Contemporary changes of thermal conditions in Poland, 1951-2015

The main subject of the research whose outcomes are presented in this paper is the spatial and temporal variability of thermal conditions in Poland during the period from 1951 to 2015. The analysis revealed the occurrence of symptoms indicating a systematic and sustained warming. Significant growth is observed in mean and extreme temperatures and their extreme percentiles, as well as in annual number of hot days, warm waves and their duration. In turn, downward trends are noted in series of the annual number of frost days, as well as in the number of cold waves and their duration. The results obtained confirm the thermal pattern determined for the whole region, especially for the southern part of the Baltic Sea basin

The longest one-man weather chronicle (1721–1786) by Gottfried Reyger for Gdańsk, Poland as a source for improved understanding of past climate variability

In the paper we focus on the notes of botanist and meteorologist Gottfried Reyger on the weather conditions in Gdańsk, Poland. In our estimation, this chronicle, covering the period from December 1721 to June 1786 (the longest weather chronicle recorded by a single person), is a reliable source of information with the potential to contribute to the understanding of climate variability in 18th-century Gdańsk, the significant old Hanseatic city in northern Poland. The temperature and precipitation series for the period 1721–1786 were indexed against contemporary conditions using the calculated percentages of cold, normal and warm decades. The climate in the 18th century in Gdańsk was colder than nowadays; the springs were much cooler, as were the winters, while the summers were warmer. A few relatively cold periods and several warm periods were identified. The first half of the analysed period was very humid, whereas the second was quite dry. The reconstructed indexed data series were compared to annual and seasonal mean values of air temperature and precipitation derived from regular instrumental observations made in Gdańsk since 1739. The linear regression method was applied to calibrate the reconstructed index series against anomalies from the 1961–1990 average. The correlation coefficient, standard error of estimate and the root-mean-square error statistics were used to diagnose the quality of calibration and verification. The highest correlation between the temperature indices and the observational series was found for winter. The reconstructed series for precipitation has a smaller variability than in reality. The reconstructed values for the years prior to 1739 indicate cold years for 1725–1732 and a wet period in the 1730s

Blood pressure and glaucoma: At the crossroads between cardiology and ophthalmology

Glaucoma is an optic nerve neuropathy of undetermined cause. Although many mechanisms are thought to be involved in the development and progression of the disease, only an increased intraocular pressure has been established as a clinically significant modifiable risk factor. Nevertheless, up to 40% of patients develop glaucoma without evidence of increased intraocular pressure.  Ample evidence suggests that alterations in the control of arterial blood might negatively affect optic nerve function. However, evidence-based guidelines on the management of arterial blood pressure in glaucoma patients are lacking. Regrettably, intraocular pressure is generally not included as a secondary end-point in clinical trials on arterial hypertension. Considering the relative simplicity of intraocular pressure measurements and large number of patients included in hypertension studies, the benefits of including intraocular pressure as a secondary end-point could be of a great value for improving care for glaucoma patients. Therefore, closer collaboration between cardiologists and ophthalmologists is needed.

Tissue coverage of paclitaxel and sirolimus eluting stents in long term follow-up: Optical coherence tomography study

Background: Implantation of drug eluting stents (DES) has become a standard treatment ofpatients undergoing percutaneous coronary intervention (PCI). Incomplete strut coverage isa potential risk factor for late stent thrombosis. Optical coherence tomography (OCT) enablesin vivo identification of incomplete neointimal coverage.Methods: Study included 62 patients after sirolimus eluting stents (SES) or paclitaxel elutingstents (PES) implantation. OCT examination was performed at least 24 months after theinitial procedure (35.4± 9.4 months). In cross-sectional still frames selected from each 1 mm ofanalyzed stents a total number of visible struts and number of struts with or without completeneointimal coverage was assessed. Measurements of neointimal coverage, presented as a meanthickness of tissue, were performed. Patients were followed up for 3 years and the frequency ofmajor adverse cardiac events was recorded.Results: In the analyzed 28 SES and 37 PES 9998 struts were identified. Complete neointimalcoverage was observed in 83.5% and 79.2% of SES and PES struts respectively (p = 0.48).There was no difference in incidence of not covered or malapposed struts between SES and PES groups. Mean thickness of the tissue covering SES struts was 0.165 ± 0.095 mm, and 0.157 ± 0.121 mm for PES. The mean neointimal thickness difference (SES vs. PES) was notstatistically significant. In a 36 months follow-up 1 death was observed — potentially attributedto stent thrombosis.Conclusions: A long term OCT follow-up after DES implantation shows high incidence ofuncovered struts regardless of the stent type. Clinical significance of this finding remains questionableand requires further large scale trials

Droughts in the area of Poland in recent centuries in the light of multi-proxy data

The history of drought occurrence in Poland criteria used were those proposed by McKee et al. (1993) and in the last millennium is poorly known. To improve this modified for the climate conditions of Poland by Lab˛edzki knowledge we have conducted a comprehensive analysis us (2007). ing both proxy data (documentary and dendrochronological) More than 100 droughts were found in documen and instrumental measurements of precipitation. The paper tary sources in the period 1451–1800, including 17 presents the main features of droughts in Poland in recent megadroughts. A greater than average number of droughts centuries, including their frequency of occurrence, cover were observed in the second halves of the 17th century and age, duration, and intensity. The reconstructions of droughts the 18th century in particular. Dendrochronological data con based on all the mentioned sources of data covered the pe firmed this general tendency in the mentioned period. riod 996–2015. Examples of megadroughts were also cho Analysis of SPI (including its lowest values, i.e. droughts) sen using documentary evidence, and some of them were de showed that the long-term frequency of droughts in Poland scribed. has been stable in the last two or three centuries. Extreme Various documentary sources have been used to identify and severe droughts were most frequent in the coastal part droughts in the area of Poland in the period 1451–1800 and of Poland and in Silesia. Most droughts had a duration of 2 to estimate their intensity, spatial coverage, and duration. months (about 60 %–70 %) or 3–4 months (10 %–20 %). Fre Twenty-two local chronologies of trees (pine, oak, and fir quencies of droughts with a duration of 5-or-more months from Poland were taken into account for detecting nega were lower than 10 %. The frequency of droughts of all cat tive pointer years (exceptionally narrow rings). The delimita egories in Poland in the instrumental period 1722–2015 was tion of droughts based on instrumental data (eight long-term greatest in winter, while in the documentary evidence (1451– precipitation series) was conducted using two independent 1800) droughts in this season are rarely mentioned. approaches (Standard Precipitation Index, SPI, calculated for The occurrence of negative pointer years (a good proxy for 1-, 3-, and 24-month timescales, and a new method proposed droughts) was compared with droughts delimited based on by authors). For delimitation of droughts (dry months), the documentary and instrumental data. A good correspondence was found between the timing of occurrence of droughts identified using all three kinds of data (sources)

Serelaxin — do we have a breakthrough in acute heart failure therapy? Results of the RELAX-AHF trial

Ostra niewydolność serca (AHF) jest chorobą o bardzo złym rokowaniu, na którą każdego roku na świecie zapada ponad 15 milionów pacjentów. Mimo wielu prób klinicznych prowadzonych w ostatnich dekadach rokowanie chorych leczonych z jej powodu nie poprawiło się, a w stosowanej farmakoterapii nie wprowadzono poważniejszych zmian. W terapii AHF wciąż brakuje leku, który poprawiałby wyniki odległe, nie zwiększając przy tym w znacznym stopniu ryzyka niedokrwienia mięśnia sercowego czy groźnych arytmii. Serelaksyna, czyli rekombinowana ludzka relaksyna 2, to hormon którego podwyższone wartości obserwuje się we krwi u kobiet w ciąży. Relaksyna, aktywując sprzężony z białkiem G receptor LGR7 (RXFP-1), prowadzi do zwiększonej produkcji tlenku azotu przez komórki śródbłonka. W ten sposób działa naczyniorozszerzająco, zmniejsza opór obwodowy, poprawia pojemność minutową oraz przepływ nerkowy.W badaniu klinicznym II fazy preRELAX-AHF potwierdzono wstępną hipotezę, zgodnie z którą zastosowanie serelaksyny może przynosić korzyści chorym hospitalizowanym z powodu AHF. Kontynuację badań nad potencjalną rolą tego związku w terapii AHF stanowiło badanie RELAX-AHF. Jego wyniki wskazują, że serelaksyna to pierwszy lek w terapii AHF, którego zastosowanie w początkowym okresie hospitalizacji wpływa korzystnie na wyniki odległe. Ta przełomowa cząsteczka zmniejszała 180-dniową śmiertelność zarówno z przyczyn sercowo-naczyniowych, jak i ogólnych wśród pacjentów z AHF. Serelaksyna skutecznie ograniczała także odczuwaną duszność, charakteryzując się korzystnym profilem bezpieczeństwa. W niniejszym artykule przedstawiono założenia, metodologię oraz wyniki prospektywnego, randomizowanego, przeprowadzonego metodą podwójnie ślepej próby badania klinicznego RELAX-AHF służącego porównaniu skuteczności i bezpieczeństwa stosowania serelaksyny względem placebo w leczeniu pacjentów hospitalizowanych z powodu AHF.Acute heart failure (AHF) is a condition with very poor prognosis. More than 15 million people suffer from heart failure worldwide. Although numerous clinical trials have been conducted, prognosis of patients with AHF has not improved over the last decades. There have been no major changes in AHF pharmacotherapy either. In the treatment of AHF there is a lack of a drug that would improve long-term outcomes without a significant increase in the risk of myocardial ischaemia or serious arrhythmias. Serelaxin is a recombinant human relaxin 2. Increased concentrations of this hormone are observed during pregnancy. Relaxin activates a G-protein coupled receptor LGR7 (RXFP-1) and therefore stimulates endothelial nitric oxide production. As a result, it dilates blood vessels and increases arterial compliance, cardiac output and renal blood flow. A phase 2 preRELAX-AHF trial confirmed the initial hypothesis that patients hospitalized for AHF may benefit from receiving serelaxin. Further research into the potential role of this compound in the treatment of AHF was performed in the RELAX-AHF study. Its results indicate that serelaxin is the first drug applied in the early treatment of AHF that improves long-term prognosis. This break through molecule reduced cardiovascular and all-cause death at 180 days in AHF patients. Serelaxin was also effective at reducing dyspnoea and proved to be well tolerated and safe. In the article, the hypotheses, methods and results of the prospective, double-blind, randomized controlled RELAX-AHF trial comparing efficacy and safety of serelaxin with placebo in patients hospitalized for AHF are presented

Clinical characteristics of hypertensive patients undergoing total hip or knee replacement

Introduction. Orthopaedic surgeries are major procedures, often associated with perioperative risk. They are especially challenging for elderly patients afflicted with several comorbidities and cardiovascular risk factors. Currently, one of the most frequent types of orthopaedic surgeries is joint alloplasties of hip or knee. The aim of this study was to establish the clinical characteristics of hypertensive patients undergoing total hip or knee replacement and to describe the frequency of the early complication of the surgery, which is a need for blood transfusion. Material and methods. The study enrolled 199 consecutive patients who underwent hip or knee alloplasty. From this group patients with previous diagnosis of hypertension were selected for further assessment. All patients were screened for presence of cardiovascular risk factors and cardiovascular disease, according to the current guidelines. All patients were also followed for the necessity of blood transfusion during the hospitalisation. Results. From the screened population 135 patients had previous diagnosis of hypertension and met inclusion criteria (mean age 69.0 } 9.3 years, 30.4% male). From those patients, 70 (48.1%) underwent knee replacement, and 65 (51.9%) had hip replacement. As for the prevalence of cardiovascular disease, 16 (11.9%) had coronary artery disease, 5 (3.7%) had a history of previous myocardial infarction and 2 (1.5%) had diagnosed heart failure. Cardiovascular risk factors were also highly prevalent in the study population, 26 (19.3%) patients had diagnosed dyslipidemia, 27 (20.0%) had diabetes and 58 (43.0%) were obese. There were no statistical differences in the prevalence of those factors between patients with hip and knee replacement. 33 (24.4%) had blood loss during the operation, which led to a need for blood transfusion (19 (29.2%) patients in hip replacement group, and 14 (20%) in knee replacement group, p = 0.05). We found no differences in the prevalence of cardiovascular disease and cardiovascular risk factors between patients who required and did not require blood transfusion (p > 0.05). Conclusions. Hypertensive patients who undergo hip or knee replacement have high prevalence of cardiovascular risk factors and other cardiovascular disease, therefore are at high perioperative risk. No differences are seen between patients with hip and knee replacement. There is also a high frequency of blood transfusions in this group

Optimal aNtiplatelet pharmacotherapy guided by bedSIDE genetic or functional TESTing in elective PCI patients: A pilot study: ONSIDE TEST pilot

Background: Dual antiplatelet therapy (DAPT) is recommended after elective percutaneous coronary intervention (PCI) in stable coronary artery disease (SCAD) patients; however, still one-third of patients do not obtain adequate platelet inhibition that may result in increased cardiovascular risk. The aim of the ONSIDE TEST study is to evaluate the clinical impact of point-of-care genotyping- and platelet function-based personalized dual antiplatelet strategies in SCAD individuals undergoing PCI. Methods: Fifty patients were randomized to one of the three study arms: 1) genotyping, 2) platelet function testing (PFT) and 3) control. Patients were tested with point-of-care Spartan RX CYP2C19 System (group 1) and VerifyNow P2Y12 assay (group 2). In cases of inadequate response to clopidogrel, a loading dose of prasugrel was administered before PCI. The main clinical endpoint is the incidence of periprocedural myocardial injury (PMI). Results: Five (32%) patients in the genotyping arm and two (13%) in the in the PFT arm were identi-fied as poor clopidogrel metabolizers. The periprocedural platelet reactivity was significantly lower in the genotyping (80 ± 49.0 PRU) and PFT (36.5 ± 47 PRU) arms as compared to the control arm (176 ± 67.8 PRU), p = 0.01 and p = 0.03, respectively. PMI appeared in 17 (37%) patients of the entire study population. Conclusions: Personalized DAPT results in an improved platelet inhibition. Apart from genotyping and aggregometry, it is feasible to integrate into everyday clinical practice PMI rates which are relevant when comparing different strategie