Ocena skuteczności klipsowania tętniaków wewnątrzczaszkowych w terminie odległym za pomocą angiografii tomografii komputerowej

Background and purpose The aim of this retrospective study was to assess the effectiveness of aneurysm clipping by computed tomography angiography (CTA) in a long-term follow-up. Material and methods The CTA examination was performed in 119 patients who had 143 aneurysms clipped. The examinations were performed 3 to 11 years (mean 6 years) after clipping using a GE Lightspeed PRO16 scanner. Results In all cases but one, good quality CTA images, suitable for evaluation of the arteries around the clip site, were obtained. Complete aneurysm closure without neck remnant or regrowth was confirmed in 137 (96%) aneurysms. In 4 (3%) cases, neck remnants were detected (2 on the anterior communicating artery [AComA] and 2 on the middle cerebral artery [MCA]). A total clip slippage from the aneurysm dome was revealed in 1 case. One case of aneurysm re-rupture was noted, 11 years after clipping. The rebleeding was caused by AComA aneurysm regrowth. Among these 6 patients with unsatisfactory clipping, 2 required further treatment and 4 remain under observation. Nineteen ‘de novo’ aneurysms in other locations were found in 14 (12%) patients. Summing up all of the pathological findings in the study group, there were 18 (15%) patients who needed further management including close surveillance or re-treatment. Conclusions Computed tomography angiography is a simple and reliable method of aneurysm clipping evaluation. The long-term follow-up CTA confirmed the permanent and complete obliteration of 96% of the aneurysms. The rate of unsatisfactory aneurysm closure was 4%, but only 1.4% needed re-treatment during a mean follow-up of 6 years. The annual risk of aneurysm re-rupture was 0.1%.Wstęp i cel pracy Celem niniejszej retrospektywnej pracy była ocena skuteczności klipsowania tętniaków wewnątrzczaszkowych w odległym terminie po operacji za pomocą angiografii tomografii komputerowej (angio-TK). Materiał i metody Angio-TK wykonano u 119 pacjentów ze 143 zaklipsowanymi tętniakami. Badania przeprowadzano w ciągu 3–11 lat od operacji (średnio 6 lat) aparatem CT GE Lightspeed PRO16. Wyniki U wszystkich pacjentów, poza jednym, uzyskano obrazy pozwalające na wiarygodną ocenę naczyń w pobliżu założonego klipsa. Spośród 143 zaklipsowanych tętniaków, w 137 (96%) przypadkach stwierdzono prawidłowe zamknięcie, bez cech odtwarzania się ani pozostałości tętniaka. Pozostałość szyi klipsowanego tętniaka (2 na tętnicy łączącej przedniej i 2 na tętnicy mózgu środkowej) stwierdzono w 4 przypadkach. W jednym przypadku uwidoczniono całkowite zsunięcie się klipsa z tętniaka tętnicy łączącej przedniej. W okresie objętym analizą zanotowano jeden przypadek nawrotowego krwotoku podpajęczynówkowego po 11 latach od operacji. Powodem był odrost tętniaka tętnicy łączącej przedniej. Spośród 6 chorych z niezadowalającym zaklipsowaniem, 2 wymagało dalszego leczenia, a 4 – obserwacji. U 14 (12%) pacjentów wykryto 19 tętniaków de novo w innych lokalizacjach, z których 18 nie wymagało leczenia. Biorąc pod uwagę wszystkie nieprawidłowości naczyniowe w badanej grupie, 18 (15%) pacjentów wymagało dalszej obserwacji lub leczenia. Wnioski W ocenie autorów angio-TK jest wygodnym i wiarygodnym sposobem kontroli po operacjach zaklipsowania tętniaka. Odległe badania angio-TK wykazały, że klipsowanie całkowicie i trwale wyłącza z krążenia 96% tętniaków. Odsetek niezadowalającego zaklipsowania wyniósł 4%, ale tylko 1,4% pacjentów wymagało dalszego leczenia w okresie obserwacji wynoszącym średnio 6 lat. Ryzyko ponownego krwotoku z zaklipsowanego tętniaka wyniosło 0,1% na rok

Forecast and impact of electromobility development on the Polish Electric Power System

Thanks to the development of technology, the presence of electric vehicles (EVs) on the roads is no longer a purely theoretical issue. Also in Poland, electric cars are already visible on the streets, and charging stations (EVCS) are increasingly being installed near newly emerging buildings and housing estates. The article attempts to determine to what extent the use of electric cars will affect the demand for power and energy in the Polish electric power system (PEPS). The basis for PEPS modernization plans should be a detailed analysis of the technical adequacy of all its subsystems: generation, transmission and distribution, on the basis of which it will be possible to assess the potential impact of EVCS infrastructure operation on the Polish electric power system. This publication presents an example of such analysis for the distribution sub- sector, most exposed to potential negative interactions with the future, extensive infrastructure of EVCS

Heart rate control and its predictors in patients with heart failure and sinus rhythm. Data from the European Society of Cardiology Long-Term Registry

Background: Higher resting heart rate (HR) in patients with heart failure (HF) and sinus rhythm (SR) is associated with increased mortality. In patients hospitalized for HF, the aim herein, was to assess the use and dosage of guideline-recommended HR lowering medications, HR control at discharge and predictors of HR control. Methods: In the present study, were Polish participants of the European Society of Cardiology HF Long-Term (ESC-HF-LT) Registry. Those selected were hospitalized for HF,  with reduced ejection fraction (HFrEF) and SR at discharge (n = 236). The patients were divided in two groups ( < 70 and ≥ 70 bpm). Logistic regression was used to identify the predictors of HR ≥ 70 bpm. Results: Of patients with HFrEF and SR, 59% had HR ≥ 70 bpm at hospital discharge. At discharge, 96% and only 0.5% of the patients with HFrEF and SR received beta-blocker and ivabradine, respectively. In the HF groups < 70 and ≥ 70 bpm, only 11% and 4% of patients received beta-blocker target doses, respectively. There was no difference in the use of other guideline-recommended medications. Age, New York Heart Association class, HR on admission and lack of HR lowering medications were predictors of discharge HR ≥ 70 bpm. Conclusions: Heart rate control after hospitalization for HFrEF is unsatisfactory, which may be attributed to suboptimal doses of beta-blockers, and negligence in use other HR lowering drugs (including ivabradine)

Maize (Zea mays) reaction in response to rubber rag additive into the soil

The amount of used and worn out tires around the world reaches about 10 million tons. Rubber introduction to the environment in this shape is connected with its pollution, caused by tires’ chemical composition, which, apart from synthetic and natural rubber, contain soot as a filler, plasticizers having some amounts of polycyclic aromatic hydrocarbons and helping substances: activators, accelerator of vulcanization, cross-link means and homogenizers. The most important activator is zinc oxide. The aim of the conducted studies was to determine the influence of rubber rag added to the subsoil on the amount of yield, physiological state and the amount of taken zinc by maize (Zea mays). It was found that the rubber rag introduced into the soil caused an increase in the yield of maize and the plants growing on the soil with the highest amount of rubber rag showing higher efficiency photosynthetic apparatus than others. The zinc content in the aboveground parts of maize increased with the increase of rubber rag in the soil

Forecast and impact of electromobility development on the Polish Electric Power System

Thanks to the development of technology, the presence of electric vehicles (EVs) on the roads is no longer a purely theoretical issue. Also in Poland, electric cars are already visible on the streets, and charging stations (EVCS) are increasingly being installed near newly emerging buildings and housing estates. The article attempts to determine to what extent the use of electric cars will affect the demand for power and energy in the Polish electric power system (PEPS). The basis for PEPS modernization plans should be a detailed analysis of the technical adequacy of all its subsystems: generation, transmission and distribution, on the basis of which it will be possible to assess the potential impact of EVCS infrastructure operation on the Polish electric power system. This publication presents an example of such analysis for the distribution sub- sector, most exposed to potential negative interactions with the future, extensive infrastructure of EVCS

Intraspinal Transplantation of the Adipose Tissue-Derived Regenerative Cells in Amyotrophic Lateral Sclerosis in Accordance with the Current Experts’ Recommendations: Choosing Optimal Monitoring Tools

Stem cells (SCs) may constitute a perspective alternative to pharmacological treatment in neurodegenerative diseases. Although the safety of SC transplantation has been widely shown, their clinical efficiency in amyotrophic lateral sclerosis (ALS) is still to be proved. It is not only due to a limited number of studies, small treatment groups, and fast but nonlinear disease progression but also due to lack of objective methods able to show subtle clinical changes. Preliminary guidelines for cell therapy have recently been proposed by a group of ALS experts. They combine clinical, neurophysiological, and functional assessment together with monitoring of the cytokine level. Here, we describe a pilot study on transplantation of autologous adipose-derived regenerative cells (ADRC) into the spinal cord of the patients with ALS and monitoring of the results in accordance with the current recommendations. To show early and/or subtle changes within the muscles of interest, a wide range of clinical and functional tests were used and compared in order to choose the most sensitive and optimal set. Additionally, an analysis of transplanted ADRC was provided to develop standards ensuring the derivation and verification of adequate quality of transplanted cells and to correlate ADRC properties with clinical outcome

Epigenetics of Epileptogenesis-Evoked Upregulation of Matrix Metalloproteinase-9 in Hippocampus

<div><p>Enhanced levels of Matrix Metalloproteinase-9 (MMP-9) have been implicated in the pathogenesis of epilepsy in humans and rodents. Lack of Mmp-9 impoverishes, whereas excess of Mmp-9 facilitates epileptogenesis. Epigenetic mechanisms driving the epileptogenesis-related upregulation of MMP-9 expression are virtually unknown. The aim of this study was to reveal these mechanisms. We analyzed hippocampi extracted from adult and pediatric patients with temporal lobe epilepsy as well as from partially and fully pentylenetetrazole kindled rats. We used a unique approach to the analysis of the kindling model results (inclusion in the analysis of rats being during kindling, and not only a group of fully kindled animals), which allowed us to separate the molecular effects exerted by the epileptogenesis from those related to epilepsy and epileptic activity. Consequently, it allowed for a disclosure of molecular mechanisms underlying causes, and not consequences, of epilepsy. Our data show that the epileptogenesis-evoked upregulation of Mmp-9 expression is regulated by removal from Mmp-9 gene proximal promoter of the two, interweaved potent silencing mechanisms–DNA methylation and Polycomb Repressive Complex 2 (PRC2)-related repression. Demethylation depends on a gradual dissociation of the DNA methyltransferases, Dnmt3a and Dnmt3b, and on progressive association of the DNA demethylation promoting protein Gadd45β to Mmp-9 proximal gene promoter <i>in vivo</i>. The PRC2-related mechanism relies on dissociation of the repressive transcription factor YY1 and the dissipation of the PRC2-evoked trimethylation on Lys27 of the histone H3 from the proximal <i>Mmp-9</i> promoter chromatin <i>in vivo</i>. Moreover, we show that the DNA hydroxymethylation, a new epigenetic DNA modification, which is localized predominantly in the gene promoters and is particularly abundant in the brain, is not involved in a regulation of MMP-9 expression during the epileptogenesis in the rat hippocampus as well as in the hippocampi of pediatric and adult epileptic patients. Additionally, we have also found that despite of its transient nature, the histone modification H3S10ph is strongly and gradually accumulated during epileptogenesis in the cell nuclei and in the proximal Mmp-9 gene promoter in the hippocampus, which suggests that H3S10ph can be involved in DNA demethylation in mammals, and not only in <i>Neurospora</i>. The study identifies <i>MMP-9</i> as the first protein coding gene which expression is regulated by DNA methylation in human epilepsy. We present a detailed epigenetic model of the epileptogenesis-evoked upregulation of <i>MMP-9</i> expression in the hippocampus. To our knowledge, it is the most complex and most detailed mechanism of epigenetic regulation of gene expression ever revealed for a particular gene in epileptogenesis. Our results also suggest for the first time that dysregulation of DNA methylation found in epilepsy is a cause rather than a consequence of this condition.</p></div

Model of the epileptogenesis-evoked upregulation of Mmp-9 expression in the hippocampus.

<p><b>(A)</b> In the control rat hippocampus, Mmp-9 proximal promoter is bound by YY1, which nucleates the DNA methyltransferases, Dnmt3a and Dnmt3b, as well as PRC2, leading to the strong promoter DNA methylation and simultaneous trimethylation on lysine 27 of histone H3 in the surrounding chromatin. (<b>B)</b> In partially kindled rat hippocampus, YY1 dissociates out of the gene promoter, leading to a partial removal from the chromatin region other silencing proteins Dnmt3a, Dnmt3b, and PRC2. Concomitantly, DNA-demethylation-related protein Gadd45β and the activating histone mark H3S10ph start to accumulate in the chromatin. Consequently, it induces partial demethylation of the Mmp-9 gene promoter and leads to a reduction in its chromatin of the repressive chromatin mark H3K27me3. These complex molecular events lead to a moderate stimulation of the Mmp-9 gene expression. <b>(C)</b> In the fully kindled rat hippocampus, Mmp-9 expression is highly upregulated as a consequence of a much more profound proximal promoter demethylation (due to a complete dissociation from its chromatin of Dnmt3a and Dnmt3b as well as a strongly increased accumulation of Gadd45β), disappearance of the PRC2-related repression with a complete removal of H3K27me3, and a significant increase in the abundance of H3S10ph in the chromatin region.</p

Mmp-9 upregulation during epilepsy development is strictly dependent on epileptogenesis-evoked demethylation of its gene promoter.

<p>To block epilepsy development, we used dizocilpine (the NMDA receptor antagonist displaying anticonvulsant activity). 0.1 mg/kg of dizocilpine or saline was intraperitoneally injected to rats 30 min before each PTZ dose administration (30 mg/kg). (<b>A) <i>Dizocilpine treatment effectively suppresses the development of PTZ-evoked epilepsy in rats</i></b>. Animals were observed up to 2 h after each PTZ injection and seizures were scored according to a modified Racine’s scale. Values are means ± SEM (*, <i>p</i><0.05; <i>n</i> = 11). (<b>B) <i>PTZ kindling-evoked upregulation of the Mmp-9 mRNA expression is fully inhibited by dizocilpine administration in the rat hippocampus</i>.</b> Dizocilpine administration suppresses the PTZ kindling–evoked augmentation in the hippocampal Mmp-9 mRNA expression, whereas repeated PTZ treatment without dizocilpine injections leads to significant upregulation of Mmp-9 mRNA level. For RT-qPCR analysis equal amounts of RNA isolated from naive (control), PTZ-treated (saline + PTZ), and dizocilpine-treated (dizocilpine + PTZ) rat hippocampi were used. Data is presented as fold change in mRNA expression. Values are means ± SEM (*, <i>p</i><0.05; ***, <i>p</i><0.001; <i>n</i> = 8). <b>(C) <i>Dizocilpine treatment completely inhibits the PTZ kindling-dependent Mmp-9 proximal promoter demethylation in the rat hippocampus</i></b>. <i>Mmp-9</i> proximal promoter methylation level was evaluated using qPCR in DNA samples obtained by immunoprecipitation of methylated DNA from naive (control), PTZ-treated (saline+PTZ), and dizocilpine-treated (dizocilpine+PTZ) rat hippocampi. Data is presented as a percent of input. Values are means ± SEM (*, <i>p</i><0.05; <i>n</i> = 5).</p