Frailty syndrome in daily practice of interventional cardiology ward-rationale and design of the FRAPICA trial : a STROBE-compliant prospective observational study.

The effect of frailty on short and long term results of interventional treatment of coronary heart disease is not well defined. The evaluation of frailty may be helpful in appointment of most suitable treatment option and timing of patient follow-up. The frailty syndrome in daily practice of interventional cardiology ward (FRAPICA) study objective is to evaluate prognostic capability of the Fried frailty scale and instrumental activities of daily living scale (IADL) in elderly patients with symptomatic coronary heart disease. This is a single center, prospective, observational study. Patients aged ≥65 years are eligible. The objectives are to report Fried frailty scale and IADL scale dispersion before hospital discharge and to assess predictive impact of both scores. The endpoints are: success of interventional treatment, its complications (procedure related myocardial infarction, dye-induced renal function deterioration, loss of blood), 3-year mortality, either all-cause and cardiovascular, re-infarction, re-intervention, stroke, new-onset heart failure, any hospital readmission, and a combination of all above mentioned. Secondary analyses will focus on distinct clinical patient presentations, sub-classifications of frailty for modeling of long-term risk. FRAPICA trial will improve understanding of the associations between frailty syndrome, cardiovascular system diseases, their invasive treatment, and short and long-term outcomes. It will allow for more individualized assessment of risk and will identify new goals for interventions. (ClinicalTrials.gov Identifier NCT03209414

Ribs of Pinna nobilis shell induce unexpected microstructural changes that provide unique mechanical properties

The reinforcement function of shell ribs depends not only on their vaulted morphology but also on their microstructure. They are part of the outer layer which, in the case of the Pinna nobilis bivalve, is built from almost monocrystalline calcitic prisms, always oriented perpendicular to the growth surfaces. Originally, prisms and their c-axes follow the radii of rib curvature, becoming oblique to the shell thickness direction. Later, prisms bend to reach the nacre layer perpendicularly, but their c-axes retain the initial orientation. Calcite grains form nonrandom boundaries. Most often, three twin disorientations arise, with two of them observed for the first time. Nano-indentation and impact tests demonstrate that the oblique orientation of c-axes significantly improves the hardness and fracture toughness of prisms. Moreover, compression tests reveal that the rib area achieves a unique strength of 700 MPa. The detection of the specific microstructure formed to toughen the shell is novel.The work was supported by the Polish National Agency for Academic Exchange (grant PPI/APM/2018/1/00049/U/001) and the National Science Center (grant UMO-2018/29/B/ST8/02200). MS was supported by the European Union from the resources of the European Social Fund (Project No.WNDPOWR. 03.02.00-00-I043/16). AGC was funded by project CGL2017-85118-P of the Spanish Ministerio de Ciencia e Innovación

Pancreatic injury following elective abdominal aortic repair

Wstęp. Śmiertelność okołooperacyjna u chorych po operacjach tętniaków aorty brzusznej (AAA) jest nadal znaczna, co wiąże się powikłaniami, które trudno przewidzieć. Celem niniejszej pracy była analiza biochemiczna, ultrasonograficzna i kliniczna trzustki po operacjach planowych tętniaków aorty brzusznej. Materiał i metody. Prospektywnej ocenie poddano grupę 132 chorych kwalifikowanych do tej operacji. Analizowano wiek chorych, płeć, stan zdrowia z uwzględnieniem wywiadów w kierunku przewlekłego lub ostrego zapalenia trzustki, współistniejącej cukrzycy, choroby niedokrwiennej mięśnia sercowego, przewlekłej obturacyjnej choroby płuc, przewlekłej niewydolności nerek, otyłości (BMI > 30 kg/m2), kamicy pęcherzyka żółciowego oraz alkoholizmu. Wymiar tętniaka analizowano w przedziałach 4,5-5,5 cm, 5,6-7,0 cm, powyżej 7 cm. Badania laboratoryjne wykonywano 3-krotnie: przed zabiegiem, w 2. i 5. dobie po zabiegu. Oceniano stężenie amylazy w surowicy, AspAT, AlAT, bilirubinę, kwas mlekowy, lipazę. W badaniu USG oceniano trzustkę przed zabiegiem oraz w 5. dobie po zabiegu. Wyniki. U 20 pacjentów po zabiegu operacyjnym wystąpił statystycznie znamienny wzrost stężeń lipazy i amylazy w surowicy (p < 0,01). W tej grupie było 15 mężczyzn i 5 kobiet (brak znamienności statystycznej w odniesieniu do płci); 12 osób było powyżej 70 rż., a 8 miało mniej niż 70 lat (w odniesieniu do granicy wiekowej 70 lat różnica znamienna statystycznie przy p < 0,05). Wielkość AAA powyżej 7 cm stwierdzono u 11 osób. U 2 pacjentów wystąpiły objawy kliniczne i laboratoryjne wskaźniki ostrego zapalenia trzustki. Wnioski. Uszkodzenia trzustki obserwowane po planowych operacjach AAA wiążą się z wielkością tętniaka, zwłaszcza gdy jego średnica jest większa niż 7 cm. Najprawdopodobniej łączy się to z jatrogennym uszkodzeniem śródoperacyjnym. W patologii uszkodzenia trzustki po operacjach AAA prawdopodobnie ma znaczenie również niedokrwienie narządu spowodowane dużą utratą krwi. Zaburzenia funkcji trzustki występują częściej u starszych osób po 70 rż.Background. Open repair of abdominal aortic aneurysm (AAA) is still associated with substantial perioperative mortality, which is in turn related to complications that are difficult to predict. The purpose of this study was a biochemical, clinical and ultrasonographic analysis of pancreas in patients after elective repair of AAA. Material and methods. A group of 132 patients scheduled for the elective AAA repair was analyzed. Data regarding age, gender, medical history with a special emphasis on pancreatic disease, diabetes, ischemic heart disease, chronic obstructive pulmonary disease, chronic renal insufficiency, obesity (BMI > 30), cholelithiasis and alcoholism was taken and analyzed. According to the size of the aneurysms three groups were created: 4.5-5.5 cm; 5.6-7.0 cm and > 7.0 cm. The laboratory test were performed three times: preoperatively, on the 2nd and on the 5th postoperative day. Serum amylase, lipase, AspAT, AlAT, bilirubin and lactic acid were analyzed. Ultrasound scan was performed preoperatively and on the 5th postoperative day. Results. In 20 patients statistically significant increase of serum level of amylase and lipase was found (p < 0.01). The gender of the patient did not have any significant influence on the development of pancreatic dysfunction. The pancreatic dysfunction occurred in eight patients younger than 70 years of age and in 12 older than 70 years of age and the difference was statistically significant (p < 0.05). The aneurysm greater than 7.0 cm in 11 patients was found. Both clinical and biochemical symptoms of acute pancreatitis were present in two patients (1.5%). The pancreatic injury was more frequent in patients with large AAA (> 7 cm). Conclusion. Pancreatic injury after elective AAA repair is related to the size of the aneurysm and probably caused by intraoperative iatrogenic trauma. Ischemia of the pancreas caused by blood loss may also play a role. Pancreatic dysfunction is more frequent in patients over 70 years of age

Anisotropy of mechanical properties of pinctada margaritifera mollusk shell

The mechanical properties such as compressive strength and nanohardness were investigated for Pinctada margaritifera mollusk shells. The compressive strength was evaluated through a uniaxial static compression test performed along the load directions parallel and perpendicular to the shell axis, respectively, while the hardness and Young modulus were measured using nanoindentation. In order to observe the crack propagation, for the first time for such material, the in-situ X-ray microscopy (nano-XCT) imaging (together with 3D reconstruction based on the acquired images) during the indentation tests was performed. The results were compared with these obtained during the micro-indentation test done with the help of conventional Vickers indenter and subsequent scanning electron microscopy observations. The results revealed that the cracks formed during the indentation start to propagate in the calcite prism until they reach a ductile organic matrix where most of them are stopped. The obtained results confirm a strong anisotropy of both crack propagation and the mechanical strength caused by the formation of the prismatic structure in the outer layer of P. margaritifera shell.The research was co-financed by the European Union from the resources of the European Social Fund (Project No.WND-POWR.03.02.00-00-I043/16), the DAAD program. A.C. acknowledges project CGL2017-85118-P of the Spanish Ministerio de Ciencia e Innovación for funding

Quaternary Zinc Alloys with Magnesium, Calcium and Strontium after Hydrostatic Extrusion—Microstructure and Its Impact on Mechanical and Corrosion Properties

The development of bioabsorbable implants from Zn alloys is one of the main interests in the new generation of biomaterials. The main drawbacks of Zn-based materials are their insufficient mechanical properties. In the presented studies, a quaternary alloy composed of zinc with magnesium (0.2–1 wt. %), calcium (0.1–0.5 wt. %) and strontium (0.05–0.5 wt. %) was prepared by gravity casting followed by hot extrusion and then by hydrostatic extrusion. Microstructural characterization using scanning electron microscopy (SEM) and X-ray diffraction (XRD) phase analysis was performed. The mechanical properties were examined, using static tensile tests. Corrosion properties were analyzed using immersion tests. Samples were immersed in Hanks’ solution (temperature = 37 °C, pH = 7.4) for 14 days. All alloys were subjected after corrosion to SEM observations on the surface and cross-section. The corrosion rate was also calculated. The microstructure of the investigated quaternary alloy consists of the α-Zn grains and intermetallic phases Mg2Zn11, CaZn13 and SrZn13 with different grain sizes and distribution, which impacted both mechanical and corrosion properties. Thanks to the alloying by the addition of Mg, Ca, and Sr and plastic deformation using hydrostatic extrusion, outstanding mechanical properties were obtained along with improvement in uniformity of corrosion rate

Zespół Hornera jako powikłanie nieudanej próby założenia portu naczyniowego drogą kaniulacji żyły szyjnej wewnętrznej

BACKGROUND: Horner syndrome is a rare but likely underdiagnosed complication of internal jugular vein cannulation. CASE REPORT: We present a case of a young woman undergoing chemotherapy for gestational trophoblastic disease for whom venous port implantation was attempted due to poor peripheral vein access. Despite ultrasound guidance, the procedure was unsuccessful and complicated by a local haematoma, causing compression of the sympathetic nerves with Horner syndrome. The symptoms subsided within 3 weeks without treatment. The possible pathomechanisms of Horner syndrome after central venous cannulation are presented with suggested diagnostic and therapeutic approaches. Special emphasis must be placed on excluding carotid artery dissection because it carries the risk of subsequent cerebral vascular incidents. In the event of a carotid dissection, a multidisciplinary team must choose a pharmacological (antiplatelet drugs/anticoagulation) or interventional approach. CONCLUSION: Even with ultrasonography, central venous cannulation is not free of serious risks. In case of anisocoria following an uneventful procedure, diagnostic imaging of the vascular structures in the neck is mandatory for the exclusion of potentially serious complications, such as carotid dissection or venous thrombosis.BACKGROUND: Horner syndrome is a rare but likely underdiagnosed complication of internal jugular vein cannulation. CASE REPORT: We present a case of a young woman undergoing chemotherapy for gestational trophoblastic disease for whom venous port implantation was attempted due to poor peripheral vein access. Despite ultrasound guidance, the procedure was unsuccessful and complicated by a local haematoma, causing compression of the sympathetic nerves with Horner syndrome. The symptoms subsided within 3 weeks without treatment. The possible pathomechanisms of Horner syndrome after central venous cannulation are presented with suggested diagnostic and therapeutic approaches. Special emphasis must be placed on excluding carotid artery dissection because it carries the risk of subsequent cerebral vascular incidents. In the event of a carotid dissection, a multidisciplinary team must choose a pharmacological (antiplatelet drugs/anticoagulation) or interventional approach. CONCLUSION: Even with ultrasonography, central venous cannulation is not free of serious risks. In case of anisocoria following an uneventful procedure, diagnostic imaging of the vascular structures in the neck is mandatory for the exclusion of potentially serious complications, such as carotid dissection or venous thrombosis

Verification of the Perception of the Local Community concerning Air Quality Using ADMS-Roads Modeling

Road transport is one among the sources of air pollution in a city, which results in lowering the comfort of life and increases the occurrence of respiratory diseases. The level of pollutants emitted in the city is variable, and it depends on the type and nature of the source and the manner of land development. For this reason, the purpose of the article is an attempt at a spatial (inner) diversification of a city in terms of air quality, using a study of perception and semantic differentials (SD). The research, which covered the period from June to November 2021, was performed in Kielce&mdash;the Polish Smart City&mdash;among local experts, people well acquainted with the city and knowledgeable about air quality and the impact of pollution on human health. The results allowed the demarcation of areas with the best and the worst parameters in terms of air quality within the city. Verification of the survey was carried out using the ADMS-Roads (Atmospheric Dispersion Modeling System) software for modeling pollution levels and GIS software, using data on road traffic. The verification allowed checking whether the respondents participating in the research accurately evaluated the city space. The modeling proved that within the two selected areas, the pollution level is similar, and it does not exceed the permitted values. This might indicate that in society there is still low awareness of air quality, particularly in terms of knowing the sources of pollutants and their impact on human health, and perception of areas with the best and the worst air quality was the result of an analysis of the manner of land development and its morphology

Limitations in the treatment of ovarian carcinoma

Removal of all foci of ovarian carcinoma during the first surgery considerably improves overall survival. Obtaining complete cytoreduction is not, however, possible in each case. When the procedure is performed in a referral center, complete cytoreduction is obtained in as many as 75–90% of patients. A lot of recent studies indicate that experience of the physician who performs the first procedure affects the degree of cytoreduction. Moreover, the experience of the center in which treatment is started also influences overall survival. Therefore, one might contribute to the improvement of the therapy outcome by refining one’s surgical skills. The experience of a surgeon is essential in resecting metastatic foci in sites such as the hepatoduodenal ligament, omental foramen, splenic recess of the peritoneum, superior omental recess, splenic hilum, tail of the pancreas as well as areas of the diaphragmatic and renal vessels. For a procedure to be effective, it must involve the entire peritoneum with all its recesses. The essential elements of the procedure which decide about the degree of cytoreduction are: 1) removing the rectum and peritoneum of the lower recess (modified posterior exenteration); 2) resection of the ovarian vessels and para-aortic lymphadenectomy; 3) removing the peritoneum of the diaphragm and partial resection of the diaphragm; 4) fragmentary resection of the gastrointestinal tract; 5) splenectomy with resection of foci in the lesser sac. The paper presents anatomic limitations that affect surgical treatment of ovarian carcinoma in these regions.Usunięcie wszystkich ognisk raka jajnika w czasie pierwszej operacji wydłuża znamiennie całkowite przeżycie. Doprowadzenie do całkowitej cytoredukcji nie jest jednak możliwe w każdym przypadku. Gdy zabieg przeprowadza się w ośrodku referencyjnym, całkowita cytoredukcja osiągana jest nawet u 75–90% operowanych chorych. Wiele ostatnich badań wskazuje, że o stopniu cytoredukcji decyduje doświadczenie lekarza, który wykonał pierwszą operację. Istotne dla całkowitego przeżycia jest także doświadczenie ośrodka, w którym rozpoczyna się leczenie. Dlatego dbając o warsztat chirurgiczny, można przyczynić się do poprawy wyników terapii. Doświadczenie chirurga jest niezbędne w resekcji ognisk przerzutowych w takich miejscach, jak więzadło wątrobowo-dwunastnicze, otwór sieciowy, zachyłek śledzionowy otrzewnej, zachyłek górny torby sieciowej, wnęka śledziony, ogon trzustki, okolice naczyń przeponowych i naczyń nerkowych. Aby zabieg zakończył się sukcesem, powinien dotyczyć całej otrzewnej i wszystkich jej zachyłków. Kluczowe elementy tej operacji, decydujące o stopniu cytoredukcji, to: 1) usunięcie odbytnicy i otrzewnej zachyłka dolnego (zmodyfikowane wytrzewienie tylne); 2) resekcja naczyń jajnikowych i limfadenektomia okołoaortalna; 3) usunięcie otrzewnej z przepony i częściowe resekcje przepony; 4) resekcje odcinkowe przewodu pokarmowego; 5) splenektomia wraz z resekcją ognisk z torby sieciowej. W pracy przedstawiono anatomiczne ograniczenia wpływające na przebieg leczenia chirurgicznego raka jajnika w tych obszarach

Microstructure-properties relation of hydrostatically extruded absorbable zinc alloys:Effect of Mg and Cu addition on corrosion properties and biocompatibility

Pure Zn is well-known for its appropriate corrosion rate, making it suitable for use as future absorbable implants. Yet, it suffers from insufficient strength, thus, both plastic deformation and alloying are required. Hydrostatic extrusion has proven to be an efficient technique, providing high mechanical properties for zinc alloys. However, its effect on degradation rate and biocompatibility of Zn alloys remains unknown. Thus, within the present study, an attempt to evaluate those properties has been made on hydrostatically extruded pure Zn, Zn–Mg and Zn–Mg–Cu alloys. The materials were characterized by advanced microscopy techniques and uniaxial tensile tests. Corrosion properties were assessed based on electrochemical and static immersion tests. Finally, the cytotoxic effect of zinc extracts on endothelial cells were examined by standard MTT assays combined with confocal imaging. The results showed that hydrostatic extrusion results in significant refinement of α-Zn grains and the intermetallic phase Mg2Zn11 for the investigated alloys. The alloys exhibited ultimate tensile strength exceeding 300 MPa and elongation higher than 20%. Corrosion tests demonstrated that all the materials showed a similar level of degradation rate. Moreover, the uniform distribution of the intermetallic phase contributed to homogeneous corrosion of Zn alloys. Biological studies indicated that the least cytotoxic response in endothelial cells was obtained for the Zn–Mg alloy. Such an effect was caused by the limited amount of released Zn ions in the favor of Mg ions. The refinement of α-Zn grains and intermetallic phases caused by hydrostatic extrusion were key factors determining the performance of Zn-based materials.</p