Zespół sercowo-nerkowy — definicja, patomechanizmy, problemy kliniczne

Termin „zespół sercowo-nerkowy” (CRS) używany jest, aby podkreślić współwystępowanie zaburzeń funkcji serca i nerek oraz oddziaływanie patologii jednego organu na drugi. W 2010 roku grupa ekspertów zaproponowała wyodrębnienie 5 podtypów CRS w zależności od tego, który narząd pierwotnie objęty jest patologią oraz czy ma ona charakter ostry czy przewlekły. Patofizjologia powstawania CRS jest złożona, a liczne mechanizmy są ze sobą ściśle powiązane. Prowadzenie pacjenta z rozwiniętym CRS pozostaje wyzwaniem dla klinicysty. W chwili obecnej nie ma ściśle określonych wytycznych, jak należy postępować w codziennej praktyce. Jednocześnie pacjenci z upośledzoną funkcją nerek, ze względów bezpieczeństwa, wykluczani są z większości dużych badań klinicznych. Biorąc pod uwagę trudności z prawidłowym dawkowaniem diuretyków u chorych z niewydolnością serca, trzeba zadać pytanie, jakimi narzędziami należy posługiwać się, aby unikać nadmiernego odwodnienia chorego oraz monitorować postępy leczenia? W przyszłości przydatnymi parametrami mogą okazać się wczesne markery ostrego uszkodzenia nerek (AKI), między innymi lipokalina neutrofilowa związana z żelatynazą (NGAL), cząsteczka 1 uszkodzenia nerek (KIM-1) czy cystatyna C (CysC). Substancje te mogą pełnić funkcję ostrzegawczą dla klinicysty. W przypadku nadmiernego odwodnienia pacjenta umożliwi to szybszą modyfikację terapii, co pozwoli zapobiec rozwinięciu się pełnoobjawowego CRS. Zwykle pojawienie się NGAL w surowicy wyprzedza podwyższenie stężenia kreatyniny średnio o 48–72 godzin, co pozwala na wczesną identyfikację czynnika uszkadzającego oraz jego eliminację. Pomiar stężenia wczesnych biomarkerów AKI, choć nie zastąpi pomiaru stężenia kreatyniny, może być użyteczny we wczesnej diagnostyce i leczeniu rozwijającego się CRS

Slow breathing improves cardiovascular reactivity to mental stress and health-related quality of life in heart failure patients with reduced ejection fraction

Background: Previous studies have demonstrated therapeutic benefits of slow breathing (SLOWB) in chronic heart failure (HF) but its impact on cardiovascular reactivity in response to laboratory stressors remains unknown.Methods: Using device-guided breathing this study explored the acute and long-term effects of SLOWB on hemodynamic responses to handgrip, mental and cold pressor tests, and health-related quality of life (QoL) in stable HF patients with reduced ejection fraction (HFrEF) who had received all available optimal drug and device therapies. Blood pressure (BP) and heart rate (HR) were measured in 21 patients with HFrEF (23.9 ± 5.9%) at rest, during laboratory stressors, before and after acute SLOWB, and 12 weeks after SLOWB home training (30 min daily). Health-related QoL (MacNew questionaries) was assessed before and 12 weeks after SLOWB home training.Results: Resting BP significantly increased in response to three laboratory stressors. Pressor and cardiac changes during mental stress were greater than responses to the handgrip test (p < 0.05). Mental stress also produced a greater HR change than cold pressor test (p < 0.05). Both acute and long-term SLOWB significantly reduced BP and HR responses to mental stress (p < 0.05), but not to isometric and cold pressor tests. SLOWB improved scores of all domains of QoL (p < 0.05) at 12 weeks follow-up.Conclusions: These findings demonstrate that SLOWB reduces acute and chronic effects of cardiovascular reactivity to mental stress and improves various aspects of health-related QoL in patients with severe HFrEF. Whether stress reduction and psychological changes achieved with SLOWB may translate to improved outcomes in HFrEF warrants further exploration

Helminths associated with terrestrial slugs in some parts of Europe

A survey of helminths associated with terrestrial slugs focusing on the invasive Arion vulgaris and the native A. ater was conducted on populations from France, Germany, Netherlands, Norway and Poland. In total, 648 terrestrial slugs were collected from 18 sample sites, and identified by means of morphological examination, dissection of genitalia and molecular analysis using mitochondrial DNA. In addition to A. vulgaris and A. ater, also A. vulgaris/A. rufus hybrids and A. ater/A. rufus hybrids were collected. Helminth species were identified based on morphological features and sequencing of the 18S and ITS rDNA regions. The parasites included four nematode species: Alloionema appendiculatum, Angiostoma sp., Phasmarhabditis hermaphrodita, Entomelas sp., two trematode species: Brachylaima mesostoma, Eurytrema sp., and one cestode (tapeworm) species: Skrjabinia sp. Alloionema appendiculatum was the most common helminth in the investigated slug populations. Furthermore, we found higher prevalence of trematodes in the invasive A. vulgaris compared with the native A. ater, while differences in the prevalence for nematodes were not as clear.publishedVersio

The theme of adventure in “Perceval, the Story of the Grail” and “ Erec and Enide” of Chrétien de Troyes

Celem niniejszej pracy magisterskiej jest analiza motywu przygody, obecnego w literaturze średniowiecznej, zawartego w dwóch powieściach arturiańskich Chrétiena de Troyes: „Percewalu z Walii czyli opowieści o Graalu” i „Ereku i Enidzie”. Praca składa się z trzech rozdziałów, wstępu oraz konkluzji. Pierwszy rozdział pracy, „Przygoda i poszukiwanie”, przedstawia pogłębioną analizę pojęć: „przygoda” i „poszukiwanie”. Drugi rozdział, „Przygoda i ewolucja bohaterów”, skupia się na dwóch rycerzach króla Artura, czyli Percewalu i Ereku i ukazuje ich metamorfozę w odniesieniu do przeżytych przygód. Ostatni rozdział pracy, „Współdzielona podróż- rola kobiet”, jest poświęcony kobietom Percewala i Ereka : Blanchefleur oraz Enidzie i koncentruje się na znaczeniu dam w życiu rycerzy.The purpose of the thesis is to analyse the theme of adventure present in Medieval literature, especially included in two Arthurian romances: "Perceval, the Story of the Grail" and" Erec and Enide" of Chrétien de Troyes. The thesis consists of three chapters preceded by an introduction and followed by a conclusion. The first chapter, “The adventure and the quest”, contains a deepened analysis of the notions of the adventure and the quest. The second chapter, “The adventure and the evolution of protagonists”, focuses on the figures of two knights of King Arthur : Perceval and Erec, and presents a metamorphosis of these characters during their adventures. The last chapter, “Shared adventure - the role of women” is dedicated to the women in Perceval and Erec’s lives :Blanchefleur and Enide, and is concentrated on the importance of these ladies in the life of these knights.Le but du présent mémoire de maîtrise est d’analyser le motif de l’aventure, présent dans la littérature du Moyen Âge, inscrit dans deux romans arthuriens de Chrétien de Troyes : « Perceval ou le Conte du Graal » et « Erec et Enide». Le travail se compose de trois chapitres précédés par l’introduction et suivis de la conclusion. Le premier chapitre, « L’aventure et la quête », propose une analyse approfondie des notions de l'aventure et de la quête. Le deuxième chapitre, « L’aventure et l’évolution des protagonistes », est centré autour des personnages de deux chevaliers du roi Arthur : Perceval et Erec et présente la métamorphose de ces héros à l’aune de leurs aventures. Le dernier chapitre, « L’aventure partagée – le rôle des femmes », est dédié aux femmes de Perceval et d'Erec, à savoir Blanchefleur et Enide et se focalise sur l’importance de ces dames dans la vie des chevaliers

A comprehensive phylogeographic study of Arion vulgaris Moquin-Tandon, 1855 (Gastropoda: Pulmonata: Arionidae) in Europe

Arion vulgaris Moquin-Tandon, 1855 is regarded as one of the 100 most invasive species in Europe. The native distribution range of this species is uncertain, but for many years, the Iberian Peninsula has been considered as the area of origin. However, recent studies indicate that A. vulgaris probably originated from France. We have investigated the genetic structure of 33 European populations (Poland, Norway, Germany, France, Denmark, Switzerland) of this slug, based on two molecular markers, mitochondrial cytochrome c oxidase subunit I (COI, mtDNA) and nuclear zinc finger (ZF, nDNA). Our investigation included published data from two previous studies, giving a total of 95 populations of A. vulgaris from 26 countries. This comprehensive dataset shows comparable haplotype diversity in Central, North and Western Europe, and significantly lower haplotype diversity in the East. All haplotypes observed in the East can be found in the other regions, and haplotype diversity is highest in the Central and Western region. Moreover, there is strong isolation by distance in Central and Western Europe, and only very little in the East. Furthermore, the number of unique haplotypes was highest in France. This pattern strongly suggests that A. vulgaris has originated from a region spanning from France to Western Germany; hence, the slug is probably alien/invasive in other parts of Europe, where it occurs. Our results indicate the necessity to cover as much of the distribution range of a species as possible before making conclusive assumptions about its origin and alien status.publishedVersio

Helminths associated with terrestrial slugs in some parts of Europe

A survey of helminths associated with terrestrial slugs focusing on the invasive Arion vulgaris and the native A. ater was conducted on populations from France, Germany, Netherlands, Norway and Poland. In total, 648 terrestrial slugs were collected from 18 sample sites, and identified by means of morphological examination, dissection of genitalia and molecular analysis using mitochondrial DNA. In addition to A. vulgaris and A. ater, also A. vulgaris/A. rufus hybrids and A. ater/A. rufus hybrids were collected. Helminth species were identified based on morphological features and sequencing of the 18S and ITS rDNA regions. The parasites included four nematode species: Alloionema appendiculatum, Angiostoma sp., Phasmarhabditis hermaphrodita, Entomelas sp., two trematode species: Brachylaima mesostoma, Eurytrema sp., and one cestode (tapeworm) species: Skrjabinia sp. Alloionema appendiculatum was the most common helminth in the investigated slug populations. Furthermore, we found higher prevalence of trematodes in the invasive A. vulgaris compared with the native A. ater, while differences in the prevalence for nematodes were not as clear

Potamopyrgus antipodarum (Gray, 1843) dans les eaux polonaises : son haplotype mitochondrial et son rôle d'hôte intermédiaire pour les trématodes

The New Zealand mud snail (Potamopyrgus antipodarum (Gray, 1843)) is on the list of one hundred worst invasive species. Researchers point out that genetic variation between populations of P. antipodarum manifested in differences in life-history traits. The main objective of our investigation was to gain pioneer knowledge about mitochondrial haplotypes of P. antipodarum in Polish waters on the background of these haplotypes recorded in the world and confirmation of the main role of P. antipodarum in the life cycle of digenean trematodes. We examined 1000 individuals of P. antipodarum from five water bodies in three different parts of Poland for the presence of larval stages of digenean trematodes. For several randomly selected individuals we carried out DNA sequencing of the 16S ribosomal RNA gene as marker of this non-indigenous mollusk. Only one 16S rRNA haplotype of P. antipodarum was recorded in Polish waters, defined in this study as haplotype 1 which turned out to be the most widespread in Europe. Potamopyrgus antipodarum is a source of trematode metacercariae belonging mainly to the family Echinostomatidae. As a result, we can demonstrate that it plays a role as the second intermediate host of digenean trematodes in European waters

The genus

Bird schistosomes are commonly established as the causative agent of swimmer's itch − a hyper-sensitive skin reaction to the penetration of their infective larvae. The aim of the present study was to investigate the prevalence of the genus Bilharziella in comparison to other bird schistosome species from Lake Drawsko − one of the largest recreational lakes in Poland, struggling with the huge problem of swimmer's itch. In total, 317 specimens of pulmonate snails were collected and examined. The overall digenean infection was 35.33%. The highest bird schistosome prevalence was observed for Bilharziella sp. (4.63%) in Planorbarius corneus, followed by Trichobilharzia szidati (3.23%) in Lymnaea stagnalis and Trichobilharzia sp. (1.3%) in Stagnicola palustris. The location of Bilharziella sp. on the presented phylogeny showed that it is with high probability a different species than known so far B. polonica. Our finding complements the confirmed occurrence of bird schistosomes in European water bodies. Overall, presented research reveals the special importance of P. corneus as a source of the bird schistosome cercariae. This study suggests that the health threat connected with the blood flukes need to be further investigated by constant monitoring of their occurrence in intermediate hosts