bluuebunny/crossref_metadata_2025 huggingface dataset:
Immunohistochemical Markers and the Clinical Course of Adenosarcoma: a Series of Seven Cases
Authors: Omi Makiko , Tonooka Akiko , Chiba Tomohiro , Nomura Hidetaka , Kanao Hiroyuki , Takazawa Yutaka
Published: July 2020

Background: Uterine adenosarcoma, a rare subtype of uterine tumor, is a biphasic tumor consisting of epithelial and mesenchymal elements. There is no research comparing histopathological features of primary and recurrent tumors, including immunohistochemistry; furthermore, the relationship between pathology and the clinical course is unclear. We reviewed the pathology and immunohistochemical features of 7 adenosarcoma cases and investigated the relevance of the histomorphological features to the clinical course. We also compared immunohistochemical features of primary and recurrent tumors.Methods: Seven patients with adenosarcoma who underwent surgery in our hospital were evaluated. We performed immunohistochemical staining for the estrogen receptor (ER), progesterone receptor (PR), p53, and two SWI/SNF chromatin-remodeling proteins (SMARCA4, BCOR), which were recently developed for the diagnosis of undifferentiated sarcomas in addition to conventional staining methods. Results: All patients were International Federation of Gynecology and Obstetrics stage 1B to 1C. All tumors were polypoid, and every patient presented with abnormal uterine bleeding. Six patients were over 50 years old and were menopausal; 1 patient was under 50 years old and was non-menopausal (average age 59.1 years). Histologically, the sarcomatous components were homologous in 6 patients and heterogenous in 1 patient. Four patients were recurrent patients; 3 were non-recurrent. All 4 recurrent patients showed high-grade morphology with sarcomatous overgrowth and were negative for ER and PR. Three recurrences could be evaluated by imaging, showing recurrence only in a distant area; biopsy specimens from these tissues revealed the identical mesenchymal component found in the primary tumor without a benign epithelial component. Immunohistochemical staining results were also the same as for the original tumor, except for the p53 expression in 1 patient. At the primary site, p53 was overexpressed in 2 recurrent patients and had a wild-type level in 1 recurrent patient; however, all 3 recurrent tissues showed overexpression of p53. None of the 7 cases showed SMARCA4 loss, and BCOR expression was positive in 1 case.Conclusions: Initial pathological analysis of the adenosarcoma with appropriate immunohistochemical staining is vital for prognostic assessment. Expression of p53 might increase at recurrence. SMARCA4 and BCOR could be an index of malignancy, regardless of sarcomatous overgrowth.
Time-varying Discrimination Accuracy of Longitudinal Biomarkers for the Prediction of Mortality Compared to Assessment at Fixed Time Point in Severe Burns Patients
Authors: Yoon Jaechul , Kym Dohern , Hur Jun , Won Jae Hee , Yim Haejun , Cho Yong Suk , Chun Wook
Published: July 2020

Background: The distribution of biomarkers over time is considered as an indicator of disease progression and helps in the early detection of disease, thereby reducing disease-related mortality. The ability of biomarkers to predict outcomes has been evaluated using conventional cross-sectional methods. In this study, we investigated the prognostic performance of longitudinal biomarkers over time.Methods: Patients aged >18 years who were admitted to the burn intensive care unit within 24 h of a burn incident were enrolled. Information regarding longitudinal biomarkers, such as white blood cell; platelet count; lactate, creatinine, and total bilirubin levels; and prothrombin time (PT), were retrieved from a clinical database warehouse. Time-dependent receiver operating characteristic curves using cumulative/dynamic and incident/dynamic (ID) approaches were used to evaluate time-varying prognostic performance.Results: In total, 2259 patients were included in this retrospective study and divided into survival and non-survival groups. By determining the area under the curve using the ID approach, platelets showed the highest c-index [0.930 (0.919–0.941)] across all time points. On the other hand, the c-index of PT and creatinine levels was 0.862 (0.843–0.881) and 0.828 (0.809–0.848), respectively.Conclusions: Platelet count is the best prognostic marker. PT and creatinine levels also show good overall diagnostic ability. Although lactate is a strong predictor, it shows relatively poor prognostic performance in burns patients.
Sex differences in family planning knowledge, attitudes, and use in Uganda
Authors: Nuwasiima Afra , Watsemba Agnes , Eyapu Allan , Kaddu Peter , Loiseau Justin
Published: July 2020

Background
Literature is satiated with studies focusing on knowledge, attitude, and practices of family planning (FP) among the female population, conversely, the gaps in sex-disaggregated data on FP continue to exist. This study sought to report sex differences existing in FP knowledge, attitude, and use in Uganda.
Methods
This study uses data from a household survey that covered 16 districts in Uganda. Multi-stage cluster randomized sampling was employed for participant selection. Bivariate analysis for categorical data was conducted. Multilevel logistic regression model was applied to model the effects of socio-demographic characteristics on the uptake and unmet need of FP services.
Results
Data from 4,352 respondents in the ratios of 70% female and 30% of males were analyzed. The mean age was 28.7 SD (8.5) and was not significantly different between males and females. More male respondents had secondary or higher level of education (44%) than females (36%). Low percent (16%) of females reported having no child compared to 38% in males. Knowledge of at least one modern FP method was high, but small significant differences were revealed between males (96%) and females (98%). Significant differences were further seen in specific FP methods. A small proportion agreed that community health workers (CHWs) were always available to offer FP services and no sex variations were observed. The proportion of married females using a modern FP method was 39% compared to 45% for married males. Condom use as a dual protection method potentially overstated FP use among males by 16%. Significant differences were revealed in total unmet need between males (19%) and females (24%). Males, young adults, the more educated and those in marriage or active relationship were more likely to use modern FP services.
Conclusions
Our study found significant sex differences in knowledge, attitudes and use of FP services. Initiatives to create demand for FP services for both males and females should study sex differences in FP knowledge, attitudes, and methods choice. Findings also revealed low involvement of CHWs in delivery of FP services to both males and females. More research is needed on how CHWs can be leveraged to reach both males and females with appropriate FP services and follow up to improve uptake and retention
A Novel Approach to Minimally Invasive Hysterectomy Without the Use of a Uterine Manipulator; Kamran’s TLH.
Authors: Gendia Ahmed , Waseem Kamran M. , Donlon Noel E
Published: July 2020

Background: Hysterectomy remains one of the most common major gynaecological procedure, with total laparoscopic hysterectomy (TLH) now the established as the technique of choice over conventional open approaches. This approach depends on the use of a uterine manipulator to facilitate uterine retraction and colpotomy. This study describes a novel approach in performing total laparoscopic hysterectomy without the use of uterine manipulator or vaginal tubes and reports the intra- and post-operative outcome of this technique.Methods: A single centre retrospective analysis of patients who underwent TLH without uterine manipulator or vaginal tube “Kamran’s TLH” for benign conditions was performed from January 2017 to October 2019. Data collected included patients demographics, intraoperative finding and postoperative course.Results: A total of eighty six hysterectomies were performed utilizing the Kamran’s TLH (KTLH) approach. Mean age was 52.2 (±11) years old and BMI was 28.2(±7). TLH with bilateral salpingo-oophorectomy was performed in 63(73.3%) patients and TLH with preservation of ovaries in 23 (26.7%) patients. Mean operative time was 64.7(±27.9) minutes and estimated bloods loss was 46.2(±54.6) ml. No intraoperative complications were recorded and there was no conversion to open surgery. Only one patient required readmission and surgery for vaginal vault dehiscence during their postoperative course.Conclusion: Uterine manipulator is a key component in performing laparoscopic hysterectomy. However, our approach demonstrated that TLH can be safely performed without the use of any uterine or vaginal manipulation.
Gradual Lengthening of the Ulna for the Treatment of Forearm Deformities in Children with Hereditary Multiple Exostosis: A Retrospective Study
Authors: Zheng Chao , Han Huanli , Cao Yujiang
Published: July 2020

Objectives: Hereditary multiple exostosis (HME) often involves forearm deformities. The aim of this study was to present the clinical results of 37 children who underwent the surgical procedure of ulnar lengthening with two different types of single arm external fixators.Methods: We evaluated 37 children with forearm deformities caused by HME treated in our hospital from January 2008 to July 2019. The surgical procedures included resection of exostosis, osteotomy of the ulna, and gradual lengthening of the ulna with a single arm external fixator. According to the type of external fixator they received, the children were divided into two groups: group A received monorail fixators, and group B received multi-joint fixators. Radiographic and functional parameters were assessed. Complications were recorded.Results: All patients were followed up for an average of 4.6 years (3.0 to 6.5). In both group A and group B, the ulna shortening (US), radial articular angle (RAA), carpal slip (CS), elbow flexion, forearm pronation, supination, and Mayo Elbow Performance Score (MEPS) values improved significantly from preoperatively to postoperatively (p < 0.05). However, ulnar deviation was observed in 4 cases in group B and no cases in group A. According to logistic regression, the difference was only related to age (p<0.05) and the type of external fixator (p<0.05). Conclusions: Ulnar lengthening with unilateral external fixation is a safe and effective procedure for the treatment of HME. Regarding complications, deviation of the ulna axis was more likely to occur in older children with multi-joint external fixators.
Association of Ultra-processed Food Consumption With Cardiovascular Mortality in the US Population: Long-term Results From a Large Prospective Multicenter Study
Authors: Zhong Guo-Chao , Gu Hai-Tao , Peng Yang , Wang Kang , Wu You-Qi-Le , Hu Tian-Yang , Jing Feng-Chuang , Hao Fa-Bao
Published: July 2020

Background
Ultra-processed foods have now become dominant in the global food system. Whether their consumption is associated with cardiovascular mortality remains controversial. Moreover, data on ultra-processed foods and cardiovascular outcomes are scarce in the US population. We aimed to examine the association of ultra-processed food consumption with cardiovascular mortality in a US population.
Methods
A population-based cohort of 91891 participants was identified from the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial. Dietary data were collected through a validated 137-item food frequency questionnaire. Ultra-processed foods were defined by the NOVA classification. Cox regression was used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for cardiovascular mortality. Restricted cubic spline regression was used to test nonlinearity. Subgroup analyses were conducted to identify the potential effect modifiers.
Results
After an average follow-up of 13.5 years (1236049.2 person-years), 5490 cardiovascular deaths were documented, including 3985 heart disease deaths and 1126 cerebrovascular deaths. In the fully adjusted model, participants in the highest vs. the lowest quintiles of ultra-processed food consumption had higher risks of death from cardiovascular disease (HRquintile 5 vs. 1, 1.52; 95% CI, 1.39–1.67) and heart disease (HRquintile 5 vs. 1, 1.70; 95% CI, 1.52–1.89) but not cerebrovascular disease (HRquintile 5 vs. 1, 1.00; 95% CI, 0.80–1.23). A nonlinear dose–response pattern was observed for overall cardiovascular and heart disease mortality (all Pnonlinearity<0.05), with a threshold effect observed at ultra-processed food consumption of 2.5 servings/day and 2.4 servings/day, respectively; below the thresholds, no significant associations were observed for these two outcomes. Subgroup analyses showed that the increased risks of mortality from ultra-processed foods were significantly higher in women than in men (all Pinteraction<0.05).
Conclusions
High consumption of ultra-processed foods is associated with increased risks of overall cardiovascular and heart disease mortality. These harmful associations may be more pronounced in women. Our findings are needed to be confirmed in other populations and settings.
Two Cases of Continued Progression of Chronic Ocular Graft-Versus-host Disease Without Concurrent Systemic Comorbidities Treated by Amniotic Membrane Transplantation.
Authors: Ikarashi Hideto , Aketa Naohiko , Shimizu Eisuke , Takano Yoji , Fujishima Hiroshi , Kawakita Tetsuya , Uchino Yuichi , Matsumoto Yukihiro , Ogawa Junko , Tsubota Kazuo , Ogawa Yoko
Published: July 2020

BackgroundChronic ocular graft-versus-host disease (oGVHD) is an ocular comorbidity of graft-versus-host disease (GVHD) that usually occurs concurrently with systemic manifestations. Failure to detect and treat oGVHD in its early stages may lead to progression of ocular signs and symptoms leading to oGVHD that is refractory to conventional treatment. Case presentationWe report the clinical course of a 19-year-old male and a 59-year-old female with severe and progressive chronic oGVHD without concurrent systemic signs of chronic graft-versus-host disease (cGVHD). Although their systemic conditions had been stable, both suffered from severe oGVHD and were referred to our clinic. Both cases exhibited marked improvement in conjunctival inflammation and fibrotic changes after amniotic membrane transplantation (AMT). Both cases underwent keratoplasty eventually to stabilize ocular surface conditions and to improve visual function.Conclusions We reported the clinical outcomes of 2 cases of chronic oGVHD without concurrent systemic comorbidities that were treated with AMT. The clinician should be aware that cGVHD may persist in target organs even in the absence of concurrent systemic comorbidities following seemingly successful systemic treatment. A multidisciplinary team approach is essential in the early detection and therapeutic intervention for chronic oGVHD.
A Profession in Danger: Stakeholders’ Perspectives on Supporting The Pharmacy Profession in Lebanon
Authors: Hijazi Mohamad Ali , Bou-Karroum Karen , Kassas Sara , Alameddine Mohamad
Published: July 2020

Background: Lebanon boosts one of the highest pharmacist to population ratios globally (20.3/10,000). Yet, workforce analyses elicited serious concerns with the distribution, practice environments and regulation of Lebanese pharmacists. Recent workforce data shows that the profession has been majorly destabilized with hundreds of pharmacists closing their pharmacies or losing their employment. Proper planning for the future of the pharmacy profession in Lebanon necessitate a deeper understanding of the current challenges and the necessary policy and practice recommendations. The aim of this study is to examine stakeholders’ perspectives on the current pharmacist workforce challenges and the necessary measures to support the profession.Methods: The research team carried out a series of semi-structured interviews with twenty-one key stakeholders within the pharmacy profession in Lebanon. We categorized stakeholders according to their experience as policy makers, practitioners, academicians, and media experts. The interview guide included questions about workforce trends, labor market challenges and recommendations for improvement. Interviews were transcribed and analyzed thematically.Results: Four major themes emerged from this study: the oversupply of pharmacists in Lebanon, the demand supply imbalance, poor regulation of the pharmacy practice, and the difficult practice environment. There was a consensus among interviewees that the oversupply of pharmacists is due to the poor workforce planning and weak regulatory framework, combined with the easy integration of foreign-trained pharmacists into the labor market. The lack of coordination between the educational and practice sectors is further widening the demand-supply gap. Interviewees further revealed that the regulatory policies on pharmacy practice were outdated and/or weakly enforced which increases the risk of unethical practices and erodes the image of pharmacists in the society. With respect to the practice environment, there is an ongoing struggle by Lebanese pharmacists to maintain profitability and exercise their full scope of practice.Conclusion: The poor pharmacy workforce planning and regulation is significantly weakening the pharmacy profession in Lebanon. A concerted effort between the various stakeholders is necessary to enhance workforce planning, regulate supply, optimize the integration of pharmacists into work sectors of need, and to enhance the financial and professional wellbeing of pharmacists in Lebanon.
Evaluation of a Multidisciplinary Lipid Clinic to Improve the Care of Individuals With Severe Lipid Conditions: A Re-aim Framework Analysis
Authors: Jones Laney K , McMinn Megan , Kann David , Lesko Michael , Sturm Amy C , Walters Nicole , Chen Nan , Fry Kerrianne , Brownson Ross C , Gidding Samuel S , Williams Marc S , Rahm Alanna Kulchak
Published: July 2020

Background . Individuals with complex dyslipidemia, or those with medication intolerance, are often difficult to manage in primary care. They require the additional attention, expertise, and compliance counseling that occurs in multidisciplinary lipid clinics (MDLCs). We conducted a program evaluation of the first year of a newly implemented MDLC utilizing the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework to provide empirical data not only on program effectiveness, but also on components important to local sustainability and future generalizability. Methods . The purpose of the MDLC is to increase uptake of guideline-based care for lipid conditions. Established in 2019, the MDLC provides care via a centralized clinic location within the healthcare system. Primary care providers and cardiologists were invited to refer individuals with lipid conditions. Using a pre/post study design, we evaluated implementation outcomes from the MDLC using the RE-AIM framework. Results . In 2019, 420 referrals were received, and 83 patients were seen in the MDLC (reach). In the lipid subgroups, we found improved diagnosis of condition, increase in prescribing of more aggressive lipid-lowering therapies, high rates of medication prior authorization approvals, and significant reductions in lipid levels (effectiveness). Of the 796 active primary care and cardiology providers in 2019, only 18% (146/796) referred patients to the MDLC (adoption). At the patient-level, 50% (41/82) of patients had at least one follow-up visit with the MDLC, with 12% (10/82) having two or more follow-up visits in 2019 (implementation). At the provider-level, an average of 35 patient referrals per month were made from primary care providers or cardiologists (SD 12) (implementation). During monthly meetings of the operational team, the decision to transition from in-person follow-up to telehealth appointments was implemented to increase capacity and sustain the clinic (maintenance). Conclusions . We found improved diagnosis and risk stratification, increase in guideline-recommended treatments prescribed and clinically significant lowering of lipid levels. Attention to factors including multiple points of contact, duration of visits, extraneous comorbidities and social support could aid in better understanding the success of patient outcomes.
Hypertension Care Cascade at a Large Urban HIV Clinic in Uganda: A Mixed Methods Study Using the Capability, Opportunity, Motivation for Behavior Change (COM-B) Model
Authors: Muddu Martin , Ssinabulya Isaac , Kigozi Simon P. , Ssennyonjo Rebecca , Ayebare Florence , Katwesigye Rodgers , Mbuliro Mary , Kimera Isaac , Longenecker Chris T. , Kamya Moses R. , Schwartz Jeremy I. , Katahoire Anne R. , Semitala Fred C.
Published: July 2020

Background: Persons Living with HIV (PLHIV) receiving antiretroviral therapy (ART) have a high prevalence of hypertension (HTN) and increased risk of mortality from cardiovascular diseases. HTN and HIV care integration is recommended in Uganda, though its implementation has lagged. In this study, we sought to analyze the HTN and HIV care cascades and explore barriers and facilitators of HTN/HIV integration within a large HIV clinic in urban Uganda.Methods: We conducted an explanatory sequential mixed methods study at Mulago ISS clinic in Kampala, Uganda. We determined proportions of patients in HTN and HIV care cascade steps of: Screened, Diagnosed, Initiated on treatment, Retained, and Controlled. Guided by the Capability, Opportunity, Motivation and Behavior (COM-B) model, we then conducted semi-structured interviews and focus group discussions with healthcare providers and hypertensive PLHIV (n=45). We coded the qualitative data deductively and analyzed the data thematically categorizing them as themes that influenced HTN care positively or negatively. These denoted barriers and facilitators, respectively.Results: Of 15,953 adult PLHIV, 99.1% were initiated on ART, 89.5% were retained in care and 98.0% achieved control (viral suppression) at one year. All 15,953 (100%) participants were screened for HTN, of whom 24.3% had HTN. HTN treatment initiation, one-year retention, and control were low at 1.0%, 15.4% and 5.0%, respectively. Barriers and facilitators of HTN/HIV integration appeared in all three COM-B domains. Barriers included low patient knowledge of HTN complications, less priority by patients for HTN treatment compared to ART, sub-optimal provider knowledge of HTN treatment, lack of HTN treatment protocols, inadequate supply of anti-hypertensive medicines and lack of HTN care performance targets. Facilitators included patients’ and providers’ interest in HTN/HIV integration, patients’ interest in PLHIV peers support, providers’ knowledge and skills for HTN screening, optimal ART adherence counseling, and availability of automated BP machines. Conclusion: The prevalence of HTN among PLHIV is high, but the HTN care cascade is sub-optimal in this successful HIV clinic. To close these gaps, models of integrated HTN/HIV care are urgently needed. These findings provide a basis for designing contextually appropriate interventions for HTN/HIV integration in Uganda and other low and middle-income countries.
RESEARCH ON THE INCIDENCE OF MALIGNANT TESTICULAR TUMORS IN UKRAINE AND SUMY REGION
Authors: Brusovtsov D. , Lуndіn M. , Sikora V. , Hyriavenko N. , Romaniuk A.
Published: July 2020

The oncological incidence of testicular cancer is the current medical and social problem in Ukraine and in the world. Despite the relatively low incidence rate for this pathology, it is of fundamental importance for clinicians, since it is the most common type of malignant tumors in young men of working age (15–45 years). In particular, the incidence of testicular cancer in the Sumy region slightly differs from the national average. That is why the objective of our study was to analyze the level of testicular neoplasia among the population of the Sumy region and Ukraine in 2011–2019, as well as to compare them. Based on the obtained data, the Sumy region is included in the group of regions of Ukraine with an over-threshold incidence of testicular cancer. Statistical data analysis showed a tendency to decrease of the overall incidence of testicular cancer among the adult population in Ukraine during the study period (on average, 2.55 per 100,000 population). At the same time, in the Sumy region, there was a gradual increase in the frequency of cases of this sociopathology in men with the highest indicators reached in 2017 (4.33 per 100,000 population). Consequently, in Ukraine, this pathology affected men mainly at the age of 35–39. However, it is should be noted that the age range of morbidity in the Sumy region was somewhat broader and mainly affected the population aged 30–39, and, in some years –men at the age of 20–29. It was established that testicular cancer affects the pediatric population, although it is extremely rare. Considering that seminoma is the most common type of testicular tumor, we focused on an in-depth study of its morphological features. Statistical data analysis revealed a link between the incidence of testicular cancer and the age of the male population. An important element of the research is the study of etiopathological factors that affect the growth of the degree of involvement, caused by this pathology.
CARDIOVASCULAR COMPLICATIONS OF OBSTRUCTIVE SLEEP APNEA SYNDROME: FOCUS ON MYOCARDIAL REPOLARIZATION ABNORMALITIES
Authors: Zhdan V. M. , Katerenchuk O. I. , Ivanytskyi I. V. , Kyrian O. A. , Haymenova G. S.
Published: July 2020

Obstructive sleep apnea syndrome is a risk factor for cardiovascular disease occurrence and progression. The leading pathophysiological mechanism is hyperactivation of the sympathetic autonomic nervous system. Changes in myocardial repolarization processes may serve as an early marker of increased risk for myocardial ischemia in individuals without cardiovascular diseases. Also, it is unclear how the treatment of obstructive sleep apnea syndrome can influence autonomic regulation and myocardial repolarization.
The objective of the study was to evaluate the relationship of autonomic dysfunction and myocardial repolarization abnormalities caused by obstructive sleep apnea syndrome and its changes after the treatment of the underlying condition.
Results: 15 patients with obstructive sleep apnea syndrome of mild and moderate degrees were enrolled in the study group. The control group was formed by healthy individuals. An increased tonic sympathetic activity was observed in the study group. It was associated with increased values of the T-wave symmetry standard quadratic deviation index. Treatment of obstructive sleep apnea syndrome by otorhinolaryngological procedures (septoplasty, uvulopalatoplasty, removal of nasal polyps, uvulopalatopharyngoplasty) resulted in improvement of tonic autonomic regulation (in terms of sinus rhythm variability) and normalization of myocardial repolarization that was evaluated in 3 months after treatment.
Conclusions. Tonic sympathetic hyperactivation changes the processes of myocardial repolarization in patients with obstructive sleep apnea syndrome. Treatment of obstructive sleep apnea syndrome with otorhinolaryngological procedures improves autonomic regulation and myocardial repolarization processes.
OPTIMIZATION OF INDEPENDENT WORK OF STUDENTS IN THE LIGHT OF INNOVATIVE EDUCATIONAL TECHNOLOGIES WHEN STUDYING INTERNAL MEDICINE
Authors: Kudria I. P. , Shevchenko T. I. , Shaposhnyk O. A. , Tretiak N. G.
Published: July 2020

The article deals with the organization of independent work of students with the active use of innovative educational technologies that open up new opportunities for optimizing the educational process in a medical university and set teachers tasks that are aimed at developing modern forms and methods of its implementation, which contribute to the organization of professional activities at a qualitatively new level. The purpose of the article is to analyze various aspects and methods of independent work of students in the light of innovative educational technologies in the study of internal medicine to optimize the educational process.
The site of the Ukrainian Medical Stomatological Academy has a web-page of Internal Medicine Department № 1, where students can find guidelines for independent work for IV and VI courses in preparation for classes in Ukrainian, Russian and English using the Internet. Future doctors use multimedia technologies at meetings of the student scientific society, during educational events and open lessons for school students, organizing educational hours among the student audience, which expands opportunities for creativity, develops competence and mobility, and strengthens the role of independent work. Using the information of the group "department of internal medicine № 1" in the social network Facebook, students not only master modern learning technologies in the era of the so-called information society but also master communication skills with other people, learn to search in different ways and analyze certain information. As a result of the functioning of the computer class, students have the opportunity to pass the test control of the initial and final levels of knowledge in the current and final practical classes, test tasks from the license exam "KROK-2", which encourages them to more thorough preparation for classes in internal medicine. In the course of studying internal medicine, it is important to create and optimize conditions for independent work of students for further development of professional competencies of a doctor: the ability to work with information on the global Internet, to use the capabilities of modern computer systems and innovative technologies to solve professional problems.
The use of innovative educational technologies in the organization of independent work of future doctors at Internal Medicine Department № 1 contributes to a deeper study of internal medicine, the formation of professional knowledge and their application in practice, and strengthening the connection between educational and scientific work, and also optimizes the learning process of medical students, which ensures the dynamic development of a specialist's personality, activates his creative and clinical thinking, helps to implement an individual approach to training and meets the requirements of modern medical education.
CHARACTERISTICS OF THE OPTIMIZED MODEL OF MEDICAL CARE FOR THE POPULATION WITH DISEASES OF BLOOD AND BLOOD-FORMING ORGANS AT THE REGIONAL LEVEL
Authors: Horokh V. V.
Published: July 2020

The article presents an optimized model of medical care for the population with diseases of the blood and blood-forming organs at the regional level in modern conditions of health care reform based on the current legislation of Ukraine on health care reform and scientific literature on the organization of medical care for patients with diseases of the blood and blood-forming organs. The scientific substantiation of the optimized model of hematological medical care at the regional level in the conditions of reforming the health care system of the country was carried out within the existing medical-demographic and socio-economic situation, taking into account the positive changes in the future. The model envisages the structure and organization of medical care for patients at all stages and levels of medical care. The structural basis of the model of providing medical care to patients with diseases of the blood and blood-forming organs is the available resources of the current health care system. Its implementation requires additional financial resources for logistics in accordance with industry standards, which should be provided in the provision of medical care and without the implementation of the proposed model. The model provides a concentration of resources, which determines its economic efficiency. The implementation of the proposed optimized model of medical care for the population with diseases of the blood and blood-forming organs at the regional level will provide the population suffering from these diseases to provide affordable medical care in stages and levels of its provision depending on health status.
LYME DISEASE. MODERN ISSUE CONDITION
Authors: Chemych M. , Lutai I.
Published: July 2020

Nowadays Lyme disease (systemic tick-borne borreliosis, Lyme borreliosis) remains one of the most widespread zoonotic diseases with inoculable transmission mechanism, with ixodid ticks as carriers and Borrelia burgdorferi sensu lato as the causative agent. The disease is characterized by a staged course and severe damage to various organs and systems.
In Ukraine, the natural foci of this disease are almost throughout the country. Sumy region occupies a leading place in terms of morbidity. In Ukraine, the most affected regions are Kyiv (29.00 cases per 100 thousand population), Cherkasy (25.4), Vinnytsia (23.9), Sumy (25.89) regions, and Kyiv city (22.54). Lyme disease is mainly registered in the spring-autumn period, this may be due to increased visits to recreation areas and seasonal activity of ticks (May–June, September–October).
Scientific data about etiology, epidemiology, clinical course, diagnostics, therapy, and disease preventive measures were analyzed.
It was found that B. burgdorferi s. l. is one of the most widespread agents with inoculable transmission mechanism on the European continent, including Ukraine. There is no single worldwide conception concerning preventive measures, diagnostics, and treatment, which necessitates the further study of this problem. Detection of antibodies to B. Burgdorferi s. l. in the human blood serum is not evidence of infection but testifies the previous contact with these pathogens and the presence of high risk of Lyme disease development.
To improve the epidemiologic situation concerning Lyme disease it is required to study sites of the disease in Ukraine more thoroughly, to improve epidemiological surveillance system by creating disease spread map for diseases which are transferred by ticks in Sumy region, to plan a series of anti-epidemic and preventive measures, which are of practical use for population, to prevent asymptomatic disease course and chronization.
Critical energy landscape of linear soft spheres
Authors: Franz Silvio , Sclocchi Antonio , Urbani Pierfrancesco
Published: July 2020

We show that soft spheres
interacting with a linear ramp potential when overcompressed beyond
the jamming point fall in an amorphous solid phase which
is critical, mechanically marginally stable and share many
features with the jamming point itself.
In the whole phase, the relevant local minima of the potential energy landscape
display an isostatic contact network of perfectly touching spheres
whose statistics is controlled by an infinite lengthscale.
Excitations around such energy minima are non-linear,
system spanning, and characterized by a set of non-trivial critical
exponents. We perform numerical simulations to measure their values
and show that, while they coincide,
within numerical precision, with the critical exponents appearing at jamming,
the nature of the corresponding excitations is richer.
Therefore, linear soft spheres appear as a novel class of finite dimensional systems
that self-organize into new, critical, marginally stable, states.
Recovery of phosphorus from stored urine using continuous flow reactor in decentralised level operations
Authors: Ramesh Sakthivel S. , Azizurrahaman Md , Ganesh Prabhu V. , Chariar V. M.
Published: July 2020

Past studies have shown that phosphate recovery in the form of struvite is relatively a simple process, which can be achieved by adding a magnesium source in stored urine. However, struvite recovery process at a decentralised level becomes uneconomical due to high input cost of magnesium salts and operational cost. While use of cheaper alternative magnesium sources such as bittern, low-grade MgO and wood ash could lead to partial cost reduction, it is also important to reduce the overall operational costs to make struvite recovery process economically viable and sustainable. In this study, a continuous flow reactor was developed for low-cost struvite recovery from stored urine at decentralised community scale operations. Our study revealed that over 81.2% of phosphate present in urine can be recovered in the form of struvite. Comparison of results from stirred and unstirred experiments shows that higher recovery efficiency is obtained due to minimal loss of fines. Operation and financial assessment of the process shows that struvite recovery can be profitable due to continuous operation of the reactor requiring minimal process control and manpower requirement.
Bacterial community evolution along full-scale municipal wastewater treatment processes
Authors: Zhang Lei , Cheng Yanan , Qian Chang , Lu Wenxuan
Published: July 2020

Sewage pollution is a major threat to public health because sewage is always accompanied by pathogens. Generally, wastewater treatment plants (WWTP) receive and treat sewage to control pathogenic risks and improve environmental health. This study investigated the changes in the bacterial community over the course of treatment by a WWTP. Illumina MiSeq high-throughput sequencing was performed to characterize the bacterial communities in the WWTP. This study found that potential pathogens in the WWTP, especially the genera Arcobacter and Acinetobacter, were greatly reduced. In addition, high chemical oxygen demand levels provided excessive growth substrates for the genera Hyphomicrobium and Rhodoplanes, the abundance of which could exceed autotrophic bacteria, increasing the ammonium removal. According to the network analysis, the bacterial assemblage was not randomly arranged in the WWTP, and various defined processes led to higher intra-phylum (such as Proteobacteria) coexistence than expected. Moreover, the metabolic functions of bacterial communities significantly improved in the WWTP compared with the influent. Together, the data in this study emphasize the need to understand the bacterial community of WWTPs better. When analyzing the risks of WWTP drainage systems to the environment and human health, these data should be considered.
Mathematical modeling of resistive states and dynamic switching of a metal oxide memristor
Authors: Ebrahim Abdulla H. , Udovichenko Sergey Yu.
Published: July 2020

A mathematical model of resistive states and dynamic switching of a memristor from a low-conductive to a highly-conductive state is presented. The model based on a physical model of charge transport without taking into account the heat transfer process in the metal-oxide-metal structure with the dominant transport mechanism of electron tunneling through oxygen vacancies migrating under the influence of an inhomogeneous self-consistent electric field. An analytical solution for the oxygen vacancies distribution over the oxide layer was found by the approximation of a constant electric field. The memristor model with inhomogeneous electric field is implemented as a specialized program based on the finite difference method for solving a stationary nonlinear first-order differential equation. This model well describes the physical effect of reduction in the conductivity growth of a thin dielectric layer under the dominant transport mechanism of electron tunneling through oxygen vacancies, which arises as a result of an increase in the concentration of trapped electrons with increasing voltage at the electrodes near the threshold switching voltage. Numerical modeling of discrete resistive states and dynamic resistive switching of a memristor has been carried out. The obtained current-voltage characteristic of the memristor with the help of numerical simulation is in better agreement with the experimental data compared to the analytical simulation. The numerical model can be used in the research and development of memristors with given electrical characteristics. A simple analytical memristor model, which does not require a large amount of computation, is applicable for modeling basic processes such as write operation, signal summation, and associative self-learning that occur in super-large memory and logic matrices of a biomorphic neuroprocessor when memristors are used as synapses of neurons.
Mathematical modeling heat and mass transfer in a vertical hydraulic fracture crack during inflation and cleaning*
Authors: Bulgakova Guzel T. , Sharifullin Andrey R. , Sitdikov Marat R.
Published: July 2020

When designing hydraulic fracturing for high-temperature formations, it is important to know the temperature change in the fracture during the injection of fracturing fluid. The temperature profile in the hydraulic fracture is necessary to calculate the optimal composition of the fracturing fluid, which necessarily includes a crosslinker (crosslinker) and a breaker (breaker), the concentration of which is calculated by the temperature at the end of the crack. Currently, this concentration is calculated based on the maximum temperature of the formation, which can lead to a decrease in the efficiency of hydraulic fracturing, since a breaker will not completely destroy the crosslinked gel. Therefore, when a well is brought into operation after the stimulation, proppant removal may occur, reducing the effectiveness of stimulation to zero. In this regard, the optimization of the decision-making process in the design of hydraulic fracturing in terrigenous and carbonate reservoirs by calculating the optimal parameters of process fluids based on predicting heat and mass transfer processes occurring during processing is a very urgent task. A tool has been developed to improve the design efficiency of hydraulic fracturing based on mathematical modeling of temperature fields in a hydraulic fracture during its development and during the period of technological sludge.
A mathematical model that describes the temperature dynamics in a hydraulic fracture taking into account fluid leakage into the formation represents the evolutionary equation of convective heat transfer with a source, which is defined as the density of the heat flux from the formation. To check the adequacy of the model of temperature dynamics in a hydraulic fracture, a model of temperature recovery in a fracture is presented with the subsequent adaptation of simulation results to actual data. Developed mathematical models can be used in hydraulic fracturing simulators.
Mathematical modeling of the equilibrium complete replacement of methane by carbon dioxide in a gas hydrate reservoir at negative temperatures
Authors: Borodin Stanislav L. , Belskikh Denis S.
Published: July 2020

Gas hydrates, which contain the largest amount of methane on our planet, are a promising source of natural gas after the depletion of traditional gas fields, the reserves of which are estimated to last about 50 years. Therefore, it is necessary to study the methods for extracting gas from gas hydrates in order to select the best of them and make reasoned technological and engineering decisions in the future.
One of these methods is the replacement of methane in its hydrate with carbon dioxide. This work studies the construction of a mathematical model to observe this method. The following process is considered in this article: on one side of a porous reservoir, initially saturated with methane and its hydrate, carbon dioxide is injected; on the opposite side of this reservoir, methane and/or carbon dioxide are extracted. In this case, both the decomposition of methane hydrate and the formation of carbon dioxide hydrate can occur.
This problem is stated in a one-dimensional linear formulation for the case of negative temperatures and gaseous carbon dioxide, which means that methane, carbon dioxide, ice, methane, and carbon dioxide hydrates may be present in the reservoir. A mathematical model is built based on the following: the laws of conservation of masses of methane, carbon dioxide, and ice; Darcy’s law for the gas phase motion; equation of state of real gas; energy equation taking into account thermal conductivity, convection, adiabatic cooling, the Joule — Thomson effect, and the release or absorption of latent heat of hydrate formation. The modelling assumes that phase transitions occur in an equilibrium mode and that methane can be completely replaced by carbon dioxide. The results of numerical experiments are presented.
SUV39H1-Mediated DNMT1 is Involved in the Epigenetic Regulation of Smad3 in Cervical Cancer
Authors: Zhang Li , Tian Sijuan , Zhao Minyi , Yang Ting , Quan Shimin , Song Lihua , Yang Xiaofeng
Published: July 2020

Background:

Smad3 is a pivotal intracellular mediator for participating in the activation of multiple immune
signal pathway.

Objective:

The epigenetic regulation mechanism of the positive immune factor Smad3 in cervical cancer remains
unknown. Therefore, the epigenetic regulation on Smad3 is investigated in this study.

Methods:

The methylation status of SMAD3 was detected by Methylation-specific PCR (MS-PCR) and Quantitative
Methylation-specific PCR (MS-qPCR) in cervical cancer tissues and cell lines. The underlying molecular mechanisms of
SUV39H1-DNMT1-Smad3 regulation was elucidated using cervical cancer cell lines containing siRNA or/and overexpression system. Confirmation of the regulation of DNMT1 by SUV39H1 used Chromatin immunoprecipitation-qPCR
(ChIP-qPCR). The statistical methods used for comparing samples between groups were paired t tests and one-way
ANOVAs.

Results:

H3K9me3 protein which regulated by SUV39H1 directly interacts with the DNMT1 promoter region to regulate
its expression in cervical cancer cells, resulting in the reduce expression of the downstream target gene DNMT1. In
addition, DNMT1 mediates the epigenetic modulation of the SMAD3 gene by directly binding to its promoter region. The
depletion of DNMT1 effectively restores the expression of Smad3 in vitro. Moreover, in an in vivo assay, the expression
profile of SUV39H1-DNMT1 was found to correlate with Smad3 expression in accordance with the expression at the
cellular level. Notably, the promoter region of SMAD3 was hypermethylated in cervical cancer tissues, and this
hypermethylation inhibits the subsequent gene expression.

Conclusion:

These results indicate that SUV39H1-DNMT1 is a crucial Smad3 regulatory axis in cervical cancer.
SUV39H1-DNMT1 axis may provide a potential therapeutic target for the treatment of cervical cancer.