Cilazapril increases plasma ghrelin concentration in obese patients with arterial hypertension

Wstęp: Grelina jest hormonem polipeptydowym wydzielanym głównie przez komórki ściany żołądka. W warunkach fizjologicznych grelina zwiększa łaknienie i wydzielanie hormonu wzrostu. U osób otyłych stwierdzono obniżone stężenie greliny w osoczu. W badaniach doświadczalnych i klinicznych wykazano, że grelina przyczynia się do obniżenia ciśnienia tętniczego. Jak dotąd nie przeprowadzono jednak badań nad wpływem leków przeciwnadciśnieniowych na grelinemię. Materiał i metody: U 52 otyłych chorych z nadciśnieniem tętniczym (HA + O), 14 otyłych chorych z prawidłowym ciśnieniem tętniczym (O) i 15 osób zdrowych z prawidłową masą ciała oznaczono stężenie greliny w osoczu na czczo, jak również po podaniu standardowego posiłku. Następnie chorzy HA + O zostali w sposób losowy przydzieleni do jednej z czterech grup leczonych przez 6 tygodni odpowiednio: cilazaprilem, bisoprololem, amlodipiną lub indapamidem. Po tym okresie leczenia powtórzono oznaczenia grelinemii. Wyniki: Nie stwierdzono różnic grelinemii zarówno na czczo [HA + O - 780 (676-960) pg/ml; O - 751 (619-899) pg/ml], jak i po podaniu standardowego posiłku pomiędzy HA + O i O. Stężenie greliny w osoczu było znamiennie wyższe u osób zdrowych z prawidłową masą ciała (987 [765-1366] pg/ml) w porównaniu z O oraz HA + O. U HA + O leczenie cilazaprilem spowodowało wzrost o 28,0% (p = 0,04), a leczenie bisoprololem zmniejszenie grelinemii o 18,9% (p = 0,01). Podawanie amlodipiny lub indapamidu nie wpływało istotnie na stężenie greliny w osoczu. Nie stwierdzono występowania korelacji pomiędzy ciśnieniem tętniczym a grelinemią lub zmianami grelinemii po 6 tygodniach leczenia. Wnioski: 1. Uzyskane wyniki nie potwierdzają istotnej roli greliny w regulacji ciśnienia tętniczego u osób otyłych. 2. Leczenie cilazaprilem przyczynia się do wzrostu grelinemii. (Endokrynol Pol 2010; 61 (1): 21-27)Introduction: Ghrelin is a polypeptide hormone secreted mainly by the stomach cells, stimulating food intake and growth hormone release. Decreased plasma ghrelin concentration was found in obese subjects. Clinical and experimental data suggest that ghrelin also exerts a blood pressure lowering property. The influence of antihypertensive medication on plasma ghrelin concentration has not been studied, yet. Material and methods: Plasma ghrelin concentration was estimated in 52 hypertensive obese (HA + O), 14 normotensive obese (O), and 15 lean healthy subjects in the fasting state, and after ingestion of a standard meal. HA + O patients were randomly allocated into 4 groups treated alternatively with: cilazapril, bisoprolol, amlodipine, or indapamide. After 6 weeks of antihypertensive monotherapy, the assessments were repeated. Results: Similar fasting [HA + O - 780 (676-960) pg/ml; O - 751 (619-899) pg/ml] and postprandial plasma ghrelin concentrations were found in hypertensive and normotensive obese subjects. Plasma ghrelin concentrations in lean healthy subjects were significantly higher (987 (765-1366) pg/ml) in comparison to O and HA + O. Treatment with cilazapril was followed by a 28.0% increase of plasma ghrelin concentration (p = 0.04), while with bisoprolol, a 18.9% decrease (p = 0.01). No significant changes of ghrelinaemia were observed in HA + O treated with amlodipine or indapamide. No significant correlation between blood pressure and plasma ghrelin concentration before the therapy and their changes after 6 weeks of medication were found. Conclusions: 1. Our data do not support the major role of ghrelin in blood pressure regulation in obesity. 2. An increase of plasma ghrelin concentration after treatment with cilazapril was observed. (Pol J Endocrinol 2010; 61 (1): 21-27

Report from the research: "The factory of culture – paid and voluntary work at cultural festivals"

The research material is based on in-depth, partially structured interviews. However, the scope of topics was very wide and conversations mostly referred to: problems that the employees encountered at work, their motivation, expectations towards current work, as well as their future prospects. Answers that gradually appeared in the interviews have been then confronted with the analysis of data and documents that the Ministry of Culture and National Heritage made available. Budgets of particular festivals and general data on their financial support have also been confronted with the interviews. Such an analysis gave us a stronger, structural base for conclusions made over the interpretation of interviews. One question that surprised us, but also showed us the benefits of the grounded theory, was the fact that data obtained from interviews mirrored the data from the documents. In total there were 48 interviews with the employees, co-workers and volunteers who worked at 12 festivals financed by the Ministry of Culture and National Heritage located in 6 different cities in Poland

Unstained viable cell recognition in phase-contrast microscopy

AbstractIndividual cell recognition is a relevant task to be accomplished when single-ion microbeam irradiations are performed. At INFN-LNL facility cell visualization system is based on a phase-contrast optical microscope, without the use of any cell dye. Unstained cells are seeded in the special designed Petri dish, between two mylar foils, and at present the cell recognition is achieved manually by an expert operator. Nevertheless, this procedure is time consuming and sometimes it could be not practical if the amount of living cells to be irradiated is large. To reduce the time needed to recognize unstained cells on the Petri dish, it has been designed and implemented an automated, parallel algorithm. Overlapping ROIs sliding in steps over the captured grayscale image are firstly pre-classified and potential cell markers for the segmentation are obtained. Segmented objects are additionally classified to categorize cell bodies from other structures considered as sample dirt or background. As a result, cell coordinates are passed to the dedicated CELLView program that controls all the LNL single-ion microbeam irradiation protocol, including the positioning of individual cells in front of the ion beam. Unstained cell recognition system was successfully tested in experimental conditions with two different mylar surfaces. The recognition time and accuracy was acceptable, however, improvements in speed would be useful

Centrilobular nodules in high resolution computed tomography of the lung in IPAH patients — preliminary data concerning clinico-radiological correlates

Introduction: Inhomogeneity of lung attenuation pattern is observed in high resolution chest computed tomography (HRCT) in some IPAH patients despite lack of interstitial lung disease. Such radiological changes are described either as ill-defined centrilobular nodules (CN) or as focal ground glass opacities (FGGO). There is no consensus in the literature, whether they indicate the distinct type of IPAH, or pulmonary venoocclusive disease (PVOD) with subtle radiological changes. Thus the aim of the present pilot study was to assess the frequency and clinical significance of inhomogenic lung attenuation pattern in IPAH. Material and methods: 52 IPAH patients (38 females, 14 males, mean age 41 years ± 15 years), entered the study. All available chest CT scans were reviewed retrospectively by the experienced radiologist, not aware about the clinical data of the patients. Results: CN were found in 10 patients (19%), FGGO — in 12 patients (23%). No lymphadenopathy or interlobular septal thickening suggestive of PVOD were found. The significant differences between CN and the remaining patients included: lower mean age — 31 and 43.5 years, (p = 0.02), lack of persistent foramen ovale (PFO) — 0% and 43% (p = 0.03), and higher mean right atrial pressure (mRAP) — 12.5 mm Hg and 7.94 mm Hg (p = 0.01). No significant survival differences were observed between the groups of CN, FGGO and the remaining patients. Conclusion: Centrilobular nodules in IPAH were combined with lack of PFO, higher mRAP and younger age of patients.  INTRODUCTION: Inhomogeneity of lung attenuation pattern is observed in high resolution chest computed tomography (HRCT) in some IPAH patients despite lack of interstitial lung disease. Such radiological changes are described either as ill-defined centrilobular nodules (CN) or as focal ground glass opacities (FGGO). There is no consensus in the literature, whether they indicate the distinct type of IPAH, or pulmonary venoocclusive disease (PVOD) with subtle radiological changes. Thus the aim of the present pilot study was to assess the frequency and clinical significance of inhomogenic lung attenuation pattern in IPAH. MATERIAL AND METHODS: 52 IPAH patients (38 females, 14 males, mean age 41 years ± 15 years), entered the study. All available chest CT scans were reviewed retrospectively by the experienced radiologist, not aware about the clinical data of the patients. RESULTS: CN were found in 10 patients (19%), FGGO — in 12 patients (23%). No lymphadenopathy or interlobular septal thickening suggestive of PVOD were found. The significant differences between CN and the remaining patients included: lower mean age — 31 and 43.5 years, (p = 0.02), lack of persistent foramen ovale (PFO) — 0% and 43% (p = 0.03), and higher mean right atrial pressure (mRAP) — 12.5 mm Hg and 7.94 mm Hg (p = 0.01). No significant survival differences were observed between the groups of CN, FGGO and the remaining patients. CONCLUSION: Centrilobular nodules in IPAH were combined with lack of PFO, higher mRAP and younger age of patients.

Low DLCO in idiopathic pulmonary arterial hypertension — clinical correlates and prognostic significance

INTRODUCTION: Decreased diffusing capacity of the lung for carbon monoxide (DLCO) is observed in some idiopathic pulmonary arterial hypertension (IPAH) patients, but its clinical significance is uncertain. We aimed to assess clinical correlates and prognostic significance of low DLCO in IPAH patients. MATERIAL AND METHODS: In the group of 65 IPAH patients the cut off value for low DLCO was set up based on histogram as < 55% of predicted value. Demographic data, exercise capacity, lung function tests, hemodynamic parameters and survival of the patients were compared depending on DLCO value. RESULTS: Low DLCO was found in 18% of the patients, and it was associated with male sex, older age, worse functional status and exercise capacity, and higher prevalence of coronary artery disease. Low DLCO carried a 4-fold increase of death risk in 5-year perspective. CONCLUSIONS: Low DLCO was a marker of worse functional capacity and increased risk of death in studied IPAH patients.INTRODUCTION: Decreased diffusing capacity of the lung for carbon monoxide (DLCO) is observed in some idiopathic pulmonary arterial hypertension (IPAH) patients, but its clinical significance is uncertain. We aimed to assess clinical correlates and prognostic significance of low DLCO in IPAH patients. MATERIAL AND METHODS: In the group of 65 IPAH patients the cut off value for low DLCO was set up based on histogram as < 55% of predicted value. Demographic data, exercise capacity, lung function tests, hemodynamic parameters and survival of the patients were compared depending on DLCO value. RESULTS: Low DLCO was found in 18% of the patients, and it was associated with male sex, older age, worse functional status and exercise capacity, and higher prevalence of coronary artery disease. Low DLCO carried a 4-fold increase of death risk in 5-year perspective. CONCLUSIONS: Low DLCO was a marker of worse functional capacity and increased risk of death in studied IPAH patients

Diagnostic value of non-enhanced computed tomography in identifying location of ruptured cerebral aneurysm in patients with aneurysmal subarachnoid haemorrhage

Background. In patients with SAH and multiple aneurysms, the ruptured lesion must be identified to prevent recurrent bleeding.Aim of the study. To assess the diagnostic value of non-enhanced computed tomography (NECT) in identifying the rupture site in patients with subarachnoid haemorrhage (SAH) and multiple aneurysms.Material and methods. We included patients with SAH revealed by NECT and multiple aneurysms detected on computed tomography angiography (CTA) in whom a ruptured aneurysm was identified during neurosurgery. Two radiologists predicted the location of the ruptured aneurysm based on the distribution of the SAH and location of intracerebral haematoma (ICH) by NECT.Results. Eighty-three patients with a mean age of 55.7 ± 14.4 years were included. Ruptured aneurysms were significantly larger (mean size 7.7 ± 4.7 mm) than unruptured aneurysms (mean size 5.9 ± 4.5 mm; p = 0.014). Interobserver agreement was 0.86 (p < 0.001). Overall sensitivity and specificity of radiological prediction were 78.3% (95% CI, 68.6%-87.1%) and 96.4% (95% CI, 94.3%-97.8%) respectively. Overall PPV and NPV were 78.3% (95% CI, 67.6%-86.3%) and 96.8% (95% CI, 94.8%-98.1%) respectively. The sensitivity and PPV for aneurysms in the anterior communicating, anterior, and middle cerebral arteries appeared to be significantly higher than in other locations (p = 0.015 and 0.019 respectively). Analysis of independent predictive factors of correct radiological location revealed that ICH predisposes to a correct radiological diagnosis with an odds ratio of 8.57 (95% CI, 1.07-68.99; p = 0.03).Conclusions. NECT has a high diagnostic value in identifying the source of bleeding in patients with multiple aneurysms for anterior circulation aneurysms, especially with coexisting ICH. For other locations, NECT is not reliable enough to base treatment decisions upon

Zakrzepowo-zatorowe nadciśnienie płucne — nie marnujmy szansy na skuteczne leczenie operacyjne!

Chronic thromboembolic pulmonary hypertension (CTEPH) can be defined as pulmonary hypertension with persistent pulmonary perfusion defects causes by unresolved thrombi. All symptomatic CTEPH patients with documented pulmonary vascular resistance > 300 dyn*sec*cm–5 and proximal lesions should be considered for surgical treatment — pulmonary endarterectomy. The role of pharmacological treatment remains controversial and should be restricted to inoperable cases and persistent pulmonary hypertension after pulmonary endarterectomy. Every year about 30 procedures is performed in two specialised centers in Poland with 1 year mortality at 8–9 %. Number of procedures done gives the frequency of pulmonary endarterectomy at 0.7/million of population/year. Current data from UK indicate the actual ratio of surgical treatment of CTPH at 2/million/year. The article discusses reasons for CTEPH is underdiagnosed and why rate of surgical therapy in Poland is too low. Kardiol Pol 2011; 69, 8: 875–87

Guzki środkowej części zrazika w tomografii komputerowej płuc o wysokiej rozdzielczości u chorych na IPAH — wstępne korelacje kliniczno-radiologiczne

  WSTĘP: Zmiany miąższowe w tomografii komputerowej płuc o wysokiej rozdzielczości (TKWR) obserwowane są u niektórych chorych na idiopatyczne tętnicze nadciśnienie płucne (IPAH), pomimo że nie mają oni śródmiąższowej choroby płuc. Najczęściej opisuje się: słabo odgraniczone guzki środkowej części zrazika (CN, centrilobular nodules) albo ogniskowe zacienienia typu matowej szyby (FGGO, focal ground glass opacities). Nie wiadomo czy obecność tych zmian wskazuje na odmienny typ IPAH czy też na zarostową chorobę żył płucnych (PVOD, pulmonary venoocclusive disease). Celem pracy była ocena częstości występowania i znaczenia klinicznego zmian miąższowych w płucach stwierdzanych w TKWR u chorych na IPAH. MATERIAŁ I METODY: Do badania zakwalifikowano 52 chorych na IPAH (38 kobiet, 14 mężczyzn, średni wiek 41 ± 15 lat). Wszystkie dostępne badania TKWR zostały poddane retrospektywnej analizie doświadczonego radiologa, nieposiadającego wiedzy na temat danych klinicznych. WYNIKI: U 10 chorych (19%) stwierdzono CN, u 12(23%) FGGO. U badanych chorych nie występowały cechy PVOD, takie jak powiększenie węzłów chłonnych czy też pogrubienie przegród międzyzrazikowych. Wykazano, że chorzy z CN w porównaniu z pozostałymi byli istotnie młodsi (średnie wieku wynosiły 31 lat oraz 43,5 roku, p = 0,02), nie posiadali drożnego otworu owalnego (0% oraz 43%, p = 0,03), mieli istotnie wyższe średnie ciśnienie w prawym przedsionku (12,5 mm Hg oraz 7,94 mm Hg, p = 0,01). Nie wykazano jednak istotnych różnic dotyczących rokowania. WNIOSKI: Chorzy na IPAH, u których stwierdzono w TKWR guzki środkowej części zrazika, charakteryzowali się nieobecnością PFO, młodszym wiekiem i wyższym ciśnieniem w prawym przedsionku w porównaniu z pozostałymi chorymi.

Evaluation of carbetocin (Pabal) efficacy in the prevention of the postpartum hemorrhage in women after cesarean section – preliminary report

Abstract Objectives: The aim of this study was to evaluate the efficacy of carbetocin in prevention of PPH in women after cesarean section. Material and Methods: We enrolled 60 patients who had undergone cesarean section in tertiary referential center, Department of Perinatology, Medical University of Lodz, Poland, between January and June 2008. Each patient obtained a single 100μg dose of carbetocin intravenously during cesarean section, immediately after the delivery of the baby and prior to the delivery of the placenta . We evaluated postoperative blood parameters in 2 and 12 hours after the operation, the proportion of patients requiring additional uterotonic agents and adverse events in the whole population and in the group of women with high risk of PPH. Results: 58.1% of patients underwent emergency and 41.3% elective cesarean section delivery. The risk factor of PPH was identified in 38 women (63.3%). The results of this study indicate that carbetocin produces rapid and longlasting uterine tone. A small drop in mean hemoglobin and hematocrit levels 2 and 12 hours after the operation was observed. 15% of patients required the use of additional uterotonic agents. In the group of women with high risk of PPH, carbetocin appeared to be effective in 79% of the patients. Only 11.4% of patients had minor adverse events. Conclusions: Carbetocin appears to be an effective new drug in the prevention of postpartum hemorrhage, not only among women undergoing cesarean section but also in the group of women with PPH risk factors

Characterization of patients with pulmonary arterial hypertension : data from the polish registry of pulmonary hypertension (BNP-PL)

Current knowledge of pulmonary arterial hypertension (PAH) epidemiology is based mainly on data from Western populations, and therefore we aimed to characterize a large group of Caucasian PAH adults of Central-Eastern European origin. We analyzed data of incident and prevalent PAH adults enrolled in a prospective national registry involving all Polish PAH centers. The estimated prevalence and annual incidence of PAH were 30.8/mln adults and 5.2/mln adults, respectively and they were the highest in females ≥65 years old. The most frequent type of PAH was idiopathic (n = 444; 46%) followed by PAH associated with congenital heart diseases (CHD-PAH, n = 356; 36.7%), and PAH associated with connective tissue disease (CTD-PAH, n = 132; 13.6%). At enrollment, most incident cases (71.9%) were at intermediate mortality risk and the prevalent cases had most of their risk factors in the intermediate or high risk range. The use of triple combination therapy was rare (4.7%). A high prevalence of PAH among older population confirms the changing demographics of PAH found in the Western countries. In contrast, we found: a female predominance across all age groups, a high proportion of patients with CHD-PAH as compared to patients with CTD-PAH and a low use of triple combination therapy