Analiza porównawcza wybranych parametrów angiogenezy naczyniowej w łożyskach pochodzących z ciąż bliźniaczych dwuzygotycznych

Introduction: Most of preIntroduction: Most pregnancies after assisted reproduction techniques are dizygotic twin gestations. There is a close relationship between the development and functioning of the placenta and the growth of both fetuses in dizygotic twin pregnancies. Angiogenesis is the process of creating new capillaries. Objectives: The aim of the study was to compare the expression of vascular endothelial growth factor (VEGF) and endothelial nitric oxide synthase (eNOs) between placentas of dizygotic twins, taking into account their birth weight. Materials and Methods: The study included 35 women in dizygotic twin pregnancies, resolved after 30 completed weeks of gestation by a caesarean section. The patients were divided into two groups: twins whose weight did not differ by more than 20% (group 1) and twins whose weight differed by more than 20% (group 2). Twins with higher and lower birth weight were classified as A and B, respectively. A comparative analysis of the placentas of twins A and B with regard to the selected parameters of angiogenesis, i.e. VEGF and eNOs, was performed. Results: A strong expression of VEGF was observed in twins with lower birth weight in group 1, as well as a strong expression of eNOs in twins with higher weight in group 2, and with lower weight in group 1. Conclusions: Neovascularization is more expressed in the placentas of twins with lower birth weight (in the group with no significant differences in weight), possibly reflecting the existence of efficient mechanisms of compensation. High expression of e-NOS may indicate an increased risk of ischemia with intact endothelium.Wstęp. Większość przypadków ciąż pochodzących z technik wspomaganego rozrodu to ciąże bliźniacze dwuzygotyczne. Obserwuje się ścisłą zależność między rozwojem i funkcjonowaniem łożyska a wzrastaniem obu płodów. Angiogeneza to proces tworzenia nowych naczyń włosowatych. Cel pracy. Porównanie wartości ekspresji czynnika wzrostu śródbłonka naczyniowego – VEGF oraz endotelialnej syntazy tlenku azotu – eNOs między łożyskami bliźniąt dwuzygotycznych z uwzględnieniem ich masy urodzeniowej. Materiał i metody. Do badania zakwalifikowano 35 kobiet w ciąży bliźniaczej dwuzygotycznej po ukończonym 30 tygodniu ciąży rozwiązanych drogą cięcia cesarskiego. Grupa została podzielona na dwie części: bliźnięta, których masa nie różniła się o ponad 20% (grupa 1) i bliźnięta, których masa różniła się o ponad 20% (grupa 2). Bliźnię o wyższej masie urodzeniowej zakwalifikowane zostało jako A, natomiast bliźnię o niższej masie urodzeniowej jako B. Dokonana została analiza porównawcza łożysk bliźniąt A i B pod względem wybranych parametrów angiogenezy – VEGF i eNOs. Wyniki. Stwierdzono silną ekspresję VEGF w grupie 1 u bliźnięcia B oraz silną ekspresję eNOs w grupie 2 u bliźniąt A i w grupie 1 u bliźniąt B. Wnioski. Neowaskularyzacja jest bardziej nasilona w łożyskach bliźniąt o niższej masie urodzeniowej, gdzie nie obserwowano istotnej różnicy mas, co być może jest wyrazem istnienia sprawnych mechanizmów kompensacyjnych. Wysoka ekspresja e-NOs może oznaczać zwiększone ryzyko niedotlenienia przy jednocześnie nieuszkodzonym śródbłonku

Downregulation of Polo-like kinase-1 (PLK-1) expression is associated with poor clinical outcome in uveal melanoma patient

Introduction. Uveal melanoma (UM) is the most common primary eye tumour in adults. Distant metastases are seen in 50% of cases regardless of treatment, which contributes to high mortality rates. Polo-like kinase-1 (PLK-1) is a protein regulator of mitotic entry and cytokinesis. Increased PLK-1 expression has been shown in different tumours, which makes its inhibition a potential treatment target. To date, no study has been published to discuss the prognostic role of PLK-1 expression in patients with uveal melanoma. Material and methods. We assessed by immunohistochemistry PLK-1 expression in uveal melanoma cells collected in 158 patients treated by primary enucleation. We determined the correlation between PLK-1 levels evaluated by the immunoreactivity scale (IRS) method and detailed clinical as well as histological parameters. Additionally, we determined the association between PLK-1 expression levels and long-term prognosis. Results. Elevated PLK-1 expression in tumour cells, defined as IRS > 2, was observed in 70% (111/158) of cases, whereas low expression or no expression was seen in the remaining 30% (47/158) of patients. There was a significant correlation between low PLK-1 expression and a higher clinical tumour stage (pT, p = 0.04) as well as a higher AJCC prognostic stage group (p = 0.037). We observed an inverse correlation between PLK-1 expression and tumour cell pigment content (p = 0.0019). There was no correlation between PLK-1 expression and other histological parameters such as mitotic rate or histological subtype. The Kaplan-Meier’s analysis demonstrated that low PLK-1 expression was associated with significantly reduced overall survival (p = 0.0058). A similar trend, albeit not significant, was observed for disease-free survival (p = 0.088). Conclusions. Downregulated PLK-1 expression is a negative prognostic factor in uveal melanoma. It warrants further, multicentre research on prognostic role of PLK-1 expression and possibility of PLK-1 inhibition in uveal melanoma

Transapical aortic valve implantation – a rescue procedure for patients with aortic stenosis and “porcelain aorta”

Surgical aortic valve replacement (AVR) still remains the treatment of choice in symptomatic significant aortic stenosis (AS). Due to technical problems, extensive calcification of the ascending aorta (“porcelain aorta”) is an additional risk factor for surgery and transapical aortic valve implantation (TAAVI) is likely to be the only rescue procedure for this group of patients. We describe the case of an 81-year-old woman with severe AS and “porcelain aorta”, in whom the only available life-saving intervention was TAAVI

Is certain food and nutrients associated with the risk of lung cancer? A systematic review

This review explores the intricate relationship between dietary factors and lung cancer risk based on a thorough examination of relevant literature and articles. The findings highlight a significant association between specific dietary elements and lung cancer risk. Increased intake of fiber, fruit, and vitamin C is linked to a notable 9% reduction in risk, particularly for squamous cell carcinoma. Notably, vegetables exhibit a risk reduction for current smokers, while offal, red meat, and processed meat may elevate risk, especially in heavy smokers. Contradictory evidence surrounds dairy products, with fermented dairy inversely correlated. Beer and cider consumption are associated with an increased risk, primarily among current smokers. In contrast, avocados demonstrate a promising link to decreased lung cancer risk. Vitamin K intake shows an inverse relationship, particularly in males and ever smokers. High retinol intake may elevate risk, potentially modifying the effects of tobacco exposure. Nuts consumption is significantly linked to reduced lung cancer risk and overall cancer mortality. Dietary polyunsaturated fatty acids (PUFA) demonstrate a noteworthy risk reduction for lung cancer, with supplementation improving overall survival in patients with the disease. Palmitic acid, a component of saturated fatty acids, is implicated in promoting lung metastasis, emphasizing the intricate nature of dietary influences on cancer. In summary, while lung cancer is primarily associated with tobacco smoking, this review underscores the multifaceted interplay between diet and lung cancer risk. Further research is crucial to unravel underlying mechanisms and provide definitive evidence on the impact of specific dietary factors, emphasizing the importance of continued exploration in this complex field

The course of pregnancy and perinatal period in overweight or obese pregnant women with regard to the condition of the newborn – own experience

Summary Objectives: The aim of the study was to estimate whether obesity and overweight influence the course of a pregnancy and labor and to assess the condition of a newborn. Material and Methods: 92 cases of pregnant women with singleton pregnancy were analyzed and assessed. The patients were divided into three groups according to their body mass index. Women with BMI between 18.5 and 24.9 comprised the first group (controls), those with BMI from 25.0 to 29.9 – the second group (overweight but not obese) and those with BMI of 30 and above – the third one (obese). Results: Average weight gain in the course of a pregnancy was significantly lower in the obese group whereas average blood pressure in obese women was significantly higher than in the control group. Gestational complications, such as hypertension and gestational edemas were more common in the third group. Birth weight and neonatal outcome were similar in all groups. Conclusions: 1. There is a higher risk of complications in pregnancy in overweight and obese women. 2. Obesity of women may worsen the outcome of the neonate

Cryptic SARS-CoV-2 lineage identified on two mink farms as a possible result of long-term undetected circulation in an unknown animal reservoir, Poland, November 2022 to January 2023

In late 2022 and early 2023, SARS-CoV-2 infections were detected on three mink farms in Poland situated within a few km from each other. Whole-genome sequencing of the viruses on two of the farms showed that they were related to a virus identified in humans in the same region 2 years before (B.1.1.307 lineage). Many mutations were found, including in the S protein typical of adaptations to the mink host. The origin of the virus remains to be determined.</p

Analysis of delivery types in women after previous cesarean section

Objective: The study was undertaken to analyze the course of pregnancy and delivery in women after previous cesarean section. Material and methods: The study group consisted of 1272 pregnant women after one cesarean section, who delivered at the 1st Department of Gynecology and Obstetrics, Medical University of Lodz between 1st January 2007 and 31st December 2010. Results: Among patients after previous cesarean section, the most numerous group constituted women whose pregnancy was resolved with an elective repeat cesarean section, without the attempt to deliver vaginally – 58,96% whereas the remaining 41,04% of the women were qualified to make an attempt at vaginal delivery. 48,28% of them succeeded to gave birth vaginally and 51,72% underwent repeat cesarean section. Conclusions: Proper qualification of patients after previous caesarean section for a natural vaginal birth allows a successful vaginal delivery. A critical analysis of the indications for surgical delivery needs to be performed in order to lower the rate of cesarean sections

Conduction disturbances and permanent cardiac pacing after transcatheter implantation of the CoreValve aortic bioprosthesis: initial single centre experience

Background: The rate of significant conduction disturbances requiring permanent pacemaker implantation (PPI) following surgical aortic valve replacement (AVR) is 2&#8211;8%. Transcatheter aortic valve implantation (TAVI) is an alternative management approach in patients with severe aortic stenosis who are not considered candidates for AVR. The TAVI using the CoreValve (CV) bioprosthesis is associated with a nearly 30% rate of conduction disturbances requiring postprocedural PPI. Aim: To provide an initial evaluation of the rate of conduction disturbances and the need for PPI, and to analyse factors that increase the risk of this complication in patients undergoing TAVI using CV bioprosthesis. In addition, we evaluated the rate of permanent conduction disturbances in patients who underwent PPI at one year after TAVI. Methods: We studies 22 initial patients in a single centre who underwent CV bioprosthesis implantation in 2009&#8211;2010. After exclusion of 6 patients with preprocedural PPI, we ultimately evaluated 16 patients. Uni- and multivariate analyses were performed using &chi;2, Fisher, and Wilcoxon tests, and logistic regression analysis was performed using the SAS software. Results: Overall, 8 (50%) patients in our study group required PPI after TAVI (TAVI + PPI), and the remaining 8 patients did not require PPI (TAVI). The most common indication for PPI was complete heart block. The decision to implant a pacemaker was made on average at 9 &#177; 7 days following TAVI (range 3 to 22 days). When we analysed risk factors for PPI that were unrelated to the TAVI procedure, we found that the TAVI + PPI group was characterised (vs the TAVI group) by a significantly larger diameter of the native aortic valve (p = 0.03) and a larger left ventricular outflow tract (LVOT) dimension in the frontal (p = 0.02) and the corresponding frontal dimension in the transverse view (p = 0.01) by computed tomography angiography. Logistic regression analysis showed that the risk of PPI increased more than 2.5 times for each increase in the aortic annulus diameter by 1 mm (OR 2.64; 95% CI 0.90&#8211;7.74). None of the risk factors related to TAVI resulted in a significant increase in the rate of PPI. Among the patients who underwent PPI, we only noted a trend for a larger valvulotomy balloon diameter (p = 0.08), shorter procedure duration (p = 0.06), and deeper CV insertion within LVOT (p = 0.09). In addition, the bioprosthesis was inserted deeper in those patients who developed new LBBB after TAVI (p = 0.06). The ECG analysis at one day after the procedure showed a significant prolongation of PR, QRS, QT, and QTc intervals, and increased left axis deviation in the TAVI + + PPI group. In addition, the TAVI + PPI group showed increased QRS duration (p = 0.03) and increased left axis deviation (p = 0.049) compared to the TAVI group. Each increase in QRS duration by 10 ms was associated with 2.5-fold increase in the risk of PPI (OR 1.10; 95% CI 0.97&#8211;1.22), and each increase in PR interval duration by 10 ms with a 23% increase in risk (OR 1.02; 95% CI 0.99&#8211;1.05). New LBBB following CV implantation was noted significantly more frequently in the TAVI + PPI group vs the TAVI group (p < 0.0003). Pacemaker interrogation at one year after TAVI showed that the mean percentage of ventricular pacing in all patients with a pacemaker (DDD and VVI) pacing was 41%, and it was less than 10% in 2 patients. Conclusions: 1. Transcatheter implantation of a CV bioprosthesis is associated with an increased risk of persistent conduction disturbances and subsequent PPI. 2. New LBBB after TAVI may predict the need for PPI. 3. Careful ECG monitoring is necessary for one week after CV bioprosthesis implantation due to a risk of atrioventricular conduction disturbances and the need for PPI. 4. Patients at an increased risk of postprocedural PPI may be those with deep bioprosthesis insertion in LVOT, larger LVOT diameter, and larger aortic annulus diameter in the frontal view. These observations require confirmation in a larger group of patients.Background: The rate of significant conduction disturbances requiring permanent pacemaker implantation (PPI) following surgical aortic valve replacement (AVR) is 2&#8211;8%. Transcatheter aortic valve implantation (TAVI) is an alternative management approach in patients with severe aortic stenosis who are not considered candidates for AVR. The TAVI using the CoreValve (CV) bioprosthesis is associated with a nearly 30% rate of conduction disturbances requiring postprocedural PPI. Aim: To provide an initial evaluation of the rate of conduction disturbances and the need for PPI, and to analyse factors that increase the risk of this complication in patients undergoing TAVI using CV bioprosthesis. In addition, we evaluated the rate of permanent conduction disturbances in patients who underwent PPI at one year after TAVI. Methods: We studies 22 initial patients in a single centre who underwent CV bioprosthesis implantation in 2009&#8211;2010. After exclusion of 6 patients with preprocedural PPI, we ultimately evaluated 16 patients. Uni- and multivariate analyses were performed using &#967; 2, Fisher, and Wilcoxon tests, and logistic regression analysis was performed using the SAS software. Results: Overall, 8 (50%) patients in our study group required PPI after TAVI (TAVI + PPI), and the remaining 8 patients did not require PPI (TAVI). The most common indication for PPI was complete heart block. The decision to implant a pacemaker was made on average at 9 +- 7 days following TAVI (range 3 to 22 days). When we analysed risk factors for PPI that were unrelated to the TAVI procedure, we found that the TAVI + PPI group was characterised (vs the TAVI group) by a significantly larger diameter of the native aortic valve (p = 0.03) and a larger left ventricular outflow tract (LVOT) dimension in the frontal (p = 0.02) and the corresponding frontal dimension in the transverse view (p = 0.01) by computed tomography angiography. Logistic regression analysis showed that the risk of PPI increased more than 2.5 times for each increase in the aortic annulus diameter by 1 mm (OR 2.64; 95% CI 0.90&#8211;7.74). None of the risk factors related to TAVI resulted in a significant increase in the rate of PPI. Among the patients who underwent PPI, we only noted a trend for a larger valvulotomy balloon diameter (p = 0.08), shorter procedure duration (p = 0.06), and deeper CV insertion within LVOT (p = 0.09). In addition, the bioprosthesis was inserted deeper in those patients who developed new LBBB after TAVI (p = 0.06). The ECG analysis at one day after the procedure showed a significant prolongation of PR, QRS, QT, and QTc intervals, and increased left axis deviation in the TAVI + PPI group. In addition, the TAVI + PPI group showed increased QRS duration (p = 0.03) and increased left axis deviation (p = 0.049) compared to the TAVI group. Each increase in QRS duration by 10 ms was associated with 2.5-fold increase in the risk of PPI (OR 1.10; 95% CI 0.97&#8211;1.22), and each increase in PR interval duration by 10 ms with a 23% increase in risk (OR 1.02; 95% CI 0.99&#8211;1.05). New LBBB following CV implantation was noted significantly more frequently in the TAVI + PPI group vs the TAVI group (p < 0.0003). Pacemaker interrogation at one year after TAVI showed that the mean percentage of ventricular pacing in all patients with a pacemaker (DDD and VVI) pacing was 41%, and it was less than 10% in 2 patients. Conclusions: 1. Transcatheter implantation of a CV bioprosthesis is associated with an increased risk of persistent conduction disturbances and subsequent PPI. 2. New LBBB after TAVI may predict the need for PPI. 3. Careful ECG monitoring is necessary for one week after CV bioprosthesis implantation due to a risk of atrioventricular conduction disturbances and the need for PPI. 4. Patients at an increased risk of postprocedural PPI may be those with deep bioprosthesis insertion in LVOT, larger LVOT diameter, and larger aortic annulus diameter in the frontal view. These observations require confirmation in a larger group of patients