Postępowanie okołooperacyjne u pacjentów z wszczepionymi stentami typu DES

Considering the fact that the majority of stents implanted during percutaneous coronary intervention are drug-eluting stents (DES) and 5–25% of patients require a non-cardiac surgery within 5 years of implanting the stent, appropriate therapeutic procedures in the perioperative period are clinically significant. To prevent late thrombosis in patients with implanted DES, it is recommended to prolong — compared to implantation of bare metal stents — dual antiplatelet therapy. In the perioperative period, it is crucial to maintain balance between the risk of a potentially fatal haemorrhage and stent thrombosis. Taking into account the fact that premature cessation of dual antiplatelet therapy is the most significant risk factor of stent thrombosis, correct perioperative actions in patients with high risk of bleeding may present many clinical difficulties. In the study, factors that impact the risk of thrombosis and haemorrhage, as well as up-to-date guidelines and methods regarding the perioperative period procedures in patients with implanted DES have been presented.W związku z tym, że obecnie większość stentów implantowanych w trakcie przezskórnej interwencji wieńcowej to stenty uwalniające lek (DES), a 5–25% pacjentów wymaga zabiegu niekardiochirurgicznego w okresie 5 lat od wszczepienia stentu, to odpowiednie postępowanie w okresie okołooperacyjnym staje się istotnym problemem klinicznym. W celu prewencji późnej zakrzepicy u pacjentów z wszczepionymi stentami typu DES zaleca się przedłużony, w porównaniu ze stentami metalowymi, czas stosowania podwójnej terapii przeciwpłytkowej (DAPT). W okresie okołozabiegowym bardzo ważne jest odpowiednie balansowanie między ryzykiem niebezpiecznego dla życia krwawienia oraz zakrzepicy w stencie. Zważając na fakt, że przedwczesne przerwanie DAPT jest najbardziej znaczącym czynnikiem ryzyka zakrzepicy w stencie, to odpowiednie postępowanie w okresie okołooperacyjnym u pacjentów obciążonych wysokim ryzykiem krwawienia może przysporzyć wielu problemów klinicznych. W pracy przedstawiono czynniki wpływające na ryzyko zakrzepicy oraz krwawienia w okresie okołozabiegowym, a także najnowsze wytyczne i metody postępowania okołooperacyjnego u pacjentów z wszczepionymi stentami typu DES

Advances in the Treatment of Kidney and Upper Urinary Tract Cancers

Kidney and upper tract urinary cancers (UTUC) are diseases of increasing population coverage, the treatment of which is undergoing a continuous process of evolution [...

Dissolved oxygen and water temperature dynamics in lowland rivers over various timescales

The impact of floodplain hydrology on the in-stream dissolved oxygen dynamics and the relation between dissolved oxygen and water temperature are investigated. This has been done by examining the time series of dissolved oxygen and water temperature coupled with meteorological and hydrological data obtained from two lowland rivers having contrasting hydrological settings. Spectral analysis of long-term oxygen variations in a vegetated river revealed a distinct scaling regime with slope ‘–1’ indicating a self-similar behaviour. Identical slopes were obtained for water temperature and water level. The same power-law behaviour was observed for an unvegetated river at small timescales revealing the underlying scaling behaviour of dissolved oxygen regime for different types of rivers and over various time scales. The results have shown that the oxygenation of a vegetated river is strongly related to its thermal regime and flow conditions. Moreover, analysis of short-term fluctuations in the unvegetated river demonstrated that physical factors such as rainfall and backwaters play a substantial role in the functioning of this ecosystem. Finally, the results show that the relation between water temperature and dissolved oxygen concentration at the diurnal timescale exhibits a looping behaviour on the variable plot. The findings of this study provide an insight into the sensitivity of rivers to changing hydro-physical conditions and can be useful in the assessment of environmental variability

The association between RDW and survival of patients with squamous cell carcinoma of the tongue. Simple, cheap and convenient?

AimThe purpose of this study was to evaluate the prognostic impact of red-cell distribution width (RDW) on the overall survival (OS) of patients with squamous cell carcinoma (SCC) of the tongue.BackgroundDevelopment of cancer is connected with an ongoing inflammatory process which is reflected by laboratory indices, such as RDW that can be used as prognostic tools.Material and methodsThe study group consists of 74 consecutive patients treated with radical radiotherapy or chemo-radiotherapy for SSC of the tongue at one institution between 2005−2014. RDW was assessed based on routine blood tests done before the start of the treatment. ROC curve was applied to assess value of RDW in prediction of OS, and a cut-off value for further tests was obtained using the Younden index. The survival analysis was performed using the Kaplan-Meier method, log-rank testing and Cox regression model.ResultsThe AUC for RDW in ROC analysis was 0.703, and the optimal cut-off value was 13.5%. 5-year OS was significantly lower in patients with RDW ≥ 13.5% compared with patients with RDW

The Association between Lymph Node Dissection and Survival in Lymph Node-Negative Upper Urinary Tract Urothelial Cancer

The benefit of lymph node dissection (LND) during radical nephroureterectomy (RNU) in lymph node (LN)-negative (cN0/pN0) UTUC remains controversial. We aimed to assess the association between LND and its extent and survival in LN-negative UTUC. The Surveillance, Epidemiology, and End Results database was searched to identify patients with non-metastatic chemotherapy-naïve cN0/pNx or pN0 UTUC who underwent RNU +/− LND between 2004 and 2019. Overall, 4649 patients with cN0/pNx or pN0 UTUC were analyzed, including 909 (19.55%) individuals who had LND. Among them, only in 368 patients (7.92%) was LND extended to at least four LNs, and the remaining 541 patients (11.64%) have had < four LNs removed. In the whole cohort, LND contributed to better cancer-specific survival (CSS) and overall survival (OS). Furthermore, a propensity score-matched analysis adjusted for confounders confirmed that improved CSS and OS was achieved only when ≥ four LNs had been removed, especially in muscle-invasive UTUC. A multivariable analysis further confirmed an association between the extent of LND and CSS. To conclude, adequate LND during RNU was associated with improved OS and CSS in LN-negative UTUC, particularly in muscle-invasive stage. This underscores that a sufficient LN yield is required to reveal a therapeutic benefit in patients undergoing RNU

Application of Pneumatic Lithotripter and Holmium Laser in the Treatment of Ureteral Stones and Kidney Stones in Children

Objective. Treatment options for urolithiasis in children include URSL and RIRS. Various types of energy are used in the disintegration of deposits in these procedures. We decided to evaluate the usefulness of URSL and RIRS techniques and compare the effectiveness of pneumatic lithotripters and holmium lasers in the child population based on our experience. Materials and Methods. One hundred eight (108) children who underwent URSL and RIRS procedures were enrolled in the study and divided into two (2) groups according to the type of energy used: pneumatic lithotripter versus holmium laser. We evaluated the procedures’ duration and effectiveness according to the stone-free rate (SFR) directly after the procedure and after fourteen (14) days and the rate of complications. Results. The mean operative time was shorter in the holmium laser group. A higher SFR was observed in the holmium laser but it was not statistically significant in the URSL and RIRS procedures. The rate of complications was similar in both groups. Conclusions. The URSL and RIRS procedures are highly efficient and safe methods. The use of a holmium laser reduces the duration of the procedure and increases its effectiveness in comparison with the use of a pneumatic lithotripter