Emerging trends for urban freight transport-The potential for sustainable micromobility.

AIM: Active transportation referring to non-motorized modes of transport is promoted and popularized both in practice and in the scientific literature, while their use for urban freight transport has been largely neglected. Thus the main scope of the paper is to indicate the development potential of micromobility use in urban freight transport and to check its influence on urban sustainability. METHODS: The authors have hypothesized that active means of transport, with a focus on micromobility, have great development potential in freight transportation in cities. The implemented methods for analyzing the relationship between users' characteristics, micromobility, and its impact on urban sustainable development, were logit and probit modelling. The authors' system includes an analysis of factors connected with the topics of sustainability and micromobilty, that have met an essential scientific gap that this paper addresses. Logistic (logit) regression is used mainly for binary, ordinal, and multi-level outcomes to find the probability of success (i.e. occurrence of some event). Probit regression, however, is primarily used in binary response models and assumes the normal distribution of data. RESULTS: The main finding of the article has led the authors to the statement that active means of transport, including micromobility have great development potential in freight transportation in cities. CONCLUSIONS: Knowledge of the acceptance of micromobility solutions is essential for municipal authorities in shaping the development of urban transport systems. Thus proper strategies and actions need to be prioritized to leverage the sustainability-related co-benefits of active transport.

Role of matrix metalloproteinases and their tissue inhibitors in the pathological mechanisms underlying maxillofacial cystic lesions.

Cystic lesions are considered to be one of the most common pathologies of the maxillofacial region, and matrix metalloproteinases (MMPs) may represent potential etiological factors. The aim of the present study was to elucidate the role of MMP-2 and MMP-9, and their endogenous tissue inhibitors, tissue inhibitor of metalloproteinase (TIMP)-1 and TIMP-2, respectively, in the pathogenesis of maxillofacial cystic lesions. A total of 25 patients diagnosed with radicular cysts (RCs; n=20), dentigerous cysts (n=3) and retention cysts (RtCs; n=7) were enrolled in the present study. Gelatin zymography was performed to assess the gelatinolytic activity of MMP-2 and MMP-9, and commercial ELISA kits were used to determine TIMP-1 and TIMP-2 concentrations. Gelatin zymography revealed the presence of both MMP-2 and MMP-9 in all types of samples analyzed. An increase in MMP-9 activity, TIMP-1 concentration and MMP-9/TIMP-1 ratio was observed in the fluid obtained from RCs compared with that obtained from RtCs. In conclusion, MMP-9 may be involved in the pathogenesis of RCs, whereas the activity of MMP-2 in the wall of RtCs was low, and this gelatinase did not appear to significantly affect the development of this type of lesion.

Statistical Size Effect in Fatigue Properties for Mini-Specimens.

The study verifies the sensitivity of selected construction materials (S235JR structural steel and 1.4301 stainless steel) to the statistical size effect. The P-S-N curves were determined experimentally under high-cycle fatigue conditions for two specimen sizes (mini-specimen and standard specimen). The results were analyzed using a probabilistic model of the three-parameter Weibull cumulative distribution function. The analysis included the evaluation of the technological process effects on the results based on the material microstructure near the surface layer and the macro-fractography. The differences in the susceptibility to the size effect validated the applicability of the test method to mini-specimen and showed different populations of the distribution of critical material defects.

Probabilistic Estimation of Fatigue Strength for Axial and Bending Loading in High-Cycle Fatigue.

In this paper, the sensitivity to the type of loads (axial and bending loading) of selected construction materials (AW6063 T6 aluminum alloy, S355J2+C structural steel, and 1.4301 acid-resistant steel) in high-cycle fatigue was verified. The obtained S-N fatigue characteristics were described by a probabilistic model of the 3-parameters Weibull cumulative distribution function. The main area of research concerned the correct implementation of the weakest link theory model. The theory is based on a highly-stressed surface area and a highly-stressed volume in the region of the highest stresses. For this purpose, an analytical model and a numerical model based on the finite element method were used. The model that gives the lowest error implemented in specific test conditions was determined on the basis of high-cycle fatigue analysis. For the analyzed materials, it was a highly-stressed volume model based on the weakest link theory.

Clinical situations requiring radial or brachial access during carotid artery stenting.

INTRODUCTION: Radial or brachial access may be preferred in the case of severe peripheral artery disease (PAD) or difficult aortic arch anatomy during carotid artery stenting (CAS). AIM: To evaluate the clinical conditions indicating potential benefit from non-femoral access as well as feasibility and safety of transradial/transbrachial access (TRA/TBA) as an alternative approach for CAS. MATERIAL AND METHODS: Since 2013, 67 patients (mean age: 70 years old, 44 men, 42% symptomatic) were selected for CAS with the TRA/TBA approach. The composite endpoint was stroke/death/myocardial infarction within 30 days of the procedure and compared to the propensity score matched transfemoral approach (TFA) group. Clinical (including neurological) examination and Doppler ultrasonography were performed before the procedure, at discharge and at 30 days. RESULTS: CAS with TRA/TBA was successful in 63/67 patients. Transfemoral access was not feasible due to PAD in 35 (52.2%) patients, bovine arch in 10 (14.9%), obesity (BMI > 35 kg/m2) in 9 (13.4%), severe degenerative disease of the spine in 7 (10.5%), arch type III in 5 (7.5%) and excessive subclavian stent protrusion in 1 (1.5%) patient. Mean NASCET carotid artery stenosis was reduced from 81% to 9% (p < 0.001). The composite endpoint occurred in 3 (4.8%) cases and it was not statistically significantly different from the matched TFA group (6.3%; p = 0.697). No access site complications requiring surgical intervention or blood transfusion developed. CONCLUSIONS: Transradial and transbrachial CAS may be an effective and safe procedure, and it may constitute a viable alternative to the femoral approach in patients with severe PAD, difficult aortic arch anatomy or obesity.

Carotid artery stenting with Roadsaver stent. Early and four-year results from a single-center registry.

INTRODUCTION: Prevention of peri- and postprocedural complications is still a challenge in carotid artery stenting (CAS). AIM: To assess immediate and long-term safety and effectiveness of CAS using the Roadsaver double-nitinol-layer-micromesh stent. MATERIAL AND METHODS: Since 2014, 298 CAS procedures in 287 non-consecutive patients (203 men, mean age 70.5 ±8.6 years, 100% symptomatic/high risk lesions) have been performed using the Roadsaver stent and proximal (40%) or distal (60%) neuroprotection system. Clinical and neurological examinations as well as duplex ultrasound were completed before CAS, before discharge, at 1, 6 and 12 months, then annually. RESULTS: All CAS procedures were successful. Carotid stenosis was reduced from 84.9 ±9.9% to 11.0 ±9.4% (p < 000.1). In hospital, 1 ipsilateral periprocedural major (0.3%) and 3 minor (1.34%) ischemic strokes occurred, 2 (0.7%) patients died due to a cerebral hemorrhage on day 9 and 21. Three (1.0%) additional ipsilateral minor strokes within 30 consecutive days occurred. Thus, 30-day complications were observed in 9 (3.0%) patients. Two minor strokes were associated with in-stent thrombosis (0.7%). The 4-year follow-up showed 82% overall survival (95% CI: 69-91%) with no significant difference between asymptomatic (77%) and symptomatic patients (97%; p = 0.076). The stroke-free survival was 89% (95% CI: 77-95%), 84% asymptomatic vs. 98% symptomatic (p = 0.187). Seven (2.3%) patients developed > 50% in-stent restenosis. CONCLUSIONS: Carotid artery stenting using the Roadsaver stent for symptomatic patients and high risk lesions showed to be safe and effective, with a low complication rate and acceptable in-stent restenosis risk in 4-year follow-up.

Fatigue Life for Different Stress Concentration Factors for Stainless Steel 1.4301.

This paper presents the results of the static tensile and fatigue life tests under rotating bending of round 1.4301 (AISI 304) steel samples. The fatigue tests were carried out on smooth and notched samples with three different rounding angles with a shape factor of 1.4, 2 and 2.6. A fatigue life was determined for samples with different shape factors subject to identical loads. The results showed that the scatter of fatigue test results decreases with an increase in shape factor. To evaluate the cracking properties (cracking mode and mechanism), microstructure and fractographic tests of the fractured samples were carried out.

Comparison of drug-eluting and bare metal stents for extracranial vertebral artery stenting.

INTRODUCTION: Drug-eluting stents of the first (DES I) and second generation (DES II) proved superior to bare metal stents (BMS) in the coronary territory. However, there are limited data on whether they have any advantage over BMS in vertebral artery stenosis (VAS). AIM: To compare outcomes of DES (DES I, DES II) and BMS in the treatment of symptomatic extracranial VAS. MATERIAL AND METHODS: During 13-year study period (2003-2016), 392 consecutive patients underwent VAS angioplasty in 428 arteries, including implantation of 148 DES (DES I: 21; DES II: 127 lesions), and 280 BMS. RESULTS: The technical success rates for DES and BMS groups were 96.7% and 94.6% (p = 0.103), with similar periprocedural complication rates (1.4% vs. 2.2%; p = 0.565). VAS degree was reduced from 86 ±9.7 to 2.7 ±5.0% in DES (p < 0.001) and from 84.1 ±9.4 to 4.3 ±6.9% in BMS (p < 0.001). Angiography confirmed in-stent restenosis/occlusion (ISR/ISO) 50-99% in 53 (14.2%) and 21 (5.6%) out of 373 patients (409 arteries) with at least 6-month follow-up. ISR/ISO rates were similar in DES vs. BMS (22.8% vs. 19.4%; p = 0.635), as well as in DES I vs. DES II (6/19; 31.6% vs. 25/92; 27.2%, p = 0.325). Stainless steel (24/135; 17.8%) and cobalt-chromium (23/121;19%) BMS had significantly lower incidence of ISR/ISO, as compared to platinum-chromium (7/18; 38.9%), p = 0.034. ISR/ISO was associated with age (p = 0.01) and CRP level > 5 mg/l (p = 0.043), while greater stent length was associated with ISR only in the DES group (p = 0.024). CONCLUSIONS: Our results do not support significant differences in ISR/ISO rates between DES and BMS, although differences between particular stent types and ISR rates require further investigation.

Health-related quality of life in ischaemic stroke survivors after carotid endarterectomy (CEA) and carotid artery stenting (CAS): confounder-controlled analysis.

INTRODUCTION: Atherosclerotic carotid artery stenosis (CS)-related strokes are a significant overall stroke burden contributor. AIM: To evaluate the effect of surgical (carotid endarterectomy - CEA) vs. percutaneous (neuroprotected carotid artery stenting - CAS) carotid revascularization on health-related quality of life (HRQoL) in stroke survivors: analysis controlled for major HRQoL determinants beyond strokes. MATERIAL AND METHODS: Our database of 856 carotid revascularization procedures (48.7% symptomatic CS) performed over 3 years showed 42 pairs (CEA-CAS) of right hemispheric stroke patients matched for age, sex, marital and educational status, hyper-tension, heart failure and diabetes, who underwent uneventful carotid revascularization, experienced no major adverse clinical events, and completed the Short Form Outcome Study (SF-36) questionnaire within 7 days before, 14 days after, 6 months after, and 12 months after carotid revascularization. RESULTS: Baseline HRQoL was low and similar in both groups (30.8 ±4.6% vs. 29.1 ±3.9%, p = 0.68; data given for CEA vs. CAS). National Institute of Health Stroke Scale chronic severity was 5.4 ±2.8 vs. 5.9 ±3.1 (p = 0.44). Revascularization was associated with a major HRQoL improvement, that was significantly greater in CAS (60.4 ±9.2% vs. 71.5 ±6.2%, p < 0.001). At 6 months the CEA-CAS difference was narrower (70.7 ±9.7% vs. 74.6 ±5.9%, p = 0.026), becoming statistically insignificant at 12 months (72.6 ±6.7% vs. 75.1 ±5.1%, p = 0.062). The early CEA-CAS difference was driven by less bodily pain and better physical functioning/role-physical plus better role-emotional and higher general well-being scores in CAS (p < 0.05). CONCLUSIONS: Carotid revascularization has a major positive impact on stroke survivor patient-reported HRQoL. The improvement is initially greater in CAS, with the remaining difference small at 12 months and statistically insignificant.

One-day, sequential carotid artery stenting followed by cardiac surgery in patients with severe carotid and cardiac disease.

Optimal management of patients with internal carotid artery (ICA) stenosis concurrent with severe cardiac disease remains undefined. The aim of this study is to evaluate the safety and feasibility of the one-day, sequential approach by carotid artery stenting (CAS) immediately followed by cardiac surgery. The study included 70 consecutive patients with symptomatic > 50% or ⩾ 80% asymptomatic ICA stenosis coexisting with severe coronary/valve disease, who underwent one-day, sequential CAS + cardiac surgery. The majority of patients (85.7%) had CSS class III or IV angina and 10% had non-ST elevation myocardial infarction. The EuroSCORE II risk was 2.4% (IQR 1.69-3.19%). All CAS procedures were performed according to the 'tailored' algorithm with a substantial use of proximal neuroprotection devices of 44.3%. Closed-cell (75.7%) and mesh-covered (18.6%) stents were implanted in most cases. The majority of patients underwent isolated coronary artery bypass grafting (88.6%) or isolated valve replacement (7.1%). No major adverse cardiac and cerebrovascular events (MACCE) occurred at the CAS stage. There were three (4.3%) perioperative MACCE: one myocardial infarction and two deaths. All MACCE were related to cardiac surgery and were due to the high surgical risk profile of the patients. Up to 30 days, no further MACCE were observed. No perioperative or 30-day neurological complications occurred. In this patient series, one-day, sequential CAS and cardiac surgery was relatively safe and did not result in neurological complications. Thus, a strategy of preoperative CAS could be considered for patients with severe or symptomatic ICA stenosis who require urgent cardiac surgery.

Highly-calcific carotid lesions endovascular management in symptomatic and increased-stroke-risk asymptomatic patients using the CGuard™ dual-layer carotid stent system: Analysis from the PARADIGM study.

OBJECTIVES: To assess feasibility, safety, angiographic, and clinical outcome of highly-calcific carotid stenosis (HCCS) endovascular management using CGuard™ dual-layer carotid stents. BACKGROUND: HCCS has been a challenge to carotid artery stenting (CAS) using conventional stents. CGuard combines a high-radial-force open-cell frame conformability with MicroNet sealing properties. METHODS: The PARADIGM study is prospectively assessing routine CGuard use in all-comer carotid revascularization patients; the focus of the present analysis is HCCS versus non-HCCS lesions. Angiographic HCCS (core laboratory evaluation) required calcific segment length to lesion length ≥2/3, minimal calcification thickness ≥3 mm, circularity (≥3 quadrants), and calcification severity grade ≥3 (carotid calcification severity scoring system [CCSS]; G0-G4). RESULTS: One hundred and one consecutive patients (51-86 years, 54.4% symptomatic; 106 lesions) received CAS (16 HCCS and 90 non-HCCS); eight others (two HCCS) were treated surgically. CCSS evaluation was reproducible, with weighted kappa (95% CI) of 0.73 (0.58-0.88) and 0.83 (0.71-0.94) for inter- and intra-observer reproducibility respectively. HCCS postdilatation pressures were higher than those in non-HCCS; 22 (20-24) versus 20 (18-24) atm, p = .028; median (Q1-Q3). Angiography-optimized HCCS-CAS was feasible and free of contrast extravasation or clinical complications. Overall residual diameter stenosis was single-digit but it was higher in HCCS; 9 (4-17) versus 3 (1-7) %, p = .002. At 30 days and 12 months HCCS in-stent velocities were normal and there were no adverse clinical events. CONCLUSION: CGuard HCCS endovascular management was feasible and safe. A novel algorithm to grade carotid artery calcification severity was reproducible and applicable in clinical study setting. Larger HCCS series and longer-term follow-up are warranted.

Association between clinical stage of oral cancer and expression of immunohistochemical markers.

AIM: The aim of this study is to demonstrate the possible correlation between the expression of examined protein markers - p53, EGFR, PCNA, p44/42 in the mass of the tumor and the clinical stage of disease. MATERIAL: 48 patients of the Department and Clinic of Oral and Maxillofacial Surgery, Lublin diagnosed with oral cancer. The control group consisted of 10 patients diagnosed with leukoplakia lesions in the oral cavity. The methods: Immunohistochemical analysis using the detection system DAKO K5007 Cat - Dako REAL ™ Detection System, Peroxidase DAB +, Rabbit / Mouse. RESULTS: Based upon the statistical results, significant correlation between p53 protein and tumor staging; however, a correlation between the level of expression of EGFR, p44/42, PCNA and staging was not likewise revealed. CONCLUSIONS: Looking for oral squamous cell carcinoma markers remains an actual issue. Identification of specific markers of oral cancer could be used in screening the population, determining prognosis and response to treatment.

Evaluation of Fibrinolytic Inhibitors: Alpha-2-Antiplasmin and Plasminogen Activator Inhibitor 1 in Patients with Obstructive Sleep Apnoea.

Obstructive sleep apnoea (OSA) induces thrombophilia and reduces fibrinolysis. Alpha-2-antiplasmin (a-2-AP) and plasminogen activator inhibitor 1 (PAI-1) are major inhibitors of the fibrinolytic system. Increased concentrations of these factors are associated with a higher risk of cardiovascular diseases. The aim of this study was to assess plasma a-2-AP and PAI-1 in patients with OSA and evaluate correlations with the polysomnographic record and selected risk factors of cardiovascular diseases. The study group comprised 45 patients with OSA, and the control group consisted of 19 patients who did not meet the diagnostic criteria of OSA. Plasma a-2-AP and PAI-1 concentrations were assessed by enzyme-linked immunosorbent assay (ELISA). In the study group, the median value of plasma a-2-AP was higher than that of the control group (157.34 vs. 11.89 pg/ml, respectively, P<0.0001). A-2-AP concentration increased proportionally to the severity of OSA. The concentration of a-2-AP was positively correlated with the apnoea-hypopnoea index (AHI), apnoea index (AI), respiratory disturbances time (RDT), and desaturaion index (DI), and negatively correlated with mean and minimal oxygen saturation (SpO2 mean, SpO2 min, respectively). The median value of PAI-1 was higher in the study group than the control group (12.55 vs. 5.40 ng/ml, respectively, P = 0.006) and increased along with OSA severity. PAI-1 concentration was positively correlated with AHI, AI, RDT, DI, and body mass index (BMI) and negatively correlated with SpO2 mean and SpO2 min. Higher plasma concentrations of a-2-AP and PAI-1 in patients with OSA indicated that these patients had increased prothrombotic activity. OSA increases the risk of cardiovascular complications as it enhances prothrombotic activity.

Cognitive impairment in carriers of glucocerebrosidase gene mutation in Parkinson disease patients.

AIM: Parkinson disease (PD) is the common neurodegenerative disease with motor and numerous non-motor symptoms, including cognitive impairment. Mutation of glucocerebrosidase (GBA) gene is the most common genetic risk factor of sporadic PD. The aim of this study was to assess clinical features of PD associated with GBA mutation. METHODS: One hundred and thirty-eight PD patients were involved and examined by the movement disorder specialist using several scales including Unified Parkinson Disease Rating Scale (UPDRS) part II and III, Hoehn and Yahr (H&Y) staging, Mini-Mental State Examination (MMSE) and Hamilton Depression Scale (HDS). The exons 8 and 9 of GBA was sequenced and screened for variants. RESULTS: The GBA variants were found in 16 (11.6%) PD patients: N370S mutation in 5 (3.6%) and T369M variant in 11 (7.9%). No significant differences between the group of mutation carriers and non-carriers were found in relation to clinical features except for dementia (MMSE score<26) occurring more often in N370S mutation carriers (60.0% vs 19.6%, p=0.03). CONCLUSION: The N370S GBA mutation is the risk factor for cognitive impairment in PD patients.

Tremor in neuropathies of different origin.

BACKGROUND AND PURPOSE: Tremor accompanies some poly-neuropathies, but its prevalence and its clinical and electrophysiological manifestations are not well known. The aim of the study was to assess the occurrence and characteristics of hand tremor in patients with polyneuropathy of different origins, as well as relations between the occurrence of tremors and clinical and neurographic findings of polyneuropathy. MATERIAL AND METHODS: Eighty-nine patients diagnosed with polyneuropathy of known aetiology, and 50 age- and sex-matched healthy volunteers were included in the study. All subjects were interviewed regarding the occurrence of tremor. Tremor was assessed clinically and objectively using a triaxial accelerometer and electromyographic (EMG) recordings. A load test with a weight of 500 γ was performed in order to differentiate between enhanced physiological tremor (EPT) and essential tremor-like (ET-L) tremor. RESULTS: Tremor was found in 59.5% of patients in clinical assessment and in 74% of patients in objective evaluation, significantly more often than in controls (12%). Tremor was detected in all types of polyneuropathy apart from paraproteinaemic IgM polyneuropathy. Tremor was postural (70%), but resting (51%) or kinetic (32%) tremor was also present. In the majority of cases, the severity of the tremor was mild. Essential tremor-like tremor prevailed in the study group. The occurrence of hand tremor was not related to the axonal or demyelinating type of polyneuropathy, nor to the conduction velocity or other electrophysiological findings of the investigated upper limb nerves. CONCLUSION: Tremor accompanies 60-70% of patients with polyneuropathy; it is mostly postural, ET-L type with mild severity, and unrelated to other typical clinical and electrophysiological findings of neuropathy.

Chiral gas chromatography as a tool for investigations into illicitly manufactured methylamphetamine.

The aim of this study was to develop a chiral gas chromatographic method for the separation of compounds likely to be found in the EMDE synthesis of methylamphetamine, a heavily abused stimulant drug. Here we describe the separation of the enantiomers of ephedrine, pseudoephedrine, chlorinated intermediates and methylamphetamine using fluorinated acid anhydrides as chemical derivatization reagents prior to gas chromatographic analysis on a 2,3-di-O-methyl-6-t-butyl silyl-ß-cyclodextrin stationary phase (CHIRALDEX™ B-DM). Separation of the enantiomers of pseudoephedrine, methylamphetamine and chloro-intermediates was achieved using PFPA derivatization, and enantiomers of ephedrine using TFAA derivatization, in run times of less than 40 minutes. The use of HFBA as a derivatization reagent for this set of analytes is also discussed.

Replantation and transplantation following avulsion of two maxillary incisors.

Here we describe replantation and transplantation as a treatment conducted in a 16-year-old patient following a bicycle accident. An avulsed left central incisor in maxilla was replanted after extra-oral root canal treatment, and the lost right central incisor of the maxilla was replaced by a left lateral incisor of the mandible in the region of the fracture fissure. Follow-up examination at 34 months showed validity of treatment, although slight evidence of replacement resorption in the transplanted and replanted teeth was revealed.

Kynurenic acid in human saliva--does it influence oral microflora?

Kynurenic acid (KYNA) is an endogenous antagonist of alpha7 nicotinic receptors and all ionotropic glutamate receptors. Its neuroprotective activity has been suggested. In this study, the presence of KYNAin human saliva and its potential bactericidal role was investigated. KYNAwas found in all samples of human saliva with mean concentration of 3.4 nM. The concentration of KYNA in saliva obtained from patients with odontogenic abscesses was 3.5 times higher than in healthy subjects. We have shown that the human gingival fibroblasts produce KYNAand an inflammatory stimulant, lipopolysaccharide, enhanced its synthesis in vitro. The bactericidal effect of KYNA was also presented. We hypothesize that KYNA may contribute to the control of oral microflora.

[Facial skeleton traumas in farmers in east-central region of Poland (part I)]. / Urazy czaszki twarzowej powstale podczas pracy w rolnictwie w rejonie srodkowowschodnim Polski (czesc I).

On the base of medical documentation, we presented epidemiological analysis of 215 patients treated for traumas of facial skeleton, which occurred during agricultural tasks. It was concluded that the injuries mentioned above occurred more frequently in males at the age between 18-40. The traumas in this group occurred mainly during use of jig saw or other tools and machinery used in agriculture. However in the female population injuries of facial skeleton resulted mainly from zoogenous trauma and accidental fall downs.