Nutrition and Bone Marrow Adiposity in Relation to Bone Health.

Bone remodeling is energetically demanding process. Energy coming from nutrients present in the diet contributes to function of different cell type including osteoblasts, osteocytes and osteoclasts in bone marrow participating in bone homeostasis. With aging, obesity and osteoporosis the function of key building blocks, bone marrow stromal cells (BMSCs), changes towards higher accumulation of bone marrow adipose tissue (BMAT) and decreased bone mass, which is affected by diet and sex dimorphism. Men and women have unique nutritional needs based on physiological and hormonal changes across the life span. However, the exact molecular mechanisms behind these pathophysiological conditions in bone are not well-known. In this review, we focus on bone and BMAT physiology in men and women and how this approach has been taken by animal studies. Furthermore, we discuss the different diet interventions and impact on bone and BMAT in respect to sex differences. We also discuss the future perspective on precision nutrition with a consideration of sex-based differences which could bring better understanding of the diet intervention in bone health and weight management.

[STORY of the Papilla - a Case Report]. / Príbeh jedné papily.

PURPOSE: To present a case report with "unclear" and sudden decrease of left eye visual acuity and bilateral visual fields defects. METHODS: A case report. CASE PRESENTATION: A 66-year-old woman was referred to our Center of Neuroophthalmology and Orbitology by a neurologist for a history of sudden decrease of visual acuity of her left eye 3 years ago. From September 2009, she was examined at various and not only ophthalmology departments. One by one the optic nerve neuritis, traumatic, compressive or toxic neuropathy and also nutritive neuropathy because of vitamin B(12) deficiency were excluded. The patient underwent also a genetic examination for Lebers hereditary optic nerve neuropathy, but this diagnosis was not confirmed. On magnetic resonance imaging, an atrophy of both optic nerves was described, with no further progression found during the follow-up examination after one year. In available patients medical records we found out that on optical coherence tomography scans optic disc drusen of the both eyes are visible, but this wasnt described in the records. Also, an examination of Visual Evoked Potential was performed - this confirmed the diagnosis of optic disc drusen. However, our patient was further examined for visual lost of the left eye. At the time of presentation (January, 2014), her best-corrected visual acuity of the right eye was 0.5, and counting fingers at 50 cm distance with correct light projection in the left eye. Static perimetric examination demonstrated bilateral and concentric narrowing of visual fields. The eyes were parallel, with no limitation of their movements in any direction. The patient was without diplopia, the direct pupil reactions to the light were sluggish bilaterally, and anterior segments of both eyes were with no pathologies. Examination of the fundus revealed bilateral findings of pale optic disc with absent optic cup and indistinct "lumpy" margins. Waxy pearl-like irregularities of the papila of both eyes were visible even without pupil dilatation. Bilateral optic disc drusen were confirmed by ultrasonography, fundus autofluorescence and spectral-domain optical coherence tomography. CONCLUSION: Optic disc drusen are often asymptomatic, frequently it is an accidental finding during the biomicroscopy of fundus due to ordinary eye examination. Rarely, optic disc drusen can cause blood circulation failure on the optic disc with typical defects of the visual field. Thats why we shouldnt forget the optic disc drusen in the differential diagnosis considerations.

[Cytomegalovirus retinitis in HIV negative patients - retrospective study]. / Cytomegalovirová retinitida u HIV negativních pacientu - retrospektivní studie.

AIM: To evaluate own experience with the diagnosis and treatment of cytomegalovirus (CMV) retinitis in HIV negative patients with immunodeficiency. METHODS: Retrospective study and case reports. RESULTS: In the Centre for diagnosis and treatment of Uveitis 1869 patients with uveitis we have examined from June 2003 to June 2012. CMV retinitis was diagnosed in 7 patients (1 woman and 6 men) according to the typical clinical findings and history of immunodeficiency. In 2 atypical findings was the diagnosis confirmed by determination of DNA pathogen in vitreous sample (a patient with non-Hodgkin lymphoma) or by positive serology (CMV in leukocytes - indolent form of CMV retinitis in a patient with systemic lupus erythematosus). In 8 cases we found fulminant form, in 1 case indolent form of CMV retinitis. The average age of patients was 39,1 years (18-51 years old), ratio of men to women 6 : 3. In 6 of 9 cases we noticed bilateral retinitis. The average period of observation in our study was 15,8 months (1-48 months). Five of our patients underwent bone marrow transplantation, 2 patients were treated with systemic immunosuppressive drugs (colitis ulcerosa, systemic lupus erythematosus) and 2 patients had chemotherapy for lymphoma. The initiation or modification of treatment (gancyklovir p.o./i.v., foscarnet i.v.) was consulted and coordinated with others specialists. After initiation of treatment we followed-up 7 patients. In 4 eyes of 3 patients (31 %) the improvement of visual acuity was documented, in 5 eyes of 5 patients (38 %) the visual acuity was stabilized. The worsening of vision in 4 eyes of 3 patients (31 %) was caused by complications without any connection to virostatic therapy. All of our patients, who underwent bone marrow transplantation, died within 12 months since the diagnosis of CMV retinitis was determined. CONCLUSION: The diagnosis of CMV retinitis only in 9 cases (0,48% of all uveitic patients) confirms the rare occurrence of this retinitis. The important tool to the diagnosis of CMV retinitis is the history of immunodeficiency. In an atypical findings, the analysis of intraocular fluids or serological tests could help to the final diagnosis. The occurrence of CMV retinitis signify a very unfavourable prognosis for patients who underwent bone marrow transplantation and these patients died within 12 months since CMV retinitis has been diagnosed. The management of the therapy requires close interdisciplinary cooperation.

[Effect of fiberoptic bronchoscopy (FOB) with bronchoalveolar lavage (BAL) on gas exgange in patients after cardiac surgery].

UNLABELLED: Fiberoptic bronchoscopy (FOB) has become a commonplace procedure in ICUs in patients after operation. We studied the outcomes of 35 FOBs performed in 26 patients (18 male and 8 female) during their stay in the ICU of "St. Ekaterina" University Hospital in Sofia after cardiac surgery with Cardiopulmonary Bypass. 33 (95%) of our patients were receiving mechanical ventilation at the time of the FOB. Bronchoalveolar lavage (BAL) was added to all procedures. 21 (60%) patients demonstrated an improvement after FOB. We defined improvement as either an increase of PaO2 with 10 or more mmHg in 6 hours after the procedure or better aeration on the follow-up chest radiograph (CXR). In 19 (54%) FOBs a great amount of secretions, plugging up bronchial lumens was seen. 14 (73%) of these patients were improved after the FOB. From the rest 16 patients, in whom such increased amount of secretions was not seen on FOB, only 7 (43%) demonstrated an improvement after the FOB. 16 procedures were performed on indications of atelectasis. 9 (56%) of them showed an improvement after the FOB. When atelectasis was not present on the CXR, an improvement was found in 12 (63%) cases. CONCLUSIONS: 1. FOB is most effective in removing retained secretions. 2. Although not so effective in resolving atelectasis that is not caused by central plugging, FOB should not be neglected because of the additional benefit of BAL for clearing more distal airways.

Theoretical study of mexiletine and its interaction with cationic and anionic receptor sites.

Theoretical methods are applied to study the antiarrhythmic (AA) mexiletine (1-(2,6-dimethylphenoxy)-2-aminopropane). The AM1 method is used to construct a three-centre binding model for this drug. This model consists of an amine nitrogen atom that is protonated to a higher degree at physiological pH, flat hydrophobic regions of aromatic rings and additional functional groups with lone electron pairs of oxygen. Based on these ideas, a model for the binding of mexiletine at the transmembrane protein was constructed. An ab initio SCF method was used to study the two-component mexiletine-receptor binding site composed of acetate (Glu-, Asp-) and protonated methylamine (Lys+, Arg+). The binding of mexiletine to the receptor may be understood by considering a two-step process of recognition and binding of AA to its receptor. Within this model the mexiletine cation is recognised in the first step and bonded to the negatively-charged part of the receptor. In a subsequent step, the interaction between the amide oxygen and cationic amine group of the membrane protein may follow.

[Isotope nephrography in patients with obesity]. / Izotopnaia nefrografiia u bol'nykh s ozhireniem.

131I-hippuran nephrography conducted in 80 patients aged 26-53 with I and II degree obesity has revealed changes in the excretory phase (36.9 per cent of the patients with I degree obesity) and secretory and excretory and some vascular and metabolic abnormalities were registered in 79.4 per cent of those with II degree obesity. Weight gain had an adverse effect on the condition of such patients. Isotope nephrography enables one to study risk factors (arterial hypertension, atherosclerosis, diabetes mellitus).

[Complex radioisotope diagnosis of thyroid gland diseases in vivo and in vitro]. / Kompleksnaia radioizotopnaia diagnostika zabolevanii shchitovidnoi zhelezy in vivo i in vitro.

A variety of in vivo and in vitro methods: radioactive iodine accumulation, thyroid suppression and stimulation test, a scintigraphic study and a radioimmunoassay to determine triiodothyronine-binding capacity (free T3), thyroxine (T4) concentration and the effective thyroxine ratio (ETR), was used for diagnostic specification and accurate planning of therapy of patients with thyroid diseases. The suppression test combined with the results of the in vitro analysis (free T3, T4 and ETR) was decisive for establishing diagnosis.