Polish Helicopter Emergency Medical Service (HEMS) Response to Stroke: A Five-Year Retrospective Study.

BACKGROUND A stroke is a serious life-threatening emergency that requires immediate intervention in an appropriate therapeutic center. The aim of this study was to analyze the time of medical procedures at the scene and changes in the state of stroke patients during transport by HEMS in Poland. The presented research is the first nationwide study covering such a large group of stroke patients, for whom aerial support was used in the therapeutic process. MATERIAL AND METHODS A retrospective cross-sectional study of 48553 missions performed by Polish Medical Air Rescue (PMAR) during the 5-year study period resulted in 3906 stroke patients who, after medical rescue operations by HEMS crew, were transported by helicopters to hospitals. RESULTS Helicopters in 3475 (88.97%) cases were utilized as a support for Ground Emergency Medical Service (GEMS). The maximum duration of HEMS operation from activation to patient transfer to the hospital did not exceed 108 min and the median was 60 min. Over 87% of patients with HEMS reported stroke symptoms and arrived at the medical center with the possibility of implementing thrombolytic therapy. The factor that affected the deterioration of patients' condition was the drawing out of the extent of time spent by the crew at the scene. CONCLUSIONS The use of HEMS in Poland in the case of patients with stroke symptoms ensures fast and professional assistance at the site of the medical emergency as well as safe transport to specialized centers, shortening the time of proper treatment implementation.

Soluble tumour necrosis factor receptor I is a promising early indicator of complicated clinical outcome in patients following severe trauma.

Post-traumatic mortality rates are still very high and show an increasing tendency. Early identification of patients at high risk of severe complications has a significant impact on treatment outcomes. The aim of the study was to better understand the early pathological inflammatory response to injury and infection, and to determine the usefulness of the assessment of TNF-α and sTNFR1 concentrations in the peripheral blood as early indicators of severe post-traumatic complications. The study was carried out in a group of 51 patients after trauma, treated in the ED, including 32 patients who met the inclusion criteria for immunological analysis. Patients were divided into two groups using the ISS scale (A ISS ≥ 20, B ISS < 20). The highest TNF-α and sTNFR1 concentrations in both groups were recorded at admission and were significantly higher in group A compared to group B (A vs. B TNF-α 2.46 pg/ml vs. 1.78 pg/ml; sTNFR1 1667.5 pg/ml vs. 875.2 p < 0.005). The concentration of sTNFR1 in patients with severe complications was significantly higher compared to patients without complications and preceded clinical symptoms of complications (C+ vs. C- 1561.5 pg/ml vs. 930.6 pg/ml, p < 0,005). The high diagnostic sensitivity calculated from the ROC curves was found for the concentrations of both cytokines: TNF-α (AUC = 0.91, p = 0.004) and sTNFR1 (AUC = 0.86, p = 0.011). Elevated levels of sTNFR1, determined in the peripheral blood shortly after injury, are significantly associated with the occurrence of later complications, which in some patients lead to death. In contrast, high levels of TNF-α shortly after injury are associated with mortality.

The diagnostic value of early cytokine response in patients after major trauma - preliminary report.

This study was aimed to give a better understanding of the mechanisms of early immune response to trauma by assessing the concentration of cytokines in peripheral blood. The study group comprised 32 patients admitted to the Emergency Department due to injury. Depending on the magnitude of the Injury Severity Score (ISS) trauma patients were divided into two groups. In group A (ISS ≥ 20), 13 patients had complications, and five died, while in group B (ISS < 20) only three patients had complications (e.g. respiratory failure and infections). Depending on the extent of the injury, significant differences were observed in the concentrations of cytokines in the treatment groups. The highest levels of IL-6 and IL-1Ra in both groups were recorded in the third hour of hospitalisation and were considerably higher in group A compared to the concentration of these cytokines in group B (p = 0.001). In patients with complications, IL-6 and IL-1Ra concentrations were significantly higher compared to those without complications. Spearman's rho-correlation showed a statistically significant positive correlation between baseline concentrations of IL-6 (r = 0.64, p < 0.001) and IL-1Ra (r = 0.37, p = 0.042) and the values of the ISS. A high diagnostic sensitivity calculated from ROC curves was found for IL-6 concentrations. In summary, our findings suggest that elevated levels of the cytokines tested, determined in the peripheral blood shortly after injury, may be significantly associated with the occurrence of severe complications, which in some patients can lead to death. Monitoring the levels of these cytokines in patients with a high risk of serious complications should be used routinely.

Usefulness of Pancreas Donor Risk Index and Pre-Procurement Pancreas Allocation Suitability Score: Results of the Polish National Study.

BACKGROUND Pre-procurement pancreas suitability score (P-PASS) and pancreas donor risk (PDRI) index are scoring systems believed to predict suitability of pancreatic grafts. Most European countries and the United States apply PDRI, while Poltransplant keeps using P-PASS: more than 16 points raises a red flag for graft use. Recent data discourage use of PDRI to predict pancreas graft survival. The aim of the present study was to assess PDRI and P-PASS as predictors of transplanted pancreas survival in a Polish population. MATERIAL AND METHODS From February 1998 to September 2015, 407 pancreas transplantations were performed in Poland: 370 (90.9%) simultaneous pancreas-kidney transplantation and 37 (9.1%) pancreas transplantation alone or pancreas after kidney. The endpoint was death-uncensored 12-month graft survival with satisfactory glycemic control without insulin. RESULTS Average P-PASS was 15.9±2.66 and PDRI was 0.96±0.37. Recipients who survived 12 months with good graft function had an average P-PASS score of 15.7 and PDRI of 0.95. Recipients with death-uncensored graft loss had a mean P-PASS of 16.4 and PDRI of 0.99. Univariate analysis revealed donor age, body mass index (BMI), and P-PASS to be significant risk factors for 1-year pancreas graft survival. CONCLUSIONS P-PASS, but not PDRI, is a reliable tool to predict pancreas graft survival in the Polish population.

Formulation and candidacidal activity of magnetic nanoparticles coated with cathelicidin LL-37 and ceragenin CSA-13.

Fungal infections caused by Candida spp. represent an emerging problem during treatment of immunocompromised patients and those hospitalized with serious principal diseases. The ever-growing number of fungal strains exhibiting drug resistance necessitates the development of novel antimicrobial therapies including those based on membrane-permeabilizing agents and nanomaterials as drug carriers. In this study, the fungicidal activities of LL-37 peptide, ceragenin CSA-13 and its magnetic derivatives (MNP@LL-37, MNP@CSA-13) against laboratory and clinical strains of C. albicans, C. glabrata and C. tropicalis were evaluated. These experiments confirm the high anti-fungal activity of these well-characterized agents mediated by their interaction with the fungal membrane and demonstrate elevated activity following immobilization of LL-37 and CSA-13 on the surface of magnetic nanoparticles (MNPs). Furthermore, MNP-based nanosystems are resistant to inhibitory factors present in body fluids and effectively inhibit formation of fungal biofilm. Simultaneously, synthesized nanostructures maintain immunomodulatory properties, described previously for free LL-37 peptide and CSA-13 substrate and they do not interfere with the proliferation and viability of osteoblasts, confirming their high biocompatibility.

Magnetic nanoparticles as a drug delivery system that enhance fungicidal activity of polyene antibiotics.

This study was designed to assess the antifungal/anti-biofilm and hemolytic properties of two polyene antibiotics, amphotericin B (AMF) and nystatin (NYS), attached to the surface of magnetic nanoparticles (MNP) against clinical isolates of Candida species and human red blood cells, respectively. The developed nanosystems, MNP@AMF and MNP@NYS, displayed stronger fungicidal activity than unbound AMF or NYS. Synergistic activity was observed with a combination of polyenes and MNPs against all tested Candida strains. Nanosystems were more potent than unbound agents when tested against Candida strains in the presence of pus, and as agents able to prevent Candida biofilm formation. The observed inactivation of catalase Cat1 in Candida cells upon treatment with the nanosystems suggests that disruption of the oxidation-reduction balance is a mechanism leading to inhibition of Candida growth. The significant decrease of polyenes lytic activity against host cells after their attachment to MNPs surface indicates improvement in their biocompatibility.

Current views on the mechanisms of immune responses to trauma and infection.

According to the World Health Organization, post-traumatic mortality rates are still very high and show an increasing tendency. Disorders of innate immune response that may increase the risk of serious complications play a key role in the immunological system response to trauma and infection. The mechanism of these disorders is multifactorial and is still poorly understood. The changing concepts of systemic inflammatory response syndrome (SIRS) and compensatory anti-inflammatory response syndrome (CARS) early inflammatory response, presented in this work, have been extended to genetic studies. Overexpression of genes and increased production of immune response mediators are among the main causes of multiple organ dysfunction syndrome (MODS). Changes in gene expression detected early after injury precede the occurrence of subsequent complications with a typical clinical picture. Rapid depletion of energy resources leads to immunosuppression and persistent inflammation and immune suppression catabolism syndrome (PICS). Early diagnosis of immune disorders and appropriate nutritional therapy can significantly reduce the incidence of complications, length of hospital stay, and mortality. The study presents the development of knowledge and current views explaining the mechanisms of the immune response to trauma and infection.

The Role of Medical Air Rescue Services in Medical Transport of Organ Recipients in Poland: Organizational Solutions Supporting Transplantation Medicine.

BACKGROUND: The aim of this study was to analyze the use of fixed-wing air ambulance (FWAA) services in Poland during the period 2012-2013, with particular emphasis on air transport of organ recipients to transplantation centers. MATERIAL AND METHODS: This was a retrospective, cross-sectional analysis of data derived from standard FWAA medical documentation. RESULTS: In the years 2012-2013 there were 500 emergency (52.7%) and 447 elective (47.3%) missions. Children who were 1-10 years old comprised the single largest group in both emergency (EM) and elective (EL) missions, accounting for 17% of all flights. EM transports carried mainly patients aged 49-59 (18.5%), and 35.1% of all EM transports concerned patients with end-stage renal disease qualified as organ recipients who were transported to transplantation centers. With a total of 2278 kidney transplantations performed in Poland within the period analyzed, up to 7.8% recipients were transported by air medical services. For EL flights, the most numerous group were patients aged 1-10 (25.4%) and this group comprised mainly patients with congenital disorders (17.9%) and cardiovascular diseases (15.8%). The average flight duration was similar for both EM and EL groups (41.7±10.5 min vs. 40.4±8.7 min, respectively) (p=NS), as was the average distance covered (321.8±99.4 km vs. 310.5±87.4 km, respectively) (p=NS). In the case of patients with end-stage renal disease, the average distance and flight time were significantly longer than those for all other groups in total: 382.5±96.4 km vs. 302.6±87.3 km (p<0.001) and 74.9±10.2 min vs. 39.7±8.8 min (p<0.001), respectively. CONCLUSIONS: The most frequent clinical indication for FWAA transport was end-stage renal disease and most of those flights were carried out as EM. The FWAA service plays a vital role in the organization of pre-transplantation transport to referral centers in Poland. This analysis supports the data for evaluation and potential changes in the Polish distribution and allocation rules for kidney transplantation.

[Rescue procedures in the major trauma of upper extremities - the role of the Polish medical air rescue in the therapeutic process]. / Postepowanie ratunkowe w ciezkich urazach konczyn górnych - rola lotniczego pogotowia ratunkowego w procesie terapeutycznym.

BACKGROUND: Due to the growing use of various types of industrial and agricultural machinery, occupational accidents are among the most serious ones and quite frequently result in the permanent posttraumnatic disability of the injured person. In Poland, a replantation service has been operating since 2010. Each day, one out of six centres provides emergency replantation service accepting amputation calls from across the country. Patients qualified for replantation often need to be transported from places located even several hundred kilometres from the target hospital. MATERIAL AND METHODS: The analysis covered 174 Helicopter Emergency Medical Service (HEMS) missions and 112 interhospital transports. The data were obtained as a result of a retrospective analysis of the air and medical documentation of 23 460 missions carried out by the Polish Medical Air Rescue (Samodzielny Publiczny Zaklad Opieki Zdrowotnej Lotnicze Pogotowie Ratunkowe - SP ZOZ LPR) aircrafts in the years 2011-2013. RESULTS: In the period under study, the Polish Medical Air Rescue helicopters dressed 135 patients with upper extremity amputations at the scene and transported them to hospitals as part of HEMS missions. At the same time, SP ZOZ LPR aircrafts made 102 interhospital transports. Ninety patients were qualified for treatment in replantation service centres. The average air transport time was 76 min, while the total transport time was 172.3 min. With transport exceeding 300 kin, the average time advantage over the ground transport was approximately 1.5 h. CONCLUSIONS: In justified cases, the use of helicopters and airplanes is an optimal method of transporting patients with the major trauma to upper extremities.

Interaction between transplant coordinator and non-heart-beating donor family members.

Thanks to continuous advances in transplantology in Poland, over 1000 patients a year are given a chance for new life or improvement of its quality. The number of identified brain-dead donors increases every year, so is the number of transplanted organs. Unfortunately, despite the substantially improved transplantation system in Poland, the number of patients awaiting organ transplants is markedly higher than the number of donors and still many patients die before the transplantation is possible. In recent years, the worldwide attempts have been made to increase the number of donors to help the largest possible group of patients with end-stage organ failure. One of the options is to re-start non-heart-beating donation. The contact with the family of a potential non-heart-beating donor is crucial for identification, donation and transplantation of organs. Conversations of transplant coordinators with patients' relatives and their information regarding the patient's opinion about organ donation are extremely important for the entire transplantation process.

The early and long term function and survival of kidney allografts stored before transplantation by hypothermic pulsatile perfusion. A prospective randomized study.

BACKGROUND: A prospective evaluation of the influence of methods of kidney storage prior to transplantation on long-term graft function has not been shown so far. A retrospective study undertaken in 415 patients in our department showed the benefit of machine perfusion (MP) on long-term results. The aim of the present study was to assess prospectively the long term function and survival of paired kidney allografts retrieved from the same donor, comparing the influence of cold storage (CS) and MP. MATERIAL/METHODS: 74 recipients included in the study received kidneys from 37 cadaveric donors. Kidneys were randomized to storage by CS or MP. There were no significant differences between the groups as to age, gender, duration of ESRD treatment, PRA titres, HLA compatibility and immunosuppressive regimens. RESULTS: At 10 years follow-up recipients of CS-stored kidneys returned to dialysis treatment twice as frequently as recipients of MP-stored kidneys (50% vs. 25%, p=0.02). CONCLUSIONS: Kidney storage by MP improves graft survival and reduces the number of patients who return to dialysis treatment at long-term post-transplant.

Prognostic significance of free radicals: mediated injury occurring in the kidney donor.

BACKGROUND: Brain death is associated with hemodynamic disturbances in systemic circulation and metabolic storm, and, thus, free radical-mediated injury to donor tissues was hypothesized. An assessment of oxidative stress in the donor and its effect on posttransplant kidney graft function comprised the scope of the study. METHODS: A prospective study was performed in 27 donors and 50 kidney transplant recipients. Sera from 27 brain-dead organ donors and preservation media were tested for malondialdehyde (MDA) and for total antioxidant status (TAS). Kidneys were preserved in University of Wisconsin-gluconate solution with machine perfusion. Mean ischemia time was 36.7+/-8 hours. Organs were transplanted to recipients on the Polish National Waiting List and posttransplant kidney function was monitored periodically. Posttransplant delayed graft function (DF) was diagnosed when a patient required at least one dialysis within first week after transplantation. Acute rejection was diagnosed clinically and confirmed with fine-needle biopsy if necessary. RESULTS: Thirty-two recipients had immediate graft function (IF), and 18 suffered from DF. MDA level in preservation solution at the end of machine perfusion was significantly higher in the DF group (52.6+/-31 vs. 25.3+/-19 micromol/L) whereas donor TAS activity was lower (1.14+/-0.2 vs. 0.97+/-0.3 mmol/mL). Patients who suffered from acute rejection received kidneys from donors with significantly higher serum MDA (66+/-73 micromol/ml vs. 23+/-49 for patients without rejection). Serum creatinine 12 to 48 months after transplantation correlated to donor- and preservation-solution MDA (P<0.006). CONCLUSIONS: Free-radical mediated injury occurring in the donor and during preservation is strictly correlated with immediate and long-term kidney function. It may also cause grafts to be prone to acute rejection.

[Lipid abnormalities in schizophrenia--current knowledge]. / Zaburzenia metabolizmu lipidów w schizofrenii--aktualny stan wiedzy.

Preclinical and clinical data suggest that lipid abnormalities are involved in the pathogenesis of schizophrenia. The arguments in favour of this theory come from assessments of reduced tissue levels of essential fatty acids, altered phospholipases A2 enzyme activity and genetic studies on polymorphisms of their genes, increased brain levels of apolipoproteins D and L, increased turn-over of brain phospholipids in phosphorus-31 magnetic resonance spectroscopy, evaluation of the niacin flush test as a possible diagnostic marker and promising results of treatment trials using supplementation with eicosapentaenoic acid preparations, although some inconsistencies need further examination.