Evaluation of Conventional Cardiovascular Risk Factors and Ordinal Coronary Artery Calcium Scoring in a Lung Cancer Screening Cohort.

(1) Background: Lung cancer screening (LCS) consists of low-dose computed tomography (LDCT) results to reduce lung cancer-related mortality. The LCS program has a unique opportunity to impact CVD mortality by providing tools for CVD risk assessment and implementing preventative strategies. In this study, we estimated standardized CVD risk (SCORE) and assessed the prevalence of coronary artery calcium (CAC) in a Polish LCS cohort. (2) Methods: In this observational study, 494 LCS participants aged 50-79 years with a cigarette smoking history of at least 30 pack-years were included. Medical history, anthropometric measurements, blood pressure measurements, serum glucose, and cholesterol levels were assessed in one visit. CVD risk assessment using SCORE tables was performed. The results were compared to the general population (NATPOL 2011 study). On LDCT scans, CAC was classified using an Ordinal Score ranging from 0 to 12. (3) Results: The prevalence of classic cardiovascular risk factors was very high. Among study participants, 83.7% of men and 40.7% of women were classified with a very high CVD SCORE risk (>10%). CAC was reported in 190 (47%) participants. Calcification was categorized as severe (CAC ≥ 4) in 84 (21%) participants. (4) Conclusions: Due to the high cardiovascular risk, intensive preventive strategies are recommended for LCS participants.

Multicenter registry of Impella-assisted high-risk percutaneous coronary interventions and cardiogenic shock in Poland (IMPELLA-PL).

BACKGROUND: Impella is a percutaneous mechanical circulatory support device for treatment of cardiogenic shock (CS) and high-risk percutaneous coronary interventions (HR-PCIs). IMPELLA-PL is a national retrospective registry of Impella-treated CS and HR-PCI patients in 20 Polish interventional cardiological centers, conducted from January 2014 until December 2021. AIMS: We aimed to determine the efficacy and safety of Impella using real-world data from IMPELLA-PL and compare these with other registries. METHODS: IMPELLA-PL data were analyzed to determine primary endpoints: in-hospital mortality and rates of mortality and major adverse cardiovascular and cerebrovascular events (MACCE) at 12 months post-discharge. RESULTS: Of 308 patients, 18% had CS and 82% underwent HR-PCI. In-hospital mortality rates were 76.4% and 8.3% in the CS and HR-PCI groups, respectively. The 12-month mortality rates were 80.0% and 18.2%, and post-discharge MACCE rates were 9.1% and 22.5%, respectively. Any access site bleeding occurred in 30.9% of CS patients and 14.6% of HR-PCI patients, limb ischemia in 12.7% and 2.4%, and hemolysis in 10.9% and 1.6%, respectively. CONCLUSIONS: Impella is safe and effective during HR-PCIs, in accordance with previous registry analyses. The risk profile and mortality in CS patients were higher than in other registries, and the potential benefits of Impella in CS require investigation.

Emerging Role of Balloon Pulmonary Angioplasty in Chronic Thromboembolic Pulmonary Disease-Insights from the 2022 ESC Guidelines.

In this article, we discuss the topic of chronic thromboembolic pulmonary disease (CTEPD) and the growing role of balloon pulmonary angioplasty (BPA) in its treatment. We present the pathophysiology of CTEPD which arises from an incomplete resolution of thrombi in the pulmonary arteries and leads to stenosis and occlusion of the vessels. The article focuses mainly on the chronic thromboembolic pulmonary hypertension (CTEPH) subpopulation for which prognosis is very poor when left untreated. We describe a multimodal approach to treating CTEPH, including pulmonary endarterectomy (PEA), BPA, and pharmacological therapies. Additionally, the benefits of pharmacological pre-treatment before BPA and the technical aspects of the procedure itself are outlined. It is emphasized that BPA does not replace PEA but serves as a complementary treatment option for eligible patients. We summarized efficacy and treatment goals including an improvement in functional and biochemical parameters before and after BPA. Patients who received pre-treatment with riociguat prior to BPA exhibited a notable reduction in the occurrence of less severe complications. However, elderly patients are still perceived as an especially vulnerable group. It is shown that the prognosis of patients undergoing BPA is similar to PEA in the first years after the procedure but the long-term prognosis of BPA still remains unclear. The 2022 ESC/ERS guidelines highlight the significant role of BPA in the multimodal treatment of CTEPH, emphasizing its effectiveness and recommending its consideration as a therapeutic option for patients with CTEPD, both with and without pulmonary hypertension. This review summarizes the available evidence for BPA, patient selection, procedural details, and prognosis and discusses the potential future role of BPA in the management of CTEPH.

The Basic Premises of EU Regulations Regarding the Safety of Unmanned Aircraft in the Context of their Development Process.

The development of UA is one of the most important challenges for the future of aviation. Consequently, this is one of the major challenges for the future of aviation law, particularly for those legal regulations that aim to provide an adequate level of civil aviation safety. The main goal is to show the results of the analysis of the legal framework created in Europe and to show where Europe is going in the nearest future. The method of study comprised content analysis of existing legislation. Results of the study shows inter alia that although the analysis of the adopted solutions is necessary for a better understanding, a comprehensive assessment of these solutions will be possible at the earliest after the end of the adopted transition periods, i.e. after 2023.

Prevalence, symptom burden and under-diagnosis of chronic obstructive pulmonary disease in Polish lung cancer screening population: a cohort observational study.

OBJECTIVES: Lung cancer screening using low-dose CT may be not effective without considering the presence of comorbidities related to chronic smoking. The aim of the study was to establish the prevalence of chronic obstructive pulmonary disease (COPD) in group of phighlight the potential benefits atients participating in the largest Polish lung cancer screening programme MOLTEST-BIS and attempt to confirm the necessity of combined lung cancer and COPD screening. DESIGN: Cohort, prospective study. SETTING: Medical University of Gdansk, Poland PARTICIPANTS: The study included 754 participants in lung cancer screening trial from the Pomeranian region, aged 50-70 years old, current and former smokers with a smoking history ≥30 pack-years. PRIMARY AND SECONDARY OUTCOME MEASURES: Questionnaire, physical examination, anthropometric measurements, spirometry test before and after inhaled bronchodilator (400 µg of salbutamol) RESULTS: Obstructive disorders were diagnosed in 186 cases (103 male and 83 female). In the case of 144 participants (19.73%), COPD was diagnosed. Only 13.3% of participants with COPD were known about the disease earlier. According to classification of airflow limitation 55.6% of diagnosed COPD were in Global Initiative for Chronic Obstructive Lung Disease (GOLD) 1 (mild), 38.9% in GOLD 2 (moderate), 4.9% in GOLD 3 (severe) and 0.7% in GOLD 4 (very severe) stage. Women with recognition of COPD were younger than men (63.7 vs 66.3 age) and they smoked less cigarettes (41.1 vs 51.9 pack-years). CONCLUSIONS: Prevalence of COPD in Polish lung cancer screening cohort is significant. The COPD in this group is remarkably under-diagnosed. Most diagnosed COPD cases were in the initial stage of advancement. This early detection of airflow limitation highlights the potential benefits arising from combined oncological-pulmonary screening.NKBBN.

UAS Safety Operation - Legal Issues on Reporting UAS Incidents.

INTRODUCTION: This paper examines regulations which govern procedures for reporting incidents other than accidents or serious incidents related to unmanned aircraft system (UAS) operations. The regulations are discussed in the context of available data and the paper included an analysis of them from both a European and national perspective. The goal of the paper is to provide a series of recommendations with regard to the procedures for reporting and analyzing UAS incidents in order to improve the safe integration of unmanned and manned aviation. This article also explores the legal consequences that arise from the midair collision between a UAS and a manned aircraft. MATERIAL AND METHODS: The method of study comprises a content analysis of existing legislations. The current doctrine was confronted with existing regulations, documents and materials. RESULTS: The results of the study show that there is a practical problem of objectively identifying operators of a UAS as well as in defining what exactly constitutes an "incident". It can be reasonably concluded that reporting and analyzing UAS-related incidents allows for the assessment and development of strategies for integrating manned and unmanned aviation. It is worth mentioning that drones and UAS technology requires refinement, especially in technological terms. It is reasonable to take action aimed at raising awareness amongst UAS users of the need to report incidents, as well as engaging UAS users in the investigative process which follows such occurrences.

Excess Air Ratio Management in a Diesel Engine with Exhaust Backpressure Compensation.

The paper investigates the operation of a wideband universal exhaust gas oxygen (UEGO) sensor in a diesel engine under elevated exhaust backpressure. Although UEGO sensors provide the excess air ratio feedback signal primarily in spark ignition engines, they are also used in diesel engines to facilitate low-emission combustion. The excess air signal is used as an input for the fuel mass observer, as well as to run the engine in the low-emission regime and enable smokeless acceleration. To ensure a short response time and individual cylinder control, the UEGO sensor can be installed upstream of a turbocharger; however, this means that the exhaust gas pressure affects the measured oxygen concentration. Therefore, this study determines the sensor's sensitivity to the exhaust pressure under typical conditions for lean burn low-emission diesel engines. Identification experiments are carried out on a supercharged single-cylinder diesel engine with an exhaust system mimicking the operation of the turbocharger. The apparent excess air measured with the UEGO sensor is compared to that obtained in a detailed exhaust gas analysis. The comparison of reference and apparent signals shows that the pressure compensation correlations used in gasoline engines do not provide the correct values for diesel engine conditions. Therefore, based on the data analysis, a new empirical formula is proposed, for which the suitability for lean burn diesel engines is verified.

Long-term outcomes after acute myocardial infarction in countries with different socioeconomic environments: an international prospective cohort study.

BACKGROUND: Hospital-based data on the impact of socioeconomic environment on long-term survival after myocardial infarction (MI) are lacking. We compared outcome and quality of secondary prevention in patients after MI living in three different socioeconomic environments including patients from three tertiary-care teaching hospitals with similar service population size in Switzerland, Poland and Ukraine. METHODS: This is a prospective cohort study of patients with a first MI in three different tertiary-care teaching hospitals in Bern (Switzerland), Gdansk (Poland) and Lutsk (Ukraine) during the acute phase in the year 2010 and follow-up of these patients with a questionnaire and, if necessary, telephone interviews 3.5 years after the acute event. The study cohort comprises all consecutive patients hospitalised in every one of the three study centres during the year 2010 for a first MI in the age ≤75 years who survived ≥30 days. RESULTS: The proportion of patients with ST-segment elevation myocardial infarction (STEMI) was high in Gdansk (Poland) (80%) and in Lutsk (Ukraine) (74%), while the ratio of STEMIs to non-STEMIs was nearly 50:50 in Bern (Switzerland) (50.6% STEMIs). Percutaneous coronary intervention (PCI) was the first choice therapy both in Bern (Switzerland) (100%) and in Gdansk (Poland) (92%), while it was not performed at all in Lutsk (Ukraine). We found substantial differences in treatment and also in secondary prevention interventions including cardiac rehabilitation. All-cause mortality at 3.5 year follow-up was 4.6% in Bern (Switzerland), 8.5% in Gdansk (Poland) and 14.6% in Lutsk (Ukraine). CONCLUSION: Substantial differences in treatment and secondary prevention measures according to low-income, middle-income and high-income socioeconomic situation are associated with a threefold difference in mortality 3.5 years after the acute event. Countries with low socioeconomic environment should increase efforts and be supported to improve care including secondary prevention in particular for MI patients. A greater number of PCIs per million inhabitants itself does not guarantee lower mortality scores.

[The effect of levothyroxine on the proliferative activity of the thyroid follicular cells]. / Wplyw lewotyroksyny na aktywnosc proliferacyjna komórekpecherzykowych tarczycy.

INTRODUCTION: Pharmacological treatment of non-toxic nodular goitre with levothyroxine has caused a discussion about its effectiveness and safety. The aim of the study was to examine the influence of levothyroxine on the proliferative activity of the thyroid follicular cells. MATERIAL AND METHODS: Cytological material was obtained from 32 euthyroid females, aged 34-69 years, by USG-guided Fine-Needle Aspiration Biopsy (FNAB), before and after 6 months treatment with levothyroxine. The patients were divided into 2 age groups: up to 45 years (14 patients) and above 45 years (18 females). Proliferative activity of the follicular cells was assessed by the proliferative index (PI), representing the percentage of follicular cells with positive reaction with the antibody Ki-67. Microscopic evaluation was carried out using morphometric computer system MicroImage InCD UDF (Olympus). RESULTS: After 6-months of treatment IP values decreased significantly in both groups studied (8.59 +/- 3.07 vs 6.51 +/- +/- 1.91; p < 0.001 in females aged < 45 years and 7.72 +/- 1.83 vs 5.09 +/- 1.51; p < 0.001 in the older group). CONCLUSION: Our results indicate that levothyroxine has an influence on the proliferative activity of the thyroid follicular cells, particularly in post-menopausal women.