Возможности радикального лечения варикотромбофлебита на фоне варикозной болезни и трофических язв

КОНЕЧНОСТИ НИЖНЕЙ ЯЗВАТРОМБОФЛЕБИТ /ХИРВАРИКОЗНАЯ ЯЗВАВАРИКОЗНОЕ РАСШИРЕНИЕ ВЕН /ОС

Middle Ordovician carbonate facies development, conodont biostratigraphy and faunal diversity patterns at the Lynna River, northwestern Russia

The Ordovician Period has emerged as a highly dynamic time in Earth history. Comprehensive work on chrono, chemo-and biostratigraphy has resulted in an overall wellconstrained systemic framework, but several local successions around the globe still await detailed analysis in many respects. Herein we perform a highresolution analysis of abiotic and biotic signals in the Lynna River section, a key locality in northwestern Russia. As this section has been pivotal in documenting the temporal evolution of the Great Ordovician Biodiversification Event on Baltica, the macroscopic and microscopic characteristics of the local succession reveal important paleoenvironmental information that ties into the global development during the Middle Ordovician. The results add particularly to the understanding of the characteristics and largescale sedimentary ‘behavior’ of the Baltoscandian paleobasin. Microfacies vary consistently with the macroscopic appearance of the rocks, with intervals characterized by competent limestone being associated with coarser carbonate textures and intervals dominated by marly beds associated with finer textures. Along with carbonate textures, fossil grain assemblages vary in a rhythmic (~cyclic) manner. The local rocks are commonly partly dolomitized, with the proportion of dolomitization increasing upsection. Regional comparisons suggest that the changes in overall macro and microfacies were strongly related to variations in sea level. New highresolution conodont biostratigraphic data largely confirm previous regional correlations based on lithostratigraphy and trilobite faunas, and enable more robust correlations worldwide

The role of public actors in construction logistics: effects on and of relational interfaces

Public actors are increasingly enforcing the use of specifically designed construction logistics setups (CLS) to cope with logistical challenges and minimising disturbances on third parties in large construction projects. The organising of these CLS is contingent on the interaction among several types of actors. The purpose of the paper is to advance the understanding of the design and use of CLS and the distribution of various outcomes of such arrangements on the actors involved. The paper analyses the role of public actors in the initiating of CLS and how this affects the relational interfaces in the CLS triad of developers, contractors and logistics service providers, and the outcomes of their interactions. First, the main reason for a public actor to initiate a CLS is not cost, productivity or innovativity gains, but to decrease disturbances on third parties. Second, developers and contractors are forced to use the CLS initiated by the public actor. This makes them take on a forced customer role, explaining why these actors are often resistant to adopt to a certain CLS. Third, ripple effects, such as unintended costs and productivity impacts, occur in the construction supply chain because of the use of CLS

Acute central nervous system toxicity during treatment of pediatric acute lymphoblastic leukemia : phenotypes, risk factors and genotypes

Publisher Copyright: © 2022 Ferrata Storti Foundation Published under a CC BY-NC license.Central nervous system (CNS) toxicity is common at diagnosis and during treatment of pediatric acute lymphoblastic leukemia (ALL). We studied CNS toxicity in 1, 464 children aged 1.0-17.9 years, diagnosed with ALL and treated according to the Nordic Society of Pediatric Hematology and Oncology ALL2008 protocol. Genome-wide association studies, and a candidate single-nucleotide polymorphism (SNP; n=19) study were performed in 1, 166 patients. Findings were validated in an independent Australian cohort of children with ALL (n=797) in whom two phenotypes were evaluated: diverse CNS toxicities (n=103) and methotrexate-related CNS toxicity (n=48). In total, 135/1, 464 (9.2%) patients experienced CNS toxicity for a cumulative incidence of 8.7% (95% confidence interval: 7.31-10.20) at 12 months from diagnosis. Patients aged ≥10 years had a higher risk of CNS toxicity than had younger patients (16.3% vs. 7.4%; P<0.001). The most common CNS toxicities were posterior reversible encephalopathy syndrome (n=52, 43 with seizures), sinus venous thrombosis (n=28, 9 with seizures), and isolated seizures (n=16). The most significant SNP identified by the genome-wide association studies did not reach genomic significance (lowest P-value: 1.11x10-6), but several were annotated in genes regulating neuronal functions. In candidate SNP analysis, ATXN1 rs68082256, related to epilepsy, was associated with seizures in patients <10 years (P=0.01). ATXN1 rs68082256 was validated in the Australian cohort with diverse CNS toxicities (P=0.04). The role of ATXN1 as well as the novel SNP in neurotoxicity in pediatric ALL should be further explored.Peer reviewe

What is the definition of acute episodic and chronic pain in critically ill neonates and infants? : a global, four-stage consensus and validation study

Objectives To define and validate types of pain in critically ill neonates and infants by researchers and clinicians working in the neonatal intensive care unit (NICU) and high dependency unit (HDU). Design A qualitative descriptive mixed-methods design. Procedure/s Each stage of the study was built on and confirmed the previous stages. Stage 1 was an expert panel to develop definitions; stage 2 was a different expert panel made up of neonatal clinicians to propose clinical characteristics associated with the definitions from stage 1; stage 3 was a focus group of neonatal clinicians to provide clinical case scenarios associated with each definition and clinical characteristics; and stage 4 was a survey administered to neonatal clinicians internationally to test the validity of the definitions using the clinical case scenarios. Results In stage 1, the panel (n=10) developed consensus definitions for acute episodic pain and chronic pain in neonates and infants. In stage 2, a panel (n=8) established clinical characteristics that may be associated with each definition. In stage 3, a focus group (n=11) created clinical case scenarios of neonates and infants with acute episodic pain, chronic pain and no pain using the definitions and clinical characteristics. In stage 4, the survey (n=182) revealed that the definitions allowed an excellent level of discrimination between case scenarios that described neonates and infants with acute episodic pain and chronic pain (area under the receiver operating characteristic=0.87 and 0.89, respectively). Conclusions This four-stage study enabled the development of consensus-based and clinically valid definitions of acute episodic pain and chronic pain. There is a need to define and validate other pain types to inform a taxonomy of pain experienced by neonates and infants in the NICU and HDU

Secular trend, seasonality and effects of a community-based intervention on neonatal mortality: follow-up of a cluster-randomised trial in Quang Ninh province, Vietnam.

BACKGROUND: Little is know about whether the effects of community engagement interventions for child survival in low-income and middle-income settings are sustained. Seasonal variation and secular trend may blur the data. Neonatal mortality was reduced in a cluster-randomised trial in Vietnam where laywomen facilitated groups composed of local stakeholders employing a problem-solving approach for 3 years. In this analysis, we aim at disentangling the secular trend, the seasonal variation and the effect of the intervention on neonatal mortality during and after the trial. METHODS: In Quang Ninh province, 44 communes were allocated to intervention and 46 to control. Births and neonatal deaths were assessed in a baseline survey in 2005, monitored during the trial in 2008-2011 and followed up by a survey in 2014. Time series analyses were performed on monthly neonatal mortality data. RESULTS: There were 30 187 live births and 480 neonatal deaths. The intervention reduced the neonatal mortality from 19.1 to 11.6 per 1000 live births. The reduction was sustained 3 years after the trial. The control areas reached a similar level at the time of follow-up. Time series decomposition analysis revealed a downward trend in the intervention areas during the trial that was not found in the control areas. Neonatal mortality peaked in the hot and wet summers. CONCLUSIONS: A community engagement intervention resulted in a lower neonatal mortality rate that was sustained but not further reduced after the end of the trial. When decomposing time series of neonatal mortality, a clear downward trend was demonstrated in intervention but not in control areas. TRIAL REGISTRATION NUMBER: ISRCTN44599712, Post-results

Evaluation of contemporary treatment of high- and very high-risk patients for the prevention of cardiovascular events in Europe – Methodology and rationale for the multinational observational SANTORINI study

Publisher Copyright: © 2021 The AuthorsBackground and aims: Clinical practice before 2019 suggests a substantial proportion of high and very high CV risk patients taking lipid-lowering therapy (LLT) would not achieve the new LDL-C goals recommended in the 2019 ESC/EAS guidelines (<70 and < 55 mg/dL, respectively). To what extent practice has changed since the last ESC/EAS guideline update is uncertain, and quantification of remaining implementation gaps may inform health policy. Methods: The SANTORINI study is a multinational, multicentre, prospective, observational, non-interventional study documenting patient data at baseline (enrolment) and at 12-month follow-up. The study recruited 9606 patients ≥18 years of age with high and very high CV risk (as assigned by the investigators) requiring LLT, with no formal patient or comparator groups. The primary objective is to document, in the real-world setting, the effectiveness of current treatment modalities in managing plasma levels of LDL-C in high- and very high-risk patients requiring LLT. Key secondary effectiveness objectives include documenting the relationship between LLT and levels of other plasma lipids, high-sensitivity C-reactive protein (hsCRP) and overall predicted CV risk over one year. Health economics and patient-relevant parameters will also be assessed. Conclusions: The SANTORINI study, which commenced after the 2019 ESC/EAS guidelines were published, is ideally placed to provide important contemporary insights into the evolving management of LLT in Europe and highlight factors contributing to the low levels of LDL-C goal achievement among high and very high CV risk patients. It is hoped the findings will help enhance patient management and reduce the burden of ASCVD in Europe.Peer reviewe