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Kidney dysfunction significantly increases the cardiovascular risk, even in cases of minor functional declines. Hypertriglyceridemia is the most common lipid abnormality reported in patients with kidney disorders. PPAR-α (peroxisome proliferator-activated receptor-α) agonists called fibrates are the main agents used to lower triglyceride levels. Kynurenic acid (KYNA) is a tryptophan (Trp) derivative directly formed from L-kynurenine (L-KYN) by kynurenine aminotransferases (KATs). KYNA is classified as a uremic toxin, the level of which is correlated with kidney function impairments and lipid abnormalities. The aim of this study was to analyze the effect of the most commonly used triglyceride-lowering drugs, fenofibrate and gemfibrozil, on KYNA production and KAT activity in rat kidneys in vitro. The influence of fenofibrate and gemfibrozil on KYNA formation and KAT activity was tested in rat kidney homogenates in vitro. Fenofibrate and gemfibrozil at 100 µM-1 mM significantly inhibited KYNA synthesis in rat kidney homogenates. Both fibrates directly affected the KAT I and KAT II isoenzyme activities in a dose-dependent manner at similar concentrations. The presented results reveal the novel mechanism of action of fibrates in the kidneys and suggest their potential role in kidney function protection beyond the well-known anti-hyperlipidemic effect.

Background: Nowadays, depression is a serious clinical problem, as the prevalence of its various forms increases and there are growing numbers of patients with severe forms of depression and treatment-refractory depression. Depressed patients have been observed to have decreased levels of kynurenic acid (KYNA), which is the only endogenous antagonist of ionotropic N-methyl-D-aspartate (NMDA) receptors. The aim of this study was to identify subgroups of patients differing in the dynamics of changes in KYNA concentration during electroconvulsive therapy (ECT)., Subjects and Methods: The study included 32 patients with an ICD-10 diagnosis of a major depressive episode receiving ECT treatment and 48 healthy volunteers. Blood serum KYNA concentrations were determined using HPLC-based methods, and clinical assessment was performed using the Montgomery-Åsberg Depression Rating Scale (MADRS) and the Clinical Global Impressions (CGI) Scale., Results: Three subgroups of patients with depression were identified which differed in baseline KYNA levels and in the dynamics of changes in blood serum KYNA concentrations during and after ECT., Conclusions: The largest number of patients with clinical improvement (83%) was observed in the subgroup with significantly lower pre-treatment, treatment and post-treatment KYNA concentrations than those determined in the control group. This subgroup of patients also showed the lowest dynamics of changes in KYNA concentrations during ECT. Clinical improvement was observed in 75% of depressed patients who had insignificantly lower pre-treatment levels of KYNA and slightly higher levels of this acid after 6 and 12 ECT sessions than controls. The smallest number of patients with clinical improvement (50%) was observed in the subgroup of patients who had similar pre-treatment and treatment concentrations of KYNA to controls and whose post-treatment concentrations of KYNA were significantly lower than those of healthy individuals.

Objectives: The aim of the present study was to compare blood serum kynurenic acid (KYNA) concentrations measured before ECT and after 1, 6 and 12 electroconvulsive treatment (ECT) sessions in patients with diagnoses of recurrent depressive disorder (RDD), depression in bipolar disorder (DBD) and schizoaffective disorder (SAD)., Methods: The study group comprised of 50 patients with ICD-10 diagnoses of RDD, DBD and SAD. Blood serum KYNA concentrations were determined and clinical assessment was performed using the MADRS and the GAF scale., Results: Significant differences were found in blood serum KYNA levels between RDD, DBD and SAD patients treated with electroconvulsive therapy and healthy controls: 1) KYNA concentrations in DBD patients measured before ECT and after 12 ECT sessions were significantly lower than in the control group; 2) KYNA concentrations in the serum of RDD patients measured before ECT and after one and 12 ECT sessions were significantly lower than in the control group, while those measured after 6 ECT session did not differ significantly from KYNA concentrations in healthy controls; 3) higher pre-treatment blood serum concentrations of KYNA in DBD patients correlated with a higher number of illness phases and poorer general functioning before treatment; 4) significant relationships were found between higher blood serum concentrations of KYNA in RDD patients after 1 ECT session and male gender, and between higher KYNA concentrations after 6 ECT sessions and increased depression and poorer functioning before treatment in those patients., Conclusions: Results show that KYNA concentrations in all diagnostic groups were lower before ECT (not statistically significant for the SAD group) and that there were no significant changes in those concentrations (compared with the baseline) during ECT.

Introduction: Surgery is an extreme physiological stress for the elderly. Aging is inevitably associated with irreversible and progressive cellular degeneration. Patients above 75 years of age are characterized by impaired responses to operative stress and a very narrow safety margin., Aim: To evaluate perioperative complications in patients aged ≥ 75 years who underwent cardiac surgery in comparison to outcomes in younger patients., Material and Methods: The study was conducted at the Silesian Centre for Heart Diseases in Zabrze in 2009-2014 after a standard of perioperative care in seniors was implemented to reduce complications, in particular to decrease the duration of mechanical ventilation and reduce postoperative delirium. The study group included 1446 patients., Results: The mean duration of mechanical ventilation was 13.8 h in patients aged ≥ 75 years and did not differ significantly compared to younger patients. In-hospital mortality among seniors was 3.8%, a value significantly higher than that observed among patients younger than 75 years of age. Patients aged ≥ 75 years undergoing cardiac surgery have significantly more concomitant conditions involving other organs, which affects treatment outcomes (duration of hospital stay, mortality)., Conclusions: The implementation of a standard of perioperative care in this age group reduced the duration of mechanical ventilation and lowered the rate of postoperative delirium.

Fungi from Malassezia species may be a component of human and animal skin onthocenosis but also may cause general mycoses in patients from high risk groups. The aim of study was the evaluation of some clinic data in patients with tinea versicolor, who entered to Department of Biology and Medical Parasitology, Centre for Treatment of Parasitic Diseases and Mycoses, Medical University of Lodz. Forty four patients with tinea versicolor were examined. Localization and number of skin lesions as well as eventually risk factor were examined. In all patients mycological examine was done; morphotic elements of fungi in direct and stained slides were found, cultures on solid medium with oil olive were done. In Wood light fluorescence of changed skin was observed. The most incidence of tinea versicolor was observed in young persons to compare with to another age groups. The most frequently localization of clinical lesions concerned back skin, back and chest. In women - to compare with to male patients--clinical lesions on back skin were significantly more frequent. The only one factor was conducived to infection--it was a seborrhea of the skin, observed mainly in patients from the youngest age group.

Aim: To assess the early results of the pulmonary artery valve transcatheter implantation (PAVTI) in pts included into POL-PAVTI registry. Detailed medical and economic analyses were performed., Methods: Pulmonary artery valve implantation was performed in 14 pts (9 men), aged 16-31 (mean 24.6 +/- 4.8) years, with pulmonary homograft dysfunction after total repair of tetralogy of Fallot (4 pts), pulmonary atresia (2 pts), pulmonary stenosis (1 pt), common arterial trunk type I (1 pt), Ross procedure (3 pts) and TGA - Rastelli operation (3 pts). Eleven pts underwent in the past 2-5 surgical or/and catheter interventions. Indication for PAVTI was based on clinical evaluation and echocardiographic studies. Assessment of morphological and functional features of the right ventricle (RV) and homograft with the use of cardiac magnetic resonance (CMR) was performed in 10 cases. Pulmonary stenosis (max. pulmonary gradient 32-119, mean 72 +/- 28 mmHg) was observed in 13 pts and/or significant pulmonary regurgitation in 10 pts. The procedure was performed in general anesthesia. The deployment of a valved stent in the pulmonary valve position was preceded by a metal stent implantation. Results were evaluated by echocardiography two days after the procedure and one month later. Four patients were evaluated 6 months after procedure., Results: Time of the procedure varied 60-190 (mean 127 +/- 35) min, time of fluoroscopy ranged 12-31 (mean 21 +/- 11) min. PAVTI was successfully performed in all pts without serious complications. Patients were discharged from the hospital 48-293 (mean 120 +/- 71) h after procedure. Significant reduction of pulmonary gradient after the procedure assessed by echocardiography was observed on the second day (20-60, mean 38 +/- 12 mmHg, p < 0.0001) and one month (19-52, mean 34 +/- 9 mmHg, p < 0.0001). Mild pulmonary regurgitation was observed in 2 pts. In 5 pts evaluated 6 months after procedure haemodynamic parameters were unchanged; no late complications were observed. Average cost of the procedure including a price of the valve (82 000 PLN) was 98 000 PLN., Conclusions: Pulmonary artery valve transvascular implantation is an effective and safe method of non-surgical treatment for patients with homograft dysfunction. Cost-effectiveness is approvable.

Nitric oxide (NO) is present in exhaled air in humans and its level may decrease in heart diseases. In the present study we prospectively investigated how heart transplantation treated with oral immunosuppresive drugs based on ciclosporine A influences the exhaled NO concentration (exNO). The study was performed in 17 patients after heart transplantation in various time after procedure and 15 nonsmoking healthy volunteers as a control group. Patients after heart transplantation were free of clinical signs of rejection. End-tidal concentration of exNO was measured by the use of a chemiluminescence method. We found no statistically significant differences in the exNO level between patients after heart transplantation and healthy controls (6.81+/-2.70 part per billion (ppb) in the transplant group vs. 6.01+/-3.43 ppb in the control group). We conclude that heart transplantation and immunosuppresive therapy do not influence the exhaled NO concentration.

Unlabelled: THE AIM of the study was to show first results of newborn life threatening respiratory failure treatment with extracorporeal membrane oxygenation (ECMO) in Poland., Material: Nine newborns were treated with extracorporeal membrane oxygenation in Silesian Center for Heart Diseases. Newborns were born in 38 week of gestational age (36-41 weeks) with mean birth weight of 3490 g. Reasons for the referral were: meconium aspiration syndrome, infection, and pulmonary hypertension. Each newborn fulfilled an Extracorporeal Life Support Organization (ELSO) criteria for extracorporeal membrane oxygenation., Results: seven out of nine of patients treated with extracorporeal membrane oxygenation survived. Full clinical stabilization was reached about 6th hour of treatment. Mean extracorporeal oxygenation time was 162 hours. For eight newborns veno-venous method was applied and for one newborn veno-arterial method. Roller pump was used in 7 cases and centrifugal pomp in one case. Five newborns had uneventful treatment. During extracorporeal membrane oxygenation therapy we have observed several complications: PDA, hemorrhagic complications, renal failure, arterial hypertension, septicemia, tubing rupture., Conclusions: extracorporeal oxygenation is an effective method of treatment for newborn life threatening respiratory failure. Obtained results do not differ much from Extracorporeal Life Support Organization register results. The most essential problem for extracorporeal membrane oxygenation therapy is correct qualification, early referral, safe transportation as well as the development of centers providing ECMO treatment.

The effect of nitric oxide synthase (NOS) inhibitors on the brain production of endogenous glutamate receptor antagonist, kynurenic acid, was estimated in vitro. Under standard incubation conditions N(G)-nitro-L-arginine, but not N(G)-nitro-L-arginine methyl ester, up to 5 mM, or 7-nitroindazole, up to 100 microM, inhibited de novo synthesis of kynurenic acid in cortical slices. However, during prolonged incubation, N(G)-nitro-L-arginine methyl ester also reduced the production of kynurenic acid. The substrate for NOS, L-arginine (up to 5 mM), did not influence kynurenic acid synthesis and did not reverse the N(G)-nitro-L-arginine-evoked changes, suggesting that the observed effects are not related to disturbed generation of NO. Enzymatic studies revealed that N(G)-nitro-L-arginine and its methyl ester blocked the activity of brain kynurenine aminotransferase (KAT) I. The activity of KAT II was diminished only by N(G)-nitro-L-arginine. Kinetic analyses have shown that N(G)-nitro-L-arginine and its methyl ester reduce Vmax and increase Km of KAT I, whereas N(G)-nitro-L-arginine diminishes Vmax of KAT II. In conclusion, we report that N(G)-nitro-L-arginine and its methyl ester impair brain synthesis of kynurenic acid, probably via NO-independent mechanism, what could contribute, at least partially, to the enhancement of neurotoxicity or seizures observed in some experimental designs based on their use.

The role of adenosine receptor agonists in the convulsant activity of mitochondrial toxin, 3-nitropropionic acid (3-NPA), was studied in mice. The occurrence of seizures evoked by peripheral application of 3-NPA was inhibited with the use of A1 adenosine receptor agonist, R-N6-phenylisopropyladenosine and A1/A2 agonist, 2-chloroadenosine. Moreover, both drugs prevented 3-NPA-induced mortality. Similarly, A1/A2 agonist, 5'-N-ethylcarboxamidoadenosine, protected against seizures evoked by the intracerebral administration of 3-NPA, and this effect was reversed by the co-application of adenosine receptor antagonist, 8-(p-sulfophenyl)theophylline. Obtained results suggest that A1 adenosine receptor activation may modulate the chain of events leading to the development of 3-NPA-induced seizures.

3-Nitropropionic acid (3-NPA) is a mitochondrial toxin inhibiting the activity of succinate dehydrogenase. Its experimental application in rodents causes lesions of the striatum resembling the course of Huntington's disease in humans. Recently, we have shown that 3-NPA is also a potent convulsive and proconvulsive agent. This study investigated the effects of adenosine receptor agonists on neurodegeneration and convulsions induced by 3-NPA. Adenosinergic agonists prevented seizures but not striatal neuronal loss evoked by 3-NPA, what suggests that different mechanisms might contribute to these pathologies associated with application of mitochondrial toxin.

Prolonged seizures may alter the brain function in numerous ways. It is conceivable that they might lead to modifications of seizure susceptibility or anticonvulsive drug efficacy, however, only limited data address this issue. Therefore, we have decided to estimate the antiepileptic activity of drugs interfering with GABA-ergic neurotransmission in mice subjected to prolonged clonic seizures 2 weeks before, using pentetrazol test. The activity of valproate, but not diazepam or phenobarbital, was diminished in animals following repetitive clonic seizures. It might be hypothesized that in humans suffering from epilepsy, prolonged seizures in the past might contribute to the lowered efficacy of valproic acid later on.

Rat spinal cord slices produced kynurenic acid (KYNA) upon exposure to L-kynurenine. Aminooxyacetic acid, non-selective aminotransferase inhibitor, and L-glutamate, but neither N-methyl-D-aspartate (NMDA), alpha-amino-3-hydroxy-5-metyloisoxazolo-4-propionate (AMPA), nor kainate, diminished synthesis of KYNA. L-Glutamate action was less potent in spinal than in cortical slices. Metabotropic agonists, L-(+)-2-amino-4-phosphonobutyrate (L-AP4) and (+/-)-1-aminocyclopentane-trans-1,3-dicarboxylic acid (t-ACPD), used in concentrations inhibiting cortical KYNA synthesis, were ineffective in spinal cord. Spinal KYNA production seems less susceptible to inhibitory modulation.

The anticonvulsant action of chlormethiazole was evaluated with the use of subthreshold doses of convulsants affecting the purinergic, glycinergic and gamma-aminobutyric acid (GABA)-mediated transmission, i.e. aminophylline, strychnine, bicuculline and picrotoxin in the model of generalized tonic-clonic convulsions. Chlormethiazole protected mice against maximal electroshock-induced seizures with an ED50 of 130.8 mg/kg. Aminophylline (100 mg/kg) and strychnine (0.4 mg/kg) reversed the protective action of chlormethiazole against electroconvulsions raising the ED50 values of this drug to 218.6 and 208.6 mg/kg, respectively. In contrast, GABA antagonists, bicuculline and picrotoxin, neither affected the protection provided by chlormethiazole nor did they alter the protective activity of valproate, phenobarbital, diphenylhydantoin and carbamazepine against electroconvulsions. Our results indicate that (a) the anticonvulsant activity of chlormethiazole might be related to its interaction with strychnine-sensitive glycinergic as well as purinergic neurotransmission, (b) purinergic and strychnine-sensitive glycinergic events contribute more prominently than GABAergic ones to the anticonvulsant activity of the drugs providing protection against maximal electroshock-induced convulsions.

A number of data concerning the central action of mitochondrial toxins, substances impairing mitochondrial synthesis of ATP and thus compromising cellular energy status, has emerged within last years. 3-Nitropropionic acid (3-NPA) is an irreversible inhibitor of succinate dehydrogenase and mitochondrial complex II. The experimental administration of 3-NPA may lead to selective neuronal loss and chorea-like behavioral alterations but, as was recently shown, it also evokes clonic convulsions in rodents. The gathered data suggest that disturbed mitochondrial energy metabolism might initiate the chain of events culminating in seizure episode and that 3-NPA might become a useful tool in studying "mitochondrial" seizures. It has been hypothesized that the resistance to standard anticonvulsive therapy occurring among high proportion of epilepsy sufferers may result from the impairment of mitochondrial energy status due to either genetic predispositions or environmental influences.

The levels of the neuroprotective excitatory amino acid receptor antagonist kynurenic acid (KYNA) have been previously shown to be reduced in several regions of the brain of Huntington's disease (HD) patients. Thus, KYNA has been speculatively linked to the pathogenesis of HD. We have examined KYNA levels and the activity of its two biosynthetic enzymes (kynurenine aminotransferases (KAT) I and II) in 12 regions of brains from late-stage HD patients and control donors (n = 17 each). KYNA levels were measured in the original tissue homogenate. Using [3H]kynurenine as the substrate, enzyme activities were determined in dialyzed tissue homogenates. KYNA levels in the caudate nucleus decreased from 733 +/- 95 in controls to 401 +/- 62 fmol/mg tissue in HD (p < 0.01). The activity of both enzymes was highest in cortical areas (e.g. control frontal cortex: KAT I: 148 +/- 18 fmol/mg tissue/h; KAT II: 25 +/- 2 fmol/mg tissue/h). The activities of both KAT I and KAT II, when expressed per mg original weight, showed significant decreases (48-55%) in the HD putamen (p < 0.01). Trends toward lower enzyme activities and KYNA concentrations were detected in other brain areas as well. Kinetic analyses, performed in putamen and cerebellum, showed an approximately 3-fold increase in Km values for both KAT I and KAT II in the putamen only. Vmax values remained unchanged in the HD brain. These findings indicate a selective impairment in KYNA biosynthesis in the neostriatum of HD patients, possibly due to the loss of (an) endogenous KAT activator(s).(ABSTRACT TRUNCATED AT 250 WORDS)

Previous investigations in seizure-prone mice have suggested that an abnormally elevated production of the astrocyte-derived neuroexcitant, quinolinic acid (QUIN), plays a role in seizure susceptibility. In order to evaluate further the role of QUIN metabolism in genetic murine seizure models, the activities of its biosynthetic enzyme 3-hydroxyanthranilic acid oxygenase (3HAO), and of two other astrocytic enzymes, kynurenine aminotransferase (KAT) and glutamine synthetase (GS), were measured in the brains of seizure-prone EL and DBA/2 mice and two non-epileptic strains (BALB/c and Swiss-Webster). 3HAO activity was found to be markedly higher in both EL and DBA/2 mice than in the non-epileptic strains in all brain regions examined. The activity of 3HAO was not modified by the tossing procedure employed to promote seizures in EL mice. While some strain differences were noted in the activities of KAT and GS, these enzymes did not distinguish seizure-prone from the non-epileptic mice. In order to delineate better the relationship between glial activation and 3HAO, KAT and GS, further studies were performed in the ibotenate-lesioned hippocampus. In mice (but not in rats), the activity of 3HAO was selectively increased in gliotic tissue. These data demonstrate substantial species and strain differences in astroglial enzymes and in their response to brain injury. The observation of widespread abnormally high 3HAO activity in two distinct seizure-prone mouse strains strengthens the hypothesis that enhanced production of QUIN contributes to seizure susceptibility in mice.

In order to examine the status of quinolinic acid (QUIN) metabolism in a model of delayed excitotoxic neurodegeneration, the de novo production of QUIN from 3-hydroxyanthranilic acid was assessed in brain homogenates and brain slices of mice injected with hamster neurotropic measles virus. In the hippocampus, which presents exclusive nerve cell loss in this model, the activity of 3-hydroxyanthranilic acid oxygenase, an astrocytic enzyme responsible for the biosynthesis of QUIN, was increased 3.3-fold by 7 days after virus inoculation. Less dramatic increases were observed in the cerebral cortex and the striatum, while cerebellar enzyme activity was not different from control values. In the same brain homogenates, no changes occurred in the activities of kynurenine aminotransferase, the biosynthetic enzyme of the neuroprotectant kynurenic acid, and of the astrocytic marker glutamine synthetase. At 7 days postinoculation, hippocampal slices from virus-treated animals, when exposed to 3-hydroxyanthranilic acid, produced 18 times more QUIN than slices from control animals. Notably, a significant increase was also seen 3 days postinoculation, i.e., at a time when astrocytes had started to proliferate but prior to the onset of neurodegeneration (Eur. J. Neurosci. 3:66-71, 1991). These data suggest that astrocyte-derived QUIN may play a causative role in the occurrence of hippocampal nerve cell loss in measles virus-infected mice.