Sepsis and septic shock are life-threatening conditions that are globally responsible for almost 20%of mortality,especially in low and middle-income countries.This review was conducted on PubMed and Google Scholar dat...Sepsis and septic shock are life-threatening conditions that are globally responsible for almost 20%of mortality,especially in low and middle-income countries.This review was conducted on PubMed and Google Scholar databases with keywords sepsis,septic shock,sepsis management,and sepsis complications.Articles published up to July 2023 in English were included.Diagnosis and management should be carried out without unnecessary delay.Cooperation between various medical specialties including intensive care doctors,neurologists,hepatologists,cardiologists,and pediatric doctors is needed if a child is affected.New strategies have to be implemented in low and middle-income countries to decrease the sepsis incidence and reduce mortality in the population.展开更多
BACKGROUND Diabetic sensorimotor polyneuropathy is an important risk factor for foot ulceration and amputation.Thus,patients with diabetes should be screened for this disorder according to local guidelines.An obstacle...BACKGROUND Diabetic sensorimotor polyneuropathy is an important risk factor for foot ulceration and amputation.Thus,patients with diabetes should be screened for this disorder according to local guidelines.An obstacle to the diagnosis of this disease may be the lack of unified diagnostic criteria due to the lack of properly validated scales used for assessment.AIM To validate both sections(A and B)of the Michigan Neuropathy Screening Instrument(MNSI)in Polish(PL)patients with diabetes.METHODS A cross-sectional study using a test(A1,B1)and re-test(A2,B2)formula was performed in 80 patients with diabetes.The gold standard used for neuropathy detection was a nerve conduction study(NCS)which was performed in all participants.Reliability of the MNSI-PL was assessed using the Cronbach’s alpha,Kuder-Richardson formula 20(KR-20),split-half reliability,the Gottman split-half tests,and correlation between first and second half was accessed.Stability was assessed using an intraclass correlation coefficient(ICC).For external validation,we used simple linear correlation,binomial regression,and agreement between two different tools using a Bland-Altman plot analysis.RESULTS The scale was internally consistent(Cronbach’s alpha for the full scale:0.81 for A and 0.87 for B).MNSI-PL scores in test/retest showed high stability(ICC=0.73 for A and ICC=0.97 for B).The statistically important correlations between MNSI-PL and NCS were found for B1,B2,and A1(P<0.005).The cut-off points of≥3 for section A(sensitivity of 90%-100%;specificity of 33%-40%)and≥2 for section B(sensitivity of 81%-84%;specificity of 60%-70%)were obtained during neuropathy detection.CONCLUSION The MNSI-PL is a reliable and valid instrument in screening for diabetic neuropathy.展开更多
Parkinson's disease(PD) is characterized by alphasynucleinopathy that affects all levels of the braingut axis including the central, autonomic, and enteric nervous systems. Recently, it has been recognized that th...Parkinson's disease(PD) is characterized by alphasynucleinopathy that affects all levels of the braingut axis including the central, autonomic, and enteric nervous systems. Recently, it has been recognized that the brain-gut axis interactions are significantly modulated by the gut microbiota via immunological,neuroendocrine, and direct neural mechanisms. Dysregulation of the brain-gut-microbiota axis in PD may be associated with gastrointestinal manifestations frequently preceding motor symptoms, as well as with the pathogenesis of PD itself, supporting the hypothesis that the pathological process is spread from the gut to the brain. Excessive stimulation of the innate immune system resulting from gut dysbiosis and/or small intestinal bacterial overgrowth and increased intestinal permeability may induce systemic inflammation, while activation of enteric neurons and enteric glial cells may contribute to the initiation of alpha-synuclein misfolding.Additionally, the adaptive immune system may be disturbed by bacterial proteins cross-reacting with human antigens. A better understanding of the brain-gutmicrobiota axis interactions should bring a new insight in the pathophysiology of PD and permit an earlier diagnosis with a focus on peripheral biomarkers within the enteric nervous system. Novel therapeutic options aimed at modifying the gut microbiota composition and enhancing the intestinal epithelial barrier integrity in PD patients could influence the initial step of the following cascade of neurodegeneration in PD.展开更多
To evaluate circulating IL9 in inflammatory bowel disease and disease-associated anemia/cachexia and assess its potential as a mucosal healing marker.METHODSSerum IL9 as well as other cytokines (IL1β, IL6, IL13, IFN...To evaluate circulating IL9 in inflammatory bowel disease and disease-associated anemia/cachexia and assess its potential as a mucosal healing marker.METHODSSerum IL9 as well as other cytokines (IL1β, IL6, IL13, IFNγ, TNFα, and VEGF-A) were determined in 293 individuals: 97 patients with Crohn’s disease (CD) and 74 with ulcerative colitis (UC) and in 122 apparently healthy controls. The clinical activity of CD and UC was expressed in terms of the Crohn’s Disease Activity Index (CDAI) and the Mayo Scoring System (MDAI), respectively, and the severity of bowel inflammation in UC patients was assessed using Mayo endoscopic score. Cytokine concentrations were measured by a flow cytometry-based method using Luminex xMAP<sup>®</sup> technology. High-sensitive C-reactive protein concentrations (hsCRP) were determined in CD and UC patients using the enhanced immunoturbidimetric method.RESULTSSystemic IL9 was significantly lower in healthy individuals [9 pg/mL (95%CI: 8.2-10)] than in patients with inflammatory bowel disease (IBD): both inactive [14.3 pg/mL (11.9-19.9)] and active [27.6 pg/mL (24.5-32), P < 0.0001]. Cytokine concentrations were significantly higher in active CD [27.4 pg/mL (23.4-32.2)] and in active UC [32.7 pg/mL (27-38.9)] compared to inactive diseases [15.9 pg/mL (10.8-23.4) in CD and 19.4 pg/mL (13.9-27.1) in UC, P = 0.001]. IL9 correlated weakly with CDAI (ρ = 0.32, P = 0.003) and MDAI (ρ = 0.35, P = 0.002) and strongly with endoscopic inflammation in UC (ρ = 0.74, P < 0.0001). As a negative marker of mucosal healing (MH), IL9 had an accuracy superior to hsCRP and IL6 [97% (P < 0.0001), 67% (P = 0.071), and 55% (P = 0.525), respectively]. IL9 was significantly higher in cachectic IBD patients [30.25 pg/mL (24.4-37.5) vs 21.88 pg/mL (18-26.5), P = 0.026] and negatively correlated with hemoglobin concentrations (ρ = -0.27, P < 0.001). Multiple regression showed IL1β and IL13 to be the independent predictors of circulating IL9 in healthy individuals, IFNγ or IL6 in active and inactive UC, respectively, and IL13 and VEGF-A in both active and inactive CD.CONCLUSIONThe systemic IL9 level is higher in IBD and corresponds with endoscopic inflammation, suggesting its possible application as a negative marker of mucosal healing in UC.展开更多
BACKGROUND Mesenchymal stromal/stem cells (MSCs) constitute a promising tool in regenerative medicine and can be isolated from different human tissues. However, their biological properties are still not fully characte...BACKGROUND Mesenchymal stromal/stem cells (MSCs) constitute a promising tool in regenerative medicine and can be isolated from different human tissues. However, their biological properties are still not fully characterized. Whereas MSCs from different tissue exhibit many common characteristics, their biological activity and some markers are different and depend on their tissue of origin. Understanding the factors that underlie MSC biology should constitute important points for consideration for researchers interested in clinical MSC application. AIM To characterize the biological activity of MSCs during longterm culture isolated from: bone marrow (BM-MSCs), adipose tissue (AT-MSCs), skeletal muscles (SMMSCs), and skin (SK-MSCs). METHODS MSCs were isolated from the tissues, cultured for 10 passages, and assessed for: phenotype with immunofluorescence and flow cytometry, multipotency with differentiation capacity for osteo-, chondro-, and adipogenesis, stemness markers with qPCR for mRNA for Sox2 and Oct4, and genetic stability for p53 and c-Myc;27 bioactive factors were screened using the multiplex ELISA array, and spontaneous fusion involving a co-culture of SM-MSCs with BM-MSCs or AT-MSCs stained with PKH26 (red) or PKH67 (green) was performed. RESULTS All MSCs showed the basic MSC phenotype;however, their expression decreased during the follow-up period, as confirmed by fluorescence intensity. The examined MSCs express CD146 marker associated with proangiogenic properties;however their expression decreased in AT-MSCs and SM-MSCs, but was maintained in BM-MSCs. In contrast, in SK-MSCs CD146 expression increased in late passages. All MSCs, except BM-MSCs, expressed PW1, a marker associated with differentiation capacity and apoptosis. BM-MSCs and AT-MSCs expressed stemness markers Sox2 and Oct4 in long-term culture. All MSCs showed a stable p53 and c-Myc expression. BM-MSCs and AT-MSCs maintained their differentiation capacity during the follow-up period. In contrast, SK-MSCs and SM-MSCs had a limited ability to differentiate into adipocytes. BM-MSCs and AT-MSCs revealed similarities in phenotype maintenance, capacity for multilineage differentiation, and secretion of bioactive factors. Because AT-MSCs fused with SM-MSCs as effectively as BM-MSCs, AT-MSCs may constitute an alternative source for BM-MSCs. CONCLUSION Long-term culture affects the biological activity of MSCs obtained from various tissues. The source of MSCs and number of passages are important considerations in regenerative medicine.展开更多
Simple liver cysts are congenital with a prevalence of 2.5%-4.25%. Imaging, whether by US, CT or MRI, is accurate in distinguishing simple cysts from other etiologies, including parasitic, neoplastic, duct-related, an...Simple liver cysts are congenital with a prevalence of 2.5%-4.25%. Imaging, whether by US, CT or MRI, is accurate in distinguishing simple cysts from other etiologies, including parasitic, neoplastic, duct-related, and traumatic cysts. Symptomatic simple liver cysts are rare, and the true frequency of symptoms is not known. Symptomatic simple liver cysts are predominantly large （〉 4 cm）, right-sided, and more common in women and older patients. The vast majority of simple hepatic cysts require no treatment or follow-up, though large cysts （〉 4 cm） may be followed initially with serial imaging to ensure stability. Attribution of symptoms to a large simple cyst should be undertaken with caution, after alternative diagnoses have been excluded. Aspiration may be performed to test whether symptoms are due to the cyst; however, cyst recurrence should be expected. Limited experience with both laparoscopic deroofing and aspiration, followed by instillation of a sclerosing agent has demonstrated promising results for the treatment of symptomatic cysts. Here, we describe a patient with a large, symptomatic, simple liver cyst who experienced complete resolution of symptoms following cyst drainage and alcohol ablation, and we present a comprehensive review of the literature.展开更多
Compelling evidence indicates sex and gender differences in epidemiology, symptomatology, pathophysiology, and treatment outcome in irritable bowel syndrome (IBS). Based on the female predominance as well as the corre...Compelling evidence indicates sex and gender differences in epidemiology, symptomatology, pathophysiology, and treatment outcome in irritable bowel syndrome (IBS). Based on the female predominance as well as the correlation between IBS symptoms and hormonal status, several models have been proposed to examine the role of sex hormones in gastrointestinal (GI) function including differences in GI symptoms expression in distinct phases of the menstrual cycle, in pre- and post-menopausal women, during pregnancy, hormonal treatment or after oophorectomy. Sex hormones may influence peripheral and central regulatory mechanisms of the brain-gut axis involved in the pathophysiology of IBS contributing to the alterations in visceral sensitivity, motility, intestinal barrier function, and immune activation of intestinal mucosa. Sex differences in stress response of the hypothalamic-pituitary-adrenal axis and autonomic nervous system, neuroimmune interactions triggered by stress, as well as estrogen interactions with serotonin and corticotropin-releasing factor signaling systems are being increasingly recognized. A concept of “microgenderome” related to the potential role of sex hormone modulation of the gut microbiota is also emerging. Significant differences between IBS female and male patients regarding symptomatology and comorbidity with other chronic pain syndromes and psychiatric disorders, together with differences in efficacy of serotonergic medications in IBS patients confirm the necessity for more sex-tailored therapeutic approach in this disorder.展开更多
AIM: To investigate the feasibility of separation and cultivation of circulating tumor cells (CTCs) in pancreatic cancer (PaC) using a filtration device.
AIM： To evaluate the effect of sumatriptan, a selective 5-HT1 agonist, on anorectal function in irritable bowel syndrome （IBS） patients. METHODS： Twenty-two IBS patients selected according to the Rome II criteria ...AIM： To evaluate the effect of sumatriptan, a selective 5-HT1 agonist, on anorectal function in irritable bowel syndrome （IBS） patients. METHODS： Twenty-two IBS patients selected according to the Rome II criteria （F 15, M 7; mean age 29.3±6.8, range 22-44 years） were examined. The study was blind, randomized and placebo-controlled with a crossover design. Anorectal manometry and rectal balloon distension test were performed before and after the administration of placebo and sumatriptan. RESULTS： The administration of sumatriptan caused a significant increase in the resting anal canal pressure from 9.2±2.0 kPa to 13.1±3.3 kPa （P〈0.0001） connected with the increase in the anal sphincter length and high pressure zone. After sumatriptan injection a remarkable increase in the threshold for the first sensation from 27±9 mL to 34±12 mL （P〈0.05） and urge sensation from 61±19 mL to 68±18 mL （P〈0.01） was observed. Sumatriptan did not affect either the volume evoking the rectoanal inhibitory reflex or the results of the straining test. CONCLUSION： 5-HT1 receptors participate in the regulation of anorectal function. Elucidation of the role of 5-HT1 receptors in the pathophysiological mechanisms of IBS may have some therapeutic implications.展开更多
Elevated intra-abdominal pressure(IAP)is a known cause of increased morbidity and mortality among critically ill patients.Intra-abdominal hypertension(IAH)and abdominal compartment syndrome can lead to rapid deteriora...Elevated intra-abdominal pressure(IAP)is a known cause of increased morbidity and mortality among critically ill patients.Intra-abdominal hypertension(IAH)and abdominal compartment syndrome can lead to rapid deterioration of organ function and the development of multiple organ failure.Raised IAP affects every system and main organ in the human body.Even marginally sustained IAH results in malperfusion and may disrupt the process of recovery.Yet,despite being so common,this potentially lethal condition often goes unnoticed.In 2004,the World Society of the Abdominal Compartment Syndrome,an international multidisciplinary consensus group,was formed to provide unified definitions,improve understanding and promote research in this field.Simple,reliable and nearly costless standardized methods of non-invasive measurement and monitoring of bladder pressure allow early recognition of IAH and timely optimized management.The correct,structured approach to treatment can have a striking effect and fully restore homeostasis.In recent years,significant progress has been made in this area with the contribution of surgeons,internal medicine specialists and anesthesiologists.Our review focuses on recent advances in order to present the complex underlying pathophysiology and guidelines concerning diagnosis,monitoring and treatment of this life-threatening condition.展开更多
AIM: To establish seroprevalence and provide characteristics of Toxoplasma gondii(TG) infection in children with recurrent headaches. METHODS: The study was performed in 178 children aged 7-17 years admitted consecuti...AIM: To establish seroprevalence and provide characteristics of Toxoplasma gondii(TG) infection in children with recurrent headaches. METHODS: The study was performed in 178 children aged 7-17 years admitted consecutively to the Department of Pediatric Neurology from November 2009 to July 2011. The children were surveyed with a questionnaire with the help and assistance of their parents and blood samples taken on admission were studied for the presence of specific anti-TG Ig M, Ig G antibodies and Ig G avidity using enzyme immunoassay Platelia Toxo Ig M, Ig G. RESULTS: The study showed that 19 children(8 boys, 11 girls; 8-17 years old, mean age 14.36 years) hadhigh serum anti-TG Ig G antibody levels(range: 32.2 > 240 UI/m L, mean 120.18 UI/m L; positive value for Ig G was ≥ 9 UI/m L). The avidity index(AI) ranged from 0.202 to 0.925(scale: ≥ 0.5 high AI). The results for Ig M antibodies were all negative and the obtained results ranged from 0.113 to 0.25 U/m L(mean = 0.191 IU/m L) and all values below 0.8 IU/m L were considered negative. The most frequent complaints found in the seropositive patients were headaches that affected the frontal(13 children), occipital(4) and parietal areas(5). Headaches usually had a pulsating(in 7 patients) and squeezing(6) character and rarely were piercing, dull or expanding. Interestingly, 8 children did not feel discomfort during the headaches, probably because they did not have sufficiently increased intracranial pressure yet. The headaches usually appeared 1-2 times/mo, lasted for 2-6 h, and had a mean intensity of 5.5 points in a 10 point subjective scale. The comorbidities included epilepsy(5 patients), various infections in 3 children(chronic eustachitis, chronic rhinitis, chronic purulent tonsillitis, streptococcal pharyngitis, meningitis, allergic diseases), disturbances of behavior, deficits of attention, and ocular and motor concentration disorders in 1 child. The electroencephalographic and neuroimaging studies performed in our patients had a very limited value in establishing cerebral toxoplasmosis.CONCLUSION: Ten point six seven percent of the studied children had markedly increased serum anti-TG Ig G antibodies and high AI indicated chronic infestation. It is suggested that tests for TG infection should be introduced to routine diagnostics in patients with recurrent headaches.展开更多
Objective To investigate the relationship between frailty syndrome （FS） and adherence to pharmacological and non-pharmacological treatment for hypertension. Methods The study included 100 patients diagnosed with hyp...Objective To investigate the relationship between frailty syndrome （FS） and adherence to pharmacological and non-pharmacological treatment for hypertension. Methods The study included 100 patients diagnosed with hypertension and treated with one or more hypotensive drugs. Results Frail patients obtained low scores （4.1 ± 2.0） for adherence to pharmaceutical treatment of hypertension, while non-frail patients obtained moderate scores （6.1 ± 2.1）. Non-frail patients had higher scores in two out of four domains of the Health Behavior Inventory （HBI）： positive mental attitudes （3.6 ± 0.4 vs. 3.2 ± 0.5; P = 0.006） and health practices （3.6 ± 0.5 vs. 3.2 ± 0.5; P 〈 0.03）; as well as higher global scores （HBI raw score）： 83.3 ±10.6 vs. 77.3 ± 9.5; P 〈 0.03. Multiple regression analysis showed that frailty syndrome （FS） was a statistically significant independent determinant of worse adherence to pharmacological treatment （β= -0.27; P 〈 0.001） and health behaviors （β = -0.10; P = 0.036）. Education was a statistically significant independent determinant of better adherence to pharmacological treatment （β = 0.82; P = 0.012）, while net income positively affected health behaviors as measured by the HBI （β = 0.39; P = 0.046）. Conclusions FS is a significant independent factor contributing to worse adherence to pharmacological and non-pharmacological treatment of hypertension. Better education significantly improves patients＇ adherence to the prescribed pharmacological treatment, while a good financial standing evidenced by high net income is a determinant of better adherence to health-related behaviors recommended in hypertension treatment.展开更多
AIM: To evaluate the impact of chemoradiation admi- nistered pre- or postoperatively on prognosis in females following R0 extended resection with sphincter- preserving total mesorectal excision (TME) for locally advan...AIM: To evaluate the impact of chemoradiation admi- nistered pre- or postoperatively on prognosis in females following R0 extended resection with sphincter- preserving total mesorectal excision (TME) for locally advanced rectal cancer and to assess the association between chemoradiation and intra- and postoperative variables. METHODS: Twenty-one females were treated for locally advanced but preoperatively assessed as primarily resectable rectal cancer involving reproductive organs. Anterior resection with TME and excision of internal genitalia was combined with neo- or adjuvant chemoradiation. Two-year disease-free survival analysis was performed with the Kaplan-Meier method and log- rank test. The association between chemoradiation and other variables was evaluated with the Fisher’s exact test and Mann-Whitney test. RESULTS: Survival rate decreased in anaemic females (51.5% vs 57.4%), in patients older than 60 years (41.8% vs 66.7%) with poorly differentiated cancers (50.0% vs 55.6%) and tumors located ≤ 7 cm from the anal verge (42.9% vs 68.1%) but with the lack of importance. Patients with negative lymph nodes and women chemoradiated preoperatively had significantly favourable prognosis (85.7% vs 35.7%; P= 0.03 and 80.0% vs 27.3%; P = 0.01, respectively). Preoperative chemoradiation compared to adjuvant radiochemotherapy was not significantly associated with the duration of surgery, incidence of intraoperative bowel perforation and blood loss ≥ 1 L, rate of postoperative bladder and anorectal dysfunction, and minimal distal resection margin. It significantly influenced minimal radial margin (mean 4.2 mm vs 1.1 mm; P < 0.01). CONCLUSION: Despite involving internal genitalia, long-term disease-free survival and sphincter preservation may be achieved with combined-modality therapy for females with T4 locally advanced rectal carcinoma. Neoadjuvant chemoradiation does not compromise functional results and may significantly improve oncological outcomes probably due to enhanced radial clearance.展开更多
BACKGROUND The evaluation of the efficacy of platelet-rich plasma(PRP) in clinical practice yields conflicting results and raises numerous controversies. This may be due to different concentrations of biologically act...BACKGROUND The evaluation of the efficacy of platelet-rich plasma(PRP) in clinical practice yields conflicting results and raises numerous controversies. This may be due to different concentrations of biologically active components in PRP obtained with the use of different methods of gravity separation.AIM To compare the content, repeatability and correlations between biologically active components in PRP obtained with four different commercial systems.METHODS From a whole blood sample of each of 12 healthy male volunteers, 4 PRP samples were prepared using 4 different commercial kits [Arthrex Autologous Conditioned Plasma(ACP), Mini GPS Ⅲ, Xerthra, Dr. PRP] in accordance with the instructions provided by the manufacturers. A comparative analysis of blood cell components-13 selected inflammatory cytokines and 7 growth factors-in the obtained PRP samples was performed using the Kruskal-Wallis test by ranks. The repeatability of results in each method was evaluated by the estimation of the coefficient of variation. The Spearman correlation was used to estimate the relationship between blood cell content and cytokines.RESULTS Significantly higher concentrations of platelets(PLT), white blood cells(WBC) and red blood cells(RBC) were found in PRP obtained with the use of Mini GPS Ⅲ than in PRP obtained using other systems. Significant differences in the content of growth factors and cytokines in PRP were found. A positive correlation of the amount of PLT, RBC and WBC with the concentration of most of the growth factors was found but in only three inflammatory cytokines. The obtained correlations between blood cell components and cytokines differed between the systems in terms of statistical significance, which may be due to insufficient sample size. The repeatability of the obtained PLT concentration also varied between protocols with the lowest in Xerthra and the highest in Arthrex ACP.CONCLUSION Significant differences in the content of biologically active components and their repeatability were found in PRP obtained by various methods, providing new data for further research.展开更多
Severe acute respiratory syndrome coronavirus-2(SARS-CoV-2)seems to employ two routes of entrance to the host cell;via membrane fusion(with the cells expressing both angiotensin converting enzyme 2(ACE2)and transmembr...Severe acute respiratory syndrome coronavirus-2(SARS-CoV-2)seems to employ two routes of entrance to the host cell;via membrane fusion(with the cells expressing both angiotensin converting enzyme 2(ACE2)and transmembrane peptidase/serine subfamily member 2/4(TMPRSS2/4))or via receptor-mediated endocytosis(to the target cells expressing only ACE2).The second mode is associated with cysteine cathepsins(probably cathepsin L)involvement in the virus spike protein(S protein)proteolytic activation.Also furin might activate the virus S protein enabling it to enter cells.Gastrointestinal tract(GIT)involvement in SARS-CoV-2 infection is evident in a subset of coronavirus disease 2019(COVID-19)patients exhibiting GIT symptoms,such as diarrhea,and presenting viral-shedding in feces.Considering the abundance and co-localization of ACE2 and TMPRSS2 in the lower GIT(especially brush-border enterocytes),these two receptors seem to be mainly involved in SARS-CoV-2 invasion of the digestive tract.Additionally,in vitro studies have demonstrated the virions capability of infection and replication in the human epithelial cells lining GIT.However,also furin and cysteine cathepsins(cathepsin L)might participate in the activation of SARS-CoV-2 spike protein contributing to the virus invasiveness within GIT.Moreover,cathepsin L(due to its involvement in extracellular matrix components degradation and remodeling,the processes enhanced during SARS-CoV-2-induced inflammation)might be responsible for the dysregulation of absorption/digestion functions of GIT,thus adding to the observed in some COVID-19 patients symptoms such as diarrhea.展开更多
Background Anxiety disorder, one of the highly disabling, prevalent and common mental disorders, is known to be more prevalent in persons with type 2 diabetes mellitus (T2DM) than the general population, and the comor...Background Anxiety disorder, one of the highly disabling, prevalent and common mental disorders, is known to be more prevalent in persons with type 2 diabetes mellitus (T2DM) than the general population, and the comorbid presence of anxiety disorders is known to have an impact on the diabetes outcome and the quality of life. However, the information on the type of anxiety disorder and its prevalence in persons with T2DM is limited. Aims To assess the prevalence and correlates of anxiety disorder in people with type 2 diabetes in different countries. Methods People aged 18-65 years with diabetes and treated in outpatient settings were recruited in 15 countries and underwent a psychiatric interview with the Mini-International Neuropsychiatric Interview. Demographic and medical record data were collected. Results A total of 3170 people with type 2 diabetes (56.2% women;with mean (SD) duration of diabetes 10.01 (7.0) years) participated. The overall prevalence of anxiety disorders in type 2 diabetic persons was 18%;however, 2.8% of the study population had more than one type of anxiety disorder. The most prevalent anxiety disorders were generalised anxiety disorder (8.1%) and panic disorder (5.1%). Female gender, presence of diabetic complications, longer duration of diabetes and poorer glycaemic control (HbA1c levels) were significantly associated with comorbid anxiety disorder. A higher prevalence of anxiety disorders was observed in Ukraine, Saudi Arabia and Argentina with a lower prevalence in Bangladesh and India. Conclusions Our international study shows that people with type 2 diabetes have a high prevalence of anxiety disorders, especially women, those with diabetic complications, those with a longer duration of diabetes and poorer glycaemic control. Early identification and appropriate timely care of psychiatric problems of people with type 2 diabetes is warranted.展开更多
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 particu...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±598μg/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±187μg/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 threeparameter 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.展开更多
Breast cancer(BC) in men represents between 0.5% and 1% of all BC diagnosed each year. We report a case of advanced BC in a 62-year-old male treated at our interdisciplinary Breast Cancer Center. The patient presented...Breast cancer(BC) in men represents between 0.5% and 1% of all BC diagnosed each year. We report a case of advanced BC in a 62-year-old male treated at our interdisciplinary Breast Cancer Center. The patient presented with a newly diagnosed large, symptomatic mass in his left breast. Clinical examination showed a not movable mass of 16 cm diameter, deforming the whole breast; the overlying skin was livid and hypervascularized. Enlarged lymph nodes were palpable in the axillary pit. He had no concomitant diseases at time of presentation. He denied any first- or second degree family medical history of cancer of any type and he never received radiotherapy. Ultrasound guided minimal-invasive 14-gauge core biopsy revealed a moderately differentiated encapsulated papillary carcinoma with high expression of estrogen and progesterone receptors(both > 80%, IRS 12) and HER2-negative. Because of the tumor size a mastectomy with axillary dissection and chest wall reconstruction using a latissimus dorsi flap was performed. Histological analysis showed invasive growth besides typical(non-invasive) papillary carcinoma and was classified as invasive solid papillary carcinoma; p T3(10 cm), p N0(0/15), M0,R0; Oncotype DX Recurrence Score indicated low risk(RS: 2). After discussion in the interdisciplinary tumor board meeting, radiation therapy and tamoxifen were recommended. The patient had an uneventful recovery and is disease-free after two years of follow-up. Male BC is typically diagnosed at an advanced stage, most likely due to a lack of awareness that men can develop BC. Therefore, in case of a large tumor, a flap-based thoracic reconstruction may be required.展开更多
AIM:To evaluate the different visual pathways represented by the Heidelberg Engineering Perimeter flicker defined form and RareBit(magnocellular and parvocellular respectively)in different age-groups and according to ...AIM:To evaluate the different visual pathways represented by the Heidelberg Engineering Perimeter flicker defined form and RareBit(magnocellular and parvocellular respectively)in different age-groups and according to the fatigue.METHODS:Totally 64 eyes of 32 healthy subjects were included in the prospective study.Each participant underwent screening—ophthalmic examination including best-corrected visual acuity,anterior and posterior segment assessment,and visual field examination with Heidelberg Edge Perimetry(HEP)-standard automated perimeter(SAP)24-2.They were observed for 2 y previously to the enrollment.This helped to define that the enrolled patients did not bear the glaucoma-developing potential.During the screening and after two years the HEP had been conducted in the standard protocol 24-2 and RareBit perimetry(RBP)in accordance with the manufacturer’s description.Participants were randomly assigned to the groups:flicker defined form(FDF)-first or RBP-first.This defined from which additional visual field test the participant started.Participants were additionally subdivided to younger and older study groups.The effect of subject variables was explored with Mann-Whitney U-test.Testing for the presence of correlations between parameters was performed using the Spearman Rank Order Correlations and confirmed by the parametric tests.For the influence of additional factors,the Kruskal-Wallis test was performed.RESULTS:The positive correlation between meandeviation(MD)and mean hit rate(MHR)and pattern standard deviation(PSD)and standard deviation of MHR(±MHR)were found in younger study group(P=0.005,r=0.481 and P=0.0074,r=0.465),whereas in the older subgroup no correlation was observed.Additionally,the randomization protocol helped in defining the role of fatigue on the HEP-FDF results.Participant for whom the HEPFDF was performed after RareBit had significantly worse results than those for whom the HEP-FDF was first.In the younger group,the MHR and±MHR depend from age in that group(P<0.05,r=0.43 and r=-0.57 respectively)while no age-dependent differences were found in HEPrelated parameters.On the contrary in the older group the MD and PSD varies with age(P<0.05,r=0.47 and r=-0.44 respectively)while the RBP parameters remained unchanged.The questionnaire showed that participants preferred RareBit over HEP-FDF in terms of a duration time,comfort,understanding of the test procedures,and ocular pain(P<0.05).CONCLUSION:The influence of patient’s fatigue should be considered during HEP-FDF examination.An overlap hypothesis should be reevaluated after determining of other factors that affect HEP-FDF and RareBit results.展开更多
文摘Sepsis and septic shock are life-threatening conditions that are globally responsible for almost 20%of mortality,especially in low and middle-income countries.This review was conducted on PubMed and Google Scholar databases with keywords sepsis,septic shock,sepsis management,and sepsis complications.Articles published up to July 2023 in English were included.Diagnosis and management should be carried out without unnecessary delay.Cooperation between various medical specialties including intensive care doctors,neurologists,hepatologists,cardiologists,and pediatric doctors is needed if a child is affected.New strategies have to be implemented in low and middle-income countries to decrease the sepsis incidence and reduce mortality in the population.
基金Supported by the Ministry of Health Subvention from the IT Simple System of the Wroclaw Medical University by Wroclaw Medical University,No.SUBZ.C310.22.075the MCDTR grant from the National Institute of Diabetes and Digestive and Kidney Diseases,No.P30DK092926.
文摘BACKGROUND Diabetic sensorimotor polyneuropathy is an important risk factor for foot ulceration and amputation.Thus,patients with diabetes should be screened for this disorder according to local guidelines.An obstacle to the diagnosis of this disease may be the lack of unified diagnostic criteria due to the lack of properly validated scales used for assessment.AIM To validate both sections(A and B)of the Michigan Neuropathy Screening Instrument(MNSI)in Polish(PL)patients with diabetes.METHODS A cross-sectional study using a test(A1,B1)and re-test(A2,B2)formula was performed in 80 patients with diabetes.The gold standard used for neuropathy detection was a nerve conduction study(NCS)which was performed in all participants.Reliability of the MNSI-PL was assessed using the Cronbach’s alpha,Kuder-Richardson formula 20(KR-20),split-half reliability,the Gottman split-half tests,and correlation between first and second half was accessed.Stability was assessed using an intraclass correlation coefficient(ICC).For external validation,we used simple linear correlation,binomial regression,and agreement between two different tools using a Bland-Altman plot analysis.RESULTS The scale was internally consistent(Cronbach’s alpha for the full scale:0.81 for A and 0.87 for B).MNSI-PL scores in test/retest showed high stability(ICC=0.73 for A and ICC=0.97 for B).The statistically important correlations between MNSI-PL and NCS were found for B1,B2,and A1(P<0.005).The cut-off points of≥3 for section A(sensitivity of 90%-100%;specificity of 33%-40%)and≥2 for section B(sensitivity of 81%-84%;specificity of 60%-70%)were obtained during neuropathy detection.CONCLUSION The MNSI-PL is a reliable and valid instrument in screening for diabetic neuropathy.
文摘Parkinson's disease(PD) is characterized by alphasynucleinopathy that affects all levels of the braingut axis including the central, autonomic, and enteric nervous systems. Recently, it has been recognized that the brain-gut axis interactions are significantly modulated by the gut microbiota via immunological,neuroendocrine, and direct neural mechanisms. Dysregulation of the brain-gut-microbiota axis in PD may be associated with gastrointestinal manifestations frequently preceding motor symptoms, as well as with the pathogenesis of PD itself, supporting the hypothesis that the pathological process is spread from the gut to the brain. Excessive stimulation of the innate immune system resulting from gut dysbiosis and/or small intestinal bacterial overgrowth and increased intestinal permeability may induce systemic inflammation, while activation of enteric neurons and enteric glial cells may contribute to the initiation of alpha-synuclein misfolding.Additionally, the adaptive immune system may be disturbed by bacterial proteins cross-reacting with human antigens. A better understanding of the brain-gutmicrobiota axis interactions should bring a new insight in the pathophysiology of PD and permit an earlier diagnosis with a focus on peripheral biomarkers within the enteric nervous system. Novel therapeutic options aimed at modifying the gut microbiota composition and enhancing the intestinal epithelial barrier integrity in PD patients could influence the initial step of the following cascade of neurodegeneration in PD.
基金Supported by National Science Center,No.DEC-2011/01/D/NZ5/02835
文摘To evaluate circulating IL9 in inflammatory bowel disease and disease-associated anemia/cachexia and assess its potential as a mucosal healing marker.METHODSSerum IL9 as well as other cytokines (IL1β, IL6, IL13, IFNγ, TNFα, and VEGF-A) were determined in 293 individuals: 97 patients with Crohn’s disease (CD) and 74 with ulcerative colitis (UC) and in 122 apparently healthy controls. The clinical activity of CD and UC was expressed in terms of the Crohn’s Disease Activity Index (CDAI) and the Mayo Scoring System (MDAI), respectively, and the severity of bowel inflammation in UC patients was assessed using Mayo endoscopic score. Cytokine concentrations were measured by a flow cytometry-based method using Luminex xMAP<sup>®</sup> technology. High-sensitive C-reactive protein concentrations (hsCRP) were determined in CD and UC patients using the enhanced immunoturbidimetric method.RESULTSSystemic IL9 was significantly lower in healthy individuals [9 pg/mL (95%CI: 8.2-10)] than in patients with inflammatory bowel disease (IBD): both inactive [14.3 pg/mL (11.9-19.9)] and active [27.6 pg/mL (24.5-32), P < 0.0001]. Cytokine concentrations were significantly higher in active CD [27.4 pg/mL (23.4-32.2)] and in active UC [32.7 pg/mL (27-38.9)] compared to inactive diseases [15.9 pg/mL (10.8-23.4) in CD and 19.4 pg/mL (13.9-27.1) in UC, P = 0.001]. IL9 correlated weakly with CDAI (ρ = 0.32, P = 0.003) and MDAI (ρ = 0.35, P = 0.002) and strongly with endoscopic inflammation in UC (ρ = 0.74, P < 0.0001). As a negative marker of mucosal healing (MH), IL9 had an accuracy superior to hsCRP and IL6 [97% (P < 0.0001), 67% (P = 0.071), and 55% (P = 0.525), respectively]. IL9 was significantly higher in cachectic IBD patients [30.25 pg/mL (24.4-37.5) vs 21.88 pg/mL (18-26.5), P = 0.026] and negatively correlated with hemoglobin concentrations (ρ = -0.27, P < 0.001). Multiple regression showed IL1β and IL13 to be the independent predictors of circulating IL9 in healthy individuals, IFNγ or IL6 in active and inactive UC, respectively, and IL13 and VEGF-A in both active and inactive CD.CONCLUSIONThe systemic IL9 level is higher in IBD and corresponds with endoscopic inflammation, suggesting its possible application as a negative marker of mucosal healing in UC.
基金the National Science Center,No.N407121940the Wroclaw Centre of Biotechnology,the Leading National Research Centre(KNOW)program for the years 2014-2018
文摘BACKGROUND Mesenchymal stromal/stem cells (MSCs) constitute a promising tool in regenerative medicine and can be isolated from different human tissues. However, their biological properties are still not fully characterized. Whereas MSCs from different tissue exhibit many common characteristics, their biological activity and some markers are different and depend on their tissue of origin. Understanding the factors that underlie MSC biology should constitute important points for consideration for researchers interested in clinical MSC application. AIM To characterize the biological activity of MSCs during longterm culture isolated from: bone marrow (BM-MSCs), adipose tissue (AT-MSCs), skeletal muscles (SMMSCs), and skin (SK-MSCs). METHODS MSCs were isolated from the tissues, cultured for 10 passages, and assessed for: phenotype with immunofluorescence and flow cytometry, multipotency with differentiation capacity for osteo-, chondro-, and adipogenesis, stemness markers with qPCR for mRNA for Sox2 and Oct4, and genetic stability for p53 and c-Myc;27 bioactive factors were screened using the multiplex ELISA array, and spontaneous fusion involving a co-culture of SM-MSCs with BM-MSCs or AT-MSCs stained with PKH26 (red) or PKH67 (green) was performed. RESULTS All MSCs showed the basic MSC phenotype;however, their expression decreased during the follow-up period, as confirmed by fluorescence intensity. The examined MSCs express CD146 marker associated with proangiogenic properties;however their expression decreased in AT-MSCs and SM-MSCs, but was maintained in BM-MSCs. In contrast, in SK-MSCs CD146 expression increased in late passages. All MSCs, except BM-MSCs, expressed PW1, a marker associated with differentiation capacity and apoptosis. BM-MSCs and AT-MSCs expressed stemness markers Sox2 and Oct4 in long-term culture. All MSCs showed a stable p53 and c-Myc expression. BM-MSCs and AT-MSCs maintained their differentiation capacity during the follow-up period. In contrast, SK-MSCs and SM-MSCs had a limited ability to differentiate into adipocytes. BM-MSCs and AT-MSCs revealed similarities in phenotype maintenance, capacity for multilineage differentiation, and secretion of bioactive factors. Because AT-MSCs fused with SM-MSCs as effectively as BM-MSCs, AT-MSCs may constitute an alternative source for BM-MSCs. CONCLUSION Long-term culture affects the biological activity of MSCs obtained from various tissues. The source of MSCs and number of passages are important considerations in regenerative medicine.
文摘Simple liver cysts are congenital with a prevalence of 2.5%-4.25%. Imaging, whether by US, CT or MRI, is accurate in distinguishing simple cysts from other etiologies, including parasitic, neoplastic, duct-related, and traumatic cysts. Symptomatic simple liver cysts are rare, and the true frequency of symptoms is not known. Symptomatic simple liver cysts are predominantly large （〉 4 cm）, right-sided, and more common in women and older patients. The vast majority of simple hepatic cysts require no treatment or follow-up, though large cysts （〉 4 cm） may be followed initially with serial imaging to ensure stability. Attribution of symptoms to a large simple cyst should be undertaken with caution, after alternative diagnoses have been excluded. Aspiration may be performed to test whether symptoms are due to the cyst; however, cyst recurrence should be expected. Limited experience with both laparoscopic deroofing and aspiration, followed by instillation of a sclerosing agent has demonstrated promising results for the treatment of symptomatic cysts. Here, we describe a patient with a large, symptomatic, simple liver cyst who experienced complete resolution of symptoms following cyst drainage and alcohol ablation, and we present a comprehensive review of the literature.
基金Supported by The Veterans Administration Research Career Scientist Award(to TachéY)National Institute of Health grants No.P50 DK-64539(to TachéY)No.K01-DK088937(to Larauche M)
文摘Compelling evidence indicates sex and gender differences in epidemiology, symptomatology, pathophysiology, and treatment outcome in irritable bowel syndrome (IBS). Based on the female predominance as well as the correlation between IBS symptoms and hormonal status, several models have been proposed to examine the role of sex hormones in gastrointestinal (GI) function including differences in GI symptoms expression in distinct phases of the menstrual cycle, in pre- and post-menopausal women, during pregnancy, hormonal treatment or after oophorectomy. Sex hormones may influence peripheral and central regulatory mechanisms of the brain-gut axis involved in the pathophysiology of IBS contributing to the alterations in visceral sensitivity, motility, intestinal barrier function, and immune activation of intestinal mucosa. Sex differences in stress response of the hypothalamic-pituitary-adrenal axis and autonomic nervous system, neuroimmune interactions triggered by stress, as well as estrogen interactions with serotonin and corticotropin-releasing factor signaling systems are being increasingly recognized. A concept of “microgenderome” related to the potential role of sex hormone modulation of the gut microbiota is also emerging. Significant differences between IBS female and male patients regarding symptomatology and comorbidity with other chronic pain syndromes and psychiatric disorders, together with differences in efficacy of serotonergic medications in IBS patients confirm the necessity for more sex-tailored therapeutic approach in this disorder.
基金Supported by Research project"CTC in gastrointestinal cancer"awarded by League Against Cancer Prague,Czech Republic and grant of the Czech Ministry of Health,No.IGA NT14439-3/2013the projects by Ministry of Helath Czech Republic,conceptual development of research organization,University Hospital Motol,Prague Czech Republic,No.000 64203
文摘AIM: To investigate the feasibility of separation and cultivation of circulating tumor cells (CTCs) in pancreatic cancer (PaC) using a filtration device.
基金Supported by the grant from GlaxoSmithKline Pharmaceuticals S.A.
文摘AIM： To evaluate the effect of sumatriptan, a selective 5-HT1 agonist, on anorectal function in irritable bowel syndrome （IBS） patients. METHODS： Twenty-two IBS patients selected according to the Rome II criteria （F 15, M 7; mean age 29.3±6.8, range 22-44 years） were examined. The study was blind, randomized and placebo-controlled with a crossover design. Anorectal manometry and rectal balloon distension test were performed before and after the administration of placebo and sumatriptan. RESULTS： The administration of sumatriptan caused a significant increase in the resting anal canal pressure from 9.2±2.0 kPa to 13.1±3.3 kPa （P〈0.0001） connected with the increase in the anal sphincter length and high pressure zone. After sumatriptan injection a remarkable increase in the threshold for the first sensation from 27±9 mL to 34±12 mL （P〈0.05） and urge sensation from 61±19 mL to 68±18 mL （P〈0.01） was observed. Sumatriptan did not affect either the volume evoking the rectoanal inhibitory reflex or the results of the straining test. CONCLUSION： 5-HT1 receptors participate in the regulation of anorectal function. Elucidation of the role of 5-HT1 receptors in the pathophysiological mechanisms of IBS may have some therapeutic implications.
文摘Elevated intra-abdominal pressure(IAP)is a known cause of increased morbidity and mortality among critically ill patients.Intra-abdominal hypertension(IAH)and abdominal compartment syndrome can lead to rapid deterioration of organ function and the development of multiple organ failure.Raised IAP affects every system and main organ in the human body.Even marginally sustained IAH results in malperfusion and may disrupt the process of recovery.Yet,despite being so common,this potentially lethal condition often goes unnoticed.In 2004,the World Society of the Abdominal Compartment Syndrome,an international multidisciplinary consensus group,was formed to provide unified definitions,improve understanding and promote research in this field.Simple,reliable and nearly costless standardized methods of non-invasive measurement and monitoring of bladder pressure allow early recognition of IAH and timely optimized management.The correct,structured approach to treatment can have a striking effect and fully restore homeostasis.In recent years,significant progress has been made in this area with the contribution of surgeons,internal medicine specialists and anesthesiologists.Our review focuses on recent advances in order to present the complex underlying pathophysiology and guidelines concerning diagnosis,monitoring and treatment of this life-threatening condition.
文摘AIM: To establish seroprevalence and provide characteristics of Toxoplasma gondii(TG) infection in children with recurrent headaches. METHODS: The study was performed in 178 children aged 7-17 years admitted consecutively to the Department of Pediatric Neurology from November 2009 to July 2011. The children were surveyed with a questionnaire with the help and assistance of their parents and blood samples taken on admission were studied for the presence of specific anti-TG Ig M, Ig G antibodies and Ig G avidity using enzyme immunoassay Platelia Toxo Ig M, Ig G. RESULTS: The study showed that 19 children(8 boys, 11 girls; 8-17 years old, mean age 14.36 years) hadhigh serum anti-TG Ig G antibody levels(range: 32.2 > 240 UI/m L, mean 120.18 UI/m L; positive value for Ig G was ≥ 9 UI/m L). The avidity index(AI) ranged from 0.202 to 0.925(scale: ≥ 0.5 high AI). The results for Ig M antibodies were all negative and the obtained results ranged from 0.113 to 0.25 U/m L(mean = 0.191 IU/m L) and all values below 0.8 IU/m L were considered negative. The most frequent complaints found in the seropositive patients were headaches that affected the frontal(13 children), occipital(4) and parietal areas(5). Headaches usually had a pulsating(in 7 patients) and squeezing(6) character and rarely were piercing, dull or expanding. Interestingly, 8 children did not feel discomfort during the headaches, probably because they did not have sufficiently increased intracranial pressure yet. The headaches usually appeared 1-2 times/mo, lasted for 2-6 h, and had a mean intensity of 5.5 points in a 10 point subjective scale. The comorbidities included epilepsy(5 patients), various infections in 3 children(chronic eustachitis, chronic rhinitis, chronic purulent tonsillitis, streptococcal pharyngitis, meningitis, allergic diseases), disturbances of behavior, deficits of attention, and ocular and motor concentration disorders in 1 child. The electroencephalographic and neuroimaging studies performed in our patients had a very limited value in establishing cerebral toxoplasmosis.CONCLUSION: Ten point six seven percent of the studied children had markedly increased serum anti-TG Ig G antibodies and high AI indicated chronic infestation. It is suggested that tests for TG infection should be introduced to routine diagnostics in patients with recurrent headaches.
文摘Objective To investigate the relationship between frailty syndrome （FS） and adherence to pharmacological and non-pharmacological treatment for hypertension. Methods The study included 100 patients diagnosed with hypertension and treated with one or more hypotensive drugs. Results Frail patients obtained low scores （4.1 ± 2.0） for adherence to pharmaceutical treatment of hypertension, while non-frail patients obtained moderate scores （6.1 ± 2.1）. Non-frail patients had higher scores in two out of four domains of the Health Behavior Inventory （HBI）： positive mental attitudes （3.6 ± 0.4 vs. 3.2 ± 0.5; P = 0.006） and health practices （3.6 ± 0.5 vs. 3.2 ± 0.5; P 〈 0.03）; as well as higher global scores （HBI raw score）： 83.3 ±10.6 vs. 77.3 ± 9.5; P 〈 0.03. Multiple regression analysis showed that frailty syndrome （FS） was a statistically significant independent determinant of worse adherence to pharmacological treatment （β= -0.27; P 〈 0.001） and health behaviors （β = -0.10; P = 0.036）. Education was a statistically significant independent determinant of better adherence to pharmacological treatment （β = 0.82; P = 0.012）, while net income positively affected health behaviors as measured by the HBI （β = 0.39; P = 0.046）. Conclusions FS is a significant independent factor contributing to worse adherence to pharmacological and non-pharmacological treatment of hypertension. Better education significantly improves patients＇ adherence to the prescribed pharmacological treatment, while a good financial standing evidenced by high net income is a determinant of better adherence to health-related behaviors recommended in hypertension treatment.
文摘AIM: To evaluate the impact of chemoradiation admi- nistered pre- or postoperatively on prognosis in females following R0 extended resection with sphincter- preserving total mesorectal excision (TME) for locally advanced rectal cancer and to assess the association between chemoradiation and intra- and postoperative variables. METHODS: Twenty-one females were treated for locally advanced but preoperatively assessed as primarily resectable rectal cancer involving reproductive organs. Anterior resection with TME and excision of internal genitalia was combined with neo- or adjuvant chemoradiation. Two-year disease-free survival analysis was performed with the Kaplan-Meier method and log- rank test. The association between chemoradiation and other variables was evaluated with the Fisher’s exact test and Mann-Whitney test. RESULTS: Survival rate decreased in anaemic females (51.5% vs 57.4%), in patients older than 60 years (41.8% vs 66.7%) with poorly differentiated cancers (50.0% vs 55.6%) and tumors located ≤ 7 cm from the anal verge (42.9% vs 68.1%) but with the lack of importance. Patients with negative lymph nodes and women chemoradiated preoperatively had significantly favourable prognosis (85.7% vs 35.7%; P= 0.03 and 80.0% vs 27.3%; P = 0.01, respectively). Preoperative chemoradiation compared to adjuvant radiochemotherapy was not significantly associated with the duration of surgery, incidence of intraoperative bowel perforation and blood loss ≥ 1 L, rate of postoperative bladder and anorectal dysfunction, and minimal distal resection margin. It significantly influenced minimal radial margin (mean 4.2 mm vs 1.1 mm; P < 0.01). CONCLUSION: Despite involving internal genitalia, long-term disease-free survival and sphincter preservation may be achieved with combined-modality therapy for females with T4 locally advanced rectal carcinoma. Neoadjuvant chemoradiation does not compromise functional results and may significantly improve oncological outcomes probably due to enhanced radial clearance.
基金Supported by the Wroclaw Medical University as a Regional Center of Excellence in the field of medical sciences and health sciences implemented under the funds of the Ministry of Science and Higher Education(Republic of Poland)in the program"Regional Initiative of Excellence"in the years 2019-2022,No.RID.Z501.20.008。
文摘BACKGROUND The evaluation of the efficacy of platelet-rich plasma(PRP) in clinical practice yields conflicting results and raises numerous controversies. This may be due to different concentrations of biologically active components in PRP obtained with the use of different methods of gravity separation.AIM To compare the content, repeatability and correlations between biologically active components in PRP obtained with four different commercial systems.METHODS From a whole blood sample of each of 12 healthy male volunteers, 4 PRP samples were prepared using 4 different commercial kits [Arthrex Autologous Conditioned Plasma(ACP), Mini GPS Ⅲ, Xerthra, Dr. PRP] in accordance with the instructions provided by the manufacturers. A comparative analysis of blood cell components-13 selected inflammatory cytokines and 7 growth factors-in the obtained PRP samples was performed using the Kruskal-Wallis test by ranks. The repeatability of results in each method was evaluated by the estimation of the coefficient of variation. The Spearman correlation was used to estimate the relationship between blood cell content and cytokines.RESULTS Significantly higher concentrations of platelets(PLT), white blood cells(WBC) and red blood cells(RBC) were found in PRP obtained with the use of Mini GPS Ⅲ than in PRP obtained using other systems. Significant differences in the content of growth factors and cytokines in PRP were found. A positive correlation of the amount of PLT, RBC and WBC with the concentration of most of the growth factors was found but in only three inflammatory cytokines. The obtained correlations between blood cell components and cytokines differed between the systems in terms of statistical significance, which may be due to insufficient sample size. The repeatability of the obtained PLT concentration also varied between protocols with the lowest in Xerthra and the highest in Arthrex ACP.CONCLUSION Significant differences in the content of biologically active components and their repeatability were found in PRP obtained by various methods, providing new data for further research.
文摘Severe acute respiratory syndrome coronavirus-2(SARS-CoV-2)seems to employ two routes of entrance to the host cell;via membrane fusion(with the cells expressing both angiotensin converting enzyme 2(ACE2)and transmembrane peptidase/serine subfamily member 2/4(TMPRSS2/4))or via receptor-mediated endocytosis(to the target cells expressing only ACE2).The second mode is associated with cysteine cathepsins(probably cathepsin L)involvement in the virus spike protein(S protein)proteolytic activation.Also furin might activate the virus S protein enabling it to enter cells.Gastrointestinal tract(GIT)involvement in SARS-CoV-2 infection is evident in a subset of coronavirus disease 2019(COVID-19)patients exhibiting GIT symptoms,such as diarrhea,and presenting viral-shedding in feces.Considering the abundance and co-localization of ACE2 and TMPRSS2 in the lower GIT(especially brush-border enterocytes),these two receptors seem to be mainly involved in SARS-CoV-2 invasion of the digestive tract.Additionally,in vitro studies have demonstrated the virions capability of infection and replication in the human epithelial cells lining GIT.However,also furin and cysteine cathepsins(cathepsin L)might participate in the activation of SARS-CoV-2 spike protein contributing to the virus invasiveness within GIT.Moreover,cathepsin L(due to its involvement in extracellular matrix components degradation and remodeling,the processes enhanced during SARS-CoV-2-induced inflammation)might be responsible for the dysregulation of absorption/digestion functions of GIT,thus adding to the observed in some COVID-19 patients symptoms such as diarrhea.
文摘Background Anxiety disorder, one of the highly disabling, prevalent and common mental disorders, is known to be more prevalent in persons with type 2 diabetes mellitus (T2DM) than the general population, and the comorbid presence of anxiety disorders is known to have an impact on the diabetes outcome and the quality of life. However, the information on the type of anxiety disorder and its prevalence in persons with T2DM is limited. Aims To assess the prevalence and correlates of anxiety disorder in people with type 2 diabetes in different countries. Methods People aged 18-65 years with diabetes and treated in outpatient settings were recruited in 15 countries and underwent a psychiatric interview with the Mini-International Neuropsychiatric Interview. Demographic and medical record data were collected. Results A total of 3170 people with type 2 diabetes (56.2% women;with mean (SD) duration of diabetes 10.01 (7.0) years) participated. The overall prevalence of anxiety disorders in type 2 diabetic persons was 18%;however, 2.8% of the study population had more than one type of anxiety disorder. The most prevalent anxiety disorders were generalised anxiety disorder (8.1%) and panic disorder (5.1%). Female gender, presence of diabetic complications, longer duration of diabetes and poorer glycaemic control (HbA1c levels) were significantly associated with comorbid anxiety disorder. A higher prevalence of anxiety disorders was observed in Ukraine, Saudi Arabia and Argentina with a lower prevalence in Bangladesh and India. Conclusions Our international study shows that people with type 2 diabetes have a high prevalence of anxiety disorders, especially women, those with diabetic complications, those with a longer duration of diabetes and poorer glycaemic control. Early identification and appropriate timely care of psychiatric problems of people with type 2 diabetes is warranted.
文摘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±598μg/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±187μg/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 threeparameter 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.
文摘Breast cancer(BC) in men represents between 0.5% and 1% of all BC diagnosed each year. We report a case of advanced BC in a 62-year-old male treated at our interdisciplinary Breast Cancer Center. The patient presented with a newly diagnosed large, symptomatic mass in his left breast. Clinical examination showed a not movable mass of 16 cm diameter, deforming the whole breast; the overlying skin was livid and hypervascularized. Enlarged lymph nodes were palpable in the axillary pit. He had no concomitant diseases at time of presentation. He denied any first- or second degree family medical history of cancer of any type and he never received radiotherapy. Ultrasound guided minimal-invasive 14-gauge core biopsy revealed a moderately differentiated encapsulated papillary carcinoma with high expression of estrogen and progesterone receptors(both > 80%, IRS 12) and HER2-negative. Because of the tumor size a mastectomy with axillary dissection and chest wall reconstruction using a latissimus dorsi flap was performed. Histological analysis showed invasive growth besides typical(non-invasive) papillary carcinoma and was classified as invasive solid papillary carcinoma; p T3(10 cm), p N0(0/15), M0,R0; Oncotype DX Recurrence Score indicated low risk(RS: 2). After discussion in the interdisciplinary tumor board meeting, radiation therapy and tamoxifen were recommended. The patient had an uneventful recovery and is disease-free after two years of follow-up. Male BC is typically diagnosed at an advanced stage, most likely due to a lack of awareness that men can develop BC. Therefore, in case of a large tumor, a flap-based thoracic reconstruction may be required.
基金Supported by the Wroclaw Medical University grant(No.Pbmn-168).
文摘AIM:To evaluate the different visual pathways represented by the Heidelberg Engineering Perimeter flicker defined form and RareBit(magnocellular and parvocellular respectively)in different age-groups and according to the fatigue.METHODS:Totally 64 eyes of 32 healthy subjects were included in the prospective study.Each participant underwent screening—ophthalmic examination including best-corrected visual acuity,anterior and posterior segment assessment,and visual field examination with Heidelberg Edge Perimetry(HEP)-standard automated perimeter(SAP)24-2.They were observed for 2 y previously to the enrollment.This helped to define that the enrolled patients did not bear the glaucoma-developing potential.During the screening and after two years the HEP had been conducted in the standard protocol 24-2 and RareBit perimetry(RBP)in accordance with the manufacturer’s description.Participants were randomly assigned to the groups:flicker defined form(FDF)-first or RBP-first.This defined from which additional visual field test the participant started.Participants were additionally subdivided to younger and older study groups.The effect of subject variables was explored with Mann-Whitney U-test.Testing for the presence of correlations between parameters was performed using the Spearman Rank Order Correlations and confirmed by the parametric tests.For the influence of additional factors,the Kruskal-Wallis test was performed.RESULTS:The positive correlation between meandeviation(MD)and mean hit rate(MHR)and pattern standard deviation(PSD)and standard deviation of MHR(±MHR)were found in younger study group(P=0.005,r=0.481 and P=0.0074,r=0.465),whereas in the older subgroup no correlation was observed.Additionally,the randomization protocol helped in defining the role of fatigue on the HEP-FDF results.Participant for whom the HEPFDF was performed after RareBit had significantly worse results than those for whom the HEP-FDF was first.In the younger group,the MHR and±MHR depend from age in that group(P<0.05,r=0.43 and r=-0.57 respectively)while no age-dependent differences were found in HEPrelated parameters.On the contrary in the older group the MD and PSD varies with age(P<0.05,r=0.47 and r=-0.44 respectively)while the RBP parameters remained unchanged.The questionnaire showed that participants preferred RareBit over HEP-FDF in terms of a duration time,comfort,understanding of the test procedures,and ocular pain(P<0.05).CONCLUSION:The influence of patient’s fatigue should be considered during HEP-FDF examination.An overlap hypothesis should be reevaluated after determining of other factors that affect HEP-FDF and RareBit results.
