Designing Method of Compact n-to-2n Decoders

What decoder is, everyone knows. The paper presents fast and efficient method of layouts design of n-to- 2n-lines decoders. Two scenarios of layout arrangement are proposed and described. Based on a few building blocks only, especially prepared, and appropriate procedure of their placement, a decoder of any size can be build. Layouts of all needed fundamental blocks were designed in CMOS technology, as standard library. Moreover, some important parameters, such area, power dissipation and delay, were assessed and compared for decoders designed with proposed method and traditional. Power consumption were considered under extended model, which takes into account changes of input vectors, not only switching activity factor. All designs were done in UMC 180 CMOS technology

Lead dependent tricuspid dysfunction: Analysis of the mechanism and management in patients referred for transvenous lead extraction

Background: Lead-dependent tricuspid dysfunction (LDTD) is one of important complicationsin patients with cardiac implantable electronic devices. However, this phenomenon isprobably underestimated because of an improper interpretation of its clinical symptoms. Theaim of this study was to identify LDTD mechanisms and management in patients referred fortransvenous lead extraction (TLE) due to lead-dependent complications.Methods: Data of 940 patients undergoing TLE in a single center from 2009 to 2011 wereassessed and 24 patients with LDTD were identifi ed. The general indications for TLE, pacingsystem types and lead dwell time in both study groups were comparatively analyzed. Theradiological and clinical effi cacy of TLE procedure was also assessed in both groups with precisionestimation of clinical status patients with LDTD (before and after TLE). Additionally,mechanisms, concomitant lead-dependent complications and degree (severity) of LDTD beforeand after the procedure were evaluated. Telephone follow-up of LDTD patients was performedat the mean time 1.5 years after TLE/replacement procedure.Results: The main indications for TLE in both groups were similar (apart from isolatedLDTD in 45.83% patients from group I). Patients with LDTD had more complex pacing systemswith more leads (2.04 in the LDTD group vs. 1.69 in the control group; p = 0.04). Therewere more unnecessary loops of lead in LDTD patients than in the control group (41.7% vs.5.24%; p = 0.001). There were no signifi cant differences in average time from implantationto extraction and the number of preceding procedures. Signifi cant tricuspid regurgitation(TR-grade III–IV) was found in 96% of LDTD patients, whereas stenosis with regurgitationin 4%. The 10% frequency of severe TR (not lead dependent) in the control group patients wasobserved. The main mechanism of LDTD was abnormal leafl et coaptation caused by: loop ofthe lead (42%), septal leafl et pulled toward the interventricular septum (37%) or too intensivelead impingement of the leafl ets (21%). LDTD patients were treated with TLE and reimplantationof the lead to the right ventricle (87.5%) or to the cardiac vein (4.2%), or surgery procedure with epicardial lead placement following ineffective TLE (8.3%). The radiological and clinicaleffi cacy of TLE procedure was very high and comparable between the groups I and II (91.7%vs. 94.2%; p = 0.6 and 100% vs. 98.4%; p = 0.46, respectively). Repeated echocardiographyshowed reduced severity of tricuspid valve dysfunction in 62.5% of LDTD patients. The follow--up interview confi rmed clinical improvement in 75% of patients (further improvement aftercardiosurgery in 2 patients was observed).Conclusions: LDTD is a diagnostic and therapeutic challenge. The main reason for LDTDwas abnormal leafl et coaptation caused by lead loop presence, or propping, or impingementthe leafl ets by the lead. Probably, TLE with lead reimplantation is a safe and effective optionin LDTD management. An alternative option is TLE with omitted tricuspid valve reimplantation.Cardiac surgery with epicardial lead placement should be reserved for patients withineffective previous procedures

Are type I dural arteriovenous fistulas safe? : single-centre experience of endovascular treatment of dural arteriovenous fistulas

Introduction: There are mixed reports on the incidence of intracranial haemorrhage in patients with dural arteriovenous fistulas. We assessed new proposed risk factors (i.a. number of outflows and outflow diameter) of intracerebral haemorrhage due to intracranial dural arteriovenous fistula and presented our personal experience in endovascular treatment of dural arteriovenous fistulas. Material and methods: The patient database from January 2006 and December 2016 was reviewed, and 25 patients with 28 dural arteriovenous fistulas were identified. Results: 50% of patients presented with intracerebral haemorrhage. Multiple dural fistulas occurred in 12% of patients. Spearman's rank correlation coefficient revealed that there was a strong association between Cognard classification type and time needed to treat (r = 0.59, p < 0.05), as well as the volume of contrast used (r = 0.77, p < 0.05). Infratentorial (r = 0.53, p < 0.05) and right-sided (r = 0.66, p < 0.05) localisation were more challenging to treat. Bleeding was associated with poorer clinical outcome (r = 0.48, p < 0.05). No significant differences were found between the non-haemorrhagic group and the haemorrhagic group regarding the number of outflows (p = 0.459) and largest outflow diameter (p = 0.298). Clinical evaluation at follow-up was as follows: 56% of patients were asymptomatic, 24% had non-significant disability, maintaining independency, 16% had moderate disability, and 8% died - one in the course of intracerebral haemorrhage and one due to other sustained injuries. There were no reported embolisation- related complications. Conclusions: To conclude, regardless of presentation, both symptomatic and asymptomatic dural arteriovenous fistulas deserve clinical attention, structured evaluation, and follow-up. Type I fistulas were associated with haemorrhage in 1/3 of all cases. Overall our results indicate that the risk of haemorrhage and dire consequences is multifactorial

Superior ophthalmic vein and ophthalmic artery in immediate evaluation after endovascular treatment of carotid-cavernous fistulas

Purpose: To validate superior ophthalmic vein (SOV) and ophthalmic artery (OA) usefulness in immediate evaluation of new endovascular approaches to treat carotid-cavernous fistulas (CCFs). Material and methods: A retrospective review of 597 intracerebral malformation embolisations yielded 40 embolisations of CCF in the treatment of 18 patients. Two interventional radiologists performed detailed radiological angiographic assessments. Results: Mean age at initial admission was 58.9 years (SD 18.5 years, range 24-85 years). Patients presented with: chemosis (50%), ocular bruit (50%), exophthalmos (61%), diminished visual acuity (77.8%), headache (16.7%), and intracerebral haemorrhage (5.55%), and 5.55% were asymptomatic. Unilateral fistulas (10-55.5%) showed more diversified venous drainage pattern than bilateral ones (8-44.4%). There were statistically significant differences in post-traumatic and spontaneous CCF regarding age (p = 0.036), type of fistula (p = 0.0008), and presence of pseudoaneurysm (p = 0.036). 77.8% of patients had increased ipsilateral SOV diameter. SOV enlargement was not associated with type of fistula, history of trauma, or degree of exophthalmos. Ipsilateral ophthalmic artery was visible in all patients on both pre- and postprocedural angiography on lateral projection. Pre- and post-procedural SOV diameter was significantly different. Internal carotid artery patency was 100%, while the overall final angiographic or clinical success was 85.7%. We had three cases of peri-procedural complications. Conclusions: We reported changeable dynamics of SOV and OA after endovascular treatment of CCFs and proved the feasibility of coils and Onyx-18 in the treatment thereof

Influence of chronic kidney disease on prognosis and treatment of acute coronary syndromes

Przewlekła choroba nerek (CKD) w co najmniej 3. stadium występuje u 30–40% pacjentów leczonych z powodu zawału serca i stanowi silny, niezależny czynnik złego rokowania w tej grupie chorych. Ze względu na fakt, że chorych z upośledzoną funkcją nerek wykluczano z dużych randomizowanych badań, wiedza dotycząca leczenia ostrych zespołów wieńcowych (ACS) u osób z CKD jest skąpa, a optymalne postępowanie terapeutyczne w tej grupie chorych nie zostało jednoznacznie określone. W niniejszej pracy przedstawiono obecny stan wiedzy dotyczący rewaskularyzacji naczyń wieńcowych u chorych z CKD i ACS.Chronic kidney disease (CKD) stage ≥ 3 occurs in 30–40% of patients with myocardial infarction and is a strong and independent predictor of poor prognosis in this group of patients. Due to the fact that patients with impaired renal function were excluded from large randomized trials knowledge regarding the treatment of acute coronary syndromes (ACS) in patients with CKD is still lacking and optimal therapy in this group of patients has not been clearly defined. The following paper presents an overview of current knowledge on coronary revascularization in patients with CKD and ACS

Nerkopochodne włóknienie układowe

Nerkopochodne włóknienie układowe (NSF) jest nową jednostką chorobową, dotyczącąwyłącznie pacjentów z upośledzoną funkcją nerek, w większości przypadków eksponowanychna działanie gadolinowego środka cieniującego. Nerkopochodne włóknienieukładowe charakteryzuje się występowaniem objawów skórnych zlokalizowanychgłównie w obrębie kończyn (podudzia, przedramiona), rzadziej tułowia. Zmienionachorobowo skóra pacjentów z NSF jest pogrubiała, stwardniała i bolesna. Proceswłóknienia nie ogranicza się jedynie do powłok ciała, może obejmować narządywewnętrzne, prowadząc do rozwoju groźnych powikłań oraz zgonu chorego. LeczenieNSF jak dotychczas ma charakter wyłącznie objawowy, a zasadniczym celem terapiijest poprawa funkcji nerek, która może prowadzić do złagodzenia objawów, a nawetcałkowitego ich ustąpienia. Zgodnie z zaleceniami FDA należy unikać stosowaniakontrastu gadolinowego u chorych z GFR poniżej 30 ml/min/1,73 m2 (MDRD)

The crystal structure of superoxide dismutase from Plasmodium falciparum

Background: Superoxide dismutases (SODs) are important enzymes in defence against oxidative stress. In Plasmodium falciparum, they may be expected to have special significance since part of the parasite life cycle is spent in red blood cells where the formation of reactive oxygen species is likely to be promoted by the products of haemoglobin breakdown. Thus, inhibitors of P. falciparum SODs have potential as anti-malarial compounds. As a step towards their development we have determined the crystal structure of the parasite's cytosolic iron superoxide dismutase. Results: The cytosolic iron superoxide dismutase from P. falciparum (PfFeSOD) has been overexpressed in E. coli in a catalytically active form. Its crystal structure has been solved by molecular replacement and refined against data extending to 2.5 angstrom resolution. The structure reveals a two-domain organisation and an iron centre in which the metal is coordinated by three histidines, an aspartate and a solvent molecule. Consistent with ultracentrifugation analysis the enzyme is a dimer in which a hydrogen bonding lattice links the two active centres. Conclusion: The tertiary structure of PfFeSOD is very similar to those of a number of other iron-and manganese-dependent superoxide dismutases, moreover the active site residues are conserved suggesting a common mechanism of action. Comparison of the dimer interfaces of PfFeSOD with the human manganese-dependent superoxide dismutase reveals a number of differences, which may underpin the design of parasite-selective superoxide dismutase inhibitors

Diuretyki w leczeniu niewydolności serca — wciąż nie wszystko wiadomo

Fluid retention is one of the most important clinical problems in patients with heart failure (HF). The reason the majority of hospitalizations in patients with HF is overhydration which may cause a number of clinical symptoms, such as dyspnoea, oedema, limitation of physical activity. Diuretic therapy is one of the basic elements of HF therapy. Diuretics have been used for decades and it seems that their use should not wake up in the moment, no doubt. It turns out, however, that knowledge of diuretic therapy in this difficult group of patients is still incomplete. The following article discusses the basic information on the use of diuretics in patients with HF, and specifically discusses the causes of resistance to diuretics, the issue of combining diuretics with different mechanisms of action and metabolic alkalosis, which is underestimated side effect of long-term use of diuretics.Retencja płynów jest jednym z najważniejszych problemów klinicznych chorych z niewydolnością serca (HF). Powodem większości hospitalizacji tych chorych pozostaje przewodnienie będące przyczyną występowania wielu objawów klinicznych, takich jak: duszność, obrzęki, ograniczenie wydolności fizycznej. Leczenie moczopędne stanowi jeden z podstawowych elementów terapii HF. Leki moczopędne stosuje się od kilkudziesięciu lat i wydaje się, że ich wykorzystanie nie powinno obecnie budzić żadnych wątpliwości. Okazuje się jednak, że wiedza dotycząca leczenia moczopędnego w tej trudnej klinicznie grupie pacjentow nadal jest niepełna. W artykule zawarto podstawowe informacje dotyczące stosowania leków moczopędnych u chorych z HF, natomiast dokładniej omówionoprzyczyny oporności na leki moczopędne, zagadnienie łączenia diuretyków o różnych mechanizmach działania oraz alkalozę metaboliczną, będącą niedocenianym działaniem niepożądanym długotrwałego stosowania diuretyków

Zastosowanie robotów medycznych w kardiologii — przegląd obecnych rozwiązań technicznych

The constant development of Information and Communication Technologies (ICTs) and the growing demand for highly specialized medical procedures, as well as striving to increase the precision of these procedures caused, that support by robotic devices is sought. The article presents the main directions of development of robotic application in cardiac surgery and cardiology with special emphasis on projects conducted in Poland. Currently, first commercial robotic systems for applications in cardiac surgery, interventional cardiology and ablation of cardiac arrhythmias are available. Plenty of research and development projects, which intend to introduce new robotic systems for other invasive procedures and non-invasive cardiology, is ongoing.Stały rozwój technologii informacyjno-komunikacyjnych (ICT) oraz rosnące zapotrzebowanie na wysoko specjalistyczne procedury medyczne, jak również dążenie do zwiększania precyzji tych procedur, doprowadziła do poszukiwania wsparcia w urządzeniach robotycznych. Artykuł prezentuje główne kierunki rozwoju robotyki w kardiochirurgii i kardiologii ze szczególnym uwzględnieniem projektów prowadzonych w Polsce. Obecnie są już dostępne komercyjne systemy robotyczne do zastosowań w kardiochirurgii, kardiologii interwencyjnej oraz ablacjach zaburzeń rytmu serca. Prowadzonych jest wiele projektów badawczo- rozwojowych mających na celu wprowadzenie nowych systemów robotycznych do innych procedur zabiegowych oraz kardiologii nieinwazyjnej

Reduced NGF in gastric endothelial cells is one of the main causes of impaired angiogenesis in aging gastric mucosa

This study detected reduced nerve growth factor (NGF) expression within gastric endothelial cells in both elderly patients and aged rats. Reduced NGF correlated with impaired angiogenesis and delayed gastric ulcer healing in aged rats. The defects could be reversed by exogenous NGF via phosphoinositide-3 kinase/serine threonine kinase signaling protein, and mammalian target of rapamycin signaling, and was dependent on serum response factor. These data show that down-regulation of endothelial NGF expression in aging is a significant contributor to impaired gastric mucosal repair