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Joanna Kamińska,1,* Marek Stopiński,1,* Krzysztof Mucha,2,3 Michał Pac,2 Marek Gołębiowski,4 Monika A Niewczas,5,6 Leszek Pączek,2,3 Bartosz Foroncewicz2 1Department of Internal Diseases and Dialysis Unit, West Hospital of Saint John Paul II, Grodzisk Mazowiecki, Poland; 2Department of Immunology, Transplantology and Internal Diseases, Medical University of Warsaw, Warsaw, Poland; 3Institute of Biochemistry and Biophysics, Polish Academy of Sciences, Warsaw, Poland; 4Department of Clinical Radiology, Medical University of Warsaw, Warsaw, Poland; 5Research Division, Joslin Diabetes Center, Boston, MA, USA; 6Department of Medicine, Harvard Medical School, Boston, MA, USA*These authors contributed equally to this workCorrespondence: Bartosz ForoncewiczDepartment of Immunology, Transplantology and Internal Diseases, Medical University of Warsaw, Nowogrodzka 59, Warsaw, 02-006, PolandTel +48-22-502 1641Fax +48-22-502 2127Email bartosz.foroncewicz@wum.edu.plBackground: Chronic kidney disease (CKD) is associated with cardiovascular disease (CKD), mineral and bone disorder (CKD-MBD) and high mortality. Bone-related factors such as osteopontin (OPN), osteocalcin (OC), osteoprotegerin (OPG) and fibroblast growth factor 23 (FGF23) were linked to cardiovascular complications of CKD and are expected to have predictive value in CKD patients.Purpose: The aim of this study was to assess the relationship of OPN, OC, OPG and FGF23 to clinical characteristics and to evaluate their ability to predict mortality in patients with different CKD stages.Methods: The following study groups were enrolled: subjects with end-stage renal disease (38 ESRD), CKD stages 3 and 4 (19 CKD3-4) and non-CKD controls (19), respectively. Blood was withdrawn once to perform the measurements and cardiac computed tomography was used to evaluate coronary calcium score (CS). Patients were followed for 5 years for the ascertainment of their all-cause mortality.Results: Serum OPN, OC and OPG concentrations increased significantly along with the progression of renal disease. We found a significant positive correlation among these proteins. Additionally, OPN and OPG were significantly and positively correlated to CS. Serum OPG revealed the strongest correlation to the calcium turnover markers of GFR decline and was significantly associated with an increased risk of death in subjects with CKD3-4 or ESRD (HR 5.8, CI 95%).Conclusion: Single measurement of osteoprotegerin is associated with 5-year all-cause mortality in patients with CKD3-4 or ESRD. We suggest assessing its concentration, preferably in combination with calcium score, to stratify mortality risks in CKD patients.Keywords: calcium score, chronic kidney disease, osteocalcin, osteopontin, osteoprotegerin

Byline: B. Czarkowska-PA,czek (1,2), J. Przybylski (1), A. Marciniak (3), M. PawAowska (3), J. Juskowa (3), B. Foroncewicz (3), K. Mucha (3) Keywords: myocardial infarction; collagenase; elastase; transforming growth factor beta; fibrynolysis Abstract: Myocardial infarction (MI) is caused by occlusion of coronary artery and insufficient oxygen supply to a certain area of myocardium. Its necrosis appears as a result of MI. The process of tissue repair after MI is very complicated and it is influenced by numerous factors, including growth factors and proteolytic enzymes. The aim of the study was to determine serum transforming growth factor [beta] (TGF-[beta]) concentration on day 2 and 7 after MI and to asses the relationship of this growth factor with serum proteolytic activity of collagenase and elastase. In addition, the effect of fibrynolytic treatment on these factors was evaluated. About 100 patients with MI were enrolled to the study. The control group consisted of 50 healthy individuals. We observed that TGF-[beta]1 concentration correlated positively with collagenase activity on the second day after MI and that it also correlated positively with elastase activity on day 2 and 7 after MI. Moreover, treatment with streptokinase (SK) caused a significant increase of TGF-[beta] serum concentration. Our data indicate that TGF-[beta]1 may be one of the factors involved in tissue repair process after MI. Its effect seems to be mediated by collagenase and elastase and may change with the time that elapsed after MI. Author Affiliation: (1) Department of Biophysics and Human Physiology, Medical University of Warsaw, Warsaw, Poland (2) Department of Biophysics and Human Physiology, Medical University of Warsaw, ChaAubiAskiego 5, 02-006, Warsaw, Poland (3) Department of Immunotherapy, Transplantology and Internal Diseases, Medical University of Warsaw, Warsaw Article History: Registration Date: 01/01/2004

Provides an overview of the present status of nursing administrators and suggests a new structure of management to improve the efficiency of nursing care in Hungary. Insufficiencies in the country's health management system; Determination of the structure and operation of the health institutions by a ministerial order, the Organizational Statutes; Basis of the suggested management model on collective management.

The College for Health Workers was established in 1973 in Hungary with the aim to educate and train highly qualified healthcare workers to meet all the demands of special health care. Although matrons (nursing administrators) who have graduated from the College are capable of performing special tasks to ensure quality care, they do not have the corresponding authority and recognition. Below, how nurse researchers in Hungary proved this hypothesis. [ABSTRACT FROM AUTHOR]