Physiological Response of Nutrient-Stressed Lemna gibba to Pulse Colloidal Silver Treatment

Wastewater is a source of many environmental pollutants and potentially high concentrations of essential plant nutrients. Site-specific nutrient levels may influence the response of exposed plants to a chemical stressor. In the present study, we focused on the responses of model aquatic macrophyte swollen duckweed (Lemna gibba L.) to a short pulse exposure and a commercially available colloidal silver product as a potential environmental chemical stressor, combined with two levels of total nitrogen and phosphorus nutrition. Treatment with the commercially available colloidal silver product caused oxidative stress in L. gibba plants under both high and low nutrient levels. Plants grown and treated under high nutrient levels showed lower levels of lipid peroxidation and hydrogen peroxide accumulation, as well as higher levels of photosynthetic pigment content in comparison to treated plants under low nutrient levels. Higher free radical scavenging activity for plants treated with silver in combination with high nutrient levels resulted in better overall protection from silver-induced oxidative stress. The results showed that external nutrient levels significantly affected the L. gibba plant's response to the colloidal silver presence in the environment and that nutrient levels should be considered in the assessment of potential environmental impact for contaminants.

Are immunosuppressive conditions and preoperative corticosteroid treatment risk factors in inguinal hernia repair?

INTRODUCTION

Immunosuppressive conditions and/or preoperative corticosteroid treatment have a negative influence on wound healing and can, therefore, lead to higher rates of surgical site infections (SSIs) and seromas. For inguinal hernia, no such studies have been carried out to date.

METHODS

In an analysis of data from the Herniamed Registry, 2312 of 142,488 (1.6%) patients with primary unilateral inguinal hernia repair had an anamnestic history of an immunosuppressive condition and/or preoperative corticosteroid treatment. Using propensity score matching, 2297 (99.4%) pairs with comparative patient characteristics were formed. These were then compared using the following primary outcome criteria: intra- and postoperative complications, complication-related reoperations, recurrence at one-year follow-up, pain on exertion, pain at rest, and chronic pain requiring treatment at one-year follow-up. Of the 2297 matched pairs with primary unilateral inguinal hernia repair, 82.76% were male patients. 1010 (44.0%) were operated in laparo-endoscopic techniques (TEP, TAPP), 1225 (53.3%) in open techniques (Bassini, Shouldice, Lichtenstein, Plug, TIP, Gilbert, Desarda), and 62 (2.7%) in other techniques.

RESULTS

The matched pair analysis results did not identify any disadvantage in terms of the outcome criteria for patients with an anamnestic history of immunosuppressive condition and/or preoperative corticosteroid treatment (yes vs no). In particular, no disadvantage was noted in the rate of surgical site infections (0.65% vs 0.70%; ns) or seromas (1.22% vs 1.57%; ns). The overall rates of postoperative complications were 3.40% vs 4.31% (p = ns) (plus 0.22% concordant events in five matched pairs).

CONCLUSION

In primary unilateral inguinal hernia surgery, an immunosuppressive condition and/or preoperative corticosteroid treatment does not appear to have a negative influence on wound complications.

Growth inhibition and recovery patterns of common duckweed Lemna minor L. after repeated exposure to isoproturon

Aquatic non-targeted organisms are more likely to be exposed to herbicides in multiple pulse events then long continuous exposure. The potential of an organism to recover between exposures has an important role in the overall effects of the toxicant. Common duckweeds show high potential for recovery after a single exposure to isoproturon. To evaluate the growth patterns and recovery potential between multiple exposures, L. minor plants were exposed to isoproturon in three repetitive 7-day treatment cycles in three time-variable exposure scenarios with equivalent time-weighted average concentrations. The growth was significantly inhibited during each exposure phase with significant cumulative effects in every subsequent treatment cycle resulting in a cumulative decrease in biomass production. However, inhibitory effects were reversible upon transferring plants to a herbicide-free nutrient solution. These results indicate that L. minor plants have a high recovery potential even after multiple exposures to isoproturon. Observed cumulative decrease in biomass production, as well as the potential for fast and efficient recovery from repeated herbicide exposure, might affect the competitiveness of L. minor in surface water communities. The observations made during each exposure period, recovery patterns, and the resulting cumulative effects over time may contribute to further development, calibration and validation of mechanistic toxicokinetic/toxicodynamic models for simulating the effects of pesticides on aquatic plants populations in the laboratory and environmental conditions.

Phytotoxicity assessment of isoproturon on growth and physiology of non-targeted aquatic plant Lemna minor L. - A comparison of continuous and pulsed exposure with equivalent time-averaged concentrations

Phenylurea herbicides are often present in the aquatic ecosystems and may be accumulated by the non-targeted organisms and impose a negative effect on the organism and the community. This study aims to investigate and compare the effects of two different isoproturon (IPU) pulse exposure scenarios on the non-targeted aquatic plant Lemna minor with effects observed in the standard test with continuous exposure. The obtained results showed that continuous IPU treatment causes significant reduction of photosynthetic pigment concentration and proteins as well as inhibition of L. minor growth. The activities of CAT, G-POX, and APX were significantly induced to diminish the accumulation of ROS under IPU treatment, but the induction of antioxidant enzymes was not sufficient to protect the plants from herbicide-induced oxidative stress. The growth of L. minor under pulse exposure to IPU recovers fast, but pulse treatment results in significant physiological changes in treated plants. The accumulation of H₂O₂ and lipid peroxidation products, alongside the reduced concentration of proteins and photosynthetic pigments in pulse treatment after a recovery period, indicates that IPU causes prolonged oxidative stress in L. minor plants. The recovery potential of L. minor plants after treatment with herbicides may have an important role in maintaining the population of essential primary producers in aquatic ecosystems, but IPU-induced physiological changes could potentially have a significant role in modulating the response of the plants to the next exposure event.

Physiological and biochemical effect of silver on the aquatic plant Lemna gibba L.: Evaluation of commercially available product containing colloidal silver

This paper aims to evaluate the effects of a product containing colloidal silver in the aquatic environment, using duckweed Lemna gibba as a model plant. Therefore, growth parameters, photosynthetic pigments content and protein content as physiological indices were evaluated. Changes in the content of non-enzymatic antioxidants and activity of several antioxidant enzymes, alongside with the accumulation of hydrogen peroxide and lipid peroxidation end-products were assessed to explore the potential of colloidal silver to induce oxidative stress. The commercially available colloidal silver product contained a primary soluble form of silver. The treatment with colloidal silver resulted in significant physiological and biochemical changes in L. gibba plants and a consequent reduction of growth. Accumulation of silver caused altered nutrient balance in the plants as well as a significant decrease in photosynthetic pigments content and protein concentration. The antioxidative response of L. gibba plants to treatment with colloidal silver was inadequate to protect the plants from oxidative stress caused by metal accumulation. Silver caused concentration-dependent and time-dependent hydrogen peroxide accumulation as well as the elevation of lipid peroxidation levels in L. gibba plants. The use of commercially available products containing colloidal silver, and consequent accumulation of silver, both ionic and nanoparticle form in the environment, represents a potential source of toxicity to primary producers in the aquatic ecosystem.

Comparison of efficacy of low-volume bowel cleansers prior to colonoscopy: a randomised, prospective, open-label trial

INTRODUCTION

The aim of the study was to compare the efficacy and tolerability of polyethylene glycol/ascorbic acid (PEGA), sodium picosulfate/magnesium citrate (SPMC) and the oral sulfate formula (SIR) in a single- or split-dose regimen for bowel preparation prior to colonoscopy.

METHODS

Randomised, multicentre, open-label study. The subjects received either PEGA, SPMC or SIR in the single- or split-dose regimen before the colonoscopy. Quality and tolerability of the preparation and complaints during preparation were recorded using a 5 point scale.

RESULTS

558 subject were analysed. Preparation quality was comparable in the single-dose regimen. The rate of satisfactory bowel cleansing (Aronchick score 1+2) was higher for split-dose SIR and PEGA compared to SPMC (95.6%, 86.2% vs. 72.5%, p.

Real-time CO2 uptake/emission measurements as a tool for early indication of toxicity in Lemna-tests

This paper presents an application of continuous monitoring of the emission and uptake rate of CO₂ in Lemna toxicity test. On a real-time basis, the CO₂ concentration data were collected by the Arduino platform-based respiratory activity measuring system (ResTox) and reported as CO₂ concentration dynamic curves. The results of CO₂ measurements demonstrated that tested metals (Co, Cu, Hg, and Cd), as well as herbicides (nicosulfuron, diquat, and tembotrione), stimulated the CO₂ exchange rates at low doses, while at high doses CO₂ exchange rates were inhibited. The addition of higher concentrations of clopyralid stimulated photosynthetic activity and caused a higher increase in respiration rates indicating its mode of action as auxin mimic herbicide. The results obtained underline the necessity of considering other biological endpoints like continuous measurements of gas exchange from the very beginning of exposure to toxicants. Simultaneous measurements of real-time CO₂ concentrations, as the primary effect of toxicant mode of action, and processes that are supported by carbon flux, as the secondary effect or endpoint, are needed to relate actual and substrate-induced or inhibited respiration and photosynthesis to those processes. Therefore, continuous measurements of CO₂ exchange rates can be implemented for the initial screening of potential toxicity to give valuable information that is needed for further examination of toxicity mechanisms and risk assessment.

The role of adapted and non-adapted resistance sources in breeding resistance of winter wheat to Fusarium head blight and deoxynivalenol contamination

Since resistance is the most important agent in regulating deoxynivalenol (DON), breeding for higher resistance is the key to improve food safety. Fusarium damaged kernels (FDK) show a closer correlation with DON than visual symptoms. This implies a difference in genetic regulation. For this reason, the mapping should be extended not only for the visual symptoms, but also for FDK and DON. Quantitative trait loci influencing only Fusarium head blight (FHB) symptoms, may not be relevant for FDK and DON. Type I and II were pooled to overall resistance at spray inoculation. From 2010 to 2016 three selection platforms were compared by checking running variety breeding programs. The use of exotic sources in breeding significantly increased the number of more resistant genotypes in each selection phase from F3-F8 generations compared to the control program where crosses were not planned for FHB resistance and screening in early generations was also not performed. However, also in this breeding platform – at a lower rate – moderately or highly resistant genotypes could be selected. Of them, eight cultivars were/are in commercial production. The Fusarium breeding program using only adapted and more resistant parents generally gave closer results to exotic breeds, and several highly resistant genotypes were produced as a result. For winter wheat the phenotypic screening at high disease pressure is the key to select highly resistant materials. At low infection pressure the high and medium resistant genotypes come in the same group. The use of more isolates increases the chance to have strong selection pressure each year. FHB resistance was combined with leaf rust, yellow rust, powdery mildew, leaf spot resistance and high protein content (15-18%). The cultivar registration and post registration screening is the key in improving food safety in commercial production.

Study of Ni-Catalyzed Graphitization Process of Diamond by in Situ X-ray Photoelectron Spectroscopy

Graphene on diamond has been attracting considerable attention due to the unique and highly beneficial features of this heterostructure for a range of electronic applications. Here, ultrahigh-vacuum X-ray photoelectron spectroscopy is used for in situ analysis of the temperature dependence of the Ni-assisted thermally induced graphitization process of intrinsic nanocrystalline diamond thin films (65 nm thickness, 50-80 nm grain size) on silicon wafer substrates. Three major stages of diamond film transformation are determined from XPS during the thermal annealing in the temperature range from 300 °C to 800 °C. Heating from 300 °C causes removal of oxygen; formation of the disordered carbon phase is observed at 400 °C; the disordered carbon progressively transforms to graphitic phase whereas the diamond phase disappears from the surface from 500 °C. In the well-controllable temperature regime between 600 °C and 700 °C, the nanocrystalline diamond thin film is mainly preserved, while graphitic layers form on the surface as the predominant carbon phase. Moreover, the graphitization is facilitated by a disordered carbon interlayer that inherently forms between diamond and graphitic layers by Ni catalyst. Thus, the process results in formation of a multilayer heterostructure on silicon substrate.

Implementation of the European health interview survey (EHIS) into the German health update (GEDA)

Background

This methodological paper describes the integration of the ‘European Health Interview Survey wave 2’ (EHIS 2) into the ‘German Health Update’ 2014/2015 (GEDA 2014/2015-EHIS).

Methods

GEDA 2014/2015-EHIS is a cross-sectional health survey. A two-stage stratified cluster sampling approach was used to recruit persons aged 15 years and older with permanent residence in Germany. Two different modes of data collection were used, self-administered web questionnaire and self-administered paper questionnaire. The survey instrument implemented the EHIS 2 modules on health status, health care use, health determinants and social background variables and additional national questions. Data processing was conducted according to the quality and validation rules specified by Eurostat.

Results

In total, 24,824 questionnaires were completed. The response rate was 27.6%. The two-stage cluster sample method seems to have been successful in achieving a sample with high representativeness. The final micro data file was inspected, approved and certified by Eurostat. Access to micro data of the EHIS 2 can be provided by Eurostat via research contract and to the GEDA 2014/2015-EHIS public use file by the Research Data Centre of the Robert Koch Institute. First EHIS 2 results are available at the Eurostat website.

Conclusions

Integrating a multinational health survey into an existing national health monitoring system was a challenge in Germany. The national survey methodology for conducting the survey had to be further developed in order to meet the overarching goal of harmonizing the health information from national statistical offices and public health research institutes across the European Union. The harmonized EHIS 2 data source will profoundly impact international public health research in the near future. The next EHIS wave 3 will be conducted around 2019.

Cholecystectomy for Acute Cholecystitis After Renal Transplantation

BACKGROUND

The aim of our study was to evaluate the rate of surgical complications, patient outcomes, and impact on graft function in renal transplant recipients in whom cholecystectomy for acute cholecystitis was performed.

METHODS

We reviewed data on transplant patients from January 1, 2006, to December 31, 2013. The subgroup of patients who required subsequent cholecystectomy for acute cholecystitis was assessed, and their data were further analyzed.

RESULTS

Thirty-one patients who underwent cholecystectomy for acute cholecystitis after renal transplantation were included in the study. Clinical signs such as pain in the right upper quadrant, temperature >38°C, and elevation in bilirubin levels occurred in 20 (64.5%), 8 (25.8%), and 3 (9.7%) patients, respectively. Ultrasound signs of acute cholecystitis were present in 27 patients (87.1%). In terms of laboratory values, white blood cell counts >10 × 10(9)/L occurred in 17 patients (54.8%), and C-reactive protein levels >40 mg/L were reported in 21 patients (67.7%). The conversion rate to open surgery was 32.3% (10 patients). In 13 cases, acalculous cholecystitis was present (41.9%). The average serum creatinine level 1 year after cholecystectomy had no statistically significant differences. One patient required temporary dialysis during the postoperative period (with subsequent graft recovery), and 1 graft was lost.

CONCLUSIONS

Acute cholecystitis in kidney transplant recipients is a serious complication, with frequent difficulties related to evaluation and diagnosis. Because clinical signs could be very mild compared with severity of gallbladder affliction, there is little room if any for conservative treatment in these patients. We have not noticed adverse impact of acute cholecystitis on 1-year graft function.

Biosystem models, generated from a complex rule/reaction/influence network and from two functionality prototypes

In this work we have further developed the Direct Computer Mapping (DCM) based modelling and simulation methodology. A unified, transition-based representation of complex rule, reaction and influence networks has been introduced and two prototypes (one general state- and another general transition-prototype) have been developed for the unified functional modelling of the state and transition nodes. Starting from the network and from the functional prototypes, an automatic generation method of the graphically editable and extensible GraphML description of biosystem models has been elaborated. The new developments have been implemented in the improved kernel of DCM models. The applied knowledge representation makes possible the unified generation and execution of the balance-based quantitative and influence- or rule-based qualitative, as well as optionally time-driven, multiscale biosystem models. Application of the developed methodology has been illustrated by the improved implementation of the formerly studied and upgraded example biosystem model for combining the detailed, quantitative p53/miR34a signalling system with the pathological model through an extended rule-based coupling model.

Measurement of capillary fragility: a useful tool to differentiate lipedema from obesity?

Lipedema is a disproportional obesity featuring spontaneous or light pressure-induce pain and frequent hematoma formation due to even minor traumatic injuries. It is generally distinguished from general obesity primarily based on clinical hallmarks; however, this becomes difficult when appearing in a concomitant form (combination of obesity and lipedema). Our study group has recently demonstrated that lipedema-associated bruising is correlated with increased capillary fragility (CF) and also that CF could be significantly improved by complex decongestive physiotherapy (CDP). In this study, we measured CF in female subjects with lipedema (15) or non-complicated obesity (15) who were body mass index (BMI) and waist-to-hip ratio (WHR) matched. CF was evaluated with the vacuum suction method (VSM) using Parrot's angiosterrometer in both groups. Application of VSM resulted in a significantly higher number of petechiae in subjects with lipedema. Capillary fragility measurement appears to be a useful differential diagnostic tool between lipedema and obesity under these trial parameters.

Suitability of a preserved human cadaver model for the simulation of facemask ventilation, direct laryngoscopy and tracheal intubation: a laboratory investigation

BACKGROUND

Using fresh or formalin-embalmed cadavers has not been generally accepted for the purposes of teaching airway management. We investigated whether cadavers 'preserved according Thiel's embalming method' (PATEM) are suitable for the simulation of facemask ventilation and tracheal intubation by direct laryngoscopy.

METHODS

This observational cluster sampling, controlled simulation study, included eight PATEM cadavers and eight manikins in two clusters. Twenty experienced anaesthetists were randomly assigned to execute 80 facemask ventilations and 80 tracheal intubations in both groups. The ease of facemask ventilation was the primary endpoint. The secondary endpoint was the composite outcomes of laryngoscopy and tracheal intubation.

RESULTS

The success rate at the first attempt at mask ventilation was 74% (59/80 attempts) on cadavers and 41% (33/80 attempts) on manikins (P<0.0001). Twenty one subjects received an oral airway in both groups and succeeded in facemask ventilation 20 times on cadavers and four times on manikins (P=0.004). Two-handed technique mask ventilation was required 24 times on manikins and once on cadavers (P=0.0016). In one attempt on a manikin the mask ventilation was impossible. Poor laryngeal view (Cormack-Lehane grade 3) occurred 14 times among cadavers (17.5%) and once in manikins (1.25%) (P=0.007), whereas difficulties in tracheal intubation were encountered 16 times in cadavers (20%) vs 17 times in manikins (21.25%) (P=0.84). In a subjective evaluation the participants preferred the cadaver model over the manikins (P<0.0001).

CONCLUSIONS

PATEM cadavers were better suited for facemask ventilation and provided a more realistic environment for laryngoscopy and tracheal intubation than the studied manikins.

Is ionized oxygen negatively or positively charged more effective for carboxyhemoglobin reduction compare to medical oxygen at atmospheric pressure?

Carbon monoxide (CO) reversibly binds to hemoglobin forming carboxyhemoglobin (COHb). CO competes with O(2) for binding place in hemoglobin leading to tissue hypoxia. Already 30 % saturation of COHb can be deadly. Medical oxygen at atmospheric pressure as a therapy is not enough effective. Therefore hyperbaric oxygen O(2) inhalation is recommended. There was a question if partially ionized oxygen can be a better treatment at atmospheric pressure. In present study we evaluated effect of partially ionized oxygen produced by device Oxygen Ion 3000 by Dr. Engler in elimination of COHb in vitro experiments and in smokers. Diluted blood with different content of CO was purged with 5 l/min of either medicinal oxygen O(2), negatively ionized O(2) or positively ionized O(2) for 15 min, then the COHb content was checked. In vivo study, 15 smokers inhaled of either medicinal oxygen O(2) or negatively ionized O(2), than we compared CO levels in expired air before and after inhalation. In both studies we found the highest elimination of CO when we used negatively ionized O(2). These results confirmed the benefit of short inhalation of negatively ionized O(2), in frame of Ionized Oxygen Therapy (I O(2)Th/Engler) which could be used in smokers for decreasing of COHb in blood.

De novo Prograf versus de novo Advagraf: are trough level profile curves similar?

BACKGROUND

According to the clinical trials, Advagraf (ADV) has efficacy and safety profile similar to Prograf (PROG). The aim of this study was to compare the graft functions, dosages, and tacrolimus (TAC) trough level profile curves of patients on de novo PROG and ADV therapy.

METHODS

The ADV group included 39 de novo renal cases who had received initial immunosuppression (IS) with once-daily TAC (1 × 0.2 mg/kg from day1 after transplantation). We compared them with a PROG group of 38 transplant patients who received equivalent IS with twice-daily TAC (2 × 0.1 mg/kg from day1). In both groups, the IS was combined with antimetabolites and steroids. The mean follow-up time was similar (13.5 ± 7 days) in both groups after renal transplantation until the emission of the patients from our clinic.

RESULTS

TAC mean total daily dose was reduced and whole-blood trough levels decreased over the time in early postoperative days. Only on day 3 and day 4 after transplant, a significant higher adjustment in the ADV dosage was necessary to achieve sufficient TAC trough levels. The average TAC trough level profile curves were similar in PROG and ADV groups, but the individual curves were very different. Mainly in patients on ADV therapy, the initial concentrations were often >30 ng/mL, and in some cases on the 9th posttransplant day decreased to <5 ng/mL, then slowly increased into the required therapeutic range.

CONCLUSIONS

The results demonstrate that patients after renal transplantation can be safely treated de novo with ADV. Setting the required therapeutic TAC blood levels may require more attention to avoid the "fluctuations" of trough level profile curve during the early postoperative period. Our data suggest that dose adjustment of ADV can be carried out more carefully compared with PROG on the basis of clinical symptoms and the value of TAC blood levels to avoid acute rejection and toxicity.

Endogenous thrombin potential and examination of a further 31 analytes in liver transplant candidates

BACKGROUND

To predict the change in patient status and differentation of the basic diseases, endogenous thrombin potential (ETP), clinical chemistry, and coagulation variables were measured in liver transplant-listed patients with different etiologies.

METHODS

Differences in values of ETP and analytes of 30 control persons and 164 cirrhotic patients were examined by means of binary logistic regression. The relationship between the analytes and ETP parameters were analyzed by means of Spearman correlation. The different etiologies of cirrhosises were studied by factor and discriminant analyses. Binary logistic regression was applied to forecast changes in clinical status. Survival analysis was carried out with the appropriate variable.

RESULTS

International Normalized Ratio and activated partial thromboplastin time values were higher, whereas the area-under-the-curve values were lower in cirrhosis than in healthy subjects. A strong relationship was found only between the peak height and the anti-thrombin III (ATIII) values. In the factor analysis, 3 factors were found, which explained 81.6% of the total variance. Combination of aspartate aminotransferase and ATIII mostly separated the basic disease groups from each other in the discriminant analysis. From 35 variables, the lactate dehydrogenase (LDH) and ATIII have been suited for predicting the change in patient status. Eighty percent of patients with low ATIII and high LDH levels had deterioration of their clinical status.

CONCLUSIONS

Our study demonstrated that the ETP parameters did not provide additional information compared with "conventional" coagulation tests in cirrhosis. On the basis of our study, LDH and ATIII appear to be promising analytes to assess the clinical status of patients with cirrhosis. In our opinion, the classification system of liver transplant-listed patients can be improved with their use.

Coherent phonon dynamics in micro- and nanocrystalline diamond

We report on the time-resolved coherent anti-Stokes Raman spectroscopy of phonon dephasing in micro- and nanocrystalline diamond films. The dephasing times T(2) were found to be dependent on the morphology of diamond films (average size of crystals and content of nondiamond carbon phase) and changed from 0.7 to 1.72 ps. The dephasing times were found to be temperature independent in the range 10-295 K. In addition to diamond Raman active phonon mode at 1332 cm(-1), we investigated also the dynamics of a broad Raman peak at 1530 cm(-1) which is present in samples with higher content of nondiamond sp(2) hybridized carbon phase. This peak was found to be homogenously broadened with very fast dephasing (T(2)~50 fs).

Autophagy is required for zebrafish caudal fin regeneration

Regeneration is the ability of multicellular organisms to replace damaged tissues and regrow lost body parts. This process relies on cell fate transformation that involves changes in gene expression as well as in the composition of the cytoplasmic compartment, and exhibits a characteristic age-related decline. Here, we present evidence that genetic and pharmacological inhibition of autophagy - a lysosome-mediated self-degradation process of eukaryotic cells, which has been implicated in extensive cellular remodelling and aging - impairs the regeneration of amputated caudal fins in the zebrafish (Danio rerio). Thus, autophagy is required for injury-induced tissue renewal. We further show that upregulation of autophagy in the regeneration zone occurs downstream of mitogen-activated protein kinase/extracellular signal-regulated kinase signalling to protect cells from undergoing apoptosis and enable cytosolic restructuring underlying terminal cell fate determination. This novel cellular function of the autophagic process in regeneration implies that the role of cellular self-digestion in differentiation and tissue patterning is more fundamental than previously thought.

Both autologous bone marrow mononuclear cell and peripheral blood progenitor cell therapies similarly improve ischaemia in patients with diabetic foot in comparison with control treatment

BACKGROUND

The aim of our study was to compare the effect of bone marrow mononuclear cell and peripheral blood progenitor cell therapies in patients with diabetic foot disease and critical limb ischaemia unresponsive to revascularization with conservative therapy.

METHODS

Twenty-eight patients with diabetic foot disease (17 treated by bone marrow cells and 11 by peripheral blood cell) were included into an active group and 22 patients into a control group without cell treatment. Transcutaneous oxygen pressure and rate of major amputation, as the main outcome measures, were compared between bone marrow cells, peripheral blood cell and control groups over 6 months; both cell therapy methods were also compared by the characteristics of cell suspensions. Possible adverse events were evaluated by changes of serum levels of angiogenic cytokines and retinal fundoscopic examination.

RESULTS

The transcutaneous oxygen pressure increased significantly (p < 0.05) compared with baseline in both active groups after 6 months, with no significant differences between bone marrow cells and peripheral blood cell groups; however, no change of transcutaneous oxygen pressure in the control group was observed. The rate of major amputation by 6 months was significantly lower in the active cell therapy group compared with that in the control group (11.1% vs. 50%, p = 0.0032), with no difference between bone marrow cells and peripheral blood cell. A number of injected CD34+ cells and serum levels of angiogenic cytokines after treatment did not significantly differ between bone marrow cells and peripheral blood cell.

CONCLUSIONS

Our study showed a superior benefit of bone marrow cells and peripheral blood cell treatments of critical limb ischaemia in patients with diabetic foot disease when compared with conservative therapy. There was no difference between both cell therapy groups, and no patient demonstrated signs of systemic vasculogenesis.

Schizophrenia patients with and without post-traumatic stress disorder (PTSD) have different mood symptom levels but same cognitive functioning

OBJECTIVE

To investigate differences in cognitive function and level of psychopathology in patients with schizophrenia (SZ) with or without psychological traumatization/post-traumatic stress disorder (PTSD). We hypothesized that traumatized patients with or without PTSD would have more severe cognitive impairments because of the neuropathological changes associated with PTSD, and more severe psychopathology compared with non-traumatized SZ patients.

METHOD

Seventy-five SZ patients with traumatization and 217 SZ patients without traumatization were evaluated regarding the symptoms and cognitive functioning, using standard symptom scales (PANSS; CDSS) and a neuropsychological test battery (IQ, verbal memory, attention, working memory, psychomotor speed, and executive functioning).

RESULTS

No significant differences were observed between the groups in cognitive test performance. The patients in the traumatized group with PTSD showed significantly more current depression than the non-traumatized group (P = 0.012).

CONCLUSION

The findings did not support the hypothesis that the presence of comorbid PTSD/traumatization in SZ is associated with increased cognitive impairment. The increase in current depression in SZ with comorbid traumatization suggests that more severe psychopathology is associated with traumatization.

Randomised clinical trial: a 1-week, double-blind, placebo-controlled study of pancreatin 25 000 Ph. Eur. minimicrospheres (Creon 25000 MMS) for pancreatic exocrine insufficiency after pancreatic surgery, with a 1-year open-label extension

BACKGROUND

Pancreatic exocrine insufficiency (PEI) often occurs following pancreatic surgery.

AIM

To demonstrate the superior efficacy of pancreatin 25 000 minimicrospheres (Creon 25000 MMS; 9-15 capsules/day) over placebo in treating PEI after pancreatic resection.

METHODS

A 1-week, double-blind, randomised, placebo-controlled, parallel-group, multicentre study with a 1-year, open-label extension (OLE). Subjects ≥18 years old with PEI after pancreatic resection, defined as baseline coefficient of fat absorption (CFA) <80%, were randomised to oral pancreatin or placebo (9-15 capsules/day: 3 with main meals, 2 with snacks). In the OLE, all subjects received pancreatin. The primary efficacy measure was least squares mean CFA change from baseline to end of double-blind treatment (ancova).

RESULTS

All 58 subjects randomised (32 pancreatin, 26 placebo) completed double-blind treatment and entered the OLE; 51 completed the OLE. The least squares mean CFA change in the double-blind phase was significantly greater with pancreatin vs. placebo: 21.4% (95% CI: 13.7, 29.2) vs. -4.2% (-12.8, 4.5); difference 25.6% (13.9, 37.3), P < 0.001. The mean ± s.d. CFA increased from 53.6 ± 20.6% at baseline to 78.4 ± 20.7% at OLE end (P < 0.001). Treatment-emergent adverse events occurred in 37.5% subjects on pancreatin and 26.9% on placebo during double-blind treatment, with flatulence being the most common (pancreatin 12.5%, placebo 7.7%). Only two subjects discontinued due to treatment-emergent adverse events, both during the OLE.

CONCLUSIONS

This study demonstrates superior efficacy of pancreatin 25 000 over placebo in patients with PEI after pancreatic surgery, measured by change in CFA. Pancreatin was generally well tolerated at the high dose administered (EudraCT registration number: 2005-004854-29).

Significance of mycophenolate monitoring in liver transplant recipients: toward the cut-off level

Mycophenolate mofetil blocks the "de novo" -purine synthesis to reduce the incidence and severity of acute rejection episodes. There has been an increased interest in utility of monitoring mycophenolic acid (MPA) levels, however currently the MPA monitoring is not part of the protocol following liver transplantation. We assessed whether trough MPA monitoring could be advisable in liver transplant patients or not. For this reason MPA levels of 56 liver transplants were measured on 3, 5, 10, 14, 21, 30, 60, and 180 posttransplant days. The optimal cut-off of MPA level (≥1.73 mg/L) for all (56) and ≥1.34 mg/L for ciclosporin-treated- and ≥1.98 mg/L for the tacrolimus-treated transplants were calculated by statistical analysis to reduce the incidence of acute rejection. MPA concentrations of 3 days period before the day of clinical diagnosis acute rejection were well below the cut-off value. Only 3 (16%) out 19 patients with acute rejection had higher MPA levels than the cut-off value on the day of diagnosis of acute rejection. In conclusion, our data suggests that MPA predose level monitoring, especially in the early "filling phase" after transplantation, is applicable in liver allograft recipients given adjunctive MMF, protecting them from the ineffective immunosuppression.

Role of Aspergilli and Penicillia in mycotoxin contamination of maize in Hungary

Aspergillus and Penicillium species and their mycotoxins, including aflatoxins, ochratoxins, fumonisins and patulin, are frequently encountered on cereal products. The occurrence of these species and their mycotoxins on maize was investigated in Hungary after harvest in two consecutive years. Surface-sterilized cereal seeds were placed on selective media, and the isolated fungal strains were identified using morphological methods. In 2010 and 2011, 81.94% and 14.33%, respectively, of the samples were found to be contaminated with potentially toxigenic isolates. The species identification of selected isolates was carried out using sequence-based methods. Several Aspergillus flavus isolates were identified, which are potential aflatoxin producers. Other mycotoxinproducing species were also isolated, including black Aspergilli, which potentially produce ochratoxins and fumonisins, and A. clavatus, which produces patulin. In 2010 a large number of Penicillium species occurred in the samples, producing a wide range of mycotoxins. The mycotoxin content of the samples was analysed using the ELISA and HPLC techniques. Aflatoxins were not detected in any of the samples, while ochratoxins and fumonisins were successfully identified in some of the maize seeds.

Tacrolimus inhibits intimal hyperplasia in arterialised veins in rats

OBJECTVES

We investigated whether tacrolimus (FK506) can inhibit neointimal formation in arterialised vein grafts in rats.

METHODS

Lewis iliolumbar veins were implanted into the abdominal aorta of isogeneic rats. Animals in the treatment groups had daily intramuscular injections of tacrolimus at 0.2 mg/kg (group B) and 0.1 mg/kg (Group C), respectively. The control group A had no treatment. Light microscope evaluations of arterialised vein grafts were performed 30 days after operation. We determined the presence of endothelial cells, the thickness of intima and media, and the degree of infiltration by MHC class II positive, CD4 positive, and CD8 positive cells into the adventitia.

RESULTS

The intimal thickness in group B (5.0±1.0 µm) was statistically lower (P < 0.05) when compared to group C (7.0±3.0 µm). The intimal thickness in untreated group A (12.7±7.0 µm) was statistically higher (P < 0.01) when compared to both treated groups B and C, respectively. The medial thickness and degree of adventitial infiltration by MHC class II positive, CD8 positive, and CD4 positive cells did not differ between groups.

CONCLUSION

Treatment with tacrolimus (FK506) showed a dose dependant inhibition of neointimal hyperplasia in arterialised vein grafts in rats (Tab. 1, Fig. 3, Ref. 22).

Lymphedema treatment decreases pain intensity in lipedema

Lipedema is a disproportional obesity featuring light pressure-induced or spontaneous pain. On the basis of our clinical observations, lymphedema therapy, as practiced in our clinic, reduces the perception of pain beyond leg volume reduction. We therefore aimed to measure pain intensity prior and subsequent to treatment. 38 women with lipedema were enrolled in the study with 19 patients undergoing treatment and 19 serving as the control group using exclusively moisturizers. Treatment consisted of once daily manual lymph drainage (MLD), intermittent pneumatic compression (IPC), and multilayered short-stretch bandaging performed throughout a 5-day-course. Pain was evaluated with a 10-item questionnaire, a pain rating scale (PRS), and the Wong-Baker Faces scale. Treatment resulted in a significant reduction of pain with a decrease in mean scores of all three measures. In the control group, only PRS showed significant decrease. Our study results indicate that this treatment regimen not only reduces leg volume and capillary fragility, but also improves pain intensity in patients with lipedema.

Cytomegalovirus seroprevalence among solid organ donors in Hungary: correlations with age, gender, and blood group

BACKGROUND

Cytomegalovirus (CMV) is endemic throughout the world, affecting most of the population, but the seroprevalence of CMV is known to vary among countries. CMV causes a mild infection in persons with intact immunity; however, CMV infection in organ transplantation is associated with significant morbidity and mortality. The present retrospective study was designed to evaluate the age-, gender-, and blood group-adjusted CMV seroprevalence among solid organ donors, representing fairly the overall Hungarian population (according to Hungarian Central Statistic Institute). This information is important for calculating risk-factors for CMV-seronegative recipients. No nationwide estimates of CMV seroprevalence in Hungary (as a representative of Eastern Middle Europe) have been published yet.

METHODS

We investigated 2070 organ donors for CMV seroprevalence by measuring the CMV-specific immunoglobulin G. The donors were divided into 3 age groups (2-20, 21-50, and 51-70 years old). A study was also conducted on a fourth group consisting of 200 residents from an old age home. CMV seroprevalence differences were searched according to age-, gender- and blood-group distribution.

RESULTS

The CMV seroprevalence of organ donors is 85% and of all investigated persons is 86%. The age-specific prevalence increases, starting from 72% in the first group to 99% in the fourth group. Seroprevalence of females was found to be significantly higher than of males (P=.0001).

CONCLUSION

We have shown that the overall CMV seroprevalence in the Hungarian population is moderately high at 86%. The opportunity for CMV-seronegative recipients to get a graft from a seronegative donor is statistically only 2%. The seroprevalence of the youngest age group is 72% and so it can be concluded that the Hungarian population acquires the infection mainly in childhood or in the early adulthood. Female gender is a risk factor for CMV infection. This fact must be taken into consideration during the planning of patients' follow-up, prophylaxis, and therapy.

[Treatment of critical limb ischemia and diabetic foot disease by the use of autologous stem cells]

AIM

The aim of our study was to assess safety and effectiveness of therapy of critical limb ischaemia by autologous stem cells and evaluation of potential adverse events.

METHODS

Fourteen patients were included into the study (11 men, 3 women, mean age 61.9 +/- 9.6 years, mean diabetes duration 23.5 +/- 11.1 years, mean glycated hemoglobin 6 +/- 1%). Eight patients were treated by bone marrow stromal cells, 6 patients by peripheral blood progenitor cells after stimulation by filgrastim. The suspension of stem cells was then applied into the muscles of ischemic limbs. We evaluated transcutaneous oxygen tension (TcPO2), subjective pain sensation assessed by Visual Analog Scale (VAS) and wound healing.

RESULTS

TcPO2 significantly increased in all patients from 10 +/- 8.7 mm Hg before the treatment to 39.4 +/- 9.5 mm Hg after 6 months (p = 0.0005) after stem cell therapy. We also observed significant area defect reduction and pain decrease during the follow-up period. Median of area defect was reduced from 4.3 (0.7 - 31.7) before the treatment to 0.06 (0 - 0.5) cm2 after 6 months from the treatment (p = 0.0078). Decrease in rest pain was observed in all patients, mean VAS decreased from 5.3 +/- 1.8 to 1.1 +/- 1.3 after 6 months (p = 0.002).

CONCLUSION

Our study suggests that stem cell therapy of diabetic foot disease is an effective therapeutic option with no adverse events for patients with severe peripheral arterial disease. This treatment leads to increase of transcutaneous oxygen tension, improves wound healing and decreases the rest pain.

Smoking following renal transplantation in Hungary and its possible deleterious effect on renal graft function

Smoking is a known risk factor for kidney damage and also influences graft function following renal transplantation. Because smoking habits following kidney transplantation are not systematically evaluated, we analyzed them in a single center in Hungary. The survey was conducted among 402 randomly selected kidney graft recipients. We assessed smoking-related questions as well as clinical kidney disease and transplantation data. Posttransplantation renal function was analyzed based on serum creatinine values at 1 month and at 3 years after transplantation. In our study 25% (n = 102) of patients continued to smoke after transplantation. Smokers who received grafts displayed a significantly younger age compared with nonsmokers (40.1 +/- 13.4 vs 47.1 +/- 12.7 years; P < .001) independent of underlying kidney disease. Posttransplantation kidney function in smokers did not differ at 1 month after engraftment, but was significantly impaired at 3 years as assessed based on serum creatinine levels: 138.9 +/- 42.4 versus 128.4 +/- 48.5 micromol/L (P < .05). Decrease of renal function correlated with smoking intensity defined in pack-years (r(2) = 0.102; P < .05). Smoking is common following kidney transplantation in Hungary and might represent a risk factor for kidney damage following renal transplantation. Therefore, effective tobacco-dependence treatment is necessary in this patient population.

Postconditioning attenuates remote organ injury after lower limb arterial occlusion

Introduction

External aortic compression due to acute gastric dilation is a rare etiology of the lower limb ischemia. This phenomenon leads the author to design experimental study for reperfusion syndrome. The lower limb ischemia-reperfusion (IR) injury consists of local and systemic components called the reperfusion syndrome. It can progrediate into a multi-organ failure which defines postoperative survival. A postconditioning is a surgical technique, which has a potential to reduce IR injury, therefore to prohibit the development of reperfusion syndrome.

Aim

XXXto examine on an experimental model, whether postonditioning is a practicable technique in infarenal aortic surgeries.

Materials and Methods

Male Wistar rats underwent 180 minutes of infrarenal aortic occlusion with 4, 24 and 72 hours of reperfusion. Postconditioning (10 sec. reocclusion / 10 sec. perfusion in 6 cycles) was applied in one group of each reperfusion time. Blood, urine, and histological (muscle, lung, kidney and liver) samples were collected at the postischemic 4th, 24th, and 72th hour.

Results

The early inflammatory response (TNFa, free radicals) and late local inflammation were reduced by posctonditioning significantly. Postconditioning was able to reduce the remote organ injury of lungs and kidneys, the morphological and laboratorial results showed significant difference between the postconditioning and the control group in these two organs. The method's positive effect on remote organ injury remained long-term.

Conclusion

Postconditioning seems to be an applicable process to reduce both local inflammatory and systemic complications of IR injury following vascular surgeries.

Radical surgery for pancreatic malignancy in the elderly

BACKGROUND

Improving life expectancy is associated with increasing incidence of pancreatic cancer. We reviewed morbidity and mortality in patients aged 65 years and older undergoing curative intent surgery in two centers in the Czech Republic.

METHODS

Data were retrieved by retrospective analysis of the medical records over the period 2000-2007. In total, 60 patients were included. The mean age was 71 years (median 70 years; range 65-85 years). Most patients (43, 72%) underwent hemipancreatoduodenectomy, combined in 4 with portomesenterial vessel resection. Twelve patients (20%) had distal pancreatectomy and 5 patients (8%) total pancreatectomy.

RESULTS

Overall morbidity was 28%. Only 10 patients (18%) developed serious surgical complications in terms of pancreatic leak (5, 8%), biliary leak (2, 3%), and intra-abdominal inflammatory collection (4, 7%). Four patients (6.6%) died within 30 days. The 1-year survival was 62.8%.

CONCLUSION

We can conclude that age per se is not a contraindication to surgery. Patient's overall general condition, co-existing co-morbidities, and ability to get over with any potential complications are more important. and IAP.

Small difference in international normalized ratio may yield a significant impact on prioritizing patients listed for liver transplantation

Priority for liver transplantation is currently based on the Model for End-stage Liver Disease (MELD) score. The aim of our study was to assess in detail the contribution of international normalized ratio (INR) differences for MELD scores because of interlaboratory variability. The samples from 92 cirrhotic patients were measured on different systems combining three coagulometers and three thromboplastin products to determine variations in INR and MELD score. The INR differences among the first four systems varied between 0 and 0.2, resulting in MELD differences of 0 to 2. The MELD scores of 92 patients changed only among 10 possible integers so that normally 2 to 10 patients shared the same MELD value. In some cases, one MELD score difference resulted in a 10 superpositioning on the waiting list. Including one more system (mechanical vs optical) into our investigations achieved a five MELD difference. Supposing an extreme situation where one patient competes with his or her lowest, all the other with their highest possible score (and visa versa), the difference may be even 20 positions, overturning the complete waiting list. In conclusion substantial interlaboratory differences in MELD score have profound clinical consequences.