Robust determination of relaxation times spectra of long-time multirelaxation processes.

Long-time relaxation processes occur in numerous physical systems. They are often regarded as multirelaxation processes, which are a superposition of exponential decays with a certain distribution of relaxation times. The relaxation times spectra often convey information about the underlying physics. Extracting the spectrum of relaxation times from experimental data is, however, difficult. This is partly due to the mathematical properties of the problem and partly due to experimental limitations. In this paper, we perform the inversion of time-series relaxation data into a relaxation spectrum using the singular value decomposition accompanied by the Akaike information criterion estimator. We show that this approach does not need any a priori information on the spectral shape and that it delivers a solution that consistently approximates the best one achievable for given experimental dataset. On the contrary, we show that the solution obtained imposing an optimal fit of experimental data is often far from reconstructing well the distribution of relaxation times.

A Multiclass Classification Model for Tooth Removal Procedures.

Surprisingly little is known about tooth removal procedures. This might be due to the difficulty of gaining reliable data on these procedures. To improve our understanding of these procedures, machine learning techniques were used to design a multiclass classification model of tooth removal based on force, torque, and movement data recorded during tooth removal. A measurement setup consisting of, among others, robot technology was used to gather high-quality data on forces, torques, and movement in clinically relevant dimensions. Fresh-frozen cadavers were used to match the clinical situation as closely as possible. Clinically interpretable variables or "features" were engineered and feature selection took place to process the data. A Gaussian naive Bayes model was trained to classify tooth removal procedures. Data of 110 successful tooth removal experiments were available to train the model. Out of 75 clinically designed features, 33 were selected for the classification model. The overall accuracy of the classification model in 4 random subsamples of data was 86% in the training set and 54% in the test set. In 95% and 88%, respectively, the model correctly classified the (upper or lower) jaw and either the right class or a class of neighboring teeth. This article discusses the design and performance of a multiclass classification model for tooth removal. Despite the relatively small data set, the quality of the data was sufficient to develop a first model with reasonable performance. The results of the feature engineering, selection process, and the classification model itself can be considered a strong first step toward a better understanding of these complex procedures. It has the potential to aid in the development of evidence-based educational material and clinical guidelines in the near future.

Health care effects and medical benefits of a smartphone-based diabetes self-management application: study protocol for a randomized controlled trial.

BACKGROUND: Diabetes self-management is a mainstay of diabetes care, but the implementation of self-management regimens into daily life is complex and often results in discouragement and distress. Modern approaches such as smartphone-based self-management applications are therefore needed to support people with diabetes. Since reimbursability would increase the availability of such digital applications to people with diabetes, we designed a study that meets all scientific and methodological requirements set by the German Digital Healthcare Act to allow reimbursement for a specific application (mySugr PRO). Here, we report the protocol of this study that aims at evaluating the efficacy of the digital self-management application with regard to patient-reported outcomes and medical benefits. METHODS/DESIGN: This multicenter, open-label, randomized, parallel-group, controlled trial will evaluate the health care effects and medical benefits of mySugr PRO. A total of 466 people with diabetes will be randomly allocated (2:1 randomization) to the interventional group (n = 311) that will use the digital self-management application during the 12-week study period or the control group (n = 155; no usage of the application). Baseline and follow-up examinations will assess diabetes distress as the primary endpoint as well as empowerment, HbA1c, blood glucose data, self-management, general well-being, and treatment satisfaction as secondary endpoints. Statistical analyses will use an intention-to-treat procedure (using multiple imputation for missing values) as well as a per-protocol approach for sensitivity analysis. DISCUSSION: To the best of our knowledge, this study will be one of the largest diabetes-specific evaluations of a digital health application supporting people with diabetes in their diabetes self-management that follow the requirements of the German Digital Healthcare Act. TRIAL REGISTRATION: German Clinical Trial Register DRKS00022923 . Registered on 22 October 2020.

Polychlorinated naphthalenes, biphenyls, dibenzo-p-dioxins, and dibenzofurans as well as polycyclic aromatic hydrocarbons and alkylphenols in sediment from the Detroit and Rouge Rivers, Michigan, USA.

Sediment from the upper Detroit and lower Rouge Rivers in southeastern Michigan, USA, were analyzed to examine the distribution of polychlorinated naphthalenes (PCNs), biphenyls (PCBs), dibenzo-p-dioxins (PCDDs), and dibenzofurans (PCDFs) as well as polycyclic aromatic hydrocarbons (PAHs) and alkylphenolic compounds such as butylphenol, octylphenol, and nonylphenol (NP). Sediments from a non-point source location in Lake Michigan were also analyzed for target compounds. Concentrations of target compounds in the upper Detroit and lower Rouge Rivers varied considerably among locations, and notable spatial variation existed. Concentrations of PCNs and PCDDs/PCDFs in sediments from the upper Detroit and lower Rouge Rivers ranged from 0.08 to 187 ng/g and 69 to 1420 pg/g dry weight, respectively. Total PCBs, PAHs, and NP concentrations ranged from 8 to 25,000, 17 to 44,000, and < 10 to 60,000 ng/g dry weight, respectively. Concentrations of all target compounds except PCNs were significantly correlated with total organic carbon content of sediments. Similarly, concentrations of PCBs, PCDDs, and PCDFs were significantly correlated with each other. The distribution of organic contaminants in the upper reaches of the Detroit River and lower Rouge River suggested the presence of localized, but multiple, sources of contamination for each compound class. Conners Creek combined sewer overflow has been identified as one of the potential sources for the upper Detroit River, where the highest concentrations PCBs and PCDDs/PCDFs were found. Polycyclic aromatic hydrocarbon and NP concentrations were consistently high in sediment from the lower Rouge River. Analysis of data from selected locations suggested that PCNs contributed a greater proportion of the dioxin-like activity than PCBs and PCDDs/PCDFs contributed.

Pulmonary thromboembolism.

Pulmonary embolism (PE) is a serious complication of chronic obstructive pulmonary disease (COPD). Retrospective studies on patients with COPD treated in the intensive care unit (ICU) were performed to determine: 1) the frequency of PE; 2) the clinical course of PE in cases of COPD in the ICU; and 3) the frequency of PE as a cause of death in the studied group. The frequency of PE was 10.9% in COPD patients. In the group analysed, clinical presentation of PE was characterized by acute severe, life-threatening complications leading to death in 86.7% of cases. PE was the most frequent cause of death (40.6%) in COPD patients in the ICU. The results of treatment of pulmonary embolism in chronic obstructive pulmonary disease are poor and mortality in this group of patients is very high. We believe that improvement of management can be achieved by antithromboembolic prophylaxis, which should be instituted as soon as possible in all patients with chronic obstructive pulmonary disease in the intensive care unit.

[Pulmonary embolism as a serious complication of chronic obstructive pulmonary disease from material from Ward "R"]. / Zator tetnicy plucnej jako powiklanie przewleklej obturacyjnej choroby pluc w materiale sali "R".

Pulmonary embolism (PE) is a serious complication of the chronic obstructive pulmonary disease (COPD). Retrospective studies on patients with COPD treated intensive care unit (ICU) were performed to determine: 1. frequency of PE, 2. clinical course of PE in ICU-COPD-cases, 3. frequency of PE as a cause of death in the studied group. There was 10.9% of PE in COPD patients. In the analyzed group clinical presentation of PE was characterized by acute, severe, life threatening complications leading to death in 86.7%. PE was the most frequent cause of death (40.6%) in ICU-COPD patients. The results of treatment of PE in COPD are poor and the mortality in that group of patients is very high. We believe, that the improvement of management can be achieved by antithromboembolic prophylaxis, which should be instituted as soon as possible in all ICU-COPD-patients.

[Secondary ambulatory prophylaxis of venous thromboembolism: outcome of patients who were lost to follow-up]. / Wtórna ambulatoryjna profilaktyka zylnej choroby zakrzepowo-zatorowej: losy chorych, którzy utracili kontakt z przychodnia.

We have attempted to determine the outcome of 87 out-patients who were lost from follow-up. Several factors have been assessed: causes of lost from follow-up duration of oral anticoagulation, recurrent venous thromboembolic events, cause of death (if applicable).

[Pneumonia and panophthalmitis as first signs of pneumococcal endocarditis]. / Zapalenie pluc i wnetrza galki ocznej jako pierwsze etapy pneumokokowego zapalenia wsierdzia.

A case of pneumonia associated with pneumococcal endocarditis of bicuspid aortic valve complicated by pneumococcal meningitis and panophthalmitis successfully treated by antibiotics and late valve replacement was described.

[Pericardial syndrome in the course of pulmonary embolism in personal material]. / Zespól osierdziowy w przebiegu zatoru tetnicy plucnej w materiale wlasnym.

UNLABELLED: Dressler-like syndrome has been described in about 3-4% of patients after pulmonary embolism (PE). Out of 207 patients admitted to our hospital in whom the clinical diagnosis of PE was confirmed by scintigraphy, spiral computer tomography and angiography, in 19 patients (9.2%) pericardial fluid was detected and pericardial syndrome (PS) after PE was diagnosed. Other causes of pericarditis were excluded. Mean value of pericardial fluid in echocardiographic examination-behind left ventricular posterior wall was 3.84 mm (range 2-10 mm). No clinical or echocardiographic symptoms of cardiac tamponade were observed. In 6 patients PS complicated clinically massive PE, in 3 patients-non-massive PE, in 10 patients recurrent PE. In 6 patients fibrinolytic and in 13 patients heparin therapy was instituted. In 3 cases corticosteroids were given. No increase of pericardial fluid during fibrinolytic or heparin therapy was observed. CONCLUSIONS: 1. PS after PE is more frequent, than it was estimated previously 2. During therapy of PE the echocardiographic monitoring of the amount of pericardial fluid is mandatory 3. The clinician considering in similar situations the risk-benefit ratio of fibrinolytics and anticoagulants should not abstain from the use of these drugs in the presence of PS after PE, in cases with high probability of cardiac tamponade-pericardial catheter should be used.

[Secondary prophylaxis of venous thromboembolism: analysis of 49 fatal cases]. / Wtórna profilaktyka przeciwzakrzepowa zylnej choroby zakrzepowo-zatorowej: analiza 49 zgonów.

The analysis of 49 fatal cases of venous thromboembolism--VTE (15% of total ambulatory patients number during long observation was performed. The advanced age of patients, multiple risk factors, underlying circulatory and respiratory tract diseases, malignancies, previous episodes of VTE especially with secondary pulmonary hypertension were the most important factors determining fatal prognoses in those patients.

[Low doses of rtPA administered as a bolus in treatment of clinically acute massive pulmonary embolism]. / Male dawki rtPA podawane w bolusach w leczeniu klinicznie masywnego zatoru tetnicy plucnej.

12 patients (7 male and 5 female) with confirmed pulmonary embolism (PE) with: angiography-5 cases, conventional contrast-enhanced CT-2 cases, echocardiography-2 cases, autopsy-3 cases were diagnosed as clinically acute PE. Criteria of clinically acute PE were: cardiac arrest-1 case-2 cases, shock-1 case, acute cor pulmonale-9 cases and acute cor pulmonale with shock. All patients were treated with heparin, administered with therapeutic prolongation of aPTT. Clinically acute PE (if possible confirmed with angiography, TC and/or echocardiography) was treated with rtPA administered in 10 minutes lasting bolus in doses 0.6-0.8 mg per kg of body weight (50 mg of rtPA during 10 minutes administered into peripheral veins). In 9 patients with pulmonary hypertension, significant decrease of tricuspidal gradient (measured echocardiographically during several hours after administration of rtPA) was documented. Improvement in PaO2, SaO2 and decrease of heart rate and respiratory rate were also achieved. No serious bleeding complications were observed after mentioned treatment. Control investigations (conventional contrast-enhanced CT and spiral CT) performed several days after rtPA administration revealed thrombus in pulmonary artery. We conclude: I rtPA administered in bolus simultaneously with heparin significantly decreased pulmonaryhypertension; rtPA administered simultaneously with heparin is safe method of treatment of PE; hemodynamic improvement after administration of rtPA is not univocal with full fibrynolitic effect.

[The value of measuring adenosine deaminase activity in pericardial effusion fluid for diagnosing the etiology of pericardial effusion]. / Wartosc oznaczania aktywnosci deaminazy adenozyny w plynie osierdziowym w diagnostyce etiologii wysieku osierdziowego.

The diagnosis of tuberculous pericarditis is difficult. The cultures of the pericardial fluid for M.tuberculosis are often negative. The determination of ADA activity in pleural fluid in TB patients /PTS/ is very useful. It seemed reasonable to measure ADA activity in pericardial effusion. ADA activity in pericardial fluid of 40PTS/19 women and 21 men/with large pericardial effusion of different etiologies who were treated in our institute in years 1988-1995 was investigated. The median age was 44 years. In each case the pericardiocentesis was performed. PTS were grouped as follows: group I-4 PTS with strongly suspected TB pericarditis, group II-32 PTS with malignancy and group III-4 PTS with miscellaneous diseases. In group I the mean ADA activity was 24U/I(3-60), in group II 18U/I (3-60) and in group III 18U/I (0-37) (with a cutoff value for ADA activity of 40U/I). It was definitive bacteriologic diagnosis of TB pericarditis in PTS of group I. Our observation does not confirm the earlier data about the high ADA activity in clinically suspected TB pericarditis without bacteriologic diagnosis. The value of ADA determination in pericardial fluid is its high specificity (97%) in excluding of TB etiology of pericardial effusion.

[Evaluation of intrapericardial cisplatin administration in cases of recurrent malignant pericardial effusion and cardiac tamponade]. / Ocena skutecznosci leczniczej wewnatrzosierdziowego zastosowania cysplatyny w przypadkach nawracajacych wysieków nowotworowych i tamponady serca.

30 consecutive patients with large malignant pericardial effusion (MPE) entered this prospective study. After pericardiocentesis and insertion of a polyurethane catheter, pericardial fluid was drained. Malignant etiology of pericardial fluid was confirmed by cytological examination. After confirmation of MPE cisplatin (10 mg in 20 ml normal saline) was instilled over 5 minutes during 5 consecutive days directly into pericardial space. If fluid reaccumulation occurred the courses were repeated every 3 weeks. Treatment was considered successful if the patient with malignant effusion survived 30 days without recurrence of symptoms of large pericardial effusion and other interventions directed to the pericardium were required. Positive effect of intrapericardial treatment with cisplatin was achieved in 18 cases (60%). Mean period of response was 3, 7 months (+/-6). Cisplatin administered directly into pericardial space is effective and safe method of treatment of recurrent MPE. Sclerosis of the pericardial space is rare complication connected with CP. Positive effect of CP can depend on improvement of lymphatic drainage from heart. CP seems to be method of choice in intal intrapericardial treatment in patients with malignant cardiac tamponade and recurrent MPE in course of lung cancer.

[Echocardiographic analysis of cardiac size and function in patients with severe obstructive sleep apnea]. / Echokardiograficzna analiza wielkosci i funkcji serca u chorych z ciezkim obturacyjnym bezdechem sennym.

The purpose of this study was to determine usefulness of non invasive echocardiographic measurements in patients with severe obstructive sleep apnea (OSA). Diagnosis of OSA was established by polysomnography. We investigated 18 patients (16M, 2F), mean age 45 +/- 10 years, mean weight 114 +/- 16 kg and mean apnea/hypopnea index 69 +/- 23. Two-dimensional (2D) and Doppler echocardiography (DOP) was used to assess: 1. Systolic function of left ventricle by determination of cardiac output (CO), ejection fraction (EF), 2. Diastolic function of left ventricle by calculation of mitral early diastolic velocity to arterial velocity ratio (Ev/Av) and atrial flow to total mitral flow ratio (AF/Tf), 3. Right ventricle thickness in systole (RVWS) and diastole (RVWD), and its diastolic diameter (RVD), 4. Pulmonary arterial pressure (PAP) by evaluation of acceleration time in the pulmonary artery (ACT) and tricuspid regurgitation jet velocity (TR). Results (mean +/- SD): Co 6.67 +/- 2.0 L/min, EF 44 +/- 5.6%, RVWS 10.9 +/- 1.3 mm, RVWD 6.7 +/- 1.1 mm, RVD 30.3 +/- 2.8 mm, Ev/Av 1.22 +/- 0.39, Af/Tf 0.38 +/- 0.11, AcT 121.4 +/- 20.3 ms. These data confirm that intermittent hypoxia and increased ventricular afterload cause both systolic and diastolic left ventricular dysfunction. Right ventricular hypertrophy found despite normal resting, wake, PAP could be probably attributed to transient pulmonary hypertension during repeatable nocturnal hypoxic episodes.

[Very low doses of tissue plasminogen activator in treatment of acute massive pulmonary embolism]. / Bardzo male dawki tkankowego aktywatora plazminogenu w leczeniu masywnego zatoru tetnicy plucnej.

57 years old woman with clinically acute massive pulmonary embolism confirmed by CT enhanced by contrast administration was treated with very low dose of rtPA (0.33 mg/kg) simultaneously with constant infusion of heparin (with therapeutic prolongation of aPTT). Excellent clinical effect and decrease of SPAP were achieved.

[Massive pulmonary artery embolism complicated by acute pulmonary heart disease]. / Masywny zator tetnicy plucnej powiklany ostrym sercem plucnym.

43-year old woman, with considerable overweight had been admitted to Intensive Medical Care Unit with suspicion of pulmonary embolism (PE). The patient had the limb immobilized in gypsum for last several weeks. This episode was tangled with recurrent thrombosis of deep veins in the left limb, treated with heparin and oral anticoagulants irregularly without sufficient control. Taking into consideration the data of anamnesis, clinical picture and the results of ECG, chest X-ray, gasometric and echocardiographic examination we got much closer to the recognition of PE. Our suspicion of PE was confirmed by the result of pulmonary angiography. Indications for thrombolytic treatment (r-tPA) had been established. During the following hours considerable improvement of general state was observed. The therapy was continued with constant drip infusion of heparin. No prolongation of therapeutic PTT was observed. The deficit of AT III was diagnosed. In this situation the patient was given AT III to obtain normalization of its level and therapeutic extension of PTT. Therefore there were settled indications for the operation of uterus with myoma changes. As the rich thrombolytic material in the leg's vein was found the patient was implanted LGM Filter, with excellent prophylactic effect (no PE in perioperative period). The clinical course of our case enabled to present most of diagnostic, therapeutic and preventive methods applied in venous thromboembolism.

[LGM inferior vena cava filters--follow up 50 patients]. / Filtry LGM zakladane do zyly glównej dolnej--obserwacja 50 chorych.

In the Department of Medicine at the Institute of Tuberculosis and Lung Diseases 50 LGM inferior vena cava filters have been inserted since 1993. Indications for filters placement were as follows: recurrent pulmonary embolism (PE) despite anticoagulation-16 patients (pts), severe bleeding complications of thrombolytic or anticoagulant therapy-9 pts, contraindications for thrombolytic and/or anticoagulant treatment-3 pts, massive PE-6 pts, chronic thromboembolic-major vessel pulmonary hypertension (CTEPH)-18 pts, extensive deep vein thrombosis of lower limbs or vena cava inferior in patients with urgent indications for surgery-10 pts. In every patient diagnostic procedures were performed after 1, 3, 6, 12, 24 and 36 months of follow-up period. Only one non-fatal episode of recurrent PE was documented. Other complications were rare and insignificant. The LGM inferior vena cava filters are effective and safe in such selectively chosen group of patients.

Botulinum toxin A and lidocaine have an impact on adipose-derived stem cells, fibroblasts, and mature adipocytes in vitro.

Lipofilling with autologous fat tissue is widely used in plastic and reconstructive surgery to treat soft-tissue deficiency. Unfortunately, implanted cells disappear gradually and make it difficult to predict the resorption rate. Several adjuvants are used to improve the success of fat tissue grafting. In this study, the effect of botulinum toxin (BoNT) on mature adipocytes, as well as adipose-derived stem cells (ASC) and fibroblasts was evaluated. As lidocaine is the most prevalent drug to anesthetize the donor site as well as the area to be treated with autologous fat, this local anesthetic was examined too. Primary ASCs, fibroblasts, and mature adipocytes were exposed to 1, 10, and 20 IU/ml BoNT A and 1% lidocaine. Cells were tested on proliferation, viability, and LDH release. Adipogenic differentiation potential was evaluated by quantitative real-time PCR analyzing the expression of FABP4. BoNT had no significant influence on the proliferation or viability of tested cells. By trend, low concentrations of BoNT improved adipogenic potential of ASCs. Lidocaine had a strong diminishing effect on the proliferation of ASCs and fibroblasts and on the viability of these cells. Mature adipocytes show no significant inferior viability after BoNT or lidocaine treatment. BoNT has no negative effect on ASCs, mature adipocytes, or fibroblasts in vitro. Lidocaine (1%) negatively influences the proliferation and viability of fibroblasts and partly of ASCs but not of mature adipocytes.