Novel Hematological Parameters in the Assessment of the Extent of Cardiac Implantable Electronic Device-Related Infections.

BACKGROUND: Patients with infectious complications related to the presence of cardiac implantable electronic devices (CIED) constitute a heterogeneous group, ranging from local pocket infection (PI) to lead-related infectious endocarditis (LRIE) infection spreading along the leads to the endocardium. The detection of isolated LRIE and the assessment of the spread of infection in a patient with PI is often difficult and requires complex imaging and microbiological tests. The aim of the current study is to evaluate the usefulness of new simple hematological parameters in detecting infectious complications in patients with CIED, differentiating vegetation and vegetation-like masses, and assessing the extent of infections in patients with PI. METHODS: A retrospective analysis of clinical data of 2909 patients (36.37% with CIED-related infections), undergoing transvenous lead extraction (TLE) procedures in three high-volume centres in the years 2006-2020, was conducted. Receiver operating characteristic (ROC) curve analysis was used to assess the sensitivity and specificity of neutrophil-to-lymphocyte ratio (NLR), neutrophil-to-platelet ratio (NPR), and lymphocyte-to-platelet ratio (LPR) in the diagnosis of CIED infections, evaluate the spread of the infectious process in patients with PI and differentiate additional structures related to the presence of lead. RESULTS: The values of NLR and NPR were significantly higher in infectious patients than non-infectious controls (3.07 vs. 2.59; p < 0.001, and 0.02 vs. 0.01; p = 0.008) and the area under the ROC curve (AUC) was 0.59; p < 0.001 and 0.56; p < 0.001, respectively. The high specificity of the new markers in detecting the infectious process was demonstrated: 72.82% for NLR (optimal cut-off value: 3.06) and 79.47% for NPR (optimal cut off value: 0.02). The values of NLR and NPR were significantly higher in patients with vegetations than in non-infectious patients with the presence of additional lead-related masses (3.37 vs. 2.61; p < 0.001 and 0.03 vs. 0.02; p = 0.008). The AUC of NLR and NPR for the prediction of vegetations was 0.65; p < 0.001 and 0.60; p < 0.001 with the highest specificity of NPR (82.78%) and an optimal cut-off value of 0.03. NLR and NPR were higher in patients with LRIE compared to isolated PI (4.11 vs. 2.56; p < 0.001 and 0.03 vs. 0.02; p < 0.001) and the ROC curve analysis for coexistence LRIE with PI showed the AUC for NLR: 0.57; p < 0.001 and AUC for NPR: 0.55; p = 0.001. High specificity in the detection of coexistence between PI and LRIE was demonstrated for NLR (87.33%), with an optimal cut-off value of 3.13. CONCLUSIONS: Novel hematological markers (NLR and NPR) are characterized by high specificity in the initial diagnosis of CIED infections, with optimal cut-off values of 3.06 and 0.02. NLR is also useful in the assessment of the spread of infection in patients with PI, with a calculated optimal cut-off value of 3.13. NPR may be helpful in the differentiation of vegetation and vegetation-like masses with an optimal cut-off value of 0.03.

Tricuspid Valve Damage Related to Transvenous Lead Extraction.

BACKGROUND: Damage to the tricuspid valve (TVD) is now considered either a major or minor complication of the transvenous lead extraction procedure (TLE). As yet, the risk factors and long-term survival after TLE in patients with TVD have not been analyzed in detail. METHODS: This post hoc analysis used clinical data of 2631 patients (mean age 66.86 years, 39.64% females) who underwent TLE procedures performed in three high-volume centers. The risk factors and long-term survival of patients with worsening tricuspid valve (TV) function after TLE were analyzed. RESULTS: In most procedures (90.31%), TLE had no negative influence on TV function, but in 9.69% of patients, a worsening of tricuspid regurgitation (TR) to varying degrees was noted, including significant dysfunction in 2.54% of patients. Risk factors of TLE relating to severe TVD were: TLE of pacing leads (5.264; p = 0.029), dwell time of the oldest extracted lead (OR = 1.076; p = 0.032), strong connective scar tissue connecting a lead with tricuspid apparatus (OR = 5.720; p < 0.001), and strong connective scar tissue connecting a lead with the right ventricle wall (OR = 8.312; p < 0.001). Long-term survival (1650 ± 1201 [1-5519] days) of patients with severe TR was comparable to patients without tricuspid damage related to TLE. CONCLUSIONS: Severe tricuspid valve damage related to TLE is relatively rare (2.5%). The main risk factors for the worsening of TV function are associated with a longer lead dwell time (more often the pacing lead), causing stronger connective tissue scars connecting the lead to the tricuspid apparatus and right ventricle. TVD is unlikely to affect long-term survival after TLE.

Early, Delayed and Late Cardiac Implantable Electronic Device Infections: Do the Timing of Onset and Pathogens Matter?

Infections involving cardiac implantable electronic devices (CIEDs) occur at different times after device-related procedures. The aim of this study was to investigate the timing of onset and factors influencing the occurrence of all types of CIED infections to identify the type of pathogen and to examine the long-term survival of patients with all types of CIED infections. We performed a post hoc analysis of the clinical data from 3344 patients who underwent transvenous lead extraction (TLE) at a single high-volume center between 2006 and 2020, including a group of 890 patients with CIED infections. The occurrence of pocket infection (PI), lead-related infective endocarditis (LRIE) and PI coexisting with LRIE (PI + LRIE) was assessed at the following time intervals: 0−12 months, 13−36 months and > 36 months since last CIED-related procedure. In the study group, there were 274 (30.79%) early infections, 266 (29.89%) delayed infections and 350 (39.32%) late infections. Pocket infection was the most common early complication (97; 39.43%), while LRIE was predominant over 36 months from the last CIED procedure (172; 54.09%). The most common early infections were PIs that were associated with the preceding CIED-related procedure. Late LRIE was most likely to occur in patients with intracardiac lead abrasion. The probability of early versus late LRIE was higher in patients with CoNS cultures. The timing of infection onset irrespective of its type does not affect long-term survival after transvenous lead extraction. The majority of infectious complications (69%) occur more than 12 months after the last CIED-related procedure. Early infections are probably associated with pocket contamination during CIED-related procedure, while delayed and late systemic infections are related to other lead-dependent factors (especially to intracardiac lead abrasion). Time to LRIE onset is associated with pathogen type. The timing of symptom onset does not affect long-term survival after TLE.

Effective, Environmentally Friendly PVC Plasticizers Based on Succinic Acid.

The plasticizers used in this study were synthesized from renewable raw materials using succinic acid, oleic acid, and propylene glycol. Four environmentally friendly plasticizer samples were obtained; their chemical structures and compositions were confirmed by gas chromatography (GC) and infrared spectroscopy (FT-IR) analyses, and their physicochemical properties and thermal stability (TGA analysis) were investigated. The obtained ester mixtures were used as poly(vinyl chloride) (PVC) plasticizers and their plasticization efficiency was determined in comparison to traditional, commercially available phthalate plasticizers, such as DEHP (di(2-ethylhexyl phthalate) and DINP (diisononyl phthalate). Mechanical properties and migration resistance were determined for soft PVC with the use of three concentrations of plasticizers (40 PHR, 50 PHR, and 60 PHR). It was observed that the obtained plasticizers exhibited the same plasticization efficiency and were characterized with good mechanical and physical properties in comparison to commercial plasticizers. The tensile strength was approx. 19 MPa, while the elongation at break was approx. 250% for all tested plasticizers at a concentration of 50 PHR. Furthermore, plasticizer migration studies showed that the synthesized plasticizers had excellent resistance to plasticizer leaching. The best migration test result obtained was 70% lower than that for DEHP or DINP. The ester mixture that was found to be the most favorable plasticizer was characterized by good thermal and thermo-oxidative stability (5% weight loss temperature: 227.8 °C in air and 261.1 °C in nitrogen). The results of the research clearly indicate that the synthesized esters can provide a green alternative to toxic phthalate plasticizers.

Lead Dependent Tricuspid Valve Dysfunction-Risk Factors, Improvement after Transvenous Lead Extraction and Long-Term Prognosis.

BACKGROUND: Lead-related tricuspid valve dysfunction (LDTVD) has not been studied in a large population and its management remains controversial. METHODS: An analysis of the clinical data of 2678 patients undergoing transvenous lead extraction (TLE) in years 2008-2021 was conducted, with a separate group of 119 patients with LDTVD. Potential risk factors for LDTVD, improvement in valve function, and long-term prognosis after TLE were assessed. RESULTS: LDTVD was diagnosed in 4.44% of patients referred for lead extraction due to different reasons. The most common mechanism of LDTVD was propping upward or clamping down the leaflet by the lead (85.71%). The probability of LDTVD was higher in female sex, patients with valvular heart disease, atrial fibrillation, heart failure, large right ventricle and high pulmonary artery systolic pressure, the presence of only pacing lead, and in case of collision of the lead with tricuspid valve and adhesion of the lead to the heart structures. The prognosis of patients with LDTVD was worse, however, patients with improved valve function after TLE showed a significantly better long-term survival. CONCLUSIONS: Lead dependent tricuspid valve dysfunction is a potentially serious condition that requires thorough diagnostics and thoughtful management. The risk factors for LDTVD are primarily related to the course of the lead and its adhesion to the heart structures. Improvement of tricuspid valve function after TLE is observed in 35.29% of patients Patients with LDTVD have a worse long-term survival, but the improvement in valve function following TLE contributes to a significant reduction in mortality.

Transesophageal Echocardiography As a Monitoring Tool During Transvenous Lead Extraction-Does It Improve Procedure Effectiveness?

BACKGROUND: Transesophageal echocardiography (TEE) is a valuable tool for monitoring the patient during transvenous lead extraction (TLE), but the direct impact of TEE on the effectiveness and safety of TLE has not yet been documented. METHODS: The effectiveness of TLE and short-term survival were compared between two groups of patients: 2106 patients in whom TEE was performed before and after TLE and 1079 individuals in whom continuous TEE monitoring was used. The procedure-related risk of major complications was assessed using a predictive SAFeTY TLE score. RESULTS: The patients monitored by TEE were characterized by older age, more comorbidities and higher SAFeTY TLE scores (6.143 ± 4.395 vs. 5.593 ± 4.127; p = 0.004). Complete procedural success was significantly higher in the TEE-guided group (97.683% vs. 95.442%, p < 0.01). The rate of serious complications in the TEE-guided group was lower than the predictive SAFeTY TLE score-a reduction of 28.75% (p < 0.05). Periprocedural mortality in the TEE-guided and non-TEE-guided groups was zero vs. six deaths (p = 0.186). Short-term survival was comparable between the groups. CONCLUSIONS: Transesophageal echocardiography as a monitoring tool during transvenous lead extraction provides valuable results-higher rates of complete procedural success and a reduced risk of the most severe complications, thus preventing periprocedural deaths.

Assessment of Perceived Attractiveness, Usability, and Societal Impact of a Multimodal Robotic Assistant for Aging Patients With Memory Impairments.

The aim of the present study is to present the results of the assessment of clinical application of the robotic assistant for patients suffering from mild cognitive impairments (MCI) and Alzheimer Disease (AD). The human-robot interaction (HRI) evaluation approach taken within the study is a novelty in the field of social robotics. The proposed assessment of the robotic functionalities are based on end-user perception of attractiveness, usability and potential societal impact of the device. The methods of evaluation applied consist of User Experience Questionnaire (UEQ), AttrakDiff and the societal impact inventory tailored for the project purposes. The prototype version of the Robotic Assistant for MCI patients at Home (RAMCIP) was tested in a semi-controlled environment at the Department of Neurology (Lublin, Poland). Eighteen elderly participants, 10 healthy and 8 MCI, performed everyday tasks and functions facilitated by RAMCIP. The tasks consisted of semi-structuralized scenarios like: medication intake, hazardous events prevention, and social interaction. No differences between the groups of subjects were observed in terms of perceived attractiveness, usability nor-societal impact of the device. The robotic assistant societal impact and attractiveness were highly assessed. The usability of the device was reported as neutral due to the short time of interaction.

Challenges for Service Robots-Requirements of Elderly Adults with Cognitive Impairments.

OBJECTIVE: We focused on identifying the requirements and needs of people suffering from Alzheimer disease and early dementia stages with relation to robotic assistants. METHODS: Based on focus groups performed in two centers (Poland and Spain), we created surveys for medical staff, patients, and caregivers, including: functional requirements; human-robot interaction, the design of the robotic assistant and user acceptance aspects. Using Likert scale and analysis made on the basis of the frequency of survey responses, we identified users' needs as high, medium, and low priority. RESULTS: We gathered 264 completed surveys (100 from medical staff, 81 from caregivers, and 83 from potential users). Most of the respondents, almost at the same level in each of the three groups, accept robotic assistants and their support in everyday life. High level priority functional requirements were related to reacting in emergency situations (calling for help, detecting/removing obstacles) and to reminding about medication intake, about boiling water, turning off the gas and lights (almost 60% of answers). With reference to human-robot interaction, high priority was given to voice operated system and the capability of robotic assistants to reply to simple questions. CONCLUSION: Our results help in achieving better understanding of the needs of patients with cognitive impairments during home tasks in everyday life. This way of conducting the research, with considerations for the interests of three stakeholder groups in two autonomic centers with proven experience regarding the needs of our patient groups, highlights the importance of obtained results.

Synthesis of Fatty Acid Esters of Selected Higher Polyols Over Homogeneous Metallic Catalysts.

Studies on the synthesis of esters of natural origin fatty acids (oleic acid) and a branched synthetic isostearic acid derived from oleic acid with commercially available selected higher polyols in the presence of homogeneous metallic catalysts have been carried out. The effects of the synthesis temperature, molar ratio and the catalysts amount have also been studied. It was shown that higher fatty acid conversion and selectivity to tri- and tetraesters were obtained for organotin catalyst Fascat 2003, which was used as the esterification catalyst. Anti-wear test confirmed good tribological properties of the obtained esters.

[Application of conscious sedation in infants undergoing the auditory brainstem responses (ABR) examination]. / Zastosowanie sedacji plytkiej u niemowlat w przygotowaniu do badania potencjalów sluchowych z pnia mózgu (ABR).

Results of ABR examination in infants undergone the hearing screening examinations were presented. Since February 2004 the group of 184 children were examined. In 29 of them (15.8%) there was a need of further hearing examination using evoked auditory brainstem responses. In 20 of them the examination was done in sleep induced by 6% chloral hydrate enema. The process of sleep was normal and no disturbances of breathing or circulatory systems were observed. The obtained responses from brainstem were not interfered by any artifacts and basic waves were legible and easy for interpretation. Correct results of the ABR examination were obtained in 21/29 (72%) children, while in 7/28 (24%) various degree of hearing losses were detected. Those children were referred for hearing rehabilitation to the Third Degree of Reference Center. It was emphasized in the study that results of ABR examination after conscious sedation induced by 6% chloral hydrate enema accounted the suggestion for its wider use in other clinical and hospital center.

[Histomorphology of the pharyngoesophageal sphincter as prognostic factor of developing esophageal speech]. / Histomorfologia zwieracza gardlowo-przelykowego jako czynnik prognostyczny w opanowaniu mowy przelykowej.

Histomorphologic evaluation of the pharyngoesophageal sphincter (pes) in the decreased persons aged 11-82 was done. These persons, in the lifetime, never suffered from: a) neurologic diseases (among others-myasthenia, progressive muscle atrophy), b) neoplasm of the esophagus, c) dysphagia. The aim of the report was the explanation whether the degenerative changes in pes, seen in the course of ageing, should be included into the risk factors of the high pressure occuring in its area after total laryngectomy. The analysis of the histopathological specimens revealed that after 40 years of age connective tissue in the pes is spreading and the number of muscular fibers is decreasing. Till 60 years of age the degenerative process in pes is very differentiated. Some histopathological specimens, in persons of this age section, didn't differ much from those seen in young cases. In the following decades o life degenerative process intensifies successively. In the histopathological specimens intensive proliferation of the fibrotic and fat tissue was found and considerable decrease of muscular fiber number. The investigations on risk factors of high pressure in the area of pes (results made know in paper given for print) revealed that in elder patients after total laryngectomy, its values are higher than in young ones. In patients till 55 years of age, in 72.29% (n = 26/36) of examined cases, the pressure in the pes area didn't exceed 3.99 kPa (30 mmHg). In the age of 55 years and above such a pressure was observed only 39.1% (n = 18/46) of examined. Degenerative changes in pes, depending on age, can be in part of patients (particularly in elder ones) one of the risk factors of the high pressure in the pes area, which should be taken in account in prognosis of esophageal speech mastering by the patient.

[Factors influencing the hormonal function in patients after the treatment of larynx cancer]. / Czynniki wplywajace na utrzymanie sie prawidlowej funkcji hormonalnej tarczycy u pacjentów po leczeniu raka krtani.

It has been revealed that the hypothyreosis (subclinical as a rule) can be found after every method applied in treatment of the larynx cancer. Correlation of data obtained with the time function allowed to specify survival probability of patients in euthyreosis after therapy termination. Among the factors supposed to be involved in keeping patient's normal thyroid gland function the following have been taken into account: sex, age, stage of the neoclassic process, scope of the surgical intervention on the larynx and lymph nodes of the neck, thyroid gland surgery and dose of irradiation given in Gy/T at the time of radiotherapy. Substantial impact on hypothyreosis was attributed to: method of laryngeal cancer, treatment, the range of its structures removal and surgical intervention on thyroid gland (excision of the thyroid lobe or its translocation for larynx reconstruction). It was found that the probability of survival in euthyreosis in patients treated by surgery and by combined method was the least after laryngopharyngectomy. In 3 years follow up period after such a therapy it amounted to 75% for surgical method and 48% for combined one. It was evident that the dysfunction of the thyroid gland resulted mostly from combined method of laryngeal cancer therapy (even without surgical intervention on thyroid glad). The probability of survival in euthyreosis in those patients was the least of all and amounted to 78.7% after 1 year of therapy termination and 42.9% after 6. In patients treated with combined method and intervention on thyroid gland, the survival probability in euthyreosis was 25% after excision thyroid lobe and 20% after its translocation for larynx reconstruction. After exclusive surgical therapy the probability amounted to 96% and after radiotherapy 88.6%. Prolongation of the follow up after radiotherapy (over 1 year) didn't increase the number of patients with hypothyreosis. The necessity of the evaluation of the thyroid gland hormonal function in every one patient has been stressed. This should be done before treatment and 1, 6, and 12 months after the termination of the therapy, and then once a year.

[Pathomorphology of the thyroid gland after treatment of laryngeal cancer]. / Patomorfologia gruczolu tarczowego po leczeniu raka krtani.

The aim of the report was the explanation of the pathogenesis of thyroid gland dysfunction after laryngeal cancer treatment. Assessment of histopathological specimens from thyroid gland was done. They were taken from the following patients: a) irradiated primary with the radical dose (n = 5), b) after combined therapy (n = 2) and c) at the autopsy from the persons aged between 30-80, without thyroid gland disease history (n = 30). It was found that the thyroid gland underwent degenerative changes after external irradiation or combined therapy, which became more intense with the passage of time. They consist among other things in diminishing of the follicle lining cells with the obliteration of the follicle structure of thyroid, damage to the blood vessel walls, fibrotic tissue proliferation with the following gland atrophy. In the histological specimens of the thyroid gland taken at the autopsy distinct obliteration of the follicle structure with the atrophy of follicle and intensified fibrotic process after 80 years of age was seen. Results of the investigations suggest that the main pathogenic factor in hypotyhyreosis after radiotherapy or combined therapy are the degenerative changes in the thyroid gland and their overlapping with circulatory disorders after surgery. Morphological changes in thyroid gland following aging increase the risk of hypotyhyreosis.

[Factors influencing morphology and function of the pharynx and pharyngoesophageal sphincter after total laryngectomy. Part II. The impact of degenerative changes in the neck segment of the vertebral column on the rest pressure within pharyngoesophageal sphincter after laryngectomy]. / Czynniki wplywajace na morfologie i funkcje gardla oraz zwieracza gardlowo-przelykowego po laryngektomii calkowitej. Czesc II. Wplyw zmian zwyrodnieniowych w szyjnym odcinku kregoslupa na cisnienie spoczynkowe w obrebie zwieracza gardlowo-przelykowego po laryngektomii calkowitej.

Radiological examinations of the vertebral column neck segment were done in 41 patients after total laryngectomy (n = 29) and laryngopharyngectomy (n = 12). Degeneration changes of different degree (from I degree to IV degree) were stated in 37 cases. Criteria of assessment were as follows: a) the width of the intervertebral space b) appearance and degree of the exostoses c) the length of the degenerative process in vertebral segment of the neck. The advanced degenerative changes in the vertebral column (IV degree) included all neck segment and were characterized by significant narrowing of the intervertebral spaces and exostoses longer than 0.5 cm. These changes were seen statistically more often in the patients after 50. The pharyngoesophageal sphincter's (p.e.s.) rest pressure was statistically rising significantly with the degree of the degeneration changes in the vertebral column. The high pressure in p.e.s. (5.7 + 2.85 kPa--43 + 21 mm Hg) was seen only in the cases of the IV degree degree. In the patients with the IV degree degree of degenerative changes in 67% retention of saliva in the hypopharynx was seen. Probably it was due to irritation of the sympathetic part of the autonomic system. The statistically significant correlation between the degree of the degenerative changes and the complains like pain during the head movement and limitation of the neck motion was also observed. In IV degree degree these complains were noted in 57% cases. The results of the investigations prove the hypothesis of influence of the sympathetic part of the autonomic system on the pharyngoesopghageal sphincter rest pressure.

[Factors influencing pharynx' and pharyngoesophageal sphincter's morphology and their function after total laryngectomy]. / Czynniki wplywajace na morfologie i funkcje gardla oraz zwieracza gardlowo-przelykowego po laryngektomii calkowitej.

The usefulness of the videolaryngoscopy in patients after total laryngectomy/laryngopharyngectomy was discussed. They serve for: a) evaluation of the pharynx and of the pharyngoesophageal sphincter (pes) morphology, b) prognosis of the esophageal speech developing. In the study videolaryngoscopy was done in 82 patients (7 female and 75 male). In 62 of them total laryngectomy was done (among them in 50/62--with standard pharynx suture, in 9/62--with the pes plasty, and 3/62--with simple pes myotomy). In 20 case of laryngopharyngectomies--4/20 standard pharynx suture was done, 12/20 were reconstructed with tongue flap, 3/20--with pes plasty, and in 1/20 simple myotomy was performed. The investigations were carried out between 1 to 36 months after total laryngectomy and 24 month after laryngopharyngectomy. The analysis of the videolaryngoscopy imagings revealed that the pharynx and pes morphology after laryngectomy/laryngopharyngectomy (shape, thickness of the mucose, weakened wall peristalsis, secretion retention, lack or presence of the pes relaxation at the time of examination) correlates with the rest pressure in the pes area, measured by Seeman's method and with the occurrence of the esophageal speech mastering. The most significant changes in morphology and function of the pharynx (irregular shape, weakened wall peristalsis, retention of secretion) as well as the highest pressure in the area (5.1 +/- 3.33 kPa-38 +/- 25 mm Hg) was found after pharyngolaryngectomy. The shape of the pharynx in all the patients after laryngectomy with plasty or simple myotomy of the pes was regular, with thin and smooth mucosa while the rest pressure was low (3.0 +/- 1.18 kPa(-)+/- 22.5 +/- 8.8 mm Hg). In the analyzed material at the rest pressure in the sphincter area from 0.7 to 4kPa (from 5 to 30 mm Hg), 93% (41/44) of the patients have mastered the esophageal speech. It was stressed that videolaryngoscopy is entirely sufficient for the approximate assessment of the rest pressure in the pes area and prognosis of the esophageal speech development process.

[Hypothyroidism after combined therapy of laryngeal cancer]. / Niedoczynnosc kliniczna tarczycy po leczeniu skojarzonym raka krtani.

The hormonal function of the thyroid gland in patients with laryngeal cancer, treated with combined method, has been discussed. The first group of them was having one of the thyroid lobes used for reconstruction of the structural defects following partial laryngectomy, the second one, for oncologic reasons--part or the whole gland--excised. Hormonal dysfunction of the thyroid gland was present in 7/10 of the treated patient. In 2 of them the full hypofunction (FH) of the thyroid gland could be observed. Most likely the hypothyreosis was the result of the surgical interference in the thyroid gland (disorders in blood supply in translocated for larynx repair thyroid lobe, excision of the lobe/s for oncological reasons) and degenerative process due to the external irradiation. The monitored hormonal function of the thyroid gland revealed the possibility of transformation of subclinical hypofunction (SH) into FH even after long period of therapy termination. The obligatory monitoring of the thyroid gland hormonal activity for many years has been stressed, as well as the necessity of supplementary therapy at the time of SH.