Tricuspid intervention for less-than-severe regurgitation at time of minimally invasive mitral valve surgery in patients with AF

Background: While to address moderate tricuspid regurgitation (TR) at time of left-side heart surgery is recommended by the guidelines, the procedure is still seldom performed and especially in the minimally invasive setting. Atrial fibrillation (AF) is known marker of both mortality and TR progression after mitral valve surgery. Aims: The current study aimed to address the safety of adding a tricuspid intervention to minimally invasive mitral valve surgery (MIMVS) in patients with preoperative AF. Methods: We retrospectively analyzed data from Polish National Registry of Cardiac Surgery Procedures between 2006 and 2021. We included all patients who underwent MIMVS (mini-thoracotomy-, totally thoracoscopic- or robotic surgery) and presented with moderate tricuspid regurgitation and AF preoperatively. The primary endpoint was death from any cause at 30 days and at longest available follow between MIMVS with tricuspid intervention vs MIMVS alone. We used propensity score matching to account for baseline differences between groups. Results: We identified 1,545 patients with AF undergoing MIMVS, 54.7% were men aged 66.7±9.2years. Of those, 733 (47.4%) underwent concomitant tricuspid valve intervention. At 13 years, addition of tricuspid intervention was associated with 33% higher mortality as compared to MIMVS alone. HR 1.33; 95 CIs (1.05-1.69); P=0.02. PS matching resulted in 565 well-balanced pairs. Concomitant tricuspid intervention did not influence long-term follow-up: HR, 1.01; 95 CIs (0.74-1.38); P=0.94. Conclusions: After adjusting for baseline cofounders the addition of tricuspid intervention for moderate tricuspid regurgitation to MIMVS did not increase perioperative mortality nor influence long-term survival

Out-of-hospital cardiac arrest: Do we have to perform coronary angiography?

Out-of-hospital cardiac arrest (OHCA) remains a leading cause of global mortality, while survivors are burdened with long-term neurological and cardiovascular complications. OHCA management at the hospital level remains challenging, due to heterogeneity of OHCA presentation, the critical status of OHCA patients reaching the return of spontaneous circulation (ROSC), and the demands of post ROSC treatment. The validity and optimal timing for coronary angiography is one important, yet not fully defined, component of OHCA management. Guidelines state clear recommendations for coronary angiography in OHCA patients with shockable rhythms, cardiogenic shock, or in patients with ST-segment elevation observed in electrocardiography after ROSC. However, there is no established consensus on the angiographic management in other clinical settings. While coronary angiography may accelerate the diagnostic and therapeutic process (provided OHCA was a consequence of coronary artery disease), it might come at the cost of impaired post-resuscitation care quality due to postponing of intensive care management. The aim of the current statement paper is to discuss clinical strategies for the management of OHCA including the stratification to invasive procedures and the rationale behind the risk-benefit ratio of coronary angiography, especially with patients in critical condition

W poszukiwaniu jakości życia współczesnej rodziny polskiej

Praca recenzowana / peer-reveiwed pape

Analysis of a Possibility of Using Fuzzy Logic to Assess the Reliability of Aircraft On-Board Systems

The paper attempts to present the current state of knowledge in the use of fuzzy logic in order to assess the reliability of technical objects over the past two decades. In world literature, one can recall three main trends related to the use of fuzzy logic in the reliability estimation. The first one deals mainly with an analysis and assessment of the risk of failure. In the second mainstream, the researchers try to analyse the human factor, which also influences system malfunction. The third group of reliability studies the possibility of using fuzzy logic for proper service planning and thus preventing damage. In each of the three mentioned trends, fuzzy logic complements the classic methods of estimating and predicting reliability

Fuzzy Logic in Aircraft Onboard Systems Reliability Evaluation—A New Approach

This paper is a continuation of research into the possibility of using fuzzy logic to assess the reliability of a selected airborne system. The research objectives include an analysis of statistical data, a reliability analysis in the classical approach, a reliability analysis in the fuzzy set theory approach, and a comparison of the obtained results. The system selected for the investigation was the aircraft gun system. In the first step, after analysing the statistical (operational) data, reliability was assessed using a classical probabilistic model in which, on the basis of the Weibull distribution fitted to the operational data, the basic reliability characteristics were determined, including the reliability function for the selected aircraft system. The second reliability analysis, in a fuzzy set theory approach, was conducted using a Mamdani Type Fuzzy Logic Controller developed in the Matlab software with the Fuzzy Logic Toolbox package. The controller was designed on the basis of expert knowledge obtained by a survey. Based on the input signals in the form of equipment operation time (number of flying hours), number of shots performed (shots), and the state of equipment corrosion (corrosion), the controller determines the reliability of air armament. The final step was to compare the results obtained from two methods: classical probabilistic model and fuzzy logic. The authors have proved that the reliability model using fuzzy logic can be used to assess the reliability of aircraft airborne systems

Fabrication of silver nanoisland films by pulsed laser deposition for surface-enhanced Raman spectroscopy

The results of studies on the fabrication and characterization of silver nanoisland films (SNIFs) using pulsed laser deposition (PLD) and the evaluation of these films as potential surface-enhanced Raman scattering (SERS) substrates are reported. The SNIFs with thicknesses in a range of 4.7 ± 0.2 nm to 143.2 ± 0.2 nm were deposited under different conditions on silicon substrates. Size and morphology of the fabricated silver nanoislands mainly depend on the substrate temperature, and number and energy of the laser pulses. SERS properties of the fabricated films were evaluated by measuring SERS spectra of para-mercaptoaniline (pMA) molecules adsorbed on them. SERS enhancement factors are shown to depend on the SNIF morphology, which is modified by changes of the deposition conditions. The highest enhancement factor in the range of 105 was achieved for SNIFs that have oval and circular silver nanoislands with small distances between them