Elevated levels of soluble glycoprotein V - The plasma marker of platelet activation by thrombin in patients with early stage primary biliary cholangitis (PBC).

PURPOSE: There is a growing body of evidence for a prothrombotic tendency in patients with primary biliary cholangitis (PBC). The aim of the study was to evaluate coagulation disorders in patients with early stage PBC compared to healthy controls and evaluation of their relationship with clinical data, with particular emphasis on minimal hepatic encephalopathy (MHE). PATIENTS AND METHODS: Fifty-one participants (PBC group - 38 patients, all patients but one Child-Pugh A; control group - 13 healthy controls) were included in our prospective, single center study. We assessed the plasma levels of sGPV, plasma procoagulant phospholipids (PPL) and rotational thromboelastometry (ROTEM) profiles in all study participants. Porto-systemic encephalopathy syndrome test was used to assess MHE. RESULTS: The sGPV levels were higher in the PBC group compared to the controls: 36.07 â€‹± â€‹11.32 â€‹ng/mL vs 27.04 â€‹± â€‹11.72 â€‹ng/mL, p â€‹= â€‹0.031. The PPL level was lower in the PBC group compared to controls resulting in increased clotting time in a factor Xa-based coagulation assay: 54.65 (47.83-58.83) sec. vs 45.90 (43.3-50.5) sec., p â€‹= â€‹0.0065. PPL levels were correlated with platelet count (rho â€‹= â€‹-0.46, p â€‹= â€‹0.001). ROTEM parameters did not differ significantly between groups. Coagulation parameters did not differ significantly between patients with and without MHE. CONCLUSIONS: We have showed increased levels of sGPV - a plasma marker of platelet activation by thrombin in patients with early stage PBC compared to healthy controls. We found no relationship between the coagulation disorders and the occurrence of MHE. The PPL level was lower in the PBC group.

Autoimmune sclerosing cholangitis might be triggered by SARS-CoV-2 infection in a child - a case report.

The spectrum of liver involvement during coronavirus disease 2019 (COVID-19) is broad and mainly includes elevated liver enzymes and cholestasis. Severe acute respiratory syndrome corona- virus-2 (SARS-CoV-2) infection most often leads to a transient moderate increase in liver enzymes that is not accompanied by disturbances in the synthetic function of the liver. However, there is increasing evidence that SARS-CoV-2 infection is associated with the development of autoimmune disorders. The pathogenesis of autoimmune hepatobiliary diseases is not fully understood, taking into account genetic and environmental factors such as viral infections. We present a pediatric case of autoimmune sclerosing cholangitis (ASC), which was diagnosed 2 months after SARS-CoV-2 infection. To the best of our knowledge, ASC potentially triggered by COVID-19 has not been reported in pediatric patients. Further studies are needed to describe the clinical impact of the development of autoimmune liver diseases potentially associated with SARS-CoV-2 infection in pediatric patients. Our observations indicate that children with liver injury potentially caused by COVID-19 require long-term monitoring of liver function parameters.

Invitation to participate in a multi-center study for validation of cerebral computed tomography angiography and computed tomography perfusion in the determination of cerebral circulatory arrest during brain death/death by neurological criteria diagnosis procedure in paediatric population below 12 years of age.

We would like to invite paediatric intensive care units (PICU) to join our multi-center trial concerning patient population < 12 y/o and aiming at: • validation of computed tomography angiography (CTA)/computed tomography perfusion (CTP) tests for brain death/death by neurological criteria (BD/DNC) diagnosis procedures, • validation of duplex Doppler insonation of extracranial segments of the internal cerebral arteries and the vertebral arteries for choosing an optimal time for CTA/CTP testing.

Minimal hepatic encephalopathy may be present despite the absence of non-invasive and elastography evidence of cirrhosis in patients with primary biliary cholangitis.

PURPOSE: Minimal hepatic encephalopathy (MHE) is an important complication of chronic liver disease (CLD); however, MHE burden in patients with primary biliary cholangitis (PBC) has not been determined yet. Therefore, our study aimed to assess the prevalence of MHE in a typical cohort of middle-aged, patients with PBC suspicion of liver fibrosis and to investigate the relationship between MHE, basic laboratory tests and the stage of liver fibrosis. PATIENTS AND METHODS: Fifty-one patients (38 with PBC and 13 controls), were prospectively enrolled. Portosystemic Encephalopathy-Syndrome test was used to diagnose MHE. Elastography point qualification (ElastPQ) and non-invasive markers (APRI and FIB-4) were used to assess liver fibrosis. The severity of CLD was assessed using the Model of End-Stage Liver Disease (MELD) and Child-Pugh score. RESULTS: MHE was diagnosed in 9 patients (24.3%) with PBC and none in the control group. As many as 44.4% of the patients with MHE had neither advanced fibrosis nor cirrhosis, as demonstrated using non-invasive markers of liver fibrosis or ElastPQ. The MELD score was the only predictor of MHE with cut-off value 8.5 [AUC â€‹= â€‹0.753, CI95% â€‹= â€‹0.569 to 0.938)] with sensitivity of 56%, specificity of 85% and accuracy of the test of 78%. Non-invasive markers of liver fibrosis and ElastPQ did not predict MHE. CONCLUSIONS: MHE may occur in PBC despite no evidence of advanced liver fibrosis or cirrhosis. The slightly elevated MELD score may indicate a substantially increased risk of MHE in patients with PBC.

The imbalance of peripheral interleukin-18 and transforming growth factor-ß1 levels in patients with cirrhosis and esophageal varices.

INTRODUCTION: The presence of esophageal varices in liver cirrhosis indicates clinically significant portal hypertension (PH), that results from structural and dynamic changes in the liver and systemic circulation including the activation of several fibrotic and inflammatory pathways. We assessed if interleukin-18 (IL-18) and transforming growth factor-ß1 (TGF-ß1) serum levels can be used as PH markers and reflect its severity. MATERIAL AND METHODS: IL-18 and TGF-ß1 peripheral blood levels were analyzed in 83 cirrhotic patients with esophageal varices compared to healthy individuals, in relation to MELD and Child-Pugh scores, laboratory and Doppler ultrasound parameters, and non-selective beta-blocker therapy (NSBB). RESULTS: IL-18 concentration was significantly higher in cirrhotic patients, while TGF-ß1 concentration was lower than in controls. MELD score correlated positively with IL-18 levels and negatively with TGF-ß1 levels. IL-18 levels correlated positively with bilirubin, INR, ALT and AST levels, and negatively with albumin levels and erythrocyte count. TGF-ß1 levels correlated positively with platelet count, leukocyte, and erythrocyte count, and negatively with bilirubin levels and prothrombin time. Moreover, significant correlations were found: between IL and 18 levels and portal, mesenteric superior, and splenic vein velocity, and between TGF-ß1 levels and splenic vein diameter and spleen size. In a subgroup of patients, IL-18 levels significantly decreased after NSBB. CONCLUSION: The observed imbalance of peripheral IL-18 and TGF-ß1 levels indicates clinically significant PH associated with the presence of esophageal varices in cirrhosis. The correlation of IL-18 levels with liver failure indicators and decrease with NSBB suggest an important role of IL-18 in disease progression and its potential use as noninvasive test for PH assessment.

Minimally invasive medial maxillectomy and the position of nasolacrimal duct: the CT study.

Several minimally invasive modifications of endoscopic medial maxillectomy have been proposed recently, with the least traumatic techniques utilizing the lacrimal recess as a route to enter the sinus. The aim of the study was to analyze the anatomy of medial maxillary wall in the region of nasolacrimal canal and, thus, to determine the capability of performing minimally invasive approach to the maxillary sinus leading through the lacrimal recess. The course of nasolacrimal canal and the distance between the anterior maxillary wall and the nasolacrimal canal (the width of lacrimal recess) were evaluated in 125 randomly selected computed tomography (CT) head examinations. The proportion of cases with unfavorable anatomical conditions (lacrimal recess too narrow to accept a 4 mm optic) to perform minimally invasive middle maxillectomy was assessed. The width of lacrimal recess, measured at the level of the inferior turbinate attachment, varied between 0 and 15.2 mm and was related to slanted course of nasolacrimal canal. The more perpendicular the axis of the canal to the nasal flor, the narrower the lacrimal recess. In about 16% of cases, lacrimal recess width was less than 4 mm and in 14.4% it was missing. The endoscopic approach to maxillary sinus leading through lacrimal recess is possible in about 70% of patients. In the remaining group of patients when the lacrimal recess is too narrow, this type of approach may be difficult to perform without damaging the piriform aperture rim or bony framework of nasolacrimal duct, or it may be impracticable when lacrimal recess is missing.

Evaluation of the thrombus of abdominal aortic aneurysms using contrast enhanced ultrasound - preliminary results.

It is hypothesized that the degree of vascularization of the thrombus may have a significant impact on the rupture of aortic aneurysms. The presence of neovascularization of the vessel wall and mural thrombus has been confirmed only in histopathological studies. However, no non-invasive imaging technique of qualitative assessment of thrombus and neovascularization has been implemented so far. Contrast-enhanced ultrasound (CEUS) has been proposed as a feasible and minimally invasive technique for in vivo visualization of neovascularization in the evaluation of tumors and atherosclerotic plaques. The aim of this study was the evaluation of mural thrombus and AAAs wall with CEUS. CEUS was performed in a group of seventeen patients with AAAs. The mural thrombus enhancement was recognized in 12 cases, yet no significant correlation between the degree of contrast enhancement and AAAs diameter, thrombus width, and thrombus echogenicity was found. We observed a rise in AAAs thrombus heterogeneity with the increase in the aneurysm diameter (r = 0.62, p = 0.017). In conclusion CEUS can visualize small channels within AAAs thrombus, which could be a result of an ongoing angiogenesis. There is a need for further research to find out whether the degree of vascularization of the thrombus may have a significant impact on the rupture of aneurysms.

Endothelin 1 and transforming growth factor-ß1 correlate with liver function and portal pressure in cirrhotic patients.

OBJECTIVE: The invasive measurement of hepatic venous pressure gradient is the recommended method for the assessment of portal hypertension. We assessed if the mediators that regulate portal hypertension may be used as noninvasive markers of portal hypertension and liver insufficiency. MATERIALS AND METHODS: We explored in prospective, observational study the concentration of endothelin-1, nitric oxide, and transforming growth factor-ß1/2 in peripheral and hepatic venous blood; their relationship with the values of portal hypertension and liver insufficiency; and their level changes 4-6 months after non-selective beta-blocker therapy in cirrhotic patients with non-bleeding esophageal varices. RESULTS: (1) Cirrhotics have significantly increased peripheral endothelin 1 and decreased transforming growth factor-ß1 levels; (2) peripheral levels of all factors correlated significantly with their hepatic levels; (3) after therapy, peripheral endothelin-1 levels significantly increased, but transforming growth factor-ß2 levels decreased and were lower in patients with pressure gradient value normalization; (4) before and after therapy, peripheral and hepatic endothelin-1, transforming growth factor-ß1/2 levels correlated significantly with liver failure indicators (laboratory parameters, Child-Pough and MELD scores) and pressure gradient values. CONCLUSIONS: Peripheral endothelin-1 and transforming growth factor-ß1 levels, which strongly correlate with their hepatic levels, reflect the stage of portal hypertension and liver insufficiency in cirrhosis.

Doppler ultrasound detection of preclinical changes in foot arteries in early stage of type 2 diabetes.

BACKGROUND: There are few reports regarding the changes within the vessels in the initial stage of type 2 diabetes. The aim of this study was to estimate the hemodynamic and morphological parameters in foot arteries in type 2 diabetes subjects and to compare these parameters to those obtained in a control group of healthy volunteers. MATERIAL/METHODS: Ultrasound B-mode, color Doppler and pulse wave Doppler imaging of foot arteries was conducted in 37 diabetic patients and 36 non-diabetic subjects to determine their morphological (total vascular diameter and flow lumen diameter) and functional parameters (spectral analysis). RESULTS: In diabetic patients, the overall vascular diameter and wall thickness were statistically significantly larger when compared to the control group in the right dorsalis pedis artery (P=0.01; P=0.001), left dorsalis pedis artery (P=0.007; P=0.006), right posterior tibial artery (P=0.005; P=0.0005), and left posterior tibial artery (P=0.007; P=0.0002). No significant differences were observed in both groups in flow lumen diameters and blood flow parameters (PSV, EDV, PI, RI). In the diabetic group, the level of HbA1c positively correlated with flow resistance index in the right dorsalis pedis artery (r=0.38; P=0.02), right posterior tibial artery (r=0.38; P=0.02) and left posterior tibial artery (r=0.42; P=0.009). The pulsatility index within the dorsalis pedis artery decreased with increased trophic skin changes (r=-0.431, P=0.009). CONCLUSIONS: In the diabetic group, overall artery diameters larger than and flow lumina comparable to the control group suggest vessel wall thickening occurring in the early stage of diabetes. Doppler flow parameters are comparable in both groups. In the diabetic group, the level of HbA1c positively correlated with flow resistance index and negative correlation was observed between the intensity of trophic skin changes and the pulsatility index.

Activity of N-acetyl-ß-D-hexosaminidase in the saliva of children with type 1 diabetes.

BACKGROUND/AIM: Type 1 diabetes is one of the most common chronic diseases in children. The aim of the study was to evaluate the catabolism of glycoconjugates in saliva of children with type 1 diabetes, by measurement of the activity of N-acetyl-ß-D-hexosaminidase (HEX) in their saliva. MATERIAL/METHODS: The study was performed in 65 children with type 1 diabetes and 39 healthy children. Salivary HEX activity was determined spectrophotometrically by the method of Zwierz et al. in the modification of Marciniak et al. Protein was determined by the bicinchoninic acid method (BCATM Assay Protein Kit). Concentration of the HEX activity was expressed in pKat/mL and HEX specific activity in pKat/µg of protein. RESULTS: A significant increase in the concentration and the specific activity of HEX in the saliva of children with type 1 diabetes, compared to healthy children, was found. CONCLUSIONS: Type 1 diabetes increases salivary catabolism of glycoconjugates reflected by the significant increase in the activity of HEX in the saliva of children with type 1 diabetes compared to healthy children. The salivary HEX activity may be used in the diagnosis of children with type 1 diabetes after confirmation of our results on a larger cohort of children with type 1 diabetes.

Fatal drowning as a result of an airplane crash--case report.

An ULM (Ultra Light Motorized) plane Aeroprakt 22-L with two men on board dived unexpectedly into the Dworackie lake near the town of Olecko in Warmia and Mazury district, Northeastern Poland. The pilot and the passenger had multiorgan blunt injuries, including subdural and subarachnoid hemorrhage, fractured ribs, fractured thigh (in one of the deceased) and pulmonary contusions as a result of the impact with the lake. The multiorgan injuries and unconsciousness resulting from head trauma prevented the casualties from saving themselves. The underlying cause of the death was the crash into the lake, however drowning was assessed as the proximate cause of death. The accident was analyzed together with an account prepared by State Commission on Aircraft Accident Investigation and with the Human Factor Analysis and Classification System - HFACS (the standardized method of analysis of flight accidents, the tool originally developed and tested within the U.S. military).

Palliative embolization of hemorrhages in extensive head and neck tumors.

BACKGROUND: A lot has changed in terms of intervention technique, indications and embolic agents since Duggan introduced embolization to management of postraumatic epistaxis in 1970. Embolization is used in treatment of spontaneous and traumatic epistaxis, palliative tumors and vascular defects, as well as vascularized tumors and juvenile nasopharyngeal angiofibromas. The possibility of simultaneous visualization of pathology and implementation of therapy is one of its greatest advantages. MATERIAL/METHODS: Authors analyzed the efficacy of selective embolization treatment of haemorrhage in advanced head and neck tumors. Seventy-six patients with such tumors treated at the Department of Otolaryngology in Bialystok between1999 and 2011 were examined. RESULTS: Embolization of bleeding vessel within the tumor was effective (hemorrhage was stopped) in 65 patients (86%). Although the method is highly efficient, it is still associated with complications. Fourteen patients suffered from headaches that lasted for several days and six from face edema. Rebleeding was rare. Unfortunately, there was one case of hemiparesis. CONCLUSIONS: We conclude that superselective endovascular treatment deserves to be considered alongside standard options for the palliative or preoperative management of acute hemorrhage from advanced head and neck cancers.

The effect of contrast medium SonoVue® on the electric charge density of blood cells.

The effect of contrast medium SonoVue® on the electric charge density of blood cells (erythrocytes and thrombocytes) was measured using a microelectrophoretic method. We examined the effect of adsorbed H⁺ and OH⁻ ions on the surface charge of erythrocytes or thrombocytes. Surface charge density values were determined from electrophoretic mobility measurements of blood cells performed at various pH levels. The interaction between solution ions and the erythrocyte's or thrombocyte's surface was described by a four-component equilibrium model. The agreement between the experimental and theoretical charge variation curves of the erythrocytes and thrombocytes was good at pH 2-9. The deviation observed at a higher pH may be caused by disregarding interactions between the functional groups of blood cells.

[Activity of N-acetyl-ß-hexosaminidase and its isoenzymes A and B in cancer]. / Aktywnosc N-acetylo-ß-D-heksozoaminidazy i jej izoenzymów A i B w nowotworach.

There were approximately 93,060 deaths from cancers in Poland in 2008, and about 105,000 are predicted for the year 2025. Early detection of cancer is a major problem throughout the world, which is why many researchers are still looking for specific and sensitive markers of malignant tumors. Our work is a review of recent publications on activity of N-acetyl-ß-D-hexosaminidase (HEX) and its isoenzymes A (HEX A) and B (HEX B) as potential markers of malignant tumors. HEX is the most active of the lysosomal exoglycosidases, taking part in degradation of glycoconjugates (glycoproteins, glycolipids, proteoglycans). HEX cleaves N-acetyl-D-glucosamine and N-acetyl-D-galactosamine from non-reducing ends of oligosaccharide chains of glycoproteins, glycolipids and glycosaminoglycans. The activity of HEX, and its isoenzymes A (HEX A) and B (HEX B), was determined by spectrophotometric and isoelectric focusing methods. There was a statistically significant increase in activity of HEX in tumors of the kidney, pancreas, thyroid, colon, ovary, brain, salivary gland, stomach and larynx, which suggests potential applicability of HEX and its isoenzymes in cancer diagnosis.

Hypotensive effect of atorvastatin in hypertensive patients: the association among flow-mediated dilation, oxidative stress and endothelial dysfunction.

INTRODUCTION: To investigate the hypothesis that atorvastatin decreases blood pressure (BP) values and improves endothelial function assessed by flow-mediated dilation (FMD) in normolipidaemic hypertensive patients. MATERIAL AND METHODS: Fifty-six hypertensive patients were randomized in a 2 : 1 proportion to atorvastatin (80 mg/day/3 months; group A; n = 39) or previous standard anti-hypertensive therapy (group B), which means the patients were treated with angiotensin-converting enzyme inhibitors, diuretics, ß-blockers, calcium antagonists and angiotensin receptor blockers. The study had a crossover design: after 3 months, both groups were changed (group A* stopped and group B* started atorvastatin treatment). Nitric oxide (NO), total antioxidant status (TAS), endothelin-1 (ET-1), and peroxide concentrations as well as FMD were measured before, after 3 and after 6 months of treatment. Atorvastatin added to existing treatment decreased BP in both groups. RESULTS: Flow-mediated dilation improved in both statin-treated groups, but only significantly in group B* (from 11.9 ±8.3% to 22.1 ±9.0%; p < 0.05). In patients with FMD improvement, there was a greater BP reduction. After treatment discontinuation, FMD significantly decreased (from 19.6 ±12.6% to 13.0 ±10.5%; p < 0.05), which was consistent with BP increase. Changes in FMD were not significantly related to the increase in NO and TAS concentrations and decrease in ET-1 and peroxides measurements. CONCLUSIONS: The hypotensive effect of atorvastatin is associated with FMD improvement in normolipidaemic, hypertensive patients. Although this could be related to changes in oxidative stress and endothelial function, this was not demonstrated in this study and warrants further investigation.

Genetic identification of a gunshot victim four years posthumously.

The paper presents a personal identification case of an unrecognized corpse, presumably belonging to a male missing for four years. The cadaver was buried in a ground ditch and covered with slaked lime and soil. During the investigation the burial place was indicated. The corpse was exhumed and afterwards transferred to the Department of Forensic Medicine, Medical University of Bialystok. External examination and autopsy findings demonstrated adipocere formation and putrefaction, as well as two gunshot wounds in the thorax and the head assumed to be the cause of death. Personal identification procedure included skeletal and dental examination. As a source material for genetic typing, the femur, brain, lung, kidney and spleen samples were collected. DNA templates were extracted by a modified organic procedure and genotyped with the use of AmpFISTR Identifiler Amplification Kit and PowerPlex Y System in an ABI 310 Genetic Analyzer (Applied Biosystems). All the soft tissue samples yielded sufficient quantity and quality of DNA to perform genetic profiling.

Contrast-enhanced ultrasonography versus computed tomographic angiography in the monitoring of patients after endovascular repair of abdominal aortic aneurysm -- preliminary experience.

BACKGROUND: Computed tomographic angiography (CTA) is routinely used in the monitoring of patients after endovascular repair of abdominal aortic aneurysm. The aim of the study was to determine if contrast-enhanced ultrasonography (CEUS) provides equivalent results to CTA in detection of endo-leaks in patients after abdominal aortic stentgraft placement. MATERIAL AND METHODS: In a group of 7 patients (6 men and 1 woman; aged 71+/-7 years) after repair procedure, 16 CTA and 16 CEUS follow-up examinations were performed. Second-generation contrast agent (Sonovue) and low-mechanical index technique were used for ultrasonography imaging. RESULTS: Computed tomographic angiography showed seven cases of type I, five cases of type II, and no endo-leaks in four examinations. In 15 out of 16 studies, the results of CEUS were consistent with the results of CTA. In one discrepant study, type II endo-leak was detected with CEUS while CTA was negative. CONCLUSIONS: Contrast-enhanced ultrasonography and CTA examinations in patients after endovascular repair of abdominal aortic aneurysm provide comparable results. CEUS may be considered an alternative technique to CTA.

[Pathologies of the cervical spine anatomy as a possible cause of young patients vertigo]. / Nieprawidlowosci odcinka szyjnego kregoslupa jako mozliwa przyczyna zawrotów glowy u mlodych osób.

Vertigo occurs in many diseases, especially in older people. It is a specific diagnostic problem in young people. In the paper, 86 young patients with incidental vertigo were clinically assessed. Electronystagmography, eye-tracking pattern test, optokinetic test and cervical spine X rays were used in examination. The results were compared with the control group of young and healthy people and also with the older patients group with degenerative changes of the cervical spine. In the examined group the disturbances of physiologic cervical lordosis were found in 33.8% and positional nystagmus in 23%. The vestibular tests and hearing were frequently normal. These results suggest that disturbances of physiologic cervical lordosis may be the cause of balance disturbances.

Detectability of SGM Plus profiles in heart and lungs tissue samples incubated in different environments.

The aim of the study was assessment of environmental effect on typeability of AmpFlSTR SGM Plus loci: D3S1358, VWA, D16S539, D2S1338, D81179, D21S11, D18S51, D19S433, TH01, FGA and gender marker amelogenin. Heart and lungs specimens collected during autopsies of five persons aged 20-30 years were incubated at 21 degrees C and 4 degrees C in different environmental conditions, fresh different water and soil conditions. DNA was extracted by organic method from tissue samples collected in 7-day intervals and subsequently typed using AmpFlSTR SGM Plus kit and ABI 310. Incubation at 21 degrees C and prevented air access, as well as in peat soil and in sand favoured faster DNA degradation reflected by decrease in typeability rate. In samples with negative genotyping results no DNA was found by fluorometric quantitation. Decomposed soft tissues are potential material for DNA typing.