Merkel cell carcinoma of skin-current controversies and recommendations

The review covers the current recommendations for Merkel cell carcinoma (MCC), with detailed discussion of many controversies. The 2010 AJCC staging system is more in-line with other skin malignancies although more complicated to use. The changes in staging system over time make comparison of studies difficult. A wide excision with margins of 2.5–3 cm is generally recommended. Even for primary </= 1 cm, there is a significant risk of nodal and distant metastases and hence sentinel node biopsy should be done if possible; otherwise adjuvant radiotherapy to the primary and nodal region should be given. Difficulties of setting up trials owing to the rarity of the disease and the mean age of the patient population result in infrequent reports of adjuvant or concurrent chemotherapy in the literature. The benefit, if any, is not great from published studies so far. However, there may be a subgroup of patients with high-risk features, e.g. node-positive and excellent performance status, for whom adjuvant or concurrent chemotherapy may be considered. Since local recurrence and metastases generally occur within 2 years of the initial diagnosis, patients should be followed more frequently in the first 2 years. However delayed recurrence can still occur in a small proportion of patients and long-term follow-up by a specialist is recommended provided that the general condition of the patient allows it. In summary, physician judgment in individual cases of MCC is advisable, to balance the risk of recurrence versus the complications of treatment

Effect of aliskiren on post-discharge outcomes among diabetic and non-diabetic patients hospitalized for heart failure: insights from the ASTRONAUT trial

Aims The objective of the Aliskiren Trial on Acute Heart Failure Outcomes (ASTRONAUT) was to determine whether aliskiren, a direct renin inhibitor, would improve post-discharge outcomes in patients with hospitalization for heart failure (HHF) with reduced ejection fraction. Pre-specified subgroup analyses suggested potential heterogeneity in post-discharge outcomes with aliskiren in patients with and without baseline diabetes mellitus (DM). Methods and results ASTRONAUT included 953 patients without DM (aliskiren 489; placebo 464) and 662 patients with DM (aliskiren 319; placebo 343) (as reported by study investigators). Study endpoints included the first occurrence of cardiovascular death or HHF within 6 and 12 months, all-cause death within 6 and 12 months, and change from baseline in N-terminal pro-B-type natriuretic peptide (NT-proBNP) at 1, 6, and 12 months. Data regarding risk of hyperkalaemia, renal impairment, and hypotension, and changes in additional serum biomarkers were collected. The effect of aliskiren on cardiovascular death or HHF within 6 months (primary endpoint) did not significantly differ by baseline DM status (P = 0.08 for interaction), but reached statistical significance at 12 months (non-DM: HR: 0.80, 95% CI: 0.64-0.99; DM: HR: 1.16, 95% CI: 0.91-1.47; P = 0.03 for interaction). Risk of 12-month all-cause death with aliskiren significantly differed by the presence of baseline DM (non-DM: HR: 0.69, 95% CI: 0.50-0.94; DM: HR: 1.64, 95% CI: 1.15-2.33; P < 0.01 for interaction). Among non-diabetics, aliskiren significantly reduced NT-proBNP through 6 months and plasma troponin I and aldosterone through 12 months, as compared to placebo. Among diabetic patients, aliskiren reduced plasma troponin I and aldosterone relative to placebo through 1 month only. There was a trend towards differing risk of post-baseline potassium ≥6 mmol/L with aliskiren by underlying DM status (non-DM: HR: 1.17, 95% CI: 0.71-1.93; DM: HR: 2.39, 95% CI: 1.30-4.42; P = 0.07 for interaction). Conclusion This pre-specified subgroup analysis from the ASTRONAUT trial generates the hypothesis that the addition of aliskiren to standard HHF therapy in non-diabetic patients is generally well-tolerated and improves post-discharge outcomes and biomarker profiles. In contrast, diabetic patients receiving aliskiren appear to have worse post-discharge outcomes. Future prospective investigations are needed to confirm potential benefits of renin inhibition in a large cohort of HHF patients without D

Identifying status of an ICT system using rough sets

The article presents a method to identify operational state of an data communications (ICT) system. Supporting the management or operation of the simulation process. Method which was used is based on rough set theory

Reliability of data obtained from video systems of traffic surveillance

The paper presents a way for estimating the reliability of data obtained with video systems of traffic surveillance. It describes the elements of factors determining the reliability of this indicator and presents a method for determining it using a computer simulation. This indicator can be used for assessing the quality of services

Metodyka tworzenia wirtualnej odlewni

Systemic approach to design of factories requires that engineering, organisational and economic aspects should be considered concurrently. That prompts the need to develop a solution, based on the state-of-the-art IT technologies, to enable us to solve the problems associated with foundry production planning. The paper outlines a methodology of creating the simulation model of a virtual foundry, as a tool for foundry design. An integrative approach is suggested for development of a complete foundry model, enabling the design of more efficient production systems. The underlying principles of such models are discussed, the basic stages involved in the methodology are outlined and the range of its applicability is defined.Systemowe podejście do projektowania bądź rekonstrukcji systemów wytwarzania wymaga równoległego rozpatrywania zagadnień technologicznych, technicznych, organizacyjnych i ekonomicznych. Stwarza to potrzebę opracowania rozwiązania, opartego na najnowszych osiągnięciach technologii informatycznych, pozwalającego na kompleksowe rozwiązywanie problemu projektowania systemów produkcji odlewniczej. W pracy przedstawiono metodykę tworzenia (budowy) modelu symulacyjnego tzw. wirtualnej odlewni jako narzędzia projektowania zakładu odlewniczego. Zaproponowano iteracyjne podejście tworzenia kompleksowego modelu odlewni, dające w efekcie mozliwość projektowania bardziej wydajnych systemów wytwórczych. Przedstawiono zasady konstrukcji takiego modelu, opisano podstawowe etapy metodyki oraz określono mozliwości jej zastosowania

Virtual factory as a method of foundry design and production management

The paper outlines the methodology of virtual design of a foundry plant as a system. The most important stage in the procedure involves the development of a model defined as a set of data about the system. Model development involves two stages: defining the model’s architecture and specifying the model data in the form of parameters and input-output relationships. The structure is understood as configuration of machines and transport units, representing the sub-systems and system components. As the main purpose of the simulation procedure is to find the characteristics of the system’s behaviour, the merits of the iterative method involving analysis, synthesis and evaluation of results are fully explored

Profitability of Photovoltaic and Energy Storage System in a Foundry Plant

The article presents a case study on the effectiveness of photovoltaic farm and battery energy storage in one of the Polish foundries. In the study, we consider two investment options: stand-alone PV farm of 1MWp and the farm together with battery energy storage with a maximum capacity of 4MWh. The Payback Period and Net Present Value were used as measures of investment profitability. The paper provides a detailed presentation of the assumptions made, as well as the PV electricity production model of the farm and the optimization model that determines the operation cycle of the energy storage. The case study presented in the article shows that the PV farm is economically sensible and profitable, but the battery energy storage is too costly to give a positive economic effect. Energy storage is an important element that provides flexibility in the energy supply system, so it is necessary to find a technical solution that gives this flexibility. Such a solution could be a virtual power plant, which could include a foundry energy system with a RES installation inside

Virtual Factory as a Method of Foundry Design and Production Management

The paper outlines the methodology of virtual design of a foundry plant as a system. The most important stage in the procedure involvesthe development of a model defined as a set of data about the system. Model development involves two stages: defining the model’sarchitecture and specifying the model data in the form of parameters and input-output relationships. The structure is understood asconfiguration of machines and transport units, representing the sub-systems and system components. As the main purpose of thesimulation procedure is to find the characteristics of the system’s behaviour, the merits of the iterative method involving analysis,synthesis and evaluation of results are fully explored