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Background Sarcopenia is a potentially reversible condition, which requires proper screening and diagnosis. Aims To validate a Polish version of sarcopenia screening questionnaire (SARC-F), and assess its clinical performance. Methods Cross-sectional validation study in community-dwelling subjects ≥ 65 years of age. Diagnosis of sarcopenia was based on the 2018 2nd European Working Group on Sarcopenia in Older People (EWGSOP2) consensus. Hand grip and 4-m gait speed were measured, and the Polish version of SARC-F was administered. Results The mean (SD) age of 73 participants (21.9% men) was 77.8 (7.3) years. Seventeen participants (23.3%) fulfilled the EWGSOP2 criteria of sarcopenia, and 9 (12.3%) criteria for severe sarcopenia. Fourteen (19.2%) participants fulfilled the SARC-F criteria for clinical suspicion of sarcopenia. The Cronbach’s alpha coefficient for internal was 0.84. With EWGSOP2 sarcopenia as a gold standard, the sensitivity of SARC-F was 35.3% (95% CI 14.2–61.7, p = 0.33), specificity was 85.7% (95% CI 73.8–93.6, p p = 0.79) and 81.4% (p p p = 0.33). Overall the predictive power of SARC-F was low (c-statistic 0.64). Discussion SARC-F is currently recommended for sarcopenia case finding in general population of older adults. However, its sensitivity is low, despite high specificity. Conclusions At present SARC-F is better suited to rule out sarcopenia then to case-finding. Further refinement of screening for sarcopenia with the use of SARC-F seems needed.

Bariatric surgery is considered as a first line treatment in extreme obese patients to achieve a reduction in health risks. However, after surgical procedure obese patients with normal blood pressure (BP) levels still present residual risk, which may be partly related to lack of correction of BP profile and variability. Aim: To evaluate short (10 days) and mid-term (6 months) changes of mean values, profile and variability of BP after bariatric surgery in extremely obese patients with and without hypertension. Materials & methods: A follow-up of cross-sectional study was conducted in 90 obese patients (aged 41.7 ± 11.3, BMI = 46.7 ± 5.7 kg/m2), who met the eligibility criteria and underwent bariatric surgery. Each patient underwent 24-h ambulatory BP monitoring with profile and variability estimation before, 10 days and 6 months after the intervention. Results: Sixty-seven (74.4%) patients had hypertension. Significant decrease from baseline in mean values of systolic and diastolic BP in 10 days (p < .005) and 6 months (p < .005) follow-up were observed only in patients with hypertension. Moreover, only hypertensive subjects revealed significant reduction (p < 0,05) from baseline in 24-h systolic and diastolic BP weighted standard deviation and average real variability after surgical procedure. No changes were found in dipping status. Conclusions: Bariatric surgery not only decreased BP levels, but also contributed to reduction in BP variability in early period after intervention mainly in patients with pre-existing hypertension

OBJECTIVE To assess changes of post-occlusive reactive hyperemic response in skin microcirculation among extremely obese patients 10 days and 6 months after bariatric surgery for patients with and without hypertension. METHODS Skin blood flow was measured using PeriFlux laser Doppler fluxmetry. Data were analyzed in the entire group and two subgroups: with and without hypertension. RESULTS Data from 88 patients (mean age 42.1 ± 11.2 years, 40.5% men) were analyzed. Six months after bariatric surgery, the time to reach peak flows had been shortened (2.4 ± 1.7 vs 2.1 ± 1.0 seconds, P

Wstęp: prawie 300 milionów ludzi na świecie BMI przekracza 30 (kg/m2). Otyłość jest przyczyną wielu poważnych schorzeń, takich jak cukrzyca typu 2, nadciśnienie tętnicze czy niealkoholowe stłuszczenie wątroby. Chirurgia bariatryczna jest jedyną efektywną metodą uzyskania redukcji masy ciała u pacjentów z otyłością olbrzymią. Cele: Celem tej pracy jest ocena wpływu chirurgii bariatrycznej na niealkoholowe stłuszczenie wątroby u pacjentów operowanych z powodu otyłości olbrzymiej. Materiał i metodologia: Włączyliśmy 20 pacjentów zakwalifikowanych do zabiegu bariatrycznego z BMI >40 kg/m2 lub BMI >35kg/m2 z współwystępującymi chorobami towarzyszącymi. Średnia masa ciała badanej grupy wynosiła 143,85 kg, ze średnim BMI 49,16 kg/m2. Przed zabiegiem dokonano oceny stopnia niealkoholowego stłuszczenia wątroby przy użyciu skali Sherifa Saadeha podczas badania ultrasonograficznego. Dokonaliśmy także oceny stężeń enzymów wątrobowych. Obserwację i wizyty kontrolne kontynuowano do 12 miesięcy po zabiegu. Wyniki: Dwanaście miesięcy po operacji średnia masa ciała badanej grupy wynosiła 102,34 kg. WL wyniosło średnio 33,0%, EWL 58,8%, a EBMIL 61,37%. U wszystkich pacjentów zaobserwowano remisję stłuszczenia wątroby. Uszkodzenie wątroby, ocenione przy użyciu ultrasonografii, zmniejszyło się ze średnio 1,85 pkt w skali Sherifa Saadeha przed zabiegiem do 0,15 pkt po 12 miesiącach (p=0,00). Poziomy enzymów wątrobowych zmalały z 64,5 (U/l) do 27,95 (U/l) dla ALT (p=0,00) oraz z 54,4 (U/l) do 27,2 (U/l) dla AST. Wnioski: rocedury bariatryczne nie tylko pozwalają na znaczącą oraz trwała utratę masy ciała, ale także przyczyniają się do zmniejszenia stłuszczenia wątroby oraz poprawy jej funkcjonowania. Introduction; p to 300 million people have the body mass index (BMI) greater than 30 kg/m2. Obesity is the cause of many serious diseases, such as type 2 diabetes, hypertension, and non-alcoholic fatty liver disease (NAFLD). Bariatric surgery is the only effective method of achieving weight loss in patients with morbid obesity. Objectives: The aim of the study was to assess the impact of bariatric surgery on non-alcoholic fatty liver disease in patients operated on due to morbid obesity. Material and Methods: We included 20 patients who were qualified for bariatric procedures based on BMI > 40 kg/ m2 or BMI > 35kg/m2 with the presence of comorbidities. The average body weight in the group was 143.85kg, with an average BMI of 49.16kg/m2. Before the procedure, we evaluated the severity of non-alcoholic fatty liver disease in each patient using the Sheriff-Saadeh ultrasound scale. We also evaluated the levels of liver enzymes. Follow-up evaluation was performed twelve months after surgery. Results: Twelve months after surgery, the average weight was 102.34 kg. The mean %WL was 33.01%, %EWL was 58.8%, and %EBMIL was 61.37%. All patients showed remission of fatty liver disease. Liver damage, evaluated with ultrasound imaging, decreased from an average of 1.85 on the Sheriff-Saadeh scale, before surgery, to 0.15 twelve months after surgery (p < 0.001). As regards liver enzymes, the level of alanine aminotransferase decreased from 64.5 (U/l) to 27.95 (U/l) (p < 0.001), and the level of aspartate aminotransferase decreased from 54.4 (U/l) to 27.2 (U/l). Conclusions: Bariatric procedures not only lead to a significant and lasting weight loss, but they also contribute to the reduction of fatty liver disease and improve liver function.

During blood pressure (BP) measurement, the recommended positioning of the cuff bladder center is directly above the brachial artery. We investigated the relevance of incorrect cuff positioning during (1) auscultatory measurement with an appropriate or improperly small cuff and (2) oscillometric measurement with a wide-range cuff designed to guarantee accurate measurements regardless of position. In subjects with wide BP and arm circumference ranges, (1) auscultatory BP was repeatedly measured with a properly positioned cuff (reference) and, simultaneously, with an identical cuff placed on the other arm in either a correct or an incorrect position (test). The measurements were performed with a properly sized (N=57) or an improperly small cuff (N=33). (2) Auscultatory measurements obtained with a properly positioned and sized cuff were compared with oscillometric measurements obtained with a specially designed wide-range cuff (Omron IntelliWrap) placed on the contralateral arm either in a correct or an incorrect position. Auscultatory BP measures were unaffected by incorrect positioning of a properly sized cuff, whereas with undercuffing, BP was overestimated with the cuff displaced by 90° laterally (systolic/diastolic BP differences: 4.9±4.6/4.0±4.6 mm Hg, P

BACKGROUND Insulin resistance and renal tubular sodium handling influence arterial structure and function and play an essential role in salt-sensitive forms of hypertension. METHODS In a population with prevailing sodium consumption, we assessed the relationship between cardiovascular phenotypes (peripheral and central blood pressures, elastic properties of large arteries, the left ventricular structure) and sodium handling parameters (daily urinary sodium excretion, fractional urinary lithium excretion in proximal—FELi and distal tubules), as a function of insulin sensitivity—measured by homeostasis model assessment–insulin resistance (HOMA-IR), leptin-to-adiponectin (L/A) ratio, and homeostasis model assessment–adiponectin (HOMA-AD). RESULTS In patients with FELi below the median value (corresponding to the group with increased proximal sodium reabsorption) and higher insulin resistance as measured by HOMA-IR, pulse wave augmentation indexes were significantly higher—AIxP (99.4% vs. 86.2%; P = 0.007), AIxC1 (159.4% vs. 144.2%; P = 0.04), and AIxC2 (36.1% vs. 28.3%; P = 0.02), than in patients with lower insulin resistance. The same trend was observed in relation to L/A ratio—AIxP (98.7% vs. 87.1%; P = 0.005), AIxC1 (158.6% vs. 144.5%; P = 0.02), and AIxC2 (35.6% vs. 28.5%; P = 0.01) and HOMA-AD—AIxP (99.7% vs. 83.8%; P = 0.001), AIxC1 (160.5% vs. 140.3%; P = 0.007), and AIxC2 (36.6% vs. 26.3%; P = 0.003). Such relationships were not observed in patients with FELi above the median value. CONCLUSIONS In the hypertensive population with prevailing sodium intake, insulin resistance and increased sodium reabsorption in proximal tubules may affect arterial wall function.

e aim of the study was to evaluate the usefulness of Identification of Seniors at Risk (ISAR) scale among elderly patients admitted to the department of internal medicine.The ISAR score was performed among patients aged59 years a er admission to the hospital ward. Data from medical history about diseases, taken medicines, falls, length of hospital stay and mortality were compared in patients with ISAR score of 0-1 and over 1 and in subjects with and without history of falls. Regression analysis was used to detect predictors of the length of hospital stay or death.The sample consisted of 102 subjects aged 80.9 ± 7.9 years, 45.5% of men, 34.6% had history of falls. The number of diseases was 11.3 ± 3.9 and number of medicines - 8.9 ± 3.7. The score of ISAR ≥2 was found in 90.2% of patients, length of hospital stay was 10.3 ± 8.4 days, mortality rate was 9.9%. Patients with ISAR score2 were younger, showed a smaller number of diseases, used less drugs and had less frequency of falls than those with score ≥2. Patients with history of falls had higher mean ISAR score, higher number of diseases and medicines than the others. The increased number of diseases and higher ISAR score significantly influenced the length of hospital stay. None of the analyzed factors had any impact on mortality.The score of ISAR scale together with number of diseases have a positive impact on the length of hospital stay.

Background. Sodium overload is related to the development of primary hypertension and its complications. Methods. In 131 (65 female) treated hypertensives (average blood pressure 144/82 mmHg and duration of hypertension 11.7 years), we measured peripheral and central arterial pressures, peripheral (AIxP) and central (AIxC1, AIxC2) augmentation indices, pulse-wave velocity (PWV) and daily urinary sodium excretion, and conducted genetic studies of ACE D/I and CYP11B2 C-344T polymorphisms. Proximal (FELi) and distal (FDRNa) sodium reabsorption measurements were performed using endogenous lithium clearance. Results. We found statistically significant interactions between FELi and ACE D/I polymorphism with respect to AIxC2 (PINT = 0.05) and between FELi and CYP11B2 C-344T polymorphism with respect to AIxC1 (PINT = 0.01), AIxC2 (PINT = 0.04) and AIxP (PINT = 0.01). In the group of ACE I allele carriers compared with DD homozygotes, the AIxC1 (154.1 vs 140.6%; p = 0.02), AIxC2 (33.3 vs 26.9%; p = 0.02) and AIxP (94.6 vs 85.2%; p = 0.01) were higher in the subgroup with FELi below the median value (FELi1), but not in the subgroup with FELi above the median value (FELi2). In the group of CYP11B2 TT homozygotes compared with C allele carriers, we observed higher values of AIxC1 (158.5 vs 146.4%; p = 0.03), AIxC2 (36.0 vs 29.4%; p = 0.01) and AIxP (99.0 vs 88.7%; p = 0.005) in the FELi1 but not the FELi2 subgroup. Conclusions. In the population with assumed high dietary sodium intake and long-standing history of hypertension, the relation between proximal sodium reabsorption and the development of arterial stiffness depends on the genetic context of the selected genetic polymorphisms of the renin—angiotensin—aldosterone system, independent of blood pressure.

Introduction: Although recently a matter of epidemiologic controversy, sodium overload and its interaction with genetic factors predispose to hypertension and related target organ complications. Methods: In 131 (66 male) treated hypertensives, we measured peripheral and central arterial pressures and pulse wave augmentation indexes (AIx P , AIx C1 , AIx C2 ), pulse wave velocity (PWV), daily urinary sodium excretion and did genetic studies of AGTR1 A1166C and AGTR2 G1675A polymorphisms. Proximal (FE Li ) and distal (FDR Na ) sodium reabsorption measurements were performed using endogenous lithium clearance. Results: In men, we found interaction between FDR Na and AGTR2 G1675A polymorphism with respect to AIx C1 ( p INT =0.01), AIx C2 ( p INT =0.05) and AIx P ( p INT =0.006). Arterial stiffness increased with higher sodium reabsorption in the distal tubule, in the presence of AGTR2 G allele with the opposite tendency in A allele carriers. In the subgroup with FDR Na below median, as compared to those with FDR Na above median, the AIx C1 (139.6±3.8 vs 159.1±5.7%; p =0.009), AIx C2 (26.3±1.8 vs 33.3±1.7%; p =0.016) and AIx P (83.4±2.5 vs 96.5±2.6%; p

Introduction: Although recently a matter of epidemiologic controversy, sodium overload and its interaction with genetic factors predispose to hypertension and related target organ complications. Methods: In 131 (66 male) treated hypertensives, we measured peripheral and central arterial pressures and pulse wave augmentation indexes (AIxP, AIxC1, AIxC2), pulse wave velocity (PWV), daily urinary sodium excretion and did genetic studies of AGTR1 A1166C and AGTR2 G1675A polymorphisms. Proximal (FELi) and distal (FDRNa) sodium reabsorption measurements were performed using endogenous lithium clearance. Results: In men, we found interaction between FDRNa and AGTR2 G1675A polymorphism with respect to AIxC1 ( pINT=0.01), AIxC2 ( pINT=0.05) and AIxP ( pINT=0.006). Arterial stiffness increased with higher sodium reabsorption in the distal tubule, in the presence of AGTR2 G allele with the opposite tendency in A allele carriers. In the subgroup with FDRNa below median, as compared to those with FDRNa above median, the AIxC1 (139.6±3.8 vs 159.1±5.7%; p=0.009), AIxC2 (26.3±1.8 vs 33.3±1.7%; p=0.016) and AIxP (83.4±2.5 vs 96.5±2.6%; pConclusions: The relation between sodium reabsorption in the distal tubule and the development of arterial stiffness depends on the AGTR2 G1675A polymorphism in blood pressure independent fashion.

In a population with high sodium consumption, we assessed relation between brachial and central blood pressures, elastic properties of large arteries, echocardiographic left ventricular diastolic function and sodium reabsorption as fractional urinary lithium excretion in proximal (FELi) and fractional sodium reabsorption in distal tubules assessed using the endogenous lithium clearance. Mean±s.d. age of 131 treated hypertensive patients (66 men and 65 women) was 61.9±7.5 years. We found significant interaction between left ventricular diastolic function and FELi with respect to the values of brachial blood pressure: systolic (SBP), diastolic (DBP) and mean blood pressure (MBP) (all PINT0.03). In patients with FELi below the median value and impaired left ventricular diastolic function, the values of SBP (149.3 vs 132.5 mm Hg; P=0.005), DBP (85.1 vs 76.1 mm Hg; P=0.001), MBP (106.5 vs 94.9 mm Hg; P=0.001), central SBP (SBPC) (137.4 vs 122.0 mm Hg; P=0.01), central DBP (DBPC) (84.8 vs 76.0 mm Hg; P=0.003), central MBP (MBPC) (106.9 vs 95.9 mm Hg; P=0.007), aortic pulse wave augmentation (18.0 vs 13.5 mm Hg; P=0.03), pulse wave velocity (14.6 vs 12.5 m s(-1); P=0.02) and central aortic pulse wave augmentation index (155.7% vs 140.9%; P=0.01) were significantly higher than in patients with normal left ventricular diastolic function. Such relationships were not observed in the entire group and patients with FELi above the median value. In the hypertensive population with high sodium intake, increased sodium reabsorption in proximal tubules may affect blood pressure parameters and arterial wall damage, thus contributing to the development of left ventricular diastolic function impairment.