New Urbanization of the Steppe. Astana: A Capital Called the Capital

Relocating the capital of Kazakhstan from Almaty to Akmola (then renamed Astana) in 1997 has been the subject of an intense debate, particularly within media. The process of creating the new capital of Kazakhstan should consider the broader perspective of historical, political and ideological, social, climatic and geographical factors, and finally to put the matter in terms of architecture and urban planning. The author considers this very broad perspective, finally expressing the hope that the project of “the city of the future” analyzed in the article, will become a permanent part of the Kazakh reality

Observations on hearing preservation in patients with hybrid-L electrode implanted at Poznan University of Medical Sciences in Poland

The objective of the paper is to evaluate the hearing preservation rate in patients with high frequency hearing loss, treated with Cochlear Nucleus Freedom Hybrid-L implant in the Otolaryngology Department, Poznan University of Medical Sciences in Poland. Study was designed as the retrospective analysis. Twenty-one patients were operated and implanted with Nucleus Freedom Hybrid-L implant. Pure tone thresholds were recorded prior to the surgery and at the time of speech processor switch-on. Patients were subdivided into two groups with respect to their PTA thresholds: group A—classic indications and group B—extended indications. Average PTA for three frequencies (250, 500, 1,000 Hz) were calculated for each patient pre- and postoperatively. In the group of 21 implanted patients in 17 cases we have observed preservation of hearing (12 patients from group A, 5 patients from group B) with a mean value of 13.1 dB. In 4 out of 21 patients deafness on the implanted ear was noted. Our results clearly indicate that with standard procedure hearing preservation can be obtained in majority of patients. Hearing preservation was not achieved in 19 %, but owing to design of the electrode of the Cochlear Nucleus Hybrid-L that enables to work as CI platform alone, in patients who lost their hearing after surgery re-implantations were not required. This proves that EAS is a safe and reliable method to help patients with specific type of hearing loss

63. Raki Płaskonabłonkowe głowy i szyi u młodych dorosłych – retrospektywna wieloczynnikowa analiza oraz wstępne wyniki badań nad rolą czynnika genetycznego w ich etiopatogenezie

Celem pracy jest analiza cech klinicznych raków płaskonabłonkowych głowy i szyi u chorych poniżej 45 roku życia („young adult”) oraz ocena udziału czynnika genetycznego w ich etiopatogenezie. W ocenie klinicznej uwzględniono dane dotyczące: A.- pacjentów: wiek (średnia 40.9 lat), płeć (mężczyźni 85%, kobiety 15%) oraz ekspozycja na typowe czynniki ryzyka (palący papierosy −96.8%, spożywający alkohol −96.7%), B.- guza: lokalizacja (krtań 69%, jama ustna i gardło 28%), stopień zaawansowania klinicznego (głównie stadium IV −58.7%), typ histologiczny (ca planoepitheliale keratodes 71.2%, akeratodes 28.8%) i stopień zróżnicowania histologicznego (głownie G1+G2 −94.3%), C.- zastosowanego leczenia: metoda (głównie skojarzone: operacja + radioterapia −61.3%) oraz wyniki (wznowa miejscowa −15.9%, wznowa węzłowa −18.5%, przeżycia 3-letnie 46%, przeżycia 5-letnie 35%). W ocenie roli czynnika genetycznego zastosowano 3 techniki: genotypowanie, test bleomycynowy i test kometkowy. U 24 chorych oznaczono polimorfizm genów metabolizmu kancerogenów oraz genów związanych z naprawą DNA. Stwierdzono częstsze niż w grupie pacjentów starszych występowanie następujących genotypów ryzyka: GSTM1 (-) współwystępujący z NAT2 4/6A oraz NAT2 4/6A oraz allelu ryzyka: NAT2 4; allel ryzyka CYP 1A1 4 występował rzadziej niż w grupie starszych, natomiast częstość występowania genotypu ryzyka XPD 35931AA w obu grupach była zbliżona. U 5 pacjentów oznaczono poziom niestabilności chromosomowej za pomocą testu bleomycynowego – stwierdzono zbliżone wartości współczynnika b/c w grupie pacjentów młodszych i starszych przy jednocześnie wyraźnie większym odsetku uszkodzonych komórek w grupie młodych dorosłych. W obu grupach zarówno wartość współczynnika b/c jak i procent uszkodzonych komórek były wyrażnie większe niż w grupie osób zdrowych. W grupie 7 pacjentów za pomocą techniki comet assay określono uszkodzenia spontaniczne i indukowane oraz zdolności naprawy DNA – stwierdzono wysoki i zbliżony w grupie pacjentów młodych i starszych poziom uszkodzeń DNA – zarówno spontanicznych i indukowanych oraz zbliżone zdolności naprawy DNA

Imbalance in the levels of angiogenic factors in patients with acute and chronic central serous chorioretinopathy

Background: The pathogenesis of central serous chorioretinopathy (CSC) remains a subject of intensive research. We aimed to determine correlations between plasma levels of selected angiogenic factors and different forms of CSC. Methods: Eighty patients were enrolled in the study including 30 with a chronic form of CSC, 30 with acute CSC, and 20 controls. Presence of active CSC was determined by fluorescein angiography (FA), indocyanine green angiography (ICGA), and swept-source optical coherence tomography (SS-OCT). Plasma concentrations of angiopoietin-1, endostatin, fibroblast growth factor, placental growth factor (PlGF), platelet-derived growth factor (PDGF-AA), thrombospondin-2, vascular endothelial growth factor (VEGF), VEGF-D, and pigment epithelium–derived factor were measured, and the results were compared between groups. Additionally, mean choroidal thickness (CT) was measured in all patients. Results: Levels of angiopoietin-1 (p = 0.008), PlGF (p = 0.045), and PDGF-AA (p = 0.033) differed significantly between the three groups. Compared with the controls, VEGF (p = 0.024), PlGF (p = 0.013), and PDGF-AA (p = 0.012) were downregulated in the whole CSC group, specifically PDGF-AA (p = 0.002) in acute CSC and angiopoietin-1 (p = 0.007) in chronic CSC. An inverse correlation between mean CT and VEGF levels was noted in CSC patients (rho = −0.27, p = 0.044). Conclusions: Downregulated angiopoietin-1, VEGF, PDGF-AA, and PlGF levels may highlight the previously unknown role of the imbalanced levels of proangiogenic and antiangiogenic factors in the pathogenesis of CSC. Moreover, downregulated VEGF levels may suggest that choroidal neovascularization in CSC is associated with arteriogenesis rather than angiogenesis

The evaluation of a surgery and the short-term benefits of a new active bone conduction hearing implant - the Osia®

Introduction: Modern medicine offers a wide spectrum of different hearing devices, and bone conduction implants can be found among them. Objective: The presentation of the outcomes of the implantation of a new active bone conduction hearing implant --- the Osia®, and its comparison with the well-known passive transcutaneous system --- the Baha® Attract. Materials and methods: Eight adult patients with bilateral mixed hearing loss were randomly divided into two groups. Group 1 was implanted with the Osia®, and group 2 was implanted with the Baha® Attract. The details of the surgery were analyzed, along with the functional and audiological results. Results: In all the cases, the surgery was successful, and the healing uneventful. In both groups, it was observed that pure tone audiometry and speech audiometry in free field improved significantly after the implantation (mean gain in pure tone audiometry for the Osia group 42.8 dB SPL and for the Baha group 38.8 dB SPL). In the Osia group, the results after the surgery were much better than with the Baha® 5 Power processor on the Softband. The patients implanted with the Osia® evaluated the quality of their hearing as being superior to those implanted with the Baha® Attract. There was an evident improvement in the abbreviated profile of hearing aid benefit questionnaire and in the speech, spatial and qualities of hearing scale for both systems

Three year experience with the cochlear BAHA attract implant: a systematic review of the literature

Background Bone conduction devices are widely used and indicated in cases of conductive, mixed or single sided deafness where conventional hearing aids are not indicated or tolerated. Percutaneous bone-conduction devices gave satisfactory hearing outcomes but were frequently complicated by soft tissue reactions. Transcutaneous bone conduction devices were developed in order to address some of the issues related to the skin-penetrating abutment. The aim of this article is to present a systematic review of the indications, surgical technique and audiological, clinical and functional outcomes of the BAHA Attract device reported so far. Methods A systematic computer-based literature search was performed on the PubMed database as well as Scopus, Cochrane and Google Scholar. Out of 497 articles, 10 studies and 89 reported cases were finally included in our review. Results The vast majority of implanted patients were satisfied with the aesthetics of the device scoring highly at the Abbreviated Profile of Hearing Aid Benefit, Glasgow Benefit Inventory and Client Oriented Scale of Improvement. Overall, hearing outcomes, tested by various means including speech in noise, free field hearing testing and word discrimination scores showed a significant improvement. Complications included seroma or haematoma formation, numbness around the area of the flap, swelling and detachment of the sound processor from the external magnet. Conclusions The functional and audiological results presented so far in the literature have been satisfactory and the complication rate is low compared to the skin penetrating Bone Conduction Devices. Further robust trials will be needed to study the long-term outcomes and any adverse effects

Laser photocoagulation or intravitreal therapy – dilemma concerning treatment of diabetic macular edema

Leczenie cukrzycowego obrzęku plamki stanowi dla lekarza okulisty wyzwanie terapeutyczne. Jeszcze niedawno główną metodą leczenia tego schorzenia była fotokoagulacja laserowa siatkówki, która zwykle nie prowadziła do znaczącej poprawy widzenia. Współcześnie mamy do dyspozycji skuteczne, ale kosztowne terapie doszklistkowe, w których stosuje się preparaty anty-VEGF i leki sterydowe. Dodatkowo na rynku pojawiły się lasery mikropulsowe niepowodujące uszkodzenia siatkówki. W tym kontekście niezbędne wydają się stworzenie nowego schematu leczenia cukrzycowego obrzęku plamki oraz zmiana sposobu myślenia o roli fotokoagulacji laserowej w tym procesie terapeutycznym.For an ophthalmologist, treatment of diabetic macular edema is a therapeutic challenge. Up to recently, the leading method of treatment of this clinical entity was laser photocoagulation, which in most cases didn’t result in improvement of vision. At present, at our disposal are effective, but expensive, intravitreal therapies by anti-VEGF and steroid medications. Additionally, micropulse lasers, that do not damage the retina, emerged on the market. In this context, it is necessary to create a new algorithm of treatment of diabetic macular edema, as well as change our way of thinking about the role of laser photocoagulation in treating of DME

Risk factors for central serous chorioretinopathy

Central serous chorioretinopathy is a well-described ocular disorder affecting primarily young individuals. As chronic forms of central serous chorioretinopathy are often leading to significant visual impairment, potential risk factors for its development are constantly analyzed in numerous studies. Review of available research shows that predominant risk factors for central serous chorioretinopathy include male gender, steroid intake, pregnancy, Cushing syndrome, chronic or acute stress, maladaptive personal traits, and increased choroidal thickness. Other factors, such as hypertension, gastric ulcer and reflux or genetic predispositions probably increase the risk of central serous chorioretinopathy onset, but its quantification remains the question of debate

Increase in Central Retinal Edema after Subthreshold Diode Micropulse Laser Treatment of Chronic Central Serous Chorioretinopathy

Purpose. Subthreshold diode micropulse laser (SDM) treatment is believed to be safe method of treating clinical entities involving retinal edema. We present a case of serous edematous reaction of the retina to SDM treatment. Methods. Case report. Results. A patient with chronic central serous chorioretinopathy (CSCR) was treated with SDM Yellow multispot laser. Procedure had been preceded by careful titration of the laser power, which after achieving of the threshold parameter was decreased by 50%. The follow-up visit two days after treatment revealed significant central retinal edema and subretinal fluid. Fundus autofluorescence image showed thermal reaction from the RPE in the form of small spots of hyperfluorescence corresponding to the laser multispot pattern used for treatment. Retinal edema resolved after topical bromfenac and single intravitreal bevacizumab injection. Slight pigmentary reaction from the RPE persisted. Conclusion. In the treatment of CSCR, there is a need to significantly reduce threshold SDM power parameters or simply use very low power without titration