Diabetic autonomic neuropathy

In inflammatory conditions such as RA, the neutrophil has tended to be dismissed as a short-lived, terminally differentiated, irrelevant bystander cell. However, this is clearly not the case. A better understanding of the complex heterogeneous pathways and processes that constitute RA, in parallel with a more sophisticated knowledge of neutrophil biology has identified many potential roles for these cells in the persistence of inflammation and progression of joint damage, which should not be underestimated. Not only are neutrophils found in high numbers within the rheumatoid joint, both in synovial tissue and in joint fluid, they have a huge potential to directly inflict damage to tissue, bone and cartilage via the secretion of proteases and toxic oxygen metabolites, as well as driving inflammation through antigen presentation and secretion of cytokines, chemokines, prostaglandins and leucotrienes. Drugs already used to treat RA down-regulate many neutrophil functions, including migration to the joint, degranulation and production of inflammatory mediators, and these cells should be considered as important targets for the development of new therapies in the future.

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Neutrophil function in inflammation and inflammatory diseases

Patients with chronic atrophic gastritis or intestinal metaplasia (IM) are at risk for gastric adenocarcinoma. This underscores the importance of diagnosis and risk stratification for these patients. High definition endoscopy with chromoendoscopy (CE) is better than high definition white-light endoscopy alone for this purpose. Virtual CE can guide biopsies for staging atrophic and metaplastic changes and can target neoplastic lesions. Biopsies should be taken from at least two topographic sites (antrum and corpus) and labelled in two separate vials. For patients with mild to moderate atrophy restricted to the antrum there is no evidence to recommend surveillance. In patients with IM at a single location but with a family history of gastric cancer, incomplete IM, or persistent Helicobacter pylori gastritis, endoscopic surveillance with CE and guided biopsies may be considered in 3 years. Patients with advanced stages of atrophic gastritis should be followed up with a high quality endoscopy every 3 years. In patients with dysplasia, in the absence of an endoscopically defined lesion, immediate high quality endoscopic reassessment with CE is recommended. Patients with an endoscopically visible lesion harboring low or high grade dysplasia or carcinoma should undergo staging and treatment. H. pylori eradication heals nonatrophic chronic gastritis, may lead to regression of atrophic gastritis, and reduces the risk of gastric cancer in patients with these conditions, and it is recommended. H. pylori eradication is also recommended for patients with neoplasia after endoscopic therapy. In intermediate to high risk regions, identification and surveillance of patients with precancerous gastric conditions is cost-effective.

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Management of epithelial precancerous conditions and lesions in the stomach (MAPS II): European Society of Gastrointestinal Endoscopy (ESGE), European Helicobacter and Microbiota Study Group (EHMSG), European Society of Pathology (ESP), and Sociedade Portuguesa de Endoscopia Digestiva (SPED) guideline update 2019.

Venous thromboembolism

The importance of beta-adrenergic signaling in the heart has been well documented, but it is only more recently that we have begun to understand the importance of this signaling pathway in skeletal muscle. There is considerable evidence regarding the stimulation of the beta-adrenergic system with beta-adrenoceptor agonists (beta-agonists). Although traditionally used for treating bronchospasm, it became apparent that some beta-agonists could increase skeletal muscle mass and decrease body fat. These so-called "repartitioning effects" proved desirable for the livestock industry trying to improve feed efficiency and meat quality. Studying beta-agonist effects on skeletal muscle has identified potential therapeutic applications for muscle wasting conditions such as sarcopenia, cancer cachexia, denervation, and neuromuscular diseases, aiming to attenuate (or potentially reverse) the muscle wasting and associated muscle weakness, and to enhance muscle growth and repair after injury. Some undesirable cardiovascular side effects of beta-agonists have so far limited their therapeutic potential. This review describes the physiological significance of beta-adrenergic signaling in skeletal muscle and examines the effects of beta-agonists on skeletal muscle structure and function. In addition, we examine the proposed beneficial effects of beta-agonist administration on skeletal muscle along with some of the less desirable cardiovascular effects. Understanding beta-adrenergic signaling in skeletal muscle is important for identifying new therapeutic targets and identifying novel approaches to attenuate the muscle wasting concomitant with many diseases.

Role of β-Adrenoceptor Signaling in Skeletal Muscle: Implications for Muscle Wasting and Disease

Disturbances of the autonomic nervous system play a crucial role in the pathogenesis and clinical course of many diseases. Recently, rapid development has occurred in the clinical assessment of autonomic function. Various procedures have been described as diagnostic tools to monitor autonomic dysfunction. Some of them are mostly used for research purposes. Many, however, have found their place in routine clinical evaluation. Our paper presents selected methods of assessment of the autonomic nervous system with particular emphasis on those that are useful in diagnosis and treatment of diseases of the cardiovascular system. We discuss multiple tests based on cardiovascular reflexes, methods of studying heart rate variability as well as direct catecholamine measurements. Moreover, we outline tests of sudomotor function and microneurography.

https://www.termedia.pl/Journal/-19/pdf-14270-1?filename=Methods of evaluation.pdf

Methods of evaluation of autonomic nervous system function

A case of non-Q myocardial infarction in a previously healthy 17-year-old body builder, who used clenbuterol, a long-actingβ 2 adrenergic agonist with anabolic and lipolytic effects, is reported. Only 1 case report of myocardial infarction associated with the use of clenbuterol was found in a literature review and that case was, however, associated with anabolic steroid use. This is the first case report to describe myocardial infarction in a young male body builder only taking clenbuterol. (Circ J 2005; 69: 1144 ‐ 1146)

Myocardial infarction in a 17-year-old body builder using clenbuterol.

Background: A role for dendritic cells (DC) in the development of adult rheumatoid arthritis has been suggested. To date, this problem has been poorly explored in juvenile idiopathic arthritis (JIA). Objective: To analyse distribution and maturation status of blood DC (BDC) in JIA. Methods: Absolute BDC counts were assessed by the “single platform” method in peripheral blood (PB) of 47 untreated children with JIA and 32 healthy controls. Moreover, BDC were investigated in JIA synovial fluid (SF). When the panel of monoclonal antibodies against BDC antigens (BDCA) was used, three BDC subpopulations were determined: myeloid type 1 (mDC1; BDCA-1+/HLA-DR+/CD19−), myeloid type 2 (mDC2; BDCA-3+/HLA-DR+/CD14−) and plasmacytoid (pDC; BDCA-2+/HLA-DR+/CD123+). Results: A considerable deficiency of all subtypes of BDC was found in the PB of children with JIA. BDC counts in JIA SF were significantly higher than in PB both from children with JIA (p Conclusions: A deficiency of BDC in PB is accompanied by enrichment of SF with those cells. Probably, circulating BDC migrate to joints where they undergo maturation and help to mediate and maintain the local immune response. Interestingly, the level of PD BDC deficiency seems to influence the outcome in children with JIA.

https://ard.bmj.com/content/annrheumdis/early/2007/10/26/ard.2007.077669.full.pdf

Distribution and clinical significance of blood dendritic cells in children with juvenile idiopathic arthritis

Objective: To evaluate different aspects of apoptosis in children with juvenile idiopathic arthritis (JIA). 

Methods: The frequency of TUNEL positive peripheral blood (PB) lymphocytes (apoptotic index (AI)), as well as serum CD95 (APO1/Fas) antigen expression and serum levels of sFas and interleukin 15 (IL15), were examined in 44 cases of JIA. Results were correlated with type of onset, activity of JIA, and acute phase indicators. 

Results: The AI of lymphocytes was significantly higher in patients with JIA than in controls (p=0.020). The mean AI of lymphocytes was increased in JIA with systemic type of onset and high activity (p=0.001). Moreover, IL15 levels in systemic disease were higher than in controls (p=0.012). An increased AI correlated with raised IL15 (p=0.046), erythrocyte sedimentation rate (p=0.005) and C reactive protein (CRP; p=0.017). Additionally, correlation was found between IL15 and CRP levels (p=0.039). CD95 and sFas levels were unchanged compared with controls. 

Conclusion: PB lymphocytes of children with JIA have an increased tendency to undergo apoptosis. The degree of apoptosis depends on the type of onset and activity of JIA and correlates with serum levels of IL15. Further studies are needed to explain whether this is an epiphenomenon of the disease activity or is related to the pathogenesis of JIA.

https://ard.bmj.com/content/annrheumdis/62/8/761.full.pdf

Apoptosis of peripheral blood lymphocytes in patients with juvenile idiopathic arthritis

1 Coordinator of the PFP Guidelines on Diabetes (Polish Diabetes Society) 2 Chairman of the PFP Editorial Board 3 Secretary of the PFP Editorial Board 4 Member of the PFP Editorial Board (Polish Cardiac Society) 5 Member of the PFP Editorial Board (Polish Society of Hypertension) 6 Expert of the PFP Editorial Board (Polish Cardiac Society) 7 Member of the PFP Editorial Board (Polish Society for Atherosclerosis Research) 8 Member of the PFP Editorial Board (The College of Family Physicians in Poland) 9 Member of the PFP Editorial Board (Polish Paediatric Society) 10 Member of the PFP Editorial Board (Polish Society of Internal Medicine) 11 Member of the PFP Editorial Board (Polish Society of Neurology) 12 Expert of the PFP Editorial Board (Polish Cardiac Society) 13 PFP Coordinator 2007 (Polish Diabetes Society)

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Jerzy Stańczyk

Papers

Methods of evaluation of autonomic nervous system function

Myocardial infarction in a 17-year-old body builder using clenbuterol.

Distribution and clinical significance of blood dendritic cells in children with juvenile idiopathic arthritis

Apoptosis of peripheral blood lymphocytes in patients with juvenile idiopathic arthritis

Epidemiology and prevention Polish Forum for Prevention Guidelines on Diabetes