Enhancing Patient Selection in Stage IIIA-IIIB NSCLC: Invasive Lymph Node Restaging after Neoadjuvant Therapy.

Restaging of mediastinal lymph nodes plays a crucial role in the multimodal treatment of stage IIIA Non-Small-Cell Lung Cancer (NSCLC). This study aimed to assess the impact of restaging using endobronchial ultrasound (EBUS), endoesophageal ultrasound (EUS), and transcervical extended mediastinal lymphadenectomy (TEMLA) after neoadjuvant chemotherapy (CHT) or chemoradiotherapy (CRT) on the 5-year overall survival (OS) of patients with NSCLC diagnosed with clinical stage IIIA-IIIB and metastatic ipsilateral mediastinal nodes (N2) who underwent radical pulmonary resections. Patients diagnosed with stage IIIA-IIIB NSCLC and N2 mediastinal nodes were included in this study. Restaging of mediastinal lymph nodes was performed using EBUS, EUS, and TEMLA. The patients were divided into two groups based on the restaging method: the TEMLA restaging group and the chest CT scan-only group. The primary outcome measure was the 5-year OS rate, and the secondary outcome measures included median OS and survival percentages. Statistical analysis, including the log-rank test, was conducted to assess the differences between the two groups. The TEMLA restaging group demonstrated significantly better overall survival compared to the chest CT scan-only group (log-rank test, p = 0.02). This was evident through a four-fold increase in median OS (59 vs. 14 months) and a higher 5-year OS rate of 55.9% (95% CI: 40.6-71.1) compared to 25.0% (95% CI: 13.7-36.3) in the chest CT scan-only group (p = 0.003). Invasive restaging of mediastinal lymph nodes improves the selection of patients with stage IIIA-IIIB (N2) NSCLC after neoadjuvant therapy. The use of EBUS, EUS, and TEMLA provides valuable information for identifying patients who may benefit from surgery by identifying N2 to N0-1 downstaging. These findings emphasize the importance of incorporating restaging procedures into the treatment decision-making process for NSCLC patients with mediastinal lymph node involvement.

Autopsy Histopathologic Lung Findings in Patients Treated With Extracorporeal Membrane Oxygenation.

CONTEXT.­: Extracorporeal membrane oxygenation (ECMO) is increasingly used in the treatment of respiratory and cardiac failure, but data describing lung histopathology in ECMO recipients are limited. OBJECTIVE.­: To examine pulmonary histopathologic findings in patients who underwent venovenous (VV) ECMO for pulmonary reasons, or venoarterial (VA) ECMO for cardiac indications shortly before death, and to determine if the pulmonary changes provided insights into therapy that may prevent complications and improve outcome. DESIGN.­: We conducted a retrospective study of lung autopsies, from VV and VA ECMO recipients and patients with acute respiratory distress syndrome (ARDS) and non-ECMO treatment, between 2008 and 2020 in Silesia Center for Heart Diseases in Zabrze, Poland. RESULTS.­: Among 83 ECMO patients (42-64 years; male, 57 [68.7%]), the most common histopathologic findings were bronchopneumonia (44 [53.0%]), interstitial edema (40 [48.2%]), diffuse alveolar damage (DAD; 32 [38.6%]), hemorrhagic infarct (28 [33.7%]), and pulmonary hemorrhage (25 [30.1%]). DAD was associated with longer ECMO treatment and longer hospital stay. The use of VV ECMO was a predictor of DAD in patients with ARDS and undergoing ECMO, but it also occurred in 21 of 65 patients (32.3%) in the VA ECMO group, even though VA ECMO was used for heart failure. CONCLUSIONS.­: Although DAD was significantly more common in lung autopsies of VV ECMO patients, one-third of VA ECMO patients had histopathologic changes characteristic of ARDS. The presence of DAD in lung autopsies of patients treated with VA ECMO indicates that in these patients, protective lung ventilation should be considered.

The use of non-invasive respiratory assistance to facilitate bronchofiberoscopy performance in patients with hypoxemic (type one) respiratory failure - Study protocol.

PURPOSE: Bronchofiberoscopy (FOB) is a procedure routinely performed for: lung cancer, obstruction, interstitial diseases, foreign bodies' removal, airway clearance, and hemoptysis. It causes acute airway narrowing leading to respiratory and cardiovascular stress. Due to increasing number of ill patients with respiratory failure (RF), conventional oxygen therapy (COT) is frequently insufficient to assure accurate oxygenation and prevent RF in patients requiring FOB. In this clinical scenario, patients may be intubated and supported with invasive mechanical ventilation (IMV) with the specific aim of allowing a safe FOB. However, this invasive strategy is associated with an increased risk of IMV-associated complications. MATERIALS AND METHODS: Our study is a planned prospective multicenter three-arm randomized controlled trial (RCT). The target number of 300 patients was calculated based on the intubation risk in RF patients, which is 0.2-2%. The patients will be assigned to each arm based on Horowitz index. In each arm, the patients will be randomly assigned to one out of two dedicated respiratory support methods in each group i.e. COT/high flow nasal cannula (HFNC), HFNC/non-invasive ventilation (NIV) and NIV/IMV. In the manuscript the current state of art in the area of respiratory support is discussed. We have underlined knowledge gaps in medical evidence which we are planning to reveal with our results. RESULTS: The results of our study are clinically crucial, because they address current gaps concerning COT/HFNC/NIV/IMV. CONCLUSION: The expected findings of this study would allow for careful selection of respiratory support method to safely perform FOB in patients with hypoxemic RF.

May noninvasive mechanical ventilation and/ or continuous positive airway pressure increase the bronchoalveolar lavage salvage in patients with pulmonary diseases? Randomized clinical trial - Study protocol.

PURPOSE: Bronchoalveolar lavage (BAL) procedure is a useful tool in the diagnosis of patients with interstitial lung disease (ILD) and is helpful in clinical research of chronic obstructive pulmonary disease (COPD) patients. Still little is known about predictors of poor BAL salvage. The trial aims to find the most efficient way to improve BAL recovery. MATERIAL AND METHODS: Our study is a prospective, multicenter, international, two-arm randomized controlled trial. We aim to obtain BAL samples from a total number of 300 patients: 150 with ILD and 150 with COPD to achieve a statistical power of 80 â€‹%. Patients with initial BAL salvage <60 â€‹% will be randomized into the non-invasive ventilation (NIV) or continuous positive airway pressure (CPAP) arm. The NIV and CPAP will be set according to the study protocol. The influence on BAL salvage will be assessed in terms of BAL volume and content. Multivariable analysis of the additional test results to determine predictors for low BAL recovery will be conducted. In a study subgroup of approximately 20 patients per specific disease, a metabolomic assessment of exhaled air condensate will be performed. All procedures will be assessed in terms of the patient's safety. The trial was registered on clinicaltrials.gov (ID# NCT05631132). Interested experienced centers are invited to join the research group by writing to the corresponding author. CONCLUSION: The results of our prospective study will address the currently unsolved problem of how to increase BAL salvage in patients with pulmonary diseases without increasing the risk of respiratory failure exacerbation.

Influence of Aortic Valve Stenosis and Wall Shear Stress on Platelets Function.

Aortic valve stenosis (AS) is a common heart valve disease in the elderly population, and its pathogenesis remains an interesting area of research. The degeneration of the aortic valve leaflets gradually progresses to valve sclerosis. The advanced phase is marked by the presence of extracellular fibrosis and calcification. Turbulent, accelerated blood flow generated by the stenotic valve causes excessive damage to the aortic wall. Elevated shear stress due to AS leads to the degradation of high-molecular weight multimers of von Willebrand factor, which may involve bleeding in the mucosal tissues. Conversely, elevated shear stress has been associated with the release of thrombin and the activation of platelets, even in individuals with acquired von Willebrand syndrome. Moreover, turbulent blood flow in the aorta may activate the endothelium and promote platelet adhesion and activation on the aortic valve surface. Platelets release a wide range of mediators, including lysophosphatidic acid, which have pro-osteogenic effects in AS. All of these interactions result in blood coagulation, fibrinolysis, and the hemostatic process. This review summarizes the current knowledge on high shear stress-induced hemostatic disorders, the influence of AS on platelets and antiplatelet therapy.

Influence of Surface Structure on Ball Properties during a Professional Water Polo Game.

The use of modern materials in sports, in terms of chemical composition and surface texture, entails both progress in results and an increasing discrepancy in the technical parameters of the equipment used. This paper aims to demonstrate the differences between balls admitted to a league and world championships in composition, surface texture, and the influence of these parameters on the water polo game. This research compared two new balls produced by top companies producing sports accessories (Kap 7 and Mikasa). To obtain the goal, the measurement of the contact angle, analysis of the material using Fourier-transform infrared spectroscopy, and optical microscopic evaluation were used. The analysis of the surface free energy shows significant differences (Kap 7 32.16 mJ/m2, Mikasa 36.48 mJ/m2). In the case of both balls, anisotropies of the structure of the furrows were observed, however, the Mikasa ball is slightly more homogeneous than the Kap 7 ball. The obtained results from the analysis of the contact angle, as well as the composition and real feedback from the players, indicated the need to standardize the material aspect of the regulations so that the sports results are repeatable every time.

Relationship between vertical jump tests and ice skating performance in junior Polish ice hockey players.

The aim of this study was to determine the relationships between vertical jumps (VJ) and various on-ice skating performances of junior ice hockey players (n = 19). The three modes of VJ or off-ice measures were countermovement jump with arm swing (CMJ), squat jump (SJ) and depth drop jump (DDJ). The on-ice skating performance was measured by the skating multistage aerobic test (SMAT), forward and backward acceleration test, top speed test, and repeated sprint ability (RSA) test. The relationships between the variables were quantified using Pearson's product-moment correlation. DDJ showed a significant positive correlation with forward average skating speed (FASS) (r = 0.62) and strong correlations with backward average skating speed (BASS) (r = 0.81), and maximum skating speed (MSS) (r = 0.71). SJ was found to be strongly correlated with BASS (r = 0.82) and MSS (r = 0.76), whereas the only on-ice performance that significantly correlated with CMJ was BASS (r = 0.68). All three modes of VJ were inversely and non-significantly correlated with performance decrement index and fatigue index, as determined by the RSA test. SMAT was not significantly correlated with either VJ or RSA. Correlations between all three modes of VJ tests were significant. Therefore, this study concludes that: (1) DDJ can be used as a predictor of all the ice skating speed tests, whereas SJ can predict BASS and MSS. CMJ, on the other hand, can predict the performance of only BASS. (2) RSA performance cannot be predicted from CMJ, SJ, or DDJ tests, and (3) neither any of the VJ nor RSA can predict skating endurance of junior ice hockey players.

The Effects of Two Different Rest Intervals on the Repeated Skating Ability of Ice Hockey Forwards and Defensemen.

The purpose of this study was to evaluate the effects of two different rest intervals (2 min and 3 min), between two consecutive sets of repeated sprint skating ability (RSSA) tests, on the repeated sprint ability of ice hockey Forwards and Defensemen. Two protocols of RSSA tests, RSSA-2 and RSSA-3, were completed by 16 ice hockey Forwards and 8 Defensemen. Defensemen were heavier (p < 0.05) than Forwards, although their % body fat did not differ significantly. In RSSA-2, athletes performed six sets of 3×80 m sprint skating with 2 min passive recovery between two consecutive sets. In RSSA-3, the rest interval between the sets was 3 min. Average speed, average heart rate (HRaver), blood lactate concentration ([BLa]), and the rate of perceived exertion (RPE) were measured in both RSSA-2 and RSSA-3 tests. Both Forwards and Defensemen skated faster in RSSA-3 than in the corresponding set of RSSA-2. Forwards were faster than Defensemen in both the tests, however, the difference was significant (p < 0.05) only in RSSA-2. In Forwards and Defensemen, HRaver increased gradually from set 1 through set 6 in RSSA-2 and RSSA-3. In most of the sets, RPE was higher in RSSA-2 than in RSSA-3, and Defensemen perceived higher exertion than Forwards. No difference in [BLa] was noted between Forwards and Defensemen, although players of both positions showed higher [BLa] in RSSA-3 than in RSSA-2. This study concludes that (1) Forwards skate faster than Defensemen, (2) average heart rate and [BLa] do not vary between Forwards and Defensemen, and (3) a higher perceived exertion is observed in Defensemen than Forwards during repeated sprint skating tests.

Value, time and outcomes of elevated lactate levels in adult patients on extracorporeal membrane oxygenation.

INTRODUCTION: Lactate levels have been recognized as a reliable tool for monitoring critically ill patients requiring venoarterial extracorporeal membrane oxygenation (VA ECMO) or venovenous extracorporeal membrane oxygenation (VV ECMO) but the reasons behind the overproduction of lactate are different and the influance for survival remains controversial. We analyzed the lactate values and lactate clearance in adult patients in these two forms of extracorporeal support. METHODS: Patient demographics, ECMO duration, 30-day mortality, lactate values and lactate clearance at 24, 48 and 72 h from ECMO initiation of patients supported with VV and VA ECMO at Silesian Centre for Heart Deasese, between January 2011 and April 2020 were retrospectively analyzed. The changes in lactate levels were analyzed using the non-parametric U Mann-Whitney tests and Chi-square test. The ROC curves were draw and the area under the curve was calculated. RESULTS: The study comprised 91 adult patients, Mortality in the first 30 days from initiation of VV and VA ECMO was 39% and 66%, respectively. Lactate levels were significantly higher in non-survivors that received VV and VA ECMO (p < .001), while lactate clearance was similar (p = .256 and p = 1.000, respectively). Survival curves for patients with elevated (>2.0 mmol/L) vs normal (≤2.0 mmol/L) lactate levels at 72 h were significantly different for VV ECMO (p = .007) and VA ECMO (p = .037) but in both groups of ECMO, lactate levels above 2.0 mmol/L at 72 h from ECMO initiation predicted 30 day-mortality. CONCLUSION: This results emphasized the importance of lactate levels below 2.0 mmol/L at 72 h from both VV and VA ECMO initiation.

Surgery Training System Supported by Organic Materials.

The aim of the study was the qualitative assessment of new materials based on a polycarbonate matrix in terms of its use in 3D printing and its processing and geometric modification (cutting). Filaments made of the new material doped with talc in five different proportions were visually inspected with a microscope. The calibration and test models were made using the FFF (fused filament fabrication) technique. In addition, its susceptibility to the drill and the behavior of the shavings were assessed and the temperature changing during drilling was measured. The implant was inserted to measure its resonance stability in each of the holes made and translated into the value of the implant stability quotient (ISQ) ranging from 1 to 100. The results were compared to those obtained for the training model of the skull bone. The amount of filler has been shown to affect the composite. Moreover, due to the properties of talc, a compatibilizer (polyol) was used. Differences were observed between the model made of the commercial material, the model made of the dried, tested material, and the model made of the undried material. It was confirmed that the presence of water in the material during its processing is important.

Cenospheres-Reinforced PA-12 Composite: Preparation, Physicochemical Properties, and Soaking Tests.

The main aim of this research was the preparation of a polymer-ceramic composite with PA-12 as the polymer matrix and modified aluminosilicate cenospheres (CSs) as the ceramic filler. The CSs were subjected to an early purification and cleaning process, which was also taken as a second objective. The CSs were surface modified by a two-step process: (1) etching in Piranha solution and (2) silanization in 3-aminopropyltriethoxysilane. The composite was made for 3D printing by FDM. Raw and modified CSs and a composite with PA-12 were subjected to the following tests: surface development including pores (BET), real density (HP), chemical composition and morphology (SEM/EDS, FTIR), grain analysis (PSD), phase composition (XRD), hardness (HV), and static tensile tests. The composites were subjected to soaking under simulated body fluid (SBF) conditions in artificial saliva for 14, 21, and 29 days. Compared to pure PA-12, PA-12_CS had generally better mechanical properties and was more resistant to SBF at elevated temperatures and soaking times. These results showed this material has potential for use in biomedical applications. These results also showed the necessity of developing a kinetic aging model for aging in different liquids to verify the true value of this material.

Production of Electrolytic Composite Powder by Nickel Plating of Shredded Polyurethane Foam.

Ni-poly(DPU) composite powder was produced under galvanostatic conditions from a nickel bath with the addition of pulverized polymer obtained during the shredding of polyurethane foam (poly(DPU)). The Ni-poly(DPU) composite powder was characterized by the presence of polymer particles covered with an electrolytical amorphous-nanocrystalline nickel coating. The phase structure, chemical composition, morphology, and the distribution of elements was investigated. The chemical analysis showed that the powder contains 41.7% Ni, 16.4% C, 15.7% O, 8.2% P and 0.10% S. The other components were not determined (nitrogen and hydrogen). The phase analysis showed the presence of NiC phase. Composite powder particles are created as a result of the adsorption of Me ions on the fragmented polymer. The current flowing through the galvanic bath forces the flow of the particles. The foam particles with adsorbed nickel ions are transported to the cathode surface, where the Ni2+ is discharged. The presence of compound phosphorus in galvanic solution generates the formation of amorphous-nanocrystalline nickel, which covers the polymer particles. The formed nickel-polymer composite powder falls to the bottom of the cell.

Mallampati Score Is an Independent Predictor of Active Oxygen Therapy in Patients with COVID-19.

Mallampati score has been identified and accepted worldwide as an independent predictor of difficult intubation and obstructive sleep apnea. We aimed to determine whether Mallampati score assessed on the first patient medical assessment allowed us to stratify the risk of worsening of conditions in patients hospitalized due to COVID-19. A total of 493 consecutive patients admitted between 13 November 2021 and 2 January 2022 to the temporary hospital in Pyrzowice were included in the analysis. The clinical data, chest CT scan, and major, clinically relevant laboratory parameters were assessed by patient-treating physicians, whereas the Mallampati score was assessed on admission by investigators blinded to further treatment. The primary endpoints were necessity of active oxygen therapy (AOT) during hospitalization and 60-day all-cause mortality. Of 493 patients included in the analysis, 69 (14.0%) were in Mallampati I, 57 (11.6%) were in Mallampati II, 78 (15.8%) were in Mallampati III, and 288 (58.9%) were in Mallampati IV. There were no differences in the baseline characteristics between the groups, except the prevalence of chronic kidney disease (p = 0.046). Patients with Mallampati IV were at the highest risk of AOT during the hospitalization (33.0%) and the highest risk of death due to any cause at 60 days (35.0%), which significantly differed from other scores (p = 0.005 and p = 0.03, respectively). Mallampati IV was identified as an independent predictor of need for AOT (OR 3.089, 95% confidence interval 1.65−5.77, p < 0.001) but not of all-cause mortality at 60 days. In conclusion, Mallampati IV was identified as an independent predictor of AOT during hospitalization. Mallampati score can serve as a prehospital tool allowing to identify patients at higher need for AOT.

Individual Determinants as the Causes of Failure in Learning to Swim with the Example of 10-Year-Old Children.

BACKGROUND: The purpose of the present study was to identify which, and to what extent, selected individual determinants of 10-year-old children may limit the final achievement in learning to swim. In view of the above, the research hypothesis was formulated that some children, despite regular attendance at swimming classes, do not achieve the learning outcomes set in the curriculum. The reason for this may be unfavorable (compared to their peers) morphological and functional characteristics, coordination motor abilities, and problems with fear of water. METHODS: The study was conducted on a group of 271 students from the third grade of elementary schools who could not swim when they entered the physical education classes at the swimming pool and then participated in at least 25 swimming lessons during the school year. After these classes, the students performed swimming tests, and their somatic and functional characteristics and coordination motor abilities were measured. RESULTS: In 46.1% of the participants, the final achievement level was lower than assumed in the school curriculum. The biggest problem for teachers and students in the initial teaching and learning to swim was the high fear of water, especially among girls. Furthermore, children characterized by lower body height and body weight, a lower sum of three skinfolds, and lower BMI had problems with progress in swimming. Despite the differences, these values did not correlate significantly with the final achievement level in swimming, except for body height in boys. Slower progress in swimming was also associated with lower vital capacity, whereas no relationship was found between final achievement level in swimming and trunk flexibility or foot mobility. However, significant correlations occurred for coordination motor abilities, as in almost all tests the participants characterized by the achievement level below the objectives set out in the curriculum performed significantly worse than children in the group with the achievement level meeting the objectives. CONCLUSIONS: In many cases, children who begin learning to swim from scratch make significant progress, but for many of them, the achievement levels are lower than the requirements set out in the school curriculum. The biggest problem for teachers and students in the initial teaching and learning to swim was the high fear of water, especially among girls.

Polyurethane-Based Porous Carbons Suitable for Medical Application.

The main aim of the study was to synthesize and analyze spectral data to determine the structure and stereometry of the carbon-based porous material internal structure. Samples of a porous biomaterial were synthesized through anionic polymerization following our own patent and then carbonized. The samples were investigated using MALDI ToF MS, FTIR ATR spectroscopy, optic microscopy, SEM, confocal laser scanning microscopy and CMT imaging. The analysis revealed the chemical and stereological structure of the obtained porous biomaterial. Then, the parameters characterizing the pore geometry and the porosity of the samples were calculated. The developed material can be used to collect adsorption of breathing phase samples to determine the parity composition of exhaled air.

Pulmonary function, exercise capacity and dyspnea in patients 7 ​years after Nuss surgery.

PURPOSE: Pectus excavatum is a frequent thoracic malformation increasingly treated with minimally invasive methods (MIRPE), which are performed for cardio-respiratory problems and in some centers also for esthetic considerations. Theoretically, MIRPE may increase thoracic elastic recoil, work of breathing and cause emphysema. The aim of the present study was to determine whether teenagers who underwent MIRPE may expect normal thoracic cage development, cardio-respiratory function, exercise capacity and asymptomatic functioning. MATERIAL AND METHODS: Fifty five patients (21.1 â€‹± â€‹3.0 years) who underwent MIRPE between 2000 and 2010 were assessed 6.8 (±2.4) years after surgery. Controls were matched for sex, age and height to the intervention participants. Spirometry, body plethysmography, diffusion capacity and the 6 â€‹min walking test (6MWT) were performed. Anteroposterior (AP) and transverse chest diameters were measured. RESULTS: Participants who underwent MIRPE had normal pulmonary function, and exercise capacity. After adjustment for potential confounders, the intervention group had lower mean BMI [-1.88 â€‹± â€‹0.56 (kg/m2); p â€‹= â€‹0.001] and chest AP diameter [-2.79 â€‹± â€‹0.57 (cm); p â€‹< â€‹0.001], but higher residual volume (RV%) [12.98 â€‹± â€‹5.31 (%); p â€‹= â€‹0.001], RV% total lung capacity (TLC) [5.56 â€‹± â€‹0.92 (%); p â€‹< â€‹0.001], forced expiratory volume in 1 â€‹s/forced vital capacity (FEV1/FVC) [2.64 â€‹± â€‹1.28 (%); p â€‹= â€‹0.039] and 6MWT distance [29.10 â€‹± â€‹13.02 (m); p â€‹= â€‹0.025]. CONCLUSIONS: Young adults who undergo MIRPE may expect normal pulmonary function and exercise capacity. Observed differences in air trapping require further assessment in terms of emphysema development risk.

ARNI in HFrEF-One-Centre Experience in the Era before the 2021 ESC HF Recommendations.

BACKGROUND: Sacubitril/valsartan, an angiotensin receptor-neprilysin inhibitor (ARNI), has demonstrated a survival benefit and reduces heart failure hospitalization in patients with heart failure with reduced left ventricular ejection fraction (HFrEF); however, our experience in this field is limited. This study aimed to summarize a real clinical practice of the use of ARNI in HFrEF patients hospitalized due to HFrEF in the era before the 2021 ESC HF recommendations, as well as assess their clinical outcome with regard to ARNI administration. METHODS AND MATERIALS: Overall, 613 patients with HFrEF hospitalized in 2018-2020 were enrolled into a retrospective one-centre cross-sectional analysis. The study population was categorized into patients receiving (82/13.4%) and not-receiving (531/82.6%) ARNI. Clinical outcomes defined as rehospitalization, number of rehospitalizations, time to the first rehospitalization and death from any cause were analysed in the 1-2 year follow-up in the ARNI and non-ARNI groups, matched as to age and LVEF. RESULTS: Clinical characteristics revealed the following differences between ARNI and non-ARNI groups: A higher percentage of cardiovascular implantable electronic devices (CIED) (p = 0.014) and defibrillators with cardiac resynchronization therapy (CRT-D) (p = 0.038), higher frequency of atrial fibrillation (p = 0.002) and history of stroke (p = 0.024) were in the ARNI group. The percentage of patients with HFrEF NYHA III/IV presented an increasing trend to be higher in the ARNI (64.1%) as compared to the non-ARNI group (51.5%, p = 0.154). Incidence of rehospitalization, number of rehospitalizations and time to the first rehospitalization were comparable between the groups. There were no differences between the numbers of deaths of any cause in the ARNI (28%) and non-ARNI (28%) groups. The independent negative predictor of death in the whole population of ARNI and non-ARNI groups was the coexistence of coronary artery disease (CAD) (beta= -0.924, HR 0.806, p = 0.011). CONCLUSIONS: Our current positive experience in ARNI therapy is limited to extremely severe patients with HFrEF. Regardless of the more advanced HF and HF comorbidities, the patients treated with ARNI presented similar mortality and rehospitalizations as the patients treated by standard therapy.

Post-tracheostomy complications: respiratory failure caused by authologic foreign body-case report.

Tracheostomy is performed frequently as a palliative treatment in patients with end-stage respiratory failure (RF). However, in patients requiring prolonged mechanical ventilation it may be difficult to recognize and can often lead to life-threatening RF. We present two cases of acute-on-chronic respiratory failure (ACRF) occurring in patients who had undergone tracheostomy [one with percutaneous dilatational tracheostomy (PDT) and the second with surgical tracheostomy (ST)]. The first case was admitted due to ACRF several months after previous successful decannulation and the second case after failure of several attempts of weaning from tracheal cannula. In both cases, noninvasive mechanical ventilation assisted flexible bronchoscopy (NIV-FB) was able to identify and solve the tracheal stenosis secondary to stiff banana-shaped whitish foreign bodies. Histology sampling and genetic testing confirmed autologous foreign body formation-tracheal cartilage calcification. NIV-FB was found to be safe and effective in both diagnosis and treatment of the tracheal stenosis. Life-threatening RF connected with tracheal stenosis may be caused by rupture of tracheal cartilage ossification in patients with a history of ST and PDT. Bronchofiberoscopy performed with NIV will be a useful procedure to evaluate and treat the respiratory tract in patients with RF with suspected tracheal stenosis.

Exhaled Air Metabolome Analysis for Pulmonary Arterial Hypertension Fingerprints Identification-The Preliminary Study.

Pulmonary arterial hypertension (PAH) is a rare disease with a serious prognosis. The aim of this study was to identify biomarkers for PAH in the breath phase and to prepare an automatic classification method to determine the changing metabolome trends and molecular mapping. A group of 37 patients (F/M: 8/29 women, mean age 60.4 ± 10.9 years, BMI 27.6 ± 6.0 kg/m2) with diagnosed PAH were enrolled in the study. The breath phase of all the patients was collected on a highly porous septic material using a special patented holder PL230578, OHIM 002890789-0001. The collected air was then examined with gas chromatography coupled with mass spectrometry (GC/MS). The algorithms of Spectral Clustering, KMeans, DBSCAN, and hierarchical clustering methods were used to perform the cluster analysis. The identification of the changes in the ratio of the whole spectra of biomarkers allowed us to obtain a multidimensional pathway for PAH characteristics and showed the metabolome differences in the four subgroups divided by the cluster analysis. The use of GC/MS, supported with novel porous polymeric materials, for the breath phase analysis seems to be a useful tool in selecting bio-fingerprints in patients with PAH. The four metabolome classes which were obtained constitute novel data in the PAH population.

Assessment of encrustation and physicochemical properties of poly(lactide-glycolide) - Papaverine hydrochloride coating on ureteral double-J stents after long-term flow of artificial urine.

Implantation of ureteral stents is associated with inconvenience for the patient, which is related to the natural ability of the ureter to contract. The most frequently used solution is the systemic administration of a diastolic drug, which has a relaxing effect on smooth muscle cells and decreases inconvenience. Current interdisciplinary research aimed at reducing the complications after the implantation of ureteral stents used in the treatment of upper urinary tracts with regard to infection, initiation of encrustation, and fragmentation of stents, and patient pain has not been resolved. This study presents the results of research regarding the impact of a biodegradable coating with the active substance on the physical and chemical properties of ureteral stents used in the treatment of the upper urinary tract. The surface of polyurethane double-J stents was coated with poly(lactide-glycolide) (PLGA) 85/15 loaded with papaverine hydrochloride (PAP) with diastolic properties. The coating for ureteral stents has been designed for short-term implantation. The effect of the coating on the process of encrustation and PAP release by the dynamic in vitro model with artificial urine (AU) up to 30 days was evaluated. The influence of AU on the physical and chemical properties of ureteral stents was determined. As part of the study, surface structure and topography researches; chemical composition analyses using X-ray photoelectron spectroscopy, Fourier transform infrared spectroscopy, and wetting; and surface roughness studies of both PUR stents and coated stents were carried out. The proposed biodegradable PLGA+PAP coating is characterized by controlled drug release, while optimal physicochemical properties does not increase the encrustation process.