Czynniki ryzyka śmiertelności w infekcyjnym zapaleniu wsierdzia — doświadczenia jednego ośrodka

Introduction. Infective endocarditis (IE) is a disease associated with high morbidity and mortality. Multiple risk factors have been identified for mortality in IE.  Material and methods. 21 patients diagnosed with IE between January 2018 and January 2019 were retrospectively analysed. All data was expressed as mean ± standard error (SE). Variables were analysed with chi-square, Fisher’s exact, and Mann-Whitney tests. A p-value < 0.05 was identified as statistically significant.  Results. Total mortality was 52.4% and in-hospital mortality was 28.6%. Patients who died in the course of IE were older compared to survivors (66.7 ± 19.8 years vs 70.8 ± 11.6). Staphylococci and Streptococci spp. were causative patho- gens in 71.4% of cases of IE. Morphology was the most important feature that identified patients who died: white blood cells were higher in non-survivors (35.39 ± 14.36 vs 12.02 ± 4.67, p < 0.05); haemoglobin level was decreased (7.47 ± 0.96 vs 9.51 ± 1.33, p < 0.05); and thrombocytopenia (82.50 ± 45.85 vs 179.8 ± 56.13, p < 0.05) was characteristic for non-survivors. The plates-to-leucocytes ratio in patients who died during hospitalisation was 3.01 ± 2.89. For patients who survived hospitalisation it was 15.10 ± 10.86 (p = 0.0069). Similar results were achieved when comparing patients who died during hospitalisation 3.01 ± 2.89 vs patients who survived until 2019 16.94 ± 12.62 (p = 0.004662).  Conclusion. Morphology is recommended as the key diagnostic test in predicting mortality risk in patients with IE. The plates-to-leucocytes ratio is also a significant marker of mortality. Prompt identification and close monitoring of risk factors may prevent a higher mortality rate in IE. Wstęp. Infekcyjne zapalenie wsierdzia (IE) jest chorobą charakteryzującą się wysoką chorobowością i śmiertelnością. Zidentyfikowano liczne czynniki ryzyka śmiertelności w IE.  Materiał i metody. Dwudziestu jeden hospitalizowanych pacjentów z rozpoznanym IE w okresie od stycznia 2018 roku do stycznia 2019 poddano analizie retrospektywnej. Dane przedstawiono jako średnie z odchyleniem standardowym, wykona- no testy: χ2, Fishera i Mann-Whitneya. Współczynnik prawdopodobieństwa p poniżej 0, 05 uznano za statystycznie istotny.  Wyniki. Ogólna śmiertelność wynosiła 52,4%, natomiast wewnątrzszpitalna 28,6%. Pacjenci z IE, którzy zmarli, byli w starszym wieku w porównaniu z tymi, którzy przeżyli (66,7 ± 19,8 v. 70,8 ± 11,6). Gronkowce i paciorkowce były naj- częstszymi patogenami u pacjentów z IE; stanowiły 71,4% przypadków. Najważniejszą cechą, która odróżniała pacjentów zmarłych w przebiegu IE, była morfologia krwi. Większa liczba białych krwinek (35,39 ± 14,36 v. 12,02 ± 4,67; p &lt; 0,05), niższe stężenie hemoglobiny (7,47 ± 0,96 v. 9,51 ± 1,33; p &lt; 0,05) i płytek krwi (82,50 ± 45,85 v. 179,8 ± 56,13; p &lt; 0,05) były charakterystyczne dla osób, które zmarły w przebiegu IE. Stosunek trombocytów do leukocytów u pacjen- tów zmarłych podczas hospitalizacji wynosił 3,01 ± 2,89, w porównaniu z osobami, które przeżyły, u których wynosił 15,10 ± 10,86 (p = 0,0069). Podobne wyniki otrzymano, kiedy porównano pacjentów zmarłych w trakcie pobytu w szpi- talu — 3,01 ± 2,89 z pacjentami, którzy przeżyli do 2019 roku — 16,94 ± 12,62 (p = 0,004662).  Podsumowanie. Morfologia okazała się kluczowym badaniem dodatkowym umożliwiającym prognozowanie ryzyka śmiertelności w grupie pacjentów z IE. Stosunek liczby trombocytów i leukocytów jest również ważnym markerem śmiertelności. Identyfikacja oraz uważne monitorowanie czynników ryzyka może się przyczynić do obniżenia wysokiego ryzyka śmiertelności w IE.

Results of an Expert Consensus Survey on the Treatment of Pulmonary Arterial Hypertension With Oral Prostacyclin Pathway Agents

Background Treatment of pulmonary arterial hypertension (PAH) has evolved substantially over the past two decades and varies according to etiology, functional class (FC), hemodynamic parameters, and other clinical factors. Current guidelines do not provide definitive recommendations regarding the use of oral prostacyclin pathway agents (PPAs) in PAH. To provide guidance on the use of these agents, an expert panel was convened to develop consensus statements for the initiation of oral PPAs in adults with PAH. Methods A systematic literature search was conducted using MEDLINE. The established RAND/University of California Los Angeles appropriateness method, which incorporates the Delphi method and the nominal group technique, was used to create consensus statements. Idiopathic, heritable, repaired congenital heart defect, and drug- or toxin-induced PAH (IPAH+) was considered as one etiologic grouping. The process was focused on the use of oral treprostinil or selexipag in patients with IPAH+ or connective tissue disease-associated PAH and FC II or III symptoms receiving background dual endothelin receptor antagonist/phosphodiesterase type 5 inhibitor therapy. Results The panel developed 14 consensus statements regarding the appropriate use of oral PPAs in the target population. The panel identified 13 clinical scenarios in which selexipag may be considered as a treatment option. Conclusions The paucity of clinical evidence overall, and particularly from randomized trials in this setting, creates a gap in knowledge. These consensus statements are intended to aid physicians in navigating treatment options and using oral PPAs in the most appropriate manner in patients with PAH

Innovations and advances in instrumentation at the W. M. Keck Observatory

Since the start of operations in 1993, the twin 10 meter W. M. Keck Observatory telescopes have continued to maximize their scientific impact and to produce transformative discoveries that keep the observing community on the frontiers of astronomical research. Upgraded capabilities and new instrumentation are provided though collaborative partnerships with Caltech and UC instrument development teams. The observatory adapts and responds to the observers’ evolving needs as defined in the observatory’s strategic plan, periodically refreshed in collaboration with the science community. This paper summarizes the performance of recently commissioned infrastructure projects, technology upgrades, and new additions to the suite of instrumentation at the observatory. We will also provide a status of projects currently in the design or development phase, and since we need to keep our eye on the future, we mention projects in exploratory phases that originate from our strategic plan. Recently commissioned projects include telescope control system upgrades, OSIRIS spectrometer and imager upgrades, and deployments of the Keck Cosmic Web Imager (KCWI), the Near-Infrared Echellette Spectrometer (NIRES), and the Keck I Deployable Tertiary Mirror (KIDM3). Under development are upgrades to the NIRSPEC instrument and adaptive optics (AO) system. Major instrumentation in design phases include the Keck Cosmic Reionization Mapper and the Keck Planet Finder. Future instrumentation studies and proposals underway include a Ground Layer Adaptive Optics system, NIRC2 upgrades, the energy sensitive instrument KRAKENS, an integral field spectrograph LIGER, and a laser tomography AO upgrade. Last, we briefly discuss recovering MOSFIRE and its return to science operations

Implementation the GLONASS system in aeronautical application

The article determines the accuracy of positioning of the aircraft with the use of a satellite system GLONASS. In addition, the SPP (Single Point Positioning) absolute positioning method was utilized in research test in article. Research test was carried out in the new software APS (Aircraft Positioning Software), used for precise GPS/GLONASS satellite positioning in air navigation. The article describes the research method and presents mathematical formulas of the SPP positioning method. In the research test, the positioning accuracy of the Cessna 172 aircraft was obtained based on comparison of results between APS and RTKLIB software. The difference of Cessna 172 aircraft coordinates in the XYZ geocentric frame between the APS and RTKLIB solution is between -7 m to +6 m. The research material developed in the article comes from an aeronautical experiment carried out with the Cessna 172 aircraft for the EPDE military airport in Deblin

Verification of the precise position of the aircraft in air navigation based on the solution of the RTK-OTF technique

The article presents the possibility of applying the differential technique RTK-OTF to recover the position of the aircraft in the post-processing mode. Within the framework of the conducted research, the authors designated the geocentric coordinates XYZ of the aircraft and compared them. In the research experiment, they used archive materials from the test flight of the aircraft Cessna 172 around the airfield in Deblin on 1 June 2010. The actual position of the aircraft Cessna 172 was recovered on the basis of GPS kinematic observations registered by the receiver Topcon HiperPro mounted on board the aircraft. In the calculations, the authors also used static GPS observations from the reference station REF1 as well as virtual reference stations VirA and VirB. The final coordinates of the aircraft Cessna 172 with three independent determinations RTK-OTF were defined in the AOSS v.2.0 programme. On this basis, they made verification of accuracy in determining XYZ coordinates of the aircraft Cessna 172. The dispersion of results for the difference in the designation of the X coordinate of the aircraft ranges from –0.19 m to +0.05 m. On the other hand, the size of the difference in the designation of Y-coordinate of the aircraft ranges from –0.07 m to +0.11 m. In addition, the dispersion of the results for the difference in the designation of the Z coordinate of the aircraft is from 0.19 m to +0.12 m