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The dynamically changing epidemiological situation caused by the SARS-CoV-2 virus is associated with the increased burden and fatigue of medical personnel. The aim of the study was to evaluate: (1) oxygen and carbon dioxide blood pressure and saturation levels in medical personnel caring for patients isolated due to SARS-CoV-2 in ICUs, (2) adverse symptoms reported by medical personnel after leaving the isolation zone. Design: A Prospective Cohort Study. Methods: The project was implemented in the first quarter of 2021. Medical personnel working with patients isolated due to SARS-CoV-2 in the ICU of three hospitals were eligible for the study. The participants of the study were subjected to two analyses of capillary blood by a laboratory diagnostician. Results: In the studied group of medical personnel (n = 110) using FFP2/FFP3 masks, no significant differences (p &gt, 0.05) were found between the parameters of geometric examination performed before and after leaving the isolation ward of the hospital. After working in the isolation ward, nurses reported malaise (somnolence, fatigue, sweating, dizziness) more often than paramedics (44% vs. 9%, p = 0.00002). The risk of ill-being in nurses was approximately nine times higher than in paramedics (OR = 8.6, Cl 95%: 2.7 to 26.8) and increased with the age of the subjects (OR = 1.05, Cl 95%: 1.01 to 1.08). Conclusion: FFP2/FFP3 filter masks did not worsen blood oxygenation in medical staff caring for patients isolated due to SARS-CoV-2 in the ICU. The presence of subjective symptoms such as fatigue may be due to lack of adequate hydration.

The World Health Organization (WHO) has recognised obesity as one of the top ten threats to human health. Obesity is not only a state of abnormally increased adipose tissue in the body, but also of an increased release of biologically active metabolites. Moreover, obesity predisposes the development of metabolic syndrome and increases the incidence of type 2 diabetes (T2DM), increases the risk of developing insulin resistance, atherosclerosis, ischemic heart disease, polycystic ovary syndrome, hypertension and cancer. The lymphatic system is a one-directional network of thin-walled capillaries and larger vessels covered by a continuous layer of endothelial cells that provides a unidirectional conduit to return filtered arterial and tissue metabolites towards the venous circulation. Recent studies have shown that obesity can markedly impair lymphatic function. Conversely, dysfunction in the lymphatic system may also be involved in the pathogenesis of obesity. This review highlights the important findings regarding obesity related to lymphatic system dysfunction, including clinical implications and experimental studies. Moreover, we present the role of biological factors in the pathophysiology of the lymphatic system and we propose the possibility of a therapy supporting the function of the lymphatic system in the course of obesity.

Introduction: The spread of multidrug-resistant pathogens is a serious problem and challenge for the whole medical community. Carbapenem-resistant Klebsiella pneumoniae (CRKP) infections in immunocompromised patients have a severe course and may be fatal. Increasingly, these bacteria are exhibiting resistance to carbapenem antibiotics, which have been used as so-called drugs of last resort. The emergence of the new coronavirus and the pandemic that it has caused require changes to protect against the spread of the new SARS-CoV-2. These changes paradoxically may contribute to the spread of other infections. Methods: PubMed, Cochrane Library databases were searched using relevant keywords. A literature review of carbapenem-resistant Klebsiella pneumoniae infection in patients hospitalized for COVID-19 was conducted according to PRISMA recommendations. A written review protocol was not prepared. Results: 1016 studies in scientific databases were searched. After rejecting duplicate studies, 964 results were obtained. Inclusion and exclusion criteria were then applied, and studies were qualitatively analyzed. Finally, 11 studies were included in the review. The results of infected patients were from six countries. The prevalence of CRKP in Covid-19 patients ranged from 0.35–53%. The majority of CRKP infected patients were male (85%), with a mean age of 61 years. Among isolates, the predominant genes were KPC, OXY-48, CTX-M, TEM, NDM and SHV. Conclusion: The results presented in our review indicate the necessity of paying attention to carbapenem-resistant Klebsiella pneumoniae infections in patients with COVID-19. In order to prevent the increase of bacterial resistance, rational antibiotic therapy should be used, as well as continuous control and surveillance of hospital infections caused by multidrug-resistant organisms.

The aim of the study was to evaluate the effect of manual therapy and the use of ibuprofen on the severity of dysmenorrhea and changes in the level of sex hormones in young women with dysmenorrhea. Material and methods: The study included six women, aged 22 ± 2 years, with primary dysmenorrhea (PD). A physiotherapist examined the tenderness and flexibility of the muscles. The patients were subjected to a gynecological and physiotherapeutic examination; the concentrations of progesterone and 17-beta-estradiol were also determined. In subgroup A (n = 3), manual therapy was performed 3 × 45 min; in subgroup B (n = 3), the patients received ibuprofen 3 × 400 mg/day. Results: In subgroup A, all patients showed a decrease in the level of progesterone and an increase in the concentration of estradiol. In subgroup B, the concentration of progesterone and 17-beta estradiol decreased in two subjects. In subgroup A, manual therapy reduced the severity of headache, back pain, diarrhea, fatigue, and PMS. In subgroup B, the use of ibuprofen only alleviated back pain and fatigue. Moreover, in subgroup A, after the application of manual therapy, improvement in flexibility and pain relief of the examined muscles was demonstrated. On the other hand, in subgroup B, no improvement in flexibility or reduction in muscle soreness was found in patients who took ibuprofen. Conclusions: Manual therapy may reduce menstrual pain in women with dysmenorrhea. However, the results need to be confirmed in studies conducted on a larger group of patients with dysmenorrhea.

The observed dynamic knee valgus and the limited dynamic balance described in the literature are modifiable risk factors for injuries in athletes. Therefore, identification and appropriate prevention are crucial in managing the development of young athletes. The aim of the study was to assess the effectiveness of three exercises strengthening the muscles: gluteal medius, popliteal and tibialis posterior to reduce dynamic knee valgus and improve the dynamic balance of the lower limbs in young football players with poor knee control. A total of 134 footballers were assessed for eligibility, and finally 45 participants (age 12–15) met the inclusion criteria. Participants were assessed with 2D video kinematic analysis during single-leg squats to assess the knee valgus angles and the dynamic balance (Y-Balance Test). No significant interactions between groups (Control and Exercise) and time (baseline and after 6 week) were noted for dynamic valgus for the left and right knee (p > 0.05). For the dynamic balance, there were statistically significant results, but not clinically relevant for anterior, posteromedial, and composite direction for the right lower limbs and for the anterior direction for left lower limbs in the exercise group. However, there were no significant differences (p > 0.05) in all of the YBT scores for both lower limbs between groups. This study demonstrated that there were no statistically significant differences in dynamic knee valgus angles and dynamic balance values after 6 weeks of exercise program in young footballers with poor knee control. Future randomized trials should focus on more comprehensive exercises, where possible using biofeedback methods to improve knee kinematics.

Objective: In recent years, there have been only a few studies showing an improvement of the lymphatic system function in patients with abnormal body weight after the use of manual lymphatic drainage (MLD). The aim of the study was to assess the effectiveness of using MLD of the abdominal cavity as one of the forms of therapy for lymphatic system dysfunction in people with abnormal body weight. Material and methods: The study presents the therapy of two women aged 30 to 59. They underwent 10 treatments of manual lymphatic drainage of the abdominal cavity (30 minutes x 3 times a week). Biochemical tests were performed before and after the MLD treatment. The degree of obesity was determined on the basis of the BMI (body mass index) and WHR (waist-to-hip ratio). The 7-point Likert scale was used to evaluate the patients’ quality of life. Results: The overweight patient showed an improvement in biochemical parameters, including a decrease in the level of C-peptide and C-reactive protein, and a better quality of life compared to the state before the therapy. This subject scored 3 points before vs. 5 points after the MLD treatment. The patient with class 2 obesity and comorbidities showed no improvement in biochemical parameters, however, there was a change for better in the quality of life after the therapy. The patient scored 3 points before vs. 4 points after the MLD treatment. Conclusions: Preliminary studies indicate potential benefits of using MLD for improving biochemical parameters, including a reduction of inflammation in an overweight patient.

Rugby is a demanding contact sport. In light of research, poor balance, reduced jumping ability, muscle strength, and incorrect landing patterns might contribute to the increased risk of injury in athletes. Investigating the relationship between tests assessing these abilities might not only allow for the skillful programming of preventive training but also helps in assessing the risk of injury to athletes. Thus, the main purpose of this study was to investigate the relationship between dynamic balance, vertical and horizontal jumps, and jump-landings movement patterns. Thirty-one healthy amateur adolescent rugby players (age: 14.3 &plusmn, 1.6 years, height 171.4 &plusmn, 9.7 cm, body mass 80 &plusmn, 26 kg) participated in the study. Data were collected by the Y-balance Test (YBT), Counter Movement Jump (CMJ), Single Leg Hop for Distance (SLHD), and Landing Error Score System (LESS). Significant positive correlations were found between SLHD both legs (SLHDb) and YBT Composite both legs (COMb) (r = 0.51, p = 0.0037) and between SLHDb and CMJ (r = 0.72, p &lt, 0.0001). A relationship was also observed between the CMJ and YBT COMb test (r = 0.51, p = 0.006). Moderate positive correlations were found between the dominant legs in SLHD and the posterolateral (r = 0.40, p = 0.027), posteromedial (r = 0.43, p = 0.014), and composite (r = 0.48, p = 0.006) directions of the YBT. These results indicate that variables that are dependent on each other can support in the assessment of injury-risk and in enhancing sports performance of young athletes.

Diabetes mellitus (DM) has become a vital societal problem as epidemiological studies demonstrate the increasing incidence of type 1 and type 2 diabetes. Lesions observed in the retina in the course of diabetes, referred to as diabetic retinopathy (DR), are caused by vascular abnormalities and are ischemic in nature. Vascular lesions in diabetes pertain to small vessels (microangiopathy) and involve precapillary arterioles, capillaries and small veins. Pericyte loss, thickening of the basement membrane, and damage and proliferation of endothelial cells are observed. Endothelial cells (monolayer squamous epithelium) form the smooth internal vascular lining indispensable for normal blood flow. Breaking its continuity initiates blood coagulation at that site. The endothelium controls the process of exchange of chemical substances (nutritional, regulatory, waste products) between blood and the retina, and blood cell passing through the vascular wall. Endothelial cells produce biologically active substances involved in blood coagulation, regulating vascular wall tension and stimulating neoangiogenesis. On the other hand, recent studies have demonstrated that diabetic retinopathy may be not only a microvascular disease, but is a result of neuroretinal degeneration. Neuroretinal degeneration appears structurally, as neural apoptosis of amacrine and Muller cells, reactive gliosis, ganglion cell layer/inner plexiform (GCL) thickness, retinal thickness, and retinal nerve fiber layer thickness, and a reduction of the neuroretinal rim in minimum rim width (MRW) and functionally as an abnormal electroretinogram (ERG), dark adaptation, contrast sensitivity, color vision, and microperimetric test. The findings in early stages of diabetic retinopathy may precede microvascular changes of this disease. Furthermore, the article’s objective is to characterize the factors and mechanisms conducive to microvascular changes and neuroretinal apoptosis in diabetic retinopathy. Only when all the measures preventing vascular dysfunction are determined will the risk of complications in the course of diabetes be minimized.

Autoimmune thyroiditis (AIT) frequently coexists with type 1 diabetes (DM1) and additionally increases the extent of microcirculatory complications due to DM1. We hypothesized that in pediatric patients with DM1, impairment of macrocirculation could be further augmented by a coexisting autoimmune process. Therefore, we investigated the influence of AIT on large arteries in DM1 pediatric patients. Our group consisted of 19 DM1, 19 DM1 + AIT patients and 29 control subjects. The groups were comparable regarding age and gender. The DM1 and DM1 + AIT patients were matched for age at onset of DM1 and diabetes duration. Macrocirculation was described using pulsatility indices (PIs) determined for common carotid (CCA) and peripheral arteries of upper and lower limbs. CCA resistance index (RI) and ABI were also assessed. Children with DM1 + AIT had only significantly lower CCA_PI and CCA_RI in comparison with controls whereas in the absence of AIT such difference was not found. The diabetes duration and age of onset did not correlate with carotid indices. Total cholesterol level was higher both in DM1 + AIT and DM1 groups than in the control group. For low density lipoproteins cholesterol, a significant difference was found between DM1 + AIT and control groups. Age‐independent impact of AIT on CCA_PI was confirmed by multivariate analysis. Common carotid pulsatility is deteriorated by autoimmune thyroiditis independently of age in children with type 1 diabetes mellitus., Autoimmune thyroiditis frequently coexist with type 1 diabetes and additionally increases the extent of microcirculatory complications due to type 1 diabetes mellitus, but its impact on large arteries has been rarely studied. We investigated the influence of autoimmune thyroiditis on large arteries in type 1 diabetes mellitus pediatric patients. It was concluded that common carotid pulsatility is deteriorated by autoimmune thyroiditis independently of age in children with type 1 diabetes mellitus.

Background and objective: Allergy belongs to a group of mast cell-related disorders and is one of the most common diseases of childhood. It was shown that asthma and allergic rhinitis diminish the risk of various cancers, including colon cancer and acute lymphoblastic leukemia. On the other hand, asthma augments the risk of lung cancer and an increased risk of breast cancer in patients with allergy has been observed. Thus, the relation between allergy and cancer is not straightforward and furthermore, its biological mechanism is unknown. The HTRA (high temperature requirement A) proteases promote apoptosis, may function as tumor suppressors and HTRA1 is known to be released by mast cells. Interleukin-12 (Il-12) is an important cytokine that induces antitumor immune responses and is produced mainly by dendritic cells that co-localize with mast cells in superficial organs. Material and methods: In the present study we have assessed with ELISA plasma levels of the HTRA proteins, Il-12, and of the anti-HTRA autoantibodies in children with allergy (40) and in age matched controls (39). Children are a special population, since they usually do not have comorbidities and take not many drugs the processes we want to observe are not influenced by many other factors. Results: We have found a significant increase of HTRA1, 2 and 3, and of the Il-12 levels in the children with atopy (asthma and allergic rhinitis) compared to controls. Conclusion: Our results suggest that the HTRA1&ndash, 3 and Il-12 levels might be useful in analyzing the pro- and antioncogenic potential in young atopic patients.

The World Health Organization (WHO) has recognized obesity as one of the top ten threats to human health. It is estimated that the number of obese and overweight people worldwide exceeds the number of those who are undernourished. Obesity is not only a state of abnormally increased adipose tissue in the body, but also of increased release of biologically active adipokines. Adipokines released into the circulating blood, due to their specific receptors on the surface of target cells, act as classic hormones affecting the metabolism of tissues and organs. What is more, adipokines and cytokines may decrease the insulin sensitivity of tissues and induce inflammation and development of chronic complications. Certainly, it can be stated that in an era of a global obesity pandemic, adipokines may gain more and more importance as regards their use in the diagnostic evaluation and treatment of diseases. An extensive search for materials on the role of white, brown and perivascular fatty tissue and obesity-related metabolic and chronic complications was conducted online using PubMed, the Cochrane database and Embase.

Dysmenorrhea often significantly reduces the quality of women’s life and is still an important public health problem. Despite numerous studies, the pathomechanism of dysmenorrhea is not fully understood. Previous research indicates the complexity of biochemical reactions between the endocrine, vascular, and immune systems. Prostaglandins play a major role in the pathomechanism of dysmenorrhea. In contrast, cytokines and other proinflammatory factors in primary dysmenorrhea are less studied. In addition to the applied pharmacotherapy, more and more studies proving the effectiveness of non-pharmacological methods appear. Therefore, the present work contains a review of the latest research concerning factors involved in dysmenorrhea, as well as therapeutic options. In the literature search, authors used online databases, PubMed, and clinitrials.gov and browsed through individual gynecology, physiotherapy journals and books.

The increase in type 1 diabetes mellitus (T1DM) incidence in children is worrying and not yet fully explored. It is suggested that probably air pollution exposure could contribute to the development of T1DM. The aim of the study was to investigate the relationship between the concentration of gaseous pollutants including, nitrogen dioxide (NO2), nitric oxides (NOx), sulphur dioxide (SO2), carbon monoxide (CO), and particulate matter (PM) in the air, and the number of new cases of T1DM in children. The number of new cases of T1DM was obtained from the Clinic of Paediatrics, Diabetology, and Endocrinology, Medical University of Gdańsk. The number of children of 0–18 years old in Pomeranian Voivodeship was acquired from the Statistical Yearbook. The concentrations of PM10 absorbance, NO2, NOx, SO2, and CO were measured at 41 measuring posts, between 1 January 2015 and 31 December 2016. It was detected that the average annual concentration of PM10 was higher than the value acceptable to the WHO. Furthermore, the average 24-hour concentration of PM10 was 92 μg/m3 and was higher compared to the acceptable value of 50 μg/m3 (acc. to EU and WHO). Moreover, the number of new cases of T1DM showed a correlation with the annual average concentration of PM10 (β = 2.396, p<0.001), SO2 (β = 2.294, p<0.001), and CO (β = 2.452, p<0.001). High exposure to gaseous pollutants and particulate matter in ambient air may be one of the factors contributing to the risk of developing T1DM in children. Therefore, it is important to take action to decrease air pollutant emissions in Poland. It is crucial to gradually but consistently eliminate the use of solid fuels, such as coal and wood in households, in favour of natural gas and electricity. The development of new technologies to improve air quality, such as “best available techniques” (BAT) or renewable energy sources (water, wind, and solar generation) is of critical importance as well.

Purpose. The aim of the research was to conduct an assessment of the prevalence of dysmenorrhea and associated factors among Polish women. Patients and Methods. A cross-sectional study was conducted among Polish women using an online questionnaire. The mean age of the participants was 23 ± 4 years. Out of the total of 1,317 women who took part in the study, 1,127 were included in the analysis, and 190 were excluded due to incomplete answers. The questionnaire consisted of 19 questions that were grouped into three parts. The first concerned sociodemographic data such as age, weight, education, and residence (urban or rural). The second part of the questionnaire pertained to the factors of dysmenorrhea (premenstrual syndrome, age of menarche, and family history of dysmenorrhea.). In the third part, the women were asked about their diet, alcohol intake, cigarette smoking, and physical activity. Results. Dysmenorrhea affected 94% of the interviewed women. Dysmenorrhea was most likely to occur among respondents whose mothers had a history of dysmenorrhea (p<0.005). Significant relationship between the occurrence of dysmenorrhea among respondents and their sisters was also observed (p<0.005). The prevalence of premenstrual syndrome (PMS) was significantly higher in women reporting dysmenorrhea (p<0.005). Other significant factors associated with dysmenorrhea were age of menarche (p<0.005), stress frequency (p=0.005), lack of physical activity (p=0.037), and self-esteem (p=0.042). However, in the respondents, no significant relationship was observed between dysmenorrhea and diet, smoking, body mass index, and alcohol intake. Conclusion. The study points to the fact that the problem of dysmenorrhea affects many Polish women. Women with dysmenorrhea were characterized with a family history of dysmenorrhea, occurrence of PMS, early age of menarche, stressful lifestyle, lack of physical activity, and low self-esteem. We suggest that further assessment of factors contributing for dysmenorrhea among women is necessary.

Acute kidney injury (AKI) is described as a relatively common complication of exercise. In clinical practice the diagnosis of AKI is based on serum creatinine, the level of which is dependent not only on glomerular filtration rate but also on muscle mass and injury. Therefore, the diagnosis of AKI is overestimated after physical exercise. The aim of this study was to determine changes in uremic toxins: creatinine, urea, uric acid, asymmetric dimethylarginine (ADMA), symmetric dimethylarginine (SDMA), trimethylamine N-oxide (TMAO) and urinary makers of AKI: albumin, neutrophil gelatinase-associated lipocalin (uNGAL), kidney injury molecule-1 and cystatin-C (uCyst-C) after long runs. Sixteen runners, mean age 36.7 &plusmn, 8.2 years, (2 women, 14 men) participating in 10- and 100-km races were studied. Blood and urine were taken before and after the races to assess markers of AKI. A statistically significant increase in creatinine, urea, uric acid, SDMA and all studied urinary AKI markers was observed. TMAO and ADMA levels did not change. The changes in studied markers seem to be a physiological reaction, because they were observed almost in every runner. The diagnosis of kidney failure after exercise is challenging. The most valuable novel markers which can help in post-exercise AKI diagnosis are uCyst-C and uNGAL.

Introduction: Nephrogenic systemic fibrosis (NFS) is a generalized disorder occurring in people with kidney failure. This new disease entity can lead to significant disability or even death. Gadolinium-associated systemic fibrosis is related to exposure to contrast agents used for magnetic resonance imaging. The aim of this study was to review the literature in available scientific databases on NFS—complication after gadolinium-containing contrast agents. Methods: PubMed and Cochrane Library databases were searched using adequate key words. A literature review of the described cases of NSF occurrence after exposure to gadolinium-containing contrast agents was performed. A review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. A review written protocol was not drafted. Results: Originally, 647 studies were searched in scientific databases. After rejecting the duplicate results, 515 results were obtained. Finally, nine studies were included in the review. A total of 173 cases with NSF were included in the analysis. The majority of patients were undergoing dialysis. The contrast agent used for MRI was most often gadodiamide and gadopentetate dimeglumine. The time from exposure to NSF symptoms was from two days to three years. Three authors pointed out other factors in their papers that could potentially influence the occurrence of NSF. These included: metabolic acidosis, ongoing infection, higher doses of erythropoietin and higher serum concentrations of ionized calcium and phosphate. Since 2008, the number of reported cases of NSF has decreased significantly. More recent guidelines and reports indicate that not all contrast agents are associated with the same risk of developing NSF. Conclusions: Most NSF occurs after exposure to linear contrast agents. Therefore, it is recommended to limit their use, especially in dialyzed patients and patients with a GFR < 30 mL/min.

The family of lysosome-associated membrane proteins (LAMPs) encompassing LAMP1, LAMP2 and DC-LAMP (LAMP3) are the major constituents of the glycoconjugates coat present on the inside of the lysosomal membrane. LAMP3 is highly expressed only in certain cell types and during the differentiation stages. Its expression is linked the maturation of dendritic cells, inflammation, poor prognosis of certain tumors, and the locus where it is encoded was identified as a risk factor for Parkinson's disease (PD). Here, we investigated the capacity of Vitamin D3 to modulate the expression of LAMP3 during the dendritic cells differentiation and maturation. Our results demonstrated that the Vitamin D3 reduce the LAMP3 mRNA/protein expression during the dendritic cells differentiation and maturation, via NFκB pathways. Furthermore, we demonstrated that the Vitamin D3 was able to modulate the expression of LAMP3 likewise to in vitro tolerogenic dendritic cells. In summary, these data showed that the decrease of LAMP3 expression by Vitamin D3could enhance the tolerogenic characteristic of dendritic cells.

The aim of our study was to evaluate the relation between the concentration of particulate matter of less than 10 μm in diameter (PM10) in air and the effect of psychrophilic bacteria, mesophilic bacteria and mould fungi on the number of new cases of type 1 diabetes mellitus in children and adolescents in the Lubelskie Voivodeship in the years 2015-2016.Epidemiological data on the number of new cases of T1DM was obtained from the Department of Paediatric Endocrinology and Diabetology of the Medical University in Lublin. The number of births for the year 2015 and 2016 in the Lublin Voivodeship was acquired from the statistical yearbook by the Polish Central Statistical Office (GUS). Data on PM10 concentration in the Lubelskie Voivodeship was obtained from the report and annual evaluations of air quality prepared by the Voivodeship Inspectorate of Environmental Protection (WIOŚ) in Lublin. The analysis of psychrophilic bacteria, mesophilic bacteria and mould fungi in air was performed with use of the impact method and an air sampler.In the years 2015-2016 in the Lubelskie Voivodeship the number of births was 39 381 and 152 new cases of type 1 diabetes mellitus were recorded. The annual and 24-hour concentration of PM10 in air in 2015 was higher compared to 2016; however, the difference was not statistically significant. Moreover, we detected a higher number of psychrophilic bacteria 2739 vs 1000 CFU/m3 and a significantly higher number of mesophilic bacteria 92493 vs 1000 CFU/m3 than the norm specified in the Polish standard PN-89/Z-04111/02. A further analysis of air samples collected in the Lubelskie Voivodeship revealed lower a concentration of mould fungi compared to the Polish standard PN-89/Z-04111/02 (3840 vs 5000 CFU/m3, respectively). We isolated 9 types of mould fungi and 1 type of yeast-like fungus that are thought to have a negative effect on people's health. The statistical analysis revealed a relation between the number of new cases of T1DM and the number of psychrophilic bacteria (β= 2.86; p0.05), mesophilic bacteria (β = 2.824; p0.05) and the number of mould fungi (β=2.923; p0.001). The analysis of linear regression revealed a relation between the number of new T1DM cases and mean annual concentration of PM10 for the year 2016 (p0.001). However, there was no relation observed between the number of new cases of T1DM and the mean annual concentration of PM10 in air in the Lubelskie Voivodeship in 2015.Our preliminary results confirm the not yet fully explored relation between air pollution and the risk of type 1 DM in children and adolescents.Wstęp. Celem naszych badań było określenie zależności pomiędzy stężeniem zawieszonego pyłu o średnicy do 10 µm (PM10) w powietrzu atmosferycznym oraz wpływu obecności bakterii psychrofilnych, mezofilnych, grzybów pleśniowych na liczbę świeżych zachorowań na cukrzycę typu 1 u dzieci i młodzieży w województwie lubelskim w latach 2015–2016. Pacjenci i metody. Dane epidemiologiczne dotyczące liczby nowych zachorowań na cukrzycę T1DM otrzymano z Kliniki Endokrynologii i Diabetologii Dziecięcej UM w Lublinie. Liczbę urodzeń w latach 2015 i 2016 w województwie lubelskim odczytano z roczników statystycznych GUS. Dane dotyczące stężenia pyłu PM10 w województwie lubelskim uzyskano z raportu i rocznych ocen jakości powietrza, opracowanych przez WIOŚ w Lublinie. Badanie bakterii psychrofilnych, mezofilnych oraz grzybów pleśniowych w powietrzu atmosferycznym wykonano metodą szczelinowo-zderzeniową za pomocą próbnika do poboru powietrza. Wyniki. W latach 2015–2016 w województwie lubelskim liczba urodzeń dzieci wynosiła 39 381, a odnotowano 221 nowych przypadków zachorowań na cukrzycę typu 1. W powietrzu atmosferycznym wykazano wyższe w 2015 roku, lecz nie nieistotnie statystycznie roczne jak też 24h stężenie pyłów PM10 w porównaniu do roku 2016. Ponadto wykryto wyższą liczbę bakterii psychrofilnych 2739 vs 1000 CFU/m3 oraz istotnie wyższą liczbę bakterii mezofilnych 2493 vs 1000 CFU /m3 w odniesieniu do normy PN-89/Z-04111/02. W dalszej analizie z pobranych próbek powietrza w województwie lubelskim wykryto niższe w porównaniu z normą PN-89/Z-04111/02 stężenie grzybów pleśniowych odpowiednio 3840 vs 5000 CFU/m3. Jednakże wyizolowano dziewięć gatunków grzybów pleśniowych oraz jeden gatunek drożdżaka o potencjalnym negatywnym wpływie na zdrowie człowieka. W analizie statystycznej wykazano zależność pomiędzy liczbą nowych zachorowań na T1DM a liczbą bakterii psychrofilnych (β= 2,86; p0,05), mezofilnych (β = 2,824; p0,05) oraz liczbą grzybów pleśniowych (β=2,923; p0,001). Analiza regresji liniowej wykazała zależność pomiędzy liczbą nowych zachorowań na T1DM a średnim rocznym stężeniem pyłu PM10 w roku 2016 (p0,001). Natomiast nie wykazano zależności pomiędzy liczbą nowych zachorowań na T1DM a średnim rocznym stężeniem PM10 w powietrzu atmosferycznym w województwie lubelskim w roku 2015. Wnioski. Nasze wstępne wyniki badań wspierają słabo poznany związek zanieczyszczenia powietrza a ryzyka rozwoju cukrzycy typu 1 u dzieci i młodzieży.

In the recent years we have been observing an increased incidence of type 1 diabetes in children and adolescents. This leads to a more frequent acute complication of type 1 diabetes among children with hyperglycemia. The most common of these is diabetic ketoacidosis (DKA), while cerebral edema is the most dangerous. In children with DKA, cerebral edema most often presents with clinical symptoms but may also appear in the so-called “subclinical” form. That is why the search continues for new methods of assessing and monitoring cerebral edema in the course of DKA treatment. Ultrasonographic optic nerve sheath diameter (US ONSD) assessment is performed in various clinical scenarios when cerebral edema is suspected. It is most often performed in adult patients but increasingly often in children. US ONSD assessment is useful in the treatment of DKA in children with type 1 diabetes. This manuscript provides an overview of research results available in PubMed and other available databases on the course of treatment of DKA in children with type 1 diabetes.

Dynamic knee valgus (DKV) as an incorrect movement pattern is recognized as a risk factor for lower limb injuries. Therefore, it is important to find the reasons behind this movement to select effective preventive procedures. There is a limited number of publications focusing on specific tasks, separating the double-leg from the single-leg tasks. Test patterns commonly used for DKV assessment, such as single-leg squat (SLS) or single leg landings (SLL), may show different results. The current review presents the modifiable factors of knee valgus in squat and landing single-leg tests in healthy people, as well as exercise training options. The authors used the available literature from PubMed, Scopus, PEDro and clinicaltrials.gov databases, and reviewed physiotherapy journals and books. For the purpose of the review, studies were searched for using 2D or 3D motion analysis methods only in the SLL and SLS tasks among healthy active people. Strengthening and activating gluteal muscles, improving trunk lateral flexion strength, increasing ROM dorsiflexion ankle and midfoot mobility should be taken into account when planning training programs aimed at reducing DKV occurring in SLS. In addition, knee valgus during SLL may occur due to decreased hip abductors, extensors, external rotators strength and higher midfoot mobility. Evidence from several studies supports the addition of biofeedback training exercises to reduce the angles of DKV.

In the present study, we have decided to evaluate whether serum interleukin 34 (IL-34) levels may have diagnostic value in predicting the risk of vascular diabetic complications. The study included 49 patients with type 2 diabetes mellitus (T2DM) and 23 high-risk group. The receiver operating characteristic (ROC) curve analysis has shown that IL-34 has more discriminatory power than C-reactive protein (CRP) for the risk of diabetic complications. The cut-off value for IL-34 was established as 91.2 pg/mL. The gist of our research was identification of IL-34 as an additional potential inflammatory biomarker for the prediction of the risk of vascular diabetic complications.

The objective of the research was to investigate serum levels of interleukin-12 (IL12) in relation to percentage of yeast-like fungi colonies residing in the gastrointestinal tract in children and adolescents with type 1 diabetes mellitus (T1DM). The study involved 83 children and adolescents, including 53 T1DM patients and 30 healthy control subjects. In the studied population biochemical tests were performed and yeast-like fungi were identified in the faeces. Moreover, IL12 absorbance was measured and measurements ofCandida albicansIgG and IgM antibodies were performed with microplate reader ChroMate 4300 (Awareness Technology, Inc., USA) at wavelengthλ=450 nm. In the group of T1DM children and adolescents with disease duration ≤ 2 years, high levels of IL12 were found with lower percentage of yeast-like fungal colonies versus T1DM patients with disease duration > 2 years and ≤5 years, as well as versus T1DM patients with disease duration > 5 years. Additionally, serum levels of IL12 were found to be decreasing by 18.1 pg/ml with each year of diabetes duration. IL12 serum levels were also found to be decreasing by 52.9 pg/ml with each 1% increase in HbA1c. We suggest that high IL12 levels can inhibit infection with yeast-like fungi colonizing the gastrointestinal tract in children and adolescents with T1DM. Further studies are needed to confirm the antifungal activity of IL12.

Myopia is a condition of the eye where parallel rays focus in front of, instead of on, the retina, which results in excessive refractive power of the cornea or the lens or eyeball elongation. Studies carried out in recent years show that the etiology of myopia is complex with genetic and environmental factors playing a role. Refraction defects decrease the quality of vision, while progressing myopia can lead to partial loss of vision, which can be particularly dramatic in young adults. Therefore, it is so crucial to take appropriate actions aimed at preventing myopia progression. This is a review of nonpharmacological therapeutic possibilities of refraction defect prevention in young adults, with special regard to myofascial therapy, osteopathy, and massage of acupuncture points surrounding the eye.

Background and Aims: Urinary neutrophil gelatinase associated lipocalin (uNGAL) and urinary kidney injury molecule-1 (uKIM-1) are markers of acute kidney injury. The albuminuria is a well-known abnormality after physical exercise. The aim of this study was to investigate changes in uNGAL and uKIM-1 after intensive exercise causing albuminuria. Methods: The study population consisted of 19 participants (10 males and 9 females). The mean age of participants was 35.74 years. All were fit amateur runners; the mean body mass index was 21.99 in females and 24.71 in males. The subjects underwent a graded treadmill exercise test (GXT) according to the Bruce protocol. Maximal oxygen consumption (VO2max) was measured. Immediately before and after the test urine was collected. Urinary creatinine, albumin, NGAL, and KIM-1 were measured. Albumin to creatinine (ACR), KIM-1 to creatinine (KCR), and NGAL to creatinine (NCR) ratios were calculated. Results: The mean VO2max was 53.68 in females and 59.54 mL/min/kg in males. Albuminuria and ACR were significantly higher after exercise. An increase in the ACR from 8.82 to 114.35 mg/g (p < 0.01) was observed. uKIM-1 increased significantly after exercise from 849.02 to 1,243.26 pg/mL (p < 0.05). KCR increased from 1,239.1 to 1,725.9 ng/g but without statistical significance (p = 0.07). There were no statistical changes in pre- and post-run uNGAL levels. There was no correlation between post-GXT albuminuria and uKIM-1. Conclusions: uKIM-1 is a very sensitive marker of kidney dysfunction. In our study, uKIM-1 increased significantly after a very short period of exercise. It is not clear if the increase in KIM-1 is caused by post-exercise albuminuria.

The diagnosis and treatment of diabetic retinopathy (DR) in young adults have significantly improved in recent years. Research methods have widened significantly, for example, by introducing spectral optical tomography of the eye. Invasive diagnostics, for example, fluorescein angiography, are done less frequently. The early introduction of an insulin pump to improve the administration of insulin is likely to delay the development of diabetic retinopathy, which is particularly important for young patients with type 1 diabetes mellitus (T1DM). The first years of diabetes occurring during childhood and youth are the most appropriate to introduce proper therapeutic intervention before any irreversible changes in the eyes appear. The treatment of DR includes increased metabolic control, laserotherapy, pharmacological treatment (antiangiogenic and anti-inflammatory treatment, enzymatic vitreolysis, and intravitreal injections), and surgery. This paper summarizes the up-to-date developments in the diagnostics and treatment of DR. In the literature search, authors used online databases, PubMed, and clinitrials.gov and browsed through individual ophthalmology journals, books, and leading pharmaceutical company websites.

The aim of this study was to estimate the threshold serum concentrations of advanced glycation end products (AGEs) and their soluble receptors (sRAGE) as well as tumour necrosis factor alpha (TNFα), vascular endothelial growth factor(165) (VEGF(165)) and interleukin-12 (IL-12) in predicting the occurrence of microangiopathy in children and adolescents with type 1 diabetes mellitus (T1DM). We studied 88 children and adolescents (age range: 6-20 yrs) with T1DM and 32 control subjects (age range: 7-20 yrs). All study participants had their daily urinary albumin excretion, HbA1c and serum creatinine levels measured, and underwent an eye examination and 24-h blood pressure monitoring. Moreover, serum concentrations of AGEs, sRAGE, TNFα, VEGF(165) and IL-12 were measured. In order to calculate the threshold values of the studied parameters, the Receiver Operating Characteristic (ROC) curve analysis was used. The results of our study have shown that among all the studied parameters a discriminative ability was found for TNFα, VEGF(165), duration of the disease, serum AGEs concentrations and daily urinary albumin excretion. However, the highest value of the area under the ROC curve (AUC(ROC)) in predicting the occurrence of diabetic microangiopathy was found for serum TNFα concentrations with its threshold value of 1.7 pg/ml [AUC(ROC) = 0.88 (95% CI: 0.79-0.97)]. The sensitivity and specificity for this variable was at the level of 85.7% and 94.3%, respectively. In conclusion, according to our results serum TNFα concentrations over 1.7 pg/ml may point to the presence of diabetic microangiopathy in children and adolescents T1DM.

Background The objective of the research was to investigate vascular endothelial growth factor (VEGF) levels in the context of lipid metabolism and amount of yeast-like fungi colonizing the digestive tract in children and adolescents with type 1 diabetes mellitus (T1DM). Methods The study included 45 children with T1DM and 27 age- and sex-matched healthy control subjects. In the study sample 33 T1DM patients were administered insulin pump therapy and 12 T1DM patients were administered multiple daily injections with insulin pen devices. All T1DM patients were free of micro- and macrovascular complications. In T1DM patients and healthy controls biochemical tests were performed and measurements of yeast-like fungi colonizing the alimentary tract were conducted. Moreover all study subjects had their serum VEGF levels measured with ELISA test. Results The subgroup of children and adolescents with T1DM and yeast-like fungus colony number 10^3 CFU/g was shown statistically significantly lower HbA1c levels, and lower but not statistically significantly total cholesterol, LDL cholesterol and VEGF levels versus T1DM patients with the amount of yeast-like fungi 10^6 CFU/g. Moreover higher HDL levels were observed in this subgroup versus T1DM patients with the amount of yeast-like fungi 10^6 CFU/g although the difference was not statistically significant. Conclusions Our study has shown no influence of yeast-like fungi on lipid metabolism and VEGF level in children and adolescents with T1DM. Comprehensive treatment of T1DM patients and intensive insulin therapy with help of personal insulin pumps can reduce or prevent the development of long-term diabetic complications. Further studies in this field are needed.

Beata Kowalewska,1 Katarzyna Zorena,2 Małgorzata Szmigiero-Kawko,3 Piotr Wąż,4 Małgorzata Myśliwiec3 1Department of Tropical Medicine and Epidemiology, Institute of Maritime and Tropical Medicine, 2Department of Immunology and Environmental Microbiology, 3Clinic of Paediatrics, Diabetology and Endocrinology, 4Department of Nuclear Medicine, Medical University of Gdańsk, Gdańsk, Poland Objective: To conduct qualitative and quantitative assessment of yeast-like fungi in the feces of children and adolescents with type 1 diabetes mellitus (T1DM) with respect to their metabolic control and duration of the disease.Materials and methods: The studied materials included samples of fresh feces collected from 53 children and adolescents with T1DM. Control group included 30 age- and sex-matched healthy individuals. Medical history was taken and physical examination was conducted in the two study arms. Prevalence of the yeast-like fungi in the feces was determined as well as their amounts, species diversity, drug susceptibility, and enzymatic activity.Results: The yeast-like fungi were found in the samples of feces from 75.4% of T1DM patients and 70% controls. In the group of T1DM patients, no correlation was found between age (Rs=0.253, P=0.068), duration of diabetes (Rs=−0.038, P=0.787), or body mass index (Rs=0.150, P=0.432) and the amount of the yeast-like fungi isolated in the feces. Moreover, no correlation was seen between the amount of the yeast-like fungi and glycated hemoglobin (Rs=0.0324, P=0.823), systolic blood pressure (Rs=0.102, P=0.483), or diastolic blood pressure (Rs=0.271, P=0.345).Conclusion: Our research has shown that children and adolescents with T1DM show higher species diversity of the yeast-like fungi, with Candida albicans being significantly less prevalent versus control subjects. Moreover, fungal species in patients with T1DM turn out to be more resistant to antifungal treatment. Keywords: children, diabetes mellitus type 1, yeast-like fungi, drug susceptibility, metabolic control, duration of the disease

Diabetes type 1 is a chronic autoimmune disease in which insulin-producing cells are gradually destroyed by autoreactive T cells. Human regulatory cells play important role in controlling autoimmunity, and their qualitative or quantitative dysfunctions may result in ineffective suppression of autoreactive T cells. CD62L is a surface molecule that plays role in homing capabilities of Tregs, and only cells with high expression of CD62L have high suppressive potential. Tregs are also characterized by the constant expression of TNFR2. The frequency of Tregs carrying TNFR2 is higher in inflammatory conditions. We investigated blood regulatory T cells with CD62L expression and regulatory T cells expressing TNFR2 in type 1 diabetic patients. We found differences in these populations when comparing to healthy individuals. We propose that these may be associated with inflammatory conditions that are present in patients with type 1 diabetes. The lower percentage of Tregs and Treg CD62Lhighmay contribute to ineffective suppression of proinflammatory cytokines production during type 1 diabetes.

The aim of the study was to analyse the relationship between the serum level of vascular endothelial growth factor (VEGF) and the incidence of hypertension (HT) in children and adolescents with type I diabetes mellitus (T1DM). One hundred and five patients with T1DM were enrolled in the study. The control group consisted of 30 healthy controls. All the T1DM patients were subjected to biochemical analyses, ophthalmologic examination and 24-h blood pressure monitoring. Besides, all the patients and healthy controls had serum VEGF levels measured with the use of the ELISA methodology. The essence of our research is that patients with T1DM and HT and with microalbuminuria (MA) and diabetic retinopathy (DR) (MA/DR) are characterized by a significantly higher level of VEGF (340.23±93.22 pg ml(-1)) in blood serum in comparison with the group of T1DM patients without HT and MA/DR (183.6±96.6 pg ml(-1)) and with healthy controls (145.32±75.58 pg ml(-1)). In addition, the VEGF level was significantly higher in T1DM patients, who presented all three complications, that is HT, retinopathy and MA in comparison with T1DM patients without HT, but with MA/DR (P=0.036). On the other hand, no statistically significant differences (P=0.19) were noted in the level of VEGF in serum between T1DM patients without HT and MA/DR and the healthy control group. At a further stage of analysis, using the method of multiple regression, it was shown that systolic pressure, HbA1c and duration of disease are independent factors influencing the concentration of VEGF. Summarizing, the measurement of VEGF serum levels allows for the identification of groups of patients who have the highest risk of HT and, subsequently, progression of vascular complications.

The aim of the work was to evaluate the levels of angiogenin and VEGF in children and adolescents with longstanding diabetes mellitus type 1 (DM1) in relation to the duration of the disease. The study was performed on a group of 64 patients diagnosed with DM1. 52 healthy children and adolescents volunteered as the control group. Patients with duration of diabetes less than 5 years (group 1) were younger, but their age at the onset of the disease was older. Moreover they had lower 24 hour urine albumin excretion as well as angiogenin and VEGF serum levels with regard to the group of patients with longer, exceeding 5 years duration of the disease (group 2). Detailed statistical analysis revealed that the patients with shorter duration and no complications were characterized by a statistically significant lower serum angiogenin and VEGF levels in relation to the patients over 5 years from diagnosis and showing complications (group 2A). Statistical analysis revealed that the group 1 patients without complications were characterized by the highest levels of angiogenin and VEGF in relation to the group 2B patient. Our results suggest that evaluation of pro-angiogenic factors at early stages of diabetes may become an additional prognostic marker when assessing the risk of retinopathy development in children and adolescents with long-standing DM1. Possibly, in future, anti-angiogenic therapy will become a substantial element in prevention of diabetic retinopathy in young patients with long-standing DM1.This review article also discussed some recent patent related to the field.

The aim of the study was to assess the relationship between IL-6 gene polymorphism at −174(G>C) and the coincidence of celiac and autoimmune thyroid diseases with type 1 diabetes mellitus (DM1) in children. 200 children with DM1 aged 13.23 ± 3.54 years and 172 healthy controls were analyzed. The IL-6 gene −174(G>C) polymorphism at the promoter region of the gene was analyzed by the PCR–RFLP method. The genotype distribution was significantly different in diabetic children as compared to the healthy controls ( p = 0.01). In DM1 patients GC heterozygotes were the most common (52.5%), while CC homozygotes accuted for 29% and GG homozygotes only for 18% of cases. In contrast, GG homozygotes were much more frequent among healthy children (31%). Besides, the GG homozygotes were significantly more frequent among diabetic children with celiac disease ( p = 0.04) in relation to those without autoimmune complications. In children with autoimmune thyroiditis, the distribution of the IL-6 genotypes was similar to that seen in diabetic patients without autoimmune complications ( p = 0.24). The results of our study suggest that the diabetic children, who have IL-6 gene −174GG genotype may have an increased risk for celiac disease development.

The aim of the study was to analyze the relation between early diabetic retinopathy and the pro-inflammatory cytokines tumor necrosis factor alpha (TNF-alpha), interleukin-6 (IL-6), vascular endothelial growth factor (VEGF) in children with diabetes mellitus type 1. Two hundred and two children with diabetes mellitus type 1 aged 13.2+/-3.83 years and 85 healthy controls were analyzed. Patients were divided into two subgroups: children with retinopathy (Group 1, n=39) and children without retinopathy (Group 2, n=163). All the children had 24h urine albumin secretion rate, glycosylated hemoglobin HbA1c level, and C-reactive protein level measured, underwent 24h blood pressure monitoring and had ophthalmologic examination performed. Additionally, all the children had serum TNF-alpha, IL-6 and VEGF level measured using an ELISA test (Quantikine High Sensitivity Human). Statistically significant higher blood serum levels of HbA1c, VEGF, TNF-alpha and IL-6 were found in the Group 1 in comparison with the Group 2. Additionally, the children of the Group 1 showed statistically significant correlation between serum VEGF and serum TNF-alpha (R=0.35, p=0.000), CRP level (R=0.23, p=0.006), 24h albumin urine secretion rate (R=0.45, p=0.000) and duration of the disease (R=0.26, p=0.002). The results of the current study suggest that there is a relationship between VEGF, TNF-alpha, IL-6 and the development of the diabetic retinopathy in children with diabetes mellitus type 1.

In spite of the extensive research the complex pathogenesis of diabetic retinopathy (DR) has not been fully elucidated. For many years it has been thought that diabetic retinopathy manifests only with microangiopathic lesions, which are totally responsible for the loss of vision in diabetic patients. In view of the current knowledge on the microangiopathic changes in the fundus of the eye, diabetic retinopathy is perceived as a neurodegenerative disease. Several clinical tools are available to detect neuronal dysfunction at early stages of diabetes. Many functional changes in the retina can be identified before vascular pathology develops, suggesting that they result from a direct effect of diabetes on the neural retina. In the course of diabetes there is a chronic loss of retinal neurons due to increased frequency of apoptosis. The neuronal apoptosis begins very early in the course of diabetes. This observation has led to suggestions that precautions against DR should be implemented immediately after diabetes is diagnosed. Neurodegeneration cannot be reversed; therefore treatments preventing neuronal cell loss in the retina need to be developed to protect diabetic patients. This review is an attempt to summarize what is currently known about the mechanisms of neuronal apoptosis in the context of diabetic retinopathy and vascular degeneration as well as about potential treatments of DR.

Objectives. Post exercise proteinuria (PEP) is found in about 20–40% of sportsmen after intensive exercise. Urinary NGAL is a new marker of tubulointerstitial kidney damage. The relationship between PEP and uNGAL has not been defined yet. In presented study a resting uNGAL as a predictor of PEP was analyzed. The changes of albuminuria after exercise were monitored to estimate a frequency and range of PEP. Methods. 40 amateur healthy runners (mean age 36.65 ±10.61 years) participating in 10-km run took part in the study. Before and after the competition urine was collected. NGAL, albumin and creatinine were subsequently measured in urine. uNGAL to creatinine ratio (NCR) and albumin to creatinine ratio (ACR) were calculated. Results. 28 participants (mean age 37.9 ±11.46, 19 M, 9 F) with uNGAL below 15 ng/ml before competition were analyzed. The increase of ACR was observed in every case. Mean post-exercise ACR was 104.55 ±123.1 mg/g and was significantly higher than pre-exercise ACR 6.33 ±5.86 mg/g (p < 0.0005). The positive correlation was found between resting NCR and post-exercise ACR (r = 0.60, p < 0.05). Conclusions. Resting uNGAL positively correlated with PEP. The possible explanation of these findings is that persons with PEP had some early, occult tubulointersitial kidney damage. It is speculated that those runners have higher risk of chronic kidney disease.

The aim of this study was identification of the immunologic markers of the damage to the eye apparatus at early stages of diabetes mellitus (DM) type 1 children. One hundred and eleven children with DM type 1 were divided into two groups: those with nonproliferative diabetic retinopathy (NPDR) and without retinopathy. All the children had their daily urine albumin excretion, HbA1c, C-peptide measured, 24-hour blood pressure monitoring, and ophthalmologic examination. Levels of TNF-α, IL-6, and IL-12 in serum were measured by ELISA tests (Quantikine High Sensitivity Human by R&D Systems, Minneapolis, Minn, USA). The NPDR children demonstrated a significantly longer duration of the disease in addition to higher HbA1c, albumin excretion rate, C-reactive protein, systolic blood pressure, as well as TNF-αand IL-6 levels than those without retinopathy. The logistic regression revealed that the risk of NPDR was strongly dependent on TNF-α[(OR 4.01; 95%CI 2.01–7.96)]. TNF-αappears to be the most significant predictor among the analyzed parameters of damage to the eye apparatus. The early introduction of the TNF-αantagonists to the treatment of young patients with DM type 1 who show high serum activity of the TNF-αmay prevent them from development of diabetic retinopathy.

In recent years the frequency of fungal infections in human populations has increased considerably. The most common type offungus attacking the human organism is Candida albicans. Yeast-like fungi occur naturally in the oral cavity, intestines, vagina, or skin, however in amounts not dangerous to human health. The studies so far have shown that patients with diabetes type 1 (T1DM) to a large degree are exposed to complications related to fungal infections. A substantial growth of fungi observed in diabetic patients may unfavorably affect metabolic compensation, and lead to increased demand for insulin, as well as to the difficult to cure symptom infections. The weaker the immune resistance in patients with diabetes, the greater the risk of ailments related to candidiasis. The article contains a review of recent literature regarding the problems related to occurrence of yeast-like fungi in digestive tract of children with diabetes type 1.W ciągu ostatnich lat częstość występowania infekcji grzybiczych w populacji ludzkiej znacznie wzrosła. Najczęściej atakującym ludzki organizm gatunkiem grzyba jest Candida albicans. Grzyby drożdżopodobne naturalne występują w jamie ustnej, jelitach, pochwie czy na skórze, jednak są to ilości, które nie zagrażają zdrowiu człowieka. W dotychczasowych badaniach wykazano, że chorzy z cukrzycą typu 1 (T1DM) w dużym stopniu są narażeni na powikłania związane z rozwojem zakażeń grzybiczych. Wzrost grzybów obserwowany u chorych na cukrzycę może niekorzystnie wpływać na wyrównanie metaboliczne, prowadzić do zwiększenia zapotrzebowania na insulinę jak też trudnej do wyleczenia objawowej grzybicy. Ryzyko rozwoju dolegliwości wiązanych z zakażeniami grzybami drożdżopodobnymi jest tym większe, im bardziej jest osłabiona odporność immunologiczna u pacjentów chorujących na cukrzycę. W artykule dokonano przeglądu piśmiennictwa ostatnich lat, dotyczącego problemów związanych z występowaniem drożdżaków w układzie pokarmowym dzieci chorujących na cukrzycę typu 1.

Aims The aim of our research was to gain data about the efficacy of intravitreal injections of a recombinant tissue plasminogen activator (rTPA) in dissolving vitreoretinal tractions (VRTs). Materials and methods The study group consisted of patients of our Ophthalmology Clinic who had received an injection of rTPA (TPA Group) for an existent vitreomacular traction confirmed by optical coherence tomography and stereoscopic examinations. The control group consisted of patients who had declined treatment despite the existence of a vitreomacular traction confirmed by the same diagnostic methods. Each group consisted of 30 people (30 eyes). The observation period was 6 months. Conclusion In both groups some of the VRTs had dissolved. In the TPA group the traction dissolved in 10 patients (33.33%) and in the control group only in 5 (16.67%). It is also important to point out that the mean baseline membrane thickness was higher in the TPA group than in the control group. Observing patients in both groups we noticed that the dissolution of vitreoretinal membrane occurred most frequently in those cases where the membrane was thin. In the TPA group, the mean membrane thickness after 6 months decreased considerably. At the same time, no significant change in the membrane thickness could be observed in the control group. Observation of the retinal thickness allows us to draw the following conclusion: in the TPA group, the retinal thickness in the macular area (edema) had decreased over the study period, whereas in the control group it had increased. In those cases where the traction had dissolved, the edema of the retina decreased by the end of the 6-month period in both groups. In the TPA group, the dissolution of the membrane occurred most often within 3 months from the primary injection. Based on statistics, we can confirm that in the control group there was a decrease in visual acuity during the 6 months of the study period. At the same time, visual acuity in the TPA group underwent a small improvement. A 6-month observation had shown that in patients with strong VRTs, and in particular with VRTs accompanied by epiretinal membranes, a single intraocular injection is not enough to achieve posterior vitreous detachment. We have also shown that rTPA is a safe drug, with no adverse effects observed during the study period., Video abstract

Objective: The assessment of the clinical significance of TNF-α, IL-10 and NAG with its A and B isoforms concentrations in children with DM type 1 for the detection of early stages of both diabetic retinopathy and nephropathy. Patients and methods: One hundred and two children with DM type 1 and 35 healthy controls were analyzed. Levels of TNF-α, IL10 and total NAG enzyme activity with its A and B isoforms were measured in serum and urine of all participants. Results: Children with diabetic retinopathy had a significantly higher levels of TNFα in serum ( P = 0.01) in comparison to those without retinopathy. The activity of NAG ( P = 0.002) and its isoform A ( P = 0.006) and isoform B ( P = 0.001) were significantly higher in children with diabetic retinopathy in comparison to those without this complication. Conversely, within the group with retinopathy, more children had detectable concentrations of IL10 in serum as compared to those without retinopathy ( P = 0.01). Conclusions: These results suggest that NAG activity and TNF-α concentration in diabetic retinopathy patients might show a relationship with a degree of renal glomeruli epithelial cells and renal proximal tubules damage.

Aim To explore the relationships between tumor necrosis factor-alpha (TNFalpha), interleukin-6 (IL-6) and urinary N-acetyl-beta-D-glucosaminidase (NAG) and the function of renal proximal tubules in children with type 1 diabetes mellitus (DM1). Methods Fifty-six children with DM1 and 35 healthy controls were analyzed. We measured NAG (A and B isoforms) in urine as well as serum TNFalpha and urinary IL-6. Results The children with DM1 with microalbuminuria (group A) had significantly higher urinary IL-6 and serum TNFa than the children without microalbuminuria (group B). The diabetic patients with no sign of nephropathy showed significantly higher TNFalpha and NAG and its A and B isoforms in urine compared to the healthy group. Additionally, groups A and B both showed a positive significant correlation between serum TNFalpha and urinary isoform B. Conclusions From our pilot results it appears that TNFalpha might be a sensitive marker of damage to the renal proximal tubules occurring prior to microalbuminuria. Conversely, the increase in NAG and its isoform B activity in patients with no clinical sign of diabetic nephropathy may indicate the onset of microalbuminuria.

Fifteen out of the forty-five patients with long-standing diabetes mellitus type I were characterised by the presence of TNFalpha in the sera when examined on several occasions over a period of five years. TNFalpha-producing patients had a better control of the disease and a smaller percentage of them suffered from diabetic complications as compared with those not producing this cytokine. TNFalpha-producing patients had lower levels of the proinflammatory markers - IL6 and CRP, and higher concentrations of ACTH and cortisol than those not producing this cytokine. We suggest that TNFalpha released systemically in diabetic patients stimulates the hypophysis-adrenal axis, and in that way indirectly ameliorates autoimmune response occurring during the advanced phase of the disease.

The concequence of type 1 (T1DM) and type 2 diabetes mellitus (T2DM) is the development of chronic vascular complications encompassing micro- as well as macrocirculation. Diabetic retinopathy (DR), microvascular and visually devastating diabetic complication, is estimated to be the leading cause of blindness in working-aged adults in the developed countries, and this upward trend is continuing. Retinal vascular leakage, inflammation, and neovascularization (NV) are the main features of DR. Also, closely linked to retinopathy are neural changes such as neuronal cell death, gliosis, microglial activation, and altered glutamate metabolism. Gaining knowledge of the mechanisms of action of factors influencing retinal neovascularization, as well as the search for new, effective treatment methods, especially in advanced stages of DR, puts special importance on research concentrating on various treatment methods of diabetic retinopathy [1–3]. This special issue encompasses 16 papers including original scientific theses and clinical studies which deepen our current knowledge by presenting additional DR risk factors. Apart from this, it presents review papers widening our knowledge on new, noninvasive diagnostic methods of testing for diabetic maculopathy as well as on new trends in the treatment of late vascular complications in adults and young patients with T1DM and T2DM. The first step in managing DR is to reduce the risk of its development and progression by controlling the risk factors such as hyperglycemia, hypertension, and hyperlipidemia. Therefore, in the study presented by J. Tolwinska et al. the authors prove that intensification of insulin therapy in the form of continuous subcutaneous insulin infusion (CSII) might have a beneficial effect on reducing the risk of development of early micro- and macrovascular damage in young patients with T1DM. They find a significant correlation between the arterial intima-media thickness (IMT) and flow-mediated dilatation (FMD) with the metabolic control of diabetes. In another paper K. Semeran et al. evaluated the bioelectric function of the retina and the serum levels of interleukin-17 (IL-17), vascular endothelial growth factor (VEGF), and adrenomedullin (ADM) in young patients with T1DM. Interestingly, even before recognizing the fundus eye changes characteristic for DR, the authors had observed bioelectric retinal disturbances in adolescent patients with T1DM. The authors suggest that the presented results provide new possibilities in diagnosing preclinical chronic diabetic complications in T1DM patients. The paper by K. Zorena et al. presents the relationship between serum transforming growth factor beta 1 (TGF-β1) concentrations and the duration of T1DM in children and adolescents. The authors show that serum TGF-β1 concentrations and the duration of the disease are independent risk factors of microangiopathy development in children and adolescents with T1DM. Meanwhile B. Urban et al. present the results of endothelial cell density (ECD) and central corneal thickness (CCT) in adolescent T1DM patients. They discover that the mean density of corneal endothelium cells in patients with diabetes was reduced by 18% in comparison to the control group. In addition, the researchers have shown a significant correlation between corneal endothelium density and the duration of diabetes in patients with T1DM. Two interesting review papers by K. Zorena et al. and D. Raczynska et al. included in this special issue discuss the newest data on biomarkers involved in the risk of development and progression of DR in patients with T1DM and T2DM and current trends in the monitoring and treatment of DR in young adults. An exquisite review paper by B. L. Sikorski et al. provides knowledge on the new technique the Optical Coherence Tomography (OCT). OCT is used by the ophthalmologists to obtain the images of retinal cross-section in patients with diabetes. The traditional approach to the diagnosis of DM includes fundus ophthalmoscopy and fluorescein angiography. Although they're very useful clinically, these methods do not contribute much to the evaluation of retinal morphology and its thickness. That is why OCT facilitates the measurement of the macular thickening, quantification of the diabetic macular oedema, and the detection of vitreoretinal traction. Due to its high prevalence, incidence, and risk of macrovascular and microvascular complications, T2DM is one of the potentially most damaging diseases and the biggest public health problems at present. Diabetic eye disease with its complications, especially diabetic retinopathy that leads to macular edema and retinal neovascularization, is the leading cause of visual dysfunction and blindness among adult working-age population in economically developed societies worldwide. In this special issue M. Tomic et al. and S. Kastelan et al. have proven in their original papers that apart from other known DR risk factors it is also the adipose tissue that markedly contributes to the chronic, low-grade inflammation in T2DM patients. The authors examined the correlation between the inflammatory and clotting markers, endothelial dysfunction markers, and the anthropometric parameters as well as their connection with DR in T2DM patients. Their review paper included in the same issue presents the most up-to-date knowledge on the pharmacological treatment in diabetic retinopathy [S. Kastelan et al.]. Glucagon-like peptide-1 (GLP-1) is a potent glucoincretin hormone released from intestinal L-cells in response to the nutrient ingestion. An emerging clinical interest in the management of T2DM has been shown for GLP-1. In vitro studies presented by A. Puddu et al. showed that GLP-1/GLP-1R axis might potentially contribute to the prevention of retinal pigment epithelium (RPE) cell dysfunction and DR. The paper of A. Gebka et al. presents an original research on the effect of oral supplementation with alpha-lipoic acid (ALA) in patients with T1DM and T2DM. The authors show that oral supplementation with ALA at a relatively low dose (300 mg once daily) for 3 months maintains functional vision in T1DM patients and even improves it in T2DM patients. Authors suggest that supplementation with ALA represents an achievable adjunct therapy to help prevent loss of vision in patients with T1DM and T2DM. This special issue also presents data on the genetic studies on the DR. The aim of the study by J. Wang et al. was to investigate whether polymorphisms of the two genes in the complement pathway, complement factor H (CFH) and complement factor B (CFB), are associated with DR in patients with T2DM. The authors report that CFH-rs800292 and CFB-rs1048709 polymorphisms are associated with the development of DR as well as with its delayed progression. However, the D. Romaniuk et al. in their preliminary study present the results of gene expression of insulin-like growth factor 1 (IGF1), insulin-like growth factor 1 receptor (IGF1R), and insulin-like growth factors binding protein-3 (IGFBP3) in epiretinal membranes (ERMs) of patients with PDR. They suggest That IGF 1 and IGF1R differential expression can be Involved in the pathogenesis or progression of proliferative vitreoretinal disorders. Subsequent studies were presented by A. M. Abu El-Asrar et al. The authors investigated the correlations between the levels of brain-derived neurotrophic factor (BDNF) and the levels of high-mobility group box-1 (HMGB1) in the vitreous fluid and serum of patients with PDR and in the retinae of rats with diabetes. They also investigated the effect of intravitreal administration of HMGB1. The authors show that blocking HMGB1 signaling pathways might be a novel therapeutic strategy for neuronal dysfunction in vision-threatening diabetic retinopathy. Finally, G. Mohammad et al. investigated the hypothesis that poly-(ADP-ribose) polymerase (PARP) activation mediates retinal neuropathy by reducing brain-derived neurotrophic factor (BDNF), synaptophysin, and glutamine synthetase (GS) levels in the retina. To test this hypothesis, they measured the levels of reactive oxygen species (ROS) generation, PARP, phosphorylated ERK1/2 (p-ERK1/2), BDNF, synaptophysin, GS, and cleaved caspase-3 in the retina of diabetic rats. In addition, the authors analyzed whether treatment with the PARP inhibitor 1,5-isoquinolinediol suppresses the neurodegenerative changes in the retinas of diabetic rats. They reported a beneficial effect of the PARP inhibitor in increasing neurotrophic support and ameliorating early retinal neuropathy induced by diabetes. Summarizing, all the data presented and discussed by all the authors who have contributed to this special issue point to the new diagnostic as well as therapeutic perspectives of DR.

In this paper we asked whether the increased production of two proinflammatory cytokines-tumor necrosis factor-alpha (TNF alpha) and interleukin-6 (IL6) in the absence of the inflammatory stimulus, a phenomenon frequently occurring in the elderly, may contribute to the decrease of natural killer (NK) cytotoxic activity. NK cell activity is a part of a nonspecific immunity directed against infected and transformed cells. We measured the levels of bioactive TNF alpha and IL6 during cytotoxic NK reactions and analyzed the effect of neutralizing monoclonal antibodies anti-TNF alpha and anti-IL6 on the outcome of cytotoxic reaction. Bioactive TNF alpha was produced in higher amounts during cytotoxic reactions of the elderly with low NK activity in comparison with its production by the elderly with high NK activity. Anti-TNF alpha decreased already low cytotoxic responses of the elderly while not having an effect on the cytotoxic potential of high responders. More of the bioactive IL6 was released during cytotoxic reactions of the elderly as compared with young people. There was, however, no relation between the height of NK cytotoxic activity and the amount of IL6. Our results suggest that the increased level of TNF alpha seen in the elderly low NK responders may pose a compensatory mechanism, necessary to keep the highest possible level of NK responses. The increased bioactivity of IL6 during NK reaction of the elderly does not seem to participate in the regulation of the level of NK cytotoxic activity.

The aim of this study was to evaluate the relationship between serum transforming growth factorβ1 (TGF-β1) concentrations and the duration of type 1 diabetes mellitus (T1DM) in children and adolescents. One hundred and sixteen patients with T1DM and 19 healthy controls were examined. Serum TGF-β1 concentrations were measured using the cytometric bead array (CBA). A positive association between the time of diabetes duration and higher serum TGF-β1 concentrations was observed. Similarly, the prevalence of microvascular complications, such as retinopathy and nephropathy, increased with the duration of diabetes. Logistic regression analysis showed that serum TGF-β1 concentrations and the duration of the disease are independent risk factors of microangiopathy development. Higher serum TGF-β1 concentrations were associated with a significant risk of microangiopathy development after 10 years of T1DM duration. In the successive years of the disease, the effect was even stronger. The results of our study indicate that serum TGF-β1 concentrations are one of the factors that may have an impact on the progression of vascular complications in children and adolescents with T1DM.