Analysis of the connection between pain, disability and a radiological image determining the treatment process

The objective of this paper is to analyse the correlation between pain and the degree of disability, and the lesions shown on radiological examination of KOA. Material and method: The study encompassed 31 female patients (42 knees) aged 51-70 years, with diagnosed idiopathic knee osteoarthritis. Medical history and analysis of previously performed x-ray scans were conducted. The history included questions regarding pain (VAS, WOMAC index) and the maximum marching distance, the presence of oedema and instability as well as disability in everyday life (WOMAC index). The radiological lesions were assessed using the Kellgren and Lawrence Grading Scale. Moreover, the widths of the joint spaces were measured. Results: The patients’ pain in everyday activities (WOMAC) showed a positive correlation with the presence of osteophytes (r=0.32), and the intensity of the pain on the VAS correlated with the presence of joint osteophytes (r=0.46) and with the elevation of the intercondylar eminence (r=0.32). The other disorders on the x-ray image did not correlate with the pain. Positive correlations were identified between the presence of oedema (r=0.57) and instability (r=0.39), and the presence of lesions in the patellofemoral joint. The patients’ disability in everyday activities (WOMAC) showed a negative correlation with the width of the joint spaces (r<-0.34). However, no correlations were observed between the remaining x-ray lesions and the WOMAC index. Conclusions: Only a small number of subjects showed a correlation indicating an interdependency between the painful sensations and the degree of disability versus the progression of radiographic lesions. Among the KOA risk factors, it is worth noting the presence of obesity which, in these studies, affected more than half of the female patients.Celem pracy jest analiza zależności pomiędzy dolegliwościami bólowymi i stopniem niesprawności a zmianami wykazanymi w radiologicznym badaniu ChZSK. Materiał i metoda: Przebadano 31 pacjentek (42 kolana) w wieku 51-70 lat z rozpoznaną idiopatyczną chorobą zwyrodnieniową stawu kolanowego. Przeprowadzono wywiad i ocenę uprzednio wykonanego zdjęcia rtg. W wywiadzie zawarte były pytania dotyczące bólu (skala VAS, indeks WOMAC) oraz maksymalnego dystansu marszem, występowania obrzęku i niestabilności oraz niesprawności w życiu codziennym (indeks WOMAC). Zmiany radiologiczne oceniono wg skali Kallgren’a i Lavrence’a. Ponadto zmierzono również szerokości szpar stawowych. Wyniki: Ból pacjentek w czynnościach codziennych (WOMAC) korelował dodatnio obecnością osteofitów (r=0,32) a intensywność odczuwanego bólu w skali VAS korelowała z obecności osteofitów w stawie (r=0,46) oraz z uniesieniem wyniosłości międzykłykciowej (r=0,32). Pozostałe zaburzenia w obrazie rtg nie korelowały z bólem. Zauważono dodatnie korelacje pomiędzy występowaniem obrzęku (r=0,57) i niestabilności (r=0,39) a obecnością zmian w stawie rzepkowo-udowym. Niesprawność pacjentek w czynnościach codziennych (WOMAC) korelowała ujemnie z szerokością szpar stawowych (r<-0,34). Natomiast pomiędzy pozostałymi zmianami w rtg a wskaźnikiem WOMAC nie zanotowałam korelacji. Wnioski: Jedynie u niewielkiej liczby badanych wystąpiła korelacja wskazująca na zależność pomiędzy odczuciami bólu istopniem niesprawności, a zaawansowaniem zmian wykazanych w radiogramach. Spośród czynników ryzyka ChZSK warto zwrócić uwagę na obecność otyłości, która w przedstawionych badaniach wystąpiła u ponad połowy pacjentek

Intravenous N-acetylcysteine for the PRevention Of Contrast-induced nephropathy : a prospective, single-center, randomized, placebo-controlled trial : the INPROC trial

Introduction: Contrast-induced nephropathy (CIN) is a common clinical problem that is growing in importance as an increasing number of tests and procedures which utilize contrast media (CM) are performed. Aim: To evaluate the efficacy of intravenous N-acetylcysteine (NAC) for prevention of CIN after diagnostic and/or interventional procedures requiring CM administration. Material and methods: In a prospective, single-center, randomized, placebo-controlled trial the preventive effects of N-acetylcysteine were evaluated in 222 patients undergoing elective angiography and/or angioplasty. Patients were randomly assigned to receive either NAC or placebo. All patients received intravenous hydration with normal saline before and after catheterization. Serum creatinine (SCr) and estimated glomerular filtration rate were assessed at baseline, at 48–72 h and 10–15 days after CM administration. Contrast-induced nephropathy was defined as an increase in SCr of at least 44 μmol/l (0.5 mg/dl) or an increase of ≥ 25% of the baseline value 48–72 h after CM administration. Results: Contrast-induced nephropathy occurred in 30 of 222 patients (13.5%): 9 of 108 patients in NAC (8.3%) and 21 of 114 patients in the control group (18.4%; p = 0.0281). The multivariate Cox analysis revealed that elevated SCr at 10–15 days (HR = 2.69; p = 0.018) and baseline SCr level (HR = 1.009; p = 0.015) were independent prognostic variables for adverse events during follow-up. Conclusions: Our findings suggest that intravenous NAC along with intravenous hydration may help prevent declining renal function after CM exposure. Elevated SCr level 10–15 days after CM administration was associated with increased risk of adverse events in long-term observation, while elevated SCr within 72 h was not. Measuring SCr at least 10 days after exposure to CM may provide a better outcome measure

The role of serial carotid intima-media thickness assessment as a surrogate marker of atherosclerosis control in patients with recent myocardial infarction

Introduction: Despite percutaneous coronary intervention (PCI), patients after their first myocardial infarction (MI) are at high risk of ischemic event recurrence. Therefore, there is a need for objective markers of adequate atherosclerosis control, independent of prescribed pharmacotherapy and patients’ compliance. Such a potential indicator of major adverse cerebral and coronary event (MACCE) risk might be change in carotid intima-media thickness (CIMT), which indicates atherosclerosis growth. Aim: To evaluate the potential associations between CIMT changes and the incidence of MACCE and recurrent MI. Material and methods: The CIMT assessments at baseline and during 2 follow-up visits were performed in 215 patients admitted with MI, in whom PCI was performed for an index lesion, followed by best medical treatment. The incidences of MACCE (cardiovascular death, recurrent MI, ischemic stroke) and new onset angina were recorded prospectively. Results: The MACCE were recorded in 65 (30.2%) patients and angina due to coronary lesion progression (CLP) in 27 (12.5%) patients. Although initial CIMT values were similar in patients who suffered MACCE vs. MACCE-free patients (1.43 ±0.40 vs. 1.45 ±0.44 mm; p = 0.486), patients in whom MACCE occurred had greater annual CIMT growth as assessed at the first (0.024 ±0.12 vs. 0.009 ±0.16 mm/year; p 0.003 mm/year (sensitivity: 84.5%, specificity: 49.3%) for MI plus CLP (AUC = 0.673) occurred an independent indicator of MACCE (HR = 3.00; 95% CI: 1.496–6.016), recurrent MI (HR = 4.59, 95% CI: 1.591–13.217), and MI plus CLP (HR = 3.50, 95% CI: 1.759–6.964). Conclusions: Annual CIMT change might be a potentially valuable marker of atherosclerosis response to post-MI treatment

Prospective multicentre study of carotid artery stenting using the MER™ Stent : the OCEANUS study : 30-day and one-year follow-up results

Introduction: Constant technological progress in the field of carotid stenting translates into improved short- and long-term results of endovascular treatment. The introduction of a new generation, self-expanding, open-cell stent has provided a new treatment option in endovascular management of carotid stenosis. Aim: To evaluate 30-day and 1-year clinical outcomes of non-consecutive patients with high risk of carotid endarterectomy, who underwent 5F cylinder-tapered MER™ open-cell carotid stent implantation. Material and methods: It was a single-arm, prospective study conducted in four experienced catheterisation centres. The use of embolic protection devices was mandatory. The primary endpoint was stroke in 30-day follow-up. The secondary endpoints were 30- day and 1-year cumulative incidence of death, stroke and myocardial infarction, 1-year target vessel revascularisation, procedural success (residual stenosis ≤ 30%), restenosis rate (%DS ≥ 50%), and Serious Adverse Device Effect (SADE) rate in 1-year follow-up. Results: In total 100 patients were recruited for the study, with the majority being males (n = 61). The mean age was 68.3 ±8.2 years, and most of the patients were asymptomatic (n = 56). In 55 (55%) patients direct stenting was performed, with the use of proximal protection devices in 19 (19%) patients. Mean internal carotid artery/common carotid artery stenosis before and after stent implantation was 81.98 ±9.15% and 12.52 ±8.70%, respectively (p < 0.001). Procedural success was achieved in all cases. One ischaemic stroke was observed at 30 days (1%, primary endpoint). At 1-year follow-up two myocardial infarctions and three deaths occurred with no additional stroke. Conclusions: The OCEANUS study indicated the safety and efficacy of the MER™ stent during 30-day and 1-year follow-up in both symptomatic and asymptomatic patients. The majority of patients were event-free. However, larger cohort studies are needed to evaluate MER™ stents in detail

Prospective study on the prognostic value of repeated carotid intima-media thickness assessment in patients with coronary and extra coronary steno-occlusive arterial disease

It is debatable whether the rate of change in carotid intima‑media thickness (CIMT) may be used as a risk indicator of major adverse cerebral and coronary events (MACCEs) in patients with either coronary (CAD) and peripheral artery disease (PAD). This prospective study aimed to evaluate the association between CIMT changes and the incidence of MACCEs, in patients with symptomatic CAD and PAD. The study comprised 466 patients admitted with steno‑occlusive disease, in whom revascularization was performed for an index lesion. Group 1 included 305 subjects with CAD, and group 2, 161 patients with PAD. CIMT was measured at baseline and at a median of 21 and 41 months afterwards. The incidence of MACCE, cardiovascular death (CVD), myocardial infarction (MI), and ischemic stroke was recorded prospectively during 5 years. CIMT increased with a mean (SD) progression rate of 0.027 (0.16) mm/y in group 1 and 0.026 (0.17) mm/y in group 2 (P = 0.89). CIMT regression was recorded in 112 patients (36.7%) and 61 patients (37.9%) in groups 1 and 2, respectively, at baseline (P = 0.80), and 82 patients (26.9%) and 42 patients (26.1%) in groups 1 and 2, respectively, in follow‑up (P = 0.85). Maintained CIMT regression was independently associated with a reduced risk of MACCEs (hazard ratio [HR], 0.25, 95% CI, 0.15-0.42), MI (HR, 0.32; 95% CI, 0.20-0.51), ischemic stroke (HR, 0.29; 95% CI, 0.18-0.45), and CVD (HR, 0.24; 95% CI, 0.15-0.40), while the CIMT progression rate of 0.056 mm/y was associated with an increased risk of MACCEs (sensitivity, 53.2%; specificity, 72.2%; area under the receiver operating curve, 0.65). Maintained CIMT regression is associated with 68% to 75% reduction in the risk of a cardiovascular event. However, a long‑term maintained CIMT regression is achieved in one‑fourth of patients with either CAD or PAD

Recommendations on the use of innovative medical technologies in cardiology and cardiac surgery and solutions leading to increased availability for Polish patients

There is a great need for innovative technologies that will improve the health and quality of life (QoL) of Polish patients with cardiac problems. It is important that the safety and effectiveness of the technology are confirmed by scientific evidence on which guidelines and clinical recommendations are based. Scientific evidence for medical devices is also increasingly important for decision-making in finance approval from public funds. New technologies in cardiology and cardiac surgery contribute to improved patient QoL, increased treatment effectiveness and facilitated diagnosis. Hence, it is necessary to increase accessibility to such technologies, primarily through the development of clinical recommendations, and education of medical personnel in conjunction with public funding. The aim of this publication is to present the recommendations of leading experts in the field of cardiology and cardiosurgery, supported by clinical research results, regarding the use of the cited innovative medical technologies and solutions leading to their increased availability for Polish patients.

Heart failure in Poland: Left ventricular assist device destination therapy and other challenges of interventional cardiology and cardiac surgery

Patients with severe heart failure (HF), who are not eligible for cardiac transplantation and receive optimal medical management, based mainly on the use of pharmacological treatment and devices such as resynchronization therapy (implantable cardioverter-defibrillator), achieve poor clinical outcomes and constitute a group with extremely poor prognosis. Currently, the technology used in the latest generation left ventricular assist devices (LVADs), such as the HeartMate 3, makes it possible to achieve patient survival at the level obtained by patients after heart transplantation, and they can be used not only in patients eligible for heart transplantation as a bridge to transplant, but also in those with significantly worse prognosis, who are ineligible for heart transplantation as destination therapy. The objective of this publication is to present recommendations from experts in cardiology and cardiac surgery, supported by clinical trial results, on the use of LVADs as a destination therapy in HF patients who are not eligible for cardiac transplantation. The paper also presents the issue of cardiac transplantation and extracorporeal membrane oxygenation therapy in Poland, as well as current challenges faced by interventional cardiology and cardiac surgery in Poland