Pogłębienie relacji dawca–biorca jako rezultat żywego dawstwa

Kidney transplant from a living donor is the best method of treatment for end-stage renal disease, as life expectancy of the organ and the recipient is longer, while the kidney itself is characterized by better functionality. A donation of a kidney to a close person is an act of empathy, but it is also associated with strong stress. A research was conducted to specify whether the relation between the donor and the recipient changes after a kidney donation, and what the nature of such changes would be. The survey was conducted on patients who had donated their kidneys to people who were either genetically related to them or remained in an emotional relationship — spouses. The research was conducted between 01/02/2013 and 15/12/2014. Evidence was gathered from 52 surveyed patients of age between 23 and 73. Completed results confirmed the strengthening of the bond between the donor and the recipient. Changes in relations were positive, with a visible improvement of interpersonal relations, as well as the feeling of closer affinity between the donor and the recipient. Women after donation spent more time with the recipients. Also, in the instanceswhere the donor spent more time with the recipient, they provided more positive feedback on the medical care received during the perioperative period and in the procedure of periodic checks.Przeszczepienie nerki od dawcy żyjącego jest najlepszym sposobem leczenia schyłkowej niewydolności nerek, ponieważ przeżycie narządu i biorców jest dłuższe, a sama nerka charakteryzuje się lepszą funkcją. Donacja nerki osobie bliskiej jest aktem empatii,lecz wiąże się z silnym stresem. Przeprowadzono badanie, którego głównym celem było ustalenie, czy po donacji nerki relacja między dawcą a biorcą zmienia się, a jeśli tak, to jaki kierunek obierają te zmiany. Badaniu o charakterze ankietowym poddano pacjentów po donacji nerki, którzy byli dawcami tego narządu dla osoby spokrewnionej genetycznie lub pozostającej w związku emocjonalnym (małżonek), u których dokonano pobrania nerki w latach 1993–2009. Ostatecznej analizie poddano dane zebrane od 52 dawców w wieku 23–73 lat. Uzyskane wyniki potwierdziły pogłębienie relacji między dawcą a biorcą nerki. Zmiany w relacjach były pozytywne, podkreślano głębszy charakter i pogłębienie relacji interpersonalnych, a także poczucie zwiększonej bliskości między dawcą a biorcą. Kobiety po zabiegu donacji spędzały więcej czasu z biorcą. Dawca spędzający więcej czasu z biorcą dokonywał pozytywniejszej oceny opieki medycznej otrzymanej w okresie okołooperacyjnym i w procedurze badań kontrolnych

Opieka pielęgniarska nad żywym dawcą nerki z krwawieniem pooperacyjnym — opis przypadku

Publikowane badania wskazują, iż nefrektomia u żywego dawcy jest bezpieczna i wiąże się z niskim ryzykiem powikłań. Najczęstszym powikłaniem podczas nefrektomii laparoskopowej jest krwawienie z naczyń nerkowych. Do rzadszych powikłań można zaliczyć perforację jelita, do której może dojść podczas preparowania tkanek, oraz ryzyko anestezjologiczne związane z możliwością wystąpienia reakcji alergicznych podczas znieczulenia. W okresie pooperacyjnym mogą wystąpić zakażenia rany operacyjnej, układu moczowego czy pokarmowego, zakrzepica żylna lub zatorowość płucna. W pracy opisano przypadek 32-letniego dawcy, u którego w 2. dobie wystąpiło krwawienie pooperacyjne z koniecznością reoperacji. Opieka pielęgniarska winna być dostosowana do stanu pacjenta, uwzględniać obserwację i diagnostykę w kierunku możliwych powikłań oraz obejmować udział w leczeniu wszelkich pojawiających się komplikacji

Expression and Complex Formation of MMP9, MMP2, NGAL, and TIMP1 in Porcine Myocardium but Not in Skeletal Muscles in Male Pigs with Tachycardia-Induced Systolic Heart Failure

Matrix metalloproteinases (MMPs) are involved in the remodeling of extracellular matrix in various tissues. Their functioning could be related to the formation of complexes, containing MMP9, MMP2, tissue inhibitor of metalloproteinases type 1 (TIMP1), and neutrophil gelatinase-associated lipocalin (NGAL). Such complexes have not been investigated in either myocardial or skeletal muscles. We examined 20 male pigs with heart failure (HF), and 5 sham-operated animals. There were no differences in the mRNA expression of MMP9, MMP2, TIMP1, and NGAL between diseased and healthy animals, in either left ventricle (LV) myocardium or skeletal muscles. In LV from both diseased and healthy animals, in nonreducing and nondenaturing conditions, we demonstrated the presence of high molecular weight (HMW) complexes (130, 170, and 220 kDa) containing MMP9, TIMP1, and NGAL (also MMP2 in 220 kDa complex) without proteolytic activity, and a proteolytically active 115 kDa MMP9 form together with 72 and 68 kDa bands (proMMP2 and MMP2). Proteolytically active bands were also spontaneously released from HMW complexes. In skeletal muscles from both diseased and healthy animals, in nonreducing and nondenaturing conditions, we found no HMW complexes, and proteolytic activity was associated with the presence of 72 and 68 kDa bands (proMMP2 and MMP2)

Hemosiderin Accumulation in Liver Decreases Iron Availability in Tachycardia-Induced Porcine Congestive Heart Failure Model

Despite advances in the management of iron deficiency in heart failure (HF), the mechanisms underlying the effects of treatment remain to be established. Iron distribution and metabolism in HF pathogenesis need to be clarified. We used a porcine tachycardia-induced cardiomyopathy model to find out how HF development influences hepatic and myocardial iron storing, focusing on ferritin, the main iron storage protein. We found that cumulative liver congestion (due to the decrease of heart function) overwhelms its capacity to recycle iron from erythrocytes. As a consequence, iron is trapped in the liver as poorly mobilized hemosiderin. What is more, the ferritin-bound Fe3+ (reflecting bioavailable iron stores), and assembled ferritin (reflecting ability to store iron) are decreased in HF progression in the liver. We demonstrate that while HF pigs show iron deficiency indices, erythropoiesis is enhanced. Renin–angiotensin–aldosterone system activation and hepatic hepcidin suppression might indicate stress erythropoiesisinduced in HF. Furthermore, assembled ferritin increases but ferritin-bound Fe3+ is reduced in myocardium, indicating that a failing heart increases the iron storage reserve but iron deficiency leads to a drop in myocardial iron stores. Together, HF in pigs leads to down-regulated iron bioavailability and reduced hepatic iron storage making iron unavailable for systemic/cardiac needs

Additional file 1: Figure S1. of Sex differences in porcine left ventricular myocardial remodeling due to right ventricular pacing

Indices of LV function at different time points for sham-operated pigs and RV-paced pigs. A and B show changes over time in LVPWd (LVPWd—end-diastolic thickness of left ventricle posterior wall); C and D show LVPWs—end-systolic thickness of left ventricle posterior wall, E and F show SV (stroke volume) in right ventricular (RV) paced and sham-operated pigs; G and H show LA/Ao (left atrial/aorta ratio) separately in male and female animals (black squares—RV paced female pigs, black circles—RV paced male pigs, gray squares—female controls, gray circles—male controls). Values are presented as means ± SEM. Data (separately for control and TIC animals) were tested using one-way ANOVA. Figure S2. Relationship between BNP mRNA expression and echocardiographic parameters. Elevated BNP mRNA was significantly correlated with increased LVEDV in males (A) as well as with a decrease in LVEF in males (B) and females (C). Regression lines have been fit to all data points. Figure S3. Relationship between GATA4 mRNA expression and TGFβ1 and BNP expression level as well as LVEF. Elevated GATA4 mRNA was significantly correlated with increased BNP mRNA level in males (A) as well as in females (B). Only in males elevated GATA4 mRNA was also significantly correlated with TGFβ1 BNP mRNA level (C) and with a decrease in LVEF (D). Regression lines have been fit to all data points. Figure S4. Relationship between NGAL mRNA expression and LVEDV. Elevated NGAL mRNA was significantly correlated with increased LVEDV in males. Regression lines have been fit to all data points. Figure S5. Relationship between collagen mRNA level and TGFβ1 expression. Elevated Col1A1 (A), Col1A2 (B), and Col3A1 (C) mRNAs were significantly correlated with an increase in TGFβ1 mRNA level in males. In females increased expression of Col1A1 (D) and Col3A1 (E) was related to TGFβ1 mRNA level. Regression lines have been fit to all data points. Figure S6. Relationship between ECM turnover markers and echocardiographic parameters. (A) Reduced total gelatinolytic activity was significantly correlated with an increase in BNP mRNA level in males. (B) Decreasing water soluble collagen was related to an decrease in NGAL mRNA. (C) In male subjects from the mild HF group, the water soluble collagen correlated with the relative increase in LVEDV. Regression lines have been fit to all data points. Figure S7. Relationship between cardiomyocyte diameter and echocardiographic parameters. In females cardiomyocyte cross-sectional diameter correlated with LVEDV. Regression lines have been fit to all data points. Table S1. Initial values of echocardiography parameters in sham-operated male pigs (controls) and right ventricle paced pigs with induced heart failure. Table S2. Echocardiography parameters reflecting the structure and functioning of left ventricle in sham-operated male pigs (controls) and right ventricle paced pigs with induced heart failure. Table S3. Sex-related differences in selected echocardiography parameters assessed in left ventricular myocardium in male pigs with and without tachycardia-induced cardiomyopathy (the results of the two-way ANOVA). Table S4. Relationships between selected echocardiographic parameters and HF insufficiency in male and female pigs with and without tachycardia-induced cardiomyopathy (the results of Spearman’s rank correlatory coefficients)