Via Medica Journals
Not a member yet
55128 research outputs found
Sort by
Air pollution and cardiovascular diseases. Opinion and recommendations of experts from the Prevention and Epidemiology Section of the Polish Cardiac Society
No full textAir pollution is currently a global health problem. A key component of polluted air includes particulate matter (PM2.5 and PM10), carbon monoxide, nitrogen oxides, sulfur oxides, and volatile organic compounds. According to World Health Organization data, air pollution accounts for one in eight deaths annually (6.7 million deaths worldwide). Poland ranks first, with a rate of 732.82 deaths per one million inhabitants. Air pollution significantly contributes to the development and progression of cardiovascular diseases, including hypertension, acute coronary syndromes, cardiac arrhythmias, heart failure, chronic kidney disease, and stroke. The impact of air pollution on hypertension is associated with endothelial dysfunction, vascular inflammation, and activation of the autonomic nervous system. The populations most at risk are older adults and individuals with diabetes. Air pollution also significantly affects the incidence of acute coronary syndromes through both short- and long-term exposure. A strong correlation has been demonstrated between increased air pollution levels and the risk of ventricular arrhythmias as well as out-of-hospital cardiac arrest. The impact of polluted air on heart failure is bidirectional: it contributes to the progression of risk factors leading to heart failure, while also increasing the likelihood of acute decompensation. In the case of chronic kidney disease, the primary harmful factor is exposure to PM2.5 particles, which cause vascular damage and glomerulosclerosis. There is strong evidence linking smog exposure with an increased risk of ischemic stroke, whereas data regarding hemorrhagic stroke remain limited. There is a clear need to develop recommendations for healthcare systems, both to improve monitoring and to implement preventive strategies. Such recommendations should include medical documentation standards, guidance on minimizing exposure to polluted air, individualized counseling for patients, as well as group and telephonic counseling. Implementing such measures may help reduce patient exposure and its associated health risks
Zalecenia Polskiego Towarzystwa Ginekologii Onkologicznej dotyczące diagnostyki i leczenia raka jajnika (2025)
No full textOne of the primary responsibilities of scientific societies is to develop modern guidelines aimed at standardizing and improving patient treatment outcomes. Therefore, the Polish Society of Gynecologic Oncology has undertaken the task of developing recommendations for the diagnosis and treatment of patients with ovarian cancer.
The guidelines were developed based on an analysis of the methodology of identified scientific evidence regarding the diagnosis, treatment, and post-treatment follow-up of ovarian cancer, using the AGREE II (Appraisal of Guidelines for Research and Evaluation) tool for guideline assessment. The strength of individual pieces of scientific evidence was defined according to the criteria described by the Agency for Health Technology Assessment and Tariff System (AOTMiT).
These recommendations are intended for practicing physicians involved in the treatment of patients with ovarian cancer.Jednym z podstawowych zadań towarzystw naukowych jest tworzenie nowoczesnych zaleceń, których celem jest ujednolicenie oraz poprawa wyników leczenia chorych. Dlatego też Polskie Towarzystwo Ginekologii Onkologicznej podjęło się opracowania wytycznych dotyczących diagnostyki i leczenia chorych na raka jajnika. Zalecenia zostały opracowane na podstawie analizy metodologii zidentyfikowanych dowodów naukowych dotyczących diagnozowania, leczenia i obserwacji po leczeniu raka jajnika, wykorzystując metodę Appraisal of Guidelines for Research and Evaluation (AGREE) II — narzędzie do oceny wytycznych. Siłę poszczególnych dowodów naukowych zdefiniowano zgodnie z kryteriami opisanymi przez Agencję Oceny Technologii Medycznych i Taryfikacji (AOTMiT). Zalecenia przeznaczone są dla lekarzy praktyków zajmujących się leczeniem chorych na raka jajnika
High-dose adaptive radiotherapy for inoperable breast cancer with skin invasion after failure of chemotherapy
Full text linkIntroduction. In patients with inoperable breast cancer and skin invasion, the failure of chemotherapy results in symptoms such as bleeding, discharge, and offensive odor, significantly impacting the patient’s quality of life. The purpose of this study was to investigate the feasibility and efficacy of high-dose adaptive radiotherapy for inoperable breast cancer with skin invasion after chemotherapy failure.
Material and methods. In this retrospective study, six consecutive patients diagnosed with inoperable breast cancer, characterized by regional lymph node metastases and, in four cases, oligometastases, were evaluated. All patients showed skin invasion after the failure of chemotherapy. We conducted planned adaptive high-dose radiotherapy using helical tomotherapy to the whole breast and metastatic regional lymph node areas. Subsequently, we administered boost adaptive radiotherapy to the breast cancer and the metastatic lymph nodes. The total doses delivered to the breast cancer and metastatic lymph nodes ranged from 66 to 75 Gy and 60 to 70 Gy, respectively.
Results. After a median follow-up of 18 months, the rates of 2-year local progression-free survival, disease-specific survival, and overall survival were 100%, 62.5%, and 50.0%, respectively. Grade 1 dermatitis was observed in five patients, whereas one patient experienced grade 2 skin edema.
Conclusions. High-dose adaptive radiotherapy may be a feasible and effective treatment option for patients with advanced breast cancer with skin invasion who have failed chemotherapy
Human annotator versus fully automated deep learning segmentation of vestibular schwannoma on magnetic resonance imaging — a systematic review and comparison meta-analysis
No full textIntroduction. Vestibular schwannoma (VS) is a tumor that requires careful clinical management. Gamma Knife stereotactic radiosurgery remains a major treatment option; however, manual delineation of the tumor from MRI is challenging. Recently, deep learning (DL) techniques have emerged in the field of neuroradiology, providing fast and accurate segmentation; however, no meta-analysis has compared head-to-head human and automated DL annotation.
Material and methods. Scientific databases were systematically searched from inception to April 2025. Studies in which fully automated DL segmentation of VS was compared to independent human annotator(s) were included. Evaluation metrics included dice score (DSC), average symmetric surface distance (ASSD), 95% Hausdorff distance (95% HD), and relative volume error percentage (RVE). Meta-analysis was performed with a fixed-effects model.
Results. Four studies were included, and expert comparisons included neurosurgeons, radiologists, skull-base otorhinolaryngologists, and physicians. The pooled DSC was significantly higher with the use of fully automated segmentation (MD 2.00; 95% CI 1.30–2.70; p < 0.001). The relative volume error was significantly higher using DL techniques (MD 3.94%; 95% CI 2.36–5.52%; p < 0.001). The HD95 was significantly lower in the human-annotated images (MD 0.06; 95% CI 0.00–0.11; p = 0.04).
Conclusions. According to available research, this is the first meta-analysis to compare human annotators to DL-based automated segmentations of VS on MRI scans. While DL-based algorithms yield higher DSC, they lead to higher RVE and HD95. High heterogeneity in the included studies needs to be resolved through high-quality trials in the future
Long-term therapeutic response in gallbladder cancer — the potential of chemoimmunotherapy
No full textMalignant biliary tract tumors, including gallbladder cancer and cholangiocarcinoma, are associated with particularly poor prognoses. For many years, chemotherapy with cisplatin and gemcitabine was the only available treatment option for patients with the advanced disease. A breakthrough in the management of this patient group came with the introduction of immunotherapy, especially in combination with chemotherapy. The TOPAZ-1 clinical trial demonstrated that the use of the programmed death-ligand 1 (PD-L1) checkpoint inhibitor durvalumab, in combination with cisplatin and gemcitabine, improves treatment efficacy, significantly prolonging both overall survival (OS) and progression-free survival (PFS).
Using available research, the case reports of patients with unresectable advanced biliary tract adenocarcinoma who were treated with chemotherapy combined with durvalumab are presented herein. The treatment was initiated within an Expanded Access Program (EAP) and subsequently continued within the Polish National Health Fund’s Drug Program (Program Lekowy Ministerstwa Zdrowia). In selected patients, disease stabilization was observed and a long-term therapeutic response with maintenance of very good performance status (Eastern Cooperative Oncology Group 0) over many months of treatment — significantly exceeded the outcomes reported in the registration trial. In one case, the patient had been receiving treatment for over 30 months and remains in good clinical condition (as of July 2025). Treatment was well tolerated in both cases and led to substantial prolongation of progression-free survival.
These findings illustrate the high efficacy and acceptable safety profile of durvalumab combined with chemotherapy in patients with advanced biliary tract cancers. Long-term treatment response in this population gives hope for better prognosis and improved quality of life in selected cases
Ventricular and supraventricular ectopic beats burden is correlated with bone mineral density and osteoporotic fracture risk in postmenopausal women
No full textBackground: Patients with osteoporosis (OP) have an increased 10-year cardiovascular death risk. Low bone mineral density (BMD) observed in OP may be associated with arrhythmic presentation of cardiovascular diseases.Aims: We assessed arrhythmia occurrence in females with osteoporosis.Methods: One hundred three postmenopausal females, consulted by an endocrinologist, were divided into 2 groups according to BMD (assessed by dual-energy X-ray absorptiometry), expressed as T-score (T-sc; OP ≤–2.5, control >–2.5), taken from the femoral neck (T-sc Neck), the entire total hip (T-sc TH), and/or the spine (T-sc L2–L4, L1–L4). The occurrence of arrhythmia was evaluated using 24-hour Holter electrocardiography monitoring (HM). Major osteoporotic and total hip fracture risks (MOFR and THFR, respectively) were assessed by the FRAX scale.Results: Arrhythmic burden correlated with BMD: correlations were observed between the number of ventricular ectopic beats (VEB) in HM and the T-sc Neck (r = –0.20; P = 0.04), T-sc TH (r = –0.22; P = 0.03) as well as between the number of supraventricular ectopic beats (SVEB) in HM and the T-sc Neck (r = –0.21; P = 0.03), and T-sc TH (r = –0.23; P = 0.02). Multivariable analysis (linear regression model) showed age and T-sc TH as independently related with ectopy: age (b = 0.07; 95% CI, 0.01–0.13; P = 0.03) and T-sc TH (b = –0.58; 95% CI, –1.07 to –0.08; P = 0.02) were predictors for VEB. Ectopic beats count was also positively correlated with osteoporotic fracture risk: VEB with THFR (r = 0.206; P = 0.04), and SVEB with MOFR (r = 0.21; P = 0.04).Conclusions: Postmenopausal women diagnosed with osteoporosis are likely to have higher risk of ventricular and supraventricular arrhythmias than women without osteoporosis. Moreover, we documented that the presence of cardiac arrhythmia increases with the risk of osteoporotic fracture
Right ventricular outflow tract repair in tetralogy of Fallot: Comparison of two surgical methods in long-term follow-up
No full textConduction system pacing-guided mapping and ablation of fascicular ventricular tachycardia in complete heart block
No full textRybocyklib — wybrane aspekty stosowania leku w codziennej praktyce
No full textRak piersi HR/+/ & HER2/–/ jest najczęstszym podtypem biologicznym, a w jego rozwoju ważną rolę odgrywają kinazy CDK4/6, regulujące cykl komórkowy. Nadmierna aktywacja kinaz może skutkować opornością na hormonoterapię. Zahamowanie aktywności CDK4/6 prowadzi do zatrzymania cyklu komórkowego w fazie G1 oraz indukcji apoptozy. Inhibitory CDK4/6, w tym rybocyklib, w połączeniu z hormonoterapią są standardem leczenia w zaawansowanym oraz wczesnym HR/+/ & HER2/–/ raku piersi, w którym wydłużają — odpowiednio — czas przeżycia wolnego od progresji i całkowitego oraz zmniejszają ryzyko nawrotu choroby. Rybocyklib może powodować działania niepożądane (między innymi dotyczące wątroby oraz układu sercowo-naczyniowego), a jako silny inhibitor CYP3A4 wchodzi w liczne interakcje lekowe. Wysoki odsetek (31%) przedwczesnego przerwania uzupełniającego leczenia rybocyklibem podkreśla potrzebę właściwego doboru chorych i monitorowania tolerancji. Autorzy niniejszego artykułu zwracają uwagę na praktyczne aspekty minimalizowania ryzyka działań niepożądanych, kontrolę interakcji i znaczenie przestrzegania zaleceń terapeutycznych
Trastuzumab derukstekan w leczeniu chorych na zaawansowanego HER2-dodatniego raka żołądka lub połączenia żołądkowo-przełykowego. Komentarz do listy priorytetów refundacyjnych (TOP 10 ONKO) w 2025 roku
No full textBrakU 15–20% chorych na raka żołądka lub połączenia żołądkowo-przełykowego z przerzutami stwierdza się nadekspresję receptora HER2 lub amplifikację kodującego go genu. Standardem leczenia pierwszej linii takich chorych jest chemioterapia z trastuzumabem. Ostatnie badania wykazały, że dodanie pembrolizumabu do tego schematu — u chorych z obecną dodatkowo ekspresją PD-L1 (CPS ≥ 1) — poprawia PFS i OS.
W przypadku progresji raka HER2-dodatniego po leczeniu pierwszej linii stosuje się leczenie jak w raku HER2- -ujemnym, gdyż inne terapie anty-HER2 badane w przeszłości okazały się nieskuteczne.
Nową opcją leczenia jest trastuzumab derukstekan (T-DXd) — koniugat przeciwciała anty-HER2 z lekiem cytotoksycznym. W badaniu DESTINY-Gastric04 T-DXd wykazał przewagę nad standardowym leczeniem drugiej linii (ramucyrumab z paklitakselem) pod względem ORR, PFS, OS. T-DXd został zarejestrowany w USA i UE, a w Polsce znalazł się na liście priorytetów refundacyjnych na 2025 rok. Trwają też badania nad jego zastosowaniem w pierwszej linii oraz u chorych z niską ekspresją HER2. W tej ostatniej kohorcie aktywność leku wynika z tak zwanego bystander effect. W przyszłości możliwe są kolejne terapie ukierunkowane na HER2, co sugeruje dynamiczny rozwój tego obszaru onkologii