University Clinical Hospital In Bialystok

The aryl hydrocarbon receptor (AHR) is a ligand-activated transcription factor linking environmental signals to immune regulation and neurodegeneration. While AHR agonists exert protective effects in Alzheimer’s disease (AD) models, their relevance in humans remains unclear. We investigated AHR agonistic activity in serum and cerebrospinal fluid (CSF) across AT1-defined AD subtypes and its association with amyloid beta (Aβ) metabolism. We measured AHR agonistic activity using a luciferase reporter assay in serum and cerebrospinal fluid (CSF) from 138 individuals (113 non-demented, 25 demented) classified by CSF Aβ1-42, Aβ1-42/Aβ1-40 ratio and pTau181 into four AT1 groups: A + T1 + (AD), A + T1- (isolated decrease of Aβ1-42/Aβ1-40 or Aβ1-42), A-T1 + (isolated tau pathology/PASSED), and A-T1- (biomarker-negative controls). Serum AHR agonistic activity was significantly reduced in biomarker-positive individuals compared to controls (Δ z-score = 2.25, 95% CI [1.33, 3.17], p < 0.001), with the most pronounced reductions observed in two distinct phenotypes: non-demented A-T1 + individuals (z-score = -2.33, 95% CI [-3.26, -1.40]) and A + T1 + patients with preserved CSF Aβ1-42 despite pathological Aβ1-42/Aβ1-40 ratios (p = 0.006 compared to A + T1 + with pathological Aβ1-42). Serum AHR activity correlated negatively with CSF Aβ1-40 (ρ = -0.31, p < 0.001) and Aβ1-42 (ρ = -0.20, p = 0.021) across all participants. The relationship between pTau181 and serum AHR activity showed significant effect modification by amyloidopathy (A) (interaction p < 0.0001): negative in A- individuals (β = -0.54, p < 0.0001) but positive at high pTau181 levels in A + cases (β = 0.12, p = 0.025). CSF AHR activity showed no significant differences between AT1 groups. Peripheral AHR agonistic activity is reduced in early and atypical AD phenotypes and correlates with amyloid peptides Aβ1-42 and Aβ1-40 in CSF. The amyloid status-dependent reversal of pTau181-AHR associations suggests distinct regulatory mechanisms across AT1 groups.

Background. Nitric oxide has emerged as a key physiological signalling molecule that has a significant impact on vessels, skeletal muscle function and exercise performance. With this in mind, increasing its production is of great interest to clinicians and athletes, making citrulline malate a potential medication and one of the most popular ergogenic supplements. Aim. This article aims to review current knowledge on citrulline malate supplementation, with emphasis on its pharmacokinetics, proposed medical application and ergogenic benefits. Material and Methods. Literature search in PubMed and Google Scholar for clinical trials, meta-analyses, and reviews on citrulline malate using keywords: citrulline malate, nitric oxide, muscle endurance, medical applications, supplementation”. Results. Citrulline malate exhibit its positive impact on many medical conditions. In pulmonary hypertension by improving exercise tolerance and modestly reducing arterial pressure. In metabolic conditions, leading to better glycaemic control, improved lipid profiles, and reduced inflammation in diabetes. Men with mild erectile dysfunction report subjective improvements when using citrulline malate alone or alongside other therapies. In atherosclerosis, it increases the elasticity of the arteries, which becomes weaker in advanced disease. Beyond medical applications, citrulline malate supplementation is primarily known for supporting short-term, high-intensity exercise by delaying fatigue, improving endurance, lowering perceived exertion during resistance training and reducing post-workout muscle soreness. Conclusion: Citrulline malate could be used as medical application and can enhance exercise performance by delaying fatigue and reducing muscle soreness. Larger, rigorously controlled trials are required to establish optimal dosing, target activities and long-term safety.

Introduction. Overactive bladder (OAB) de novo, while not considered a life-threatening condition, can be a significant issue for the patient. Moreover, urge urinary incontinence is more difficult to manage than stress urinary incontinence (SUI). Even in the absence of incontinence, this condition can significantly reduce the quality of life and satisfaction with the intervention. Objective. To summarise the existing data on OAB de novo after midurethral loop implantation (MULI) and to analyse the risk factors for the development of this condition and the existing options for correction, with an assessment of the prospects for further clinical trials. Materials &amp; methods. The search for publications was performed on national and international abstract databases eLibrary.Ru, Pubmed, Cochrane Library. The following keywords were used for the search: ‘de novo hyperactivity’, ‘de novo urgency’, ‘de novo OAB’, ‘midurethral sling complications’, ‘hyperactivity after sling implantation’. A chronological limit of 20 years (2004-2024) was used. A total of 317 sources (publications from peer-reviewed periodicals) were retrieved. 234 publications were excluded after reading the abstract because they did not fit the assigned topic. For further analysis, 24 papers were selected from the remaining works that met the criteria of scientific reliability. Results. According to the world literature, OAB de novo appears in 6.4% to 11.5% of patients who underwent MULI. However, there are studies where the above condition was observed in 41% of cases at 20-year follow-up. The underlying causes of involuntary bladder contractions may include various neurological diseases, inflammatory process, decreased activity of pelvic floor muscle tone inhibitors, increased neurotransmitter release, increased sensitivity to neurotransmitters, increased afferent innervation and infravesical obstruction. The mechanism for the development of OAB de novo remains an ongoing challenge. Conclusion. Any surgical intervention to correct SUI may lead to adverse effects, in particular OAB de novo. Information on the prevalence of this condition, as well as on approaches to its treatment, varies from study to study. There is a high percentage of underestimation of urgency symptoms at the preoperative stage. Therefore, a more detailed history should be taken and targeted investigations should be carried out at the initial consultation. OAB de novo following MULI significantly reduces patients' quality of life and satisfaction with the treatment.

Cannabinoids derived from Cannabis sativa L., particularly cannabidiol (CBD) and minor cannabinoids such as cannabigerol (CBG), cannabichromene (CBC), tetrahydrocannabivarin (THCV), and cannabidivarin (CBDV), have attracted increasing interest due to their potential therapeutic properties in dermatology. These compounds exert anti-inflammatory, antimicrobial, immunomodulatory, sebostatic, and antiproliferative effects, which may benefit a range of skin conditions. Preclinical and early clinical data suggest that cannabinoids may effectively alleviate inflammation, pain, pruritus, and microbial infections in various dermatologic disorders. Topical and transdermal routes show promise due to improved safety and targeted delivery. CBD has demonstrated efficacy in reducing sebum production in acne, modulating immune responses in psoriasis, and accelerating wound healing in EB. However, findings for alopecia areata remain inconsistent. Emerging delivery systems, including CBG-based emulgels and CBD transdermal patches, may improve local bioavailability and clinical outcomes. Cannabinoids, especially CBD, exhibit significant potential as adjuvant or alternative treatments for inflammatory, infectious, and autoimmune skin diseases. Despite promising preliminary results, large-scale, randomized, placebo-controlled trials are needed to establish optimal dosing, formulations, safety, and long-term efficacy in clinical dermatology.

BACKGROUND: Percutaneous nephrolithotripsy is the main surgical method for removing large renal calculi. One of the key stages of the procedure is percutaneous access to the renal collecting system. Retrograde contrast administration is not always required for a successful renal puncture. AIM: The work aimed to evaluate the efficacy, indications, and contraindications of directive puncture of the renal collecting system. METHODS: The study was conducted from January 2020 to August 2022. It included 90 patients who underwent percutaneous nephrolithotripsy in the supine position. Patients were divided into two groups. Group A underwent an ultrasound- or fluoroscopy-guided renal collecting system puncture; Group B had a puncture using retrograde ureteropyelography. Intra- and postoperative parameters were assessed, including total operation time, puncture duration, puncture success rate, visualization, puncture technique, and drainage type. RESULTS: The groups were statistically homogeneous except for body mass index, which was higher in Group B (p = 0.0441) but did not affect the study outcome. There were no significant differences in puncture duration (p = 0.378) or visualization quality (p = 0.8221). Six hours after surgery, pain intensity was higher in the directive puncture group (p = 0.0422), whereas other pain and complication parameters did not differ between groups. Hemoglobin levels were lower in the directive puncture group (p = 0.0109) but remained within the normal range. CONCLUSION: Directive puncture is a safe technique that is not inferior to the conventional method involving preliminary ureteral catheterization. However, it requires surgical experience and is unsuitable for patients with radiolucent calculi when performing fluoroscopy-guided punctures or in the absence of renal collecting system dilatation when performing ultrasound-guided punctures.

Given the high popularity of creatine as a dietary supplement, its pleiotropiceffects, and its well-established safety profile, it is worth considering as an adjuncttherapy for osteoporosis—a condition that predominantly affects postmenopausalwomen due to hormonal changes, particularly a decline in estrogen levels—and hasbecome a silent epidemic of the 21st century. Creatine may indirectly enhance musclemass and strength, leading to increased mechanical stress on bones, and some studiessuggest that creatine might also directly influence osteoblast activity and bonemetabolism, potentially promoting bone formation. These direct and indirectmechanisms may improve bone health in at-risk women, reducing the risk of falls andfractures and ultimately contributing to a better quality of life. This research exploresthe effects of creatine on bone remodeling, metabolic activity, resistance trainingperformance, and its potential anti-inflammatory properties in the context of skeletalhealth maintenance. It also examines appropriate creatine dosing in older adults—whichtypically does not require a loading phase—and evaluates the safety of creatine use inaging women.

Tirzepatide is a novel dual agonist of glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) receptors that offers promising therapeutic potential beyond glycemic control. Originally developed for the treatment of type 2 diabetes mellitus, tirzepatide has demonstrated a wide array of pleiotropic effects in clinical studies. These include significant reductions in body weight, improvements in lipid profiles, decreased blood pressure, and attenuation of hepatic steatosis. Emerging data also support its cardioprotective and nephroprotective roles, as well as efficacy in patients with heart failure with preserved ejection fraction (HFpEF). Furthermore, tirzepatide is currently under investigation for the treatment of obstructive sleep apnea and shows early promise in neuroprotection. This review summarizes the current evidence on the diverse biological actions of tirzepatide and discusses their potential clinical implications in the context of metabolic syndrome and associated comorbidities. Materials and methods: A review of the literature available in the PubMed database was performed, using the key words: “tirzepatide”, “obesity treatment”, “GIP”, “GLP-1”, “glucose-dependent insulinotropic polypeptide”, “glucagon-like peptide-1”. Conclusion: The clinical benefits of tirzepatide extend well beyond glucose lowering, encompassing a broad spectrum of metabolic, cardiovascular and renal effects. These pleiotropic actions position tirzepatide as a valuable pharmacological agent in the multifactorial management of type 2 diabetes, obesity and related conditions. Continued investigation into its mechanisms of action and therapeutic scope may further redefine its role in the treatment of complex metabolic disorders. Given the growing body of evidence, tirzepatide represents a paradigm shift toward integrated care for patients with metabolic syndrome and its systemic manifestations.

We report a rare case of recurrent evisceration following radical cystoprostatectomy with Bricker urinary diversion in a 71-year-old patient with type 2 diabetes mellitus, chronic obstructive pulmonary disease, hypertension, and peripheral arterial disease. Despite an initially uneventful recovery, the patient presented with full-thickness wound dehiscence and evisceration just eight days after discharge. His recovery was further complicated by comorbidities and poor adherence to postoperative activity restrictions. After several abdominal wall re-explorations and debridements, combined with negative pressure wound therapy (NPWT), definitive reconstruction was achieved using a pedicled musculocutaneous flap, followed by split-thickness skin grafting. At 10-month follow-up, the patient achieved full wound healing with satisfactory functional and cosmetic outcomes. This case highlights the importance of risk stratification, early use of advanced wound management techniques, and multidisciplinary care in complex surgical patients.

Intratesticular foreign bodies are rare. We present the case of a young man who, three months after experiencing scrotal trauma, was evaluated for a suspected intratesticular foreign body. The incident occurred during the use of a wire brush attached to a grinder, likely resulting in the penetration of a small metallic fragment into the scrotal wall and testicular tissue. Initial ultrasound imaging was inconclusive, and the patient was treated empirically with antibiotics. Although his symptoms resolved over time, ongoing concern led to multiple follow-up visits. A third ultrasound performed approximately 12 weeks post-injury revealed a linear, hyperechoic structure, raising suspicion for a retained foreign body and prompting surgical referral. Upon admission, the patient was asymptomatic, and physical examination revealed only a small, firm nodule in the left testis. Surgical exploration confirmed the presence of a thin metallic wire, which was removed without complications. This case illustrates the diagnostic difficulty of identifying retained intratesticular foreign bodies when early imaging is non-diagnostic and symptoms subside. It emphasizes the value of repeated high-resolution ultrasonography in cases with a suggestive clinical history.