Risk profiles and one-year outcomes of patients with newly diagnosed atrial fibrillation in India: Insights from the GARFIELD-AF Registry.

BACKGROUND: The Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) is an ongoing prospective noninterventional registry, which is providing important information on the baseline characteristics, treatment patterns, and 1-year outcomes in patients with newly diagnosed non-valvular atrial fibrillation (NVAF). This report describes data from Indian patients recruited in this registry. METHODS AND RESULTS: A total of 52,014 patients with newly diagnosed AF were enrolled globally; of these, 1388 patients were recruited from 26 sites within India (2012-2016). In India, the mean age was 65.8 years at diagnosis of NVAF. Hypertension was the most prevalent risk factor for AF, present in 68.5% of patients from India and in 76.3% of patients globally (P < 0.001). Diabetes and coronary artery disease (CAD) were prevalent in 36.2% and 28.1% of patients as compared with global prevalence of 22.2% and 21.6%, respectively (P < 0.001 for both). Antiplatelet therapy was the most common antithrombotic treatment in India. With increasing stroke risk, however, patients were more likely to receive oral anticoagulant therapy [mainly vitamin K antagonist (VKA)], but average international normalized ratio (INR) was lower among Indian patients [median INR value 1.6 (interquartile range {IQR}: 1.3-2.3) versus 2.3 (IQR 1.8-2.8) (P < 0.001)]. Compared with other countries, patients from India had markedly higher rates of all-cause mortality [7.68 per 100 person-years (95% confidence interval 6.32-9.35) vs 4.34 (4.16-4.53), P < 0.0001], while rates of stroke/systemic embolism and major bleeding were lower after 1 year of follow-up. CONCLUSION: Compared to previously published registries from India, the GARFIELD-AF registry describes clinical profiles and outcomes in Indian patients with AF of a different etiology. The registry data show that compared to the rest of the world, Indian AF patients are younger in age and have more diabetes and CAD. Patients with a higher stroke risk are more likely to receive anticoagulation therapy with VKA but are underdosed compared with the global average in the GARFIELD-AF. CLINICAL TRIAL REGISTRATION-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01090362

Subcortical volumes across the lifespan: data from 18,605 healthy individuals aged 3-90 years

Age has a major effect on brain volume. However, the normative studies available are constrained by small sample sizes, restricted age coverage and significant methodological variability. These limitations introduce inconsistencies and may obscure or distort the lifespan trajectories of brain morphometry. In response, we capitalized on the resources of the Enhancing Neuroimaging Genetics through Meta-Analysis (ENIGMA) Consortium to examine age-related trajectories inferred from cross-sectional measures of the ventricles, the basal ganglia (caudate, putamen, pallidum, and nucleus accumbens), the thalamus, hippocampus and amygdala using magnetic resonance imaging data obtained from 18,605 individuals aged 3-90 years. All subcortical structure volumes were at their maximum value early in life. The volume of the basal ganglia showed a monotonic negative association with age thereafter; there was no significant association between age and the volumes of the thalamus, amygdala and the hippocampus (with some degree of decline in thalamus) until the sixth decade of life after which they also showed a steep negative association with age. The lateral ventricles showed continuous enlargement throughout the lifespan. Age was positively associated with inter-individual variability in the hippocampus and amygdala and the lateral ventricles. These results were robust to potential confounders and could be used to examine the functional significance of deviations from typical age-related morphometric patterns.Education and Child Studie

Metacognitive Reading Strategies: Analysis of Self-report Data and Oculomotor Behaviour of Russian Schoolchildren

The paper presents the results of a study aimed to investigate the correlations between oculomotor reading behavior and self-report data of Russian high school students on their practice of using metacognitive strategies. It was found that high school students tended to use problem-solving reading strategies, while seldom using supportive reading strategies. Differences in the use of metacognitive strategies were found between schools that emphasized differently the development of reading competence in middle school. The findings suggested that there were differences in oculomotor measures across groups with varying levels of metacognitive strategy use. The paper outlines possible directions for further research on this topic.</p

The Diversification As The Trends Of Reforming Additional Professional Education Of Social Workers

The authors substantiate in the article the urgency of modernizing the system of additional vocational education for social workers. Diversification of education is one of the ways to solve this problem; diversification of education provides a new vector of the development of the system: its flexibility, accessibility, the ability to respond promptly to any changes in the social sphere. Diversification is the principle of innovative structuring of the system of additional vocational education, providing the possibility of variability in educational services and programs, forms, types, technologies of instruction. The authors demonstrate the mechanisms for implementing diversification processes in the context of additional professional education for social workers. The globalization of information technology, the socio-economic transformation of Russian society, the problems of its development require a rethinking of the quality of education that meets national interests, goals and strategies for progress. The problem of improving the quality of education has received a special sound today in connection with the actualization of the task of innovative education, which could provide training for specialists capable of carrying out innovative activities in all spheres of society. The introduction of professional standards of specialists in the social sphere, independent evaluation of qualifications against the backdrop of socioeconomic changes in modern Russia make new demands on the professional level of social workers and the availability of professional competences. The social worker of the new formation must possess a whole range of professional knowledge, skills and skills in the field of social work, innovative technologies of social services for the population, be financially and legally competent, and be sociable, tactful, diplomatic, empathetic, etc. [Lomakina 2001]. The current state of Russian education confirms the dependence of the structure and functioning of this social institution on the conditions of the socio-cultural and political environment. State policy and the management process in the field of education are closely related to modern Russian modernization processes that have revealed crisis phenomena in Russian society, affected virtually all spheres of public life, and have and continue to have a serious impact on the functioning of the main sociopolitical institutions

Combination therapeutic options in the treatment of the luteal phase deficiency

Luteal phase deficiency (LPD) is described as a condition of insufficient progesterone exposure to maintain a regular secretory endometrium and allow for normal embryo implantation and growth. There is evidence that both follicular and luteal phase abnormalities can result in LPD cycles. The aim of this randomized prospective noncomparative study is to evaluate the effectiveness of combination therapy in patients with LPD. This prospective study included 35 women of the reproductive age. They were diagnosed with the LPD with sonographically and laboratory-verified methods. The age of patients was 36 ± 0.46 years. The results of the study sonographically demonstrated an increase in the diameter of the corpus luteum from 1.36 ± 0.32 (initially) to 2.16 ± 0.21 mm after combination therapy. In addition, there was a statistically significant increase in the level of estrogens and progesterone in the corresponding phases of the menstrual cycle. Thus, the combination therapy for patients with LPD contributes to the recovery of cyclic events in the hypothalamic-pituitary-gonadal system, which determines the restoration of the endocrine function of the ovaries and promotes adequate secretory rearrangement of the endometrium in women of reproductive age. © 2017 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group on behalf of the UR MED GRUPP (LLC)

Combination therapeutic options in the treatment of the luteal phase deficiency

Luteal phase deficiency (LPD) is described as a condition of insufficient progesterone exposure to maintain a regular secretory endometrium and allow for normal embryo implantation and growth. There is evidence that both follicular and luteal phase abnormalities can result in LPD cycles. The aim of this randomized prospective noncomparative study is to evaluate the effectiveness of combination therapy in patients with LPD. This prospective study included 35 women of the reproductive age. They were diagnosed with the LPD with sonographically and laboratory-verified methods. The age of patients was 36 ± 0.46 years. The results of the study sonographically demonstrated an increase in the diameter of the corpus luteum from 1.36 ± 0.32 (initially) to 2.16 ± 0.21 mm after combination therapy. In addition, there was a statistically significant increase in the level of estrogens and progesterone in the corresponding phases of the menstrual cycle. Thus, the combination therapy for patients with LPD contributes to the recovery of cyclic events in the hypothalamic-pituitary-gonadal system, which determines the restoration of the endocrine function of the ovaries and promotes adequate secretory rearrangement of the endometrium in women of reproductive age. © 2017 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group on behalf of the UR MED GRUPP (LLC)

Роль рецепторов к окситоцину и вазопрессину в патогенезе тазовой боли, обусловленной аденомиозом

Pathogenetic mechanisms underlying the development of adenomyosis-associated pelvic pain are currently not fully understood and require a comprehensive approach in their analysis to determine the most effective diagnosis and individualized therapy. Objective. To expand the understanding of the pathogenesis of pelvic pain associated with adenomyosis. Methods. The study evaluated 30 (n = 30) biopsy samples obtained after hysterectomy from women with grade II-III diffuse adenomyosis accompanied by severe painful syndrome who received no hormonal therapy. The morphological comparison group consisted of 30 (n = 30) biopsy samples obtained from women with painless adenomyosis operated for abnormal uterine bleeding who did not receive any hormone therapy either. After hysterectomy, fragments of the uterine wall including the endometrium and myometrium were subjected to standard histological procedures with preparation of 5-μm paraffin sections. For general morphological assessment the sections were stained with hematoxylin and eosin. Nerve fibers were visualized using immunohistochemical (IHC) staining with monoclonal antibodies (Abcam, UK) to oxytocin receptors (OTR) (Anti-Oxytocin Receptor antibody, Clone ab217212, 1: 300) and polyclonal antibodies to vasopressin receptors (V1aR) (Anti-AVPR1A / V1aR antibody, Clone ab140492, 1: 200). Statistical analysis was performed using the SPSS 7.5 for Windows statistical software package (IBM Analytics, USA). In the absence of normal distribution, the non-parametric Wilcoxon test (Statistical Methods for Research Workers) was used with a significance level at p 0.05). The total density of OTR immunological labeling in foci of the adenomyotic lesion was 73.7 ± 1.8% vs. 35.2 ± 1.4% in the morphological control group (p <0.05), which indicated a significant effect of oxytocin as a ureterotonic (uterotonic?) peptide enhancing nonperistaltic contractions of the myometrium and local vasoconstriction in adenomyosis. In the cytoplasm of smooth muscle cells (SMC) of all myometrium layers and blood vessels, a moderate (score 2), sometimes pronounced (score 3) IHC response to V1aR (88.4 ± 2.3%) was found. In contrast, in the morphological control group, a moderate (score 2) IHC response to V1aR (43.2 ± 1.8%, p <0.05) was observed in SMC cytoplasm in all layers of the myometrium and blood vessels. Conclusions: As distinct from painless diffuse adenomyosis, the pathogenesis of adenomyosis-associated pelvic pain is based on increased activities of the ureterotonic (uterotonic?) factors, oxytocin (OTR, 2.5 times - 92.2 ± 2.1% vs. 36.3 ± 2.4%, p <0.05) and vasopressin (V1aR, 2.05 times - 88.4 ± 2.3% vs. 43.2 ± 1.8%, p <0.05) in the myometrium, which induces spontaneous, nonperistaltic contractions of spastic myometrium associated with increased expression of their receptors in the pattern under study.Механизмы, лежащие в основе развития аденомиоз-ассоциированной тазовой боли, на сегодняшний день до конца не раскрыты. Необходим комплексный подход к решению этой проблемы для разработки наиболее эффективных методов диагностики и персонифицированной терапии. Цель исследования - изучить роль рецепторов к окситоцину и вазопрессину в патогенезе тазовой боли при аденомиозе. Методика. Изучено 30 образцов ткани после после гистерэктомий у женщин с диффузным аденомиозом ІІ-ІІІ степени, сопровождающимся болевым синдромом выраженной степени тяжести, и не получавших ранее гормональную терапию. Группа морфологического контроля - 30 биоптатов женщин с аденомиозом, без болевого синдрома, прооперированных по поводу аномальных маточных кровотечений. Эти пациентки также не получали гормональную терапию. Образцы, включавшие эндометрий и миометрий, подвергали стандартным гистологическим процедурам, готовили парафиновые срезы (5 мкм). Общую морфологическую оценку проводили при окраске срезов гематоксилином и эозином. Визуализацию клеток осуществляли после иммуногистохимического окрашивания с использованием моноклональных антител к рецепторам окситоцина и поликлональные антитела к рецепторам вазопрессина. Результаты. По данным морфометрического анализа эпителиальной выстилки эндометриоидных гетеротопий статистически значимых различий в высоте клеток железистого эпителия, диаметре желез и их плотности на единицу площади между исследуемыми группами не установлено. Суммарная плотность иммунологически маркированных рецепторов к окситоцину в очагах аденомиотического поражения составила 73.7±1.8%, в группе морфологического контроля - 35.2±1.4%. В цитоплазме гладкомышечных клеток всех слоев миометрия и сосудов обнаруживали умеренную (2 балла), местами выраженную (3 балла) иммуногистохимическую реакцию к рецепторам вазопрессина - 88,4±2.3%. В группе морфологического контроля в цитоплазме гладкомышечных клеток всех слоев миометрия и сосудов также отмечалась умеренная иммуногистохимическая реакция к рецепторам вазопрессина - 43,2±1.8%. Изменение плотности рецепторов к окситоцину и вазопресину статистически значимы (p <0.05). Зключение. Патогенетически обоснованным механизмом тазовой боли у женщин с диффузным аденомиозом является изменение рецепторной чувствительности тканей миометрия к действию окситоцина и вазопрессина, что может проявляться спонтанными дисперистальтическими сокращениями миометрия спазматического характера