Bratislava Medical Journal-Bratislavske Lekarske Listy最新文献

Cisplatin is commonly used in the treatment of lung, genitourinary, and gastrointestinal cancers. Peripheral neuropathy is the most important side effect, leading to a decrease in the dose of cisplatin or its complete cessation in the early period. 16 rats were given cisplatin at a dose of 2.5 mg/ kg/day twice a week for 4 weeks to induce neuropathy model. The rats taking Cisplatin were divided into 2 groups. Group 1 rats (n = 8) were given 1 ml/kg/day 0.9 % NaCl intraperitoneally, and Group 2 rats were given 10 mg/kg/day Propofol intraperitoneally daily for 4 weeks. The remaining 8 rats served as the control group. At the end of the study, all animals were tested for motor functions. Blood samples were collected for the measurement of plasma lipid peroxidation (malondialdehyde; MDA), tumor necrosis factor (TNF-α), glutathione (GSH), IL-6 and HSP-70 levels. Electromyography findings revealed that compound muscle action potential (CMAP) amplitude was significantly higher in the cisplatin-Propofol group than in the cisplatin-saline group. Also, cisplatin-Propofol treated group showed significantly lower TNF-α, MDA and IL-6 levels and higher GSH and HSP-70 levels than cispalatin-Saline group (p < 0.01, p < 0.001). In addition, while the CMAP latency was decreased in the propofol group, the CMAP amplitude was increased, and a significant improvement was observed in the Inclined test scores. Besides, histological examinations showed an increase in axon diameter and NGF expression with Propofol treatment. This study demonstrated that Propofol exerts protective activity against cisplatin-induced neurotoxicity by increasing endogenous antioxidants and reducing lipid peroxidation and inflammation (Tab. 3, Fig. 4, Ref. 30). Text in PDF www.elis.sk Keywords: cisplatin, neuropathy, propofol, oxidative damage, ınflammation.

Objectives: Betulinic acid is pentacyclic triterpenoid known to exert antitumor effects by modulating many cellular pathways in various human malignancies. However, its modulatory role in autophagy in renal cell carcinoma remains unclear. Here, we observed how betulinic acid affects autophagy in renal cell carcinoma cells.

Methods: After treating cells with betulinic acid, we determined the gene expression and protein levels of Beclin-1 and ATG-5 by qPCR and ELISA assay to observe its effects on autophagy.

Results: The qPCR results demonstrated that Beclin-1 expression level was low in untreated metastatic renal adenocarcinoma ACHN cells and increased in response to 25 µM and 50 µM betulinic acid treatment. ATG-5 expression level was decreased in primary clear cell renal cell carcinoma CAKI-2 cells treated with 50 µM betulinic acid. In the ELISA assay results, we observed that betulinic acid caused a decrease in Beclin-1 protein level at 25 µM concentration and in ATG-5 protein level at 50 µM concentration in CAKI-2 cells.

Conclusion: In our preliminarily study, it was concluded that the role of autophagy may differ in renal cell carcinoma cells depending on their origin and that the effects of betulinic acid on autophagy in these cells may vary accordingly (Fig. 4, Ref. 40). Text in PDF www.elis.sk Keywords: betulinic acid, autophagy, kidney, cancer, cell.

Background: Vascular endothelial growth factor (VEGF) is a signalling protein of critical importance for angiogenesis. In an effort to better understand its significance in hypertension-induced injury of the heart and kidney we aimed at studying the changes in its expression in an experimental model and correlated it with capillary density in the myocardium and the renal parenchyma.

Methods: We used two age groups of spontaneously hypertensive rats (6- and 12-month-old), indicative of early and advanced hypertension. VEGF expression was assessed and a semi-quantitative analysis of its immunoreactivity was conducted. Changes in capillary density in the myocardium and kidney were assessed for statistical significance and correlations with VEGF expression were established.

Results: We reported stronger VEGF expression in animals with early compared to advanced hypertension in all examined structures. Capillary density decreased significantly at age 12 months compared to 6 months and was significant in all examined structures. A positive correlation was established between capillary density and the expression of VEGF.

Conclusion: These findings underscore the key significance of VEGF for compensatory angiogenesis and suggest that a statistically significant depletion of these vascular adaptive mechanisms is a major aspect in the cascade of hypertension-induced injury of the heart and kidney (Tab. 3, Fig. 26, Ref. 47).

Objective: To evaluate the effectiveness of endoscopic and surgical intervention in treating anastomotic leaks after oesophagectomy.

Background: Anastomotic leak after oesophagectomy is a severe complication associated with significant morbidity and mortality. This study aimed to analyse our experience with the management of anastomotic leak after oesophagectomy.

Methods: A retrospective study evaluated the treatment outcome and duration of treatment in patients with anastomotic dehiscence or conduit necrosis after oesophagectomy from November 2008 to November 2021.

Results: The group consists of forty-seven patients. Twenty-one (44.7 %) patients had dehiscence of the neck anastomosis, twenty patients (42.6 %) had dehiscence of the chest anastomosis, and six (12.8 %) patients had conduit necrosis. Nineteen patients with dehiscence were primarily treated by endoscopic insertion of a self-expanding metal stent with perianastomotic drainage; the other patients were primarily treated surgically. Mortality associated with anastomosis dehiscence was 27.7 % (thirteen patients). Stent use in treatment was a statistically significant parameter regarding the length of hospital stay and mortality.

Conclusion: Self-expanding metal stents can reduce leak-related morbidity and mortality after oesophagectomy and may be considered a cost-effective treatment alternative (Tab. 2, Fig. 2, Ref. 21).

Objective: To investigate factors influencing the frequency and type of microembolic signals (MES) detected using transcranial Doppler (TCD) in patients undergoing elective coronary intervention, and to correlate MES with silent stroke detected using magnetic resonance imaging (MRI) and cognitive dysfunction.

Methods: The subset study of a randomized clinical trial was conducted on 70 patients (58 males; mean age 59.9 ± 8.4 years) who underwent bilateral TCD monitoring of middle cerebral arteries (MCAs) during elective coronary interventions. Neurologic examination and brain MRI were performed prior to, and 24 h post‑intervention. Cognitive function tests were performed prior to, and on day 30 post‑intervention.

Results: The incidence of detected MES was 94.3 %. Eighteen (25.7 %) patients had new clinically asymptomatic ischemic lesions on MRI. The number of solid MES negatively correlated with changes in revised Addenbrooke's Cognitive Examination test (ACE-R) and, the number of solid MES and combinations of solid and gaseous MES negatively correlated with changes in Mini Mental‑State Examination (MMSE) conducted on day 30 after the intervention (p < 0.05 in all cases).

Conclusion: Cardiac catheterization was associated with a high risk of cerebral embolism in our patients. A higher number of solid MES and combinations of solid and gaseous MES was associated with the deterioration in cognitive tests (Tab. 5, Fig. 3, Ref. 30).

Background: Familial combined hypolipidaemia is a condition characterised by very low concentrations of circulating very-low-density lipoprotein (VLDL), low-density lipoprotein cholesterol (LDL), and high-density lipoprotein cholesterol (HDL). It is thought that low LDL/combined hypolipidaemia can protect from cardiovascular disease (CVD), but this is not what we found in a case we present.

Objective: We report on a 57-years-old male patient with combined hypolipidaemia who presented with premature peripheral vascular disease. We investigated also his two sons, 32- and 27-years-old, who manifested a tendency to low lipid levels.

Methods and results: We used Illumina exome analysis in all three individuals and in all of them we could exclude the major effect of the variants within the genes most frequently mutated in hypolipidaemia, including recently reported LIPC gene variant. Instead, in all three individuals we identified a novel ABCA1 variant, possibly responsible for the decreased HDL levels. The proband and one of his sons also share the splicing APOC3 variant rs138326449, known to be associated with decreased TG levels.

Conclusion: The heterogeneous nature and the risk of atherosclerosis in combined hypolipidaemia seems to be variable, based on an interplay between low HDL and LDL levels, and it depends on the combination of variants that cause it (Tab. 2, Ref. 38).

Objective: There is ongoing research on treatments that promote antioxidant and anti-inflammatory mechanisms, which will reduce mortality in sepsis. In this study, we compared the anti-inflammatory and antioxidant activities of quercetin and ascorbic acid using a sepsis model induced in infant rats.

Methods: A total of 28 infant rats 21-days-old that had just completed the lactation period were divided into four groups: control, sepsis, sepsis + quercetin, and sepsis + ascorbic acid. The sepsis model was created with an intraperitoneal injection of bacterial lipopolysaccharide. After 24 hours, blood samples were collected for analysis of serum levels of inflammatory cytokines (IL-1β, IL-6, TNF-α, and CRP) and antioxidants (CAT, GPx, SOD, and GST).

Results: The superoxide dismutase levels were significantly higher in the sepsis + ascorbic acid group compared to the sepsis and sepsis + quercetin groups. The levels of the most active cytokines in sepsis were significantly lower in the serum samples of the septic subjects who received quercetin and ascorbic acid.

Conclusion: The antioxidant activity, which is impaired in sepsis, was increased by both molecules. We observed that these two molecules, which are free of side effects, have a positive influence on the progression of sepsis to severe and fatal sepsis in childhood (Tab. 2, Ref. 38).

Objective: The aim of the paper is to determine the prevalence of levator ani muscle injuries and identify risk factors among women undergoing vaginal birth after Caesarean section (VBAC) compared to those with elective repeat Caesarean section (ERCS).

Material and methods: This prospective observational comparative study was conducted at the 2nd Clinic of Gynaecology and Obstetrics of FM CU and UN Bratislava. Women with a history of one Caesarean section were included in the study. They were divided into those who had a successful VBAC and those who delivered by ERCS. The mothers underwent a 3D/4D ultrasound examination of the pelvic floor muscles 3‒5 days after childbirth. The study evaluates the frequency and risk factors of avulsion injury of the levator ani muscle (LAM) in a group of 46 women after a successful vaginal delivery after a previous Caesarean section and 32 women after ERCS using 3D/4D transperineal ultrasound examination of the pelvic floor.

Results: A total of 78 women were included in the study, 46 after VBAC and 32 after ERCS. In the first group, we recorded LAM avulsion injury in 13 cases (28.3 %); in the post-ERCS group, we did not record this injury (p < 0.0001). We also found an overdistended hiatal area (21.0 vs 19.4 cm2) and a more frequent occurrence of the area exceeding 25 cm2 (21.3 % vs 6.2 %, p = 0.0340) which was approaching the statistical significance. In the first group, we identified an increase in weight during pregnancy to 15 kg and a neonatal birthweight of 4,000 g or higher as risk factors for LAM injury.

Conclusion: In the group of women with VBAC, there is a statistically significant risk of LAM avulsion and a higher occurrence of the overdistended area of ​​the hiatus urogenitalis, especially in women with larger foetuses and in those who experienced greater weight gain during pregnancy (Tab. 3, Ref. 50). Text in PDF www.elis.sk Keywords: pelvic floor, levator ani muscle avulsion, vaginal birth after Caesarean section.

Background: Urinary tract infections (UTI) are the most common infectious complications after kidney transplantation (KTx) with highest incidence in the first three months of transplantation. UTI in transplant recipients increase morbidity and mortality, risk of graft failure and incidence of acute rejection episodes. According to published data, urinary tract infections significantly affect graft survival. The aim of our study was to identify possible risk factors for the development of UTI.

Material and methods: We retrospectively analyzed a cohort of patients who received kidney transplantation between January 2014 and December 2016 in the Transplant Center of Louis Pasteur University Hospital in Košice. One hundred and fifty-three patients after kidney transplantation were included in the study.

Results: A total of 47 Caucasian patients (30%) developed UTI, namely - acute pyelonephritis after KTx. We identified independent risk factors associated with UTI such as female gender OR (7.98, 95% CI 2.88-22.12, p < 0.001), diabetes mellitus (OR 5.26, 95% CI 2.01-13.74, p = 0.001; 95% CI 4.57-53.82, p < 0.001) urologic complication (OR 15.68, 95% CI 4.57-53.82; p < 0.001) and acute rejection episode (OR 3.15, 95% CI 1.13-8.76, p = 0.027). The most common microbiological agent was Escherichia coli.

Conclusion: We identified the aforementioned risk factors of urinary tract infections in the files of our patients. Statistically, the most significant risk factors are the female gender, and presence of urological complications. The urological complications and BMI of the patients are considered modifiable factors. Based on our analysis, we confirmed a significantly higher number of ACR patients who overcame infection which is in accordance with the published data on association of UTI with the development of acute cellular rejection (ACR) (Tab. 2, Fig. 1, Ref. 15).