Therapeutic Apheresis in Metabolic Syndrome

Nanomembrane-based Apheresis as Safe and Effective Therapy for Cytomegalovirus and Epstein-Barr Virus Reactivation

BACKGROUND: Heavy training schedules or endurance competitions in marathon are forms of extreme physical stress and lead to immunodepression in runners which could be associated with increased susceptibility to viral reactivation by ubiquitous viral infection such as cytomegalovirus (CMV) and Epstein-Barr virus (EBV). Lately, it was confirmed presence of elevated CMV and EBV loads and the lower antibody titers in competitive athletes. The most common clinical features are fatigue and adynamia accompanied with liver damage, varying from mild and transient elevation of aminotransferases to serious acute hepatitis and liver failure. CASE REPORT: Bearing in mind that a professional practice of marathon running is hazardous for the liver, therapeutic action is necessary as soon as possible to avoid serious complications and even cessation of professional competition. In our case report of professional female marathon runner, we need to treat CMV and EBV reactivation which caused liver damage, prevented regular trainings, and upcoming competitions. We opted for four sessions of nanomembrane based apheresis performed every other day for removal pathological products resulting from virus reactivation to break through the course of the disease and to prevent complications. After completing the whole procedure control laboratory tests and abdominal ultrasound were in physiological ranges. CONCLUSION: Hence, nanomembrane based apheresis can be effective and safe treatment of liver damages for elite marathon runners as well as for athletes.

Effect of type 2 diabetes mellitus on efficacy and safety of therapeutic apheresis for severe hypertriglyceridemia

The efficacy and safety of triglyceride (TG) apheresis in patients with type 2 diabetes mellitus (DM) is unclear. Diabetic complications may predispose patients to adverse events (AEs) associated with the apheresis procedure, and diabetic dyslipidemia may negatively affect the efficacy of therapeutic apheresis (TA). We investigated the effect of DM on the efficacy and complications of TA. Patients with severe hypertriglyceridemia who underwent apheresis for treatment or for the prevention of acute pancreatitis were included in this retrospective study. Epidemiological data, lipid parameters, and AEs were recorded before and after each therapeutic session. A total of 166 procedures were performed in 27 patients. Group 1 included 17 patients with type 2 DM, and Group 2 included 10 patients without DM. The mean percentage decrease in TG levels (TG%) was higher in Group 1 (71.9% vs 60.6%, P < .001). The TG% was negatively correlated with the duration of DM in Group 1 (r = -.49, P < .001). The total number of TA sessions was 142 in patients who underwent double filtration plasmapheresis and 24 in patients who underwent therapeutic plasma exchange. We observed 9 (5.4%) mild-to-moderate AEs. No intergroup difference was observed in the total number of AEs (P = .06). TA is safe and effective in patients with type 2 DM with severe hypertriglyceridemia.

Advanced glycation end products and adipocytokines and oxidative stress in placental tissues of pregnant women with gestational diabetes mellitus

Correlation between expression levels of advanced glycation end products (AGEs) and adipocytokines and oxidative stress index malondialdehyde (MDA) in placental tissues of pregnant women with gestational diabetes mellitus (GDM) was investigated. Seventy-two cases of GDM pregnant women who received routine prenatal examination and gave birth in the Department of Obstetrics, Binzhou City Center Hospital from March 2016 to May 2017 were collected as the observation group. Another 80 cases of normal pregnant women who gave birth at the same time were selected as the control group. Enzyme linked immunosorbent assay (ELISA) was used to detect the expression levels of AGEs, visfatin, APN and IL-6 in the lysate of placental tissues. MDA levels were measured by thiobarbituric acid method. Correlation of expression levels of AGEs, visfatin, APN, IL-6 and MDA were analyzed. The expression level of MDA in placental tissues of the observation group was significantly higher than that of the control group (t=16.44, P<0.001). The correlation of expression levels between AGEs, adipocytokines and MDA in placental tissues of the two groups was analyzed, and it was found that the expression levels of AGEs, visfatin and IL-6 in the two groups were positively correlated with MDA. There was a significantly negative correlation between APN and MDA in the two groups. The incidence of cesarean section, neonatal hypoglycemia, fetal distress and macrosomia in the observation group was significantly higher than that in the control group (P<0.05). There was no significant difference in the incidence of membrane rupture and premature birth between the two groups (P>0.05). In conclusion, the expression levels of AGEs, visfatin and IL-6 in placental tissues of GDM pregnant women are positively correlated with MDA. There is a significant negative correlation between APN and MDA, and they play an important role in the pathogenesis of GDM.