The influence of Klotho protein and prooxidant-antioxidant balance combination on the mortality of HD patients.

PURPOSE: End-stage renal disease patients on chronic hemodialysis (HD) have a shortened life expectancy compared to the general population. The aim of this study was to evaluate a possible link between three new and emerging factors in renal pathophysiology: Klotho protein, telomere length in peripheral blood mononuclear cells (TL) and redox status parameters before HD (bHD) and after HD (aHD), and to test mortality prediction capability of these emerging parameters in a population of HD patients. METHODS: The study included 130 adult patients with average age 66 (54-72), on HD (3 times per week; 4-5 h per session). Klotho level, TL, routine laboratory parameters, dialysis adequacy and redox status parameters: advanced oxidation protein products (AOPP), prooxidant-antioxidant balance (PAB), superoxide anion (O2.-), malondialdehyde (MDA), ischemia-modified albumin (IMA), total sulfhydryl group content (SHG), and superoxide dismutase (SOD) were determined. RESULTS: Klotho concentration was significantly higher aHD; 68.2 (22.6-152.9) vs. bHD 64.2 (25.5-119.8) (p = 0.027). The observed increase in TL was not statistically significant. AOPP, PAB, SHG, and SOD activity were significantly increased aHD (p > 0.001). The patients with the highest mortality risk score (MRS) had significantly higher PAB bHD (p = 0.002). Significantly lower O2.- (p < 0.001), SHG content (p = 0.072), and IMA (p = 0.002) aHD were found in patients with the lowest MRS values. Principal component analysis revealed redox balance-Klotho factor as a significant predictor of high mortality risk (p = 0.014). CONCLUSION: Decreased Klotho and TL attrition as well as redox status disturbance could be connected with higher mortality rate in HD patients.

Case study scrub nurse role in aorto-bifemoral reconstruction with transbrachial balloon endoclamping technique.

INTRODUCTION: Aortoiliac arterial disease is a chronic progressive disease which is characterized by steno-occlusive changes in the aorta and iliac arteries. The gold standard for the treatment of patients with the advanced stage of the disease is aorto-bifemoral reconstruction. Patients with circumferential juxtarenal calcifications of the aorta bear a high risk of intraoperative complications, due to difficult cross-clamping in such zones. CASE REPORT: We present a case of a 73-year-old patient who has been admitted due to left leg rest pain and second toe ulceration. Multislice computed tomography showed significant stenosis of the aortoiliac segment with a circumferentially calcified abdominal aorta. Aortobifemoral reconstruction was performed featuring endoluminal occlusion of the aorta using a balloon catheter which was placed through the left brachial artery. The procedure and the postoperative course were uneventful, and the patient was discharged on the sixth postoperative day. CONCLUSION: The hybrid endovascular and open surgery technique presented emerged as a valid alternative for selected high-risk patients. Scrub nurses should be familiarized with endovascular techniques and tools and be aware of the measures to be protected from the harmful effects of ionizing radiation.

The silk of Plodia interpunctella as a potential biomaterial and its cytotoxic effect on cancer cells.

Insect silk has been widely studied for its application in regenerative medicine. However, the data about Plodia interpunctella silk as a biomaterial and its anticancer properties are insufficient. Thus, the aim of this study was to investigate native silk as a substrate for growing normal human fibroblasts MRC-5, and test potential cytotoxic effects of the two silk extracts (with DMSO and Trypsin for sericin isolation) on HCT-116 colorectal carcinoma cells and MRC-5 fibroblasts as a control. Fifth-instar larval silk, collected for 15 and 30 days, was used for testing of proliferation and adhesion of MRC-5, 24 h and 72 h after seeding. Light- and fluorescence-microscope showed cell adhesion and spread on silk, as well as enhanced number of cells after 72 compared to 24 h and nonsignificant percentage of apoptotic cells on the silk. Although insoluble, P. interpunctella silk showed remarkable cytotoxic activity on HCT-116 cells, without significant cytotoxity on normal fibroblasts after 24 h and weak effects after 72 h. This study provides significant information about P. interpunctella silk as a potential biomaterial and shows the presence of some active constituents with anticancer properties, thus pointing to the possibility for exploitation of this worldwide pest insect in biomedical application.

A Rare Case of Infectious Multifocal Serpiginoid Choroiditis

Multifocal serpiginoid choroiditis is an infectious variety of serpiginous choroiditis. The disease is characterized by infectious etiology and overlapping clinical features in an intermediary form of acute posterior multifocal placoid pigment epitheliopathy and serpiginous choroiditis. In a 33-year-old patient, bilateral multiple placoid partially confluent chorioretinal lesions were diagnosed after a febrile flu-like episode. On the right eye, there was a progressive decrease in visual acuity. Later, the lesions had a prolonged progressive devastating clinical course and widespread distribution of placoid lesions, and took the form of serpiginoid choroiditis. We conducted extensive laboratory work-up and ancillary investigation for granulomatous diseases such as tuberculosis and sarcoidosis, and the results were not consistent with these entities. Systemic medical work-up revealed a history of exposure to the human immunodeficiency virus, herpes simplex virus 1, varicella zoster virus and cytomegalovirus. The titer of Mycoplasma pneumoniae IgM antibodies was positive. After serological analysis positive for Mycoplasma pneumoniae, systemic antibiotic therapy and anti-inflammatory doses of corticosteroids were administered. Improvement of visual acuity after the introduction of causal antibiotic therapy in combination with anti-inflammatory therapy confirmed our suspicion that Mycoplasma pneumoniae was the etiologic cause of multifocal serpiginoid choroiditis.

Assessment of oxidative status in patients with acute kidney injury: a pilot study.

Extensive experimental evidence confirms the role of oxidative stress as a major contributor to the pathogenesis of acute kidney injury (AKI). However, less information is available on the evolution of prooxidant-antioxidant parameters from early to end-phase renal function decline in humans. This study aimed to determine the oxidative status in dynamic throughout the evolutionary phases of the disease. The study included patients with cardiovascular pathology and AKI hospitalized in the intensive care unit (n = 69) and age-matched healthy controls (n = 30). They were followed through three phases of AKI; the first [corrected] phase was the phase of diagnosis, which is characterized by oliguria/anuria, the [corrected] second phase was established diuresis, and the [corrected] third phase was the polyuric phase. In these phases of the disease, blood samples were taken from the patients for biochemical analysis. From the collected whole blood, we measured spectrophotometrically prooxidants: index of lipid peroxidation, measured as Thiobarbituric acid reactive substances (TBARS), nitrite (NO2⁻), superoxide anion radical (O2⁻) and hydrogen peroxide (H2O2), and antioxidants: activity of superoxide dismutase (SOD), catalase (CAT) and reduced glutathione (GSH) from erythrocyte lysate. Comparing the results of the three measurements, a significant difference was found in the levels of NO2⁻ and GSH, both of which increased in the second phase (P < 0.05) and then decreased in the third phase, and a significant increase in TBARS, which was elevated in the second phase (P < 0.05) and did not change significantly until the third phase. Our results showed phase-dependent modification in 3 parameters of the oxidative status (TBARS, NO2⁻ and GSH). Whether these changes contribute to the deterioration of renal function in AKI remains to be established.

Two cases of uveitis masquerade syndrome caused by bilateral intraocular large B-cell lymphoma.

INTRODUCTION: Sometimes it is not easy to clinically recognize subtle differences between intraocular lymphoma and noninfectious uveitis. The most common lymphoma subtype involving the eye is B-cell lymphoma. CASE REPORT: We presented two patients aged 59 and 58 years with infiltration of the subretinal space with a large B-cell non-Hodgkin intraocular lymphoma. The patients originally had clinically masked syndrome in the form of intermediate uveitis. As it was a corticosteroid-resistant uveitis, we focused on the possible diagnosis of neoplastic causes of this syndrome. During hospitalization, the neurological symptoms emerged and multiple subretinal changes accompanied by yellowish white patches of retinal pigment epithelium with signs of vitritis, which made us suspect the intraocular lymphoma. Endocranial magnetic resonance imaging established tumorous infiltration in the region of the left hemisphere of the cerebellum. The histopathological finding confirmed the diagnosis of large B-cell non-Hodgkin lymphoma of risk moderate degree, immunoblast--centroblast cytological type. The other patient had clinical chronic uveitis accompanied by yellowish shaped white echographic changes of the retina and localized changes in the level of the subretina. The diagnosis of lymphoma was made by brain biopsy. CONCLUSION: Uveitis masquerade syndrome should be considered in all patients over 40 years with idiopathic steroid-resistant uveitis. Treatment begun on time can affect the course and improve the prognosis of uveitis masquerade syndrome (UMS) and systemic disease.

Exercise-induced changes in redox status of elite karate athletes.

Regular training has been claimed to increase the activity of antioxidant enzymes and, consequently, augments the resistance to oxidative stress; however, large volumes of training performed by elite sportsmen could lead to a chronic oxidative stress state. The aim of our study was to assess the oxidative status of elite athletes at the beginning of the preparatory and the beginning of the competition training phases, so that the influence of three months of programmed physical activity on redox status could be determined. The chronic effects of exercise on the redox state of the athletes were compared to the effects of a single bout of karate training. Thirty elite karate athletes, 16-30 years old, were subjected to maximal graded exercise test to estimate their aerobic capacity; blood sampling was also performed to measure levels of superoxide anion radical (O2⁻), hydrogen peroxide (H2O2), superoxide dismutase activity (SOD) and catalase activity (CAT). The only significant change after the three-month training process was found in the significantly decreased CAT activity (X ± SE: 7.95 ± 0.13 U/g Hb × 10³ in the preparatory period, 6.65 ± 0.28 U/g Hb × 10³ in the competition stage; P < 0.01). After a single karate training session, there was statistically significant decrease of O2⁻(X ± SE: 32.7 ± 4.9 nmol/ml in the preparatory period, 24.5 ± 2.5 nmol/ml in the competition stage; P < 0.05) and increase of H2O2(X ± SE: 11.8 ± 1.0 nmol/ml in the preparatory period, 14.2 ± 0.9 nmol/ml in the competition stage; P < 0.01), as well as significant CAT increase (X ± SE: 6.6 ± 0.6 U/g Hb × 10³ in the preparatory period, 8.5 ± 0.5 U/g Hb × 10³ in the competition stage; P < 0.05). Although the three-month training process induced, at the first sight, negative changes in the redox state, expressed through the decrease in CAT activity, adequate response of the antioxidant system of our athletes to acute exercise was preserved.

[Oxidative status evaluation in elite karate athletes during training process].

BACKGROUND/AIM: Oxidative stress is a state of disturbed balance between reactive oxygen species (ROS) and reactive nitrogen species (RNS) on the one hand, and antioxidative defense on the other. As a result of oxidative stress we have irreversible changes in cell function leading to pathological tissue changes, development of many diseases and fast aging process. Increased consumption of oxygen during exercise could be the cause of oxidative stress. The aim of the study was to establish oxidative status of elite karate athletes in the state of rest and after the loading, monitoring the parameters of oxidative stress and components of antioxidative defense in a training process. METHODS: During training process, a group of 30 elite karate athletes was included in the study of prevalence. They were males, from 16 to 30 years of age. The examination was conducted both in resting condition and after the loading. Oxidative status was determined by the level of superoxide anion radical (O2-), hydrogen peroxide (H2O2) as prooxidants, and enzymes of the antioxidant defanse system: superoxide dismutase (SOD) and catalase (CAT). RESULTS: There was a homogenous group of young athletes of normal weight and fats percentage. A significant decrease of O2- after the load was founded, while the levels of H2O2 was significantly increased. Activity of SOD was not significantly changed after exsercise while that of CAT was significantly increased. CONCLUSION: In the long run a programmed physical exercise does not lead to oxidative stress, but an excessive physical load may cause its occurrence.

Uso profiláctico de cefadroxilo en cirugía de mano / The prophylactic use of cefadroxil in hand surgery

El cefadroxilo es una cefalosporina de primera generación utilizada en pacientes sometidos a intervenciones quirúrgicas de cirugía de mano electivas, manejados ambulatoriamente. Se incluyeron en el estudio 25 pacientes con fracturas de metacarpianos que requirieron fijación interna y control ambulatorio, y a quienes se les indicó cefadroxilo 500 mg cada 12 horas durante 10 días. La complicación más común fue edema, que se presentó tempranamente a las 24 horas en un total de 20 pacientes (80 por ciento) persistieron con dicho síntoma con parámetros paraclínicos normales. El cefadroxilo usado en forma profiláctica en pacientes sometidos a intervenciones quirúrgicas de cirugía de mano, reúne ciertas características que hacen de él un excelente antibiótico