Study of adiponectin in chronic liver disease and cholestasis

Purpose

Adiponectin is an adipocytokine suggested to have a hepatoprotective effect. To date, little information is available in the literature regarding changes in serum adiponectin levels in cirrhosis and cholestasis and the associated metabolic disturbances. In order to elucidate the role of adiponectin in chronic liver disease our aim was to determine serum adiponectin in patients with different grades of cirrhosis and cholestasis and to correlate it with markers of liver injury, inflammation and cholestasis. We also aimed to correlate adiponectin with markers of metabolic syndrome such as body mass index and insulin resistance.

Methods

Forty patients with cirrhosis; 30 patients with cirrhosis and cholestasis; and 20 matched controls were studied. They were subjected to clinical assessment, laboratory investigations: serum bilirubin, ALT, AST, alkaline phosphatase, GGT, albumin, C-reactive protein, prothrombin activity, fasting blood sugar, insulin. HOMA index was calculated. Abdominal ultrasonography and upper GI endoscopy were performed.

Results

Adiponectin was elevated in patients with cirrhosis and cirrhosis/cholestasis and was significantly higher in Child A and B. Adiponectin showed correlation with liver cell injury, marker of inflammation, synthetic liver function and markers of cholestasis. Adiponectin did not correlate with complications of cirrhosis as ascites and esophageal varices nor did it correlate with BMI or HOMA.

Conclusions

Adiponectin is elevated in cirrhosis and shows correlation with degree of hepatocellular injury and cholestasis. Finally, adiponectin levels in cirrhosis do not correlate with parameters of body composition or metabolism but exclusively with reduced liver function.     

The cytokine balance during CABG surgery with and without cardiopulmonary bypass

BackgroundWe investigated the cytokine response during coronary artery bypass grafting (CABG) surgery with and without cardiopulmonary bypass (off-pump) and the effect on patient's outcome in the early postoperative period.MethodsEighteen patients were studied, 9 patients undergoing off-pump surgery (group 1) and 9 patients with CPB (group 2). Demographic and preoperative characteristics were comparable in both groups. Plasma levels of TNF-α, IL-6, IL-8, IL-10, IL-4, tumour necrosis soluble receptors-1 (TNFsr-1) and tumour necrosis soluble receptors-2 (TNFsr-2) were measured before skin incision (T0), before revascularization (T1), after revascularization (T2), 2 h (T3) and 24 (T4) hours after skin closure. Levels of myocardial enzymes were also measured in the first postoperative morning.ResultsSerum levels of TNF-α and IL-8 increased in group 2 at T3 and T4 more than at T0 (p < 0.05). IL-6 increased in both groups with higher levels in group 2 than in group 1 at T3 (773 ± 331 vs 315 ± 189 pg/ml; p < 0.05). IL-10 was higher in group 2 than in group 1 at T2 (115 ± 119 vs 13 ± 4 pg/ml; p < 0.001) and at T3 (212 ± 171 vs 31 ± 29 pg/ml; p < 0.05). At T3 levels of TNFsr-1 and TNFsr-2 were higher in group 2 than in group 1 (TNFsr-1 4858 ± 1325 vs 2089 ± 584 pg/ml; p < 0.01 and TNFsr-2 4971 ± 63 vs 3801 ± 738 pg/ml; p < 0.05). Production of IL-4 did not increase in neither group. The length of ICU stay was less in group 1 than in group 2 (52 ± 33 vs 26 ± 11 h; p < 0.05) as well as was the length of hospital stay (7.1 ± 0.4 vs 5.3 ± 0.5 days; p < 0.001).ConclusionOff-pump procedure evoked a lower cytokine response than CABG with CPB. This minimised myocardial damage and shorten the stay in the ICU and the hospital.     

Mean platelet volume/platelet count ratio as a predictor of long-term mortality after non-ST-elevation myocardial infarction

Previous studies reported an association between elevated mean platelet volume (MPV) and post-myocardial infarction mortality. This study explores the association between long-term mortality after non-ST-segment elevation myocardial infarction (NSTEMI) and the peripheral blood platelet indices (i.e., the mean platelet volume (MPV), platelet count, and the MPV/platelet (MPV/P) ratio). Two physicians independently reviewed the data of 619 NSTEMI patients. The blood samples were drawn and analyzed within 1?h of admission, the second, and the last hospital days. Patients were stratified into equal tertiles according to the platelet count, MPV, and MPV/platelet ratio. The primary outcome, 4-year all-cause mortality, was compared among the platelet indices tertile models. According to MPV, platelet count, and MPV/platelet ratio tertile models, there was a trend of higher 4-year mortality for the lower and upper tertiles in comparison to the middle tertiles. However, only the admission MPV/platelet ratio tercile model was statistically significant for predicting the 4-year mortality. The mortality rate of the highest MPV/platelet (48/207 (23%)) and the lowest (41/206 (20%)) tertiles were significantly higher than the middle tertile (19/206 (9%)), p?=?0.0004 by the chi-squared test. After adjusting for Global Registry of Acute Coronary Events, the patients in the combined first and third MPV/P tertiles had higher mortality in reference to those in the middle MPV/P tercile (hazard ratio 1.951, confidence interval 1.032-3.687, and p?相似文献   

Targeting Mcl-1 for the therapy of cancer

INTRODUCTION: Human cancers are genetically and epigenetically heterogeneous and have the capacity to commandeer a variety of cellular processes to aid in their survival, growth and resistance to therapy. One strategy is to overexpress proteins that suppress apoptosis, such as the Bcl-2 family protein Mcl-1. The Mcl-1 protein plays a pivotal role in protecting cells from apoptosis and is overexpressed in a variety of human cancers. AREAS COVERED: Targeting Mcl-1 for extinction in these cancers, using genetic and pharmacological approaches, represents a potentially effectual means of developing new efficacious cancer therapeutics. Here we review the multiple strategies that have been employed in targeting this fundamental protein, as well as the significant potential these targeting agents provide in not only suppressing cancer growth, but also in reversing resistance to conventional cancer treatments. EXPERT OPINION: We discuss the potential issues that arise in targeting Mcl-1 and other Bcl-2 anti-apoptotic proteins, as well problems with acquired resistance. The application of combinatorial approaches that involve inhibiting Mcl-1 and manipulation of additional signaling pathways to enhance therapeutic outcomes is also highlighted. The ability to specifically inhibit key genetic/epigenetic elements and biochemical pathways that maintain the tumor state represent a viable approach for developing rationally based, effective cancer therapies.     

Learning priorities and attitudes towards computer-assisted learning of general medical practitioners, general dental practitioners and dental hygienists

Objectives: The objectives of this survey were to assess the attitudes and learning priorities of general medical practitioners (GMPs), general dental practitioners (GDPs), and dental hygienists (DHs) working at Jordan University of Science and Technology (JUST), Irbid, Jordan in relation to post‐graduate education, to gather information on their attitudes and skills in using computers and computer‐assisted learning (CAL) and to see whether the material in this form is acceptable to participate as a means of teaching. Methods: Data for this study was gathered via a questionnaire distributed to 63 health professionals including GMPs, general dental practitioners and DHs (mean age 24.79 ± 2.69 years) working at JUST. Results: Of the 63 participants, 80% of the participants have home computers, 38% have office computers at work and only 25% have both home and office computers. Approximately 53% of the participants had their first CAL experience at home. Seventy‐three of the participants indicated that connection to Internet is necessary for their work. Seventy‐one of the participants were interested in the possibility of using CAL to further improve and increase their medical knowledge. The most important topic for doctors was ‘learning about new techniques which may supersede those in current use’, for DHs it was ‘improve knowledge or skill in radiology’, and for dentists it was ‘reinforcement of well established techniques commonly used in dental practice’. Conclusions: It is necessary for practicing health care professionals to update themselves by taking continuous education courses after graduation more conveniently via CAL methods.     

Conservation Environments’ Effect on the Compressive Strength Behaviour of Wood–Concrete Composites

This paper addresses the issues in making wood–concrete composites more resilient to environmental conditions and to improve their compressive strength. Tests were carried out on cubic specimens of 10 × 10 × 10 cm³ composed of ordinary concrete with a 2% redwood- and hardwood-chip dosage. Superficial treatments of cement and lime were applied to the wood chips. All specimens were kept for 28 days in the open air and for 12 months in: the open air, drinking water, seawater, and an oven. Consequently, the compressive strength of ordinary concrete is approximately 37.1 MPa. After 365 days of exposure to the open air, drinking water, seawater, and the oven, a resistance loss of 35.84, 36.06, 42.85, and 52.30% were observed, respectively. In all environments investigated, the untreated wood composite concrete’s resistance decreased significantly, while the cement/lime treatment of the wood enhanced them. However, only 15.5 MPa and 14.6 MPa were attained after the first 28 days in the cases of the redwood and the hardwood treated with lime. These findings indicate that the resistance of wood–concrete composites depends on the type of wood used. Treating wood chips with cement is a potential method for making these materials resistant in conservation situations determined by the cement’s chemical composition. The current study has implications for researchers and practitioners for further understanding the impact of these eco-friendly concretes in the construction industry.     

Consensus statement on the epidemiology,diagnosis,prevention,and management of cow's milk protein allergy in the Middle East:a modified Delphi-based study

Background This study aimed to develop an expert consensus regarding the epidemiology,diagnosis,and management of cow's milk protein allergy (CMPA) in the Middl...     

Staff attitudes and perceptions towards the use of coercive measures in psychiatric patients

The failure of efforts to significantly reduce the use of physical coercive measures (PCMs) in psychiatric hospitals remains a global concern. There is a gap in the understanding of staff's characteristics that may affect their attitudes and perceptions towards PCMs. This study used a cross-sectional design to examine the attitudes and perceptions of staff working at a mental health centre in Israel regarding the use of PCMs and to explore whether staff attitudes differed depending on their professional and demographic background. This study also sought to explore staff willingness to accept a policy of reducing the use of PCMs. The data were collected from 149 staff members (nurses, physicians, and auxiliary staff) working at mental health centre, using a questionnaire developed for this study. The findings indicate a low degree of support for use of PCMs among participants who were older, female, more qualified psychiatric nurses, with longer duration of employment, and those who have not participated in coercive intervention in the past year. The majority of the sample reported a low willingness to reduce the use of PCMs, and a lack of institutional support after participating in a coercive event. High hospital occupancy and insufficient staffing were perceived as contributing factors to coercive incidents. Therefore, availability of trained and experienced staff, elimination of organizational barriers, along with creating and maintaining a safe clinical environment should be a priority. Alternative non-coercive interventions should further be taught and used for managing aggressive and violent behaviour in the psychiatric clinical settings.