Sir Gordon Morgan Holmes (1876-1965): one of the founders of modern neurology.

Sir Gordon Morgan Holmes (1876-1965) was one of the most important founders of modern neurology and a great teacher and scientist. He was the first scientist to challenge the theory of the unitary function of the cerebellum and described cerebellar disorders. Holmes together with Thomas Grainger Stewart (1877-1957) described 40 cases of the rebound phenomenon in cerebellar disease (Stewart-Holmes maneuver or Stewart-Holmes test). He also described the symptoms of inherited neurodegenerative spinocerebellar ataxia involving the olivary nucleus (Gordon-Holmes syndrome). Independently from the Australian neurologist William John Adie (1886-1935), he described the partial iridoplegia (Holmes-Adie pupil or Holmes-Adie syndrome). His teaching skills became clearly visible in Goulstonian and Croonian lectures dedicated to spinal cord injuries.

Informed Consent in Obligatory Vaccinations?

Vaccinations cause controversies for numerous reasons: medical, religious, and even personal. The following paper focuses on one more, underestimated conflict between individual autonomy and public health in regard to obligatory childhood vaccinations. Every medical intervention should be preceded by informed consent; however, informed consent in the case of obligatory vaccinations cannot be voluntary and valid. Moreover, asking parents to sign an informed consent form is paradoxical in a situation where not signing it will lead to legal consequences. Our paper tries to accentuate the issue of involuntariness and invalidity of informed consent in the case of obligatory vaccination and tries to propose a solution that acknowledges requirements for vaccinations and makes parents feel safer coming in and out of a vaccination visit.

Zygmunt Kramsztyk (1849-1920) - the most outstanding medical philosopher among Polish ophthalmologists of the 19th and 20th centuries.

Zygmunt Kramsztyk (1849-1920) was a Polish ophthalmologist of Jewish origin, the founder of the ,,Medical Critique" magazine. He studied medicine at the Main School of Warsaw and Imperial University of Warsaw, graduating in 1 872, and completed his PhD in 1879 submitting the dissertation entitled "On changes perceived in eyes of leukaemic patients". From 1880 to 1904 he was the head of the Ophthalmic Ward at the Orthodox Jew Hospital in Warsaw. In 1898 he was appointed the chief physician in that hospital, remaining in this role for the next 4 years. Zygmunt Kramsztyk wrote critiques, essays and popular science articles. He penned many works on ophthalmology. He also wrote a textbook entitled "Clinical symptoms of eye diseases".

Activity of MMP1 and MMP13 and amino acid metabolism in patients with alcoholic liver cirrhosis.

BACKGROUND: Alcoholic liver disease remains one of the most common causes of chronic liver disease worldwide. The aim of this study was to assess the usefulness of metalloproteinases (MMP1 and MMP13) as diagnostic markers of alcoholic liver disease and to determine the changes in free amino acid profile in the patients with alcoholic liver cirrhosis. MATERIAL AND METHODS: Sixty patients with alcoholic liver cirrhosis treated in various hospitals of the Lublin region were randomly enrolled. The control group consisted of 10 healthy individuals without liver disease, who did not drink alcohol. Additionally, a group of alcoholics (22 persons) without liver cirrhosis was included in the study. The activity of MMP-1 and MMP-13 in blood plasma of patients and controls was measured using the sandwich enzyme immunoassay technique with commercially available quantitative ELISA test kits. Amino acids were determined by automated ion-exchange chromatography. RESULTS: No significant differences were observed in the activity of MMP-1 in alcoholics with or without liver cirrhosis or in controls. Increased serum MMP-13 was found in patients with liver cirrhosis (stage A, B, C) compared to the control group. Patients with alcoholic liver cirrhosis (stage A, B, C) demonstrated reduced concentrations of glutamic acid and glutamine compared to the control group. Plasma levels of valine, isoleucine, leucine, and tryptophan were significantly lower in patients with alcoholic liver cirrhosis (stage C) than in controls. CONCLUSIONS: MMP-13 can be useful to confirm the diagnosis of alcoholic liver cirrhosis, but levels of MMP-1 are not significantly increased in patients with liver cirrhosis compared to controls. The serum branched-chain amino acid (BCAA) is markedly reduced in patients with stage C alcoholic liver cirrhosis.

Genetic tests as the strongest motivator of cooperation between participants and biobanks-Findings from cross-sectional study.

Introduction: The development of the scientific potential linked with biobanking and research on human biological material is highly dependent on the willingness of potential donors to cooperate with entities that collect the material. For this reason, it is crucial to identify the circumstances and factors that may encourage potential participants to donate their biological material. In particular, knowledge of the motivational factors that can be modified by the persons managing a biobank may prove notably important for shaping the organizational and communication policy of the biobank and other scientific institutions. Material and methods: The research was carried out on a group of 1,100 people over 18 years of age representing the adult population of Poland in 2021. Results: More than half of the respondents declared their willingness to donate a blood sample for research purposes to a biobank (57.8%). The most often indicated incentives among the factors supporting the donation of biological material were offers of: obtaining the results of genetic tests predicting the risk of diseases (77.1%), blood tests (71.3%), the possibility of obtaining a small remuneration (64.6%) and the carrying out of genetic ancestry tests (60.4%). Conclusion: Offering the possibility of performing additional diagnostic tests, especially genetic tests, may significantly increase the willingness of potential donors to cooperate with biobanks and other entities collecting human biological material for the purpose of scientific research. However, attention should also be paid to the challenges and risks linked with respecting the privacy and autonomy of research participants.

Brain and aviation: on the 80th anniversary of Constantin von Economo's (1876-1931) death.

2011 marks the 80th anniversary of the death of Constantin Alexander von Economo who conducted advanced research on the cytoarchitectonics of the brain. This Austrian neurologist and the pioneer of aviation described encephalitis lethargica, discovered the spindle neurons, and postulated the existence of the sleep and wakefulness centre in the brain. What is more he realized two of the biggest dreams of humankind: conquering space and getting to know the secrets of the human brain.

Effects of cigarette smoking, metabolic syndrome and dehydroepiandrosterone deficiency on intima-media thickness and endothelial function in hypertensive postmenopausal women.

BACKGROUND: Cigarette smoking is a major risk factor of atherosclerosis. The aim of this study was to assess the relationship between smoking and arterial hypertension as well as endothelial dysfunction in postmenopausal women without clinically manifested symptoms of atherosclerosis. MATERIAL/METHODS: The study groups consisted of 35 current smokers and 45 nonsmokers. The thickness of intima-media complex (IMT), a marker of atherosclerosis, was measured in carotid arteries. Plasma concentrations of fasting glucose, insulin, lipoproteins, inflammatory markers (tumor necrosis factor-alpha, intercellular adhesion molecule-1), matrix metalloproteinases (metalloproteinase-9, tissue inhibitor of metalloproteinase-1), insulin, and dehydroepiandrosterone sulfate (DHEA-S) were measured. RESULTS: Smokers compared with nonsmokers showed lower fasting glucose levels in blood (87.0±10.9 and 93.2±13.6 mg/dl, p<0.05), higher mean systolic (131.1±15.9 vs. 123.0±10.9 mm Hg, p<0.05) and diastolic (81.7±11.4 vs. 75.2±9.2 mm Hg, p<0.05) blood pressure during daytime, and higher average heart rate during the daytime (78.2±9.3/min vs. 71.5±9.5/min, p<0.01) and at night (67.2±10.6/min vs. 61.7±7.7/min, p<0.05), respectively. The IMT in the right carotid artery was significantly higher in smokers than in nonsmokers (0.96±0.16 mm vs. 0.82±0.21, p<0.05) and was positively correlated with smoking intensity (R=0.36) and habit duration (R=0.35). The comparison of inflammatory markers, metalloproteinases, and DHEA-S concentrations in plasma did not reveal significant differences between the 2 groups. A significant negative correlation between DHEA-S concentration in plasma and IMT in right carotid artery was found in smokers. CONCLUSIONS: Smoking in hypertensive postmenopausal women is associated with lower fasting blood glucose and BMI values, but higher arterial pressure and heart rate, and increases in IMT in right carotid artery.

Lipemia retinalis - an unusual cause of visual acuity deterioration.

BACKGROUND: Hyperlipidemia is an identified factor of premature vessel atherosclerosis. Lipemia retinalis is an unusual retinal manifestation of hyperlipidemia and is thought to be directly correlated with the serum triglyceride level. CASE REPORT: This paper discusses the case of a 55-year-old patient with lipemia retinalis, which deteriorated his visual acuity. The patient had an extremely high serum cholesterol level (1053 mg/dl) and a very high level of triglycerides (1513 mg/dl). The normalization of serum lipids, reversion of retinal vessels alterations and visual acuity improvement was achieved after an intensive statin lipid-lowering therapy. Pathological changes of the patient's retina, connected with lipemia retinalis, disappeared completely. CONCLUSIONS: Hyperlipidemia can cause lipemia retinalis, which is characterized by the hyperlipidemic vascular lesions-whitish color of vessels, lipid infiltration into the retina and decrease of visual acuity. The lipid-lowering therapy may lead to the normalization of the appearance of the fundus and restore the visual acuity.

[Polish physicians'opinions concerning morally controversial medical practices]. / Opinie lekarzy polskich o kontrowersyjnych moralnie procedurach medycznych.

OBJECTIVES: Some lawful procedures are morally controversial and this situation can sometimes provoke conflicts between patients and physicians (conscience clause problem). The aim of our survey was to collect opinions about medical procedures that are accepted by Polish law and unaccepted by the Catholic Church--dominating denomination in Poland, and analyzing conditions determining these opinions. MATERIAL AND METHODS: Cross sectional study. An anonymous survey was distributed among 528 physicians who work in public hospitals in eastern Poland (turn = 61%). The sample consist of: 51% women, 49% men; 52% work AT surgical wards, 48% at non-surgical wards; average work period: 17.03 years (SD = 10.73; min. = 1, max. = 45); 93% Catholics; average religiosity (measured by the Scale of Religious Attitudes): M = 5.47 (SD = 1.01; min. = 1.60, max. = 6.80). The questionnaire contained questions about: hormonal contraceptives, artificial fertilization, abortion in the case of rape and fetus defect. RESULTS: The majority of respondents accepts artificial fertilization (70%), about half accepts abortion in case of fetus defect (50%), almost half accepts abortion in case of rape (41%) and contraception for minors (43%). There was statistically significant differences between physicians with different religiosit--the lack of approval for above procedures correlates with increasing religiosity. CONCLUSIONS: Individual religiosity (regardless of denomination) is the most important condition influencing Polish physician's opinions and attitudes concerning contraception, abortion and artificial fertilization. Physicians with higher religiosity (about 25%) in the situation of divergence between their moral beliefs and patient's demands will choose for their beliefs, which can cause conflicts. Physician-patient relationship's models should take into account physicians'cultural beliefs and not only the cultural beliefs of the patients.

Quality of Informed Consent in Mammography Screening-The Polish Experience.

Breast cancer is one of the leading forms of cancers in women worldwide. In Poland, it accounts for approx. 20% of all cancers diagnosed, with approximately 11,000 new cases and 5000 deaths from this disease annually. To prevent unfavourable statistics, Poland introduced free breast cancer screening programmes, available to women aged 50-69. Over a million women take advantage of this programme each year. The aim of the research was to assess the quality of consent women give prior to mammography screening and address the question of whether this quality is sufficient to make an informed choice. The study was conducted on a representative group of 600 Polish women over 50 years old (475 of them had undergone mammography screening), who agreed to take part in the study. Using the computer-assisted interview technology (CATI) method, all women were asked about their perception of breast cancer and screening and those who had undergone mammography were quizzed about the consent process. They will form the focus of this research. The validated tool contained items on both the benefits and risks of screening. The results indicate that the quality of informed consent was insufficient. A discrepancy was observed in the awareness between the benefits and risks of mammography screening. The main motivations to undergo screening were: prophylactic purposes and the free-of-charge nature of this health service. Population-based screening programmes for breast cancer should be reconsidered in terms of information policy, and the quality of informed consent should be increased.

Artificial Intelligence in Nutrients Science Research: A Review.

Artificial intelligence (AI) as a branch of computer science, the purpose of which is to imitate thought processes, learning abilities and knowledge management, finds more and more applications in experimental and clinical medicine. In recent decades, there has been an expansion of AI applications in biomedical sciences. The possibilities of artificial intelligence in the field of medical diagnostics, risk prediction and support of therapeutic techniques are growing rapidly. The aim of the article is to analyze the current use of AI in nutrients science research. The literature review was conducted in PubMed. A total of 399 records published between 1987 and 2020 were obtained, of which, after analyzing the titles and abstracts, 261 were rejected. In the next stages, the remaining records were analyzed using the full-text versions and, finally, 55 papers were selected. These papers were divided into three areas: AI in biomedical nutrients research (20 studies), AI in clinical nutrients research (22 studies) and AI in nutritional epidemiology (13 studies). It was found that the artificial neural network (ANN) methodology was dominant in the group of research on food composition study and production of nutrients. However, machine learning (ML) algorithms were widely used in studies on the influence of nutrients on the functioning of the human body in health and disease and in studies on the gut microbiota. Deep learning (DL) algorithms prevailed in a group of research works on clinical nutrients intake. The development of dietary systems using AI technology may lead to the creation of a global network that will be able to both actively support and monitor the personalized supply of nutrients.

Serum Concentration of Fluoride in Patients with Alcoholic Liver Cirrhosis from the Lublin Region in Eastern Poland.

In view of previous reports, it is important to determine the relationship between liver function and the level of fluoride in the serum. The aim of this study was to investigate serum concentrations of fluoride in 72 patients with alcoholic liver cirrhosis, living in the region of Lublin (Eastern Poland) divided based on the severity of disease according to the Child-Turcotte-Pugh criteria. Higher plasma fluoride concentrations were associated with changes in liver related parameters. In all groups of analyzed patients with different stages of alcoholic liver cirrhosis, elevated levels of plasma fluoride and increased activities of both alanine aminotransferase (ALT) and total bilirubin concentration were shown.

Leukocyte cell-derived chemotaxin-2 and fibroblast growth factor 21 in alcohol-induced liver cirrhosis.

BACKGROUND: The importance of early diagnosis of alcoholic liver disease underscores the need to seek better and especially non-invasive diagnostic procedures. Leukocyte cell-derived chemotaxin-2 (LECT2) has been widely studied to determine its usefulness in monitoring the course of non-alcoholic fatty liver disease but not for alcoholic liver cirrhosis (ALC). AIM: To determine the concentration of LECT2 in the blood serum of patients in relation to progressive stages of ALC, its relation to fibroblast growth factor 1 (FGF-1) and FGF-21, and to examine the possible wider use of LECT2 in diagnosing ALC. METHODS: A retrospective case-control study was conducted with 69 ALC cases and 17 controls with no ALC. Subjects were recruited from the region of Lublin (eastern Poland). Liver cirrhosis was diagnosed based on clinical features, history of heavy alcohol consumption, laboratory tests, and abdominal ultrasonography. The degree of ALC was evaluated according to Pugh-Child criteria (the Pugh-Child score). Blood was drawn and, after centrifugation, serum was collected for analysis. LECT2, FGF-1, and FGF-21 were determined using enzyme-linked immunosorbent assay kits. RESULTS: The LECT2 Levels in the control group were 18.99 ± 5.36 ng/mL. In the study groups, they declined with the progression of cirrhosis to 11.06 ± 6.47 ng/mL in one group and to 8.06 ± 5.74 ng/mL in the other (P < 0.0001). Multiple comparison tests confirmed the statistically significant differences in LECT2 Levels between the control group and both test groups (P = 0.006 and P < 0.0001). FGF-21 Levels were 44.27 ± 64.19 pg/mL in the first test group, 45.4 ± 51.69 pg/mL in the second (P = 0.008), and 13.52 ± 7.51 pg/mL in the control group. The difference between the control group and the second test group was statistically significant (P = 0.007). CONCLUSION: We suggest that LECT2 may be a non-invasive diagnostic factor for alcohol-induced liver cirrhosis. The usefulness of LECT2 for non-invasive monitoring of alcohol-induced liver cirrhosis was indirectly confirmed by the multiple regression model developed on the basis of our statistical analysis.

Oxidative stress-induced growth inhibitor 1 in alcohol-induced liver cirrhosis.

INTRODUCTION AND OBJECTIVE: Human oxidative stress-induced growth inhibitor 1 (OSGIN1) is a protein identified in 2001 which belongs to the OKL38 protein family. The aim of the study was to investigate the levels of this protein depending on the severity of alcohol-induced liver cirrhosis. MATERIAL AND METHODS: The study group consisted of 60 patients: 30 patients with cirrhosis in the P-Ch A and B stage and 30 in the P-Ch C stage. The control group consisted of 18 healthy individuals without liver diseases, who did not abuse alcohol. Oxidative stress induced growth inhibitor 1 (OSGIN1), fibroblast growth factor 1 (FGF1) and fibroblast growth factor 21 (FGF21) were determined in blood serum using enzyme-linked immunosorbent assay (ELISA) kits. All absorbance readings were conducted using an Epoch Microplate Spectrophotometer (BioTek Instrumentals, Inc., Winooski, VT, USA). OSGIN1, FGF1 and FGF21 concentrations were determined using Sandwich enzyme immunoassay kits (by Cloud Clone Corp., Katy, TX, USA). Statistica 13.3 (TIBCO Software, Inc.) was used for data analysis. RESULTS: The concentration of OSGIN1 was 0.028 ± 0.017 in the control group which increased with the advancement of liver cirrhosis (stage of Pugh-Child): 0.075 ± 0.098 in the P-Ch A + B group and 0.121 ± 0.134 in the P-Ch C stage. Multiple comparison tests confirmed statistically significant differences in OSGIN1 concentration between the control group and P-Ch C (p <0.02). Significant correlations were noted between OSGIN1 and FGF1 (r = 0.39; p = 0.004) and between OSGIN1 and FGF21 (r = 0.53; p <0.0001). CONCLUSIONS: The study revealed that the level of OSGIN1 increased significantly in the P-Ch C stage of liver cirrhosis. It is possible that OSGIN1 may be used for the non-invasive diagnosis of ALD, but its possible diagnostic value is still very uncertain.

The analysis of the ethical, organizational and legal aspects of Polish biobanks activity.

BACKGROUND: Biobanks create new opportunities for the public health (Public Health Genomics) but need some regulations. Polish biobanks are in the phase of dynamic transformations aiming at integrating their activity and adjusting them to the international standards. The aim of this article is to present the current standards held in the most important Polish institutions collecting biological samples. METHODS: A survey was conducted by the questionnaire filled by managers and directors of 24 Polish biobanks. Questions concerned obtaining patient informed consent (also a consent to some future researches and access to dates by other organizations), protection of privacy, storage of the samples and the relevant information, the opinion related to the need of establishing Polish national DNA data bank and possibilities of the scientific international cooperation. RESULTS: The written consent to carry out research on the samples is obtained almost everywhere, but 29% of biabanks does not acquire the consent for the future usage of the samples. Almost all inquired banks (93%, n = 22) declare the willingness to start an international cooperation. Most of respondents support the idea of establishing the Polish national DNA bank by the fusion of the already existing banks. CONCLUSION: The inquiry findings point that the current biobanks procedures do not differ to any relevant degree from procedures applied in the West European countries. Many of Polish biobanking organizations are willing to cooperate with foreign sites. It may enhance the European biobanking network and gene-environmental research.

Factors influencing serum chemerin and kallistatin concentrations in patients with alcohol-induced liver cirrhosis.

INTRODUCTION: In Poland, an increasing number of patients are hospitalized due to liver diseases. One of the common liver diseases is cirrhosis, which can be caused by alcohol, viral hepatitis, autoimmune processes and metabolic diseases. MATERIAL AND METHODS: The study included 99 patients with alcoholic cirrhosis from the Lublin region of Eastern Poland. The control group consisted of 20 healthy individuals without liver disease who did not abuse alcohol. The concentrations of serum kallistatin and chemerin were determined using ELISA kits. OBJECTIVE: The aim of the study is to evaluate serum levels of kallistatin and chemerin in patients with different stages of alcoholic liver cirrhosis. RESULTS: The highest chemerin level was found in the control group - 182.6±80.4 ng/ml. In other stages of liver cirrhosis, the following levels were observed: 175.7±62.7 ng/ml in Child-Pugh stage A (Ch-P A), 150.2±59.7 ng/ml in Ch-P B and 110.3±73.6 ng/ml in Ch-P C. Significant differences in chemerin levels between controls and Ch-P C patients (p=0.01), as well as between the Ch-P A patients and Ch-P C patients (p=0.02), were demonstrated. The highest kallistatin level was demonstrated in the control group - 8.2±3.5 µg/ml. In other stages of liver cirrhosis, the following concentrations were found: 7.2±27 µg/ml in Ch-P A, 4.4±2.2 µg/ml in Ch-P B and 3.5±1.9 µg/ml in Ch-P C. Statistically significant differences were observed between controls and Ch-P B patients (p<0.001), controls and Ch-P C patients (p<0.001), Ch-P A and Ch-P B patients (p=0.01), as well as Ch-P A and Ch-P C patients (<0.001). CONCLUSIONS: The levels of chemerin and kallistatin decrease with progression of liver damage during alcoholic liver cirrhosis. The impairment of its synthetic function leads to reductions in levels of the adipokines studied.

Damien de Veuster (1840-1889): A life devoted to lepers.

Father Damien de Veuster, or Saint Damien of Molokai (1840-1889), was one of the pioneers of the holistic approach to care provision for leprosy patients and contributed to the overcoming of the patients' social stigmatization. He devoted his life to the lepers living in America's only leper colony, on the Hawaiian island of Molokai, where people with leprosy were required to live under government-sanctioned medical quarantine. Father Damien gained practical skills in caring for the sick, eagerly learning wound cleansing, bandaging techniques, and drug administration from a nurse. Mahatma Gandhi said that Father Damien's work had inspired his own social campaigns in India.

Afamin and adropin in patients with alcohol-induced liver cirrhosis.

The aim of the study was to determine serum concentrations of afamin and adropin in patients with alcoholic liver cirrhosis and to define their correlation with the stage of disease. The study included 99 patients with alcoholic cirrhosis from the region of Lublin, (Eastern Poland). Liver cirrhosis was diagnosed based on clinical features, history of heavy alcohol consumption, laboratory tests and abdominal ultrasonography. The control group consisted of 20 healthy individuals without liver disease who did not abuse alcohol. The serum afamin and adropin concentrations were determined using ELISA kits. The concentration of afamin was found to be significantly lower in patients with compensated alcoholic liver cirrhosis, i.e. P-Ch B (85.1±40.6 µg/ml) and P-Ch C (56.4±32.3 µg/ml) individuals, compared to the control group (135.9±43.6 µg/ml); p-value was <0.01 and <0.001, respectively. As far as adropin is concerned, a reverse relationship was demonstrated: the highest concentration was found in patients with P-Ch C (11.7±5.7 ng/ml) cirrhosis. Furthermore, the above concentration was significantly higher compared to patients with P-Ch A cirrhosis (7.2±2.8 ng/ml; p<0.05) and controls (7.5±2.6 ng/ml; p<0.05). The concentration of afamin decreases with the severity of alcoholic liver cirrhosis, which most likely results from impaired hepatic synthesis. Otherwise, the higher the stage of disease according to the Child-Pugh score, the higher the concentration of adropin.

Analysis of the concept of informed consent concerning the use of genetic material according to the European Convention on Bioethics and in other solutionsm - Propositions for broad consent for future genetic research from the point of view of the activity of the Biobank.

OBJECTIVE: The aim of the article is a critical presentation of the typology of consents included in the European Convention on Bioethics and in other formal solutions concerning the gathering of genetic material in institutions called Biobanks. MATERIAL AND METHODS: Existing types of Acts of Consent are inaccurate in their scope and possess insufficient information regarding the gathering of genetic material (application, usage, processing) and their final (future and diverse) use. RESULTS: Lack of precise legal regulations on the broad future use of genetic material may result in various formal problems relating both to research participants as well as those commissioning the research. Ultimately, it may lead to various complications with the appropriate legal interpretation of consent and possible claims on behalf of the donors. CONCLUSIONS: The presented proposition of consent with a terminal premise is to be applied eventually to legal and formal aspects of the collecting of genetic material. It is a possible solution which would clarify the issue of informed consent, and may be implemented in the regulations of the Convention as well as constitute a self-contained legislative solution to this matter. For example, Polish law in its current form, without the ratification of the Bioethical Convention, allows the collecting of material for genetic testing for determination of the risk of genetic defects in common genetic material from people who are planning to have a child.