Cytogenetic and Array-CGH Characterization of a Complex de novo Rearrangement Involving Duplication and Deletion of 9p and Clinical Findings in a 4-Month-Old Female

Approximately 15 patients with partial trisomy 9p involving de novo duplications have been previously described. Here, we present clinical, cytogenetic, FISH and aCGH findings in a patient with a de novo complex rearrangement in the short arm of chromosome 9 involving an inverted duplication at 9p24→p21.3 and a deletion at 9pter→p24.2. FISH probes generated from BACs selected from the UCSC genome browser were utilized to verify this rearrangement. It is likely that some previously described duplications of 9p may also be products of complex chromosomal aberrations. This report in which FISH and aCGH were used to more comprehensively characterize the genomic rearrangement in a patient with clinical manifestations of 9p duplication syndrome underscores the importance of further characterizing cytogenetically detected rearrangements

Angiomatous meningiomas have a distinct genetic profile with multiple chromosomal polysomies including polysomy of chromosome 5

Meningiomas are a diverse group of tumors with a broad spectrum of histologic features. There are over 12 variants of meningioma, whose genetic features are just beginning to be described. Angiomatous meningioma is a World Health Organization (WHO) meningioma variant with a predominance of blood vessels. They are uncommon and confirming the histopathologic classification can be challenging. Given a lack of biomarkers that define the angiomatous subtype and limited understanding of the genetic changes underlying its tumorigenesis, we compared the genomic characteristics of angiomatous meningioma to more common meningioma subtypes. While typical grade I meningiomas demonstrate monosomy of chromosome 22 or lack copy number aberrations, 13 of 14 cases of angiomatous meningioma demonstrated a distinct copy number profile – polysomies of at least one chromosome, but often of many, especially in chromosomes 5, 13, and 20. WHO grade II atypical meningiomas with angiomatous features have both polysomies and genetic aberrations characteristic of other atypical meningiomas. Sequencing of over 560 cancer-relevant genes in 16 cases of angiomatous meningioma showed that these tumors lack common mutations found in other variants of meningioma. Our study demonstrates that angiomatous meningiomas have distinct genomic features that may be clinically useful for their diagnosis

Preliminary evaluation of effective vibration analysis for the fault diagnosis of natural gas engine-driven compressor

In this paper were presented results of preliminary research of the fault diagnosis of natural gas engine-driven compressor by vibration analysis. Natural gas engine-driven compressors are heavily exploited during delivering natural gas to the transmission network of Poland. Every failure brings about interferences to gas system, furthermore it causes notably cost of maintenances. The major failures are piston seizures and overly level of vibration causes by exceedingly wear, an unbalanced engine after repairs and dry friction. During research investigated three natural gas engine-driven compressors. Acceleration of engine cylinders was measured in cylinder axis and perpendicularly axis and acceleration of compressor cylinders, engine fundament and gas receiver in three axes. Results obtain during investigation of engine cylinders one gas engine-driven compressor collates with results of validation of engine cylinders after their stripping. Preliminary results of investigation indicate proper trend to set up diagnostic symptoms. It was found that for increasing of information amount is necessary to carry out synchronous measurements and its envelops in domain of crankshaft rotation angle. Very important source of diagnostic information can be shaft acceleration, determined basing on existing system of signals generation. The investigation is to be continued

The practical considerations of dose constraints in diagnostic medical departments using ionizing radiation

The term “dose constraint” has been used in radiological protection since 1990. Its practical application has varied from country to country to the present day. The authors of this paper believe that it is an underestimated tool for the purpose of radiological protection. This study aims to estimate local dose constraints for workers in conventional nuclear medicine and radiology departments, on the basis of doses received in the last 3 to 4 years by different groups of workers. The levels of exposure to employees of the nuclear medicine department correspond well to levels in other countries, but for employees belonging to the radiology department, the levels are significantly lower. Unification of the practical application of dose constraints and legislation concerning their specific values would increase the relevance and effectiveness of these operational units. This is a playing field for radiation safety officers for the determination and widespread publication of local dose constraints in their particular medical departments

The influence of carbon dioxide field flooding in mitral valve operations with cardiopulmonary bypass on S100ß level in blood plasma in the aging brain

Mariusz Listewnik,1 Katarzyna Kotfis,2 Paweł Ślozowski,1 Krzysztof Mokrzycki,1 Mirosław Brykczyński1 1Department of Cardiac Surgery, Pomeranian Medical University, Szczecin, Poland; 2Department of Anesthesiology, Intensive Therapy and Acute Intoxications, Pomeranian Medical University, Szczecin, Poland Introduction: The risk of air microembolism during cardiopulmonary bypass (CPB) is high and influences the postoperative outcome, especially in elderly patients. The use of carbon dioxide (CO2) atmosphere during cardiac surgery may reduce the risk of cerebral air microembolism. The aim of our study was to assess the influence of CO2 field flooding on microembolism-induced brain damage assessed by the level of S100ß protein, regarded as a marker of brain damage.Materials and methods: A group of 100 patients undergoing planned mitral valve operation through median sternotomy using standard CPB was recruited for the study. Echocardiography was performed prior to and after the CPB. CO2 insufflation at 6 L/minute was conducted in the study group. Blood samples for S100ß protein analysis were collected after induction of anesthesia, 2 hours after aorta de-clamping, and 24 hours after operation.Results: The S100ß level in blood plasma did not differ significantly between the study and the control group (0.13±0.08 µg/L, 1.12±0.59 µg/L, and 0.26±0.23 µg/L and 0.18±0.19 µg/L, 1.31±0.62 µg/L, and 0.23±0.12 µg/L, P=0.7, 0.14, and 0.78). The mean increase of the S100ß concentration was 13% lower in the group with CO2 protection than in the control group (0.988 µg/L vs 1.125 µg/L), although statistically insignificant. Tricuspid valve annuloplasties (TVAs) had significant impact on the increase in S100ß concentration in the treatment group after 24 hours (TVA [-] 0.21±0.09 vs TVA [+] 0.42±0.42, P=0.05). In patients >60 years, there were significant differences in the S100ß level 2 and 24 hours after the procedure (1.59±0.682 µg/L vs 1.223±0.571 µg/L, P=0.048, and 0.363±0.318 µg/L vs 0.229±0.105 µg/L, P=0.036) as compared with younger patients.Conclusion: The increase in S100ß concentration was lower in the group with CO2 protection than in the control group. Age and an addition of TVA significantly influenced the level of S100ß concentration in the tests performed 2 hours after aortic clamp release. Keywords: mitral valve surgery, S100ß, air microembolism, cardiopulmonary bypass, carbon dioxide insufflatio

Diabetes and elevated preoperative HbA1c level as risk factors for postoperative delirium after cardiac surgery: an observational cohort study

Katarzyna Kotfis,1 Aleksandra Szylińska,2 Mariusz Listewnik,3 Mirosław Brykczyński,3 E Wesley Ely,4,5 Iwona Rotter21Department of Anesthesiology, Intensive Therapy and Acute Intoxications, Pomeranian Medical University, Szczecin, Poland; 2Department of Medical Rehabilitation and Clinical Physiotherapy, Pomeranian Medical University, Szczecin, Poland; 3Department of Cardiac Surgery, Pomeranian Medical University, Szczecin, Poland; 4Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA; 5Geriatric Research, Education and Clinical Center (GRECC) Service, Department of Veterans Affairs Medical Center, Tennessee Valley Healthcare System, Nashville, TN, USA Introduction: Postoperative delirium (POD) is a common complication of cardiac surgery associated with increased mortality, morbidity, and long-term cognitive dysfunction. Diabetic patients, especially those with poor diabetes control and long-standing hyperglycemia, may be at risk of developing delirium. The aim of this study was to analyze whether the occurrence of POD in cardiac surgery is associated with diabetes or elevated preoperative glycated hemoglobin (HbA1c) level.Materials and methods: We performed a cohort analysis of prospectively collected data from a register of cardiac surgery department of a university hospital. Delirium assessment was performed twice a day during the first 5 days after the operation based on Diagnostic Statistical Manual of Mental Disorders, fifth edition criteria.Results: We analyzed a cohort of 3,178 consecutive patients, out of which 1,010 (31.8%) were diabetic and 502 (15.8%) were diagnosed with POD. Patients with delirium were more often diabetic (42.03% vs 29.86%, P<0.001) and on oral diabetic medications (34.66% vs 24.07%, P<0.001), no difference was found in patients with insulin treatment. Preoperative HbA1c was elevated above normal (≥6%) in more delirious than nondelirious patients (44.54% vs 33.04%, P<0.001), but significance was reached only in nondiabetic patients (20.44% vs 14.86%, P=0.018). In univariate analysis, the diagnosis of diabetes was associated with an increased risk of developing POD (OR: 1.703, 95% CI: 1.401–2.071, P<0.001), but only for patients on oral diabetic medications (OR: 1.617, 95% CI: 1.319–1.983, P<0.001) and an association was noted between HbA1c and POD (OR: 1.269, 95% CI: 1.161–1.387, P<0.001). Multivariate analysis controlled for diabetes showed that POD was associated with age, heart failure, preoperative creatinine, extracardiac arteriopathy, and preoperative HbA1c level.Conclusion: More diabetic patients develop POD after cardiac surgery than nondiabetic patients. Elevated preoperative HbA1c level is a risk factor for postcardiac surgery delirium regardless of the diagnosis of diabetes. Keywords: glycated hemoglobin, POD, mortality, outcome, IC

Early delirium after cardiac surgery: an analysis of incidence and risk factors in elderly (≥65 years) and very elderly (≥80 years) patients

Katarzyna Kotfis,1 Aleksandra Szylińska,2 Mariusz Listewnik,3 Marta Strzelbicka,1 Mirosław Brykczyński,3 Iwona Rotter,2 Maciej Żukowski1 1Department of Anesthesiology, Intensive Therapy and Acute Intoxications, Pomeranian Medical University, Szczecin, Poland; 2Department of Medical Rehabilitation and Clinical Physiotherapy, Pomeranian Medical University, Szczecin, Poland; 3Department of Cardiac Surgery, Pomeranian Medical University, Szczecin, Poland Introduction: Postoperative delirium is a common complication of cardiac surgery associated with increased mortality, morbidity, and long-term cognitive dysfunction. The aim of this study was to identify incidence and risk factors of delirium in elderly (≥65 years) and very elderly (≥80 years) patients undergoing major cardiac surgery. Materials and methods: We performed a retrospective cohort analysis of prospectively collected data from a register of the cardiac surgery department of a tertiary referral university hospital between 2014 and 2016. Analysis was performed in two groups, ≥65 years and ≥80 years. Results: We analyzed 1,797 patients ≥65 years, including 230 (7.24%) patients ≥80 years. Delirium was diagnosed in 21.4% (384/1,797) of patients above 65 years, and in 33.5% (77/230) of octogenarians. Early mortality did not differ between patients with and without delirium. Intensive care unit (ICU) stay (p<0.001), hospital stay (p<0.001), and intubation time (p=0.002) were significantly longer in patients undergoing cardiac surgery ≥65 years with delirium. According to multivariable analysis, ≥65 years, age (odds ratio [OR] 1.036, p=0.002), low ejection fraction (OR 1.634, p=0.035), diabetes (1.346, p=0.019), and extracardiac arteriopathy (OR 1.564, p=0.007) were found to be independent predictors of post-cardiac surgery delirium. Postoperative risk factors for developing delirium ≥65 years were atrial fibrillation (1.563, p=0.001), postoperative pneumonia (OR 1.896, p=0.022), elevated postoperative creatinine (OR 1.384, p=0.004), and prolonged hospitalization (OR 1.019, p=0.009). Conclusion: Patients above 65 years of age with postoperative delirium have poorer outcome and are more likely to have prolonged hospitalization and ICU stay, and longer intubation times, but 30-day mortality is not increased. In our study, eight independent risk factors for development of post-cardiac surgery delirium were age, low ejection fraction, diabetes, extracardiac arteriopathy, postoperative atrial fibrillation, pneumonia, elevated creatinine, and prolonged hospitalization time. Keywords: elderly, age, delirium, cardiac surgery, risk factors, mortality, outcom

Analysis of the influence of respiratory disorders observed in preoperative spirometry on the dynamics of early inflammatory response in patients undergoing isolated coronary artery bypass grafting

Aleksandra Szylińska,1 Mariusz J Listewnik,2 Iwona Rotter,1 Aleksandra Rył,3 Andrzej Biskupski,2 Mirosław Brykczyński2 1Department of Medical Rehabilitation, 2Department of Cardiac Surgery, 3Department of Histology and Developmental Biology, Pomeranian Medical University, Szczecin, Poland Background: Preoperative spirometry provides measurable information about the occurrence of respiratory disorders. The aim of this study was to assess the association between preoperative spirometry abnormalities and the intensification of early inflammatory responses in patients following coronary artery bypass graft in extracorporeal circulation. Material and methods: The study involved 810 patients (625 men and 185 women) aged 65.4±7.9 years who were awaiting isolated coronary artery bypass surgery. On the basis of spirometry performed on the day of admittance to the hospital, the patients were divided into three groups. Patients without respiratory problems constituted 78.8% of the entire group. Restricted breathing was revealed by spirometry in 14.9% and obstructive breathing in 6.3% of patients. Results: Inter-group analysis showed statistically significant differences in C-reactive protein (CRP) between patients with restrictive spirometry abnormalities and patients without any pulmonary dysfunction. CRP concentrations differed before surgery (P=0.006) and on the second (P<0.001), fourth (P=0.005) and sixth days after surgery (P=0.029). There was a negative correlation between CRP levels and FEV1. Conclusion: In our study, the most common pulmonary disorders in the coronary artery bypass graft patients were restrictive. Patients with abnormal spirometry results from restrictive respiratory disorders have an elevated level of generalized inflammatory response both before and after the isolated coronary artery bypass surgery. Therefore, this group of patients should be given special postoperative monitoring and, in particular, intensive respiratory rehabilitation immediately after reconstitution. Keywords: pulmonary function, C-reactive protein, cardiac surger

Balancing intubation time with postoperative risk in cardiac surgery patients – a retrospective cohort analysis

Katarzyna Kotfis,1 Aleksandra Szylińska,2 Mariusz Listewnik,3 Kacper Lechowicz,1 Monika Kosiorowska,3 Sylwester Drożdżal,1 Mirosław Brykczyński,3 Iwona Rotter,2 Maciej Żukowski1 1Department of Anesthesiology, Intensive Therapy and Acute Intoxications, Pomeranian Medical University, Szczecin, Poland; 2Department of Medical Rehabilitation and Clinical Physiotherapy, Pomeranian Medical University, Szczecin, Poland; 3Department of Cardiac Surgery, Pomeranian Medical University, Szczecin, Poland Introduction: Intubation time in patients undergoing cardiac surgery may be associated with increased mortality and morbidity. Premature extubation can have serious adverse physiological consequences. The aim of this study was to determine the influence of intubation time on morbidity and mortality in patients undergoing cardiac surgery.Methods: We performed a retrospective analysis of data on 1,904 patients undergoing isolated coronary artery bypass grafting (CABG) and stratified them by duration of intubation time after surgery – 0–6, 6–9, 9–12, 12–24 and over 24 hours. Postoperative complications risk analysis was performed using multivariate logistic regression analysis for patients extubated ≤12 and >12 hours.Results: Intubation percentages in each time cohort were as follows: 0–6 hours – 7.8%, 6–9 hours – 17.3%, 9–12 hours – 26.8%, 12–24 hours – 44.4% and >24 hours – 3.7%. Patients extubated ≤12 hours after CABG were younger, mostly males, more often smokers, with lower preoperative risk. They had lower 30-day mortality (2.02% vs 4.59%, P=0.002), shorter hospital stay (7.68±4.49 vs 9.65±12.63 days, P<0.001) and shorter intensive care unit stay (2.39 vs 3.30 days, P<0.001). Multivariate analysis showed that intubation exceeding 12 hours after CABG increases the risk of postoperative delirium (OR 1.548, 95% CI 1.161–2.064, P=0.003) and risk of postoperative hemofiltration (OR 1.302, 95% CI 1.023–1.657, P=0.032).Conclusion: Results indicate that risk of postoperative complications does not increase until intubation time exceeds 12 hours. Shorter intubation time is seen in younger, men and smokers. Intubation time >12 hours is a risk factor for postoperative delirium and hemofiltration after cardiac surgery. Keywords: intubation, cardiac surgery, CABG, mortality, complications, delirium&nbsp