Background and Objectives: This study aimed to evaluate the association between QoL, self-assessed physical activity, and the presence and severity of muscle spasms in chronic hemodialysis patients. Patients undergoing regular in-center hemodialysis (HD) have much lower quality of life (QoL) than healthy individuals. However, there is limited knowledge about the impact of specific common complications of hemodialysis, particularly muscle spasms on the overall well-being of patients. Materials and Methods: In this prospective, single-center study, 67 chronic HD patients were surveyed regarding the prevalence of muscle spasms using a validated 9-multiple-choice-question survey, alongside the Physical Activity Questionnaire (IPAQ) and The Short Form (36) Health Survey (SF-36). Based on the muscle spasms survey answers, patients were divided into two subgroups: with (n = 39) and without muscle spasms (n = 28). Results: The findings revealed that patients with muscle spasms had a higher body mass index (BMI) (p = 0.005), a shorter dialysis vintage (p = 0.063), and significantly longer sitting times (p = 0.017). Multivariate analysis identified BMI (p = 0.034), sitting time (p = 0.009), physical functioning scores (p = 0.032), and dialysis vintage (p = 0.040) as significant predictors of muscle spasms. Conclusions: This study concluded that muscle spasms are associated with lower QoL among HD patients. The contributing factors to this dependance are BMI, dialysis vintage, physical functioning, and sitting time.

Background: In patients with familial adenomatous polyposis (FAP), the duodenum is another high-risk region for malignancy after the large bowel. However, endoscopic and surgical management differs for papillary lesions and adenomas located in other parts of the duodenum. The aim of the study was to present the principles of the endoscopic surveillance of extrapapillary polyps based on a single-center 14-year observational study. Methods: The retrospective analysis was carried out in 2010–24 on a group of 45 people enrolled in endoscopic surveillance of the upper gastrointestinal tract due to FAP. The evaluation was aimed at detecting the malignant transformation of extrapapillary duodenal adenomas, with a radical removal of high-risk lesions. The severity of polyposis in the subsequent years of observation as well as the effectiveness of routine polypectomy on downstaging according to the Spiegelmann score were also assessed. Results: Invasive duodenal cancer was not detected in any case; however, high-grade dysplasia (HGD) was confirmed in five patients. The severity of polyposis and the number of polyps with HGD increased in following examinations, but routine polypectomy performed mainly during the 4th and 5th endoscopies allowed for a transient decrease in the Spiegelman score. Finally, progression of duodenal polyposis was observed in 18 patients, another 4 experienced regression (downstaging) and in 23 cases the stage of severity did not change. In addition, five patients were diagnosed with LST-G lesions, which were removed without recurrence. Conclusions: The patient’s age correlates with the severity of polyposis and the risk of malignancy, but routine endoscopic resections eliminate potentially invasive lesions and contribute to disease regression expressed by the Spiegelmann score. The radical endoscopic therapy of extrapapillary duodenal lesions limits the indications for surgical procedures.

BACKGROUND Necrotizing fasciitis, a subtype of necrotizing soft-tissue infection, is a rare but life-threatening condition that requires a prompt and decisive approach. Early surgical debridement remains a key treatment; however, after debridement, the management of complex wounds, particularly in high-risk patients, remains a major clinical challenge and often requires prolonged hospitalization and multiple surgical interventions. These situations may warrant alternative techniques, such as negative pressure wound therapy, to support effective wound healing. This case demonstrates that a bedside strategy to manage necrotizing fasciitis may offer a safe and effective alternative in patients for whom repeated operations carry substantial risks. CASE REPORT A 52-year-old woman with multiple comorbidities developed abdominal necrotizing fasciitis. After the initial radical debridement, all subsequent interventions were successfully performed at the patient's bedside, including negative pressure wound therapy, continuous antiseptic irrigation with an elastomeric infusion pump, and kinesiotaping. This minimally invasive approach resulted in complete wound closure within 3 months, without requiring additional surgical procedures. CONCLUSIONS This case highlights the potential of bedside management in selected patients with necrotizing fasciitis, particularly those exhibiting a high risk of surgical complications. Adjunctive therapies such as negative pressure wound therapy and kinesiotaping played a key role in accelerating wound healing and reducing treatment costs. Bedside strategies may offer a cost-effective alternative to conventional operative care in some cases of necrotizing fasciitis.

Claudins (CLDNs) are small transmembrane proteins that constitute a key component of tight junctions, playing a crucial role in maintaining epithelial barrier integrity and regulating paracellular ion flux. To date, 27 members of the CLDN family have been identified in mammals. CLDNs are expressed throughout the gastrointestinal tract, with marked regional variability along different anatomical segments. Alterations in CLDN expression have been widely observed under pathological conditions such as inflammatory bowel diseases, bacterial infections, and various malignancies. Typically - though not invariably - pathological states are associated with a reduced expression of barrier-forming CLDNs, which restrict paracellular flux of solutes and ions, and increased expression of channel-forming CLDNs that selectively permit the passage of specific ions while still limiting the permeability of larger molecules and oppositely charged ions, leading to compromised epithelial integrity and enhanced paracellular permeability. Beyond structural role of CLDNs, they have been implicated in signal transduction, regulation of cell polarity, and proliferation, which makes them important players in tumorigenesis and metastasis. Consequently, CLDNs are under extensive investigation as potential diagnostic and prognostic biomarkers, as well as therapeutic targets in gastrointestinal cancers. Notably, clinical trials are currently underway evaluating therapeutic agents targeting for instance CLDN18.2 for the treatment of gastric and gastroesophageal cancers. The aim of this work is to summarize the current knowledge about CLDNs, their presence under physiological conditions, and their role in gastrointestinal diseases.

Background: Antinuclear antibodies (ANA) can be detected in patients with rheumatoid arthritis (RA) and pose many diagnostic challenges, especially when RA presents an atypical course and requires differentiation from other systemic connective tissue diseases (sCTDs). This study assessed ANA fluorescence patterns and immunoblot profiles, as well as the relationships between ANA titers, antibody expression intensity, and markers of disease activity in patients with RA. Methods: This single-center, cross-sectional, observational study included 81 RA patients (53 ANA-positive) meeting the 2010 ACR/EULAR classification criteria. ANA titers and fluorescence patterns were assessed using indirect immunofluorescence. Anti-extractable nuclear antigen (ENA) autoantibody profiles and expression intensity were assessed using immunoblot analysis. Demographic, clinical, and laboratory data were obtained. Spearman’s rank correlation coefficient was used to analyze the relationship between ANA titers and selected variables. Univariate and multivariate logistic regression analyses were performed to identify factors associated with ANA positivity. Results: The cohort consisted primarily of women (86.4%) with moderate disease activity. ANA fluorescence patterns were heterogeneous, with nucleolar and homogeneous patterns most frequently observed. Immunoblot analysis also revealed diverse autoantibody profiles without a clearly dominant specificity. Ro-52, SS-A, and Sm antibodies were detected more frequently, although their prevalence remained relatively low. No statistically significant correlations were found between ANA titers and inflammatory markers, serological parameters, or disease activity indices. Conclusions: RA patients with positive ANA demonstrated marked immunological heterogeneity, without concomitant symptoms of sCTD. A positive result in RA may reflect generalized immune dysregulation rather than a distinct clinical subtype. Further studies with larger cohorts are needed to clarify the clinical significance of ANAs in rheumatoid arthritis.

BACKGROUND Hemolytic uremic syndrome (HUS) is a severe disease classified under thrombotic microangiopathies and characterized by acute kidney injury, microangiopathic hemolytic anemia, and thrombocytopenia. HUS can be divided into 2 subtypes: typical HUS and atypical HUS (aHUS). The standard treatment for aHUS, a complement-mediated thrombotic microangiopathy, as approved in the United States and European Union involves long-term administration of eculizumab or ravulizumab with complement-mediated thrombotic microangiopathy. This report is of a 70-year-old woman with aHUS triggered by artificial mitral valve dysfunction. CASE REPORT A 70-year-old woman with history of artificial mitral valve replacement was admitted to the nephrology department with suspected HUS. She presented with malaise, dyspnea, anemia, thrombocytopenia, hemolysis, and schistocytes in blood smear. Complement factors were normal, but sC5b-9 was elevated, suggesting complement overactivation. ADAMTS-13 was >10%, ruling out thrombotic thrombocytopenic purpura. Infection with a Shiga toxin-producing bacterium was ruled out. Genetic tests for complement factors revealed no pathogenic variants. The patient was treated with eculizumab, leading to significant clinical improvement. Due to her cardiac history, a comprehensive cardiologic evaluation was performed, revealing perivalvular leakage and severe dysfunction of the mitral valve prosthesis. She subsequently underwent a 2-step intravascular mitral valve repair. The administration of eculizumab resulted in clear improvement in hemolysis, renal function, and platelet count prior to mitral valve surgery, strongly supporting the diagnosis of an aHUS-type thrombotic microangiopathy. Surgical intervention was subsequently performed and contributed to long-term stabilization. CONCLUSIONS This case underscores the challenges of treating thrombotic microangiopathy in a patient with multiple comorbidities and complicated medical history.