Paulina Pudło

BACKGROUND: Contrast-associated acute kidney injury (CA-AKI) after endovascular thrombectomy (EVT) worsens outcomes in acute ischemic stroke, but threshold-based definitions do not capture prognostic information from subthreshold changes. We tested whether early creatinine change within 48 hours of EVT conveys graded prognostic information beyond dichotomous CA-AKI. METHODS: We performed a secondary analysis of the CAN-REST registry (Contrast-Associated Nephropathy After Endovascular Stroke Treatment), a retrospective multicenter observational cohort study of 6638 EVT-treated adults with acute ischemic stroke enrolled at 73 centers in 16 countries between January 1 and December 31, 2023. Early creatinine change was quantified as the natural logarithm ratio of 48-hour creatinine to baseline creatinine (ln[48-hour/baseline creatinine]), with CA-AKI defined per Kidney Disease: Improving Global Outcomes criteria (≥0.3 mg/dL or ≥1.5× baseline rise within 48 hours). Multivariable logistic regression adjusted for prespecified baseline and periprocedural covariates examined associations with 90-day modified Rankin Scale shift and in-hospital mortality; linear versus restricted cubic spline specification was selected by likelihood ratio testing, and contrasts were estimated at ±10%, ±25%, and ±50%. RESULTS: Greater creatinine worsening within 48 hours of EVT was independently associated with an unfavorable 90-day modified Rankin Scale shift (adjusted common odds ratio per 1-unit log-ratio increase, 1.48 [95% CI, 1.07–2.04]; linear) and in-hospital mortality (nonlinear dose-response, of larger magnitude). A 10% increase in creatinine at 48 hours—well below Kidney Disease: Improving Global Outcomes threshold—was associated with worse functional outcome (adjusted common odds ratio, 1.04 [95% CI, 1.01–1.07]) and death (adjusted odds ratio, 1.22 [95% CI, 1.13–1.32]); a 10% decrease in creatinine at 48 hours was associated with lower odds of both outcomes (adjusted common odds ratio, 0.96 [95% CI, 0.93–0.99]; adjusted odds ratio, 0.74 [95% CI, 0.65–0.86]). The functional-outcome association concentrated at upper modified Rankin Scale cut-points (severe disability, death); effect modification by baseline renal function was not significant. CONCLUSIONS: Early creatinine change after EVT conveys graded, outcome-specific prognostic information extending below formal CA-AKI thresholds, with a dose-response detectable at changes as modest as ±10%, complementing binary CA-AKI as a framework for post-EVT renal risk assessment. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT06596603.

Alzheimer’s disease (AD) is a progressive neurodegenerative disorder marked by memory impairment, cognitive deterioration, and neurobiological changes, notably the accumulation of amyloid-beta (Aβ) and tau pathology. Recent data suggests that consistent physical activity (PA) may delay the onset and progression of Alzheimer's disease (AD) through various neuroprotective mechanisms. This research synthesizes results from 31 contemporary investigations encompassing both human and animal subjects. The focus is on the impact of physical activity on brain-derived neurotrophic factor (BDNF) expression, cerebral blood flow, inflammation reduction, and proteinopathy management. Brain-Derived Neurotrophic Factor (BDNF) is crucial for maintaining synaptic plasticity and promoting neurogenesis in the hippocampus, both of which are significantly compromised in Alzheimer's Disease (AD). PA-induced elevations in BDNF enhance cognitive resilience and neuronal integrity. Furthermore, exercise has been shown to enhance cerebral perfusion, so improving the delivery of oxygen and nutrients while promoting the disposal of waste, including glymphatic flow. The anti-inflammatory effects of PA entail the downregulation of pro-inflammatory cytokines (e.g., IL-6, TNF-α) and the upregulation of anti-inflammatory mediators, which alleviate chronic neuroinflammation commonly seen in Alzheimer's disease. Furthermore, PA appears to reduce oxidative stress by enhancing innate antioxidant systems, including superoxide dismutase and glutathione peroxidase. PA may significantly affect essential pathophysiological features of AD, such as amyloid-beta buildup and tau hyperphosphorylation, by promoting proteostasis and stimulating autophagy. Research from both preclinical and clinical studies repeatedly reveals associations between regular physical activity and improved cognitive function, augmented brain structural integrity, and less neurodegeneration. The data indicate that physical activity serves as a cost-effective, accessible, and non-pharmacological intervention with significant neuroprotective potential to reduce the risk of Alzheimer's disease and delay its development.

Introduction: The human skin microbiome is essential for maintaining skin homeostasis, modulating the immune response, and protecting against external threats. In recent years, researchers have increasingly focused on prebiotics and postbiotics bioactive chemicals that promote the proliferation of beneficial microorganisms or are produced by them as potential regulators of skin health. Although probiotics have attracted considerable interest as therapeutic agents, recent attention has focused on prebiotics, which selectively stimulate beneficial microbial populations, and postbiotics nonviable microbial products or metabolites with biological activity. Materials and Methods: This narrative review was based on an extensive analysis of the scientific literature published between 2010 and 2024. References were selected from sources such as PubMed, Scopus, and Google Scholar. The review focused on studies examining the mechanisms of action, clinical outcomes, and potential of prebiotics and postbiotics in the treatment or management of dermatological conditions. Results: The reviewed studies indicate that prebiotics and postbiotics can influence the skin microbiome by increasing microbial diversity, restoring barrier function, and reducing inflammatory responses. Evidence supports their effectiveness as supplements in the treatment of acne vulgaris, atopic dermatitis, psoriasis, and rosacea. Furthermore, their inclusion in cosmetic formulations appears to improve hydration, reduce transepidermal water loss, and enhance the skin's innate defense mechanisms. Conclusions: Prebiotics and postbiotics represent a potential microbiome-targeted therapeutic approach to dermatological problems, both cosmetic and medical. Their incorporation into dermatological and cosmetological techniques may facilitate personalized, non-invasive, and preventative skin care approaches. However, additional, standardized, large-scale clinical trials are necessary to confirm their long-term safety and efficacy.

Jaskra to postępująca neuropatia nerwu wzrokowego, która nieleczona prowadzi do nieodwracalnej ślepoty. Schorzenie to zajmuje drugie miejsce na świecie wśród przyczyn trwałej utraty wzroku. Choć podstawowym celem leczenia jest obniżenie ciśnienia śródgałkowego, to coraz większą uwagę zwraca się na strategie neuroprotekcyjne, mające na celu ochronę komórek zwojowych siatkówki przed degeneracją. Celem niniejszej pracy jest przegląd dostępnych metod neuroprotekcji w jaskrze. Omówiono w niej zarówno farmakologiczne podejścia, obejmujące inhibitory kinazy Rho, antagonistów glutaminianu (memantynę, cytykolinę), agonistów receptorów adrenergicznych (brymonidynę), statyny, czynniki neurotroficzne, antyoksydanty, kanabinoidy, preparaty roślinne (Ginkgo biloba, hupercyna A), jak i nowoczesne terapie oparte na komórkach macierzystych. Uwzględniono również mechanizmy działania tych substancji oraz aktualny stan badań klinicznych. Choć wiele z opisanych metod uzyskało obiecujące wyniki w modelach eksperymentalnych, to skuteczność kliniczna większości interwencji pozostaje przedmiotem dalszych badań.

Background: Metabolic syndrome (MetS) is one of the most serious public-health challenges, affecting approximately 25 % of the adult population worldwide and more than doubling the risk of cardiovascular disease (CVD). It is characterised by the coexistence of abdominal obesity, insulin resistance, dyslipidemia and arterial hypertension, which translates into markedly increased mortality risk. Physical activity (PA) has been identified as a key modifiable factor in the prevention and treatment of this cluster of disorders. The aim of this review is to discuss in detail the impact of various forms of PA on the components of MetS and on CVD risk. Methods and Materials: A systematic review of the scientific literature was carried out, analysing randomised trials, meta-analyses and observational studies that assessed the effectiveness of aerobic, resistance and high-intensity interval training. Conclusions: Regular PA exerts a multidirectional influence on all components of MetS, effectively reducing abdominal obesity, insulin resistance, dyslipidemia and hypertension. Aerobic training shows the greatest efficacy in improving metabolic parameters, whereas the combination of aerobic and resistance modalities provides the most favourable therapeutic outcomes. In secondary prevention of CVD, PA achieves effectiveness comparable to pharmacotherapy and significantly surpasses it in post-stroke patients. The underlying mechanisms include improvements in insulin sensitivity, enhanced glucose uptake by skeletal muscle, and beneficial modulation of adipokine and cytokine profiles. The review underlines the importance of regular PA as a public-health strategy and highlights the need for further research aimed at optimising intervention programs.

Polycystic ovary syndrome (PCOS) is a prevalent endocrine and metabolic disorder in reproductive age women, marked by insulin resistance, hyperandrogenism, menstrual irregularities, and increased cardiometabolic risk. This review synthesizes current evidence on the clinical effectiveness of metformin versus alternative strategies across anthropometric, glycemic, and lipid outcomes in women with PCOS. This narrative review synthesizes secondary data from systematic reviews and meta-analyses retrieved from PubMed and Google Scholar, comparing metformin with other interventions in reproductive-age women with PCOS across anthropometric, glucose, or lipid outcomes. Metformin showed modest benefits in reducing body mass index, body weight, and waist circumference, with greater effects in overweight and obese individuals. Combined therapies, especially with glucagon-like peptide-1 receptor agonists, were more effective than metformin alone. In glucose metabolism, metformin outperformed placebo and oral contraceptives in reducing fasting glucose, fasting insulin, and homeostatic model assessment of insulin resistance, especially in women with higher insulin resistance. Effects on lipid profiles were moderate; metformin lowered total cholesterol, low-density lipoprotein cholesterol, and triglycerides, particularly when combined with statins. Its effect on high-density lipoprotein cholesterol was limited and sometimes less favorable than that of oral contraceptives. Metformin remains a core treatment in PCOS, with consistent, modest benefits across metabolic and anthropometric domains. Its effectiveness improves when matched to patient profiles and combined with other agents or lifestyle changes.