Interpretacja stężeń troponin sercowych w świetle czwartej uniwersalnej definicji zawału serca z 2018 roku

Cardiac troponin (cTn) is a laboratory test routinely used in patients with suspected acute coronary syndrome (ACS). Unfortunately, wide variety of laboratory assays and different cut-off values regarding gender may result in difficulties with diagnosis and delay the treatment. Troponin I and less specific troponin T are used to diagnose ACS. Dynamic changes in cTn concentration are required to confirm the diagnosis of myocardial infarction (MI). The fourth universal definition of myocardial infarction defines five major types of MI — atherosclerotic plaque disruption, imbalance between myocardial oxygen supply and demand unrelated to acute coronary atherothrombosis, cardiac death with symptoms suggestive of myocardial ischaemia and new ischaemic electrocardiographic changes, MI connected with percutaneous coronary intervention or coronary bypass grafting. Considering this definition, increased cTn concentrations are not always related to abnormal findings in coronary angiography and can be associated with many conditions. Increased high sensitivity cTn values in healthy individuals can be induced by intense physical activity, which is confirmed by studies performed in marathoners. While elevated cTn levels are observed in 20–60% of patients with acute ischemic stroke and are associated with an increased long-term mortality, acute MI is diagnosed only in 3,5% of patients. Elevated cTn levels often accompany chronic kidney disease, however changes in serial testing are obligatory for acute MI diagnosis. Deterioration of kidney function is more connected with elevated TnT rather than TnI levels. Regardless of the reason, increased cTn concentration is a negative predictive factor. Patients with elevated cTn levels need further diagnosis, risk stratification and a long-term follow-up.Stężenia troponin sercowych (cTn) oznacza się rutynowo w diagnostyce ostrego zespołu wieńcowego (ACS). Rozpoznanie ACS mogą jednak utrudniać różne rodzaje testów laboratoryjnych oraz inne punkty odcięcia wartości patologicznych u kobiet i mężczyzn. W diagnostyce ACS znajdują zastosowanie troponina I (TnI) oraz mniej specyficzna troponina T (TnT). Do potwierdzenia zawału serca (MI) konieczne jest stwierdzenie dynamicznych zmian stężenia cTn. W czwartej uniwersalnej definicji zawału serca wyróżnia się pięć głównych typów MI w zależności od patomechanizmu: związany z pęknięciem blaszki miażdżycowej, związany z dysproporcją między podażą a zapotrzebowaniem mięśnia sercowego na tlen, zgon sercowy u pacjentów z objawami sugerującymi niedokrwienie mięśnia sercowego i nowymi zmianami niedokrwiennymi w elektrokardiografii oraz MI towarzyszący angioplastyce wieńcowej i pomostowaniu aortalno-wieńcowemu. Zgodnie z tą definicją podwyższone stężenie cTn nie zawsze wynika z obecności istotnych zwężeń w tętnicach wieńcowych i może towarzyszyć wielu stanom. Wzrost wartości cTn oznaczanej metodą wysokoczułą u zdrowych osób może być indukowany intensywnym wysiłkiem fizycznym, co potwierdzają badania maratończyków. Podwyższone stężenie cTn występuje u 20–60% pacjentów z udarem niedokrwiennym mózgu i wiąże się z wyższą śmiertelnością odległą, jednak ostry MI w tej grupie chorych diagnozuje się jedynie u 3,5% osób. Podwyższone stężenie troponin sercowych często towarzyszy przewlekłej chorobie nerek, jednak w przypadku podejrzenia ACS znaczenie ma dynamika seryjnych pomiarów. Pogorszenie funkcji nerek ma większy wpływ na wzrost stężenia cTnT niż cTnI. Niezależnie od przyczyny podwyższone wartości cTn stanowią niekorzystny czynnik rokowniczy. Pacjenci, u których stwierdzono wzrost wartości cTn, wymagają rozszerzenia diagnostyki, stratyfikacji ryzyka i długoterminowej obserwacji

Profiles of occupational burnout in the group of representatives of high-risk professions in Poland

(1) Background: Working in a high-risk profession is associated with taking on a large responsibility and risking loss of health or life. These professions include, among others, air traffic controllers, firefighters, and ECDs. People working in these professions are particularly vulnerable to experiencing high levels of stress and developing professional burnout syndrome. The aim of the conducted research was to assess the external and internal differences in the intensity of occupational burnout dimensions among representatives of high-risk occupations and to distinguish burnout profiles among them. (2) Methods: The total number of participants working in high–risk occupations who took part in the study was N = 1239, including the following job positions: air traffic controllers (n = 107), firefighters (n = 580), and ECDs (n = 558). The respondents completed the following self-report questionnaires: a structured survey and the Link Burnout Questionnaire. The following statistical tests were performed: cluster analysis, analysis of variance, and chi-square test of independence. (3) Results: The highest intensity of burnout dimensions was presented by representatives of ECDs. Profiles reflecting the types of occupational burnout were distinguished. The representatives of air traffic controllers demonstrated the following profiles: 1—low risk of burnout with a component of psychophysical exhaustion; 2—exhausted with a moderate tendency to disappointment; 3—burned out, ineffective, and uninvolved. The profiles of the ECDs were: 4—engaged, with a reduced sense of effectiveness; 5—with a reduced sense of effectiveness; 6—burned out with a low sense of effectiveness. However, the profiles of the firefighters were: 7—not burned out; 8—at risk of burnout; 9—exhausted with a tendency towards disappointment. Individuals representing the various burnout profiles differed in terms of the severity of the dimensions of occupational burnout as well as sociodemographic and work-related characteristics. (4) Conclusions: The process of occupational burnout varies among people in various high-risk occupations and due to sociodemographic characteristics. The internal differentiation of people representing high-risk professions requires different psychological interventions and preventive measures

Pilot-Scale Studies of WO3/S-Doped g-C3N4 Heterojunction toward Photocatalytic NOx Removal

Due to the rising concentration of toxic nitrogen oxides (NOx) in the air, effective methods of NOx removal have been extensively studied recently. In the present study, the first developed WO3/S-doped g-C3N4 nanocomposite was synthesized using a facile method to remove NOx in air efficiently. The photocatalytic tests performed in a newly designed continuous-flow photoreactor with an LED array and online monitored NO2 and NO system allowed the investigation of photocatalyst layers at the pilot scale. The WO3/S-doped-g-C3N4 nanocomposite, as well as single components, were characterized by X-ray diffraction (XRD), scanning electron microscopy (SEM), Brunauer–Emmett–Teller surface area analysis (BET), X-ray fluorescence spectroscopy (XRF), X-ray photoemission spectroscopy method (XPS), UV–vis diffuse reflectance spectroscopy (DR/UV–vis), and photoluminescence spectroscopy with charge carriers’ lifetime measurements. All materials exhibited high efficiency in photocatalytic NO2 conversion, and 100% was reached in less than 5 min of illumination under simulated solar light. The effect of process parameters in the experimental setup together with WO3/S-doped g-C3N4 photocatalysts was studied in detail. Finally, the stability of the composite was tested in five subsequent cycles of photocatalytic degradation. The WO3/S-doped g-C3N4 was stable in time and did not undergo deactivation due to the blocking of active sites on the photocatalyst’s surface

Environmentally Friendly Fabrication of High-Efficient Fe-ZnO/Citric Acid-Modified Cellulose Composite and the Enhancement of Photocatalytic Activity in the Presence of H₂O₂

In the present study, a novel Fe-ZnO/citric acid-modified cellulose composite (x%Fe-ZnO-y%CAC) was synthesized using an environmentally friendly hydrothermal method. The obtained samples were characterized by X-ray diffraction (XRD), scanning electron microscopy (SEM), UV–vis diffuse reflectance spectroscopy (DRS), Fourier transform infrared spectroscopy (FTIR), nitrogen physisorption, and electrochemical and photocurrent density analyses. The influence of the additives from the series of x%Fe-ZnO-y%CAC photocatalysts with Fe content from 0 to 5% and CAC content from 0 to 80% on photocatalytic degradation of ibuprofen (IBU) under simulated solar light was investigated. The photocatalyst 0.5%Fe-ZnO-40%CAC showed high photocatalytic activity of 0.0632 min−1 first-order kinetic rate constant and 46% TOC reduction of IBU under simulated solar light irradiation. Additionally, H2O2-assisted photocatalytic process was investigated for facilitating the IBU degradation in the presence of 0.5%Fe-ZnO-40%CAC; the first-order kinetic rate constant was 2.7 times higher compared to the process without addition of H2O2. Moreover, the effect of radical scavengers was examined to explain the degradation mechanism of IBU by synthesized photocatalysts supported with H2O2. The demonstrated system provides a low-cost and green approach to improve the photocatalytic activity of x%Fe-ZnO-y%CAC photocatalysts

The Impact of Uterus Didelphys on Fertility and Pregnancy

Uterus didelphys occurs as a result of abnormal fusion of the paramesonephric ducts and is characterized by complete duplication of uterine horns, cervix, and very often also the vagina or presence of longitudinal vaginal septum. Most women with a uterus didelphys are asymptomatic; some cases may coincide with dyspareunia or dysmenorrhea. The anomaly is associated with a higher risk of miscarriage, preterm labor, breech delivery, and decreased live births. We present the case of a 26-year-old woman (primigravida) who was known to have uterus didelphys. The diagnosis was made when the patient was 23 years old using ultrasound and hysteroscopy. The patient became pregnant after 18 months of efforts. The patient was referred to prenatal care in the 13th week of pregnancy with vaginal bleeding. In the 23rd week of pregnancy, gestation cholelithiasis was diagnosed. The pregnancy progressed without obstetric complications and the fetus developed normally. Due to the vaginal septum and fact that the patient felt stressed, the pregnancy was terminated at term by cesarean section. We concluded that uterus didelphys can be asymptomatic making an early diagnosis difficult. A pregnancy belongs to a high-risk group and more attention should be paid to this case. Cesarean section should be considered, especially in case of the presence of vaginal septum

Folate/homocysteine metabolism and lung cancer risk among smokers.

BACKGROUND:Folate and homocysteine are involved in DNA synthesis and methylation processes, which are deregulated during carcinogenesis. OBJECTIVES:The aim of this study was to assess the relationship between folate/homocysteine concentrations, the functional polymorphisms of folate/homocysteine genes and lung cancer risk among cigarette smokers. STUDY DESIGN:The study included 132 lung cancer patients and 396 controls from northern Poland, matched by sex, age and smoking status. The median cigarette pack-years of smoking among both cases and controls was 30.0. Serum, red blood cell (RBC) folates and serum homocysteine concentrations were measured. The genotypes in selected polymorphic sites of the MTHFR, CBS, SHMT1, MTHFD1, MTRR, MTR, TYMS DHFR, TCN2, and SLC19A1 genes were determined. All study participants underwent scanning with low-dose computed tomography. RESULTS:Serum folate concentrations above the median (> 17.5 nmol/l among the healthy controls) were associated with an increased lung cancer risk (odds ratio [OR], 1.54, 95% confidence intervals [CI], 1.04-2.29, P = 0.031). An analogous trend was observed when the population was analysed after subdivision according to RBC folate concentrations, that is, above a value of 506.5 nmol/l (OR, 1.53; 95% CI, 0.95-2.47; P = 0.084). Additionally, in a subset of women, an increased risk of lung cancer development was associated with the SLC19A1 c.80AA genotype (c.80AA versus GG OR, 3.14; 95% CI, 1.32-7.46; P = P = 0.010). CONCLUSION:These results suggest that, in the population consisting of heavy smokers, high folate levels add to the cancerogenic effect of smoking