Beata Kuśnierz-Cabala

Publications of Beata Kuśnierz-Cabala

• [Serum amyloid A (SAA) as a diagnostic marker in periodontal diseases].

  Authors: Maria Chomyszyn-Gajewska, Beata Kuśnierz-Cabala

  Przegla̧d lekarski. 01/2011; 68(6):326-8.

  The contemporary knowledge of serum amyloid A (SAA) as a diagnostic marker in periodontal diseases was presented on the basis of the chosen literature.

• [Types of hemodialysis vascular access in patients on renal replacement therapy and its complications during a one year observation period].

  Authors: Marcin Krzanowski, Katarzyna Janda, Eve Chowaniec, Beata Kuśnierz-Cabala, Władysław Sułowicz

  Przegla̧d lekarski. 01/2011; 68(7):343-7.

  The type of vascular access is an important determinant of complications in the dialysis population. The aim of the study was to evaluate types of hemodialysis vascular access at hemodialysis start,The type of vascular access is an important determinant of complications in the dialysis population. The aim of the study was to evaluate types of hemodialysis vascular access at hemodialysis start, in the course of treatment and complications during a one year observation period. The study group consisted of 213 patients [126 (59%) males; 87 (41%) females] treated for 54 months (range from 2 to 384 months) by maintenance hemodialysis at the Nephrology Department of the University Hospital. Mean age of the patients equaled 57.4 years and ranged from 21 to 91 years. The observation period began on June 1st, 2009 and finished on May 31st, 2010. At the start of the dialysis therapy - 99 (46.5%) patients had arterio-venous fistula (AVF), 81 (38.0%) temporary catheters (TC), and 33 (15.5%) permanent catheters (PC). At the beginning of the one-year observation period, 161 (75.6%) of the patients were treated using an AVF, 37 (17.4%) using a CP, 11 (5.1%) CT, and 4 (1.9%) using an artificial graft (AVG). At the end of the one year observation period - 179 (84%) patients were dialyzed using AVF, while 30 (14.1%) patients on PC, and 4 (1.9%) using a AVG. Statistically significant differences in possessing AVF were noted between start of renal replacement therapy and the start and finish of the one year observation period (p < 0.0001), as well as beginning and finish of the observation period (p < 0.002). During the observation period - 37 (20.7%) patients with an AVF required intervention due to complications associated with vascular access; where 4 from 11 (36.4%) patients in this group had AVF located on the arm and 33 from 150 (22.0%) on the forearm. The most common complications associated with AVF were thrombosis (23 = 14.3%), narrowing of the fistula (9 = 5.6%), too high output flow (HOF) 2 = 1.2% and the steal syndrome (SS) 3 (1.9%). Infectious complications were noted in 4 from 37 patients with PC (10.8%), and significantly less with AVF-4 from 161 (2.5%) (p < 0.0001). AVG infection occurred in 2 (50%) individuals of this group. Conclusions: AVF created using patients' own vessels of the forearm is characterized with decreased risk of complications in comparison to fistulas made of artificial materials or permanent catheters. However, fistula thrombosis of the AVF is still the most common complication requiring surgical intervention.

• [Analysis of osteopontin in patients with acute pancreatitis].

  Authors: Beata Kuśnierz-Cabala, Danuta Galicka-Latała, Józefa Panek, Anna Gurda-Duda, Paulina Dumnicka, Bogdan Solnica, Jan Kulig

  Przegla̧d lekarski. 01/2011; 68(5):248-52.

  The aim of this study was to analyze osteopontin (OPN) concentrations in patients with acute pancreatitis (AP) and its suitability for diagnosis and prediction of severity during the first 3 daysThe aim of this study was to analyze osteopontin (OPN) concentrations in patients with acute pancreatitis (AP) and its suitability for diagnosis and prediction of severity during the first 3 days from admission to hospital. The study group consisted of 40 patients admitted and hospitalized at I-st and II-nd Depatments of Surgery Jagiellonian University Collegium Medicum in Krakow. All laboratory tests necessary for diagnosis and monitoring of patients were performed in the Diagnostic Dept. of University Hospital, other immunochemistry parameters were assesed in the Diagnostic Dept. of Clinical Biochemistry Jagiellonian University using ELISA kits. The concentrations of OPN in severe acute pancreatitis were significantly higher than in patients with mild form of disease in the whole observation period. Simultaneously, we observed that increased in OPN concentrations in consecutive days of AP may be helpful in prediction of severity and compilations during AP.

• [Evaluation of selected laboratory markers of liver fibrosis in patients with chronic hepatitis type C].

  Authors: Beata Kuśnierz-Cabala, Bogdan Solnica, Tomasz Mach, Grazyna Biesiada, Paulina Dumnicka

  Przegla̧d lekarski. 01/2010; 67(7):450-3.

  The aim of the study was to compare 4 non-invasive biochemical scores of liver fibrosis (age/PLT; AST/ALT; APRI and FORNS) with results of hepatic biopsies classified according to Batts-Ludwig scale.The aim of the study was to compare 4 non-invasive biochemical scores of liver fibrosis (age/PLT; AST/ALT; APRI and FORNS) with results of hepatic biopsies classified according to Batts-Ludwig scale. The study included a total of 99 patients: 44 (44.4%) women with mean +/- SD age of 42 +/- 11.9 years and 55 (55.6%) men (43 +/- 12.2) treated for chronic hepatitis C. RESULTS: Levels of several markers changed significantly after 3 months of treatment (with interferon alpha and ribavirin) comparing to values on admission to hospital: we observed statistically significant differences of ALT: 32.6 +/- 15.7 vs. 61.5 +/- 35.6 (U/l), p<0.001; AST: 34.1 +/- 11.1 vs. 48.2 +/- 26.5 (U/l), p<0.05 and total cholesterol concentration: 4.0 +/- 0.4 vs. 4.9 +/- 0.9 (mmol/l), p<0.01 in women; AST/ALT ratio in both men (0,8 +/- 0,3 vs. 0.69 +/- 0.25; p<0.05) and women (1.2 +/- 0.4 vs. 0.84 +/- 0.24; p<0.001) and age/PLT score: 0.4 +/- 0.3 vs. 0.28 +/- 0.12 (p<0.01) in men. CONCLUSIONS: Non-invasive biochemical scores: age/PLT, APRI and FORNS showed acceptable compliance with liver morphological status characterized in Batts-Ludwig scale as we observed significant differences between F0-F1 and F3-F4 groups. Age/PLT, APRI and FORNS seems to be helpful in prediction of early stage of liver fibrosis in patients with chronic hepatitis C. After 3 months of standard antiviral therapy (interferon alpha and ribavirin) we did not observe statistically significant differences in values of FORNS and APRI scores. Simultaneously, we noticed significant decrease in activity of aminotransferases and AST/ALT ratio recognized by clinicians as standard markers of inflammatory and necrosis processes.

• Serum fetuin A concentrations in patients with acute pancreatitis.

  Authors: Beata Kuśnierz-Cabala, Anna Gurda-Duda, Józefa Panek, Danuta Fedak, Paulina Dumnicka, Bogdan Solnica, Jan Kulig

  Clinical laboratory. 01/2010; 56(5-6):191-5.

  Acute pancreatitis (AP) is a mild and self-limiting disease in most patients, but necrotizing pancreatitis develops in up to 20 - 30% of the cases. Early recognition of severe AP has been consideredAcute pancreatitis (AP) is a mild and self-limiting disease in most patients, but necrotizing pancreatitis develops in up to 20 - 30% of the cases. Early recognition of severe AP has been considered as a key determinant of successful therapy. The aim of this study was to evaluate the clinical value of fetuin A as the new predictor of complications and fatal outcome during acute pancreatitis (AP). The study included 40 patients with AP of diverse severity (28 mild, 12 severe), assessed during the early phase of AP (1st - 7th day of hospitalization). Fetuin A level was measured by ELISA kit (BioVendor). Median serum fetuin A concentrations had a tendency to decrease during examination from 0,371 g/L at admission to 0,288 g/L on the 7th day of hospitalization. In each of 7 days of observation, correlation between the increase in fetuin A and the absolute number of RBC was found (R = 0,34: 1st day R = 0,35: 3rd day, p < 0,05; R = 0,57: 5th day, p < 0,001; R = 0,65: 7th day, p < 0,01). Additionally, we observed the reverse relationship between the decrease in fetuin A and the increase in some inflammatory markers (IL-6: R = -0,61, p < 0,0001; SAA: R = -0,58, p < 0,001; HGF: R = -0,60, p < 0,01; PCT: R = -0,475, p < 0,01). The strongest positive correlation was noticed on the 5th day of hospitalization between decreased levels of fetuin A and albumin (R = 0,83; p < 0,0001). Fetuin A level monitoring is potentially a new marker for non-invasive and accurate prediction status for the hospitalization of patients with AP similar to other negative acute phase proteins like albumin.

• Neopterin and other inflammatory markers in the early period following allogeneic bone marrow transplantation: series of 3 cases.

  Authors: Beata Kuśnierz-Cabala, Dorota Hawrylecka, Patrycja Mensah-Glanowska, Beata Piątkowska-Jakubas, Bogdan Solnica, Aleksander Skotnicki, Paulina Dumnicka

  Polskie archiwum medycyny wewnetrznej. 11/2009; 119(11):756-760.

  The 3 case reports presented here constitute a pilot study assessing the profile of changes in concentrations of selected inflammatory markers, including C-reactive protein, serum amyloid A,The 3 case reports presented here constitute a pilot study assessing the profile of changes in concentrations of selected inflammatory markers, including C-reactive protein, serum amyloid A, neopterin, and interleukin 18, in an early period after allogeneic stem cell transplantation.

• An evaluation of the utility of additional tests in the preoperative diagnostics of acute appendicitis.

  Authors: Ryszard Anielski, Beata Kuśnierz-Cabala, Krystyna Szafraniec

  Langenbeck's archives of surgery / Deutsche Gesellschaft fur Chirurgie. 11/2009;

  BACKGROUND: Determining the optimum algorithm for diagnostic procedure in suspected acute appendicitis (AA) may not only reduce the number of unnecessary operations, but also the frequency ofBACKGROUND: Determining the optimum algorithm for diagnostic procedure in suspected acute appendicitis (AA) may not only reduce the number of unnecessary operations, but also the frequency of complications, and may contribute measurably to reducing the costs of treating patients with acute abdominal conditions. OBJECTIVE: The aim of the study was to assess the value of standard diagnostic methods and measurement of selected biochemical and hematological parameters (C-reactive protein, CRP; interleukin-6, IL-6; procalcitonin, PCT; total count of white blood cell, WBC) in the accuracy of preoperative AA diagnosis. MATERIAL AND METHODS: The prospective study included 132 patients (female: 52.3%, male: 47.7%) emergency admitted to the Surgical Department, aged 15 to 74 years (mean 36 years), with a suspicion of appendicitis. Measurement of PCT concentration was carried out by immunoluminometric assay, IL-6 concentration by micro enzyme-linked immunosorbent assay and CRP concentration by immunonephelometric assay. Statistical analysis was done by the chi-square test and Fisher's exact test for categorized discrete variables, and the Mann-Whitney U and Kruskal-Wallis tests for continuous variables. In order to assay the diagnostic utility of tests, the receiver operating characteristic model of curve analysis was used. RESULTS: AA was confirmed in 89 (67.5%) of the patients operated on (group A). Twenty-six (19.7%) of the patients were not operated on and did not require surgery (group C); in 13 patients (9.8%) operated with a preliminary diagnosis of AA, no changes in the appendix were found during the course of the operation (group B). Four (3%) of the patients treated conservatively for periappendicular infiltration were excluded from the following analysis (group D). The mean count of WBC in AA was 13.22 +/- 4.45 x 103/muL, with no statistical significance between groups, which does not allow the patients requiring surgery to be distinguished. The highest elevation of IL-6 concentration was observed in the group with the AA and the periappendicular infiltration: 101.5 +/- 355.9 vs. 173.6 +/- 228.33 pg/mL, respectively; p < 0.05. No surgery patients of group C showed considerably lower CRP concentrations than those of group D: CRP: 2.05 +/- 3.6 vs. 6.36 +/- 4.74 mg/L; p < 0.05. In cases of advanced forms of AA, the gangrenous with perforation, higher marker values are obtained than those in the phlegmonose form (186.60 +/- 541.2 vs. 40.08 +/- 48.3 pg/mL; (p < 0.05) for IL-6 and 8.88 +/- 7.45 vs. 2.84 +/- 3.83 mg/L; (p < 0.001) for CRP, respectively). CONCLUSIONS: 1. AA diagnosis based only on an assessment of clinical status may lead to an increase in the number of people operated with false-positive diagnoses of AA. 2. Applying additional diagnostic methods such as IL-6 determination seems to be useful in reducing the numbers of false-positive diagnoses of AA. 3. Laboratory tests, i.e., CRP, IL-6, and PCT are much more useful in assessing the risk of complications during the course of AA.

• Effect of Hemodialysis on Acid Leukocyte-Type Ribonuclease, Alkaline Ribonuclease and Polymorphonuclear Elastase Serum Levels in Patients with End-Stage Renal Disease.

  Authors: Jerzy W Naskalski, Maria Kapusta, Danuta Fedak, Paulina Dumnicka, Beata Kuśnierz-Cabala, Marek Kuźniewski, Władysław Sułowicz

  Nephron. Clinical practice. 07/2009; 112(4):c248-c254.

  Background: Low-molecular-weight proteins (LMWPs) are substances of molecular weights 10-35 kDa, which accumulate in plasma of patients with end-stage renal disease (ESRD) due to the abolishment ofBackground: Low-molecular-weight proteins (LMWPs) are substances of molecular weights 10-35 kDa, which accumulate in plasma of patients with end-stage renal disease (ESRD) due to the abolishment of plasma renal filtration. LMWPs are considered as a separate group of uremic toxins. Aim: The influence of hemodialysis (HD) on the release of some LMWPs from leukocytes was assessed by comparing levels of serum pancreatic-type alkaline RNase and leukocyte-type acid RNase as well aspolymorphonuclear (PMN) elastase. Methods: The mentioned proteins were assayed in 58 ESRD patients on HD prior and after the dialysis session and compared with the results obtained from 36 healthy subjects. The levels of elastase and acid and alkaline RNase were correlated with HD parameters, residual diuresis, predialysis concentrations of serum creatinine, urea and albumin as well as pre- and postdialysis granulocyte count. Results: Changes in PMN elastase produced by the dialysis session positively correlate with changes in acid RNase levels (r = 0.3650; p = 0.0061), while there is no such correlation for alkaline RNase. There is a negative correlation between pre- and postdialysis differences in levels of acid and alkaline RNases (r = -0.3542; p = 0.008), indicating that HD induces liberation of a factor suppressing alkaline RNase. Levels of acid and alkaline RNase negatively correlate with residual diuresis, indicating its significance in control of LMWP accumulation (r = -0.3970; p = 0.0025; r = -0.2596; p = 0.0533, respectively). Conclusions: Dialysis treatment causes an increase in both acid leukocyte-type and alkaline pancreatic-type RNase activity in plasma. Dialysis-related increases in acid RNase activity correlate with the respective changes in PMN elastase, which suggests that leukocyte activation during dialysis contributes to an increase in plasma LMWPs.

• Assessment of the prognostic value of certain acute-phase proteins and procalcitonin in the prognosis of acute pancreatitis.

  Authors: Anna Gurda-Duda, Beata Kuśnierz-Cabala, Wojciech Nowak, Jerzy W Naskalski, Jan Kulig

  Pancreas. 12/2008; 37(4):449-53.

  OBJECTIVES: Of patients with acute pancreatitis (AP), 20% develop severe attacks that need early and intensive therapy. Yet, to administer such treatment, it is important to classify early on theOBJECTIVES: Of patients with acute pancreatitis (AP), 20% develop severe attacks that need early and intensive therapy. Yet, to administer such treatment, it is important to classify early on the patients with mild and severe pancreatitis. The aim of this study was to evaluate the role of serum amyloid A, C-reactive protein, procalcitonin, and routinely measured parameters in the early prediction of the course of AP. METHODS: A total of 40 consecutive patients with AP confirmed by computed tomography were prospectively enrolled in the study-29 were graded as mild and 11 were graded as severe. Blood samples were obtained on admission and 24 hours thereafter. RESULTS: Procalcitonin concentration in both measurements was significantly higher in patients with severe pancreatitis, and the cutoff level was estimated at 0.5 ng/mL. Although serum amyloid A and C-reactive protein levels rose significantly during the period of observation, these were not differentiated between both groups. Among the routinely measured parameters, a prognostic value was found for total calcium concentration, lactic dehydrogenase activity, and glucose concentration. CONCLUSIONS: The best efficiency in the early prediction of severe AP would be achieved with the measurement of procalcitonin, total calcium level, and lactic acid dehydrogenase activity immediately after admission to the ward.

• Dual, time-dependent deleterious and protective effect of anandamide on the course of cerulein-induced acute pancreatitis. Role of sensory nerves.

  Authors: Artur Dembiński, Zygmunt Warzecha, Piotr Ceranowicz, Anna M Warzecha, Wiesław W Pawlik, Marcin Dembiński, Kazimierz Rembiasz, Paweł Sendur, Beata Kuśnierz-Cabala, Romana Tomaszewska, Eve Chowaniec, Peter C Konturek

  European journal of pharmacology. 07/2008;

  Some recent studies indicate that cannabis may induce acute pancreatitis in humans and administration of anandamide increases the severity of acute pancreatitis; whereas another study exhibits someSome recent studies indicate that cannabis may induce acute pancreatitis in humans and administration of anandamide increases the severity of acute pancreatitis; whereas another study exhibits some therapeutic effects in acute pancreatitis. Aim of the present study was to discover what is the reason for these opposite confusing results and to determine the role of sensory nerves in this effect. Acute pancreatitis was induced in rats by cerulein. Anandamide, an endogenous cannabinoid, was administered i.p. (1.5 mumol/kg) before or 2 h after cerulein administration. Stimulation of sensory nerves was performed by capsaicin (0.5 mg/kg s.c.). In rats treated with combination of anandamide plus capsaicin, capsaicin was given 10 min after each dose of anandamide. After the last injection of cerulein or 4 h later, the study was terminated. In our study we observed that stimulation of sensory nerves by capsaicin, before administration of cerulein, reduced the severity of acute pancreatitis. Anandamide, administered alone before cerulein, increased pancreatic damage in acute pancreatitis. Anandamide administered in combination with capsaicin, before cerulein, abolished the capsaicin-induced protective effect on the pancreas. Opposite effects were observed when capsaicin and anandamide were administered after injection of cerulein. Capsaicin increased the severity of acute pancreatitis, whereas anandamide reduced pancreatic damage and reversed the deleterious effect of capsaicin. We conclude that the effect of anandamide on the severity of acute pancreatitis depends on the phase of this disease. Administration of anandamide, before induction of pancreatitis, aggravates pancreatic damage; whereas anandamide administered after induction of pancreatitis, reduces the severity of acute pancreatitis. Sensory nerves are involved in the mechanism of this biphasic effect of anandamide.

• Lower confidence limits for critical systematic errors.

  Authors: Wojciech Gernand, Paulina Dumnicka, Beata Kuśnierz-Cabala, Maria Kapusta, Bogdan Solnica

  Clinical biochemistry. 12/2007; 40(16-17):1317-20.

  OBJECTIVES: The critical systematic error (DeltaSE(C)) can be used to select a quality control scheme. It is just an estimate of the true DeltaSE(C), however, and its precision depends on the sampleOBJECTIVES: The critical systematic error (DeltaSE(C)) can be used to select a quality control scheme. It is just an estimate of the true DeltaSE(C), however, and its precision depends on the sample size. Thus, the lower confidence limit (LCL) of DeltaSE(C) should be adopted instead to guard against false optimism. DESIGN AND METHODS: LCLs are calculated as a function of DeltaSE(C) and sample size using a modified version of Bissell's formula. RESULTS: The uncertainty in DeltaSE(C) may be significant. The largest relative difference between DeltaSE(C) and its LCL is 52.2%, for DeltaSE(C)=2 and n=20. This difference decreases with increasing DeltaSE(C) and sample size. CONCLUSIONS: It is shown that taking into account the uncertainty in DeltaSE(C) can greatly influence quality control planning decisions. Caution should thus be exercised when interpreting control data and choosing an appropriate quality control strategy. The derived equation for LCL is simple, and can be immediately applied to practical solutions.

• [Diagnostic value of serum amyloid A protein (SAA) determination]

  Authors: Beata Kuśnierz-Cabala, Danuta Galicka-Latała, Jerzy W Naskalski

  Przegla̧d lekarski. 02/2007; 64(2):115-7.

  Although serum amyloid A (SAA) was discovered almost 25 years ago, its biological role is still unknown. Similarly to C-reactive protein, SAA belongs to acute reaction proteins, synthesised in theAlthough serum amyloid A (SAA) was discovered almost 25 years ago, its biological role is still unknown. Similarly to C-reactive protein, SAA belongs to acute reaction proteins, synthesised in the liver after stimulation by proinflammatory cytokines like: TNFalpha, IL-1beta and IL-6. SAA level in acute inflammatory process of bacterial, mycotical, autoimmunological, oncological or extensive tissue damage is from 100 to 1000 mg/l. Additional SAA examination in patients with oncological disorders is accepted as a valuable survival index.

• Does coronary artery calcification in patients with diabetic nephropathy depend on the advancement of renal failure?

  Authors: Marcin Krzanowski, Beata Kuśnierz-Cabala, Przemysław Miarka, Katarzyna Wójcik, Tomasz Stompór, Wladyslaw Sułowicz

  Medicinski pregled. 01/2007; 60 Suppl 2:39-42.

  Calcium-phosphate disorders and vascular calcification are highly prevalent in patients with diabetes mellitus and nephropathy. The aim of the study was to compare the prevalence and advancement ofCalcium-phosphate disorders and vascular calcification are highly prevalent in patients with diabetes mellitus and nephropathy. The aim of the study was to compare the prevalence and advancement of vascular calcification in patients with end-stage diabetic nephropathy on peritoneal dialysis and diabetic patients with chronic renal disease stages 2-4. The study group included 31 patients with type 2 diabetes and diabetic nephropathy divided into 2 groups: 12 patients (aged 50-74 years: mean 58.6+/-8.8) undergoing peritoneal dialysis and 19 patients (aged 46-82 years; mean 65.8+/-9.7) with chronic kidney disease stages 2-4 (GFR range 24-78 ml/min/1.73 m2). Coronary artery calcification score, was assessed using multi-slice computed tomography. Coronary artery calcification score did not differ significantly between groups (CaSc values 1085.2 vs 452.4 AgU; NS). The patients undergoing peritoneal dialysis showed significantly higher levels of parathyroid hormone (658.2 vs. 74.3 pg/ml; p=0.001), fibrinogen (5.82 vs. 3.89 g/l; p<0.0001) and alkaline phosphatase (330.9 vs. 168.0 U/l; p=0.001). Despite more advanced abnormalities in calcium-phosphate balance parameters and more active inflammation in peritoneal dialysis subjects we failed to demonstrate any statistically significant difference in coronary artery calcification score between patients with diabetic nephropathy on peritoneal dialysis and those with chronic kidney disease stages 2-4.

• [Usefulness of interleukin 18 determination in clinical diagnostics]

  Authors: Beata Kuśnierz-Cabala, Danuta Galicka-Latała, Jerzy W Naskalski, Jacek Sieradzki

  Przegla̧d lekarski. 02/2006; 63(9):789-91.

  Interleukin-18 (IL-18) is a proinflammatory pleiotropic cytokine playing a major role in the inflammatory cascade. It was written up for the first time in 1995 as a factor inducing interferon gammaInterleukin-18 (IL-18) is a proinflammatory pleiotropic cytokine playing a major role in the inflammatory cascade. It was written up for the first time in 1995 as a factor inducing interferon gamma in Kupffer cells, macrophages as well as T and B cells. Authors are presenting actual publications concerning usefulness in interleukin 18 determination in clinical diagnostics.

• [Analysis of selected inflammatory markers in patients with stable renal graft (RTx) 36 months after transplantation]

  Authors: Marcin Krzanowski, Tomasz Stompór, Beata Kuśnierz-Cabala, Ewa Ignacak, Władysław Sułowicz, Jerzy W Naskalski

  Przegla̧d lekarski. 02/2006; 63(8):597-601.

  Chronic inflammation is an inherent feature of chronic renal failure. Successful renal transplantation (RTx) is the only known renal replacement therapy sufficient to reverse most of the metabolicChronic inflammation is an inherent feature of chronic renal failure. Successful renal transplantation (RTx) is the only known renal replacement therapy sufficient to reverse most of the metabolic disturbances of chronic uremia, although still some of these abnormalities may be present or even new problems may occur (mostly as the side effects of immunosuppressive drugs). The aim of this study was to evaluate the level of inflammation in 20 patients (9 F, 11 M, aged mean 44.0 +/- 11.8 years) with well-preserved renal function 36 months after kidney transplantation, using serum levels of selected cytokines (IL-6, IL-18, TNFalpha and soluble receptor for TNF - sTNFRII), acute phase proteins (CRP, fetuin A) and hepatocyte growth factor (HGF). Procalcitonin was also assessed as the sensitive indicator of active infection. Obtained results were compared with the control group of healthy subjects in a respective age. Serum levels of IL-6, TNF-R and IL-18 were significantly higher, and HGF and fetuin A--significantly lower in patients vs. controls (p < 0.05 for all differences). Significant negative correlations were noted between glomerular filtration rate (GFR) and serum TNF, sTNFRII and IL-18 in RTx patients, whereas strong positive relationship between GFR and fetuin A was observed. Serum creatinine correlated with IL-6, IL-18, TNFalpha, sTNFRII and hsCRP levels and serum urea-with TNFalpha, sTNFRII, IL-6 and IL-18. Significant negative associations were also noticed between serum fetuin A and most of the tested inflammatory markers: sTNFRII (r = -0.77; p = 0.0005), IL-6 (r = -0.63; p = 0.009), hsCRP (r = -0.62; p = 0.009) and IL-18 (r = -0.60; p = 0.01). Obtained results permit us to conclude that the increased activity of inflammation can still be noticed in RTx patients 36 months after successful engraftment. This process is inversely associated with the level of kidney function. The role of fetuin A as the 'negative' acute phase protein was also demonstrated in this group of patients.

• [Role of neopterin in clinical diagnostics]

  Authors: Beata Kuśnierz-Cabala, Jerzy W Naskalski, Danuta Galicka-Latała

  Przegla̧d lekarski. 02/2005; 62(7):716-9.

  Neopterin is a low-molecular mass substance synthesized from guanosine triphosphate (GTP) in monocytes/macrophages due to IFNgamma stimulation. The cellular immune system is involved in or affectedNeopterin is a low-molecular mass substance synthesized from guanosine triphosphate (GTP) in monocytes/macrophages due to IFNgamma stimulation. The cellular immune system is involved in or affected by the disease process in various conditions such as viral infections (AIDS), autoimmune disorders (rheumatoid arthritis, systemic lupus erythematosis, Crohn's disease), malignancy and monitoring after solid organ transplants. Similar to procalcitonin, neopterin determination can assist in the differential diagnosis between viral and bacterial infection and as an indicator for impending septic complications (MODS vs. sepsis). Because of fact that reduced glamerular filtration rate neopterin accumulates in the blood, neopterin determination in multiorgan failure or sepsis patients are limited. The aim of this study was to evaluate the usefulness of neopterin in clinical diagnostics.

• Comparison of sensitivity and specificity of serum poly-C avid ribonuclease activity and C-reactive protein concentration in detection of mild and severe acute pancreatitis.

  Authors: Beata Kuśnierz-Cabala, Jerzy W Naskalski, Boguslaw Kedra, Józefa Panek

  Clinical chemistry and laboratory medicine : CCLM / FESCC. 06/2004; 42(5):549-55.

  The aim of this study was to compare diagnostic performance of C-reactive protein (CRP) and poly-C avid ribonuclease (P-RNase) levels in the prediction of a severe clinical course of acuteThe aim of this study was to compare diagnostic performance of C-reactive protein (CRP) and poly-C avid ribonuclease (P-RNase) levels in the prediction of a severe clinical course of acute pancreatitis (AP). The study included 36 patients with mild and 20 with severe AP. CRP concentration was measured by an immunonephelometric method and P-RNase activity by the rate of polycytidylate hydrolysis at pH 7.8. At the time of admission, both P-RNase and CRP levels were significantly increased in all patients when compared to healthy subjects (29.2 vs. 18.7 U/l and 91.1 vs. 2.89 mg/l; p < 0.001). Up to days 3 and 4 a further increase in P-RNase was observed. On the other hand, the increase in CRP continued only through days 2 and 3 (p < 0.001). Severe acute pancreatitis (SAP) and mild acute pancreatitis (MAP) differed significantly with respect to P-RNase levels on all days studied; whereas CRP levels differed significantly on days 2-5 but did not differ at admission. Receiver operating characteristic (ROC) curve function analysis yielded the best sensitivity of SAP detection for P-RNase, equaling 72.2%, at the cut-off point value 65.3 U/l on day 3 after admission. The sensitivity of CRP for detection of SAP was 85.0% at 125.7 mg/l on the 2nd day after admission. Both parameters studied were significantly associated with the severity of the AP clinical course; however, on days 1 and 2 post-admission, P-RNase was more specific for detection of SAP than CRP (94.4% vs. 77.1% on the 1st day and 94.4% vs. 55.5% on the 2nd day). In conclusion, P-RNase has shown an excellent performance for early differentiation of acute necrotizing pancreatitis.

• [Diagnostic value of procalcitonin (PCT) determination]

  Authors: Beata Kuśnierz-Cabala, Danuta Galicka-Latała

  Przegla̧d lekarski. 02/2004; 61(9):978-80.

  A large number of publications, primarily clinical studies, demonstrate the increasing use of procalcitonin (PCT) in modern clinical practice. PCT is a propeptide of calcitonin induced by a varietyA large number of publications, primarily clinical studies, demonstrate the increasing use of procalcitonin (PCT) in modern clinical practice. PCT is a propeptide of calcitonin induced by a variety of stimuli including bacterial endotoxins, proinflammatory cytokines and triggering events such as trauma or cardiogenic shock. PCT is not or only slightly induced by viral infections, autoimmune disorders, neoplastic diseases and organs transplantation. The aim of this study was to evaluate the usefulness of PCT as a diagnostic and prognostic tool in patients for early differentiation between bacterial and nonbacterial infection origin.

• Dual, time-dependent deleterious and protective effect of anandamide on the course of cerulein-induced acute pancreatitis. Role of sensory nerves

  Authors: Artur Dembiński, Zygmunt Warzecha, Piotr Ceranowicz, Anna M. Warzecha, Wiesław W. Pawlik, Marcin Dembiński, Kazimierz Rembiasz, Paweł Sendur, Beata Kuśnierz-Cabala, Romana Tomaszewska, Eve Chowaniec, Peter C. Konturek

  European Journal of Pharmacology.

  Some recent studies indicate that cannabis may induce acute pancreatitis in humans and administration of anandamide increases the severity of acute pancreatitis; whereas another study exhibits someSome recent studies indicate that cannabis may induce acute pancreatitis in humans and administration of anandamide increases the severity of acute pancreatitis; whereas another study exhibits some therapeutic effects in acute pancreatitis. Aim of the present study was to discover what is the reason for these opposite confusing results and to determine the role of sensory nerves in this effect. Acute pancreatitis was induced in rats by cerulein. Anandamide, an endogenous cannabinoid, was administered i.p. (1.5 μmol/kg) before or 2 h after cerulein administration. Stimulation of sensory nerves was performed by capsaicin (0.5 mg/kg s.c.). In rats treated with combination of anandamide plus capsaicin, capsaicin was given 10 min after each dose of anandamide. After the last injection of cerulein or 4 h later, the study was terminated. In our study we observed that stimulation of sensory nerves by capsaicin, before administration of cerulein, reduced the severity of acute pancreatitis. Anandamide, administered alone before cerulein, increased pancreatic damage in acute pancreatitis. Anandamide administered in combination with capsaicin, before cerulein, abolished the capsaicin-induced protective effect on the pancreas. Opposite effects were observed when capsaicin and anandamide were administered after injection of cerulein. Capsaicin increased the severity of acute pancreatitis, whereas anandamide reduced pancreatic damage and reversed the deleterious effect of capsaicin. We conclude that the effect of anandamide on the severity of acute pancreatitis depends on the phase of this disease. Administration of anandamide, before induction of pancreatitis, aggravates pancreatic damage; whereas anandamide administered after induction of pancreatitis, reduces the severity of acute pancreatitis. Sensory nerves are involved in the mechanism of this biphasic effect of anandamide.

• [A special case of thyroid associated ophthalmopathy in the course of Graves-Basedow disease]

  Authors: Agata Bałdys-Waligórska, Beata Kuśnierz-Cabala, Bohdan Huszno

  Endokrynologia Polska. 57(5):536-40.

  INTRODUCTION: The exact pathogenesis of Graves' ophthalmopathy and the possibility of causal treatment of this disease still remain unclear. Currently no standard treatment guidelines have beenINTRODUCTION: The exact pathogenesis of Graves' ophthalmopathy and the possibility of causal treatment of this disease still remain unclear. Currently no standard treatment guidelines have been accepted. While treatment procedures have been established in specialized centres, management of complicated and long-lasting cases is always individual. We present an unusual case of Graves' ophthalmopathy accompanied by other autoimmune diseases. CASE REPORT: Our patient, MB, female, born in 1961, was diagnosed with Graves' disease 13 years ago. Recurrent hyperthyroidism and large goitre qualified her for strumectomy (performed twice) and long-term antithyroid treatment. Four years after her initial diagnosis, relapsing severe (ophthalmopathy index: 9 points, CAS: 7 points) occurred which persisted despite continuous administration of glucocorticoids. Due to imminent blindness, orbital decompression had to be performed, three times since. Concurrent autoimmune diseases: ulcerative colitis and seronegative rheumatoid arthritis were also stated. Two years ago, due to loss of vision acuity, rapid progression of exophthalmos and recurrence of hyperthyroidism, immunosuppressive treatment with azathioprine was undertaken over a period of 12 months. The present condition of the patient is satisfactory. CONCLUSION: Judging from the discussed course of treatment, in rare and difficult cases of proliferative ophthalmopathy, early immunosuppressive treatment other than glucocorticoids, should be considered.