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The improvement seen in the diagnostic procedures and treatment of thoracic tumours means that patients have an increased chance of longer overall survival. Nevertheless, we can still find those who have had a recurrence or developed a secondary cancer in the previously treated area. These patients require retreatment including re-irradiation. We have reviewed the published data on thoracic re-irradiation, which shows that some specific healthy tissues can tolerate a significant dose of irradiation and these patients benefit from aggressive treatment; however, there is a risk of damage to normal tissue under these circumstances. We analysed the literature data on re-irradiation in the areas of vertebral bodies, spinal cord, breast, lung and oesophagus. We evaluated the doses of primary and secondary radiotherapy, the treatment techniques, as well as the local control and median or overall survival in patients treated with re-radiation. The longest OS is reported in the case of re-irradiation after second breast-conserving therapy where the 5-year OS range is 81 to 100% and is shorter in patients with loco-reginal re-irradiation where the 5-y OS range is 18 to 60%. 2-year OS in patients re-irradiated for lung cancer and oesophagus cancer range from 13 to 74% and 18 to 42%, respectively. Majority grade ≥3 toxicity after second breast-conserving therapy was fibrosis up to 35%. For loco-regional breast cancer recurrences, early toxicity occurred in up to 33% of patients resulting in mostly desquamation, while late toxicity was recorded in up to 23% of patients and were mostly ulcerations. Early grade ≥3 lung toxicity developed in up to 39% of patients and up to 20% of Grade 5 hemoptysis. The most frequently observed early toxicity grade ≥3 in oesophageal cancer was oesophagitis recorded in up to 57% of patients, followed by hematological complications which was recorded in up to 50% of patients. The most common late complications included dysphagia, recorded in up to 16.7% of patients. We have shown that thoracic re-irradiation is feasible and effective in achieving local control in some patients. Re-irradiation should be performed with maximum accuracy and care using the best available treatment methods with a highly conformal, image-guided approach. Due to tremendous technological progress in the field of radiotherapy, we can deliver radiation precisely, shorten the overall treatment time and potentially reduce treatment-related toxicities.

Hepatocellular carcinoma (HCC) is the most common primary liver cancer and a major cause of cancer-related morbidity and mortality around the world. Frequently, concurrent liver dysfunction and variations in tumor burden make it difficult to design effective and standardized treatment pathways. Contemporary treatment guidelines designed for an era of personalized medicine should consider these features in a more clinically meaningful way to improve outcomes for patients across the HCC spectrum. Given the heterogeneity of HCC, we propose a detailed clinical algorithm for selecting optimal treatment using an evidence-based and practical approach, incorporating liver function, tumor burden, the extent of disease, and ultimate treatment intent, with the goal of individualizing clinical decision making.

The Hoffa fracture is an extremely rare injury of one or two condyles of the femur in the frontal plane, more often associated with injury to other structures of the knee joint area. The main cause of the Hoffa fracture is considered to be a high-energy injury (road accident in 80.5% of cases). The isolated Hoffa fracture accounts for 0.65% of all femoral fractures. To date, there is no consensus on surgical approach or optimal technique of internal fixation for the frontal fracture of the femoral condyles. There is also a large percentage of mistakes in the X-ray diagnosis of this pathology. The existing classifications have not found wide application in clinical practice, being difficult and inapplicable for solving the issue of treatment tactics and preoperative planning. The aim of the study is to present modern views on the diagnosis, principles and techniques of surgical treatment of patients with the Hoffa fractures based on the analysis of the literature. Based on the analyzed literature, conclusions are drawn about the need for careful collection of injury anamnesis, increased surgeon caution in the presence of this injury clinical picture and the simultaneous absence of pathology on standard knee joint X-rays, the need to perform an additional examination in the form of lateral (non-standard) projections of the knee joint X-rays, CT or MRI. During preoperative planning, preference should be given to minimally invasive technologies, including arthroscopically-associated methods of treatment.

BACKGROUND: The placement of a pulmonary-to-systemic arterial shunt in children with severe pulmonary hypertension (PH) has been demonstrated, in relatively small studies, to be an effective palliation for their disease.OBJECTIVES: The aim of this study was to expand upon these earlier findings using an international registry for children with PH who have undergone a shunt procedure.METHODS: Retrospective data were obtained from 110 children with PH who underwent a shunt procedure collected from 13 institutions in Europe and the United States.RESULTS: Seventeen children died in-hospital postprocedure (15%). Of the 93 children successfully discharged home, 18 subsequently died or underwent lung transplantation (20%); the mean follow-up was 3.1 years (range: 25 days to 17 years). The overall 1- and 5-year freedom from death or transplant rates were 77% and 58%, respectively, and 92% and 68% for those discharged home, respectively. Children discharged home had significantly improved World Health Organization functional class (P < 0.001), 6-minute walk distances (P = 0.047) and lower brain natriuretic peptide levels (P < 0.001). Postprocedure, 59% of children were weaned completely from their prostacyclin infusion (P < 0.001). Preprocedural risk factors for dying in-hospital postprocedure included intensive care unit admission (hazard ratio [HR]: 3.2; P = 0.02), mechanical ventilation (HR: 8.3; P < 0.001) and extracorporeal membrane oxygenation (HR: 10.7; P < 0.001).CONCLUSIONS: A pulmonary-to-systemic arterial shunt can provide a child with severe PH significant clinical improvement that is both durable and potentially free from continuous prostacyclin infusion. Five-year survival is comparable to children undergoing lung transplantation for PH. Children with severely decompensated disease requiring aggressive intensive care are not good candidates for the shunt procedure.

Background The vaccine is a preparation of biological origin containing antigens that stimulate the body’s immune system to produce acquired immunity. Vaccines can contain killed or “live” (attenuated) microorganisms as well as fragments of these (antigens). Although many vaccines are used routinely in pregnancy to provide a seroprotective immune response for mother, fetus and neonate there is much controversy over their use during this unique time. The aim of the study was to find out about the knowledge of adult Poles on the use of preventive vaccinations during pregnancy. Methods The study involved 700 people (100%) aged 18 to 80 years ($$ \overline{x} $$ x ¯ = 32.16 ± 16.46). Most of the respondents were women (511; 73%). The study consisted of 9 questions about preventive vaccinations of pregnant women and 5 questions about members of the studied group. The aforementioned questions formed the basis of the preparation of the presented article. Results A significant part of respondents (322; 46%) did not have knowledge on the topic of safeness of using preventive vaccinations during pregnancy, 196 (28%) respondents believed that such procedure is not safe. Most of the respondents (371; 53%) did not know about the possibility of using “live” vaccines during pregnancy. 14 (2%) of respondents believed that pregnancy should be terminated in case of administration of a “live” vaccine to a pregnant woman. According to 294 (42%) respondents, vaccinations with “live” vaccines should be completed at least 3 months before the planned pregnancy. The subjects were not aware of the issue of post-exposure vaccination against tetanus and rabies among pregnant women. The respondents’ responses were divided on the issue of the safest trimester of pregnancy for vaccine administration. Almost 1/3 of the respondents (203; 29%) indicated the third trimester as the safest for their performance. Conclusion The knowledge of the surveyed group, the majority of whom were women, about the use of vaccinations before and during pregnancy was unsatisfactory. There is a need to educate the public about the benefits and risks of performing or avoiding preventive vaccinations during pregnancy.

Relevance. The paper demonstrates the need to implement modern diagnostic techniques for diagnosis of precancerous and cancerous lesions at early or preclinical stages. Additional diagnostic methods are necessary, e.g. tissue autofluorescence, which allows revealing insidious pathological risk zones, particularly precancerous and cancerous lesions, to evaluate the condition of the oral tissues in patients with chronic oral mucosa disorders, especially caused by trauma. Purpose – to assess trauma-specific effectiveness of autofluorescence spectroscopy (AFS) in risk group patients with chronic trauma of the oral mucosa to reveal early malignization signs.Materials and methods. 25 subjects were selected for the study and divided into 2 groups: main group – 20 patients with different manifestations of chronic oral mucosa trauma; control group – 5 subjects without visible clinical manifestations and without oral trauma factors. Autofluorescence spectroscopy was performed in both groups using AFS-400 stomatoscope.Results. The received data demonstrated that the change in autofluorescence doesn’t allow drawing final conclusions on the presence or absence of chronic oral trauma malignization signs.Conclusion. AFS-400 stomatoscope may be effective in differentiating between healthy and damaged tissues, but there is no solid evidence that the change in fluorescence shade can help differentiate between various types of damaged tissues. Autofluorescence spectroscopy should be considered as an additional method for examination of patients with chronic oral mucosa trauma to reveal early malignization signs.

OBJECTIVE Our objective was to determine the incidence and risk factors for intravenous acetazolamide-associated acute kidney injury (AKI).METHODS We utilized a retrospective cohort study including patients RESULTS A total of 868 patients met study criteria (male 55.8%, median age 0.66 years [IQR 0.19, 3.0 years]). Intravenous acetazolamide was administered at 5.1 ± 2.8 mg/kg/dose for a median of 4 doses (IQR 2, 6). Median baseline SCr was 0.28 mg/dL (IQR 0.22, 0.37), corresponding to a creatinine clearance of 115 ± 55 mL/min/1.73 m2. Acute kidney injury occurred in 26.8% (n = 233) of patients (stage I = 20.1%, stage II = 3.7%, stage III 3.1%), and no patients received renal replacement therapy. An ordinal logistic regression model identified an increased odds of AKI with cyclosporine, ethacrynic acid, and piperacillin-tazobactam administration.CONCLUSIONS Acute kidney injury occurs frequently in critically ill pediatric patients receiving intravenous acetazolamide.

Lucilia sericata bottle fly worms can be used to heal infected, chronic, or necrotic wounds, including those associated with ulceration and diabetic foot. The study aimed to evaluate changes in the microflora in patients treated with L sericata larvae due to leg ulcers and diabetic foot. One hundred twenty‐nine patients diagnosed with lower limb ulceration and diabetic foot were enrolled in the study, of which 80 of them met the eligibility criteria for maggot debridement therapy (MDT). On the contrary, 49 unqualified patients were offered ozone therapy (22 with leg ulcers; 27 with diabetic foot). In each of these patients, a microbiological swab was performed before and after the start of therapy. The group of 80 patients was further divided into four equal groups in terms of the treated area (lower leg vs foot) and the number of larvae/cm2 (5 vs 10). Twenty‐three particular species of bacteria in the infected wound were studied microbiologically in terms of presence/absence within the wound environment before and after treatment of patients with diabetic foot and lower limb ulceration. It was noted that there was a more intensive bacterial accumulation in the feet of patients compared to legs; furthermore, this applies to almost all analysed species. Diabetes status is also a clinical factor that generates a lower chance of bacterial appearance in the wound environment. Densification of MDT larvae per wound area unit also reduced the chance of the presence of Corynebacterium species, Enterobacteriaceae, Pseudomonas aeruginosa, Staphylococcus aureus MSSA, and Streptococcus coagulase negativa; however, it increased the likelihood of occurrence for Proteus mirabilis and the Proteus species. A microbiological analysis in this non‐reference study shows the efficacy of larval therapy for leg and foot ulcers. Rearrangement of the microflora within the wound has been reported as a result of the therapy.

International audience; Introduction: COVID-19 lockdown measures have been sources of both potential stress and possible psychological and addiction complications. A lack of activity and isolation during lockdown are among the factors thought to be behind the growth in the use of psychoactive substances and worsening addictive behaviors. Previous studies on the pandemic have attested to an increase in alcohol consumption during lockdowns. Likewise, data suggest there has also been a rise in the use of cannabis, although it is unclear how this is affected by external factors. Our study used quantitative data collected from an international population to evaluate changes in cannabis consumption during the lockdown period between March and October, 2020. We also compared users and non-users of the drug in relation to: (1) socio-demographic differences, (2) emotional experiences, and (3) the information available and the degree of approval of lockdown measures. Methods: An online self-report questionnaire concerning the lockdown was widely disseminated around the globe. Data was collected on sociodemographics and how the rules imposed had influenced the use of cannabis and concerns about health, the economic impact of the measures and the approach taken by government(s). Results: One hundred eighty two respondents consumed cannabis before the lockdown vs. 199 thereafter. The mean cannabis consumption fell from 13 joints per week pre-lockdown to 9.75 after it (p < 0.001). Forty-nine respondents stopped using cannabis at all and 66 admitted to starting to do so. The cannabis users were: less satisfied with government measures; less worried about their health; more concerned about the impact of COVID-19 on the economy and their career; and more frightened of becoming infected in public areas. The risk factors for cannabis use were: age (OR = 0.96); concern for physical health (OR = 0.98); tobacco (OR = 1.1) and alcohol consumption during lockdown (OR = 1.1); the pre-lockdown anger level (OR = 1.01); and feelings of boredom during the restrictions (OR = 1.1). Conclusion: In a specific sub-population, the COVID-19 lockdown brought about either an end to the consumption of cannabis or new use of the drug. The main risk factors for cannabis use were: a lower age, co-addictions and high levels of emotions. Methods: An online self-report questionnaire concerning the lockdown was widely disseminated around the globe. Data was collected on sociodemographics and how the rules imposed had influenced the use of cannabis and concerns about health, the economic impact of the measures and the approach taken by government(s).Results: One hundred eighty two respondents consumed cannabis before the lockdown vs. 199 thereafter. The mean cannabis consumption fell from 13 joints per week pre-lockdown to 9.75 after it (p < 0.001). Forty-nine respondents stopped using cannabis at all and 66 admitted to starting to do so. The cannabis users were: less satisfied with government measures; less worried about their health; more concerned about the impact of COVID-19 on the economy and their career; and more frightened of becoming infected in public areas. The risk factors for cannabis use were: age (OR = 0.96); concern for physical health (OR = 0.98); tobacco (OR = 1.1) and alcohol consumption during lockdown (OR = 1.1); the pre-lockdown anger level (OR = 1.01); and feelings of boredom during the restrictions (OR = 1.1).Conclusion: In a specific sub-population, the COVID-19 lockdown brought about either an end to the consumption of cannabis or new use of the drug. The main risk factors for cannabis use were: a lower age, co-addictions and high levels of emotions.

The beneficial use of chemicals in modern human society inevitably leads to their emission into the environment. Pharmaceuticals are crucial for improving and safeguarding public health, whether treating acute infections with historically poor prognoses or increasing the length and quality of our lives by treating chronic conditions such as cardiovascular diseases, cancer, endocrine disorders and improving psychiatric well-being. The use of pharmaceuticals is unlikely to diminish and as such we expect their continuous or even increasing discharge into aquatic and terrestrial environments, predominantly through excretion by patients. This article is protected by copyright. All rights reserved.

Urinary tract infections (UTIs) are one of the most common reasons for antibiotic prescriptions among women worldwide. UTIs are also associated with intra- and postoperative catheterization, which is an essential component of many gynecological surgical procedures, including midurethral sling (MUS) placement. The aim of this study was to compare the incidence of UTI subsequent to a MUS procedure. The study involved 562 female patients who underwent MUS procedures due to stress urinary incontinence (SUI). Patients were assigned in a 1:1 ratio to two study groups: patients receiving 500 mg of ciprofloxacin three times a day for 3 consecutive days after surgery or patients receiving 5 mL of Canephron taken orally three times a day for 3 weeks. After analyzing the collected data, it was found that in the group of patients receiving ciprofloxacin, 29 women (10.98 %) had a UTI, whereas in the group of patients receiving Canephron, 36 women (13.64 %) had a UTI within 6 months after the patient’s MUS procedure. No statistically significant difference between the two groups was noted. Postoperative prophylaxis with a phytodrug can be perceived as an attractive option in the reduction of antibiotic consumption among female patients after a MUS procedure.

The influence of various rhythmic extreme cold effects on the state of autonomic regulation of heart rate in young and aged rats was studied. According to the spectral analysis of heart rate variability, it has been found that in young rats, using rhythmic extreme cold exposures (RECE) temperature regimens of (-120 °С; -120 °С; -120 °С) and (-60 °С; -120 °С; -120 °С) significantly increased adaptive capabilities of the body due to the activation of its own homeostatic regulatory systems. At the same time, the combined regimen of RECE (-60 °С; 120 °С; -120 °С) occurred to be the most optimal for aged animals, since its use was not accompanied with an excessive activation of sympathoadrenal system at the early stages of experimental studies, in contrast to the regimen (120 °С; -120 °С; -120 °С). In addition, the use of this cooling mode contributed to a statistically significant increase in the total power of spectrum of neurohumoral regulation not so much due to a rise in activity of humoral-metabolic regulation link, the prevalence of which is characteristic of an old age, but due to an increase in the tone of vegetative centers, herewith the parasympathetic effects on the myocardium prevailed sympathetic ons.

The expression of the C-type natriuretic peptide (CNP) gene has been detected in the growth cartilage of the long bones and vertebrae. This article provides an overview of the role of CNP in bone growth and presents the results of the authors' research on the concentration of the NTproCNP and its relationship with growth velocity and bone markers in healthy school-age children.The study involved 75 girls and 59 boys aged from 9.0-11.8 years (mean 10.29±0.74). Body weight, height and lower limb length were measured, and blood samples were collected twice at six-month intervals. In the first serum sample, the concentrations of NTproCNP, C-terminal propeptide type I (CICP), C-terminal telopeptide type I collagen (ICTP) osteocalcin (OC) and bone-specific alkaline phosphatase (BAP) were determined. In the second sample, NTproCNP concentration was assessed.During the six-month follow-up period, the increase in body height and weight of girls was greater than boys (p0.000; p=0.003, respectively). While during the first examination the concentration of NTproCNP in girls and boys was similar, during the second examination it was higher in girls than in boys (p=0.04). Weak positive correlations between the increase in body height and NTproCNP, CICP, BAP as well as OC were found. There were no correlations between NTproCNP and the bone markers.The results suggest that NTproCNP concentration depends on growth velocity in children. There is increasing evidence that a better knowledge of CNP biology contributes to a better understanding of bone growth mechanisms.

Laura Kulik,1 Leonardo G da Fonseca,2 Aiwu Ruth He,3 Jordi Rimola,4 Andrea Wilson Woods,5 York F Zöllner,6 Peter R Galle7 1Northwestern University, Chicago, IL, USA; 2Clinical Oncology, Instituto do Cancer do Estado de São Paulo, São Paulo, Brazil; 3Georgetown University, Washington, DC, USA; 4Radiology Department, Hospital Clínic de Barcelona, Barcelona, Catalonia, Spain; 5Blue Faery: The Adrienne Wilson Liver Cancer Association, Birmingham, AL, USA; 6Hamburg University of Applied Sciences, Competence Center Health, Hamburg, Germany; 7University Medical Centre Mainz, Mainz, GermanyCorrespondence: Peter R GalleUniversity Medical Centre Mainz, Mainz, GermanyTel +49 6131 177275Email Peter.Galle@unimedizin-mainz.deAbstract: A virtual expert roundtable was convened on April 16, 2020, to discuss the evolving landscape of care for treating patients with advanced hepatocellular carcinoma (HCC) and discuss questions related to patient care and treatment selection. This commentary presents highlights from this discussion and provides an expert opinion about approaches to treatment for HCC in the Americas and the European Union. We anticipate that atezolizumab plus bevacizumab will become the standard of care for advanced HCC patients. However, this approach will make decisions regarding the sequencing of treatments for second-line therapies and beyond more challenging. Therapy will require individualization based on patient characteristics and preferences, while insurance coverage decisions and requirements may also impact the options that patients can access. Additional research regarding prognostic and predictive biomarkers is needed to help better identify optimal treatment approaches for specific patient populations. Multidisciplinary tumor boards will continue to play a critical role in guiding treatment selection for individual patients. Atezolizumab plus bevacizumab offers a promising new first-line therapeutic option for patients with advanced HCC, but more research is needed to optimize and individualize patient therapy.Keywords: hepatocellular carcinoma, immuno-oncologics, biomarkers, patient-reported outcomes

BACKGROUND AND AIMS Radioembolization (yttrium-90 [Y90]) is used in hepatocellular carcinoma (HCC) as a bridging as well as downstaging liver-directed therapy to curative liver transplantation (LT). In this study, we report long-term outcomes of LT for patients with HCC who were bridged/downstaged by Y90. APPROACH AND RESULTS Patients undergoing LT following Y90 between 2004 and 2018 were included, with staging by United Network for Organ Sharing (UNOS) tumor-node-metastasis criteria at baseline pre-Y90 and pre-LT. Post-Y90 toxicities were recorded. Histopathological data of HCC at explant were recorded. Long-term outcomes, including overall survival (OS), recurrence-free survival (RFS), disease-specific mortality (DSM), and time-to-recurrence, were reported. Time-to-endpoint analyses were estimated using Kaplan-Meier. Univariate and multivariate analyses were performed using a log-rank test and Cox proportional-hazards model, respectively. During the 15-year period, 207 patients underwent LT after Y90. OS from LT was 12.5 years, with a median time to LT of 7.5 months [interquartile range, 4.4-10.3]. A total of 169 patients were bridged, whereas 38 were downstaged to LT. Respectively, 94 (45%), 60 (29%), and 53 (26%) patients showed complete, extensive, and partial tumor necrosis on histopathology. Three-year, 5-year, and 10-year OS rates were 84%, 77%, and 60%, respectively. Twenty-four patients developed recurrence, with a median RFS of 120 (95% confidence interval, 69-150) months. DSM at 3, 5, and 10 years was 6%, 11%, and 16%, respectively. There were no differences in OS/RFS for patients who were bridged or downstaged. RFS was higher in patients with complete/extensive versus partial tumor necrosis (P

The evolution of locoregional therapies in the last decade has been refined with improved patient selection and a development of a more personalized approach. In doing so, there has been associated improved outcomes and less toxicity. With the rapidly changing landscape of systemic therapy, the role of locoregional therapies alone or in combination for downstaging and curative intent will continue to evolve.

Prognostic models to predict individual early postoperative morbidity after liver resection for colorectal liver metastases (CLM) are not available but could enable optimized preoperative patient selection and postoperative surveillance for patients at greater risk of complications. The aim of this study was to establish a prognostic model for the prediction of morbidity after liver resection graded according to Dindo.N = 679 cases of primary liver resection for CLM were retrospectively analyzed using univariable and multivariable ordinal regression analyses. Receiver operating characteristics curve (ROC) analysis was utilised to assess the sensitivity and specificity of predictions and their potential usefulness as prognostic models. Internal validation of the score was performed using data derived from 129 patients.The final multivariable regression model revealed lower preoperative levels, a greater number of units of intraoperatively transfused packed red blood cells (pRBCs), longer duration of surgery, and larger metastases to independently influence postoperatively graded morbidity. ROC curve analysis demonstrated that the multivariable regression model is able to predict each individual grade of postoperative morbidity with high sensitivity and specificity. The areas under the receiver operating curves (AUROC) for all of these predictions of individual grades of morbidity were 0.700, indicating potential usefulness as a predictive model. Moreover, a consistent concordance in Grades I, II, IV, and V according to the classification proposed by Dindo et al. was observed in the internal validation.This study proposes a prognostic model for the prediction of each grade of postoperative morbidity after liver resection for CLM with high sensitivity and specificity using pre- and intraoperatively available variables.Prognostische Modelle zur Vorhersage der individuellen früh-postoperativen Morbidität nach Leberresektion von kolorektalen Lebermetastasen sind nicht verfügbar, könnten aber eine optimierte präoperative Patientenselektion und postoperative Überwachung von Patienten mit erhöhtem Risiko ermöglichen. Ziel dieser Studie war daher ein prognostisches Modell für die Vorhersage der Morbidität nach Leberresektion klassifiziert nach Dindo zu etablieren.N = 679 Fälle von primären Leberresektionen kolorektaler Lebermetastasen wurden retrospektiv unter Nutzung von multivariabel und ordinalen Regressionsanalysen ausgewertet. Analysen der Receiver operating characteristics curve (ROC) wurden zur Überprüfung der Sensitivität und Spezifität der Vorhersagen und der potenziellen Bedeutung als prognostisches Modell eingesetzt. Das Modell wurde anhand weiterer 129 Fälle intern validiert.Das finale multivariable Regressionsmodel zeigte für niedrige präoperative Hb-Werte, hohen intraoperativen Transfusionsbedarf, lange OP-Zeiten sowie größere Metastasen einen deutlichen Einfluss auf die postoperative Morbidität. Die Analyse der ROC-curve beweist die Fähigkeit des multivariable Regressionsmodels die einzelnen Grade postoperativer Morbidität mit hoher Spezifität und Sensitivität vorherzusagen. Die “Area under the receiver operating curve” (AUROC) für die Vorhersage aller einzelnen Morbiditätsgrade von 0,700 unterstreicht den potenziellen Nutzen als prognostisches Model. Die interne Validierung zeigt eine klare Konkordanz hinsichtlich der Grade I, II, IV und V nach Dindo.Diese Studie schlägt ein prognostisches Modell für die Vorhersage der postoperativen Morbidität nach Leberresektion von kolorektalen Lebermetastasen mit hoher Sensitivität und Spezifität unter Nutzung von prä- und intraoperativen Variablen vor.

Annotation. Among gynecological diseases, external genital endometriosis leads to disorders of reproductive function and promotes the development of infertility. Currently, the search for less traumatic and more effective treatments for endometriosis continues. The aim of our study was to analyze the diameter of endometrioid cysts in women with infertility on the background of endometriosis before and after sclerotherapy using pre-pregnancy preparation of a complex vitamin preparation with inositol and vitamin D3. The study included 105 women aged 22 to 40 years with endometriosis-associated infertility. The presence of cysts was confirmed by ultrasound and bimanual examination. The drug FT 500 plus was prescribed in a dosage of 1 sachet – once a day from the 2nd or 3rd day of the cycle for 2 menstrual cycles (the cycle in which sclerotherapy was performed and the next cycle). Vitamin D3 “EuTilia D3” was prescribed in prophylactic doses of 2000 IU to women, or therapeutic (depending on the diagnosed or refuted diagnosis of vitamin D hypovitaminosis). The sclerotherapy procedure was performed by transvaginal puncture of the cyst and aspiration of its contents under the control of transvaginal ultrasound, introduction into the capsule of the cyst (without violating its integrity) 76% ethanol solution. It was found that women with endometriosis-associated infertility, who underwent pre-pregnancy preparation with a complex vitamin preparation with inositol and vitamin D3 after sclerotherapy, probably decreased the diameter of cysts in the right (5.85 times) and left (5.57 times) ovaries relative to data before sclerotherapy. When comparing the diameter of cysts in women who underwent pre-pregnancy preparation with a complex vitamin preparation with inositol and vitamin D3, depending on the type of surgery (sclerotherapy or cystectomy) found a probable decrease in the diameter of cysts after sclerotherapy in the right (82.89%) and left (82.05%) ovaries for such data after cystectomy. Therefore, sclerotherapy with pregravidar preparation with a complex vitamin preparation with inositol and vitamin D3 in women with endometriosis-associated infertility probably reduces the diameter of cysts relative to the experimental group without pregravidar preparation, as well as to the group with a history of cystectomy.

Background: Hepatic steatosis and chemotherapy in the treatment of colorectal liver metastases (CLM) are often linked to increased mortality and morbidity after liver resection. This study evaluates the influence of macrovesicular hepatic steatosis and chemotherapeutic regimes on graded morbidity and mortality after liver resection for CLM. Methods: A total of 323 cases of liver resection for CLM were retrospectively analysed using univariable and multivariable linear, ordinal and Cox regression analyses. The resected liver tissue was re-evaluated by a single observer to determine the grade and type of hepatic steatosis. Results: Macrovesicular steatosis did not influence postoperative morbidity and survival, as evidenced by risk-adjusted multivariable Cox regression analysis (p = 0.521). Conversion chemotherapy containing oxaliplatin was an independent and significant risk factor for mortality in risk-adjusted multivariable Cox regression analysis (p = 0.005). Identified independently, significant risk factors for postoperative morbidity were neoadjuvant treatment of metastases of the primary tumour with irinotecan (p = 0.003), the duration of surgery in minutes (p = 0.001) and the number of intraoperatively transfused packed red blood cells (p ≤ 0.001). Surprisingly, macrovesicular hepatic steatosis was not a risk factor for postoperative morbidity and was even associated with lower rates of complications (p = 0.006). Conclusion: The results emphasize the multifactorial influence of preoperative liver damage and chemotherapy on the severity of postoperative morbidity, as well as the significant impact of conversion chemotherapy containing oxaliplatin on survival.

BACKGROUND High-dose atorvastatin did not improve 1-year vein graft patency in the recent Aggressive Cholesterol Therapy to Inhibit Vein Graft Events trial. However, it remains unknown whether high-intensity statins may impact graft disease in the years that follow. METHODS In the trial, patients (N = 173) were randomized to receive atorvastatin 10 or 80 mg for 1 year after coronary bypass surgery (CABG). Beyond 1 year, the choice of statin was left to the patient's physician. In this study of participants who agreed to follow-up (N = 76), low-density lipoprotein (LDL) levels were measured and graft patency was assessed 3 years after surgery. RESULTS The rate of vein graft disease 3 years after surgery was not significantly reduced with atorvastatin 80 mg during the first postoperative year or the use of open-label high-intensity statin thereafter (p = NS). However, a trend was observed between higher LDL levels during the first postoperative year and a greater incidence of vein graft disease at 3 years (p = .12). Among patients who had LDL levels more than 90 mg/dl in the first year after CABG, 38.5% had vein graft disease at 3 years, compared to 19.0% for those with LDL levels less than 90 mg/dl (p = .15). Higher mean LDL levels during the first postoperative year were associated with a higher rate of vein disease 3 years after surgery both at the graft level (p = .03) and at the patient level (p = .03) in multivariate analysis. CONCLUSIONS Higher LDL levels during the first postoperative year were associated with significantly greater vein graft disease 3 years after CABG.

Chronic Graft versus Host Disease (cGvHD) is an important cause of late non-relapse morbidity and mortality following allogeneic hemopoietic stem cell transplantation (allo-HSCT) [1]. The incidence...

Introduction: In recent years, numerous studies have focused on the analysis of the primary mechanisms and forms of therapy in children and adolescents with attention deficit hyperactivity disorder (ADHD). The analysis of such topics among similarly diagnosed young adults is only beginning to gain popularity. The present article attempts to answer the question of whether the level of individual temperament traits will predict an increase in the severity of ADHD symptoms in young adults. Materials and methods: The questionnaire study involved 111 young adults aged from 18 to 28 (M= 23; SD= 2.12; 70 women and 41 men). Fifty-one people were included in the clinical group, and sixty were qualified for the control one. The participants of the study completed a health questionnaire and a structured diagnostic interview on ADHD symptoms in adults (DIVA 2.0) and a questionnaire for the diagnosis of basic, biologically determined dimensions of human personality (FCZ-KT (R)). Results: The results indicate a significant role of four temperament traits that may be considered as specific risk factors for the aggravation of ADHD symptoms. These include briskness, rhythm, endurance and activity. Conclusions: In Strelau's Regulatory Theory of Temperament, the variability of temperament traits (in the Polish population) is attributed in 44% to genetic factors. The remaining 56% indicate non-genetic factors. The obtained results may indicate which factors are important in therapeutic work both in the group of young adults with ADHD symptoms, and may also constitute a source of information for parents or teachers regarding younger children with these symptoms. Wstęp: Na przestrzeni ostatnich lat przedmiotem wielu badań była analiza mechanizmów pierwotnych i form terapii dzieci i młodzieży z zespołem nadpobudliwości psychoruchowej z zaburzeniami uwagi (ADHD). Analiza podobnej tematyki wśród młodych dorosłych z tą diagnozą dopiero współcześnie zaczyna zyskiwać na popularności. W niniejszym artykule podjęto próbę odpowiedzi na pytanie czy nasilenie poszczególnych cech temperamentu będzie przewidywało wzrost nasilenia objawów ADHD u młodych dorosłych. Materiał i metoda: W badaniu kwestionariuszowym wzięło udział 111 osób w wieku od 18 do 28 lat (M=23; SD=2,12; 70 kobiet i 41 mężczyzn). Do grupy klinicznej włączono 51 osób, zaś do grupy kontrolnej zakwalifikowano 60 osób. Uczestnicy badań uzupełniali ankietę stanu zdrowia oraz ustrukturalizowany wywiad diagnostyczny dotyczący objawów ADHD u dorosłych (DIVA 2.0) i kwestionariusz do diagnozy podstawowych, biologicznie zdeterminowanych wymiarów osobowości człowieka (FCZ - KT (R)). Wyniki: Wskazują na istotną rolę czterech czynników temperamentalnych, które mogą być uznane za swoiste czynniki ryzyka nasilenia objawów ADHD. Należą do nich żwawość, rytmiczność, wytrzymałość i aktywność. Dyskusja: W Regulacyjnej Teorii Temperamentu Strelaua zmienność cech temperamentu (w polskiej populacji) przypisuje się w 44% czynnikom genetycznym. Pozostałe 56% wskazuje na czynniki pozagenetyczne (56%). Uzyskane wyniki mogą wskazywać jakie czynniki są istotne w pracy terapeutycznej w grupie młodych dorosłych z objawami ADHD, jak również mogą stanowić źródło informacji dla rodziców, czy nauczycieli względem młodszych dzieci z tymi objawami.

Purpose The purpose of this study was to describe medical device-related pressure injuries (MDRPIs) in hospitalized pediatric patients. Design A prospective, descriptive study. Sample/subjects and setting The sample comprised 625 patients cared for in 8 US pediatric hospitals. Participants were aged preterm to 21 years, on bed rest for at least 24 hours, and had a medical device in place. Methods Two nursing teams, blinded to the other's assessments, worked in tandem to assess pressure injury risk, type of medical devices in use, and preventive interventions for each medical device. They also identified the presence, location, and stage of MDRPI. Subjects were observed up to 8 times over 4 weeks, or until discharge, whichever occurred first. Results Of 625 enrolled patients, 42 (7%) developed 1 or more MDRPIs. Two-thirds of patients with MDRPIs were younger than 8 years. Patients experiencing MDRPIs had higher acuity scores on hospital admission, were more frequently cognitively and/or functionally impaired, or were extreme in body mass index. Respiratory devices caused the most injuries (6.19/1000 device-days), followed by immobilizers (2.40/1000 device-days), gastric tubes (2.24/1000 device-days), and external monitoring devices (1.77/1000 device-days). Of the 6336 devices in place, 36% did not have an MDRPI preventive intervention in place. Clinical variables contributing to MDRPI development included intensive care unit care (odds ratio [OR] 8.9, 95% confidence interval [CI] 1.9-43.6), use of neuromuscular blockade (OR 3.7, 95% CI 1.7-7.8), and inotropic/vasopressor medications (OR 2.7, 95% CI 1.7-4.3). Multivariable analysis indicated that Braden QD scores alone predicted MDRPI development. Conclusion Medical devices are common in hospitalized infants and children and these medical devices place patients at risk for MDRPI.

Background Aortic annular erosion is a serious complication of aortic valve endocarditis or previous aortic valve replacement. This study examined the outcomes of a technique for left ventricular outflow tract reconstruction using a polyester tube graft, followed by translocation of the aortic valve and coronary arteries. Methods A total of 23 patients with extensive annular erosion resulting from endocarditis or previous aortic valve replacement with or without pseudoaneurysm formation, or occurring after excision of the native valve, underwent suture of a polyester tube graft in the left ventricular outflow tract below the annulus, replacement of the aortic valve and proximal ascending aorta with a composite graft, and reimplantation of the coronary arteries with the use of interposition polyester grafts. The mean age of the patients was 50 years, and 57% were men. Results There were no hospital deaths. The mean duration of follow-up was 6.5 years and extended to 16 years. Actuarial survival at 1, 5, and 10 years was 86.7%, 82.2%, and 62.6%, respectively. Two patients required reoperation for a graft-graft pseudoaneurysm and for degeneration of a porcine bioprosthesis. Echocardiograms obtained at a mean of 75 months postoperatively in 15 of the 23 patients demonstrated normal left ventricular outflow tract dimensions and velocities and a mean effective valve orifice area of 1.07 cm2/m2. All coronary artery grafts were patent on angiography a mean of 40 months postoperatively in 13 patients. Conclusions Extended experience with this technique confirms its safety and effectiveness for patients with extensive destruction of the aortic annulus. It represents a suitable alternative to other currently used techniques.

IIntroduction The scope of examination of patients with closed intraarticular fractures of the calcaneus against the background of concomitant pathology has been discussed up to date. The aim of the study was to improve the accuracy of predicting the nature of postoperative wound healing after osteosynthesis of intra-articular fractures of the calcaneus from the extended lateral approach on the background of chronic obliterating diseases of the lower limb arteries of different etiology, smoking and a combination of these factors. Material and methods Sixty-nine patients who were smokers and/or suffered from chronic obliterating diseases with a total of 74 closed intra-articular fractures of the heel bones were analyzed. All patients received a comprehensive clinical and instrumental examination consisting of radiography and computed tomography of the calcaneus to determine the proximal-distal gradient (PDG), ankle-brachial index (ABI) and transcutaneous oximetry (TrOc). A single-factor analysis of variance was performed, after which an expert evaluation of the features was performed, as well as testing of models with different sets of signs. Results The disperse analysis of variance in respect of 74 cases for the relevant group of patients allowed us to obtain two models: the first with a level of statistical significance p0 less 0,001 (χ2 – 82,63; df = 7) and the predictive efficiency of 97.3 % in regard to possible complications after open reduction with internal fixation; the second level of statistical significance p0 less 0,001 (χ2 – 34,76; df = 7) and prognostic effectiveness of 93,24 % related to the risk of repeated surgical interventions. Conclusions The proposed method of predicting the development of complications in the immediate postoperative period after internal osteosynthesis of the calcaneus allows estimation of the risks of complications by calculating PDG, ABI and TrOc with high efficiency (97.3 %). The proposed discriminant model predicts the need for repeated surgical interventions with an efficiency of 93.24 %, and feasibility of surgical treatment with an extended lateral approach.

Macrovascular invasion is considered a contraindication to liver transplantation for hepatocellular carcinoma (HCC) due to a high risk of recurrence. The aim of the present multicenter study was to explore the outcome of HCC patients transplanted after a complete radiological regression of the vascular invasion by locoregional therapies and define sub-groups with better outcomes. Medical records of 45 patients were retrospectively reviewed, and imaging was centrally assessed by an expert liver radiologist. In the 30 patients with validated diagnosis of macrovascular invasion, overall survival was 60% at 5 years. Pretransplant alpha-fetoprotein (AFP) value was significantly different between patients with and without recurrence (P = 0.019), and the optimal AFP cutoff was 10ng/ml (area under curve = 0.78). Recurrence rate was 11% in patients with pretransplant AFP < 10ng/ml. The number of viable nodules (P = 0.008), the presence of residual HCC (P = 0.036), and satellite nodules (P = 0.001) on the explant were also significantly different between patients with and without recurrence. Selected HCC patients with radiological signs of vascular invasion could be considered for transplantation, provided that they previously underwent successful treatment of the macrovascular invasion resulting in a pretransplant AFP < 10 ng/ml. Their expected risk of post-transplant HCC recurrence is 11%, and further prospective validation is needed.

Multiple systemic agents have recently been approved in the first- and second-line setting for hepatocellular carcinoma (HCC), increasing the therapeutic options for patients and treating physicians. The randomised controlled trials that led to these approvals were predominantly conducted in a population comprised of patients with advanced HCC. However, these trials also included a subset of patients who had progressed after locoregional therapies (LRTs), mostly transarterial chemoembolisation. With a greater number of systemic agents available, the role of LRTs has become a topic of debate, specifically regarding when to transition to systemic therapy in unresectable HCC and the potential opportunities for combining locoregional and systemic therapies. Trials of immuno-oncology agents (notably T cell checkpoint inhibitors) are ongoing in the advanced disease setting and these agents also present opportunities for combination therapies, both with other systemic agents and with LRTs in earlier stage disease. This article will review strategies to guide patient selection for LRT as well as the development of locoregional-systemic combinations based on scientific rationale and the challenges of clinical trial design in this setting.

Background: Previous studies have shown that chloride liberal fluids may be associated with worse renal outcomes. Deterioration of kidney function during hyperchloremia/chloride overload is believed to be induced by disturbances in renal perfusion, but exact mechanisms of chloride nephrotoxicity are unclear. The purpose of this randomized, crossover study was to investigate the effect of chloride loading on renal plasma flow (RPF), filtration fraction (FF) and glomerular filtration rate (GFR) in order to elucidate potential nephrotoxic mechanisms of chloride infusion. Methods: Fifteen healthy males were investigated twice after treatment with 2L isotonic saline and plasma-lyte with a wash-out period of at least 10 days. Within 15 mins after completion of infusion, the kidney parameters (RPF, FF and GFR) were estimated by Technetium-99m diethylenetriamine penta-acetic acid (99-mTc-DTPA) renography. Results: 99-mTc-DTPA renography showed reduction in both mean GFR (114 ± 13 ml/min vs.119 ± 12 ml/min, p = 0.04) and RPF (977 ± 272 ml/min vs. 1066 ± 197 ml/min, p = 0.19) and increasing FF (12% ± 2% vs. 11% ± 2%, p = 0.19) after 0.9% saline comparing to Plasmalyte, but only GFR reduction was statistically significant. Reduction in GFR and RPF and increasing in FF after 0.9% saline was observed in 10 subjects while in 5 others the reverse trend was shown. There were no statistically significant differences between mean systolic and diastolic blood pressure (BP) before and after each infusion except baseline diastolic BP. Weight changes (Δ weight) were similar after each infusion. Conclusions: We have demonstrated that high chloride infusion can affect kidney function in healthy subjects and seems to lead to impairment in both RPF and GFR.

Low spot urinary creatinine concentration (SUCR) is a marker of muscle wasting and clinical outcome. The risk factors for low SUCR in heart failure (HF) remain poorly understood. We explored the risk factors for low SUCR related to poor outcomes. In 721 HF patients (age: 52.3 ± 11 years, female: 14%, NYHA: 2.7 ± 0.7) SUCR and Dexa body composition scans were performed. BMI prior HF-onset, weight loss, and appendicular muscle mass were obtained. Each patient was classified as malnutrition or normal by GLIM criteria and three other biochemical indices (CONUT, PNI, and GRNI). Sarcopenia index (SI) as creatinine to cystatin C ratio was also calculated. Within 1 year, 80 (11.1%) patients died. In ROC curve we identified a SUCR value of 0.628 g/L as optimally discriminating surviving from dead. In low SUCR group more advanced HF, higher weight loss and catabolic components of weight trajectory (CCWT), more frequent under-nutrition by GLIM, and lower SI were observed. In multivariate analysis the independent predictors of low SUCR were SI, CCWT, and GNRI score. In conclusion: the risk of low SUCR was associated with a worse outcome. Low SUCR was associated with greater catabolism and sarcopenia but not with biochemical indices of malnutrition.

The aim of the present study was to create spatial and spatio-temporal patterns of cutaneous malignant melanoma (MM) incidence in Upper Silesia, Poland, using the largest MM database (&lt, 4K cases) in Central Europe, focusing on the agricultural sector. The data comprised all the registered cancer cases (C43, according to the International Classification of Diseases after the 10th Revision) between the years 2004–2013 by the Regional Cancer Registries (RCRs) in Opole and Gliwice. The standardized incidence ratios (SIRs), spatio-temporal growth rates (GRs), and disease cluster relative risks (RRs) were estimated. Based on the regression coefficients, we have indicated irregularities of spatial variance in cutaneous malignant melanoma, especially in older women (≥60), and a possible age-migrating effect of agricultural population density on the risk of malignant melanoma in Upper Silesia. All the estimates were illustrated in choropleth thematic maps.

OBJECTIVES To identify independent predictors of and derive a risk score for invasive herpes simplex virus (HSV) infection. METHODS In this 23-center nested case-control study, we matched 149 infants with HSV to 1340 controls; all were ≤60 days old and had cerebrospinal fluid obtained within 24 hours of presentation or had HSV detected. The primary and secondary outcomes were invasive (disseminated or central nervous system) or any HSV infection, respectively. RESULTS Of all infants included, 90 (60.4%) had invasive and 59 (39.6%) had skin, eyes, and mouth disease. Predictors independently associated with invasive HSV included younger age (adjusted odds ratio [aOR]: 9.1 [95% confidence interval (CI): 3.4–24.5] 28 days), prematurity (aOR: 2.3, 95% CI: 1.1 to 5.1), seizure at home (aOR: 6.1, 95% CI: 2.3 to 16.4), ill appearance (aOR: 4.2, 95% CI: 2.0 to 8.4), abnormal triage temperature (aOR: 2.9, 95% CI: 1.6 to 5.3), vesicular rash (aOR: 54.8, (95% CI: 16.6 to 180.9), thrombocytopenia (aOR: 4.4, 95% CI: 1.6 to 12.4), and cerebrospinal fluid pleocytosis (aOR: 3.5, 95% CI: 1.2 to 10.0). These variables were transformed to derive the HSV risk score (point range 0–17). Infants with invasive HSV had a higher median score (6, interquartile range: 4–8) than those without invasive HSV (3, interquartile range: 1.5–4), with an area under the curve for invasive HSV disease of 0.85 (95% CI: 0.80–0.91). When using a cut-point of ≥3, the HSV risk score had a sensitivity of 95.6% (95% CI: 84.9% to 99.5%), specificity of 40.1% (95% CI: 36.8% to 43.6%), and positive likelihood ratio 1.60 (95% CI: 1.5 to 1.7) and negative likelihood ratio 0.11 (95% CI: 0.03 to 0.43). CONCLUSIONS A novel HSV risk score identified infants at extremely low risk for invasive HSV who may not require routine testing or empirical treatment.

The aim of this document is to provide a concise scientific review of the currently available COVID-19 vaccines and those in development, including mRNA, adenoviral vectors, and recombinant protein approaches. The anticipated use of COVID-19 vaccines in patients with chronic liver disease (CLD) and liver transplant (LT) recipients is reviewed and practical guidance is provided for health care providers involved in the care of patients with liver disease and LT about vaccine prioritization and administration. The Pfizer and Moderna mRNA COVID-19 vaccines are associated with a 94%-95% vaccine efficacy compared to placebo against COVID-19. Local site reactions of pain and tenderness were reported in 70%-90% of clinical trial participants, and systemic reactions of fever and fatigue were reported in 40%-70% of participants, but these reactions were generally mild and self-limited and occurred more frequently in younger persons. Severe hypersensitivity reactions related to the mRNA COVID-19 vaccines are rare and more commonly observed in women and persons with a history of previous drug reactions for unclear reasons. Because patients with advanced liver disease and immunosuppressed patients were excluded from the vaccine licensing trials, additional data regarding the safety and efficacy of COVID-19 vaccines are eagerly awaited in these and other subgroups. Remarkably safe and highly effective mRNA COVID-19 vaccines are now available for widespread use and should be given to all adult patients with CLD and LT recipients. The online companion document located at https://www.aasld.org/about-aasld/covid-19-resources will be updated as additional data become available regarding the safety and efficacy of other COVID-19 vaccines in development.

The public health workforce broadly-across disciplines, tiers, and settings-requires strategic skills to advance population health outcomes. In early 2020, the Region V Public Health Training Center conducted a competency-based training needs assessment survey with all 501 local health departments in the 6-state region, including small agencies that were previously excluded from available national data sources. Health officials or designees from 290 agencies responded (58% response rate) with perspectives regarding the ability of their staff to sufficiently apply strategic skills. Findings highlight training needs among the region's local governmental public health workforce and differences in those needs by the size of population served by the agency. Notable training priorities include the skill domains of Budgeting & Financial Management and Change Management, among others.

Objectives This study analysed if children of families in need of dental interventions can be identified by using the caries status of the first-born child as a predictor for caries in younger siblings of the same family. Material and methods All children aged 4 to 15 years, i.e. 13,596 children, visiting a compulsory school in the canton of Basel-Stadt, Switzerland, during the school year 2017/2018 were analysed. Total caries experience and untreated carious lesions at time of examination were recorded as well as a subset of socioeconomic factors such as gender, age, nationality, birth order and the family’s place of residence. Results A total of 6738 schoolchildren who had at least one sibling of school age could be included. Differences in caries experience and the presence of active carious lesions were found for age, nationality and place of residence but not for gender or birth order. Younger siblings had odds of having a history of caries 3.7 times higher (95% confidence interval: 3.0–4.4) and odds of having active carious lesions 3.5 times higher (95% confidence interval: 2.6–4.7) if the eldest child in the family already had caries. Conclusion Caries could be shown to be family-dependent. Younger siblings had a more than three-fold higher risk for caries if the first-born child already had carious lesions. Clinical relevance Based on these results, the caries status of the first-born child could be used as a potential indicator to detect vulnerable families and to initiate targeted preventive measures.

Summary. The results of a comprehensive diagnosis and surgical treatment of 104 patients with acute intestinal obstruction were analyzed. An analysis of the results of a study on the diagnosis of enteric insufficiency syndrome in acute intestinal obstruction showed that violations of the clinical and laboratory parameters of homeostasis and endotoxemia are manifested with a significant delay. Only clinical and instrumental research methods allow early detection of the presence of enteric insufficiency syndrome in patients of this category and timely pathogenically substantiated correction of this syndrome.

Introduction Osteoporosis is a chronic condition with serious sequela, including primarily bone fractures, and impacts on almost all spheres of human life. It is important for patients undergoing treatment to accept their health status and feel satisfied with life. Objective The aim of the study was to determine the relationship between socio-demographic factors, duration of the illness, self-assessment of the patient’s knowledge of osteoporosis, and also between illness management support and acceptance of the illness and life satisfaction among females with chronic osteoporosis, resident in rural areas. Material and methods The study, conducted from September 2016 – June 2017, involved 207 patients of the Clinic of Orthopaedics and Rehabilitation and the Clinic of Gynaecology at the Independent Public Teaching Hospital No. 4 in Lublin, eastern Poland. The study used the Acceptance of Illness Scale (AIS) and the Satisfaction With Life Scale (SWLS). Statistical analysis was performed with Student’s t-test, analysis of variance (ANOVA), Tukey’s range test, and chi-squared test. A p-value of

Ionizing radiation may cause cardiotoxicity not only at high, but even at low (considered as harmless) doses, yet the molecular mechanisms of the heart’s response to low doses are not clear. In this work, we used high-resolution nuclear magnetic resonance (NMR) spectroscopy to detect the early and late effects of radiation on the metabolism of murine hearts. The hearts of C57Bl/6NCrl female mice were irradiated in vivo with single 0.2 Gy or 2 Gy doses using 6 MV photons, then tissues were collected 48 h and 20 weeks after exposure. The most distinct changes in the profile of polar metabolites were detected 48 h after irradiation with 2 Gy, and included increased levels of pantothenate and glutamate as well as decreased levels of alanine, malonate, acetylcarnitine, glycine and adenosine. Significant effects of the 2 Gy dose were also observed 20 weeks after irradiation and included decreased levels of glutamine and acetylcarnitine when compared with age-matched controls. Moreover, several differences were observed between hearts irradiated with 2 Gy and analyzed either 48 h or 20 weeks after the exposure, which included changes in levels of acetylcarnitine, alanine, glycine, glutamate, glutamine, formate, myo-inositol and trimethylamine. No statistically significant effects induced by the 0.2 Gy dose were observed 20 weeks after irradiation. In general, radiation-affected compounds were associated with energy metabolism, fatty acid beta-oxidation, oxidative stress and damage to cell structures. At the same time, radiation-related effects were not detected at the level of tissue histology, which indicated a higher sensitivity of metabolomics-based tests for cardiac tissue response to radiation.

Objective: Besides glucose intolerance, dyslipidemia, and hypertension, visceral obesity is one of the most important atherogenic pathological factors in patients with metabolic syndrome (MetS). Th...

Background A variety of intraoperative strategies are currently used for organ protection during open operations on the thoracoabdominal aorta. We report our experience with cardiopulmonary bypass and hypothermic circulatory arrest as the primary modality for organ protection, focusing on the early outcomes. Methods During a 30-year interval, 285 patients underwent thoracoabdominal aortic aneurysm repair with the use of cardiopulmonary bypass with an interval of circulatory arrest (72 Crawford extent I, 107 extent II, 104 extent III, and 2 extent IV). Degenerative aneurysms were present in 72.6% and aortic dissections in 26.4% of patients. Emergent operations for rupture or acute dissection were required in 6.7% of the patients. Results Thirty-day mortality was 7.4% and was highest for the Crawford extent II and extent III patients (10.3% and 6.7%, respectively). Permanent paralysis or paraplegia occurred in 15 patients (5.3%). The rates were highest for the extent II and extent III patients (6.5% and 6.7%, respectively). Cerebrospinal fluid drainage had no impact on the development of spinal cord injury, and implantation of intercostal/lumbar arteries had a protective effect only in patients with extent II repair. Stroke occurred in 4.2% of patients and renal failure that required dialysis occurred in 6.2%. One-year actual survival was 90.4%. Conclusions Our extended experience with this technique confirms its safety and effectiveness when used on a routine basis. The rates of spinal cord injury and permanent renal failure are among the lowest reported in the literature. Particularly favorable outcomes were observed in younger patients and patients undergoing elective operations.

Background Pulmonary hypertension is a rare, life-threatening disease with limited therapeutic options and no definitive cure. Continuous intravenous prostacyclin therapy is indicated for treatment of severe disease. These medications have a narrow therapeutic index and a brief half-life; therefore, administration errors can be lethal. Objective To reduce medication errors through an inpatient program to improve, standardize, and disseminate continuous intravenous prostacyclin therapy practice guidelines. Methods Data were collected from the electronic safety reporting system of a single hospital to determine the number and types of continuous intravenous prostacyclin therapy errors that were reported over an 8-year period. A clinical database and hospital pharmacy records were used to determine the number of days on which hospitalized pediatric patients received the therapy. Interventions A nursing-directed quality improvement initiative to enhance the safety of continuous intravenous prostacyclin therapy for pediatric patients was begun in January 2009. Efforts to improve safety fell into 4 domains: policy, process, education, and hospital-wide safety initiatives. Results The number of therapy errors per 1000 patient days fell from 19.28 in 2009 to 5.95 in 2016. Chi-square analysis was used to compare the result for 2009 with that for each subsequent year, with P values of .66, .35, .16, .09, .03, .12, and .25 found for 2010 through 2016, respectively. Conclusions The trend in reduction of continuous intravenous prostacyclin therapy errors suggests that proactive processes to standardize its administration, emphasizing both policy and education, reduce medication errors and increase patient safety.

Purpose The aim of this study was to describe treatment procedure and early clinical outcomes of high-dose-rate (HDR) interstitial brachytherapy (BT) in clinically localized prostate cancer patients previously treated for rectal cancer with abdominoperineal rectal resection and external beam radiation therapy (EBRT). Material and methods Between February and July 2015, two patients with clinically localized prostate cancer without rectal access were treated in our brachytherapy department. HDR interstitial brachytherapy was conducted with the guidance of fluoroscopy and computed tomography (CT) imaging. Brachytherapy was combined with hormonal therapy. Results Follow-up lasted for 34 and 39 months for patient 1 and 2, respectively. Both patients remained free from biochemical recurrence according to the Phoenix definition. No severe G3/G4 late toxicity was observed, and neither patient experienced any gastrointestinal morbidity. Acute and late urinary toxicities were at an acceptance level, and were scored G1 and G2 for patient 1, and G3 and G1 for patient 2, respectively. Conclusions Fluoroscopy and 3D CT image-guided interstitial brachytherapy is feasible and appears to be a suitable treatment technique for patients with clinically localized prostate cancer after previous rectal resection and external beam radiation therapy.

Background and Aims: Placement of the duodenal-jejunal bypass liner (DJBL) leads to rapid weight loss and restoration of insulin sensitivity in a similar fashion to bariatric surgery. Increased systemic bile add levels are candidate effectors for these effects through postprandial activation of their receptors TGR5 and FXR. We aimed to quantify postprandial bile acid, GLP-1 and FGF19 responses and assess their temporal relation to the weight loss and metabolic and hormonal changes seen after DJBL placement.Methods: We performed mixed meal testing in 17 obese patients with type 2 diabetes mellitus (DM2) directly before, one week after and 6 months after DJBL placement.Results: Both fasting and postprandial bile add levels were unchanged at 1 week after implantation, and greatly increased 6 months after implantation. The increase consisted of unconjugated bile add species. 3 hour-postprandial GLP-1 levels increased after 1 week and were sustained, whereas FGF19 levels and postprandial plasma courses were unaffected.Conclusions: DJBL placement leads to profound increases in unconjugated bile add levels after 6 months, similar to the effects of bariatric surgery. The temporal dissociation between the changes in bile adds, GLP-1 and FGF19 and other gut hormone responses warrant caution about the beneficial role of bile acids after DJBL placement. This observational uncontrolled study emphasizes the need for future controlled studies. (C) 2019 Elsevier Inc. All rights reserved.

There were studied the possibilities of predicting the effectiveness of treatment with roflumilast in the complex therapy of patients with chronic obstructive pulmonary disease (COPD) with low and high risk by assessing the clinical and functional parameters (lung function, severity of respiratory complaints, frequency of exacerbations in the previous year) and serum indicators of systemic inflammation (C-reactive protein, TNF-α, IL-6, IL-8, fibrinogen). One-year study included 60 patients with COPD, among whom there were 22 patients with low risk (group 1) and 38 patients with high risk (group 2), according to the multi-faceted classification of disease. Each group was divided into 2 subgroups depending on the response to treatment: subgroup A included the patients whose therapy was effective and subgroup B consisted of the patients whose therapy was not effective. The criteria for the effectiveness of the treatment were: group 1 – the absence of exacerbations during a year or 1 episode that did not require hospitalization, the initial test CAT (COPD Assessment Test) – 10 points and lower, dyspnea on the mMRC scale no more than 2 points, an increase in FEV1 by 11% or more; in patients of group 2 the number of exacerbations was 0 or no more than 2 and they did not require hospitalization, dyspnea on the mMRC scale was no more than 2 points, there was no decrease in FEV1. The effectiveness of treatment was evaluated in points (4 points meant effective treatment, below 4 points – not effective treatment). It was found out that in group 1 in subgroup A after treatment the results of CAT (p

Aim. Lower urinary tract symptoms (LUTS) frequently affect patients immediately after midurethral sling (MUS) placement. The objective of the study was to assess if solifenacin or mirabegron decreases incidence of LUTS in women who underwent transobturator MUS. Methods. A prospective randomized trial was conducted on patients undergoing ambulatory transobturator midurethral sling due to stress urinary incontinence (SUI). All participants were questioned before and after surgery for occurrence of bothersome LUTS. A total of 328 patients who underwent transobturator MUS were randomly assigned to one of three groups: prophylaxis with 10 mg of solifenacin, prophylaxis with 50 mg of mirabegron, or without any additional treatment. LUTS evolution and efficacy of solifenacin and mirabegron were analyzed based on results of assessments made during follow-up visits at 1 and 6 weeks after surgery. Comparison of the prevalence of LUTS was done using chi2 test. Results. Prevalence of urgency and frequency episodes increased notably 1 week after sling placement and then came down to baseline levels. Solifenacin and mirabegron significantly reduced the incidence of urgency after 1 week, but after 6 weeks the beneficial effect was observed only in case of solifenacin. Treatment with mirabegron reduced the percentage of patients suffering from frequency after 6 weeks. Although prevalence of nocturia did not raise after sling placement, both treatments significantly reduced the incidence of this complaint after 6 weeks. Pharmacological treatment did not modulate the course of hesitancy and terminal dribbling. Conclusions. Treatment with solifenacin or mirabegron may significantly reduce the incidence of undesired LUTS after MUS.

To investigate laboratory parameters as predictors of overall survival (OS) for hepatocellular carcinoma (HCC) treated with radioembolization and develop/validate a scoring system.With IRB approval, we included all patients with baseline alpha-fetoprotein (AFP) 100 ng/dL from our prospectively acquired HCC radioembolization database. Neutrophil-lymphocyte ratio, albumin-bilirubin (ALBI), and AFP were measured at baseline and at 1-, 3-, and 6-month post-radioembolization Landmarks. OS was assessed from these Landmarks. Univariate/multivariate analyses were performed to evaluate OS predictability of these parameters. Baseline Imaging, Laboratory, and Combination scoring systems were developed. Developing/validating groups were created to investigate/validate the score's OS predictability. Time-dependent receiver operating characteristics (ROC) were evaluated. Patients were stratified into groups I, II, and III by using 25th and 75th percentile cutoffs according to change in Laboratory Score from baseline.345/401 (86%), 238/401 (59%), and 167/401 (42%) patients had laboratory parameters available at the 1-, 3-, and 6-month Landmarks, respectively. ALBI and AFP were significant OS prognosticators at all Landmarks. The Laboratory Score [ALBI + (0.3 × LnAFP)] was developed/internally validated to predict OS from these Landmarks. Areas under the curve of time-dependent ROCs of the Baseline Imaging vs. Laboratory scores in predicting patient OS post 3 and 6 months Landmarks were 0.56 versus 0.82 and 0.57 versus 0.77, respectively. OS differences in groups I, II, and III according to change in Laboratory Score from baseline were significant (p 0.001).Post-radioembolization AFP and ALBI scores were significant OS prognosticators. A decrease in post-therapeutic Laboratory Score, which combines AFP and ALBI, correlates with an improved OS.