Components of metabolic syndrome in relation to plasma levels of retinol binding protein 4 (RBP4) in a cohort of people aged 65 years and older.

PURPOSE: Elevated plasma concentration of retinol binding protein 4 (RBP4) has recently emerged as a potential risk factor as a component of developing metabolic syndrome (MS). Therefore, this study aimed to analyse the relationship between components of MS and concentrations of plasma RBP4 in a population of subjects 65 years and older. METHODS: The study sample consisted of 3038 (1591 male) participants of the PolSenior study, aged 65 years and older. Serum lipid profile, concentrations of RBP4, glucose, insulin, C-reactive protein, IL-6, and activity of aminotransferases were measured. Nutritional status (BMI/waist circumference) and treatment with statins and fibrates were evaluated. Glomerular filtration rate (eGFR), de Ritis ratio, and fatty liver index (FLI), as well as HOMA-IR were calculated. RESULTS: Our study revealed a strong relationship between components of MS and RBP4 in both sexes: plasma RBP4 levels were increased in men by at least 3×, and in women by at least 4×. Hypertriglyceridemia was most strongly associated with elevated plasma RBP4 levels. Multivariate, sex-adjusted regression analysis demonstrated that chronic kidney disease [OR 1.86 (95% CI 1.78-1.94)], hypertriglyceridemia [OR 1.52 (1.24-1.87)], hypertension [OR 1.15 (1.12-1.19)], low serum HDL cholesterol [OR 0.94 (0.92-0.97)], and age > 80 years [OR 0.86 (0.81-0.90)] were each independently associated with RBP4 concentration (all p < 0.001). CONCLUSIONS: In Caucasians 65 years and older, RBP4 serum levels are associated with a number of components of MS, independent of sex and kidney function. Hypertriglyceridemia as a component of MS is most significantly related to RBP4 concentration.

Resting energy expenditure and gut microbiota in obese and normal weight subjects.

OBJECTIVES: It is suggested that gut microbiota play a role in the pathogenesis of obesity enhancing energy utilization from digested food. The influence of gut microbiota on resting energy expenditure (REE) has not been evaluated yet. AIM: The aim of the study is to assess the composition on gut microbiota and its association with REE in obese and normal weight subjects. SUBJECTS AND METHODS: REE measurement and semi-quantitative analysis of gut microbiota composition in aerobic and anaerobic conditions were performed in 50 obese and 30 normal weight subjects without concomitant diseases. RESULTS: A count of bacterial colony was greater in obese than in normal weight subjects. However, the proportion of Bacteroides spp. and Firmicutes was similar in both study groups. A positive correlation between REE (kcal/d) and total bacterial count (r = 0.26, p < 0.05), as well as between REE and the percentage of Firmicutes (r = -0.24, p < 0.05) was found. The multiple regression analysis did not prove an independent impact of total bacterial as well as Bacteroides spp. and Firmicutes counts on REE. CONCLUSIONS: The composition of gut microbiota is not associated with the level of resting energy expenditure. The proportion of Bacteroides and Firmicutes in gut microbiota is not related to body mass.

Prevalence of metabolic syndrome and insulin resistance in overweight and obese women according to the different diagnostic criteria.

AIM: Metabolic syndrome (MS) is a cluster of risk factors favoring the development of type 2 diabetes and cardiovascular diseases. The prevalence of MS diagnosis is dependent of used diagnostic criteria. The aim of the study is to compare the prevalence of MS in overweight and obese women without concomitant diseases according to the different diagnostic criteria and their sensitivity to identify subjects with insulin resistance. METHODS: The study involved 126 overweight and obese women without concomitant diseases. In all subjects body mass, height, waist circumference and blood pressure were measured and plasma glucose, insulin and lipids levels were determined. MS was diagnosed using WHO, NCEP ATP III, IDF 2005 and IDF 2009 modified criteria. The insulin resistance was assessed based on the homeostatic model assessment insulin resistance (HOMA-IR≥2.5). RESULTS: The prevalence of MS was 43.8%, 43.8%, 38.1% and 18.1% according to IDF 2005, IDF 2009 modified, NCEP ATP III and WHO criteria, respectively. Insulin resistance was diagnosed in 89 women (70.6%). None of MS definitions allowed for proper discrimination of insulin resistant subjects. The highest sensitivity, but lowest specificity of insulin resistant discrimination had both IDF criteria (44.9% and 72.9%, respectively), while the highest specificity WHO criteria was missing sensitivity (91.8% and 17.9%, respectively). CONCLUSION: On the basis of both IDF criteria MS is diagnosed in significantly larger subset of overweight and obese women. However, NCEP ATPIII and both IDF criteria identify only less than half insulin resistant overweight and obese women as those with MS.

The effect of three-month pre-season preparatory period and short-term exercise on plasma leptin, adiponectin, visfatin, and ghrelin levels in young female handball and basketball players.

OBJECTIVE: The aim of the study was to assess the effect of a 3-month pre-season preparatory period and shortterm moderate aerobic exercise and intensive fitness and speed exercise on adipokine and ghrelin levels in young female handball and basketball players. MATERIALS AND METHODS: Fifty healthy young female professional basketball and handball players were enrolled into the study before the opening of the season (after a 2-month holiday with no training or dietary restrictions). Serum estradiol and plasma leptin, adiponectin, visfatin, and ghrelin levels were determined at the beginning and the end of a 3-month period of moderate aerobic training. Plasma adipokines and ghrelin levels were additionally assessed after 2 h of moderate aerobic exercise or after intensive fitness and speed exercise training. RESULTS: Long-term moderate aerobic exercise was followed by a significant decrease in plasma ghrelin and leptin levels (921±300 vs 575±572 pg/ml, p<0.001 and 16.4±15.6 vs 11.8±16.3 ng/ml, p<0.01, respectively); plasma adiponectin and visfatin remained unchanged. No changes were observed in plasma ghrelin and leptin levels after short-term moderate aerobic exercise or after intensive fitness and speed exercise. Plasma visfatin concentration increased significantly after short-term moderate aerobic exercise (22.1±8.7 vs 27.6±9.0 ng/ml, p<0.001), whilst adiponectin increased after intensive fitness and speed exercise (16.7±7.8 vs 21.0±9.8 µg/ml, p<0.001). CONCLUSIONS: Regular moderate aerobic training in preparation for the match season is followed by a decline in circulating leptin and ghrelin levels even in athletes without body weight changes. Short-term intensive fitness and moderate aerobic exercise seem to modulate the production of different adipokines.

-174G/C interleukin-6 gene polymorphism and the risk of transplanted kidney failure or graft loss during a 5-year follow-up period.

The influence of cytokine gene polymorphisms on transplanted kidney outcome is not well understood. The aim of this one-centre study was to analyse the association between tumour necrosis factor-α (TNF-α), interleukin-6 (IL-6), IL-10, interferon-γ (IFN-γ) and transforming growth factor-ß1 (TGF-ß1) genotypes and the incidence of delayed graft function (DGF), acute rejection (AR) and 5-year kidney graft loss. Genotyping was performed in 199 subsequent kidney graft recipients from deceased donors without induction therapy based on polymerase chain reaction method using sequence-specific primers for TNF-α (-308A/G), IL-10 (-1082A/G, -819T/C and -592A/C), IL-6 (-174G/C), IFN-γ (+874T/A) and TGF-ß1 (in codons 10T/C and 25G/C). Genotypes were grouped according to the strength of cytokine expression. During a 5-year follow-up period, 14 patients died with functioning graft and 33 developed graft failure. The analysed polymorphisms were not associated with the incidence of DGF. The frequency of early episodes of AR was significantly associated only with TGF-ß1 genotype. There was an association between -174G/C IL-6 gene polymorphism and the death-censored kidney graft survival. The risk of graft loss during 5-year follow-up period was greater by 57% for GG or GC (higher IL-6 production) than for CC carriers. None of the other analysed polymorphisms significantly influenced both patients and kidney graft survival, also in the analysis of the subgroup with human leucocyte antigen-DR mismatch. -174G/C IL-6 genotype of the kidney graft recipient could modulate the rate of graft excretory function deterioration and the risk of graft loss by influencing their constitutional expression.

Pharmacotherapy of patients with benign prostate enlargement and storage symptoms in everyday clinical practice.

OBJECTIVE: Storage symptoms significantly deteriorate the quality of life in men with benign prostate enlargement (BPE). Muscarinic receptor antagonists (MRAs) and ß3-adrenergic receptors agonists alone, or in combination with selective α1-alpha-antagonists, are considered the most effective medicines relieving storage symptoms. The aim of this study was to analyze the pharmacotherapy of storage symptoms in men with BPE, and their compliance with the European Association of Urology (EAU) guidelines. PATIENTS AND METHODS: The survey was conducted in 2018 by 261 urologists among 24,613 men with lower urinary tract symptoms (LUTS) and BPE treated pharmacologically. Data concerning recent severity of non-neurological LUTS, storage symptoms and pharmacotherapy were collected. RESULTS: Storage symptoms were reported by 12,356 patients (50.2%) with BPE, more frequently nocturia (75.8%), than urinary urgency (57.8%) and frequency (44.3%). Patients with storage symptoms were more frequently prescribed with MRAs and mirabegron (43.1% vs. 5.0% and 2.4% vs. 0.3%, respectively; p<0.001). Of note, 54.5% of patients with storage symptoms were treated neither with MRAs, nor ß3-adrenergic receptors agonists. In the subgroup with storage symptoms, the increasing severity of LUTS accounted for more frequent prescription of MRA (2.1% vs.  29.1% vs. 42.8% in patients with mild, moderate, and severe LUTS, respectively). Decision tree analysis revealed that patients with urinary urgency and urinary frequency, as well as younger ones with urinary urgency but without urinary frequency, were more frequently prescribed with MRAs. CONCLUSIONS: Urinary urgency and frequency are associated with increased utilization of MRAs in men with BPE in everyday clinical practice. The attitude of Polish urologists toward management of persistent storage symptoms in BPE patients is in line with the EAU guidelines.

Increasing the dosage of pregabalin in patients with focal epilepsy decreases the frequency of seizures and ameliorates symptoms of anxiety, depression and insomnia.

OBJECTIVE: The effectiveness of the treatment depends on the adequate dosage of medications. In clinical practice, drugs are often used at doses that are too low, which results in suboptimal levels of clinical improvement. The aim of the study was to evaluate the effects of increasing the dose of previously taken pregabalin in a group of patients with focal epilepsy and generalized anxiety disorder (GAD). PATIENTS AND METHODS: This open study involved 993 patients (46 ± 14 years old) suffering from epilepsy with focal seizures and concomitant GAD treated with pregabalin add-on therapy. The severity of anxiety was assessed with GAD-7 Scale. The number of epileptic seizures was monitored before and after the increase of the pregabalin dose. RESULTS: On the initial visit, the mean daily dose of pregabalin was 159 ± 82 mg. During the study period (nine months) the mean dose was increased to 327 ± 163 mg. After nine months, based on the intention-to-treat analysis, 27.1% (N = 253) of the subjects experienced seizure resolution, and 57.8% (N = 539) reduction in seizure frequency by at least 50%. At the beginning of the study, despite pregabalin administration, 60.7% of patients were above the diagnostic threshold for GAD diagnosis. The add-on therapy resulted in the improvement of the depressive and anxiety symptoms, and insomnia, greater in those that experienced seizure resolution or reduction in their frequency. CONCLUSIONS: (1) Patients with focal epilepsy with concomitant anxiety disorder experience reduction in seizure frequency, improvement of anxiety, depressive symptoms and insomnia using PGB as an add-on therapy. (2) Our data suggest that pregabalin as an add-on treatment is a reasonable choice for patients with focal epilepsy who have concomitant symptoms of an anxiety disorder.

Prediction of detrusor underactivity based on non-invasive functional tests and clinical data in patients with symptoms of bladder outlet obstruction.

OBJECTIVE: Detrusor underactivity (DU) is a common but relatively under-researched bladder dysfunction. Recently, there has been renewed interest in this topic. The aim of the study was to develop a decision-making algorithm to predict the impaired detrusor contractility in patients with LUTS (lower urinary tract symptoms). PATIENTS AND METHODS: A retrospective analysis covered 96 consecutive patients (aged 63 ± 8 years) treated pharmacologically for 50 ± 37 months due to LUTS (persisting for 64 ± 41 months). Functional tests included uroflowmetry and flow cystometry. RESULTS: Weakened detrusor functioning was detected in 58 (60.4%) patients. Decision-making algorithm that included uroflowmetry, flow cystometry and clinical data, was showed to allow to diagnose impaired detrusor function with accuracy of 73% (95% CI - confidence interval: 61-83%) and specificity of 76% (95% CI: 54-90%). The positive predictive value of the classification tree graph is equal to 90% (95% CI: 78 -96%) and the negative predictive value is 50% (95% CI: 34-66%). The weakened detrusor function was more frequent in patients with: time to reach maximum flow rate higher than 13.5 s; time to reach maximum flow rate lower than 13.5 s and mean flow ratio higher than 4.5 ml/s, but time of flow longer than 44.5 s; time to reach maximum flow rate lower than 13.5 s and mean flow ratio lower than 4.5 ml/s, but time of flow longer than 52.5 s. CONCLUSIONS: The results of the uroflowmetry can be used to predict the impaired detrusor contractility in patients with LUTS.

A case of acute rejection shortly after initiation of lamivudine therapy in a simultaneous pancreas and kidney recipient with viral hepatitis type B.

We describe a patient with hepatitis B antigenemia, who received a simultaneous pancreas and kidney transplant, developed reactivation of hepatitis B virus infection with aminotransferase elevation, and unexpectedly suffered an acute rejection episode within a few weeks after initiation of lamivudine therapy. At the time of rejection diagnosis, the cyclosporin A (CyA) trough level was 2 times lower than before the start of lamivudine therapy. Only an improvement in liver CyA metabolism in the course of lamivudine therapy can explain such an essential decline. Thus, it is important to emphasize how crucial it is to frequently monitor the CyA level in the early period of lamivudine therapy in transplanted patients with hepatitis to ensure adequate immunosuppression and to avoid acute rejection episodes.

Influence of Sociodemographic, Behavioral and Other Health-Related Factors on Healthy Ageing Based on Three Operative Definitions.

OBJECTIVES: Healthy ageing (HA) is a key concept and highly desirable phenomenon in every ageing and already old societies. The aim of our study was to evaluate the influence of socio-economic conditions as well as life-style and other health-related factors on the WHO definition of HA. DESIGN, SETTING, PARTICIPANTS: The study used cross-sectional data of the PolSenior Project - nationwide research evaluating different aspects of ageing in Poland - which included 4'653 respondents aged 65 years and over. MEASUREMENTS: Data were collected by trained interviewers in respondents' homes. Three definitions of HA including or not the participants' chronic conditions were analyzed. RESULTS: The prevalence of HA appeared as high as 17.6% if none or 1 chronic disease was present and 42.8% if no information about chronic diseases was taken into account. The association between known health predictors (age, marital status, education, income) and HA was observed. Moreover, HA appeared in relation with indicators of physical functioning and lifestyle. There was a strong concordance between HA and the fair self-rated health (OR = 1.87; 1.99, and 2.74 for the 1st, 2nd and 3rd definitions, respectively) and opposite relation with self-reported need for help (OR = 0.15; 0.15; and 0.13, respectively). CONCLUSIONS: The HA definition based on no functional activity limitations, no cognitive impairment, no depressive symptoms, no more than one disease and being socially active seems to be a useful approach of HA.

Relationship Between Individual Components of the Extended-Criteria Donor Definition and the First Post-transplant Kidney Graft Resistance Index, Measured by Doppler Sonography.

BACKGROUND: Despite an increasing utilization of kidneys procured from expanded-criteria donors, little is known about the effects of particular expanded-criteria donors definition components, that is, hypertension, increased creatinine prior to procurement, and cerebrovascular cause of death on the kidney graft Doppler parameters measured shortly after transplantation, whose increased values are associated with unfavorable outcomes. Hence, we analyzed the relationship between expanded-criteria donors components and resistance index values measured within 2 to 3 days post-transplant. MATERIAL AND METHODS: The initial post-transplant resistance index value was measured in 676 consecutive successful first cadaveric kidney graft recipients without delayed graft function or early acute rejection episode. We analyzed resistance index values in 460 patients transplanted with organs from donors <50 years and in 216 recipients with organs from donors >50 years old. RESULTS: In general, expanded-criteria donors status did not influence the initial resistance index values in the whole study group. Unexpectedly, in older donor groups, both the occurrence of donor hypertension and cerebrovascular cause of death resulted in significantly lower resistance index values in kidney graft recipients (0.73 ± 0.10 vs 0.76 ± 0.11 in the non-hypertension group, P = .013 and 0.74 ± 0.11 vs 0.78 ± 0.10 in the non-cerebrovascular cause of death group, P = .015, respectively). In the Cox proportional regression model for graft survival, cerebrovascular cause of death was increasing the risk of graft loss by 55%, while recipient's age had the opposite effect, decreasing the risk of graft loss by 2% per year. CONCLUSIONS: Regardless of the limited influence of expanded-criteria donor status on first post-transplant resistance index value, the long-term observation shows moderate but significantly worse kidney graft survival, mostly as a result of the cerebrovascular cause of donor's death.

No Significant Influence of Reduced Initial Tacrolimus Dose on Risk of Underdosing and Early Graft Function in Older and Overweight Kidney Transplant Recipients.

BACKGROUND: Nowadays, a reduced initial daily dose of tacrolimus (Tac) (0.1-0.15 mg/kg) is recommended for the majority of kidney transplant recipients (KTRs). The aim of the study was to analyze the safety of such a regimen, including the risk of first inadequately low Tac blood level, acute rejection (AR) occurrence, or early graft dysfunction. METHODS: In 2011, we introduced a modified (0.1-0.15 mg/kg/d) initial Tac dosing regimen in older (>55 years) and/or overweight KTRs. To assure the safety of this protocol, we monitored the risk of inadequately low blood Tac level (<6 ng/mL) and incidence of AR or delayed graft function (DGF). The historical cohort with the higher Tac dosing regimen (0.2 mg/kg/d, n = 208) served as a control group. RESULTS: The mean Tac daily dose in 78 KTRs (group with reduced dosing) was 0.133 (95% confidence interval [CI], 0.130-0.136) mg/kg and was significantly lower than the standard, previously prescribed dose of 0.195 (95% CI, 0.194-0.197) mg/kg. Of note, induction therapy was employed twice more often in the reduced Tac dosing group. The dose reduction resulted in a slight, nonsignificant decrease in first Tac trough level. The percentages of patients with first Tac troughs <6 ng/mL (5.1% vs 4.8%), AR (6.4% vs 5.8%), and DGF (25.6% vs 31.2%) were similar in the reduced and standard dosing groups. CONCLUSION: The currently recommended reduction in Tac initial dosing does not increase the risk of inadequate immunosuppression and does not affect the early graft function. Regardless of Tac dose reduction, there is still a substantial risk of Tac overdosing in older or overweight KTRs.

Influence of Polypharmacy on the Quality of Life in Stable Kidney Transplant Recipients.

BACKGROUND: Kidney transplant recipients are frequently treated for other medical conditions and experience polypharmacy. The aim of our study was to evaluate quality of life in relation to medicines' burden in these patients. METHODS: We studied 136 unselected patients with mean post-transplant time of 7.2 ± 4.6 years. Quality of life was evaluated using a validated Polish version of the Kidney Disease Quality of Life-Short Form questionnaire. Data concerning the type (generic name) and number of currently prescribed medications were collected by interview survey. The participants were divided into 3 groups: group 1, patients with a maximum of 4 different medications (n = 37); group 2, patients with 4 to 9 medications (n = 76); and group 3, patients receiving at least 10 different medications (n = 23). RESULTS: The number of medicines taken regularly ranged from 2 to 16. Patients with ≥10 drugs had the highest body mass index and lowest estimated glomerular filtration rate. Patients treated with ≥10 drugs, compared to patients from the 2 other groups, had presented lower subscales results concerning the physical functioning (65.9 vs 84.5 in group 1 and 83.4 in group 2, P < .001 for both comparisons), pain (57.2 vs 82.7 and 76.5, respectively, P < .001 for both), social function (66.8 vs 82.1 and 80.4, respectively, P = .04 for both), and energy/fatigue (54.8 vs 67.7, P = .03 and 65.4, P < .05). Multivariate regression analysis revealed that the number of drugs independently influenced physical functioning, pain, and social function subscales. CONCLUSIONS: Polypharmacy is associated with lower quality of life in patients after successful kidney transplantation. The negative impact of polypharmacy is particularly seen regarding physical functioning and pain severity.

Prevalence of anemia in relation to socio-economic factors in elderly Polish population: the results of PolSenior study.

Anemia is an independent risk factor for functional decline and mortality among older adults. Since mild anemia in older people is often under-diagnosed and ignored, its prevalence needs precise determination and recognition of predisposing factors. None of the previous studies based on the data obtained from the representative elderly population identified the influence of socio-economic factors on the prevalence of anemia. PolSenior was a cross-sectional population-based study performed on the nationally representative sample of Polish seniors. Complete blood count was assessed in 4003 respondents aged 65 years or above (1910 women) divided into six five-year cohorts and a reference group of 622 people aged 55 - 59 years (333 women). Anemia was defined based on the WHO criteria: Hb < 12.0 g/dL in women and Hb < 13.0 g/dL in men. The following socio-economic factors were evaluated through the multiple logistic regression analysis: education level, marital status, place of residence, living arrangements and self-reported poverty. The prevalence of anemia in older persons standardized for the population was 10.8% (17.4% of the study group) and was more frequent in men than in women (20.8% versus 13.6%). The frequency of anemia progressed with age from 5.3% in the youngest to 37.7% in the oldest cohort, and the progression was higher in men. The multiple logistic regression analysis revealed the link between anemia and age in both genders, as well as unmarried status and urban dwelling in men. When age was not taken into account, logistic regression showed the link between anemia and unmarried status, urban place of residence (both genders), and low level of education (women only). Among seniors, those poorly educated, unmarried and city inhabitants require intense screening for anemia.

Atrial fibrillation independently linked with depression in community-dwelling older population. Results from the nationwide PolSenior project.

BACKGROUND: Depression is a frequently observed comorbid condition in patients with cardiovascular diseases. In contrast to coronary heart disease and heart failure there is a limited amount of published data concerning the increased prevalence of depression among patients with atrial fibrillation (AF). Therefore, we decided to assess the prevalence of depression in Polish community-dwelling older patients with a history of AF. METHODS: The data were collected as part of the nationwide PolSenior project (2007-2012). Out of 4979 individuals (age range 65-104 years), data on self-reported history of AF were available for 4677 (93.9%). Finally, 4049 participants without suspected moderate or severe dementia in Mini Mental State Examination test were assessed with the 15-item Geriatric Depression Scale (GDS), and a score of 6 points and more was regarded as suspected depression. RESULTS: Mean age (±SD) of the study population was 78.1 (±8.3) years; 52% were males. The history of AF was reported by 788 (19.5%) subjects. In the univariate analysis a self-reported AF history was associated with 42% increase of suspected depression (41% vs 29%; P < 0.001). In multivariate logistic regression AF remained an independent predictor of depression (OR = 1.69; 95%CI: 1.43-2.00), stronger than heart failure, diabetes or coronary heart disease. CONCLUSIONS: In community-dwelling geriatric Polish population AF is associated with higher prevalence of depression. This association is independent from the demographic factors, disabilities and comorbidities (including history of stroke).

Plasma adiponectin concentration in patients after successful kidney transplantation--a single-center, observational study.

BACKGROUND AND AIM: Adiponectin is an anti-inflammatory protein secreted almost exclusively by adipocytes which improves insulin sensitivity and presents antiatherogenic properties. Plasma adiponectin concentration is almost 3 times higher in hemodialysis patients and markedly decreased after successful kidney transplantation. However, until now, there are no studies analyzing plasma adiponectin concentration in kidney transplant patients (KTx) during the long-term period after transplantation. Therefore, the aim of present study was to examine plasma adiponectin concentration in KTx patients during the wide range of time after transplantation. MATERIAL AND METHOD: Single center, cross-sectional study including 228 KTx adult recipients (143 M and 85 F) with estimated glomerular filtration rate (eGFR) > or = 15 ml/min, 80 hemodialysis patients (34 M and 46 F) and 52 healthy subjects (33 M and 19 F). Plasma adiponectin concentration was estimated together with HOMA-IR (homeostasis model assessment insulin resistance index) and plasma lipid profile. RESULTS: In KTx patients plasma adiponectin concentration 14.0 (13.1-15.0) microg/ml was significantly (p < 0.001), lower than in hemodialysis ones 29.0 (24.7-33.3) microg/ml, however, significantly (p < 0.001) higher than in healthy subjects 10.1 (8.8-11.5) microg/ml. Among KTx patients the highest plasma adiponectin concentration was observed in the subgroup of patients surviving with the functioning graft more than 8 years after transplantation. In KTx patients, significant, negative correlations were found between plasma adiponectin concentration and BMI (p = 0.017), HOMA-IR (p = 0.02) and estimated GFR (p < 0.009), respectively. Multiple regression analysis performed in the group of KTx patients, with plasma adiponectin concentration as the dependent variable and BMI, age, gender, estimated GFR as independent variables showed that in this model (R2 = 0.09) plasma adiponectin concentration significantly depends on BMI (p = 0.035), gender (p = 0.004) and eGFR (p = 0.023). CONCLUSIONS: Patients with long-term renal graft survival are characterized by a higher plasma adiponectin concentration. Kidney graft function (assessed as estimated GFR) is an important factor influencing plasma adiponectin concentration.

Did volume of lymphocele after kidney transplantation determine the choice of treatment modality?

INTRODUCTION: Lymphocele is a lymph collection that forms after surgery following injury to lymph nodes and vessels. The aim of the study was to perform a retrospective analysis of different treatment modalities of lymphocele in patients after kidney transplantation. MATERIAL AND METHODS: A lymphocele located in renal graft area was observed in 25 of 386 transplanted patients (6.5%). Mean patient age was 45 (95% confidence interval [CI], 40 to 50) years. Mean observation time was 35 (95% CI, 27 to 43) months. RESULTS: Mean time from transplantation to diagnosis of lymphocele was 29 days (range, 4 to 127). In 13 patients (54.2%), the lymphocele was symptomatic, requiring initial treatment by repeated needle aspirations or percutaneous drainage. Among 7 patients with persistence of the lesion treatment by sclerotherapy with doxycycline, povidone-iodine, and/or ethanol was successful in 4 cases who showed maximal lymphocele volume of 500 mL. Three other patients, namely, volumes of 120, 874, and 2298 mL were referred for surgery; in two cases, internal marsupialization was performed and in one case external drainage was necessary due to abscess formation. Mean time from the diagnosis to recovery in patients requiring surgical treatment was 15 (range, 8 to 24) weeks. Eleven patients with asymptomatic lymphoceles (mean volume 45 mL; range, 8 to 140) were monitored to resolution after a mean of 4 (range, 1 to 11) weeks. CONCLUSION: All lymphoceles with the maximal volume exceeding 140 mL were clinically symptomatic. Initial percutaneous drainage with or without sclerotherapy was an effective method of treatment. Punctures, drainage, and sclerotherapy were not effective in patients with lymphoceles (>500 mL).

A novel approach to the visualisation of heat-induced structural change in bone.

A new approach to visualising heat-induced change in bone was attempted. This was an attempt to counter the serious limitations of existing analytical methods yet still allow for the examination of subtle changes that occur due to burning. A new form of Magnetic Resonance Imaging was deemed to fulfil this remit. Preliminary tests were performed and proved successful in creating clear, well-defined images of progressive heat-induced structural changes in bone. The implications for improving our understanding of heat-induced change, and therefore our methods of human identification, are significant.

The intrarenal vascular resistance parameters measured by duplex Doppler ultrasound shortly after kidney transplantation in patients with immediate, slow, and delayed graft function.

BACKGROUND: Evaluation of pulsatility (PI) and resistive (RI) indexes by duplex Doppler ultrasound shortly after kidney transplantation reflects the exacerbation of interstitial edema. The aim of study was to characterize factors that influence PI and RI in patients with immediate (IGF), slow (SGF), or delayed (DGF) kidney graft function. PATIENTS AND METHODS: PI and RI were measured in 200 transplanted patients at 2 to 4 days postoperatively. We excluded patients with acute rejection episodes within the first month. IGF, which was defined as serum creatinine <264 micromol/L at 3 days, SGF, which was defined as creatinine >264 micromol/L by day 3 with a maximum of one dialysis, and DGF, which was defined as more than 1 dialysis were observed in 33.3%, 41.5%, and 25.2% of patients, respectively. The examined donor parameters were age, hypotensive episodes, catecholamine infusion, central venous pressure, and glomerular filtration rate. The recipient factors were age, history of hypertension, diabetes mellitus, ischemic heart disease, and stroke. Additionally cold ischemia time (CIT), HLA mismatch, and PRA were analyzed. RESULTS: The lowest PI and RI values were observed among patients with IGF (PI 1.37 [1.28 to 1.46]; RI 0.72 [0.69 to 0.74]); moderate values in SGF (PI 1.65 [1.52 to 1.78]; RI 0.78 [0.76 to 0.80]) and the highest values in DGF (PI 2.09 [1.83 to 2.35]; RI 0.83 [0.80 to 0.86]) differences that were highly significant. Hypotensive episodes and catecholamine infusion in the preharvest period had essential impacts on PI or RI values in the early posttransplant period. There was no significant correlation between PI or RI values and CIT. A slower ATN resolution was observed in DGF patients with higher PI values. CONCLUSION: Ischemic injury, which occurred mainly prior to organ harvesting, played a dominant role determining intrarenal resistance in the early posttransplant period.