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Objective: To assess the depth of chest compressions (CC) provided by schoolchildren and their relation with providers’s anthropometric characteristics. Methods: We organized 1-hour hands-on training sessions for 11-14y.o. in volunteering schools. After training, willing subjects performed 2 min of recorded continuous CCs by means of Laerdal Resusci Anne® with CPRMeter2®, with visual feedback. Compression pace was given by metronome; instructors supervised the correct body position. Collected data included age, sex, as well as measured body weight and height. Results: We analyzed records from N = 702 children (mean age: 12.76 ± 1.02 years, 379 (51.63%) boys) out of 761 participating in the study. Their mean median compression depth (MCD) was 46.70 ± 7.74 mm, which was below minimal effective CC depth advised by current guidelines (50 mm). This corresponded to low mean fraction of CCs ≥ 50 mm (CCF ≥ 50 mm, 42.86 ± 33.67%), and only 42.88% of children achieving at least 50% of compressions ≥ 50 mm. Boys had significantly higher mean MCD and CCF ≥ 50 mm than girls (MCD: 49.34 ± 7.05 mm vs 45.97 ± 8.07 mm, p

Childhood obesity, with its metabolic complications, is a problem of public health. The International Diabetes Federation (IDF) has recommended glucose levels 1 h post oral glucose load (1h-PG) > 155–209 mg/dL as diagnostic for intermediate hyperglycemia (IH), while >209 mg/dL for type 2 diabetes (T2D). The aim of the study was to assess the occurrence of prediabetes, IH, and T2D in children and adolescents with simple obesity according to the criteria of American Diabetes Association (ADA) and of IDF, and the effect of COVID-19 pandemic on these disorders. Analysis included 263 children with simple obesity, screened either in prepandemic (PRE—113 cases) or post-pandemic period (POST—150 cases). All children underwent 2 h OGTT with measurements of glucose and insulin every 0.5 h, lipid profile, and other tests; indices if insulin resistance (IR): HOMA, QUICKI, Matsuda index, AUC (glu/ins) were calculated. The incidence of T2D, prediabetes, and IH was higher in POST with respect to PRE, with significant differences in the indices of IR, except for HOMA. Significant differences were observed in the assessed parameters of glucose metabolism among the groups with T2D, prediabetes, IH, and normal glucose tolerance (NGT), with some similarities between IH (based on 1h-PG) and prediabetes. Increased frequency of dysglycemia among children and adolescents with simple obesity is observed after COVID-19 pandemic. Metabolic profile of patients with IH at 1h-PG is “intermediate” between NGT and prediabetes.

Background: While insulin pumps remain the most common form of therapy for youths with type 1 diabetes (T1DM), they differ in the extent to which they utilize data from continuous glucose monitoring (CGM) and automate insulin delivery. Methods: The aim of the study was to compare metabolic control in patients using different models of insulin pumps. This retrospective single-center study randomly sampled 30 patients for each of the following treatments: Medtronic 720G without PLGS (predictive low glucose suspend), Medtronic 640G or 740G with PLGS and Medtronic 780G. In the whole study group, we used CGM systems to assess patients’ metabolic control, and we collected lipid profiles. In three groups of patients, we utilized CGM sensors (Guardian 3, Guardian 4, Libre 2 and Dexcom G6) to measure the following glycemic variability proxy values: time in range (TIR), time below 70 mg/dL (TBR), time above 180 mg/dL (TAR), coefficient of variation (CV) and mean sensor glucose. Results: Medtronic 640G or 740G and 780G users were more likely to achieve a target time in the target range 70–180 mg/dL (≥80%) [Medtronic 720G = 4 users (13.3%) vs. Medtronic 640G/740G = 10 users (33.3%) vs. Medtronic 780G = 13 users (43.3%); p = 0.0357)] or low glucose variability [Medtronic 720G = 9 users (30%) vs. Medtronic 640G/740G = 18 users (60%) vs. Medtronic 780G = 19 users (63.3%); p = 0.0175)]. Conclusions: Any integration between the insulin pump and CGM was associated with better glycemic control. More advanced technologies and artificial intelligence in diabetes help patients maintain better glycemia by eliminating various factors affecting postprandial glycemia.

Introduction Attention deficit hyperactivity disorder (ADHD) affects 5%–10% of paediatric population and is reportedly more common in children with type 1 diabetes (T1D), exacerbating its clinical course. Proper treatment of ADHD in such patients may thus provide neurological and metabolic benefits. To test this, we designed a non-commercial second phase clinical trial comparing the impact of different pharmacological interventions for ADHD in children with T1D.Methods and analysis This is a multicentre, randomised, open-label, cross-over clinical trial in children and adolescents with ADHD and T1D. The trial will be conducted in four reference paediatric diabetes centres in Poland. Over 36 months, eligible patients with both T1D and ADHD (aged 8–16.5 years, T1D duration >1 year) will be offered participation. Patients’ guardians will undergo online once-weekly training sessions behaviour management for 10 weeks. Afterward, children will be randomised to methylphenidate (long-release capsule, doses 18-36-54 mg) versus lisdexamphetamine (LDX, 30-50-70 mg). Pharmacotherapy will continue for 6 months before switching to alternative medication. Throughout the trial, the participants will be evaluated every 3 months by their diabetologist and online psychological assessments. The primary endpoint (ADHD symptom severity, Conners 3.0 questionnaire) will be assessed by a blinded investigator. Secondary endpoints will include HbA1c, continuous glucose monitoring indices and quality-of-life (PedsQL).Ethics and dissemination The trial is approved by Bioethical Committee at Medical University of Lodz and Polish regulatory agency (RNN/142/22/KE, UR/DBL/D/263/2022). The results will be communicated to the research and clinical community, and Polish agencies responsible for healthcare policy. Patient organisations focused on paediatric T1D will be notified by a consortium member. We hope to use the trial’s results to promote collaboration between mental health professionals and diabetes teams, evaluate the economic feasibility of using LDX in patients with both diseases and the long run improve ADHD treatment in children with T1D.Trial registration numbers EU Clinical Trials Register (EU-CTR, 2022-001906-24) and NCT05957055.

IntroductionThe safety of COVID-19 vaccines in children with juvenile idiopathic arthritis (JIA) is the concern of patients and their parents and doctors in the current pandemic reality. The main objective of the study was to evaluate the safety of COVID-19 vaccine in patients with JIA.MethodA cohort study based on short clinical follow-up of 43 children with JIA was conducted in the years 2021–2022 in two centres of paediatric rheumatology in Poland. All patients received mRNA COVID-19 vaccine. The patients' data were collected using appropriate validated questionnaire. Disease activity was evaluated using Juvenile Arthritis Disease Activity Score 27-joint count (JADAS-27).ResultsTen (22.7%) children had COVID-19 infection before getting COVID-19 vaccine. After first dose of COVID-19 vaccine 25/43 (58.1%) patients presented typical adverse events: arm pain or oedema at the application side or weakness. Also, twenty five (58.1%) children had side effects after second dose of this vaccine, however the spectrum of the symptoms was wider (additionally: headache, fever, lymphadenopathy, arrhythmia). Thirteen out of 43 (30.2%) patients had active disease before and 8/43 (18.6%) after COVID-19 vaccination, while the degree of JADAS-27 activity was higher in the study group before COVID-19 vaccination (p = 0.047).ConclusionsOur study found out that children and adolescents with JIA with remission without treatment or on the long-term treatment—cDMARDs or even bDMARDs, can be safely vaccinated for COVID-19. Moreover, the study found that COVID-19 vaccination does not interfere with the JIA treatment and does not exacerbate symptoms of the disease and that vaccination protected against developing COVID-19 in children with JIA even on treatment.

Uzbrojenie średniowiecznych Nowej Marchii i Ziemi Torzymskiej dalekie są od należytego rozpoznania. Niepublikowany dotąd miecz późnośredniowieczny odkryty przypadkowo w latach 70. XX w. gdzieś w okolicach Słubic (dziś zbiory prywatne), pozwala naszą wiedzę na ten temat znacznie rozwinąć. Miecz przetrwał do naszych czasów w dość dobrym stanie. Znaczna długość i smukłość głowni z granią, pozwala sklasyfikować go jako typ XVIIIb, 12 (12a), T3 wg Oakeshotta. Głownie typu XVIIIb znane są głównie ze znalezisk z zachodniej i środkowej Europy i produkowano je w Pasawie w Bawarii oraz w Hall w Tyrolu. Argumenty typologiczne, jak i ikonograficzne wskazują na datowanie miecza na sam koniec XV – początek XVI w., z lekkim wskazaniem na czas około 1500 r. Forma miecza, umożliwiająca walkę zarówno jedną, jak i dwiema rękami, pozwala uznać okaz ten za miecz bękarci (Bastardschwert), a wyraźne wzmocnienie sztychu wskazuje na jego przeznaczenie jako broni wykorzystywanej w trakcie pieszej walki w zbroi (tzw. Harnischfechten). Jego pojawienie się na pogranicza Nowej Marchii i Ziemi Torzymskiej wiązać należy z renesansem idei organizacji turniejów rycerskich, jaki zapanował wśród władców Rzeszy.

IntroductionOne of the most important complications of obesity is insulin resistance, which leads to carbohydrate metabolism disorders such as type 2 diabetes. However, obesity is also associated with development of an autoimmune response against various organs, including pancreatic beta cells. The prevalence of such autoimmune processes in children and their possible contribution to the increased incidence of type 1 diabetes is currently unclear. Therefore, the present study assessed the prevalence of autoantibodies against pancreatic islet beta cell’s antigens in children and adolescents with simple obesity.Material and methodsThis prospective observational study included pediatric patients (up to 18 years of age) with simple obesity hospitalized between 2011 and 2016 at the Department of Pediatrics, Diabetology, Endocrinology and Nephrology of the Medical University of Lodz. Children with acute or chronic conditions that might additionally affect insulin resistance or glucose metabolism were excluded. Collected clinical data included sex, age, sexual maturity ratings (Tanner`s scale), body height and weight, waist and hip circumference, amount of body fat and lean body mass. Each participant underwent a 2-hour oral glucose tolerance test with simultaneous measurements of glycaemia and insulinemia at 0`, 60` and 120`. In addition, glycated hemoglobin HbA1c, fasting and stimulated c-peptide, total cholesterol, as well as high- and low-density cholesterol and triglycerides were measured. Insulin resistance was assessed by calculating HOMA-IR index. The following autoantibodies against pancreatic islet beta cells were determined in each child: ICA - antibodies against cytoplasmic antigens of pancreatic islets, GAD - antibodies against glutamic acid decarboxylase, ZnT8 - antibodies against zinc transporter, IA2 - antibodies against tyrosine phosphatase, IAA – antibodies against insulin.ResultsThe study group included 161 children (57.4% boys, mean age 13.1 ± 2.9 years) with simple obesity (mean BMI z-score +2.2 ± 1.6). Among them, 28 (17.4%) were diagnosed with impaired glucose metabolism during OGTT [23 (82.2%) – isolated impaired glucose tolerance (IGT), 3 (10.7%) – isolated impaired fasting glucose (IFG), 2 (7.1%) – IFG and IGT]. Of the children tested, 28 (17.4%) were tested positive for at least one islet-specific autoantibody [with similar percentages in boys (15, 17.4%) and girls (13, 17.3%), p=0.9855], with ICA being the most common (positive in 18, 11.2%), followed by IAA (7, 4.3%), ZnT8 (5, 3.1%), GADA (3, 1.9%) and IA2 (1, 0.6%). There was no association between the presence of the tested antibodies and age, sex, stage of puberty, parameters assessing the degree of obesity, HbA1c, lipid levels and basal metabolic rate. However, autoantibody-positive subjects were more likely to present IFG or IGT in OGTT compared to those who tested completely negative (9, 32.1% vs 19, 14.3%, p=0.0280). Their HOMA-IR was also significantly higher (HOMA-IR: 4.3 ± 1.9 vs 3.4 ± 1.9, p=0.0203) and this difference remained statistically significant after adjusting for sex and age (p=0.0340).ConclusionsChildren and adolescents with simple obesity presented a higher prevalence of markers of autoimmune response against pancreatic beta cells than the general population. Most often, they had only one type of antibody - ICA. The presence of autoimmune response indicators against pancreatic islet antigens is more common in obese patients with impaired carbohydrate metabolism and is associated with lower insulin sensitivity.

Abstract Background Fibroblast growth factor 19 (FGF19), fibroblast growth factor 21 (FGF21) and Klotho are regulators of energy homeostasis. However, in the pediatric population, the relationships between obesity, metabolic disorders and the aforementioned factors have not been clearly investigated. We analyzed the role of FGF19, FGF21 and Klotho protein in children with normal body weight as well as in overweight and obese subjects and explored their associations with insulin resistance (IR) and metabolic syndrome (MS) and its components. Methods This was a cross-sectional study conducted in a group of hospitalized children and adolescents. Laboratory investigations included serum analysis of FGF19, FGF21, and Klotho with ELISA kits as well as the analysis of the lipid profile and ALT serum concentrations. Moreover, each subject underwent an oral glucose tolerance test (OGTT) with fasting insulinemia measurement to detect glucose tolerance abnormalities and calculate the Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) index. Furthermore, the clinical analysis included blood pressure measurement, body fat percentage estimation and assessment of the prevalence of MS and its components. Results The study was conducted with 174 children/adolescents aged 6–17 years with normal body weight (N = 48), obesity (N = 92) and overweight (N = 34). Klotho concentration was significantly higher in the obese children [median 168.6 pg/ml (90.2 to 375.9)]) than in the overweight [131.3 pg/ml (78.0 to 313.0)] and normal-body-weight subjects [116.6 pg/ml (38.5 to 163.9)] (p = 0.0334) and was also significantly higher in insulin-resistant children than in insulin-sensitive children [185.3 pg/ml (102.1 to 398.2) vs 132.6 pg/ml (63.9 to 275.6), p = 0.0283]. FGF21 was elevated in patients with MS compared to the FGF21 levels in other subjects [136.2 pg/ml (86.5 to 239.9) vs 82.6 pg/ml (41.8 to 152.4), p = 0.0286]. The multivariable model showed that FGF19 was an independent predictor of IR after adjusting for pubertal stage and BMI Z-score. Conclusions Klotho levels were associated with body weight status in children and adolescents. Moreover, Klotho, FGF19 and FGF21 concentrations correlated with IR status and/or components of MS.

Pozdně středověká, bohatě zdobená kamenina Falkeho skupiny, vyráběná pravděpodobně v Lužici, je badateli obecně považována za luxusní zboží. Více než sto fragmentů této specifické skupiny nádob bylo nalezeno na území dnešního Lubušského vojvodství, které na přelomu pozdního středověku a raného novověku tvořilo pohraniční oblast mezi Slezskem, Lužicí, Braniborskem a Velkopolskem. Analýza nálezů z této oblasti poukazuje na jejich výrobu v několika různých dílnách, vyrábějících rovněž jejich keramické napodobeniny. Kontext analyzovaných fragmentů naznačuje, že byla používána nejen ve šlechtickém a církevním prostředí, ale znali ji také zámožní měšťané a případně bohatší obyvatelé venkova.

Z území Polska je známo více než dvacet pozdně středověkých železných seker s výrazně zmenšenými rozměry. Tři z nich byly objeveny na pomezí Slezska, Velkopolska a Braniborska, přičemž pocházejí z fortifikovaných sídel a městských nálezových kontextů. V odborné literatuře byly tyto artefakty považovány za amulety, hračky, zbraně, odznaky či nástroje. Autor dochází k závěru, že menší exempláře mohly být používány jako apotropaické amulety nebo předměty související s kultem svatého Wolfganga, zatímco větší sekery s kaleným ostřím byly nejspíše specializovaným tesařským nářadím, v případě potřeby snad užívaným i jako příležitostná zbraň.

BackgroundAnalysis of variants in distant regulatory elements could improve the current 25–50% yield of genetic testing for monogenic diseases. However, the vast size of the regulome, great number of variants, and the difficulty in predicting their phenotypic impact make searching for pathogenic variants in the regulatory genome challenging. New tools for the identification of regulatory variants based on their relevance to the phenotype are needed.MethodsWe used tissue-specific regulatory loci mapped by ENCODE and FANTOM, together with miRNA–gene interactions from miRTarBase and miRWalk, to develop Remus, a web application for the identification of tissue-specific regulatory regions. Remus searches for regulatory features linked to the known disease-associated genes and filters them using activity status in the target tissues relevant for the studied disorder. For user convenience, Remus provides a web interface and facilitates in-browser filtering of variant files suitable for sensitive patient data.ResultsTo evaluate our approach, we used a set of 146 regulatory mutations reported causative for 68 distinct monogenic disorders and a manually curated a list of tissues affected by these disorders. In 89.7% of cases, Remus identified the regulator containing the pathogenic mutation. The tissue-specific search limited the number of considered variants by 82.5% as compared to a tissue-agnostic search.ConclusionRemus facilitates the identification of regulatory regions potentially associated with a monogenic disease and can supplement classical analysis of coding variations with the aim of improving the diagnostic yield in whole-genome sequencing experiments.

During the Middle Ages arms and armour were considered luxury products. They were not used every day and not by everyone. Nonetheless, the circle of their buyers was relatively wide, making their prices extremely diversified. On the other hand, as weaponry was bought every several years, the demand was limited. It resulted in a relatively small number of workshops in which weapons were produced. Besides specialised production sites located in towns or at royal courts, there were also rural forges, where arms and armour were produced for the needs of less wealthy members of the medieval society. The production of armaments in the borderlands of Silesia, Greater Poland, Brandenburg and Lusatia (roughly equivalent to today’s Lubuskie Voivodeship), laying mostly outside the borders of medieval Poland, has not been yet explored in the scholarly works. Researching the subject is difficult due to the lack of direct sources. There is, however, some indirect evidence. Iron, in medieval times obtained mainly from bog ores, was the most important raw material for the manufacture of a majority of military equipment. Therefore, the first indication of the arms and armour manufacturing in the studied borderland during the Middle Ages and the Early Modern Period can be found in written sources, which mention many small metallurgical workshops (forges and hammer-mills). Early mentions concern following settlements: Drożków near Żary, Klikowa near Iłowa, Szprotawa (Sprottau), Łozy upon the Kwisa, Sanice near Przewóz, Dobrzyń and Bucz (Fig. 1). Direct evidence confirming the functioning of s place of iron production was discovered during archaeological excavations in Podrosche (former part of Przewóz). Most scholars assumes that rural smithies did not participate in the production of arms and armour on a large scale, mostly limiting their activity to horseshoeing, forging basic agricultural and carpentry tools (including axes and hatchets) as well as sharpening and repairing more elaborate artefacts . Mass-produced arrow- and boltheads, as well as iron parts of staff weapons, could also be manufactured there, although rather only in times of war. Remains of such a rural smithy (dated to the 15th c.) were recorded in Nowa Wieś, Międzyrzecz District (Fig. 2). A large amount of iron slag was found in the fill of the feature, along with smithing tools, finished and unfinished smithing products and also pieces of armaments. Castle forges were more specialised in manufacture and repair of individual parts of military equipment. Remains of such workshops were found, among others, in: Miedzyrzecz (Fig. 3) and Santok (Fig. 4), while inventories of the Teutonic castles in Kostrzyn (Küstrin) and Drezdenko, in which large amounts of saltpetre, sulphur and lead was recorded, may indicate that gunpowder and projectiles were produced in those strongholds. Little is known about metal crafts’ organisation in the region as written sources provide almost no information. (Fig. 5) There is no doubt that blacksmith guilds existed in larger towns of the area, as it was typical for medieval urban centres of Central and Western Europe, although the relatively late mentions in written records provide little information on the subject. Some data was acquired as a result of examination of archaeological finds. Some of them are signed with craftsmen’s marks, which if identified may indicate a place of origin for particular pieces of arms. They, however, show these objects were manufactured outside the region (Fig. 6). It is finds like unfinished items and intermediate products that can suggests local production of armaments in the places where they were discovered (Fig. 7). Therefore, indirect evidence shows that although the scale of the production was rather small, it met the demand of local purchasers (of various wealth). The need for simple and mass produced arms might be fulfilled by castle, town and rural forges.

This paper focuses on a copper-alloy goad discovered in 2017 in Lubniewice in Lubuskie Voivodeship, Poland. An interdisciplinary analysis has shown that the goad was originally part of a lavishly decorated copper-alloy spur representing a type known from high-status West Slavic graves (e.g. Lutomiersk, Ciepłe) and settlement sites. Because objects of this kind are made of costly material, and because expert skills were required to produce them, it is argued that they were commissioned by a very specific group of people who used them as “material markers” of their distinct cultural and religious identity. It is not unlikely that the owners of such spurs were members of the elite retinue of the Piasts who played important roles on and off the battlefield.

People with type 1 diabetes have an increased risk of developing microvascular complications, which have a negative impact on the quality of life and reduce life expectancy. Numerous studies in animals with experimental diabetes show that c-peptide supplementation exerts beneficial effects on diabetes-induced damage in peripheral nerves and kidneys. There is substantial evidence that c-peptide counteracts the detrimental changes caused by hyperglycemia at the cellular level, such as decreased activation of endothelial nitric oxide synthase and sodium potassium ATPase, and increase in formation of pro-inflammatory molecules mediated by nuclear factor kappa-light-chain-enhancer of activated B cells: cytokines, chemokines, cell adhesion molecules, vascular endothelial growth factor, and transforming growth factor beta. However, despite positive results from cell and animal studies, no successful c-peptide replacement therapies have been developed so far. Therefore, it is important to improve our understanding of the impact of c-peptide on the pathophysiology of microvascular complications to develop novel c-peptide-based treatments. This article aims to review current knowledge on the impact of c-peptide on diabetic neuro- and nephropathy and to evaluate its potential therapeutic role.

In 2016, an Early Medieval sword scabbard chape was handed over to the Museum of Kostrzyn Fortress. According to the person submitting it, it was found about 5-6 years earlier in the northern part of Kostrzyn nad Odrą. The main decorative motif of the openwork field is a heraldically arranged bird. The closest analogies to the chape in question are dated to the second half of the 10th and 11th century. Artefacts of this type could have been produced in Scandinavia, but also in the Rus and Baltic areas. Unfortunately, we are not able to say what raw material was used to cast the artefact in question. An analysis of the metal composition of the find carried out on the surface of the artefact demonstrated that a very heterogeneous lead alloy was used, which could have also been a result of lead-bleaching. The same technology was also observed on the chapes from Ruthenia. Scholars have explained the presence of an ornithomorphic motif on the surface of the artefact in various ways

Polyunsaturated fatty acids (PUFAs) are bioactive lipids which modulate inflammation and immunity. They gained recognition in nutritional therapy and are recommended dietary supplements. There is a growing body of evidence suggesting the usefulness of PUFAs in active therapy of various gastrointestinal (GI) diseases.In this review we briefly cover the systematics of PUFAs and their metabolites, and elaborate on their possible use in inflammatory bowel disease (IBD), functional gastrointestinal disorders (FGIDs) with focus on irritable bowel syndrome (IBS), and colorectal cancer (CRC). Each section describes the latest findings from in vitro and in vivo studies, with reports of clinical interventions when available.