bluuebunny/crossref_metadata_2025 huggingface dataset:
Experimental investigation and numerical optimization of sheet metal forming limits during deep drawing process of DD14 steel
Authors:   Department of Mechanical Engineering, Badji Mokhtar University, Hamza Faouzi , Boussaid Ouzine ,   Department of Mechanical Engineering, Badji Mokhtar University, Hamadache Hamid ,   Department of Mechanical Engineering, Badji Mokhtar University, Guedri Abdelmoumene ,   Department of Mechanical Engineering, Med Chérif Messaadia University
Published: March 2024

This work aims to experimentally study the deep drawability of DD14 hot-rolled steel sheets and to optimize numerically the material formability. The material anisotropy was confirmed by metallographic analysis of the material and tensile tests on specimens taken in three orientations with respect to the sheet rolling direction. Where the stress-strain curves show a sensitivity of material to the Piobert-Lüders phenomenon. The die pressure and the blank holder were considered as controlling factors on plastic instability and the success of the deep drawing operation. The forming limit curves (FLC) were plotted to highlight the different deformation modes that the sheet metal underwent during the deep drawing process. The collected deep-drawn parts observation shows severe plastic instability, until fracture. The initial plastic anisotropy is determined by the Hill48 quadratic criterion and the work hardening by the Hollomon power law. It results, during the experimental tests, that the front bottom corners of the deep drawn part are the areas at high risk of damage. The various numerical simulation scenarios followed by comparisons with the experimental results, allowed us to confirm the optimum conditions that minimize the material's plastic instability risks, forming operation “Step” and BHP “Amplitude”.
Effect of GGBFS and fly ash proportions on fresh, tensile and cracking features of alkali activated concrete with low NaOH concentrations
Authors:   Department of Civil Engineering, National Institute of Technology, Warangal, India, Venkateswarlu Mangalapuri , T.D Gunneswara Rao T.D Gunneswara Rao ,   Department of Civil Engineering, National Institute of Technology, Warangal, India
Published: March 2024

This study mainly investigated the tensile and cracking features of ash alkali activated concrete with different slag-fly ash proportions and low NaOH concentrations cured at ambient temperature. High-molarity NaOH leads to risk and is costly, whereas, in field conditions, heat curing is difficult. Therefore, in this study three mixes (mix-A, B and C) were developed using 0/100, 20/80, 40/60, 60/40, 80/20, and 100/0 slag-fly ash proportions in this study. Sodium hydroxide (SH) and sodium silicate (SS) were used as activators and concentrations of sodium hydroxide were used as 1M, 2M and 4M in mixes A, B and C respectively, but alkaline ratio (SS/SH) was fixed as 1.5 in all the mixes. Slump, and strength aspects (compressive, split tensile, and flexural) were evaluated. The tensile (tensile strength, tension stiffening) and cracking characteristics (crack spacing, crack width) were evaluated under uniaxial tensile loading on reinforced prismatic members. From test outcomes, workability in terms of slump of the composites decreased with increased percentage of slag or granulated blast furnace slag (GGBFS) in the total binder, but the tensile (tensile stress and tension stiffening effect) and compressive strengths increased with increasing percentage of GGBFS. Better cracking properties (i.e., minimum crack widths and reduced crack spacings) were observed when the mixes contained higher percentages of GGBFS. The obtained crack spacings were correlated with CEB-FIP model code, and existing research studies. The crack spacings obtained in this study are consistent with CEB-FIP model code. Finally, this study demonstrated that when slag-fly ash alkali activated concretes were prepared with solutions containing low NaOH concentrations and cured at room temperature (ambient), there was an increase in the strength and cracking properties with higher percentages GGBFS.
Prospects for induction of labor with oxytocin within 12 hours (perinatal center experience)
Authors: Baranova Maria V. , Ksenofontov Aleksei M. , Shestak E. V. , Vagushchenko Uliana A.
Published: March 2024

Objective. Demonstrate the expediency and effectiveness of labor induction for more than 6 hours (up to 12 hours of the latent phase).
Materials and methods. A cohort, descriptive, single-center study was conducted. The effectiveness of labor induction with oxytocin for more than 6 hours was estimated. The birth medical histories of 3265 patients of SBHI of Sverdlovsk Region "Yekaterinburg Regional Perinatal Center" from January 2020 to December 2022, who underwent pre-induction and induction of labor, were analyzed.
Results. The group of patients, who underwent induction of labor with oxytocin, was 2261 cases. In 1269 (56.13 %) patients, vaginal delivery occurred after less than 6 hours of labor induction with oxytocin. In 992 patients (43.87 %) induction of labor with oxytocin was continued for more than 6 hours. Only 320 labors resulted in abdominal delivery due to ineffective labor induction, which amounted to 32.3 % (of the number of labor inductions with oxytocin for more than 6 hours) and 14.2 % (of the total number of labor inductions with oxytocin).
Conclusions. Induction of labor with oxytocin for more than 6 hours (up to 12 hours of the latent phase) is reasonable and effective. It allows to avoid abdominal delivery in up to 30 % of patients of the study group.
Analysis of hardware methods of treatment of patients with temporomandibular joint dysfunction
Authors: Dolgalev Alexander A. , Khristoforando D. Yu. , Garus Ya. N. , Ivensky V. N. , Brazhnikova A. N. , Khorev O. Yu. , Bulycheva E. A. , Geletin P. N. , Kerefova Z. V. , Chepurko Yu. V. , Uspenskaya O. A.
Published: March 2024

Objective. To conduct a comparative analysis of effectiveness of treatment of patients with dysfunction of temporomandibular joint (DTMJ) using hardware methods of treatment with occlusive mouthguards of various types.
Materials and methods. 99 patients (88 females and 11 males aged 41,2 ± 10,7) with different combinations of revealed and confirmed signs of DTMJ were examined from 2013 to 2023. According to the personal clinical picture, complaints revealed, aetiology and pathogenesis of the disease all the patients of the comparison group and 2 main groups (99 patients) were administered individual complex treatment for DTMJ. The treatment was aimed at the elimination of pain, relief of masticatory muscles spasm, improvement of the extent of opening of mouth, correction of the lower jaw position, occlusive interference elimination and restoration of height of the lower third of the face.
While carrying out the hardware treatment, occlusive mouthguards of 3 types were made based on the jaw model of the patients. The models were got from the silicone imprints of the jaw.
Results. MR images of temporomandibular joints of the 99 patients showed that ventral dislocation of articular disk occurred most frequently (in 88 patients). Less frequently (4 % of cases) it was combined with dislocation of the disk laterally. Rarely distal dislocation of the articular disk occurred – 1,9 % of cases (2 patients). Study of the results of the appliance of different types of occlusive mouthguards demonstrates the necessity to work out the types of occlusive devices allowing decompression of temporomandibular joint elements, centering lower jaw position and orthodontic elimination of dentofacial abnormalities and deformities which lead to occlusive interference.
Conclusions. Analysis of occlusive devices used in the diagnosis and treatment of patients with DTMJ shows that the most effective devices are those that successfully combine elements of splints with a narrower purpose.
Dynamics of formation of anti- bodies to SARS-CoV-2 after coronavirus infection in children
Authors: Bogomolova Irina K. , Peregoedova Valentina N.
Published: March 2024

Objective. To estimate the level of antibodies to SARS-CoV-2-IgM and SARS-CoV-2-IgG in children with COVID-19 in acute period and during 1 year period of follow-up after coronavirus infection.
Materials and methods. Blood samples for the presence of IgM and IgG antibodies to SARS-CoV-2 were analyzed in 119 children aged 11.0 [10.1; 11.2] with COVID-19 in the acute period (29.4 % asymptomatic, 51.3 % mild and 19.3 % moderate), and SARS–CoV-2-IgG in the dynamics of the follow-up after 1 (n=55), 6 (n=33) and 12 (n=32) months from the moment of discharge from the hospital in a prospective cohort study. The levels of SARS-CoV-2 surface glycoprotein S, including the receptor-binding domain – RBD were measured at different time by using enzyme-linked immunosorbent assay.
Results. The level of IgM positive rate for SARS-CoV-2 was initially negative in 86.6 % of children with COVID-19. The original seroconversion (on admission to the hospital) was 38.7 % and it increased to 96.7 % in 1 month and to 100 % in 12 months of observation. There were no statistically significant differences in IgG persistence depending on the age and course of COVID-19.
Conclusions. The new coronavirus infection causes a long-term response of IgG antibodies to SARS-CoV-2 which persists for one year of observation and increases by 12 months after the infection regardless of the severity of COVID-19.
Influence of vaccine prevention on the spread and serotype composition of Streptococcus pneumoniae in military collectives
Authors: Mukhachev Ivan S. , Blagonravova Anna S. , Feldblyum Irina V. , Alyeva Maya Kh.
Published: March 2024

Objective. Study of the effect of vaccination against pneumococcal infection on the prevalence and serotype composition of S. pneumoniae in military personnel.Materials and methods. The study was conducted among 369 military personnel of the military unit of the Sverdlovsk region. Determination of the frequency and serotype of S. pneumoniae was carried out upon admission and after 1.5 months of stay in the military collective using the multiplex PCR method.Results. After 1.5 months of stay of servicemen in the military collective, a significant activation of pneumococcal circulation was established (χ2McNemar=24.038; p0.001). The risk of S. pneumoniae infection among unvaccinated military personnel was 1.39 times higher compared to vaccinated military personnel (RR=1.39; 95% CI 1.209–1.596). In the group of unvaccinated military personnel, the frequency of occurrence of vaccine serotypes was 2.6 times higher than in vaccinated ones (χ2 = 6.25; p = 0.01).Conclusions. The proactive influence of immunization against pneumococcal infection on the prevalence and serotype landscape of S. pneumoniae has been established: A low prevalence of vaccine serotypes and a predominance of non-typeable serotypes have been revealed among vaccinated individuals.
Analysis of a clinical case of managing a patient with intraoperative bladder injury
Authors: Kalinkina Olga B. , Tezikov Yury V. , Lipatov Igor S. , Mayorova Maria O. , Sreseli Georgy M.
Published: March 2024

To analyze a clinical case of successful treatment of a patient with intraoperative bladder injury.
The results of examination and treatment of patient S., 39 years old, were studied. The reasons for iatrogenic bladder injury in this clinical case were two surgeries on the bladder in childhood, a pronounced adhesive process of the small pelvis, and the inability to foresee the atypical localization of the bladder welded to the anterior abdominal wall. A pronounced adhesive process might also be caused by endometriosis, which had not been diagnosed and treated in this patient.
Timely referral of the patient to a gynecologist for a check-up with ultrasound examination of the pelvic organs would have allowed to reveal endometriosis, timely treat it and avoid the formation of a large endometrioid cyst, which required surgical treatment. In this clinical case attention is drawn to the lack of an interdisciplinary approach to the management of this patient, defects in dispensary supervision. Despite the complication occurred, performing the stages of operation together with an urologist, adequately prescribed postoperative therapy for the prevention of recurrence of endometriosis, rehabilitation in the urology department made a favorable course of the postoperative period possible, bladder function was restored and clinical manifestations of endometriosis were controlled.
Study of antiarrhythmic activity 2-(n-butylpyrrolidine)-N-(2-bromophenyl)carboxamide hydrochloride
Authors: Rudakova Irina P. , Chashchina S. V. , Starkova A. V.
Published: March 2024

Objective. To study the efficacy of a new derivative 2-(alkylpyrrolidine)-N-(aryl)carboxamide with high antiarrhythmic activity.
Materials and methods. To study the antiarrhythmic activity of the compound, the experiment was carried out on models of arrhythmia caused by intravenous administration of aconitine and adrenaline. The effect was estimated by its ability to prevent the onset of arrhythmia, prolong the survival time of the animals or by the duration of an arrhythmia attack. In addition, the electrocardiogram of awake rats was analyzed. The studied compound and the comparison drug (lidocaine) were injected to the animals intravenously in effective antiarrhythmic doses.
Results. In aconitine arrhythmia 2-(n-butylpyrrolidine)-N-(2-bromophenyl) carboxamide hydrochloride provides statistically significant limitation of the duration of arrhythmia attacks in experimental animals (1.7 times) in comparison with the control and also reduction of arrhythmia duration in comparison with
lidocaine (2.5 times); besides, this compound guarantees animals’ survival in 100 % of cases. When causing
arrhythmia by adrenaline administration, the compound does not prevent the occurrence of cardiac rhythm disorder. The electrocardiogram readings of animals do not change significantly.
Conclusions. 2-(n-butylpyrrolidine)-N-(2-bromophenyl) carboxamide hydrochloride (compound K-23) shows visible activity in models of arrhythmia caused by administration of aconitine and calcium chloride, which may indicate its ability to impede the sodium flow through the cell membrane by slowing depolarization of cardiomyocytes.
Since the compound studied, demonstrates high antiarrhythmic activity without changing the ECG readings, the drug created on its basis may be effective.
100th anniversary of perm scientific school of medical diagnostics
Authors: Mishlanov V. Ju.
Published: March 2024

Department of Propaedeutics of Internal Diseases of E.A. Vagner Perm Medical University is celebrating its 100th anniversary. The original name was the Department of Medical Diagnostics. It was the development of medical diagnostic methods that became the key theme of the 100-years development of the scientific and pedagogical school in medicine. Modern scientific achievements of the department's employees are known in Russia and abroad. They include new principles of making a medical diagnosis in a remote consultation, remote monitoring of patients with the application of interactive questionnaires and use of biosensor data. New methods of studying the human body based on measuring electrical impedance are being used.
The concentration of serum neopterin in patients with surgical treatment of spondyloarthrosis complicated byfacet syndrome
Authors: Pronin Artur Yu. , Karakulova Yuliya V. , Sosnin Dmitriy Yu.
Published: March 2024

Objective. To study the concentration of serum neopterin in patients before and after surgical treatment of pain syndrome caused by the formation of facet syndrome associated with spondyloarthrosis.
Materials and methods. The study involved 52 patients (32 men and 20 women) hospitalized to the neurosurgical department of the City Clinical Hospital No. 4. The main group consisted of 26 patients with spondyloarthrosis complicated by chronic pain associated with facet syndrome. The comparison group (n=26) consisted of patients with pain syndrome in radiculopathy. The control group (comparable in gender and age) consisted of 10 people who underwent periodic examination. The concentration of neopterin in blood serum was determined by solid-phase enzyme immunoassay (ELISA) using the Neopterin ELISA kit (cat. No. 59321; lot ENO230) ("IBL", Germany).
Results. Statistically significant differences in the level of serum neopterin concentration (p = 0.0016) were revealed between the studied groups. The highest concentration of neopterin was noted in the comparison group, where it was 10.31 ± 2.02 nmol/l, exceeding the results of the control group (p=0.02256) and the main group (p=0.04996). Three months after surgical treatment of patients in the main group, the median content of serum neopterin decreased by 1.161 times (p = 0.049029).
Conclusion. Further studies to clarify the influence of pain on metabolic processes and neopterin in particular are required.
Risk factors for development of type 2 diabetes mellitus in patients with obesity in late post-COVID period
Authors: Yuzhakova E. V. , Shanko Z. G. , Smirnova E. N.
Published: March 2024

Objective. To study the risk factors for developing type 2 diabetes mellitus in patients with obesity after COVID-19.
Materials and methods. 61 case histories and outpatient card abstracts of patients with obesity, who suffered from moderate and severe forms of COVID-19 from 02.2021–04.2022 were analyzed. Demographic, laboratory and clinical parameters were studied during hospitalization and 12 months after discharge from the hospital. All patients initially were divided into 2 groups according to the glycated hemoglobin level. Group 1 consisted of 46 patients with prediabetes and group 2 included 15 patients without carbohydrate disorders.
Results. The median age of all patients was 64 (59–66) years. Median of HbAlc was 6,0 (5,6–6,2) %, BMI –34 (33–35) kg/m2. 24 patients from group 1, who took DPP-4-inhibitors in early post-COVID-19 period constituted subgroup 1A and 22 patients, who refused treatment with these drugs, constituted subgroup 1B. Currently, 2 patients from subgroup 1A and 10 patients from subgroup 1B (χ2=8,2 р=0,004) have been diagnosed with DM2. In patients who developed DM2 in late post-COVID period the levels of HbAlc, fasting plasms glucose and BMI at the time of admission to the hospital were significantly higher (n=12) than in patients with persistent prediabetes (n=34), (p0,05). Positive correlation between these parameters and the risk of developing DM2 (R=0,5, p0,05; R=0,74, p0,05; R=0,54, p0,05, respectively) was determined. In group 2, DM2 is currently diagnosed in 2 male patients with BMI over 40 kg/m2. When comparing subgroup 1B and group 2, it was found out that DM2 in the post-COVID period occurs in every second patient with the previous initial carbohydrate disorders: in 10 people of 22 – in subgroup 1B (every 2nd patient) versus 2 patients from group 2 (every 7th patient), (χ2=4,2, p=0,04). Online calculator from medstatistic. ru was used to determine relative risk (RR).
Conclusions. Thus, presence of impaired glucose tolerance increases the risk of development of DM2 in late post-COVID period. In patients with hyperlycemia on hospitalization for COVID-19, who did not receive incretin therapy (subgroup 1B) risk of DM2 was 3,4 times higher (CI 95 %=0,87–13,40). Patients, who received incretin (subgroup 1A) had risk of DM2 = 0,6 (CI 95 %=0,09–3,97). It should be assumed that incretin therapy prevents development of DM2 in patients with hyperglycemia/impaired glucose tolerance after COVID-19.
Determination of the Ki-67 threshold value for predicting lymph nodes involvement in patients with gastric cancer
Authors: Ashimov Е. А. , Chichevatov D. А. , Radovsky V. V. , Kolesnikova Е. А. , Klimin S. А. , Gamayunov S.  V. , Zagainov V. Е. , Kiselev N. М.
Published: March 2024

The search for biological markers to assess metastatic involvement of the lymph nodes in gastric cancer is one of the key steps in determining treatment tactics. The role of Ki-67 as a marker of cell proliferation in gastric cancer remains relevant. The aim of our study is to determine the Ki-67 threshold value for predicting the lymph nodes metastases. A retrospective analysis of 154 patients with gastric cancer showed an independent and statistically significant relationship between the depth of tumor invasion T (p = 0.002), the differentiation grade G (p = 0.010), the value of the Ki-67 index (p < 0.0001) and metastatic involvement of the lymph nodes. Using ROC analysis we found that Ki-67 ≥ 45 % correlates with the optimal level of sensitivity (55.9 %), specificity (84.2 %) and accuracy (73.4 %) of the method AUC 0.738 (p >< 0.043; 95 % CI 0,654–0,823). When evaluating the overall survival of patients>< 0.0001) and metastatic involvement of the lymph nodes. Using ROC analysis we found that Ki-67 ≥ 45 % correlates with the optimal level of sensitivity (55.9 %), specificity (84.2 %) and accuracy (73.4 %) of the method AUC 0.738 (p < < 0.043; 95 % CI 0,654–0,823). When evaluating the overall survival of patients >0.043; 95 % CI 0,654–0,823). When evaluating the overall survival of patients with Ki-67 > 45 %, we found that the median OS was 32 months [HR 2.2; 95 % CI 1.2–3,9; p = 0.005], while it was not reached in the group with Ki-67 < 45 %.

A Ki-67 level of ≥ 45 % is the optimal threshold for determining the likelihood of lymph node metastasis in gastric cancer.
Influence of the radiotherapy target volume and prognostic factors on the results of treatment of patients with cervical lymph nodes metastases of squamous cell carcinoma of unknown primary
Authors: Sheiko А. V.
Published: March 2024

Introduction: The issues of the radiotherapy target volumes in cases of cervical lymph nodes metastases of squamous cell carcinoma of unknown primary (SCCUP) remain unresolved due to the lack of clinical studies. Escalation or de-escalation of treatment may be directly related to prognostic factors. Purpose of this study was to evaluate the results of treatment using ipsilateral (only involved side of the neck) or total (bilaterally neck and pharyngeal mucosa) radiation therapy (RT) and to analyze the influence of clinical factors on overall survival (OS) and progression-free survival (PFS).

Methods: A retrospective non-randomized clinical trial was conducted. Two-year OS and PFS were assessed in 26 SCCUP patients, who underwent combined treatment, including radiation therapy. Inoperable patients received either definitive RT (3.85 %) or sequential chemoradiation therapy (CRT, 11.5 %), or concurrent CRT (3.85 %). Operable patients underwent neoadjuvant RT with lymph node dissection (34.6 %) or lymph node dissection with adjuvant RT (11.5 %) or adjuvant sequential CRT (7.7 %) or adjuvant concurrent CRT (27 %); 50 % of patients received RT in a dose of more than 60 Gy, in 50 % it was less than 60 Gy. In 54 % of patients, only the ipsilateral cervical lymph nodes were included in the irradiation volume while 46 % of patients received RT to the pharyngeal mucosa and lymph nodes of the neck bilaterally (total radiation therapy group).

Results: The median follow-up was 17 months. The 2‑year OS was 71.5 % (95 % CI 49.3–85.3 %), the 2‑year PFS was 72.1 % (95 % CI 44.5–87.6 %). There were no significant differences in 2‑year OS between the ipsilateral and total radiotherapy groups (HR = 1.08 [0.29–4.06], p = 0.904). Only a factor of extranodal extension (ENE) had a statistically significant impact on OS (HR = 6.05 [1.45–25.19], p = 0.0134).

Conclusion: There was no statistically significant difference in 2‑year OS and PFS between the ipsilateral and total radiation therapy groups. A negative prognostic factor is the extranodal extension (ENE) of a metastatic tumor. Prospective randomized trials are needed.
Study of the pharmacokinetics, pharmacodynamics, and safety of the biosimilar pembrolizumab RPH-075 compared to Keytruda® in patients with malignant neoplasms
Authors: Samoylenko I.  V. , Pokataev I. А. , Zhukova L. G. , Stroyakovsky D.  L. , Orlova R.  V. , Mudunov А. М. , Pak М. В. , Zernova Е. V. , Sobolev А. V. , Mochalova А. S. , Alekseev B. Ya. , Sekacheva М. I. , Ledin Е. V. , Petkova А. V. , Khanonina Е. К. , Podolyakina А. I. , Razzhivina V. А.
Published: March 2024

Introduction: Pembrolizumab is a humanized monoclonal antibody selectively blocking the interaction between the PD-1 receptor and its ligands. The drug RPH-075 is a biosimilar to the original Keytruda®.

Objective: To establish the equivalence of pharmacokinetic (PK) properties, as well as pharmacodynamic (PD) parameters, safety, and immunogenicity of the drug RPH-075 compared to Keytruda® in patients with malignant tumors.

Materials and Methods: This multicenter double-blind randomized study included 90 patients with melanoma and non-small cell lung cancer who were randomized into two treatment groups (RPH-075 and Keytruda ®) in 1:1 ratio. In both groups, pembrolizumab was administered as monotherapy at a dose of 200 mg intravenously every 3 weeks until progression or intolerable toxicity. The primary aim of the study was to assess PK after the first administration. The primary endpoint for PK assessment was AUC(0–504), and for safety, it was the frequency of adverse events (AE). The decision on PK equivalence was planned to be made if the two-sided 90 % confidence interval (CI) for the geometric mean ratio of AUC(0–504) after a single administration of each drug would be within 80.00–125.00 %. Secondary endpoints included Cmax after the first administration, as well as the other PK, safety, and immunogenicity parameters. This study also assessed PK and PD parameters after multiple administrations, and a pilot efficacy assessment was planned.

Results: This article presents the analysis of data from the first stage of the study (after the first drug administration with a 3‑week observation period). The data analysis was blinded, and the treatment groups were coded as A and B. The 90 % CI for the geometric mean ratio of AUC(0–504) after the administration of drug A to AUC(0–504) of drug B was 93.50–121.16 %, and for the ratio of B to A, it was 82.54–106.95 %. The obtained intervals met the specified equivalence limit of 80.00–125.00 %, allowing us to conclude that RPH-075 and original Keytruda® are PK equivalent. Both drugs demonstrated comparably high saturation of PD-1 receptors on CD4+ / CD8+ lymphocytes at the end of the first cycle (day 22). Binding antibodies to pembrolizumab were detected in 2 patients (one in each group) over the analyzed period, indicating comparably low immunogenicity for both drugs. Safety profile analysis during this period revealed 7 AEs in 4 patients in group A and 4 AEs in 3 patients in group B. The frequency of AEs did not significantly differ between the groups.

Conclusions: PK, PD, immunogenicity, and safety parameters of the pembrolizumab biosimilar RPH-075 were equivalent to those of the original Keytruda®.
Uveal melanoma: the value of molecular genetic testing for early detection of metastatic disease. Clinical case
Authors: Yarovaya V. А. , Golanov А. V. , Nazarova V. V. , Zaretskii А. R. , Levashov I. А. , Kulagina А. К. , Melnikova Т. V. , Matyaeva А. D. , Yarovoy А. А.
Published: March 2024

To date, the issue of not only timely diagnosis and treatment of patients with uveal melanoma (UM), but also the prediction of this pathology remains relevant. The technology of fine needle aspiration biopsy (FNAB) makes it possible to assess the risk of developing metastatic disease using tumor specimen in patients undergoing organ-preserving treatment by cytological and molecular genetic testing in the primary intraocular lesion. Here we present a case of newly identified locally advanced (T3a) UM, outline the possibilities of organ-preserving treatment using Gamma Knife stereotactic radiosurgery, and also demonstrate the feasibility of conducting a comprehensive prognostic testing on FNAB material, including cytological and molecular genetic and morphological prognostic factors. The results of this testing have made it possible to recommend a more frequent surveillance monitoring regime for metastatic disease, which ultimately led to the early detection of UM liver metastases, followed by their successful treatment.
Preliminary results of surgical treatment and neoadjuvant chemotherapy in upper rectal cancer
Authors: Lukmonov S.  N. , Belenkaya Y.  V. , Gordeev S.  S. , Sadikov A.  J. , Mamedli Z. Z.
Published: March 2024

Introduction: There is a lack of information on the role of neoadjuvant chemotherapy in upper rectal cancer. The aim of our research was to investigate the role of neoadjuvant chemotherapy in upper rectal cancer treatment.

Materials and methods: We conducted a retrospective cohort multicenter study to analyze the medical records of patients with upper rectal cancer from 2007 to 2020 obtained from the archive of Research Institute FSBI «N. N. Blokhin Cancer Research Center» of the Ministry of Health of Russia, A. N. Ryzhikh National Medical Research Centre for Coloproctology, Stavropol regional Clinical oncological Dispensary and Kaliningrad oncological Center. All patients were divided into 2 groups: group 1 included patients who underwent neoadjuvant chemotherapy with CAPOX as the first treatment step, and group 2 included patients who underwent upfront surgery. Primary endpoint was 3‑year disease-free survival (DFS) rate. We also estimated the pathological complete response (pCR) rate, treatment toxicity, postoperative morbidity rate (Clavien – Dindo), degree of tumor regression, local recurrence rate, distant metastases rate, 3‑year overall survival (OS) and the neoadjuvant chemotherapy completion rate.

Results: 118 patients were included in the neoadjuvant chemotherapy group and 103 patients — in the surgery group. Study groups were well balanced and comparable for gender, the ASA status and the tumor differentiation grade. More patients in the neoadjuvant chemotherapy group had clinically positive lymph nodes (p = 0.002). Median follow-up period was 36 months. There were no significant differences in 3‑year OS and DFS. The local recurrence rate was 3.9 % in the surgery group versus 0 % in the neoadjuvant chemotherapy group (p = 0.046). There were no significant differences between study groups in the distant metastases rate (p = 0.293). Sixteen (13.6 %) patients had a pCR after neoadjuvant chemotherapy. The neoadjuvant chemotherapy completion rate was 91.5 %. The hematological toxicity grade 3–4 was observed in 3.3 % (4 patients), the non-hematological toxicity grade 3–4 in 3.3 % (4 patients).

Conclusion: NACT has an acceptable toxicity profile, does not impede oncological treatment results, and can be used in a selected group of patients for early systemic control.
Case reports of BRAF V600E-mutated tumors effectively treated using the agnostic approach
Authors: Prokudina N.  V. , Kramchaninov М. М.
Published: March 2024

A tumor-agnostic approach to cancer treatment that implies the selection of agents targeting specific genetic aberrations and signaling pathways regardless of the tumor site of origin represents a new direction in personalized oncology. Pembrolizumab is the first therapy approved for unresectable microsatellite instability-high (MSI-H) tumors of any location. In 2022, the combination of dabrafenib and trametinib was approved by the US Food and Drug Administration (FDA) for the treatment of patients with solid tumors harboring BRAF V600E mutations. Melanomas, colorectal cancers, and non-small cell lung cancers are BRAF-mutated in 60 %, 15 %, and 5–8 % of cases, respectively. BRAF-mutated glioblastoma (3 %), cholangiocarcinoma (5–7 %), pancreatic cancer (1–16 %), and Langerhans cell histiocytosis (57 %) have also been reported.

We present two case reports of BRAF-mutated salivary gland and pancreatic cancers in patients with progressive disease despite standard-of-care therapy who were treated with a combination of dabrafenib and trametinib according to the agnostic approach.

The presented case reports have demonstrated that the agnostic approach and treatment with BRAF / MEK inhibitors stabilize the disease in patients with BRAF-positive cancers, including those with multiple metastases, and represent an additional therapeutic option for patients with rare BRAF-mutated cancers for which very few pharmacologic options are available.
From Continuous Coverage to Medicaid Expansion: North Carolina’s Changing Public Payer Landscape
Authors: Dowler Shannon
Published: March 2024

During the COVID-19 pandemic, people who may have otherwise lost Medicaid coverage kept it without the need to reapply annually. In 2023, this continuous coverage began to unwind just as North Carolina prepared to expand Medicaid. This issue of the North Carolina Medical Journal tracks the evolution of the state’s public payer landscape in unprecedented times of change, with data, analysis, and personal experiences from public health, philanthropy, clinicians, and Medicaid members.
Keeping People Enrolled During Medicaid Expansion and COVID-19 Continuous Coverage Unwinding
Authors: Sandoe Emma
Published: March 2024

North Carolina is expanding Medicaid insurance coverage while simultaneously removing coverage from individuals as a result of the end of the COVID-19 emergency. These large-scale eligibility changes have created an opportunity for improved processes. North Carolina chose to build upon the existing Medicaid Family Planning program to maintain access to health care while launching Medicaid expansion.
Reflecting on Nearly Two Years of North Carolina’s Healthy Opportunities Pilots
Authors: Van Vleet Amanda
Published: March 2024

In March 2022, the North Carolina Department of Health and Human Services launched a first-in-the-nation program, the Healthy Opportunities Pilots, to reimburse for evidence-based, non-medical services through Medicaid. This article reflects on nearly two years of the pilot, including early findings and lessons learned to date.
Shared Success: Developing a Plan to Evaluate the Implementation and Impact of Medicaid Expansion in North Carolina
Authors: Dowler Shannon , Lerche Julia , Luques Melanie , Nash Matthew , Thompson Sam , White Janelle
Published: March 2024

The North Carolina Department of Health and Human Services plans to utilize a data-driven approach to evaluate the impacts of Medicaid expansion in the state. The evaluation plan includes tracking enrollment counts, creating metrics for monitoring of activities, setting measurable goals, and involving trusted community partners throughout.
NC Medicaid’s Telehealth Evolution: Access and Utilization in a Post-Pandemic State
Authors: Kuhn Jessica , Thompson Sam , Fletcher Hannah , Koenigsmark Tess , Dowler Shannon
Published: March 2024

Telehealth was instrumental in NC Medicaid’s ability to pro­vide health care during the COVID-19 pandemic. Analyses of utilization and survey data and interviews with key Medicaid payors and providers reveal trends in beneficiary access to and utilization of services, presenting NC Medicaid with opportunities to build upon lessons learned.
Lives Worth Saving: The Impact of Medicaid Expansion on Individuals in Recovery
Authors: Crosbie Kelly
Published: March 2024

A quarter of a million North Carolinians admit to experienc­ing opioid use disorder; over 1,000 die each year. Only 1 in 5 receives effective, evidence-based treatment. Medicaid covers treatment and will increase access for members with opioid use disorder, who have been found to fare better than those with private insurance.
NC Medicaid’s Early Experience with a Hospital at Home Program During the Public Health Emergency
Authors: Keil Arianna , Fair Ryan , Qi Wendy , Thompson Sam , Dowler Shannon
Published: March 2024

A quarter of a million North Carolinians admit to experienc¬ing opioid use disorder; over 1,000 die each year. Only 1 in 5 receives effective, evidence-based treatment. Medicaid covers treatment and will increase access for members with opioid use disorder, who have been found to fare better than those with private insurance.
Opportunities for Integration in the Dual Medicare-Medicaid Population: North Carolina Landscape Analysis
Authors: Freed Salama S. , Frascino Nicole , Jones Kelley A. , Giri Abhigya , Stewart Lucas , Hendel Keren , Clark Amy G. , Van Houtven Courtney , Higgins Aparna , Kaufman Brystana G.
Published: March 2024

Background

NC Medicaid is amid a transformation to value-based care models. The transformation requires the consideration of models that may best serve the 1 in 5 NC Medicaid beneficiaries who are dually enrolled in Medicare. The lack of integration of Medicare and Medicaid administration, financing, and care may contribute to suboptimal health outcomes and care experiences. Integrating Medicare and Medicaid to improve care for dually enrolled individuals requires knowledge of the demographic, eligibility, and enrollment trends, as well as the medical needs of these individuals throughout North Carolina.

Methods

We performed a cross-sectional analysis of 2019 NC Medicaid administrative enrollment data and 2015–2020 Medicare and Medicaid public use files.

Results

Nearly half of North Carolina’s full-benefit dual-eligible (FBDE) population was eligible for Medicare due to disability. About one-third of the FBDE population lost full Medicaid benefits at some point during 2019; of these, 65% were under age 65. Most FBDE beneficiaries were enrolled in Medicaid fee-for-service, with 3.5% enrolled in Community Alternatives Program (CAP) waivers, 2% in Medicaid waivers for beneficiaries with behavioral health or intellectual and developmental disabilities (BH/IDD) or traumatic brain injury (TBI), and 1% in the Program of All-Inclusive Care for the Elderly (PACE). Enrollment in Medicare Duals Special Needs Plans (D-SNPs) increased from 7.3% of the FBDE population in 2015 to 32.5% in 2021.

Limitations

This descriptive, cross-sectional evaluation of North Carolina duals may not be generalizable to other time periods and contexts.

Conclusion

Medicare-Medicaid integration presents an opportunity to improve the value of care for dual-eligible beneficiaries and aligns with the goals of NC Medicaid transformation. Integration strategies that leverage the current infrastructure may minimize disruption of services for beneficiaries and mitigate the impacts of unstable enrollment, particularly among working-age adults and disabled beneficiaries. The diversity within the dual-eligible populations requires a strategy designed to improve health equity across race, disability, eligibility, geography, and health care needs.
Exploring the causes of obstructive jaundice: a single-centre retrospective analysis
Authors: Murshid Mohsin Yahya , Al-Alhazmi Abdulellah Talal , Ansari Farrukh Alim
Published: March 2024

Background: Obstructive jaundice is a condition caused by bile flow blockage and has various benign and malignant etiologies. Accurate and timely diagnosis is essential for effective treatment, particularly in cases of possible malignancy. Advances in diagnostic methods have improved our understanding and management of diseases. This study aimed to investigate the causes and clinical presentation of obstructive jaundice in Saudi Arabian population.
Methods: This study included 193 patients diagnosed with obstructive jaundice admitted to the surgical wards from January 2019 to December 2022. Methods involved comprehensive clinical evaluations, medical history reviews, physical examinations, laboratory tests, and diagnostic imaging to identify the underlying disease. Data were collected systematically and statistically analyzed.
Results: The study included 193 patients with a male-to-female ratio of 1:1.4, and an average age of 54.10 years. Malignant causes, primarily carcinoma of the pancreatic head, accounted for 59.4% of cases, while benign causes, notably choledocholithiasis, accounted for 41.6%. Symptoms included jaundice, abdominal pain, and loss of appetite, with treatment varying according to the identified cause.
Conclusions: The study highlights that obstructive jaundice is more commonly found in females and tends to be caused by benign conditions in younger people, while malignant causes are more prevalent in older individuals. The most common malignant cause is carcinoma of the pancreatic head, and leading benign cause is choledocholithiasis. For diagnosing obstructive jaundice, key imaging techniques include magnetic resonance cholangiopancreatography (MRCP), endoscopic retrograde cholangiopancreatography (ERCP), and computed tomography (CT).
Expert dialogue on topical minocycline gel in acne vulgaris: minologue India
Authors: Kohli Malavika , Sangolli Prabhakar , Aurangabadkar Sanjeev , Damisetty Rajetha , Satish D. A. , Parasramani Shrichand G. , Ganjoo Anil , Jakhar Deepak , Nott Anand , Gandhi Miti , Dhoot Dhiraj , Chitnis Kruttika , Barkate Hanmant
Published: March 2024

Acne vulgaris is a common skin disorder with a global prevalence of about 9.4%. Oral antibacterials are recommended but they are associated with potential systemic side effects. Topical minocycline 4% has been recently approved by the United States Food and Drug Administration (US-FDA) for the management of moderate to severe acne. Although efficacy and safety are established, little is known of its real word usage. To review and appraise existing literature and make recommendations on the real world usage and positioning of topical minocycline 4% in acne management. The minocycline 4% consensus was developed by nine acne experts and was evidence-based on a review of recent topical minocycline 4% literature. A total of 11 questions were discussed regarding different domains like positioning of topical minocycline in acne management as monotherapy and combination therapy, safety and use in special population. Several recommendations were given regarding topical minocycline use like: no monotherapy use; consider use in combination with other anti-acne treatments like isotretinoin, adapalene and benzoyl peroxide; not recommended to be combined with systemic antibiotics; low chances for hyperpigmentation; use of sun protection measures; consider risk benefit ratio in pregnancy; use in lactation not recommended; and can be used only in children >9 years of age. This consensus has discussed and answered many real world usage questions and place in therapy for topical minocycline in acne management and finds it a useful addition to the existing armamentarium.
Anti-phospholipid antibody syndrome with skin as a primary involved organ: an interesting case report
Authors: Soni Aum N. , Parmar Harshad V. , Prajapati Hinal J.
Published: March 2024

Anti-phospholipid antibody (APLA) syndrome is a multisystem vascular thrombopathy characterized by presence of antibodies against phospholipid antigens. Resulting thrombosis due to these antibodies leads to hallmark obstetric complications, cutaneous and cerebral vascular involvement, pulmonary embolism and thrombosis which can occur in vasculature of any organ system of body. Though APLA syndrome is characterized by pregnancy loss and foetal morbidity, isolated cutaneous or other system presentation has been reported especially in male patients. Here we present an interesting case report of an old aged male patient presenting with cutaneous ulcers and skin involvement as presenting feature.
We Can Tell More Than One Story: Comic Making Locates Researcher and Children’s Voices in Co-Representing Childhoods in the COVID-19 Pandemic
Authors: Spray Julie
Published: March 2024

Childhood studies’ long concern with elevating children’s perspectives has focused attention on “voice” rather than researcher-participant dialogue, precluding critical attention to the normative adult researcher voice. This article investigates how cocreating comics with children about the COVID-19 pandemic engaged a different researcher voice and produced different representations of pandemic childhoods. Making comics with children aged 7–11, I asked: What does it mean for researchers to speak in speech? I suggest that shifting researcher voices can help researchers recognize the conventions that allow adults to colonize spoken conversation with children, denaturalizing adult voice and allowing us to tell more than one story.
Editorial – Application of Nanoscopic Quantum Systems in Retinal Restoration
Authors: Mohammadi Hadi , Rafii-Tabar Hashem
Published: March 2024

This is an Editorial and does not have an abstract. Please download the PDF or view the article in HTML.
Full Thickness Prophylactic Scleral Windows Decrease the Rate of Choroidal Effusion and Drainage Surgery after Ahmed Glaucoma Valve Implantation
Authors: Baghbanmanesh Afsoon , Sadat Masoumpour Masoumeh , Razeghinejad Reza
Published: March 2024

Purpose: To evaluate the effect of creating a full-thickness prophylactic scleral window (PSW) during Ahmed glaucoma valve (AGV) surgery on the rate of postoperative choroidal effusion and choroidal drainage surgery.
Methods: In this retrospective matched case-control study, after insertion of AGV tube a PSW was created in one group. The control-matched group had AGV without a PSW. Primary outcome measures were the rate of choroidal effusion formation and choroidal drainage surgery.
Results: In total, 544 patients (604 eyes) had undergone AGV implantation from 2013 to 2017. The PSW group consisted of 111 eyes of 111 patients and the control group had 111 eyes of 98 matched patients. There were no differences for systemic diseases, number of anti-glaucoma drugs, aspirin use, smoking, laterality of the operated eye, axial length, and central corneal thickness between the groups. Out of 12 eyes with choroidal effusion, only one belonged to the PSW group (P=0.02). Six eyes in the control group needed choroidal drainage surgery, but none of the eyes in the PSW group required this procedure (P=0.02). No intra- and postoperative issues were observed at the site of the scleral window in the PSW group.
Conclusion: PSW creation during AGV surgery is a safe method to decrease the rate of choroidaleffusion and choroidal drainage surgery
Short-Term Effects of Adding Topical Ketorolac to Intravitreal Bevacizumab in Diabetic Macular Edema: A Crossover Randomized Clinical Trial
Authors: Ramezani Alireza , Molazem Hossein , Entezari Morteza , Nikkhah Homayoun , Rezanejad Saman , Yaseri Mehdi
Published: March 2024

Purpose: To evaluate the short-term additive effects of topical ketorolac to intravitreal bevacizumab (IVB) in the management of center-involved diabetic macular edema (CI-DME).
Methods: In a randomized double-masked placebo-controlled crossover clinical trial, eyes with CI-DME and the best-corrected visual acuity (BCVA) between (20/40) and (20/400) were included. These eyes should have had at least one intravitreal anti-VEGF injection in the preceding two months. They were randomized into two groups; while both groups received two IVB injections with a six-week interval, one group received topical ketorolac every 6 hr in the first interval and artificial tears every 6 hr as a placebo in the second interval and the other group received the same medications using a crossover method. The main outcome measures were changes in BCVA and central macular thickness (CMT) .
Results: Fifty-seven eyes of 35 patients with CI-DME were included in the study. The mean BCVA improvement was –0.09 ± 0.47 logMAR in the periods of receiving ketorolac and –0.03 ± 0.12 logMAR in the periods of placebo treatment, respectively (P = 0.99). Corresponding changes in CMT were –13.1 ± 170.1 and +11.7 ± 157.7 µm in the ketorolac and placebo periods, respectively (P = 0.322). The treatment effect was not statistically significant regarding both BCVA and CMT changes. Statistical analysis also disclosed that the carryover effect was insignificant for BCVA and CMT. Although the period effect was not significant for BCVA, it was at a meaningful level for CMT changes (P = 0.012).
Conclusion: This crossover clinical trial demonstrated that in the course of DME treatment with IVB injections, topical ketorolac did not have any additive beneficial effect at least during a six-week period.