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Background: Acceleration load causes several physiological changes that play important roles in pilot performance. One of the problems is determining individual factors responsible for the differences in changes in the level of central nervous system (CNS) arousal after exposure to acceleration loads. We were interested in whether the coping style and anxiety as a trait might differentiate the subjects in terms of reactions of the CNS to +Gz load-related stress., Methods: Examined were 31 male volunteers with ages between 23 and 30 yr. Measurements were obtained under controlled conditions before, during, and every 2 min up to 12 min after centrifugation. The study was conducted using the Coping Inventory for Stressful Situations (CISS) and State Trait Anxiety Inventory. The value of Critical Flicker Fusion Threshold (CFFT) corresponded to the level of CNS arousal., Results: Two significantly different trends of changes in CNS arousal were identified: class 1 (higher level of fatigue following +Gz load) and class 2 (lower level of fatigue following +Gz load). Significant differences were observed in CISS scores with Task-Oriented Coping value in class 1 (M = 65.94, SD = 5.47) being considerably greater than in class 2 (M = 62, SD = 4.37). For Emotion-Oriented and Distraction Coping, the mean value in class 1 (M = 29.53, SD = 7.72; M = 16.82, SD = 3.8) was significantly lower than in class 2 (M = 34.33, SD = 6.68; M = 19.42, SD = 3.4)., Discussion: The nature of the changes in CFFT values over time is associated with coping style. Coping styles are very valuable in the prediction of CNS arousal caused by exposure to +Gz stress.Biernacki MP, Lewkowicz R, Zieliński P, Wojtkowiak M. Coping and changes in arousal after exposure to +Gz load. Aerosp Med Hum Perform. 2017; 88(11):1034-1039.

Introduction: An important problem for pilots is visual disturbances occurring under +Gz acceleration. Assessment of the degree of intensification of these disturbances is generally accepted as the acceleration tolerance level (ATL) criterion determined in human centrifuges. The aim of this research was to evaluate the visual-motor responses of pilots during rapidly increasing acceleration contained in cyclic intervals of +6 Gz to the maximum ATL., Methods: The study involved 40 male pilots ages 32-41 yr. The task was a quick and faultless response to the light stimuli presented on a light bar during exposure to acceleration until reaching the ATL. Simple response time (SRT) measurements were performed using a visual-motor analysis system throughout the exposures which allowed assessment of a pilot's ATL., Results: There were 29 pilots who tolerated the initial phase of interval acceleration and achieved +6 Gz, completing the test at ATL. Relative to the control measurements, the obtained results indicate a significant effect of the applied acceleration on response time. SRT during +6 Gz exposure was not significantly longer compared with the reaction time between each of the intervals. SRT and erroneous reactions indicated no statistically significant differences between the "lower" and "higher" ATL groups., Conclusion: SRT measurements over the +6-Gz exposure intervals did not vary between "lower" and "higher" ATL groups and, therefore, are not useful in predicting pilot performance. The gradual exposure to the maximum value of +6 Gz with exposure to the first three intervals on the +6-Gz plateau effectively differentiated pilots.

Objectives: Back pain in Air Force fast jet pilots has been studied by several air forces and found to be relatively common. The objective of the study was to determine the prevalence and degree of the pain intensity in the cervical, thoracic and lumbar spine, subjective risk factors and their effect on the pilots' performance while flying high maneuver aircrafts and the consequences for cognitive deficiencies., Material and Methods: The study was designed as a retrospective, anonymous questionnaire survey, collecting data on the age, aircraft type, flying hours, pain characteristics, physical activity, etc. The study was participated by 94 pilots aged 28-45 years (mean age: 35.9 ± 3.3 years), actively flying fast jet aircrafts Su-22, Mig-29 and F-16. The estimates regarding the level of the subjective back pain were established using visual analogue scales (VAS)., Results: The values of the Cochran and Cox T-test for heterogeneous variances are as follows: for the total number of flying hours: F = 2.53, p = 0.0145, for the pilot's age: F = 3.15, p = 0.003, and for the BMI factor F = 2.73, p = 0.008., Conclusions: Our questionnaire survey showed a significant problem regarding spinal conditions in high performance aircraft pilots. The determination of the risk factors may lead to solving this problem and help eliminate the effect of the unfavorable environment on piloting jet aircrafts. Experiencing back pain during the flight might influence the mission performance and flight safety. The costs of pilots education are enormous and inability to fly, or even disability, leads to considerable economic loss. More research on specific prevention strategies is warranted in order to improve the in-flight working environment of fighter pilots.

Introduction: Pilots flying at very high speed are exposed to the effects of prolonged accelerations while changing their flight path. The aim of this research was to assess the impact of sustained accelerations on the visual-motor response times of pilots and the acceleration tolerance level (ATL) as a measure of pilots' endurance to applied +G(z)., Method: The study involved 18 young pilots, 23-25 yr of age. The subjects' task was to quickly and accurately respond to the light stimuli presented on a light bar during exposure to acceleration at +4.5 G(z) and until reaching the ATL. Simple response time (SRT) measurements were performed using a visual-motor analysis system throughout the exposures, which allowed the assessment of a pilot's ATL., Results: The pilots' ATL ranged from 270 to 366 s (Mean = 317.7 +/- 26.15 SD). The analysis of the SRT indicated a significant effect of duration of acceleration on the visual response time. The results of the post hoc comparisons showed that SRT increased with longer durations of the same level of +G(z) load and then decreased, reaching values similar to the controls., Conclusion: Exposure to prolonged acceleration of +4.5 G(z) significantly increases SRT. There was no statistically significant difference in SRT between the pilots with "short" and "long" time exposures. A pilot's SRT during a prolonged +4.5 G(z) exposure could be a reliable indicator of pilot G performance in the fast jet. Deterioration of SRT may be used to predict imminent +G(z) endurance limits between pilots with widely varying endurance abilities.

Successful Crohn's disease conservative treatment is often associated with use of few, sometimes new drugs. Their clinical use apart from inflammatory process decrease is associated with some risk. In the paper we report a case of 23-year-old woman suffering from Crohn's disease treated successfully with anti-TNF antibodies. Apart from successful anti-inflammatory there were observed not symptomatic perforation of the alimentary tract. Patients treated with strong anti-inflammatory drugs require especially careful monitoring also because of possibility of occurrence of not symptomatic life-threatening conditions.

The Aim: Non-erosive reflux disease is presented in reflux diseases classifications not adequately Many esophageal lesions were described in different endoscopic techniques but not one classification was proposed. In many patients with signs of prolonged gastro-esophageal reflux in endoscopic assessment pale mucosa above gastro-esophageal junction was observed. In some patients color of esophagus in distal part becomes white and grey. We decided to check what histological lesions appear in all endoscopically visible lesions., Material and Methods: We analyzed 29 patients with chronic reflux disease and with endoscopic assessment of upper alimentary tract in which white color was observed in distal part of esophagus was observed. Biopses were taken from sites at least 2 cm from Z-line. Endoscopic assessment was performed by one endoscopist specialized in reflux disease. Biopsies were assessed by one pathologist specialized in upper alimentary tract diseases assessment., Results: In all cases biopsies taken from distal esophageal, white-coloured mucosa were assessed by pathologist as esophagitis caused by gastro-esophageal reflux., Conclusions: White color of the distal part of esophagus in patients with chronic reflux disease is unanimously associated with microscopic lesions associated with reflux disease.

Technology development in data processing in ultrasonography let new imaging method feasible. New method of imaging is elastography (elastosonography, ultrasonographic elastography). It relays on the presumption that pathologically changed tissues have different elasticity and change their shape in different way than health tissue. Elastography is used in lesions in alimentary tract diagnostics. Sensitivity and specificity in malignant lesions differentiation is 85% and 90%. In elastography there is used conventional ultrasonography device that is equipped with additional transformator that is located in probe. Examination is performed with multiple pressing the organ. Imaging is acquired in real-time regime they are colour-coded and they are created during compression. As a result of computer analysis images are generated in two colours. On the basis of character of normal and increased rigidity images were classified in five point scale from one to five. Indication to elastography is suspicion of malignant lesions in traditional ultrasonography and monitoring of liver cirrhosis and fibrosis. More trials are required to evaluate this method more reliably. Then it could be recommended for everyday clinical use.

Gastroesophageal reflux disease has become recently an important question, especially in developed countries. Untreated or improperly treated could in chronic disease or can lead to serious complications including esophageal cancer. Early diagnosis establishment basing on clinical symptoms and diagnosing methods. Typical signs of gastroesophageal reflux diseases are acidity, regurgitation, especially after heavy meals or body position change. Those signs are basic for diagnosing establishment. It is recommended to introduce empiric treatment and more diagnostics should be employed if the treatment is not successful. Among diagnosing methods constant development is taking place what is associated with technology progress along with clinical trials. Authors in the paper basic diagnosing tools are presented showing their possibilities and limitations. Proper use of those diagnosing tools that should lead to quick diagnosis establishment.

Non-erosive gastroesophageal reflux disease (NERD) is still underappreciated type of gastroesophageal reflux disease (GERD). It is not a homogenous group of patients with real reflux, oversensitivity of esophagus and functional dyspepsia. Nowadays often in classifications of GERD patients with NERD are omitted. Many endoscopic lesions are found in esophagus in NERD, especially color change of mucosa. Erythrema is nowadays taken into account. Unequivocal are also opinions about histological image. Many histological lesions are found but not a specific lesions were typified. Probably it is the best to associate NERD with clinical symptoms, endoscopic and histological image.

Crohn disease treatment is a considerable challenge for a medical doctor. Gaining clinical remission is not enough. The important factor taken into account in treatment is gaining clinical remission and complete mucosal healing. Treatment useful in mucosal healing consists of immunosupresants as azathioprine, 6-markaptopurin, methotrexate and biological treatment. Important factors influencing mucosal healing is choice of medical treatment and its proper timing. More aggressive treatment in top-down scheme appears to be more successful in this aspekt than classical treatment with use of steroids. This data requires verification with more clinical trials.

The rising incidence of alimentary tract diseases forces imaging metod development. Developing radiologic diagnostics changed imaging methods role and increased quality demand. X-ray based methods are still used in diagnosing many illnesses. Basic abdominal x-ray in nightshift condition is necessary to diagnose perforation or obstruction. Ultrasonographic, computed tomography and magnetic resonance imaging methods are the most important nowadays. The most popular and non-invasive method of imaging is ultrasonography. It is irreplaceable thanks to its availability and precision diagnosing many internal organs. One of the newest method is magnetic resonance and imaging in all possible scans. Complimentary method is computed tomography. It is based on human body layers analysis. Method is based on x-rays and assessing all tissues absorption. It can produce three dimensional imaging. The newest software can produce virtual imaging of all body cavities as well as colon. Basic and highly specialistic methods should be carefully planned in diagnostic-therapeutic process. In decision making what method should be used, medical doctor and patient should take part, taking into account all indication and cotraindications as well as method limitations.

Gastroesophageal reflux disease is a serious clinical problem. In clinical classification of gastroesophageal reflux disease we differentiate esophageal and non-esophageal syndromes. In case of esophageal syndromes we differentiate based on clinical signs and syndromes with esophageal mucosal lesions based diagnosed on base of upper alimentary tract endoscopic and histopathologic assessment. In clinical diagnosis establishing basics are clinical symptoms as heartburn, regurgitation. Usually, recently found typical symptoms of light intensification can be concluded with diagnosis gastroesophageal reflux disease and without other diagnostic tools treatment could be introduced. Helpful diagnostic test is a test with proton pump inhibitors. Endoscopic assessment should be performed at least once in every patient with chronic gastroesophageal reflux disease in order to eliminate complications (Barrett disease). Main impedance advantage is possibility of reflux diagnosis disregarding ph value. Continuous monitoring of impedance in many segments of esophagus can help to establish direction of reflux and its characteristics and extent establishment. (liquid, gaseous, mixed). The main role in pharmacological gastroesophageal reflux disease treatment plays drugs decreasing acid output, proton pump inhibitors (PPI). Dosage of chronic use should be assess individually. The Basic rule is the use of possibly minimal therapeutic dose of PPI. In this paper authors presented basics of gastroesophageal reflux disease diagnosing, monitoring and treatment.

Development in immunology and better understanding of prolonged inflammatory process is basic in inflammatory bowel diseases treatment development. The new generation of drugs could be included infliximab and adalimumab. To the same group we include tumour necrosis factor inhibitors (infliximab, adalimumab, etanercept, certolizumab, onercept), selective adhesive molecules inhibitors (natalizumab, alicaforsen), Th1 dependent reaction inhibitors (anti-il-12, tacrolismus, il-10), lymphocytes migration inhibitors (natalizumab). Those drug are under development or in various clinical trials phases and are the future of inflammatory bowel diseases treatment.

Objectives: Human reactions to environmental changes have been the subject of numerous investigations related to pathophysiology, aviation psychology, aviation, and sports. The present study aimed at evaluating the perception of light stimulus via the Critical Flicker Fusion threshold (CFF) measurements among aviation pilots., Materials and Methods: The study was carried out under hypoxic conditions corresponding to 5000 m altitude, for a period of 30 min, without the use of supplemental oxygen. Fourteen volunteer pilots, 23-30 years of age, were examined in the hypobaric chamber (HC). The measurements were performed at normobaria and at the initial and final phase of hypoxia. Heart rate (HR) and blood oxygen saturation (SaO2) were monitored., Results: The high altitude hypoxia was found to produce a decrease in the CFF threshold F(3.39) = 3.207, p < 0.05, and SaO2 F(3.39) = 52.651, p < 0.001, as well as HR increase F(3.39) = 7.356, p < 0.001. The results indicate that the higher the decrease in SaO2 under hypoxic conditions, the higher the decrease in CFF r = .567 p < 0.05. Likewise, the higher the increase in HR, the higher the decrease in CFF r = -0.491 p < 0.05., Conclusions: Under hypoxic conditions, the perceptual ability of the pilots is gradually decreasing. This has been confirmed by the findings of the physiological examinations. The authors express an opinion that it would be advisable to introduce CFF measurement into the hypobaric chamber tests as it allows individual assessment of the pilot's perceptual ability under conditions of incomplete physiological compensation of the high altitude hypoxia.

Unlabelled: The evolution of surgery of no neoplastic diseases of the gastroesophageal junction, particularly gastroesophageal reflux disease (GERD), is an unquestionable factor for further analysis of indications for treatment and treatment results. Full-symptomatic GERD with coexisting sliding hiatal hernia is an indication for surgical treatment for a long time. The question is when to operate functional disorders of the esophagus and lower esophageal sphincter (LES) and what the results of the treatment are. Aim of study was to analyze results of surgical treatment of patients with GERD on the background of functional disorders and patients with sliding and mixed hiatal hernia., Material and Methods: This study retrospectively analyzed the data of 49 patients operated in Department of General, Oncological and Thoracic Surgery. Patients were divided into two groups. First group: patients with symptomatic GERD with confirmed 24 hour pH monitoring night-time and after-meal acid refluxes--23 subjects. Second group: patients with symptomatic GERD with type I and III hiatal hernia proven by gastroscopy, radiological tests and intraoperative examinations--26 subjects. There was no sign of decreased esophageal propulsive function among examined patients. For surgical intervention from the first group were qualified patients after ineffective conservative management. All patients underwent Nissen procedure--laparoscopy, hernioplasty and floppy fundoplication, and agreed on follow-up evaluation after 3, and some after 6 and 12 months which included case history, gastroscopy and 24 hour pH monitoring., Results: Operative management resulted in withdrawal of suffered subjective symptoms and remission of lesions in lower part of esophagus. 10% of the patients had LES motor activity dysfunction not qualified for surgical consultation. There was no case of recurrence of hiatal hernia., Conclusions: Patients suffering from LES functional disorders and type I and III hiatal hernia can be effectively treated with surgical management.

Tretament in gastro-esophageal reflux disease (GERD) is in constant change. It is caused by the fact of change and development of diagnostic and therapeutic methods. Alternative methods of treatment are still searched beacause patients do not accept many years long drug treatment or surgical procedures. New methods are developed. Some of them as endoscopic fundoplication or methods of polimerizing substances injection in the area of lower esophageal sphincer have been abandoned because of low quickly diminishing efficacy Endoscopic sewing that implicate all layers of gaster is still under clinical trials and is considered as interesting. Stertt's procedure that is based on electromagnetic wave application in the area of lower esophageal sphincter is used in clinical practice. Despite effective methods of diagnosing and treatment of GERD there is no evidence of lowering incidence of complications of GERD. It is still common to find esophagus stricture as the first illness manifastation. Chronic character of GERD is associated with intestinal metaplasia and adenocarcinoma of the esophagus in its distal part. The most effective endoscopic methods of the treatment include: endoscopic dilation of the strictures and endoscopic methods of patological epithelium removal in Barrett's esophagus. These are: photodynamic therapy, argon coagulation, laser thermoablation, multipolar ablation and endoscpic mucosectomy. The paper is the review of the methods aimed at GERD and its complication treatment.

Unlabelled: Hiatal hernia seems to be one of the significant clinical problems. The criteria of its diagnosis, occurrence and possible influence on esophageal reflux disease are still controversial. The aim of this paper is to research the incidence of hiatal hernia based on endoscopic criteria of its diagnosis and its influence on other esophageal diseases., Material and Methods: More than 729 patients, to whom endoscopy was made, were examined. The accepted endoscopic features of hiatal hernia and other lesions which could be related to it and other characteristic features of esophageal reflux disease were searched., Results: On the basis of accepted diagnostic criteria the hiatal hernia was diagnosed in 44.16% of men and in 42.77% of women. There were no difference in hiatal hernia occurrence in relation to age, gender and weight. The endoscopic features of esophageal reflux disease were found in 36.14% of women and 61.47% of men. The statistically significant incidence was observed in patients with hernia 55.99% women and 74.51% men and without hernia respectively in 22.81% and 51.16%. Similar differences took place in specific types of gastroesophageal disease, especially endoscopic features characteristic for Barrett's esophagus were observed nine times more frequently in men with hernia. Types with erosions were observed twice as much in patients with hernia of both sex. Esophagus mucosae cloudiness was observed three times more frequently in women with hernia and 50% more frequently in women., Conclusions: All the data suggests there is a significant coincidence between hiatal hernia and esophageal reflux disease.

Gastro-esopgageal reflux disease (GERD) incidence increase in most developed countries. It concerns 5 to 15% of the population. It requuires life style modification as well as prolonged medicamentd intake. The current situation requires development of new techniques of diagnosing and treatment as well as enhancement of old ones. The effective care of the patient suffering from GERD requires interdisciplinary cooperation. It means general practicioner, gastroenterologist, diatary specialist and sometimes psychologist and recently more commonly surgeon. Despite development of new dianostic methods still basic medical care should be based on anamnesis, physical assessment, endoscopic and radiological procedures. Other methods are designed to treat more complicated or associated with the higher risk of complication manifestations of GERD. Still individual assessment is of all given results allow the proper choice of proceeding and method of treatment. Ph-metry and manometry of esophagus or nowadays more commonly used ph-metry with impedancy and its combination with manometry does not answer all the diagnostic questions. Authors present possibilities and limitations of basic diagnostic methods used in GERD.

Objectives: Visual disturbances are commonly accepted criteria for acceleration tolerance assessment. Researchers during centrifuge experiments use them as a safe criterion for cessation of acceleration exposure. Visual disturbances analysis is a non-invasive method of assessing retinal blood flow. Limitation of visual stimuli perception is a measure of physiological state of the experiment participants before hemodynamic changes, which reach a critical level manifested by G-induced loss of consciousness. Detection of these disturbances play an important role during the acceleration tolerance assessment. In this study, an attempt was made to answer the question on how many mistakes or incorrect reactions had to be identified to classify the ability of the pilot to fly on military jets., Materials and Methods: A new computer-aided research apparatus of our own design was used to assess visual disturbances, being a criterion of +Gz tolerance. In the center of monitor screen, a line of 3 light points was projected. During the centrifuge test, green lateral lights randomly changed their shapes from circles to squares while central light, being a point of vision fixation, remained unchanged. To assess its efficacy, 14 volunteers participated in the tests with various stimuli exposure. The authors aimed at selecting parameters of stimuli and exposure so that the division of reactions presented in the table would correspond with the score scale appropriate for our goals., Results: Preliminary tests showed that appropriately selected light intensity of the exposed stimuli enables the use of test results to assess the number of erroneous reactions, and consequently the level of pilots' concentration during centrifuge tests., Conclusions: It has been found that the chosen luminance range of the projected light points is correct as it allows to evaluate the reactions, which should be considered erroneous. Additionally, prolongation of the correct reaction time to the mean value of about 400 ms facilitates better differentiation of results. Proper results evaluation, depending on the number of errors, lack of reactions or prolonged reactions made the assessment easier with computer-aided methods.

In recent few years there took place a significant development of endoscopic antireflux procedures. There appeared a need for review of these procedures. There could be distinguished three basic directions in treatment; endoscopic sewing, injection and implantation technique based on administering polymer-based, biologically neutral substances and the technique based on applying radiation of radiowave length in the region of lower esophageal sphincter.

Gastroesophageal reflux disease (GERD) is one of the most common publication subjects in gastroenterology field for more than twenty years. The following article is a review of endoscopic methods of treatment of GERD complications. It is interesting that complications of disease are quite common despite the constant development of diagnostics and treatment methods. It is still common to diagnose the disease when the first manifestation is the esophagus constriction. The complication of GERD is the intestinal metaplasia and adenocarcinoma of the distal part of the esophagus. There are effective endoscopic methods of GERD complications treatment. The most effective are esophagus dilations and endoscopic pathological mucosae layer removal like photodynamic therapy, laser ablation, argon coagulation, multipolar coagulation or mucosectomy.

The goal of this paper was studying the effectiveness of frequently repeated low values of long duration acceleration on circulatory system response during gradual onset rate of acceleration on a human centrifuge.

The effects of acceleration (Gz) on changes in the levels of cortisol in saliva and of cortisol and testosterone in serum have been studied in 48 cadet pilots exposed to a linear acceleration gradient (0.2 G/s) until a loss of coordination when the mean G value was found to be 5.94 +/- 0.57. Three patterns of salivary cortisol responses were discerned based on Gz-induced significant changes: increase (I; n = 20), decrease (D; n = 8), the magnitude of changes being dependent on the pre-Gz values. Fifteen min after the Gz load, the mean salivary cortisol was significantly higher from the pre-Gz value in all subjects combined. In 19 subjects, who consented to blood sampling, significant increases in serum cortisol were observed both 3 and 15 min post-Gz (by 37 and 57% respectively) while, a significant increase in serum testosterone concentration has been observed only 3 min post-Gz. Testosterone levels 3 min post-Gz were significantly correlated with the final Gz values (r = 0.54; p < 0.05). A significant correlation was also observed between all salivary and serum cortisol values combined (r = 0.696; p < 0.001). It has been concluded that acceleration stress, although of very short duration, proved very potent in eliciting glucocorticoid and androgen responses.

Twenty-five men with decreased acceleration tolerance limits were subjected to two weeks centrifuge training, in which selected characteristics of +Gz acceleration (head-feet directed) were applied. The training loads were controlled basing on the responses of blood flow velocity and heart rate. The results show that the human centrifuge training in which the graded loads are based on measurement of these parameters, increases acceleration tolerance limits. It is also demonstrated that the human centrifuge training methods can be used in pilots after convalescence period or on finding lowered acceleration tolerance produced by other causes. The physical and physiological methods of increasing acceleration tolerance limits (ATL) consist some of the most important and urgent problems of today to be solved in modern military aviation. This demand is produced not only by the systematically increasing requirements as to the highest health performance of the military pilot, but also by the enormous costs of the flying equipment and training. In the group of different methods of increasing ATL, the human centrifuge training is an open problem. The available literature presents only a few reports in which the +Gz acceleration (i.e. head-pelvis directed) was used as the loading stimulus in pilots' training. The reasons for the lack of interest in this direction of examination include: easily developed decompensation of the circulatory system; cummulated effects of acceleration, and lack of optimal criteria to evaluate the body systems loads. Moreover, the positive effects of training could be baffled by the above mentioned factors.(ABSTRACT TRUNCATED AT 250 WORDS)