Institute of Fundamental Technological Research

Background: Chatbots using the Large Language Model (LLM) generate human responses to questions from all
categories. Due to staff shortages in healthcare systems, patients waiting for an appointment increasingly use
chatbots to get information about their condition. Given the number of chatbots currently available, assessing the
responses they generate is essential.
Methods: Five chatbots with free access were selected (Gemini, Microsoft Copilot, PiAI, ChatGPT, ChatSpot) and
blinded using letters (A, B, C, D, E). Each chatbot was asked questions about cardiology, oncology, and psoriasis.
Responses were compared to guidelines from the European Society of Cardiology, American Academy of
Dermatology and American Society of Clinical Oncology. All answers were assessed using readability scales
(Flesch Reading Scale, Gunning Fog Scale Level, Flesch-Kincaid Grade Level and Dale-Chall Score). Using a 3-
point Likert scale, two independent medical professionals assessed the compliance of the responses with the
guidelines.
Results: A total of 45 questions were asked of all chatbots. Chatbot C gave the shortest answers, 7.0 (6.0 – 8.0), and Chatbot A the longest 17.5 (13.0 – 24.5). The Flesch Reading Ease Scale ranged from 16.3 (12.2 – 21.9)
(Chatbot D) to 39.8 (29.0 – 50.4) (Chatbot A). Flesch-Kincaid Grade Level ranged from 12.5 (10.6 – 14.6) (Chatbot A) to 15.9 (15.1 – 17.1) (Chatbot D). Gunning Fog Scale Level ranged from 15.77 (Chatbot A) to 19.73 (Chatbot D). Dale-Chall Score ranged from 10.3 (9.3 – 11.3) (Chatbot A) to 11.9 (11.5 – 12.4) (Chatbot D).
Conclusion: This study indicates that chatbots vary in length, quality, and readability. They answer each question
in their own way, based on the data they have pulled from the web. Reliability of the responses generated by
chatbots is high. This suggests that people who want information from a chatbot need to be careful and verify the answers they receive, particularly when they ask about medical and health aspects.

Chatbots,Readability,Cardiovascular health,Oncology

Brachial aortic Pulse Wave Velocity (baPWV) and bone mineral density (BMD) are important indicators of cardiovascular health and bone strength, respectively. However, the gender-specific association between baPWV and BMD remains unclear. The aim of our study is to evaluate the relationship between baPWV and
BMD in men and women populations Methods: A comprehensive search was conducted in electronic databases for relevant studies published between the 1th and 30rd of April 2023. Studies reporting the correlation between baPWV and BMD in both males and
females were considered. A random-effects model was used to calculate pooled correlation coefficients (r). Results: Relevant data for both genders were found in six articles. In all publications included in the meta-analysis, the total number of studied individuals was 3800, with 2054 women and 1746 men. Pooled correlation coefficient was -0,24 (95% CI: -0.34; -0.15) in women population, and -0.12 (95%CI: -0.16, -0.06) in
men. Conclusions: Based on the published data, we found that baPWV is negatively correlated with bone density in women. However, in men we do not find such a
relationship. These findings suggest the importance of considering gender-specific factors when assessing the cardiovascular and bone health relationship.

Bone mineral density, osteoporosis, brachial aortic Pulse Wave Velocity, arterial stiffness, gender differences

Abstract: BackgroundDiet-related diseases remain leading causes of death in most developed countries around the world. The aim of the study was to compare opinions of patients and family physicians on receiving and providing recommendations about physical activity, diet and use of medication. Methods: The questionnaire study was conducted among patients of 36 primary health care clinics in Poland between September 2018 and February 2019. Patients and physicians were interviewed separately by trained researchers. Data from 509 patients and 167 family doctors were analyzed. Results: The median age of patients was 44 years (interquartile range: 29–55) and 70% were women. The majority of physicians were women (59%) and the median age was 37 years (IQR: 31–50). There was a significant difference between physicians’ declarations on providing recommendations on diet (92% vs. 39%) and activity (90% vs. 37%) versus patients’ declarations on receiving them. Conclusions: The results indicate that there is significant room for improvement in providing patients with proper recommendations on diet and physical activity by their family physicians. Primary care physicians should put more emphasis on clear communication of recommendations on diet and physical activity.

diet

AIMS: Bradyarrhythmias are potentially life-threatening medical conditions. The most widespread treatment for slow rhythms is artificial ventricular pacing. From the inception of the idea of artificial pacing, ventricular leads were located in the apex of the right ventricle. Right ventricular apical pacing (RVAP) was thought to have a deteriorating effect on left ventricular systolic function. The aim of this study was to systematically assess results of randomized controlled trials to determine the effects of right ventricular apical pacing on left ventricular ejection fraction (LVEF). Methods: we systematically searched the Cochrane Central Register of Controlled Trials, PubMed, and EMBASE databases for studies evaluating the influence of RVAP on LVEF. Pooled mean difference (MD) with a 95% confidence interval (CI) was estimated using a random effect model. Results: 14 randomized controlled trials (RCTs) comprising 885 patients were included. In our meta-analysis, RVAP was associated with statistically significant left ventricular systolic function impairment as measured by LVEF. The mean difference between LVEF at baseline and after intervention amounted to 3.35% (95% CI: 1.80–4.91). Conclusion: our meta-analysis confirms that right ventricular apical pacing is associated with progressive deterioration of left ventricular systolic function.

artificial pacing

Chronic kidney disease (CKD), which is characterized by the gradual loss of kidney function, is a growing worldwide problem due to CKD-related morbidity and mortality. There are no reliable and early biomarkers enabling the monitoring, the stratification of CKD progression and the estimation of the risk of CKD-related complications, and therefore, the search for such molecules is still going on. Numerous studies have provided evidence that miRNAs are potentially important par- ticles in the CKD field. Studies indicate that some miRNA levels can be increased in patients with CKD stages III–V and hemodialysis and decreased in renal transplant recipients (miR-143, miR-145 and miR-223) as well as elevated in patients with CKD stages III–V, decreased in hemodialysis patients and even more markedly decreased in renal transplant recipients (miR-126 and miR-155). miRNA have great potential of being sensitive and specific biomarkers in kidney diseases as they are tissue specific and stable in various biological materials. Some promising non-invasive miRNA biomarkers have already been recognized in renal disease with the potential to enhance diagnostic accuracy, predict prognosis and monitor the course of disease. However, large-scale clinical trials enrolling heterogeneous patients are required to evaluate the clinical value of miRNAs.

Chronic kidney disease

Objectives: Burnout among physicians is an increasingly recognized phenomenon affecting different aspects of patient care and safety. This meta-analysis quantifies association of burnout and its subscales with self-reported medical errors among physicians. Methods: This meta-analysis followed the principles formulated in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Meta-analyses of Observational Studies. The MEDLINE, PubMed, Web of Science, PsycInfo, and Eric databases were searched until February 5, 2019, using various combinations of key terms without any language restrictions: burnout, physicians, error, safety, and quality. Reference lists of selected studieswere hand searched. Datawere extracted frompublished reports. All quantitative studies reporting prevalence of burnout and its association with self-reported errors among physicians were considered. The analyses of heterogeneity (Cochran Q, I^2), publication bias (Begg- Mazumdar and Egger), three subgroups, and sensitivity were performed. The effect of overall burnout and Maslach Burnout Inventory subscales on self-reported errors was calculated as odds ratios with 95% confidence interval. Results: Thirteen studies on 20,643 physicians and residents were included. The overall burnout among participants was associated with a significantly increased risk of self-reported errors (odds ratio = 2.72, 95% confidence interval = 2.19–3.37). Emotional exhaustion, depersonalization, and personal accomplishment were all independently predicting factors of self-reported errors. Cochran Q test and inconsistency index I2 were as follows: Q = 27.2; P = 0.0013, I^2 = 67% (36%–83%). Conclusions: The results provide evidence that not only overall burnout but also its subscales independently are to be associated with a significantly increased risk of self-reported errors among physicians. As self-reported errors may translate into different types of adverse events, this strong and unequivocal association should be of major concern to healthcare organizations.

burnout, error, patient safety, quality of care

Background. Blood flow-mediated dilation (FMD) is a noninvasive assessment of vascular endothelial function in humans. The study of the FMD in hypertensive (HT) patients is an important factor supporting the recognition of the early mechanisms of cardiovascular pathologies, and also of the pathogenesis related to hypertension. Objectives. To investigate whether FMD measured on the radial artery (FMD-RA) using high-requency ultrasounds can be used asan alternative to FMD assessed with the lower frequency system onthe brachial artery in patients with HT. Materials and methods. The simultaneous measurements of FMD-RA and FMD measurements in the brachial artery (FMD-BA) were performed on 76 HT patients using 20 MHz and 7–12 MHz linear array probes, and were compared to the FMD measured in healthy groups. All quantitative data are presented as mean ± standard deviation (SD); the p-values of the normality and tests for variables comparisons are listed. The agreement of the FMD-RA and FMD-BA in HT patients was assessed with the Bland–Altman method, and using the intraclass correlation coefficient (ICC). In some statistical calculations, the FMD-RA values were rescaled by dividing them by a factor of 2. Results. The mean FMD-RA and FMD-BA in HT patients were 5.16 ±2.18% (95% confidence interval (95% CI): [4.50%, 5.82%]) and 2.13 ±1.12% (95% CI: [1.76%, 2.49%]), respectively. The FMD-RA and FMD-BA values of HT patients were significantly different than those in respective control groups. The p-values of Mann–Whitney–Wilcoxon tests were less than 0.05. The Bland–Altman coefficient for both measurement methods, FMD-RA and FMD-BA, was 3%, and the ICC was 0.69. Conclusions. Our findings show that FMD-RA, supplementary to FMD-BA measurements, can be used to assess endothelial dysfunction in the group of HT patients. In addition, the FMD-RA measurements met the criteria of high concordance with the FMD-BA measurements.

hypertension, brachial artery, radial artery, endothelial function

Introduction. To investigate the public interest in cancer screening before, during and after one year of the COVID-19 pandemic, in relation to the number of cases and deaths caused by the coronavirus. Material and methods. Google Trends (GT) was used to obtain data on online interest in screening for the most common cancer types during COVID-19 pandemic. Results. It was found that although online interest in screening collapsed during the early stages of the pandemic, it managed to gradually return to its pre-pandemic levels six months later despite a growing number of COVID-19 related deaths. Nevertheless, some data and reports suggest that this unprecedented crisis may result in increased mortality and incidence rates. Conclusions. The study raises the importance of continuous and active actions aimed at raising cancer awareness which appears to be crucially important during a public health crisis such as the COVID-19 pandemic.

cancer screening

Introduction: Real-time continuous glucose monitoring (CGM) has changed the way people with type 1 diabetes mellitus (T1DM) and health care providers perceive diabetes management and glucose control. Objectives: The purpose of this meta-analysis was to compare the emotional well-being of adults with T1DM who used CGM and those using conventional self-monitoring of blood glucose (SMBG). Patients and methods: The MEDLINE/PubMed, Cochrane Library / Embase, CINAHL, Scopus, Web of Science, and ProQuest databases were searched for relevant publications. Primary outcome measures were health-related quality of life, glycemic control, and fear of hypoglycemia. Randomized controlled trials and survey studies focused on the quality of life and fear of hypoglycemia among adult patients using CGM and SMBG were included in the analysis. Results: The meta-analysis included 11 studies involving a total of 1228 patients with T1DM. Analysis of the Worry subscale of the Hypoglycemia Fear Survey indicated a reduction of hypoglycemia fear in CGM users compared with SMBG users (Cohen d = –0.24; 95% CI, –0.41 to –0.07; mean difference, –3.15; 95% CI, –5.48 to –0.82). Outcome analysis of studies including the Diabetes Treatment Satisfaction Questionnaire showed Cohen d of 0.23 (95% CI, –0.18 to 0.63). The overall value of Cohen d equaled –0.24 (95% CI, –0.57 to 0.09), indicating a lack of effect of CGM use on improving HbA1c levels; however, after one of the studies was excluded from calculations, the reduction of HbA1c levels was significantly higher in CGM users (Cohen d = –0.33; 95% CI, –0.66 to 0.00; P = 0.047).
Conclusions: This is the first quantitative meta-analysis of studies involving adult patients exclusively with T1DM, providing further evidence for the ability of CGM systems to reduce fear of hypoglycemia and improve quality of life. Continuous glucose monitoring systems have advantage over SMBG in adults with T1DM and improve HbA1c levels.

adults, continuous glucose monitoring, quality of life, self-monitoring of blood glucose, type 1 diabetes

Introduction: In recent years, healthcare systems around the world have been subject to profound changes driven by advances in technology, new regulations as well as demographic and societal trends. This volatile and stressful environment has had its consequences for healthcare organizations and their employees. The resulting phenomena of burnout or lowered well-being may affect key aspects of healthcare delivery on individual, organizational, and financial levels. Objectives: The objective of this paper was to investigate the level of burnout and well-being in a group of Polish physicians, its impact on errors, and associations with other factors. Methods: This was a cross-sectional survey using a self-administered questionnaire with 65 questions and validated tools such as the Maslach Burnout Inventory and the World Health Organization–5 Well-being Index (WHO-5). Correlations between variables were investigated using Spearman rank correlation analysis. Univariable and multivariable logistic regression models were used to evaluate predictors of burnout and errors. The study included residents and physicians of various specialties. Results: A total of 125 residents and physicians, mostly internists and cardiologists, participated in the study, out of which 84 (67%) were found to be burned out. The median WHO-5 score was 40 points. Two-thirds of all physicians admitted to making an error in the last 3 months, which was strongly associated with burnout. Conclusions: The level of burnout among respondents was high and had numerous negative consequences that may affect the entire healthcare system. The results suggest there is an urgent need to address the problem of burnout among physicians.

burnout, errors, patient safety, suicidal ideation, well-being

Pulse wave velocity (PWV) is commonly used for assessing arterial stiffness and it is a useful and accurate cardiovascular mortality predictor. Currently, many techniques and devices for PWV measurement are known, but they are usually expensive and require operator experience. One possible solution for PWV measurement is photoplethysmography (PPG), which is convenient, inexpensive and provides continuous PWV results. The aim of this paper is validation of a new device for PPG sensor-based measurement of multi-site arterial PWV using a SphygmoCor XCEL (as the reference device) according to the recommendations of the Artery Society Guidelines (ASG). In this study, 108 subjects (56 men and 52 women, 20–91 years in 3 required age groups) were enrolled. The multi-site PWV was simultaneous measured by 7 PPG sensors commonly used in pulse oximetry in clinical settings. These sensors were placed on the forehead, and right and left earlobes, fingers and toes. Pulse transit time (PTT) was measured offline as the difference of time delay between two onsets of the pulse wave determined by the intersecting tangent method. The PWV was calculated by dividing the distance between PPG sensors by PTT. During PPG signals measurement, reference carotid to femoral PWV (cfPWV) was performed with a SphygmoCor XCEL system. The Pearson correlation coefficient (r) between the obtained PWV results was calculated. The Bland-Altman method was used to establish the level of agreement between the two devices. Mean difference (md) and standard deviation (SD) were also calculated. The multi-site PWV was highly correlated with accuracy at the ASG-defined level of “Acceptable” (md < 1.0 m/s and SD ≤ 1.5 m/s) with cfPWV: forehead - right toe (r = 0.75, md = 0.20, SD = 0.97), forehead - left toe (r = 0.79, md = 0.18, SD = 0.91), right ear - right toe (r = 0.79, md = 0.11, SD = 0.96), left ear - left toe (r = 0.75, md = 0.43, SD = 0.99), right ear - left toe (r = 0.78, md = 0.40, SD = 0.93), left ear - right toe (r = 0.78, md = 0.11, SD = 0.96), right finger - right toe (r = 0.66, md = 0.95, SD = 1.29), left finger - left toe (r = 0.67, md = 0.68, SD = 1.35). This study showed that PWV measured with the multi-site PPG system, in relation to the obtained numerical values, correlated very well with that measured using the commonly known applanation tonometry method. However, it should be noted, that the measured PWV concerns the central and muscular part of the arterial tree while the cfPWV is only for the central one. The best results were obtained when the proximal PPG sensor was placed on the head (ear or forehead) and the distal PPG sensor on the toe. PPG sensors can be placed in many sites at the same time, which provides greater freedom of their configuration. Multi-site photoplethysmography is an alternative method for PWV measurement and creates new possibilities for the diagnostics of cardiovascular diseases.

photoplethysmography, pulse wave velocity, multi-site pulse wave velocity, pulse transmit time, arterial stiffness, cardiovascular diseases

Numerous studies have indicated that the progression of chronic kidney disease (CKD) to end-stage renal disease (ESRD) is strictly associated with the accumulation of toxic metabolites in blood and other metabolic compartments. This accumulation was suggested to be related to enhanced generation of toxins from the dysbiotic microbiome accompanied by their reduced elimination by impaired kidneys. Intestinal microbiota play a key role in the accumulation of uremic toxins due to the fact that numerous uremic solutes are generated in the process of protein fermentation by colonic microbiota. Some disease states, including CKD, are associated with the presence of dysbiosis, which can be defined as an “imbalanced intestinal microbial community with quantitative and qualitative changes in the composition and metabolic activities of the gut microbiota”. The results of studies have confirmed the altered composition and functions of gut microbial community in chronic kidney disease. In the course of CKD protein-bound uremic toxins, including indoxyl sulfate, p-cresyl glucuronide, p-cresyl sulfate and indole-3-acetic acid are progressively accumulated. The presence of chronic kidney disease may be accompanied by the development of intestinal inflammation and epithelial barrier impairment leading to hastened systemic translocation of bacterial-derived uremic toxins and consequent oxidative stress injury to the kidney, cardiovascular and endocrine systems. These findings offer new therapeutic possibilities for the management of uremia, inflammation and kidney disease progression and the prevention of adverse outcomes in CKD patients. It seems that dietary interventions comprising prebiotics, probiotics, and synbiotics could pose a promising strategy in the management of uremic toxins in CKD.

chronic kidney disease, uremic toxins, gut microbiota, cardiovascular risk

Anemia is frequently observed in the course of chronic kidney disease (CKD) and it is associated with diminishing the quality of a patient's life. It also enhances morbidity and mortality and hastens the KD progression rate. Patients with CKD frequently suffer from a chronic inflammatory state which is related to a vast range of underlying factors. The results of studies have demonstrated that persistent inflammation may contribute to the variability in Hb levels and hyporesponsiveness to erythropoietin stimulating agents (ESA), which are frequently observed in CKD patients. The understanding of the impact of inflammatory cytokines on erythropoietin production and hepcidin synthesis will enable one to unravel the net of interactions of multiple factors involved in the pathogenesis of the anemia of chronic disease. It seems that anti-cytokine and anti-oxidative treatment strategies may be the future of pharmacological interventions aiming at the treatment of inflammation-associated hyporesponsiveness to ESA. The discovery of new therapeutic approaches towards the treatment of anemia in CKD patients has become highly awaited. The treatment of anemia with erythropoietin (EPO) was associated with great benefits for some patients but not all.

inflammation, chronic kidney disease, anemia, anemia of inflammation, ESA hyporesponsiveness

Anincreasing number of evidence indicates that metabolic factorsmayplay an important role in the evelopment and progression of certain types of cancers, including renal cell carcinoma (RCC). This tumour is the most common kidney cancer which accounts for approximately 3–5% of malignant tumours in adults. Numerous studies indicated that concomitant diseases, including diabetes mellitus (DM) and hypertension, as well as obesity, insulin resistance, and lipid disorders, may also influence the prognosis and cancer-specific overall survival. However, the results of studies concerning the impact of metabolic factors on RCC are controversial. It appears that obesity increases the risk of RCC development; however, it may be a favourable factor in terms of prognosis. Obesity is closely related to insulin resistance and the development of diabetes mellitus type 2 (DM2T) since the adipocytes in visceral tissue secrete substances responsible for insulin resistance, e.g., free fatty acids. Interactions between insulin and insulin-like growth factor (IGF) system appear to be of key importance in the development and progression of RCC; however, the exact role of insulin and IGFs in RCC pathophysiology remains elusive. Studies indicated that diabetes increased the risk of RCC, but it might not alter cancer-related survival. The risk associated with a lipid profile is most mysterious, as numerous studies provided conflicting results. Even though large studies unravelling pathomechanisms involved in cancer growth are required to finally establish the impact of metabolic factors on the development, progression, and prognosis of renal cancers, it seems that the monitoring of health conditions, such as diabetes, low body mass index (BMI), and lipid disorders is of high importance in clear-cell RCC.

renal cell carcinoma, obesity, insulin resistance, diabetes mellitus, lipid disorders

Introduction: Depressive disorders are the most common mental health problem among patients undergoing dialysis. Furthermore, depression is an independent factor increasing the mortality and frequency of hospitalization in this group of patients, yet psychological intervention programs aimed at improving the mental health of dialysis patients have still not been developed. This meta-analysis aimed to assess the effects of cognitive-behavioral therapy on depressive symptoms in dialysis patients. The main hypothesis of this study is that cognitive-behavioral therapy is an effective psychological method of reducing the severity of depression symptoms among patients undergoing dialysis. Material and methods: A systematic search was conducted using Medline, PubMed, Web of Science, Scopus and Google Scholar. Data extraction was carried out by two independent researchers. The severity of depression symptoms in the included studies was measured by the Beck Depression Inventory. A random-effects model was used to estimate the pooled mean difference of these values between patients undergoing CBT and the controls. Results: Four of the 1841 search results met the inclusion criteria with data from 226 patients who had undergone dialysis therapy due to renal disorders and psychological intervention based on cognitive-behavioral therapy. This therapy significantly reduced the level of depression symptoms in all studies included in the meta-analysis (mean difference = –5.3, p = 0.001; 95% CI: –7.95 to –2.66). Conclusions: The study showed that the use of psychological intervention based on cognitive-behavioral therapy was an effective method of decreasing the severity of depressive symptoms in hemodialyzed patients. For the sake of patient well-being, it seems reasonable to extend renal replacement therapy with psychological intervention such as cognitive-behavioral therapy.

depression, dialysis, cognitive-behavioral therapy, renal replacement

Agrowing amount of evidence prompts us to update the first version of recommendations for lung ultrasound in internal medicine (POLLUS-IM) that was published in 2018. The recommendations were established in everal stages, consisting of: literature review, assessment of literature data quality (with the application of QUADAS, QUADAS-2 and GRADE criteria) and expert evaluation carried out consistently with the modified Delphi method (three rounds of on-line discussions, followed by a secret ballot by the panel of experts after each completed discussion). Publications to be analyzed were selected from the following databases: Pubmed, Medline, OVID, and Embase. New reports published as of October 2019 were added to the existing POLLUS-IM database used for the original publication of 2018. Altogether, 528 publications were systematically reviewed, including 253 new reports published between September 2017 and October 2019. The new recommendations concern the following conditions and issues: pneumonia, heart failure, monitoring dialyzed patients' hydration status, assessment of pleural effusion, pulmonary embolism and diaphragm function assessment. POLLUS-IM 2020 recommendations were established primarily for clinicians who utilize lung ultrasound in their everyday clinical work.

lung ultrasound, chest ultrasound, internal medicine, recommendations

Objective: To analyze accuracy of articles about COVID-19 prevention most frequently shared through social media platforms. Methods: Identifying, using the Buzzsumo analytic tool, 30 most frequently shared articles in April 2020 about COVID-19 prevention and classifying them according to number of shares, accuracy, topic and sharing platform. Calculations were made using descriptive statistics tools and chi-square test. Results: The top 30 articles about coronavirus prevention were shared 4904 160 times over a period of one month with 96.8% of all shares through Facebook. Most of the articles (80%) was found to be accurate, however they accounted for only 64% of shares. The inaccuracies referred mostly to handwashing. The most shared articles were about medications followed by masks and hand washing. Conclusions: Articles about coronavirus prevention are usually accurate, yet relatively less likely to be shared than inaccurate ones. Facebook remains a dominant social media platform for sharing content. Buzzsumo could be considered a tool in certain situations such as pandemic for health authorities to quickly investigate different health topics popular on social media. Lay Summary: Most of the articles about COVID-19 prevention, identified as most frequently shared through social media platform during the pandemic, was found to be accurate. However, inaccurate content was more likely to be shared than by Facebook users compared with accurate content. This suggests the need for health authorities to monitor content shared on social media in extraordinary situations such as pandemics.

coronavirus, COVID-19, social media, misinformation, public health

The aim of this study was to analyse knowledge on colon cancer prevention among patients of primary care and identify their sources of information. The questionnaire study was conducted among patients of 36 primary healthcare clinics in Poland between September 2018 and February 2019. Patients were interviewed separately by trained researchers. Over 39% of the primary health patients declared that their knowledge about colon cancer prevention is unsatisfactory. Information about colon cancer prevention varied according to sex, age and BMI. Men declared lower level of knowledge than women: 46% of men thought it was unsatisfactory compared with 36%of women (p = 0.003). Preventive recommendations weremore often provided to patients over 60 years old (p < 0.01). Overweight and obese patients were more likely to receive recommendations on diet (p < 0.001) and physical activity (p < 0.001) than patients with normal weight. Themost common source of information on colon cancer prevention was Internet (68%) and medical doctors (60%). There is a need for developing colon cancer prevention policy. Crucial aspect includes educational programs aimed at improving patient’s knowledge and involving medical staff. The policymakers should pay greater attention to cancer prevention policies and medical staff involved in prevention to quality of communication to make sure patients thoroughly understand information they are provided.

colon cancer, prevention, primary healthcare, education, communication

The article presents a new normalization of flow-mediated dilation (FMD) in the radial artery, taking into account the parameter BSSR being equal to the ratio of the basal shear rate (BS) measured before the cuff inflation and post occlusive shear rate (SR). The in vivo usefulness of the new normalization algorithm wasevaluated in two groups of patients. In group I, comprising 15 healthy volunteers, the normalized FMD/SR was(3.19 ± 1.4)*10^-4, while in group II, comprising 13 patients with stable coronary artery disease (CAD), it was(1.02 ± 0.76)*10^-4. We calculated almost 50% larger difference between the average values after normalizing FMD/BSSR. Specifically, the FMD/BSSR was equal to 28 ± 9.40 in group I and 6.01 ± 3.74 in group II. The prediction of CAD patients based on FMD/SR values had a sensitivity of 83.3% and a specificity of 84.6%, whereas the prediction of CAD patients based on the FMD/BSSR values revealed 100% sensitivity and specificity. These results confirm the usefulness of the novel normalization algorithm of the FMD in differentiation of normal patients from those with stable CAD.

flow-mediated vasodilation, radial artery, shear rate, pulsed Doppler, ultrasonography, coronary artery disease

The brain is subject to damage, due to ageing, physiological processes and/or disease. Some of the damage is acute in nature, such as strokes; some is more subtle, like white matter lesions. White matter lesions or hyperintensities (WMH) can be one of the first signs of micro brain damage. We implemented the Acoustocerebrography (ACG) as an easy to use method designed to capture differing states of human brain tissue and the respective changes. Aim: The purpose of the study is to compare the efficacy of ACG and Magnetic Resonance Imaging (MRI) to detect WMH in patients with clinically silent atrial fibrillation (AF). Methods and results: The study included 97 patients (age 66.26 ± 6.54 years) with AF. CHA2DS2- VASc score (2.5 ±1.3) and HAS BLED (1.65 ± 0.9). According to MRI data, the patients were assigned into four groups depending on the number of lesions: L0 – 0 to 4 lesions, L5 – 5 to 9 lesions, L10 – 10 to 29 lesions, and L30 – 30 or more lesions. Authors found that the ACG method clearly differentiates the groups L0 (with 0–4 lesions) and L30 (with more than 30 lesions) of WMH patients. Fisher's Exact Test shows that this correlation is highly significant (p < 0.001). Conclusion: ACG is a new, easy and cost-effective method for detecting WMH in patients with atrial fibrillation. The ACG measurement methodology should become increasingly useful for the assessment of WMH.

acoustocerebrography, brain MRI, atrial fibrillation, white matter hyperintensities

Cardiovascular disease (CVD) is one of the major causes of perioperative complications. Screening of patients referred to major surgery is a costly and time and resources- consuming process. The study aimed to assess the usefulness of an electronic stethoscope with dedicated analytical software operated by a nurse for detecting heart disease in patients prepared for major orthopedic surgery. The study group consisted of 137 patients aged (46 – 91) with defined cardiovascular diseases qualified for hip or knee replacement surgery and 94 healthy age-matched volunteers. Heart auscultation with Littmann lectronic stethoscope using Littmann® StethAssist™ Heart and Lung Sound Visualization Software software was conducted and analyzed by a trained nurse. The signal recorded was analyzed by the blinded researcher using dedicated custom- made algorithm. Finally, 91 signals (52 CVD (+) patients, 39 CVD (-) patients) were analyzed. Eventually a classifier with a sensitivity of 92% and a specificity of 97% was obtained in a group. The global accuracy of the classifier was 95%. Heart auscultation by nursing staff using Littmann® StethAssist™ Heart and Lung Sound Visualization Software with dedicated custom- made can be cheap and noninvasive method of identifying patients with cardiovascular disease made algorithm for arthroplasty.

electronic stethoscope, heart auscultation, nurse, arthroplasty, cardiovascular disease

A precise, multi-track system for the simultaneous, real-time measurement of electrocardiographic (ECG) and many photopletysmographic (PPG) signals is described. This system allows the calculation of pulse wave delay parameters such as pulse arrival time (PAT) and pulse transit time (PTT). The measurement system was built on a custom, real-time embedded system with multiple specific analogue-front-end devices. Signals were recorded on-line and data were processed off-line in the Matlab software. Testing of human subjects was carried out on a group of 16 volunteers. The system was capable of taking a measurement of one 24-bit ECG and eight 22-bit PPG tracks with high precision (input-referred noise 1.4 μV for ECG and about 20 pA for PPG). All signals are sampled simultaneously (phase shift between ECG and PPG is only 1.5 ms for 250 Hz frequency sampling). Significant differences in pulse wave delays were found for the 16 subjects studied (e.g. about 100 ms for PAT on a right toe, 40 ms for differential PAT on left-right toes and about 100 ms for PTT calculated for forehead-right toe pulse wave). The proposed system provides a simultaneous and continuous evaluation of pulse wave delays for the entire arterial bed. The proposed measurement methods are comfortable and can be used for a long time. Simultaneous measurements of pulse wave delays at various sites increase the reliability of measurement and create new possibilities for medical diagnosis.

biomedical monitoring, cardiovascular diseases, pulse arrival time, pulse transit time, pulse wave delay, simultaneous measurement

In the article we describe the new, high frequency, 20 MHz scanning/Doppler probe designed to measure the flow mediated dilation (FMD) and shear rate (SR) close to the radial artery wall. We compare two US scanning systems, standard vascular modality working below 12 MHz and high frequency 20 MHz system designed for FMD and SR measurements. Axial resolutions of both systems were compared by imaging of two closely spaced food plastic foils immersed in water and by measuring systolic/diastolic diameter changes in the radial artery. The sensitivities of Doppler modalities were also determined. The diagnostic potential of a high frequency system in measurements of FMD and SR was studied in vivo, in two groups of subjects, 12 healthy volunteers and 14 patients with stable coronary artery disease (CAD). Over three times better axial resolution was demonstrated for a high frequency system. Also, the sensitivity of the external single transducer 20 MHz pulse Doppler proved to be over 20 dB better (in terms of a signal-to-noise ratio) than the pulse Doppler incorporated into the linear array. Statistically significant differences in FMD and FMD/SR values for healthy volunteers and CAD patients were confirmed, p-values < 0:05. The areas under Receiver Operating Characteristic (ROC) curves for FMD and FMD/SR for the prediction CAD had the values of 0.99 and 0.97, respectively. These results justify the usefulness of the designed high-frequency scanning system to determine the FMD and SR in the radial artery as predictors of coronary arterial disease.

low mediated dilation, shear rate, axial resolution, elevation resolution, pulsed Doppler, ultrasonic imaging

Układ oddechowy pacjenta jest początkowo diagnozowany przy zastosowaniu stetoskopu. Osłuchowa interpretacja zjawisk fizycznych jest skomplikowana i wymaga od lekarza doświadczenia oraz predyspozycji. W niniejszym artykule zaprezentowano system pomiarowy i oprogramowanie badawcze, a także proces generacji cech dystynktywnych szmerów oddechowych różnicujących przypadki chorobowe od zdrowych. Wybrane reprezentacje stanowią obiecującą podstawę do opracowania systemu klasyfikującego wspierającego proces diagnostyczny

szmery oddechowe, klasyfikacja, cyfrowe przetwarzanie sygnałów

Background: Smoking cessation is often associated with weight gain. This study was conducted to verify whether it affects outcomes of bariatric surgery. Objectives: To present cigarette consumption among patients after bariatric surgery in a long-term follow-up and to evaluate whether smoking cessation impacts weight loss. Setting: High-volume bariatric center, Military Hospital, Poland. Methods: We collected data of patients who underwent bariatric surgery between 2003 and 2009. The data included sex, age, weight, body mass index, and smoking habits. An online survey regarding current weight, co-morbidities, and smoking was distributed. Percentage excess weight loss was calculated with an ideal weight for body mass index of 25 kg/m2. Results: One hundred seven patients had laparoscopic adjustable gastric banding between 2003 and 2006; 47 were included in the study. The mean follow-up time was 11.2 (±1.2). Of patients, 51% (n = 24) were smokers before surgery. In the follow-up 43% (n = 20) were smokers, of whom 4 patients began smoking after surgery. Twenty-seven patients were nonsmokers, 8 of whom quit over the years (33% of previous smokers). One hundred twenty-seven underwent laparoscopic sleeve gastrectomy between 2006 and 2009; 84 were included in the study. Our median follow-up was 8.0 years. Thirty-two patients never smoked; 52 were smoking before surgery, yet 24 successfully quit. In both groups there were no statistically significant differences in percentage excess weight loss between smokers and nonsmokers, or between those who quit and did not. Conclusions: In the long-term follow-up after laparoscopic adjustable gastric banding, 33% of smokers quit and 17% previously nonsmoking began smoking. After laparoscopic sleeve gastrectomy, 46% of previously smoking patients successfully quit. Smoking status was not significantly associated with weight loss.

Smoking, Obesity, Surgery, Sleeve, Long term

Acoustocerebrography is a novel, non-invasive, transcranial ultrasonic diagnostic method based on the transmission of multispectral ultrasound signals propagating through the brain tissue. Dedicated signal processing enables the estimation of absorption coefficient, frequency-dependent attenuation, speed of sound and tissue elasticity. Hypertension and atrial fibrillation are well known factors correlated with white matter lesions, intracerebral hemorrhage and cryptogenic stroke numbers. The aim of this study was to compare the acoustocerebrography signal in the brains of asymptomatic atrial fibrillation patients with and without hypertension. The study included 97 asymptomatic patients (40 female and 57 male, age 66.26 +/- 6.54 years) who were clinically monitored for atrial fibrillation. The patients were divided into two groups: group I (patients with hypertension) n = 75, and group II (patients without hypertension) n = 22. Phase and amplitude of all spectral components for the received signals from the brain path were extracted and compared to the phase and amplitude of the transmitted pulse. Next, the time of flight and the attenuation of each frequency component were calculated. Additionally, a fast Fourier transformation was performed and its features were extracted. After introducing a machine learning technique, the ROC plot of differentiations between group I and group II with an AUC of 0.958 (sensitivity 0.99 and specificity 0.968) was obtained. It can be assumed that the significant difference in the acoustocerebrography signals in patients with hypertension is due to changes in the brain tissue, and it allows for the differentiating of high-risk patients with asymptomatic atrial fibrillation and hypertension.

changes in the brain, hypertension in atrial, acoustocerebrography

Introduction Sleeve gastrectomy (LSG) is one of the most popular bariatric procedures. We present our long-term results regarding weight loss, comorbidities, and gastric reflux disease. Material and Methods We identified patients who underwent LSG in our institution between 2006 and 2009. We revised the data, and the patients with outdated contact details were tracked with the national health insurance database and social media (facebook). Each of the identified patients was asked to complete an online or telephone survey covering, among others, their weight and comorbidities. On that basis, we calculated the percent total weight loss (%TWL) and percent excess weight loss (%EWL), along with changes in body mass index (ΔBMI). Satisfactory weight loss was set at >50% EWL (for BMI = 25 kg/m2). We evaluated type 2 diabetes (T2DM) and arterial hypertension (AHT) based on the pharmacological therapy. GERD presence was evaluated by the typical symptoms and/or proton pump inhibitor (PPI) therapy. Results One hundred twenty-seven patients underwent LSG between 2006 and 2009. One hundred twenty patients were qualified for this study. Follow-up data was available for 100 participants (47 female, 53 male). Median follow-up period reached 8.0 years (from 7.1 to 10.7). Median BMI upon qualification for LSG was 51.6 kg/m2. Sixteen percent of patients required revisional surgery over the years (RS group), mainly because of insufficient weight loss (14 Roux-Y gastric bypass—LRYGB; one mini gastric bypass, one gastric banding). For the LSG (LSG group n = 84), the mean %EWL was 51.1% (±22.3), median %TWL was 23.5% (IQR 17.7–33.3%), and median ΔBMI was 12.1 kg/m2 (IQR 8.2–17.2). Fifty percent (n = 42) of patients achieved the satisfactory %EWL of 50%. For RS group, the mean %EWL was 57.8%(±18.2%) and median %TWL reached 33% (IQR 27.7–37.9%). Sixty-two percent (n = 10) achieved the satisfactory weight loss. Fifty-nine percent of patients reported improvement in AHT therapy, 58% in T2DM. After LSG, 60% (n = 60) of patients reported recurring GERD symptoms and 44% were treated with proton pomp inhibitors (PPI). In 93% of these cases, GERD has developed de novo. Conclusions Isolated LSG provides fairly good effects in a long-term follow-up with mean %EWL at 51.1%. Sixteen percent of patients require additional surgery due to insufficient weight loss. More than half of the subjects observe improvement in AHT and T2DM. Over half of the patients complain of GERD symptoms, which in most of the cases is a de novo complaint.

bariatric surgery, sleeve, long-termfollow-up, comorbidities, GERD

A high-frequency scanning system consisting of a 20-MHz linear array transducer combined with a 20-MHz pulsed Dopplerprobe was introduced to evaluate the degree of radial artery flow-mediated dilation (FMD [%]) in two groups of patients after5 min of controlled forearm ischemia followed by reactive hyperemia. In group I, comprising 27 healthy volunteers, FMD (mean ± standard deviation) was 15.26 ± 4.90% (95% confidence interval [CI]: 13.32%–17.20%); in group II, comprising 17 patients with chronic coronary artery disease, FMD was significantly less at 4.53 ± 4.11% (95% CI: 2.42%–6.64%). Specifically, the ratio FMD/SR (mean ± standard deviation),wasequalto5.36×10−4±4.64×10−4 (95%CI:3.54×10−4 to7.18×10−4)ingroupIand1.38×10−4±0.89×10−4 (95% CI: 0.70 × 10−4 to 2.06 × 10−4) in group II. Statistically significant differences between the two groups were confirmed by a Wilcoxon–Mann–Whitney test for both FMD and FMD/SR (p < 0.01). Areas under receiver operating characteristic curves for FMD and FMD/SR were greater than 0.9. The results confirm the usefulness of the proposed measurements of radial artery FMD and SR in differentiation of normal patients from those with chronic coronary artery disease. (E-mail: anowicki@ippt.gov.pl) © 2018 World Federation for Ultrasound in Medicine & Biology. All rights reserved.

Flow-mediated vasodilation, Radial artery, Shear rate, Reactive hyperemia, Endothelium, Pulsed doppler, Ultrasonography

In patients suffering from chronic kidney disease (CKD), the prevalence of cardiovascular disease is much more common than in the general population. The role of vitamin D deficiency had been underestimated until a significant association was found between vitamin D therapy and survival benefit in haemodialysis patients. Vitamin D deficiency is present even in the early stages of chronic kidney disease. The results of experimental studies have revealed the relationship between vitamin D deficiency and impairment of cardiac contractile function, higher cardiac mass and increased myocardial collagen content. Experimental models propose that intermediate end points for the relationship between vitamin D deficiency and higher risk of cardiovascular disease comprise diminished left ventricular hypertrophy (LVH), enhanced left ventricular diastolic function, anddecreasedfrequencyofheartfailure. Multipleobservationalstudieshavedemonstrated an association between the use of active vitamin D therapy in patients on dialysis and with CKD and improved survival. However, there are also many studies indicating important adverse effects of such treatment. Therefore, large randomized trials are required to analyze whether supplementation of vitamin D may affect outcomes and whether it is safe to be used in CKD patient

vitamin D, chronic kidney disease, cardiovascular disease, mortality, vitamin D analogues, treatment

The aim of this study was to establish recommendations for the use of lung ultrasound in internal medicine, based on reliable data and expert opinions.
Methods: The bibliography from the databases (Pubmed, Medline, OVID, Embase) has been fully reviewed up to August 2017. Members of the expert group assessed the credibility of the literature
data. Then, in three rounds, a discussion was held on individual recommendations (in accordance with the Delphi procedure) followed by secret voting. Results: Thirty-eight recommendations for the use of lung ultrasound in internal medicine were established as well as discussed and subjected to secret voting in three rounds. The first 31 recommendations concerned the use of ultrasound in the diagnosis of the following conditions: pneumothorax, pulmonary consolidation, pneumonia, atelectasis, pulmonary embolism, malignant neoplastic lesions, interstitial lung lesions, cardiogenic pulmonary edema, interstitial lung diseases with fibrosis, dyspnea, pleural pain and acute cough. Furthermore, seven additional statements were made regarding the technical conditions of lung ultrasound examination and the need for training in the basics of lung ultrasound in a group of doctors during their specialization programs and medical students. The panel of experts established a consensus on all 38 recommendations.

Hydrogenated oils containing trans fatty acids (TFA) are used to produce margarine and various processed foods. TFA affect serum lipid levels, fatty acids metabolism, and endothelial function. High TFA intake is linked to increased all-cause mortality, coronary heart disease mortality and cardiovascular disease (CVD) incidence. Denmark was first to introduce law that limited TFA content in food; this action led to lower CVD mortality. Seven European countries have followed this practice until now, in a few others the food industry voluntarily reduced TFA use. The issue remains unaddressed in Poland. Legal TFA limit should be established, as it is the optimal solution considering both CVD prevention and the associated cost savings in public healthcare.

Poland, cardiovascular disease, nutrition policy, trans fatty acids

The prevalence of renal diseases is rising and reaching 5–15% of the adult population. Renal damage is associated with disturbances of body homeostasis and the loss of equilibrium between exogenous and endogenous elements including drugs and metabolites. Studies indicate that renal diseases are influenced not only by environmental but also by genetic factors. In some cases the disease is caused by mutation in a single gene and at that time severity depends on the presence of one or two utated alleles. In other cases, renal disease is associated with the presence of alteration within a gene or genes, but environmental factors are also necessary for the development of disease. Therefore, it seems that the analysis of genetic aspects should be a natural component of clinical and xperimental studies. The goal of personalized medicine is to determine the right drug,for the right patient,at the right time. Whole-genome examinations may help to change the approach to the disease and the patient resulting in the creation of“personalized medicine”with new diagnostic and treatment strategies designed on the basis of genetic background of each individual. The identification of high-risk patients in pharmacogenomics analyses will help to avoid many unwarranted side effects while optimizing treatment efficacy for individual patients. Personalized therapies for kidney diseases are still at the preliminary stage mainly due to high costs of such analyses and the complex nature of human genome. This review will focus on several areas of interest: renal disease pathogenesis, diagnosis, treatment, rate of progression and the prediction ofprognosis.

renal diseases, personalized medicine, treatment, diagnosis, biomarkers

Hydrogenated oils containing trans -fatty acids (TFA) are used to produce margarine and various processed foods. TFA affect serum lipid levels, fatty acid metabolism, and endothelial function. High TFA intake is linked to increased allcause mortality, coronary heart disease mortality, and cardiovascular disease (CVD) incidence. Denmark was the first country to introduce a law that limited TFA content in food; this action led to lower CVD mortality. So far 7 European countries have followed this practice, in a few others the food industry voluntarily reduced TFA use. The issue remains mostly unaddressed in the rest of the world. Legal TFA limits should be commonly established as they are the optimal solution considering both CVD prevention and the associated cost savings in public healthcare.

Trans -fatty acids, Cardiovascular disease, Nutrition policy

W artykule przedstawiono koncepcję analizy spektralnej sygnałów fonokardiograficznych. Zaprezentowano wyniki analizy sygnałów zawierających od kilku do kilkunastu uderzeń serca oraz sygnałów krótkich zawierających pojedyncze uderzenie serca. Przedstawiono propozycje kilkudziesięciu widmowych cech dystynktywnych oraz ocenę ich przydatności w diagnostyce schorzeń kardiologicznych. (Multifaceted Spectral Analysis of Phonocardiographic Signals)

fonokardiografia, elektrokardiografia, metrologia medyczna, tony serca, analiza spektralna

Wprowadzenie i cel pracy. Rozwój technologii informacyjno-komunikacyjnej może doprowadzić do poprawy sytuacji w służbie zdrowia. Telepielęgniarstwo pozwoli na rozszerzenie praktyki pielęgniarskiej oraz wielu funkcji takich jak: opiekuńczo-pielęgnacyjna, profilaktyczna, diagnostyczna, rehabilitacyjna i związana z promocją zdrowia. Celem pracy jest ukazanie telepielęgniarstwa w ortopedii, a także zaprezentowanie wielu korzyści, jakie niesie zarówno dla pacjenta, jak i dla personelu medycznego. Skrócony opis stanu wiedzy. Starzejące się społeczeństwo potrzebuje zarówno wykwalifikowanego personelu pielęgniarskiego, jak i możliwości uzyskania szybkiej konsultacji lekarskiej i pielęgniarskiej. Udzielanie wskazówek, porad i opieki pielęgniarskiej przez pielęgniarki specjalistki w swej profesji m.in. za pomocą wideokonferencji przysporzy znaczących korzyści zarówno pacjentom, lekarzom, pielęgniarkom, jak i rehabilitantom. Podsumowanie. Wdrożenie wirtualnych wizyt może doprowadzić do poprawy sytuacji w ochronie zdrowia. Telepielęgniarstwo rozszerzyłoby kompetencje pielęgniarki, a także podniosłoby jakość świadczonych przez nie usług. Być może zatrzymałoby również emigrację zarobkową pielęgniarek w Polsce.

telepielęgniarstwo, ortopedia, edukacja pacjenta, nowe technologie, kształcenie, niedobór personelu pielęgniarskiego

Streaming velocity depends on intensity and absorption of ultrasound in the media. In some cases, such as ultrasound scattered on blood cells at high frequencies, or the presence of ultrasound contrast agents, scattering affects the streaming speed. The velocities of acoustic streaming in a blood-mimicking starch suspension in water and Bracco BR14 contrast agent were measured. The source of the streaming was a plane 20MHz ultrasonic transducer. Velocity was estimated from the averaged Doppler spectrum. The single particle driving force was calculated as the integral of the momentum density tensor components. For different starch concentrations, the streaming velocity increased from 8.9 to 12.5mm/s. This corresponds to a constant 14% velocity increase for a 1 g/l increase in starch concentration. For BR14, the streaming velocity remained constant at 7.2mm/s and was independent of the microbubbles concentration. The velocity was less than in reference, within 0.5mm/s measurement error. Theoretical calculations showed a 16% increase in streaming velocity for 1 g/l starch concentration rise, very similar to the experimental results. The theory has also shown the ability to reduce the streaming velocity by low-density scatterers, as was experimentally proved using the BR14 contrast agent.

ultrasound, radiation force, starch, contrast agent, blood, thrombolysis

Background: Laparoscopic adjustable gastric banding (LAGB) is the third most popular bariatric procedure worldwide. Various authors present ambivalent long-term follow up results. Methods: We revised records of the patients who underwent LAGB between 2003 and 2006 along with history of additional check-ins. Patients with outdated details were tracked with the national health insurance database and social media (Facebook). An online survey was sent. The patients who did not have their band removed were included in this study. We calculated the percent total weight loss (%TWL) and percent excess weight loss (%EWL), along with changes in body mass index (ΔBMI). Satisfactory weight loss was set at >50% EWL (for BMI = 25 kg/m(2)). Since eight patients gained weight, we decided to include negative values of %TWL, %EWL, and ΔBMI. Results: One hundred seven patients underwent LAGB from 2003 to 2006. The mean follow-up time was 11.2 (±1.2) years. Eleven percent of patients were lost to follow up (n = 12). There was one perioperative death. Fifty-four of the patients (n = 57) had their band removed. Thirty-seven patients still have the band (39%) and were included in the study. The mean %EWL was 27% (-56-112%) and %TWL was 11% (-19-53%). Twelve patients achieved %EWL > 50% (32%). Thiry-two patients still suffer from obesity, with BMI over 30 kg/m(2). Eight patients (22%) gained additional weight. Patients with %EWL > 50% suffered less from gastroesophageal reflux disease symptoms than those with EWL < 50% (p < 0.05). Conclusions: Out of 107 cases, only 11.2% of patients with gastric band (n = 12) achieved satisfactory %EWL. Twenty-two percent of patients regained their weight or even exceeded it. Overall results suggest that LAGB is not an effective bariatric procedure in long term observation.

Life with a Gastric Band. Long-Term Outcomes of Laparoscopic Adjustable Gastric Banding—a Retrospective Study (PDF Download Available). Available from: https://www.researchgate.net/publication/309486095_Life_with_a_Gastric_Band_Long-Term_Outcomes_of_Laparoscopic_Adjustable_Gastric_Banding-a_Retrospective_Study [accessed Dec 05 2017].

Laparoscopy, Bariatric surgery, LAGB, Gastric band, Long term follow-up

Background:
There is a growing interest in the application of non-invasive clinical tools allowing one to assess the endothelial function, preceding atherosclerosis. The precision in estimating of the artery Flow Mediated Vasodilation (FMD) using standard 10-12 MHz linear array probes does not exceed 0.2 mm, far beyond that required.

Methods:
We have introduced a wide-band, high frequency 25-30 MHz, Golay encoded wobbling type imaging to measure dilation of the radial artery instead of the brachial one. 18 young volunteers, and 4 volunteers with cardiac events history, were examined. In the second approach 20 MHz linear scanning combined with 20 MHz pulsed Doppler attached to the linear array was used. The radial artery FMD was normalized using shear rate at the radial artery wall.

Results and Conclusions:
For the “healthy” group, the FMD resulting from reactive hyperemia response was over 20%; while in the “atherosclerotic” group, the FMD was at least twice as small, not exceeding 10%. The shear rate (SR) normalized FMDSR was in the range from 7.8 to 9.9 in arbitrary units, while in patients with minor cardiac history FMDSR was clearly lower, 6.8 to 7.6. The normalized FMDSR of radial artery RARR can be an alternative to the brachial FMD where the precision of measurements is lower and the diameter dilation does not exceed 7-10%.

thick film transducers, atherosclerosis, flow mediated vasodilation

The main aim of this study was to verify the suitability of the hydrogel sonographic model of the left ventricle (LV) in the computed tomography (CT) environment and echocardiography and compare the radial strain calculations obtained by two different techniques: the speckle tracking ultrasonography and the multislices computed tomography (MSCT). The measurement setup consists of the LV model immersed in a cylindrical tank filled with water, hydraulic pump, the ultrasound scanner, hydraulic pump controller, pressure measurement system of water inside the LV model, and iMac workstation. The phantom was scanned using a 3.5 MHz Artida Toshiba ultrasound scanner unit at two angle positions: 0° and 25°. In this work a new method of assessment of RF speckles’ tracking. LV phantom was also examined using the CT 750 HD 64-slice MSCT machine (GE Healthcare). The results showed that the radial strain (RS) was independent on the insonifying angle or the pump rate. The results showed a very good agreement, at the level of 0.9%, in the radial strain assessment between the ultrasound M-mode technique and multislice CT examination. The study indicates the usefulness of the ultrasonographic LV model in the CT technique. The presented ultrasonographic LV phantom may be used to analyze left ventricle wall strains in physiological as well as pathological conditions. CT, ultrasound M-mode techniques, and author's speckle tracking algorithm, can be used as reference methods in conducting comparative studies using ultrasound scanners of various manufacturers.

Computed tomography, Echocardiography, Left ventricle, Speckles tracking, Strain, Ultrasound phantoms

The present work concerns the sonographic model of the left ventricle (LV) examined in the Computed Tomography (CT) environment and compare radial strain calculations obtained by two different techniques: the speckle tracking ultrasonography and the Multislices Computed Tomography (MSCT). The Left Ventricular (LF) phantom was fabricated from 10% solution of the poly(vinyl alcohol) (PVA). Our model of the LV was driven by the computer- controlled hydraulic piston Super -Pump (Vivitro Inc., Canada) with adjustable fluid volumes. The stroke volume was set at of 24ml. The fluid pressure was changed within range of 0- 60 mmHg, and the pulse rate was of 60 cycles/per minute. The relationships between computer controlled left ventricular wall deformations and its visual izations of the echocardiographic and CT imaging, both in the normal and pathological conditions were examined. The difference of assessment the Radial Strain between two methods was not exceeding 1.1%.

Two different tissue phantoms of the left ventricle to imitate a beating left ventricle were developed: first was prepared using a sponge material and second phantom was constructed using a polyvinyl alcohol material modeled into a homogeneous hollow cylinder: approximately 10 cm and 12 cm in length for the first and second phantom, respectively. Both phantoms were 5 cm in diameter, with a wall thickness of 1.0 cm. Additionally, a small part of the wall of the second phantom was processed to simulate the stiffness of myocardial infarction. The phantoms were connected at the end to an adjustable external pump. The pulse volume inside the cylinder was set between 12 to 50 ml at rates of 40, 60, 100, 120 beats/minute. The phantoms were immersed in water for ultrasound scanning with two different insonation angles (90 and 65 degrees). Strain and strain rate were measured with different combinations of angles and pulse rates. The main aim of this work was to develop the new method for validation of the human infarct wall strain calculation procedures using the speckles tracking.

soft tissue, phantom, ultrasound

The main objective of this study is to develop an echocardiographic model of the left ventricular and numerical modeling of the speckles- markers tracking in the ultrasound (ultrasonographic) imaging of the left ventricle. The work is aimed at the creation of controlled and mobile environment that enables to examine the relationships between left ventricular wall deformations and visualizations of these states in the form of echocardiographic imaging and relations between the dynamically changing distributions of tissue markers of studied structures.

left ventricle, echocardiography, speckle modeling, ultrasound phantoms, strain, strain rate

A clinically applicable method for noninvasive measurement of hematocrit based on 20 MHz multigate Doppler ultrasound was developed. The ultrasound attenuation coefficient in blood is obtained by measuring the power of the signal coming from gates at different depths. A robust averaging method is introduced, which provides stable and repeatable results by using the echo signals from all depths inside the vessel. In vitro measurements have been done on porcine blood with hematocrit ranging from 3.0% to 65.0%. Steady and pulsatile flow conditions have been simulated using a peristaltic pump. The attenuation coefficient indicated the linear relation to hematocrit. The resulting correlation coefficient was R=0.999 for the continuous blood flow and R=0.992 for pulsatile flow. In vivo measurements have been performed in the brachial artery in 43 patients with hematocrit in the range of 32.0% to 49.3%. The mean absolute error has been 3.24% with a standard deviation of 3.72%.

blood, hematocrit, Doppler, ultrasonic attenuation

Precise quantitative analysis of the sonothrombolysis process is required to minimise the amount of thrombolytic drug dangerous for the patient, because it can cause internal hemorrhage. Verification of the effects of other drugs or other procedures for the elimination of thrombi, for example ultrasound contrast microbubbles, also requires quantitative research. For microscopic examination of the thrombolysis process, the Rexolite parallel plate flow chamber has been used. The internal dimensions of the chamber were 11x1x20 mm. In order to eliminate the standing wave, the incident wave was perpendicular to the reflected one. The narrowband chirp driven transducer suppressed the surface waves in Rexolite. The clot dissolution was processed at 40 kHz – 6 MHz ultrasound frequencies and 2 W/cm2 spatial averaged, temporal averaged intensities. The thrombus was obtained from a 5 μl drop of blood placed directly inside a flow chamber. The flow chamber was filled with the cell culture medium Dulbecco's modified Eagle's medium. The flow in the chamber was forced by a peristaltic pump at a speed of 3.8 ml/min. The Actilyse tissue plasminogen activator at a concentration of 10 μg/ml was added. The similarity of the thrombolysis process obtained from 5 μl of blood with a similar volume fragment cut from a larger thrombus was experimentally verified. Thrombus volume was estimated from microscopic photographs by calculating its surface area and its optical transparency. At 2 W/cm2 ultrasound intensity, took the thrombus 4, 8, 9 and 12 minutes to completely dissolve for the centre ultrasound frequencies of 40.9, 149, 209 kHz and 1.02 MHz, respectively. For higher frequencies, the thrombus only reduced its volume by 82%, 69% and 27% for the frequencies 2.10, 3.34 and 6.63 MHz, respectively. Sonication for 20 - 60 minutes did not cause further dissolution of thrombi.

ultrasound, blood, thrombus, thrombolysis, parallel plate flow chamber

Under the influence of pathological changes, the blood coagulates inside the blood vessel, creating a thrombus. The thrombus dissolution process is called thrombolysis. The aim of the study is to evaluate the thrombolysis process by the interaction of the thrombolitic drug and ultrasound. The clot dissolution process was analyzed in a specially designed, transparent for ultrasound parallel plate flow chamber. Inside, a freshly coagulated human blood sample was exposed to ultrasound. A liquid containing the tissue plasminogen activator drug in a concentration of 10 μg/ml passed around the sample. The liquid flow was forced by a peristaltic pump. The source of ultrasound was a 1 MHz flat ultrasonic transducer with a 25 mm diameter. The transducer radiated a 1000 periods burst, repeated every 2500 periods and space averaged time averaged intensities of 0.2-1.6 W/cm2. The efficacy of thrombus dissolution was observed by means of a designed parallel plate flow chamber and the time of thrombus complete dissolution was measured. The best result for the 1 MHz frequency and space averaged time averaged intensity of 1.6 W/cm2 was recorded, where the thrombus was dissolved within 5.5 minutes.

ultrasound, blood, thrombus, thrombolysis, parallel plate flow chamber

Parallel plate flow chambers are widely used for cell research in conditions of constant or pulsatile liquid flow. They are also used to analyze the formation of thrombi. The authors designed a flow chamber that is transparent to ultrasound, thus enabling the microscopic observation of the thrombus dissolution process by interaction of drug, microbubbles and ultrasound in real time, in-vitro. Sonothrombolysis was performed at 1 MHz and 3.3 MHz ultrasound frequencies, at space-averaged and time-averaged intensities ISATA of 0.2 – 1.6 W/cm2. 1 mm thick slices of the human blood clots were exposed to ultrasound in the presence of the Actilyse tissue plasminogen activator at a concentration of 10 μg/ml flowing around the sample. Next, the effect of SonoVue microbubbles at a concentration of 5x105/ml on the dissolution of the thrombus was investigated. Thrombus size changes were observed under a 4x magnification microscope and were recorded as a function of time. The best result was achieved for the Actilyse tissue plasminogen activator at the 1 MHz and 1.6 W/cm2 ISATA, the thrombus was sonolysed within 5.5 minutes. The noticeable effect of the SonoVue microbubbles on the thrombolysis process appeared at 3.3 MHz, the thrombus was sonolysed in 12 min at ISATA = 1.6 W/cm2.

ultrasound, blood, thrombus, thrombolysis, parallel plate flow chamber

The article attempts to select an ultrasound system to assess of endothelium dysfunction-dependent flow mediated dilation (FMD) and shear rate (SR) in radial artery after several minutes of hyperaemia. Methods: We compare the effective axial resolution and Doppler sensitivity of the standard US working below 12 MHz and high frequency (close to 20 MHz) scanning systems measuring the vessel diameter and blood flow measurements in radial arteries. FMD and FMD and SR were measured in Control group of 14 healthy volunteers, and in 13 with stable coronary artery diseases (CAD). Results: In a laboratory experiment of imaging two closely spaced food plastic foils, over three times better axial resolution was demonstrated for the 20 MHz ultrasound system in which the resolution was close to 0.1 mm. Also the sensitivity of the external single 20 MHz pulse Doppler transducer proved to be over 20 dB better (in terms of signalto-noise ratio) than the pulse Doppler incorporated into the L14-5 linear array. FMD in Control group was in the range of 8÷16% with mean±sd equal to 12.13 ± 2.34%; in CAD group FMD was in the range of 0.1÷7 % with mean±sd equal to 3.01±2.18% which was significantly less. FMD/SR was equal to 3.08 ± 1.34 × 10–4 in Control group and 1.01 ± 0.76 × 10–4 in CAD group with ranges equal to 1.66 ÷ 7.8× 10–4 and 0.4 ÷ 2.4× 10–4, respectively. Conclusions: Increasing scanning and Doppler mode frequency to 20 MHz improved the precision of FMD and SR measurements. Statistically significant differences between the two groups were confirmed by statistical tests for FMD and FMD/SR with p-values < 0.05. The results obtained suggest the usefulness of the proposed ultrasonic system for measurements of FMD and SR in the radial artery to differentiate normal subjects from those with CAD.

radial artery, shear rate, reactive hyperaemia, endothelium, pulsed Doppler

A novel high-frequency scanning system, with a 20-MHz linear array transducer combined with 20-MHz pulsed Doppler, was introduced to evaluate the degree of radial artery flow-mediated dilation (FMD) and shear rate (SR)-normalized FMD (FMD/SR) after 5 min of reactive hyperaemia. In group I, comprising 27 healthy volunteers, FMD was 15 ± 4.8%, and in group II, comprising 17 patients with coronary artery disease, FMD was significantly smaller, being equal to 4.6 ± 4%. FMD/SR was equal to 5.365 ± 4.835·10-4 in group I and 1.3 ± 0.89·10-4 in group II. Statistically significant differences between the two groups were confirmed by Wilcoxon-Mann-Whitney test for FMD and FMD/SR (p-values < 0.01). AUCs of ROC curves for FMD and FMD/SR were greater than 0.9. The results confirm the usefulness of the proposed measurements of radial artery FMD and SR in differentiation of normal subjects from those with atherosclerotic lesions.

flow mediated vasodilation, radial artery, shear rate, reactive hyporaemia, endothelium, pulsed Doppler, ultrasonography.

Preceding atherosclerosis is endothelial dysfunction. There is therefore interest in the application of non-invasive clinical tools to assess endothelial function. There are commercially available ultrasound scanners to estimate Brachial Artery Reactive Response BARR by measuring the flow-mediated vasodilatation (FMD) of the brachial artery using 10–12 MHz linear array probes; however the precision in estimating of artery dilation does not exceeds 0.2 mm, far beyond the required one. We have introduced a high frequency scanning schemes; 25–35 MHz encoded (Golay) wobbling type imaging with- out Doppler (uScan developed in our lab, thick film wide bandwidth transducer, 50 microns axial resolution). In the second approach we have used 20 MHz linear scanning with 20 MHz pulsed Doppler attached to the linear array. Instead of brachial artery we have examined the radial artery where Radial Artery Reactive Response RARR was measured. The radial artery FMD were normalized using AUC of shear rate at the radial artery wall. The precision of the radial artery diameter measurements is over two times better using 20 MHz US instead of 7.5 MHz used for brachial artery FMD. The measured initial internal radial artery diameter was in range of 1.59–2.35 mm, the maximum diameter 2.01–2.60 mm was observed 40 to 55 seconds after releasing the cuff. In a limited number (14) of examined young, healthy patients the FMDSR were in the range from 7.8
to 9.9 in arbitrary units. In older patients with minor cardiac history the normalized FMDSR was clearly lower, 6.8 to 7.6.

thick film transducers, atherosclerosis, flow mediated vasodilation.

Preceding atherosclerosis is endothelial dysfunction. There is therefore interest in the application of non-invasive clinical tools to assess endothelial function. There are commercially available ultrasound scanners to measure flow-mediated vasodilatation (FMD) of the brachial artery using 10-12 MHz linear array probes, however the attainable precision in estimating the changes in artery dilation does not exceeds 0.2 mm, far beyond the required one. We have introduced a high frequency scanning schemes 25-35MHz encoded (Golay) wobbling type imaging without Doppler (uScan developed in our lab, thick film wide bandwidth transducer, 50 microns axial resolution) and 20 MHz ultrasound (Ultrasonix) with 20 MHz pulsed Doppler attached to the linear array. The FMD results were normalized using AUC of shear rate at the radial artery wall.

thick-film transducers, flow-mediated vasolidation, radial artery, shear rate

The main goal of this study was to verify the suitability of sonographic model of the left ventricle (LV) in Computed Tomography (CT) environment and compare radial strain calculations obtained by two different techniques: speckle tracking ultrasonography and Multislices Computed Tomography (MSCT). The Left Ventricular (LF) phantom was fabricate from 10% solution of the poly(vinyl alcohol) (PVA). Our model of the LV was driven by the computer-controlled hydraulic piston Super-Pump (Vivitro Inc., Canada) with adjustable fluid volumes. During cycle of the pump, the Stroke Volume (SV) of water was pumped into the LV phantom and returned to the pump, resulting in changing the inner and outer diameters of the phantom. The stroke volume was set at of 24ml. The fluid pressure was changed within range of 0-60 mmHg, and the pulse rate was equal 60 cycles/per minute. The relationships between computer controlled left ventricular wall deformations and its visualizations of the echocardiographic and CT imaging, both in the normal and pathological conditions were examined. The difference of assessment the Radial Strain between two methods was not exceeding 1.1%.

Background: Hypertension (HT) is the leading cause of global disease burden and overall health loss. The brain is one of the main target organs affected by HT. HT is a potentially modifiable risk factor that leads to the formation of large vessel macroangiopathy, small vessel disease, microangiopathy, and microhemorrhages. Early detection of the brain changes (BC) gives a chance to receive appropriate treatment and protection from irreversible damage. Acoustocerebrography (ACG) is a set of techniques to capture the states of human brain tissue, and its changes on its molecular and cellular level. It is based on noninvasive measurements of various parameters obtained by analyzing an ultrasound pulse emitted across the human's skull. The main idea of this method relies in the relation between the tissue density, bulk modulus, and speed of propagation, for ultrasound waves in this medium. In our previous studies we showed that ACG is an effective method for detecting white matter lesions compared to the Magnetic Resonance Imaging. Additionally we showed that ACG allows to obtain a differentiated signal originates from atrial fibrillation (AF) patients and high-risk patients wit AF and HT.
Aim: The aim of the study was early detection of the BC in patients with HT using ACG.
Methods: The study included 136 female and 98 male patients (age 43.6±15.7 years) who were surveyed in the clinical research. The patients were divided into two groups: group I (patients with HT) n=33, and control group II (patients without HT) n=201. Phase and amplitude of all frequency components of the received signals from the brain path were extracted and compared to the phase and amplitude of the transmitted pulse. By doing so, the time of flight and the attenuation of each frequency component were calculated. Additionally, a fast Fourier transformation (FFT) was performed and its features were extracted.
Results: After introducing a machine learning technique, the ROC plot with an AUC of 0.929 with sensitivity 0.879 and specificity 0.831 was obtained (Fig. 1).
Conclusion: ACG is new promising method, which allows for early detection of change in the brain in the patients with HT.

Preceding atherosclerosis is an endothelial dysfunction. Therefore there is a growing interest in the application of non - invasive clinical tools to assess endothelial function. Commercially available ultrasound machines can measure flow - mediated vasodilatation of the brachial artery using maximum 10-12 MH z linear probes. The higher the probe frequency, the better the axial resolution. Recently, a new technology of piezoelectric transducers based on PZT thick film technology has been developed in Meggitt (Denmark) as a response to a call for devices working at higher frequencies. The thick films exhibited at least 30% bandwidth broadening comparing to the standard PZ 27 transducers, resulting in an increase in match filtering encoding output by a factor of 1.4 - 1.5 and finally resulting in a signal to noise gain of the same order. The introduction of a high frequency 25 - 30 MHz ultrasound scanner to measure radial artery diameter after reactive hyperemia open s a new window for more precise imaging of endothelial function.

thick film transducers, atherosclerosis, flow mediated vaso dilation

Ultradźwięki są stosowane w medycynie zarówno w diagnostyce - ultrasonografii jak i w terapii. Działanie terapeutyczne sprowadza się do efektów termicznych, uśmiercania komórek przez apoptozę oraz efektów sonomechanicznych. Terapie in-vivo są poprzedzane testami in-vitro komórek umieszczonych na szalce Petriego. W tej pracy zostaną przedstawione dwa efekty oddziaływania fali akustycznej na komórki: wspomaganie rozpuszczania skrzepliny oraz apoptoza komórek nowotworowych.
Do badań przygotowano zbiornik wypełniony odgazowaną wodą destylowaną z termostatem i mieszadłem elektromagnetycznym. W zbiorniku umieszczono płaski przetwornik ultradźwiękowy, promieniujący do góry, w kierunku zanurzonej w wodzie szalki Petriego ze skrzepliną lub komórkami.
W pierwszej części oddziaływano falą ultradźwiękową o częstotliwości 1.0 MHz i natężeniu Isata = 0.2 W/cm2 na skrzeplinę uzyskaną z kropli krwi 30 min po pobraniu. Skrzeplinę umieszczono w roztworze soli fizjologicznej z dodatkiem leku rozpuszczającego skrzeplinę tPA typu Actilyse 50 w stężeniu 10μg/ml i nadźwiękawiano przez 20 min. Eksperyment powtórzono z kolejnymi skrzeplinami stosując same ultradźwięki oraz sam lek Actilyse. Współdziałanie leku i fali ultradźwiękowej w ciągu 20 min spowodowało całkowite rozpuszczenie skrzepliny. W pozostałych przypadkach skrzeplina pozostała zmniejszając swoją objętość o 10-20%.
W drugiej części badano wpływ fali ultradźwiękowej 1.0 MHz na komórki nowotworowe szczurzego glejaka C6. Komórki wysiano na dnie szalki i hodowano w pożywce DMEM w temperaturze 37ºC. Następnie do pożywki dodano 1mM kwasu 5-aminolewulinowego ALA. Po 24h inkubacji, komórki poddano działaniu ultradźwięków o natężeniu Isata = 0.4, 0.8 oraz 1.2 W/cm2 przez 3 min. Po kolejnych 24h, żywotność komórek zbadano spektrofotometrem po dodaniu do pożywki odczynnika MTT assay. Badania powtórzono dla komórek bez ALA oraz bez ultradźwięków. Dla natężenia Isata = 1.2 W/cm2, żywotność komórek wynosiła 39% dla współdziałania ALA i ultradźwięków, 78% dla ALA oraz 99% dla ultradźwięków.
Przygotowane przez autorów stanowisko pomiarowe umożliwia prowadzenie badań in-vitro nad terapeutycznym oddziaływaniu ultradźwięków na komórki. Uzyskano pozytywne rezultaty w wykorzystaniu ultradźwięków zarówno do rozpuszczania skrzeplin – sonotrombolizy jak i uśmiercania komórek nowotworowych – terapii sonodynamicznej. Stosowano ultradźwięki małej mocy, niepowodujące zniszczenia komórek przez przegrzanie lub kawitację.

ultradźwięki terapeutyczne, sonotromboliza, tromboliza, leczenie nowotworów

The aim of this study was to verify suitability of sonographic model of LV (left ventricle) in CT (computed tomography) environment and to compare in vitro radial strain calculations obtained by two different techniques: speckle tracking ultrasonography and multislice CT.