bluuebunny/crossref_metadata_2025_split huggingface dataset:
Yerel yönetimlerde stratejik planlama uygulamalarının kurum performansına etkisi
Authors: Karğın Çakar Öznur , Esen Ayla 
Published: September 2023

Stratejik yönetim faaliyetleri, kurum kaynaklarının verimli kullanılması ve kurumların uzun vadede sürdürülebilirliğinin sağlanması açısından önemli role sahiptir. Ülkemizde kamu kurumlarında stratejik yönetim, kamu reformları çerçevesinde 5018 sayılı Kamu Mali Yönetimi ve Kontrol Kanunu’nun yürürlüğe girmesi ile birlikte daha fazla zaman ve kaynak ayırılan bir süreç haline gelmiştir. Kamu reformları sonucunda kurumların faaliyetlerini gerçekleştirirken stratejik planlama uygulamaları ile kıt kaynaklarını daha etkili ve verimli kullanmaları amaçlanmaktadır. Bu araştırmanın amacı, belediyelerin yürüttükleri stratejik planlama uygulamalarının etkinliğini değerlendirmek ve bu uygulamaların yerel yönetim kurumlarında topluma katkı ve verimlilik düzeylerine ne derece etki ettiğini ortaya koymaktır. Bu bağlamda, belediyelerdeki stratejik planlama uygulamalarının belirleyici alt boyutlarının, kurum performansı alt boyutlarına etkisinin ölçülmesi hedeflenmiştir. Araştırma kapsamında İstanbul’daki yerel yönetim kurumlarında çalışan orta ve üst kademe yöneticilerden toplam 100 adet anket formu toplanmıştır. Gerçekleştirilen analizlerin sonucunda, “belediyelerde kurumsal yapının stratejik planlamaya uygunluğu” ve “stratejik planlama sürecinde karşılaşılan sorunları çözme becerisi” boyutlarının, belediyelerin “topluma katkı performansını” pozitif etkilediği görülmüştür. “Stratejik plan hazırlama ve uygulama süreci etkinliği” ile “stratejik plan uygulamalarında karşılaşılan sorunları çözme becerisi” boyutları da kurumların verimliliğini olumlu etkileyen unsurlar olarak ortaya çıkmıştır. Çalışmada, yerel yönetimlerde stratejik planlama uygulamaları, Planlama Okulu’nun öne sürdüğü normatif stratejik planlama yaklaşımı ile ele alınmış olup, stratejik planlama ile kurum performansı arasındaki ilişki Planlama Okulu bakış açısı çerçevesinde de değerlendirilmiştir.
Commissioning of 6 and 10 MV Beams for Total Body Irradiation (TBI)
Authors: Garcia Joel Charles , De Arruda Botelho Marina , Baptista Delano Valdivino Santos , Viegas Cláudio , Santos Fortes Saulo 
Published: September 2023

The objective of the TBI treatment is the ablation of the bone marrow and the destruction of the circulating leukemia cells, once they are widely distributed throughout the body. Using beam parameters acquired under conventional SSD in TBI treatments may add non-negligible uncertainties in the monitor units calculation or in the beam profiles. The study, aims to commission the 6 and 10 MV photon beams, of the Varian accelerator CX model. A slab phantom and dosimetric assembly were used under TBI conditions. The accuracy of the TPS was evaluated against the experimental data. A set of data were acquired, highlighting the TPR table and methodology for calculating MU has been implemented. The TPS has presented a statistical uncertainty of ± 2.7 % compared to the experimental data for monitor unit calculation. The use of an acrylic spoiler has been shown to be clinically advantageous where, for a 6 MV beam, the entrance PDD was 75 % without a spoiler and 99.5 % with a spoiler. For a 10 MV beam, it was verified that without a spoiler, the entrance PDD was about 55 %, but with a spoiler, it was about 93 %. For medium Heterogeneous the TPS underestimated dose values by up to - 3.5 % with a mean deviation of – 2.9 %, for 6 MV and for 10 MV, the TPS overestimated the dose values by up to 1.1 %, with an average deviation of 1.0 % using the acrylic thorax phantom. The data obtained can be used clinically.
Growth differentiation factor-15 — a new indicator of unfavorable prognosis in uncomplicated myocardial infarction
Authors: Sabirzyanova A. S. , Galyavich A. S. , Baleeva L. V. , Galeeva Z. V. 
Published: September 2023

Aim. To evaluate the role of growth differentiation factor-15 (GDF-15) in long-term prognosis in patients with uncomplicated myocardial infarction (MI).Material and methods. The study included 118 patients with uncomplicated ST-elevation and non-ST-elevation MI. In addition to the routine examination, all patients were analyzed for GDF-15, as well as the N-terminal pro-brain natriuretic peptide (NT-proBNP) by enzyme immunoassay in the first 48 hours from the onset of MI symptoms. The changes in the patients' condition were assessed by questioning after 1, 3, 6, 12 months, as well as the analysis of medical records in the event of repeated cardiovascular events and deaths. The endpoints were cardiovascular death, hospitalization for recurrent MI, and/or unstable angina. To assess the value of quantitative variables in predicting recurrent cardiovascular events, the ROC analysis was used. The survival function of patients was assessed using the Kaplan-Meier method.Results. Twelve-month follow-up revealed 29 recurrent cardiovascular events, including 2 deaths and 8 recurrent MIs. GDF-15 was predictive of recurrent cardiovascular events with a sensitivity of 77,3% and a specificity of 56,2% (ROCAUC, 0,7±0,065 (95% confidence interval (CI), 0,572-0,827), p=0,004). Patients with GDF-15 ≥2,075 ng/mL had a higher risk of recurrent cardiovascular events (hazard ratio (HR), 3,4 (95% CI, 1,342-8,613), p=0,005). Another prognostic factor influencing the rate of recurrent cardiovascular events was NT-proBNP. An NTproBNP level ≥578 pg/mL was associated with an increased risk of cardiovascular death and rehospitalization for unstable angina and recurrent MI (HR, 4,3 (95% CI 1,828-10,239), p=0,00019).Conclusion. The combined increase in GDF-15 ≥2,075 ng/mL and NT-proBNP ≥578 pg/mL in patients with uncomplicated MI increases the risk of recurrent cardiovascular events over the next 12 months (HR, 4,5 (95% CI, 2,087-9,736), p=0,00018).
Diagnostic criteria for proximal left bundle branch block and their significance in predicting the success of cardiac resynchronization therapy
Authors: Rimskaya E. M. , Kashtanova S. Yu. , Salami Kh. F. , Kukharchuk E. V. , Malkina T. A. , Gaman S. A. , Komlev A. E. , Mironova N. A. , Stukalova O. V. , Imaev T. E. , Akchurin R. S. , Golitsyn S. P. 
Published: September 2023

Aim. To develop diagnostic criteria for proximal left bundle branch block (LBBB) based on non-invasive methods and to determine the significance of these criteria in predicting the effect of cardiac resynchronization therapy (CRT).Material and methods. To develop criteria, 58 patients (21 men, mean age, 76,1±7,1 years) with LBBB occurred immediately after transcatheter aortic valve implantation (TAVI) were included. To assess the significance of the developed criteria, the second group included 22 patients (11 men, mean age, 57,9±9,3 years) with dilated cardiomyopathy (DCM), who had indications for CRT. The effectiveness of CRT was assessed by echocardiography 6 months after implantation. All patients in the DCM group and 15 patients in the TAVI group underwent superficial epiand endocardial non-invasive mapping using Amycard 01C EP Lab (EP Solutions SA, Switzerland). Patients in the DCM group underwent contrast-enhanced cardiac magnetic resonance imaging (MRI) before device implantation.Results. The criteria for proximal LBBB included 3 electrocardiographic features: QRS complex >130 ms in women and 140 ms in men, QSor rS-configuration in V1 lead, notch in two or more lateral leads (I, avL, V5, V6), and 2 mapping criteria: characteristic location of block line and delayed activation point. In the DCM group, the criteria were positive in 13 of 22 patients (59%). The developed criteria for proximal LBBB showed a relatively strong, significant relationship with the positive effect of CRT (сhi-square test =5,46, p=0,02, Cramer test =0,5, odds ratio (OR)=15,0, 95% confidence interval (CI), 1,32-169,9, p=0,002). An additional analysis showed that both the criteria for proximal block and CRT effect are associated with myocardial fibrosis according to MRI. In particular, intramural stria-shaped contrast accumulation in the interventricular septum leads to a change in characteristic of proximal block mapping phenomena — displacement of delayed activation point (chi-square test =13,9, p<0,001, Cramer test =0,79) and displacement or absence of conduction block lines (chi-square test =6,92, p=0,009, Cramer test =0,56) and prevents the CRT effect (OR =8,67, 95% CI, 1,05-71,57 p=0,03).Conclusion. Proximal LBBB is only one of the factors determining the effectiveness of CRT. Proximal LBBB may mask significant myocardial structural changes that prevent the CRT success.
Prognostic role of atrial fibrillation in patients with non-compaction cardiomyopathy
Authors: Komissarova S. M. , Rineyskaya N. M. , Melnikova O. P. , Sevruk T. V. , Efimova A. A. 
Published: September 2023

Aim. To evaluate the prognostic role of atrial fibrillation (AF) as a predictor of adverse events and outcomes in a cohort of patients with non-compaction cardiomyopathy (NCCM).Material and methods. We examined 216 patients with NCCM (140 men and 76 women, median age, 39 (30; 50) years). In addition to traditional clinical methods, all patients underwent late gadolinium-enhanced cardiac magnetic resonance imaging (MRI). The endpoints of the study included progression of NYHA class III heart failure (HF) with the need for hospitalization, ventricular tachyarrhythmias, and thromboembolic events (TEEs).Results. There were 54 out of 216 (23,6%) patients with AF, of which 18 had paroxysmal AF, 16 — persistent AF, and 20 — permanent AF. During the follow-up period (median follow-up, 36 (6; 72) months), 98 out of 216 (45,4%) patients with NCCM had adverse events and outcomes as follows: 16 (7,4%) had ventricular tachyarrhythmias, of which 12 (5,6%) — sudden cardiac death with successful resuscitation and implantation of an implantable cardioverter-defibrillator; 62 (28,7%) patients had NYHA III-IV class HF progression; 20 (9,3%) patients had TEEs. The rate of adverse cardiac events was significantly higher in patients with AF (74,1% vs 35,8%, χ2=23,93, p<0,001) compared with patients without AF, including the incidence of TEEs (20,4% vs 5,6%, χ2=10,58, p=0,002) and HF progression to class III (46,3% vs 22,8%, χ2=10,9, p=0,002).Multivariate analysis showed that the following most significant predictors of HF progression risk: left ventricular ejection fraction (LVEF) <50% according to cardiac MRI (hazard ratio (HR), 95,8; 95% confidence interval (CI), 10,2 -898,6; p=0,0001), presence of AF (HR, 8,2; 95% CI, 2,2-31,3; p=0,0022) and left atrial volume index (LAVI) >43 ml/m2 (HR, 5,2; 95% CI, 2,1-12,8; p=0,0004); predictors of TEE risk were the presence of AF (HR, 6,5; 95% CI, 2,0-20,8; p=0,0020) and LAVI >43 ml/m2 (HR, 6,0; 95% CI, 1,8-19,7; p=0,036). No association of AF with ventricular tachyarrhythmias was found in the study cohort of patients with NCCM. Predictors of ventricular tachyarrhythmias were LVEF <50% (HR, 4,5; 95% CI, 2,950,4; p=0,0241) and the presence of non-sustained ventricular tachycardia (HR, 3,5; 95% CI, 1,3-9,3 p=0,0139).Conclusion. The present study shows that, along with the traditional predictor of adverse events in patients with NCCM (LVEF <50%), the identified additional predictors (AF and LAVI >43 ml/m2) can be used to identify patients at high risk of complicated NCCM for the timely prevention and treatment.
Diagnostic value of exercise stress echocardiography on a horizontal cycle ergometer in patients with low-risk non-ST elevation acute coronary syndrome
Authors: Abramenko E. E. , Ryabova T. R. , Yolgin I. I. , Ryabov V. V. 
Published: September 2023

Aim. To evaluate the diagnostic accuracy of exercise stress echocardiography on a horizontal cycle ergometer for the detection of obstructive coronary artery disease (CAD) in patients with low-risk non-ST-elevation acute coronary syndrome (NSTE-ACS).Material and methods. The study included 95 patients aged 53 (46;63) years (men, 58%), hospitalized in the regional vascular center with low-risk NSTE-ACS. Patients with known CAD, impaired resting left ventricular contractility were not included. During hospitalization, standard stress echocardiography on a horizontal cycle ergometer and invasive or non-invasive coronary angiography (CAG) were performed. All values of coronary obstruction ≥70% were verified by invasive CAG. The assessment of myocardial revascularization was observational.Results. All patients had normal structural and functional cardiac parameters at rest. No adverse events were recorded during the tests. The result of stress echocardiography according to impaired local contractility (ILC) criterion was positive in 9 (16%), negative in 28 (49%), incomplete symptom-limited in 20 (35%) patients. Coronary artery stenosis ≥50%/≥70% was detected in 78/78% of cases in the subgroup with a positive result, in 29/11% — with a negative result, 30/10% — with a non-diagnostic result. The association of ILC with stenosis ≥70% was higher, with an odds ratio of 30,1 (4,9; 186,5) vs 8,5 (1,6; 46,1) for stenosis ≥50%. There were following diagnostic accuracy for stenosis ≥70%: sensitivity — 70%, specificity — 93%, positive predictive value — 78%, negative predictive value — 89%, overall accuracy — 86%.Conclusion. Exercise stress echocardiography on a horizontal cycle ergometer in patients with low-risk NSTE-ACS patients is safe and feasible. The method has moderate sensitivity and positive predictive value and high specificity, negative predictive value and overall accuracy for the detection of anatomically significant coronary artery stenosis. In the structure of results, there is a significant proportion (35%) of symptom-limited tests incomplete due to heart rate, characterized by the lowest incidence of obstructive atherosclerosis.
Severe cardiac AL amyloidosis in an elderly patient with multiple SARS-CoV-2 reinfection: a case report
Authors: Reznik E. V. , Nguyen T.L. , Ettinger O. A. , Lazarev V. An. , Borisovskaya S. V. , Guseva A. I. , Salikov A. V. , Golukhov G. N. 
Published: September 2023

Introduction. The relationship between systemic amyloidosis and coronavirus disease 2019 (COVID-19) has not been sufficiently studied to date. This paper presents a case of the persistence of COVID-19 markers in an elderly patient with systemic amyloidosis.Brief description. A 74-year-old patient with heart failure with preserved ejection fraction and type 2 diabetes was repeatedly hospitalized due to decompensated heart failure. Based on the data of protein electrophoresis with immunotyping, biopsy of subcutaneous fat and bone marrow, echocardiographic data, the patient was diagnosed with systemic AL amyloidosis with cardiac involvement. During hospitalizations in April, August and December 2020, positive polymerase chain reaction test for SARS-CoV-2 were obtained, while there were no clinical manifestations of infection for a long time and adequate antibody production.Conclusion. A case report demonstrates multiple SARS-CoV-2 reinfection in a severe comorbid elderly patient, as an unfavorable prognostic factor.
Role of radionuclide assessment of global and regional mechanical dyssynchrony of the heart in prognosis of cardiac resynchronization therapy in patients with heart failure
Authors: Mishkina A. I. , Atabekov T. A. , Shipulin V. V. , Batalov R. E. , Sazonova S. I. , Popov S. V. , Zavadovsky K. V. 
Published: September 2023

Aim. To determine the prognostic significance of cardiac regional mechanical dyssynchrony (MD), assessed by radionuclide equilibrium ventriculography (REVG) in candidates for cardiac resynchronization therapy (CRT).Material and methods. The study included 65 patients with indications for CRT according to current guidelines. Prior to CRT, all patients underwent REVG to assess cardiac contractile function and MD. According to the phase analysis, indicators of global and regional cardiac MD were evaluated: phase standard deviation (PSD), histogram band width (HBW), entropy, and interventricular dyssynchrony. The regional assessment included an evaluation of phase histograms obtained from the analysis of the contraction of certain walls: left ventricular (LV) anterior, lateral, posterior wall, right ventricular (RV) free wall, and the interventricular septum. To evaluate the effectiveness of treatment 6 months after CRT, all patients underwent echocardiography, on the basis of which patients were divided into groups of responders and non-responders.Results. REVG revealed significant differences in the initial regional MD values between the groups of responders and non-responders: in responders, MD values of RV free wall (PSD: 39 (28-67) vs 28 (20-50), p=0,03) and LV anterior wall (PSD: 28,5 (16-40) vs 14 (11-24), p=0,0005) were higher, and the LV lateral wall was lower (PSD: 10 (7-14) vs 15 (9-26), p=0,007) than in non-responders. Multivariate logistic regression found following independent predictors of a positive response to CRT: heart failure of ischemic origin, LV HBW, RV free wall PSD, anterior wall PSD, LV lateral wall HBW (p<0,001). The sensitivity and specificity of the model was 93% and 91%, respectively.Conclusion. Regional MD scintigraphy parameters increase the predictive value of REVG in CRT candidates. The most informative in this regard are the PSD of RV free wall and LV anterior wall, as well as the HBW of LV lateral wall.
Patients with atrial fibrillation and a low risk of thromboembolic events: prescription rate of anticoagulant therapy according to a retrospective analysis
Authors: Druzhilov M. A. , Kuznetsova T. Yu. 
Published: September 2023

Aim. To conduct a retrospective analysis of the prevalence of main risk factors for thromboembolic events (TEEs) and the prescription rate of anticoagulant therapy (ACT) in patients with atrial fibrillation (AF) and a low CHA2DS2-VASc score in certain Russian regions using artificial intelligence technologies.Material and methods. The information was obtained from the Webiomed predictive analytics platform. The sample included 87601 patients with AF aged 18-74 years (men, 49,5%, mean age, 59,3±12,3 years, mean CHA2DS2-VASc score, 2,3±1,5) who received care in medical organizations in 6 constituent entities of the Russian Federation in the period from 2016 to 2019. CHA2DS2VASc score of 1 and 2 in a man and a woman, respectively, was regarded as a moderate risk, while score of 0 and 1, respectively, as a low risk of TEEs.Results. There were 22337 (25,5%) patients with AF at moderate risk and 18366 (21,0%) patients at low risk of TEEs. With a moderate risk of TEEs, CHA2DS2-VASc score of 1 in 70,4% of cases was determined by hypertension, while in 15,7% — by age 65-74 years, in 9,0% — by heart failure, in 2,9% — by myocardial infarction and/or peripheral arterial disease, in 2,0% — by type 2 diabetes. In patients with AF and a moderate risk of TEEs, ACT was prescribed in 4927 (22,1%) patients, while with a low risk of TEEs — in 1833 (10,0%). Among patients with AF and a high risk of TEEs (n=46898, 53,5%), 1216 (24,6%) patients with ischemic stroke (IS) did not initially have a high CHA2DS2-VASc risk.Conclusion. In clinical practice, among patients with AF aged 18-74 years, there are quite often individuals with CHA2DS2-VASc score of 1 not associated with sex. These patients need an individualized approach in ACT, which is the basis for prospective studies in order to optimize the assessment of cardioembolic IS risk, as well as to analyze the efficacy and safety of long-term ACT.
Atrial septal defect. Clinical guidelines 2023
Authors: Bokeria L. A. , Kim A. I. , Zelenikin M. M. , Avramenko A. A. , Alekyan B. G. , Belov V. A. , Bogdanov V. N. , Boriskov M. V. , Borisova N. A. , Brodsky A. G. , Volkov S. S. , Gavrilov R. Yu. , Garmash O. I. , Gladyshev I. V. , Golubova T. F. , Gorbatikov K. V. , Gorbatykh Yu. N. , Gorbachevsky S. V. , Grigoryan A. M. , Eliseeva L. V. , Yevtushenko A. V. , Irtyuga O. B. , Kovalev I. A. , Komissarov M. I. , Krivoshchekov E. V. , Krupyanko S. M. , Kupryashov A. A. , Kurganova A. V. , Levchenko E. G. , Lezhnev A. A. , Lyubchik V. N. , Martynyuk T. V. , Movsesyan R. R. , Nalimov K. A. , Nikiforov A. B. , Petrushenko D. Yu. , Plotnikov M. V. , Podoksenov A. Yu. , Pursanov M. G. , Svobodov A. A. , Semenyak E. G. , Sinelnikov Y. S. , Tataurova V. P. , Teplov P. V. , Trunina I. I. , Chernogrivov A. E. , Shekhmametyev R. M. , Shlyakhto E. V. , Shmalts A. A. , Yakovleva A. N. , Alexandrova S. A. , Baryshnikova I. Yu. , Bergen T. A. , Rychina I. E. , Sinitsyn V. E. , Yurpolskaya L. A. 
Published: September 2023

Association of Cardiovascular Surgeons of Russia Russian Society of Cardiology (RSC)Association of Pediatric Cardiologists of RussiaRussian Scientific Society of Specialists in X-Ray Endovascular Diagnostics and TreatmentAll-Russian Public Organization for the Promotion of Radiation Diagnostics and Therapy "Russian Society of Radiologists and Radiologists".Task Force members declared no financial support/conflicts of interest. If conflicts of interest were reported, the member(s) of the working group was (were) excluded from the discussion of the sections related to the area of conflict of interest.
Potential of anticoagulant therapy in cardiology practice for thrombocytopenia. Literature review
Authors: Pereverzeva K. G. , Yakushin S. S. , Korshikova A. An. 
Published: September 2023

The review article discusses the issues of anticoagulant therapy in cardiovascular patients with thrombocytopenia (TP), gives the concept of ethylenediaminetetraacetic acidand heparin-induced TP. The management of patients with heparin-induced TP is analyzed in detail, which consists in the discontinuation of unfractionated and low molecular weight heparin administration with replacement to direct thrombin inhibitors (lepirudin or argatroban), fondaparinux or direct oral anticoagulants.The authors emphasize that the anticoagulant administration to most patients with platelet count >50×109/l is possible in full prophylactic and therapeutic doses. Reducing the level of platelets to 25-50×109/l in most cases requires a reduction in the anticoagulant dose by 50%. At a platelet level of 20-25×109/l or less, anticoagulant therapy should be avoided in most patients.In addition to the scope of anticoagulant therapy, TP also determines the choice of anticoagulant as follows: in patients with acute coronary syndrome, bivalirudin or fondaparinux are recommended, while in patients with cancer and stable TP, warfarin or direct oral anticoagulants can be prescribed. In progressive TP (if heparin-induced TP is ruled out), low molecular weight heparins should be used.