Effects of fenofibrate on plasma cytokine concentrations in patients with atherosclerosis and hyperlipoproteinemia IIb

BACKGROUND AND OBJECTIVE

In recent studies atherosclerosis has often been referred to as immune disease. The atherosclerotic plaque consists of large amounts of inflammatory cells, mainly monocytes/macrophages and T lymphocytes. Macrophages activated by low-density lipoproteins (LDL) secrete tumor necrosis factor alpha (TNF-alpha) and interleukin-1 (IL-1) in vitro, while LDL-stimulated T lymphocytes release interferon gamma (IFN-gamma). The aim of this study was to estimate the plasma levels of TNF-alpha, IL-1, IFN-gamma in patients with hyperlipoproteinemia IIb (HLPIIb) and atherosclerosis. Since the fibrates are drugs of choice in HLPIIb, we additionally evaluated the effect of fibrates on the cytokine levels.

METHODS

Ten patients with HLPIIb were treated with micronized fenofibrate for 1 month. Before and after treatment, the cytokine levels were measured by the ELISA method. To accurately evaluate cytokine levels, we excluded atherosclerotic patients and control subjects with any inflammatory disease.

RESULTS

The initial lipid parameters were as follows: total cholesterol (TC): 6.9 +/- 0.24 mmol/l, triglycerides (TG): 3.44 +/- 0.53 mmol/l, LDL: 4.35 +/- 0.12 mmol/l, and apolipoprotein B (ApoB): 1.62 +/- 0.05 g/l. After 1 month of fenofibrate treatment the parameters decreased to the following values: TC 5.36 +/- 0.42 mmol/l (p < 0.05), TG 1.94 +/- 0.30 mmol/l (p < 0.05), ApoB 1.43 +/- 0.04 g/l (p < 0.01), and LDL 3.75 +/- 0.34 mmol/l (p > 0.05). Before therapy, TNF-alpha levels in atherosclerotic patients were higher than in control subjects, 19.2 +/- 1.6 and 9.9 +/- 1.1 pg/ml, respectively (p < 0.01). After 1-month therapy, TNF-alpha levels in atherosclerotic patients were 9.2 +/- 1.0 pg/ml (p < 0.01). Similarly, the initial levels of IFN-gamma were higher in atherosclerotic patients compared with healthy subjects, 44.4 +/- 5.3, and 19.4 +/- 2.1 pg/ml, respectively (p < 0.01). After fenofibrate therapy, IFN-gamma levels decreased to 24.8 +/- 2.9 pg/ml (p < 0.01). The decreased levels of TC, TG, and LDL correlated with the decreased levels of TNF-alpha and IFN-gamma.

CONCLUSION

The results of this study indicate that plasma TNF-alpha and IFN-gamma levels in hyperlipidemic patients are higher than in healthy subjects, and that fenofibrate is effective in decreasing lipids and cytokines in plasma.

[Needle testicular biopsy in the diagnosis of male infertility]

OBJECTIVES

Evaluation of testicular tissue is very important diagnostic procedures in cryptozoospermia and azoospermia. It is verified the patient for treatment (stimulation spermatogenesis), for micromanipulation ICSI or for insemination donor semen procedure. Surgical biopsy is very popular between andrologist and urologist, but needle biopsy seems to be easier and safer.

DESIGN

The authors present their experience with needle testicular biopsy during the diagnosis patients with azoospermia or cryptozoospermia and the men with paraplegia after trauma and without ejaculation.

MATERIAL AND METHODS

The study group included 63 biopsies in 58 men with azoospermia and severe oligoasthenozoospermia (cryptozoospermia) and 2 with paraplegia. The specimens were taken from 125 testes under general anesthesia (i.v-Diprivan, Propofol, Zeneca and Fentanyl) using biopsy needle from Hepafix B. Braun Melsungen, Germany. All procedures were performed as a day case.

RESULTS

In 95% specimens were adequate for histopathological investigations and for planning the treatment. Only one complication (0, 8%) -small haematoma testis was observed.

CONCLUSIONS

The needle biopsy of testicular tissue is sufficiency in histopathological examination, safe for patients and easy for urologists. The total cost is much more lower than cost of surgical biopsy.

[Levels of tumor necrosis factor alpha in serum of patients with hyperlipoproteinemia IIB before and after micronized fenofibrate therapy]

Tumor necrosis factor alpha (TNF alpha) secreted by activated macrophages stimulates proliferation and migration of vascular smooth muscle in atherogenesis. Up to now, the effect of fibrates on concentration of TNF-alpha has not been investigated. The aim of this study was to estimate TNF-alpha plasma concentration in healthy subjects before and after fenofibrate therapy in patients with hyperlipoproteinaemia IIb and to correlate their levels with plasma concentration of total cholesterol (TC), low density lipoproteins (LDL) and apolipoprotein B (ApoB).

METHODS

10 patients with hyperlipoproteinaemia IIb were treated with micronized fenofibrate (Lipanthyl 200 m-Fournier) for 1 month. Cytokines levels before and after therapy was measured by the ELISA method with Genzyme kits.

RESULTS

The levels of lipid parameters at the onset study were as follows: TC: 265.4 +/- 9.4 mg%, TG: 344 +/- 53 mg%, LDL: 167.2 +/- 4.7 mg%, and ApoB: 1.62 +/- 0.05 g/l. After 1-month therapy with Lipanthyl 200 m the parameters decreased: TC 206 +/- 16 mg% (p < 0.05), TG: 194 +/- 30 mg% (p < 0.05), ApoB: 1.43 +/- 0.04 g/l (p < 0.01), and LDL: 144.4 +/- 12.9 mg% (ns). The decreased level of TC, TG and LDL correlated with the decreased concentration of TNF alpha. Before treatment the TNF concentration was 19.2 +/- 1.6 pg/ml and was higher than the concentration of control subjects (9.9 +/- 1.1 pg/ml, p < 0.01). After 1-month therapy the level of TNF alpha in blood from patient was 9.2 +/- 1.0 pg/ml (p < 0.01). The results of this study indicate that the concentrations of TNF alpha in plasma from hyperlipidemic patients are higher than concentrations of healthy subjects. Fenofibrate decreased the levels of this cytokine. This effect may be of significance for the treatment of HLPIIb and of atherosclerosis prevention.

[Advanced nasopharyngeal tumor]

Nasopharyngeal cancer is a rare neoplasm in most parts of the world, it is the most common cancer the Chinese. Nasopharyngeal cancer is often misdiagnosed because of the variety of subtle signs and symptoms and the difficulty of examining this region. The most common neoplasms of the nasopharynx are epithelial malignancies originates from epithelial cells in the nasopharynx. The authors has presented a rare case of advanced nasopharyngeal adenocarcinoma.

[A case of maxillary tumor--difficulties with diagnosis and treatment]

Atypical fibroxanthoma is an uncommon mesenchymal neoplasm. It is cytologically malignant but usually clinically being tumor which typically arises in sundamaged skin of the head and neck region. The principal differential diagnoses are spindle cell squamous carcinoma, melanoma and leiomyosarcoma. Immunohistochemistry plays a key role in diagnosis. We report a patient with atypical fibroxanthoma of the maxilla and the neck.

Hepatitis B and C virus infection in Polish children with malignancies

Infections by hepatotropic viruses belong to the most common complications of chemotherapy in children suffering from neoplastic diseases. The rate of hepatitis B virus (HBV) or hepatitis C virus (HCV) infection and the effectiveness of passive immunization against HBV were studied in 285 children; 148/285 with lymphoproliferative diseases and 137/285 with solid tumours. HBV infection was observed in 10.2% children receiving hepatitis B immune globulin as compared to 36.8% without passive immunization against HBV. Anti-HCV antibodies were similar in both groups amounting 38.7% and 32.6% respectively.

CONCLUSION

The results show that hepatitis B immune globulin administration is effective and that HCV might become the main cause of hepatitis among immunosuppressed patients in the future.

[Interferon alpha in the treatment of chronic hepatitis B in children]

Nine children suffering from chronic hepatitis due to hepatitis B virus (HBV) infection were treated with recombinant IFN-alpha-2C for 16 weeks. Replication of HBV was inhibited in 5 cases while a decreased inflammatory process in the liver was attained in 3. The treatment was very well tolerated in all of the studied children. A significant increase of ALT activity in the fourth week of treatment seems to be a positive prognostic factor.

[Metastasis of clear cell renal cancer to the nose and nasal sinuses]

Metastases of malignant tumours of remote location to the nose and nasal sinuses are rare. The possibility of their occurrence should be, however, taken into account, since rhinological manifestations may precede the diagnosis of primary tumour. This is true especially in the case of clear-cell renal cancer whose metastases are the most frequently found secondary malignant tumours of the nose and nasal sinuses. A case is described of clear-cell renal cancer metastasis to the frontal sinus.

Impairment of the oxygen-dependent microbicidal mechanisms of polymorphonuclear neutrophils in patients with type 2 diabetes is not associated with increased susceptibility to infection

Phagocytosis, bactericidal capacity and some selected parameters of oxygen-dependent bactericidal mechanisms were evaluated in 20 patients with type 2 diabetes being in similar (intermediate) state of metabolic control and in 15 healthy individuals. Polymorphonuclear neutrophils (PMNs) from diabetics showed normal ability to phagocytose staphylococci, a decreased Intracellular bacteria killing, the impaired stimulated superoxide anion (O2-) and hydrogen peroxide (H2O2) production and the low intracellular myeloperoxidase activity. The obtained data seem to indicate that the decreased bacterial killing by PMNs isolated from diabetics are partly at least related to an impairment of the oxygen-dependent bactericidal mechanisms. Since none of the diabetic patients suffered from recurrent infection the clinical significance of our finding is still uncertain.

Adherence of blood T cells to rat microvascular endothelial cells. Comparative studies of T lymphocytes isolated from various tissues

Lymphocytes isolated from various tissues exhibit different magnitudes of adherence to endothelial cells (EC) in vitro. Nevertheless, a good correlation between the lymphocyte adherence to EC in vitro and their migratory properties to sites of inflammation in vivo was found. The main goal of this study was to compare, using unstimulated and IFN-gamma-, TNF-alpha- or LPS-pretreated EC, the adherence of T cells isolated from blood (BTC), with the adherence of T lymphocytes obtained from other tissues. The results show that BTC belong to poorly adhering cells. However, their adherence was increased about 3-fold, when EC were pretreated with IFN-gamma, TNF-alpha or LPS. This adherence was very similar to that observed for lymph node T cells (LNTC) and 2-3 times lower than the adherence of spleen T cells (SpTC) and peritoneal exudate T cells (PETC). In some experiments, T lymphocytes were incubated for 1 h with concanavalin A (Con A) and this led to the highest increase of BTC adherence, but the enhancement of the adherence was significantly smaller than the increase noted for SpTC and PETC. The differences in the adherence of lymphocytes isolated from various tissues may suggest that different adhesion molecules are responsible for their binding to EC.

The influence of thymus extracts on the chemotaxis of polymorphonuclear neutrophils (PMN) from patients with insulin-dependent diabetes mellitus (IDD)

The main goal of this study was to evaluate the possible influence of thymus extracts on the chemotaxis of PMN isolated from diabetic patients. The analyzed group consisted of fifty patients with insulin-dependent diabetes mellitus (IDD), and twenty healthy adults were taken as controls. The results showed, that PMN isolated from patients with IDD manifested the impaired chemotaxis toward zymosan-activated plasma (ZAP), plasma incubated with cellophane and supernate from E. coli culture. Both thymus extracts did not change the directed migration toward control plasma and toward ZAP. THYMEX-L did improve the migration of diabetic PMN toward plasma incubated with cellophane, whereas TFX-THYMOMODULIN ameliorated the impaired chemotaxis toward supernate from E. coli culture. Both thymus extracts can attract PMN obtained from healthy donors, but not the cells isolated from diabetic patients.

Effect of T cell activation on lymphocyte-endothelial cell adherence and the role of VLA-4 in the rat

Lymphocyte migration from the blood is in part controlled by lymphocyte surface adhesion molecules, such as VLA-4 and LFA-1. Small lymph node lymphocytes from rats adhere poorly to rat microvascular endothelial cells (EC), while lymphoblasts from antigen-challenged lymph nodes have an enhanced adherence to EC and preferentially migrate to inflamed tissues. This lymphoblast adherence is partially inhibited by anti-VLA-4. The effects of in vitro activation of lymph node lymphocytes on lymphocyte-EC adhesion were examined. In vitro stimulation of T cells with concanavalin A or calcium ionophore and phorbol myristate acetate (PMA) for 1-4 hr caused a marked (7- to 12-fold) increase in lymphocyte adhesion to unstimulated and IFN-gamma- or LPS-treated EC. This adhesion was partially inhibited by anti-VLA-4, was not associated with increased VLA-4 expression, was partially inhibited at 4 degrees C, and was virtually eliminated at 4 degrees C with anti-VLA-4. Anti-CD3 or IL-2 stimulation of T cells also enhanced lymphocyte adhesion but required 2-3 days of culture. This adhesion was not inhibited by anti-VLA-4 and was almost totally inhibited at 4 degrees C, suggesting a primarily LFA-1-mediated adhesion. In conclusion, stimulation of T cells with Con A or calcium ionophore plus PMA caused a rapid enhancement of lymphocyte-EC adhesion mediated in part through VLA-4, while stimulation of T cells with anti-CD3 or IL-2 enhanced lymphocyte adhesion apparently independent of VLA-4.

Effect of organophosphoric pesticides on the behaviour of NBT-dye reduction and E rosette formation tests in human blood

Investigations have been undertaken to determine the effect of occupational exposure to organophosphoric pesticides on the behaviour of NBT-dye reduction and spontaneous E rosette formation tests. A significant decrease of the values of the examined cellular parameters of human immunity and of the absolute lymphocyte count in peripheral blood was found in 31 workers, as compared to 30 controls. Moreover, the NBT-dye reduction decrease showed a positive linear correlation with a reduced acetylcholinesterase (AChE) activity. The exposure time showed a negative linear correlation of the phagocytic index of the NBT-dye reduction test. It is concluded that depressed NBT-dye reduction and diminished spontaneous E rosette formation may be regarded as a probable mode of the effect of organophosphoric chemicals on metabolic and membrane damage of human cells. A possible role of endogenous acetylcholine poisoning in the development of these pathologic conditions is also discussed.

A person–environment analysis of job stress: A contingency model explanation

The contingency model of leadership was applied in a field study of job stress. Fifty-one university administrators completed a series of questionnaires that assessed their leadership style, degree of situational control within their work setting, perceived job stress, physical health, and psychological well-being. Multivariate analyses of variance (MANOVAs) showed that administrators whose leadership style and level of situational control were "in match" reported significantly less job stress, fewer health problems, and fewer days missed from work than administrators who were "out of match." The results are discussed as supporting the person-environment fit model of job stress.

Limberg flap coverage for axillary defects resulting from excision of hidradenitis suppurativa

After excision of the apocrine gland containing tissue, we advocate wound closure with a Limberg flap. Our results to date suggest that this approach, which combines definitive treatment with surgical economy, warrants an aggressive attitude toward even early cases of axillary "apocrinitis".