Descriptive Analysis of Trauma Admission Trends before and during the COVID-19 Pandemic.

INTRODUCTION: Traumatic injuries are a significant global health concern, with profound medical and socioeconomic impacts. This study explores the patterns of trauma-related hospitalizations in the Lublin Province of Poland, with a particular focus on the periods before and during the COVID-19 pandemic. AIM OF THE STUDY: The primary aim of this research was to assess the trends in trauma admissions, the average length of hospital stays, and mortality rates associated with different types of injuries, comparing urban and rural settings over two distinct time periods: 2018-2019 and 2020-2021. METHODS: This descriptive study analyzed trauma admission data from 35 hospitals in the Lublin Province, as recorded in the National General Hospital Morbidity Study (NGHMS). Patients were classified based on the International Classification of Diseases Revision 10 (ICD-10) codes. The data were compared for two periods: an 11-week span during the initial COVID-19 lockdown in 2020 and the equivalent period in 2019. RESULTS: The study found a decrease in overall trauma admissions during the pandemic years (11,394 in 2020-2021 compared to 17,773 in 2018-2019). Notably, the average length of hospitalization increased during the pandemic, especially in rural areas (from 3.5 days in 2018-2019 to 5.5 days in 2020-2021 for head injuries). Male patients predominantly suffered from trauma, with a notable rise in female admissions for abdominal injuries during the pandemic. The maximal hospitalization days were higher in rural areas for head and neck injuries during the pandemic. CONCLUSIONS: The study highlights significant disparities in trauma care between urban and rural areas and between the pre-pandemic and pandemic periods. It underscores the need for healthcare systems to adapt to changing circumstances, particularly in rural settings, and calls for targeted strategies to address the specific challenges faced in trauma care during public health crises.

Continuous lumbar erector spinae plane block as an alternative to epidural analgesia in pain treatment in patients undergoing hip replacement surgery - a prospective pilot study.

INTRODUCTION: Postoperative pain associated with hip replacement surgery can be severe, decreasing the patient's mobility and satisfaction with perioperative treatment. Regional techniques are commonly used as postoperative analgesia in hip surgery patients. MATERIAL AND METHODS: We performed a prospective pilot study on patients undergoing hip replacement surgery. We anesthetized each participant with spinal technique and allocated patients according to postoperative analgesia to the continuous epidural group and the continuous lumbar erector spinae plane block (ESPB) group. We measured postope-rative oxycodone consumption with patient-controlled analgesia (PCA) demands. At several points, we evaluated the patients' pain at rest and during activity on the visual analog scale (VAS, 0-10), their quadriceps femoris' muscle strength on the Lovett scale (0-5), and their ability to sit, stand upright, and walk on the Timed Up and Go test. Moreover, we assessed the patients' recovery through the Quality of Recovery 40 (QoR-40) questionnaire on the first postoperative day. RESULTS: We found lower oxycodone consumption via PCA in the epidural than in the ESPB group (9.1 (mean) mg (5.2-13.0) (confidence interval) vs. 15.5 mg (9.8-21.3), P = 0.049). Patients in the ESPB group had more demands with PCA than participants in the epidural group (10.5 (median) (6-16) (interquartile range) vs. 25 (16-51), P = 0.016). We did not find differences between the groups in the other outcomes or in terms of postoperative complications. CONCLUSIONS: The results suggest that the continuous lumbar ESPB group is equivalent to epidural analgesia as a pain treatment technique in patients undergoing hip replacement surgery.

Evaluating Changes in Trauma Epidemiology during the COVID-19 Lockdown: Insights and Implications for Public Health and Disaster Preparedness.

The COVID-19 pandemic demanded changes in healthcare systems worldwide. The lockdown brought about difficulties in healthcare access. However, trauma still required further attention considering its modifications. The presented study aims to investigate the variances in epidemiological patterns of trauma during the lockdown and the previous year, with a view to better understand the modifications in healthcare provision. The authors analyzed data from the first lockdown in 2020 (12 March-30 May) and the same period in 2019 from 35 hospitals in Lublin Province. A total of 10,806 patients in 2019 and 5212 patients in 2020 were included in the research. The uncovered changes adhered to the total admissions and mortality rate, the frequency of injuries in particular body regions, and injury mechanisms. The lockdown period resulted in a reduction in trauma, requiring an altered approach to healthcare provision. Our research indicates that the altered approach facilitated during such periods is essential for delivering tailored help to trauma patients.

Comparing the Healing Abilities of Fluorapatite and Hydroxyapatite Ceramics in Regenerating Bone Tissue: An In Vivo Study.

Some reports in the literature show the advantages of fluoride-containing apatite ceramics over hydroxyapatite (HAP), at least in some aspects. While HAP has been used extensively in the treatment of bone defects, fluoridated apatite has hardly been tested in vivo. In order to verify the biological properties of fluoride-doped apatite and to assess its therapeutic potential, we synthesized fluorapatite (FAP) and applied it as a filling in bone defects of experimental animals (rabbits). The treatment effects were evaluated on extracted bones after 3 and 6 months from implantation using peripheral quantitative computed tomography (pQCT), dual-energy X-ray absorptiometry (DXA), radiography (X-ray) and histological staining. The study proved the integration between FAP and the bone tissue, thus indicating its stimulating effect on new bone formation and mineralization. The results achieved after 3 months of treatment were difficult to interpret unequivocally and suggested the transient delay in FAP integration of bone in comparison with HAP. The reasons for this phenomenon are unclear. Most likely, these differences between FAP and HAP resulted mainly from the different porosities, densities and ionic reactivity of the ceramics, which in our opinion affected their solubility, integration and degree of bone tissue resorption. However, it was shown that 6 months after implantation, similar level of bone defect regeneration was achieved for both FAP and HAP. In this article, we present our hypothesis concerning the basis of this phenomenon.

Use of neural network based on international classification ICD-10 in patients with head and neck injuries in Lublin Province, Poland, between 2006-2018, as a predictive value of the outcomes of injury sustained.

INTRODUCTION AND OBJECTIVE: Head and neck injuries are a heterogeneous group in terms of both clinical course and prognosis. For years, there have been attempts to create an ideal tool to predict the outcomes and severity of injuries. The aim of this study was evaluation of the use of selected artificial intelligence methods for outcome predictions of head and neck injuries. MATERIAL AND METHODS: 6,824 consecutive cases of patients who sustained head and neck injuries, treated in hospitals in the Lublin Province between 2006-2018, whose data was provided by National Institute of Public Health / National Institute of Hygiene, were analyzed retrospectively. Patients were qualified using International Statistical Classification of Diseases and Related Health Problems (10th Revision). The multilayer perceptron (MLP) structure was utilized in numerical studies. Neural network training was achieved with the Broyden-Fletcher-Goldfarb-Shanno (BFGS) method. RESULTS: In the designed network, the highest classification efficiency was obtained for the group of deaths (80.7%). The average value of correct classifications for all analyzed cases was 66%. The most important variable influencing the prognosis of an injured patient was diagnosis (weight 1.929). Gender and age were variables of less significance with weight 1.08 and 1.073, respectively. CONCLUSIONS: Designing a neural network was hindered due to the large amount of cases and linking of a large number of deaths with specific diagnosis (S06). With a predictive value of 80.7% for mortality, ANN can be a promising tool in the future; however, additional variables should be introduced into the algorithm to increase the predictive value of the network. Further studies, including other types of injuries and additional variables, are needed to introduce this method into clinical use.

Analysis of the Effect of Component Ratio Imbalances on Selected Mechanical Properties of Seasoned, Medium Viscosity Bone Cements.

The paper presents the results of experimental strength tests of specimens made of two commercially available bone cements subjected to compression, that is a typical variant of load of this material during use in the human body, after it has been used for implantation of prostheses or supplementation of bone defects. One of the factors analysed in detail was the duration of cement seasoning in Ringer's solution that simulates the aggressive environment of the human body and material degradation caused by it. The study also focused on the parameters of quantitative deviation from the recommended proportions of liquid (MMA monomer, accelerator and stabiliser) and powder (PMMA prepolymer and initiator) components, i.e., unintentional inaccuracy of component proportioning at the stage of cement mass preparation. Statistical analysis has shown the influence of these factors on the decrease in compressive strength of the cements studied, which may be of significant importance in operational practice.

Mortality prediction by 'Life Threat Index' compared to widely used trauma scoring systems.

INTRODUCTION AND OBJECTIVE: Injuries are an extremely important problem in public life and account for up to one-third of deaths in the entire human population. Available trauma scoring systems provide a good estimation of mortality; however, some factors affect their utility in daily practice. Therefore, a new easily applicable in any given country trauma scoring system has been developed and proposed in this study. MATERIAL AND METHODS: A retrospective study of the medical records of 485 patients were evaluated, together with diagnostic performance with regard to mortality, was calculated for the Revised Trauma Score (RTS), Injury Severity Score (ISS), The New Injury Severity Score (NISS), Trauma and Injury Severity Score (TRISS), International Classification based Injury Severity Score (ICISS) and the newly-developed Life Threat Index (LTI). Sensitivity, specificity, accuracy, PPV and NPV were calculated for each scoring system, and overall diagnostic performance was estimated with the use of ROC curves. RESULTS: Apart from RTS, all scoring systems showed similar performance regarding mortality prediction. TRISS and LTI showed the highest sensitivity reaching 0.998 and AUC of 0.89 and 0.87, respectively, which proved its usefulness in predicting mortality. CONCLUSIONS: LTI proved to be one of the most sensitive in comparison with widely-used and recognized trauma scoring systems. Based on LTI methodology, it can be applied in any given country or region, even without a previously developed trauma database.

Diagnostics of Articular Cartilage Damage Based on Generated Acoustic Signals Using ANN-Part II: Patellofemoral Joint.

Cartilage loss due to osteoarthritis (OA) in the patellofemoral joint provokes pain, stiffness, and restriction of joint motion, which strongly reduces quality of life. Early diagnosis is essential for prolonging painless joint function. Vibroarthrography (VAG) has been proposed in the literature as a safe, noninvasive, and reproducible tool for cartilage evaluation. Until now, however, there have been no strict protocols for VAG acquisition especially in regard to differences between the patellofemoral and tibiofemoral joints. The purpose of this study was to evaluate the proposed examination and acquisition protocol for the patellofemoral joint, as well as to determine the optimal examination protocol to obtain the best diagnostic results. Thirty-four patients scheduled for knee surgery due to cartilage lesions were enrolled in the study and compared with 33 healthy individuals in the control group. VAG acquisition was performed prior to surgery, and cartilage status was evaluated during the surgery as a reference point. Both closed (CKC) and open (OKC) kinetic chains were assessed during VAG. The selection of the optimal signal measures was performed using a neighborhood component analysis (NCA) algorithm. The classification was performed using multilayer perceptron (MLP) and radial basis function (RBF) neural networks. The classification using artificial neural networks was performed for three variants: I. open kinetic chain, II. closed kinetic chain, and III. open and closed kinetic chain. The highest diagnostic accuracy was obtained for variants I and II for the RBF 9-35-2 and MLP 10-16-2 networks, respectively, achieving a classification accuracy of 98.53, a sensitivity of 0.958, and a specificity of 1. For variant III, a diagnostic accuracy of 97.79 was obtained with a sensitivity and specificity of 0.978 for MLP 8-3-2. This indicates a possible simplification of the examination protocol to single kinetic chain analyses.

Diagnostics of Articular Cartilage Damage Based on Generated Acoustic Signals Using ANN-Part I: Femoral-Tibial Joint.

Osteoarthritis (OA) is a chronic, progressive disease which has over 300 million cases each year. Some of the main symptoms of OA are pain, restriction of joint motion and stiffness of the joint. Early diagnosis and treatment can prolong painless joint function. Vibroarthrography (VAG) is a cheap, reproducible, non-invasive and easy-to-use tool which can be implemented in the diagnostic route. The aim of this study was to establish diagnostic accuracy and to identify the most accurate signal processing method for the detection of OA in knee joints. In this study, we have enrolled a total of 67 patients, 34 in a study group and 33 in a control group. All patients in the study group were referred for surgical treatment due to intraarticular lesions, and the control group consisted of healthy individuals without knee symptoms. Cartilage status was assessed during surgery according to the International Cartilage Repair Society (ICRS) and vibroarthrography was performed one day prior to surgery in the study group. Vibroarthrography was performed in an open and closed kinematic chain for the involved knees in the study and control group. Signals were acquired by two sensors placed on the medial and lateral joint line. Using the neighbourhood component analysis (NCA) algorithm, the selection of optimal signal measures was performed. Classification using artificial neural networks was performed for three variants: I-open kinetic chain, II-closed kinetic chain, and III-open and closed kinetic chain. Vibroarthrography showed high diagnostic accuracy in determining healthy cartilage from cartilage lesions, and the number of repetitions during examination can be reduced only to closed kinematic chain.

Evaluation of the Effect of Selected Physiological Fluid Contaminants on the Mechanical Properties of Selected Medium-Viscosity PMMA Bone Cements.

Revision surgeries several years after the implantation of the prosthesis are unfavorable from the patient's point of view as they expose him to additional discomfort, to risk of complications and are expensive. One of the factors responsible for the aseptic loosening of the prosthesis is the gradual degradation of the cement material as a result of working under considerable loads, in an aggressive environment of the human body. Contaminants present in the surgical field may significantly affect the durability of the bone cement and, consequently, of the entire bone-cement-prosthesis system. The paper presents the results of an analysis of selected mechanical properties of two medium-viscosity bone cements DePuy CMW3 Gentamicin and Heraeus Palamed, for the samples contaminated with saline and blood in the range of 1-10%. The results obtained for compressive strength and modulus of elasticity were subjected to statistical analysis, which estimated the nature of changes in these parameters depending on the amount and type of contamination and their statistical significance.

Highly Porous Fluorapatite/ß-1,3-Glucan Composite for Bone Tissue Regeneration: Characterization and In-Vitro Assessment of Biomedical Potential.

A novel fluorapatite/glucan composite ("FAP/glucan") was developed for the treatment of bone defects. Due to the presence of polysaccharide polymer (ß-1,3-glucan), the composite is highly flexible and thus very convenient for surgery. Its physicochemical and microstructural properties were evaluated using scanning electron microscopy (SEM), Fourier transform infrared spectroscopy (FTIR), mercury intrusion, mechanical testing and compared with the reference material, which was a hydroxyapatite/glucan composite ("HAP/glucan") with hydroxyapatite granules (HAP) instead of FAP. It was found that FAP/glucan has a higher density and lower porosity than the reference material. The correlation between the Young's modulus and the compressive strength between the materials is different in a dry and wet state. Bioactivity assessment showed a lower ability to form apatite and lower uptake of apatite-forming ions from the simulated body fluid by FAP/glucan material in comparison to the reference material. Moreover, FAP/glucan was determined to be of optimal fluoride release capacity for osteoblasts growth requirements. The results of cell culture experiments showed that fluoride-containing biomaterial was non-toxic, enhanced the synthesis of osteocalcin and stimulated the adhesion of osteogenic cells.

Leiomyoma as a case of renal tumor.

Leiomyoma is a benign tumor originate from mesenchymal or connective tissue. Because of a low incidence, difficulties in differentiation from other renal tumors with imaging modalities, the definitive diagnosis of a leiomyoma is possible after examination of a specimen. We present a case of 79-years-old women with incidentally discovered renal tumor in CT scan. Because of the small size of a tumor, patient was informed about possibility of active surveillance. Partial nephrectomy was performed with a histopathologic diagnosis of renal leiomyoma. After 6 months of a follow-up, patient is found to be asymptomatic and free of disease.

Social Prestige of the Paramedic Profession.

BACKGROUND: There is a lack of research on social image, prestige, and the position of the paramedic profession in the social structure. The main objective of the study was to determine the place of the paramedic profession in the hierarchy of prestige of professions as viewed by the public. In operationalizing the term 'prestige', we deemed the word 'respect' to best fit the sense of the subjective evaluation of prestige with regard to a profession. MATERIAL AND METHODS: The data comes from cross-sectional survey-based research. The research was carried out on a group of 600 people over 18 years of age. The sample was of a random nature, and the selection of respondents was calculated on the basis of them being representative of the Polish population. RESULTS: The median of respect declared for the paramedic profession, on a scale of 1 to 5, was 4.49, which placed the profession in fourth place in the ranking. The assessment of respect for paramedics among other medical professions placed them in third place, directly after doctors and midwifes. CONCLUSIONS: The profession of paramedic is characterized by high social prestige, locating it at the forefront of the medical profession and other examined professions, but its social position, expressed by objective measures (earnings, structural possibilities, social power), is significantly lower.

Factors with the strongest prognostic value associated with in-hospital mortality rate among patients operated for acute subdural and epidural hematoma.

INTRODUCTION: Traumatic brain injury (TBI) still remains a serious health problem and is called a "silent epidemic". Each year in Europe 262 per 100,000 individuals suffer from TBI. The most common consequence of severe head injuries include acute subdural (SDH) and epidural hematomas (EDH), which usually require immediate surgically treatment. The aim of our study is to identify factors which have the strongest prognostic value in relation to in-hospital mortality rate among of patients undergoing surgery for EDH and SDH. PATIENTS AND METHODS: Cohort included 128 patients with isolated craniocerebral injuries who underwent surgery for EDH (28 patients) and SDH (100 patients) in a single, tertiary care Department of Neurosurgery. The data were collected on admission of patients to the Emergency Department and retrospectively analyzed. The following factors were analyzed: demographic data, physiological parameters, laboratory variables, computed tomography scan characteristics and the time between trauma and surgery. Likewise, we have investigated the in-hospital mortality of patients at the time of discharge. RESULTS: We found that the factors with the strongest prognostic values were: the initial GCS score, respiratory rate, glycaemia, blood saturation, systolic blood pressure, midline shift and type of hematoma. Additionally, we proved that a drop by one point in the GCS score almost doubles the risk of in-hospital death while the presence of coagulopathy increases the risk of in-hospital death almost six times. CONCLUSION: Most of the factors with the strongest prognostic value are factors that the emergency team can treat prior to the hospital admission. Coagulopathy, however that has the strongest influence on in-hospital death rate can only be efficiently treated in a hospital setting.

Fluorapatite ceramics for bone tissue regeneration: Synthesis, characterization and assessment of biomedical potential.

Calcium phosphates, due to their similarity to the inorganic fraction of mineralized tissues, are of great importance in treatment of bone defects. In order to improve the biological activity of hydroxyapatite (HAP), its fluoride-substituted modification (FAP) was synthesized using the sol-gel method and calcined at three different temperatures in the range of 800-1200 °C. Physicochemical and biological properties were evaluated to indicate which material would support bone regeneration the best. X-ray diffraction (XRD), scanning electron microscopy (SEM) with energy dispersive X-ray spectrometry (EDS), and Fourier transform infrared spectroscopy (FTIR) revealed that fluoride ions were incorporated into the apatite lattice structure. In studies it was found that fluorapatite sintered at the highest temperature had the lowest porosity, no internal pores and the highest density. In vitro ion reactivity assessments showed that during the 28-day immersion of the samples in the simulated body fluid, the uptake of calcium and phosphorus ions was inversely correlated to the calcination temperature. All tested materials were non-toxic since the cytotoxicity MTT assay demonstrated that the viability of preosteoblast cells incubated with sample extracts was high. Fluorapatite sintered at 800 °C was determined to be of optimal porosity and fluoride release capacity and then used in cell proliferation studies. The results showed that it significantly shortened the doubling time and thus enhanced the proliferation of osteogenic cells, as compared to the fluoride solutions and control group. Therefore, this material is proposed for the use in orthopedic applications and bone tissue engineering.

Different regulation of PARP1, PARP2, PARP3 and TRPM2 genes expression in acute myeloid leukemia cells.

BACKGROUND: Acute myeloid leukemia (AML) is a heterogenic lethal disorder characterized by the accumulation of abnormal myeloid progenitor cells in the bone marrow which results in hematopoietic failure. Despite various efforts in detection and treatment, many patients with AML die of this cancer. That is why it is important to develop novel therapeutic options, employing strategic target genes involved in apoptosis and tumor progression. METHODS: The aim of the study was to evaluate PARP1, PARP2, PARP3, and TRPM2 gene expression at mRNA level using qPCR method in the cells of hematopoietic system of the bone marrow in patients with acute myeloid leukemia, bone marrow collected from healthy patients, peripheral blood of healthy individuals, and hematopoietic stem cells from the peripheral blood after mobilization. RESULTS: The results found that the bone marrow cells of the patients with acute myeloid leukemia (AML) show overexpression of PARP1 and PARP2 genes and decreased TRPM2 gene expression. In the hematopoietic stem cells derived from the normal marrow and peripheral blood after mobilization, the opposite situation was observed, i.e. TRPM2 gene showed increased expression while PARP1 and PARP2 gene expression was reduced. We observed positive correlations between PARP1, PARP2, PARP3, and TRPM2 genes expression in the group of mature mononuclear cells derived from the peripheral blood and in the group of bone marrow-derived cells. In AML cells significant correlations were not observed between the expression of the examined genes. In addition, we observed that the reduced expression of TRPM2 and overexpression of PARP1 are associated with a shorter overall survival of patients, indicating the prognostic significance of these genes expression in AML. CONCLUSIONS: Our research suggests that in physiological conditions in the cells of the hematopoietic system there is mutual positive regulation of PARP1, PARP2, PARP3, and TRPM2 genes expression. PARP1, PARP2, and TRPM2 genes at mRNA level deregulate in acute myeloid leukemia cells.

Initial Factors Affecting 6-month Outcome of Patients Undergoing Surgery for Acute Post-traumatic Subdural and Epidural Hematoma.

INTRODUCTION: The most frequent consequences of a traumatic brain injury are acute subdural (SDH) and epidural hematoma (EDH), which usually require a surgical treatment. Most of the factors affecting the prognosis have been analyzed on a wide group of traumatic brain injuries. Nonetheless, there are few studies analyzing factors influencing the prognosis regarding patients with EDH and SDH. The aim of the study is to identify factors which have prognostic value in relation to 6-month outcome of patients undergoing surgery for acute hematoma. PATIENTS AND METHODS: The study included a group of 128 patients with isolated craniocerebral injuries. The patients were divided into two groups, namely a group of 28 patients operated on due to epidural hematoma and a group of 100 patients operated on due to acute subdural hematoma. All patients were operated and treated in the Department of Neurosurgery at the Medical University in Lublin from 1.10.2014 to 31.08.2017. The following factors from the groups were analyzed: demographic data, physiological factors, laboratory factors, computed tomography scan characteristics, and time between the trauma and the surgery. All the factors were correlated with six-month outcome in Glasgow outcome scale. RESULTS: The univariate analysis has confirmed the influence of many factors affecting the outcomes. CONCLUSION: It is interesting that the factors such as GSC score, saturation, respiratory rate, and systolic blood pressure were associated with outcome with highly statistically significant differences in both group. These are factors that, with an appropriate treatment, could be normalized at the place of the accident.

The Initial Factors with Strong Predictive Value in Relation to Six-Month Outcome among Patients Operated due to Extra-Axial Hematomas.

INTRODUCTION: Traumatic brain injuries (TBI) are a real social problem, with an upward trend worldwide. The most frequent consequence of a traumatic brain injury is extra-axial hemorrhage, i.e., an acute subdural (SDH) and epidural hematoma (EDH). Most of the factors affecting the prognosis have been analyzed on a wide group of traumatic brain injuries. Nonetheless, there are few studies analyzing factors influencing the prognosis regarding patients undergoing surgery due to acute subdural and epidural hematoma. The aim of this study was to identify the factors which have the strongest prognostic value in relation to the 6-month outcome of the patients undergoing surgery for SDH and EDH. PATIENTS AND METHODS: The study included a group of 128 patients with isolated craniocerebral injuries. Twenty eight patients were operated upon due to EDH, and a group of 100 patients were operated upon due to SDH. The following factors from the groups were analyzed: demographic data, physiological factors, laboratory factors, computed tomography scan characteristics, and time between the trauma and the surgery. All of these factors were correlated in a multivariate analysis with the six-month outcome in the Glasgow outcome scale. RESULTS: The factors with the strongest prognostic value are GCS score, respiration rate, saturation, glycaemia and systolic blood pressure. CONCLUSION: Initial GCS score, respiratory rate, saturation, glycaemia and systolic blood pressure were the factors with the strongest prognostic value.

Is an emergency department a safer place for hypothermic victims than an ambulance? A comparison of the knowledge of medical personnel concerning hypothermia.

OBJECTIVE: Introduction: Improper initial management of a victim in severe hypothermia is associated with a risk of cardiac arrest. At the same time, an uncontrolled drop in core body temperature in trauma victims is an independent risk factor for mortality. Medical personnel require a thorough understanding of the pathophysiology and treatment of hypothermia. Gaps in this understanding can lead to serious complications for patients. The aim: To compare knowledge concerning hypothermia between medical personnel working in emergency departments (ED) and emergency medical services (EMS). PATIENTS AND METHODS: Materials and methods: A total of 5,362 participants were included in the study. In this study, EMS and ED personnel were encouraged to participate in an e-learning course on hypothermia. Subsequently, the scores of a pre-test, lesson tests and post-test completed by participants of this course were compared. RESULTS: Results: Pre-test scores were significantly higher among personnel working in EMS compared with those working in EDs. Nurses employed in EDs had significantly more failures in completing the course than EMS nurses. The most difficult topics for all practitioners were post-traumatic hypothermia and hypothermia-related clotting disorders. CONCLUSION: Conclusions: EMS personnel have a higher level of knowledge of hypothermia than ED personnel. Moreover, an e-learning course is an effective tool for improving medical personnel's knowledge of hypothermia.

Potential Involvement of BIRC5 in Maintaining Pluripotency and Cell Differentiation of Human Stem Cells.

The BIRC5 gene encodes a survivin protein belonging to class III of inhibitors of apoptosis, IAP. This protein serves a dual role. First, it regulates cell death, and second, it is an important regulator of mitosis progression, although its physiological regulatory function has not been fully understood. Many studies have shown and confirmed that survivin is practically absent in mature tissues in nature, while its overexpression has been reported in many cancerous tissues. There is little information about the significance of BIRC5 expression in normal adult human stem cells. This paper presents the study and analysis of survivin expression at the transcription level using qPCR method, in hematopoietic stem cells from peripheral blood mobilized with a granulocyte growth factor, adherent cells derived from the umbilical cord, and normal bone marrow stem cells. The expression of this gene was also examined in the blood of normal healthy individuals. The results of the analysis have shown that the more mature the cells are, the lower the expression of the BIRC5 gene is. The lowest expression has been found in peripheral blood cells, while the highest in normal bone marrow cells. The more the CD34+ and CD105 cells in the tested material are, the higher the BIRC5 expression is. Stem cells from cell culture show higher BIRC5 expression. The study confirms the involvement of BIRC5 from the IAP family in many physiological processes apart from apoptosis inhibition. The possible effect of BIRC5 on cell proliferation; involvement in cell cycle, cell differentiation, survival, and maintenance of stem cells; and the possible effect of IAP on the antineoplastic properties of mesenchymal stem cells have been demonstrated. Our research suggests that BIRC5 may be responsible for the condition of stem cell pluripotency and its high expression may also be responsible for the dedifferentiation of tumor cells.