COMPARISON OF PERSONAL DOSE EQUIVALENT Hp(10) IN 137CS RADIATION BETWEEN THE PRIMARY STANDARDS LABORATORIES OF JAPAN AND AUSTRALIA USING BeO OSL PERSONAL DOSEMETERS

A comparison of personal dose equivalent Hp(10) for 137Cs radiation was conducted between the primary standards laboratories of Japan and Australia. A set of 120 commercially available passive BeO OSL dosemeters were used (Dosimetrics GmbH, Munich). The aim was to investigate the precision which could be obtained with this technique, and to confirm the personal dose equivalent delivery methods in each standards laboratory. A dose of 5 mSv was delivered to 40 dosemeters in each country, and 40 dosemeters were used as controls. The result of the comparison was a ratio of Hp(10) in Japan to Australia of 1.006 with a combined standard uncertainty of 3.2%. The statistical uncertainty was 0.32% indicating that passive dosemeters can be used for comparisons of high precision.

Preschool children blood pressure percentiles by age and height

We aimed to construct blood pressure (BP) references for the Polish preschool children and to compare them with the United States, German and European references. BP was measured oscillometrically using a validated device in 4378 randomly selected Polish children aged 3-6 years who were free of chronic diseases and behaved quietly during BP measurement. Height and weight were also measured. Gender-specific BP percentiles were constructed for age and height simultaneously with the use of quantile regression and a polynomial regression model. Systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial blood pressure reference percentiles by gender, age and height are presented. The Polish preschool children's 90th and 95th SBP and DBP percentiles were mostly lower than those in the United States, German and IDEFICS study BP references. Compared with the German oscillometric BP reference and with the United States sphygmomanometric BP reference, differences in the 95th SBP percentiles ranged by age from -5 to 0 mm Hg and from -2 to -1 mm Hg, in boys and girls, respectively, whereas the differences in the 95th percentiles of DBP ranged from -7 to -1 mm Hg and from -5 to -1 mm Hg, in boys and girls, respectively. Polish preschool children's BP percentiles based on measurements with the use of a validated oscillometric device in a nationally representative sample are lower than those from the current United States, German and European references. When interpreting BP measurements in children, adequate referential values should be used.

Elevated expression of runt-related transcription factors in human abdominal aortic aneurysm

Abdominal aortic aneurysm (AAA) is a multifactorial disease of unknown etiology. AAA is caused by segmental weakening of the aortic walls and progressive aortic dilation leading to the eventual rupture of the aorta, accompanied by intense inflammation. Additionally, studies have indicated a close relationship between the pathogenesis and progression of AAA and cellular immune responses in aneurysm wall tissue. The Runt-related genes (RUNX) encode multifunctional mediators of the of intracellular signal transduction pathways in vascular remodeling, endothelial function, immune response and inflammation. The aim of this study was to evaluate the expression level of RUNX regulatory genes in AAA tissues and to assess the correlations between them. The study was performed on AAA wall-tissue samples obtained from patients with AAA during open aneurysm repair and normal aortic tissues collected from healthy organ donors. There are no proven clinical management strategies or pharmaco-therapeutics to prevent AAA progression once an AAA has been detected. Moreover, so far no biomarkers have been established to indicate the disease status of AAA. Hence, understanding the pathogenesis of AAA has recently become an increasing priority in basic and translational vascular research. We identified significantly higher mRNA and protein level of all of three Runt-related genes in aneurysmal aorta compared to a normal aorta. Increased expression of RUNX2 was demonstrated for the first time in abdominal aortic aneurysm tissue. Additionally, relationships between the activity of RUNX genes in the pathological tissue were identified. The results of elevated expression of RUNX genes and their relationships in the AAA tissues suggest the involvement of conserved Runt-related genes in the pathophysiology of AAA development.

Intestinal Microbiota, Obesity and Prebiotics

Over the past few decades there has been a significant increase in the prevalence of obesity in both children and adults. Obesity is a disease that has reached epidemic levels on a global scale. The development of obesity is associated with both environmental and genetic factors. Recent studies indicate that intestinal microorganisms play an important function in maintaining normal body weight. One of the objectives in the gut microbiota research is to determine the role it plays and can it be a reliable biomarker of disease risk, including the predisposition to obesity. This article discusses (1) the role of prebiotics and gut microbiota in maintaining a healthy body weight and (2) potential influence on the gut microbiota in the prevention and treatment of obesity.

New approach to the rehabilitation of post-stroke focal cognitive syndrome: effect of levodopa combined with speech and language therapy on functional recovery from aphasia

OBJECTIVE

Few studies confirm that pharmacological treatments support post-stroke recovery. The purpose of this study was to determine whether the combination of levodopa with language therapy improves aphasia rehabilitation.

METHODS

We did a prospective, randomized, placebo-controlled, double-blind study in which twenty patients received levodopa before each language therapy session, and an additional 19 received a placebo. Language training was provided during a 3-week period. The efficacy variables were changes from baseline in Boston Diagnostic Aphasia Examination (BDAE) scores.

RESULTS

Patients receiving levodopa experienced greater language improvement in verbal fluency and repetition, compared to patients receiving placebo. Improvement was particularly distinct in patients with anterior lesions.

CONCLUSIONS

Supplementing language therapy with levodopa may improve recovery from aphasia in patients with frontal lesions.

Patient survival and causes of death on hemodialysis and peritoneal dialysis--single-center study

Survival and causes of death in children dialyzed in a single center were analyzed. During the last 12 years a chronic dialysis program was introduced in 146 children in our center and 125 of them, eligible for observation, were included in this analysis; 58 patients were on hemodialysis (HD) and 67 on peritoneal dialysis [continuous ambulatory peritoneal dialysis/automated peritoneal dialysis (CAPD/APD)]. Mean age at the start of dialysis was 13.1 years in HD and 9.8 years in CAPD/APD patients. Overall, 16 patients died (12.5%); 6 (10.3%) on HD and 10 (14.9%) on CAPD/APD; 4 HD patients died of hemorrhagic stroke and 2 were killed in road traffic accidents. Of 10 CAPD/APD patients, 7 died of heart failure, ischemic stroke, and/or disseminated thromboembolic disease. Another was killed in a road traffic accident and 2 died during the course of severe infections. The 1-year patient survival rate was 96.6% in HD patients and 95% in CAPD/APD patients, 2-year survival 94% and 93% and 5-year survival 91% and 78%, respectively (P=0.2, NS). In conclusion, the survival rate for HD and CAPD patients is similar, although after 2 years of therapy, it is lower in CAPD patients. The main causes of death are cardiovascular. However, in CAPD/APD patients, heart failure with low cardiac output and thromboembolic complications are major causes of death, and in HD patients the main cause is hemorrhagic stroke.

[Tubulointerstitial nephritis related to immunotherapy and immunostimulation: a report of two cases]

Two cases of tubulointerstitial nephritis (TIN) with renal failure related to immunotherapy (case 1) and immunostimulation (case 2) have been described. Case 1: 18 years old male patient with hay fever was admitted because of rapid increase of serum creatinine from 1.1 mg/dl to 5.5 mg/dl, fever, weight loss and anemia which developed during 6 months after second course of immunotherapy. Case 2: 12 years old boy was admitted because of fever, weight loss and rapid progression to renal failure after treatment of pharyngitis with antibiotics and immunostimulant drug. In both patients renal biopsy was performed and TIN with huge lymphocytes T infiltrates was diagnosed. After 6 months treatment with corticosteroids renal function turned back to previous levels in both patients. Pathogenesis and treatment of TIN is discussed.

Folate, vitamin B12, and sulfur amino acid levels in patients with renal failure

We examined the plasma profile of sulfur amino acids (SAA) in patients with chronic renal failure (CRF) and looked for any correlation with serum folate (FA) and/or vitamin B12. Group 1 comprised 9 patients with CRF and glomerular filtration rate (GFR) >20 ml/min per 1.73 m2, 9 patients with GFR<20 ml/min per 1.73 m2 comprised group 2, and 14 patients on hemodialysis group 3. The control group comprised 16 healthy children. Homocysteine (Hcy), methionine (Met), cysteine (Cys), and serine (Ser) were measured with gas chromatography. FA and vitamin B12 were measured using enzymatic immunoassay. Median SAA concentrations were significantly lower in controls than in the three groups of patients. Hcy concentrations were 0.8 micromol/l in controls versus 5 micromol/(group 1), 9 micromol/l (group 2), and 20 micromol/l (group 3). Met concentrations were 26 micromol/l in controls versus 26 micromol/l (group 1), 66 micromol/l (group 2), and 281 micromol/l (group 3). Cys concentrations were 10 micromol/ in controls versus 98 micromol/l (group 1), 54 micromol/l (group 2), and 122 micromol/l (group 3). Ser concentrations were 88 micromol/ in controls versus 153 micromol/l (group 1), 239 micromol/l (group 2), and 240 micromol/l (group 3). The median concentrations of FA were lower in controls than in groups 2 and 3: 5.5 ng/ml versus 8 ng/ml and 15 ng/ml, respectively. Vitamin B12 concentrations did not differ between groups. Vitamin levels did not correlate with SAA. The only difference between patients with Hcy levels in the lower and upper quartile was in Met concentration (38 vs. 263 micromol/l, P<0.02) and GFR (P<0.01). In conclusion, patients with CRF had higher SAA concentrations than healthy children. FA concentrations are higher in CRF patients than in healthy children but did not correlate with concentrations of SAA.

[Familial, recurring plasma infusion dependent thrombotic thrombocytopenic purpura/hemolytic uremic syndrome]

Two siblings with chronic relapsing TTP/HUS from early childhood are presented. An onset of the disease was probably neonatal period and it did not involved the organ until puberty. During puberty the course of the disease aggravated with renal involvement and became fulminant in a girl who died disseminated TTP. Her older brother had episode of severe atypical HUS responding to plasma therapy. Now, his renal function is normal but the symptoms are depend an regular, prophylactic plasma infusions.

[Mechanism of progression of chronic renal failure and new treatment strategies]

Chronic renal failure is a self-perpetuating, progressive disease leading to end-stage renal failure, even if primary insult to the kidneys was removed. Progressive course of disease is caused by chronic interstitial inflammation leading to fibrosis, tubular atrophy, and glomerular sclerosis. Main predictive risk factors of the disease progression include: proteinuria, systemic and glomerular hypertension. It is presumed that in most cases progressive course of the disease is related to genetic predisposition to greater activity of renin-angiotensin system. Among attempts to slow progressive course of the disease effective are interventions acting on renin-angiotensin system, endothelin 1 and on profibrotic cytokines. Role of dietary factors and potential treatment modalities are discussed.

[Sulphur amino acids, vitamin B12 and folic acid in children with chronic renal failure]

Aim of the study was to: 1) estimate plasma profile of sulphur AA in children with chronic renal failure (CRF) and in children on hemodialysis (HD), and 2) to evaluate any correlation with serum folic acid (FA) and vitamin B12.

PATIENTS

32 pts with CRF: 9 with GFR > 20 ml/min/1.73 m2 (group 1), 9 with GFR < 20 ml/min/1.73 m2 (group 2), and 14 pts on HD (group 3).

METHODS

plasma homocysteine (Hcys), methionine (Met), cysteine (Cys), serine (Ser) were measured with gas chromatography. Serum FA and vit. B12 were measured using MEIA method.

RESULTS

median Hcys concentrations were the lowest in group 1: 5 mumol/l vs 9 mumol/l (group 2) and 20 mumol/l (group 3) (p = 0.03). Similarly, the lowest Met levels were observed in group 1--26 mumol/l, vs 66 mumol/l (group 2) and 281 mumol/l (group 3) (p = 0.001). Median Cys level in group 1 was 98 mumol/l vs 54 mumol/l (group 2), and 122 mumol/l (group 3) (p = 0.02). No differences were found in median Ser levels: 153 mumol/l (group 1) vs 239 mumol/l (group 2) and 240 mumol/l (group 3). The median concentrations of FA were 6.3 ng/ml (group 1) vs 8 ng/ml (group 2) and 15 ng/ml (group 3) (NS). Median concentrations of vit. B12 were 256 pg/ml (group 1) vs 379 pg/ml (group 2) and 322 pg/ml (group 3) (NS). There were no correlation between sulphur AA and FA and vit. B12 levels. The only difference between pts with Hcys levels remaining in lower and upper quartile concerned Met concentration (38 vs 263 mumol/l, p < 0.02) and GFR (p < 0.01).

CONCLUSIONS

Hyperhomocysteinemia develops already in moderate CRF. In pts on HD levels of Met and Cys are also raised. FA and vit. B12 concentrations are normal and do not correlate with plasma concentrations of sulphur AA.

[Analysis of causes of death in children and adolescents on chronic peritoneal dialysis and hemodialysis in 10 year period: single center experience]

Causes of death in children and adolescents treated with chronic peritoneal dialysis or hemodialysis in 1990-1999 in single centre were analysed. Overall 131 patients were treated, including 55 on peritoneal dialysis (PD) and 76 on hemodialysis (HD). Overall mortality in a 10-year period was 12% (16 patients). 10 patients in PD (18%) and 6 patients in HD group (7.8%) died. The main causes of death in PD patients were cardiac insufficiency, sudden cardiac arrest, ischemic stroke and atherothrombotic disease. In HD patients the main cause of death was hemorrhagic stroke.

[Different effect of angiotensin convertase inhibitors and AT1 receptor blockers on renal function in patients with chronic renal failure: report of two cases]

In two patients with chronic renal failure (CRF) different effects of angiotensin convertase inhibitors (ACEI) and angiotensin receptor 1 blockers (AT1B) were observed. In patient 1 with CRF due to hemolytic-uremic syndrome (HUS), with arterial hypertension (HT) and proteinuria, a switch from AT1B to ACEI led to significant deterioration of renal function. After restitution of AT1B, renal function returned to previous range. The 2nd patient with CRF and severe HT, without proteinuria, due to atypical HUS, was on CAPD. Because of severe HT he received 3-4 hypertensives and ACEI in full dose was the main medication. Despite relatively low urea and creatinine values while on dialysis and high residual diuresis several attempts an end of CAPD was unsuccessful because of hyperkalemia and unacceptable increase of urea and creatinine concentrations after few days. Conversion from ACEI to AT1B enabled withholding CAPD, stabilisation of renal function and good control of HT. It seems that in patients with CRF without hyperfiltration syndrome and sensitive to changes in glomerular hemodynamics, in whom blockade of angiotensin action is needed AT1B may be a better option than ACEI. When using ACEI in patients with CRF, it is important to adjust the dose to renal function.

Novel cytokine-independent induction of endothelial adhesion molecules regulated by platelet/endothelial cell adhesion molecule (CD31)

Tumor necrosis factor-alpha, interleukin-1, and endotoxin stimulate the expression of vascular endothelial cell (EC) adhesion molecules. Here we describe a novel pathway of adhesion molecule induction that is independent of exogenous factors, but which is dependent on integrin signaling and cell-cell interactions. Cells plated onto gelatin, fibronectin, collagen or fibrinogen, or anti-integrin antibodies, expressed increased amounts of E-selectin, vascular cell adhesion molecule-1, and intercellular adhesion molecule-1. In contrast, ECs failed to express E-selectin when plated on poly-L-lysine or when plated on fibrinogen in the presence of attachment-inhibiting, cyclic Arg-Gly-Asp peptides. The duration and magnitude of adhesion molecule expression was dependent on EC density. Induction of E-selectin on ECs plated at confluent density was transient and returned to basal levels by 15 h after plating when only 7 +/- 2% (n = 5) of cells were positive. In contrast, cells plated at low density displayed a 17-fold greater expression of E-selectin than did high density ECs with 57 +/- 4% (n = 5) positive for E-selectin expression 15 h after plating, and significant expression still evident 72 h after plating. The confluency-dependent inhibition of expression of E-selectin was at least partly mediated through the cell junctional protein, platelet/endothelial cell adhesion molecule-1 (PECAM-1). Antibodies against PECAM-1, but not against VE-cadherin, increased E-selectin expression on confluent ECs. Co- culture of subconfluent ECs with PECAM-1- coated beads or with L cells transfected with full-length PECAM-1 or with a cytoplasmic truncation PECAM-1 mutant, inhibited E-selectin expression. In contrast, untransfected L cells or L cells transfected with an adhesion-defective domain 2 deletion PECAM-1 mutant failed to regulate E-selectin expression. In an in vitro model of wounding the wound front displayed an increase in the number of E-selectin-expressing cells, and also an increase in the intensity of expression of E-selectin positive cells compared to the nonwounded monolayer. Thus we propose that the EC junction, and in particular, the junctional molecule PECAM-1, is a powerful regulator of endothelial adhesiveness.

[Results of treating uremia anemia with human recombinant erythropoietin]

Human recombinant erythropoietin has been administered to 10 children with uremic anaemia in the course of renal failure. Children have been treated with repeated hemodialyses. During a 6-month follow-up, hematocrit and hemoglobin have been 30% and 9-10 g/dL, respectively. An increase in serum uric acid with a decrease in iron levels and transferrin saturation have been noted in all children. No serious adverse reactions have been seen.

[Human recombinant erythropoietin in treatment of uremic anemia in children with continual ambulatory peritoneal dialysis]

Human recombinant erythropoietin has been administered to 6 children with uremic anaemia in the course of end stage renal disease, treated with CAPD. The drug has been injected subcutaneously in the dose of 2,000 U twice a week, until hematocrit and hemoglobin values equivalent to 30% and 9-10 g/dL have been achieved. A decrease in cytotoxic antibodies titre has been noted during a 6-month follow-up. No serious adverse reactions have been seen.