bluuebunny/crossref_metadata_2025 huggingface dataset:
ANALIZA WYBRANYCH PARAMETRÓW BIOAKTYWNYCH CZARNEGO CZOSNKU UZYSKANEGO W KRÓTKIM TRYBIE FERMENTACJI
Authors: DULIŃSKI ROBERT , BYCZYŃSKI ŁUKASZ , KWIECIEŃ INGA , KARBOWSKI ADRIAN
Published: May 2024

Background. Garlic (Allium sativum L.) is characterized by many health-promoting properties due to the presence of sulfur compounds, including allillin, S-allyllocysteine and the high content of polyphenolic compounds. In order to eliminate specific organoleptic characteristics – unfavorable from some consumers’ point of view, garlic can be subjected to a special, low-temperature heat treatment, referred to as aging. This process results in the hydrolysis of poly- and oligosaccharides (fructans) with the participation of intracellular enzymes (fermentation) and the formation of Maillard reaction products (condensation of sugars with amines). As a result, the color, consistency, taste and smell of the final product change and the so-called black garlic is obtained. The aim of the study was to compare the antioxidant properties and the level of total polyphenols, saccharide profile, the content of selected B vitamins and released amino acids of two varieties of raw and black garlic. The experiments were carried out with the use of a commercial short-term fermentation unit from TIROSS. The process was carried out at 70 °C for 192 hours. The amo unt of released amino acids was determined by the ninhydrin method, the content of polyphenols was found using the Folin-Ciocâlteu reagent,antioxidant properties were specified using DPPH free radical and the content of vitamin B and saccharide profile by HPLC. Results and conclusions. The results obtained indicate not only an increase in antioxidant activity, the sum of polyphenols and riboflavin, but also a decrease in the level of free amino acids and thiamine in the garlic obtained after the aging process. The project is in line with a global trend related to the nutrition model oriented towards a vegan diet and the search for new, health-promoting ingredients or recipes based on raw materials with already pre-confirmed attributes as ingredients of functional food.
THE EFFECT OF A DIET ON THE OCCURRENCE OF OCHRATOXIN A IN BODY FLUIDS
Authors: ROPEJKO KAROLINA , TWARUŻEK MAGDALENA
Published: May 2024

Background. Ochratoxin A (OTA), a secondary metabolite of fungi, is produced by fungi of the As pergillus and Penicillium genera. It is supplied to the body with food consumed by people. The purpose of this study was to determine the occurrence of ochratoxin A in human body fluids in relation to diet. A part of the study group consisted of women who were donors from a breast milk bank. The aim of this study was to determine the correlation of ochratoxin A in body fluids (milk, urine, serum) and the diet of the women covered by the study. The study material consisted of 60 urine samples, 60 milk samples and 60 blood samples. Ochratoxin A in milk and urine was determined by HPLC with fluorescence detection. For the determination of ochratoxin A in blood serum, we used a liquid chromatography-mass spectrometer (LC - MS/MS) method. Results and conclusions. As a result of the analysis, it was found that as the frequency of consump tion of dried grape fruit increases, there is a significant increase in the level of OTA in breast milk. Next, it was shown that as the frequency of beer consumption increases, there is a significant increase in the level of OTA in maternal urine. Finally, it was shown that a significant increase in maternal serum OTA levels occurs with an increase in the frequency of consumption of dried fruit. OTA was found in 4 out of 60 milk samples, in 40 out of 60 urine samples and in 60 out of 60 serum samples. The surveyed women’s average age was 31 (ranging from 22 to 41). Given all the respondents, 46 lived in the city, 14 in rural areas, 35 were economically active, 22 were not, and 3 were on maternity leave. On average, they had 2 children (from 1 to 4). Of all children being fed, 35 were male and 25 female. On average, delivery occurred on the 37th week of pregnancy (between the 27th and 42nd week).
Wick multiplication and its relationship with integration and stochastic differentiation on spaces of nonregular test functions in the Lévy white noise analysis
Authors: Kachanovsky N.A.
Published: May 2024

We deal with spaces of nonregular test functions in the Lévy white noise analysis, which are constructed using Lytvynov's generalization of a chaotic representation property. Our goal is to study properties of a natural multiplication $-$ a Wick multiplication on these spaces, and to describe the relationship of this multiplication with integration and stochastic differentiation. More exactly, we establish that the Wick product of nonregular test functions is a nonregular test function; show that when employing the Wick multiplication, it is possible to take a time-independent multiplier out of the sign of a generalized stochastic integral; establish an analog of this result for a Pettis integral (a weak integral); obtain a representation of the generalized stochastic integral via formal Pettis integral from the Wick product of the original integrand by a Lévy white noise; and prove that the operator of stochastic differentiation of first order on the spaces of nonregular test functions satisfies the Leibnitz rule with respect to the Wick multiplication.
Regular behavior of subharmonic in space functions of the zero kind
Authors: Zabolotskyi M.V. , Zabolotskyi T.M. , Tarasyuk S.I. , Hal Yu.M.
Published: May 2024

Let $u$ be a subharmonic in $\mathbb{R}^m$, $m\geq 3$, function of the zero kind with Riesz measure $\mu$ on negative axis $Ox_1$, $n(r,u)=\mu\left(\{x\in\mathbb{R}^m \colon |x|\leq r\}\right)$, \[N(r,u)=(m-2)\int_1^r n(t,u)/t^{m-1}dt,\] $\rho(r)$ is a proximate order, $\rho(r)\to\rho$ as $r\to+\infty$, $0<\rho<1$. We found the asymptotic of $u(x)$ as $|x|\to+\infty$ by the condition $N(r,u)=\left(1+o(1)\right)r^{\rho(r)}$, $r\to+\infty$. We also investigated the inverse relationship between a regular growth of $u$ and a behavior of $N(r,u)$ as $r\to+\infty$.
FARKLI NEVİDEN FİKRİ İÇTİMAIN HÜKÜM FIKRASINA YANSIMASI
Authors: Kılıç Ahmet
Published: May 2024

Farklı neviden fikri içtima, ceza hukukuna ilişkin birçok hususta özellik arz eder ve ayrı bir değerlendirmeyi gerektirir. Bu hususlardan biri hüküm fıkrasıdır. Türk hukukunda, farklı neviden fikri içtima ilişkisini oluşturan tüm suçların hüküm fıkrasında yer almasının gerekli olup olmadığı ve gerekliyse hüküm fıkrasının nasıl formüle edilmesi gerektiği kapsamlı şekilde değerlendirilmemektedir. Çalışmamızda, öncelikle bu konuya ilişkin Yargıtay kararları ile Türk ve Alman doktrindeki görüşlere yer verilmiş, ardından savunduğumuz görüş ifade edilerek bu görüşün sonuçları değerlendirilmiştir. Bu çalışmada savunduğumuz temel görüş; farklı neviden fikri içtima kapsamındaki tüm suçlar bakımından mahkûmiyet kararı verilmesi, ancak Türk Ceza Kanunu m. 44 gereği sadece en ağır cezayı gerektiren suça dayalı olarak bir cezanın belirlenmesi gerektiği yönündedir.
СТАЛИЙ РОЗВИТОК УКРАЇНИ ЯК ІННОВАЦІЙНИЙ ПІДХІД ДО ЇЇ ПОВОЄННОГО ВІДНОВЛЕННЯ
Authors: Замула І. , Шавурська О. , Кірейцева Г.
Published: May 2024

Вступ. Основною метою міжнародного економічного співробітництва у досягненні цілей сталого розвитку є вирішення глобальних проблем щодо подолання бідності, збереження планети та економічний розвиток в цілому.Проблематика. Додаткових досліджень потребує оцінка досягнень та окреслення можливостей України у реалізації цілей сталого розвитку як інноваційного підходу до її повоєнного відновлення, що є актуальним для залучення імпакт-інвестицій як інноваційного інструменту інвестування.Мета. Оцінка досягнень та окреслення можливостей України у реалізації економічних, соціальних і екологічних цілей сталого розвитку в умовах повоєнного відновлення.Матеріали й методи. В основу дослідження покладено концепцію сталого розвитку. Для вивчення сучасного стану досягнення сталого розвитку Україною та окреслення повоєнних перспектив використано емпіричні (спостереження, опис) та теоретичні (аналіз, синтез, абстрагування, узагальнення, індукція, дедукція, пояснення) методи наукового дослідження.Результати. Аналіз соціальних та екологічних цілей сталого розвитку в Україні свідчить про позитивну динаміку до 2022 року та ілюструє високий потенціал у досягненні цілей сталого розвитку. З 2022 року ситуація у всіх складових сталого розвитку є кризовою. Через війну стрімко зросла міграція населення та рівень безробіття, зросла смертність і скоротилася народжуваність, знизилися економічні показники розвитку країни. Найгірша ситуація в Україниу реалізації екологічних цілей.Висновки. Для повоєнного відновлення необхідним є створення умов для залучення інвестицій, більша частина яких має бути імпакт-інвестиціями. Для цього необхідно врегулювати на законодавчому рівні імпакт-інвестування, сприяти розкриттю у звітності підприємств інформації про їхню соціальну та екологічну діяльність, а також формувати посередницькі платформи для інвесторів, які бажають здійснювати капіталовкладення у сталий розвиток.
КОСМІЧНА ПІДТРИМКА ОПЕРАЦІЙ (ДІЙ) СИЛ ОБОРОНИ УКРАЇНИ: СИСТЕМНИЙ ПІДХІД ТА ПРАКТИЧНІ РЕКОМЕНДАЦІЇ
Authors: Ковбасюк С. , Випорханюк Д.
Published: May 2024

Вступ. Ключовим елементом процесу трансформації сучасних збройних сил є введення космічних сил і засобів в усі фази планування та проведення операцій об’єднаних (міжвидових) угруповань військ (сил). Як вид або рід збройних сил створюються космічні сили, основним завданням яких є здійснення космічної підтримки операцій (бойових дій).Проблематика. Проблемним є невідповідність нинішнього стану космічної діяльності у секторі безпеки й оборони України сучасним загрозам і завданням забезпечення обороноздатності держави та необхідності суттєвого удосконалення її головної, системотворної, ланки — космічної діяльності сил оборони України.Мета. Визначення шляхів підвищення ефективності космічної діяльності в секторі безпеки і оборони Українишляхом аналізу сутності космічних можливостей сил оборони, досвіду НАТО і США щодо здійснення космічноїпідтримки операцій об’єднаних угруповань військ.Матеріали й методи. Систематизація та аналіз нормативних документів і публікацій щодо практичної реалізації космічної підтримки операцій об’єднаних угруповань військ.Результати. Визначено причини невідповідності нинішнього стану космічної діяльності у секторі безпеки і оборони України сучасним загрозам та завданням забезпечення обороноздатності держави. Проаналізовано досвід НАТО і США щодо організації та здійсненню космічної підтримки операцій об’єднаних угруповань військ, а також сутність космічних можливостей. Визначено шляхи покращення космічної діяльності в секторі безпеки і оборони України.Висновки. Забезпечення космічної підтримки операцій об’єднаних угруповань військ є основою підвищенняефективності виконання завдань за призначенням, головна функція якої полягає у виробленні спеціальних інформації, продуктів та послуг, отриманих у результаті космічної діяльності, системного використання космічних інфраструктур держави, іноземних партнерів і комерційних компаній в інтересах оборони держави.
Development of Titanium Production in Ukraine: Evolving Prospects Based on National R&D
Authors: VENGER V. , BYKONIA O. , GAKHOVYCH N. , KUSHNIRENKO O. , TSYPLITSKA O.
Published: May 2024

Introduction. The development of Ukraine’s resource potential in the field of mining and advanced processing of titanium raw materials is one of the important components of countering military threats and the national economy recovering based on new technologies.Problem Statement. The realities of wartime reinforce the importance of domestic resource involvement to resumption of the titanium products complete production cycle in Ukraine, which can facilitate integration into global value chains.Purpose. To determine the directions of titanium production development in Ukraine based on the available resource and production potential, foreign and domestic R&D.Materials and Methods. The authors have used data of statistical observations of the State Statistics Service in Ukraine, the U.S. State Geological Survey, the World Intellectual Property Organization; methods of systematic approach, economic and statistical, calculation and design, graph analytical methods, statistical comparisons and grouping, systematic and comparative analysis.Results. The possibilities of realizing resource, production, and R&D potential for deep processing of titanium metal in Ukraine have been substantiated. The directions of the Ukrainian titanium industry development have been offered. The construction of new and/or modernization of production facilities for processing Ukrainian titanium raw materials based on domestic scientific developments has been substantiated.Conclusions. Ukraine has a strategic potential to create a full cycle of titanium products production. Providing favorable conditions for attracting investment and access to capital and financial and economic instruments facilitates technological modernization. This, in turn, will help open “a window of opportunities” for Ukraine for manufacturing titanium products with high added value for the needs of the military industrial complex and other high-tech industries.
Experimental Studies of Pressure Pulsations in Draft Tube Diffuser of Pump-Turbine Models for Heads up to 200 m
Authors: RUSANOV A. , SUBOTIN V. , KHORYEV O. , LYNNYK O. , BYKOV Yu. , KOROTAIEV P. , AHIBALOV Ye.
Published: May 2024

Introduction. Increasing the share of balancing capacities to cover daily peaks in electricity consumption is one of the top priorities of the postwar development of Ukraine’s energy sector.Problem Statement. Today, power plant hydraulic turbines need both to increase effi ciency and to expand their operating range. For example, the new hydraulic units of the Dniester PSP shall operate in turbine mode in the range of 40—100% of rated capacity, while the four previous units operate in the range of 70—100%. This requirement can be met by increasing efficiency and reducing pulsations at low power output.Purpose. Based on studying the infl uence of blade spatial shape of a Francis pump-turbine runners on fl ow parthydrodynamics, to identify the patterns of pressure fluctuations distribution in draft tube diff user of the hydraulic unit model.Materials and Methods. Three options of models (the original and two modifi ed ones) have been studied onthe IMEP ECS-30 hydrodynamic test stand. The runner blades are made of PLA plastic by 3D printing. Pressurepulsations are measured by sensors at two points of draft tube diff user at a distance of 0.2 and 1.5 runner diameters from the runner bottom shroud.Results. Three modifi cations of the pump-turbine runner for heads up to 200 m have been designed and experimentally studied with the use of circumferential lean that diff er from the original version only in relative position of blade profiles. The analysis of obtained energy and pulsation characteristics of the models in turbine modehas shown that the model with the runner having a negative circular blade lean has the best performance.
Conclusions. The determined influence of spatial shape of the runner blades on the energy and pulsation characteristics of the Francis pump-turbine model for heads up to 200 m has made it possible to increase its efficiency and to reduce the level of pressure fluctuations in the flow part.
Humidity Diode Sensors Based on 1D Nanosized Silicon Structures
Authors: LINEVYCH Ya. , KOVAL V. , DUSHEІKO M. , LAKYDA M.
Published: May 2024

Introduction. Humidity measurement is essential in microelectronics, aerospace, biomedical, and food industries, as well as in households for climate control. Currently, various types of devices have been used as humidity sensors: capacitive, resistive, diode, gravimetric, optical structures, field-effect transistors and devices based on surface acoustic waves.Problem Statement. Today, there is a need to develop IC-compatible humidity sensors that have high sensitivityand low cost. To this end, silicon nanowires have been successfully used in resistive and capacitive humidity sensors. However, there is a lack of research on the nanowire effect on device parameters of diode-type humidity sensors.Purpose. To develop diode sensors based on silicon nanowires and to determine the effect of process parameters of synthesis and structural features of nanowires on the performance of humidity sensors.Materials and Methods. The process of sensor fabrication includes several steps: chemical cleaning of silicon wafer, synthesis of silicon nanowires using standard or modified metal-assisted chemical etching, phosphorus diffusion to create a p-n junction, front and back metallization. The surface morphology of the nanostructures has been studied by scanning electron microscopy. The humidity-sensitive characteristics have been studied with theuse of salt hygrostats.Results. It has been shown that the addition of one-dimensional silicon nanostructures to the diode-type sensor signifi cantly improves its characteristics. The rectification ratio increases from 161 to 1807, the response ups from 4.5 to 25, the sensitivity grows from 1.6 to 4.02 (%RH)–1, while the response time and recovery time are reduced from 85/90 to 25/30 s, the hysteresis value goes down from 75 to 16%, the signal deviation after cycling drops from 15to 3%, and the signal fluctuation during continuous device operation decreases from 17 to 15%.Conclusions. The results have shown that the use of a simple and cheap nanowire synthesis technology is effective to produce humidity sensors.
Conceptualization of Intelligent Control System for Humanitarian Demining Robotic Complexes Based on Verbal Methods
Authors: HUTSA O. , YELCHANINOV D. , YANUSHKEVYCH D. , TOLKUNOV I. , IVANOV L. , PETROVA R. , MOROZOVA A.
Published: May 2024

Introduction. Humanitarian demining is characterized by growing attention to the problems of creating and using robotic systems. The most important aspect of their use is the control method.Problem Statement. At present, the fi rst generation robotic complexes (controlled devices) have been the mostcommon, the second generation complexes (semi-autonomous devices) have been improving. To switch to the third generation complexes (autonomous devices), it is necessary to develop intelligent control systems based on artificial intelligence technologies. The most used for system development are quantitative methods, but such models are “black box models” that do not provide complete clarity about their behavior.Purpose. To develop conceptual model of intelligent control systems for humanitarian demining robotic complexes based on verbal methods.Materials and Methods. Formal logic methods, verbal analysis qualitative methods, and BPMN.
Results. Conceptual model of intelligent control systems for humanitarian demining robotic complexes and sym bolic models of representing relevant declarative and procedural knowledge based on verbal methods have been developed.Conclusions. The conceptual model makes it possible to formulate Symbolic Models in the notations of selected verbal methods. At the decision-making level, the ordinary classifi cation method by denotation of the terms used by experts in the selected subject area has been chosen. At the executive level, the BPMN method has been chosen to create process diagrams in graphical notation. The verbal methods make it possible to create “white-box models” that unambiguously interpret the dependence of output and input variables and to explain the model behavior. Symbolic models in the notations of selected verbal methods allow the implementation of an intelligent control systems for a specifi c humanitarian demining robotic complex.
Stent Ablation by Rotational Atherectomy for Management of Resistant Lesions within and across the Stent Struts in Coronary Arteries
Authors: Kadiyala Vikas , Yeo Khung Keong
Published: May 2024

Background: Non-dilatable stent underexpansion has limited treatment options. Stent ablation by rotational atherectomy (RA) for the management of non-dilatable coronary stents is an off-label strategy. The principle of stent ablation by RA of underexpanded stent relies on modification of both stent and underlying calcium. This study aims to describe and compare the use of RA for non-dilatable lesions in two anatomical categories: group 1 (within the stent struts) and group 2 (across the stent struts). Methods: A total of seven patients who had undergone stent ablation by RA were analysed. Indications for revascularisation were acute coronary syndrome or chronic stable angina. Two groups are described: RA within underexpanded stents (group 1) and across the stent struts (across stented bifurcation; group 2). Results: The burr:artery ratio was
0.6 ± 0.1 in group 1 and 0.5 in group 2 (p=0.24). The maximum rotational speed was 154,400 ± 2,500 and 155,000 rpm in the two groups. The total number of RA runs was 3.6 ± 0.90 in group 1 and 7.0 ± 2.8 in group 2, respectively, p=0.04. Procedural success was achieved in all cases with no complications. Conclusion: RA is a feasible bailout option for resistant non-dilatable lesions within and across the stent struts.
Application of Transcatheter Electrosurgery in Structural Heart Interventions: A Report of Three Different Techniques
Authors: So Chak-yu , Lai Leo Kar Lok , Wong Ling Na , Chui Ka-Lung , Kam Kevin Ka-ho , Chan Albert KM , Lee Alex PW , Wu Eugene B , Wong Randolph HL , Chan Yat-Sun
Published: May 2024

Transcatheter electrosurgery is a novel technique to traverse or cut tissue, within blood-filled spaces, using alternating current directed by guidewires and catheters. We report the first series of transcatheter electrosurgery procedures in Asia including transcaval access for transcatheter aortic valve implantation, intentional aortic leaflet laceration to mitigate the risk of coronary occlusion in transcatheter aortic valve implantation and intentional laceration of anterior mitral valve leaflet to mitigate the risk of left ventricular outflow tract obstruction. These procedures are potentially valuable in Asian patients because of their smaller body build compared to Caucasians posing a higher risk of coronary or left ventricular outflow tract obstruction during transcatheter valve implantation. There is a need to adopt transcatheter electrosurgery in Asia to treat more surgically inoperable patients, including proper simulation training, bench training and clinical proctorship.
Coronary Revascularisation in Heart Failure with Reduced Ejection Fraction
Authors: Haring Bernhard , Böhm Michael
Published: May 2024

The role of myocardial revascularisation in patients suffering from ischaemic cardiomyopathy with extensive coronary artery disease and heart failure with reduced ejection fraction (HFrEF) remains controversial. Percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) are considered revascularisation procedures. Evidence prior to the latest medical treatment advances only suggests a long-term benefit of CABG over pharmacological therapy in this population. When angina-related symptoms dominate patients’ lives despite optimal medical treatment, PCI can be considered if the patient is ineligible for CABG after carefully weighing up the perioperative risk. Viability and/or ischaemia detection to guide revascularisation have been unable to accurately predict treatment effects of CABG or PCI. Optimal heart failure treatment should be initiated in all patients presenting with ischaemic cardiomyopathy and HFrEF as the first and most important measure to improve long-term prognosis.
Hospitalizációt igénylő gyermekkori akut rhinosinusitisek 2016 és 2022 között klinikánkon – retrospektív elemzés
Authors: Kelemen Éva , Bella Zsolt , Erdélyi Eszter , Kiss Fekete Beáta , Sztanó Balázs , Rovó László , Kiricsi Ágnes
Published: May 2024

Bevezetés: A rhinosinusitis az orr- és orrmelléküregek
nyálkahártyájának váladékképződéssel és ödémás duzzanattal járó gyulladása. Az
akut bakteriális rhinosinusitis főként szövődményes eseteiben gyakran szükséges
fekvőbeteg-intézménybe való felvétel. Célkitűzés: A Szegedi
Tudományegyetem Fül-Orr-Gégészeti és Fej-Nyaksebészeti Klinikájának
fekvőbetegosztályára 2016 és 2022 között akut rhinosinusitis miatt felvett
gyermekek anyagának retrospektív elemzése, illetve annak megállapítása, hogy a
COVID–19-járvány befolyással volt-e a felvételt igénylő esetek arányára.
Módszer: Demográfiai és klinikai adatok gyűjtése, az
eredmények összehasonlítása hazai és nemzetközi irodalmi adatokkal.
Eredmények: 497 gyermekből 471 beteg kezelése kizárólag
ambulánsan történt. 26 gyermek, 17 fiú és 9 lány került felvételre (1 fő 2
alkalommal). Az átlagéletkor 7,65 év volt. A felvételek 52%-a a három téli
hónapban, az összes felvétel 89%-a a novembertől áprilisig terjedő időszakban
történt. 19 esetben akut ethmoiditis, 5 esetben akut sinusitis maxillaris, 2
esetben akut pansinusitis, 1 alkalommal akut sphenoiditis volt a felvételi
diagnózis. A felvétel oka 19 gyermeknél a következményes szemhéjödéma, 7 esetben
az alkalmazott terápia melletti progresszió volt, 1 betegnél intracranialis
szövődmény igazolódott. Az átlagos hospitalizáció 4,2 nap volt. 16 esetben
amoxicillin-klavulánsav, 11 esetben cefuroxim parenteralis adása történt. 9
esetben (8 orbitalis, 1 intracranialis szövődmény) elkerülhetetlen volt a műtét.
Minden betegnél funkcionális endoszkópos beavatkozás történt. 2 alkalommal,
orbitatályog miatt, külső megnyitásra is szükség volt, az intracranialis
szövődménynél idegsebészeti műtét is történt. Megbeszélés: A
vizsgált paraméterek korrelálnak az irodalmi adatokkal, a COVID–19-járványnak
tulajdonítható esetszámváltozást nem tapasztaltunk.
Következtetés: Az akut rhinosinusitis konzervatív
terápiával általában gyógyítható, de előfordulhatnak súlyos, életet
veszélyeztető szövődmények. Bár a kórházi felvételt igénylő esetek száma
csökkent, a szövődmények aránya nem változott, ezért nagyon fontos azok gyors
felismerése és hatékony kezelés. Orv Hetil. 2024; 165(19): 747–753.
Életmódváltás? Nincs kifogás!
Authors: Czeglédi Edit
Published: May 2024

A hazánk felnőtt lakosságának közel egyharmadát érintő elhízás krónikus betegség,
amely más krónikus betegségek kockázati tényezőjeként rontja a szomatikus és
mentális egészséget, az életminőséget és az életkilátásokat. Valamennyi
bizonyítékalapú testsúlycsökkentő terápia alapja az életmódváltás, amely
minimálisan az energiabevitel korlátozását és a fizikai aktivitás növelését
igényli. A betegek azonban az esetek túlnyomó többségében vonakodnak az
életmódváltástól, aggodalmakat fejezve ki ezzel kapcsolatban (például „Én a
levegőtől is hízom!”, „Nem bírok sportolni!”, „Nem akarok éhezni!”). Gyakori az
orvosok részéről e félelmek „kifogásként” történő értelmezése. Ez az
interpretáció egyfelől indulatot szül a páciensek irányában, másfelől meggátolja
a figyelmes meghallgatást és az empátia kifejezését, így az ellenállás
hátterében álló tényezők nem kerülnek feltárásra, feloldásra. Ennek
következtében a szakember vagy nem tudja bevonni a pácienst a terápiába, vagy ha
mégis, akkor az együttműködés mértéke elmarad az elvárttól, rontva a kezelés
hatékonyságát. A páciens kioktatása vagy akár elmarasztalása pedig rontja az
orvos-beteg kapcsolatot, és az egészségügyi ellátórendszer kerüléséhez vezethet,
ami súlyosbíthatja úgy a súlyfelesleg mértékét, mint a kísérő betegségek
lefolyását. A jelen tanulmány célja annak bemutatása, hogy hogyan érdemes
reagálni a páciensek vonakodást kifejező mondataira, és milyen kommunikációs
eszközökkel facilitálhatjuk a súlycsökkentő kezelésbe való sikeres bevonódást és
az életmódváltás iránti elköteleződés erősödését, eszközöket adva az
egészségkárosító szokások fokozatos leépítéséhez és a hosszú távon is
fenntartható, hatékony, egészséges testtömegkontrollt szolgáló egészségvédő
szokások kialakításához. Orv Hetil. 2024; 165(19): 727–733.
Appendectomia gyermekkorban: laparoszkópia vagy nyitott műtét?
Authors: Fadgyas Balázs , Garai Gábor István , Őri Dorottya , Monostori Georgina , Vajda Péter
Published: May 2024

Bevezetés: A felnőtt-, illetve a gyermekkori appendicitis
kezelése kapcsán számos irodalmi adat áll rendelkezésre mind a nyitott, mind a
laparoszkópos appendectomia előnyeiről és hátrányairól.
Célkitűzés: Egy országos centrumban kívántuk vizsgálni a
gyermekkorban végzett laparoszkópos és nyitott appendectomiák eredményeit.
Módszer: Retrospektív, megfigyelésen alapuló
kohorszvizsgálatot végeztünk a 2011 és 2020 között nyitott vagy laparoszkópos
appendectomián átesett 0–18 éves gyermekek körében. A társbetegséggel bíró
betegeket kizártuk a vizsgálatból. A betegeket nyitott (idesoroltuk a konvertált
műtéteket is) és laparoszkópos appendectomia szerint csoportosítottuk, illetve a
szövettani eredményeik alapján „nem komplikált” (negatív, simplex, catarrhalis,
phlegmonosus, gangraenás) és „komplikált” (perforált) appendicitis-alcsoportokat
állítottunk fel. A posztoperatív szövődményeket (sebgyógyulási zavar, ileus,
intraabdominalis abscessus) és a kórházi ápolási időt vizsgáltuk. A statisztikai
analízisekhez Fisher -féle egzakt, khi2- (chi2 test for
trend) és Mann–Whitney-féle U-tesztet használtunk. Eredmények:
A vizsgálatba 1444 beteget vontunk be (nyitott: 842, laparoszkópos: 602), a
mediánéletkor 10,93 (SD 3,49) év volt. Szövődményeket számottevően inkább
nyitott műtétek után (83/842, 9,86%), kevésbé a laparoszkópos megoldás után
(45/602, 7,48%) észleltünk (p = 0,1163). A kórházi tartózkodás mediánértéke
nyitott műtétek után 3 (2,4) nap, laparoszkópia esetén 4 (3,5) nap volt
(p<0,0001). A nem komplikált eseteknél a medián ápolási idő laparoszkópia
után rövidebb: 3 (2,3) nap, míg nyitott műtétet követően hosszabb: 3 (3,5) nap
volt (p<0,0001). Komplikált esetek mellett a kórházi tartózkodás mediánideje
laparoszkópia után 8 (6, 10), nyitott műtét után 8 (7, 10) napnak adódott (p =
0,0202). Megbeszélés: A laparoszkópia eleinte a
nőgyógyászatban, majd a sebészetben és csak ezek után a gyermeksebészetben is a
napi rutin része lett. Következtetés: Mind a nyitott, mind a
laparoszkópos appendectomia biztonságos beavatkozás gyermekkorban. A két módszer
között nem észleltünk különbséget a szövődmények tekintetében, de laparoszkópos
beavatkozás után szignifikánsan rövidebbnek találtuk a kórházi ápolási időt. A
gyermekkori nem komplikált (korai stádiumban felismert) appendicitisek műtéti
kezelésében a rövidebb kórházi tartózkodás miatt a laparoszkópos appendectomia a
választandó módszer. Orv Hetil. 2024; 165(19): 742–746.
SYMPOSIUM “MAGNESIUM DEFICIENCY IN PEDIATRIC PRACTICE: VERSIONS AND CONTRAVERSIONS”
Authors: Editorial Article
Published: May 2024

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The state of the reproductive system of adolescent girls after vaccination against human papillomavirus using a quadrivalent vaccine
Authors: Karachentsova Irina V. , Sibirskaya Elena V. , Fomina Mariya M. , Dyadik Tatyana G.
Published: May 2024

Background. Currently, oncological diseases and their possible prevention are being actively studied. Cancer mortality remains high. A national project “Healthcare” has been started in Russia, including the Federal projects “Fighting Cancer” and “Development of Children’s Health Care, including the creation of a modern infrastructure for providing medical care to children”. In a number of regions, girls can be vaccinated against the human papillomavirus (HPV). The main reason for refusing HPV vaccination is an unfounded fear of negatively affecting the fertility and other bad data. The aim of the study is an investigation of the reproductive system of adolescent girls with completed course of vaccination against HPV using quadrivalent vaccine. Methods. We selected 65 schoolgirls in Moscow by analyzing medical documentation data. All of them were vaccinated against HPV and examined by a gynecologist. The state of their reproductive system was assessed. Results. Most girls received the vaccine at the age of 12–13, according to the regional vaccination calendar of the city of Moscow. They were vaccinated with the quadrivalent vaccine twice with an interval of 6 months; no adverse event was noted. The mean period of time since vaccination was 2.7 ± 1.1 years. The mean age of menarche, mean menstrual cycle length, and mean bleeding time were normal in girls vaccinated against HPV. Among menstrual disorders, dysmenorrhea and oligomenorrhea were most often observed, but the data did not differ from the population average. The incidence of abnormal uterine bleeding and breast pathology was lower. No papillomas were detected. Pubertal development corresponded to age of all girls. Conclusion. It has been established that vaccination against the human papillomavirus does not have a negative impact on the reproductive system of teenage girls. However, additional dynamic studies are needed at different age periods of girls and women vaccinated against HPV to confirm the positive effect on the sexual sphere and formation of strong adherence to vaccination.
Premature ovarian insufficiency in patients with galactosemia
Authors: Karachentsova Irina V. , Sibirskaya Elena V. , Khairullina Adelina A.
Published: May 2024

Background. Galactosemia is a congenital disorder of carbohydrate metabolism caused by a defect in any of the enzymes of galactose metabolism. One of the long-term complications is premature ovarian insufficiency (POI), which is more common in patients with the c.563A>G (Q188R) mutation in the homozygous state in the galactose-1-phosphate uridylyltransferase (GALT) gene. At the same time, fertility factors may be higher in patients with POI caused by classical galactosemia (CG) compared with other causes of POI, which makes it difficult to resolve the issue of the need to use fertility preservation methods for this group of patients in the prepubescent period. Case report. This article describes two clinical observations of patients with CG who were diagnosed with hypergonadotropic hypogonadism. Patient A. was initiated hormone replacement therapy (HRT) at the age of 11, and according to the results of osteodensitometry, there is currently no decrease in bone mineral density. In patient C. at the age of 14, before the start of HRT, ovaries without pronounced follicular apparatus, osteopenia and osteoporosis were detected. The issue of the necessity and timing of the use of fertility preservation methods is being considered. Conclusion. Patients with CG are recommended to monitor hormonal profile indicators for timely administration of HRT. Cryopreservation of ovarian tissue should be considered as one of the options for maintaining fertility in patients with CG, taking into account that some of them still have the possibility of spontaneous pregnancy, despite the POI.
SYMPOSIUM “WHAT TO CHOOSE FOR A PEDIATRICIAN: TREAT BY YOURSELF OR SEND TO A SUBSPECIALIST?”
Authors: Editorial Article
Published: May 2024

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SYMPOSIUM “SMALL DOSES IN BIG PEDIATRICS”
Authors: Editorial Article
Published: May 2024

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SYMPOSIUM “HPV VACCINATION — A FUTURE WITHOUT CERVICAL CANCER”
Authors: Editorial Article
Published: May 2024

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SYMPOSIUM “VACCINE-PREVENTABLE DISEASES IN A MEGALOPOLIS. PROSPECTS FOR THE MODERNIZATION OF THE REGIONAL CALENDAR OF PREVENTIVE VACCINATIONS”
Authors: Editorial Article
Published: May 2024

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SYMPOSIUMS “COMING TO SCHOOL SOON: CLINICAL DISCUSSIONS AND NEW ALGORITHMS” AND “NIEMANN — PICK DISEASE TYPE A/B: THE DIFFICULTIES OF DIAGNOSIS AND THE POSSIBILITIES OF THERAPY”
Authors: Editorial Article
Published: May 2024

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SYMPOSIUMS “CHALLENGENG ROAD TO LONG-TERM CONTROL OF BRONCHIAL ASTHMA: HOW TO BUILD A ROUTE?” AND “EARLY INTERVENTION IN THE MANAGEMENT OF PATIENTS WITH ATOPIC DERMATITIS”
Authors: Editorial Article
Published: May 2024

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Rationale, completeness and quality of evidence for the use of ursodeoxycholic acid in neonatal hyperbilirubinemia
Authors: Zakharova Olesya V.
Published: May 2024

Background. Systematic reviews are considered the highest evidence of the effectiveness and safety of treatment methods used in clinical practice. The veracity of a results and conclusions of systematic reviews is directly related to their quality. The aim of the study is an assessment of the currency, completeness and methodological quality of published systematic reviews on the evaluation of the effectiveness of ursodeoxycholic acid (UDCA) for the treatment of neonatal hyperbilirubinemia. Materials and methods. A meta-epidemiological methodological study was conducted. The search for evidence sources was performed in November 2023 in the specialized databases MEDLINE, Cochrane Central Register of Controlled Trials (CENTRAL), Cochrane Database of Systematic Reviews (CDSR), LILACS, CNKI, LENS.ORG, еLibrary.Ru, in registers ClinicalTrials.gov, ICTRP, ISRCTN, PROSPERO, as well as in the Google Academy and Google search engines. Additionally, the lists of references and citations of selected publications have been reviewed. Only systematic reviews and randomized clinical trials are included in the study. The search was carried out to assess the currency and completeness of systematic reviews. A systematic review is considered currency if the most recent studies are included in its analysis. A systematic review is considered complete if its analysis includes all identified studies that meet the inclusion criteria set by the review authors and are published no later than the date of the last search conducted by the review authors. The methodological quality of the systematic reviews was assessed using the AMSTAR-2 tool. Results. As a result of the search, 4 systematic reviews and 23 randomized trials were identified. All reviews evaluated the effect of UDCA in combination with phototherapy on the level of total serum bilirubin, the duration of phototherapy and the frequency of adverse events (for example, loose stools, vomiting, rash) compared with phototherapy alone and/or placebo. All systematic reviews have been published over the past two years, but have already lost their currency. There are missing studies and/or outcomes in each review. The methodological quality of the reviews was found to be extremely low. Conclusion. Given the listed shortcomings of systematic reviews, their results and conclusions should be treated with caution. In order to obtain the most accurate and reliable evidence, a new systematic review is needed.
Preventive Efficacy, Safety, Immunogenic Activity, and Evaluation of Post-Vaccination Responses Following Immunization with Combined Trivalent Vaccine Vaktrivir (Measles-Rubella-Parotitis) in Premature Infants
Authors: Semerikov Vadislav V. , Yаkobyuk Nina O. , Sofronova Lyudmila V. , Yuminova Nadezhda V. , Vorobjeva Natalia N. , Kontarov Nikolay A.
Published: May 2024

Background. Registration of combined trivalent vaccine Vaktrivir (measles-rubella-parotitis) in Russia necessitates studies on its preventive efficacy, safety, immunogenic activity, and post-vaccination responses following the immunization of premature infants. Objective. The aim of the study is to evaluate efficacy, safety, and immunogenic activity of combined trivalent vaccine (measles-rubella-parotitis) and level of post-vaccination responses following the immunization of premature infants. Methods. Experimental studies were conducted to evaluate safety, immunogenicity, and postvaccinal responses after immunization of premature infants with combined within prospective comparative clinical observation. Results. Administration of the combined trivalent vaccine Vaktrivir (measles-rubella-parotitis) in premature infants has shown: no cases of measles, rubella or parotitis among vaccinated persons within prospective clinical observation for 2 years; no disturbances in parameters of clinical blood analysis, biochemical blood count, total IgE, IgA, IgM, IgG (immunogram), or urine analysis among vaccinated children over time; no subjective perceptions, adverse events signs at physical examination among vaccinated compared to baseline parameters; low post-vaccination reactions (6.7%) and similar tolerance of trivalent vaccine Vaktrivir among full-term infants (3.3%) (p = 0.301). Conclusion. Administration of the combined trivalent vaccine Vaktrivir (measles-rubella-parotitis) in premature infants has demonstrated high safety profile and immunogenic properties for measles, rubella and parotitis components, good tolerability, and low post-vaccination responses after immunization, comparable to vaccination of full-term infants.
Clinical Case of Rare Genetic Disorder (Proud Syndrome) in a Child
Authors: Vertianova Anastasiia N. , Monakhova Anna V. , Suraeva Ulyana S. , Matiasova Olga M. , Shutkova Alla Yu. , Tush Elena V. , Yacishina Elena E. , Suslova Marina A. , Khaletskaya Olga V.
Published: May 2024

Background. Proud syndrome is rare inherited disease with X-linked inheritance associated with mutations in the homeobox gene ARX. Typical clinical signs of this syndrome are severe mental retardation, intractable epilepsy, agenesis (dysgenesis) of corpus callosum. Less common features are genital abnormalities, microcephaly, facial dysmorphia, and skeletal malformations.Clinical case description. The article describes the clinical findings of Proud syndrome in girl A., admitted to Children’s City Clinical Hospital No. 1 in Nizhny Novgorod. The girl was born without asphyxia at term through natural vaginal delivery after the first uneventful pregnancy. Body weight at birth was 2600 g. The genealogical history is burdened by the presence of epilepsy in girl’s father relatives. There were no deviations in psychomotor skills development before disease onset. Hemi-convulsive seizures (switching sides) have appeared at the age of 6 months. These attacks had status course and were resistant to anticonvulsant therapy. Neuroimaging has revealed agenesis of corpus callosum. Regression of psychomotor development, new behavioral disorders (stereotypes and auto-aggression), hyperexcitability, and sleep disorders were observed in dynamics. The diagnosis of Proud syndrome was confirmed by identification of probably pathogenic mutation in the ARX gene (c.1111C>T, p. Arg 371*64). The features of anticonvulsant management were demonstrated in the patient.Conclusion. This clinical case presents typical clinical picture of Proud syndrome. The disease is non-curable. Such patients should be administered with syndromic therapy: constant anticonvulsant therapy, correction of behavioral disorders (classes with specialist on mental defects), neurologist, epileptologist, psychiatrist observations. Parental examination is crucial ARX mutation search in order to determine the prognosis for further child-bearing (parents refused to perform genetic study at the time of article writing).
Case report of the perinatal form of Nieman-Pick disease type С against the backdrop of pathogenetic off-label therapy
Authors: Mingacheva Nailya R. , Kamalova Aelita A. , Artykova Nargis A. , Rakhmaeva Razilya F. , Sageeva Gulnara I.
Published: May 2024

Background. Niemann–Pick disease type C is a multisystem orphan disease caused by mutations in the NPC1 and NPC2 genes and characterized by clinical polymorphism. The difficulties of managing such patients lie in the diagnosis and differential diagnostic search with other conditions with cholestasis, as well as the initiation of substrate-reducing therapy in young children. Case report. Previously, a case report of Niemann–Pick disease type C, with the manifestation of the disease in infancy and the appointment of off-label pathogenetic therapy was described. The article presents the results of dynamic monitoring of the child on this therapy, its effectiveness and safety. The leading syndromes in the clinical presentation of the disease were cholestasis, cytolysis, hepatosplenomegaly, as well as psychomotor retardation. An extensive differential diagnostic search was conducted with the exception of diseases such as toxic, viral hepatitis, alpha-1-antitrypsin deficiency, autoimmune liver diseases, aminoacidopathy, Alagille syndrome. Genetic testing on the “Cholestasis” panel revealed a mutation in the NPC1 gene. Biochemical diagnostics showed an increase in the concentration of lysosphingomyelin-509 and increased activity of chitotriosidase in dry blood spots. When sequencing the NPC1 gene by Sanger, the nucleotide substitution chr18:21131617G> A in the homozygous state was detected in the child. At 9 months, by the decision of the medical board, the child was prescribed pathogenetic therapy, the effectiveness of which was confirmed by clinical and laboratory relief of cholestasis, positive dynamics of neurological manifestations, in addition, the drug is satisfactorily tolerated by the patient, despite the preservation of an isolated increase in the level of aspartate aminotransferase. Conclusion. The presented case report confirms the need for a thorough differential diagnostic search with the inclusion of a wide range of diseases with the leading cholestasis for the timely detection of infants with Niemann- Pick disease type C, as well as the importance and effectiveness of early administration of pathogenetic therapy.
Successful Treatment of Multiple Arterial Thrombosis in Premature Infant: Clinical Case
Authors: Matros Ekaterina S. , Aksenov Anton O. , Demina Sofia A. , Larina Liubov E.
Published: May 2024

Background. Neonatal thrombosis remains a complex and urgent challenge due to the presence of certain features of the hemostasis system in newborns and the variety of clinical signs. Management approaches are still under consideration, therapeutic experience of thrombolytic therapy (TLT) remains limited and requires benefit-risk assessment. Clinical case description. Clinical case of premature infant with multiple arterial thrombosis diagnosed on the 1st day of life is presented. Modern diagnostic features have allowed to establish the right diagnosis quickly and to start the treatment in time despite the similarities of clinical signs with congenital heart disease. Conclusion. TLT and heparin therapy have saved the child’s life, reversed ischemia, and preserved lower limbs from death. Doctors must perform dynamic monitoring during TLT to diagnose and correct hemorrhagic complications in timely manner.
XXV CONGRESS OF PEDIATRICIANS OF RUSSIA WITH INTERNATIONAL PARTICIPATION “ACTUAL PROBLEMS OF PEDIATRICS”
Authors: Editorial Article
Published: May 2024

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Estimating Agent Skill in Continuous Action Domains
Authors: Archibald Christopher , Nieves-Rivera Delma
Published: May 2024

Actions in most real-world continuous domains cannot be executed exactly. An agent’s performance in these domains is influenced by two critical factors: the ability to select effective actions (decision-making skill), and how precisely it can execute those selected actions (execution skill). This article addresses the problem of estimating the execution and decision-making skill of an agent, given observations. Several execution skill estimation methods are presented, each of which utilize different information from the observations and make assumptions about the agent’s decision-making ability. A final novel method forgoes these assumptions about decision-making and instead estimates the execution and decision-making skills simultaneously under a single Bayesian framework. Experimental results in several domains evaluate the estimation accuracy of the estimators, especially focusing on how robust they are as agents and their decision-making methods are varied. These results demonstrate that reasoning about both types of skill together significantly improves the robustness and accuracy of execution skill estimation. A case study is presented using the proposed methods to estimate the skill of Major League Baseball pitchers, demonstrating how these methods can be applied to real-world data sources.