Prognostic value of red blood cell distribution width in patients with left ventricular systolic dysfunction: Insights from the COMMIT-HF registry

Background: Previous studies have reported that in patients with heart failure, an increased value of red cell distribution width (RDW) is associated with adverse outcomes. Nonetheless, data regarding the association between RDW values and long-term mortality in patients with left ventricular systolic dysfunction (LVSD) are lacking. The aim of this investigation was to examine the relationship between mortality and RDW in patients with ischemic and non-ischemic LVSD. Methods: Under analysis was 1734 patients with a left ventricular ejection fraction (LVEF) ≤ 35% of whom were hospitalized between 2009 and 2013. Patients were divided into three groups based on RDW tertiles. Low, medium and high tertiles were defined as RDW ≤ 13.4%, 13.4% < RDW ≤ 14.6% and RDW > 14.6%, respectively. Results: There was a stepwise relationship between RDW intervals and comorbidities. Patients with the highest RDW values were older and more often diagnosed with anemia, diabetes, atrial fibrillation and chronic kidney disease. The main finding of our analysis was the presence of an 8-fold increase in all-cause mortality in the entire cohort between high and low RDW tertile. Cox hazard analysis identi­fied RDW as an independent predictive factor of mortality in all patients (HR 2.8; 95% CI 2.1–3.8; p < 0.0001) and in subgroups of patients with ischemic (HR 2.8; 95% CI 2.0–3.9; p < 0.0001) and non-ischemic (HR 3.3; 95% CI 2.01–5.5; p < 0.0001) LVSD. Conclusions: The highest RDW tertile was independently associated with higher long-term mortality compared with low and medium tertiles, both in all patients with a LVEF ≤ 35% and in subgroups of patients with ischemic and non-ischemic LVSD

An Integrated EPLOS Database as a Tool Supporting TSL Companies

The paper presents the conceptual design of a database for the European Portal of Logistics Services (EPLOS) and its application. The database contains the data on logistics companies, the infrastructure for road, railway, inland, and air transport, as well as the data on the nodal elements of logistics infrastructure (warehouse facilities, seaports, transhipment terminals). Complete and verified information is the fundamental condition for rational decisions about the realization of logistics processes on a meso- and macroeconomic scale. Authors present the relations in the making of the EPLOS database, its assumed scope, and the potential benefits for the TSL market from accessing the EPLOS database

Telemonitoring chorych z niewydolnością serca

W związku z wciąż narastającą liczbą chorych z przewlekłą niewydolnością serca, rozszerzeniem wskazań do implantacji kardiowertera–defibrylatora, szczególnie w profilaktyce pierwotnej nagłego zgonu sercowego, oraz udowodnioną skutecznością terapii resynchronizującej w redukcji całkowitej śmiertelności w tej grupie chorych liczba implantowanych kardiostymulatorów, kardiowerterów–defibrylatorów oraz układów resynchronizujących z opcją kardiowertera–defibrylatora zwiększa się z roku na rok. Pacjenci z implantowanym urządzeniem wymagają kontynuacji opieki w warunkach ambulatoryjnych, a same urządzenia regularnej kontroli technicznej i adaptacji ich funkcji do indywidualnych potrzeb chorego. Od kilku lat dostępna jest w systemie opieki zdrowotnej możliwość zdalnego monitorowania chorych z implantowanymi urządzeniami, która umożliwia częstszą kontrolę urządzeń i lepszą opiekę nad pacjentami, zwłaszcza z zaawansowaną niewydolnością serca. Olbrzymi rozwój technologii pozwala na pozyskiwanie coraz większej liczby danych dotyczących samego urządzenia, jak i parametrów klinicznych, takich jak np. rytm serca, częstotliwość oddechów, aktywność pacjenta, stopień wyrównania niewydolności serca i innych. W artykule zdefiniowano pojęcia telemedycyny i telemonitoringu, przedstawiono doniesienia z badań potwierdzających skuteczność i bezpieczeństwo telemonitorowania chorych oraz zasygnalizowano kwestie prawne i ekonomiczne związane ze stosowaniem tej metody

A Model for the Designing of Multimodal Transport Processes and the Concept of Its Integration with the EPLOS System

The paper proposes a new single criterion mathematical model for the designing of multimodal transport processes by taking into account the cargo’s susceptibility and the concept of its inclusion into the EPLOS system, which is done as part of the EUREKA initiative. This system will integrate the data from logistics sources and transport and logistics infrastructure from many sources. In the first phase of its implementation, it will cover the Czech Republic, Poland, and the Baltic States. Using the EPLOS system integrating data from various sources needed to solve this problem is a proposal to overcome the main barrier to the effective planning of multimodal transport processes – a lack of reliable information

An implantable cardioverter-defibrillator for primary prevention in non-ischemic cardiomyopathy: A systematic review and meta-analysis

Background: Recent data regarding the comparison of implantable cardioverter-defibrillator (ICD) therapy and optimal medical treatment in patients with non-ischemic cardiomyopathy has indicated no mortality benefit as a result of ICD therapy. Although the recommendations for ICD implantation did not change, it is worth noting that these findings significantly affected the daily practice of ICD implantation in Europe. Methods: To assess the effect of ICD implantation in comparison to pharmacotherapy in the non-ischemic cardiomyopathy heart failure population through a systematic review and meta-analysis of the available carefully designed prospective randomized controlled trials. Only prospective randomized controlled trials comparing ICD implantation in primary prevention vs. optimal pharmacological therapy or placebo and reporting mortality results were included in the meta-analysis. The authors have chosen to include the following trials: CAT, AMIOVIRT, DEFINITE, and DANISH. Results: A meta-analysis of pooled hazard ratios (HR) from all trials conducted on a total of 1789 patients found that ICD therapy decreased all-cause mortality in comparison to optimal pharmacological treatment, with a HR of 0.48 (95% confidence interval [CI] 0.67–1.01); p = 0.06. The data from the AMIOVIRT, DANISH, and DEFINITE trials, with a total of 1677 participants, showed a significant reduction of sudden cardiac deaths as a result of ICD implantation, with a HR of 0.48 (95% CI 0.31–0.67); p < 0.001. Conclusions: In comparison with optimal medical treatment, ICD implantation in patients with heart failure improves the long-term prognosis in terms of sudden cardiac death, with a strong tendency towards all-cause mortality reduction

Can we further improve the quality of nephro-urological care in children with myelomeningocele?

Myelomeningocele (MMC) results from a failure of normal neural tube fusion in early fetal development. Retrospective, observational study of medical data of 54 children treated in Pediatric Nephrology and Urology Clinics for five years was performed. The following data were analyzed: serum creatinine, eGFR, urine analysis, renal scintigraphy (RS), renal ultrasound, and urodynamics. Mean age of studied population: 12.3 years, median of eGFR at the beginning and at the end of survey was 110.25 and 116.5 mL/min/1.73 m2 accordingly. Median of frequency of urinary tract infections (fUTI): 1.2 episodes/year. In 24 children: low-pressure, in 30 children: high-pressure bladder was noted. Vesicouretral reflux (VUR) was noted in 23 children (42.6%). fUTI were more common in high-grade VUR group. High-grade VURs were more common in group of patients with severe renal damage. At the end of the survey 11.1% children were qualified to higher stages of chronic kidney disease. Renal parenchyma damage progression in RS was noted in 22.2% children. Positive VUR history, febrile recurrent UTIs, bladder wall trabeculation, and older age of the patients constitute risk factors of abnormal renal scans. More than 2.0 febrile, symptomatic UTIs annually increase by 5.6-fold the risk of severe renal parenchyma damage after five years

Palliative surgery in cases of unresectable pancreatic head cancer

Wstęp. W niniejszej pracy omówiono postępowanie paliatywne u chorych z nieresekcyjnym rakiem głowy trzustki. Celem pracy było porównanie różnych rodzajów operacji, wykonywanych przy braku możliwości leczenia radykalnego. Materiał i metody. Analizie poddano 108 chorych z rakiem głowy trzustki, których operowano w Klinice Chirurgii Ogólnej i Transplantacyjnej w latach 1995-2004. U 94 chorych śródoperacyjnie stwierdzono nieresekcyjność zmiany bez naciekania dwunastnicy. Chorych tych podzielono na 2 grupy: w pierwszej (60 chorych) wykonano zespolenie odbarczające drogi żółciowe, a w drugiej (34 chorych) - zespolenie odbarczające drogi żółciowe i dodatkowo zabieg drenujący żołądek. W obu grupach operowanych chorych porównano średni czas pobytu w szpitalu, częstość występowania powikłań chirurgicznych i śmiertelność. Wyniki. Obydwie grupy chorych były porównywalne pod względem wieku i płci. Chorzy po operacji zespolenia żółciowego przebywali w szpitalu średnio 19,2 ± 7,9 dnia, a po zabiegu uzupełnionym o profilaktyczne zespolenie żołądkowo-jelitowe - 18,1 ± 9,1 dnia. Porównując częstość powikłań pooperacyjnych i śmiertelność w grupach, nie stwierdzono pomiędzy nimi różnic istotnych statystycznie. Wnioski. Tradycyjnie stosowany w zabiegach paliatywnych przy zaawansowanym raku trzustki drenaż dróg żółciowych można rozszerzyć o zespolenie żołądkowo-jelitowe bez ryzyka zwiększenia częstości powikłań pooperacyjnych.Background. The authors discuss surgical palliative procedures in patients with unresectable pancreatic head cancer. Aim of the study is to compare diffrent surgical procedures in respect of postoperative complication and mortality rate in cases, when the radical treatment was not possible. Material and methods. We analysed 108 patients who underwent surgery for the pancreatic head cancer in Department of General and Transplant Surgery of the Medical University in Łódź between years 1995 and 2004. Of those in 94 cases unresectable lesion without duodenal involvement was detected during surgery. The patients were divided into two groups - in the first group of 60 - biliary by-pass procedure has been done and in the second group of 34 - similiar procedure with gastroenterostomy. We compared the frequency of postoperative complications and mortality rate in mentioned above groups. Results. Patients, who underwent combined biliary and gastric by-pass remained in hospital for 18.1 ± 9.1 and following biliary by-pass alone - 19.2 ± 7.9 days. There were no statistically significant differences between these groups while the complication frequency and mortality rate were found similar. Conclusions. In advanced pancreatic cancer, traditionally executed biliary drainage can be extended by a gastro-jejunostomy without the increased risk of post-operative complications or mortality

Left main disease management strategy: Indications and revascularization methods in particular groups of subjects

Surgical revascularization with coronary artery by-pass grafting is still recommended in vast majority of patients with unprotected left main disease. The aim of the paper was to analyze optimal treatment of left main disease in selected groups of patients, on the basis of current guidelines and information gained from literature data. We focused on data in relation to treatment of elderly patients, diabetics and those hemodynamically unstable. Additionally we discussed the issue of anti-platelet therapy and informed consent. As far as efficacy of treatment is concerned, not only method of revascularization but also general condition of the patient, the factors influencing peri-operative risk and optimal pharmacotherapy should be taken into account. Therefore establishment of the heart team is crucial when choosing the most suitable method of invasive treatment of left main disease

The application of the genetic algorithm to multi-criteria warehouses location problems on the logistics network

This paper presents multi-criteria warehouses location problem in the logistics network. In order to solve this problem the location model was developed. The limitations and optimization criteria of the model were determined. Optimization criteria refer to transportation costs, costs associated with warehouses, e.g.: local taxes, expenditure on starting the warehouse, the constant costs, the labour force costs, the purchase costs of the additional land for the expansion, the transition costs of the raw material via the warehouses. The final location of warehouse facilities was obtained using a genetic algorithm. The genetic algorithm was developed in order to solve the multi-criteria warehouses location problem. This paper describes the stages of the genetic algorithm i.e. the stage of designating the initial population, the crossover and mutation process, the adaptation function. In this paper, the process of calibration of this algorithm was presented. The results of the genetic algorithm were compared with the random results

Numerical model for small-signal modulation response in vertical-cavity surface-emitting lasers

We present a numerical model allowing for simulations of small-signal modulation (SSM) response of vertical-cavity surface-emitting lasers (VCSELs). The model of SSM response utilizes only the data provided by a static model of continuous-wave operation for a given bias voltage. Thus the fitting of dynamic measurement parameters is not needed nor used. The validity of this model has been verified by comparing experimental SSM characteristics of a VCSEL with the results of simulations. A good agreement between experiment and simulations has been observed. Based on the results obtained in the simulations of the existing laser, the impact of the number of quantum wells in the active region on the modulation properties has been calculated and analyzed