bluuebunny/crossref_metadata_2025 huggingface dataset:
Protocol for a feasibility study investigating the UCalgary’s Cannabis Café: education and harm reduction initiative for postsecondary students
Authors: Mader Joel , Smith Jacqueline M , Smith Jennifer , Christensen Darren Robert
Published: February 2020

Introduction

High rates of cannabis consumption among emerging adults in Canada represent an important public health issue. As part of the legalisation of cannabis, health objectives were established by the Government of Canada including reducing risky patterns of consumption and cannabis related harm among vulnerable populations. Despite these ambitions, few evidenced based education programmes have been evaluated in the literature. The aim of this study is to describe and evaluate the acceptability of a novel harm reduction and education initiative titled, UCalgary’s Cannabis Café. The Cannabis Café incorporates components shown to be effective in reducing risky substance consumption on campuses and substance related stigma. An important objective of the Café is the dissemination of methods to reduce risk in the form of Canada’s Lower-Risk Cannabis Use Guidelines.

Methods and analysis

The study will take the form of a non-experimental, observational cohort design, where participants will be asked to complete four surveys (baseline, immediate follow-up, 1 month and 3 months). The primary outcomes of the study will be the feasibility of the initiative including acceptability and implementation. Secondary outcomes include knowledge uptake of methods to reduce risk of cannabis related harm, descriptive cannabis norms and changes in cannabis consumption.

Ethics and dissemination

The study was approved by the University of Calgary Conjoint Health Research Ethics Board (#REB18-1364). The investigators will develop a guideline outlining the Cannabis Café to assist in the replication of this initiative at other locations and publish the results from the study in a peer-reviewed manuscript.
Integrated care experiences and out-of-pocket expenditures: a cross-sectional survey of adults receiving treatment for HIV and hypertension in Malawi
Authors: Moucheraud Corrina , Hing Matthew , Seleman Juliet , Phiri Khumbo , Chibwana Florence , Kahn Daniel , Schooley Alan , Moses Agnes , Hoffman Risa
Published: February 2020

Objectives

As HIV-positive individuals’ life expectancy extends, there is an urgent need to manage other chronic conditions during HIV care. We assessed the care-seeking experiences and costs of adults receiving treatment for both HIV and hypertension in Malawi.

Design, setting and participants

A cross-sectional survey was conducted with HIV-positive adults with hypertension at a health facility in Lilongwe that offers free HIV care and free hypertension screening, with antihypertensives available for purchase (n=199). Questions included locations and costs of all medication refills and preferences for these refill locations. Respondents were classified as using ‘integrated care’ if they refilled HIV and antihypertensive medications simultaneously. Data were collected between June and December 2017.

Results

Only half of respondents reported using the integrated care offered at the study site. Among individuals using different locations for antihypertensive medication refills, the most frequent locations were drug stores and public sector health facilities which were commonly selected due to greater convenience and lower medication costs. Although the number of antihypertensive medications was equivalent between the integrated and non-integrated care groups, the annual total cost of care differed substantially (approximately US$21 in integrated care vs US$90 for non-integrated care)—mainly attributable to differences in other visit costs for non-integrated care (transportation, lost wages, childcare). One-third of those in the non-integrated care group reported no expenditure for antihypertensive medication, and six people in each group reported no annual hypertension care-seeking costs at all.

Conclusions

Individuals using integrated care saw efficiencies because, although they were more likely to pay for antihypertensive medications, they did not incur additional costs. These results suggest that preferences and experiences must be better understood to design effective policies and programmes for integrated care among adults on antiretroviral therapy.
Bone health in bipolar disorder: a study protocol for a case–control study in Australia
Authors: Williams Lana J , Stuart Amanda L , Berk Michael , Brennan-Olsen Sharon L , Hodge Jason M , Cowdery Stephanie , Chandrasekaran Vinoomika , Pasco Julie A
Published: February 2020

Introduction

Little is known about the bone health of adults with bipolar disorder, aside from evidence purporting bone deficits among individuals with other mental illnesses, or those taking medications commonly used in bipolar disorder. In this paper, we present the methodology of a case–control study which aims to examine the role of bipolar disorder as a risk factor for bone fragility.

Methods and analysis

Men and women with bipolar disorder (~200 cases) will be recruited and compared with participants with no history of bipolar disorder (~1500 controls) from the Geelong Osteoporosis Study. Both cases and controls will be drawn from the Barwon Statistical Division, south-eastern Australia. The Structured Clinical Interview for DSM-IV-TR Research Version, Non-patient edition is the primary diagnostic instrument, and psychiatric symptomatology will be assessed using validated rating scales. Demographic information and detailed lifestyle data and medical history will be collected via comprehensive questionnaires. Participants will undergo dual energy X-ray absorptiometry scans and other clinical measures to determine bone and body composition. Blood samples will be provided after an overnight fast and stored for batch analysis.

Ethics and dissemination

Ethics approval has been granted from Barwon Health Research Ethics Committee. Participation in the study is voluntary. The study findings will be disseminated via peer-reviewed publications, conference presentations and reports to the funding body.
School-based interventions for preventing substance use in indigenous children ages 7–13: a scoping review protocol
Authors: Maina Geoffrey , Phaneuf Taryn , Kennedy Megan , Mclean Maeve , Gakumo Ann , Nguemo Joseph , King Alexandra , Mcharo Solomon Kasha
Published: February 2020

Introduction

Throughout the world, indigenous peoples share traumatic colonial experiences that have caused gross inequalities for them and continue to impact every aspect of their lives. The effect of intergenerational trauma and other health disparities have been remarkable for Indigenous children and adolescents, who are at a greater risk of adverse mental health and addiction outcomes compared with non-indigenous people of the same age. Most indigenous children are exposed to addictive substances at an early age, which often leads to early initiation of substance use and is associated with subsequent physical and mental health issues, poor social and relational functioning, and occupational and legal problems. The aim of this paper is to report the protocol for the scoping review of school-based interventions for substance use prevention in Indigenous children ages 7–13 living in Canada, the USA, Australia and New Zealand. This scoping review seeks to answer the following questions: (1) What is known about indigenous school-based interventions for preventing substance use and (2) What are the characteristics and outcomes of school-based interventions for preventing substance use?

Methods and analysis

This scoping review will use steps described by Arksey and O’Malley and Levac: (1) identifying the research question(s); (2) identifying relevant studies; (3) selecting the studies; (4) charting the data; (5) collating, summarising and reporting the results and (6) consulting with experts. Our findings will be reported according to the guidelines set by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews.

Ethics and dissemination

Ethics review approval is not required for this project. Findings from this study will be presented to lay public, at scientific conferences and published in a peer-reviewed journal.
Atlas of the OMERACT Heel Enthesitis MRI Scoring System (HEMRIS)
Authors: Mathew Ashish J , Krabbe Simon , Eshed Iris , Lambert Robert GW , Laredo Jean-Denis , Maksymowych Walter P , Gandjbakhch Frederique , Emad Yasser , Stoenoiu Maria Simona , Foltz Violaine , Bird Paul , Carron Philippe , Paschke Joel , Conaghan Philip G , Pedersen Susanne J , Glinatsi Daniel , Østergaard Mikkel
Published: February 2020

Objective

Assessment of enthesitis, a key feature in spondyloarthritis (SpA) and psoriatic arthritis (PsA), using objective and sensitive methods is pivotal in clinical trials. MRI allows detection of both soft tissue and intra-osseous changes of enthesitis. This article presents an atlas for the Outcome Measures in Rheumatology (OMERACT) Heel Enthesitis Magnetic Resonance ImagingMRI Scoring System (HEMRIS).

Methods

Following a preliminary selection of potential examples of each grade, as per HEMRIS definitions, the images along with detailed definitions and reader rules were discussed at web-based, interactive meetings between the members of the OMERACT MRI in Arthritis Working Group.

Results

Reference images of each grade of the MRI features to be assessed using HEMRIS, along with reader rules and recommended MRI sequences are depicted.

Conclusion

The presented reference images can be used to guide scoring Achilles tendon and plantar fascia (plantar aponeurosis) enthesitis according to the OMERACT HEMRIS in clinical trials and cohorts in which MRI enthesitis is used as an outcome.
High tunnels without anti-insect netting benefit organic cherry tomato production in regions with cool and short growing seasons
Authors: Kong Yun , Llewellyn David , Zheng Youbin
Published: February 2020

The potential market for locally produced organic cherry tomatoes (Solanum lycopersicum var. cerasiforme) is large in Canada, but it is challenging to grow this warm-season crop in open fields (OFs) due to the cool and short growing season. To test the feasibility of using high tunnels (HTs) for improving organic production in southern Ontario, plant growth, fruit yield and quality, and pest and disease incidence were compared for ‘Sarina hybrid’ cherry tomato among three production systems: OF, HT, and high tunnel with anti-insect netting (HTN) in Guelph, ON, in 2015 and 2016. Averaged over the 2 yr, the highest marketable fruit yield was achieved in HT (≈70 t ha−1), followed by HTN (≈50 t ha−1), with the lowest yield obtained in OF (≈24 t ha−1). Compared with OF, increased plant growth, extended harvest period, reduced pest numbers, and increased proportion of marketable fruits all led to the higher marketable yields in HT and HTN. Under HT vs. OF, fruit quality attributes, such as soluble solids content and post-harvest water loss, were better in 2015 and similar in 2016. Although the insect netting reduced pest incidence and disease infection, fruits harvested from HTN had lower yield, smaller size, and lower soluble solids content than those from HT in both years. Therefore, HT can be recommended for organic production of cherry tomatoes in southern Ontario.
Flavor physics: Precision as an avenue to discovery
Authors: Guadagnoli Diego
Published: February 2020

This paper describes the work pursued in the years 2008–2013 on improving the Standard Model prediction of selected flavor-physics observables. The latter includes: (1) [Formula: see text], that quantifies indirect CP violation in the [Formula: see text] system and (2) the very rare decay [Formula: see text], recently measured at the LHC. Concerning point (1), the paper describes our reappraisal of the long-distance contributions to [Formula: see text],[Formula: see text] that have permitted to unveil a potential tension between CP violation in the [Formula: see text]- and [Formula: see text]-system. Concerning point (2), the paper gives a detailed account of various systematic effects pointed out in Ref. 4 and affecting the Standard Model [Formula: see text] decay rate at the level of 10% — hence large enough to be potentially misinterpreted as nonstandard physics, if not properly included. The paper further describes the multifaceted importance of the [Formula: see text] decays as new physics probes, for instance how they compare with [Formula: see text]-peak observables at LEP, following the effective-theory approach of Ref. 5. Both cases (1) and (2) offer clear examples in which the pursuit of precision in Standard Model predictions offered potential avenues to discovery. Finally, this paper describes the impact of the above results on the literature, and what is the further progress to be expected on these and related observables.
Parallel distributed networks dissociate episodic and social functions within the individual
Authors: DiNicola Lauren M. , Braga Rodrigo M. , Buckner Randy L.
Published: February 2020

Association cortex is organized into large-scale distributed networks. One such network, the default network (DN), is linked to diverse forms of internal mentation, opening debate about whether shared or distinct anatomy supports multiple forms of cognition. Using within-individual analysis procedures that preserve idiosyncratic anatomical details, we probed whether multiple tasks from two domains, episodic projection and theory of mind (ToM), rely on the same or distinct networks. In an initial experiment (6 subjects, each scanned 4 times), we found evidence that episodic projection and ToM tasks activate separate regions distributed throughout the cortex, with adjacent regions in parietal, temporal, prefrontal, and midline zones. These distinctions were predicted by the hypothesis that the DN comprises two parallel, interdigitated networks. One network, linked to parahippocampal cortex (PHC), is preferentially recruited during episodic projection, including both remembering and imagining the future. A second juxtaposed network, which includes the temporoparietal junction (TPJ), is differentially engaged during multiple forms of ToM. In two prospectively acquired independent experiments, we replicated and triplicated the dissociation (each with 6 subjects scanned 4 times). Furthermore, the dissociation was found in all zones when analyzed independently, including robustly in midline regions previously described as hubs. The TPJ-linked network is interwoven with the PHC-linked network across the cortex, making clear why it is difficult to fully resolve the two networks in group-averaged or lower-resolution data. These results refine our understanding of the functional-anatomical organization of association cortex and raise fundamental questions about how specialization might arise in parallel, juxtaposed association networks.

NEW & NOTEWORTHY Two distributed, interdigitated networks exist within the bounds of the canonical default network. Here we used repeated scanning of individuals, across three independent samples, to provide evidence that tasks requiring episodic projection or theory of mind differentially recruit the two networks across multiple cortical zones. The two distributed networks thus appear to preferentially subserve distinct functions.
An Adolescent Female with Bipolar Disorder Presenting with Lithium-Induced Hyperthyroidism
Authors: Rana Pratibha , Alba Aponte Patria , Babar Ghufran
Published: February 2020

Lithium therapy has been associated with several endocrine disorders including thyroid dysfunction, diabetes insipidus, and hyperparathyroidism. While its suppressive effect on thyroid function is well known, it is very rare to observe lithium-induced hyperthyroidism especially in the pediatric population. Here, we describe a case of lithium-induced hyperthyroidism in an adolescent female with bipolar disorder. The patient is a 17-year-old female who was treated with lithium for bipolar disorder and presented with symptoms and laboratory findings consistent with hyperthyroidism. Since thyroid autoantibodies were negative, thyroid dysfunction was attributed to lithium toxicity. Indeed, her clinical and biochemical hyperthyroid state resolved after stopping lithium therapy. Lithium-associated hyperthyroidism can occur in the pediatric population. We propose close monitoring of thyroid hormone levels in children on lithium therapy.
Successful Treatment of Pediatric Refractory/Relapsed AML with KIR-Ligand-Mismatched Cord Blood Transplant after FLAG-IDA Reinduction Therapy with or without the GO Regimen
Authors: Toyama Daisuke , Matsuno Ryosuke , Sugishita Yumiko , Kaneko Ryota , Okamoto Naoko , Koganesawa Masaya , Fujita Sachio , Akiyama Kosuke , Isoyama Keiichi , Yamamoto Shohei
Published: February 2020

Prognosis in pediatric patients with refractory/relapsed acute myeloid leukemia (AML) is grim, and there is no standard treatment for such patients. Combined treatment with intensive chemotherapy and gemtuzumab ozogamicin (GO), a monoclonal anti-CD33 antibody conjugated with calicheamicin, is useful as reinduction therapy in refractory/relapsed AML. Here, we describe three cases of pediatric refractory/relapsed AML that were successfully managed with FLAG-IDA (fludarabine, cytarabine, granulocyte colony-stimulating factor, and idarubicin), with or without GO, as reinduction therapy before a KIR-ligand-mismatched cord blood transplant. This strategy relies on the fact that killer cell immunoglobulin-like receptors (KIR) on cord blood natural killer (NK) cells recognize human leukocyte antigen (HLA) class I alleles, and that donor KIR-ligand incompatibility may be associated with lower incidence of relapse and improved survival in AML, as cells that lack these inhibitory HLA ligands can activate NK cells. All three patients are currently alive and have been disease-free for 24–65 months, although one patient developed severe sinusoidal obstructive syndrome (SOS). Thus, our strategy can result in excellent outcomes in pediatric patients with refractory/relapsed AML.
The Fault Diagnosis of Rolling Bearing Based on Variational Mode Decomposition and Iterative Random Forest
Authors: Qin Xiwen , Guo Jiajing , Dong Xiaogang , Guo Yu
Published: February 2020

Rolling bearing is a critical part of machinery, whose failure will lead to considerable losses and disastrous consequences. Aiming at the research of rotating mechanical bearing data, a fault identification method based on Variational Mode Decomposition (VMD) and Iterative Random Forest (iRF) classifier is proposed. Furthermore, EMD and EEMD are used to decompose the data. At the same time, three mainstream classifiers were selected as the benchmark model. The results show that the proposed model has the highest recognition accuracy.
Thyroid Eye Disease due to Immune Reconstitution Inflammatory Syndrome as a Consequence of Antiretroviral Therapy in the Setting of AIDS
Authors: Nallu Ravali , Madhavan Parvathy , Chirch Lisa , Luthra Pooja
Published: February 2020

We describe a case of worsening Graves’ orbitopathy due to immune reconstitution inflammatory syndrome (IRIS) in a 38-year-old HIV-infected male after beginning ART (antiretroviral therapy). Two years after initiation of ART, the patient developed symptoms of hyperthyroidism and thyroid eye disease (TED) or Graves’ orbitopathy (GO). Thyroid iodine uptake scan was consistent with Graves’ disease. The CT scan of the orbits revealed minimal right-sided proptosis, consistent with GO. He was treated with methimazole and a short course of high-dose prednisone for GO. Thyroid function tests normalized, and eye symptoms eventually stabilized. This case demonstrates the importance of awareness and early recognition of IRIS in its many forms, as it has significant therapeutic implications.
Logarithmic Fuzzy Entropy Function for Similarity Measurement in Multimodal Medical Images Registration
Authors: Miao Yu , Gao Jiaying , Zhang Ke , Shi Weili , Li Yanfang , Zhao Jiashi , Jiang Zhengang , Yang Huamin , He Fei , He Wei , Qin Jun , Chen Tao
Published: February 2020

Multimodal medical images are useful for observing tissue structure clearly in clinical practice. To integrate multimodal information, multimodal registration is significant. The entropy-based registration applies a structure descriptor set to replace the original multimodal image and compute similarity to express the correlation of images. The accuracy and converging rate of the registration depend on this set. We propose a new method, logarithmic fuzzy entropy function, to compute the descriptor set. It is obvious that the proposed method can increase the upper bound value from log(r) to log(r) + ∆(r) so that a more representative structural descriptor set is formed. The experiment results show that our method has faster converging rate and wider quantified range in multimodal medical images registration.
Ischemic Postconditioning Mitigates Retinopathy in Tree Shrews with Diabetic Cerebral Ischemia
Authors: Zhao Ling , Liao Qiwei , Zhang Yueting , Tan Shufen , Li Shuqing , Ke Tingyu
Published: February 2020

Ischemic postconditioning (PC) is proved to efficiently protect diabetic patients with acute myocardial infarction from ischemia-reperfusion injury. We aimed to explore the protective roles of ischemic PC on diabetic retinopathy in tree shrews with diabetic cerebral ischemia. A diabetic tree shrew model was established through high-fat diet feeding combined with streptozotocin (STZ) injection, while cortical thrombotic cerebral ischemia was induced photochemically. Tree shrews were divided into the normal control group, sham operation group, diabetes mellitus group, diabetes mellitus+cerebral ischemia group, and diabetes mellitus+cerebral ischemia+PC group (in which the tree shrews with diabetic cerebral ischemia were treated with ischemic PC). H&E staining was used to examine the pathological changes in the retina, and immunohistochemistry was performed to determine the retinal expression of VEGF (vascular endothelial growth factor). The modeling resulted in 77% tree shrews with diabetes. Ischemic PC reduced the blood glucose levels in the tree shrews with diabetic cerebral ischemia. Tree shrews with diabetes had thinned retina with disordered structures, and these pathological changes were aggravated after cerebral ischemia. The retinopathy was alleviated after ischemic PC. Retina expression of VEGF was mainly distributed in the ganglion cell layer in tree shrews. Diabetes and cerebral ischemia increased retinal VEGF expression in a step-wise manner, while additional ischemic PC reduced retinal VEGF expression. Therefore, ischemic PC effectively alleviates retinopathy in tree shrews with diabetic cerebral ischemia, and this effect is associated with reduced retinal VEGF expression.
Amlodipine-Induced Gingival Hyperplasia in a Young Male with Stage 5 Chronic Kidney Disease
Authors: John Kevin , Mishra Ajay Kumar , Gunasekaran Karthik , Iyyadurai Ramya
Published: February 2020

Gingival hyperplasia is a rare finding in clinical practice. Nevertheless, when it occurs, it is a finding of great value as it can lead to definite clinical diagnosis. The present case is a 19-year-old male who was referred for further management of stage 5 chronic kidney disease. On evaluation, he was found to have gingival hyperplasia. He was evaluated for reversible causes of kidney disease, and since none were found, renal replacement therapy was advised. He had been taking amlodipine for blood pressure control. As this was presumed to be the cause of gingival hyperplasia, it was stopped and replaced by a combination of beta-blocker and prazosin. At six-month follow-up, he had complete resolution of gingival hyperplasia. Amlodipine as a cause of gingival hyperplasia is a rare occurrence. However, it is crucial to keep in mind such a possible side effect of this commonly prescribed antihypertensive drug.
A Review on the Contemporary Development of Composite Materials Comprising Graphene/Graphene Derivatives
Authors: Li Fenfen , Long Linyu , Weng Yunxuan
Published: February 2020

As two‐dimensional materials with a high specific surface area, strength, and electrical and thermal conductivity, graphene (Gr) and its derivatives have great application prospects in various fields such as structural reinforcement, energy storage, optics, and electrical and thermal conductivity. However, the current preparation method of Gr is complicated and expensive. Its preparation cost can be reduced using Gr composites that include inorganic materials or other polymers. Composite materials comprising Gr and inorganic materials are generally prepared using sinter molding, chemical reduction, or chemical deposition. Gr should be able to mitigate several of the defects resulting from inorganic materials, including their poor toughness, small specific capacity, and low photoelectric conversion rate. The mitigation of these defects should result in the expansion of the applications of Gr composites for use in capacitors, catalysts, and sensors, among other devices. Although solution blending or in situ polymerization produces a relatively good mixing effect, in general, melt blending is used in the large‐scale processing of Gr composites with polymer materials. Gr can be used to partially mitigate several weaknesses of polymer materials, including their low strength, poor electrical and thermal conductivities, and poor isolation performance, and expand the applications of Gr composites for use in electrical and thermal conductive materials and functional membrane materials, among other applications. The goal of the present paper is to introduce the structural properties of Gr and a surface modification method for Gr. In addition, the preparation methods and application fields of different Gr composite materials are reviewed. Finally, the development prospects and key issues are discussed.
Association of MC1R Variants and Risk of Melanoma in Melanoma-Prone Families with CDKN2A Mutations
Authors: Goldstein Alisa M. , Landi Maria Teresa , Tsang Shirley , Fraser Mary C. , Munroe David J. , Tucker Margaret A.
Published: February 2020

Major risk factors for melanoma include many nevi, especially dysplastic nevi, fair pigmentation, freckling, poor tanning ability, and germ line mutations in the CDKN2A, CDK4, or MC1R genes. We evaluated the relationship between MC1R and melanoma risk in CDKN2A melanoma-prone families with extensive clinical and epidemiologic data. We studied 395 subjects from 16 American CDKN2A families. Major melanoma risk factors were assessed by clinical examination or questionnaire; MC1R was sequenced. Odds ratios were estimated by unconditional and conditional logistic regression models. We examined the distribution of MC1R variants and median ages at melanoma diagnosis in multiple primary melanoma (MPM) and single primary melanoma (SPM) patients. Presence of multiple MC1R variants was significantly associated with melanoma, even after adjustment for major melanoma risk factors. All 40 MPM patients had at least one MC1R variant; 65% of MPM patients versus only 17% of SPM patients had at least two MC1R variants (P < 0.0001). For all 69 melanoma patients combined, as well as the 40 MPM patients, there was a statistically significant decrease in median age at diagnosis as numbers of MC1R variants increased (P = 0.010 and P = 0.008, respectively). In contrast, no significant reduction in age at melanoma diagnosis was observed for SPM patients (P = 0.91). The current study suggests that the presence of multiple MC1R variants is associated with the development of multiple melanoma tumors in patients with CDKN2A mutations. Additional studies are needed to confirm these findings and to explore the mechanisms that may contribute to this relationship.
Ambulant erworbene Pneumonie: Komorbiditäten als Risikofaktoren erkennen
Authors: Krüger Stefan
Published: February 2020

Background: UK specific data on the risk of developing hospitalised CAP for patients with underlying comorbidities is lacking. This study compared the likelihood of hospitalised all-cause community acquired pneumonia (CAP) in patients with certain high-risk comorbidities and a comparator group with no known risk factors for pneumococcal disease. Methods: This retrospective cohort study interrogated data in the Hospital Episodes Statistics (HES) dataset between financial years 2012/13 and 2016/17. In total 3,078,623 patients in England (aged ≥18 years) were linked to their hospitalisation records. This included 2,950,910 individuals with defined risk groups and a comparator group of 127,713 people who had undergone tooth extraction with none of the risk group diagnoses. Risk groups studied were chronic respiratory disease (CRD), chronic heart disease (CHD), chronic liver disease (CLD), chronic kidney disease (CKD), diabetes (DM) and post bone marrow transplant (BMT). The patients were tracked forward from year 0 (2012/13) to Year 3 (2016/17) and all diagnoses of hospitalised CAP were recorded. A Logistic regression model compared odds of developing hospitalised CAP for patients in risk groups compared to healthy controls. The model was simultaneously adjusted for age, sex, strategic heath authority (SHA), index of multiple deprivation (IMD), ethnicity, and comorbidity. To account for differing comorbidity profiles between populations the Charlson Comorbidity Index (CCI) was applied. The model estimated odds ratios (OR) with 95% confidence intervals of developing hospitalised CAP for each specified clinical risk group.Results: Patients within all the risk groups studied were more likely to develop hospitalised CAP than patients in the comparator group. The odds ratios varied between underlying conditions ranging from 1.18 (95% CI 1.13, 1.23) for those with DM to 5.48 (95% CI 5.28, 5.70) for those with CRD. Conclusions: Individuals with any of 6 pre-defined underlying comorbidities are at significantly increased risk of developing hospitalised CAP compared to those with no underlying comorbid condition. Since the likelihood varies by risk group it should be possible to target patients with each of these underlying comorbidities with the most appropriate preventative measures, including immunisations.
Bronchiale Thermoplastie bei Asthmapatienten mit schwerer Obstruktion: Benefit und Komplikationsrisiko
Authors: Hagmeyer Lars
Published: February 2020

Background: Randomized clinical trials of bronchial thermoplasty (BT) were conducted in patients with a baseline FEV1 greater than 50%. There is a paucity of data regarding BT in patients with more severe obstruction, and consequently these patients are often excluded from receiving BT. The purpose of this study was to compare safety and efficacy outcomes in a large cohort of patients with an FEV1 less than 50% with those of a cohort of less obstructed patients. Methods: Consecutive patients with severe asthma were drawn from the Australian BT Registry. Patients were grouped into (1) those with a baseline prebronchodilator FEV1 % predicted <50% (n = 32) or (2) those with an FEV1 ≥50% (n = 36). Adverse outcomes were defined as (1) remaining in hospital longer than the planned 24-hour admission posttreatment or (2) being readmitted to hospital for any cause within 30 days of a treatment. Efficacy outcomes were evaluated 6 months after BT. Results: More severely obstructed patients were no more likely to have experienced any adverse event. Significant improvements in Asthma Control Questionnaire score, exacerbation frequency, reliever medication use, and requirement for daily oral steroids were observed in both groups, and were of a similar degree. Conclusions: This study demonstrates that BT can confidently be offered to patients with asthma with an FEV1 that is 30% to 50% of predicted without risk of more frequent or more severe adverse events, and with the expectation of the same degree of response as patients with better lung function.
Fallbericht zu schweren multiplen Bronchusstenosen bei einem Patienten, der ‹das Unüberlebbare überlebte›
Authors: Crowhurst Thomas , Lightfoot Joshua , Yeo Aeneas , Reddi Benjamin , Nguyen Phan , Whitford Helen , Holmes-Liew Chien-Li
Published: February 2020

Hintergrund: In der Literatur werden nur wenige Fälle von multiplen Bronchusstenosen beschrieben, und keiner von vergleichbarer Schwere wie der unsere. Dieser Fall ist von Relevanz aufgrund seiner Seltenheit, der zu gewinnenden pathophysiologischen Erkenntnisse, der erfolgreich angewandten interventionell-pneumologischen Behandlungsstrategien, und seiner möglichen Beispielrolle für eine seltene Indikation für eine Hochrisiko-Lungentransplantation. Vorstellung des Falls: Bei einem 47-jährigen Mann traten multiple rezidivierende netzartige Bronchusstenosen auf, 5 Wochen nachdem er eine Episode schwerer Tracheobronchitis durchgemacht hatte, die vermutlich durch eine chemische Inhalationsverletzung verursacht worden war und zunächst zum vollständigen bilateralen Lungenkollaps geführt und eine veno-venöse extrakorporale Membranoxygenierung erforderlich gemacht hatte. Die Stenosen verschlossen die Bronchien an vielen Stellen vollständig und verursachten schwere Typ-II-Ateminsuffizienz, sodass maschinelle Beatmung und eine bronchoskopische Punktion und Dilatation sowie letztlich eine bilaterale Lungentransplantation vorgenommen wurden. Schlussfolgerung: Dieser sehr seltene Fall unterstreicht die Folgemorbidität, die eine verheerende Tracheobronchitis nach sich ziehen kann, wenngleich sie heute im Zeitalter der extrakorporalen Membranoxygenierung kurzfristig überlebt werden kann.
CPAP-Applikation bei der Thorakozentese: Pleuralen Druckabfall mindern und Komplikationen verhindern
Authors: Lesser Thomas
Published: February 2020

Background: Excessive drop of pleural pressure (Ppl) during therapeutic thoracentesis may be related to adverse events and/or to repeated procedures due to incomplete drainage. Objective: This was a pilot study of the impact of the application of continuous positive airway pressure (CPAP) at +5 cm H2O upon the Ppl profile during thoracentesis. Methods: This was a prospective, controlled study of 49 consecutive adults who underwent thoracentesis. Enrollment was via alternation on a one-to-one basis. Pleural manometry was used to compare serial Ppl in patients using CPAP at +5 cm H2O (CPAP group) with Ppl in patients without CPAP (control group). Results: Mean volumes drained were comparable between CPAP and control groups (1,380 vs. 1,396 mL). Patients in the CPAP group had a significantly greater change in volume per centimeter water column pressure (p = 0.0231, 95% confidence interval 6.41-82.61). No patient in the CPAP group had a Ppl less than -20 cm H2O at termination of the procedure, while 8 (33%) control group patients developed a pressure lower than -20. No patient in either group developed re-expansion pulmonary edema. Conclusion: The application of CPAP at +5 cm H2O mitigates the decreases in Ppl caused by thoracentesis via an increase in pleural compliance. The clinical implications of this finding merit study.
Serum Alkaline Phosphatase Level Predicts Cardiac Valve Calcification in Maintenance Hemodialysis Patients
Authors: Guo Jing , Zeng Ming , Zhang Yanjuan , Huang Hui , Yang Guang , Xu Fangyan , Ren Wenkai , Wang Jing , Huang Yaoyu , Wang Ningning , Xing Changying
Published: February 2020

Purpose: Cardiac valve calcification (CVC) is frequently occurred in maintenance hemodialysis (MHD) patients and is associated with cardiovascular and all-cause mortality. This study aimed to evaluate the relationships between risk factors and extent of CVC and further provide the treatment target in MHD patients. Methods: One hundred and forty-five patients who received MHD ≥3 months were enrolled. CVC was assessed by an echocardiographic, semi-quantitative manner called global cardiac calcium scoring system (GCCS), and demographic, clinical, and laboratory parameters including mineral metabolism markers were collected. Results: The average age of the patients was 50 ± 12 years, and 54.5% were men. The mean GCCS was 1.8 ± 2.4; 57.2% of patients had GCCS ≥1. Age, dialysis vintage, serum alkaline phosphatase (ALP), and intact parathyroid hormone levels were positively correlated with CVC, whereas serum albumin levels were negatively related to CVC, based on univariate analysis. With multivariate linear regression analysis, serum ALP was the only bone-derived biomarker that showed significant correlation with CVC. Serum ALP ≥232 U/L was a robust predictor of CVC and was associated with the likelihood of GCCS ≥1 (OR 3.92, 95% CI 1.37–11.2, p = 0.011). The decision tree model was used to identify ALP ≥232 U/L and age ≥60 years as important determinative variables in the prediction of CVC in MHD patients. Conclusion: Serum ALP level is significantly associated with CVC in MHD patients. ALP is suggested to be a promising interventional target for cardiovascular calcification in MHD patients.
Kellner’s Symptom Questionnaire, a Highly Sensitive Patient-Reported Outcome Measure: Systematic Review of Clinimetric Properties
Authors: Benasi Giada , Fava Giovanni A. , Rafanelli Chiara
Published: February 2020

Introduction: Patient-reported outcomes (PROs) are of increasing importance in clinical medicine. However, their evaluation by classic psychometric methods carries considerable limitations. The clinimetric approach provides a viable framework for their assessment. Objective: The aim of this paper was to provide a systematic review of clinimetric properties of the Symptom Questionnaire (SQ), a simple, self-rated instrument for the assessment of psychological symptoms (depression, anxiety, hostility, and somatization) and well-being (contentment, relaxation, friendliness, and physical well-being). Methods: The PRISMA guidelines were used. Electronic databases were searched from inception up to March 2019. Only original research articles, published in English, reporting data about the clinimetric properties of the SQ, were included. Results: A total of 284 studies was selected. The SQ has been used in populations of adults, adolescents, and older individuals. The scale significantly discriminated between subgroups of subjects in both clinical and nonclinical settings, and differentiated medical and psychiatric patients from healthy controls. In longitudinal studies and in controlled pharmacological and psychotherapy trials, it was highly sensitive to symptoms and well-being changes and discriminated between the effects of psychotropic drugs and placebo. Conclusions: The SQ is a highly sensitive clinimetric index. It may yield clinical information that similar scales would fail to provide and has a unique position among the PROs that are available. Its use in clinical trials is strongly recommended.
ГЕМАТОЛОГІЧНІ ТА БІОХІМІЧНІ ПОКАЗНИКИ У ПАЦІЄНТІВ ІЗ ХРОНІЧНИМ ОБСТРУКТИВНИМ ЗАХВОРЮВАННЯМ ЛЕГЕНЬ ТА АРТЕРІАЛЬНОЮ ГІПЕРТЕНЗІЄЮ
Authors: Maksiv H. Ya. , Marushchak M. I.
Published: February 2020

Мета роботи. Проаналізувати лабораторні показники загальноклінічного та біохімічного аналізу крові у пацієнтів із коморбідним перебігом хронічного обструктивного захворювання легень й артеріальної гіпертензії. Матеріали і методи. У дослідженні взяли участь 53 хворих на ХОЗЛ, 28 з яких мали артеріальну гіпертензію та перебували на стаціонарному лікуванні. Визначення показників загального аналізу крові проводили на автоматичному гематологічному аналізаторі, показники біохімічного аналізу крові визначали за допомогою стандартних наборів на автоматичному біохімічному аналізаторі фірми COBAS INTEGRA. Результати й обговорення. При дослідженні показників загального аналізу крові у хворих на ХОЗЛ та при поєднаному його перебігу й АГ патологічних змін не було. Необхідно відмітити достовірно вищий відсоток еозинофілів та швидкості зсідання еритроцитів у хворих на ХОЗЛ стосовно контрольної групи. При аналізі рівня глюкози встановлено вірогідно вищу її концентрацію (на 29,5 %) при поєднаному перебігу ХОЗЛ й АГ проти контрольної групи. Вміст загального білка у хворих дослідних груп мав тенденцію до зниження, проте статистично значимо не відрізнявся від даних у контрольній групі. Встановлено вірогідно вищу концентрація сечовини й креатиніну в пацієнтів із коморбідним перебігом ХОЗЛ й АГ. Середні показники рівнів електролітів крові (натрій і калій) хворих на коморбідний перебіг ХОЗЛ й АГ відповідали встановленим нормам, тоді як концентрація кальцію достовірно зменшилася (на 47,6 %) стосовно контрольної групи.. Висновки. Коморбідний перебіг хронічного обструктивного захворювання легень та артеріальної гіпертензії характеризується порушенням білкового (вищі рівні сечовини і креатиніну) й вуглеводного (вища концентрація глюкози стосовно контролю) обмінів, дисбалансом електролітів (зниженням рівня кальцію) стосовно контрольної групи.
УЛЬТРАСТРУКТУРНІ ЗМІНИ КОМПОНЕНТІВ ПАРОДОНТА ЗА УМОВИ ЕКСПЕРИМЕНТАЛЬНОГО ПАРОДОНТИТУ НА ТЛІ ГІПЕРТИРЕОЗУ
Authors: Shcherba V. V. , Nebesna Z. M. , Usynskyi R. S. , Korda M. M.
Published: February 2020

Мета роботи. Вивчити ультраструктурні зміни тканин пародонта за умови експериментального пародонтиту на тлі гіпертиреозу.

Матеріали і методи. Дослідження проведені на 36 безпородних статевозрілих білих щурах-самцях, яких поділили на такі групи: перша – контрольні тварини; друга – тварини з моделлю пародонтиту; третя – щури з пародонтитом на тлі гіпертиреозу. Тканини пародонта підлягали електронномікроскопічному дослідженню на 22-гу добу експерименту.

Результати й обговорення. Проведені ультраструктурні дослідження компонентів пародонта щурів за умови пародонтиту встановили реорганізацію його структурних елементів. Порушення мікроциркуляції призводило до набряку основної речовини ясен та періодонта, виявлено зміни ультраструктури клітинних елементів та ушкодження волокнистих структур. Проведені субмікроскопічні дослідження компонентів пародонта щурів за умови пародонтиту на тлі гіпертиреозу встановили більш виражені деструктивно-дегенеративні та запальні зміни епітеліальної та власної пластинок усіх ділянок ясен та періодонта, виявили ушкодження ядер та цитоплазми кератиноцитів, фібробластів, лейкоцитів, фрагментацію та лізис волокон, набряк аморфного компонента.

Висновки. Експериментальний пародонтит на тлі гіпертиреозу супроводжується більш вираженими деструктивно-дегенеративними та запальними змінами відносно пародонтиту без супутньої патології, що свідчить про негативний вплив тиреоїдної дисфункції на перебіг пародонтиту.
ЗАСТОСУВАННЯ ІНФОРМАЦІЙНИХ ТЕХНОЛОГІЙ ТА КРЕАТИВНИХ СЕРЕДОВИЩ ДЛЯ НАВЧАННЯ ІНТЕРНІВ
Authors: Kilivnik V. S. , Smirnova V. L. , Panchyshyn N. Ya.
Published: February 2020

Мета роботи. Проаналізувати сучасний стан та можливості удосконалення навчального процесу при підготовці інтернів та обґрунтувати застосування інформаційних технологій та креативних середовищ в умовах санаторію та кафедри медичної реабілітації і медико-соціальної експертизи медичного університету.

Матеріали і методи. У дослідженні застосовано інформаціологічний, бібліосемантичний та аналітичний методи.

Результати й обговорення. У Немирові, що на Поділлі, створено 10 музеїв та одну картинну галерею. Серед них: музей народних музичних інструментів (в районному будинку культури); музеї Марка Вовчка, М. Трублаїні (у школі № 2); музей «Літературна Немирівщина»; краєзнавчий музей (в жіночому Свято-Троїцькому ставропігійному монастирі); старовинний палац та парк, музеї княгині М. Г. Щербатової, етнографічний, історії медицини та фармації, музичних інструментів, радіоелектроніки, бібліотека стародруків та картинна галерея сучасних українських художників (у клінічному санаторії «Авангард»). Музеї знайомлять із культурою минулого та сучасності. Вони стали ефективними засобами навчання, розвитку та виховання. Це підтверджено позитивними результатами опитування у 96,5 % випадків слухачів-інтернів та курсантів-лікарів, яких ми опитали протягом 2013–2019 рр. Інтеграція активних видів навчання, підвищення творчого потенціалу та адаптація технологій навчання до індивідуальних особливостей інтернів, упровадження нових технологій навчання сприяють активації їх пізнавальної діяльності, підвищують мотивацію до використання інформаційно-комунікаційних технологій у професійній діяльності.

Висновки. Розширення освітньо-культурного середовища для підготовки інтернів за рахунок ресурсів музеїв сприятиме євроцентричній трансформації української освіти. Музеї та картинна галерея санаторію «Авангард» створені з урахуванням можливості виконання не тільки навчальних, а й реабілітаційних програм. Застосування інформаційних технологій навчання допомагає інтенсифікувати усі рівні навчально-виховного процесу, підвищити його ефективність та якість. Вітчизняний та наш власний досвід свідчать про доцільність застосування запропонованих підходів щодо організації освітнього процесу в навчальних закладах країни.
ЗАКОНОМІРНІ ЗМІНИ ЕРИТРОЦИТАРНИХ, ТРОМБОЦИТАРНИХ І ЛЕЙКОЦИТАРНИХ ІНДЕКСІВ ТА ЕНЗИМІВ ПЛАЗМИ КРОВІ В РІЗНИХ ВІКОВИХ ГРУПАХ ІНТАКТНИХ ЩУРІВ
Authors: Yastremska N. M. , Petryk N. M.
Published: February 2020

Мета роботи. Виявити особливості змін гематологічних показників крові у віковому аспекті.

Матеріали і методи. Дослідження проведено на 15 безпородних щурах-самцях лінії Wistar, яких поділили на три групи по 5 тварин за віковим аспектом, а саме, перша група  статевонезрілі з масою тіла 80–120 г, вік 1,5–2 місяці, друга – статевозрілі щури з масою 180–200 г, вік 6 місяців та третя – старі шестимісячні тварини з масою 320–360 г, вік 20 місяців. Для дослідження було відібрано цільну кров та сироватку, забір крові здійснено з порожнини серця. Дослідження параметрів загального аналізу крові було проведено на гематологічному аналізаторі Horiba Yumizen H500, а оцінку активності ензимів плазми крові – на біохімічному аналізаторі Master T.

Результати й обговорення. На основі аналізу біохімічного профілю плазми крові у  другій групі, порівняно з третьою, виявлено достовірне збільшення АсАт і АлАт на 36,8 та 3,27 % відповідно, а у першій, порівняно з третьою, на 94,5 та 9,5 %. Аналогічну тенденцію спостерігали при аналізі лужної фосфатази (ЛФ) так, в першій групі виявлено достовірне збільшення її активності на 202,04 %, порівняно з показником третьої групи, а у другій, порівняно з третьою, на 98,5 %. Аналіз ширини розподілу еритроцитів показав, що в першій групи, порівняно з другою, RDW-CV і RDW-SD достовірно збільшується на 8,83 і 9,77 % відповідно, а порівняно з третьою групою – 13,1 і 15,73 %. Виявлено відносне невелике збільшення MCV в у першій групі, порівняно з другою, MCV на 0,76 %, а порівняно з третьою, на 4,12 %. На відміну від еритроцитарних індексів збільшення тромбоцитарних прямо пропорційне зростанню віку тварин, по групах у такій послідовності І(PDW, MPV, P-LCC)>ІІ (PDW, MPV, P-LCC)> ІІІ (PDW, MPV, P-LCC)ІІІ. Результат аналізу двох основних фракцій лейкоцитів NEU, LYM свідчить  про активне включення першої ланки імунного захисту в групі статевозрілих тварин. Так, абсолютний вміст NEU, LYM в другій групі тварин, порівняно з першою, достовірно збільшується на 141 та 128,7 % відповідно.

Висновки. Виявлено збільшення активності трансаміназ (АлАт, АсАт), лужної фосфатази (ЛФ) та наростання гетерогенності фракцій еритроцитів  у групі статевонезрілих тварин. Реологічний аналіз тромбоцитарних індексів свідчить  про підвищення кількості незрілих тромбоцитів та високу імовірність їх агрегації у  групі старих щурів. У загальному сумарне значення лейкоцитів прогресивно зростає у міру збільшення вікового діапазону.