Nutritional status in patients aged over 65 years and its influence on the quantity and type of complications occurring 3, 6 and 12 months after hospitalisation: a clinical prospective study.

BACKGROUND: Malnutrition in hospitalised patients is associated with frequent complications and increased mortality. The present study aimed to determine the prevalence of abnormal nutritional status in patients aged over 65 years with a diagnosis of cardiovascular diseases and also to determine its relationship with the duration of hospitalisation and the incidence of complications over 3, 6 and 12 months of observation. A comparison was also made of diagnostic performance between the various classifications used to diagnose abnormal nutritional status. METHODS: In total, 76 patients aged over 65 years with cardiovascular conditions were involved in the study. Abnormal nutritional status was identified on the basis of Mini-Nutritional Assessment-Short Form (MNA-SF) test results, laboratory tests and European Society for Clinical Nutrition and Metabolism (ESPEN) nutritional status assessment criteria. During 3, 6 and 12 months of observation, data were collected concerning the number of re-hospitalisations and the presence of complications. RESULTS: Abnormal nutritional status was reported in 78% of participants. Malnutrition, as diagnosed on the basis of laboratory findings and also on the basis of ESPEN criteria comprising the value of fat free mass index (FFMI), was significantly related to prolonged hospitalisation and an increased complication rate. The results of the MNA-SF test performed at baseline revealed no relationship with the incidence of complications during the first stage of the study. CONCLUSIONS: Abnormal nutritional status was a common phenomenon in the group of patients under investigation. The set of criteria for assessing the nutritional status that had the highest association with the duration of hospitalisation and the incidence of complications includes laboratory tests and ESPEN criteria comprising the value of FFMI.

Progressive effects of silver nanoparticles on hormonal regulation of reproduction in male rats.

The growing use of silver nanoparticles (AgNPs) in various applications, including consumer, agriculture and medicine products, has raised many concerns about the potential risks of nanoparticles (NPs) to human health and the environment. An increasing body of evidence suggests that AgNPs may have adverse effects of humans, thus the aim of this study was to investigate the effects of AgNPs on the male reproductive system. Silver particles (20nm AgNPs (groups Ag I and Ag II) and 200nm Ag sub-micron particles (SPs) (group Ag III)) were administered intravenously to male Wistar rats at a dose of 5 (groups Ag I and Ag III) or 10 (group Ag II) mg/kg of body weight. The biological material was sampled 24h, 7days and 28days after injection. The obtained results revealed that the AgNPs had altered the luteinising hormone concentration in the plasma and the sex hormone concentration in the plasma and testes. Plasma and intratesticular levels of testosterone and dihydrotestosterone were significantly decreased both 7 and 28days after treatment. No change in the prolactin and sex hormone-binding globulin concentration was observed. Exposure of the animals to AgNPs resulted in a considerable decrease in 5α-reductase type 1 and the aromatase protein level in the testis. Additionally, expression analysis of genes involved in steroidogenesis and the steroids metabolism revealed significant down-regulation of Star, Cyp11a1, Hsd3b1, Hsd17b3 and Srd5a1 mRNAs in AgNPs/AgSPs-exposed animals. The present study demonstrates the potential adverse effect on the hormonal regulation of the male reproductive function following AgNP/AgSP administration, in particular alterations of the sex steroid balance and expression of genes involved in steroidogenesis and the steroids metabolism.

Time-dependent biodistribution and excretion of silver nanoparticles in male Wistar rats.

Silver nanoparticles (AgNPs) are the most commonly used nanoparticles owing to their antimicrobial properties. The motivation of the present study was (1) to analyze the effect of silver particle size on rat tissue distribution at different time points, (2) to determine the accumulation of AgNPs in potential rat target organs, (3) to analyze the intracellular distribution of AgNPs and (4) to examine the excretion of AgNPs by urine and feces. AgNPs were characterized by dynamic light scattering (DLS), zeta potential measurements, BET surface area measurements, transmission and scanning electron microscopy. AgNPs (20 and 200 nm) were administered intravenously (i.v.) to male Wistar rats at a dose of 5 mg kg(-1) of body weight. Biological material was sampled 24 h, 7 and 28 days after injection. Using inductively coupled plasma-mass spectrometry (ICP-MS) and transmission electron microscopy (TEM) it was observed that AgNPs translocated from the blood to the main organs and the concentration of silver in tissues was significantly higher in rats treated with 20 nm AgNPs as compared with 200 nm AgNPs. The highest concentration of silver was found in the liver after 24 h. After 7 days, a high level of silver was observed in the lungs and spleen. The silver concentration in the kidneys and brain increased during the experiment and reached the highest concentration after 28 days. Moreover, the highest concentration of AgNPs was observed in the urine 1 day after the injection, maintained high for 14 days and then decreased. The fecal level of silver in rats was the highest within 2 days after AgNPs administration and then decreased.

The effects of 1st and 2nd generation biodiesel exhaust exposure on hematological and biochemical blood indices of Fisher344 male rats - The FuelHealth project.

Diesel exhaust emissions (DEE), being one of the main causes of ambient air pollution, exert a detrimental effect on human health and increase morbidity and mortality related to cardiovascular and pulmonary diseases. Therefore, the objective of the present study was to investigate potential adverse effects of exhausts emissions from B7 fuel, the first-generation biofuel containing 7% of fatty acid methyl esters (FAME), and SHB20 fuel, the second-generation biofuel containing 20% FAME/hydrotreated vegetable oil (HVO), after a whole-body exposure with and without diesel particle filter (DPF). The experiment was performed on 95 male Fischer 344 rats, divided into 10 groups (8 experimental, 2 control). Animals were exposed to DEE (diluted with charcoal-filtered room air to 2.1-2.2% (v/v)) for 7 or 28 days (6 h/day, 5 days/week) in an inhalation chamber. DEE originated from Euro 5 engine with or without DPF treatment, run on B7 or SHB20 fuel. Animals in the control groups were exposed to clean air. Our results showed that the majority of haematological and biochemical parameters examined in blood were at a similar level in the exposed and control animals. However, exposure to DEE from the SHB20 fuel caused an increase in the number of red blood cells (RBC) and haemoglobin concentration. Moreover, 7 days exposure to DEE from SHB20 fuel induced genotoxic effects manifested by increased levels of DNA single-strand breaks in peripheral blood lymphocytes. Furthermore, inhalation of both types of DEE induced oxidative stress and caused imbalance of anti-oxidant defence enzymes. In conclusion, exposure to DEE from B7, which was associated with higher exposure to polycyclic aromatic hydrocarbons, resulted in decreased number of T and NK lymphocytes, while DEE from SHB20 induced a higher level of DNA single-strand breaks, oxidative stress and increased red blood cells parameters. Additionally, DPF technology generated increased number of smaller PM and made the DEE more reactive and more harmful, manifested as deregulation of redox balance.

Silver ions are responsible for memory impairment induced by oral administration of silver nanoparticles.

Increasing use of silver nanoparticles (AgNPs) results in increased human exposure. AgNPs are able to cross brain-blood barrier and are a risk factor for the brain. Thus, we hypothesized that AgNPs exposure might affect hippocampal dependent memory, which required cognitive coordination processes. To verify the assumption, in this study we evaluated the effects of orally administered bovine serum albumin (BSA)-coated AgNPs on spatial memory, which engage cognitive coordination processes for on-going stimuli segregation. Rats following 28 days of oral administration with 1 mg/kg (n = 10) or 30 mg/kg (n = 10) BSA-AgNPs or saline, a control groups (n = 10, n = 8), were tested with an active place avoidance task in the Carousel Maze test. The study revealed significant impairment of long- and short-term memory, irrespectively of dose of AgNPs, whereas non-cognitive activity was on a similar level. We found significantly higher content of silver in the hippocampus in comparison to the lateral cortex. No silver was found in the cerebellum and the frontal cortex. The nanoSIMS analysis reveal a weak signal of silver in the hippocampus of AgNPs treated animals that should be attributed to the presence of silver in ionic form rather than AgNPs. Our findings indicate that oral exposure to a low dose AgNPs induces detrimental effect on memory and cognitive coordination processes. The presence of silver ions rather than AgNPs in different brain regions, in particular the hippocampus, suggests crucial role of silver ions in AgNPs-induced impairment of the higher brain functions.

Posttransplantation glomerulonephritis: risk factors associated with kidney allograft loss.

AIM OF THE STUDY: Chronic glomerulonephritis (GN) is reported as a common cause of late kidney allograft loss. The aim of this study was to identify risk factors associated with kidney allograft loss in the course of posttransplantation GN. PATIENTS AND METHODS: The study analyzed 75 kidney allograft recipients with biopsy-confirmed posttransplantation GN, including 27 cases of immunoglobulin (Ig)A nephropathy (IgAN), 30 of membranous GN (MGN), 6 of mesangiocapillary GN (MCGN); and 12 of focal segmental GN (FSGS). The risk factors for kidney allograft loss, defined as dialysis reintroduction after GN onset, were identified through are historical cohort study. CLINICAL FINDINGS: After the onset of posttransplantation GN, the median time to dialysis introduction was 46 months. The risk factors for kidney allograft loss were as follows: male gender (hazard ratio [HR] = 1.92; 95% confidence intervall [CI] 1.0-3.70; P = .052), initial unsatisfactory kidney function (HR = 1.86 per 1 mg/dL serum creatinine increment; 95% CI 1.0-3.46; P < .05), graft dysfunction at diagnosis (HR = 1.65 per 1 mg/dL serum creatinine increment; 95% CI 1.32-2.07; P < .001), nephrotic syndrome (HR = 2.3; 95% CI 1.13-4.99; P < .05) late-onset GN (HR = 1.1 per each additional year of observation, 95% CI 1.0-1.21; P < .05), and MPGN as a type of GN. Enhanced immunosuppression increased and ACEI and/or statin treatment decreased the risk of return to dialysis, respectively: HR = 1.56, 95% CI 0.76-3.18, P = .22; HR = 0.39, 95% CI 0.16-0.98, P = .0037; and HR = 0.367, 95% CI 0.15-0.88, P = .025. CONCLUSIONS: Identification of risk factors can help discover patients who will have a faster progression to kidney allograft loss due to GN. In posttransplantation GN, statins and/or ACEI should be prescribed, if there are no contraindications.

The weight of pharmacokinetic parameters for mycophenolic acid in prediction of rejection outcome: the receiver operating characteristic curve analysis.

Often the clinical researcher is confronted with the question of how accurate a particular laboratory test is to identify disease. To confirm the ability of pharmacokinetic (PK) parameters to discriminate between patients with or without acute rejection after kidney transplantation, an analysis of receiver operating characteristic (ROC) curves was performed in 51 adult patients, among whom nearly 50% experienced biopsy-proven acute rejection episodes during the first 90 days posttransplant. All patients received cyclosporine or tacrolimus, prednisone, and mycophenolate mofetil (MMF). The following PK variables were determined for mycophenolic acid, an active metabolite of MMF: predose (C(0)), maximum concentration (C(max)), and area under the concentration-time curve (AUC(0-12h)). ROC plots of sensitivity versus 1-specificity were generated to determine whether a particular PK parameter could discriminate renal transplant recipients with an acute rejection from those who experienced no rejection. Area under the ROC curves and the 95% confidence interval limits were calculated using the method of Hanley and McNeil. The C(0) and C(max) were less predictive values for acute rejection than AUC(0-12h). The AUC parameter appeared the most effective to discriminate an acute rejection episode during MMF therapy. This study indicated the utility of ROC curve analysis to select PK parameters to predict acute rejection episodes.

IgA nephropathy in kidney allograft recipients-therapeutic perspective.

INTRODUCTION: A growing number of patients are losing their kidney allografts due to glomerulonephritis. Although posttransplant IgA nephropathy (IgAN) is regarded as benign, it may lead to late allograft loss in a substantial number of patients. The aim of this study was to evaluate the influence of posttransplant IgAN on long-term transplantation outcomes, risk factors for progression of graft dysfunction, and effectiveness of therapeutic interventions. PATIENTS AND METHODS: We evaluated, potential risk factors for accelerated graft loss among 27 kidney allograft recipients with posttransplant IgAN, comparing graft survival in a control group matched for population and transplantation-related parameters. We evaluated the effectiveness of therapeutic interventions regarding immunosuppressive regimen, and hypertension control including angiotensin converting enzyme inhibitor (ACEI) usage with Kaplan-Meier, Cox proportional hazard plots, and log-rank tests in statistical analyses. RESULTS: Compared with the control group, patients with IgAN experienced a 6.57 higher risk for dialysis dependence (P < .01, 95% CI 1.4 to 30.83). The risk for accelerated graft loss in the course of IgAN was associated with graft dysfunction (RR = 2.16 for additional 1 mg/dL of serum creatinine at glomerulonephritis presentation; P < .03, 95% CI 1.2 to 4.36) and intense proteinuria as evidenced by a RR = 4.67 for the presence of the nephrotic syndrome (P < .05, 95% CI 0.95 to 22.8). Immunosuppression enhancement resulted in a significantly decreased risk of dialysis dependence, namely, RR = 4.76 (95% CI 1.12 to 20, P < .04). With ACEI treatment there was a tendency for a 2.8-fold decreased risk of dialysis dependence, without reaching statistical significance (P = .14). CONCLUSIONS: Patients with posttransplant IgAN may benefit from intensifying maintenance immunosuppression, which slows progression to end-stage graft dysfunction.

Treatment of chronic viral hepatitis type B with oral mucosal administration of natural human interferon alpha lozenges.

Results of the administration of natural human interferon alpha (nIFN-alpha) into the oral cavity of 28 patients with chronic aggressive viral hepatitis type B are shown. Diagnosis of chronic aggressive viral hepatitis type B was based on clinical symptoms of disease, histopathological changes as evidenced by liver biopsy and persistence of HBV markers in patient sera. The daily dose of nIFN-alpha ranged from 75-200 IU/day. The twenty eight patients have been treated for a variable amount of time: thirteen over 300 days, two over 180 days, two over 120 days and eleven for less than 120 days. Only those patients who have been treated for over 300 days are considered to have completed the therapeutical program and remain under observation only. Oral IFN-alpha therapy is safe and efficacious in patients with chronic aggressive viral type B hepatitis. Among these 28 patients, 23 were initially positive for both hepatitis Bs antigen (HBsAg) and hepatitis Be antigen (HBeAg). Eight of these 23 patients have lost HBeAg and developed anti-HBe antibody. In addition one patient from this group seroconverted 356 days after initiation of treatment with IFN-alpha. Three patients lost HBs and HBe antigens and developed antibodies to both HBs and HBe antigens. Two patients who had eliminated HBe antigen before IFN-alpha therapy eliminated HBeAg following treatment and developed antibodies against HBs antigen. Three additional patients initially HBsAg+.HBcAg-, and HBeAg- developed antibody to HBe antigen during IFN-alpha therapy. At the time of this report 12 of the 23 initially viremic patients have seroconverted (52%).(ABSTRACT TRUNCATED AT 250 WORDS)

Usefulness of cytologic examination of urinary sediment with the millipore method in routine diagnosis based on 125 cases.

The paper evaluates the usefulness of cytologic examination of urine sediment performed by millipore method, based on 125 cases. The method permits high quality cytologic smears obtained even from cellularly poor urines. The sensitivity of this analysis is directly proportional to the histological grade of the tumour. In the case of transitional cell carcinoma G1, the sensitivity was 65%, in G2-79.3% and in G3-92.9%. High sensitivity of this examination was found in carcinoma in situ. Our study is of retrospective character, the results presented were obtained on the basis of one cytoanalysis of urine sediment.

[Fertility of women after surgical intervention on organs of reproduction]. / Plodnosc kobiet po zabiegach operacyjnych na narzadach plciowych.

The research included 114 female patients treated at the Clinic of Obstetrics and Gynaecology in the years 1986-1991. Information was based on a questionnaire, with 40 (35%) answers. Basic parameters of fertility were evaluated in women, who underwent surgical intervention on reproductive organs and they were discussed in connection with other conditioning. It was ascertained that the decision concerning infertility treatment is taken up by young patients, up to 25 years of age, during the first 5 years of marriage. Duration of the treatment in the majority of patients lasts longer than 5 years. Routine surgical interventions in the area of reproductive organs do not increase significantly the possibility of conception. Whereas in this group we deal more often with ectopic pregnancy.

[Multiple pregnancy as a cause of premature delivery]. / Ciaza wieloplodowa jako przyczyna porodu przedwczesnego.

Authors analysed management, complications and outcome of 13 multifetal pregnancies (11 triplet and 2 quadruplet), their duration, the way of delivery, indications for cesarean section and perinatal mortality rate. A majority of the multifetal pregnancies were diagnosed before the end of 20 weeks gestation, and 69.2% of women had cervical cerclages. Tocolysis was used in 9 cases (69.2%). The mean gestational age at delivery was 32.8 weeks. Cesarean section was performed in nine cases (29 neonates). Of the 41 neonates there were 2 stillbirth (4.88%) and 3 neonatal death (7.31%). In 87.9% of cases, delivery occurred before the end of 37 weeks gestation. The most common maternal complications were toxemia (23.1%) and anemia (46.2%).

[Problems diagnosing cat scratch disease]. / Problemy diagnostyczne choroby kociego pazura.

The diagnosis of cat scratch disease is hampered by the fact the basic laboratory investigations fail to demonstrate characteristic changes of this disease, and the diagnosis is based usually on epidemiological history and the clinical symptom complex. The diagnosis is confirmed by the complement binging test with the antigen obtained from pathologically changed lymph nodes with values over 1.5 being pathognomonic for the disease, and by the cutaneous tests of Hanger-Rose and Mollaret. The authors present 2 cases treated for the disease stressing differences in its course.

[Hepatic reactions in the course of viral meningoencephalitis in patients hospitalized in 1985-1989]. / Odczyny watrobowe w przebiegu wirusowych zapalen opon mózgowo-rdzeniowych i mózgu u chorych hospitalizowanych w latach 1985-1989.

In the years 1985-1989 in a department for parasitic and occupational diseases in Bialystok, 112 patients were hospitalized with the diagnosis of lymphocytic meningitis. The most common aetiological factor were viruses (30.6%), arboviruses (25.9%), and then herpes viruses (6.25%), and mumps virus (5.3%). In 36 patients (32%) no aetiological factor of the inflammatory process was established. In 22 patients (19.6%) a simultaneous hepatocellular damage was found in the form of jaundice (15 patients, that is 13.4%), and hepatomegaly in seven patients. The observed hepatic involvement was found in the group of patients with severe clinical course of meningitis. Most frequently hepatic reaction was observed in the group of lymphocytic meningitis caused by arboviruses. Among the biochemical indices of hepatocellular damage a significant increase in relation to normal value was found of serum bilirubin level (mean = 1.75 mg%; normally mean = 1.1 mg%), alanine aminotransferase activity was 2.5 times higher than the mean normal value (mean = 77.6 IU; normal value mean = 30 IU). The observed hepatic changes were transient and regressed together with the regression of acute inflammatory state in the central nervous system.

Time-dependent supplementation of vitamin E influences leptin expression in the aortic layers of rats fed atherogenic diet.

An excessive consumption of a diet rich in saturated fatty acids is a key factor in pathogenesis of cardiovascular diseases which are strictly connected with leptin imbalance in the vessels. However, whether vitamin E supplementation would influence leptin expression in aortic layers is still unknown. For 3 or 6 weeks male Wistar rats were fed a high-fat (20% w/w) diet with lard as dietary fat source with or without vitamin E supplementation (50 mg/100 g of diet). The 6-week intake of an atherogenic diet increased total cholesterol (TC) and high density lipoprotein cholesterol (HDL) plasma levels simultaneously lowering TC/HDL ratio (ANOVA p≤0.0001 for all three parameters). After longer period of feeding it was stated that leptin expression in all three aortic layers was enhanced (ANOVA p≤0.0001 for endothelium, tunica media and adventitia, respectively) with decreased leptin plasma concentration (ANOVA p≤0.0001). After both periods of feeding vitamin E supplementation caused an increase in plasma HDL content and a decrease of TC/HDL ratio. In the 3-week experiment vitamin E addition caused a decrease in leptin plasma levels (Fisher's test, 3L versus 3LE: p≤0.002) and an increase in leptin expression in all three aortic layers (Fisher's test, 3L versus 3LE p≤0.005, p≤0.01 and p≤0.05 respectively for endothelium, tunica media and adventitia). The contradictory results were observed in the 6-week experiment in which vitamin supplementation decreased leptin expression in the aortic endothelium (Fisher's test, 6L versus 6LE: p≤0.001) with lack of changes in the other two layers of the aorta and plasma. The study showed that vitamin E supplementation influenced leptin expression in aortic layers in rats fed atherogenic diet differently depending on the length of feeding period. It may suggest that vitamin E consumption plays an important role in the control of leptin status in the endothelium.