[Disability due to arterial hypertension and alimentary factors, determining cardiovascular risk].

The problem of disability is associated with the problem of socially significant diseases, the main feature and at the same time the key characteristic of which is mass character. The epidemic nature of the spread and the medical and social burden of arterial hypertension (AH) leads to the assignment of this pathology to the number of socially significant diseases. The aim of the study was to analyze primary disability due to AH in Moscow and clinical and pathogenetic parallels between the level of arterial pressure and alimentary factors determining cardiovascular risk (CVR). Material and methods. The object of study was the data on the primary disability of the population of Moscow during the period 2011-2017 according to the form of state statistical observation #7-sobes and data of the Ministry of Health of Russia. The study was retrospective. The subject of a selective study was an analysis of the nosological spectrum of causes of disability, the nature of functional impairment and the degree of disability of elderly people who underwent inpatient treatment at the hospital for war veterans of the Rostov region in 2018-2019. The analysis of the spectrum of factors that determine the CVR. Results and discussion. The total number of newly recognized disabled (NRD) due to hypertension amounted to 11,069 people. The growth of the share of NRD of young age (6.8-11.7%), a decrease in the proportion of NRD of middle age (45.3-41.7%) and elderly in 2015-2016 (39.1-39.9%), but the growth of this indicator in this contingent in 2017 to 46.6% were noted. The proportion of NRD group III increased (to 69.1%), NRD group II decreased (to 20.3%) with a negative trend of growth in the proportion of VPI of the most severe group I. Selective survey data among people with disabilities undergoing inpatient treatment at the hospital for war veterans of the Rostov Region (2018-2019) indicated that they had a wide range of factors determining the CVR. Conclusion. The persistence of patients with hypertension triggers, supporting its further progression, is the cause of the low effectiveness of therapy and exacerbates the prognosis. It is advisable to have a unified approach to improving the efficiency of dietary use at the stages of complex treatment, prophylactic and rehabilitation programs with the goal of primary and secondary prevention of hypertension and disability due to this socially significant pathology.

[Neurosyphilis in clinical practice].

Presented is the description of the 41-year-old patient who was delivered to the emergency department of the clinical hospital. The patient has clinical manifestations of the stroke. Intracerebral hematoma of the right cerebral hemisphere was diagnosed on clinical examination. Serosurrey was positive for syphilis. Due to the suspected neurosyphilis, the central laboratory performed additional examination.

Landmarks of the normal adult human trochlea based on axial MRI measurements: a cross-sectional study.

PURPOSE: For deepening trochleoplasty, a procedure used worldwide to correct trochlear dysplasia, only few surgical steps are described precisely. Important surgical landmarks, such as optimal cartilaginous trochlear depth and percentages of the new lateral and medial facet, remain unanswered. METHODS: A cross-sectional study (January 2011-August 2012) was carried out in adult patients (16-35 years) without trochlear dysplasia, who underwent magnetic resonance imaging (MRI). The main outcome was trochlear depth. The secondary outcome was the lateral/medial facet ratio. Measurements were made on the first axial cut from proximal with complete cartilage coverage of the trochlea. Differences between men and women were assessed. RESULTS: Fifty-three patients (70% men) were included. Mean age was 24.6 years (SD±5.5). Overall mean trochlear depth was found to be as 4.0 mm (95% CI 3.6-4.3). Values differed significantly by gender (p=0.0271) with a mean of 3.4 mm (95% CI 3.0-3.8) for women and a mean of 4.2 mm (95% CI 3.8-4.7) for men. The mean ratio between the lateral and medial facet was 1.71 (95% CI 1.62-1.80), the lateral facet contributing 62.6% (95% CI 61.3-63.8) and the medial facet contributing 37.4% (95% CI 36.2-38.7) to the total cartilage length. For the facet ratio, there was no statistically significant gender difference (n.s.). CONCLUSIONS: This study provides data on important landmarks for deepening trochleoplasty based on average MRI measurements in the general population. The difference between the MRI measurement and actual cartilage surface measurement is likely to be minimal, but is yet to be evaluated. Further evaluation of these landmarks by prospectively performing deepening trochleoplasty will determine the value of the clinical implication. LEVEL OF EVIDENCE: II.

Evaluating the treatment of metastatic colorectal cancer with monoclonal antibodies.

The ability to tailor biologic therapy based on the status of tumor biomarkers and monoclonal antibodies has become very important in the last years. The role of tumor biomarkers in treating colorectal cancer, specifically the K-RAS gene, was identified. K-RAS had a higher interest after Lievre and colleagues reported at the 2008 American Society of Clinical Oncology (ASCO) meeting, their analysis of K-RAS mutations in tumors from patients who did not appear to benefit from cetuximab therapy, providing additional data involving K-RAS mutant tumors and their lack of response to cetuximab, as part of first-line therapy for metastatic colorectal cancer. Furthermore, other trials evaluated the K-RAS status and the first-line treatment of metastatic colorectal cancer, the treatment of refractory metastatic cancer and dual-antibody therapy in the first-line treatment of colorectal cancer. Patients with mutant K-RAS colorectal tumors have no benefit from cetuximab, no matter the type of chemotherapy regimen.

3D representation of the surface topography of normal and dysplastic trochlea using MRI.

The three-dimensional (3D) image of the articular surface topography of the normal and the dysplastic trochlea has not been defined. The aim of this study was to represent both the normal and dysplastic trochlear geometry in 3D using magnetic resonance imaging (MRI). Using the segmentation software program Amira (Mercury Computer Systems, Inc., Chelmsford, USA) we created 3D reconstructions of the distal femur bone and cartilage using MRI scans. Bone and cartilage of the distal femur were traced slice by slice in the acquisitioned dimension while the Amira program reconstructed the 3D model. This model was then transferred to the Rhinoceros 4.0 software (Robert McNeel & Associates, Seattle, USA) for measuring. Using this system a non-invasive 3D representation of the articular cartilage and bone of the normal trochlea and depiction of different types of trochlear dysplasia were possible. Potential advantages of these MRI measurements are assessment of the 3D articular cartilage of the whole trochlea and the bony contours on the same image, no imaging errors from joint malpositioning, no ionizing radiation, precise preoperative planning according to the documented pathomorphology, and comparison between the preoperative and the postoperative shapes. The disadvantages include higher costs compared to radiography or CT scans, and time consuming reconstruction, making them currently a research tool.

Managing fetal alcohol spectrum disorder in the public school system: a needs assessment pilot.

BACKGROUND: Published data and Canadian population reports suggest that approximately 1% of students in Toronto may have learning problems related to Fetal Alcohol Spectrum Disorders (FASDs). It is therefore imperative to understand how the needs of affected students are being met by various practitioners in their school environment. To date no comprehensive follow-up studies on FASD-affected children, families and educators in Toronto public schools are available. Documentation of school experiences associated with FASDs is needed to aid in developing appropriate and efficient intervention models for FASDs. OBJECTIVES: Identify and document needs as related to school capacities and education practitioner capabilities with respect to their abilities to support children diagnosed with FASDs. METHODS: A qualitative approach using semi-structured interviews was utilized for this exploratory pilot study. Twelve practitioners from various disciplines, all of whom work for Toronto public schools participated. RESULTS: Participants represented approximately 3500 students enrolled amongst their schools and classrooms. Only one respondent reported having worked with a child diagnosed with an FASD during their career. Education practitioners commonly report a lack of knowledge of FASDs and how to appropriately plan for affected children. CONCLUSIONS: Practitioners need additional supports in order to address FASDs in their schools. As this is the first pilot study on FASDs in the Ontario school system, further study is warranted.

Immunological alterations in newly diagnosed primary Sjögren's syndrome characterized by skewed peripheral T-cell subsets and inflammatory cytokines.

OBJECTIVES: To describe how certain peripheral immune parameters reflect the inflammatory alterations in patients with primary Sjögren's syndrome (pSS). We determined lymphocyte subpopulations and their state of activation from peripheral blood, evaluating both soluble serum T-helper (Th)1/Th2-type cytokines and intracytoplasmic cytokines. METHODS: Forty-nine patients with newly diagnosed pSS and 40 healthy individuals, all free from immunomodulant or immunosuppressive medication, were studied. Peripheral blood lymphocyte subgroups were quantified by flow cytometry, soluble cytokines were assessed using enzyme-linked immunosorbent assay (ELISA), and intracellular cytokine levels were measured after phorbol myristate acetate (PMA) stimulation by flow cytometry after staining of intracellular cytokines. RESULTS: Patients with primary SS had higher percentages of activated CD3+/CD69+ T cells than controls. When comparing naïve vs. memory subsets of CD4+ and CD8+ T cells, a shift towards the memory phenotype was observed for both. Natural killer (NK) cell and NK T-cell (NKT) percentages and Th0 and Th1 cell numbers were increased in patients compared to controls. Among circulating cytokines, interferon (IFN)-gamma was high, whereas interleukin (IL)-10 was decreased in SS when compared to controls. CONCLUSIONS: SS, considered as a systemic autoimmune disease, is characterized by a complex interplay of various cytokines and immune cells. The skewed T-cell subsets and cytokine imbalance play important roles in an orchestrated proinflammatory cascade.

Promoting older adults' well-being through Internet training and use.

The purpose of the current research was to test the psychological impact of learning how to use computers and the Internet in old age, hypothesizing that such activities would contribute to seniors' well-being and personal sense of empowerment. Employing a quasi-experimental research design, we offered a course, conducted in small groups, in computer operation and Internet browsing to 22 older adults (mean age of 80) who went to day-care centers for the elderly or resided in nursing homes. A comparison group of 26 participants (similar in all major respects) was engaged in other activities. Both groups were administered measures of physical functioning, life satisfaction, depression, loneliness and self-control at pre- and post-intervention four months later. Individual semi-structured interviews were conducted with participants who finished the computer course. ANCOVA was employed for controlling the effects of control variables and pre-intervention differences on participants who completed the activities. Results showed a significant improvement among participants in the intervention group in all measures except physical functioning, whereas deterioration in all measures was detected in the comparison group. Computer and Internet use seems to contribute to older adults' well-being and sense of empowerment by affecting their interpersonal interactions, promoting their cognitive functioning and contributing to their experience of control and independence.

ATM haplotypes and breast cancer risk in Jewish high-risk women.

While genetic factors clearly play a role in conferring breast cancer risk, the contribution of ATM gene mutations to breast cancer is still unsettled. To shed light on this issue, ATM haplotypes were constructed using eight SNPs spanning the ATM gene region (142 kb) in ethnically diverse non-Ashkenazi Jewish controls (n=118) and high-risk (n=142) women. Of the 28 haplotypes noted, four were encountered in frequencies of 5% or more and accounted for 85% of all haplotypes. Subsequently, ATM haplotyping of high-risk, non-Ashkenazi Jews was performed on 66 women with breast cancer and 76 asymptomatic. One SNP (rs228589) was significantly more prevalent among breast cancer cases compared with controls (P=4 x 10(-9)), and one discriminative ATM haplotype was significantly more prevalent among breast cancer cases (33.3%) compared with controls (3.8%), (P< or =10(-10)). There was no significant difference in the SNP and haplotype distribution between asymptomatic high-risk and symptomatic women as a function of disease status. We conclude that a specific ATM SNP and a specific haplotype are associated with increased breast cancer risk in high-risk non-Ashkenazi Jews.

Identification of transcription factor binding sites with variable-order Bayesian networks.

MOTIVATION: We propose a new class of variable-order Bayesian network (VOBN) models for the identification of transcription factor binding sites (TFBSs). The proposed models generalize the widely used position weight matrix (PWM) models, Markov models and Bayesian network models. In contrast to these models, where for each position a fixed subset of the remaining positions is used to model dependencies, in VOBN models, these subsets may vary based on the specific nucleotides observed, which are called the context. This flexibility turns out to be of advantage for the classification and analysis of TFBSs, as statistical dependencies between nucleotides in different TFBS positions (not necessarily adjacent) may be taken into account efficiently--in a position-specific and context-specific manner. RESULTS: We apply the VOBN model to a set of 238 experimentally verified sigma-70 binding sites in Escherichia coli. We find that the VOBN model can distinguish these 238 sites from a set of 472 intergenic 'non-promoter' sequences with a higher accuracy than fixed-order Markov models or Bayesian trees. We use a replicated stratified-holdout experiment having a fixed true-negative rate of 99.9%. We find that for a foreground inhomogeneous VOBN model of order 1 and a background homogeneous variable-order Markov (VOM) model of order 5, the obtained mean true-positive (TP) rate is 47.56%. In comparison, the best TP rate for the conventional models is 44.39%, obtained from a foreground PWM model and a background 2nd-order Markov model. As the standard deviation of the estimated TP rate is approximately 0.01%, this improvement is highly significant.

Anti-endothelial cell antibodies in mixed connective tissue disease: frequency and association with clinical symptoms.

OBJECTIVE: Anti-endothelial cell antibodies (AECA) have been described in a number of systemic autoimmune-inflammatory diseases. However, little is known about the relationship of AECA with mixed connective tissue disease (MCTD). METHODS: Using an ELISA, the presence of AECA was evaluated in the sera of 33 patients with MCTD and of 30 healthy subjects as controls. Serum levels of AECA were correlated with clinical activity, as well as the existence of various organ manifestations. RESULTS: Significantly increased AECA production was observed in MCTD patients (OD = 0.337+/-0.193) compared to controls (OD = 0.136+/-0.065). In addition, patients with active MCTD exerted significantly elevated serum AECA levels (OD = 0.487+/-0.090) than did patients with inactive MCTD (OD = 0.135+/-0.040) or controls. MCTD patients with pulmonary hypertension had a tendency of increased serum AECA levels (OD = 0.452+/-0.080) compared to patients without this manifestation (OD = 0.307+/-0.039). Sera of MCTD patients with AECA concentrations higher or lower than the mean serum AECA level in controls+2SD (OD = 0.266) were considered as AECAhigh (n = 19/33) and AECAlow (n = 14/33), respectively. Interestingly, all patients with active disease had AECAhigh, while all inactive MCTD patients had AECAlow sera. IgG purified from ten MCTD sera (OD = 0.415+/-0.290) showed a tendency to up-regulate E-selectin expression on cultured human umbilical vein endothelial cells (HUVEC) compared to IgG from control sera. In addition, AECAhigh MCTD sera exerted significantly increased stimulatory effect on endothelial E-selectin expression (OD = 0.651+/-0.190) compared to AECAlow (OD = 0.178+/-0.110) or control sera (OD = 0. 131+/-0.080). CONCLUSION: AECA may activate endothelial cells by the up-regulation of E-selectin expression and thus may be implicated in the pathogenesis of MCTD. Furthermore, serum AECA may be a useful marker of endothelial activation and clinical activity in this disease.

[Results of laparoscopic repair of abdominal wall hernias using an ePTFE-polypropylene composite mesh]. / Ergebnisse der laparoskopischen Versorgung von Bauchwandhernien mit einem PTFE-Polypropylen-Komposite-Netz.

BACKGROUND: The standard technique for laparoscopic ventral hernioplasty (peritoneal onlay) reduces the recurrence rate and the rate of other complications, in particular the risk of infections. However, the procedure requires a special mesh to mitigate the risk of visceral adhesions. For this purpose an ePTFE mesh is generally used. There are limited reported clinical data regarding the long-term results and benefits of other biomaterials. STUDY DESIGN: Bard Composix mesh was used for laparoscopic ventral hernia repair. This biomaterial combines two different clinically proven materials--polypropylene with a thin layer of ePTFE--to maximize ingrowth of surrounding tissue, while mitigating the risk of visceral adhesions. Demographic, operative and postoperative data were collected and analyzed. Follow-up clinical evaluations were conducted 6-10 days, 4 weeks, and every 6 (th) month after surgery in all patients. RESULTS: Fifteen patients were involved in the study. The mean operating time was 101.2 min (64-190 min). There were no intraoperative complications or conversion to open procedure. Postoperative complications were 1 seroma, 4 cases of prolonged ileus, one tacks-site pain requiring second-look laparoscopy. Hospital discharge occurred on average 6 days (3-10 days) after surgery. The mean follow-up was 12.4 months (range 5-29 months). No late complications or hernia recurrence were observed. CONCLUSIONS: Laparoscopic prosthetic ventral hernioplasty using the composite polypropylene/ePTFE mesh offers short hospital stay and acceptable complications for primary and recurrent ventral hernias. Disadvantage of the composite mesh is the difficulty to roll this product into a sufficiently small size to permit its easy introduction into the abdominal cavity.

[Hand-assisted laparoscopic technique (HALS) in colorectal surgery (Case reports and review of the literature)]. / Kézzel asszisztált laparoszkópos technika (HALS) a colorectalis sebészetben (Esetismertetések és irodalmi áttekintés).

Hand-assisted laparoscopic surgery (HALS) is a new technique in which the surgeon's hand is introduced to the abdominal cavity through a mini-laparotomy, while pneumoperitoneum is maintained. We describe the technique of HALS used successfully in the treatment of two patients of colorectal disease. We describe current literature and our initial clinical experience. Our conclusion is that, besides colorectal surgery, HALS technique may prove useful for other abdominal procedures as well; however its real value should be estimated in prospective randomized trials.

Heart rate variability analysis.

The expansion of heart rate variability analysis has been facilitated by the remarkable development of computer sciences and digital signal processing during the last thirty years. The beat-to-beat fluctuation of the heart rate originates from the momentary summing of sympathetic and parasympathetic influences on the sinus node. According to the extensive associations of the autonomic nervous system, several factors affect heart rate and its variability such as posture, respiration frequency, age, gender, physical or mental load, pain, numerous disease conditions, and different drugs. Heart rate variability can be quantitatively measured by time domain and frequency domain methods that are detailed in the paper. Non-linear methods have not spread in the clinical practice yet. Various cardiovascular and other pathologies as well as different forms of mental and physical load are associated with altered heart rate variability offering the possibility of predicting disease outcome and assessing stress.

Comparison of the anti-Ro/SSA autoantibody profile between patients with primary and secondary Sjögren's syndrome.

OBJECTIVE: To measure serum levels of anti-Ro52-kD/SSA, anti-Ro60-kD/SSA and anti-La/SSB autoantibodies in patients with primary and secondary Sjögren's syndrome. To examine if there is any connection between the disease and the subtype-spectrum of these antibodies. METHODS: We measured serum levels of anti-Ro52-kD/SSA, anti-Ro60-kD/SSA and anti-La/SSB autoantibodies by ELISA, in the sera of patients with primary Sjögren's syndrome with or without extraglandular manifestations and with or without anti-La/SSB positivity and of patients with systemic lupus erythematosus/Sjögren's syndrome overlapping disease with or without anti-La/SSB positivity. RESULTS: Differences of the distribution of the anti-Ro52-kD/SSA and the anti-Ro60-kD/SSA were found between the primary and secondary Sjögren's syndrome patients' groups; when Sjögren's syndrome is accompanied by systemic lupus erythematosus, the occurrence of anti-Ro60-kD/SSA autoantibodies is significantly higher than in primary Sjögren'syndrome. CONCLUSION: Our results suggest that there is a possible connection between the distribution of the subtypes of the anti-Ro/SSA autoantibodies and the disease type in primary/secondary Sjögren's syndrome.

Retrospective evaluation of 5-fluorouracil-interferon-a aTreatment of advanced colorectal cancer patients.

The authors describe the retrospective analysis of treatment by 5-fluorouracil and interferon-a aof 34 patients with advanced colorectal cancer. An average of 4.6 treatment cycles (3 12) was applied. Complete remission was not observed; partial remission was observed in 8 patients; in 13 patients no change occurred and progression was detected in 14 cases. Remission rate was 22.8%, mean response time was 5.2 (3 12) months, mean progress-free survival 5.6 (0 22) months. Mean survival from the start of treatment was 11.9 (1 42) months and from the establishment of the diagnosis 26.1 (3 60) months. Severe life-threatening side-effects did not occur; other side-effects such as fever, nausea, diarrhea, leucopenia, and anemia responded to drugs. Treatment by 5-FU and interferon, in accordance with other authors findings, improved survival and well-being of patients but no breakthrough has been achieved.

Case series: coexistence of Sjögren's syndrome and sarcoidosis.

OBJECTIVE: To present cases of coexisting sarcoidosis and Sjogren's syndrome (SS). METHODS: We analyzed the clinical data of our 464 patients with SS with a clinical picture suggesting coexisting SS and sarcoidosis. We followed them for several years. RESULTS: We found 5 patients with coexisting SS and sarcoidosis. In 3 patients, pure sarcoidosis could mimic SS. CONCLUSION: In our experience, the frequency of sarcoidosis in SS is much higher than in the general population. One of the European criteria is that before the diagnosis of SS is made, the presence of sarcoidosis must be excluded. From our experience of 5 cases we determined that the 2 diseases can coexist, which indicates the value of these criteria.

[Sjögren's syndrome and multiple myeloma]. / Sjögren-szindróma és myeloma multiplex.

In our recent work we present two cases of coexisting Sjögren's syndrome and myeloma multiplex. Our results obtained studying a high number of patients suggest that the occurrence of myeloma in Sjögren's syndrome is much higher than in normal population. This can possibly be explained by the common pathogenetical factors of the two diseases. The survival of one of our two patients in 4 years, and her disease is still in complete remission. The possible explanation of the therapeutical success can be the rather aggressive chemotherapeutical approach in her case. Perhaps the prognosis of myeloma coexisting with Sjögren's syndrome is different that of pure myeloma, it is suggested that the earliest possible aggressive therapy of myeloma accompanied by Sjögren's syndrome can be useful and recommendable.