Adipokines: Biomarkers for osteoarthritis?

Osteoarthritis(OA)is one of the most common degenerative joint diseases in aging population.Obesity is an important risk factor for initiation and progression of OA.It is accepted that excess body weight may lead to cartilage degeneration by increasing the mechanical forces across weight-bearing joints.However,emerging data suggest that additional metabolic factors released mainly by white adipose tissue may also be responsible for the high prevalence of OA among obese people.Adipocyte-derived molecules‘‘adipokines’’have prompt much interest in OA pathophysiological research over the past decade since they play an important role in cartilage and bone homeostasis.Therefore,the aim of this review is to summarize the current knowledge on the role of adipokines including leptin,adiponectin,visfatin and resistin in OA and their potential to be used as biomarkers for earlier diagnosis,classifying disease severity,monitoring disease progression,and testing pharmacological interventions for OA.In OA patients,leptin,visfatin and resistin showed increased production whereas adiponectin showed decreased production.Leptin and adiponectin are far more studied than visfatin and resistin.Importantly,altered adipokine levels also contribute to a wide range of diseases.Further experiments are still crucial for understanding the relationship between adipokines and OA.     

Presumed Consent for Organ Donation: Is Romania Prepared for It?

Introduction

In November 2007, a legislative initiative regarding the presumed consent for organ donation was proposed for parliamentary debate in Romania and was followed by public debate. The study aimed to asses public opinions expressed in the Romanian media.

Materials and Methods

An Internet search was made. The pro and con reasons, the affiliation of parts involved in the debate and suggested future direction of action were identified.

Results

The Internet search had 8572 results. The parts involved in the pro and con debate consisted of governmental structures, physicians, ethicists, politicians, media, religious authorities, nongovernmental associations, and lay persons. The main pros were the low rate of organ donation and the long waiting lists, enhancement of organ procurement, avoidance of wasting valuable organs, avoiding responsibility, and the stress imposed to the family in giving the donation consent, humanitarian purposes (saving lives), going along with the scientific progress, and less bureaucracy. The main cons were an unethical issue, violation of human rights, denial of brain death, unethical advantage of public ignorance, unethical use of underprivileged people, little results in terms of organ procurement, but huge negative effects on public opinion, public mistrust in transplant programs and impossibility of refusal identification due to particularities of the Romanian medical system.

Conclusion

The con opinions prevailed. For the moment, Romania seems to be unprepared to accept presumed consent. A future change in public perception regarding organ transplantation may modify the terms of a public debate.     

Hemofiltration treatment for sepsis: is it time for controlled trials?

While the use of hemofiltration to treat septic shock has potential benefits, the existing studies are difficult to compare because of their variety of inclusion criteria. The concept is to remove the various mediators of severe sepsis and septic shock, such as cytokines and eicosanoids, so that acute renal failure and the resultant multi-organ failure and possible death can be delayed or prevented. The dilemmas include: (a) hemofiltration cannot distinguish between these pro-inflammatory mediators as they are of similar molecular weights, and thus it is difficult to determine which one or combination should be eliminated for the best hemodynamics; (b) timing of the hemofiltration to remove a particular cytokine may make a difference in patient outcome; (c) the most efficacious convection rate of ultrafiltration has not been determined yet; (d) since these mediators quickly saturate the membrane, it should be frequently changed, and thus biocompatibility, availability and costs are added issues; (e) the choice of buffer is different according to the diagnosis of these critically ill patients. Before designing clinical trials, further experimentation is necessary to explore these problems.     

Hepatic resection for colorectal metastases: value for risk scoring systems?

INTRODUCTION: Predictors of outcome in patients with metastatic colorectal cancer remain inconsistent. We aimed to identify predictors of outcome in these patients, to develop a prognostic scoring system, and to assess the general applicability of the current major risk scoring systems. MATERIALS AND METHODS: Following IRB approval, medical records of 662 consecutive patients undergoing resection of colorectal metastases to the liver during 1960 to 1995 were reviewed. Clinicopathologic and outcome data were assessed from records and mailed questionnaire. Clinicopathologic variables were tested using univariate and multivariate analyses; best-fit models were then generated to study the effect of each independent risk factor on outcome. To validate existing scoring models, our independent data set was applied to those scores. The relative concordance probability estimates were calculated for these models and compared with that of the proposed Mayo model. RESULTS: The overall and disease-specific 5-year survival rates were 37% and 42%, respectively. The probability of recurrence at any site was 65% at 5 years. Perioperative blood transfusion and positive hepatoduodenal nodes were the major determinants of survival and recurrence. To assess the general applicability of the proposed risk scoring systems, we imported the data from our patient population into 3 other scoring systems. Neither survival nor recurrence among our patients was stratified discretely by any of the scoring systems. Based on probability estimates, all models were only marginally better than chance alone in predicting outcome. CONCLUSION: Broad application of risk scoring systems for patients with metastatic colorectal cancer has limited clinical value and refinement and external validation should be undertaken before utilization.