The Therapy of Vulvar Carcinoma-Evaluation of Surgical Options in a Retrospective Monocentric Study

(1) Background: Surgical-oncological treatment methods are continuously put to the test in times of evidence-based medicine-notably, a constant reevaluation remains key, especially for tumor entities with increasing incidence such as vulvar carcinoma. (2) Methods: In order to determine the postoperative clinical course of different methods of vulvar excision (vulvectomy, hemivulvectomy) as well as inguinal lymph node removal (lymphadenectomy, sentinel lymph node biopsy) with regard to postoperative wound-healingprocess, perioperative hemorrhage, and re-resection rates, we retrospectively analyzed surgical, morphological and laboratory data of 76 patients with a pathological diagnosed vulvar cancer. (3) Results: Analysis of our data from a single center revealed a comparable perioperative clinical course regardless of the chosen method of vulvar excision and inguinal lymph node removal. (4) Conclusions: Thus, our results emphasize the current multimodality in surgical therapy of vulvar carcinoma, in which consideration of known prognostic factors together with the individual patient's clinical situation allow guideline-based therapy aimed at maximizing surgical safety.

Independent predictors of long-COVID in patients without comorbidities. Data from the Polish long-COVID cardiovascular (PoLoCOV-CVD) study

 

Coronavirus disease 2019 (COVID-19) is a serious respiratory disease that results from infection with a newly discovered coronavirus (SARS-COV-2). Patients recovering from SARS-COV2 infection complain of persisting symptoms which may lead to chronic fatigue syndrome and as well as many other complications. The vast majority of COVID-19 patients remaining in isolation/quarantine, due to the mild course of the disease, do not require hospitalization. There are many studies describing the course and complications of patients hospitalized due to COVID-19. There is little published data on how nonhospitalized patients get sick and what are the early and late complications of SARS-CoV-2 infection. Little is also known about Long-COVID (LC) in patients without comorbidities. Therefore, the aim of our analysis was to assess the predictors of long-lasting symptoms in patients without comorbidities suffering from COVID-19.

Methods

Patients ≥18 years of age diagnosed with COVID-19, were examined after full recovery (resolution of clinical symptoms, minimum 14 days after last symptoms). Patient information, course of the disease with symptoms, post-COVID-19 complaints were collected within 4–8 weeks after the COVID-19 recovery. We followed patients for at least 3 months. Patients were ordered the following tests: 12-lead ECG, 24-hour Holter ECG monitoring, 24-hour Holter blood pressure monitoring, Echocardiographic of the Heart assessment, Biochemical tests: lipid profile, glucose or glycosylated hemoglobin level, D-dimers. In patients with indications, the following were additionally performed: Magnetic resonance imaging of the heart, Computed tomography angiography (CTA) of pulmonary vessels, Angio CT of coronary vessels or other diagnostic tests.

Results

We identified 701 consecutive patients without comorbidities of whom 488 pts completed 3 month follow-up. Comparisons were made between LC group (n=218) and non-LC group (n=270). The demographic and laboratory characteristics of the studied group are presented in Table 1. Patients with severe course of acute phase of COVID-19 developed LC more often (72 vs. 28%, p<0.001). Significant differences regarding sex, weight, height, body mass index were observed. Patients with LC more often presented with dyspnoea, significant fatigue, chest pain, leg muscle pain, headache, arthralgia and chills. No statistically significant difference was observed regarding laboratory tests, 24-hour systolic and diastolic BP and echocardiographic parameters. LC group had higher 24-hour heart rate (77 [72–83] vs. 75 [70–81], p=0.021). Multivariate regression analysis showed that LC patients had higher BMI (odds ratio 1.057, 95% confidence intervals 1.016–1.100) and almost twice as often had a severe course (1.736, 1.071–2.814) and presented with arthralgia in the acute phase (1.901, 1.225–2.950).

Conclusions

Severe course of COVID-19, BMI, and arthralgia are independently related to long-COVID in patients without comorbidities.

Funding Acknowledgement

Type of funding sources: None.

The influence of UV light on the course of fluorescent enzyme assays

Experiments were carried out to illustrate the effect of UV light on the course of the enzymatic reaction of the coumarin derivative. Only the pulsating light of the UV diode gives the correct results for the determination of the kinetic constants of the enzymatic reaction. The enzyme concentration limit was found where the description of the M-M model breaks. It was shown that the system determines the kinetic parameters of enzymatic reactions: V_max-the maximum rate of reaction and K_M-the Michaelis constant. This method produces kinetic constants calculated from the changes in enzyme product concentration using the Michaelis-Menten model. To verify the results, we used a statistical analysis that checks the correctness of the model used.

Comparison of inpatient and outpatient cardiac rehabilitation following myocardial infarction

Funding Acknowledgements

Type of funding sources: None.

Background

Cardiac rehabilitation (CR) following myocardial infarction (MI) improves prognosis. Models of second phase CR differ across countries. The aim of the study was to compare outcomes in MI survivors participating in outpatient and inpatient CR programmes.

Methods

We included all patients hospitalized due to acute MI in Poland between October 2017 and December 2018 (n=96634). Among them 4411 patients were referred to and commenced outpatient CR, whereas 11626 patients started inpatient CR within 30 days following discharge. All the patients were the subject of prospective follow-up. The primary endpoint was defined as death from any cause.

Results

The mean follow-up was 332.8±128.1 days. Younger age, male sex, and a cancer in the history were related to higher probability, whereas diabetes, heart failure, chronic kidney disease, chronic obstructive pulmonary disease, ST-elevation myocardial infarction, and myocardial revascularization were related to lower probability of participation in the outpatient CR. Participation in outpatient CR was related to the risk of all-cause mortality both in univariable (hazard ratio [95% confidence intervals] 0.37 [0.26-0.51]) and multivariable analysis (0.53 [0.38-0.74]). Participation in the outpatient CR was also related to the lower risk of death or MI or stroke (0.57 [0.48-0.67] and 0.72 [0.61-0.84]) and a lower risk of death or hospitalization due to cardiovascular reasons: 0.78 (0.73-0.84) and 0.85 (0.80-0.91) for the univariable and multivariable analyses respectively. The analysis of propensity score matched groups confirmed the results.

Conclusion

Outpatient CR following MI may be related to improved prognosis compared to the inpatient programme.

Biochemical and cardiovascular predictors of PIMS risk in children after COVID-19 recovery =- the results of the LATE COVID Kids study

Background

Unfortunately, the number of children with the pediatric inflammatory multisystem syndrome (PIMS) associated with previous coronavirus disease has been increasing significantly.

Purpose

The aim of the present study was to characterize biochemical and cardiovascular predictors of PIMS risk in children recovered from COVID-19 based on the data from the LATE-COVID-Kids study (NCT04799444).

Methods

131 consecutive COVID-19 convalescents (mean age: 8.89±4.91; 67 boys and 64 girls) hospitalized for the clinical evaluation after the acute phase of the COVID-19 were classified into two groups related to symptoms: 29 children finally diagnosed with PIMS and 102 children with no-PIMS. All patients had confirmed coronavirus infection based on the positive results of nucleic acid test (RT-PCR - reverse transcriptase-polymerase chain), and they were serologically tested for antibodies against SARS-CoV-2. They had detailed laboratory testing, electrocardiography, and echocardiography.

Results

The time from COVID-19 recovery was from 1 to 10 months (median 4.0 [3.00–5.00] months). Children with PIMS were significantly younger in comparison to those without (6.60±4.50 vs 9.50±4.80 years, respectively; p=0,005). In comparison to non-PIMS group, children with PIMS had higher level of antithrombin III (111±7.23 vs. 104±10.9; p=0.0015), CK-MB (29.0 [18.5–36.0] vs. 21.0 [15.0–30.7]; p=0.03) and heart rate [HR]/min (100 [89.0–112] vs. 90.0 [79.0–100]; p=0.006) but lower PQ interval (120 [110–120] vs. 130 [120–140]; p=0.023) on admission to hospital. Moreover, the immunological parameters: IgA and neutrophils were lower in children with PIMS vs. no-PIMS (0.69 [0.47–0.85] vs. 1.19 [0.71–1.50]; p=0.0001 and 37.4%±13.3 vs. 43.0±11.6; p=0.0045, respectively), but lymphocytes were significantly higher (50.6±13.6 vs. 43.7±10.9; p=0.002). Some acid-base balance parameters were higher in children following PIMS vs. no-PIMS children group: pCO2 (41.30±5.70 vs. 45.0±7.00; p=0.019), pO2 (50.1 [38.4–59.7] vs. 37.8 [27.9–49.9]; p=0.007), and O2Sat (84.2 [69.3–90.6] vs. 64.2 [44.3–82.6]; p=0.004); however, concentration of HCO3- (23.6 [22.2–24.4] vs. 24.3 [22.8–26.2]; p=0.023) was lower in group of PIMS children.

Conclusions

Based on our best knowledge, it is the first data on the possible predictors of PIMS risk in children recovered from COVID-19. We showed that children with PIMS have significantly higher levels of antithrombin III, CK-MB, HR, as well as lymphocytes, pCO2, pO2 and O2Sat on admission to hospital and lower levels of PQ interval, IgA, neutrophils and concentration of HCO3. We continue our research to confirm these results and to create the PIMS SCORE algorithm to allow prediction of children with the risk of PIMS occurrence after COVID-19 recovery.

Funding Acknowledgement

Type of funding sources: None.

Long term outcomes of a coordinate care program in patients after myocardial infarction (KOS-MI)

Introduction

Despite significant progress in treatment of myocardial infarction (MI), the annual mortality remains a challenge. Since 2017, The Coordinated Care in Myocardial Infarction Program (KOS-MI) has been introduced in Poland, which guarantees and coordinates patients to achieve complete revascularization, electrotherapy when necessary, cardiac rehabilitation and access to cardiologist for patients after MI.

Purpose

The aim of this study was to assess long term outcomes (3-year follow-up) of patients enrolled in KOS-MI.

Methods

This is a prospective multicenter registry of 1973 consecutive patients with myocardial infarction hospitalized in 4 centers of American Heart of Poland from 11.2017 to 11.2018. Patients which constituted a study group were enrolled in KOS-MI program at discharge. A control group consisted patients who received standard of care. Propensity score matching was utilized for patients baseline characteristic matching and results adjustment. Follow-up was obtained from the National Health Fund registry citizens. Combine endpoint of MACCE consisted of death, MI, stroke and repeated revascularization.

Results

In total 753 patients were enrolled in KOS program and 1173 constituted a control group. More than 90% of patients in both groups underwent PCI. Patients in KOS-MI were mostly men (70% vs. 65%; p&lt;0,05), were younger (65 vs. 68; p&lt;0,05), admitted with STEMI (44,8% vs. 37,5%; p&lt;0,05) with previous history of heart failure (23% vs. 17%; p&lt;0,05). Patients in the control group had more comorbidities: chronic kidney disease (9,8% vs. 4,4%; p&lt;0,05), previous AMI (17,6% vs. 12,6%; p&lt;0,05), prior PCI (15,7% vs. 11%; p&lt;0,05) and atrial fibrillation (11,7% vs. 8,4%; p&lt;0,05). They were more often admitted with NSTEMI (62,5% vs. 55,3%; p&lt;0,05) and acute heart failure (4,7% vs. 2,7%; p&lt;0,05). KOS patients had more often completed revascularization performed (50% vs. 33,4%; p&lt;0,05). Following propensity score matching 576 pairs were matched, and patient baseline characteristic were well balanced in all variables.

In long- term follow-up (mean 2,8±0,27 years) mortality was significantly lower in KOS group (9% vs. 16,3%; p&lt;0,05) and MI similar (10,8% vs. 13,1%; p=0,14). MACCE was higher in the control group (43% vs. 30,2%; p&lt;0,05). Prevalence of hospitalization for HF and repeated revascularization was higher in the control group (14,7% vs. 9,4%; p&lt;0,05 and 27,9% vs. 21%; p&lt;0,05, respectively). After adjustment MACCE remained significantly lower for KOS-MI, whereas there was tendency for lower mortality, hospitalization for HF and repeated revascularizations (Figure 1).

Conclusions

Combination and coordination of unrestricted rehabilitation, complete revascularization, electrotherapy and ambulatory cardiologist care in the KOS-MI program improves long term prognosis in patients after MI.

Funding Acknowledgement

Type of funding sources: None. Figure 1

Temporal changes in the implementation of secondary prevention of coronary artery disease in every day practice

Funding Acknowledgements

Type of funding sources: None.

OnBehalf

-

Introduction

Patients with coronary artery disease (CAD) are at high risk of recurrent cardiovascular events and control of their risk factors is crucial.

Objectives

Comparison of risk factors control in patients with CAD in 2016–2017 and 2011–2013.

Patients and methods

Five hospitals with cardiology departments serving the city and surrounding districts participated in the study. Consecutive patients hospitalized due to an acute coronary syndrome or a myocardial revascularization procedure were interviewed 6–18 months after hospitalization. The surveys were carried out in 2011–2013 and 2016–2017.

Results

We examined 616 patients in 2011–2013 and 388 in 2016–2017 (mean age: 64.7 ± 8.8 vs. 66.4 ± 8.4, P &lt;0.01). After adjusting for covariates the proportion of patients with high blood pressure decreased by 8.9% (95% confidence intervals: -2.1% – -15.6%) and proportion of patients with high LDL cholesterol decreased by 9.5% (-2.2% – -16.7%) in 2016/2017 compared to 2011/2013, whereas the proportion of smoking patients (-0.2% [-6.0% – 5.5%]) and those with high glucose level (3.9% [-2.2% - 10.0%]) and with body mass index ≥25 kg/m2 (3.8% [-3.9% – 11.6%]) did not change significantly. The proportion of patients prescribed antiplatelets (6.5% [2.6% - 10.3%]), β-blockers (7.4% [2.2% - 12.6%]), angiotensin converting enzyme inhibitors or sartans (8.6% [2.9% – 14.3%]), calcium antagonists (8.1% [1.3 – 15.0]) and anticoagulants (5.5% [0.7% - 10.2%]) increased significantly.

Conclusions

In CAD patients, there was an increase of the proportion of patients with cardiovascular drugs prescribed and a slight improvement in the control of blood pressure and LDL cholesterol between 2011–2013 and 2016–2017. However, no significant changes were found for the other main risk factors.

Patients who do not reach treatment goal Survey Smoking, % BP not at goal, %a BP ≥140/90 mmHg, % LDL cholesterol ≥1.8 mmol/l, % HbA1c ≥7.0%b, % Fasting glucose ≥7.0 mmol/l, % BMI≥25 kg/m2, % BMI≥30 kg/m2, % 2011-2013 19.0 50.3 43.0 71.9 14.1 15.9 81.2 33.8 2016-2017 16.2 40.7 39.2 60.3 14.9 20.2 83.4 38.3 P value 0.26 &lt;0.01 0.24 &lt;0.001 0.76 0.09 0.37 0.14 Differences adjusted for age, sex, index diagnosis, duration of education, professional activity (95% confidence intervals) 2016-2017 vs 2011-2013 -0.2(-6.0 - 5.5) -8.9(-15.6 - -2.1) -6.7(-14.3 - 1.0) -9.5(-16.7 - -2.2) 2.0(-3.4 - 7.4) 3.9(-2.2 - 10.0) 3.8(-3.9 - 11.6) 1.6 (-5.8 - 9.0) Abbreviations BMI, body mass index; BP, blood pressure; LDL, low-density lipoprotein a BP goal of &lt;140/90mmHg (&lt;130/80 mmHg in diabetics) in 2011–2013 and &lt;140/90 mmHg (&lt;140/85 mmHg in diabetics) in 2016–2017 b available for 362 patients in 2011-2013 and 383 patients in 2016-2017

Managed care improves prognosis in AMI patients irrespectively of the hospital setting. Data from the MAnaged Care for Acute Myocardial Infarction Survivors (MACAMIS) Programme

Background

In 2017 a nation-wide system of managed care for MI survivors comprising acute treatment of MI, cardiac rehabilitation and cardiac ambulatory care within one year following MI was implemented in Poland. The managed care programme (MCP) was proved to be related to lower risk of all-cause death. The goal of the analysis was to assess the effectiveness of MCP in patients discharged from university, district, municipal and non-public hospitals.

Methods

The database of survivors of acute MI discharged from hospital from October 1, 2017 to December 31, 2018 was analyzed. Patients who died within 10 days after discharge were excluded from the analysis. The primary end-point was defined as death from any cause. Propensity-Score Matching using nearest neighbor matching was used to form comparable groups of patients participating and not participating in the MCP. The Cox proportional hazard regression analysis was used to assess the relation between MCP and the overall mortality.

Results

MCP was implemented in the first stage in 48 hospitals spread around the country (about 34% of all hospitals treating acute MI patients in Poland). Among them 14 were university, 20 district, 8 municipal and 6 nonpublic hospitals. Out of 34064 patients discharged from hospitals with MCP implemented 10404 patients (30.5%) participated in MCP. They were matched with 10404 patients not participating in the MCP. About 24% of the analyzed patients were discharged from university hospitals, 42% from district hospitals, 20% from nonpublic, 14% from municipal and other hospitals. During 326.3±134.8 days of follow-up 1062 patients died (4.4% vs. 6.5% of patients participating and not participating in the MCP; p&lt;0.001). Hazard ratios related to MCP of patients hospitalized in each hospital categories are presented in the table.

Conclusion

The implemented in Poland nation-wide system of managed care for MI survivors is related to improved survival in all hospital settings.

Funding Acknowledgement

Type of funding source: None

Managed care improves prognosis in acute myocardial infarction survivors. Data from the MAnaged Care for Acute Myocardial Infarction Survivors (MACAMIS) Programme

Background

Mortality following acute myocardial infarction (MI) remains high despite progress in pharmacotherapy and interventional treatment. In 2017 a nation-wide system of managed care for MI survivors comprising a continuum of acute treatment of MI, staged revascularization, cardiac rehabilitation, cardiac electrotherapy and cardiac ambulatory care within one year following MI was implemented in Poland. The managed care programme (MCP) includes also the quality of care assessment based on clinical measures (e.g. cardiovascular risk factors control) as well as on the rate of minor and major cardiovascular events. The goal of the analysis was to assess the overall mortality of MI survivors participating and not participating in the MCP.

Methods

The database of survivors of acute MI discharged from hospital from October 1, 2017 to December 31, 2018 was analyzed. Patients who died within 10 days after discharge were excluded from the analysis. The primary end-point was defined as death from any cause. Propensity-Score Matching (PSM) using nearest neighbor matching was used to form comparable groups of patients participating and not participating in the MCP. The Cox proportional hazard regression analysis was used to assess the relation between MCP and the overall mortality.

Results

MCP was implemented in the first stage in 48 hospitals spread around the country (about 34% of all hospitals treating acute MI patients in Poland). Out of 87739 analyzed patients (age: 68.1±11.9 years; 55581 men and 32158 women) 34064 were hospitalized in hospitals with MCP implemented. Altogether 10404 patients (11.9% of the whole cohort; 30.5% of those hospitalized in hospitals with MCP implemented) participated in MCP. They were matched with 10404 patients not participating in the MCP. During 324.8±140.5 days of follow-up 7413 patients died. One-year mortality was lower in patients participating in the MCP both when we analyzed the whole cohort (4.4% vs. 9.5%; p&lt;0.001) as well as when we limited the analysis to the PSM groups (4.4% vs. 6.5%; p&lt;0.001, figure 1). MCP was related to the overall mortality in univariate (HR 0.43 [0.39–0.48]) as well as in multivariate analysis (0.64 [0.57–0.71]) in the whole cohort as well as in the PSM cohort (HR 0.63 [0.56–0.72] and 0.64 [0.56–0.72] for the univariate and multivariate analysis respectively). When we limited the analysis to hospitals in which MCP was implemented one-year mortality was 4.3% vs. 6.3% (p&lt;0.001) whereas univariate HR was 0.51 (0.44–0.60) and multivariate HR 0.52 (0.44–0.61).

Conclusion

The implemented in Poland nation-wide system of managed care for MI survivors is related to improved survival. Therefore, the Ministry of Health plans to implement the programme in all cardiac centers in Poland.

Funding Acknowledgement

Type of funding source: None

Physical activity in patients with coronary heart disease: results from the EUROASPIRE V Survey

Background

Physical inactivity is common in patients with coronary heart disease (CHD) and associated with an unfavorable prognosis. The study aim was to assess the physical activity levels as well as the intention to become physically active in patients with stable CHD with an additional focus on the association with their risk profile.

Methods

Analyses are based on the cross-sectional EUROASPIRE V survey, conducted under the auspices of the ESC EURObservational Research Project in 2016–2017. The survey encompassed 8,261 CHD patients, included in 27 countries, with a mean age of 62.4 years (±9.6, range 18 - 80 years), 25.8% of them were female. Physical activity level according to the overall patients' risk profile and their medical management was assessed, and the intention to become physically active in order to reduce their risk for recurrent events was investigated.

Results

The physical activity status found in CHD patients included was far from satisfactory in general, since only 34.4% of those interviewed were regularly physically active (for more than 30 minutes duration on average 5 times a week). Nearly half (47.3%) of the patients reported they are performing more everyday physical activity in general after the index event; while only every fifth patient (21.4%) reported to follow the specific exercise advice from a health or exercise professional, every tenth (11.3%) attending the fitness club or leisure centre, and only 6.1% joining the community walking groups. Regular exercise to increase physical fitness (defined as planned physical activity performed 3–5 times per week for 20–60 minutes) was confirmed by 34.8%, while interestingly 40.4% of patients declared regular physical activity as part of the self-reported lifestyle change in order to lose their body weight. A better cardiovascular risk profile as well as receiving physical activity advice or weight loss advice was associated with better physical activity levels.

Conclusions

Although an increase in the proportion of patients being adequately physical active after their index event, physical activity levels remain suboptimal in many CHD patients. There is an obvious need for improvement, with regards to both finding more effective ways of advice and encouraging our patients to increase the amount of their everyday exercise, as well regularly to monitor their lifestyle change.

Funding Acknowledgement

Type of funding source: Private grant(s) and/or Sponsorship. Main funding source(s): The survey was supported through research grants to the European Society of Cardiology from Amgen, Eli Lilly, Sanofi (Gold Sponsors), Pfizer (Silver Sponsor), and Ferrer and Novo Nordisk (Bronze Sponsors).

Comparative experimental and theoretical study of the rotational excitation of CO by collision with ortho- and para-D2 molecules

A joint crossed beam and quantum mechanical investigation of the rotationally inelastic collisions of CO with ortho- and para-D₂ molecules is reported. A new 4D potential energy surface (PES) averaged over the ground vibrational states of D₂ and CO is used to calculate the rovibrational bound states of the ortho-D₂-CO complexes. Close coupling calculations are then performed in the rigid rotor approximation for ortho- and para-D₂ colliding with CO for the experimentally investigated transition of CO (j = 0 → 1) and for collision energies ranging from 0.1 to 25 cm^-1. The agreement between theory and experiment is found to be very good for both the bound state energies of the ortho-D₂-CO complexes and for the inelastic scattering cross-sections showing that the free rotation of two rigid rotors is a very good model of the D₂-CO system in this low collision energy domain.

New boron based salts for lithium-ion batteries using conjugated ligands

A new anion design concept, based on combining a boron atom as the central atom and conjugated systems as ligands, is presented as a route for finding alternative Li-salts for lithium-ion batteries. The properties of a wide range of novel anions designed in this way have been evaluated by DFT calculations focusing on three different fundamental success factors/measures: the strength of the cation-anion interaction, ultimately determining both the solubility and the ionic conductivity, the oxidation limit, determining their possible use vs. high voltage cathodes, and the reduction stability, revealing a possible role of the anion in the SEI-formation at the anode. For a few anions superior properties vs. today's existing or suggested anions are predicted, especially the very low cation-anion interaction strengths are promising features. The design route itself is shown to be versatile in determining the correlation between different choices of ligands and the resulting overall properties - where the most striking feature is the decreased lithium cation interaction energy upon using the (1Z,3Z)-buta-1,3-diene-1,2,3,4-tetracarbonitrile ligands. This also opens avenues for the further design of novel anions beyond those with a boron central atom.

Functionalization of polycarbonate with proteins; open-tubular enzymatic microreactors

This paper examines a set of techniques for the immobilization of enzymes on the surface of microchannels fabricated in polycarbonate (PC). Our experiments identify the method that uses combined physico-chemical immobilization on a layer of polyethyleneimine (PEI) as a reproducible vista for the robust immobilization of proteins. As an example, we demonstrate the fabrication, throughput and stability of an open-tubular reactor draped with alkaline phosphatase (ALP, EC 3.1.3.1) as a model enzyme. As PC is suitable for industrial applications the method could potentially be used to immobilize proteins in numbered-up implementations.