MicroRNA expression profiles in liver and colon of sexually immature gilts after exposure to Fusarium mycotoxins

To improve our knowledge of the role of microRNAs (miRs) in responses of the porcine digestive system to two Fusarium mycotoxins, zearalenone (ZEN) and deoxynivalenol (DON), we examined the expression of 7 miRs (miR-9, miR-15a, miR-21, miR-34a, miR-122, miR-125b, and miR-192), previously found to be deregulated in diseased liver and colon cells. In this study, immature gilts were exposed to NOEL doses of ZEN (40 μg/kg/d), DON (12 μg/kg/d), ZEN+DON (40+12 μg/kg/d), and placebo (negative control group) for 7, 14, 21, 28, 35, and 42 days. Before the treatment, expression levels of the selected miRs were measured in the liver, the duodenum, the jejunum, and the ascending and the descending colon of the gilts. Hierarchical clustering of the tissues by their miR expression profiles was consistent with what would be expected based on the anatomical locations and the physiological functions of the organs, suggesting that functions of the miRs are related to the specificities of the tissues in which they are expressed. A subset of 2 pairs of miRs (miR-21+miR-192 and miR-15a+miR-34a), which were assigned to two distinct clusters based on their tissue abundance, was then evaluated in the liver and the ascending and the descending colon during the treatment. The most meaningful results were obtained from the ascending colon, where a significant effect of the treatment was observed, suggesting that during the exposure to mycotoxins, the pathways involved in cell proliferation and survival were disordered. Changes in miR expression in the liver and the descending colon of the treated gilts were smaller, and were associated more with treatment duration than the exposure to ZEN, DON, or ZEN+DON. Further research should focus on identification of genes whose expression is regulated by these aberrantly expressed miRs. This should facilitate understanding of the miRNA-regulated biological effects of mycotoxins

Autoimmunologiczne choroby tarczycy u chorych na pierwotne nadciśnienie płucne

Abnormal metabolism due to thyroid disorders could cause the additional significant right ventricular(RV) overload in patients with primary pulmonary hypertension (PPH). The purpose of this study was the prospective determination of autoimmune thyroid status in PPH patients. Material: 45 patients (33 women and 12 men, mean age 38 years ± 13) with moderate and severe PPH (mean pulmonary artery pressure 61 mm Hg ± 18 mm Hg). PPH was diagnosed when other reason of pulmonary hypertension had been excluded especially thromboembolic, venous and hypoxemic. Methods: Titer of antibodies to thyroglobulin and thyroid peroxidase were measured. Thyroid gland dysfunction was determined by biochemical measurements of thyrotropin and free thyroxine; thyroid ultrasonographic examination was also performed. The prevalence of thyroid autoantibodies is estimated at 13% in general population. Results: In 14 patients (31%) increased titer of thyroid antibodies was found in our group. Hyperthyroidism was recognized in 2 patients and in 3 cases we diagnosed hypothyroidism with high antibodies level requiring treatment. Ultrasonographic abnormalities were revealed in 21 patients (nodular changes - 11 patients, fibrosis -3 patients, chronic inflammation symptoms - 7). Ultrasonographic abnormalities were present in all patients with detectable antithyroid antibodies. We haven't confirmed more frequent prevalence of hormonal disorders in patient treated with prostacycline's analogues. Conclusion: The prevalence of autoimmune thyroid diseases is about 3 times higher in PPH patients than in general population. The treatment of patients with clinically evident hyper- or hypothyroidism is necessary. The monitoring of clinically silent disorders seems to be recommended especially prior to lung transplantation qualification

Unusual cause of right heart failure decompensation in 21-years old patient with idiopathic pulmonary arterial hypertension - a case report

W niniejszej pracy przedstawiono przypadek 21-letniej pacjentki z idiopatycznym tętniczym nadciśnieniem płucnym, u której doszło do zaostrzenia prawokomorowej niewydolności serca z podwyższonym stężeniem troponiny T w przebiegu masywnego krwawienia do jamy brzusznej. Krwotok był spowodowany pęknięciem torbieli jajnika w trakcie terapii doustnym antykoagulantem z podwyższonym INR (5,14). U pacjentki, przyjętej z objawami wstrząsu, stwierdzono również cechy zaostrzenia prawokomorowej niewydolności serca w obrazie echokardiograficznym i podwyższenie stężenia NT-proBNP. W opisywanym przypadku zmniejszenie perfuzji wieńcowej i hipoksja tkankowa, pogłębiona utratą krwi i nośnika tlenowego, prawdopodobnie doprowadziły do uszkodzenia prawej komory serca i uwolnienia troponiny T z kardiomiocytów. Po podaniu dożylnym witaminy K, krystaloidów oraz przetoczeniu krwi uzyskano stabilizację stanu chorej oraz powrót wartości biomarkerów do poziomu sprzed zaostrzenia. Po odstawieniu leczenia przeciwzakrzepowego nie obserwowano nawrotu krwawienia. W wykonanym po 15 miesiącach badaniu hemodynamicznym nie stwierdzono trwałego upośledzenia funkcji prawej komory serca.The authors describe a case of 21-years old woman with idiopathic pulmonary arterial hypertension with atypical clinical consequences of massive internal bleeding. Despite significant hypovolemia clinical and laboratory presentation was one of RV failure with dilatation of right heart ventricle and increased plasma level of markers of myocardial stretch and injury (NT-proBNP and troponin, respectively). This is attributed to impaired right ventricular coronary perfusion and hypoxia. Intensive treatment restored baseline RV conditions and at 15 months follow-up no persistent right heart impairment was observed. This case demonstrates that bleeding should be also considered in differential diagnosis of exacerbation of right ventricular failure in patients with pulmonary arterial hypertension

Abnormalities in high-resolution computed tomography of the lungs in patients with idiopathic pulmonary arterial hypertension - correlation with hemodynamic parameters and prognostic significance

Wstęp: Prognozowanie długości przeżycia chorych na idiopatyczne płucne nadciśnienie tętnicze (IPAH) oparte jest głównie na wskaźnikach hemodynamicznych, czynnościowych oraz na stężeniu biomarkerów. Znaczenie zmian stwierdzanych w obrazie tomografii komputerowej klatki piersiowej o wysokiej rozdzielczości (TKWR) nie było dotychczas badane. Materiał i metody: Retrospektywnej analizie poddano badanie TKWR klatki piersiowej 48 chorych na IPAH: 37 kobiet i 11 mężczyzn w wieku 41 ± 15 lat. Wyniki: W 12 przypadkach (25%) stwierdzono zacienienia o typie matowej szyby, w 8 przypadkach (17%) - guzki wewnątrzzrazikowe, w pozostałych przypadkach (58%) obraz TKWR klatki piersiowej był prawidłowy. Obecność guzków wewnątrzzrazikowych wiązała się z istotnie gorszymi parametrami hemodynamicznymi: niższą objętością wyrzutową serca (guzki 41,0 ± 8,5 ml; matowa szyba 60,8 ± 15,1 ml; prawidłowy obraz TKWR 58,1 ± 18,0 ml; p = 0,03) i wyższym ciśnieniem w prawym przedsionku serca (guzki 12,2 ± 4,86 mm Hg; matowa szyba 6,9 ± 3,9 mm Hg; prawidłowy obraz TKWR 7,6 ± 5,3 mm Hg; p = 0,047). W grupie chorych z guzkami stwierdzono znacznie podwyższone ryzyko zgonu w analizie jednoczynnikowej (HR 5,35; 95% CI: 1,16-24,7; p = 0,03) i w analizie wieloczynnikowej (HR 6,98; 95% CI: 1,41-34,59; p = 0,02). Obecność zacienień typu matowej szyby nie wykazywała istotnych powiązań z wielkością parametrów hemodynamicznych, nie miała też istotnego znaczenia rokowniczego. Wnioski: Guzki wewnątrzzrazikowe, opisywane w badaniu TKWR klatki piersiowej u chorych na IPAH, były skojarzone z niekorzystnym profilem hemodynamicznym i wykazywały niezależny od innych czynników negatywny wpływ na przeżycie.Introduction: The risk stratification in idiopathic pulmonary arterial hypertension (IPAH) patients is currently based on haemodynamic and functional parameters as well as serum biomarker concentrations. Until now the importance of changes appearing in high-resolution computed tomography (HRCT) of the lungs of patients with IPAH has not been investigated. Material and methods: Lung HRCT scans were analysed retrospectively in 48 IPAH patients (patients): 37 women, 11 men, mean age 41 ± 15 years. Results: Focal ground-glass opacifications (FGG) were found in 12 patients (25%), and centrilobular nodules (CN) were found in 8 patients (17%). In the remaining 58% of patients HRCT revealed no changes (N). Significantly lower stroke volume was found in the CN group (41.0 ± 8.5 ml) compared to 60.8 ± 15.1 ml in the FGG group and 58.1 ± 18.0 ml in the N group (p = 0.03). Right atrial pressure was significantly higher in the CN group (12.2 ± 4.86 mm Hg) than in the FGG group (6.9 ± 3.9 mm Hg) and the N group (7.6 ± 5.3 mm Hg), p = 0.047. The presence of nodules was combined with considerably increased risk of death, both in univariate analysis (HR 5.35, 95% CI: 1.16-24.7, p = 0.03) and in multivariate analysis (HR 6.98, 95% CI: 1.41-34.59, p = 0.02). Ground-glass opacifications correlated neither with haemodynamic nor functional indexes, and were of no prognostic significance. Conclusions: The presence of centrilobular nodules in lung HRCT scans of IPAH patients was combined with more severe haemodynamic compromise and was an independent negative prognostic indicator

An expert opinion of the Polish Cardiac Society Working Group on Pulmonary Circulation and the Polish Society for Rheumatology on the diagnosis and treatment of pulmonary hypertension in patients with connective tissue disease

Systemic connective tissue diseases (CTDs) comprise a large group of diseases that are auto-immune in nature and characterized by the involvement of multiple systems and organs. Pul-monary hypertension (PH) of various etiologies may develop in the course of CTD, including pulmonary arterial hypertension (PAH), PH secondary to the lung disease, postcapillary PH in the course of left heart disease, and chronic thromboembolic pulmonary hypertension (CTEPH). In addition, the different forms of PH may coexist with each other. Among patients with CTD, PAH occurs most commonly in those with systemic sclerosis, where it affects ap-proximately 8%–12% of patients. The prognosis in patients with untreated PAH is very poor. It is particularly important to identify the high-risk CTD-PAH population and to perform effi-cient and accurate diagnostics so that targeted therapy of the pulmonary arteries can be intro-duced. Echocardiography is used to screen for PH, but clinical and echocardiographic suspicion of PH always requires confirmation by right heart catheterization. Confirmation of PAH ena-bles the initiation of life-prolonging pharmacological treatment in this group of patients, which should be administered in referral centers. Drugs available for pharmacological management include endothelin receptor antagonists, phosphodiesterase-5 inhibitors, and prostacyclins

Lung transplantation in patients with pulmonary arterial hypertension: The opinion of the Polish Cardiac Society Working Group on Pulmonary Circulation

Pulmonary arterial hypertension is a rare but progressive disease that leads to death. Modern drug treatment slows the progression of the disease and prolongs patients’ lives, but often, even maximal treatment with parenteral prostacyclin does not prevent deterioration. In the case of inadequate clinical response to drug treatment, lung transplantation (LTx) should be considered. This article aims to analyze thoroughly indications to refer a patient for consultation with a transplant center, the optimal timing of listing for LTx, contraindications for the procedure, bridging techniques, as well as tests needed before and after transplantation. We outline the technique of the procedurę and evaluate psychological aspects of LTx

Idiopathic venous thromboembolism or occult cancer?

The relationship between cancer and an increased incidence of venous thromboembolism (VTE) is well documented. VTE is a common complication of cancer, which usually occurs in the advanced stages of the disease. It often manifests itself before the cancer has been diagnosed and frequently is the first symptom of malignancy. In particular, pulmonary embolism is a major epidemiological problem because of its prevalence and high mortality. This article contains a review of the literature on VTE and occult cancer. It indicates the problem of a lack of an effective diagnostic strategy for malignancy in patients with idiopathic venous thromboembolism

Severe aortic stenosis in a patient with breast cancer

We present a case of 68-year-old female with severe symptomatic aortic stenosis and locally advanced breast cancer disqualified from mastectomy due to heart failure and from aortic valve replacement due to malignant neoplasm. The patient received neoadjuvant chemotherapy without anthracyclines. The aortic valve replacement was performed and then mastectomy and lymphadenectomy were made without hemodynamic complications. Adjuvant hormonotherapy was started. During 42 months of follow-up the patient remained free of recurrent cancer disease as well as no progression of heart failure was observed