The protective effect of a new absorbent incontinence design against an alkaline pH challenge on the epidermal barrier.

BACKGROUND: Incontinence-associated dermatitis (IAD) is one of the most common complications of incontinence. Improved diaper designs can minimize the occurrence of IAD. PURPOSE: To develop a novel diaper design to minimize the damaging effects of incontinence on the epidermal barrier. METHODS: An optimized diaper design was tested for surface dryness (ie, rewet), maintenance of a skin-adapted surface pH of 5.5, and ability to protect epidermal barrier function from an alkaline pH 10.7 challenge. RESULTS: The diapers released a mean (standard deviation [SD]) of 1.2 (0.2) mg/cm2 of solution under pressure after the first loading and a mean of 2.9 (1.7) mg/cm2 after the second loading. The surface pH remained between 4.5 and 5.5 over 5 hours. In healthy skin, transepidermal water loss (TEWL) increased by a mean of 3.43 (4.67) g/m2/h after the alkaline urine solution challenge with the new diaper design versus a mean of 8.38 (5.67) g/m2/h with a cellulose patch (P < .001) as a control. The mean erythema readings were 1.18 (1.30) g/m2/h for the new design and 2.56 (1.25) g/m2/h for the cellulose patches (P < .001). CONCLUSION: The new diaper design minimizes rewetting, maintains an acidic surface, and protects the epidermal barrier against an alkaline pH challenge. This design may help prevent IAD.

First-in-human study of CPL207280, a novel G-protein-coupled receptor 40/free fatty acid receptor 1 agonist, in healthy volunteers after single and multiple administration.

AIM: To assess the safety, tolerability and pharmacokinetic (PK) profile of single and multiple doses of CPL207280, a new G-protein-coupled receptor 40 agonist developed to treat type 2 diabetes (T2D). METHODS: The phase 1 study in healthy volunteers (White, age 18-55 years, body mass index 18.5-29.9 kg/m2 ) was performed after single (24 subjects, 5-480 mg) and multiple (32 subjects, 60-480 mg) once-daily administration of CPL207280.  The effect of food intake and interaction with metformin were evaluated in additional cohort (12 subjects, 120 mg). The primary objective was the safety and tolerability of CPL207280. Secondary objectives included PK and pharmacodynamic (PD) characteristics (glucose, insulin, C-peptide, proinsulin, glucagon levels) observed during the 14-day treatment period. RESULTS: No deaths or serious adverse events (AEs) were reported. All reported AEs were classified as unrelated to the study product. No clinically significant differences in safety parameters were observed between cohorts and no food or metformin effect on safety parameters was identified. The ascending dose of CPL207280 caused an increase in the PK parameters maximum observed plasma concentration (Cmax ) or area under the plasma concentration-time curve up to 24 h. However, dose-normalized Cmax decreased with ascending dose. There was no relationship between the CPL207280 dose or prandial state and terminal elimination half-life and terminal elimination rate constant. No clear relationship between CPL207280 dose and PD area under the effect curve values was observed. CONCLUSIONS: CPL207280 was found to be safe and well tolerated by healthy volunteers (with a low risk of hepatotoxicity) for up to 14 days of administration. The PK profile of CPL207280 supports single-daily administration and justifies further development of this therapy for patients with T2D.

Regional differences in physicians' behavior and factors influencing the intensity of PCSK9 inhibitor therapy with alirocumab: a subanalysis of the ODYSSEY APPRISE study.

Background: Despite better accessibility of the effective lipid-lowering therapies, only about 20% of patients at very high cardiovascular risk achieve the low-density lipoprotein cholesterol (LDL-C) goals. There is a large disparity between European countries with worse results observed for the Central and Eastern Europe (CEE) patients. One of the main reasons for this ineffectiveness is therapeutic inertia related to the limited access to appropriate therapy and suitable dosage intensity. Thus, we aimed to compare the differences in physicians' therapeutic decisions on alirocumab dose selection, and factors affecting these in CEE countries vs. other countries included in the ODYSSEY APPRISE study. Methods: ODYSSEY APPRISE was a prospective, single-arm, phase 3b open-label (≥12 weeks to ≤30 months) study with alirocumab. Patients received 75 or 150 mg of alirocumab every 2 weeks, with dose adjustment during the study based on physician's judgment. The CEE group in the study included Czechia, Greece, Hungary, Poland, Romania, Slovakia, and Slovenia, which we compared with the other nine European countries (Austria, Belgium, Denmark, Finland, France, Germany, Italy, Spain, and Switzerland) plus Canada. Results: A total of 921 patients on alirocumab were involved [modified intention-to-treat (mITT) analysis], including 114 (12.4%) subjects from CEE countries. Therapy in CEE vs. other countries was numerically more frequently started with lower alirocumab dose (75 mg) at the first visit (74.6 vs. 68%, p = 0.16). Since week 36, the higher dose was predominantly used in CEE patients (150 mg dose in 51.6% patients), which was maintained by the end of the study. Altogether, alirocumab dose was significantly more often increased by CEE physicians (54.1 vs. 39.9%, p = 0.013). Therefore, more patients achieved LDL-C goal at the end of the study (<55 mg/dl/1.4 mmol/L and 50% reduction of LDL-C: 32.5% vs. 28.8%). The only factor significantly influencing the decision on dose of alirocumab was LDL-C level for both countries' groups (CEE: 199.2 vs. 175.3 mg/dl; p = 0.019; other: 205.9 vs. 171.6 mg/dl; p < 0.001, for 150 and 75 mg of alirocumab, respectively) which was also confirmed in multivariable analysis (OR = 1.10; 95% CI: 1.07-1.13). Conclusions: Despite larger unmet needs and regional disparities in LDL-C targets achievement in CEE countries, more physicians in this region tend to use the higher dose of alirocumab, they are more prone to increase the dose, which is associated with a higher proportion of patients reaching LDL-C goals. The only factor that significantly influences decision whether to increase or decrease the dose of alirocumab is LDL-C level.

Adjuvant Effect of Whole-Cell Pertussis Component on Tetanus Toxoid Potency in Murine Model.

There is currently an increasing interest in the development of new-generation purified antigen-based vaccines with a higher safety profile compared to conventional inactivated vaccines. The main problem of subunit vaccines is their lower immunogenicity compared to whole-cell vaccines and inducing weaker and shorter-lasting immune responses. In this paper, the results of the assay of the potency of the tetanus component combined with the diphtheria component and whole-cell pertussis vaccine (DTwP), diphtheria and tetanus vaccine (DT), and in monovalent tetanus vaccine (T) are presented. In the mice model, an adjuvant impact of the whole-cell pertussis component on the immune response against tetanus was observed. It was noticed that the potency of tetanus component in the DTwP vaccine was significantly higher than tetanus potency in DT and T vaccines, despite the same bounding ability unit of the tetanus toxoid in the vaccine formulations. The levels of induction of tetanus antibodies by the tested vaccines were also examined. There were no differences in the induction of humoral responses against tetanus by tested vaccines. This publication discusses the possible mechanisms of impact of the whole-cell pertussis component on the other vaccine antigens and the positive and negative aspects of using the whole-cell pertussis component as an adjuvant.

An observational study of wounds treated with hydro-responsive wound dressings.

OBJECTIVE: Acute and hard-to-heal wounds are a significant burden to both a patient's quality of life and resources in healthcare systems. Here, we evaluate the outcomes of a non-comparative case series study in which Ringer's solution-preactivated polyacrylate dressings were used to treat acute and hard-to-heal wounds (the presence of Ringer's solution provides a wound dressing that allows, upon application, the immediate hydration of the underlying wound tissue). METHOD: Patients with acute and hard-to-heal wounds were enrolled into an open-labelled, non-comparative observational study. Patients were treated with Ringer's solution-preactivated polyacrylate dressings to enable wound debridement and wound cleansing for up to 12 weeks. RESULTS: A total of 303 patients were enrolled in the study and 278 were included in the analysis. Wound size decreased, from a median of 3.6cm2 (interquartile range (IQR): 1.2-9.3] at baseline to a median of 2.6cm2 (IQR: 1.1-7.8] at 84 days. Relative wound area reduction (WAR) was 43.1% at 84 days and estimated probability of achievement of a WAR of ≥40% and ≥60% was 68.7% and 53.4%, respectively. Median time to achieve a WAR of ≥40% and ≥60% was 54 days and 75 days, respectively. The median percentage of wound area covered by fibrin had decreased from 50.0% to 10% and granulation tissue had increased from 25% to 50% after 84 days. In addition, periwound skin condition, local signs of infection and pain all showed improvement. The majority of the wounds were assessed as 'healed' or 'better' at the conclusion of the evaluation period. CONCLUSION: Based on the findings of this study, the use of Ringer's solution-preactivated polyacrylate dressings in daily practice has the potential to improve clinical outcomes, including healing, in patients with acute and hard-to-heal wounds.

Longitudinal Evaluation of Biomarkers in Wound Fluids from Venous Leg Ulcers and Split-thickness Skin Graft Donor Site Wounds Treated with a Protease-modulating Wound Dressing.

Venous leg ulcers represent a clinical challenge and impair the quality of life of patients. This study examines impaired wound healing in venous leg ulcers at the molecular level. Protein expression patterns for biomarkers were analysed in venous leg ulcer wound fluids from 57 patients treated with a protease-modulating polyacrylate wound dressing for 12 weeks, and compared with exudates from 10 acute split-thickness wounds. Wound healing improved in the venous leg ulcer wounds: 61.4% of the 57 patients with venous leg ulcer achieved a relative wound area reduction of ≥ 40%, and 50.9% of the total 57 patients achieved a relative wound area reduction of ≥ 60%. Within the first 14 days, abundances of S100A8, S100A9, neutrophil elastase, matrix metalloproteinase-2, and fibronectin in venous leg ulcer exudates decreased significantly and remained stable, yet higher than in acute wounds. Interleukin-1ß, tumour necrosis factor alpha, and matrix metalloproteinase-9 abundance ranges were similar in venous leg ulcers and acute wound fluids. Collagen (I) α1 abundance was higher in venous leg ulcer wound fluids and was not significantly regulated. Overall, significant biomarker changes occurred in the first 14 days before a clinically robust healing response in the venous leg ulcer cohort.

The usefulness of progression-free survival in surgical treatment of lung metastases.

Introduction: The history of the treatment of neoplastic metastases and its evolution over more than one hundred years has raised many doubts as to the purposefulness of such management. The main problem that made it difficult to draw certain statistically confirmed conclusions was the inability to conduct prospective studies. Over the years, based on the experience gained and the multicenter analyses carried out, it was determined which elements of the surgical treatment affect the prognosis. Some doubts are raised by the issue of the progression of secondary proliferative disease, which results in a greater number of metastasectomies. Aim: To investigate the factors influencing progression-free survival (PFS) after surgical treatment of secondary proliferative disease with lung involvement. This parameter is directly related to the overall survival time. Material and methods: Five hundred and seventy-seven patients treated surgically due to secondary neoplastic disease with lung involvement were included. One-, three- and five-year PFS was examined. PFS was defined as the time from the first to the next metastasectomy or death from any other cause. One-factor and multi-factor statistical analysis was used. Results: Longer PFS was found in patients over 60 years of age, after unilateral and radical metastasectomies, with a longer time from primary tumor resection to secondary lesions (disease-free interval, DFI). The longest PFS was found for colorectal cancer, the shortest for sarcoma. The presence of nodal metastases and gender did not differentiate PFS. Conclusions: The greatest probability of longer relapse-free survival, and thus longer overall survival, occurs in patients after radical unilateral metastasectomy. Another parameter that positively influences PFS is longer DFI. Histological type differentiates PFS.

Safety, tolerability, and efficacy of a widely available nusinersen program for Polish children with Spinal Muscular Atrophy.

Spinal muscular atrophy (SMA) is a devastating neuromuscular disorder with limited treatment options. Nusinersen is the first disease-modifying therapy to treat children and adults with SMA. This study aimed to review the safety, tolerability, and efficacy data of a nusinersen treatment program in Polish children. A total of 298 patients aged from 0 to 18 years were included in the nusinersen treatment program in Poland between March 1 and September 20, 2019. All patients were prospectively followed for at least one year. The mean age at treatment onset was 6.9 years. SMA type 1 symptoms were reported in 127 patients (43.5%), SMA type 2 symptoms in 68 cases (23.3%), and SMA type 3 in 93 patients (31.8%). No patient met the inefficiency criteria defined in the program. One year after treatment initiation, all patients assessed by the CHOP-INTEND scale had improved or remained stable. The mean change in CHOP-INTEND score was an increase of 8.9 points between baseline and after one-year treatment (p < 0.001). Except for 2 fatal cases, not related to the treatment, no serious adverse events were reported. The results of our study indicate that treatment with nusinersen is beneficial for children with SMA regardless of their age, baseline functional status, or the number of SMN2 gene copies. Therapy with nusinersen was effective and well tolerated by patients.

The Prevalence of Acute Respiratory Distress Syndrome (ARDS) and Outcomes in Hospitalized Patients with COVID-19-A Study Based on Data from the Polish National Hospital Register.

Acute respiratory distress syndrome (ARDS) is a serious complication of COVID-19. This study aimed to evaluate the prevalence of ARDS among patients hospitalized with COVID-19 in Poland as well as to characterize clinical outcomes in patients hospitalized with COVID-19-associated ARDS. This is a retrospective, secondary analysis of epidemiological data from 116,539 discharge reports on patients hospitalized with COVID-19 in Poland between March and December 2020. The overall prevalence of ARDS was 3.6%, respectively 2.9% among females, and 4.4% among males (p < 0.001). Of the 4237 patients hospitalized with COVID-19-associated ARDS, 3764 deaths were reported (88.8%). Participants aged 60 years and over had more than three times higher odds of COVID-19-associated ARDS. Men had higher odds of COVID-19-associated ARDS than women (OR = 1.55; 95% CI: 1.45-1.65; p < 0.001). Patients with COVID-19 and diabetes had higher odds of COVID-19-associated ARDS (OR = 1.16; 95% CI: 1.03-1.30; p = 0.01). Among patients with COVID-19-associated ARDS, older age, male sex (OR = 1.27; 95% CI: 1.03-1.56; p = 0.02), and presence of cardiovascular diseases (OR = 1.26; 95% CI: 1.00-1.59; p = 0.048) were significantly associated with the risk of in-hospital death. Among patients hospitalized with COVID-19 in Poland, the prevalence of ARDS was relatively low, but the in-hospital mortality rate in patients with COVID-19-associated ARDS was higher compared to other EU countries.

Data-driven case fatality rate estimation for the primary lineage of SARS-CoV-2 in Poland.

After more than one and a half year since the COVID-19 pandemics outbreak the scientific world is constantly trying to understand its dynamics. In this paper of the case fatality rates (CFR) for COVID-19 we study the historic data regarding mortality in Poland during the first six months of pandemic, when no SARS-CoV-2 variants of concern were present among infected. To this end, we apply competing risk models to perform both uni- and multivariate analyses on specific subpopulations selected by different factors including the key indicators: age, sex, hospitalization. The study explores the case fatality rate to find out its decreasing trend in time. Furthermore, we describe the differences in mortality among hospitalized and other cases indicating a sudden increase of mortality among hospitalized cases at the end of the 2020 spring season. Exploratory and multivariate analysis revealed the real impact of each variable and besides the expected factors indicating increased mortality (age, comorbidities) we track more non-obvious indicators. Recent medical care as well as the identification of the source contact, independently of the comorbidities, significantly impact an individual mortality risk. As a result, the study provides a twofold insight into the COVID-19 mortality in Poland. On one hand we explore mortality in different groups with respect to different variables, on the other we indicate novel factors that may be crucial in reducing mortality. The later can be coped, e.g. by more efficient contact tracing and proper organization and management of the health care system to accompany those who need medical care independently of comorbidities or COVID-19 infection.

Factors determining adherence to guidelines and restrictions during the initial period of the COVID-19 pandemic in Poland before the vaccination rollout.

INTRODUCTION: In Poland, like in many other countries, guidelines and certain restrictions were introduced in order to reduce the impact of the pandemic and curb the spread of the virus. These related to such behaviours as washing and disinfecting hands, wearing face masks in designated places, keeping social distance and frequently ventilating rooms. However, not all people follow the guidelines, which can lead to both health and social ramifications. The key objective of this study was an in-depth analysis of how safety rules (SR) were complied with in Poland during the initial pandemic period before the vaccines were rolled out, as well as determining factors that could affect the compliance with SR. METHODS: The study was conducted in the form of a series of cross-sectional surveys using the CATI method on a representative Polish sample in 8 rounds of interviews. Random sampling was applied. The first round was carried out from 2 to 6 July 2020, the last from 17 to 21 August 2020. The authors' original survey questionnaire was used. Factors affecting the compliance with SR were analysed using the multivariate logistic regression method on a combined group of participants from all the study rounds. RESULTS: In total, 4,800 subjects participated in the study, of which 2,512 were women (52.3%) and 2,288 were men (47.7%). Compliance with guidelines was defined based on four survey questions relating to: disinfecting hands when not at home, not touching items with bare hands when not at home, wearing face masks or covering mouth and nose, as well as washing hands after coming back home. Two affirmative answers to these questions or wearing a face mask alone (covering mouth and nose) were interpreted as compliance with SR. SR were more frequently followed by women OR=1.234 95% CI (0.988-1.543), persons over the age of 65 OR=2.098 95% CI (1.409-3.122), people with university education OR=1.315 95% CI (0.950-1.820) and residents of large cities OR=2.179 95% CI (1.382-3.437). Factors that supported compliance with SR were older age, fear of contracting COVID-19 and knowledge of SR. DISCUSSION AND CONCLUSIONS: During the first wave of the pandemic, the SR compliance level was high. Nevertheless, the study identified social groups with a higher risk of non-compliance. This indicates a need for properly addressing communication to these groups, especially that, as was demonstrated, the knowledge alone of pandemic-related messages significantly increased the likelihood of following SR and restrictions. The study of infection-preventing behaviours and their context may provide essential information to guide public policies and communication strategies that would support these behaviours in order to control the spread of the virus more effectively.

The effect of infectious agents on the prevalence of allergies.

PURPOSE: The role of infectious agents in allergy development is ambivalent. On one hand, there are reports of an association between a previous infection (especially a viral respiratory tract infection) and developing hypersensitivity to inhaled allergens, which in turn may increase the risk of developing allergic reactions. On the other hand, there are reports emphasizing a protective effect of a number of infectious agents against allergy development. The aim the study was to find possible associations between a past infectious or parasitic disease and an allergic condition. MATERIAL AND METHODS: The study population was a group of 18,648 subjects. The study, which was a part of the project: 'Implementation of a System for the Prevention and Early Detection of Allergic Diseases in Poland', was conducted in 9 selected regions of Poland and used the ECRHS and ISAAC questionnaires adapted for Europe. The following statistical tools were used: Pearson's chi-squared test, Fisher's exact test, and logistic regression. RESULTS: This research was an attempt to clear association between a history of measles or viral hepatitis and the likelihood of developing asthma, especially in males (χ2 = 5.29; p<0.05). Past parasitic disease showed a clear association with a suspected allergic rhinitis in various groups of patients (differing both in terms of sex and age). CONCLUSIONS: A history of some forms of either infectious or parasitic diseases has a measurable effect on the risk of developing allergies.

Factors influencing the effect of surgical treatment in secondary proliferative disease with lung involvement.

INTRODUCTION: Surgical treatment of neoplastic lung metastases is a big therapeutic problem, at the stage of qualifying for the procedure, in the surgical technique itself, and in the tactics of managing subsequent disease relapses. The most doubtful aspect is determining which factors influence the prolongation of survival in patients with such a diagnosis. AIM: To determine which factors influence the effectiveness of surgical treatment of neoplastic metastases to the lungs. MATERIAL AND METHODS: A group of 577 patients was subjected to the study. An analysis of all performed operations (1009) was also carried out according to the set goals. Statistical analysis was performed using the estimates of the χ2 test, Kaplan-Meier estimator, and log-rank test. RESULTS: It was established what statistically significant factors may improve the treatment effectiveness. It was found that the lack of radicalism was influenced by: the number of lung metastases, the presence of changes in the lymph nodes, age, histology of the primary tumor and its location, and the number of treatments. Nodal metastases are more common in non-radical procedures, depend on the patient's age, are more often found in unilateral procedures, and depend on the location and histology of the primary tumor. CONCLUSIONS: It was found that the radical nature of the procedure did not affect the progression of the disease, but it did have an impact on survival. Relapses are more common in bilateral procedures, reducing survival. Lymph node metastases worsen the prognosis.

Characteristics and Clinical Outcomes of 116,539 Patients Hospitalized with COVID-19-Poland, March-December 2020.

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes Coronavirus Disease 2019 (COVID-19). This study aimed to characterize patients hospitalized with COVID-19 in Poland between March and December 2020, as well as to identify factors associated with COVID 19-related risk of in-hospital death. This retrospective analysis was based on data from the hospital discharge reports on COVID-19 patients hospitalized in Poland between March and December 2020. A total of 116,539 discharge reports on patients hospitalized with COVID-19 were analyzed. Among patients with COVID-19, 21,490 (18.4%) died during hospitalization. Patients over 60 years of age (OR = 7.74; 95%CI: 7.37-8.12; p < 0.001), men (OR = 1.42; 95%CI: 1.38-1.47; p < 0.001) as well as those with cardiovascular diseases (OR = 1.51; 95%CI: 1.46-1.56; p < 0.001) or disease of the genitourinary system (OR = 1.39; 95%CI: 1.31-1.47; p < 0.001) had much higher odds of COVID 19-related risk of in-hospital death. The presence of at least one comorbidity more than doubled the COVID 19-related risk of in-hospital death (OR = 2.23; 95%CI: 2.14-2.32; p < 0.01). The following predictors of admission to ICU were found in multivariable analysis: age over 60 years (OR: 2.03; 95%CI: 1.90-2.16), male sex (OR: 1.79; 95%CI: 1.69-1.89), presence of at least one cardiovascular disease (OR: 1.26; 95%CI: 1.19-1.34), presence of at least one endocrine, nutritional and metabolic disease (OR: 1.17; 95%CI: 1.07-1.28).

Cardiac Morphology, Function, and Hemodynamics in Patients With Morbid Obesity and Nonalcoholic Steatohepatitis.

Background The patients with nonalcoholic fatty liver disease demonstrate an increased cardiovascular risk. The adverse influence of liver abnormalities on cardiac function are among many postulated mechanisms behind this association. The aim of the study was to evaluate cardiac morphology and function in patients with morbid obesity referred for bariatric surgery with liver biopsy. Methods and Results We evaluated with echocardiography 171 consecutive patients without known cardiac disease (median age 42 [interquartile range, 37-48] years, median body mass index 43.7 [interquartile range, 41.0-47.5], 67% female patients. Based on the liver biopsy results, there were 44 patients with nonalcoholic steatohepatitis (NASH), 69 patients with isolated steatosis, and 58 patients without steatosis. Patients with NASH demonstrated signs of left ventricular concentric remodeling and hyperdynamic circulation, including indexed left ventricular end-diastolic diameter [cm/m2]: NASH 1.87 [0.22]; isolated steatosis 2.03 [0.33]; without steatosis 2.01 [0.19], P=0.001; relative wall thickness: NASH 0.49±0.05, isolated steatosis 0.47±0.06, without steatosis 0.46±0.06, P=0.011; cardiac index [L/m2]: NASH 3.05±0.54, isolated steatosis 2.80±0.44, without steatosis 2.79±0.50, P=0.013. After adjustment for sex, age, blood pressure, and heart rate, most of the measures of the left ventricular systolic and diastolic function, left atrial size, right ventricular function, and right ventricular size did not differ between groups. Conclusions In a group of patients with extreme obesity, NASH was associated with left ventricular concentric remodeling and hyperdynamic circulation. Increased cardiac output in NASH may represent an additional risk factor for incident cardiovascular events in this population.

Flow-diverting devices in the treatment of unruptured ophthalmic segment aneurysms at a mean clinical follow-up of 5 years.

A shift toward the endovascular treatment of ophthalmic segment aneurysms is noticeable. However, it is not clear if the long-term treatment results improve with the development of endovascular methods. The aim of this study was to present the outcomes of the treatment of unruptured ophthalmic aneurysms using flow diverting devices (FDD) with or without coiling. This retrospective study included 52 patients with 65 UIAs treated in 2009-2016. The mean aneurysm size was 8.8 mm. Eight aneurysms were symptomatic. Therapeutic procedures included: 5 failed attempts, 55 first sessions with FDD deployment (bilateral procedures in 3) and 3 retreatment procedures. To cover 55 ICAs, 25 Silk, 26 Pipeline, 9 Fred and 1 Surpass FDD were used. FDD with coiling was applied in 19(29.2%), mainly for symptomatic and larger aneurysms. Mean radiological and clinical follow-up was 12 and 61 months, respectively. Postprocedural deterioration was noted in 3(5.8%) patients, but in long-term the modified Rankin Scale grades 0-2 were achieved in 98.1% of patients. One patient died from the treated aneurysm rupture (annual risk-0.07%). Raymond-Roy occlusion classification class I or II was achieved in 98.5% in the long term, with similar results in both groups. Complications occurred in 40.4% of patients and the most frequent were: imperfect FDD deployment (15%), failed attempt of FDD deployment (9.6%) and late FDD stenosis (9.6%). Flow-diverting devices, with additional coiling in selected cases, may offer a very high proportion of satisfactory outcomes. However, in our experience the high risk of complications remains.

Observed and relative survival and 5-year outcomes of patients discharged after acute myocardial infarction: the nationwide AMI-PL database.

BACKGROUND: Long­term follow­up data from a large Polish acute myocardial infarction (AMI­PL) database are still unavailable. AIMS: This study aimed to assess the 5­year outcomes of patients discharged after hospitalization for AMI in Poland in relation to age. METHODS: The studywas based on the nationwide AMI­PL registry including data on the management and long­term outcomes of all patients admitted to hospitals with AMI (codes I21-I22 according to the International Classification of Diseases and Related Health Problems, 10th Revision [ICD ­10]), derived from the database of the obligatory healthcare payer in Poland.The current analysis included all patients after AMI who were discharged alive between the years 2009 and 2010 (n = 134 602). RESULTS: The median age of the study patients was 66.8 years, 62.8% of them were male, and 57.1% had ST­segment elevation myocardial infarction. Older patients, especially those at age ≥80 years, were less likely to receive invasive treatment during the index hospitalization and follow­up. There were 37 437 deaths during the follow­up, and the observed 5­year survival ranged from 0.921 in women at the age below 55 years to 0.383 in men older than 80 years. Relative survival, however, ranged from 0.94 to 0.68 in these age­sex groups. The mortality risk increased with age, was higher in men, in patients treated noninvasively, hospitalized for non-ST­segment elevation myocardial infarction, and discharged from non­cardiology wards. Patients were rehospitalized due to cardiovascular reasons in 63% of cases, heart failure in 17.9%, and AMI in 12.8%. CONCLUSIONS: More than 1 in 4 patients discharged after hospitalization for AMI died within 5 years. Age strongly affects the treatment and long­term outcomes of AMI patients. Our findings indicate the need for improvement in secondary prevention after AMI.

Features of personality and professional burnout syndrome of physicians - analysis based on questionnaires studies.

INTRODUCTION: This observational study was ordered by the Medical Practitioners' Chamber in Warsaw. THE OBJECTIVE: of the study was to evaluate the problem of professional burnout of physicians correlation between professional burnout and features of personality. MATERIAL AND METHODS: Professional burnout was considered relative to different features of personality. This study was initially carried out from 2005-2008, but further analysis of burnout and personality was carried out from 2017-2018. The research tools were anonymous, validated questionnaires. The sample size was based on the size of the population- the registry of the Regional Chamber of Medical Practitioners and literature on burnout prevalence. The respondents' work places were randomly selected from the Mazovian District register. RESULTS: The test on burnout was completed by 378 respondents, while 62 subjects completed a personality test. Results showed that burnout syndrome was an occupational problem for healthcare workers. Professional burnout affected as many as 42% of respondents (n = 158). It affected two age groups in particular: physicians up to 31 years old and individuals aged 41-50. Moreover, neuroticism was found to be significantly related to burnout syndrome. CONCLUSION: burnout syndrome is common among professionally active medical practitioners, and neuroticism may be correlated with burnout syndrome.

Characteristics of aeromedical transport, both interhospital and directly from the scene of the incident, in patients with acute myocardial infarction or acute trauma between 2011-2016 in Poland: A case-control study.

BACKGROUND: Patients with acute myocardial infarction (AMI) or acute trauma (AT) are transported by air to save time. Helicopter Emergency Medical Service (HEMS) provides both flights to and from the emergency scene, as well as interhospital transport (interHtransport). OBJECTIVES: The objective of this study was to compare aeromedical transport and HEMS missions of AMI and AT patients regarding safety, medical procedures and the length of flights. MATERIAL AND METHODS: This is a case-control study analyzing the medical history records of AMI and AT patients transported between hospitals and from the scene identified using ICD-10 codes. Research of customary data (age, sex and general health status measured with Glasgow Coma Scale (GCS) and Revised Trauma Score (RTS)) was performed. RESULTS: There were 48,555 flights in the years 2011-2016, of which 7,645 (15.7%) were interhospital (19% AMI and 12% AT). Out of these, 40,910 (84.3%) HEMS missions were to patients on the scene (10% AMI and 13% AT). No fatalities were noted. The AMI GCS score was higher than in AT patients: 15.0 vs 14.0, respectively. The medical procedures during transport of AMI patients between hospitals and from the scene were the following: cardiopulmonary resuscitation (CPR): 6 vs 73 cases (p < 0.001); oxygen therapy: 41.1% vs 50.2%, respectively. The median distance was 59.4 km vs 52.1 km (p < 0.001), while median flight time was 45.0 min vs 38.0 min (p < 0.001), respectively. Regarding AT patients, the procedures performed (during interhospital and from the scene transport) were the following: CPR: 5 vs 244 cases (p < 0.001); intubation: 10.7% vs 17.3% (p < 0.001); sedation: 50.1% vs 24.3% (p < 0.001); oxygen therapy: 17.6% vs 36.6% (p < 0.001); spinal board: 17.1% vs 66% (p < 0.001); cervical collar: 15.9% vs 63.4% (p < 0.001), respectively. Interhospital transport and HEMS mission median flight distance was 135.9 km vs 56.3 km (p < 0.001), while median flight time was 66.0 min vs 45.0 min (p < 0.001), respectively. CONCLUSIONS: Aeromedical transport is safe and very rarely requires resuscitation during the flight. The long distances of flights and time required can reflect the scarcity of trauma centers (TCs) compared to cardiovascular wards. The location of hemodynamic centers in Poland is optimal.

Investigating safety of vulnerable road users in selected EU countries.

PROBLEM: Vulnerable road users comprise over half of all road accident victims in the EU and their safety situation is not improving as fast as for motorists. The paper examines factors affecting fatality risk of pedestrians, cyclists, motorcyclists, and moped riders in seven EU countries using data from CARE database. METHOD: Comparing accident severity indicators between countries is problematic because of data quality issues, different degree of underreporting, and different exposure levels. To avoid bias arising from these issues, fatality risk is modeled with binary logistic regression. Risk factors considered include accident location by area type, junction type, and traffic control, as well as lighting condition. Results are presented as odds ratios of fatal accident outcome in different countries under specific circumstances compared to reference conditions. It is shown that the error in OR values due to underreporting is small. RESULTS AND DISCUSSION: Wide confidence intervals of the odds ratios in some countries confirm problems with accident data quality. Fatality risk is always higher for non-urban versus urban area and for darkness versus daylight conditions, but the odds ratios are different for different countries. Inconsistent results are obtained for accident location with respect to junction and its control type. Possible reasons for these differences are suggested and discussed. Practical applications: The proposed method avoids the data quality bias of accident severity indicators, thus, it can be used in international comparisons of vulnerable road user accidents. The article findings also support the concept of changes in legislation, such as reducing the speed limit in urban areas in Poland at night. Generally, the experience of countries with low VRU fatality risk identified in the article can be transferred to those with a higher risk.