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Primary hyperaldosteronism (PHA) is the most common form of secondary hypertension of hormonal origin. It affects about 10% of all hypertensive patients. It is connected with increased morbidity and mortality from cardiovascular diseases (CVD) compared to patients with essential hypertension, at a similar age. Usually, it is an effect of bilateral adrenal hyperplasia (BAH) or aldosterone-producing adenoma (APA), rarer causes of PHA are: unilateral adrenal hyperplasia, aldosterone-producing adrenocortical carcinoma, ectopic aldosterone-producing tumors, and familial hyperaldosteronism (FH). Recent genetic studies have thrown a new light on the pathogenesis of PHA, classifying it as a channelopathy. Several mutations within the ion channels encoding genes have been identified. A possible link between PHA and polymorphism of aldosterone synthase gene and ion channel genes is still being investigated. In this manuscript, we focus on the genetic aspects of PHA, and present an up-to-date compilation of available data with a widened pathogenetic approach. [ABSTRACT FROM AUTHOR]

Background: Nonadherence to medical treatment and lack of cooperation in hypertensive patients >65 years of age are believed to be caused by a number of age-related problems, such as cognitive impairment. Numerous epidemiological and prospective studies have demonstrated that hypertension that remains untreated for many years or is unsuccessfully treated for reasons such as poor compliance and adherence of the patient may lead to cognitive impairment. Objective: The objective of this study was to investigate the occurrence of cognitive impairment and its effect on treatment compliance and adherence in elderly hypertensive patients. Design: This study was an analytical cross-sectional study. Patients and methods: The study was conducted on 300 patients aged 65–91 years (mean age=71.8 years, SD=7.8 years) diagnosed with hypertension. The following research tools were used: 1) Hill-Bone High Blood Pressure Compliance Scale (HBCS) and 2) Mini–Mental State Examination (MMSE). We also analyzed medical documentation to obtain basic sociodemographic and clinical data. The study was approved by the Bioethics Committee of the Medical University of Wroclaw (no KB-144/2016). Results: Cognitive impairment occurred in 60% of the patients. A group of 63% patients complied with antihypertensive therapy, with the mean score of 20.8 points. Cognitive impairment was strongly correlated with the total score of the HBCS questionnaire (p<0.001) and two of its subscales: "appointment keeping" (p<0.001) and "medication taking" (p<0.001). Conclusion: Compliance and adherence levels are higher in patients with a higher educational level, whereas male sex adversely affects treatment adherence in elderly hypertensive patients. [ABSTRACT FROM AUTHOR]

The aim of the study was to determine the relationship between exposure to cigarette smoke and the morphology of atherosclerotic plaques in the extracranial arteries assessed by computed tomography angiography in patients with hypertension. The study included 61 hypertensive patients: 17 active smokers (group A), 18 non-smokers, declaring environmental exposure to tobacco smoke (group B), and 26 non-smokers, not declaring exposure to cigarette smoke (group C). The number of segments with plaques was significantly higher in group A compared to groups B and C. The number of segments with non-calcified and mixed plaques was significantly higher in group A and group B than in group C. A positive correlation between cigarette-years and the number of segments with atherosclerotic plaques was noted. In summary, both active smoking and environmental exposure to tobacco smoke appear to increase the number of segments of the extracranial arteries with non-calcified and mixed atherosclerotic plaques. [ABSTRACT FROM AUTHOR]

The purpose was to evaluate the early cardiotoxic effects of the treatment in the course of hematopoietic stem cell transplantation (HSCT) in patients with hematologic malignancies. The studies were conducted on 47 patients qualified for the HSCT. Echocardiography was carried out prior to the HSCT and after the HSCT. It was shown that higher age, administration of cyclophosphamide and higher glucose concentrations represented independent risk factors for the worsening of left ventricular diastolic function. Higher cumulative dose of anthracyclines in the previous cytostatic treatment, higher age and administration of cyclophosphamide represented independent risk factors for worsening of left ventricular systolic function. Peri-transplant therapy in the course of HSCT in patients with hematologic malignancies gives the negative effect on the diastolic and systolic left ventricular function, however, previous treatment is of importance, as higher cumulative dose of anthracyclines represents an independent risk factor for the worsening of left ventricular systolic function. [ABSTRACT FROM AUTHOR]

The aim of the study was to examine endothelial function in patients with hematological malignancies treated with high-dose chemotherapy followed by hematopoietic stem cell transplantation. The studies were conducted on 43 consecutive patients qualified for HSCT following high-dose chemotherapy based on the current standards. Then, due to exclusion criteria, a group of 38 patients were chosen for further investigations. Evaluation of endothelial function by means of flow-mediated dilatation (FMD) was conducted in patients with hematological malignancies before HSCT (test A) and after HSCT (test B). Brachial artery diameter (BAD) after occlusion, change in BAD and FMD were significantly lower after HSCT as compared to the results obtained before the transplantation ( p < 0.05). The regression analysis indicated that administration of fludarabine and cytarabine, and also higher blood concentrations of creatinine represented risk factors for the impairment of endothelial function expressed as decreased FMD value. In patients with hematopoietic malignancies treated with HSCT, endothelial function assessed by the flow-mediated dilatation was impaired after chemotherapy and stem cell administration. [ABSTRACT FROM AUTHOR]

The purpose of this study was to assess the vasoconstrictive effects of adenosine in the kidney microcirculation in hypertensive patients with renal artery stenosis (RAS). Twelve patients with resistant hypertension and moderate RAS were selected for the study. In all patients, systolic, diastolic and mean translesional pressure gradients, distal pressure (Pd), aortic pressure (Pa) andPd/Paratio were measured using a pressure guidewire at baseline and after intrarenal bolus administration of 400 μg adenosine. We observed significant changes in mean translesional pressure gradient and systolicPdafter pharmacological stimulation. The results suggest that in hypertensive patients with RAS, vasomotor activity of the kidney microcirculation may be preserved. [ABSTRACT FROM PUBLISHER]

Background: Acute myeloid leukemia (AML) is a heterogeneous neoplasm of the bone marrow with poor prognosis. In clinical practice new prognostic factors are still needed. MicroRNAs (miRs), small endogenous noncoding RNAs, play an essential role in the development and progression of acute leukemia. The aim of the study was to evaluate miR-204 expression in patients with AML at diagnosis and after induction chemotherapy, in comparison to healthy controls. We also investigated, if miR-204 expression correlates with clinical features of AML patients. Methods: miR-204 expression has been analyzed using RT-PCR in 95 bone marrow specimens from newly diagnosed AML patients in comparison to 20 healthy subject. Results: We showed down-regulated miR-204 expression in AML patients, which was associated with shorter patients' survival. Higher expression of miR-204 in patients after induction therapy was correlated with complete remission achieving. Conclusions: We showed low miR-204 expression in AML and found it to be an independent prognostic factor in this patient population. [ABSTRACT FROM AUTHOR]

Introduction: The study aimed to evaluate the relationship between plasma asymmetric dimethylarginine (ADMA) concentration and development of left ventricular diastolic dysfunction (LVDD) in patients with essential hypertension (EH). Moreover, an attempt was made to define independent risk factors of LVDD in patients with eH. Material and methods: A group of 106 individuals with eH was obtained (mean age: 47.18 ±11.76 years). Two groups of patients were distinguished: group I - individuals with eH with LVDD (n = 57); group II - persons with eH without LVDD (n = 49). Echocardiographic examination was conducted by the transthoracic technique. High-performance liquid chromatography was used to measure dimethylarginine concentrations. Results: In the group suffering from EH with LVDD, mean ADMA concentration was significantly higher and the ratio of arginine to ADMA was significantly lower than in patients with eH without LVDD. No significant differences were detected between mean concentrations of plasma symmetric dimethylarginine concentration (SDMA) and arginine or in arginine/SDMA ratios in the studied groups. Independent factors of LVDD risk in the study group included higher plasma ADMA concentration, higher serum low-density lipoprotein (LDL) concentration, higher values of body mass index (BMI), higher values of left ventricular mass index (LVMI) and higher values of mean blood pressure (mBP) (ORADMA = 1.731; ORLDL = 1.188; ORBMI = 1.056; ORLVMI = 1.062; ORmBP = 1.014; p < 0.05). Conclusions: The results of this study showed that ADMA concentration may be of prognostic value in relation to manifestation of LVDD in patients with eH. [ABSTRACT FROM AUTHOR]

Background: In a Phase III trial, 485 patients (⩾65 years) with newly diagnosed acute myeloid leukemia received decitabine 20 mg/m2 intravenously for 5 days every 4 weeks or a treatment choice (supportive care or cytarabine 20 mg/m2 subcutaneously for 10 days every 4 weeks). Materials and methods: We summarized overall and progression-free survival by baseline white blood cell count using two analyses: ,1, 1-5, .5×109/L; #10 or .10×109/L. Results: There were 446 deaths (treatment choice, n=227; decitabine, n=219). Median overall survival was 5.0 (treatment choice) versus 7.7 months (decitabine; nominal P=0.037). Overall survival differences between white blood cell groups were not significant; hazard ratios (HRs) favored decitabine. Significant progression-free survival differences favored decitabine for groups 1-5×109/L (P=0.005, HR =0.67), greater than 5×109/L (P=0.027, HR =0.71), and up to 10×109/L (P=0.003, HR =0.72). Conclusion: There was a trend toward improved outcome with decitabine, regardless of baseline white blood cell count. [ABSTRACT FROM AUTHOR]

Background: CXCR4 chemokine receptor is constitutively expressed on normal and malignant B lymphocytes derived from patients with B-cell lymphoproliferative disorders and has a significant role in cell migration to lymph nodes and bone marrow. Non-Hodgkin's lymphomas (NHL) constitute a heterogeneous group of lymphoproliferative diseases, which can localize not only to lymph nodes, but also can migrate to peripheral blood and metastase to other organs, including bone marrow. Aim: The purpose of this study was to determine CXCR4 gene expression in peripheral blood and bone marrow of NHL patients before and after treatment. Methods: Samples of lymphoma lymph nodes, peripheral blood and bone marrow aspirates of patients with B-cell NHL were taken at diagnosis and after chemotherapy. Gene expression was determined by the reverse transcription (RT)-polymerase chain reaction method. Expression was estimated from 0 AU (no amplificate signal) to 3 AU (maximal amplificate signal). Results: No significant difference in the level of CXCR4 expression was found in reactive lymph nodes compared to lymphoma samples We observed high level of CXCR4 expression in most patients before treatment: in bone marrow: 3 AU-10 pts, 2 AU–8 pts, 1 AU–2 pts. In peripheral blood: 3 AU–14 pts, 2 AU–4 pts, 1 AU–1 pts, 0 AU–1 pts. After chemotherapy, significant decrease in CXCR4 expression was observed. Bone marrow: 3 AU–5 pts, 2 AU–7 pts, 1 AU–5 pts, 0 AU–3 pts (p = 0.03). Peripheral blood: 3 AU–2 pts, 2 AU–6 pts, 1 AU–10 pts, 0 AU–2 pts (p = 0.0002). There was a good response to treatment in patients with significant decrease of CXCR4 expression in the bone marrow after treatment with 10-fold lower risk of death (p = 0.03). Conclusions: Decrease in CXCR4 expression in the bone marrow of NHL patients after chemotherapy may be a good prognostic factor. [ABSTRACT FROM AUTHOR]

Highlights: [•] CXCL12 (rs1801157) and CXCR4 (rs2228014) gene polymorphisms were investigated in multiple myeloma (MM). [•] Association with disease susceptibility and progression was studied. [•] CXCR4 T variant was rarely detected among patients but all of them presented with the highest ISS score. [•] CXCL12-3′A variant was more frequent in patients with less advanced MM and with lower ISS score. [•] Presence of CXCL12-3′A allele was also associated with better survival. [ABSTRACT FROM AUTHOR]

Background: Sleep sex also known as sexsomnia or somnambulistic sexual behavior is proposed to be classified as NREM (non-rapid eye movement) parasomnia (as a clinical subtype of disorders of arousal from NREM sleep—primarily confusional arousals or less commonly sleepwalking), but it has also been described in relation to REM (rapid eye movement) parasomnias. Methods: The authors searched the PubMed database to identify relevant publications and present the co-occurrence of sexsomnia and other sleep disorders as a non-systematic review with case series. Results: In the available literature the comorbidity of sexsomnia and other sleep disorders were reported mainly in case reports and less in case series. Sexsomnia was reported both with one and with multiple sleep-related disorders, with NREM parasomnias and obstructive sleep apnea (OSA) being the most commonly reported. Furthermore, the authors enrich the article with new findings concerning two novel cases of sleep bruxism triggering recurrent sexsomnia episodes. Conclusions: Sexsomnia has still not been reported in the literature as often as other parasomnias. The coexistence of sexsomnia and other sleep-related disorders should be more thoroughly examined. This could help both in sexsomnia as well as other sleep-related disorders management. [ABSTRACT FROM AUTHOR]

Multiple myeloma (MM) is a haematologic malignancy characterized by the presence of atypical plasma cells. Basigin (BSG, CD147) controls lactate export through the monocarboxylic acid transporter 1 (MCT1, SLC16A1) and supports MM survival and proliferation. Additionally, BSG is implicated in response to treatment with immunomodulatory drugs (thalidomide and its derivatives). We investigated the role of single nucleotide polymorphisms (SNPs) in the gene coding for BSG and SLC16A1 in MM. Following an in silico analysis, eight SNPs (four in BSG and four in SLC16A1) predicted to have a functional effect were selected and analyzed in 135 MM patients and 135 healthy individuals. Alleles rs4919859 C, rs8637 G, and haplotype CG were associated with worse progression-free survival (p = 0.006, p = 0.017, p = 0.002, respectively), while rs7556664 A, rs7169 T and rs1049434 A (all in linkage disequilibrium (LD), r2 > 0.98) were associated with better overall survival (p = 0.021). Similar relationships were observed in thalidomide-treated patients. Moreover, rs4919859 C, rs8637 G, rs8259 A and the CG haplotype were more common in patients in stages II–III of the International Staging System (p < 0.05), while rs8259 A correlated with higher levels of β-2-microglobulin and creatinine (p < 0.05). Taken together, our results show that BSG and SLC16A1 variants affect survival, and may play an important role in MM. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented which discusses the treatment of leukemia cutis with combination of cladribine, rituximab, and cyclophosphamide in a 56-year-old woman with B-cell chronic lymphocytic leukemia.

Invasive fungal infections (IFI) still remain one of the main reason of mortality in patients who undergo allogeneic stem cell transplantation. Candida spp. and Aspergillus spp. are most common pathogens that cause IFI. Allogeneic transplant recipients very often can present with complications, like graft versus host disease (GVHD) or need for immunosuppression, which predispose for IFI. Improved clinical outcome of patients with IFI depends on proper prophylaxis as well as early initiation of antifungal treatment. [ABSTRACT FROM AUTHOR]

Purpose Determination of the relationship between the estimated total volume of the carotid bodies (V rCB + lCB ), assessed by computed tomography angiography (CTA), and the autonomic cardiac function in patients with essential hypertension (EH). Materials and methods The study included 69 patients with diagnosed and pharmacologically treated EH. The estimated volume of each carotid body (CB) was evaluated on the basis of scans obtained in the CTA of carotid arteries, using the following formula: 4/3 × π × half of transverse dimension of CB in axial projection × half of longitudinal dimension of CB in the axial projection × half of craniocaudal dimension of CB in the sagittal/coronal projection. Cardiac autonomic function was assessed using time domain analysis of heart rate variability (HRV). Results The mean values of SDNNi, rMSSD and pNN50 at 24-h monitoring, during daily activity and during night rest, were significantly lower in patients with hypertension with the values of V rCB + lCB ≥ median compared to the group of hypertensive patients with the values of V rCB + lCB < median. Moreover, in patients with EH with the values of V rCB + lCB ≥ median, the mean values of SDNN were lower during daily activity. Based on the regression analysis, it was found out that the higher values of V rCB + lCB are an independent risk factor in HRV reduction (expressed as a reduction in the rMSSD). Conclusion In patients with EH, a relationship between the volume of CB, assessed by CTA of carotid arteries, and autonomic cardiac function seems to be probable. [ABSTRACT FROM AUTHOR]

During the past three decades invasive fungal infections have been increasingly occurred in immunocompromised patients. The most common pathogens are Candida and Aspergillus spp., however over the last few years, there has been a significant increase of infections caused by Fusarium, Mucor or Trichosporon spp. The use of broad-spectrum antifungal prophylaxis plays also a role in rising frequency of multi-drug resistant fungi. Invasive fungal infections are characterizated by severe clinical course and high mortality rate. Non-specific symptoms and difficulties in diagnosis, along with late institution of antifungal therapy, are associated with poor clinical outcome. Therapeutic strategies include prophylaxis, pre-emptive and empirical treatment and treatment of proven fungal infections. The choice of optimal therapeutic option should be based on the risk assessment, patient risk-group stratification, appropriate diagnosis, clinical features and diagnostic tests. Late diagnosis and delayed introduction of antifungal therapy are important predictors of death in invasive fungal infections. [ABSTRACT FROM AUTHOR]

Invasive fungal infections (IFI) constitute a serious complication in a patient with hematologic malignancies, especially in acute myeloid leukemia (AML) patients. Predisposing factors for fungal infections are immunosuppression, neutropenia, surgical interventions or intra-articular injections. Fungal arthritis is a rare manifestation of IFI. We present a case of a 75-year-old AML patient, who developed candida arthritis in course of decitabine treatment. [ABSTRACT FROM AUTHOR]