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The phenomenon of autoimmunity develops as a result of the triggering factor released by damaged cells. This leads to an infiltration of CD4+ cells involved in stimulating the effector cells cytotoxicity and stimulating the humoral response. One of the most common autoimmune disorders are autoimmune thyroid diseases, including Hashimoto's thyroiditis and Graves's diseases. Helper T lymphocytes, which are divided into Th1, Th2, Tregs, and the relatively new groups Th17, Th22, and Th9, are involved in the pathogenesis of AITD. CD4+ cell subtypes mature and differentiate by specific transcription factors and in a specific interleukin environment. Not only are Th1 and Th2 cells involved in the development of AITD, but also Th17, Th22, and Th9 lymphocytes and their correlation to Tregs lymphocytes. The plasticity of the CD4+ cells is very important, affecting the balance between these cells, as well the factors modulating their phenotypic variability. Patients with AITD have an increased percentage of Th17, Th22, and Th9 cells as well as defective function of Tregs lymphocytes. The balance between Th17 cells (and also other cytotoxic T cells) and Treg cells is also very important. Understanding the role of CD4 cells in the pathogenesis of AITD may be important not only for the development of the knowledge, but also for determining therapeutic targets.

Through pleiotropic effects related to the presence of its receptors in major human organs, vitamin D (VD) plays an important role in systemic homeostasis, especially in the proper functioning of muscles and bones. In light of the published data from both animal and human studies, VD deficiency should be considered a risk factor for obesity-related morbidity, prediabetes, and type 2 diabetes (T2D); in addition, VD supplementation in VD deficiency has a beneficial effect on the effects of treatments aimed at normalization of body weight (including incretin drugs) and the metabolism of carbohydrates in prediabetes and T2D. The objective of this paper is to present the current knowledge and evidence on the relationship between VD deficiency and obesity, prediabetes, and T2D. The paper is intended to be used as a practical guide. The authors propose that serum 25(OH)D concentrations be determined in adults who are obese or overweight (i.e., belonging to the group presenting with a multiple increase in the risk of VD deficiency) or adults who are obese or overweight and have prediabetes or T2D. The baseline VD levels should determine the therapeutic dose and be helpful in assessing the effectiveness of therapy. The available literature lacks precise information regarding the recommended doses of VD in obese people, with 4000 IU being a frequently suggested daily dose. Most papers recommend that body weight be taken into account when determining the dose of VD in the obese; the dose should be higher than in individuals with normal body mass index (BMI). The authors suggest that in the case of low VD levels (< 20.0 ng/mL), quite frequently as low as 12.0–15.0 ng/mL, in an adult obese patient, VD therapy should be started at 20,000 IU two times per week or 50,000 IU once a week with 25(OH)D and calcium levels being checked after one month so that a decision can be made on the further course of therapy. The suggested 25(OH)D concentration target range is > 30–50 ng/mL. In a patient-tailored supplementation model, the dose of VD should depend on body weight and, most importantly, on the baseline VD level. In the absence of the expected effects, the authors suggest that the dose of VD (usually vitamin D3) be increased or the treatment be switched to calcifediol or alfacalcidol, or calcitriol in special cases such as impaired kidney or liver function. It is important to emphasize the need to individualize the management and monitor blood calcium and creatinine levels during chronic VD therapy, including high-dose therapy.

Introduction:The incidence of neuroendocrine tumours (NETs) increased over the last years. Most of them are non-functioning, and the course of the disease is asymptomatic for a long time. This results in late diagnosis at an advanced stage. The aim of our study was the evaluation of selected circulating cytokines of interleukin-6 family – interleukin 6 (IL-6), oncostatin M (OSM), and cardiotrophin-1 (CT1) – in NETs.Material and methods:The study group comprised 80 patients (56%) in several subgroups, including gastroenteropancreatic (GEPNETs, n = 64, 80%) and bronchopulmonary neuroendocrine tumours (BPNETs, n = 16; 20%). Serum IL-6, OSM, and CT1 concentrations were tested using ELISA.Results:The median concentration of IL-6 was 41.5 pg/ml in the study group and 32.6 pg/ml in the control group, and the difference was statistically significant (p < 0.001). The concentration of OSM was significantly lower in the study group than in the control group (p < 0.001), at 105.6 pg/ml and 115.5 pg/ml, respectively. There was a significant difference (p < 0.01) in concentration of CT1 in the study group (222.0 pg/ml) and controls (267.2 pg/ml). Our investigation into selected IL-6 family cytokines revealed differential modulation of signal transduction pathways.Conclusions:These findings suggest that despite utilising a common signalling transducer, individual IL-6 family cytokines exert distinct biological effects on neuroendocrine tumour development. Notably, IL-6 appears to promote tumourigenesis, while OSM and CT1 exhibit inhibitory effects on gastro-entero-pancreatic and bronchial neuroendocrine tumour development. Further studies are necessary to validate the diagnostic utility of IL-6 family cytokines in NETs.

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Vertigo and balance disorders are common symptoms reported by approximately 15–20% of the adult population worldwide. For many years thyroid diseases have been suspected as the cause of vertigo by ENT physicians. Almost every patient hospitalised due to severe vertigo is investigated for thyroid disease as a suspected cause of acute vestibulopathy. The issue presented in this paper is related to a difficult and poorly understood relationship between autoimmune thyroid disease and peripheral vertigo.

INTRODUCTION: Ischaemic stroke (IS) is a disease that is a common cause of death and one of the most common causes of disability in adults. There is a continuous need to conduct stroke pathogenesis studies. A certain role here can be attributed to adipose-derived hormones. The aim of this paper is to assess the blood concentration for selected adipocytokines: omentin-1, irisin, protein-1 related with C1q/TNF (CTRP1), vaspin and nesfatin-1 in IS patients, and an attempt to define their role as risk factors for ischaemic stroke. MATERIAL AND METHODS: The study included 46 patients with ischaemic stroke (27 females, 19 males, average 67.6 years of age). The control group consisted of 32 patients (16 females, 16 males, average 64.1 years of age) who had never had cerebrovascular diseases. RESULTS: The concentration of omentin-1 and CTRP1 in the group of stroke patients was higher than in the control group, whereas the concentrations of nesfatin-1 and irisin was significantly lower than in the control group. The vaspin level was similar in both groups of patients. Statistical analysis using logistic regression allows us to find that CTRP1 can be a significant stroke risk factor. A statistically significant positive correlation was found between the concentration of CTRP1 and NIHSS. However, no correlation between the concentration of other adipocytokines under investigation and the severity of ischaemic stroke was found. CONCLUSIONS: From among the adipocytokines under investigation, higher concentrations of omentin-1 and CTRP1 and lower blood concentrations of nesfatin-1, irisin significantly increase the odds of getting to the group of ischaemic patients. It seems that CTRP1 can be an independent predictive factor of IS.

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INTRODUCTION: Despite considerable progress in knowledge, ischaemic stroke is still a disease that causes serious clinical problems. A role in its pathogenesis can be attributed to i.a. adipose tissue hormones. The aim of this paper is to assess the blood levels of selected adipocytokines in patients during the acute phase of ischaemic stroke as compared to healthy persons, and an attempt to indicate a correlation between their blood concentrations and the level of stroke severity and its outcomes. MATERIAL AND METHODS: The study included 46 patients with fresh ischaemic stroke (27 females, 19 males, average age 67.6 years). All patients had a CT scan of the head, their neurological condition was assessed using a stroke severity scale, and their blood levels of resistin, chemerin, and visfatin were tested. The control group consisted of 32 patients (16 females, 16 males, average age 64.1 years) who had never suffered cerebrovascular diseases. RESULTS: Elevated levels of both resistin and chemerin were found in the group of patients with ischaemic stroke (9.17 ± 2.95 ng/mL vs. 6.55 ± 2.01 ng/mL for resistin and 265.0 ± 59.3 ng/mL vs. 191.0 ± 43.6 ng/mL for chemerin). It was also found that the blood concentration of chemerin was higher in females than in males with stroke. However, no difference was found in visfatin blood concentration between the group with ischaemic stroke and the control group (1.65 ± 1.09 ng/mL vs. 1.5 ± 1.39 ng/mL). CONCLUSIONS: Higher resistin and chemerin blood concentrations significantly increase the risk of ischaemic stroke. The level of stroke severity at the moment of its occurrence and during its course do not depend on the concentrations of adipocytokines under analysis.

INTRODUCTION: The aim of this study was to assess the therapeutic effect and the safety of pre-surgical treatment with long-acting octreotide in patients with acromegaly. MATERIAL AND METHODS: This project was conducted in 25 centres across Poland as a non-interventional, multicentre, observational study in patients with acromegaly, in which long-acting octreotide Sandostatin® LAR®) was administered before surgery. They were 148 patients included into the study: 88 females and 60 males aged 18–86 years (51.3 ± 13.4). RESULTS: Eighty patients completed the study (underwent tumour surgery). The CRF included: baseline visit, four follow-up visits every three months before surgery, and two follow-up visits every three months after surgery. Sandostatin® LAR® was administered every four weeks. The efficacy measures were as follows: change of growth hormone (GH) and insulin-like growth factor 1 (IGF-1) levels, number of patients fulfilling criteria of cure, and change of adenoma (micro- and macroadenomas) size during the treatment. Normalisation of GH and IGF-1 concentrations were obtained in 42.4 and 49.1% of patients at the end of medical therapy, respectively. Normalisation of GH and IGF-1 concentrations were obtained in 77.9 and 83.8% of patients after surgery, respectively. Reduction of microadenoma size was documented in 58.8% of patients, and in 70% of patients with macroadenomas at the end of medical therapy. In 74.0% of patients no pituitary tumour was shown on MRI after surgery. CONCLUSION: We have shown good surgical outcome in patients with acromegaly after pre-treatment with somatostatin analogue, and good tolerance and safety of the therapy, supporting the national recommendation for pre-surgical treatment with long-acting somatostatin analogues in acromegaly patients.