573 Different renal function patterns in acute heart failure patients

Aims The role of worsening renal function during acute heart failure (AHF) hospitalization is still debated. Very few studies have extensively evaluated the renal function (RF) trend during hospitalization by repetitive measurements. The aim of this study is to investigate the prognostic relevance of different RF trajectories together with the congestion status in hospitalized patients. Methods and results This is a post hoc analysis of a multi-centres study including 467 patients admitted with AHF who were screened for the Diur-AHF Trial. We recognized five main RF trajectories based on serum creatinine and estimated glomerular filtration rate (eGFR) behaviour: according to the RF curve our sample was divided into 1-stable (S), 2-transient improvement (TI), 3-permanent improvement (PI), 4-transient worsening (TW), and 5-persistent worsening (PW). The primary outcome was the combined endpoint of 180 days including all causes of mortality and re-hospitalization. We recruited 467 subjects with a mean congestion score of 3.5 ± 1.08 and a median creatinine value of 1.28 (1.00–1.70) mg/dl, eGFR 50 (37–65) ml/min/m2, and NTpro BNP 7000 (4200–11 700) pg/ml. A univariate analysis of the RF pattern demonstrated that TI and PW patterns were significantly related to poor prognosis [HR: 2.71 (1.81–4.05); P < 0.001; HR: 1.68 (1.15–2.45); P = 0.007, respectively]. Conversely, the TW pattern showed a significantly protective effect on outcome [HR: 0.34 (0.19–0.60); P < 0.001]. Persistence of congestion and BNP reduction ≥ 30% were significantly related to clinical outcome at univariate analysis [HR: 2.41 (1.81–3.21); P < 0.001 and HR: 0.47 (0.35–0.67); P < 0.001]. A multivariable analysis confirmed the independently prognostic role of TI, PW patterns, persistence of congestion, and reduced BNP decrease at discharge. Conclusions Various RF patterns during AHF hospitalization are associated with different risk(s). PW and TI appear to be the two trajectories related to worse outcome. Current findings confirm the importance of RF evaluation during and after hospitalization.

572 Different renal function patterns in acute heart failure patients

Aims The role of worsening renal function during acute heart failure (AHF) hospitalization is still debated. Very few studies have extensively evaluated the renal function (RF) trend during hospitalization by repetitive measurements. The aim of this study is to investigate the prognostic relevance of different RF trajectories together with the congestion status in hospitalized patients. Methods and results This is a post hoc analysis of a multi-centres study including 467 patients admitted with AHF who were screened for the Diur-AHF Trial. We recognized five main RF trajectories based on serum creatinine and estimated glomerular filtration rate (eGFR) behaviour: according to the RF curve our sample was divided into 1-stable (S), 2-transient improvement (TI), 3-permanent improvement (PI), 4-transient worsening (TW), and 5-persistent worsening (PW). The primary outcome was the combined endpoint of 180 days including all causes of mortality and re-hospitalization. We recruited 467 subjects with a mean congestion score of 3.5 ± 1.08 and a median creatinine value of 1.28 (1.00–1.70) mg/dl, eGFR 50 (37–65) ml/min/m2, and NTpro BNP 7000 (4200–11 700) pg/ml. A univariate analysis of the RF pattern demonstrated that TI and PW patterns were significantly related to poor prognosis [HR: 2.71 (1.81–4.05); P < 0.001; HR: 1.68 (1.15–2.45); P = 0.007, respectively]. Conversely, the TW pattern showed a significantly protective effect on outcome [HR: 0.34 (0.19–0.60); P < 0.001]. Persistence of congestion and BNP reduction ≥ 30% were significantly related to clinical outcome at univariate analysis [HR: 2.41 (1.81–3.21); P < 0.001 and HR: 0.47 (0.35–0.67); P < 0.001]. A multivariable analysis confirmed the independently prognostic role of TI, PW patterns, persistence of congestion and reduced BNP decrease at discharge. Conclusions Various RF patterns during AHF hospitalization are associated with different risk(s). PW and TI appear to be the two trajectories related to worse outcome. Current findings confirm the importance of RF evaluation during and after hospitalization.

Application of law vs «improvement of legislation» (some considerations on current legal practice)

Relevant problems of the practice of application of law and permanent process of improvement of the Ukrainian legislation are examined in this article. In particular authors stress on contradiction between process of the permanent improvement of the legislation and sustainability, predictability and legal certainty as principles of legal system. On the one hand, constant reforming of the legislation of Ukraine does not give possibility for subjects of law to create stable legal relations, which are regulated in a predictable way. On the other hand, legislation of Ukraine must be actual and even few “step ahead” the actual situation in Ukraine. It must give necessary methods, tools and legal instruments, which regulate relations between subjects of law. Described judicial and notarial practical cases show in what way flexibility of the legislation could be provided in conditions of the ongoing changes. Authors consider that qualified and high-quality application of the current legislation by the subjects of application of law gives possibility to provide flexibility of the legislation. Such application of law is done by subjects applying the law, although their actions are not directly provided for by the legislation, but they are not prohibited either. Essential principle of such application of law must be the whole tendency to create those legal consequences of the application of law which will not lead to the direct infringement of somebodies rights and interests within the process of application of law. Illustrated lawsuit and case of notarial practice show how exactly interpretative mechanism and analogy as a tool of the subject applying the law help to avoid infringements of rights and interests of heirs of the deceased person. Keywords: application of law, improvement of the legislation, notary, judge, court and notarial practice.

Ultrasound of the hand in systemic sclerosis

Systemic sclerosis is a chronic connective tissue disease characterized by multi-organ involvement but the main clinical changes occur in the hands, secondary to skin, joint and microvascular damage. Therefore the hand received a special attention for imaging and especially for ultrasound evaluation. In rheumatology US become an extension of the clinical examination and particularly in systemic sclerosis it has been proven to help with a better assessment of the skin, blood vessels, joints and tendons involvement. This evolution was allowed by permanent improvement of technology along with expanding the range of ultrasound applications which happened especially in past decade.

Priority problems of the work of Ukrainian customs authorities in the terms of European and Euro-Atlantic integration

Today, more and more companies focus on problems in customs clearance of products crossing the border during the implementation of export-import activities. In the context of European and Euro- Atlantic integration, which promote the accession of Ukrainian enterprises to the single European market, one of the priority tasks is the urgent solution of existing problems in the customs sphere. After all, one of the integral stages of Ukraine’s economic integration into the European Union is the successful accession of customs authorities to the Customs Union through harmonization of customs procedures with European norms, introduction of common customs principles and permanent improvement of customs activities on the basis of progressive customs instruments. The results of the survey of domestic exporters and importers that was conducted by the Institute for Economic Research and Policy Consulting indicated the following key problems in the work of Ukrainian customs authorities: insufficient quality of customs legislation; low level of transparency and openness of customs authorities; corruption and bribery among customs officers; intentional overstatement of the customs value of goods; low level of quality of technical support of customs authorities; low level of qualification of customs officers; frequent changes in the organizational management structure of customs authorities and their management; burdensome fiscal function of customs authorities. The identified problems in the work of customs authorities of Ukraine in the context of European and Euro-Atlantic integration made it possible to identify priority directions for improving customs procedures: increasing efficiency, transparency and non-discrimination of customs procedures for export-import operations, reducing the cost of customs clearance for export-import, absolute harmonization of domestic customs legislation with European norms, unification of customs procedures with European customs practices in export-import operations, reduction of bureaucracy of customs procedures in export-import operations, optimization of customs payments in export-import operations, etc. The implementation of these directions of improvement of customs procedures in the export-import operations should take place with the use of specific urgent customs instruments, which will promptly solve the existing urgent problems in the work of customs authorities.

Phosphorus in the shallow, urban lake subjected to restoration - case study of Lake Domowe Duże in Szczytno

The paper presents the results of the research on the restoration of the shallow Lake Domowe Duże in Szczytno (area 0.6 km2, average depth 3.4m). Restoration treatments were carried out in the years 2010-2012 and consisted in the inactivation of phosphorus using polyaluminium chloride. Technical restoration was supported by biomanipulation treatments consisting in stocking the lake with predatory fish. Water quality study were carried out before remediation and annually for a decade (2010-2019) during and after the application of coagulant. It was shown that the efficiency of removing excess phosphorus from water column was high (decrease from 0.23 mgP L-1 to 0.05 mgP L-1). The effects achieved during the coagulant application were maintained for 5 years after the end of the project. Currently, the phosphorus pool is still twice as low as before the treatments, but it is gradually increasing. The main external factor limiting permanent improvement of water quality is the open hydrological system and transport of biogenic matter by surface inflows draining anthropogenically transformed areas. Maintaining permanent improvement of water quality will require continuation of restoration measures.

EMP absolute and variable characteristics

English for Specific Purpose appeared due to an urgent demand for an international language worldwide in the fields of Business, Trading, Medicine, Law, Tourism and since the increasing awareness of General English Curriculum does not fit the learners’ specific needs, especially in higher education. Designing an ESP course is a never – ending process which requires permanent improvement and changing in the syllabus, design and ESP teaching materials used within classrooms. The aim of this study was to analyze the challenges that arise in teaching English for Medical Students by examining the ESP absolute and variable characteristics. Some practical suggestions are also given in order to overcome these problems.

Physical Drivers and Dominant Oceanographic Processes on the Uruguayan Margin (Southwestern Atlantic): A Review and a Conceptual Model

The Uruguayan continental margin (UCM), located in the Southwestern Atlantic margin’s subtropical region, is positioned in a critical transitional region regarding the global ocean circulation (Río de la Plata (RdlP) outflow and Brazil-Malvinas Confluence), as also reflected in seafloor features (northernmost distribution of a large depositional contourite system and RdlP paleovalley). This complex oceanographic scenario occurring in a relatively small area highlights the advantage of considering the UCM as a natural laboratory for oceanographic research. The present work provides the first conceptual “control” model of the physical drivers (i.e., climate, geomorphology) and main oceanographic processes (i.e., hydrodynamics, sediment, and carbon dynamics) occurring along the UCM, reviewing and synthesizing available relevant information based on a functional integrated approach. Despite the conspicuous knowledge gaps on critical processes, a general picture of the system’s functioning is emerging for this complex biophysical setting. This includes conceptualizations of the actual controls, main processes, feedbacks, and interactions responsible for system dynamics. The structure adopted for developing our conceptual models allows permanent improvement by empirical testing of the working hypothesis and incorporating new information as scientific knowledge advances. These models can be used as a baseline for developing quantitative models and, as representations of relatively “pristine” conditions, for stressors models by identifying sources of stress and ecological responses of key system attributes under a transboundary approach.

PRIMARY HYPERPARATHYROIDISM ACCOMPANIED BY RECOVERY OF PARATHYROID BLOOD FLOW THREE MONTHS AFTER SPONTANEOUS PARATHYROID HEMORRHAGE

Objective: The objective of this report was to describe an unusual case of emerging primary hyperparathyroidism (PHPT) accompanied by recovery of parathyroid blood flow 3 months after spontaneous parathyroid hemorrhage. Methods: Neck images and laboratory tests including serum calcium and parathyroid hormone (PTH) were performed to evaluate parathyroid hemorrhage. Pathologic findings after parathyroidectomy are also presented. Results: A 58-year-old woman developed acute onset of neck pain and swelling with ecchymosis. Computed tomography showed a right paratracheal hematoma-like lesion behind the thyroid. Ultrasound (US) of the neck revealed a round, hypoechoic nodule measuring 27 × 25 × 18 mm in the right lower thyroid pole without vascular flow. Blood tests showed a corrected calcium of 9.3 mg/dL (normal, 8.7 to 10.3 mg/dL), and intact PTH of 68 pg/mL (normal, 10 to 65 pg/mL). Intact PTH measurement in fine-needle aspirate of the lesion was 339 pg/mL, confirming parathyroid origin. Repeat US after 3 months showed a remarkable decrease in lesion size with significant blood flow. Blood biochemistry showed a corrected calcium of 10.9 mg/dL, and an intact PTH of 237 pg/mL. She eventually underwent parathyroidectomy, and pathologic examination revealed parathyroid adenoma with a tiny thrombus. Conclusion: Spontaneous remission of PHPT after parathyroid hemorrhage has been known to occur sporadically, a phenomenon referred to as autoparathyroidectomy. Although spontaneous remission with permanent improvement of PHPT may be observed, PHPT can recur in the relative short term after parathyroid hemorrhage, and so follow-up blood biochemistry surveillance is necessary. Also, evaluating parathyroid blood flow using color Doppler US might be useful in verifying the recurrence of PHPT.

2. Choosing the Teaching Career by Students in the Arts

In order to build strategies for the permanent improvement of the educational offer in higher education institutions, taking into account the expectations of the beneficiaries can be an important direction to consider. Thus, the present study aims to radiograph the reasons why the students of the National University of Arts “George Enescu” in Iași (UNAGE) also choose a training trajectory for the route of the teaching career. To achieve this objective, we used in our research the linguistically adapted questionnaire “Orientations for Teaching Survey - OTS” (Ferrell, C.M., Daniel, L.G, 1993), which was answered by 140 UNAGE students. The hypothesis that the reasons why these students prepare to become teachers are intrinsic, extrinsic and altruistic was confirmed by statistical analyzes.