Impact of renal impairment on atrial fibrillation: ESC-EHRA EORP-AF Long-Term General Registry

Background: Atrial fibrillation (AF) and renal impairment share a bidirectional relationship with important pathophysiological interactions. We evaluated the impact of renal impairment in a contemporary cohort of patients with AF. Methods: We utilised the ESC-EHRA EORP-AF Long-Term General Registry. Outcomes were analysed according to renal function by CKD-EPI equation. The primary endpoint was a composite of thromboembolism, major bleeding, acute coronary syndrome and all-cause death. Secondary endpoints were each of these separately including ischaemic stroke, haemorrhagic event, intracranial haemorrhage, cardiovascular death and hospital admission. Results: A total of 9306 patients were included. The distribution of patients with no, mild, moderate and severe renal impairment at baseline were 16.9%, 49.3%, 30% and 3.8%, respectively. AF patients with impaired renal function were older, more likely to be females, had worse cardiac imaging parameters and multiple comorbidities. Among patients with an indication for anticoagulation, prescription of these agents was reduced in those with severe renal impairment, p <.001. Over 24 months, impaired renal function was associated with significantly greater incidence of the primary composite outcome and all secondary outcomes. Multivariable Cox regression analysis demonstrated an inverse relationship between eGFR and the primary outcome (HR 1.07 [95% CI, 1.01–1.14] per 10 ml/min/1.73 m2 decrease), that was most notable in patients with eGFR <30 ml/min/1.73 m2 (HR 2.21 [95% CI, 1.23–3.99] compared to eGFR ≥90 ml/min/1.73 m2). Conclusion: A significant proportion of patients with AF suffer from concomitant renal impairment which impacts their overall management. Furthermore, renal impairment is an independent predictor of major adverse events including thromboembolism, major bleeding, acute coronary syndrome and all-cause death in patients with AF

Clinical complexity and impact of the ABC (Atrial fibrillation Better Care) pathway in patients with atrial fibrillation: a report from the ESC-EHRA EURObservational Research Programme in AF General Long-Term Registry

Background: Clinical complexity is increasingly prevalent among patients with atrial fibrillation (AF). The ‘Atrial fibrillation Better Care’ (ABC) pathway approach has been proposed to streamline a more holistic and integrated approach to AF care; however, there are limited data on its usefulness among clinically complex patients. We aim to determine the impact of ABC pathway in a contemporary cohort of clinically complex AF patients. Methods: From the ESC-EHRA EORP-AF General Long-Term Registry, we analysed clinically complex AF patients, defined as the presence of frailty, multimorbidity and/or polypharmacy. A K-medoids cluster analysis was performed to identify different groups of clinical complexity. The impact of an ABC-adherent approach on major outcomes was analysed through Cox-regression analyses and delay of event (DoE) analyses. Results: Among 9966 AF patients included, 8289 (83.1%) were clinically complex. Adherence to the ABC pathway in the clinically complex group reduced the risk of all-cause death (adjusted HR [aHR]: 0.72, 95%CI 0.58–0.91), major adverse cardiovascular events (MACEs; aHR: 0.68, 95%CI 0.52–0.87) and composite outcome (aHR: 0.70, 95%CI: 0.58–0.85). Adherence to the ABC pathway was associated with a significant reduction in the risk of death (aHR: 0.74, 95%CI 0.56–0.98) and composite outcome (aHR: 0.76, 95%CI 0.60–0.96) also in the high-complexity cluster; similar trends were observed for MACEs. In DoE analyses, an ABC-adherent approach resulted in significant gains in event-free survival for all the outcomes investigated in clinically complex patients. Based on absolute risk reduction at 1 year of follow-up, the number needed to treat for ABC pathway adherence was 24 for all-cause death, 31 for MACEs and 20 for the composite outcome. Conclusions: An ABC-adherent approach reduces the risk of major outcomes in clinically complex AF patients. Ensuring adherence to the ABC pathway is essential to improve clinical outcomes among clinically complex AF patients

Impact of clinical phenotypes on management and outcomes in European atrial fibrillation patients: a report from the ESC-EHRA EURObservational Research Programme in AF (EORP-AF) General Long-Term Registry

Background: Epidemiological studies in atrial fibrillation (AF) illustrate that clinical complexity increase the risk of major adverse outcomes. We aimed to describe European AF patients\u2019 clinical phenotypes and analyse the differential clinical course. Methods: We performed a hierarchical cluster analysis based on Ward\u2019s Method and Squared Euclidean Distance using 22 clinical binary variables, identifying the optimal number of clusters. We investigated differences in clinical management, use of healthcare resources and outcomes in a cohort of European AF patients from a Europe-wide observational registry. Results: A total of 9363 were available for this analysis. We identified three clusters: Cluster 1 (n = 3634; 38.8%) characterized by older patients and prevalent non-cardiac comorbidities; Cluster 2 (n = 2774; 29.6%) characterized by younger patients with low prevalence of comorbidities; Cluster 3 (n = 2955;31.6%) characterized by patients\u2019 prevalent cardiovascular risk factors/comorbidities. Over a mean follow-up of 22.5 months, Cluster 3 had the highest rate of cardiovascular events, all-cause death, and the composite outcome (combining the previous two) compared to Cluster 1 and Cluster 2 (all P <.001). An adjusted Cox regression showed that compared to Cluster 2, Cluster 3 (hazard ratio (HR) 2.87, 95% confidence interval (CI) 2.27\u20133.62; HR 3.42, 95%CI 2.72\u20134.31; HR 2.79, 95%CI 2.32\u20133.35), and Cluster 1 (HR 1.88, 95%CI 1.48\u20132.38; HR 2.50, 95%CI 1.98\u20133.15; HR 2.09, 95%CI 1.74\u20132.51) reported a higher risk for the three outcomes respectively. Conclusions: In European AF patients, three main clusters were identified, differentiated by differential presence of comorbidities. Both non-cardiac and cardiac comorbidities clusters were found to be associated with an increased risk of major adverse outcomes

Water in mining from the origins to the beginning of the 19th century

W artykule przedstawiono problematykę zagrożenia wodnego w górnictwie od jego zarania do początków XIX wieku. Woda zawsze towarzyszyła górnictwu podziemnemu będąc jego błogosławieństwem, ale jednocześnie przekleństwem. Woda była tym czynnikiem, który przesączając się przez warstwy skale wypłukiwał związki chemiczne, na podstawie których poszukiwacze ukrytych skarbów mogli zorientować się jakie kopaliny użyteczne występują w warstwach górotworu. Woda też zazdrośnie strzegła dostępu do pożądanych surowców, zalewając wyrobiska, a często wręcz uniemożliwiając ich eksploatację. Woda w początkach górnictwa, aż do wynalezienia pierwszych maszyn parowych, była najtańszym i ogólnie dostępnym źródłem energii do napędzania maszyn wykorzystywanych w górnictwie. Do początków XIX wieku były to przede wszystkim wyciągi szybowe, ale też i pompy, którymi odwadniano kopalnię. Wodę wykorzystywano również w procesie przeróbki surowców, ich wzbogacania i do transportu urobku z kopalni – tzw. sztolnie spławne. Złożoność zagadnienia występowania wody w złożach kopalin użytecznych i sposób w jak ówcześni górnicy podchodzili do tego zagadnienia świadczy o ambiwalentnym stosunku do wody w początkowym okresie rozwoju górnictwa. Stosunek górników do wody diametralnie zmienił się wraz z chwilą wprowadzenia do kopalń pomp odwadniających, najpierw parowych, potem z silnikami elektrycznymi. Od tego momentu mówiąc o wodzie w kopalni rozumie się tylko i wyłącznie zagrożenie, z którym należy walczyć. Zagadnieniom wykorzystania wody w procesach technologicznych w kopalniach poświęcone będą dalsze artykuły, które są planowana do druku w kolejnych numerach rocznika.The article presents the problem of water hazards in the mining industry from its origins to the beginning of the 19th century. Water has always accompanied underground mining, being its blessing yet also a curse at the same time. Water was the factor that washed through the layers of rock scouring chemical compounds. On that basis seekers of hidden treasures could find useful minerals in rock layers. Water also jealously guarded access to desirable raw materials, flooding excavations or even preventing them from being exploited. Since the beginning of mining until the invention of the first steam engines, water was the cheapest and widely available energy source for propulsion of machinery used in mining. Until the beginning of the 19th century, these were mainly shafts but also pumps that dewatered mines. Water was also used in the processing of raw materials, their enrichment and transportation from the mine, using so-called navigation adits. The complexity of the problem which the presence of water posed in the deposits of useful minerals and the way in which the miners approached that issue is a testimony to the ambivalent attitude towards water in the early period of mining development. Miners’ attitude to water fundamentally changed with the introduction of dewatering pumps in mines, using steam engines first and then electric motors. From that point on, talking about water in a mine meant struggling against a threat. Part two of the article, which is planned to be printed in the next issue of the yearbook, will be devoted to the use of water in technological processes in mines

Protection of underground excavations of historical value

Wzrost zainteresowania turystyką podziemną, powoduje, że coraz to nowe obiekty podziemne są udostępniane do zwiedzania. W prawie każdym województwie możemy znaleźć obiekty podziemne przyciągające turystów. Jednak często prace związane z ich udostępnieniem są prowadzone w sposób niefachowy. Wprowadzenie turysty w „podziemia” często jest związane z licznymi niebezpieczeństwami wynikającymi z zagrożeń jakie sprawiają skały w których obiekt został wykonany jak i z warunkami klimatycznymi panującymi w obiekcie podziemnym. Właśnie te dodatkowe utrudnienia powodują, że prace związane z adaptacją wyrobisk podziemnych muszą być prowadzone nie tylko pod nadzorem odpowiednich służb konserwatorskich ale i specjalistów z zakresu budownictwa podziemnego. Udostępnione wyrobiska muszą spełniać warunki bezpieczeństwa określone nie tylko w Prawie Geologiczno-Górniczym ale też w Prawie Budowlanym.The increased interest in underground tourism means that more and more underground facilities are made available to explore. In almost every voivodeship underground facilities that attract tourists can be found. However, work related to making these facilities available is often done in an unprofessional manner. Introducing a tourist into the “underground” often entails risks that arise from the dangers posed by the rock in which the site is located and the overall conditions in the underground facility. These additional impediments make for the adaptation of underground excavations to be conducted not only under the supervision of proper preservation services but also underground construction professionals. Excavations that are made available must comply with the safety requirements specified in the Geological and Mining Law and in Construction Law

Drainage adits in Upper Silesia – industrial technology heritage and important elements of the hydrotechnical infrastructure

Adits played an important role in the hydrotechnical infrastructure for centuries. Initially, they were used mainly to drain wetland and supply water to the population. There were also inherent in the conduct of mining activities. They were used as exploratory, development and supply headings. Their usual function was to drain, ventilate and transport, and after the cessation of mining they became important elements of the hydrotechnical infrastructure in the transformed mining areas. The article presents issues related to the revitalization of the Main Key Hereditary Adit and Friedrich Adit as essential for the areas in which they are located. Both are hydraulic structures with the possibility of adaptation for tourism purposes. The need to consider some technical activities to be undertaken in this type of objects was pointed out, not only including aspects related to their proper protection so that they can continue to safely perform their function, but also to the preservation of their historical values. Due to their age and the method of drilling used in them, those headings are often included in the list of monuments and protected by law

Technical condition of galleries lining as a source of roof falls hazard

W artykule poruszono zagadnienia związane z utrzymaniem stateczności wyrobisk korytarzowych przy pogarszającym się stanie technicznym obudowy. Omówiono metodę diagnozowania obudów wyrobisk korytarzowych oraz przedstawiono wartościowanie zużycia elementów obudowy i jego wpływ na ocenę stanu technicznego konstrukcji. Wskazano na konieczność prowadzenia szkoleń dla pracowników dozoru w zakresie diagnozowania i oceny stanu technicznego obudów wyrobisk górniczych oraz objęcia wyrobisk stałym monitoringiem w aspekcie zagrożenia obwałami i zawałami.The article addressed the issues, connected width maintenance of galleries stability at the deterioration of lining technical condition. Described methods of diagnostic galleries lining and presented influence of lining technical wear on this technical condition. Indicated necessity of trainings for staff towards diagnostic and evaluating the technical condition of lining and lead constant monitoring of galleries in terms of hazard from roof falls

Protection, maintenance and renovation of stone casings of underground excavations

Ochrona wyrobisk podziemnych przed negatywnym oddziaływaniem czynników środowiskowych jest zagadnieniem nadzwyczaj złożonym. Obudowa, która może być wykonana z kamienia naturalnego lub sztucznego, będzie ulegać destrukcyjnym wpływom w stopniu zależnym od rodzaju i jakości materiału, z którego została wykonana. Również oddziaływanie środowiska na obudowę może być bardzo zróżnicowane. Rodzaj i intensywność działań są uzależnione od takich czynników jak: rodzaj skał w których wykonano wyrobisko, głębokość lokalizacji wyrobiska, stosunki wodne na powierzchni terenu i w skałach otaczających wyrobisko. Również sposób przewietrzania jak i skład chemiczny powietrza doprowadzanego do wyrobiska wpływa na intensywność i rodzaj korozji materiału obudowy. Omawiając tak skomplikowane zagadnienie trudno podać jednoznaczną diagnozę i metodologię postępowania przy rozwiązywaniu problemu zabezpieczenia obudów kamiennych przed destrukcyjnym oddziaływaniem czynników środowiskowych. Każde wyrobisko należy traktować indywidualnie, uwzględniając nie tylko warunki środowiskowe i rodzaj obudowy ale również jego przyrodnicze i historyczne walory. W artykule podano również najważniejsze czynniki środowiskowe mające wpływ na destrukcję oraz podano metodologię ograniczenia ich wpływu na stan zachowania konstrukcji murowych wyrobisk podziemnych. Podkreślono także, że zabiegi zmierzające do zabezpieczenia wyrobiska i jego obudowy, choćby najskuteczniejsze, nie mogą doprowadzić do zniszczenia jego specyfiki i walorów historycznych.Protection of underground excavations against the negative impact of environmental factors is an extremely complicated and complex issue. The construction, which may be made of natural or artificial stone, undergoes destructive influence depending on the type and quality of the material from which it was made. Other factors such as execution time, the manner of execution and quality of materials used in construction will also influence its resistance. Environmental factors affecting the underground constructions can be very diverse as well. The nature and intensity of their activities depend on the type of rock, the depth of the excavation, water conditions on the surface and in the rocks surrounding the excavation. The way of ventilation and the chemical composition of air entering the pit determine the intensity and type of material corrosion. There is neither one clear diagnosis nor the methodology on solving the issue on protection and maintenance of underground constructions. Each pit needs to be examined individually, taking into account special environmental conditions, type of construction but also its natural and historical values. Even the most effective activities aimed at protecting excavations cannot lead to the destruction of their outlook and historical assets