Features Of Instrument Research Articles

CLINICAL AND INSTRUMENTAL CHARACTERISTICS OF HEART FAILURE IN PATIENTS WITH DIFFERENT FORMS OF ATRIAL FIBRILLATION

The incidence of heart failure (HF) in the general population has reached an epidemic threshold, which is a very important problem for modern medicine. HF is accompanied by frequent comorbidity with atrial fibrillation (AF). At the current stage of scientific research, considerable attention is directed to improve the treatment of patients with HF on the background of AF with the aim of developing a complex and individual approach to the treatment of such patients.
 The purpose. Study the clinical and instrumental features of heart failure in patients with various forms of atrial fibrillation.
 Materials and methods. 90 patients aged 45-65 were examined. All patients were divided into groups: I group – patients with HF with sinus rhythm or AF (persistent and persistent), (n=50). II group - patients without HF with AF, (n=40). III – control group: 36 practically healthy people.
 The control group included persons who did not have any complaints and denied any history of cardiovascular diseases. The groups probably did not differ among themselves in terms of age and gender composition.
 All patients underwent a collection of complaints, disease history, life history, electrocardiography (ECG), echocardiography (ECHOKG), Holter ECG monitoring, heart rate variability (HRV), and a 6-minute walking test. AF diagnosis was carried out according to the clinical protocol for providing medical care to patients with atrial fibrillation, approved by the order of the Ministry of Health of Ukraine dated 07.03.2006 No. 436.
 The diagnosis of coronary heart disease (CHD) was carried out in accordance with the order of the Ministry of Health of Ukraine No. 436 of 03.07.2006 and the classification, standards of diagnosis and treatment of cardiovascular diseases of 2021.
 ECG recording was performed on a Cardiofax electrocardiograph (Electrokardiograph, 8820G, Germany) in 12 commonly accepted leads with recording of at least 4 PQRST cardiac complexes. According to the ECG data, the presence of deviation of the ST segment from the isoline, its size and shape, the polarity and amplitude of the T wave, signs of left ventricular hypertrophy, as well as the presence of heart rhythm and conduction disorders were evaluated.
 Research results. The analysis of the main clinical manifestations of HF in patients with AF showed that in most cases, 20 (80.0%) of patients had an anginal attack, which was combined with a palpitation in 24 (96.0%) and interruptions in the work of the heart in 23 (92, 0%) patients, shortness of breath in 22 (88.0%), anxiety in 13 (52.0%) and lack of air in 8 (32.0%) patients. Patients with AF without HF were troubled by anginal attacks, palpitations in 22 (88.0%) patients, heart failure in 20 (80.0%), shortness of breath in 18 (72.0%) patients. In patients with HF and AF, according to the ECG, depression of the ST segment, hypertrophy of the left ventricle, dispersion of the QT interval were detected.
 Conclusions:
 
 For patients with heart failure, the presence of anginal pain syndrome, shortness of breath, palpitations and interruptions in the work of the heart is typical.
 According to ECG data, ST segment depression, left ventricular hypertrophy, QT interval dispersion, atrial fibrillation, sinus tachycardia and extrasystole (supraventricular and ventricular) were found.
 Patients with heart failure demonstrated a lower level of household physical activity, worse indicators of the 6-minute walk test, worse quality of life.

Синдром Дресслера

The purpose is to present a literature review on a rather rare pathology — Dressler syndrome, paying special attention to one of its main components — pericarditis. Material and methods. Russian and foreign literature on Dressler syndrome were studied, with special attention to the sources over the recent 10 years. Results. A review of the medical literature on the topic — Dressler syndrome is presented, describing the concept, etio-pathogenetic aspects, classification, epidemiology, a brief historical background, clinical picture, laboratory and instrumental features, and tactics of patient management. Conclusion. Dressler syndrome is understood as a symptom complex that occurs due to myocardial damage of various genesis with the development of autoimmune aggression and subsequent hyperergic reaction with benign lesion of serous membranes, leading to the appearance of pericarditis, pleurisy, pneumonitis and other symptoms. The initial clinical manifestations and the subsequent course of this syndrome, as a rule, are often unexpressed. Therefore, a timely assessment of clinical and instrumental data that go beyond the usual course of the post-infarction / postoperative period, as well as the effect of the therapy used, contributes to the timely diagnosis of this syndrome and, accordingly, the appointment of adequate pathogenetic therapy.

Правовая политика и организованное взаимодействие общества и природы: теоретико-правовой аспект

It has become an axiom that man is an integral part of nature, which determines the search for optimal tools for organized interaction between society and nature. The article draws attention to the special functional intermediary value of legal policy in the field of ecology, which ensures goal-setting in the organized interaction of society and nature. The interrelationship, but not the identity, of the legal policy in the field of ecology and the ecological function of the state is demonstrated. The article pays attention to the basic scientific concepts that have developed around the concept of “legal policy”: axiological, instrumental and subject-functional. The importance of legal policy in the field of ecology, its existential content is demonstrated. Adaptive variability and at the same time stabilizing nature of legal policy is noted. The political and legal essence of the Constitution of the Russian Federation as a basic political and legal act in the field of regulation of environmental relations is proved. Attention is drawn to the main documents of strategic planning in the field of ecology, as well as their fundamental shortcomings. The study focuses on such controversial issues as the form of law of strategic planning documents; the right of the President of the Russian Federation to advance legal regulation; the permissibility of the introduction of new legal phenomena by strategic planning documents that do not have an appropriate corpus of norms at the level of federal legislation. It is concluded that it is necessary to search for axiological, instrumental and subject-functional features of legal policy in the field of ecology.

Клинико-лабораторные, инструментальные, морфологические особенности гангренозного и флегмонозного аппендицита у пациентов с COVID-19-инфекцией

Objective. To present clinical, laboratory, instrumental and morphological features of phlegmonous and gangrenous appendicitis in patients with COVID-19 infection. Patients and methods. During the period from March 2020 to August 2022, 23 patients were observed with positive results of testing of nasopharyngeal sample for SARS-CoV-2 RNA and performed appendectomy. The age group of children is 8–17 years old (the average age is 14.1 years), there were 13 boys, 10 girls. The premorbid state is not burdened. The rationale for appendectomy was: acute abdominal pain, local soreness on the right side of the abdomen, their preservation until the surgical removal of the appendix and their disappearance after surgery. During ultrasound of the abdominal cavity, all patients had ECHO signs of inflammatory transformation of the vermiform process. The disease was accompanied by repeated vomiting on the background of subfebrile (13 children) or normal temperature (10 children). Respiratory syndrome is poor, 4 children had abdominal pain, 9 children had hyperemia of the pharynx, chest CT did not reveal inflammatory changes. Repeated virological examination showed the positive result in 3 of 9 examined; EIA for IgM and IgG detection was positive in 7 (out of 7 examined) with diagnostic titers in 3 patients. During histological examination, the length of the removed appendixes is ~8.1 cm (4–12.5 cm), partial or complete desquamation of the epithelium, massive infiltration by lymphocytes or neutrophils, circulatory disorders, in some cases (gangrenous appendicitis) – the phenomena of thrombosis of small vessels, mesenteriolitis, periappendicitis. Typical E. Coli was found in 4 out of 23 abdominal fluid samples. Conclusion. The complex of clinical, laboratory, instrumental and morphological data confirmed the diagnosis of appendicitis and the course of COVID-19, indicating the need for surgical intervention and the appointment of antiviral therapy, noting the need to continue the study. Key words: phlegmonous, gangrenous appendicitis, children, laparoscopic removal, ultrasound of abdomen, morphological examination of the appendix

Spontaneous intracranial hypotension: a case series and literature review.

Spontaneous intracranial hypotension (SIH) is a condition of negative intracranial pressure resulting from cerebrospinal fluid (CSF) leakage from the dural sac and is a well-known cause of orthostatic headache. Diagnosis and management can be difficult, often requiring coordination between multiple disciplines. Low CSF pressure and diffuse meningeal enhancement on brain MRI are the major instrumental features of the classic syndrome. Neuroimaging plays a key role in diagnosing SIH, particularly in atypical clinical presentations, by recognizing the specific findings of brain sagging on MRI and detecting the level of CSF leak on spinal imaging, thus guiding therapy accordingly. Since SIH could present with such a heterogeneous clinical picture, careful history taking and increased awareness of atypical presentations are of utmost importance. We review the existing SIH literature, illustrate management, clinical and neuroimaging findings of four consecutive patients with atypical SIH, who were recently referred to our hospital for evaluation to simplify and streamline the management of SIH.

Reflectance of Jezero Crater Floor: 1. Data Processing and Calibration of the Infrared Spectrometer (IRS) on SuperCam

AbstractThe Perseverance rover, Mars 2020 mission, landed on the surface of the Jezero crater, on 18 February 2021. This Martian crater is suspected to have hosted a paleolake as evidenced by the numerous detections of aqueously altered phases and thus is a promising candidate for the search for past Martian life. The SuperCam instrument, a collaboration by a consortium of American and European laboratories, plays a leading role in this investigation, thanks to its highly versatile payload providing rapid, synergistic, fine‐scale mineralogy, chemistry, and color imaging. After its landing, the first measurements of Martian targets with the infrared spectrometer of SuperCam (IRS) showed new instrumental behaviors that had to be characterized and calibrated to derive unbiased science data. The IRS radiometric response has thus been calibrated using periodic observations of the Aluwhite SuperCam Calibration Target (SCCT). Parasitic effects were understood and mitigated, and the instrumental dark and noise are characterized and modeled. The reflectance calibrated data products, provided periodically on the NASA Planetary Data System, are corrected for the main instrumental features. This radiometric calibration allowed us to study the 2.5 μm absorption band, which has been discovered in the Séítah unit and is associated with phyllosilicates‐carbonates mixtures.

Тактика ведения амбулаторных пациентов с коронавирусной инфекцией COVID-19

Oblective. Optimisation of managing patients with COVID-19 in outpatient department based on clinical, laboratory, instrumental features of the disease in different periods of the pandemic. Patients and methods. A retrospective analysis of medical records of 400 COVID-19 patients aged 21 to 59 years (200 people during the period of maximum circulation of the variant "Delta" and 200 people during the period of maximum circulation of "Omicron"). There are 2 groups – 100 patients are in group 1 (21–44 years, average age 36.6 years) and 100 patients are in group 2 (45–59 years, average age 48.4 years). In all cases, the basis for the examination was the presence of symptoms of acute respiratory infection (ARI) and detection of SARS-CoV-2 in the study of a smear from nasopharynx and oropharynx by PCR. The modern statistical methods were used for data processing, relative and absolute indicators were evaluated. Results. In comparative analysis of clinical symptoms depending on the variant in COVID-19, significant differences were found in frequency of shortness of breath, heavy breathing , cough, myalgia, taste and smell loss, fatigue in patients with COVID-19 delta variant. Also COVID-19 Delta variant was statistically more severe compared to Omicron variant. Statistically more often patients suffer from sore throat during the circulation of "Omicron" variant. Leukopenia, monocytosis and high ESR have been observed in patients with COVID-19 delta variant. Conclusion. Outpatients with clinical manifestations of respiratory infection in epidemic season should conduct laboratory differential diagnosis of SARS-CoV-2 by PCR, blood test, including biochemical profile and coagulation test. In case of positive test , the further tactics of patient management depend on the form of disease ( mild forms – outpatient observation, severe forms -inpatient observation, in moderate forms for the management of patient , it is necessary to pay attention to the presence of comorbid pathology). Key words: COVID-19, genovariant, Delta, Omicron, outpatients

Features of the influence of degenerative changes of the cervical spine in the V1 segment of the spinal artery on the character of extravasal compression

BACKGROUND. The peculiarity of the cervical spine (CS) is a complex movable musculoskeletal, ligamentous-articular apparatus that carries a significant static and dynamic load. X-ray research methods could not based on the definition of degenerative changes in bones and joints, explain compression-reflex and myotonic syndromes in the pathology of the CS.
 OBJECTIVE. To reveal the clinical, instrumental, and hemodynamic features of the course of vertebral artery compression syndrome (VACS) and their role in determining diagnostic and therapeutic tactics.
 MATERIALS AND METHODS. The features of diagnosis and treatment tactics of 1,118 patients with degenerative lesions of the CS and VACS were analyzed. X-ray examination made it possible to solve common tasks of diagnosis. During the analysis of X-ray examination in segment V1 showed degeneration of dystrophic changes.
 RESULTS AND DISCUSSION. Analyzing the expressiveness of VACS in compression scores, we obtained the following results for the identified variants of dystrophic changes of VACS in the projection of the V1 segment: variant I – 14.7±1.84; variant II – 15.3±1.72; variant III-A – 17.1±1.78; variant III-B – 16.2±1.67; variant IV-A – 16.8±1.69; variant IV-B – 15.9±1.48. The analysis of degenerative-dystrophic changes of the CS at the level of the maximum positional compression showed that the expressiveness of the extravasal positional compression in the V1 segment did not differ significantly in variants I, II, III.
 CONCLUSIONS. 1. Degenerative changes in CS occur long before the appearance of the clinical manifestation of VACS. 2. The expressiveness of the degenerative damage of the musculoskeletal system of the CS according to the X-ray examination does not correspond to the clinical course of VACS. 3. Character of radiological functional instability in CS is not reflected in the complex clinical symptoms of VACS. 4. A multimodal approach to analgesia guarantees full control over all links of the pain process.

1041 ELECTROCARDIOGRAPHIC HETEROGENEITY OF PATIENTS WITH VARIANT TRANSTHYRETIN AMYLOID CARDIOMYOPATHY: GENOTYPE PHENOTYPE CORRELATIONS

Abstract Transthyretin (TTR) amyloid cardiomyopathy due to mutation on TTR gene (vATTR) has extremely different features according to the type of mutation, ranging from a mild to an extensive cardiac involvement. Data about electrocardiographic findings (ECG) in vATTR are limited and not informative of genotype correlation. Aim of this study is to analyze ECG characteristics and their correlation to clinical and echocardiographic aspects in patients with vATTR cardiomyopathy, focusing on different TTR mutations. This is a multicentric, retrospective, observational study performed in six Italian referral centres for cardiac amyloidosis. We divided patients in two groups, according to the previously described phenotypic manifestations of the TTR mutation. Of 64 patients with vATTR cardiomyopathy, 23 (36%) had prevalent cardiac (PC) TTR mutations and 41 (64%) patients had a prevalent neurological (PN) TTR mutations. Patients with PC mutations were more frequently males and older, with advanced NAC staging. At baseline ECG, atrial fibrillation was more common in patients with PC, while pacemaker induced rhythm in those with PN mutations. Prevalence of atrioventricular and intraventricular blocks, pseudonecrosis pattern and low voltages were not significantly different in both groups. PQ and QRS durations were longer and voltage to mass ratio was lower in PC mutations. Different TTR mutations tend to have distinctive ECG features. The standard ECG in vATTR is extremely heterogeneous and the specific mutations are associated with distinct instrumental and clinical features. The differences between PN and PC vATTR are only partially explained by the different degree of cardiac infiltration.

1110 PROGNOSTIC IMPACT OF SIGNIFICANT MITRAL REGURGITATION IN PATIENTS WITH SEVERE LOW FLOW, LOW GRADIENT AORTIC STENOSIS UNDERGOING TRANSCATHETER AORTIC VALVE REPLACEMENT

Abstract Aim This study sought to determinate the prevalence, clinical impact, and clinical outcome of significant moderate-to-severe mitral regurgitation (MR) in patients with severe low flow, low gradient aortic stenosis (LFLG-AS) undergoing transcatheter aortic valve replacement (TAVR). Methods All consecutive patients with severe LFLG-AS undergoing TAVI in two high-volume Italian centres from 2013 to 2022 were prospectively included. LFLG-AS was defined as indexed aortic valve area (iAVA) ≤0.6 cm2/m2, mean transaortic gradient <40 mmHg and stroke volume index <36 ml/m2. LFLG-AS was classified as classical if left ventricular ejection fraction (LVEF) was <50%, and paradoxical in patients with preserved LVEF >50%. Demographic, clinical, instrumental, and procedural features were systematically collected by using an electronic case report form. MR severity was graded according to the current guidelines, and patients were categorized based on the MR severity at baseline in two groups: mild and moderate-to-severe MR. The primary study outcome was the composite of all-cause mortality and rehospitalization for worsening heart failure (HF) up to 1 year; secondary outcomes were the single components of the primary outcome. Results The study included 268 patients [81±6 years; 142 (53%) females]; moderate-to-severe MR was reported in 57 patients (21%). At baseline moderate-to-severe MR compared to those with mild MR showed statistically significant differences between age (p 0.008), female sex (p 0.007), hypertension (p 0.036), diabetes (p 0.001) atrial fibrillation/flutter (p 0.018) and chronic kidney disease (p 0.012). In the overall population, only one patient died during the hospitalization and at one-year follow-up, the primary outcome was reported in 49 patients (18%); all-cause death occurred in 26 (10%), and HF rehospitalization in 24 (9%). Regarding the two subgroups, Kaplan-Meier curves showed that survival free from the composite outcome was significantly lower in patients with moderate-to-severe MR compared to those with mild MR (Log Rank <0.001, Figure 1A). Survival free from all-cause mortality and HF rehospitalization was also significantly lower in patients with moderate-to-severe MR (Log-Rank <0.001 and Log-Rank=0.002, respectively; Figure 1B and 1C). Conclusion In this study, many patients with LFLG-AS undergoing TAVR had coexisting moderate-to-severe MR. TAVI confirmed a high safety profile, LFLG-AS patients showed a high incidence of adverse events up to 1 year, especially those with coexisting moderate-to-severe MR. Moderate-to-severe MR should be duly considered for better prognostic stratification and clinical management of these particular TAVR patients during follow-up. Figure 1

142 ADVANCED HEART FAILURE IN PATIENTS WITH ARRHYTHMOGENIC CARDIOMYOPATHY

Abstract Background Arrhythmogenic Cardiomyopathy (ACM) is a primary disease of the heart muscle, characterized by fibro-fatty myocardial replacement. Improvements in the clinical diagnosis and antiarrhythmic therapy, including the use of the defibrillator (ICD) and endo-epicardial catheter ablation, have increased the survival of these patients, who experience late complications such as advanced heart failure, which sometimes requires cardiac transplantation. Aim of the study To evaluate clinical, instrumental and genetic features of patients affected with ACM who developed heart failure (HF) and to sought for possible predictive factors of HF. Methods From the entire cohort of probands and family members followed at the Cardiomyopathy unit of our University (555 patients), 34 patients (29%), both probands (n= 26, 77%) and family members who experienced HF (6%) were selected (24 males, 71%). Their anamnestic, clinical, and instrumental data were compared with those without episodes of HF (n-HF). Results The mean age at diagnosis in HF cohort was 45.2 (±18) years. In 14 patients (41%) HF was the first symptom that led to diagnosis. According to 2010 TFC 30 patients (88%) had a definite diagnosis of ACM. The most frequently observed phenotype was the biventricular ACM (n=27, 79%). A disease-related genetic variant was found in 18 (53%) and DSP was the more common disease-gene, accounting for 24% of cases. The mean duration of follow-up was 12.6 (±11.0) years (min-max, 1-20 years). During this period a total of 14 subjects (41.2%) experienced life-threatening arrhythmias (LTA), while 13 patients (38.2%) died, of whom 11 (84.6%) because of refractory HF. Eighteen patients (53%) underwent cardiac transplantation (mean age 43±17 years), approximately 4 (±3.5) years after the onset of symptoms. Comparison with the n-HF cohort of ACM patients showed a significant difference on presence of T-wave inversion (TWI) in V1-V3 (p=0.001), TWI in V4-V6 (p=0.010), low QRS voltages both in precordial and limb leads (both p<0.001) and presence of left bundle-branch block and right bundle-branch block (both p<0.001). Regarding CMR, HF cohort was characterized by a significantly more dilated right and left ventricle EDV (both p<0.001), EF reduction (both p<0.001), presence of wall motion alterations (respectively, p=0.007 and p<0.001) and LGE (respectively, p=0.002 and p=0.005) compared to n-HF group. Regarding outcomes evaluation, the HF group showed more frequently LTA (HF=41.2% vs n-HF 21.5%, p=0.008). Finally, the presence of right bundle-branch block at ECG (OR=20.562, CI 1.884-224.413, p=0.013) and of impaired RV ejection fraction (OR=0.821, CI 0.719-0.937, p=0.004) were found to be independent predictors of HF. Conclusions Heart failure is a rare complication in patients affected with ACM, with a prevalence of 6% in our study. The mean age of onset of HF was 45.2 (±18) years. Furthermore, 18 patients (53%) had an unfavorable progression to heart transplantation. The presence of right bundle branch block at ECG and an impaired CMR RV-EF were found to be predictors of HF. Our results suggest the importance of scheduling a close follow-up in ACM patients who show initial signs and/or symptoms of HF, taking into consideration the fast rate of progression to refractory HF, once established.

373 ADONHERS (AGED DONOR HEART RESCUE BY STRESS ECHO) PROTOCOL FOR HEART DONATION FROM MARGINAL DONOR HEARTS: MONOCENTRIC RETROSPECTIVE STUDY ON RECIPIENT'S SURVIVAL AFTER 10-YEAR FOLLOW-UP

Abstract Backgorund Amelioration of therapies and increased survival in heart failure (HF) is leading to a growing number of patients affected by advanced HF, with an overall 1-year prognosis ranging from 25 to 75%. The gold standard treatment for end stage HF is heart transplantation (Htx), but lack of organs donors remains an important limitation. Marginal hearts can potentially improve and be utilized after a re-evaluation by “aggressive” assessment of donor left ventricular function. Purpose In our study we analysed if recipients of marginal donor hearts, selected by dipyridamole stress echocardiography, had different outcome compared to recipients with acceptable donor hearts. Methods Data collected from 2006 and 2014 of patients who received orthotopic Htx from marginal heart donors (group 1) and were retrospectively analysed and compared with recipients of acceptable heart donors (group 2). Bedside standard echocardiography and dipyridamole stress echo was performed for the selection of marginal hearts > 55 years old or < 55 with comorbidities/mildly dysfunctional left ventricle. Clinical, laboratory and instrumental features of the two groups of recipients were evaluated and patients with homogenous baseline characteristics were selected to reduce biases among the two groups. Follow-up through routine heart transplant surveillance included visit, echocardiography, blood tests, serial endomyocardial biopsies and coronary angiography. Results Twenty-two recipients were included in the study. Mean donors age was 41 ± 23, 45 ± 29 years for group 1 vs 36 ± 12 for group 2. The average follow-up was 113 months. Age, cardiovascular risk and morpho-functional characteristics of the left ventricle were comparable between the two population (P> 0.05). Left atrial size was significantly higher in marginal hearts (Optimal: p=0.007; Marginal: p=0.003). Acceptable recipients showed a higher impact of CAV (p= 0.019) together with more elevated values of cholesterol and triglycerides (p = 0.048 and p = 0.012 respectively). No differences concerning cellular or humoral rejection were found between the two groups. Four patients deceased, 3 had received a standard donor heart and 1 was from the marginal donor group, with and overall median time to death of 124 months. Conclusions Our small pilot study shows how the evaluation of marginal donor hearts with echo stress result to no affect recipients survival compared with controls of acceptable hearts. A well-controlled selection of marginal hearts could therefore improve the shortage of organs, reducing the long line of patients waiting for a heart.

«But Fire thought she’d really rather be Water instead»: Tori Amos and her natural narration

This study closely examines Tori Amos’s practice of narration, and especially her lyrics, in the context of the integral organic co-agency / co-operation of the layers of American singer-songwriter’s musical-lyrical-performative language. The interpretation that this practice receives in the current research is that it is conceptually (and poetically) natural and containing the efficient (political) tool of natural introspection. As the analysis of Amos’s lyrics demonstrates the natural introspection in her oeuvre expands throughout spontaneously intuitive to considerately determinate gesture, as well as from self-observation to (com)prehension of the world. Such a non-hierarchical oscillation debases the deeply rooted understanding (at least what concerns the western tradition) of a (co)existence (at best) of a subject and a so-called environment; it actualizes, alternatively, the natural work (or, the work with the natural) outside the binary limitations, such as «internal-external». The subversive character of this work is guaranteed, as this study aims to show, through its instrumental and topological features. A poetically informed ecological labor (namely, the critically important practice of attending and of relationship-building) that is fully definitive of the singer-songwriter’s creative fact directs her to simultaneously address the natural topologically – as a result, Amos unpacks the natural introspection’s emancipatory potential. Following Elizabeth Grosz’s line of thinking on the entwining interaction of materiality and ideality the study offers a reading of the natural introspection as embodying the natural logic of becoming that continuously emancipates. The praxis of narration – as it is present in Tori Amos, a teller / singer of stories – appears as one on the plane of continuation and recreation of life.

Payment Features and Incentives as Drivers for Non-Cash Payments Usage – the Evidence from Poland

Theoretical background: There is evidence that sustainable economic growth is strictly connected with non-cash payments development. Nevertheless, in many countries, cash still remains the dominant means of payment. Cash can be treated as a store of value and a means of payment. The paper focuses on its transactional function and addresses the need to recognise drivers that can shift consumers away from cash. Purpose of the article: The paper aims to analyse what features of payment instruments and what kind of incentives could convince consumers to switch from cash to non-cash payments. Research methods: The data analysed were collected during the first survey on this topic conducted in 2018 on a representative sample of Polish consumers. The selected statistical methods were applied to analyse research data. Among them are correlation analysis and Thurstone’s method of paired comparisons to analyse preferences and association (co-occurrence) for exploring consumers’ preferences related to their payment choices. Main findings: The results show that in Poland consumers’ payment choices are driven rather by the cost than other payment instrument features such as speed, convenience or security. These results are consistent with the greater sensitivity of Polish consumers to financial incentives than material bonuses or tax benefits. The analysis has also shown a statistically significant correlation between the kind of incentive and the consumer’s characteristics.

Prognostic value of left ventricular global longitudinal strain in patients with hypertrophic cardiomyopathy

ABSTRACT. Hypertrophic cardiomyopathy (HCM) is one of the widespread genetically determined diseases of the myocardium, which is accompanied by the development of diastolic and, subsequently, systolic dysfunction of the myocardium. The aim of our study was to evaluate the clinical and instrumental features of patients with hypertrophic cardiomyopathy with impaired left ventricular global longitudinal strain (GLS) and its prognostic value for the development of cardiovascular events in the Ukrainian population of patients with hypertrophic cardiomyopathy. Materials and methods. The data of 35 patients with hypertrophic cardiomyopathy who underwent a comprehensive clinical and instrumental examination with determination of the absolute global longitudinal strain on speckle-tracking echocardiography were retrospectively analyzed. The patients were divided into two groups: Group I (GLS< 14.5) and Group II (GLS≥ 14.5). Results. A decrease in global longitudinal strain was associated with a longer disease duration (8 (5-11) vs 3 (2-5) years, p=0.003), increasing of complaints on irregularity of heart beat (66.7% vs 23.5%, p= 0.018) and weakness (61.1% vs 23.5%, p=0.04), increased systolic blood pressure (SBP) (130 (120-140) vs 110 (100-120) mm Hg, p= 0.009), the absence of patients without signs of heart failure (0 vs 29.4%, p=0.019), an increase in IVRT (106.19±28.62 vs 84.57±27.54 ms, p=0.044) and a greater number of ventricular extrasystoles (17 (4-69) vs 2 (0.5-3), p=0.014). According to the Kaplan-Meier analysis of survival in relation to fatal and non-fatal cardiovascular events or their combination with hospitalization for heart failure, they had significantly worse survival rates (Log-Rank, p=0.016 and p=0.003). Conclusions. Hypertrophic cardiomyopathy patients with poor global longitudinal strain scores were characterized by worse clinical and instrumental data and an unfavorable cardiovascular prognosis.

Implementing pathways to anesthesiology: Promoting diversity, equity, inclusion, and success.

Implementing pathways to anesthesiology: Promoting diversity, equity, inclusion, and success.

The Debut of Inflammatory Musculoskeletal Pathology in Patients Receiving Anticancer Therapy with PD-1/PD-L1 Pathway Inhibitors

Objective: to describe musculoskeletal immune-mediated adverse events (iAEs) associated with the therapy of solid tumors with immune checkpoint inhibitors (ICIs, inhibitors of the PD-1/PD-L1 pathway).Patients and methods. 13 patients receiving ICIs therapy with musculoskeletal iAEs were examined. The average age of patients was 59±10 years. All cases had a histologically verified diagnosis of a malignant solid neoplasm: melanoma (n=5), kidney cancer (n=3), bladder cancer (n=2), non-small cell lung cancer (n=1), breast cancer (n=1), cervical cancer (n=1). All patients were prescribed inhibitors of the PD-1/PD-L1 signaling pathway: nivolumab (n=6), pembrolizumab (n=3), atezolizumab (n=3), prolgolimab (n=1). In 7 (54%) patients, in addition to musculoskeletal disorders, other AEs were also detected: thyroiditis (n=3), neuropathy (n=2), rash (n=1), dry syndrome (n=1), hepatitis (n=1). The median time from the start of antitumor immunotherapy (IT) to the onset of musculoskeletal pathology was 20 [9; 48] weeks.Results and discussion. Clinical manifestations of musculoskeletal pathology included: synovitis in 9 (69%) patients, tenosynovitis in 11 (85%), enthesitis in 4 (31%), morning stiffness in the joints for more than 30 minutes in 4 (31%). In 11 cases, musculoskeletal pathology was persistent (in 9 patients with arthritis and 2 with periarthritis) and in 2 – transient. The knee (77%), shoulder (69%) and hand (54%) joints were most frequently affected, with bilateral involvement in 9 (69%) patients. Inflammatory changes in the joints were represented by mono- (n=1), oligo- (n=3) and polyarthritis (n=5), including those involving the small joints of the hands and/or feet (n=5) and predominantly affecting the joints of the lower limbs (n=3). In 3 patients with arthritis, periarticular changes dominated in clinical picture (in 2 patients with symmetrical polyarthritis and severe tenosynovitis, in another 1 patient – with RS3PE syndrome). The severity of musculoskeletal pathology was assessed using the CTCAE v5.0 toxicity criteria: grade 1 was documented in 2 (15.5%), grade 2 in 9 (69%), and grade 3 in 2 (15, 5%) patients. Laboratory workup revealed elevation of ESR ≥30 mm/h (median – 34 [14; 42] mm/h) in 7 out of 12 (58%) patients, elevation of CRP level >5 mg/l (median – 7.2 [4.6; 12.9] mg/l) – in 7 out of 10 (70%). In 7 out of 10 patients, antinuclear antibodies (Hep2) were detected in titers: 1:160 (n=2), 1:320 (n=3), 1:640 (n=2). Rheumatoid factor and antibodies to cyclic citrullinated peptide were not detected in any case. Therapy for musculoskeletal AEs included non-steroidal anti-inflammatory drugs (n=10), oral systemic glucocorticoids – GC (n=5), methotrexate – MT (n=1) and hydroxychloroquine (n=5), intra-articular administration of GC (n=1). Five patients with arthritis required long-term therapy (median duration – 12 [3; 12] months), in 1 patient with polyarthritis and severe tenosynovitis, antitumor IT was interrupted for the duration of the course of MTX treatment.Conclusion. It has been shown that musculoskeletal iAEs have heterogeneous manifestations and may require long-term treatment and in rare cases, anticancer therapy interruption. Additional studies and close cooperation between rheumatologists and oncologists are needed to obtain a more complete understanding of the nature and spectrum of musculoskeletal AEs, to identify their clinical, laboratory and instrumental features, and to develop an management of patients algorithm.

A Nanofocused Light on Stradivari Violins: Infrared s-SNOM Reveals New Clues Behind Craftsmanship Mastery.

It is well-known that all the phases of the manufacturing influence the extraordinary aesthetic and acoustic features of Stradivari's instruments. However, these masterpieces still keep some of their secrets hidden by the lack of documentary evidence. In particular, there is not a general consensus on the use of a protein-based ground coating directly spread on the wood surface by the Cremonese Master. The present work demonstrates that infrared scattering-type scanning near-fields optical microscopy (s-SNOM) may provide unprecedented information on very complex cross-sectioned microsamples collected from two of Stradivari's violins, nanoresolved chemical sensitivity being the turning point for detecting minute traces of a specific compound, namely proteins, hidden by the matrix when macro or micro sampling approaches are exploited. This nanoresolved chemical-sensitive technique contributed new and robust evidence to the long-debated question about the use of proteinaceous materials by Stradivari.

Minor Salivary Gland Surgery and Histopathological Scoring System: A Systematic Review

Sjögren’s syndrome is a systemic autoimmune disease characterized by chronic inflammation of the exocrine glands with an associated functional deficit. The clinical picture is characterized by symptoms such as dry eyes (xerophthalmia) and dry mouth (xerostomia). The disease is defined as primary if no other autoimmune diseases are associated, otherwise, it is defined as secondary. A systematic review was made using the databases PubMed (MEDLINE), Scopus, and keywords “biopsy,” “classification,” “clinical pathology,” “salivary glands,” and “Sjogren’s syndrome.” The diagnosis of Sjögren’s syndrome is based on a combination of clinical, serologic, instrumental, and histological features. In addition to ocular tests, a biopsy of the minor salivary glands represents one of the most relevant examinations for the diagnosis. In fact, the evaluation of specific histopathological features represents one of the most important criteria proposed in the last international consensus of 2016, which developed the most recent classification criteria for Sjögren’s syndrome. Knowledge of classification criteria, minor salivary gland biopsy techniques, and histopathological features are essential for the clinician to evaluate the pathology report and make a diagnosis of Sjögren’s syndrome. The aim of this review is to describe the classification criteria of the disease proposed to date, the main biopsy techniques used to analyze the minor salivary glands, and finally, the histopathological diagnostic scoring systems currently applied.

Safety and efficacy of ranolazine in hypertrophic cardiomyopathy: Real-world experience in a National Referral Center

ObjectivesWe assessed the efficacy and safety of ranolazine in real-world patients with hypertrophic cardiomyopathy (HCM). BackgroundRanolazine is an anti-anginal drug that inhibits the late phase of the inward sodium current. In a small prospective trial, ranolazine reduced the arrhythmic burden and improved biomarker profile in HCM patients. However, systematic reports reflecting real-world use in this setting are lacking. MethodsChanges in clinical and instrumental features, symptoms and arrhythmic burden were evaluated in 119 patients with HCM before and during treatment with ranolazine at a national referral centre for HCM. ResultsPatients were treated with ranolazine for 2 [1–4] years; 83 (70%) achieved a dosage ≥1000 mg per day. Treatment interruption was necessary in 24 patients (20%) due to side effects (n = 10, 8%) or disopyramide initiation (n = 8, 7%). Seventy patients (59%) were treated with ranolazine for relief of angina. Among them, 51 (73%) had total symptomatic relief and 47 patients (67%) showed ≥2 Canadian Cardiovascular society (CCS) angina grade improvement. Sixteen patients (13%) were treated for recurrent ventricular arrhythmias, including 4 with a clear ischemic trigger, who experienced no further arrhythmic episodes while on ranolazine. Finally, 33 patients (28%) were treated for heart failure associated with severe diastolic dysfunction: no symptomatic benefit could be observed in this group. ConclusionRanolazine was safe and well tolerated in patients with HCM. The use of ranolazine may be considered in patients with HCM and microvascular angina.