bluuebunny/crossref_metadata_2025 huggingface dataset:
Cost-effectiveness and Diet Quality in a 3-year Follow-up of a Randomised Controlled Trial (The BALANCE trial)
Authors: Torreglosa Camila Ragne , Sarti Flávia Mori , Ferreira Ângela Cristine Bersch , Weber Bernardete , Santos Renato Hideo Nakagawa , Silvestrini Murilo Mazzotti , Filho Alexandre Dias Porto Chiavegatto
Published: July 2020

Background: A healthy diet is essential to reduce cardiovascular disease (CVD) risk and mortality. However, recent studies lack conclusive evidence on the affordability of cardioprotective diets worldwide. The Brazilian Cardioprotective Nutritional Program Trial (BALANCE Program) is a randomized multicenter clinical trial that proposes regionally adapted cardioprotective diet that achieves nutritional recommendations and incorporates accessible and affordable foods. The study aim is to analyze cost-effectiveness of the BALANCE Program in comparison to generic dietary advice for individuals, based on diet costs and nutritional quality among patients with high adherence to the study protocol in both control and intervention groups.Methods: We conducted a cost-effectiveness analysis of subsample from the BALANCE Program (1,161 individuals with previous event of CVD and high adherence to study protocol enrolled in 35 research sites throughout Brazil) after a 3-year follow-up. Direct costs and nutritional quality of diets reported by participants were estimated at the individual level. Diet costs were based on market prices collected from five major supermarket chains. Effectiveness was measured in terms of diet quality, according to adherence to the Brazilian Health Eating Index Revised (BHEI-R). Mean differences were compared between groups using generalized estimating equation. Monte Carlo simulations were performed to comprise probabilistic sensitivity analysis regarding trends in the comparison between groups.Results: At baseline, mean direct diet costs were equal (U$3.9/day), and there were small differences in BHEI-R between groups (53.5 points in BALANCE Program, and 51.8 points in control group). After the 3-year follow-up, the intervention was associated with a mean cost saving of U$0.31/day (95%CI: -0.59; -0.04) and mean BHEI-R increase of 4.38 (95%CI: 2.81; 5.95). Conclusion: The intervention was dominant strategy in terms of cost-effectiveness due to higher effectiveness at lower costs in comparison with the control group.Conclusions: There was a statistically significant effect of the intervention regarding increase in diet quality and reduction in cost after 3 years compared to the control group. The BALANCE intervention may be an option to improve diet quality with lower costs among Brazilians with CVD.Trial registration: NCT, NCT01620398. Registered June 15, 2012. https://clinicaltrials.gov/ct2/show/NCT01620398
Financial Inclusion And The Growth Of Small Medium Enterprises In Uganda: Empirical Evidence From Selected Districts In Lango Sub Region
Authors: Eton Marus - , Mwosi Fabian , Okello-Obura Constant , Turyehebwa Abanis , Uwonda Gilbert
Published: July 2020

The growth and failure of small and medium enterprises has been a topic of discussions world over amongst policy makers and researchers. This study was guided by the following objectives: To examine the contributions of Small Medium Enterprises (SMEs), to determine the challenges affecting Small Medium Enterprises, to examine how financial inclusiveness supports the growth of Small medium enterprises and to establish the relationship between financial inclusion and Small Medium Enterprises. The study used a cross sectional research design. Descriptive design was used and supplemented by inferential statistics. Correlation and regression analysis were adopted. The study revealed that financial inclusion is significant in supporting SMEs growth. The study also revealed that cost of acquiring and servicing financial services are high, there is also difficulty in using some of the financial services, and the way financial providers treat financial users, some lacked some degree of respect and dignity. The study recommends that financial providers should continue sensitizing the public on the available financial services beyond credit services, which are common and known. Digital financial service providers should encourage their clientele to use digitalized financial services which are cheap, secure and risk averse. Cost of capital should also be reduced to encourage borrowing while SMEs should innovatively produce goods that can be competitive at both domestic and international markets.
Relationship Between Foot Flexibility and Leg Muscle Stiffness After Running: a Cross-sectional Study
Authors: Kudo Shintarou
Published: July 2020

BackgroundDeformation of the foot is related to the development of running injuries. The prevention of running injuries requires the management of changes in leg muscle stiffness after running. However, the relationship of muscle stiffness and the structure and flexibility of the foot arch is unclear. The purpose of this study was to investigate differences in muscle stiffness and flexibility of the arch before and after running.MethodsTwenty lower limbs of 10 healthy volunteers were enrolled. All of the subjects performed the same running task on a treadmill set at an incline of 7%, running at a speed of 8 km/h for 60 min. The shear elastic modulus of the longitudinal axis of the medial and lateral gastrocnemius (MG, LG), flexor digitorum longus (FDL), and abductor hallucis muscles were measured both before and after running using ultrasound shear wave elastography. Arch height index (AHI) and arch height flexibility (AHF) were measured at 10, 50, and 90% of the body weight loaded position, respectively. The correlation of AHI, AHF, and alterations in each muscle stiffness before and after running was assessed using Spearman’s rank correlation coefficient.ResultsThe FDL, LG, and MG were significantly harder after running than before running. The AHI and AHF had no significantly difference between before and after running. There were significant moderate correlations between AHF50 before running and stiffness of the FDL after running.ConclusionIncreased stiffness of the FDL is related to medial tibial stress syndrome. Our results indicate that stiffness of the arch is associated with greater stiffness of the FDL, which restricts performance of the dynamic function of stretching the muscle and tendon complex of the toe flexor with weight loading on the foot.
Association between the Methylation of CpG Islands in JAK-STAT Pathway-Related Genes and Colorectal Cancer
Authors: Pu Rui , Sun Hongru , Liu Yupeng , Tian Tian , Bi Haoran , Xia Tingting , Zhang Lei , Zhang Yuanyuan , Zhu Lin , Rong Jiesheng , Zhao Yashuang
Published: July 2020

Background: The Janus kinase-signal transducer and activator of transcription (JAK-STAT) pathway is involved in a series of biological processes. Aberrant promoter methylation of CpG islands plays an important role in carcinogenesis. However, the association between the DNA methylation of JAK-STAT pathway-related genes in peripheral blood leukocytes and colorectal cancer (CRC) susceptibility remains unclear. Methods: We conducted a case-control study of 403 patients with CRC and 419 cancer free controls, and the DNA methylation levels of four genes (JAK2, STAT1, STAT3, and SOCS3) in peripheral blood samples from all subjects were assessed using a methylation-sensitive high-resolution melting (MS-HRM) analysis. Results: Compared with controls, the methylation of the JAK2, STAT1 and SOCS3 genes significantly increased the CRC risk (ORadjusted=1.96, 95% CI, 1.12-3.41, P=0.01; ORadjusted=5.37, 95% CI, 3.74-7.71, P<0.01; ORadjusted=3.30, 95% CI, 1.58-6.87, P<0.01, respectively). This trend was also found via stratified analysis. In the multiple CpG site methylation (MCSM) analysis, a high MCSM value denoted a significantly increased risk of CRC (ORadjusted=4.97, 95% CI, 3.34-7.37, P<0.01). Antagonistic interactions were identified between the methylation of JAK2, STAT1 and high levels of MCSM and environmental factors with CRC risk (P<0.05). Conclusion: In peripheral blood, the methylation statuses of JAK2, STAT1, and high levels of MCSM, which are promising biomarkers, were significantly associated with CRC risk. An interaction between gene methylation and environmental factors contributed to the risk of CRC.
The Antiemetic Effect of Xiao-Ban-Xia-Tang Formula is Associated With Regulating CaM/CaMKII/ERK1/2 Signaling Pathway in Cisplatin and 1-phenylbiguanide Hydrochloride Induced Rat Pica Models
Authors: Xia Lei , Xian Yihong , Feng Xiaodi , Cheng Qianqian , Chen Siqi , Li Yaqi , Meng Qi , Nie Ke
Published: July 2020

Background: Xiao-Ban-Xia-Tang (XBXT) formula is a traditional Chinese herbal formula for treating emesis. Chemotherapy-induced nausea and vomiting (CINV) are serious side effects of chemotherapy, which was closely related to the activation of 5-hydroxytryptamine 3 receptor (5-HT3R). In this paper, the effect of XBXT on cisplatin- and 1-phenylbiguanide hydrochloride (1-PBG, a selective 5-HT3R agonist)- induced pica behavior in male Wistar rats and inhibition of calmodulin/calmodulin-dependent protein kinase II/extracellular signal-regulated kinase 1/2 (CaM/CaMKII/ERK1/2) signaling pathway were investigated. Methods: XBXT (1.6 g/kg, twice daily) was orally administered from day 1 after intraperitoneal injection of cisplatin (6 mg/kg) and 1-PBG (25 mg/kg) to day 3. Pica behavior (consumption of kaolin, a type of clay) was recorded every 24 h. The expression and co-localization of CaM and 5-HT3R in small intestine and brain were detected by immunofluorescence. The expression of CaMKII, pCaMKII, ERK1/2, and pERK1/2 proteins were detected by Western blot. Results: XBXT treatment significantly decreased kaolin ingestion (pica) of rats after treatment of cisplatin and 1-PBG during both 0 - 24 h (respectively, from 1.57 g to 0.87 g; from 1.04 g to 0.11 g) and 0 - 72 h (respectively, from 2.98 g to 1.85 g; from 2.29 g to 0.35 g) periods. The fluorescence expression of CaM and 5-HT3R and expression of CaMKII, pCaMKII, ERK1/2 and pERK1/2 in the small intestine and brain of cisplatin- and 1-PBG-treated rats were remarkably suppressed by XBXT.Conclusions: The present study implies that inhibiting CaM/CaMKII/ERK1/2 signaling is an underlying mechanism of XBXT for treating CINV. These insights provide an experimental basis of XBXT for the clinical treatment of CINV.
Epidemiological Survey and Screening Strategy for Dengue Virus in Blood Donors from Yunnan Province
Authors: LI LING , LI YING , Lu Shaofang , Dong Jing , Xu Haixia , Zhang Qian , Weng Rong , Yin Yundi , He Rui , Fang Peng , Shi Hua , Yu Yinghan , Wu Ji , Liu Zhong , Hess John R.
Published: July 2020

BACKGROUND Dengue virus (DENV) can be transmitted through blood transfusion. DENV was not screened regularly in Xishuangbanna Blood Center. This study was conducted in Xishuangbanna Blood Center with an attempt to develop DENV screening strategies in one of China’s high-incidence areas.METHODS Blood samples were collected randomly between June 2019 and August 2019. These samples were first screened for dengue IgG and IgM antibodies using enzyme-linked immunosorbent assay (ELISA). All reactive samples and some randomly-chosen non-reactive samples were used to detect DENV RNAs using real time polymerase-chain-reaction (RT-PCR) assay. After RT-PCR assay, these samples were further tested for soluble nonstructural protein 1 (NS1) using colloidal gold method. The demographic data of DENV positive donors were collected.RESULTS A total of 2,254 donor samples were collected and tested for dengue IgG and IgM antibodies by ELISA between June 2019 and August 2019. ELISA testing revealed that 598 donor samples were anti-IgG and/or anti-IgM reactive, with a serological prevalence rate of 26.53%. Among all the donor samples, 26 were RT-PCR positive and/or NS1 positive. Moreover, there were significant differences in the prevalence rate of DENV in terms of occupation (P=0.001), education(P<0.001) and ethnicity (P=0.026). CONCLUSION The prevalence of DENV in Xishuangbanna Blood Center was higher than most other blood centers that have implemented DENV donor screening. Our study provides the first-hand data about the prevalence of DENV and allows development of a screening strategy for clinical use.
Influence of Leadership Practices on Organizational Safety Performance
Authors: Sadiq Adeshina Waheed
Published: July 2020

This study analyzes the reasons why leadership does not influence the counteraction to incidents (through the implementation of safety systems and technology), which cause serious injuries or deaths in US oil and gas companies. The modified Delphi method summarizes eight oil and gas industry experts’ consensus on how leadership can reduce workplace incidents and improve organizational safety performance. The study selects eight safety specialists and leadership experts in executive positions in the US oil and gas industry, who participated in three rounds of discussions regarding the impact of leadership practices on the effectiveness of the safe conditions and were interviewed through a series of questionnaires. The study identifies five key aspects that can help improve the safety process efficiency in the company and provide the basis for future research: empowering employees to stop dangerous operations; formation of effective health, safety and environmental management system; employees’ involvement in the formation of organizational safety initiatives, the creation of corporate culture in the company, the use of consistent behavior patterns in promoting safety improvements across the organization. The study concludes that preventing incidents and improving safety performance in an organization requires effective coordination of the five components, which, according to the experts’ evaluations are the most important in terms of organization development. Therefore, leaders and practitioners in this field, who often face safety performance challenges, should apply a safety ecosystem approach to prevent incidents from occurring and improve safety performance within their businesses. The study results contribute towards a deeper understanding of how organizational management can apply existing knowledge on compliance with safe working conditions to prevent incidents in the company using different strategies to counteract them. The study identifies the main limitations related to the use of the modified Delphi method. They include the difficulties in determining the optimal sample size and attracting a sufficient number of study participants. The second limitation is that due to fewer participants, the conclusion from the study represents the views of the participants which may vary if a sufficiently large number of participants took part in the study.

Keywords: Incident Prevention, Leadership, Management System, Organizational Culture, Safety Culture.
Analysis of PYL Genes and Their Potential Relevance to Stress Tolerance and Berry Ripening in Grape
Authors: Zhao Yanxia , Qi Guimei , Ren Fengshan , Wang Yongmei , Wang Pengfei , Wu Xinying
Published: July 2020

Abscisic acid (ABA) is an essential phytohormone that regulates plant growth and development, particularly in response to abiotic stress. The ABA receptor PYR/PYL/RCAR (PYL) family has been identified from some plant species. However, knowledge about the PYL family (VvPYLs) in grape (Vitis vinifera) is limited. This study aims to conduct genome-wide analyses of VvPYLs. We successfully identified eight PYL genes from the newest grape genome database. These VvPYLs could be divided into three subfamilies. Exon-intron structures were closely related to the phylogenetic relationship of the genes, and PYL genes that clustered in the same subfamily had a similar number of exons. VvPYL1, VvPYL2, VvPYL4, VvPYL7, and VvPYL8 were relatively highly expressed in roots. VvPYL1, VvPYL3, VvPYL7, and VvPYL8 were expressed in response to cold, salt, or polyethylene glycol stress. VvPYL6 was up-regulated by cold stress for 4 hours, and the expression of VvPYL2 was 1.74-fold greater than that of the control under cold stress. VvPYL8 was up-regulated 1.64-, 1.83-, and 1.90-fold compared with the control when treated with salt, PEG, or cold stress after 4 hours, respectively. Additionally, abiotic stress-inducible elements exist in VvPYL2, VvPYL3, VvPYL7, and VvPYL8, indicating that in these four genes, the response to abiotic stress may be regulated by cis-regulatory elements. The transcriptional levels of VvPYL1 and VvPYL8 significantly increased from fruit set to the ripening stage and decreased in the berry when treated by exogenous ABA. The eight VvPYL genes have diverse roles in grape stress responses, berry ripening, or development. This work provides insight into the role of VvPYL gene families in response to abiotic stress and berry ripening in grape.
Therapy and control of bronchial asthma in children and adolescents
Authors: Surovenko T. N. , Glushkova E. F.
Published: July 2020

Up to 22% of the population in the world suffer from bronchial asthma according to the data from different regions and sources. This is about 358 million people. At the same time, accurate figures for the prevalence of this disease cannot be obtained. Despite the many ongoing studies of this disease, developed treatment options, asthma hasn’t become a fully controlled disease. The problem of control and treatment of the disease as well as patient compliance is of great concern to modern clinicians. Every year GINA releases new documents and makes changes in the treatment and diagnosis of this chronic bronchopulmonary disease. Children’s asthma has become not only the most common chronic disease, but also the most common cause of children hospitalization.This article provides an overview of the international randomized clinical trials results and expert opinions regarding the treatment of uncontrolled bronchial asthma in children and adolescents. The results of 2017–2020 meta-analyzes regarding the use of tiotropium in children and adolescents are described. The use of basic therapy schemes is disclosed, including the use of tiotropium bromide in accordance with the recommendations of the Russian Respiratory Society and GINA.The authors also presented a clinical case of difficultly controlled bronchial asthma in a child of 12 years old. The use of tiotropium bromide in this patient is described in detail and the effectiveness of this drug is demonstrated.
Accidental discovery of HIV infection in a child at the age of 1 year 10 months: analysis of a clinical case
Authors: Striga E. V. , Zaytseva O. V. , Komelyagin D. Yu. , Iamatina S. V. , Dubin S. A. , Vladimirov F. I. , Petukhov A. V. , Blagikh O. E. , Gromova T. N. , Belyayeva T. Yu.
Published: July 2020

The article presents a clinical example of a case of accidental diagnosis of human immunodeficiency virus in a child at the age of 1 year 10 months with an abscess in the parotid region on the left and the newly diagnosed lymphoproliferative syndrome. The expression of lymphoproliferative syndrome did not correspond to the clinical picture of the underlying disease, therefore differential diagnosis was made between such diseases as histiocytosis, haemoblastosis, primary immunodeficiency disorders, salmonellosis, yersiniosis, tuberculosis. As a result, a human immunodeficiency virus was diagnosed in a child of young age who does not have an apparently burdened history. As a result, the child was timely sent to a specialized hospital for in-depth examination and treatment.
Usage of glucometer with mobile application in real clinical practice
Authors: Vitebskaya A. V.
Published: July 2020

Introduction. Glycemic control in patients with diabetes mellitus type 1 (DM1) can be held using glucometer with mobile application, continuous glucose monitoring (CGM), and intermediately scanned CGM (isCGM). isCGM do not need calibration with glucometer as CGM, but its usage in children and adolescents is recommended only together with glucometer.

Aim: to study characteristics of glucometer usage in real clinical practice in a patient which utilizes glucometer with mobile application and is CGM simultaneously.

Materials and methods. A 17-year-old girl with diabetes mellitus type 1 was advised to use isCGM together with glucometer Contour Plus One (ISO 15197:2013) and mobile application Contour Diabetes.

Results. The first three months, while insulin dose titration and education, the patient used glucometer 1–9 times a day (3.0 (2.0; 4.0)), filled in diary. These led to decrease of glycaemia (10.7 (5.5; 14.7) – 7.8 (5.2; 9.5) mmol/L) and variability (56–45%), increase of percent of measurements within range (38–57%), according to glucometer; decrease of mean glycaemia (11.8–8.5 mmol/L) and increase of time in range (TIR) (14–59%), according to isCGM. The next three months, while diabetes mellitus type 1 compensation, according to glucometer (glycaemia 6.9 (4.9; 9.7) mmol/L, variability 48%, percent of measurements within range 71%) and isCGM (mean glycaemia mean glycaemia 7.3 mmol/L, TIR 67%), the patient stopped to fill in diary, decreased number of measurements by glucometer to 1.0 (1.0; 2.0) times a day. Mean month glycaemia was 5.5–9.8% lower according to glucometer than isCGM. The patient used glucometer in cases with relatively high risk of hypoglycemia more often.

Conclusion. Usage of glucometer with mobile application can increase adherence to treatment. If glucometer and isCGM used simultaneously the patients measure glycaemia with glucometer in cases of decompensated diabetes mellitus type 1 and while insulin titration more often. Mean month glycaemia according to glucometer, if used every day, corresponds with isCGM data. We must discuss with patients circumstances when they use glucometer because this can influence glycemic control indicators in mobile application reports.
Inherited heart rhythm and conduction disorders in children with infectious diseases
Authors: Chuprova S. N. , Rudneva E. P. , Lobzin Yu. V.
Published: July 2020

Introduction. One of the causes of sudden cardiac death in children is inherited arrhythmias. In view of the links between the increase in body temperature and the manifestation of some inherited cardiac arrhythmias (including typical electrocardiographic changes), the frequency of inherited cardiac arrhythmias in children with infectious diseases have been analyzed.

The relevance of the study: is initiated by the necessity of timely diagnosis of inherited cardiac arrhythmias and conduction in children in order to prevent sudden cardiac death in them.

The purpose of the study: to determine the frequency of inherited arrhythmias in children with infectious diseases based on clinical and electrocardiographic analysis.

Materials and methods: 3584 electrocardiograms (ECGs) of children with infectious diseases (average age 8.5 ± 5.3 years old; boys – 57.5%, girls – 42.5%) hospitalized in the Pediatric Research and Clinical Center for Infectious Diseases were analyzed. Patients with changes in the ECGs were given additional examination depending on the intended diagnosis (inherited arrhythmias): 24-Hour Holter ECG monitoring, stress test, echocardiography. The family history was also clarified, and the parents’ ECG was analyzed.

Results and conclusions. ECG changes, which are typical for Brugada syndrome (type 1), were detected in two children (0.05%) at first. Long QT syndrome was also detected in two children (0,05%). Mutations in the SCN5A gene were identified in children with Brugada syndrome, and in the KCNQ1 gene with long QT syndrome. An episode of monomorphic ventricular tachycardia was recorded at night in a 5-year-old girl with atrioventricular block 1 degree, hypoadaptation of the QT interval with repeated Holter ECG monitoring during sleep. Cases of life-threatening ventricular arrhythmias have previously been described in the literature in patients with Brugada syndrome. An increase in body temperature leads to disruption of the sodium ion channels which underlie the development of this syndrome, thereby, on the one hand, increasing the risk of life-threatening arrhythmias and sudden cardiac death, on the other hand, to the clinical manifestation of the disease, allowing the diagnosis to be made in time. In the cases of long QT syndrome, in our study, the increase in the corrected QT interval (QTc) is most likely due to a change in heart rate rather than a direct effect of an increase in body temperature on the ion channels.
Intestinal microbiota in children with obesity. Role of probiotics
Authors: Zakharova I. N. , Berezhnaya I. V. , Skorobogatova E. V. , Aysanova M. R. , Bocharova T. I.
Published: July 2020

Obesity is a global problem of modern healthcare. In 2016, the World Health Organization estimated that 39% of people over 18 were overweight, and the number of obese people worldwide almost tripled over the period from 1975 to 2016. The number of overweight and obese children is growing at an alarming rate, with the World Health Organization estimating that in 2016 the number of overweight children under the age of 5 will exceed 41 million. Scientific evidence supports the hypothesis that the development of obesity is closely related to changes in both the function and composition of the intestinal microbiota, which plays a significant role in controlling energy metabolism and changes in body mass index. The main therapy for obesity and associated metabolic disorders to date has been a corrected diet combined with physical activity. The new therapeutic strategy for the treatment and prevention of obesity is based on changing the metabolic activity of the intestinal microbiota using probiotics. Studies on changes in metabolic activity and obesity in rodents have shown encouraging results. The beneficial effects of probiotics on human health today no longer require proof. Probiotics have an integrated effect on the physical, biochemical and metabolic parameters associated with obesity, combined with adequate nutrition and lifestyle correction. Probiotics in the presence of prebiotics have more pronounced metabolic functions, help stabilize the intestinal microbiota, maintain a healthy body weight and control factors associated with fat accumulation and chronic inflammation.
Therapeutic potential of combination antimicrobial drug amoxycillin/clavulanate in children
Authors: Drozdov V. N. , Ermakova D. D. , Serebrova S. Yu. , Komissarenko I. A. , Shikh E. V. , Starodubtsev A. K. , Marin T. V.
Published: July 2020

Combination of amoxicillin/clavulanate firstly occurred on a pharmacological market in 1977 and it is still has been used successfully for treatment of infections in children and adults. Clavulanic acid provides an opportunity to fight microorganisms that produce specific enzymes – beta-lactamases. Despite the global antibiotic resistance problem, amoxicillin/clavulanate is still active against different infections in children. The level of susceptibility to amoxicillin/clavulanate of St. pneumonia is high for a period of 40 years. Based on the multicenter study of the antimicrobial resistance of pneumococci, haemophilus, group A streptococci, moraxella PeGAS I-III findings, susceptibility to amoxicillin/clavulanate of St. Pneumoniae in Russian Federation has been changed slightly from 100% to 99.6% over a period of 1993 – 2009 y. The systematic review with meta-analysis published in 2019 showed that the sensitivity of hemophilic bacillus and moraxella to amoxicillin/clavulanate in the treatment of acute otitis media accounted for 98% each. The article presents data on clavulanic acid action mechanism, spectrum of amoxicillin/clavulanate activity on the ground of clinical trials and meta-analyses, priority of suspension usage in pediatric practice is explained. Possibilities of using in pediatric practice were also viewed.
Prolonged reception of cholecalcipherol – the basis of effective prevention of hypovitaminosis D in young years
Authors: Zakharova I. N. , Klimov L. Ya. , Dolbnya S. V. , Kuryaninova V. A. , Maltsev S. V. , Malyavskaya S. I. , Yagupova A. V. , Tsutsaeva A. N. , Soloveva E. A. , Golysheva E. V. , Dyatlova A. A. , Alhimidi A. A. , Kipkeev Sh. O.
Published: July 2020

Introduction. Vitamin D plays a fundamental role in the regulation of calcium and phosphorus homeostasis, and in recent decades its non-calcemic effects have been intensively studied.

The aim of the work was to analyze the patterns of vitamin D availability in young children against the background of prolonged use of an aqueous solution of cholecalciferol in preventive doses.

Materials and methods: 192 children of the first three years of life were examined (Arkhangelsk – 77 (40.1%), Moscow – 38 (19.8%), Stavropol – 77 (40.1%) children). Assessment of vitamin D availability was carried out by the level of serum calcidiol (25(OH)D). Based on the initial vitamin D supply, patients were divided into groups, and participants used cholecalciferol preparations for 30 days.

Results. The baseline vitamin D supply was 26.0 (19.5–35.4) ng/ml. Median 25(OH)D in children in the Moscow region is higher than in Arkhangelsk and Stavropol (p<0.0001). After using vitamin D in therapeutic doses, the median 25 (OH) D in Arkhangelsk was 46.7 (32.3–64.5) ng/ml, in Moscow – 52.6 (40.2–64.9) ng/ml, in Stavropol – 51.4 (41.3–69.8) ng/ml. According to the results of taking the prophylactic dose (1000 IU/day), satisfactory vitamin D was detected in 105 (54.7%) patients, insufficiency (from 20 to 30 ng/ml) – in 70 (36.5%), deficiency (from 10 up to 20 ng/ml) – in 17 (8.8%) children. Among children who had a 25(OH)D level of more than 30 ng/ml at the end of the study, the use of vitamin D preparations of 50–100 IU/kg and in 42 (41.0%) was effective in 62 (59.0%) children – in a dose of 100–150 IU/day, and in the group of patients with a level of 25(OH)D less than 30 ng/ml – a dose of 50 to 100 IU/kg was used in 69 (79.3%) patients, and a dosage of 100–150 IU/kg in only 18 (20.7%) children (p < 0.0005).

Conclusion. The used prophylactic dosage of 1000 IU/day of an aqueous solution of cholecalciferol was effective in most compliance children. The elimination of deficiency and the prevention of vitamin D deficiency is most effective when used for 6 months or more.
Paediatric osteoporosis: features of skeletal mineralization in children, prevention, and treatment
Authors: Тaranushenko T. E. , Kiseleva N. G.
Published: July 2020

The prevention and treatment of osteoporosis in children is an urgent problem of pediatrics and pediatric endocrinology. This is due to the need for preventive measures for the formation of adequate bone mass and bone strength, the duration of rehabilitation during the development of the disease and the occurrence of fractures, as well as the requirements for optimizing the treatment of this pathology in childhood.Bone tissue is a dynamic and constantly updated system. The main regulators of osteogenesis include trace elements (calcium, phosphorus, zinc, fluorine, etc.), vitamin D, hormones (parathyroid hormone, calcitonin, growth hormone, corticosteroids, etc.), growth factors (IRF-1, IRF-2, ERF, FRF, etc.), local bone-resorbing factors (IL-1, IL-6, TNF, PGE, etc.) and mechanical stress. Remodeling processes continue throughout life, but are most intense until 18 years of age.The most important risk factors for developing osteoporosis are a history of prematurity and / or IUGR, rickets, low intake of protein, calcium and vitamin D, weight deficiency, periods of active growth, low physical activity, endocrine diseases (diabetes mellitus, growth hormone deficiency, hypogonadism, etc.), somatic pathology (chronic diseases of the kidneys, liver, malabsorption), taking certain medications (GCS, anticonvulsants, cytostatics, etc.). Clinical manifestations of osteoporosis in children include signs of tissue calcium deficiency (trophic changes in the nails, hair and tooth enamel, paresthesia, pain in the calf muscles) and a decrease in bone mineralization (impaired posture, slowed growth, pain in the spine and large joints, pathological low-energy fractures) Measures to prevent osteoporosis in childhood include regular physical activity, a balanced diet, adequate insolation, and the identification and treatment of somatic pathology. Additional pharmacological correction is carried out in risk groups – the recommended course use of preparations containing vitamin D, calcium and other osteotropic minerals.The treatment of osteoporosis in children and adolescents is actively debated. A mandatory component of therapy are calcium salts in combination with vitamin D. The possibility of using bisphosphonates is being examined, the effect of monoclonal antibodies (denosumab), somatropin and anabolic steroids on bone metabolism is being studied. In addition, non-pharmacological methods are prescribed - orthopedic correction for fractures, exercise therapy, gymnastics, therapeutic swimming and massage.
Vaccinal prevention of chickenpox: relevance of the problem
Authors: Nikolaeva S. V. , Pogorelova O. O. , Khlypovka Yu. N. , Gorelov A. V.
Published: July 2020

Chickenpox is an acute viral infection which is a serious public health problem. According to the World Health Organization, there are 4,2 million severe forms of disease requiring hospitalization and 4,200 deaths annually. The CP cause is DNA-containing herpesvirus 3, Varicella-zoster. The first symptoms of the disease appear after the incubation period, which lasts from 10 to 21 days, and are manifested by fever, malaise and the appearance of a characteristic rash in the form of small vesicles with transparent content on the skin and mucous membranes. The vesicles are progressively covered with crust, which disappears within 7–10 days. Chicken pox is more frequent in the mild and moderate form, but it may develop severe forms, atypical course, complications (most often bacterial skin infections and lesions of the nervous system are registered in children (more often – chicken encephalitis), and in adults - pneumonia). Vaccinal prevention is the most effective and scientifically proven method of infection control, and chickenpox currently belongs to such infections. The currently used chickenpox vaccines were developed in the mid 1970s, used in some countries from the mid 1980s, and from the early 1990s began to be used in routine immunization programmes in leading countries. Since then, their safety and immunogenicity as well as high efficiency of routine chickenpox vaccine prevention in both healthy and high-risk individuals have been proved. Accumulated experience has shown that a vaccine can reduce the number of cases and the frequency of hospitalizations and deaths when mass immunization is carried out.
Place of combination drugs in the therapy of acute bronchitis in children
Authors: Kolosova N. G. , Grebeneva I. V. , Denisova V. D. , Maksimova E. M.
Published: July 2020

Acute respiratory tract infections accompanied by cough play a significant role in respiratory pathology in childhood. The incidence of acute respiratory infections among children is 4–5 times higher than among the adult population and accounts for more than 90% of all infectious and parasitic diseases registered in Russia. The highest rates of acute respiratory infections are observed among children of preschool age, especially in the first three years of life. As in adults, children’s cough, described as a symptom of «upper respiratory infection» or «acute bronchitis», is the most commonly diagnosed acute manifestation in primary care. These 2 diagnoses represent 75% of all cough cases. The most common etiological agents in acute bronchitis are respiratory viruses: adenovirus, influenza viruses and parainfluenza viruses, respiratory syncytial virus, rhinovirus, human Bocavirus, Coxsackievirus, herpes simplex virus, etc. Drug therapy for coughing is prescribed when there is a nonproductive cough that does not perform its protective function, meaning it does not contribute to the purification of the respiratory tract, and is aimed at dilution of sputum, reducing its adhesiveness (viscosity) and thus increase the effectiveness of coughing. The main groups of mucoactive drugs that are usually considered in this case are mucolytics, mucoregulators, mucokinetics, expectorants, and combination drugs. Combination drugs created to eliminate various elements of pathogenesis of respiratory diseases, accompanied by a nonproductive cough and bronchoobstruction, deserve close attention due to the possibility of using several active substances in fixed drug combinations with accurate dosages and proven clinical effectiveness, reducing the number of simultaneously taken drugs, reducing the risk of developing undesirable events. Oral administration of combined medicines becomes especially important in conditions when inhalation therapy is impossible.
Mukolitics in the therapy of respiratory diseases in pediatric practice
Authors: Rashitova E. L. , Zakirova A. M. , Kadriev A. G. , Kadriev A. A.
Published: July 2020

Introduction. Mucolytic drugs are included in treatment standards and clinical guidelines for the management of children with respiratory diseases.

Target. To study the effectiveness of mucoactive therapy through its comparative evaluation in pediatric practice with respiratory pathology.

Materials and methods. A total of 48 patients (mean age 8.6 ± 4.1 years) with respiratory diseases were examined. They received conventional therapy and were divided into groups: the main one took Ambroxol (26) in syrup 15 mg/5 ml three times a day 4 days; comparison – a complex cough syrup with marshmallow (22) three times a day – 7 days. Dynamic control of clinical symptoms through statistical analysis and on special scales, accounting for clinical symptoms were evaluated out on the 1st, 3rd, 5th, 7th and 10th day from the start of mucoactive therapy.

Results and discussion. The reception of ambroxol was accompanied by a pronounced muco-regulatory effect. On the 2nd day of treatment: significant relief of sputum discharge (p = 0.0002), dry cough stopped faster (p = 0.0007), wet cough remained in the recovery period for a short time (p = 0.003); by the 4th–6th day of treatment, a significant decrease in sputum volume and its production period (p = 0.017), shorter duration of dry (3.82 ± 0.84 and 1.79 ± 0.18 days; p = 0.022) and wet rales in the lungs (3.57 ± 0.78 and 1.61 ± 0.21 days; p = 0.024), the severity of dry cough in the main group by 5–7 days in children with allergopathology was less (p = 0.0001). On the 7th day, the severity of wet rales in patients of the main group was 0.08 ± 0.05 points, and in the comparison group 0.18 ± 0.07 points (p = 0.0003), the duration of wet cough (4.4 ± 0.23 against 5.71 ± 0.38 points), sputum discharge (4.63 ± 0.38 against 5.74 ± 0.35 points) and rhinorrhea (2.69 ± 0.57 against 4.42 ± 0.32 points) (p < 0.05).

Findings. The clinical effectiveness of secretolitics is confirmed by reliably quick relief of dry and wet cough, sputum production intensity.
Taste sensations: history of study, evolutionary feasibility and strategies for forming correct taste preferences in children
Authors: Zakharova I. N. , Dmitrieva Yu. A. , Machneva E. B. , Tsutsaeva A. N.
Published: July 2020

Taste preferences influence not only the formation of human health, but also many areas of his life. That is why the problem of understanding the nature and regularities of taste formation has been a concern for scientists since ancient times and remains relevant nowadays. The article presents generalized data on the history of studying taste from the times of Ancient Greece to our time. Notions about the system of taste sensations in works of Aristotle, Galen, Avicenna, Vesaliy, other medieval scientists and researchers of New time are described. The authors also present an overview of current studies on the evolutionary appropriateness of taste sensations using the expression of sweet taste receptors in animals with different diets. It has been shown that obligate carnivorous animals have lost the function of sweet taste receptors, and in hummingbirds eating sweet floral nectar, on the contrary, another sweet taste receptor has acquired the function of a sweet taste receptor to detect sugars. The authors pay special attention to the available ways of forming correct taste preferences and overcoming eating disorders in infants, which is important from the point of view of the child’s future health. In particular, strategies for repeated taste effects of new foods as well as multisensory interactions with food, including sound, visual, olfactory, tactile and tasting effects are presented. It is particularly important to develop correct taste habits in children with eating disorders such as neophobia and food selectivity. Understanding the multifactorial nature of taste preferences and their impact on human health allows finding new strategies to «teach» taste from early childhood.
Lactase deficiency and gastrointestinal allergies in young children
Authors: Ziatdinova N. V. , Malanicheva T. G. , Bareeva L. A.
Published: July 2020

Intestinal colic, food allergies are one of the common causes of the initial treatment of children in their first year of life in outpatient practice. Gastrointestinal allergy is a lesion of the gastrointestinal tract of an allergic nature, is in second place among the pathologies associated with food allergies, where allergy to cow’s milk proteins leads. In recent years, the diagnosis of lactase deficiency, unreasonably leads to an unreasonable transfer of the child to artificial curing and the appointment of lactose-free mixtures. In some patients with gastrointestinal manifestations, secondary LN is quite often formed. The article discusses the clinical forms of LN and GA. Undigested lactose increases the cell-mediated pro-inflammatory processes in the body, which, in turn, leads to the stimulation of the development of inflammatory and allergic processes in children. The possibilities and effectiveness of concomitant diet therapy are discussed, including using replacement therapy with the enzyme lactase, which eliminates the main cause of childhood colic, helps the absorption of breast milk or mixture, thus providing babies with the necessary nutrients for physiological development. The article presents results of the clinical observation carried out in a group of 20 full term babies aged 2–5 months with secondary lactase deficiency in the setting of gastrointestinal allergy with positive clinical response: highly quick control of symptoms of intestinal dyspepsia, improvement in stool frequency and consistency were detected on Day 7 from the start of enzyme therapy in 85% of children. Symptoms of intestinal colic (95%), flatulence (80%) were also reversed, regurgitation decreased in frequency and volume (85%) by the end of Week 1 of the therapy and completely disappeared by the end of Week 2. Lab tests confirmed the clinical efficacy of the therapy. A significant improvement in coprogram indicators was identified in 80% of children by the end of Week 2 from the start of therapy. The researchers found out that the carbohydrate content in the coprogram decreased by 1.8 times from 1.3% ± 0.5 to 0.7% ± 0.5 (p <0.05) in most children, and there was no significant decrease of this indicator in 20% of patients. The results show that the prescription of enzyme replacement therapy in combined gastrointestinal allergy and secondary lactase deficiency in children aged 6 months helped keep breastfeeding volumes, and reverse symptoms of lactase deficiency in most cases.
Molecular-guided therapy for disseminated cervical cancer: present and future
Authors: Rumyantsev A. А.
Published: July 2020

Сervical cancer is recognized as one of the leaders in mortality from gynecological oncological diseases. The incidence and mortality from cervical cancer over the past 10 years remained at a consistently high level. For a long time, the only treatment option for metastatic and/or recurrent cervical cancer was cytotoxic chemotherapy, but its results remained extremely unsatisfactory: the 5-year overall survival rate was about 12%. This article is devoted to a review of the current possibilities of targeted and immunotherapy of metastatic and/or recurrent cervical cancer. We reviewed the most recent studies in the field of the effectiveness of antiangiogenic therapy including a critical and detailed analysis of the results of the GOG-240 phase III study. The data of modern literature in the field of immunotherapy using PD-1 / PD-L1 signaling pathway inhibitors in metastatic cervical cancer has been studied. It was found that a significant number of patients (34-95%) showed increased expression of PD-L1 in the tumor tissue, and 3-6% of patients showed a high level of microsatellite instability (MSI) in the tumor, which reveals the possibility of immunotherapy for this disease. We also conducted a review of ongoing clinical studies on the use of targeted and immunotherapy of advanced cervical cancer and the prospects for changing the “landscape” of treatment for this disease were assessed. On the example of a clinical case of treatment of a real patient, the possibilities of modern targeted and immunotherapy of metastatic cancer of the cervix uteri were analyzed, which gave a possibility to ensure long-term survival for the patient with an initially poor prognosis.
Is it possible to improve primary therapy of advanced ovarian cancer?
Authors: Khokhlova S. V.
Published: July 2020

In 2011, a standard approach to the treatment of primary ovarian cancer (OC) included a cytoreductive surgery, which could be performed after 2–3 cycles of neoadjuvant chemotherapy, and chemotherapy consisting of platinum and taxanes. Such approach was provided for all patients, regardless of tumour histology and any molecular biological and genetic factors. The most complete picture of management and therapy of patients can be made using the treatment of a specific patient as an example. After application to the N.N. Blokhin National Medical Research Center of Oncology in 2011, the patient with OC received standard primary therapy and subsequent treatment of the recurrent disease, which was accompanied by various types of adverse events resulting in the poor quality of life for the patient. The data that some patients with OC have a BRCA1/2 mutation that is significant for prognosis and treatment came to hand later and, unfortunately, the awareness of a significant germinal BRCA1 mutation was of no use to the woman any longer. The life expectancy of this patient was 47 months. This is the average life expectancy for patients with stage IIIC OC. Major changes have been brought in the primary therapy of OC. If a diagnosis of low-grade IIIC ovarian adenocarcinoma was established in this patient today, needless to say that the BRCA1 mutation would be identified during the first-line chemotherapy, and in case of full or partial treatment effect, we would prescribe olaparib as maintenance therapy to the patient. Considering the fact that the median progression-free survival has not yet been achieved in the patients of SOLO-1 study, who received olaparib therapy, and is only approaching 54 months, it can be assumed that even the first relapse could not have developed in this patient.