Rozpoznanie i leczenie nadciśnienia tętniczego u pacjentów ze współistniejącą cukrzycą w świetle zmieniających się wytycznych

Hypertension and diabetes are, after smoking, obesity and hypercholesterolemia, the most important cardiovascular risk factors. It is common for these diseases to coexist, which leads to a poorer prognosis. There are differing medical association guidelines regarding the values of blood pressure when treatment should start, but instructions are consistent with the goals of treatment for diabetic patients. The guidelines published in 2017 by the American College of Cardiology/American Heart Association (ACC/AHA) suggest a value of 130/80 mm Hg for both diagnosis and starting treatment. The European Society of Cardiology/European Society of Hypertension (ESC/ESH) guidelines published in 2018 recommend a value of 140/90 mm Hg when we should start therapy, with the goal of treatment below 130/80 mm Hg, but only if drug tolerance is good. The exception is patients aged over 65, for whom we should maintain systolic blood pressure in the range 130–140 mm Hg. The new Polish 2019 guidelines from the Polish Diabetology Association (PTD, Polskie Towarzystwo Diabetologiczne) and the Polish Society of Hypertension (PTNT, Polskie Towarzystwo Nadciśnienia Tętniczego) have been adjusted to align with the ESC/ESH guidelines. In this article, we look at changes in the guidelines over the last 20 years. We also look back at the clinical trials which have had the biggest impact on the guidelines. We describe the optimal treatment of hypertension in diabetic patients. Among all the hypotensive drugs recommended as a first choice are angiotensin-converting enzyme inhibitors or angiotensin AT1 receptor blockers, together with calcium channel blockers and/or diuretics. There is increasing evidence regarding the positive influence of diabetic drugs on blood pressure, especially sodium-glucose cotransporter 2 inhibitors.Nadciśnienie tętnicze i cukrzyca to obok nikotynizmu, otyłości i hipercholesterolemii najważniejsze czynniki zwiększające ryzyko zachorowania na choroby układu sercowo-naczyniowego. Często występują jednocześnie, co pogarsza rokowanie pacjentów. Aktualne wytyczne towarzystw naukowych różnią się wartościami ciśnienia, od których włącza się leczenie farmakologiczne, pokrywają się natomiast w kwestii celów leczenia nadciśnienia tętniczego dla chorych na cukrzycę. W opublikowanych w 2017 roku wytycznych American College of Cardiology/American Heart Association (ACC/AHA) zaproponowano rozpoznawanie i włączanie terapii przy wartościach ciśnienia tętniczego powyżej 130/80 mm Hg. W wytycznych European Society of Cardiology/European Society of Hypertension (ESC/ESH) z 2018 roku jako próg włączania terapii hipotensyjnej zaleca się wartość 140/90 mmHg dla, natomiast jako cel leczenia — obniżanie ciśnienia tętniczego poniżej 130/80 mmHg, jeśli pacjenta dobrze to toleruje. Wyjątek stanowią pacjenci powyżej 65. roku życia, dla których zaleca się utrzymanie skurczowego ciśnienia tętniczego w granicach 130–140 mm Hg. Wytyczne Polskiego Towarzystwa Diabetologicznego i wytyczne Polskiego Towarzystwa Nadciśnienia Tętniczego z 2019 roku zaktualizowano według zaleceń ESC/ESH. W pracy omówiono zmiany zaleceń w ostatnich 20 latach oraz podano przykłady badań klinicznych wpływających na te zmiany. Omówiono także optymalizację leczenia nadciśnienia tętniczego w cukrzycy. Wśród leków hipotensyjnych podstawą są leki blokujące układ renina–angiotensyna, inhibitory konwertazy angiotensyny lub antagoniści receptora AT1 dla angiotensyny II, w połączeniu z antagonistą wapnia lub/i diuretykiem. Jest również coraz więcej danych na temat pozytywnego wpływu leków hipoglikemizujących, zwłaszcza inhibitorów kotransportera sodowo-glukozowego 2, na profil ciśnienia tętniczego

Splenic Hematoma as a First Manifestation of Cytomegalovirus Infection

Splenic rupture is rare but life threatening complication of mononucleosis syndrome. It has been suggested that subcapsular splenic hematoma formation precedes rupture. The case of 44-year-old, previously healthy, male with splenic hematoma occurring after rising of heavy cargo is reported. Mononucleosis syndrome was suggested based on routine laboratory tests (elevated white blood cell count with predominance of lymphocytes and raised serum transaminases) and CMV infection was confirmed by serological test. Nonoperative management was used since the patient was hemodynamically stable with no further signs of splenic rupture. The same approach has been used in growing number of cases of patients with spontaneous splenic rupture in mononucleosis syndrome. Importance of considering splenic hematoma and/or rupture if abdominal pain occurs in the course of mononucleosis syndrome is outlined as well as importance of routine laboratory tests in suspecting mononucleosis syndrome in otherwise clinically silent patient

Splenunculus. A misdiagnosed pancreatic tumor

An intrapancreatic accessory spleen, often referred to as a splenunculus, can imitate neuroendocrine or lobular pancreatic cancer. 17% of accessory spleens are found within the pancreatic tail. We report the case of a splenunculus found within the tail of the pancreas during a laparoscopy for a suspected pancreatic neuroendocrine tumor.Wewnątrztrzustkowa śledziona dodatkowa jest wczesną anomalią rozwojową, która może naśladować neuroendokrynne lub zrazikowe nowotwory trzustki. W 17% przypadków występuje w ogonie trzustki i jest często określana jako splenunculus. W pracy zaprezentowano przypadek chorego, u którego podczas operacji laparoskopowej z powodu podejrzenia guza neuroendokrynnego trzustki stwierdzono wewnątrztrzustkową śledzionę dodatkową umiejscowioną w ogonie tego narządu

Alleviation of nickel toxicity in wheat (Triticum aestivum L.) seedlings by selenium supplementation

Hydroponically grown wheat seedlings were treated with 50 μM N i and/or 15 μM Se. After a 7-day culture period, their growth parameters, N i, Se, F e, and M g contents, electrolyte leakage, photosynthetic pigment concentrations, and photochemical activity of photosystem II were determined. Exposure of wheat seedlings to N i alone resulted in reduction in the total shoot and root lengths, by 22% and 50%, respectively. Addition of Se to the N i-containing medium significantly improved the growth of these organs, compared to the seedlings subjected to N i alone. Application of Se decreased the accumulation of N i in shoots and roots and partially alleviated the N i-induced decrease in F e and M g concentations in shoots. Electrolyte leakage increased in response to N i stress, but in shoots it was diminished by Se supplementation. Exposure to N i led to a decrease in chlorophyll a and b contents and enhancement of chlorophyll a/b ratio, but did not influence the concentration of carotenoids. Enrichment of the N i-containing medium with Se significantly increased chlorophyll b content, compared to the seedlings treated with N i alone. Photochemical activity, estimated in terms of the maximum quantum yield of photosystem II, decreased in response to N i treatment but was significantly improved by simultaneous addition of Se. Results of our study suggest that alleviation of N i toxicity in wheat seedlings by Se supplementation may be related to limitation of N i uptake

Pseudanabaena galeata CCNP1313 : biological activity and peptides production

Even cyanobacteria from ecosystems of low biodiversity, such as the Baltic Sea, can constitute a rich source of bioactive metabolites. Potent toxins, enzyme inhibitors, and anticancer and antifungal agents were detected in both bloom-forming species and less commonly occurring cyanobacteria. In previous work on the Baltic Pseudanabaena galeata CCNP1313, the induction of apoptosis in the breast cancer cell line MCF-7 was documented. Here, the activity of the strain was further explored using human dermal fibroblasts, African green monkey kidney, cancer cell lines (T47D, HCT-8, and A549(ACE2/TMPRSS2)) and viruses (SARS-CoV-2, HCoV-OC43, and WNV). In the tests, extracts, chromatographic fractions, and the main components of the P. galeata CCNP1313 fractions were used. The LC-MS/MS analyses of the tested samples led to the detection of forty-five peptides. For fourteen of the new peptides, putative structures were proposed based on MS/MS spectra. Although the complex samples (i.e., extracts and chromatographic fractions) showed potent cytotoxic and antiviral activities, the effects of the isolated compounds were minor. The study confirmed the significance of P. galeata CCNP1313 as a source of metabolites with potent activity. It also illustrated the difficulties in assigning the observed biological effects to specific metabolites, especially when they are produced in minute amounts

A polygenic risk score for multiple myeloma risk prediction

This work was partially supported by intramural funds of the University of Pisa, DKFZ, and University Hospital of Southern Jutland, Denmark, and by a grant of the French National Cancer Institute (INCA). The authors wish to thank Dr. Dominic Edelmann (Division of Biostatistics, DKFZ) for helpful advice about data analysis.There is overwhelming epidemiologic evidence that the risk of multiple myeloma (MM) has a solid genetic background. Genome-wide association studies (GWAS) have identified 23 risk loci that contribute to the genetic susceptibility of MM, but have low individual penetrance. Combining the SNPs in a polygenic risk score (PRS) is a possible approach to improve their usefulness. Using 2361 MM cases and 1415 controls from the International Multiple Myeloma rESEarch (IMMEnSE) consortium, we computed a weighted and an unweighted PRS. We observed associations with MM risk with OR = 3.44, 95% CI 2.53-4.69, p = 3.55 x 10(-15) for the highest vs. lowest quintile of the weighted score, and OR = 3.18, 95% CI 2.1 = 34-4.33, p = 1.62 x 10(-13) for the highest vs. lowest quintile of the unweighted score. We found a convincing association of a PRS generated with 23 SNPs and risk of MM. Our work provides additional validation of previously discovered MM risk variants and of their combination into a PRS, which is a first step towards the use of genetics for risk stratification in the general population.University of Pisa, DKFZUniversity Hospital of Southern Jutland, DenmarkInstitut National du Cancer (INCA) Franc

Identification of miRSNPs associated with the risk of multiple myeloma

Accepted articleMultiple myeloma (MM) is a malignancy of plasma cells usually infiltrating the bone marrow, associated with the production of a monoclonal immunoglobulin (M protein) which can be detected in the blood and/or urine. Multiple lines of evidence suggest that genetic factors are involved in MM pathogenesis, and several studies have identified single nucleotide polymorphisms (SNPs) associated with the susceptibility to the disease. SNPs within miRNA-binding sites in target genes (miRSNPs) may alter the strength of miRNA-mRNA interactions, thus deregulating protein expression. MiRSNPs are known to be associated with risk of various types of cancer, but they have never been investigated in MM. We performed an in silico genome-wide search for miRSNPs predicted to alter binding of miRNAs to their target sequences. We selected 12 miRSNPs and tested their association with MM risk. Our study population consisted of 1,832 controls and 2,894 MM cases recruited from seven European countries and Israel in the context of the IMMEnSE (International Multiple Myeloma rESEarch) consortium. In this population two SNPs showed an association with p<0.05: rs286595 (located in gene MRLP22) and rs14191881 (located in gene TCF19). Results from IMMEnSE were meta-analyzed with data from a previously published genome-wide association study (GWAS). The SNPs rs13409 (located in the 3UTR of the POU5F1 gene), rs1419881 (TCF19), rs1049633, rs1049623 (both in DDR1) showed significant associations with MM risk. In conclusion, we sought to identify genetic polymorphisms associated with MM risk starting from genome-wide prediction of miRSNPs. For some mirSNPs, we have shown promising associations with MM risk. What's new? Even though deregulation of miRNA expression has been associated with human cancers little information is available regarding their relation with MM susceptibility. We performed an in silico genome-wide search for miRSNPs and selected the most promising ones for an association study. The SNPs with the strongest associations with MM risk are localized in genes which have never been related with MM.This work was partially funded by: intramural funds of German Cancer Research Center (DKFZ), Grant ref. HUS412A1271 from the “Gerencia Regional de Salud de la Junta de Castilla y Léon”. This work was supported by grants from the Instituto de Salud Carlos III (Madrid, Spain; PI12/02688). Catalan Government DURSI grant 2014SGR647 and Instituto de Salud Carlos III, co7funded by FEDER funds –a way to build Europe– grants PI11701439 and PIE13/00022info:eu-repo/semantics/publishedVersio