Ryszard Andrzejak

Physical and psychological impairments of women with upper limb lymphedema following breast cancer treatment

Objective: The aim of the study was to identify factors associated with worse physical and emotional functioning of breast cancer survivors with upper extremity lymphedema.

Metabonomic analysis of serum of workers occupationally exposed to arsenic, cadmium and lead for biomarker research: a preliminary study.

Environmental metabonomics is the application of metabonomics to characterize the interactions of organisms with their environment. Metabolic profiling is an exciting addition to the armory of the epidemiologist for the discovery of new disease risk biomarkers and diagnostics. This work is a continuation of research searching for preclinical serum markers in a group of 389 healthy smelter workers exposed to lead, cadmium and arsenic. Changes in the metabolic profiles were studied using Proton Nuclear Magnetic Resonance Spectroscopy on pooled serum samples from both the metal exposed and control groups. These multivariate metabonomic datasets were analyzed with Principal Component Analysis and Partial Least Squares Discriminant Analysis. Analysis of metabolic profiles of people exposed to heavy metals suggests energy metabolism disturbance induced by heavy metals. Changes in lipid fraction (very-low-density lipoprotein - VLDL, low-density lipoprotein - LDL), unsaturated lipids and in the level of amino acids suggest perturbation of the metabolism of lipids and amino acids. This study illustrated the high reliability of NMR-based metabonomic profiling on the study of the biochemical effects induced by the mixture of heavy metals. This approach is capable of identifying intermediate biomarkers of response to toxicants at environmental/occupational concentrations, paving the way to its use in a monitoring of smelter workers exposed to low doses of lead, cadmium and arsenic.

Relation between occupational exposure to lead, cadmium, arsenic and concentration of cystatin C.

UNLABELLED Lead, cadmium and arsenic represent well recognized toxic agents which in a specific manner disturb function of cardiovascular system. Cystatin C has been accepted to be a significant prognostic factor for cardiovascular diseases. The study aimed at defining relationship between occupational exposure to lead, cadmium and arsenic on one hand and concentration of cystatin C on the other. The studies were performed on 282 men occupationally exposed to lead, cadmium and arsenic. Among the tested individuals several groups of persons were distinguished: exposed exclusively to lead (Pb group), cadmium (Cd group), arsenic (As group), to lead and cadmium (Pb/Cd group), to lead and arsenic (Pb/As group) or to cadmium and arsenic (Cd/As group). In all the individuals serum concentration of cystatin C was estimated. Concentration of cystatin C was found to be significantly higher in Pb group than in Cd and As groups, also in Pb/Cd group higher than in Cd group and in Pb/As group than in As group. Positive linear correlations were established between Pb concentration in blood (Pb-B) and serum concentration of cystatin C (r=0.59; p<0.05) as well as between urinary concentration of As (As-U) and serum concentration of cystatin C (r=0.41; p<0.05). Regression analysis demonstrated that higher blood level of lead, higher urinary level of arsenic, more advanced age and higher body mass index represented independent risk factors of an increased serum concentration of cystatin C in the group of persons exposed to lead, cadmium and arsenic. CONCLUSIONS Higher blood level of lead and higher urinary level of arsenic represented independent risk factors of an increased serum concentration of cystatin C in the group of persons occupationally exposed to lead, cadmium and arsenic. Concentration of lead in blood was significantly influencing serum concentration of cystatin C. The highest mean serum concentration of cystatin C was detected in the group of foundry workers exposed simultaneously to lead and arsenic.

The relationship between occupational exposure to lead and manifestation of cardiovascular complications in persons with arterial hypertension

The chronic exposure to lead represents a risk factor of arterial hypertension development. Ambulatory blood pressure monitoring is the most prognostically reliable method of measuring of arterial blood pressure. The study is aimed at evaluating the relationship between occupational exposure to lead and manifestation of cardiovascular complications in patients with arterial hypertension. The studies included 73 men (mean age, 54.26±8.17 years) with arterial hypertension, treated with hypotensive drugs: group I-persons occupationally exposed to lead (n=35) and group II-individuals not exposed to lead (n=38). An analysis of results obtained during ambulatory blood pressure monitoring disclosed significantly higher values of mean systolic blood pressure, mean blood pressure, pulse pressure, and variability of systolic blood pressure in the group of hypertensive patients occupationally exposed to lead as compared to patients with arterial hypertension but not exposed to lead. The logistic regression showed that a more advanced age, higher concentration of blood zinc protoporphyrin, and a higher mean value of pulse pressure represented independent risk factors of left ventricular hypertrophy in the group of persons with arterial hypertension and chronically exposed to lead (OR(age)=1.11; OR(ZnPP)=1.32; OR(PP)=1,43; p<0.05). In view of the above data demonstration that occupational exposure to lead represents an independent risk factor of increased pulse pressure may be of key importance in the process of shaping general social awareness as to harmful effects of lead compounds on human health.

Proteomic analysis of serum of workers occupationally exposed to arsenic, cadmium, and lead for biomarker research: a preliminary study.

The main factor of environmental contamination is the presence of the heavy metals lead, cadmium, and arsenic. The aim of serum protein profile analysis of people chronically exposed to heavy metals is to find protein markers of early pathological changes. The study was conducted in a group of 389 healthy men working in copper foundry and 45 age-matched non-exposed healthy men. Toxicological test samples included whole blood, serum, and urine. Thirty-seven clinical parameters were measured. Based on the parameters values of the healthy volunteers, the centroid in 37-dimensional space was calculated. The individuals in the metal-exposed and control groups were ordered based on the Euclidean distance from the centroid defined by the first component according to Principal Component Analysis (PCA). Serum samples of two individuals, one from the control and one from the metal-exposed group, were chosen for proteomic analysis. In optimized conditions of two-dimensional gel electrophoresis (2-DE), two protein maps were obtained representing both groups. Twenty-eight corresponding protein spots from both protein maps were chosen and identified based on PDQuest analysis and the SWISS-2DPAGE database. From a panel of six proteins with differences in expression greater than a factor of two, three potential markers with the highest differences were selected: hemoglobin-spot 26 (pI 7.05, Mw 10.53), unidentified protein-spot 27 (pI 6.73, Mw 10.17), and unidentified protein-spot 25 (pI 5.75, Mw 12.07). Further studies are required to prove so far obtained results. Identified proteins could serve as potential markers of preclinical changes and could be in the future included in biomonitoring of people exposed to heavy metals.

The influence of the intensity of smoking and years of work in the metallurgy on pro-oxidant/antioxidant balance in the blood of smelters.

The aim of this study was to investigate the effect of cigarette smoking and occupational exposure to heavy metals on the degree of pro-oxidant/antioxidant imbalance in smelters. The investigations were performed on the blood and urine of 400 subjects: 300 male copper smelters and 100 nonexposed male subjects. Biological material was divided into three groups: nonsmokers, those who smoked less than 20 cigarettes a day and those who smoked more than 20 cigarettes a day. The results showed a significant increase in the concentration of lead, cadmium and arsenic in the blood and urine of smelters, while smoking more than 20 cigarettes a day caused a further increase in the concentration of these metals. The level of malondialdehyde was approximately twofold higher in the plasma of the smelters compared to the control group. We have observed a disturbance in the level of antioxidants in erythrocyte lysate manifested by an increase in metallothionein and glutathione concentrations as well as superoxide dismutase and glutathione peroxidase activities and the decrease in glutathione S-transferase activity. Cigarette smoking, years of work in metallurgy and age of smelters were additional factors significantly affecting the pro-oxidant/antioxidant balance.

Ambulatory blood pressure monitoring and structural changes in carotid arteries in normotensive workers occupationally exposed to lead

Occupational exposure to lead may cause an increase in blood pressure. The aim of the study was to estimate the effect of occupational exposure to lead on selected parameters of ambulatory blood pressure monitoring (ABPM) and structural changes in carotid arteries. The study included 33 normotensive men occupationally exposed to lead and 39 unexposed men employed in administration of the foundry. All of the men underwent 24-hour ambulatory blood pressure monitoring and high-resolution B-mode ultrasonography to determine intima-media thickness (IMT). The group of men occupationally exposed to lead manifested significantly higher mean systolic blood pressure (MSBP), mean diastolic blood pressure (MDBP), mean blood pressure (MBP), pulse pressure (PP), variability of diastolic blood pressure (VDBP), and IMT than the unexposed group. The studied groups did not differ in mean values of variability of systolic blood pressure (VSBP). As compared to the unexposed group, in men exposed to lead, atherosclerotic plaques were significantly more common. In the group of persons exposed to lead the Pearson’s correlation coefficient analysis revealed significant linear positive correlations between MSBP and IMT, between lead level and the number of atherosclerotic plaques, and between lead level and PP. Multivariate stepwise regression analysis demonstrated that higher lead level in blood and higher triglyceride concentration in blood represent independent risk factors of an increased pulse pressure in the group of individuals occupationally exposed to lead. Occupational exposure to lead can be associated with increased blood pressure and accelerated progression of atherosclerosis.

Electrocardiographic evaluation in patients with systemic scleroderma and without clinically evident heart disease.

Background: In patients with systemic scleroderma (SSc), clinically evident cardiac involvement is recognized to be a poor prognostic factor. The aim of the study was to evaluate electrocardiographic changes, parameters of heart rate variability (HRV), and heart rate turbulence (HRT) in patients with SSc without evident symptoms of heart disease.

Usefulness of Intravascular Low-Power Laser Illumination in Preventing Restenosis After Percutaneous Coronary Intervention

Despite the several years of studies, no factor that could reduce the restenosis rate without significant limitations has been introduced. The aim of the present study was to evaluate the influence of low-power 808-nm laser illumination of coronary vessels after percutaneous angioplasty in preventing restenosis. The procedure of laser intravascular illumination was performed on 52 patients (laser group), and another 49 patients formed the control group. All patients were monitored for major adverse cardiac events (MACE) at the 6- and 12-month follow-up points. The MACE rate after 6 and 12 months was 7.7% in the laser group at both points. The MACE rate was 14.3% and 18.5% at 6 and 12 months of follow-up in the control group, respectively (p = NS). Follow-up coronary angiography was performed after 6 months. The difference in the restenosis rate was insignificant (15.0% vs 32.4%); however, significant differences were observed in the minimal lumen diameter (2.18 ± 0.70 vs 1.76 ± 0.74 mm; p < 0.05), late lumen loss (0.53 ± 0.68 vs 0.76 ± 0.76 mm; p < 0.01), and the late lumen loss index (0.28 ± 0.39 vs 0.46 ± 0.43; p < 0.005) in favor of the laser group. In conclusion, the new therapy seemed effective and safe. Marked differences between late loss, late loss index, and minimal lumen diameter were observed. The late lumen loss in the laser group was only slightly greater than that in studies of drug-eluting stents, and MACE rate remained within very comparable ranges. This suggests that intravascular laser illumination could bring advantages comparable to those of drug-eluting stents without the risk of late thrombosis.

Adventitial lymphatics of internal carotid artery in healthy and atherosclerotic vessels

OBJECTIVES Presence of lymphatics in adventitia of major arteries remains controversial. Presence of lymphatics in adventitia of internal carotid artery was not documented and its relation to atherosclerosis was not studied. The aim of our study was to evaluate presence of lymphatic vessels in adventitia of internal carotid artery in healthy and atherosclerotic arteries. METHODS Fragments of arterial wall of internal carotid artery were obtained during the surgical eversion endarterectomy in 15 patients with internal carotid artery stenosis and 2 healthy organ donors. 21 arteries were studied. Patients age ranged from 56 to 77 years. Fragments of arterial wall were embeded in paraffin. Lymphatics of arterial adventitia were visualized with immunohistochemistry using LYVE-1 and anty-podoplanin antibodies. RESULTS The lymphatic vessels were visualized in adventitia of 20 carotid arteries. The serial sections have revealed that both LYVE-1 and podoplanin have identical specificity for lymphatic endothelium Number of lymphatics in adventitia significantly correlated with thickness of intima (p<0.046). CONCLUSIONS Lymphatics are present in adventitia of internal carotid artery. Number of adventitial lymphatics increases with severity of atherosclerosis measured as intimal thickness.