Mutism, selective mutism, staying silent, pause – serious gaps in the theory and practice of speech therapy

The article discusses the importance of the scientific description of mutism. The paper starts with linguistic arguments and talks about the phenomenon from the perspective of speech disorders typology and from the perspective of the mute person himself/herself. It suggests that the tempo of utterance (which is different from the tempo of speech) should be included in the study of mutism. It also discusses the competence of speech therapists to diagnose and program the therapy of mute people. The conclusion of the article is that the interdisciplinary research of mutism would allow for better understanding of this phenomena and a more effective therapy.Udostępnienie publikacji Wydawnictwa Uniwersytetu Łódzkiego finansowane w ramach projektu „Doskonałość naukowa kluczem do doskonałości kształcenia”. Projekt realizowany jest ze środków Europejskiego Funduszu Społecznego w ramach Programu Operacyjnego Wiedza Edukacja Rozwój; nr umowy: POWER.03.05.00-00-Z092/17-00

Ocena bezpieczeństwa i efektywność jabłczanu sunitynibu w przerzutowych guzach neuroendokrynnych trzustki (NEN G1/G2) w zależności od liczby i rodzaju wcześniejszych linii terapeutycznych — doniesienie wstępne

Introduction: The objective of this paper was to assess the safety and efficacy of sunitinib malate in patients with well-differentiated metastatic pancreatic neuroendocrine neoplasms (PNENs) who relapsed on standard therapy.Material and methods: Overall, eight patients with well-differentiated pancreatic neuroendocrine tumours/neoplasm (NET/NEN G1/G2, Ki-67 < 20%), who had relapsed on a standard therapy approach, were treated. All had non-resectable, progressive disease. All received therapy using a standard dose of sunitinib malate. Adverse events were evaluated using NCI-CTC AE v. 3.0.Results: Of the eight patients, seven had non-secretor and single secretor tumour (gastrinoma). Partial remission (PR) was noted in three patients (one after a single therapeutic line, two after two lines), five patients had stabilisation (SD) — including three individuals after three lines, one patient after two lines and another after a single line. Haematological adverse events: leukopenia (25%) — occurred in one patient after three lines and in one patient after two lines; anaemia (25%) — in one patient after three lines and in one patient after one therapeutic line. Mucocutaneous lesions were noted in 37.5% of patients after 2–3 lines of treatment. All of them experienced fatigue syndrome irrespective of the number of therapies. The majority of the patients simultaneously received somatostatin analogues, which did not exacerbate the toxicity profile. The median progression-free survival time (PFS) was 11 months.Conclusions: Sunitinib may be considered as a fairly well-tolerated and effective therapeutic option in progressive non-resectable PNEN patients in the second and subsequent lines of treatment, irrespective of the types of treatment previously applied. (Endokrynol Pol 2014; 65 (6): 472–478)Wstęp: Celem pracy była ocena bezpieczeństwa oraz analiza skuteczności jabłczanu sunitynibu u chorych z przerzutowymi wysokozróżnicowanymi guzami neuroendokrynnymi trzustki (PNET) w drugiej i kolejnych liniach leczenia.Materiał i metody: Analizie poddano 8 pacjentów z wysoko zróżnicowanymi guzami neuroendokrynnymi trzustki (NEN G1/G2, Ki-67 < 20%), u których wystąpiła progresja choroby i otrzymali sunitynib. Wszyscy chorzy byli w stadium nieoperacyjnym. Sunitynib był podawany w standardowej dawce. Działania niepożądane oceniono na podstawie kryteriów NCI-CTC AE v. 3.0.Wyniki: Leczono 8 pacjentów; 7 guzów nieaktywnych hormonalnie i 1 o typie gastrinoma. Częściową remisję (PR) uzyskano u 3 chorych (1 po 1 linii terapeutycznej, 2 — po 2 liniach), 5 chorych miało stabilizację (SD) — w tym 3 było po 3 liniach, 1 po 2 liniach i 1 po 1 linii terapeutycznej. Powikłania hematologiczne: leukopenia (25%) — wystąpiły u 1 pacjenta po 3 liniach i u 1 pacjenta po 2 liniach; niedokrwistość (25%) — u 1 pacjenta po 3 liniach i u 1 pacjenta po 1 linii terapeutycznej. U 37,5% chorych wystąpiły zmiany skórno-śluzówkowe po 2–3 liniach leczenia. U 100% chorych obserwowano zespół zmęczenia niezależnie od liczby terapii. Większość chorych jednocześnie otrzymywała SSA, co nie pogorszyło profilu toksyczności. Mediana czasu wolnego od progresji PFS (progression free survival) – wyniosła 11 miesięcy.Wnioski: Sunitynib może być rozważany, jako dość dobrze tolerowana, skuteczna opcja terapeutyczna u chorych z nieresekcyjnymi PNET w drugiej oraz kolejnych liniach leczenia, niezależnie od rodzaju uprzednio zastosowanych metod. (Endokrynol Pol 2014; 65 (6): 472–478

The significant impact of age on the clinical outcomes of laparoscopic appendectomy : results from the Polish Laparoscopic Appendectomy multicenter large cohort study

Acute appendicitis (AA) is the most common surgical emergency and can occur at any age. Nearly all of the studies comparing outcomes of appendectomy between younger and older patients set cut-off point at 65 years. In this multicenter observational study, we aimed to compare laparoscopic appendectomy for AA in various groups of patients with particular interest in the elderly and very elderly in comparison to younger adults. Our multicenter observational study of 18 surgical units assessed the outcomes of 4618 laparoscopic appendectomies for AA. Patients were divided in 4 groups according to their age: Group 1- 8 days. Logistic regression models comparing perioperative results of each of the 3 oldest groups compared with the youngest one showed significant differences in odds ratios of symptoms lasting >48hours, presence of complicated appendicitis, perioperative morbidity, conversion rate, prolonged LOS (>8 days). The findings of this study confirm that the outcomes of laparoscopic approach to AA in different age groups are not the same regarding outcomes and the clinical picture. Older patients are at high risk both in the preoperative, intraoperative, and postoperative period. The differences are visible already at the age of 40 years old. Since delayed diagnosis and postponed surgery result in the development of complicated appendicitis, more effort should be placed in improving treatment patterns for the elderly and their clinical outcome

Risk factors for serious morbidity, prolonged length of stay and hospital readmission after laparoscopic appendectomy : results from Pol-LA (Polish Laparoscopic Appendectomy) multicenter large cohort study

Laparoscopic appendectomy (LA) for treatment of acute appendicitis has gained acceptance with its considerable benefits over open appendectomy. LA, however, can involve some adverse outcomes: morbidity, prolonged length of hospital stay (LOS) and hospital readmission. Identification of predictive factors may help to identify and tailor treatment for patients with higher risk of these adverse events. Our aim was to identify risk factors for serious morbidity, prolonged LOS and hospital readmission after LA. A database compiled information of patients admitted for acute appendicitis from eighteen Polish and German surgical centers. It included factors related to the patient characteristics, peri- and postoperative period. Univariate and multivariate logistic regression models were used to identify risk factors for serious perioperative complications, prolonged LOS, and hospital readmissions in acute appendicitis cases. 4618 laparoscopic appendectomy patients were included. First, although several risk factors for serious perioperative complications (C-D III-V) were found in the univariate analysis, in the multivariate model only the presence of intraoperative adverse events (OR 4.09, 95% CI 1.32-12.65, p = 0.014) and complicated appendicitis (OR 3.63, 95% CI 1.74-7.61, p = 0.001) was statistically significant. Second, prolonged LOS was associated with the presence of complicated appendicitis (OR 2.8, 95%CI: 1.53-5.12, p = 0.001), postoperative morbidity (OR 5.01, 95% CI: 2.33-10.75, p < 0.001), conversions (OR 6.48, 95% CI: 3.48-12.08, p < 0.001) and reinterventions after primary procedure (OR 8.79, 95% CI: 3.2-24.14, p < 0.001) in the multivariate model. Third, although several risk factors for hospital readmissions were found in univariate analysis, in the multivariate model only the presence of postoperative complications (OR 10.33, 95% CI: 4.27-25.00), reintervention after primary procedure (OR 5.62, 95% CI: 2.17-14.54), and LA performed by resident (OR 1.96, 95%CI: 1.03-3.70) remained significant. Laparoscopic appendectomy is a safe procedure associated with low rates of complications, prolonged LOS, and readmissions. Risk factors for these adverse events include complicated appendicitis, postoperative morbidity, conversion, and re-intervention after the primary procedure. Any occurrence of these factors during treatment should alert the healthcare team to identify the patients that require more customized treatment to minimize the risk for adverse outcomes

Modelling air quality according to INSPIRE data specifications, ISO standards and national regulations

Protection of the environment is an activity of many institutions, organizations and communities from global to regional and local scales. Any activity in this area needs structured database records, using advanced methodology, given, among others, in INSPIRE documents, ISO standards of 19100 series, and national regulations. The goal of this paper is to analyse both the legal provisions related to the air quality and also data sources associated with the prevention of air pollution. Furthermore, the UML application schema of the spatial data related to the air protection is proposed, for the use by urban planners. Also, the overview of the methodology of geographic information is given, including the Unified Modelling Language (UML), as well as the basic concepts of conceptual models within the INSPIRE project. The study is based on the relevant literature and documents, as well as on the expert knowledge gained through urban planning practice, as well as on the analysis of the spatial planning regulations. The UML application schema for different aspects related to the air protection, as presented in this paper, is an example of how to use the methodology also in other fields of the environment protection. Spatial planners know how to improve the air quality, but in the present state of law they often suffer from the lack of planning tools for real actions. In the spatial planners work an important issue are data that allow a thorough analysis of the area

3D Printing of Composite Material for Electromechanical Energy Harvesters

In this paper, a novel, composite material is proposed based on ferromagnetic wires immersed in a polymer that is well suited for 3D printing. The magnetic properties of this material are examined using FEM and compared with the properties of a more traditional composite based on magnetic powder. For a 50% ferromagnetic volume in the material, the proposed composite has a 67% higher value of saturation magnetic flux density and 87% higher value of maximum permeability, compared with the powder-based material. The authors believe that the proposed material could be used in the manufacturing of small electromechanical devices such as energy harvesters, thus vastly widening the possible fields of application related to 3D printing techniques

3D Printing of Composite Material for Electromechanical Energy Harvesters

In this paper, a novel, composite material is proposed based on ferromagnetic wires immersed in a polymer that is well suited for 3D printing. The magnetic properties of this material are examined using FEM and compared with the properties of a more traditional composite based on magnetic powder. For a 50% ferromagnetic volume in the material, the proposed composite has a 67% higher value of saturation magnetic flux density and 87% higher value of maximum permeability, compared with the powder-based material. The authors believe that the proposed material could be used in the manufacturing of small electromechanical devices such as energy harvesters, thus vastly widening the possible fields of application related to 3D printing techniques