Analysis of Saliva Pepsin Level in Patients with Tracheoesophageal Fistula and Voice Prosthesis Complications

The aim of this crossectional study was to investigate the relationship between pepsin concentration in saliva and the occurrence of tracheoesophageal fistula (TEF) complications and voice prosthesis (VP) complications, after total laryngectomy and VP implantation. We assessed the concentrations of pepsin in the saliva of 41 laryngectomized patients and correlated it with the incidence of TEF complications (periprostethic leakage, atrophy, esophageal mucosa hypertrophy, granulations, fistula enlargement, and VP dislocation), VP complications (transprosthetic leakage, Candida infection) and voice quality. Pepsin levels were measured by enzyme-linked immunoadsorbent assay (ELISA). Voice quality was assessed by Harrison-Robilard – Schultz (HRS) scale. In all, 17 (42%) patients had complications. All of them had TEF complications, whereas VP complication, together with TEF was found in 9 (22%) patients. We found no significant correlation between adjuvant radiotherapy and TEF complications. Most of patients, 30 (73%), had positive pepsin level in saliva. Median value of pepsin concentration in all patients was 4.8 (range 81.7). Median pepsin concentration was higher in patients free of TEF or VP complications (6.6, range 81.7 vs. 3.2, range 19.3) but that difference was not statistically significant (Mann-Whitney test, Z –1.562, p=0.118). In addition, statistically insignificant negative correlation between pepsin levels and voice quality measured by HRS scale (Spearman’s rho, p>0.05). Although reflux was proposed as cause of TEF complications and pepsin has been proven as a most sensitive and specific marker of ekstraesophageal reflux, we did not find any statistically significant correlation between pepsin levels and occurrence of TEF or VP complications

Assessment of antinuclear antibodies (ANA): National recommendations on behalf of the Croatian society of medical biochemistry and laboratory medicine

Antinuclear antibodies (ANA) represent a family of autoantibodies targeting ubiquitous cellular constituents and are a hallmark of systemic inflammatory autoimmune rheumatic diseases named connective tissue diseases (CTD). The gold standard method for ANA determination is indirect immunofluorescence (IIF) on the human laryngeal epidermoid carcinoma cell line type 2 substrate (HEp-2), but with increasing demand for ANA testing, novel methods eased for automation emerged, which allows testing by staff less experienced in this specific field of laboratory diagnostic. In 2016 The working group (WG) for laboratory diagnostics of autoimmune diseases as part of the Committee for the Scientific Professional Development of the Croatian Society of Medical Biochemistry and Laboratory Medicine (CSMBLM) published the data of a survey regarding general practice in laboratory diagnostics of autoimmune diseases in Croatia. Results indicated high diversity in the performance of autoantibody testing as well as reporting of the results and indicated the need of creating recommendations for the assessment of ANA that would help harmonize diagnostics of systemic autoimmune rheumatic diseases in Croatia. This document encompasses twenty-seven recommendations for ANA testing created concerning indications for ANA testing, preanalytical, analytical, and postanalytical issues, including rational algorithm and quality control assurance. These recommendations are based on the relevant international recommendations and guidelines for the assessment of ANA testing and relevant literature search and should help to harmonize the approach in ANA testing and clarify differences in interpretation of the results obtained using different methods of determination

Antineutrophil Cytoplasmic Antibodies (ANCA): Diagnostic Utility and Potential Role in the Pathogenesis of Vasculitis

Antineutrophil cytoplasmic antibodies (ANCA) are a heterogeneous group of circulating antibodies directed toward the cytoplasmic constituents of neutrophils and monocytes. ANCA have been de scribed in various diseases including idiopathic systemic vasculitides, connective tissue diseases, inflammatory bowel diseases, autoimmune liver diseases, infectious diseases, and some drugs. ANCA recognize different target antigens such as proteinase 3 (PR3-ANCA), myeloperoxidase (MPO-ANCA), cathepsin G, lactoferrin, bactericidal/permeability-increasing protein (BPI), and some others. However, only PR3-ANCA and MPO-ANCA are closely associated with systemic vasculitides, in particular Wegener´s granulomatosis, microscopic polyangiitis and its renal limited manifestation, and Churg-Strauss syndrome. Both in vitro and in vivo experimental data strongly support a pathogenic role for ANCA in vasculitis and glomerulonephritis

Effect of adjunctive lidocainebased scalp block and laryngotracheal local anesthesia vs general anesthesia only on plasma and cerebrospinal fluid pro-inflammatory cytokine concentrations in patients with cerebral aneurysm: a randomized controlled trial

Aim To compare the effect of adjunctive lidocaine-based scalp block and laryngotracheal local anesthesia vs general anesthesia only on pro-inflammatory cytokine concentra - tions in patients with non-ruptured brain aneurysms under - going elective open surgery. Methods This parallel, randomized, controlled, open-label trial was conducted at Clinical Hospital Center Zagreb be - tween March 2019 and March 2020. At the beginning of an - esthesia, lidocaine group received 40 mg of 2% lidocaine for laryngotracheal topical anesthesia and 4 mg/kg for the scalp block. Control group underwent general anesthesia only. Plasma concentrations of IL-6, TNF-α, and IL-1β were mea - sured before anesthesia (S0); at the incision (S1); at the end of surgery (S2); 24 hours postoperatively (S3). Cerebrospinal fluid (CSF) cytokine concentrations were measured at the in - cision (L1) and the end of surgery (L2). Results Forty patients (each group, 20) were randomized; 37 were left in the final analysis. IL-6 plasma concentrations increased significantly compared with baseline at S3 in li - docaine group, and at S2 and S3 in control group. In both groups, changes in TNF-α and IL-1β were not significant. CSF cytokine concentrations in lidocaine group did not change significantly; in control group IL-6 and IL-1β were significantly higher at L2 than at L1. CSF IL-6 in control group significantly increased at L2, but TNF-α and IL-1β did not. No differences in clinical outcome and complication rates were observed. Conclusion Adjunctive lidocaine-based scalp block and lar - yngotracheal local anesthesia might attenuate CSF IL-6 con - centration increase in patients with brain aneurysm

Cytoprotective Effects of β-Melanocortin in the Rat Gastrointestinal Tract

Recently discovered anti-inflammatory and immunomodulatory properties of melanocortin peptides led to the conclusion that they might serve as new anti-inflammatory therapeutics. The purpose of this work was to examine the effectiveness of β-melanocortin (β-MSH) in two experimental models: ethanol-induced gastric lesions and TNBS (2, 4, 6-trinitrobenzenesulfonic acid)-induced colitis in male Wistar rats. Three progressive doses of β-MSH were used: 0.125, 0.250 and 0.500 mg/kg. Our results suggest that β-MSH acts as a protective substance in the gastric lesions model, which can be seen as a statistically significant reduction of hemorrhagic lesions at all three doses, compared to the control group. The most efficient dose was 0.250 mg/kg. Statistically significant reduction in mucosal surface affected by necrosis and the reduction of overall degree of inflammation in the colitis model indicates an anti-inflammatory effect of β-MSH at a dose of 0.250 mg/kg. The results justify further research on β-MSH peptide and its derivates in the inflammatory gastrointestinal diseases, and point out the possibility of using β-MSH in studies of digestive system pharmacology

Urinary brain-derived neurotrophic factor and nerve growth factor as noninvasive biomarkers of overactive bladder in children

IntroductionOveractive bladder (OAB) is the most common urinary disorder and the leading cause of functional daytime intermittent urinary incontinence in children. The aim of this study was to determine whether urinary brain-derived neurotrophic factor (BDNF) and nerve growth factor (NGF) concentrations, normalized to urine creatinine, could be used as biomarkers for diagnosis and treatment monitoring of OAB in children. Materials and methodsUrine samples of 48 pediatric patients with OAB were collected at the start of anticholinergic therapy (baseline), at follow-up visits (3 and 6 months), and from 48 healthy controls. Urinary BDNF and NGF concentrations were determined by ELISA method (Merck, Darmstadt, Germany) and Luminex method (Thermo Fisher Scientific, Waltham, USA). Differences of frequency between quantifiable analyte concentrations between subject groups were determined using Fisher’s exact test. ResultsThere was no statistically significant difference between quantifiable analyte concentrations between patients at baseline and the control group for BDNF and NGF by either the ELISA or Luminex method (P = 1.000, P = 0.170, P = 1.000, and P = N/A, respectively). There was a statistically significant difference between quantifiable BDNF by the ELISA method between patients at baseline and complete success follow-up (P = 0.027), while BDNF by Luminex method and NGF by both methods were not statistically significant (P = 0.078, P = 0.519, and P = N/A, respectively). ConclusionsThis study did not demonstrate that urinary BDNF and NGF concentrations, can be used as biomarkers for diagnosis and therapy monitoring of OAB in children

Analysis of Saliva Pepsin Level in Patients with Tracheoesophageal Fistula and Voice Prosthesis Complications

The aim of this crossectional study was to investigate the relationship between pepsin concentration in saliva and the occurrence of tracheoesophageal fistula (TEF) complications and voice prosthesis (VP) complications, after total laryngectomy and VP implantation. We assessed the concentrations of pepsin in the saliva of 41 laryngectomized patients and correlated it with the incidence of TEF complications (periprostethic leakage, atrophy, esophageal mucosa hypertrophy, granulations, fistula enlargement, and VP dislocation), VP complications (transprosthetic leakage, Candida infection) and voice quality. Pepsin levels were measured by enzyme-linked immunoadsorbent assay (ELISA). Voice quality was assessed by Harrison-Robilard – Schultz (HRS) scale. In all, 17 (42%) patients had complications. All of them had TEF complications, whereas VP complication, together with TEF was found in 9 (22%) patients. We found no significant correlation between adjuvant radiotherapy and TEF complications. Most of patients, 30 (73%), had positive pepsin level in saliva. Median value of pepsin concentration in all patients was 4.8 (range 81.7). Median pepsin concentration was higher in patients free of TEF or VP complications (6.6, range 81.7 vs. 3.2, range 19.3) but that difference was not statistically significant (Mann-Whitney test, Z –1.562, p=0.118). In addition, statistically insignificant negative correlation between pepsin levels and voice quality measured by HRS scale (Spearman’s rho, p>0.05). Although reflux was proposed as cause of TEF complications and pepsin has been proven as a most sensitive and specific marker of ekstraesophageal reflux, we did not find any statistically significant correlation between pepsin levels and occurrence of TEF or VP complications

Effect of local anesthesia with lidocaine on perioperative proinflammatory cytokine levels in plasma and cerebrospinal fluid in cerebral aneurysm patients

Cerebral aneurysm surgery has significant mortality and morbidity rate. Inflammation plays a key role in the pathogenesis of intracranial aneurysms, their rupture, subarachnoid hemorrhage and neurologic complications. Proinflammatory cytokine level in blood and cerebrospinal fluid (CSF) is an indicator of inflammatory response. Cytokines contribute to secondary brain injury and can worsen the outcome of the treatment. Lidocaine is local anesthetic that can be applied in neurosurgery as regional anesthesia of the scalp and as topical anesthesia of the throat before direct laryngoscopy and endotracheal intubation. Besides analgesic, lidocaine has systemic anti-inflammatory and neuroprotective effect.Primary aim of this trial is to determine the influence of local anesthesia with lidocaine on the perioperative levels of pro-inflammatory cytokines interleukin-1β, interleukin-6, and tumor necrosis factor-α in plasma and CSF in cerebral aneurysm patients. METHODS: We will conduct prospective randomized clinical trial among patients undergoing craniotomy and cerebral aneurysm clipping surgery in general anesthesia. Patients included in the trial will be randomly assigned to the lidocaine group (Group L) or to the control group (Group C). Patients in Group L, following general anesthesia induction, will receive topical anesthesia of the throat before endotracheal intubation and also regional anesthesia of the scalp before Mayfield frame placement, both done with lidocaine. Patients in Group C will have general anesthesia only without any lidocaine administration. The primary outcomes are concentrations of cytokines interleukin-1β, interleukin-6 and tumor necrosis factor-α in plasma and CSF, measured at specific timepoints perioperatively. Secondary outcome is incidence of major neurological and infectious complications, as well as treatment outcome in both groups. DISCUSSION: Results of the trial could provide insight into influence of lidocaine on local and systemic inflammatory response in cerebrovascular surgery, and might improve future anesthesia practice and treatment outcome