Evaluation of Parameters Affecting the Occurrence of Systemic Inflammatory Response Syndrome in Patients Operated on Due to Kidney Tumors

The application and prognostic nature of systemic inflammatory reaction syndrome (SIRS) is still being researched, as using SIRS parameters to predict patient status is cheap, efficient, fast, and easy. The study aimed to determine SIRS markers and postoperative complications occurrence in patients undergoing kidney tumor surgery, and to verify if SIRS occurrence depends on age, sex, BMI (body mass index), comorbidities, patients' general condition before the surgery, type of surgery, intraoperative blood loss, or intraoperative ischemia time. Body temperature, heart rate, respiratory rate, and leukocyte count were measured in patients (n = 285) operated on due to a kidney tumor on the first (T0) and third (T3) postoperative day. Univariable and multivariable logistic regression were used to analyze the factors affecting postoperative SIRS and complications occurrence. T0: SIRS developed in patients with higher BMI, >2 ASA points, and more substantial intraoperative blood loss. T3: SIRS developed in obese or overweight patients, with >2 ASA points, significantly higher relative HR change, lower relative body temperature change, respiratory rate, and leukocyte count. BMI values, preoperative general health status, and the amount of intraoperative blood loss in patients undergoing surgery due to a kidney tumor can contribute to SIRS occurrence. Patient's sex, age, tumor size, type of surgery, operated side, and time of intraoperative ischemia do not affect SIRS occurrence.

HOMOCYSTEINE AND CARDIOVASCULAR DISEASE - A CURRENT REVIEW

Cardiovascular diseases remain the leading cause of death worldwide for the past 20 years. Of these, ischemic heart disease has the highest mortality rate. In over 98% of cases it is caused by atherosclerosis of the coronary arteries. Homocysteine is an amino acid, containing a sulfhydryl group, which is formed as a result of the metabolism of the amino acids methionine and cysteine, which is supplied with protein-containing foods. A small amount of it is necessary for the proper functioning of the body, however, an increased concentration in blood plasma, which hyperhomocysteinemia, negatively affects blood vessels leading to the development of atherosclerosis and thrombotic com¬plications. The adverse effect on blood vessels results from various mechanisms, such as: excessive activation of Toll-like 4 receptor, activation N-methyl-d-aspartate receptors, increased production of reactive oxygen species, and impairment of nitric oxide synthesis. Elevated levels of reactive oxygen species are associated with increased expression of proinflammatory cytokines such as IL-1β, IL-6, TNF-α (tumor necrosis tumor necrosis factor), MCP-1 and intracellular adhesion molecule-1. Another factor contributing to hyperhomocysteinemia is mutation of the MTHFR gene, which in normal conditions is responsible for maintaining homocysteine levels within the normal range. People with MTHFR mutation are more prone to develop atherosclerosis and the following complications: myocardial infarction, stroke, thrombotic episodes and coronary artery disease. The aim of this paper is to present evidence supporting the role of homocysteine in the development of many cardiovascular diseases.

APELIN IN HEART FAILURE

Apelin is a biologically active protein encoded by the APLN gene. It was first isolated in 1998 as a ligand for the APJ receptor. It exists in several isoforms differing in polypeptide chain length and biological activity. It is secreted by white adipose tissue, and its expression has been identified in many body tissues, including the cardiovascular system, kidneys, lungs, CNS (especially the hypothalamus, suprachiasmatic and ventricular nuclei), skeletal muscle, mammary glands, adrenal glands, ovaries, stomach, liver cells, placenta, and breast milk. However, the highest concentrations were observed in the endocardium and endothelium of vascular smooth muscle cells. In myocardial tissue, apelin has a positive inotropic effect and exerts an opposing effect to the RAA (renin-angiotensin-aldosterone) system, lowering blood pressure. Therefore, its positive role in early stages of heart failure, in patients with hypertension and ischemic heart disease is emphasized. The synthesis and secretion of apelin by adipocytes makes it possible to classify this peptide as an adipokine. Therefore, its production in adipose tissue is enhanced in obesity. Furthermore, apelin has been shown to increase cellular sensitivity to insulin and improve glucose tolerance in the onset of type 2 diabetes, and therefore appears to play a significant role in the pathogenesis of metabolic disease. An accurate assessment of the importance of apelin in cardiovascular disease requires further studies, which may contribute to the use of apelin in the treatment of heart failure.

The Management of Chronic Back Pain in Primary Care Settings: Exploring Perceived Facilitators and Barriers to the Development of Patient-Professional Partnerships

Supporting patients in forming partnerships with health professionals is the key of effective self-management. This study aimed to explore the nature of patient-professional partnerships and its related factors that create facilitators and barriers to patients' self-management ability. A constructivist grounded theory approach was undertaken. Three main themes emerged: interaction and communication, integrated care, and service and system. A theoretical model was generated that posits effective communication, individualized integrated care, and high-quality service as key influences on the successful development of patient-professional partnerships and patients' ability to self-manage. Giving attention to these factors helps understand the development, implementation, mechanisms, and evaluation of building a patient-professional partnership and maximizes the opportunities for patient self-management of chronic pain. Future research and practice are needed to move beyond a simplistic focus on health outcomes to address the complex links between partnerships and treatment delivery processes, and interventions, effects, and patients' context.

Plasma amino acid coatings for a conformal growth of titania nanoparticles

We report on the conformal synthesis of ultrathin films from the amino acid histidine on flat silicon substrates and 3D periodic polymer structures via plasma enhanced chemical vapor deposition. We demonstrate the efficient utilization of this functional amino acid nanocoating for the formation of individual titania nanoparticles with dimensions from 2 to 15 nm depending upon reduction conditions. The titania nanoparticles were grown directly on histidine-functionalized planar and 3D polymer substrates by a wet-chemistry method that showed uniform surface coverage that reached approximately 75%. This approach demonstrates the potential for modifying the optical properties of periodic porous polymeric structures via direct conformal growth of titania nanoparticles.

End stage renal disease by patients with malignancy--ethical problems

The problem of co-occurrence of kidney failure, as well as ESRD and malignancy is relatively often and brings a significant therapeutical and moral challenge. The ethical basis of our consideration are "Evangelium Vitae" by John Paul II and "Declaration Jura et Bona". The fundamental choice is whether to start and/or continue the kidney replacement treatment. We present 3 algorithms for the most typical situations. The first ethical postulate in our considerations is that patients with the malignancy of good prognosis should not be denied of any treatment chance and should be dialysed as any other patient. In the situation of patients with neoplastic disease with bad prognosis and ESRD, the question of 'withholding or withdrawing' dialysis is essentially part of a fundamental question, what should be the ultimate goal of medicine? There is no doubt that the person most authorized to take a decision in such a situation is the patient provided it is a conscious decision based on full information. Therefore any decision to cease treatment, even submitted at the public notary, should be verified as long as a conscious contact with a patient is possible. In the situation of continued lack of logical contact with the patient who has not left any clear disposition for such circumstances we must take the decision based on their benefit. It is more than desired that the decision acquires the approval of the patient's family but in the situation when it is not possible the doctor decide. In the doubtful cases we should take decisions "towards life".

[Some ethical and historical aspects concerning placental blood transfusion]

Recently, a greater interest is observed concerning the taking of placental blood in order to use it in future. This article pays attention to some ethical aspects like the ownership of the placenta or the possible commercial problems. We reminded the very first study on placental blood transfusion which took place before the World War II and also other abandoned methods used in transfusion in the past.

[About the beginnings of otolaryngology in Poland in commemoration of the 150th anniversary of Teodor Heryng's birthday and the 100th anniversary of the founding of the first Laryngology Ward in Warsaw]

In this study was remain biography of two pioneers of polish laryngology--Teodor Heryng and Leopold Lubliner. The first laryngological subdivision in Warsaw was localised in St. Roch hospital. The first full equipment laryngological division where was open in Jewish hospital.

Does moxonidine increase cytotoxic activity of ethanol in rats? Preliminary report on the base of the ultrastructural study

Combined effects of moxonidine and ethanol on ultrastructure of selected Wistar-Kyoto rat organs (kidney, liver, heart) were investigated. In cells of the animals, which received moxonidine alone, no morphological changes were found. In the group of rats which received alcohol, several typical submicroscopical changes were found, especially related to the mitochondria. After the combined administration of ethanol and moxonidine the pathological changes were bigger than those found in animals which received alcohol alone. Those changes were particularly significant in kidney and liver. The results might indicate that moxonidine increased cytotoxic activity of ethanol on several organs in rats.

Day/night ratio of microproteinuria and blood pressure rhythm in type II diabetes

The paper discusses the results of the studies conducted with a group of patients with type II diabetes without clinical nephropathy. The aim of the study was to attempt to determine the markers for early stages of diabetic nephropathy in NIDDM patients. The following examinations were carried out: the level of selected microproteinuric components, 24 h monitoring of arterial blood pressure, and electrocardiogram (ECG). Among the patients examined, the level of alfa-1-microglobulin, albumin and immunoglobulin G (IgG) in diabetic patients was higher than in the control group, and the increased activity of beta NAG was observed. The 24 h profile of blood pressure and the ratio afternoon/night of albumin excretion flattened in the majority of diabetic patients. The results of the study suggest that the proximal tubules and the membranes of renal glomeruli are damaged as early as during the period of subclinical diabetic nephropathy.

[Microproteinuria and circadian rhythm of blood pressure in patients with arterial hypertension]

Microproteinuria is a recognized sign of early nephropathy in the course of arterial hypertension. There is few data concerning the excretion of proteins other than albumin in this group of patients. The aim of the study was to examine circadian rhythm of alfa-l-microglobulin (AlMG), albumin (ALB), immunoglobulin G (IgG) excretion and N-acetyl-beta-glukosaminidase (beta NAG)-activity, then to compare the results with the results of 24 hour ambulatory monitoring of arterial blood pressure in patients with arterial hypertension. The study comprised 28 patients. The control group included 27 healthy volunteers. Albumin concentration was determined by Beckman ICS2 nephelometer, using Beckman and Dako reagents. Blood pressure and ECG were monitored by analysis with ABP-system (AMP-USA). In patients with arterial hypertension significantly higher levels of ALB, AlMG, IgG and increased beta NAG activity were observed in morning urine samples. Despite hypotensive treatment blood pressure values were slightly, though significantly higher than in the control group. Among patients in the study circadian BP rhythm was disturbed. The results obtained suggest that in this group of patients subclinical nephropathy develops involving renal glomeruli and proximal tubules--probably resulting from vascular and humoral disorders, with accompanied hypertension.

[Evaluation of the accuracy of arterial pressure measurements with different types of devices used for self-monitoring]

The self-control is the important item in hypertension treatment. The results of blood pressure measurements were received by using various types using different of oscillometric equipment (thumb, wrist and arm manket) and compared with the outcomes of mercury sphygmomanometer which was used in the same trial. The satisfactory correlation of results from different types of equipment was confirmed with the exception of the thumb oscillometric apparatus results.

Human erythropoietin improves the blood platelet phospholipid composition in chronically hemodialyzed patients

Phospholipids play an essential role in platelet structure and function. In uremic patients an abnormal platelet phospholipid pattern is observed. We examined the influence of recombinant human erythropoietin (rhuEPO) on platelet phospholipid composition in hemodialyzed patients. Before rhuEPO therapy, phosphatidylethanolamine, phosphatidylinositol, and phosphatidylcholine were significantly reduced as compared with a healthy control group. After rhuEPO treatment, the phosphatidylethanolamine, phosphatidylinositol, and phosphatidylcholine concentrations showed a significant increase. We conclude that rhuEPO partially normalizes the platelet phospholipid composition in uremia.

[The effect of human recombinant erythropoietin on levels of plasma phospholipids in patients chronically treated with hemodialysis]

In uremic patients a disturbed lipid metabolism is observed. In our former works a positive effect of erythropoietin (EPO) on blood platelet phospholipids composition in uremic patients was indicated. In this study we examined the EPO influence on blood plasma phospholipids in chronically hemodialyzed patients. Phospholipids were measured by thin layer chromatography method before and 3 months after the beginning of EPO treatment. EPO was administered subcutaneously, 2000 U twice a week. Decreased phosphatidylethanolamine, phosphatidylinositol and phosphatidylcholine levels were shown in patients before EPO treatment, compares with the control group. During EPO therapy the phospholipid levels approached to normal values. Conclusion is that EPO administration has a positive influence on blood plasma phospholipids in hemodialyzed patients. The detailed importance of this event has been not known yet, but our observations suggest that EPO profoundly interferes with lipid metabolism.

[Change of platelet function after the beginning of repeated hemodialysis treatment in patients with uremia]

The disturbances of platelet function in end-stage renal failure varies in dialysed and non-dialysed patients. We examined some platelet function in 11 uremic patients treated conservatively (TC) and, again in the same patients, 3-month after the beginning of repeated hemodialysis treatment (HD). The blood samples were taken before hemodialysis. In TC patients normal platelet count, prolonged bleeding time, normal platelet aggregation, unchanged PF4 activity and decreased PF3 availability were shown, compared with control group. In HD patients also normal platelet count and prolonged bleeding time were noted, but increased platelet aggregation, increased PF4 activity and PF3 availability were observed, compared with control group and with TC patients. We conclude that in TC patients rather decreased platelet function was observed; after the beginning of hemodialysis treatment some platelet function became significantly enhanced, which suggests platelet activation. Moreover, in HD patients the disturbances of platelet function before dialysis were shown, then it is possible that platelet activation persists in interdialytic period.

[Distribution of platelet membrane phospholipids in patients chronically hemodialyzed using cuprophane and cellulose acetate membranes]

The hemodialysis treatment is associated with a number of untoward events due to the blood-membrane contact. The severity of these reactions depends greatly on the kind of membrane. One of such effects is platelet activation with platelet membrane phospholipid translocation. The aim of this study was to assess the platelet membrane phospholipids distribution during hemodialysis through cuprophane (group I--12 patients) and cellulose acetate (group II--13 patients) membranes. Samples were taken before hemodialysis 14 days after treatment with the same dialyzer type. Phospholipids distribution was determined using a non penetrating tracer (TNBS) and by highly purified phospholipases hydrolysis. In patients of the group I a significant increase of phosphatidylserine and phosphatidylethanolamine at the outer platelet membrane surface was noted, as well as decrease in the other phospholipid classes, compared with control group. In patients of the group II the disturbances of phospholipid distribution were markedly smaller, and concerned only phosphatidylserine and sphingomyelin. Our data indicate that in patients dialyzed with the use of cuprophane membrane the disturbances of platelet membrane phospholipid distribution persist during the dialysis period. The milder intensity of these disturbances in patients treated using cellulose acetate suggests a better biocompatibility of this membrane.

The effect of pilocarpine on electrodermal resistance in chronic hemodialyzed patients

Electric resistance of forearm skin was examined in 40 hemodialyzed (HD) patients under resting conditions and after subjecting the skin to the action of a 10% pilocarpine gel. The results were compared with a control group of a 100 healthy volunteers. An increased skin resistance was observed before dialysis and then a significant post-dialysis fall to the normal level followed. The response to the applied pharmacological stimulus in the HD group was similar to that in the control group. The results suggest that the rise in skin resistance in patients with renal failure and the so-called uremic dry skin, are not connected with the dysfunction of the glands themselves but rather with their insufficient stimulation.

[Arrhythmia in patients on dialysis treatment for chronic renal failure]

In 6 patients treated with repeated peritoneal dialyses 48-hour ECG monitoring was carried out. In no patient significant heart rhythm disturbances were demonstrated during the dialysis and 24 hours after its completion. On the ground of pathological results of Valsalva's manoeuvre function disturbances of the autonomic nervous system were disclosed but these showed no correlation with premature ventricular and supraventricular++ ectopic beats appearing periodically in some patients. The study showed that under conditions of sufficient control of electrolyte balance (especially potassium) the patients treated with peritoneal dialyses are not a group at risk for arrhythmia development.

Leukopenia with different regenerated haemodialysis membranes

The white blood cell count (WBC) decreases during haemodialysis and it was investigated as a function of different dialysis membranes. Each of them was used four times, applying different sterilization methods. Twelve chronic haemodialysis patients were studied and dialysed with cuprophan and polyacrylonitrile (PAN) membranes. Cuprophan was studied by a dry sterilization method and after perchloric acid and formalin treatment. PAN was studied with dry sterilization and after perchloric acid. As it has been shown, cuprophan membranes cause significantly more marked neutropenia than PAN. No significant difference was seen in pO2, pH, pCO2 and bicarbonate between dialysers used four times. The results indicate differences in biocompatibility between cuprophan and PAN membranes, independent of the sterilization method employed.