Fat tissue and adiponectin: new players in critical care?

Historically, adipose tissue was thought to be a passive tissue that stores energy and protects the body from temperature and injury. In contrast to this concept, it is now evident that adipose tissue is an active endocrine organ secreting many kinds of adipocytokines, including adiponectin. Presumably, adipose tissue and its products may have some impact on numerous pathways of response to trauma, sepsis and stress. The discussion on a plausible role of adiponectin in critical illness has been raised by the fact of finding hypoadiponectinemia in critically ill patients. The nature of this phenomenon, however, remains to be elucidated, and noteworthy clinical studies should prompt further efforts in basic research to explain the mechanisms beyond the clinical observation of low adiponectin levels in humans with severe illness

Substantia nigra hyperechogenicity in Polish patients with Parkinson’s disease

Background: Hyperechogenicity of the substantia nigra (SN) measured by transcranial sonography (TCS) is a characteristic feature observed in patients with Parkinson’s disease (PD). To our knowledge, no SN hyperechogenicity data are available for Polish population. Moreover most of studies come from few centres, which used the one type of ultrasound device. The main aim of the study was to investigate the association between PD and SN hyperechogenicity measured by sonographic machine, not assessed so far.Materials and methods: In this study cross-sectional study SN hyperechogenicity was evaluated in 102 PD patients and 95 control subjects. Midbrain was visualised by Aloka Prosound 7 ultrasound device. SN area measurement, the relation to the clinical features of PD, inter- and intra-observer reliability were evaluated.Results: We confirmed that SN echogenicity is significantly increased in PD patients compared to control subjects (p < 0.001). The area under curve for PD patients vs. controls was 0.93. Receiver operating characteristic analysis indicated a cut-offs for SN echogenicity at 0.19 cm2 with accuracy equal to 90%, specificity — 86% and sensitivity — 93.7%. The SN hyperechogenicity was not related to PD clinical findings. Reliability was good if an experienced sonographer performed the SN measurements.Conclusions: This study shows that the SN abnormality observed by TCS isa specific feature, which can be helpful in the process of PD diagnosing

Management of acute ischemic stroke

Terapia udaru niedokrwiennego mózgu należy do najbardziej dynamicznie rozwijających się dziedzin współczesnej neurologii. Wprowadzenie preparatów o działaniu trombolitycznym spowodowało przełom w podejściu terapeutycznym, prowadząc do przejścia od leczenia ściśle objawowego w kierunku postępowania przyczynowego. Sztywne kryteria czasowe terapii trombolitycznej powodują jednak istotne ograniczenia jej stosowania. Wydaje się, że w przyszłości będą dominować procedury rewaskularyzacyjne: mechaniczne i farmakologiczne, oparte na doprecyzowanych zasadach kwalifikacji poszczególnych podtypów udaru do danej metody leczniczej. W pracy przedstawiono obowiązujące wytyczne objawowej i przyczynowej terapii ostrego okresu udaru niedokrwiennego mózgu, a także nowoczesne techniki mechanicznego udrażniania tętnic.Stroke management is a fast developing branch of contemporary neurology. Use of thrombolytic agents has revolutionized stroke therapeutic options, making them more specific and causative. However, strict time frames are a major and often impassable limitation of thrombolytic therapy. It is revascularization procedures that are probable future stroke therapy options, precisely adjusted to stroke subtype. The paper provides updated stroke management recommendations, presenting symptomatic, as well as thrombolytic and revascularizating therapeutic options

Aging and Neurological Diseases

Current knowledge indicates that the aging process starts with subclinical changes at the molecular level. These include the accumulation of mutations, telomere attrition, and epigenetic alterations leading to genomic instability. Such defects multiply exponentially over time, resembling a “snowball effect,” and eventually leading to morphological and functional deterioration of the brain, including progressive neuronal loss, reduced levels of neurotransmitters, excessive inflammation, and disrupted integrity of vessels, followed by infarction and microbleeds. Additionally, the decreasing efficiency of DNA repair mechanisms increases the susceptibility to reactive oxygen species and spontaneous mutagenesis, resulting in age-related neoplasia. Moreover, the malnutrition and malabsorption seen commonly in the elderly may cause deficiency of vitamin B12 and folic acid, both necessary for homocysteine metabolism, and lead to vascular damage. Altogether, these lead to brain damage in old age and greatly increase the risk of developing diseases of the central nervous system, such as stroke, epilepsy, Parkinson’s disease, Alzheimer’s disease, and other dementias

Prelude 1

Abstract: Our acute awareness of the cosmetic, psychosocial and sexual importance of subcutaneous adipose tissue contrasts dramatically with how poorly we have understood the biology of this massive, enigmatic, often ignored and much-abused skin compartment. Therefore, it is timely to recall the exciting, steadily growing, yet underappreciated body of evidence that subcutaneous adipocytes are so much more than just 'fat guys', hanging around passively to conspire, at most, against your desperate attempts to maintain ideal weight. Although the subcutis, quantitatively, tends to represent the dominant architectural component of human skin, conventional wisdom confines its biological key functions to those of energy storage, physical buffer, thermoregulation and thermoinsulation. However, already the distribution of human superficial adipose tissue, by itself, questions how justified the popular belief is that 'skin fat' (which actually may be more diverse than often assumed) serves primarily thermoinsulatory purposes. And although the metabolic complications of obesity are well appreciated, our understanding of how exactly subcutaneous adipocytes contribute to extracutaneous disease -and even influence important immune and brain functions! -is far from complete. The increasing insights recently won into subcutaneous adipose tissue as a cytokine depot that regulates innate immunity and cell growth exemplarily serve to illustrate the vast open research expanses that remain to be fully explored in the subcutis. The following public debate carries you from the evolutionary origins and the key functional purposes of adipose tissue, via adipose-derived stem cells and adipokines straight to the neuroendocrine, immunomodulatory and central nervous effects of signals that originate in the subcutis -perhaps, the most underestimated tissue of the human body. The editors are confident that, at the end, you shall agree: No basic scientist and no doctor with a serious interest in skin, and hardly anyone else in the life sciences, can afford to ignore the subcutaneous adipocyte -beyond its ample impact on beauty, benessence and body mass

Impaired Glucose Metabolism in Bipolar Patients: The Role of Psychiatrists in Its Detection and Management

Bipolar patients have a higher risk of type 2 diabetes and obesity, which are associated with cardiovascular diseases as the leading cause of death in this group. Additionally, there is growing evidence that impaired glucose metabolism in bipolar patients is associated with rapid cycling, poor response to mood stabilizers and chronic course of illness. The aim of the study was to assess the prevalence of type 2 diabetes and other types of impaired glucose metabolism in bipolar patients along with an evaluation of the Fasting Triglycerides and Glucose Index (TyG) as a method of the insulin sensitivity assessment. The analysis of fasting glycemia, insulinemia and lipid profile in euthymic bipolar patients was performed, and the Homeostasis model assessment for insulin resistance (HOMA-IR) and TyG were computed. Type 2 diabetes was observed in 9% and insulin resistance with HOMA-IR in 48% of patients. The TyG and HOMA-IR indices were correlated (p < 0.0001), the TyG index value of 4.7 had the highest sensitivity and specificity for insulin resistance detection. The usefulness of TyG in the recognition of insulin resistance in bipolar patients was suggested. The significant role of psychiatrists in the detection and management of impaired glucose metabolism in bipolar patients was presented

Psychopatologia chorób układu nerwowego w wieku podeszłym

Choroby naczyniowe i zwyrodnieniowe ośrodkowego układu nerwowego należą do jednych z najczęstszych problemów zdrowotnych wieku podeszłego. Zaburzenia funkcji poznawczych, afektu i zachowania, a także objawy wytwórcze stanowią nieodłączny element obrazu klinicznego większości spośród tych chorób. Objawy psychopatologiczne wywierają istotny wpływ na decyzje terapeutyczne, są też źródłem dodatkowego cierpienia dla osób chorych oraz ich bliskich i opiekunów, nierzadko przesądzając o konieczności instytucjonalnej opieki nad pacjentem. Znajomość i prawidłowe rozpoznanie charakteru objawów psychopatologicznych pozwala na rozpoczęcie adekwatnej terapii, która daje szansę poprawy jakości życia zarówno samego pacjenta, jak i jego opiekunów. W artykule przedstawiono manifestację kliniczną zaburzeń psychicznych występujących w przebiegu powszechnych dla wieku podeszłego chorób ośrodkowego układu nerwowego