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Background: Extracorporeal membrane oxygenation (ECMO) is effective in a selected critically ill patient population with promising results in refractory hypoxemia related to the novel coronavirus disease (COVID-19). However, it requires specialized clinicians and resources in advanced technology. Moreover, the COVID-19 remains an ongoing global emergency, and there is no evidence-based practice in preparedness. This article proposes an innovative and optimized nursing care protocol, the Standard Operating Procedure (SOP), that regulates safety and efficiency in using personal protective equipment (PPE) during ECMO-relevant procedures while providing ECMO therapy for patients with COVID-19., Methods: After performing a narrative literature search, we developed a high-fidelity translational simulation scenario. It included practicing appropriate donning and doffing PPE during work organization, ECMO-related procedures, and routine daily nursing care and management of ECMO over nine hours. In addition, we held supplementary constructive debrief meetings to consult international expert in the field., Results: A proposal for nursing standardized operating procedures was created, divided into categories. They included work organization, workload references, competences, infrastructural conditions, cannulation equipment, daily routine nursing care, and procedures during ECMO., Conclusions: High-fidelity medical simulation can play an important role in staff training, improvement in previously gained proficiency, and development of optimal SOP for nursing care and management during ECMO in patients with COVID-19. Optimal SOPs may further guide multidisciplinary teams, including intensive care units and interventional departments., (© 2021. The Author(s).)

Background: Successful implementation of medical technologies applied in life-threatening conditions, including extracorporeal membrane oxygenation (ECMO) requires appropriate preparation and training of medical personnel. The pandemic has accelerated the creation of new ECMO centers and has highlighted continuous training in adapting to new pandemic standards. To reach high standards of patients' care, we created the first of its kind, National Education Centre for Artificial Life Support (NEC-ALS) in 40 million inhabitants' country in the Central and Eastern Europe (CEE). The role of the Center is to test and promote the novel or commonly used procedures as well as to develop staff skills on management of patients needing ECMO., Method: In 2020, nine approved and endorsed by ELSO courses of "Artificial Life Support with ECMO" were organized. Physicians participated in the three-day high-fidelity simulation-based training that was adapted to abide by the social distancing norms of the COVID-19 pandemic. Knowledge as well as crucial cognitive, behavioral and technical aspects (on a 5-point Likert scale) of management on ECMO were assessed before and after course completion. Moreover, the results of training in mechanical chest compression were also evaluated., Results: There were 115 participants (60% men) predominantly in the age of 30-40 years. Majority of them (63%) were anesthesiologists or intensivists with more than 5-year clinical experience, but 54% had no previous ECMO experience. There was significant improvement after the course in all cognitive, behavioral, and technical self-assessments. Among aspects of management with ECMO that all increased significantly following the course, the most pronounced was related to the technical one (from approximately 1.0 to more 4.0 points). Knowledge scores significantly increased post-course from 11.4 ± SD to 13 ± SD (out of 15 points). The quality of manual chest compression relatively poor before course improved significantly after training., Conclusions: Our course confirmed that simulation as an educational approach is invaluable not only in training and testing of novel or commonly used procedures, skills upgrading, but also in practicing very rare cases. The implementation of the education program during COVID-19 pandemic may be helpful in founding specialized Advanced Life Support centers and teams including mobile ones. The dedicated R&D Innovation Ecosystem established in the "ECMO for Greater Poland" program, with developed National Education Center can play a crucial role in the knowledge and know-how transfer but future research is needed., Competing Interests: The authors have declared that no competing interests exist.

Background: Extracorporeal membrane oxygenation (ECMO) has been proven to support in lifesaving rescue therapy. The best outcomes can be achieved in high-volume ECMO centers with dedicated emergency transport teams., Aim: The aim of this study was to analyze the safety of ECMO support during medical transfer on the basis of our experience developed on innovation cooperation and review of literature., Methods: A retrospective analysis of our experience of all ECMO-supported patients transferred from regional hospital of the referential ECMO center between 2015 and 2020 was carried out. Special attention was paid to transportation-related mortality and morbidity. Moreover, a systematic review of the Medline, Embase, Cochrane, and Google Scholar databases was performed. It included the original papers published before the end of 2019., Results: Twelve (5 women and 7 men) critically ill ECMO-supported patients with the median age of 33 years (2-63 years) were transferred to our ECMO center. In 92% ( n  = 11) of the cases venovenous and in 1 case, venoarterial supports were applied. The median transfer length was 45 km (5-200). There was no mortality during transfer and no serious adverse events occurred. Of note, the first ECMO-supported transfer had been proceeded by high-fidelity simulations. For our systematic review, 68 articles were found and 22 of them satisfied the search criteria. A total number of 2647 transfers were reported, mainly primary (90%) and as ground transportations (91.6%). A rate of adverse events ranged from 1% through 20% but notably only major complications were mentioned. The 4 deaths occurred during transport (mortality 0.15%)., Conclusions: Our experiences and literature review showed that transportation for ECMO patients done by experienced staff was associated with low mortality rate but life-threatening adverse events might occur. Translational simulation is an excellent probing technique to improve transportation safety., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2021 Mateusz Puslecki et al.)

Competing Interests: The authors declare no conflict of interest.

Introduction: Severe heart failure decompensation requires circulatory mechanical support in emergency situations. Polish paracorporeal pulsatile pumps, POLVAD-MEV, are designed for biventricular end-stage heart dysfunction., Aim: To evaluate long-term POLVAD-MEV therapy by multiple pump exchange in patients on a transplant list., Material and Methods: There were 3 patients in INTERMACS level 1 referred for emergency POLVAD-MED implantation due to acute heart failure deterioration. The paracorporeal pulsatile mechanical support was applied due to severe biventricular dysfunction., Results: They were supported by paracorporeal biventricular POLVAD-MEV pumps for 438, 473 and 394 days until heart transplantation. During the hospitalisation the pumps required multiple pumps exchanges within 29 ±10 (4-49) day intervals., Conclusions: POLVAD-MEV paracorporeal pulsatile pumps present a safe option for long-term circulatory support in a selected group of patients. Therapy requires pump exchange but enables survival while awaiting a heart transplant., Competing Interests: Authors report no conflict of interest., (Copyright © 2020 Polish Society of Cardiothoracic Surgeons (Polskie Towarzystwo KardioTorakochirurgów) and the editors of the Polish Journal of Cardio-Thoracic Surgery (Kardiochirurgia i Torakochirurgia Polska).)

Autophagy is an evolutionarily conserved process that occurs in yeast, plants, and animals. Despite many years of research, some aspects of autophagy are still not fully explained. This mostly concerns the final stages of autophagy, which have not received as much interest from the scientific community as the initial stages of this process. The final stages of autophagy that we take into consideration in this review include the formation and degradation of the autophagic bodies as well as the efflux of metabolites from the vacuole to the cytoplasm. The autophagic bodies are formed through the fusion of an autophagosome and vacuole during macroautophagy and by vacuolar membrane invagination or protrusion during microautophagy. Then they are rapidly degraded by vacuolar lytic enzymes, and products of the degradation are reused. In this paper, we summarize the available information on the trafficking of the autophagosome towards the vacuole, the fusion of the autophagosome with the vacuole, the formation and decomposition of autophagic bodies inside the vacuole, and the efflux of metabolites to the cytoplasm. Special attention is given to the formation and degradation of autophagic bodies and metabolite salvage in plant cells.

A novel approach to using peatlands for assessment of cumulative contributions from long-range transport of pollutants (LRTP) - airborne trace elements - to spatial pollution was exemplified in evaluating retrospective atmospheric deposition of priority pollutants (Pb, Cd, Hg) in peat bogs in Norway in areas minor affected by local sources of pollution and in NW Poland located on the way of possible LRTP from Poland to Norway. Peat from the corresponding 14 C-dated layers of five ombrotrophic bogs in each country, was analysed for trace element contents. Pollutant concentrations/load distribution along the peat profiles related to bulk density has given a clear evidence of uneven density-dependent temporal vertical migration of all studied elements that distorts the chronology of their deposition. Much higher loads of Pb, Cd and Hg in southern Norwegian bogs than in bogs located in NW Poland proved transboundary transport from neighbouring highly industrialized European countries to be much more significant contributor to high deposition of the priority pollutants in this area and rather excludes LRTP from Poland as a major source of total land pollution in southernmost Norway. The study showed excellent applicability of peat bogs for the exact assessment of retrospective cumulative pollutant loads from LRTP, but not for the identification of deposition chronology. Combining the use of ombrotrophic peat bogs as tools for retrospective monitoring of cumulative land pollution with airborne elements with current LRTP data within the Cooperative Programme for Monitoring and Evaluation of the Long-Range Transmission of Air Pollutants in Europe (EMEP) may provide a complete reliable picture of the effect of anthropogenic emissions on soil quality and create a foundation of optimum environmental policy and activities in this field., (Copyright © 2018. Published by Elsevier B.V.)

Peroxisomes are cell organelles that play an important role in plants in many physiological and developmental processes. The plant peroxisomes harbor enzymes of the β-oxidation of fatty acids and the glyoxylate cycle; photorespiration; detoxification of reactive oxygen and nitrogen species; as well as biosynthesis of hormones and signal molecules. The function of peroxisomes in plant cells changes during plant growth and development. They are transformed from organelles involved in storage lipid breakdown during seed germination and seedling growth into leaf peroxisomes involved in photorespiration in green parts of the plant. Additionally, intensive oxidative metabolism of peroxisomes causes damage to their components. Therefore, unnecessary or damaged peroxisomes are degraded by selective autophagy, called pexophagy. This is an important element of the quality control system of peroxisomes in plant cells. Despite the fact that the mechanism of pexophagy has already been described for yeasts and mammals, the molecular mechanisms by which plant cells recognize peroxisomes that will be degraded via pexophagy still remain unclear. It seems that a plant-specific mechanism exists for the selective degradation of peroxisomes. In this review, we describe the physiological role of pexophagy in plant cells and the current hypotheses concerning the mechanism of plant pexophagy.

Background: Treatment of the aortic arch pathologies is technically challenging. In this study we assess early and late outcomes of hybrid aortic arch repairs that comprise extra-anatomic surgical procedures completed by thoracic endovascular interventions [thoracic endovascular aortic repair (TEVAR)]., Methods: Since 2007, 21 patients (8 women and 13 men) with a median age of 48 years have undergone hybrid procedures for aortic arch pathologies. All of them were treated without cardio-pulmonary bypass. All survivors were followed up regularly and imaging examination were performed. A technical success, procedural complications as well as the early and late mortality and morbidity rates were evaluated., Results: All patients survived surgery and TEVAR was technically successful in all of them. However, 2 individuals died (in-hospital mortality rate 9.5%) during in-hospital stay, both due to multi-organ failure (MOF). Additionally, one patient developed symptoms of cerebral stroke, another one of spinal cord ischemia. During the follow-up that ranged from 6 to 118 months and was completed by 100% of the survivors, one patient died 3 years after procedure because of sepsis (aorto-oesophageal fistula prior to intervention) and late vascular graft occlusions were noted in three cases., Conclusions: Hybrid procedures on the aortic arch that comprise surgical and endovascular interventions has become an attractive and safe therapeutic option with acceptable mortality and morbidity rate. They may be considered as a method of choice in treatment of the elderly and high-risk patients., Competing Interests: Conflicts of Interest: The authors have no conflicts of interest to declare.

Background: Introduction of invasive endovascular techniques constituted a real a breakthrough in the treatment of aortic aneurysm dissection and rupture. We assessed the effectiveness and safety of thoracic endovascular aortic repair (TEVAR) in patients with thoracic aortic pathologies., Methods: Between 2007 and 2017, 118 patients with thoracic aortic pathology underwent TEVAR. Among them, 20 (16.9%) patients required hybrid procedures. Stent grafts indication were thoracic aortic aneurysm in 46 (39.0%) patients, type B dissection in 68 (57.6%) patients and other indications in 4 (3.3%). Procedural success rate, in-hospital and late mortality and morbidity were evaluated., Results: The patients were followed-up for a mean of 55 months (range, 6-118 months). The technical success rate was 96%. Five patients died during the first 30 days after procedure (mortality 4.2%), four due to ischemic stroke followed by multi-organ failure and another one hemodynamically significant type I endoleak. Most of them were noted in the first years of our study. Five others died during post-discharged period. Four patients developed neurological complications, including stroke (n=2; 1.7%) and paraparesis (n=2; 1.7%). There were 6 (5.1%) primary (5 type I and 1 type II) and 3 (2.5%) secondary endoleaks (1 type I and 2 type III). Secondary interventions were required in 8 subjects. There was one case of stent collapse and two retrograde aortic dissection., Conclusions: Treatment of descending aortic diseases by using stent graft implantation has become the method of choice, decreasing the risk of open surgery, especially in patients with severe clinical state and comorbidities. However, effectiveness and safety may be achieved by experience team., Competing Interests: Conflicts of Interest: The authors have no conflicts of interest to declare.

Background: Despite advances in mechanical ventilation, severe acute respiratory distress syndrome (ARDS) is associated with high morbidity and mortality rates ranging from 30% to 60%. Extracorporeal Membrane Oxygenation (ECMO) can be used as a "bridge to recovery". ECMO is a complex network that provides oxygenation and ventilation and allows the lungs to rest and recover from respiratory failure, while minimizing iatrogenic ventilator-induced lung injury. In the critical care settings, ECMO is shown to improve survival rates and outcomes in patients with severe ARDS. The primary objective was to present an innovative approach for using high-fidelity medical simulation before setting ECMO program for reversible respiratory failure (RRF) in Poland's first unique regional program "ECMO for Greater Poland", covering a total population of 3.5 million inhabitants in the Greater Poland region (Wielkopolska)., Aim and Methods: Because this organizational model is complex and expensive, we use advanced high-fidelity medical simulation to prepare for the real-life implementation. The algorithm was proposed for respiratory treatment by veno-venous (VV) Extracorporeal Membrane Oxygenation (ECMO). The scenario includes all critical stages: hospital identification (Regional Department of Intensive Care) - inclusion and exclusion criteria matching using an authorship protocol; ECMO team transport; therapy confirmation; veno-venous cannulation of mannequin's artificial vessels and implementation of perfusion therapy and transport with ECMO to another hospital in a provincial city (Clinical Department of Intensive Care), where the VV ECMO therapy was performed in the next 48 h, as training platform., Results: The total time, by definition, means the time from the first contact with the mannequin to the cannulation of artificial vessels and starting VV perfusion on ECMO, did not exceed 3 h - including 75 min of transport (the total time of simulation with first call from provincial hospital to admission to the Clinical Intensive Care department was 5 h). The next 48 h for perfusion simulation "in situ" generated a specific learning platform for intensive care personnel. Shortly after this simulation, we performed, the first in the region: ECMO used for RRF treatment. The transport was successful and exceeded 120 km. During first year of Program duration we performed 6 successful ECMO transports (5 adult and 1 paediatric) with 60% of adult patient survival of ECMO therapies. Three patients in good condition were discharged to home. Two years old patient was successfully disconnected from ECMO and in stabile condition is treated in Paediatric Department., Conclusions: We discovered the important role of medical simulation, not only as an examination for testing the medical professional's skills, but also as a mechanism for creating non-existent procedures. During debriefing, it was found that the previous simulation-based training allowed to build a successful procedural chain, to eliminate errors at the stage of identification, notification, transportation and providing ECMO perfusion therapy., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Efforts directed to reduction of greenhouse gas emissions have led to the introduction of new firing/co-firing technologies and alternative fuels in the coal-based power industry. This has resulted in the formation of combustion products with new properties that can affect the reuse of these wastes and/or pose a hazard to the environment. One of the power-plant fly ash (FA) reuse options is its application as a solidifying dense mixture with water for backfilling mine workings or in engineering constructions. In this comparative study, geotechnical properties of three groups of FA were evaluated: (i) weathered and freshly generated ash from hard coal combustion in conventional pulverized coal boilers without (C-PCA, C-PFA) and with selective non-catalytic reduction installations for NO x reduction (NC-PFA); (ii) FA from hard coal co-firing with alternative fuels: off gases (GC-PFA) or biomass (BC-PFA) in pulverized coal boilers; (iii) FA from coal (C-FFA) or biomass combustion (B-FFA) in fluidized-bed boilers. The transportability, bonding and solidification properties, uniaxial compression strength, and rewetting of dense mixtures were evaluated by measurements of volumetric density, fluidity, water retention capacity, bonding time, solidification time, uniaxial compression test, and slakeability at the background of the FA chemical composition. Calcareous C-FFA > B-FFA displayed the best geotechnical properties. Other materials showed poorer geotechnical properties than FFA and could be aligned in the order BC-PFA > GC-PFA > NC-PFA > C-PFA > C-PCA.

The implemented "ECMO for Greater Poland" program takes full advantage of the ECMO (extracorporeal membrane oxygenation) perfusion therapy to promote health for 3.5 million inhabitants in the region. The predominant subjects of implementation are patients with hypothermia, with severe reversible respiratory failure (RRF), and treatment of other critical states leading to heart failure such as sudden cardiac arrest, cardiogenic shock or acute intoxication. Finally, it promotes donation after circulatory death (DCD) strategy in selected organ donor cases. ECMO enables recovery of organs' function after unsuccessful lifesaving treatment. Because this organizational model is complex and expensive, we use advanced high-fidelity medical simulation to prepare for real-life implementation. During the first four months, we performed scenarios mimicking "ECMO for DCD," "ECMO for ECPR (extended cardiopulmonary resuscitation)," "ECMO for RRF" and "ECMO in hypothermia." It helped to create algorithms for aforementioned program arms. In the following months, three ECMO courses for five departments in Poznan (capitol city of Greater Poland) were organized and standardized operating procedures for road ECMO transportation within Medical Emergency System were created. Soon after simulation program, 38 procedures with ECMO perfusion therapy including five road transportations on ECMO were performed. The Maastricht category II DCD procedures were done four times on real patients and in two cases double successful kidney transplantations were carried out for the first time in Poland. ECMO was applied in two patients with hypothermia, nine adult patients with heart failure, and five with RRF, for the first time in the region. In the pediatric group, ECMO was applied in four patients with RRF and 14 with heart failure after cardiac surgery procedures. Additionally, one child was treated successfully following 200 km-long road transport on ECMO. We achieved good and promising results especially in VV ECMO therapy. Simulation-based training enabled us to build a successful procedural chain, and to eliminate errors at the stage of identification, notification, transportation, and providing ECMO perfusion therapy. We discovered the important role of medical simulation, not only to test the medical professional's skills, but also to promote ECMO therapy in patients with critical/life-threatening states. Moreover, it also resulted in increase of the potential organ pool from DCD in the Greater Poland region., (© 2018 International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc.)

Background: Optimal preservation of endothelial integrity of the vessels used as aortocoronary grafts is a crucial determinant of long-term clinical success of coronary artery bypass grafting (CABG). The purpose of this study was to evaluate an impact of two common techniques to harvest left internal thoracic artery (LITA) on endothelial integrity., Methods: One hundred twenty consecutive patients (84 males and 36 females) with a mean age of 64.9±8.8 years undergoing CABG were randomized to receive pedicled (group P; n=60) or skeletonized (group S; n=60) LITA grafts. During surgery LITA was harvested by the same experienced cardiac surgeon. The most peripheral surplus segments of LITA were obtained and then analysed histologically under light microscope. Additionally, endothelial expression of CD31, CD34, CD133 and nitric oxide synthase (eNOS) were evaluated by means of immunohistochemistry., Results: In both groups, no cases of major arterial wall damage such as disruption, dissection, thrombosis or subadventitial hematoma were noted on LITA cross sections. Immunohistochemical assessment of protein expression revealed no differences in endothelial expression of CD133, CD34 antigens (markers of regeneration potential) and eNOS (indicating preserved functional integrity) between studied groups. Contrary to them, endothelial immunoreactivity of CD31, a marker of the morphological integrity of the endothelium, was revealed to be stronger in group P., Conclusions: The skeletonized method of LITA harvesting may be associated with worse preservation of morphological integrity of endothelium but without compromising functional integrity and potential for tissue regeneration., Competing Interests: Conflicts of Interest: The authors have no conflicts of interest to declare.

Background: Simulation is widely accepted as an important tool in training and educating healthcare providers. The first regional polish extracorporeal membrane oxygenation (ECMO) program called "ECMO for Greater Poland" was recently started., Methods: We present a prototype for ECMO prepared for high-fidelity medical simulation in extracorporeal life support. ECMO therapy is a complex, difficult and expensive therapy in patient care. We have constructed an advanced ECMO simulation prototype, which can be used as a training tool in scenarios that prepare for real-life experiences. The "ECMO for Greater Poland" program uses high-fidelity simulation as a superior tool to simulate several complex clinical scenarios, and consequently train healthcare providers in rare, complicated and expensive procedures. The training course is standardized and allows repeatable training, improvement of skills, and an objective verification of trained skills., Results: The ECMO simulation prototype is designed to replicate the physiological circulatory system and simulate several scenarios (i.e., bleeding, low pressure, occlusion, reaction for proper and incorrect pharmacological treatment). The electronic core control unit (CCU) with silicone tubes, artificial vessels (modified polyethylene) and analog components can be connected to an ECMO machine to emulate the human body during an ECMO simulation. If necessary, damaged and used parts can easily be replaced. The total cost of the simulator is approximately 450 and 50 USD for disposable parts., Conclusions: This newly developed advanced ECMO simulation prototype was recently introduced into education and regularly training of healthcare providers of the "ECMO for Greater Poland" program. The simulation based training program is financially affordable and enables clinical teaching in a wider range of clinical scenarios. The ECMO simulation prototype consequently improves level of expertise of the healthcare providers and finally improves quality in patient care., Competing Interests: Conflicts of Interest: The authors have no conflicts of interest to declare.

Introduction: Whether or not the source of aortic pathology is Marfan syndrome (MFS) or other processes leading to development of abdominal aorta aneurysms (AAA), the awareness of pathology may lead to an emotional upset and low assessment of satisfaction with life., Aim: To assess, in regard to MFS patients with aortic pathology and to abdominal aortic aneurysm patients: 1) whether or not self-efficacy (SE) and health locus of control (HLoC) affect the patients' satisfaction with life; 2) whether the two groups of patients differ in terms of mental dispositions., Material and Methods: The study population consisted of 16 MFS patients with aortic pathology and 16 AAA patients, 9 men and 7 women in each group. The mean age of the MFS patients was 28.5 ±8.214, and of the AAA patients 64.25 ±7.019. The following scales were applied: Generalized Self-Efficacy Scale, Satisfaction With Life Scale, Multidimensional Health Locus of Control Scale., Results: Abdominal aorta aneurysms patients compared to MFS patients gave a higher rating for SE ( MD = 33.94 and MD = 29.56), internal health locus of control ( MD = 25.00 and MD = 21.13), external personal HL o C ( MD = 24.50 and MD = 19.25), external impersonal HLoC ( MD = 23.06 and MD = 18.25), and satisfaction with life ( M = 22.06 and M = 20.13). Internal and external HL o C were significantly lower in MFS patients compared to AAA patients., Conclusions: In patients with aortic diseases, special attention must be paid to the state of personal resources (PR). Interactions made by medical professionals should focus on enhancing PR supporting the patients' self-knowledge on their SE. This will help to improve their satisfaction with life and form a positive attitude to the illness.

Background: Aortic stenosis and coronary artery disease (CAD) sharing similar risk factors are associated with aging of the human population., Aim: The purpose of this study was to examine whether age affects clinical presentation, intraoperative management, and outcomes of patients who undergo simultaneous operations of aortic valve replacement (AVR) and coronary artery bypass grafting (CABG)., Methods: The study involved 452 consecutive patients aged 64.8 ± 8.2 years (range 38-79 years), who underwent combined AVR and CABG between 2005 and 2015. They were divided into three groups: Y (young; below the first quartile; n = 114), M (middle-aged; 58-71 years; n = 225) and E (elderly; above the third quartile; n = 113). Pre- and intraoperative variables were analysed. The deaths that occurred in hospital and throughout follow-up were defined as cardiac- or non-cardiac-related. The probability of survival was calculated with the use of Kaplan-Meier curves., Results: Coronary artery disease was more extensive in group E than in group Y (p < 0.05). Complete myocardial revasculari-sation was performed in 94.1%, 76.2%, and 62.8% in groups Y, M, and E, respectively (p < 0.05). In-hospital mortality was 2.0%, 5.3%, and 6.4%, in groups Y, M, and E, respectively. Early morbidity was significantly higher in group E than in groups M or Y. The 12- and 60-month freedom from cardiac-related death was higher in group Y (0.98 ± 0.02 and 0.94 ± 0.03) than in group E (0.93 ± 0.02 and 0.85 ± 0.03; p = 0.023, respectively). Left ventricular ejection fraction below 0.4 and incomplete revascularisation were associated with worse prognosis, particularly in group E., Conclusions: Elderly patients undergoing combined procedures of AVR and CABG having more extensive CAD less often receive complete revascularisation, are at higher risk of early organ failure, and present markedly reduced rates of freedom from cardiac-related deaths throughout follow-up than younger subjects.

The number of people waiting for a kidney or liver transplant is growing systematically. Due to the latest advances in transplantation, persons after irreversible cardiac arrest and confirmation of death have become potential organ donors. It is estimated that they may increase the number of donations by more than 40%. However, without good organization and communication between pre-hospital care providers, emergency departments, intensive care units and transplantation units, it is almost impossible to save the organs of potential donors in good condition. Various systems, including extracorporeal membrane oxygenation (ECMO), supporting perfusion of organs for transplantation play a key role. In 2016 the "ECMO for Greater Poland" program was established. Although its main goal is to improve the survival rate of patients suffering from life-threatening cardiopulmonary conditions, one of its branches aims to increase the donation rate in patients with irreversible cardiac arrest. In this review, the role of ECMO in the latter group as the potential organ donors is presented.

Maintaining the viability of organs from donors after circulatory death (DCD) for transplantation is a complicated procedure, from a time perspective in the absence of appropriate organizational capabilities, that makes such transplantation cases difficult and not yet widespread in Poland. We present the procedural preparation for Poland's first case of organ (kidney) transplantation from a DCD donor in which perfusion was supported by extracorporeal membrane oxygenation (ECMO). Because this organizational model is complex and expensive, we used advanced high-fidelity medical simulation to prepare for the real-life implementation. The real time scenario included all crucial steps: prehospital identification, cardiopulmonary resuscitation (CPR), advanced life support (ALS); perfusion therapy (CPR-ECMO or DCD-ECMO); inclusion and exclusion criteria matching, suitability for automated chest compression; DCD confirmation and donor authorization, ECMO organs recovery; kidney harvesting. The success of our first simulated DCD-ECMO procedure in Poland is reassuring. Soon after this simulation, Maastricht category II DCD procedures were performed, involving real patients and resulting in two successful double kidney transplantations. During debriefing, it was found that the previous simulation-based training provided the experience to build a successful procedural chain, to eliminate errors at the stage of identification, notification, transportation, donor qualifications and ECMO organ perfusion to create DCD-ECMO algorithm architecture.

Background: We assess the effectiveness and our experience in emergency thoracic endovascular aortic repair (TEVAR) in patients with post-traumatic acute thoracic aortic injury (TAI) and associated multiorgan trauma. TAI is a life-threatening condition. It usually results from a sudden deceleration caused by vehicle accident, a fall or some other misfortune. Techniques of endovascular aortic repair have become promising methods to treat emergent TAI., Methods: Since 2007, 114 patients with thoracic aorta pathologies have been treated by TEVAR. Our study involved 15 (incl. 14 men) of them (13%) who underwent stent graft implantation for post-traumatic either aortic rupture or pseudoaneurysm. The procedural access was limited to small skin incision in one groin and percutaneous puncture of the contralateral femoral artery. We evaluated technical success, early and long-term mortality, complication rate of procedure and throughout clinical and instrumental follow-up., Results: Technical success rate was 100%. All patients survived the endovascular interventions. No additional procedures or conversions to open surgery were necessary. After the operation, none of the patients had symptoms of stroke or spinal cord ischemia (SCI). No serious stent-graft-related adverse events such as endoleak, infection or migration were noted during follow-up period that ranged from 6 to 108 months., Conclusions: In our department, techniques of TEVAR with stentgraft implantation have become methods of choice in treatment of traumatic TAIs since they have enabled to minimize operational risk, particularly in unstable multitrauma patients in severe clinical status. TEVAR for TAI performed in emergency settings provide favorable long-term results., Competing Interests: Conflicts of Interest: The authors have no conflicts of interest to declare.

We present the case of a 33-year-old man with middle aortic syndrome. The final diagnosis was established with magnetic resonance imaging. He underwent a successful aorto-aortic bypass. Two-year follow-up imaging showed the new graft was patent, with no abnormalities at the anastomosis sites. At the last follow-up examination he was asymptomatic with no neurological dysfunction.

Patients with ascending aortic aneurysm undergoing complex surgical procedures are at increased risk of early postoperative excessive blood loss. The aim of this study was to analyze safety and efficacy of routine transfusions of platelet (PLT) concentrates in reduction of hemorrhagic postoperative complications. The study involved 396 consecutive patients (289 males and 107 females) with the mean age of 55.9 ± 13.6 years who underwent elective operations for aortic aneurysms. They were divided retrospectively into two groups, without (group A; n = 123) or with the routine use of PLTs (group B; n = 273). PLTs were transfused intraoperatively just after completion of cardiopulmonary bypass. Twelve patients in group A (9.8%) and 10 (3.7%) in group B required re-thoracotomy due to hemorrhage (p = 0.027). Routine transfusions of PLT concentrates reduced postoperative incidence of excessive pericardial effusion from 24.1% in group A to 2.1% in group B (p = 0.002). In a consequence, significantly less units (p < 0.0001) of red blood concentrates and fresh frozen plasma were transfused in group B than in group A. The rates of other adverse events in the early postoperative period did not differ between groups. Patients with pericardial effusion required 6.3 ± 2.7 additional days of hospitalization due to surgical re-intervention. Neither blood transfusion-related infections nor adverse reactions were noted. In conclusion, routine intraoperative transfusions of PLT concentrates in patients with ascending aortic aneurysms significantly reduced a need for re-intervention due to both early bleeding and late cardiac tamponade.

Different ions typically used in downstream processing of biologicals are evaluated for their potential in anion exchange chromatography of an industrially produced, pandemic influenza H1N1 virus. Capacity, selectivity and recovery are investigated based on single step elution parallel chromatography experiments. The inactivated H1N1 feedstream is produced in Madin-Darby Bovine Kidney cells. Interesting effects are found for sodium phosphate and sodium citrate. Both anions are triprotic kosmotropes. Anion exchange chromatography generally offers high scalability to satisfy sudden demands for vaccines, which may occur in case of an emerging influenza outbreak. Appropriate pH conditions for H1N1 adsorption are determined by Zeta potential measurements. The dynamic binding capacity of a salt tolerant polyamine-type resin is up to 6.4 times greater than the capacity of a grafted Q-type resin. Pseudo-affinity interactions of polyamines with the M2 protein of influenza may contribute to the obtained capacity increase. Both resins achieve greater capacity in sodium phosphate buffer compared to Tris/HCl. A recovery of 67% and DNA clearance close to 100% without DNAse treatment are achieved for the Q-type resin. Recovery of the virus from the salt tolerant resin requires the use of polyprotic acids in the elution buffer. 85% of the DNA and 60% of the proteins can be removed by the salt tolerant resin. The presence of sodium phosphate during anion exchange chromatography seems to support stability of the H1N1 particles in presence of hydrophobic cations., (Copyright © 2016 The Authors. Published by Elsevier B.V. All rights reserved.)

Introduction: Cardiac tamponade is a life-threatening clinical entity that requires emergent treatment. A variety of therapeutic methods have been applied. The purpose of this retrospective analysis was to study the efficacy of emergent surgical pericardiotomy in both the relief of cardiac tamponade and in the prevention of recurrence of pericardial effusion., Material and Methods: This study involved 90 consecutive patients (58 males and 32 females) with a mean age of 57.4 ± 14.1 years, who underwent emergent pericardiotomy in the years 2006 to 2011 due to symptomatic primary cardiac tamponade. At the end of the follow-up period all living subjects had control echocardiographic examination. Survival analysis was performed with the use of the Kaplan-Meier method., Results: The mean duration time of surgery was 14.2 ± 4.5 minutes. All patients survived surgery but one died during in-hospital stay. During the post-discharge follow-up period (median 49 months) 32 patients died for any reason. One-year and four-year probability of survival was 0.68 ± 0.05 and 0.64 ± 0.05, respectively. Malignancy diagnosis was associated with significant negative impact on survival. One-year and four-year probability of survival was 0.56 ± 0.06 and 0.53 ± 0.06 for cancer patients while it was 0.93 ± 0.05 and 0.89 ± 0.06 for the others, respectively. In two cases, only cancer patients, re-intervention due to effusion recurrence was necessary., Conclusions: Pericardiotomy, although invasive, is a safe method to relieve cardiac tamponade. It is also very efficient in the prevention of recurrence of pericardial effusion, even in cancer patients.

This paper is the second one of two companion papers. It presents results of a study aimed at assessing the effect of real time weathering transformations of Coal Combustion Residuals (CCRs) on trace element binding/release and its environmental implications. The study is based on the chemical composition of pore solutions extracted from primary alkaline Class F CCRs, 0 to >40 years old, sampled from the surface layer and vertical profiles at four selected typical CCRs impoundments. The long-term weathering transformations were found to lead to gradual acidification to pH < 4 of this primary alkaline material, due to internal processes of mineral formation/dissolution. Direct analysis of the pore solutions and a statistical analysis have shown different susceptibility of many trace elements to release during internal acidification processes occurring at consecutive Wash-out I (pH > 8), Dissolution II (8 ≥ pH ≥ 7) and Delayed Release III (pH < 7) stages of weathering compared to that at external sources of pH. The elements occurring in the CCRs are represented by three major groups showing the highest release to pore water: (a) within the acidic pH range (Na, K, Zn, Fe, Cd, Mo, Cr, B, Mn, Be and Ni; (b) within the near-neutral pH range (Al, V, Ba, Cu and Ag) and also Sb, Hg and Co not analyzed at pH < 7; (c) within the alkaline pH range (Ca, Mg, Pb, As, Se, Tl). Elements whose concentrations exceeded the threshold values for good chemical status of groundwater (TVs) at all weathering stages over the entire pH range studied were K, Al, B, Cr, Mo, V, As, Se, Sb and Hg, while Na, Zn, Fe and Cd showed particularly high delayed release at pH < 7, thus confirming the need of a precautionary approach to CCRs uncontrolled disposal and bulk reuse as common fill in view of long term environmental safety and sustainability., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Coal combustion residuals (CCRs) are one of the most abundant high-volume waste materials disposed in impoundments worldwide. Some methods of CCR recycling, e.g. their use as structural fill for low lying areas or as soil amendment, also expose this material to atmospheric conditions. Combustion processes result in concentration of trace elements in CCRs at about an order of magnitude compared to coal. In order to assess an effect of long-term weathering transformations of CCRs on trace element binding/release, a study has been carried out. It is based on the chemical composition of real pore solutions extracted from the most abundant primary alkaline Class F bituminous CCRs, 0 to >40 years old, sampled from the surface layer and vertical profiles at four different impoundments. In this part of the study, results of a hydrogeochemical simulation of the saturation state of real pore solutions with respect to mineral phases of CCRs with use of the PHREEQC program, related to actual pH values reflecting the full cycle of weathering transformations, have been discussed. This study is the first geochemical proof of the general trend towards a progressive acidification up to pH < 4 of primary alkaline CCRs due to release of protons during internal processes of formation of gibbsite and aluminosilicate minerals, buffered by carbonates at the alkaline - near-neutral stages, and followed by parallel dissolution and buffering by aluminosilicates at pH < 7 after carbonate depletion, to the level up to pH∼3.5-4.0. The intrinsic geochemical changes have resulted in the different susceptibility of trace elements to release and associated changes in risk to the environment at consecutive stages of weathering., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Introduction: The severity of coronary artery disease (CAD) may have an impact on the outcomes of patients (pts) after aortic valve replacement (AVR) and coronary artery bypass grafting (CABG)., Aim: The aim of the study was to analyze survival after simultaneous AVR and CABG with respect to CAD severity., Material and Methods: The study involved 143 consecutive pts (40 women and 103 men) with a mean age of 65.1 ± 7.7 years treated between 2006 and 2009. The indication for surgery was aortic stenosis accompanied by left main or three-vessel disease (group A; n = 43) and by single- or two-vessel disease (group B; n = 100). In-hospital and late mortality were analyzed. Post-discharge survival was estimated using the Kaplan-Meier method. Moreover, selected preoperative clinical and echocardiographic data as well as intraoperative variables were compared between the groups., Results: In-hospital mortality was 4.7% in group A and 3.0% in group B (NS). The 12-month and 48-month survival probability rates were 0.88 ± 0.05 and 0.83 ± 0.06 in group A, and 0.97 ± 0.01 and 0.92 ± 0.03 in group B, respectively (p < 0.05). Patients in group A and B differed (p < 0.05) with respect to the preoperative prevalence of arterial hypertension (65.1% vs. 42.0%) and atrial fibrillation (18.6% vs. 6.0%) as well as with regard to the rate of complete revascularization (20.9% vs. 85.0%, group A and B, respectively)., Conclusions: Coronary artery disease severity impacts long-term survival after combined AVR and CABG. Patients with left main or three-vessel disease more often undergo incomplete surgical revascularization, and this fact may be one of the predictors of an unfavorable outcome.

We present a case of the native valve used to complete closure of a ruptured aneurysm of the sinus of Valsalva. Aneurysm of the sinus of Valsalva is rare and a non-coronary artery is affected in only 20% of cases. To close the rupture, we decided to use a non-coronary leaflet in a young patient with moderate aortic stenosis and fibrosis of the leaflets. In our opinion, use of a native non-coronary valve leaflet should be considered when making intra-operative decisions for repair of non-coronary aneurysm of the sinus of Valsalva.

Introduction: There has been a growing interest in off-pump coronary artery bypass (OPCAB) grafting in recent years. Beating-heart surgery is believed to be less invasive as it allows the side effects of extracorporeal circulation to be avoided., The Aim of the Study: The aim of the study was to compare blood product transfusion rates between two groups of patients undergoing surgery for ischemic heart disease with either the off-pump technique or using cardiopulmonary bypass (CPB)., Material and Methods: There were 152 patients enrolled in the prospective randomized study. All procedures were elective. There were 84 patients (62 men and 20 women) at the mean age of 63.74 ± 7 years who underwent OPCAB (group I), and 68 patients (54 men and 14 women) at the mean age of 63.51 ± 6 years who underwent cardiopulmonary bypass (group II)., Results: There were no perioperative deaths. The mean number of grafts was 2.27 ± 0.3 (OPCAB group) and 2.63 ± 0.6 (CPB group) (p < 0.05). The mean number of packed red blood cells transfused in the OPCAB group was 2.31 ± 0.18 units/patient and 3.94 ± 0.30 units/patient in the CPB group (p < 0.05). The mean number of fresh frozen plasma units transfused was 1.13 ± 0.13 in the OPCAB group vs. 1.57 ± 0.15 in the CPB group (p < 0.05). There were 12 patients (14%) in the OPCAB group who had no transfusion., Conclusions: One of the most important advantages of the OPCAB technique is that it makes it possible to reduce the rate of blood product transfusions.

Background: Venous aortocoronary graft arterialization may precede a preterm occlusion in some coronary artery bypass grafting (CABG) patients. The aim of the present study was to identify ultrastructural variations in the saphenous vein wall that may have an impact on the development of venous graft disease in CABG patients., Methods: The study involved 365 consecutive patients with a mean age of 62.9 ± 9.4 years who underwent isolated CABG. The thickness and area of the whole venous wall, the tunica intima, the tunica media and the adventitia and the number and shape (length, thickness and length/thickness ratio) of the nuclei in the medial smooth muscle cells nuclei in the distal saphenous vein segments were evaluated by ultrastructural studies. Patients were followed up for 41 to 50 months (mean 45.1 ± 5.1). Saphenous vein graft patency was assessed by follow-up coronary angiography. Logistic regression models were used to identify independent risk factors for late graft failure., Results: In 71 patients significant lesions in the saphenous vein grafts were observed. The whole venous wall thickness (437.5 µm vs. 405.5 µm), tunica media thickness (257.2 µm vs. 211.5 µm), whole venous wall area (2.23 mm(2) vs. 2.02 mm(2)) and tunica media area (1.09 mm(2) vs. 0.93 mm(2)) were significantly larger for this group of patients than for those without graft disease. In the latter group more elongated smooth muscle cell nuclei (higher length/thickness ratio) were found in the tunica media of the saphenous vein segments. Thickening of the saphenous vein tunica media and chunky smooth muscle cell nuclei were identified as independent risk factors for graft disease development., Conclusions: Saphenous vein tunica media hypertrophy (resulting in wall thickening) and chunky smooth muscle cell nuclei might predict the development of venous graft disease.

Background: Outcome after surgery for cardiac myxoma is very good, although due to relatively low prevalence in general population there are only a few reports with long-term follow-up that involved large number of patients., Aim: To evaluate short- and long-term outcome after myxoma removal in a single cardiac surgical centre., Methods: The study involved 64 patients (42 women and 22 men) at the age ranging from 21 to 79 (mean 54.1 ± 18.8) years who were treated between 1981-2009 in our institution. All patients were operated on from median sternotomy and cardiopulmonary bypass. Additionally, in 6 (9.4%) patients coronary artery bypass grafting was performed (1 to 3 grafts were implanted) and in other 2 (3.1%) ostium secundum atrial septal defect was closed. Patient survival and complications rate were assessed using the Kaplan-Meier curves. Moreover, functional status at the last follow-up examination was evaluated., Results: Two patients died in the perioperative period (in-hospital mortality 3.1%) and 4 during follow-up ranging from 5 to 320 months (median 81 months, cumulated follow-up period 5376 patient-months). Four other patients were lost from follow-up. One-year survival probability was 0.95 ± 0.03, 5-year - 0.88 ± 0.04 and 10-year - 0.84 ± 0.06. Estimated 10-year freedom from cardiac complications was 0.72 ± 0.08, hospital readmission 0.80 ± 0.07 and cardiac surgical reintervention 0.96 ± 0.03. None of the patients had tumour recurrence. At the last follow-up examination, 90.7% of patients were in functional NYHA classes I or II., Conclusions: Surgery for cardiac myxoma is associated with low long-term mortality and morbidity. Functional status following operation improved significantly after surgery.

Recently it was shown that oxidative stress has a negative influence on immunological response. The aim of the study was to investigate the influence of N-acetylcysteine on intracellular oxidative stress and cytokine synthesis in peripheral blood lymphocytes in children with end stage renal disease (ESRD). MATERIAL AND METHODS. We examined 25 children (age 2-16 ys.) with ESRD. To determine oxidative stress we used dihydrorhodamine 123 (DHR). Intracellular oxidation of DHR in T. lymphocytes reflected intracellular oxidative stress within cells. The intracellular synthesis of cytokines (IL-2, IFN-r, IL-4, IL-6) was detected with flow cytometty RESULTS. We found lower intracellular stress and higher cytokines synthesis after incubation with N-acetylcysteine (NA C) in all subpopulations of lymphocytes. CONCLUSIONS. Our results shows that patients with ESRD present increased oxidative stress in T lymphocytes which may lead to decreased cytokines synthesis and abnormal immune response. NAC has favorable influence on these abnormalities.

The synthesis of a range of highly functionalized peptidomimetic macrocycles has been accomplished using ring-closing metathesis and enyne tandem cross-metathesis-ring-closing metathesis reactions. This approach gives access to rigidified macrocycles modeled on the structures of cyclic peptides and designed to be biologically stable. The potential for peripheral functionalization of these templates has been demonstrated using Diels-Alder reactions, palladium(0) coupling reactions, and amide formation both in the solution phase and using polymer-supported syntheses.