Sylwia Kędziora

Medical University of Warsaw, Warszawa, Masovian Voivodeship, Poland

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Publications (10)8.6 Total impact

  • R. Slotwinski · W. Olszewski · S. Kędziora · A. Dabrowska · G. Lech

    No preview · Article · Sep 2012 · Clinical Nutrition Supplements
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    ABSTRACT: Septic infections in malnourished surgical patients show the highest morbidity and mortality rate. The attempt to correct postoperative immune and nutritional disorders by introducing immune-enhancing nutrition (immunonutrition) is a promising way of improving outcome, but as yet little is known about the mechanisms of correcting an extensive postoperative inflammatory response (systemic inflammatory response syndrome [SIRS]) to a massive infection using this type of nutrition. A significant role in the innate antibacterial and inflammatory response is played by Toll-like receptors (TLRs) that recognize pathogen-associated molecular patterns (PAMPs). The regulatory impact of immunonutrition on TLR expression in surgical septic patients seems to be a new research direction. In this paper special emphasis was put on clinical trials and the research results for the TLR-dependent immune response and anti-bacterial/anti-inflammatory response applying immuno-modulatory nutrition with increased concentrations of glutamine and unsaturated fatty acids.
    No preview · Article · Jan 2012 · Przegląd Gastroenterologiczny

  • No preview · Article · Dec 2011 · Clinical Nutrition Supplements
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    ABSTRACT: The mechanisms of correcting immune disorders in patients with pancreatic cancer requiring major surgery procedures by introducing perioperative immune-enhancing diet (immunonutrition) are still unclear. The purpose of our study was to investigate the effect of pancreatic cancer, extensive surgery and immunonutrition versus enteral standard nutrition on the apoptotic signaling pathways. The randomized studies were performed in 72 patients before and after pancreatic cancer resection with preoperative standard (Group I) or enteral immunonutrition (Group II). The expressions of Bcl-2, Bax, caspases-3, -9, NF-κB, PARP-1/89 kDa, TNFR1/CD120a and Fas/CD95 in peripheral blood lymphocytes were assessed by western blot analysis and flow cytometry before and on day 1, 3 and 7 after surgery. In malnourished patients before and after surgery, the expression of Bcl-2, Bax, NF-κB, PARP-1 was significantly lower, whereas the expression of caspases, as well as the percentage of cells with death receptors were significantly higher when compared with the control group. There was no difference in Bcl-2, Bax and PARP-1 expression between the control group and the patients with normal nutritional status (Group III) before surgery. In comparison to the standard nutrition, the preoperative immunonutrition increased the Bcl-2 and Bax expression inconsiderably but significantly increased the percentage of CD95- and CD120a-positive lymphocytes after surgery. In malnourished patients with pancreatic cancer, the overwhelming expression of caspases and the decrease expression of anti-apoptotic proteins may lead to inappropriate lymphocyte apoptosis and higher cell depletion. The preoperative enteral immunonutrition prevents the postoperative decrease in lymphocyte subsets, but a higher level of lymphocyte susceptibility to undergo accelerated apoptosis can also be considered.
    No preview · Article · Aug 2011 · Archivum Immunologiae et Therapiae Experimentalis
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    ABSTRACT: Septic infections in patients treated in intensive care units show the highest mortality rates. Despite advances in treatment methods, there is still no therapy available to efficiently reduce the excessive inflammatory response, which can increase the risk of multiple organ failure. One of the ways to discover new, more efficient treatment methods involves regulating the mechanisms of inflammatory response to a massive infection. Toll-like receptors (TLRs) that recognize pathogen-associated molecular patterns play a significant role in innate antibacterial and inflammatory responses. The regulatory impact of immunonutrition on TLR expression in septic patients seems to be a promising research direction. This paper presents the main mechanisms for the innate immune response to lipopolysaccharide, based on the research results for both TLR-dependent and independent signaling pathways. Special emphasis was put on the research results for the TLR-dependent immune response and the anti-bacterial/anti-inflammatory response after applying immunonutrition with increased concentrations of glutamine and unsaturated fatty acids.
    No preview · Article · Feb 2011 · Archivum Immunologiae et Therapiae Experimentalis
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    ABSTRACT: Aim: To evaluate the status of programmed leukocyte death (apoptosis) in malnourished pancreatic cancer patients in comparison with healthy controls. Material and methods: The percentage of leukocytes with death receptors Fas (CD95) and TNFR1 (CD120a) was investigated in 72 pancreatic cancer patients in comparison with 30 healthy volunteers. Percentages of cells with receptors were assessed by flow cytometry. Results: Results of the study show a significantly higher percentage of CD95+/CD3- cells and lymphocytes with TNFR1 in the group with pancreatic cancer in comparison with healthy controls. Conclusions: Our studies show up-regulation of the pro-apoptotic signalling system in the leukocytes of patients with pancreatic cancer and a switch to apoptosis. These alterations may lead to leukocyte dysfunction and immune system suppression.
    No preview · Article · Jan 2011 · Przegląd Gastroenterologiczny
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    ABSTRACT: Introduction: Pancreatic cancer surgery is one of the most invasive operations in upper abdominal surgery, with a high incidence of postoperative complications. Extensive tissue trauma and malnutrition results in disorders of programmed cell death influencing the patient's susceptibility to infections. The attempt to correct the postoperative immune disorders by introducing preoperative or postoperative immunonutrition is a promising way of improving outcome after pancreatic surgery. Aim: To investigate the influence of surgical trauma and immunonutrition on the changes of apoptotic signalling pathways, randomized studies were performed in patients after pancreatic cancer surgery receiving preoperative standard or enteral immunonutrition. Material and methods: The expression of TNFRI/CD120a, Fas/CD95 and Bcl-2 in lymphocytes was assessed by flow cytometry before and on day 1, 3 and 7 after surgery. The percentage of Fas (CD95+/CD3-) and TNFRI (CD120a) positive lymphocytes in the whole group of pancreatic cancer patients was significantly higher before as well as after surgery. The percentage of Bcl-2-positive lymphocytes was significantly decreased on day 1 and 7 after surgery. In comparison to standard nutrition, preoperative immunonutrition significantly increased the percentage of CD95 and TNFRI positive lymphocytes after surgery. Results: Our studies revealed the up-regulation of pro-apoptotic signalling systems in peripheral blood lymphocytes of malnourished patients with pancreatic cancer. These pathological alterations in expression of apoptotic signalling pathway proteins may increase lymphocyte dysfunction and immune system suppression, especially after pancreatic resection. Preoperative enteral immunonutrition has a modulatory effect on apoptotic signalling pathways.
    No preview · Article · Jan 2011 · Przegląd Gastroenterologiczny
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    ABSTRACT: Aim: To investigate whether preoperative enteral immunonutrition possesses some anti-apoptotic properties and can influence the lymphocyte apoptotic signalling pathways in patients with pancreatic cancer. Material and methods: The studies were performed in 48 patients operated on for pancreatic cancer. Thirty-four malnourished patients were randomized to receive either the enteral preoperative standard diet (group I) or the immune-enhancing enteral diet (immunonutrition) (group II). Fourteen patients (group III) of normal nutritional status did not receive the preoperative nutrition. The control group comprised 30 healthy volunteers. The expression of Bcl-2, Bax, caspase-3 and -9, NF-κB, PARP-1/89 kDa, and TNFR1/CD120a in peripheral blood lymphocytes was assessed by Western blot analysis before and after preoperative nutrition and after surgery. Results: In malnourished patients before and after surgery (group I, II) the expression of Bcl-2, Bax, NF-κB, and PARP-1 was significantly lower, whereas the expression of caspases and TNFR1 was significantly higher as compared with the control group. There was no difference in Bcl-2, Bax and PARP-1 expression between the control group and the patients with normal nutritional status (group III) before surgery. The differences between groups I and II in all proteins' expression were not statistically significant both before and after pancreatic surgery. Conclusions: Our findings suggest the down-regulation of anti-apoptotic and up-regulation of pro-apoptotic signalling systems in lymphocytes of malnourished patients with pancreatic cancer and a switch to apoptosis. Preoperative enteral immunonutrition has no significant effect on the apoptotic signalling pathways and the anti-apoptotic impact of such nutrition in pancreatic cancer patients is questionable.
    No preview · Article · Jan 2010 · Przegląd Gastroenterologiczny
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    ABSTRACT: In conditions of metabolic stress (trauma, burns, cancer, cachexia) glutamine as a source of energy is used more than in the physiological state and becomes a conditionally essential amino acid. Because of this, glutamine should be supplemented in these conditions. The European Society for Clinical Nutrition and Metabolism (ESPEN) since 2005 has presented recommendations of glutamine's use in different diseases and clinical states. This article presents current recommendations of glutamine supplementation in both enteral and parenteral nutrition.
    No preview · Article · Jan 2010 · Przegląd Gastroenterologiczny
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    ABSTRACT: The beneficial impact of probiotic strains on human health and longevity was noticed over 100 years ago. Since then, microorganisms with probiotic properties have been used in prophylaxis and therapy of many medical conditions, mainly those affecting the gastrointestinal tract but also those caused by immunological disturbances, such as food allergies, atopic dermatitis and reoccurring upper respiratory tract infections. Despite the very wide range of recommendations for probiotic use, many of them are not supported by reliable research confirming medicinal properties of probiotics. The results of randomized trials, published meta-analyses and literature reviews regarding probiotic use in many medical conditions are surveyed in the present work.
    No preview · Article · Jan 2010 · Przegląd Gastroenterologiczny