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Purpose We aimed to study brain tissue oxygenation during the period of controlled reduction of arterial blood pressure – a maneuver often used in extended endoscopic skull base surgery for bloodless operative field. Methods Intracranial pressure, arterial blood pressure and the resultant cerebral perfusion pressure were measured during extended endoscopic skull base surgery in 5 patients with diagnosed tumors of the skull base and arterial hypertension. Simultaneously, in those patients, we measured partial pressure of oxygen in the brain parenchyma (PbtO2). Results Values of PbtO2 lower than 15 mm Hg (risk of brain ischemia) were observed in 3 patients for periods of 40 min, 110 min and 123 min, respectively. In 2 of these patients, no hypotension (mean arterial pressure Conclusion Moderate reduction of arterial pressure, often used to obtain bloodless operative field during extended endoscopic skull base surgery, may in patients with the medical history of arterial hypertension be associated with critically low values of partial oxygen pressure in brain tissue.

COVID-19 vaccinations are about to begin in various countries or are already ongoing. This is an unprecedented operation that is also met with a loud response from anti-vaccine communities—currently using all available channels to manipulate public opinion. At the same time, the strategy to educate on vaccinations, explain their mechanism of action, and build trust in science is subdued in different world parts. Such actions should go much beyond campaigns promoting the COVID-19 vaccines solely on the information provided by the health institutions and national authorities. In this paper, actions provided by independent expert groups needed to counteract the anti-vaccine propaganda and provide scientific-based information to the general public are offered. These actions encompass organizing groups continuously communicating science on COVID-19 vaccines to the general public; tracking and tackling emerging and circulating fake news; and equipping celebrities and politicians with scientific information to ensure the quality of messages they communicate, as well as public letters, and statements of support for vaccination by healthcare workers, recognized scientists, VIPs, and scientific societies; and no tolerance to false and manipulated claims on vaccination spread via traditional and social media as well as by health professionals, scientists, and academics. These activities should be promptly implemented worldwide, regardless of the current status and availability of the COVID-19 vaccine in a particular region. If we are about to control the pandemic for the sake of public benefit, it is high time to collectively speak out as academic and medical societies with support from decision-makers. Otherwise, the battle will be lost to those who stand against scientific evidence while offering no feasible solution to the problem.

There is a high prevalence of premature mortality and unhealthy lifestyle behaviours in Lower Silesia in Poland (regional capital is the city of Wroclaw). One plausible reason is low health literacy among this population. Health literacy is one of the most important elements of public health and health promotion endeavours. It can be conceptualised as abroad range of cognitive and social skills as well as knowledge needed by an individual to maintain good health, prevent or manage diseases, and effectively engage with healthcare professionals and resources. The Health Promotion Foundation (HPF), in collaboration with regional institutions and organisations, initiated in 2017 a broad initiative to improve health in this region. The overarching aim of the wider programme is to improve the quality of care among primary care patients. The project stream led by HPF aims to improve knowledge and health-related competences in the population of primary care patients in Lower Silesia. It involves (1) needs assessment based on the analysis of data on health status and neds from 50 participating primary care clinics, followed by (2) development of tailored face-to-face workshops that will be delivered by trained public health students, (3) who will be mentored using train-the-trainer approach. It is anticipated that the project will impact on three main areas in the long term. First, it will lead to creation of a package of workshops that could be delivered to other primary care patients. Second, it will create opportunities for students majoring in public health in the region to become directly involved in activities focused on health education and promotion. Three, it is anticipated that the project will lead to improvements in health and wellbeing among the participating patient groups. The present report describes the scope and method of the project.

The relationship and clinical implications of atrial fibrillation (AF) in acute pulmonary embolism (PE) are poorly investigated. We aimed to analyze clinical characteristics and prognosis in PE patients with paroxysmal AF episode. Methods. From the 391 patients with PE 31 subjects with paroxysmal AF were selected. This group was compared with patients with PE and sinus rhythm (SR) and 32 patients with PE and permanent AF. Results. Paroxysmal AF patients were the oldest. Concomitant DVT varies between groups: paroxysmal AF 32.3%, SR 49.5%, and permanent AF 28.1% (p=0.02). The stroke history frequency was 4.6% SR, 12.9% paroxysmal AF, and 21.9% permanent AF (p<0.001). Paroxysmal AF comparing to permanent AF and SR individuals had higher estimated SPAP (56 versus 48 versus 47 mmHg, p=0.01) and shorter ACT (58 versus 65 versus 70 ms, p=0.04). Patients with AF were more often classified into high-risk group according to revised Geneva score and sPESI than SR patients. In-hospital mortality was lower in SR (5%) and paroxysmal AF (6.5%) compared to permanent AF group (25%) (p<0.001). Conclusions. Patients with PE-associated paroxysmal AF constitute a separate population. More severe impairment of the parameters reflecting RV afterload may indicate relation between PE severity and paroxysmal AF episode. Paroxysmal AF has no impact on short-term mortality.

Introduction Self-medication can contribute to the inappropriate use of antibiotics in respiratory tract infections (RTI). This phenomenon has not been well described, particularly in Poland. The aim of our study was to describe the prevalence of antibiotic self-medication for RTI, to explore factors influencing antibiotic use without prescription, and to determine the available sources of such antibiotics. Material and methods A self-administered questionnaire completed by patients presenting to family medicine clinics at Lodz and Wroclaw from 1(st) March to 15(th) May 2010. Results A total of 891 patients in ten clinics completed the survey (response rate, 89.1%). Overall, 41.4% (n = 369) of patients reported self-medication with an antibiotic for RTI. The most common reason for antibiotic self-medication was a belief that antibiotics treat the majority of infections, including influenza and influenza-like illnesses (43.9%; n = 162). The predominant sources of antibiotics for self-medication were antibiotics from previous prescriptions stored by the patient at home (73.7%, n = 272), those received from a pharmacy without prescription (13.5%; n = 50), or from family members and friends (12.7%; n = 47). Conclusions Antibiotic self-medication for RTI was common in this population. This may be due to the belief that the antibiotics treat the majority of infections. A recommendation to either ask patients to return unused antibiotics to the physician's office or to dispense antibiotics in the exact amount which is necessary for an individual course, as well as the targeted education of pharmacy personnel and the general population, appear to be justified.

Introduction: Lumbar sympathectomy seems to be technically a much more demanding procedure than thoracic sympathectomy. Nevertheless, some patients require this particular procedure. In our centre, the operation is performed no sooner than 12 months after initial thoracic sympathectomy as a simultaneous bilateral retro-peritoneoscopic procedure. Aim: To evaluate early effectiveness of totally videoretroperitoneoscopic lumbar sympathectomy from a posterior approach. Material and methods: Between June 2008 and June 2009, there were 12 patients operated on for primary plantar hyperhidrosis in the Department of General, Endocrine and Transplant Surgery, Medical University of Gdansk, Poland. A bilateral procedure was performed in 6 patients, and in 6 other cases (initial ones) the procedure had to be split due to too slow progress of the procedure (learning curve). Results: Mean operation time was 92.5 ±27.16 min (for 6 bilateral procedures) and 84 ±20.17 min (for the initial 12 unilateral procedures). There was no postoperative mortality. Morbidity involved post-sympathectomy syndrome presenting as moderate burning pain in the buttocks and thighs up to 4 weeks postoperatively. Postoperative stay was 1 day in 7 cases and 2 days in 3 cases (due to long train travel awaiting the patient on his/her way home). In the majority of patients, early postoperative results were very good, expressed by both the subjective opinion of the patient and gravimetric results. In one case dryness of the feet was so severe that the patient had to consult a dermatologist. Conclusions: We believe that videoretroperitoneoscopic lumbar sympathectomy from a posterior approach is a good method of treatment for primary hyperhidrosis with plantar symptoms, but should be reserved for surgeons experienced in laparoscopic and retroperitoneoscopic surgery.

For the first time, a direct sensitive method of *NO(2) detection and measurement in biological material has been established. It is based on the interaction of this radical with the coordination compound of Cr(III) with aminodeoxysugar as biosensor. Our new method makes it possible to precisely assess *NO(2) level in experimental acute necrotizing pancreatitis induced by L-arginine, where oxidative and nitrosative stresses are supposed to play a key role in the pathomechanism of the disease. As much as 20 nmol of *NO(2)/mg protein was detected which correlated with severe deterioration of pancreatic acinar cell ultrastructure. Protective effect of superoxide radical scavenger 4-OH-TEMPO expressed as *NO(2) level decrease confirmed by preserved acinar cell ultrastructure and decreased pancreatic amylase release to blood serum is demonstrated. This study reveals a possible pathomechanism of L-arginine induced acute pancreatitis.

We have characterized the susceptibility of various RNA bulges, loops and other single-stranded sequences to hydrolysis promoted by Pb2+. The reactivity of bulges depends primarily on the structural context of the flanking base-pairs and the effect of nucleotide present at the 5′ side of the bulge is particularly strong. The efficiency of stacking interactions between the bulged residue and its neighbors seems to determine cleavage specificity and efficiency. Hydrolysis of two- and three-nucleotide bulges depends only slightly on their nucleotide composition. In the case of terminal loops, the efficiency of their hydrolysis usually increases with the loop size and strongly depends on its nucleotide composition. Stable tetraloops UUCG, CUUG and GCAA are resistant to hydrolysis, while in some other loops of the GNRA family a single, weak cleavage occurs, suggesting the existence of structural subclasses within the family. A very efficient, specific hydrolysis of a phosphodiester bond in the single-stranded region adjacent to the stem in oligomer 12 resembles highly specific cleavages of some tRNA molecules. The reaction occurs in the presence of Pb2+,but not in the presence of several other metal ions. The Pb2+-cleavable RNA domain may be considered another example of leadzyme. The results of Pb2+-induced hydrolysis in model RNA oligomers should be useful in interpretation of cleavage patterns of much larger, naturally occurring RNA molecules.

The objective of this study was to assess the dynamics of oxidative damage to cellular macromolecules such as proteins, lipids, and DNA under conditions of oxidative stress triggering early stages of estrogen-dependent carcinogenesis. A rodent model of carcinogenesis was used. Syrian hamsters were sacrificed after 1, 3, 5 h and 1 month from the initial implantation of 17beta-estradiol (E2). Matching control groups were used. Kidneys as target organs for E2-mediated oxidative stress were excised and homogenized for biochemical assays. Subcellular fractions were isolated. Carbonyl groups (as a marker of protein oxidation) and lipid hydroxyperoxides were assessed. DNA was isolated and 8-oxodGuo was assessed. Electron paramagnetic resonance spectroscopy was used to confirm the results for lipid peroxidation. Exposition to E2 in rodent model leads to a damage of macromolecules of the cell, including proteins and DNA, but not lipids. Proteins appear to be primary target of the damage but are shortly followed by DNA. It has previously been speculated that protein peroxides can increase DNA modifications. This time sequence was observed in our study. Nevertheless, direct relation between protein and DNA damage still remains unsolved.

The objective of this study was to assess the dynamics of oxidative damage to cellular macromolecules such as proteins, lipids, and DNA under conditions of oxidative stress triggering early stages of estrogen-dependent carcinogenesis. A rodent model of carcinogenesis was used. Syrian hamsters were sacrificed after 1, 3, 5h and 1 month from the initial implantation of 17β-estradiol (E2). Matching control groups were used. Kidneys as target organs for E2-mediated oxidative stress were excised and homogenized for biochemical assays. Subcellular fractions were isolated. Carbonyl groups (as a marker of protein oxidation) and lipid hydroxyperoxides were assessed. DNA was isolated and 8-oxodGuo was assessed. Electron paramagnetic resonance spectroscopy was used to confirm the results for lipid peroxidation.

We report a case of Wernicke's encephalopathy after sleeve gastrectomy, which had been complicated by stomach wall edema and aggravated by dietary non-compliance. Despite intense parenteral nutrition, thiamine deficiency became clinically evident. It suggests that nutritional preparations used were unable to cover the increased thiamine requirement. After intense thiamine supplementation, gradual improvement occurred during the 6 months after the diagnosis, without permanent cognitive impairment. Clinicians involved in postoperative management of bariatric surgery patients must consider Wernicke's syndrome in hyper-emetic patients, who show unclear neurological deterioration. Early diagnosis and treatment can instantly improve the patient's condition without permanent sequelae.

Laparoscopic ventral hernia repair is becoming a popular technique with good results and fast postoperative recovery. The mesh is placed directly under the peritoneum and anchored with transabdominal sutures and tacks. However, the ideal size of the mesh covering the hernia orifice is know, nor the ideal type or amount of tacks has to be described.To assess the forces acting on a single tack, a mathematical model of the ventral hernia was created. The force was described in reference to the surface of the hernia orifice and the pressure in the abdominal cavity. The following different types of mesh were examined in vitro: Proceed (knitted mesh), Dual Mesh (expanded polytetrafluoroethylene [ePTFE] flat mesh), and Shelhigh (biologic flat mesh). The following different tacks also were examined: Protac, Anchor, and EMS. A pig model was used to measure the forces needed to destroy the connection between mesh and tissue and to describe the place of destruction (mesh, tissue, or tack) and the force needed.The force acting on a single tack proportionally depends on the surface of the hernia orifice and the pressure in the abdominal cavity. The force needed to disconnect the tissue and mesh reached 8.97 +/- 0.11 N for ProTac, 2.67 +/- 0.22 N for Anchor, and 6.67 +/- 1.32 N for EMS. These values do not allow the mesh to be held in the right position when the orifice exceeds 10 cm for Protac and EMS. The disconnection of the EMS and Protac junction damages the tissue. Anchor tacks are insufficient to hold the mesh and stay in the tissueIn the case of small hernias (diameter10 cm) EMS or ProTac used alone are not enough to hold the mesh. Anchor is not recommended alone in any hernia.

Specificity of targeting of the oxidative stress towards lipid and protein fractions in a model of estrogen-induced Syrian hamster nephrocarcinogenesis was evaluated. The amount of proteins modified by oxidative stress was significantly elevated as early as one month after the initial implantation of estradiol to the experimental versus the control group, while the stress did not affect lipids. Subcellular localization of the oxidative stress target was determined by the analysis of protein oxidation in subcellular fractions of kidney cells. The endoplasmic reticulum membranes were the fraction most affected by the oxidative stress.

Chronic administration of estradiol leads to generation of estrogen-dependent renal cancer in male Syrian hamsters within 9–12 months. The pathogenesis of this tumour is associated with oxygen free radicals, however, it is still not clear which metabolic pathway of estrogens is responsible for the generation of the radicals, and which part of the cell is mostly affected by it. The paper presents an experiment in which the protein oxidation measured by carbonyl groups level in 9-month estrogenization scheme. The level of carbonyl groups was significantly elevated starting from the 1st month of estrogenization until the 9th. The weight of the kidneys reflecting possible tumuorigenesis was also significantly increased in estrogenized group starting at the 2nd month of the experiment. The weight of the testes, a sign of adequate estrogenicity, was decreased dramatically in the estrogenized group from the first to the last month of experiment. The results suggest that the kidney of estrogenized male Syrian hamster suffers from oxidative stress affecting proteins.

The structural and sequence requirements for the biosynthesis of tRNA(Tyr) pseudouridine (psi 35) have been studied. Nucleotide substitution at the 32nd position slightly reduced modification efficiency in the case of transition (C32 to U32) while transversion (C32 to G32) had no effect on the modification process in wheat germ extract. Insertion of one nucleotide into the anticodon stem caused a 2-fold reduction of modification efficiency. Mutants with a partially deleted 12 nt long intron of pre-tRNA(Tyr) exhibited different effects: deletion of 5 nt (7 nt long intron) gave only a reduction in pseudouridylation while deletion of 7 nt (5 nt long intron) almost completely abolished the reaction. The generated mini-substrate consisting of pre-tRNA(Tyr) anticodon stem and intron sequence was partially modified which proved that the crucial elements for recognition of psi 35 introduction had to present in this construct.

AIM: To investigate the influence of neutrophil adhesion molecule blockade with monoclonal antibody (MoAb CD11b) and E. coli lipopolysaccharide (LPS) administration on experimental acute pancreatitis (AP). METHODS: AP was induced by four ip injections of cerulein (Cn) at 1-h intervals. MoAb CD 11b and LPS were administered at the beginning of the experiment. RESULTS: The neutrophil count and chemiluminescence were diminished at the beginning of AP. The oxidative stress parameters were found within the pancreatic gland. MoAb CD 11b used for AP resulted in a significant reduction of pancreatic infiltration and pancreatitis oxidative stress parameters. Serum interleukin-6 (IL-6) was not detected in AP animals, whereas high serum IL-6 concentration was noted only in animals receiving LPS. CONCLUSION: Neutrophils are involved in pancreatic damage in the early stage of AP. Neutrophil infiltration reduction protects the pancreatic gland from destruction during AP. LPS does not change the early course of Cn pancreatitis in rats.

Background Data regarding the safety of endoscopic skull base exploration are very scarce. With this method, fragile vital structures (cranial nerves, the optic complex, brainstem, hypothalamus or cerebral ventricles) are exposed to direct illumination within a closed space. Also, high-speed drills, cauterization and ultrasonic aspiration deliver a significant load of thermal energy. The aim of this study was to record the temperature close to the structures of the skull base and in the intradural space during the procedures performed using extended endoscopic transnasal approaches. Methods The temperature of the skull base was continuously recorded during six transnasal endoscopic procedures. Implantable copper-constantan thermocouples were inserted: one into the esophagus and another through the nostril to reach the operative field at the skull base. Results At the beginning of the procedure, the temperature of the operative field was on average 36.8 °C ± 0.80 °C, i.e. only 1 °C higher than the esophageal temperature. Then it grew continuously during the whole procedure, to eventually reach a level of 42–43 °C at the final stage, whereas the esophageal temperature remained stable. Occasionally, the temperature increased up to 45 °C during cauterization and ultrasonic aspiration, and even up to 62 °C during high-speed drilling. Conclusion Endoscopic skull base surgery is associated with an incessant increase of the temperature of the intraoperative field. The temperature can peak suddenly to levels which can potentially harm neural structures and influence the rate of postoperative complications.