In vitro simulation of the effect of peritoneal dialysis solution on mesothelial cells

All previous in vitro biocompatibility tests of peritoneal dialysis fluids have shown that these have inhibitory effects on the function of peritoneal mesothelium. This report presents results from in vitro experiments performed to study the effect of dialysis fluids (Dianeal 1.36 and Dianeal 3.86; Baxter, Round Lake, IL) on the function of mesothelial cells under conditions that simulate the in vivo state of these solutions in the peritoneal cavity. Thus, cells were initially exposed only to the unused fluids that were thereafter gradually diluted (over 4 hours) with pooled effluent dialysate from continuous ambulatory peritoneal dialysis patients. During the following 20 hours, cells were incubated in a mixture of unused fluid (10% vol/vol) and dialysate effluent (90% vol/vol). The mesothelial cells exposed to dialysis fluids under such conditions became activated cells compared with exposed to dialysate effluent (control) alone. Thus, synthesis by mesothelial cells of all tested substances was enhanced during exposure of the mesothelium to the dialysis fluids: interleukin-6: Dianeal 1.36, +257%; Dianeal 3.86, +181% (both P < 0.05); hyaluronic acid: Dianeal 1.36, +72%; Dianeal 3.86, +63% (both P < 0.05); tissue plasminogen activator: Dianeal 3.86, +33% (P < 0.05); and plasminogen activator/inhibitor-1: Dianeal 1.36, +28%; Dianeal 3.86, +38% (both P < 0.05). Our results show that the peritoneal mesothelium becomes activated when it is exposed to acidic, hyperosmotic dialysis fluids diluted with the dialysate effluent, in a manner that imitates the in vivo changes in these solutions during their intraperitoneal dwell.

Anti-inflammatory effect of sulodexide during acute peritonitis in rats

BACKGROUND/AIMS

Peritonitis is one of the complications of peritoneal dialysis. We demonstrate the systemic and intraperitoneal anti-inflammatory action of sulodexide given systemically.

METHODS

Dialysis was performed in male Wistar rats with acute peritonitis induced by addition of endotoxin to the fluid. Sulodexide (10 mg/kg b.w.) was used acutely as supplement to the dialysis fluid or chronically, during 7 days preceding the study by intramuscular (i.m.) injection.

RESULTS

In rats given i.m. sulodexide the dialysate cell count was lower by 45% (p < 0.001) versus untreated rats with peritonitis. Dialysate elastase activity in i.m. sulodexide-treated rats was lower by 22% (p < 0.05) compared to peritonitis. In rats treated with i.m. sulodexide the increase of plasma tumor necrosis factor-alpha was reduced by 53% (p < 0.002). Pretreatment with i.m. sulodexide reduced transperitoneal loss of total protein and albumin during peritonitis by 26% (p < 0.002) and by 16% (p < 0.05), respectively.

CONCLUSION

Sulodexide given systemically reduces the intraperitoneal and vascular inflammatory response during acute peritonitis in rats.

Foreign body in the gastrointestinal tract leading to small bowel obstruction--case report and literature review

The presence of a foreign body in the gastrointestinal tract constitutes a common pathology, considering surgical clinical practice. The management of the ingestion of a foreign body depends on many factors. The study presented a case of a 33-year-old female patient subjected to surgical treatment, due to deliberate swallowing of a balloon. The above-mentioned was the amateur equivalent of intragastric balloon insertion, inducing weight loss. This is a rare cause of a foreign body ingestion, seldomly found in literature data. The patient reported to the Emergency Department on the second day after ingestion with symptoms of mechanical subobstruction, and after initial diagnostics, was qualified for surgery. The postoperative period proved uneventful. The study illustrated the often unfavourable access to false data on the internet, which may stimulate towards the above-mentioned behaviour.

Dysfunctional Coping Mediates the Relationship between Stress and Mental Health in Health-Care Staff Working amid the COVID-19 Pandemic

OBJECTIVE

This cross-sectional study aimed to assess the stress outcomes in health-care staff working during the COVID-19 pandemic and to explore the role of coping in the relationship between stress outcomes and mental health dimensions with Preacher &amp; Hayes's mediation analysis.

SUBJECTS AND METHODS

One hundred seventy participants including physicians (n = 41; 24.1%), nurses (n = 114, 67.1%), and paramedics (n = 15, 8.8%) with a mean age of 37.69 ± 12.23 years and an average seniority of 14.40 ± 12.32 years were administered the Toronto Alexithymia Scale-20, Cohen's Perceived Stress Scale (PSS-10), the Emotional Processing Scale, and Positive and Negative Affect Schedule. The data were analyzed by estimation of simple correlation coefficients and a Preacher and Hayes's mediation procedure.

RESULTS

Participants reported elevated levels of stress (7-8 sten on the sten scale developed for the PSS-10 questionnaire). Statistically significant differences in the stress levels between nurses, paramedics, and physicians could not be determined. In contrast, significant association between mental health outcomes and the occupational category could not be found.

CONCLUSION

Our observations support the assumption about a controlling role of coping in the relationship between work-related stress, alexithymia, emotional processing loneliness and positive/negative affect in medical staff working amid pandemic.

The relationship between the symptom of fatigue and the functioning of patients with inflammatory bowel diseases after surgery

INTRODUCTION

The occurrence of fatigue in patients suffering from inflammatory bowel diseases (IBD) is influenced by pain, frequent bowel movements, stress associated with symptoms and time of their occurrence reaction of surroundings, fear for their own health, sleep disturbances, side effects of pharmacological treatment, physical and mental exhaustion, hindered social contacts and difficulties at work.

AIM

To evaluate the fatigue and the assessment of functioning of patients with IBD, who were treated surgically.

MATERIAL AND METHODS

To evaluate the functioning of patients, a Polish version of the Inflammatory Bowel Disease Questionnaire was used. To evaluate the occurrence of fatigue in studied subjects, a Polish version of the Functional Assessment of Chronic Illness Therapy - Fatigue Scale was used. The activity of disease was evaluated with the use of the Crohn's Disease Activity Index for patients with Crohn's disease (CD) and the Clinical Activity Index for patients with ulcerative colitis (UC).

RESULTS

Before surgery, there was no significant difference between CD and UC patients, with regard to the mean FACIT-F (28.76 for CD and 28.76 for UC, p = 0.72). Also, after surgery, there was no significant difference between CD and UC patients, with regard to the mean FACIT-F (14.8 for CD and 16.0 for UC, p = 0.71). The IBD patients who underwent surgery for CD and UC had significantly lower FACIT-F scores compared to the patients before the surgery (p = 0.001 and p = 0.0001, respectively). IBD patients who underwent surgery for CD and UC had significantly better functioning and higher IBDQ total scores compared to the patients before the surgery.

CONCLUSIONS

Surgical treatment significantly reduces the fatigue symptom in patients with IBD. The severity of fatigue correlates with disease activity and functioning in the respective areas.

Immunohistochemical evaluation of cellular composition of the immune system of lymph nodes in acute appendicitis

Introduction. There is not much data about the composition of populations of the immune system in acute appendicitis. The basic histopathological criterion for the diagnosis of acute appendicitis is neutrophil infiltration of the muscle membrane. Aim. The subject of this publication is a semi-quantitative evaluation of B lymphocytes (CD20+), T lymphocytes (CD3+) and macrophages (CD68+), and the determination of the number of active lymph nodes during the course of inflammation.Material and Methods. The study material was obtained from 79 patients who had an appendectomy due to acute appendicitis. In this group, the tissue was obtained from: 34 women (aged 20 to 91) and 45 men (aged 20 to 72).Results. In the course of acute appendicitis, there is involvement of lymph node B lymphocytes, T lymphocytes and macrophages. Independent of the type of inflammation, the cellular make-up of the nodes is similar. The number of lymph nodes decreases with age and is gender dependent.Conclusions. In the course of acute appendicitis, there is involvement of lymph node B lymphocytes, T lymphocytes and macrophages. The number of lymph nodes decreases with age and is gender dependent. A statistically significant number of the examined cells of the immunological system in the lymph nodes changed due to inflammation (p<0.001). B and T lymphocytes in the lymph nodes and in the mucous membrane of the appendix differed depending on the sex, and the presence of B lymphocytes in the mucous membrane was significantly higher in the group of 20-40 years of age. T lymphocytes were predominant in the centres of the lymph nodes in groups 20-40 and 61-91 years of age, and in the peripheral zones in the group of 41-60 years of age.

Creating an Innovative Artificial Intelligence-Based Technology (TCRact) for Designing and Optimizing T Cell Receptors for Use in Cancer Immunotherapies: Protocol for an Observational Trial

BACKGROUND

Cancer continues to be the leading cause of mortality in high-income countries, necessitating the development of more precise and effective treatment modalities. Immunotherapy, specifically adoptive cell transfer of T cell receptor (TCR)-engineered T cells (TCR-T therapy), has shown promise in engaging the immune system for cancer treatment. One of the biggest challenges in the development of TCR-T therapies is the proper prediction of the pairing between TCRs and peptide-human leukocyte antigen (pHLAs). Modern computational immunology, using artificial intelligence (AI)-based platforms, provides the means to optimize the speed and accuracy of TCR screening and discovery.

OBJECTIVE

This study proposes an observational clinical trial protocol to collect patient samples and generate a database of pHLA:TCR sequences to aid the development of an AI-based platform for efficient selection of specific TCRs.

METHODS

The multicenter observational study, involving 8 participating hospitals, aims to enroll patients diagnosed with stage II, III, or IV colorectal cancer adenocarcinoma.

RESULTS

Patient recruitment has recently been completed, with 100 participants enrolled. Primary tumor tissue and peripheral blood samples have been obtained, and peripheral blood mononuclear cells have been isolated and cryopreserved. Nucleic acid extraction (DNA and RNA) has been performed in 86 cases. Additionally, 57 samples underwent whole exome sequencing to determine the presence of somatic mutations and RNA sequencing for gene expression profiling.

CONCLUSIONS

The results of this study may have a significant impact on the treatment of patients with colorectal cancer. The comprehensive database of pHLA:TCR sequences generated through this observational clinical trial will facilitate the development of the AI-based platform for TCR selection. The results obtained thus far demonstrate successful patient recruitment and sample collection, laying the foundation for further analysis and the development of an innovative tool to expedite and enhance TCR selection for precision cancer treatments.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04994093; https://clinicaltrials.gov/ct2/show/NCT04994093.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/45872.

[Analysis of endometriosis cases from 10-years of surgical material]

Analysis of ten years of surgical material of the histopathological research of 1865 patients population proved that in 231 cases (12.4%) patients suffered endometriosis. The ailment occurred most often in the age group 41-50 years. In general endometriosis afflicted corpus uterus (50.8% cases). In two patients the pathology was observed in abdomen wall scar after cesarean section (0.8%).

[Multiple, giant retroperitoneal space lipomas]

A case is presented of multiple retroperitoneal lipoma in a 59-year-old woman, displacing the left kidney to the right side. The dimensions of four tumours exceeded significantly the expected size determined in USG examination. The authors believe that in view of the size of the tumours, their multiplicity, and histological pleomorphism the patient requires further careful observation despite radical excision of the lesion.

[Pregnancy induced changes in lipid-lipoprotein serum profile in women and newborn birth weight]

The pregnancy is associated with hyperlipoproteinemia including an increased level of total cholesterol, LDL-cholesterol, HDL2 and HDL3-cholesterol and triglycerides. The mechanism of pregnancy associated hyperlipoproteinemia remain unclear. The aim of the study was to estimate the relationship between the newborn body mass at delivery and changed by pregnancy lipid-lipoprotein blood profile in women. Studies were carried out in the cases of 67 women. Blood samples were studied at 25 week of pregnancy, during the labor, and at 5th day after delivery. No influence of the pregnancy-changed lipid-lipoprotein pattern of the mothers on the body mass of newborns was found in any of the investigated period.

Retroperitoneal hematoma in COVID-19 patients - case series

COVID-19 patients, particularly those with severe pulmonary involvement, are at an increased thromboembolic risk related, among various causes, to the cytokine storm and excessive activation of the coagulation cascade and platelets. Different intensity of anticoagulation for them is proposed, mainly with low molecular weight heparins (LMWHs); in a confirmed pulmonary embolism (PE) the therapeutic dose of LMWH is routinely used. Some authors suggest that hemorrhagic complications in COVID-19 patients are rare. At the same time, one can find reports on internal bleeding, including retroperitoneal hematoma (RPH) and other abdominal hematomas.

CASE REPORTS

The authors describe 5 cases (3 of those aged more than 80 years) with giant RPHs and with moderate/severe COVID-19 pneumonia, treated before RPH diagnosis with different enoxaparin doses. The therapeutic dose was given to the male with verified PE limited to the segmental/subsegmental pulmonary arteries and initially to the female in whom echocardiography was strongly suggestive of PE, yet this diagnosis was excluded on CT angiography. In one patient, the enoxaparin dose was escalated from 40 mg bd to 60 mg bd after the D-dimer increase. Two patients had bleeding complications despite the enoxaparin dose restricted to 40 mg/daily or bd. Two males had a coexistent psoas hematoma while in only one female there was a coexistent femoral hematoma. RPHs occurred between day 4 and 14 of hospitalization and all were treated conservatively. Three patients who died were particularly charged, so their deaths were not merely directly associated with RPH, which was closely analyzed in one autopsy performed. The authors underline that the choice of anticoagulation intensity in patients with COVID-19 pneumonia without venous thromboembolism seems sometimes difficult but recent publications indicate the low prophylactic enoxaparin dose as an optimal option. Anticoagulation dose escalation based only on the D-dimer level may not be appropriate for certain patients; moreover, the D-dimer increase is commonly observed during internal bleeding.

[The type of material primary hyperlipoproteinemia and newborn birth weight]

Twenty four cases of hyperlipoproteinemia were reported in the investigated group of 67 mother, which delivered behind 38 and 41 week of pregnancy newborns above 2500 g body mass. They were characterized as IIa and IV types according to the WHO classification. Fifteen mothers had HLP of IV type. The average delivery body mass of newborns of these mothers was 3550 g. Nine mothers had HLP of IIa type and these mothers delivered the lightest newborns, average delivery body mass was 3117 g while the average of with normolipidemia mothers was 3238 g. The chi 2 test indicated that the delivery body mass of the newborns is related to the type of hyperlipoproteinemia of mother (p < 0.05).

[Spontaneous splenic rupture as a complication of infectious mononucleosis]

Spontaneous splenic rupture as a complication of infectious mononucleosis in 17-years old man was described. Clinical manifestations of infectious mononucleosis were typical without any sign of the splenic rupture. At the end of third week of the disease sonographic investigation revealed subcapsular hematoma of the spleen without overt rupture. The patient was observed. Five days later in the next sonographic investigation the second hematoma of the spleen appeared. Patient was treated underwent splenectomy and he remain alive and well. Authors suggest that in cases with subcapsular hematoma of the spleen splenectomy remains the treatment of choice. Mononucleosis patients with significant enlarged spleen should be observed very carefully. Authors propose control sonographic investigation in 3rd or 4th week of the disease in those cases.

[Atypical clinical picture of strangulated obturator hernia]

Strangulated obturator hernia is a very rare condition found almost always in elderly, debilitated multiparas usually with concomitant severe chronic illnesses. The authors presented a case of a young, 35-years-old woman of normal constitution, nullipara, without previous abdominal surgery. This unusual clinical picture despite the symptoms of intestinal obstruction caused difficulties in the correct preoperative diagnosis. It is the youngest case of patient with strangulated obturator hernia described in Polish medical literature.

[Our experience with the treatment of cancer of the adrenal cortex]

Nineteen patients with suprarenal tumours were treated surgically within 9 years. Suprarenal cortex carcinoma was diagnosed in 4 of them. One patient was operated twice within 18 months: first the tumour from the right suprarenal gland was removed, then--from the left. Four out of 5 removed tumours were quite sizeable; only in one patient tumour was less than 5 cm in diameter. For diagnostic purposes urography, arteriography, computer tomography and USG were used. Because the characteristic symptoms of the diagnose were absent. Patients reported for the treatment when the disease was markedly advanced. This study stresses the necessity of operative treatment despite discouraging results of diagnostic examinations.

Relationship between stress and alexithymia, emotional processing and negative/positive affect in medical staff working amid the COVID-19 pandemic

The psychological burden of the COVID-19 pandemic may have a lasting effect on emotional well-being of healthcare workers. Medical personnel working at the time of the pandemic may experience elevated occupational stress due to the uncontrollability of the virus, high perceived risk of infection, poor understanding of the novel virus transmission routes and unavailability of effective antiviral agents. This study used path analysis to analyze the relationship between stress and alexithymia, emotional processing and negative/positive affect in healthcare workers. The sample included 167 nurses, 65 physicians and 53 paramedics. Sixty-two (21.75 %) respondents worked in COVID-19-designated hospitals. Respondents were administered the Toronto Alexithymia Scale-20, Cohen's Perceived Stress Scale, Emotional Processing Scale, and the Positive and Negative Affect Schedule. The model showed excellent fit indices (χ2 (2)=2.642, p=0.267; CFI=0.999, RMSEA=0.034, SRMR=0.015). Multiple group path analysis demonstrated physicians differed from nurses and paramedics at the model level (X2diff (7)=14.155, p<0.05 and X2diff (7)=18.642, p<0.01, respectively). The relationship between alexithymia and emotional processing was stronger in nurses than in physicians (difference in beta=0.27; p<0.05). Individual path χ2 tests also revealed significantly different paths across these groups. The results of the study may be used to develop evidence-based intervention programs promoting healthcare workers' mental health and well-being.

[Vesico-uterine fistula as a complication after the second cesarean section]

The case of vesico-uterine fistula after second Cesarean section is presented. The diagnosis was based on history data, urine examination, histerosalpingography and cystoscopy. Transvesical fistulectomy with good results was performed 6 month after Cesarean section.

[Economic aspects in selection of treatment method for tibial and femoral shaft fractures]

The aim of the study was the analysis of the costs of the treatment the patients with tibial and femur shaft fractures treated operatively and conservatively. There were 643 adults and among them 145 patients with femur shaft fractures treated by intramedullary nailing using open Küntscher method (48 patients), closed Küntscher method (35 patients), plating (35 patients) and conservatively (19 patients). There were also 498 patients with tibial shaft fractures treated by intramedullary nailing using closed Küntscher method (105 patients), plating (109 patients), screws (82 patients) and conservatively (202 patients). The cost of the treatment was the lowest in groups of patients with femoral and tibial shaft fractures treated by intramedullary nailing using closed Küntscher method.

[Fenotypical characteristic of coagulase negative staphylococci isolated from patients hospitalized on burn ward and surgical ward]

The aim of the study was to analysis of the adhesion factors of coagulase-negative staphylococci (CNS) to intravenous catheter: ability to adhesion, slime production, hydrophobicity of surface of cells and susceptibility to antibiotics. The researches heve been done on CNS strains isolated from cardiosurgical patients. Slime production ability was evaluated using plate method according to Christensen and Congo Red Agar method. Adherence of bacterial strains to intravenous catheter (polytetrafluoroethylene) in vitro was determined using the method of Richards. Hydrophobicity of surface of cells was determined on the basis of agregattion in (NH4)2SO4 Susceptibility to antibiotics was determined using the disc-diffusion method. Out of the analyzed strains 19% were labeled as slime producing in the plate method and 14% in the Congo red Agar method. 43% of analyzed strains were found to have TTC reduction of 3+, 19% of 2+ and 28% of 1+. Among these 10% of the assesed strains did not reduce TTC.

Evaluation of CD10 expression as a diagnostic marker for colorectal cancer

Aim

We aimed to determine the potential of CD10 as a marker for the early diagnosis of adenocarcinoma of the colon.

Background

Adenocarcinoma is diagnosed in one out of 20 individuals in the USA and western European countries. Its prognosis and treatment depend largely on the severity of the disease at the time of diagnosis. Additional new biological markers are being sought that can help diagnose colon cancer at an early stage. One such marker present in both serum and tumor tissue is CD10.

Methods

CD10 concentrations were tested by ELISA and immunohistochemistry in serum and tissue samples, respectively, from 113 patients diagnosed histopathologically and treated for adenocarcinoma of the colon. Additionally, the ROC curve with optimal cut-off point based on Youden's criterion was calculated for CD10.

Results

Serum concentrations of CD10 and its tissue expression in patients diagnosed with adenocarcinoma of the colon correlate with cancer staging based on the Astler-Coller-Dukes classification. To ascertain the optimal cut-off point for CD10 as a predictor of belonging to the study group, ROC curve was prepared for CD10. Optimal cut-off point for CD10 was 0.57, with prediction of belonging to the study group for CD10 ≥ 0.57.

Conclusion

CD10 can be a useful marker in the early diagnosis of adenocarcinoma of the colon.

[Changes in tissue plasminogen activator in experimental peritonitis caused by pathogenic factors]

Significantly higher tissue plasminogen activator activities were found in the abdominal exudate of rats with peritonitis caused by Escherichia coli than in rats with peritonitis caused by Staphylococcus aureus and Candida albicans. The changes of intraabdominal fibrinolysis may be depended on the type of microorganism.