Search

One of the recurring motifs in Herta Müllerʼs work is the experience of the city, which often becomes a space of threat, violence, uncertainty, and finally repression and death. The German Nobel Prize laureate describes urban spaces, where the fate of the city is intertwined with the fate of the protagonists, depicting a world of people who are downtrodden, lost, defeated, and yet not without hope. This article discusses selected works by Herta Müller, in which the multidimensional image of the city opens up new fields for reflection and allows us to gain insight into how a totalitarian state functions. The cities the author describes are reflective of all Romanian cities under the dictatorship of Nicolae Ceaușescu; they are places of depravity and terror. This article also explores the aesthetics of ugliness which affects the understanding of the role of cities in Herta Müllerʼs prose, and analyzes important urban symbols such as asphalt, apartment blocks, parks and the flora and fauna characteristic of communist cities. In many of Müllerʼs texts, cities form a dramatic backdrop for acts of violence and repression against ‘the Stranger’ – for instance, the German minority, the Roma community, and women. Thus, the experience of an individual becomes the experience of the whole community, which makes Herta Müllerʼs work enduringly relevant.

Objectives In this review, the authors aimed to clarify the relationship between the occurrence of osteoporosis and diabetes, analyze the differences between the pathogenesis of osteoporosis in different types of diabetes and propose the most effective diagnostic strategy and fracture risk assessment in diabetic patients. Material and methods A analysis of publications in MEDLINE, COCHRANE and SCOPUS databases was performed, searching for reports on the diagnostics, fracture risk assessment, prevention, and treatment of osteoporosis in patients with diabetes mellitus (DM) published in the years 2016–2022. The key words for the search were: diabetes, osteoporosis, and low-energy fracture. Results Bone complications of T1DM are more severe than T2DM, because of the lack of anabolic effect of insulin on bones. In T2DM the risk of fractures is elevated; however, identifying the mechanisms underlying the increased risk of fractures in T2DM is not clear. The FRAX tool is not appropriate for assessing the fracture risk in young patients with T1DM. It is quite useful in older patients with T2DM, but in these patients the calculated fracture risk may be underestimated. In T2DM the fracture risk often does not correspond to BMD value as measured by dual-energy X-ray absorptiometry (DXA). Diagnostic tools such as the trabecular bone score may play a significant role in this group of patients. Conclusions Optimal strategies to identify and treat high risk individuals require further research and proper definition. The diagnostic criteria for osteoporosis should be clearly defined as well as fracture risk assessment and choice of anti-osteoporotic medication. In all cases of secondary osteoporosis, treatment of the underlying disease is the most important. The relationship between high risk of fractures and diabetes is inseparable, and its full understanding seems to be the key to effective management.

Objective. To characterize the eosinophilic granulomatosis with polyangiitis (EGPA) population from the POLVAS registry depending on ANCA status and diagnosis onset, including their comparison with the granulomatosis with polyangiitis (GPA) subset with elevated blood eosinophilia (min. 400/μl) (GPA HE) to develop a differentiating strategy. Methods. A retrospective analysis of the POLVAS registry. Results. The EGPA group comprised 111 patients. The ANCA-positive subset (n = 45 [40.54%]) did not differ from the ANCA-negative one in clinics. Nevertheless, cardiovascular manifestations were more common in ANCA-negative patients than in those with anti-myeloperoxidase (MPO) antibodies (46.97% vs. 26.92%, p = 0.045). Patients diagnosed before 2012 (n = 70 [63.06%]) were younger (median 41 vs. 49 years, p

The quality of the silicon-buried oxide bonded interface of SOI devices created by thin Si film transfer and bonding over pre-patterned cavities, aiming at fabrication of DG and SON MOSFETs, is studied by means of chargepumping (CP) measurements. It is demonstrated that thanks to the chemical activation step, the quality of the bonded interface is remarkably good. Good agreement between values of front-interface threshold voltage determined from CP and I-V measurements is obtained.

This paper presents for the first time the results of charge-pumping (CP) measurements of FILOX vertical transistors. The aim of these measurements is to provide information on the density of interface traps at the Si-SiO2 interface fabricated in a non-standard process. Flat-band and threshold voltage, as well as density of interface traps are determined. Good agreement between threshold-voltage values obtained from CP and I-V measurements is observed.

This paper presents the results of charge-pumping measurements of SOI MOSFETs. The aim of these measurements is to provide information on the density of interface traps at the front and back Si-SiO2 interface. Three-level charge-pumping is used to obtain energy distribution of interface traps at front-interface

This work reports on changes in the properties of ultra-thin PECVD silicon oxynitride layers after high- temperature treatment. Possible changes in the structure, composition and electrophysical properties were investigated by means of spectroscopic ellipsometry, XPS, SIMS and electrical characterization methods (C-V, I-V and charge- pumping). The XPS measurements show that SiOxNy is the dominant phase in the ultra-thin layer and high-temperature annealing results in further increase of the oxynitride phase up to 70% of the whole layer. Despite comparable thickness, SIMS measurement indicates a densification of the annealed layer, because sputtering time is increased. It suggests complex changes of physical and chemical properties of the investigated layers taking place during high-temperature annealing. The C-V curves of annealed layers exhibit less frequency dispersion, their leakage and charge-pumping currents are lower when compared to those of as-deposited layers, proving improvement in the gate structure trapping properties due to the annealing process.

The goal of this work was to study nitrogen implantation from plasma with the aim of applying it in dual gate oxide technology and to examine the influence of the rf power of plasma and that of oxidation type. The obtained structures were examined by means of ellipsometry, SIMS and electrical characterization methods.

This study describes the effects of high temperature annealing performed on structures fluorinated during initial silicon dioxide reactive ion etching (RIE) process in CF4 plasma prior to the plasma enhanced chemical vapour deposition (PECVD) of the final oxide. The obtained results show that fluorine incorporated at the PECVD oxide/Si interface during RIE is very stable even at high temperatures. Application of fluorination and high temperature annealing during oxide layer fabrication significantly improved the properties of the interface (Ditmb decreased), as well as those of the bulk of the oxide layer (Qeff decreased). The integrity of the oxide (higher Vbd ) and its uniformity (Vbd distribution) are also improved.

This study describes a novel technique to form good quality low temperature oxide (< 350°C). Low temperature oxide was formed by N2O + SiH4:N2 plasma in a plasma enhanced chemical vapour deposition (PECVD) system on the silicon surface reactively etched in CF4 plasma (RIE – reactive ion etching). The fabricated oxide demonstrated excellent (for low temperature dielectric formation process) currentvoltage (I−V) characteristics, such as: low leakage current, high breakdown voltage and good reliability. Experimental results indicate that the proposed method of fluorine incorporation into the SiO2/Si inteface improves electrical parameters of MOS structures.

Cholesteatoma is a specific medical condition involving the abnormal, non-cancerous growth of skin-like tissue in the middle ear, potentially leading to a collection of debris and even infections. The receptor for advanced glycation (RAGE) and its ligand, high-mobility box 1 (HMGB1), are both known to be overexpressed in cholesteatoma and play a potential role in the pathogenesis of the disease. In this study, we investigated the role of small extracellular vesicles (sEVs) in carrying HMGB1 and inducing disease-promoting effects in cholesteatoma. No significant differences in the concentration of isolated sEVs in the plasma of cholesteatoma patients (n = 17) and controls (n = 22) were found (p > 0.05); however, cholesteatoma-derived sEVs carried significantly higher levels of HMGB1 (p < 0.05). In comparison to sEVs isolated from the plasma of controls, cholesteatoma-derived sEVs significantly enhanced keratinocyte proliferation and IL-6 production (p < 0.05), potentially by engaging multiple activation pathways including MAPKp44/p42, STAT3, and the NF-κB pathway. Thus, HMGB1(+) sEVs emerge as a novel factor potentially promoting cholesteatoma progression.

Abstract Transforming growth factor β (TGFβ) is a major component of tumor‐derived small extracellular vesicles (TEX) in cancer patients. Mechanisms utilized by TGFβ+ TEX to promote tumor growth and pro‐tumor activities in the tumor microenvironment (TME) are largely unknown. TEX produced by head and neck squamous cell carcinoma (HNSCC) cell lines carried TGFβ and angiogenesis‐promoting proteins. TGFβ+ TEX stimulated macrophage chemotaxis without a notable M1/M2 phenotype shift and reprogrammed primary human macrophages to a pro‐angiogenic phenotype characterized by the upregulation of pro‐angiogenic factors and functions. In a murine basement membrane extract plug model, TGFβ+ TEX promoted macrophage infiltration and vascularization (p < 0.001), which was blocked by using the TGFβ ligand trap mRER (p < 0.001). TGFβ+ TEX injected into mice undergoing the 4‐nitroquinoline‐1‐oxide (4‐NQO)‐driven oral carcinogenesis promoted tumor angiogenesis (p < 0.05), infiltration of M2‐like macrophages in the TME (p < 0.05) and ultimately tumor progression (p < 0.05). Inhibition of TGFβ signaling in TEX with mRER ameliorated these pro‐tumor activities. Silencing of TGFβ emerges as a critical step in suppressing pro‐angiogenic functions of TEX in HNSCC.

Literature usually represents a horse as a loyal companion of a man, a noble and intelligent animal. The image of a horse in some works, however, relies on their mystery, it evokes anxiety, fear. It symbolizes an internal unease or a drive to escape. Sometimes a horse is equated to the messenger of death; it personifies dark, incomprehensible forces that cannot be understood by a human mind. This aspect of the unexplored equine nature in Germanlanguage literature is addressed in this study.

The authors report a case of a 67-year-old woman with giant cell arteritis with acute Achilles tendon rupture, which occurred after 3 days of levofloxacin therapy introduced because of newly diagnosed erosive gastritis associated with Helicobacter pylori infection. The Achilles tendon rupture was surgically treated and the patient made a complete recovery. In view of the widespread use of levofloxacin in practice, this case report raises important clinical implications. Tendinopathies are a known complication, quite rare in the healthy population, but the risk of rupture significantly increases in the population of patients over 60 years of age, with chronic usage of glucocorticosteroids, impaired renal function and recipients of organ transplants. What needs underlining, there are also described differences between individual fluoroquinolones as a cause of tendon damage in this group. Considering the widespread use of this group of drugs in patients, knowledge about the risk of adverse events including tendinopathy promotes safe use of fluoroquinolones.

Graves’ ophthalmopathy (GO) is a chronic autoimmune inflammatory disorder involving orbital tissues. A receptor for advanced glycation end products (RAGE) and its ligand high mobility group box 1 (HMGB1) protein trigger inflammation and cell proliferation and are involved in the pathogenesis of various chronic inflammatory diseases. This study was aimed to evaluate RAGE and HMGB1 expression in GO to determine its potential clinical significance. To the best of our knowledge, this is the first study showing RAGE and HMGB1 expression in orbital tissue using immunohistochemistry. Sections of orbital adipose tissue obtained from patients diagnosed with GO (23 patients; 36 orbits) and normal controls (NC) (15 patients; 15 orbits) were analyzed by immunohistochemistry for RAGE and HMGB1 expression. Expression profiles were then correlated with clinical data of the study group. RAGE and HMGB1 expression were elevated in GO patients in comparison with NC (p=0.001 and p=0.02, respectively). We observed a correlation between RAGE expression and occurrence of dysthyroid optic neuropathy (DON) (p=0.05) and levels of TSH Receptor Antibodies (TRAb) (p=0.01). Overexpression of RAGE and HMGB1 might be associated with GO pathogenesis. In addition, RAGE and HMGB1 proteins may be considered as promising therapeutic targets, but this requires further research.

This study aimed to investigate the associations of microRNA (miRs) signatures with cytokines, serum lipids, and disease activity in patients with psoriatic arthritis (PsA), ankylosing spondylitis (AS), and rheumatoid arthritis (RA). In total, 65 patients (PsA n = 25, AS n = 25, RA n = 15) and 25 healthy controls (HC) were enrolled into the study. The expression of miR-223-5p, miR-92b-3p, miR-485-3p, miR-10b-5p, let-7d-5p, miR-26a-2-3p, miR-146b-3p, and cytokines levels were measured in sera. DIANA-mirPath analysis was used to predict pathways targeted by the dysregulated miRs. Disease activity scores were calculated. Lipid profile, uric acid, glucose level, and C-reactive protein (CRP) concentrations were determined in the blood. Based on lipid profiles, the PsA group had hypertriglyceridaemia, and RA patients revealed mixed dyslipidaemia, while in AS, no specific changes were found. miR expression analysis revealed upregulation of miR-26a-2-3p and miR-10b-5p in PsA, miR-485-3p in AS, and let-7d-5p in RA. Several correlations between disease activity indexes, metabolites levels, and expression of miRs were observed in PsA, RA, and AS patients. Finally, in ROC analysis, miR-26a-2-3p/miR-485-3p, and let-7d-5p/miR-146b-3p tandems revealed high sensitivity and specificity in distinguishing between PsA, AS, and RA. Our study illustrates the superiority of miR expressions in distinguishing between RA, PsA, and AS. In PsA, a unique regulatory pathway exists through miR-26a-2-3p, miR-223-5p, miR-10b-5p, and miR-92b-3p that converges proatherogenic metabolism and disease activity.

Background: Activated T lymphocytes play an important role in the pathogenesis of rheumatic diseases (RD). Mesenchymal stem cells (MSCs) possess immunoregulatory activities but such functions of MSCs from bone marrow of systemic lupus erythematosus (SLE), systemic sclerosis (SSc), and ankylosing spondylitis (AS) patients are impaired. Adipose tissue–derived MSCs (ASCs) are an optional pool of therapeutically useful MSCs, but biology of these cells in RD is poorly known. This study aimed at investigating the effect of ASCs from RD patients and healthy donors (HD) on the expression of the key T-cell activation markers. Methods: ASCs were isolated from subcutaneous abdominal fat from SLE ( n = 16), SSc ( n = 18), and AS ( n = 16) patients, while five human ASCs lines from HD were used as a control. Untreated and cytokine (tumor necrosis factor α + interferon γ)-treated ASCs were co-cultured with allogenic, mitogen (phytohemagglutinin)-stimulated peripheral blood mononuclear cells (PBMCs) or purified anti-CD3/CD28-activated CD4 + T lymphocytes. Contacting and noncontacting ASCs-PBMCs co-cultures were performed. RD/ASCs were analyzed in co-cultures with both allogeneic and autologous PBMCs. Flow cytometry analysis was used to evaluate expression of CD25, HLA-DR, and CD69 molecules on CD4 + and CD8 + cells. Results: In co-cultures with allogeneic, activated CD4 + T cells and PBMCs, HD/ASCs and RD/ASCs downregulated CD25 and HLA-DR, while upregulated CD69 molecules expression on both CD4 + and CD8 + cells with comparable potency. This modulatory effect was similar in contacting and noncontacting co-cultures. RD/ASCs exerted weaker inhibitory effect on CD25 expression on autologous than allogeneic CD4 + and CD8 + T cells. Conclusion: RD/ASCs retain normal capability to regulate expression of activation markers on allogeneic T cells. Both HD/ASCs and RD/ASCs exert this effect independently of their activation status, mostly through the indirect pathway and soluble factors. However, autologous CD4 + and CD8 + T cells are partially resistant to RD/ASCs inhibition of CD25 expression, suggesting weaker control of T-cell activation in vivo .

A chronic inflammatory process characteristic of obstructive sleep apnea promotes vascular endothelial dysfunction and atherogenesis. This process can lead to destabilization and rupture of cardiovascular plaques, which clinically manifests as an acute coronary syndrome or stroke. The aim of this study was to investigate the inflammatory pathway leading to plaque destabilization in non-to-mild and moderate-to-severe groups of OSA patients. This prospective study involved enrollment of patients scheduled for endarterectomy. A sleep study was performed prior to surgery. Immunohistochemistry was performed on atherosclerotic plaques from carotid arteries obtained during standard open endarterectomy to determine levels of CD40, CD40L receptors, MCP-1, and MMP-9. The 46 patients included 14 controls, 13 with mild, 11 with moderate, and 8 with severe OSA. Increased expression of CD40, CD40L receptors, MCP-1, and MMP-9 were found to be proportionate with OSA severity. However, significant differences among groups were observed only for MCP-1 (p = 0.014). Increased expression of inflammatory markers (CD40, CD40L, MCP-1, MMP-9) is associated with increasing OSA severity. This suggests the CD40-CD4-L inflammatory pathway may contribute to plaque instability and rupture in OSA patients.

Introduction: Adipose tissue exerts widespread effects on the metabolism and immune system, but its activity differs between the genders. In the general population low-grade adipose tissue inflammation contributes to development of diseases of affluence. Little is known about the systemic impact of peripheral fat tissue in osteoarthritis (OA) and rheumatoid arthritis (RA), characterized by chronic, low- and high-grade systemic inflammation, respectively. To clarify this we evaluated the secretory activity of subcutaneous abdominal adipose tissue (SAAT) obtained from male patients affected with RA (n = 21) and OA (n = 13), and assessed its association with body mass and composition, demographic, clinical and laboratory data. Material and methods: Basal and interleukin (IL)-1β-triggered secretion of selected adipocytokines from SAAT explants was measured by specific enzyme-linked immunosorbent assays (ELISA). Patients’ body composition was evaluated by bioelectric impendence technique. Results : Rheumatoid SAAT secreted more adiponectin and macrophage migration inhibitory factor (MIF) than respective osteoarthritis tissue. In both RA and OA patient groups, stimulation of SAAT explants with IL-1β(1 ng/ml/100 mg tissue) significantly up-regulated release of pro-(IL-6, IL-8, tumor necrosis factor – TNF) and anti-inflammatory (IL-10) cytokines but had no effect on the secretion of adiponectin, leptin, MIF and hepatocyte growth factor (HGF). Compared with RA, patients with OA were more obese. In RA patients SAAT-released adiponectin and TNF inversely correlated with body mass index (BMI) and visceral fat rating (FVSC). In addition, SAAT-secreted adiponectin and leptin positively correlated with DAS28 and disease duration, respectively. In the OA group tissue-released TNF positively correlated with patients’ age. Conclusions : We conclude that in RA male patients adipocytokines originating from SAAT are of clinical importance because: (i) adiponectin and TNF may contribute to maintenance of normal body composition and mass, (ii) in addition adiponectin may play a pathogenic role. Moreover, in both RA and OA male patients secretory activity of SAAT may vary with time.

Objectives: Observational studies provide insights into real-life situations. Therefore, we assessed the effects of oral avocado/soybean unsaponifiable (ASU) capsules on pain relief and functional ability in patients, while they were receiving a routine treatment for knee osteoarthritis (OA). Material and methods : An open, prospective, observational 6-month study was conducted in 99 centers in Poland in a group of 4822 patients with symptomatic knee OA receiving one 300 mg ASU capsule/day as a routine medication. The patients had no diagnoses of other rheumatic diseases and were not treated with other symptomatic slow-acting drugs for osteoarthritis (SYSADOAs). Data on OA symptoms and therapy were collected from the initiation of ASU treatment (visit 0) and during 3 consecutive control visits performed every 2 months (visits 1–3). Functional Lequesne index, severity of joint pain of one symptomatic knee (Laitinen index and VAS), use of analgesics and non-steroidal anti-inflammatory drugs (NSAIDs), adherence to treatment and adverse events were evaluated and recorded using electronic Case Report Forms. Results : Four thousand one hundred and eighty-six patients (86.8%) attended all 4 visits. In 94.2% of patients (mean age 60.7 ±11.6 years SD, 73.4% female) at least one OA risk factor was identified. There was a significant improvement in functional ability between the last and baseline visits as evidenced by the median Lequesne index decreasing from 8 to 4 points (p < 0.001). Measures of pain intensity also fell significantly (p < 0.001) throughout the study: median Laitinen score decreased from 6 to 3 points, median pain at rest VAS – from 1.8 to 0 cm and median pain during walking VAS – from 5.6 to 1.9 cm. The significant differences were also noted between consecutive visits. The proportion of patients using analgesics and NSAIDs declined from 58.8% at the baseline visit to 24.9% at the last visit 3 (p < 0.001). Defined daily dose of NSAIDs decreased significantly from 1 at the baseline visit to 0.67 at the visit 3. Severe adverse events associated with ASU treatment were not observed. Conclusions : It was the first observational study in Poland evaluating the effects of routine knee OA treatment with oral ASU. Only a small group of patients (13.2%) treated with ASU discontinued the study. The majority of patients adherent to the ASU treatment for 6 months showed gradual alleviation of joint pain, improvement in functional ability and a significant reduction in NSAIDs intake.

The current methods of cardiovascular (CV) risk assessment in the course of inflammatory connective tissue diseases are a subject of considerable controversy. Comparing different methods of CV risk assessment in current rheumatoid arthritis (RA) guidelines, only a few of them recommend the use of formal risk calculators. These are the EULAR guidelines suggesting the use of SCORE and the British Society for Rheumatology guidelines performed in collaboration with NICE preferring the use of QRISK-2. Analyzing the latest American and British reports, two main concepts could be identified. The first one is to focus on risk calculators developed for the general population taking into account RA, and the calculator that might fulfill this role is the new QRISK-2 presented by NICE in 2014. The second concept is to create RA-specific risk calculators, such as the Expanded Cardiovascular Risk Prediction Score for RA. In this review we also discuss the efficiency of a new Pooled Cohort Equation and other calculators in the general and RA population.

Cardiovascular events are the main cause of the increased risk of death in patients with rheumatoid arthritis (RA). Death rates associated with cardiovascular diseases in RA are 50% higher in comparison with the general population. In the last decade several new technologies and new strategy in the treatment of RA were introduced but the risk of cardiovascular incidents remained unchanged. Various alterations of the lipid profile, observed in RA patients during the treatment with disease modifying antirheumatic drugs (DMARDs) are the subject of several and often contraversal studies. In this review we present and analyzed the results of current research on the lipid profile in RA patients treated with the synthetic and biologic DMARDs. The role of the lipid profile alterations in the pathogenesis of accelerated atherosclerosis in RA has been discussed.

The aim of this paper is to examine the multidimensional way of presenting dogs in selected German works. Dogs trigger a whole range of emotions in man, such as attachment and protectiveness, but also the dangerous instinct associated with the desire for power and domination. Dogs can be both devoted companions and friends to man but also objects of ruthless training. Therefore, Theodor Fontane’s and Thomas Mann’s works, which present the function of animals in a surprising light, may be an excellent point of reference.

Na różne formy osteoporozy ludzie chorowali od zawsze, ale nawetprzed 100 laty był to jeszcze problem zdrowotny niewielkiej grupyosób – tych, które wyjątkowo dożywały sędziwego wieku lub teżcierpiały na choroby, o których dziś wiemy, że powodują osteo -porozy wtórne, ale w dawnych czasach praktycznie nieleczone,częściej były powodem zgonu niż złamań osteoporotycznych.W wieku XX, a zwłaszcza w jego drugiej połowie, nastąpiło znacznewydłużenie średniego czasu życia oraz przyspieszenie postęputechnologicznego i cywilizacyjnego. Osteoporoza jawi się jakopoważny, narastający problem społeczny. Zostaje zauważonaprzez lekarzy również w Polsce. Niniejsze opracowanie jest próbąspojrzenia z polskiej perspektywy na postęp wiedzy i praktykimedycznej w tym zakresie.

W reumatoidalnym zapaleniu stawów (RZS) istnieje podwyższoneryzyko występowania zawału serca i innych powikłań ze strony układukrążenia. W aktywnym RZS stwierdza się ponadto stan pobudzeniaukładu krzepnięcia i fibrynolizy, co w pewnym stopniu tłumaczyczęstsze incydenty sercowo-naczyniowe. Celem przeprowadzonychbadań było sprawdzenie, czy powszechnie uznana za bezpieczną,ogólnoustrojowa krioterapia stosowana w fizykoterapii RZS możezaburzać chwiejną równowagę układu hemostatycznego. Wykonanobadania wybranych parametrów układu krzepnięcia i fibrynolizyu 46 pacjentów z RZS oraz 20 pacjentów z chorobą zwyrodnieniowąstawów (OA), poddanych 10 cyklom leczenia w komorze kriogenicznej(w temperaturze –120°C przez 3 min). Stwierdzono, że taka terapianie powoduje hamowania odczynu ostrej fazy u chorych na RZS– stężenie białka C-reaktywnego (CRP) we krwi nie uległo zmianie.Zaobserwowano natomiast zmiany w układzie fibrynolitycznymw postaci zmniejszenia stężenia tkankowego aktywatora plazminogenu(t-PA) w osoczu i zwiększenia stężenia kompleksów plazminy––antyplazminy (PAP) (p < 0,05) u chorych na RZS, a także zmniejszeniastężenia t-PA i zwiększenia stężenia inhibitora aktywatoraplazminogenu (PAI-1) (p < 0,05) u chorych na OA. Pomimo brakujakichkolwiek negatywnych objawów klinicznych związanych z tymizmianami autorzy uważają, że terapia chorych na RZS w komorzekriogenicznej może zaburzać równowagę w układzie hemostazy–fibrynolizy i u niektórych pacjentów może zwiększać ryzyko zakrzepicyi powikłań sercowo-naczyniowych.

Cel pracy: Ocena czynników ryzyka i częstości występowaniaupadków i złamań kości u chorych na reumatoidalne zapaleniestawów (RZS). Materiał i metody: Do badania kwalifikowano pacjentów chorychna RZS (spełniających kryteria ACR z 1984 r.). Dane na temat stanuzdrowia zebrano na podstawie ankiety zawierającej Kwestio -nariusz Oceny Stanu Zdrowia (HAQ), pytań dotyczących chorób,przyjmowanych leków, upadków i złamań kości w okresie ostatnich12 miesięcy. Wyniki: Przebadano 167 kobiet (89,8%) i 19 mężczyzn (średni wiek± SD 58,5 ±13,8 roku). Średni czas trwania choroby wynosił14,4 ±10,7 roku. Średnia wartość HAQ 1,36 ±0,76. Z grupy 186 osóbupadek przydarzył się 80 badanym (43%). U 28 chorych (35%)upadek zakończył się złamaniem bądź złamaniami obwodowymi.Liczba upadków dodatnio korelowała z wynikiem HAQ (r = 0,32;p < 0,05) oraz czasem trwania choroby (r = 0,31; p < 0,05).Głównymi czynnikami ryzyka upadków w badanej grupie byłyzawroty głowy [iloraz szans (OR) = 2,68], stosowanie lekówhipotensyjnych (OR = 2,27) i przeciwdepresyjnych (OR = 2,56),deformacje stóp (OR = 3,14) oraz wysoki wskaźnik HAQ(OR = 2,08). Czas trwania RZS (OR = 1,05) i wiek (OR = 1,04) praktycznienie wpływały na ryzyko upadków. Głównymi czynnikamiryzyka złamań kości w badanej grupie były osteoporoza (t-score< –2,5) (OR = 4,70), stosowanie leków hipotensyjnych (OR = 4,98),deformacje stóp (OR = 4,82), zawroty głowy (OR = 3,30) orazwysoki wskaźnik HAQ (OR = 3,12). Wnioski: Upadki są poważnym problemem w przebiegu RZS.Głównymi czynnikami sprzyjającymi upadkom i złamaniomu chorych na RZS są deformacje stóp, zawroty głowy, zażywanieleków obniżających ciśnienie tętnicze oraz wysoka wartość HAQ.