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Tepes M, Krezic I, Vranes H, Smoday IM, Kalogjera L, Zizek H, Vukovic V, Oroz K, Kovac KK, Madzar Z, Rakic M, Miskic B, Sikiric S, Barisic I, Strbe S, Antunovic M, Novosel L, Kavelj I, Vlainic J, Dobric I, Staresinic M, Skrtic A, Seiwerth S, Blagaic AB, Sikiric P. Stable Gastric Pentadecapeptide BPC 157 Therapy: Effect on Reperfusion Following Maintained Intra-Abdominal Hypertension (Grade III and IV) in Rats. Pharmaceuticals (Basel) 2023; 16:1554. [PMID: 38004420 PMCID: PMC10675657 DOI: 10.3390/ph16111554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 10/20/2023] [Accepted: 10/27/2023] [Indexed: 11/26/2023] Open
Abstract
Given in reperfusion, the use of stable gastric pentadecapeptide BPC 157 is an effective therapy in rats. It strongly counteracted, as a whole, decompression/reperfusion-induced occlusion/occlusion-like syndrome following the worst circumstances of acute abdominal compartment and intra-abdominal hypertension, grade III and grade IV, as well as compression/ischemia-occlusion/occlusion-like syndrome. Before decompression (calvariectomy, laparotomy), rats had long-lasting severe intra-abdominal hypertension, grade III (25 mmHg/60 min) (i) and grade IV (30 mmHg/30 min; 40 mmHg/30 min) (ii/iii), and severe occlusion/occlusion-like syndrome. Further worsening was caused by reperfusion for 60 min (i) or 30 min (ii/iii). Severe vascular and multiorgan failure (brain, heart, liver, kidney, and gastrointestinal lesions), widespread thrombosis (peripherally and centrally) severe arrhythmias, intracranial (superior sagittal sinus) hypertension, portal and caval hypertension, and aortal hypotension were aggravated. Contrarily, BPC 157 therapy (10 µg/kg, 10 ng/kg sc) given at 3 min reperfusion times eliminated/attenuated venous hypertension (intracranial (superior sagittal sinus), portal, and caval) and aortal hypotension and counteracted the increases in organ lesions and malondialdehyde values (blood ˃ heart, lungs, liver, kidney ˃ brain, gastrointestinal tract). Vascular recovery promptly occurred (i.e., congested inferior caval and superior mesenteric veins reversed to the normal vessel presentation, the collapsed azygos vein reversed to a fully functioning state, the inferior caval vein-superior caval vein shunt was recovered, and direct blood delivery returned). BPC 157 therapy almost annihilated thrombosis and hemorrhage (i.e., intracerebral hemorrhage) as proof of the counteracted general stasis and Virchow triad circumstances and reorganized blood flow. In conclusion, decompression/reperfusion-induced occlusion/occlusion-like syndrome counteracted by BPC 157 therapy in rats is likely for translation in patients. It is noteworthy that by rapidly counteracting the reperfusion course, it also reverses previous ischemia-course lesions, thus inducing complete recovery.
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Affiliation(s)
- Marijan Tepes
- Department of Pharmacology, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia; (M.T.); (I.K.); (H.V.); (I.M.S.); (L.K.); (H.Z.); (V.V.); (K.O.); (K.K.K.); (Z.M.); (I.B.); (S.S.); (L.N.); (I.K.); (A.B.B.)
- Department of Clinical Medicine, Faculty of Dental Medicine and Health Osijek, 31000 Osijek, Croatia;
- PhD Program Translational Research in Biomedicine-TRIBE, School of Medicine, University of Split, 21000 Split, Croatia
| | - Ivan Krezic
- Department of Pharmacology, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia; (M.T.); (I.K.); (H.V.); (I.M.S.); (L.K.); (H.Z.); (V.V.); (K.O.); (K.K.K.); (Z.M.); (I.B.); (S.S.); (L.N.); (I.K.); (A.B.B.)
| | - Hrvoje Vranes
- Department of Pharmacology, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia; (M.T.); (I.K.); (H.V.); (I.M.S.); (L.K.); (H.Z.); (V.V.); (K.O.); (K.K.K.); (Z.M.); (I.B.); (S.S.); (L.N.); (I.K.); (A.B.B.)
| | - Ivan Maria Smoday
- Department of Pharmacology, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia; (M.T.); (I.K.); (H.V.); (I.M.S.); (L.K.); (H.Z.); (V.V.); (K.O.); (K.K.K.); (Z.M.); (I.B.); (S.S.); (L.N.); (I.K.); (A.B.B.)
| | - Luka Kalogjera
- Department of Pharmacology, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia; (M.T.); (I.K.); (H.V.); (I.M.S.); (L.K.); (H.Z.); (V.V.); (K.O.); (K.K.K.); (Z.M.); (I.B.); (S.S.); (L.N.); (I.K.); (A.B.B.)
| | - Helena Zizek
- Department of Pharmacology, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia; (M.T.); (I.K.); (H.V.); (I.M.S.); (L.K.); (H.Z.); (V.V.); (K.O.); (K.K.K.); (Z.M.); (I.B.); (S.S.); (L.N.); (I.K.); (A.B.B.)
| | - Vlasta Vukovic
- Department of Pharmacology, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia; (M.T.); (I.K.); (H.V.); (I.M.S.); (L.K.); (H.Z.); (V.V.); (K.O.); (K.K.K.); (Z.M.); (I.B.); (S.S.); (L.N.); (I.K.); (A.B.B.)
| | - Katarina Oroz
- Department of Pharmacology, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia; (M.T.); (I.K.); (H.V.); (I.M.S.); (L.K.); (H.Z.); (V.V.); (K.O.); (K.K.K.); (Z.M.); (I.B.); (S.S.); (L.N.); (I.K.); (A.B.B.)
| | - Katarina Kasnik Kovac
- Department of Pharmacology, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia; (M.T.); (I.K.); (H.V.); (I.M.S.); (L.K.); (H.Z.); (V.V.); (K.O.); (K.K.K.); (Z.M.); (I.B.); (S.S.); (L.N.); (I.K.); (A.B.B.)
| | - Zrinko Madzar
- Department of Pharmacology, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia; (M.T.); (I.K.); (H.V.); (I.M.S.); (L.K.); (H.Z.); (V.V.); (K.O.); (K.K.K.); (Z.M.); (I.B.); (S.S.); (L.N.); (I.K.); (A.B.B.)
| | - Mislav Rakic
- Department of Abdominal Surgery, Clinical Hospital Dubrava, 10040 Zagreb, Croatia;
| | - Blazenka Miskic
- Department of Clinical Medicine, Faculty of Dental Medicine and Health Osijek, 31000 Osijek, Croatia;
| | - Suncana Sikiric
- Department of Pathology, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia; (S.S.); (S.S.)
| | - Ivan Barisic
- Department of Pharmacology, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia; (M.T.); (I.K.); (H.V.); (I.M.S.); (L.K.); (H.Z.); (V.V.); (K.O.); (K.K.K.); (Z.M.); (I.B.); (S.S.); (L.N.); (I.K.); (A.B.B.)
| | - Sanja Strbe
- Department of Pharmacology, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia; (M.T.); (I.K.); (H.V.); (I.M.S.); (L.K.); (H.Z.); (V.V.); (K.O.); (K.K.K.); (Z.M.); (I.B.); (S.S.); (L.N.); (I.K.); (A.B.B.)
| | - Marko Antunovic
- Department of Pharmacology, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia; (M.T.); (I.K.); (H.V.); (I.M.S.); (L.K.); (H.Z.); (V.V.); (K.O.); (K.K.K.); (Z.M.); (I.B.); (S.S.); (L.N.); (I.K.); (A.B.B.)
| | - Luka Novosel
- Department of Pharmacology, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia; (M.T.); (I.K.); (H.V.); (I.M.S.); (L.K.); (H.Z.); (V.V.); (K.O.); (K.K.K.); (Z.M.); (I.B.); (S.S.); (L.N.); (I.K.); (A.B.B.)
| | - Ivana Kavelj
- Department of Pharmacology, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia; (M.T.); (I.K.); (H.V.); (I.M.S.); (L.K.); (H.Z.); (V.V.); (K.O.); (K.K.K.); (Z.M.); (I.B.); (S.S.); (L.N.); (I.K.); (A.B.B.)
| | - Josipa Vlainic
- Laboratory for Advanced Genomics, Division of Molecular Medicine, Institute Ruder Boskovic, 10000 Zagreb, Croatia;
| | - Ivan Dobric
- Department of Surgery, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia;
| | - Mario Staresinic
- Department of Surgery, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia;
| | - Anita Skrtic
- Department of Pathology, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia; (S.S.); (S.S.)
| | - Sven Seiwerth
- Department of Pathology, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia; (S.S.); (S.S.)
| | - Alenka Boban Blagaic
- Department of Pharmacology, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia; (M.T.); (I.K.); (H.V.); (I.M.S.); (L.K.); (H.Z.); (V.V.); (K.O.); (K.K.K.); (Z.M.); (I.B.); (S.S.); (L.N.); (I.K.); (A.B.B.)
| | - Predrag Sikiric
- Department of Pharmacology, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia; (M.T.); (I.K.); (H.V.); (I.M.S.); (L.K.); (H.Z.); (V.V.); (K.O.); (K.K.K.); (Z.M.); (I.B.); (S.S.); (L.N.); (I.K.); (A.B.B.)
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Amic F, Drmic D, Bilic Z, Krezic I, Zizek H, Peklic M, Klicek R, Pajtak A, Amic E, Vidovic T, Rakic M, Milkovic Perisa M, Horvat Pavlov K, Kokot A, Tvrdeic A, Boban Blagaic A, Zovak M, Seiwerth S, Sikiric P. Bypassing major venous occlusion and duodenal lesions in rats, and therapy with the stable gastric pentadecapeptide BPC 157, L-NAME and L-arginine. World J Gastroenterol 2018; 24:5366-5378. [PMID: 30598581 PMCID: PMC6305534 DOI: 10.3748/wjg.v24.i47.5366] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 11/26/2018] [Accepted: 12/01/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To investigate whether duodenal lesions induced by major venous occlusions can be attenuated by BPC 157 regardless nitric oxide (NO) system involvement.
METHODS Male Wistar rats underwent superior anterior pancreaticoduodenal vein (SAPDV)-ligation and were treated with a bath at the ligated SAPDV site (BPC 157 10 μg, 10 ng/kg per 1 mL bath/rat; L-NAME 5 mg/kg per 1 mL bath/rat; L-arginine 100 mg/kg per 1 mL bath/rat, alone and/or together; or BPC 157 10 μg/kg instilled into the rat stomach, at 1 min ligation-time). We recorded the vessel presentation (filled/appearance or emptied/disappearance) between the 5 arcade vessels arising from the SAPDV on the ventral duodenum side, the inferior anterior pancreaticoduodenal vein (IAPDV) and superior mesenteric vein (SMV) as bypassing vascular pathway to document the duodenal lesions presentation; increased NO- and oxidative stress [malondialdehyde (MDA)]-levels in duodenum.
RESULTS Unlike the severe course in the SAPDV-ligated controls, after BPC 157 application, the rats exhibited strong attenuation of the mucosal lesions and serosal congestion, improved vessel presentation, increased interconnections, increased branching by more than 60% from the initial value, the IAPDV and SMV were not congested. Interestingly, after 5 min and 30 min of L-NAME and L-arginine treatment alone, decreased mucosal and serosal duodenal lesions were observed; their effect was worsened at 24 h, and no effect on the collateral vessels and branching was seen. Together, L-NAME+L-arginine antagonized each other’s response, and thus, there was an NO-related effect. With BPC 157, all SAPDV-ligated rats receiving L-NAME and/or L-arginine appeared similar to the rats treated with BPC 157 alone. Also, BPC 157 in SAPDV-ligated rats normalized levels of NO and MDA, two oxidative stress markers, in duodenal tissues.
CONCLUSION BPC 157, rapidly bypassing occlusion, rescued the original duodenal flow through IAPDV to SMV flow, an effect related to the NO system and reduction of free radical formation.
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Affiliation(s)
- Fedor Amic
- Department of Pharmacology, Medical Faculty, University of Zagreb, Zagreb 10000, Croatia
- Department of Pathology, Medical Faculty, University of Zagreb, Zagreb 10000, Croatia
| | - Domagoj Drmic
- Department of Pharmacology, Medical Faculty, University of Zagreb, Zagreb 10000, Croatia
- Department of Pathology, Medical Faculty, University of Zagreb, Zagreb 10000, Croatia
| | - Zdenko Bilic
- Department of Pharmacology, Medical Faculty, University of Zagreb, Zagreb 10000, Croatia
- Department of Pathology, Medical Faculty, University of Zagreb, Zagreb 10000, Croatia
| | - Ivan Krezic
- Department of Pharmacology, Medical Faculty, University of Zagreb, Zagreb 10000, Croatia
- Department of Pathology, Medical Faculty, University of Zagreb, Zagreb 10000, Croatia
| | - Helena Zizek
- Department of Pharmacology, Medical Faculty, University of Zagreb, Zagreb 10000, Croatia
- Department of Pathology, Medical Faculty, University of Zagreb, Zagreb 10000, Croatia
| | - Marina Peklic
- Department of Pharmacology, Medical Faculty, University of Zagreb, Zagreb 10000, Croatia
- Department of Pathology, Medical Faculty, University of Zagreb, Zagreb 10000, Croatia
| | - Robert Klicek
- Department of Pharmacology, Medical Faculty, University of Zagreb, Zagreb 10000, Croatia
- Department of Pathology, Medical Faculty, University of Zagreb, Zagreb 10000, Croatia
| | - Alen Pajtak
- Department of Pharmacology, Medical Faculty, University of Zagreb, Zagreb 10000, Croatia
- Department of Pathology, Medical Faculty, University of Zagreb, Zagreb 10000, Croatia
| | - Enio Amic
- Department of Pharmacology, Medical Faculty, University of Zagreb, Zagreb 10000, Croatia
- Department of Pathology, Medical Faculty, University of Zagreb, Zagreb 10000, Croatia
| | - Tinka Vidovic
- Department of Pharmacology, Medical Faculty, University of Zagreb, Zagreb 10000, Croatia
- Department of Pathology, Medical Faculty, University of Zagreb, Zagreb 10000, Croatia
| | - Mislav Rakic
- Department of Pharmacology, Medical Faculty, University of Zagreb, Zagreb 10000, Croatia
- Department of Pathology, Medical Faculty, University of Zagreb, Zagreb 10000, Croatia
| | - Marija Milkovic Perisa
- Department of Pharmacology, Medical Faculty, University of Zagreb, Zagreb 10000, Croatia
- Department of Pathology, Medical Faculty, University of Zagreb, Zagreb 10000, Croatia
| | - Katarina Horvat Pavlov
- Department of Pharmacology, Medical Faculty, University of Zagreb, Zagreb 10000, Croatia
- Department of Pathology, Medical Faculty, University of Zagreb, Zagreb 10000, Croatia
| | - Antonio Kokot
- Department of Pharmacology, Medical Faculty, University of Zagreb, Zagreb 10000, Croatia
- Department of Pathology, Medical Faculty, University of Zagreb, Zagreb 10000, Croatia
| | - Ante Tvrdeic
- Department of Pharmacology, Medical Faculty, University of Zagreb, Zagreb 10000, Croatia
- Department of Pathology, Medical Faculty, University of Zagreb, Zagreb 10000, Croatia
| | - Alenka Boban Blagaic
- Department of Pharmacology, Medical Faculty, University of Zagreb, Zagreb 10000, Croatia
- Department of Pathology, Medical Faculty, University of Zagreb, Zagreb 10000, Croatia
| | - Mario Zovak
- Department of Pharmacology, Medical Faculty, University of Zagreb, Zagreb 10000, Croatia
- Department of Pathology, Medical Faculty, University of Zagreb, Zagreb 10000, Croatia
| | - Sven Seiwerth
- Department of Pharmacology, Medical Faculty, University of Zagreb, Zagreb 10000, Croatia
- Department of Pathology, Medical Faculty, University of Zagreb, Zagreb 10000, Croatia
| | - Predrag Sikiric
- Department of Pharmacology, Medical Faculty, University of Zagreb, Zagreb 10000, Croatia
- Department of Pathology, Medical Faculty, University of Zagreb, Zagreb 10000, Croatia
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Grgurevic I, Bokun T, Salkic NN, Brkljacic B, Vukelić-Markovic M, Stoos-Veic T, Aralica G, Rakic M, Filipec-Kanizaj T, Berzigotti A. Liver elastography malignancy prediction score for noninvasive characterization of focal liver lesions. Liver Int 2018; 38:1055-1063. [PMID: 29028279 DOI: 10.1111/liv.13611] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 10/03/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND & AIMS To analyse elastographic characteristics of focal liver lesions (FLL)s and diagnostic performance of real-time two-dimensional shear-wave elastography (RT-2D-SWE) in order to differentiate benign and malignant FLLs. METHODS Consecutive patients diagnosed with FLL by abdominal ultrasound (US) underwent RT-2D-SWE of FLL and non-infiltrated liver by intercostal approach over the right liver lobe. The nature of FLL was determined by diagnostic work-up, including at least one contrast-enhanced imaging modality (MDCT/MRI), check-up of target organs when metastatic disease was suspected and FLL biopsy in inconclusive cases. RESULTS We analysed 196 patients (median age 60 [range 50-68], 50.5% males) with 259 FLLs (57 hepatocellular carcinomas, 17 cholangiocarcinomas, 94 metastases, 71 haemangiomas, 20 focal nodular hyperplasia) of which 70 (27%) were in cirrhotic liver. Malignant lesions were stiffer (P < .001) with higher variability in intralesional stiffness (P = .001). The best performing cut-off of lesion stiffness was 22.3 kPa (sensitivity 83%; specificity 86%; positive predictive value [PPV] 91.5%; negative predictive value [NPV] 73%) for malignancy. Lesion stiffness <14 kPa had NPV of 96%, while values >32.5 kPa had PPV of 96% for malignancy. Lesion stiffness, lesion/liver stiffness ratio and lesion stiffness variability significantly predicted malignancy in stepwise logistic regression (P < .05), and were used to construct a new Liver Elastography Malignancy Prediction (LEMP) score with accuracy of 96.1% in validation cohort (online calculator available at http://bit.do/lemps). CONCLUSION The comprehensive approach demonstrated in this study enables correct differentiation of benign and malignant FLL in 96% of patients by using RT-2D-SWE.
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Affiliation(s)
- Ivica Grgurevic
- Department of Gastroenterology, Hepatology and Clinical Nutrition, University Hospital Dubrava, University of Zagreb School of Medicine and Faculty of Pharmacy and Biochemistry, Zagreb, Croatia
| | - Tomislav Bokun
- Department of Gastroenterology, Hepatology and Clinical Nutrition, University Hospital Dubrava, University of Zagreb School of Medicine and Faculty of Pharmacy and Biochemistry, Zagreb, Croatia
| | - Nermin N Salkic
- Department of Gastroenterology and Hepatology, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina
| | - Boris Brkljacic
- Department of Diagnostic and Interventional Radiology, University Hospital Dubrava, University of Zagreb School of Medicine, Zagreb, Croatia
| | - Mirjana Vukelić-Markovic
- Department of Diagnostic and Interventional Radiology, University Hospital Dubrava, University of Zagreb School of Medicine, Zagreb, Croatia
| | - Tajana Stoos-Veic
- Department of Pathology and Cytology, University Hospital Dubrava, Zagreb, Croatia.,Faculty of Medicine, University "J.J. Strossmayer", Osijek, Croatia
| | - Gorana Aralica
- Department of Pathology and Cytology, University Hospital Dubrava, University of Zagreb School of Medicine, Zagreb, Croatia
| | - Mislav Rakic
- Department of Abdominal Surgery, University Hospital Dubrava, Zagreb, Croatia
| | - Tajana Filipec-Kanizaj
- Department of Gastroenterology and Hepatology, University Hospital Merkur, University of Zagreb School of Medicine, Zagreb, Croatia
| | - Annalisa Berzigotti
- Hepatology, Swiss Liver Center, University Clinic for Visceral Surgery and Medicine, Inselspital, University of Berne, Berne, Switzerland
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Sokolic J, Sotosek Tokmadzic V, Knezevic D, Medved I, Vukelic Damjani N, Balen S, Rakic M, Lanca Bastiancic A, Laskarin G. Corrigendum to "Endothelial dysfunction mediated by interleukin-18 in patients with ischemic heart disease undergoing coronary artery bypass grafting surgery" [Med. Hypotheses 104 (2017) 20-24]. Med Hypotheses 2018; 111:40. [PMID: 29406994 DOI: 10.1016/j.mehy.2017.12.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- J Sokolic
- Clinic of Anesthesiology and Intensive Care Medicine, Clinical Hospital Center Rijeka, 51 000 Rijeka, Kresimirova 42, Croatia
| | - V Sotosek Tokmadzic
- Clinic of Anesthesiology and Intensive Care Medicine, Clinical Hospital Center Rijeka, 51 000 Rijeka, Kresimirova 42, Croatia; Department of Anesthesiology, Reanimatology and Intensive Care, Faculty of Medicine, University of Rijeka, 51000 Rijeka, B. Branchetta 20, Croatia.
| | - D Knezevic
- Department of Anesthesiology, Reanimatology and Intensive Care, Faculty of Medicine, University of Rijeka, 51000 Rijeka, B. Branchetta 20, Croatia
| | - I Medved
- Department of Surgery, Faculty of Medicine, University of Rijeka, 51000 Rijeka, Tome Strizica 3, Croatia
| | - N Vukelic Damjani
- Department of Transfusion Medicine, Clinical Hospital Center Rijeka, 51 000 Rijeka, Kresimirova 42, Croatia
| | - S Balen
- Department of Transfusion Medicine, Clinical Hospital Center Rijeka, 51 000 Rijeka, Kresimirova 42, Croatia
| | - M Rakic
- Division of Cardiology, Hospital for Medical Rehabilitation of the Hearth and Lung Diseases and Rheumatism "Thalassotherapia" Opatija, 51410 Opatija, M. Tita 188, Croatia
| | - A Lanca Bastiancic
- Division of Cardiology, Hospital for Medical Rehabilitation of the Hearth and Lung Diseases and Rheumatism "Thalassotherapia" Opatija, 51410 Opatija, M. Tita 188, Croatia
| | - G Laskarin
- Division of Cardiology, Hospital for Medical Rehabilitation of the Hearth and Lung Diseases and Rheumatism "Thalassotherapia" Opatija, 51410 Opatija, M. Tita 188, Croatia; Department of Physiology and Immunology, Medical Faculty, University of Rijeka, 51000 Rijeka, B. Branchetta 20, Croatia
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Persic V, Ruzic A, Miletic B, Samsa DT, Rakic M, Raljevic D, Pejcinovic VP, Eminovic S, Zaputovic L, Laskarin G. Granulysin Expression in Lymphocytes that Populate the Peripheral Blood and the Myocardium after an Acute Coronary Event. Scand J Immunol 2015; 75:231-42. [PMID: 21967803 DOI: 10.1111/j.1365-3083.2011.02646.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
We aimed to analyse granulysin (GNLY)-mediated cytotoxicity in the peripheral blood of patients with non-ST-segment elevation myocardial infarction (NSTEMI) treated with anti-ischaemic drug therapy. Thirty-nine NSTEMI patients with a median age of 70 years and 28 age-matched healthy subjects were enrolled in this study. On day 7 after MI, the number of GNLY(+) lymphocytes in the peripheral blood increased approximately six-fold of that in the healthy subjects, measured by flow cytometry. On day 14, the number of GNLY(+) cells significantly decreased in T, NKT, and both CD56(+dim) and CD56(+bright) NK subsets. GNLY(+) CD3(+) and GNLY(+) CD56(+) cells infiltrated central zone of myocardial infarction (MI). In persons who died in the first week after MI, GNLY(+) cells were found within accumulation of apoptotic leucocytes and reached the apoptotic cardiomyocytes in border MI zones probably due to the influence of interleukin-15 in peri-necrotic cardiomyocytes, as it is was shown by immunohistology. By day 28, the percentage of GNLY(+) lymphocytes in peripheral blood returned to the levels similar to that of the healthy subjects. Anti-GNLY mAb decreased apoptosis of K562 targets using peripheral blood NK cells from days 7 and 28 after MI, while in assays using cells from days 1 and 21, both anti-GNLY and anti-perforin mAbs were required to significantly decrease apoptosis. Using NK cells from day 14, K562 apoptosis was nearly absent. In conclusion, it seems that GNLY(+) lymphocytes, probably attracted by IL-15, not only participate partially in myocardial cell apoptosis, but also hasten resolution of cardiac leucocyte infiltration in patients with NSTEMI.
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Affiliation(s)
- V Persic
- Division of Cardiology, Hospital for Medical Rehabilitation of the Hearth and Lung Diseases and Rheumatism "Thalassotherapija" Opatija, Opatija, CroatiaDepartment of Medical Rehabilitation, Medical Faculty, University of Rijeka, Rijeka, CroatiaDepartment of Pathology, Medical Faculty, University of Rijeka, Rijeka, CroatiaDivision of Cardiology Clinical Hospital Center Rijeka, Rijeka, CroatiaDepartment of Internal Medicine, Medical Faculty, University of Rijeka, Rijeka, CroatiaDepartment of Physiology and Immunology, Medical Faculty, University of Rijeka, Rijeka, Croatia
| | - A Ruzic
- Division of Cardiology, Hospital for Medical Rehabilitation of the Hearth and Lung Diseases and Rheumatism "Thalassotherapija" Opatija, Opatija, CroatiaDepartment of Medical Rehabilitation, Medical Faculty, University of Rijeka, Rijeka, CroatiaDepartment of Pathology, Medical Faculty, University of Rijeka, Rijeka, CroatiaDivision of Cardiology Clinical Hospital Center Rijeka, Rijeka, CroatiaDepartment of Internal Medicine, Medical Faculty, University of Rijeka, Rijeka, CroatiaDepartment of Physiology and Immunology, Medical Faculty, University of Rijeka, Rijeka, Croatia
| | - B Miletic
- Division of Cardiology, Hospital for Medical Rehabilitation of the Hearth and Lung Diseases and Rheumatism "Thalassotherapija" Opatija, Opatija, CroatiaDepartment of Medical Rehabilitation, Medical Faculty, University of Rijeka, Rijeka, CroatiaDepartment of Pathology, Medical Faculty, University of Rijeka, Rijeka, CroatiaDivision of Cardiology Clinical Hospital Center Rijeka, Rijeka, CroatiaDepartment of Internal Medicine, Medical Faculty, University of Rijeka, Rijeka, CroatiaDepartment of Physiology and Immunology, Medical Faculty, University of Rijeka, Rijeka, Croatia
| | - D Travica Samsa
- Division of Cardiology, Hospital for Medical Rehabilitation of the Hearth and Lung Diseases and Rheumatism "Thalassotherapija" Opatija, Opatija, CroatiaDepartment of Medical Rehabilitation, Medical Faculty, University of Rijeka, Rijeka, CroatiaDepartment of Pathology, Medical Faculty, University of Rijeka, Rijeka, CroatiaDivision of Cardiology Clinical Hospital Center Rijeka, Rijeka, CroatiaDepartment of Internal Medicine, Medical Faculty, University of Rijeka, Rijeka, CroatiaDepartment of Physiology and Immunology, Medical Faculty, University of Rijeka, Rijeka, Croatia
| | - M Rakic
- Division of Cardiology, Hospital for Medical Rehabilitation of the Hearth and Lung Diseases and Rheumatism "Thalassotherapija" Opatija, Opatija, CroatiaDepartment of Medical Rehabilitation, Medical Faculty, University of Rijeka, Rijeka, CroatiaDepartment of Pathology, Medical Faculty, University of Rijeka, Rijeka, CroatiaDivision of Cardiology Clinical Hospital Center Rijeka, Rijeka, CroatiaDepartment of Internal Medicine, Medical Faculty, University of Rijeka, Rijeka, CroatiaDepartment of Physiology and Immunology, Medical Faculty, University of Rijeka, Rijeka, Croatia
| | - D Raljevic
- Division of Cardiology, Hospital for Medical Rehabilitation of the Hearth and Lung Diseases and Rheumatism "Thalassotherapija" Opatija, Opatija, CroatiaDepartment of Medical Rehabilitation, Medical Faculty, University of Rijeka, Rijeka, CroatiaDepartment of Pathology, Medical Faculty, University of Rijeka, Rijeka, CroatiaDivision of Cardiology Clinical Hospital Center Rijeka, Rijeka, CroatiaDepartment of Internal Medicine, Medical Faculty, University of Rijeka, Rijeka, CroatiaDepartment of Physiology and Immunology, Medical Faculty, University of Rijeka, Rijeka, Croatia
| | - V Pehar Pejcinovic
- Division of Cardiology, Hospital for Medical Rehabilitation of the Hearth and Lung Diseases and Rheumatism "Thalassotherapija" Opatija, Opatija, CroatiaDepartment of Medical Rehabilitation, Medical Faculty, University of Rijeka, Rijeka, CroatiaDepartment of Pathology, Medical Faculty, University of Rijeka, Rijeka, CroatiaDivision of Cardiology Clinical Hospital Center Rijeka, Rijeka, CroatiaDepartment of Internal Medicine, Medical Faculty, University of Rijeka, Rijeka, CroatiaDepartment of Physiology and Immunology, Medical Faculty, University of Rijeka, Rijeka, Croatia
| | - S Eminovic
- Division of Cardiology, Hospital for Medical Rehabilitation of the Hearth and Lung Diseases and Rheumatism "Thalassotherapija" Opatija, Opatija, CroatiaDepartment of Medical Rehabilitation, Medical Faculty, University of Rijeka, Rijeka, CroatiaDepartment of Pathology, Medical Faculty, University of Rijeka, Rijeka, CroatiaDivision of Cardiology Clinical Hospital Center Rijeka, Rijeka, CroatiaDepartment of Internal Medicine, Medical Faculty, University of Rijeka, Rijeka, CroatiaDepartment of Physiology and Immunology, Medical Faculty, University of Rijeka, Rijeka, Croatia
| | - L Zaputovic
- Division of Cardiology, Hospital for Medical Rehabilitation of the Hearth and Lung Diseases and Rheumatism "Thalassotherapija" Opatija, Opatija, CroatiaDepartment of Medical Rehabilitation, Medical Faculty, University of Rijeka, Rijeka, CroatiaDepartment of Pathology, Medical Faculty, University of Rijeka, Rijeka, CroatiaDivision of Cardiology Clinical Hospital Center Rijeka, Rijeka, CroatiaDepartment of Internal Medicine, Medical Faculty, University of Rijeka, Rijeka, CroatiaDepartment of Physiology and Immunology, Medical Faculty, University of Rijeka, Rijeka, Croatia
| | - G Laskarin
- Division of Cardiology, Hospital for Medical Rehabilitation of the Hearth and Lung Diseases and Rheumatism "Thalassotherapija" Opatija, Opatija, CroatiaDepartment of Medical Rehabilitation, Medical Faculty, University of Rijeka, Rijeka, CroatiaDepartment of Pathology, Medical Faculty, University of Rijeka, Rijeka, CroatiaDivision of Cardiology Clinical Hospital Center Rijeka, Rijeka, CroatiaDepartment of Internal Medicine, Medical Faculty, University of Rijeka, Rijeka, CroatiaDepartment of Physiology and Immunology, Medical Faculty, University of Rijeka, Rijeka, Croatia
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Klaric E, Rakic M, Sever I, Milat O, Par M, Tarle Z. Enamel and Dentin Microhardness and Chemical Composition After Experimental Light-activated Bleaching. Oper Dent 2015; 40:E132-41. [PMID: 25748206 DOI: 10.2341/14-148-l] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To evaluate 1) the influence of five bleaching agents (with additional light activation) on enamel and dentin surface microhardness and chemical composition and 2) the remineralizing potential of artificial saliva and amorphous calcium phosphate (ACP). METHODS AND MATERIALS The study was conducted on 125 human third molars dissected into quarters for separate enamel and dentin measurements. The bleaching process was performed with 38% and 25% hydrogen peroxide (HP) and 30%, 16%, and 10% carbamide peroxide (CP) gels two times for 15 minutes each time. All bleaching gels were tested alone and in combination with ZOOM2, light-emitting diode (LED), organic LED, and femtosecond laser. A total of 25 bleaching combinations (n=10) were evaluated. Microhardness was measured by a Vickers diamond. Chemical analysis was performed using energy-dispersive X-ray spectroscopy. RESULTS Bleaching agents used in the absence of light activation caused a significant reduction in enamel and dentin surface microhardness (p<0.001), ranging from 8% for 16% CP to 40% for 25% HP. The effects of different light activations were negligible. After two-week treatment with ACP and artificial saliva, maximum deviation from baseline microhardness was just 3%. Such treatment increased the concentrations of calcium, phosphorus, and fluorine. CONCLUSIONS An increase in peroxide concentration and gel acidity negatively affected microhardness and concentrations of calcium and phosphorus in enamel and dentin. ACP and artificial saliva stimulated the remineralization of hard tissues.
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Novakovic N, Todorovic T, Rakic M, Milinkovic I, Dozic I, Jankovic S, Aleksic Z, Cakic S. Salivary antioxidants as periodontal biomarkers in evaluation of tissue status and treatment outcome. J Periodontal Res 2013; 49:129-36. [PMID: 23710550 DOI: 10.1111/jre.12088] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND OBJECTIVE One of the major pathologic patterns in periodontitis represents an imbalance among the production of free radicals and local antioxidants resulting in periodontal tissue destruction. The objective of the study was to investigate the influence of non-surgical periodontal treatment on salivary antioxidants and to evaluate their capacity as biomarkers reflecting periodontal tissue condition and therapy outcome. MATERIAL AND METHODS Sixty-three systemically healthy non-smokers, including 21 periodontally healthy subjects (HC) and 42 patients with current chronic periodontitis fulfilled the inclusion criteria. Half of the patients received scaling and root planing (SRP) and the other half received only oral hygiene instructions. Full mouth clinical measurements, including gingival index (GI), plaque index (PI), periodontal pocket depth, clinical attachment level and saliva sampling were performed at baseline visit and 2 mo after treatment/baseline visit. Total antioxidant capacity (TAOC), albumins (ALB), uric acid (UA), superoxide dismutase (SOD) and glutathione peroxidase (GPX) were evaluated in saliva samples using commercial kits. RESULTS All measured antioxidants were affected by treatment resulting in significant increase in TAOC (p < 0.005), ALB (p < 0.001), UA (p < 0.001) and GPX (p < 0.001) and decrease of SOD (p < 0.005) in response to SRP, where no differences were observed for any of parameters in the oral hygiene instructions group. Comparison of antioxidant levels between the HC and SRP group showed that before treatment ALB were significantly higher in HC when compared to the SRP group (p = 0.039), and GXP (p = 0.000) and SOD (p = 0.021) levels were significantly higher in the SRP group. Comparison of values after treatment showed that TAOC was significantly higher in the HC than in the SRP group (p = 0.001), but UA was, inversely, significantly higher in the SRP group (p = 0.034). All clinical parameters except clinical attachment level were significantly decreased after SRP and significant correlations were observed between SOD and GI (p = 0.017), SOD and PI (p = 0.011), GPX and GI (p = 0.003) and GPX and PI (p = 0.008). CONCLUSION Non-surgical periodontal treatment affected salivary TAOC, ALB, UA, SOD and GPX; moreover, these biochemical parameters convincingly reflected periodontal status and tissue response on treatment.
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Affiliation(s)
- N Novakovic
- Department for Periodontology and Oral Medicine, Faculty of Dental Medicine, University of Belgrade, Belgrade, Serbia
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Laskarin G, Persic V, Ruzic A, Miletic B, Rakic M, Samsa DT, Raljevic D, Pejcinovic VP, Miskulin R, Rukavina D. Perforin-mediated cytotoxicity in non-ST elevation myocardial infarction. Scand J Immunol 2011; 74:195-204. [PMID: 21388427 DOI: 10.1111/j.1365-3083.2011.02554.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The aim of this investigation was to examine the role of perforin (P)-mediated cytotoxicity in the dynamics of tissue damage in patients with non-ST-segment elevation myocardial infarction (NSTEMI) treated with anti-ischaemic drugs. We enrolled 48 patients with NSTEMI in this study [age, 71.5 years; 61.5/76 (median, 25th/75th percentiles)]. The percentage of total peripheral blood P(+) lymphocytes was elevated owing to the increased frequency of P(+) cells within natural killer (NK) subsets, T and NKT cells in patients on day 1 after NSTEMI when compared with healthy controls. Positive correlations were found between cardiac troponin I plasma concentrations and the frequency of P(+) cells, P(+) T cells, P(+) NK cells and their CD56(+dim) and CD56(+bright) subsets during the first week after the NSTEMI. The expression of P in NK cells was accompanied by P-mediated cytotoxicity against K-562 targets at all days examined, except day 21, when an anti-perforin monoclonal antibody did not completely abolish the killing. The percentage of P(+) T cells, P(+) NKT cells and P(+) NK subsets was the highest on the day 1 after NSTEMI and decreased in the post-infarction period. CD56(+) lymphocytes were found in damaged myocardium, suggesting their tissue recruitment. In conclusion, patients with NSTEMI have a strong and prolonged P-mediated systemic inflammatory reaction, which may sustain autoaggressive reactions towards myocardial tissue during the development of myocardial infarction.
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Affiliation(s)
- G Laskarin
- Division of Cardiology, Hospital for Medical Rehabilitation of Hearth and Lung Diseases and Rheumatism Thalassotherapia-Opatija, Opatija, Croatia.
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Abstract
We report a very rare case of 5-year-old boy with osteoid osteoma of the cervical vertebral body. The patient presented with a 6-month history of neck pain with radiation into the shoulder and arm on the left side, which was relieved by ibuprofen. Neurological examination and plain radiographs of the cervical spine were normal. CT scan and bone scintigraphy, rather than MRI suggested the pathological diagnosis, which was confirmed on histological examination. The patient underwent excision of the lesion via an anterior approach with complete resolution of the pain postoperatively.
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Affiliation(s)
- D V Radulovic
- Institut for Neurosurgery, Clinical Center Serbia, A, Belgrade, Serbia and Montenegro.
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Radulovic D, Nestorovic B, Rakic M, Janosevic V. Enlargement to a saccular aneurysm and subsequent rupture of infundibular widening of posterior communicating artery. Neurochirurgie 2007; 52:525-8. [PMID: 17203900 DOI: 10.1016/s0028-3770(06)71360-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
A small dilatation known as infundibular widening (IFw) is frequently seen (7%-25%) on the posterior communicating artery (PComA) at its origin from the internal carotid artery. Development and subsequent rupture of an aneurysm on a previously radiographically demonstrated IFw has rarely been documented. We present two patients who suffered from subarachnoid hemorrhage (SAH). Initial cerebral angiography demonstrated IFw on PComA. They were readmitted to the hospital 9 and 11 years later, after a new SAH. Repeated cerebral angiography revealed an aneurysm arising from the site where the IFw had been seen previously in both cases. The aneurysms were clipped with favorable outcome. This report adds two new cases documenting enlargement of PComAIFw into an aneurysm. Patients with PComAIFw, especially those who have experienced SAH, should be considered for periodic follow-up to rule out the development of an aneurysm over time.
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Affiliation(s)
- D Radulovic
- Institute of Neurosurgery, Clinical Center of Serbia, Visegradska 26, 11000 Belgrade, Serbia and Montenegro.
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Vrebalov-Cindro V, Reic P, Ognjenovic M, Jankovic S, Andelinovic S, Karelovic D, Kapural L, Rakic M, Primorac D. Peripheral nerve war injuries. Mil Med 1999; 164:351-2. [PMID: 10332175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2023] Open
Abstract
OBJECTIVE The purpose of this study is to evaluate peripheral nerve war injuries sustained during the war in southern Croatia and Bosnia and Herzegovina. PATIENTS AND METHODS During the war in Croatia, 713 patients (99% male and 1% female) with wounds inflicted by firearms were examined at the Laboratory of Neurophysiology, University Hospital, Split. The patients, soldiers and civilians alike, ranged in age from 6 to 73 years (average, 28 years). All patients with firearm nerve war injuries underwent detection by electromyography and plurisegmental examination of the damaged peripheral nerve (neurography). The patients were examined and controlled on three occasions: within 2 months after wounding; up to 6 months after wounding; and more than 6 months after wounding. RESULTS Single peripheral nerve lesions were present in 80% of the patients, and multiple peripheral nerve or plexus lesions were present in 20% of the patients. Peroneal and ulnar nerves were most often involved (20.9% and 19.8%, respectively). Associated massive injuries to the muscles, large blood vessels, or vital organs were present in 45% of the patients. Wounds were inflicted by shell fragments in 80% of the patients and by projectiles in 20% of the patients. CONCLUSION According to our results, better recovery was achieved with conservative treatment and when physical therapy was initiated early with maximal patient cooperation. Electromyoneurographic findings were the most valid in the prognostic classification of war-inflicted peripheral nerve injuries.
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Smulders YM, Rakic M, Slaats EH, Treskes M, Sijbrands EJ, Odekerken DA, Stehouwer CD, Silberbusch J. Fasting and post-methionine homocysteine levels in NIDDM. Determinants and correlations with retinopathy, albuminuria, and cardiovascular disease. Diabetes Care 1999; 22:125-32. [PMID: 10333913 DOI: 10.2337/diacare.22.1.125] [Citation(s) in RCA: 108] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The increased cardiovascular risk in subjects with NIDDM is partly explained by an association with established risk factors like hypertension, dyslipidemia, and obesity. Mild hyperhomocysteinemia has emerged as a new risk factor for cardiovascular disease. The purpose of this study was to assess its role in NIDDM. RESEARCH DESIGN AND METHODS We studied predictors of homocysteine levels and correlations between homocysteine and (micro-)albuminuria, retinopathy, and history of cardiovascular disease in normotensive NIDDM subjects under stable metabolic control. This was done in 85 NIDDM subjects by measuring fasting and post-methionine-loading homocysteine levels together with blood pressure, BMI, serum cholesterol, triglyceride, HDL cholesterol, folate, vitamin B12, pyridoxal-5-phosphate, HbA1c, and (micro-)albuminuria and creatinine clearance in triplicate 24-h urine samples. The relationship between micro- and macrovascular complications and fasting homocysteine only was studied in an additional 65 subjects, giving a total of 150 subjects. RESULTS In multiple regression analysis, significant (P < 0.05) predictors of fasting homocysteine were low-normal values of creatinine clearance (threshold effect at < 80 ml.min-1 .1.73 m-2), folate (< 20 nmol/l), and vitamin B12 (< 350 pmol/l), and postmenopausal status in women. Determinants of post-methionine homocysteine were pyridoxal-5-phosphate levels < 80 nmol/l, creatinine clearance, and sex (higher levels in women). Hyperhomocysteinemia did not cluster with other cardiovascular risk factors, like hypertension, obesity, or dyslipidemia. Regarding cardiovascular complications, fasting homocysteine, but not post-methionine homocysteine, was higher in subjects with a history of cardiovascular disease. There was a stepwise increase in the prevalence of subjects with cardiovascular disease with increasing fasting homocysteine. The prevalence of cardiovascular disease was 19.4% in the bottom quartile of fasting homocysteine, versus 55.0% in the top quartile (P for trend < 0.01). Neither fasting homocysteine nor post-methionine homocysteine correlated with (micro-)albuminuria or with retinopathy. CONCLUSIONS The findings suggest that homocysteine levels in NIDDM rise even with modest deterioration of renal function and when vitamin status is in the low to low-normal range. Fasting homocysteine correlates with macrovascular disease, but we found no evidence of a correlation with retinopathy or (micro-)albuminuria. Post-methionine homocysteine levels do not show a correlation with micro- or macrovascular complications.
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Affiliation(s)
- Y M Smulders
- Department of Internal Medicine, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
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Smulders YM, Slaats EH, Rakic M, Smulders FT, Stehouwer CD, Silberbusch J. Short-term variability and sampling distribution of various parameters of urinary albumin excretion in patients with non-insulin-dependent diabetes mellitus. J Lab Clin Med 1998; 132:39-46. [PMID: 9665370 DOI: 10.1016/s0022-2143(98)90023-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We determined the degree of variability and sampling distribution of several commonly used parameters of microalbuminuria in patients with non-insulin-dependent diabetes mellitus (NIDDM) and proposed a sampling strategy for estimating the level of albuminuria. Four patients with NIDDM with previously documented microalbuminuria collected 30 consecutive split (overnight and daytime) 24-hour urine samples (experiment A). These samples were analyzed for total 24-hour albumin excretion; daytime, overnight, and 24-hour albumin concentration; and daytime, overnight, and 24-hour albumin-to-creatinine ratio. In a second experiment (B), 10 patients collected 10 consecutive overnight urine samples. Finally, a total of 300 separate triplicate urine samples were analyzed for the variability of 24-hour albumin excretion (100 samples) and albumin-to-creatinine ratios in 24-hour urine (100 samples) and overnight urine (100 samples). We found that the sampling distribution shape of all parameters of albuminuria is positively skewed, without consistent evidence of log-normality. When two methods were used for quantifying day-to-day variability (the interquartile range/median ratio and the chance of a single measurement being >50% off the actual value of albuminuria), the overnight albumin-to-creatinine ratio is the least-variable parameter of albuminuria, scoring 0.38% and 10% on both methods, respectively, in experiment A. Collecting multiple samples of overnight urine improves accuracy. The largest gain in precision in estimating the actual value of albuminuria is obtained for sample sizes of three and five and does not increase with nonconsecutive sampling of urine. Based on the combined data from experiments A and B, the expected mean deviation of the median of three and five overnight samples from the actual level of the overnight albumin-creatinine ratio is 17.9% and 12.1%, respectively. An analysis of variability in three sets of 100 triplicate 24-hour urine samples shows that the overnight albumin-to-creatinine ratio is a significantly more-constant parameter of microalbuminuria than the amount of albumin excreted in 24 hours or the albumin-to-creatinine ratio in 24-hour urine (p < 0.05). We concluded that the parameters of diabetic albuminuria have positively skewed, non-log-normal sampling distributions. The overnight albumin-to-creatinine ratio is the least-variable parameter of microalbuminuria. We recommend collecting three consecutive early morning urine samples, using the median value of the albumin-to-creatinine ratio in these samples for quantifying albuminuria.
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Affiliation(s)
- Y M Smulders
- Department of Internal Medicine, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
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Markovic L, Rakic M, Djordjic L, Jovanovic M, Vuckovic V, Janicijevic M. Sellar and juxtasellar expansive lesions: Differential diagnostic problems. Clin Neurol Neurosurg 1997. [DOI: 10.1016/s0303-8467(97)82432-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Jovanovic M, Antunovic V, Janicijevic M, Nestorovic N, Rakic M, Dordic L. Head injuries during wartime caused by missiles of different velocity. Clin Neurol Neurosurg 1997. [DOI: 10.1016/s0303-8467(97)82203-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Rakic M, Jovanovic S, Janicijevic M, Antunovic V, Djordjic L, Piperski V, Nestorovic B. Relationship between surgical and immunohistochemical parameters of the invasiveness of meningiomas. Significance for recurrence. Clin Neurol Neurosurg 1997. [DOI: 10.1016/s0303-8467(97)81382-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Smulders YM, Rakic M, Stehouwer CD, Weijers RN, Slaats EH, Silberbusch J. Determinants of progression of microalbuminuria in patients with NIDDM.A prospective study. Diabetes Care 1997; 20:999-1005. [PMID: 9167114 DOI: 10.2337/diacare.20.6.999] [Citation(s) in RCA: 50] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To assess the degree of interindividual variation in the rate of progression of microalbuminuria and to identify determinants of progression of microalbuminuria in patients with NIDDM. RESEARCH DESIGN AND METHODS In a prospective cohort study, 58 microalbuminuric NIDDM patients were followed for a period of at least 24 months. During this period, the level of microalbuminuria in these patients was assessed in triplicate 24-h urine samples on at least four separate visits. All patients had stable metabolic control and controlled blood pressure during follow-up. Microalbuminuria was defined as an albumin-to-creatinine ratio in 24-h urine of between 3 and 30 mg/mmol. The individual rates of progression of microalbuminuria were calculated from linear regression analysis. At baseline, the following data were collected for all patients: age, sex, ethnicity, time since diagnosis of NIDDM, smoking habits, drug use, blood pressure, BMI, HbA1c, serum creatinine, cholesterol, triglyceride, and HDL cholesterol concentrations. RESULTS Microalbuminuria was found to progress linearly in time. Considerable differences in rates of progression of microalbuminuria were found, the absolute yearly change in albumin-to-creatinine ratio ranging from -5.2 to 12.9 mg/mmol. In bivariate analyses, serum triglyceride concentration, use of ACE inhibitors, mean arterial blood pressure, HDL cholesterol, and time since diagnosis of NIDDM correlated with progression of microalbuminuria (P < or = 0.05). In stepwise multiple regression analysis, a high triglyceride-to-HDL cholesterol ratio at baseline (P = 0.006) and the use of ACE inhibitors (P = 0.007) were identified as the only independent predictors of progression of microalbuminuria. CONCLUSIONS The rate of progression of microalbuminuria in NIDDM differs considerably between subjects. Diabetic dyslipidemia (high serum triglyceride and low HDL cholesterol) is a predictor of more rapid progression of microalbuminuria in patients with well-controlled blood pressure.
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Affiliation(s)
- Y M Smulders
- Department of Internal Medicine, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
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Abstract
The usual presentations and manifestations of systemic lupus erythematosus (SLE) are well known. We describe a patient with SLE that was discovered in the course of evaluation of an abscess, found to be associated with non-O:1 Vibrio cholerae.
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Affiliation(s)
- D Nedunchezian
- St. Vincent's Medical Center of Richmond, Staten Island, New York 10310-1699
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Affiliation(s)
- M Rakic
- Department of Anesthesiology, General Hospital, Split, Croatia
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Rakic M, Elhosseiny A, Ramadan F, Iyer R, Howard RG, Gross L. Adult-type osteopetrosis presenting as carpal tunnel syndrome. Arthritis Rheum 1986; 29:926-8. [PMID: 3741505 DOI: 10.1002/art.1780290718] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
We describe a patient with adult-type osteopetrosis presenting as carpal tunnel syndrome. Radiographs demonstrated sclerosis of the carpal bones, bone biopsy revealed wide bone spicules containing areas of cartilage, and electrophysiologic studies confirmed the diagnosis of median nerve entrapment in the carpal tunnel. Any condition which alters the size or shape of the carpal canal or its contents may result in median nerve compression.
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Djordjevic V, Laketic S, Rakic M. [Therapy of bronchial asthma using gamma glubulin. Results of treatment using standardized and blood-group differentiated gamma globulin]. Fortschr Med 1974; 92:1276-8. [PMID: 4140135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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