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A large group of patients with significant asymptomatic or low-symptomatic coeliac trunk stenosis require deeper consideration. On angiography, CT and MRI, 10–24% of examined patients are found to have their coeliac trunk compressed by the median arcuate ligament of the diaphragm. The associated median arcuate ligament syndrome, which is also called coeliac trunk compression syndrome or Dunbar syndrome, is rarely fully symptomatic. It is estimated that there are up to 7% of patients with such a clinical presentation. An asymptomatic or low-symptomatic course of the disease in patients with the syndrome is mainly explained by a developed collateral circulation, particularly involving the arterial arcades of the head of pancreas. In such cases, CT angiography detects collateral circulation in 22–69.6% of examined patients. The present authors often observed coeliac trunk blood flow to normalise in a standing position. According to them, the main causative factor for this phenomenon is the deflection of the coeliac trunk and its compression against the aorta by a lowered left lobe of the liver. The researchers observed it in many individuals; in this study, 5 cases are presented.

Melanoma is one of the most aggressive human malignancies. The determination of prognostic biomarkers is important for the early detection of recurrence and for the enrollment of the patients into different treatment regimens. Herein, we report the 10-year survival of 375 melanoma patients depending on their serum selenium levels. The study group was followed up from the date of melanoma diagnosis until death or 2020. Patients were assigned to one of four categories, in accordance with the increasing selenium level (I–IV quartiles). The subgroup with low selenium levels had a significant lower survival rate in relation to patients with high selenium levels, HR = 8.42; p = 0.005 and HR = 5.83; p = 0.02, for uni- and multivariable models, respectively. In the univariable analysis, we also confirmed the association between Breslow thickness, Clark classification and age at melanoma prognosis. In conclusion, a low serum selenium level was associated with an increased mortality rate in the 10 years following melanoma diagnosis. Future studies in other geographic regions with low soil selenium levels should be conducted to confirm our findings.

Background: Pre-ablation identification of left atrial (LA) low voltage areas (LVA) among long-standing persistent atrial fibrillation (LSPAF) population remains challenging. Aims: The aim of the study was to analyze the potential of selected scores originally developed to assess arrhythmia recurrences, thromboembolic complications, or progression from paroxysmal to persistent AF to predict the presence of LA-LVA in LSPAF patients. Methods: One hundred and fifty-two patients underwent pulmonary vein isolation followed by high-density-high-resolution LA voltage mapping. AF risk scores, such as APPLE, ATLAS, CAAP-AF, DR-FLASH, CHA2DS2-VASc, and HATCH were retrospectively calculated. A receiver operating characteristic curve analysis was performed to evaluate the ability of the scores to predict LVA. Results: Low voltage areas were detected in 52% of the patients. 28% of the patients with LVA presented severe global LVA burden, whereas 56% of the patients showed a disseminated pattern of remodeling. CAAP-AF ≥7, DR-FLASH ≥4, and CHA2DS2-VASc ≥3 predicted the presence of LVA, whereas ATLAS ≤7 indicated the absence of LVA. ATLAS ≤8, CAAP-AF ≤9, DR-FLASH ≤4, and CHA2DS2-VASc ≤3 predicted the absence of severe LVA. APPLE ≤3 and CHA2DS2-VASc ≤2 predicted the absence of a LVA disseminated pattern. Among predictive scores, ATLAS (AUC, 0.633, 95% CI, 0.543–0.723, P = 0.004), DR-FLASH (AUC, 0.696; 95% CI, 0.594–0.81; P

Background: Remote monitoring of cardiovascular implantable electronic devices allows the assessment of system effectiveness, arrhythmia occurrence, and indirectly, clinical changes. Medical interventions can be performed earlier because of a faster transfer of information to the monitoring site, even in the case of asymptomatic arrhythmias or abnormalities in the operation of the system. Aims: The aim of the study was to assess the effectiveness of remote monitoring of implantable cardioverter-defibrillators and evaluation in an outpatient setting during 12-month follow-up. Methods: We analyzed 176 patients at 10 sites (men, 84.1%). The mean (SD) age of the patients was 60.7 (12.5) years (range, 20–86 years), and mean (SD) follow-up period was 405 (70) days (range, 131–723 days). Results: A total of 354 outpatient and 514 remote follow-up visits were conducted. Episodes of arrhythmias and device malfunctions were detected with similar frequency in outpatient visits and in remote visits. During the study period, patient sense of safety increased. More patients preferred joined remote and outpatient visits as the optimal healthcare model. As the patient survey showed, the greatest benefit of the CareLink network was fast intervention and an increased sense of safety. Conclusions: The strategy of remote monitoring appeared to be feasible, safe, and patient friendly, demonstrating that the majority of patients do not require an additional in -person visit within 1 year from the device implantation just to confirm the proper functioning of the implantable cardioverter--defibrillators.

The article presents the concept of maintaining the required level of the engineering infrastructure (IT) usefulness through the use of a reconfiguration mechanism in relation to the usefulness of the safeguard subsystem and the hazard subsystem. Basic IT elements have been emphasized and characterized from the point of view of controlling its current level of usefulness (reliability and security). A model of engineering infrastructure was proposed for maintaining the required level of usefulness. Desired current IT usefulness is obtained by generating appropriate functional and IT security configurations from a set of allowable solutions. The proposed concept of ensuring reliability and security, taking into consideration the impact of not only various types of risk factors, but also changes in the conditions of the working/operating environment of both IT, its basic domain systems, and the information system, is the authors’ own proposition.

A patient presented with incessant ventricular tachycardia (VT) of suspected epicardial origin. The earliest activation of the LV apex, however with negative entrainment and pace-mapping was detected. Diagnosis of cardiac tamponade lead to the repair of the right ventricle apex laceration with an epicardial radiofrequency ablation following limited pace-mapping. Ablation lesions covering left ventricle apical segment rendered the patient VT free.

Antiplatelet response to clopidogrel and its influence upon the risk of cardiovascular adverse events among patients with stable coronary artery disease undergoing percutaneous coronary intervention (PCI) has not been investigated fully. Two hundred eleven patients treated with aspirin and clopidogrel were included in the study. Immediately before PCI, residual platelet reactivity testing with impedance aggregometry assay and a single-nucleotide polymorphism genotyping analysis targeting variants of CYP2C19, ABCB1, and PON1 genes was performed. After the index PCI, the patients were screened for cardiovascular events 6 months following bare-metal stent implantation or 12 months following drug-eluting stent implantation. High on-treatment platelet reactivity (HTPR) was observed in 19.43% individuals and low-TPR (LTPR) in 26.54%. In multivariate analysis, HTPR was significantly (p

Background : Left atrial (LA) arrhythmogenic substrate beyond the pulmonary veins (PV) seems to play a crucial role in the maintenance of atrial fibrillation (AF). The aim of this study was to evaluate the association of selected parameters with the presence and extent of voltage-defined LA fibrosis in patients with long-standing persistent AF (LSPAF) undergoing catheter ablation. Methods: One hundred and sixteen consecutive patients underwent high density-high resolution voltage mapping of the LA with a multielectrode catheter following PV isolation and restoration of sinus rhythm with cardioversion. A non-invasive dataset, such as clinical variables, two-and three-dimensional echocardiography determined LA size and function and fibrillatory-wave amplitude on a standard surface electrocardiogram were obtained during AF before ablation. Results: Low-voltage areas (LVA; 15 cm 2 [IQR 8–31]) were detected in 56% of patients. Twenty nine percent of them presented mild, 43% moderate and 28% severe global LVA burden. In univariate analysis, age ≥ 57 years old, female sex, body surface area ≤ 1.76 m 2 , valvular heart disease, moderate mitral regurgitation, chronic coronary syndrome, hypothyroidism, CHA 2 DS 2 -VASc score ≥ 3 and ≥ 4 predicted the presence of LVA. In multivariate analysis only female sex, valvular heart disease and CHA 2 DS 2 -VASc ≥ 4 remained statistically significant. AF duration, LA size and function and fibrillatory-waves amplitude were neither associated with the prediction of the LVA, nor severe LVA burden. Conclusions: A LSPAF diagnosis does not indicate the presence of voltage defined fibrosis in many cases. Simple non-invasive screening of the LSPAF population could predict LVA prevalence.

Introduction. Atrioventricular nodal reentrant tachycardia (AVNRT) is the most common regular tachyarrhythmia; however, its clinical presentation has not been investigated in detail. The aim of the study was to assess the clinical presentation and identify the potential factors significantly affecting the natural history of AVNRT in patients undergoing RF ablation. Material and methods. Ninety-two consecutive patients with invasive diagnosis of typical AVNRT who underwent RF ablation were included. All patients were actively screened for the presence of structural heart disease (SHD). The retrospective, arrhythmia focused interviews regarding its clinical history, affecting factors and treatment were conducted. The medical records and tachycardia ECG tracings data were included, if available. Results. Seventy-five percent of patients had evidence of the arrhythmia exacerbation. No relationship between the coronary (66%) or brain (33%) hypoperfusion symptoms and clinical factors was found. Time to the tachycardia diagnosis was significantly longer in women (13 ± 11 vs 7 ± 8 years, p = 0.006). Pharmacological AVNRT management was not consistent with the ESC guidelines. The arrhythmia symptoms were occurring later if SHD was present (44 ± 13 vs 30 ± 5 years, p = 0.001). The longer AVNRT cycle length (CL), modified by the age when symptoms appeared and the presence of impaired myocardial contractility, the longer time to the arrhythmia diagnosis and exacerbation. Mitral valve prolapse (MVP) was more common in female patients compared with the general population and was found to be the factor delaying AVNRT diagnosis. Conclusions. In the majority of patients AVNRT exacerbation takes place. The coronary and brain hypoperfusion symptoms that patients often experience are nonspecific. There is a significant delay in the arrhythmia diagnosis, especially in women. SHD, AVNRT CL and MVP were identified as factors that significantly modify the arrhythmia clinical presentation.

Introduction: The VisiTag module (CARTO3) provides an objective assessment of radiofrequency (RF) ablation parameters. This study aimed to determine the predictive value and optimal VisiTag threshold settings for prediction of gaps in mature atrial scar, as assessed non-invasively using cardiac magnetic resonance (CMR) imaging. Methods: Twenty-four subjects (11 paroxysmal atrial fibrillation) underwent first-time RF ablation with operators blinded to VisiTag data. Three-dimensional late gadolinium enhancement (LGE) CMR scans were performed at 3 months (1.3 × 1.3 × 4 mm3). A survey of UK operators defined the standard VisiTag settings (“Force,” 8 g; “Time,” 10 seconds; “Percentage Time,” 50%; “Range,” 3 mm; “Impedance” and “Temperature” “off”). Each ablation procedure was exported 27 times, varying single VisiTag parameters from default values. The presence of gaps in VisiTag markers (18 sectors) was assessed for each export and compared with gaps in CMR enhancement. Results: At default settings, VisiTag gaps were specific (97.5%) but less sensitive (50.4%) for CMR gaps. Sensitivity improved at higher thresholds (89.2% at 20 g, 85.6% at 30 seconds, 88.5% impedance 10 Ω, 92.8% temperature 42°C), but with a lower positive predictive value (PPV) (42.3%, 42.7%, 41.1%, and 37.7%, respectively, vs 90.9% at baseline). “Force” thresholds demonstrated stable PPV from 2 to 8 g (P = 0.24), but a rapid fall at forces more than 10 g. The binomial logistic regression model explained 41.7% of gaps; χ 2(4), 148; P < 0.0001, correctly classifying 82% of cases (specificity 94.9%, sensitivity 56.8%). Conclusion: Gaps in VisiTags predict gaps in CMR LGE enhancement with high specificity at default settings. Sensitivity may be improved using more stringent thresholds but at the potential cost of unnecessary ablation, particularly when a force more than 10 g is stipulated.

In the study we have used a standard Thermo Scientific TaqMan protocol which can be found under this link: http://tools.thermofisher.com/content/sfs/brochures/taqman-assay-genetic-variation-research-br.pdf

Introduction: Standard pre-operative diagnosis of nodular goitre is not always conclusive. The decision about nodular goitre surgery is increasingly based on molecular methods. The aim of the study was to determine BRAF T1799A mutation and KRas proto-oncogene mutation, and the analysis of RASSF1A promoter methylation level in cytological material obtained from FNAB specimens of thyroid nodules. Material and methods: The study population consisted of 85 women and 12 men. The study material was genomic DNA isolated from peripheral blood and thyroid bioptates. Pyrosequencing was used for the evaluation of RASSF1 methylation level. KRas mutation was investigated with Sanger sequencing. BRAF mutation was analysed by standard methods of real-time amplification detection (real-time PCR) with the use of specific starters surrounding the mutated site. Results: A significant positive correlation was demonstrated between mean methylation of four CpG islands of RASSF1A gene and thyroid tumour volume and its largest diameter (p < 0.05). KRas mutation was not detected in any of the 97 patients. In 7/85 subjects (8.2%) BRAF mutation was observed. In 6/7 patients with BRAF mutation, FNAB of thyroid nodules confirmed a benign nature of the lesions; the material was non-diagnostic in one patient, and papillary thyroid cancer was diagnosed on the basis of postoperative histopathology assessment. Conclusions: The results of genetic tests reported in our study indicate that the presence of BRAF mutation or higher RASSF1A methylation levels in FNAB cytology specimens of benign lesions may be useful in the assessment of oncological risk, while the evaluation of KRas proto-oncogene mutation is not a valuable test in pre-operative diagnosis of nodular goitre. (Endokrynol Pol 2015; 66 (5): 384–393)

Adrenal tumors, discovered incidentally in approximately 4.5% of imaging procedures, are known as adrenal incidentalomas. Nonclassic congenital adrenal hyperplasia, mild form of 21-hydroxylase deficiency, may lead to the development of adrenocortical tumors. The aim of the study was to evaluate prevalence of the most common nonclassic mutations of CYP21A2 gene in patients with adrenal incidentalomas and investigate possible relationship with clinical outcome. One hundred adult patients with such lesions were enrolled. Clinical, imaging and biochemical evaluation were performed to rule out hormonal overproduction or potential malignancy. All subjects and a control group of 100 neonates were genotyped for P30L, P453S, and V281L mutations of CYP21A2 gene using direct sequencing. Clinical and imaging features as well as hormone levels were analyzed. Heterozygous CYP21A2 gene mutations were detected in 8 subjects but not in the neonates. Thus, the risk of carrying mutant allele was significantly higher in subjects with adrenal tumors (OR=8.7; 95% CI=2.23–389.56; p=0.003). Mean concentrations of renin, basal, and stimulated 17-hydroxyprogesterone were higher and ACTH was lower in the carriers than in the remaining subjects. Furthermore, the carriers had higher incidence of hypertension (100 vs. 52.1%, p=0.008) and diabetes (50 vs. 11.9%, p=0.003). ACTH-stimulated 17-hydroxyprogesterone levels varied widely among the carriers. In summary, prevalence of P30L, P453S, and V281L mutations of CYP21A2 gene is increased in patients with adrenocortical tumors. In these subjects, carrying the analyzed mutant alleles may increase the risk of diabetes and hypertension. ACTH-stimulation test does not satisfactorily predict presence of heterozygous CYP21A2 mutations in patients with adrenal tumors.

The aim of this study was to compare the periodontal status in patients with type 2 diabetes based on glycated haemoglobin levels and other risk factors.75 patients with DM2 were grouped according to glycemic control: 40 subjects with HbA1c7.0% and 35 subjects with HbA1c≥7.0%. We performed measurements of HbA1c, C-reactive protein (CRP), Approximal Plaque Index (API), Gingival Severity Index (GSI), tooth mobility (TM) as well as periodontal parameters such as probing depth (PD) and clinical attachment level (CAL). Age, gender and duration of the disease were analyzed too.No significant differences in PD, CAL, API, GSI and TM were found between the analyzed groups. HbA1c positively correlated with CRP (p=0.046) and the duration of DM2 (p=0.012) but not with the periodontal parameters. Patients' age was positively correlated with both the duration of DM2 (p=0.002) and CAL (p=0.034). Regardless of HbA1c, men had significantly worse periodontal parameters compared to women (respectively: PD 2.73mm vs. 2.18mm, p=0.01; CAL 3.84mm vs. 2.54mm, p=0.005; proportion of deep pockets 9.06% vs. 2.97%, p=0.01; proportion of teeth with grade 2 mobility 9.14% vs. 2.8%, p=0.02).The selected group of patients attending the Diabetes Outpatient Clinic showed a similar periodontal status with regard to glycated haemoglobin levels and other risk factors except gender. Male gender turned out to be a significant risk factor for periodontal disease in patients with type 2 diabetes mellitus.

Wstęp: Obserwacje kliniczne wskazują, że u pacjentów z cukrzycą stwierdza się częstsze występowanie zmętnienia torebki soczewki po operacji fakoemulsyfikacji zaćmy z wszczepieniem soczewki. Nowe metody operacyjne i modyfikacje sztucznych soczewek wewnątrzgałkowych zmniejszają częstość występowania zmętnienia torebki tylnej soczewki (PCO) i wykonywania YAG – kapsulotomii z powodu zaćmy wtórnej. Wyniki przeprowadzonych dotychczas badań sugerują, że operacja usunięcia zaćmy z wszczepieniem soczewek pokrytych heparyną zmniejsza ryzyko PCO u pacjentów z cukrzycą typu 2.Celem pracy była ocena wpływu soczewki akrylowej hydrofobowej heparynizowanej na częstość występowania I stopnia zaawansowania zmętnienia przedniej (ACO) i tylnej torebki soczewki oraz ostrości wzroku u pacjentów z cukrzycą typu 2 po niepowikłanej operacji zaćmy.Materiały i metody: Do prospektywnego badania zakwalifikowano 18 pacjentów (36 oczu) z cukrzycą typu 2, bez cech retinopatii. Przeprowadzono standardową operację usunięcia zaćmy z wszczepieniem soczewki akrylowej hydrofobowej heparynizowanej (Polylens Y10AS) do jednego oka (grupa badana) i nieheparynizowanej (Alcon SA60AT) do drugiego oka (grupa kontrolna). Oceniano najlepiej skorygowaną ostrość wzroku do dali (DBCVA) oraz występowanie ACO i PCO w badaniu retroiluminacji. Otrzymane wyniki badań poddano analizie statystycznej.Wyniki: W okresie rocznej obserwacji nie stwierdzono różnic istotnych statystycznie w występowaniu ACO i PCO w oczach pacjentów z cukrzycą z wszczepionymi soczewkami heparynizowanymi w porównaniu z oczami tych samych pacjentów z implantami nieheparynizowanymi. Nie wykazano także znaczących różnic w DBCVA między omawianymi grupami w ciągu 12 miesięcy obserwacji.Wnioski: Wyniki przedstawionych badań sugerują, że soczewki akrylowe hydrofobowe heparynizowane i nieheparynizowane wykazują podobną biokompatybilność u pacjentów z cukrzycą typu 2.

The association of BRCA1/2 mutations with melanoma is not completely determined; the interpretation of variants of unknown significance is also problematic. To evaluate these issues we explored the molecular basis of melanoma risk by performing whole-exome sequencing on a cohort of 96 unrelated Polish early-onset melanoma patients and targeted sequencing of BRCA1/2 genes on additional 30 melanoma patients with familial aggregation of breast and other cancers. Sequencing was performed on peripheral blood. We evaluated MutationTaster, Polyphen2, SIFT, PROVEAN algorithms, analyzed segregation with cancer disease (in both families with identified BRCA2 variants) and in one family performed LOH (based on 2 primary tumors). We found neither pathogenic mutations nor variants of unknown significance within BRCA1. We identified two BRCA2 variants of unknown significance: c.9334G>A and c.4534 C>T. Disease allele frequency was evaluated by genotyping of 1230 consecutive melanoma cases, 5000 breast cancer patients, 3500 prostate cancers and 9900 controls. Both variants were found to be absent among unselected cancer patients and healthy controls. The MutationTaster, Polyphen2 and SIFT algorithms indicate that c.9334G>A is a damaging variant. Due to lack of tumour tissue LOH analysis could not be performed for this variant. The variant segregated with the disease. The c.4534 C>T variant did not segregate with disease, there was no LOH of the variant. The c.9334G>A variant, classified as a rare variant of unknown significance, on current evidence may predisposes to cancers of the breast, prostate and melanoma. Functional studies to describe how the DNA change affects the protein function and a large multi-center study to evaluate its penetrance are required.

The paper presents the system architecture for the access control subsystem for the RFID-equipped restricted access administrative office. The presented diagrams are the result of the analytical work performed by the multidisciplinary team of experts. The team was composed of IT specialist, security systems specialists and employees of the secret office. The presented models include the fact that the facilities in the secret office (cabinet, sluice, photocopier, desks) are equipped with the RFID reader, which allows to immediately read the documents that are within their reach. The logical architecture and the description of main functions of the privileges module has been presented in purpose to describe how to manage access control functionality in administrative office with RFID tagged documents.

This article outlines methods of business process automation for the purpose of the RFID-equipped restricted access administrative office. The events, which constitute part of the Business Process Model and Notation (BPMN), were extended in such a manner so as to allow performance of automated actions during their occurrence. Additionally, an analogous mechanism of automated action at the user interface level, was described. Last but not least, the article presents the manner of operations of certain elements in the office, i.e. the business processes, and methods of communication between them.

The paper attempts to describe a method of using formal evaluating the impact of testing of software on the level of its reliability. Presented method has been developed on the basis of formal model of software testing process that has been constructed in the paper for some assumed testing scheme. Using the discrete-time software reliability-growth model with the purpose of estimating the mean value of the number of predicted errors encountered during the program testing process is proposed. On the basis of this estimation both the duration and the cost of the program testing process can be rationally determined. The method under the investigation has been proposed for the mean of planning the software testing process of document management system with RFID tags.

The paper presents models of data flow between tasks in business processes describing work of a modern restricted access administrative office. The presented models are the result of the analytical work performed by the multidisciplinary team of experts. The team was composed of IT specialist, security systems specialists and employees of the secret office. Business process diagrams and data flow diagrams are presented together to emphasize the importance of data in every business process task to be performed - despite the fact if it is an automated or human task.

Wstep: Stymulacja resynchronizująca (CRT) korzystnie wplywa na funkcje lewej komory, zmniejsza objawy kliniczne niewydolności serca (HF), poprawia wydolnośc fizyczną, a takze zmniejsza śmiertelnośc. Redukcja przeplywu wiencowego i jego rezerwy (CFR), ktora wystepuje u pacjentow z HF w przebiegu kardiomiopatii rozstrzeniowej, wiąze sie z gorszym rokowaniem. U osob z kardiomiopatią rozstrzeniową niewiencową (DCM) czesto stwierdza sie obecnośc bloku lewej odnogi peczka Hisa (LBBB). Juz sam LBBB niekorzystnie wplywa na funkcje lewej komory, perfuzje wiencową, szczegolnie w zakresie przegrody miedzykomorowej. Cel: Celem badania byla ocena wplywu stymulacji resynchronizującej na wiencowy przeplyw krwi i rezerwe przeplywu oraz ich znaczenie dla poprawy wydolności serca u pacjentow z DCM. Metody: Zbadano 21 pacjentow (5 kobiet, średni wiek 57,8 ± 8,1 roku) z HF (średnia frakcja wyrzutowa = 26 ± 7%) na tle DCM z LBBB zakwalifikowanych do CRT. Wszyscy mieli angiograficznie prawidlowe naczynia wiencowe. Pomiary przeplywu krwi i CFR wykonano techniką wewnątrzwiencowego doplera w 3 tetnicach wiencowych wyjściowo i średnio 6,7 miesiąca po zastosowaniu CRT. Wyniki: U pacjentow, u ktorych zaobserwowano poprawe kliniczną po zastosowaniu resynchronizacji, CFR wzrosla istotnie w zakresie galezi przedniej zstepującej lewej tetnicy wiencowej (LAD). CFR dla galezi okalającej lewej tetnicy wiencowej (LCX) i prawej tetnicy wiencowej (RCA) nie poprawila sie ani w calej grupie, ani w grupie pacjentow z poprawą kliniczną. Poprawa w zakresie CRF dla LAD koreluje jedynie ze zwezeniem zespolu QRS. Ponadto wyjściowo nie stwierdzono zalezności miedzy parametrami przeplywu krwi i CFR w duzych tetnicach nasierdziowych a stanem wydolności serca oraz parametrami dyssynchronii (szerokością zespolu QRS, parametrami echokardiograficznymi). Wnioski: W DCM rezerwa przeplywu wiencowego w LAD byla znamiennie mniejsza niz w LCX i RCA. Istotna poprawa CFRw LAD w wyniku zastosowania CRT koreluje jedynie ze zwezeniem zespolu QRS.

The Schimmelpenning-Feuerstein-Mims (SFM) syndrome is a rare phakomatosis which comprises a nevus sebaceous of Jadassohn, seizures and developmental delay associated with a wide spectrum of extracutaneous abnormalities including neurological, skeletal, ocular, cardiovascular and urogenital defects. We are presenting a case of an 18-year-old patient with systemic features of the SFM syndrome and an extensive linear nevus sebaceous partially removed with a carbon dioxide (CO2) laser. The treatment options of skin lesions in patients with SFM are discussed.

Background: Clinical studies in humans have shown the site of atrial stimulation to influence atrioventricular (AV) conduction times and refractory periods, the demonstration of dual AV nodal (AVN) pathways, and induction of AVN reentry. These studies often found conflicting results. Moreover, among enrolled patients a minority of them were found to have AVN reentrant tachycardia (AVNRT). Aim: The purpose of this study was to investigate the effect of right and left atrial pacing on the electrophysiological properties of the AV junction in the typical AVNRT population. Methods: Ninety-two consecutive patients with typical AVNRT were included. Atrial pacing was performed from the high right atrium (HRA) and the left atrium via the proximal coronary sinus (CS). Results: Stimulation from either the HRA or the CS could result in dual AVN physiology and AVNRT. No site-dependent differences in the ease of induction of dual AVN pathways with variability of initiation from either site were found. However, AVNRT was easier to induce from the HRA. With CS pacing the leftward but not the rightward AVN approaches were the entry point to the AV node because of significantly shorter AH conduction times compared to HRA pacing. Conduction over the leftward AVN extensions could initiate the tachycardia with significantly shorter critical AH interval compared to conduction over the rightward AVN extensions; however, the AH interval during AVNRT and its cycle length were not significantly different. Conclusions: Rightward and leftward AVN extensions are regular features of the AV node. Their different electrophysiological properties lead to variation in the demonstration of discontinuous AVN conduction and AVNRT during right and left atrial pacing. Despite the observation that the left AVN extensions could compose the entry point to the reentrant circuit, there is no evidence that they constitute the critical component of sustained typical AVNRT.

The wheat curl mite (WCM), Aceria tosichella Keifer, is a major pest of cereals worldwide. It is also a complex of well-defined genetic lineages with divergent physiological traits, which has not been accounted for in applied contexts. The aims of the study were to model the thermal niches of the two most pestiferous WCM lineages, designated MT-1 and MT-8, and to assess the extent to which temperature determines the distribution of these lineages. WCM population dynamics were modeled based on thermal niche data from March to November on the area of Poland (>311,000 km2). The most suitable regions for population development were predicted and compared to empirical field abundance data. Congruence between modeled parameters and field data for mite presence were observed for both WCM lineages although congruence between modeled thermal suitability and mite field abundance was observed only for MT-8. Thermal niche data for MT-1 and MT-8 provide biological insights and aid monitoring and management of WCM and the plant viruses it vectors. The presented models accurately estimate distributions of WCM and can be incorporated into management strategies for both current and predicted climate scenarios.

Skin is the most common localization of primary melanoma, however in 2–6% of patients a metastasis of melanoma without a detectable primary tumor is found [1]. This is referred to as melanoma of unknown primary origin (MUP). It usually presents as cutaneous or subcutaneous nodules or lymph node metastases [2]. The theories concerning the etiology of MUP include the presence of a melanoma that was misdiagnosed and excised without the further histopathological examination, a regressed melanoma; or a primary nodal melanoma connected with malignant transformation of a nevus cell in a lymph node or other non-skin tissue. In support of the last two theories, in melanomas a partial spontaneous regression connected with immunological mechanisms frequently occurs, moreover ectopic melanocytes may be found in lymph nodes and the other tissues, being a potential reservoir of the cells, which may undergo a neoplastic transformation [2]. In patients with MUP metastases may be found primarily in the skin, subcutaneous tissue, internal organs, bones and brain [1]. In more than 50% of MUP cases, similarly to sporadic melanomas with a known primary origin, a mutation of the gene encoding kinase protein BRAF (V600E) is found. The coexistence of melanoma with the other skin cancers may be connected with the presence of genes encoding the factors regulating the cell cycle, e.g. p53 protein. A female patient with metastasis of melanoma to the lymph node of the right groin of unknown primary origin, with a coexistence of three basal cell carcinomas is presented in the report. A 33-year-old female patient, generally healthy, with a positive history of drug abuse in the past, presented with a few centimeters’ large, painless nodule within the right inguinal region. Ultrasound examination revealed a longitudinal tumor, partly solid and partly polycystic with vascularized septa. The nodule was surrounded by the capsule and revealed no features of infiltration of the adjacent tissues (Figure 1). Histopathological examination of an excised lesion showed the presence of nodal tissue with the metastasis of melanoma with HMB45 positive, S-100 positive, Melan-A positive, V-9 positive, MIB-1 (a proliferation marker which recognizes the Ki-67 antigen) locally positive (Figures 2 A, B). Keratin AE1/AE3, CG30 and leucocyte common antigen (LCA) were negative in neoplastic cells. There was no history of any surgically excised melanocytic or pigmented lesions. The patient declared extensive exposure to ultraviolet in the past, but without any episodes of sun burns. Family melanoma history was negative, however the patient's mother had a history of one basal cell carcinoma (BCC) at the age of 62. Figure 1 An ultrasound picture of an enlarged lymph node within the right inguinal region Figure 2 Histopathological examination of an excised tumor presenting nodal tissue with the metastasis of melanoma. A – 40×. B – 400× Lymphadenectomy of the whole group of lymph nodes within the right inguinal region revealed no metastases to the other nodes. Dermatological examination, performed after the diagnosis of MUP, revealed the presence of numerous solar lentigines and melanocytic nevi on the trunk and extremities with features of atypical lesions in macroscopic and dermoscopic evaluation in some of them. Moreover, the existence of two nodular lesions without dermoscopic features of melanocytic nevi were diagnosed on the abdomen, as well as a single erythematous patch in the left scapular area. Seventeen suspected skin lesions were qualified for surgical removal. The excised nevi revealed histopathological features of benign lesions, no melanoma cells were found in the biopsy specimens. Two nodular lesions on the abdomen and the macular one within the left scapular area showed histopathological features of basal cell carcinoma. Laboratory analyses were within the normal range. The activity of lactate dehydrogenase was within the normal range. A detailed diagnostic imaging, including whole-body positron emission tomography-computed tomography (PET-CT) screening, computed tomography of the abdomen, pelvis, chest and head, endoscopy of the gastrointestinal tract, ultrasound examination of breast and the female genital organ, gynecological and ophthalmic evaluation, examination of the anal region confirmed neither the presence of primary melanoma nor metastases in the other localizations. A mutation in codon V600 of the gene encoding BRAF kinase protein was confirmed in the patient. Further genetic evaluation (assessment of mutations in BRCA1 and CHEK2 genes) confirmed no features of high hereditary cancer susceptibility. Regarding the absence of primary origin of melanoma, differentiation between regional and distant metastases, as well as an evaluation of clinical staging (stage IIIb or IV according to AJCC/UICC staging system) and prognostic factors could not be performed. No indications for the further complementary adjuvant treatment were established. The first exclusion criteria for diagnosis of a true unknown primary melanoma were defined by Das Gupta et al. in 1963 [3]. They included the history of orbital enucleation or exenteration, history of a skin lesion removed, the presence of a scar of previous local treatment in the area drained by the involved lymph node and lack of a thorough physical assessment, including ophthalmic, anal and genital examination. Our patient confirmed the presence of some skin lesion on the right buttock that was mechanically removed by scratching a few years ago. Skin biopsy from the remaining slightly pigmented macule at this site revealed only a scant inflammatory infiltration with lymphoid cells. No other evidence of potential regression was found. The hypothesis of primary origin of melanoma in the lymph node was also considered. No evidence of primary tumor in thorough physical assessment could confirm this assumption in the presented case [4, 5]. Unfortunately, there are no clear criteria defining the diagnosis of this variant of melanoma. Moreover, the literature data lack certain descriptions with histological confirmation of primary nodal melanoma. Another unusual observation was the coexistence of MUP with multifocal BBC in the presented female. Melanoma patients may develop a second malignancy. The most common are second skin tumors, with the highest incidence of BCCs and multiple melanomas [6]. In one study, second malignancies were seen in 11.0% of all melanoma patients, BCCs accounted for one-fourth of all cases. However, the mean age at the time of melanoma and BBC diagnosis was over 60 years [6]. The incidence of BCC in the population younger than 40 years is low, however it is increasing, most likely due to the coexistence of multiple risk factors, with extensive exposure to UV as the most important one [7]. Also genetic defects, as in basal cell nevus syndrome, Muir-Torre syndrome and xeroderma pigmentosum are risk factors for the accelerated development of early-onset BCC. A decrease in DNA repair may determine the genetic susceptibility of non-melanoma skin cancer at a young age [7]. The presented patient had no noticeable symptoms of any genetic syndrome coexisting with a higher risk of BCC development. However, she declared a cumulative sun exposure in the past and that, with concomitance of defects in DNA repair, could have resulted in the development of melanoma and non-melanoma skin cancer. To the best our knowledge, this is the first description of MUP coexisting with early-onset multifocal BCC diagnosed at the same time.

The article discusses the problem of risk management in the context of safety of an organization's information assets. Assuming system of information risk management as a basic element of organization management in the aspect of information safety of modern organizations, this document focuses on methods and techniques of qualitative risk estimates. Basic standards and good practice from areas of risk management and ensuring information safety in the organization were recalled.

Risk is an inherent part of the functioning of every organization therefore the risk management should be a natural activity at each level of management. A common mistake in the management process of an organization is separating the security system, including the risk management system, and treating it as an isolated element. The article presents the place and role of the risk management system in the context of safety of the IT resource of an organization. A model of the risk management system was developed as the basic element of the organization management system and function supporting the continued operation in terms of IT safety of modern organizations.

The paper presents business processes in the RFID-equipped restricted access administrative office. The presented diagrams are the result of the analytical work performed by the multidisciplinary team of experts. The team was composed of IT specialist, security systems specialists and employees of the secret office. The presented models include the fact that the facilities in the secret office (cabinet, sluice, photocopier, desks) are equipped with the RFID reader, which allows to immediately read the documents that are within their reach.

The study outlines the method for examining the properties of the RFID-tagged document management system. The system is composed of computers, where the software for supporting processes of the RFID-tagged doc-uments was installed. Furthermore, the system cooperates with many other elements of the secret office (cabinets, sluices, photocopiers, desks). The examination of the properties of the RFID-tagged document management system is, in this case, complex due to the number of a possible examination scenarios. The simulation method for examining the system properties was proposed. It allows to conduct the examination of the properties in a short period of time for numerous testing scenarios.

The paper presents models of data flow between RFID devices in a modern restricted access administrative office. The presented diagrams are the result of the analytical work performed by the multidisciplinary team of experts. The team was composed of IT specialist, security systems specialists and employees of the secret office. The presented models include the fact that the facilities in the secret office (cabinet, sluice, photocopier, desks) are equipped with the RFID reader, which allows to immediately read the documents that are within their reach.

A 75-year-old woman without structural heart disease presented with incessant regular monomorphic atrial tachycardia (AT). Spontaneous arrhythmia termination was repeatedly followed by a single sinus beat before reinitiation. Variations in tachycardia cycle length (CL) between 200 and 400 ms were frequently observed. The P-wave morphology was consistent with a focal origin from the crista terminalis; however, electroanatomic mapping (CARTO 3 system, Biosense Webster Inc., Diamond Bar, CA) demonstrated centrifugal activation of the right atrium originating from the atrial septal wall near the fossa ovalis. Further mapping at the site of the earliest atrial activation during AT revealed a rapid, regularly discharging focus (Figure 1, blue dot) at fixed 100-ms CL represented by the low-amplitude (0.17 mV) spike electrograms (↓) with an isoelectric interval between successive spikes. The accompanying local atrial potential (▼) during firing was clearly sharper, higher (0.75 mV), and well separated from the preceding spike at fixed 30-ms conduction delay but of lower amplitude (0.95 mV) than that during sinus beats (*). The recorded abnormal activity could not be detected when the catheter tip was moved a few millimeters. The initiation and termination of firing at the site of interest were recorded during catheter manipulation. The onset of AT on the surface electrocardiogram did not always coincide with the initiation of local, high-frequency activity but did terminate immediately with cessation of local firing. The first tachycardia P wave and subsequent discernible P waves were identical. Alterations in the degree of atrial capture by the focal activity (from 2:1 to

The testing stage, creating great opportunities to verify and shape software reliability, significantly increases the cost of its production. The effectiveness of the work related to testing, expressed by the interdependence of the level of program product reliability and the cost of testing it, strongly depends on the adopted testing strategy, specifying the organization and scope of the work performed. In this situation, therefore, there is a need to define the conditions for a compromise in terms of reliability and cost requirements set for the software. The practical finding of this compromise can be greatly facilitated if there are possibilities to formally assess the level of software quality and the cost of testing it using appropriate indicators. The paper attempts to describe a method of determining a program testing strategy as a result of solving a two-criteria optimization problem, with the program reliability coefficient and the cost of testing as component criteria. The paper consists of description of the program testing process and mathematical model of this process, formulation of the problem of two-criteria optimization of the program testing strategy, remarks on method of solving the problem that has been formulated. proposed. To illustrate the method of finding an optimal testing strategy that has been proposed a numerical example is considered.

We describe a case of a patient with the history of a monomorphic postinfarction ventricular tachycardia that exhibited a right bundle branch block morphology and a superior axis. Because of electrical and hemodynamic instability of arrhythmia, classical mapping techniques were not applied. An electroanatomic voltage map during sinus rhythm was performed. A Purkinje potential (PP) preceding the QRS complex was recorded at posteroseptal area of a scar. Radiofrequency energy delivery at sites where a PP was detected resulted in a successful ablation.

Summary Background Despite the progress in contemporary medicine comprising diagnostic and therapeutic methods, lung cancer is still one of the biggest health concerns in many countries of the world. The main purpose of the study was to evaluate the detection rate of pulmonary nodules and lung cancer in the initial, helical low-dose CT of the chest as well as the analysis of the relationship between the size and the histopathological character of the detected nodules. Material/Methods We retrospectively evaluated 1999 initial, consecutive results of the CT examinations performed within the framework of early lung cancer detection program initiated in Szczecin. The project enrolled persons of both sexes, aged 55–65 years, with at least 20 pack-years of cigarette smoking or current smokers. The analysis included assessment of the number of positive results and the evaluation of the detected nodules in relationship to their size. All of the nodules were classified into I of VI groups and subsequently compared with histopathological type of the neoplastic and nonneoplastic pulmonary lesions. Results Pulmonary nodules were detected in 921 (46%) subjects. What is more, malignant lesions as well as lung cancer were significantly, more frequently discovered in the group of asymptomatic nodules of the largest dimension exceeding 15 mm. Conclusions The initial, low-dose helical CT of the lungs performed in high risk individuals enables detection of appreciable number of indeterminate pulmonary nodules. In most of the asymptomatic patients with histopathologically proven pulmonary nodules greater than 15 mm, the mentioned lesions are malignant, what warrants further, intensified diagnostics.

A 69-year-old woman (case 1) and a 36-year-old man (case 2) without comorbidities, normal pulmonary veins (PV) anatomy and atrial, mitral, PV dimensions were referred for cryoballoon ablation of paroxysmal atrial fibrillation (AF). Although atrial tachycardia (AT) and a frequent atrial ectopy (AE) had never been documented, ongoing AT or AE mimicking sinus rhythm (SR) were noticed at admission. An electrophysiological study, in a drug free state, with catheters placed into the coronary sinus, in the right atrium (RA) and His bundle was performed. The positive P wave in lead V1, superimposed on the negative T wave and the negative P wave in lead aVL in case 1 (Figs. 1A, B), and similarities in the P wave morphology during AE and SR and negative P waves in lead aVL in case 2 (Figs. 2A–C), suggested PV AT/AE. Activation mapping with a circular catheter within each PV was performed. Right inferior PV (RIPV) depolarisation preceded the onset of the ectopic P wave by 60 ms (Fig. 1A) and 50 ms (Fig. 2B), respectively. During cryoapplication with a 28 mm cryoballoon catheter (Fig. 3), SR was restored (Figs. 1B, 2C). We did not notice PV electrical activity within other PVs during AT/AE and SR. Although a single culprit PV was found, isolation of the remaining PVs was performed. Post-ablation, there was a bidirectional block within all PVs and no AT/AF was induced. No recurrences of any atrial arrhythmias were seen during the 18 month drug free post ablation follow-up. Focal AT/AE is a rare arrhythmia mainly arising from the RA (83%). The most frequent foci within the left atrium (LA) are superior PV ostia. Their origin from RIPV and coexisting AF with a trigger limited to the same PV, while it is commonly associated with multiple triggers from multiple veins (94%), is uncommon. Although AT and AF may be initiated by PV triggers, it is unclear whether in the presented cases there were two independent arrhythmogenic foci within one PV or a single AT/AE focus that resulted in a long-term AF. Many authors have suggested that PV AT and PV AF represent distinct entities. PV foci initiating AF have been identified to be located deep within the PV, in contrast to a more ostial location for AT. PV AT patients have a discrete, in contrast to diffuse, process involving PVs and the LA seen in AF. In PV AT patients without a history of AF following a focal ablation, AF episodes have not been documented during long-term follow-up. A single documented episode of a PV AT/AE indicates that the supposed previous episodes were short lasting and self-terminating, or just initiated AF.

This article outlines the methodology of the IT system risk analysis and management, including various categories of risk factors significant from the point of view of the sensitive data processing and completeness of the procedure for determining the IT system risk level. The presented methodology is divided into the IT system risk analysis and the risk management method. The IT system risk level assessed by the risk analysis method described in this article constitutes an input value for the risk management method outlined in the further part hereof, referring to the IT systems used for the processing of documents at different levels of sensitivity.