Interakcje leków przeciwpadaczkowych

Szacuje się, że niepożądane działania leków występują u 10–20% pacjentów leczonych szpitalnie i u około 7% populacji ogólnej. Wśród nich dużą grupę stanowią niebezpieczne konsekwencje niepożądanych interakcji leków (20–30%). Ocenia się, że 6% z nich wynika ze stosowania leków przeciwpadaczkowych (AED, antiepileptic drugs). Monoterapia jest rekomendowanym sposobem leczenia padaczki, tym niemniej podawanie więcej niż jednego AED nie należy do rzadkości, zwłaszcza u chorych opornych na stosowaną terapię. Współistnienie innych schorzeń poza padaczką zwiększa liczbę równocześnie stosowanych leków i stwarza ryzyko wystąpienia istotnych klinicznie interakcji lekowych typu lek–lek. Polski Przegląd Neurologiczny 2010; 6 (3): 141–15

Atypical regressive corneal endothelial cysts in long-term confocal follow-up

Corneal endothelium is formed of 1 layer of mitochondria-rich cubic cells whose main role is to maintain corneal transparency. Corneal endothelial disorders represent group of both inherited and noninherited and may affect proper vision. A 36-year-old male patient with suspicion of corneal endothelial dystrophy underwent visual acuity, intraocular pressure, the basic slit-lamp examination, anterior segment optical coherence tomography (AS-OCT) (Visante, Carl Zeiss Meditec, Dublin, CA), and corneal confocal microscopy in vivo (Rostock Cornea Module, Heidelberg Engineering Retina Tomograph III, Heidelberg, Germany). During the 3-year observation the patient reported symptoms mainly in the right eye. Slit-lamp examination revealed endothelial changes, much more pronounced in the right eye. Examination by the AS-OCT Visante showed hyperreflective dots within the right corneal endothelium. In order to assess endothelial cell morphology, analysis using corneal confocal microscopy in vivo was performed. Scans revealed presence of single endothelial deposits and severe cell changes of different morphology in both eyes. In the right eye, less pronounced changes of the polymorphic structure-polygonal guttas in different stages, linear and branched loss with "nuclear-like" formations and accompanying sediments. In the left eye, severe homomorphous polygonal "guttas-like" changes with "nuclear-like" formations were observed. Endothelial cysts' features were dynamically changing during follow-up time with different effects on the patient's clinical state. Corneal confocal microscopy allows accurate imaging of the endothelial cells and their detailed characteristics. Structural changes within the endothelial cells are not always proportional to visual acuity and slit-lamp image. The presented case is an example of an unusual corneal endothelial syndrome with probably nondystrophic background due to observed dynamic state with regressive tendency

Історичний розвиток гендерних уявлень (Historical development of gender ideas)

У статті аналізуються та узагальнюються історичні наукові уявлення стосовно поняття “гендер”, розглядається історія розвитку гендерних уявлень про роль чоловіка та жінки в різні вікові періоди суспільства. Вченими зазначається вплив гендерних стереотипів, які панували в зазначені історичні періоди, на формування статево-рольової поведінки членів суспільства, зокрема жінки. Підтверджується вплив гендерних стереотипів на становище жінки в соціумі, її непримирення з роллю підпорядкованості чоловікові. (In the article historical scientific presentations are analysed and summarized in relation to the concept of “gender”, history of development of гендерних pictures is examined of role of man and woman in different age-old periods of society. Scientists are mark influence of gender stereotypes which dominated in noted historical periods, on forming of sex-role conduct of members of society. Influence of gender stereotypes on position of woman in society, its unreconciliation is confirmed with the role of subordination to the man

Prosionek - usłużny heavymetalowiec w biomonitoringu środowiska

Równonogi lądowe {Isopoda), do których należy prosionek szorstki (Porcellio scaber) są jedynymi skorupiakami, które opanowały to środowisko; występują niemal we wszystkich ekosystemach i siedliskach lądowych, nawet na pustyniach [SUTTON, 1980; WARBURG, 1995]. Gatunkowe bogactwo Isopoda zależy od typu siedliska ale również w przypadku siedlisk ubogich w gatunki ich liczebność może być znaczna. Dane dotyczące zagęszczenia i biomasy tej grupy zwierząt są bardzo rozbieżne nawet w obrębie jednego gatunku i zależą od warunków klimatycznych, typu siedliska oraz jego przestrzennego zróżnicowania [DAVIS i in., 1977, HORNUNG i WARBURG, 1995]. W przypadku zagrożenia ogólną reakcją obronną równonogów są zachowania agregacyjne. W ciągu dnia ukrywają się pod kamieniami, konarami drzew, warstwą liści, czyli w miejscach o wysokiej wilgotności [HORNUNG, 1991]. Jako że są to zwierzęta o aktywności nocnej, ich naturalnymi wrogami są głównie chrząszcze z rodziny biegaczowatych {Carabidae), aktywnie polujące, nie budujące sieci pająki z rodziny pogońcowatych {Lycosidae), wije, ropuchy i polujące nocą ptaki [SUTTON, 1980]. (Fragment tekstu

Innovativer Oxidansatz auf Basis von Sc₂O₃/Y₂O₃ Heterostrukturen zur Galliumnitrid-Integration auf der Si(111) Plattform

Motivation: Preparation of GaN virtual substrates on large-scale Si wafers is intensively pursued as a cost-effective approach for high power/high frequency electronics (HEMT's etc.) and optoelectronic applications (LED, LASER). However, the growth of high quality GaN layers on Si is hampered by several difficulties mainly related to a large lattice mismatch (-17%) and a huge difference in the thermal expansion coefficient (56%). As a consequence, GaN epitaxial layers grown on Si substrates show a high number of defects (threading dislocations etc.), which severely deteriorate the overall quality of the GaN films. Additionally, due to the different thermal expansion coefficients of the substrate and the film, µm-thick GaN layers crack during post-growth cooling. To solve these integration problems, different semiconducting (e.g. AlN, GaAs, ZnO, HfN) and insulating (e.g. Al₂O₃, MgO, LiGaO₂) buffer layers, separating the Si substrate from the GaN film, are applied. Goal: In this thesis, a novel buffer approach for the integration of GaN on Si is proposed and investigated. The new approach employs Sc₂O₃/ Y₂O₃ bilayer templates as a step-graded buffer to reduce the lattice mismatch between GaN and the Si(111) substrate. According to the bulk crystal lattices, since the Y₂O₃ has an in-plane lattice misfit of -2% to Si, Sc₂O₃ -7% to Y₂O₃, the lattice misfit between GaN and the substrate can be theoretically reduced by about 50% from -17% (GaN/Si) to -8% (GaN/Sc₂O₃). Experimental: The GaN/Sc₂O₃/ Y₂O₃/Si(111) heterostructures are prepared in a multichamber molecular beam epitaxy system on 4 inch Si(111) wafers. In order to obtain complete information on the structural quality of the oxide buffer as well as the GaN layer, synchrotron- and laboratory-based x-ray diffraction, transmission electron microscopy and photoluminescence measurements are performed. The topography of the films is characterized by scanning electron microscopy and chemical inter-diffusion is investigated by energy-dispersive x-ray spectroscopy. The nucleation processes of the GaN onSc₂O₃ buff er are followed in-situ by reflection high energy electron diffraction and the interface chemistry is analyzed by means of x-ray photoelectron spectroscopy. Results: It is found, that the Sc₂O₃/ Y₂O₃ buffer approach provides a template of high structural quality for GaN overgrowth. The bi-layer buffer plays a lattice match mediator role between GaN and Si and acts as a barrier against impurity diffusion. GaN grown on Sc₂O₃/ Y₂O₃/Si(111) templates is single crystalline with a wurtzite structure and (0001) oriented. Due to the -8% lattice mismatch between GaN and Sc₂O₃, GaN growth proceeds by the nucleation of 3D islands. The size of the islands, coalescence time and the relaxation process depend on the GaN growth conditions and have a strong influence on the topography of closed layers, crystalline quality (defect density) as well as optical properties. The best GaN material parameters are obtained for the layers grown in Ga-rich regime when the Ga/N ratio is slightly higher than unity. The main three defects found in the µm-thick GaN layers are a) threading dislocation, with density in the order of 10^10 cm-2, b) stacking faults, resulting in cubic inclusions in the hexagonal matrix and c) inversion domain boundaries causing Ga-polar regions in the mainly N-polar film. A theoretical GaN/Sc₂O₃ interface model is discussed to explain these experimental findings. Despite the relatively large number of structural defects, photoluminescence shows sharp and strong donor-bound exciton transition and very low intensity yellow emission, which indicate that GaN layers grown on Sc₂O₃/ Y₂O₃/Si(111) are promising for future optoelectronic applications. Outlook: Future growth strategies will focus on interface engineering approach to further reduce the lattice mismatch between GaN(0001) and Sc₂O₃ (111) surfaces, enable growth of unipolar GaN films and trigger the occurrence of an early 2D-like growth mode to avoid cubic GaN inclusions and guarantee low threading dislocation densities.Motivation: Die Herstellung von virtuellen GaN-Substraten auf großflächigen Siliziumscheiben wird intensiv als kostengünstige Lösung in der Hochleistung-/Hochfrequenz-Elektronik (HEMT´s, usw.) und für optoelektronische Anwendungen (LED, LASER) verfolgt. Jedoch wird das Wachstum von qualitativ hochwertigen GaN-Schichten auf Si-Substraten durch mehrere Schwierigkeiten, hauptsächlich verbunden mit einer großen Gitterfehlanpassung (-17%) und einem großen Unterschied in den thermischen Ausdehnungskoeffizienten (56%), behindert. Infolgedessen zeigen die auf Silizium epitaxisch aufgewachsenen GaN-Schichten eine hohe Anzahl an Defekten (Schraubenversetzungen, usw.), welche die Gesamtqualität der GaN-Filme stark verschlechtern. Zusätzlich entstehen auf Grund der unterschiedlichen thermischen Ausdehnungskoeffizienten des Substrats und des Films bei µm-dicken GaN Schichten Brüche während des Kühlens nach dem Wachstum. Um diese Integrationsprobleme zu lösen, werden unterschiedliche halbleitende (z.B. AlN, GaAs, ZnO, HfN) und isolierende (z.B. Al₂O₃, MgO, LiGaO₂) Pufferschichten, welche das Siliziumsubstrat von der GaN-Schicht trennen, verwendet. Ziel: In dieser Doktorarbeit wird ein neuartiger Pufferansatz für die Integrierung von GaN auf Silicium vorgeschlagen und untersucht. Der neue Ansatz beruht auf den Sc₂O₃/ Y₂O₃- Zweischicht-System, dass als gestufter Pufferansatz die Gitterfehlanpassung zwischen GaN und Si(111) verringert. Gemäss den Kristallvolumengittern, wonach Y₂O₃ eine Gitterfehlanpassung in der Ebene von -2% zu Silizium und Sc₂O₃ eine von -7% zu Y₂O₃ besitzt, kann theoretisch die Gitterfehlanpassung zwischen dem Substrat und GaN um 50% von -17% (GaN/Si) auf -8% (GaN/Sc₂O₃) reduziert werden. Experimenteller Teil: Die GaN/Sc₂O₃/ Y₂O₃/Si(111)-Heterostrukturen wurden in einer Mehrkammer-Molekularstrahlepitaxieanlage auf 4 Inch Si(111) Scheiben erstellt. Um vollständige Informationen über die strukturelle Qualität des Oxidpuffers sowie der GaN-Schicht zu erhalten, wurden Synchrotron- und Labor-basierte Röntgenbeugung, Transmissionselektronenmikroskopie und Photolumineszenzuntersuchungen durchgeführt. Die Topografie der Filme ist mittels Rasterelektronenmikroskopie charakterisiert und die chemische Interdiffusion ist durch Energiedispersive Röntgenspektroskopie untersucht worden. Die Keimbildungsprozesse von GaN auf dem Sc₂O₃-Puffer sind in-situ durch Beugung hochenergetischer Elektronen in Reflektiongeometrie und die Grenzflächenchemie ist mittels Röntgen-Photoelektronen-Spektroskopie analysiert worden. Ergebnisse: Es wurde festgestellt, dass der Sc₂O₃/ Y₂O₃-Pufferansatz eine Vorlage mit hoher struktureller Qualität für das Aufwachsen von GaN bietet. Der zweischichtige Puffer spielt für Gitteranpassung zwischen GaN und Silicium eine Vermittlungsrolle und wirkt als Barriere gegen Diffusion von Verunreinigungen. GaN, gewachsen auf der Sc₂O₃/ Y₂O₃/Si(111)-Vorlage, ist einkristallin und besitzt eine (0001) orientierte Wurtzit-Struktur. Aufgrund der -8% Gitterfehlanpassung zwischen GaN und Sc₂O₃ verläuft das Wachstum von GaN über die Keimbildung von dreidimensionalen Inseln. Die Größe der Inseln, die Koaleszenzzeit und der Relaxationsprozess sind abhängig von den GaN Wachstumsbedingungen und haben starken Einfluss auf die Topographie der geschlossenen Schichten, auf die Kristallqualität (Defektdichte) ebenso wie auf die optischen Eigenschaften.Die besten Materialparameter für GaN sind für im Ga-reichen Regime erzielt worden, wenn das Ga/N-Verhältnis geringfügig höher als eins ist. Die drei Hauptdefektarten, welche in den µm-dicken GaN-Schichten gefunden wurden, sind a) Schraubenversetzungen mit einer Dichte in der Grössenordnung von 10^10 cm-2, b) Stapelfehler, wodurch kubische Einschlüsse in der hexagonalen Matrix resultieren, und c) Inversionsdomänengrenzen, welche Ga-polare Regionen im hauptsächlich N-polaren Film verursachen. Ein theoretisches GaN/Sc₂O₃-Grenzflächenmodell wird diskutiert, um diese experimentellen Ergebnisse zu erklären. Trotz der relativ großen Anzahl von strukturellen Defekten, zeigt die Photolumineszenz einen scharfen und starken Donor-gebundenen Excitonübergang und eine sehr geringe Intensität an gelber Emission, was aufzeigt, dass GaN-Schichten, aufgewachsen auf Sc₂O₃/ Y₂O₃/Si(111), vielversprechend für zukünftige optoelektronische Anwendungen sind. Ausblick: Zukünftige Wachstumsstrategien werden sich auf den Grenzflächenanpassungsansatz fokussieren, um die Gitterfehlanpassung zwischen GaN(0001) und Sc₂O₃ (111) weiter zu verringern, was das Einsetzen eines frühen zweidimensionalen Wachstumsmodus auslöst, wodurch kubische GaN-Einschlüsse vermieden und geringe Schraubenversetzungsdichten garantiert werden können. Ferner muss die Massgeschneiderte Grenzfläche das Wachstum von unipolaren GaN bewirken, so dass Inversionsdomänengrenzen vollkommen unterdrückt werden

Longitudinal observation of the retinal nerve fibre layer in glaucoma patients treated with brimonidine combined with timolol or timolol alone

INTRODUCTION. The aim of the study was to evaluate the retinal nerve fibre layer (RNFL) thickness loss in primary open-angle glaucoma (POAG) patients treated topically with anti-glaucoma drops containing brimonidine and timolol combination or solely timolol. MATERIALS AND METHODS. Retrospective case series study of patients with POAG diagnosis followed up for a five-year period. Inclusion criteria were fulfilled by a group of 98 patients consisting of 53 combination and 45 monotherapy treatments. Intraocular pressure (IOP) at the level of 21 mm Hg or below for each measurement was observed in 52 patients, while incidences of pressure above 21 mm Hg were measured in 46 patients. POAG diagnosis was based on standard optical coherence tomography, IOP, and visual field examinations. RESULTS. Mean annual loss of RNFL thickness in the overall study group (if IOP levels are not taken into consideration) treated with timolol monotherapy was 1.8 ± 1.5 μm, while in group treated with brimonidine + timolol combination therapy it was 1.7 ± 1.5 μm (p > 0.05). In selected groups of patients with incidents of pressure rises, the mean annual loss of retinal nerve fibre layer thickness was 1.8 ± 1.6 and 1.9 ± 1.4 μm, respectively, for the monotherapy and combination therapy groups (p > 0.05). In the group of patients with no reported IOL rises, mean annual loss of RNFL thickness was 1.8 ± 0.9 and 1.1 ± 0.4 μm, respectively, for the monotherapy and combination therapy groups (p < 0.01). No significant differences were observed for the visual field mean deviation. CONCLUSIONS. POAG patients with low values of IOP might achieve slower progression of RNFL thinning on brimonidine combined with timolol therapy.

Bone metastases diagnosis possibilities in studies with the use of 18F-NaF and 18F-FDG

Scintigraphy of the skeletal system is performed mainly with the use of 99mTc-MDP. There are other radiopharmaceuticals showing affinity to bone lesions: 99mTc-MIBG, 201Tl, 131I (in the case of papillary or follicular thyroid cancers), and 99mTc (V) DMSA (in the case of medullary cancer). Currently, positron emitted radioisotopes are also used in clinical practice. It seems that 18F-NaF/PET is a highly sensitive and specific modality for detection of metastases and other bone lesions. Certain data concerning the role of 18F-FDG, 18F-choline, or 68Ga-DOTATATE can be found. The aim of this article is to review the role of 18F-NaF and 18F-FDG in diagnosis of bone metastases. Nuclear Med Rev 2011; 14, 2: 105–10

Risk factors of pneumonia associated with mechanical ventilation

Background: The hospitalization of patients treated in the intensive care unit (ICU) in 5–15% of cases is associated with the occurrence of a complication in the form of ventilator-associated pneumonia (VAP). Purpose: Retrospective assessment of risk factors of VAP in patients treated at ICUs in the University Hospital in Krakow. Methods: The research involved the medical documentation of 1872 patients treated at the ICU of the University Hospital in Krakow between 2014 and 2017. The patients were mechanically ventilated for at least 48 h. The obtained data were presented by qualitative and quantitative analysis (%). The qualitative variables were compared using the Chi2 test. Statistically significant was the p < 0.05 value. Results: VAP was demonstrated in 23% of all patients treated in ICU during the analyzed period, and this infection occurred in 13% of men and 10% of women. Pneumonia associated with ventilation was found primarily in patients staying in the ward for over 15 days and subjected to intratracheal intubation (17%). A statistically significant was found between VAP and co-morbidities, e.g., chronic obstructive pulmonary disease, diabetes, alcoholism, obesity, the occurrence of VAP and multi-organ trauma, hemorrhage/hemorrhagic shock, and fractures as the reasons for admitting ICU patients. Conclusions: Patients with comorbidities such as chronic obstructive pulmonary disease, obesity, diabetes, and alcoholism are a high-risk group for VAP. Particular attention should be paid to patients admitted to the ICU with multi-organ trauma, fractures, and hemorrhage/hemorrhagic shock as patients predisposed to VAP. There is a need for further research into risk factors for non-modifiable VAP such as comorbidities and reasons for ICU admission in order to allow closer monitoring of these patients for VAP

Long-term outcomes of allogeneic ocular surface reconstruction : keratolimbal allograft (KLAL) followed by penetrating keratoplasty (PK)

Purpose. Long-term results of the patients with total LSCD, who had undergone keratolimbal allograft (KLAL) for limbal reconstruction followed by penetrating keratoplasty (PK). Methods. +e study analyzes surgical treatment of 43 eyes with severe ocular surface disorders. All subjects underwent KLAL to achieve suitable conditions for consecutive PK. Due to failures of primary treatment in 17 eyes (39%), the KLAL was repeated. PK was performed in all the patients at 9-12 months after KLAL. As a retrospective study we analyzed data from the medical records including the preoperative and postoperative best corrected visual acuity, corneal clarity, surgical outcomes and complications, postoperative intraocular pressure, graft rejection, and other comorbidities and complications. Results. +e preoperative visual acuity ranged from light perception to 0.01. +e final improvement of visual acuity within a gain of one or more lines with the Snellen chart, including the results of successive surgical treatments after PK, was achieved in 23 operated eyes (53%). Early graft rejection was observed in 4 eyes (9%). In 3 eyes, it was manifested as endothelial rejection, and in 1 eye, as combined endothelial and epithelial rejection. PK failure requiring repetitive PK was present in 14 eyes (32%). Phthisis bulbi developed in 6 eyes (14%). Glaucoma or ocular hypertension was reported in 25 eyes (58%). A majority were treated with up to 3 topical agents or referred for trabeculectomy in 3 cases, transscleral cyclophotocoagulation in 2 eyes, and EX-PRESS glaucoma shunt implantation in 3 cases. Conclusions. Successful KLAL carries a high risk of subsequent PK failure. Visual function remains the second aim of treatment; the primary one is to stabilize the surface

Zastosowanie pookluzyjnej reakcji przekrwiennej w ocenie funkcji śródbłonka mikrokrążenia

 Endothelial dysfunction is a globalized systemic dise­ase process consisting of attenuated vasodilation and augmented vasoconstriction. Post-occlusive reactive hyperemia (PORH) is commonly used as a marker of microvascular endothelial function. Laser-Doppler techniques are the most commonly used methods to ob­serve changes in microvascular perfusion in response to PORH. Recently, there is a new non-invasive method to assess microcirculation, which is based on monito­ring of the dihydronicotinamide adenine dinucleotide fluorescence. This method allows not only to evaluate microvascular function in the post-ischemic period, but also to assess it during transient ischemia of the tissue. There is compelling evidence for a link between microvascular dysfunction and the pathogenesis of cardiovascular disease.Dysfunkcja śródbłonka to ogólnoustrojowy proces cho­robowy, w którym dochodzi do osłabienia potencjału wazodylatacyjnego i wzmożenia wazokonstrykcji. Po­okluzyjna reakcja przekrwienna (PORH) jest uznanym testem oceny funkcji śródbłonka mikrokrążenia. W celu obserwacji zmian perfuzji mikrokrążenia w odpowiedzi na PORH najczęściej wykorzystuje się techniki lase­rowo-doplerowskie. Od niedawna dostępna jest nowa nieinwazyjna metoda oceny mikrokrążenia opierająca się na monitorowaniu fluorescencji dinukleotydu niko­tynoamidoadeninowego. Technika pozwala nie tylko na ocenę funkcji mikrokrążenia w okresie po niedo­krwieniu, ale co istotne — umożliwia ocenę reakcji na przejściowe niedokrwienie tkanki. Istnieją przekonu­jące dowody na istnienie związku między dysfunkcją mikrokrążenia a patogenezą chorób układu sercowo­-naczyniowego