Mahle (Poland)

Abstract Background and Aims Peritoneal dialysis (PD) is one of well-established renal replacement therapy method and its usefulness is unquestionable. Despite this fact the number of patients treated with PD in Poland remains on the level about 4% of all patients treated with dialysis. There are several reasons of such low patients ratio e.g. late referral to dialysis, limited access to PD services as well as procedure description and public Payer requirements. The aim of analysis was peritoneal dialysis cost-effectiveness assessment compared with hemodialysis in patients starting chronic dialysis treatment and detailed comparison of both methods in terms of their cost-effectiveness for healthcare system. This study also assessed the impact of increasing the prevalence of peritoneal dialysis compared to hemodialysis on the Polish healthcare system. Method Assessment of cost-effectiveness of peritoneal dialysis versus hemodialysis was performed on cost-utility analysis basis, which result is incremental cost-utility ratio (ICUR) where the measure of health effect is quality-adjusted life years (QUALY). Health effect assessment was made on systematic review basis (studies comparing directly hemodialysis and peritoneal dialysis have been taken into consideration). Additionally one way sensitivity analysis was perform to check additional factors which may influence on ICUR. In budget impact analysis three scenarios have been taken into consideration – current status as base scenario and two additional scenarios with PD patients population growth in 5 years horizon (where the PD patient population will grow to 10% patients on dialysis in the fifth year) All calculations were performed according Polish Health Technology Assessment (HTA) regulations. Results The analysis showed that peritoneal dialysis is cost-effective compared to hemodialysis. The costs of an additional quality-adjusted life year obtained using PD instead of HD are lower than the applicable cost-effectiveness threshold (set, according to Polish HTA recommendation, at PLN 217,641). Peritoneal dialysis generates additional savings for the payer in selected cost categories like hospitalizations, costs of creating renal replacement access and costs related to deaths. Also peritoneal dialysis instead of hemodialysis is a treatment option with superior health benefits in terms of quality-adjusted survival. Results of one-way sensitivity analysis, conducted for the results of cost-utility and cost-consequence analysis indicate the possibility to get even better results (lower ICUR rate) than in the basic analysis. The main factor improving the results is PD patients better quality of life arising from possibility of home treatment and higher independence, less visits in hospital/dialysis center, lower dietary and fluid restrictions, possibility of professional of social activity at an unchanged level. Budget impact analysis shows that PD patients ratio increase (from 4% to 10% of dialyzed patients population) won't significantly influence on total healthcare system spendings for dialysis. In 5 years horizon this change will generate 0.7% growth of overall spending for dialysis. Conclusion According to analysis performed, peritoneal dialysis appears as cost effective treatment option from healthcare system perspective. The origin of low PD patient number lies in other limitations like regulatory barriers (procedure description and public payer requirements), low awareness of possible treatment option (low quality or lack of predialysis education) and late referral to dialysis. To increase PD patients population in Poland systemic changes are needed—incentive for the centers achieving specified PD ratio, obligation for predialysis education for all patients referred to renal replacement therapy, access facilitation for the patients unable to self-treatment (assisted PD with nurse or medical assistant).

Ornithine transcarbamylase (OTC) deficiency is the most common urea cycle disorder. It may occur due to various changes to the OTC gene located on the X chromosome. Many sequence variants in the OTC gene result in different severity and require different types of molecular testing. We present a familial case of hyperammonemia possibly caused by the small CNV (duplication) within exon 2 of the OTC gene that was not detected by standard sequencing methods. In this case, the knowledge of the underlying molecular changes to the gene results in an appropriate approach to future sibling screening. Collecting more data, especially regarding rare variants of genetic disorders, is essential as it will help to create the best diagnostic-therapeutic path in prenatal and neonatal care in the future. Early diagnosis and treatment can lead to a better prognosis, and this case emphasizes the importance of understanding genetic changes in OTC deficiency.

Abstract This paper presents the results of study on the possibility of Nocolok flux deposition to aluminium substrates using the low-pressure cold gas spraying (LPCS) method. An innovative method of applying flux in the form of a powder without organic adhesive additives was proposed, allowing strict control of the deposited material. The influence of the flux powder feeding rate (PFR – 4.5 g/min, 6.3 g/min and 8.5 g/min) on the efficiency of the brazing process of AA3003 aluminium alloy plates was investigated. The results of energy dispersive spectrometry (EDS) analysis of the deposited flux coatings are presented for various process parameters. The wettability tested by spreading the B-AlSi12 filler metal on flux-covered aluminium substrates increased significantly with increasing PFR – the contact angle decreased from 21.0° to 4.6°. Microstructure analysis confirmed the high quality of the brazed joints, which were devoid of braze incompatibilities.

The article performs an analysis of the durability of punches applied in the process of producing a valve forging from chromium-nickel steel. A forging of this type is made in two operations: coextrusion of a long shank, followed by finishing forging in closed dies of the valve head. The product obtained in this way (after other additional finishing procedures) constitutes the key element of the combustion engine (resistant to high pressures and temperatures) in motor trucks. Unfortunately, a significant problem in this production process is a relatively low durability of the forging tools, especially the punch used in the second forging operation. The key element at this stage, deciding about the punch’s further operation, is the area of the so-called “calotte”. The short-term life of the tools results from very hard performance conditions present during the forging process (periodical high mechanical and thermal loads, long path of friction). The latter cause intensive abrasive wear as well as high adhesion of the forging material to the tool surface. Based on the performed studies, including the following: technology analysis, numerical modelling, macro analyses combined with 3D scanning of tool sections as well as microstructural tests and hardness measurements, it was established that it is crucial to properly select the process parameters (charge and tool temperature, tribological conditions), as even slight changes introduced into them significantly affect the operation time of the forging tools. Mastering and proper implementation of the analyzed forging technology requires numerous further studies and tests, which will enable its perfection and thus increase the durability of the tools as well as the quality of the produced items.

PAWEŁ TWARDOWSKI