Local spoilers and pathways to reconciliation : the Polish perspective on the Polish-Ukrainian relations in the Borderlands

In the last three decades Polish-Ukrainian reconciliation has taken a structured and regular form of an international dialogue dominated and controlled by central governments, which simultaneously diminished the importance of the local perspective. Yet, it is the regional level where the Polish-Ukrainian tensions have originally escalated at, and the local borderlands' communities have always played a crucial role in the inter-ethnic relations. That is why this article tackled the topic of Polish-Ukrainian reconciliation as framed by the Polish borderlands’ elites, framing it with three dimensions of reconciliation: encounters, relationship, and innovation. It critically addressed the intractable tensions between Poles and Ukrainians in the borderlands, exploring the contemporary dynamics of distrust, narrowness and historical resentments which are continuously present in the local Polish narrative and stand in the way of reconciliation. The role of the European integration was viewed as an important context and a double-edged sword in the Polish-Ukrainian reconciliation. The article contended that it is crucial to look at Polish-Ukrainian reconciliation beyond the state-level and consider that without the involvement of the borderlands and their perspective, the process is still on a rocky road. The findings were based on primary and secondary sources, including semi-structured interviews conducted in the Polish-Ukrainian borderlands

Przetoka ramienno-odłokciowa jako alternatywa dla dostępu dializacyjnego z protezy naczyniowej na ramieniu - przegląd piśmiennictwa

Celem pracy była ocena wartości przetoki ramienno-odłokciowej jako alternatywy dla dostępu dializacyjnego z protezy naczyniowej na ramieniu na podstawie przeglądu piśmiennictwa. Przetoka ramienno-odłokciowa, po raz pierwszy opisana przez Daghera w 1976 roku, może być wykonana jedno- lub dwuetapowo. Operacja dwuetapowa pozwala na wykorzystanie żył odłokciowych o mniejszej średnicy, które zarterializowane po kilku tygodniach mogą być przemieszczone do kanału podskórnego. Brak możliwości wykorzystania żyły odłokciowej opisano w 5–7%. Niedokrwienie obwodowe po wytworzeniu przetok ramienno-odłokciowych występowało w 2,9%, zwężenia w 2,3%, zakrzepica w 9,7%, zakażenie w 3,6%, obrzęk kończyny w 3,7%, niewydolność serca w 0,2%, tętniaki w 1,9%. Mała liczebność grup, ich niejednorodność, brak randomizacji w większości prac i wykorzystywanie przez autorów rozmaitych definicji poszczególnych wskaźników drożności, które nie zawsze są zgodne z obowiązującymi rekomendacjami, utrudnia porównywanie wyników. Operacje powtórne z powodu powikłań przetok ramienno-odłokciowych były rzadsze niż dostępów z protez naczyniowych. Wskaźniki drożności pierwotnej przetok ramienno-odłokciowych po 12 i 24 miesiącach wynoszą 72% (35–92%) i 60,4% (28–86%), wskaźniki drożności wtórnej po 12 i 24 miesiącach wynoszą 74,6% (55–96%) i 67,5% (52–86%). Anomalie anatomiczne, zwężenia i niedrożności rzadko dotyczą żyły odłokciowej. Operacje dwuetapowe pozwalają na zwiększenie liczby dostępów autogennych. W porównaniu z dostępami z protez naczyniowych przetoki ramienno-odłokciowe są rzadziej poddawane operacjom powtórnym z powodu powikłań, ich wskaźniki drożności są porównywalne z przetokami ramienno-odpromieniowymi, a w materiale wielu autorów są wyższe niż dostępów z protez naczyniowych. Przetoka ramienno-odłokciowa jest korzystną alternatywą dla dostępu dializacyjnego z protezy naczyniowej na ramieniu.The aim of this literature review is to assess brachiobasilic arteriovenous fistula (BBAVF) for haemodialysis as an alternative for arteriovenous graft (AVG) in the upper arm. BBAVF, first described by Dagher in 1976, can be created as a one- or two-stage procedure. The twostage procedure allows the utilization of a basilic vein of small diameter, which, when arterialized, can be transposed into the subcutaneous tunnel after a few weeks. The inability to use the basilic vein for BBAVF creation was described in 5-7% of cases. Distal extremity ischaemia after BBAVF placement was reported in 2.9% of cases, stenoses in 2.3%, thrombosis in 9.7%, infection in 3.6%, arm oedema in 3.7%, high output cardiac failure in 0.2%, and pseudoaneurysm formation in 1.9% of cases. The small number of accesses in the studied groups, their heterogeneity, the lack of randomization in the majority of papers and the use of inconsistent patency rate definitions make versatile and reliable comparison difficult. Reinterventions due to complications of BBAVFs were less frequent than those due to complications of AVGs. Primary patency rates of BBAVFs at 12 and 24 months were 72% (35-92%) and 60.4% (28-86%) respectively, and secondary patency rates at 12 and 24 months were 74.6% (55-96%) and 67.5% (52-86%) respectively. Anatomical abnormalities, stenoses, and occlusion rarely involve the basilic vein. A two-stage procedure allows an increase in the number of autogenous vascular accesses. In comparison to AVGs, BBAVFs less frequently undergo re-interventions due to complications, their patency rates are comparable to brachiocephalic fistulas, and in many instances are higher than those of AVGs. BBAVF is an advantageous alternative for upper arm AVG

New therapeutic approaches in the treatment of node-positive cervical cancer patients based on molecular targets: a systematic review

Cervical uterine cancer is the second most frequent female cancer worldwide and a substantial burden for low-income societies and the patients themselves. Understanding the molecular mechanisms of metastasis permits the development of therapies that limit tumor progression, as well as providing health and social benefits. Pathomorphology is still the basis of research and a reference standard for molecular analysis. The aim of our study was to research and critically evaluate clinical trials that use new oncological approaches for node-positive cervical cancer to gain an insight into the molecular mechanisms of tumor metastasis. Inclusion criteria: node-positive disease at baseline; at least a first phase clinical study comprising adult female patients; novel clinical approach (e.g., radiotherapy, immunotherapy, targeted therapy, vaccines, radiosurgery); histologic measurement of treatment efficacy (preferably lymph node ultrastaging); and publications in English language only. Information sources: US Clinical trials registry, EU Clinical trials register, ISRCTN registry, and Ovid, EBSCO and Cochrane Collaboration databases. Access dates: from January 2010 to April 2018. Exclusions: Abstracts that did not meet the inclusion criteria or with unreliable data. We collected complete data (e.g., the entire publication associated with included abstracts, heterogeneity examination of individual studies, and validity measurement of the statistical methods used). Results were analyzed in relation to the most recent understanding of the pathogenesis of cervical cancer metastasis. We proposed a possible direction for drug treatment of epithelial tumors based on the mechanisms of metastasis

Accuracy of the European Thyroid Imaging Reporting and Data System (EU-TIRADS) in the valuation of thyroid nodule malignancy in reference to the post-surgery histological results

Purpose: To assess the clinical usefulness of the European Thyroid Imaging and Reporting Data System (EU-TIRADS) in the valuation of thyroid nodules malignancy in reference to post-surgery histological results. Material and methods: Pre-operative ultrasound was performed in consecutive patients admitted for thyroid surgery between June 2017 and January 2018. Thyroid nodules were classified according to EU-TIRADS to five groups: 1-5. At least one fine-needle aspiration biopsy (FNAB)/patient (dominant or suspected nodule) was performed in an outpatient clinic. The final diagnosis was based on the histological result. The percentage of cancers in each EU-TIRADS group was evaluated. Finally, sensitivity, specificity, accuracy, as well as positive and negative predictive values for malignancy were assessed. Results: Fifty-two patients with a total of 140 thyroid nodules (median: 3 nodules/thyroid [minimum-maximum: 1-6]) were enrolled in the study. Thyroid cancer was diagnosed in 0% (0/6) in EU-TIRADS 2; 0% (0/92) in EU-TIRADS 3; 5.9% (2/34) in EU-TIRADS 4, and 75% (6/8) in EU-TIRADS 5. In nodules assessed as EU-TIRADS ≥ 4 sensitivity, specificity, positive and negative predictive values for malignancy were, respectively: 75% (CI 95%: 40.7-93.5), 94.1% (CI 95%: 86.0-98.5), 75% (CI 95%: 40.7-93.5), and 94.1% (CI 95%: 86.0-98.5). Conclusions: EU-TIRADS is a valuable and simple tool for assessment of the risk of malignancy of thyroid nodules and demonstrates a high ultrasound correlation with histological post-surgery results. FNAB should be performed in all nodules assessed as EU-TIRADS ≥ 4, due to higher risk of malignancy

Orwell w realu, czyli o systemie Echelon z perspektywy polskiego prawa

„Freedom and privacy ofcommunication is guaranteed. The restrictions may be imposed only in cases specified in the Act and in the manner specified therein.” This pronounced and clear declaration, being not only a legal guarantee is included in paragraph 49 of Constitution of the Republic of Poland. We look at it from the hindsight, which was created by a system of global invigilation of communication, not only electronic one, called Echelon. It was widely known before Edward Snowden was heard in Hong Kong. Echelon was talked, written about and discussed not only in European Parliament but also at other formal forum. Yet, in our country this phenomenon did not arouse much interest either of lawyers, ministers, senators, government or politicians. There is probably the first attempt of assessing the consequences of Echelon from the view of Polish law. We limit ourselves intentionally to the point which was reachable for everyone before Snowden. We believe that it has a particular meaning: it illustrates that in our country there is a dramatic implementation of the constitutional right to democratic rule of law. It makes us realize where we live and what we can

Course of fatigue among patients previously hospitalised due to COVID-19

Introduction. Discrepancies exist regarding the clinical course and prognostic factors for post-COVID fatigue. Therefore, our aim was to assess the timely course of fatigue and its possible predictors in patients previously hospitalised due to SARS-CoV-2 infection. Material and methods. Patients and employees of the University Hospital in Krakow were assessed with the use of a validated neuropsychological questionnaire. Included were participants aged 18 or more, previously hospitalised due to COVID-19, who completed questionnaires only once > 3 months after the onset of infection. Individuals were retrospectively asked about the presence of eight symptoms of chronic fatigue syndrome at four timepoints: before COVID-19, within 0–4 weeks, 4–12 weeks, and > 12 weeks post-infection. Results. We enrolled 204 patients [40.2% women, median age 58 (46–66) years] evaluated after a median of 187 (156–220) days from the first positive nasal swab test for SARS-CoV-2. The most common comorbidities were hypertension (44.61%), obesity (36.27%), smoking (28.43%), and hypercholesterolemia (21.08%); none of the patients required mechanical ventilation during hospitalisation. Before COVID-19, 43.62% of patients reported at least one symptom of chronic fatigue. Within 4, 4–12, and > 12 weeks after COVID-19, the prevalence of chronic fatigue was 76.96%, 75.49%, and 66.17%, respectively (all p < 0.001). The frequency of chronic fatigue symptoms decreased within > 12 weeks following the onset of infection but did not return to baseline values, except for self-reported lymph node enlargement. In a multivariable linear regression model, the number of fatigue symptoms was predicted by female sex [β 0.25 (0.12; 0.39), p < 0.001 and 0.26 (0.13; 0.39), p < 0.001 for weeks 0–12 and > 12, respectively], and age [for < 4 weeks, β –0.12 (–0.28; –0.01), p = 0.029]. Conclusions. Most patients previously hospitalised due to COVID-19 suffer from fatigue > 12 weeks after infection onset. The presence of fatigue is predicted by female sex and – only for the acute phase — age

Sex-related patient-reported brain fog symptoms in non-hospitalised COVID-19 patients

Introduction. Previous studies on the prognostic role of sex in post-COVID-associated brain fog have yielded divergent results. Moreover, limited evidence exists regarding the evolution of brain fog symptoms over time, especially in ambulatory patients and separately for women and men. Therefore, the aim of the current study was to assess brain fog symptoms in nonhospitalised patients with COVID-19, according to their sex. Material and methods. We created a neuropsychological questionnaire including eight questions on the presence of brain fog symptoms in the following four time periods: before COVID-19, and 0–4, 4–12, and > 12 weeks post-infection. The validity and reliability of the questionnaire were assessed. In this cross-sectional study, questionnaires were filled out anonymously and retrospectively once only by patients or through a survey link posted online. Included were patients ≥ 18 years, with > 3 months since the SARS-CoV-2 infection onset confirmed by RT-PCR from a nasopharyngeal swab. Results. The study included 303 patients (79.53% women, 47.52% medical personnel). Median time between COVID-19 onset and questionnaire completion was 208 (IQR 161–248) days. Women, compared to men, reported a higher prevalence of problems with writing, reading, and counting (< 4 weeks, OR 3.05, 95% CI: 1.38–6.72; 4–12 weeks, OR 2.51, 95% CI: 1.02–6.14; > 12 weeks, OR 3.74, 95% CI: 1.12–12.56) and thoughts communication (< 4 weeks, OR 2.53, 95% CI: 1.41–4.54; 4–12 weeks, OR 3.74, 95% CI: 1.93–7.24; > 12 weeks, OR 2.00, 95% CI: 1.01–3.99). The difference between the two sexes in answering questions in an understandable/unambiguous manner was statistically significant between four and 12 weeks after infection (OR 2.63, 95% CI: 1.36–5.10), while a sex difference in recalling new information was found below 12 weeks (OR 2.54, 95% CI: 1.44–4.48 and OR 2.43, 95% CI: 1.37–4.31 for < 4 and 4–12 weeks, respectively). No sex differences in reporting problems with multitasking, remembering information from the past, determining the current date, or field orientation were noted. Conclusions. Non-hospitalised women and men retrospectively report a different course of COVID-19-associated brain fog

Prognostic value of computed tomography derived measurements of pulmonary artery diameter for long-term outcomes after transcatheter aortic valve replacement

Background: An increase in pulmonary artery diameter (PAD) on multi-detector computed tomography (MDCT) may indicate pulmonary hypertension. We assessed the prognostic value of MDCT-derived measurements of PAD on outcomes after successful transcatheter aortic valve replacement (TAVR).Methods: Consecutive patients treated with TAVR from February 2013 to October 2017, with a 68.8% rate of new generation valves, underwent pre-interventional MDCT with measurements of PAD (in the widest short-axis within 3 cm of the bifurcation) and ascending aortic diameter (AoD; at the level of the PAD). The PAD/AoD ratio was calculated. Patients with high-density lipoprotein cholesterol levels ≤46 mg/dl and C-reactive protein levels ≥0.20 mg/dl at baseline were identified as the frail group. One-year mortality was established for all subjects.Results: Among studied 266 patients (median age, 82.0 years; 63.5% women) those who died at 1 year (n = 34; 12.8%) had larger PAD and PAD/AoD (28.9 [5.0] vs. 26.5 [4.6] mm and 0.81 [0.13] vs. 0.76 [0.13] mm vs. the rest of the studied subjects; P = 0.005 and P = 0.02, respectively) but similar AoD. The cutoff value for the PAD to predict 1-year mortality was 29.3 mm (sensitivity, 50%; specificity, 77%; area under the curve, 0.65). Patients with PAD >29.3 mm (n = 72; 27%) had higher 1-year mortality (23.6% vs. 8.8%, log-rank P = 0.001). Baseline characteristics associated with PAD 29.3 mm were a bigger body mass index, more frequent diabetes mellitus, more prior stroke/transient ischemic attacks and atrial fibrillation, and lower baseline maximal aortic valve gradient with higher pulmonary artery systolic pressure (PASP). PAD >29.3 mm and frailty, but not baseline PASP, remained predictive of 1-year mortality in the multivariable model (hazard ratio [HR], 2.221; 95%CI, 1.038–4.753; P = 0.04 and HR, 2.801; 95% CI, 1.328–5.910; P = 0.007, respectively).Conclusion: PAD >29.3 mm on baseline MDCT is associated with higher 1-year mortality after TAVR, independently of echocardiographic measures of PH and frailty