Spot Urinary Creatinine Concentration in Patients with Chronic Heart Failure Identifies a Distinct Muscle-Wasting Phenotype with a Strikingly Different Risk of Mortality.

BACKGROUND: There is a raising awareness that heart failure (HF) is a highly heterogeneous, multiorgan syndrome with an increasing global prevalence and still poor prognosis. The comorbidities of HF are one of the key reasons for presence of various phenotypes with different clinical profile and outcome. Heterogeneity of skeletal muscles (SMs) quantity and function may have an impact on patient's phenotype. AIM: We intended to compare clinical characteristics of phenotypes defined by a combination of various SM mass taken as a fat-free compartment from DEXA scans and different levels of SUCR (Spot Urinary Creatinine). All-cause mortality with mortality predicted by MAGGIC in such phenotypes were compared. METHODS: In 720 HF patients with reduced ejection fraction (age: 52.3 ± 10 years, female: 14%, NYHA: 2.7 ± 0.7, LVEF: 24.3 ± 7.3%), admitted to the hospital for heart transplantation candidacy assessment, morning SUCR along with body composition scanning (DEXA) was performed. All study participants were dichotomized twice, first by low or normal appendicular muscle mass index (ASMI) and second by SUCR (Spot Urinary Creatinine) < and ≥of 1.34 g/L. Four study groups (phenotypes) were created as combinations of lower or higher SUCR and low or normal ASMI. RESULTS: Low ASMI was found in 242 (33.6%) patients, while the remaining 478 had normal muscle mass. In 446 patients (61.9%), SUCR was <1.34 g/L. During 3 years of follow-up, 223 (31.0%) patients died (all-cause). The phenotype of lower both ASMI and SUCR was associated with the highest mortality. The death rate in phenotype with both low ASMI and SUCR exceeded by 70% the risk estimated by MAGGIC. This difference was significant as judged by the 95% confidence interval for MAGGIC estimation. In Cox regression analysis adjusted for MAGGIC and parameters known to increase risk, the relative risk of patients with phenotype of low both ASMI and SUCR was elevated by 45-55% as compared to patients with all other phenotypes. The protective role of higher SUCR in patients with muscle wasting was, therefore, confirmed in Cox analysis. CONCLUSIONS: Measurement of SUCR in HF patients can identify clinical phenotypes with skeletal muscle wasting but strikingly different risk of death that is actually not captured by MAGGIC score. The higher level of SUCR was associated with similar risk independently of presence of muscle wasting. As the analysis of SUCR is cheap and easy to perform, it should be further tested as a potentially useful biomarker, which may precisely phenotype HF patients independently of their skeletal muscle status.

Long-term prognostic scores may underestimate the risk of death in patients with heart failure with reduced ejection fraction in whom red cell distribution width is elevated.

INTRODUCTION: Risk prediction in patients with heart failure with reduced ejection fraction (HFrEF) is one of the key challenges for clinicians. Novel biomarkers aggregating several important pathophysiological pathways may modify the diagnostic discrimination of validated scores. The red cell distribution width (RDW) is a cheap and easily available measure of anisocytosis, and was shown to have a strong independent prognostic power in short- and medium­term prognosis in HFrEF. OBJECTIVES: Our aim was to assess the prognostic power of RDW in optimally treated chronic HFrEF, and to investigate whether different RDW may impact the prognostic accuracy of validated long­term scores in HFrEF. PATIENTS AND METHODS: The study included 551 patients at a median (interquartile range [IQR]) age of 54 (47-59) years, of whom 86.6% were men. The patients represented the median New York Heart Association class III (IQR, II-III), and ischemic etiology occurred in 56.6% of the cases. In all patients, RDW as a coefficient of variation was calculated, along with Meta­Analysis Global Group in Chronic Heart Failure Score (MAGGIC­HF) and Seattle Heart Failure Survival Model (SHFSM). RESULTS: The patients were followed for 5 years and all­cause mortality was assessed. We recorded 166 (30.1%) and 225 (40.8%) deaths at 3 and 5 years, respectively. Scores based on MAGGIC­HF and SHFSM algorithms for the respective prediction of 3- and 5­year mortality were calculated for each patient and compared with the observed mortality. There was a significant underestimation of mortality in the patients with RDW above 15.4% (reference values, 11.5%-14.5%), while in those with lower RDW SHFSM overestimated the actual risk. The excess mortality in the higher RDW group was confirmed by the Hosmer-Lemeshow statistic. CONCLUSIONS: The RDW has a strong prognostic value in chronic HFrEF, independently of the risk assessed by the MAGGIC­HF or the SHFSM score.

Prognostic Value of Spot Urinary Creatinine Concentration and Its Relationship with Body Composition Parameters in HF Patients.

BACKGROUND: Low 24-h urinary excretion of creatinine in patients with heart failure (HF) is believed to reflect muscle wasting and is associated with a poor prognosis. Recently, spot urinary creatinine concentration (SUCR) has been suggested as a useful prognostic factor in selected HF cohorts. This more practical and cheaper approach has never been tested in an unselected HF population. Moreover, neither the relation between SUCR and body composition markers nor the association of SUCR with the markers of volume overload, which are known to worsen clinical outcome, has been studied so far. The aim of the study was to check the prognostic value of SUCR in HF patients after adjusting for body composition and indirect markers of volume overload. METHODS: In 911 HF patients, morning SUCR was determined and body composition scanning using dual X-ray absorptiometry (DEXA) was performed. Univariable and multivariable predictors of log SUCR were analyzed. All participants were divided into quartiles of SUCR. RESULTS: In univariable analysis, SUCR weakly correlated with fat-free mass (R = 0.09, p = 0.01). Stronger correlations were shown between SUCR and loop diuretic dose (R = 0.16, p < 0.0001), NTproBNP (R = -0.15, p < 0.0001) and serum sodium (R = 0.16, p < 0.0001). During 3 years of follow-up, 353 (38.7%) patients died. Patients with lower SUCR were more frequently female, and their functional status was worse. The lowest mortality was observed in the top quartile of SUCR. In the unadjusted Cox regression analysis, the relative risk of death in all three lower quartiles of SUCR was higher by roughly 80% compared to the top SUCR quartile. Apart from lower SUCR, the significant predictors of death were age and malnutrition but not body composition. After adjustment for loop diuretic dose and percent of recommended dose of mineralocorticoid receptor antagonists, the difference in mortality vanished completely. CONCLUSIONS: Lower SUCR levels in HF patients are associated with a worse outcome, but this effect is not correlated with fat-free mass. Fluid overload-driven effects may link lower SUCR with higher mortality in HF.

I Am the 1 in 10-What Should I Eat? A Research Review of Nutrition in Endometriosis.

Endometriosis is a chronic, painful, estrogen-related inflammatory disease that affects approximately 10% of the female population. Endometriosis has a significant negative impact on quality of life. Nutrition may be involved in the development and severity of endometriosis. The purpose of this paper is to discuss in detail the nutritional recommendations for patients with endometriosis. This article discusses the importance of nutrients such as polyphenols, vitamins C, D and E, PUFAs, and iron in the development of endometriosis. Alternative diets, such as the Mediterranean, anti-inflammatory, vegetarian, low-nickel and low-FODMAP diets, have also been presented in the context of their potential beneficial effects on the course of endometriosis.

Calcium and vitamin D content in the menus offered to elderly people during spa treatment in Krynica-Zdrój resort.

Background: Calcium and Vitamin D are key nutrients in the diet of elderly people due to osteoporosis. One of the places where seniors, through observation, can gain knowledge on how to compose a meal to make it wholesome is a sanatorium that combines spa treatment and rehabilitation with diet therapy. Objective: The aim of the study was to assess the menus in terms of the content of calcium and vitamin D in the meals consumed by the elderly people during spa treatment in the health resort and to compare the results with the Polish Dietary Reference Values. Material and methods: The study was carried out at Krynica Zdrój resort among patients who underwent spa therapy as part of 14-day stay periods. Menus prepared for 3 different diets were assessed, namely regular diet, easy-to-digest diet and diet for diabetics with limitation of easily digestible carbohydrates. The meals were served for 309 people (194 women and 115 men) most of them aged over 50. Results: All meals served in the spa were deficient in calcium and vitamin D. The mean daily intake of calcium throughout the six months was 711.68 mg, whereas the Estimated Average Requirement (EAR) for both women and men is 1000 mg. The mean contents of vitamin D in all 3 served diets were at a similar level. The diets daily supplied approximately 4-5 µg vitamin D/person, which constituted about 30% of the daily requirement for this vitamin. Conclusions: In order to reduce the risk of diseases resulting from calcium and vitamin D deficiency, the amount of foods containing these nutrients should be increased in daily diet or, if this is impossible, they should be supplemented.

Binge eating disorder and stress level among patients attending nutrition counseling.

Introduction: Introduction: binge eating disorder (BED) is characterized by eating much more than what most people would eat under similar circumstances. Inability to cope with stress and emotions may be the reason for BED episodes. Objective: to assess the level of stress and BED severity based on the number of episodes of compulsive overeating among patients attending nutrition counseling. Methods: a total of 100 people (60 women and 40 men) were taking part in the study. A questionnaire in which subjects answered questions concerning diet, number of meals, and coping with stressful situations was used. A nutritional diary was used to assess the amount of BED episodes and consumed products, and the emotions felt during consumption. PSS-10 was used to measure the response to stressful situations. Results: all subjects had episodes of compulsive overeating but the majority of respondents (52 %) had no more than 3 episodes of binge eating per week. During a BED episode patients most often chose sweets (58.2 %). The main way of responding of people on stressful situations was snacking, especially sweets. Conclusions: high levels of stress correlated positively with the number of BED episodes and excessive body weight. The PSS-10 questionnaire could be a useful tool in nutrition counseling.

Introducción: Introducción: el trastorno por atracón (BED) se caracteriza por comer mucho más de lo que la mayoría de la gente comería en circunstancias similares. La incapacidad para lidiar con el estrés y las emociones puede ser la razón de los episodios de BED. Objetivo: evaluar el nivel de estrés y la gravedad del BED en función del número de episodios de sobrealimentación compulsiva entre los pacientes que acuden a asesoramiento nutricional. Métodos: en el estudio participaron 100 personas (60 mujeres y 40 hombres). Se utilizó un cuestionario en el que los sujetos respondieron a preguntas relativas a la dieta, la cantidad de comidas y el afrontamiento de las situaciones estresantes. Se utilizó un diario nutricional para evaluar la cantidad de episodios de BED, los productos consumidos y las emociones durante el consumo. Se utilizó el PSS-10 para medir la respuesta a las situaciones estresantes. Resultados: todas las personas tuvieron episodios de comer compulsivamente, pero la mayoría de los encuestados (52 %) no presentaron más de 3 episodios de atracones en la semana. Durante un episodio de BED, los pacientes eligieron con mayor frecuencia los dulces (58,2 %). La principal forma de respuesta de las personas ante situaciones estresantes era picar, especialmente dulces. Conclusiones: los altos niveles de estrés se correlacionaron positivamente con el número de episodios de BED y el peso corporal excesivo. El cuestionario PSS-10 podría ser una herramienta útil en un asesoramiento nutricional.

The attitude of Polish consumers toward food irradiation as one of the methods of food preservation.

Background: Food irradiation is one of the methods of food preservation. Unfortunately, despite many opinions from national and international organizations that confirm the safety of the irradiation technique, the irradiated food market is slowly developing, which is particularly noticeable in European countries, including Poland. Objectives: The main objective of this study was to determine the attitude of Polish consumers toward irradiated food and to find out whether familiarizing the respondents with educational materials on the irradiation technique would change their attitudes. Material and methods: In response to the objective of the study, an online survey (with the presentation of educational materials) was conducted with 609 respondents living in the Silesian Voivodeship, Poland. A specially prepared author's questionnaire was used, containing questions relating to: sociodemographic data, food preservation, food irradiation. An integral part of the survey was a multimedia presentation containing information about the food irradiation process. Results: A low level of knowledge about food irradiation was found--90.31% (n = 550) of the respondents had never heard of this method of preservation before. The percentage of respondents with a positive attitude toward radiation-preserved products increased significantly after providing informative material, from 6.20 (n = 38) to 67.16% (n = 409). The final attitude of the respondents toward irradiated food varied and depended on age, education and place of residence-positive attitudes toward irradiation predominated among those who were young (<30 years old), had a higher education and lived in cities >100,000 inhabitants. Educational materials also had a significant impact on consumers' interest in purchasing irradiated food-the percentage of people declaring a willingness to purchase this type of product increased from 19.20 (n = 117) to 59.30% (n = 361). Almost 60% of the respondents were willing to purchase irradiated foods. Women, on average, were more likely to be interested in purchasing irradiated food compared to men. Conclusions: The survey indicates that irradiated food could be commercially introduced in Poland, but on the condition that an effective educational program is planned.

Nutritional and Non-Nutritional Predictors of Low Spot Urinary Creatinine Concentration in Patients with Heart Failure.

Low spot urinary creatinine concentration (SUCR) is a marker of muscle wasting and clinical outcome. The risk factors for low SUCR in heart failure (HF) remain poorly understood. We explored the risk factors for low SUCR related to poor outcomes. In 721 HF patients (age: 52.3 ± 11 years, female: 14%, NYHA: 2.7 ± 0.7) SUCR and Dexa body composition scans were performed. BMI prior HF-onset, weight loss, and appendicular muscle mass were obtained. Each patient was classified as malnutrition or normal by GLIM criteria and three other biochemical indices (CONUT, PNI, and GRNI). Sarcopenia index (SI) as creatinine to cystatin C ratio was also calculated. Within 1 year, 80 (11.1%) patients died. In ROC curve we identified a SUCR value of 0.628 g/L as optimally discriminating surviving from dead. In low SUCR group more advanced HF, higher weight loss and catabolic components of weight trajectory (CCWT), more frequent under-nutrition by GLIM, and lower SI were observed. In multivariate analysis the independent predictors of low SUCR were SI, CCWT, and GNRI score. In conclusion: the risk of low SUCR was associated with a worse outcome. Low SUCR was associated with greater catabolism and sarcopenia but not with biochemical indices of malnutrition.

Relationship between chronotype and consumption of stimulants.

Consumption of some stimulants may lead to health problems. The aim of the study was to identify a potential correlation between extreme chronotypes and the tendency to use various stimulants. The preferred time of consumption was also checked, both on working and nonworking days. The study was conducted in January 2020 using the CAWI method. 306 people took part in the survey. To determine the chronotype of the surveyed people, the polish version of MEQ questionnaire (Morningness - Eveningness Questionnaire) was used. Because 178 respondents were intermediate types, 128 people participated in the second part of the study, including 68 owls and 60 larks. Activity preferences during the day of respondents were checked and compared with data about the quantity and frequency of using stimulants like coffee, energy drinks, alcohol and cigarettes. Chi-square test was used for testing relationships. The time periods for taking stimulants differed between groups and were associated with activity during the day. It has been shown that people with evening chronotype use more energy drinks (p = .009), alcohol drinks (p = .013) and cigarettes or e-cigarettes (p = .021), especially in the group of respondents aged ≥30. Social jet lag was statistically higher in the group of owls and larks; however, consumption of stimulants depended on age and chronotype, not social jet lag. People with the morning chronotype are less likely to use stimulants. Owls showed a greater and more frequent use of energy drinks, alcohol and cigarettes, especially those older than 30 years. Assessing eveningness among people aged more than 30 may be helpful in characterizing an overall risk profile.

Assessment of calcium and vitamin D content in meals served for preschool children attending to kindergartens in some Silesian cities.

BACKGROUND: Adequate nutrition is one of the most important factors for influencing growth and development of children. Providing adequate amounts of minerals is extremely important in the developmental age, especially in periods of intensive growth. Calcium and vitamin D deficiency may have a negative impact on the health of children, both in the short and long term. OBJECTIVE: The aim of this study was to evaluate the content of calcium and vitamin D in the meals of preschoolers and to compare the obtained results to Polish dietary reference values for children aged 4-6 years. MATERIAL AND METHODS: The study was conducted in 40 randomly selected kindergartens in some Silesian cities and were concerning 1,746 children. 10-day-menus and preschool inventory reports describing the amount of food used for meal preparation were obtained from every kindergarten. 10-day-menus were analysed in terms of calcium and vitamin D content with the use of the Dieta 5 software. The obtained results were developed in Microsoft Excel 2016. RESULTS: The analysis of 10-days menus showed significant deficiencies in both calcium and vitamin D intake in the assessed food rations. The mean calcium level was 416.0 mg while vitamin D was 1.47 µg. The content of calcium and vitamin D in the examined 10-days menus did not meet the dietary reference values. CONCLUSIONS: The necessity to modify menus in terms of increasing the consumption of the analysed nutrients was demonstrated, as well as the need to implement nutritional education for preschool staff and parents was suggested.

[Do the requirements included in the regulation on health and safety at school effectively prevent children from carrying too heavy schoolbags?] / Czy wymagania zawarte w rozporzadzeniu w sprawie bezpieczenstwa i higieny pracy w szkolach zapobiegaja noszeniu przez dzieci zbyt ciezkich tornistrów?

BACKGROUND: Excessive spinal load caused by a schoolbag has a major impact on the child's body posture. The National Sanitary Inspector recommends the limit of schoolbag weight as corresponding to 10-15% of the student's weight. The aim of the study was to assess the spinal load of children aged 6-9 years, caused by schoolbags, and to check if it meets the requirements expressed as a percentage of the child's weight. The weight of the items in schoolbags was also established. In addition, parents' awareness about schoolbags and the child's use of additional storage spaces (lockers) were analyzed. MATERIAL AND METHODS: Overall, 332 children aged 6-9 years (172 girls, 160 boys) attending selected schools in a city located in the Silesian Voivodeship participated in the study. The study included determining schoolbag weight and presenting it in relation to the child's weight. The Mann-Whitney U test was used for 2 independent variables with non-normally distributed data (the Shapiro-Wilk test). The Kruskal-Wallis test was used to compare >2 independent trials. The level of statistical significance was set at p = 0.05. RESULTS: An average schoolbag weighted 3.57±0.58 kg. Schoolbag weight did not exceed 15% of the student's weight in 75% of the students; however, the schoolbags of only 17% of the students weighed less than 10% of the student's weight. The heaviest schoolbags were found among first-grade students. The girls had significantly heavier schoolbags compared to the boys (p = 0.037). The students using school lockers had heavier schoolbags than those who left unnecessary items on common shelves in the classroom (p = 0.006). CONCLUSIONS: The issue of heavy schoolbags remains a challenge for public health decision-makers despite the regulation that requires to provide children with space to leave books at school. The current rules do not effectively prevent children from carrying too heavy schoolbags. It is advisable to take measures to set an absolutely mandatory standard with which schools and students will be required to comply. Med Pr. 2020;71(6):687-97.

The Association between Serum Levels of 25[OH]D, Body Weight Changes and Body Composition Indices in Patients with Heart Failure.

We try to determine the association between weight changes (WC), both loss or gain, body composition indices (BCI) and serum levels of 25[OH]D during heart failure (HF). WC was determined in 412 patients (14.3% female, aged: 53.6 ± 10.0 years, NYHA class: 2.5 ± 0.8). Body fat, fat percentage and fat-free mass determined by dual energy X-rays absorptiometry (DEXA) and serum levels of 25[OH]D were analyzed. Logistic regression was used to calculate odds ratios for 25[OH]D insufficiency (<30 ng/mL) or deficiency (<20 ng/mL) by quintiles of WC, in comparison to weight-stable subgroup. The serum 25[OH]D was lower in weight loosing than weight stable subgroup. In fully adjusted models the risk of either insufficient or deficient 25[OH]D levels was independent of BCI and HF severity markers. The risk was elevated in higher weight loss subgroups but also in weight gain subgroup. In full adjustment, the odds for 25[OH]D deficiency in the top weight loss and weight gain subgroups were 3.30; 95%CI: 1.37-7.93, p = 0.008 and 2.41; 95%CI: 0.91-6.38, p = 0.08, respectively. The risk of 25[OH]D deficiency/insufficiency was also independently associated with potential UVB exposure, but not with nutritional status and BCI. Metabolic instability in HF was reflected by edema-free WC, but not nutritional status. BCI is independently associated with deficiency/insufficiency of serum 25[OH]D.

Comparison of Oxidative Stress Parameters in Heart Failure Patients Depending on Ischaemic or Nonischaemic Aetiology.

BACKGROUND: Abnormalities in the oxidative and antioxidant states causing oxidative stress were both found in heart failure (HF) of various aetiologies and atherosclerosis. AIM OF STUDY: The goals of the study were as follows: comparison of oxidative stress parameters (OSP) in ischaemic cardiomyopathy (ICM) (n = 479) and nonischaemic cardiomyopathy (nICM) (n = 295) patients; assessment of the relationships of OSP with functional capacity (NYHA class), maximal oxygen consumption (max.O2), left ventricle ejection fraction (LVEF), and NT-proBNP concentration; and determination of the mutual relations of OSP in subgroups of patients with ICM and n-ICM. METHODS: Serum concentrations of total antioxidant capacity (TAC), total oxidant status (TOS), uric acid (UA), bilirubin, albumin, protein sulfhydryl groups (PSH), and malondialdehyde (MDA) were measured. The oxidative stress index (OSI) and MDA/PSH ratio were calculated. RESULTS: Higher concentrations of TAC (1.14 vs 1.11 mmol/l; p < 0.001) and MDA (1.80 vs 1.70 µmol/l; p < 0.05) and higher MDA/PSH ratios (0.435 vs 0.358; p < 0,001) were observed in ICM than in nICM patients. Simultaneously, lower values of the OSI index (4.27 vs 4.6; p < 0, 05), PSH (4.10 vs 4.75 µmol/g of protein; p < 0,001), and bilirubin (12.70 vs 15.40 µmol/l; p < 0,001) concentrations were indicated in ICM patients. There were no differences in TOS, UA, and albumin between the examined groups. The NYHA class and VO2max correlate with MDA, bilirubin, and albumin in both groups, while with UA only in the ICM group. Correlations between the NYHA class, VO2max, and PSH were indicated in nICM. The association of LVEF with UA, bilirubin, and albumin has been demonstrated in the ICM group. The study showed negative correlations between TAC, MDA, and PSH and positive between TAC and MDA in both groups. In ICM patients, MDA positively correlated with UA. A negative correlation between PSH and concentrations of UA and bilirubin was expressed only in the nICM group. CONCLUSION: The obtained results confirm the relationship between the severity of HF and oxidative stress. The mechanisms of oxidative stress and antioxidant defence are partially different in the ICM and the nICM patients.

Health inequalities among students of lower secondary schools in Bytom, Poland.

INTRODUCTION AND OBJECTIVE: Poverty and low level of education pose the biggest threats to public health. Moreover, they generate inequalities in public healthThe aim of the study was to check if there are any inequalities in health among teenagers living in Bytom, Poland. MATERIAL AND METHODS: In 2011 and 2012, an epidemiological cross-sectional study was conducted on 1,099 students from lower secondary schools from Bytom. The students completed a questionnaire which was based on an earlier Health Behaviour in School-aged Children study (HBSC). Socio-Economic Status of teenagers (SES) was determined according to the Family Affluence Scale (FAS), the intensity of possible problems in the place of residence and on parents' education. Impact of SES on health self-assessment, asthma, pneumonia, bronchitis with addition to spinal deformities were also investigated. RESULTS: A good or very good level of health was declared by students from families representing a high level of FAS and residing in a more peaceful, less troubled neighbourhood. The highest level of asthma prevalence (10.9%) occurred among students from families with a low level of FAS. The students from families with high FAS were less affected by spinal deformities (34.6%). Students living in a troubled neighbourhood more often suffered from bronchial asthma, pneumonia, bronchitis and spinal deformities. CONCLUSIONS: The level of family affluence depends on the parents' education and all the analysed health problems occurred more frequently in children whose parents had completed at least general secondary education. A high economic standard of living and a peaceful neighbourhood determined good or very good health self-assessment among the surveyed students.

Exposure to impulse noise at an explosives company: a case study.

Impulse noise encountered in workplaces is a threat to hearing. The aim of this study was to assess the occupational exposure to impulse noise produced by detonation of dynamite on the premises of an explosives company. Test points were located on the blast test area (inside and outside the bunker) and in work buildings across the site. Noise propagation measurement was performed during 130 blast tests at nine measurement points. At every point, at least 10 separate measurements of A-weighted equivalent sound pressure level (LAeq), maximum A-weighted sound pressure level (LAmax) and C-weighted peak sound pressure level (LCpeak) were made. Noise recorded in the blast test area exceeded occupational exposure limits (OELs). Noise levels measured in buildings did not exceed OELs. Results of the survey showed that for 62% of respondents, impulse noise causes difficulties in performing work. The most commonly reported symptoms include headaches, nervousness and irritability.

[Ultraviolet exposure from indoor tanning devices as a potential source of health risks: Basic knowledge of the proper use of these devices for practical users, physicians and solarium staff]. / Promieniowanie nadfioletowe solariów jako potencjalne zródlo zagrozen zdrowotnych ­ podstawowa wiedza dla uzytkowników, lekarzy i personelu solariów o prawidlowym korzystaniu z tych urzadzen.

Bearing in mind the adverse health effects of exposure to ultraviolet (UV) radiation in solarium, especially the risk of carcinogenesis, there is a need to adopt legal regulations by relevant Polish authorities. They should set out the principles for indoor tanning studios operation, supervision and service of the technical parameters of tanning devices and training programs to provide the staff with professional knowledge and other aspects of safety in these facilities. The mechanism of the harmful effects of ultraviolet radiation on the human body, scale of overexposure, resulting from excessive sunbathing are described. Methods for estimating UV exposure and possible actions aimed at reducing the overexposure and preventing from cancer development caused by UV are also presented in this paper. Med Pr 2017;68(5):653-665.

Impairment in Pain Perception in Adult Rats Lesioned as Neonates with 5.7-Dihydroxytryptamine.

BACKGROUND: Whereas some studies have demonstrated the essential role of 5-hydroxytryptamine (5-HT) in tramadol and acetaminophen analgesia, other research has presented conflicting results. To dispel doubts, some aspects of the involvement of 5-HT in the antinociceptive properties of these drugs remain to be clarified. OBJECTIVES: The aim of this study was to determine whether the serotoninergic system dysfunction produced by neonatal 5-HT lesion in rats may affect the antinociceptive effects of tramadol and acetaminophen administered in adulthood. MATERIAL AND METHODS: Three days after birth, the control rats were pretreated with desipramine HCl (20 mg/kg i.p.) 30 min before intraventricular saline--vehicle injection. A separate group received 5.7-DHT; 2×35 µg in each lateral ventricle. At the age of 8 weeks, 5-HT and 5-hydroxyidoleaceticacid (5-HIAA) concentrations were determined in the thalamus and spinal cord by an HPLC/ED method. The antinociceptive effects of tramadol (20 mg/kg i.p.) or acetaminophen (100 mg/kg i.p.) were evaluated by a battery of tests. RESULTS: 5.7-DHT lesioning was associated with a reduction in 5-HT and 5-HIAA content of the thalamus (>85% and >90%) and spinal cord (>58% and 70%). Neonatal 5.7-DHT treatment produced a significant reduction in the antinociceptive effect of tramadol in the hot plate, tail-immersion, paw withdrawal and writhing tests. In the formalin hind paw test, the results were ambiguous. 5-HT lesion was also associated with a decrease in the analgesic effect of acetaminophen in the hot plate and writhing tests. A similar relationship wasn't found in the other assessments conducted with the use of acetaminophen. CONCLUSIONS: The present study provides evidence that (1) an intact serotoninergic system is required for the adequate antinociceptive action of tramadol, and (2) the serotoninergic system exerts a negligible influence on acetaminophen-induced analgesia in rats. We hypothesize that similar abnormalities in nociception may occur in patients with 5-HT dysfunction (e.g. depression), so these results should be complied in analgesic dosage adjustment.

Perinatal manganese exposure and hydroxyl radical formation in rat brain.

The present study was designed to investigate the role of pre- and postnatal manganese (Mn) exposure on hydroxyl radical (HO(•)) formation in the brains of dopamine (DA) partially denervated rats (Parkinsonian rats). Wistar rats were given tap water containing 10,000 ppm manganese chloride during the duration of pregnancy and until the time of weaning. Control rat dams consumed tap water without added Mn. Three days after birth, rats of both groups were treated with 6-hydroxydopamine at one of three doses (15, 30, or 67 µg, intraventricular on each side), or saline vehicle. We found that Mn content in the brain, kidney, liver, and bone was significantly elevated in dams exposed to Mn during pregnancy. In neonates, the major organs that accumulated Mn were the femoral bone and liver. However, Mn was not elevated in tissues in adulthood. To determine the possible effect on generation of the reactive species, HO(•) in Mn-induced neurotoxicity, we analyzed the contents of 2.3- and 2.5-dihydroxybenzoic acid (spin trap products of salicylate; HO(•) being an index of in vivo HO(•) generation), as well as antioxidant enzyme activities of superoxide dismutase (SOD) isoenzymes and glutathione S-transferase (GST). 6-OHDA-depletion of DA produced enhanced HO(•) formation in the brain tissue of newborn and adulthood rats that had been exposed to Mn, and the latter effect did not depend on the extent of DA denervation. Additionally, the extraneuronal, microdialysate, content of HO(•) in neostriatum was likewise elevated in 6-OHDA-lesioned rats. Interestingly, there was no difference in extraneuronal HO(•) formation in the neostriatum of Mn-exposed versus control rats. In summary, findings in this study indicate that Mn crosses the placenta but in contrast to other heavy metals, Mn is not deposited long term in tissues. Also, damage to the dopaminergic system acts as a "trigger mechanism," initiating a cascade of adverse events leading to a protracted increase in HO(•) generation, and the effects of Mn and 6-OHDA are compounded. Moreover, HO(•) generation parallels the suppression of SOD isoenzymes and GST in the brains of rats lesioned with 6-OHDA and/or intoxicated with Mn-the most prominent impairments being in frontal cortex, striatum, and brain stem. In conclusion, ontogenetic Mn exposure, resulting in reactive oxygen species, HO(•) formation, represents a risk factor for dopaminergic neurotoxicity and development of neurodegenerative disorders.

Association between chemotherapy and plasma adipokines in patients with colorectal cancer.

BACKGROUND: A link between chemotherapy, the serum level of selected adipokines and clinical outcome in colorectal patients was investigated. METHODS: Leptin, adiponectin, resistin, visfatin and insulin were measured by ELISA in colorectal cancer patients before and 3 months after the administration of cancer therapy. From August 2012 to August 2013, 34 patients with pathologically documented advanced colorectal cancer (T3/T4 with metastases or nodal status up to N3) and measurable metastatic disease, who required palliative chemotherapy based on the combination of 5-fluorouracil, oxaliplatin and irinotecan, were prospectively recruited in this study. Patients previously underwent curative surgical tumour resection, but the disease was disseminated (metastases in the liver and/or lungs) at the time of admission to the hospital. RESULTS: Of the 34 patients in this study, 5 accomplished a chemotherapy course with partial response (PR), 23 with SD (stabilisation) and 6 with progression (PD). For further study, only patients with good prognostic outcomes (i.e., PR and SD patients) were included. The mean level of leptin before chemotherapy was 26.39 ± 9.53 ng/ml. After six courses of cancer treatment, the leptin level increased by 118-57.44 ± 27.72 ng/ml (p<0.001). Additionally, the adiponectin level increased considerably (47%) from 9.89 ± 3.96 ng/ml to 14.51 ± 7.79 ng/ml (p<0.001). In contrast to leptin and adiponectin, the resistin and visfatin levels decreased significantly from 7.24 ± 1.17 and 1.98 ± 0.44 to 6.36 ± 1.36 and 1.48 ± 0.34 ng/ml (p<0.001), respectively. Insulin also declined remarkably from 16.20 ± 1.96 to 12.87 ± 1.80 (p<0.001). There were no significant differences the between male and female patients regarding age, BMI, and leptin, adiponectin, resistin, visfatin and insulin serum levels. CONCLUSIONS: The results of the present study are relevant because we found that chemotherapy in colorectal cancer patients, in addition to its beneficial clinical impact on the course of disease, positively affects cytokine production and release (increases the anti-inflammatory adiponectin and decreases visfatin and resistin, which are proangiogenic and promote cancer cell proliferation). The restoration of adequate adipose tissue function is essential for patients to achieve a good survival prognosis.

Coupling forces resulting from the type of chain saw used.

INTRODUCTION: Woodcutters' working conditions are difficult due to the presence of numerous occupational hazards. Petrol-fuelled chain saws commonly used in forestry produce vibration, which may lead to the development of non-specific disorders in the upper extremities of the chain saw operator, referred to as hand-arm vibration syndrome (HAVS). The magnitude of coupling forces exerted on a vibrating tool handle may affect the severity of HAVS and hand-wrist cumulative trauma disorders. The aim of the presented study was to measure coupling forces exerted by fellers on various chain saws and to find correlation between force magnitude and type of tool used. MATERIAL AND METHODS: Coupling forces applied by workers on different types of chain saws were measured by means of a hydro-electronic force meter. All measurements were carried out during the harvesting of wood in real work conditions. RESULTS: Mean force applied by forestry workers on their tools was 44.2 N. Coupling forces registered during cutting wood with small universal chain saws were larger than forces exerted on models characterized by higher power profile. Forces applied on comparable tools produced by various manufacturers also differed. CONCLUSIONS: The relationship between coupling forces and power of the chain saw should lead to ergonomic improvements of the tool and vibration-reducing devices. These results can also be used as a recommendation for fellers in a range of using proper machines for different types of cut or types of wood. They may also be applicable to develop more effective methods for assessing vibration exposure risks among woodcutters.