Management of hypertension in hemodialysis patients

Hypertension occurs in 50–90% of hemodialysis patients and is one of the main causes of increased cardiovascular risk in these patients. The factors responsible for the development of hypertension in this population include water retention, activation of the sympathetic nervous and the rennin–angiotensin– aldosterone systems, calcium–phosphate disturbances, impaired secretory function of vascular endothelial cells, obstructive sleep apnea or treatment with erythropoiesis stimulating agents. The reference method in terms of diagnosis, monitoring of treatment and prognosis seems to be 44 hours automated ambulatory blood pressure measurement. This method is, however, the cost and poorly accepted by patients. So it is recommended that the patients should record themselves their blood pressure measurements at home in interdialytic period. Recent recommendations of the JNC 8, KDIGO and ESH/ESC guidelines do not clearly indicate the optimal values of blood pressure in patients treated with hemodialysis. According to the recommendations NKF/KDOQI of 2005 the target blood pressure before HD should be < 140/90 mm Hg, and after HD < 130/80 mm Hg. Optimal blood pressure in an outpatient setting should be ≤ 135/85 mm Hg during the day and ≤ 120/80 mm Hg at night. The basic method to bring blood pressure to normal is to achieve the patient „dry weight”. The profiling sodium concentration in the dialysate and to limit its intake in the diet is helpful. Pharmacological reduction of blood pressure is associated with a reduced risk of cardiovascular events and cardiovascular mortality. Increasing the frequency and/or duration of dialysis may also be treated as an alternative method of treatment of hypertension.Nadciśnienie tętnicze występuje u 50–90% chorych hemodializowanych i jest jedną z głównych przyczyn podwyższonego ryzyka sercowo-naczyniowego w tej grupie pacjentów. Do czynników odpowiedzianych za rozwój nadciśnienia w tej populacji zalicza się zatrzymywanie wody w okresie międzydializacyjnym, aktywację układu współczulnego oraz układu renina–angiotensyna–aldosteron (RAA), zaburzenia gospodarki wapniowo-fosforanowej, nieprawidłową czynność wydzielniczą komórek śródbłonka naczyniowego, obturacyjny bezdech senny czy leczenie środkami stymulującymi erytropoezę. Na podstawie badań za metodę referencyjną w aspekcie diagnostyki, monitorowania leczenia oraz prognozy rokowania można uznać 44-godzinny automatyczny ambulatoryjny pomiar ciśnienia. Metoda ta jest jednak kosztowana i słabo akceptowana przez pacjentów. Ciśnienie jest więc mierzone powszechnie w stacjach dializ, najczęściej w sposób niestandaryzowany, dlatego rekomenduje się pacjentom wykonywanie i rejestrowanie pomiarów ciśnienia w warunkach domowych. Najnowsze zalecenia the Eighth Joint National Committee (JNC 8), Kidney Disease: Improving Global Outcomes (KDIGO), Europejskiego Towarzystwa Nadciśnienia Tętniczego (ESH, European Society of Hypertension) oraz Europejskiego Towarzystwa Kardiologicznego (ESC, European Society of Cardiology) nie wskazują jednoznacznie optymalnych wartości ciśnienia tętniczego u pacjentów leczonych hemodializą. Według zaleceń The National Kidney Foundation/Kidney Disease Outcomes Quality Initiative (NKF/KDOQI) z 2005 roku prawidłowe ciśnienie tętnicze u pacjentów hemodializowanych przed zabiegiem powinno wynosić < 140/90 mm Hg, a po zabiegu < 130/80 mm Hg. Optymalne ciśnienie tętnicze w warunkach ambulatoryjnych powinno wynosić ≤ 135/85 mm Hg w dzień oraz ≤ 120/80 mm Hg w nocy. Podstawową metodą na doprowadzenie ciśnienia tętniczego do normy lub poprawę jego kontroli jest osiągnięcie u pacjenta „suchej wagi”. Pomocne jest profilowanie stężenia sodu w dializacie oraz ograniczenie jego spożycia w diecie. Farmakologiczne obniżenie ciśnienia tętniczego wiąże się ze zmniejszeniem ryzyka powikłań sercowo- -naczyniowych i śmiertelności sercowo-naczyniowej. Zwiększenie częstości i/lub czasu dializ można również traktować jako alternatywną metodę leczenia nadciśnienia tętniczego

Poland and the European Community - comments on economic cooperation and integration

The article outlines the problems and difficulties arising in the process of co-operation and gradual economic integration of Poland and the European Community (or, currently: the European Union). These difficulties are related on the one hand to the maintaining by the EC of various trade barriers with regard to post-socialist countries, on the other hand to the incompatibility of Poland's economy with the EC standards, particularly those concerning the quality of products. The transitional period provided for in the Association Agreement is therefore very useful for broadly planned adjustment programs. The necessary strengthening of the competitiveness of Poland's economy may be obtained through an active industrial policy, as well as a subtle yet effective protection of the local market. The great challenge of the integration of the formerly separated parts of Europe can be met more easily with the help of a closer regional co-operation between the so-called Visegrad countries. Their current rivalry should thus be superseded by the co-ordination of actions aiming at integration with the EC.Digitalizacja i deponowanie archiwalnych zeszytów RPEiS sfinansowane przez MNiSW w ramach realizacji umowy nr 541/P-DUN/201

Policy and Theory of Regions Activation in Poland

The article contains a set of reflections concerning policy of activation of regions in Poland. The author endeavours to prove that undertakings connected with aecelaretion of economic development and with improvement of the state of their economies have had as a rule a compact character with main directions of the socio-economic policy of the state. Starting from the year 1918 the author has investigated actions connected with activation of regions development. The first step in that sphere was levelling regional disproportions after the period of the partitions of Poland. After the Second World War a fundamental problem of the state economic policy consisted in ensuring quick reconstruction processes, and — in spatial dimension — in ensuring integration of the coutry's economy within its new borders. That task was simultaneously a great activation operation. A great role had been played in searching for theoretical concepts by the research of the Poznań school under direction of S. Kruszczyński. An important role in research on methods of economic activation had also been played by Kraków and Warsaw centres. Actions of all centres have been co-ordinated by the National Commission of Spatial Development of the Polish Academy of Sciences with St. Leszczycki. International co-operation between the CMEA countries also contributed to activation processes of particular regions. The author states in the conclusion that activation operations were effective if they were connected with main directions of a development strategy determined by socio-economic policy on the national scale. From the scientific point of view the reserve (resource) theory of backward regions activation proved realistic and adequate, ithoogh especially strong for regions possessing raw materiails.Digitalizacja i deponowanie archiwalnych zeszytów RPEiS sfinansowane przez MNiSW w ramach realizacji umowy nr 541/P-DUN/201

Poland and the European Community - comments on economic cooperation and integration

The article outlines the problems and difficulties arising in the process of co-operation and gradual economic integration of Poland and the European Community (or, currently: the European Union). These difficulties are related on the one hand to the maintaining by the EC of various trade barriers with regard to post-socialist countries, on the other hand to the incompatibility of Poland's economy with the EC standards, particularly those concerning the quality of products. The transitional period provided for in the Association Agreement is therefore very useful for broadly planned adjustment programs. The necessary strengthening of the competitiveness of Poland's economy may be obtained through an active industrial policy, as well as a subtle yet effective protection of the local market. The great challenge of the integration of the formerly separated parts of Europe can be met more easily with the help of a closer regional co-operation between the so-called Visegrad countries. Their current rivalry should thus be superseded by the co-ordination of actions aiming at integration with the EC.Digitalizacja i deponowanie archiwalnych zeszytów RPEiS sfinansowane przez MNiSW w ramach realizacji umowy nr 541/P-DUN/201

The GC-box is critical for high level expression of the testis-specific Hsp70.2/Hst70 gene

The Hsp70.2/Hst70 gene, which belongs to the 70 kDa heat-shock protein (HSP) family, is expressed specifically in primary spermatocytes and spermatids. The regulatory elements required for a high level of testis-specific expression of the gene are placed between the two major transcription start sites T1 and T2 (approximately 350 and 115 bp upstream of the starting ATG codon). Here we have shown that sequences proximal to the exon1/intron splicing site in the 5' untranslated region of the Hsp70.2/Hst70 gene, which include a highly conserved element called box B, are required for efficient expression of the chloramphenicol acetyltransferase reporter gene in testes of transgenic mice. However, in spite of the drastically reduced overall activity, the stage-specific expression pattern of the transgene was preserved after removal of these sequences. We have also shown that GC-box located downstream of the box B (approximately 210 bp upstream of the starting ATG codon) is indispensable for efficient expression of the Hsp70.2/Hst70 gene promoter in spermatogenic cells. The GC-box specifically binds proteins present in nuclear extracts from testes (putatively Sp1-like factors). A change in the pattern of such GC-box-interacting factors corresponds to activation of the Hsp70.2/Hst70 gene, confirming the importance of this regulatory element