Archives of Medical Science

Online ISSN: 1734-1922
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Article
Serotonin is a key neurotransmitter in the central nervous system. It has been suggested that serotoninergic dysfunction mediates the pathophysiology of temporomandibular dysfunction (TMD). Polymorphisms in the serotonin receptor gene (HTR2A) can alter its transcription, affecting the number of receptors in the serotoninergic system, altering nociceptive pain and hyperalgesia in TMD. The aim of this study is to investigate the association of the 102T-C polymorphism in the HTR2A gene in Brazilian patients with TMD. This cross-sectional study examined 100 patients, of both genders, with TMD as index cases and 100 healthy volunteers as controls, also of both genders. DNA was extracted from peripheral blood leukocytes, and the site that encompassed the polymorphism in the HTR2A gene was amplified by polymerase chain reaction followed by restriction fragment length polymorphism (PCR-RFLP). Our results revealed that there were significantly more females among index cases compared with the control group (p < 0.05). The CC genotype of the 102T-C polymorphism was more frequent in patients with TMD vs. controls (OR: 2.25; 95% CI: 1.13-4.46; p < 0.05). The present study supports the view that the 102T-C polymorphism in the HTR2A gene is associated with TMD in this studied Brazilian population.
 
Article
Atopic dermatitis (AD) is a chronic skin inflammatory disease in which Th2-derived cytokines play an essential role. Aim of the study was to assess interleukin 4, 10 and 13 (IL-4, IL-10 and IL-13) serum concentrations in AD patients and to correlate the values with the occurrence of genotypes of selected polymorphisms in genes encoding these cytokines. Seventy-six AD patients (mean age 11.4 years) and 60 healthy controls were enrolled in the study. Blood samples were analyzed for IL-4, IL-10 and IL-13 concentrations with ELISA assay and genotyping for -590C/T IL-4, -1082A/G IL-10 and -1055C/T IL-13 polymorphisms with PCR-RFLP. The obtained results revealed statistically higher serum concentration of IL-10 and IL-13 in AD patients when compared to healthy controls (10.30 pg/ml vs. 8.51 pg/ml for IL-10 and 5.67 pg/ml vs. 4.98 pg/ml for IL-13). There were no significant differences between AD patients and controls in regard to IL-4 serum level (5.10 pg/ml vs. 7.1 pg/ml). Analyzing the association between level of the examined cytokines and genotype polymorphisms -590 C/T for the IL-4 gene, -1082 A/G for the IL-10 gene and -1055 C/T for the IL-13 gene, we found a statistically higher IL-10 serum level among carriers of the G allele in the -1082 G/A IL-10 polymorphism both in AD and control groups. We did not find any significant differences between serum level of IL-4 and IL-13 in regard to genotype occurrence in examined polymorphisms: -590 C/T for the IL-4 gene and -1055 C/T for the IL-13 gene. The obtained results confirm the genetic background of IL-10 synthesis in the Polish population.
 
Effects of midazolam on phorbol-12-myristate-13-acetate (PMA)-induced activation and expression of MMP-9 in chondrosarcoma SW1353 cell lines. Cell-free conditioned medium and supernatants were assayed for MMP-9 activation and expression by ge la tin zymography (A) and western blotting (B), respecti vely. Lane 1 is the culture medium of HT1080 cells in which the constitutive proMMP-2 and proMMP- 9 were expressed (A). SW1353 cells (2 × 106 cells/ml in 6-well plates) were treated with various concentrations of midazolam (5, 10, and 20 μM) or vehicle (DMSO) for 15 min before treatment with PMA (10 ng/ml) for 24 h. α-tubulin is used as an internal control (B)
Data are shown as the mean (SEM of three independent experiments). ###p < 0.001 compared with the untreated group, *p < 0.05 **p < 0.01, and ***p < 0.001, compared with the vehicle group
Effects of midazolam on phorbol-12- myristate-13-acetate (PMA)-induced expression of MMP-1 (A) and MMP-13 (B) in chondrosarcoma SW1353 cell lines. Cell lysates were obtained and analyzed for MMP-1 and MMP-13 protein expressions by Western blotting. SW1353 cells (2 × 106 cells/ml in 6-well plates) were treated with various concentrations of midazolam (5 μM, 10 μM, and 20 μM) or vehicle (DMSO) for 15 min before treatment with PMA (10 ng/ml) for 24 h. α-Tubulin is used as an internal control
Data are shown as the mean (SEM of three independent experiments). ###p < 0.001 compared with the untreated group, *p < 0.05, **p < 0.01, and ***p < 0.001, compared with the vehicle group
Effects of midazolam on phorbol-12- myristate-13-acetate (PMA)-induced degradation of IκB-α in chondrosarcoma SW1353 cell lines. Cell lysates were obtained and analyzed for IκB-α protein degradation by Western blotting. SW1353 cells (2 × 106 cells/ml in 6-well plates) were treated with various concentrations of midazolam (5 μM, 10 μM, and 20 μM) or vehicle (DMSO) for 15 min before treatment with PMA (10 ng/ml) for 24 h. α-Tubulin is used as an internal control
Data are shown as the mean (SEM of three independent experiments). ##p < 0.001 compared with the resting group, *p < 0.05, and **p < 0.01, compared with the vehicle group
Effects of midazolam on phorbol-12- myristate-13-acetate (PMA)-induced expression of pERK1/2 (A) and p38 (B) in chondrosarcoma SW1353 cell lines. Cell lysates were obtained and analyzed for pERK1/2 and p-p38 protein expression by Western blotting. SW1353 cells (2 × 106 cells/ml in 6-well plates) were treated with various concentrations of midazolam (5 μM, 10 μM, and 20 μM) or vehicle (DMSO) for 15 min before treatment with PMA (10 ng/ml) for 24 h. α-Tubulin is used as an internal control
Data are shown as the mean (SEM) of three independent experiments. ###p < 0.001 compared with the untreated group, *p < 0.05, **p < 0.01 and ***p < 0.001, compared with the vehicle group
Article
Midazolam, a benzodiazepine, has a hypnotic effect and is widely used as an intravenous sedative. Past studies have clearly established that midazolam has beneficial effects in attenuating ischemia-reperfusion injury more than other currently used sedative drugs. However, the role of midazolam on chondroprotection via inhibition of matrix metalloproteinases (MMPs) is warrant investigation. The aim of this study was to examine the mechanisms of action of midazolam on MMP expression via nuclear factor κB (NF-κB) signaling in activated chondrosarcoma cells maintained in vitro. Chondrocytes, SW1353 cells, were stimulated with phorbol 12-myristate 13-acetate (PMA) in the absence or presence of various concentrations of midazolam (5-20 µM). Release of MMP-9 into the culture media was determined by gelatin zymography. The expressions of MMP-1, MMP-9 and MMP-13, phosphorylation of extracellular signal-regulated kinase (ERK), p38 mitogen-activated protein kinases and degradation of IκB-α were determined by western blotting assay. Midazolam significantly down-regulated PMA-induced MMP-9 protein expression at concentrations of 5, 10 and 20 µM, the values were 1.95 ±0.09 (p < 0.01), 1.71 ±0.12 (p < 0.01) and 1.35 ±0.20 (p < 0.001), respectively. At concentrations of 5, 10 and 20 µM, it was significantly inhibited the PMA-induced expressions of MMP-1 (2.27 ±0.10, 1.98 ±0.11 and 1.56 ±0.15; p < 0.001) and MMP-13 (0.89 ±0.04, 0.81 ±0.07, and 0.74 ±0.09; p < 0.001), respectively. Midazolam at concentrations of 10 and 20 µM for 15 min significantly reversed the rate of degradation (0.895 ±0.051; p < 0.05 and 0.926 ±0.060; p < 0.01, respectively) of IκB-α in PMA-chondrocyte cells. In addition, this sedative drug inhibited PMA-induced levels of phos-ERK (1.243 ±0.12, 1.108 ±0.16 and 0.903 ±0.19, respectively) and phos-p38 (1.146 ±0.10, 1.063 ±0.13 and 0.946 ±0.18, at concentrations of (5, 10 and 20 µM), respectively. These results are important for understanding the mechanism of midazolam in inhibiting PMA-induced MMP expression through the signaling pathways of either NF-κB or ERK/p38 MAPKs down-regulation.
 
Article
Morphea is a disease included in the group of scleroderma type autoimmune diseases. Interleukin (IL)-17A may play a role at every stage of its pathogenesis. The study aimed at evaluation of IL-17A and IL-23 (as the main cytokine which is supposed to stimulate and maintain synthesis of IL-17) in pathogenesis of morphea. The studies were performed on 41 blood samples from patients with morphea. Skin was sampled from 29 patients. The evaluation included: (1) expression of IL-17A and IL-23 genes in peripheral blood mononuclear cells (PBMC) using real-time polymerase chain reaction (PCR), (2) plasma concentrations of IL-17A and IL-23 using ELISA, (3) expression of IL-17A and IL-23 genes in skin using real-time PCR. The results of gene expression are expressed as median number of copies per million copies of GAPDH. Higher expression of IL-17A has been demonstrated in PBMC of morphea vs. control group (2630 and 1906 respectively; p = 0.004), accompanied by absence of significant differences in its plasma concentration (10 pg/ml in both groups) and by lowered expression in affected skin (9119 and 19113 respectively; p = 0.036). The results failed to demonstrate elevated IL-23 plasma concentration in morphea vs. control group (5 pg/ml and 6 pg/ml respectively; p = 0.335) or its increased expression in the skin (292 vs. 427; p = 0.383), although we noted its increased expression in PBMC (4419 vs. 808; p < 0.001). BASED ON THE OBSERVED CORRELATIONS WE SUGGEST THAT: (1) IL-17A does not represent a factor which promotes tissue injury in morphea, (2) IL-23 may playa role in pathogenesis of morphea.
 
Article
We would save many lives and spare a lot of suffering if we could only detect and accurately determine the character and TMN staging of pancreatic tumors (PTs). With improved diagnosis, we could offer specific treatment that would result in better treatment outcome. The aim of study was to determine the significance of neoplastic markers CA 19-9 and CEA for prognosis in inflammatory and carcinomatous PTs. We based our research upon a group of 170 patients. The patients were treated in our Oncologic Surgery Department from January 2007 to December 2010 for PTs. The patients were divided into four groups depending on the character of the tumor and underwent the following treatments: group 1 - 34 patients with carcinoma of the ampulla of Vater, group 2 - 64 patients with PTs at different stages (1, 2, 3) according to TMN classification, group 3 - 62 patients with PTs at stage 4 on the TMN scale (unresectable tumors), group 4 - 28 patients with inflammatory PTs. The results of Ca 19-9 in group 2 were 736.00 (25-75% 220.40-4285.00) ng/ml before surgery, 53.00 (25-75% 12.60-84.00) ng/ml in the 7 days after surgery, 29.4 (25-75% 7.90-113.00) ng/ml at day 30, and 119.00 (25-75% 96.30-621.00) ng/ml 3 months after the operation. These results were significantly higher than the control group but were significantly lower than the results for group 3 (unresectable tumors). The highest average concentration and median for CA 19-9 and CEA were noted in patients with unresectable PTs (the 3(rd) group). The average concentration for CEA was lowest in group 4, but much higher than the lab limits. The sensitivity of the CA 19-9 marker may be as high as 88%. Values of CA 19-9 above 852 U/ml may indicate TNM stage 4, consistent with an unresectable PT. In the cases where CA 19-9 is within normal limits but C-reactive protein is above normal limits (often thirty times the upper limit), in comparison to the control group and to patients with pancreatic neoplasms, strong consideration should be given towards the inflammatory characteristics of the pancreatic changes and conservative treatment should be applied.
 
Histological sections of the carotid artery (Masson trichrome stain). A – Group 1, B – group 2, C – group 3. Carotid artery sections obtained from control group showed thin and intact lamina and collagen-rich adventitia (A). Accumulation of intimal collagen in the remaining two groups (B, C)
Histological sections of the carotid artery (hematoxylin and eosin stain). A – Group 1, B – group 2, C – group 3. The ratio of intimal thickness/media thickness was lower in group 3 than that of group 2. Arrowheads point at internal elastic laminae
Article
A common problem encountered in routine daily practice of cardiovascular surgery is migration of smooth muscle cells leading to intimal hyperplasia developing at vascular anastomosis sites which then causes luminal narrowing. The aim of this study was to investigate the antiproliferative effect of 1,25 (OH)2D3 on intimal hyperplasia. Twenty-one male white New Zealand rabbits weighing 2-3 kg were selected. There were 3 groups of animals each consisting of 7 rabbits. Group 1 was the control group. Group 2 was the sham group and group 3 consisted of rabbits receiving 1,25 (OH)2D3. The right carotid arteries of the subjects in groups 2 and 3 were transected and re-anastomosed. A daily dose of 25 ng 1,25 (OH)2D3 per 100 g body weight was administered for 14 days to rabbits in group 3. Rabbits in group 2 were not subject to any pharmaceutical agent. All the subjects were sacrificed at the end of the 28(th) postoperative day. Their right carotid arteries were resected and then investigated histopathologically. Intimal thickness and intimal area were measured as significantly lower in group 1 when compared with the other groups (p = 0.004). In group 3, the ratios of thickness of tunica intima/thickness of tunica media and area of tunica intima/area of tunica media were significantly lower than those of group 2 (p = 0.015, p = 0.003). 1,25 (OH)2D3, the active metabolite of vitamin D, reduces the intimal hyperplasia developing after vascular anastomoses.
 
Article
Celecoxib in a dose of 200 mg is safe for the breast feeding mother, as its milk levels are extremely low. We investigated the efficacy of celecoxib in improving postoperative pain management in parturients under patient-controlled epidural analgesia (PCEA). We studied 64 healthy parturients undergoing elective caesarean section under combined spinal-epidural anesthesia. Postoperative analgesia was performed via PCEA with ropivacaine 0.15% and fentanyl 2 µg/ml (4 ml bolus administration, lock-out 15 min). Patients were randomly allocated to receive either only PCEA (n = 32) or PCEA plus celecoxib 200 mg orally (n = 32). Paracetamol 500 mg was given orally as rescue analgesia. We recorded visual analogue scale (VAS) scores for pain at rest and movement, attempted and given PCEA doses, Bromage scores, level of sensory blockade, rescue doses of paracetamol, maternal side effects during the first 24 h after the PCEA instrumentation, and the overall patient satisfaction. Fifty-six patients completed the entire protocol. Patient demographics, duration of surgery, side effects, attempted and given PCEA doses, and motor and sensory blockade did not differ between the groups. Significantly lower VAS scores at rest and movement, fewer paracetamol doses (p = 0.039) and increased patient satisfaction (p = 0.001) were found in the celecoxib group compared to controls. A single dose of 200 mg of celecoxib effectively improved pain management in parturients with PCEA, limited the need for supplemental analgesics and improved efficacy of analgesia, increasing patient satisfaction.
 
Article
Pharmacological therapy is a crucial step in the management of individuals with the metabolic syndrome, when lifestyle modifications alone cannot achieve the therapeutic goals. The present study aimed to evaluate the efficacy of comprehensive interventions with the pharmacological treatment in individuals with the metabolic syndrome. A cross-sectional population-based survey examined a sample of adults before and after conducting a community trial. Physical examination and blood sampling, data regarding the demographic characteristics, medical status and history of medication use were obtained. Pharmacologic treatment related to metabolic syndrome's components was also determined. The most common pharmacologic agents consumed by individuals with metabolic syndrome were β-blockers (26.1% and 30.4% in 2001 and 2007, respectively), followed by lipid-lowering agents (5.4% and 14% in 2001 and 2007, respectively), with significant differences before and after intervention. The prevalence of metabolic syndrome was higher in women than in men both before (36.4% vs. 14%) and after the community trial (26.1% vs. 16%, respectively) in the intervention areas (p < 0.001). We found a significant increase in medication use to control blood pressure and dyslipidemia among the individuals with the metabolic syndrome, notably in the intervention areas. In addition to the population approach, the high-risk approach should be considered in community trials for prevention and control of non-communicable diseases.
 
Article
Our aim was to compare changes of body mass index (BMI) and waist circumference (WC) curves of Iranian children by comparing the results of two national surveys of a surveillance program, i.e. CASPIAN-I (2003-2004) and CASPIAN-III (2009-2010). The second objective was to evaluate the prevalence of obesity, overweight and underweight among 10-18-year-old Iranian children and adolescents. This study was performed among students who were selected by multistage random cluster sampling from urban and rural areas of 27 provinces of Iran, as part of a national survey of school student high risk behavior entitled CASPIAN-III, conducted in 2009-2010. We evaluated 5088 school students (50.2% boys). In rural areas, underweight was more common in boys and overweight and obesity in girls. In urban areas underweight and obesity were more common in boys, whereas overweight was more common in girls. The highest prevalence of underweight (23.5%) was seen in students aged 13 years and the lowest (11.4%) in those aged 18 years. Underweight was significantly more common in rural than in urban areas (22.1% vs. 15.8%, respectively, p < 0.0001) and overweight/obesity was more common in urban than in rural areas. Compared with the findings in 2003-2004, the overall prevalence of elevated body mass index (16.6%) including obesity (9.1%) and overweight (7.5%) as well as underweight (17.5%) increased from 2003 to 2010. In recent years, the double burden of nutritional disorders has increased among Iranian children and adolescents, especially in rural areas. This change may be related to epidemiologic transition, notably in terms of nutrition transition and rapid changes in lifestyle habits. This finding is an important issue for policy-makers for interventional preventive programs.
 
Age distribution of CARVG and NRVG
Seasonal distribution of CARVG and NRVG
Article
Rotaviruses are the leading cause of community-acquired and nosocomial gastroenterocolitis in children. There are limited data concerning the epidemiology of nosocomial rotavirus gastroenterocolitis (NRVG) in Central European countries, including Poland. The aim of our study was to analyse the epidemiology of NRVG in a large tertiary hospital in Warsaw. We analysed retrospectively data of 63 173 patients aged 0-18 years hospitalized in the period 2006-2010. Nosocomial rotavirus gastroenterocolitis was defined as acute gastroenterocolitis (> 3 loose, or looser than normal, stools in 24 h and/or vomiting), confirmed with rapid immunochromatographic test (BioMaxima, Poland), if symptoms developed > 48 h after admission. In total 575 cases of NRVG were diagnosed. The cumulative attack rate of NRVG was calculated as 0.91% (95% CI: 0.85-0.98%). The incidence density was 2.05/1000 bed-days (95% CI: 0.19-0.22/1000 bed-days). The mean proportion of NRVG among all rotavirus infections was 24%. The highest rates of NRVG were noted at wards where the mean duration of hospital stay was longer than 5 days (General Paediatrics and Neonatal Pathology). Seventy-one percent of children with NRVG were younger than 2 years. The mean duration of hospital stay of children with NRVG was longer than the average duration of hospitalization (11.6 days vs. 4.6 days, p < 0.01). Our study showed a relevant incidence of NRVG, which can prolong the children's hospital stay. Limiting the number of NRVG is important to improve patients' safety and to avoid additional costs. Routine vaccination against rotavirus diseases could reduce the number of NRVG.
 
Article
Sarcopenia and cachexia are significant medical problems with a high disease-related burden in cardiovascular illness. Muscle wasting and weight loss are very frequent particularly in chronic heart failure and they relate to poor prognosis. Although clinically largely underestimated, the fields of cachexia and sarcopenia are of great relevance to cardiologists. In cachexia and sarcopenia a significant number of research publications related to basic science questions of muscle wasting and lipolysis were published between 2010 and 2012. Recently, the two processes of muscle wasting and lipolysis were found to be closely linked. Treatment research in pre-clinical models involves studies on a number of different therapeutic entities, including ghrelin, selective androgen receptor modulators (SARMs), as well as drugs targeting myostatin or melanocortin-4. In the human setting, studies using enobosarm (a SARM) and anamorelin (ghrelin) are in phase III. The last 3 years have seen significant efforts to define the field using consensus statements. In the future, these definitions should also be considered for guidelines and treatment trials in cardiovascular medicine. The current review aims to summarize important information and development in the fields of muscle wasting, sarcopenia and cachexia, focusing on findings in cardiovascular research, in order for cardiologists to have a better understanding of the progress in this still insufficiently known field.
 
Article
The study is aimed at presenting new diagnostic and therapeutic proposals for patients with alcohol use disorders. The revised ICD-11 which is currently being updated is coming closer to American standards in disease classification. The latest update of the American DSM-5 has been a notable step forward as it integrates alcohol abuse and alcohol dependence into a single disorder called alcohol use disorder. Recent developments in research into diagnostic tools have brought changes in the approach to therapy. According to most international guidelines, the form of treatment should be customised to the individual patient, with consideration given to his/her mental and physical condition, personality and natural setting. A significant change is the recommendation of a harm reduction strategy as a useful alternative to total abstinence in alcohol dependence treatment for some patients.
 
Comparison of 7-year follow-up in patients with benign and malignant cardiac tumors, operated on in the Cardiac Surgery Clinic of the Medical University of Lodz
Intraoperative image of a malignant tumor, situated in the left atrium
TTE image of the above shown malignant cardiac tumor
Intraoperative image of myxoma
Myxoma of the left atrium, visualized by TTE
Article
Although myxoma is the most frequent cardiac tumor, other conditions should be taken into consideration in the differential diagnosis. Transthoracic echocardiography (TTE), followed by transesophageal echocardiography (TEE) remain the principal methods for cardiac tumor screening and visualizing. The aim of the study was to compare the diagnostics, surgical treatment and prognosis of malignant and benign cardiac tumors. From 1986 to 2009 there were 121 patients with cardiac tumors operated on in the Cardiac Surgery Clinic of the Medical University in Lodz. Patients were referred to surgery mainly on the basis of the TTE and TEE image. In 4 cases valvular prosthesis implantation or valve repair were carried out. Patients remained under long-term observation in the Cardiac Surgery Outpatient Clinic. Myxoma was diagnosed in 114 cases. Malignancies were discovered in 7 cases. The left atrium was the most frequent localization. The echocardiographic image differed significantly in benign and malignant tumors. The postoperative period was complicated by embolic events or myocardial infarctions. Only malignant tumors were associated with mortality due to cardiovascular events. The survival for malignant tumors was significantly shorter. Short and long-term results of operative treatment are very good for benign tumors in contrast to cardiac malignancies. The TTE and TEE image can be very significant in the final diagnosis.
 
Article
There is no available information about the effects of remifentanil labor analgesia on newborns' vital signs in the first hours after delivery. The aim of the study was to assess changes in the heart rate, blood pressure and oxygen saturation during the first 24 h of neonatal life after using remifentanil patient-controlled analgesia (PCA) for labor analgesia. Forty-four full-term neonates, 23 from intravenous PCA remifentanil labor anesthesia 0.2 µg/kg, repeated not more frequently than every 2 min, and 21 born to mothers without any pharmacological forms of analgesia, were studied. Heart rate, oxygen saturation, and systolic (SBP) and diastolic blood pressure (DBP) were monitored using a Nellcor Oxi Max monitor N5500 (Tyco Healthcare), and recorded at 1 h, 6 h, 12 h and 24 h. No significant differences in heart rate (p = 0.54; p = 0.26; p = 0.60; p = 0.83), oxygen saturation (p = 0.21; p = 0.27; p = 0.61; p = 0.9) and DBP (p = 0.98; p = 0.31; p = 0.83; p = 0.58) between the groups at 1 h, 6 h, 12 h and 24 h. Newborns from the remifentanil group had lower SBP at 1 h of life (59 mm Hg vs. 68.5 mm Hg) but the difference was just on the borderline of statistical significance (p > 0.06). There were no significant differences in SBP between the groups at 6 h (p = 0.65), 12 h (p = 0.11), and 24 h (p = 0.89) of life. Remifentanil PCA analgesia during labor does not significantly modify the oxygen saturation, heart rate and blood pressure in infants during the first day of their life. Therefore, further studies are needed to explain the observed trend for arterial hypotension in the first hour of life in infants born to mothers treated with remifentanil.
 
Article
By targeting different subtypes of 5-hydroxytryptamine (5HT) receptors in the gastrointestinal (GI) tract, several drugs have been introduced for the management of irritable bowel syndrome (IBS). Renzapride is a full agonist for 5HT4 receptor and an antagonist to 5HT2b and 5HT3 receptors which is thought a promising therapeutic agent for constipation predominant IBS (C-IBS) patients due to its accelerating effect on the GI tract. In this meta-analysis, our aim was to evaluate the efficacy and tolerability of renzapride in the management of IBS. A search was done from 1992 to February 2013 for placebo-controlled trials that investigated the efficacy of renzapride in IBS. Relative risk (RR) for clinical efficacy in IBS patients treated for 5 weeks or less comparing renzapride to placebo was 1.07 (95% CI = 0.89-1.29, p = 0.38). This value for IBS patients treated for more than 5 weeks was 1.04 (95% CI = 0.78-1.239, p = 0.77). The RR for clinical efficacy in IBS patients treated with renzapride (4 mg) for 5 weeks or less and more than 5 weeks in comparison to placebo was 1.2 (95% CI = 0.97-1.48, p = 0.1) and 1.16 (95% CI = 0.98-1.37, p = 0.08), respectively, which were statistically non-significant but clinically important. The analysis of tolerability demonstrated that amongst different reported adverse effects, renzapride caused diarrhea more than placebo (RR = 1.61 with a 95% CI = 1.16-2.24, p = 0.004). The RR for withdrawals from renzapride compared to placebo was 1.58 (95% CI = 1.26-2.07, p = 0.0007). Renzapride is not superior to placebo in relieving IBS symptoms and causes significant incidences of diarrhea and drop-outs due to adverse effects in treated patients vs. placebo. Thus, this medicine might be a cost burden to patients without providing good effectiveness.
 
Article
Oxidative stress is associated with the development and progression of cardiovascular disease. Plasma 8-isoprostane prostaglandin F2a (8-iso-PGF2a) levels are a reliable marker of oxidative stress. Patients (n = 151) with hypertension, dyslipidemia and impaired fasting glucose were randomly allocated to rosuvastatin (10 mg/day) plus telmisartan 80 mg/day (RT group, n = 52) or irbesartan 300 mg/day (RI group, n = 48) or olmesartan 20 mg/day (RO group, n = 51). After 6 months of treatment, changes in plasma 8-iso-PGF2a levels were blindly evaluated. A decrease of 8-iso-PGF2a levels vs baseline was observed only in the RT group (-8.6%; p = 0.02). A trend for decrease vs. baseline was observed in the RI (-5.7%; p = 0.40) and RO (-3.7%; p = 0.60) groups. Changes of 8-iso-PGF2a levels between groups were not significantly different (p = 0.70). The combination of rosuvastatin with sartans of different peroxisome proliferator receptor-γ activating capacity was associated with a decrease in levels of plasma 8-iso-PGF2a. This decrease reached significance only in the telmisartan group.
 
The immunoreactivity of Cx43 in the transplant core and the border of CCI at 1, 2 and 4 weeks post-transplantation. (A and B) Cx43-positive staining in 16-m sections from the brains of the NSCs-transplanted and the control rats at 1, 2 and 4 weeks. Immunoreactivity of Cx43 was significantly increased in the brains of the NSCs-transplanted rats compared to the control rats at different time points (C). The scale bar represents 30 m
* and ** indicate p < 0.05 and p < 0.01 vs. the control group at different time points
Gene and protein expression of Cx43 in the injured brain. In (A) and (C), lanes 1, 2 and 3 are from control rats and lanes 4, 5 and 6 are from NSCs-transplanted rats. Lanes 1 and 4, 2 and 5, and 3 and 6 are derived from rats at 1, 2 and 4 weeks post-transplantation, respectively. Representative results from semi-quantitative RT-PCR for Cx43 (A) and densitometric analysis of these bands (B). The intensity of each band was standardized to the band intensity of β-actin. Representative Western blots for Cx43 (C) and densitometric analysis of protein bands (D). The intensity of each band was standardized to the band intensity of GAPDH. Data are expressed as the mean ± SD (n = 3 in each group)
* and ** indicate p < 0.05 and p < 0.01 vs. the control group at different time points
Article
Reestablishment of functional networks after traumatic brain injury (TBI) has been proffered as one of the goals of neural stem cell (NSC) transplantation therapeutics. Gap junctions provide essential means for direct cellular communication by transferring small molecules and ions, which may provide insights into the interplay between grafted NSCs and host cells. Thirty-six adult male Wister rats were used in this study. The controlled cortical impact (CCI) model of brain injury has been performed. Seventy-two hours after CCI injury, animals were randomly assigned to two groups: PBS- and NSC- transplanted group. NSCs-transplanted group received delivery of the NSCs suspension to the cortex below the injury cavity in the ipsilateral hemisphere. At 1, 2, and 4 weeks post-transplantation, we investigated the expression patterns of gap junction-associated connexin 43 (Cx43) in the transplant site and the border of CCI by immunohistochemistry, Western blot and RT-PCR. Our findings showed that Cx43 staining was significantly greater in the transplant site and the border of CCI in the NSCs-transplanted rats compared to the control rats at different time points (p < 0.01 at 1 week, p < 0.05 at 2 and 4 weeks). Significantly higher gene and protein expression of Cx43 was found in NSCs-transplanted rats compared to the control rats in the period of 4 weeks post-transplantation (p < 0.01), and remained at a higher level until 2 weeks with or without NSC transplantation. It is proposed that gap junction-associated Cx43 might participate in NSCs' beneficial effects via gap-junctional coupling by which grafted NSCs integrate into host neural tissue following transplantation after TBI.
 
Article
Connexin 43 (Cx43) mediates the effect of thyroid hormone on Sertoli cell maturation in vitro. We investigated the influence of triiodothyronine (T3) administration on Cx43 expression in relation to the progress in seminiferous tubule maturation. Male rats were daily injected with 100 µg T3/kg body weight from birth until postnatal day (pnd) 5 (transient treatment - tT3) or until pnd 15 (continuous treatment - cT3) or solvent - control (C). On pnd 16 serum hormone levels, body and testes weight, seminiferous tubule morphometry, Cx43 immunostaining and germ cell degeneration were investigated. Cx43 expression was also assessed in six 50-day-old adult untreated rats. tT3 increased 2.6-fold serum level of T3, testes weight, and seminiferous tubule diameter, and induced maturation-like dislocation of Cx43 expression from the apical to the peripheral region of Sertoli cell cytoplasm. In addition, incidence of Cx43-positive tubules declined from 86% in C to 46% after tT3, being similar to the adult value (30% of tubules Cx43-positive). In turn, cT3 increased serum T3 level 12-fold, and decreased body weight. Seminiferous tubules became shortened and distended, Sertoli cell cytoplasm vacuolated, Cx43 expression had minimal intensity and germ cell degeneration increased. Cx43 might intermediate a short and transient stimulatory effect of T3 on seminiferous tubule maturation that disappeared together with exposure to the toxic effect of a continuously high level of the hormone.
 
Article
Ginkgo biloba extract (GBE) EGb761 is widely used for cardiovascular prevention. Here, we investigated the effects of GBE on atherosclerotic lesion development in rabbits with a high-fat diet. Forty New Zealand white male rabbits were randomly divided into four groups. The first two were the normal diet group (C) and the high-fat group (HF). The remaining two groups were those who received a high cholesterol diet supplemented with either the standard drug (simvastatin 2 mg/kg/day) or GBE (3 mg/kg/day). At 12 weeks, histopathological and chemical analyses were performed. Plasma lipid measurement showed that GBE inhibited high-fat diet-induced increase of serum triglyceride (TG), total cholesterol (TC), and low density lipoprotein cholesterol (LDL-C) by 59.1% (0.9 ±0.2 4 mmol/l vs. 2.2 ±0.4 mmol/l), 18.2% (31.1 ±1.4 mmol/l vs. 38.0 ±0.4 mmol/l) and 15% (28.9 ±1.3 mmol/l vs. 34.0±1.0 mmol/l), respectively, at 12 weeks (p < 0.01). The en face Sudan IV-positive lesion area of the aorta in the GBE group (51.7 ±3.1%) was significantly lower compared with that in the HF group (88.2 ±2.2%; p < 0.01). The mean atherosclerotic lesion area of the GBE group was reduced by 53.2% compared with the HF group (p < 0.01). Immunohistochemistry and western blot analysis showed that GBE markedly suppressed high-fat diet-induced upregulation of connexin 43 (Cx43) in rabbits (p < 0.01). Thus, our study revealed that GBE prevented atherosclerosis progress through modulating plasma lipid, suppressing atherosclerotic lesion development, and attenuating the expression of Cx43 protein.
 
Article
The aim of the present study was to investigate expression of HSP70 and p-53 proteins as mechanisms of protection of the renal tubular epithelial cells from l-arginine that induces cellular stress. The study material consisted of 16 white Wistar female rats. The rats were divided into 2 equal groups. The rats in the experimental group received L-arginine 40 mg/kg body weight per capita every other day for 2 weeks and were decapitated after 3 weeks of the experiment. After decapitation, specimens from the kidney were collected, fixed in 10% formalin, and then embedded in paraffin blocks. Proteins HSP70 and p-53 on slides were detected using the standard three-step immunohistochemical method. The quantitative evaluation of HSP70 and p-53 expression showed that the area occupied with positive HSP70 and p-53 reaction in the rat renal tubular cells of the experimental group (p-53: 2835.44 ±254.72 µm(2); HSP70: 24111.42 ±4290.88 µm(2)) was more statistically significant than the control group (p-53: 1882.05 ±466.43 µm(2); HSP70: 11388.63 ±1455.24 µm(2)). In the present study, the dose of L-arginine was similar to the one that was used in the gestosis treatment of pregnant women. The renal epithelial cells responded to L-arginine therapy, increasing expression of HSP70 and p-53 proteins. The study showed that L-arginine as a donor of exogenous nitric oxide has a disruptive effect on the renal tubular cells of rat kidneys. Thus it is going to be a subject of the author's future investigations.
 
Change of the duration of effort and distance in the 6-minute walk test
Change of VO2max and change of maximum effort load in the spiroergometry test
Change of the systolic (SBP) and diastolic blood pressure (DBP) in 24-hour ambulatory blood pressure monitoring
Article
The influence of physical exercise on the parameters of the cardiovascular system of elderly persons has not been sufficiently investigated yet. The aim of the study was to assess the influence of regular 6-week physical exercise using the Nordic walking (NW) method in a group of elderly persons on their physical performance and regulation of selected parameters assessing the cardiovascular system. Fifty patients over 65 years of age participated in the study. The study encompassed: medical interview, physical examination, resting ECG, spiroergometry examination, 6MWT (6-minute walk test) and 24-hour ambulatory blood pressure monitoring (ABPM). During the exercise programme, the pulse was monitored using pulsometers. After the completion of the training, check-up tests assessing the same parameters were performed. The control group consisted of 18 persons over 65 years of age with similar cardiovascular problems. In the test group, duration of the physical effort increased by 1.02 min (p = 0.0001), the maximum load increased by 10.68 W (p = 0.0001), values of VO2max by 2.10 (p = 0.0218), distance improved in 6MWT by 75.04 m (p = 0.00001), systolic blood pressure decreased by 5.50 mm Hg (p = 0.035) and diastolic blood pressure by 3.50 mm Hg (p = 0.054) as compared to the control group. Systematic NW physical exercise limited by the pulse had a beneficial effect on the physical performance of elderly persons as assessed with main parameters. A short 6-week programme of endurance exercises had a hypotensive effect in elderly persons over 65 years of age.
 
Article
The aim of the study was to assess the role of patient counselling, nurse assistance and effects of biochemical examinations in adherence of women with postmenopausal osteoporosis to alendronate 70 administration over 12 months of therapy. Compliance and persistence to alendronate 70 therapy were assessed in a prospective study of 123 postmenopausal women, followed up for one year. The patients were divided into 4 groups (controls, counselled group, biochemical group and nurse assisted group) with monitoring every 6 months; in the nurse assisted group, additional phone contacts were made after 3 and 9 months of treatment. After 12 months, compliance and persistence were analysed. The medication possession ratio (MPR) was regarded as optimal when its value exceeded 80%. The compliance to alendronate 70 therapy was 54.03% in the control group and the mean persistence with medication was 197 days. The MPR above 80% was observed in 37.5%, and, after 1 year, 43.75% of patients were found persistent with the therapy. In the remaining groups, both compliance and persistence were higher but not statistically significantly, compared to the control group. Neither patient's age, education, diet, nor physical activity influenced the compliance with prescribed therapy. The most common reason to discontinue therapy was either its side effects or smoking. The obtained results suggest that better adherence with medical recommendations is observed in patients who receive additional attention, e.g. counselling, biochemical tests or nursing care. The critical elements for therapy discontinuation were side effects and smoking.
 
Article
Alzheimer's disease (AD) is characterized by progression of memory problems to a slow global decline of cognitive function. Inflammation when left unregulated becomes a major cofactor in the pathogenesis of AD. PTGS2 is of crucial relevance in the inflammatory response, and it has been shown to play a considerable role in AD pathogenesis. To assess the possible putative role of a PTGS2 polymorphism (-765 G/C) in AD patients, we examined, by pyrosequencing, its distribution in 84 Sicilian AD patients and in 80 controls. No significant statistical difference in PTGS2 -765 G/C genotype distribution was found comparing patients with AD and controls. In addition, no significant difference was observed in the distribution of the PTGS2 -765 alleles between AD patients and controls. These findings suggest that the PTGS2 -765 G/C polymorphism may not be associated with AD in the Sicilian population.
 
Schematic representation of CBS gene locus on 21 chromosome, indicating position of T833C (intron 7) and 844ins68 (exon 8) polymorphisms 
Article
The cystathionine beta synthase (CBS) gene plays an important role in homocysteine metabolism because it catalyzes the first step of the transsulfuration pathway, during which homocysteine is converted to cystathionine. Polymorphisms of CBS have been associated with cancer. We examined the role of the 844ins68 polymorphism by comparing the genotypes of 371 healthy Mexican women with the genotypes of 323 Mexican women with breast cancer (BC). The observed genotype frequencies for controls and BC patients were 1% and 2% for Ins/Ins, 13% and 26% for W/Ins, and 86% and 72% for W/W, respectively. We found that the odds ratio (OR) was 2.2, with a 95% confidence interval (95% CI) of 1.5-3.3, p = 0.0001. The association was also evident when comparing the distribution of the W/Ins-Ins/Ins genotypes in patients in the following categories: 1) menopause and high γ-glutamyltransferase (GGT) levels (OR of 2.17, 95% CI: 1.17-4.26, p = 0.02), 2) chemotherapy response and high lactate dehydrogenase (LDH) levels (OR 2.2, 95% CI: 1.08-4.4, p = 0.027), 3) chemotherapy response and high GGT levels (OR 2.46, 95% CI: 1.2-4.8, p = 0.007), and 4) body mass index (BMI) and III-IV tumor stage (OR 3.2, 95% CI: 1.2-8.3, p = 0.013). We conclude that the genotypes W/Ins-Ins/Ins of the 844ins68 polymorphism in the CBS gene contribute significantly to BC susceptibility in the analyzed sample from the Mexican population.
 
Article
Pre-eclampsia (PE) is the most serious syndrome of human pregnancy and it is potentially life-threatening for both mother and fetus. The aim of the study was to identify the role of high temperature requirement A1 (HtrA1) in pre-eclampsia. One hundred consecutive pregnancies complicated by PE and 100 normal controls were included in our study. The changes in serum HtrA1 and fetal growth restriction were recorded. The placentae after delivery was also obtained for laboratory analyses. High temperature requirement A1 expressed positively in all placenta tissues, but showed higher expression from control, PE with AGA (pre-eclamptic pregnancies with appropriate-for-gestational-age newborns) to PE with fetal growth restriction (FGR) groups. Early-onset PE happened more frequently while in PE with AGA, late-onset PE was more common. Additionally, we found that only during ∼28-32 gestational weeks, sera HtrA1 level of PE with AGA and PE with FGR was increased significantly compared with the control group (p < 0.05). In contrast, there was no significant difference between groups in other gestational ages in the third trimester (p > 0.05). HtrA1 could potentially affect trophoblast migration and invasion during placentation, resulting in the shallow invasion noted in pre-eclampsia. HtrA1 may play an important role in the etiology and severity of PE and FGR. But the actual mechanism still needs deep research.
 
Article
An increased level of low-density lipoprotein (LDL) is a very well established risk factor of coronary artery disease (CAD). Unoxidized LDL is an inert transport vehicle of cholesterol and other lipids in the body and is thought to be atherogenic. Recently it has been appreciated that oxidized products of LDL are responsible for plaque formation properties previously attributed to the intact particle. The goal of this article is to review the recent understanding of the LDL oxidation pathway. The role of oxidized products and key enzymes (lipoprotein-associated phospholipase A2 and carboxyl ester lipase) are also extensively discussed in the context of clinical conditions.
 
Article
The Injury Severity Score (ISS) and the New Injury Severity Score (NISS) are widely used for anatomic severity assessments after trauma. We present here the Tangent Injury Severity Score (TISS), which transforms the Abbreviated Injury Scale (AIS) as a predictor of mortality. The TISS is defined as the sum of the tangent function of AIS/6 to the power 3.04 multiplied by 18.67 of a patient's three most severe AIS injuries regardless of body regions. TISS values were calculated for every patient in two large independent data sets: 3,908 and 4,171 patients treated during a 6-year period at level-3 first-class comprehensive hospitals: the Affiliated Hospital of Hangzhou Normal University and Fengtian Hospital Affiliated to Shenyang Medical College, China. The power of TISS to predict mortality was compared with previously calculated NISS values for the same patients in each data set. The TISS is more predictive of survival than NISS (Hangzhou: receiver operating characteristic (ROC): NISS = 0.929, TISS = 0.949; p = 0.002; Shenyang: ROC: NISS = 0.924, TISS = 0.942; p = 0.008). Moreover, TISS provides a better fit throughout its entire range of prediction (Hosmer Lemeshow statistic for Hangzhou NISS = 29.71; p < 0.001, TISS = 19.59; p = 0.003; Hosmer Lemeshow statistic for Shenyang NISS = 33.49; p < 0.001, TISS = 21.19; p = 0.002). The TISS shows more accurate prediction of prognosis and a linear relation to mortality. The TISS might be a better injury scoring tool with simple computation.
 
Article
The decision on the time and choice of strategy of treatment of abdominal aortic aneurysm must be especially carefully balanced. The aim of the study was to evaluate the tissue factor (TF) plasma level as a potential factor useful in anticipation of abdominal aortic aneurysm and/or iliac arterial aneurysm via comparison of plasma TF level in patients with ruptured and non-ruptured aneurysms. The study included 33 patients with aneurysm (17 operated on electively because of non-ruptured aneurysm and 16 operated on emergently due to ruptured aneurysm), 33 claudicant patients with atherosclerosis of the abdominal aorta and iliac arteries with normal diameter of arteries, and 30 healthy controls. Plasma TF level was assessed by ELISA method using the IMUBIND Tissue Factor ELISA Kit (American Diagnostica Inc.). The study showed an increased TF level in patients with aneurysm (134 ±54 pg/ml) and in patients with atherosclerosis without concomitant aneurysm (91 ±30 pg/ml) in comparison with the control group (62 ±20 pg/ml), respectively p < 0.001 and p = 0.008. A significantly higher TF plasma level was observed in patients with ruptured abdominal aortic aneurysms (160 ±57 pg/ml) as compared to patients with non-ruptured aortic aneurysms (109 ±39 pg/ml) or peripheral arterial occlusive disease (91 ±30 pg/ml), respectively p < 0.001 and p < 0.001. The difference in TF level between the group with non-ruptured aortic aneurysms (109 ±39 pg/ml) and the patients with atherosclerosis without aneurysm (91 ±30 pg/ml) was not statistically significant. No difference in TF level between patients with non-ruptured AAA/IAA and patients with aortic and iliac atherosclerosis without aneurysm indicates that an increased TF plasma level is not specific for any of the above-mentioned vascular pathologies.
 
Article
One of the most severe complications of repair surgery for abdominal aortic aneurysms (AAA) is acute kidney injury (AKI). Acute kidney injury is an inflammatory process whose pathogenesis involves endothelial cells (EC). The aim of this study was to assess the dynamics of endothelium injury markers measured during elective AAA surgery which might confirm the inflammatory character of AKI. The study group consisted of 14 patients with AAA. We measured plasma soluble forms of intercellular adhesion molecule-1 (ICAM-1), vascular cell adhesion molecule-1 (VCAM-1), E-selectin, P-selectin as well as the levels of von Willebrand factor (vWF) before, during (including intra-abdominal vein levels before and after aortic clamp removal) and within 2 days after surgery. We have found a biphasic response of ICAM-1, VCAM-1 and P-selectin with an initial fall and subsequent rise. However, only VCAM-1 changes were significant compared to its baseline value. The maximum decrease of VCAM-1 was observed in the renal vein 5 min after aortic clamp removal (335.42 ±129.63 ng/ml vs. 488.90 ±169.80 ng/ml baseline value, p < 0.05), and the highest rise 48 h after aortic clamp removal (721.46 ±333.99 vs. baseline, p < 0.05). Vascular cell adhesion molecule-1 turned out to be the most sensitive indicator of EC injury and inflammatory status after AAA surgery. During AAA surgery, soluble forms of P-selectin, ICAM-1 and VCAM-1 demonstrate a biphasic response with an initial fall and subsequent rise. These soluble forms could have a modulatory effect on the development of inflammation.
 
Comparison of all procedures without X-ray with those performed exclusively in 2008
Potential CARTO map performed during non-fluoroscopic ablation of post-myocardial left
ventricular VT in patient with anaemia because of myelodysplastic syndrome. Violet indicates healthy
regions, red – low voltage regions. Brown points – places where RF application was done; red points – Purkinje potentials; blue circle – mitral annulus
Article
The aim of the study was to describe the experience in performing ablation without fluoroscopy. From 575 ablation procedures with CARTO performed in the period 2003-2008, 108 (42 M; age 40 ±16 years) were done without fluoroscopy. One patient had ablation using the Localisa system. There was one man with thrombocytopenia and two pregnant women. Right ventricular (RV) outflow tract arrhythmias and other RV arrhythmias were noted in 38 patients (35%) and 17 patients (15%), respectively. There were 5 (4.6%) left ventricular (LV) outflow tract arrhythmias and 19 (17.5%) other LV tachycardias; right accessory pathways in 17 patients (20%), in the middle cardiac vein in 1, Mahaim fibres in 1, and 3 cases of permanent junctional reciprocating tachycardias. One patient with CRT had AV node ablation (Localisa). In 3 patients there were also other arrhythmias treated: slow AV nodal pathway, typical flutter isthmus and right atrial tachycardia. In 2004, 1/96 CARTO procedures was done without fluoroscopy, in 2006 2/97, in 2007 19 (2 in LV) of 93, in 2008 87 (22 in LV) of 204. The percentage of ablations without fluoroscopy in every hundred CARTO procedures was: 1%, 1%, 8%, 23%, 46%, 28% (mean 18%). There were no procedure-related complications. It is feasible to perform ablations within both right and left sides of the heart without fluoroscopy. The number and type of non-fluoroscopic procedures depends on the operator's experience. Pregnant patients, with malignant history or with hematologic diseases should be ablated without fluoroscopy in centres that specialise in these kinds of procedures.
 
Article
The aim of this study was to evaluate the diagnostic performance of SonoVue-enhanced ultrasonography in the follow-up of rabbit kidney lesions induced by percutaneous radiofrequency ablation. New Zealand rabbits (28) underwent percutaneous radiofrequency ablation (RFA) to generate renal lesions. Lesions were evaluated by conventional 2D ultrasound and contrast-enhanced ultrasonography (CEUS) at 1 day, 1 week, 1 month and 3 months after RFA, and the results were compared to gross pathology. One day and 1 week after RFA, renal lesions were wedge-shaped in the gross dissection cross-sectional profiles. Conventional ultrasound could not indicate the extent of the lesions; however, CEUS could exactly delineate the lesion shape and size. At 1 and 3 months, lesions were observed as hyperechogenic areas on conventional ultrasound, and as small perfusion defects on CEUS. The differences in the lesion measurements obtained by CEUS and in pathological specimens were not statistically significant (p > 0.05). The conclusion could be deduced from the study that SonoVue-enhanced ultrasonography was effective for the follow-up of normal rabbit kidney percutaneous radiofrequency ablation.
 
Article
Assuming that spina bifida (SB) is a genetically controlled disease, the aim of our study was to evaluate the degree of genetic homozygosity and the distribution of AB0 blood types among patients with SB occulta and SB aperta by the homozygously recessive characteristics (HRC) test. Our study included an analysis of the presence, distribution and individual combination of 15 selected genetically controlled morpho-physiological traits in a sample of 100 patients with SB (SB occulta N = 50 and SB aperta N = 50) and a control group of individuals (N = 100). We found a statistically significant difference between the mean values for genetic homozygosity (SB 4.5 ±0.3; control 3.0 ±0.2, p < 0.001) and also differences in the presence of certain individual combinations of such traits. In 12 (80.0%) of the 15 observed characteristics, recessive homozygosity was expressed to a greater degree among the group of SB patients, while for 9 (60.0%) of the traits this level of difference was statistically significant (Σ(χ) (2) = 266.3, p < 0.001). There was no difference in average homozygosity of such genetic markers between groups of SB occulta and SB aperta patients, but the type of individual variation in the two studied groups significantly differed. In the group of patients with SB the frequency of 0 blood group was significantly increased while B blood group was significantly decreased. Our results clearly show that there is a populational genetic difference in the degree of genetic homozygosity and variability between the group of patients with SB and individuals without clinical manifestations, indicating a possible genetic component in the aetiopathogenesis of spina bifida.
 
Article
We sought to determine the usefulness of ambulatory 24-hour Holter monitoring in detecting asymptomatic pacemaker (PM) malfunction episodes in patients with dual-chamber pacemakers whose pacing and sensing parameters were proper, as seen in routine post-implantation follow-ups. Ambulatory 24-hour Holter recordings (HM) were performed in 100 patients with DDD pacemakers 1 day after the implantation. Only asymptomatic patients with proper pacing and sensing parameters (assessed on PM telemetry on the first day post-implantation) were enrolled in the study. The following parameters were assessed: failure to pace, failure to sense (both oversensing and undersensing episodes) as well as the percentage of all PM disturbances. Despite proper sensing and pacing parameters, HM revealed PM disturbances in 23 patients out of 100 (23%). Atrial undersensing episodes were found in 12 patients (p < 0.005) with totally 963 episodes and failure to capture in 1 patient (1%). T wave oversensing was the most common ventricular channel disorder (1316 episodes in 9 patients, p < 0.0005). Malfunction episodes occurred sporadically, leading to pauses of up to 1.6 s or temporary bradycardia, which were, nevertheless, not accompanied by clinical symptoms. No ventricular pacing disturbances were found. Asymptomatic pacemaker dysfunction may be observed in nearly 25% of patients with proper DDD parameters after implantation. Thus, ambulatory HM during the early post-implantation period may be a useful tool to detect the need to reprogram PM parameters.
 
Age of the questioned
Knowledge of the what the AED is according to the age, place of stay and the level of education of the questioned
Job seniority of questioned employees who possess knowledge of AED presence at the work place
Knowledge of the circumstances in which the AED should be used according to the date of the first aid course graduation
Results of the answers to the question: “Would you use the AED, knowing of its accessibility, in the situation of SCA?”
Article
The Public Access to Defibrillation (PAD) program was designed to raise the awareness of sudden cardiac death (SCA) pre-hospital management among the community. The goal of the following research was to confirm the final impact of the Polish PAD program on various resident groups that differ by age, training and education level. The trial total number of participants reached 404 people from three cities divided into two groups. In group one (n = 295) were randomly selected people inside the trial area and in group two (n = 109) we had individuals who were theoretically trained in basic life support (BLS) algorithms, including the use of an automatic external defibrillator (AED). The research method was based on two different questionnaires completed by participants from each group. The greatest knowledge of SCA, as well as the use of AED, and the best practical skills, were possessed by the residents of cities with a population over 100 000, aged between 18 and 30 years, who completed secondary or higher education (31.7%). The group with the smallest knowledge about SCA lived in the country (10.7%). The second group with little knowledge of the subject consisted mostly of individuals with primary education (4.19%) or professional abilities and over 50 years old (2.16%). There must be some actions taken in order to increase the community awareness concerning automatic defibrillation. Training on AED and the possibility of practical exercise needs to be organized and should be conducted especially among residents of the countryside and people under 30 or over 50 years old.
 
Forest plots of pooled sensitivity of ADA for the diagnosis of TBP. The point estimates of sensitivity from each study are shown as solid circles. Error bars indicate 95% confidence intervals
Forest plots of pooled specificity of ADA for the diagnosis of TBP. The point estimates of specificity from each study are shown as solid circles. Error bars indicate 95% confidence intervals
Summary receiver operating characteristic (SROC) curve of ADA for the diagnosis of TBP. The size of each solid circle represents the size of each study included in the present meta-analysis. The regression SROC curve indicates the overall diagnostic accuracy
Linear regression test of funnel plot asymmetry. The statistically non-significant value (p = 0.86) for the slope coefficient suggests symmetry in the data and a low likelihood of publication bias
Article
Tuberculous peritonitis remains a diagnostic challenge for clinicians. Many studies have investigated the usefulness of adenosine deaminase (ADA) in ascites for the diagnosis of tuberculous peritonitis; however, the overall diagnostic accuracy of ADA for tuberculous peritonitis remains unclear. The aim of the present meta-analysis was to determine the overall accuracy of ADA measurements in the diagnosis of tuberculous peritonitis. We performed a systematic search in PubMed and Embase to identify published studies that evaluated the diagnostic role of ADA for tuberculous peritonitis. Quality was assessed according to standardized Quality Assessment of Diagnostic Accuracy Studies criteria. Sensitivity, specificity and other measures of accuracy of ADA assay in order to diagnose tuberculous peritonitis were pooled using random effects models. Summary receiver operating characteristic curve (SROC) was used to summarize overall test performance. Sixteen studies met inclusion criteria for the present meta-analysis. The pooled sensitivity and specificity for diagnosing tuberculous peritonitis were 0.93 (95% CI: 0.89-0.95) and 0.96 (95% CI: 0.94-0.97), respectively. The positive likelihood ratio was 15.80 (95% CI: 10.87-22.95), negative likelihood ratio was 0.09 (95% CI: 0.05-0.16) and diagnostic odds ratio was 249.28 (95% CI: 113.11-549.39). The area under the SROC was 0.98. Ascitic ADA determination is a relatively sensitive and specific test for the diagnosis of tuberculous peritonitis. Measurement of ADA in ascites is thus likely to be a useful diagnostic method for tuberculous peritonitis.
 
Frog-leg lateral radiograph of the normal and abnormal hip joint. A – Normal hip joint: α angle was 34.9°C, femoral head-neck offset was 13.79 mm. B – Abnormal hip joint (cam impingement): α angle was 65.5°C (> 50°C), femoral head-neck offset was 5.75 mm (< 7.2 mm)
AP radiograph of the pelvis showed normal hip joint and coxa profunda, A – Normal hip joint, the acetabular floor (black arrow) lateral to the ilioischial line (white arrow). B – Coxa profunda, the acetabular floor (black arrow) medial to the ilioischial line (white arrow)
AP radiograph of the pelvis showed normal hip joint and acetabular retroversion. A – Normal hip joint, the anterior acetabular rim (black arrow) medial to posterior acetabular rim (white arrow); there was no crossing between them. B – Retroverted acetabula; the anterior acetabular rim (black arrow) is more lateral than the posterior acetabular rim (white arrow) (the so-called crossover or figure-of-eight sign)
MRI manifestations of the acetabular labral tears. A – T1WI showed a normal acetabular labrum (white arrow), B and C – STIR showed a region of increased signal in the labrum (white arrow) indicative of an acetabular labral tear, D – Fs-FRFSE-T2 showed high signal intensity in the articular cavity representing joint effusion, E – Fs-FRFSE-T2 showed high signal intensity in femoral head, indicating bone marrow edema
Article
To analyze the X-ray and magnetic resonance imaging (MRI) features of acetabular labral tears, so as to improve the recognition of the disease. Imaging features of 19 patients with acetabular labral tears confirmed by arthroscopy were analyzed retrospectively. All cases were examined by X-ray. Fourteen patients underwent MRI examinations. Seventeen of the 19 patients had at least one osseous abnormality consistent with femoroacetabular impingement (FAI) under arthroscopy; among them 7 cases were cam impingement, 3 cases were pincer impingement and 7 cases were mixed impingement. X-ray manifestations: 12 of the 19 patients had FAI; among them 6 cases were cam impingement, 2 cases were pincer impingement and 4 cases were mixed impingement. Five cases showed various degrees of degenerations of hip joint. Two patients had no identifiable structural abnormalities. Magnetic resonance imaging showed various degrees of injury of labrum in 6 patients, joint effusion in 5 cases, and bone marrow edema of femoral head in 3 cases. The FAI has much to do with acetabular labral tears. X-ray examination is important for FAI diagnosis. Given its high sensitivity and accuracy, MRI is an effective preoperative tool for defining the location and extent of labral tears. Combined with X-ray imaging and clinical manifestation, MRI can provide a reliable basis for clinical diagnosis and treatment of acetabular labral tears.
 
Article
The aim of the study was to evaluate the prevalence of resistance to acetylsalicylic acid (ASA), used for secondary prevention of stroke, including the assessment of risk factors associated with the lack of ASA anti-aggregatory action. Patients after a transient ischaemic attack (TIA) or ischaemic stroke in the acute (n = 111) and chronic phase (n = 87) were enrolled in the study. The assessment of platelet function was performed by whole blood impedance aggregometry using a multi-channel platelet function analyser (Multiplate). A proper response to ASA was found in 121 patients (61.1%) (ASA responders), a partial response to ASA in 59 patients (29.8%) (ASA partial responders), and ASA resistance in 18 patients (9.1%) (ASA non-responders). Acetylsalicylic acid resistance was observed more frequently in the chronic phase. The mean low-density lipoprotein (LDL) concentration was higher in ASA non-responders (p = 0.02). The mean heart rate (p = 0.03) and the mean haematocrit (p = 0.03) were higher in the group of ASA partial responders and ASA non-responders. Angiotensin II receptor antagonists were more often used in the group of ASA partial responders and ASA non-responders (p = 0.04). Diuretics were more rarely used by ASA non-responders, whereas fibrates were more rarely used by ASA partial responders. The method enabled the detection of ASA resistance in some patients with cerebrovascular disease. The study revealed some possible risk factors of ASA resistance: long ASA therapy, increased heart rate, higher LDL concentration, and higher haematocrit value. The relationship between the effect of ASA and other medications (angiotensin II receptor blockers, fibrates, diuretics) requires further study. Platelet function monitoring should be considered in patients at a greater risk of ASA resistance.
 
Article
Diabetic retinopathy (DR) is a serious complication of long-standing diabetes mellitus. It affects about 25% of all patients with diabetes mellitus and causes a significant decrease in the quality of life. Despite many years of research, the exact pathway that leads to the development and progression of DR is not clear. Recent studies suggest that polyunsaturated fatty acids (PUFAs) and their metabolites could play a significant role in DR. There is evidence to suggest that an imbalance between pro- and anti-inflammatory eicosanoids and enhanced production of pro-angiogenic factors may initiate the onset and progression of DR. This implies that PUFAs and their metabolites that possess anti-inflammatory actions and suppress the production of angiogenic factors could be employed in the prevention and management of DR.
 
Article
The aim of this study was to evaluate the efficacy and safety of colistin treatment in patients with pulmonary infection caused by Pseudomonas aeruginosa or Acinetobacter baumannii. The relevant studies were identified through a search of public databases including PubMed, MEDLINE and EMBASE up to December 2012. A meta-analysis was conducted to compare the clinical response, mortality and renal damage of colistin (colistin group) versus other effective antibiotics (control group). The odds ratio (OR) was chosen as the effect size. A total of 9 studies were eventually identified. The result of the meta-analysis showed that the pooled OR of clinical response was 1.24 (95% CI = 0.68-2.27, p > 0.05) for patients in the colistin group versus the control group, indicating no significant difference in efficacy between colistin and control groups. Similar results were obtained by the further subgroup meta-analyses by sample size, research year, ethnicity and study method. Treatment with colistin versus other agents did not affect hospital mortality (OR = 1.05, 95% CI = 0.58-1.89, p > 0.05) or renal damage (OR = 1.25, 95% CI = 0.78-2.00, p > 0.05). The combined estimate of our analysis was strong across multiple sensitivity analyses and without significant publication bias. Our results suggest that colistin may be as efficacious and safe as standard antibiotics for the treatment of pulmonary infection.
 
Article
Introduction Validation of compliance with severe sepsis bundles is still needed. The purpose of this study was to determine compliance and its outcomes in severe community-acquired pneumonia (CAP) patients in a limited resources country. Material and methods A prospective cohort study of 212 severe CAP patients was carried out. The implementation programme was organized into two continuous phases. The primary outcomes were compliance and hospital mortality. Results Compliance with administration of antibiotics and vasopressors as well as plateau pressure on average < 30 cm H2O was high in both groups. In the bundles group, patients received more serum lactate monitoring (62.3% vs. 11.3%), more blood cultures (47.1% vs. 24.5%), more fluid resuscitation (63.2% vs. 26.4%) and volumes infused (1319.8 ±1107.4 ml vs. 461.9 ±799.3 ml), more inotropic dobutamine and/or packed red blood cells (21.7% vs. 10.0%), more low-dose steroids (56.5% vs. 15.0%), and more glucose control (51.9% vs. 6.6%) compared with such patients in the control group. The rates of total compliance with 6-hour, 24-hour, and 6/24-hour bundles in the prospective period were 47.1%, 51.9%, and 42.5%, respectively. Hospital mortality was reduced from 44.3% to 29.2% (p = 0.023) in the bundles group, and the compliant subgroup had a more than twofold decrease in mortality (17.8% vs. 37.7%, p = 0.003). Serum lactate measured, blood cultures, and fluid resuscitation showed independent relationships with decreased mortality. Conclusions Total compliance was relatively low, but the implementation of severe sepsis bundles could clearly reduce mortality from severe CAP.
 
Article
The aim was to compare the efficacy of long-acting and short-acting gonadotropin-releasing hormone (GnRH) agonists by long protocol on embryo quality, endometrial thickness and pregnancy rate in in vitro fertilization. In this retrospective study, long-term pituitary downregulation, achieved with long- and short-acting GnRH agonists (GnRHa), was performed for patients undergoing in vitro fertilization (n = 175). There were no significant differences between the long and short-acting GnRH group (63.16% vs. 66.26%, p > 0.05), and the secondary and primary infertility group (63.47% vs. 66.86%, p > 0.05) in embryo quality. Logistic regression analysis showed that type of infertility and endometrial thickness were significantly associated with pregnancy outcome. Patients in the long-acting GnRHa group had a thicker endometrium on the day of human chorionic gonadotrophin (hCG) administration (10.79 ±2.62 mm vs. 9.64 ±1.97 mm, p < 0.01), lower serum luteinizing hormone (LH) concentration (1.21 ±1.13 vs. 2.53 ±3.39) and a higher pregnancy rate (59.60% vs. 43.42%, p < 0.05) than those of patients in the short-acting GnRHa group. This work suggests that types of agonist protocol and infertility may not affect embryo quality. Type of infertility and endometrial thickness may be positive predictors for clinical pregnancy, but the key finding is that the long-acting GnRHa protocol may be an effective method of improving endometrial thickness, endometrial receptivity and pregnancy rate in in vitro fertilization.
 
Article
Several studies have shown that lactoferrin (LF) and neopterin (NT) are correlated with infection. The aim of this study is to determine whether serum levels of LF and NT are associated with postoperative infectious complications in patients with acute traumatic spinal cord injury. A total of 268 patients with acute traumatic spinal cord injury who underwent spinal surgery were enrolled in this study. Serum levels of LF, NT, and C-reactive protein (CRP), in addition to white blood cell count (WBC) and erythrocyte sedimentation rate (ESR), were measured preoperatively and 24 h postoperatively. In total, 22 of 268 patients (8.2%) developed postoperative infectious complications. The levels of serum LF, NT, and CRP were significantly higher in the infected patients than in the non-infected patients. No significant differences were observed in postoperative WBC count and ESR between the two groups. Multivariate logistic regression revealed that LF (OR: 1.004 (1.002-1.007)), NT (OR: 1.137 (1.054-1.227)), and CRP (OR: 1.023 (1.002-1.044)) were significantly associated with the presence of postoperative infectious complications. The area under receiver operating characteristic curves for LF, NT, and CRP was 0.709, 0.779, and 0.629, respectively. Elevated serum concentrations of LF and NT are associated with early infection after surgery. Compared to CRP, elevated levels of LF and NT are better indicators for predicting postoperative infectious complications in patients with acute traumatic spinal cord injury.
 
ROC analysis evaluating the usefulness of SmRV/SmLV in the diagnosis of PE
Article
The diagnosis of acute pulmonary embolism (APE) in patients with chronic heart failure (CHF) remains a difficult task, despite the refinement of imaging techniques. The goal of this study was to assess the value of measuring tricuspid and mitral valve systolic annular velocities in CHF patients with suspected PE by tissue Doppler imaging (TDI). The study included 75 patients with previously diagnosed CHF, admitted due to resting dyspnea, with a maximum tricuspid regurgitation pressure gradient (TRPG) of ≥ 35 mm Hg and positive D-dimer assay. Spiral computed tomography (sCT) was performed on all subjects to confirm APE. Acute pulmonary embolism was diagnosed in 35 patients (PE+), and excluded in 40 others (PE-). Tissue Doppler imaging was performed to measure maximum systolic lateral annular velocities in the mitral (SmLV) and tricuspid (SmRV) valves, as well as the SmRV/SmLV ratio. PE+ subjects were found to have higher SmLV than PE- subjects (6.0 cm/s (2.0-13.8 cm/s) vs. 4.2 cm/s (1.3-9.1 cm/s), p = 0.003). SmRV/SmLV ratios were 1.05 (0.50-2.50) and 1.56 (0.62-4.30), respectively (p < 0.0001). Areas under ROC curves for diagnosis of APE were 0.700 for SmLV and 0.789 for SmRV/SmLV. In multivariate logistic regression analysis, only SmRV/SmLV was statistically significant, with an odds ratio for APE of 6.26 (95% CI: 1.53-25.59; p = 0.009). Tissue Doppler imaging of the lateral tricuspid and mitral annuli is a useful clinical tool that can help identify PE in CHF patients. Those patients who fulfill these criteria should be considered for further diagnostic studies to confirm PE.
 
Article
Proctocolectomy with ileal pouch-anal anastomosis (IPAA) was performed in ulcerative colitis (UC) for emergent or urgent indications in three stages. Since the three-step procedure imposes enormous demands on a patient, there was an attempt to introduce primary IPAA for urgent indications. The aim of this study was to compare early complications after Hartmann's colectomy (HC) and IPAA in a selected group of patients. Medical records of 274 patients who underwent surgery for UC between 1996 and 2010 were retrospectively evaluated. Finally, a group of 77 patients with acute form of UC entered this study. All patients were divided into two groups. Group 1 consisted of 32 (42%) patients who underwent HC, whereas group 2 comprised 45 (58%) patients after IPAA. There was no postoperative mortality. Respiratory failure occurred in 8 (24%) patients after HC and in 6 (14%) patients who underwent IPAA. Intra-abdominal sepsis developed in 4 (12%) patients after HC and in 8 (17%) undergoing IPAA. Fascia dehiscence was present in 3 (8%) patients after HC and in 4 (9%) with IPAA. Bowel obstruction occurred in 1 (4%) patient after the former operation and in 3 (6%) patients after the latter one. Wound infection was diagnosed in 6 (20%) patients after HC and in 9 (20%) after IPAA. The differences between the investigated groups of patients were not statistically significant. The IPAA could be performed for urgent indications only in the patients with no critical dilatation of the colon or with active UC but without signs of severe malnutrition.
 
Top-cited authors
Maciej Banach
  • Medical University of Łódź
Marisa Coelho
Rúben Fernandes
  • Polytechnic Institute of Porto
Peter Paul Toth
  • Johns Hopkins Medicine
Patimah Ismail
  • Universiti Putra Malaysia