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Pancreatic head cancer is a highly fatal disease. For now, surgery offers the only potential long-term cure albeit with a high risk of complications. However, the progress of surgical technique during the past decade has resulted in 5-year survival approaching 30% after resection and adjuvant chemotherapy. This paper presents current data on the recommended extent of lymphadenectomy, the resection margin, on the definition of resectable and borderline resectable tumors and mesopancreas. Surgical techniques proposed to improve PD are presented: the artery first approach, the uncinate process first, the mesopancreas first approach, the triangle operation, periarterial divestment, and multiorgan resection.

Krótkowzroczność jest główną przyczyną zaburzeń widzenia, będąc najczęstszą wadą refrakcji. Istnieje wiele podziałów krótkowzroczności uwzględniających wielkość wady refrakcji, dziedziczność, moment pojawienia się wady refrakcji, stan szczegółów dna oka czy długość osiową gałki ocznej. W literaturze istnieje duża niespójność w tym zakresie. Można znaleźć wiele terminów opisowych, jak również klasyfikacji określających rodzaje krótkowzroczności, co prowadzi do trudności przy porównywaniu wyników badań. Celem artykułu jest przedstawienie aktualnej definicji i podziału krótkowzorczności na podstawie przeglądu piśmiennictwa PubMed z ostatnich 5 lat.

AIM: To assess the incidence of mitral valve prolapse in patients with newly diagnosed primary open angle glaucoma. METHODS: The study included 12 patients without any other comorbidities or taking any general or local medications. Each patient underwent a full ophthalmological examination with visual field assessment and optical computed tomography of the macula and optic nerve head. Carotid Doppler ultrasound was performed to exclude impaired blood flow in this region and transthoracic echocardiography with assessment of the function and morphology of the heart valves. RESULTS: In the study group, mitral valve prolapse was found in seven patients (58.3%), while mitral valve regurgitation in 11 patients (91.7%). One case of normal pressure glaucoma and four cases of juvenile glaucoma were diagnosed. There were also other risk factors for glaucoma: myopia (58.3%), migraine headaches (41.7%), a positive family history of glaucoma (16.7%). CONCLUSION: Mitral valve prolapse could be indicated as a new risk factor for glaucoma. It seems reasonable to conduct screening tests for glaucoma in patients with mitral valve prolapse in the course of echocardiography.

Bartosz Molasy,1,2 Patryk Zem&lstrok;a,1 S&lstrok;awomir Mrowiec,3 Ewa Grudzi&nacute;ska,3 Katarzyna Ku&sacute;nierz3 1Students’ Scientific Society of the Department of Gastrointestinal Surgery, Medical University of Silesia, Katowice, Poland; 2Department of General Surgery, St Alexander Hospital, Kielce, Poland; 3Department of Gastrointestinal Surgery, Medical University of Silesia, Katowice, PolandCorrespondence: Ewa Grudzi&nacute;ska, Department of Gastrointestinal Surgery, Medical University of Silesia, Medyków 14, Katowice, 40-752, Poland, Tel +48 32 7894252, Email ewa.grudzinska@sum.edu.plPurpose: Metastases of pancreatic neuroendocrine tumors (pNETs) can be found at the time of diagnosis in 20– 50% of cases. Small asymptomatic tumors may be left for observation; however, they can metastasize. The aim of the study was to evaluate risk factors for distant and lymph node metastases of pNETs.Patients and methods: One hundred and fourteen patients with postoperatively confirmed pNET were analyzed retrospectively in a single ENETS Center of Excellence. The relationship between location, size, differentiation of the tumor, and occurrence of lymph node and distant metastases was analyzed.Results: pNETs’ location was pancreatic head – 38 (33.3%), body or tail – 68 (59.7%), and 8 (7.0%) involved the entire organ. Fifty-six (49.1%) tumors were graded G1, 50 (43.9%) G2, and 8 (7.0%) G3. Seventy-two (63.2%) tumors were ≥ 2 cm in diameter, and 42 (36.8%) < 2 cm. Twenty-two (19.3%) patients had distant metastases and 47 (41.2%) had lymph node metastases. In ≥ 2 cm tumors distant and lymph node metastases were more frequent (p < 0.05). Distant metastases incidence was significantly higher in distally located tumors (p = 0.01) and in G2 and G3 tumors (p < 0.01). In 9.5% of < 2cm tumors, distant metastases were present at diagnosis.Conclusion: Distant metastases are more often found in larger, distally located pNETs grade G2 and G3, while a higher occurrence of lymph node metastases seems to be associated only with larger tumor size. A considerable number of tumors < 2 cm in size have distant metastases already at the diagnosis, which might indicate the need for careful qualification of smaller lesions for observation.Keywords: pancreas, neuroendocrine tumor, lymphatic metastasis, lymph nodes, pancreatic surgery

Ewa Grudzi&nacute;ska, Monika Modrzejewska 2nd Department of Ophthalmology, Pomeranian Medical University, Szczecin, PolandCorrespondence: Monika Modrzejewska 2nd Department of Ophthalmology, Pomeranian Medical University, Powsta&nacute;ców Wielkopolskich 72, Szczecin, 70-111, PolandTel +48 91 4661293Fax +48 91 466 1294Email monika_modrzej@op.plPurpose: To assess pattern electroretinogram (PERG) recordings in patients with axial myopia with a special focus on the correct interpretation of findings.Patients and Methods: Sixty patients divided into three groups according to the spherical equivalent of refractive error (group 1, error − 3 D to − 6 D; group 2, error > − 6 D; and controls, error − 1 D to +1 D) were examined. Data for the right eye of every patient were considered in the statistical analysis. All patients had a full ophthalmic examination including the measurement of visual acuity, intraocular pressure, degree of refractive error, axial length, biomicroscopic evaluation of the anterior segment, fundoscopy and PERG. The differences of basic parameters and P50 and N95 amplitudes as well as P50 implicit time between groups were studied. Correlations between P50 and N95 amplitudes and P50 implicit time were axial length and refractive error was established.Results: The P50 amplitude, N95 amplitude and P50 peak time differed significantly between the groups (P< 0.01). No significant differences were found for the N95/P50 ratio. Significantly lower P50 and N95 amplitudes (r=− 0.42, P< 0.01; r=− 0.42, P< 0.01) and increased P50 peak time (r=0.64, P< 0.01) correlated with elongated axial length. A 1-mm increase in axial length corresponded with a 0.41 μV decrease in the P50 amplitude and 0.55 μV reduction of the N95 amplitude. There was also 1.11 ms increase of P50 wave peak time per 1 mm increase of axial length. Significantly lower amplitudes and longer peak times are associated with increased axial length and increased refractive error.Conclusion: According to results observed in this study, the correct interpretation of PERG recordings requires the consideration of axial length.Keywords: refractive error, P50 amplitude, N95 amplitude, P50 peak time, eyeball length

Purpose: To assess the thickness of the retinal nerve fiber layer (RNFL), ganglion cell and inner plexus layer (GCIPL) and blood flow parameters in retrobulbar vessels, and to analyze correlations between these parameters in myopes. Methods: The study included forty myopic and 20 healthy eyes. Standard eye examination was supplemented with OCT of the optic nerve and macula (GCIPL, RNFL, RNFL in each quadrant and rim area of the optic nerve) and color Doppler imaging of retrobulbar arteries [peak systolic and end-diastolic velocities, pulsatile index and resistance index (RI) in the ophthalmic (OA), central retinal (CRA), nasal posterior ciliary and temporal posterior ciliary arteries]. Results: Significant correlations were found between blood flow parameters in the CRA, RNFL and GCIPL thickness, and axial length (AL) and spherical equivalent (SE). There were significant positive correlations between RNFL with PSV and EDV in the CRA and negative correlations between RNFL and RI in the CRA. GCIPL was positively correlated with PSV and EDV in the CRA. The decrease in RA was associated with reduced blood flow velocities in the CRA, TPCA and NPCA. Conclusion: The reduced retrobulbar blood flow in healthy young myopes is correlated with increasing AL and refractive value, and thinning of the RNFL and GCIPL. Reduction of the rim-area of the optic disc is associated with vascular and retinal circulatory disorders. These phenomena indicate the vascular basis of the described changes. To the best of our knowledge, this is the first study which correlates ocular circulation with retinal structure.

Background: Jejunal diverticulosis and jejunal lipomatosis are uncommon conditions. Usually asymptomatic, they may cause severe complications in some cases. Intussusception is unusual in adults, but when diagnosed swiftly it can be treated surgically, usually with good outcome. Case presentation: We present a 60-year-old female patient with a history of chronic malnutrition and anemia, complaining of acute abdominal pain, vomiting and diarrhea. Contrast-enhanced abdominal computed tomography (CT) showed intussusception, multiple giant jejunal diverticula and multiple lipomas. The patient underwent urgent surgery, but radical treatment was not possible due to the extent of the diseases. One month later, another surgery was needed due to ileostomy obstruction caused by lipomas. The patient’s condition deteriorated due to malnutrition and concomitant metabolic disorders, which eventually led to her demise. Conclusions: Radical treatment is not always possible in an extensive jejunal disease. Prolonged malnutrition impairs postoperative healing, and therefore surgical or nutritional treatment should be considered in jejunal diverticulosis before the onset of severe complications requiring urgent surgical intervention.

Essential oils from flowers and leaves of Grindelia integrifolia DC. were investigated for the first time in terms of chemical composition and antimicrobial activity. The GC-FID/MS analysis allowed for the identification of 58 and 72 volatiles, comprising 92.4 and 90.1% of the oils, respectively. The major components of the flower oil were α-pinene (34.9%) and limonene (13.1%), while myrcene (16.9%), spathulenol (12.3%), β-eudesmol (11.9%) and limonene (10.1%) dominated among the leaf volatiles. The antimicrobial activity, evaluated against 12 selected bacteria and fungus, was found moderate, with the strongest effect of both oils observed against C. albicans (MIC = MBC: 0.63 and 0.31 mg/mL for flower and leaf oil, respectively).

Grudzińska Ewa, Fabian-Danielewska Anna, Gibka Magdalena. Methods of preventing and retarding the progression of myopia. Journal of Education, Health and Sport. 2019;9(7):357-362. eISSN 2391-8306. DOI http://dx.doi.org/10.5281/zenodo.3345026 http://ojs.ukw.edu.pl/index.php/johs/article/view/7156 The journal has had 7 points in Ministry of Science and Higher Education parametric evaluation. Part B item 1223 (26/01/2017). 1223 Journal of Education, Health and Sport eISSN 2391-8306 7 © The Authors 2019; This article is published with open access at Licensee Open Journal Systems of Kazimierz Wielki University in Bydgoszcz, Poland Open Access. This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author (s) and source are credited. This is an open access article licensed under the terms of the Creative Commons Attribution Non commercial license Share alike. (http://creativecommons.org/licenses/by-nc-sa/4.0/) which permits unrestricted, non commercial use, distribution and reproduction in any medium, provided the work is properly cited. The authors declare that there is no conflict of interests regarding the publication of this paper. Received: 01.07.2019. Revised: 05.07.2019. Accepted: 21.07.2019. Methods of preventing and retarding the progression of myopia Authors: Ewa Grudzińska ewagrudz@gmail.com https://orcid.org/0000-0002-9335-6764 II Department of Ophthalmology, Pomeranian Medical University in Szczecin, Powstańców Wielkopolskich 72, 70-111 Szczecin, Poland Pomeranian University of Medical Science, Doctoral Study of the Faculty of Medicine, ul. Żołnierska 54, 71-210 Szczecin Anna Fabian- Danielewska , anna1.fabian@gmail.com http://orcid.org/0000-0003-1290-4608 Pomeranian University of Medical Science, Doctoral Study of the Faculty of Medicine, ul. Żołnierska 54, 71-210 Szczecin Magdalena Gibka magdalena_gibka@interia.pl https://orcid.org/0000-0002-0013-5840 Pomeranian University of Medical Science, Doctoral Study of the Faculty of Medicine, ul. Żołnierska 54, 71-210 Szczecin Abstract: Myopia is an increasing problem worldwide. Its prevalence is predicted to over 4 billion ofpeople in 2050, what would be almost 50% of the population. Therefore, authors have analyzed available literature in terms of treatment that may be able to prevent or slow the progression of myopia. There are risk factors such as genetic factors which nowadays could not be modified. However, there are other risk factor such as near work or protective factor such as time spent outdoor which could be modified. Moreover, therapeutic interventions seem to play more significant role. Among available methods it is mentioned: pharmacology including drops of atropine and pirenzepine, undercorrection, contact lenses, orthokeratology, bifocal or multifocal spectacles and soft multifocal contact lenses. Methods are described with their mechanism of action and efficacy. Key words: myopia; prevention; therapy; progression

Fabian-Danielewska Anna, Korabiusz Katarzyna, Wawryków Agata, Stecko Monika, Janik-Fuks Inga, Maciejewska Martyna, Grudzińska Ewa, Gibka Magdalena. Nutrition of healthy infants. Journal of Education, Health and Sport. 2019;9(7):299-302. eISSN 2391-8306. DOI http://dx.doi.org/10.5281/zenodo.3337389 http://ojs.ukw.edu.pl/index.php/johs/article/view/7142 The journal has had 7 points in Ministry of Science and Higher Education parametric evaluation. Part B item 1223 (26/01/2017). 1223 Journal of Education, Health and Sport eISSN 2391-8306 7 © The Authors 2019; This article is published with open access at Licensee Open Journal Systems of Kazimierz Wielki University in Bydgoszcz, Poland Open Access. This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author (s) and source are credited. This is an open access article licensed under the terms of the Creative Commons Attribution Non commercial license Share alike. (http://creativecommons.org/licenses/by-nc-sa/4.0/) which permits unrestricted, non commercial use, distribution and reproduction in any medium, provided the work is properly cited. The authors declare that there is no conflict of interests regarding the publication of this paper. Received: 20.06.2019. Revised: 25.06.2019. Accepted: 16.07.2019. Nutrition of healthy infants Anna Fabian-Danielewska1, Katarzyna Korabiusz2, Agata Wawryków2, MonikaStecko2, Inga Janik-Fuks2, Martyna Maciejewska2, Ewa Grudzińska1, Magdalena Gibka1 1. Pomeranian Medical University in Szczecin, PhD study at the Faculty of Medicine 2. Pomeranian Medical University in Szczecin, PhD Studies at the Faculty of Health Sciences Abstract The daily energy requirement of infants depends on age, sex and body weight. Breastfeeding is the most appropriate way to feed babies in the first 6 months of their lives. According to WHO recommendations, one should aim for exclusive breast-feeding for the first 6 months of your child's life. After 6 months, the baby's diet should be extended, continuing breastfeeding. It is recommended to continue feeding with the mother's milk, according to the WHO, until the second year of life, and according to AAP up to 12 months, with the simultaneous introduction of supplementary foods. When, for various reasons, it is not possible to feed the infant with mother's milk, the products substituting for female milk are used. Infant formula is intended for children under 6 months of age and fully satisfies the nutritional needs of an infant. Complementary Feeding should be started between 17 and 26 weeks of age. Key words: nutrition, breast-feeding, infant formula, complementary feeding

The role of cytokines in the pathogenesis of chronic venous disease (CVD) remains obscure. It has been postulated that oscillatory flow present in incompetent veins causes proinflammatory changes. Our earlier study confirmed this hypothesis. This study is aimed at assessing chemokines and growth factors (GFs) released by lymphocytes in patients with great saphenous vein (GSV) incompetence. In 34 patients exhibiting reflux in GSV, blood was derived from the cubital vein and from the incompetent saphenofemoral junction. In 12 healthy controls, blood was derived from the cubital vein. Lymphocyte culture with and without stimulation by phytohemagglutinin (PHA) was performed. Eotaxin, interleukin 8 (IL-8), macrophage inflammatory protein 1 A and 1B (MIP-1A and MIP-1B), interferon gamma-induced protein (IP-10), monocyte chemoattractant protein-1 (MCP-1), interleukin 5 (IL-5), fibroblast growth factor (FGF), granulocyte colony-stimulating factor (G-CSF), granulocyte-macrophage colony-stimulating factor (GM-CSF), platelet-derived growth factor-BB (PDGF-BB), and vascular endothelial growth factor (VEGF) were assessed in culture supernatants by a Bio-Plex assay. Higher concentrations of eotaxin and G-CSF were revealed in the incompetent GSV, compared with the concentrations in the patients’ upper limbs. The concentrations of MIP-1A and MIP-1B were higher in the CVD group while the concentration of VEGF was lower. In the stimulated cultures, the concentration of G-CSF proved higher in the incompetent GSV, as compared with the patients’ upper limbs. Between the groups, the concentration of eotaxin was higher in the CVD group, while the IL-5 and MCP-1 concentrations were lower. IL-8, IP-10, FGF, GM-CSF, and PDGF-BB did not reveal any significant differences in concentrations between the samples. These observations suggest that the concentrations of chemokines and GFs are different in the blood of CVD patients. The oscillatory flow present in incompetent veins may play a role in these changes. However, the role of cytokines in CVD requires further study.

Essential oils from flowers and leaves of

The pathogenesis of chronic venous disease (CVD) remains unclear, but lately inflammation is suggested to have an important role in its development. This study is aimed at assessing cytokines released by lymphocytes in patients with great saphenous vein (GSV) incompetence. In 34 patients exhibiting oscillatory flow (reflux) in GSV, blood was derived from the cubital vein and from the incompetent sapheno-femoral junction. In 12 healthy controls, blood was derived from the cubital vein. Lymphocyte culture with and without stimulation by phytohemagglutinin (PHA) was performed. Interleukins (IL) 1β, 2, 4, 10, 12 (p70), and 17A; interleukin 1 receptor α (IL-1ra); tumor necrosis factor-α (TNF-α); interferon-gamma (IFN-γ); and RANTES were assessed in culture supernatants by the Bio-Plex assay. In both stimulated and unstimulated samples, in the examined group, IL-1β and IFN-γ had higher concentrations and RANTES had lower concentrations when compared to those in the control group. In the examined group, IL-4 and IL-17A had higher concentrations without stimulation and TNF-α had higher concentrations with stimulation. The GSV samples had higher IL-2, IL-4, IL-12 (p70), and IFN-γ concentrations without stimulation and lower IL-2 and TNF-α concentrations with stimulation when compared to those of the upper limb in the examined group. These observations indicate that the oscillatory flow present in incompetent veins causes changes in the cytokine production by lymphocytes, promoting a proinflammatory profile. However, the relations between immunological cells, cytokines, and the endothelium require more insight.

Myopia is the most common refractive error and the subject of interest of various studies assessing ocular blood flow. Increasing refractive error and axial elongation of the eye result in the stretching and thinning of the scleral, choroid, and retinal tissues and the decrease in retinal vessel diameter, disturbing ocular blood flow. Local and systemic factors known to change ocular blood flow include glaucoma, medications and fluctuations in intraocular pressure, and metabolic parameters. Techniques and tools assessing ocular blood flow include, among others, laser Doppler flowmetry (LDF), retinal function imager (RFI), laser speckle contrast imaging (LSCI), magnetic resonance imaging (MRI), optical coherence tomography angiography (OCTA), pulsatile ocular blood flowmeter (POBF), fundus pulsation amplitude (FPA), colour Doppler imaging (CDI), and Doppler optical coherence tomography (DOCT). Many researchers consistently reported lower blood flow parameters in myopic eyes regardless of the used diagnostic method. It is unclear whether this is a primary change that causes secondary thinning of ocular tissues or quite the opposite; that is, the mechanical stretching of the eye wall reduces its thickness and causes a secondary lower demand of tissues for oxygen. This paper presents a review of studies assessing ocular blood flow in myopes.

Chronic venous disease (CVD) is a very common health problem concerning up to 1/3 of the society. Although venous hypertension and valvular incompetence have been long known to be crucial for development of the illness, its exact aetiology remains unclear. Recent findings indicate that inflammatory processes may be crucial for development of incompetent valves and vein wall remodelling. One of the most interesting theories describes “leucocyte trapping” as the mechanism responsible for elevated vein wall permeability and oxidative stress in the veins. At the same time, the cytokine profile of the blood in incompetent veins has not been thoroughly examined. Popular anti-inflammatory drugs relieve some symptoms but do not have much proved effects in prevention and treatment. We intend to summarize the existing knowledge of the immunological aspects of CVD in order to emphasize its importance for understanding the aetiology of this illness. We also wish to indicate some aspects that remain to be studied in more detail.

RATIONALE Pancreaticopleural and pancreaticomediastinal fistulas are rare complications of pancreatitis. They are often misdiagnosed and there are no strict guidelines of treatment. In this study, we present a brief report of a combined pancreaticopleural and pancreaticomediastinal fistula extending to the cervical region, causing dysphagia and cervical swelling as initial symptoms. PATIENT CONCERNS A 36-year-old female with history of alcohol abuse and pancreatitis presented progressing dysphagia and mild dyspnea on admission. DIAGNOSIS Chest X-ray and chest and abdominal computed tomography scan (CT) indicated pancreaticopleural fistula combined with pancreaticomediastinal fistula, a diagnosis confirmed by high amylase levels in pleural fluid. INTERVENTIONS Conservative treatment was administered and ERCP was performed but pancreatic duct stenting was impossible. The patient presented rapid anterior cervical swelling with progressing dysphagia and dyspnea. CT showed fistula penetration to the cervical region. The patient underwent urgent surgery and pancreaticojejunal anastomosis was performed. OUTCOMES The surgery led to recovery. Six months later, the patient reported good health and weight gain. LESSONS Coexistence of pancreaticopleural and pancreaticomediastinal fistula with cervical penetration is an extremely rare pancreatitis complication. It presents with dysphagia and anterior cervical swelling as initial symptoms. It is important to consider this complication in all patients with history of pancreatitis, presenting with dysphagia.