Where is obstetric anesthesiology heading in the next decade? An Eastern European perspective

European countries of "Eastern Block" origin took different healthcare and economic development trajectories after the Berlin Wall fell. Despite decreased maternal and neonatal mortality in the last two decades, healthcare disparities exist between the various countries. Minimum standards for obstetric anesthesia are not available for every maternity patient. Lack of equity in access to healthcare for maternity patients is multifactorial and includes differences in systems of care and health economics, and shortages of medical personnel. The war in Ukraine generates additional challenges for healthcare systems in the region, resulting from a significant increase in the number of refugees, some of whom are pregnant and require maternity services, including obstetric anesthesia and analgesia and maternal critical care. The next decade's challenges comprise the implementation of evidence-based medicine advances in the field of obstetric anesthesia and analgesia, and of maternal critical care at national levels, including access to neuraxial opioids, the broad implementation of enhanced recovery after cesarean section protocols, and more frequent use of labor epidural analgesia. Further, there needs to be improvement in medical education provided in the national language, so that healthcare providers, patients, and their families can build and provide a safe environment for maternity patients. In addition, better provision of services and access to healthcare providers who have been well trained and are dedicated to dealing with obstetric patients. These measures will hopefully enhance the quality of care for maternity patients, focusing on further reduction of maternal and neonatal morbidity and mortality, which is a priority and a highly desirable long-term outcome.

Effects of various rotational speeds of hydrodynamic disintegrator on carbon, nutrient, and energy recovery from sewage sludge

Until recently, sewage sludge produced in wastewater treatment processes was considered problematic waste. It currently constitutes a valuable substrate for raw materials and energy recovery. One of the methods of intensifying resource recovery from sludge is its pretreatment by means of disintegration methods. This study presents the CFD modelling and experimentally investigates the use of a hydrodynamic cavitation rotor operated with various rotational speeds (1500, 2500, and 300 rpm) for the recovery of organic compounds, nutrients, and energy. Rheological properties of raw sludge, a non-Newtonian fluid, were determined and used in the modelling calculations. Cavitation zones were observed for 2500 rpm and 3000 rpm, although a stronger cavitation effect occurred for a rotational speed of 3000 rpm. A rotational speed of 1500 rpm was too low to generate a pressure drop below 1705 Pa, and no cavitation was recorded. An increase in rotational speed from 1500 rpm to 3000 rpm for each analysed energy density caused an increase in SCOD and nitrogen concentration. Moreover, it was determined that at low energy densities (<105 kJ/L), mechanical tearing was the dominant factor responsible for carbon recovery, and at its higher values (≥105 kJ/L), the cavitation phenomenon became increasingly important. Rotation speed also had a significant effect on methane yield (YCH4). An increase in YCH4 by 6.2% was recorded only for disintegrated sludge at a rotational speed of 1500 rpm in reference to untreated sludge. Disintegration conducted at higher rotational speeds led to a decrease in YCH4 (-0.7% for 2500 rpm and -7.9% for 3000 rpm).

Re-flocculation reduces the effectiveness of sewage sludge pretreatment through hydrodynamic disintegration prior to anaerobic digestion

Circular economy model, based on the "make, use, reuse, remake, recycle" approach, is an alternative to progressive depletion of non-renewable fossil fuels. Sewage sludge can be a source of renewable energy obtained through the anaerobic conversion of their organic fraction into biogas. This process is mediated by highly complex microbial communities and its efficiency depends on the availability of substrates to microorganisms. Disintegration of the feedstock in the pre-treatment step may intensify the anaerobic digestion, but re-flocculation of disintegrated sludge (reassembly of the released fractions into larger agglomerates) may result in a reduced availability of the released organic compounds for microbes. Pilot-scale studies on re-flocculation of disintegrated sludge were conducted to select parameters for scaling-up the pre-treatment and intensifying the anaerobic digestion process in two large Polish wastewater treatment plants (WWTPs). Samples of thickened excess sludge from full-scale WWTPs were subjected to hydrodynamic disintegration at three energy density levels of 10 kJ/L, 35 kJ/L and 70 kJ/L. Microscopic analyses of disintegrated sludge samples were carried out twice: i) immediately after the disintegration process at a given energy density level, ii) and after 24-h incubation at 4 °C following the disintegration. Micro-photographs of 30 randomly selected fields of view were taken for each analysed sample. A method of the image analysis was developed as a tool to measure dispersion of sludge flocs to assess the re-flocculation degree. Re-flocculation of the thickened excess sludge occurred within 24 h after hydrodynamic disintegration. This was evidenced by a very high re-flocculation degree, reaching up to 86%, depending on the origin of the sludge and the energy density levels used for the hydrodynamic disintegration.

AB0101 INCREASED DNA DAMAGE AND LACK OF DNA REPAIR IN FIBROBLAST-LIKE SYNOVIOCYTES OF INDIVIDUALS AT RISK OF DEVELOPING RHEUMATOID ARTHRITIS

Background

Rheumatoid arthritis (RA) is a chronic inflammatory immune-mediated disease leading to synovial tissue inflammation and bone destruction. Inflammation-induced DNA damage in fibroblast-like synoviocytes (FLS) is thought to play an important role in RA pathogenesis. However, since a recent functional genomics study revealed a causal role for FLS in the genetic susceptibility of RA and synovial inflammation is absent in autoantibody positive individuals at risk for RA, we aimed to investigate whether DNA damage in FLS is present before onset of disease.

Objectives

Determine the extent of DNA damage in FLS and their capacity to repair this damage during the earliest phases of systemic autoimmunity.

Methods

We included individuals with arthralgia who were IgM rheumatoid factor (RF) and/or anti-citrullinated protein antibody (ACPA) positive but without any evidence of arthritis (RA-risk individuals, n=6), RA patients (n=6), osteoarthritis (OA) patients (n=6) and controls without inflammatory disease (n=6). Synovial tissue biopsies were collected either during joint surgery or individuals underwent a mini-arthroscopy of a knee joint. Subsequently, FLS were in vitro expanded upon enzymatic synovial tissue digestion. DNA damage in FLS (passage 6) was assessed by immunofluorescence staining for yH2AX. DNA damage repair was assessed by first irradiating the cells with 1 gray to induce DNA damage and assess yH2AX staining directly and after 3 and 24 hours of culture to allow for DNA repair.

Results

Preliminary immunofluorescence staining for yH2AX shows that DNA damage is present in RA-risk and RA FLS to more extent compared with FLS from non-inflammatory controls. OA FLS exhibit even more DNA damage and their nuclei show signs of impaired chromosomal segregation, forming micronuclei with high yH2AX staining intensity. Overall, DNA damage repair is slower in FLS from RA-risk individuals, RA and OA patients compared with controls as shown by persistent yH2AX staining after inducing DNA damage.

Conclusion

These findings reveal increased DNA damage and concomitant impaired DNA repair in FLS of not only patients with synovial inflammation but also in FLS from RA-risk individuals, suggesting that DNA damage is already present in absence of overt synovial tissue inflammation and before clinical disease onset. More research is needed to investigate DNA damage or lack of DNA repair as potential driver in development of RA.

Disclosure of Interests

None declared

Common ALDH3A1 Gene Variant Associated with Keratoconus Risk in the Polish Population

Background: ALDH3A1 protein is important in maintaining corneal physiology and protecting the eye from UV damage. However, none of the genome-wide association studies has indicated that the ALDH3A1 locus is associated with keratoconus. In this study, we examined the potential role of ALDH3A1 variants as risk factors for keratoconus incidence and severity in a large group of Polish keratoconus patients. Methods: In the first stage we analyzed the coding region sequence of the ALDH3A1 in a subgroup of keratoconus. Then, we genotyped three selected ALDH3A1 variants in a larger KC group of patients (n = 261) and healthy controls (n = 317). Results: We found that the rs1042183 minor allele A is a risk factor for keratoconus in the dominant model (OR = 2.06, 95%CI = 1.42–2.98, p = 0.00013). The rs2228100 variant genotypes appear to be associated with an earlier age of KC diagnosis in the Polish population (p = 0.055 for comparison of three genotypes and p = 0.022 for the dominant inheritance model). Conclusions: The rs1042183 variant in ALDH3A1 is associated with keratoconus risk in the Polish population. The differences in the allele frequency between both populations could be partially responsible for the difference in the disease prevalence.

DRD4 Exon 3 Gene Polymorphisms in Patients Diagnosed with Polysubstance Use Disorder and Co-Occurrence of a Depressive Episode

Background: There has been a noticeable and systematic growth of the use of psychoactive substances over the past few decades. Dual diagnosis is a clinical term referring to the occurrence of psychoactive substance use disorder comorbid with another psychiatric disorder in the same person. The most common type of dual diagnosis is the co-occurrence of alcohol use disorder and mood disorders in the form of a depressive episode. Co-occurrent substance use disorders are frequently influenced by genetic factors. In selecting our area of research, we focused on dopamine and the DRD4 (Dopamine Receptor D4) gene polymorphism as well as associations with personality features. The aim of the study: The aim of the study was to compare DRD4 exon 3 (DRD4 Ex3) gene polymorphisms in patients diagnosed with polysubstance use disorder and co-occurrence of a depressive episode to DRD4 exon 3 gene polymorphisms in patients diagnosed with polysubstance use disorder and without co-occurrence of a depressive episode and a group of healthy volunteers. The study also aimed at establishing associations between personality features and DRD4 exon 3 gene polymorphisms of male patients diagnosed with polysubstance use disorder with co-occurrence of a depressive episode which may present a specific endophenotype of this group of patients. Methods: The study group comprised 602 male volunteers: patients diagnosed with polysubstance use disorder comorbid with a depressive episode (PUD MDD) (n = 95; mean age = 28.29, standard deviation (SD) = 7.40), patients diagnosed with polysubstance use disorder (PUD) (n = 206; mean age = 28.13, SD = 5.97), and controls (n = 301; mean age = 22.13, SD = 4.57). The patients and control subjects were diagnosed by a psychiatrist using the Mini International Neuropsychiatric Interview (MINI), the NEO Five-Factor Personality Inventory (NEO-FFI), and the State-Trait Anxiety Inventory (STAI) questionnaires. An analysis of the DRD4 exon 3 polymorphism was performed. Results: The patients diagnosed with PUD MDD compared to the control group of healthy volunteers showed significantly higher scores on both the STAI status and features scale and the NEO-FFI Neuroticism and Openness Scale, as well as lower scores on the Extraversion, Agreeableness, and Conscientiousness NEO-FFI scales. In the DRD4 exon 3 gene polymorphism, the s allele was more frequent in the PUD MDD compared to the l allele, which was less frequent. The results of the 2 × 3 factor analysis of variance (ANOVA) in patients and controls and the variant DRD4 exon 3 interaction were found on the Extraversion Scale and the Conscientiousness Scale of the NEO-FFI. Conclusions: The associations show that psychological factors combined with genetic data create a new area of research on addiction, including the problem of dual diagnosis. However, we want to be careful and draw no definite conclusions at this stage of our research.

Incisional Surgical Site Infections After Mass and Layered Closure of Upper Abdominal Transverse Incisions: First Results of a Randomized Controlled Trial

OBJECTIVE

To compare the early results of mass and layered closure of upper abdominal transverse incisions.

SUMMARY OF BACKGROUND DATA

Contrary to midline incisions, data on closure of transverse abdominal incisions are lacking.

METHODS

This is the first analysis of a randomized controlled trial primarily designed to compare mass with layered closure of transverse incisions with respect to incisional hernias. Patients undergoing laparotomy through upper abdominal transverse incisions were randomized to either mass or layered closure with continuous sutures. Incisional surgical site infection (incisional-SSI) was the primary end-point. Secondary end-points comprised suture-to-wound length ratio (SWLR), closure duration, and fascial dehiscence (clinicatrials.gov NCT03561727).

RESULTS

A total of 268 patients were randomized to either mass (n=134) or layered (n=134) closure. Incisional-SSIs occurred in 24 (17.9%) and 8 (6.0%) patients after mass and layered closure, respectively (P =0.004), with crude odds ratio (OR) of 0.29 [95% confidence interval (95% CI) 0.13-0.67; P =0.004]. Layered technique was independently associated with fewer incisional-SSIs (OR: 0.29; 95% CI 0.12-0.69; P =0.005). The number needed to treat, absolute, and relative risk reduction for layered technique in reducing incisional-SSIs were 8.4 patients, 11.9%, and 66.5%, respectively. Dehiscence occurred in one (0.8%) patient after layered closure and in two (1.5%) patients after mass closure (P >0.999). Median SWLR were 8.1 and 5.6 (P <0.001) with median closure times of 27.5 and 25.0 minutes (P =0.044) for layered and mass closures, respectively.

CONCLUSIONS

Layered closure of upper abdominal transverse incisions should be preferred due to lower risk of incisional-SSIs and higher SWLR, despite clinically irrelevant longer duration.

Skin autofluorescence as a novel predictor of acute kidney injury after liver resection

Abstract

Background

Skin autofluorescence (SAF) reflects accumulation of advanced glycation end-products (AGEs). The aim of this study was to evaluate predictive usefulness of SAF measurement in prediction of acute kidney injury (AKI) after liver resection.

Methods

This prospective observational study included 130 patients undergoing liver resection. The primary outcome measure was AKI. SAF was measured preoperatively and expressed in arbitrary units (AU).

Results

AKI was observed in 32 of 130 patients (24.6%). SAF independently predicted AKI (p = 0.047), along with extent of resection (p = 0.019) and operative time (p = 0.046). Optimal cut-off for SAF in prediction of AKI was 2.7 AU (area under the curve [AUC] 0.611), with AKI rates of 38.7% and 20.2% in patients with high and low SAF, respectively (p = 0.037). Score based on 3 independent predictors (SAF, extent of resection, and operative time) well stratified the risk of AKI (AUC 0.756), with positive and negative predictive values of 59.3% and 84.0%, respectively. In particular, SAF predicted AKI in patients undergoing major and prolonged resections (p = 0.010, AUC 0.733) with positive and negative predictive values of 81.8%, and 62.5%, respectively.

Conclusions

AGEs accumulation negatively affects renal function in patients undergoing liver resection. SAF measurement may be used to predict AKI after liver resection, particularly in high-risk patients.

Questions around mutation T1010I in MET gene: results of next generation sequencing in Polish patient with suspected hereditary adenoid cystic carcinoma

OBJECTIVE

Adenoid cystic carcinoma (ACC) is a slowly growing cancer, which is the most common malignant tumor of the salivary glands. It is claimed that it is a non-inherited cancer. People with family history of ACC are reported extremely rarely. We present patients with suspected hereditary ACC.

MATERIALS AND METHODS

Next generation sequencing (NGS) was performed for both RNA and DNA isolated from FFPE material.

RESULTS

In DNA from tumor tissue we detected the mutation in MET gene, in exon 14 c.3029C>T (p.Thr1010Ile). It has never been proven that this mutation may play a role in the pathogenesis of ACC. The most important for our case report seems to be the patient's family history of cancer occurrence which indicates presence of familial cancer aggregation (familial cancer syndrome) and even familial lung cancer.

CONCLUSIONS

ACC is extremely rare; it is difficult to observe a specific genetic pattern and NGS can provide a lot of information about the genetic causes of this disease. Our work shows that the MET p.Thr1010Ile mutation can be associated with the hereditary occurrence of ACC.

An assessment of physical efficiency in cadet pilots before and after the implementation of a program preparing for flights

OBJECTIVES

The aim of the study was to examine the impact of the training program on directed physical fitness.

MATERIAL AND METHODS

The research involved 35 male cadets of the Polish Air Force Academy in Dęblin. The examined persons were on average 19 years old. All the examined persons were divided into 2 groups. Group I (N = 25, the test group) carried out a program on Special Aviation Gymnastic Instruments. Group II (N = 10, the control group) conducted the standard physical military education program. In both groups, the test was performed twice, before (examination I) and after (examination II) the preparatory process, using the following tests: pull-ups, a 16.5-meter race, a 10×10-meter shuttle race, forward bends, and the Aviation Synthetic Efficiency Test (ASET). The findings obtained in these tests were converted into points for the overall evaluation of physical fitness. The training lasted 70 days.

RESULTS

In group I, in examination II, there was a statistically significant increase in the results of pull-ups (p < 0.01), the 16.5-meter race (p < 0.01), the 10×10-meter shuttle race (p < 0.05), forward bends for 2 min (p < 0.05) and the overall physical fitness (p < 0.05), compared to examination I. In group II, in examination II, the authors proved an insignificant increase in the findings when contrasted with examination I. The test results between groups I and II did not show any significant differences in the examined efficiency tests. In group I, in examination I, significant correlations were found between the overall physical fitness and pull-ups, the 10×10-meter shuttle race, the 16.5-meter race, forward bends and ASET. Examination II demonstrated significantly stronger correlations between the overall physical fitness and forward bends as well as ASET. In group II, in examination II, a significant correlation was shown between the overall physical fitness and the 16.5-meter race.

CONCLUSIONS

A significant correlation between the overall physical fitness and ASET in examination II indicates an impact of the training program on the targeted efficiency of the cadet pilots. Int J Occup Med Environ Health. 2021;34(5):647-58.

PEComa-A Rare Liver Tumor

PEComa (perivascular epithelioid cell tumor) is a rare liver tumor. Decisions regarding patient management are currently based on a few small case series. The aim of this study was to report the clinicopathological features of PEComa in order to provide guidance for management, complemented by our own experience. This retrospective observational study included all patients with PEComa who underwent surgical treatment in two departments between 2002 and 2020. A total of 20 patients were diagnosed with PEComa following histopathological examination. The age of the patients ranged from 21 to 73 years. The majority of patients were women (85%). In most patients, the tumors were incidental. In diagnostic studies, PEComas with high arterial vascularization have been described. Liver resection was the treatment of choice. There was only one postoperative complication. During histopathological evaluation, tumors were composed mostly of epithelioid cells, rarely with spindle cell components, thick-walled vessels, and adipocytes in different proportions. Melanocytic markers (HMB45, MelanA) and at least one smooth muscle marker were expressed in all tumors. Features suggestive of malignancy were found in three cases. In conclusion, PEComa is a rare liver tumor that is usually diagnosed incidentally. In radiological studies, tumors with high arterial vascularization are observed. Liver resection is the treatment of choice.

Intraductal papillary neoplasm of the bile duct - A comprehensive review

BACKGROUND

Intraductal papillary neoplasm of the bile ducts is a rare tumor type. Management decisions are currently based upon a small case series. The authors have large own experience with IPNB.

OBJECTIVE

The review aims at reporting on clinicopathological features of IPNB in order to provide guidance for management.

METHODS

We searched PubMed, Medline, Microsoft Academic and Embase databases to identify studies of relevance. The analysis of own experience was also included.

RESULTS

We analyzed 59 retrospective series and 25 cases from authors' clinical experience. The main sign was jaundice and cholangitis, 33% and 48%, respectively. CT's were performed in 63-76% and MR in 40-56%. Intraductal mass was found in 31-32% and duct dilatation in 27-30%. Endoscopic Retrograde Cholangio-Pancreatography (ERCP) was performed in 48-62%. IPNB with invasive carcinoma was found in 35.7-60% and IPNB with intraepithelial neoplasia in 36-60%. Histopathological confirmation before surgery was rare. The main treatment of IPNB is resection, in our material, both, hepatectomy and hepatectomy plus bile duct resections were performed in 40% of patients. The percentage of postoperative complications was 20%. The 5-year survival rate of all IPNB's patients was 53.6%; in patients with associated invasive carcinoma - 22.2% and without invasive carcinoma - 100% (p ​= ​0.001).

CONCLUSIONS

Early surgery is advisable for radiologically suspected IPNB. The results of treatment depend on histopathology. They are worse at intraductal invasive carcinoma than at neoplasm with neoplasia.

Diagnostic value of plasma expression of microRNAs complementary to Drosha and Dicer in lung cancer patients

OBJECTIVE

Lung cancer (LC) is diagnosed mostly in advanced, non-operable stage, with poor prognosis. The analysis of microRNAs may be a useful tool for early and non-invasive detection of cancer. Dicer and Drosha are enzymes with an essential role for microRNA biogenesis. The aim of our study was to analyze the expression of miRNA-27a-3p, miRNA-31, miRNA-182, miRNA-195 with the ability to reciprocal regulation of Dicer and Drosha expression in lung cancer patients.

PATIENTS AND METHODS

The relative expression of microRNAs was detected by qPCR in plasma of 160 LC patients. The U-Mann Whitney test was used to compare the relative expression between particular groups of lung cancer patients and healthy individuals. The diagnostic value of microRNAs examination was analyzed using a receiver operating curve.

RESULTS

We demonstrated that the plasma levels of miRNA-27, miRNA-31 and miRNA-182 were significantly higher and miRNA-195 significantly lower in the whole group of LC patients and in patients with early stages of NSCLC, in comparison with healthy donors. ROC analysis showed that four studied microRNAs have a potential diagnostic value for early stages of NSCLC with AUC=0.95 for miRNA-27a (94% sensitivity and 81% specificity, p=0.0001), 0.71 for miRNA-31 (73% sensitivity and 61% specificity, p=0.001) 0.77 for miRNA-182 (70% sensitivity and 79% specificity, p=0.0001) and 0.82 for miRNA-195 (74% sensitivity and 80% specificity, p=0.0001).

CONCLUSIONS

We have proved that the expression of miRNA-27a-3p, miRNA-31, miRNA-182, and miRNA-195 in patients with LC is different from the expression of these molecules in healthy people. The examination of these microRNAs in plasma could be used in non-invasive lung cancer diagnosis.

The assessment of the impact of a training process on the habituation of the vestibular-vegetative system, using a special rotational test as a condition of maintaining flight safety

OBJECTIVES

The authors formulated a hypothesis that, on completion of the training program by cadets, their vestibular habituation would increase, measured by the time of the duration of the test on the unlocked looping, in contrast to the initial values and the control group.

MATERIAL AND METHODS

The research involved 35 male cadets, first-year students of the Polish Air Force Academy in Dęblin. The examined persons were on average 20 years of age. They were divided into 2 groups. Group A (N = 25, tested) continued training on Special Aviation Gymnastic Instruments (SAGI). The cadets were a homogeneous group of participants in the jet pilot course, selected by the Military Aeromedical Board. Group B (N = 10, control) conducted the standard physical military education program. Groups A and B were tested on the unlocked looping before and after the training process. In the training process, the groups had heart rate (HR) monitored.

RESULTS

The cadets in group A on the test in the unlocked looping, at the beginning of the training period, had an average score of 468.5±96.6 s, and on completion of the training period 575.6±47.9 s, which is a statistically significant difference at p < 0.000001. Similarly, the examined individuals in group B received an average score of 396.2±31.8 s, and at the end of the training period 473.4±72.0 s, which is a statistically significant difference at p < 0.01. In group A, a statistically significant decrease in the average HR value was observed. In group B, there was a statistically significant increase in the average HR value.

CONCLUSIONS

The exercises on SAGI have a beneficial impact on improving the habituation of the vestibular organ in training cadets in examination II, as opposed to examination I and the control group. Int J Occup Med Environ Health. 2020;33(4):497-506.

ICD-11 vs. ICD-10 - a review of updates and novelties introduced in the latest version of the WHO International Classification of Diseases

In June 2018, WHO published the 11th edition of the International Classification of Diseases (ICD). The new edition introduced numerous changes. One of the most important was to rebuild the coding system and adapt ICD to digital use. A reconstruction of the coding system enabled more comprehensive alphanumeric coding of complex clinical situations by the introduction of cluster coding. The chapter on mental disorders has also changed. ICD-11 has been updated to take into account the results of international expert cooperation and new information on mental disorders. Many of the secondary clinical categories have been moved higher in the hierarchy that created new subchapters. Many categories have been moved to other subchapters. Taking into account the modern epidemiology and knowledge about the etiology of mental disorders, some categories have been removed from ICD. Moreover, several nonexistent categories have been added. The article summarizes and discusses the most important changes in ICD with the introduction of ICD-11, both in the coding system and in individual subchapters covering mental health issues.

Carbon Fiber and Nickel Coated Carbon Fiber-Silica Aerogel Nanocomposite as Low-Frequency Microwave Absorbing Materials

Silica aerogel-based materials exhibit a great potential for application in many industrial applications due to their unique porous structure. In the framework of this study, carbon fiber and nickel coated carbon fiber–silica aerogel nanocomposites were proposed as effective electromagnetic shielding material. Herein, the initial oxidation of the surface of carbon fibers allowed the deposition of a durable Ni metallic nanolayer. The fibers prepared in this way were then introduced into a silica aerogel structure, which resulted in obtaining two nanocomposites that differed in terms of fiber volume content (10% and 15%). In addition, analogous systems containing fibers without a metallic nanolayer were studied. The conducted research indicated that carbon fibers with a Ni nanolayer present in the silica aerogel structure negatively affected the structural properties of the composite, but were characterized by two-times higher electrical conductivity of the composite. This was because the nickel nanolayer effectively blocked the binding of the fiber surface to the silica skeleton, which resulted in an increase of the density of the composite and a reduction in the specific surface area. The thermal stability of the material also deteriorated. Nevertheless, a very high electromagnetic radiation absorption capacity between 40 and 56 dB in the frequency range from 8 to 18 GHz was obtained.

Hydroxyapatite coating on titanium endosseous implants for improved osseointegration: Physical and chemical considerations

BACKGROUND

For many years, hydroxyapatite (HA) has been used as a bioactive endosseous dental implant coating to improve osseointegration. As such, the coating needs to be of high purity, adequate thickness, crystalline, and of a certain roughness in order to stimulate rapid fixation and form a strong bond between the host bone and the implant. There are a number of ways of preparing the HA coating, resulting in various coating properties. Herein, we report the preparation of the HA coating using a direct electrochemical method without the need for subsequent heat treatment.

OBJECTIVES

The aim of this study was to investigate the physicochemical properties of the HP coating, deposited on titanium implants by a modified electrochemical method.

MATERIAL AND METHODS

The coating was characterized in terms of surface chemical composition, structure, morphology, coating thickness and roughness.

RESULTS

The coating was found to be composed of homogenous HA with Ca/P and Ca/O ratios of 1.62 and 0.35, respectively. No other forms of calcium phosphate were detected. The degree of crystallinity of HA was 92.4%. The surface roughness was moderate (Sa = 1.04 μm) with the coating thickness of 2-3 μm. The scanning electron microscopy (SEM) analysis revealed a uniform, integrated layer of rod-like HA crystals with the longitudinal axes parallel to the implant surface.

CONCLUSIONS

The coating reported herein was found to have potentially favorable chemical and physical characteristics fostering osseointegration.

Correction: Graphene material preparation through thermal treatment of graphite oxide electrochemically synthesized in aqueous sulfuric acid

Correction for ‘Graphene material preparation through thermal treatment of graphite oxide electrochemically synthesized in aqueous sulfuric acid’ by B. Gurzęda et al., RSC Adv., 2017, 7, 19904–19911.

Cost-utility of extracorporeal membrane oxygenation rewarming in accidentally hypothermic patients-A single-centre retrospective study

BACKGROUND

Extracorporeal membrane oxygenation (ECMO) has become the treatment of choice for severely hypothermic patients in cardiac arrest or acute cardiac failure. Highly specialized ECMO centres have been established, however, no centre has ever reported the costs of extracorporeal rewarming. The aim of this study was to assess the costs of the treatment of patients in Swiss Stage III and IV rewarmed with veno-arterial ECMO.

METHODS

A retrospective exploratory cohort study analysed twenty-nine consecutive patients treated for hypothermia in the Severe Accidental Hypothermia Centre in Cracow, Poland. The main outcome parameters were the overall and specific costs of the ICU treatment of patients rewarmed with veno-arterial ECMO. The secondary outcome parameter was cost utility, determined by the costs involved for every year of life gained. Costs were processed using the bottom-up method and classified into six categories. Survivors were followed up after 1 year.

RESULTS

The mean cost of VA-ECMO was $5133 USD, which equalled 35% of all ICU expenditures ($14 668 USD). One year after discharge, 13 of 29 patients were still alive (45%). The overall gain of life of the thirteen 1-year survivors was 28 years, while the mean cost related to treatment with VA-ECMO for each year of life gained was 1138 USD.

CONCLUSIONS

In this study, the costs of VA-ECMO rewarming and intensive care treatment per patient were substantially lower than in other studies reporting ECMO and intensive care treatment of other causes.

Evaluation of ALK gene rearrangement in central nervous system metastases of non-small-cell lung cancer using two-step RT-PCR technique

PURPOSE

RT-PCR technique has showed a promising value as pre-screening method for detection of mRNA containing abnormal ALK sequences, but its sensitivity and specificity is still discussable. Previously, we determined the incidence of ALK rearrangement in CNS metastases of NSCLC using IHC and FISH methods.

MATERIALS

We evaluated ALK gene rearrangement using two-step RT-PCR method with EML4-ALK Fusion Gene Detection Kit (Entrogen, USA). The studied group included 145 patients (45 females, 100 males) with CNS metastases of NSCLC and was heterogeneous in terms of histology and smoking status.

RESULTS

21% of CNS metastases of NSCLC (30/145) showed presence of mRNA containing abnormal ALK sequences. FISH and IHC tests confirmed the presence of ALK gene rearrangement and expression of ALK abnormal protein in seven patients with positive result of RT-PCR analysis (4.8% of all patients, 20% of RT-PCR positive patients). RT-PCR method compared to FISH analysis achieved 100% of sensitivity and only 82.7% of specificity. IHC method compared to FISH method indicated 100% of sensitivity and 97.8% of specificity. In comparison to IHC, RT-PCR showed identical sensitivity with high number of false positive results.

CONCLUSION

Utility of RT-PCR technique in screening of ALK abnormalities and in qualification patients for molecularly targeted therapies needs further validation.

Graphene material preparation through thermal treatment of graphite oxide electrochemically synthesized in aqueous sulfuric acid

The present work demonstrates a simple and low-cost method to produce bulk quantities of graphene material through the thermal treatment of graphite oxide (GO).

Influence of expanded graphite coming from the electrochemical oxidation of phenol on cement-polymer matrix

In presented article the polymer-modified cement mortars with expanded graphite covered by the oligomer film, being a by-product of phenol electro-oxidation, were investigated. The changes in the morphology of EG and EG/oligomer as well as in the microstructure of cement-polymer composites modified with EG/oligomer were verified using the scanning electron microscopy (SEM). The evaluation of adhesion between EG/oligomer and cement-polymer mortar based on the mechanical tests, especially their flexural behavior. It was shown that the oligomer film formed on EG surface made graphite flakes more durable and resistant to bending. Moreover, the oligomer due to the interaction with polymer network in cement-polymer mortar led to the improvement of flexural toughness of composite.

Sensitive methods for screening of the MEK1 gene mutations in patients with central nervous system metastases of non-small cell lung cancer

BACKGROUND

The mitogen-activated protein kinases 1 and 2 (MEK1, MEK2) are fundamental partners in the RAS-RAF-MEK-ERK pathway that is involved in regulation of cell proliferation, differentiation and survival. Downregulation of the MEK cascades has been implicated in acquiring of the malignant phenotype in various cancers. Somatic mutations in MEK1 gene (substitutions K57N, Q56P, D67N) were described in <1 % of non-small cell lung cancer (NSCLC) and they were more commonly reported in adenocarcinoma patients with current or former smoking status.

MATERIALS AND METHODS

In the following study, we assessed the MEK1 gene mutations in 145 FFPE tissue samples from central nervous system (CNS) metastases of NSCLC using HRM-PCR and ASP-qPCR techniques. The studied group was heterogeneous in terms of histopathology and smoking status. The prevalence of the MEK1 gene mutation was correlated with the occurrence of mutations in KRAS, EGFR, DDR2, PIK3CA, NRAS, HER2, AKT1 and PTEN genes.

RESULTS

Using HRM and ASP-qPCR methods we identified one (0.7 %; 1/145) MEK1 substitution (Q56P) in CNS metastases of NSCLC. The mutation was identified in a single, 50-year-old, current smoking men with adenocarcinoma (1.25 %; 1/80 of all adenocarcinomas).

CONCLUSIONS

According to the current knowledge, the incidence of MEK1 gene mutation in CNS metastatic lesion of NSCLC is the first such report worldwide. The analysis of gene profile in cancer patients may extend the scope of molecularly targeted therapies used both in patients with primary and metastatic tumors of NSCLC.

Graphene material prepared by thermal reduction of the electrochemically synthesized graphite oxide

The present work describes a simple and effective way to produce bulk quantities of graphene material.

The relationship between RRM1 gene polymorphisms and effectiveness of gemcitabine-based first-line chemotherapy in advanced NSCLC patient

Purpose

Chemotherapy with platinum compounds and gemcitabine is frequently used in first-line treatment of advanced non-small cell lung cancer (NSCLC) patients in which tyrosine kinase inhibitors (EGFR or ALK) cannot be administered. Unfortunately, less than half of the patients achieve the benefit from chemotherapy. Gemcitabine is an analog of deoxycytidine (pyrimidine antimetabolite) with antitumor activity. The excess of deoxycytidine synthesized by RRM1 enzyme activity may be a cause of competitive displacement of gemcitabine, which reduces the efficacy of this cytostatic. The aim of this study was to determine the association between single nucleotide polymorphisms (SNPs) of the RRM1 promoter (−37C>A, −524C>T) and the effectiveness of first-line chemotherapy based on platinum compounds and gemcitabine in NSCLC patients.

Patients and methods

SNPs were determined by SNaPshot PCR^® in DNA isolated from peripheral blood of 91 NSCLC patients.

Results

The median progression-free survival (PFS) was significantly longer in carriers of AA (−37C>A) as well as CC (−524C>T) genotype of RRM1 compared to patients with other genotypes (10.5 vs 3.5 months, p = 0.0437; HR = 2.17, 95 % CI 1.02–4.62 and 10.5 vs 3.5 months, p = 0.0343; HR = 2.12, 95 % CI 1.06–4.27). In addition, the CC genotype carriers (−37C>A) showed a significant increase in the risk of shortening overall survival (OS) in comparison to patients with AA or AC genotypes (9.5 vs 18 months, p = 0.0193; HR = 2.13, 95 % CI 1.13–4.03).

Conclusions

Presence of rare AA (−37C>A) and CC (−524C>T) genotypes of the RRM1 may be favorable predictive factors for chemotherapy with platinum compounds and gemcitabine in NSCLC patients.

Methylation of the DCLK1 promoter region in circulating free DNA and its prognostic value in lung cancer patients

INTRODUCTION

The possibility of detection of suppressor genes methylation in circulating free DNA (cf-DNA) of cancer patients and the lack of methylation in healthy individuals makes this epigenetic alternation an ideal diagnostic marker of neoplastic processes. Moreover, hypermethylation in several genes promoter was described as a biomarker of lung cancer. Methylation in the gene encoding doublecortin-like kinase 1 (DCLK1) is observed in patients with colorectal cancer and cholangiocarcinoma. However, there are no studies concerning DCLK1 methylation in lung cancer patients. The aims of the study was to evaluate the frequency of DCLK1 promoter methylation in cf-DNA of lung cancer patients and of healthy persons as well as the usefulness of this test for predicting the lung cancer course.

MATERIALS AND METHODS

DCLK1 methylation status was evaluated in DNA isolated from peripheral blood plasma from 65 lung cancer patients and 95 healthy individuals. After DNA bisulfitation, DCLK1 methylation was determined using the qMSP-PCR technique. Moreover, the presence of DCLK1 methylation was correlated with the overall survival (OS) probability of lung cancer patients.

RESULTS

DCLK1 promoter methylation was detected in 32 lung cancer patients (49.2 %) and 8 healthy individuals (8.4 %). The methylation of the region before transcription start site (TSS) and the region after TSS of DCLK1 gene was detected in 28 and 11 patients, respectively. In seven cases (10.8 %), the DCLK1 promoter methylation in both regions was reported simultaneously. The methylation was observed slightly frequently in patients with small cell lung cancer (75 % of SCLC patients). The median overall survival of patients with DCLK1 promoter methylation was lower than that of patients without DCLK1 gene modification (p = <0.001, HR = 4.235).

CONCLUSIONS

The evaluation of DCLK1 promoter region methylation may be useful in both early diagnosis and prediction of the course of lung cancer.