recording sheets of official competitions were utilized in order to analyse sport results (pole vault). STATISTICAL METHODS OF DATA ANALYSIS

In a statistical analysis the percentage of the difference between the initial and final test was taken into consideration, as well as standard deviation. The

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results of correlation analysis were presented as Pearson coefficients of correlation. Mean, minimal and maximum values were also determined. RESEARCH RESULTS

The analysis of special fitness test results showed varied dynamics (Table I). When comparing first and second research stages, the improvement in running tests results can be observed. In running without and with a pole the mean value increased by 0.04% and 0.06s, the minimal by 0.05%, 0.09s, whereas the maximum by 0.01%, 0.02s, and the standard deviation by 25%, 22.22% respectively. In both parameters the values received were consistent. The standard deviation fluctuated from 0.04 to 0.11. Table I. Test results of special fitness of 19-year-old pole

vault jumpers It. Tests

Examined parameters

Statistical values

1 test 2 test

Improvement%

15-metre run M 1.69 1.65 2.366 1 out of a 20-metre run-up min 1.63 1.58 3.07 (s) max 1.74 1.69 2.87 SD 0.04 0.05 25.00 15-metre run M 1.83 1.77 3.28 2 out of a 20-metre run-up min 1.77 1.68 5.08 with a pole max 1.99 1.97 1.01 (s) SD 0.09 0.11 22.22 Standing long jump M 289.2 294.6 1.87 3 (cm) min 270 276 2.22 max 300 302 0.67 SD 11.54 10.81 6.33 Long jump M 612.6 634 3.502 4 with a 35-metre run-up min 573 590 2.97 last 15 metres - max 659 670 1.67 maintaining rhythm (cm) SD 32.05 33.43 4.31 Feet lifting to a fixed bar M 7.18 6.85 4.6 5 with arms straight min 5.13 5.18 0.97 in a hang max 9.09 8.40 7.59 5 x in a set time (s) SD 1.71 1.33 22.22 Rope climbing M 4.77 4.50 5.66 6 3-metre rope min 4.03 3.56 11.66 (s) max 5.87 5.50 6.3 SD 0.76 0.76 0.00 Vaulting box jump M 80.40 85.40 6.22 7 over a crossbar min 60 65 8.33 (cm) max 127 130 2.36 SD 26.61 25.56 3.95 Overhead 4-kilo shot put M 17.70 18.03 1.86 8 throw min 17.06 17.55 2.87 (m) max 18.02 18.35 1.83 SD 0.39 0.34 12.82 Pole vault jump M 442 460 4.07 9 (cm) min 400 400 0.00 max 510 551 8.04 SD 40.87 55.18 35.01

In a running test without and with a pole all subjects improved their results. The maximum improvement in results in a running test without a pole was 3.07%, whereas in a running test with a pole it improved by 5.08% (See Table II). In a standing long jump test and a long jump with a run-up the standard deviation was at the level of 10.81 – 33.43, and its value increased in successive tests by 6.33% and 4.31% respectively. Mean, minimal and maximum values of the results increased from 0.76% to 3.50%. In the tests discussed above, all subjects improved their achievements by 0.67% up to 6.23%, the latter being maximum improvement.

In successive tests, i.e. feet lifting to a fixed bar

with arms straight in a hang, 3-metre rope climbing, vaulting box jump over a crossbar and overhead 4-kilo shot put throw, the standard deviation was maintained at the level of 0.34 up to 26.61, whereas its value increased in successive tests (apart from a 3-metre rope climbing test, where it remained at the same level) by 22.22%, 3.95% and 12.82% respectively. In a 3-metre rope climbing, vaulting box jump over a crossbar and overhead 4-kilo shot put throw, all subjects improved their results by 1.08% up to 11.66%, whereas in feet lifting to a fixed bar with arms straight in a hang two subjects had worse results, and three improved their scores. In pole vault jump the standard deviation in the first stage of research was 40.87, in the second it was 55.18, whereby its value, when comparing first and second stage of research, increased by 35.01%. The minimal value did not change, the mean value increased by 4.07%, and the maximal by 8.04%. In this test the result of one subject did not change, and the remaining ones improved their results from 2.27% up to 8.04%.

The analysis of tests results did not reveal a clear tendency for the standard deviation of parameters under the study to decrease. Nevertheless, a steady growth in the results in particular tests was observed. The dynamics of the development in the results that characterize special fitness of 19-year-old jumpers did

Table II. Development of individual special fitness of 19-year-old pole vault jumpers in %

Tests Subject 15-metre run without a pole (s)

15-metre run with a pole (s)

Standing long jump (cm)

Long jump with a run-up (cm)

Feet lifting to a bar 5x (s)

3-metre rope climbing (s)

Vaulting box jump over a crossbar (cm)

Overhead 4-kilo shot put throw (m)

Pole vault jump (cm)

1 2 % 1 2 % 1 2 % 1 2 % 1 2 % 1 2 % 1 2 % 1 2 % 1 2 % W.P. 1.70 1.69 0.59 1.79 1.71 4.47 296 302 2.03 626 665 6.23 5.63 5.77 2.49 4.03 3.56 11.66 127 130 2.36 17.92 18.25 1.84 510 551 8.04K.S. 1.63 1.58 3.07 1.79 1.77 1.12 290 295 1.72 659 670 1.67 5.13 5.18 0.97 4.06 3.97 2.22 70 75 7.14 17.62 17.81 1.08 440 450 2.27M.H. 1.74 1.69 2.87 1.99 1.97 1.01 290 298 2.76 604 625 3.48 7.98 7.54 5.51 4.97 4.71 5.23 75 80 6.67 17.89 18.18 1.62 430 450 4.65M.Ł. 1.71 1.64 4.1 1.83 1.74 4.92 300 302 0.67 601 620 3.16 8.07 7.37 8.67 4.93 4.77 3.25 60 65 8.33 18.02 18.35 1.83 430 450 4.65P.A. 1.67 1.65 1.2 1.77 1.68 5.08 270 276 2.22 573 590 2.97 9.09 8.40 7.59 5.87 5.50 6.30 70 77 10.0 17.06 17.55 2.87 400 400 0.0


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not open the door to new information about the issue in question.

THE NATURE OF CORRELATIONS BETWEEN SPECIAL FITNESS TESTS AND A SPORT RESULT IN POLE VAULT

The analysis of correlation of motor fitness results in 19-year-old pole vault jumpers in the first stage of tests revealed varied interdependence between the capabilities. The interdependence was particularly high between a pole vault jump, a vaulting box jump over a crossbar (0.9047), and even stronger between rope climbing and feet lifting to a bar (0.9599). The highest correlation was found between a standing long jump and an overhead 4-kilo shot put throw (0.9668) (See Table 3). The juxtaposition of the remaining tests did not reveal any significant correlations.

It is curious that a correlation coefficient between those tests that were highly interdependent in the first stage, slightly decreased in the second stage of research. Yet, a high correlation was still present between strength tests, i.e. rope climbing and feet lifting to a fixed bar (0.9279), standing long jump, and overhead 4-kilo shot put throw (0.9183). The

correlation between pole vault jump and vaulting box jump over a crossbar slightly decreased. The dependencies between other tests remained at a similar level (See Table IV).

When analysing the progress of dependencies of respective tests with a pole vault sport result, it is clear that the greatest improvement between the two stages of the research emerged in a long jump with a run-up and rope climbing (0.7995, 0.5833 respectively) (See Table V). In the remaining tests it was noted to worsen.

The test results extend theoretical scholarly achievements in the subject of the level of physical preparedness presented in the works of S. Socha, 1986 [11]; H. Sozański, 1995 [12]; Z. Ważny, 1989, 1990 [13, 14]; W.A. Zaporożanow, 1997 [15] and others.

The input into the theory and methodology of track and field events comprises new cognitive and functional values, at the same time optimizing a

training process of pole vault jumpers in accordance with the requirements established for directed processes pointed to by M.A. Godik, 1988 [16]; Z. Naglak, 1991 [17]; W.N. Płatonow, 1997 [18].

Table III. Correlation coefficient of individual special fitness tests of 19-year-old pole vault jumpers (February 2008)

It. Tests 1 2 3 4 5 6 7 8 9

1 15-metre run out of a 20-metre run-up (s) X

2 15-metre run out of a 20-metre run-up with a pole (s) 0.7446 X

3 Standing long jump (cm) 0.3418 0.2352 X

4 Long jump with a 35-metre run-up last 15 m – maintaining rhythm (cm) -0.4699 -0.1208 0.5112 X

5 Feet lifting to a fixed bar arms straight; 5 x in a set time (s) 0.4444 0.2561 -0.4892 -0.9526 X

6 3-metre rope climbing (s) 0.2068 0.0874 -0.7052 -0.9203 0,9599* X

7 Vaulting box jump over a crossbar (cm) 2 -0.1764 0.2308 0.2452 -0.5125 -0.5281 X

8 Overhead 4-kilo shot put throw (m) 0.5495 0.4525 0,9668* 0.3864 -0.3627 -0.6085 0.2465 X 9 Pole vault jump (cm) 0.117 -0.1388 0.5979 0.5199 -0.7223 -0.7974 0,9047* 0.5654 X

Table IV. Correlation coefficient of individual special fitness tests of 19-year-old pole vault jumpers (June 2008) It. Tests 1 2 3 4 5 6 7 8 9 1 15-metre run out of a 20-metre run-up (s) X 2 15-metre run out of a 20-metre run-up with a pole 0.2843 X 3 Standing long jump (cm) 0.1686 0.3408 X 4 Long jump with a 35-metre run-up Last 15 metres - maintaining rhythm (cm) -0.2476 0.047 0.6422 X

5 Feet lifting to a fixed bar with arms straight; 5 x in a set time (s) 0.3982 0.078 -0.5432 -0.9837 X

6 3-metre rope climbing (s) 0.038 0.008 -0.7062 -0.9693 0,9279* X 7 Vaulting box jump over a crossbar (cm) 0.5401 -0.2038 0.2831 0.5009 -0.4268 -0.6664 X 8 Overhead 4-kilo shot put throw (m) 0.4435 0.3273 0,9183* 0.3157 -0.1921 -0.4453 0.2559 X 9 Pole vault jump (cm) 0.4042 -0.0697 0.7031 0.7225 -0.6346 -0.8701 0.8729 0.6242 X

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SUMMARY

When compiling test results it can be noted that, despite the improvement in the majority of special fitness parameters of 19-year-old jumpers, these parameters vary to a considerable extent. It becomes most emergent in long jump with a run-up and vaulting box jump over a crossbar, whereas the greatest progress of the parameters under the study was observed in running tests and in feet lifting to a fixed bar.

Regularly executed tests of sportsmen’s special fitness will make it possible to optimize a training process in separate micro cycles.

The analysis of test results made it possible to indicate the dynamics of 19-year-old jumpers’ physical fitness and to determine the degree of dependencies between particular indices of physical fitness and sport results.

The greatest correlations in a pole vault jump were discovered in both stages of the research in a vaulting box jump over a crossbar, namely 0.9047 and 0.8729 for each stage. A medium correlation was noted in strength indices, i.e. 0.5199 – 0.7225. As regards running speed tests, no significant correlations with sport results were observed, probably due to a considerable variation and a small number of subjects. It should be pointed that the greatest progress of dependencies between particular tests of special fitness and a pole vault jump, based on the comparison of both research stages, was noted in a long jump with a run-up and rope climbing. It is therefore curious why the correlation with a test of feet lifting to a fixed bar did not increase. Since the number of 19-year-old pole vault jumpers was small, it is problematic to draw any far-reaching conclusions. The scope of the research allowed solely to find out the tendencies in the correlations between individual tests against a sport result in pole vault.

CONCLUSIONS

The most significant progress of the correlations with a sport result in pole vault was revealed in a long jump with a run-up and rope climbing.

The remaining parameters of strength and speed generated a separate group of interdependencies.

A systematic approach towards collecting data on a training process will make it possible to control it in a rational manner.

A selection of appropriate training programs developed exclusively to account for the capabilities of a given sportsman, where monitors should serve as a decisive criterion of training process effectiveness, may prove a milestone on the way to reach the top. REFERENCES 1. Harre D (1985): Trainingslehre. Berlin. Sportverlag. 279. 2. Naglak Z. (1991): Metodyka trenowania sportowca.

AWF Wrocław. 3. Shephard R.J. , Astrand P.O. (1992): Endurance in sport.

Blackwell Scientific Pubikations; 638. 4. Płatonow W.N. (1997): Obszaja teoria podgotowki

sportsmienow w olimpijskom sportie. Olimpijskaja literatura. Kijew 579.

5. Ważny Z. (2001): Teoria treningu sportowego u progu XXI wieku. W. Materiały konferencyjne pod red. Z. Mroczyńskiego, K Prusika, W. Ratkowskiego: Lekkoatletyka w teorii i praktyce, WAF Gdańsk.

6. Drabik J. (1997) : Testowanie sprawności fizycznej u dzieci, młodzieży i dorosłych. AWF, Gdańsk.

7. Kochanowicz K. (1998): Kompleksowa kontrola w gimnastyce sportowej. AWF, Gdańsk.

8. Klimczyk M. (2008): Kierowanie i kontrola szkolenia sportowego tyczkarzy na etapach – wstępnym i podsta-wowym. Wydawnictwo Uniwersytetu Kazimierza Wielkiego, Bydgoszcz.

9. Mleczko E. (1992): Przegląd na temat motoryczności człowieka. Antropomotoryka, nr. 8 ,s. 109-139.

10. Sozański H. (red), (1993): Podstawy teorii treningu. Warszawa.

11. Socha S., Ważny Z.(red.), (1986): Lekkoatletyka. AWF, Katowice.

Table V. Correlation coefficient of individual fitness tests of 19-year-old jumpers 1

It. Tests 1 2 3 4 5 6 7 8 9 1 15-metre run out of a 20-metre run-up (s) X 2 15-metre run out of a 20-metre run-up witha a pole (s) -0.3386 X 3 Standing long jump (cm) -0.5452 -0.4433 X

4 Long jump with a 35-metre run-up, last 15 metres - maintaining rhythm (cm) -0.6358 0.4137 0.1766 X

5 Feet lifting to a fixed bar with arms straight; 5x in a set time 0.277 0.561 -0.2798 -0.0961 X 6 3-metre rope climbing (s) -0.8605 0.4175 0.3685 0,9401* -0.1786 X 7 Vaulting box jump over a crossbar (cm) 0.4266 0.1072 -0.1812 -0.7855 0.6324 -0.7025 X 8 Overhead 4-kilo shot put throw (m) -0.4991 0.7393 0.1442 0.1962 0.6554 0.3545 0.4123 X 9 Pole vault jump (cm) -0.1316 0.0382 -0.0742 0.7995 -0.2739 0.5833 -0.8882 -0.3782 X


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12. Sozański H. (1995): Kierunki unowocześnienia procesu treningu. Trening, Kwartalnik Metodyczno-Szkoleniowy, nr 1, RCMSzUKFiS, Warszawa.

13. Ważny Z.(1989). Modelowe wskaźniki cech mistrzostwa sportowego. Biblioteka Trenera. RCMSzKFiS, Warszawa.

14. Ważny Z. (1990): Kontrola efektów potreningowych. Koncepcja i propozycja rozwiązań praktycznych. RCMSzKFiS, Warszawa.

15. Zaporożanow W. A. (1997): Skok o tyczce. W: Lekko-atletyka, Technika, Metodyka nauczania, podstawy treningu pod redakcją S. Socha. COSRC-MSzKFiS, Warszawa.

16. Godik M.A. (1988): Sportiwnaja mietrołogia. FiS, Moskwa.

17. Naglak Z.(1991): Metodyka trenowania sportowca. AWF, Wrocław.

18. Płatonow W. N. (1997): Obszczaja tieorija podgotowki sportsmienow w olimpijskom sportie. Olimpijskaja Literatura, Kijów.

Address for correspondence: Faculty of Physical Education Kazimierz Wielki University in Bydgoszcz Kierownik: dr Mariusz Zasada ul. Sportowa 2 85-091 Bydgoszcz tel,/fax. 663089733 (052} 37 67 910 e-mail: [email protected] Received: 23.06.2009 Accepted for publication: 25.08.2009


ORIGINAL ARTICLE / PRACA ORYGINALNA Ewa Kopczyńska1, Roman Makarewicz2, Maciej Dancewicz3, Janusz Kowalewski3, Hanna Kardymowicz4,

Tomasz Tyrakowski1

THE CORRELATION BETWEEN MMP-9, MMP-2, TIMP-1, VEGF

SERUM CONCENTRATIONS IN LUNG CANCER

KORELACJA STĘŻEŃ MMP-9, MMP-2, TIMP-1, VEGF W SUROWICY

CHORYCH NA RAKA PŁUCA

Departments of Collegium Medicum of Nicolaus Copernicus University in Toruń: 1Pathobiochemistry and Clinical Chemistry

Head: prof. dr hab. n. med. Tomasz Tyrakowski

2Oncology and Brachytherapy Head: dr hab. n. med. Roman Makarewicz, prof. UMK

3Thoracic and Tumors Surgery Head: dr hab. n. med. Janusz Kowalewski, prof. UMK

4Department of Laboratory Diagnostics of Oncology Centre in Bydgoszcz, Poland Head: mgr Hanna Kardymowicz

S u m m a r y I n t r o d u c t i o n . Matrix metalloproteinases 9 and 2,

tissue inhibitor of metalloproteinases 1 and vascular endothelial growth factor are involved in cancer invasion and metastasis. MMP-9 and MMP-2 are enzymes that degrade components of extracellular matrix; TIMP-1 is their specific inhibitor, whereas VEGF is a factor stimulating the proliferation and migration of endothelial cells. The angiogenic factors form a complicated regulatory network of mutual activation and/or inhibition.

T h e a i m of this study was to evaluate the correlation between MMP-9, MMP-2, TIMP-1 and VEGF serum concentrations in lung cancer patients.

M a t e r i a l a n d m e t h o d s . The study group consisted of 45 patients with non-small-cell lung cancer (16 females and 29 males) ranging in age from 47 to 80 years (mean age 63.2 ± 826). Serum concentrations of MMP-9, MMP-2, TIMP-1 and VEGF were evaluated by ELISA test.

R e s u l t s . In the study group, statistically significant positive correlations were found between MMP-9 and TIMP-1 (R=0.395), MMP-9 and VEGF (R=0.594) and between VEGF and TIMP-1 (R=0.393). MMP-2 did not correlate with any of the factors.

The clinical data were compared also in the subgroups classified according to patients` age and sex, histological type of tumor, T, N, M categories and clinical staging. The positive correlation, often strong, between MMP-9 and VEGF in the majority of subgroups was found. In addition, concentrations of MMP-9 and TIMP-1 showed correlations in the subgroups with less advanced cancer (subgroups with categories T1-T2, N0, M0 and I-IIIA). No statistically significant dependence was found between concentrations of MMP-9 and MMP-2.

C o n c l u s i o n . A positive correlation of serum MMP-9 concentration with its inductor (VEGF) and inhibitor (TIMP-1) in lung cancer patients was observed.

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S t r e s z c z e n i e W s t ę p . Metaloproteinazy macierzy 9 i 2, tkankowy

inhibitor metaloproteinaz-1 oraz naczyniowo-śródbłonkowy czynnik wzrostu to czynniki związane z inwazją nowotworową i tworzeniem przerzutów. MMP-9 i MMP-2 są enzymami degradującymi komponenty macierzy zewnątrzkomórkowej, TIMP-1 jest ich specyficznym inhibitorem, VEGF - czynnikiem stymulującym proliferację i migrację komórek śródbłonka. Istnieje zależność w działaniu i wzajemnym aktywowaniu i/lub hamowaniu tych czynników.

C e l e m p r a c y była ocena korelacji stężeń MMP-9, MMP-2, TIMP-1 i VEGF w surowicy u chorych na raka płuca.

M a t e r i a ł i m e t o d y . Grupę badaną stanowiło 45 chorych na raka niedrobnokomórkowego płuca (16 kobiet i 29 mężczyzn) w wieku od 47 do 80 lat (średnia wieku 63,2 ± 8,26). Stężenie MMP-9, MMP-2, TIMP-1 i VEGF oznaczano w surowicy krwi metodą ELISA.

W y n i k i . W badanej grupie istotne statystycznie dodatnie korelacje stwierdzono pomiędzy MMP-9 i TIMP-1 (R=0,395), MMP-9 i VEGF (R=0,594) oraz pomiędzy VEGF i TIMP-1 (R=0,393). MMP-2 nie korelował z żadnym z czynników.

Zależności pomiędzy badanymi czynnikami oceniono także w podgrupach wydzielonych na podstawie wieku i płci chorych, typu histologicznego guza, cech T, N i M oraz stopnia zaawansowania klinicznego choroby nowotworowej. Pomiędzy stężeniami MMP-9 i VEGF w większości podgrup stwierdzono dodatnią korelację, często silną. Z kolei stężenia MMP-9 i TIMP-1 wykazywały korelację w podgrupach chorych z mniej zaawansowanym procesem nowotworowym (podgrupy z cechą T1-T2, N0, M0 i I-IIIA). Pomiędzy stężeniem MMP-9 i MMP-2 nie stwierdzono żadnej istotnej statystycznie zależności.

W n i o s k i . Stężenie MMP-9 w surowicy chorych na raka płuca dodatnio korelowało ze stężeniem swojego induktora (VEGF) oraz inhibitora (TIMP-1).

Key words: lung cancer, MMP-9, MMP-2, TIMP-1, VEGF Słowa kluczowe: rak płuca, MMP-9, MMP-2, TIMP-1, VEGF INTRODUCTION

Tumor progression, invasion and metastasis results from cancer cells multiplication and migration and also depends on new blood vessels formation. Cancer cells are source of proangiogenic factors, such as VEGF (vascular endothelial growth factor) and bFGF (basic fibroblast growth factor) and proteolytic enzymes. These enzymes, including metalloproteinases, degrade basement membranes of blood vessels and connective tissue surrounding the cancer. The action of proteolytic enzymes in extracellular matrix leads to loosening of the structure and to formation of space for migrating cancer and endothelial cells. Proliferation and migration of these cells is ensued by secreted factors [1, 2].

Based on substrate specificity, sequence similarity, and domain organisation, matrix metalloproteinases (MMPs) can be divided into six groups: collagenases, gelatinases, stromelysins, matrilysins, membrane-type MMPs, other MMPs. Gelatinases A and B (MMP-2 and MMP-9) degrade gelatin, collagen, laminin, fibronectin and other matrix components [3, 4]. Their increased expression/concentration has been observed in different tumors, including lung cancer [5-8].

In tissues, metalloproteinases exist in complexes with their endogenous inhibitors – TIMPs (tissue inhibitors of metalloproteinases). The specific inhibitor of gelatinases was identified as TIMP-1. Thus, activity

of these enzymes depends on the expression ratio of MMP to TIMP [3]. In carcinomas, the balance between matrix metalloproteinases and their inhibitors is disturbed and the increase of MMP-9/TIMP-1 ratio is also observed in lung cancer patients [9-12].

The activity of metalloproteinases in early stages of cancer growth is associated with expression of growth factors and their receptors. The MMP-9 activity results in the release of, among other factors, TGF-beta (transforming growth factor beta), IGF (insulin-like growth factor), TNF-alfa (tumor necrosis factor alfa), IL-1beta (interleukin 1 beta), IL-8 (interleukin 8) and VEGF. On the other hand, the genes of both gelatinases are activated by VEGF [13,14].

Vascular endothelial growth factor not only stimulates endothelial cells migration, their proliferation and formation of new blood vessels, but also affects vessel permeability and protects endothelial cells through activating antiapoptotic proteins (Bcl-2, surviving, etc.) [15-17]. The role of VEGF in cancer progression, including lung cancer, seems unquestionable [18, 19].

Before diagnostic application of above mentioned data, the estimation of correlations between MMP-9, MMP-2, TIMP-1 and VEGF is at least needed.

The correlation between MMP-9, MMP-2, TIMP-1, VEGF serum concentrations in lung cancer

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THE AIM OF STUDY

The aim of the present study was to evaluate the correlation between concentration of MMP-9 and MMP-2, TIMP-1, VEGF in blood serum of lung cancer patients.

PATIENTS AND METHODS Patients

The study groups consisted of 45 patients with non-small lung cancer (16 females and 29 males) ranging in age from 47 to 80 years (mean age 63,2 ± 8,26). In clinical staging, 18 patients were classified as stage I, 7 patients as stage II, 10 patients as stage IIIA, 6 patients as stage IIIB and 4 patients as stage IV. 22 patients had adenocarcinoma, 11 patients - squamous cell carcinoma and in the remaining 12 patients – histological type was not determined.

MMP-9, MMP-2, TIMP-1 and VEGF concentrations were evaluated on establishing the diagnosis of cancer, before treatment.

The subjects were patients of the University Hospital Department of Thoracic and Tumor Surgery, Nicolaus Copernicus University Collegium Medicum in Bydgoszcz. Material

Blood samples were collected in the test tubes without an anticoagulant. Within an hour of collection, the blood samples were centrifuged at 3000 rpm for 15 minutes. The serum was frozen at -70˚C until the time of assays. Methods of determination

MMP-9, MMP-2, TIMP-1 and VEGF concentrations were assayed by commercially available sandwich enzyme-linked immunosorbent assay kits (Quantikine Human Immunoassay, R&D Systems). Statistical analysis

The relationships between the parameters were examined using Spearman`s correlation analysis. The results were considered statistically significant for p<0.05.

RESULTS

In Table I and Figure 1, the correlation between MMP-9, MMP-2, TIMP-1 and VEGF concentrations in

the studied group was presented. Statistically significant positive correlations were found between MMP-9 and TIMP-1 (R=0,395), MMP-9 and VEGF (R=0,594), VEGF and TIMP-1 (R=0,393). MMP-2 did not correlate with any of the parameters.

Table I. The correlation between MMP-9, MMP-2, TIMP-1,

VEGF MMP-9 MMP-2 TIMP-1

MMP-2 R=-0.137 p=0.3692

TIMP-1 R=0.395 p=0.0072

R=-0.003 p=0.9850

VEGF R=0.594 p=0.00002

R=-0.180 p=0.2378

R=0.393 p=0.0076

R – Spearman`s correlation coefficient p<0.05 was considered statistically significant

Value ranges (R&D Systems): MMP-9: 169 – 705 ng/ml MMP-2: 117 – 410 ng/ml TIMP-1: 87 – 524 ng/ml VEGF: 62 – 707 pg/ml Figure 1. The correlation between MMP-9 and MMP-2,

TIMP-1, VEGF

In Table II, the correlations between the four parameters in the subgroups classified according to the patients` age and sex, histological type, T, N, M categories and clinical staging have been presented.

MMP-9 correlated with its inhibitor TIMP-1 in several subgroups, namely: in patients older than 64 yrs (R=0,418), in patients with T1-T2 category (R=0,431), N0 category (R=0,602), M0 category (R=0,406) and in patients with less advanced cancer (I-IIIA) (R=0,377).

The correlation between MMP-9 and VEGF was observed. Spearman`s correlation coefficient was higher in patients older than 64 yrs than in younger patients (R=0,683 vs. R=0,424) and it was identical in females and males (R=0,618). These two parameters correlated with each other in patients with adenocarcinoma (R=0,658), but there was no

The correlation: MMP-9 vs. other parameters

MMP-2: 63.0-512.6 ng/ml; TIMP-1: 137.8-578.8 ng/ml; VEGF: 92.8-1872.6 pg/mlThe concentration of MMP-9: 318,8-1779,8 ng/ml;

Num

ber (

n)

MMP2 TIMP1 VEGF

MMP9


78

correlation in squamous cell carcinoma patients. Also, the correlation coefficient between MMP-9 and VEGF was higher in patients with T3-T4 category than T1-T2 (R=0,800 vs. R=0,550) and a little higher in patients with N0 than with N1-N3 (R=0,658 vs. R=0,554). Only in one of the subgroups, classified according to category M, i.e. in the subgroup with M0 category, the correlation between MMP-9 and VEGF was statistically significant (R=0,595). Positive correlation (R=0,424) was observed in patients with earlier tumor stages (I-IIIA), however, it was not observed in patients with advanced cancer (IIIB-IV).

Table II. The correlation between parameters in subgroups MMP-9:

MMP-2 MMP-9 : TIMP-1

MMP-9 : VEGF

MMP-2: TIMP-1

MMP-2: VEGF

TIMP-1: VEGF

AGE ≤ 64 years (n=23)

R=0.424 p=0.044

AGE > 64 years (n=22)

R=0.418 p=0.053

R=0.683 p=0.00046

Sex – female (n=16)

R=0.618 p=0.011

Sex – male (n=29)

R=0.618 p=0.00035

R=0.427 p=0.021

SQUAMOUS CELL CA. (n=11)

ADENOCARCINOMA (n=22)

R=0.658 p=0.00087

T1-T2 category (n=30)

R=0.431 p=0.017

R=0.550 p=0.0016

R=0.383 p=0.0369

T3-T4 category (n=11)

R=0.800 p=0.0031

N0 category (n=30)

R=0.602 p=0.0004

R=0.658 p=0.000077

R=0.528 p=0.0027

N1-N3 category (n=14)

R=0.554 p=0.040

M0 category (n=40)

R=0.406 p=0.0093

R=0.595 p=0.000051

R=0.425 p=0.0063

M1 category (n=4)

Tumor stage – I-IIIA (n=35)

R=0.377 p=0.026

R=0.424 p=0.044

Tumor stage – IIIB-IV (n=10)

For p<0.05, only coefficient R was given T – tumor N – nodes M – metastases

In all studied subgroups, no correlation between

concentrations of MMP-9 and MMP-2 was observed. There were also no correlations between MMP-2

and TIMP-1 and VEGF in any of the subgroups. VEGF, similarly to MMP-9, correlated with TIMP-

1 in the subgroups with T1-T2 category (R=0,383), N0 (R=0,528), M0 (R=0,425), and in males (R=0,427).

There was no correlation between the studied parameters in the subgroup with metastases (M1 category) and in patients with clinical stage III and IV. DISCUSSION

The problem of correlation between different factors related to angiogenesis in cancer patients was addressed in article of Zaman et al. [20]. It was shown

that among 11 different factors (VEGF, MMP-9, sTie-2, fibronectin), in several types of cancers, only changes in concentrations of VEGF and MMP-9 correlated with each other. The correlation coefficient in colon cancer was R=0,77, and in breast cancer R=0,58.

The authors of this study estimated the correlation between MMP-9 and VEGF firstly because of their dependence in activity and mutual activation. The second reason for estimating this correlation was the relationship between MMP-9 and VEGF concentration and clinical staging, found in our earlier study. It was observed that concentrations of both MMP-9 and VEGF were the highest in patients with the highest tumor stage, i.e. stage IIIB and IV.

We evaluated the correlation between MMP-9 and MMP-2 because of the fact that both of them belong to the same group of metalloproteinases, i.e. gelatinases, which perform similar functions and are produced by tumor cells.

Thirdly, the correlation between MMP-9 and TIMP-1 was estimated due to the fact that TIMP-1 is a specific inhibitor of MMP-9. The ratio of both concentrations decides about effective MMP-9 activity, also in cancer. The results of our earlier study of MMP-9/TIMP-1 ratio usefulness in the estimation of invasion and metastasis of lung cancer have been published.

The correlation coefficient between MMP-9 and VEGF was R=0,59 (p=0,00002). We can draw a conclusion that the dependence in action and mutual activating between VEGF and MMP-9, including the development of cancer, is reflected in correlation between their concentrations in body fluids. This observation concerns not only the blood, but also, as indicated by Jin et al. [21], pleural effusion. Concentrations in this fluid, of both VEGF and MMP-9, were increased in the lung cancer patients, and the correlation between these parameters was statistically significant.

The authors of this study estimated also the correlation between MMP-9 and VEGF in subgroups classified according to patients` age and sex, histological type, T, N, M categories and clinical staging. The positive correlation in patients with adenocarcinoma was especially interesting. Such a correlation was not observed in patients with squamous cell carcinoma. It is also worth mentioning that there is a lack of correlation between these parameters in the subgroups consisting of patients with

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79

metastases (M category) and patients with advanced tumor stage (IIIB-IV), while in the remaining subgroups, a positive correlation, often strong, was found.

No statistically significant dependence between concentration of MMP-9 and MMP-2 in lung cancer patients was found both in the whole group and in the subgroups.

Furthermore, concentrations of MMP-9 and TIMP-1 showed correlation, both in the whole study group (R=0,395), and in the subgroups of patients with categories T1-T2, N0, M0 and tumor stage I-IIIA, i.e. in patients with less advanced cancer. In studies of Gouyer et al. [22], the correlation coefficient between mRNA MMP-9 and TIMP-1 was 0,423. CONCLUSIONS

1. MMP-9 concentration in the serum of lung cancer patients did not show correlation with the second gelatinase, i.e. MMP-2; however, it positively correlated with the concentrations of its inhibitor (TIMP-1) and inductor (VEGF).

2. MMP-9 showed correlation with TIMP-1 in patients older than 64 years, in patients with category T1-T2, category N0, category M0 and in patients with stage I-IIIA (i.e. in older patients and with less advanced cancer).

3. MMP-9 and VEGF showed strong positive correlation in all subgroups, except the subgroups of patients with M1 category, patients with stage IIIB-IV and squamous cell carcinoma patients.

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Matrix metalloproteinases in tumor invasion: role for cell migration. Pathol Int 2002; 52: 255-264.

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3. Visse R, Nagase H.: Matrix metalloproteinases and tissue inhibitors of metalloproteinases. Circ Res 2003; 92: 827-839.

4. Overall CM.: Molecular determinants of metalloproteinase substrate specificity. Mol Biotech 2002; 22: 51-86.

5. Ohbayashi H.: Matrix metalloproteinases in lung diseases. Current Protein and Peptide Sci 2002; 3: 409-421.

6. Leinonen T, Pirinen R, Bohm J et al.: Expression of matrix metalloproteinases 7 and 9 in non-small cell lung

cancer. Relation to clinicopathological factors, beta-catenin and prognosis. Lung Cancer 2006; 51: 313-321.

7. Iizasa T, Fujisawa T, Suzuki M et al.: Elevated levels of circulating plasma matrix metalloproteinase 9 in non-small cell lung cancer patients. Clin Cancer Res 1999; 5: 149-153.

8. Laack E, Kohler A, Kugler C et al.: Pretreatment serum levels of matrix metalloproteinase-9 and vascular endothelial growth factor in non-small-cell lung cancer. Ann Oncol 2002; 13: 1550-1557.

9. Suzuki M, Iizasa T, Fujisawa T et al.: Expression of matrix metalloproteinases and tissue inhibitor of matrix metalloproteinases in non-small cell lung cancer. Invasion and Metastasis 1998; 18: 134-141.

10. Simi L, Andreani M, Davini F et al.: Simultaneous measurement of MMP9 and TIMP1 mRNA in human non small cell lung cancers by multiplex real time RT-PCR. Lung Cancer 2004; 45: 171-179.

11. Ming S, Sun T, Xiao W, Xu X.: Matrix metalloproteinase-2, -9 and tissue inhibitor of metallo-proteinase-1 in lung cancer invasion and metastasis. CMJ 2005; 118: 69-72.

12. Jumper C, Cobos E, Lox C.: Determination of the serum matrix metalloproteinase 9 (MMP-9) and tissue inhibitor of matrix metalloproteinase-1 (TIMP-1) in patients with either advanced small-cell lung cancer or non-small-cell lung cancer prior to treatment. Respir Med 2004; 98: 173-177.

13. Folgueras AR, Pendás AM, Sanchez LM, Lopez-Otin C.: Matrix metalloproteinases in cancer: from new functions to improved inhibition strategies. Int J Dev Biol 2004; 48: 411-424.

14. Hojilla CV, Mohammed FF, Khokha R.: Matrix metalloproteinases and their tissue inhibitors direct cell fate during cancer development. Brit J Cancer 2003; 89: 1817-1821.

15. Ferrara N.: Vascular endothelial growth factor: basic science and clinical progress. Endocr Rev 2004; 25: 581–611.

16. Byrne AM, Bouchier–Hayes DJ, Harmey JH:. Angiogenic and cell survival functions of vascular endothelial growth factor (VEGF). J Cell Mol Med 2005; 9: 777–794.

17. Pinedo HM, Slamon DJ.: Translational research: the role of VEGF in tumor angiogenesis. Oncologist 2000; 5: 1–2.

18. Tamura M, Oda M, Matsumoto I et al.: The combination assay with circulating vascular endothelial growth factor (VEGF)-C, matrix metalloproteinase-9, and VEGF for diagnosing lymph node metastasis in patients with non-small cell lung cancer. Ann Surg Oncol 2004; 11: 928-933.

19. Tamura M, Ohta Y.: Serum vascular endothelial growth factor-C level in patients with primary nonsmall cell lung carcinoma. Cancer 2003; 98: 1217-1222.

20. Zaman K, Driscoll R, Hahn D et al.: Monitoring multiple angiogenesis – related molecules in the blood of cancer patients shows a correlation between VEGF-A and MMP-9 levels before treatment and divergent


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changes after surgical vs.conservative therapy. Int J Cancer 2006; 118: 755-764.

21. Jin HY, Lee KS, Jin SM, Lee YC.: Vascular endothelial growth factor correalates with matrix metalloproteinases in the pleural effusion. Respir Med 2004; 98: 115-122.

22. Gouyer V, Conti M, Devos P et al.: Tissue inhibitor of metalloproteinase 1 is an independent predictor of prognosis in patients with nonsmall cell lung carcinoma who undergo resection with curative intent. Cancer 2005; 103: 1676-1684.

Address for correspondence: dr n. med. Ewa Kopczyńska Uniwersytet Mikołaja Kopernika w Toruniu Collegium Medicum im. Ludwika Rydygiera Katedra i Zakład Patobiochemii i Chemii Klinicznej ul. M. Skłodowskiej-Curie 9 85-094 Bydgoszcz tel.: (052) 585 3600 e-mail: [email protected] Received: 11.08.2009 Accepted for publication: 2.09.2009


ORIGINAL ARTICLE / PRACA ORYGINALNA Barbara Ruszkowska1, Sławomir Manysiak2, Liliana Bielis1, Beata Małecka1, Grażyna Dymek2,

Lilla Senterkiewicz2, Danuta Rość1, Grażyna Odrowąż-Sypniewska2

FIBRINOGENOLYSIS IN POSTMENOPAUSAL WOMEN TAKING ORAL HORMONE REPLACEMENT THERAPY

FIBRYNOGENOLIZA U KOBIET W OKRESIE POMENOPAUZALNYM

STOSUJĄCYCH HORMONALNĄ TERAPIĘ ZASTĘPCZĄ DROGĄ DOUSTNĄ

1Chair of Pathophysiology, Nicolaus Copernicus University Collegium Medicum in Bydgoszcz Head: dr hab. Danuta Rość, prof. UMK

2Chair and Department of Laboratory Medicine, Nicolaus Copernicus University Collegium Medicum in Bydgoszcz

Head: prof. dr hab. n. med. Grażyna Odrowąż-Sypniewska

S u m m a r y T h e a i m o f t h e s t u d y was to assess selected

parameters of fibrinolysis: concentration of antigen plasminogen activator inhibitor type 1 (PAI-1: Ag), fibrinogen, D-dimers and activity of antiplasmin (AP) in postmenopausal women who were taking oral hormone replacement therapy (HRT).

S u b j e c t s a n d m e t h o d s . The study involved 56 healthy, non –smoking postmenopausal women (1 – 2 years after menopause). 26 women aged 44 – 58 years (mean age 52 years) were taking oral hormone replacement therapy. The control group consisted of 30 women who did not take HRT, aged 44 - 58 years (mean age 49 years). The following parameters of hemostasis were determined in plasma:

concentration of PAI-1: Ag, D-dimers, fibrinogen and activity of AP.

R e s u l t s . Significant decrease in fibrinogen concentration (p<0.05) was observed among women using oral HRT vs control group. Activity of antiplasmin among women taking oral HRT was significantly lower (p<0.03) than in the control group. No statistically significant changes in concentration of D-dimers and PAI-1: Ag were noted.

C o n c l u s i o n . In conclusion decrease of fibrinogen concentration and decrease of AP activity with no significant modification of D-dimers and PAI-1: Ag concentration, that occurred among women taking oral HRT indicate the activation of fibrinogenolysis, although this is to be confirmed in larger studies.

S t r e s z c z e n i e C e l e m p r a c y była ocena wybranych parametrów

fibrynolizy, takich jak: stężenie antygenu inhibitora aktywatora plazminogenu typu 1 (PAI-1: Ag), fibrynogenu, D-dimerów i aktywność antyplazminy (AP) u kobiet w okresie pomenopauzalnym, stosujących hormonalną terapię zastępczą (HTZ) drogą doustną

M a t e r i a ł i m e t o d y . Badaniami objęto 56 zdrowych kobiet, niepalących po menopauzie (1-2 lat po menopauzie). 26 kobiet w wieku 44-58 (średnia 52 lata)

stosowało doustną hormonalną terapię zastępczą. Grupę kontrolną stanowiło 30 kobiet w wieku 44-54 (średnia 49 lat) niestosujących HTZ. Materiałem do badań było osocze cytrynianowe, oznaczono następujące parametry hemostazy: stężenie antygenu PAI-1: Ag, fibrynogenu, D-dimerów oraz aktywność AP.

W y n i k i . W grupie kobiet stosujących HTZ drogą doustną zaobserwowano, w porównaniu z grupą kontrolną, niższe stężenie fibrynogenu (p<0,05) i niższą aktywność AP

Barbara Ruszkowska et al.

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(p<0,03), natomiast nie wykazano różnic w stężeniu D-dimerów i PAI-1: Ag.

W n i o s e k . Występowanie u kobiet stosujących HTZ drogą doustną obniżonego stężenia fibrynogenu i niższej

aktywności AP, przy braku zmian stężenia D-dimerów i PAI-1: Ag, wskazuje na aktywację fibrynogenolizy.

Key words: menopause, fibrinolysis, hormone replacement therapy Słowa kluczowe: menopauza, fibrynoliza, hormonalna terapia zastępcza INTRODUCTION

The most important physiological role of the fibrinolytic system is to dissolve intravascular fibrin deposits and to keep the patency in the vascular bed [1, 2]. The fibrinolytic system components participate in the physiological and pathological processes like: spermatogenesis, ovulation, egg’s implantation, morphogenesis, cell migration or invasion of cancer. Maintaining a balance between clotting process and fibrinolysis is important for the remaining hemostasis. The balance disorders between thrombus formation and degradation, simultaneously with the increase in concentration of clotting factors and the decrease of coagulation inhibitors or the decrease of concentration of plasminogen, plasminogen activators and the increase in concentration of fibrinolysis inhibitors can lead to the occurrence of thrombotic and embolic events [1-3].

According to the World Health Organization (WHO), menopause is the time in a woman’s life when the reproductive capacity ceases. Woman has reached menopause when she has not had a period for 12 months [4]. The ovaries gradually and inevitably stop functioning and their production of steroid hormones falls. The basis of hormone imbalance in perimenopausal women are disorders of the efficiency of the hypothalamus - hypophysis - ovary axis. The result of cessation of ovaries function is a decreased estrogen and progesterone production. The secretion of gonadotrophins follicle-stimulating hormone (FSH) and luteinizing hormone (LH) by hypophysis is increased during and after menopause [5-8].

Sex hormone disorders in perimenopausal women lead to metabolic changes in various tissues and organs. The menopause symptoms are caused by declining and fluctuating hormone levels. The most common symptoms of menopause are hot flashes, mood swings, nocturnal sweat, palpitation, insomnia, atrophy of the sexual - urinary system, osteoporosis, higher risk of ischemic heart disease [6-9].

There are few processes observed in the hemolytic system after menopause: increased concentration of

fibrinogen, PAI-1, Lp(a), increased activity of factor VII, decrease of concentration of t-PA, as well as gradual increase of endogenous inhibitors of coagulation activity. These changes result in the increased risk for thromboembolic disease in women after menopause [10, 11].

The symptoms of sex hormone deficiency can be diminished by hormone replacement. HRT appeases climacteric symptoms, improves quality of life and prevents osteoporosis [10].

Available data show different results concerning the influence of oral estrogens and gestagens on hemostasis and fibrinolysis. Some of the researches suggest the estrogens seem to be procoagulative. Activity of estrogens increased concentration of fibrynogen, factor VII and concurrently decreased concentration of endogenous coagulation inhibitors. The other ones claim that fibrynogen and factor VII concentration decreases and the protein C activity increases. Oral HRT affects the fibrynolysis by decreasing concentration of tissue activator plasminogen (t-PA) and PAI-1 [10, 12]. The conflicting results are bound to the kind of hormone, dose and route for administration, that are very important as they determine the kind of side effects and a possibility of appearing pathologies such as endometrial proliferation and progression of atherosclerosis [6, 10, 13].

The aim of the study was to assess selected parameters of fibrinolysis in postmenopausal women who were taking oral hormone replacement therapy (HRT). SUBJECTS AND METHODS Study group

The study involved 56 healthy, nonsmoking, postmenopausal women, who were 1-2 years after menopause. 26 women aged 44-58 years (mean age 52 years) were taking oral hormone replacement therapy (for 6-14 months). HRT was taken continuously in the

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form of composite preparation: estrogen-progestagen combinations [2 mg 17 beta-estradiol (E2) and 1 mg norethisterone acetate (NETA)- (Kliogest, Novo Nordisk Pharma, Warsaw, Poland)]. The persistent climacteric symptoms like heavy and regular hot flashes with drenching sweat were the main condition to start HRT.

The control group consisted of 30 healthy, aged 44-54 years (mean age 49 years), who did not take HRT.

The blood pressure (BP) and body mass index (BMI) were measured at the beginning of the study. The systolic blood pressure (SBP) range was 120 +/-19 mmHg, diastolic blood pressure (DBP) range was 74 +/- 15 mmHg, the BMI range was 21.0 +/- 5.0 kg/m2. The concentration of FSH was between 34.3 and 116.7 lU/l in women taking oral HRT. The concentration of FSH was also assayed in the control group and was found to be 37.4 – 117.3 lU/l.

Women in both groups had no diabetes mellitus or glucose intolerance. They never had any incident of thrombosis or systemic illnesses. None was taking any medication that might interfere with fibrinolytic system. All women included in the study had a complete gynecological examination, cytology smear, palpable breast examination, mammography and biochemical examinations (lipid profile and hormone profile).

Women in both groups were the patients of the Outpatient Gynaecology Centre of the University Hospital in Bydgoszcz. Written informed consent, which contained explanation of the main study aspects and collaboration conditions, was obtained from each participant before entering the study. The study was approved by the Bioethics Committee of the Nicolaus Copernicus University Collegium Medicum in Bydgoszcz (no. KB/305/2004).

Fasting blood specimens were obtained from examined women after 30 minute rest between 730 and 930 am, after a 12-hour overnight fast. Blood samples for hemostatic tests (4.5 ml) were taken in tubes (Becton Dickinson Vacutainer® System, Plymouth, UK) containing 3.2 % sodium citrate without stasis (the final blood-anticoagulant ratio was 9: 1). The collected blood samples were immediately mixed and centrifuged at 3000 g at + 4°C for 20 minutes. The obtained platelet - poor plasma was divided into 200 µl. Eppendorf-type tubes and then plasma samples were frozen at -86 °C until assayed, but no longer than 6 months.

Hemostatic assays The concentration of antigen plasminogen activator

inhibitor type 1- PAI-1: Ag was determined by Enzyme Linked Immunosorbent Assay (ELISA) – (ASSERACHROM®PAI-1, Diagnostica Stago, Asnieres, France), D-dimers were assayed by ELISA – (ASSERACHROM®D-DI Diagnostica Stago, Asnieres, France). The tests for concentration of fibrinogen and activity of antiplasmin were performed in an automated coagulometr CC – 3003 apparatus and reagents produced by Bio-Ksel Co, Poland. Other measurements

Level of serum FSH was determined by standardized micromolecular immunoenzymatic test (Microparticle Enzyme Immunoassay – MEIA), AXSYM®SYSTEM, Abbott laboratories, Diagnostics Division, Abbott Park, IL 60064, USA. Statistical Analysis

Statistical analysis was performed using Statistica 6.0 software (StatSoft®, Krakow, Poland). Shapiro-Wilk test was used to assess normality of the distribution. Analyzed data followed a normal distribution. Student’s t-test was used to calculate the mean differences between groups. Results were presented as mean and standard deviation (SD). The Spearman correlation coefficients were calculated to determine if there were any associations between BMI and hemostatic parameters. The p-values < 0.05 were considered statistically significant. RESULTS

The average concentration of fibrinogen D-dimers, PAI-1: Ag and the activity of antiplasmin (AP) in women taking oral HRT compared to the control group was shown in Table I. Women taking oral HRT had significantly lower concentration of fibrinogen (p<0.05) than women in the control group. Activity of AP among women taking oral HRT was significantly lower (p<0.03) than in women from the control group. The average concentration of D-dimers in women taking oral HRT and the control group was similar. Concentration of PAI-1: Ag in women taking oral HRT was lower vs control group, however this difference was not statistically significant.

We compared the clinical and biochemical data in relation to BMI (Table II). As widely accepted, BMI ≥25 was regarded as overweight. The concentration of


84

fibrinogen, D-dimers, PAI-1: Ag, activity of AP and BP did not differ significantly within the study and control groups. Significant differences were observed between concentration of fibrinogen and activity of AP among study and control groups independently from BMI. Regardless of BMI, women using oral HRT had a higher concentration of D-dimers in comparison to the control group, however this difference was not statistically significant .

There was no significant correlation between BMI and hemostatic parameter changes (Table III).

Table I. Clinical and biochemical data concerning women

enrolled into the study Tabela I. Kliniczne i biochemiczne parametry kobiet

uczestniczących w badaniu

Oral HRT Doustna HTZ

X±SD

Control group Grupa

kontrolna X±SD

Significance level

Poziom istotności p-values

Age (years) 52.4 ± 3.3 49.4 ± 4.1 0.06 BMI (kg/m2) 22.9 ± 3.0 23.4 ± 2.4 0.84 SBP (mmHg) 127.8 ± 10.7 125.8 ± 12.5 0.87 DBP (mmHg) 74.0 ± 5.8 74.2 ± 5.1 0.79 FSH (lU/L) 45.5 ± 31.7 46.8 ± 33.5 0.61

Fibrinogen (g/l) 3.4 ± 0.7 3.7 ± 0.5 0.05* Antiplasmin (%) 84.5 ± 18.9 95.5 ± 17.9 0.03* PAI-1 (ng/ml) 31.9±20.8 41.8±26.1 0.09

D-dimers (ng/ml) 378.4 ± 184.3 369.2 ± 145.6 0.22 Abbreviations: X- Mean, SD- Standard Deviation, NS- Not significant, HRT- Hormone replacement therapy, Skróty: X- Średnia, SD- Odchylenie standardowe, NS- Nieistotne statystycznie, HTZ- Hormonalna Terapia Zastępcza,

Table II. Values of parameters of fibrinolysis and BP values

in particular study groups in relation to BMI Tabele II. Wartości parametrów fibrynolizy i ciśnienia

tętniczego krwi w poszczególnych badanych grupach w zależności od BMI

BMI < 25 BMI ≥25

Oral HRT n=19

Control group n=20

p-Values

Oral HRT n=7

Control group n=10

p-Values

Fibrinogen (g/l)

3.3 ± 0.6 3.7 ± 0.4 0.07 3.4 ± 0.6 3.7 ± 0.4 0.07

AP (%) 84.5 ± 15.9

94.2 ± 15.0

0.06 85.2 ± 16.3

95.6 ± 12.9

0.06

D-dimers (ng/ml)

383.9 ± 157.3

370.6 ± 145.0

0.21 381.2 ± 186.6

372.8 ± 153.0

0.34

PAI-1 (ng/ml)

32.7 ± 21.7

38.9 ± 28.7

0.14 35.0 ± 22.1

42.9 ± 23.1

0.21

SBP (mmHg)

124.4 ± 10.7

126.0 ± 12.5

0.81 126.3 ± 7.7

130.0 ± 8.9

0.62

DBP (mmHg)

71.6 ± 8.0 71.5 ± 7.3

0.89 73.7 ± 6.4 72.4 ± 7.4

0.79

Abbreviations: X- Mean, SD- Standard Deviation, HRT- Hormone replacement therapy Skróty: X- Średnia, SD- Odchylenie standardowe, NS- Nieistotne statystycznie, HTZ- Hormonalna Terapia Zastępcza

Table III. Correlation coefficients of analysed parameters of hemostasis in particular study groups in relation to BMI

Tabela III. Współczynnik korelacji analizowanych para-metrów hemostazy w poszczególnych grupach badanych względem BMI

Oral HRT N R p-values

BMI & fibrinogen 26 0,015 0.94 BMI & PAI-1 26 0,319 0.11

BMI & D-dimers 26 0,345 0.08 BMI & Antiplasmin 26 0.376 0.06

DISCUSSION

Oral HRT causes an increase in the hormone levels in the liver. The basis of this process is first transition effect. About 70 % of oral estrogens are metabolized by the liver. Estrogens, which are not metabolized and their metabolites are excreted in the bile and reabsorbed in the intestine. This process leads to the repeated transition effect of these substances through the liver [12, 14, 15]. The estrone/estradiol ratio could be as high as 5: 1 in women taking oral HRT while this ratio in women taking transdermal HRT is 1: 1 [12, 16]. Oral HRT stimulates the liver cells which in turn produce many active biological substances: angiotensinogen, sex hormone binding globulins (SHBG), thyroxin, ceruloplasmin and clotting factors [12, 15, 16].

Our study results showed decrease of concentration of fibrinogen in the women taking oral HRT in comparison with the control group.

The concentration of fibrinogen increases with aging, moreover it is higher during pregnancy and menopause in obese women and in women taking contraceptives [17].

The oral estrogens cause a decrease of fibrinogen concentration, but in many studies no significant differences were found in concentration of fibrinogen during hormonal replacement therapy [9, 18]. The Postmenopausal Estrogen/Progestin Interventions-trial (PEPI) research showed a slight decrease of fibrinogen concentration when taking only estrogens replacement (mix of horse estrogens of a natural origin –conjugate estrogens- in a dose of 0.625 mg/day) [19]. The results of our study are in accordance with the results of Andersen et al. [20]. They show significant decrease of fibrinogen concentration when taking oral estrogen-progesterone therapy, which consists of estradiol valerate (dose – 2 mg/day) and cyproterone acetate (dose – 1mg/day) and was taken in the second phase of menstrual cycle [20].

Fibrinogenolysis in postmenopausal women taking oral hormone replacement therapy

85

The observed digestion of fibrinogen by plasmin in women taking oral HRT is a beneficial effect of the influence of HRT on hemostasis. Higher concentration of fibrinogen is an independent risk factor of atherosclerosis. Decreased fibrinogen concentration prevents the development of atherosclerosis in menopausal women and proves higher effectiveness of oral HRT in this scope. Our results show a decrease of AP activity in women taking oral HRT in comparison with the control group.

Increased AP activity was found after surgical procedure, in inflammatory state, thrombosis, pregnancy, whereas decrease of its activity is observed in disseminated intravascular coagulation (DIC), liver diseases (like hepatic cirrhosis), hepatitis virus infection, hepatocarcinoma, during labour and during a thrombolytic treatment [21].

Taking oral estrogens leads to hepatocyte activation and synthesis of active biological substances stimulation. An increase in the concentration of fibrinogen and activity of AP should be expected. According to preliminary reports, HRT causes fibrinolytic system activation which leads to forming of plasmin in the blood. Decreased AP activity, which was observed, is an effect of using AP up in the plasmin inactivation process [9].

Decreased activity of AP can be caused by impaired production of this inhibitor by the liver or by using it up in the plasmin inactivation process and forming plasmin-AP complexes (PAP) or both processes at the same time [21-23].

The study results showed a tendency to an increased D-dimers concentration among women using oral HRT vs control group. The concentration of D-dimers increases during the coagulation. Vehkavaara S. et. al examined the influence of the route for administration on hemostasis. Their study results showed increased concentration of D-dimers in women taking oral HRT [24]. The increased concentration of D-dimers in women taking oral HRT can be used as a marker of thromboembolic disease.

The observed decrease of fibrinogen concentration and AP activity in the women taking oral HRT is probably an effect of degradation of fibrinogen by plasmin. This supposition is in accordance with no differences in concentration of D-dimers observed in women from both groups. D-dimers are formed when plasmin degrades cross-linked fibrin. The plasmin starts to digest proteins and also fibrinogen if the fibrin level is lower than AP concentration.

When qualifying women for HRT both indications and contraindications must be taken into account. HRT should start as soon as possible when first symptoms of hipoestrogenism appear. HRT applied early reduces the risk of ischemic heart disease and death. It’s accepted worldwide that the HRT has a positive role in reducing the symptoms of menopause. On the other hand, long-term HRT increases the potential risk of developing cancer and/or thromboembolic disease. Therefore it must not be forgotten that every patient should be treated individually [25, 26].

CONCLUSION

In conclusion, decrease of fibrinogen concentration and decrease of AP activity with no significant modification of D-dimers and PAI-1: Ag concentration, that occurred among women taking oral HRT indicate the activation of fibrinogenolysis, although this is to be confirmed in larger studies.

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PAR system in human physiology. Ann. Acad. Med. Bydgost. 2004; 18: 27-31.

2. Stachowiak G., Stetkiewicz T., Połać I. et al.: The role of plasminogen activator inhibitor 1 (PAI-1) after menopause- the influence hormonal therapy of his period. Przegl. Menopauz. 2005; 6: 17-21.

3. Stefańczyk L., Owczarek D., Stachowiak G. et al.: Evaluation of fibrinolysis in menopausal women suffering from lower limb deep vein thrombosis. Przegl. Menopauz. 2004; 3: 73-77.

4. World Health Organization Research on the menopause in the 1990s. Report of a WHO. Scientific Group Organ. Technical Report Series, Geneva 1996; 866: 1-107.

5. Knochenhauer E., Azziz R.: Ovarian hormones and adrenal androgens during a woman’s life span. J. Am. Acad. Dermatol. 2001; 45: 105-115.

6. Wojnowska D., Juszkiewicz-Borewiec M., Chodorowska G.: Menopause and skin aging. Post. Dermatol. Alergol. 2006; 3: 149-156.

7. Al.-Azzawi F.: The menopause and its treatment in perspective. Postgrad. Med. J. 2001; 77: 292-304.

8. Banger M.: Affective syndrome during perimenopause. Maturitas 2002; 41: 13-18.

9. Soszka T.: Hormone replacement therapy effects on the hemostatic system. Przegl. Menopauz. 2004; 1: 12-22.

10. Collejon R.D., Franceschini A.S., Montes B.M. et al.: Hormone replacement therapy and hemostasis: Effects in Brazilian postmenopausal women. Maturitas 2005; 52: 249-255.

11. Stachowiak G., Pakalski A., Połać I. et al.: The risk of thromboembolic complications to oral contraception and


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hormone replacement therapy. Przegl. Menopauz. 2004; 1: 53-57.

12. Hoibraaten E., Qvigstad E., Andersen T.O. et al.: The effects of hormone replacement therapy (HRT) on hemostatic variables in women with previous venous thromboembolism-results from a randomized, double-blind, clinical trial. Thromb. Haemost. 2001; 85: 775-781.

13. Pertyński T., Stachowiak G.: Choosing the route of drug administration for hormone therapy of the menopausal period- when is it worth to truck tablets for patches? Przegl. Menopauz. 2006; 5: 323-328.

14. Stachowiak G., Połać I., Stefańczyk L. et al.: Haemostasis and oral hormone replacement therapy. Przegl. Menopauz. 2002; 1: 23-27.

15. Żochowska E., Stanosz S., Sieja K., et al. The influence of oral hormonal supplement therapy on serum gonadotrophins, estrogens, prolactin and growth hormone levels in postmenopausal women with osteopenia. Gin. Prakt. 2006; 1: 20-27.

16. Boyd R.A., Zegarac E.A., Eldon M.A.: Pharmacokinetic characterization of 7-day 17ß-estradiol transdermal delivery system in healthy postmenopausal women. Pharm. Res. 1993; 10: 332.

17. Post M.S., van der Mooren M.J., van Baal W.M. et al.: Effects of low-dose oral and transdermal estrogen replacement therapy on hemostatic factors in healthy postmenopausal women: a randomized placebo-controlled study. Am. J. Obstet. Gynecol. 2003; 189: 1221-1227.

18. Iacoviello L. Vischetti M., Zito F. et al.: Gene encoding fibrinogen and carciovascular risk. Hypertension 2001; 38: 1199-1203.

19. The Writing Group for the PEPI Trial. Effects of estrogen or estrogen/progestin regimes on heart disease risk factors in postmenopausal women. JAMA1995; 271: 199-208.

20. Andersen L.F., Gram J., Skouby S.O. et al.: Effects of hormone replacement therapy on hemostatic cardiovascular risk factors. Am. J. Obstet. Gynecol. 1999; 180: 283-289.

21. Takada A., Takada Y., Urano T.: The physiological aspects of fibrinolysis. Thromb. Res. 1994; 76: 1-31.

22. Saitoh O., Matsumoto H., Sugimori K. et al.: Intestinal protein loss and bleeding assessed by fecal hemoglobin, transferrin, albumin, and alpha-1-antitrypsin levels in patients with colorectal diseases. Digestion. 1995; 56: 67-75.

23. Roman S., Knauer O., Cucuianu M.: Clinical studies on alpha 2 plasmin inhibitor. Med. Interne. 1990; 28: 73-81

24. Vehkavaara S., Silveira A., Hakala-Ala-Pietila T. et al.: Effects of Oral and Transdermal Estrogen Replacement Therapy on Markers of Coagulaton Fibrinolysis Inflammation and Serum Lipids and Lipoproteins in Postmenopausal Women. Thromb. Haemost. 2001; 85: 619-625.

25. Stachowiak G., Połać I., Stefańczyk L. et al.: Haemostasis and oral hormone replacement therapy. Przegl. Menopauz. 2002; 1: 23-27.

26. Dębski R.: The hormone replacement therapy and the diseases of the arteries. Przegl. Menopauz. 2006; 5: 274-279.

Address for correspondence: dr n. med. Barbara Ruszkowska Katedra Patofizjologii Collegium Medicum UMK ul. M. Skłodowskiej-Curie 9 85-094 Bydgoszcz email: [email protected] tel. 52/585-34-75 fax. 52/585-35-95

Received: 14.07.2009 Accepted for publication: 25.08.2009


ORIGINAL ARTICLE / PRACA ORYGINALNA Monika Zawadka, Stanisław Krajewski, Wojciech Hagner, Joanna Pawlak, Karolina Wiśniewska

THE INFLUENCE OF PARKINSON’S DISEASE ON BALANCE DISORDERS

WPŁYW CHOROBY PARKINSONA NA ZABURZENIA RÓWNOWAGI

Chair and Clinic of Rehabilitation, Nicolaus Copernicus University Collegium Medicum in Bydgoszcz

Head: dr hab. n. med. Wojciech Hagner, prof. UMK

S u m m a r y B a c k g r o u n d a n d p u r p o s e . Balance disorders

are a common symptom of Parkinson’s disease. The goal of this study is to estimate its influence on balance disorders and the risk of fall.

M a t e r i a l a n d m e t h o d s . The study group was composed of 30 patients with Parkinson’s disease and 30 healthy subjects (control group). Balance disorders were assessed using Romberg test, Unterberg test and Babiński- Weil test. The risk of fall was assessed using Berg test.

R e s u l t s a n d c o n c l u s i o n s . The present study showed that patients with Parkinson's disease undergo balance deterioration and are more likely to fall in contrast to subjects who are not affected by the disease. In the group of ill people it was found that the balance disorders occur in a smaller degree in women than in men. Among the analised factors the stage of the disease (by Hoehn-Yahr scale) evidently determines the occurrence and the intensification of the balance disorders.

S t r e s z c z e n i e W s t ę p i c e l p r a c y . Zaburzenia równowagi

stanowią częsty objaw w chorobie Parkinsona. Celem pracy jest ocena wpływu choroby Parkinsona na zaburzenia równowagi, a także wskazanie, w której z badanych grup występuje większe ryzyko upadku.

M a t e r i a ł i m e t o d y . W badaniu wzięło udział 30 osób leczonych z powodu choroby Parkinsona oraz 30 osób zdrowych (grupa kontrolna). Zaburzenia równowagi były oceniane za pomocą prób: Romberga, Babińskiego-Weila i Unterbergera Do oceny ryzyka zagrożenia upadkiem posłużono się skalą równowagi Berga.

W y n i k i i w n i o s k i . Przeprowadzone badania wykazały, iż osoby z chorobą Parkinsona doświadczają pogorszenia równowagi, a także narażone są na ryzyko upadku, w znacznie większym stopniu niż osoby, które nie są obciążone tą chorobą. W badanej grupie chorych stwierdzono, że zaburzenia równowagi występują w mniejszym stopniu u kobiet niż u mężczyzn. Spośród analizowanych czynników to stopień zaawansowania choroby (wg skali Hoehna-Yahra) najwyraźniej determinuje występowanie i nasilenie zaburzeń równowagi.

Key words: balance disorders, Parkinson’s disease, risk of fall Słowa kluczowe: zaburzenia równowagi, choroba Parkinsona, ryzyko upadku INTRODUCTION

Parkinson's illness is one of the most common illnesses of the central nervous system. Balance disorders are not classified as the classic triad of symptoms (trembling, stiffness, slowing of move-

ments). None the less they have a big impact on the development of the overall disability of the sick person in the further stages of the disease [6, 12].

Monika Zawadka et al.

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Balance disorders are rarely reported by patients in the first period of the disease. However they can be detected in the stabilographic examination in the preclinical phase of the disease [12]. In the advanced stage of the illness balance disorders of a sick person can be detected by fast and unexpected pulling back of shoulders when the patient stands with the feet slightly apart [9].

Balance disorders and problems in keeping the right position of the body in a patient with Parkinson's disease are not connected with the labyrinth and cerebellum. The causes are: leaning silhouette, narrowness of the base, increasing difficulties in walking, bigger muscle tension and trembling of the limbs [10]. From the biomechanical point of view, the maintenance of balance depends on the ability of keeping the point of gravity in the position above the body base surface determined by the points of support. [5].

Among elderly people especially the ones with Parkinson's disease the aggravation of the ability of the balance maintenance is connected with the increased risk of falling down [9]. The frequency of falls in elderly people with Parkinson's disease is connected with the aggravation of the mechanism of controlling the static and dynamic balance of the body [13]. The balance control also consists of many mechanisms that normally are not connected with a single area of the brain [3]. The falls and consequent injuries (fractures) are a serious problem for elderly people. The patient is getting more and more dependent on others and hospitalization is more frequent. This leads to the loss of independence in everyday life activities, which worsens the quality of life [11, 14]. The factors responsible for falls are: age, visual disorders, cognitive disorders, incontinence of urine and stool, use of tranquillizers and hypnotic drugs, incorrect body posture, associated illnesses (e.g.. illness of the locomotor system) and past injuries. The risk of fall factor is also fluctuation caused by the use of L-dopa medications [11]. The right exercises reduce the risk of falls in elderly people [17]. The prevention of falls in Parkinson's disease is realized through rehabilitation and primary and secondary prophylaxis. It is necessary to get to know the most common cause of falls and try to eliminate them [11]. The purpose of this work is to estimate the effects of Parkinson's disease on balance disorders. This study is also supposed to determine the group of people who have an increased risk of falls.

MATERIAL AND METHOD

The study included 60 people who were divided into 2 groups. The first one was composed of 30 people (16 women and 14 men) between 55 and 85 years old who were treated for Parkinson's disease. The average age in the group was 70 years(±3,4). They were the people with different doses and types of the medication and the duration of the disease as well as stage of the clinical progression (according to the Hoehn-Yahr scale) were different too. The control group consisted of 30 healthy people (19 women and 11 men between 58-85 years old) without neurological disorders. The average age was 69 years(±3,85). Most people suffering from Parkinson's disease who were surveyed belong to the 'AKSON' association of disabled people in Bydgoszcz. Due to the different progression of disease the research took place in the house of patient and consisted of tests that evaluated the ability to maintain the balance. Classical fitness tests of posture and walking were used for estimation of ability of posture's balance maintenance. Among them there were used Romberg test, Babiński-Weil test, Unterberger test. Berg's balance scale was used to estimate the risk of falls.

ROMBERG TEST

The Romberg Test estimates the balance during standing with open and closed eyes. In the normal conditions the patient is able to stand in both situations [18]. Point scale 4 - patient stands with closed eyes without imbalance 3 - patient stands with closed eyes with balance disorder 2 - patient stands with open eyes without imbalance 1 - patient stands with open eyes with balance disorder 0 - patient is not able to keep the right position with open and closed eyes THE BABIŃSKI-WEIL TEST

In the Babiński-Weil test the patient makes two steps forward and two steps back with closed eyes and he/she repeats it every 30 seconds. In the normal conditions the patient just slightly deflects the track of steps from the starting position.

The influence of Parkinson's disease on balance disorders

89

Point scale 8 - patient steps forward and back with closed eyes for 30 seconds without balance disorders 7 - patient steps forward and back with closed eyes for 30 seconds slightly changing the direction of walking 5 - patient steps forward and back with open eyes for 30 seconds without balance disorders 4 - patient steps forward and back with open eyes for 30 seconds slightly changing the direction of walking 1 - patient does not fully complete the test 0 - patient is not able to complete the test UNTERBERGER STEPS TRIAL

In the Unterberger test the patient makes 25 steps raising high his knees with closed eyes and staying in the same place. In the normal conditions the patient just slightly changes the direction of walking (the 45 degree deviation from the original direction is acceptable). Points scale 6 - patient makes 25 steps with closed eyes without balance disorders 5 - patient makes 25 steps with closed eyes with balance disorders 4 - patient makes 25 steps with open eyes without balance disorders 3 - patient makes 25 steps with open eyes with balance disorders 1 - patient does not fully complete the test 0 - patient is not able to complete the test with open and closed eyes BERG SCALE

This test evaluates fourteen typical everyday life activities demonstrating the ability of maintaining the sitting or standing position in the increasingly difficult conditions. The maintenance of the balance in the sitting position is evaluated as the result of gradual reduction of the supporting surface [5]. This test can be used to observe the state of balance and to estimate the course of the disease and its response to the treatment which was used [4]. The Berg scale evaluates the activities in the point scale from 0-4, where 4 means full completion of the test, 0 not being able to complete the test. The maximal number of points to get in the Berg scale is 56 The activities that are rated in the Berg scale:

1. Changing the position from the sitting one to the standing one

2. Independent standing 3. Sitting without the back support with the feet on

the floor or stool 4. Changing the position from the standing to the

sitting one 5. Changing the seat 6. Independent standing with closed eyes without

support 7. Standing with feet kept together 8. Standing and reaching forward with an open hand 9. Lifting up an object from the floor and acquiring

standing position 10. Turning the body through the right and left

shoulder in the standing position 11. 360 degree spin 12. Putting first the right and then the left foot on the

step or stool without support 13. Standing without support with one foot in front 14. Standing on one leg

The above mentioned tests were modified for the research needs. Modifications concerned the time of the test and the number of repetitions of the given movement. The point scale was used to count the points average value of the tests that were performed by people with and without Parkinson's disease.

The Hoehn-Yahr scale (H-Y) was used in all the patients with Parkinson's disease to estimate the clinical stage of the illness. The data was compiled by the package of the statistical tests SPSS for Windows, version 13.0. RESULTS

An analysis was made with respect to the tests in the group with Parkinson's disease and the control group. Results of the analysis are presented in the Table I.

The average point values in the Romberg test for the people with Parkinson's disease are 3.7; SD=(± 0.46) and 4, SD= (±0) in the control group. The result of the test is t = 1.964, at the level of relevance p <0.001.

The average point values in the Unterberger test are 4.4; SD= (±1,05), in the control group 5.7; SD= (±0,25). The result of the test is t = 3.319, at the level of relevance p<0.001.

The average point values in the Babiński-Weil test are 5.8; SD= (±1,4) and 7.4; SD= (±0.25) in the control

Monika Zawadka et al.

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group. The result of the test is t =- 3.122, at the level of relevance p <0.001. Table I. Comparative characteristics of the risk of fall on the

Berg's scale in the tested groups

People with Parkinson's disease n=30

Control group n=30 Berg's scale

Maximum=56 points Women

n=16 Men n=14

General result

Women n=19

Men n=11

General result

Average 51 45 48 55 55,6 55 Standard deviation ±2.3 ±7.3 ±5.4 ±0.6 ±0.45 ±0.55

A variety of factors were analysed to show better

the impact of Parkinson's disease on balance disorders. These factors include sex and the stage of progress of the disease. The average point values in the Romberg test for the people with Parkinson's disease were 3.7; SD= (±0.4) for women and 3.6; SD= (±0.55) for men. The average point values in the Unterberger test were, for women 4.5; SD= (±0.95) and 4.3; SD= (±1.2) in the men's group. The average point values in the Babiński-Weil test for ill women and men were respectively 5.7; SD= (±1.25) and 5.8; SD= (±1.65). Table II. Numerical characteristics of increased balance

disorders in relation to the stage of the disease (by the H-Y scale)

Name of the test Romberg Unterberger Babiński- Weil

Stage by the H-Y scale

I-II n=7

III-IV n=20

V n=3

I-II n=7

III-IV n=20

V n=3

I-II n=7

III-IVn=20

V n=3

Average 4 3.7 2.3 5.6 4.6 0 7.8 5.9 0 Standard deviation ±0 ±0.35 ±1.05 ±0.25 ±0.85 ±0 ±0.2 ±1.65 ±0

In the table II numerical characteristics of the

increased balance disorders were shown, considering the stage of the disease according to the Hoehn-Yahr scale DESCRIPTION OF THE RESULTS AND DISCUSSION

Over 35% of people in advanced stages of Parkinson's disease suffer from falls, while 18% of them end with a fracture. The Stolzy research and the results mentioned above [16] show that among the diseases of the nervous system falls are most frequent in the following order: Parkinson's disease (62% of the patients), faints, polyneuropathy, cerebral stroke. In the Gray and Hildebrand material [7] for 118 people with Parkinson's disease there were 237 falls, 59% of the

people had at least one fall. Żak at al. [19] observed that in the general population of elderly people the number of falls during the first year after the fall has increased fivefold. Bloem et al. [2] noticed falls in more than half of the people with Parkinson's disease. The research done for the purpose of this paper also showed that balance disorders are a big problem for elderly people, particularly those with Parkinson's disease. This illness can be considered as a form of accelerated ageing of the central nervous system, because many of its symptoms, but less intensive, are observed in elderly patients without neurological disorders [13]. Unfortunately, there is no information in literature how the ability of keeping the balance is perturbed by the ageing process, and how much by Parkinson's disease. Evaluation of balance in the standing position is a key element of medical research in people with Parkinson's disease [15]. The research has shown that people with Parkinson's disease experience deterioration of balance significantly stronger than those of a similar age, which were in the control group.

The Romberg test showed that every healthy person is able to stand with closed eyes without balance disorders. 17% of patients with Parkinson's disease had the problems with it. The Unterberger test, that examinates the ability of keeping the balance in dynamic conditions, showed even bigger differences between the groups. The control group did the test without balance disorders or with the small imbalance. One third of the ill people was not able to do the test (big balance disorders) or did the test under visual control (moderate balance disorders). The Babiński-Weil walk test proves that the meaning of the vision in the posture control depends on the level of difficulty of keeping the balance [1]. This exercise demands from the patients keeping the balance during walking back and forwards with closed eyes for 30 seconds. For one third of the people with the Parkinson's disease this exercise turned out more difficult because in comparison with healthy people it demanded a visual control from them (moderate and big balance disorders). The research proves that in the critical circumstances vision becomes more important in keeping the posture balance [1].

The fact is that elderly patients are the group where with the time progress the risk of fall increases because of the pathological and involutional changes [19]. On the basis of the observations made by Berg and his group the results below 45 points inform about balance disorders which means that falls are more possible [4]. An analysis of the results showed that in 17% of the people with Parkinson's disease there is an increasing risk of falls. The people with Parkinson's disease

The influence of Parkinson's disease on balance disorders

91

obtained a lower average value in the test using the Berg scale, in comparison with healthy people, respectively 48 (±5.4) and 55 (±0.55). In the group of patients the biggest problem was standing on one leg, standing without support with one foot in front, putting the foot while standing on the step or stool without support and making the turns. It is connected with the increasing difficulty of exercises and the reduction of the supporting surface, which makes keeping the balance more difficult. The only exercise of the Berg scale that was done correctly in both groups was sitting without back support with the feet on the floor or stool.

The analysis of the results was also made inside the group of people with the Parkinson's disease. Studying the problem of balance disorders in women and men with Parkinson's disease we can see that women have better results in the tests that were carried out in spite of the more advanced stage of the disease (by Hoehn-Yahr scale) and they revealed longer average time of the illness duration. In the available literature there are cases of increased as well as reduced deviations of women's posture, which means that it is not possible that sex in any way determines the tendency of balance disorders [14]. The patients with Parkinson's disease in the tests that were performed were characterized by different levels of symptoms by Hoehn-Yahr scale. The analysis of the results revealed that the people in a further stage of the disease have bigger balance disorders. The Parkinson's disease has the progressive tendency and leads to the deterioration in the performance of daily activities that also require the maintenance of balance [12]. CONCLUSIONS 1. The present study showed that patients with

Parkinson's disease undergo balance deterioration and are more likely to fall in contrast to subjects who are not affected by the disease.

2. Among the analised factors the stage of the disease (by Hoehn-Yahr scale) evidently determines the occurrence and the intensification of balance disorders.

3. In the group of ill people it was found that the balance disorders occur in a smaller degree in women than in men.

REFERENCES 1. Bacik B.: Znaczenie kompleksu lędźwiowo-miedniczno -

biodrowego w kontroli stabilnej postawy stojącej. Wyd. AWF, Katowice 2005, 20-28.

2. Bloem B.R., Grimbergen Y.A., Kramer M., Willemsen M., Zwinderman AH.: Prospective assessment of falls in Parkinson’s disease. J Neurol. 2001, 248, 11, 950-958

3. Błaszczyk J.W.: Biomechanika Kliniczna. Wyd. PZWL, Warszawa 2004, 192-132.

4. Bogle Thorbahn L.D, Newton R.A.: Use of the Berg Balance Test to Predict Falls in Elderly Persons. Physical Therapy 1996, 76, 6, 576-585.

5. Browne J.E., O’Hare N.J.: Przegląd metod badania zdolności utrzymania równowagi w pozycji stojącej. Rehabilitacja Medyczna 2002, 6, 1, 72- 76.

6. Dymecki J., Kulczycki J.: Neuropatologia, Wyd. Elsevier Urban & Partner, Wrocław 2005, 275-280.

7. Gray P., Hildebrand K.: Fall risk factors in Parkinson’s disease. J. Neurosci. Nurs. 2000, 32, 4, 222-228.

8. Held-Ziółkowska M.: Równowaga statyczna i dynamiczna ciała. Magazyn Otolaryngologiczny, 2006, V, 2, 39-46.

9. Morris M.E.: Zaburzenia ruchowe u pacjentów z chorobą Parkinsona - model dla celów rehabilitacji. Rehabilitacja Medyczna 2001, 5, 2, 18-36.

10. Opara J., Dyszkiewicz A.: Stabilometria w chorobie Parkinsona. Rehabilitacja w praktyce, 2008, 1, 12-13.

11. Opara J., Błaszczyk J., Dyszkiewicz A.: Zapobieganie upadkom w chorobie Parkinsona. Rehabilitacja Medyczna, 2005, 9, 1, 31-34.

12. Petit H., Allain H., Vermesch P.: Choroba Parkinsona - klinika i leczenie, wyd. Sanmedia, Warszawa 1997, 28-33, 36-44

13. Romero D.H., Stelmach G.E: Changes in postural control with aging and Parkinson’s disease. IEEE Eng Med Biol Mag. 2003, 22, 2, 27–31.

14. Sihvonen S.: Postural Balance and Aging. Cross-sectional Comparative Studies and a Balance Training Intervention. University of Jyväskylä. Studies in Sport, Physical Education and Health 2004, 101, 9-21.

15. Smithson F., Morris M.E., Iansek R.: Performance on Clinical Tests of Balance In Parkinson’s Disease. Phys Ther. 1998,78, 577-592.

16. Stolze H., Klebe S., Zechlin C., Becker C., Friege L., Deuschl G.: Falls in frequent neurological diseases – prevalence, risk factors and aetiology. J. Neurol. 2004, 251, 1, 79-84.

17. Twardowska-Rajewska J.: Krótki program usprawniania seniorów w celu minimalizowania zaburzeń równowagi. Doniesienia wstępne. Gerontologia Polska 2006, 14, 1, 41-45.

18. Zembaty A.: Kinezyterapia. Wyd. Kasper, Kraków 2002, 185-186.

19. Żak M., Skalska A., Ocetkiewicz T.: Upadki osób w starszym wieku – ocena zmiany ryzyka dokonywana po roku od upadku. Rehabilitacja Medyczna 2004, 8, 3, 19-22.

Address for correspondence: Monika Zawadka ul. Dworcowa 15/7 07-200 Wyszków tel.: 0504099619 e-mail: [email protected] Received: 16.09.2008 Accepted for publication: 14.07.2009


Regulamin ogłaszania prac w Medical and Biological Sciences 1. Redakcja przyjmuje do druku wyłącznie prace

poprzednio nie publikowane i nie zgłoszone do druku w innych wydawnictwach.

2. W Medical and Biological Sciences zamieszcza się: artykuły redakcyjne prace a) poglądowe, b) oryginalne eksperymentalne i kliniczne, c) kazuistyczne, które mogą być napisane w języku polskim lub angielskim.

3. Objętość pracy wraz z materiałem ilustracyj-nym, piśmiennictwem i streszczeniem nie po-winna przekraczać 15 stron maszynopisu przy pracach poglądowych oraz 12 stron przy pra-cach oryginalnych i kazuistycznych. Przekro-czenie objętości skutkuje opłatą 100 zł od do-datkowej strony.

4. Praca powinna być napisana jednostronnie w programie Word (na jednej stronie może być do 32 wierszy, tj. 1800 znaków, margines z le-wej strony – 4 cm), czcionką 12 pkt., interlinia – 1,5.

5. W nagłówku należy podać: a) imiona i nazwiska autorów oraz tytuły na-

ukowe, b) tytuł pracy (również w j. ang.), c) nazwę kliniki (zakładu) lub innej instytu-

cji, z której praca pochodzi, d) tytuł naukowy, imię i nazwisko kierowni-

ka kliniki (zakładu), innej instytucji, e) adres do korespondencji, który powinien

zawierać również e-mail, tel i faks. 6. Każda praca powinna zawierać streszczenie

w języku polskim i angielskim oraz słowa klu-czowe w j. polskim i angielskim, a także pi-śmiennictwo.

7. Praca przygotowana w języku angielskim po-winna zawierać tytuł w j. polskim, streszczenie w j. angielskim i polskim oraz słowa kluczowe w j. angielskim i polskim.

8. Prace oryginalne powinny mieć następujący układ: streszczenie w języku polskim i angiel-skim, słowa kluczowe w j. polskim i angiel-skim, wstęp, materiał i metody, wyniki, dysku-sja, wnioski, piśmiennictwo.

9. Tabele i ryciny należy ograniczyć do niezbęd-nego minimum. Tabele numerujemy cyframi rzymskimi. Tytuł tabeli w jęz. polskim i angiel-skim umieszczamy nad tabelą. Opisy wewnątrz

tabeli zamieszczamy w języku polskim i angiel-skim.

10. Ryciny (fotografie, rysunki, wykresy itp.) nu-merujemy cyframi arabskimi. Tytuł ryciny w jęz. polskim i angielskim umieszczamy pod ryciną. Opisy wewnątrz rycin zamieszczamy w języku polskim i angielskim.

11. Odnośniki do piśmiennictwa zaznaczamy w tekście cyframi arabskimi i umieszczamy w nawiasie kwadratowym.

12. Streszczenie powinno mieć charakter struktu-ralny, tzn. zachować podział na części, jak tekst główny. Objętość streszczenia zarówno w języ-ku polskim jak i angielskim – ok. 250 wyrazów.

13. Autor dostarcza pracę na dyskietce oraz 3 eg-zemplarze, w tym 1 kompletny, zgodny z dys-kietką, zawierający nazwiska autorów i nazwę instytucji, z której praca pochodzi (patrz pkt. 5 i 9) oraz 2 egz. przeznaczone dla recenzentów bez nazwisk autorów, nazwy instytucji i innych danych umożliwiających identyfikację.

14. Na dyskietce w odrębnych plikach powinny być umieszczone: a) tekst pracy, b) tabele, c) ryciny (fotografie w formacie BMP, TIF,

JPG lub PCX; ryciny w formacie WMF, EPS lub CGM),

d) podpisy pod ryciny i tabele w formacie MS Word lub RTF.

15. Fotografie powinny mieć postać kontrastowych zdjęć czarno-białych na błyszczącym (ewentu-alnie matowym) papierze. Na odwrocie należy podać imię i nazwisko autora, tytuł pracy, nu-mer oraz oznaczyć górę i dół.

16. Należy zaznaczyć w tekście miejsca, w których mają być zamieszczone ryciny. Wielkość ryci-ny: podstawa nie powinna przekraczać 120 mm (z opisami).

17. Piśmiennictwo – tylko prace cytowane w tek-ście (maksymalnie 30 pozycji) – powinno być ponumerowane i ułożone wg kolejności cyto-wania, każdy tytuł od nowego wiersza. Pozycja piśmiennictwa dotycząca czasopisma musi za-wierać kolejno: nazwisko, inicjał imienia autora (ów) – maksymalnie trzech – tytuł pracy, tytuł czasopisma wg skrótów stosowanych w „Index Medicus”, rok, numer tomu i stron. Przy cyto-waniu pozycji książkowej (monografii, pod-ręczników) należy podać nazwisko i inicjały imion autorów, tytuł dzieła, wydawcę, miejsce i rok wydania.


18. Z pracą należy przesłać oświadczenie, iż nie była ona dotąd publikowana, a także że nie zo-stała złożona do innego wydawnictwa oraz zgodę kierownika zakładu na publikację.

19. Do każdej pracy należy dołączyć oświadczenie podpisane przez wszystkich współautorów, że aktywnie uczestniczyli w jej realizacji i przygo-towaniu do druku oraz akceptują bez zastrzeżeń tekst pracy w formie przesłanej do redakcji.

20. Prace niespełniające wymogów regulaminu będą zwracane autorom.

21. Redakcja zastrzega sobie prawo poprawiania usterek stylistycznych oraz dokonywania skró-tów.

22. Za prace zamieszczone w Medical... autorzy nie otrzymują honorarium.

23. Redakcja nie przekazuje autorom bezpłatnych egzemplarzy Medical...

24. Prace publikowane w Medical... są oceniane przez dwóch recenzentów.

25. Medical and Biological Sciences są punktowa-ne zgodnie z listą czasopism Ministerstwa Na-uki i Informatyzacji i otrzymują 4 punkty.

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