Ocena zaawansowania niedrobnokomórkowego raka płuca metodą tomografii komputerowej i pozytonowej tomografii emisyjnej skojarzonej z tomografią komputerową

Introduction. Lung cancer is the leading cause of death from cancer in developed countries. Radiological imaging methods are the basic methods in early diagnosis of this disease. TNM classification is a very important tool for optimal treatment in non-small lung cancer (NSCLC). Conventional radiological techniques allow the evaluation of the stage on the basis of anatomical changes only, while PET-CT provides information about the biochemical processes that may precede anatomical changes. The aim of this study was to compare the accuracy and sensitivity of CT and PET-CT in the staging of NSCLC. Material and methods. The study was conducted on a group of 99 patients with NSCLC diagnosed at the Institute of Tuberculosis and Lung Diseases in the period from January 2008 to May 2010. CT and PET-CT were performed in all patients. Histological or cytological examination of the material obtained from biopsy, bronchoscopy, mediastinoscopy, and intraoperatively was the reference test. TNM classification was performed independently after CT and PET-CT. Results and conclusions. It has been shown that PET-CT is a more accurate and sensitive method than CT in the staging process in NSCLC. PET-CT allowed the correct classification of the T, N, M, and total TNM in, respectively, 97%, 95%, 99%, and 89% of cases, while for CT it was, respectively, 95%, 84%, 84%, and 68% (p = 0.0002).Wstęp. Rak płuca jest najczęstszą przyczyną zgonów z powodu nowotworów złośliwych w krajach rozwiniętych. Metody diagnostyki obrazowej stanowią podstawę wczesnego rozpoznania tej choroby. Klasyfikacja TNM jest bardzo ważnym narzędziem pozwalającym na optymalne postępowanie w niedrobnokomórkowym raku płuca (NSCLC). Konwencjonalne techniki radiologiczne pozwalają na ocenę stopnia zaawansowania tylko na podstawie zmian anatomicznych, natomiastpozytonowa tomografia emisyjna skojarzona z tomografią komputerową (PET-CT) dostarcza informacji o procesach biochemicznych, mogących poprzedzać zmiany anatomiczne. Celem pracy było porównanie dokładności i czułości CT i PET-CT w ocenie zaawansowania NSCLC. Materiał i metody. Badanie przeprowadzono w grupie 99 chorych na NSCLC diagnozowanych w Instytucie Gruźlicy i Chorób Płuc w okresie od stycznia 2008 rou do maja 2010 roku. U wszystkich chorych wykonywano badania CT i PET-CT. Testem referencyjnym było badanie histologiczne lub cytologiczne materiału uzyskanego z oligobiopsji, bronchoskopii, mediastinoskopii oraz śródoperacyjnie. Klasyfikacji TNM dokonano niezależnie po badaniu CT i PET-CT. Wyniki i wnioski. Wykazano, że badanie PET-CT jest metodą bardziej dokładną i czułą od CT w ocenie stopnia zaawansowania NSCLC. Badanie PET-CT pozwala na właściwą klasyfikację cech T, N, M i łącznie TNM, odpowiednio w: 97%, 95%, 99%, 89% przypadków; natomiast badanie CT odpowiednio w: 95%, 84%, 84%, 68% (p = 0,0002)

Omecamtiv mecarbil in chronic heart failure with reduced ejection fraction, GALACTIC‐HF: baseline characteristics and comparison with contemporary clinical trials

Aims: The safety and efficacy of the novel selective cardiac myosin activator, omecamtiv mecarbil, in patients with heart failure with reduced ejection fraction (HFrEF) is tested in the Global Approach to Lowering Adverse Cardiac outcomes Through Improving Contractility in Heart Failure (GALACTIC‐HF) trial. Here we describe the baseline characteristics of participants in GALACTIC‐HF and how these compare with other contemporary trials. Methods and Results: Adults with established HFrEF, New York Heart Association functional class (NYHA) ≥ II, EF ≤35%, elevated natriuretic peptides and either current hospitalization for HF or history of hospitalization/ emergency department visit for HF within a year were randomized to either placebo or omecamtiv mecarbil (pharmacokinetic‐guided dosing: 25, 37.5 or 50 mg bid). 8256 patients [male (79%), non‐white (22%), mean age 65 years] were enrolled with a mean EF 27%, ischemic etiology in 54%, NYHA II 53% and III/IV 47%, and median NT‐proBNP 1971 pg/mL. HF therapies at baseline were among the most effectively employed in contemporary HF trials. GALACTIC‐HF randomized patients representative of recent HF registries and trials with substantial numbers of patients also having characteristics understudied in previous trials including more from North America (n = 1386), enrolled as inpatients (n = 2084), systolic blood pressure < 100 mmHg (n = 1127), estimated glomerular filtration rate < 30 mL/min/1.73 m2 (n = 528), and treated with sacubitril‐valsartan at baseline (n = 1594). Conclusions: GALACTIC‐HF enrolled a well‐treated, high‐risk population from both inpatient and outpatient settings, which will provide a definitive evaluation of the efficacy and safety of this novel therapy, as well as informing its potential future implementation

Scalability analysis of selected structures of a reconfigurable manufacturing system taking into account a reduction in machine tools reliability

Scalability is a key feature of reconfigurable manufacturing systems (RMS). It enables fast and cost-effective adaptation of their structure to sudden changes in product demand. In principle, it allows to adjust a system's production capacity to match the existing orders. However, scalability can also act as a "safety buffer" to ensure a required minimum level of productivity, even when there is a decline in the reliability of the machines that are part of the machine tool subsystem of a manufacturing system. In this article, we analysed selected functional structures of an RMS under design to see whether they could be expanded should the reliability of machine tools decrease making it impossible to achieve a defined level of productivity. We also investigated the impact of the expansion of the system on its reliability. To identify bottlenecks in the manufacturing process, we ran computer simulations in which the course of the manufacturing process was modelled and simulated for 2-, 3-, 4- and 5-stage RMS structures using Tecnomatix Plant Simulation software

Diagnostic delays in rheumatic diseases with associated arthritis

Objective : The objective of this study was to determine the length of delay in diagnosis of inflammatory rheumatic diseases, and to indicate the main factors responsible for such delays. Material and methods : A retrospective multi-centre questionnaire survey carried out among 197 patients with diagnosed inflammatory rheumatic diseases or undergoing the diagnostic process. Results : The most common early symptoms of inflammatory rheumatic disease included joint pain (94%), joint swelling (78%), morning joint stiffness (77%), fatigue (76%), and sleep disturbed by joint pain (74%). When asked about the reasons for seeking medical help, most patients indicated intensification of the symptoms (89%) and the fact that the symptoms made them unable to perform daily activities or work (86%). Limited access to specialists (70%) and the conviction that the symptoms will resolve spontaneously (57%) had the biggest impact on delaying a visit to a doctor. Before visiting a rheumatologist, the patients consulted their symptoms with their general practitioners (GPs, 95%), orthopaedicians (43%), and neurologists (29%). Almost half of the patients (48%) consulted their symptoms with at least 2 non-rheumatologists, whereas as many as 21% of patients visited 4 or more specialists. After the onset of symptoms of rheumatic disease, 28% of patients delayed seeing any doctor for 4 months or longer. 36% of patients waited 4 months or longer for a referral to a rheumatologist. The great majority of the patients (85%) made an appointment with a rheumatologist within a month of receiving a referral. 25% of patients waited 4 months or longer to see a rheumatologist. Conclusions : Diagnostic delays result from both the level of patients’ awareness (ignoring early symptoms) and improper functioning of the health care system. In the case of the health care system, the source of delays is not only “queues to rheumatologists”, but also referring patients to non-rheumatologists

Case reportsUnfortunate outcome of subsequent vascular complications in female patients assigned to percutaneous coronary intervention – case report

We present a case of a 58-year-old female who underwent elective PCI of the left anterior descending coronary artery. The procedure was complicated by vessel dissections and myocardial infarction. Cardiogenic shock complicated acute coronary syndrome required intraaortic balloon pumping what led to descending aortic dissection successfully treated with stentgraft implantation. However, the patient died due to intractable cardiogenic shock

The cosmic ray detector for the NICA collider

Multi-Purpose Detector (MPD) is a main part of a new Ion Collider fAcility (NICA) located in Dubna, Russia. To increase MPD functionality, it was proposed to add an additional muon trigger system for off-beam calibration of the MPD sub-detectors and for rejection of cosmic ray background during experiments. The system could also be very useful for astrophysical observations of cosmic showers initiated by high energy primary particles. This article describes the main goals of MCORD detector and the early stage of MCORD design, based on plastic scintillators with silicon photomultiplier photodetectors (SiPM) for scintillation readout and electronic system based on MicroTCA standard

The cosmic ray detector for the NICA collider

Multi-Purpose Detector (MPD) is a main part of a new Ion Collider fAcility (NICA) located in Dubna, Russia. To increase MPD functionality, it was proposed to add an additional muon trigger system for off-beam calibration of the MPD sub-detectors and for rejection of cosmic ray background during experiments. The system could also be very useful for astrophysical observations of cosmic showers initiated by high energy primary particles. This article describes the main goals of MCORD detector and the early stage of MCORD design, based on plastic scintillators with silicon photomultiplier photodetectors (SiPM) for scintillation readout and electronic system based on MicroTCA standard

Cardiac myosin activation with omecamtiv mecarbil in systolic heart failure

BACKGROUND The selective cardiac myosin activator omecamtiv mecarbil has been shown to improve cardiac function in patients with heart failure with a reduced ejection fraction. Its effect on cardiovascular outcomes is unknown. METHODS We randomly assigned 8256 patients (inpatients and outpatients) with symptomatic chronic heart failure and an ejection fraction of 35% or less to receive omecamtiv mecarbil (using pharmacokinetic-guided doses of 25 mg, 37.5 mg, or 50 mg twice daily) or placebo, in addition to standard heart-failure therapy. The primary outcome was a composite of a first heart-failure event (hospitalization or urgent visit for heart failure) or death from cardiovascular causes. RESULTS During a median of 21.8 months, a primary-outcome event occurred in 1523 of 4120 patients (37.0%) in the omecamtiv mecarbil group and in 1607 of 4112 patients (39.1%) in the placebo group (hazard ratio, 0.92; 95% confidence interval [CI], 0.86 to 0.99; P = 0.03). A total of 808 patients (19.6%) and 798 patients (19.4%), respectively, died from cardiovascular causes (hazard ratio, 1.01; 95% CI, 0.92 to 1.11). There was no significant difference between groups in the change from baseline on the Kansas City Cardiomyopathy Questionnaire total symptom score. At week 24, the change from baseline for the median N-terminal pro-B-type natriuretic peptide level was 10% lower in the omecamtiv mecarbil group than in the placebo group; the median cardiac troponin I level was 4 ng per liter higher. The frequency of cardiac ischemic and ventricular arrhythmia events was similar in the two groups. CONCLUSIONS Among patients with heart failure and a reduced ejection, those who received omecamtiv mecarbil had a lower incidence of a composite of a heart-failure event or death from cardiovascular causes than those who received placebo. (Funded by Amgen and others; GALACTIC-HF ClinicalTrials.gov number, NCT02929329; EudraCT number, 2016 -002299-28.)

The very forward CASTOR calorimeter of the CMS experiment

International audienceThe physics motivation, detector design, triggers, calibration, alignment, simulation, and overall performance of the very forward CASTOR calorimeter of the CMS experiment are reviewed. The CASTOR Cherenkov sampling calorimeter is located very close to the LHC beam line, at a radial distance of about 1 cm from the beam pipe, and at 14.4 m from the CMS interaction point, covering the pseudorapidity range of $-$6.6 $\lt\eta\lt$ $-$5.2. It was designed to withstand high ambient radiation and strong magnetic fields. The performance of the detector in measurements of forward energy density, jets, and processes characterized by rapidity gaps, is reviewed using data collected in proton and nuclear collisions at the LHC