Putting the pulp in pulp fiction

Between interlocking story lines and black humor, few films have gained such universal critical acclaim (without winning Best Picture) as Quentin Tarantino's 1994 mob masterpiece Pulp Fiction. Dominated by brilliant dialogue, violence, and subtle criticisms of American culture, the Best Original Screenplay-winning film intertwined food to further each of these critical plot threads. Indeed, Tarantino's use of food was central to every major scene in the film, heralding impending violence and offering a tangible and relatable avenue for a commentary on American culture at that time

New technologies and metabolic control in type 1 diabetes mellitus

The introduction of more rigorous criteria of metabolic control, rapid- and long-acting insulin analogues and the advances in diabetes technology (improved insulin deliv­ery systems and blood glucose monitoring) have not been translated into better glycaemic control in patients with type 1 diabetes, which is quite similar to that observed 20–30 years ago in the Diabetes Control and Complica­tions Trial (DCCT). Continuous subcutaneous insulin infusion (CSII) provided by personal insulin pumps may improve glycaemic control; however, observed results are not so good as it has been expected and are only slightly better or similar to these obtained with multiple daily insulin injections (MDII). Real-time continuous glucose monitoring (CGM) seems to be very useful to achieve target glycaemic control and to avoid hypoglycaemia in both CSII and MDII patients. While using CGM, levels of HbA1c are lower, time spent in hypoglycaemia is shorter and frequency of hypoglycaemia episodes is reduced. To receive optimum benefit, excellent compliance and fre­quent readings of measurements are required. The most common real-time sensors used in Poland are: Medtronic Enlite, Dexcom G4 Platinum and Abbott FreeStyle Libre. Unfortunately, for majority of patients with type 1 diabe­tes CGM devices have no reimbursement. (Clin Diabetol 2017; 6, 3: 111–114)The introduction of more rigorous criteria of metabolic control, rapid- and long-acting insulin analogues and the advances in diabetes technology (improved insulin deliv­ery systems and blood glucose monitoring) have not been translated into better glycaemic control in patients with type 1 diabetes, which is quite similar to that observed 20–30 years ago in the Diabetes Control and Complica­tions Trial (DCCT). Continuous subcutaneous insulin infusion (CSII) provided by personal insulin pumps may improve glycaemic control; however, observed results are not so good as it has been expected and are only slightly better or similar to these obtained with multiple daily insulin injections (MDII). Real-time continuous glucose monitoring (CGM) seems to be very useful to achieve target glycaemic control and to avoid hypoglycaemia in both CSII and MDII patients. While using CGM, levels of HbA1c are lower, time spent in hypoglycaemia is shorter and frequency of hypoglycaemia episodes is reduced. To receive optimum benefit, excellent compliance and fre­quent readings of measurements are required. The most common real-time sensors used in Poland are: Medtronic Enlite, Dexcom G4 Platinum and Abbott FreeStyle Libre. Unfortunately, for majority of patients with type 1 diabe­tes CGM devices have no reimbursement. (Clin Diabetol 2017; 6, 3: 111–114

Comparing Different Levels of Technical Systems for a Modular Safety Approval - Why the State of the Art Does Not Dispense with System Tests Yet

While systems in the automotive industry have become increasingly complex, the related processes require comprehensive testing to be carried out at lower levels of a system. Nevertheless, the final safety validation is still required to be carried out at the system level by automotive standards like ISO 26262. Using its guidelines for the development of automated vehicles and applying them for field operation tests has been proven to be economically unfeasible. The concept of a modular safety approval provides the opportunity to reduce the testing effort after updates and for a broader set of vehicle variants. In this paper, we present insufficiencies that occur on lower levels of hierarchy compared to the system level. Using a completely new approach, we show that errors arise due to faulty decomposition processes wherein, e.g., functions, test scenarios, risks, or requirements of a system are decomposed to the module level. Thus, we identify three main categories of errors: insufficiently functional architectures, performing the wrong tests, and performing the right tests wrongly. We provide more detailed errors and present examples from the research project UNICARagil. Finally, these findings are taken to define rules for the development and testing of modules to dispense with system tests

Viral hepatitis diagnosis in primary care settings

W pracy omówiono najważniejsze zagadnienia dotyczące epidemiologii, czynników ryzyka zakażenia, obrazu klinicznego, i zasad rozpoznawania wirusowych zapaleń wątroby. Opisano najczęściej występujące w Polsce zakażenia wirusami hepatropowymi. Omówiono także główne powikłania przewlekłych wirusowych zapaleń wątroby, takie jak marskość wątroby i rak wątrobowo-komórkowy. Szczególny nacisk położono na aspekty praktyczne i współczesne zasady zlecania i interpretacji wyników badań laboratoryjnych i serologicznych z punktu widzenia lekarza pierwszego kontaktu.In this article key aspects of epidemiology, risk factors, clinical presentation and diagnostic guidelines of viral hepatitis infections most frequently observed in Poland are being discussed, including long-term setbacks, like liver cirrhosis and hepatocellular carcinoma. Practical aspects of proper diagnostic procedures and modern rules on conducting laboratory tests and serological testing results interpretation, from a point of view of primary care physician, are highlighted

Nowe technologie a wyrównanie cukrzycy typu 1

Mimo zaostrzenia kryteriów wyrównania metabolicz­nego, wprowadzenia szybkodziałających i długodzia­łających analogów insuliny oraz znacznego postępu technologicznego w zakresie podawania insuliny i monitorowania glikemii wyrównanie cukrzycy typu 1 nadal pozostaje niezadowalające i nie różni się znaczą­co od czasu badania DCCT przeprowadzonego przed 20–30 laty. Prowadzenie terapii za pomocą osobistych pomp insulinowych (OPI) pozwala na poprawę wy­równanie cukrzycy, jednak efekty nie są tak dobre, jak można się było spodziewać, a wyniki są jedynie nieznacznie lepsze lub podobne do tych uzyskiwanych metodą wielokrotnych wstrzyknięć insuliny (WWI). Wydaje się, że metodą pozwalającą na osiągnięcie docelowych wartości glikemii przy równoczesnym unikaniu hipoglikemii, zarówno u osób stosujących OPI, jak i WWI, jest ciągłe monitorowanie glikemii (CGM) dokonywane w czasie rzeczywistym (real-time). Stosowanie CGM pozwala na istotną redukcję HbA1c, przy równoczesnym skróceniu czasu trwania hipogli­kemii oraz redukcję częstości epizodów hipoglikemii. Warunkiem osiągnięcia poprawy jest jednak dobra współpraca z chorym i częste korzystanie z wyników pomiarów. W Polsce najpowszechniejszymi systema­mi CGM są: Medtronic Enlite, Dexcom G4 Platinum i Abbott FreeStyle Libre. Dla większości chorych na cukrzycę typu 1 nie są one jednak refundowane przez Narodowy Fundusz Zdrowia

Sleep-disordered breathing is a risk factor for delirium after cardiac surgery: a prospective cohort study

INTRODUCTION: Delirium is a frequent complication after cardiac surgery. Although various risk factors for postoperative delirium have been identified, the relationship between nocturnal breathing disorders and delirium has not yet been elucidated. This study evaluated the relationship between sleep-disordered breathing (SDB) and postoperative delirium in cardiac surgery patients without a previous diagnosis of obstructive sleep apnea. METHODS: In this prospective cohort study, 92 patients undergoing elective cardiac surgery with extracorporeal circulation were evaluated for both SDB and postoperative delirium. Polygraphic recordings were used to calculate the apnea-hypopnea index (AHI; mean number of apneas and hypopneas per hour recorded) of all patients preoperatively. Delirium was assessed during the first four postoperative days using the Confusion Assessment Method. Clinical differences between individuals with and without postoperative delirium were determined with univariate analysis. The relationship between postoperative delirium and those covariates that were associated with delirium in univariate analysis was determined by a multivariate logistic regression model. RESULTS: The median overall preoperative AHI was 18.3 (interquartile range, 8.7 to 32.8). Delirium was diagnosed in 44 patients. The median AHI differed significantly between patients with and without postoperative delirium (28 versus 13; P = 0.001). A preoperative AHI of 19 or higher was associated with an almost sixfold increased risk of postoperative delirium (odds ratio, 6.4; 95% confidence interval, 2.6 to 15.4; P <0.001). Multivariate logistic regression analysis showed that preoperative AHI, age, smoking, and blood transfusion were independently associated with postoperative delirium. CONCLUSIONS: Preoperative SDB (for example, undiagnosed obstructive sleep apnea) were strongly associated with postoperative delirium, and may be a risk factor for postoperative delirium. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s13054-014-0477-1) contains supplementary material, which is available to authorized users

Fast and Successful Management of Intraocular Inflammation with a Single Intravitreal Dexamethasone Implant

Purpose: To investigate the efficacy and safety of a single dexamethasone intravitreal implant (Ozurdex®, 700 µg). Methods: In this prospective noncomparative case series, 84 patients (54 females) received a dexamethasone intravitreal implant. At weeks 4, 12 and 24 after the injection, vitreous haze, macular thickness and best corrected visual acuity (BCVA) were assessed and adverse events reported. Results: Clearance of vitreous haze could be achieved after 4 weeks in 61% of all eyes (p < 0.001) and remained significant until week 24 (p < 0.001). This was paralleled by a reduction of central retinal thickness after 4 (p < 0.001), 12 (p < 0.001) and 24 weeks (p < 0.006). Significant and fast improvement of BCVA was already achieved after 4 weeks (p < 0.001) but vanished by week 24. Intraocular pressure reached ≥35 mm Hg in 3 eyes and was significantly more frequent in intermediate uveitis compared to posterior uveitis (p < 0.016). Conclusions: The dexamethasone implant is effective in controlling intraocular posterior segment inflammation and reduces central retinal thickness fast and effectively. © 2014 S. Karger AG, Basel