Tumour necrosis factor, interleukin-1 and adenosine deaminase in tuberculous pleural effusion

AbstractTumour necrosis factor (TNF) and interleukin-1 (IL-1) are powerful mediators with a key role in inflammation. This study was undertaken to study the presence of TNF and IL-1 in tuberculous effusion where there is marked inflammation and where examination of the pleural fluid may give information about the local inflammatory reaction. Adenosine deaminase activity (ADA, a marker of TB pleurisy) was also tested. Tumour necrosis factor, IL-1 and ADA levels were measured in the pleural fluid and serum of 97 patients; 33 with tuberculous effusion, 33 with malignant effusion, and 31 patients with benign non-tuberculous effusion. Pleural fluid TNF and ADA levels were higher in tuberculous (TB) patients than in patients with benign disorders or cancer (P<0·01). Serum TNF levels were also higher in TB patients than other benign (P<0·01) or malignant (P<0·05) effusions. There was a positive correlation between serum and pleural fluid values (r=0·998–0·999, P<0·001) although pleural fluid concentration was higher (P<0·001), possibly suggesting local production in the pleural cavity. Pleural fluid IL-1 levels were not raised in any patient group but there was a positive correlation between TNF and IL-1. In addition, a positive correlation was found between TNF and ADA levels, probably indicating some common production mechanism. Furthermore, ADA sensitivity in the diagnosis of tuberculous effusion was augmented by the combined use of TNF and ADA. The use of both these markers may prove useful in the differential diagnosis of TBC pleurisy

FUNCTIONAL ANALYSIS AND FUNCTIONAL MAPS OF QUALIFICATIONS IN ECVET CONTEXT

Introduction. Activation of the process of internationalisation and mobility in Russian Vocational Education and Training (VET) is quite possible by adapting principles and methodology of the European Credit Transfer System for Vocational Education and Training (ECVET). The need to achieve transparency of qualifications, recognition of learning outcomes in view of achieving qualifications, accumulation, comparison and transfer of learning outcomes becomes more apparent and urgent for integration processes of VET systems in Russia and European Union countries and is currently under consideration by the RUECVET project team. The aimis to adjust application of functional analysis to description of an occupation in terms of work functions with the following conversion of the defined functions into sets of learning outcomes necessary for characterizing a qualification. The ECVET principles and technical specifications form the context of the research in order to develop an adequate VET study programme for achieving the correspondent qualification of level 4 or 5 of the European Qualifications Framework (EQF) in the Russian education environment. Methodology and research methods. The methodology is based on the functional analysis of an occupational sector and the functions performed within it in such a manner that the following identification of the correspondent units of learning outcomes for the relevant qualification can be fulfilled. The research has been conducted by means of the content-analysis, modelling and expert estimation method.Results and scientific novelty. Comparative analysis of approaches to the design of occupations and qualifications in both national and European environments is presented in the article. The functional analysis is used for allocation of work functions and creation of units of learning outcomes related to a particular qualification. The procedure of applying functional analysis to an occupation as well as the technology of consequent construction of the functional map for the correspondent qualification taking into account the relevant educational and occupational standards and sectoral preferences have been elaborated. The result of the study is adaptation of methodology of functional analysis and verification of the developed procedure when constructing a functional map of the chosen qualification. The procedures are illustrated on the qualification of a lawyer achieved in the VET study programme “Legislation and Social Protection”, equivalent to level 5 of the European Qualifications Framework (EQF). Successful experiments with occupations of welders, electricians, web designers, hospitality managers and others related to the qualifications of level 4 and 5 of EQF have been also completed in RUECVET project, although are not described in the article due to the restricted volume.Practical significance. The derived procedures are useful for development of a set of detailed learning outcomes from functional mapping by allocating knowledge and skills and using the concept of unit of learning outcomes for compilation of a qualification in accordance with the relevant educational and occupational standards and employers’ understanding how the real work should be performed. The procedures are useful also for identifying units of learning outcomes to build an adequate VET study programme in ECVET context of Russian educational system. Введение. Активизации процессов мобильности и интернационализации в системе среднего специального и высшего российского образования способствует внедрение в нее методологии и инструментария European Credit System for Vocational Education and Training – ECVET (Европейской системы зачетных единиц для профессионального образования и обучения). Необходимость прозрачности приобретаемых студентами квалификаций, устанавливающихся посредством единых механизмов оценки, признания, накопления и сравнения результатов профессиональной подготовки, становится более очевидной и актуальной в связи с интеграцией образовательного пространства России и Европы. В настоящее время изыскания в этом направлении ведутся группой ученых, участвующих в пилотном международном проекте RUECVET1. Цель публикации – представить разработанную авторским коллективом исследователей методику описания квалификации – определения подразумевающихся под ней трудовых функций с последующим их преобразованием в показатели результатов обучения, характеризующих данную квалификацию, которая присваивается по завершении программы профессиональной подготовки. Методология и методы. В ходе работы в качестве методолого-методической базы использовались функциональный и сравнительный виды анализа, методы контент-анализа, моделирования и экспертной оценки. Результаты и научная новизна. Сопоставлены подходы к проектированию профессий и квалификаций, применяющиеся в странах Евросоюза и в Российской Федерации. Исходя из синтезированного опыта разных государств, адаптированного к российским экономическим и образовательным реалиям, выделены обобщенные трудовые функции ряда специальностей, соответствующих 4-му или 5-му уровням Европейской рамки квалификаций (EQF). На основе этих функций и с учетом содержания действующих образовательных и профессиональных стандартов, а также мнения работодателей сформированы блоки результатов обучения, требующихся для достижения определенного квалификационного уровня. Продемонстрирован процесс создания функциональной карты конкретной квалификации. Технология построения функциональной карты проиллюстрирована на примере специальности среднего профессионального образования «Право и организация социального обеспечения» (в EQF относится к 5-му уровню). Отмечается, что ряд подобных успешных экспериментов был проведен с профессиями сварщика, электрика, веб-дизайнера, специалиста по гостеприимству и др. Практическое значение. Предлагаемые процедуры детализации профессиональных знаний, умений, навыков и компетенций и комплектования из них блоков результатов обучения в виде функциональных карт для конструирования и оценки квалификации позволяют разрабатывать адекватные требованиям мирового рынка труда программы профессионального образования. Технология, основанная на функциональном анализе, отвечает принципам и техническим требованиям ECVET и дает возможность измерять и регистрировать результаты обучения согласно международной системе зачетных единиц (кредитов).Education, Audio-visual and Culture Executive Agency, Erasmus+, ref. № 574097-EPP-1–2016–1-CYEPPKA2-CBHE-JPИсполнительное агентство по образованию, аудиовизуальным средствам и культуре (проект № 574097-EPP-1–2016–1-CYEPPKA2-CBHE-J

Microscopic polyangiitis complicated by the development of prostate cancer and utamide-induced hepatitis

We report a case of a 65-year-old man with microscopic polyangiitis who developed prostate cancer and gastric adenocarcinoma after prolonged oral use of cyclophosphamide. Acute hepatitis with jaundice and marked increase in aminotranferases occurred after 6 months of flutamide treatment for metastatic prostate carcinoma. It is suggested that patients with vasculitis or other autoimmune disorders should avoid prolonged use of cyclophosphamide and other cytotoxic drugs in order to minimize long-term adverse effects, of which the risk of cancer is by far the most important. In patients on flutamide treatment, careful monitoring of flutamide administration with repeated liver function tests should be undertaken, and the drug must be immediately discontinued in patients with abnormal results to avoid progression of liver injury

Disseminated tuberculosis complicating anti-TNF-alpha treatment

An unusually large number of cases of tuberculosis, often of miliary or disseminated form, have been reported in patients receiving infliximab therapy for rheumatoid arthritis or Crohn’s disease. We describe a patient with rheumatoid arthritis who was treated with infliximab and became systemically ill with Mycobacterium tuberculosis-disseminated infection. Patients who are candidates for treatment with turnout necrosis factor-alfa inhibitors should be evaluated for the presence of latent or active M. tuberculosis infection

A Method for Assessing the Reliability of Heart Rates obtained from Ambulatory ECG

In this paper we present a method of assessing the reliability of heart rates (HRs) obtained from ambulatory ECGs. Our method assigns a Reliability Index (RI) to ECG segments based on a set of physiologically relevant rules prior to using a template matching approach. We validated the algorithm on 1500 manually annotated samples of ECG taken from two different studies and using three different sensors at different sampling rates. The sensitivity of our method was 98% and the specificity was 94%. Our method matched or was more conservative than the human annotations in 99.4% of the samples, making it a promising tool for inclusion in next-generation wearable sensors. © 2012 IEEE

Leukotriene B-4 in exhaled breath condensate and sputum supernatant in patients with COPD and asthma

Study objectives: Some patients with COPD present with significant reversibility of airflow limitation after receiving bronchodilation therapy. Leukotriene B-4 (LTB4) has been implicated in the pathophysiology of both COPD and asthma. We tested the hypothesis that COPD patients with airflow reversibility and asthmatic patients who smoke might have similar levels of LTB4 in exhaled breath condensate (EBC) and sputum supernatant. The repeatability and stability of LTB4 measurements were additionally studied. Design: Prospective, cross-sectional study. Patients or participants: We studied 30 patients with COPD (15 smokers [FEV1, 56% predicted; SD, 6% predicted]; 15 patients with significant reversibillity in airway obstruction after bronchodilation [FEV1, 14% predicted; SD, 2% predicted]). Fifteen asthmatic patients who smoked, with similar FEV1 and reversibility were also studied. Ten healthy smokers served as control subjects. Setting: A hospital research laboratory. Interventions: Spirometry and reversibility testing were performed on the first visit. On the following day, EBC was collected for the measurement of LTB4, and induced sputum was collected for differential cell counts and LTB4 measurement in the sputum supernatant. Measurements and results: LTB4 levels in EBC [mean (SD)] were increased in COPD patients (mean, 86.7 pg/mL; SD, 19 pg/mL) and asthmatic patients (mean, 97.5 pg/mL; SD, 15 pg/mL) compared to control subjects (mean, 32.3 pg/mL; SD, 10 pg/mL; p &lt; 0.0001 for both groups). COPD patients with airflow reversibility (mean, 99.8 pg/mL; SD, 12 pg/mL) had values similar to those of asthmatic patients (mean, 97.5 pg/mL; SD, 15 pg/mL; p = 0.2) and higher than those of COPD patients without airflow reversibility (mean, 73.7 pg/mL; SD, 17 pg/mL; p = 0.002). Similar results were observed in the sputum supernatant. Measurements of LTB4 in EBC and sputum were repeatable on two consecutive days, but measurements in the frozen samples of EBC and sputum were not stable after 3 weeks. Conclusions: Patients with asthma and reversible COPD presented with higher LTB4 values compared to patients with nonreversible COPD and healthy smokers. This difference may be mainly attributed to the presence of reversibility in airway obstruction, probably as part of a common underlying inflammatory process

Spontaneous physiological variability modulates dynamic functional connectivity in resting-state functional magnetic resonance imaging

It is well known that the blood oxygen level-dependent (BOLD) signal measured by functional magnetic resonance imaging (fMRI) is influenced—in addition to neuronal activity—by fluctuations in physiological signals, including arterial CO2, respiration and heart rate/heart rate variability (HR/HRV). Even spontaneous fluctuations of the aforementioned physiological signals have been shown to influence the BOLD fMRI signal in a regionally specific manner. Related to this, estimates of functional connectivity between different brain regions, performed when the subject is at rest, may be confounded by the effects of physiological signal fluctuations. Moreover, resting functional connectivity has been shown to vary with respect to time (dynamic functional connectivity), with the sources of this variation not fully elucidated. In this context, we examine the relation between dynamic functional connectivity patterns and the time-varying properties of simultaneously recorded physiological signals (end-tidal CO2 and HR/HRV) using resting-state fMRI measurements from 12 healthy subjects. The results reveal a modulatory effect of the aforementioned physiological signals on the dynamic resting functional connectivity patterns for a number of resting-state networks (default mode network, somatosensory, visual). By using discrete wavelet decomposition, we also show that these modulation effects are more pronounced in specific frequency bands