bluuebunny/crossref_metadata_2025 huggingface dataset:
Pyoderma gangrenosum of the upper eyelid
Authors: Bromeo Albert John , Suller Armida
Published: July 2019

A 3-year-old woman presented with a large ulcerated lesion involving the left upper eyelid and left earlobe with erythematous, swollen, undermined and advancing borders. Culture of the ulcer showed no growth of organisms. Treatment with empiric intravenous and topical antibiotics showed no improvement. Workup revealed an elevated white blood cell count with elevated neutrophil count, elevated erythrocyte sedimentation rate and C reactive protein and positive antinuclear antibody. A skin biopsy showed a neutrophilic dermatitis with vasculitis. The patient was started on oral prednisone, which resulted in halting of the progression of ulceration and clinically decreased skin inflammation. The skin biopsy and positive response to corticosteroids confirmed the diagnosis of pyoderma gangrenosum. Pyoderma gangrenosum is a rare inflammatory skin condition and rarely presents as lesions of the eyelid. Early initiation of immunosuppressive therapy prevents disfigurement. Eyelid reconstruction in these cases may prove to be difficult.
The mediation effect of multiple gestations on the association between in vitro fertilisation and severe maternal morbidities: a retrospective cohort study
Authors: Tan Jing , Qi Ya-Na , Zhang Jing , Wang Wen , Zhang Gui-Ting , Zou Kang , Liu Xing-Hui , Sun Xin
Published: July 2019

Objective

To investigate whether the association between in vitro fertilisation (IVF) and severe maternal morbidity (SMM) was mediated by multiple gestations.

Design

A retrospective cohort study.

Setting

The study was conducted at six hospitals in China.

Participants

Pregnant women at 20 gestational weeks or longer.

Outcome measure

The outcome was SMM, which was a composite of potential life-threatening conditions, the use of critical medical interventions, or the status of maternal near-miss that occurred during pregnancy, childbirth or within 42 days of pregnancy termination, as defined by WHO.

Results

In total, 22 368 eligible pregnant women were included, among whom 497 (2.2%) received IVF, and 776 developed SMM (incidence 34.7/1000 live births, 95% CI 32.3/1000 to 37.1/1000). Four multivariable logistic regression models were constructed. Model 1, without including the variable of multiple gestations, showed that IVF was associated with higher risk of SMM (adjusted OR (aOR) 1.54, 95% CI 1.03 to 2.29). Model 2, assessing the association between IVF and multiple gestations, showed that IVF was strongly associated with multiple gestations (aOR 14.75, 95% CI 11.38 to 19.10). Model 3, by adding the variable of multiple gestations to model 1, showed that IVF was not statistically associated with SMM (aOR 0.89, 95% CI 0.58 to 1.36), but multiple gestations were associated with higher risk of SMM (aOR 5.92, 95% CI 4.88 to 7.83). Model 4, investigating the association between IVF and SMM among singleton pregnancies, showed no statistically significant association (aOR 0.70, 95% CI 0.37 to 1.32). An additional analysis by adding the interaction term of IVF by multiple gestations to model 3 showed no statistical significance of the interaction term (aOR 1.15, 95% CI 0.36 to 3.68), confirming the absence of exposure-mediator interaction.

Conclusions

Using the established rule for judging mediation effect, the results suggested that multiple gestations might mediate the association between the use of IVF and higher risk of SMM. Further prospective studies are warranted to test our finding.
Barriers to smoking cessation: a qualitative study from the perspective of primary care in Malaysia
Authors: Chean Kooi-Yau , Goh Lee Gan , Liew Kah-Weng , Tan Chia-Chia , Choi Xin-Ling , Tan Kean-Chye , Ooi Siew-Ting
Published: July 2019

Objectives

This qualitative study aims to construct a model of the barriers to smoking cessation in the primary care setting.

Design

Individual in-depth, semistructured interviews were audio-taped, then verbatim transcribed and translated when necessary. The data were first independently coded and then collectively discussed for emergent themes using the Straussian grounded theory method.

Participants and setting

Fifty-seven current smokers were recruited from a previous smoking related study carried out in a primary care setting in Malaysia. Current smokers with at least one failed quit attempts were included.

Results

A five-theme model emerged from this grounded theory method. (1) Personal and lifestyle factors: participants were unable to resist the temptation to smoke; (2) Nicotine addiction: withdrawal symptoms could not be overcome; (3) Social cultural norms: participants identified accepting cigarettes from friends as a token of friendship to be problematic; (4) Misconception: perception among smokers that ability to quit was solely based on one’s ability to achieve mind control, and perception that stopping smoking will harm the body and (5) Failed assisted smoking cessation: smoking cessation services were not felt to be user-friendly and were poorly understood. The themes were organised into five concentric circles based on time frame: those actionable in the short term (themes 1 and 2) and the long term (themes 3, 4, 5).

Conclusions

Five themes of specific beliefs and practices prevented smokers from quitting. Clinicians need to work on these barriers, which can be guided by the recommended time frames to help patients to succeed in smoking cessation.
Age at identification, prevalence and general health of children with autism: observational study of a whole country population
Authors: Rydzewska Ewelina , Hughes-McCormack Laura Anne , Gillberg Christopher , Henderson Angela , MacIntyre Cecilia , Rintoul Julie , Cooper Sally-Ann
Published: July 2019

Objectives

Reported childhood prevalence of autism varies considerably between studies and over time, and general health status has been little investigated. We aimed to investigate contemporary prevalence of reported autism by age, and general health status of children/young people with and without autism.

Design

Secondary analysis of Scotland’s Census, 2011 data. Cross-sectional study.

Setting

General population of Scotland.

Participants

All children (n=916 331) and young people (n=632 488) in Scotland.

Main outcome measures

Number (%) of children/young people reported to have autism and their general health status; prevalence of autism; prevalence of poor health (fair, bad and very bad health); odds ratios (95% confidence intervals) of autism predicting poor health, adjusted for age and gender and OR for age and gender in predicting poor health within the population with reported autism.

Results

Autism was reported for 17 348/916 331 (1.9%) children aged 0–15, and 7715/632 488 (1.2%) young people aged 16–24. The rate increased to age 11 in boys and age 10 in girls, reflecting age at diagnosis. Prevalence was 2.8% at age 10 (4.4% for boys; 1.1% for girls), and 2.9% at age 11 (4.5% for boys; 1.1% for girls). 22.0% of children and 25.5% of young people with autism reported poor health, compared with 2.0% and 4.4% without autism. Autism had OR=11.3 (11.0 to 11.7) in predicting poor health. Autistic females had poorer health than autistic males, OR=1.6 (1.5 to 1.8).

Conclusion

Accurate information on the proportion of autistic children and their health status is essential plan appropriate prevention and intervention measures and provide resources for those who may put demand on services designed for autistic people.
RAIN study: a protocol for a randomised controlled trial evaluating efficacy, safety and cost-effectiveness of intravenous-to-oral antibiotic switch therapy in neonates with a probable bacterial infection
Authors: Keij Fleur M , Kornelisse René F , Hartwig Nico G , Mauff Katya , Poley Marten J , Allegaert Karel , Reiss Irwin K M , Tramper-Stranders Gerdien A
Published: July 2019

Introduction

High morbidity and mortality rates of proven bacterial infection are the main reason for substantial use of intravenous antibiotics in neonates during the first week of life. In older children, intravenous-to-oral switch after 48 hours of intravenous therapy has been shown to have many advantages and is nowadays commonly practised. We, therefore, aim to evaluate the effectiveness, safety and cost-effectiveness of an early intravenous-to-oral switch in neonates with a probable bacterial infection.

Methods and analysis

We present a protocol for a multicentre randomised controlled trial assessing the non-inferiority of an early intravenous-to-oral antibiotic switch compared with a full course of intravenous antibiotics in neonates (0–28 days of age) with a probable bacterial infection. Five hundred and fifty patients will be recruited in 17 hospitals in the Netherlands. After 48 hours of intravenous treatment, they will be assigned to either continue with intravenous therapy for another 5 days (control) or switch to amoxicillin/clavulanic acid suspension (intervention). Both groups will be treated for a total of 7 days. The primary outcome will be bacterial (re)infection within 28 days after treatment completion. Secondary outcomes are the pharmacokinetic profile of oral amoxicillin/clavulanic acid, the impact on quality of life, cost-effectiveness, impact on microbiome development and additional yield of molecular techniques in diagnosis of probable bacterial infection.

Ethics and dissemination

This study has been approved by the Medical Ethics Committee of the Erasmus Medical Centre. Results will be presented in peer-reviewed journals and at international conferences.

Trial registration number

NCT03247920
BMI trajectories and risk factors among 2-11-year-old children by their immigrant status: evidence from the Longitudinal Study of Australian Children
Authors: Zulfiqar Tehzeeb , Burns Richard A , D’Este Catherine , Strazdins Lyndall
Published: July 2019

Objective

This study aimed to identify body mass index (BMI) trajectories and their predictors in Australian children by their maternal immigrant status.

Methods

Data on 4142 children aged 2–3 years were drawn from the birth cohort of the Longitudinal Study of Australian Children. BMI was calculated according to the International Obesity Task Force cut-off points. Immigrant status was determined by the Australian Bureau of Statistics and the United Nations Development Programme, Human Development Index criteria. Latent class growth analysis estimated distinct BMI trajectories, and multinomial logistic regression analysis examined factors associated with these BMI trajectories.

Results

Two BMI groups and six BMI trajectories were identified. The stable trajectories group included high-risk (10%, n=375), moderate-risk (5%, n=215) and low-risk (68%, n=2861) BMI trajectories. The changing trajectories group included delayed-risk (6%, n=234), gradual-risk (8%, n=314) and declining-risk (3%, n=143) BMI trajectories. We found some evidence that children of immigrants from low-and middle-income countries were more likely to have moderate-risk and high-risk BMI trajectories compared with low-risk BMI trajectory. However, these associations were insignificant in fully adjusted models. The explanatory risk factors for moderate-risk and high-risk BMI trajectory were birth weight, family socioeconomic position, and organised sports participation. Our results also suggest that 4–7 years of age may be important for the prevention of overweight/obesity in children.

Discussion

A better understanding of the risk factors associated with distinct BMI trajectories in immigrant children will inform effective preventive strategies. Some of these risk factors such as non-participation in organised sports, and high screen time, may also impede the integration of immigrant children into the host culture. Obesity prevention strategies aimed at increasing physical activities in immigrant children could help deliver a social and health benefit by increasing social integration among children of immigrants and Australians.
Patient–physician relationship and use of gut feeling in cancer diagnosis in primary care: a cross-sectional survey of patients and their general practitioners
Authors: Pedersen Anette Fischer , Andersen Christina Maar , Ingeman Mads Lind , Vedsted Peter
Published: July 2019

Objectives

To examine whether the quality of the patient–physician relationship, assessed by the general practitioner (GP) and the patient, associates with GPs’ use of gut feeling (GF) in cancer diagnosis.

Design

Cross-sectional questionnaire survey of cancer patients and their GPs.

Setting

Danish primary care.

Participants

Newly diagnosed cancer patients and their GPs. Patients completed a questionnaire and provided the name of the GP to whom they have presented their symptoms. The named GP subsequently received a questionnaire.

Primary and secondary outcome measures

GPs’ use of GF in the diagnostic process for the particular patient. GPs who answered that they used their GF ‘to a high degree’ or ‘to a very high degree’ were categorised as ‘used their GF to a great extent’. GPs who answered that they used their GF ‘to some degree’, ‘to a limited degree’ or ‘not at all’ were categorised as ‘limited or no use of GF’.

Results

GPs were less likely to use GF when they assessed relational aspects of the patient encounter as difficult compared with less difficult (OR=0.67; 95% CI 0.46 to 0.97). The physician-reported level of empathy was positively associated with use of GF (OR=2.60; 95% CI 1.60 to 4.22). The lower use of GF in difficult encounters was not modified by level of empathy.

Conclusions

Experiencing relational aspects of patient encounter as difficult acted as a barrier for the use of GF in cancer diagnosis. Although physician-rated empathy increased use of GF, high empathy did not dissolve the low use of GF in difficult encounters. As diagnosis of cancer is a key challenge in primary care, it is important that GPs are aware that the sensitivity of cancer-related GF is compromised by a difficult patient–physician relationship.
Using prescribing very short answer questions to identify sources of medication errors: a prospective study in two UK medical schools
Authors: Sam Amir H , Fung Chee Yeen , Wilson Rebecca K , Peleva Emilia , Kluth David C , Lupton Martin , Owen David R , Melville Colin R , Meeran Karim
Published: July 2019

Objective

To assess the utility and ability of the novel prescribing very short answer (VSA) question format to identify the sources of undergraduate prescribing errors when compared with the conventional single best answer (SBA) question format and assess the acceptability of machine marking prescribing VSAs.

Design

A prospective study involving analysis of data generated from a pilot two-part prescribing assessment.

Setting

Two UK medical schools.

Participants

364 final year medical students took part. Participation was voluntary. There were no other inclusion or exclusion criteria.

Outcomes

(1) Time taken to mark and verify VSA questions (acceptability), (2) differences between VSA and SBA scores, (3) performance in VSA and (4) SBA format across different subject areas and types of prescribing error made in the VSA format.

Results

18 200 prescribing VSA questions were marked and verified in 91 min. The median percentage score for the VSA test was significantly lower than the SBA test (28% vs 64%, p<0.0001). Significantly more prescribing errors were detected in the VSA format than the SBA format across all domains, notably in prescribing insulin (96.4% vs 50.3%, p<0.0001), fluids (95.6% vs 55%, p<0.0001) and analgesia (85.7% vs 51%, p<0.0001). Of the incorrect VSA responses, 33.1% were due to the medication prescribed, 6.0% due to the dose, 1.4% due to the route and 4.8% due to the frequency.

Conclusions

Prescribing VSA questions represent an efficient tool for providing detailed insight into the sources of significant prescribing errors, which are not identified by SBA questions. This makes the prescribing VSA a valuable formative assessment tool to enhance students’ skills in safe prescribing and to potentially reduce prescribing errors.
Collaboratively seeking to improve contraceptive counselling at the time of an abortion: a case study of quality improvement efforts in Sweden
Authors: Kilander Helena , Brynhildsen Jan , Alehagen Siw , Fagerkrantz Amanda , Thor Johan
Published: July 2019

Background

Many women find it difficult to choose and initiate a contraceptive method at the time of an abortion. There is a gap between regular clinical practice and existing evidence on motivational and person-centred counselling, as well as on use of long-acting reversible contraception (LARC). This study aims to describe and evaluate a Quality Improvement Collaborative (QIC) designed to enhance contraceptive services, with regard to changes in healthcare professionals’ (HCPs’) counselling in clinical practice, and in women’s subsequent choice of, and access to, contraception.

Methods

Three multiprofessional teams working in abortion services from three hospitals in Sweden, and two women contributing with user experience, participated in a QIC during the period March–November 2017. Using a case study design, we collected and analysed both quantitative and qualitative data.

Results

Teams agreed on QIC goals, including that ≥50% of women would start LARC within 30 days post-abortion, and tested multiple evidence-based changes, aided by the two women’s feedback. During the QIC, participating HCPs reported that they gained new knowledge and developed skills in contraceptive counselling at the time of an abortion. The teams welcomed the development of a performance feedback system regarding women’s post-abortion contraception. While the majority of women counselled during the QIC chose LARC, only 20%–40% received it within 30 days post-abortion.

Conclusion

The QIC, incorporating user feedback, helped HCPs to develop capability in providing contraceptive services at the time of an abortion. Timely access to LARC remains a challenge in the present setting.
Hyperexcitability of Cortical Oscillations in Patients with Somatoform Pain Disorder: A Resting-State EEG Study
Authors: Ye Qian , Yan Dong , Yao Manlin , Lou Wutao , Peng Weiwei
Published: July 2019

Patients with somatoform pain disorder (SPD) suffer from somatic pain that cannot be fully explained by specific somatic pathology. While the pain experience requires the integration of sensory and contextual processes, the cortical oscillations have been suggested to play a crucial role in pain processing and integration. The present study is aimed at identifying the abnormalities of spontaneous cortical oscillations among patients with SPD, thus for a better understanding of the ongoing brain states in these patients. Spontaneous electroencephalography data during a resting state with eyes open were recorded from SPD patients and healthy controls, and their cortical oscillations as well as functional connectivity were compared using both electrode-level and source-level analysis. Compared with healthy controls, SPD patients exhibited greater resting-state alpha oscillations (8.5-12.5 Hz) at the parietal region, as reflected by both electrode-level spectral power density and exact low-resolution brain electromagnetic tomography (eLORETA) cortical current density. A significant correlation between parietal alpha oscillation and somatization severity was observed in SPD patients, after accounting for the influence of anxiety and depression. Functional connectivity analysis further revealed a greater frontoparietal connectivity of the resting-state alpha oscillations in SPD patients, which was indexed by the coherence between pairs of electrodes and the linear connectivity between pairs of eLORETA cortical sources. The enhanced resting-state alpha oscillation in SPD patients could be relevant with attenuated sensory information gating and excessive integration of pain-related information, while the enhanced frontoparietal connectivity could be reflecting their sustained attention to bodily sensations and hypervigilance to somatic sensations.
Effects of Blink Rate on Tear Film Optical Quality Dynamics with Different Soft Contact Lenses
Authors: García-Montero María , Rico-del-Viejo Laura , Martínez-Alberquilla Irene , Hernández-Verdejo Jose Luis , Lorente-Velázquez Amalia , Madrid-Costa David
Published: July 2019

Objective. The aim of this study was to investigate tear film optical quality dynamics for four types of silicone hydrogel contact lenses (SHCLs) for daily wear over a 15-day period and for different blink rate (BR) patterns. Methods. A prospective randomized, double-blind, cross-over pilot study including four SHCLs (A: lotrafilcon B (Air Optix plus HydraGlyde, Alcon Laboratories); B: samfilcon A (Ultra, Bausch & Lomb); C: comfilcon A (Biofinity, CooperVision); and D: filcom V3 (Blu:gen, Mark’Ennovy)). Serial measurements of Objective Scatter Index (OSI) using the HD Analyzer (Visiometrics S.L., Terrassa, Spain) were taken at different blinking patterns: blinking every 2.5 seconds (high BRs) and every 9 seconds (low BRs). They were performed during the first visit before CL insertion (baseline), after 20 minutes of CL wear (Day 1), and during the last visit after 8 hours of CL wear on day 15 of use (Day 15). Results. Normal young healthy subjects were recruited and fitted with the four lenses. For low BRs, the mean OSI value increased over time for all CLs and the slope of the curve also increased for all CLs, except for CL D. However, for high BRs, the mean OSI value increased only for CLs B and C and the slope of the curve did not change over time for any of them. Conclusions. These results suggest that the tear film optical quality dynamics after wearing SCHLs for 15 days seems to undergo a slight deterioration only for lowest BR.
A Small Glomus Tympanicum Tumor Resected by Minimally Invasive Transcanal Endoscopic Approach
Authors: Ohki Masafumi , Kikuchi Shigeru
Published: July 2019

We present a case of the transcanal endoscopic resection of a glomus tympanicum tumor. A 51-year-old woman presented with pulsatile tinnitus of the right ear persisting for 6 months. A reddish mass was observed through her tympanic membrane. A computed tomography scan revealed a small mass in the mesotympanum. She was diagnosed with a right-sided glomus tympanicum tumor. The glomus tympanicum tumor was classified as type 1 using the Glasscock–Jackson classification, class A using the Fisch classification, and class A1 using the modified Fisch and Mattox classification. The tumor was transcanally and completely resected by endoscopy without any complication. Before and after the surgery, pure-tone audiometry showed a normal hearing level. Preoperative right-sided pulsatile tinnitus resolved after the surgery. Transcanal endoscopic ear surgery is a favorable surgical method for small localized glomus tympanicum tumors.
Spontaneous Progressive Muscle Weakness with Persistent Leukocytosis
Authors: Hirji Sameer A. , Karamchandani Manish M. , Scott Jonathan W. , Menard Matthew T.
Published: July 2019

Iliacus compartment syndrome is a rare clinical condition which can result in a severe, unilateral, femoral neuropraxia. Recognition of this syndrome as the cause of a developing neuropathy is often delayed given a lack of familiarity with this clinical diagnosis and the retroperitoneal location of the iliacus muscle. Prompt diagnosis is important to avoid risk of consequent muscle necrosis, rhabdomyolysis, and possibly permanent nerve injury. We describe a case of iliacus compartment syndrome in an elderly, frail woman with end-stage renal disease, anticoagulated for atrial fibrillation, who presented with subacute, progressive lower extremity muscle weakness and pain in the setting of complicated metabolic derangements. She was found to have a spontaneous large hematoma in her left iliacus muscle on computed tomography scan. Despite an initial diagnostic delay, she was successfully managed with an iliacus fasciotomy, which led to complete resolution of her symptoms.
The Determination of Parkinson’s Drugs in Human Urine by Applying Chemometric Methods
Authors: Ertokus Guzide Pekcan
Published: July 2019

The spectrophotometric-chemometric analysis of levodopa and carbidopa that are used for Parkinson’s disease was analyzed without any prior reservation. Parkinson’s drugs in the urine sample of a healthy person (never used drugs in his life) were analyzed at the same time spectrophotometrically. The chemometric methods used were partial least squares regression (PLS) and principal component regression (PCR). PLS and PCR were successfully applied as chemometric determination of levodopa and carbidopa in human urine samples. A concentration set including binary mixtures of levodopa and carbidopa in 15 different combinations was randomly prepared in acetate buffer (pH 3.5).). UV spectrophotometry is a relatively inexpensive, reliable, and less time-consuming method. Minitab program was used for absorbance and concentration values. The normalization values for each active substance were good (r2>0.9997). Additionally, experimental data were validated statistically. The results of the analyses of the results revealed high recoveries and low standard deviations. Hence, the results encouraged us to apply the method to drug analysis. The proposed methods are highly sensitive and precise, and therefore they were implemented for the determination of the active substances in the urine sample of a healthy person in triumph.
Maternal Vitamin D Status and Its Effect on Vitamin D Levels in Early Infancy in a Tertiary Care Centre in Sri Lanka
Authors: Anusha Kaneshapillai , Hettiaratchi Usha , Gunasekera Dulani , Prathapan Shamini , Liyanage Guwani
Published: July 2019

Epidemiologic studies from South Asian countries have reported vitamin D deficiency among all age groups. However, there is very little information on vitamin D levels, especially in the vulnerable populations (pregnant/breast feeding mother and infants) in Sri Lanka. More data on vitamin D status of such populations will be important for policy decisions to be made at a national level. Similarly, it will be valuable for healthcare programs in other countries (e.g., United States, Australia, Europe, and Canada) as Sri Lankans are a fast-growing migrant population to those countries. The purpose of this study was to investigate maternal vitamin D status and its effects on infants in a state sector tertiary care centre in Sri Lanka. This prospective cohort study was conducted on 140 healthy pregnant mothers in the third trimester (mean gestational age 39±1 weeks). Blood was collected for 25(OH)D and parathyroid hormone (PTH). Sun exposure and feeding patterns of the infants were recorded based on maternal reporting. Mean age of the infants at follow-up visit was 36±7 days. Vitamin D (25 (OH)D) deficiency (<25 nmol/L) was observed in 12% pregnant mothers, 5% lactating mothers, and 63% infants. Insufficiency (<50 nmol/L) was found in an additional 51% and 43% in pregnant and lactating mothers and 25% of infants. Mean 25(OH)D was higher in pregnant (46.4±17.5 nmol/L) and lactating (51.9±17.0 nmol/L) mothers than infants (28.1±13.7 nmol/L). Maternal vitamin D level during pregnancy was a significant risk factor (OR: 6.00, 95%CI: 1.522-23.655) for infant deficiency and insufficiency. Sun exposure of infants showed a significant positive correlation with vitamin D level (OR: 3.23, 95%CI: 1.19-8.68). In conclusion, the presence of Vitamin D deficiency/insufficiency is higher in infants compared to pregnant/lactating mothers. Low maternal 25(OH)D during pregnancy was a risk factor for deficiency in infants. Although majority of lactating mothers had sufficient vitamin D, most of their exclusively breastfed offspring were deficient.
РЕОЛОГІЧНІ ДОСЛІДЖЕННЯ ГЕЛЮ, ЩО МІСТИТЬ ВОДНИЙ ВИТЯГ З КСЕНОДЕРМИ, ДЛЯ МІСЦЕВОГО ЛІКУВАННЯ ОПІКІВ
Authors: Vons B. V. , Melnyk Y. Y. , Hroshovyi T. A. , Skorokhoda V. Y. , Chubka M. B.
Published: July 2019

Мета роботи. Дослідження реологічних (тиксотропних) властивостей розробленого гелю та встановлення впливу температури на його стабільність.
Матеріали і методи. Об’єктом дослідження обрано гель для місцевого лікування опіків на основі зшитого кополімеру акрилової кислоти – карбомеру Carbopol® Ultrez 21, що містить водний витяг із ксенодерми та лідокаїну гідрохлорид. Реологічні властивості досліджували на ротаційному віскозиметрі «Rheomat-30». Досліджували такі характеристики гелю, як напруга зсуву, динамічна в’язкість і механічну стабільність.
Результати й обговорення. Для визначення типу течії, наявності тиксотропних властивостей і механічної стабільності гелю досліджено реограми його текучості. Під час експериментів встановлено, що досліджуваний гель є неньютонівською рідиною та має пластичний тип текучості, що характеризує його як структуровану дисперсну систему. Наявність тиксотропних властивостей у досліджуваному гелі характеризує задовільну здатність до екструзії з туб і намазування.
Висновки. Визначено залежність реологічних властивостей, зокрема, структурної в’язкості досліджуваного гелю від температури. Розраховані значення механічної стабільності гелю дозволяють спрогнозувати стабільність препарату впродовж передбачуваного терміну його придатності.
ВИВЧЕННЯ ГОСТРОЇ ТОКСИЧНОСТІ ТА ГЕПАТОПРОТЕКТОРНОЇ АКТИВНОСТІ ЕКСТРАКТІВ ТРАВИ ПОЛИНУ ГІРКОГО ТА ПОЛИНУ ЗВИЧАЙНОГО
Authors: Grycyk R. A. , Kireev I. V. , Struk О. А. , Ivanochko V. M.
Published: July 2019

Мета роботи. Дослідження гострої токсичності та гепатопротекторної активності трави полину гіркого та полину звичайного.

Матеріали і методи. Для визначення гострої токсичності використовували методику доклінічного вивчення безпечності лікарських засобів. Вивчення гепатозахисної активності екстрактів полину гіркого та полину звичайного проводили на моделі гострого тетрахлорметанового гепатиту. Як препарат порівняння використовували гепатопротектор вітчизняного виробництва таблетки «Силібор».

Результати й обговорення. В результаті проведеного дослідження встановлено, що внутрішньошлункове введення екстрактів трави полину гіркого та полину звичайного у дозі 6000 мг/кг не призводить до загибелі тварин, змін зі сторони інтегральних, гематологічних, біохімічних показників та морфологічної структури внутрішніх органів піддослідних тварин не виникає, що вказує на відсутність токсичної дії екстрактів в даній дозі, та характеризує їх як практично нетоксичні (V клас токсичності, LD50 > 5000 мг/кг) відповідно до класифікації речовин за токсичністю.

При гострому токсичному уражені печінки екстракти полину гіркого та полину звичайного проявляють виразну гепатопротекторну активність, пригнічуючи перекисні деструктивні процеси та зменшуючи розвиток синдрому цитолізу і практично не поступаються препарату порівняння «Силібор».

Висновки. Вивчення гострої токсичності після внутрішньошлункового введення екстрактів трави полину гіркого та полину звичайного у дозі 6000 мг/кг не призводило до загибелі тварин, вони були охайними, мали задовільний апетит, нормально реагували на звукові і світлові подразники, процеси сечовиділення і дефекації були у нормі, порушення дихання та судом не спостерігали.

Досліджувані екстракти полину гіркого та полину звичайного проявляють при гострому токсичному ураженні печінки гепатопротекторну активність, про що свідчить зниження інтенсивності процесу перекисного окислення ліпідів та зменшення токсичності дії тетрахлорметану, доводячи біохімічні показники крові та гомогенату печінки тварин до рівня інтактних.
КОНТРОЛЬ ТЕМПЕРАТУРИ ТІЛА ПІД ЧАС ПРОВЕДЕННЯ ЛІКУВАЛЬНОЇ ГІПОТЕРМІЇ У НОВОНАРОДЖЕНИХ З ГІПОКСИЧНО-ІШЕМІЧНОЮ ЕНЦЕФАЛОПАТІЄЮ
Authors: Surkov D. M. , Mochulska O. M.
Published: July 2019

Мета дослідження – визначити вплив коливань температури тіла під час проведення лікувальної гіпотермії на перебіг та наслідки помірної і тяжкої гіпоксично-ішемічної енцефалопатії.

Матеріали та методи. У дослідження включено 205 доношених новонароджених з гіпоксично-ішемічною енцефалопатією II–IIІ ст. за шкалою Sarnat у термін ≤72 год після пологів. Методом стратифікації немовлят було поділено за часом прийняття у ВАІТН на групу 0–6 год після народження (n=56) та групу понад 6 год життя (n=149). Проаналізовано вплив пасивної гіпотермії 33–35 °С на перебіг та результати лікування гіпоксично-ішемічної енцефалопатії.

Результати дослідження та їх обговорення. Не виявлено достовірної відмінності поміж досліджуваними групами щодо загальної тривалості респіраторної підтримки (р=0,296), строків, коли було проведено екстубацію трахеї (р=0,468), та тривалості перебування у ВАІТН (р=0,165). Отримано достовірну різницю в загальній тривалості лікування до виписування зі стаціонару між групою до 6 год після народження та групою понад 6 год життя (відповідно, 25 [18,3–33] днів проти 22 [14–29], р=0,032). Крім того, було порівняно профілі температури тіла протягом 72 год лікувальної гіпотермії у новонароджених, в яких у подальшому виникла або не розвинулась церебральна лейкомаляція. Результати проведеного мультиваріантного дисперсійного аналізу (ANOVA) не виявили достовірної відмінності між групами (р=0,890).

Висновок. Пасивна гіпотермія з підтримкою температури тіла 33–35 °С є ефективною процедурою. Коливання температури тіла ±0,5 °С за межі цього коридору, а також початок проведення гіпотермії в термін понад 6 год після народження не мають істотного впливу на перебіг та наслідки помірної і тяжкої гіпоксично-ішемічної енцефалопатії.
РОЗРОБКА СИСТЕМИ ЕФЕКТИВНОГО ПРОГНОЗУВАННЯ, РАННЬОЇ ДІАГНОСТИКИ І ПРОФІЛАКТИКИ ПЕРИНАТАЛЬНОЇ ПАТОЛОГІЇ В ЖІНОК ІЗ ПАТОЛОГІЄЮ СЕЧОВИДІЛЬНОЇ СИСТЕМИ ЗАЛЕЖНО ВІД ГЕНОТИПУ ПОЛІМОРФНИХ ВАРІАНТІВ ГЕНА VEGF
Authors: Melenchuk L. M. , Chorna L. B.
Published: July 2019

Мета дослідження – встановити частоту генотипів та алелів поліморфного локусу 405G/C гена VEGF та розробити систему ефективного прогнозування та ранньої діагностики і профілактики перинатальної патології. Матеріали та методи. Об’єктом дослідження були 40 вагітних жінок із патологією сечовидільної системи, які були поділені за діагнозами ниркової патології: гострий пієлонефрит (І група, ГП), хронічний пієлонефрит (ІІ група, ХП) та 30 здорових жінок із фізіологічним перебігом вагітності. Проводили виділення ДНК із лейкоцитів периферійної крові 70 вагітних жінок та ампліфікацію послідовностей ДНК in vitro, використовуючи метод полімеразної ланцюгової реакції (ПЛР). Результати дослідження та їх обговорення. Результати показали, що у групі жінок із ГП найчастіше виявлявся генотип GG поліморфного локусу 405G/C гена VEGF – 46,7 % та виявлено вищу частоту CC генотипу – 20,0 %. У групі жінок із ХП показано вищу частоту генотипу GG – 48,0 % та зниження частки носіїв генотипу CC – 4 %. Встановлено, що у групі вагітних жінок із ХП частота носіїв генотипу GG (48,0 %) та частота G алеля (75,0 %) вищi порівняно з групою жінок із ГП та контрольною групою жінок, проте відмінності не досягли рівня статистичної вірогідності. Висновок. Виявлена нами тенденція до зростання частки G алеля та GG генотипу може вказувати на те, що алель G локусу 405G/C гена VEGF може бути додатковим генетичним чинником ризику схильності до виникнення хронічного пієлонефриту, проте для більш коректних висновків дослідження слід продовжити на більшій вибірці пацієнтів.
ПОРІВНЯЛЬНА ОЦІНКА ЕФЕКТИВНОСТІ РІЗНИХ СХЕМ МЕДИКАМЕНТОЗНОЇ КОРЕКЦІЇ ЗОВНІШНЬОГО ГЕМОРОЮ У ПОРОДІЛЬ
Authors: Pavlovska O. M. , Pavlovska K. M. , Krasnova Zh. O.
Published: July 2019

Мета дослідження – дослідити ефективність різних схем медикаментозного лікування при виникненні зовнішнього геморою у породіль.

Матеріали та методи. Було обстежено 48 жінок віком 28–45 років з діагностованим зовнішнім гемороєм у післяпологому періоді. Породіль було розділено на дві групи залежно від призначеного медикаментозного лікування. Пацієнтки I групи отримували комплексну медикаментозну терапію, до складу якої було включено пребіотик («Дуфалак»), ангіопротектор/венотонік («Нормовен») та ректальні антигемороїдальні супозиторії («Натальсид»). Породіллі II групи отримували монотерапію у вигляді ректальних антигемороїдальних супозиторіїв («Натальсид»). Також під час лікування обов’язково рекомендували дотримання певних правил харчування. Усім пацієнткам проводили рутинне клініко-лабораторне обстеження. Контроль ефективності лікування здійснювали через 7 та 14 днів. Також проводили динамічне спостереження протягом 12 місяців для аналізу тривалості лікувального ефекту та фіксації рецидивів зовнішнього геморою в обстежених пацієнток.

Результати дослідження та їх обговорення. Покращення загального стану, самопочуття та нівелювання основних клінічних ознак зовнішнього геморою після 7-денного лікування відмітила переважна більшість жінок I групи – 83,3 % та 62,5 % породіль II групи, які отримували монотерапію. Після двотижневого курсу терапії цей показник становив 95,8 % та 75,0 % відповідно. При проведенні проспективного аналізу встановлено, що при застосуванні лише препаратів локальної дії рецидиви захворювання протягом року фіксувалися в 16,7 % випадків. У групі жінок, яким була рекомендована медикаментозна корекція, яка впливала на різні патогенетичні ланки формування даного захворювання прямої кишки, цей показник склав лише 4,2 %.

Висновки. При загостренні або виникненні зовнішнього геморою в жінок у післяпологовому періоді прогностично виправданим та раціональним є призначення саме комплексної медикаментозної терапії. Важливо не тільки нівелювати локальні прояви даної патології прямої кишки, але впливати на різні патогенетичні складові її формування. Так, фізіологічна санація та стимуляція перистальтичної активності кишечника за допомогою пребіотиків, призначення ангіопротекторів/венотоніків системної дії загалом сприяють досягненню довготривалої ремісії захворювання. Застосування при зовнішньому геморої лише препаратів з локальною дією має позитивний, проте іноді короткотривалий лікувальний ефект.
ЗАСТОСУВАННЯ КАЛЬЦІЮ ІОНОФОРУ У ПАЦІЄНТОК ЗІ ЗНИЖЕНИМ РЕПРОДУКТИВНИМ ПРОГНОЗОМ У ПРОТОКОЛАХ ДРТ
Authors: Strelko H. V. , Aidin B. , Ulanova V. V. , Maliuta O. V. , Pischana T. H. , Korotkevych N. V. , Korobko M. Yu.
Published: July 2019

Мета дослідження – вивчення ефективності використання Са іонофору в протоколах ЕКЗ – ICSI у пацієнток зі зниженим репродуктивним прогнозом.

Матеріали та методи. Проведено дослідження ефективності методики активації ооцитів у протоколах ЕКЗ – ICSI у пацієнток після як мінімум однієї невдалої спроби ДРТ. Застосовували ідентичні протоколи КСО. Результативність оцінювали, виходячи з ембріологічних (частота запліднення, дроблення ембріонів, відсоток бластуляції) і клінічних показників (частота настання вагітності).

Результати дослідження та їх обговорення. Застосування кальцію іонофору в момент проведення процедури ICSI дозволяє поліпшити відсоток запліднення ооцитів, відсоток дроблення, відсоток бластуляції. Це, у свою чергу, дозволило підвищити частоту настання вагітності в програмах ЕКЗ – ICSI.

Висновок. Поліпшення ембріологічних показників дозволило істотно поліпшити результати щодо частоти настання вагітності в жінок старшого репродуктивного віку зі зниженим прогнозом по настанню вагітності.
CURRENT OPPORTUNITIES FOR DETERMINING OF PREDICTORS OF THREATENED PRETERM LABOR
Authors: Krut Yu. Ya. , Shevchenko A. A. , Syusyuka V. G.
Published: July 2019

The aim of the study – to ascertain predictors of a threat of premature birth.

Materials and Methods. 63 patients participated in the gestation period of 22–34 weeks in a prospective open study. Pregnant women were divided into two groups. Thus, the group I included 44 pregnant women, with the threat of PL, and the group II included 19 patients with normal course of pregnancy.

All women were tested for body mass index (BMI), progesterone, insulin and cortisol on the day of admission.

Statistical processing of materials was carried out by using the software package "Statistica 6.0" (StatSoft, USA) and MedCalc. 10.2.0.0. To determine the predictors of the occurrence of a TPL, the method of binary logistic regression analysis was used. All statistical tests were two-sided; the p-0.05 level was considered as significant.

Results and Discussion. An analysis of the results of the observation of 63 pregnant women was provided. In 12 women, pregnancy ended in preterm labor, which was 19 % of the total. The following indicators fell to the dependent predictors of TPL occurrence: body mass index (BMI) ≤ 24 kg/m² significantly increased the odds ratio (OR) of TPL 7.76 times; insulin level <8.65 µMU/ml significantly increased ORR of TPL 5.14 times; OR of TPL increases in 7.02 times, in case that the level of cortisol is less than 577.9 ng/ml; progesterone <139.5 ng/ml increases the odds ratio of TPL in 4.39 times. Taking into account the data of univariate regression analysis, multivariate models of independent predictors of TPL were created. According to the first model (p = 0.0001), independent risk factors for miscarriage include: the age of pregnant women over 25 years, an insulin level more than 8.7 μMO/ml, and the level of cortisol less than 577.9ng/ml. According to the second model (p <0.0001), independent risk factors which increase the risk of TPL occurrence are: BMI less than 24 kg/m2, insulin level more than 8.7 μMO/ml, cortisol level less than 577.9ng / ml. However, the most interesting is the third model (p <0.0001) of independent risk factors for TPL. It includes four indicators: the level of progesterone, less than 139.5 ng/ml, the level of cortisol, less than 577.9 ng/ml, the BMI, less than 24 kg/m2 and the age of pregnant, more than 25 years.

Conclusions. It was found that in pregnant women with a threat of preterm birth the age and BMI are the most informative, and in combination with the hormonal examination of women are of primary importance. The obtained results indicate the expedien­cy of inclusion to the standard examination of pregnant women with a threat of premature birth, a comprehensive determination of the level of progesterone, insulin and cortisol, which will enable to identify the risk group for this complication in time and to propose preventive measures.
Stropharia atroferruginea (Agaricales, Strophariaceae), a new species from Battagram district, Pakistan
Authors: KHAN MUHAMMAD BINYAMIN , ISHAQ MUHAMMAD , KIRAN MUNAZZA , FIAZ MUHAMMAD , KHALID ABDUL NASIR
Published: July 2019

A new species, Stropharia atroferruginea, is described from Battagram district Pakistan, based on morpho-anatomical and molecular (ITS & LSU) analyses. Its characterizing features are the dark red to dark reddish-brown pileus with round squamules and decurrent lamellae, the cogwheeled annulus and the clavate to sub-bulbous stipe base, and ellipsoid to oblong basidiospores. Photographs and comparisons with closely related species are also included.
Empowering Through Embodied Awareness: Evaluation of a Peer-Facilitated Trauma-Informed Mindfulness Curriculum in a Woman’s Prison
Authors: Rousseau Danielle , Long Nicole , Jackson Elizabeth , Jurgensen James
Published: July 2019

The cumulative effects of trauma, violence, and substance abuse both define women’s pathways into the correctional system and contribute to their unique needs within it. This research offers a case study of the implementation of a gender-responsive, trauma-informed integrated mindfulness program within a women’s prison. Applying a yoga-based psycho-educational approach, the manualized curriculum was presented in a 16-session, closed-group format with peer-facilitation and pre- and postprogramming assessments. Overall, outcomes of this study were promising. Program participants demonstrated improvements in the use of healthy coping skills, experience of traumatic stress, symptoms of anxiety and depression, self-compassion, sense of connection, ability to relate to others, emotional awareness, and self-regulation.
Why Story Matters: A Review of Narrative in Serious Games
Authors: Naul Emily , Liu Min
Published: July 2019

Literature has shown that immersive learning environments such as digital educational games and simulations often incorporate storytelling elements in their designs as narrative can be an effective way of making learning more meaningful to students. The purpose of this study is to review the literature on the role narrative can play in the experience of a learner engaging in learning games and to synthesize research on features of story that have demonstrated success in these learning environments. The findings have shown that distributed narrative, intrinsically integrated fantasies, empathetic characters and virtual agents, and adaptiveness or responsivity are four characteristics of game narratives found to be effective. Several learning game analyses were performed to illustrate how these games used narrative to foster greater immersion, engagement, motivation, and learning. Finally, a narrative design strategy for serious games is suggested which integrates the effective narrative features as shown in the example games, along with two analysis frameworks, Game Discourse Analysis and Narrative Centered Informant Design. The findings of this study should provide much-needed insights to designers and researchers who are involved in creating immersive learning environments.
Extending the Membership Negotiation Model: Previous Work Experience and the Reproduction and Transformation of Structures
Authors: Endacott Camille G. , Myers Karen K.
Published: July 2019

Membership negotiation is the communicative process by which individuals transform from nonmembers to organizational members. This investigation extends the membership negotiation model proposed by Scott and Myers by incorporating previous work experience as a medium of membership negotiation and others’ perceptions of the value of that experience. The proposed extended model also identifies how membership negotiation has broad effects by maintaining and transforming structures, and extending outcomes beyond individual roles to work group, organizational, and societal implications. We offer implications and future directions for investigations into membership negotiation, socialization of employees with previous work experience, and organizational structure.
College Expectations Promote College Attendance: Evidence From a Quasiexperimental Sibling Study
Authors: Brumley Lauren D. , Russell Michael A. , Jaffee Sara R.
Published: July 2019

When adolescents are asked how likely they think it is that they will go to college, does their answer influence what they will actually do? Typically, it is difficult to determine whether college expectations promote academic achievement or just reflect a reasonable forecast of what is likely to happen to them. We used a sample of siblings from the National Longitudinal Study of Adolescent to Adult Health ( N = 1,766) to test whether associations between college expectations and educational attainment remained after accounting for unobserved family factors that may shape both educational expectations and attainment. Compared with their siblings, adolescents with higher college expectations were also 43% more likely to attend college, even when analyses controlled for grades and IQ. The effect of college expectations on college attendance was strongest among youths living in higher-socioeconomic-status families.
Research of smoothness on torque coordination of two-wheel independently driven hub electric vehicle based on fuzzy control
Authors: Zhang Chuanwei , Zhang Dongsheng , Zeng Hongjun , Wang Rui , Wen Jianping , Mo Wei
Published: July 2019

Aiming at the problems of drive torque coordination, steering vibration and asymmetry of two-wheel independent drive hub electric vehicle, a new torque coordination control algorithm of driving wheel is proposed based on fuzzy control theory. The algorithm takes yaw rate deviation and centroid side deviation as inputs of fuzzy controller, outputs additional yaw moment needed by vehicle, and distributes it to each driving wheel reasonably according to the requirements of each driving wheel. Under the coordination of the driving anti-skid control algorithm, the vibration of driving wheels was reduced and the vehicle can run smoothly. The algorithm is verified by Simulink-CarSim joint simulation, and a fast prototype experiment platform based on dSPACE is built. The results of experiment and simulation show that the control strategies are effective and feasible.