Category Archives: Number

Aquaporin 2 Expression in Human Fetal Kidney Development

Gergő Ráduly, Zsuzsánna Pap, Loránd Dénes, Annamária Szántó, Zoltán Pávai

Department of Anatomy and Embryology, University of Medicine and Pharmacy of Tîrgu Mureş

DOI: 10.2478/amma-2018-0010

Introduction: The metanephrogenic zone, renal cortex and renal pyramids develop into their final form by week 13. The metanephric kidney produces large quantities of diluted urine in order to maintain volumes of amniotic fluid. Aquaporins are transmembrane protein channels that enable water transport through biological membranes. Aquaporin 2 (AQP2) is a water channel found in the supranuclear region and apical area of the cell membrane of the kidneys collecting tubule cells. Its main function is reabsorption of water through vasopressin stimulation.
Materials and methods: Immunohistochemistry was used to study fetal renal tissue of 34 post-mortem fetuses of 9 weeks to 24 weeks gestational age.
Results: AQP2 expression is present in connecting tubules and collecting tubules during the targeted time period. From week 9 to 12, the expression is cytoplasmic. From week 13 to 20 the enhancement of expression in the apical cell membrane occurs with the advancement of fetal age. At the end of the studied period, from week 21 to 24, both cytoplasmic and apical expression were observed. In animal studies AQP2 expression has an increasing trend during development. In contradiction with these results, other authors described low AQP2 levels in the human fetal kidney.
Conclusions: This study helps to understand the amniotic fluid’s homeostasis during pregnancy. In the beginning of the fetal period AQP2 protein is present in the cytoplasm of epithelial cells of the collecting duct and distal connecting duct. During the fetal period, AQP2 expression in collecting ducts becomes more enhanced in the apical membrane of the cells.

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MTHFR – Ala222Val Effects on Metabolic Syndrome Progression

Katalin Csép, Eszter Szigeti, Krisztina Szalman

University of Medicine and Pharmacy Tirgu Mures, Romania

DOI: 10.2478/amma-2018-0009

Objective: Methylene-tetrahydrofolate reductase (MTHFR) is involved in adapting metabolism to environmental challenges by various mechanisms, including the control of gene expression by epigenetic and post-translational changes of transcription factors. Though a metabolic syndrome candidate gene, association studies of its common polymorphism rs1801133 (MTHFR-Ala222Val) remain inconclusive with important ethnic differences, and the effect on disease progression was not addressed.
Methods: 307 middle-aged metabolic syndrome patients in a central Romanian hospital setting were investigated metabolically, and genotyped by PCR-RFLP. Disease progression was assessed by the age of onset of metabolic components, as well as development of non-alcoholic fatty liver disease and atherosclerotic complications.
Results: The minor allele frequency of rs1801133 was 30.13%. Metabolic parameters showed no statistically significant differences according to genotype, but variant carriers developed dysglycemia and dyslipidemia earlier (53.28±10.8 vs 59.44±9.31 years, p<0.05 and 58.57±11.31 vs 64.72±10.6 years, p<0.1).While the polymorphism did not influence hepatic complications, an inverse association was found for manifest atherosclerosis (OR=0.49, p=0.006, 95%CI:0.29-0.81), which may be folate-status dependent, and needs further investigations. Simultaneous analysis with transcription factor polymorphisms (rs1801282, rs8192678) showed that the more protective genotypes were present the later metabolic disturbances developed, and in the presence of the other two variants the apparent protective cardiovascular effect disappeared.
Conclusions: The common functional polymorphism rs1801133 may influence metabolic syndrome progression, the age of onset of components and development of atherosclerotic complications. Besides simple additive effects, complex mitigating and aggravating variant interactions may exist, and the protective or predisposing outcome may depend on modifiable environmental factors.

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The Value of Perioperative ECG Recordings in the Cardiovascular Monitoring and Risk Assessment of Asymptomatic Patients with Total Hip Arthroplasty

Attila Frigy1, István Szabó-Györke2, Krisztina Csomor2, András Czédula3, Sándor-György Zuh4, István Gergely4

1. Department of Internal Medicine IV, University of Medicine and Pharmacy of Tirgu Mures, Romania
2. University of Medicine and Pharmacy of Tirgu Mures, Romania
3. Clinic of Orthopedics and Traumatology, Clinical County Hospital Mures, Tirgu Mures, Romania
4. Department of Orthopedics I, University of Medicine and Pharmacy of Tirgu Mures, Romania

DOI: 10.2478/amma-2018-0008

Aim: To evaluate the value of a more closed perioperative ECG follow-up in the investigation and forecasting of cardiovascular events during and after hospital admission.
Methods: We included in the study 30 asymptomatic patients from cardiac point of view (14 women, 16 men, mean age 63 years), who underwent total hip arthroplasty. ECGs were performed on the day before surgery, on the day of surgery, after the intervention, and on the 3rd day. We looked for the correlations between ECG changes and clinical events.
Results: The commonest postoperative new ECG changes were QTc prolongation (14 patients – 46,6%) and sinus tachycardia (8 patients – 26,6%). There were no major cardiac events during hospitalization, and we found possible correlations in two cases between perioperative ST-T changes and postdischarge clinical events: one exitus and one case of ischemic heart disease.
Conclusions: Our data do not support the efficacy of a more closed, routine ECG follow-up in the studied, low risk patient population, but new perioperative ST-T changes always have to be taken into account.

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Erratum

Due to an editing error of the authors, the article „Laparoscopic Greater Curvature Plication for Morbid Obesity: Indications, Results, Perspectives” published in Acta Medica Marisiensis, 2015;61(2):142-144 (DOI: 10.1515/amma-2015-0041) was published without the financial support statement. By the request of corresponding author Borz C, we publish the following erratum:
Disclosure. None of the authors reported conflict of interest regarding this study. The study was financially supported by the University of Medicine and Pharmacy Tirgu Mureș, grant no. 8918/2015.

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Mediators of Inflammation as a Link Between Diabetes Mellitus and Periodontal Breakdown

Adriana Monea, Lia Yero Eremie, Csilla Bukhari, Gabriela Beresescu, Carmen Biris

University of medicine and pharmacy Tirgu-Mures, Romania

DOI: 10.2478/amma-2018-0005

Our objective was to investigate immunological changes that occur in saliva of subjects with type 2 diabetes mellitus (T2DM) without signs of periodontal disease and to establish if salivary inflammatory cytokines are a possible link between diabetes mellitus and periodontal breakdown. Material and methods. Twenty T2DM subjects with no periodontal disease and twenty healthy controls were registered for the present study. TNF-α and IL-6 level from saliva and serum were measured. Periodontal tissue samples were histologically examined.

Results: TNF-α and IL-6 levels were higher in T2DM subjects compared to controls, with an extremely significant difference in saliva (p<0.001). Significant inflammation, affecting both epithelial and connective tissues was present in periodontal biopsies. Conclusions: The subjects showed an increased TNF-α and IL-6 levels, both in serum and -mostly in -saliva of diabetics without signs of periodontal disease, confirming the hypothesis of immunological implication, as a correlation between periodontal disease incidence and diabetes mellitus. Histologic alterations, suggesting a local inflammatory state, were present in periodontal tissue of diabetics, confirming the above hypothesis. The study reveals that saliva analysis is a quite efficient method in testing the periodontal breakdown progression in the subjects with T2DM.

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A winter song in the black forest

Sanda-Maria Copotoiu

Editor-in-Chief

At the beginning of a new year, the editors decided to publish an article dedicated to the emergency rescue system in Romania. It is basically not only a brief recall of the history of the airborne medical system in Romania, but also an update on the assets and the performances of the medicalized helicopters. Twenty-eight years following the establishment of the SMURD in Romania, and fifteen years from the birth of the helicopter fleet in Romania, airborne crews experienced the leapfrog from debutants to experienced, consolidated medical teams. [More]

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Emergency Air Rescue System in Romania

Sebastian Tranca1, Robert Szabo2, Cătălin Dache3, Mihai Mureșan3

1. “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
2. Emergency County Clinical Hospital Cluj-Napoca, Romania
3. The General Aviation Inspectorate of the Ministry of Internal Affairs, Romania

DOI: 10.2478/amma-2018-0007

The helicopter, as a means of transport, has facilitated a significant decrease in intervention time at the site of request, increasing the chances of survival of the critical patient. Since 2003, SMURD has managed to form a fleet composed of nine helicopters and two airplanes. From an operational and strategic point of view, the SMURD intervention unit, set up seven Aeromedical Operational Bases (A.O.B.) equipped with helicopters and materials necessary for their operation. There is a dynamic increase in the number of air rescue missions in Romania, with most missions being carried out by the air rescue bases in Târgu Mureş and Bucharest. Specialty literature has clearly demonstrated the positive impact on the survival of critical patients assisted by airborne crews, so it is necessary for the Romanian air rescue system to grow up. It is necessary to increase the number of air bases, purchase new helicopters and to continue the training programs of both pilots and medical personnel.

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Clinical Conditions and Predictive Markers of Non-Dipper Profile in Hypertensive Patients

Ioan Tilea1, Dorina Petra2, Elena Ardeleanu3, Adina Hutanu4, Andreea Varga1

1. Family Medicine, Dept. M3 – Internal Medicine, Faculty of Medicine, University of Medicine and Pharmacy Tirgu Mures, Romania
2. Internal Medicine I, Dept. M3 – Internal Medicine, Faculty of Medicine, University of Medicine and Pharmacy Tirgu Mures, Romania
3. Family Medicine, Dept. XVI – Balneology, Medical Rehabilitation and Rheumatology, Faculty of Medicine, University of Medicine and Pharmacy “Victor Babes” Timisoara, Romania
4. CCAMF, University of Medicine and Pharmacy Tîrgu Mureș, Romania Department of Laboratory Medicine, University of Medicine and Pharmacy Tîrgu Mureș, Romania

DOI: 10.2478/amma-2018-0006

Hypertension remains one of the primary causes of premature cardiovascular mortality representing a major independent risk factor. The importance of ambulatory blood pressure monitoring in clinical evaluation of hypertensive patients, beyond diagnosis, is the identification of circadian dipping/non-dipping profile. The non-dipper pattern in hypertensive and normotensive patients is associated with significant target organ damage and worse outcomes, as an increased cardiovascular risk condition. Non-dipping pattern has been found to be associated with specific clinical conditions. Obesity, diabetes mellitus, metabolic syndrome, obstructive sleep apnea syndrome, chronic kidney disease, autonomic and baroreflex dysfunctions, salt sensitivity, hormonal changes, gender and age were extensively studied. Research efforts are focused on recognizing and exploring predictive markers of abnormal blood pressure circadian pattern. Previous studies acknowledge that red cell distribution width, mean platelet volume, fibrinogen level, C-reactive protein, serum uric acid and gamma-glutamyltransferase, are independently significant and positive associated to non-dipping pattern. Moreover, research on new biomarkers are conducted: Chitinase 3-Like-Protein 1, atrial and B-type natriuretic peptide, brain-derived neurotrophic factor, chemerin, sphingomyelin and the G972R polymorphism of the insulin receptor substrate-1 gene. This review summarizes the current knowledge of different clinical conditions and biomarkers associated with the non-dipper profile in hypertensive patients.

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Sciatic Nerve Regeneration in Wistar Albino Rats Evaluated by in vivo Conductivity and in vitro 1H NMR Relaxometry

Anamaria Victoria Bumbu1, Radu Fechete2, Marcel Perian3, Bogdan Septimiu Bumbu3, Klara Brinzaniuc3

1. Spitalul Clinic Judetean De Urgenta Oradea, Romania
2. Technical University of Cluj-Napoca, Romania
3. University of Medicine and Pharmacy Tîrgu Mures, Romania

DOI: 10.2478/amma-2018-0004

Objective: The aim of this study was to evaluate and quantify functional and structural nerve regeneration after reconstruction using either direct suture or silicon graft.
Methods: Thirty-two adult Wistar Albino rats were divided in two equal groups. The left sciatic nerve was cross-sectioned and reconstructed using either direct suture (DS group) or a silicone graft (SG group). At 4, 6, 8 and 10 weeks two rats were randomly chosen from each group for in vivo measurement of nerve electric conductivity and subsequently sacrificed together with other two rats from the same group for in vitro 1H NMR relaxometry measurements. The T2 distributions were assigned to 1H located in different pools corresponding to the nerve structure.
Results: In the injured nerve we observed a significant increase in the stimulation threshold and a decrease in conduction velocity when compared with the healthy nerve in both groups. Whereas the conduction velocity increased progressively from 4 to 10 weeks in the DS group, the opposite evolution was observed in the SG group. In both groups, the first two peaks corresponding to water bound to collagen and epineurium had smaller transverse relaxation times in the injured nerves, while there was no change in the peaks corresponding to perineurium and free water between healthy and injured nerves.
Conclusions: Significant differences were observed between direct suture and nerve graft reconstructions from both a functional and structural point of view. In the case of direct suture reconstruction, the nerve was functionally healed at 10 weeks after injury.

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