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We focus on optimization of dynamic spectrally-spatially flexible optical networks (SS-FONs), in which distance-adaptive, spectral super-channel (SCh) transmission is realized over weakly-coupled multi-core fibers (MCFs). In such networks, the inter-core crosstalk (XT) effect in MCFs impairs the quality of transmission (QoT) of optical signals, which has a negative impact on overall network performance. In this context, a key issue is the selection of a modulation format (MF) for a particular lightpath, since each MF offers a different tradeoff between spectral efficiency (number of occupied frequency slices) and transmission reach, and both these elements are in a close relation with the experienced XT. In fact, it is difficult to quantify the impact of the MFs used in a given network on the deterioration in QoT due to the XT effect and on overall network performance, as the levels of XT experienced by particular lightpaths depend directly on the ongoing transmissions in neighbor MCF cores, and those (i.e., established lightpaths) are subject to stochastic changes in dynamic SS-FONs. Therefore, in this article, we propose an approach that selects a MF for a lightpath based only on the transmission distance, i.e., length of the applied routing path. In particular, for each considered MF, we define a Modulation format Distance Limit (MDL) parameter that is used to select the MF for a lightpath by a simple comparison of the considered routing path length against the MDL parameter. To facilitate the very complex process of determining the best values of the MDL parameter, we propose a machine learning (ML) approach, namely, supervised learning regression method, with the overall goal to optimize network performance in terms of bandwidth blocking probability (BBP). Extensive simulation experiments performed in different network scenarios show that the proposed method ML allows to achieve performance gains when compared to various reference approaches, including a more computationally expensive method that is based on dynamic (flexible) selection of MFs.

We aimed to define reference ranges of glycemic variability indices derived from continuous glucose monitoring data for non-diabetic infants during post-operative intensive care treatment after cardiac surgery procedures. We performed a prospective cohort intervention study in a pediatric intensive care unit (PICU). Non-diabetic infants aged 0–12 months after corrective cardiovascular surgery procedures were fitted upon arrival to the PICU with a continuous glucose monitoring system (iPro2, Medtronic, Minneapolis, MN, USA). Thirteen glycemic variability indices were calculated for each patient. Complete recordings of 65 patients were collected on the first postoperative day. During the first three postsurgical days 5%, 24% and 43% of patients experienced at least one hypoglycemia episode, and 40%, 10% and 15%—hyperglycemia episode, respectively, in each day. Due to significant differences between the first postoperative day (mean glycemia 130 ± 31 mg/dL) and the second and third day (105 ± 18 mg/dL, 101 ± 22.2 mg/dL; p < 0.0001), we proposed two separate reference ranges—for the acute and steady state patients. Thus, for individual glucose measurements, we proposed a reference range between 85 and 229 mg/dL and 69 and 149 mg/dL. For the mean daily glucose level, ranges between 122 and 137 mg/dL and 95 and 110 mg/dL were proposed. In conclusion, rt-CGM revealed a very high likelihood of hyperglycemia in the first postsurgical day. The widespread use of CGM systems in a pediatric ICU setting should be considered as a safeguard against dysglycemic episodes; however, reference ranges for those patients should be different to those used in diabetes care.

We investigate the blocking performance of a dynamic, spectrally and spatially flexible optical network (SS-FON) in which spectral super-channels (SChs) utilizing multiple modulation formats (MFs) are carried over weakly-coupled multi-core fibers (MCFs) and the amount of transceivers (TRX) in network nodes is limited. In the SS-FON scenario considered, lightpath requests may be blocked not only because of the lack of spectrum resources or due to low transmission quality (QoT), as frequently considered in previous works, but also because of insufficient TRX resources. The main goal of this study is to evaluate the joint impact of these three blocking factors on overall network performance.

Spectrally and spatially flexible optical networks (SS-FONs), which combine space division multiplexing (SDM) with flexible-grid elastic optical network (EON) technologies, bring additional complexity to network control due to the handling of a larger number of spatial modes in SDM than in conventional EONs. To effectively optimize such networks, in particular, to generate good-quality solutions of low optimality gaps in reasonable computation times, efficient algorithms are required. In this work, we focus on the routing, spatial mode, and spectrum allocation (RSSA) problem in the SS-FONs in which conversion of spatial modes in switching nodes is allowed. We propose and evaluate two enhancements in RSSA processing, namely, algorithm parallelization and application of dedicated data structures, which are built into a hybrid simulated annealing with greedy RSSA heuristic algorithm. To assess the quality of generated RSSA solutions, we develop suitable procedures for estimating solution lower bounds. The results of numerical experiments show the effectiveness of proposed techniques in speeding up the search for good-quality RSSA solutions.

Dizziness is a symptom of many diseases. Patients very frequently come with such ailment to the hospital emergency department. It is a state which may last a few seconds or minutes and increase or recede with time. Therefore, the admitted patients frequently cannot assess their own illness in a precise and objective way. The dizziness definition is also quite ambiguous. Dizziness is defined as the sensation of one own’s body movement or spinning and movement of the surrounding. It is very important to record the patient’s medical history since the diagnostic procedure may depend on the symptoms’ character. Dizziness may be a symptom of a serious disease, although it is not easy to find its cause. It appears not only in case of the labyrinth and nervous system disorders, but also in the systemic and functional diseases. Dizziness and balance disorder are the direct cause of admitting one in every thirty patients. The symptom indicated the directly life-threatening disease only within the 3-8.5% of patients (cerebral circulation insufficiency - 6%, cardiac dysrhythmia - 1.5%, brain tumour < 1%). Analyzing the data concerning the problem of dizziness occurrence within the general population, it has been noticed that this symptom has been reported two or three times more frequent by women than by men. Dizzinesses are classified pathogenetically and clinically into labyrinthine and non-labyrinthine, paroxysmal and permanent, acute and chronic. Dizziness is hard to diagnose because the symptoms reported by patients are only their own subjective sensations. The data presented in the article implicate the increasing number of patients with such disorders. Apart from dizziness, the patients complain also about the hearing disorders and nausea, which make their proper functioning impossible. It is inappropriate to start the treatment without knowing the cause. Establishing, on the basis of patient’s medical history and physical examination, whether the dizziness is of peripheral or central origin, is essential for the further diagnosis. After establishing the main diagnosis, the casual and symptomatic treatment is implemented, in some cases - there is a vestibular rehabilitation or even a surgical treatment.

The ability of fast response in case of increasing health problems of a child which lead directly to life-threatening situations is a necessary condition for creating opportunity of child’s survival until it will be transported to intensive care unit, where it will be provided with care by a specialist. In case of healthy children the most common cause of acute respiratory failure is obstruction of upper respiratory tract. There is an enormous variety of causes of upper airway obstruction, but the most important are the result of congenital defects, acute inflammation, anaphylactic reactions, foreign body aspiration and injuries. Consequence of the hypoventilation resulting from significant impediment of airflow through the obstructed airways is impaired gas exchange in the lungs. This leads to the increasing hypoxemia (PaO 2 45 mmHg). This condition is called the total respiratory failure. The persistence of hypoventilation leads to hypoxia of vital organs (heart muscle, brain), increased anaerobic metabolism, acidosis, and inevitably to cardiac arrest as a result of homeostasis disorders. Respiratory failure is defined as acute when developing suddenly and is potentially reversible. We can find such a situation in the fast-increasing stenosis of the larynx. Symptoms of severe dyspnoea occur in a short time, but can be interrupted by an effective airway patency. Acute respiratory failure is a state of direct threat to life, which is why it is crucial to give a prompt aid to the sick child. The aim of this paper is to discuss the signs and symptoms, knowledge of which is essential for rapid identification and initial differentiation of the causes of acute upper airway obstruction in children. The principles of first-aid for children with acute respiratory failure and above all the description of life-saving procedures will be presented.

Network dimensioning is a specific kind of optimization problems. In general the main goal in this task is to ensure a connection between given pairs of nodes (source-target) with possible high efficiency. When each pair (demand) brings different revenue, the problem of blocking less attractive demands appears. Usually this situation is caused by not including any fairness criterion into optimization and thus optimizing only the total (revenue) efficiency of the system. Another complication is the fact of inverse proportionality of these criteria. In this paper an optimization model has been examined which takes into account a fairness criterion and minimizes the loss of system efficiency. It may also be understood as optimizing the ratio of fairness degree to the mean of the traffic flow in the network. For implementation of the model the CPLEX package was used. As input data the example of backbone Polish network structure was chosen. To evaluate the approach, basic statistics which help in describing the equity of distribution such as standard deviation, kurtosis and Gini coefficient are used.

Background Second-stage palliation with hemi-Fontan or bidirectional Glenn procedures has improved the outcomes of patients treated for single-ventricle heart disease. The aim of this study was to retrospectively analyze risk factors for death after second-stage palliation of single-ventricle heart and to compare therapeutic results achieved with the hemi-Fontan and bidirectional Glenn procedures. Material and methods We analyzed 60 patients who had undergone second-stage palliation for single-ventricle heart. Group HF consisted of 23 (38.3%) children who had been operated with the hemi-Fontan method; Group BDG consisted of 37 (61.7%) who had been operated with the bidirectional Glenn method. The analysis focused on 30-day postoperative mortality rates, clinical and echocardiographic data, and early complications. Results The patients’ ages at the time of repair was 33 ± 11.2 weeks; weight was 6.7 ± 1.2 kg. The most common anatomic subtype was hypoplastic left heart syndrome, in 36 (60%) patients. The early mortality rate was 13.3%. Significant preoperative atrioventricular valve regurgitation, single-ventricle heart dysfunction, pneumonia/sepsis, and arrhythmias were associated with higher mortality rates after second-stage palliation. Multivariate analysis identified significant preoperative single-ventricle heart dysfunction as an independent predictor of early death after second-stage palliation. No differences were found in the analyzed variables after bidirectional Glenn compared with hemi-Fontan procedures. Conclusion Significant preoperative atrioventricular valve regurgitation, arrhythmias and pneumonia/sepsis are closely correlated with mortality in patients with single-ventricle heart after second-stage palliation. Preoperative significant single-ventricle heart dysfunction is an independent mortality predictor in this group of patients. There are no differences in clinical, echocardiographic data, or outcomes in patients treated with the hemi-Fontan compared with bidirectional Glenn procedures.

We focus on the problem of crosstalk-aware lightpath provisioning in a dynamic, spectrally and spatially flexible optical network, in which spectral super-channels are carried over multi-core fibers with distance-adaptive transmission. The problem involves establishing a lightpath for a connection such that the inter-core crosstalk (XT) between the new lightpath and any exiting lightpaths does not cause the quality of transmission of any of these light-paths to be below an acceptable level. To this end, we analyze and compare two broad classes of schemes that aim to ensure acceptable XT levels in the network. The first is based on static/worst-case XT, whereas the second uses dynamic/ precise XT estimation. These methods are implemented in a dynamic XT-aware routing, spatial mode, and spectrum allocation algorithm that solves the lightpath-provisioning problem efficiently with the goal of minimizing bandwidth blocking. Extensive simulation experiments performed in realistic network scenarios indicate that the utilized XT estimation methodology has a significant impact on network performance, with the precise XT approach favored over the worst-case XT strategy.

Follicle stimulating hormone receptor (FSHR) genetic variation at position 2039 AG (rs6166, p.Asn680Ser) was repetitively shown to correspond to the measures of ovarian sensitivity and the outcomes of gonadotropin stimulation. However, to date, there has been no study revealing the mechanisms behind the associations observed. The aim of the present research was to investigate the relationship between rs6166 and mRNA expression of FSHR-dependent genes such as LHCGR, CYP19A1, and FSHR itself with particular reference to the FSHR transcript variants (deletions of exon 2, 6, and 9 and insertion of a novel exon between exons 8 and 9) in the cell culture model. Steroid production and its dependency on FSHR genotype were also assessed. A total of 22 normoovulatory patients undergoing IVF treatment were recruited. Granulosa cells were obtained by ovary puncture and cultured for 7 days to regain responsiveness to FSH in a gonadotropin-free medium. Stimulation was carried out for 24 hours in a serum-depleted environment using 0.5 UI/l rhFSH. Gene expression was assessed by real-time PCR and genotype was determined by allele-specific PCR. The distribution of p.Asn680Ser genotypes was as follows: 10 homozygotes Asn/Asn, 8 heterozygotes Asn/Ser, and 4 homozygotes Ser/Ser. Expression of total FSHR in all samples studied increased by a mean factor of 1.9 (95% CI: 0.39-11.53, p0.001) upon stimulation. All of the analyzed FSHR transcript variants were detectable in non-stimulated and stimulated cells. The only distinct transcript that followed up-regulation was deletion of exon 2. Homozygotes Asn/Asn tended to have higher rhFSH-induced expression of FSHR as compared to the carriers of Ser/Ser genotype. Relative expression of LHCGR and CYP19A1 although up-regulated showed no significant difference with respect to the FSHR genotype. Variable modulation of FSHR expression by its own ligand is likely to explain different clinical behavior of patients with FSHR genetic variants. The putative contribution of rs6166 requires further investigation.

Introduction. Literature provides much evidence of negative effects of alcohol, nicotine, or drugs in pregnancy. There are also data indicating the relationship of stress and physical work with many complications during this period. Aim. The aim of the study was to assess the exposure of pregnant women to tobacco smoking, alcohol, stress, exercise, medications, and analysis of their awareness and knowledge on the subject, indicating the high-risk groups. Material and methods. The study was conducted in August and September 2012 in gynecology and obstetric clinics in Lublin with 138 pregnant women. A questionnaire containing 26 questions was a proprietary research tool. Results. In the study group, 25.3% of women were exposed to harmful tobacco compounds in the first trimester. Smoking was observed statistically more often among young women and the women exposed to high stress. Every fifth woman has abnormal knowledge of alcohol use observed significantly more often among women with unplanned pregnancy, young and under high stress level. Fifty per cent of economically active participants were performing physical work during pregnancy and 20.2% were exposed to high stress, which correlated significantly with higher education and performed “desk job”. Every fourth respondent among half of the respondents who use the self-treatment in case of complaint would apply NSAIDs. Conclusions. Lack of knowledge and awareness of pregnant women make them reach for harmful substances. Some pregnant women perform heavy physical work as well as are exposed to stress, which results in more frequent recourses to drugs. Some drugs are often seen as safe and accepted by pregnant women without consulting a doctor.

The aim of this study was to examine the expression of P-glycoprotein (P-gp) in CD3 lymphocytes of children with nephrotic syndrome (NS) in relation to their clinical response to glucocorticoid (GC) treatment. The examinations were performed on two groups. The study group (I) consisted of 88 children aged 2.0–20.0 years with NS, divided according to their clinical response to GC: NFR—non-frequent relapse NS; FR—frequent relapse NS; SD—steroid-dependent NS. The control group (II) consisted of 18 healthy children never treated with GC. We measured P-gp expression on CD3 lymphocytes of patients with NS using a flow cytometry assay. The CD3/P-gp was significantly higher than in controls. The difference was higher in SD (P=0.0001) and FR - (P=0.0002) group. The difference in NFR was smaller. Mean CD3/P-gp (in percent) was twice as high in SD children than in NFR, and the difference, as between FR and NFR, was statistically significant (P

UNLABELLED The major problem of total parenteral treatment consists in the balancing of the source and dose of the nutritional mixture, so as to not deepen malnutrition with a positive impact on the patients' organism. The aim of the study was to evaluate selected factors that induce hepato-biliary complications in patients treated by means of parenteral nutrition at home. MATERIAL AND METHODS The retrospective study comprised 70 patients with biochemistry performed every three months. Considering statistical analysis patients were allocated to four groups, depending on the period of treatment. Group A analysis results were based on the activity of aminotransferases, group B on the activity of bilirubin. Both groups A and B were additionally divided into group I where we assigned normal values of control lab results, and group II with improper results after treatment. RESULTS Differences between groups Ia vs IIa were presented on the basis of the daily supply of glucose: mean- 2.52 vs 3.49 g/kg (p=0.000003), glucose/lipids ratio: mean- 3.76 vs 4.90 g/kg (p=0.0001), daily non-protein energy: mean- 16.73 vs 21.06 kcal/kg (p=0.0001). Differences between groups Ib vs IIb were presented on the basis of the daily supply of glucose: mean- 2.76 vs 3.46 g/kg (p=0.0007), glucose/lipids ratio: mean- 3.98 vs 5.13 g/kg (p=0.01), daily non-protein energy: mean-17.96 vs 20.36 kcal/kg (p=0.04). Based on the above-mentioned analysis the main goal in the prevention of hepatic complications should lead to the reduction of the dose of glucose. Increased glucose supply leads to increased number of hepato-biliary complications. CONCLUSIONS Based on obtained results we were able to conclude that in case of liver complications associated with parenteral nutrition, proper management consists in the modification of nutritional mixtures (reduction in the daily glucose supply and change in the proportions of extra-protein energy). Such management has the greatest clinical effect. When determining the composition of the nutritional mixture one should adjust the glucose supply, so as to offset both sources of extra-protein energy.

Purpose In a retrospective analysis of the prevalence of KRAS mutations in patients with advanced non-small cell lung cancer (NSCLC), we detected a unique and not earlier described case of a double combination of mutations at codons 12 and 13 of the KRAS gene in a patient with lung adenocarcinoma. Material/Methods To determine the molecular characteristics of the infrequent mutation and the mutational status of the KRAS gene in metastatic brain tumors in the same patient, we performed morphological and molecular tests. Results Molecular analysis of the nature of the double mutation showed that the unique combination of variants is a monoallelic mutation. This type of changes has not yet been registered in the Catalogue of Somatic Mutations in Cancer database. Molecular assessment of the KRAS mutation status in the brain metastatic site in the same patient, showed no mutations in codons 12 and 13. Moreover, we did not find mutation at exon 19 and 21 of EGFR gene, both in primary tumor as well as in secondary metastatic foci in the brain. Conclusions The presented case shows an example of KRAS gene molecular mosaicism and heterogeneity of lung adenocarcinoma primary and metastatic tumors. Molecular heterogeneity of lung adenocarcinoma tumors can significantly affect eligibility of patients for targeted therapies.

The presence of obesity and the features of metabolic syndrome plays a predictive role in cardiovascular diseases (CVD) in adults. It seems reasonable to seek new risk factors in the development of CVD. Defining the genetic background of obesity could help to select patients from a high risk group and help to introduce prevention and treatment, which, in consequence, lead to the lowering of morbidity and mortality. One of the genes probably related to the body weight is the Fat Mass and Obesity Associated Gene (FTO).of the study was an attempt to assess the relationship between the FTO polymorphism rs9939609 and body mass index in children from Podlaskie voievodship.405 children aged 4-18 were selected for the study. The examination included body mass index, waist circumference, blood pressure and lipid profile analysis. FTO rs9939609 polymorphism was assessed using a discrimination allele method with the application of ABI 7900HT Fast Real-Time PCR System.FTO rs9939609 polymorphism was related to the standarized body mass index and the AA genotype carriers had a higher risk of obesity. This polymorphism was also associated with waist circumference, systolic blood pressure and triglycerides concentration. It was not correlated with diastolic blood pressure and total HDL- and LDL-cholesterol concentrations.Our results demonstrate that rs9939609 FTO gene polymorphism is related to the body mass index in children. Our results should be confirmed in studies on a large cohort of healthy Polish children.

Cutaneous tuberculosis (tuberculosis cutis) is one of the extrapulmonary forms of tuberculosis, which may affect the skin only or co-exist with tuberculosis of other organs, particularly the lungs. We describe a case of lupus vulgaris in a 72-year-old male patient with a single lesion localized on his lower extremity, developing for 30 years before correct diagnosis and previously treated with topical steroids. Bacillus infection in other organs was not detected. Diagnosis of tuberculosis was made based on personal history, clinical picture, hypersensitivity to tuberculin, histopathology and polymerase chain reaction. A multidrug therapy with rifampicin, isoniazid and pyrazinamide resulted in regression of the lesion. The common lack of knowledge about the clinical picture of cutaneous tuberculosis causes its late diagnosis and treatment.

The variation in time required to obtain cessation of proteinuria in children with nephrotic syndrome (NS) represents one aspect of the variations shown by these children in response to glucocorticoid (GC) treatment. Polymorphism of the GC receptor gene (NR3C1) has been postulated as one factor that would partially explain differences in both the clinical presentation and the reaction to treatment in GC-treated diseases. We genotyped 118 children diagnosed with NS who initially responded to oral GC treatment [steroid-responsive nephrotic syndrome (SRNS) group] and 136 healthy children for three intron B single nucleotide polymorphisms of NR3C1, namely Bcl I (C/G), rs33389 (C/T) and rs33388 (A/T). In the SRNS group, we performed a three-marker haplotype analysis of NR3C1 in relation to the response to prednisone, represented as time to proteinuria resolution (TPR) as categorical and ordinal variable. Results: The distribution of individual polymorphisms and three-marker haplotypes was similar in healthy children and SRNS patients (all p values >0.05). The GTA haplotype was associated with a higher GC sensitivity, as determined by TPR, and was found to be more prevalent in early (response ≤7 days) than late (response >7 days) prednisone responders (27.7 vs. 14.5%, hap-score = −2.22, p = 0.05 adjusted for biopsy results). These results are in agreement with those reported earlier on an association of intron B haplotypes with GC sensitivity. The distribution of GC polymorphisms among the residents of north-eastern Poland was also determined.

The study was aimed at investigating the association between MDR-1 genetic polymorphisms [C1236T, G2677T(A), C3435T] and parameters describing the clinical course and treatment response of childhood steroid-responsive nephrotic syndrome (SRNS). Three MDR-1 genetic markers were analyzed in 108 children diagnosed with SRNS and in 135 healthy controls with neither allergic nor renal disease. All subjects were genotyped by PCR-restriction fragment length polymorphism (RFLP) analysis, and an EM algorithm-based analysis was utilized to estimate haplotype frequencies. As expected, there was no difference in genotypic and allelic distribution between and among SRNS patients and healthy children. However, all individual polymorphisms were strongly associated with time to response to initial prednisone therapy. The frequencies of the mutated alleles were higher in late responders (time to remission: >7 days) to oral prednisone (0.53, 0.52,0.66) than in early responders (time to remission

Cardiovascular mortality is increased in chronic kidney diseases. Patients' survival correlates with hemoglobin concentration. Anemia significantly affects cardiovascular system, especially the heart. Heart failure, anemia and chronic renal failure are mutually related. Recently, cardio-renal-anemia syndrome (CRAS) was defined. Iron replacement and EPO treatment can break the pathogenetic circle of events leading to heart failure. Increased hemoglobin concentration can also induce a positive impact on renal function. Early diagnosis and correction of anemia has a substantial role in prophylaxis of left ventricular hypertrophy in patients with chronic renal insufficiency.

Contemporary view on diagnosis and treatment of paraproteinemia is presented dealing particularly with nephrological implications. Treatment of multiple myeloma including new drugs is presented in details. Treatment of cryofibrinogenemia and amyloidosis are also reviewed.