COVID-19 — Toward a comprehensive understanding of the disease

The evidence on the pathophysiology of the novel coronavirus SARS-CoV-2 infection is rapidly growing. Understanding why some patients suffering from COVID-19 are getting so sick, while others are not, has become an informal imperative for researchers and clinicians around the globe. The answer to this question would allow rationalizing the fear surrounding this pandemic. Understanding of the pathophysiology of COVID-19 relies on an understanding of interplaying mechanisms, including SARS-CoV-2 virulence, human immune response, and complex inflammatory reactions with coagulation playing a major role. An interplay with bacterial co-infections, as well as the vascular system and microcirculation affected throughout the body should also be examined. More importantly, a compre­hensive understanding of pathological mechanisms of COVID-19 will increase the efficacy of therapy and decrease mortality. Herewith, presented is the current state of knowledge on COVID-19: beginning from the virus, its transmission, and mechanisms of entry into the human body, through the pathological effects on the cellular level, up to immunological reaction, systemic and organ presentation. Last but not least, currently available and possible future therapeutic and diagnostic options are briefly commented on

Obturacyjny bezdech senny — dlaczego należy go rozpoznawać i leczyć w grupie kierowców?

Wypadki drogowe stanowią ważną przyczynę zgo­nów i niepełnosprawności, szczególnie u osób aktywnych zawodowo. Grupą kierowców w więk­szym stopniu narażoną na tego rodzaju wypadki są zawodowi kierowcy, a zwłaszcza osoby z obtu­racyjnym bezdechem sennym (OSA), który stanowi dodatkowo czynnik ryzyka rozwoju wielu schorzeń kardiologicznych (m.in. nadciśnienia tętniczego, udaru mózgu, zaburzeń rytmu czy zawału serca). Ze względów bezpieczeństwa jest niezwykle istot­ne, aby choroba ta była wcześnie zdiagnozowana, właściwie leczona i kontrolowana. Z tego powodu Grupa Robocza ds. OSA działająca pod auspicjami Komisji Europejskiej, a wcześniej również amery­kańska Federal Motor Carrier Safety Administration, American Thoracic Society oraz kanadyjskie Cana­dian Thoracic Society — Canadian Sleep Society, przygotowały zalecenia dotyczące wydawania oraz recertyfikacji praw jazdy u zawodowych kierowców z OSA, a także warunków natychmiastowego za­wieszenia prawa jazdy w tej grupie kierowców. Ze względu na fakt, że częstą, choć potencjalnie nie­doszacowaną, przyczyną wypadków drogowych jest zaśnięcie za kierownicą, są prowadzone badania w celu identyfikacji pacjentów cechujących się szczególnie zwiększonym ryzykiem takiego epizodu. W artykule przedstawiono rolę OSA jako czynnika ryzyka nie tylko incydentów sercowo-naczynio­wych, ale także wypadków drogowych, możliwości wyodrębnienia grup pacjentów narażonych na taki wypadek (szczególnie będący skutkiem zaśnięcia za kierownicą) oraz zalecenia towarzystw nauko­wych i agend rządowych dotyczące postępowania w tej grupie chorych

Association of Beta-Blockers with Survival on Patients Presenting with ACS Treated with PCI: A Propensity Score Analysis from the BleeMACS Registry

Purpose: The aim was to evaluate prognostic value of beta-blocker (BB) administration in acute coronary syndromes (ACS) patients in the percutaneous coronary intervention (PCI) era. Methods and Results: The BleeMACS project is a multicenter, observational, retrospective registry enrolling patients with ACS worldwide in 15 hospitals. Patients discharged with BB therapy were compared to those discharged without a BB before and after propensity score with matching. The primary endpoint was all-cause mortality at 1 year. Secondary endpoints included in-hospital reinfarction, in-hospital heart failure, 1-year myocardial infarction, 1-year bleeding and 1-year composite of death and recurrent myocardial infarction. After matching, 2935 patients for each group were enrolled. The primary endpoint of 1-year death was significantly lower in the group on BB therapy (4.5 vs 7%, p < 0.05), while only a trend was noted for recurrent acute myocardial infarction (4.5 vs 4.9%, p = 0.54). These results were consistent for patients older than 80 years of age, for ST-elevation myocardial infarction (STEMI) patients, and for those discharged with complete versus incomplete revascularization, but not for non-STEMI/unstable angina patients. Conclusions: BB therapy was related to 1-year lower risk of all-cause mortality, independently from completeness of revascularization, admission diagnosis, age and ejection fraction. Randomized controlled trials for patients treated with PCI for ACS should be performed

Prediction of Post-Discharge Bleeding in Elderly Patients with Acute Coronary Syndromes: Insights from the BleeMACS Registry

Background A poor ability of recommended risk scores for predicting in-hospital bleeding has been reported in elderly patients with acute coronary syndromes (ACS). No study assessed the prediction of post-discharge bleeding in the elderly. The new BleeMACS score (Bleeding complications in a Multicenter registry of patients discharged with diagnosis of Acute Coronary Syndrome), was designed to predict post-discharge bleeding in ACS patients. We aimed to assess the predictive ability of the BleeMACS score in elderly patients. Methods We assessed the incidence and characteristics of severe bleeding after discharge in ACS patients aged ≥ 75 years. Bleeding was defined as any intracranial bleeding or bleeding leading to hospitalization and/or red blood transfusion, occurring within the first year after discharge. We assessed the predictive ability of the BleeMACS score according to age by Fine-Gray proportional hazards regression analysis, calculating receiver-operating characteristic (ROC) curves and the area under the ROC curves (AUC). Results The BleeMACS registry included 15,401 patients of whom 3,376/15,401 (21.9%) were aged ≥ 75 years. Elderly patients were more commonly treated with clopidogrel and less often treated with ticagrelor or prasugrel. Of 3,376 elderly patients, 190 (5.6%) experienced post-discharge bleeding. The incidence of bleeding was moderately higher in elderly patients (hazard ratio [HR], 2.31, 95% confidence interval [CI], 1.92-2.77). The predictive ability of the BleeMACS score was moderately lower in elderly patients (AUC, 0.652 vs. 0.691, p = 0.001). Conclusion Elderly patients with ACS had a significantly higher incidence of post-discharge bleeding. Despite a lower predictive ability in older patients, the BleeMACS score exhibited an acceptable performance in these patients

Analysis of dynamic properties of the PRT vehicle-track system

The paper presents the issue of modelling the system of the PRT vehicle – track. The PRT – Personal Rapid Transit concept is defined as an innovative transport system composed of small vehicles (3–5 persons) moving on the light infrastructure situated at a height of above 5 meters above the ground. This is a system that combines the features of individual and public transport. An important feature of this system is the implementation of the transport approach known as the ‘point to point’ rule that is to say between the initial and the final stop the vehicle does not stop at the intermediate stops. The vehicle has no driver. Routing choice and collision avoidance are performed through a complex computer system

Cooperative concurrent games

In rational verification, the aim is to verify which temporal logic properties will obtain in a multi-agent system, under the assumption that agents (“players”) in the system choose strategies for acting that form a game theoretic equilibrium. Preferences are typically defined by assuming that agents act in pursuit of individual goals, specified as temporal logic formulae. To date, rational verification has been studied using non-cooperative solution concepts—Nash equilibrium and refinements thereof. Such non-cooperative solution concepts assume that there is no possibility of agents forming binding agreements to cooperate, and as such they are restricted in their applicability. In this article, we extend rational verification to cooperative solution concepts, as studied in the field of cooperative game theory. We focus on the core, as this is the most fundamental (and most widely studied) cooperative solution concept. We begin by presenting a variant of the core that seems well-suited to the concurrent game setting, and we show that this version of the core can be characterised using ATL⁎. We then study the computational complexity of key decision problems associated with the core, which range from problems in PSpace to problems in 3ExpTime. We also investigate conditions that are sufficient to ensure that the core is non-empty, and explore when it is invariant under bisimilarity. We then introduce and study a number of variants of the main definition of the core, leading to the issue of credible deviations, and to stronger notions of collective stable behaviour. Finally, we study cooperative rational verification using an alternative model of preferences, in which players seek to maximise the mean-payoff they obtain over an infinite play in games where quantitative information is allowed

Reduced ghit protein expression in nickel transformed mouse cells and nickel induced murine sarcomas.: Mol.Cell Biochem.

NRC publication: Ye

Double superior vena cava and left brachiocephalic vein agenesis: a rare systemic vein anomaly and potential source of CIED and CVC placement complications

Abnormal systemic vein development produces anomalous veins, which—in the case of persistent left superior vena cava and/or left brachiocephalic vein (BCV)—exhibit considerable topographic and morphometric differences in comparison with their usual anatomy. The nature and extent of those developmental anomalies—detected during intravenous procedures, such as cardiac implantable electronic device (CIED) lead insertion or central venous catheter (CVC) placement—may hinder the procedure itself and/or adversely affect its outcome, both at the stage of cardiac lead advancement through an abnormally shaped vessel and lead positioning within the heart. This may lead to problems in achieving optimal sensing and pacing parameters and in ensuring that the patient cannot feel the pacing impulses. These events accompanied a de novo CIED implantation procedure in the patient with a double SVC and left BCV agenesis, who ultimately required reoperation