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OBJECTIVE: An increased cardiovascular mortality and morbidity has been widely reported in patients with atrial fibrillation (AF). In this study, a subanalysis of the AntiThrombotic Agents Atrial Fibrillation (ATA‐AF) is performed with the aim to evaluate estimated glomerular filtration rate (eGFR) as an independent prognostic marker of cardiovascular mortality and morbidity in patients with AF. METHODS AND RESULTS: The ATA‐AF study enrolled 7148 patients with AF, in 360 Italian centers. The eGFR was calculated from data reported in patient notes or hospital database. This post‐hoc analysis included 1097 AF patients with eGFR data available and 1‐year clinical follow‐up. The endpoint was assessed as cardiovascular mortality and/or hospital admission for cardiovascular causes at follow‐up. Patients were also divided in two groups according to the eGFR (

Background and objectives: T regulatory lymphocytes (Treg) are one of the subsets of T-lymphocytes involved in the interaction of neoplastic tumors and the host immune system, and they may impair the immune reaction against cancer. It has been shown that Treg are increased in the peripheral blood of patients with various cancers. In colorectal cancer, the prognostic role of Treg remains controversial. Colorectal cancer is a heterogenous disease, with many variations stemming from its primary tumor location. The aim of this study is to analyse the relationship between the amount of Treg in the peripheral blood of patients with left-sided colorectal cancer in various stages of disease and long-term survival. Materials and Methods: A prospective analysis of 94 patients with left-sided colorectal cancer and a group of 21 healthy volunteers was carried out. Treg levels in peripheral blood were analysed using flow cytometry. Results: There was a statistically significant difference between the amount of Treg in the Ist and IInd TNM stages (p = 0.047). The number of Treg in the entire study group was significantly lower than in the control group (p = 0.008) and between patients in stages II and III and the control group (p = 0.003 and p = 0.018). The group of pT3+pT4 patients also had significantly lower Treg counts in their peripheral blood than the control group (p = 0.005). In the entire study group, the level of Treg cells in the peripheral blood had no influence on survival. The analysis of the TNM stage subgroups also showed no difference in survival between patients with “low” and “high” Treg counts. Conclusion: The absolute number of Treg in the peripheral blood of patients with left-sided colorectal cancer was significantly decreased in comparison to healthy controls, especially for patients with stage II+III disease. Treg presence in the peripheral blood had no impact on survival.

The successes and failures of water reuse schemes are shaped by complex interrelationships between technological, economic, and socio-political factors. However, it has long been recognized that the main challenges to more effective water management are largely social rather than technical. This article reviews the recent literature (2007–2017) to analyze driving factors associated with farmers’ concerns and public perception of reclaimed wastewater for irrigation. The aim of the paper is to synthetize how both environmental and health risks and the yuck factor could be addressed in order to promote mutual understanding between farmers and the public. Results show: (1) how farmers and the public perceive environmental and health risks in a similar way, (2) how the yuck factor is more noticeable for the public than farmers, and (3) how constructed wetlands, reclaimed water exchange consortiums, product certification, and direct site visits to water reuse infrastructure could be promoted in order to foster understanding between farmers and the public. The article concludes by providing key research questions for managers and public authorities relating to how to focus on the study of technical and social issues related to water reuse This research was funded by Juan de la Cierva postdoctoral research fellow awarded to Sandra Ricart (grant number FJCI-2015-24346), and by the national competitive project PLUVIRESMED, funded by the Spanish Ministry of Economy and Competitiveness (grant number CSO2015-65182-C2-2P).

Wstęp. Główne czynniki ryzyka wielu chorób wynikają z nieprawidłowych zachowań zdrowotnych i są przyczyną m. in. rozwoju nowotworów złośliwych, w tym raka nerki. Jednym z elementów zachowań zdrowotnych jest określenie stanu odżywienia, celem wczesnego wykrycia zaburzeń i podjęcia interwencji. Cel pracy. Określenie i porównanie zachowań zdrowotnych ze stanem odżywienia pacjentów z rozpoznanym rakiem nerki. Materiał i metody. Badanie przeprowadzono wśród 100 osób, u których wykonany był zabieg operacyjny z powodu raka nerki. W badaniach zastosowano metodę analizy dokumentacji medycznej oraz sondaż diagnostyczny z wykorzystaniem narzędzia standaryzowanego – Inwentarza Zachowań Zdrowotnych. Wyniki. Wskaźnik zachowań zdrowotnych dla ogółu badanych wyniósł średnio 75,56 pkt. Najwyższe wyniki uzyskano w kategorii zachowań profi laktycznych (średnia 3,89), następnie w kategorii pozytywnych nastawień psychicznych (średnia 3,34) oraz w kategorii praktyk zdrowotnych (średnia 2,91). Najniższy wynik uzyskano w kategorii prawidłowych nawyków żywieniowych (średnia 2,49). Stwierdzono zależność pomiędzy wiekiem, BMI, a kategorią prawidłowe nawyki żywieniowe (p ≤ 0,001) oraz pomiędzy wiekiem, BMI, a kategorią praktyki zdrowotne (p < 0,001). Wnioski. W całej badanej grupie najniższe wyniki uzyskano w kategorii prawidłowych nawyków żywieniowych. Pomimo stwierdzenia w całej grupie najniższych wyników w kategorii prawidłowych nawyków żywieniowych, pacjenci w starszym wieku i z wyższym BMI uzyskali wyższe wyniki, ale w zakresie praktyk zdrowotnych uzyskali wyniki niskie. Introduction. The main risk factors of numerous diseases result from abnormal health behaviors and among others are causing development of malignant tumors, including kidney cancer. One of the elements of health behaviors is to determine the state of nutrition, in order to early detect disorders and to undertake interventions. Aim of the study. Determination and comparison of health behaviors with the nutritional status of patients with diagnosed kidney cancer. Material and methods. The study was conducted among 100 people who underwent surgery because of kidney cancer. The research used the method of analysis of medical documentation and a diagnostic survey with a tool – Health Behavior Inventory. Results. The average index of health behaviors for all respondents was 75.56 points. The highest results were obtained in the category of preventive behaviors (mean 3.89), then in the category of positive mental attitudes (mean 3.34) and in the category of health practices (mean 2.91). The lowest result was obtained in the category of proper eating habits (mean 2.49). The relationship between age, BMI, and the category of normal eating habits (p ≤.001) was observed as well as between age, BMI, and the category of a health practice (p < 0.001). Conclusions. The lowest results were obtained in the category of proper eating habits. Despite obtaining the lowest results in the category of normal eating habits in the whole group, among patients with a higher BMI and in the elderly patients, normal eating habits were found at a higher level, but their health practices remain at a low level.

Background & Aims: Surgery in cirrhosis is associated with a high morbidity and mortality. Retrospectively reported prognostic factors include emergency procedures, liver function (MELD/Child-Pugh scores) and portal hypertension (assessed by indirect markers). This study assessed the prognostic role of hepatic venous pressure gradient (HVPG) and other variables in elective extrahepatic surgery in patients with cirrhosis. Methods: A total of 140 patients with cirrhosis (Child-Pugh A/B/C: 59/37/4%), who were due to have elective extrahepatic surgery (121 abdominal; 9 cardiovascular/thoracic; 10 orthopedic and others), were prospectively included in 4 centers (2002–2011). Hepatic and systemic hemodynamics (HVPG, indocyanine green clearance, pulmonary artery catheterization) were assessed prior to surgery, and clinical and laboratory data were collected. Patients were followed-up for 1 year and mortality, transplantation, morbidity and post-surgical decompensation were studied. Results: Ninety-day and 1-year mortality rates were 8% and 17%, respectively. Variables independently associated with 1-year mortality were ASA class (American Society of Anesthesiologists), high-risk surgery (defined as open abdominal and cardiovascular/thoracic) and HVPG. These variables closely predicted 90-, 180- and 365-day mortality (C-statistic >0.8). HVPG values >16 mmHg were independently associated with mortality and values ≥20 mmHg identified a subgroup at very high risk of death (44%). Twenty-four patients presented persistent or de novo decompensation at 3 months. Low body mass index, Child-Pugh class and high-risk surgery were associated with death or decompensation. No patient with HVPG 0.63 developed decompensation. Conclusions: ASA class, HVPG and high-risk surgery were prognostic factors of 1-year mortality in cirrhotic patients undergoing elective extrahepatic surgery. HVPG values >16 mmHg, especially ≥20 mmHg, were associated with a high risk of post-surgical mortality. Lay summary: The hepatic venous pressure gradient is associated with outcomes in patients with cirrhosis undergoing elective extrahepatic surgery. It enables a better stratification of risk in these patients and provides the foundations for potential interventions to improve post-surgical outcomes.

Relació de les fitxes d’indrets de la Conca de Barberà

The caldera collapse of Deception Island Volcano, Antarctica, was comparable in scale to some of the largest eruptions on Earth over the last several millennia. Despite its magnitude and potential for far-reaching environmental effects, the age of this event has never been established, with estimates ranging from the late Pleistocene to 3370 years before present. Here we analyse nearby lake sediments in which we identify a singular event produced by Deception Island's caldera collapse that occurred 3980 ± 125 calibrated years before present. The erupted tephra record the distinct geochemical composition of ejecta from the caldera-forming eruption, whilst an extreme seismic episode is recorded by lake sediments immediately overlying the collapse tephra. The newly constrained caldera collapse is now the largest volcanic eruption confirmed in Antarctica during the Holocene. An examination of palaeorecords reveals evidence in marine and lacustrine sediments for contemporaneous seismicity around the Antarctic Peninsula; synchronous glaciochemical volcanic signatures also record the eruption in ice cores spread around Antarctica, reaching >4600 km from source. The widespread footprint suggests that this eruption would have had significant climatic and ecological effects across a vast area of the south polar region.

The increasing amount of renewable power generation systems is a challenging issue for the control and operation of the electrical networks. One of the main issues is their lack of inertia, which is becoming a greater problem as much as the share of the power plants based on traditional synchronous generators gets reduced. In this regard, the new grid codes ask these plants to provide new functionalities such as the frequency support and inertia emulation. In this paper, a synchronous power controller for grid-connected converters is proposed as a good solution for the renewable generation systems with energy storage. It provides inertia, damping, and flexible droop characteristics. Different from the faithful replication of the swing equation of synchronous machines, an alternative control structure is proposed, by which the damping and inherent droop slope can be configured independently to meet the requirements in both dynamics and frequency regulations. Analysis and experimental results are both shown to validate the proposed controller.

Background Laparoscopic surgery has become the standard treatment for colorectal cancer. A tumor that does not involve serosa is invisible intraoperatively, and manual palpation of the tumor during laparoscopy is not possible. Therefore, accurate localization of the neoplastic infiltrate remains one of the most important tasks prior to elective laparoscopic surgery. The aim of this study was to evaluate the utility of a magnetic endoscopic imaging (MEI) for precise preoperative endoscopic localization of neoplastic infiltrate within the large bowel. Materials and methods The study enrolled 246 patients who underwent elective surgery for colorectal cancer in 2012–2015 with accurate preoperative colonoscopic localization of the tumor. The analysis concerned patients with neoplastic infiltrate localized more than 30 cm from the anal verge. For evaluative purposes and accuracy of localization, the intestine was divided anatomically into 13 parts. Colonoscopic examinations were conducted with two types of endoscopes: group I—with MEI and group II—without MEI. Patients were assigned to the groups by random allocation. Ultimate confirmation of the tumor localization was accomplished by intraoperative evaluation. Results Group I involved 127 patients and group II 129. The two groups were compared in terms of age, sex, BMI and frequency of previous abdominal procedures. Proper localization of the lesion was confirmed in 95.23 % of group I patients and in 83.19 % of group II patients (p Conclusions A magnetic endoscopic imaging allows more accurate localization of neoplastic infiltrate within the large intestine compared to standard colonoscopy alone, especially within the sigmoid colon. This method can be particularly useful in planning and performing laparoscopic procedures to diminish the likelihood of improper bowel segment resection. ClinicalTrials.gov number NCT01688557

The TNM pN stage based on the number of metastatic lymph nodes is an independent prognostic factor in gastric cancer. Many studies have highlighted the phenomenon of stage migration and problems in comparing groups of patients with different numbers of total lymph nodes harvested within TNM staging. The current version of UICC/AJCC and JGCA TNM classifications postulates a minimal number of 16 lymph nodes as the base for N stage determination. Alternative systems such as lymph node ratio (LNR), positive to negative lymph node ratio (PNLNR), and LOGODDS (or LODDS), were implemented to increase the quality of LN assessment. These methods have reached the background in the literature, but to date no standard approach according to the cut-offs for the stages has been implemented. LOGODDS is the method that most reflects the number of harvested lymph nodes. The rationale for alternative staging methods, their correlations, and limitations are presented.

Introduction. The Vipera berus (common viper) is the only species of venomous snake found in Poland. The aim of this study was to determine to what extent coagulopathy has occurred as a post-bite complication. Materials and method. The medical records of 138 adult patients in the Sucha Beskidzka hospital with the diagnosis of snake bite between 2001–2014 were retrospectively analyzed. Demographic, clinical and laboratory data were collected. Antivenom was given to all patients, except one, with snake bites, but laboratory test were taken prior to administration of antivenom. Obtained results were compared to those of the control group, composed of 176 adults hospitalized in the same period for an elective laparoscopic cholecystectomy. Results. The mean platelet count in the study group was 239.94×109/L (SD=56.56) and 248.77×109/L (SD=57.82) in the control group. In 98% of the study group and 100% of the control group the platelet value (PLT) fell within laboratory norms (130 to 420×109/L), 2 patients after snake bites had a PLT lower than normal, and thrombocytosis was not observed in either group. A reference range of 0.85–1.3 INR below normal was found in 2 patients in the study group and 15 from the control group, while values above the normal range were found in 8 patients (6.7%) from the snake bite group and no patients from the control group. In the study group, the INR ranged from 0.78–1.43 with a mean of 1.046 (SD=0.14), while in the control group the range was from 0.79–1.28, with a mean of 0.95 (SD=0.08). There was a significant difference in INR between the study and control groups (p

Introduction Atypical ductal hyperplasia (ADH) is a benign lesion, which due to the risk of coexisting cancer is classified as a lesion of uncertain malignant potential. Aim To identify clinical predictors of cancer underestimation in patients with ADH diagnosed after vacuum-assisted breast biopsy (VABB). Material and methods Between 2001 and 2016, a total of 3804 vacuum-assisted core needle biopsies were performed at the First Chair of General Surgery of the Jagiellonian University Medical College in Krakow, including 2907 ultrasound (US)-guided biopsies and 897 digital stereotactic procedures. Seventy-six women were diagnosed with ADH and 72 of them underwent subsequent surgical excision. Demographic factors, medical history, family history, clinical symptoms, type and size of lesion determined in imaging scans, size of biopsy needle, and presence of coexisting lesions in VABB specimens were analysed as potential predictors of malignancy underestimation. Results Underestimation of breast carcinoma occurred in 21 (29.2%) patients. The upgrade rate was significantly higher only in patients with a lesion visible both in mammography (MMG) and US examinations and combined BIRADS-5. Conclusions Vacuum-assisted core needle biopsy is a minimally invasive technique used in diagnosing ADH. As the risk of breast malignancy underestimation is relatively high, open surgical biopsy remains the recommended procedure, especially in patients with lesions detected both in mammography and US examination. As we could not identify the factors that preclude cancer underestimation, all the women diagnosed with ADH should be informed about the risk of cancer underestimation.

The three cell lines, designated as gastric cancer (GC)1401, GC1415 and GC1436 were derived from peritoneal effusions from patients with gastric adenocarcinoma. Cell lines were established in tissue culture and in immunodeficient, non-obese diabetic/severe combined immunodeficiency (NOD/SCID) mice. All cell lines were cultured in Dulbecco's modified Eagle's medium supplemented with 5% fetal bovine serum. These cell lines were grown as an adherent monolayer with doubling time ranging between 25 h (GC1436 cell line) and 30–34 h (GC1401 and GC1415, respectively). All cells showed morphological features of epithelial-like cells, forming sheets of polygonal cells. Chromosomal analysis showed that the modal numbers ranged from 52 (GC1401), 51–56 (GC1415) and 106 (GC1436). High heterogeneity, resulting from several structural and numerical chromosomal abnormalities were evident in all cell lines. The surface marker expression suggested a tumor origin of the cells, and indicated the intestinal phenotype of a GC (CD10+, MUC1). All three cell lines were tumorigenic but not metastatic, in vivo, in NOD/SCID mice. The lack of metastatic potential was suggested by the lack of aldehyde dehydrogenase 1A1 activity. In conclusion, these newly established GC cell lines widen the feasibility of the functional studies on biology of GC as well as drug testing for potential therapeutic purposes.