Aufgabe dieser Arbeit war es, den Serumspiegel von Pentraxin-3-Werten im Blutplasma bei Lebererkrankungen zu bestimmen und mit anderen diagnostischen Parametern zu vergleichen. Vorausgegangene Studien hatten bereits darauf hingewiesen, dass PTX3-Werte als früh verfügbare und aussagekräftige Marker bei Entzündungskrankheiten in verschiedenen Organen hilfreich sein können. Es wurden zwei Patientenkollektive miteinander verglichen. Von 25 Patienten ohne Lebertransplantation und von 39 Patienten nach Lebertransplantation wurden die PTX3-Werte mit Hilfe des „Quantikine® Human Pentraxin 3/TSG-14 Immunoassay“ gemessen. Die Werte der Patienten nach Lebertransplantation wurden noch unterteilt in die Zeiträume drei oder mehr Monate sowie fünf oder mehr Monate nach der Transplantation. Die statistische Prüfung erfolgte mit Hilfe des t-Tests. Das Patientenkollektiv mit Lebererkrankungen wies hochsignifikante Steigerungen des PTX3-Wertes gegenüber dem Normwert auf. Das jeweilige Patientenalter sowie das Geschlecht der untersuchten Personen besaßen nur einen geringfügigen Einfluss auf die PTX3-Konzentration. Bei Patienten mit Lebertransplantation hatten sich die PTX3-Werte nach drei oder mehr Monaten weitgehend normalisiert, weitere Messungen nach fünf oder mehr Monaten bestätigten diese Tendenz, die geringfügige Differenz zum Normwert war nicht mehr statistisch signifikant. Die PTX3-Messwerte der an Lebererkrankungen leidenden Patienten wurden zudem mit anderen klinisch-diagnostischen Parametern verglichen. Im Vergleich mit CRP, ALT, AST, AP und GGT zeigte die statistische Analyse signifikante und hochsignifikante Unterschiede mit stärkeren Erhöhungen der PTX3-Werte. Daraus lässt sich ableiten, dass PTX3 eine zuverlässige Rolle bei der klinischen Diagnose von Lebererkrankungen einnehmen kann.

The liver is a vital organ, playing numerous critical roles in the body. The liver's ability to perform essential functions is disturbed by injuries that are often associated with many complications such as calcification. Although many reports in the literature document observations of liver calcification, the mechanisms regulating this phenomenon remain unclear. Herein, we aim to investigate the cellular and molecular events that occur during pathological calcification of the liver. / To study the mechanisms of calcification, assessments included histological-staining, immunolabeling, and biochemical and electron microscopy analyses. The findings suggest that calcification may result from hydroxyapatite precipitation in necrotic or apoptotic hepatocytes. Similarly, calcification may be associated with differentiated myofibroblasts expressing bone matrix proteins downstream of TGFbeta signalling. / To identify specific protein regulators linked to the various stages in calcification, and to assess the protein composition of the tissue, a proteomic analysis was used. This analysis identified IQGAP1, an effector of the Rho-GTPases and a master regulator of cell adhesion and migration. IQGAP1 is strongly expressed in myofibroblasts, suggesting that IQGAP1 may be implicated in myofibroblasts migrating towards calcification. Studies on IQGAP1 interactions with its binding partners reveal that it is part of a protein complex that includes beta-catenin, an adhesion protein, and Rac1, a cytoskeletal regulator. These results suggest that IQGAP1 may play an important role in myofibroblast migration upon liver injury. / Having identified that activin and TGFbeta signalling are activated in myofibroblasts, we hypothesised that they may stimulate myofibroblast differentiation and proliferation. Studies using a C3H/10T1/2 cell model reveal that both activin and TGFbeta stimulate differentiation, but only activin induces cell proliferation in a Smad-independent fashion, which requires activation of the ERK/MAPK pathway. / In summary, this work provides new mechanistic insights on the global regulation of liver calcification. The various phases of this work collectively cover the central role of myofibroblasts in liver injury: association with calcification, rapid proliferation, differentiation to an activated form, and migration toward the injured area. The findings allow us to better understand the mechanisms by which liver myofibroblasts are regulated in a specific pathological context.

Lietuvoje vis daugiau atliekama kepenų transplantacijų. Šiuo metu pacientų išgyvenimas didėja, todėl atsiranda problema, kad slaugytojams, trūksta žinių ir informacijos apie fizinės ir emocinės sveikatos problemas kylančias pacientams, kuriems yra atlikta kepenų transplantacija. Gastroenterologijos skyriaus slaugytojų, kurios slaugo pacientus po atliktos kepenų transplantacijos, vienas iš slaugos tikslų yra skatinti pacientus dalyvauti slaugoje bei siekti sveikatą skatinančio elgesio. Atlikus tyrimą bus išsiaiškinta, kokios fizinės ir emocinės sveikatos problemos kyla pacientams, kuriems atlikta kepenų transplantacija. Suprasdami ir žinodami šiems pacientams kylančias problemas, slaugytojai galės geriau planuoti slaugą, pasitelkti į pagalbą kitus specialistus. Darbo tikslas – atskleisti, kokia yra pacientų, kuriems atlikta kepenų transplantacija, fizinė ir emocinė sveikata. Šiam tikslui pasiekti buvo pasirinktas atlikti kokybinis tyrimas. Kokybinio tyrimo klausimas: Kokia yra pacientų, kuriems atlikta kepenų transplantacija, fizinė ir emocinė sveikata? Tyrimo objektas – pacientų, kuriems atlikta kepenų transplantacija, fizinė ir emocinė sveikata. Tyrimo priemonė – pusiau struktūruotas interviu. Tyrimo dalyviai – pacientai, kuriems atlikta kepenų transplantacija ne mažiau kaip prieš du mėnesius. Tyrimo rezultatai atskleidė, kad: 1. Pacientams po atliktos kepenų transplantacijos iškilo naujų fizinės sveikatos problemų susijusių su atsiradusiu cukriniu diabetu, padidėjusiu... [toliau žr. visą tekstą] / Every year more and more liver transplantations are performed in Lithuania.these days more Patients trial these operations and this creates a problem that nursing staff lacks informatikon about physical and emotional healtcare problems that these Patients face. One of the tasks for nursing staff of Gastroenterology divisions is to encourage Patients to participate in the nursing process and to promote Health-improving behavior. The research aims to help explaining what physical and emotional healthcare problems Patients face after liver transplantation. By knowing and understanding these problems nursing staff will have more tools in nursing planning and also will be able to ask for a timely help by other specialists. Goal of this thesis is to examine physical and emotional Health of Patients after liver transplantation. Qualitative method was chosed to implement this research. Key question of the research is: what is the physical and emotional Health of Patients after liver transplantation? Object of the research is physical and emotional Health of Patients after liver transplantation. Tool of the research is semi-structured interview. Respondents of the research are Patients who experienced liver transplantation not more than two month ago. Results of the research are the following: 1. Patients after liver transplantation face new physical healthcare problems related to diabetes, increased arterial blood presure, special diet, physical activity, smoking and consunning... [to full text]

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Diss. (sammanfattning) Stockholm : Karol. inst., 2005. / Härtill 6 uppsatser.

Diss. (sammanfattning) Umeå : Univ., 2007. / Härtill 5 uppsatser.

Diss. (sammanfattning) Göteborg : Univ., 2010.

As dilatações vasculares intrapulmonares (DVIP) constituem a anormalidade vascular pulmonar mais freqüente e a principal causa de hipoxemia grave em hepatopatas. A associação de doença hepática, aumento do gradiente alvéoloarterial de oxigênio e DVIP é chamada de "síndrome hepatopulmonar". O objetivo principal deste estudo foi verificar se os níveis de DVIP aferidos por ecocardiografia com contraste estão relacionados à intensidade de shunt intrapulmonar, medida por dois diferentes métodos: cintilografia com 99mTc-MAA e gasometria com O2 a 100%. Foram estudados 28 candidatos a transplante hepático portadores com DVIP identificadas e graduadas por ecocardiografia conforme escala semi-quantitativa (graus I a IV). A idade média foi de 47,5 anos, e a doença hepática foi classificada como Child-Pugh B na maioria dos casos (60,7%). A intensidade das DVIP foi classificada como I, II, III e IV em 13 (46,4%), 9 (32,1%), 2 (7,1%) e 4 (14,3%) casos, respectivamente. Dos 28 pacientes, 21 (75%) tiveram quantificação de shunt pelo método cintigráfico e gasométrico, 6 (21,4%) apenas pelo método cintigráfico e 1 caso (3,6%) pelo método gasométrico apenas. A PaO2 média entre os pacientes com DVIP graus I e II por ecocardiografia foi 89,1 ± 11,0mmHg, enquanto naqueles com DVIP classificadas como graus III e IV foi 74,7 ± 13,2mmHg (p = 0,01). A média dos valores de shunt por cintilografia nos 27 pacientes submetidos ao exame foi 14,9 ± 9,0% do débito cardíaco (mínimo 6,9% e máximo 39%), sendo 11,7 ± 3,8% nos pacientes com DVIP graus I e II, e 26,3 ± 9,7% nos pacientes com DVIP graus III e IV (p = 0,01). A média dos valores de shunt pelo teste com O2a 100% foi 9,8 ± 3,9%, sendo 8,3 ± 2,3% nos pacientes com DVIP graus I e II, e 16,3 ± 2,6% nos pacientes com DVIP graus III e IV (p < 0,001). Observou-se uma relação estatisticamente significativa entre a graduação de DVIP por ecocardiografia e o valor de shunt aferido por gasometria com O2 a 100% (rs = 0,609, p < 0,01) e por cintilografia (rs = 0,567, p < 0,001). Observou-se relação estatisticamente significativa entre os valores de shunt medidos por cintilografia e aqueles medidos por gasometria com O2 a 100% nos 21 pacientes que se submeteram à quantificação de shunt pelos 2 métodos (rs = 0,666, p < 0,001). A avaliação semi-quantitativa do grau de DVIP por ecocardiografia apresentou correlação moderada a boa com os valores de shunt aferidos pelos dois outros métodos estudados, sendo que a melhor correlação foi observada com o teste com O2 a 100%. / Intrapulmonary vascular dilatations (IPVD) are the most common pulmonary vascular abnormality and the main cause of acute hypoxemia in patients with severe liver disease. The association of liver disease, increased alveolar-arterial oxygen gradient and IPVD is known as "hepatopulmonary syndrome". The chief aim of this study was to determine whether IPVD levels, as determined by contrast echocardiography, are related to intrapulmonary shunt intensity, as measured by Tc- 99m MAA scintigraphy and by 100% oxygen gasometry. Twenty-eight IPVD patients, all candidates for liver transplant, were studied. IPVD were identified using echocardiography and graded on the semiquantitative scale (levels I to IV). The mean age was 47.5 years. Liver disease was classified as Child-Pugh B in 60.7% of cases. IPVD intensity was classified as level I, II, III and IV in 13 (46.4%), 9 (32.1%), 2 (7.1%) and 4 (14.3%) cases, respectively. Of the 28 patients, shunt intensity was determined using both scintigraphy and gasometry in 21 patients (75%), by scintigraphy only in 6 (21.4%) and by gasometry only in 1 (21.4%). Mean PaO2 was 89.1 ± 11.0mmHg among level I and II patients and 74.7 ± 13.2mmHg among level III and IV patients (p = 0.01). The mean shunt by scintigraphy was 14.9 ± 9.0% of cardiac output (minimum 6.9% and maximum 39%), being 11.7 ± 3.8% among level I and II patients and 26.3 ± 9.7% among level III and IV patients (p = 0.01). The mean shunt by gasometry was 9.8 ± 3.9%, being 8.3 ± 2.3% among level I and II patients and 16.3 ± 2.6% among level III and IV patients (p < 0.001). There was a significative correlation between IPVD level and shunt intensity: rs = 0.609; p < 0.01 by gasometry and rs = 0.567; p < 0.001 by scintigraphy. In those patients undergoing both tests, a significant relation was found between shunt intensity as measured by scintigraphy and by gasometry: rs = 0.666; p < 0.001. Hypoxemic individuals had significantly higher levels of intrapulmonary vascular dilatation than did nonhypoxemic individuals. Semiquantitative evaluation of IPVD level showed moderate to good correlation with shunt intensity under each of the two methods used, with the better correlation being found under 100% oxygen gasometry.

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