External quality monitoring facilitates improvement in already well-performing stroke units: insights from RES-Q Poland.

INTRODUCTION: The Registry of Stroke Care Quality (RES-Q) is used in Poland for quality monitoring by numerous hospitals participating in the Angels Initiative. Our aim was to assess the degree of improvement in highly stroke-oriented centres that report cases to the RES-Q each year. MATERIAL AND METHODS: This retrospective analysis included Polish stroke units that from January 2017 to December 2020 contributed to the RES-Q at least 25 patients annually. RESULTS: Seventeen out of 180 Polish stroke units reported patients each year (2017, n = 1,691; 2018, n = 2,986; 2019, n = 3,750; 2020, n = 3,975). The percentage of ischaemic stroke patients treated with alteplase remained stable (26%, 29%, 30% and 28%, respectively). The door-to-needle time progressively decreased, from a median 49 minutes to 32 minutes. The percentage of patients treated ≤ 60 minutes and ≤ 45 minutes significantly increased (from 68% to 86% and from 43% to 70%, respectively), with no change observed between 2019 and 2020. Despite a general improvement in dysphagia screening (81%, 91%, 98% and 99%), screening performed within the first 24h from admission became less frequent (78%, 76%, 69% and 65%). In-hospital mortality significantly increased (11%, 11%, 13% and 15%), while the proportion of patients discharged home remained stable. CONCLUSIONS: Quality-oriented projects facilitate the improvement of stroke care, even in centres demonstrating good baseline performance. Polish stroke units that consistently reported cases to the RES-Q demonstrated improvement in terms of door-to- -needle time and dysphagia screening. However, there is still a need to shorten the time to dysphagia screening, and carefully monitor stroke unit mortality following the COVID-19 pandemic.

Sense of happiness in Polish patients with multiple sclerosis.

INTRODUCTION: Happiness is crucial to patient well-being and their acceptance of their disease. The aim of this study was to assess the sense of happiness in persons with multiple sclerosis (PwMS), compare it to the level of happiness in patients with other neurological conditions, and determine which factors affect the sense of happiness in PwMS. MATERIAL AND METHODS: Five hundred and eighty-nine PwMS and 145 control subjects (post-stroke patients with chronic pain syndromes and neuropathies) were included in the study. Due to the differences between the groups in terms of demographic variables, an adjusted group of PwMS (n = 145) was selected from the entire group of PwMS. All patients were assessed using the Oxford Happiness Questionnaire (OHQ), the Satisfaction with Life Scale (SLS), and the Family APGAR Questionnaire. Based on regression analysis, the study examined which variables affected the level of happiness in the groups. RESULTS: Analysis of the OHQ scores showed that PwMS had a lower sense of happiness compared to the control group in the overall score [113.21 (25-42) vs. 119.88 (25-49), respectively; p = 0.031] and the subscales (OHQ subscale 1 - 54.52 vs. 57.84, respectively; p = 0.027; subscale 2 - 35.61 vs. 37.67; respectively; p = 0.044). Based on linear regression analysis, life satisfaction (ß = 0.40; p < 0.001), positive orientation (ß = 0.32; p < 0.001), and primary education (ß = 0.08; p = 0.009) were the most significant predictors of a higher level of happiness in PwMS. Similar results were found in the control group. CONCLUSIONS: The sense of happiness in PwMS was lower than in patients with other conditions. The most important factors influencing happiness included life satisfaction and positive orientation. Influencing these predictors should be the aim of psychological interventions, especially in patients with a reduced sense of happiness.

Systemic thrombolysis in ischaemic stroke patients with COVID-19.

OBJECTIVE: Intravenous thrombolysis (IVT) with recombinant tissue plasminogen activator is the core medical therapy of acute ischaemic stroke (AIS). COVID-19 infection negatively modifies acute stroke procedures and, due to its pro-coagulative effect, may potentially impact on IVT outcome. Thus, short-term efficacy and safety of IVT were compared in patients with and without evidence of SARS-CoV-2. METHODS: An observational, retrospective study included 70 patients with AIS, including 22 subjects (31%) with evidence of acute COVID-19 infection, consecutively treated with IVT in 4 stroke centres between 15 September and 30 November 2020. RESULTS: Patients infected with COVID-19 were characterized by higher median of National Institute of Health Stroke Scale (NIHSS) score (11.0 vs. 6.5; p < .01) and D-dimers (870 vs. 570; p = .03) on admission, higher presence of pneumonia (47.8% vs. 12%; p < .01) and lower percentage of 'minor stroke symptoms' (NIHSS 1-5 pts.) (2% vs., 18%; p < .01). Hospitalizations were longer in patients with COVID-19 than in those without it (17 vs. 9 days, p < .01), but impact of COVID-19 infection on patients' in-hospital mortality or functional status on dismission has been confirmed neither in uni- or multivariate analysis. CONCLUSION: SARS-CoV-2 infection prolongs length of stay in hospital after IVT, but does not influence in-hospital outcome.

Elastography as a possible useful method of assessment of skin involvement in systemic sclerosis.

Introduction: Scleroderma (Sc) is a connective tissue disorder associated with internal organ involvement, increased mortality, and unknown pathogenesis. It has been found that the more extensive the skin involvement the more severe internal organ manifestations and increased disability. The Rodnan skin score (RSS) is one of the established methods to examine skin thickness among patients with Sc. Due to RSS limitations, for instance, lack of detection of subclinical changes, a new tool is needed for the evaluation of Sc. In recent studies, shear wave elastography (SWE) has been examined as a potential tool to assess skin involvement through the evaluation of skin strain. Aim: To verify whether elastography is a reliable method to examine Sc progression and possibly provide one useful site to perform the examination - as an easy, cheap, and reliable examination tool. Material and methods: Forty Sc patients were examined, and 28 healthy individuals were recruited for the control group. Among the patients and control group, skin thickness was assessed using the RSS and skin strain measurements using elastography in 20 body locations. Results: SWE in the right-hand finger can be treated as an important diagnostic indicator of the severity of Sc. Conclusions: SWE is a reliable method for evaluating skin involvement among patients with systemic sclerosis (SSc). Right finger measurements correlate positively with Rodnan's results and can be a predictor of the severity of SSc. This study found SWE to be a reliable method for examining SSc progression and possibly one useful site for the examination.

High-resolution ultrasound imaging of skin involvement in systemic sclerosis: a systematic review.

To collect evidence on the application of ultrasound in skin assessment in patients with systemic sclerosis (SSc). The authors carried out a review of the literature via Pubmed MEDLINE database. The search terms were: skin imaging in systemic sclerosis, ultrasound skin imaging in patients with systemic sclerosis. The selection and analysis of articles were performed by two independent evaluators. The authors analyzed 10 studies characterizing 470 patients with systemic sclerosis. The patients were young adults, mainly women. The described methods of ultrasound were: ultrasound elastography (7.14%), ultra-high-frequency (7.14%) and B-mode ultrasonographic imaging (21.43%), high-frequency ultrasonography (21.43%), shear-wave elastography (21.43%) and others (21.43%). Skin measurements reported in the analyzed studies were: skin ultrasound in all studies, skin thickness (8 studies), skin elasticity (5 studies), skin stiffness (2 studies), subcutaneous tissue thickness (1 study). Ultrasound measurements were compared to different types of scales and measurements used in the description of disease progression. Ultrasound may be used in the clinical assessment of skin involvement in SSc. To the best of our knowledge, articles currently reporting the use of ultrasound in skin imaging show interesting ideas and provide basis for further research. Skin involvement in SSc assessed with ultrasound should be compared to skin biopsy. It is necessary to develop guidance for conducting skin measurements using ultrasound in patients with scleroderma. Currently, skin imaging in SSc is of limited clinical use due to a variety of methods and the lack of a standard operating procedure. The authors of analyzed studies suggested that high-frequency ultrasound provided a quantitative and reliable evaluation of dermal thickness in patients with SSc.

Cerebral microbleeds in neurological practice: concepts, diagnostics and clinical aspects.

INTRODUCTION: Due to the widespread use of magnetic resonance imaging (MRI) in neurological diagnostics, the number of patients detected as having cerebral microbleeds (CMBs) continues to increase. However, their clinical impact still remains controversial, especially the question of whether CMBs significantly increase the risk of life-threatening intracerebral haemorrhage (ICH) in patients undergoing intravenous thrombolysis (IVT) or endovascular thrombectomy (EVT), or in patients on anticoagulant therapy or statins. STATE OF THE ART: The term 'CMB' is a radiological concept that aims to illustrate microscopic pathology of perivascular hemosiderin deposits corresponding most probably to small foci of past bleeding. MRI images in sequence T2*-GRE and susceptibility-weighted imaging (SWI) are used for a diagnosis of a CMB. This review summarises the current knowledge regarding the definition, prevalence, genetics, risk factors, radiological diagnosis and differential diagnosis of a CMB. We discuss its role as an indicator of future ischaemic or haemorrhagic events in high risk patients or those on antiplatelet or anticoagulant therapy, and its prognostic value for reperfusion strategies and for the development of dementia. FUTURE DIRECTION: The place of CMBs in current guidelines is explored herein. It must be emphasised that the recommendations relating to CMBs are expert opinions. Therefore, at the end of this review, we pose a number of questions that future clinical trials should answer.

Clinical course and outcome of SARS-CoV-2 infection in multiple sclerosis patients treated with disease-modifying therapies - the Polish experience.

INTRODUCTION: The aim of this study was to report the course and outcome of SARS-CoV-2 infection in multiple sclerosis (MS) patients treated with disease-modifying therapies (DMTs) in Poland. A major concern for neurologists worldwide is the course and outcome of SARS-CoV-2 infection in patients with MS treated with different DMTs. Although initial studies do not suggest an unfavourable course of infection in this group of patients, the data is limited. MATERIALS AND METHODS: This study included 396 MS patients treated with DMTs and confirmed SARS-CoV-2 infection from 28 Polish MS centres. Information concerning patient demographics, comorbidities, clinical course of MS, current DMT use, as well as symptoms of SARS-CoV-2 infection, need for pharmacotherapy, oxygen therapy, and/or hospitalisation, and short-term outcomes was collected up to 30 January 2021. Additional data about COVID-19 cases in the general population in Poland was obtained from official reports of the Polish Ministry of Health. RESULTS: There were 114 males (28.8%) and 282 females (71.2%). The median age was 39 years (IQR 13). The great majority of patients with MS exhibited relapsing-remitting course (372 patients; 93.9%). The median EDSS was 2 (SD 1.38), and the mean disease duration was 8.95 (IQR 8) years. Most of the MS patients were treated with dimethyl fumarate (164; 41.41%). Other DMTs were less frequently used: interferon beta (82; 20.70%), glatiramer acetate (42; 10.60%), natalizumab (35;8.84%), teriflunomide (25; 6.31%), ocrelizumab (20; 5.05%), fingolimod (16; 4.04), cladribine (5; 1.26%), mitoxantrone (3; 0.76%), ozanimod (3; 0.76%), and alemtuzumab (1; 0.25%). The overall hospitalisation rate due to COVID-19 in the cohort was 6.81% (27 patients). Only one patient (0.3%) died due to SARS-CoV-2 infection, and three (0.76%) patients were treated with mechanical ventilation; 106 (26.8%) patients had at least one comorbid condition. There were no significant differences in the severity of SARS-CoV-2 infection regarding patient age, duration of the disease, degree of disability (EDSS), lymphocyte count, or type of DMT used. CONCLUSIONS AND CLINICAL IMPLICATIONS: Most MS patients included in this study had a favourable course of SARS-CoV-2 infection. The hospitalisation rate and the mortality rate were not higher in the MS cohort compared to the general Polish population. Continued multicentre data collection is needed to increase the understanding of SARS-CoV-2 infection impact on the course of MS in patients treated with DMTs.

Familial localized scleroderma with paediatric onset: a review.

Localized scleroderma is an inflammatory disease causing sclerosis of the skin. The aetiology and pathogenesis of localized scleroderma remain unclear. Localized scleroderma is considered a genetically driven disease. It is not well understood if genetic factors or environmental exposure individually can cause its development or if their interaction is needed to trigger the disease. Some authors postulate that familial clustering is evidence of a hereditary disease. Familial localized scleroderma has been rarely reported and is a case worth studying. We present the review of literature on this subject with 3 additional cases of familial localized scleroderma with paediatric onset.

How to perform high ultrasound examination of skin involvement among patients with systemic sclerosis - proposition of a unified protocol.

INTRODUCTION: A fast and cheap method of skin assessment in systemic sclerosis (SSc) is an area of extensive research. Established in 1979, the Rodnan skin score is a palpation-based method used among clinicians. This method has some limitations, such as: examiner's skills, subjective results, and no standardization. In the last few years researchers have been exploring ultrasound-based techniques as a possible tool for skin assessment among patients with SSc. The aim of the study is to develop a protocol of elastography-based skin imaging evaluation among patients with SSc. MATERIAL AND METHODS: Review of the literature and own experience. RESULTS: Proposition of elastography-based skin imaging protocol among patients with SSc. CONCLUSIONS: The authors present a potential protocol of ultrasound-based examination of skin involvement among patients with SSc.

Applicability of shear wave elastography for the evaluation of skin strain in systemic sclerosis.

The assessment of skin fibrosis is vital for the diagnosis and monitoring of treatment in the systemic sclerosis (SSc)-a severe autoimmune disease. The elastography is a technique of skin fibrosis assessment through the evaluation of skin strain. We compared the efficacy of the shear wave elastography (SWE) and commonly used modified Rodnan skin score (RSS) in skin fibrosis assessment in SSc. The study included 40 SSc patients and 28 healthy individuals, with the exclusion of individuals with other skin/autoimmune diseases. Skin thickness using RSS and skin strain using SWE were assessed in the same 20 body localizations. Subjects' informed consent and the bioethics committee approval were obtained. Elastographic skin strain correlated positively with both partial and overall RSS values, with strong positive correlation (r ≥ 0.75) for hands and fingers localizations in particular. In SSc patients with normal RSS values, the elastographic strain was significantly higher than in healthy controls. Elastographic strain of fingers' skin evaluated in SWE is highly accurate for distinguishing SSc patients (sensitivity 0.897-0.923, specificity 0.929-0.964, positive predictive value 0.946-0.973, negative predictive value 0.867-0.900). ESW results are substantially more reproducible than those of RSS examination (intraclass correlation coefficients: 0.987 vs. 0.941). The shear wave elastography is more reproducible and has higher sensitivity than RSS in the evaluation of skin condition in SSc, especially in case of changes non-detectable on physical evaluation, indicating it might become a useful tool in SSc diagnosis.

Sex-related differences among ischaemic stroke patients treated with intravenous thrombolysis in Poland.

AIM OF STUDY: We investigated sex differences i n i schaemic s troke p atients t reated w ith i ntravenous a lteplase. CLINICAL RATIONALE FOR STUDY: We suggest that it is necessary to improve care for women with atrial fibrillation. Our data suggests that closer evaluation of treatment for ischaemic stroke in men and women is needed, preferably in the form of a prospective study. MATERIALS AND METHODS: This was a multicentre analysis of 1,830 ischaemic stroke patients treated with alteplase from 2004 to 2012. Data was prospectively collected in the Safe Implementation of Treatments in Stroke (SITS) registry. The main outcome measures were symptomatic intracerebral haemorrhage (sICH) within 36 hours of treatment, three months of functional independence, and mortality. RESULTS: Women were significantly older (mean age 71.3 vs 66.2 years; p < 0.01), more often suffered from hypertension (78.3% vs 70.1%; p < 0.01) and cardio-embolic strokes (34.7% vs 27.1%; p < 0.01), and presented heavier baseline deficits. There were no differences in sICH, but after three months fewer women were functionally independent (46.5% vs 53.3%; p < 0.01) and women had higher mortality (26.0% vs 19.7%; p < 0.01). CONCLUSIONS: Of the ischaemic stroke patients treated with intravenous thrombolysis, women had worse long-term outcomes than men. This discrepancy may be explained by the older age and higher proportion of cardio-embolic strokes with more severe baseline deficits. However, multiple logistic analysis did not show that sex itself had an impact on the greater mortality in women after a stroke, or on the poorer prognosis.

Real-world effectiveness of abobotulinumtoxinA (Dysport®) in adults with upper limb spasticity in routine clinical practice: an observational study.

AbobotulinumtoxinA (aboBoNT-A, Dysport®) is used in clinical practice as a well-tolerated and effective therapy for muscle spasticity. AboBoNT-A has been shown to reduce upper and lower limb spastic paresis in clinical trials, demonstrating improvements in muscle tone and limb function. This open-label, multicentre, observational, non-interventional study was the first to investigate aboBoNT-A's efficacy in adult patients with upper limb spasticity (ULS) in routine clinical practice in Poland. All enrolled patients received ≥1 aboBoNT-A injection cycles, per routine clinical practice (full analysis set, FAS), and ≥1 rehabilitation session. Patients attended a baseline visit (V1) and two follow-up visits (V2, V3) for retreatment, depending on the investigator's assessment of individual patient needs, with a mean interval (SD) between injections of 4.4 (1.4) and 4.5 (1.2) months. The primary effectiveness endpoint was patient- and physician-based evaluation using the Clinical Global Impression-Improvement Scale (CGII), a validated 7-point scale (1 = very much improved to 7 = very much worse) relative to baseline. CGI-I has not previously been used as a primary endpoint in studies evaluating ULS. Secondary endpoints included muscle tone in shoulder, elbow, carpal joint, and finger muscles, measured by the Modified Ashworth Scale (MAS), and muscle strength according to the Medical Research Council scale (MRC). Of 108 enrolled patients (FAS), 92 (85.2%) completed the study and 57 (52.8%) were included in the per protocol (PP) population. AboBoNT-A improved patient conditions in 96.4% and 98.6% at V2 and V3 (investigator assessment) and 92.8% and 98.6% (as reported by patient) of patients, respectively. Significant reductions in muscle tone from baseline were observed at both visits (p < 0.0001-0.0077) across muscle groups. Increased muscle strength by cumulative MRC was observed at V2 (p = 0.0566) and V3 (p = 0.0282) versus baseline. Safety was consistent with the known profile of aboBoNT-A. In conclusion, aboBoNT-A treatment is beneficial in patients with post-stroke ULS in routine clinical practice, assessed by patients and investigators.

Systemic sclerosis - multidisciplinary disease: clinical features and treatment.

Systemic sclerosis is a chronic autoimmune disease of still not fully understood pathogenesis. Fibrosis, vascular wall damage, and disturbances of innate and acquired immune responses with autoantibody production are prominent features. Systemic sclerosis has specific subsets with different autoantibodies, and differences in the affected skin areas. The suspicion of systemic sclerosis and establishing the diagnosis will be facilitated by the criteria created by EULAR/ACR experts. The treatment of this autoimmune disease remains a challenge for clinicians and new therapeutic options are constantly sought. The occurrence of various symptoms and the involvement of many organs and systems make systemic sclerosis a multidisciplinary disease and require a holistic approach. The present article summarizes different clinical features of systemic sclerosis and the profile of autoantibodies and discusses recent rules and future perspectives in disease management.

Cerebral thrombolysis in patients with ischemic stroke and heart failure.

BACKGROUND: Heart failure (HF) is common among patients with ischemic stroke (IS), however its impact on outcome after iv-thrombolysis has not been fully determined. Moreover, definition of HF has been recently modified, but majority of stroke studies classified patients regarding an old HF criteria. Thus, the aim of our study was to evaluate the relationship between both, newly and formerly defined HF and the long-term outcome, mortality and the presence of hemorrhagic complications in patients with acute IS treated with iv-thrombolysis. METHODS: We retrospectively evaluated data from 328 Caucasian patients with IS consecutively treated with iv-thrombolysis. HF was defined according to old and new definition; long-term outcome was assessed with modified Rankin Scale (mRS) score and mortality rate on 90th days after IS. RESULTS: The incidence of HF did not differ between patients with favorable (mRS 0-2) and unfavorable (mRS 3-6) functional outcome respectively for the old and for the new definition (10.4% vs. 15.5, p = 0.17; 17.4% vs. 18.1%, p = 0.88) and between those who survived and died within 90 days after IS (11.7% vs. 20.0%, p = 0.27; 17.2% vs. 25.0%, p = 0.38, respectively). Multivariate analysis showed no impact of HF diagnosis on outcome (p = 0.94) or mortality (p = 0.64). CONCLUSION: The presence of systolic HF, defined according to an old and a new definition, does not determine safety and efficacy of cerebral iv-thrombolysis in patients with IS.

Psoriasis in special localizations.

Psoriasis is a chronic inflammatory dermatosis affecting 1-3% of the general population. Patients with psoriasis represent a heterogeneous population with individual disease expression - different degrees and severity of skin involvement. Psoriatic lesions in particular localizations such as the face, scalp, intertriginous or palmoplantar areas significantly reduce quality of life. Patients often feel ashamed, embarrassed, or self-conscious about their symptoms. Furthermore, genital psoriasis significantly affects sexual health. Among patients with psoriasis, the prevalence of special localizations is estimated to be 23-27% on the nails, 49% on the face, 12-16% on the palms and soles, and up to 36% in intertriginous regions. Due to peculiar features of skin in these areas, adequate and specific management is required, which is discussed in this review.

Increasing prevalence and incidence of multiple sclerosis in Poland.

Epidemiologic data on multiple sclerosis (MS) in Poland are limited. Our objectives were to assess a mean annual incidence rate, and MS prevalence on December 31, 2015 in the Swietokrzyskie province (central Poland). We analyzed data of 1525 patients, collected in the Polish Multiple Sclerosis Registry. On December 31, 2015, overall crude prevalence of MS was not less than 121.3/100,000 (95% CI, 114.6-128.4). Significantly higher prevalence was recorded in females (167.1; 95% CI, 155.6-179.1) than in males (73.2; 95% CI, 64.2-82.6; P<0.001). The age-adjusted prevalence standardized to the European standard population was 114.2/100,000 (95% CI, 106.2-121.5). The female-male ratio was 2.4:1. The mean annual incidence was 4.5/100,000 (95% CI, 3.8-5.2). Increased MS prevalence and incidence compared to 2010 and previous studies from Poland confirmed that central Poland is a high risk area for MS.

Nail involvement in psoriatic arthritis.

Nail psoriasis is considered a significant psychological and social problem causing functional impairment in affected patients. Nail changes hamper their daily and occupational activities and contribute to a worse quality of life. Almost 50% of patients with psoriasis vulgaris and up to 80% of patients with psoriatic arthritis are afflicted with nail lesions. The important correlation between psoriatic arthritis and nail changes is well established - the presence of the latter is a strong predictor of the development of arthritis. There is a broad spectrum of nail dystrophies associated with psoriasis, ranging from the common pitting, subungual hyperkeratosis and loosening of the nail plate to less frequent discolouration and splinter haemorrhages. Some of these symptoms are also observed in other nail diseases, and further diagnostics should be performed. The assessment tools NAPSI (Nail Psoriasis Severity Index), mNAPSI (Modified Nail Psoriasis Severity Index), and PNSS (Psoriasis Nail Severity Score) are most commonly used to grade the severity of nail involvement in psoriasis and enable the evaluation of therapy effectiveness. The treatment of nail psoriasis is a major clinical challenge. It should be adjusted to the extent of dermal, articular and ungual lesions. Systemic therapies of psoriasis, especially biological agents, are most likely to be effective in treating nail psoriasis. However, as their use is limited in scope and safety, topical therapy remains a mainstay, and the combination of corticosteroids and vitamin D3 analogues is considered to be most helpful.

Prevalence and incidence of multiple sclerosis in central Poland, 2010-2014.

BACKGROUND: Comprehensive epidemiologic data for multiple sclerosis (MS) in Poland are limited. The aim of this cross-sectional population-based study was to determine the incidence and prevalence of MS in the Swietokrzyskie Region (central Poland). METHODS: This study identified MS cases every year between 1 January 2010 and 31 December 2014. The study area population on the prevalence day (December 31, 2014) was 1,263,176 (646,506 women and 616,670 men). A total of 1462 patients with a clinically definite diagnosis of MS according to McDonald's criteria (2005), recorded in the Polish Multiple Sclerosis Registry, were considered for estimation of crude, age- and sex-specific prevalence, and incidence. RESULTS: The overall crude prevalence rate of confirmed MS patients was 115.7/100,000 (95 % confidence interval (CI), 111.2-121.4). A significantly higher prevalence was recorded in females (159.6/100,000; 95 % CI, 151.1-165.3) than in males (69.7/100,000; 95 % CI, 62.4-77.3) (P < 0.001). Age-adjusted rates for the Polish and European Standard Population were 109.8/100,000 (95 % CI, 105.4-114.8) and 106.6/100,000 (95 % CI, 101.1-111.2), respectively. The female/male ratio was 2.4. The mean annual incidence was 4.2/100,000 (95 % CI. 3.7-4.4). CONCLUSION: The incidence and prevalence of MS in the Swietokrzyskie region confirm that central Poland is a high risk area for MS. Compared with previous epidemiologic studies from Poland, the prevalence of MS has increased during recent years.

Aerosol optical properties in Northern Norway and Svalbard.

We present comparisons between estimates of the aerosol optical thickness and the Ångström exponent in Northern Norway and Svalbard based on data from AERONET (Aerosol Robotic Network) stations at Andenes (69.28°N, 16.01°E, 379 m altitude) and Hornsund (77.00°N, 15.56°E, 10 m altitude) for the period 2008-2013. The five/six-year annual mean values for the aerosol optical thickness at 500 nm τ(500) at Andenes and Hornsund both were 0.09. At Hornsund, there was less variation of the monthly mean value of τ(500) than at Andenes. The annual mean values of the Ångström exponent α at Andenes and Hornsund were 1.29 and 1.34, respectively. At Andenes and Hornsund α was found to be larger than 1.1 in 68% and 84% of the observations, respectively, indicating that fine-mode particles were dominating at both sites. Both sites had a similar aerosol size distribution during summer although one site is in an arctic area while the other site is in a subarctic area.

Intravenous Thrombolysis with Recombinant Tissue-type Plasminogen Activator for Acute Ischemic Stroke in Patients with Metabolic Syndrome.

BACKGROUND: The metabolic syndrome (MetS) is common in patients with acute ischemic stroke (IS); however, its impact on outcome after intravenous thrombolysis (iv-thrombolysis) remains unclear. Thus, we aimed at evaluating the relationship between MetS and functional long-term outcome, mortality, and the presence of hemorrhagic complications in patients with IS treated with iv-thrombolysis. METHODS: We retrospectively evaluated the demographic and clinical data of 535 Caucasian patients with acute IS who were consecutively treated with iv-thrombolysis from September 2006 to June 2013 in 2 experienced stroke centers in Poland. A favorable functional long-term outcome was defined as a modified Rankin scale score less than or equal to 2 points on day 90, and hemorrhagic complications were assessed with European Cooperative Acute Stroke Study criteria. RESULTS: MetS was recognized in 192 (35.9%) patients (44.8% men; mean age, 70.8 ± 11.1 years), diabetes in 29.7%, dyslipidemia in 79.2%, and arterial hypertension in 75.5%. At 3 months, favorable outcome was found in 55.3% of patients, symptomatic intracerebral hemorrhage (SICH) in 18.3%, and 4.4 % of patients died. There was no difference regarding the presence of favorable outcome between patients with and without MetS (52.6% versus 56.9%, P = .34). The presence of SICH and 3-month mortality were more frequent in patients with MetS than without MetS (6.8% versus 2.9%, P = .03 and 23.4% versus 15.5%, P = .02, respectively); however, a multivariate analysis showed no impact of MetS on mortality or SICH. CONCLUSIONS: Results of our study provide no data to suggest that the effect of intravenous tissue-type plasminogen activator differs based on the presence or absence of MetS.