Spleen-derived immune cells are considered to play central role in the progression of ischemic brain damage contributing to both the local and systemic inflammatory response initiated by an ischemic insult in the brain tissue. Brain-spleen communication in acute ischemic brain injury has been studied especially in rodent models of stroke, which mimic the acute focal brain ischemia in humans. Rodent spleens decrease in size after experimentally induced stroke, due mainly by the release of spleen`s immune-cells into the circulation. Splenectomy prior to middle cerebral artery occlusion is protective to the ischemic brain resulting in decreased infarct volume and reduced neuroinflammation. Various therapeutic strategies in clinical use aiming to protect the neural tissue after stroke were found to involve the modulation of splenic activity, altogether indicating that the spleen might be a potential target for therapy in ischemic brain injury. Importantly, the most clinical studies demonstrated that the splenic response in stroke patients is similar to the changes seen in rodent models. Thus, despite the limitations to extrapolate the results of animal experiments to humans, rodent models of stroke represent an important tool for the study and understanding of brain-spleen communication in the pathogenesis of acute brain ischemia.
Centric diatoms of 107 different Hungarian running waters were investigated. Among them the largest was the River Danube, from which more than one hundred plankton samples were analysed by scanning electron microscopy (SEM). Only one sample was analysed from creeks, which were the smallest running waters analysed in this study. There were also channels with slow currents flowing out of rivers or connecting different rivers. In total, 41 centric taxa belonging to 11 genera were found during this study. The average number of taxa found in a single watercourse was 7, the maximum 40 and the minimum 1. Cyclotella meneghiniana was the most frequently encountered species (present in 60% of sites). Twelve taxa were found in more than 20% of sites, 7 taxa between 5-10% and 6 taxa only in one site.
Zsuzsanna Gall, Carmen Duicu, Eva Kiss, I. Egyed-Zsigmond, Manuela Cucerea and Marta Simon
Objectives of study: The adolescent population signifies the transitory period where the frequent occurrence of different histopathological lesions in patients with nephrotic syndrome (NS) is different from that seen in young children as well as that seen in adults. This study aimed to analyze the clinical features and histopathological spectrum of adolescent-onset NS. Material and methods: We retrospectively evaluated clinical features, biochemical investigations and histopathology of 103 children with idiopathic NS referred to the Pediatric Department, County Hospital of Târgu-Mureş. Fourteen patients with congenital-, infantil- and secondary NS were excluded from this study. Results: The patients were divided into 2 groups: in group A we included 69 patients diagnosed with NS diagnosed before 10 years-old, with a median age of 3.76±1.96 years, majority males (59.42%) and presenting the pure form of NS. On the other hand, in group B we included 20 adolescents having the median age at the onset of the disease 13.61±2.18 years, with equal distribution of the sexes and presenting the impure form in 65% of cases. The majority of the patients in both groups (68.11% and 70% respectively) responded to steroid therapy. The commonest histopathological subtype in both groups was focal segmental glomerulosclerosis. Conclusions: The incidence of nephrotic syndrome has increased in the last years. The impure form of NS is more frequent in the adolescents than in younger patients. Adolescents with impure and steroid-resistant NS at presentation have other lesions than minimal change disease. The early genetic diagnosis in NS is important for proper clinical management of the patients, prognosis and genetic counseling of the families.
Zsuzsanna Gáll, Éva Kiss, Kálmán Tory, Attila Fintha and Carmen Duicu
Approximately 10-20% of children and 40% of adults with idiopathic nephrotic syndrome are steroid resistant and progress to end-stage renal disease requiring dialysis or renal transplantation. In these cases, renal histology typically shows focal segmental glomerulosclerosis. Mutations in NPHS1, NPHS2, WT1, CD2AP and ACTN4 genes located on different chromosomes, expressed by glomerular podocytes, have been identified in patients with steroid-resistant nephrotic syndrome.
The authors report two cases of adolescent-onset steroid-resistant nephrotic syndrome. Both cases had similar clinical and histopathological manifestations, with different prognosis and evolution due to different mechanisms leading to proteinuria: an acquired and a genetic form. The first case, a 16 year old girl presented the onset of the disease with massive, generalized edema, secondary hypothyroidism and high blood pressure. Evolution was favorable under cyclosporine therapy. The second case, a 13-years-old adolescent girl, presented an insidious onset of the disease with mild edema. Genetic testing revealed a mutation in the WT1 gene. The patient developed end-stage kidney failure eight months after the onset of the disease and following kidney transplant had a favorable evolution. Histological examination of the renal biopsy specimen showed focal segmental glomerulosclerosis in both cases.
Conclusions: Genetic forms of nephrotic syndrome do not respond to immunosuppressive therapy and may progress to end-stage renal disease, but after kidney transplantation relapse is not expected, in contrast to the immune form. The early genetic diagnosis in steroid-resistant nephrotic syndrome is time-consuming, but is important for proper clinical management of the patients, prognosis and genetic counseling of the families.
Carmen Duicu, Oana Marginean, Eva Kiss, Lilla Lőrinczi and Claudia Banescu
Pediatricians frequently encounter hematuria in children. One of the tardy complication of pulmonary tuberculosis, which is most characteristic and common in teenagers and middle aged, is represented by genitourinary tuberculosis. Renal tuberculosis is rare during childhood. The authors present a series of cases where the presenting symptom was gross or microscopic persistent hematuria. The diagnosis of urogenital tuberculosis was established from early-morning urine culture in all cases. In a patient with symptoms of recurrent urinary tract infection or hematuria associated with sterile pyuria the suspicion of GUTB must be considered. A delayed diagnosis of renal tuberculosis led to kidney damage and sequels of GUTB, including renal failure. Our cases report emphasizes that in case of persistent hematuria GUTB may be considered as a differential diagnosis
Ágnes Bolgovics, Éva Ács, Gábor Várbíró, Keve Tihamér Kiss, Balázs A. Lukács and Gábor Borics
Diatom composition of the rheoplankton (phytoplankton) in the Sajó-Hernád river system (Slovakia and Hungary) was studied. Forty two sample sites were designated on the watershed from source to mouth of the two rivers and their tributaries. Samples were taken in July 2012. Altogether, 258 diatom taxa were identified. The microflora was dominated by tychoplanktonic elements. According to the relative abundance of the occurring taxa, four groups could be distinguished. Differentiation of these groups was confirmed by differences in the habitat characteristics, viz. altitude, width of watercourse, macrophyte coverage and river bed material. Diversity of diatom taxa in the phytoplankton was also studied. A positive relationship was found between the macrophyte coverage and the Simpson and the Shannon indices. In contrast, a negative relationship was shown between the macrophyte coverage and Berger-Parker diversity, in which metric the role of the dominant taxa is emphasized. Although the phytoplankton in rhithral rivers is influenced by stochastic events, our results reveal that geographical and hydromorphological characteristics of the rivers and coverage of macrophytes can also play role in shaping the composition and diversity of the phytoplankton.
Petra Gulácsi-Bárdos, Éva Nieszner, Emese Tóth-Zsámboki, Katarína Vargová, Sarolta Leé, Zsófia Horváth, Máté Vámos, Róbert Gábor Kiss and István Préda
Objective: We examined the vascular system, from the microvasculature to the aorta, in diabetes mellitus, using non-invasive methods.
Methods: We enrolled patients with type 1 diabetes: 17 patients without complications (DMW) and 19 patients with clinically manifest complications (DMC). Control group was represented by 34 healthy volunteers (C). We examined microvascular function with laser-Doppler flowmetry, using post-occlusive reactive hyperemia test and local heating. Arterial stiffness was studied by arteriograph, determining augmentation index and pulse wave velocity. We measured serum levels of sE-selectin and sICAM-1, markers of endothelial dysfunction.
Results: Microvascular reactivity was significantly reduced in DMC-, and tendentiously in DMW groups. sE-selectin level was significantly higher in DMC group than in controls. Arterial stiffness was the highest in the DMC group and the lowest in the DMW group. Heart rate was significantly higher in both diabetic groups compared to controls. Time to maximum flow during PORH test tended to be the shortest in DMW group.
Conclusions: Our results confirm impairment of the microvascular system in diabetic patients, even in early, uncomplicated stage of the disease, and might demonstrate diffuse hyperkinesis in the vascular system, resulting from the insulin effect or refering to the “vasodilation phase” of diabetes mellitus.