Land Policy for Flood Risk Management-Toward a New Working Paradigm

Flood risk management (FRM) aims to integrate necessary technical measures with environmental and societal approaches. Focusing on the process and governance of how to plan, implement, and maintain solutions therefore becomes essential. Among the different stakeholders, landowners are a key group to be considered. This contribution elaborates on the interconnections between land policy, FRM and private land ownership. It is based on the European COST Action network LAND4FLOOD, which brings together academics and stakeholders from various disciplines and more than 35 countries. We argue for a less project oriented and more process oriented approach, a focus on land management and more emphasis on small-scale measures. This represents a break with some of the recent working paradigms of FRM

Heterologous Expression of ATG8c from Soybean Confers Tolerance to Nitrogen Deficiency and Increases Yield in Arabidopsis

Nitrogen is an essential element for plant growth and yield. Improving Nitrogen Use Efficiency (NUE) of crops could potentially reduce the application of chemical fertilizer and alleviate environmental damage. To identify new NUE genes is therefore an important task in molecular breeding. Macroautophagy (autophagy) is an intracellular process in which damaged or obsolete cytoplasmic components are encapsulated in double membraned vesicles termed autophagosomes, then delivered to the vacuole for degradation and nutrient recycling. One of the core components of autophagosome formation, ATG8, has been shown to directly mediate autophagosome expansion, and the transcript of which is highly inducible upon starvation. Therefore, we postulated that certain homologs of Saccharomyces cerevisiae ATG8 (ScATG8) from crop species could have potential for NUE crop breeding. A soybean (Glycine max, cv. Zhonghuang-13) ATG8, GmATG8c, was selected from the 11 family members based on transcript analysis upon nitrogen deprivation. GmATG8c could partially complement the yeast atg8 mutant. Constitutive expression of GmATG8c in soybean callus cells not only enhanced nitrogen starvation tolerance of the cells but accelerated the growth of the calli. Transgenic Arabidopsis over-expressing GmATG8c performed better under extended nitrogen and carbon starvation conditions. Meanwhile, under optimum growth conditions, the transgenic plants grew faster, bolted earlier, produced larger primary and axillary inflorescences, eventually produced more seeds than the wild-type. In average, the yield was improved by 12.9%. We conclude that GmATG8c may serve as an excellent candidate for breeding crops with enhanced NUE and better yield

Two Major Autoantibody Clusters in Systemic Lupus Erythematosus

Systemic lupus erythematosus is a chronic autoimmune disease of complex clinical presentation and etiology and is likely influenced by numerous genetic and environmental factors. While a large number of susceptibility genes have been identified, the production of antibodies against a distinct subset of nuclear proteins remains a primary distinguishing characteristic in disease diagnosis. However, the utility of autoantibody biomarkers for disease sub-classification and grouping remains elusive, in part, because of the difficulty in large scale profiling using a uniform, quantitative platform. In the present study serological profiles of several known SLE antigens, including Sm-D3, RNP-A, RNP-70k, Ro52, Ro60, and La, as well as other cytokine and neuronal antigens were obtained using the luciferase immunoprecipitation systems (LIPS) approach. The resulting autoantibody profiles revealed that 88% of a pilot cohort and 98% of a second independent cohort segregated into one of two distinct clusters defined by autoantibodies against Sm/anti-RNP or Ro/La autoantigens, proteins often involved in RNA binding activities. The Sm/RNP cluster was associated with a higher prevalence of serositis in comparison to the Ro/La cluster (P = 0.0022). However, from the available clinical information, no other clinical characteristics were associated with either cluster. In contrast, evaluation of autoantibodies on an individual basis revealed an association between anti-Sm (P = 0.006), RNP-A (P = 0.018) and RNP-70k (P = 0.010) autoantibodies and mucocutaneous symptoms and between anti-RNP-70k and musculoskeletal manifestations (P = 0.059). Serologically active, but clinically quiescent disease also had a higher prevalence of anti-IFN-α autoantibodies. Based on our findings that most SLE patients belong to either a Sm/RNP or Ro/La autoantigen cluster, these results suggest the possibility that alterations in RNA-RNA-binding protein interactions may play a critical role in triggering and/or the pathogenesis of SLE

Beta1-Adrenoceptor Polymorphism Predicts Flecainide Action in Patients with Atrial Fibrillation

BACKGROUND: Antiarrhythmic action of flecainide is based on sodium channel blockade. Beta(1)-adrenoceptor (beta(1)AR) activation induces sodium channel inhibition, too. The aim of the present study was to evaluate the impact of different beta(1)AR genotypes on antiarrhythmic action of flecainide in patients with structural heart disease and atrial fibrillation. METHODOLOGY/PRINCIPAL FINDINGS: In 145 subjects, 87 with atrial fibrillation, genotyping was performed to identify the individual beta(1)AR Arg389Gly and Ser49Gly polymorphism. Resting heart rate during atrial fibrillation and success of flecainide-induced cardioversion were correlated with beta(1)AR genotype. The overall cardioversion rate with flecainide was 39%. The Arg389Arg genotype was associated with the highest cardioversion rate (55.5%; OR 3.30; 95% CI; 1.34-8.13; p = 0.003) compared to patients with Arg389Gly (29.5%; OR 0.44; 95% CI; 0.18-1.06; p = 0.066) and Gly389Gly (14%; OR 0.24; 95% CI 0.03-2.07; p = 0.17) variants. The single Ser49Gly polymorphism did not influence the conversion rate. In combination, patients with Arg389Gly-Ser49Gly genotype displayed the lowest conversion rate with 20.8% (OR 0.31; 95% CI; 0.10-0.93; p = 0.03). In patients with Arg389Arg variants the heart rate during atrial fibrillation was significantly higher (110+/-2.7 bpm; p = 0.03 vs. other variants) compared to Arg389Gly (104.8+/-2.4 bpm) and Gly389Gly (96.9+/-5.8 bpm) carriers. The Arg389Gly-Ser49Gly genotype was more common in patients with atrial fibrillation compared to patients without atrial fibrillation (27.6% vs. 5.2%; HR 6.98; 95% CI; 1.99-24.46; p<0.001). CONCLUSIONS: The beta(1)AR Arg389Arg genotype is associated with increased flecainide potency and higher heart rate during atrial fibrillation. The Arg389Gly-Ser49Gly genotype might be of predictive value for atrial fibrillation

Applications of lignin in the agri-food industry

Of late, valorization of agri-food industrial by-products and their sustainable utilization is gaining much contemplation world-over. Globally, 'Zero Waste Concept' is promoted with main emphasis laid towards generation of minimal wastes and maximal utilization of plantbased agri-food raw materials. One of the wastes/by-products in the agri-food industry are the lignin, which occurs as lignocellulosic biomass. This biomass is deliberated to be an environmental pollutant as they offer resistance to natural biodegradation. Safe disposal of this biomass is often considered a major challenge, especially in low-income countries. Hence, the application of modern technologies to effectively reduce these types of wastes and maximize their potential use/applications is vital in the present day scenario. Nevertheless, in some of the high-income countries, attempts have been made to efficiently utilize lignin as a source of fuel, as a raw material in the paper industry, as a filler material in biopolymer based packaging and for producing bioethanol. However, as of today, agri-food industrial applications remains significantly underexplored. Chemically, lignin is heterogeneous, bio-polymeric, polyphenolic compound, which is present naturally in plants, providing mechanical strength and rigidity. Reports are available wherein purified lignin is established to possess therapeutic values; and are rich in antioxidant, anti-microbial, anti-carcinogenic, antidiabetic properties, etc. This chapter is divided into four sub-categories focusing on various technological aspects related to isolation and characterization of lignin; established uses of lignin; proved bioactivities and therapeutic potentials of lignin, and finally on identifying the existing research gaps followed by future recommendations for potential use from agri-food industrial wastes.Theme of this chapter is based on our ongoing project- Valortech, which has received funding from the European Union’s Horizon 2020 research and innovation program under grant agreement No 810630

Nerves projecting from the intrinsic cardiac ganglia of the pulmonary veins modulate sinoatrial node pacemaker function

Rationale: Autonomic nerves from sinoatrial node (SAN) ganglia are known to regulate SAN function. However, it is unclear whether remote pulmonary vein ganglia (PVG) also modulate SAN pacemaker rhythm. Objective: To investigate whether in the mouse heart PVG modulate SAN function. Methods and Results: In hearts from 45 C57BL and 7 Connexin40+/GFP mice, we used tyrosine-hydroxylase (TH) and choline-acetyltransferase (ChAT) immunofluorescence labeling to characterize adrenergic and cholinergic elements, repectively, within the PVG and SAN. PVG project postganglionic nerves to the SAN. TH and ChAT stained nerves, enter the SAN as an extensive, dense mesh-like neural network. Neurons in PVG are biphenotypic, containing ChAT and TH positive neurons. In Langendorff-perfused hearts, we compared effects of electrical stimulation of PVG, posterior (PRCVG) and anterior right vena cava ganglia (ARCVG) using 200-2000 ms trains of pulses (300&#956;s, 0.2-0.6mA, 200Hz). Sympathetic and/or parasympathetic blockade was achieved using 0.5&#956;M propranolol and 1&#956;M atropine, respectively. Epicardial optical mapping of SAN activation was performed before, during and after ganglion stimulation. PVG stimulation increased the P-P interval by 36±9%; PRCVG stimulation increased the P-P interval by 42±11%. ARCVG stimulation produced no change. Propranolol perfusion increased the PVG stimulation effect to 43±13%. Atropine caused a 5±6% decrease. In optical mapping experiments of whole hearts and isolated atrial preparations, PVG stimulation shifted the origin of SAN discharges to varying locations. Conclusions: PVG contain cholinergic, adrenergic and biphenotipic neurons whose axons project across the right atrium to richly innervate the SAN region and contribute significantly to regulation of SAN function.Zarzoso Muñoz, M.; Rysevaite, K.; Milstein, ML.; Calvo Saiz, CJ.; Kean, AC.; Atienza Fernández, F.; Pauza, DH.... (2013). Nerves projecting from the intrinsic cardiac ganglia of the pulmonary veins modulate sinoatrial node pacemaker function. Cardiovascular Research. 566-575. doi:10.1093/cvr/cvt081S566575Johnson, T. A., Gray, A. L., Lauenstein, J.-M., Newton, S. S., & Massari, V. J. (2004). Parasympathetic control of the heart. I. An interventriculo-septal ganglion is the major source of the vagal intracardiac innervation of the ventricles. Journal of Applied Physiology, 96(6), 2265-2272. doi:10.1152/japplphysiol.00620.2003Rysevaite, K., Saburkina, I., Pauziene, N., Noujaim, S. F., Jalife, J., & Pauza, D. H. (2011). Morphologic pattern of the intrinsic ganglionated nerve plexus in mouse heart. Heart Rhythm, 8(3), 448-454. doi:10.1016/j.hrthm.2010.11.019Yuan, B.-X., Ardell, J. L., Hopkins, D. A., & Armour, J. A. (1993). Differential cardiac responses induced by nicotine sensitive canine atrial and ventricular neurones. Cardiovascular Research, 27(5), 760-769. doi:10.1093/cvr/27.5.760Rysevaite, K., Saburkina, I., Pauziene, N., Vaitkevicius, R., Noujaim, S. F., Jalife, J., & Pauza, D. H. (2011). Immunohistochemical characterization of the intrinsic cardiac neural plexus in whole-mount mouse heart preparations. Heart Rhythm, 8(5), 731-738. doi:10.1016/j.hrthm.2011.01.013Pauza, D. H., Pauziene, N., Pakeltyte, G., & Stropus, R. (2002). Comparative quantitative study of the intrinsic cardiac ganglia and neurons in the rat, guinea pig, dog and human as revealed by histochemical staining for acetylcholinesterase. Annals of Anatomy - Anatomischer Anzeiger, 184(2), 125-136. doi:10.1016/s0940-9602(02)80005-xPauza, D. H., Skripka, V., & Pauziene, N. (2002). Morphology of the Intrinsic Cardiac Nervous System in the Dog: A Whole-Mount Study Employing Histochemical Staining with Acetylcholinesterase. Cells Tissues Organs, 172(4), 297-320. doi:10.1159/000067198Arora, R. C., Waldmann, M., Hopkins, D. A., & Armour, J. A. (2003). Porcine intrinsic cardiac ganglia. The Anatomical Record, 271A(1), 249-258. doi:10.1002/ar.a.10030Gatti, P. J., Johnson, T. A., & John Massari, V. (1996). Can neurons in the nucleus ambiguus selectively regulate cardiac rate and atrio-ventricular conduction? Journal of the Autonomic Nervous System, 57(1-2), 123-127. doi:10.1016/0165-1838(95)00104-2Zhuang, S., Zhang, Y., Mowrey, K. A., Li, J., Tabata, T., Wallick, D. W., … Mazgalev, T. N. (2002). Ventricular Rate Control by Selective Vagal Stimulation Is Superior to Rhythm Regularization by Atrioventricular Nodal Ablation and Pacing During Atrial Fibrillation. Circulation, 106(14), 1853-1858. doi:10.1161/01.cir.0000031802.58532.04CHEN, J., WASMUND, S. L., & HAMDAN, M. H. (2006). Back to the Future: The Role of the Autonomic Nervous System in Atrial Fibrillation. Pacing and Clinical Electrophysiology, 29(4), 413-421. doi:10.1111/j.1540-8159.2006.00362.xArmour, J. A. (2008). Potential clinical relevance of the ‘little brain’ on the mammalian heart. Experimental Physiology, 93(2), 165-176. doi:10.1113/expphysiol.2007.041178LAZZARA, R., SCHERLAG, B. J., ROBINSON, M. J., & SAMET, P. (1973). Selective In Situ Parasympathetic Control of the Canine Sinoatrial and Atrioventricular Nodes. Circulation Research, 32(3), 393-401. doi:10.1161/01.res.32.3.393Gray, A. L., Johnson, T. A., Ardell, J. L., & Massari, V. J. (2004). Parasympathetic control of the heart. II. A novel interganglionic intrinsic cardiac circuit mediates neural control of heart rate. Journal of Applied Physiology, 96(6), 2273-2278. doi:10.1152/japplphysiol.00616.2003Pappone, C., Santinelli, V., Manguso, F., Vicedomini, G., Gugliotta, F., Augello, G., … Alfieri, O. (2004). Pulmonary Vein Denervation Enhances Long-Term Benefit After Circumferential Ablation for Paroxysmal Atrial Fibrillation. Circulation, 109(3), 327-334. doi:10.1161/01.cir.0000112641.16340.c7MIQUEROL, L., MEYSEN, S., MANGONI, M., BOIS, P., VANRIJEN, H., ABRAN, P., … GROS, D. (2004). Architectural and functional asymmetry of the His–Purkinje system of the murine heart. Cardiovascular Research, 63(1), 77-86. doi:10.1016/j.cardiores.2004.03.007Jalife, J., Slenter, V. A., Salata, J. J., & Michaels, D. C. (1983). Dynamic vagal control of pacemaker activity in the mammalian sinoatrial node. Circulation Research, 52(6), 642-656. doi:10.1161/01.res.52.6.642Fedorov, V. V., Hucker, W. J., Dobrzynski, H., Rosenshtraukh, L. V., & Efimov, I. R. (2006). Postganglionic nerve stimulation induces temporal inhibition of excitability in rabbit sinoatrial node. American Journal of Physiology-Heart and Circulatory Physiology, 291(2), H612-H623. doi:10.1152/ajpheart.00022.2006Saburkina, I., & Pauza, D. H. (2006). Location and variability of epicardiac ganglia in human fetuses. Anatomy and Embryology, 211(6), 585-594. doi:10.1007/s00429-006-0110-4Slavíková, J., Kuncová, J., Reischig, J., & Dvořáková, M. (2003). Neurochemical Research, 28(3/4), 593-598. doi:10.1023/a:1022837810357Tan, A. Y., Li, H., Wachsmann-Hogiu, S., Chen, L. S., Chen, P.-S., & Fishbein, M. C. (2006). Autonomic Innervation and Segmental Muscular Disconnections at the Human Pulmonary Vein-Atrial Junction. Journal of the American College of Cardiology, 48(1), 132-143. doi:10.1016/j.jacc.2006.02.054Vaitkevicius, R., Saburkina, I., Rysevaite, K., Vaitkeviciene, I., Pauziene, N., Zaliunas, R., … Pauza, D. H. (2009). Nerve Supply of the Human Pulmonary Veins: An Anatomical Study. Heart Rhythm, 6(2), 221-228. doi:10.1016/j.hrthm.2008.10.027Mabe, A. M., & Hoover, D. B. (2009). Structural and functional cardiac cholinergic deficits in adult neurturin knockout mice. Cardiovascular Research, 82(1), 93-99. doi:10.1093/cvr/cvp029Beau, S. L., Hand, D. E., Schuessler, R. B., Bromberg, B. I., Kwon, B., Boineau, J. P., & Saffitz, J. E. (1995). Relative Densities of Muscarinic Cholinergic and β-Adrenergic Receptors in the Canine Sinoatrial Node and Their Relation to Sites of Pacemaker Activity. Circulation Research, 77(5), 957-963. doi:10.1161/01.res.77.5.957Mangoni, M. E., & Nargeot, J. (2008). Genesis and Regulation of the Heart Automaticity. Physiological Reviews, 88(3), 919-982. doi:10.1152/physrev.00018.2007Brack, K. E., Coote, J. H., & Ng, G. A. (2003). Interaction between direct sympathetic and vagus nerve stimulation on heart rate in the isolated rabbit heart. Experimental Physiology, 89(1), 128-139. doi:10.1113/expphysiol.2003.002654Levy, M. N., & Zieske, H. (1969). Autonomic control of cardiac pacemaker activity and atrioventricular transmission. Journal of Applied Physiology, 27(4), 465-470. doi:10.1152/jappl.1969.27.4.465Hartzell, H. C. (1988). Regulation of cardiac ion channels by catecholamines, acetylcholine and second messenger systems. Progress in Biophysics and Molecular Biology, 52(3), 165-247. doi:10.1016/0079-6107(88)90014-4LEVY, M. N., YANG, T., & WALLICK, D. W. (1993). Assessment of Beat-by-Beat Control of Heart Rate by the Autonomic Nervous System: Molecular Biology Techniques Are Necessary, But Not Sufficient. Journal of Cardiovascular Electrophysiology, 4(2), 183-193. doi:10.1111/j.1540-8167.1993.tb01222.xLevy, M. N. (1971). Brief Reviews. Circulation Research, 29(5), 437-445. doi:10.1161/01.res.29.5.437Ng, G. A., Brack, K. E., & Coote, J. H. (2001). Effects of Direct Sympathetic and Vagus Nerve Stimulation on the Physiology of the Whole Heart - A Novel Model of Isolated Langendorff Perfused Rabbit Heart with Intact Dual Autonomic Innervation. Experimental Physiology, 86(3), 319-329. doi:10.1113/eph8602146Goldberg, J. (1975). Intra-SA-nodal pacemaker shifts induced by autonomic nerve stimulation in the dog. American Journal of Physiology-Legacy Content, 229(4), 1116-1123. doi:10.1152/ajplegacy.1975.229.4.1116Shibata, N., Inada, S., Mitsui, K., Honjo, H., Yamamoto, M., Niwa, R., … Kodama, I. (2001). Pacemaker Shift in the Rabbit Sinoatrial Node in Response to Vagal Nerve Stimulation. Experimental Physiology, 86(2), 177-184. doi:10.1113/eph8602100Glukhov, A. V., Fedorov, V. V., Anderson, M. E., Mohler, P. J., & Efimov, I. R. (2010). Functional anatomy of the murine sinus node: high-resolution optical mapping of ankyrin-B heterozygous mice. American Journal of Physiology-Heart and Circulatory Physiology, 299(2), H482-H491. doi:10.1152/ajpheart.00756.2009Michaels, D. C., Matyas, E. P., & Jalife, J. (1987). Mechanisms of sinoatrial pacemaker synchronization: a new hypothesis. Circulation Research, 61(5), 704-714. doi:10.1161/01.res.61.5.704Boyett, M. (2000). The sinoatrial node, a heterogeneous pacemaker structure. Cardiovascular Research, 47(4), 658-687. doi:10.1016/s0008-6363(00)00135-8Lemery, R., Birnie, D., Tang, A. S. L., Green, M., & Gollob, M. (2006). Feasibility study of endocardial mapping of ganglionated plexuses during catheter ablation of atrial fibrillation. Heart Rhythm, 3(4), 387-396. doi:10.1016/j.hrthm.2006.01.009Pokushalov, E., Romanov, A., Shugayev, P., Artyomenko, S., Shirokova, N., Turov, A., & Katritsis, D. G. (2009). Selective ganglionated plexi ablation for paroxysmal atrial fibrillation. Heart Rhythm, 6(9), 1257-1264. doi:10.1016/j.hrthm.2009.05.018Scherlag, B. J., Nakagawa, H., Jackman, W. M., Yamanashi, W. S., Patterson, E., Po, S., & Lazzara, R. (2005). Electrical Stimulation to Identify Neural Elements on the Heart: Their Role in Atrial Fibrillation. Journal of Interventional Cardiac Electrophysiology, 13(S1), 37-42. doi:10.1007/s10840-005-2492-2Puodziukynas, A., Kazakevicius, T., Vaitkevicius, R., Rysevaite, K., Jokubauskas, M., Saburkina, I., … Pauza, D. H. (2012). Radiofrequency catheter ablation of pulmonary vein roots results in axonal degeneration of distal epicardial nerves. Autonomic Neuroscience, 167(1-2), 61-65. doi:10.1016/j.autneu.2012.01.001Bauer, A., Deisenhofer, I., Schneider, R., Zrenner, B., Barthel, P., Karch, M., … Schmidt, G. (2006). Effects of circumferential or segmental pulmonary vein ablation for paroxysmal atrial fibrillation on cardiac autonomic function. Heart Rhythm, 3(12), 1428-1435. doi:10.1016/j.hrthm.2006.08.025Armour, J. A. (2010). Functional anatomy of intrathoracic neurons innervating the atria and ventricles. Heart Rhythm, 7(7), 994-996. doi:10.1016/j.hrthm.2010.02.01

Hormonal contraceptives and hormone replacement therapy as a possible factor of breast cancer

Background. Breast cancer is a disease with an increasing incidence, and it originates from several factors. Risk factors of this disease represent a diverse group of parameters, which also include hormonal influences. Objective. The aim of the present study was to determine if there is a relationship between hormonal contraceptives and hormone replacement therapy in patients with diagnosed most common types of breast cancer taking into account the age at which the disease was diagnosed in selected sonographic clinic in the district of Nitra, Slovak Republic. Material and Methods. As a part of an ongoing retrospective study from 2005, a cohort of 300 randomly selected patients aged 25-87 years with diagnosed breast cancer have been monitored in 2012. The age at which breast cancer was diagnosed, and relationship to hormone therapy were analysed based on medical documentation. Results. Among 300 randomly selected patients with a confirmed diagnosis of breast cancer the group at the age of 40-59 was the most numerous (mean age was 53.06±11.25 years). The mean age of 45 patients who were given hormonal contraceptives (HC) was 46.44±7.34 years, whereas the mean age of 82 patients who were subjected to hormone replacement therapy (HRT) was 53.63±6.67 years. In women who took hormonal treatment, breast cancer was diagnosed at the mean age of 50.60±7.56 years, while women who never took HRT or HC, were diagnosed around the age of 53.92±12.35 years. The most common types of cancer were the infiltrating ductal carcinoma and lobular carcinoma. From all patients, the relapse occurred among 14 of them, about 4.86 years later. Only 2 patients had breast cancer on both diagnosed breast. After a surgery, the cancer was observed in 7 patients. The positive family history was confirmed with 34 patients. Conclusions. Nowadays, the breast cancer treatment, especially at early stages, is successful, however, the malignant breast neoplasm remains the most common oncological disease causing the death amongst women. In the assessment of the impact of HC and HRT on breast cancer, it is not possible to provide a clear conclusion, because their influence on the tumour is difficult to verify.Wprowadzenie. Rak piersi jest chorobą, której występowanie uzależnione jest od wielu czynników. Czynniki te są zróżnicowane, a wśród nich wyróżnia się czynniki hormonalne. Cel. Na podstawie danych medycznych podjęto próbę oceny występowania zależności różnych typów raka piersi u kobiet a stosowaniem antykoncepcji hormonalnej oraz hormonalnej terapii zastępczej. Materiał i metody. Praca stanowi część trwającego od 2005 roku badania stanu zdrowia pacjentek w wieku 25-87 lat. Badaniami objęto kohortę 300 kobiet, u których w 2012 roku zdiagnozowano raka piersi. W badaniach przeprowadzonych na podstawie analizy dokumentacji medycznej oceniano zależność między wiekiem kobiety, w którym zdiagnozowano raka piersi a terapią hormonalną. Wyniki. W grupie 300 kobiet ze zdiagnozowanym rakiem piersi, najliczniejszy udział stanowiły kobiety w wieku 40-59 lat (średnia 53.06±11.25 lat). Wśród pacjentek wyróżniono 45 kobiet stosujące HC (HC – antykoncepcje hormonalną) ze średnim wiekiem 46.44±7.34 lat oraz 82 kobiety stosujące HRT (HRT – hormonalną terapię zastępczą) ze średnim wiekiem w tej grupie 53.63±6.67 lat. Wśród kobiet, które przyjmowały preparaty hormonalne średni wiek wykrycia raka piersi wynosił 50.60±7.56 lat, w porównaniu do kobiet nie stosujących żadnej terapii hormonalnej 53.92±12.35 lat. Wśród badanych kobiet najczęściej stwierdzany był naciekający nowotwór wewnątrzprzewodowy (ductal carcinoma) oraz wewnątrzzrazikowy (lobular carcinoma). U 2 pacjentek stwierdzono dwa rodzaje nowotworu. Wśród 14 pacjentek wykryto nawrót choroby, średni czas od powtórnego zdiagnozowania nowotworu wynosił 4.86 lat. Po operacji chirurgicznej nowotwór wykazano u 7 kobiet. W grupie 34 pacjentek stwierdzono występowanie nowotworu piersi w rodzinie. Wnioski. W obecnych czasach leczenie nowotworu piersi, szczególnie we wczesnych stadiach choroby przynosi satysfakcjonujące rezultaty. Jednak złośliwe postacie nowotworu nadal są przyczyną wysokiej śmiertelności wśród kobiet. W niniejszym badaniu nie udało się wskazać istotnej zależność pomiędzy występowaniem nowotworu piersi a stosowaniem HC i HRT wśród badanych kobiet

Understanding the dialysis access steal syndrome : A review of the etiologies, diagnosis, prevention and treatment strategies

Distal hypoperfusion ischemic syndrome (DHIS), commonly referred to as hand ischemia or 'steal' after dialysis access placement, occurs in 5-10% of cases when the brachial artery is used, or 10 times that of wrist arteriovenous fistulas (AVFs) using the radial artery. It is typically seen in elderly women with diabetes, and may carry severe morbidity including tissue or limb loss if not recognized and treated. Three distinct etiologies include (1) blood flow restriction to the hand from arterial occlusive disease either proximal or distal to the AV access anastomosis, (2) excess blood flow through the AV fistula conduit (true steal), and (3) lack of vascular (arterial) adaptation or collateral flow reserve (ie atherosclerosis) to the increased flow demand from the AV conduit. These three causes of steal may occur alone or in concert. The diagnosis of steal is based on an accurate history and physical examination and confirmed with tests including an arteriogram, duplex Doppler ultrasound (DDU) evaluation with finger pressures and waveform analysis. Treatment of steal includes observation of developing symptoms in mild cases. Balloon angioplasty is the appropriate intervention for an arterial stenosis. At least three distinct surgical corrective procedures exist to counteract the pathophysiology of steal. The ultimate treatment strategy depends on severity of symptoms, the extent of patient co-morbidity, and the local dialysis access technical team support and skills available