Janusz Sierdziński

Long-term cholecalciferol administration in hemodialysis patients: a single-center randomized pilot study.

Background Data on the potent pleiotropic extraskeletal effects of vitamin D have renewed interest in its use in selected populations, including patients with chronic kidney disease, but the available data are still insufficient to make recommendations. This study assessed the long-term effect of small cholecalciferol doses on serum vitamin D, parathormone (PTH), and bone mineral density (BMD) in hemodialysis patients. Material/Methods Nineteen patients with serum 25(OH)D <20 ng/mL were randomized into cholecalciferol (2000 IU 3×/week) and no-treatment groups, then observed for 1 year. Patients with hypercalcemia, hyperphosphatemia, and receiving vitamin D/calcimimetics were excluded. Serum 25(OH)D, 1,25(OH)2D, PTH, and alkaline phosphatase activity were examined every 2 months and BMD was measured before and after the study. Results We observed normalization of serum 25(OH)D with an increase in medians from 11.3 to 44.9 ng/mL (P=0.02) in the cholecalciferol group and no change in the controls (P<0.001). Simultaneously, median serum 1,25(OH)2D increased from 18.2 to 43.1 pmol/L (P=0.02) in the cholecalciferol group and from 10.6 to 21.2 pmol/L (P=0.02) in controls (P=0.013). The treatment was associated with a small increase in serum calcium, but serum phosphate, PTH, alkaline phosphatase, and BMD remained unchanged in both groups. Conclusions Oral cholecalciferol at a dose of 2000 IU/3×/week is an effective and safe way to treat vitamin D deficiency in hemodialysis patients, leading to a significant increase in serum 1,25(OH)2D. However, it was insufficient to suppress the activity of parathyroid glands or to significantly change BMD.

Contribution of volume overload to the arterial stiffness of hemodialysis patients

Abstract Arterial stiffness is evaluated with the measurement of pulse wave velocity (PWV), while overhydration (OH) and nutritional status are evaluated with bioimpedance spectroscopy (BIS). In this study, we investigated the effect of a single dialysis session on arterial stiffness, hydration status, and laboratory parameters. The observational, cross-sectional, cohort study included 71 HD patients with mean age 64 ± 16 yrs. A Complior device was used to perform PWV measurements. The patients were examined immediately before and 15 min after a mid-week hemodialysis session. Body fluids and nutritional status were studied using a Body Composition Monitor (BCM), Fresenius Medical Care. Clinical and laboratory data were also analyzed. Multivariate regression analysis of PWV before HD showed that an OH increase of 1 L relate to a PWV parameter rise before HD of 0.523 m/s. Multivariate regression analysis of PWV after HD showed that a rise of central SBP after HD of 10 mmHg relate to a PWV increase after HD of 0.707 m/s. Our data indicate that hydration status and blood pressure may be major determinants of PWV in HD patients.

Short-term effect of kinesiology taping on temperature distribution at the site of application

ABSTRACT The aim of the study was to assess skin temperature after short-term kinesiology tape application. Seventy-four healthy volunteers with no history of lower back pain participated in the study. Kinesiology tape was applied in the experimental group, and Matopat Classic adhesive tape was applied in the placebo group. Study participants wore the tape for four consecutive days and were then thermographically analyzed for changes in skin temperature. Examination of skin surface temperature distribution revealed a significantly lower temperature (mean decrease, 1.3°C P = .001 area1, 1.5°C P = .001 area2, 1.6 P = .008 area3) immediately after kinesiology tape the removal. One hour after removal of the tape, a statistically significant increase in temperature was observed over all three areas (mean increase, 0.9°C P = .025 area1, 1.0°C P = .0008 area2, 1.0 P = .011 area3). In group 2, there were no statistically significant temperature changes. Based on the findings, we determined that kinesiology taping may affect skin temperature at the site of application.

Microvessel density in head and neck squamous cell carcinoma

PurposeMicrovessel density (MVD) corresponds to the intensity of neo-angiogenesis. MVD assessments are based on the expression levels of the vascular endothelium markers such as, e.g., CD34 or CD105. The goal of this study was to assess MVD among patients with head and neck squamous cell carcinoma (HNSCC), and to evaluate the predictive value of MVD in head and neck cancers.MethodsThe study included 49 patients treated for HNSCC and 11 patients with dysplasia of the upper respiratory tract epithelium. Control tissues consisted of 12 normal mucous membranes of the throat. Expression levels of MVD markers were assessed by immunohistochemistry (IHC) using tissue microarrays (TMA). Clinicopathological factors and patients’ survival over the 5-year follow-up period were analyzed.ResultsThe MVD/CD34 values were found to be significantly elevated in the HNSCCs compared to the non-malignant control tissues (p = 0.001) and to dysplastic tissues. (p = 0.02). Significantly higher MVD/CD105 values were also seen in the tumor compared to the control tissues (p = 0.001) or the dysplastic tissues (p = 0.001). Unexpectedly, significantly lower MVD/CD34 values were seen in the tumor tissues of patients with the T3–T4 tumors compared to those with T1–T2 tumors (p = 0.01).ConclusionsHNSCCs have statistically higher MVD values compared to dysplasia of the upper respiratory tract epithelium. However, the MVD/CD34 values did not correlate with local invasiveness (the T feature) of HNSCCs. This counterintuitive observation suggests that assessments of MVD as performed on TMA by IHC using anti-CD34 or anti-CD105 antibodies considered to be specific for endothelial cell markers might underestimate the extent of the tumor vascularity in HNSCC.

Serum metalloproteinase concentration might be a new predictor of cardiovascular risk in obese women.

INTRODUCTION Increased levels and activity of some matrix metalloproteinases (MMPs) are described in obesity-related vascular diseases. Factors that influence MMP blood concentration are still being investigated. This research aims to evaluate the concentration of most types of MMPs: collagenases (MMP-1, -3, -8, -13), matrilysin (MMP-7), gelatinase (MMP-9), and metalloelastase (MMP-12) in serum of women in reproductive age in relation with their body mass index (BMI), age, oestradiol, and progesterone concentrations. MATERIAL AND METHODS Blood samples were taken from 54 healthy reproductive-aged women with normal menstrual cycles. The weight and height of all women were measured, and body mass index (BMI) was calculated. Concentration of MMP-1, -3, -7, -8, -9, -12, and MMP-13 was evaluated using a Procarta Immunoassay Kit. Serum concentrations of oestradiol and progesterone were evaluated by immunochemiluminescence (32 in the proliferative and 20 in the secretory phase of menstrual cycle). The results of the study were statistically calculated using Pearson, Spearman, and Kruskal-Wallis tests. RESULTS Positive correlation between MMP-7, -8, -9, -12, and -13 levels and BMI was demonstrated. Significantly higher concentrations of MMPs were found especially in obese women compared to women with normal BMI. In healthy, regularly menstruating premenopausal women, MMP levels did not correlate with oestradiol and progesterone concentrations. CONCLUSIONS The results suggest that body mass can influence MMP serum concentration in women with regular menstrual cycles.

Comparison of 3 Times a Week 4- and 5-Hour In-Center Hemodialysis Sessions with Use of Continuous Non-Invasive Hemodynamic Monitoring

BACKGROUND Very aggressive ultrafiltration rate (lasting 3.5-4 h) may result in inadequate hemodialysis (HD). Our aim was to characterize HD-induced cardiovascular adaptation and its links to fluid removal during 4- vs. 5-h HD sessions. MATERIAL AND METHODS The study involved 50 HD patients. A Cardioscreen device (Messtechnik, Ilmenau, Germany) was used to perform non-invasive hemodynamic measurements during mid-week HD sessions. Body fluids and nutritional status were assessed with a Body Composition Monitor (Fresenius Medical Care). Clinical and laboratory data were also analyzed. RESULTS It was shown that when comparing 3 times a week 4- vs. 5-h dialysis sessions, body mass index (BMI [kg/m²]), Kt/V, and ultrafiltration volume (UFV [mL]) were significantly lower in the 4-h dialysis group (23.1±3.5 vs. 27.1±4.7; 1.36±0.28 vs. 1.55±0.23; 1770±601 vs. 2831±836; P<0.05, respectively). Cardiac index (CI [L/min/m²]) and thoracic fluid content (TFC [1/kW]) were significantly reduced in 4-h dialysis sessions (3.1±0.6 to 2.7±0.7; 35.1±8.4 to 32.8±6.8; P<0.05, respectively). In patients treated with 5-h dialysis sessions, we found that heart rate (HR [bpm]) was significantly increased (69±10 to 74±15; P<0.05) and TFC was reduced (34.3±8.9 to 31.5±8.2; P<0.05). In patients treated with 4-h dialysis sessions, systemic vascular resistance index (SVRI [dyn·s·cm^-5/m²]) increased from 2369±799 before HD to 2592±735 after HD (P=0.342). CONCLUSIONS The obtained data indicate that in extended (5-h) HD sessions, hemodynamic compensation occurred with increased HR, while in short (4-h) HD sessions, compensation occurred with increased SVRI. Providing longer but less intensive HD is more physiologic than the conventional therapy, and will improve patient tolerability and clinical outcomes.

Assessment of Arterial Stiffness, Volume, and Nutritional Status in Stable Renal Transplant Recipients

AbstractReduction of cardiovascular death might have a significant effect on the long-term survival rates of renal transplant recipients (RTRs). The aim of the study was to assess the relation between arterial stiffness and graft function, adipose tissue content, and hydration status in patients after kidney transplantation (KTx).The study included 83 RTR patients (mean age: 55 ± 13 years) who had been admitted to a nephrology-transplantation outpatient clinic 0.5 to 24 years after KTx. Clinical and laboratory data were analyzed and eGFR was calculated with the CKD-EPI formula. Arterial stiffness was assessed in all RTRs with pulse wave propagation velocity (PWV) with the use of a complior device. In addition, fluid and nutritional status was assessed with a Tanita BC 418 body composition analyzer. The control group consisted of 31 hospital workers who received no medication and had no history of cardiovascular disease.Multivariable linear regression analysis, with PWV as a dependent variable, retained the following independent predictors in the final regression model: red blood cell distribution width (RDW) (B = 0.323; P = 0.004), age (B = 0.297; P = 0.005), tacrolimus therapy (B = −0.286; P = 0.004), and central DBP (B = 0.185; P = 0.041). Multivariable linear regression analysis with eGFR as a dependent variable retained the following independent predictors in the final regression model; creatinine concentration (B = −0.632; P = 0.000), hemoglobin (B = 0.280; P = 0.000), CRP (B = −0.172; P = 0.011), tacrolimus therapy (B = 0.142; P = 0.039), and triglycerides (B = −0.142; P = 0.035).Our data indicates that: kidney transplant recipients can present modifiable CVD risk factors linked to increased arterial stiffness, DBP, waist circumference, SCr, time on dialysis, CyA therapy, and visceral fat mass; RDW is a parameter associated with arterial stiffness; and parameters such as CyA therapy, time on dialysis, PWV, RDW, and triglycerides show negative associations with the allograft function assessed with eGFR.

Evaluation of the Effectiveness of Preoperative Physiotherapy Using the Lysholm-Gillquist Scale in Patients Qualified for Surgical Arthroscopic Anterior Cruciate Ligament Reconstruction - Pilot Study.

BACKGROUND Recent years have seen a noticeable increase in the number of people experiencing total damage to the anterior cruciate ligament in the knee joint. The causes are many, but increased sporting activity among people who generally lead a hypokinetic lifestyle is regarded as the most important factor. Researchers are seeking to optimize the surgical treatment and rehabilitation. AIM OF THE STUDY To evaluate the effectiveness of preoperative physiotherapy according to the Lysholm and Gillquist scale in patients scheduled for arthroscopic anterior cruciate ligament reconstruction. MATERIAL AND METHODS The study involved a random sample of 30 patients with confirmed complete rupture of anterior cruciate ligament (ACL) qualified for surgical ACL reconstruction. Within this group, an experimental group consisted of 15 patients (mean age 41.0 ± 7 years) who attended physiotherapy before surgery based on recognized therapeutic models. A control group consisted of 15 patients (mean age 39.0 ± 9 years). The Lysholm and Gillquist 100-point scale was used for assessment. Students t test, the Mann-Whitney U test and the Wilcoxon test were used for statistical analysis. The level of statistical significance was set at p < 0.05. RESULTS The operated knee improved functionally in both the experimental and control group. In the experimental group, the difference was 20 points and was statistically significant at p = 0.000. In the control group, the difference was 6 points, which was also within the limit of statistical significance at p = 0.002. CONCLUSIONS 1. Patients with total ACL rupture attending a pre-operative rehabilitation program led by a physiotherapist (experimental group) achieved greater improvement in functional status compared with the control group. 2. These results indicate a need to analyze the impact ofpreoperative rehabilitation on the final outcome of patients after complete ACL rupture.