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Analizując dorobek polskiej doktryny, rola wykładni prawa wydaje się niedoceniana, co szczególnie widać przy lakonicznym wyjaśnianiu przez jej przedstawicieli tzw. „błędnej wykładni” jako podstawy skargi kasacyjnej. Tymczasem przyjęcie przez ustawodawcę „błędnej wykładni” za podstawę wniesienia skargi kasacyjnej świadczy o doniosłości roli wykładni w ujęciu ustawodawcy. Celem skargi kasacyjnej jest przy tym zapewnienie jednolitej wykładni prawa, w której upatruje się bezpieczeństwa prawnego. Tymczasem zgodnie z metodą i wykładnią prawa powszechnie stosowaną obecnie m.in. w Niemczech, bezpieczeństwo prawne jest zapewniane nie tyle przez jednolitość orzecznictwa, co przez oparcie rozstrzygnięć sędziowskich na wartościach konstytucyjnych, zapewniających sprawiedliwość orzeczeń.

The combination of policy concerns over climate and demographic change, energy shortages, resource efficiency and the natural environment, has led municipalities to be expected to reflect sustainability in different actions, including the decision-making on a considerable amount of their real property assets. As more and more municipalities, use the highest and best use analysis for reviewing the configuration of real property asset portfolio to achieve public goals, this provokes an examination of the reflection of sustainability (environmental, economic and social dimensions) in this kind of elaboration. Thus, this paper aims to investigate how Polish municipalities deal with the incorporation of sustainability into the highest and best use analysis and its operationalization in four tests (legally permissible, physically possible, financially feasible, and maximally productive). The research goal was pursued based on quantitative research using surveys conducted between April and May 2022 among eleven municipalities (creating the largest metropolitan areas in Poland) and qualitative research by the content analysis of HBU analyses prepared for them in previous years.

The recommendations were developed as answers to previously formulated questions concerning everyday diagnostic and therapeutic challenges. They were developed based on a review of the current literature using the GRADE methodology. The experts suggest that PF-ILD be diagnosed based on a combination of different criteria, such as the aggravation of symptoms, progression of radiological lesions, and worsening of lung function test parameters. The experts recommend a precise diagnosis of an underlying disease, with serological testing for an autoimmune disease always being included. The final diagnosis should be worked out by a multidisciplinary team (MDT). Patients with an interstitial lung disease other than IPF who do not meet the criteria for the progressive fibrosis phenotype should be monitored for progression, and those with systemic autoimmune diseases should be regularly monitored for signs of interstitial lung disease. In managing patients with interstitial lung disease associated with autoimmune diseases, an opinion of an MDT should be considered. Nintedanib rather than pirfenidon should be introduced in the event of the ineffectiveness of the therapy recommended for the treatment of the underlying disease, but in some instances, it is possible to start antifibrotic treatment without earlier immunomodulatory therapy. It is also admissible to use immunomodulatory and antifibrotic drugs simultaneously. No recommendations were made for or against termination of anti-fibrotic therapy in the case of noted progression during treatment of a PF-ILD other than IPF. The experts recommend that the same principles of non-pharmacological and palliative treatment and eligibility for lung transplantation should be applied to patients with an interstitial lung disease other than IPF with progressive fibrosis as in patients with IPF.

Międzynarodowa Organizacja Morska (International Maritime Organization – IMO) jest agendą wyspecjalizowaną Narodów Zjednoczonych. Przez ponad sześćdziesiąt lat funkcjonowania, IMO przechodziła wiele reform. W ramach IMO tworzona jest międzynarodowa legislacja morska, mająca za przedmiot m.in. sprawy bezpieczeństwa morskiego i zapobiegania zanieczyszczaniu morza przez statki. Zmiany, które dokonały się w przemyśle żeglugowym na przestrzeni kilku dziesięcioleci, również zmiany w układzie sił na świecie oraz potrzeba przykładania coraz większej wagi do skutecznej ochrony środowiska, w tym środowiska morskiego, nieprzerwanie wywierają istotny wpływ na funkcjonowanie, a w konsekwencji, na reformę Organizacji. Celem niniejszego artykułu jest przedstawienie najważniejszych kwestii związanych z reformą IMO.

Colorectal neuroendocrine neoplasm (CRNEN), especially rectal tumours, are diagnosed with increased frequency due to the widespread use of colonoscopy, including screening examinations. It is important to constantly update and promote the principles of optimal diagnostics and treatment of these neoplasms. Based on the latest literature and arrangements made at the working meeting of the Polish Network of Neuroendocrine Tumours (June 2021), this paper includes updated and supplemented data and guidelines for the management of CRNEN originally published in Endokrynologia Polska 2017; 68: 250-260.

Updated Polish recommendations for the management of patients with neuroendocrine neoplasms (NENs) of the small intestine (SINENs) and of the appendix (ANENs) are presented here. The small intestine, and especially the ileum, is one of the most common locations for these neoplasms. Most of them are well-differentiated and slow-growing tumours; uncommonly - neuroendocrine carcinomas. Their symptoms may be untypical and their diagnosis may be delayed or accidental. Najczęściej pierwszą manifestacją ANEN jest jego ostre zapalenie. Typical symptoms of carcinoid syndrome occur in approximately 20-30% of SINENs patients with distant metastases. In laboratory diagnostics the assessment of 5-hydroxyindoleacetic acid concentration is helpful in the diagnosis of carcinoid syndrome. The most commonly used imaging methods are ultrasound examination, computed tomography, magnetic resonance imaging, colonoscopy and somatostatin receptor imaging. Histopathological examination is crucial for the proper diagnosis and treatment of patients with SINENs and ANENs. The treatment of choice is a surgical procedure, either radical or palliative. Long-acting somatostatin analogues (SSAs) are essential in the medical treatment of functional and non-functional SINENs. In patients with SINENs, at the stage dissemination with progression during SSAs treatment, with high expression of somatostatin receptors, radioisotope therapy should be considered first followed by targeted therapies - everolimus. After the exhaustion of the above available therapies, chemotherapy may be considered in selected cases. Recommendations for patient monitoring are also presented.

After another meeting of experts of the Polish Network of Neuroendocrine Tumours, updated recommendations for the management of patients with gastric and duodenal neuroendocrine neoplasms, including gastrinoma, have been issued. As before, the epidemiology, pathogenesis and clinical symptoms of these neoplasms have been discussed, as well as the principles of diagnostic procedures, including biochemical and histopathological diagnostics and tumour localisation, highlighting the changes introduced in the recommendations. Updated principles of therapeutic management have also been presented, including endoscopic and surgical treatment, and the options of pharmacological and radioisotope treatment. The importance of monitoring patients with gastric and duodenal NENs, including gastrinoma, has also been emphasised.

In this paper, we present the current guidelines for the diagnostics and management of pancreatic neuroendocrine neoplasms (PanNENs) developed by Polish experts providing care for these patients in everyday clinical practice. In oncological diagnostics, in addition to biochemical tests, molecular identification with the use of NETest liquid biopsy and circulating microRNAs is gaining importance. Both anatomical and functional examinations (including new radiopharmaceuticals) are used in imaging diagnostics. Histopathological diagnosis along with immunohistochemical examination still constitute the basis for therapeutic decisions. Whenever possible, surgical procedure is the treatment of choice. Pharmacological management including biotherapy, radioisotope therapy, targeted molecular therapy and chemotherapy are important methods of systemic therapy. Treatment of PanNENs requires a multidisciplinary team of specialists in the field of neuroendocrine neoplasms.

Introduction: Osteoporosis is the most common metabolic bone disease. Vitamin D deficiency, often associated with osteoporosis and other bone tissue disorders, is spread worldwide. Among other factors, obesity seems to be a major cause of the growing hypovitaminosis D. The aim of the study was to assess the correlation between body mass index (BMI) and vitamin D concentrations in postmenopausal women diagnosed with osteoporosis. Materials and Methods: Sixty-nine women with postmenopausal osteoporosis were included in the study. Dual-energy X-ray absorptiometry and vitamin D measures were performed in all patients. Three groups, BMI- dependent, were distinguished: normal weight, overweight and obesity group. Results: Vitamin D deficiency was found in all women with postmenopausal osteoporosis. There was no correlation between BMI and vitamin D level. Conclusions: Vitamin D deficiency is frequent in the population of patients diagnosed with postmenopausal osteoporosis, regardless of their BMI.

The in vitro culture technique can be used for micropropagation of medicinal plants as well as for creating genotypes with an improved profile of phytochemical compounds. For this purpose, somaclonal variability may be used for the induction of genetic diversity among regenerants. The paper presents a protocol for obtaining

The recommendations were developed as answers to previously formulated questions concerning everyday diagnostic and therapeutic challenges. They were developed based on a review of the current literature using the GRADE methodology. The experts suggest that PF-ILD be diagnosed based on a combination of different criteria, such as the aggravation of symptoms, progression of radiological lesions, and worsening of lung function test parameters. The experts recommend a precise diagnosis of an underlying disease, with serological testing for an autoimmune disease always being included. The final diagnosis should be worked out by a multidisciplinary team (MDT). Patients with an interstitial lung disease other than IPF who do not meet the criteria for the progressive fibrosis phenotype should be monitored for progression, and those with systemic autoimmune diseases should be regularly monitored for signs of interstitial lung disease. In managing patients with interstitial lung disease associated with autoimmune diseases, an opinion of an MDT should be considered. Nintedanib rather than pirfenidon should be introduced in the event of the ineffectiveness of the therapy recommended for the treatment of the underlying disease, but in some instances, it is possible to start antifibrotic treatment without earlier immunomodulatory therapy. It is also admissible to use immunomodulatory and antifibrotic drugs simultaneously. No recommendations were made for or against termination of anti-fibrotic therapy in the case of noted progression during treatment of a PF-ILD other than IPF. The experts recommend that the same principles of non-pharmacological and palliative treatment and eligibility for lung transplantation should be applied to patients with an interstitial lung disease other than IPF with progressive fibrosis as in patients with IPF.

Idiopathic pulmonary fibrosis (IPF) is a progressive, chronic disease of the lungs which is characterized by heavy symptom burden, especially in the last year of life. Despite recently established anti-fibrotic treatment IPF prognosis is one of the worst among interstitial lung diseases. In this review available evidence regarding pharmacological and non-pharmacological management of the main IPF symptoms, dyspnea and cough, is presented.

Continuous progress in the diagnostics and treatment of neuroendocrine neoplasms (NENs), the emerging results of new clinical trials, and the new guidelines issued by medical societies have prompted experts from the Polish Network of Neuroendocrine Tumours to update the 2017 recommendations regarding the management of neuroendocrine neoplasms. This article presents the general recommendations for the management of NENs, resulting from the findings of the experts participating in the Fourth Round Table Conference, entitled "Polish Guidelines for the Diagnostics and Treatment of Neuroendocrine Neoplasms of the gastrointestinal tract, Żelechów, June 2021". Drawing from the extensive experience of centres treating these cancers, we hope that we have managed to formulate the optimal method of treating patients with NENs, applying the latest reports and achievements in the field of medicine, which can be effectively implemented in our country. The respective parts of this work present the approach to the management of: NENs of the stomach and duodenum (including gastrinoma), pancreas, small intestine, and appendix, as well as large intestine.

Periodontal diseases are characterized by progressive inflammation that destroys the tooth-supporting tissues, leading to gum bleeding and tooth loss. Porphyromonas gingivalis is considered one of the main etiological agents responsible for the initiation and progression of chronic periodontitis. This gram-negative, anaerobic bacterium is a part of a multi-species oral biofilm. P. gingivalis does not have the full pathway of protoporphyrin IX synthesis, nor does it produce siderophores. Therefore, for survival and proliferation, it requires heme as a source of iron and protoporphyrin IX. In order to obtain heme, P. gingivalis uses a number of mechanisms that affect the ability of this bacterium to initiate a pathological condition. This review presents the current knowledge regarding the best-known and characterized systems involved in heme acquisition by P. gingivalis. We focused on processes occurring in the initial states of infection, where gingipain, hemagglutinins, and hemolysins play a crucial role. The mechanisms encoded by hmu, iht and hus operons, including proteins with hemophore-like properties, as well as TonB-dependent outer membrane receptors are described. We present their function and participation in the progression of the infection. In addition, we describe mechanisms produced by P. gingivalis and other periodontopathogens in synergistic processes promoting the growth and virulence of P. gingivalis. We also describe processes regulating iron and heme homeostasis, including the homolog of the Fur protein, the two-component system HaeSR, as well as the OxyR, SigH, and PgDps proteins.

Introduction: Despite considerable progress in knowledge, ischaemic stroke is still a disease that causes serious clinical problems. A role in its pathogenesis can be attributed to i.a. adipose tissue hormones. The aim of this paper is to assess the blood levels of selected adipocytokines in patients during the acute phase of ischaemic stroke as compared to healthy persons, and an attempt to indicate a correlation between their blood concentrations and the level of stroke severity and its outcomes. Material and methods: The study included 46 patients with fresh ischaemic stroke (27 females, 19 males, average age 67.6 years). All patients had a CT scan of the head, their neurological condition was assessed using a stroke severity scale, and their blood levels of resistin, chemerin, and visfatin were tested. The control group consisted of 32 patients (16 females, 16 males, average age 64.1 years) who had never suffered cerebrovascular diseases. Results: Elevated levels of both resistin and chemerin were found in the group of patients with ischaemic stroke (9.17 ± 2.95 ng/mL vs. 6.55 ± 2.01 ng/mL for resistin and 265.0 ± 59.3 ng/mL vs. 191.0 ± 43.6 ng/mL for chemerin). It was also found that the blood concentration of chemerin was higher in females than in males with stroke. However, no difference was found in visfatin blood concentration between the group with ischaemic stroke and the control group (1.65 ± 1.09 ng/mL vs. 1.5 ± 1.39 ng/mL). Conclusions: Higher resistin and chemerin blood concentrations significantly increase the risk of ischaemic stroke. The level of stroke severity at the moment of its occurrence and during its course do not depend on the concentrations of adipocytokines under analysis.

This is a review considering atypical manifestations of granulomatosis with polyangiitis (GPA). Virtually any organ can be affected, and in some patients, GPA can manifest unusually. Since thoracic involvement of GPA often predominates, the first who might be expected to establish a diagnosis are pulmonary specialists. We would like to familiarize pulmonary specialists with several extra-ELK (E: ear-nose-throat; L: lung; K: kidney) involvements of the disease. We describe sites rarely affected by GPA like the breast, skeletal system, orbit and eye, heart and vessels, central nervous system, urogenital system as well as endocrine and gastrointestinal tract involvement.

Prostate cancer is the most commonly diagnosed cancer among men in the world and in Poland it is the second cause of death in men suffering from cancer. Recent evidence suggests that obesity is associated with prostate cancer. Increased BMI correlates with aggressive disease and with higher risk of recurrence and mortality in prostate cancer patients. Obesity can promote the progression of prostate cancer through endocrine disturbances, mainly in sex steroids, through chronic inflammation resulting in altered production of adipokines, peripheral insulin resistance with hyperinsulinemia and oxidative stress. Diagnosis of metabolic syndrome can be used in the global assessment of prognosis in patients with prostate cancer. The aim of the paper is to present current state of knowledge about connections between obesity, metabolic syndrome, sex steroids and adipokines in men with prostate cancer.

Prostate cancer is one of the most frequent cancers in men. Although several treatment options exist, their clinical effectiveness is still not satisfactory. One the possible reason of such situation might be the presence of myeloid-derived suppressor cells (MDSC) and their pro-turnorigenic activity. MDSC possess irnmunosuppressive ability and in many studies were shown to support tumor development and progression. In this study we addressed the question whether commonly used therapies of prostate cancer affect the level of MDSC populations in the patients' blood. We compared the level of granulocytic (Gr-MDSC), monocytic (Mo-MDSC) and early stage MDSC (eMDSC) in the blood of patients at different clinical stage and different tumor grading scores, who underwent either surgery or hormonal therapy alone or were given a combined treatment, including e.g. radiotherapy. The obtained results showed that the level of Gr-MDSC was significantly lower in all treated patients comparing to untreated group. On the other hand, surgery or hormonal therapy alone did not affect the level of Mo-MDSC. These results were independent of the PSA level, the tumor grading and clinical stage of the patients. In conclusion, we suggest that Mo-MDSC should be considered as a potential therapy target in the course of prostate cancer treatment to enhance its anti-tumor effectiveness.

To acquire heme

Prostate cancer (PC) is the second most often diagnosed malignancy in men and one of the major causes of cancer death worldwide. Despite genetic predispositions, environmental factors, including a high-fat diet, obesity, a sedentary lifestyle, infections of the prostate, and exposure to chemicals or ionizing radiation, play a crucial role in PC development. Moreover, due to a lack of, or insufficient T-cell infiltration and its immunosuppressive microenvironment, PC is frequently classified as a “cold” tumor. This is related to the absence of tumor-associated antigens, the lack of T-cell activation and their homing into the tumor bed, and the presence of immunological cells with regulatory functions, including myeloid-derived suppressor cells (MDSCs), regulatory T cells (Treg), and tumor-associated macrophages (TAMs). All of them, by a variety of means, hamper anti-tumor immune response in the tumor microenvironment (TME), stimulating tumor growth and the formation of metastases. Therefore, they emerge as potential anti-cancer therapy targets. This article is focused on the function and role of MDSCs in the initiation and progression of PC. Clinical trials directly targeting this cell population or affecting its biological functions, thus limiting its pro-tumorigenic activity, are also presented.

Graves' disease (GB), also known as Basedow's disease, is the most common cause of hyperthyroidism, and thyroid orbitopathy (TO) is its most common non-thyroid manifestation with an incidence of 42.2/million people/year. Based on the guidelines of the European Graves' Orbitopathy Group (EUGOGO), certain management standards presented in our publication should be used to optimize and improve the efficacy of TO treatment. Deciding on the optimal treatment for both hyperthyroidism and TO requires a cooperative team of specialists: endocrinologist, ophthalmologist, radiation therapist, and surgeon, as well as consideration of the risk of relapse and possible complications of the treatment method. The inflammatory activity and severity of TO should be diagnosed based on the investigator's own experience and according to standard diagnostic criteria. Assessment of the inflammatory activity of TO can be performed using the clinical activity score (CAS) and using imaging methods - mainly MRI. The severity of TO is assessed using a seven-grade NOSPECS classification and a three-grade EUGOGO scale. In moderate to severe and active TO, i.v. methylprednisolone pulses are the treatment of choice. It is important to maintain the standard and regimen of treatment. The recommended standard as first-line treatment in most patients with moderate to severe and active TO is the combined use of methylprednisolone i.v. (cumulative dose of 4.5 g over 12 weeks) with concurrent administration of mycophenolate sodium 0.72 g per day for 24 weeks. In more severe forms of moderate to severe and active TO, a higher cumulative dose of methylprednisolone i.v. is recommended as an alternative first-line treatment (7.5 g) as monotherapy starting with a dose of 0.75 g once a week for 6 weeks and 0.5 g for a further 6 weeks. EUGOGO guidelines recommend that in cases of no clinical response after 6 weeks of first-line treatment with i.v. methylprednisolone and mycophenolate, after 3-4 weeks, a second course of i.v. methylprednisolone monotherapy should be started with a higher cumulative dose of 7.5 g. Other second-line treatment options are orbital radiotherapy with or without oral or i.v. systemic glucocorticosteroid therapy, cyclosporine, or azathioprine in combination with p.o. glucocorticosteroid, methotrexate monotherapy, and a group of biologic drugs rituximab, tocilizumab, teprotumumab). Keeping in mind that TO is a sight-threatening disease, we expect, through the treatment applied, to maintain full visual acuity, pain relief, single vision in the useful part of the visual field, and a positive cosmetic effect.

The main goal of revitalization is to improve the spatial condition of the city, which improves its image and increases the value of space. Any revitalization process requires the acquisition of geolocation data. This data can help visualize the spatial changes that were the goal of revitalization efforts. Acquiring such data is not always easy and requires the use of multiple sources of GIS information. The purpose of this paper is a spatial presentation of the analyzed areas with their identification before and after the revitalization process using spatial data made available in an open resource on Google Maps map application. Data is presented for two cities: Bydgoszcz (Poland), Varna (Bulgaria), characterized by a similar population. The paper uses current and archival orthophotos of the revitalized areas, Street View panoramic views from street level and own photographic documentation. The results of the analysis show that regardless of the stage of revitalization, the use of spatial data is essential in the designation of a degraded area, as well as later in its design, monitoring and management.

Supplemental material, sj-docx-1-taj-10.1177_20406223221117982 for Therapeutic decisions in a cohort of patients with idiopathic pulmonary fibrosis: a multicenter, prospective survey from Poland by Katarzyna Górska, Marta Maskey-Warzęchowska, Małgorzata Barnaś, Adam Białas, Adam Barczyk, Hanna Jagielska-Len, Ewa Jassem, Aleksander Kania, Katarzyna Lewandowska, Sebastian Majewski, Magdalena M. Martusewicz-Boros, Wojciech J. Piotrowski, Alicja Siemińska, Krzysztof Sładek, Małgorzata Sobiecka, Marzena Trzaska-Sobczak, Witold Tomkowski, Beata Żoł and Rafał Krenke in Therapeutic Advances in Chronic Disease

Supplemental material, sj-docx-1-taj-10.1177_20406223221117982 for Therapeutic decisions in a cohort of patients with idiopathic pulmonary fibrosis: a multicenter, prospective survey from Poland by Katarzyna Górska, Marta Maskey-Warzęchowska, Małgorzata Barnaś, Adam Białas, Adam Barczyk, Hanna Jagielska-Len, Ewa Jassem, Aleksander Kania, Katarzyna Lewandowska, Sebastian Majewski, Magdalena M. Martusewicz-Boros, Wojciech J. Piotrowski, Alicja Siemińska, Krzysztof Sładek, Małgorzata Sobiecka, Marzena Trzaska-Sobczak, Witold Tomkowski, Beata Żoł and Rafał Krenke in Therapeutic Advances in Chronic Disease

The study was designed to evaluate the effect of thyroid function on serum levels of different adipokines in obesity. We investigated relationships between the thyroid axis and serum levels of leptin, adiponectin, and chemerin, and we assessed the influence of autoimmune thyroiditis (AIT) on those relations.The participants of this study included 181 euthyroid patients (147 women and 34 men) with obesity [body mass index (BMI) 30-39.9 kg/m²] and severe (morbid) obesity (BMI ≥ 40 kg/m²), aged 18 to 65 years. We divided all obese patients by thyrotropic hormone (TSH) tertiles, and we compared all participants according to BMI. Patients were further divided into the following subgroups: with chronic autoimmune thyroiditis and without autoimmune thyroiditis.Comparison of obese patients according to TSH tertile showed significantly higher serum concentrations of leptin, chemerin, and thyroid antibodies and an increased leptin/adiponectin ratio in the group with high normal TSH. We observed statistically significant correlations between serum TSH and BMI, leptin, chemerin, thyroid peroxidase antibodies, and the leptin/adiponectin ratio. In patients diagnosed with autoimmune thyroiditis, higher levels of antibodies and TSH were found, but there were no differences in homeostatic model assessment index (HOMA-I), the leptin/adiponectin ratio, and adipokine levels. In obese patients the relationships between serum leptin, chemerin, the leptin/adiponectin ratio, and BMI were dependent on each other.Serum leptin, chemerin, the leptin/adiponectin ratio, and BMI are significantly higher in patients with high normal TSH; however, selected adipokines are not related to the presence of autoimmune thyroiditis. There are interplays between TSH, adipokines, and obesity, but how these relationships are related remains unknown.

The non-enzymatic addition of glucose (glycation) to circulatory and tissue proteins is a ubiquitous pathophysiological consequence of hyperglycemia in diabetes. Given the high incidence of periodontitis and diabetes and the emerging link between these conditions, it is of crucial importance to define the basic virulence mechanisms employed by periodontopathogens such as Porphyromonas gingivalis in mediating the disease process. The aim of this study was to determine whether glycated proteins are more easily utilized by P. gingivalis to stimulate growth and promote the pathogenic potential of this bacterium. We analyzed the properties of three commonly encountered proteins in the periodontal environment that are known to become glycated and that may serve as either protein substrates or easily accessible heme sources. In vitro glycated proteins were characterized using colorimetric assays, mass spectrometry, far- and near-UV circular dichroism and UV–visible spectroscopic analyses and SDS-PAGE. The interaction of glycated hemoglobin, serum albumin and type one collagen with P. gingivalis cells or HmuY protein was examined using spectroscopic methods, SDS-PAGE and co-culturing P. gingivalis with human keratinocytes. We found that glycation increases the ability of P. gingivalis to acquire heme from hemoglobin, mostly due to heme sequestration by the HmuY hemophore-like protein. We also found an increase in biofilm formation on glycated collagen-coated abiotic surfaces. We conclude that glycation might promote the virulence of P. gingivalis by making heme more available from hemoglobin and facilitating bacterial biofilm formation, thus increasing P. gingivalis pathogenic potential in vivo.

Szczypiór-Piasecka Karina, Siemińska Julia, Antczak Krzysztof, Mińko Alicja. Comprehensive rehabilitation program after post-resistive hip arthroplasty of GMRS as a result of treatment of the aneurysm cyst of the femoral neck. Journal of Education, Health and Sport. 2021;11(9):550-564. eISSN 2391-8306. DOI http://dx.doi.org/10.12775/JEHS.2021.11.09.072 https://apcz.umk.pl/JEHS/article/view/JEHS.2021.11.09.072 https://zenodo.org/record/5530438 The journal has had 5 points in Ministry of Science and Higher Education parametric evaluation. § 8. 2) and § 12. 1. 2) 22.02.2019. © The Authors 2021; This article is published with open access at Licensee Open Journal Systems of Nicolaus Copernicus University in Torun, 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: 15.09.2021. Revised: 20.09.2021. Accepted: 27.09.2021. Comprehensive rehabilitation program after post-resistive hip arthroplasty of GMRS as a result of treatment of the aneurysm cyst of the femoral neck Karina Szczypiór-Piasecka karinaszczypior@interia.pl ORCID iD https://orcid.org/0000-0002-9562-9201 Klinika Ortopedii, Traumatologii i Onkologii Narządu Ruchu Pomorskiego Uniwersytetu Medycznego w Szczecinie, Poland Julia Siemińska karinaszczypior@interia.pl ORCID iD https://orcid.org/0000-0002-4340-0085 SKN Rehabilitacji Ortopedycznej i Terapii Manualnej przy KOTiONR PUM, Poland Krzysztof Antczak karinaszczypior@interia.pl ORCID iD https://orcid.org/0000-0001-8443-0611 Studium Doktoranckie Pomorskiego Uniwersytetu Medycznego, Poland Alicja Mińko karinaszczypior@interia.pl ORCID iD https://orcid.org/0000-0003-2299-3958 Pomorski Uniwersytet Medyczny w Szczecinie, Poland Abstract Malignant bone cancer is rarely detected in its early stages and there is usually already soft tissue infiltration at diagnosis. Symptoms that occur include pain that worsens at night, tissue thickening, and limitation of limb mobility due to bone destruction. Researchers point to the necessary cooperation of the medical team to correctly diagnose the disease, plan the patient's treatment and conduct rehabilitation. THE AIM OF THE STUDY was to describe a case of a patient after resection of a malignant bone tumor (Fibrolastic osteosarcoma) and to create a program of comprehensive postoperative rehabilitation. MATERIAL AND METHODS The case study presented in this study confirms the need for holistic treatment of a patient diagnosed with a malignant bone tumor. In patient A.S. at the age of 23, an aneurysmal cyst in the neck of the left femur was diagnosed with a pathological fracture and extensive bone destruction. Radical treatment with total post-resection arthroplasty was performed. Inpatient physiotherapy is described, starting one day after the surgery, focusing on the prevention of postoperative complications and the treatment of dysfunctions resulting from surgery. as a result of surgery. The rehabilitation 5 months after the surgery was also presented, during which the focus was on restoring the correct ranges of joint mobility and restoring the correct muscle strength. The work confirms the necessity of a holistic application of the patient care process, which includes diagnostics, treatment and rehabilitation. RESULTS Physiotherapy is introduced the day after surgery and continues until the patient is discharged home. Physiotherapeutic methods and exercises are adapted to the scope of the operation, general condition and age of the patient. The goal is for the patient to achieve the greatest possible independence of movement and daily activities. In post-hospital rehabilitation, the goal is to restore the normal, achievable, mobility and stability of the joints. The patient should adopt the correct gait pattern with the minimum possible protection with orthopedic equipment. CONCLUSIONS 1. Patients after proximal femur resection and GMRS replacement surgery should begin rehabilitation on the first day after surgery. 2. Manual therapy and osteopathy are extremely important in the rehabilitation program after surgery to remove a bone tumor. Key words: cancer, sarcoma, osteosarcoma, rehabilitation.

Introduction: Osteoporosis and obesity are considered civilisation diseases. Menopause is a time of increased bone resorption and increased mass of adipose tissue. Adipocytokines secreted by the adipose tissue are believed to be a potential factor in the pathogenesis of osteoporosis. Material and methods: The aim of this research was to assess leptin, adiponectin, and resistin secretion in obese postmenopausal women with osteoporosis and determine whether obesity might be a factor mitigating the risk of osteoporosis. The study involved 80 postmenopausal women with osteoporosis divided into groups: I with BMI of 30.0 34.9, obese; and II with BMI of 18–24.9, normoweight. Leptin, adiponectin and resistin concentrations were assessed, and bone mineral density (BMD) was measured in the L1-L4 section of the spine using the DXA densitometric method. Results: The results of the comparison of the two groups indicate a statistically significant dependence in groups regarding leptin secretion; the group of obese women demonstrated significantly higher concentrations. No differences between the groups were demonstrated for adiponectin or resistin secretion. Conclusions: Higher leptin concentration and a positive correlation with BMI was confirmed in obese postmenopausal women with osteoporosis. It was also demonstrated that BMD increases with growing BMI. No effect of obesity on the secretion of adiponectin or resistin in women with postmenopausal osteoporosis was found. From among the investigated adipocytokines, only leptin can be considered a bone tissue protective factor in postmenopausal women.

The Dukla Nappe in the Skrzydlna area exposes two types of melange reflecting two different phases of basinal and tectonic evolution of the Outer West Carpathian orogen in its Polish sector. The Oligocene-age sedimentary melange (olistostrome) is related to growth of the accretionary wedge, whereas the Miocene-age diapiric melange postdates the orogenic thrusting. Textural and structural features of the very coarse-grained sedimentary melange suggest non-cohesive debris flows and high-density turbidity currents as predominant emplacement mechanisms. Growth strata, associated with progressive unconformities, and facies contrast between the underlying fine-grained unit and the overlying olistostrome reflect a considerable uplift of the source area and rotation of the adjacent part of the basin floor. The olistostrome and the overlying turbidite succession form a retrogressive sequence interpreted as a submarine canyon infill grading to a small submarine fan. The diapiric melange, injected into the Oligocene-age succession of the Dukla Nappe, contains the Early and Late Cretaceous-age blocks and matrix derived from the underlying Silesian Nappe. The features reflecting diapiric emplacement include matrix proportion increase and block content decrease towards the melange margins, scaly fabric and shear zones. Both melanges, interpreted in the past as chaotic bodies, upon detailed examination reveal genesis-related subtle internal organization.

Background Histoplasmosis is a mycosis caused by soil-based fungus Histoplasma capsulatum endemic in the USA, Latin America, Africa and South-East Asia. The disease is usually self-resolving, but exposure to a large inoculum or accompanying immune deficiencies may result in severe illness. Symptoms are unspecific with fever, cough and malaise as the most common. Thus, this is a case of disease which is difficult to diagnose and very rare in Europe. As a result, it is usually not suspected in elderly patients with cough and dyspnea. Case presentation This is a case of a 78-year-old patient, admitted to our department due to respiratory failure, cough, shortness of breath, fever and weight loss with no response to antibiotics administered before the admission. Chest CT revealed numerous reticular and nodular infiltrations with distribution in all lobes. The cytopathology of BAL showed small parts of mycelium and numerous oval spores. Considering clinical presentation and history of travel to Mexico before onset of disease, pulmonary histoplasmosis was diagnosed. After introduction of antifungal treatment rapid improvement was achieved in terms of both clinical picture and respiratory function. Conclusions Since the risk of Histoplasma exposure in Europe is minimal, patients, who present with dyspnea, fever and malaise are not primarily considered for diagnosis of histoplasmosis. However, taking into account increasing popularity of travelling, also by elderly or patients with impaired immunity, histoplasmosis should be included into differential diagnosis.

The business activity of real estate development companies depends on very many macro as well as micro factors. The main determinants of their operation on the real estate market include those of a supply-demand as well as institutional-legal nature. In practice, it turns out, however, that even in the case of excellent financial and sales results for at least a few years, they are faced with increasingly large problems and limitations, which first influence a decrease in growth rate, and later can be a source of problems with financial liquidity. The aim of the work is to identify the most important current determinants connected with the business activity of real estate development companies, accounting for both regulatory as well as market risks. A study states that in 2017–2018, conditions of management in the housing sector have changed and symptoms of their deterioration are visible. The results of the carried out analyses indicate that the investment boom and very favorable climate for carrying out activities connected with real estate development, especially on the housing market, which has been around since at least 2015, began to show increasingly clearer symptoms indicating a halt in the growth rate and a worsening situation of real estate developers at the beginning of 2018. The applied research methods include a study of the source literature and current legal regulations, as well as the analysis of statistical and financial data derived from rich, both primary and secondary empirical databases. The financial data used in the study relate primarily to the leading development companies listed on the Warsaw Stock Exchange. Działalność firm deweloperskich zależy od bardzo wielu makro-, mezo- oraz mikroczynników. Do głównych uwarunkowań funkcjonowania dewelopera na rynku nieruchomości należą te o charakterze popytowo-podażowym oraz instytucjonalno-prawnym. W praktyce okazuje się jednak, że nawet przy bardzo dobrych wynikach finansowych i sprzedażowych osiąganych od co najmniej kilku lat przedsiębiorcy napotykają na coraz większe ograniczenia i problemy, które najpierw wpływają na spowolnienie tempa wzrostu, a następnie mogą być źródłem kłopotów z płynnością finansową. Celem artykułu jest identyfikacja najważniejszych aktualnych uwarunkowań związanych z działalnością firm deweloperskich, z uwzględnieniem wybranych ryzyk regulacyjnych i rynkowych. W opracowaniu postawiono tezę, że w latach 2017–2018 warunki gospodarowania w sektorze mieszkaniowym uległy zmianie i widać symptomy ich pogorszenia. Wyniki przeprowadzonych analiz wskazują, iż trwający od co najmniej 2015 roku okres boomu inwestycyjnego w Polsce i bardzo dobrego klimatu dla prowadzenia działalności deweloperskiej, zwłaszcza na rynku mieszkaniowym, zaczął na początku 2018 roku ujawniać coraz wyraźniej symptomy świadczące o wyhamowaniu tempa wzrostu i pogarszaniu się sytuacji niektórych firm deweloperskich. Zastosowane metody badawcze obejmują studium literatury przedmiotu oraz aktualnych regulacji prawa, a ponadto analizę danych statystycznych i finansowych pochodzących z bogatych, zarówno pierwotnych, jak i wtórnych baz danych empirycznych. Dane finansowe wykorzystywane w opracowaniu dotyczą przede wszystkich wiodących spółek deweloperskich notowanych na Giełdzie Papierów Wartościowych w Warszawie.

The pathogenesis of the disorders of calcium metabolism is not fully understood. This review discusses the studies in which metabolomics was applied in this area. Indeed, metabolomics could play an essential role in discovering biomarkers and elucidating pathological mechanisms. Despite the limited bibliography, the present review highlights the potential of metabolomics in identifying the biomarkers of some of the most common endocrine disorders, such as primary hyperparathyroidism (PHPT), secondary hyperparathyroidism (SHPT), calcium deficiency, osteoporosis and vitamin D supplementation. Metabolites related to above-mentioned diseorders were grouped into specific classes and mapped into metabolic pathways. Furthermore, disturbed metabolic pathways can open up new directions for the in-depth exploration of the basic mechanisms of these diseases at the molecular level.

Human oral and gut microbiomes are crucial for maintenance of homeostasis in the human body. Porphyromonas gingivalis, the key etiologic agent of chronic periodontitis, can cause dysbiosis in the mouth and gut, which results in local and systemic infectious inflammatory diseases. Our previous work resulted in extensive biochemical and functional characterization of one of the major P. gingivalis heme acquisition systems (Hmu), with the leading role played by the HmuY hemophore-like protein. We continued our studies on the homologous heme acquisition protein (Bvu) expressed by Bacteroides vulgatus, the dominant species of the gut microbiome. Results from spectrophotometric experiments showed that Bvu binds heme preferentially under reducing conditions using Met145 and Met172 as heme iron-coordinating ligands. Bvu captures heme bound to human serum albumin and only under reducing conditions. Importantly, HmuY is able to sequester heme complexed to Bvu. This is the first study demonstrating that B. vulgatus expresses a heme-binding hemophore-like protein, thus increasing the number of members of a novel HmuY-like family. Data gained in this study confirm the importance of HmuY in the context of P. gingivalis survival in regard to its ability to cause dysbiosis also in the gut microbiome.

The work presents identification of antimicrobial peptides and proteins (AMPs) in the hemolymph of Galleria mellonella larvae infected with two Pseudomonas aeruginosa strains (ATCC 27,853 and PA18), differing in the profile of secreted proteases. The insects were immunized with bacteria cultivated in rich (LB) and minimal (M9) media, which resulted in appearance of a similar broad set of AMPs in the hemolymph. Among them, 13 peptides and proteins were identified, i.e. proline-rich peptides 1 and 2, lebocin-like anionic peptide 1 and anionic peptide 2, defensin/galiomicin, cecropin, cecropin D-like peptide, apolipophoricin, gallerimycin, moricin-like peptide B, lysozyme, apolipophorin III, and superoxide dismutase. Bacterial strain- and/or medium-dependent changes in the level of proline-rich peptide 1, anionic peptide 1 and 2, moricin-like peptide B, cecropin D-like and gallerimycin were observed. The analysis of the expression of genes encoding cecropin, gallerimycin, and galiomicin indicated that they were differently affected by the bacterial strain but mainly by the medium used for bacterial culture. The highest expression was found for the LB medium. In addition to the antibacterial and antifungal activity, proteolytic activity was detected in the hemolymph of the P. aeruginosa-infected insects. Based on these results and those presented in our previous reports, it can be postulated that the appearance of AMPs in G. mellonella hemolymph can be triggered not only by P. aeruginosa pathogen associated molecular patterns (PAMPs) but also by bacterial extracellular proteases secreted during infection. However, although there were no qualitative differences in the set of AMPs depending on the P. aeruginosa strain and medium, differences in the level of particular AMPs synthesized in response to the bacteria used were observed.