The Need for Regional Labor Markets for Mid-Level Specialists and the Priorities of Graduates of Secondary Vocational Education in Employment Issues

The article considers the problems of imbalance of supply and demand in regional labor markets, as well as the role of career guidance in choosing a profession. The article discloses the main management decisions for regulating reception targets, taking into account labor market requirements. The authors give examples of calculating the imbalance of supply and demand in personnel in regional labor markets using the example of the region’s need for mid-level medical workers. The article considers the aspects of employment of graduates of professional educational organizations, including labor migration and international experience. As a result of the study, the authors identified and formulated the general laws of labor migration of graduates of professional educational organizations and solutions to reduce the outflow of labor resources from the region. Separately, the authors examined the employment of graduates of the SVE (secondary vocational education) system in Moscow and St. Petersburg. The article was completed within the framework of the topic of the State Task of the RANEPA N 11.5 “Study of models for the transformation of regional systems of secondary vocational education and their need for resource support” for 2021

Violation of the Hormonal Spectrum in Polycystic Ovaries in Combination with Insulin Resistance. What is the Trigger: Insulin Resistance or Polycystic Ovary Disease?

متلازمة المبيض متعدد التكيسات هي السبب الرئيس للعقم لدى النساء. حيث يناقش البحث دور مقاومة الأنسولين في تطور تكيس المبايض. تم تحليل الطيف الهرموني للمرضى الذين يعانون من متلازمة تكيس المبايض و / أو مقاومة الأنسولين. اشتملت الدراسة على مرضى يعانون من متلازمة تكيس المبايض دون مقاومة الأنسولين (عددهم = 48) ومقاومة الأنسولين (عددهم = 39). كانت مجموعات المقارنة من المرضى الذين ليس لديهم تاريخ من متلازمة تكيس المبايض: مجموعة تحكم بدون مقاومة الأنسولين (عددهم = 46) ومجموعة من المرضى الذين يعانون من مقاومة الأنسولين (عددهم = 45). تم تحديد المعلمات التالية في المرضى: FSH ، LH ، TSH ، T3f ، T4f، PRL ، E2 ، 17-OHd ، Pr ، AMH ، مجموع الاختبار ، Testf ، DHEAS ، DHEAS ، SHBG ، ACTH ، الكورتيزول ، IRI ، IGF-1 ، C- الببتيد ، ومستوى الجلوكوز. تم حساب مؤشر HOMA-IR ونسبة LH / FSH واختبار إجمالي / SHBG. تم إجراء تحليل الارتباط أيضًا بين HOMA IR ومؤشرات المظهر الهرموني و IGF-1 و C-peptide. تم العثور على تغيرات أحادية الاتجاه في مستويات الهرمونات التالية في مقاومة الأنسولين و / أو متلازمة تكيس المبايض و / أو مقاومة الأنسولين بالنسبة لقيم التحكم: استراديول ، هرمون التستوستيرون الكلي ، الكورتيزول ، البرولاكتين ، AMG ، و SHBG. نتيجة لتحليل الارتباط ، تم إنشاء علاقات سلبية بين مؤشر HOMA .IR ومستويات E2 والكورتيزول و AMH في المرضى (باستثناء المجموعة الضابطة) تفترض الدراسة أن تكوين النمط الظاهري للمبيض المتعدد الكيسات مع مزيج من مقاومة الأنسولين يمكن أن يتشكل في المرضى الذين يعانون من مقاومة الأنسولين نتيجة لانخفاض مستوى الاستراديول ، SHBG وزيادة محتوى التستوستيرون الكلي و AMH.Polycystic ovary syndrome (PCOS) is the main cause of female infertility. The role of insulin resistance in the development of polycystic ovary is actively discussed here. The study included patients with PCOS without insulin resistance (n = 48) and with insulin resistance (n = 39). The comparison groups were patients with no history of PCOS: a control group without insulin resistance (n = 46) and a group of patients with insulin resistance (n = 45). The following parameters were determined in patients: FSH, LH, TSH, T3f, T4f, PRL, E2, 17-OHd, Pr, AMH, Test total, Testf, DHEAS, DHEASs, SHBG, ACTH, cortisol, IRI, IGF-1, C-peptide, and glucose level. The HOMA-IR index and the LH / FSH ratio and the total / SHBG test were calculated. Correlation analysis was also performed between HOMA IR and indicators of the hormonal profile, IGF-1, and C-peptide.Unidirectional changes in the levels of the following hormones were found in insulin resistance, PCOS and / or insulin resistance relative to control values: estradiol, total testosterone, cortisol, prolactin, AMG, and SHBG. As a result of the correlation analysis, negative relationships were established between the HOMA IR Index and the levels of E2, cortisol and AMH in patients (except for the control group).We assume that the formation of the phenotype of polycystic ovary with a combination of insulin resistance can be formed in patients with insulin resistance as a result of a decrease in the level of estradiol, SHBG and an increase in the content of total testosterone and AMH

СИНДРОМ «ЗАПЕРТОГО ЧЕЛОВЕКА» ВСЛЕДСТВИЕ МНОЖЕСТВЕННЫХ ИНФАРКТОВ СТВОЛА ГОЛОВНОГО МОЗГА И ОЧАГОВ ДЕМИЕЛИНИЗАЦИИ ПОСЛЕ ЛУЧЕВОЙ ТЕРАПИИ АДЕНОМЫ ГИПОФИЗА С АКРОМЕГАЛИЕЙ

Locked-in syndrome (LIS) is a rare neurological disorder, usually appears as a result of the pons cerebellar damage, mostly after the brain stroke. Locked-in syndrome is characterized by the paralysis of skeletal muscles (respiratory, facial, pharyngeal, lingual and muscles of the extremities). Patient is unable to speak and breath, facial expressions and voluntary movements are also impossible. Acromegaly is a disease that can be described by the increase of the growth hormone (GH) and Insulin-like growth factor (IGF-1) and develops in most cases due to the pituitary adenomas. Pituitary adenoma (PA) can be treated by neurosurgical techniques, pharmaceutical and radiation therapy (RT). We present a clinical case of 33-year-old woman with PA-caused acromegaly, that developed muscle weakness, nausea, vomit and respiratory disturbance in a 2 months after the radiation therapy. Subacute comatose state was developed in the patient. MRI of the brain revealed a multi-focal lesion of the media-basal regions on both sides, frontal corpus callosum and brain stem. Differential diagnosis included an acute demyelination (SD, PML), viral encephalitis and vasculitis. Treatment included methylprednisolone pulse therapy and plasmapheresis. The consciousness cleared up, but there was no spontaneous breathing, tetraplegia persisted. Autoimmune and infectious diseases was excluded. The homozygous mutation PAI-1-675 4G/4G was found. In this case, acromegaly induced endothelial dysfunction was the pathogenesis factor of multiple cerebral infarctions and demyelinating lesions, as well as RT and its proven pathological influence on the vascular wall and the fibrinolytic system. The revealed thrombophilia was also a factor of multiple cerebral infarctions. A Potential combination of pathogenic factors in the development of cerebral should be taken into account in predicting complications of RT. Cиндром «запертого человека» (СЗЧ) является редким неврологическим расстройством, обычно возникающим в результате поражения моста мозга, чаще всего вследствие инсульта. При СЗЧ возникает паралич скелетных мышц (дыхательные, лицевые, глотки, языка, а также конечностей), т. е. утрачивается способность к речи, мимике, произвольным движениям, дыханию. Акромегалия – заболевание, при котором наблюдается повышение уровня гормона роста (GH), инсулиноподобного фактора роста 1 (IGF-1), и развивается в большинстве случаев при аденомах гипофиза. При лечении аденомы гипофиза применяют нейрохирургические методики, медикаментозную и лучевую терапию (ЛТ). В представленном клиническом наблюдении у 33-летней женщины через 2 месяца после дистанционной ЛТ опухоли гипофиза, проявлявшейся акромегалией, появилась мышечная слабость, тошнота, рвота, нарушения дыхания. Развилось подостро коматозное состояние. При магнитно-резонансной томографии головного мозга выявлено многоочаговое поражение медиобазальных отделов обоих полушарий, передних отделов мозолистого тела и ствола. Дифференциальный диагноз включал острую демиелинизацию (SD, PML), вирусный энцефалит и васкулит. Пациентка получила пульс-терапию Метилпреднизолоном, плазиообмен. Сознание прояснилось, но самостоятельное дыхание не восстановилось, оставалась тетраплегия. Аутоиммунные заболевания и инфекционные болезни были исключены. Обнаружена мутантная гомозигота PAI-1-675 4G\4G. В данном случае, вероятно, патогенетическими факторами развития множественных инфарктов и очагов демиелинизации выступили как сама акромегалия, приводящая к эндотелиальной дисфункции, так и ЛТ с ее доказанным патологическим воздействием на сосудистую стенку и фибринолитическую систему. Множественным инфарктам способствовала и выявленная тромбофилия. Возможное сочетание патогенетических факторов развития инфарктов головного мозга следует учитывать при прогнозировании осложнений ЛТ

LOCKED-IN SYNDROME DUE TO MULTIPLE BRAIN STEM INFARCTIONS AND FOCI OF DEMYELINATION AFTER RADIATION THERAPY OF PITUITARY ADENOMA WITH ACROMEGALY

Locked-in syndrome (LIS) is a rare neurological disorder, usually appears as a result of the pons cerebellar damage, mostly after the brain stroke. Locked-in syndrome is characterized by the paralysis of skeletal muscles (respiratory, facial, pharyngeal, lingual and muscles of the extremities). Patient is unable to speak and breath, facial expressions and voluntary movements are also impossible. Acromegaly is a disease that can be described by the increase of the growth hormone (GH) and Insulin-like growth factor (IGF-1) and develops in most cases due to the pituitary adenomas. Pituitary adenoma (PA) can be treated by neurosurgical techniques, pharmaceutical and radiation therapy (RT). We present a clinical case of 33-year-old woman with PA-caused acromegaly, that developed muscle weakness, nausea, vomit and respiratory disturbance in a 2 months after the radiation therapy. Subacute comatose state was developed in the patient. MRI of the brain revealed a multi-focal lesion of the media-basal regions on both sides, frontal corpus callosum and brain stem. Differential diagnosis included an acute demyelination (SD, PML), viral encephalitis and vasculitis. Treatment included methylprednisolone pulse therapy and plasmapheresis. The consciousness cleared up, but there was no spontaneous breathing, tetraplegia persisted. Autoimmune and infectious diseases was excluded. The homozygous mutation PAI-1-675 4G/4G was found. In this case, acromegaly induced endothelial dysfunction was the pathogenesis factor of multiple cerebral infarctions and demyelinating lesions, as well as RT and its proven pathological influence on the vascular wall and the fibrinolytic system. The revealed thrombophilia was also a factor of multiple cerebral infarctions. A Potential combination of pathogenic factors in the development of cerebral should be taken into account in predicting complications of RT

The Intensity of Free Radical Processes and the Testosterone and Estradiol Levels in Seminal Fluid of Men with Different Types of Pathospermia - Personalized Approach

Background: We studied the intensity of free-radical processes and the testosterone and estradiol levels in seminal fluid of men with normospermia, asthenozoospermia, oligozoospermia, oligoasthenozoospermia, teratozoospermia. Results: An increased ability to generate reactive oxygen species in seminal fluid in patients with oligozoospermia was determined. Increased levels of testosterone and estradiol in semen were noted in pathospermia associated with reduced sperm motility. A positive correlation was found between the free-radical processes intensity and testosterone levels increase, and high correlation (r = 0.8) between the testosterone and estradiol levels in seminal fluid in patients with oligozoospermia was marked. Conclusion: The prooxidant and antioxidant processes conjugacy violation occurs in one of the pathospermia types - asthenozoospermia, which is reflected in the absence of all studied parameters correlation in the seminal fluid

Cohort profile. the ESC-EORP chronic ischemic cardiovascular disease long-term (CICD LT) registry

The European Society of cardiology (ESC) EURObservational Research Programme (EORP) Chronic Ischemic Cardiovascular Disease registry Long Term (CICD) aims to study the clinical profile, treatment modalities and outcomes of patients diagnosed with CICD in a contemporary environment in order to assess whether these patients at high cardiovascular risk are treated according to ESC guidelines on prevention or on stable coronary disease and to determine mid and long term outcomes and their determinants in this population

Rivaroxaban with or without aspirin in stable cardiovascular disease

BACKGROUND: We evaluated whether rivaroxaban alone or in combination with aspirin would be more effective than aspirin alone for secondary cardiovascular prevention. METHODS: In this double-blind trial, we randomly assigned 27,395 participants with stable atherosclerotic vascular disease to receive rivaroxaban (2.5 mg twice daily) plus aspirin (100 mg once daily), rivaroxaban (5 mg twice daily), or aspirin (100 mg once daily). The primary outcome was a composite of cardiovascular death, stroke, or myocardial infarction. The study was stopped for superiority of the rivaroxaban-plus-aspirin group after a mean follow-up of 23 months. RESULTS: The primary outcome occurred in fewer patients in the rivaroxaban-plus-aspirin group than in the aspirin-alone group (379 patients [4.1%] vs. 496 patients [5.4%]; hazard ratio, 0.76; 95% confidence interval [CI], 0.66 to 0.86; P<0.001; z=−4.126), but major bleeding events occurred in more patients in the rivaroxaban-plus-aspirin group (288 patients [3.1%] vs. 170 patients [1.9%]; hazard ratio, 1.70; 95% CI, 1.40 to 2.05; P<0.001). There was no significant difference in intracranial or fatal bleeding between these two groups. There were 313 deaths (3.4%) in the rivaroxaban-plus-aspirin group as compared with 378 (4.1%) in the aspirin-alone group (hazard ratio, 0.82; 95% CI, 0.71 to 0.96; P=0.01; threshold P value for significance, 0.0025). The primary outcome did not occur in significantly fewer patients in the rivaroxaban-alone group than in the aspirin-alone group, but major bleeding events occurred in more patients in the rivaroxaban-alone group. CONCLUSIONS: Among patients with stable atherosclerotic vascular disease, those assigned to rivaroxaban (2.5 mg twice daily) plus aspirin had better cardiovascular outcomes and more major bleeding events than those assigned to aspirin alone. Rivaroxaban (5 mg twice daily) alone did not result in better cardiovascular outcomes than aspirin alone and resulted in more major bleeding events