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Vitamin D is known for almost 100years. Since time of its discovery, numerousstudies on vitamin D functionin the human body were performed.Considered from the beginning asan important factor in rickets prevention,thanks to the continuous developmentof knowledge, vitamin D isregarded now as an important factorfrom the point of view of the wholebody homeostasis. Newly-find featuresof vitamin D allow to use thissubstance concentration in serumas a biomarker of general health andcreate opportunities of vitamin D usein the prevention and treatment ofmany diseases. The aim of this articleis to present basic function ofvitamin D in human body, sources ofthis substance, its metabolism andmolecular mechanism of action, takinginto account the evolution of thestate of knowledge about Vitamin D- from early researches leading to itsdiscovery, through the finding of itsbasic functions to the present studieson vitamin D mechanisms of action atmolecular and genomic level.

Introduction: The aim of our studywas to assess the values of total cholesterol,high-density lipoprotein cholesterol(HDL-C), low-density lipoproteincholesterol (LDL-C) and triglyceridesbefore and after treatment with metforminin lean patients with polycysticovary syndrome (PCOS).

Material and methods: 32 patients received metformin 1500 mg per day inthree divided doses. Lipids measurementswere performed twice: beforeand after 6 months of treatment with metformin.

Results: In lean patients withPCOS after treatment with metforminwe observed: statistically significantlower LDL-C levels (4.16±0.79 mmol/lvs 3.4±0.86 mmol/l, p<0.05) and triglycerideslevels (1.8±0.53 mmol/l vs1.12±0.64 mmol/l, p<0.05). We observedan increase in HDL values and a decreasein total cholesterol values, butthese changes were not statistically significant(1.5±0.71 mmol/l vs 1.71±0.69mmol/l, p=0.09; 5.87±0.92 mmol/l vs5.69±0.97 mmol/l, p=0.11).

Conclusion: Our study showed thattreatment of 1500 mg metformin forabout six months among PCOS womenresults in an improvement in serumlipid profiles. We observed a significantdecrease in LDL-C and triglycerides valuesafter metformin therapy.

Connective tissue diseases area group of more than 300 separatediseases. It can affect every system oforgans, including the cardiovascularsystem. This process is particularlyhighly expressed in rheumatoid arthritis,systemic lupus erythematosusand scleroderma.Rheumatoid arthritis (RA) affects0.5-1.0% of Europeans. The mostcommon cardiac manifestation of RAis pericarditis. Its main risk factor isthe occurrence of rheumatic nodulesin people with the presence ofserum rheumatoid factor. An importanthealth problem in RA is also anincreased risk of atherosclerosis andischemic myocardial disease, the intensityof which grows independentlyof traditional risk factors and mainlydepends on the severity of inflammationand duration of the disease. Inrheumatoid arthritis also endocarditis,heart valves damage and ventriculararrhythmias can occure.Systemic lupus erythematosus(SLE) is most common in womenbetween age 16 to 55. Cardiovascularcomplications of this disease arethe third biggest cause of death ofpatients. The most common cardiacmanifestation of SLE is pericarditisoccurring in approximately 20 to 50%of the ill. Libman-Sacks non-infectiousendocarditis characterized bythickening of the heart valves and thepresence of non-bacterial vegetationis characteristic for SLE.Systemic sclerosis is characterizedby progressive fibrosis of skinand internal organs and disorders ofthe morphology and function of bloodvessels. Cardiac manifestations ofsystemic sclerosis are mainly heartfailure and arrhythmias.The European League AgainstRheumatism (EULAR) has developeda number of recommendations relatedto the prevention and therapy ofcardiovascular events in RA. Since anincreased risk of cardiovascular complicationsapplies to many rheumaticdiseases, there is a need to extend these recommendationsto other connective tissue diseases.

Despite the significant progressthat has been made in recent years inparathyroid imaging, improvementsin surgical techniques and availabilityof surgical quality control based onintraoperative parathyroid hormonelevels (PTH) assay, approximately1-5% of patients undergoing surgeryhave state of persistent hyperparathyroidism.The most common causes ofpersistent hyperparathyroidism are:limited surgical experience, a failure torecognize multiglandular parathyroiddisease, ectopic parathyroid adenomalocation, insufficient range of resectionof diseased parathyroid glands,parathyroid capsule tearing leadingto parathyromathosis, as well as parathyroidcancer. In this clinical observationthe case of a 52-years old man isdescribed who underwent surgicalremoval of 2 parathyroid adenomas,and within few days he was found tohave persistent hypercalcemia. Aftercompleting the diagnostic imaging andbiochemical work-up that patient underwentbilateral neck re-explorationwith removal of ectopic giant supernumeraryparathyroid adenoma (60mm in diameter and 22.8 g in weight)which was localized in the upper partof the posterior mediastinum, resultingin stable normocalcemia afterwards.

Background: Pulmonary embolismis a clinical manifestation of venousthromboembolism (VTE), alsocomprising deep vein thrombosis. Itis considered to be a consequenceof environmental and genetic factors.The number of predisposing risk factorsis high. Some authors view VTEas a part of the cardiovascular diseasecontinuum and suggest that cardiovasculardisease risk factors suchas the metabolic syndrome or diabetesmellitus may predispose to VTE.

Aim: The analysis of patients hospitalizedin the department of cardiologydue to pulmonary embolismand a multifactorial comparison of 2groups of patients i.e. with and withoutdiabetes mellitus.

Patients and methods: A retrospectiveanalysis of 11435 patientmedical records from a 7-year periodwas performed. Patients with confirmedpulmonary embolism wereenrolled for further evaluation. Sixtyseven patients (36 women and 31men), aged 70.3±13.3 (age range: 30-93) were divided into two groups i.e.patients with and without diabetes.The statistical analysis of the obtainedresults was performed usingSPSS 21 Software.

Results: Statistically significantlyhigher total, LDL, and HDL cholesterolconcentrations were observed inpatients without diagnosed diabetes.Similar significant differences werenot observed for other cardiovascularrisk factors except for hypertensionand obesity which was more frequentin diabetic patients.

Conclusions: In patients with pulmonaryembolism the prevalence of diabeteswas related to lower total, LDLand HDL cholesterol concentrations.The differences between the groupsmay be explained by more intensivemedical surveillance in patients withpreviously diagnosed diabetes.

Recently a great progress in thediagnosis and treatment of multiplemyeloma has been made. Substantialrevisions in diagnostic criteria were introduced.As a result a neoplasm calledvery high risk asymptomatic myelomais currently regarded a disease thatneeds to be treated. The comprehensionof progression mechanism andclonal evolution not only helped tounderstand the disease course butmight contribute to expand treatmentoptions and individualize the therapy.Modern triple therapy containing IMiDsand proteasome inhibitors resultedin the higher response rate than everbefore which led to triple therapy incorporationas a frontline treatment.U.S. Food and Drug Administration(FDA) registered for new drugs in2015 (two monoclonal antibodies andtwo oral drugs) in relapsed/refractorymyeloma. Together with currently existingdrugs it considerably expendedthe therapeutically spectrum. Evendrugs that are not effective when usedas a monotherapy like panobinostatand elotuzumab play important rolein complex therapy, particularly inrefractory patients. The most recenttrials dedicated to the role of the noveldrugs in the induction phase suggestthat high–dose therapy followed byautologous stem cell transplantationimprove progression free survivaland quality of life. Myeloma treatmentschedules incorporate more and moreinnovative immunotherapy methods:adoptive T-cell therapies, vaccinesand monoclonal antibodies. Althoughmultiple myeloma is still regardedincurable neoplasm, due to betterdisease understanding and access tonovel drugs, we are getting closer thanever before to evolve therapy that willprovide long-lasting effects or at leastconverting it into the chronic slowlydeveloping disease.

Factors such as genetics, the environment,infections, and the humanbody microbiota, mainly gastrointestinaltract microbiota may play a rolein the pathogenesis of autoimmunedisorders. There is an increasing evidencethat suggest an association betweengastrointestinal tract dysbiosis,and in particular gut dysbiosis, andconnective tissue diseases but it stillremains unclear whether alterationsin the microbiome are a pathogeniccause or an effect of autoimmunedisease. Given the strong variabilityand abundance of microbes living inclose relation with human host, it becomesa difficult task to define whatshould be considered the normal orthe favorable microbiome. Furtherstudies are needed to establish howthe human microbiome contributes todisease susceptibility, and to characterizethe role of microbial diversity inthe pathogenesis of connective tissuediseases and their clinical manifestations.The identification of dysbiosisspecific for certain connective tissuediseases may help in the developmentof an individualized managementfor each patient. This review aims tosummarize current data on the role ofthe gastrointestinal tract microbiomein connective tissue diseases.

Objectives: To report the resultsof hybrid approach combining percutaneouscoronary intervention (PCI)and minimally invasive aortic valvereplacement through right anteriorminithoracotomy (RT-AVR) for patientswith aortic valve disease andcoronary artery disease.

Materials and methods: Retrospectiveanalysis of 53 hybrid RT-AVR/PCI procedures where RT-AVR wasperformed first in the operating roomand followed immediately by PCI performedin the catheterization laboratory.

Results: Predicted with Euro-SCORE II and observed hospital mortalitywas 8.7±2.9% and 1.9% respectively.Hospital and intensive careunit length of stay were 5.6±2.4 and1.8±1.4 days respectively. Biologicalaortic valve prosthesis was implantedin 40 (75.5%) patients. PCI of LAD wasperformed in 5 patients (9.4%), of Dgin 10 (18.9%) patients, of Mg or Cx in21 (39.6%) patients, of PDA or RCA in25 (47.2%) patients. Two vessels andthree vessels PCI were performed in5 (9.4%) and 3 (5.7%) patients respectively.DES were used during PCI in42 (79.2%) patients. Dual antiplatelettherapy with 75 mg of Aspirin and 75mg of Clopidogrel started after RTAVR/PCI. Complications occurredin 16 (30.2%) patients after hybridRT-AVR/PCI procedure. Prolongedabove 24 hours mechanical ventilationtime was necessary in 3 patients(5.7%). Renal insufficiency occurredin 4 (7.5%), stroke in 1 (1.9%) patient.Pacemaker was implanted in 2 (3.8%)patients after surgery. Conversion toconventional surgery through mediansternotomy was performed in 1 patient(1.9%), surgical revision due topostoperative bleeding in 2 patients(3.8%). No perioperative myocardialinfarction and no mediastinitis wasdiagnosed after RT-AVR/PCI procedure.Postoperative chest blooddrainage was 245.0±181.0 ml. Red blood cells transfusionwas required in 10 (18.9%) patients.

Conclusions: The hybrid RT-AVR/PCI procedure forthese high risk patients with aortic valve disease and coronaryartery disease presented in our series favourablemortality results compared to predicted with EuroSCOREII mortality for conventional cardiac surgery.

Problems with the childbirth accompaniedthe human civilizationsince its beginning. From the ancienttimes, physicians and other peoplespecializing in healing, tried to helpwomen in this special moment of life.At the base of this exceptional meaningof childbirth for humans lies thefact, that if something is going wrongthere are two victims - mother and thechild.As a result, many times there hadbeen very dramatic attempts of helpin this the most difficult journey whichin his life every man is undergoing. Inthis paper a comprehensive review ofliterature about the history of caesareansection from ancient times to theend of 17th century was done.

Chronic kidney disease (CKD) isconsidered as a disease of civilizationof the XXI century. The increaseof patients with CKD is associatedwith a higher incidence of hypertension,diabetes and aging. Hypertensionoccurs in 60-90% of patientswith CKD. It is worth to underline thatthe nephroprotective therapy can delayor even stop the progression ofCKD to end-stage renal disease. Thetherapy nephroprotective should beunderstood as both pharmacologicaland nonpharmacological treatment.The aim of this study was toevaluate the health awareness ofpatients with CKD, as well as thedegree of patient compliance especiallyin terms of pharmacologicaland non-pharmacological treatment.

Material and methods: A crosssectionalsurvey was offered for1300 patients with CKD who are areunder the care of the Department ofNephrology, Transplantology and InternalMedicine, University Hospitalin Gdansk. 972 patients (M/F) (74.8%)responded positively to participate inthe study

Results: It was shown that 91.2%of the patients measured blood pressureat home. 41.2% measured bloodpressure everyday and 54.2% of patientsused at least one non-pharmacologicaltreatment for hypertension.71.7% of patients declared that buyall drugs prescribed by the doctor.53.4% of patients used the possibilityof substitution drugs prescribedby a doctor for cheaper preparationsrecommended by the pharmacist.85.7% of patients taking medicinesaccording to doctor’s advice (frequency,dose).

Conclusions: The results of thestudy indicate that the education ofpatients, the therapeutic process andtheir health awareness are good, especiallyamong patients treated withperitoneal dialysis. It should be continuedas educational program because these activitiesmay contribute to improving the prognosis and quality oflife. A patients after kidney transplantation are particularlyvulnerable to the effects of failure to comply with recommendations.