Prevalence of the stages of chronic kidney disease (CKD) according to simplified MDRD formula in patients from ambulatory settings.

BACKGROUND: The staging system of chronic kidney disease (CKD) classification plays an important role in patients stratification according to disease activity. The aim of the study was to evaluate the frequency of appearance of consecutive stages of chronic kidney disease based on simplified MDRD formula in patients with diagnosed CKD. Additionally, relationship between eGFR values and selected biochemical parameters and comorbidities were analyzed. METHODS: The study was performed retrospectively in the group of 1176 patients (636 males and 540 females) aged between 17-98 years (mean 64.7) with creatinine level > 120 µmol/l and/or creatinine clearance < 90 ml/min/1.73 m2. RESULTS: The highest percentage of patients were designated to the 3rd CKD stage. There were positive correlations between eGFR and Hb, Ht, Fe, LDL-Ch, AspAT, HbA1c and negative correlations between eGFR and age, mean and systolic blood pressure, as well as with P, K, iPTH, and uric acid concentration. Patients with cardiovascular diseases had significaintly lower eGFR values as compare with patients without such complications, respectively: atrial fibrillation, arterial hypertension, chronic heart failure, ischaemic heart disease (p < 0.01), and myocardial infarction (p < 0.04). CONCLUSIONS: The highest percentage of patients with diagnosed CKD belong to the 3rd stage of disease. Patients with cardiovascular complications have significantly lower eGFR as compared with those without such disturbances.

[Clinical usefulness of heparin-coated dialyzers]. / Przydatnosc kliniczna dializatorów heparynizowanych.

Hemodialysis procedures involve activation of the coagulation system, which creates the need for heparinization to prevent clotting in the extra- corporeal circulatory system. Heparin-based anticoagulation in dialysis, increases the risk of bleeding during and after hemodialysis procedure. Patients with active bleeding or an increased its risk should be dialyzed without heparin or with limited anticoagulation, while ensuring protection against clotting in the dialyzers and dialysis lines. The search for a reliable and comfortable manner of hemodialysis in patients at risk of bleeding did not bring long-term satisfactory results. It seems that a breakthrough in this field was the introduction of dialyzers with polyacrylonitrile membrane with adsorption capacity of heparin during their pre-rinse and then membrane dialyzers with hydrogel polyacrylonitrile heparinized during the manufacturing process. The authors evaluated the clinical usefulness of heparinized dialyzers based on 1140 Evodial hemodialysis sessions performed in 11 patients with increased risk of bleeding in the Dialysis Unit of the Department of Nephrology, University Hospital, Krakow during years 2012-2014. It has been shown that heparinized dialyzers are useful not only in patients with acute bleeding organ, but also in patients with chronic bleeding or chronic bleeding risk non responding for therapeutic methods. Their use allows the individualization of anticoagulation therapy by reducing the dose of heparin.

[Dialysis therapy in elderly patients--selected aspects. Can patients treated by hemodialysis cease further therapy?]. / Dializoterapia u pacjentów w podeszlym wieku- -wybrane aspekty. Czy chory objety leczeniem powtarzanymi hemodializami moze zaprzestac dializy?

UNLABELLED: Even though significant progress has been attained in the question of dialysis therapy--experts have not addressed the aspect of when is proper moment to initiate dialysis therapy. It has not been proven that early starting of hemodialysis with higher GFRvalues has positive influence on decreasing mortality in this patients population. Steady rise in the number of elderly patients with multiple comorbidities qualified for hemodialysis results in increased mortality in this group. Aside from the continuing discussion pertaining to dialysis therapy initiation authors have attempted to answer the question: "Does qualification and initiation of maintenance hemodialysis treatment permanently close the aspect of resignation from therapy due to clinical improvement?". The study consisted of 140 subjects treated by maintenance hemodialysis in the Dialysis Unit Department of Nephrology, University Hospital, in Cracow, during the years between 2009-2012. Among 63 patients with initiated hemodialysis during this period--5 patients resigned from therapy due to clinical improvement. These were elderly patients between the ages of 74-88 years with chronic renal disease probably due to ischemic and/or diabetic nephropathy exacerbated by hypotension, dehydration, myocardial infarct or administration of contrast materials. CONCLUSIONS: Initiation of maintenance hemodialysis therapy according to actual standards does not exclude the possibility in resignation from dialysis treatment due to clinical improvement, especially in the elderly patients group. Enormously significant during this period is precise clinical patient evaluation in the subject of volemia, which in turn protects the patient from excess ultrafiltration that in turn eliminates residual diuresis.

[Comparison of the hemodialysis adequacy conducted based on low-flux polysulfone dialyzers and high-flux helixone dialyzers]. / Porównanie adekwatnosci hemodializy prowadzonej z uzyciem niskoprzeplywowych dializatorów polisulfonowych i wysokoprzeplywowych dializatorów helixonowych.

UNLABELLED: Hemodialysis (HD) is a dynamic process, which occurs during movement through a semipermeable membrane, water soluble substances of low molecular weight. Transport across the membranes of low-flux (LF) dialyzers is based mainly on diffusion and through the membranes of high-flux (HF) dialyzers, diffusion and convection. The aim of the study was to compare the adequacy of hemodialyses conducted on the basis of the low-flux dialyzers with polysulfone membrane, and the high-flux dialyzers with helixone membrane. MATERIAL AND METHODS: The study included 60 patients (23 women and 37 men) aged 24-84 years (mean 60.73 +/- 15.75) treated with maintenance hemodialysis (three times per week). The study enrolled clinically stable patients after a minimum 3-months period of HD. Blood tests were performed 1 time a month before the middle week dialysis session. For the first six months HD was based on LF dialyzers with polysulfone membrane, and then for an additional 6 months based on HF dialyzers with helixone membrane. RESULTS: The performed study demonstrated a statistically significant higher values of: spKtV and URR% and lower values of the urea before and after HD sessions performed based on HF-HD as compared with LF-HD (spKt/V LF = 1.26 +/- 0.23 vs. spKtV HF = 1.37 +/- 0.17; p < 0.001, URR% LF = 66.74 +/- 5.86 vs. URR% HF = 70.57 +/- 3.71; p < 0.001, urea before LF-HD = 21.57 +/- 4.57 mmol/I vs. HF-HD = 20.57 +/- 4.21 mmol/I; p < 0.01 and the urea after LF. HD = 7.19 +/- 2.25 mmol/l vs. HF-HD = 6.03 +/- 1.55 mmol/l; p < 0.001). Conclusions: The study showed better adequacy of HD treatment performed based on the high-flux dialyzers with helixone membrane as compared with low-flux dialyzers with polysulfone membrane.

Carpal tunnel syndrome in hemodialysis patients as a dialysis-related amyloidosis manifestation--incidence, risk factors and results of surgical treatment.

BACKGROUND: Carpal tunnel syndrome (CTS) is the most common complication of dialysis-related amyloidosis (DRA) developing in patients on long-term dialysis therapy. The aim of this study was to evaluate the incidence of CTS and identify factors influencing the development of CTS in patients on maintenance hemodialysis, as well as results of its surgical treatment. MATERIAL/METHODS: The study included 386 patients, among whom CTS was diagnosed in 40 patients (10.4%) on the basis of signs and physical symptoms, as well as by nerve conduction. The group of patients with CTS and the group of patients without CTS were compared according to age (mean 54.50 vs. 56.48 years) and duration of dialysis treatment. Initial analysis of CTS incidence by sex, presence of anti-HCV antibodies, and location of arterio-venous fistula (AV fistula) was undertaken. RESULTS: Duration of dialysis treatment was the statistically significant risk factor for the development of CTS (16.05 vs. 4.51 years; p<0.0001). Among patients treated for a long period on hemodialysis (20-30 years), 100% required surgical release procedures, while 66.66% of those treated for 15-19 years, 42.1% of those treated for 10-14 years, and 1.6% of those treated for less than 10 years. CTS was diagnosed more often in anti-HCV-positive patients as compared with anti-HCV-negative patients (47.5 vs. 6.9%; p<0.0001). No significant differences were found when comparing CTS incidence by sex or between the development of CTS requiring surgical release intervention and location of the AV fistula. CONCLUSIONS: Surgical release procedure of the carpal tunnel gave good treatment results in patients with CTS.

Biomaterials in the Reconstruction of Nasal Septum Perforation.

INTRODUCTION: Septal perforations are among the most common craniofacial defects. The causes of septal perforations are varied. OBJECTIVES: The purpose of the study was to develop a septal cartilage implant biomaterial for use in the reconstruction of nasal septal perforations and prepare personalized implants for each patient individually using 3D printing technology. METHODS: Fragments of septal nasal cartilage from 16 patients undergoing surgery for a deviated nasal septum were analyzed to establish microfeatures in individual samples. A scanning electron microscope was used to estimate the microstructure of the removed septal cartilage. 3D models of porous scaffolds were prepared, and a biomaterial was fabricated in the shape of the collected tissue using a 3D printer. RESULTS: Of the various materials used in the Fused Deposition Modeling (FDM) technology of 3D printing, PLLA was indicated as the most useful to achieve the expected implant features. The implant was designed using the indicated pre-designed shape of the scaffold, and appropriate topography, geometry and pore size were included in the design. CONCLUSIONS: The implant's structure allows the use of this device as a framework to carry nanoparticles (antibiotics or bacteriophages). It is possible to create a porous scaffold with an appropriately matched shape and a pre-designed geometry and pore size to close nasal septal perforations even in cases of large septal cartilage defects.

[Clinical usefulness of Nephral ST dialyzers in hemodialyzed patients with increased risk of bleeding]. / Przydatnosc kliniczna dializatorów Nephral ST u chorych hemodializowanych z ryzykiem krwawienia.

Hemodialyzed patients with increased risk of bleeding can be dialyzed according to a method of limited anticoagulant use including saline flush technique, regional citrate anticoagulation, regional heparinization or use of membranes with low thrombogenic properties. Methods that limit anticoagulation use are not completely effective, increase work load for the dialysis team and create a risk of complications. The aim of the study was to evaluate the clinical usefulness of Nephral ST dialyzers with poli-acrylonitrile membranes treated with polyethylenimine binding heparin in hemodialyzed patients with increased risk of bleeding. In 12 patients with increased bleeding risk, 121 hemodialyzed sessions were performed utilizing Nephral ST dialyzers. Heparin was not administered during the procedure. Degree of clotting of the dialyzer and the venous drip chamber was evaluated using a 4-degree visual scale. Platelet count, partial activation time of thromboplastine (APTT), thrombin time (TT), antithrombin III, as well as d-dimer concentrations were measured before dialysis and after 15, 120 and 240 minutes of procedure. No complications of massive clotting necessitating premature termination of dialysis was noted. In most sessions trace or small clotting was observed in the dialyzers and drip chambers. No significant differences in platelet count and AT III levels were measured. Increased TT and APTT after 15 minutes of dialysis were observed, which was probably due to release of small amounts of dialyzer membrane heparin. After 120 and 240 minutes these values returned to normal ranges. These observations along with increased d-dimers after 240 minutes suggested an increased risk of clotting during evaluated sessions. Application of Nephral ST dialyzers permits for heparin-free dialysis procedure in patients with increased risk of bleeding.

[Electrophysiological diagnosis of severe carpal tunnel syndrome in patients on maintenance hemodialysis with created arterio-venous fistula and concomitant polyneuropathy]. / Diagnostyka elektrofizjologiczna ciezkich postaci zespolu ciesni nadgarstka u chorych przewlekle dializowanych z wytworzona przetoka tetniczo-zylna oraz wspólistniejaca polineuropatia.

UNLABELLED: Carpal tunnel syndrome (CTS) is the most frequent neuropathy observed in maintenance haemodialysis patients. In spite of the established diagnostic guidelines and many different methods of nerve conduction testing, sometimes difficult to distinguish very advanced CTS (absent median motor and sensory responses) from uremic neuropathy. In the last few years the 2LI-DML test has been accepted as a reliable method for the diagnosis for very advanced stage of CTS. The aim of this study was to evaluate the usefulness of nerve conduction testing based on the interlatency difference (2LI-DML) between the second lumbrical (2L) and second dorsal interosseous (21) muscles in the diagnosis of severe forms of carpal tunnel syndrome in long-term hemodialysis patients with superimposed polyneuropathy. From the group of 40 patients with CTS the 2LI-DML test was used in five cases of long-term hemodialysis with severe damage of the median nerves (absent median motor and sensory responses) and with forearm arteriovenous fistulas and concomitant uremic polyneuropathy. The presence of forearm arteriovenous fistulas makes needle electrode test impossible to apply. The performed 2LI-DML test allowed for a confirmation of clinical diagnosis of CTS in all the patients. A mean difference of motor latency between the second lumbrical and the second interosseous muscles was significantly prolonged and amounted to 10.91+2.36 ms. CONCLUSIONS: The 2LI-DML test is the only test that may be used to diagnose CTS in patients with severe damage of the median nerves and with forearm arterio-venous fistulas and superimposed polyneuropathy. The test is fast, simple to perform and well-tolerated by such patients.

[Chronic kidney disease (CKD) in source documentation of the outpatient clinic of the Department of Nephrology. Part III. CKD, comorbidities and performed surgical procedures]. / Przewlekla choroba nerek (PChN) w materiale Poradni Nefrologicznej. Czesc III. PChN a schorzenia wspólistniejace i przebyte zabiegi operacyjne.

UNLABELLED: The aim of the study was to investigate the incidence of comorbidities and performed surgical procedures in the group of patients with different stages of chronic kidney diseases (CKD). 1183 patients aged between 17 and 98 years with creatinine level > 120 micromol/I and/or creatinine clearance < 90 ml/min/1.73m2 were analyzed. In the studied group 31.3% of patients had diagnosed ischaemic heart disease, 25.2% diabetes, 64.5% arterial hypertension, 10.6% overcome myocardial infarction, 6.7% atrial fibrillation, 9.8% cardiac failure, 7.7% urolithiasis, 26.6% obesity (BMI > 30) and 10.6% were post nephrectomy. Patients with performed surgical procedures in the past constituted 22.8%. With the usage of statistical analysis, we attempted to find connections between GFR calculated based on the abbreviated MDRD formula, Cockcroft-Gault formula and 24h urine collection and potential risk factors for every method separately; later noted correlations were evaluated. Statistically significant correlations were found between GFR and BMI, occurence of atrial fibrillation, myocardial infarction, chronic cardiac failure, urolithiasis, ischaemic heart disease, obesity, female sex, previous coronary artery bypass graft, hypertension and previous surgical procedures. CONCLUSIONS: 1. Comorbidities are frequent in patients with CKD and 22.8% of them had performed in the past one or more surgical procedures. 2. There is a relationship between GFR values and cardiovascular complications.

[Coincidence of HCV and HGV infections in hemodialysis patients]. / Wspólwystepowanie zakazen wirusem HCV i HGV w populacji chorych dializowanych.

UNLABELLED: HCV and HGV were recognized as highly prevalent in maintenance dialysis population and variable from country to country and unit to unit. The introduction of serologic tests, for detecting antibodies to HCV (anti-HCV) and HGV (anti-HGV) antigens, has facilitated the study of the epidemiology as well as clinical significance of HCV and HGV infections in patients on maintenance dialysis. The implementation of molecular biology techniques (polymerase chain reaction) for detecting HCV and HGV viremia (HCV-RNA, HGV-RNA) facilitate diagnosis and transmission routes of the infection. The aim of the study was to evaluate the coincidence of HCV and HGV infections in dialysis population and relationship between current and overcome infections and markers of liver damage. The study was performed in the group of 215 patients aged 26-81 years (mean 53.2) on 3 x week maintenance hemodialysis from 33 to 301 months (mean 101.8 months) in the Department of Nephrology, University Hospital, Cracow. Anti-HCV and anti-HGV antibodies were determined based on immunoenzymatic, IIIrd generation, methods. HCV-RNA and HGV-RNA were estimated using polymerase chain reaction (PCR). The anti-HCV antibodies were present (+) in 40 (18.6%) of patients. From the group of patients with anti-HCV (+) antibodies 42.5% were also HCV-RNA (+) whereas from the patients with anti-HCV (-) antibodies 10.4% were HCV-RNA (+). Anti-HGV antibodies tested in the group of 93 patients: 32 anti-HCV (+) and 61 anti-HCV (-) were positive in 20 (62.5%) and 22 (36.1%) patients, respectively. In the group of patients with anti-HGV (+) antibodies HGV-RNA (+) were detected in 63.6%. Anti-HCV (+) and anti-HGV (+) patients were dialysed longer as compared with negative ones: 144.5 vs. 83.5 months, p < 0.001 and 119 vs. 96.4 months, p-NS, respectively. CONCLUSIONS: 1. The prevalence of HCV and HGV infections in the dialysis population is very high. 2. The coincidence of HCV and HGV infections is frequent. 3. Our results showed that even anti-HCV (-) and anti-HGV (-) patients carry the risk of viral infection due to detected HCV-RNA and HGV-RNA in some patients.

[Hundred-years-old patient on maintenance hemodialysis--case report]. / Stuletnia chora leczona przewlekle hemodializami--opis przypadku.

Along with increasing mean age of dialyzed patients one begins to ask whether old age may be a factor influencing the decision concerning dialysis treatment. We are presenting a case concerning female patient that initiated hemodialysis at the age 99 and continued treatment for the following 18 months. After this observation period, the medical team agreed that the decision to initiate dialysis therapy in this patient positively influenced her quality of life in regard to her daily needs. The presented case proves that rationing access to dialysis treatment in regard to age would not have been appropriate.

[Chronic kidney disease in the source documentation of the outpatient clinic Department of Nephrology. Part I. Causes of renal failure and characteristics of the studied population]. / Przewlekla choroba nerek w materiale Poradni Nefrologicznej. Czesc I. Przyczyny uszkodzenia nerek oraz charakterystyka badanej populacji.

During the last years the incidence of chronic kidney disease (CKD) is permanently increasing and has become a global social and economical problem in the world as well as in Poland. The aim of the study was the retrospective analysis of medical records of patients with renal failure under supervision at the outpatient clinic, Department of Nephrology, University Hospital in Cracow. The study population enclosed 1183 patients (640 men and 543 women) aged between 17 and 98 years (mean 64.7) with creatinine concentration >120 micromol/l and/or creatinine clearance <90 ml/min/1.73 m2. Hemoglobin, iron, creatinine, urea, sodium, potasium, calcium, phosphate, magnesium, PTH, uric acid, albumin, total protein, bilirubin, glucose, total cholesterol, LDL and HDL cholesterol, triglicerydes concentration and values of hematocrite, MCV, HbA1, as well as alkaline phosphatase, AspAT, AIAT activity were estimated based on standard laboratory methods. Creatinine clearances were evaluated based on 3 different methods: simplified MDRD formula, Cockcroft-Gault formula and 24-h urine collection. Mean creatinine concentration in the studied population was 172.8 micromol/l (1.95 mg/dl). Hypertension was diagnosed in 65% of patients. In spite of treatment, more than half of the patients (51.9%) have increased systolic blood pressure and above 1/3 (35%) increased diastolic blood pressure. Mean hemoglobin concentration was 13.02 g/dl; more than 12% of patients had decreased hemoglobin below 11 g/dl. Mean values of parameters discovering calcium-phosphate metabolism were: calcium--2.33 mmol/l, phosphate--1.23 mmol/l and parathormon--169.3 pg/ml. Increased value of total serum cholesterol level was noted more than half of the patients (56.5%). Significant positive correlations were found between GFR calculated based on Cockcroft-Gault formula and BMI, hemoglobin, hematocrite, serum iron, diastolic blood pressure, total and LDL serum cholesterol, triglicerydes level, as well as AIAT activity and % values of HbA1c and negative with age, serum potassium, phosphorus, PTH and uric acid.

[Chronic kidney disease in the source documentation of the outpatient clinic Department of Nephrology. Part II. Comparison of the three different methods of glomerular filtration rate estimation]. / Przewlekla choroba nerek w materiale Poradni Nefrologicznej. Czesc II. Porównanie trzech róznych metod oceny filtracji klebuszkowej.

The aim of the study was to compare three methods of GFR estimation as simplified MDRD formula, Cockcroft-Gault formula and 24 hour urine collection used in evaluation of kidney function. The study was conducted at the outpatient clinic and enclosed 1183 patients aged between 17 and 98 years (mean 64.7) with creatinine level >120 micromol/l and/or creatinine clearance <90 ml/min/1.73 m2, described in detail in part I. After calculation we obtained different mean GFR values adequately to the method: 38.4 +/- 15.13 ml/min/1.73 m2 (simplified MDRD formula), 44.51 +/- 20.59 ml/min/1.73 m2 (Cockcroft-Gault formula) and 45.63 +/- 25.55 ml/min/1.73 m2 (24-h urine collection). Results of the GFR assessment were different according to the applied method of calculation. The smallest data dispersion was observed in GFR values calculated based on abbreviated MDRD formula and the highest when obtained based on to the 24-hour urine collection. The GFR values obtained based on 24 hour urine collection showed positive correlations with BMI (p<0.01), hemoglobine (p<0.01), hematocrite (p<0.01), diastolic blood pressure (p=0.01), albumin (p=0.041), iron (p=0.03), AIAT activity (p=0.01), and negative with age (p<0.01), phosphate (p<0.01), alkaline phosphatase activity (p=0.039), parathormone (p=0.03), potassium (p<0.01) and magnesium (p<0.01). In the group of patients with GFR values below 30 ml/min in comparison with patients with GFR values above 30 ml/min, in all three methods of GFR estimation it was shown significantly higher values of phosphate, potassium, age, and lower hemoglobin, hematocrite. It was shown also in the group with GFR below 30 ml/min values estimated based on Cockcroft-Gault formula and 24 hour urine collection significantly lower BMI.

[Diagnostic and therapeutic aspects of dialysis-related amyloidosis]. / Amyloidoza dializacyjna - aspekty diagnostyczne i terapeutyczne.

The definitive diagnosis of dialysis-related amyloidosis based on histologic findings suffers from invasive surgical procedure and punctual information. Imaging techniques: ultrasonography, X-ray, computed tomography or magnetic resonance are relatively nonspecific and not sensitive enough. Scintigraphy using radio-labelled beta-2-microglobulin currently represents the most specific method to noninvasively diagnosis dialysis-related amyloidosis. Available therapeutic methods include the removal of BMG and palliation of symptoms. Hemodialysis high-flux and hemodiafiltration based on convection are more effective in elimination of BMG than standard hemodialysis with diffusive transport as a dominant mechanism. Use of the adsorption columns Lixelle reduces plasma BMG concentration and leads to clinical improvement of DRA. Medical therapy consists of the use of low dose corticosteroids and non-steroidal anti-inflammatory drugs. Surgical therapy is often necessary in the late stages of DRA. Renal transplantation is still the optimal method of DRA treatment.

[Factors predisposing to malnutrition development in the patients on maintenance hemodialysis]. / Czynniki sprzyjajace rozwojowi niedozywienia chorych przewlekle hemodializowanych.

Malnutrition of maintenance hemodialysis patients is a serious clinical problem, strongly and negatively affecting their outcome. However, very few studies are available concerning assessment of nutritional state and its predisposing factors in the Polish hemodialysed patient population. Included were 103 patients: 49 man and 54 woman (aged 48.57 years), on maintenance hemodialysis for an average of 71.46 +/- 64.3 months. They were subjected to anthropometry, SGA scale and biochemical evaluation. Simultaneously we calculated dialysis adequacy indicators. Then we compared obtained results with anthropometrical and biochemical norms and results obtained from the group of 29 healthy volunteers. Hemodialysed patients have been significantly underweight (62.51 vs. 73.55 kg in controls). Muscle mass loss dominated: AMA/50 centile AMA in the patients vs. controls have been 75.75 vs. 99.3%. Analysing body weight after dialysis to standard body weight (obtained from anthropometric data) ratio of 5.8% of patients were severely malnourished, 60.2% moderately malnourished. Analysing the patient study group 8.4% had albumin < 35 g/l and 33.3% prealbumin < 0.3 g/l. Only 34% achieved 10-12 points in the SGA scale. Normalized pcr < 1.2 g/kg/day was obtained in 54.4% patients. In the elderly we observed malnutrition more frequently than in the younger population. When pcr increases, also LBM and albumin level in blood increases. The patients who had metabolic acidosis revealed higher pcr and lower albumin. We did not find any relationship between Kt/V and AMA, LBM or albumin. The patients, who were underdialysed revealed lower prealbumin levels.

[The "Functional -QEMG" method -- a substantial progress in electromyography (EMG)]. / Metoda "Functional-QEMG"--zasadniczy postep w elektromiografii (EMG).

In contradistinction to the traditional quantitative EMG, our new "Functional-QEMG" method provides new information about structural and functional changes in the whole population of active motor units (MUs) in various neuromuscular disorders. Individual motor unit action potentials (MUAPs) and the interference pattern (IP) recordings are analyzed not as complementary measurements but as one integral test. Such a complex of EMG signals is submitted to a non-linear dynamic analysis determining interrelationships between an active MU size and its functional properties. Structural changes in MU size represent the primary destructive process, while the resulting changes in MU functional properties due to a compensatory mechanism (a secondary restorative process) provide new and very useful diagnostic information. All EMG data are processed online and automatically classified by a special computer-assisted diagnostic program as either a normal or pathological (myogenic or neurogenic) EMG recording. At the same time severity of muscle damage is assessed. This article illustrates how both the efficacy and limitations of compensatory mechanisms are related to structural damage in various neuromuscular disorders. The "Functional-QEMG" method application in clinical practice for over ten years has evidenced that this new approach is a turning point in improving the EMG diagnosis. This automatic method provides online reliable answers to most of the questions facing an electromyographer in daily routine investigations.

[Carbonyl stress significance in the pathogenesis of dialysis-related amyloidosis]. / Znaczenie stresu karbonylowego w patogenezie amyloidozy dializacyjnej.

Advanced glycation end products play a causal role in the pathogenesis of diabetic complications. Increased concentration of advanced glycation and lipooxidation end products in uremia are independent of hyperglycemia and decreased glomerular filtration rate. Increased carbonyl stress in chronic renal failure leads to nonenzymatic protein modification. Beta-2-microglobulin modified with carbonyl stress induces cell reaction, which may initiate dialysis arthropathy.