Recent advances in immunology enabled the characterization of several signal transmitting pathways responsible for proper cytokine and chemokine signaling. Among them, Janus kinases (JAKs) are essential components of receptor activation systems. The discovery of JAK kinases enabled the synthesis of JAK kinase inhibitors (JAKi or Jakinibs), which have proven to be efficacious in the treatment of hematologic malignancies and several rheumatological disorders and continue to be investigated in many clinical indications. Blocking multiple cytokines belonging to several cytokine families with a single small molecule may, however, create a potential risk for the patients. Recently, a higher risk of thromboembolic complications, namely, deep vein thrombosis and pulmonary embolism, has been recognized as the main concern during treatment with Jakinibs. At present, it is not entirely clear whether this increased risk is related to direct cytokine blockade, the presence of concomitant diseases in treated patients or other unknown circumstances that work together to increase the risk of this side effect. In this review, we discuss data on the risk of thromboembolic side effects, with special emphasis on the mechanism that may be responsible for this increased risk. Many indirect data indicate that higher thromboembolic risk may be related to the specificity of JAK inhibitor action, such that preferentially blocking one signaling pathway upsets the balance between pro and anti-thrombotic activities.

The purpose of this article was to evaluate and compare the efficacy of radial and focused shock wave therapies applied to treat tennis elbow. Patients with tennis elbow were randomized into two comparative groups: focused shock wave therapy (FSWT; n=25) and radial shock wave therapy (RSWT; n=25). Subjects in the FSWT and RSWT groups were applied with a focused shock wave (3 sessions, 2000 shocks, 4 Hz, 0.2 mJ/mm(2)) and a radial shock wave (3 sessions, 2000 + 2000 shocks, 8 Hz, 2.5 bar), respectively. The primary study endpoints were pain relief and functional improvement (muscle strength) one week after therapy. The secondary endpoint consisted of the results of the follow-up observation (3, 6 and 12 weeks after the study). Successive measurements showed that the amount of pain patients felt decreased in both groups. At the same time grip strength as well as strength of wrist extensors and flexors of the affected extremity improved significantly. Both focused and radial shock wave therapies can comparably and gradually reduce pain in subjects with tennis elbow. This process is accompanied by steadily improved strength of the affected extremity.

Systemic sclerosis and systemic lupus erythematosus represent two distinct autoimmune diseases belonging to the group of connective tissue disorders. Despite the great progress in the basic science, this progress has not been translated to the development of novel therapeutic approaches that can radically change the face of these diseases. The discovery of JAK kinases, which are tyrosine kinases coupled with cytokine receptors, may open a new chapter in the treatment of so far untreatable diseases. Small synthetic compounds that can block Janus kinases and interact directly with cytokine signalling may provide therapeutic potential in these diseases. In this review, we discuss the therapeutic potential of Jak kinases in light of the cytokine network that JAK kinases are able to interact with. We also provide the theoretical background for the rationale of blocking cytokines with specific JAK inhibitors.

Background: Simple, easy-to-perform, safe and cost-effective methods for the prediction of adverse outcomes in older adults are essential for the identification of patients who are most likely to benefit from early preventive interventions. Methods: The study included 160 community-dwelling individuals aged 60– 74 years, with 44.4% women. A comprehensive geriatric assessment was performed in all participants. Bioimpedance body composition analysis included 149 subjects. Among other tests, functional assessment included the Barthel Index of Activities of Daily Living (Barthel Index), Mini-Mental State Examination (MMSE), Timed Up and Go (TUG) and Fried frailty phenotype. Follow-up by telephone was made after at least 365 days. The composite endpoint (CE) included fall, hospitalization, institutionalization and death. Results: Cohort characteristics: age 66.8± 4.2 years (mean±SD), 3.81± 2.23 diseases, 4.29± 3.60 medications or supplements, and good functional status (MMSE 29.0± 1.5, Barthel Index 98.1± 8.2, prevalence of Fried frailty phenotype 2.5%). During one-year follow-up, 34 subjects (21.3%; 95% confidence interval [CI] =14.9− 27.6%) experienced CE: hospitalizations (13.8%; 95% CI=8.41− 19.1), falls (9.38%; 95% CI=4.86− 13.9), death (0.63%; 95% CI=0− 1.85) and no institutionalization. A higher probability of CE was associated with age ≥ 70 years (P=0.018), taking any medication or supplements (P=0.007), usual pace gait speed ≤ 0.8 m/s (P=0.028) and TUG > 9 s (P< 0.002). TUG was the only independent measure predicting one-year CE occurrence (OR=1.22, 95% CI=1.07− 1.40, P=0.003) in multivariate logistic regression. However, its predictive power was poor; the area under the receiver operating characteristic curve was 0.659 (95% CI 0.551− 0.766, P=0.004) and Youden’s J statistic for a TUG cut-off of 9.0 s was 0.261 (sensitivity 0.618 and specificity 0.643). Conclusion: The TUG test was superior to frailty phenotype measures in predicting one-year incidence of a CE consisting of fall, hospitalization, institutionalization and death in a cohort of healthy-aging community-dwelling early-old adults, although its value as a stand-alone test was limited.

Cel pracy: Celem pracy była ocena poziomu stresu u dzieci i młodzieży ze skoliozą idiopatyczną (SI), leczonych zachowawczo metodą Dobosiewicz (DoboMed), w korelacji do parametrów klinicznych i konieczności stosowania terapii za pomocą gorsetu.Metoda: Grupę badaną (GB) stanowiło 63 pacjentów (54 dziewczęta) o średniej wieku 14,7 lat. Wszyscy objęci badaniem byli leczeni metodą DoboMed, a 31 pacjentów stosowało także gorset (ortozę). W analizie wzięto pod uwagę stan odżywienia (BMI Z-score) pacjentów, wiek diagnozy, lokalizację skrzywienia oraz czas noszenia gorsetu. Poziom stresu analizowano dwukrotnie (kwestionariusze Bad Sobernheim Questionnaire Deformity (BSSQ-Deformity) oraz Bad Sobernheim Questionnaire Brace (BSSQ-Brace)) na początku i na końcu hospitalizacji.Wyniki: Większość dzieci i młodzież z SI leczonych metodą DoboMed odczuwa niski lub średni poziom stresu związany z deformacją kręgosłupa (odpowiednio 58,7% i 36,5%). Znamiennie wyższy poziom stresu (BSSQ-Deformity) stwierdzono w grupie leczonej gorsetem w odniesieniu do grupy leczonej tylko za pomocą kinezyterapii (p<0,05). Pacjenci leczeni gorsetowo prezentowali znamiennie wyższy poziom stresu związany z noszeniem ortozy, niż z samą deformacją kręgosłupa (p<0,0001). Poziom stresu (BSSQ-Deformity) korelował znamiennie z wiekiem chorych, BMI Z-score i liczbą przebytych hospitalizacji (p<0,05). Poziom stresu związany z deformacją był znamiennie zależny od wielkości kąta skrzywienia (kąt Cobb’a) w obu analizowanych podgrupach.Wnioski: Poziom stresu pacjentów z SI jest związany ze stopniem nasilenia schorzenia, niezależnie od metody leczenia. Terapia gorsetowa jest czynnikiem indukującym i nasilającym stres. Poziom stresu związanego z gorsetowaniem, przewyższa stres związany z deformacją kręgosłupa. Inne czynniki wpływające na poziom stresu to wiek, stan odżywienia i liczba hospitalizacji. Kompleksowe leczenie powinno obejmować także opiekę psychologiczną młodych pacjentów z SI.

Chronic venous insufficiency (CVI) is the most common vascular disease. One major risk factor for its development is either long-term sitting or standing in the same position and the nature of the work performed. This study aims to assess the effectiveness of passive ankle movement in the sitting position performed using the Bella Vena robot for the symptoms of CVI with long-term observation. A group of 58 patients (mean age: 59.69 ±14.59 years) with CVI in CEAP (Clinical (C), Etiological (E), Anatomical (A), and Pathophysiological (P)) classification categories 2 and 3, and a group of 37 (mean age: 51.49 ±14.86 years) healthy volunteers performing sedentary work for at least 6 h during the working day were enrolled into the study. The total duration of observation lasted 8 months (8 visits), during which the following parameters were assessed at the beginning and end of this period: pain intensity (according to the visual analogue scale (VAS)), level of saturation on the toe, pulse rate, and lower limb Doppler ultrasound evaluation of reflux parameters. The exercises used in people with CVI resulted in a significant reduction (p ≤ 0.01) in the occurrence of symptoms. Among all respondents, after 8 months of exercise, a significant reduction in pain level according to the VAS of the lower limbs, an improvement in saturation at the toe level, and a reduction in venous reflux was recorded (p ≤ 0.05). Home exercises with the use of an automatic exercise rehabilitation device alleviated significant symptoms in patients with CVI and improved the calf muscle pump.