Association of adiponectin gene polymorphisms with blood pressure in persons with normal kidney function

Adiponektin je protein koji ima antiaterogene, protuupalne i antidijabetičke učinke u organizmu. Smatra se da je njegova koncentracija inverzno povezana s arterijskim tlakom. U ovom radu ispitivali smo utjecaj dvaju polimorfizama, -11377 C>G i -11391 G>A, gena za adiponektin na arterijski tlak u osoba s normalnom bubrežnom funkcijom. Normotoničari i hipertoničari nisu se razlikovali u plazmatskoj koncentraciji adiponektina, a koncentracija adiponektina nije bila korelirana s arterijskim tlakom niti u jednoj skupini ispitanika. Polimorfizmi gena za adiponektin nisu bili povezani niti s arterijskim tlakom niti s hipertenzijom, ali je polimorfizam -11391 G>A bio povezan s inzulinskom rezistencijom na način da je minor alel A bio alel povišenog rizika. U našoj skupini ispitanika polimorfizmi gena za adiponektin nisu bili povezani s arterijskim tlakom, ali potrebne su veće genetičke epidemiološke studije kako bi se ovaj odnos mogao podrobnije razjasniti.Adiponectin is a protein with antiatherogenous, antiinflammatory and antidiabetic effects. It was found in some studies that its plasma concentration is inversely associated with blood pressure. In this thesis we evaluated the association of two common adiponectin gene polymorphisms, -11377 C>G and -11391 G>A, with blood pressure in persons with normal kidney function. Normotensives and hypertensives did not differ in plasma adiponectin concentration and adiponectin concentration was not correlated with blood pressure in the whole group or in different subgroups. Adiponectin gene polymorphisms were not associated with blood pressure or hypertension, but polymorphism -11391 G>A was associated with insulin resistance, with minor alelle A carrying increased risk. In our group of subjects adiponectin gene polymorphisms were not associated with blood pressure but further larger epidemiologic studies are warranted to clarify this relationship completely

Kliničke karakteristike i liječenje lupusnog nefritisa - preliminarna analiza opservacijskih podataka Nacionalnog referentnog centra

Lupus nephritis (LN) is one of the most severe features of systemic lupus erythematosus (SLE). Data on LN is scarce in the Croatian population. We analysed the characteristics of LN patients diagnosed at our tertiary referral centre. In this retrospective study, we analysed the following features of patients with biopsy-proven LN diagnosed between 2011 and 2020: demographics, renal laboratory parameters, renal histopathology, and treatment. A total of 38 patients were included (30 females; mean age 39±15 years). The most common indication for kidney biopsy was proteinuria (89%). The proportion of LN classes was: class I (2.6%), II (5.3%), III (18.4%), IV (42.1%), V (13.2%), III+V (10.5%), IV+V (5.3%). The median time from SLE diagnosis to histologic confirmation of LN was 1.0 year. All patients were treated with methylprednisolone (MP), 68% received MP pulses. Induction treatment included intravenous (IV) cyclophosphamide (CYC) (71%) (15 patients treated per Euro-Lupus and 9 per the National Institutes of Health regimen), oral CYC (3%), or mycophenolate mofetil (11%). 79% of patients received antimalarials. While there is heterogeneity between different populations, our patient profile was similar to that from other European studies. Further follow-up of this group is necessary to assess outcomes in our population.Lupusni nefritis (LN) je česta i vrlo ozbiljna manifestacija sustavnog eritemskog lupusa (SLE). Još uvijek nema dovoljno podataka o karakteristikama bolesnika s LN u Hrvatskoj. Analizirali smo karakteristike bolesnika s LN koji su liječeni u referentnom centru naše tercijarne ustanove. U ovu retrospektivnu studiju uključili smo bolesnike s biopsijom potvrđenim LN u periodu od 2011. do 2020. godine, analizirali smo demografske podatke, parametre bubrežne funkcije, patohistološki nalaz bioptata bubrega i liječenje. U studiju je uključeno 38 bolesnika (30 žena, prosječna dob 39±15godina). Najčešća indikacija za biopsiju bubrega bila je proteinurija (89%). Raspodjela klasa LN bila je sljedeća: klasa I(2,6 %), II(5,3 %), III(18,4 %), IV(42,1 %), V(13,2 %), III+V(10,5 %), IV+V(5,3 %). Prosječno vrijeme od dijagnoze SLE do histološke potvrde LN bilo je 1,0 godina. Svi bolesnici su liječeni kortikosteroidima, 68 % liječeno je bolusima metilprednizolona. Indukcijska terapija uključivala je parenteralnu primjenu ciklofosfamida (CYC) (71 %) (15 bolesnika liječeno je prema Euro-lupus protokolu, 9 bolesnika prema protokolu Nacionalnog instituta za zdravlje (NIH)), peroralni CYC (3 %) ili mikofenolat mofetil (11 %). Antimalarike je primilo 79 % bolesnika. Unatoč heterogenosti između različitih populacija s LN, profil bolesnika uključen u ovu studiju sličan je ostalim europskim studijama. Daljnje praćenje potrebno je da bi se istražili ishodi u ovoj populaciji

Laparoskopska apendektomija ne povećava stopu negativne apendektomije uz nižu stopu perforiranog apendicitisa - rezultati na 1899 bolesnika u KBC Zagreb

Laparoscopic appendectomy is the method of choice of many professional societies owing to its many advantages. The question arises whether surgeons urge more easily to laparoscopic exploration due to its less invasiveness, faster recovery and adequate exploration of the entire abdominal cavity than to observation in unequivocal cases. This retrospective analysis (2009-2016) included 1899 patients undergoing laparoscopic (lap) or gridiron intra-abdominal approach treated at Zagreb University Hospital Centre. The analysis included total negative appendectomy, negative-negative appendectomy (normal appendix and no other pathology found), and negative-positive appendectomy (normal appendix but another pathology found) in children (≤16 years) and adults. There was no statistically significant difference in the rates of negative appendectomy (children) – lap vs. open (p=0.24); negative appendectomy (adults) – lap vs. open (p=0.15); negative-negative appendectomy (children) – lap vs. open (p=0.36); negative-negative appendectomy (adults) – lap vs. open (p=0.21); negative-positive appendectomy (children) – lap vs. open (p=0.53); negative-positive appendectomy (adults) – lap vs. open (p=0.56); and laparoscopy group negative appendectomy in children vs. adults (p=0.56). There was a statistically significantly higher perforation rate with the open approach in total (p<0.0001), in children (p<0.0001) and in adults (p=0.02). There was no statistically significant difference between adults and children in the perforation rate with laparoscopic approach (p=0.24) and perforation rate with open approach (p=0.29). Results confirmed that there was no statistically significant difference in the rate of negative appendectomy in all subgroups. It is concluded that laparoscopic appendectomy should be offered as the method of choice in any patient population with suspicion of acute appendicitis.Laparoskopska apendektomija metoda je izbora većine stručnih društava zbog dokazanih mnogobrojnih prednosti. Pitanje je da li se u slučajevima nejasne dijagnoze kirurzi ranije odlučuju na laparoskopsku eksploraciju u odnosu na opservaciju zbog manje invazivnosti i bržeg oporavka i eksploracije cijelog abdomena. Na KBC Zagreb retrospektivno je analizirano 1899 bolesnika u razdoblju od 2009. do 2016. godine kod kojih su operacije započete izmjeničnim rezom ili laparoskopskim pristupom (lap) kod sumnje na akutni appendicitis kod djece i odraslih (stariji od 16 godina). Analizirane su: 1) ukupno negativne apendektomije, 2) negativno-negativne apendektomije (uredan apendiks i nije nađena druga patologija) i 3) negativno-pozitivne apendektomije (uredan apendiks, ali je nađena druga patologija). Nije bilo statistički značajne razlike u stopama negativne apendektomije (djeca) – lap prema izmjeničnom rezu (p=0,24); negativne apendektomije (odrasli) – lap prema izmjeničnom rezu (p=0,15); negativno-negativne apendektomije (djeca) – lap prema izmjeničnom rezu (p=0,36); negativno-negativne apendektomije (odrasli) – lap prema izmjeničnom rezu (p=0,21); negativno-pozitivne apendektomije (djeca) – lap prema izmjeničnom rezu (p=0,53); negativno-pozitivne apendektomije (odrasli) – lap prema izmjeničnom rezu (p=0,56); negativne laparoskopske apendektomije – djeca prema odraslima (p=0,56). Utvrđena je statistički značajno viša stopa perforacija izmjeničnim rezom ukupno (p<0,0001), kod djece do 16 godina (p<0,0001) i kod odraslih (p=0,02). Nije bilo statistički značajne razlike u stopi perforacije kod laparoskopskog pristupa između odrasle i dječje populacije (p=0,24) te stopi perforacije kod pristupa izmjeničnim rezom između odraslih i djece (p=0,29). Rezultati upućuju na zaključak da niti u jednoj podskupini laparoskopska apendektomija ne rezultira višom stopom negativne apendektomije, no uz niže stope perforiranog apendicitisa pa se laparoskopska apendektomija preporuča kao metoda izbora kod sumnje na akutni apendicitis kod djece i odraslih

Expression of BMP-2 in vascular endothelial cells of recipient may predict delayed graft function after renal transplantation

BACKGROUND/AIMS: Delayed graft function (DGF) is associated with adverse outcomes after renal transplantation. Bone morphogenetic protein-2 (BMP-2) is involved in both endothelial function and immunological events. We compared expression of BMP-2 in epigastric artery of renal transplant recipients with immediate graft function (IGF) and DGF. ----- METHODS: 79 patients were included in this prospective study. Patients were divided in IGF group (64 patients) and DGF group (15 patients). BMP-2 expression in intima media (BMP2m) and endothelium (BMP2e) of epigastric artery was assessed by immunohistochemistry. ----- RESULTS: Lower intensity of BMP2e staining was recorded in DGF compared to IGF. In DGF patients, 93% had no expression of BMP2e and 7% had 1st grade expression, compared to 45% and 41% in IGF group, respectively (P=0.001) (P<0.001 for no expression and P = 0.015 for 1st grade expression). Patients who had BMP2e staining positive had lower odds for DGF (OR 0.059 [0.007, 0.477]) and this remained significant even after adjustment for donor and recipient variables, cold ischemia time, and immunological matching (OR 0.038 [0.003, 0.492]). ----- CONCLUSIONS: Our results demonstrate that BMP-2 expression in endothelial cells of epigastric arteries may predict development of DGF

Interventions aimed at loneliness and fall prevention reduce frailty in elderly urban population

Frailty is a pronounced symptom of aging associated with multiple comorbid states and adverse outcomes. The aim of this study was to evaluate the impact of 2 interventions, one based on prevention of falls and the other on prevention of loneliness, on total frailty and dimensions of frailty in urban community-dwelling elderly as well as associations with independent living. This prospective interventional study followed up 410 persons aged 75 to 95. The participants of the control and intervention groups were monitored through a public health intervention programme. The level of frailty was measured by the Tilburg Frailty Indicator (TFI) questionnaire and the factors of independent living were analyzed using validated questionnaires. After 1 year, physical frailty measured in the control group showed a statistically significant increase (r=0.11), while in the intervention groups physical frailty did not increase (both P>.05). Psychological frailty measured after 1 year in the control group was significantly higher (r=0.19), as well as in the group where the public health interventions to reduce loneliness were carried out (r= 0.19). Psychological frailty did not increase in the group in which public health interventions to prevent falls were carried out, and social frailty did not increase at all in the study period. The total level of frailty in the control group after 1 year was significantly increased (r=0.19), while no increase was seen in the overall frailty in the intervention group. Multivariate analysis has shown that both interventions where independently associated with lower end frailty. Additionally, higher baseline frailty and visit to a physician in the last year were positively associated with higher end-study frailty level, while higher number of subjects in the household and higher total psychological quality of life (SF-12) were independently associated with lower end-study frailty. Only in the prevention of falls group there was no increase in restriction in the activities of daily living throughout study follow-up. Public health interventions to prevent falls and to prevent loneliness have a positive effect on the frailty and independent living of the elderly living in their own homes in an urban community

Laparoscopic Appendectomy does not Increase the Rate of Negative Appendectomy along with a Lower Rate of Perforated Appendicitis – Results in 1899 Patients at Zagreb UHC

Laparoscopic appendectomy is the method of choice of many professional societies owing to its many advantages. The question arises whether surgeons urge more easily to laparoscopic exploration due to its less invasiveness, faster recovery and adequate exploration of the entire abdominal cavity than to observation in unequivocal cases. This retrospective analysis (2009-2016) included 1899 patients undergoing laparoscopic (lap) or gridiron intra-abdominal approach treated at Zagreb University Hospital Centre. The analysis included total negative appendectomy, negative-negative appendectomy (normal appendix and no other pathology found), and negative-positive appendectomy (normal appendix but another pathology found) in children (≤16 years) and adults. There was no statistically significant difference in the rates of negative appendectomy (children) – lap vs. open (p=0.24); negative appendectomy (adults) – lap vs. open (p=0.15); negative-negative appendectomy (children) – lap vs. open (p=0.36); negative-negative appendectomy (adults) – lap vs. open (p=0.21); negative-positive appendectomy (children) – lap vs. open (p=0.53); negative-positive appendectomy (adults) – lap vs. open (p=0.56); and laparoscopy group negative appendectomy in children vs. adults (p=0.56). There was a statistically significantly higher perforation rate with the open approach in total (p<0.0001), in children (p<0.0001) and in adults (p=0.02). There was no statistically significant difference between adults and children in the perforation rate with laparoscopic approach (p=0.24) and perforation rate with open approach (p=0.29). Results confirmed that there was no statistically significant difference in the rate of negative appendectomy in all subgroups. It is concluded that laparoscopic appendectomy should be offered as the method of choice in any patient population with suspicion of acute appendicitis