Lower Preoperative Verbal Memory Performance Is Associated with Delirium after Coronary Artery Bypass Graft Surgery: A Prospective Cohort Study.

OBJECTIVE: Cognitive impairment constitutes one of the major risk factors of delirium after coronary artery bypass graft (CABG) surgery; however, it is unclear whether only patients with global cognitive decline are at increased risk for delirium or if individuals with preserved global cognitive functions but impairments in specific cognitive domains are also more vulnerable to developing delirium. Thus, this study aimed to analyze the neurocognitive status of patients scheduled for CABG surgery with the use of an advanced computerized cognitive battery (CNS Vital Signs) and to investigate possible associations between impaired performance in selective cognitive areas and the risk of postoperative delirium development. METHODS: The study enrolled 127 participants with a median age of 67 years (IQR: 63-71). Postoperative delirium developed in 32 (25%) patients.Before surgery, the patients were screened for global cognitive impairment with the use of the Mini-Mental State Examination Test, and the individuals were asked to perform the CNS Vital Signs battery to investigate 12 specific cognitive domains. The Confusion Assessment Method and the Memorial Delirium Assessment Scale were used to screen for a diagnosis of delirium postoperatively. RESULTS: In multivariate models, a lower score of verbal memory-assessed preoperatively was independently associated with the risk of postoperative delirium development. Other independent predictors of delirium included more advanced age, gender female, depression, postoperative pyrexia, and the presence of extracorporeal circulation. CONCLUSIONS: As decreased verbal memory constitutes an independent risk factor for postoperative delirium, a verbal memory test may be a useful predictor of postoperative delirium development.

Oxidative stress and soluble receptor for advanced glycation end-products play a role in the pathophysiology of delirium after cardiac surgery.

Coronary-artery bypass graft (CABG) surgery is known to improve cardiac function and decrease mortality, albeit, this method of treatment is also associated with a neuropsychiatric complications including postoperative delirium. The pathophysiology of delirium after cardiac surgery remains poorly understood. Thus, the purpose of this study was to investigate whether oxidative stress reflected by decreased preoperative and postoperative plasma antioxidant activity is independently associated with delirium after cardiac surgery. The second aim was to assess whether decreased antioxidant activity is stress-related or mediated by other pathologies such as major depressive disorder (MDD), anxiety disorders, and cognitive impairment. Furthermore, the putative relationship between pre- and postoperative soluble receptor for advanced glycation end-products (sRAGE) overexpression and plasma antioxidant capacity was evaluated. The patients cognitive status was assessed 1 day preoperatively with the use of the Mini-Mental State Examination Test and the Clock Drawing Test. A diagnosis of MDD and anxiety disorders was established on the basis of DSM-5 criteria. Blood samples for antioxidant capacity and sRAGE levels were collected both preoperatively and postoperatively. The Confusion Assessment Method for the Intensive Care Unit was used within the first 5 days postoperatively to screen for a diagnosis of delirium. Postoperative delirium was diagnosed in 34% (61 of 177) of individuals. Multivariate logistic regression analysis revealed that low baseline antioxidant capacity was independently associated with postoperative delirium development. Moreover, increased risk of delirium was observed among patients with a preoperative diagnosis of MDD associated with antioxidant capacity decreased postoperatively. According to receiver operating characteristic analysis, the most optimal cutoff values of the preoperative and postoperative antioxidant capacity that predict the development of delirium were 1.72 mM and 1.89 mM, respectively. Pre- and postoperative antioxidant capacity levels were negatively correlated with postoperative sRAGE concentration (Spearman's Rank Correlation - 0.198 and - 0.158, p < 0.05, respectively). Patients with decreased preoperative antioxidant activity and those with depressive episodes complicated with lower postoperative antioxidant activity are at significantly higher risk of delirium after cardiac surgery development. sRAGE overexpression may be considered as protective mechanism against increased oxidative stress and subsequent cell damage.

Elevated Monocyte Chemoattractant Protein-1 as the Independent Risk Factor of Delirium after Cardiac Surgery. A Prospective Cohort Study.

BACKGROUND: The pathogenesis of postoperative delirium is largely unknown. The primary objective of this study is to assess whether increased levels of monocyte chemoattractant protein-1 (MCP-1) and high-sensitivity C-reactive protein (hsCRP) are associated with postoperative delirium in patients who have undergone cardiac surgery. The secondary objective is to investigate whether any association between raised inflammatory biomarkers levels and delirium is related to surgical and anesthetic procedures or mediated by pre-existing psychiatric conditions associated with raised pro-inflammatory markers levels. METHODS: The patients were screened for cognitive impairment one day preoperatively with the use of the Mini-Mental State Examination Test and the Clock Drawing Test. A diagnosis of major depressive disorder (MDD) and anxiety disorders was established on the basis of Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria. Blood samples were collected pre- and postoperatively for hsCRP and chemokine levels. RESULTS: Postoperative delirium developed in 34% (61 of 177) of patients. Both pre- and postoperative hsCRP, and preoperative MCP-1 levels were associated with postoperative delirium in univariate comparisons; p = 0.001; p < 0.001; p < 0.001, respectively. However, according to a multivariable logistic regression analysis, only a raised MCP-1 concentration before surgery was independently associated with postoperative delirium, and related to advancing age, preoperative anxiety disorders and prolonged intubation. CONCLUSIONS: The present study suggests that an elevated preoperative MCP-1 concentration is associated with delirium after cardiac surgery. Monitoring of this inflammatory marker may reveal the cardiovascular disease (CVD) patients who are at risk of neuropsychiatric syndromes development.

Methodology for the Quality Control Process of Additive Manufacturing Products Made of Polymer Materials.

The objective of this publication is to present a quality control methodology for additive manufacturing products made of polymer materials, where the methodology varies depending on the intended use. The models presented in this paper are divided into those that are manufactured for the purpose of visual presentation and those that directly serve the needs of the manufacturing process. The authors also a propose a comprehensive control system for the additive manufacturing process to meet the needs of Industry 4.0. Depending on the intended use of the models, the quality control process is divided into three stages: data control, manufacturing control, and post-processing control. Research models were made from the following materials: RGD 720 photopolymer resin (PolyJet method), ABS M30 thermoplastic (FDM method), E-Partial photopolymer resin (DLP method), PLA thermoplastic (FFF method), and ABS thermoplastic (MEM method). The applied measuring tools had an accuracy of at least an order of magnitude higher than that of the manufacturing technologies used. The results show that the PolyJet method is the most accurate, and the MEM method is the least accurate. The findings also confirm that the selection of materials, 3D printing methods, and measurement methods should always account not only for the specificity and purpose of the model but also for economic aspects, as not all products require high accuracy and durability.

Identification of plant leaf phosphorus content at different growth stages based on hyperspectral reflectance.

BACKGROUND: Modern agriculture strives to sustainably manage fertilizer for both economic and environmental reasons. The monitoring of any nutritional (phosphorus, nitrogen, potassium) deficiency in growing plants is a challenge for precision farming technology. A study was carried out on three species of popular crops, celery (Apium graveolens L., cv. Neon), sugar beet (Beta vulgaris L., cv. Tapir) and strawberry (Fragaria × ananassa Duchesne, cv. Honeoye), fertilized with four different doses of phosphorus (P) to deliver data for non-invasive detection of P content. RESULTS: Data obtained via biochemical analysis of the chlorophyll and carotenoid contents in plant material showed that the strongest effect of P availability for plants was in the diverse total chlorophyll content in sugar beet and celery compared to that in strawberry, in which P affects a variety of carotenoid contents in leaves. The measurements performed using hyperspectral imaging, obtained in several different stages of plant development, were applied in a supervised classification experiment. A machine learning algorithm (Backpropagation Neural Network, Random Forest, Naive Bayes and Support Vector Machine) was developed to classify plants from four variants of P fertilization. The lowest prediction accuracy was obtained for the earliest measured stage of plant development. Statistical analyses showed correlations between leaf biochemical constituents, phosphorus fertilization and the mass of the leaf/roots of the plants. CONCLUSIONS: Obtained results demonstrate that hyperspectral imaging combined with artificial intelligence methods has potential for non-invasive detection of non-homogenous phosphorus fertilization on crop levels.

Depression in Dementia or Dementia in Depression? Systematic Review of Studies and Hypotheses.

The majority of research works to date suggest that Major Depressive Disorder (MDD) is a risk factor for dementia and may predispose to cognitive decline in both early and late onset variants. The presence of depression may not, however, reflect the cause, rather, an effect: it may be a response to cognitive impairment or alters the threshold at which cognitive impairment might manifest or be detected. An alternative hypothesis is that depression may be part of a prodrome to Alzheimer's Disease (AD), suggesting a neurobiological association rather than one of psychological response alone. Genetic polymorphisms may explain some of the variances in shared phenomenology between the diagnoses, the instance, when the conditions arise comorbidly, the order in which they are detected that may depend on individual cognitive and physical reserves, as well as the medical history and individual vulnerability. This hypothesis is biologically sound but has not been systematically investigated to date. The current review highlights how genetic variations are involved in the development of both AD and MDD, and the risk conferred by these variations on the expression of these two disorders comorbidly is an important consideration for future studies of pathoaetiological mechanisms and in the stratification of study samples for randomised controlled trials.

Challenges and Prospects for Alpha-1 Antitrypsin Deficiency Gene Therapy.

Alpha-1 antitrypsin (AAT) is a protease inhibitor belonging to the serpin family. A number of identified mutations in the SERPINA1 gene encoding this protein result in alpha-1 antitrypsin deficiency (AATD). A decrease in AAT serum concentration or reduced biological activity causes considerable risk of chronic respiratory and liver disorders. As a monogenic disease, AATD appears to be an attractive target for gene therapy, particularly for patients with pulmonary dysfunction, where augmentation of functional AAT levels in plasma might slow down respiratory disease development. The short AAT coding sequence and its activity in the extracellular matrix would enable an increase in systemic serum AAT production by cellular secretion. In vitro and in vivo experimental AAT gene transfer with gamma-retroviral, lentiviral, adenoviral, and adeno-associated viral (AAV) vectors has resulted in enhanced AAT serum levels and a promising safety profile. Human clinical trials using intramuscular viral transfer with AAV1 and AAV2 vectors of the AAT gene demonstrated its safety, but did not achieve a protective level of AAT >11 µM in serum. This review provides an in-depth critical analysis of current progress in AATD gene therapy based on viral gene transfer. The factors affecting transgene expression levels, such as site of administration, dose and type of vector, and activity of the immune system, are discussed further as crucial variables for optimizing the clinical effectiveness of gene therapy in AATD subjects.

Aptamers in diagnostics and treatment of viral infections.

Aptamers are in vitro selected DNA or RNA molecules that are capable of binding a wide range of nucleic and non-nucleic acid molecules with high affinity and specificity. They have been conducted through the process known as SELEX (Systematic Evolution of Ligands by Exponential Enrichment). It serves to reach specificity and considerable affinity to target molecules, including those of viral origin, both proteins and nucleic acids. Properties of aptamers allow detecting virus infected cells or viruses themselves and make them competitive to monoclonal antibodies. Specific aptamers can be used to interfere in each stage of the viral replication cycle and also inhibit its penetration into cells. Many current studies have reported possible application of aptamers as a treatment or diagnostic tool in viral infections, e.g., HIV (Human Immunodeficiency Virus), HBV (Hepatitis B Virus), HCV (Hepatitis C Virus), SARS (Severe Acute Respiratory Syndrome), H5N1 avian influenza and recently spread Ebola. This review presents current developments of using aptamers in the diagnostics and treatment of viral diseases.

[Viral transfer of tumor necrosis factor-related apoptosis-inducing ligand (TRAIL) in gene therapy]. / Wirusowy transfer liganda czynnika martwicy nowotworu indukujacego apoptoze (TRAIL) w terapii genowej.

Tumor necrosis factor-related apoptosis-inducing ligand (TRAIL) selectively induces carcinoma cell death through the extrinsic pathway of apoptosis. Preclinical trials of gene therapy have been conducted using viral transfer of the TRAIL transgene into prostate, bladder, breast, kidney, liver, non-small cell lung cancer and also glioblastoma cells. Experiments in vitro demonstrated the extensive apoptosis of target cells as well as frequent disease regression or remission. TRAIL transfer did not show any side effects, opposite to chemotherapy. Encouraging results of TRAIL-related gene therapy were observed in rheumatoid arthritis and type 1 diabetes. Adenoviral vectors (AdV) encoding TRAIL are the most promising tool in anti-tumor therapy. They have undergone numerous modifications by increasing transfection efficiency and transgene expression in target cells. However, only one clinical phase I trial has been performed. AdV encoding the TRAIL transgene caused local inflammation and apoptosis in patients with prostate cancer.

[Influence of ureaplasma infection on the clinical state of newborns]. / Wplyw zakazenia ureaplazmami na stan kliniczny noworodków.

UNLABELLED: The aim of this study was the analysis of the clinical state of newborns infected with various species of ureaplasma. METHODS: 50 prematurely born patients with respiratory disturbances and confirmed presence of ureaplasma in the respiratory tract were analyzed. Endotracheal aspirates were collected for examination. Presence of ureaplasma was confirmed by culture and a commercial test (Biomerieux), the ureaplasma species were identified using PCR. RESULTS: In 40 examined newborns Ureaplasma parvum (U.p.) was found, in 10 Ureaplasma urealyticum (U.u.). Newborns infected with U.u. were subject to more frequent and longer therapeutic procedures supporting respiration (respirator, nCPAP), needed more frequent surfactant and antibiotic administration. In the mentioned group the mortality rate was 33%, while in newborns infected with U.p. it was 15%. CONCLUSIONS: Initial results suggest worse clinical status and higher mortality of prematurely born infected with Ureaplasma urealyticum.

Plasma antithrombin III and protein C levels in early recognition of late-onset sepsis in newborns.

OBJECTIVE: The aim of this prospective, observational study was to establish the prognostic values of plasma antithrombin III (ATIII) and protein C (PC) functional levels, determined in 150 neonates with suspected late-onset sepsis. OBSERVATIONS: Both the ATIII and PC concentrations were significantly lower in neonates with sepsis, either confirmed or not confirmed by blood culture, than data obtained in infants with excluded disease. The lowest values of plasma ATIII and PC were observed in neonates who had died in the course of sepsis. The differences between survivors and non-survivors were statistically significant (respectively, for ATIII P=0.003 and for PC P=0.00002). A highly statistically significant correlation (P=0.0016) between plasma PC functional level and risk of death was found in patients with sepsis. However, plasma ATIII concentration, evaluated in the same group of patients, did not correlate with the occurrence of death. CONCLUSION: We concluded that the measurement of plasma ATIII and, especially, PC levels may facilitate the recognition of sepsis and, with respect to PC, may have a prognostic value. Plasma PC functional concentration below 10% might be the indication for supplementation of PC concentrate.

[The assessment of food intake and declared satisfaction in medical students]. / Ocena sposobu odzywiania sie studentów SAM i deklarowana z niego satysfakcja.

Proper nutrition is one of the basic factors of the external environment which substantially influence the assurance and upkeep of a one's good state of health until old age. For students of medicine, i.e. prospective doctors, acquisition of knowledge and clinical experience should be accompanied by raising qualifications in the field of preventive treatment so that in future they can not only cure but also promote health. The aim of the present study was to analyse students' nutrition habits and to evaluate the declared satisfaction with the way of feeding. In preparation of the present paper the author used anonymous questionnaire method employing an inquiry form. The research included 416 students of the 4th and 5th years of study of the Medicine Department and 3rd and 4th year students of the Stomatology Division in 2001-2002 years. In the female group one could observe a larger consumption of vegetables and fruit, dairy products, poultry, fish and seeds of leguminous plants. Men more often eat animal fat and red meat. The analysis of the number of meals eaten shows that majority of women eat only one hot meal a day and do not eat supper. Whereas men twice as often do not eat breakfasts, they eat two or more hot meals a day and 70% of them declare they eat supper. Every second questioned person eats sweetmeats even several times a day, and only 7.7% of the population does not have the habit of intermittent eating. Analysis of the research material allowed to draw the following conclusions: 1. There is a statistically significant interdependence between the amount and quality of consumed food and the sex. 2. Women's nutritious habits are more adequate than men's nutrition habits to the dietetic prescriptions of the Institute of Food and Nutrition]. 3. Most of the men are satisfied with their nutritious habits, and the dissatisfied group is dominated by women. 4. The obtained results point to a necessity to work out and implement pro-health education within the field of young people's nutrition.

[Differentiation of students's knowledge of civilization-related diseases]. / Zróznicowanie poziomu wiedzy studentów Slaskiej Akademii Medycznej o chorobach cywilizacyjnych.

The goal of the study was to check and compare the current condition of students' knowledge on civilization-related diseases in relation to their future career as doctors, dentists, health care managers. The questionnaire consisted of 15 closed questions concerning civilization-related diseases. As opposed to majority of studies referring to this problem uniform method of assessment in accordance with the principles of didactic measurement was applied. The following test components were measured: Range, Mode, Median, Arithmetic Mean, Variance, Standard Deviation, Task Simplicity, Task Complexity, Reliability. Calculations were carried out using our own updated Excel programme. Study group consisted of 104 III year students of Division of Dentistry, 116 students of IV year Division of Dentistry, 31 students of Licentiate Faculty of Emergency Medicine in Zabrze, 18 students of Postgraduate Course in Management and Administration in Health Care Medical Faculty in Zabrze and Technical University in Gliwice, 151 IV year students of Medical Faculty in Zabrze and 121 VI year students of Medical Faculty in Zabrze. Significant differences between individual groups (surprisingly low level among future managers of health care) as well as different degree of difficulty of questions depending on the faculty and the year of study.

[Self-assessment of nutritinal status in medical students and objective measures of estimating somatic development]. / Samoocena stanu odzywienia studentów medycyny a rzeczywiste mierniki oceny rozwoju somatycznego.

Problem of "obesity epidemic" is still very common, but the knowledge about this is limited and it develops very slowly. Probably it even concerns medical students who are in touch with health problems every day and who will watch over society's health in the future. Available literature estimating people's health is mainly connected with negative measures of human health condition. Positive measures are rarely used, although they are simply in use and accessible (including financial accessibility). This kind of measures should be used in widest range to epidemiological investigation of obesity. The aim of the study was to estimate the level of medical student's obesity and to compare declared self-assessment expressed by BMI. In the research 416 III-VI year students of Medical University of Silesia were involved. We used a number of anonymous questionnaires to receive required information. We analyzed objective value of BMI, fat tissue capacity, student's self-assessment and student's satisfaction of their state of nutrition. Statistic analyzes were done using Epi Info v.5.01b program. Distribution of abnormal body weight among students under research was following: underweight--10.3% of the students, overweight--12% and II degree obesity--1.9% of investigated population. Among people with confirmed obesity only 100% of women realized this fact and 44.2% of men found their overweight as normal. Student's satisfaction of state of nutrition independently if it was proper or not, was significantly higher among men. It is necessary to teach students how to properly estimate the state of nutrition.

[Current knowledge among students of the Silesian Medical Academy about the importance and role of medical care funds]. / Ocena stanu wiedzy studentów Slaskiej Akademii Medycznej na temat roli i znaczenia kas chorych.

The purpose of this research was verification and comparison of the present state of knowledge among the students of different departments and years of study. The questions concerned the role of Medical Care Funds in the up-to-now healthcare system and the patient's rights as far as the students' future professions as doctors, dentists, healthcare managers and medical rescuers is concerned. The questionnaire included 15 questions referring to the problem of functioning of the medical care institutions after the reform of healthcare services introduced in 1999. Distinct from most of the published works of this kind, the authors adopted a uniform "assessment" method following the principles of didactic measurement. The researchers calculated: Range, Modal, Mediana, Arithmetic Average, Variance, Standard Deviation, Easiness of the Task, Difficulty of the Task, Skip Fraction, the Task's Differentiating Power, Reliability Coefficient of the Test. The calculation was conducted with the use of the Excel programme modified by the researchers to suit the needs of didactic measurement. The survey included 104 students of the 3rd year of Dental Department, 116 of the students 4th year of Dental Department, 31 students of Bachelor's Medical Rescue Studies by the Medical Department in Zabrze, 18 students of Post-Graduate Management and Administration in Healthcare by the Medical Department in Zabrze and Silesian Technical University, 151 4th year students of the Medical Department in Zabrze and 121 6th year students of the Medical Department in Zabrze. It has been proved that between the particular groups there are significant differences as far as the students' knowledge is concerned ("the healthcare managers" demonstrated quite a high knowledge ratio). And that the questions were at different difficulty levels depending on the branch and year of study represented by the respondents.