The proceedings of medical emergency teams with patients with acute myocardial infarction with an elevation of ST-segment in the Gorlice county

INTRODUCTION: Ischaemic heart disease and myocardial infarction are the main cause of morbidity and mortality in western civilizations. In the broad definition of ischaemic heart disease is a disease entity which is STEMI. It is a life-threatening condition that can lead to cardiac arrest in a short time. The development of knowledge and treatment systems has contributed to a significant decrease in-hospital mortality as a result of STEMI, however, the total mortality because of this disease has practically not decreased, because about 2/3 of deaths occur in the pre-hospital period before the patient receives reperfusion therapy. Therefore, it is so important to regularly analyse the rescue procedure and modernize solutions aimed at improving the survivability of these people. The aim of the study is to evaluate the proceeding of emergency medical teams in patients with acute myocardial infarction with ST elevation on the ECG. MATERIAL AND METHODS: The Rescue Orders Cards and Medical Rescue Operations Cards of emergency medical teams operating in the Gorlice county in the period from 01.01.2016 to 31.12.2017 were used for the study. There were identified cases in which diagnosis from group I21 according to ICD-10 was made and all other cases in which patients were transported directly to the haemodynamic regardless of the diagnosis made, and in whom in ECG was diagnosed STEMI. The study was carried out based on the analysis of medical documentation of the Emergency Service in Gorlice. A type of Desk Research analysis was also used to review the available literature and research results of other authors from recent years. RESULTS: Analysis of the research material showed that: –– statutory criteria of reach time to the patient were met in 68.3% of cases, –– 51.14% of patients with STEMI symptoms call on EMS after 2 hours from their occurrence, –– 89.36% of patients with STEMI were transported directly to the haemodynamic, –– the median from diagnosis of STEMI to hand over in cases of transport the patient to the haemodynamic was 65 minutes, –– two-stage antiplatelet treatment is used in 47.87% of cases. CONCLUSIONS: The time of reach EMS to the patient with STEMI is in most cases within the limits of the statutory standard. Most of the patients with STEMI symptoms delay call an ambulance by more than 2 hours. The vast majority of patients with a diagnosis STEMI get directly to the haemodynamic while meeting the assumed time criterion of 100 minutes. The frequency of anticoagulant and antiplatelet drug therapy is not in line with current recommendations. In most cases paramedics use ECG tele-transmission

Knowledge of and attitudes to emergency tachyarrhythmia treatment among paramedics and nurses

INTRODUCTION: Supraventricular tachycardia (SVT) is a wide term used to describe tachycardia with atri- al and/or ventricular rates exceeding 100 bpm at rest. The underlying mechanism involves His bundle or tissue lying above. As the diagnosis of SVT is often made in the prehospital settings or in an emergency department, the relevant knowledge of all medical personnel, including paramedics, on the diagnosis and treatment procedures is crucial for the patient’s outcome. It is essential to quickly assess the patient’s clinical condition and make decisions based on both electrocardiographic records and the occurrence of adverse symptoms. Some procedures and pharmacological treatments can be implemented by the paramedic on their own, some require a physician’s supervision. The aim of the study was to assess paramedics’ and nurs- es’ knowledge concerning emergency management in tachycardia. METHODS: The study was conducted in January 2019 in south-western Poland among paramedics and nurses working in the Polish National Emergency Medical System (EMS). All participants received information on the study objectives and voluntarily took part in the questionnaire survey. The questionnaire was developed by the authors and included 22 questions referring to gender, age, work experience, type of work in EMS, number of inhabitants in the workplace area, latest training in advanced life support, adverse events in hemodynamically unstable patients, vagal manoeuvres, European Resuscitation Council 2015 guidelines for narrow and broad complex tachycardia in stable and unstable patients with regular and irregular rhythms, indications for synchronized electrical cardioversion, performing synchronized electrical cardioversion in the past, concerns about cardioversion and self-assessed level of experience in tachyarrhythmia treatment. RESULTS: Overall, 200 paramedics and 50 nurses were asked to participate in the study. The final question- naire return rate was 84.5%. The mean age of the participants equalled as 37.90 ± 11.44 years; 50 (29.59%) were female; the mean work experience was 12.07 ± 10.39 years. The correct treatment in a stable patient with narrow QRS tachyarrhythmia (including vassal manoeuvres and adenosine administration) was pro- posed by 88.17% of the participants. The correct treatment in an unstable patient with broad QRS tachyar- rhythmia was proposed by 84.60% of the participants. Overall, 56.80% indicated correct treatment with a beta-blocker in a stable patient with irregular narrow complex tachyarrhythmia with a duration of over 48 hours; 87.57% knew the role of magnesium sulphate in torsade de pointes treatment. Only 34.91% had conducted electrical cardioversion in the past. According to the subjects, the main problems associated with the procedure of electrical cardioversion were: analgosedation and airway management (52.66%), the risk for sudden cardiac arrest as a result of electrical cardioversion (53.25%), and the risk of a stroke (38.46%). The proper number of electrical cardioversions in unstable patients was proposed by 73.37% of the partic- ipants; 66.86% knew the correct dose of amiodarone when the correct electrical cardioversion sequence does not restore the sinus rhythm and the patient remains unstable. Only 43.79% knew the correct initial biphasic energy for electrical cardioversion in unstable broad complex tachyarrhythmia (120–150 J), while most responders indicated energy up to 120 J. The mean self-assessed level of experience in tachyarrhythmia treatment was 6.00 ± 1.76 in a scale of 0–10, where 0 meant lack of experience and 10 stood for experience ensuring proper performance of the procedure. CONCLUSIONS: The knowledge of Polish paramedics and nurses concerning the emergency treatment of tach- yarrhythmia is unsatisfactory in many aspects. Better undergraduate and postgraduate training on advanced life support guidelines should be recommended.

Overexpression of the selective autophagy cargo receptor NBR1 modifies plant response to sulfur deficit

Plants exposed to sulfur deficit elevate the transcription of NBR1 what might reflect an increased demand for NBR1 in such conditions. Therefore, we investigated the role of this selective autophagy cargo receptor in plant response to sulfur deficit (-S). Transcriptome analysis of the wild type and NBR1 overexpressing plants pointed out differences in gene expression in response to -S. Our attention focused particularly on the genes upregulated by -S in roots of both lines because of significant overrepresentation of cytoplasmic ribosomal gene family. Moreover, we noticed overrepresentation of the same family in the set of proteins co-purifying with NBR1 in -S. One of these ribosomal proteins, RPS6 was chosen for verification of its direct interaction with NBR1 and proven to bind outside the NBR1 ubiquitin binding domains. The biological significance of this novel interaction and the postulated role of NBR1 in ribosomes remodeling in response to starvation remain to be further investigated. Interestingly, NBR1 overexpressing seedlings have significantly shorter roots than wild type when grown in nutrient deficient conditions in the presence of TOR kinase inhibitors. This phenotype probably results from excessive autophagy induction by the additive effect of NBR1 overexpression, starvation, and TOR inhibition

Mean-field Study of Charge, Spin, and Orbital Orderings in Triangular-lattice Compounds ANiO2 (A=Na, Li, Ag)

We present our theoretical results on the ground states in layered triangular-lattice compounds ANiO2 (A=Na, Li, Ag). To describe the interplay between charge, spin, orbital, and lattice degrees of freedom in these materials, we study a doubly-degenerate Hubbard model with electron-phonon couplings by the Hartree-Fock approximation combined with the adiabatic approximation. In a weakly-correlated region, we find a metallic state accompanied by \sqroot3x\sqroot3 charge ordering. On the other hand, we obtain an insulating phase with spin-ferro and orbital-ferro ordering in a wide range from intermediate to strong correlation. These phases share many characteristics with the low-temperature states of AgNiO2 and NaNiO2, respectively. The charge-ordered metallic phase is stabilized by a compromise between Coulomb repulsions and effective attractive interactions originating from the breathing-type electronphonon coupling as well as the Hund's-rule coupling. The spin-orbital-ordered insulating phase is stabilized by the cooperative effect of electron correlations and the Jahn-Teller coupling, while the Hund's-rule coupling also plays a role in the competition with other orbital-ordered phases. The results suggest a unified way of understanding a variety of low-temperature phases in ANiO2. We also discuss a keen competition among different spin-orbital-ordered phases in relation to a puzzling behavior observed in LiNiO2

Spin dynamics of frustrated easy-axis triangular antiferromagnet 2H-AgNiO2 explored by inelastic neutron scattering

We report inelastic neutron scattering measurements of the spin dynamics in the layered hexagonal magnet 2H-AgNiO2 which has stacked triangular layers of antiferromagnetically-coupled Ni2+ spins (S=1) ordered in a collinear alternating stripe pattern. We observe a broad band of magnetic excitations above a small gap of 1.8 meV and extending up to 7.5 meV, indicating strongly dispersive excitations. The measured dispersions of the boundaries of the powder-averaged spectrum can be quantitatively explained by a linear spin-wave dispersion for triangular layers with antiferromagnetic nearest- and weak next-nearest neighbor couplings, a strong easy-axis anisotropy and additional weak inter-layer couplings. The resulting dispersion relation has global minima not at magnetic Bragg wavevectors but at symmetry-related soft points and we attribute this anomalous feature to the strong competition between the easy-axis anisotropy and the frustrated antiferromagnetic couplings. We have also calculated the quantum corrections to the dispersion relation to order 1/S in spin-wave theory by extending the work of Chubukov and Jolicoeur [Phys. Rev. B v46, 11137 (1992)] and find that the presence of easy-axis anisotropy significantly reduces the quantum renormalizations predicted for the isotropic model.Comment: 17 pages and 15 figures. To appear in Physical Review

On the weak confinement of kinks in the one-dimensional quantum ferromagnet CoNb2O6

In a recent paper Coldea et al (2010 Science {\bf 327} 177) report observation of the weak confinement of kinks in the Ising spin chain ferromagnet CoNb2O6 at low temperatures. To interpret the entire spectra of magnetic excitations measured via neutron scattering, they introduce a phenomenological model, which takes into account only the two-kink configurations of the spin chain. We present the exact solution of this model. The explicit expressions for the two-kink bound-state energy spectra and for the relative intensities of neutron scattering on these magnetic modes are obtained in terms of the Bessel function.Comment: 18 pages, 9 figures; v2: figures 1,3,4 replaced, few misprints correcte

A Contribution to Identification of Novel Regulators of Plant Response to Sulfur Deficiency: Characteristics of a Tobacco Gene UP9C, Its Protein Product and the Effects of UP9C Silencing

Extensive changes in plant transcriptome and metabolome have been observed by numerous research groups after transferring plants from optimal conditions to sulfur (S) deficiency. Despite intensive studies and recent important achievements, like identification of SLIM1/EIL3 as a major transcriptional regulator of the response to S-deficiency, many questions concerning other elements of the regulatory network remain unanswered. Investigations of genes with expression regulated by S-deficiency stress encoding proteins of unknown function might help to clarify these problems. This study is focused on the UP9C gene and the UP9-like family in tobacco. Homologs of these genes exist in other plant species, including a family of four genes of unknown function in Arabidopsis thaliana (LSU1-4), of which two were reported as strongly induced by S-deficit and to a lesser extent by salt stress and nitrate limitation. Conservation of the predicted structural features, such as coiled coil region or nuclear localization signal, suggests that these proteins might have important functions possibly mediated by interactions with other proteins. Analysis of transgenic tobacco plants with silenced expression of UP9-like genes strongly argues for their significant role in regulation of plant response to S-deficit. Although our study shows that the UP9-like proteins are important components of such response and they might be also required during other stresses, their molecular functions remain a mystery

Graphene coating obtained in a cold-wall CVD process on the Co-Cr Alloy (L-605) for medical applications

Graphene coating on the cobalt-chromium alloy was optimized and successfully carried out by a cold-wall chemical vapor deposition (CW-CVD) method. A uniform layer of graphene for a large area of the Co-Cr alloy (discs of 10 mm diameter) was confirmed by Raman mapping coated area and analyzing specific G and 2D bands; in particular, the intensity ratio and the number of layers were calculated. The effect of the CW-CVD process on the microstructure and the mor-phology of the Co-Cr surface was investigated by scanning X-ray photoelectron microscope (SPEM), atomic force microscopy (AFM), scanning electron microscopy (SEM), and energy dispersive X-ray spectroscopy (EDS). Nanoindentation and scratch tests were performed to determine mechanical properties of Co-Cr disks. The results of microbiological tests indicate that the studied Co-Cr alloys covered with a graphene layer did not show a pro-coagulant effect. The obtained results confirm the possibility of using the developed coating method in medical applications, in particular in the field of cardiovascular diseases

The Enzymatic Activity of Type 1 Iodothyronine Deiodinase (D1) is Low in Liver Hemangioma: A Preliminary Study

Type 1 iodothyronine deiodinase (D1) is a crucial enzyme which converts the prohormone thyroxine (T4) into active tri-iodothyronine (T3). There has been strong evidence that the metabolism of thyroid hormones is disturbed in some neoplastic tissues such as thyroid, renal, and breast cancer. However, there are few available data about D1 enzyme activity in benign tumors such as hemangioma, which is the most common primary liver tumor. Hence this study aimed to determine the enzymatic activity of D1 in hemangiomas in relation to healthy liver tissue. Seven tumors and healthy control tissues were obtained from patients who had liver resection due to hemangioma. The activity was assessed by measurement of radioactive iodine released by deiodination catalyzed by D1. It was found that D1 activity was significantly lower in the hemagiomas than in the healthy surrounding tissue (p = 0.0017). The results indicated that thyroid hormones play important roles not only in the regulation of cell metabolism, but also in cell growth, division, and apoptosis. The active form T3 acts through its nuclear receptors and influences the up- and down-regulation of target genes. Healthy liver tissue expresses a high level of D1, but disturbed D1 activity may result in changes in the local concentration of T3 which may impair gene transcription. These finding demonstrate a low enzymatic activity of D1 in liver hemangioma and suggest an as yet unknown role of thyroid hormones in this type of benign liver tumor