The use of fixed dose combinations in the treatment of hypertension — resistant hypertension or patient resistant to treatment?

Resistant hypertension (RH) is defined as a condition in which blood pressure remains above 140/90 mm Hg despite the use of at least three antihypertensive drugs, correctly combined and in full doses (including a diuretic). In Poland, the percentage of people suffering from RH is estimated at 10–13% relative to the total number of patients with hypertension. On the other hand, in recent years we have seen a significant increase in the importance of combination products both in Europe and in the United States. Several studies have shown that therapy that includes an average of 3 antihypertensive agents (in the form of combination products) having different mechanisms of action, such as blockers of the renin-angiotensin-aldosterone system (RAAS) in combination with a calcium channel blocker (CCB) or a diuretic, provides blood pressure control in the majority of patients, not only through increased efficacy and tolerability of drugs, but also owing to the simplification of the therapeutic regimen, which promotes the compliance with medical recommendations. In this paper we present the case of a patient with resistant hypertension, whose blood pressure normalised only after the use of a combination product

Modelling the set of earthworks machinery with the use of computer simulation

The paper presents the comparison of deterministic and stochastic approach for modeling the set of earthworks machinery. Simulation takes into account the normal distribution of cycle time and efficiency of machines and points out its influence for total construction works time. Results of the simulation indicate the need of identification time and efficiency deviation as a risk factor, which can cause delay whenever earthworks cycle includes the serial work of several machines

The control of the mass of an aggregates deliveries and its impact on the effectiveness of earthworks execution

An essay presents the method and tool which can be used to control the mass of aggregates deliveries under construction site conditions. The method based on statistics allows determining the optimal quantity of transports to be inspected, required to estimate the total sum of loose materials deliveries assuming estimation error and confidence level conditions. Inspection based on described method allows to improve the effectiveness of earthworks execution as well as gives the possibility to evaluate the quality of the supplier

Results of endovascular treatment of iliac and femoral symptomatic lesions. Identification of re-intervention risk factors

Introduction. The aim of the study was to assess a presence of peripheral arterial disease risk factors in patients with symptomatic femoral and iliac lesions treated with use of Jaguar and Supera nitinol stents and to estimate potential relation between these factors and reintervention rate. Material and methods. The study group consisted of 60 patients between 46 and 85 years of age who presented with typical symptoms of intermittent claudication or critical limb ischemia and underwent percuta­neous transluminal angioplasty with stenting. We examined and divided group into two subgroups — patients who experienced or did not experience need of reintervention in treated lesion. Results. During the follow-up 24 (40%) of patients underwent reintervention in treated artery due to re­current symptoms of disease. Need of target lesion revascularization occurred more frequent in patients with hypertension (OR = 2.5), patient older than 68 (OR = 1.75) and smokers (OR = 1.75). Patency of all three arteries below knee protected from reintervention. Conclusions. Jaguar and Supera self-expanding nitinol stents has several advantages and its use were char­acterized by high procedural success and moderate frequency of reintervention correlated to some clinical findings like hypertension. Further studies are necessary to estimate factors disturbing and interfering with long-term patency.Introduction. The aim of the study was to assess a presence of peripheral arterial disease risk factors in patients with symptomatic femoral and iliac lesions treated with use of Jaguar and Supera nitinol stents and to estimate potential relation between these factors or some angiographical conditions and reintervention rate. Material and methods. The study group consisted of 60 patients between 46 and 85 years of age who presented with typical symptoms of intermittent claudication or critical limb ischemia and underwent percutaneous transluminal angioplasty with stenting using Supera or Jaguar self-expanding nitinol stent. We examined and divided group into two subgroups – patients who experienced or didn’t experience need of reintervention in treated lesion.Results. In 33 patients (55%) nitinol stent Jaguar and in 27 patients (45%) Supera were implanted. During the follow-up 24 of patients (40%) underwent reintervention in treated artery due to recurrent symptoms of disease. Need of target lesion revascularization occurred more frequent in patients with hypertension (OR=2,5), patient older than 68 (OR=1,75) and smokers (OR=1,75). Patency of all three arteries below knee protected from reintervention. Diabetes mellitus type 2, chronic kidney disease, kind or size of implanted stent and antiplatelet therapy model didn’t determine a need of reintervention. Conclusions. Jaguar and Supera self-expanding nitinol stents has several andvantages and its use were characterized by high procedural success and moderate frequency of reintervention correlated to some clinical findings like hypertension. Further studies are necessary to estimate factors disturbing and interfering with long-term patency

The utility of Prostar XL percutaneous vascular closure device after stent-graft implantation for infrarenal abdominal aortic aneurysms

Introduction. Over time, endovascular techniques of abdominal aortic aneurysm repair became the principal methods of treatment of this potentially fatal disease. Currently, endovascular aneurysm repair (EVAR) constitutes an effective alternative to open surgery, also in cases of aneurysm rupture. Low degree of invasiveness is the main advantage of this method. Introduction of a system enabling percutaneous stent-graft implantation appears to be the next step in the development of endovascular AAA surgery. Aim of the study is to evaluate the Prostar XL® closure device with regard to clinical effectiveness, safety, cost-effectiveness. Material and methods. The study included 100 patients (from January 2013 to December 2015) subject to endovascular abdominal aortic aneurysm repair in the infrarenal region of the aorta with the application of the Prostar Xl® closure device. Most patients were operated under epidural anaesthesia. Local anaesthesia (1% Lidocaine) was used in 36 patients due to comorbidities. A possible application of the closure system depended on a preoperative assessment of common femoral arteries using ultrasonography. Presence of atherosclerotic plaque on the anterior wall of the vessel disqualified the patient from percutaneous endovascular aneurysm repair (PEVAR). The main part of the procedure consisted of stent-graft implantation into the abdominal aortic aneurysm. In the final stage, puncture site on the anterior wall of common femoral arteries was closed using previously placed sutures of the Prostar XL system. The wound in the inguinal region was closed with a skin suture. Results. The analysis of obtained results demonstrated significantly shorter mean hospitalization times in patients treated with PEVAR compared to EVAR. Low rates and types of observed complications in the study group (PEVAR) compared to the control group (EVAR) are strongly in favour the percutaneous technique (PEVAR) of endovascular aortic abdominal aneurysm repair in the infrarenal region of the aorta, confirming its minimally invasive character

Graphene on quartz modified with rhenium oxide as a semitransparent electrode for organic electronic

Our research shows that commercially available graphene on quartz modified with rhenium oxide meets the requirements for its use as a conductive and transparent anode in optoelectronic devices. The cluster growth of rhenium oxide enables an increase in the work function of graphene by 1.3 eV up to 5.2 eV, which guarantees an appropriate adjustment to the energy levels of the organic semiconductors used in OLED devices.Comment: 8 pages, 3 figure

Anaphylaxis in Elderly Patients-Data From the European Anaphylaxis Registry

Background: Elicitors and symptoms of anaphylaxis are age dependent. However, little is known about typical features of anaphylaxis in patients aged 65 years or more. Methods: The data from the Network for Online Registration of Anaphylaxis (NORA) considering patients aged ≥65 (elderly) in comparison to data from adults (18–64 years) regarding elicitors, symptoms, comorbidities, and treatment measures were analyzed. Results: We identified 1,123 elderly anaphylactic patients. Insect venoms were the most frequent elicitor in this group (p < 0.001), followed by drugs like analgesics and antibiotics. Food allergens elicited less frequently anaphylaxis (p < 0.001). Skin symptoms occurred less frequently in elderly patients (77%, p < 0.001). The clinical symptoms were more severe in the elderly (51% experiencing grade III/IV reactions), in particular when skin symptoms (p < 0.001) were absent. Most strikingly, a loss of consciousness (33%, p < 0.001) and preexisting cardiovascular comorbidity (59%, p < 0.001) were more prevalent in the elderly. Finally, adrenaline was used in 30% of the elderly (vs. 26% in the comparator group, p < 0.001) and hospitalization was more often required (60 vs. 50%, p < 0.001). Discussion and Conclusion: Anaphylaxis in the elderly is often caused by insect venoms and drugs. These patients suffer more often from cardiovascular symptoms, receive more frequently adrenaline and require more often hospitalization. The data indicate that anaphylaxis in the elderly tends to be more frequently life threatening and patients require intensified medical intervention. The data support the need to recognize anaphylaxis in this patient group, which is prone to be at a higher risk for a fatal outcome

Designing the Composition of Cement-Stabilized Rammed Earth with the Association Analysis Application

The main advantage of the structural composite material known as cement-stabilized rammed earth (CSRE) is that it can be formulated as a sustainable and cost-saving solution. The use of the aggregates collected very close to a construction site allows economizing on transportation costs. Another factor that makes sustainability higher and the costs lower is a small addition of cement to the CSRE in comparison to the regular concrete. However, the low cement content makes the compressive strength of this structural material sensitive to other factors. One of them is the composition of the aggregates. Considering the fact that they are obtained locally, without full laboratory control of their composition, achieving the required compressive strength of CSRE is a challenge. To assess the possibility of achieving a certain compressive strength of CSRE, based on its core properties, the innovative algorithm of designing CSRE is proposed. Based on 582 crash-test of CSRE samples of different composition and compaction levels, along with the use of association analysis, the spreadsheet application is created. Applying the algorithm and the spreadsheet, it is possible to design the composition of CSRE with high confidence of achieving the required compressive strength. The algorithm considers a random character of aggregates locally collected and proposes multiple possible ways of increasing the confidence. They are verified through innovatively applied association analyses in the enclosed spreadsheet