Zarządzanie wiedzą i akcelerator ekspansji

Wiedza zgromadzona w organizacjach g o spodarczych należy do ważnych aktywów. W zarządzaniu nią wyróżniamy strategie: kodyfikacji i pełnej personalizacji. Właściwa kultura organizacyjna pozwala na skuteczne korzystanie z całych za sobów dostępnej wiedzy oraz na uruchomienie akceleratora ekspansjiZadanie pt. „Digitalizacja i udostępnienie w Cyfrowym Repozytorium Uniwersytetu Łódzkiego kolekcji czasopism naukowych wydawanych przez Uniwersytet Łódzki” nr 885/P-DUN/2014 zostało dofinansowane ze środków MNiSW w ramach działalności upowszechniającej nauk

Echocardiographic morphometry of the right chambers of the heart in permanent cardiac pacing

Permanent cardiac pacing is a method of choice in the treatment of specific arrhythmias and conduction disturbances. Clinical studies show that cardiac performance diminished at the site of impulse spreading. It determines local hypotrophy below the position of the pacing lead (early electric activation) with hypertrophic changes in the opposite lying myocardium (late electric activation). It seems that morphological changes, especially research by intravital methods, so relevant in permanent pacing to today™s invasive cardiologist, are not understood in full. In connection with this we decided, on the basis on the echocardiographic examination, to evaluate in detail the morphology of the right ventricle and atrium in patients with permanent pacing. Research was carried out on a group of 124 patients (68 males, 56 females) from 40±93 years of age (avg. 68 ± 14 yrs): 86 patients had implanted pacemakers or AICD (group I), the control group consisted of 38 patients with other cardiac diseases without any pacemaker devices (group II). We measured echocardiographically the following diameters: end-diastolic and systolic diameters of the right ventricle/atrium in short and long axis, diameter of the tricuspid orifice valve and calculated area of the tricuspid orifice based on a special formula. Regarding the morphometric parameters of the right ventricle and right atrium, we confirmed that all diameters of group I were overshooting in correlation to group II. Those differences, such as RVd-short and -long, RVs-long, RVinflow, RA-long and -short, TRId, were statistically significant. Regarding the area of the tricuspid orifice (TRIa), we did not observe any changes in the two examined groups. We concluded that patients with implanted devices have changes in the morphometric parameters of the right ventricle, atrium and orifice, but they do not depend on the duration of pacemaker implantation

Permanent cardiac pacing and its influence on tricuspid valve function

Implantation of transvenous devices is a widespread procedure in clinical cardiology. It is well known that the presence of the electrodes in the cardiovascular system can induce fibrosis or fibrous adhesions between them and cause tricuspid regurgitation. Moreover there are suggestions that the placement of the electrode in the tricuspid orifice may also play a role in the development of tricuspid insufficiency because of the thickening of reactive leaflets and the impairment of their mobility in morphological studies. There are no papers regarding the topography of the electrode in the right ventricle judged by means of transthoracic echocardiography. Moreover in literature we did not meet reports comparing the localisation of the lead on the tricuspid valve function. Therefore we decided to describe the detailed topographic relations between the lead and the structures of the right ventricle in a larger population and we compared the influence of the lead location for tricuspid valve function. Research was carried out on a group of 86 patients (52 M, 34 F), with a mean age of 64.7 ± 14.9 years with permanent cardiac pacemaker or implantable cardioverter-defibrillator (ICD). On the basis of echocardiograms performed we assessed the position of the lead regarding the tricuspid valve leaflets or commissure, and judged the course of the lead beneath the tricuspid valve level. Moreover special attention was focused on the placement of the tip of the electrode. We qualified its position into three categories: apex of the right ventricle, right ventricle outflow tract, and “para-apex” position. The degree of the tricuspid valve insufficiency was assessed by means of semiquantitative method based on the Color-flow Doppler echocardiography. We measured the extension and the area of the tricuspid regurgitant jet using four-gradual scale. We compared the topography of the lead at the level of the valve with its function by means of the presence and degree of its regurgitation. We stated that in 35% of cases the pacing lead was located at the level of the anterior leaflet of the tricuspid valve, in 23% at the level of the septal leaflet and in 12% at the posterior one. Besides in 10% the electrode was placed between the leaflets just over the commissures. On the other hand in the remaining 20% the lead was positioned centrally in the right atrioventricular orifice without adherence to any leaflet. Next we assessed the course of the lead beneath the tricuspid valve level and stated that most frequently (45%) it run just across the centre of the right ventricle, and in other cases was lying along the interventricular septum (in 39% of cases) or along the anterior wall of the right ventricle(in 16%). The tip of the lead was positioned exactly in the apex of the right ventricle in 74%, in the right ventricular outflow tract in 9% and in 17% its position was “para-apical”. We did not see any statistically significant differences between the presence and intensification of valve regurgitation and topography of the lead. We concluded that at the level of the tricuspid valve the lead was positioned in the anteroseptal part of tricuspid annulus and the proper apical position of the electrode’s tip occurred in approximately 75% of cases. Localisation of the electrode at the level of the tricuspid orifice does not influence its insufficiency as detected by Doppler echocardiography

Web Pages Content Analysis Using Browser-Based Volunteer Computing

Existing solutions to the problem of finding valuable information on the Websuffers from several limitations like simplified query languages, out-of-date in-formation or arbitrary results sorting. In this paper a different approach to thisproblem is described. It is based on the idea of distributed processing of Webpages content. To provide sufficient performance, the idea of browser-basedvolunteer computing is utilized, which requires the implementation of text pro-cessing algorithms in JavaScript. In this paper the architecture of Web pagescontent analysis system is presented, details concerning the implementation ofthe system and the text processing algorithms are described and test resultsare provided

The localisation of the electrode in permanently paced heart - an echocardiographical study

Permanent cardiac pacing is a widely applied procedure in invasive cardiology. The aim of our study was the analysis of the localisation of the tip of the pacemaker lead and its course in the right ventricle. Research was carried out on a group of 12 patients (5F, 7M), from 40 to 93 years of age (average 70±15 yrs) with permanent cardiac pacing or implantable cardioverter-defibrillator (ICD). Subsequent echocardiographic views were applied: an apical four chamber view, a subcostal one and a parasternal right ventricular inflow tract view. At the level of the tricuspid annulus the electrode was positioned: the anterior leaflet - 41.7% (5 pts), the anteroseptal commissure 25% (3 pts), the posterior leaflet 8.3% (1 pt) and the septal one - 8.3% (1 pt). In 16.7% (2 patients) the lead was positioned centrally in the right atrioventricular orifice. Regarding the further positioning of the electrode in the ventricle, in 41.7% (5 pts) the leads were placed along the interventricular septum, in 16.7% (2 pts) along the anterior wall of right ventricle and in 41.7% (5 pts) across the centre of the right ventricle. The tip of the lead was positioned in the apex of the right ventricle in 83.4% (10 pts). In the remaining 16.7% (2 pts) the position was not apical - in 1 patient the anterior wall of the right ventricle and in 1 patient the interventricular septum. In the VVI pacing mode the electrode did not lie on the interventricular septum. In contrast to this in 80% of patients (4 pts) having the DDD pacing mode the lead was situated on the interventricular septum on its course downwards to the ventricle. Conclusions: 1) On the level of the leaflets of the tricuspid valve the lead most often was positioned at the level of the anterior leaflet and the anteroseptal commissure. 2) Most patients had an apical localisation of the tip of the lead. 3) Differences between morphological and echocardiographic studies are related to the intravital and the two-dimensional character of echocardiography, and probably to the small population of the group examined

Influence of QRS duration and axis on response to cardiac resynchronization therapy in chronic heart failure with reduced left ventricular ejection fraction: A single center study including patients with left bundle branch block

Background: The aim of the study was to evaluate QRS duration and axis as predictors of response to cardiac resynchronization therapy (CRT) in order to reduce the proportion of non-responders.Methods: Retrospective single-center study including 42 CRT recipients, with left bundle branch block (LBBB), left ventricular ejection fraction (LVEF) < 40%, in New York Heart Association (NYHA) class ≥ II. Response to CRT was declared as NYHA class improvement ≥ 1 (symptomatic) and LVEF improvement by ≥ 10% (echocardiographic) > 6 months post implantation.Results: Symptomatic responders had longer pre- (172.3 ± 17.9 vs. 159.0 ± 18.3 ms; p = 0.027) and postimplantation (157.2 ± 24.1 vs. 136.7 ± 23.2 ms; p = 0.009) QRS duration. Preimplantation QRS < 150 ms predicted poor response (odds ratio [OR] for response vs. lack of response 0.04; 95% confidence interval [CI] 0.001–0.74). Predictors of symptomatic response included: postimplantation QRS > 160 ms (OR 7.2; 95% CI 1.24–41.94), longer QRS duration before (OR for a 1 ms increase 1.04, 95% CI 1.00–1.08) and post implantation (OR for a 1 ms increase 1.04; 95% CI 1.01–1.07). Area under the curve (AUC) for pre- and postimplantation QRS duration was 0.672 (95% CI 0.51–0.84) and 0.727 (95% CI 0.57–0.89), respectively, with cut-off points of 178.5 ms and 157 ms. For post implantation QRS axis, AUC was 0.689 (95% CI 0.53–0.85), with cut-off points of –60.5° or –38.5°. Preimplantation QRS axis was the only predictor of echocardiographic response (OR 0.98; 95% CI 0.96–1.00), with AUC of 0.693 (95% CI 0.54–0.85) and a threshold of –36°.Conclusions: Marked pre- and postimplantation QRS prolongation and preimplantation negative QRS axis deviation are moderate predictors of response to CRT

75-year-old man with lung cancer obscured by an implantable cardioverter-defibrillator — case report

We present a case of a 75-year-old man, who underwent a scheduled implantable cardioverter-defibrillatorreoperation and has had a lung cancer found in a chest X-ray taken after the procedure, that wascompletely obscured by the previous device