Warsaw Medical University Research Articles

Mapping the landscape of immunonutrition and cancer research: a comprehensive bibliometric analysis on behalf of NutriOnc Research Group.

The ongoing global health challenge of cancer is driving the pursuit of innovative avenues for prevention, treatment, and enhanced outcomes. The convergence of nutrition and immune modulation, known as immunonutrition, is ready to act as a catalyst for transformative change in cancer research and therapy. Our study employs a bibliometric analysis to uncover the evolving trends within immunonutrition and cancer research across the past 25 years. Bibliometric data, including authors, journals, affiliations, and countries, were analyzed using the Bibliometrix R package. Clustering algorithms were applied to keywords to identify thematic areas and their evolution. A total of 489 documents were analyzed, showing an annual growth rate of 8.7%, with a collaboration index of 5.41, highlighting comprehensive multidisciplinary involvement within this landscape. Core authors demonstrated sustained productivity, while occasional authors indicated widespread interest. The Medical University of Warsaw led in institutional contributions. Country-wise, Italy, France, and the USA emerged as forerunners in fostering research productivity. Key journals like 'Clinical Nutrition' served as beacons, emphasizing the multidimensional nature of this topic. The analysis highlighted growing research output and several collaborations, indicating the importance of immunoenriched nutrition in cancer treatment. The interplay of core authors and diversified engagement harmoniously accentuates the cross-disciplinary nature of this burgeoning field. International collaboration facilitated knowledge exchange. Prominent documents shaped the field, emphasizing the significance of nutritional interventions. Thematic clusters revealed varied focuses, including pharmaconutrients, surgical approaches, inflammation, and specific cancers. The expanding research output suggests further development, particularly in exploring immunoenriched nutrition's impact on cancer types and patient populations. The multidisciplinary nature and international collaborations enhance the field's progress. Gaps in research underscore the need for original studies and personalized approaches. This study guides future research, informing evidence-based nutritional interventions and advancing cancer care practices.

Standards of Value Stream Mapping as a tool supporting logistics processes in the healthcare system in Poland

According to the World Health Organisation (WHO) a health system consists of many components like organizations, institutions, resources, and people whose primary purpose is to improve health. The system is complex and requires staff, funds, information, supplies, transport, communications and overall guidance and direction to function properly. These elements interact with each other and, as in the logistics system, there are uninterrupted physical, decision-making and information flows between its most important elements, which include: service providers, service recipients (patients), a payer (the National Health Fund), control and supervision institutions, the Ministry of Health. The Polish healthcare system is struggling with many problems, such as insufficient access to health services, inefficient system management, shortages of medical staff, or underfunding. The use of Value Stream Mapping (VSM) standards can significantly contribute to the improvement of logistics processes of the Polish healthcare system. The standards can be also used to improve the processes of treatment of other diseases, but also the functioning of healthcare units.The aim of the article is to present the possibility of applying Value Stream Mapping standards in the process of ischemic stroke treatment as the results of the project ‘Lean Management in Healthcare’, implemented by the consortium consisting of the Medical University of Warsaw, the Institute of Psychiatry and Neurology in Warsaw and the Polish Society of Health Economics, financed by the National Centre for Research and Development under contract no. IS-2/200/NCBR/2015.

Analysis of short tandem repeat mutations in paternity cases from Masovian Voivodeship provinces form years 2018-2022 based on materials of the Department of Forensic Medicine, Medical University of Warsaw.

In paternity cases, genetic tests are of great importance as they allow to exclude or confirm paternity. As a result of paternity tests we can also obtain information on the frequency of short tandem repeat mutations, which are important in the statistical analysis of test results. A total of 468 cases of full paternity trios (mother, child and alleged father) were analysed from years 2018 - 2022 from the central part of Poland. For further analysis of the occurrence of the mutation 346 cases in which paternity was confirmed were qualified. DNA analysis was performed using the PowerPlex®Fusion 6C kit (Promega, USA). 36 mutations were observed in 13 of the 23 genetic markers analysed. 94.44% were one-step mutations and 5.56% were two-step mutations. Among those mutations, there were 18 insertions and 10 deletions, while in 8 cases it was not possible to determine whether an insertion or deletion occurred. There was also a significantly higher share of the father mutation in relation to the mother mutation at a ratio of 4.17:1.

Knowledge on the aetiology and prevention of tooth decay among pregnant women based on an original author’s survey study from 2022 – discussion and comparison with a 2015 survey study

Introduction: Oral health disorders in a pregnant woman have an adverse impact on the child’s health. A high maternal level of cariogenic bacteria can significantly increase the risk of tooth decay in the child. There is a positive correlation between increased plaque accumulation and premature birth and also low birth weight. Aim and methods: The aim of this study was to discuss the level of knowledge on the aetiology and prevention of tooth decay among pregnant women based on an original survey conducted in 2022 and to compare the results with a survey conducted in 2015 under the affiliation of the Warsaw Medical University, entitled “Awareness of pregnant women about preventing early childhood caries”. Both studies were subjected to a statistical analysis using Spearman’s rank correlation (p < 0.05). Additionally, PubMed data and current literature were used in writing this paper. Literature review: The analysis in both cases revealed a positive correlation between the level of knowledge and the education level of the respondents. In the 2015 group, 10% of expectant mothers knew when their first dental visit should occur, while this percentage rose to 51.9% in the 2022 group. The increase in the level of knowledge is also evident when considering questions about oral care before tooth eruption. Summary: The level of knowledge on the aetiology and prevention of tooth decay among pregnant women has increased compared to previous years and can be considered high. Further education is still needed.

The impact of home enteral nutrition planned with the use of indirect calorimetry on the nutritional status and body composition of cancer patients

BackgroundStudies show that malnutrition is common among cancer patients, ranging from about 20% to more than 70%. It is known that malnutrition that is not managed properly worsens the course of the disease, prolongs the hospital stay, and impacts the quality of life and treatment toxicities. Malnutrition has many negative effects, therefore individualization and optimization of nutritional support is crucial for the patient's health. This study aimed to assess the impact of home enteral nutrition (HEN) planned with the use of indirect calorimetry on the nutritional status and body composition of cancer patients. MethodsThis prospective, observational study included 28 patients with cancer recruited at the Nutrition Clinic of Department of General, Gastroenterologic and Oncologic Surgery, of the Medical University of Warsaw from December 2021 to December 2022. All patients were supported with HEN setup based on individual caloric needs for 3 months. We evaluated nutritional status, body composition, and biochemical markers of malnutrition. ResultsFor 67.9 % of patients, using the equations rather than indirect calorimetry would underestimate energy needs. Individualized HEN resulted in weight loss stops in 46.4 % of patients. The average change in body mass in the study group was positive and was equal to 0.46 ± 6.73 kg. No significant differences were found when comparing the mid-arm circumference (MAC) and triceps skinfold thickness (SFT) before and after inclusion in HEN, although, as in the case of body mass SFT showed an upward trend. Moreover, the percentage of patients with insufficient total protein (TP) and serum albumin concentrations decreased. This difference was statistically significant for albumin. The Nutritional Risk Index (NRI) was also significantly higher. The analysis of body composition also showed a decrease in the percentage of patients with reduced fat-free mass (FFM), body cell mass (BCM), and phase angle (PhA) value. ConclusionsThe results of our research highlight the significance of well-planned nutritional care for cancer patients. Utilizing HEN and individualized approaches can effectively preserve body mass, composition, and nutritional status while minimizing safety risks, ultimately improving quality of life. Indirect calorimetry if available can be helpful to optimize nutrition care for patients with cancer in HEN.

Serotonin Metabolism and Serotonin Receptors Expression Are Altered in Colon Diverticulosis.

Background and Objectives: Diverticulosis is frequently accompanied by altered bowel habits. The biogenic amines within colonic mucosa control bowel motility, and in particular, alterations in serotonin signaling may play a role in colon diverticulosis. The aim of the study was to assess the concentration of biogenic amines and serotonin receptor expression in the colonic mucosa in patients with diverticulosis and healthy controls. Materials and Methods: This prospective, comparative study included 59 individuals: 35 with sigmoid diverticulosis and 24 healthy controls. The study was held at the Department of Gastroenterology and Internal Medicine, Medical University of Warsaw, Poland. Mucosal samples were taken from the right and left colon during a colonoscopy in all patients. Concentrations of norepinephrine, 3-methoxy-4-hydroxyphenylglycol, dopamine, homovanillic acid, serotonin, and 5-hydroxyindoleacetic acid were measured with high-performance liquid chromatography. Expressions of human 5-hydroxytryptamine receptor 3A, 5-hydroxytryptamine receptor 4, 5-hydroxytryptamine receptor 7, solute carrier family 6 member 4 (SERT) for serotonin, as well as the neuroglia activation markers glial fibrillary acidic protein, S100 calcium-binding protein B, and proteolipid protein 1, were assessed with polymerase chain reaction. Results: The median age and sex distribution were comparable in both study groups (median 69 y vs. 52 y; p < 0.455 and males/females in cases 11/17 vs. 18/19 in controls; p < 0.309). In diverticulosis patients, there was a higher concentration of serotonin in the left affected colon compared to the right healthy part of the colon (median 8239 pg/mg vs. 6326 pg/mL; p < 0.01). The SERT expression was lower in the affected left segment compared to the right colon (median 0.88 vs. 1.36; p < 0.01). There was a higher colonic mucosa concentration of serotonin (median 8239 pg/mg vs. 6000 pg/mL; p < 0.02) and 5-hydroxyindoleacetic acid/serotonin ratio (median 0.27 vs. 0.47; p < 0.01) in diverticulosis patients compared to controls in the left side of the colon. Conclusions: The concentration of serotonin in the mucosa of the colon segment affected by diverticula is higher than in the healthy segment in the same individuals and higher than in healthy controls. These results underline serotonin signaling in colon diverticulosis pathophysiology.

Development of peanut, sesame and tree nut allergy in Polish children at high risk of food allergy: a protocol for a cross-sectional study

IntroductionPeanut allergies cause serious health problems worldwide. A strong finding has shown that the early introduction of peanuts into the diet of infants at high risk of food allergy reduces...

70 Visual Attention and Emotion Recognition Deficits in Patients with Cerebellar Tumors

Objective:Social cognition refers to processing, analyzing and understanding information about emotions and social situations. Many studies indicate a frequent deficit of these functions in people with tumors of the cerebellum. Visual search is an important attention process prior to information processing. It also mediates the relationship between cognitive function (attention) and social cognition. There are numerous data showing that disorders of various aspects of attention are fairly common in patients with tumors of the cerebellum. The question arises whether there is any relationship between these functions. The purpose of this study was to find out if there is a relationship between visual search performance and the ability to recognize emotions.Participants and Methods:The study included 19 patients with the cerebello-pontine angle (CPA) tumors (mean age = 38.84, SD = 14.27; 10 women and 9 men) and 19 healthy controls (mean age 38.26, SD = 10.40; 10 women and 9 men). The research group consisted of patients from the Department of Neurosurgery, UCK Medical University of Warsaw, the control group was healthy. The groups did not differ demographically. At the beginning, the respondents completed a questionnaire in which they were asked about demographic data and health status. Then, a series of 40 boards presenting the letters T in two colors, blue and orange, scattered in different planes was presented. The letters were right or upside down. The test person’s task was to find and click the correctly positioned orange T letter as quickly as possible. Then, a series of 56 photos of faces representing seven different emotions was presented (happiness, anger, sadness, surprise, disgust, fear and a neutral face). The test person’s task was to decide which of the emotions mentioned under the photo were presented by the presented face.Results:The results indicated that patients with tumors in the CPA area had a longer mean reaction time and lower accuracy when performing visual searches than subjects from the control group. Likewise, there were longer times and lower accuracy in the emotional recognition task. Moreover, in the group of patients with CPA tumor, the response time during visual search was negatively associated with the correctness of the response in visual search (p = -0.57, p &lt;0.05). There were also negative correlations between the reaction time and the correctness of recognizing particular emotional states: anger (p = -0.48, p &lt;0.05), disgust (p = -0.62, p &lt;0.01) and neutral (p = -0.64, p &lt;0.01). The correctness of answers in visual search correlated positively with the accuracy of emotion recognition (p = 0.72, p &lt;0.01). None of the above-mentioned relationships were found in the control group.Conclusions:The obtained results indicate a relationship between the quality of visual attention and the ability to recognize emotions in people with cerebellar lesions. In order to better understand this phenomenon, it is necessary to continue research in this field.

Eradication of cervical canal colonization associated with prophylactic cervical cerclage: the look further study.

The perioperative management of the cervical cerclage procedure is not unified. In general population controlling microbiome cervical status does not affect obstetric outcomes, but it might be beneficial in patients with cervical insufficiency. The aim of our study was to present the obstetric, neonatal and pediatric outcomes of patients undergoing the cervical cerclage placement procedure in our obstetric department using a regimen of care that includes control of the microbiological status of the cervix and elimination of the pathogens detected. Thirty-five patients undergoing cervical cerclage in the 2nd Department of Obstetrics and Gynecology, Medical University of Warsaw, were included in the study. The procedure was performed only after receiving a negative culture from the cervical canal. Thirty-one (88.6%) patients delivered after the 34th and twenty-eight (80.0%) after the 37th week of gestation. The colonization of the genital tract was present in 31% of patients prior to the procedure, in 42% of patients - during the subsequent pregnancy course and in 48% of patients - before delivery. A total of 85% of patients who had miscarriage or delivered prematurely had abnormal cervical cultures. In patients with normal cervical cultures, and 91.7% of women delivered at term. No abnormalities in children's development were found. Controlling microbiological status of the cervical canal results in better or similar outcomes to those reported by other authors in terms of obstetric and neonatal outcomes. Active eradication of the reproductive tract colonization potentially increases the effectiveness of the cervical cerclage placement.

Maximum safety and minimum risk: midline access gained by a nurse-led Vascular Access and Infusion Team

Abstract Aim. The aim of the study was to conduct a retrospective analysis of cannulations done under ultrasound guidance by the Vascular Access and Infusion Team using the Seldinger technique. Material and methods. This observational study was retrospective in nature. Analysis was carried out of 82 cannulation charts reporting procedures from March to August 2022 at the University Clinical Centre of the Medical University of Warsaw. Results. Midline access was gained in 86 patients with a success rate of 95.3% (n=82). Cannulation by nurses was performed in 93% (n=80) of the patients. The procedure required an average of 1.62 attempts. The most frequently cannulated veins were the basilic (72%, n=59) and brachial (14.6%, n=12) ones. MC removal in 40.2% (n=33) of the cases was due to the termination of intravenous therapy, and in 23.4% (n=19) was caused by complications related to infusion management. Conclusions. Implantation of midline catheters in patients, including those with difficult intravenous access, can be done eff ectively with a minimum number of cannulation attempts. Maintaining midline catheters for the entire duration of therapy is challenging due to potential complications and requires rigorous care during their use. A detailed analysis of possible complications distinguishing between diff erent types of complications and continuous improvement of observation protocols and appropriate management is advisable. It is also advisable to plan and conduct an observational study in the area of retrospective analysis.

Comparison of knowledge and awareness of epilepsy between medical students of two universities in Poland

BackgroundEpilepsy is one of the most common neurological disorders. As a chronic disease, associated with long-term treatment with antiseizure medication, it can have a negative impact on patients’ quality of life. Moreover, patients are faced with a significant psychosocial burden associated with the stigma surrounding epilepsy. Medical professionals should be well educated and free of prejudices in order to provide adequate care for patients with epilepsy. The aim of the study was to evaluate the knowledge and awareness of epilepsy among medical students of years 1–6 in Poland and examine if certain personality traits influence students’ view of epilepsy. MethodsThe study was conducted using snowball sampling of 166 Polish medical students from Medical University of Gdansk and Medical University of Warsaw. Participants completed a survey which consisted of their subjective assessment of knowledge of epileptology, actual knowledge of epileptology, and their view of stereotypes about epilepsy. In addition, students completed the IPIP-BFM-20 personality questionnaire. ResultsPolish medical students have sufficient basic knowledge about epilepsy (mean scores of students from both universities is 14 out of 25 points). There is still room for improvement, especially in the field of epidemiology, semiology, factors provoking seizures, antiseizure medications, and most importantly about first aid during seizure (e.g., 7% of respondents believed it is necessary to put something between teeth of a patient during seizure). Age and the year of study were well correlated with knowledge score (p = 0.008) and level of awareness of the stereotypes. We found that most personality traits do not have a strong impact on the level of knowledge about epilepsy. ConclusionsMost students have a satisfying level of knowledge about epilepsy. Academic teachers should put more emphasis on first aid during seizures and awareness of psychosocial challenges associated with the disease. It is crucial for future physicians to not only possess sufficient theoretical knowledge, but also establish an empathetic doctor–patient relationship in order to provide better care for patients with epilepsy and other chronic diseases.

Massive Transfusion Increases Serum Magnesium Concentration.

(1) Background: The massive transfusion of packed red blood cells (RBCs) is a lifesaving procedure, but it is associated with complications, e.g., dysmagnesemia. Since magnesium is an intracellular ion, the transfused RBCs can significantly influence the magnesium concentration in the recipient's blood. (2) Methods: A retrospective study was performed among 49 patients hospitalized in the Central Clinical Hospital of the Medical University of Warsaw who received a massive blood transfusion (≥4 units/h). Data on laboratory results and patient history were collected from the hospital database. The intracellular RBCs magnesium concentration was measured in 231 samples using the colorimetric method. (3) Results: There were statistically significant changes in the mean serum magnesium concentration preoperatively and 24 h postoperatively (0.87 ± 0.13 vs. 1.03 ± 0.14, p < 0.00001) and 48 h postoperatively (0.87 ± 0.13 vs. 1.06 ± 0.15, p < 0.00001). Patients who died had significantly higher serum magnesium concentrations (p < 0.05). The median intracellular magnesium concentration in RBCs was 0.91 (0.55-1.8) mmol/L, which is below the reference values of 1.65-2.65 mmol/L. (4) Conclusions: Transfused RBCs significantly increased the serum magnesium concentration 24 h and 48 h postoperatively. It could be a result of mild hemolysis, as the median intracellular magnesium concentration in RBCs was below the reference values.

Twenty years of Prospects in Pharmaceutical Sciences: recent changes

Prospects in Pharmaceutical Sciences (fka. Bulletin of the Faculty of Pharmacy of the Medical University of Warsaw) is an open access scientific journal, published since 2003 as a quarterly by the Medical University of Warsaw. Prospects in Pharmaceutical Sciences offers immediate Open Access to its publications, permitting any user to read, download, copy, distribute, print, search, or link to the full texts of articles, crawl them for indexing, pass them as data to software, or use them for any other lawful purpose, free of any charge. The journal does not charge authors fees for submission, editorial process, APC or any other fees. Prospects in Pharmaceutical Sciences is free for both authors and readers. This year we mark its 20th anniversary. Here we present recent changes in the official Journal of the Faculty of Pharmacy of the Medical University of Warsaw.

Contemporary Acute Kidney Injury Management

ACUTE kidney injury (AKI) was discussed in a session chaired by Jolanta Malyszko, Medical University of Warsaw, Poland, and Danilo Fliser, Saarland University Medical Centre, Homburg, Germany, at the 60th European Renal Association (ERA) Congress, which took place in Milan, Italy, between 15th–18th June 2023. The moderators started by announcing that ERA has created a new working group on AKI.

Analysis of mastoid portion of facial nerve course in temporal bone using computed tomography.

&lt;b&gt;Introduction:&lt;/b&gt; The facial nerve (FN) follows a complex route in the temporal bone. Successful temporal bone surgery requires knowledge of its course which can be achieved using imaging methods such as computed tomography. This investigation aims to analyze the FN course in its mastoid portion and second genu and the frequency of its atypical course.&lt;/br&gt;&lt;/br&gt; &lt;b&gt;Material and methods:&lt;/b&gt; This is a retrospective study that enrolled 104 CT scans of temporal bones of patients followed up in the outpatient clinic of the Otorhinolaryngology Department of Dentistry Faculty of the Medical University of Warsaw between 2020 and 2022. FN courses were classified as straight, bulging, or letter "S"-like. Other parameters estimated: &lt;/br&gt; • position of the second genu according to the prominence of the lateral semicircular canal (classified as lateral, medial, or middle) and its distance from a line adjacent to the lateral semicircular canal was measured;&lt;/br&gt; • the distance between the short process of the incus and the outermost point of the second genu;&lt;/br&gt; • the course of the mastoid portion of FN and the location of SG in comparison to the tympanic portion of n. VII. The course was later classified as lateral, medial, or middle.&lt;/br&gt;&lt;/br&gt; &lt;b&gt;Results:&lt;/b&gt; Among the 104 assessed temporal bones, the course of the mastoid portion of FN was classified as bulging in 47 cases (45.2%). Straight and letter "S"-like courses were present in 41 (39.4%) and 16 (15.4%) cases, respectively. Deviation of the second genu according to the prominence of the lateral semicircular canal was medial in 86 cases (82.7%), and middle in 4 cases (3.8%). In the rest, second genu was paramedian to the prominence of the later circular canal. The mean distance between the short process of the incus and the outermost point of SG was 4.9 mm (0.73 mm). The mastoid portion was located laterally, medially, and in the middle of the tympanic portion plane in, respectively, 4.8%, 83.7%, and 11.5%. The second genu was located laterally, medially, and in the middle of the tympanic portion plane in 1.9%, 73.1%, and 25%, respectively. In conclusion, seven temporal bones (6.7%) of five patients presented with a lateral displacement of FN in relation to the established anatomical landmarks.&lt;/br&gt;&lt;/br&gt; &lt;b&gt;Conclusions:&lt;/b&gt; Although the atypical course of FN, including the lateral displacement of the mastoid portion, is rare, screening for it is crucial before surgical exploration.

Colonization with drug-resistant pathogens among patients in long-term care facilities and under home hospice care - a cross-sectional study.

The spread of drug-resistant bacteria is deemed a worldwide threat. Patients in long-term care, including those under palliative care, are exposed to a high risk of colonization and infection with drug-resistant pathogens. This refers primarily to long-term care facilities as opposed to home care. A cross-sectional study was carried out between 1January 2018 - 30 June 2019. The study was approved by the Bioethics Committee at the Medical University of Warsaw (KB/222/2017). The aim of the study was to assess the frequency and type of colonization with drug-resistant pathogens among patients in long-term care facilities and those under home hospice care. An additional aim was evaluation the risk of pathogen transmission according to the type of provided long-term care. The study included 129 participants: 68 patients under the care of 3 long-term care facilities in Warsaw, Poland, 42 patients under home hospice care, and 19 household members of hospice patients. All included participants provided written informed consent. Oropharyngeal and rectal swabs were obtained from all participants for microbiological assessment. Colonization with pathogens was more common in long-term care facilities residents (82.4%)than in at-home hospice patients (42.9%). Risk of colonization was significantly lower in patients staying at home than in long-term care facilities patients (OR 0.16; 95% CI 0.06-0.38). Conclusions. Risk of colonization with drug-resistant pathogens depends on the type of care and is significantly higher in patients staying at long-term care facilities. Systemic measures, such as microbiological screening, are necessary to provide optimal patient care and to ensure epidemiological safety, both to patients and their caregivers.

Epstein Barr Virus Hepatitis-A Mild Clinical Symptom or a Threat?

The present study aimed to characterize pediatric patients diagnosed with hepatitis associated with primary Epstein-Barr Virus (EBV) infection. We described the changes in liver aminotransferases activity during the disease, and we analyzed the results of abdominal ultrasonography. A retrospective study was performed by analyzing the medical records of 166 immunocompetent children diagnosed with primary EBV hepatitis hospitalized at the Department of Children's Infectious Diseases, Medical University of Warsaw, Regional Hospital of Infectious Diseases in Warsaw, between August 2017 and March 2023. Elevated alanine aminotransferase (ALT) activity was noted in the first three weeks of the disease. In 46.3% of patients, ALT values exceeded five times the upper limit of the laboratory norm in the first week of illness. Aspartate aminotransferase activity increased from the first to fourth week from the onset of symptoms and showed two peaks in the first and third weeks. The changes over time of mean AST activity demonstrated significance. Transient cholestatic liver disease was the predominant type of hepatic involvement in 10.8% of children; 66.6% of them were older than 15 years. Clinical and ultrasound criteria of acute acalculous cholecystitis (AAC) were met in three female patients over 16 years of age. Hepatitis associated with primary EBV infection is usually a mild and self-limiting condition. Significantly elevated values of liver enzymes with features of cholestatic liver disease may occur in patients with a more severe course of the infection.

#3827 BICARBONATE PROFILING IN HEMODIALYSIS: MATHEMATICAL MODELING OF DATA FROM A CLINICAL TRIAL

Abstract Background and Aims During hemodialysis (HD), bicarbonate and other bases are added to the dialysis fluid to correct chronic acidosis that may develop in kidney-impaired patients, increasing plasma bicarbonate concentration to physiological levels. Previous studies have shown that both exceedingly high and low post-dialysis bicarbonate concentrations are associated with adverse clinical outcomes; however, no clear guidelines for the prescription of bicarbonate concentration in the dialysis fluid are available. Data from a recent controlled clinical trial, carried out at the Department of Nephrology, Dialysis and Internal Medicine, Medical University of Warsaw (Poland), were used to identify transport parameters of a mathematical model of acid-base homeostasis in HD patients, as the first step in the implementation of a tool to optimize bicarbonate profiling during HD. Method The study was carried out in 20 chronic patients, undergoing thrice weekly 4-hr HD. The patients underwent three treatment regimens: A) constant dialysis fluid bicarbonate concentration (HCO3,D) equal to 35 mEq/L; B) HCO3,D decreasing from 35 to 30 mEq/L after 2 hrs; C) HCO3,D increasing from 30 to 35 mEq/L after 2 hrs. The patients were divided in two cohorts: for the first (n = 11) treatment schedule was: treatment A during the first and third week, B during the second week and C during the fourth week. For the second cohort (n = 9) treatment C was carried out during the second week and treatment B during the fourth. Data were collected only during the second and third sessions of the week, and acid-base composition was determined using a blood gas analyzer. The mathematical model describes the transport of bicarbonate and dissolved CO2 from dialysis fluid to the patient and can predict changes in the acid-base equilibrium of arterial and venous plasma and erythrocytes, interstitial fluid, and tissue cells, using mass transport equations. The dialysances for bicarbonate (KHCO3) and dissolved CO2 (KCO2) were estimated via least square minimization. Results No significant difference was found comparing patients in the two cohorts, or comparing sessions of the same week. Pre-dialysis plasma bicarbonate, pH, or CO2 partial pressure (PCO2) were significantly lower for treatment B compared to treatment A. Average plasma bicarbonate concentrations for the different treatments are shown in Figure 1 for data and model simulations. Table 1 reports the average values of the estimated parameters for week. No statistically significant difference was found between sessions, cohorts, or treatments. The model fitted bicarbonate data with an average error of 2.5 ± 1.4%, and PCO2 with an error of 4.5 ± 3.6%. Simulations of mixed-venous blood, interstitial fluid, and tissue cells concentrations showed a similar response to different treatments as in arterial blood. Conclusion The model accurately describes plasma bicarbonate data with high accuracy regardless of the treatment conditions. The parameters estimated showed considerable variability between treatments (less so between the sessions of the same week), but without statistical significance. The model can be used to simulate the effect of dialysate bicarbonate profiling on acid-base equilibrium in HD patients.

Predicted health care profile after transition to adult care in Turner syndrome children-experience of single center.

Turner Syndrome (TS) is caused by the complete or partial loss of one of the X chromosomes in all or some female cell lines. The variable genotypes are responsible for a large phenotypic diversity, nevertheless most studies emphasize a weak correlation between genotype and phenotype. The study aimed to assess the occurrence of defects and diseases depending on the karyotype in patients with TS and correlation with the predicted health care profile after the transition to adulthood. 45 patients of the Department of Endocrinology and Pediatrics of the Medical University of Warsaw in 1990-2002 were analyzed. Girls were divided into 2 subgroups: "A", which included 16 patients with the karyotype 45,X, and "B", which included 29 girls with mosaic karyotypes. Based on the literature data, characteristic phenotypic features and the typical defects or diseases accompanying TS were selected, and the frequency of their occurrence was compared in both subgroups. Accordingly to this data, the predicted medical care profile was determined. In our study, patients with complete monosomy of the X chromosome had more characteristic phenotypic features. They needed sex hormone replacement therapy more often and started to menstruate spontaneously much less frequently (only 18.18% in monosomy vs. 73.91% in mosaic patients, p = 0.006). In patients with monosomy, congenital defects of the circulatory system were found more often (46.67% vs. 30.77%). The diagnosis in patients with mosaic karyotype was more often delayed, therefore the optimal time of growth hormone therapy was shorter. In our study, the X isochromosome determined the higher prevalence of autoimmune thyroiditis (83.33% vs. 12.5%, p = 0.049). We didn't find a correlation between the type of karyotype and health care profile after the transition, most of the patients needed more than 2 specialists. Most often, they required: gynecologists, cardiologists, and orthopedics. After the transition from pediatric to adulthood, patients with TS need multidisciplinary care, but not all need the same kind of assistance. The phenotype and comorbidities determine the profile of patients' health care, however it wasn't directly related to the type of karyotype in our study.

Alteration of circulating ACE2-network related miRNAs in patients with COVID-19

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Medical University of Warsaw and São Paulo Research Foundation (FAPESP). Introduction Coronavirus disease 2019 (COVID-19) is associated with an increased risk of mortality and adverse cardiovascular (CV) occurrences, especially in a group of patients with CV diseases (CVD). SARS-CoV-2 virus enters cells through angiotensin converting enzyme 2 (ACE2) cell membrane enzymes, leading to the downregulation in the ACE2-related pathways. Based on our previous in silico [1] results we hypothesized that alteration in the ACE2 interaction network caused by virus infection can affect the expression of miRNAs and influence severity of the disease. Purpose In this study we aimed to analyse the diagnostic and predictive utility of ACE2-related miRNAs, which were identified in our previous in silico analysis (miR-10b-5p, miR-124-3p, miR-200b-3p, miR-26b-5p, miR-302c-5p) in patients with COVID-19. We also aimed to unravel the functions of analyzed miRNAs, by using machine learning based tools, including SHAP for clinical data analysis, and bioinformatic tools for data mining, target predictions and enrichment analyses. Methods Blood samples and clinical data of 79 COVID-19 patients were collected at three different time points, including the day of admission, 7-days and 21-days after admission, as well as one time-point of 32 healthy volunteers. The composite endpoint was hospitalisation length of stay (&amp;gt;21 days) and/or death in follow-up. Results Delta low miR-200b-3p expression (after 7-days of admission) presents predictive utility in assessment of the hospital length of stay and/or death in ROC curve analysis (AUC:0.730, p=0.002) (Fig. 1). Delta low miR-200b-3p expression, together with diabetes mellitus (DM) are independent predictors of increased hospital length of stay and/or death (OR= 5.775; CI= 1.572- 21.214; p= 0.008, OR= 4.888; CI= 1.001- 23.858; p= 0.050, respectively). The expression levels of miR-26b-5p and miR-10b-5p in COVID-19 patients were found lower at the baseline, 7 and 21-days after admission compared to the healthy controls (p&amp;lt;0.0001 for all time points). SHAP analysis indicated levels of miR 200b-3p (day 7th), miR-302c-5p (day 7th), CRP (day 7th), neutrophils (day 0), and D-Dimer (day 0) as the most promising predictors of long hospitalisation for the COVID-19 patients. Pathway enrichment analysis showed that among top shared pathways between targets of analyzed miRNAs were IL-2 signaling pathway, and Pathways in cancer. miR-200b-3p showed regulation of COVID-19-related targets associated with T cell protein tyrosine phosphatase and HIF-1 transcriptional activity in hypoxia, key pathways in COVID-19. Bioinformatics analysis pointed out the role of those miRNAs in multiple CVD phenotypes associated with COVID-19 (Fig. 2). Conclusions In this study we validated and characterized miRNAs which could serve as novel, predictive biomarkers of the COVID-19 long term hospitalisation and can be used for early stratification of patients and prediction of severity of infection development in an individual.