The use of artificial intelligence in nephrology

Introduction and methods Artificial Intelligence(AI) is a relatively new branch of science that studies the display of intelligent behavior by machines and its use in advanced analysis and computation. Due to the potential use of AI, it has also been introduced into medicine and nephrology. The following article is an analysis of the current knowledge on the potential of AI in nephrology and its relevance to clinicians based on the latest publications contained in the PubMed and Google Scholar databases. Stage of knowledge AI found its application in the prognosis of the development of IgA nephropathy thanks to the use of a neural network, which by analyzing the results of research and the drugs used in a large group of patients has learned to detect patients at high risk of developing severe complications at the beginning of the disease. What is more, AI makes it possible to detect DKD earlier and delay renal replacement therapy. In patients undergoing hemodialysis, artificial intelligence developed a model that calculated the appropriate duration of the procedure and adjusted drugs to control blood pressure. Another example of the use of AI is its use in relation to patients undergoing kidney transplantation. The AI calculates the beneficial concentration of an immunosuppressive drug specifically for a given patient, which allows clinicians to limit adverse effects. Summary AI is a breakthrough technology that is constantly being developed. Despite the high cost of implementing this technology, it is believed that it could represent the future of medicine and be a new way in treatment techniques and in the early detection of diseases in nephrology

What does the future look like - home hemodialysis

Home hemodialysis (HHD) is a discovery from 1961 that is now experiencing a revival. It is a convenient and modern method of renal replacement therapy that allows the patient to undergo hemodialysis sessions at home. Due to the growing interest in home hemodialysis, we decided to present the potential of this renal replacement method, show both its benefits and complications resulting from its use. Undoubtedly, HHD has many benefits resulting mainly from the possibility of regulating the duration of the sessions and increasing their frequency. However, this method is also burdened with numerous complications. There are training courses in the use of HHD for patients who have just been diagnosed with end-stage renal disease as well as for patients undergoing dialysis using other methods. Appropriate patient selection is an important factor for the success of home therapy. There is a fierce battle in the home hemodialysis machine market. Manufacturers are outdoing each other in innovative technologies to ensure ease of use, trouble-free operation and minimize complications. The costs of home hemodialysis include more components than the dialysis treatment itself. Home hemodialysis gives patients comfort and independence above all. This is part of nephrology that undoubtedly requires a lot of work and development, but is certainly an invention of the 21st century

Analysis of the prevalence of pediculosis and scabies in orphanages and refugee shelters in south-eastern Poland

Grouping conditions refer to a situation when number of entities is considered as a unit. The members of such a community resides in a certain area at a specified time and has to comply with specific rules of social life. The analysis of the data from orphanages and refugee shelters in south-eastern Poland has confirmed that this type of living conditions promote transmission of scabies and pediculosis, and these diseases were most frequently diagnosed in young people taking active part in social life. Our study revealed that invasions of Pediculus humanus and Sarcoptes scabiei are still current public health threats although the obligation to report cases of these diseases in Poland has been abolished

Proteomic Approaches to Study Cysteine Oxidation: Applications in Neurodegenerative Diseases

Oxidative stress appears to be a key feature of many neurodegenerative diseases either as a cause or consequence of disease. A range of molecules are subject to oxidation, but in particular, proteins are an important target and measure of oxidative stress. Proteins are subject to a range of oxidative modifications at reactive cysteine residues, and depending on the level of oxidative stress, these modifications may be reversible or irreversible. A range of experimental approaches has been developed to characterize cysteine oxidation of proteins. In particular, mass spectrometry-based proteomic methods have emerged as a powerful means to identify and quantify cysteine oxidation sites on a proteome scale; however, their application to study neurodegenerative diseases is limited to date. Here we provide a guide to these approaches and highlight the under-exploited utility of these methods to measure oxidative stress in neurodegenerative diseases for biomarker discovery, target engagement and to understand disease mechanisms

Mechanisms of drug-induced synaptic and structural plasticity in nucleus accumbens

Substancje uzależniające powodują zmiany w budowie i funkcjonowaniu synaps, co przyczynia się do powstawania zmian behawioralnych charakterystycznych dla uzależnienia. U podłoża tych procesów leżą mechanizmy długotrwałego wzmocnienia synaptycznego (LTP) oraz długotrwałego osłabienia synaptycznego (LTD), co w efekcie prowadzi do zmian plastycznych. W literaturze opisuje się wiele substancji uzależniających, które mogą się wiązać do różnych typów receptorów, bądź transporterów. Za efekty wzmianiające substancji uzależniających w głównej mierze odpowiada neurotransmisja dopaminergiczna i glutaminergiczna w średnich neuronach kolczystych (MSN) jądra półleżącego (NAc) oraz połączenia z innych struktur układu nagrody. Badania wskazują również na istnienie związku pomiędzy długotrwałymi zmianami morfologicznymi neuronów i działaniem czynników transkrypcyjnych na aktywność genów.Drugs of abuse contribute to development of structural and functional alterations in synapses, which, in consequence, leads to the evolvement of long-lasting changes in behavioral plasticity driving addiction. Long-term potentiation (LTP) and long-term depression (LTD) are the mechanisms which underlie drug-induced synaptic plasticity in reward system of the brain. There are a great variety of addictive drugs described in literature, that can be divided into groups depending on their ability of binding to different type of receptors. For reinforcing effects of the drugs are responsible both dopaminergic inputs from ventral tegmental area (VTA) to medium spiny neurons (MSN) of nucleus accumbens (NAc) and glutamatergic afferents from other structures of the reward pathway. Studies indicate, that there is also an important link between prolonged morphological changes in dendritic tree affected by drugs and the activity of transcriptional factors on genes

Transcriptomic evaluation of transgenic mice devoid of CREB transcription factor in serotonergic and noradrenergic systems.

Depresja jest powszechnie występującym zaburzeniem psychicznym o nie do końca poznanej etiologii, objawiającym się, m.in. długotrwałym obniżeniem nastroju i napędu psychoruchowego oraz biernością w stosunku do przyjemnych bodźców, co może prowadzić do myśli i tendencji samobójczych. Jedna z przyjętych hipotez rozwoju depresji zakłada, że obserwowane objawy są efektem obniżonego poziomu monoamin w mózgu, dlatego wiele stosowanych leków przeciwdepresyjnych (LPD) zwiększa stężenie tych neuroprzekaźników w szczelinie synaptycznej. W badaniach prowadzonych na materiale post-mortem oraz modelach zwierzęcych wykazano, iż interesującym białkiem, którego ekspresja może istotnie zmieniać się pod wpływem, m.in. LPD oddziałujących na transmisję serotoninową i noradrenergiczną, jest czynnik transkrypcyjny CREB, obecny w różnych typach komórek i odpowiadający za regulację wielu genów. Dane te są jednak niespójne – obserwowano zarówno wzrost, jak i spadek ekspresji CREB pod wpływem LPD, co może wynikać z użycia w tych badaniach modeli transgenicznych z nieselektywną ablacją jedynie CREB, którego funkcja może być przejęta przez inne białka modulatorowe (m.in. CREM). Aby wyeliminować powyższe przeszkody, w badaniach opisanych w tej pracy zastosowano system warunkowej/indukowanej ekspresji genów (system Cre/loxP), który umożliwił usunięcie czynnika transkrypcyjnego CREB specyficznie w neuronach serotoninowych (linia myszy CrebTPH2CreERT2) i noradrenergicznych (linia myszy CrebDBHCre), przy czym w obu przypadkach linie te były dodatkowo utrzymywane w tle genetycznym CREM-/-. Celem pracy była wstępna weryfikacja na poziomie transkryptomicznym ewentualnych zmian wywołanych przez selektywną ablację CREB w tych populacjach komórek neuronalnych. W pierwszym etapie pracy przetestowano i dokonano wyboru najlepszej metody izolacji RNA z małych struktur mózgowych (grzbietowe jądro szwu – DRN oraz miejsce sinawe – LC). Wybrane próbki zostały poddane profilowaniu ekspresji genów techniką mikromacierzy cDNA, w celu wyodrębnienia grup genów ulegających zmiennej ekspresji pod wpływem wprowadzonej mutacji w rejonie DRN i LC. Wykazano istotne statystycznie zmiany w ekspresji 103 genów w DRN i 65 genów w LC, jednak nie zaobserwowano pomiędzy nimi korelacji istotnych w depresji. Dodatkowo, wykonano oznaczenia poziomu ekspresji wybranych genów o postulowanej istotnej roli w mechanizmach działania LPD oraz zależnych od białka CREB techniką RT-PCR w korze przedczołowej i hipokampie – strukturach mózgowych zaangażowanych w patofizjologię depresji. Wykazano zmiany ekspresji genów wyłącznie w hipokampie linii myszy z selektywnym usunięcięm białka CREB w układzie noradrenergicznym. Zmiany te dotyczyły genów z grupy neurotrofin (obniżony poziom bdnf) oraz cytokin (podwyższony poziom il-1). Z uzyskanych wyników można wnioskować o występowaniu mechanizmów kompensujących niedobór CREB w układach neuronalnych, jakie tworzą projekcje noradrenergiczne w mózgu myszy. Dalsza analiza wewnątrzkomórkowych ścieżek sygnałowych związanych z czynnikiem transkrypcyjnym CREB i jego roli w mechanizmach depresji może przyczynić się do lepszego poznania podłoża tego schorzenia i stworzenia nowych, bardziej efektywnych strategii leczenia.Depression is a prevalent psychotic disorder with not fully known etiology. It appears as a long-lasting mood deterioration, psychomotor decline and decreased interest of pleasurable stimuli leading to suicide disposition as a consequence. One of the depression hypothesis assumes that the symptoms are evoked by reduced monoamines level in the brain, hence a great deal of antidepressant drugs acts via elevation of neurotransmitters in the synaptic cleft. Human and animal studies indicate that a transcription factor CREB might be an interesting element, dependent on antidepressant drugs action through serotonin and noradrenaline transmission. CREB is present in many different cell types and regulates expression of many genes. Nevertheless, the effects of these studies are not consistent – both, an increase and a decrease of CREB level after antidepressant treatment were observed. The explanation of this phenomena might be the use of general knock-out mice of creb gene, not taking into consideration compensatory effects of other modulators (e.g. CREM). In order to avoid these obstacles, in this study, the Cre/loxP site-specific system was used to enable the ablation of CREB specifically in the serotoninergic (CrebTPH2CreERT2 mouse line) and noradrenergic (CrebDBHCre mouse line) neurons. These lines were obtained in a CREM-/- background. The purpose of this study was to evaluate potential changes on transcriptomic level, triggerd by the ablation of CREB protein in previously mentioned neuronal populations. The first step was to test and select the best method of RNA isolation from modest brain structures (dorsal raphe nucleus – DRN and locus coeruleus – LC). Samples of a choice were then used for gene expression profiling by cDNA microarray technology in order to isolate groups of genes, which expression have changed as a result of mutation in DRN and LC regions. 103 genes in DRN and 65 genes in LC have been indicated, but there was no important correlation between them in case of depression. In addition, an assessment of expression level of target genes was performed by RT-PCR technique in prefrontal cortex and hippocampus. These brain structures are involved in the pathophysiology of depression, regarding genes postulated to play an important role in mechanisms of antidepressant action and dependent on CREB activity. Changes in expression level were observed in the hippocampus isolated from the line with specific ablation of CREB in noradrenergic cells exclusively. This was due to genes qualified for group of neurotrophins (increased level of bdnf) and cytokines (reduced level of il-1). These results indicate possible existance of compensatory mechanisms in the absence of CREB in neuronal systems involving noradrenergic innervation in mouse brain. Further analysis of intracellular pathways connected to the transcription factor CREB and its role in depression may provide better understanding of the disorder undertow. It can also contribute to the production of new, more efficient treatment strategies of this disorder

Skin Lesions and Systemic Reactions in Humans Infested by Blackflies (Diptera: Simullidae) in Recreational Areas in Southeastern Poland

Due to their mass occurrence in some environments and high aggressiveness, blackflies (Simulium spp.) represent the most bothersome arthropods attacking humans. In this study, we describe the medical effects of blackfly infestations in humans in southeastern Poland. Local and systemic reactions to blackfly bites were monitored in 418 patients (61.24% of females and 38.76% of males) of medical centers. Only skin lesions at the site of the bites were found in 88.52% of the patients, whereas accompanying systemic reactions were diagnosed in 11.48%. The most common signs observed in the area of the bites were pruritus (94.74%), burning (55.02%), edema (44.02%), and erythema (40.91%). The skin lesions, which were most often grouped small papules and papular and purpuric lesions with a varied range, typically persisted for several days, or for several weeks in some patients. Statistical analyses confirmed that the persistence of the skin lesions did not depend on the sex of the patients and the number of blackfly infestations. The systemic reactions to the components of the blackfly saliva were manifested by headache, increased body temperature, arthralgia, lymphadenopathy, and menstrual disorders in the females. The patients were most often attacked simultaneously by many blackflies on exposed parts of the body, mainly the upper limb, lower limb, head, and neck areas. The investigations indicate that blackflies are an important etiological factor of dermatitis and other symptoms in humans; hence, they should be considered in clinical diagnosis

Tick Preventive Behaviors and Practices Adopted by Medical Students from Poland, Germany, and Thailand in Relation to Socio-Demographic Conditions and Their Knowledge of Ticks and Tick-Borne Diseases

Given the high medical importance of ticks, we analyzed the most common preventive behaviors and practices adopted by medical students from Poland, Germany, and Thailand, and the level of their knowledge of ticks and tick-borne diseases. A survey consisting of 19 questions was conducted among 636 randomly selected students. The study showed that the Polish and German students preferred inspection of the body on their return home (86.9% and 63.5%, respectively) and wearing protective clothes (79.8% and 32.3%, respectively) as part of prophylaxis. The Thai students most often chose wearing protective clothes (54.7%) and preventive behavior in tick habitats (42.7%). Approximately 7% of the Polish medical students and as many as 22% of the German and Thai respondents did not use any means of prevention. Our analyses suggest that the use of preventive methods and respondents’ behaviors depend on socio-demographic factors and the level of health education. The insufficient practical implementation of tick prevention measures by the medical students suggests a need for verification of health education programs in schools as well as effective popularization and educational activities. It is also necessary to develop a public health protection strategy against the effects of tick bites

The Potential Role of Migratory Birds in the Rapid Spread of Ticks and Tick-Borne Pathogens in the Changing Climatic and Environmental Conditions in Europe

This opinion piece highlights the role of migratory birds in the spread of ticks and their role in the circulation and dissemination of pathogens in Europe. Birds with different lifestyles, i.e., non-migrants residing in a specific area, or short-, medium-, and long-distance migrants, migrating within one or several distant geographical regions are carriers of a number of ticks and tick-borne pathogens. During seasonal migrations, birds that cover long distances over a short time and stay temporarily in different habitats can introduce tick and pathogen species in areas where they have never occurred. An increase in the geographical range of ticks as well as the global climate changes affecting the pathogens, vectors, and their hosts increase the incidence and the spread of emerging tick-borne diseases worldwide. Tick infestations of birds varied between regions depends on the rhythms of tick seasonal activity and the bird migration rhythms determined by for example, climatic and environmental factors. In areas north of latitude ca. 58°N, immature Ixodes ricinus ticks are collected from birds most frequently, whereas ticks from the Hyalomma marginatum group dominate in areas below 42°N. We concluded that the prognosis of hazards posed by tick-borne pathogens should take into account changes in the migration of birds, hosts of many epidemiologically important tick species

Food-Borne Transmission of Tick-Borne Encephalitis Virus—Spread, Consequences, and Prophylaxis

Tick-borne encephalitis (TBE) is the most common viral neurological disease in Eurasia. It is usually transmitted via tick bites but can also occur through ingestion of TBEV-infected milk and dairy products. The present paper summarises the knowledge of the food-borne TBEV transmission and presents methods for the prevention of its spread. The incidence of milk-borne TBE outbreaks is recorded in central, eastern, and north-eastern Europe, where Ixodes ricinus, Ixodes persulcatus, and/or Dermacentor reticulatus ticks, i.e., the main vectors of TBEV, occur abundantly. The growing occurrence range and population size of these ticks increases the risk of infection of dairy animals, i.e., goats, sheep, and cows, with viruses transmitted by these ticks. Consumers of unpasteurised milk and dairy products purchased from local farms located in TBE endemic areas are the most vulnerable to alimentary TBEV infections. Familial infections with these viruses are frequently recorded, mainly in children. Food-transmitted TBE can be monophasic or biphasic, and some of its neurological and psychiatric symptoms may persist in patients for a long time. Alimentary TBEV infections can be effectively prevented by consumption of pasteurised milk and the use of TBEV vaccines. It is recommended that milk and dairy products should be checked for the presence of TBE viruses prior to distribution. Protection of dairy animals against tick attacks and education of humans regarding the epidemiology and prophylaxis of TBE are equally important