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Abstract The single nucleotide polymorphism in NOD2 (rs2066847) is associated with conditions that may predispose to the development of gastrointestinal disorders, as well as the known BRCA1 and BRCA2 variants classified as risk factors in many cancers. In our study, we analyzed these variants in a group of patients with pancreatitis and pancreatic cancer to clarify their role in pancreatic disease development. The DNA was isolated from whole blood samples of 553 patients with pancreatitis, 83 patients with pancreatic cancer, 44 cases of other pancreatic diseases, and 116 healthy volunteers. The NOD2 (rs2066847), BRCA1 (rs80357914) and BRCA2 (rs276174813) were genotyped. The statistically significant 3-fold increased risk of pancreatic cancer was detected among the patients with rs2066847 polymorphism (OR = 2.77, p-value = 0.019). We did not find the studied polymorphisms in BRCA1 (rs80357914) and BRCA2 (rs276174813). However, the adjacent polymorphisms have been detected only in patients with pancreatic diseases. The studied variant in NOD2 occurs more frequently in pancreatic patients and significantly increases the risk of pancreatic cancer. It can be considered as a genetic risk factor that predisposes to cancer development. The analyzed regions in BRCA1 and BRCA2 may be a potential target in further search for a genetic marker of pancreatic diseases.

Abstract Background The evolution of SARS-CoV-2 has been observed from the very beginning of the fight against COVID-19, some mutations are indicators of potentially dangerous variants of the virus. However, there is no clear association between the genetic variants of SARS-CoV-2 and the severity of COVID-19. We aimed to analyze the genetic variability of RdRp in correlation with different courses of COVID-19. Results The prospective study included 77 samples of SARS-CoV-2 isolated from outpatients (1st degree of severity) and hospitalized patients (2nd, 3rd and 4th degree of severity). The retrospective analyses included 15,898,266 cases of SARS-CoV-2 genome sequences deposited in the GISAID repository. Single-nucleotide variants were identified based on the four sequenced amplified fragments of SARS-CoV-2. The analysis of the results was performed using appropriate statistical methods, with p T, 14697C > T, 15096 T > C, and 15279C > T), while the 15240C > T mutation was common among strains isolated from outpatients. The selected mutations were searched worldwide in the GISAID database, their presence was correlated with the severity of COVID-19. Conclusion Identified mutations have the potential to be used to assess the increased risk of hospitalization in COVID-19 positive patients. Experimental studies and extensive epidemiological data are needed to investigate the association between individual mutations and the severity of COVID-19.

Abstract There are several overlapping clinical practice guidelines in acute pancreatitis (AP), however, none of them contains suggestions on patient discharge. The Hungarian Pancreatic Study Group (HPSG) has recently developed a laboratory data and symptom-based discharge protocol which needs to be validated. (1) A survey was conducted involving all members of the International Association of Pancreatology (IAP) to understand the characteristics of international discharge protocols. (2) We investigated the safety and effectiveness of the HPSG-discharge protocol. According to our international survey, 87.5% (49/56) of the centres had no discharge protocol. Patients discharged based on protocols have a significantly shorter median length of hospitalization (LOH) (7 (5;10) days vs. 8 (5;12) days) p

Oxidative stress is considered one of the main reasons for the development of colorectal cancer (CRC). Depending on the stage of the disease, variable activity of the main antioxidant enzymes, i.e., superoxide dismutase (SOD), catalase (CAT) and glutathione peroxidase (GPx), is observed. Due to limited treatment methods for CRC, new substances with potential antitumor activity targeting pathways related to oxidative stress are currently being sought, with substances of natural origin, including betulin, leading the way. The betulin molecule is chemically modified to obtain new derivatives with improved pharmacokinetic properties and higher biological activity. The aim of this study was to evaluate the effects of betulin and its new derivatives on viability and major antioxidant systems in colorectal cancer cell lines. The study showed that betulin and its derivative EB5 affect the antioxidant enzyme activity to varying degrees at both the protein and mRNA levels. The SW1116 cell line is more resistant to the tested compounds than RKO, which may be due to differences in the genetic and epigenetic profiles of these lines.

The aim of this review was to assess the prevalence and factors related to the metabolic obesity with normal weight (MONW) phenotype. Studies published in English up to December 2021 in the PubMed, Science Direct and Google Scholar databases were searched. The prevalence of MONW is estimated to range from 1.0% to 28.6%, depending on the age of the study participants and the definition of MONW used in the studies. Difficulties in determining the genetic causes of MONW result primarily from the lack of a uniform definition and from the complexity of the disorder. Each component of MONW may be determined by different genes. A person’s lifestyle, in particular their diet, seems to be a significant factor in the development of MONW. Studies have so far been unable to determine the optimal type and duration of dietary intervention needed to improve the metabolic parameters in individuals with MONW.

Despite progress in the pharmacological treatment of inflammatory bowel diseases (IBD), surgery is still an integral part of the treatment of ulcerative colitis and Crohn’s disease. The probability of adverse effects of the procedure in this group of patients is related to the specificity of IBD and depends on modifiable and non-modifiable risk factors. Optimization of health must therefore rely on a multi-directional and individualized approach to a patient. Proper preparation of the patient for surgery consisting in nutritional and psychological support, improvement of physical efficiency and encouragement to give up addictions can bring a real benefit in improving the treatment results. The paper discusses the principles, benefits and limitations of the use of elements of prehabilitation in the surgical treatment of patients with IBD.

IntroductionUrinary tract infections (UTI), among which the main etiological factor is uropathogenic Escherichia coli (UPEC, E. coli), remain an important issue for clinicians. The aim of the study was to demonstrate clear differences in the pathogenic properties of urine-derived E. coli compared to other extraintestinal E. coli clinical isolates (derived from: blood, lower respiratory tracts, sputum, reproductive tract, body fluids, perianal pus, other pus, wound, postoperative wound and other sources).MethodsThe collection of 784 E. coli isolates was collected from various materials of hospitalized patients. They were analyzed in terms of virulence-associated genes (papC, sfaD/sfaE, cnf1, usp., fimG/H, hlyA), belonging to phylogenetic groups and the presence of CRISPR-Cas regions using PCR. In addition, the epidemiological data and the antibiotic resistance profiles provided by the hospital’s microbiology department were included for statistical analyses.ResultsUrine-derived E. coli showed significantly greater virulence potential compared to other isolates, but they were generally unremarkable in terms of drug resistance. The isolates most often belonged to phylogenetic group B2. Drug resistance was negatively correlated with CRISPR 2 presence and high average virulence score, but positively correlated with CRISPR 4 presence. To the best of our knowledge, we are the first to report significant differences in sputum-derived isolates—they revealed the lowest virulence potential and, at the same time, the highest drug resistance.DiscussionIn conclusion, we demonstrated significant differences of urinary-derived E. coli compared to other clinical E. coli isolates. We would like to suggest excluding penicillins from use in E. coli infection at this time and monitoring strains with a high pathogenicity potential.

Cystic renal lesions are common findings on abdominal imaging studies. Bosniak Classification version 2005 and 2019 consists of five categories of cystic masses. The 2019 modification is more detailed and extensive compared to version 2005. The novelties in version 2019 are implementation of diameter values of cystic septa and walls as well as inclusion of magnetic resonance imaging for classification of cystic renal masses. The aim of our study was to review a new proposal for the assessment of renal cysts and review the results of studies which compared diagnostic performance and interobserver agreement of both versions from 2005 and 2019.

Recurrent laryngeal nerve (RLN) paralysis, although rare, is among the most serious complications of thyroid gland surgery. It effects the quality of life of the patient, increases the costs of hospitalization, and can be the cause of legal proceedings. Therefore, it is not surprising that for a long time, devices have been sought that minimize the risk of injury to the nerves. One of them is intraoperative neuromonitoring (IONM). Despite several decades of using neuromonitoring during thyroid gland surgeries, there is still much controversy concerning its effectiveness. The divergent results of various meta-analyses are probably associated with the lack of standardization and inappropriate use of the method. Indisputable benefits from the use of IONM were proven in high-risk surgeries, such as malignant cancer, overactive thyroid gland, recurrent goitre, or retrosternal goitre. Nerve monitoring can be carried out by intermittent (I-IONM) or continuous (C-IONM) stimulation. At present, increasing importance is attached to continuous monitoring, because it protects the nerve against injury in real time, and the surgeon is warned against performance of a dangerous manoeuvre. Neuromonitoring is safe and does not show undesirable effects. Even though its use increases the costs of surgery and hospitalization, it improves the quality of the procedure and ensures the safety of the patient and the surgeon.

Abstract Background The increased metabolic activity required to sustain breastfeeding and its associated milk production helps to reduce maternal fat stores accumulated during pregnancy. This study aims to assess the association between breastfeeding duration and fatness indices in middle-aged women. Methods The analysis was carried out in a group of 7500 parous 55.5 ± 5.3 year old women included body mass index, body fat percentage, and waist-to-height ratio. The likelihood of excessive weight or obesity in relation to total breastfeeding time using multivariate logistic regression analyses. Results An analysis of adjusted odds ratios did not show significant associations between breastfeeding duration and the risk of excessive weight and obesity in premenopausal women. After menopause, women who gave birth to 2 children and breastfed 1–6 and > 12 months had a lower risk of abdominal obesity (OR 0.70; 95% CI 0.50–0.99; p = 0.042; and OR 0.68; 95% CI 0.47–0.98; p = 0.039). Women who gave birth to 3 or more children and breastfed for 1–6 months, also showed a lower risk of overweight (OR 0.52; 95% CI 0.27–0.99; p = 0.047), compared to those ones that have never breastfed. There was no relationship found between the duration of lactation and the risk of excessive body fat. Conclusion Breastfeeding may have some beneficial, long-term effect on the risk of excessive weight and abdominal obesity in women.

Familial adenomatous polyposis (FAP) is a group of diseases, mostly caused by an APC suppressor gene mutation inherited in an autosomal dominant pattern. It results in numerous adenomas formed in the epithelium of the large intestine leading to colorectal cancer in 100% of cases, with the mean age of 39, and a high risk of other fatal neoplasms. There is no causative treatment possible. Total colectomy performed at the right time is the only way to prevent the individual from developing colorectal cancer. The aim of this study was to present the diagnostic performance and treatment methods of FAP. Fast diagnosis and strict surveillance of patients and their families are the most important for effective treatment.

Colorectal cancer is the third most frequently diagnosed type of cancer in men, while it ranks second in women. The high mortality rate of people with colorectal cancer is due to the advanced stage at diagnosis and the low selectivity of the currently used cytostatics. One of the important directions in searching for new anticancer substances is research of natural origin compounds. Betulin is a promising substance from this group, showing activity against colon cancer cells with low toxicity. Studies of betulin carried out in the aspect of the evaluation of this direction of activity concerned human tumor cell lines Col2, SW707, DLD-1, HT29 and HCT116. It was also important to determine the molecular mechanisms of action of this triterpene in colon cancer cells.

The digestive protease chymotrypsin C (CTRC) protects the pancreas against pancreatitis by degrading potentially harmful trypsinogen. Loss-of-function genetic variants in CTRC increase risk for chronic pancreatitis (CP) with variable effect size, as judged by the reported odds ratio (OR) values. Here, we performed a meta-analysis of published studies on four variants that alter the CTRC amino-acid sequence, are clinically relatively common (global carrier frequency in CP >1%), reproducibly showed association with CP and their loss of function phenotype was verified experimentally. We found strong enrichment of CTRC variants p.A73T, p.V235I, p.K247_R254del, and p.R245W in CP cases versus controls, yielding OR values of 6.5 (95% confidence interval (CI) 2.4-17.8), 4.5 (CI 2.2-9.1), 5.4 (CI 2.6-11.0), and 2.6 (CI 1.6-4.2), respectively. Subgroup analysis demonstrated disease association of variants p.K247_R254del and p.R245W in alcoholic CP with similar effect sizes as seen in the overall CP group. Homozygosity or compound heterozygosity were rare and seemed to be associated with higher risk. We also identified a so far unreported linkage disequilibrium between variant p.K247_R254del and the common c.180C>T (p.G60 =) haplotype. Taken together, the results indicate that heterozygous loss-of-function CTRC variants increase the risk for CP approximately 3-7-fold. This meta-analysis confirms the clinical significance of CTRC variants and provides further justification for the genetic screening of CP patients.

Statistics show that about 35% to 55% patients admitted to a hospital ward are undernourished, 20% of whom are found in the group of patients with severe malnutrition. According to ESPEN (European Society of Parenteral and Enteral Nutrition), ‘Malnutrition is a condition resulting from a lack of absorption or a lack of consumption of nutrients, leading to a change in body composition (the reduction of free fat mass and body cell mass), thus resulting in physical and mental activity impairment and having a negative effect on the treatment of the original condition.’ Taking into consideration the serious health and socio-economic consequences related to malnutrition, a priority of the health care policy of every country should involve a targeted active response aimed at impelling hospital authorities and health care decision-makers to devise relevant hospital malnutrition battle plans and strategies. The aim of this paper is to presentat the consequences related to faulty screening of the nutritional status of hospitalised patients.

Suppressor gene research is one of the main current trends in modern cancer research. Oncogenesis, including colorectal cancer (CRC), is a process strictly dependent on the proper functioning of the suppressor genes and their proteins. The molecular genetic studies of hereditary cases and sporadic forms of cancer conducted for several years have revealed that a significant feature of the occurrence and progression of neoplastic changes is silencing of the expression of tissue-specific suppressor genes. Restoring the proper activity of the respective suppressor proteins plays a key role in anti-cancer prevention and gives hope for the development of effective personalised therapy. This review presents the latest reports on the molecular mechanisms regulating the expression, activity, and function of suppressor genes, which were silenced in tissues and cell lines of colorectal cancer, and restoration of their correct expression inhibited the proliferation and invasion of CRC cells.

Gastric cancer (GC) is one of the most common malignant cancers worldwide. Intraperitoneal dissemination is the typical mechanism of the formation of metastases in GC. The diagnosis of the presence of intraperitoneal free cancer cells (IFCCs) is treated equally to the M (metastasis) category according to the 8th edition of the TNM classification by the American Joint Committee on Cancer. IFCCs are cells which have detached from the primary tumour through exfoliation into the peritoneal cavity. The source of IFCCs may be iatrogenic due to improper surgical technique during resection of the tumour and may lead to intraperitoneal dissemination. Cytological examination of peritoneal lavage is considered as a gold standard in the confirmation of the presence of IFCCs; however, its sensitivity is very low. In order to increase the sensitivity and reliability of the examination, molecular biology techniques should be applied. In the case of detection of the presence of IFCCs in patients with GC, the patient should be qualified for chemotherapy, or possibly the use of hyperthermic intraperitoneal chemotherapy should be considered.

Introduction Ultrasonographic estimation of fetal weight (EFW) is a standard obstetrical procedure in daily clinical practice. Formulas for calculating EFW most commonly are a combination of two-dimensional measurements. A relatively new approach is the use of three-dimensional measurements such as fractional thigh volume (TVol) incorporated into specific regression equations. The objective of this study was to compare the Lee formula based on three-dimensional ultrasonographic TVol in the estimation of fetal weight before delivery in term pregnancies to the Hadlock I formula. Material and methods 2D/3D abdominal ultrasonography was performed in 104 women, 37–41 gestational weeks, and measurements of biparietal dia­meter, head circumference, abdomen circumference, and femur length, TVol were taken. Using these measurements, we compared the Lee to the Hadlock formulas in EFW. The timing of procedures was measured in 20 randomly chosen patients by an independent observer. Results Mean percentage errors of formulas, Lee vs. Hadlock, were 2.13 ±9.31% vs. –2.02 ±8.79%, (p = 0.001). There was no statistically significant difference in median absolute percentage errors between the two formulas (6.09% vs. 6.10%, p = 0.56). The proportion of newborns with estimated birth weights (BW) within ±10% of actual BW was not significantly different between the two formulas (73% vs. 71%, p = 0.11). There was a significant difference in the proportion of the newborns with estimated BW within ±5% (33% vs. 42%, p = 0.000006). Statistical measurements for test performance in detecting fetuses with BW ≥ 4000 g were sensitivity 85% vs. 60%, specificity 88% vs. 96%, and accuracy 88% vs. 89%. There was no significant difference in the time to perform the measurements (69 s for Lee formula vs. 58 s for Hadlock formula, p = 0.16). Conclusions Thigh volume measurement incorporated into the Lee single parameter formula is comparable to the Hadlock I formula in terms of accuracy in predicting fetal weight before delivery. There was no significant difference in the time needed for taking necessary measurements between the two groups.

Splanchnic vein thrombosis (SVT) is a serious vascular complication that can occur in patients with acute pancreatitis. We assessed the incidence of SVT and its relationship with acute pancreatitis (AP) and associated complications. We carried out a retrospective analysis of medical histories from patients hospitalized with AP in a single surgical center. Histories were acquired from patients with abdominal and pelvic computed tomography scans performed between the 2nd and 3rd day of hospitalization. We assessed the impact and extent of thrombosis over the disease course. We found a strong positive correlation (Cramer’s V coefficient = 0.34) between SVT and disease severity. Mortality in the study group was 7.2% (8 patients) of which 5 patients (62.5%) were diagnosed with SVT. We observed an increased incidence of death among patients with thrombosis, with results approaching significance ( P = 0.056). In our study, we found that SVT has a negative effect on the course of AP and is associated with more severe disease and increased mortality.

Introduction Type 2 diabetes (T2D) is a multifactorial disease affecting mostly adults older than 40 years. The aim of the study was to examine GST gene polymorphism influence on the risk of T2D, especially in young adults.Research design and methods 200 diabetic patients and 221 healthy controls participated in this study. Three GST gene polymorphism have been analyzed: GSTP1 (single-nucleotide polymorphism Ile105Val), homozygous deletion of GSTT1 (null/null) and GSTM1 (null/null), using TaqMan real-time quantitative PCR.Results The distribution of examined polymorphisms was similar in patient group and control group. Statistically significant differences were demonstrated for the combination of GSTP1 Val/Val and GSTT1 null/null genotypes between patients diagnosed before 40 years of age and healthy people (12.5% vs 0.9%, p=0.016). Moreover, all three examined gene polymorphism together (GSTP1 Val/Val, GSTM1nul/null and GSTT1 null/null genotype) was observed in 12.5% of patients diagnosed before 40 years of age and in 0.5% of healthy individuals (p=0.013).Conclusion In conclusion, the results suggest that GST polymorphism may be one of the risk factors for developing T2D at a younger age than the T2D population average.

Proteus mirabilis is the third most common etiological factor of urinary tract infection. It produces urease, which contributes to the formation of a crystalline biofilm, considered to be one of the most important virulence factors of P. mirabilis strains, along with their ability to swarm on a solid surface. The aim of this study was to analyze the pathogenic properties of two selected groups of clinical P. mirabilis isolates, antimicrobial susceptible and multidrug resistant (MDR), collected from hospitals in different regions in Poland. The strains were examined based on virulence gene profiles, urease and hemolysin production, biofilm formation, and swarming properties. Additionally, the strains were characterized based on the Dienes test and antibiotic susceptibility patterns. It turned out that the MDR strains exhibited kinship more often than the susceptible ones. The strains which were able to form a stronger biofilm had broader antimicrobial resistance profiles. It was also found that the strongest swarming motility correlated with susceptibility to most antibiotics. The correlations described in this work encourage further investigation of the mechanisms of pathogenicity of P. mirabilis.

These recommendations refer to the current management in pancreatic ductal adenocarcinoma (PDAC), a neoplasia characterised by an aggressive course and extremely poor prognosis. The recommendations regard diagnosis, surgical, adjuvant and palliative treatment, with consideration given to endoscopic and surgical methods. A vast majority of the statements are based on data obtained in clinical studies and experts’ recommendations on PDAC management, including the following guidelines: International Association of Pancreatology/European Pancreatic Club (IAP/EPC), American Society of Clinical Oncology (ASCO), European Society for Medical Oncology (ESMO), National Comprehensive Cancer Network (NCCN) and Polish Society of Gastroenterology (PSG) and The National Institute for Health and Care Excellence (NICE). All recommendations were voted on by members of the Working Group of the Polish Pancreatic Club. Results of the voting and brief comments are provided with each recommendation.

Antibiotic therapy and its consequences in bacterial and human aspects are widely investigated. Despite this, the emergence of new multidrug resistant bacteria is still a current problem. The scope of our work included the observation of changes among uropathogenic Escherichia coli strains after the treatment with a subinhibitory concentration of different antibiotics. The sensitive strains with or without virulence factors were incubated with amoxicillin, ciprofloxacin, gentamycin, or tobramycin. After each passage, the E. coli derivatives were compared to their wild types based on their susceptibility profiles, virulence genes, biofilm formations and the fingerprint profiles of PCR products amplified with using the (N)(6)(CGG)(4) primer. It turned out that antibiotics caused significant changes in the repertoire of bacterial virulence and biofilm formation, corresponding to acquired cross-resistance. The genomic changes among the studied bacteria were reflected in the changed profiles of the CGG-PCR products. In conclusion, the inappropriate application of antibiotics may cause a rapid rise of Multidrug Resistant (MDR) strains and give bacteria a chance to modulate their own pathogenicity. This phenomenon has been easily observed among uropathogenic E. coli strains and it is one of the main reasons for recurrent infections of the urinary tract.

Objectives The term metabolic syndrome (MetS) refers to the coexistence of interlinked risk factors of metabolic origin, contributing to the development of arteriosclerotic cardiovascular diseases as well as type 2 diabetes and their cardiovascular complications. The aim of the study is the assessment of the prevalence of MetS among paramedics of the Świętokrzyskie Center of Emergency Medical Services, depending on the adopted diagnostic criteria. Material and Methods The study included 140 paramedics (2 women and 138 men), aged 23–60 years old (median = 43 years, average age = 41.5 years, standard deviation = 10.8 years). The age distribution of the subjects was significantly different from the normal distribution (p-value < 0.0001). The oldest age group (50 years old and above) was overrepresented by nearly a half compared to the youngest group (up to 29 years old). Metabolic syndrome was defined on the basis of the International Diabetes Federation (IDF) criteria from 2005 and IDF in agreement with the American Heart Association/National Heart, Lung and Blood Institute (AHA/NHLBI) from 2009. Results According to the IDF/2005 criteria, in which the necessary condition is the diagnosis of central obesity, MetS was recorded in 26.4% of the subjects (37 people). This is statistically significantly less often than the IDF/AHA/NHLBI/2009 definition of p = 0.001 – 35%. The frequency of the MetS occurrence was statistically significantly related to the age of the subjects and the age groups. Conclusions The prevalence of the MetS in the subject group is evaluated to be significant. The prevalence of MetS is diversified by the applied diagnostic criteria with age being the factor increasing its frequency. The most common factor influencing the prevalence of MetS is blood pressure and waist circumference. Int J Occup Med Environ Health 2018;31(6):741–751

Abstract Background The aim of this study was to describe the dietary patterns in pregnant women and determine the association between diet factors, pre-pregnancy body mass index, socio-demographic characteristics and gestational weight gain. Methods The analysis was conducted on a group of 458 women. Cut-off values of gestational weight gain adequacy were based on recommendations published by the US Institute of Medicine and were body mass index-specific. Logistic regression analysis was used to assess the risk of the occurrence of inadequate or excessive gestational weight gain. Dietary patterns were identified by factor analysis. Results Three dietary patterns characteristic of pregnant women in Poland were identified: ‘unhealthy’, ‘varied’ and ‘prudent’. The factor associated with increased risk of inadequate gestational weight gain was being underweight pre-pregnancy (OR = 2.61; p = 0.018). The factor associated with increased risk of excessive weight gain were being overweight or obese pre-pregnancy (OR = 7.00; p = 0.031) and quitting smoking (OR = 7.32; p = 0.019). The risk of excessive weight gain was decreased by being underweight pre-pregnancy (OR = 0.20; p = 0.041), being in the third or subsequent pregnancy compared to being in the first (OR = 0.37; p = 0.018), and having a high adherence to a prudent dietary pattern (OR = 0.47; p = 0.033). Conclusions Women who were overweight or obese pre-pregnancy and those who quit smoking at the beginning of pregnancy should be provided with dietary guidance to prevent excessive gestational weight gain.

Epidermal growth factor (EGF) stimulates the proliferation of many different types of cells and plays an important role in the formation and growth of tumours. The interaction of EGF with cells is possible by the EGF receptor (EGFR) anchored in the cell membrane. Excess EGFR expression is found in approximately 25–82% of colorectal cancer cases. Attachment of EGF to EGFR results in a conformational change in the receptor, an increase in affinity for neighbouring receptors, receptor dimerisation, and activation of tyrosine kinase in the intraplasmic domain. Activation of EGFR leads to the initiation of the signal transduction pathway to the cell nucleus, via a number of proteins with enzymatic activity – secondary messengers, including KRAS and BRAF proteins. The assessment of the presence of mutations in the KRAS gene has become a standard element in the qualification of patients with advanced colorectal cancer for therapy with the use of monoclonal antibodies.

When medical intervention is necessary, a physician faces a serious dilemma: can he/she perform medical intervention despite the lack of informed consent, or should he/she withdraw from such an intervention? The question is even more difficult when a patient under the influence of alcohol urgently requires a medical intervention. In such cases the possibility to gain informed consent is even more problematic, and such situations are not so rare. In such situations, a doctor must often decide whether to undertake medical interventions despite the lack of informed consent of a patient, if it is justified by patient’s state of health, or to discontinue intervention, exposing him/herself to possible legal liability for such an omission.

Background: Due to the decrease in the percentage of perinatal mortality, which is one of the Millennium Development Goals, the number of children with a central coordination disorder (CCD) has increased, present in up to 40% of premature babies. Neurodevelopmental disorders detected in the diagnostic process require early interventions that will eliminate or overcome existing dysfunctions. These treatments often cause discomfort in the infant, which induces insecurity and activation of basic defense mechanisms. The aim of the work is to assess changes in cortisol concentration in infants treated with the Vojta method. Methods and findings: The study included 35 children with CCD aged between three and nine months. The participants had no comorbidities that could have affected the obtained results. The activities were planned to occur in three stages: 1. Collection of a saliva sample directly before the physiotherapy appointment. 2. Collection of saliva immediately after rehabilitation. 3. Collection of saliva 20 min after the end of rehabilitation. The physiotherapeutic intervention included the assessment of seven reactions of the body position in space according to Vojta and the conduct of a therapeutic session consisting of the first phase of rotation and creeping reflex according to Vojta. The concentration of free cortisol in saliva was assessed with LC-MS/MS. In the first measurement, none of the children presented an excess of the normative concentration of cortisol. The cortisol measurement performed directly after rehabilitation showed above-normative values in three children. In the third measurement, all of the children presented a decreased concentration of free cortisol. The analysis (paired two-tailed t-test, p < 0.05) showed statistically significant differences between particular stages of the measurements. The analysis of the scores obtained in the second measurement showed the concentration of scores in the area of “normal” at a level of 0.83 (normal concentration) and the area “above normal” at the level of 0.005 (very weak concentration). Based on the analysis of significance of the obtained scores, it was found that the result was not accidental, and the Vojta method used in the treatment of children with CCD was suitable. Conclusions: Here, for the first time, we presented how Vojta therapy was correlated with cortisol levels among children with a central coordination disorder.

Every doctor practicing treatment in the field of medicine may be confronted with a serious question: should I save my patient’s life at any cost? If a doctor resigns from emergency procedures, he/she will risk the patient’s death. However, if he/she decides to proceed regardless of a Jehovah’s Witness patient’s statement of will, in which he or she refuses transfusion, he/she takes a risk of illegal medical intervention. There is neither an easy answer, nor a serious solution, thus the only way is to choose the lesser of two evils. Notwithstanding legal issues, there are still ethical problems, which result in an internal dilemma for a doctor.

Introduction : Cardiovascular diseases are the most life-threatening in Poland and constitute the most frequent cause of death. Aim of the research : The evaluation of the frequency of the occurrence of cardiovascular disease risk factors among paramedics of the ŚCRMiTS (Świętokrzyskie Centre of Emergency Medical Services) in Kielce. Material and methods : The subject study group involved 140 paramedics of the ŚCRMiTS in Kielce, excluding the doctors. The evaluation of their condition of health included the following measurements: blood pressure, biochemical analyses: fasting lipidogram, fasting glycaemia, anthropometric measurements, and a questionnaire interview. Results : The average body mass index of the group was above the norm and equalled 28.2 ±4.1 kg/m 2 . The average blood pressure equalled: systolic – 133.8 ±14.9 mm Hg, diastolic – 83.1 ±9.2 mm Hg. The average fasting glucose concentration was 95 ±33.8 mg/dl in the subject population. The average total cholesterol concentration of the group was 198.6 ±36.6 mg/dl, high-density lipoprotein fraction concentration – 48.4 ±10.5 mg/dl, low-density lipoprotein fraction – 121 ±33.8 mg/dl, triglycerides concentration – 168.9 ±120.7 mg/dl. Fifteen risk factors were analysed altogether. Conclusions : Cardiovascular disease risk factors are a significant risk for the subject group of paramedics and they generate a disadvantageous picture of a health profile. A vast majority of the subjects had an abnormal body mass, exceeded values of blood pressure, and had bad lipidogram parameters. The spread of risk factors and the degree of exceeding reference norms increases with age. It would be justified to prepare preventive measures aimed mainly at the reduction of body weight and the decrease of other modifiable risk factors for cardiovascular diseases.

Adenoid cystic carcinoma is an invasive cancer accounting for less than 0.1% of all breast cancers. It most frequently occurs as a single, clearly defined, tender tumour. Mammographic and ultrasound images are non-characteristic and may be misinterpreted as benign change. This cancer shows no expression of ER, PGR, and HER-2 receptors; however, as opposed to triple-negative breast cancers, NST has a mild course and sporadically gives rise to metastases to locoregional lymph nodes and distant metastases. There is no consensus concerning the optimum treatment. The surgeries usually performed are lumpectomy with an open sentinel lymph node biopsy and mastectomy. However, considering the low probability of the presence of metastases in the lymph nodes, doubts arise pertaining to the justification for lymph node resection. Adjuvant radiotherapy is recommended after breast-conserving surgeries, especially with positive margins. The role of chemotherapy has not been well recognised, and hormone therapy is not recommended.

Introduction: So far, the association between a longer sleep duration, state of health, and the risk of obesity and the influence of gender on the association between sleep duration and the risk of obesity has not been fully explained. Aim of the research: To examine the relationships between self-reported sleep duration, body mass index (BMI), and body fat percentage (%BF), and also to determine whether such associations are the same in men and in women. Material and methods : This study included 10,367 participants aged 37 to 66 years. Logistic regression was applied for risk assessment of the prevalence of abnormal BMI values and %BF in groups of sleep duration. Sleep of 7–8 h per night was adopted as a reference level. Results: In men, the risk of obesity was significantly greater only in the group sleeping ≤ 6 h (OR = 1.18, 95% CI: 1.08–1.28; p < 0.05); however, in women, only among those sleeping ≥ 9 h (OR = 1.14, 95% CI: 1.02–1.26; p < 0.05). The risk of obesity, determined on the basis of %BF, was higher only in individuals sleeping ≥ 9 h. In the adjusted model, it turned out to be significant in the general study population (OR = 1.28, 95% CI: 1.07–1.53; p < 0.05) and in women (OR = 1.14, 95% CI: 1.03–1.27; p < 0.05). Conclusions: In women, a greater risk of obesity was related to a longer sleep duration (≥ 9 h), whereas in men, the tendency of obesity occurrence along with shorter sleep (≤ 6 h). Thus, the physiological consequences of sleep duration may be different in women than in men.

Introduction: It has been stated that besides the traditional elements of lifestyle such as diet and physical activity, an additional factor, namely sleep, is involved in metabolic processes, hormonal functions, and energy homeostasis. Aim of the research: To examine relationships between self-reported sleep duration and the risk of metabolic syndrome (MetS) and its components, both for men and women. Material and methods: The study involved 10,367 individuals, aged 37 to 66 years. The definition of MetS applied in this paper was developed by the International Diabetes Federation (IDF). Logistic regression was applied to assess the risk (odds ratio – OR) of MetS and its components. Results : There was no relationship observed between short sleep duration (≤ 6 h) and the risk of MetS. Long sleep duration (≥ 9 h) was connected with a higher risk of MetS only in the unadjusted model (OR = 1.11). After adjusting for confounders, a significant association was found between long sleep duration and a higher risk of abdominal obesity in the test group as a whole (OR = 1.16), as well as in the men in the group (OR = 1.22). In women, both with short (OR = 1.08) and long (OR = 1.12) sleep duration, the risk of increased concentration of glucose was found. Conclusions : Our study did not confirm the existence of an association between inadequate sleep duration and the risk of MetS, defined in accordance with IDF criteria. Sleep duration, however, is connected with some of the MetS components. It is therefore necessary to conduct further, long-term tests in this regard.

Total reflection X-ray fluorescence analysis (TXRF) was used to determine chromium, selenium and bromine concentrations in blood serum samples of 50 patients with parenteral nutrition treatment. The concentrations were measured two times, namely in the first day (I measurement) of the treatment and the seventh day (II measurement) after the chromium and selenium supplementation. For comparison purposes also serum samples of 50 patients without nutritional disorders, admitted to a planned surgical procedure to remove the gall bladder (cholecystectomy), were analyzed and treated as the control group. Descriptive statistics of measured concentrations of Cr, Se and Br both for the studied and control groups was determined. In order to check the effectiveness of Cr and Se supplementation, the results of the first and seventh day measurements for studied group were statistically compared with each other, with literature reference values and with the results of the control group (two-group comparison). These comparisons indicate the effectiveness of selenium supplementation in the applied treatment procedure. In the case of Cr and Br concentrations no statistically significant differences were observed. We conclude that monitoring of the concentration of the important trace elements in human serum should be standard procedure in parenteral nutrition treatment. In this monitoring the TXRF technique can be successfully used.

ObjectiveIdentifying metabolic disorders at the earliest phase of their development allows for an early intervention and the prevention of serious consequences of diseases. However, it is difficult to determine which of the anthropometric indices of obesity is the best tool for diagnosing metabolic disorders. The aims of this study were to evaluate the usefulness of selected anthropometric indices and to determine optimal cut-off points for the identification of single metabolic disorders that are components of metabolic syndrome (MetS).DesignCross-sectional study.ParticipantsWe analyzed the data of 12,328 participants aged 55.7±5.4 years. All participants were of European descent.Primary outcome measureFour MetS components were included: high glucose concentration, high blood triglyceride concentration, low high-density lipoprotein cholesterol concentration, and elevated blood pressure. The following obesity indices were considered: waist circumference (WC), body mass index (BMI), waist-to-height ratio (WHtR), body fat percentage (%BF), Clínica Universidad de Navarra-body adiposity estimator (CUN-BAE), body roundness index (BRI), and a body shape index (ABSI).ResultsThe following indices had the highest discriminatory power for the identification of at least one MetS component: CUN-BAE, BMI, and WC in men (AUC = 0.734, 0.728, and 0.728, respectively) and WHtR, CUN-BAE, and WC in women (AUC = 0.715, 0.714, and 0.712, respectively) (pConclusionsFor the BMI, the optimal cut-off point for the identification of metabolic abnormalities was 27.2 kg/m2 for both sexes. For the WC, the optimal cut-off point was of 94 cm for men and 87 cm for women. Prospective studies are needed to identify those indices in which changes in value predict the occurrence of metabolic disorders best.

An amendment to this paper has been published and can be accessed via the original article.

Introduction and objective The prevalence of metabolic syndrome and overweight in individuals with normal body weight is connected with higher exposure to type 2 diabetes and cardiovascular diseases. The aim of the study was to evaluate the risk and frequency of occurrence of metabolic syndrome and each of its components among individuals with normal weight. Material and Methods Data were obtained by structured interview, and by measurements of anthropometric factors and blood analyses among 13,172 individuals aged 37–66. The risk of occurrence of metabolic syndrome was analysed in tertiles within the normal range of BMI (18.5–24.9 kg/m 2 ). Results Metabolic syndrome was diagnosed in 17.27% of individuals with normal weight. A significant increase in the risk of occurrence of metabolic syndrome in females was observed within the second (OR = 2.22; 95% CI: 1.63–3.05) and the third (OR = 3.97; 95% CI: 2.97–5.36) tertiles of normal BMI values. In males, a significantly higher risk of occurrence of metabolic syndrome was noted only in the highest BMI tertile (OR = 2.16; 95% CI: 1.26–3.83), compared to the reference level. Conclusions A high frequency of occurrence of metabolic syndrome risk factors was observed among individuals with BMI close to the upper cut-off point of the normal range. In order to early diagnose metabolically obese individuals with normal weight it is necessary to check the waist circumference when BMI ≥ 22.5 kg/m 2 in females, and BMI ≥ 23.8 kg/m 2 in males, where abnormal values should be a signal that further examinations should be performed to determine other risk factors of metabolic syndrome.