Stefan Grajek

Poznan University of Medical Sciences, Posen, Greater Poland Voivodeship, Poland

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Publications (224)388.18 Total impact

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    Kardiologia polska 01/2015; 73(2). DOI:10.5603/KP.2015.0021 · 0.52 Impact Factor
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    ABSTRACT: Interleukin-6 (IL-6) is an inflammatory cytokine whose levels increase significantly during myocardial infarction (MI). It has been hypothesised that the concentrations of IL-6 at admission may be useful in prognosticating long-term outcomes. It is unclear, however, whether IL-6 could improve the prognosis of early mortality in MI. We have compared serum IL-6 levels and analysed the disease course in 158 patients with ST-elevation MI (STEMI) who either survived (n = 148) or died (n = 10) within 30 days following the admission. Patients were treated in a single university centre with primary percutaneous coronary intervention (PCI). The non-survivors (6.3%) displayed most of typical risk factors for poor outcome. In addition they had significantly higher concentrations of IL-6 at hospital admission (median values 8.5 vs. 2.0 pg/ml; p = 0.038). However, they were also significantly older than the survivors (median values 72 vs. 57 years; p = 0.0001). IL-6 levels are known to increase with age and we could confirm a significant correlation between patients' calendar age and circulating IL-6 (p = 0.009). Regression analysis revealed that IL-6 concentrations were significantly affected by patients' age but they did not independently relate to patients' outcome. Such results indicate that circulating IL-6 at admission may be of limited value in predicting early mortality in STEMI. It is important to recognize that, because of the small group of patients who died (N = 10), the results must be interpreted with caution. Therefore, we stress that these results should be viewed as preliminary and further validated in a larger set of patients.
    Immunity & Ageing 12/2014; 11(1):23. DOI:10.1186/s12979-014-0023-7 · 2.32 Impact Factor
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    ABSTRACT: Indications for sudden cardiac death (SCD) primary prevention are unknown in patients with repaired tetralogy of Fallot (ToF). The role of microvolt T-wave alternans (MTWA) in SCD risk stratification was documented. However, the prevalence of spectral MTWA and its association with ventricular arrhythmia (VA) in adults after ToF repair were not elucidated. Microvolt T-wave alternans, electrocardiogram (ECG), ambulatory ECG monitoring, echocardiography, and spiroergometry were evaluated in 102 adults after ToF repair. Microvolt T-wave alternans results were classified as normal: negative(-), abnormal: positive(+), and indeterminate(ind). Owing to similar prognostic significance, MTWA(+) and MTWA(ind) due to patient factors were combined into nonnegative group: MTWA(abnormal). Microvolt T-wave alternans(abnormal) was more frequent in the studied group as compared with controls (P = .0005). The MTWA(abnormal) group had greater right ventricular end-diastolic diameter (P = .005), higher incidence of pulmonary regurgitation (P = .015), lower peak oxygen consumption (P = .01), and higher VE/VCO2 slope (P = .04) in comparison with MTWA(normal). Univariate logistic regression proved pulmonary regurgitation (OR = 3.57, 95% CI 1.27-10.04), VA (OR = 3.26, 95% CI 1.06-10.05), right ventricular end-diastolic enlargement (OR = 1.11, 95% CI 1.03-1.2), increase in VE/VCO2 slope (OR = 1.08, 95% CI 1.01-1.17), and decrease in peak oxygen uptake (OR = .91, 95% CI 0.83-0.99) to increase MTWA(abnormal) prevalence. In adults after ToF repair, abnormal MTWA occurred more often than in controls. Probability of abnormal MTWA did not rise with prevalence of malignant VA; however, presence of abnormal MTWA was associated with VA risk factors: pulmonary regurgitation, right ventricular enlargement, and consequent heart failure. The role of MTWA in selecting patients late after ToF repair at risk of SCD needs further observation. © 2014 Wiley Periodicals, Inc.
    Congenital Heart Disease 11/2014; DOI:10.1111/chd.12240 · 1.01 Impact Factor
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    ABSTRACT: Objectives: Postconditioning has been reported to reduce infarct size in ST-segment myocardial infarction (STEMI). However, recently, few other studies did not show any effect of postconditioning and suggested that it may be even harmful. We sought to assess whether postconditioning could reduce infarct size and improve myocardial reperfusion in early presenters with STEMI. Methods: 72 STEMI patients treated with primary percutaneous coronary intervention (PCI) were randomly assigned to either the postconditioning (n = 35) or the standard PCI group (control group; n = 37). Blood samples were obtained for creatine kinase (CK) and its MB isoform (CK-MB) within 36 h. The angiographic (myocardial blush grade, MBG) and electrocardiographic (ST-segment resolution, STR) data were evaluated and compared between groups. Results: The areas under the curve of CK and CK-MB release were significantly reduced in the postconditioning group compared with the control group (38,612.91 ± 25,028.42 vs. 60,547.30 ± 25,264.63 for CK and 5,498.23 ± 3,787.91 vs. 7,443.12 ± 3,561.13 for CK-MB, p < 0.0001). MBG was significantly better in the postconditioning group than in the control group (MBG 3: 82.3 vs. 47.1%, p = 0.0023). In the postconditioning group, STR >70% was more often observed (97.1 vs. 64.1%, p = 0.0007). Conclusions: In patients with STEMI, postconditioning could significantly reduce enzymatic infarct size and improve myocardial reperfusion. © 2014 S. Karger AG, Basel.
    Cardiology 11/2014; 129(4):250-257. DOI:10.1159/000367965 · 2.04 Impact Factor
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    ABSTRACT: Transcatheter aortic valve implantation (TAVI) is nowadays an accepted method of treatment for the patients with symptomatic severe aortic stenosis who are inoperable or at very high risk of classic surgical aortic valve replacement. The Lotus Valve System is a new generation TAVI device composed of self-expanding stent prosthesis with implemented bovine pericardial leaflets, which is designed to facilitate repositiong, resheating and retrieval even in fully expanded and functioning position before the final release. In addition the Lotus valve is surrounded by flexible membrane to seal paravalvular gaps between the prosthesis and native valve. We present the first polish experiences with the Lotus Valve System. Due to its unique features the Lotus valve may improve the prognosis in patients with inoperable or high risk critical aortic stenosis.
    Kardiologia polska 10/2014; DOI:10.5603/KP.a2014.0191 · 0.52 Impact Factor
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    ABSTRACT: While the cutoffs of predictive value for ST-segment elevations resolution (STSR) following thrombolysis and/or primary PCI were well documented, the impact of pre-angiography STSR has not been established yet.
    European Journal of Internal Medicine 09/2014; DOI:10.1016/j.ejim.2014.08.007 · 2.30 Impact Factor
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    ABSTRACT: Cardiac pseudoneoplasms are rare and benign. According to World Health Organization, they are classified as tumor-like lesions. We report two patients with recurrent ventricular tachycardia (VT) in whom magnetic resonance imaging revealed a pathological mass occupying a large part of the left ventricle. The localization of both tumors precluded the possibility of resection; thus, only surgical biopsy was performed. After deducting the prospect of malignancy of the tumors, we treated both patients with amiodarone and implantation of a cardioverter–defibrillator [implanted cardioverter/defibrillator (ICD)]. VT is one of many probable symptoms indicating a tumor within the heart; therefore, treatment with an ICD should only be considered after a more thorough diagnosis.
    Cardiovascular Pathology 08/2014; 23(2014):372–375. DOI:10.1016/j.carpath.2014.07.009 · 2.34 Impact Factor
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    ABSTRACT: The aim of this study was to determine the prognostic significance of interleukin 6 (IL-6) and vascular endothelial growth factor (VEGF) in patients with chronic coronary artery disease treated who underwent percutaneous coronary intervention with stent implantation, for assessing the risk of restenosis and the occurrence of de novo lesions.
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    ABSTRACT: Histamine is a mediator, which increases the permeability of capillaries during the early phase of allergic reaction, causes smooth muscle contraction of bronchi and stimulates mucous glands in the nasal cavity. Antihistamines are the basis of symptomatic treatment in the majority of allergic diseases, especially allergic rhinitis, allergic conjunctivitis, urticaria and anaphylaxis. The cardiotoxic effects of the two withdrawn drugs, terfenadine and astemizole, were manifested by prolonged QT intervals and triggering torsades de pointes (TdP) caused by blockade of the 'rapid' I Kr potassium channels. These phenomena, however, are not a class effect. This review deals with a new generation of antihistamine drugs in the context of QT interval prolongation risk.
    Postepy Dermatologii I Alergologii 06/2014; 31(3):182. DOI:10.5114/pdia.2014.43191 · 0.66 Impact Factor
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    ABSTRACT: Remodeling and impaired blood flow in left atrial appendage (LAA), which occurs in patients with atrial fibrillation, may lead to thrombus formation and possible thromboembolic complications. Although there are several pharmacological antithrombotic possibilities, some patients with several co-morbidities and contraindications to such treatment cannot be offered any of them - LAA closure systems may be an attractive alternative. We present our early experience with two currently available different LAA transcatheter closure systems (Watchman and Amplatzer Cardiac Plug). Twenty three patients (mean age 69,1±6,8 years, 12 male) with nonrheumatic atrial fibrillation and high risk of thromboembolic complications (CHA2DS2VASc score ≥ 2 (mean 4,5±1,5), who could not be treated with the longterm oral anticoagulation because of contraindications or significant side effects, were qualified to the LAA closure. The Amplatzer Cardiac Plug (St Jude Medical) was implanted in 7 patients and Watchman Occluder (Boston Scientific, Boston, MA) in the other 15 patients. The implantation was not performed in one patient as the transoesophageal echocardiography during the procedure revealed a new thrombus in LAA. The procedural details and followup data are presented. Neither severe pericardial effusion nor device related thrombus were observed. In long term follow-up transient ischemic attack was noted only in one patient (diagnosed with thrombophilia). One patient died 14 months after the procedure due to non-cardiac reason. The LAA occluder implantation seems to be a safe and reasonable alternative for oral anticoagulation and should be considered in patients with atrial fibrillation who have contraindications or complications of pharmacological treatment.
    04/2014;
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    ABSTRACT: Antiplatelet drugs play a crucial role in the treatment of patients with myocardial infarction, particularly in association with percutaneous coronary intervention. Their main advantage is the reduction of adverse ischemic incidents and the major disadvantage is the increase in the frequency of hemorrhages. Thus, the choice of appropriate drug depends on the right risk assessment of the development of these complications in individual patients. The aim of this article is to provide an update of antiplatelet therapy in emergency myocardial infarction treatment. Currently, the most important role in the process of platelet inhibition is played by ADP P2Y12 blockers: clopidogrel, prasugrel and ticagrelor. Clopidogrel and prasugrel belong to thienopyridines, and ticagrelor, a drug of irreversible action, is an analogue of adenosine triphosphate. By 2011 clopidogrel, alongside aspirin, had the highest recommendations of world cardiology associations for acute coronary syndrome treatment. The position on clopidogrel was changed following the publication of European Society of Cardiology guidelines for STEMI in 2012 which advocate the administration of acetylsalicylic acid (ASA) and ADP receptor blocker (in combination with ASA). It needs to be stressed that prasugrel and ticagrelor received class IB recommendation, while clopidogrel received only IC. However, the most recent studies aimed at introducing a new generation of antiplatelet drugs of high efficacy in prevention of ischemic incidents and of reversible action: cangrelor and elinogrel, which raise hopes for better prognosis for myocardial infarction patients.
    Postepy w Kardiologii Interwencyjnej / Advances in Interventional Cardiology 03/2014; 10(1):32-39. DOI:10.5114/pwki.2014.41466 · 0.07 Impact Factor
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    ABSTRACT: Abstract Due to expansion of the pharmaceutical market it seems necessary to prove the efficacy of the generic drugs. The aim of this study is to compare the effects of two clopidogrel formulations: brand-name-Plavix and generic drug - Egitromb. This is a prospective, randomized study comparing two groups of patients treated with two clopidogrel: brand-name Plavix and generic drug- Egitromb. The 53 consecutive patients with stable coronary artery disease qualifying for coronary angiography and PCI were enrolled in this trial. They were randomized into two groups. In the group A (n = 28) patients received Egitromb 300 mg at admission followed by 8 days of 75 mg Egitromb daily. In the group B (n = 25) patients received Plavix 300 mg on the admission followed by 8 days of 75 mg Plavix maintenance therapy. Blood samples for multiple electrode aggregometry testing were drawn at baseline, 5 hours and 8 days after taking the loading dose. Median values of platelet aggregation inhibition did not differ between the Plavix and Egitromb groups when assessed at baseline: 239AU/min (IQR:329) vs. 209 (IQR:406; p = 0.894), 5 hours after loading: 183 AU/min (IQR:107) vs. 165 (IQR:171; p = 0.831) or at day 8: 174 AU/min (IQR:133) vs. 211 (IQR:133; p = 0.332. The study showed no difference in the therapeutic effect of two clopidogrel formulations (Egitromb and Plavix).
    Platelets 02/2014; DOI:10.3109/09537104.2013.877581 · 2.63 Impact Factor
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    ABSTRACT: Background Sildenafil, a phosphodiesterase-5 inhibitor, has been shown to decrease pulmonary vascular resistance (PVR) in patients with heart failure. The purpose of the study was to evaluate the effect of sildenafil on clinical status and pulmonary vascular reactivity in patients with congestive heart failure. Material and Methods We enrolled 20 patients (18 men and 2 women, mean age 51±12 years, diagnosed with congestive heart failure and pulmonary hypertension. This was a prospective, single-center study. Patients were treated with sildenafil 25 mg TDS for 12 months. Protocol included NYHA evaluation and repeated echocardiography, cardiac pulmonary stress tests, and right- sided catheterization. Results Initially, there were 16 (80%) patients in III NYHA status and 4 (20%) patients in II NYHA. After 12 months, 8 patients were in NYHA III (40%) status and 12 patients in NYHA II (60%). Peak oxygen consumption increased from 12±3 ml/kg/min to 19±4 ml/kg/min after 1-year therapy (p<0.001). The cardiac index increased from 3.1±0.6 L/min/m2 to 3.6±0.4 L/min/m2 (p<0.05). Pulmonary vasculature resistance decreased after 1-year therapy (4.7±1 vs. 1.6±0.5 Woods units (p<0.005) comparing to initials. Mean pulmonary artery pressure decreased to 23±6 mmHg from 42±5 mmHg (p<0.001) after 1-year therapy. Conclusions One-year sildenafil therapy effectively improved clinical status and pulmonary vascular resistance in patients diagnosed with congestive heart failure.
    Annals of transplantation: quarterly of the Polish Transplantation Society 01/2014; 19:325-30. DOI:10.12659/AOT.890657 · 1.43 Impact Factor
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    ABSTRACT: Background Diagnosis of rejection is a major objective in the management of heart transplant recipients. It has been reported that one-third of protocol biopsies in asymptomatic, biochemically stable organ transplant recipients in the first 6 months show unsuspected subclinical graft rejection. Case Report We present the case of a 43-year-old man suffering from dilated cardiomyopathy who underwent orthotropic heart transplantation. The patient was admitted for a protocol endomyocardial biopsy and magnetic resonance imaging (MRI) on the 4th postoperative month as a protocol procedure. The examination revealed clinical status NYHA I with no signs of fatigue, diminution of exercise tolerance, or shortness of breath. His body temperature was not raised. He was referred for endomyocardial biopsy and cardiovascular magnetic resonance (CMR) imaging. CMR imaging showed good left and right ventricle function and contractility. T2 imaging revealed increased signal in the area of the right ventricular free wall, seen both in 4-chamber and short axis views. The patient underwent an endomyocardial biopsy, which demonstrated diffuse infiltrate with multifocal miocyte damage and cellular edema recognized as acute rejection (3a ISHLT grade). Consequently, he was treated with parenteral methylprednisolone administration. The CMR study performed after 1 week of therapy showed that the signal intensity of the edematous areas was significantly decreased. Repetitive endomyocardial biopsy revealed no signs of rejection. Conclusions CMR can be helpful in graft monitoring following heart transplantation. It gives a whole-heart perspective that can be competitive with and/or complementary to endomyocardial biopsy. As a noninvasive study it can be applied more often and facilitates diagnosis of asymptomatic rejection episodes.
    Annals of transplantation: quarterly of the Polish Transplantation Society 01/2014; 19:447-51. DOI:10.12659/AOT.890906 · 1.43 Impact Factor
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    Kardiologia polska 01/2014; 72(9):847-53. DOI:10.5603/KP.2014.0182 · 0.52 Impact Factor
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    Kardiologia polska 01/2014; 72(7):657. DOI:10.5603/KP.2014.0139 · 0.52 Impact Factor
  • Kardiologia polska 01/2014; 72(4):387. DOI:10.5603/KP.2014.0077 · 0.52 Impact Factor
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    ABSTRACT: Background Although survival among heart recipients has increased, a limiting factor is chronic adverse effects of immunosuppression therapy. Material and Methods We performed a retrospective analysis of 22 patients (19 men and 3 women) with a mean age of 48±12 years who underwent orthotropic heart transplantation. There were 20 (91%) patients who received induction therapy (basiliximab, Simulect, Novartis Europharm Limited). All patients were treated with standard triple immunosuppressive regimen (tacrolimus, mycophenolate mofetil, and steroids). Results Patients were divided into 2 groups according to postoperative peripheral cytopenia diagnosis. There were 16 (73%) in the cytopenic group and 6 (27%) in the non-cytopenic group. Mean time of peripheral leucopenia detection was 65±13 days following surgery. The blood leucocyte count was 0.98±0.2×10^3/mm3 vs. 5.85±0.9×10^3/mm3 in patients with peripheral cytopenia compared to non-cytopenic patients (p<0.01). There was a statistically important difference in duration of intensive care unit stay between the 2 groups (p<0.01). A correlation between tacrolimus serum concentration and risk for leucopenia was also detected (p<0.05). Conclusions Basiliximab administration as induction therapy, tacrolimus serum concentration, and duration of intensive care unit stay are risk factors for leucopenia.
    Annals of transplantation: quarterly of the Polish Transplantation Society 01/2014; 19:494-8. DOI:10.12659/AOT.890816 · 1.43 Impact Factor
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    ABSTRACT: Sudden cardiac death mostly resulting from ventricular arrhythmia remains a cause of mortality in 19-30% of adults with congenital heart defects. Indications for implantable cardioverter-defibrillators in primary prophylaxis are still under research. Microvolt T wave alternans (MTWA) is one of the sudden cardiac death risk stratification methods. We determined the incidence of MTWA in these patients and its coincidence with ventricular arrhythmia as well as risk factors of ventricular arrhythmia/sudden cardiac death. 204 patients with complex congenital heart anomalies and 45 healthy volunteers underwent ambulatory ecg monitoring, a cardiopulmonary test, BNP assessment, echocardiography and an MTWA test. After excluding technically inadequate traces, the remaining 179 patients and 43 controls were classified into MTWA positive(+), negative(-) and indeterminate(ind) subgroups. Additionally, MTWA(+) and MTWA(ind) formed an 'abnormal' group, labeled. MTWA(non-). Results. Abnormal MTWA was observed more frequently in the study group compared to controls (59(33.0%)vs1(2.3%), p=0.000001). The MTWA(non-) group compared to MTWA(-) presented a higher number of males (61.0%vs37.5%, p=0.005), predominance of patients with NYHA>I (44.1%vs25.0%, p=0.007), pulmonary hypertension (16.9%vs0.8%, p=0.00007), lower blood saturation (97%(73-100)vs99%(69-100), p=0.0003), higher incidence of malignant arrhythmia (9(15.2%)vs(3(2.5%), p=0.003), lower peak oxygen consumption VO2(ml/kg/min) (23.1±5.9vs26.3±6.7, p=0.002), higher VE/VCO2slope (36.0(25-74)vs31.0(21-58), p=0.01). Multivariate logistic regression analysis proved that pulmonary hypertension (OR=13.7, p=0.03), male gender (OR=10.4, p=0.00002), VE/VCO2slope (OR=1.07, p=0.045) and VO2 (OR=0.89, p=0.04) increase the probability of MTWA(non-). Abnormal MTWA is more frequent in adults with congenital heart diseases than in the healthy population. Its probability increases in patients demonstrating clinical findings conducive to lethal arrhythmia like heart failure and pulmonary hypertension.
    Cardiology journal 10/2013; DOI:10.5603/CJ.a2013.0124 · 1.22 Impact Factor
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    ABSTRACT: Studies on the treatment of patients with an acute ST-segment elevation myocardial infarction (STEMI) with primary percutaneous coronary intervention (PCI) showed a high rate of aborted MI despite a relatively long delay from the onset of symptoms to reperfusion. To assess predictors of aborted MI in patients undergoing primary PCI. 310 STEMI patients referred for primary PCI within 12 hours of symptom onset were included into a prospective study. Relationships between incidence of aborted MI, clinical, electrocardiographic and angiographic factors were analyzed. Aborted MI was diagnosed in 29 patients (9.8%). Patients with aborted MI did not differ with respect to age (59.4±10.1 vs. 60.5±11.2 years; p=0.88), male sex (75.9% vs. 76.0%; p=0.83), hypertension (51.7% vs. 48.3%; p=0.87) or total ischemic time (215.9±104.6 vs. 241.9±134.3min; p=0.44) except for the frequency of diabetes mellitus (34.5% vs. 16.1%; p=0.02) when compared to group with true MI. TIMI flow ≥2 prior to PCI (86.2% vs. 27.7%; p<0.001), total ST-segment resolution (STSR), both pre-angiography (65.5% vs. 19.5%; p<0.001) and post-PCI (89.7% vs. 69.2%; p=0.018) and myocardial blush grade 3 (89.7% vs. 60.0%; p=0.001) were significantly more frequent in patients with aborted MI. A logistic regression model confirmed TIMI flow≥ 2 prior to PCI (OR 10.7 CI 3.1-37.8; p=0.0002), pre-angiography total STSR (OR 3.6 CI 1.2-10.5; p=0.02) and a history of previous diabetes mellitus (OR 8.6 CI 2.6-27.6; p=0.0003) as predictors of aborted MI. 1. Aborted MI was observed in 9.8% of STEMI patients undergoing PCI. 2. TIMI flow ≥2 and total STSR prior to PCI were identified as major angiographic and electrocardiographic predictors of aborted MI.
    Kardiologia polska 10/2013; 72(3). DOI:10.5603/KP.a2013.0250 · 0.52 Impact Factor

Publication Stats

644 Citations
388.18 Total Impact Points

Institutions

  • 1995–2015
    • Poznan University of Medical Sciences
      • • Department of Hypertension Angiology and Internal Medicine
      • • Department of Cardiology
      • • Clinic of of Cardiology I
      Posen, Greater Poland Voivodeship, Poland
  • 2009–2013
    • Uniwersytet Medyczny im.Karola Marcinkowskiego w Poznaniu
      Posen, Greater Poland Voivodeship, Poland
  • 2011
    • Medical University of Silesia in Katowice
      • Department of Cardiology
      Katowice, Silesian Voivodeship, Poland
  • 2006
    • Poznan University of Technology
      Posen, Greater Poland Voivodeship, Poland