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The aim of this single-center observational study was to analyze the applicability of various imaging studies to the diagnosis and further evaluation of patients with chronic recurrent multifocal osteomyelitis (CRMO). The analysis included the data of 10 patients with CRMO treated between 2016 and 2021. The mean ages of the patients at the first manifestation of CRMO and ultimate diagnosis were 10 years and 7 months and 11 years and 10 months, respectively. Conventional radiography demonstrated focal loss of bone density in only 30% of the patients. Computed tomography showed disseminated foci with non-homogeneous osteolytic/osteosclerotic structure, with a massive loss of cortical layer and strong periosteal reaction. On magnetic resonance imaging (MRI), most patients presented with multifocal hypodense areas on T1-weighted images, with the enhancement of signal on T-weighted and STIR sequences. The duration of follow-up varied between 3 months and 3 years. In 40% of the patients, both clinical symptoms and the abnormalities seen on MRI resolved completely, whereas another 50% showed partial regression of clinical and radiological manifestations. MRI findings, co-existing with characteristic clinical manifestations, play a pivotal role in establishing the ultimate diagnosis of CRMO. MRI can also be used to monitor the outcomes of treatment in CRMO patients.

Introduction IgG4-related disease (IgG4-RD) is a systemic fibrotic-inflammatory disease characterised by elevated serum concentration of IgG4 and tissue infiltration by plasma cells. IgG4-RD is a newly recognised fibro-inflammatory condition, characterised by organ mass lesions, special histopathological appearance, and - often but not always - elevated serum IgG4 concentrations. IgG4-RD is a separate, clinically distinct disease entity, but, due to its heterogeneous manifestation, it is a subject of interest of physicians of various specialties. Histopathological examination is the gold standard in the diagnosis. Case report In the paper we discuss the case of a 13-year-old patient who had been diagnosed with fully symptomatic IgG4-RD nine years after initial manifestation. Although IgG4-RD is diagnosed markedly more often in adults than in children, in this case report we would like to emphasise that the disease may also occur in paediatric patients, and it constitutes both a diagnostic and therapeutic challenge in this age group. Conclusions IgG4-RD is a poorly recognised disease, especially in the paediatric population. To the best of our knowledge, case reports on IgG4-RD in paediatric patients available in the literature are sparse. The non-specific and heterogeneous manifestation may hinder the diagnostic process, and in some cases the disease is diagnosed accidentally, especially when it is asymptomatic. Since 2015, the first-line treatment in IgG4-RD has been glucocorticoids; however, combination therapies should not be underestimated as another method to achieve permanent remission.

A linear transimpedance amplifier (TIA) for a 53 GBd PAM-4 optical link to support 100 Gb/s data on a single wavelength is reported. Designed in a 16 nm FinFET CMOS process, the chip consumes 60.8 mW with $\sqrt {\mathrm{Hz}}$ . Transimpedance can be programed from 62 to 83 dB $\rm \Omega $ in 0.5 dB $\rm \Omega $ steps to enable digital automatic gain control. Novel circuit topologies for high-bandwidth, low-noise, low-power, and high-linearity are discussed in detail. The entire signal path is realized with dc-coupled CMOS inverters biased at mid-supply to achieve maximum gain linearity. Dynamic voltage scaling tightly controls the transimpedance value, bandwidth, and in-band peaking across process, temperature, and voltage (PVT) variations to realize a robust macro with a high parametric yield needed in a system-on-chip.

The present study assessed patients’ metabolic control of phenylketonuria (PKU) during the first 2020 COVID-19 lockdown in Poland. Blood (phenylalanine) Phe results of the tests of 535 patients, performed in 2019 and in the first months of 2020, were analysed. The six-week lockdown period was compared to the preceding six-week period as well as to the two corresponding periods of 2019 (three non-lockdown periods). More patients failed to perform Phe tests in the lockdown period (32.7%) than in non-lockdown periods (15.6%, 15.1%, 17.2%, p &lt, 0.001 for all). The median Phe levels for those patients who performed testing in all the four periods did not differ between periods. However, these patients tended to perform only one test during the lockdown (ORs: 1.43 to 1.60, 95% CI: from 1.01–2.04 to 1.11–2.30, p-value 0.02 to 0.005). Patients who did not take blood during the lockdown (46.7%) performed significantly fewer blood tests in the remaining periods (median &lt, IQR&gt, 1 &lt, 0–1&gt, vs. 2 &lt, 1–4&gt, 0.001). In conclusion, direct assessment of patients’ compliance based upon Phe levels during the pandemic lockdown was not possible. Pre-pandemic non-compliant patients frequently failed to perform the test during the lockdown, whereas the previously compliant ones were more likely to perform only one test. This strongly suggests that metabolic control might have worsened.

The architecture, packaging, and performance of a Silicon Photonics single transceiver chip PAM4 optical QSFP28 transceiver module for 100 Gigabit Ethernet compliant to 100GBASE- LR1 for 10km and extendable to over 20km SMF transmission is described.

The 10th Global CRO Council (GCC) Closed Forum was held in Orlando, FL, USA on 18 April 2016. In attendance were decision makers from international CRO member companies offering bioanalytical services. The objective of this meeting was for GCC members to meet and discuss scientific and regulatory issues specific to bioanalysis. The issues discussed at this closed forum included reporting data from failed method validation runs, GCP for clinical sample bioanalysis, extracted sample stability, biomarker assay validation, processed batch acceptance criteria, electronic laboratory notebooks and data integrity, Health Canada's Notice regarding replicates in matrix stability evaluations, critical reagents and regulatory approaches to counteract fraud. In order to obtain the pharma perspectives on some of these topics, the first joint CRO–Pharma Scientific Interchange Meeting was held on 12 November 2016, in Denver, Colorado, USA. The five topics discussed at this Interchange meeting were reporting data from failed method validation runs, GCP for clinical sample bioanalysis, extracted sample stability, processed batch acceptance criteria and electronic laboratory notebooks and data integrity. The conclusions from the discussions of these topics at both meetings are included in this report.

Introduction. Controversial data on disturbances in mineral homeostasis and bone mass were reported in children with diagnosed untreated acute lymphoblastic leukemia (ALL). Early detection of bone metabolism abnormalities is important for monitoring the effect of therapy on the skeleton. The purpose of this study was to evaluate bone metabolism in children and adolescents with newly diagnosed acute lymphoblastic leukemia by assessing biomarkers of bone cell activity. Materials and methods. Propeptide of type 1 procollagen (P1NP) and osteocalcin (OC) as bone formation markers and C-terminal telopeptide of type 1 collagen (CTX) and tartrate resistant acid phosphatase 5b (TRAP 5b) as resorption markers were determined in 22 Caucasian children and adolescents (12 boys 4–21 years, 10 girls 4–16 years) with newly diagnosed, untreated ALL and in 22 age- and gender-matched controls. Results. Bone formation, in particular, and bone resorption were significantly reduced in ALL children and adolescents compared with controls (Me P1NP 51.9 vs. 433.4 μ g/L and OC 16.1 vs. 80.5 μ g/L; p < 0.0001; Me CTX 0.454 vs. 1.225 μ g/L and TRAP 5b 2.8 vs. 5.6 U/L; p < 0.001). P1NP positively correlated with OC (r = 0.56; p = 0.01) and CTX correlated with TRAP 5b (r = 0.54; p = 0.02) in children and adolescents with ALL. Median P1NP and OC concentrations in ALL children (4–9 years) were dramatically reduced compared with the healthy ones (10-fold and 9-fold respectively), whereas in adolescents with ALL (10–21 years) both bone formation markers were reduced in a lesser degree in comparison with the healthy adolescents. Conclusions. Acute lymphoblastic leukemia influences bone metabolism which is strongly related to the age of onset. More significant disturbances in bone turnover, particularly in bone formation (suppression of collagen synthesis), are observed in children with untreated ALL in comparison with adolescents with ALL.

Barczykowska Ewa, Ślusarz Robert, Lewicka Marta, Lewandowska Barbara, Kurylak Andrzej. Evaluation of paediatric injury hospitalization incidence at Hospital Ward in Grudziądz. Journal of Education, Health and Sport. 2016;6(4):429-446. eISSN 2391-8306. DOI http://dx.doi.org/10.5281/zenodo.50582 http://ojs.ukw.edu.pl/index.php/johs/article/view/3491 The journal has had 7 points in Ministry of Science and Higher Education parametric evaluation. Part B item 755 (23.12.2015). 755 Journal of Education, Health and Sport eISSN 2391-8306 7 © The Author (s) 2016; This article is published with open access at Licensee Open Journal Systems of Kazimierz Wielki University in Bydgoszcz, Poland Open Access. This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited. This is an open access article licensed under the terms of the Creative Commons Attribution Non Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted, non commercial use, distribution and reproduction in any medium, provided the work is properly cited. This is an open access article licensed under the terms of the Creative Commons Attribution Non Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted, non commercial use, distribution and reproduction in any medium, provided the work is properly cited. The authors declare that there is no conflict of interests regarding the publication of this paper. Received: 05.04.2016. Revised 25.04.2016. Accepted: 27.04.2016. Evaluation of paediatric injury hospitalization incidence at Hospital Ward in Grudziądz Ewa Barczykowska1, Robert Ślusarz2, Marta Lewicka1,3, Barbara Lewandowska4, Andrzej Kurylak1,3 1Paediatric Nursing Department, L. Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University (UMK) in Toruń 2Neurological and Neurosurgical Nursing Department, L. Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University (UMK) in Toruń 3J. Brudziński Voivodship Paediatric Hospital in Bydgoszcz 4Correction Unit No. 2 in Grudziadz Mailing address: Marta Lewicka, Collegium Medicum im. L. Rydygiera w Bydgoszczy, UMK w Toruniu, ul. Techników 3, 85-801 Bydgoszcz, Poland; Phone 52 585 21 93, e-mail: marta_grabinska@hotmail.com Abstract Introduction. Children's and adolescents' injuries are a serious medical problem, as they lead to substantial medical and socio-economic effects. Aim of the paper. The aim of the conducted research was to analyze incidence and causes of hospitalizing children between birth and 18 years of age on the grounds of injuries. Material and methods. Medical histories of 2 832 children between birth and 18 years of age treated for injuries in 2006-2010 in Wladyslaw Bieganski Regional Specialist Hospital in Grudziadz were analyzed. Results. Correlations between treatment method and subsequent years of research (p

The 9th GCCClosed Forum was held just prior to the 2015 Workshop on Recent Issues in Bioanalysis (WRIB) in Miami, FL, USA on 13 April 2015. In attendance were 58 senior-level participants, from eight countries, representing 38 CRO companies offering bioanalytical services. The objective of this meeting was for CRO bioanalytical representatives to meet and discuss scientific and regulatory issues specific to bioanalysis. The issues selected at this year's closed forum include CAPA, biosimilars, preclinical method validation, endogenous biomarkers, whole blood stability, and ELNs. A summary of the industry's best practices and the conclusions from the discussion of these topics is included in this meeting report.

Summarization: With an increasing number of low-grade primary ores starting to be cost-effectively mined, we are at the verge of mining a myriad of low-grade primary and secondary mineral materials. At the same time, mining practices and mineral waste recycling are both evolving towards sustainable near-zero-waste processing of low-grade resources within a circular economy that requires a shift in business models, policies and improvements in process technologies. This review discusses the evolution towards low-grade primary ore and secondary raw material mining that will allow for sufficient supply of critical raw materials as well as base metals. Seven low-grade ores, including primary (Greek and Polish laterites) and secondary (fayalitic slags, jarosite and goethite sludges, zinc rich waste treatment sludge and chromium-rich neutralisation sludge) raw materials are discussed as typical examples for Europe. In order to treat diverse and complex low-grade ores efficiently, the use of a new metallurgical systems toolbox is proposed, which is populated with existing and innovative unit operations: (i) mineral processing, (ii) metal extraction, (iii) metal recovery and (iv) matrix valorisation. Several promising novel techniques are under development for these four unit-operations. From an economical and environmental point of view, such processes must be fitted into new (circular) business models, whereby impacts and costs are divided over the entire value chain. Currently, low-grade secondary raw material processing is only economic and environmentally beneficial when the mineral residues can be valorised and landfill costs are avoided and/or incentives for waste processing can be taken into account. Presented on

In this study, the alkali activation potential of a Polish ferronickel slag (PS), for the production of inorganic polymers (IPs), is investigated. The effect of the main synthesis parameters, i.e., strength of the activating solution, consisting of NaOH and Na2SiO3 solutions and affecting (SiO2 + Al2O3)/Na2O and other important molar ratios in the reactive paste, pre-curing period, curing temperature and time and ageing period was investigated. The structural integrity of the produced specimens was tested after their (i) immersion in distilled water and acidic solutions for a period of 7&ndash, 30 days, and (ii) firing at temperatures between 200 &deg, C and 1000 &deg, C. Several analytical techniques including X-ray diffraction, X-ray fluorescence, Fourier transform infrared spectroscopy, Differential scanning analysis-Thermogravimetry and Scanning Electron Microscopy were used for the characterization of the produced IPs. Results show that under the optimum synthesis conditions the IPs obtain compressive strength that exceeds 65 MPa. An innovative aspect of this study is that after heating at 400 &deg, C, the specimens acquire compressive strength of 115 MPa and this indicates that they can be also used as fire resistant materials. This study highlights the potential of alkali activation for the valorization of a ferronickel slag and the production of IPs that can be used as binders or in several construction applications, thus improving the sustainability of the metallurgical sector.

Smyk Paulina, Barczykowska Ewa, ZredaPikies Aneta, Ulenberg Agata, Kurylak Andrzej. The role of pharmacotherapy, rehabilitation and nutrition in the treatment of children with West syndrome. Journal of Education, Health and Sport. 2018;8(7):221-230. eISNN 2391-8306. DOI http://dx.doi.org/10.5281/zenodo.1299949 http://ojs.ukw.edu.pl/index.php/johs/article/view/5614 https://pbn.nauka.gov.pl/sedno-webapp/works/868914 The journal has had 7 points in Ministry of Science and Higher Education parametric evaluation. Part b item 1223 (26/01/2017). 1223 Journal of Education, Health and Sport eissn 2391-8306 7 © The Authors 2018; This article is published with open access at Licensee Open Journal Systems of Kazimierz Wielki University in Bydgoszcz, Poland Open Access. This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author (s) and source are credited. This is an open access article licensed under the terms of the Creative Commons Attribution Non commercial license Share alike. (http://creativecommons.org/licenses/by-nc-sa/4.0/) which permits unrestricted, non commercial use, distribution and reproduction in any medium, provided the work is properly cited. The authors declare that there is no conflict of interests regarding the publication of this paper. Received: 02.05.2018. Revised: 18.05.2018. Accepted: 28.06.2018. The role of pharmacotherapy, rehabilitation and nutrition in the treatment of children with West syndrome Paulina Smyk1, Ewa Barczykowska1, Aneta ZredaPikies1, Agata Ulenberg2, Andrzej Kurylak1 1Department of Pediatric Nursing, Faculty of Health Sciences, Collegium Medicum in Bydgoszcz Nicolaus Copernicus University in Torun, Poland 2Laboratory for Basic Clinical Skills and Medical Simulation, Faculty of Health Sciences, Collegium Medicum in Bydgoszcz Nicolaus Copernicus University in Torun, Poland Corresponding author: Paulina Smyk Department of Pediatric Nursing Collegium Medicum in Bydgoszcz Nicolaus Copernicus University in Torun, address: Łukasiewicza 1 85 – 821 Bydgoszcz, Poland e-mail: paulina.smyk@cm.umk.pl Abstract West syndrome is classified as an epileptic encephalopathy. This syndrome is diagnosed in children aged 4-6 months. Its unsuccessful prognosis and complicated aetiology affects the delay of psychomotor development and cognitive functions of children. Repeated attacks inhibit the realization of next tasks assigned to the children’s age. Properly conducted treatment of West syndrome should be interdisciplinary and include pharmacological treatment, diet and rehabilitation. Pharmacological treatment of West syndrome includes: the ACTH hormone, corticosteroids (prednisolone), vigabatrin, valproic acid, nitrazepam, pyridoxine, zonisamide, topiramide. The therapy includes also a ketogenic diet, which assumes changes in the proportion of nutrients. Predominant ingredient in the diet are fats (80-90% of daily intake of nutrients). Further, children with West syndrome require neuropsychological and motor rehabilitation (Vojta therapy, NDT- Bobath therapy). Cooperation of therapeutic experts with parents of the children makes it possible to achieve therapeutic benefits through improvement of the children's quality of life. Mental disability and cognitive impairment associated with the syndrome result in the loss of skills already acquired by children, therefore motivation and support of the children's parents is a significant task assigned to therapeutic team members. Keywords: West syndrome, children, therapy, treatment

Biotinidase deficiency is a genetically conditioned congenital disorder of biotin metabolism. The disease is caused by mutations in the BTD-3p25 gene, located on the short strand of chromosome 3. The BTD gene conditions proper biotinidase synthesis. So far, approximately 150 mutations of this gene have been identified. The incidence proportion is one case per 61 000 births, and the carrier state – one case per 120 births. Biotin (vit. H, B7) is essential in numerous metabolic processes. The initial phase of the disease can be acute, chronic including exacerbations/remissions, progressive, and the symptoms can appear at any age. The diagnosis of patients with late-onset disease is particularly difficult, since the symptoms suggest disorders of different nature, especially neurologic. The diagnosis is based on the analysis of clinical symptoms and laboratory tests, including biotinidase activity. The supplementation of biotin is the treatment of choice. It leads to rapid resolution of symptoms and can protect against permanent consequences of the disease such as optic atrophy, hearing loss or retarded psychomotor development.

A linear TIA for a 53 GBd PAM-4 optical link to support 100 Gbps data rate on a single wavelength is reported. Designed in a 16 nm FinFET CMOS process, the chip consumes 61 mW with < 2 % THD at 600 mVpp differential output swing, 27 GHz bandwidth, and an input referred noise density of 18.3 pA/√Hz. Transimpedance can be programmed from 63 to 80 dBΩ in 0.5 dBΩ steps. Dynamic voltage scaling tightly controls the bandwidth and in-band peaking across PVT variations to improve the parametric yield.

Introduction Burns constitute the most common and severe injuries suffered in childhood. Objective The study was aimed at providing a retrospective analysis of the etiology, location, extent and depth of burns, as well as treatment methods and length of hospital stay. Material and Methods A retrospective analysis of 508 cases of children treated due to a thermal injury between 1 January 2007 31 December 2011 was conducted at the Department of Paediatrics, Urology and Paediatric Surgery, Children’s Hospital, L. Rydygier Provincial Hospital in Toruń, Poland. Results The sample group included more boys (58.9%) than girls (41.1%). The most numerous group comprised children aged 1–2 years (44.5%). Burns were largely suffered at home (91.9%). Injuries were largely caused by thermal burns (99.2%). Half of the children sustained injury to one body area (51.4%), while every third sufferer (37.9%) was affected by burns to body parts prone to trigger shock. Burns up to 5% of the Total Body Surface Area (TBSA) were suffered by half (51.2%) of the children. Most of the patients underwent conservative treatment (89.4%). Conclusions Burns were mostly suffered by children at 1–2 years of age, with boys prevailing over girls. Injuries were largely suffered at the child’s family home, in the afternoon or evening, while the child was in the care of the parents. Scalds, caused by hot liquid, constituted the most frequent type of injury. The most numerous group of affected children comprised burns to limb areas, and thorax with limbs, with the TBSA of up to 5%. The great majority of the patients underwent conservative treatment, with a hospitalization period of up to 3 days.

Introduction. Epilepsy belongs to the most frequently occurring nervous conditions. Depending on the course ofthe disease and on the support provided to the child from his/her closest family, the child’s physical, mental and social functioning differs.Aim. The aim of this paper is the physical functioning of epileptic children in the opinion of their parents.Material and Methods. The study was performed on 94 children with diagnosed epilepsy, treated in the Departmentof Infectious Diseases and Child Neurology, Poznan University of Medical Sciences. A proprietary polling questionnaire as well as a parent-targeted QOLCE (Quality of Life in Childhood Epilepsy Questionnaire) served as the measure; consequently, parents or carers to the children within the study were also included as participants.Results. The studied children were rarely left unmanned during play, and they never spent a night out. In the assessment of the physical functioning performed by fathers and mothers, a statistically significant difference (p≤0.05)was observed; children function better in this section according to mothers. The parents’/carers’ education as well asthe child’s educational facility is a statistically significant (p≤0.05) factor influencing physical functioning of a child.No significant difference was noted between the child’s area of residence (p≥0.05) and age (p≥0.05) and his/herphysical functioning.Conclusions. The majority of the studied children attended a school or a kindergarten. Epilepsy significantly limitschildren when it comes to their physical functioning. Among factors influencing the level of a child’s physical functioning, parents’ education and child’s educational facility present themselves as the most relevant. (JNNN 2015;4(4):146–151)

The 8th GCC Closed Forum for Bioanalysis was held in Baltimore, MD, USA on 5 December 2013, immediately following the 2013 AAPS Workshop (Crystal City V): Quantitative Bioanalytical Methods Validation and Implementation – The 2013 Revised FDA Guidance. This GCC meeting was organized to discuss the contents of the draft revised FDA Guidance on bioanalytical method validation that was published in September 2013 and consolidate the feedback of the GCC members. In attendance were 63 senior-level participants, from seven countries, representing 46 bioanalytical CRO companies/sites. This event represented a unique opportunity for CRO bioanalytical experts to share their opinions and concerns regarding the draft FDA Guidance, and to build unified comments to be provided to the FDA.

Cerebral palsy (CP) is a chronic and incurable disease, in which there is high possibility to significantly improve the patient’s condition. The formation of ways of describing the degree of physical impairment, the classification of everyday life communication skills or scales thanks to which there is high possibility to measure the quality of life in that specific group of patients, allows for thorough understanding of the needs, as well as systematic evaluation of therapeutic actions taken with respect to the patient with cerebral palsy. This work aims to provide the ways of describing a degree of physical impairment, the classification of everyday communication skills and the specific scales used to describe the quality of life patients with cerebral palsy. Research in the group of patients with ICP allows to learn the needs of patients and may be useful in channeling into development of the patients’ life quality from both clinical and social aspects. (JNNN 2014;3(4):183–187)

Barczykowska Ewa, Ślusarz Robert, LewickaMarta,Lewandowska Barbara, Kurylak Andrzej. Evaluation of paediatric injury hospitalization incidence at Hospital Ward in Grudziądz. Journal of Education, Health and Sport. 2016;6(4):429-446. eISSN 2391-8306. DOI http://dx.doi.org/10.5281/zenodo.50582 http://ojs.ukw.edu.pl/index.php/johs/article/view/3491 The journal has had 7 points in Ministry of Science and Higher Education parametric evaluation. Part B item 755 (23.12.2015). 755 Journal of Education, Health and Sport eISSN 2391-8306 7 © The Author (s) 2016; This article is published with open access at Licensee Open Journal Systems of Kazimierz Wielki University in Bydgoszcz, Poland Open Access. This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited. This is an open access article licensed under the terms of the Creative Commons Attribution Non Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted, non commercial use, distribution and reproduction in any medium, provided the work is properly cited. This is an open access article licensed under the terms of the Creative Commons Attribution Non Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted, non commercial use, distribution and reproduction in any medium, provided the work is properly cited. The authors declare that there is no conflict of interests regarding the publication of this paper. Received: 05.04.2016. Revised 25.04.2016. Accepted: 27.04.2016. Evaluation of paediatric injury hospitalization incidence at Hospital Ward in Grudziądz Ewa Barczykowska1, Robert Ślusarz2, Marta Lewicka1,3, BarbaraLewandowska4, Andrzej Kurylak1,3 1Paediatric Nursing Department, L. Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University (UMK) in Toruń 2Neurological and Neurosurgical Nursing Department, L. Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University (UMK) in Toruń 3J. Brudziński Voivodship Paediatric Hospital in Bydgoszcz 4Correction Unit No. 2 in Grudziadz Mailing address: Marta Lewicka, Collegium Medicum im. L. Rydygiera w Bydgoszczy, UMK w Toruniu, ul. Techników 3, 85-801 Bydgoszcz, Poland; Phone 52585 21 93, e-mail: marta_grabinska@hotmail.com Abstract Introduction. Children's and adolescents' injuries are a serious medical problem, as they lead to substantial medical and socio-economic effects. Aim of the paper. The aim of the conducted research was to analyze incidence and causes of hospitalizing children between birth and 18 years of age on the grounds of injuries. Material and methods. Medical histories of 2 832 children between birth and 18 years of age treated for injuries in 2006-2010 in Wladyslaw Bieganski Regional Specialist Hospital in Grudziadz were analyzed. Results. Correlations between treatment method and subsequent years of research (p Conclusions. 1. The most frequent causes for placing children in the hospital were cranioencephalic injuries, injuries to the osteoarticular system, and burns. 2. The children's age determined the type of injury inflicted. Children in the youngest age group were most frequently hospitalized for burns, children in the age of 3-6 years for foreign bodies, and in the group of 7-18 years of age for injuries to the chest and to the osteoarticular system. 3. Boys were more frequently injured in a manner requiring hospital treatment than girls were. 4. A decisive majority of injured children required only conservative treatment and a stay in the hospital for no more than 3 days. 5. A constant tendency of higher occurence of injuries in children during spring and summer, was observed. Keywords: children, injuries, hospitalization, child hospitalizated, trauma.

Background We sought to verify the hypothesis that children and young adults with cancer who have completed treatment differ according to the type and degree of renal damage. Procedure This study included 144 children and young adults (73 female) who had completed treatment for leukemias and lymphomas (group L, n=45), Wilms tumor (group W, n=52) and other solid tumors (group S, n=47). The following parameters were evaluated: serum concentrations of creatinine, cystatin C, β2-microglobulin, neutrophil gelatinase-associated lipocalin and urine excretion of albumin, and urinalysis with sediment. Glomerular filtration rate (eGFR) was estimated using the classic Schwartz (eGFRSch), Schwartz redux (eGFRSchred), and Filler (eGFRFiller) formulas and with the new Schwartz equation for patients with chronic kidney disease (eGFRSchCKD). Results Group S had the lowest eGFRSchCKD and eGFRFiller, the highest serum cystatin C and the highest albumin excretion compared with groups L and W. Groups S and W had lower eGFRSch and eGFRSchred and higher serum β2-microglobulin and neutrophil gelatinase-associated lipocalin compared with group L. Group W had lower eGFRSchCKD than group L. Conclusions Children and young adults with cancer who have completed treatment differ in the type and degree of renal damage they sustain.

Streszczenie Zaburzenia odzywienia nalezą do czestych objawow choroby nowotworowej. Rozwoj niedozywienia w przewleklej chorobie jest wynikiem zaburzonej rownowagi energetycznej ustroju, w ktorym zwiekszone zapotrzebowanie na skladniki odzywcze nie jest pokrywane z powodu mniejszej podazy i zwiekszonej utraty. Mechanizm rozwoju niedozywienia jest zlozony i nie do konca poznany, zalezy od czynnikow produkowanych przez tkanke nowotworową, jak i uklad immunologiczny gospodarza. Zastosowanie nowoczesnego, skojarzonego leczenia onkologicznego daje wyzsze wskaźniki wyleczen, ale wiąze sie z wiekszym ryzykiem wystąpienia skutkow ubocznych, w tym zaburzen stanu odzywienia. Dzieci z chorobą nowotworową nalezą do grupy wysokiego ryzyka utraty masy ciala i postepującego niedozywienia w toku leczenia onkologicznego. Jest wiele doniesien o gorszej tolerancji chemioterapii, wzroście powiklan infekcyjnych i wiekszej śmiertelności u pacjentow z niedozywieniem. Badanie stanu odzywienia powinno nalezec do standardu badania podmiotowego i przedmiotowego. Badania przesiewowe opierają sie na wywiadzie, pomiarach antropometrycznych i badaniach laboratoryjnych, a ich celem jest określenie stopnia niedozywienia i w razie konieczności wlączenie leczenia zywieniowego. W pracy tej przedstawiono kryteria sluzące do oceny stanu odzywienia i momentu wlączenia leczenia zywieniowego oraz zakres niezbednych badan laboratoryjnych. Wedlug tych zalecen, jak i innych doniesien z literatury, preferuje sie stosowanie zywienia dojelitowego wszedzie tam, gdzie jest to mozliwe, jako bardziej fizjologicznego i dającego mniej powiklan.

Background/Aims: This study presents an analysis of the sonographic and laboratory parameters of solitary kidney in Wilms tumour survivors (TWs) and compares these parameters with those of healthy individuals. Methods: Fifty-three TWs who completed treatment for Wilms tumour and 44 healthy individuals were enrolled. The study protocol consisted of completing a medical history, sonographic examination of the solitary kidney, estimation of glomerular filtration rate (eGFR) by the Schwartz or MDRD formulas, albumin urine excretion and BP measurement. Results: Sonographic signs of kidney damage were observed in 22 (41,5%) TWs. The most frequently detected abnormalities are hyperechoic rings around renal pyramids (28,3% TWs). Hypertrophy of the solitary kidney occurred in 71,7% of cases. The mean volume of the solitary kidney was 77% of the sum of the two kidney volumes in the control group. The median eGFR in the TWs group was 117 with 25Q-105,5, 75Q-130 ml/min/1,73 m2 vs 131,8 with 25Q-124, 75Q-140 ml/min/1,73 m2 in the control group (p=0,000). Six TWs (11,3%) had a value of eGFR below 90 ml/min/1,73 m2. Increased urine albumin excretion (> 30 mg/g) was observed in 7 TWs (13,2%) and in 3 (6,8%) individuals in the control group. Conclusion: Ultrasonographic abnormalities in solitary kidney of TWs are frequent. The most frequently detected abnormalities are hyperechoic rings around renal pyramids. Sonographic examination of TWs ought to be performed not only to detect tumour recurrence but also to assess the signs of kidney damage and their progression.

The rarity of malignant and intermediate vascular tumors in children means that little is known about their clinical course, optimal treatment, and variables predicting survival. A total of 32 children with malignant vascular tumors (14 angiosarcomas [AS], 5 epithelioid hemangioendotheliomas, and 13 intermediate vascular tumors, including other hemangioendotheliomas plus adult-type hemangiopericytomas), registered in the German and Polish Paediatric Soft Tissue Sarcomas Study Groups, were treated following the Cooperative Weichteilsarkom Studiengruppe (CWS)-81, -86, -91, and -96 protocols. Male sex, AS histology, tumor size >5 cm, and T2 invasiveness were independent predictors of inferior 5-year overall survival, while AS histology and T2 invasiveness were predictors of inferior 5-year event-free survival. AS histology was the most important negative prognostic factor for overall survival and event-free survival. Completeness of primary tumor excision was a good prognostic factor for survival in univariate, but not multivariate, analysis. Local therapy (radiotherapy and delayed surgery) were provided to the minority of patients (28% and 38%, respectively) late in the course of disease (after a mean of 9 and 6 months, respectively) and did not prevent local relapses. Response to systemic treatment was poor (44%) and did not prevent local and distant relapses. The clinical course and outcome in childhood epithelioid HE seems to be similar to intravascular tumors and less aggressive than AS. RTX and delayed surgery should be performed more frequently and earlier in the disease course. An urgent need for modification of systemic therapy is needed because of the development of many metastatic and/or combined relapses and poor response to classic chemotherapy. The problem of effective therapy for childhood AS is the most appaling: 13 of 14 patients died of progression despite multimodal treatment.

Streszczenie Wprowadzenie Otylośc jest zjawiskiem o charakterze epidemicznym oraz o stale rosnącym zasiegu. Jest przyczyną licznych powiklan w postaci zaburzen funkcjonowania fizycznego, psychicznego i spolecznego osob nią dotknietych. Tym samym stale wzrasta potrzeba podejmowania inicjatyw na rzecz skutecznego jej przeciwdzialania. Inicjatywe taką stanowi Regionalny Program Zwalczania Otylości u Dzieci i Mlodziezy, skierowany do mieszkancow wojewodztwa kujawsko-pomorskiego. Program, lącznie z realizacją zalozen medycznych i dietetycznych, obejmuje takze oddzialywanie psychologiczne, czym wpisuje sie w nurt psychologii zdrowia. Cel pracy W cześci psychologicznej Programu analizowano czynniki korelujące z realizacją zachowan zdrowotnych w rodzinach, przede wszystkim w aspekcie nawykow zywieniowych oraz aktywności fizycznej. Prowadzono edukacje dzieci i rodzicow w zakresie ksztaltowania i podtrzymywania zachowan sluzących zdrowiu. W rozmowach indywidualnych dązono do wydobycia zasobow mogących wesprzec planowane zmiany. Pacjenci i metody W okresie od lipca 2006 do lutego 2007 r. przebadano 190 dzieci z wojewodztwa kujawsko-pomorskiego w wieku 10–14 lat oraz ich rodzicow. Do diagnozy wykorzystano ankiety opracowane dla potrzeb Programu oraz rozmowe i wywiad psychologiczny. Wyniki Dzieci zapytane o okoliczności, w jakich jedzą cześciej lub wiecej, najcześciej opowiadaly: „gdy sie nudze”, „gdy jemy z kolegami chipsy, frytki, slodycze” oraz „gdy mam zmartwienie”. Źrodlem wsparcia dla wiekszości badanych dzieci jest „rodzina”. Rodzice zapytani o to, czym kierują sie zywiąc dziecko, w odpowiedzi wymieniali najcześciej: „wlasne doświadczenie” i „zwyczaje rodzinne”. Kierowanie sie „wiedzą z ksiązek i artykulow specjalistycznych” oraz oparcie na „wiedzy od lekarza, dietetyka” deklarowalo znacznie mniej osob. Wiekszośc badanych rodzicow przyznala, ze „nie przywiązuje szczegolnej wagi do zdrowej diety” oraz, ze jako rodzina „prowadzą raczej siedzący tryb zycia”. W co czwartej rodzinie co najmniej jedna osoba „naduzywa papierosow, alkoholu lub innych uzywek”. Wnioski W badanych rodzinach przywiązuje sie raczej malą wage do zachowan sprzyjających zdrowiu (takich jak przestrzeganie zdrowej diety, prowadzenie aktywnego trybu zycia, preferowanie odpoczynku czynnego). W kwestii zywienia przewaza kierowanie sie wlasnym doświadczeniem i zwyczajami przekazywanymi z pokolenia na pokolenie; wiedza specjalistyczna ma slabszy wplyw na ksztaltowanie nawykow zywieniowych. Z udzielanych odpowiedzi wynika, ze nadmierne jedzenie u dzieci jest uwarunkowane przewaznie sytuacyjnie (nuda, niewlaściwie zorganizowany czas wolny).

Wstep i cele Miesaki tkanek miekkich, mimo ze stanowią heterogenną grupe nowotworow zlośliwych, ze wzgledu na wspolne cechy biologiczne, kliniczne i wrazliwośc na stosowane cytostatyki podlegają zblizonej strategii leczenia. W 11 ośrodkach onkohematologicznych w Polsce, w ramach Polskiej Pediatrycznej Grypy Guzow Litych (PPGGL) od lat prowadzone jest leczenia zgodne z miedzynarodowym protokolem CWS. Pacjenci i metody Analizą objeto 52 pacjentow w III stopniu zaawansowania choroby, zarejestrowanych i leczonych przez PPGGL, wg protokolu CWS-96 w latach 1997–2003. Wyniki W calej analizowanej grupie chorych stwierdzono 30% wznow miejscowych, natomiast w wyselekcjonowanej grupie pacjentow z RMS stwierdzono 24% wznow miejscowych. Stwierdzono zjawisko zwiekszenia liczby wznow miejscowych u chorych, u ktorych rozpoczeto napromienianie po 20 tygodniu od rozpoczecia leczenia. Roznica ta najwyraźniej wystąpila u dzieci z rozpoznaniem RMS zarodkowego (44% vs 12,5%, p = 0,047). Wznowa miejscowa wystąpila najcześciej u pacjentow z rozpoznaniem histopatologicznym pozakostnej postaci miesaka Ewinga (PNET/EES) – 8 wznow na 13 chorych (61%). Wnioski Opoźnienie napromieniania wplywa na zwiekszenie liczby wznow miejscowych, szczegolnie u pacjentow z rozpoznaniem RMS embryonale. Wysoki odsetek niepowodzen leczenia pacjentow z rozpoznaniem pozakostnej postaci miesaka Ewinga sugeruje rozwazenie u tych chorych modyfikacji stosowanego w protokole CWS96 sposobu terapii.

Wstep Ostre zatrucia stanowią powazny problem medyczny i spoleczny, a ich czestośc nie wykazuje tendencji spadkowej. Zmieniający sie obraz kliniczny ostrych zatruc oraz postep w zakresie intensywnej terapii toksykologicznej zobowiązują do systematycznego aktualizowania wiedzy w tym zakresie. Cel pracy Celem pracy byla analiza czestości i przebiegu klinicznego ostrych zatruc u pacjentow w wieku rozwojowym. Pacjenci i metody Material stanowila dokumentacja medyczna pacjentow hospitalizowanych w Klinice Pediatrii, Alergologii i Gastroenterologii Collegium Medicum im. L. Rydygiera w Bydgoszczy oraz w Wojewodzkim Szpitalu Dzieciecym im. J. Brudzinskiego w Bydgoszczy w okresie od 01.01.2004 roku do 31.07.2007 roku. W pracy oceniano czestośc zatruc w stosunku do liczby dzieci hospitalizowanych, wiek pacjentow i rodzaj substancji toksycznej, a takze przebieg kliniczny i czas hospitalizacji. Wyniki W latach objetych analizą 441 dzieci hospitalizowano z powodu ostrych zatruc. Bylo to 230 dziewczynek i 211 chlopcow w wieku od 9 miesiecy do ukonczenia 18 roku zycia. Najczestszą przyczyną zatruc byly leki, a zatrucia dotyczyly najcześciej pacjentow w wieku od 13 do 18 lat. Miejsce zamieszkania mialo istotny wplyw na wystepowanie określonych rodzajow zatruc. Przebieg kliniczny zatruc i czas hospitalizacji zalezaly od rodzaju zatrucia oraz podjetych czynności terapeutycznych. Wnioski Najczestszą przyczyną ostrych zatruc byly leki. Czestośc zatruc zalezala od wieku i miejsca zamieszkania pacjenta. U mlodziezy i dzieci przedszkolnych dominowaly zatrucia lekami, natomiast u niemowląt i dzieci w wieku szkolnym przewazaly zatrucia innymi ksenobiotykami. Ostre zatrucia cześciej dotyczyly dzieci ze środowiska miejskiego. Rodzaj intoksykacji oraz wdrozonego postepowania terapeutycznego mial wplyw na przebieg kliniczny zatrucia i czas hospitalizacji.

Choroba nowotworowa u dziecka jest bardzo trudnym przezyciem nie tylko dla pacjenta, ale i dla jego rodzicow. Dotychczasowe wyniki badan pokazują, ze rodzice dzieci z chorobą nowotworową przezywają silny stres i mają problemy z przystosowaniem sie do trudnej sytuacji. Grupe badaną stanowilo 29 rodzicow dzieci z chorobą nowotworową. Celem badania byla 1. ocena poziomu leku jako cechy osobowości i jako stanu w grupie rodzicow dzieci chorych na nowotwor; 2. ocena wplywu niektorych czynnikow na poziom leku u rodzicow chorych dzieci: rola rodzica, czynniki socjodemograficzne, czynniki kliniczne. Metody 1. Do oceny poziomu leku wykorzystano kwestionariusz samooceny State Trait Anxiety Inventory (STAI). 2. Do oceny depresji wykorzystano skale samooceny Inwentarz Depresji autorstwa Becka 3. Kwestionariusz dla rodzicow 4. Kwestionariusz dla lekarza leczącego dziecko. Wyniki i wnioski Zanotowano u wiekszości rodzicow niski poziom leku jako cechy i jako stanu. Poziom leku jako stanu korelowal z poziomem leku jako cechy osobowości. Wyzszy poziom leku wykazywali rodzice w starszym wieku, zalezal on takze od wieku dziecka, czasu trwania choroby, plci dziecka.

Celem pracy byla ocena wystepowania i lokalizacji guzow oraz niezidentyfikowanych obiektow jasnych (UBO) w obrazie MRI ośrodkowego ukladu nerwowego (OUN) u pacjentow z nerwiakowlokniakowatością typu 1 (NF1). Material i wyniki U wszystkich pacjentow z NF1 prospektywnie, przesiewowo wykonywano badania obrazowe OUN (od 01.01.1996 r. do 31.05.2003 r.) oraz przeanalizowano dokumentacje medyczną. Badaniem objeto 69 pacjentow z NF1 (17 osob doroslych i 52 dzieci) i u 17 z nich (24,6%) stwierdzono guzy OUN, w tym u 14 (20,3%) guzy mozgu, a u 3 (4,3%) guzy kanalu kregowego. U 10 chorych byly to guzy drogi wzrokowej, a u 4 guzy pnia mozgu. U 35/69 (50,7%) pacjentow stwierdzono UBO. Zmiany o tym charakterze wystepowaly u 33/52 (63,5%) dzieci i tylko u 2/17 (11,8%) osob doroslych. Najcześciej zlokalizowane byly w obrebie pnia mozgu i w jądrach podkorowych. Wnioski 1. U pacjentow z nerwiakowlokniakowatością typu 1 cześciej wystepują guzy ośrodkowego ukladu nerwowego, zwlaszcza glejaki drog wzrokowych i guzy pnia mozgu, dlatego w opiece nad tą grupą pacjentow niezbedna jest ścisla wspolpraca z onkologiem. 2. Zmiany w centralnym ukladzie nerwowym o charakterze niezidentyfikowanych obiektow jasnych wystepują najcześciej u dzieci i ich stwierdzenie moze stanowic nowe kryterium ulatwiające rozpoznanie NF1 w tym wieku.

Skin of children, especially neonates and infants, shows profound anatomic and functional differences compared to an adult's skin. Skin's immaturity and lack of fully developed natural protective qualities, results in its immense fragility, tenderness and irritability. Due to these factors, it is crucial to use procedures considering the morphological and functional state of the skin in nursing. Based on data analysis from medical literature, up-to-date recommendations for skin, hair and nail care have been presented, for both infants and early children. Special attention has been given to navel, ‘diaper’ area and dry skin care. Skóra dzieci, szczególnie noworodków i niemowląt, wykazuje znaczne różnice anatomiczne i funkcjonalne w porównaniu ze skórą człowieka dorosłego. Niedojrzałość skóry i brak w pełni wykształconych naturalnych właści-wości ochronnych powoduje, że jest ona niezwykle wra-żliwa, delikatna i bardzo łatwo ulega podrażnieniom. Z powyższych względów konieczne jest stosowanie w pro-cesach pielęgnacyjnych procedur uwzględniających stan morfologiczny i czynnościowy skóry. Na podstawie analizy danych z piśmiennictwa medycz-nego przedstawiono aktualne zalecenia dotyczące pielęgnacji skóry, włosów, paznokci niemowlęcia i małego dziecka. Szczególną uwagę zwrócono na pielęgnację pępka, okolicy „pieluszkowej” oraz skóry suchej.

Lewicka Marta, Barczykowska Ewa, Jaworska Aleksandra, Daniluk-Matraś Irena, Kurylak Andrzej. The incidence of acute pancreatitis in children hospitalized with abdominal pain in Pediatric Surgery Clinic in Bydgoszcz. Journal of Education, Health and Sport. 2015;5(10):29-42. ISSN 2391-8306. DOI http://dx.doi.org/10.5281/zenodo.31917 http://ojs.ukw.edu.pl/index.php/johs/article/view/2015%3B5%2810%29%3A29-42 https://pbn.nauka.gov.pl/works/647539 Formerly Journal of Health Sciences. ISSN 1429-9623 / 2300-665X. Archives 2011–2014 http://journal.rsw.edu.pl/index.php/JHS/issue/archive Deklaracja. Specyfika i zawartość merytoryczna czasopisma nie ulega zmianie. Zgodnie z informacją MNiSW z dnia 2 czerwca 2014 r., że w roku 2014 nie będzie przeprowadzana ocena czasopism naukowych; czasopismo o zmienionym tytule otrzymuje tyle samo punktów co na wykazie czasopism naukowych z dnia 31 grudnia 2014 r. The journal has had 5 points in Ministry of Science and Higher Education of Poland parametric evaluation. Part B item 1089. (31.12.2014). © The Author (s) 2015; This article is published with open access at Licensee Open Journal Systems of Kazimierz Wielki University in Bydgoszcz, Poland and Radom University in Radom, Poland Open Access. This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited. This is an open access article licensed under the terms of the Creative Commons Attribution Non Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted, non commercial use, distribution and reproduction in any medium, provided the work is properly cited. This is an open access article licensed under the terms of the Creative Commons Attribution Non Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted, non commercial use, distribution and reproduction in any medium, provided the work is properly cited. The authors declare that there is no conflict of interests regarding the publication of this paper. Received: 02.08.2015. Revised 05.09.2015. Accepted: 29.09.2015. The incidence of acute pancreatitis in children hospitalized with abdominal pain in Pediatric Surgery Clinic in Bydgoszcz Marta Lewicka1, Ewa Barczykowska1, Aleksandra Jaworska2, IrenaDaniluk‑Matraś2,Andrzej Kurylak1 1Zakład Pielęgniarstwa Pediatrycznego, Collegium Medicum w Bydgoszczy 2Oddział Kliniczny Chirurgii Ogólnej i Onkologicznej Dzieci i Młodzieży, SU nr 1 im.A.Jurasza w Bydgoszczy Abstract Introduction The condition most frequently reported by children is abdominal pain, posing a substantial diagnostic problem. In paediatric population, acute pancreatitis occurs much less frequently than in adults. Aim of the study The aim of the study was to assess rate of acute pancreatitis in children accepted to hospital for abdominal pains. Material and methods The study was of a retrospective nature. 629 medical histories of children hospitalized in University Hospital No. 1 in Bydgoszcz for abdominal pains and/or acute pancreatitis were analyzed. Demographic data (sex, age, residence) and season of patients' admission were included in the study. Results The study reveals, that hospital admissions for abdominal pain more frequently regarded boys – 352 (55.96%) than girls – 277 (44.04%). Children of urban background formed 57.39% and those of rural background – 42.61%. In the studied group, acute pancreatitis concerned girls more frequently than boys (8.7% vs 3.7%). No statistical relationship was proven between the age and the acute pancreatitis occurrence. The average age of children with acute pancreatitis amounted to 11.02 years. Every third instance of acute pancreatitis was diagnosed in spring (32.4%), and every fifth (18.9%) in winter. Conclusions An increase is observed in the number of children's hospital admissions for abdominal pains. Admissions for abdominal pains formed an average of one fifth of all admissions.. A decrease in acute pancreatitis occurrence is observed in hospitalized children. Acute pancreatitis occurred twice as often in girls than in boys. Keywords: children, pain, abdominal pain, pain evaluation, pancreas, pancreatitis, acute pancreatitis.

BACKGROUND The risk factors responsible for recurrences of Wilms' tumor (nephroblastoma) are still under discussion. The aim of the study was to analyze the relationship between relapses of Wilms' tumor and the patients' clinical history. MATERIAL AND METHODS Clinical data from children registered in the Polish Pediatric Solid Tumors Study Group were analyzed. The clinical stages (CS), pathology variants (high risk: HR, intermediate risk: INT, and low risk: LOW) and chemotherapy regimens were correlated with the outcomes. RESULTS Recurrences developed in 34 out of 288 (11.8%) patients with Wilms' tumor treated in accordance with International Society for Pediatric Oncology 2001 (SIOP 2001) protocols. Of these 34 patients, 11 initially had CS I, seven were at CS II, four were at CS III, 11 were at CS IV and one had CS V. There were eight patients with second recurrences; of these, seven were in the INT risk group and one in the high histological risk group. There was no correlation between age (p=0.256) or gender (p=0.538) and the risk of tumor recurrence. In the study group, seven out of 10 patients with local recurrences are alive; as are 13 out of 22 patients with distant recurrences (p=0.703). Those who died due to disease progression comprised six out of 26 patients with a first recurrence (four HR, two INT), and seven out of eight with a second recurrence (one HR, six INT). CONCLUSIONS The prognosis after relapse in initially metastatic patients did not differ from that in patients who had primarily localized disease. The pathology variants probably had more significance.

Immunosuppressive therapy is the treatment of choice in children with acquired severe aplastic anemia (AA) and no HLA-matched family donor. The paper presents results of a multicenter study of 63 children with AA treated with rabbit antithymocyte globulin (r-ATG) and cyclosporine A as the first line treatment in the years 1996-2012. Therapeutic effects were evaluated at Days 112, 180, and 360. At Day 112, remission was achieved in 28 out of the 63 patients (44.4 %), complete remission in 10 patients (15.9 %), and partial remission in 18 (28.5 %). At Day 180, 31 patients (49.2 %) were in remission including 15 cases in complete (23.8 %), and 16 cases in partial remission (25.4 %). One year after therapy onset, 34 patients (64.9 %) were in remission including 24 patients (38.0 %) in complete and 10 (15.9 %) in partial remission. Relapse occurred in 4 patients, from 8 months up to 2 years and 2 months after remission. One child, 5 years after remission, was diagnosed with paroxysmal nocturnal hemoglobinuria. The estimated 10-year overall survival rate and 10-year event-free survival rate were 67 % and 57 %, respectively.

Aims. We present the efficacy of a strategy to control infections with hepatitis B (HBV) and C viruses (HCV) in children with cancer and assessment of risk for their relatives and health care personnel. A total of 1242 people entered the study, including 558 children with cancer, 193 relatives of infected children, 302 health care workers and 189 controls. Methods. To stop dual HBV and HCV nosocomial infection in the oncology department, a preventive strategy was introduced. It involved immunoprophylaxis against HBV, screening blood donors for HCV infection, intensification of nonspecific prophylaxis, an educational program and estimation of risk for relatives of infected children and health care personnel. Results. Retrospective analysis showed that the prevalence of HBV and HCV infections in children with cancer was 74 of 119 (62.2%) and 50 of 92 (54.3%), respectively, with the highest rate among patients with leukemia. Inferior anticancer therapeutic response were obtained in infected children. Specific anti-HBV immunoprophylaxis introduced simultaneously with anticancer therapy resulted in protection of 160 of 168 (95.2%) children in the first 4 years, when 62.9% of patients receiving therapy developed protective antibodies. Screening of blood donors and intensification of nonspecific prophylaxis reduced HCV prevalence to 2.8% during the most recent 1.5 years. Genotype analysis showed that the risk of HCV infection was 0.5% for relatives of infected children. The risk for health care personnel was 0 in the oncology ward and 1.9% in the other departments, and it reached 0.53% in control group. Conclusions. The preventive strategy of viral hepatitis in children with cancer, including passive-active HBV immunoprophylaxis from the beginning of chemotherapy and intensive nonspecific prophylactic measures is effective. With this strategy the risk of intrafamily and occupational infection is low.

Unbalanced chromosomal aberrations are one of the most common causes of mental retardation and congenital defects. We analized genotype-phenotype correlations in a girl with dysmorphism, heart defect and hypoglycaemic attacks. The proband was born at term, after 2 years childless marriage, her birth weight was 2880 g. After birth, her phenotype was described as abnormal. She had microcephaly, scull with protruding sutures, narrow, short palpebral fissures, hypoplastic nose, hypoplastic nails, singular crease on right hand, clinodactyly of V fingers, excessive hair covering her face, shoulders and thighs, heart defect and vesico-uretheral reflux. She was also diagnosed as having hypothyroidism and hypoglycaemic attacks accompanied by seizures. Cytogenetic studies and FISH with WCP4 and WCP9 probes revealed an unbalanced karyotype: 46,XX,der(9)t(4;9)(q21;p22),9ph. The proband's mother's karyotype was normal female with pericentric inversion 9. The proband's father refused consent for cytogenetic studies.

Immunosuppressive therapy is the treatment of choice in children with acquired severe aplastic anemia (AA) and no HLA-matched family donor. The paper presents results of a multicenter study of 63 children with AA treated with rabbit antithymocyte globulin (r-ATG) and cyclosporine A as the first line treatment in the years 1996–2012. Therapeutic effects were evaluated at Days 112, 180, and 360. At Day 112, remission was achieved in 28 out of the 63 patients (44.4 %), complete remission in 10 patients (15.9 %), and partial remission in 18 (28.5 %). At Day 180, 31 patients (49.2 %) were in remission including 15 cases in complete (23.8 %), and 16 cases in partial remission (25.4 %). One year after therapy onset, 34 patients (64.9 %) were in remission including 24 patients (38.0 %) in complete and 10 (15.9 %) in partial remission. Relapse occurred in 4 patients, from 8 months up to 2 years and 2 months after remission. One child, 5 years after remission, was diagnosed with paroxysmal nocturnal hemoglobinuria. The estimated 10-year overall survival rate and 10-year event-free survival rate were 67 % and 57 %, respectively.

The study has been evaluated an efficiency of preventive use of hematopoietic cytokines in children with neoplastic diseases. The analysed material consisted of 28 children with neoplastic diseases. They all had 148 incidents of chemotherapy-induced myelosuppression with prophylactic use of GM-CSF or G-CSF 5 micrograms/kg daily. The study showed that the prophylactic use of hematopoietic growth factors after the end of each chemotherapy course significantly shortens the duration of extreme neutropenia, the length of treatment of neutropenia-induced infections, the time of hospital care and decreases the delay between succeeding chemotherapy courses.

Vivencia-se, desde o final do século XX, a transição de um modelo de Estado mínimo, de cunho liberal, para a efetivação de um Estado democrático e social de direito. Diante do cenário das crises do Estado contemporâneo, o presente Artigo objetiva reflexionar sobre os modos de superação às barreiras paradigmáticas da emancipação das subjetividades humanas e da construção do bem estar comum, desmistificando, em última análise, os desenhos disciplinares e, consequentemente, desvelando as faces do protagonismo curricular em suas nuances de aderência epistemológica e pedagógica a partir dos significados aparentes e ocultos do que, como e para que ensinar. Palavras-chave: Crises dos estados nacionais; Educação superior; Democracia; Cidadania; Currículos emancipatórios. Abstract Living, in case that, stretching from the ending the century XX, the transition by one template as of Been minimum, as of dies broadminded , for the efetivation by one Been democratic and social as of straight. Foremost from the scenario the crisis from the been contemporary , the boon Article objective reflect on the subject of the manners as of the barriers paradigms from the emancipating of the subjective humans and from the construction from the well-being common, well into analysis, the drawings disciplinary and, consequently the cheeks from the leading figure curricular well into your nuances as of adherence epistemolog and educational from the of the meanings apparent and concealed whereof , as a and for it to school. Key-words: Crisis of the estates national; Higher education; Democracy; Citizenship; Curriculum emancipating.

Introduction Healthcare-associated infection is a common problem in patients from neonatal intensive care units and it is one of the leading causes of death in this group of patients. Healthcare-associated infections are associated with increases in mortality, morbidity, and prolonged length of hospital stay. The aim of the study was to assess the incidence, clinical presentation, mortality and aetiology of healthcare-associated infections in newborns in a neonatal intensive care unit between 2005 and 2010. Material and methods The research involved documentation of 2610 neonates hospitalized in this period in the Neonatal Intensive Care Unit, Dr Jan Biziel University Hospital No. 2 in Bydgoszcz. The incidence, clinical presentation, mortality and causative factors of healthcare-associated infections were assessed. Results The prevalence of healthcare-associated infections was 7.32%. The most frequent healthcare-associated infections were bloodstream infection (65.4%) and urinary tract infection (22.5%). The mortality rate was 2.1%. The most frequent pathogens were coagulase-negative staphylococci (36.1%) and Klebsiella pneumoniae (29.3%). Conclusions The rate of healthcare-associated bloodstream infections in the analysed department is low, taking into consideration the specificity of the department. There is a necessity to establish convenient definitions of various kinds of healthcare-associated infecions in neonates, especially those born preterm.

In order to assess if any differences exist in children germ cell tumours depending on age, we compared some features of germ cell tumours in two age groups:younger than 10 and between 11 and 18 years.Data of 146 patients with germ cell tumours treated in 15 Polish paediatric oncology departments between 1995 and 2005 were evaluated. They were divided into two groups: 76 children 0-10 years old (group I) and 70 patients 11-18 years old (group II). Tumour morphology, sex of patients, primary tumour and metastases localization, disease stage, biochemical markers, treatment response, disease relapse and long survival were analyzed. Every patient was treated according to the TGM 95 protocol.In group 1, 67 tumours were assessed histologically. 64%t tumours had homogenous structure with yolk sac tumour in predominance and 36% were mixed. Yolk sac tumour (YST) or teratoma as components of mixed tumours were the most commonly found. In older group 64 tumours were examined, 41% were homogenous, and seminoma/dysgerminoma predominated. In 59% mixed tumours the most common components were YST embryonal carcinoma and teratoma. The most common primary site in group I was the sacrococcygeal region while in group II - the gonads. Disseminated disease was recognized mostly in older children. Among two evaluated serum markers, AFP was increased mostly in younger patients (76% vs 44%), and 3HCG in older group (40% vs 9%). Treatment response was comparable in both groups. Two relapses were observed in each group. Poor outcome was noted in 17/140 analyzed patients: 9 (12%) in group I and 8 (11%) in group II. In 12 of patients with poor outcome the cause of death was progression and in 5 of them - treatment complications.1. Germ cell tumours in younger and older children differ in histology, primary localization and serum level of biochemical markers. 2. In older patients germ cell tumours are recognized more frequently in advanced clinical stages. 3. Treatment response was comparable in both groups. 4. There is a need to analyze the intensity of chemotherapy to precise the adequate risk groups according to primary treatment response.

Nuclear factor ĸB (NF-ĸB) is a transcription regulator of proliferation and cell death. Increased activation of NF-ĸB may be responsible for treatment failure in children with acute lymphoblastic leukaemia (ALL). This study aimed to assess changes in NF-ĸB activation in peripheral blood mononuclear cells prior to and after 6 and 12 h of prednisone administration in relation to age, initial WBC count at diagnosis and early treatment response in childhood ALL. The study comprised 55 children with de novo ALL. Cells were stained with mouse anti-NF-ĸB (p65) antibody followed by goat anti-mouse antibody conjugated with FITC and measured by laser scanning cytometer. The nuclear/cytoplasmic (N/C) ratio of NF-ĸB reflecting activation of NF-ĸB was decreased 12 h after treatment in the standard risk group patients, whereas it remained statistically unchanged in the non-standard risk group patients. Changes in the N/C ratio of NF-ĸB were not associated with age and early treatment response; however, in children with an initial WBC count higher than 20 000/μl at diagnosis, this ratio was increased after 6 and 12 h from prednisone administration. The association of higher activation of NF-ĸB with an elevated initial WBC count suggests that activation of NF-ĸB may be responsible for treatment failure in children with ALL.

Ineffective apoptosis is one of main causes of a treatment failure in childhood acute lymphoblastic leukemia (ALL). p53 plays a crucial role in triggering apoptosis of ALL in response to prednisone treatment. MDM2 is the endogenous inhibitor of apoptosis that downregulates the functional activity of p53 protein. This study is aimed to evaluate changes in MDM2 and p53 expression in peripheral blood mononuclear cells collected from children with ALL prior to and after 6 and 12 h of prednisone administration in relation to early treatment response. The study comprised 35 children with newly diagnosed ALL, subdivided into good (n = 24) and poor (n = 11) early treatment responders. MDM2 - associated APC fluorescence and p53 - associated FITC fluorescence were measured by the laser scanning cytometer. In the group of poor responders, p53 and MDM2 fluorescence were significantly higher than in the group of good responders. In the group of good early treatment responders, a statistically significant rise of p53 fluorescence measured in the nucleus and in the cytoplasm 12 h after prednisone administration as well as increase in MDM2 fluorescence measured in the cytoplasm 6 and 12 h after prednisone administration were seen. These data suggest that pretreatment overexpression of MDM2 protein may contribute to poor early treatment response.