Wsparcie społeczne u chorych z miażdżycÄ tętnic kończyn dolnych

UNIWERSYTET MIKOŁAJA KOPERNIKA w TORUNIU
COLLEGIUM MEDICUM im. LUDWIKA RYDYGIERA
W BYDGOSZCZY
MEDICAL
AND BIOLOGICAL
SCIENCES
(dawniej ANNALES ACADEMIAE MEDICAE BYDGOSTIENSIS)
TOM XXVII/2 kwiecień – czerwiec ROCZNIK 2013

R E D A K T O R N A C Z E L N Y
E d i t o r - i n - C h i e f
Beata Augustyńska
Z A S T Ę P C A R E D A K T O R A N A C Z E L N E G O
Co- e d i t o r
Jacek Manitius
K O M I T E T R E D A K C Y J N Y
E d i t o r i a l B o a r d
Aleksander Araszkiewicz, Beata Augustyńska, Michał Caputa, Stanisław Dąbrowiecki, Gerard Drewa, Eugenia Gospodarek,
Bronisław Grzegorzewski, Waldemar Halota, Olga Haus, Marek Jackowski, Henryk Kaźmierczak, Alicja Kędzia,
Michał Komoszyński, Wiesław Kozak, Konrad Misiura, Ryszard Oliński, Danuta Rość, Karol Śliwka, Eugenia Tęgowska,
Bogdana Wilczyńska, Zbigniew Wolski, Zdzisława Wrzosek, Mariusz Wysocki
K O M I T E T D O R A D C Z Y
A d v i s o r y B o a r d
Gerd Buntkowsky (Berlin, Germany), Giovanni Gambaro (Padova, Italy), Edward Johns (Cork, Ireland),
Massimo Morandi (Chicago, USA), Vladimir Palička (Praha, Czech Republic)
A d r e s r e d a k c j i
A d d r e s s o f E d i t o r i a l O f f i c e
Redakcja Medical and Biological Sciences
ul. Powstańców Wielkopolskich 44/22, 85-090 Bydgoszcz
Polska – Poland
e-mail: medical@cm.umk.pl, annales@cm.umk.pl
tel. 52 585 33 26
www.medical.cm.umk.pl
Informacje w sprawie prenumeraty: tel. 52 585 33 26
e-mail: medical@cm.umk.pl, annales@cm.umk.pl
ISSN 1734-591X
UNIWERSYTET MIKOŁAJA KOPERNIKA W TORUNIU
COLLEGIUM MEDICUM im. LUDWIKA RYDYGIERA
BYDGOSZCZ 2013

Medical and Biological Sciences, 2013, 27/2
CONTENTS
p.
REVIEWS
D o r o t a R o g a l a , D o r o t a J a c h i m o w i c z - W o ł o s z y n e k , Ż a n e t a S k i n d e r ,
M a ł g o r z a t a G i e r s z e w s k a – The use of information systems in health care practice . . . . . 5
P a w e ł S u t k o w y , A l i n a W o ź n i a k , C e l e s t y n a M i l a - K i e r z e n k o w s k a
– Positive effect of generation of reactive oxygen species on the human organism . . . . . . . . . . . . . . . 13
ORIGINAL ARTICLES
M a c i e j G a g a t , K o r y n a K r ó l i k o w s k a , A n n a K l i m a s z e w s k a - W i ś n i e w s k a ,
M a g d a l e n a I z d e b s k a , A l i n a G r z a n k a – The effect of mild hyperthermia
on morphology, ultrastructure and F-actin organization in HL-60 cell line . . . . . . . . . . . . . . . . . . . . . . 19
W o j c i e c h P a w ł o w i c z – Model study of epithelial motility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
Z u z a n n a P i e k o r z , I r e n a B u ł a t o w i c z , A g n i e s z k a R a d z i m i ń s k a , A n d r z e j
L e w a n d o w s k i , S z y m o n P i e k o r z , G r z e g o r z G r a b a r c z y k , M o n i k a
Cies i e l s k a – The influence of hatha yoga exercise on arterial pressure and pulse . . . . . . . . . . . . . . 33
A d r i a n R e ś l i ń s k i , S t a n i s ł a w D ą b r o w i e c k i , K a t a r z y n a G ł o w a c k a , J a k u b
S z m y t k o w s k i – The influence of octenidine dihydrochloride on bacterial biofilm
on the surface of a polypropylene mesh . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
E w a J o a n n a S z y m e l f e j n i k , A n n a C h i b a – The interdependence of nutritional status
and blood pressure in female students . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49

Medical and Biological Sciences, 2013, 27/2
SPIS TREŚCI
str.
PRACE POGLĄDOWE
D o r o t a R o g a l a , D o r o t a J a c h i m o w i c z - W o ł o s z y n e k , Ż a n e t a S k i n d e r ,
M a ł g o r z a t a G i e r s z e w s k a – Wykorzystanie systemów informacyjnych w praktyce
jednostek opieki zdrowotnej . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
P a w e ł S u t k o w y , A l i n a W o ź n i a k , C e l e s t y n a M i l a - K i e r z e n k o w s k a
– Pozytywne aspekty generowania reaktywnych form tlenu w organizmie człowieka . . . . . . . . . . . . . . 13
PRACE ORYGINALNE
M a c i e j G a g a t , K o r y n a K r ó l i k o w s k a , A n n a K l i m a s z e w s k a - W i ś n i e w s k a ,
M a g d a l e n a I z d e b s k a , A l i n a G r z a n k a – Wpływ łagodnej hipertermii na morfologię,
ultrastrukturę i organizację F-aktyny w komórkach linii HL-60 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
W o j c i e c h P a w ł o w i c z – Modelowe badania aktywności ruchowej nabłonka . . . . . . . . . . . . . . . . . . . . 27
Z u z a n n a P i e k o r z , I r e n a B u ł a t o w i c z , A g n i e s z k a R a d z i m i ń s k a , A n d r z e j
L e w a n d o w s k i , S z y m o n P i e k o r z , G r z e g o r z G r a b a r c z y k , M o n i k a
Cies i e l s k a – Wpływ treningu hatha jogi na wartości ciśnienia tętniczego i częstość tętna . . . . . . 33
A d r i a n R e ś l i ń s k i , S t a n i s ł a w D ą b r o w i e c k i , K a t a r z y n a G ł o w a c k a , J a k u b
S z m y t k o w s k i – Wpływ roztworu dichlorowodorku oktenidyny na biofilm wytworzony
na powierzchni siatki polipropylenowej . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
E w a J o a n n a S z y m e l f e j n i k , A n n a C h i b a – Współzależność między stanem odżywienia
a ciśnieniem tętniczym u studentek . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
Regulamin ogłaszania prac w Medical and Biological Sciences . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57

Medical and Biological Sciences, 2013, 27/2, 5-11
REVIEW / PRACA POGLĄDOWA
Dorota Rogala¹, Dorota Jachimowicz-Wołoszynek¹, Żaneta Skinder¹, Małgorzata Gierszewska²
THE USE OF INFORMATION SYSTEMS IN HEALTH CARE PRACTICE
WYKORZYSTANIE SYSTEMÓW INFORMACYJNYCH
W PRAKTYCE JEDNOSTEK OPIEKI ZDROWOTNEJ
1 Department of Organization and Management in Health Care UMK in Torun, Collegium Medicum
of L. Rydygiera in Bydgoszcz
Leader: Dorothy Jachimowicz-Wołoszynek, PhD
2 Department of Fundamentals of Obstetric Care in Torun, Nicolaus Copernicus University,
Collegium Medicum of L. Rydygiera in Bydgoszcz
Leader: Margaret Gierszewska, PhD
S u m m a r y
Information systems are now the basis of the operation of
each unit in health care. This paper describes the objectives
and benefits of the introduction of new technologies in
information systems and examples of practical use of the
systems in Poland and worldwide. In the paper chosen
programs used to monitor patient's health status and their
usefulness to professionals have been described. The inherent
savings, which are brought by the computerization of
healthcare facilities, have been pointed out as well as the
contribution of European Union funds in financing the
programs.
S t r e s z c z e n i e
Systemy informacyjne stanowią obecnie podstawę
funkcjonowania każdej jednostki w ochronie zdrowia. W
pracy opisano cele i korzyści z wprowadzania nowych
technologii w systemach informacyjnych oraz przykłady
praktycznego wykorzystanie systemów w Polsce i na
świecie. Opisano wybrane programy monitorujące stan
zdrowia pacjenta oraz ich przydatność dla profesjonalistów.
Wskazano na oszczędności, jakie niesie ze sobą
informatyzacja placówek ochrony zdrowia oraz udział
środków z Unii Europejskiej w finansowaniu programów.
Key words: information systems, telemedicine, computerization
Słowa kluczowe: systemy informacyjne, telemedycyna, informatyzacja
INTRODUCTION
Decision-making and management of healthcare
units are largely determined by the information
collected. The group of procedures consisting of
collecting, processing, storing and transmitting
information to support and facilitate the management
can be defined as an information system [1]. Such a
system is essential to normal/correct functioning of all
organizations and companies, including facilities
providing healthcare services. Today, healthcare
institutions intending to gain a strong position in the
evolving market of medical services are forced to
carefully choose specific activities relevant to the
management mechanisms of the information resources,
so that they are appropriately used in order to increase

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Dorota Rogala et al.
its chance to gain and maintain a permanent
competitive predominance in the market environment.
In healthcare, the strategic and universal purpose of
the development of information systems is to develop
and improve the efficient use of existing resources of
the information system, through the computerization of
its various parts, standardization of structures,
dictionaries, and communication protocols;
additionally by improving the quality and credibility of
information as well as the utilization of generated
information [2].
The basic objectives of information systems in
terms of the interests of health care are:
- providing the highest quality of services,
- efficient management of the unit in a competitive
environment,
- facilitating the work of medical staff [1].
The modern health care system requires a high
degree of computerization in institutions operating in
the healthcare market, implementing of which has been
greatly accelerated in recent years, for example, due to
the necessity of carrying out settlements with the
(tax)payer in the reformed health insurance system.
The compulsion to collect and transmit large
amounts of data enforced the introduction of measures
aimed at increasing a degree of computerization and it
has improved information systems of these units [3,4].
The main disadvantage is the fact that the use of paper
documents is time-consuming, and there are difficulties
in obtaining quick access to data. The existence of
electronic information flow enables to save time, and
this, in turn, allows taking the effort to improve quality
and productivity.
Experience shows, that the use of IT tools in the
information process also removes the source of
frustration and reduces the overall workload, which
prevents the generation of conflict and stress reactions
in employees [5].
The benefits of the implementation of information
systems are multidimensional. The primary effects of
computerization include:
- improving the effectiveness of personnel, through
the rapid flow of information and better access to it,
- improving the quality of services, by providing
tools to support medical staff in carrying out treatment
and broadening the scope of information used in the
treatment,
- greater control of sources of costs in the hospital,
- assistance in the management at higher levels, by
allowing analysis of the data collected,
- reduction of costs associated with processing
large amounts of information appearing in the
treatment process [1].
COMPUTERIZATION IN HEALTH CARE
Every implemented system clearly defines the area
of its influence. It should also be clearly aimed at one
of the spheres of the covered project or to meet the
selected need. The United States and Germany began
work on a system dealing with financial issues. United
Kingdom, Sweden, France and Japan realized it
primarily on the patient. These are two different
approaches, which at some point need to take account
of and complement each other. Only equitable
introduction of patient medical data correlated with
their financial information allows looking at the overall
hospital system [1]. Hospitals and medical centers are
implementing systems, which are supportive for the
management of so-called grey- administrative sphere
and medical, so-called white.
Computerization can be complex or run in stages.
In the event of a complex computerization in the
hospital, systems and specialized software are
integrated. An example of complex actions of
computerization was the Oncology Centre in
Bydgoszcz, where on the request of the Center,
MEDINFO system was implemented to support part of
the "white", some of the "grey" sphere and the
settlement of the National Health Fund (NFZ). The
system took almost all spheres of activities of the
Centre, reducing the time of registration of patients and
improving the quality of the service [6].
Computerization was carried out in stages in
Kujawsko-Pomorskie Pulmonology Center in
Bydgoszcz. In 2000, administrative system SKID (now
Xpertis) was introduced, containing the following
modules: HR - Payroll, Finance - Accountant, Cashier,
Inventory, Fixed Assets, Homebanking. The system
allows the preparation of financial statements, data
analysis, planning and forecasting. In 2001, the
medical computer system was implemented, which
included most of the functionality of the medical
aspects of hospital activities such as: Patient's
movement (Admissions) (Admissions modules, Ward,
Statistics), Pharmacy and Medication on the ward,
(Medical, Clinical)Analytical Laboratory, Diagnostic
Labs, the module of Bacteriology. Later, some new
modules of the system were introduced: Pathology,
Rehabilitation, Endoscopy, Outpatients Clinic and the

The use of information systems in health care practice 7
module, which was not integrated with the system,
supporting the Laboratory of Respiratory Disorders
during sleep. In 2007, the medical system was
supplemented by a digital radiology system within the
TELEMEDICINE program. The system allows the
distribution of diagnostic images throughout the
hospital's computer network at the indicated computer
stations. [7] The current system Xpertis provides multivariant
reports with numerous levels of summation,
simulation analysis. It allows comparing actual and
forecasted results. Additionally, it gives a direct and
immediate access to data collected in other modules of
the system [8].
Already completed systems are naturally slower to
respond to organizational and legal changes. Their
implementation requires a large amount of time, and
sometimes, it happens that quickly there is a need to
make major modifications, replacement or introduction
of a new system. In private clinics, information
systems must take into account the specificity of their
activities. Since the beginning of foundation (since the
late 90), the Family Medicine Company SA has been
creating on their own computer system. The work does
a team of company analysts and programmers. The
company has got 16 own medical clinics and includes
5 institutional clinics. In each of these, there is
independent software operating on the principle client
– server with central data synchronization on - line.
The synchronization method is an own solution of IT
specialists as well as analysts, and ensures sharing of
information between providers in actual time.
Currently, the system supports several areas of the
company: managing the database of patients and their
rights to services, customer management (contractors),
including contracts with the NFZ, employers and
insurers, work time management – the module of
planning doctors' and other staff rota, booking patients
visits, keeping records of services and electronic
medical records. The system also has analytic
functions, reporting modules, which provide the
information management; therefore, it is possible to
improve efficiency and service quality. The system is
constantly being developed and implemented with new
modules, including the run of treatment rooms,
promotion of cooperation with suppliers of medical
services (diagnostic imaging facilities, laboratories)
and the stock management. This structure allows the
system to quickly adjust to the constantly changing
external and internal conditions. The company's
experience shows that this kind of own system can
successfully handle the smaller health care facilities
[9].
Computerization of healthcare facilities is an
expensive process. Introduction of modern solutions in
many hospitals is possible thanks to funds acquired
from the European Union.
By the end of 2011, the Regional Specialist
Children's Hospital in Olsztyn is likely to complete a
complex computerization, funded by the European
Regional Development Fund (cost of the project was
3.9 million PLN). The project gives the patient the
opportunity to register online and access to patient
records at designated hospitals and clinics [10].
The county Hospital in Kedzierzyn-Koźle received
6.3 million PLN, funded by the European Union, to
implement an integrated information system. After the
introduction of the new system, the hospital predicts
the growth of market position and the opportunity to
compete with other commercial entities and to achieve
benefits associated with obtaining savings in the
operation by eliminating unnecessary expenditures
incurred by operation activities [11].
In a similar manner, one of the largest psychiatric
hospitals in Poland, Wolski Hospital in Warsaw, was
computerized. The cost of the project, entitled
'E - Hospital - the creation of a digital information
system of telemedicine, data collection, processing and
archiving data for the Wolski Hospital SP Hospital in
Warsaw', was approximately 4.2 million PLN. Half of
the amount came from European Union funds within
the Integrated Regional Operational Development
Programme. The great importance to this institution
was the introduction of electronic patient information
flow - from admission to discharge, all the information
are recorded at the so-called electronic patient record
[12].
The introduction of information systems also
translates into real savings. The University Hospital
Aachen (Germany) is a hospital which employs over
5700 staff members and treats approximately 179 000
patients in the year. With the development of the
facility, the list of used operating systems has grown.
Integration and analysis of large amounts of data from
different systems caused many difficulties. In early
2003, the hospital decided to implement SAS 9
software company SAS Institute across the
organization. The implementation included such
elements as: data integration, business intelligence
(software for budgeting and analysis, supporting the
decision-making processes), information portal, as well

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Dorota Rogala et al.
as solutions for managing results. The biggest
challenge before the implementation of SAS 9 was the
integration of data from various systems including:
Medico - Hospital Information System (3.4 million
records are updated every day), Swisslab - Laboratory
Information System (10 million records generated each
year), ERP system used for hospital resources
management. The benefits of the new system included
increased income from reimbursement of medical
costs, reduced operating time for the exchange of
information within the organization and reduced costs
of external services. Five years after the
implementation of SAS 9, the return on investment
after tax was estimated at 569% [13].
Norwegian Rikshospitalet University Hospital
estimates that by introducing a comprehensive and
modern information system, it reached annual savings
of 66 million dollars, which represents 7% of the
budget of the hospital [14].
THE USE OF INFORMATION SYSTEMS
Achievements in the development of modern
medical technology have influenced the development
of telemedicine, using technology for diagnosis,
treatment, consultation and monitoring of the health
status of patients. It gives a chance to reduce costs by
allowing the treatment and care at the patient's home.
Televisits are particularly valued by chronically ill
patients and those, who because of a long
convalescence / stay at home for a long period of time.
The audio-visual contact with a doctor or nurse
improves patient's psychological comfort, despite the
actual distance. Statistical data from the state of New
York in the U.S. show that the use of telemedicine in
home care resulted in reduction of the frequency of
ambulance and emergency visits in the hospital among
patients over 65 the age by approximately 70%. In the
Netherlands, modern telemedicine devices (based on
the model so-called Smart home) were used in seniors’
home (nursing home/residential home) in Eindhoven,
and in Finland, a project is being created to equip one
of the villages with the home telecare system. In
France, a project PROSAFE designed for people with
memory loss including Alzheimer's disease was
developed It monitors the health of patients in addition
to their behavior, the cases of disappearance from the
residence, falls, etc.
Telemedicine is also used to monitor the health
status of patients in various types of diseases. MyCare
program operating at Georgetown University Medical
Center in Washington sends glucose measurements to
the monitoring center from the miniature meters, which
are provided for diabetic patients. At the same time,
patients receive test results with recommendations on
how to proceed. Thus, it is possible to prevent serious
consequences resulting from the delayed
implementation of therapy. At Vanderbilt University,
USA, telemedicine is used to study the image of the
eye of patients with diabetes. Also, the information is
sent via the Internet to the monitoring center, where the
information is analyzed for the diagnosis of
complications associated with diabetes. This is
particularly convenient for patients living in remote
villages, because it eliminates the need for personal
visits for diagnostic purposes. In the UK, the health of
patients with asthma is monitored. The patient has a
small mobile phone – computer that senses the
deterioration of the patient’s condition. The
information is passed on automatically to the doctor,
who takes the necessary actions. Similar pilot
programs are applied in remote monitoring of patients
with hypertension, suffering from cardiac arrhythmia.
In Brazil, remote diagnoses were introduced in
dermatology patients with suspicious skin changes
[15].
In Poland, telemedicine ‘crawls’. So far, there has
been only a few interactive educational and training
videoconferencing - such as the tripartite; one from
Washington to Warsaw and Bielsko Biala or heart
surgery at Children's Health Center in Warsaw. Local
telemedicine networks are formed around large
medical centers. They focus mainly on developing and
implementation of systems to transmit ECG signals by
telephone, and X-ray images, ultrasound, CT via the
Internet and using the Intranet for consultation.
Although, all Polish hospitals have access to the
Internet, according to the report ‘The study of the
needs and potential opportunities in telemedicine in
county hospitals,’ which was developed in cooperation
with the Department of Medical Informatics and
Telemedicine Medical Academy in Warsaw and the
Association of Polish Counties, only a few facilities
have digital equipment to record test results.
Ambulances, equipped with equipment that enables the
electronic transfer of ECG results to the cardiac center
on call, function only in 16% of hospitals. Even more
rarely, consultations are carried out during the
transport of the patient (11%). The telemedicine
system in ambulances has been operating for several

The use of information systems in health care practice 9
years in Bydgoszcz. 16 rescue teams, including 5
specialist teams, are included in this system.
In the field of emergency medical service, Personal
Digital Assistant (PDA) or personal digital assistant
gives great opportunities to take advantage of. Already
in 2007, the system was tested in the emergency
stations in Katowice and Mikołów. The use of PDAs
by procedures is following:
- the doctor gets a request on the PDA along with a
map of directions to the patient,
- the software has also the option to fill the
departure card,
- in module 'interview, examination, medical
procedure " a description of the patient symptoms is
filled out (in the electronic version of the card, a doctor
does not have to enter it manually, but to record),
- the drug used does not have to be manually
entered, but can be selected from the available database
(this allows a statistical analysis of the drugs
economy),
- when the crew returns to base, the doctor sends
the contents of the PDAs to the server and signs the
printed document [16].
The PDA is also used in telemedicine. Since 2004,
one of U.S. companies has promoted its device, which,
when connected to the PDA, allows the patient to
observe own heartbeat. The data obtained can be sent
to the doctor. At The College of Medicine in Texas use
of information technology PDA in diabetes
management by patients with type 2 diabetes in the
ambulatory setting has been shown to improve selfcare
and glycemic control [17].
One of the pioneering activities of the PDA
technology in Poland is the study of bronchial asthma
and chronic obstructive pulmonary disease (COPD)
within the COMPASS program, implemented by
pulmonologists and clinical internists of Medical
College in Krakow. The program allows registration of
data of the disease, its course and treatment by
hundreds of specialists from approximately 14 000
patients with COPD and asthma. Another research
program, which uses the PDA, is OPTIMO, or ‘optimal
care of patients with diabetes in Poland.’ This program
is focused on populations with diabetes under the care
of a specialist diabetes clinic. It provides information
about the characteristics of the research population
including diagnostic and therapeutic methods
depending on the duration of illness, severity of
complications or comorbidities. It is planned to use
PDAs in the daily work of doctors. Using an electronic
questionnaire, the results of the study, complications
and treatment data will be entered. This will not only
enable safe collection of the information of patients
(without being able to identify the members of the
public), but also will help physicians to care for
patients through the use of clinical decision support
system (CDSS - Clinical Decision Support System),
developed on the basis of current Polish Diabetes
Association guidelines. The program will remind to
carry out tests provide information on current methods
of action, criteria, definitions, classifications of
complications, and the expected health effects in
diabetes treatment. With OPTIMO a doctor will be
able to quickly view the information about the methods
used in the patient's treatment, the results of the
patient's tests and the possible complications.
Moreover, the program plays an educational role,
because every month participating doctors will receive
multimedia information materials as well as sets of
questions, and educational points will be awarded for
correct answers. The program OPTIMO undergoes
further changes, because the incoming comments and
suggestions from the physicians participating in the
program are included in the modification of the
electronic questionnaire and the clinical decision
support system.
The PDA is also used in ECG and hearing
screening tests, using objective and audiometric
methods. Data is collected for ‘Program of care for
people with hearing impairment in Poland’[16].
The studies in Sweden revealed a positive attitude
towards the PDA. The PDA seems to be a valuable
tool for personnel and students in health care but there
is a need for further intervention studies, randomized
controlled trials and studies with various health care
groups in order to identify its appropriate functions and
software applications [18].
AUTOMATIC IDENTIFICATION OF PATIENT
In most European countries, the extensive use of
automatic identification in healthcare is already a
norm. In Poland, this solution is not yet widespread.
For example, identification of the patient can be done
by putting bands with a printed barcode on the wrist of
a registered person.
In the U.S. there are even more advanced
technologies, such as radio frequency identification,
known as RFID tags. Patient information can be
obtained using the identification numbers allocated to

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Dorota Rogala et al.
them. The band put on the patient, contains both chip
signal on a specific radio frequency and the barcode.
By using such solutions the hospital staff has secure
and virtually unlimited access to all data, including
those from the laboratory and pharmaceutical
information center. The system eliminated the need for
paper documentation. The fact that the information is
instantly updated in each place also reduced the
number of errors in prescribing medicines. This system
is particularly convenient when using shift work
system, where the patient is looked after by more than
one person and the instant sharing of information is
more difficult. In addition, physicians and nurses using
the wireless platform right at the bedside can order any
necessary lab tests, write notes about patient care or
update the order of the administration of medication.
The extension of the functionality of the RFID for
tracking blood for transfusion and monitoring of
surgical instruments has been introduced [19].
An assessment RFID-enabled blood transfusion
was conducted for two hospitals: the University of
Iowa Hospital and Clinics (UIHC) and Mississippi
Baptist Health System (MBHS). The study estimated
that RFID technology could reduce morbidity and
mortality effects substantially among patients receiving
transfusions [20].
The RFID system has been also introduced in the
University Hospital of Jena in Germany and designed
to improve patient safety. A significant increase in the
quality of medical services and virtually complete
elimination of the risk of medication dispensing errors
was observed. In addition to improved quality of
treatment, the RFID infrastructure is helpful in the
optimization of logistic processes. It allows
management of drug supplies depending on demand,
which reduces the amount of capital tied up in the
stock of hospital pharmacies [21].
It is worth noting that for the security of
distribution of blood, identification systems use mobile
devices for printing labels on a regular basis. Such
activities are aimed at reducing wrong-labeled samples
of blood which, according to some studies, may be
account for up to 5.8% of all containers [22].
In-patient and outpatient facilities systems are even
less common.
RFID applications have the potential to increase the
reliability of healthcare environments. RFID
technology not only offers tracking capability to locate
equipment, supplies and people in real time, but also
provides efficient and accurate access to medical data
for health professionals. However, the reality of RFID
adoption in healthcare is far behind earlier
expectations. Major barriers to adopt this technology
include technological limitations, lack of global
standards and secure authentication systems. In
healthcare environments remains as a challenge the
further use of this technology [23, 24, 25, 26].
SUMMARY
The examples of practical applications of modern
systems confirm not only their multidimensional
significance for the patient, but also for the
management of health care institutions. Effective use
of the system means not only improvement of
administrative standards, but it provides savings in the
form of reduced overall cost of treatment and care in
our country.
REFERENCES
1. Trąbka W., Komnata W., Stalmach L., Kozierkiewicz A.
Szpitalne systemy informatyczne, wyd. 2.
Uniwersyteckie Wydawnictwo Medyczne „Vesalius”,
Kraków 1999; 9-26,
2. Sala D., Kozierkiewicz A., Potrzeby informacyjne dla
zarządzania w opiece zdrowotnej, Antidotum, 1998, 2,
39-49,
3. Kozierkiewicz A., Strug A., Informatyka w ochronie
zdrowia, [w:]: Transformacja systemu ochrony zdrowia
w Polsce, Dokument MZiOS, Warszawa, 1998, 275-282,
4. Bęben A., Czy pamiętasz znachora?, Rynek Zdrowia,
2007, 10, 44-45,
5. Pilch-Kowalczyk M., Zarządzanie zakładem diagnostyki
obrazowej, Pasaż Medyczny, 2008, 7, 16-18,
6. Koziński M., Czy RUM uzdrowi służbę zdrowia?,
Teleinfo, 2006, 19, 13-15,
7. Informacja dotycząca zabezpieczenia informatycznego
oraz teleinformatycznego w Kujawsko-Pomorskim
Centrum Pulmonologii w Bydgoszczy, Kujawsko-
Pomorskie Centrum Pulmonologii, Bydgoszcz, 2007,
8. Informacja finansowa dotycząca dostarczenia i
uruchomienia rozwiązania XPERTIS dla Kujawsko-
Pomorskiego Centrum Pulmonologii w Bydgoszczy,
Kujawsko-Pomorskie Centrum Pulmonologii,
Bydgoszcz, 2008,
9. Brzozowski A., Aplikacje zdobywają oddziały, Rynek
Zdrowia, 2006, 1, 75-76,
10. Informatyzacja to szybkość działania, Medinfo, 2011, 8,
38,
11. Wydatki stają się racjonalne, Medinfo, 2011, 8, 38,
12. Marianek M., Operacje E-szpital, Pasaż Medyczny, 2008,
2, 33-34,
13. Brzozowski A., U nas za wcześnie?, Rynek Zdrowia,
2006, 11, 44-46,

The use of information systems in health care practice 11
14. Jakubiak L., Elektroniczna perełka, Rynek Zdrowia,
2007, 10, 42-44,
15. Braniecki M., Telemedycyna, dostępne on-line
2005.10.27,
www.oil.org.pl/xml/oil/oil68/gazeta/numery/n2003/2003
06/.
16. Bęben A., Kieszonkowe biuro, Rynek Zdrowia, 2007, 9,
35-37,
17. Forjuoh SN., Reis MD., Couchman GR., et al, Improving
diabetes self-care with a PDA in ambulatory care,
Telemed J E Health., 2008, 14, 3, 273-279,
18. Lindquist AM., Johansson PE., Petersson GI., et al., The
use of the Personal Digital Assistant (PDA) among
personnel and students in health care: a review, J Med
Internet Res. 2008, 28, 10, 4,
19. Klepczarek P., Bezpieczna droga pacjenta –
automatyczna identyfikacja w służbie zdrowia, Pasaż
Medyczny, 2008, 3, 31-34,
20. Briggs L., Davis R., Gutierrez A., et al., RFID in the
blood supply chain--increasing productivity, quality and
patient safety, J Healthc Inf Manag., 2009, 23, 4, 54-63,
21. Brzozowski A., Z komputerem w obchód, Rynek
Zdrowia, 2006, 11, 47- 49,
22. Lippi G., Phlebotomy Issues and Quality Improvement in
Results of Laboratory Testing, Clin. Lab., 2006, 5,
23. Wu ZY., Chen L., Wu JC., A reliable RFID mutual
authentication scheme for healthcare environments, J
Med Syst., 2013, 37, 2,
24. Yao W., Chu CH., Li Z., The adoption and
implementation of RFID technologies in healthcare: a
literature review, J Med Syst., 2012, 36, 6, 3507-3525,
25. Ting SL., Kwok SK., Tsang AH., et al., Critical elements
and lessons learnt from the implementation of an RFIDenabled
healthcare management system in a medical
organization, J Med Syst., 2011, 35, 4, 657-669,
26. Briggs L., Davis R., Gutierrez A., et al., RFID in the
blood supply chain--increasing productivity, quality and
patient safety, J Healthc Inf Manag., 2009, 23, 4, 54-63.
Address for correspondence:
Dorothy Rogala
85-830 Bydgoszcz
ul. Sandomierska 16
e-mail-dorotarogala@op.pl
telephone: 880 44 55 91
Received: 12.04.2012
Accepted for publication: 13.11.2012

Medical and Biological Sciences, 2013, 27/2, 13-17
REVIEW / PRACA POGLĄDOWA
Paweł Sutkowy, Alina Woźniak, Celestyna Mila-Kierzenkowska
POSITIVE EFFECT OF GENERATION OF REACTIVE OXYGEN SPECIES
ON THE HUMAN ORGANISM
POZYTYWNE ASPEKTY GENEROWANIA REAKTYWNYCH FORM TLENU
W ORGANIZMIE CZŁOWIEKA
The Chair of Medical Biology, Nicolaus Copernicus University,
Ludwik Rydygier Collegium Medicum in Bydgoszcz
Head: dr hab. Alina Woźniak, prof. UMK
S u m m a r y
For aerobes including human, the oxygen is an
indispensable element for life, but simultaneously at too high
concentration this gas becomes toxic. On the physiological
level, the appropriate concentration of oxygen which is the
source of reactive oxygen species (ROS), is necessary for the
proper functioning of the organism. O 2 and its derivatives as
free radicals influence the maintenance of homeostasis of the
human organism by acting at a cellular level on repair,
protective, and energetic mechanisms, and at an intercellular
level on communication between neighbouring cells and
tissues. In turn, excess or impaired removal of ROS lead to
so-called ‘oxidative stress’ that is associated with the
pathogenesis of many diseases – from cancers to
neurodegenerative, autoimmune and infectious diseases. In
the paper the significance of only physiological level of
reactive oxygen species in the human organism was
presented.
S t r e s z c z e n i e
Dla organizmów aerobowych, w tym człowieka, tlen jest
pierwiastkiem niezbędnym do życia, ale równocześnie
w zbyt wysokich jego stężeniach staje się toksyczny. Na
poziomie fizjologicznym, odpowiednie stężenie tlenu
i reaktywnych form tlenu (RFT), których jest źródłem, jest
niezbędne do prawidłowego funkcjonowania organizmu. O 2
i jego wolnorodnikowe pochodne wpływając na mechanizmy
naprawcze, ochronne i energetyczne komórek oraz na
komunikację między sąsiadującymi komórkami i tkankami,
biorą udział w utrzymaniu homeostazy organizmu człowieka.
Nadmiar RFT lub zaburzenia w ich usuwaniu prowadzą
z kolei do tzw. stresu oksydacyjnego, który związany jest
z patogenezą wielu chorób – od nowotworów, po choroby
neurodegeneracyjne, autoimmunologiczne i infekcyjne.
W pracy przedstawiono znaczenie wyłącznie fizjologicznego
poziomu reaktywnych form tlenu w organizmie człowieka.
Key words: reactive oxygen species, oxidant-antioxidant balance, human physiology
Słowa kluczowe: reaktywne formy tlenu, równowaga oksydacyjno-antyoksydacyjna, fizjologia człowieka
INTRODUCTION
Nowadays, there is clear that oxygen is a kind of
double-edged sword. It allows aerobic organisms to
obtain significantly more energy than anaerobic
organisms in fermentation processes; moreover, the
oxygen is an essential element that allows them to live.
On the other hand, aerobic organisms did not feel

14
Paweł Sutkowy et al.
better at higher concentration of oxygen than
atmospheric – then the oxygen is toxic to them.
Depending on exposure time and oxygen
concentration, toxic effects range from being worse to
diseases (neurodegenerative, autoimmune, infectious,
cancerous) and permanent organs damage [1-3]. In the
paper only physiological importance of oxygen
derivatives in the human organism was presented.
SOURCES OF REACTIVE OXYGEN SPECIES
IN THE HUMAN ORGANISM
Reactive oxygen species (ROS), including oxygen
free radicals (OFR), can be formed in the human
organism by an action of external physical factors such
as ionizing and ultraviolet radiation, ultrasounds, as
well as one of the mildest method of treatment of
biological material – lyophilisation. ROS can be also
produced as a result of an action of air ionizers, even
though producers and dealers ensure that they have a
positive effect on our health and ward off allergies [1].
The oxygen is 7-8 times more soluble in organic
solvents than in water. This property of oxygen is
crucial for the human organism because physical
properties of lipid layer of biological membrane are
similar to properties of organic solvents. Therefore, the
most important sources of ROS in the human organism
are endogenous sources. There are many reactions
during which intracellular ROS are generated: redox
cycling of xenobiotics, respiratory proteins oxidation,
reactions inside peroxisomes, oxidation of reduced
forms of low-molecular cell components,
photoreduction/photooxidation reactions and reactions
of some specific enzymes. Nevertheless, a main source
of ROS in the human organism is the respiratory
electron transport chain [1, 4].
CELLULAR RESPIRATION – THE ELECTRON
TRANSPORT CHAIN (ETC)
Aerobic respiration is based on a reduction of
molecules of oxygen (O 2 ) to molecules of water,
thereupon the energy is obtained:
C 6 H 12 O 6 (glucose) + 6O 2 → 6CO 2 + 6H 2 O + 36ATP
In fact, the molecular oxygen absorbed from the air
is metabolised in the respiratory chain that is located at
the inner membrane of mitochondria. Four electrons
and four protons with cooperation of many enzymes
and coenzymes are required to complete reducing by
cell the oxygen to the water (fig. 1) [1].
O 2 reduction may also be incomplete by premature
electron leakage to the oxygen that occurs. Then, there
is usually the one-electron reduction, thus being one of
the main source of superoxide radical anion (O •− 2 ) – a
harmful OFR that gives next ROS – fig. 1, 2. The
oxygen reduction may also be two- or/and threeelectron,
giving other reactive oxygen species as the
end products – figure 1 [5].
Fig. 1. Reduction of oxygen in the respiratory chain
Ryc. 1. Redukcja tlenu w łańcuchu oddechowym
Fig. 2. Superoxide radical anion as a source of other reactive
oxygen species
Ryc. 2. Anionorodnik ponadtlenkowy jako źródło innych
reaktywnych form tlenu
SELECTED EXAMPLES OF MOST IMPORTANT
RADICALS
The most abundant and important radicals in the
human organism are those located on carbon, oxygen,
sulfur, and nitrogen atoms. The carbon-centered
radicals such alkyl (RC • HR’), hydroxyalkyl
(RC • HOH), acyl (RC • =O), α-(alkylthio) alkyl
(RSC • HR’) radicals are formed mostly due to hydrogen
atom elimination from organic molecules. Especially
significant among the oxygen-centered radicals are:
hydroxyl ( • OH), peroxyl (ROO • ), alkoxyl (RO • ),
phenoxyl (ArO • ), and semiquinone (HO-ArO • ) radicals
and a superoxide radical anion (O 2 •− ). While the • OH is
the most reactive among the O-centered radicals in
biological systems, ROO • is probably the most

Positive effect of generation of reactive oxygen species on the human organism 15
numerous and, except for O •−
2 , these radicals are
oxidants. The representative of S-centered radicals is
the thiyl radical (RS • ) which is an intermediate in the
one-electron reduction of thiols (RSH) to disulfides
(RSSR). Some sulfur radical cations (R2S •+ ,
(R2SSR2) •+ , (RSSR) •+ , Ar2S •+ ) have also attracted
interest for their application in biochemical synthesis
as intermediates in biological redox systems. N-
centered radicals (the most common: • NO, • NO 2 and
• NO 3 ) have great importance in the field of
physiological functions of the human organism,
especially nitric oxide ( • NO). This molecule may have
•−
antioxidant or oxidant properties depending on O 2
concentration. Superoxide radical anion gives in
reaction with nitric oxide peroxynitrite (ONOO – ), as
strong oxidant [1, 2].
MOLECULAR IMPORTANCE OF ROS
ROS are the most numerous oxidants in the cell,
while reducers (antioxidants) are a group of their
scavengers. The ratio of the one to the other id est the
redox potential of the cell determines whether, a cell
will divide, differentiate or die [6, 7] – figure 3.
Fig. 3. Redox regulation of the cell activity; SOD –
superoxide dismutase, GPx – glutathione
peroxidase, CAT – catalase, GSSG – oxidized
glutathione, GSH – reduced glutathione [7]; own
modification
Ryc. 3. Regulacja reakcji utleniania i redukcji w komórce;
SOD – dysmutaza ponadtlenkowa, GPx –
peroksydaza glutationowa, CAT – katalaza, GSSG –
glutation utleniony, GSH – glutation zredukowany
[7]; w modyfikacji własnej
A temporary increase of ROS concentrations due to
the release of various growth factors during a
stimulation of tissue, such as cytokines and hormones,
including insulin, is accompanied. This is not a side
effect, but necessary factor for the correct response of
the cell to these ligands actions. ROS are necessary in
mitogenic signal transduction, gene expression,
metabolic regulation and repair processes within the
cells [7-15].
In 1995, it was demonstrated that growth factor
obtained from platelet (platelet-derived growth factor –
PDGF) for its effect requires the transient increase of
concentration of the hydrogen peroxide (H 2 O 2 ). The
use of catalase or N-acetylcysteine, which is the
precursor of glutathione, inhibits an action of this agent
[16]. Metabolic pathways which lead to the increase of
ROS levels in cells exposed to growth factors of
tyrosine receptors have been described and
characterized [17]. Furthermore, the insulin action is
regulated by mechanism dependent on redox balance.
The short-lived increase of ROS concentrations is
essential for the regulation of phosphatases activities
[18], which together with kinases control the process of
reversible phosphorylation of proteins of the insulin
signal conduction [19]. As early as in 1970s it was
found that stimulation of adipocytes by insulin is
accompanied by elevated ROS concentrations. The
necessity of ROS was confirmed in blocking
translocation of glucose transfer protein (GLUT4) by
the insulin after the supply of catalase to adipocytes
[20]. Significance of ROS for the insulin signal
conduction was also confirmed by results of the studies
where Nox, siRNA and DPI inhibitors mutations were
used [21]. The action of angiotensin II [22],
5-hydroxytryptamine [23] and 17β-estradiol [24] cause
also the transient increase of ROS concentration within
cells.
Moreover, it is very possible that interactions
between cells are modulated by changes in
concentrations of ROS [7, 8]. Reactive oxygen species
act as a second messenger in transmission of
intracellular information and can induce sanitation and
apoptosis processes, thus they have anti-tumor
functions [12, 13]. These compounds also play a key
role in inflammation through the activation of
transcription factors NF-kappaB [25, 26] and AP-1,
and the acetylation/deacetylation of nuclear histone. In
vitro studies it was shown that many substances like
polyphenols, for example curcumin and resveratrol

16
Paweł Sutkowy et al.
present in a diet, have anti-inflammatory properties
[27].
High-reactivity molecules such as ROS have also
crucial importance for correct functioning of locomotor
system. During a rest, free radicals are produced into
muscles as a consequence of activity of the
mitochondrial electron transport. Inside of working
muscles, capillary endothelial enzymes (xanthine
oxidase, nitric oxide synthase – NOS), phospholipase
A2 and in the myocardium NADH oxidoreductase are
responsible for their additional production. This way,
generated reactive oxygen species such as:
• NO,
ONOO – , O •− 2 and • OH, significantly contribute to the
achievement of maximum force of the muscle
contraction and increase strength of tetanic
contractions of the muscle [4].
In the human organism nitric oxide and other N-
centered radicals which create reactive nitrogen species
group (RNS) are particularly important [2]. • NO was
described as endothelium-derived relaxing factor
(EDRF) that plays an important role in the regulation
of blood pressure [28]. It is also significant
neurotransmitter [2] and takes part in regulation of the
activity of NF-kappaB [25, 26]. Moreover, the nitric
oxide-derived radicals may nitrosate and oxidize
tyrosine residues of proteins and affect their
phosphorylation, thus they can modulate activities of
enzymatic proteins [29]. The next important function
of RNS is to destroy pathogens in the process named
the respiratory burst of phagocytes (neutrophils,
macrophages and monocytes) [30]. The respiratory
burst is initiated by creation of active complex of an
enzyme – the NADPH oxidase. This enzyme is
activated due to numerous mediators which include
cytokines, which react with a suitable receptor on the
surface of the cell. It allows production of superoxide
anion (O •− 2 ) as a result of displacement of an electron
•−
from NADPH to molecular oxygen (O 2 ). Created O 2
undergoes a dismutation to hydrogen peroxide (H 2 O 2 ).
The dismutation reaction is catalyzed by superoxide
dismutase (SOD) but may also be spontaneous. In the
presence of ferrous ions hydroxyl radicals ( • OH) are
produced and due to an action of myeloperoxidase a
hypochlorous acid (HOCl) is formed that can react
with amines to form chloramines. The high activity of
inducible nitric oxide synthase (iNOS) inside of
activated phagocytes is another source of antibacterial
agents. Initially, a created nitric oxide (NO) reacts with
•−
O 2 and a highly bactericidal peroxynitrite (ONOO – )
is produced. The nitric oxide in high concentrations has
also antiseptic properties [28-30].
Reactive oxygen species (ROS), including oxygen
free radicals (OFR), play a significant role in a
regulation of proper functioning of human organism.
Still more facts show that inside of the human body
ROS are produced continuously and their
concentrations are tightly controlled by intra- and
extracellular antioxidants.
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Address for correspondence:
mgr Paweł Sutkowy
Katedra Biologii Medycznej
Uniwersytet Mikołaja Kopernika
Collegium Medicum w Bydgoszczy
ul. Karłowicza 24
85-092 Bydgoszcz
tel.: 52 585 37 37
tel./fax: 52 585 37 42
e-mail: pawel2337@wp.pl
Received: 13.11.2012
Accepted for publication: 5.02.2013

Medical and Biological Sciences, 2013, 27/2, 19-25
ORIGINAL ARTICLE / PRACA ORYGINALNA
Maciej Gagat, Koryna Królikowska, Anna Klimaszewska-Wiśniewska, Magdalena Izdebska, Alina Grzanka
THE EFFECT OF MILD HYPERTHERMIA ON MORPHOLOGY, ULTRASTRUCTURE
AND F-ACTIN ORGANIZATION IN HL-60 CELL LINE
WPŁYW ŁAGODNEJ HIPERTERMII NA MORFOLOGIĘ, ULTRASTRUKTURĘ I ORGANIZACJĘ
F-AKTYNY W KOMÓRKACH LINII HL-60
Department of Histology and Embryology, Nicolaus Copernicus University in Toruń, Collegium Medicum in
Bydgoszcz, Karłowicza 24, 85-092 Bydgoszcz, Poland
Head: Prof. Alina Grzanka, Ph.D.
S u m m a r y
I n t r o d u c t i o n . Hyperthermia is a well-established
physical stimulus, which is applied as an adjunctive therapy
with various cancer treatments, such as radiotherapy and
chemotherapy. However, the precise mechanism of heat
action at the cellular level remains to be elucidated, and
appears to be multi-dimensional. The purpose of the current
study was to determine the effect of mild hyperthermia on the
actin cytoskeleton in the HL-60 cell line. In addition, the
morphological and ultrastructural approaches were used to
determine the type of hyperthermia-induced cell death.
M a t e r i a l a n d m e t h o d s . All studies were
performed using human promyelocytic leukemia cell line
(HL-60). Actin filaments were visualized with phalloidin
conjugated to Alexa Fluor® 488 using fluorescence
microscopy. Morphological and ultrastructural changes in the
HL-60 cells were analysed by light and electron microscopy,
respectively.
R e s u l t s . Exposure of HL-60 cells to mild
hyperthermia resulted in the reorganization of the actin
cytoskeleton and the appearance of characteristic apoptotic
features, including cell shrinkage, chromatin condensation
and margination. In addition, swollen mitochondria were
observed. The morphological and ultrastructural changes
increased in severity with an increase in recovery time.
Similarly, actin filament remodeling was observed
immediately after the heat shock and was more evident 3 and
6 hrs after the treatment. These effects were mainly reflected
by a higher definition of the dense cortical F-actin ring as
well as the appearance of brightly fluorescent F-actin dots
and networks scattered throughout the cytoplasm.
C o n c l u s i o n s . Presented data suggest that actin
filament reorganization is involved in the process of
apoptosis initiated by mild hyperthermia. Furthermore, the
results of our studies showed that the severity of
hyperthermia-induced morphological and ultrastructural
changes as well as alterations in actin organization depend
not only on the temperature treatment but also on the
duration of post heat shock recovery.
S t r e s z c z e n i e
W s t ę p . Hipertermia jest dynamicznie rozwijającą się
metodą lecznia nowotworów, stosowaną w skojarzeniu
z radio- i/lub chemioterapią. Precyzyjny mechanizm
działania hipertermii na poziomie komórkowym nie został,
jak dotąd w pełni poznany i wydaje się on wielowymiarowy.
Celem niniejszej pracy była analiza wpływu łagodnej
hipertermii na organizację filamentów aktynowych
w komórkach linii HL-60. Za zasadną uznano także ocenę
zmian morfologicznych i ultrastrukturalnych wywołanych
przez hipertermię, celem określenia rodzaju uruchamianej
śmierci zachodzącej w badanej linii.
M a t e r i a ł y i m e t o d y . Badania przeprowadzono
na komórkach linii białaczki promielocytowej HL-60.
Filameny aktynowe wyznakowano falloidyną skoniugowaną
z Alexa Fluor® 488 i oglądano w mikroskopie
fluorescencyjnym. Morfologiczne i ultrastrukturalne zmiany
w komórkach oceniono odpowiednio, przy użyciu
mikroskopu świetlnego oraz transmisyjnego mikroskopu
elektronowego.

20
Maciej Gagat et al.
W y n i k i . W wyniku ekspozycji komórek HL-60 na
podwyższoną temperaturę obserwowano reorganizację
cytoszkieletu aktynowego oraz pojawienie się komórek o
cechach charakterystycznych dla procesu apoptozy, takich
jak obkurcznie cyto- i nukleoplazmy, kondensacja i
marginalizacja chromatyny czy obrzmienie mitochondriów.
W wyniku rearanżacji, F-aktyna lokalizowała sie głównie w
części korowej komórki w formie pierścienia lub w
cytoplazmie w postaci wyraźnie wyznakowanych sieci i
skupień. Stopień nasilenia zmian w komórkach wzrastał wraz
ze wzrostem czasu regeneracji komórek.
W n i o s k i . Uzyskane wyniki pozwalają stwierdzić, że
cytoszkielet aktynowy zaangażowany jest w realizację
procesu apoptozy indukowanej przez łagodną hipertermię.
Ponadto sugerują one, że na wystąpienie zmian w organizacji
filamentów aktynowych, jak również zmian w morfologii i
ultrastrukturze komórek ma wpływ, nie tylko zastosowany
profil temperaturowy, ale również czas regeneracji komórek.
Key words: hyperthermia, actin filaments, HL-60 cell line
Słowa kluczowe: hipertermia, filamenty aktynowe, linia komórkowa HL-60
INTRODUCTION
The term ‘hyperthermia’ refers to raising the
temperature of a part of the body or of the whole body
above the threshold temperature set at a particular
moment by the thermoregulatory system of the
organism [1,2]. Hyperthermia has been used for its
medical properties since ancient times. Presumably, the
oldest written medical report with references to
hyperthermia was found in the Egyptian Edwin Smith
surgical papyrus, dated around 3000 BC [3]; whereas,
the use of hyperthermia for cancer therapy was first
reported by Hypocrites in the treatment of breast tumor
[4]. Currently, hyperthermia is a well-established
physical modality, which is used as an adjunctive
therapy with various established cancer treatments,
such as radiotherapy and chemotherapy [5].
The scientific rationales for using hyperthermia in
cancer treatment are based on the data from in vitro,
animal and preclinical studies [3,6]. It has been shown
that the alterations in plasma membrane permeability
caused by hyperthermia lead to better infiltration and
drug absorption by the tumor [7]. It has been also
suggested that hyperthermia treatment activates the
immune system against the tumor [8]. Moreover,
cancer cells are selectively sensitive to heat shock
treatment, while the same conditions rarely affect the
growth of normal cells. Additionally, an increase in
thermosensitivity of tumor cells results in the reduction
of tumor blood flow which makes their environment
more hypoxic and acidic. Moreover, several studies
have shown that hypoxia and particularly acidity
enhance the cytotoxicity of hyperthermia [9,10].
The mechanisms of hyperthermia cytotoxicity
involve denaturation of cellular proteins and their
subsequent aggregation as well as plasma membrane
damage, inhibition of DNA repair, and changes in
intracellular calcium homeostasis. The heat-induced
alterations in cell structure and function lead to cell
cycle arrest and cell death [11].
Among the most noteworthy alterations in heatshocked
cells are the induction of heat shock proteins
(HSPs) and reorganization of the cytoskeleton [12].
The actin cytoskeleton is involved in the regulation of
fundamental cellular processes such as motility,
cytokinesis, adhesion and endocytosis [13].
Furthermore, it also participates in signal transduction
regulating cell growth, survival, and death. Therefore,
the actin cytoskeleton may represent an attractive
target for hyperthermic therapy against different types
of cancer [13, 14]. However, the mechanism of
structural and functional actin remodeling in response
to heat shock is not fully understood.
The aim of this study was to determine the effect of
mild hyperthermia on actin cytoskeleton organization
in the HL-60 cell line, in the context of involvement in
cell death process.
MATHERIAL AND METHODS
Cell culture and treatment
The human promyelocytic leukemia cell line
HL-60 was purchased from the American Type Culture
Collection (ATCC, Manassas, VA; CCL-240). The
cells were cultured in RPMI 1640 medium (Lonza)
supplemented with 10% fetal bovine serum (FBS,
PAA) and 10 mg/ml gentamicin (Lonza), at 37ºC in a
humidified 5% CO 2 atmosphere. After 48 hr cell
culture, HL-60 cells were subjected to heat shock
(40ºC, 2 hrs), followed by post-heat shock recovery at
37ºC for 0, 3 and 6 hrs. Control cells were cultured
identically without exposure to heat treatment. Cell
viability was assessed by the trypan blue dye exclusion
method.

The effect of mild hyperthermia on morphology, ultrastructure and F-actin organization in HL-60 cell line 21
Light microscopy studies
For the morphological analysis, HL-60 cells were
fixed in 4% paraformaldehyde. After fixation, the cells
were incubated with 0.1M glycine solution (Roth) and
then the cell suspension was centrifuged onto glass
slides. Thereafter, the cells were stained with Mayer's
hematoxylin and rinsed under running tap water and
dehydrated in a graded series of alcohols and xylenes.
The preparations were observed using an Eclipse E800
microscope (Nikon) with NIS-Elements ver. 3.30
image analysis system (Nikon) and CCD camera
(DS-5Mc-U1; Nikon).
Transmission electron microscopy studies
For ultrastructural analysis, the cells were fixed
with 3.6% glutaraldehyde and then postfixed with 1%
osmium tetroxide, dehydrated with graded series of
alcohol and acetone, and embedded in Epon 812. The
polymerization of the resin was performed at 37°C for
24 hrs, and then at 65°C for 120 hrs. Selected parts of
material were cut into ultra-thin sections by using an
OmU3 ultramicrotome (Reichert) and then
counterstained with uranyl acetate and lead citrate. The
material was examined using JEM 100 CX electron
microscope (JEOL).
Fluorescence microscopy studies
For fluorescence labeling of actin, the cells were
fixed with 4% paraformaldehyde. After fixation, the
cells were incubated with 0.1M glycine solution (Roth)
and then the cell suspension was centrifuged onto glass
slides. The cells were then permeabilized with 0.1%
Triton X-100 (Serva Feinbiochemica). To enable
visualization of F-actin, the cells were incubated with
phalloidin conjugated to Alexa Fluor 488 (Invitrogen,
diluted 1:40). The nuclei of the cells were labeled with
4’,6-diamidino-2-phenyloindole (DAPI; Sigma-
Aldrich). Slides were mounted in Aqua-Poly/Mount
(Polysciences) and analysed by using an Eclipse E800
microscope with a Y-FL fluorescence attachment
(Nikon), NIS-Elements ver. 3.30 image analysis
system (Nikon) and CCD camera (DS-5Mc-U1;
Nikon).
Statistical analysis
The non-parametric Mann-Whitney U test was
performed to compare the differences between
experimental groups. The results were considered
statistically significant at p

22
Maciej Gagat et al.
The effect of mild hyperthermia on the morphology
and ultrastructure of HL-60 cells
The evaluation of changes in the morphology and
ultrastructure of heat-shocked HL-60 cells was
performed. Control HL-60 cells were circular or oval
in shape and contained intact nuclei. Only a few cells
were morphologically changed (Fig. 2A).
The appearance of HL-60 cells fixed immediately
after a mild heat shock (40°C/2hrs) was not
significantly different from that of the control (Fig.
2B). However, with increasing recovery time more
advanced changes in cell morphology and
ultrastructure occurred in the heat-treated cultures.
After 3 and 6 hrs of recovery, the shrunken cells with
irregular and undulating surface as well as chromatin
condensation and marginalization were observed (Fig.
2C,D,F, 3C). The cells with fragmented nuclei were
also noticed (Fig. 2D). Additional changes, including
swollen mitochondria (Fig. 3C) and vacuolization of
the cytoplasm (Fig. 3D) were also detected. Moreover,
a few cells with the morphological appearance of
mono-nucleated giant cells were seen (Fig. 2C,F).
Fig. 2. The effect of mild hyperthermia on morphology of
HL-60 cells, stained with Mayer's hematoxylin; Nontreated
cells (A); The HL-60 cells were heat shocked
at 40ºC for 2 hrs (B) and returned to 37ºC for: 3 hrs
(C,D) or 6 hrs (E,F); The enlarged cells with one big
nucleus are seen (C,F arrows I); The shrunken cells
with fragmented nuclei (D arrows II) and/or
chromatin condensation (B, C, D, F arrows III) can
be also observed; The swollen cell with fragmented
nucleus is seen (D, E arrows IV)
Ryc. 2. Wpływ łagodnej hipertermii na morfologię komórek
linii HL-60, barwionych hematoksyliną Mayera;
Komórki kontrolne (A); Komórki HL-60 poddano
szokowi cieplnemu w temperaturze 40ºC przez 2h
(B), po czym ponownie umieszczono w 37ºC na okres
3 (C,D) lub 6h (E,F); Widoczne powiększone komórki
z jednym dużym jądrem (C, F strzałki I); Widoczne
obkurczone komórki z fragmentację jądra (D strzałki
II) i/lub kondensacją chromatyny (B,C,D,F strzałki
III) Widoczne również obrzmiałe komórki z
fragmentacją jądra (D,E strzałki IV)
Fig. 3. The
effect mild
hyperthermia
on the
ultrastructure
of HL-60
cells; Nontreated
cells
(A); The HL-
60 cells were
heat shocked
at 40ºC for 2
hrs (B) and
returned to
37ºC for: 3 hrs
(C) or 6 hrs
(D); Visible
swollen
mitochondria
(C arrows I);
Cytoplasmic
vacuolization
is seen (C,D
arrows II)
Ruc. 3. Wpływ
łagodnej
hipertermii na
ultrastrukturę
komórek HL-
60; Komórki
kontrolne (A);
Komórki HL-
60 poddano
szokowi
cieplnemu w temperaturze 40ºC przez 2h (B), po czym
ponownie umieszczono w 37ºC na okres 3 (C) lub 6h (D);
Widoczne obrzmiałe mitochondria (C strzałki I) oraz
wakuolizacja cytoplazmy (C,D strzałki II)

The effect of mild hyperthermia on morphology, ultrastructure and F-actin organization in HL-60 cell line 23
The effect of mild hyperthermia on F-actin
organization
Alexa Fluor 488-phalloidin staining was applied for
visualization of changes in filamentous actin
organization after treatment of HL-60 cells with mild
hyperthermia. Control HL-60 cells displayed a spread
F-actin cytoskeleton with well-defined peripheral
limits and intact nuclei. Only a few nuclei were
morphologically changed (Fig. 4A,A').
dense cortical F-actin ring as well as the appearance of
bright F-actin clusters and network scattered
throughout the cytoplasm (Fig. 4C,D). Moreover,
directly after heating, the cells with fragmented nuclei
and degradation of the F-actin cytoskeleton were often
observed (Fig. 4B,B'). These alterations were also
noticed following a recovery time of 3 and 6 hrs (Fig.
4C,C',D,D'). After the recovery period, actin filaments
were arranged circumferentially in dense, ring-like
structures or in the form of densifications or
aggregations under the plasma membrane (Fig. 4D).
Furthermore, F-actin became organized in dots and
networks scattered throughout the cytoplasm (Fig. 4C).
Fig. 4. The effect of mild hyperthermia on the F-actin
organization in the HL-60 cells; F-actin was stained
with Alexa Fluor 488 phalloidin, nuclei were
counterstained with DAPI; Non-treated cells (A,A');
The HL-60 cells were heat shocked at 40ºC for 2 hrs
(B,B') and returned to 37ºC for: 3 hrs (C,C') or 6 hrs
(D,D')
Ryc. 4. Wpływ łagodnej hipertermii na organizację F-aktyny
w komórkach linii HL-60; F-aktynę wyznakowano
falloidyną skoniugowaną z Alexa Fluor 488, jądra
wybarwiono DAPI; Komórki kontrolne (A,A');
Komórki HL-60 poddano szokowi cieplnemu w
temperaturze 40ºC przez 2h (B,B'), po czym
ponownie umieszczono w 37ºC na okres 3 (C,C') lub
6h (D,D')
The structural remodeling of actin was observed
immediately after heat shock treatment but was more
evident 3 and 6 hrs after the exposure. These effects
were reflected mainly by a higher definition of the
Discussion
Hyperthermia is a type of medical therapy in
which body tissues are exposed to slightly
higher temperatures to damage or make cancer cells
more sensitive to other chemical or physical factors.
Heat-shock destroys enzyme complexes present in the
cytoplasm and mitochondria membrane but also causes
alterations in enzyme system cycles, which is involved
with changes in chromatin organization, regulation of
gene expression and ion homeostasis [12, 15]. Our
previous studies showed the effect of 41 and 44.5ºC on
the morphology, ultrastructure and actin cytoskeleton
of CHO AA8 cells [16, 17]. We also investigated the
influence of hyperthermia (43.5 and 45ºC) on H1299
lung cancer cells [18]. In our studies, we noticed shape
changes and characteristic, apoptotic features in heattreated
CHO AA8 and H1299 cells [16-18].
Furthermore, H1299 cells treated with 43.5 and 45°C
heat stress showed similar changes in cell shape and
membrane structure, which were probably the
consequence of loss or reduction of integrins at the cell
surface [18]. Hyperthermia also induces changes in
actin organization, especially in switching from
filamentous to monomeric state [19]. In CHO AA8 and
H1299 reorganization of actin cytoskeleton was also
observed [16-18]. In this paper, analyses were
performed using a non-adherent human promyelocytic
leukemia cell line (HL-60) and, as previously, we
observed changes in the morphology and ultrastructure
after heat shock treatment. It is known that mild
hyperthermia promotes cell viability and proliferation
[20]. In this study, we did not find any differences in
viability between the control and heat-shocked cells.
Following a recovery period of 3 and 6 hrs, a slight
reduction in cell viability was noticed, but these data
were statistically insignificant. 3 and 6 hrs after

24
Maciej Gagat et al.
heating, the shrunken cells with condensed and
marginated chromatin were present. The cells with
fragmented nuclei were also noticed. The same results
were reported by Luchetti et al. (2002), who used 1 hr
hyperthermia (43ºC) to induce apoptotic response of
HL-60 cells, followed by a recovery time (6 hrs, 37°C)
[21]. Moreover, at the ultrustructural level, the swollen
mitochondria were detected. Cole et al. (1988) and
Wheatley et al. (1989) observed the mitochondrial
damage in cells exposed to hyperthermia [22,23]. The
43 and 45°C hyperthermia induced a decrease in pH
and mitochondrial matrix density. Many researchers
revealed that the effect of heat shock on the
mitochondrial membrane potential is associated with a
change in the cellular redox status of cells.
Depolarization of mitochondrial membrane results in
the reactive oxygen species (ROS) outburst [22,23]. In
our previous studies with CHO AA8 or H1299 cells,
apart from apoptotic cells, we observed giant cells with
one enlarged nucleus or with the features of
micronucleation. These morphological changes are
characteristic for mitotic catastrophe [16-18]. The same
results were presented by Nakahata et al. (2002), who
observed tumour cells with multiple micronuclei
whose number increased with the post-treatment
recovery time [24]. In the present study, a few mononucleated
giant cells were noted, but we cannot
identify them as cells with the mitotic catastrophe
phenotype.
Additionally, in this paper, we showed
hyperthermia-induced reorganization of actin
filaments. It is known that actin plays an important role
not only in cell motility, membrane ruffing and
formation of lamellipodia in adherent cells, but it is
also involved in proliferation, differentiation, and
apoptosis [13,14]. In 2003, Grzanka et al. presented a
correlation between actin reorganization and apoptotic
body formation during apoptosis [25]. The same
scientists noticed that F-actin was seen in the nuclei of
apoptotic cells [26]. Proapoptotic effect of
hyperthermia has been demonstrated in various cell
lines. It is known that heat shock induces changes not
only in the actin cytoskeleton but also in the
organization of microtubules and intermediate
filaments, e.g. vimentin polymers [18]. In the present
study, we observed F-actin especially at the cell
periphery. We did not reveal any significant
differences immediately after mild heat shock
treatment (40°C/2hrs). 3 and 6 hrs after heating, we
observed dense actin filaments arranged
circumferentially in the ring-like structures or in the
form of densifications or aggregations under the
plasma membrane. We also found F-actin in form of
dots and networks scattered in the cytoplasm of HL-60
cells. Our previous studies showed similar effect of
cytostatic drugs (arsenic trioxide, doxorubicin, and
taxol) on actin organization in HL-60 cells and
confirmed that actin reorganization is associated with
cell death process [25-27]. After treatment with
cytostatic drugs, the actin network in the cytoplasm
undergoes reorganization to form aggregates, which
are necessary for the formation of apoptotic bodies.
Additionally, Luchetti et al. (2002) suggested that actin
could be directly involved in chromatin rearrangement
occurring during apoptotic cell death [21].
In conclusion, our studies suggest that actin
filament reorganization is involved in the process of
apoptosis initiated by mild hyperthermia. Furthermore,
we also showed that the severity of hyperthermiainduced
morphological and ultrastructural changes as
well as alterations in actin organization depend not
only on the temperature treatment but also on the
duration of post-heat shock recovery period.
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Address for correspondence:
Prof. Alina Grzanka, Ph.D.
Nicolaus Copernicus University in Toruń
Collegium Medicum in Bydgoszcz
Department of Histology and Embryology
24 Karłowicza St., 85-092 Bydgoszcz, Poland
tel.: +48525853725; fax: +48525853734
e-mail: agrzanka@cm.umk.pl
Received: 13.11.2012
Accepted for publication: 26.03.2013

Medical and Biological Sciences, 2013, 27/2, 27-31
ORIGINAL ARTICLE / PRACA ORYGINALNA
Wojciech Pawłowicz
MODEL STUDY OF EPITHELIAL MOTILITY
MODELOWE BADANIA AKTYWNOŚCI RUCHOWEJ NABŁONKA
Department of Pathobiochemistry and Clinical Chemistry, Collegium Medicum, Nicolaus Copernicus University,
M. Skłodowskiej-Curie 9, 85-094 Bydgoszcz, Poland
Head of Department: Professor Tomasz Tyrakowski
S u m m a r y
One of the oldest achievements of human thought is the
use of plants and plant extracts in therapeutics. Drugs of
plant origin are characterized by multi-effects. In recent
years, much interest in medicinal plants containing a mixture
of biologically active substances with antimicrobial
properties has increased. In medicine, extracts from plants
and their secondary metabolites and plant extracts have been
used for many years, but now by the development of organic
chemistry, pharmacology and medicine, we can determine
which biologically active substances produced by these
plants are useful. Antimicrobial activity described selected
groups of plant secondary metabolites, which potentially
would allow their use as antimicrobial substances in
medicine. These substances can be complementary to the
basic medical treatment because their main advantage is the
lower incidence of side effects. This paper presents an
overview of research on the antimicrobial properties of
alkaloids, coumarins, flavonoids, essential oils, phytosterols,
and phenolic acids. Natural substances that inhibit the growth
of microorganisms are becoming an alternative to synthetic
compounds, as confirmed by this literature review.
S t r e s z c z e n i e
C e l e m b a d a n i a jest odnalezienie substancji
mogących wpływać na aktywność ruchową nabłonka
w modelu eksperymentalnym poruszającego się ślimaka
Achatina achatina. Ze względu na fizjologiczne,
biochemiczne i fizyczne podobieństwa pomiędzy nabłonkami
różnych gatunków, wyniki mogą mieć znaczenie dla
mechanizmów fizjologicznego oddziaływania tych
substancji.
M a t e r i a ł i m e t o d a . Sfilmowano proces ruchu
ślimaków Achatina achatina zarówno spontaniczny jak i po
wstrzyknięciu w stopę wybranych wcześniej neuroprzekaźników
(serotoniny, kompleksu serotoninowokreatyninowego
adrenaliny, noradrenaliny i dopaminy) oraz
ambroksolu. Parametry mierzono wykorzystując filmy
nagrane od spodu przez szklaną płytę po której poruszały się
zwierzęta. Fale aktywności ruchowej nabłonka występowały
na powierzchni stopy podczas ruchu.
W y n i k i i d y s k u s j a . Każda z badanych
substancji miała wpływ na ruch ślimaków. Wstrzyknięcie
serotoniny, kompleksu serotoninowo-kreatyninowego,
noradrenaliny i ambroksolu spowodowało wzmożenie
aktywności ruchowej ślimaków, z kolei adrenalina
i dopamina nie powodowały takich zmian, lub też działały
hamująco. Ważne parametry, których zmiany
zaobserwowano, to długość fali skurczu i odległości między
nimi, częstotliwość fali skurczu, prędkość ślimaka,
przesunięcie ciała na jedną falę skurczu i wydajność skurczu.
W n i o s k i . Wyniki wskazują na możliwość
zastosowania ślimaka A. achatina jako biologicznego
modelu, ponieważ w czasie ruchu ślimaka można
zaobserwować aktywność motoryczną nabłonka sterowaną
przez układ nerwowy i wywoływaną skurczami tkanki
mięśniowej, podobnie jak w ludzkich tkankach.
Wstrzyknięcie serotoniny, kompleksu serotoninowo-kreatyninowego
adrenaliny, noradrenaliny i dopaminy
w organizmie modelowym A. achatina zmienia fale skurczu
nabłonka na stopie. Postuluje się, że podobny proces
zachodzi w innych nabłonkach, w tym ludzkich.
Key words: epithelium, Achatina achatina, motility, pedal wave
Słowa kluczowe: nabłonek, Achatina achatina, aktywność ruchowa, fale skurczu

28
Wojciech Pawłowicz
INTRODUCTION
While general functions and physiology of
epithelial tissue have been thoroughly recognized, less
attention is focused on its motility, particularly the one
related to movements of different substrates on
epithelial surface. Various types of epithelium show
different patterns of movement, which serves specific
purposes, but the nature and exact mechanisms of its
regulation are not fully known. To better understand
the nature of these movements, a biological model
could be helpful, aside from traditional methods which,
like the Ussing apparatus, involve using tissue samples.
In search for such a model, a set of similarities
between snail pedal epithelium and other epithelia has
been evaluated. As the animal moves forward series of
repeated epithelial darkening areas called pedal waves
are observed, which origin at the back of the foot and
move forward towards the head as the animal moves
forward [1]. Because snail movements are similar in
physical nature to bowel movements, snails have the
potential to be used as biological models. The wave
progression and how it relates to overall mollusk
adhesive locomotion in normal, unmodified conditions
has already been studied [2,3,4]. The results showed
that both pedal wave frequency and pedal wave length
could play a key role in regulation of locomotion;
however, these studies have so far proved inconclusive
[5].
Fig. 1. Side view of a moving snail illustrating the pedal
waves where the epithelium tissue is lifted and
contracted. Different vector lengths illustrate the
variety of individual waves
Ryc. 1. Widok z boku na poruszającego się ślimaka
ilustrujący fale na stopie, gdzie nabłonek ulega
skurczeniu i podniesieniu. Różnice w wektorach
ilustrują zróżnicowanie poszczególnych fal
Another important factor is a thin layer of mucus
produced by snail, on which it slides, and which
alternately serves as adhesive material. Probably, the
pedal waves are the way to regulate friction between
the sole of the foot and the surface. The mucus, being a
non-newtonian fluid, is efficient in transferring
movement energy from the sole of the foot to the
surface [6, 7, 8]. By its prosperities, the animal is also
able to adapt to various conditions and use it more
efficiently [9]. Mammalian epithelia, such as these
covering the airways or gastrointernal tract, are also
known to produce mucus that plays a key role in
moving foreign substrates on their surfaces. In this
study, the problem whether snails respond to
pharmacological modification of their movement
pattern was examined. Vulnerability to
neurotransmitters, drugs and other chemical substances
are a key aspect in considering the use of snails as a
potential biological model of epithelium movement.
MATERIAL AND METHODS
The study used control and study groups of 10
Achatina achatina snails between 16 and 23 grams of
body mass and 40 to 50mm of shell length. The snails
were kept in a moist terrarium with a peat surface, at
room temperature, and were fed with cabbage with
addition of egg shells. During the study the snails were
placed on a transparent glass surface, and their
movement was then recorded with a digital camera
CCD DFK 41 AV02.AS with a CCTV 5-50 mm
F/1.8 lens, using IC Capture.AS 2.0 software. The
recordings were then processed and examined using
VirtualDub 1.9.9 and image analysis software.
Recordings were all conducted starting at 9 a.m., at
room temperature, and were approximately 30
seconds long per animal.
The following variables were used in the study:
length of single pedal waves [mm], length of single
intervals between pedal waves [mm], speed of
snail’s head [mm/s], frequency of pedal waves [1/s],
total distance covered per pedal wave [mm] and
epithelium fold coefficient. The last value was
calculated by the following equation and shows how
the distance covered by the animal corresponding
with the pedal wave length:
u – epithelium fold coefficient [%]
shw – distance covered per pedal wave [mm]
lw – single pedal wave length [mm]
During the study the following neurotransmitters
were tested: epinephrine, norepinephrine, dopamine,
serotonin (both pure and in a serotonin-creatinine
complex). Additionally, ambroxol – a secretolytic
agent and an inhibitor of Na+ that decreases mucus

Model study of epithelial motility 29
density – was used to check the role of mucus. The
studied neurotransmitters and ambroxol were
applied in a form of an injection, dissolved in a
physiological equivalent of Ringer’s solution set
specifically for the snails (80mmol/l NaCl, 4mmol/l
KCl, 8mmol/l CaCl2, 5mmol/l MgCl2, 5mmol/l
Tris, pH 7.8) [10]. The same solution was used in
negative control groups. In each case the substance’s
dosage was 2 μg per gram of body mass. All
variables were measured in a zero and negative
control group and test groups of the same size (10
animals). The recordings were taken directly after
drug admission and also an hour and two hours
afterwards.
All the measured and calculated variables were
then used to determine if the pharmacological
modification of movement shows statistically
significant results and wheatear these results can be
applied to previously known data. To determine this,
Welch's t test was used, with statistical significance
at 0.05.
RESULTS
Serotonin in pure form had a statistically
significant influence on variables describing
motility. Directly after injection 82.05% increase in
the animals’ movement speed and 35.13 % in the
value of epithelium fold coefficient was observed.
These changes remained statistically significant up
to an hour after admission. In comparison, the same
serotonin in a creatinine complex did not cause a
statistically significant change in movement speed,
but affected the pedal wave generation, increasing
their length by 38.34% and their frequency by
19.63%.
Epinephrine also did not show influence on the
animals’ movement speed, causing changes only in
pedal wave generation. Wave length increased by
19.66% and the interval between waves increased by
19.28%, which in turn resulted in lesser epithelium
contraction levels. On the other hand,
norepinephrine caused a different set of changes,
resulting in a major increase of 66.39% in
movement speed, followed by a 24.65% increase in
wave length.
Table I. Movement variables after substance injection
compared to control
Tabela I. Paramerty ruchu po wstrzyknięciu substancji
w porównaniu z kontrolą
* the increase in speed during the next hour was
statistically significant. (w następnej godzinie zmiana
była statystycznie istotna)
** results at p=0.05 (wyniki dla poziomu istotności
p=0,05)
Values described as % difference according to control
directly after neurotransmitter/amborxol admission.
Numbers represent mean values and standard deviation.
Statistically significant values are placed on gray
background. (Wartości przedstawiono jako % różnicę w
stosunku do kontroli bezpośrednio po podaniu
neuroprzekaźników/ambroksolu. Wartości reprezentują
średnie plus odchylenia standardowe. Wyniki istotne
statystycznie przedstawiono na szarym tle.)
Fig. 2. The effects of neurotransmitters and ambroxol on
A. achatina pedal wave length directly after
admission. The values shown are mean including
standard deviation. Statistically significant results
at p=0.05 are marked with *
Ryc. 2. Efekt oddziaływania neuroprzekaźników i ambroksolu
na długość fali skurczu u A. achatina
bezpośrednio po podaniu. Pokazane wartości
to średnie plus odchylenie standardowe.
Istotne statystycznie wartości oznaczono *

30
Wojciech Pawłowicz
The dopamine was used in this test as a reference
to the previous studies. The only statistically
significant changes observed were a 15.29%
reduction in pedal wave interval length and a
29,15% increase in the folded area/total foot area
ratio. Other motility variables remained below
statistically significant levels.
subtypes as this enables to fully evaluate the model.
The proposed method is precise and repeatable
enough to be considered for practical use. Also, the
easiness of the process and animal breeding speed
give chances for constituting a cheap and numerous
research groups.
Finally, the role of mucus and its physical
prosperities in the locomotors activity is not to be
excluded. It has been proven before that mucus
plays a key role in snail movement, and here it was
shown that its modification drastically changes the
movement pattern. A question of interest is if, and to
what extent, such changes can be applied to model
epithelium i.e. to modify the adhesive locomotion.
CONCLUSIONS
Fig. 3. Sole of the snail foot with visible pedal waves
(darker areas). 1 – spontaneous movement, 2 –
directly after abroxol injection. The wave length
and intervals between waves have increased
Ryc. 3. Stopa ślimaka z widocznymi falami skurczu
[ciemne rejony]. 1 – ruch spontaniczny, 2 –
bezpośrednio po podaniu ambroksolu. Długość
fali i odległości pomiędzy nimi uległy
zwiększeniu
After the injection of ambroxol, a variety of
changes in the movement pattern could be observed.
The speed of the animals increased by 43,51%, with
both pedal wave length and frequency increasing.
DISCUSSION
The results show a possibility for the use of A.
achatina snail as a study model to test if the
substances influence epithelial motility. The
adhesive locomotion process responded to the
pharmacological modification and thus, leads to
believe that snails use an analogous set of receptors
and neurotransmitters as mammals. The specific set
of changes in movement speed and other variables
differs according to the substance used, but follows
a unique and characteristic pattern.
Being able to use the proposed model efficiently
depends on the specific types of receptors and ion
channels in the snail’s body. The key to the further
studies is to pinpoint their location and specific
1. Serotonin, serotonin-creatinin complex,
norepineprhine and ambroxol injected into snail’s
body cause an overall increase in movement speed
while epinephrine and dopamine have no effect or
decrease movement speed.
2. The increase in movement speed depends on
the increase of pedal wave length, total distance
covered per pedal wave, the pedal wave frequency
and the epithelium fold percentage. Decrease in
movement speed does not cause such changes or is
followed by a decrease of those parameters.
3. It is proposed that in the process of adhesive
locomotion of land snails an important role is played
by epithelial motility regulated by the nervous
system and caused by muscle contraction.
4. The above mentioned snail foot activities
are a valuable biological model for testing if a
substance influences the epithelial motility.
REFERENCES
1. Barker G. M.:. The biology of terrestrial mollusks,
CABI Publishing, New Zeland 2001
2. Lissmann H.W.: The mechanism of locomotion in
gastropod mollusks I. Kinematics, J. Exp. Biol., 1945,
21, 58-69
3. Lissmann H.W.: The mechanism of locomotion in
gastropod mollusks II. Kinetics, J. Exp. Biol., 1945,
21, 37-50,
4. Tyrakowski T., Kaczorowski P., Pawłowicz W.,
Ziółkowski M.:, Discrete movements of foot
epithelium during adhesive locomotion of land snail,
Folia Biol. (Krakow) 2012, 60, 99-106

Model study of epithelial motility 31
5. Lai J.H., del Alamo J.C, Rodriguez-Rodriguez J.: The
mechanics of the adhesive locomotion of terrestrial
gastropods. J. Exp. Biol., 2010, 213, 3920-3933
6. Denny M. W.: A Quantitive Model for the Adhesive
Locomotion of The Terrestial Slug, Ariolimax
Columbians, J. Exp. Biol., 1981, 91, 195-217
7. Denny M. W.: Mechanical Prosperities of Pedal
Mucus and Their Consequences for Gastropod
Structure and Performance, Amer. Zool., 1984, 24,
23-36
8. Denny M. W.: The Physical Prosperities of the Pedal
Mucus of the Terrestrial Slug Ariolimax columbianus,
J. Exp. Biol., 1980, 88, 375-393
9. Lauga E., Hosoi A.E.: Tuning gastropod locomotion:
Modeling the influence of mucus rhelology on the cost
of crawling, Phys. Fluids, 2006, 18:113102
10. Pavlova G.A.: Effects of serotonin, dopamine and
ergometrine on locomotion in the pulmonate mollusk
Helix lucorum, J. Exp. Biol., 2001 204, 1625-1633
Address for correspondence:
e-mail: wojciech-pawlowicz@wp.pl,
tomtyr@cm.umk.pl
Phone:
Author (+48) 664-194-557
Department (+48) 52-585-35-98
Received: 25.07.2012
Accepted for publication: 18.09.2012

Medical and Biological Sciences, 2013, 27/2, 33-39
ORIGINAL ARTICLE / PRACA ORYGINALNA
Zuzanna Piekorz 1 , Irena Bułatowicz 1 , Agnieszka Radzimińska 1 , Andrzej Lewandowski 2 , Szymon Piekorz 2 ,
Grzegorz Grabarczyk 2 , Monika Ciesielska 3
THE INFLUENCE OF HATHA YOGA EXERCISE ON ARTERIAL PRESSURE AND PULSE
WPŁYW TRENINGU HATHA JOGI NA WARTOŚCI CIŚNIENIA TĘTNICZEGO
I CZĘSTOŚĆ TĘTNA
1 Z Katedry i Zakładu Kinezyterapii i Masażu Leczniczego UMK w Toruniu Collegium Medicum
im. L. Rydygiera w Bydgoszczy
p. o. kierownika: dr Irena Bułatowicz
2 Z Katedry i Zakładu Podstaw Kultury Fizycznej UMK w Toruniu Collegium Medicum
im. L. Rydygiera w Bydgoszczy
p. o. kierownika: dr Andrzej Lewandowski
3 Z Katedry i Kliniki Anestezjologii i Intensywnej Terapii UMK w Toruniu Collegium Medicum
im. L. Rydygiera w Bydgoszczy
kierownik: Dr hab. Krzysztof Kusza, prof. UMK
S u m m a r y
I n t r o d u c t i o n . Hypertension constitutes a great
problem in modern medicine. Due to it being widespread in
the society, it seems justified to introduce complex treatment
and prevent from this disease. Hypotensive qualities of yoga
exercise described in literature constitute an interest as an
alternative form of cardiological rehabilitation.
M a t e r i a l a n d m e t h o d s. In order to evaluate its
influence on the values of blood pressure and pulse, a group
of people attending hatha yoga classes was studied. It was
assumed that circulatory system parameters would decrease
when influenced by training, and the size of those changes
would depend on age, health condition and selected
environmental factors. Before, during and after the classes
arterial blood pressure and pulse were measured. The study
was supplemented by the author's questionnaire consisting of
15 questions with given response categories.
R e s u l t s . Great age difference, majority of female
subjects and those with higher education and white collar
jobs were observed during the study.
The results proved good perception of subjects' own
health condition and their little knowledge concerning
realistic parameters of their circulatory system.
Decrease of arterial blood pressure and pulse due to hatha
yoga exercise were detected during the study, as well as a
greater decreasing tendency in subjects with high arterial
blood pressure.
C o n c l u s i o n s formulated as a consequence of the
study concern the influence of hatha yoga exercise on
circulatory system parameters and its possible use in order to
obtain better hypotensive effect.
S t r e s z c z e n i e
W s t ę p . Nadciśnienie tętnicze stanowi duży problem
dla współczesnej medycyny. Z uwagi na znaczne
rozpowszechnienie w społeczeństwie zasadne wydaje się
wdrożenie kompleksowego leczenia i przeciwdziałania tej
chorobie. Wykazane w piśmiennictwie właściwości
hipotensyjne treningu jogi spowodowały zainteresowanie
możliwością wykorzystania go jako alternatywnej formy
rehabilitacji kardiologicznej.
M a t e r i a ł i m e t o d y . W celu oceny jego wpływu na
wartości ciśnienia tętniczego i częstość tętna badaniu
poddano grupę osób uczęszczających na zajęcia hatha jogi.
Założono, że parametry układu krążenia ulegną obniżeniu
pod wpływem treningu, a wielkość tych zmian będzie
uzależniona wiekiem, stanem zdrowia i wybranymi
czynnikami środowiskowymi. Dokonano pomiaru ciągłego
ciśnienia tętniczego i częstości tętna przed rozpoczęciem

34
Zuzanna Piekorz et al.
zajęć, w trakcie trwania oraz po ich zakończeniu. Badania
uzupełniono autorską ankietą, składającą się z 15 pytań
z podanymi kategoriami odpowiedzi.
W y n i k i . Zaobserwowano duże różnice wieku osób
podejmujących trening hatha jogi oraz przewagę płci
żeńskiej, wyższego wykształcenia i umysłowego charakteru
pracy.
Stwierdzono stosunkowo dobre odczucie stanu zdrowia
badanych osób i małą świadomość o rzeczywistych
parametrach własnego układu krążenia.
Wykazano obniżenie wartości ciśnienia tętniczego
i częstości tętna pod wpływem treningu hatha jogi, oraz
większą tendencję spadkową badanych parametrów u osób
z wysokimi wartościami ciśnienia tętniczego.
W n i o s k i . Sformułowano wnioski dotyczące wpływu
treningu hatha jogi na parametry układu krążenia oraz
możliwości jego stosowania w celu uzyskania efektu
hipotensyjnego.
Key words: yoga, circulatory system, hypertension, changes, environmental determinants
Słowa kluczowe: joga, układ krążenia, nadciśnienie, zmiany, uwarunkowania środowiskowe
INTRODUCTION
Yoga is one of the oldest sciences practiced by
man, while centuries old tradition and numerous
supporters confirm that it is very up to date and
universal. Its condition, which is continuous self
improvement, takes place in eight stages and leads to
achieving absolute cognition – samadhi [1]. However,
one of the side effects of yoga is its healing influence
on the organism. As a result, practicing it is a sort of
antidote for life nuisances in the 21 st century. It is very
likely that nowadays yoga can offer even more to us –
the Europeans [2].
Taking into account high frequency of hypertension
occurrence and the complexity of its etiology, it was
decided that yoga's influence on circulatory system
parameters should be evaluated. The only other trial
found in literature was performed by L. Kulmatycki,
who studied arterial pressure before and after
relaxation training of yoga in subjects with its high
values [3]. Present studies on yoga are conducted in
very few academic facilities in Poland, and one of the
most vibrant is Academy of Physical Education in
Katowice, where the Academic Yoga Society was
established. The work of members of the society and
especially its president, professor J. Szopa, has resulted
in publications concerning yoga and its influence on
the organism [4, 5, 6, 7, 8, 9, 10]. However, a
significant majority of available literature is of popular
scientific character [1, 11, 12, 13, 14, 15, 16].
The issue of non-pharmacological methods of
treating hypertension is widely described in the subject
literature [17, 18, 19]. Trials of evaluating the influence
of various forms of cardiological rehabilitation [20, 21,
22, 23], as well as relaxation exercise [24] and massage
on the circulatory system parameters [25, 26] were
found in literature. The analysis of collected literature
allows the conclusion that yoga training is connected
with the influence of both physical exercise and
relaxation on the organism. A certain bipolarity of this
exercise system explains the interest in its hypotensive
properties. Unfortunately, yoga as a tool of preventing
and treating hypertension, in significant majority of
literature appears as two separate issues, and only few
authors notice the possibility of taking advantage of
healing properties of yoga in terms of arterial pressure
[1, 2, 25, 27]. Having considered the aforementioned
ideas, trying to synthesize the knowledge derived from
literature and evaluating the influence of yoga training
on circulatory system parameters seems justified.
MATERIAL AND METHODS
The study was conducted in Bydgoszcz from June
2010 to end of February 2011, and included the
subjects participating in hatha yoga classes conducted
by a physical therapist and a yoga teacher. The group
consisted of 30 people at the age between 21 and 60,
28 of whom (93.33%) were women. The classes lasted
90 minutes and included taking poses known as asanas,
in which a crucial element is calm, steady breathing.
Each session ended with a seven – minute relaxation.
Utilizing holter blood pressure monitor, arterial
pressure and pulse values were taken before, during
and after the yoga session. The readings began five
minutes after subjects took a comfortable sitting
position. The time of reading before and after the class
was 30 minutes. Obtained readings were supplemented
by a survey, utilizing author's questionnaire including
15 multiple choice questions. First five questions
concerned social identification of the subjects, the
following ones related to their hatha yoga or other
physical activity training, while the last three questions
allowed a subjective evaluation of the respondents'
health condition in the context of specific diseases.
Collected data was compiled by means of basic
statistical methods, such as Student t test. Statistical
significance of differences was established on the level

The influence of hatha youga exercise on arterial pressure and pulse 35
of p

36
Zuzanna Piekorz et al.
Due to a significant number of subjects whose
arterial pressure was high, exceeding normal, when
evaluated in first reading, further study material was
differentiated according to its values. As a result, a
group of 13 subjects with normal values of blood
pressure was selected – from this point on referred to
as subjects with normal arterial pressure, and a group
of 17 subjects with arterial pressure (systolic pressure
≥ 140, diastolic pressure ≥ 90) – from this point on
referred to as subjects with high arterial pressure.
Comparative characteristics of the studied parameters
are presented in table III.
Table III. Comparative characteristics of the changes in
arterial pressure and pulse of subjects with
normal and high values of arterial pressure
Tab. III. Charakterystyka porównawcza zmian ciśnienia
tętniczego i częstości tętna osób z prawidłowymi
oraz wysokimi wartościami ciśnienia tętniczego
Category M 13 M 17 σ 13 σ 17 D 13 D 17 t 13 t 17
Pulse I
73.54 79.82 8.37 16.09
(beats/min)
Pulse II
66.15 69.00
8.85
(beats/min)
8.09
7.39 10.82 3.11** 2.88*
Systolic
pressure I 121.23 146.12 8.47 14.47
(mmHg)
Systolic
6.38 8.47 1.83 2.42*
pressure
II
114.85 137.65 11.48 17.91
(mmHg)
Diastolic
pressure I 83.23 103.53 4.44 12.45
(mmHg)
Diastolic
6.61 10.88 2.84* 4.80**
pressure
II
(mmHg)
76.62 92.65 6.83 15.86
* Statistically significant difference p< 0.05
** Statistically significant difference p < 0.01
For 13 persons the value of t test is: for alfa 0.05=2.18, for alfa
0.01=3.06
* Statistically significant difference p< 0.05
** Statistically significant difference p < 0.01
For 17 persons the value of t test is: for alfa 0.05=2.12, for alfa
0.01=2.92
As it may be concluded from the table, studied
parameters of subjects with normal arterial pressure
decreased after hatha yoga session. Statistically
significant differences on the level of 0.01 were
discovered only in the evaluation of the changes on
pulse. In the group of subjects with high arterial
pressure, means of all parameters decreased. All
differences of means were statistically significant, and
the lowest, as far as significance level 0.05 is
concerned, was that of systolic pressure.
DISCUSSION
When this study was initiated, it was assumed that
hatha yoga training would result in decrease of the
values of arterial pressure and pulse. Readings
obtained after data analysis confirmed this assumption.
Decrease of both pressure readings as a result of yoga
training was stated also by Kulmatycki, who studied its
influence arterial pressure in subjects with
hypertension. However, results of own study provided
a different picture of downward tendency than the
presented in similar studies published in available
literature. Particularly essential difference was that of
significantly greater decrease in diastolic pressure
before and after the session, when compared to
decrease of this parameter noted in Kulmatycki's study
[3]. A positive influence of yoga exercise on
circulatory system presented in both studies may
become a foundation for using its elements in struggle
against hypertension. It should be remembered that the
obstacle against reliable evaluation of hypotensive
influence of yoga is the fact that such small group of
subjects participated in the study.
A possible explanation of yoga's hypotensive effect
is its toning influence on the nervous system, which is
frequently and extensively discussed in literature [1, 2,
9, 29]. Yoga, along with Schultz's Autogenic Training
and Jacobson's Method are the relaxation methods
most frequently described in literature [29, 30, 31, 32],
hence it seems relevant to compare results of own
study with the influence of relations on the circulatory
system parameters. This issue became of interest to the
Wrocław's Academy of Physical Education. In their
studies they observed that autogenic training developed
by Szyszko-Bohusz resulted in decrease of both arterial
blood pressure and pulse. The authors pointed out
those methods of relaxation ought to be more
frequently adapted as a form of prophylactic and
treatment of hypertension [24]. Taking into account
aforementioned study results, it can be assumed that in
case of presently studied subjects, too, approaching a
relaxed condition in a significant manner influenced
the circulatory system parameters, and the methods
utilized to achieve such condition are characterized by
a similar effectiveness.
In order to evaluate hypotensive effect of yoga, its
effectiveness and results of studies concerning the
influence of therapeutic massage on the circulatory
system parameters were compared. A downward
tendency discovered in the analysis of data proved
analogous to the results obtained in the studies on the
influence of therapeutic massage on the selected
parameters of the circulatory system, in which the
greatest decrease of the studied parameters applied to
pulse, then diastolic and systolic pressure [25]. When

The influence of hatha youga exercise on arterial pressure and pulse 37
analyzing obtained data, a significantly higher
hypotensive influence of hatha yoga than massage was
observed [25, 26].
An important aspect of the conducted study was
propagating yoga exercise as a prophylactic and
therapeutic method, primarily concerning high blood
pressure. In Poland, basic methods of treating this
disease is pharmacotherapy and a change of lifestyle as
far as diet and undertaking physical activity is
concerned [17, 18, 19, 33, 34, 35]. Publications are
available in comprehensive medical literature
concerning studies on changes occurring in blood
pressure when affected by cardilogical rehabilitation
including work-out and utilizing cycle ergonometers.
In those studies it was proven that controlled physical
effort caused or contributed to decrease of arterial
blood pressure [20, 21, 22]. Hypotensive effect,
obtained during the study seems to confirm this
relation. Yoga exercise used as a form of cardiological
rehabilitation might exhibit a similar effectiveness.
Acquired results and available publications prove that
it is relevant to conduct other, frequently more
attractive for patients, forms of physical activity
directed at lowering arterial pressure [23]. In
consequence, it seems fully justified to use elements of
yoga as an alternative method of cardiological
rehabilitation combining hypotensive influence of
physical activity with relaxation.
In the course of the study, it became apparent that
the objective evaluation of the level of blood pressure
significantly deviates from the subjects' awareness. The
group of subjects with diagnosed hypertension
constituted only 20% of subjects in total, however, the
results obtained before hatha yoga training proved that
in more than 56% of subjects the readings of arterial
pressure exceed norms. This issue resulted in dividing
subject into two groups. The percentage of subjects in
whom readings reached values classified as
hypertension exceeds the frequency of this disease
occurring in Polish society, in which 50% of men and
40% of women suffer from hypertension [34]. Lack of
awareness concerning circulatory system parameters
and such wide spreading of its high values in the group
of subjects may imply that this condition occurs more
frequently than suggested by the statistics. It needs to
be pointed that the division was executed solely for the
requirements of the study, and actual picture of
hypertensive subjects can be evaluated only with
comprehensive medical examination. As indicated by
the analysis, decrease of readings of both systolic and
diastolic pressure, as well as pulse, is more explicit in
the group of subjects with high blood pressure. This
result is reflected in other publications, in which
decrease of arterial pressure in subjects with its high
readings was observed [20].
The thesis concerning the influence of age, time
span and frequency of practicing hatha yoga on
changes in the readings of arterial pressure and pulse
occurring after the session was not fully verified. Most
correlations are characterized by nearly insignificant
relation. Significant relation occurred solely between
the results of the studied parameters and age. Relying
on this, one could indirectly conclude that decrease of
pressure exhibited after hatha yoga exercises were
more often marked in young subjects. It may be
assumed that the circulatory system of the young
operates more efficiently, and its parameters undergo
changes resulting from effort or relaxation in a more
explicit manner. Material gathered from the survey
allowed characterization of the group of hatha yoga
participants. A significant majority of subjects were
women, which points to the conclusion that men much
more seldom select yoga as recreational physical
activity. A similar tendency can be observed in other
publications [3,6]. A tendency not related to sex was
age of the subjects. Studied group was very varied age
– wise, which seems to confirm the thesis that hatha
yoga training is suitable for participants at any age [6].
Social characteristics state that majority of members of
hatha yoga group in Bydgoszcz had higher education
and performed white collar jobs. The characteristics of
this group may be related to their higher level of self
awareness and desire of growth, as well as greater
knowledge about pro health influence of yoga, when
compared to those not as well-educated. Respondents,
when choosing hatha yoga classes, expected mainly
improving their physical, then mental comfort.
Subjects' expectations seemed to have been fulfilled,
since a great majority of the respondents pointed to a
positive influence on both physical and mental
comfort. A similarly positive effect of yoga was
described in other publications [3,6].
Obtained results, due to their relative value,
connected with low headcount of the group, do not
allow drawing unequivocal conclusions concerning
tackled problems. However, they confirm hypotensive
influence of hatha yoga and they justify executing
exercise using this method as a non pharmacological
method of treating hypertension. A positive influence
of yoga training was reinforced by the subjective

38
Zuzanna Piekorz et al.
evaluation via survey. A successful verification of the
majority of posed hypotheses ought to be treated as a
confirmation of relevance of further studies in this
area. Procured results may be utilized in preliminary
evaluation of the problem and they can form a
teajectory for further studies with expected equally
successful result, which should be widely spread and
included in treatment and prophylactic. Those
presently presented allowed formulation of the
following conclusions.
CONCLUSIONS
1. Confirmed in the study decrease in readings of
arterial pressure and pulse attests to a positive effect of
hatha yoga training on the circulatory system, and
aforementioned changes in the parameters of subjects
with high readings of arterial pressure justify executing
yoga exercise in order to gain hypotensive effect.
2. A positive influence of hatha yoga training on
the organism is confirmed by subjective perception of
the subjects in the scope of physical and mental
comfort, which can result in improving the quality of
life and reducing stress, and furthermore, it can
intensify hypotensive effect and constitute a
prophylactic for cardio-vascular diseases.
3. Objectively read arterial pressure, contrasting
with the knowledge and perception of its value in
subjects, justifies the need for its regular reading and
improving society's awareness concerning prophylactic
of hypertension.
4. The lack of influence of time span of
practicing yoga and the frequency of training on the
changes in values of arterial pressure and pulse
occurring after session, attests to the possibility of
selective and irregular utilizing elements of this
method during sessions, which aim at gaining
hypotensive effects.
5. A domination of female participants, higher
education and white collar professions in subjects may
prove the upper classes' higher awareness of the health
advantages of hatha yoga training and justify the
necessity of its propagation among the remaining part
of the society.
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Address for correspondence:
mgr Zuzanna Piekorz
Katedra i Zakład Kinezyterapii i Masażu Leczniczego
UMK w Toruniu
Collegium Medicum im. L. Rydygiera w Bydgoszczy
ul. M. Curie Skłodowskiej 9
85-094 Bydgoszcz
Received: 7.02.2012
Accepted for publication: 12.04.2013

Medical and Biological Sciences, 2013, 27/2, 41-47
ORIGINAL ARTICLE / PRACA ORYGINALNA
Adrian Reśliński 1 , Stanisław Dąbrowiecki 2 , Katarzyna Głowacka 3 , Jakub Szmytkowski 1
THE INFLUENCE OF OCTENIDINE DIHYDROCHLORIDE ON BACTERIAL BIOFILM
ON THE SURFACE OF A POLYPROPYLENE MESH
WPŁYW ROZTWORU DICHLOROWODORKU OKTENIDYNY NA BIOFILM
WYTWORZONY NA POWIERZCHNI SIATKI POLIPROPYLENOWEJ
1 Department of General and Endocrine Surgery, Ludwik Rydygier College of Medicine in Bydgoszcz,
Nicolaus Copernicus University in Torun, Poland
Acting Head: Jacek Szopiński PhD
2 Department of Nutrition and Dietetics, Ludwik Rydygier College of Medicine in Bydgoszcz,
Nicolaus Copernicus University in Torun, Poland
Acting Head: Justyna Przybyszewska PhD
3 Department of Plant Physiology, Genetics and Biotechnology,
Warmia – Mazury University in Olsztyn, Poland
Head: Ryszard Górecki prof.
S u m m a r y
Deep surgical site infections (DSSI’s) involving the
implanted biomaterial remain an important issue in hernia
surgery. The etiological factors include Staphylococcus
aureus and Escherichia coli. The ability of these
microorganisms to create a biofilm on the surface of the
implant is considered to be one of the main reasons why
successful treatment of DSSI’s is not an easy task. It is
widely agreed that an important element of a successful
treatment plan for infections involving biofilm formation is
the use of agents capable of penetrating the biofilm matrix,
and displaying a satisfactory efficacy against the
microorganisms present within. Antiseptic agents meet the
above criteria.
The goal of this study was to evaluate the influence of a
solution of octenidine dihydrochloride (Octenisept) on the
biofilm present on a surface of a monofilament
polypropylene mesh implant.
The study involved 140 bacterial strains from the
collection of the Department of Microbiology Nicolaus
Copernicus University Collegium Medicum in Bydgoszcz,
Poland. The strains included 70 (50%) S. aureus isolates and
70 (50%) E. coli isolates. The influence of an antiseptic
agent on the created biofilm was evaluated with the use of a
qualitative and quantitative method, as well as by scanning
electron microscopy (SEM).
In the qualitative assessment, the observed effect of
octenidine was a diminished intensity of biomaterial staining
after incubation with TTC in comparison to samples from the
control group. In the quantitative study, the live cell counts of
S. aureus and E. coli isolated from the biofilm present on the
implant surface, after exposure to the antiseptic agent were
found to be diminished. SEM studies have shown that
exposure to octenidine hydrochloride decreases the number
of bacteria adhering to the biomaterial surface.
The Octenisept octenidine dihydrochloride solution
displays bactericidal activity against S. aureus and E. coli
bacteria present in the biofilm created on the surface of
monofilament polypropylene mesh.

42
Adrian Reśliński et al.
S t r e s z c z e n i e
Głębokie zakażenie miejsca operowanego (GZMO)
obejmujące wszczepiony biomateriał stanowi istotny
problem w chirurgii przepuklin. Czynniki etiologiczne tego
powikłania, wśród których wymienia się m.in.:
Staphylococcus aureus i Escherichia coli tworzą biofilm na
powierzchni implantów uznawany za jedną z głównych
przyczyn trudności w leczeniu GZMO. Uważa się, że
istotnym elementem leczenia zakażeń przebiegających
z powstaniem biofilmu jest stosowanie substancji aktywnych
wobec drobnoustrojów w biofilmie oraz charakteryzujących
się zdolnością do przenikania przez jego macierz. Związkami
chemicznymi posiadającymi wymienione właściwości są
antyseptyki.
Celem pracy była ocena wpływu roztworu dichlorowodorku
oktenidyny w postaci preparatu antyseptycznego
Octenisept na biofilm wytworzony na powierzchni
monofilamentowej siatki polipropylenowej.
Badaniem objęto 140 szczepów bakterii z kolekcji
Katedry i Zakładu Mikrobiologii Collegium Medicum im.
L. Rydygiera w Bydgoszczy Uniwersytetu Mikołaja
Kopernika w Toruniu, wśród których było 70 (50%) izolatów
S. aureus oraz 70 (50%) E. coli. Ocenę wpływu antyseptyku
na wytworzony biofilm wykonano metodą jakościową,
ilościową oraz z użyciem skaningowego mikroskopu
elektronowego (SEM).
W badaniu metodą jakościową efektem działania
roztworu dichlorowodorku oktenidyny na wytworzony
biofilm było zmniejszenie intensywności zabarwienia
powierzchni biomateriału po inkubacji z TTC w stosunku do
grupy kontrolnej. W badaniu ilościowym stwierdzono
zmniejszenie liczby żywych komórek S. aureus i E. coli
izolowanych z biofilmu na powierzchni implantu po
ekspozycji na działanie antyseptyku. Natomiast badanie
z użyciem SEM wykazało, że roztwór dichlorowodorku
oktenidyny powoduje zmniejszenie liczby bakterii
przylegających do powierzchni biomateriału.
Roztwór dichlorowodorku oktenidyny w postaci
preparatu Octenisept wykazuje działanie bakteriobójcze
wobec S. aureus i E. coli w biofilmie wytworzonym na
powierzchni monofilamentowej siatki polipropylenowej.
Key words: octenidine hydrochloride, polypropylene mesh, biofilm, TTC, SEM
Słowa kluczowe: dichlorowodorek oktenidyny, siatka polipropylenowa, biofilm, TTC, SEM
INTRODUCTION
Deep surgical site infections (DSSI’s) involving the
implanted biomaterial remain an important issue in
hernia surgery [1, 2]. One of the main factors
responsible for the difficulties in the treatment of this
complication is the creation of a bacterial biofilm on
the implant surface [3]. The typical etiological factors
of DSSI’s with biofilm – forming capabilities include
Staphylococcus aureus and Escherichia coli [4].
It is widely agreed that an important element of a
successful treatment plan for infections involving
biofilm formation is the use of agents capable of
penetrating the biofilm matrix [5], and displaying a
satisfactory efficacy against the microorganisms
present within [6]. Antiseptic agents used in local
treatment of chronic problem wounds and biomaterial
infections meet the above – listed criteria [1, 7].
In theory, the ideal antiseptic agent should display a
broad spectrum of antimicrobial activity immediately
after application. Moreover, it cannot be toxic,
teratogenic or carcinogenic, and should not negatively
influence wound healing [7,8]. Such an ideal antiseptic
has not yet been reported despite ongoing research [7].
One of the chemical compounds meeting most of the
above criteria is [N,N'-(1,10-decanediyldi-1[4H]-
pyridinyl-4-ylidene)-bis-(1-octanamine)
dihydrochloride, or octenidine dihydrochloride [8, 9].
It is characterized by a particular affinity to the lipid
components of cell membranes, such as cardiolipin;
this property allows it to display good antimicrobial
efficacy with a minimal cytotoxic effect on the living
tissue [9]. In its commercially available form (the
Octenisept antiseptic solution containing 0.1%
octenidine dihydrochloride, 2.0% phenoxyethyl
alcohol and additives) it has been demonstrated to
exert a bactericidal effect on planktonic forms of S.
aureus and E. coli after exposure of as little as one
minute [10, 11]. A review of the available literature has
not yielded any publications on the influence of a oneminute
exposure to an octenidine dihydrochloride
solution on the biofilm created by S. aureus and E. coli
on the surface of biomaterial implants used in hernia
surgery.
The aim of this study was to evaluate the influence
of a solution of octenidine dihydrochloride on the
biofilm present on a surface of a monofilament
polypropylene mesh implant.
MATERIALS AND METHODS
Bacterial strains. The study involved 140 bacterial
strains from the collection of the Departament of
Microbiology of Nicolaus Copernicus University

The influence of octenidine dihydrochloride on bacterial biofilm on the surface of a polypropylene mesh 43
Collegium Medicum in Bydgoszcz, Poland. The strains
included 70 (50%) S. aureus isolates and 70 (50%) E.
coli isolates. The microorganisms had been isolated in
the period 2008–2009 from wound smears and pus
samples collected from various patients hospitalized at
the Departments of: General and Endocrine Surgery,
General and Vascular Surgery and General Surgery
and Transplantology of the Dr A. Jurasz University
Hospital No.1 in Bydgoszcz, Poland. Initial
identification of the S. aureus strains was based on
colony morphology on Columbia Agar with 5% sheep
blood (Becton Dickinson, Sparks, USA) and the
presence of clumping factor and / or free coagulase.
Species requiring verification were identified using the
ID32 Staph (bioMérieux S.A. RCS Lyon, France) test
for staphylococci. In the identification of E. coli
strains, colony morphology on the MacConkey Agar
(Becton Dickinson) was considered along with ID32 E
test results (bioMérieux). The ID32 Staph and ID32 E
tests were performed according to the manufacturer’s
instructions and the results were read after a 24 – hour
incubation in the oxygen – containing atmosphere at
37ºC in the ATB Expression system (bioMérieux),
with the use of the V 2.8.8 database. The isolates
included in the study material had different
chromosomal DNA patterns within one species, which
was verified in the initial stage of the study by pulsed –
field gel electrophoresis (PFGE). The isolates were
stored in brain heart infusion, (BHI; bioMérieux) with
an addition of 15% glycerol (Polskie Odczynniki
Chemiczne, POCH) at a temperature of -70ºC.
Evaluation of the influence of octenidine
hydrochloride solution on biofilm. The testing was
performed using a qualitative [12,13] and quantitative
method [14]; scanning electron microscopy was also
performed [15]. The investigated implant was
composed of a monofilament polypropylene mesh, as
this type of biomaterial is the most widely used in
hernia surgery [4].
In the quantitative method, utilizing the property of
metabolically active microorganisms to reduce
colorless 2,3,5-triphenyltetrazolium chloride (TTC;
POCH) to red formazan [12,13], sterile fragments of
the implant, measuring 2 x 1 cm, were incubated in 4
ml of tryptic soy broth (TSB, Becton Dickinson,
Sparks, USA) containing a bacterial inoculum
equivalent to the 0.5 McFarland turbidity standard.
Implant incubation at 37ºC continued for 48 hours in
the oxygen – containing atmosphere, with a change of
the growth medium to sterile substrate after 24 hours.
The biomaterial samples were then rinsed with 0.9%
phosphate buffered saline (PBS) at a pH of 7.2 and
placed in 4 mL of the antiseptic agent – a
commercially available octenidine dihydrochloride
solution (Octenisept, containing 0.1% octenidine
dihydrochloride, 2.0% phenoxyethyl alcohol and
additives; Schülke & Mayr). After one minute, the
implant samples were transferred to a neutralizing
solution, containing: 3% Tween 80 (Sigma), 3%
saponin ((Fluka, Steinheim, Germany), 0.1% histidine
(Sigma) and 0.1% lecithin – 0.1 % (Sigma) [16]; this
solution does not influence bacterial cells [10]. After
rinsing with PBS (pH 7.2) and placing in 4 mL of
sterile TSB with the addition of 20 L of a 1% TTC
solution, the samples were further incubated for 24
hours at 37ºC in the oxygen – containing atmosphere.
The degree of TTC reduction to red formazan,
indicating the presence of live bacteria in the biofilm,
was graded on a following scale: 0 – no TTC
reduction; 1 – slight pink dotting of the mesh surface, 2
– solid pink coloring of the entire surface, 3 – red
coloring of the mesh surface, clouding and red coloring
of the substrate (very strong TTC reduction). For each
isolate, the test was repeated three times. The control
group consisted of implant fragments incubated with
the bacterial inoculum without subsequent exposure to
the antiseptic solution.
In the quantitative assessment, the monofilament
mesh fragments were coated with bacterial biofilm
using the same procedure as described above. Samples
were rinsed with 0.9% phosphate buffered saline
(PBS) at a pH of 7.2 and placed in 4 mL of the
antiseptic agent. After one minute, the implant samples
were transferred to the neutralizing solution [16]. Next,
they were rinsed with PBS (pH 7.2) and shaken (1100
rpm) in 1 ml of 0.5% saponin for 2 minutes [17].
Serial 10-fold dilutions of the suspension thus obtained
were performed, with subsequent inoculation of three
Petrie dishes containing trypticase soy agar for every
dilution; 100 l of the solution were used per each
Petrie dish. After 24 hours of incubation of the implant
fragments at 37ºC, the result (average of three
measurements) was recorded as the number of colonyforming
units (CFU’s) per one milliliter of suspension
(CFU/ml). Again, the control group consisted of
implant fragments incubated with the bacterial
inoculum without subsequent exposure to the antiseptic
solution.

44
Adrian Reśliński et al.
The influence of octenidine dihydrochloride on the
biofilm was also evaluated by scanning electron
microscopy (SEM). Random fragments of the
biomaterial, coated with a biofilm in a procedure
identical to that described above, were rinsed with PBS
(pH 7.2) and placed in 4 mL of the antiseptic agent.
After one minute, the implant samples were transferred
to the neutralizing solution [16], rinsed with PBS (pH
7.2) and fixed in a 2.5% glutaraldehyde solution
(POCH, Gliwice, Poland) in a 0.1 M phosphate buffer
at a pH of 7.4 for 48 hours at 4 0 C. After fixation, the
material was rinsed for 2x 20 min in phosphate buffer
at room temperature. The samples were then
dehydrated in a graded series of ethanol
concentrations: 30, 50, 70, 80, 96%, 10 minutes in each
solution, and twice for 30 minutes in 99.8% ethanol.
After dehydration, the implant fragments were placed
in a solution of hexamethyldisilazane (HMDS;
Polysciences) for 45 minutes, and dried at room
temperature. The dried material was placed on copper
tables and sputter – coated with gold in an atmosphere
of argon in an ionic coater (Fine Coater, JCF-1200,
JEOL, Tokyo, Japan). The sputter-coated material was
placed in a SEM column (JSM-5310LV, JEOL, Tokyo,
Japan) and analyzed at a voltage of 15 -20 kV [15].
The results were analyzed and registered using the
NSS Version 3.0 software package (Thermo Fisher
Scientific). Like in two previous cases, the control
group consisted of implant fragments incubated with
the bacterial inoculum without subsequent exposure to
the antiseptic solution.
Statistical analysis. The statistical analysis of the
results was performed using the Statistica 10.0
software package (StatSoft Poland). The codependence
of qualitative variables was tested using the
nonparametric χ 2 test. The statistical analysis of non –
normally distributed quantitative variables was
performed using the nonparametric Wilcoxon test for
codependent samples. The adopted significance level
was p≤0.05.
RESULTS
octenidine dihydrochloride for one-minute, no TTC
reduction was observed in 2.9% of the strains; none of
the strains exhibited very strong TTC reduction. A
statistically significant (p

The influence of octenidine dihydrochloride on bacterial biofilm on the surface of a polypropylene mesh 45
Fig. 1. The influence of the antiseptic solution on the biofilm
created by S. aureus strains (n=70) and E. coli
strains (n=70) – a quantitative analysis
Ryc. 1. Wpływ roztowru antyseptyku na biofilm wytworzony
przez szczepy S. aureus i E. coli (n=70) – ocena
metodą ilościową
Fig. 4. Biofilm of E. coli (control group) on the surface of
a monofilament polypropylene mesh; SEM –
magnification 3500x
Ryc. 4. Biofilm E. coli (kontrola) na powierzchni
monofilamentowej siatki polipropylenowej; SEM
– powiększenie 3500x
Fig. 2. Biofilm of S. aureus (control group) on the surface of
a monofilament polypropylene mesh; SEM –
magnification 3500x
Ryc. 2. Biofilm S. aureus (kontrola) na powierzchni
monofilamentowej siatki polipropylenowej; SEM –
powiększenie 3500x
Fig. 5. The effect of octenidine dihydrochloride on the biofilm
of E. coli; SEM – magnification 3500x
Ryc. 5. Efekt działania dichlorowodorku oktenidyny na
biofilm E. coli; SEM – powiększenie 3500x
DISCUSSION
Fig. 3. The effect of octenidine dihydrochloride on the biofilm
of S. aureus; SEM – magnification 3500x
Ryc. 3. Efekt działania dichlorowodorku oktenidyny na
biofilm S. aureus; SEM – powiększenie 3500x
The influence of a solution of octenidine
dihydrochloride (Octenisept) on the biofilm present on
a surface of a monofilament polypropylene mesh
implant was evaluated in this study. Based on the
results of a quantitative and qualitative evaluation and
scanning electron microscopy we have ascertained that
it exerts a bactericidal effect on S. aureus and E. coli
present within a biofilm.
According to Chen and Wen [5], proper treatment
of infections associated with biofilm formation must
include agents which are efficacious against
microorganisms protected by the biofilm. Our own
results, as well as the observations of other authors

46
Adrian Reśliński et al.
[16,18], indicate that octenidine dihydrochloride
displays such properties. The antiseptic agent used in
our study showed bactericidal properties against S.
aureus and E. coli after an exposure of as little as one
minute, which is indicative of its ability to penetrate
into the biofilm. Other researchers have confirmed the
good penetration of octenidine dihydrochloride
solutions through the biofilm matrix [16,18].
In our qualitative study, exposure to octenidine
dihydrochloride resulted in a decreased intensity of the
color reaction on the surface of the biofilm – coated
implant after incubation with TTC, compared to the
control group. This effect corresponded with
a decrease in TTC reduction by the bacteria within the
biofilm; other authors also report this finding [16].
In our quantitative study, decreased live bacterial
cell counts were found in isolates from biofilm –
coated polypropylene mesh fragments after exposure to
a solution of octenidine dihydrochloride. Similar
outcomes have been reported by Bartoszewicz et al.
[16], who studied the effect of octenidine
hydrochloride on bacterial biofilm covering catheters
and suturing material.
In their SEM studies, Bartoszewicz et al. [16]
showed octenidine dihydrochloride to decrease the
number of bacteria adhering to the biomaterial surface.
Our findings are similar.
The results presented here need in vivo
verification, since in vitro conditions cannot accurately
replicate a clinical situation. However, one may
assume that octenidine dihydrochloride solutions may
be efficacious in local therapy of DSSI’s involving an
implanted biomaterial; it has been documented that
neither the presence of blood nor plasma proteins
decreases the efficacy of this agent [19]. Moreover, no
resistance to octenidine dihydrochloride has been so far
reported, even among MRSA strains [9]. The well –
documented synergy of this compound with antibiotics
may also positively influence treatment outcomes [9].
CONCLUSIONS
A solution of octenidine dihydrochloride,
commercially available as Octenisept, displays
bactericidal properties against S. aureus and E. coli
within a biofilm present on the surface of a
monofilament polypropylene hernia mesh.
The study funded by research grant NCU 06/2009.
ACKNOWLEDGEMENTS
The authors wish to thank Professor Eugenia
Gospodarek, Head of the Department of Microbiology
of Nicolaus Copernicus University Collegium
Medicum in Bydgoszcz for making this study possible.
REFERENCES
1. Jezupors A, Mihelsons M. The analysis of infection
after polypropylene mesh repair of abdominal wall
hernia. World J Sur 2006; 30: 2270-2278
2. Stremitzer S, Bachleitner-Hofmann T, Gradl B et al.
Mesh graft infection following abdominal hernia
repair: risk factor evaluation and strategies of mesh
graft preservation. A retrospective analysis of 476
operations. World J Surg 2010; 34: 1702-1709
3. Sanchez VM, Abi-Haidar YE, Itani KM. Mesh
infection in ventral incisional hernia repair: incidence,
contributing factors, and treatment. Surg Infect
(Larchmt) 2011; 12: 205-210
4. Engelsman AF, van der Mei HC, Ploeg RJ et al. The
phenomenon of infection with abdominal wall
reconstruction. Biomaterials 2007; 28: 2314-2327
5. Chen L, Wen YM. The role of bacterial biofilm in
persistent infections and control strategies. Int J Oral
Sci 2011; 3: 66-73
6. Donlan RM. Biofilm elimination on intravascular
catheters: important considerations for the infectious
disease practitioner. Clin Infect Dis 2011; 52: 1038-
1045
7. White RJ, Cutting K, Kingsley A. Topical
antimicrobials in the control of wound bioburden.
Ostomy Wound Manage 2006; 52: 26-58
8. Krzemiński M, Bartoszewicz M, Czarniak E et al. The
use of octenidine dihydrochloride in the treatment of
musculoskeletal infections. Adv Clin Exp Med 2010;
19: 631–636
9. Hübner NO, Siebert J, Kramer A: Octenidine
dihydrochloride, a modern antiseptic for skin, mucous
membranes and wounds. Skin Pharmacol Physiol 2010;
23: 244-258
10. Müller G, Kramer A. Biocompatibility index of
antiseptic agents by parallel assessment of
antimicrobial activity and cellular cytotoxicity.
J Antimicrob Chemother 2008; 61: 1281-1287
11. Koburger T, Hübner NO, Braun M et al. Standardized
comparison of antiseptic efficacy of triclosan, PVPiodine,
octenidine dihydrochloride, polyhexanide and
chlorhexidine digluconate. J Antimicrob Chemother
2010; 65: 1712-1719
12. Gallimore B., Gagnon RF, Subang R et al. Natural
history of chronic Staphylococcus epidermidis foreign
body infection in a mouse model. J Infect Dis 1991;
164: 1220-1223

The influence of octenidine dihydrochloride on bacterial biofilm on the surface of a polypropylene mesh 47
13. Różalska B, Sadowska B, Więckowska M et al.
Wykrywanie biofilmu bakteryjnego na biomateriałach
medycznych. Med Dośw Mikrobiol 1998; 50: 115-122
14. Saygun O, Agalar C, Aydinuraz K et al.: Gold and
gold-palladium coated polypropylene grafts in a S.
epidermidis wound infection model. J Surg Res 2006;
131: 73-79
15. Araujo JC, Téran FC, Oliveira RA et al. Comparison of
hexamethyldisilazane and critical point drying
treatments for SEM analysis of anaerobic biofilms and
granular sludge. J Electron Microsc (Tokyo) 2003; 52:
429-433
16. Bartoszewicz M, Rygiel A. Biofilm jako podstawowy
mechanizm zakażenia miejsca operowanego - metody
prewencji w leczeniu miejscowym. Chir Pol 2006; 8:
171–178
17. Kwiecińska-Piróg J, Bogiel T, Gospodarek E.
Porównanie dwiema metodami tworzenia biofilmu
przez pałeczki Proteus mirabilis na powierzchni
różnych biomateriałów. Med. Dośw Mikrobiol 2011;
63:131-138
18. Bartoszewicz M, Rygiel A et al. Penetration of a
selected antibiotic and antiseptic into a biofilm formed
on orthopedic steel implants. Ortop Traumatol Rehabil
2007; 9: 310-318
19. Pitten FA, Werner HP, Kramer A. A standardized test
to assess the impact of different organic challenges on
the antimicrobial activity of antiseptics. J Hosp Infect
2003; 55: 108-115
Address for correspondence:
Adrian Reśliński PhD
Department of General and Endocrine Surgery
Nicolaus Copernicus University in Torun
Ludwik Rydygier College of Medicine in Bydgoszcz
M. Skłodowskiej-Curie 9 Str.
85-094 Bydgoszcz, Poland
tel. 00 48 52 585-47-30
fax 00 48 52 585-40-16
email: bigar@wp.pl
Received: 26.03.2013
Accepted for publication: 28.05.2013

Medical and Biological Sciences, 2013, 27/2, 49-55
ORIGINAL ARTICLE / PRACA ORYGINALNA
Ewa Joanna Szymelfejnik, Anna Chiba
THE INTERDEPENDENCE OF NUTRITIONAL STATUS AND BLOOD PRESSURE
IN FEMALE STUDENTS
WSPÓŁZALEŻNOŚĆ MIĘDZY STANEM ODŻYWIENIA A CIŚNIENIEM TĘTNICZYM
U STUDENTEK
Department of Nutrition and Dietetics of the Collegium Medicum in Bydgoszcz,
Nicolaus Copernicus University of Toruń
Head: prof. dr hab. Roman Cichon
S u m m a r y
I n t r o d u c t i o n : The value of blood pressure is
affected by a number of factors, nutritional status being of
utmost importance.
T h e a i m o f t h e s t u d y was an assessment of the
interdependence between the nutritional status and systolic
blood pressure (SBP) as well as diastolic blood pressure
(DBP) in female students.
M a t e r i a l a n d m e t h o d : The research included 66
women aged 20.5±0.71, studying in Bydgoszcz. The systolic
and diastolic blood pressure was taken. The nutritional status
of the students was estimated with the use of anthropometric
parameters. To assess the status, nutritional indexes such as
the Body Mass Index (BMI) and the percentage of fat in the
body (%FM) were applied.
R e s u l t s : The mean systolic and diastolic pressure of
the female students was optimal. Hypertension was identified
only in one person (1.5% of the female students) and high
normal blood pressure - in the eight all those (12% of the
female students). The normal BMI was found in 42.4% of the
female students. However, low body mass was found in
every 5th person and undernutrition in every 3rd person. The
percentage of body fat was high (31.1±4.6%), and obesity
was identified in about 60% of the students (%FM>30%). A
significant correlation was observed between systolic
pressure and body mass (r=0.4 p

50
Ewa Joanna Szymelfejnik, Anna Chiba
(BMI) wykazano u 42,4% studentek (BMI 20,0-24,9 kg/m 2 ).
Jednak u co 5 osoby wykazano niską masę ciała, a u co
3 niedożywienie. Procentowa zawartości tłuszczu w ciele
studentek była wysoka (31,1±4,6%), a nadmierne
otłuszczenie odnotowano aż u ok. 60% studentek (%FM).
Odnotowano istotną korelację pomiędzy ciśnieniem
skurczowym oraz masą ciała (r=0,4 p

The interdependence of nutritional status and blood pressure in female students 51
RESULTS
The mean systolic pressure (SBP) of the female
students in Bydgoszcz was at 117.2 ± 9.8 mm Hg, and
the diastolic pressure (DBP) was 75.4 ± 7.7 mm Hg.
The mean heart rate was 74.9 ±11.1 beats/minute
(Tab. I).
Table I. Average value of systolic blood pressure (SBP),
diastolic blood pressure (DBP) and pulse in female
students
Tabela I. Średnia wartość ciśnienia tętniczego skurczowego
(SBP), rozkurczowego (DBP) i tętna studentek
Parametr/ parameter x± SD Me Min Max
SBP [mm Hg] 117.2±9.8 117.5 92.0 137.0
DBP [mm Hg] 75.4±7.7 75.0 57.0 90.0
Tętno [uderzeń/min]
/ Heart rate
74.9±11.1 72.0 57.0 120.0
[beats/minute]
x – średnia, SD - odchylenie standardowe, Me – mediana, Min –
minimum, Max – maximum
x – mean, SD - standard deviation, Me – median, Min – minimum,
Max – maximum
The optimum arterial SBP and DBP pressure was
found respectively in 59.1% and 69.7% of students
(Tab.II). The normal value of the systolic blood
pressure occurred in nearly one-third of all the students
(31.8%), and the normal value of diastolic pressure – in
16.7% of the population. High normal SBP and DBP
pressure was identified in 9.1% and 12.1% of the
students respectively. Among all the students, the SBP
value does not show hypertension. Hypertension was
identified only in one person. Only in 1.5% of the
students an increase in the value of DBP above the
limit was observed and hypertension was found
(Tab. II).
Table II. Classification of blood pressure in female students
Tabela II. Klasyfikacja ciśnienia tętniczego wśród studentek
Kategoria / Category N=66 %N
Optymalne / Optimal 39 59.1
SBP
Normalne / Normal 21 31.8
[mm
Wysokie prawidłowe / High normal 6 9.1
Hg]
Nadciśnienie / Hypertension 0 0
DBP
[mm
Hg]
Optymalne / Optimal 46 69.7
Normalne / Normal 11 16.7
Wysokie prawidłowe / High normal 8 12.1
Nadciśnienie / Hypertension 1 1.5
SBP – ciśnienie tętnicze skurczowe, DBP – ciśnienie tętnicze
rozkurczowe, N – liczebność, %N - odsetek populacji,
SBP - systolic blood pressure, DBP - diastolic blood pressure, N –
number, %N – percentage of population
Table III. The average value of the anthropometric
parameter measurements and nutritional status
in female students
Tabela III. Średnie wartości parametrów antropometrycznych
i wskaźników stanu odżywienia wśród
studentek
Parametr/ parameter x± SD Min Max
Wysokość/Weight
[cm]
166.5
± 5.1 152.0 181.0
Masa ciała/Body mass
[kg] 56.6 ± 10.1 42.4 98.0
A [cm] 24.4 ± 3.0 20.0 30.5
W [cm] 73.9 ± 6.3 64.0 96.0
H [cm] 90.8 ± 5.0 82.5 107.5
TSF [mm] 20.7 ± 7.7 9.7 37.6
BSF [mm] 15.6 ± 7.7 4.0 35.1
SCSF [mm] 14.8 ± 5.5 8.2 31.5
SISF [mm] 20.7 ± 7.5 6.4 36.1
% FM [%] 31.1 ± 4.6 19.6 40.1
WHR 0.8 ± 0.1 0.7 1.0
BMI [BMI kg/m 2 ] 20.3 ± 2.7 17.0 29.9
AMC [cm] 17.9 ± 2.6 10.7 25.6
x - średnia; SD - odchylenie standardowe; Min - minimum; Max -
maximum; A – obwód ramienia, W – obwód talii, H – obwód
bioder; grubość fałdu skórno-tłuszczowego nad: TSF – tricepsem,
BSF - bicepsem; SCSF - dolnym kątem łopatki; SISF - grzebieniem
kości biodrowej; % FM - procentowa zawartość tłuszczu w ciele;
WHR - wskaźnik talia -biodro; BMI - wskaźnik masy ciała; AMC -
obwód mięśni ramienia
x – mean, SD - standard deviation, Me – median, Min – minimum,
Max – maximum; A - Arm circumference, W - Waist circumference,
H – Hip circumference,TSF- triceps skinfold thickness, BSF- biceps
skinfold thickness; SCSF- subscapular skinfold thickness; SISFsuprailiac
skinfold thickness; % FM - the percentage of fat in the
body; WHR- Waist to Hip Ratio; BMI- Body Mass Index; AMCarm
muscle circumference
The characteristics of the anthropometric
parameters and indicators of nutritional status were
shown in the Tab. III. Statistical analysis showed no
statistically significant differences between blood
pressure among students with waist circumferences

52
Ewa Joanna Szymelfejnik, Anna Chiba
Table IV. Blood pressure and pulse of the sample depending
on nutritional status
Tabela IV. Ciśnienie tętnicze i tętna studentek w zależności
od stanu odżywienia
Kategoria/Category N %N
SBP
[mm Hg]
DBP
[mm
Hg]
Tętno
[uderz./min.] /
Heart rate
(beats/minute)
x± SD x± SD x± SD
Obwód talii (cm) / Waist circumference (cm)

The interdependence of nutritional status and blood pressure in female students 53
The analysis of interdependence between blood
pressure and body fat showed a high positive
correlation between systolic pressure and body fat
(r=0.5 p

54
Ewa Joanna Szymelfejnik, Anna Chiba
among the students of School of Medicine (9-10%).
The results of research among Polish adults
LIPIDOGRAM [8], WOBASZ [13] and the NATPOL-
PLUS [15,16] indicated a significant prevalence of
hypertension (29-42%) and a significant percentage of
people at risk of its development (11-30%).
The mean nutritional status of female students from
Bydgoszcz according to the BMI was adequate
(BMI=20.3±2.7 kg/m2). However, the analysis of
distribution in nutritional status classes showed low
body mass in every 5th person and underweight in
every 3rd person. Despite the underweight and low
body weight, the concern was body composition of
young women, as the average percentage of fat tissue
in the body was very high indeed (31.1±4.6%). Obesity
was identified in about 60% of the students. High
content of androidal fat in the body of students with a
low or normal BMI was observed in research
[17,18,19]. For all those with high androidal fat in the
body the authors suggest the presence of metabolic
hazards is similar to the one in obese people.
The assessment of interdependence between blood
pressure and nutritional status showed a significant
relationship between the systolic pressure and body
mass, the % FM and the BMI. The strongest
correlation was found between the content of fat in the
body and the systolic pressure (r=0.5 p

The interdependence of nutritional status and blood pressure in female students 55
13. Tykarski A., Posadzy Małaczyńska A., Wyrzykowski B.,
et al.: Rozpowszechnienie nadciśnienia tętniczego oraz
skuteczność jego leczenia u dorosłych mieszkańców
naszego kraju. Wyniki programu WOBASZ. Kardiol Pol,
2005, 63, 6 (supl.4), 614-619
14. Zdrojewski T.: Nadciśnienie tętnicze w Polsce. Terapia,
2002,10,7/8, 4-7
15. Zdrojewski T.: Rozpowszechnienie głównych czynników
ryzyka chorób układu sercowo-naczyniowego w Polsce.
Wyniki badania NATPOL PLUS. Kardiol Pol, 2004, 61,
IV-5-IV-19
16. Zdrojewski T., Bandosz P., Szpakowski P., et al.:
Rozpowszechnienie głównych czynników ryzyka chorób
układu sercowo-naczyniowego w Polsce. Wyniki
Badania NATPOL PLUS. Kardiol Pol, 2004, 61,IV-5.
17. Szczepańska J., Wądołowska l., Słowińska M.A., et al.,
Badanie wpływu częstości spożycia wybranych źródeł
błonnika na skład ciała studentek. Probl Hig Epidemiol
2011, 92(1): 103-109.
18. Conus F, Alisson DB, Rabasa-Lhoret R., et al.. Metabolic
and behavioral characteristics of metabolically obsese but
normalweight women. JCEM 2004, 89(10): 5013-5020.
19. Conus F, Rabasa-Lhoret R, Peronnet F. Characteristics of
metabolically obese normal weight (MONW) subjects.
Appl Physiol Nutr Metab 2007, 32: 4-12.
Address for correspondence:
dr inż. Ewa Joanna Szymelfejnik
Katedra i Zakład Żywienia i Dietetyki
UMK w Toruniu
Collegium Medicum im. L. Rydygiera w Bydgoszczy
ul. Dębowa 3, 85-626 Bydgoszcz
Tel. (052) 585 54 01 w.45
e-mail: szymelfejnik@wp.pl
Received: 9.05.2012
Accepted for publication: 25.09.2012

Medical and Biological Sciences, 2013, 27/2
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(z opisami).
16. Piśmiennictwo – tylko prace cytowane w tekście
(maksymalnie 30 pozycji) – powinno być
ponumerowane i ułożone wg kolejności cytowania,
każdy tytuł od nowego wiersza. Pozycja
piśmiennictwa dotycząca czasopisma musi zawierać
kolejno: nazwisko, inicjał imienia autora
(ów) – maksymalnie trzech – tytuł pracy, tytuł
czasopisma wg skrótów stosowanych w „Index
Medicus”, rok, numer tomu i stron. Przy cytowaniu
pozycji książkowej (monografii, podręczników)
należy podać nazwisko i inicjały
imion autorów, tytuł dzieła, wydawcę, miejsce
i rok wydania.
17. Z pracą należy przesłać oświadczenie, iż nie
była ona dotąd publikowana, a także że nie została
złożona do innego wydawnictwa oraz
zgodę kierownika zakładu na publikację.

Medical and Biological Sciences, 2013, 27/2
18. Do każdej pracy należy dołączyć oświadczenie
podpisane przez wszystkich współautorów, że
aktywnie uczestniczyli w jej realizacji i przygotowaniu
do druku oraz akceptują bez zastrzeżeń
tekst pracy w formie przesłanej do redakcji.
19. Prace niespełniające wymogów regulaminu
będą zwracane autorom.
20. Redakcja zastrzega sobie prawo poprawiania
usterek stylistycznych oraz dokonywania skrótów.
21. Za prace zamieszczone w Medical... autorzy nie
otrzymują honorarium.
22. Redakcja nie przekazuje autorom bezpłatnych
egzemplarzy Medical...
23. Prace publikowane w Medical... są oceniane
przez dwóch recenzentów.
24. Medical and Biological Sciences są punktowane
zgodnie z listą czasopism Ministerstwa Nauki
i Szkodnictwa Wyższego.
Redakcja:
Medical and Biological Sciences
ul. Powstańców Wielkopolskich 44/22
85-090 Bydgoszcz
Dyżury sekretarza Redakcji: wtorek 11.00-13.00
tel.: 52 585 33 26
Opracowanie redakcyjne i realizacja wydawnicza:
Redakcja w Bydgoszczy
ul. Powstańców Wielkopolskich 44/22, 85-090 Bydgoszcz
tel./faks: 52 585 33 25, e-mail: wydawnictwa@cm.umk.pl
COLLEGIUM MEDICUM im. LUDWIKA RYDYGIERA
BYDGOSZCZ 2013
Nakład: 100 egz.
Druk i oprawa: Drukarnia cyfrowa UMK, ul. Gagarina 5, 87-100 Toruń, tel.: 56 611 22 15