bluuebunny/crossref_metadata_2025 huggingface dataset:
Genome Sequence of Lipopeptide- and Antioxidant-Producing Strain Bacillus velezensis NWUMFkBS10.5
Authors: Adeniji Adetomiwa A. , Babalola Olubukola O.
Published: July 2019

Candidate biocontrol agent
Bacillus velezensis
NWUMFkBS10.5 possesses unique genomic characteristics revealed by antiSMASH analysis and
in vitro
metabolomic elucidation. Besides its capability to produce antimicrobial lipopeptides, further
in silico
genome profiling predicted the presence of metabolic pathways for synthesizing antioxidants like lampranthin-2, miraxanthin V, and 2-decarboxybetanidin.
Genomic Insight into Three Marine
Micromonospora
sp. Strains from the Gulf of California
Authors: Contreras-Castro Luis , Maldonado Luis A. , Quintana Erika T. , Carro Lorena , Klenk Hans-Peter
Published: July 2019

Three actinomycete strains, designated BL1, BL4, and CV4, were isolated from sediment samples from the Gulf of California in 2009 together with nearly 300 other actinobacteria. Genome mining and analysis of their ∼6.4-Mb sequences confirmed the bioprospecting potential of these three bacteria belonging to the genus
Micromonospora
.
Cross-sectional evaluation of emergency care capacity at public hospitals in Zambia
Authors: Chavula Chancy , Pigoga Jennifer L , Kafwamfwa Muhumpu , Wallis Lee A
Published: July 2019

Objectives

The last decade has seen rapid expansion of emergency care systems across Africa, although they remain underdeveloped. In Zambia, the Ministry of Health has taken interest in improving the situation and data are needed to appropriately guide system strengthening efforts. The Emergency Care Assessment Tool (ECAT) provides a context-specific means of measuring capacity of healthcare facilities in low- and middle-income countries. We evaluated Zambian public hospitals using the ECAT to inform resource-effective improvements to the nation’s healthcare system.

Methods

The ECAT was administered to the lead clinician in the emergency unit at 23 randomly sampled public hospitals across seven of Zambia’s 10 provinces in March 2016. Data were collected regarding hospitals’ perceived abilities to perform a number of predefined signal functions - life-saving procedures that encompass the need for both skills and resources. Signal functions (36 for intermediate facilities, 51 for advanced) related to six sentinel conditions that represent a large burden of morbidity and mortality from emergencies. We report the proportion of procedures that each level of hospital was capable of, along with barriers to delivery of care.

Results

Across all hospitals, most of the level-appropriate emergency care procedures could be performed. Intermediate level (district) hospitals were able to perform 75% (95% CI 73.2 to 76.8) of signal functions for the six conditions. Among advanced level hospitals, provincial hospitals were able to perform 68.6% (67.4% to 69.7%) and central hospitals 96.1% (95% CI 93.5 to 98.7) Main failures in delivery of care were attributed to a lack of healthcare worker training and availability of consumable resources, such as medicines or supplies.

Conclusion

Zambian public hospitals have reasonable capacity to care for acutely ill and injured patients; however, there is a need for increased training and improved supply chains.
Association betweenADAMTS7TagSNPs and the risk of myocardial infarction
Authors: Liang Li-li , Zhou Yu-lan , Cheng Jie , Xiao Yu-tong , Tang Zi-bin , Liu Sun-min , Lian Jia-chun , Wang Xin-xin , Liu Xinguang , Xiong Xing-dong
Published: July 2019

Purpose of the study

Genome-wide association studies have revealed an association of ADAMTS7 polymorphisms with the risk of cardiovascular diseases. Nonetheless, the role of ADAMTS7 polymorphisms on myocardial infarction (MI) risk remains poorly understood. Here, we aim to evaluate the effect of ADAMTS7 tag single nucleotide polymorphisms (SNPs) on individual susceptibility to MI.

Study design

Genotyping of the four tagSNPs (rs1994016, rs3825807, rs4380028 and rs7173743) was performed in 232 MI cases and 661 control subjects using PCR-ligase detection reaction (LDR) method. The association of these four tagSNPs with MI risk was performed with SPSS software.

Results

Multivariate logistic regression analysis showed that ADAMTS7 tagSNP rs3825807 exhibited a significant effect on MI risk. Compared with the TT homozygotes, the CT genotype (OR1.93, 95% CI1.30to 2.85, Pc=0.004) and the combined CC/CT genotypes (OR1.70, 95% CI1.16 to 2.50, Pc=0.028) were statistically significantly associated with the increased risk for MI. Further stratified analysis revealed a more significant association with MI risk among older subjects, hypertensives, non-diabetics and patients with hyperlipidaemia. Consistently, the haplotype rs1994016T–rs3825807C containing rs3825807 C allele exhibited increased MI risk (OR1.52, 95% CI1.10 to 2.10, p=0.010). However, we did not detect any association of the other three tagSNPs with MI risk.

Conclusions

Our finding suggest that ADAMTS7 tagSNP rs3825807 contributes to MI susceptibility in the Chinese Han population. Further studies are necessary to conﬁrm the general validity of our ﬁndings and to clarify the underlying mechanism for this association.
Research on License Plate Image Segmentation and Intelligent Character Recognition
Authors: Huang Jianping
Published: July 2019

With the accumulation of people’s wealth and the improvement of purchasing power, more and more people are buying cars as a means of travel. Walking and cycling of the past have now become a car trip. License plate recognition technology is especially important in intelligent transportation systems. It has been widely used in large shopping malls or supermarket parking lots, highway toll stations, speeding violation supervision and other fields. However, the accuracy and efficiency of license plate image recognition are insufficient. To solve the above problems, we propose a license plate character recognition method based on local HOG and layered LBP feature fusion from the perspectives of image pre-processing, license location, characters’ segmentation and recognition. First, pre-processing the license image area by highlighting the license plate image; then, the license plate is positioned based on wavelet decomposition and brightness moment; next the tilted license plate image is corrected, the license plate frame is adjusted, and characterization is performed by using the improved projection method based on the fact that the projection of the character is a single peak or a double peak. Finally, the local HOG and hierarchical LBP feature fusion methods are used to identify the license characters. The results show that the license plate’s character recognition rate of the proposed method reaches 99.71%, and the time taken is small. This not only improves the character recognition rate, but also saves recognition time. The results show that the method has important practical significance in license plates’ recognition.
A law of large numbers and large deviations for interacting diffusions on Erdős–Rényi graphs
Authors: Coppini Fabio , Dietert Helge , Giacomin Giambattista
Published: July 2019

We consider a class of particle systems described by differential equations (both stochastic and deterministic), in which the interaction network is determined by the realization of an Erdős–Rényi graph with parameter [Formula: see text], where [Formula: see text] is the size of the graph (i.e. the number of particles). If [Formula: see text], the graph is the complete graph (mean field model) and it is well known that, under suitable hypotheses, the empirical measure converges as [Formula: see text] to the solution of a PDE: a McKean–Vlasov (or Fokker–Planck) equation in the stochastic case, or a Vlasov equation in the deterministic one. It has already been shown that this holds for rather general interaction networks, that include Erdős–Rényi graphs with [Formula: see text], and properly rescaling the interaction to account for the dilution introduced by [Formula: see text]. However, these results have been proven under strong assumptions on the initial datum which has to be chaotic, i.e. a sequence of independent identically distributed random variables. The aim of our contribution is to present results — Law of Large Numbers and Large Deviation Principle — assuming only the convergence of the empirical measure of the initial condition.
Aggregation-induced emission luminogen for in vivo three-photon fluorescence lifetime microscopic imaging
Authors: Ni Huwei , Xu Zicong , Li Dongyu , Chen Ming , Tang Ben Zhong , Qian Jun
Published: July 2019

Compared with visible light, near-infrared (NIR) light has deeper penetration in biological tissues. Three-photon fluorescence microscopy (3PFM) can effectively utilize the NIR excitation to obtain high-contrast images in the deep tissue. However, the weak three-photon fluorescence signals may be not well presented in the traditional fluorescence intensity imaging mode. Fluorescence lifetime of certain probes is insensitive to the intensity of the excitation laser. Moreover, fluorescence lifetime imaging microscopy (FLIM) can detect weak signals by utilizing time-correlated single photon counting (TCSPC) technique. Thus, it would be an improved strategy to combine the 3PFM imaging with the FLIM together. Herein, DCDPP-2TPA, a novel aggregation-induced emission luminogen (AIEgen), was adopted as the fluorescent probes. The three-photon absorption cross-section of the AIEgen, which has a deep-red fluorescence emission, was proved to be large. DCDPP-2TPA nanoparticles were synthesized, and the three-photon fluorescence lifetime of which was measured in water. Moreover, in vivo three-photon fluorescence lifetime microscopic imaging of a craniotomy mouse was conducted via a home-made optical system. High contrast cerebrovascular images of different vertical depths were obtained and the maximum depth was about 600 [Formula: see text]m. Even reaching the depth of 600 [Formula: see text]m, tiny capillary vessels as small as 1.9 [Formula: see text]m could still be distinguished. The three-photon fluorescence lifetimes of the capillaries in some representative images were in accord with that of DCDPP-2TPA nanoparticles in water. A vivid 3D reconstruction was further organized to present a wealth of lifetime information. In the future, the combination strategy of 3PFM and FLIM could be further applied in the brain functional imaging.
Bacterial modulation of visceral sensation: mediators and mechanisms
Authors: Lomax Alan E. , Pradhananga Sabindra , Sessenwein Jessica L. , O’Malley Dervla
Published: July 2019

The potential role of the intestinal microbiota in modulating visceral pain has received increasing attention during recent years. This has led to the identification of signaling pathways that have been implicated in communication between gut bacteria and peripheral pain pathways. In addition to the well-characterized impact of the microbiota on the immune system, which in turn affects nociceptor excitability, bacteria can modulate visceral afferent pathways by effects on enterocytes, enteroendocrine cells, and the neurons themselves. Proteases produced by bacteria, or by host cells in response to bacteria, can increase or decrease the excitability of nociceptive dorsal root ganglion (DRG) neurons depending on the receptor activated. Short-chain fatty acids generated by colonic bacteria are involved in gut-brain communication, and intracolonic short-chain fatty acids have pronociceptive effects in rodents but may be antinociceptive in humans. Gut bacteria modulate the synthesis and release of enteroendocrine cell mediators, including serotonin and glucagon-like peptide-1, which activate extrinsic afferent neurons. Deciphering the complex interactions between visceral afferent neurons and the gut microbiota may lead to the development of improved probiotic therapies for visceral pain.
Alternate-day feeding leads to improved glucose regulation on fasting days without significant weight loss in genetically obese mice
Authors: Swoap Steven J. , Bingaman Mark J. , Hult Elissa M. , Sandstrom Noah J.
Published: July 2019

Alternate-day fasting (ADF) is effective for weight loss and increases insulin sensitivity in diet-induced obese rodents. However, the efficacy of ADF in genetic models of obesity has not been comprehensively studied. Mice that are deficient in leptin ( ob/ob mice) are obese, diabetic, and prone to deep bouts of torpor when fasted. We tested the hypotheses that an ADF protocol in ob/ob mice would result in 1) induction of torpor on fasted days, 2) minimal body weight loss if the mice experienced torpor, and 3) no improvement in glucose control in the absence of weight loss. Female ob/ob mice and littermate controls were assigned to 1) an ad libitum regimen or 2) an ADF regimen, consisting of fasting every other day with ad libitum feeding between fasts. Over a 19-day period, littermate control mice on the ADF regimen consumed the same amount of food as littermate control mice on the ad libitum regimen, whereas the ADF ob/ob mice consumed 37% less food than ad libitum ob/ob mice. Fasting days, but not fed days, led to torpor in both genotypes. Fasting days, but not fed days, led to weight loss in both genotypes relative to ad libitum controls. Fasting days, but not fed days, produced enhanced insulin sensitivity in both genotypes and normalized circulating glucose in ob/ob mice. These data demonstrate improved glucose control on fasting days with the use of ADF in a genetic model of obesity in the face of minimal weight loss.
Detecting Suspects by Large-Scale Trajectory Patterns in the City
Authors: Jin Cang-Hong , Chen Dong-Kai , Zhu Fan-Wei , Wu Ming-Hui
Published: July 2019

A massive amount of spatial-temporal records generated by sensors across the city help describe our day-to-day activities. Since the lifestyle represented by moving data varies from one individual to another, data analysts could facilitate the suspect-detection task by analyzing and classifying related trajectories of a given target. However, there are still some challenges that need to be overcome in real-life cases; for instance, the positive instances are limited, the trajectories are too diverse, and the transit behavior features are both too broader and costly to define. Moreover, people living in different areas of the city may have different life habits which can result in incorrect conclusions due to data-sensitive factors. In this paper, we describe the particular characteristics of movement behaviors regarding trajectory features. We also propose two models to improve the identification performance, namely, the trajectory pattern model (TPM) and neural network-based model. The trajectory pattern model (TPM) offers a novel view to describe users’ movement behaviors and generates more effective and universal features other than location and timestamp dimensions. The end-to-end neural network-based model aims to avoid picking human features. Statistical analysis and insightful explanations are provided to help understand the behavior of a given target. The effectiveness of our proposed solutions compared to peer solutions is demonstrated and proved via extensive evaluation.
Shear Characteristics of Cement-Stabilized Sand Reinforced with Waste Polyester Fiber Fabric Blocks
Authors: Lv Xiangfeng , Zhou Hongyuan
Published: July 2019

The present paper is devoted to investigate the effects of waste polyester fiber fabric blocks on the strength and mechanical behavior of cemented sand. In the investigation, samples were prepared at four different percentages of waste polyester fiber fabric block content (0.0%, 0.5%, 1.0%, and 1.5% by weight of soil) and two different aspect ratios (2 : 1 and 3 : 1), and conventional triaxial compression tests were carried out after the curing period. The test results indicated that the addition of fibers increased peak and residual shear strengths of cemented sand and changed its brittle behavior to a more ductile one. As the fabric block content increased, the brittleness index and initial stiffness decreased, and the peak strain and internal friction angle increased. The optimal combination of the content and aspect ratio was determined to be 0.5% and 3 : 1. The integration of the fabric blocks with the cemented sand matrix was analyzed by using the scanning electron microscopy (SEM). It is found that the reinforcement effect is related to the bond strength and friction at the interface. The micromechanical properties of the fiber/matrix interface were influenced by the undulations between the fabric block components. In summary, this study presented a low-cost and environment-friendly method for reinforcing cement-stabilized sand.
Gastric Outlet Obstruction and Sigmoid Volvulus in a Patient withPneumatosis intestinalis: An Etiology or a Complication
Authors: Shaheen Osama , Ahmad Wassim , Mhammad Najm Aldin
Published: July 2019

Pneumatosis intestinalis (PI) is a radiographic finding which refers to the presence of gas within the wall of any part of the gastrointestinal tract. While in some cases it is an incidental finding which usually represent its benign nonischemic etiology, it may indicate a catastrophic intra-abdominal condition and distinctly characteristic of ischemic enterocolitis. Herein, we discuss the clinical signs and symptoms, the radiological features, the surgical management and outcome of an extremely rare concurrent triad of PI, gastric outlet obstruction, and the sigmoid volvulus based on a case of a patient who underwent surgery in our hospital, which, we think, can emphasize the mysterious concept of PI’s mechanical etiology.
Structure, Mechanical Performance, and Dimensional Stability of Radiata Pine (Pinus radiata D. Don) Scrimbers
Authors: Wei Jinguang , Rao Fei , Huang Yuxiang , Zhang Yahui , Qi Yue , Yu Wenji , Hse Chung-Yun
Published: July 2019

Natural wood has certain advantages such as good processability and high specific strength and thus has been used for millennium as a structural material. But the mechanical performance and water resistance, particularly for fast-growing species, are unsatisfactory for high-end applications. In this study, the “new-type” scrimber technology was introduced to radiata pine (Pinus radiata D. Don) scrimbers. The structure, mechanical properties, and dimensional stability of the scrimber panels were investigated. Results showed that OWFMs as basic units of scrimber had been very even in size and superior permeability. The scrimbers exhibited a three-dimensional porous structure, and the porosity had a decrease with increasing density. Both OWFMs and densification contributed to the high performance in terms of mechanical properties and water resistance. The flexural, compressive, and short-beam shearing strength were significantly enhanced with increasing density. As the density was 0.80 g cm−3, the flexural strength (MOR) was approximately 120 MPa, much larger than many selected wood-based panels. Moreover, the water resistance and dimensional stability also were closely related to the density. At the density of 1.39 g cm−3, the water absorption rate and thinness swelling rate of the panels in boiled water were only 19% and 5.7%, respectively.
Can the Image Processing Technique Be Potentially Used to Evaluate Quality of Frying Oil?
Authors: Udomkun Patchimaporn , Innawong Bhundit , Sopa Wantakan
Published: July 2019

The objective of this study was to investigate the feasibility of a computer vision system (CVS) for assessing the contact angle of frying oil. The oil was used to fry carbohydrate- and protein-based foods for 40 h, and the oil was collected for measuring free fatty acids (FFA), peroxide value (PV), total polar materials (TPMs), and FOS reading (dielectric constant). The results showed that FFA linearly increased with frying time (R2 > 0.95) while the polynomial correlation between TPMs and FOS reading as a result of time was observed (R2 > 0.97). The contact angle obtained from CVS was highly correlated with all chemical qualities (R2 > 0.94), except PV. In addition, the contact angle models could be used to adequately predict FFA, TPMs, and FOS reading of frying oil (R2 > 0.91). This result suggested that the image processing technique through CVS could be an appropriate alternative to chemical analysis, especially for small- and medium-scale industrial frying.
Long-Term Survival in Locally Advanced KRAS Wild-Type Pancreatic Adenocarcinoma
Authors: Alhenc-Gelas Marion , Cohen Romain , Cervera Pascale , Vaillant Jean-Christophe , André Thierry
Published: July 2019

Pancreatic adenocarcinoma remains a cancer associated with a poor prognosis. For locally advanced pancreatic cancer (LAPC), median overall survival is approximately 16 months. Here we report the case of a 52-year-old LAPC patient treated with chemotherapy followed by chemoradiotherapy that was associated with a 14-year complete remission. A peritoneal relapse was then observed and chemotherapy was undergone until the patient died of infectious complications, 17 years after his diagnosis. The tumor was found KRAS, TP53, BRCA1, and BRCA2 wild-type. This KRAS wild-type LAPC-long survivor case report emphasizes the need to develop molecular approaches to predict LAPC patients’ prognosis.
Nephropathy in Hypertensive Animals Is Linked to M2 Macrophages and Increased Expression of the YM1/Chi3l3 Protein
Authors: Cavalcante Paula Andréa Malveira , Alenina Natalia , Budu Alexandre , Freitas-Lima Leandro Ceotto , Alves-Silva Thaís , Agudelo Juan Sebastian Henao , Qadri Fatimunnisa , Camara Niels Olsen Saraiva , Bader Michael , Araújo Ronaldo Carvalho
Published: July 2019

Macrophages contribute to a continuous increase in blood pressure and kidney damage in hypertension, but their polarization status and the underlying mechanisms have not been clarified. This study revealed an important role for M2 macrophages and the YM1/Chi3l3 protein in hypertensive nephropathy in a mouse model of hypertension. Bone marrow cells were isolated from the femurs and tibia of male FVB/N (control) and transgenic hypertensive animals that overexpressed the rat form of angiotensinogen (TGM(rAOGEN)123, TGM123-FVB/N). The cells were treated with murine M-CSF and subsequently with LPS+IFN-γto promote their polarization into M1 macrophages and IL-4+IL-13 to trigger the M2 phenotype. We examined the kidneys of TGM123-FVB/N animals to assess macrophage polarization and end-organ damage. mRNA expression was evaluated using real-time PCR, and protein levels were assessed through ELISA, CBA, Western blot, and immunofluorescence. Histology confirmed high levels of renal collagen. Cells stimulated with LPS+IFN-γin vitro showed no significant difference in the expression of CD86, an M1 marker, compared to cells from the controls or the hypertensive mice. When stimulated with IL-4+IL-13, however, macrophages of the hypertensive group showed a significant increase in CD206 expression, an M2 marker. The M2/M1 ratio reached 288%. Our results indicate that when stimulatedin vitro, macrophages from hypertensive mice are predisposed toward polarization to an M2 phenotype. These data support results from the kidneys where we found an increased infiltration of macrophages predominantly polarized to M2 associated with high levels of YM1/Chi3l3 (91,89%), suggesting that YM1/Chi3l3 may be a biomarker of hypertensive nephropathy.
Successful Treatment of Opioid Dependence with Flexible Doses of Injectable Prolonged Release Buprenorphine
Authors: D’Agnone Oscar
Published: July 2019

Opioid dependence (OD) may be effectively treated with well-evidenced regimens including psychosocial and pharmacotherapeutic interventions. Treatment has benefits but also limitations including risk of diversion, impact of mandatory daily supervision, and stigma. An injectable prolonged release buprenorphine with flexible dose options has recently been approved by the European Commission and is available in the UK and other European Countries. Initial positive treatment experience in patients with different clinical scenarios (patients with no recent treatment history, a transfer from oral methadone, and change from sublingual buprenorphine tablets) provides evidence of the potential benefit in a range of situations for this therapeutic option. Adoption of the injectable form was clinically successful with no withdrawal signs, nor evidence of use of other drugs. Patient reported outcomes were positive including reduction in cravings and anxiety and improved attitude, relationships, and general mood.
Alopecia in Autoimmune Blistering Diseases: A Systematic Review of Pathogenesis and Clinical Features of Disease
Authors: Xie Danica , Bilgic-Temel Asli , Abu Alrub Nada , Murrell Dédée F.
Published: July 2019

Background: Autoimmune blistering diseases (AIBD) are characterised by the body’s production of autoantibodies against structural proteins in the epidermis and/or the basement membrane on cutaneous and mucosal surfaces. Alopecia is a complication of AIBD that has generally been overlooked in patients with severe blistering diseases because it is regarded as a cosmetic issue. Yet recent research into quality of life tools has found that stigmatisation by appearance plays a significant role in blistering diseases. Aim: To review the current literature detailing the pathogenesis and clinical presentations of alopecia in AIBD patients. Method: We searched Medline, PubMed and EMBASE electronic databases up to September 2018, for empirical human and animal studies. Results: Only 36 human studies including 223 patients (190 pemphigus, 25 pemphigoid, 5 epidermolysis bullosa acquisita, 2 dermatitis herpetiformis and 1 linear IgA disease) detailed demographic and clinical manifestations of alopecia. A range of hair evaluation methods was demonstrated to reach alopecia diagnosis. Furthermore, with no universal validated scoring system for alopecia severity, alopecia patterns have been summarised. Conclusion: Previous randomised trials have not highlighted alopecia as an important outcome of AIBD, so epidemiological evaluation of the available literature has been helpful in summarising trends between existing studies and demonstrating inconsistencies.
Auditory Skills following Cochlear Implantation in Children with the Charge Syndrome
Authors: Aragón-Ramos Paula , Pedrero-Escalas Maria-Fernanda , Gavilán Javier , Pérez-Mora Rosa , Herrán-Martin Belén , Lassaletta Luis
Published: July 2019

Objectives: To assess the auditory outcomes and skills of pediatric cochlear implant (CI) users with the CHARGE syndrome. To determine the influence of inner ear malformations on the surgical procedure and speech understanding outcomes in this population. Study Design: Observational, retrospective study. Materials and Methods: Imaging, auditory testing, intraoperative findings, complications, and postoperative auditory skills and outcomes of pediatric CI users with CHARGE syndrome were recorded. Results: 6 children (8 ears) were included, 5 of whom had prelingual deafness. Their mean age at implantation was 37 months. Six of the 8 ears presented cochlear malformation; the most frequent was hypoplasia type III. Intraoperatively, the transmastoid facial recess approach was used in 5 ears, and abnormalities of facial nerve anatomy were found in 5 ears. All electrode insertions were complete. All children were, to a varying degree, able to detect and identify sound. Verbalization skills were developed by 2 children, 1 of whom used oral language as his primary mode of communication. Conclusions: Cochlear implantation performed by an experienced surgeon in patients with the CHARGE syndrome is a safe procedure with adequate treatment planning. All children had improved auditory skills although the improvement was variable.
Necrotizing Hemorrhagic Gastritis following Acute Myeloid Leukemia Induction with Midostaurin: An Unexpected Complication
Authors: Shimony Shai , Reiss Mintz Hilla , Shvartser Beryozkin Yulia , Shoham Avivit , Raanani Pia , Wolach Ofir
Published: July 2019

Midostaurin is a tyrosine multikinase inhibitor approved for the treatment of patients with newly diagnosed acute myeloid leukemia (AML) with mutated Fms-like tyrosine kinase-3. We describe a case report of a 49-year-old AML patient treated with an intensive chemotherapy regimen followed by midostaurin. After achieving complete remission with blood count recovery, he suffered from a serious, rare complication of necrotizing hemorrhagic gastritis with no evidence of infection or malignant infiltration, possibly associated with midostaurin therapy.
Predictors of Inadequate Response to Budesonide Multimatrix in Real-World Patients with Ulcerative Colitis
Authors: Greenberg Sydney , Herfarth Hans H. , Barnes Edward L.
Published: July 2019

Background: Budesonide multimatrix (MMX) system has been approved for the induction of remission in patients with active, mild to moderate ulcerative colitis (UC), and offers potential safety benefits over more commonly utilized corticosteroid therapies. Objectives: In a real-world setting we aimed to evaluate the proportion of UC patients treated with budesonide MMX who had an inadequate clinical response, defined as requiring transition to prednisone, and to identify any predictors of inadequate response. Methods: We performed a single-center retrospective cohort study evaluating adult patients with UC, ≥18 years of age, who were treated with budesonide MMX. We used bivariate and multivariable analyses to identify predictors of inadequate response to budesonide MMX. Results: Ninety-six patients were treated with budesonide MMX. Before initiation of budesonide MMX 55, 35, and 8% were on aminosalicylate, immunomodulator, and/or biologic therapy or no therapy for UC respectively. While 54% (52/96) of patients responded to budesonide MMX, 46% (44/96) required a transition to prednisone. Patients who required transition to prednisone were more likely to be male (39 vs. 19%, p = 0.035) and younger at the time of diagnosis (median age 23.5 vs. 29.0 years, p = 0.034). Age ≤29 years at diagnosis (adjusted OR 3.10, 95% CI 1.21–7.95) and male sex (adjusted OR 2.96, 95% CI 1.12–7.77) but not concomitant therapy with biologics and/or immunomodulators or disease extent were associated with increased odds of requiring transition to prednisone. Conclusions: Budesonide MMX is effective in more than half of patients with mild-to-moderate UC. Predictors of budesonide non-response and need to transition to prednisone include male sex and younger age at diagnosis.
Measurement of Adenosine Deaminase in Ascitic Fluid Contributed to the Diagnosis in a Case of Tuberculous Peritonitis
Authors: Kishimoto Kenichi , Mishiro Tsuyoshi , Mikami Hironobu , Yamashita Noritsugu , Hara Kazushi , Hamamoto Wataru , Cho Yuumi , Ikuta Yukihiro , Nagasaki Makoto , Kinoshita Yoshikazu
Published: July 2019

A diagnosis of tuberculous peritonitis (TBP) is difficult because of nonspecific manifestation and limited effectiveness of conventional diagnostic tools. Recently, the usability of measurement of ascitic adenosine deaminase (ADA) was shown. We report here a case of TBP in which measurement of ascitic ADA contributed to the diagnosis. A 93-year-old male developed a large amount of ascites. Analyses of the ascitic fluid revealed exudation, though antibiotics treatment was ineffective. Using paracentesis, the ADA level in the ascites was measured and shown to be high. Under suspicion of TBP, an exploratory laparoscopy was performed and a definitive diagnosis of TBP was made.
Cancer Patients’ Preferences for either Quality of Life or a Longer Life Determine Their Willingness to Talk about Forgoing Cancer-Specific Treatment
Authors: Laryionava Katsiaryna , Hartmann Mechthild , Sklenarova Halina , Heussner Pia , Villalobos Matthias , Jäger Dirk , Winkler Eva C.
Published: July 2019

Background: Cancer patients often face decisions whether to proceed with cancer-specific treatment or to switch to best supportive care. In these decisions, patients’ preferences should be determining cornerstones. The aim of this survey was to elicit patients’ preferences regarding discussions about forgoing treatment and factors influencing their preferences. Methods: We surveyed 194 patients at the National Center for Tumor Diseases, Germany. Quality of life (FACT-G), cancer-specific distress (QSC-R10), anxiety/depression (PHQ-4/GAD-2), preferences regarding quality/length of life (QQ), patient-physician communication (CARES-SF), and family role (CCAT-P) were assessed. Results: Patients weighting quality of life over lifetime wanted their oncologists to address treatment limitations as early as possible (p = 0.00). Patients striving for a longer lifetime did not want such discussions (p = 0.05). Having discussed treatment limitations was not associated with increased anxiety, depression, or distress. Limiting treatment was discussed only with one-third of the patients with a prognosis of less than 6 months and rather with elderly patients or patients in a worse medical condition. Attributing an important role to family decisions was associated with striving for lifetime (p = 0.01). Conclusion: Preferences for either quality or length of life were associated with patients’ willingness to discuss forgoing cancer-specific treatment. Timely discussion of realistic treatment goals is one way to avoid overtreatment. Patients striving for lifetime require increased attention and opportunities to address prognosis and risks of treatment.
Socioeconomic Status and the Risk of Stroke Recurrence in Chinese Patients
Authors: Chen Jingjing , Zhao Na , Ruan Yiming , Zheng Kuo , Xu Pengfei , Xia Yaqian , Xie Yi , Li Shun , Yuan Kang , Wang Huaiming , Liu Xinfeng , Xu Gelin
Published: July 2019

Background: The association between socioeconomic status (SES) and the risk of stroke recurrence has been rarely studied, especially in a developing country. Objective: This study aimed to evaluate the association between SES and the risk of stroke recurrence in Chinese stroke patients. Methods: Patients with first-ever ischemic stroke registered in the Nanjing Stroke Registry Program from 2013 to 2015 were enrolled and followed in this study. Information about SES, measured by disposable income and educational level, was collected at baseline. The primary endpoint was defined as fatal or nonfatal recurrent stroke after 7 days of the index stroke. The association between SES and the risk of stroke recurrence was analyzed with multivariate Cox regression model. Results: A total of 2,294 patients with first-ever stroke were included in the study. During a mean follow-up of 2.8 ± 1.2 years, 298 (13.0%) patients had stroke recurrence. After adjusting for potential confounding factors, compared with patients with a monthly family income of USD ≥1,539, those with an income of USD 769–1,538, USD 462–768, and USD 1–461 had an adjusted hazard ratio (HR) of 1.87 (95% CI 1.11–3.17), 2.40 (95% CI 1.43–4.03), and 2.79 (95% CI 1.65–4.69) for recurrence, respectively. Compared with those with an educational level of ≥13 years, patients with an educational level of 7–12 years and 0–6 years had adjusted HRs of 1.21 (95% CI 0.79–1.86) and 1.73 (95% CI 1.11–2.70), respectively. Conclusions: Chinese stroke patients with lower SES bear higher recurrent risk. These results are suggestive for secondary stroke prevention in Chinese patients.
Preservation of the Epiphysis and Growth Plate in the Surgical Management of Femoral Osteosarcoma in a Skeletally Immature Patient by Intercalary Resection and Biological Reconstruction: A Case Report
Authors: Yoda Yuhei , Yamaguchi Sayaka Iwai , Hirozane Toru , Asano Naofumi , Seki Atsuhito , Morioka Hideo , Nakayama Robert , Nakamura Masaya , Matsumoto Morio
Published: July 2019

Osteosarcoma arises most frequently in the metaphysis around the knee and its management by limb salvage surgery in skeletally immature pediatric patients is extremely challenging. Common reconstructive methods such as endoprosthetic or biological reconstruction are not fully capable of dealing with durability-related and growth-related problems and their functional outcomes are not as good as those seen in adult cases. A definitive limb salvaging procedure in children that outperforms amputation or rotationplasty has not yet been established. Herein, we report a case of stage IV osteosarcoma in the femur of a 7-year-old boy that was safely managed with intercalary resection preserving the distal femoral growth plate and epiphysis, followed by biological reconstruction using a frozen tumor-devitalized autograft. Good response to preoperative chemotherapy and the diaphyseal location of the tumor enabled us to perform a tumor resection that spared the growth plate and preserved the native knee joint structure. Plate fixation over the growth plate was terminated by removing the locking screws in the epiphysis after 44 months, which restored growth capacity to some extent. At 50 months postoperatively, no recurrence or progression of the disease was observed. The patient uses an extension shoe and reports having little discomfort in his daily life despite having a restricted range of motion and limb length discrepancy. In conclusion, limb salvage with biological reconstruction in skeletally immature patients can provide an acceptable functional outcome, including minimized limb length discrepancy, if critical damage to the growth plate and articular components can be avoided.
СУЧАСНІ АСПЕКТИ, ФАКТОРИ ВПЛИВУ І ПЕРСПЕКТИВИ РОЗВИТКУ МЕДИЧНОГО ТА ЛІКУВАЛЬНО-ОЗДОРОВЧОГО ТУРИЗМУ В УКРАЇНІ
Authors: Kholyavka V. Z. , Leshko H. S. , Mochulska O. M. , Kukhtiyi A. O.
Published: July 2019

Мета: проаналізувати сучасний стан, специфіку функціонування туристичної інфраструктури, вивчити зовнішні і внутрішні фактори, основні тенденції та перспективи розвитку медичного й лікувально-оздоровчого туризму в Україні. 

Матеріали і методи. У дослідженні застосовано бібліосемантичний, структурно-логічний, математично-статистичний та аналітичний методи.

Результати. Україна має досить розвинену туристичну інфраструктуру. Виникнення і розвиток лікувально-оздоровчого  та медичного туризму  в нашій країні зумовлені унікальним набором природних і рекреаційних ресурсів. Україна має достатню кількість курортів різної спеціалізації, які зможуть задовольнити широкий спектр потреб турис­тів із метою лікування та реабілітації, але щоб привернути увагу іноземних і вітчизняних туристів, українським курортам необхідно вирішити ряд проблем, пов’язаних із фінансуванням, управлінням та модернізацією. Стратегії розвитку курортів державного та місцевого значення мають врахувати запровадження ефективної системи фінансування, створення системи заохочення інвестицій у модернізацію та будівництво закладів санаторно-курортної галузі, надання доступних за ціною послуг, дотримання державних і міжнародних стандартів, підвищення рівня сервісу.

Висновки. Медичний та лікувально-оздоровчий туризм – один із найперспективніших видів туризму України, що розвиваються під впливом низки політичних та економічних факторів, які зумовлені трансформаційними процесами, що відбуваються в країні. Наша держава має значний природний потенціал для розвитку цієї галузі.
РЕЗУЛЬТАТИ ПОРІВНЯЛЬНОГО ДОСЛІДЖЕННЯ ПОКАЗНИКІВ ЯКОСТІ СТОМАТОЛОГІЧНОЇ ОСВІТИ НА ПІСЛЯДИПЛОМНОМУ ЕТАПІ ПІДГОТОВКИ ЗА СПЕЦІАЛЬНІСТЮ «СТОМАТОЛОГІЯ» (ПЕРВИННА СПЕЦІАЛІЗАЦІЯ ТА ПЕРЕДАТЕСТАЦІЙНИЙ ЦИКЛ)
Authors: Sichkoriz O. E. , Rybert Yu. O. , Minko L. Yu. , Ololeksiuk O. B. , Skalat A. P.
Published: July 2019

Мета: порівняти результати кількісних та якісних показників стоматологічної освіти лікарів-інтернів та слухачів факультету післядипломної освіти ЛНМУ імені Данила Галицького.

Матеріали і методи. У порівняльному дослідженні взяли участь 129 лікарів-інтернів циклу первинної спеціалізації за спеціальністю «Стоматологія» та 113 лікарів-слухачів передатестаційного циклу «Стомато­логія» Західного регіону. Дослідження проводили у вигляді бланкового тестування з використанням 80 тестових питань з відкритого буклету весна 2016 «КРОК-3. Стоматологія». Статистичну обробку матеріалів проводили за допомогою комп’ютерної програми Statistica 10.0.

Результати. Найбільшу різницю між відсотками інтернів та лікарів-слухачів, які успішно склали окремі суб­тести, спостерігали при тестуванні на категорію субтесту П. 8 «Запальні захворювання щелепно-лицевої ділянки», при якій відсоток інтернів, які склали субтест, у 2,32 раза перевищував відповідний показник серед лікарів-слухачів (86,8±1,45 % проти 39,7±2,45 %, р<0,001), а найменшу (1,56 раза) ─ при тестуванні на категорію субтесту П. 13 «Ускладнення, що виникають внаслідок стоматологічних втручань» (86,8±1,38 % проти 55,5±2,53 %, р<0,001). Середній відсотковий показник тесту лікарів-слухачів із стажем роботи до 5 років становив (50,36±1,38) %. Найнижчий результат був встановлений у лікарів-слухачів зі стажем роботи 5–10 років (32,69±4,88) %. Щодо труднощів, які виникали у них під час проходження тесту, то (96,5±1,74) % опитаних лікарів-слухачів (109 осіб) вказали, що найважче було відрізнити відповіді на запитання за ступенем їх правильності. На думку (84,1±3,44) % опитаних (95 осіб), вони були не готові до тестування.

Висновки. Проведене порівняльне дослідження кількісних та якісних показників стоматологічної освіти на після­­дипломному етапі підготовки дозволило з’ясувати відсутність у більшості лікарів-стоматологів із стажем 16 років і більше навичок із складання цього іспиту. Встановлено значний регрес показників складання цього тесту в лікарів-слухачів зі стажем роботи 5 років і більше за спеціальністю «Стоматологія». Оскільки підготовка лікарів на відповідних курсах післядипломної освіти потребує певного часу, вважаємо, що протягом найближчих 5 років рівень складності іспиту для практикуючих лікарів повинен бути простішим, аніж «КРОК-3. Стоматологія» для випускників вищих навчальних медичних закладів.
МУНІЦИПАЛЬНЕ ЗАМОВЛЕННЯ ЯК МЕХАНІЗМ РЕФОРМУВАННЯ ОХОРОНИ ЗДОРОВ’Я МІСТА ТЕРНОПОЛЯ ЗА УМОВ ДЕЦЕНТРАЛІЗАЦІЇ
Authors: Pysklyvets T. I. , Shulhai A. H. , Levchuk R. D. , Saturska H. I.
Published: July 2019

Мета: розглянути механізм муніципального замовлення медичної галузі міста Тернополя в умовах децентралізації та реформування системи охорони здоров’я. Матеріали і методи. Матеріалами дослідження є принципи фінансування системи охорони здоров’я міста Тернополя та робота місцевих медичних закладів, а методами – опис, аналіз, синтез, узагальнення, графічний дизайн. Результати. Протягом останніх років за умов децентралізації на місцеву владу покладено важливе завдання – створення максимальних можливостей надавати якісні та доступні послуги, не збільшуючи при цьому податкового навантаження на людей. Щорічно бюджет медичної галузі міста Тернополя стикається з проблемою недофінансу­вання з державного бюджету. Лише в 2018 р. дефіцит бюджету на заробітну плату становив майже 50 млн грн. Тому Тернопільська міська рада власними коштами компенсує цю різницю. У 2018 р. дофінансування з міського бюджету становить 65 млн 377 тис. грн або 24,3 % всього фінансування медицини. В 2019 р. у галузь охорони здоров’я міста закладено 84,6 млн грн або 33,6 % від загального бюджету. Також встановлено, що бюджет медицини в 2018 р. – соціально спрямований. Основний акцент зроблений на видачу безкоштовних рецептів, зубопротезування пільгових категорій громадян, медичну допомогу учасникам АТО, чорнобильцям. Охорона здоров’я – пріоритет діяльності Тернопільської міської ради. Тому кошти з міського бюджету виділяють не тільки на соціальну складову, але й на проведення капітальних ремонтів, реконструкцій, закуплення нового обладнання. Також завдяки фінансам, виділеним із міського бюджету, вперше за багато років немає дефіциту коштів на заробітну плату. Висновки. Спостерігаємо чітку позитивну тенденцію фінансування медичної галузі міста з міського бюджету, на що вказують відсутність заборгованості із заробітної плати працівникам закладів охорони здоров’я, модернізація медичних установ та оснащення їх сучасним обладнанням, підвищення тривалості життя тернополян, позитивний природний приріст.
ПРО ПРАВА МЕДИЧНИХ ПРАЦІВНИКІВ ПІД ЧАС НАДАННЯ МЕДИЧНОЇ ДОПОМОГИ В КОНТЕКСТІ РЕФОРМУВАННЯ СИСТЕМИ ОХОРОНИ ЗДОРОВ’Я
Authors: Kalyniuk N. M. , Kalyniuk N. M.
Published: July 2019

Мета: з’ясувати існуючі права медичних працівників, передбачені чинним законодавством, з огляду на реформування системи охорони здоров’я.

Матеріали і методи. Методологічною основою дослідження виступає сукупність загальних та спеціальних наукових методів пізнання. Чинні нормативно-правові акти, що проаналізовано за допомогою комплексу методів: порівняльно-правового, структурно-логічного, системно-аналітичного, формально-логічного та методу теоретичного аналізу з дотриманням принципів біотичних норм і правил; формулювання і систематизація висновків.

Результати. Аналіз чинних нормативно-правових актів дає підстави стверджувати, що права медичних працівників слід розмежувати на дві групи: загальні та спеціальні. До загальних прав медичних працівників належать ті, які гарантують певні умови їх професійної діяльності, охорону  здоров’я, соціальний захист, зокрема право на: належні умови професійної діяльності; обов’язкове страхування; створення медичних наукових товариств чи професійних спілок; судовий захист; соціальну допомогу; скорочений робочий день і додаткову відпустку; пільгові умови пенсійного забезпечення та пільгове надання житла; першочергову медичну допомогу тощо. До спеціальних прав належать такі, які передбачені виключно для медичного працівника як спеціального суб’єкта. Серед таких прав необхідно виокремити: право про надання інформації про пацієнта без його згоди чи згоди його законного представника; право на відмову від подальшого ведення пацієнта; право здійснювати медичне втручання без згоди пацієнта або його законних представників.

Чинне національне законодавство у галузі охорони здоров’я потребує вдосконалення. Одним із кроків на цьому шляху стала би імплементація передбаченого міжнародними нормативними актами права лікаря на заперечення під час виконання своїх професійних обов’язків.

Висновки. Права лікаря при наданні медичної допомоги слід розділити на загальні та спеціальні. Передбачені  чинним національним законодавством професійні права медичних працівників не завжди забезпечуються державними гарантіями і мають почасти декларативний характер. Це зумовлено відсутністю розроблених підзаконних актів, які повинні забезпечити механізм їх реалізації з урахуванням вимог сьогодення. Застосування зарубіжного досвіду, імплементація міжнародних стандартів у національне законодавство, зокрема щодо реалізації лікарем права на заперечення з міркувань совісті, забезпечить більш професійну захищеність лікаря та підвищить якість надання медичної допомоги.