Olivera Lupescu

Review article: The role of adipose tissue in uraemia‐related insulin resistance

SUMMARY:  Adipose tissue is no longer considered to be an inert tissue of which function is to store fat. It actively secretes a number of biologic active compounds that are involved in the regulation of many processes like food intake, energy expenditure, metabolism homeostasis, immunity and blood pressure homeostasis. General metabolism alteration in patients with chronic kidney disease has a profound impact on biology of adipocytes. Chronic renal failure is a pathological condition, of which two major hallmarks are chronic inflammation and insulin resistance. In uraemic patients, adipose tissue became an important source of molecules that are responsible, at least in part, for the metabolic disturbances seen in these patients. Some of these molecules act as pro‐inflammatory agents contributing to the maintenance and enhancement of the chronic inflammatory response. These pro‐inflammatory molecules, along with other molecules secreted by the adipose tissue, have a central position in the aetiology of uraemia‐associated insulin resistance. In this review, we intend to summarize some aspects of the biology of adipokines in uraemia, with emphasis on the link between these molecules and insulin resistance.

Phytomedicine in Joint Disorders

Chronic joint inflammatory disorders such as osteoarthritis and rheumatoid arthritis have in common an upsurge of inflammation, and oxidative stress, resulting in progressive histological alterations and disabling symptoms. Currently used conventional medication (ranging from pain-killers to biological agents) is potent, but frequently associated with serious, even life-threatening side effects. Used for millennia in traditional herbalism, medicinal plants are a promising alternative, with lower rate of adverse events and efficiency frequently comparable with that of conventional drugs. Nevertheless, their mechanism of action is in many cases elusive and/or uncertain. Even though many of them have been proven effective in studies done in vitro or on animal models, there is a scarcity of human clinical evidence. The purpose of this review is to summarize the available scientific information on the following joint-friendly medicinal plants, which have been tested in human studies: Arnica montana, Boswellia spp., Curcuma spp., Equisetum arvense, Harpagophytum procumbens, Salix spp., Sesamum indicum, Symphytum officinalis, Zingiber officinalis, Panax notoginseng, and Whitania somnifera.

New alternatives for erythropoietin therapy in chronic renal failure

Erythropoietin (EPO) is one of the main cytokines involved in the regulation of erythropoiesis. The main site of EPO production are the kidneys. An altered EPO production leads to pathological conditions such as anemia and polycythaemia. Due to the progressive loss of renal peritubular cells, patients with chronic kidney disease (CKD) have low EPO plasma levels. This decreases erythron stimulation with the direct consequence of developing anemia. Before the introduction in the clinical practice of rHuEpo, in the late 1980s, the only solution for treating this type of anemia were blood transfusions and anabolic steroids. Even rHuEpo has proven to be safe and effective for treatment of anemias, there are some concerns about its cost, the need for frequent parenteral administration, and development of anti-EPO antibodies. These inconveniences prompted the search for novel erythropoiesis stimulating agents. Different strategies lead to isolation or chemical synthesis of such agents as darbepoetin alfa and EPO mimetics. In this review, we present some general aspects of EPO biology, with emphasis on chronic renal failure, and expose some of the alternatives to EPO used for anemia correction.

Algorithms for Clinical Indications of Bone Substitutes - Component of Training in Orthopaedic Surgery

Modern traumatology is characterised by increasingly severe injuries, with significant soft tissue and bone loss; therefore, restoration of functional anatomy regards bone filling with proper bone integration, and otherwise surgical reconstruction is useless. Therefore, orthopaedic surgeons must have not only surgical skills, but thorough knowledge about the properties and indications of bone substitutes, which can improve surgical results in treating especially comminuted fractures. Integrating the clinical experience from a Level 1 Trauma Centre with didactic principles, and using e-learning as an educational tool, this paper refers to establishing an algorithm of clinical indications of bone substitutes in orthopaedic surgery and to introducing it into the educational process of orthopaedic trainees, as a component of vocational training.

Treatment of Chronic Bone Infections Using the Collagen Based Haemostatic - Collatamp G

Treating chronic bone infection is challenging, requiring complete excision of the affected areas and antimicrobial therapy. Acquiring active concentrations of antibiotics is difficult, as well as filling up bone defects resulting from sequestrectomy, and very few methods of treatment address both issues simultaneously. The authors describe the clinical results after using Collatamp G, a collagen-based, antibiotic filled sponge with two actions: local delivery of high antibiotic doses without systemic side effects and enhancement of healing due to collagen, thus covering the bone defect without any further osteoplastic surgery. This paper thus identifies Collatamp G as a biomaterial able to solve the above mentioned problems in treating bone infections.Keywords: bone infections, collagen matrix, gentamicine, antibiotic delivery

Fibrin Sealants in Orthopaedic Surgery

Due to its considerable systemic impact, several local and general methods to control surgical ( intra/perioperative) bleeding have been developed, with particular characteristics adapted to each type of surgery. In orthopaedic procedures, elective or urgent, bleeding is to be seriously considered , since usually both bones and soft tissues are injured or cut, so adapted haemostatic means have to be used. This issue is of particular importance especially when very small vessels are involved, and especially on large surfaces, since ligation or cauterization are useless in these situations. An effective tool in these circumstances is the group of fibrin sealants, which can stop diffuse bleeding on surfaces when produced by very small vessels. The authors present their clinical experience with fibrin sealants, underlining the indications and the limits of the method.

Sonication – further progress in the microbiological diagnosis in implant-associated infections

Sonication – further progress in the microbiological diagnosis in implant-associated infections Daniela Tălăpan, Raluca Mihăilescu, Olga Mihaela Dorobăț, Vlad Predescu, Rodica Marinescu, Olivera Lupescu, Florian Purghel, Marius Niculescu, Răzvan Ene, Alexandru Hera, Daniela Munteanu, Mariana Constantin, Emilia Căpraru, Angelica Tenita, Dana Jianu, Oana Săndulescu, Anca Streinu-Cercel, Monica Cârstoiu, Cătălin Cârstoiu, Victoria Aramă, Adrian Streinu-Cercel, Alexandru Rafila