Fatty acid composition of serum lipid fractions in type 2 diabetic patients with microalbuminuria

OBJECTIVE: To determine the fatty acid composition of serum phospholipid, triglyceride, and cholesterol ester fractions and to analyze the lipid profile of microalbuminuric type 2 diabetic patients. RESEARCH DESIGN AND METHODS: A case-control study was conducted with 72 patients: 37 were normoalbuminuric (urinary albumin excretion rate [UAER] <20 microg/min), and 35 were microalbuminuric (UAER 20-200 microg/min). After 4 weeks of a standardized diet, the fatty acid composition of phospholipid, triglyceride, and cholesterol ester fractions was determined by gas chromatography. Total cholesterol and triglycerides were measured by enzymatic-colorimetric methods; cholesterol HDL by double precipitation with heparin, MnCl(2), and dextran sulfate; and apolipoprotein B by immunoturbidimetry. RESULTS: Microalbuminuric patients showed a lower proportion of polyunsaturated fatty acids (24.8 +/- 11.0%), especially of the n-6 family (21.7 +/- 10.5%), in triglyceride fraction than normoalbuminuric patients (34.1 +/- 11.3%, P = 0.001 and 31.4 +/- 11.5%, P < 0.001, respectively). Patients with microalbuminuria also presented higher levels of saturated fatty acids in triglyceride fraction (43.4 +/- 18.0% vs. 34.7 +/- 13.1%, P = 0.022). In the logistic regression analysis, only the proportion of polyunsaturated fatty acids in triglyceride fraction remained significantly associated with microalbuminuria (odds ratio [OR] 0.92, 95% CI 0.85-0.98, P = 0.019). Total cholesterol, HDL cholesterol, triglyceride, and apolipoprotein B levels were similar in normo- and microalbuminuric patients. CONCLUSION: Microalbuminuria in type 2 diabetic patients is associated with low polyunsaturated fatty acid contents in serum triglyceride fraction. This association may represent a risk factor for cardiovascular disease and may contribute to the progression of renal disease.     

C1-esterase inhibitor reduces reperfusion injury after lung transplantation

BACKGROUND: Activation of the complement system and polymorphonuclear neutrophilic leukocytes plays a major role in mediating reperfusion injury after lung transplantation. We hypothesized that early interference with complement activation would reduce lung reperfusion injury after transplantation. METHODS: Unilateral left lung autotransplantation was performed in 6 sheep. After hilar stripping the left lung was flushed with Euro-Collins solution and preserved for 2 hours in situ at 15 degrees C. After reperfusion the right main bronchus and pulmonary artery were occluded, leaving the animal dependent on the reperfused lung (reperfused group). C1-esterase inhibitor group animals (n = 6) received 200 U/kg body weight of C1-esterase inhibitor as a short infusion, half 10 minutes before, the other half 10 minutes after reperfusion. Controls (n = 6) underwent hilar preparation only. Pulmonary function was assessed by alveolar-arterial oxygen difference and pulmonary vascular resistance. The release of beta-N-acetylglucosaminidase served as indicator of polymorphonuclear neutrophilic leukocyte activation. Extravascular lung water was an indicator for pulmonary edema formation. Biopsy specimens were taken from all groups 3 hours after reperfusion for light and electron microscopy. RESULTS: In the reperfused group, alveolar-arterial oxygen difference and pulmonary vascular resistance were significantly elevated after reperfusion. All animals developed frank alveolar edema. The biochemical marker beta-N-acetylglucosaminidase showed significant leukocyte activation. In the C1-esterase inhibitor group, alveolar-arterial oxygen difference, pulmonary vascular resistance, and the level of polymorphonuclear neutrophilic leukocyte activation were significantly lower. CONCLUSIONS: Treatment with C1-esterase inhibitor reduces reperfusion injury and improves pulmonary function in this experimental model.     

SEM ANALYSIS OF THE ACID-ETCHED ENAMEL PATTERNS PROMOTED BY ACIDIC MONOMERS AND PHOSPHORIC ACIDS

Objective:

Although self-etching bonding systems (SES) are indicated to prepare dental enamel for bonding, concerns have been expressed regarding their effectiveness. The aim of this study was to analyze the etching pattern (EP) of nine SES in comparison with 35% and 34% phosphoric acid etchants (FA) on intact (IN) and ground (GR) enamel surface.

Materials and Methods:

Twenty-two human third molars were sectioned in mesial-distal and buccal-lingual directions, and four dental fragments were obtained from each tooth. Half of the fragments were ground using 600-grit SiC paper and the other half remained intact. The fragments were randomly assigned into 22 groups, according to the texture of enamel surface (IN and GR) and the technique to etch the enamel (34% FA, 35% FA, AdheSE primer; Brush & Bond; Clearfil Protect Bond primer; iBond; One-up Bond F; OptiBond Solo Plus primer; Tyrian SPE primer; Unifil Bond primer and Xeno III). Conditioners were applied to IN and GR enamel surfaces, according to the manufacturer''s instructions. Specimens etched with phosphoric acids were washed with water, while the surfaces treated with SES were submitted to alternate rinsing with alcohol and acetone. The specimens were dried, sputter-coated and examined under a scanning electron microscope.

Results:

For both IN and GR enamel surfaces, the EP of 34 and 35% FA was deeper and more homogeneous in comparison to EP of SES, except for Tyrian SPE. The acidic monomer action of self-etching systems was more effective on GR enamel.

Conclusion:

Most of the SES are less aggressive than phosphoric acid etchants and their etching effects were reduced on intact enamel surfaces. Uniterms: Dental acid etching; Dental enamel; Electron microscopy.     

Ovarian cancer--diagnostic dilemmas and unusual therapeutic response

The aims of this paper are both to highlight some dilemmas concerning the diagnosis of primary epithelial ovarian carcinoma mainly in its early stages and to underline the capricious responses of this type of malignancy to an otherwise well coded modern management. This study is based on the analysis of the records of 78 patients with ovarian carcinoma admitted for diagnosis and surgical treatment to the Department of General Surgery of Craiova C.F.R. Clinic from 1993 through 2003. The results of this analysis are difficult to interpret due to loss to follow up (in terms of response rates) of some of our 78 operated on ovarian carcinoma patients who went on with their platinum-based chemotherapy (following surgical cytoreduction) under the supervision of different Oncology Departments nationwide. Nevertheless, it is worth mentioning that most of this study patients (71.9%) presented with advanced-stage (III and IV) ovarian carcinoma which sometimes seemed quite confusing by its clinical polymorphism but its prognosis was very much related to both the degree of surgical cytoreduction accomplished and tumor sensitivity to chemotherapy. Finally, although this study does not allow us to draw firm conclusions it is an attempt to share out our current perception on the primary epithelial ovarian cancer management.     

Blood pressure homeostasis and microvascular complications in diabetic patients

The retinopathy and nephropathy are among the most prevalent and disabling complications associated to microvascular damage in diabetes mellitus. The severity of hyperglycaemia and the presence of arterial systemic hypertension are among the main risk factors for these complications. The ambulatory blood pressure provided a better understanding of patterns of blood pressure in diabetic patients. There is a growing number of evidence relating diabetic patients with abnormal 24 h blood pressure patterns. Even subtle modifications of these patterns, frequently shown by patients diagnosed as normotensives in office blood pressure measurings, may be implicated in an increased risk of microvascular complications. Hyperglycaemia and these abnormal pressure patterns appear to have a synergistic effect on promoting and aggravating diabetic retinopathy. Impairment of the normal retinal autoregulation is one of the implicated physiopathological mechanisms. Probably, ABP may be useful in predicting an increased risk of microvascular complications on diabetic normotensive patients. The objective of this paper is to provide an updated and clinically oriented review in blood pressure homeostasis and diabetes mellitus.     

Holoprosencephaly sequence

Holoprosencephaly (HPE) sequence is a rare spectrum of cerebral and facial malformations resulting from incomplete division of the embryonic forebrain into distinct lateral cerebral hemisphere. Three ranges of increasing severity are described: lobar, semi-lobar and alobar HPE. A subtype of HPE called middle inter-hemispheric variant (MIHF) has been also reported. The etiology is heterogeneous: teratogens, chromosomal abnormalities and single gene mutations can be involved. Holoprosencephaly results in early morbidity and mortality with a reduced survival beyond neonatal period. The disorder is estimated to occur in 1/16,000 live births. This case report presents a male new born diagnosed with holoprosencephaly, accompanied by median cleft palate, absent nasal bones and chromosomal abnormalities.     

New Croatian legislation on tissue banking

Human tissues and cells are increasingly used in transplantation, and have also a very promising potential as starting material for tissue engineering and cell therapy. Due to their biological origin, tissues and cells also carry the risks of disease transmission, which need to be reduced as far as possible. Safety and quality standards for tissues and cells have to be concurrent with EU standards in all member states. EU standards in this area have been regulated by the Directive 2004/23/EC, which determines safety and quality standards for human tissues and cells. Two other directives support its implementation regulating technical requirements regarding different process phases of handling tissues and cells. Directive 2006/17/EC regulate technical requirements for donation, procurement and testing of human tissues and cells, whereas technical requirements concerning coding, processing, preservation, storage and distribution of human tissues and cells are regulated by Directive 2006/86/EC. Legal implementations of these directives throughout the European Union take places at different dynamic levels. Countries like Spain, Ireland, Denmark and Bulgaria have successfully completed this process. However, some countries have not met this challenge yet (e.g., Italy, The Netherlands, Latvia, Belgium, Luxembourg, Austria, Slovenia and Sweden), and others are only half-way through (e.g. Slovakia, Rumania, Portugal, Norway, Great Britain, et aI.). Some Member States indicated problems in the implementation of the Directive due to the limited number of experts in the field. In Croatia, the field of tissue and cell transplants is regulated by the Act of Conditions for Removal and Transplantation of Human Body Parts for Therapeutic Purposes (Official Gazette 177/04) and other decrees, which help regulating quality and safety for human tissues and cells, defining authorization systems for tissue and cell banks as well as supervising their work and determining the compliance regarding quality and safety for procurement, testing, processing and distribution of human tissues and cells for therapeutic purposes according to the required standards; Ordinance on Storing Personal Data of Donors and Recipients of Human Body Parts (OG 141/05), Ordinance on Cooperation with Related Foreign and International Organisations for the Purpose of Exchanging Organs and Human Tissues for Transplantation (OG 141/05), Ordinance on Measures to Ensure Safety and Quality of Human Body Parts for Medical Use COG 143/05), Ordinance on Distribution Principles of Unrelated Allogeneic Hematopoietic Cells and the Register of Potential Bone Marrow Donors COG 151/05), Ordinance on Distribution Criteria of Human Body Parts and Compilation of a National Waiting List (OG 152/05), Ordinance on the Method of Storage and Transportation of Human Body Parts Intended for Transplantation COG 152/05), Ordinance on Keeping Medical Documentation on Performed Removals and Transplants of Human Body Parts COG 152/05), Ordinance on Notification Procedures of the Death of Eligible Human Body Part Donors for Therapeutic Purposes (OG 152/05), Ordinance on the Work of Tissue Banks with and Supervision over Health Care Institutes or Divisions of Health Care Institutes COG 1/06), Ordinance on Method, Procedure and Medical Criteria for Death Determination of Body Part Donors for Transplants COG 3/06), and Ordinance on the Work of Coordinators in the Procedure of Removal and Transplantation of Human Body Parts for Therapeutic Purposes COG 51/06). The Croatian legislation is greatly consistent with the legislation of the European Union regarding this field. In the above mentioned law and decrees, Croatia has a legal foundation for regulating this field in compliance with EU standards.     

Retinophotography--screening method in diabetic retinopathy

The paper presents the modern screening method for diabetic retinopathy-the retino-photography. We present our experience on this issue, regarding the patients with diabetic retinopathy screened in Diabetic Eye Department, Ophthalmology Clinic Craiova, between October 2002-June 2005.