Nowa generacja stentów w przezskórnym leczeniu interwencyjnym miażdżycowych zwężeń tętnic szyjnych w prewencji udaru mózgu: stenty siateczkowe redukują ryzyko śródzabiegowej i pozabiegowej zatorowości mózgowej

Atherosclerotic carotid artery stenosis (CS) continues to be a common cause of acute ischaemic stroke. Optimized medical therapy (OMT), the first-line treatment modality in CS, may reduce or delay — but it does not abolish — CS related strokes. As per current AHA/ASA (2014) and ESC/ESVS/ESO (2017) guidelines, carotid artery stenting (CAS) is a lessinvasive alternative to carotid endarterectomy (CEA) for CS revascularization in primary and secondary stroke prevention. Atherosclerotic plaque protrusion through the struts of conventional carotid stents, confirmed on intravascular imaging with IVUS or OCT, has been implicated as a leading mechanism of delayed strokes with CAS (NB. 40–80% of, mostly minor, 30-day strokes with CAS using conventional stents are post-procedural). Different designs of mesh-covered carotid stents have been developed to prevent plaque prolapse. Several clinical studies with CGurad MicroNet-Covered Embolic Prevention Stent System (CGuard EPS) and RoadSaver/Casper were recently published. Data from over 550 patients in mesh-covered carotid stent clinical studies published to-date show an overall 30-day complication rate of ≈ 1% with near-elimination of post-procedural events. Moreover, a multi-center multi-specialty trial with routine, per-protocol, DW-MRI cerebral imaging peri-procedurally and at 30 days demonstrated minimization of peri-procedural and near-elimination of post-procedural brain embolization with CGuard EPS. While more (and long-term) evidence is still anticipated, these results — taken together with optimized intra- -procedural neuroprotection in CAS (increased use of proximal systems including trans-carotid dynamic flow reversal) — are already transforming the carotid revascularization field. Important further aims include establishing effective algorithms to identify the asymptomatic subjects at stroke risk despite OMT, and large-scale studies with mesh-covered stents including long-term clinical and duplex ultrasound outcomes.Pomimo postępu farmakoterapii, miażdżycowe zwężenie tętnicy szyjnej stanowi nadal, obok migotania przedsionków, jedną z podstawowych przyczyn udaru niedokrwiennego mózgu. Według aktualnych wytycznych leczenie endowaskularne z zastosowaniem stentów (CAS, carotid artery stenting) stanowi mniej inwazyjną alternatywę do leczenia chirurgicznego w rewaskularyzacji ZTS w pierwotnej i wtórnej prewencji udaru mózgu. Protruzja blaszki miażdżycowej do światła naczynia przez rusztowanie konwencjonalnych stentów szyjnych, systematycznie potwierdzona obrazowaniem wewnątrznaczyniowym, stanowi podstawowy mechanizm pozabiegowych udarów mózgu w CAS (40–80% — głównie niewielkich — udarów mózgu w CAS z implantacją konwencjonalnych stentów szyjnych to udary pozabiegowe). Dlatego opracowano i wdrożono do rutynowego stosowania w praktyce klinicznej dwuwarstwowe stenty szyjne, posiadające drobnokomórkową siateczkę, umieszczoną na zewnątrz albo do wewnątrz metalowego rusztowania stentu. Siateczka (nitynolowa albo z włókien syntetycznych jak PET albo PTFE) znacząco redukuje ryzyko przedostawania się fragmentów blaszki miażdżycowej do światła naczynia nie tylko w trakcie implantacji i doprężania stentu, lecz także — co ważne — zapobiega embolizacji w okresie pozabiegowym. Opublikowano ostatnio kilka średniej wielkości badań, które oceniły stent siateczkowy CGuard EPS oraz dwuwarstwowy stent metalowy RoadSaver/Casper w aspekcie klinicznych punktów końcowych. Wyniki, w grupie obejmującej łącznie ponad 550 chorych (objawowych i bezobjawowych), wykazały całkowity odsetek powikłań 30-dniowych na poziomie zaled44 Kardiologia Inwazyjna nr 4 (12), ROK 2017 wie ok. 1% oraz niemal całkowitą eliminację niekorzystnych zdarzeń klinicznych po zabiegu CAS. Ponadto wieloośrodkowa ocena stentu CGuard EPS obejmująca rutynowe, przewidziane protokołem, sekwencyjne obrazowanie mózgu w dyfuzyjnym rezonansie magnetycznym wykazała jedynie minimalną, nieistotną klinicznie, embolizację śródzabiegową i eliminację zatorowości pozabiegowej. Wyniki powyższych badań oraz istotny w ostatniej dekadzie postęp w zakresie urządzeń do czasowej ochrony mózgu przed zatorowością w trakcie CAS wpływają istotnie na rolę endowaskularnej rewaskularyzacji tętnic szyjnych we współczesnej prewencji udaru mózgu. Kluczowe cele dalszych badań to opracowanie i walidacja efektywnych algorytmów pozwalających (podobnie do skal ryzyka udaru stosowanych w migotaniu przedsionków) na identyfikację chorych z bezobjawowym zwężeniem tętnicy szyjnej zagrożonych udarem mózgu pomimo „pełnej” farmakoterapii, a także przeprowadzenie — w dużych populacjach chorych — badań stentów siateczkowych obejmujących zarówno długoterminowe obrazowanie w USG, jak i długotrwale wyniki kliniczne

Dynamic effects and large – amplitude motion in Jacobi and Poincaré shape transitions in atomic nuclei

The Jacobi and Poincaré shape transitions are very promising way to investigate the shape of the nucleus. The presented here quasi-phenomenological approach allows to estimate the experimental conditions which are necessary to observe these phenomena. The static energy minimum gives the spin ranges and the fissility of atomic nuclei soft for the shape transitions and available experimentally. Dynamical effects taken into account through the solving collective Hamiltonian for zero-point vibration estimation, changes the spin rages for the shape transitions. The static deformation of the nucleus constrained by the minimum of energy for given spin has been enhanced to dynamical nuclear shapes permitted by the zero point energy. The large amplitude vibrations around the static deformation gives the ensemble of nuclear shapes possible to be observed

Why Users (Don’t) Use Password Managers at a Large Educational Institution

We quantitatively investigated the current state of Password Manager (PM) usage and general password habits at a large, private university in the United States. Building on prior qualitative findings from SOUPS 2019, we survey n=277 faculty, staff, and students, finding that 77% of our participants already use PMs, but users of third-party PMs, as opposed to browser-based PMs, were significantly less likely to reuse their passwords across accounts. The largest factor encouraging PM adoption is perceived ease-of-use, indicating that communication and institutional campaigns should focus more on usability factors. Additionally, our work indicates the need for design improvements for browser-based PMs to encourage less password reuse as they are more widely adopted

Rola zasobów Federacji Bibliotek Cyfrowych sieci PIONIER i Wirtualnego Laboratorium Transkrypcji platformy SYNAT w realizacji naukowych projektów humanistycznych

WarszawaPrezentacja wygłoszona w czasie spotkania "Warsztaty historyków cyfrowych w ICM UW", 8 maja 2013

CATECHOLAMINES AND β2-ADRENOCEPTOR GENE EXPRESSION BEFORE AND AFTER MAXIMAL INCREMENTAL CYCLE TEST IN YOUNG ICE HOCKEY PLAYERS: RELATION TO WORK PERFORMED

The aim of this study was to assess the plasma adrenaline and noradrenaline concentrations as well as whole blood β2-adrenoceptor gene (ADRB2) expression in young ice hockey players before and immediately after exercise in relation to performed work. Nineteen Youth National Team ice hockey players were subjected to the maximal incremental cycloergometer exercise. The test was done in the pre-competitive phase of training. Among many parameters the plasma adrenaline and noradrenaline concentrations and ADRB2 gene expression in peripheral blood mononuclear cells (PBMC) were determined before and after exercise. The average performed work was 3261.3 ± 558.3 J · kg-1 and maximal oxygen consumption (VO2max) for all players was 53.85 ± 3.91 mL · kg-1 min-1. The geometric mean of the ADRB2 gene expression was statistically significantly different before and after exercise (P ≤ 0.05), while adrenaline and noradrenaline levels in plasma significantly increased after exercise. In the analysed group of athletes we found that initial level of plasma noradrenaline correlated with the performed work (r = - 0.55, P < 0.014) and normalized ADRB2 expression before the exercise correlated with the work done by them (r = 0.48, P<0.039). However, no statistically significant correlations were found between the plasma adrenaline or noradrenaline concentrations and ADRB2 gene expression in peripheral blood of the players. The performed work in the maximal incremental exercise test of regularly training young ice hockey players depends on the initial levels of noradrenaline in plasma and ADRB2 mRNA in PBMC

Myocardial Ischaemia, Coronary Atherosclerosis and Pulmonary Pressure Elevation in Antiphospholipid Syndrome Patients

Thrombotic events in antiphospholipid syndrome (APS) involve venous and arterial circulation with the possible involvement of coronary or pulmonary microcirculation.To evaluate the influence of antiphospholipid antibodies (aPL) and on myocardial ischaemia assessed by single-photon emission computerized tomography (SPECT), coronary atherosclerosis assessed by multidetector computerized tomography (MDCT) and pulmonary pressure assessed by transthoracic echocardiography (TTE) in patients with primary antiphospholipid syndrome (PAPS).TTE, SPECT (Tc 99m sestamibi) and MDCT-based coronary calcium scoring were performed in 26 consecutive PAPS patients (20 females, 6 males, aged 20-61, mean 39.7) without any signs of other autoimmunological disease and without clinical symptoms of heart disease.Out of 26 patients, TEE showed normal left and right ventricle function in 25 (96.2%) and elevated (≥ 30 mm Hg) right ventricle systolic pressure in 7 (26.9%) patients. SPECT revealed myocardial perfusion defects in 15 (57.7%) patients: exercise-induced in 6 (23.1%) and persistent in 11 (42.3%). MDCT revealed coronary calcifications in 4 (15.4%) patients. The number of plaques ranged from 1 to 11 (median 2), volume 3-201.7 mm³ (median 7), calcium scores 1.3-202.6 (median 5.7). In the group with perfusion defects or coronary calcifications (n = 15), all the patients showed elevated aCL IgG.In most of the relatively young APS patients, without any symptoms of ischemic heart disease, SPECT showed myocardial perfusion defects, and coronary calcifications in 1/6 of them. Right ventricle systolic pressure was elevated in 1/4 of APS patients. These pathologies, well known as cardiovascular risk markers, were associated with elevated levels of the IgG class of both anti-cardiolipin and antiB2 GPI antibodies. Thus, in a high percentage of APS patients, clinically silent myocardial ischaemia, pulmonary pressure elevation and coronary atherosclerosis are present and related to the presence of antiphospholipid antibodies

Co-occurrence of depression and chronic diseases

INTRODUCTION Depression is a common and serious mood disorder mainly manifested by sadness, anhedonia, lack of hope and interest in activities once enjoyed. According to WHO depression is a leading cause of disability and inability to work worldwide. Chronic disease is every condition lasting more than 1 year and requiring medical attention. The aim of this article is to show challenges of depression and chronic diseases coexistence. DISCUSSION Depression might be a factor causing difficulties in diagnosing chronic diseases as patients are less likely to cooperate. On the other it might lead to worse compliance and higher risk of chronic diseases’ development. Studies show depression coexisting with chronic illnesses is a valid problem for public health and aggravates the course and effects of treatment of those conditions. Treating an underlying disease is as important as treating depression itself as it might lead to reduction in symptoms of depression. Moreover doctors should choose drugs having regard to depression as well as lingering conditions. SUMMARY Depression still seems to be diminished and ignored in patients with chronic illnesses even though it is proved to have a destructive influence on the health of patients. It is of high importance to raise an awareness of doctors on that subject and its scale.&nbsp; There are plenty of treatment methods for depression in case of chronic diseases co-occurence which gives hope for improving a quality of life of patients and achieving better effects of therapy of an underlying disease

Trying to predict the unpredictable: Variations in device-based daily monitored diagnostic parameters can predict malignant arrhythmic events in patients undergoing cardiac resynchronization therapy

Background: The aim of this study was to evaluate the value of device-based diagnostic parameters in predicting ventricular arrhythmias in cardiac resynchronization therapy (CRT) recipients. Methods: Ninety-six CRT-D patients participating in TRUST CRT Trial were analyzed. The inclusion criteria were: heart failure in NYHA ≥ 3 class, QRS ≥ 120 ms, LVEF £ 35% and significant mechanical dyssynchrony. Patients were divided into those with (n = 31, 92 arrhyth­mias) and without (n = 65) appropriate ICD interventions within follow-up of 12.03 ± 6.7 months. Daily monitored device-based parameters: heart rate (HR), thoracic impedance (TI), HR variability and physical activity were analyzed in 4 time windows: within 10, 7, 3 days and 1 day before appropriate ICD interventions. Results: A consistent pattern of changes in three monitored factors was observed prior to ar­rhythmia: 1) a gradual increase of day HR (from 103.43% of reference within 10-day window to 105.55% one day before, all p &lt; 0.05 vs. reference); 2) variations in night HR (104.75% in 3 days, 107.65% one day before, all p &lt; 0.05) and 3) TI decrease (from 97.8% in 10 days to 96.81% one day before, all p &lt; 0.05). The combination of three parameters had better pre­dictive value, which improved further after exclusion of patients with atrial fibrillation (AF). The predictive model combining HR and TI together with LVEF and NT-proBNP was more prognostic than the model involving LVEF and NT-proBNP alone (difference in AUC 0.05, 95% CI 0.0005–0.09, p = 0.04). Conclusions: Daily device-monitored parameters show significant variations prior to ven­tricular arrhythmia. Combination of multiple parameters improves arrhythmia predictive performance by its additive value to baseline risk factors, while presence of AF diminishes it.

Assessment of the myocardial FDG-PET image quality with the use of maximal Standardized Uptake Value myocardial to background index. Application of the results in regard to semiquantitative assessment of myocardial viability with cardiac dedicated softwar

BACKGROUND: The objective of this study was to semiquantitatively assess the degree of myocardial fluorodeoxyglucose (FDG) uptake in glucose-loaded myocardial viability positron emission tomography/computed tomography (PET/CT) scans, to calculate the myocardial to background index, and correlate the index with image quality assessed on the basis of visual qualitative assessment. MATERIAL AND METHODS: The myocardial FDG-PET/CT study was carried out in 69 non-diabetic patients, who had known coronary artery disease, by intravenous injection of 250 ± 70 MBq (range: 180–320 MBq) FDG. Images were interpreted visually and patients were divided into three groups according to the grade of myocardial uptake: optimal, suboptimal, and uninterpretable. Semiquantitative analysis was performed by calculating the standardized uptake value (SUVmax) for myocardium and background (blood pool) activity, and expressed as the myocardial to background (M/B) activity ratio. RESULTS: On the basis of visual (qualitative) analysis, 60/69 (86.96%) patients showed optimal quality of FDG cardiac uptake, 3/69 (4.35%) were suboptimal, and uninterpretable FDG PET scan results were found in 6/69 (8.70%) patients. The M/B index was found to be significantly higher in images of optimal vs. suboptimal quality (6.87 ± 3.99 vs. 1.65 ± 0.78 respectively; p &lt; 0.0001). CONCLUSIONS: The index ratio of 2.2, which is consistent with the upper borderline value for visually uninterpretable images, was considered the cut-off value for scans of optimal and non-optimal quality