Publications by authors named "Ryszard Marciniak"

32 Publications

How Do Dieticians on Instagram Teach? The Potential of the Kirkpatrick Model in the Evaluation of the Effectiveness of Nutritional Education in Social Media.

Nutrients 2021 Jun 10;13(6). Epub 2021 Jun 10.

Department of Medical Education, Poznan University of Medical Sciences, 7 Rokietnicka St., 60-806 Poznan, Poland.

The growing popularity of health education on social media indicates the need for its appropriate evaluation. This paper aims to present the potential of the Kirkpatrick Model (KM) with New World Kirkpatrick Model (NWKM) additions to evaluate the nutritional education provided by dieticians via Instagram. Instagram profiles of ten dieticians providing nutritional education for their followers were analyzed in March and April 2021. The study sample included profiles of both macro- and micro-influencers. The analyzed quantitative data included Instagram Engagement Rate and the number of likes and comments per post. The qualitative analysis of the comments was performed following the theoretical framework provided by the KM and NWKM. Collected data showed followers' satisfaction, commitment, and relevance of the presented content, fulfilling the Level 1 of NWKM. Level 2 of NWKM was represented by 4 out of 5 dimensions (knowledge, attitude, confidence, commitment). No comments were found only for skills. Both Levels 3 (Behavior) and 4 (Results) of the KM were met. However, the use of the NWKM for them seems limited. The KM can be used to evaluate nutritional education on social media. The NWKM additions seem applicable mostly for Levels 1 and 2.
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http://dx.doi.org/10.3390/nu13062005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8230514PMC
June 2021

'Difficult Conversations with Patients'-A Modified Group Objective Structured Clinical Experience for Medical Students.

Int J Environ Res Public Health 2021 05 27;18(11). Epub 2021 May 27.

Department of Medical Education, Poznan University of Medical Sciences, 60-806 Poznan, Poland.

This study presents a modified Group Objective Structured Clinical Experience (GOSCE) focused on difficult conversations, in which, due to limited time and financial resources, only some students could actively participate in scenarios. We aimed to evaluate the intervention, including differences between them and observers. The intervention was organized for sixth-year medical students at a Polish medical university. The study protocol assumed a pre-post analysis of students' attitudes and self-efficacy of communication skills and their opinions about the intervention. Complete questionnaire pairs were returned by 126 students. The pre-post analysis revealed a significant improvement in their self-efficacy levels of almost all skills as well as their affective attitudes and belief in outcomes of communication learning. The improvement was significant among both the active participants and observers. It also showed a decrease in the motivation score, significant only in females. Regardless of their roles, students had positive opinions about the course and its particular aspects. The modified GOSCE may be an enjoyable and effective learning experience for students, especially in the light of limited resources. However, changes in their motivation score suggest the necessity to increase the importance of communication learning in the curriculum.
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http://dx.doi.org/10.3390/ijerph18115772DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8197999PMC
May 2021

Affective and cognitive components of students' attitudes towards communication learning - validation of the Communication Skills Attitude Scale in a cohort of polish medical students.

BMC Med Educ 2021 Apr 1;21(1):190. Epub 2021 Apr 1.

Chair and Department of Medical Education, Poznan University of Medical Sciences, 7 Rokietnicka St, 60-806, Poznan, Poland.

Background: The Communication Skills Attitude Scale (CSAS) is a recognized tool for assessment of attitudes towards communication learning. In the original version, it consists of 26 items divided on theoretical assumptions into two subscales: Positive and Negative Attitudes Scales. However, the evidence for its structure seems unsatisfactory, and a simple division into positive and negative attitudes may be insufficient to describe attitudes of medical students towards communication learning. Moreover, the existing evidence of the test-retest reliability of the CSAS seems limited. Consequently, this study aimed to provide more evidence on its psychometric properties while validating the CSAS questionnaire in a cohort of Polish medical students.

Methods: The CSAS was translated, adapted into Polish, and validated in a cohort of 389 Polish medical students. Statistical analysis involved, among others, parallel analysis to determine the number of factors, confirmatory factor analysis to compare the proposed model with theory-based ones, and test-retest reliability analysis.

Results: Conducted analysis revealed that in the examined population, the CSAS should rather consist of four than two subscales. Proposed four subscales addressed perceived outcomes of communication learning, positive and negative attitudes towards it (affective components), and factors motivating students to learn communication (a cognitive component of attitudes). Results of test-retest reliability were satisfactory for individual items and subscales.

Conclusions: This study presented a valid and reliable version of the Communication Skills Attitude Scale for Polish medical students and confirmed previous assumptions that CSAS may also be appropriate for assessment of affective and cognitive components of attitudes. Future research should, based on Ajzen's Theory of Planned Behavior, make attempts to develop a tool assessing not only attitudes but also subjective norms and perceived behavioral control.
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http://dx.doi.org/10.1186/s12909-021-02626-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8017827PMC
April 2021

Is there a time and place for health education in chain pharmacies? Perspectives of Polish community pharmacists.

Health Soc Care Community 2020 Nov 28. Epub 2020 Nov 28.

Department of Medical Education, Poznan University of Medical Sciences, Poznan, Poland.

Pharmaceutical practice has evolved significantly from the provision of drugs to a more patient-centred model. However, the ownership structure of pharmacies may impact the level of cognitive services provided by them. The discrepancy may be observed between pharmacists' opinions on how involved they should get and their actual involvement in health promotion and disease prevention. Given the growing market share of pharmacy chains in Europe, this study aimed to investigate the attitudes of pharmacists employed in them towards their role as health educators. It applies Ajzen's theory of planned behaviour to examine pharmacists' perspectives with the use of semi-structured in-depth interviews. A total of 10 semi-structured face-to-face interviews were conducted in May 2017 among Polish pharmacists employed in chains. Obtained results showed that respondents welcomed the possibility of providing health education, but simultaneously they seek physicians' and patients' acceptance for undertaking this task. Competency gaps and unfavourable working conditions may also decrease pharmacists' intention to serve as health educators. Including the role of a health educator to the scope of the pharmacists' practice requires a precise definition of their competencies and responsibilities together with additional training aimed to fill potential gaps in their qualifications. The pharmacists' image as a health educator should also be widely communicated to patients and other healthcare professionals.
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http://dx.doi.org/10.1111/hsc.13242DOI Listing
November 2020

Sex differences in excess and reservoir arterial blood pressures as markers of phenotype.

J Hypertens 2019 11;37(11):2159-2167

Department of Cardiology-Intensive Therapy, Poznan University of Medical Sciences, Poznan.

Objectives: Excess pressure and reservoir pressure are related to various clinical outcomes in cardiovascular diseases, but whether there are sex differences in healthy individuals remains uncertain. We compared phenotypes of excess pressure and reservoir pressure between healthy men and women.

Methods: Different features of noninvasively recorded radial and reconstructed aortic pressure waveforms were measured in 435 healthy adults (257 women, 59%). In addition to SBP and DBP, we compared values of maximal excess pressure and reservoir pressure (RPMAX), excess pressure and reservoir pressure time integrals, respectively, as well as relative contributions of excess pressure (EPREL) and reservoir pressure to total blood pressure time integral, respectively, between men and women divided in two age categories, below 51 (82 women and 66 men) and greater than or equal to 51 years old (175 women and 112 men), corresponding to average age of menopause for women and acceleration of vascular ageing for all.

Results: In both age categories, compared with men, women had significantly lower peripheral and aortic SBP and DBP. Analysis of covariance adjusted for BMI revealed that women who were greater than or equal to 51 years old had significantly higher excess pressure time integral, RPMAX, reservoir pressure time integral, EPREL, and relative contributions of reservoir pressure than men in the same age category. In the younger age category below 51 years old, EPREL and RPMAX were also significantly higher in women than men.

Conclusion: Our study shows that healthy women have lower peripheral and aortic SBP and DBP compared with healthy men; however, their excess and reservoir pressures are higher, particularly after 51 years of age.
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http://dx.doi.org/10.1097/HJH.0000000000002135DOI Listing
November 2019

One-shot dalbavancin infusion combined with vacuum-assisted closure of Crohn's anal fistulas.

Turk J Gastroenterol 2019 01;30(1):114-115

Department of General, and Endocrynologic Surgery, and Gastroenterologic Oncology, Poznań University of Medical Sciences, Poznań, Poland.

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http://dx.doi.org/10.5152/tjg.2018.17829DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6389299PMC
January 2019

mRNA expression of steroidogenic enzymes, steroid hormone receptors and their coregulators in gastric cancer.

Oncol Lett 2017 May 21;13(5):3369-3378. Epub 2017 Mar 21.

Department of Biochemistry and Molecular Biology, Poznań University of Medical Sciences, 60-781 Poznań, Poland.

Epidemiological and experimental findings suggest that the development of gastric cancer (GC) is regulated by steroid hormones. In postmenopausal women and older men, the majority of steroid hormones are produced locally in peripheral tissue through the enzymatic conversion of steroid precursors. Therefore, using reverse transcription-quantitative polymerase chain reaction analysis, the mRNA expression of genes encoding steroidogenic enzymes, including steroid sulfatase (STS), hydroxy-delta-5-steroid dehydrogenase 3 beta- and steroid delta-isomerase 1 (HSD3B1), 17β-hydroxysteroid dehydrogenase type 7 and aromatase (CYP19A1), was investigated in primary tumoral and adjacent healthy gastric mucosa from 60 patients with GC. Furthermore, the mRNA levels for estrogen receptor α, estrogen receptor β (ESR2) and androgen receptor (AR), along with their coregulators, including proline, glutamate and leucine rich protein 1, CREB binding protein, nuclear receptor coactivator 1 (NCOA1), nuclear receptor corepressor 1 (NCOR1) and nuclear receptor subfamily 2 group F member 1 (NR2F1), were investigated. Additionally, the association between the mRNA expression of these genes and the clinicopathological features of patients with GC was examined. Significantly decreased levels of STS, HSD3B1, ESR2, AR, NCOA1 and NCOR1 mRNA, in addition to significantly increased levels of CYP19A1 mRNA were demonstrated in tumoral tissue samples compared with adjacent healthy gastric tissue samples. Deregulated expression of these genes in the analyzed tissue samples was associated with certain clinicopathological features of GC, such as age and localization of the tumor. The results of the current study suggest that all of the genes analyzed are expressed in tumoral and adjacent healthy gastric mucosa. In addition, the results indicate that abnormal expression of STS, ESR2, AR, NCOA1 and NCOR1 may serve a role in the development and progression of GC, and may be associated with specific clinicopathological features in patients with GC.
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http://dx.doi.org/10.3892/ol.2017.5881DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5431337PMC
May 2017

Gastrointestinal tract anastomoses with the biofragmentable anastomosis ring: is it still a valid technique for bowel anastomosis? Analysis of 203 cases and review of the literature.

Int J Colorectal Dis 2017 Jan 30;32(1):107-111. Epub 2016 Sep 30.

Department of General, Endocrinological Surgery and Gastroenterological Oncology, Poznan University of Medical Sciences, Przybyszewskiego 49, 60-355, Poznan, Poland.

Purpose: Biofragmentable anastomosis ring (BAR) is an alternative to manual and stapled anastomoses performed within the upper and lower gastrointestinal (GI) tract. The aim of this study was to evaluate the effectiveness of BAR utility for bowel anastomoses based on our own material.

Methods: A retrospective analysis was performed to a total of 203 patients who underwent bowel surgery with the use of BAR anastomosis within upper and lower gastrointestinal tract between 2004 and 2014. Data for the analysis was collected based on medical records, treatment protocols, and the results of histological examinations.

Results: The study group consisted of 86 women and 117 men. The most common underlying pathology was a malignant disease (n = 165). Biofragmentable anastomosis ring (BAR) size 31 was the most commonly used (n = 87). A total of 169 colocolic or colorectal anastomoses and 28 ileocolic and 8 enteroenteric anastomoses were performed. The mortality rate was 0.5 % (n = 1) whereas re-surgery rate within 30 days was 8.4 % (n = 17). Twenty-eight patients developed perioperative complications with surgical site infection as the most common one (n = 11). Eight patients developed specific complications associated with BAR including an anastomotic leak (n = 6) and intestinal obstruction (n = 2). The mean time of hospital stay after surgery was 12.7 days.

Conclusions: The use of BAR for the GI tract anastomoses is simple and rapid method and it is characterized with an acceptable number of perioperative mortality and complication rates. Based on our experience, we recommend the use of BAR anastomosis in different types of intestinal anastomosis in varying clinical scenarios.
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http://dx.doi.org/10.1007/s00384-016-2661-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5219882PMC
January 2017

Transcript level of AKR1C3 is down-regulated in gastric cancer.

Biochem Cell Biol 2016 Apr 10;94(2):138-46. Epub 2015 Dec 10.

a Department of Biochemistry and Molecular Biology, University of Medical Sciences, Poznań, Poland.

Steroid hormones have been shown to play a role in gastric carcinogenesis. Large amounts of steroid hormones are locally produced in the peripheral tissues of both genders. Type 5 of 17β-hydroxysteroid dehydrogenase, encoded by the AKR1C3 gene, plays a pivotal role in both androgen and estrogen metabolism, and its expression was found to be deregulated in different cancers. In this study we measured AKR1C3 transcript and protein levels in nontumoral and primary tumoral gastric tissues, and evaluated their association with some clinicopathological features of gastric cancer (GC). We found decreased levels of AKR1C3 transcript (p < 0.0001) and protein (p = 0.0021) in GC tissues compared with the adjacent, apparently histopathologically normal, mucosa. Lower levels of AKR1C3 transcript were observed in diffuse and intestinal types of GC, whereas AKR1C3 protein levels were decreased in tumors with multisite localization, in diffuse histological type, T3, T4, and G3 grades. We also determined the effect of the histone deacetylase inhibitor sodium butyrate (NaBu) on AKR1C3 expression in EPG 85-257 and HGC-27 GC cell lines. We found that NaBu elevates the levels of both AKR1C3 transcript and protein in the cell lines we investigated. Together, our results suggest that decreased expression of AKR1C3 may be involved in development of GC and can be restored by NaBu.
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http://dx.doi.org/10.1139/bcb-2015-0096DOI Listing
April 2016

Management of enteroatmospheric fistula with negative pressure wound therapy in open abdomen treatment: a multicentre observational study.

Int Wound J 2017 Feb 22;14(1):255-264. Epub 2016 Mar 22.

Department of General, Endocrinological Surgery and Gastroenterological Oncology, Poznan University of Medical Sciences, Poznan, Poland.

The management of enteroatmospheric fistula (EAF) in open abdomen (OA) therapy is challenging and associated with a high mortality rate. The introduction of negative pressure wound therapy (NPWT) in open abdomen management significantly improved the healing process and increased spontaneous fistula closure. Retrospectively, we analysed 16 patients with a total of 31 enteroatmospheric fistulas in open abdomen management who were treated using NPWT in four referral centres between 2004 and 2014. EAFs were diagnosed based on clinical examination and confirmed with imaging studies and classified into low (<200 ml/day), moderate (200-500 ml/day) and high (>500 ml/day) output fistulas. The study group consisted of five women and 11 men with the mean age of 52·6 years [standard deviation (SD) 11·9]. Since open abdomen management was implemented, the mean number of re-surgeries was 3·7 (SD 2·2). There were 24 EAFs located in the small bowel, while four were located in the colon. In three patients, EAF occurred at the anastomotic site. Thirteen fistulas were classified as low output (41·9%), two as moderate (6·5%) and 16 as high output fistulas (51·6%). The overall closure rate was 61·3%, with a mean time of 46·7 days (SD 43·4). In the remaining patients in whom fistula closure was not achieved (n = 12), a protruding mucosa was present. Analysing the cycle of negative pressure therapy, we surprisingly found that the spontaneous closure rate was 70% (7 of 10 EAFs) using intermittent setting of negative pressure, whereas in the group of patients treated with continuous pressure, 57% of EAFs closed spontaneously (12 of 21 EAFs). The mean number of NPWT dressing was 9 (SD 3·3; range 4-16). In two patients, we observed new fistulas that appeared during NPWT. Three patients died during therapy as a result of multi-organ failure. NPWT is a safe and efficient method characterised by a high spontaneous closure rate. However, in patients with mucosal protrusion of the EAFs, spontaneous closure appears to be impossible to achieve.
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http://dx.doi.org/10.1111/iwj.12597DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7950031PMC
February 2017

In Vitro Studies of Antibacterial and Antifungal Wound Dressings Comprising H2TiO3 and SiO2 Nanoparticles.

Pol J Microbiol 2015 ;64(2):137-42

The incidence rate of the infected and complex wound is established at approximately 40,000/1 million of the world's adult population. The aim of this study was to assess the efficiency of three novel types of wound dressings comprising sodium chloride, metatitanic acid and silicon dioxide nanoparticles. The study design was to prove their antimicrobial properties against the microorganisms most commonly causing wound infections. The study evaluated the antimicrobial effect of tested dressings on referenced strains of bacteria (ATCC collection, Argenta, Poland) and strains of fungi species (our own collection of fungi cultured from patients). The dressings were tested with both bacterial and fungal strains on solid media (Mueller-Hinton, Sobouraud, bioMerieux, France) in the standard method. The results confirmed the inhibition of growth of bacteria and revealed zones of inhibition for Escherichia coli, Staphylococcus aureus and Enterococcus faecalis. Significant zones of inhibition were established for Staphylococcus aureus and for fungi species of the Candida sp. These results would be crucial due to the fact of the low availability of antifungal therapeutics for both systemic and topical usage. Moreover, the current standard of antifungal treatment is associated with high costs and high toxicity in general. The preliminary results are very promising but further studies are necessary. Based on the obtained results, the tested dressings may contribute to the development of the surgical armamentarium of complex wound management in the near future.
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October 2015

Expression of 17β-hydroxysteroid dehydrogenase type 2 is associated with some clinicopathological features in gastric cancer.

Biomed Pharmacother 2015 Mar 9;70:24-7. Epub 2015 Jan 9.

Department of Biochemistry and Molecular Biology, Poznań University of Medical Sciences, Poznań, Poland. Electronic address:

In most populations, gastric cancer (GC) incidence is higher in men than in women, which may suggest the role of sex steroid hormones in gastric cancerogenesis. Both, androgens and estrogens can be synthetised in peripherial tissues. This process is controlled by expression of steroidogenic enzymes. Therefore, we evaluate the 17β-hydroxysteroid dehydrogenase type 2 (HSD17B2) transcript and protein levels in gastric tumoral and nontumoral tissue. We also determined the association between HSD17B2 transcript and protein levels and some clinicopathological features in GC. We found significantly decreased levels of HSD17B2 transcript (P=0.00072) and protein (P=0.00017) in primary tumoral tissues of GC patients, as compared to nontumoral tissues. In patients above 60 years of age the amounts of HSD17B2 transcript (P=0.00044) and protein (P=0.00027) were significantly lower in tumoral than nontumoral tissues. Similarly, lower HSD17B2 levels, both in terms of the transcript and protein, were observed in tumoral tissues of male (P=0.013, P=0.0014), patients stomach (P=0.0062, P=0.045) and cardia (P=0.02, P=0.02) site of tumor, T3 (P=0.018, P=0.014) depth of invasion, N0 (P=0.017, P=0.045) lymph node metastasis, G3 (P=0.0027, P=0.014) malignancy grade. We also observed significantly reduced level of HSD17B2 transcript in tumoral tissue specimens of females (P=0.014), T4 depth of invasion (P=0.02), N3 lymph node metastasis (P=0.037) and G2 malignancy grade (P=0.045). Furthermore, diffuse GC histological types were associated with lower HSD17B2 protein level (P=0.024) than nontumoral tissues. We demonstrated that HSD17B2 transcript and protein levels are linked to some clinicopathological features in GC.
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http://dx.doi.org/10.1016/j.biopha.2014.12.042DOI Listing
March 2015

Long-term use of probiotics Lactobacillus and Bifidobacterium has a prophylactic effect on the occurrence and severity of pouchitis: a randomized prospective study.

Biomed Res Int 2014 21;2014:208064. Epub 2014 Jan 21.

Department of General Surgery, Oncologic Gastroenterologic Surgery and Plastic Surgery, Poznan University of Medical Sciences, Ulica Przybyszewskiego 49, 60-355 Poznań, Poland.

Aim: The aim of the study was to assess the impact of the long-term use of the composite probiotics in patients after restorative proctocolectomy.

Method: Forty-three patients (20 females and 23 males, aged 21 to 68 years) after restorative proctocolectomy were included in the study. After randomization patients were divided into placebo group and treatment group with oral intake of probiotic containing Lactobacillus acidophilus, Lactobacillus delbrueckii subsp. bulgaricus, and Bifidobacterium bifidus. Patients were investigated during initial visit and during final visit after 9 months. All patients were subjected to standard clinical and endoscopic examination with microscopic study of the specimens. Concentrations of calprotectin and pyruvate kinase isoenzyme M2-PK were determined in all cases.

Results: The average severity of pouchitis and the number of patients with pouchitis significantly decrease after 9 months of the probiotic taking. The concentrations of calprotectin and pyruvate kinase isoenzyme M2-PK significantly decreased after the therapy.

Conclusions: Nine months of the probiotic treatment (Lactobacillus acidophilus, Lactobacillus delbrueckii subsp. bulgaricus, and Bifidobacterium bifidus) reduced the number of patients with pouchitis, decreased the PDAI score, and also decreased the fecal pyruvate kinase and calprotectin. The long-term probiotics use is safe and well accepted and can be an effective method of the pouchitis prevention.
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http://dx.doi.org/10.1155/2014/208064DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3918689PMC
December 2014

Decreased expression of ten-eleven translocation 1 protein is associated with some clinicopathological features in gastric cancer.

Biomed Pharmacother 2014 Mar 21;68(2):209-12. Epub 2014 Jan 21.

Department of Biochemistry and Molecular Biology, Poznań University of Medical Sciences, Poznań, Poland. Electronic address:

A decrease in ten-eleven translocation 1 (TET1) transcript and 5-Hydroxymethylcytosine (5hmC) levels has recently been demonstrated in primary gastric cancer (GC). However, little is known about TET1 protein levels in gastric tumoral and nontumoral tissue. Therefore, using reverse transcription, real-time quantitative polymerase chain reaction and western blotting analysis, we determined the TET1 transcript and protein levels in tumoral and nontumoral tissue from 38 patients with GC. We also assessed the association between the decrease in TET1 transcript and protein levels and some clinicopathological features in primary GC. We found significantly decreased levels of TET1 transcript (P=0.0023) and protein (P=0.00024) in primary tumoral tissues as compared to nontumoral tissues in patients with GC. Moreover, we also observed significantly lower amounts of TET1 transcript (P=0.03) and protein (P=0.00018) in tumoral tissues in patients aged>60. We also found significant lowered TET1 protein levels in male patients (P=0.0014), stomach (P=0.044) and cardia (P=0.013) tumor localization, T3 depth of invasion (P=0.019), N1 (P=0.012) and N3 lymph node metastasis (P=0.013) and G3 histological grade (P=0.0012). There were also significant decreases in TET1 transcript levels in female patients (P=0.042), intestinal histological types (P=0.0079) and T4 depth of invasion (P=0.037). Our results demonstrated that a decrease in TET1 transcript and protein levels is associated with some clinicopathological features in GC.
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http://dx.doi.org/10.1016/j.biopha.2013.12.011DOI Listing
March 2014

Expression of 17β-hydroxysteroid dehydrogenase type 1 in gastric cancer.

Biomed Pharmacother 2013 Sep 9;67(7):651-7. Epub 2013 Jul 9.

Department of Biochemistry and Molecular Biology, Poznań University of Medical Sciences, 6 Święcickiego St., 60-781 Poznań, Poland. Electronic address:

There are several findings suggesting the protective role of estrogens in gastric carcinogenesis. Extragonadal 17β-estradiol (E2) may be formed during estrone (E1) reduction to E2 by 17-β-hydroxysteroid dehydrogenase type 1 (HSD17B1). Therefore, we studied the HSD17B1 transcript and protein levels in primary nontumoral and tumoral gastric tissue from the same 21 patients with gastric cancer (GC). We also assessed the effect of 5-Aza-2'-deoxycytidine (5-dAzaC), on the methylation status of HSD17B1 and its expression and conversion of E1 to E2 in HGC-27 and EPG 85-257 GC cells. We identified the presence of HSD17B1 transcript and protein in HGC-27 and EPG 85-257 GC cells as well as in primary nontumoral and tumoral tissues from patients with GC. Moreover, we found that 5-dAzaC significantly up-regulated the HSD17B1 transcript and protein levels, which is associated with increased conversion of E1 to E2 in HGC-27 and EPG 85-257 GC cells. The changes in HSD17B1 expression in both HGC-27 and EPG 85-257 cells were accompanied by 5-dAzaC induced DNA demethylation in the 5' flanking region. Our results demonstrated that HSD17B1 expression and its ability to convert the weak estrogen E1 to the more potent E2 can be associated with DNA methylation in the 5' flanking region in GC cells.
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http://dx.doi.org/10.1016/j.biopha.2013.06.012DOI Listing
September 2013

Effect of BMI on the quality of life in patients after appendectomy depending on surgical modality.

Pol Przegl Chir 2013 Feb;85(2):58-64

Unlabelled: Acute appendicitis is one of the most common diseases requiring rapid surgical intervention. The disease occurs most often in people between 10 and 30 years of age, the risk of acute appendicitis during the whole life is 6-20%. The aim of the study was to assess the impact of BMI on the quality of life of patients operated for acute appendicitis according to the method of operation (LA- Laparoscopical Appendectomy OA - Open Appendectomy) and follow-up time after surgery.

Material And Methods: The study was conducted on a group of 86 randomly selected patients- 40 operated conventionally (18 women and 22 men) and from 46 patients undergoing laparoscopy (33 women and 13 men), which were operated during the period between 15 July 2007 and 27 February 2009. Each patient was assessed by BMI, recognizing the value of > 25 kg/m(2) as overweight. In this study the basis of quality of life was a form Medical Outcomes Study36 -the Short Form or SF-36v.2.

Results: Patients operated on in LA for 6 months observation to better assessed general health (GH) independently of BMI, while those with BMI ≤ 25 better assessed social functioning (SF) (p =0.027), an overall assessment of Physical Component Summary (PCS) (p = 0.048),Mental Component Summary (MCS) (p = 0.022) as well as an overall indicator of quality of life (p =0.025). The relationships that was not found in observations of more than 6 months after surgery (ns).

Conclusions: Questionnaire SF-36v.2 facilitated an objective assessment of quality of life of patients operated on for acute appendicitis. Patients operated on by laparoscopic in observation for 6 months above assessed the quality of life regardless of BMI. The relationships that was not found in observations of more than 6 months after surgery (ns).
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http://dx.doi.org/10.2478/pjs-2013-0011DOI Listing
February 2013

Fibrinogen and d-dimer in contrasting relation with measures of wave reflection and arterial stiffness.

Scand J Clin Lab Invest 2012 Dec 1;72(8):629-34. Epub 2012 Oct 1.

Department of Hematology University School of Medicine, Poznan, Poland.

Introduction: The relationship between the results of coagulation tests and measures of arterial stiffness or wave reflection has been investigated in different diseases. This exploratory study aimed at the evaluation of similar associations in healthy individuals.

Material And Methods: Pulse wave analysis of reconstructed aortic pressure waveform for the central augmentation index, augmentation pressure and pulse pressure, and digital volume pulse for the stiffness index were measured at supine rest in 91 healthy volunteers (54.1 ± 8.5 years; 56 female). Standard coagulation tests for the d-dimer and fibrinogen concentrations were performed in fasting venous blood.

Results: In univariate linear regression d-dimer and fibrinogen concentrations were significantly and positively, although weakly, associated with measures related to pulse wave analysis. Multivariate linear regression adjusted to subjects' age, resting pulse rate and mean blood pressure showed that the d-dimer concentration was significantly related to central augmentation index (p = 0.014), augmentation pressure (p = 0.003) and pulse pressure (p = 0.029) whereas fibrinogen was linked to the stiffness index (p = 0.04). Higher concentrations of d-dimers and fibrinogen are associated with increased arterial stiffness and faster pulse wave propagation in healthy people and the observed associations are independent of typical determinants of the shapes of pulse pressure waveforms like age, pulse rate and mean blood pressure.

Conclusions: The independent relationships between the results of the coagulation tests and pulse wave analysis suggest that the existence of such associations may indicate a biologically plausible phenomenon.
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http://dx.doi.org/10.3109/00365513.2012.727023DOI Listing
December 2012

Intestinal pouch complications in patients who underwent restorative proctocolectomy for ulcerative colitis and familial adenomatous polyposis in 1985-2008.

Pol Przegl Chir 2011 Mar;83(3):161-70

Department of General and Colorectal Surgery, Medical University in Poznań.

Unlabelled: Restorative proctocolectomy is considered a surgical treatment of choice in ulcerative colitis (UC) and familial adenomatous polyposis (FAP).The aim of the study was to evaluate postoperative complications in patients who underwent surgery for familial adenomatous polyposis and ulcerative colitis, on the basis of a retrospective data analysis.

Material And Methods: Data of 138 patients after restorative proctocolectomy performed between 1985 and 2008 were collected at routine follow-up visits in 2004-2008. We evaluated the presence of pouchitis, the degree of ileal pouch mucosa atrophy, the presence of ileal pouch mucosal metaplasia, the presence of ileal pouch malignancies, the necessity for diverting ileostomy, the necessity for pouch resection, and severe faecal incontinence.

Results: Complications were observed in 45 (32.4%) patients. Thirty-seven patients developed pouchitis (26.6%). Low-degree dysplasia, severe dysplasia or malignancies were observed in total in 20 patients (14.4%). Six (4.3%) operated patients developed other analysed complications.

Conclusions: The most common complications of restorative proctocolectomy were dysplasia and pouchitis. The most common complication in patients operated for UC was pouchitis. The low observed incidence of intestinal pouchitis may be attributed to the implemented prophylaxis of inflammation. Dysplasia was the most common complication in patients undergoing proctocolectomy for FAP. Due to an increased risk of dysplastic lesions as compared with UC patients, careful endoscopic follow-up examinations are obligatory in this patient group. Other analysed complications were uncommon and were mostly a consequence of chronic pouchitis. Clinical symptoms of pouch-related problems were similar in both analysed groups.
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http://dx.doi.org/10.2478/v10035-011-0025-5DOI Listing
March 2011

Influence of demographic factors, basic blood test parameters and opioid type on propofol pharmacokinetics and pharmacodynamics in ASA I-III patients.

Arzneimittelforschung 2011 ;61(10):545-52

Department of Clinical Pharmacy and Biopharmacy, Karol Marcinkowski University of Medical Sciences, Poznań, Poland.

The aim of the study was to examine population pharmacokinetics (PK) and pharmacodynamics (PD) of propofol (CAS 2078-54-8) during total intravenous anesthesia monitored by spectral frequency index (SFx). Twenty-eight patients of ASA physical status I-III (ASA: American Society of Anesthesiologists) scheduled for laparoscopic cholecystectomy were included. In group I an anesthesia was induced with a bolus of propofol (2 mg/kg) and remifentanil (CAS 132875-61-7) (1.0 microg/kg), followed by a continuous infusion of remifentanil. In group II, an alfentanil (CAS 71195-58-9) (10 microg/kg) bolus dose was followed by a continuous infusion of alfentanil. The general anesthetic technique included propofol, opioid and muscle relaxant. During anesthesia, the propofol infusion rate (3-8 mg/kg/h) was adjusted to the SFx value. Venous blood samples were collected from the patients during 240 min after termination of the infusion. A two compartment model was used to describe propofol PK. A standard effect compartment model was used to describe the delay between the effect and the concentration of propofol. The SFx index was linked to the effect site concentrations through a sigmoidal Emax model. The influence of continuous (body weight, age, blood pressure, heart rate and blood oxygenation, serum protein, the erythrocyte count, hemoglobin and hematocrit, serum creatinine and creatinine clearance) and categorical (gender and the type of opioid) covariates on the pharmacokinetic and pharmacodynamic parameters was investigated. PK/PD analysis was performed using NONMEM. All the screened covariates did not influence propofol PK and PD, except of the opioid type. The central compartment volume of propofol was larger in the presence of remifentanil than in the presence of alfentanil.
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http://dx.doi.org/10.1055/s-0031-1300552DOI Listing
January 2012

Pulse pressure amplification in relation to body fatness.

Br J Clin Pharmacol 2012 Apr;73(4):546-52

Department of Internal Medicine, Division of Cardiology-Intensive Therapy Department of General, Gastroenterological and Endocrinological Surgery, University School of Medicine, 49 Przybyszewskiego, Poznan, Poland.

What Is Already Known About This Subject: Aortic-brachial pulse pressure amplification (PPA) is a measure of arterial elasticity and it is also an independent cardiovascular risk factor. The PPA is mainly determined by age, height, central and peripheral pressure waveforms characteristics, including measures of arterial stiffness and wave reflection.

What This Study Adds: In this study, however, we demonstrate that PPA is also significantly associated with indirect indices of body fatness. As the body fatness is treatable, our findings might be used as a reference for future studies on the effects of body fat reduction on PPA and the PPA-related cardiovascular risk. AIMS Arterial pressure transfer to the periphery is accompanied by pulse pressure amplification (PPA). Pulse pressure is influence by body fat. The purpose of the present study was to evaluate any possible inter-relation between body fatness and PPA in healthy subjects.

Methods: Haemodynamic and wave reflection indices were estimated by pulse wave analysis. Body fat was measured by bio-impedance.

Results: A total of 367 healthy volunteers (136 men and 231 women) was studied. Pulse pressure amplification correlated significantly with percentage of body fat (r=-0.53, P < 0.0001), age (r=-0.62, P < 0.0001), height (r= 0.43, P < 0.0001), heart rate (r= 0.28, P < 0.0001) and mean blood pressure (r=-0.29, P < 0.0001). The association of PPA with body fat was also significant in a multiple linear regression model. Age was an independent predictor of PPA and analysis of study subjects subdivided into two groups, those <50 years and those >50 years showed that body fatness correlated inversely and significantly with PPA in individuals both younger and older than 50 years (r=-0.44, P < 0.0001, r=-0.37, P < 0.0001 respectively). Augmentation pressure was also associated significantly with percentage of body fat in both subgroups (r= 0.48, P < 0.0001 and r= 0.49, P < 0.0001 respectively).

Conclusions: This study performed on healthy subjects showed that pulse pressure amplification is related to body fatness over a wide age range. Percentage body fat is significantly associated with augmentation pressure, a component of central pulse pressure.
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http://dx.doi.org/10.1111/j.1365-2125.2011.04129.xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3376431PMC
April 2012

Inflammatory bowel disease - is there something new in the immunological background?

Folia Histochem Cytobiol 2011 ;49(2):357-62

Department of Clinical Pathomorphology, Poznan University of Medical Sciences, Poland.

In the present paper we correlate clinical data, as well as histopathological, immunohistochemical and molecular biology methods, with the occurrence of both forms of inflammatory bowel disease (IBD) i.e. ulcerative colitis and Crohn's disease. We found that patients with a history of Epstein-Barr virus (EBV) or cytomegalovirus (CMV) infections, as well as steroid treatment, had increased susceptibility to the development of IBD. The diagnosis of IBD was confirmed by histopathology. Previous infections by EBV and CMV, as well as M. tuberculosis, were proved by PCR-based techniques and in situ hybridization. We found PCR-proved latent viral infections in 30-50% of the IBD patients we studied. However, we were unable to prove the presence of viral antigens by immunohistochemistry for EBV or CMV. We found positive correlations between the presence of anti-CMV IgG, as well as PCR-positive results for M. tuberculosis with an ulcerative colitis diagnosis. Additionally, up to 80% of IBD patients used steroids, which was found to be correlated with a diagnosis of Crohn's disease. Our data may support the theory that IBD could be related to previous viral infections and the use of steroids.
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http://dx.doi.org/10.5603/fhc.2011.0049DOI Listing
October 2011

The prognosis of clinical course and the analysis of the frequency of the inflammation and dysplasia in the intestinal J-pouch at the patients after restorative proctocolectomy due to FAP.

Int J Colorectal Dis 2011 Sep 11;26(9):1197-203. Epub 2011 May 11.

Department of General, Gastroenterological and Endocrynological Surgery, Poznan University of Medical Sciences, ul. Przybyszewskiego 49, 60-355, Poznań, Poland.

Purpose: The main operative method in familial adenomatous polyposis (FAP) patients is restorative proctocolectomy with "J"-shaped pouch and temporary loop ileostomy. The aim of the study was the analysis of the frequency of the dysplasia and inflammation in the intestinal pouch and prognosis of the clinical course in FAP patients after restorative proctocolectomy.

Methods: A group of 165 FAP patients (86 females and 79 males, mean age 22.49 ± 12) subjected to a restorative proctocolectomy in the years 1985-2009 was analyzed. Clinical data coming from follow-up observation in the period of 2004-2009 were evaluated. In all patients, clinical examination and endoscopy with polypectomy and/or biopsy of pouch mucosa were done.

Results: The mean time of pouchitis occurrence after an ileal pouch-anal anastomosis was 6 months. Mean time for low-grade dysplasia was 14 months. The time difference of low-grade dysplasia after the above procedure as compared to pouchitis alone was substantial. Mean time for high-grade dysplasia was 16 months and for neoplasia even 19 months. It was estimated that early pouchitis happening within the first year after surgery occurs in 5% of patients, low-grade dysplasia 4 years later in 7% of cases, high-grade dysplasia 7 years later in around 10% of patients and neoplasia 14 years after surgery in 15% of cases.

Conclusions: In conclusion, the Polyposis Registry encompassing whole country is the best way of controlling FAP patients. The regular lifelong endoscopic monitoring gives the opportunity of the early detection of the dysplasia and can protect against neoplasia.
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http://dx.doi.org/10.1007/s00384-011-1241-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3158850PMC
September 2011

Mild CFTR mutations and genetic predisposition to lactase persistence in cystic fibrosis.

Eur J Hum Genet 2011 Jul 16;19(7):748-52. Epub 2011 Mar 16.

Department of Physiology, Poznań University of Medical Sciences, Poznań, Poland.

Taking into account the reported incidence of hypolactasia in cystic fibrosis (CF) and the possible impact of milk products on nutritional status we aimed to assess the genetic predisposition to adult-type hypolactasia (ATH) and its incidence in CF. Single nucleotide polymorphism upstream of the lactase gene (LCT) was assessed in 289 CF patients. In subject with -13910C/C genotype (C/C) predisposing to ATH, hydrogen-methane breath test (BT) with lactose loading was conducted and clinical symptoms typical for lactose malabsorption were assessed. The percentage of CF patients with C/C was similar to that observed in healthy subjects (HS) (31.5 vs 32.5% ). Eleven out of 52 (24.5%) CF C/C patients had abnormal BT results. The recalculated frequency of lactose malabsorption was similar for the entire CF and HS populations (6.9 vs 7.2%). Similarly as in the control group, few CF patients have identified and linked to lactose consumption clinical symptoms. The frequency of LCT polymorphic variants in CF patients having and not having severe mutations of CFTR gene showed significant differences. The C allele was more frequent in homozygotes of the severe mutations than in patients carrying at least one mild/unknown mutation (P<0.0028) and in patients with at least one mild mutation (P < 0.0377). In conclusion, CF patients carrying mild CFTR mutations seem to have lower genetic predisposition to ATH. Lactose malabsorption due to ATH in CF is not more frequent than in the general population. Symptomatic assessment of lactose malabsorption in CF is not reliable.
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http://dx.doi.org/10.1038/ejhg.2011.36DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3137504PMC
July 2011

The diameter of the ileal J-pouch-anal anastomosis as an important risk factor of pouchitis - clinical observations.

Med Sci Monit 2011 Feb;17(2):CR91-6

Department of General, Gastroenterological and Endocrynological Surgery, K. Marcinkowski University of Medical Sciences, Poznan, Poland.

Background: Patients' quality of life after restorative proctocolectomy depends on the potential complications. Stricture of the ileal pouch-anal anastomosis is one of the complications following restorative proctocolectomy.

Material/methods: We analyzed the correlation between the diameter of the anastomosis and clinical parameters, including pouchitis disease activity index (PDAI), the activity of fecal M2-pyruvate kinase and maximum tolerable volume of the pouch. The study group consisted of 31 patients in whom covering ileostomy had been closed 72 ± 50 months before enrolement to the study. Restorative proctocolectomy for ulcerative colitis or familial adenomatous polyposis coli had been performed in this group.

Results: The study did not show any correlation between the diameter of the anastomosis and primary indication for surgery, the time elapsed after restoration of the bowel continuity, the activity of fecal M2-pyruvate kinase, or maximum tolerable volume. However, meaningful correlations between the stricture of the anastomosis and the presence and activity of pouchitis, together with the ileal villi atrophy, were detected.

Conclusions: Stricture of the anastomosis appears to be an important factor increasing the incidence of pouchitis, and is independent of the underlying condition and time after the operation. Dilation of the anastomosis and prevention of stricture should constitute a permanent element of postoperative follow-up.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3524701PMC
http://dx.doi.org/10.12659/msm.881393DOI Listing
February 2011

Adult-type hypolactasia and lactose malabsorption in Poland.

Acta Biochim Pol 2010 10;57(4):585-8. Epub 2010 Dec 10.

Department of Physiology, Poznań University of Medical Sciences, Poland.

Background: The available data on the incidence of lactose malabsorption are contradictory. Potential bias in random selection is a major drawback of studies performed to-date. Moreover, molecular analysis of polymorphism -13910 C>T upstream of the lactase (LCT) gene (NM_005915.4:c.1917+326C>T; rs4988235) has not been reported in those studies. Therefore, in this study we aimed to assess genetic predisposition and clinical manifestation of adult-type hypolactasia (ATH).

Patients And Methods: In two-hundred randomly chosen healthy subjects (HS) aged from 18 to 20 years, the presence of -13910 C>T polymorphic variants upstream of the LCT gene was assessed. In a subgroup of subjects with genotype predisposing to ATH, hydrogen-methane breath test (BT) with lactose loading was conducted to determine the current state of lactase activity. In addition, clinical symptoms typical for lactose malabsorption were assessed using the questionnaire method.

Results: Sixty-three out of 200 (31.5 %) HS had -13910 C/C genotype. Thus, genetically determined lactase persistence is expected in the remaining 137 (68.5 %) subjects. Thirteen out of 53 (24.5 %) HS having -13910 C/C genotype were proved to be lactose intolerant. Recalculating the data for the entire studied population it implies the incidence of lactose malabsorption in 7.7 % of subjects. Only three out of 13 (23.1 %) subjects with abnormal BT results, reported clinical symptoms related to lactose consumption.

Conclusions: Significantly lower than previously reported incidence of clinically detectable lactose malabsorption in young healthy adults in Poland has been documented. The -13910 C/C genotype upstream of the LCT gene indicates a predisposition to ATH, but definitely does not define the current ability to tolerate lactose.
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April 2011

Proinflammatory cytokines and IL-10 in inflammatory bowel disease and colorectal cancer patients.

Arch Immunol Ther Exp (Warsz) 2009 Jul-Aug;57(4):291-4. Epub 2009 Jul 4.

Department of Medical Microbiology, University of Medical Sciences, Wieniawskiego 3, 61-712 Poznań, Poland.

Introduction: The aim of the study was to describe the levels of circulating monocyte/macrophage pro-inflammatory cytokines (TNF-alpha, IL-1beta IL-6, and IL-8) and an anti-inflammatory cytokine (IL-10) in inflammatory bowel disease (IBD) and colorectal cancer (CRC) patients and healthy controls.

Materials And Methods: The study was conducted on 15 healthy individuals, 20 patients with ulcerative colitis (UC), 12 with Crohn's disease (CD), and 15 with CRC (Dukes' stage B). Blood serum cytokine levels were measured by ELISA.

Results: The patients with UC had significantly higher levels of the pro-inflammatory cytokines and of circulating IL-10 than the healthy controls. The patients with CD and CRC had the same specific pattern of serum cytokines of significantly elevated levels of the pro-inflammatory cytokines, but the IL-10 levels were within the range found in the healthy individuals.

Conclusions: Thus our results demonstrate that both IBD and CRC are linked with an intensified production of a wide array of monocyte/macrophage pro-inflammatory cytokines which is not accompanied by elevated levels of circulating IL-10, except for its insufficiently inhibitory elevation in UC patients.
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http://dx.doi.org/10.1007/s00005-009-0031-zDOI Listing
September 2009

Chronic pouchitis is not related to small intestine bacterial overgrowth.

Inflamm Bowel Dis 2008 Aug;14(8):1102-4

I Chair of Pediatrics, Department of Gastroenterology and Metabolism, Poznañ University of Medical Sciences, Poznañ, Poland.

Background: Restorative ileal pouch-anal anastomosis (IPAA) potentially may lead to upper gastrointestinal tract motility disturbances. In addition, a bacterial etiology of IPAA complication-pouchitis-has been suggested. The oro-anal transit time is significantly reduced in this patient group. Therefore, we investigated the hypothesis if IPAA constitutes a significant risk for small intestine bacterial overgrowth (SIBO).

Methods: Twenty-eight patients age 23-71 years with IPAA operated due to ulcerative colitis without subjective symptoms of pouchitis were evaluated as outpatients according to the prescheduled follow-up after operation and included in the study. The modified Pouchitis Disease Activity Index (PDAI) was determined in all IPAA patients, including clinical, endoscopic, and histopathological (Moskowitz criteria) parameters. In addition, anorectal manometry was performed. The presence of SIBO was determined with the use of a glucose breath test (GBT).

Results: In 1 subject (3.6%) an abnormal GBT result was recorded consistent with SIBO. In addition, 2 borderline values (7.1%) were documented. Both patients with SIBO as subjects with borderline values presented with low PDAI values. All patients with PDAI >7 had normal GBT results. In patients with SIBO the maximal tolerated rectal volume was significantly higher than in subjects without SIBO (P < 0.007). Similarly, the PDAI value was significantly lower (P < 0.014).

Conclusions: Asymptomatic chronic pouchitis is not related to SIBO. However, excessive colonization of the small intestine does occur in some IPAA patients and needs to be kept in the differential diagnosis.
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http://dx.doi.org/10.1002/ibd.20432DOI Listing
August 2008

[Mycobacterium avium subsp. paratuberculosis in inflammatory bowel diseases].

Przegl Epidemiol 2007 ;61(1):85-90

Katedra i Zakład Mikrobiologii Lekarskiej AM w Poznaniu.

In the paper results were presented of a study on manifestation of infection with Mycobacterium avium subsp.paratuberculosis in 16 patients aged 15-42 years with Leśniowski-Crohn disease (group 1), in 20 patients aged 21-50 years with ulcerative colitis (group 2) and in 12 healthy individuals aged 23-60 years (group 3, control). All the ill patients were subjected to surgery, involving partial or total resection of large intestine, while individuals in group 3 (control) were subjected to colonoscopy with sampling of large intestine. Using mechanical/enzymatic technique DNA was extracted from the tissue material and was identified using PCR-ELISA technique (Mycobacterium paratuberculosis PCR; Institut Pourquier-France). Colour reaction was evoked using the TMB substrate. In the studies presence of Mycobacterium avium subsp. paratuberculosis was noted in 10 (62.5%) patients with Leśniowski-Crohn disease, in 5 (25%) patients with ulcerative colitis and in 1 patient 1 (8.3%) patient of the control group. The obtained results permit to suggest that Mycobacterium avium subsp. paratuberculosis bacteria participate in etiopathogenesis of Leśniowski-Crohn disease.
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October 2007

Diagnostic difficulties in pouchitis--experience from a single institution.

Pol J Pathol 2004 ;55(2):65-70

Department of General, Gastroenterological and Endocrinological Surgery, University of the Medical Sciences, Poznań.

The aim of the study was to analyze the clinical, endoscopic and histological signs of pouchitis in patients operated on because of ulcerative colitis (UC) and familial adenomatous polyposis (FAP). Between 1984 and 2002, the Department of Surgery carried out 218 restorative proctocolectomies in patients with UC and 120 in FAP patients. The follow-up to assess the intensity of inflammatory changes included 110 patients: 72 UC and 38 FAP. During the endoscopic examination, samples were taken for routine histological examinations. The histological assessment was based on the so-called Moskwitz's Histological System. Acute pouchitis is diagnosed if the score is > or =4, and chronic condition--if the score is > or =4. We used a modified PDAI scale to analyze the symptoms, taking into account the microscopically detectable histological features of chronic pouchitis. The clinical symptoms of pouchitis were revealed in 28 patients (25.5%), endoscopic symptoms in 36 patients (32.7%), and histological parameters in 48 patients (28-58.3% with > or =4 score of acute pouchitis and 20-41.7% with > or =4 score of chronic pouchitis). The signs of acute and chronic pouchitis were evident in endoscopy and histology, with no clinical features observed in many cases. Patients with symptoms of chronic pouchitis require a continuous follow-up.
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November 2004
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