Advances in medical sciences最新文献

Purpose: Granulocyte concentrates (GCs) are crucial in preventing and treating hazardous infections in neutropenic patients with hematological malignancies. Our study goal was to evaluate the impact of various collection and preparation methods on the quality of GCs.

Materials and methods: Our study included 30 GCs that were collected either by leukapheresis (group L), by standard buffy coat pooling (group S), or by using the Reveos system (group R). All studied GCs were irradiated with gamma rays and stored for 24 h at room temperature without agitation. Laboratory tests included the assessment of leukocyte (WBC), neutrophil, lymphocyte and monocyte counts, pH, cell viability, phagocytosis, and the expression of CD11b, CD62L, CD66b and CXCR4 molecules.

Results: We showed that GCs prepared using different methods differed primarily in terms of cell counts, cell viability, and the CD11b, CD62L and CXCR4 expression. We also observed that gamma irradiation expectedly reduced the lymphocyte count, whereas 24-h storage drastically reduced cell viability. An additional effect of the preparation method on GCs susceptibility to quality changes due to gamma rays and 24-h storage was noticed as well.

Conclusions: Our research indicates that apheresis-derived granulocytes and pooled GCs do not differ enough to not consider more frequent use of the latter in daily clinical practice. Moreover, we concluded that gamma irradiation does not worsen the quality of granulocyte components, and freshly collected GCs should be preferred.

Purpose: We sought to investigate whether left ventricular (LV) contractility and endothelial dysfunction in diabetic patients with ischemic heart failure (HF) are associated with enhanced thrombin generation and altered fibrin clot properties compared with individuals without HF.

Materials and methods: The study included 85 HF patients with type 2 diabetes (T2DM) and ischemic heart disease (IHD). Based on echocardiographic examination, 39 (45.9 %) patients were identified as having LV ejection fraction (LVEF) of <40 % (HFrEF) while 46 patients (54.1 %) of ≥50 % (HFpEF). The control group (n = 43) consisted of diabetic and IHD participants without HF (non-HF). In all groups, endogenous thrombin potential (ETP), fibrin clot permeability (Ks), brachial artery flow-mediated dilation (FMD), and nitroglycerin-mediated dilatation (NMD) were assessed.

Results: HFrEF and HFpEF patients had less permeable fibrin clots than non-HF by 45.4 % and by 14.6 %, respectively (P < 0.05 both). HFrEF patients had higher ETP by 14.4 % (P = 0.004), lower Ks by 16.9 % (P = 0.037) and lower NMD by 34.7 % (P = 0.001) without differences in FMD as compared with HFpEF. Multivariable analysis adjusted for fibrinogen levels showed that lower LVEF (β-coefficient -0.195, 95 % confidence interval [CI] for β-coefficient -0.385 to -0.015), reduced NMD (β-coefficient -0.230, 95 %CI -0.399 to -0.061), and increased total cholesterol level (β-coefficient 0.286, 95 %CI 0.108-0.464) influenced enhanced ETP in HF population.

Conclusions: In diabetic patients with IHD, the diagnosis of HF is associated with more dense fibrin clots. HF patients with reduced versus preserved LVEF have shown enhanced thrombin generation and reduced clot permeability. Impairment of both LV systolic and vascular vasodilator function affected thrombin generation.

Purpose: This study evaluated the effectiveness of subureteric injection (SUI) compared to ureteral reimplantation in treating vesicoureteral reflux (VUR) among children, focusing on whether SUI reduces the need for surgical interventions, especially in complex cases.

Method: We retrospectively analysed 132 children diagnosed with VUR. We divided the patients into two groups: Group 1 - only VUR cases (n = 65) and Group 2 - complex cases (n = 67). We diagnosed VUR and complex pathologies by voiding cystourethrography (VCUG) and cystoscopic examination. VUR was graded according to the International Reflux Study Committee classification system. SUI and intravesical ureteroneocystostomy (UNC) were used as surgical treatment methods.

Results: In Group 2, complex pathologies included duplex renal collecting systems (1.6 %), bladder diverticulum (11.4 %), bladder trabeculation (27.8 %), and posterior urethral valves (18 %). SUI was performed in 48.5 % of patients, with 22.7 % requiring reimplantation after SUI, while 28.8 % underwent direct reimplantation. Success rates of SUI (65.6 %) and reimplantation (70.6 %) were similar (p = 0.68), though lower in children aged 0-2 years with high-grade VUR (45 % for Grade 5) and renal scarring (48 %). Mean recurrence times were 8.4 ± 3.2 months for SUI and 9.1 ± 3.8 months for reimplantation.

Conclusions: The success of SUI and ureteral reimplantation was comparable in both simple and complex cases, suggesting SUI is a viable first-line option, particularly in patients older than 2 years with low-grade reflux. However, further studies are needed to confirm these findings.