Sympathetic activation may contribute to both cardiovascular morbidity and the progression of chronic kidney disease. The role of the chemoreceptors in determining sympathetic nerve discharge in patients with chronic renal failure (CRF) is unknown. We tested the hypothesis that tonic activation of excitatory chemoreceptor afferents contributes to the elevated sympathetic activity in patients with CRF. Utilizing a double-blind, randomized, vehicle-controlled design, we examined the effects of chemoreflex deactivation on muscle sympathetic nerve activity (MSNA). We compared effects of breathing 100% oxygen for 15 min with effects of breathing room air for 15 min in 12 stable patients with CRF and in 12 control individuals with similar age, gender, blood pressure and body mass index. The baseline MSNA was elevated significantly in the patients with CRF as compared with the control individuals (50 ± 2 vs 42 ± 2 bursts/min; P < 0.05). Reductions in systolic blood pressure and pulse pressure in response to the administration of 100% oxygen were significantly different from those observed during administration of room air in patients with CRF. In patients with CRF, MSNA decreased by 29 ± 7% (P < 0.01) during hyperoxia but did not change during administration of room air (5 ± 6%; P = NS). By contrast, neither 100% oxygen or room air changed any measures in control individuals. Tonic activation of excitatory chemoreflex afferents contributes to increased efferent sympathetic activity to muscle circulation and to blood pressure control in patients with CRF. These findings may have important implications for understanding mechanisms underlying the link between CRF and cardiovascular disease.

Objectives: Patients with a diagnosed systemic connective tissue disease require regular monitoring from the point of view of interstitial lung disease. The main aim of this work is a description of the criteria for pulmonary fibrosis and the degree of the severity of the fibrosis during the course of interstitial lung disease through the TLU (transthoracic lung ultrasound). Materials and Methods: 52 patients with diagnosed diffuse interstitial lung disease were qualified for this research, together with 50 volunteers in the control group. The patients in both groups were over 18 years of age and were of both sexes. The results of the TLU of the patients underwent statistical analysis and were compared to High-Resolution Computed Tomography (HRCT) results. Results: As a consequence of the statistical analysis, we defined our own criteria for pulmonary fibrosis in TLU: irregularity of the pleura line, tightening of the pleura line, the fragmentary nature of the pleura line, blurring of the pleura line, thickening of the pleura line, artifacts of line B ≤ 3 and ≥ 4, artifacts of Am line and subpleural consolidations < 5 mm. As a result of the conducted research, a scale of severity of pulmonary fibrosis in TLU was devised (UFI – Ultrasound Fibrosis Index), enabling a division to be made into mild, moderate and severe cases. Conclusions: Transthoracic Lung Ultrasonography (TLU) gives a new outlook on the diagnostic possibilities, non-invasive and devoid of ionising radiation, of pulmonary fibrosis. This research work has allowed to discover two new ultrasound symptoms of pulmonary fibrosis (blurred pleural line and Am lines). Ziel: Patienten mit Diagnose einer systemischen Kollagenose brauchen eine regelmäßige Überwachung im Hinblick auf eine interstitielle Lungenerkrankung. Das Hauptziel dieser Arbeit ist die Beschreibung der Kriterien für eine pulmonale Fibrose und dem Schweregrad der Fibrose bei einer interstitiellen Lungenerkrankung mittels TLU (transthorakaler Lungenultraschall). Material und Methoden: 52 Patienten mit Diagnose einer diffusen interstitiellen Lungenerkrankung wurden für diese Untersuchung ausgewählt zusammen mit 50 Freiwilligen einer Kontrollgruppe. Die Patienten beider Gruppen waren über 18 Jahre alt und beiderlei Geschlechts. Das Ergebnis des TLU der Patienten wurde statistisch analysiert und mit der High-Resolution-Computertomografie verglichen. Ergebnisse: Als Folge der statistischen Analyse definierten wir unsere eigenen Kriterien für Lungenfibrose im TLU: Ungleichmäßigkeit der Pleuralinie, Straffung der Pleuralinie, unvollständige Pleuralinie, Unschärfe der Pleuralinie, Verdickung der Pleuralinie, B-Linien-Artefakte ≤ 3 und ≥ 4, Artefakte der Am-Linie und subpleurale Verdichtungen < 5 mm. Als Ergebnis aus den durchgeführten Untersuchungen wurde eine Skala der Schwere der Lungenfibrose im TLU entwickelt (UFI- Ultraschall-Fibrose-Index), die eine Unterteilung in leichte, moderate und schwere Fälle ermöglicht. Schlussfolgerung: Der transthorakale Lungenultraschall (TLU) ermöglicht neue Perspektiven der diagnostischen Möglichkeiten bei pulmonaler Fibrose, die nicht-invasiv und ohne ionisierende Strahlen sind. Diese Forschungsarbeit hat die Beschreibung von zwei neuen Ultraschallmarkern bei Lungenfibrose (unscharfe Pleuralinie und Am-Linien) ermöglicht.

This study aimed to evaluate changes in plasma amino acid and nicotinamide metabolites concentrations in rheumatoid arthritis (RA) in a search for potential biomarkers of the disease activity and the effect treatment. Analysis of plasma metabolite patterns with liquid chromatography/mass spectrometry revealed specific changes in RA as well as correlations with clinical parameters. Combined concentration parameter calculated as [aspartic acid] + [threonine] + [tryptophan] − [histidine] − [phenylalanine] offered the strongest correlation (p < 0.001) with pain joint count, swollen joint count and DAS 28. Such analysis of amino acid and related metabolite pattern offers potential for diagnosis as well as for monitoring disease progression and therapy in RA.

Introduction: Granulomatosis with polyangiitis (GPA) is a rare, ANCA-associated, systemic disease characterized by necrotizing small and medium vessel vasculitis of unknown etiology associated with granulomatous inflammation affecting the renal, pulmonary, upper airways, ocular systems and other tissues. Histological proof of the granulomatosis with polyangiitis (GPA) can be obtained by biopsy of clinically involved sites. The main purpose of this study was to examine histopathological changes in non-renal biopsies from patients with established diagnosis of GPA and evaluated the histological confirmation at diagnosis of this disease. Material and methods: A retrospective analysis was performed in patients with GPA diagnosed and treated in clinics of the University Clinical Center (UCK) in Gdansk in 1988–2009. Results: In the analyzed group of GPA patients the histopathological examination of biopsies taken from involved tissues (except kidney) was performed in 60% of patients. Thirty-six out of 93 biopsies (39%) were diagnosed as typical of GPA, 10 (10.7%) were suggestive and 51 (54.8%) were non-specific. Considering all biopsies, the diagnosis was confirmed in 24 patients (57% of patients in whom biopsies were taken). Epitheloid cell granulomas were present in 33 biopsies (43%), characteristic necrosis in 27 biopsies (35%), small vessel vasculitis in 18 biopsies (23%), while multinucleated giant cells were identified only in 9 biopsies (12%). Conclusions: Histopathological examination of the affected tissues remains the gold standard of the diagnosis of GPA. Its usefulness increases, particularly in ANCA-negative patients, in the initial phase of the disease, or in patients with atypical clinical presentation. In many cases, it is necessary to repeat biopsy to establish the diagnosis. The role of the histopathological examination seems to be particularly important when ANCA is negative or clinical symptoms are atypical of GPA.