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

Urinary Neutrophil Gelatinase-Associated Lipocalin Is Complementary to Albuminuria in Diagnosis of Early-Stage Diabetic Kidney Disease in Type 2 Diabetes

Background. Two clinical phenotypes of diabetic kidney disease (DKD) have been reported, that is, with or without increased albuminuria. The aim of study was to assess the usefulness of urinary neutrophil gelatinase-associated lipocalin (uNGAL) for the early diagnosis of DKD in the type 2 diabetes mellitus (T2DM). Methods. The study group consisted of 123 patients with T2DM (mean age 62 ± 14 years), with urine albumin/creatinine ratio (uACR) 39.64 µg/g, 13 (54%) did not have markedly increased albuminuria. Women with T2DM had higher uNCR than men (p<0.001), without difference in uACR (p=0.09). uNCR in T2DM patients correlated significantly with HbA1c. Sex, total cholesterol, and uACR were independent predictors of uNCR above 39.64 µg/g. Conclusions. Increased uNGAL and uNCR may indicate early tubular damage, associated with dyslipidemia and worse diabetes control, especially in females with T2DM

Complex percutaneous intervention on pulmonary arteries in an adult patient with a corrected Taussig-Bing anomaly

W niniejszej pracy przedstawiono przypadek udanej złożonej interwencji przezskórnej na tętnicach płucnych u 23-letniego dorosłego pacjenta ze skorygowaną anomalią Taussiga–Binga. Wada skorygowana była zabiegiem typu arterial switch; ponadto w wywiadzie odnotowano przebytą operację Bentalla i wymianę zastawki mitralnej. Przy przyjęciu pacjent był bezobjawowy, jednak wykryto istotne zwężenie tętnic płucnych. Pacjent został zakwalifikowany do cewnikowania serca. Złożony zabieg wysokiego ryzyka z implantacją trzech stentów poprawił morfologię prawej tętnicy płucnej, a w konsekwencji funkcję prawej komory. Podsumowując, dzięki niezwykłemu rozwojowi technik przezskórnych, coraz więcej pacjentów otrzymuje optymalne, spersonalizowane leczenie.This study reports a case of a successful complex percutaneous intervention on pulmonary arteries in a 23-year-old adult patient with a corrected Taussig-Bing anomaly. The patient had a history of multiple surgeries, including an arterial switch operation, the Bentall procedure, and mitral valve replacement. On admission, the patient was asymptomatic, however significant stenosis of the pulmonary arteries was detected. The patient was qualified for cardiac catheterization. The complex, high-risk procedure with the implantation of three stents improved the morphology of the right pulmonary artery and consequently the function of the right ventricle. It is concluded that with the remarkable development of percutaneous techniques, more and more patients are receiving optimal, personalised treatment

Biological properties of low-toxicity PLGA and PLGA/PHB fibrous nanocomposite implants for osseous tissue regeneration. Part I: evaluation of potential biotoxicity

In response to the demand for new implant materials characterized by high biocompatibility and bioresorption, two prototypes of fibrous nanocomposite implants for osseous tissue regeneration made of a newly developed blend of poly(L-lactide-co-glycolide) (PLGA) and syntheticpoly([R,S]-3-hydroxybutyrate), PLGA/PHB, have been developed and fabricated. Afibre-forming copolymer of glycolide and L-lactide (PLGA) was obtained by a unique method of synthesis carried out in blocksusing Zr(AcAc)4 as an initiator. The prototypes of the implants are composed of three layers of PLGA or PLGA/PHB, nonwoven fabrics with a pore structure designed to provide the best conditions for the cell proliferation. The bioactivity of the proposed implants has been imparted by introducing a hydroxyapatite material and IGF1, a growth factor. The developed prototypes of implants have been subjected to a set of in vitro and in vivobiocompatibility tests: in vitro cytotoxic effect, in vitro genotoxicity and systemic toxicity. Rabbitsshowed no signs of negative reactionafter implantation of the experimental implant prototypes

Polish Society of Gynecology and Obstetrics statement on safety measures and performance of ultrasound examinations in obstetrics and gynecology during the SARS-CoV-2 pandemic

We present recommendations on performance and safety measures of ultrasound examinations in obstetrics and gynecologyduring the SARS COV-2 pandemic. The statement was prepared based on the current knowledge on the coronavirusby the Ultrasound Section of the Polish Society of Obstetrics and Gynecology. It has to be noted that the presented guidanceis based on limited evidence and is primarily based on experiences published by authors from areas most affected bythe virus thus far, such as China, Singapore, Hong Kong, and Italy. We realize that the pandemic situation is very dynamic.New data is published every day. Despite the imposed limitations related to the necessity of social distancing, it is crucialto remember that providing optimal care in safe conditions should remain the primary goal of healthcare providers. Weplan to update the current guidelines as the situation develops

A New Digital Platform for Collecting Measurement Data from the Novel Imaging Sensors in Urology

The use of UT and EIT technologies gives the opportunity to develop new, effective, minimally invasive diagnostic methods for urology. The introduction of new diagnostic methods into medicine requires the development of new tools for collecting, processing and analysing the data obtained from them. Such system might be seen as a part of the electronic health record EHR system. The digital medical data management platform must provide the infrastructure that will make medical activity possible and effective in the presented scope. The solution presented in this article was implemented using the newest computer technologies to obtain advantages such as mobility, versatility, flexibility and scalability. The architecture of the developed platform, technological stack proposals, database structure and user interface are presented. In the course of this study, an analysis of known and available standards such as Hl7, RIM, DICOM, and tools for collecting medical data was performed, and the results obtained using them are also presented. The developed digital platform also falls into an innovative path of creating a network of sensors communicating with each other in the digital space, resulting in the implementation of the IoT (Internet of Things) vision. The issues of building software based on the architecture of microservices were discussed emphasizing the role of message brokers. The selected message brokers were also analysed in terms of available features and message transmission time

Application of endovenous mechanochemical ablation (MOCA) with Flebogrif™ to treat varicose veins of the lower extremities: a single center experience over 3 months of observation

Introduction. Chronic venous insufficiency is one of the most common medical conditions among highly developed societies. The majority of patients (70%) suffer from saphenous veins incompetency. The study presents results of a 3-month follow-up of application of venous mechanochemical ablation system with the FlebogrifTM catheter. Material and methods. The study was conducted on 200 patients, including 170 women and 30 men treated with ablation with FlebogrifTM to treat varicose veins. All patients were qualified based on the ultrasound in a standing position confirming incompetence of the great saphenous vein or small saphenous vein. The vein was punctured under ultrasound guidance in the distal part of the incompetent segment. The area of vascular access was anesthetized with 0.5 mL of 1% lignocaine. The compression therapy in the form of the first grade medical elastic stocking was used after the surgery. Results. The initial technical success of the surgery was achieved in all the patients. During the 3-month follow-up, recanalization occurred in 8 cases, in 5 patients great saphenous vein and in 3 small saphenous vein recanalised. Based on the recommendations of the European Consensus Meeting on Foam Sclerotherapy,  7 cases were defined as complete recanalization and 1 as partial. The analysis of numerical data obtained with Venous Clinical Severity Score and Clinics Ethiology Anatomy Pathophysiology Classification showed a statistically significant decrease in the severity of clinical symptoms compared to ones before the surgery and between particular days of the observation during the 3-month follow-up. Conclusions. The procedure is highly effective reaching 96% at 3 months of follow-up, provides good cosmetic effect and the low rate of complications. Minimal invasiveness of mechanochemical ablation with Flebogrif™ may improve the quality of life during the postoperative period. A long-term observation is recommended to achieve a full-value assessment of this novel method

Difficulties in the Modeling of E. coli Spreading from Various Sources in a Coastal Marine Area

Coastal and transitional waters are often used as bathing waters. In many regions, such activities play an important economic role. According to the European Union Bathing Water Directive (2006/7/EC) (BWD) the concentration of Escherichia coli in bathing water exceeding 500 CFU&middot;100 mL&minus;1 poses a high risk for bathers&rsquo; health. In order to safeguard public health, microbiological environmental monitoring is carried out, which has recently been supported or replaced by mathematical models detailing the spread of sanitary contamination. This study focuses on the problems and limitations that can be encountered in the process of constructing a mathematical model describing the spread of biological contamination by E. coli bacteria in coastal seawater. This and other studies point to the following problems occurring during the process of building and validating a model: the lack of data on loads of sanitary contamination (often connected with multiple sources of biological contamination inflow) makes the model more complex; E. coli concentrations higher than 250 CFU&middot;100 mL&minus;1 (low hazard for health) are observed very rarely, and are associated with great uncertainty; the impossibility of predicting the time and intensity of precipitation as well as stronger winds and rougher sea, which may be a significant source of E. coli. However, there is universal agreement that such models will be useful in managing bathing water quality and protecting public health, especially during big failures of the wastewater network