Організація активної роботи студентів на заняттях з англійської мови (The language that keeps silence: a principle of «poetic chatting» in r. walser’s novel «the tanners»)

У статті розглянуто як досягти більшої ефективності на заняттях з англійської мови у ВНЗ та мотивувати студентів до більшої активності та співпраці з викладачем. Подано декілька моделей завдань, за допомогою яких можна урізноманітнити навчальний процес, зробити заняття більш цікавим та заохотити студентів приймати в них активну участь. Виявлені та систематизовані фактори, які впливають на організацію активної роботи студен- тів на заняттях з англійської мови. У роботі зосереджено увагу на факторах, які впливають на ефективну співпра- цю викладача та студентів, а також що і як повинні вміти студенти ВНЗ. (The article deals with the methods of achieving effectiveness while teaching English language and means of motivating students to participate in the lesson. Some activities with the help of which lessons can be more interesting are considered. Techniques influencing student activity are arranged according to a system. In the article attention is concentrated on students and teacher cooperation. Emphasized the importance of gaining skills by students. They must take active part in various discussions, have their own opinion, have the ability to explain the material to the group mates, be motivated to study and increase their level, respect their teachers and work by themselves. It is considered how to spice up lessons and some tasks for English lessons are given. It is concluded that students who want to study well and have chosen their future profession by themselves are more motivated than students who were forced to study by their parents. It is proved that when teacher divides class into a few groups and lets them teach each other and revise material for test together students have better results. They have an opportunity to ask each other different questions without being afraid of looking stupid. Also when students explain material to their group mates they understand how it is difficult to be a teacher that also stimulates them for cooperation.

Iron sucrose: The oldest iron therapy becomes new

Several parenteral iron preparations are now available. This article focuses on iron sucrose, a hematinic, used more widely than any other for more than five decades, chiefly in Europe and now available in North America. Iron sucrose has an average molecular weight of 34 to 60 kd, and after intravenous (IV) administration, it distributes into a volume equal to that of plasma, with a terminal half-life of 5 to 6 hours. Transferrin and ferritin levels can be measured reliably 48 hours after IV administration of this agent. Iron sucrose carries no black-box warning, and a test dose is not required before it is administered. Doses of 100 mg can be administered over several minutes, and larger doses up to 300 mg can be administered within 60 minutes. The efficacy of iron sucrose has been shown in patients with chronic kidney disease (CKD) both before and after the initiation of dialysis therapy. Iron sucrose, like iron gluconate, has been associated with a markedly lower incidence of life-threatening anaphylactoid reactions and may be administered safely to those with previously documented intolerance to iron dextran or iron gluconate. Nonanaphylactoid reactions, including non-life-threatening hypotension, nausea, and exanthema, also are extremely uncommon with iron sucrose. Management of patients with the anemia of CKD mandates that we carefully examine the effectiveness and safety of this oldest of iron preparations and the accumulating present-day data regarding it and contemporaneous agents. © 2002 by the National Kidney Foundation, Inc

Surveillance and Monitoring of Dialysis Access

Vascular access is the lifeline of a hemodialysis patient. Currently arteriovenous fistula and graft are considered the permanent options for vascular access. Monitoring and surveillance of vascular access are an integral part of the care of hemodialysis patient. Although different techniques and methods are available for identifying access dysfunction, the scientific evidence for the optimal methodology is lacking. A small number of randomized controlled trials have been performed evaluating different surveillance techniques. We performed a study of the recent literature published in the PUBMED, to review the scientific evidence on different methodologies currently being used for surveillance and monitoring and their impact on the care of the dialysis access. The limited randomized studies especially involving fistulae and small sample size of the published studies with conflicting results highlight the need for a larger multicentered randomized study with hard clinical end points to evaluate the optimal surveillance strategy for both fistula and graft

What Is So Bad About a Hemoglobin Level of 12 to 13 g/dL for Chronic Kidney Disease Patients Anyway?

Randomized controlled trials (RCTs) clearly indicate a possible cardiovascular morbidity and mortality risk when deliberately targeting a normal hemoglobin (Hb) concentration of 13 to 15 g/dL. By contrast, observational studies point to greater hospitalization and mortality at Hb levels \u3c11 g/dL. There are no direct data to help us determine where, within this broad range, the optimal Hb lies. In RCTs and observational studies, significant confounding from the interrelationships of anemia and epoetin resistance occurs in patients with a serious illness. Patients with comorbidities such as malnutrition and inflammatory processes are more resistant to epoetin and, invariably, require greater cumulative epoetin doses. The effect of a higher erythropoiesis-stimulating agent (ESA) dose on increasing mortality has been noted repeatedly in post hoc analyses of RCTs. It is therefore too simplistic to solely attribute the outcomes achieved in RCTs to target Hb. We discuss various mechanisms for potential harm at higher Hb levels as opposed to those that may be obtained from higher epoetin doses. For the individual patient, the therapeutic decision should center on what Hb is most appropriate at a safe ESA dose. Consequently, an Hb of 12 to 13 g/dL may be totally appropriate in some patient populations. © 2009 National Kidney Foundation, Inc

Effect of Time on Sensitivity and Specificity of Access Flow in Predicting Thrombosis

Dialysis access monitoring may help decrease thrombosis-related morbidity. We investigated the effect of time elapsed since an access flow measurement on test accuracy of a novel flow monitoring method called variable flow (VF) Doppler. A retrospective review was conducted in 36 patients with prosthetic grafts for vascular access using access thrombosis as the clinical endpoint. Receiver operator characteristic (ROC) curves and test sensitivity and specificity were determined for various follow-up time intervals. ROC analysis showed increasing test discrimination for shorter time intervals. Sensitivity and specificity for a commonly used surveillance threshold (600 ml/min) showed specificity that was little changed (88–93%) from follow-up time intervals of 15 days to 6 months. However, sensitivity was low (21%) at 6 months, increased to 50% at 2 months, 67% at 1 month, and 100% at 15 days (a single event). Low access blood flow using VF Doppler predicts near-term thrombosis. These data further imply that the discriminative value of access flow monitoring appears to be highly dependent on time from the flow measurement, improving with shorter time intervals from the measurement.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/74923/1/j.1525-139X.2003.16107.x.pd

Multiple pumps for sodium reabsorption by the perfused kidney

Multiple pumps for sodium reabsorption by the perfused kidney. Several distinct transport mechanisms responsible for sodium reabsorption by the rat kidney can be identified by studying the function of isolated perfused kidneys. Approximately one-half of the fractional sodium reabsorption by the isolated perfused rat kidney appears to depend on Na-K-adenosine triphosphatase (AT-Pase) and is inhibited by ouabain. About 15 to 20% is associated with the reabsorption of bicarbonate and is blocked by acetazolamide. This fraction of transported sodium is unaffected by ouabain and therefore does not involve Na-K-ATPase. Neither furosemide nor ethacrynic acid produce further inhibition of sodium reabsorption in a kidney already exposed to ouabain and acetazolamide. Most of the residual transport of sodium is inhibited by cooling the perfused kidney, suggesting that it is powered by metabolic rather than physical sources of energy.Multiplicité des pompes qui assurent la réabsorption du sodium par le rein perfusé. Plusieurs mécanismes de transport distincts responsables de la réabsorption de sodium par le rein de rat peuvent être identifiés par l'étude du fonctionnement de reins isolés perfusés. La moitié, approximativement, de la réabsorption fractionnelle du sodium par les reins isolés perfusés semble dépendre de la Na-K-ATPase et est inhibée par l'ouabaïne. Environ 15 à 20% sont associes à la réabsorption du bicarbonate et bloqués par l'acetazolamide. Cette fraction du sodium transporté n'est pas affectée par l'ouabaïne et donc n'implique pas la Na-K-ATPase. Ni le furosémide ni l'acide éthacrynique ne produisent d'inhibition supplémentaire de la réabsorption de sodium par un rein déjà exposé à l'ouabaïne et à l'acetazolamide. La plus grande partie du transport résiduel du sodium est inhibée par le refroidissement du rein perfusé, ce qui suggère une source d'énergie métabolique plutôt que physique

Prophylactic mastectomy and simultaneous reconstruction

Department of surgery N1 "N.Anestiadi ", Nicolae Testemitanu State University of Medicine and Pharmacy, Chisinau, Republic of Moldova, The 6th International Medical Congress for Students and Young Doctors, May 12-14, 2016Background. Prophylactic Mastectomy (PM) meets several controversies which are especially: the value of PM for preventing breast cancer and also the extent of the mastopathy drug therapy that may reduce the risk of breast cancer without requiring PM. Materials and methods. PM was performed on 7 patients, aged between 25 and 41 years. Preoperative examination included ultrasound, mammography, CT, MRI (two cases), cytology, tests BRCA-1 and BRCA-2. Subcutaneous PM was performed bilaterally in 5 cases. In two cases of breast cancer PM was performed unilaterally for contrlateral gland. In 6 cases the operation was finished with reconstruction breast implant. Each case of PM had an individual type of incision depending on the presence and location of previous scars after the sectorial resection of the breast and degree of breast sagging. Simultaneous breast reconstruction was performed in 5 cases with implants. Results and discussion. Two patients had a pronounced ischemia of areola and nipple. The decrease skin and areola sensitivity was observed in all cases. There has been no extrusion of the implant, no breast inflammation or contracture in the postoperative period. The aesthetic result of breast reconstruction for PM "skin sparing" mastectomy after reconstruction is superior to classical mastectomy. Conclusions. We consider defining the following criteria of PM: aggravated familiar history, previously supported contralateral cancer, multicenter and multifocal cancer, age of patient, histologic factor and positive BRCA 1 and BRCA-2 tests. The decision in favor of PM should be taken only after thorough examination and in full agreement with the patient.Originality and scientific relevance of the presented study. Originality and scientific relevance of the presented study. Breast cancer is the most common form of malignancy in women that causes humanity a significant loss via not only important financial aspects, but also a high rate of physical and intellectual disability. Fibrocystic mastopathy is held responsibble for increased risk of breast carcinoma, serving as prediction marker of histological lesion or malignacy. The question is whether prophylactic treatment alone is enough or surgery has to be carried out in order to eliminate unnoticed debutant cancer

Comparison of Low-Dose Gentamicin With Minocycline as Catheter Lock Solutions in the Prevention of Catheter-Related Bacteremia

Background: Catheter-restricted antibiotic lock solutions were found to be effective in the prevention of catheter-related bacteremia (CRB), but insufficient data are available about the ideal agent and dose. We hypothesized that a low concentration of gentamicin would be as effective as the high doses studied in the past. Methods: In this prospective, open-labeled, randomized, clinical trial of patients on long-term hemodialysis therapy, patients were randomly assigned to administration of an antibiotic lock solution of gentamicin/citrate (4 mg/mL), minocycline/EDTA, or the control solution of heparin. Patients were followed up until the study end point of CRB was reached or a censoring event occurred. Interim data analysis was performed after 6 months to assess data safety; efficacy was noted and the study was terminated early. Results: Sixty-two patients were enrolled into the study, evenly distributed in 3 arms, with data from 1 patient excluded from analysis. Seven of 20 patients in the heparin group (4.0 events/1,000 catheter days), 1 of 21 patients in the minocycline group (0.4 events/1,000 catheter days), and none of 20 patients in the gentamicin group developed bacteremia. Results were statistically significant by using 2-tailed Fisher exact test; heparin versus gentamicin, P = 0.008, and heparin versus minocycline, P = 0.020. Conclusion: Antibiotic lock solutions are superior to the standard heparin lock alone in the prevention of CRBs, and low-dose gentamicin solution has efficacy similar to that of greater concentrations used in previous studies. © 2006 National Kidney Foundation, Inc