Mechanical thrombectomy in acute stroke – Five years of experience in Poland

Objectives Mechanical thrombectomy (MT) is not reimbursed by the Polish public health system. We present a description of 5 years of experience with MT in acute stroke in Comprehensive Stroke Centers (CSCs) in Poland. Methods and results We retrospectively analyzed the results of a structured questionnaire from 23 out of 25 identified CSCs and 22 data sets that include 61 clinical, radiological and outcome measures. Results Most of the CSCs (74%) were founded at University Hospitals and most (65.2%) work round the clock. In 78.3% of them, the working teams are composed of neurologists and neuro-radiologists. All CSCs perform CT and angio-CT before MT. In total 586 patients were subjected to MT and data from 531 of them were analyzed. Mean time laps from stroke onset to groin puncture was 250±99min. 90.3% of the studied patients had MT within 6h from stroke onset; 59.3% of them were treated with IV rt-PA prior to MT; 15.1% had IA rt-PA during MT and 4.7% – emergent stenting of a large vessel. M1 of MCA was occluded in 47.8% of cases. The Solitaire device was used in 53% of cases. Successful recanalization (TICI2b–TICI3) was achieved in 64.6% of cases and 53.4% of patients did not experience hemorrhagic transformation. Clinical improvement on discharge was noticed in 53.7% of cases, futile recanalization – in 30.7%, mRS of 0–2 – in 31.4% and mRS of 6 in 22% of cases. Conclusion Our results can help harmonize standards for MT in Poland according to international guidelines

Sonography of abdominal organs in precocious puberty in girls

Precocious puberty constitutes a signifi cant clinical problem due to psychological implications and health concerns as well as consequences associated with girls’ fertility. Selfacceptance, peer approval, early motherhood and future fertility – these are only a few issues associated with puberty, the disorders of which may have a negative infl uence on personality and health. The role of imaging is to determine the causes of early activation of the puberty process, to identify lesions responsible for abnormal sex hormone production and those which are the result of underlying hormonal disorders as well as to diagnose the processes which only mimic symptoms of precocious puberty. Out of all available imaging methods, sonography, thanks to its safety, availability and low cost, seems to be the best method to assess the breasts and internal organs of patients manifesting symptoms of precocious puberty both in early diagnosis and follow-up examinations. Apart from the technique of performing ultrasound examinations, the paper also explains its role in precocious puberty in girls, describes correct parameters of the organs which play the most signifi cant role in the process of puberty as well as presents the features of changes responsible for or resulting from hormonal disorders.Przedwczesne dojrzewanie płciowe stanowi istotny problem kliniczny ze względu na implikacje psychologiczne, zdrowotne, a także odnoszące się do płodności dotkniętych nim dziewcząt. Samoakceptacja, akceptacja w grupie rówieśniczej, wczesne macierzyństwo, przyszła płodność – to tylko niektóre z zagadnień związanych z dojrzewaniem płciowym, którego zaburzenia negatywnie wpływają na rozwój osobowości i zdrowie człowieka. Rolą diagnostyki obrazowej jest ustalenie przyczyn przedwczesnej aktywacji procesu dojrzewania, zdefi niowanie zmian odpowiadających za nieprawidłową produkcję hormonów płciowych oraz będących skutkiem istniejących zaburzeń, a także uwidocznienie procesów jedynie naśladujących objawy przedwczesnego dojrzewania. Spośród wszystkich dostępnych metod obrazowania ultrasonografi a, ze względu na bezpieczeństwo, dostępność, powtarzalność i niski koszt, wydaje się najlepszą metodą służącą do oceny piersi i narządów wewnętrznych pacjentek z objawami przedwczesnego dojrzewania zarówno w procesie wstępnej diagnostyki, jak i w monitorowaniu przebiegu leczenia. W artykule oprócz zagadnień dotyczących techniki badania ultrasonografi cznego omówiono jego rolę w przypadku przedwczesnego dojrzewania płciowego u dziewcząt, opisano prawidłowe parametry narządów odgrywających istotną rolę w procesie dojrzewania, a także przedstawiono cechy zmian będących przyczyną lub skutkiem zaburzeń hormonalnych

Severe Accident Simulations Dedicated to the SAMG DecisionMaking Tool Demonstration

The paper presents preliminary severe accident (SA) simulations performed to generate a database of plant states dedicated to be used with Severe Accident Management Guidelines Decision Making Tool (SAMG DM). The novel software is being developed in the framework of the NARSIS Horizon-2020 research project. It is intended to be a supporting tool for the SAMGs implementation, Emergency Preparedness and selection of Severe Accident Management (SAM) strategies. Simulations were performed with MELCOR 2.2 integral computer code for generic Nuclear Power Plant (NPP) with Gen-II Pressurized Water Reactor (PWR). The database covers results for parameters important for both in-vessel and ex-vessel phases of different accident scenarios. Two general types of scenarios are considered in the database: low-pressure and high-pressure sequences. In this paper, a comparison was prepared for two base case low-pressure scenarios, that is hot leg and cold leg LB-LOCAs without safety injection. Sensitivity simulations were performed with and without Containment Filtered Venting (CFV) as it substantially influences the containment performance. Both accidents are characterized by rapid progression with core meltdown within 2 hours and containment failure within 40 hours and eventual venting with CFV after 13-15 hours. It was observed that for the cold-leg break, the Reactor Pressure Vessel failure occurs earlier only by ~5 minutes. On the contrary, the containment failure is predicted to occur three hours earlier for the hot-leg LOCA

ONLINE FIRST Nr 14 Published ahead of print 25 March

Summary Aim. Analysis of associations between changes in neurotic personality profile and reduction of suicidal ideation (SI) -or lack of such reduction -defined as its elimination or reduction of its intensity in patients who underwent a course of intensive psychotherapy conducted in integrative approach with predominance of psychodynamic approach. Conclusions. The results confirm effectiveness of intensive psychotherapy as a treatment method that leads to comprehensive improvement encompassing reduction of neurotic personality disorders (neuroticism) and of majority of neurotic personality traits, as well as SI reduction. The revealed associations weigh in favor of hypothesis on neuroticism as SIpredisposing factor in patients with neurotic, behavioral and personality disorders

Mechanical thrombectomy in acute stroke : five years of experience in Poland

Objectives: Mechanical thrombectomy (MT) is not reimbursed by the Polish public health system. We present a description of 5 years of experience with MT in acute stroke in Comprehensive Stroke Centers (CSCs) in Poland. Methods and results: We retrospectively analyzed the results of a structured questionnaire from 23 out of 25 identified CSCs and 22 data sets that include 61 clinical, radiological and outcome measures. Results: Most of the CSCs (74%) were founded at University Hospitals and most (65.2%) work round the clock. In 78.3% of them, the working teams are composed of neurologists and neuro-radiologists. All CSCs perform CT and angio-CT before MT. In total 586 patients were subjected to MT and data from 531 of them were analyzed. Mean time laps from stroke onset to groin puncture was 250 99 min. 90.3% of the studied patients had MT within 6 h from stroke onset; 59.3% of them were treated with IV rt-PA prior to MT; 15.1% had IA rt-PA during MT and 4.7% - emergent stenting of a large vessel. M1 of MCA was occluded in 47.8% of cases. The Solitaire device was used in 53% of cases. Successful recanalization (TICI2b–TICI3) was achieved in 64.6% of cases and 53.4% of patients did not experience hemorrhagic transformation. Clinical improvement on discharge was noticed in 53.7% of cases, futile recanalization - in 30.7%, mRS of 0–2 - in 31.4% and mRS of 6 in 22% of cases. Conclusion: Our results can help harmonize standards for MT in Poland according to international guideline