New Phage-Derived Antibacterial Enzyme PolaR Targeting Rothia spp

Rothia is an opportunistic pathogen, particularly life-threatening for the immunocompromised. It is associated with pneumonia, endocarditis, peritonitis and many other serious infections, including septicemia. Of note, Rothia mucilaginousa produces metabolites that support and increase overgrowth of Pseudomonas aeruginosa, one of the ESKAPE bacteria. Endolysins are considered as antibacterial enzymes derived from bacteriophages that selectively and efficiently kill susceptible bacteria without harming human cells or the normal microbiome. Here, we applied a computational analysis of metagenomic sequencing data of the gastric mucosa phageome extracted from human patients' stomach biopsies. A selected candidate anti-Rothia sequence was produced in an expression system, purified and confirmed as a Rothia mucilaginosa- and Rothia dentocariosa-specific endolysin PolaR, able to destroy bacterial cells even when aggregated, as in a biofilm. PolaR had no cytotoxic or antiproliferative effects on mammalian cells. PolaR is the first described endolysin selectively targeting Rothia species, with a high potential to combat infections caused by Rothia mucilaginosa and Rothia dentocariosa, and possibly other bacterial groups. PolaR is the first antibacterial enzyme selected from the gastric mucosa phageome, which underlines the biological complexity and probably underestimated biological role of the phageome in the human gastric mucosa.

Health-Related Quality of Life and Functional Status Following Intensive Neurorehabilitation in a Patient after Severe Head Injury with Spinal Epidural Hematoma: A Case Report

Spinal epidural hematoma (SEH) is a very rare condition associated with trauma or occurring as a complication of lumbar puncture and can appear spontaneously. It manifests with acute pain and neurological deficits, leading to severe and permanent complications. This study aimed to assess changes in health-related quality of life and functional status following long-term intensive neurorehabilitation in a patient after severe sport-related head injury with a related SEH. The 60-year-old male patient experienced bilateral weakness of lower limbs, loss of sensation, and sphincter dysfunction. A laminectomy was performed, followed by a slight superficial and deep sensation improvement. The patient underwent intensive neurological rehabilitation treatment. The proprioceptive neuromuscular facilitation (PNF) method, PRAGMA device exercises, and water rehabilitation were provided. The study outcomes were assessed using the validated questionaries World Health Organization Quality-of-Life Scale (WHOQOL-BREF) and Health-Related Quality of Life (HRQOL-14) for health-related quality of life as well as the Functional Independence Measure (FIM) and Health Assessment Questionnaire (HAQ) for functional status. A beneficial clinical improvement was observed following the intensive rehabilitation using PNF techniques, training with a PRAGMA device, and water exercises in the case of SEH. The patient's physical condition significantly improved, with an increase in the FIM score from 66 to 122 pts. (by 56 pts.) and in the HAQ score from 43 to 16 pts. (by 27 pts.). Additionally, the QOL level increased after rehabilitation, with an increase in the WHOQOL-BREF from 37 to 74 pts. (by 37 pts.) and a decrease in unhealthy or limited days, as assessed using the HRQOL-14, from 210 to 168 (by 42 days). In conclusion, the improvement in QOL and functional level in the SEH patient were associated with high-intensity rehabilitation, simultaneous integration of three therapeutic modalities, and committed patient cooperation.

Endovenous laser therapy with echosclerotherapy as a hybrid method for chronic venous insufficiency: experience in 200 patients and literature review

OBJECTIVE

Surgical treatment of chronic venous insufficiency (CVI) includes sclerotherapy, cryosurgery, CHIVA method (from the French for ambulatory conservative hemodynamic treatment venous insufficiency), chemical and mechanical obliteration, or phlebectomy. A hybrid treatment that combines sclerotherapy with endovenous laser ablation (EVLA) at 980 nm or 1470 nm or Nd:YAG laser at 1064 nm is also increasingly used. This paper synthesizes the current knowledge of CVI of the lower limbs and demonstrates promising clinical practice experiences using a hybrid method that combines EVLA with intraoperative or postoperative ultrasound-guided foam sclerotherapy (UGFS), also known as echosclerotherapy.

PATIENTS AND METHODS

A group of 200 patients was enrolled in the study. All patients underwent a hybrid method of treatment combining EVLA and UGFS. Under tumescent anesthesia, venipuncture of the great saphenous vein (GSV) trunk was performed, followed by 1470 nm laser therapy (80-100J/10W). During the procedure, 2% polidocanol foam was injected into the insufficient collateral veins extending from the main trunk of the GSV. After surgery, compression therapy in the form of grade II compression stockings was used. All patients underwent a follow-up duplex Doppler ultrasound four weeks after the procedure.

RESULTS

It was observed that 196 patients had complete obstruction of the femoral segment of the GSV, while four patients showed signs of minor recanalization of the femoral segment. After 12 months, 198 patients showed complete fibrosis, partial or complete absorption of the saphenous vein, and varicose lesions. Two patients underwent UGFS again after 12 months because of recurrent varicose lesions. At four weeks after UGFS, local pain of thrombosed varicose lesions was observed in 20% of patients. Hemosiderin staining was observed in 15% of patients, but this completely resolved within 6-12 months. In 1% of cases, symptoms of dyspnea and cough were reported, which resolved a few minutes after the procedure - approximately 1% of patients presented with symptoms of matting. There were no severe complications during the 12-month follow-up period.

CONCLUSIONS

A high efficiency of 98% was observed (196/200 patients) at the 12-month follow-up after hybrid EVLA with UGFS treatment. Follow-up UGFS at four weeks after laser ablation showed 99% efficacy at the 12-month postoperative follow-up. Major complications after the hybrid method treatment combining EVLA with UGFS were not observed. Hybrid methods are more effective (98-99%) and give a lower chance of relapse.

Diagnostic usefulness of selected proteases and acute phase factors in patients with colorectal adenocarcinoma

BACKGROUND

Uncontrolled growth and loss of control over basic metabolic functions, leading to invasive proliferation and metastases, are the salient traits of malignant tumors in general and colorectal cancer in particular. Invasion and metastases hinder effective tumor treatment. While surgical techniques and radiotherapy can be used to remove tumor focus, only chemotherapy can eliminate dispersed neoplastic cells. However, the efficacy of the latter method is limited in the advanced stages of the disease. Therefore, recognition of the mechanisms involved in neoplastic cell spreading is indispensable for developing effective therapies.

AIM

To use a number of biomarkers involved in cancer progression and identify a panel that could be used for effective early diagnosis.

METHODS

We recruited 185 patients with colorectal adenocarcinoma (98 men, 87 women with median age 63). Thirty-five healthy controls were sex and age-matched. Dukes’ staging was as follows: A = 22, B = 52, C = 72, D = 39. We analyzed patients' blood serum before surgery. We determined: (1) Cathepsin B (CB) with Barrett's method (fluorogenic substrate); (2) Leukocytic elastase (LE) in a complex with alpha 1 trypsin inhibitor (AAT) using the immunoenzymatic MERCK test; (3) Total sialic acid (TSA) with the colorimetric periodate-resorcinol method; (4) Lipid-bound sialic acid (LASA) with the colorimetric Taut's method; and (5) The antitrypsin activity (ATA) employing the colorimetric test.

RESULTS

In patients, the values of the five biochemical parameters were as follows: CB = 16.1 ± 8.8 mU/L, LE = 875 ± 598 µg/L, TSA = 99 ± 31 mg%, LASA = 0.68 ± 0.33 mg%, and ATA = 3211 ± 1504 U/mL. Except for LASA, they were significantly greater than those of controls: CB = 11.4 ± 6.5 mU/L, LE = 379 ± 187 µg/L, TSA = 71.4 ± 15.1 mg%, LASA = 0.69 ± 0.28 mg%, and ATA = 2016 ± 690 U/mL. For CB and LASA, the differences between the four Dukes’ stages and controls were not statistically significant. The inter-stage differences for CB and LASA were also absent. The receiver operating characteristic (ROC) analysis revealed the potential diagnostic value of CB, TSA, and ATA. The area under ROC, sensitivity, and specificity for these three parameters were: 0.85, 72%, 90%; 0.75, 66%, 77%; and 0.77, 63%, 84%, respectively. The sensitivity and specificity for the three-parameter panel CB-TSA-ATA were equal to 88.2% and 100%, respectively.

CONCLUSION

The increased value of CB, TSA, and ATA parameters are associated with tumor biology, invasion, and metastasis of colorectal cancer. The presented evidence suggests the potential value of the CB-TSA-ATA biochemical marker panel in early diagnostics.

The Role of Serum Calprotectin as a New Marker in Abdominal Aortic Aneurysms - A Preliminary Report

BACKGROUND

Abdominal Aortic Aneurysm (AAA) remains a surgical challenge. There are many recognizable markers associated with the formation of AAA. Previous experiments carried out on animal models have shown a correlation between serum calprotectin and the occurrence of AAA.

OBJECTIVE

This study aimed to evaluate the level of calprotectin as a potential diagnostic biomarker in patients with diagnosed AAA.

METHODS

The study group consisted of 75 patients aged 35-75 years assigned to two groups: a control group (n=43) of healthy subjects without AAA and a study group (n=32) of patients with a diagnosed AAA. The first calprotectin test was performed upon patient admission to the hospital, and the second control test was performed after three months. The concentration of calprotectin in plasma was determined using the Immunoenzymatic Method (ELISA) with the commercially available Assaypro Kit (AssayMax™ Human Calprotectin ELISA Kit), as well as the sandwich method with polyclonal antibodies to human calprotectin and peroxidase enzyme.

RESULTS & DISCUSSION

Serum calprotectin levels in AAA patients were three times higher than in healthy subjects (p<0.05). A statistically significant twofold decrease in calprotectin concentration was observed after AAA surgery compared to the control group (p<0.05).

CONCLUSION

Calprotectin levels can be an important marker in the detection of AAA. In conclusion, AAA patients showed a threefold increase in serum calprotectin level and a twofold decrease in this marker after AAA surgery.

Application of 16S rRNA gene sequencing in Helicobacter pylori detection

Helicobacter pylori is one of the major stomach microbiome components, promoting development of inflammation and gastric cancer in humans. H. pylori has a unique ability to transform into a coccoidal form which is difficult to detect by many diagnostic methods, such as urease activity detection, and even histopathological examination. Here we present a comparison of three methods for H. pylori identification: histological assessment (with eosin, hematoxylin, and Giemsa staining), polymerase chain reaction (PCR) detection of urease (ureA specific primers), and detection by 16S rRNA gene sequencing. The study employed biopsies from the antral part of the stomach (N = 40). All samples were assessed histologically which revealed H. pylori in eight patients. Bacterial DNA isolated from the bioptates was used as a template for PCR reaction and 16S rRNA gene sequencing that revealed H. pylori in 13 and in 20 patients, respectively. Thus, 16S rRNA gene sequencing was the most sensitive method for detection of H. pylori in stomach biopsy samples.

Assessment of Changes in Concentration of Total Antioxidant Status, Acute-Phase Protein, and Prolactin in Patients with Osteoarthritis Subjected to a Complex Spa Treatment with Radon Water: Preliminary Results

Spa treatment brings many clinical benefits such as improved physical activity, pain relief, and improved quality of life. In the literature, there are only few objective studies evaluating changes in metabolism possibly influencing clinical outcomes. The main purpose of our study was the assessment of the effect of spa treatment on changes in concentration of TAS, CRP, and PRL in patients with osteoarthritis. Patients receiving spa treatment were enrolled. TAS, CRP, and PRL levels were obtained using standard tests before the beginning of treatment as well as on days 5 and 18. The study group consisted of n = 35 patients with peripheral joint and spinal osteoarthritis. The control group consisted of 15 people selected from the resort staff, who also suffered from osteoarthritis and had no contact with radon. An increase in TAS concentration was found in the study group following therapy while the control group was characterized by a significant decrease in TAS. On day 5, an increase in TAS concentration was found in both groups, however, with much worse result in the control group. No changes in CRP concentration were statistically significant. PRL concentration was proven to decrease in a statistically significant way after treatment in the study group. This trial is registered with NCT03274128.

Muscle torque production and kinematic properties in post-stroke patients: a pilot cross-sectional study

PURPOSE

Stroke-related hemiplegia is an important factor influencing parameters of gait. So far, limited papers have assessed temporo- spatial capabilities and their correlations with gait parameters in the early post-stroke stage. This pilot study evaluated the temporospatial parameters of gait and assessed the maximal isometric and isokinetic torque production of the plantar flexor and dorsiflexor muscles.

METHODS

15 patients with lower limb spasticity and 15 healthy controls were included. Stroke severity was assessed using the Modified Ashworth Scale and the Barthel Index. Gait cadence, gait speed, and gait cycle were assessed using inertial sensors during a Timed Up and Go test. Maximal isometric and isokinetic torque production of the ankle plantar flexor and dorsiflexor muscles were assessed using an isokinetic dynamometer device.

RESULTS

Post-stroke patients had statistically significantly lower gait cadence than healthy participants (17%, p < 0.05). Statistically significantly lower values of vertical acceleration were also noted during a sit-to-stand movement task (42%, p < 0.05). Plantar flexion torque of the affected limb was significantly different during isometric (63%, p ≤ 0.01) and isokinetic work for 30o/s (49%, p = 0.04), 60o/s (58%, p = 0.01) and 20 °/s (53%, p = 0.01). Dorsiflexor muscles' torque production was significantly different in isometric activity (38%, p = 0.04). A statistically significant positive correlation occurred between the absolute peak torque of the dorsiflexor muscles in both static and speed phases of gait (Rs = 0.65, p = 0.04).

CONCLUSIONS

Despite the low intensity of spasticity and early phase after stroke, differences in the muscle torque production and temporo-spatial parameters, as well as the correlations between them, were noticeable.

A comparative clinical and functional assessment of cortical button versus suture anchor in distal biceps brachii tendon repair

PURPOSE

The studies comparing the fixation methods being used for the ruptured distal biceps brachii tendon reinsertion show similar outcomes of cortical button and suture anchors usage, however, longer follow-up studies remain necessary. The goal of this study was to compare the clinical and functional three-year outcomes of the cortical button in contrast to the suture anchor fixation.

METHODS

A retrospective cohort study comprised of 28 males on average 3 years after surgical reinsertion of the distal biceps brachii tendon with the use of a cortical button (Group I, n = 11) or a suture anchor (Group II, n = 17). The outcomes assessed were range of elbow joint and forearm motion (ROM), arm circumferences, visual analogue scale (VAS), Mayo Elbow Performance Index (MEPI), Quick Disability of the Arm, Shoulder, and Hand (Quick DASH) and forearm flexor and supinator muscle torques measured under isometric and isokinetic conditions.

RESULTS

The comparison between the two studied groups revealed no statistically significant differences in ROM (p = 0.24-1.00), circumferences (p = 0.15-0.50), VAS (p = 0.71), MEPI (p = 0.23), Quick DASH (p = 0.61) or in the obtained muscle torque values (p = 0.07-1.00). However, differences in supination ROM between the surgical and non-surgical side were found in both groups (p = 0.01-0.02), and differences in pronation (p = 0.02) were found in Group II. The muscle torque values obtained in the surgical, dominant limb were lower than those in the nonsurgical, nondominant limb.

CONCLUSION

The comprehensive comparison of three-year outcomes of cortical button versus suture anchor fixations did not favour one fixation method over the other, and the results justify the clinical usage of both methods.

The Assessment of the Integrated Antioxidant System of the Body in the Course of Radon Therapy: A Pilot Study

INTRODUCTION

The sources of Reactive Oxidative Species (ROS) in the organism are the respiratory processes occurring in cells catalyzed by different enzymes. Operation of ROS is balanced by antioxidants, the compounds; although present in low concentrations, they significantly inhibit the degree of oxidation of particular molecules.

THE AIM OF THE STUDY

The aim of this study was to assess the changes in the integrated antioxidant system under the influence of radon therapy in osteoarthritis patients.

MATERIAL AND METHODS

Observation included 35 patients suffering from degenerative joints and disc disease (mean age 56.5 years) undergoing radon water therapy and control group that consisted of 15 osteoarthritis patients (mean age 54.2) without contact with radon water. Before therapy and after 18 days of treatment, serum total antioxidant status (TAS) was assessed with the use of standard colorimetric assay.

RESULTS

In the study group, we observed trends to increase TAS concentration, whereas, in the control group, TAS concentration was decreasing.

CONCLUSIONS

(1) Radon waters treatment influenced the level of TAS of osteoarthritis patients treated with the radon water. (2) The change in TAS concentrations in the study group may be the result of low doses of ionizing radiation, but further studies on larger patient's groups are demanded. This study is registered with number NCT03274128.

High antibiotic resistance of Helicobacter pylori and its effect on tailored and empiric eradication of the organism in Lower Silesia, Poland

BACKGROUND

At present, the resistance to antibiotics is considered the most important reason for Helicobacter pylori (HP) eradication failure. The aim of this study was to estimate the prevalence of antimicrobial resistance of HP strains and to evaluate tailored and empiric therapeutic regimens in patients with peptic ulcer disease associated with infection of this microorganism.

MATERIALS AND METHODS

Between May 2011 and February 2013, 185 consecutive Polish patients with at least one positive Helicobacter pylori test (urease test, histopathologic examination, and/or culture) underwent eradication therapy. Those with positive culture were prescribed a tailored triple regimen, whereas those with no culture available received an empiric quadruple concomitant regimen or levofloxacin-containing triple therapy.

RESULTS

There were no HP strains resistant to amoxicillin; however, 56.7% were resistant to metronidazole, 55.2% to clarithromycin, and 5.9% to levofloxacin. Dual resistance was detected in 32.8% of individuals. Tailored and empiric therapies achieve cure rates, respectively, 95.5% and 86.6% by intention-to-treat and 95.5% and 91.3% by per-protocol analysis (P > 0.05).

CONCLUSIONS

Antibiotic resistance is notably high in Poland currently, but both tailored and empiric therapies can achieve acceptable cure rates equal to or higher than 90%.

Secondary Aortoenteric Fistula After Abdominal Aortic Graft Implementation in Our Own Material

BACKGROUND

Secondary aortoenteric fistula is a rare but severe complication occurring after abdominal aortic graft implementation.

OBJECTIVES

The aim of our study was to review the clinical presentation, diagnosis and postoperative course of patients with aortoenteric fistulas following vascular operations on the abdominal aorta in the years 2000-2014.

MATERIAL AND METHODS

Among all the patients treated in our center, during a 10-year period, aortoenteric fistulas were observed in 24 cases. The first symptoms occurred between 4 weeks and 8 years after the procedure (3.4 years on average). The most common clinical presentation was gastrointestinal bleeding in 16 cases (66.7%). All patients underwent surgical repair of an aortoenteric fistula, with graft removal and replacement in situ using silver impregnated prosthesis.

RESULTS

The 30-day mortality rate after surgical treatment of SAEF was 37.5% (9 patients). Causes of death included: hemorrhagic shock, multi-organ failure and myocardial infarction. The early complications after the surgical repair of an aortoenteric fistula occurred in 19 (79.2%) patients. Mortality during the one-year follow-up period was 38.5% (5 patients) and the one-year complication rate was 69.2%.

CONCLUSIONS

Each patient with a history of abdominal aortic graft implementation and presenting symptoms of gastrointestinal bleeding requires careful diagnosing for aortoenteric fistula. New methods of surgical treatment offering lower mortality should be developed.

Comparison of Endovascular Aneurysm Repair with Open Repair in Patients with Abdominal Aortic Aneurysm in Our Own Material in Years 2002-2011

BACKGROUND

Endovascular abdominal aortic aneurysm repair has become an alternative to open surgical repair of abdominal aortic aneurysm since the early 1990s. The conventional method remains the gold standard in the treatment of Abdominal Aortic Aneurysm (AAA); however, a large percentage of patients do not qualify for this treatment due to the high risk of perioperational death and complications.

OBJECTIVES

The objective of this work was to compare AAA surgeries performed by both classical and endovascular methods in years 2002-2011.

MATERIAL AND METHODS

Medical documentation of elective AAA patients undergoing surgical treatment was retrospectively analyzed on the basis of archive- and computer database data. The analysis included the patients' demographics, internal disease burden, as well as causes of deaths and complications within 30 days after the procedure and 1 year follow-up.

RESULTS

Thirty-day and 1-year mortality rates in patients treated in the elective setting were 1.5% and 8.7% for endovascular method and 4.0% and 15.7% for the open method. The comparison of mortality rates in 115 high-risk patients undergoing elective OR treatment with 275 high-risk treatment patients undergoing EVAR surgery (7.8% vs. 1.5%, 8.7% vs. 15.7%, p<.01) showed that the endovascular method significantly reduced the mortality in the latter group.

CONCLUSIONS

Endovascular treatment is an attractive option in AAA; especially in heavily burdened patients, because it definitely reduces mortality. EVAR was found to be advantageous over OR in case of high-risk patients.

β-adrenergic antagonists influence abdominal aorta contractility by mechanisms not involving β-adrenergic receptors

β-adrenergic receptors (β-AR) are widely distributed in the cardiovascular system, where they considerably contribute to the control of its functions. β-blockers are commonly used in the treatment of disorders of the circulatory system. They act primarily by inhibiting cardiac β-receptors. However, there are also reports of pleiotropic action of β-blockers as well as of new compounds created to study β3 adrenergic receptors. The study aimed to investigate additional mechanisms of action of β-AR inhibitors in the rabbit abdominal aorta with emphasis on their action on α-adrenergic receptors and calcium influx. Responses to propranolol, betaxolol, metoprolol and SR59230A were evaluated in phenylephrine and PGF(2alpha) precontracted aortic rings. The effect of propranolol on the phenylephrine concentration-contraction curve was examined. Propranolol (≥ 10 μM) and SR59230A (≥ 0.1 μM) induced relaxations in phenylephrine-precontracted rings, while betaxolol and metoprolol had little effect. The β-AR inhibitors produced further contraction of tissues preincubated with PGF(2alpha), excluding SR59230A, which after initial contraction, elicited marked relaxation at a concentration above 1 ĕM. 100 μM of propranolol caused a significant rightward shift of the concentration-contraction curve to phenylephrine with no reduction in the maximum response. Incubation of aortic rings in phentolamine reduced the maximal contraction to propranolol; verapamil pretreatment by contrast enhanced contractile response. In conclusion, SR59230A and propranolol most probably act as α1-AR competitive antagonists in the presence of phenylephrine in rabbit abdominal aortic rings. After α-ARs blockade, propranolol exerts a weak relaxing activity connected with Ca2+ channel inactivation. SR59230A at a high concentration acts on the rabbit aorta by an additional mechanism needing further investigation.

The effects of aneurysm repair using an aortic prosthesis on the electrical parameters of the muscular layer of the abdominal aorta

The study was carried out on 10 swine of 20-30 kg body weight. Five animals were assigned to each of 2 groups. An aneurysm of the abdominal aorta was created experimentally in animals from the first and second study group. After 4 weeks, animals from the second group were subject to aneurysm repair using an aortic prosthesis. During the experiment, we measured the myoelectric activity of the muscular layer of the abdominal aorta and aneurysmal lesion with the ultrasonographic technique. Measurements of the aorta and aneurysmal lesion and histopathological analyses were carried out post-mortem. We found a statistically significant decrease in the myoelectric activity of the aorta on the aorta-straight prosthesis interface and a significant decrease in the thickness of the muscular layer of the aorta on the aorta-prosthesis interface. No similar changes were found for experimentally induced aneurysms of the abdominal aorta. A straight prosthesis graft may not be the perfect option in the treatment of abdominal aortic aneurysm, as it contributes to the remodelling of the tissue on the prosthesis-aorta interface. This may result in the relapse of an aneurysm and post-operative complications.

Nonspecific effects of ligands on the beta-adrenergic receptors in rabbit abdominal aorta in vitro

The study was conducted on 30 New Zealand rabbits weighing 3-4 kg from which sample strips of the abdominal aorta were collected. The study investigated the in vitro reaction of rabbit aorta smooth muscle to ligands binding to beta-adrenergic receptors. The response of aortic strips to beta-adrenergic receptor agonists (dobutamine, isoproterenol, salbutamol) and the influence of beta-adrenergic receptor antagonists (propranolol, betaxolol) on contractile activity was determined. All tested agonists induced contraction of the rabbit abdominal aorta muscle in a concentration-dependent manner (dobutamine >> isoproterenol > salbutamol). Enhanced reaction to low concentrations of agonists (dobutamine, isoproterenol) after administration of propranolol and inhibition of contractility in the presence of high concentrations thereof (dobutamine, salbutamol) was observed. Maximal reaction to agonists decreased after betaxolol pretreatment. The results indicate that all the substances with beta-agonist activity also possess contracting properties (presumably by acting at alpha-adrenergic receptors), but are much weaker in the case of isoproterenol and salbutamol than for dobutamine. Propranolol and betaxolol reduce the contractile response of smooth muscle using probably other mechanisms than those associated with adrenergic receptors.

Experimental methods of abdominal aortic aneurysm creation in swine as a large animal model

Animal models of abdominal aortic aneurysms (AAA) enable preclinical studies on new therapeutic approaches and help to understand pathophysiology of the disease. The aim of this study was to demonstrate the effectiveness of selected methods of experimental induction of abdominal aortic aneurysm in swine and to adapt the EMG examination (electromyography) to record the vessel wall changes. The animals were divided into 3 groups comprising 4 individuals in whom AAA was surgically induced. In the first group the AAA was induced by mechanical stretching of the aortic wall and injection of 500 IU elastase under pressure. The second group received elastase and 6000 IU of collagenase. In the third group 0.5 M CaCl2 solution was introduced additionally. Enlargement of abdominal aorta was monitored for 4 weeks. The first group did not show any aorta dilatation. In the second group the aortic lumen was dilated on average by 71±3.5% (P≤0.001) as shown at autopsy and by 76.6±9.3% as measured by the ultrasound method. In the third group aorta was dilatated by 104.2±11.3% as obtained by ultrasound and 72±3% at post-mortem examination. Myoelectric activity of VSMC (vascular smooth muscle cell) was demonstrated and it was characterized by the presence of three types of waves closely related to the pressure changes in the vessel lumen. We conclude that collagen fibers damage plays a significant role in the AAA development in swine. The inflammatory process in the vessel's wall also contributes to AAA development. However, myoelectrical activity of VSMC does not significantly change despite histologically confirmed loss of muscular layer.

[Minimally invasive access to the abdominal aorta in pigs]

Experiments were conducted on 10 sows weighing 50-60 kg. Animals were randomly divided into two experimental groups comprising 5 individuals each. Surgical procedure of reaching the abdominal aorta below the renal arteries was performed using two different methods. In animals from the first group the procedure involved cutting the linea alba in order to obtain access to the abdominal aorta through the abdominal cavity. In the second group the access to the abdominal aorta was obtained by retroperitoneal approach. The approach was made in lower lateral one-third of the abdomen cutting through the muscles and without opening the peritoneal cavity. The study showed superiority of the second surgical method over the median approach along the linea alba in the form of: better animal survival (100% of animals), shorter procedure time, lack of postoperative complications, shorter recovery period and better general postoperative condition

[Effect of atherosclerotic plaque on the contractility of human abdominal aorta sections]

The study was performed on 18 sections of the aneurysm-like abdominal aorta sampled during elective procedures of aneurysm correction in humans, and 10 sections of pig abdominal aorta. We examined the extent to which the presence of atherosclerotic plaque impaired the aorta contractile function and measured the thickness and weight of atherosclerosis plaque and arterial wall. We observed reduced tissue response to adrenaline in human aneurysm-like aorta in comparison to the control group. In the sections of human aorta devoid of atherosclerotic plaque the response to adrenaline was about 30% higher than in those with atherosclerotic changes but 35% lower than in normal aorta sections from pigs. The wall of aneurysm-like human aorta sections was thinner when compared to normal aorta.

In vitro contractility of normal and aneurysmal abdominal aorta muscle coat sections in human and animal material

The objective of the study was to demonstrate spontaneous contractile activity of the smooth muscle coat of the aorta in human and animal material. Spontaneous contractility of smooth muscle tissue, or tonus, is essential for the proper function of many internal organs as observed in the many types of muscle cells which make up the internal structures. The spontaneous contractile activity of the muscle tissue in blood vessels is particularly marked in resistance vessels, regulating circulation within organs or tissues. It can also be observed in large blood vessels such as arteries and veins. The contractile activity of muscular tissue isolated from arteries is the result of a number of factors, including endogenous paracrine substances, neurotransmitters released at postganglionic endings (mostly within the sympathetic system), cells capable of spontaneously generation of functional potentials (pacemaking cells) and the vascular endothelium. Pacemaking cells present in the aortic wall are an important factor in the development of the spontaneous contractility of the muscular coat of the aorta. They are capable of generating functional potentials, resulting in the constant tonus of the smooth muscular coat (comprising the aortic wall) due to tonic contraction. In vitro studies were carried out on abdominal aortic sections collected from 30 New Zealand rabbits with a body mass of 3-4 kilograms each and also on aneurysmal abdominal aortic sections collected during elective aneurysm repair procedures in humans (10 abdominal aortic sections). The 1.5 cm-long sections were mounted in chambers of an automated water bath. The sections were oriented in a transverse and longitudal fashion in order to compare contractility. The incubation medium consisted of Krebs-Henseleit buffer. Spontaneous contractile activity was observed during the study, characterized by rhythmic contractions of the muscular layer of the aorta. The contractile tension within the sections was 0.15 mN in the case of rabbit sections and 0.8 mN in the case of human sections. The average duration of a single contraction was 38.3 +/- 15.05 seconds. The average contraction frequency, i.e. the average number of contractions per minute, was 1.61 +/- 0.54 contractions per minute. The spontaneous contraction is modulated by many factors like endogenous paracrine substances, neurotransmitters or vascular endothelium.

In vitro study on the effects of some selected agonists and antagonists of alpha(1)-adrenergic receptors on the contractility of the aneurysmally-changed aortic smooth muscle in humans

The study included 18 sections of the aneurysmally-changed abdominal aortas, obtained from patients of the Provincial Specialist Hospital in Wroclaw and 18 sections of normal abdominal aortas obtained from swine. The collected samples were placed horizontally in the incubation chamber. Changes in their transverse section area were registered. They were stretched to a tension of 5 mN. Krebs-Henseleit buffer was used as the incubatory environment. Incubation of the sections was performed at a temperature of 37°C, in the gaseous mixture of oxygen and carbon dioxide used in the following proportion: 95% of O(2) and 5% of CO(2). Contractions of the aorta were registered with isotonic transducers (Letica Scientific Instruments). In the studies, we examined the influence of α(1)-adrenergic receptors (and their subtypes α(1A), α(1B), α(1D)) on the contractility of the aortic muscle in humans and swine by their stimulation or inhibition with some selected agonists or antagonists. This time, it was shown that the stimulation of α(1)-adrenergic receptors leads to contractions of the human and swine aortic muscle; the observed increase in the muscle tone may follow from the stimulation of all subtypes of alpha-1 receptor (α(1A), α(1B), α(1D)). All three subtypes of 1-adrenergic receptor are engaged in vasoconstriction, especially of α(1A) and α(1D) subtypes; the α(1B) subtype is less significant for aortic contractility. The contractile response of the aneurysmally-changed abdominal aorta in humans to agonists of α-adrenergic receptors was significantly less intense than that of the normal porcine aorta. It can be concluded that aneurysms influence the contractile response of the aorta.

[The evaluation of costs of the abdominal aortic aneurysm endovascular treatment]

Abdominal aortic aneurysm (AAA) treatment by means of stentgraft implementation is a less post-operationally after-effected, way of treating the AAA on the contrast to the more traditional method. The aim of this study was to evaluate the costs of stentgraft implementation.

MATERIAL AND METHODS

In the years 2001-2006 65 patients were implemented the intervascular prosthesis. Only the patients with severe chronic medical problems were qualified for the treatment: 31 with the respiratory failure, 29 with the circulatory failure and 5 after the stroke with spastic hemiplegia. After CT of the abdominal cave and the angiography performed at the general anaesthetic the intervascular prosthesis was implemented.

RESULTS

After the endovascular procedure was performed the complications could be noticed among 7 patients (10.76%), one patient died (1,53%). After obtaining the data from the Marketing Department the overall cost of treating the patients with endovascular prosthesis was 47500.39 PLN.

CONCLUSION

Among patients with abdominal aortic aneurysm and with severe chronic medical problems costs of the endovascular prosthesis implementation are high, because costs of the stentgraft are high.

[Costs evaluation of operation treatment of ruptured and non-ruptured abdominal aortic aneurysm]

Abdominal aortic aneurysm operation, performed in the emergency mode, has a much larger mortality than the operation of the aneurysm in scheduled mode. The aim of this study is to compare the treatment costs of the aneurysm operated in the emergency mode and scheduled mode. MATERIAL AND METHODS. 125 patients with abdominal aortic aneurysm were take under consideration, 18 of whom were admitted because of the abdominal aortic aneurysm rupture, and 107 of them were admitted without the signs of rupture. From 107 patients admitted in the scheduled mode, 25 were not qualified to the operation because of: other coexisting illnesses (10), recent stroke (1), not agreeing to the surgical intervention (4) and 10 were observed because of the small diameter of the aneurysm and lack of pain.

RESULTS

After receiving the costs from the accountants, we analyzed the costs of treatment in the ruptured and non-ruptured aortic aneurysms.

CONCLUSIONS

The total cost of the treatment of ruptured abdominal aortic aneurysm is almost as twice higher as the treatment cost of non-ruptured abdominal aortic aneurysm.

[Biomechanical characterization of the wall of abdominal aortic aneurysm exposed to infection]

Presented herein are three cases of biomechanical evaluation of the wall of the normal abdominal aorta, of the wall of an abdominal aortic aneurysm infected by Chlamydia pneumoniae, and of the wall of an abdominal aortic aneurysm uninfected by Chlamydia pneumoniae. The samples of the aortic wall and aortic aneurysm were tailored in two directions--transverse and longitudinal. The samples were inserted into the appliance 858 Mini Bionix produced by the MTS for testing the strength of materials and stretched at a constant speed. Based on the studies performed there were obtained the "tension-deformation" curves on which the points of resistance and plasticity were plotted. It has been established that the presence pneumoniae in the abdominal aortic wall favours a significant decrease in the maximal magnitude of the tension in the wall of abdominal aortic aneurysm. As compared to the wall of the abdominal aortic aneurysm, the wall of the normal abdominal aorta demonstrated the higher tension in the transverse direction than in the longitudinal whereas the wall of abdominal aortic aneurysm showed the greater tension in the longitudinal direction.

Cathepsin D expression in human colorectal cancer: relationship with tumour type and tissue differentiation grade

OBJECTIVE

Cathepsin D (CD) is one of the main proteolytic enzymes contributing to the development of cancer. The aim of this study was to CD activity assay in the homogenates of tissues from the centre of the tumour (0) and tumour free area 2 cm, and 5 cm from the tumour border in human colorectal cancer. Activity in the centre of the tumour was compared with immunohistochemical expression CD.

METHODS

CD activity was measured using acid denatured Hb as a substrate. For immunohistochemical staining peroxidase method was used.

RESULTS

Activity of CD was significantly higher (15-fold) in tumour tissue homogenates in comparison to normal mucosa adjacent (control) (p < or = 0.0001) and raised parallel to the stage of tumour tissue differentiation grade. CD activity decreased significantly (p < or = 0.0001) with the distance from the tumour border 2 cm (12.7 fold) and 5 cm (5.7 fold) in comparison to the centre of the tumour. In immunohistochemical examinations CD was detected as diffuse cytoplasmic as well as fine granular staining of the cytoplasm, with occasional coarse cytoplasmic granules staining in the same cases that were positive for both. Positive staining was observed in 2 of 3 in well-differentiated (66%), 4 of 10 in moderately-differentiated (40%) and 4 of 5 in poorly-differentiated (80%), tubular adencarcinomas represented: 3 of 7 (42%) and 9 of 13 in invasive adencarcinoma (69%).

CONCLUSION

We have observed a wide range of cathepsin D and their antigen expressions patterns in colorectal tumours with the development the disease stage, this finding may be used as a daignostic tumor marker in colorectal cancer.

[Early results of acute non-traumatic ischemia of the limbs]

The results of therapy of 726 patients with the acute non-traumatic ischemia of the limbs are discussed. These patients were treated in the 11 centres of vascular surgery in Poland between 1986 and 1988. Out of causes of the acute non-traumatic ischemia of the limbs arterial embolism was diagnosed in 450 patients, thrombosis in 229 cases, and dissecting aneurysm in 8 patients as well as phlegmasia coerulea dolens in 1 patient Surgical treatment included 665 patients, and the remaining 383 patients were treated conservatively. The results of the conservative and surgical treatment were scored with a 5-point scale. Excellent results with the return of complete functioning of the affected limb and presence of peripheral pulse were achieved in 291 patients, positive result, i.e. lack of the peripheral pulse, in 197 cases, moderate result in 80 patients in whom complete functioning of the limb has not been restored. In case of 64 patients an amputaion proved necessary. Nine four patients died.

[Suppurating lesions following surgical treatment of lower limb ischemia due to atherosclerosis]

Patients with suppurative lesions complicating surgical reconstruction of the arteries have been analysed. Such complications have been noted in 110 (102 men and 8 women) out of 311 operated patients. Considering the difference in the number of male and female patients, the risk of suppurative lesions complicating vascular surgery is proportional in both sexes. Thousand three hundred sixty six surgeries included: 361 recanalizations, 944 transplantations, and 61 arterial plasties. Percentage of suppurative complications ranged from 8.8% after transplantations to 9.8% after arterial plasties. More than one surgery has been performed in some patients. The risk of infectious complications has been higher in these patients. Despite antibiotic treatment suppurative infections have been noted in 108 (101 men and 7 women) out of 1244 operated patients, i.e. in 8.6%. Intravenous administration of antibiotics during surgery has proven the most effective prophylaxis. An infection of postoperative wound is the most severe local complication in vascular surgery. It has also been most frequent in the analysed group of patients, being 31.3% of all local complications.