The complement system in primary Sjögren’s syndrome: the expression of certain cascade and regulatory proteins in labial salivary glands – observational study

IntroductionThe complement cascade and regulatory proteins are involved in the pathogenesis of the Sjögren’s syndrome and other autoimmune diseases. The complement activation via the alternative pathway was recognized as a major pathogenic mechanism in autoimmune conditions. The aim of this study was to assess expression of complement cascade components and regulatory proteins in minor salivary glands in patients with primary Sjögren’s syndrome (pSS).Materials and methodsThe expression of C1q and C5b-9 – membrane attack complex and regulatory proteins such as: membrane cofactor protein (MCP), decay-accelerating factor (DAF) and protectin were examined using immunochemistry method in specimens from biopsy of minor salivary glands in pSS patients. The biopsy material was obtained from 20 pSS patients, 5 patients with non-specific sialadenitis and from 5 patients with suspicion of dryness syndrome without sialadenitis confirmation.ResultsNone of the examined samples showed the expression of C1q or the effector C5b-9. Membrane cofactor protein expression was lower in pSS group than in both non-specific sialadenitis and noninflamed salivary glands. The inflammatory cells in pSS samples partially expressed MCP. There were differences in the sites and intensity of membrane protectin expression exclusively on the luminal surfaces in pSS; on the luminal and, partially, antiluminal surface in non-specific inflammation, and on the entire cell surface in unaffected salivary glands. There were no DAF expression in salivary gland tissue in biopsy specimens in all studied subjects.ConclusionsThe study demonstrated the absence of complement-cascade proteins (C1q, MAC) in the salivary glands of pSS patients, which may indicated a lack of local complement activation via the classical pathway and the observed gland tissue damage being due to a mechanism other than MAC-induced cytolysis. The differences in the expression of complement regulatory proteins between pSS, non-specific sialadenitis, and normal salivary glands may indicate that alternative functions of these regulatory proteins may be of greater significance in pSS. Low MCP expression in pSS in comparison with non-specific sialadenitis and normal salivary glands, may suggest altered modulation of cell-mediated immunity in pSS. The differences in the location and intensity of protectin (CD59) expression indicates a possibility of reducing the proinflammatory effect of protectin in pSS.     

Renal anaemia treatment in haemodialysis patients in the Central and Eastern European countries in everyday clinical practice follow-up

Background

Chronic kidney disease is almost always accompanied by anaemia. Erythropoietin-stimulating agents (ESA) can increase haemoglobin concentration and thus reduce the frequency of anaemia-related complications including the cardiovascular events.

Aim

The aim of the study was to collect prospective data on 12-month standard ESA therapy used in haemodialyzed patients in selected CEE countries as well as on cardiovascular complications, iron status and anaemia treatment.

Patients and methods

Fifty centres in 3 countries participated in the study. A group of 398 haemodialysed stable patients (M-231, F-167) aged 19–90 years (57.5 ± 14.7) on standard ESA therapy for chronic renal anaemia were recruited. Twelve-month prospective data on iron parameters, ESA therapy and cardiovascular events were collected. The use of iron, folic acid and blood transfusions were also assessed. Patient were divided into three groups according to ESA therapy start: group A—patients who received ESA after start of haemodialysis, group B—patients who received ESA within 3 months from the day of first haemodialysis and group C—patients who had received ESA more than 3 months before haemodialysis. Chi² test for qualitative data and Kruskall–Wallis test for quantitative data with p < 0.05 were used in statistical analysis.

Results

At prestudy period, the mean weekly dose of ESA in group C was statistically lower than in the remaining two groups (3,823 ± 3,169 vs. 5,276 ± 2,915 and 6,427 ± 3,441 units/week, p < 0.001), but during prospective phase of the study the doses did not differ among groups A, B and C. No major fluctuation of ESA administration schedule was observed during the study in the groups; however, at majority of visits, the mean frequency of ESA administration in group C was statistically higher than in groups A and B. At baseline visit, the haemoglobin concentration in group A patients (10.86 ± 1.34 g/dL) was slightly lower than in group B (11.26 ± 1.43 g/dL) and group C (10.98 ± 1.35 g/dL) (p = 0.025), but at subsequent visits these differences disappeared and mean haemoglobin concentration was stable around 11 g/dL. Ferritin concentration increased from 280 ± 241 at baseline to 506 ± 405 at month 12, and no important differences in the groups were observed. The other haematological parameters (haematocrit, iron concentration) remained stable during the entire study. The frequency of blood transfusion and total volume of blood in group C were lower than in groups A and B. During the prospective 12-month follow-up, 23 (5.8 %) of the patients died and 35 (8.8 %) were transplanted. No differences in death or transplantation rate were observed among groups A, B and C. The number of patients with adverse events, serious adverse events or drug-related adverse events in all groups was similar. In conclusion, ESA therapy increased haemoglobin concentration and no major differences in haematological parameters among the groups were observed during the entire study irrespective of early versus late start. Mortality, cardiovascular events or other adverse events were similar among the groups during the observation period; however, the limitation of the study is the sample size.     

The Effect of the Reaction pH on Properties of Lead(II) Azide

Lead(II) azide is an initiating explosive; even a small amount can trigger an explosion caused by simple external stimuli, such as sparks, flames, friction or pinpricks, and is able to initiate the explosive reaction of rock-crushing explosives. Due to the fact that this initiating explosive triggers further reactions, the effect of priming detonators depends on the properties of its material. Its sensitivity is associated with the size of its crystals. For instance, it is used for mining detonators in the form of fine crystals. The quality of the crystals is also correlated to the safety of the production process, i.e., the crystals should be round-shaped rather than needle-like since breaking it would inevitably trigger an explosion. The process of lead(II) azide production on an industrial scale is based on the reaction of lead(II) nitrate with sodium azide with the presence of dextrin, which determines the desired shape of the crystals. The reaction pH affects the number of sediment particles formed in a periodical reactor. Changing the pH from 6.5 to 7.5 leads to the rapid growth of crystal particles.     

Effects of Elevated Temperatures on the Properties of Cement Mortars with the Iron Oxides Concentrate

Using the waste materials in the production of the building materials limits the storage of the wastes, burdensome for the environment and landscape, and makes possible to manufacture the materials and products with the use of the less volume of the raw materials. Cement concretes and mortars as the basic building materials offer the broad prospects of utilization of the recyclable or waste materials. The wastes from the iron ore processing are the solid wastes resulting from the process of enrichment of the ore concentrate. The paper presents the results of testing three mortars, in which a part of fine aggregate was replaced with the iron oxide concentrate (IOC) resulting from such a process. IOC has been used as a substitute of 10%, 20% and 30% (by mass) of the fine aggregate. The effect of the concentrate on the mechanical performance of the mortars at the high temperature (up to 600 °C) was also investigated. The IOC is a neutral material, not affecting chemically the process of cement hydration. The addition of IOC slightly improves the strength of the cement mortars (by 5% to 10%). In the case of the larger amount (20–30%) of the addition, the use of superplasticizer is necessary. The IOC significantly improves the high temperature resistance of the cement mortars (300 °C). The cement mortars containing 30% of the IOC addition keep 80% of the initial flexural and compressive strength when exposed to the temperature 450 °C.     

Impact of Left Ventricular Remodeling on Ventricular Repolarization and Heart Rate Variability in Patients after Myocardial Infarction Treated with Primary PCI: Prospective 6 Months Follow‐up

Background: The relation between postinfarction left ventricle remodeling (LVR), autonomic nervous system and repolarization process is unclear. Purpose of the study was to assess the influence of LVR on the early (QTpeak) and late (TpeakTend) repolarization periods in patients after myocardial infarction (MI) treated with primary PCI. The day‐to‐night differences of repolarization parameters and the relation between QT and heart rate variability (HRV) indices, as well left ventricle function were also assessed. Methods: The study cohort of 104 pts was examined 6 months after acute MI. HRV and QT indices (corrected to the heart rate) were obtained from the entire 24‐hour Holter recording, daytime and nighttime periods. Results: LVR was found in 33 patients (31.7%). The study groups (LVR+ vs LVR?) did not differ in age, the extent of coronary artery lesions and treatment. Left ventricle ejection fraction (LVEF) was lower (38%± 11% vs 55%± 11%, P < 0.001), both QTc (443 ± 26 ms vs 420 ± 20 ms, P < 0.001) and TpeakTendc (98 ± 11 ms vs 84 ± 12 ms, P < 0.005) were longer in LVR + patients, with no differences for QTpeakc. Trends toward lower values of time‐domain (SDRR, rMSSD) HRV parameters were found in LVR+ pts. Day‐to‐night difference was observed only for SDRR, more marked in LVR‐group. Remarkable relations between delta LVEF (6 months minus baseline), delta LVEDV and TpeakTendc were found, with no such relationships for QTpeakc. Conclusions: The patients with LVR have longer repolarization time, especially the late phase‐ TpeakTend, which represents transmural dispersion of repolarization. Its prolongation seems to be related to local attributes of myocardium and global function of the left ventricle but unrelated to the autonomic nervous influences. Remodeling with moderate LV systolic dysfunction is associated with insignificant decrease in HRV indices and preserved circadian variability.     

Ischemic mitral valve repair: predictive significance of restrictive left ventricular diastolic filling

AIM: The aim of the present study was to evaluate the impact of left ventricular (LV) diastolic filling impairment on postoperative results in patients with low LV ejection fraction (EF) undergoing combined coronary artery bypass grafting (CABG) and mitral valve (MV) repair. METHODS AND RESULTS: Study population consisted of 53 patients with ischemic MV incompetence and LV systolic dysfunction (mean EF-26.1 +/- 6%), who underwent CABG with MV repair. Patients were divided into three groups according to the LV diastolic filling pattern. Study protocol included evaluation of perioperative mortality (30 days inhospital mortality), NYHA functional class, and two-dimensional Doppler echocardiographic examination preoperatively, 10-14 days, and 12 months after surgery. The highest perioperative mortality rate (33.3%), unimproved functional status (in 78.5% of the patients, NYHA functional class remained unchanged late after surgery), and hemodynamic deterioration (LV dilatation, progression of mitral regurgitation (MR) was observed in the restriction group). Though early after surgery, MR reduction was significant in this group, at even one year after surgery 85.7% of patients presented with >grade 1 of MR (P < 0.05). Logistic regression analysis showed that restrictive LV diastolic filling is an important independent preoperative marker (P = 0.035) of progression of MR late after MV repair. CONCLUSION: In patients with severe LV dysfunction undergoing combined CABG and MV repair, restrictive LV diastolic filling pattern is an important preoperative marker of high perioperative mortality rate, further negative remodeling of LV, and progression of mitral regurgitation late after MV repair.