Medical University of Lodz

Abstract Climate change adaptation has become an increasingly prominent topic in urban research and policy debates. However, most existing studies continue to focus on large metropolitan areas, leaving so-called secondary cities—urban centers with populations between 50 000 and 200 000—comparatively understudied despite their central role in Europe’s territorial, economic, and service-delivery systems. This article addresses this gap by introducing the socioinstitutional vulnerability index (SIVI), a composite tool designed to capture both the social and institutional dimensions of climate vulnerability. Drawing on a diverse set of demographic, socioeconomic, and governance indicators—including unemployment, energy poverty, institutional capacity, and civic participation—we assess 30 medium-sized cities in central and southern Europe. The analysis reveals five distinct vulnerability profiles. Central European cities tend to demonstrate stronger institutional capacity but deeper social inequalities, whereas cities in southern Europe frequently exhibit robust civic engagement despite more limited administrative and financial resources. These patterns highlight a persistent disconnect between physical exposure and adaptive capacity, challenging risk assessment models that rely solely on climatic hazards. The findings underscore that one-size-fits-all approaches to climate adaptation are insufficient. Instead, local strategies must be grounded in the socioinstitutional realities of each city. The proposed SIVI provides a practical, scalable framework for public institutions to identify vulnerabilities and design context-sensitive interventions, with potential application beyond Europe—including in Latin America, South Asia, and other contexts characterized by uneven governance capacity.

Intense physical exercise, especially when performed frequently or for prolonged durations, can disturb iron balance through a combination of increased demand, increased loss, and impaired absorption. The strongest evidence comes from endurance sport, military training, and periods of intensified loading, where iron deficiency without anemia and overt iron-deficiency anemia are both common clinical problems. Mechanisms include exercise-induced inflammation and hepcidin upregulation, intravascular hemolysis, gastrointestinal microischemia with occult blood loss, hematuria, sweat losses, menstrual blood loss, low energy availability, and the amplified iron demand of altitude-related erythropoiesis. Importantly, the hematologic response to training also includes plasma volume expansion, which can mimic anemia without true iron deficiency and complicate interpretation. In athletes, clinically meaningful iron deficiency may present before hemoglobin falls, with fatigue, impaired recovery, lower maximal oxygen uptake, diminished training quality, and reduced work efficiency. Diagnosis therefore requires more than hemoglobin alone and should integrate ferritin, transferrin saturation, inflammatory context, and where indicated soluble transferrin receptor or reticulocyte indices. Management begins with confirmation of true deficiency and identification of the mechanism, followed by dietary optimization, oral iron when indicated, and selective use of parenteral iron in carefully chosen cases. This review summarizes the physiology linking exercise to iron homeostasis, identifies athlete groups at highest risk, distinguishes pseudoanemia from true deficiency, and provides a practical framework for diagnosis, prevention, and treatment.

The rabies virus is responsible for one of the most severe diseases transmitted from animals to humans. Rabies is associated with an almost 100% case-fatality rate once clinical symptoms develop. The aim of this study is to present the principal routes of rabies virus transmission to humans and to discuss strategies for limiting viral spread through preventive measures, based on the available literature concerning the pathogenesis, epidemiology, and prophylactic methods applied in both animals and humans. The primary route of transmission to humans is a bite from an infected animal. However, other, less common routes of infection are also possible, including contact of secretions from an infected animal with mucous membranes or damaged skin. Extremely rare cases of transmission have also been reported through aerosol exposure or through organ transplantation from an infected donor. In Europe, wild animals constitute the main reservoir of the rabies virus, with particular emphasis on foxes, highlighting the critical role of oral vaccination programs targeting these species. Vaccination of domestic animals, as well as pre-exposure and post-exposure prophylaxis in humans, also remain essential components of rabies prevention. A multidisciplinary approach to rabies control, integrating the efforts of veterinary and medical services through infection control in animal populations, improved access to vaccines and rabies immunoglobulin, and increased public awareness regarding the disease, its transmission routes, and preventive measures, may ultimately contribute to the complete elimination of human rabies in the future.

Clinical trials are conducted under rigorous ethical and regulatory frameworks to protect participants, including ethics committee approval, informed consent, oversight, and personal data protection. However, public awareness of these safeguards in Poland remains insufficiently studied. We conducted a nationwide cross-sectional survey via computer-assisted web interviews with 1200 adults in Poland (January 2023). Awareness was defined as agreement with statements reflecting ethical and regulatory safeguards; "high awareness" indicated endorsement of at least 7 out of 9 items. A questionnaire covered nine core principles of clinical trials, including ethical review, informed consent, participant rights, and data protection. Descriptive statistics, chi-square tests, and logistic regression identified factors associated with high awareness (≥ 7/9 endorsed items). Awareness was generally high: 88.1% recognised the need for trials to introduce new drugs and 83.7% knew that informed consent was required. However, gaps in knowledge regarding regulatory oversight and data protection were identified. In the final multivariable logistic regression model, lower education was associated with reduced odds of high awareness (secondary vs. higher: aOR = 0.56; post-secondary vs. higher: aOR = 0.54), as was uncertainty about prior clinical trial participation ("do not know" vs. no: aOR = 0.55). Model discrimination was limited (AUC = 0.59). Awareness of core ethical safeguards, such as informed consent, was high, but gaps remained in regulatory oversight and data protection. Education was the strongest correlate, indicating a need for targeted communication.

Background: Diffuse alveolar haemorrhage (DAH) is a rare but potentially life-threatening pulmonary complication of systemic autoimmune diseases. Although interstitial lung disease (ILD) is a hallmark of antisynthetase syndrome (ASyS), DAH has been only exceptionally reported in this setting. Methods: We present two patients with ASyS who developed DAH confirmed by bronchoalveolar lavage. Results: The first case involved a 52-year-old woman initially diagnosed with rheumatoid arthritis, later reclassified as rheumatoid arthritis-ASyS overlap, who developed DAH in the context of progressive ILD. The second case concerned a 37-year-old man with newly diagnosed ASyS who presented with recurrent DAH early in the disease course. Both patients required high-dose corticosteroids, followed by escalation of immunosuppressive therapy with rituximab or mycophenolate mofetil, resulting in clinical and radiological improvement. These cases illustrate the diagnostic challenges posed by DAH in ASyS, particularly due to overlapping features with infection and ILD exacerbation. They also highlight the importance of early bronchoscopy and timely intensification of immunosuppression. Conclusions: Increased awareness of DAH as a rare manifestation of ASyS may facilitate earlier recognition and improve outcomes in patients presenting with acute respiratory deterioration, anaemia, or haemoptysis.

The emergence of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and dual GIP/GLP-1 agonists has revolutionized obesity pharmacotherapy, enabling weight loss magnitudes of 15–20%, previously attainable primarily through bariatric surgery. A significant clinical challenge, however, is the "muscle gap"—the substantial loss of lean body mass (LBM) observed in pivotal trials. This review provides a critical analysis of the impact of incretin-based therapies on tissue composition, skeletal muscle quality, and functional performance. Drawing on the latest clinical and molecular evidence, we demonstrate that the influence of GLP-1 RAs on skeletal muscle is multidimensional. While absolute muscle mass typically decreases, advanced imaging data suggest an improvement in metabolic muscle "quality" through the reduction of intramuscular fat infiltration and enhanced capillary perfusion. This paper emphasizes that structured exercise - particularly resistance training - and nutritional optimization are not merely supportive measures but essential foundations of therapy required to maintain functional strength and prevent iatrogenic sarcopenia. The review further explores the unique osteoprotective effects of GLP-1 RAs, which safeguard bone mineral density during rapid weight loss, and discusses emerging pharmacological frontiers, including co-pharmacotherapy with myostatin inhibitors and triple agonists like retatrutide. Longitudinal insights from the S-LiTE trial indicate that the sustainability of metabolic benefits post-treatment is heavily dependent on exercise-induced adaptations. We conclude that optimal obesity management requires a multidisciplinary approach where pharmacotherapy serves as an adjunct to structured lifestyle changes, prioritizing functional fitness and long-term musculoskeletal health.

Statins, or HMG-CoA reductase inhibitors, represent one of the most extensively researched and frequently prescribed pharmacological agents, primarily utilized to reduce cardiovascular risk through the modulation of serum cholesterol levels. Although their efficacy in reducing global mortality and cardiovascular events is well-established, genetic variability persists among different populations which may predispose patients to dose-related adverse effects and reduced efficancy of statin therapy. This heterogeneity has driven a shift in the scientific landscape toward exploring common genetic polymorphisms within the genes encoding genes involved in pharmacodynamic pathways. This review aims to provide a comprehensive analysis of clinically significant polymorphisms within the pharmacodynamic pathways of statins. Methods: A systematic literature review was conducted in accordance with PRISMA guidelines. Databases including PubMed, Embase, and the Cochrane Library were searched for peer-reviewed publications from 2021 to 2025. Following a rigorous selection process based on Evidence-Based Medicine (EBM) criteria. Conclusions: Despite rapid progress in the field of pharmacogenomics, the role of genetic polymorphisms among genes involved in pharmacodynamic pathways of statin therapy still requires more research in order to establish robust evidence of their role in the overall lipid-lowering efficacy of statins.

Background: Hamstring muscle injuries (HMI) remain the most prevalent non-contact injury in high-speed sports, particularly football and athletics. Despite sports medicine advancements, HMI is characterised by high recurrence rates (12–33%), causing significant time loss and performance decrements. Aim: This paper provides a comprehensive literature review regarding the functional anatomy, risk factors, diagnostic classification, and evidence-based treatment strategies for HMI. Material and methods: A narrative literature review was conducted using PubMed and MEDLINE. We focused on high-quality studies (systematic reviews, randomised controlled trials, clinical guidelines) published between 2010 and 2025, covering conservative and surgical management. Results: The biceps femoris long head's bi-articular architecture and dual innervation predispose it to eccentric strain during sprinting. Diagnosis has evolved with the British Athletics Muscle Injury Classification (BAMIC), which identifies intratendinous involvement as predicting prolonged recovery. Conservative management remains the gold standard for mid-substance injuries; L-protocol (lengthening) and eccentric strengthening show superior outcomes over concentric training. Surgery is indicated for complete proximal avulsions or high-grade partial tears with retraction (>2 cm); acute repair yields better outcomes than chronic reconstruction. Conclusions: Effective HMI management requires a multimodal approach. While conservative care resolves most injuries, precise MRI diagnosis is crucial to identify surgical candidates early. Return to play must be criteria-based, prioritising restored eccentric strength, fascicle length, and sprint mechanics over time-based protocols or imaging clearance.

Gene expression silencing is one of the key tools in molecular biology and is widely applied in in vitro studies to investigate gene function and the mechanisms regulating cellular processes. The dynamic development of molecular techniques has resulted in the availability of numerous strategies that enable either transient or permanent reduction of gene activity at different stages of gene expression. The aim of this work is to review and compare gene expression silencing methods used in in vitro models, with particular emphasis on their mechanisms of action, efficiency, durability of the effect, and experimental limitations. The article discusses classical approaches based on RNA interference, including the use of siRNA, shRNA, and microRNA modulation, as well as strategies employing antisense oligonucleotides. Special attention is given to technologies based on the CRISPR system, including CRISPRi as a tool for reversible transcriptional repression and CRISPR–Cas9, which enables permanent disruption of gene function. Issues related to the delivery of molecular tools into cells, validation of silencing efficiency, and the importance of appropriate experimental controls are also addressed. Analysis of the literature indicates that the choice of an appropriate method should be tailored to the research objective, the characteristics of the gene under investigation, and the planned duration of the experiment. Increasingly, a complementary approach—combining different gene silencing strategies is recommended, as it enhances the reliability of results obtained in in vitro studies.

Background: Lateral elbow tendinopathy (LET) is a prevalent musculoskeletal disorder characterized by pain and functional impairment at the common extensor origin. This narrative review explores the critical paradigm shift from the historical inflammatory "epicondylitis" model to a modern mechanobiological framework. Objective: To synthesize current evidence-based perspectives on the pathophysiology, diagnosis, and management of LET, emphasizing the optimization of quality of care through active loading protocols. Evidence Synthesis: Pathophysiological understanding has evolved from an inflammatory model to one of tendinosis, characterized by angiofibroblastic hyperplasia and a failed healing response. Clinical diagnosis relies on provocative maneuvers and objective measures, specifically Pain-Free Grip Strength (PFGS) and the Patient-Rated Tennis Elbow Evaluation (PRTEE), to ensure diagnostic quality and monitor therapeutic efficacy. A critical appraisal of passive interventions, such as corticosteroid injections and NSAIDs, highlights their limitations and potential for long-term clinical failure. In contrast, mechanotransduction-driven active protocols—including isometric loading for acute analgesia and Heavy Slow Resistance (HSR) training for structural remodeling—represent the modern gold standard. Furthermore, the integration of a biopsychosocial framework and the enhancement of patient health literacy are essential for addressing nociplastic pain and ensuring sustainable functional reintegration. Conclusions: Effective management of LET requires a structured, criterion-based transition to active management, prioritizing therapeutic loading over passive symptom masking to maximize long-term musculoskeletal health and minimize recurrence.