OBJECTIVES: This clinical trial aimed to compare the ultrasound-guided in-plane infraclavicular cannulation of the axillary vein (AXV) and the ultrasound-guided out-of-plane cannulation of the internal jugular vein (IJV). DESIGN: A prospective, single-blinded, open label, parallel-group, randomized trial. SETTING: Two university-affiliated ICUs in Poland (Opole and Lublin). PATIENTS: Mechanically ventilated intensive care patients with clinical indications for central venous line placement. INTERVENTIONS: Patients were randomly assigned into two groups: the IJV group (n = 304) and AXV group (n = 306). The primary outcome was to compare the IJV group and AXV group through the venipuncture and catheterization success rates. Secondary outcomes were catheter tip malposition and early mechanical complication rates. All catheterizations were performed by advanced residents and consultants in anesthesiology and intensive care. MEASUREMENTS AND MAIN RESULTS: The IJV puncture rate was 100%, and the AXV was 99.7% (chi-square, p = 0.19). The catheterization success rate in the IJV group was 98.7% and 96.7% in the AXV group (chi-square, p = 0.11). The catheter tip malposition rate was 9.9% in the IJV group and 10.1% in the AXV group (chi-square, p = 0.67). The early mechanical complication rate in the IJV group was 3% (common carotid artery puncture—4 cases, perivascular hematoma—2 cases, vertebral artery puncture—1 case, pneumothorax—1 case) and 2.6% in the AXV group (axillary artery puncture—4 cases, perivascular hematoma—4 cases) (chi-square, p = 0.79). CONCLUSIONS: No difference was found between the real-time ultrasound-guided out-of-plane cannulation of the IJV and the infraclavicular real-time ultrasound-guided in-plane cannulation of the AXV. Both techniques are equally efficient and safe in mechanically ventilated critically ill patients.

Background: A high-volume center with a multidisciplinary team is regarded as the optimal place for providing extracorporeal membrane oxygenation (ECMO). We hypothesize that an ECMO center can also be successfully created and subsequently developed entirely by intensivists in a mid-size mixed intensive care unit (ICU). Methods: A model was created for setting up a new ECMO referral center within the structure of an existing mixed ICU in a tertiary hospital. A retrospective analysis was carried out of the first 33 patients treated in the initial period of the center’s activity, from mid 2018 to the end of 2020. Results: An ECMO center was established and developed entirely based on the resources of an existing mixed ICU. Thirty-three patients were treated. They had an overall survival rate at 90 days of 60.6%. In veno-venous (VV) mode ECMO duration, ICU length of stay, and SOFA score were significantly higher than in veno-arterial mode. No significant differences in clinical characteristics were observed between survivors and non-survivors on VV-ECMO. Conclusions: A regional ECMO center can be set up as an integral part of a mixed ICU in a tertiary hospital. Extracorporeal therapy, such as continuous renal replacement therapy and mechanical ventilation can be managed entirely by intensivists. Further studies are needed to show that the ICU-based approach to setting up a new ECMO center is no less effective than the multidisciplinary approach.

We would like to present a case of a young male patient with fulminant myocarditis and multi-organ failure treated in our intensive care unit. In the early phase of the treatment, we simultaneously applied mechanical circulatory support (MCS) devices, including veno-arterial extracorporeal membrane oxygenation (ECMO). The use of short-term MCS devices in fulminant myocarditis and in other forms of severe heart failure has increased in recent years [1]. The results of some clinical trials indicate that this mode of treatment, when applied in the early phase of cardiogenic shock, yields promising final results [2,3].A 27-year old, previously healthy man was admitted to the Emergency Department with dyspnea, chest pain, and arterial hypotension. He had been suffering from flu-like syndrome for a week prior to admission. Upon hospital arrival, his mean arterial pressure was 50 mm Hg, and the heart rate was 120 beats per minute. Transthoracic echocardiogram (TTE) revealed severe dysfunction of both ventricles with 15% left ventricular (LV) ejection fraction (EF), 8 cm s -1 velocity-time integral of the left ventricle outflow track (LVOT VTI), and 12 mm tricuspid annular plane systolic excursion (TAPSE). Laboratory tests showed troponin above

Introduction: Type 2 diabetes (T2DM) is a common complex metabolic disorder that has a strong genetic predisposition. Fat mass and obesity-associated protein (FTO) is one of the genes of interest to us. Hypomethylation of a CpG site in the FTO gene was significantly associated with the risk of T2DM. The aim of the study was to find the answer to the question of whether the polymorphism changes of the FTO gene in the pathogenesis of type 2 diabetes are comparable in young, middle aged, and elderly people. Material and methods: The study involved 282 consecutive patients with type 2 diabetes, who attended a primary healthcare clinic in Southern Poland. The study subjects were divided into three groups according to the age at which type 2 diabetes mellitus was diagnosed (> 40 years old, 40-60 years old, and > 60 years old). The genotyping of rs9939609, rs1421085, and rs9930506 FTO polymorphisms was conducted using TaqManPre-designed SNP Genotyping Assay. Results: No statistically significant difference was shown between the examined FTO polymorphism (rs9939609, rs1421085, and rs9930506) distribution between the subjects diagnosed with diabetes < 40 years , 40-60 years, and > 60 years old. Conclusions: There were no statistically significant relationships between the different analysed anthropometric and other parameters and distribution of examined FTO polymorphisms (rs9939609 , rs1421085, and rs9930506). The age of diabetes was not affect by the tested FTO polymorphisms (rs9939609 , rs1421085, and rs9930506).

Introduction: Elevated serum parathormone (PTH) levels have been observed in acute kidney injury and are related to calcium-phosphate metabolism disturbance, decreased renal production of 1,25 dihydroxyvitamin D3, impaired renal PTH excretion, and other renalindependent factors. There are no data regarding PTH concentration kinetics in critically ill patients undergoing continuous renal replacement therapies (CRRT) in an intensive care setting. The primary objective of this study was to investigate trends in PTH serum levels in critically ill patients with multiorgan failure undergoing CRRT, by performing periodic PTH measurements in the acute phase of critical illness. Material and methods:This was a single-centre, prospective, observational study conducted in an mixed, university-affiliated intensive care unit. Critically ill patients who fulfilled all of the following criteria were included: respiratory failure; circulatory failure; acute kidney injury treated by CRRT; and sequential organ failure assessment score (SOFA score) of 5 or more.Patients who met any of the following criteria were excluded: acute liver failure; hypercalcemia at admission (total calcium serum level > 10.6 mg/dL; total ionized calcium plasma level > 1.35 mmol/L); parathyroid gland disease; end-stage renal disease; patients undergoing therapeutic plasma exchange or extracorporeal membrane oxygenation procedures; aged under 18 years; pregnant; and life expectancy after admission to the intensive care unit anticipated to be less than 72 hours as assessed by the investigator.Results: Thirty patients met the inclusion criteria. A statistically significant change in PTH over time was observed (Friedman ANOVA; p = 0.0001). The post-hoc test showed a statistically significant decrease in PTH: measurements 5-8 relative to measurement 1, and measurements 4-8 relative to measurement 2 (p < 0.05). No significant correlations between 25 hydroxyvitamin D3 deficiency, age, diagnosis, SOFA score, and PTH levels were observed.A statistical test indicated that serum concentrations of PTH were significantly higher in the de novo sepsis group (p < 0.05). Conclusions:The PTH serum concentration decreases during the course of CRRT in the majority of patients. When the course of the disease starts to be complicated by sepsis, PTH serum levels then remain high. A probable reason for this is the existence of the inflammatory state triggered by sepsis.

Background. The continuously increasing incidence of type 2 diabetes mellitus (DMt2) is an important problem in current medicine. In addition to well-known environmental factors that may contribute to this disease, genetic factors may also play a role. One of the genes that may be responsible for an increased risk of DMt2 development is the transcription factor TCF7L2 gene. This work was aimed to assess a correlation between the rs7903146 polymorphism in the TCF7L2 gene and age at DMt2 diagnosis, presence of obesity, arterial hypertension, and time elapsed from DMt2 diagnosis to the start of insulin therapy. Methods. An analysis of the studied polymorphism was performed in 282 patients diagnosed with DMt2. Patients were divided into groups depending on the age of the onset of DMt2: group A (n = 82)-DMt2 diagnosis below the age of 40 years, group B (n = 100)-DMt2 diagnosis between the ages of 40 and 60 years, group C (n = 100)-DMt2 diagnosis above the age of 60 years. Results. In group C, there was a significantly lower number of patients with a TT genotype of the studied polymorphism compared to the combined group A + B (P < 0.05). Conclusions. There is a correlation between the rs7903146 polymorphism in the TCF7L2 gene and age at DMt2 diagnosis. No correlation has been demonstrated between the studied polymorphism and the presence of obesity, arterial hypertension, and time elapsed from DMt2 diagnosis to the start of insulin therapy.

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