Toward a descriptive model of solar particles in the heliosphere

During a workshop on the interplanetary charged particle environment held in 1987, a descriptive model of solar particles in the heliosphere was assembled. This model includes the fluence, composition, energy spectra, and spatial and temporal variations of solar particles both within and beyong 1 AU. The ability to predict solar particle fluences was also discussed. Suggestions for specific studies designed to improve the basic model were also made

Prevalence of professional burnout among practicing cardiologists in the constituent entities of the Russian Federation

The burnout syndrome among healthcare professionals is a headline problem in the world, as it leads to poor health of medical workers, affects patient satisfaction with health care and the healthcare system as a whole. At the same time, existing preventive measures can improve the well-being of staff.Aim. To study the prevalence of professional burnout syndrome among practicing cardiologists in the Russian Federation (RF).Material and methods. This cross-sectional study was carried out using the method of online anonymous surveying. The inclusion criterion was the current practical activity in the RF. The study involved 452 cardiologists from 8 federal districts (women; n=377, 83,4%), 48,2% of which worked in a hospital. Occupational burnout was assessed using the Maslach Burnout Inventory (MBI) questionnaire in the Russian language adaptation for healthcare workers by N. E. Vodopyanova and E. S. Starchenkova. The score was calculated on three subscales (emotional exhaustion, depersonalization, personal accomplishment), the maximum score for the subscales was 54, 30 and 48, respectively. The personal accomplishment subscale is the opposite as follows: the higher the score, the less the symptom severity. Additionally, demographic parameters, working conditions, the desire to change job and field of activity were taken into account. Regression analysis was used to establish associations of burnout with factors.Results. The median score of the emotional exhaustion subscale was 29,5 (23,0; 35,0) points, depersonalization — 12,0 (8,0; 16,0) and personal accomplishment — 32,0 (28,0; 37,0). Men had higher depersonalization score than women as follows: 15,0 (10,0; 18,0) vs 11,0 (8,0; 15,0), p=0,001. High degrees of emotional exhaustion and depersonalization (burnout) were found in 235 (52%) cardiologists, while all three symptoms simultaneously — in 132 (29,2%) doctors. There were no symptoms of burnout in 84 (18,6%) cardiologists. A high degree of burnout was associated with a desire to change job (p<0,001).Conclusion. A high prevalence of professional burnout among practicing cardiologists in the RF was revealed, which, in turn, is associated with the desire to change job or occupation

The worldwide impact of telemedicine during COVID-19: current evidence and recommendations for the future.

During the COVID-19 pandemic, telemedicine has emerged worldwide as an indispensable resource to improve the surveillance of patients, curb the spread of disease, facilitate timely identification and management of ill people, but, most importantly, guarantee the continuity of care of frail patients with multiple chronic diseases. Although during COVID-19 telemedicine has thrived, and its adoption has moved forward in many countries, important gaps still remain. Major issues to be addressed to enable large scale implementation of telemedicine include: (1) establishing adequate policies to legislate telemedicine, license healthcare operators, protect patients' privacy, and implement reimbursement plans; (2) creating and disseminating practical guidelines for the routine clinical use of telemedicine in different contexts; (3) increasing in the level of integration of telemedicine with traditional healthcare services; (4) improving healthcare professionals' and patients' awareness of and willingness to use telemedicine; and (5) overcoming inequalities among countries and population subgroups due to technological, infrastructural, and economic barriers. If all these requirements are met in the near future, remote management of patients will become an indispensable resource for the healthcare systems worldwide and will ultimately improve the management of patients and the quality of care

Experience of using multielectrode catheter systems to perform radiofrequency renal sympathetic denervation in patients with resistant hypertension: immediate procedural effects

Aim. To investigate the baseline characteristics of patients with resistant hypertension (HTN) undergoing radiofrequency renal sympathetic denervation (RD) and to determine immediate procedural effects.Material and methods. During 2018-2019, two series of radiofrequency RD procedures were performed in patients with true resistant HTN using balloon-type (bipolar ablation) or spiral-type (unipolar ablation) multielectorde catheters. The basic demographic, clinical and laboratory characteristics of included patients were assessed. A comparative analysis of two groups was carried out depending on the type of catheter used. Dynamics of office systolic blood pressure (SBP) were assessed as ∆ between the two following timepoints: at screening and at hospital discharge. The safety of radiofrequency RD was assessed. Multiple linear regression was used to determine the factors associated with the ∆ of office SBP after radiofrequency RD.Results. A total of 48 patients taking 4 (4;6) antihypertensive drugs were sequentially included. Radiofrequency RD was performed with a balloon-type catheter in 27 patients (mean age, 56±12 years old; 12 males) and with a spiral-type catheter in 21 patients (50±14 years old; 8 males). Radiofrequency RD was significantly longer in the spiral catheter group than in balloon one (110 versus 60 minutes, p<0,001), as was the mean number of RF applications (24 versus 12, p=0,002). None of the patients had acute kidney injury after RD (creatinine ∆, -0,6 µmol/L; 95% CI [-3,97; 2,78]). A total of 4 patients had complications (3 femoral arterial pseudoaneurisms, one renal arterial dissection), all of which did not affect the average length of hospital stay (from 4 to 5 days). At discharge, there was a pronounced decrease in office SBP (adjusted for baseline characteristics) with the mean of -26 mm Hg (95% CI [-29; -23]). There were following main factors associated with the office SBP ∆: smoking status (positive), baseline office SBP (positive), and blood glucose (negative).Conclusion. Radiofrequency RD using multielectode catheters is characterized by favorable short-term hemodynamic effects. We have found novel potential predictors of these effects. Further research will focus on testing initial hypotheses in the long term

Comparative benchmark analysis of coverage by specialists involved in healthcare provision to patients with cardiovascular diseases in the regions of the Northwestern Federal District

Control of cardiovascular diseases  (CVDs), which are the cause of premature mortality and high economic  costs,  is one of the priorities of social policy. Human resources are a key link in health system performance.  In Russia, there is a significant geographical  heterogeneity  in the distribution of medical workers and structural disproportions  in certain specialties.  Regional  differences  in the availability of specialists in cardiology system have not been studied enough.Aim. To perform a comparative benchmark analysis of coverage by specialists involved  in healthcare  provision  to patients with cardiovascular  diseases  in the regions of the Northwestern Federal District (NWFD), identifying regional differences for the period from 2015 to 2019.Material and methods. To assess the number of specialists involved in providing care to patients with CVDs, data from the federal statistical monitoring forms №30 “Information on a medical organization” for 2015-2019 of the subjects of the Northwestern Federal District were used. Multiple linear regression was used to compare the basic estimated parameters of provision per 10000 population with specialists at the level of district as a whole and in NWFD regions  with data for Russia as a whole. P<0,05 was considered significant.Results. Among the subjects of Northwestern Federal District, differences  were revealed  in all specialties  of varying severity. While the estimated parameter of provision with cardiologists  in Russia is 0,896 (95%  CI, 0,794-0,998),  there are differences  in the regions in a wide range from -0,446 (Vologda Oblast) to +0,502 (St. Petersburg).  Regional  differences  in the provision of vascular radiology specialists from the basic estimated level for Russia were observed  only in two subjects. At the same time, for all subjects in general, an increase in the indicator from 2015 to 2019 by 0,011 [95% CI, 0,006; 0,016] per year (p<0,001) was observed.  The smallest range of differences was observed for cardiovascular surgeons:  with a baseline  estimate  in Russia of 0,158 [95% CI, 0,140; 0,176] the range of differences was from -0,086 to +0,198. For emergency  medicine paramedic, the largest number of subjects with positive values of the statistical correction of the average relative to Russia was noted (7 out of 11 regions). For neurologists and intensivists, on the contrary, the largest number of subjects with negative values (7 out of 11 regions)  was revealed.  Structural staff disproportions in cardiology care system were revealed.Conclusion. In the NWFD, in general, coverage  by specialists involved in health-care provision for CVD are higher than the estimated base level for Russia. However,  their uneven distribution within the district and its subjects is observed. The demonstrated mathematical approach to assessing staff differences  at the subject or district level can be used to develop measures to achieve the goals of the regional health personnel policy

Practical efficacy and safety of Konsilar D24 in patients with hypertension: data from the KONSONANS program

Aim. In practice, to evaluate the efficacy, safety and long-term adherence to therapy with a fixed-dose combination of ramipril/indapamide (Konsilar-D24) in patients with grade 1-2 hypertension (HTN) who have not achieved blood pressure (BP) control with prior therapy or have not taken antihypertensive therapy.Material and methods. This multicenter open-label observational program included 524 patients with grade 1-2 HTN who did not take antihypertensive therapy or did not reach the target BP level with mono or dual antihypertensive therapy, as well as patients shifted to Konsilar-D24 therapy no later than two weeks before the start of the program. All patients signed a written informed consent to participate in the program. The safety analysis set includes all patients who have taken at least one dose of a fixed-dose combination of ramipril/indapamide and have visited physician at least once during the program. The effectiveness analysis set included all patients in the safety population who completed the study in accordance with protocol (n=511). Clinical systolic blood pressure (SBP), diastolic BP (DBP) and heart rate were assessed at baseline, as well as at 0,5, 1, 3 and 6 months of treatment. A post hoc subgroup analysis of changes in BP and heart rate was performed depending on age, sex and baseline body mass index.Results. The fixed-dose combination of ramipril with indapamide significantly reduced SBP and DBP after 2-week treatment (-20,9±10,1 mm Hg; pConclusion. Despite the limitations inherent in observational studies, the KONSONANS program has demonstrated high efficacy and safety of fixed-dose combination of ramipril/indapamide taken once a day in hypertensive patients. Ramipril/indapamide fixed-dose combination therapy significantly improved BP control and achieved even lower individual target BP levels in the majority of hypertensive patients

MASked-unconTrolled hypERtension management based on office BP or on ambulatory blood pressure measurement (MASTER) Study: a randomised controlled trial protocol.

Masked uncontrolled hypertension (MUCH) carries an increased risk of cardiovascular (CV) complications and can be identified through combined use of office (O) and ambulatory (A) blood pressure (BP) monitoring (M) in treated patients. However, it is still debated whether the information carried by ABPM should be considered for MUCH management. Aim of the MASked-unconTrolled hypERtension management based on OBP or on ambulatory blood pressure measurement (MASTER) Study is to assess the impact on outcome of MUCH management based on OBPM or ABPM

Kainate Receptor-Mediated Modulation of Hippocampal Fast Spiking Interneurons in a Rat Model of Schizophrenia

Kainate receptor (KAR) subunits are believed to be involved in abnormal GABAergic neurotransmission in the hippocampus (HIPP) in schizophrenia (SZ) and bipolar disorder. Postmortem studies have shown changes in the expression of the GluR5/6 subunits of KARs in the stratum oriens (SO) of sectors CA2/3, where the basolateral amygdala (BLA) sends a robust projection. Previous work using a rat model of SZ demonstrated that BLA activation leads to electrophysiological changes in fast-spiking interneurons in SO of CA2/3. The present study explores KAR modulation of interneurons in CA2/3 in response to BLA activation. Intrinsic firing properties of these interneurons through KAR-mediated activity were measured with patch-clamp recordings from rats that received 15 days of picrotoxin infusion into the BLA. Chronic BLA activation induced changes in the firing properties of CA2/3 interneurons associated with modifications in the function of KARs. Specifically, the responsiveness of these interneurons to activation of KARs was diminished in picrotoxin-treated rats, while the after-hyperpolarization (AHP) amplitude was increased. In addition, we tested blockers of KAR subunits which have been shown to have altered gene expression in SO sector CA2/3 of SZ subjects. The GluR5 antagonist UBP296 further decreased AP frequency and increased AHP amplitude in picrotoxin-treated rats. Application of the GluR6/7 antagonist NS102 suggested that activation of GluR6/7 KARs may be required to maintain the high firing rates in SO interneurons in the presence of KA. Moreover, the GluR6/7 KAR-mediated signaling may be suppressed in PICRO-treated rats. Our findings indicate that glutamatergic activity from the BLA may modulate the firing properties of CA2/3 interneurons through GluR5 and GluR6/7 KARs. These receptors are expressed in GABAergic interneurons and play a key role in the synchronization of gamma oscillations. Modulation of interneuronal activity through KARs in response to amygdala activation may lead to abnormal oscillatory rhythms reported in SZ subjects

Transport of small anionic and neutral solutes through chitosan membranes: Dependence on cross-linking and chelation of divalent cations

Chitosan membranes were prepared by solvent casting and cross-linked with glutaraldehyde at several ratios under homogeneous conditions. The cross-linking degree, varying from 0 to 20%, is defined as the ratio between the total aldehyde groups and the amine groups of chitosan. Permeability experiments were conducted using a side-by-side diffusion cell to determine the flux of small molecules of similar size but with different chemical moieties, either ionized (benzoic acid, salicylic acid, and phthalic acid) or neutral (2-phenylethanol) at physiological pH. The permeability of the different model molecules revealed to be dependent on the affinity of those structurally similar molecules to chitosan. The permeability of the salicylate anion was significantly enhanced by the presence of metal cations commonly present in biological fluids, such as calcium and magnesium, but remained unchanged for the neutral 2-phenylethanol. This effect could be explained by the chelation of metal cations on the amine groups of chitosan, which increased the partition coefficient. The cross-linking degree was also correlated with the permeability and partition coefficient. The change in the permeation properties of chitosan to anionic solutes in the presence of these metallic cations is an important result and should be taken into consideration when trying to make in vitro predictions of the drug release from chitosan-based controlled release systems

Differential Patterns of Synaptotagmin7 mRNA Expression in Rats with Kainate- and Pilocarpine-Induced Seizures

Previous studies in rat models of neurodegenerative disorders have shown disregulation of striatal synaptotagmin7 mRNA. Here we explored the expression of synaptotagmin7 mRNA in the brains of rats with seizures triggered by the glutamatergic agonist kainate (10 mg/kg) or by the muscarinic agonist pilocarpine (30 mg/kg) in LiCl (3 mEq/kg) pre-treated (24 h) rats, in a time-course experiment (30 min - 1 day). After kainate-induced seizures, synaptotagmin7 mRNA levels were transiently and uniformly increased throughout the dorsal and ventral striatum (accumbens) at 8 and 12 h, but not at 24 h, followed at 24 h by somewhat variable upregulation within different parts of the cerebral cortex, amigdala and thalamic nuclei, the hippocampus and the lateral septum. By contrast, after LiCl/pilocarpine-induced seizures, there was a more prolonged increase of striatal Synaptotagmin7 mRNA levels (at 8, 12 and 24 h), but only in the ventromedial striatum, while in some other of the aforementioned brain regions there was a decline to below the basal levels. After systemic post-treatment with muscarinic antagonist scopolamine in a dose of 2 mg/kg the seizures were either extinguished or attenuated. In scopolamine post-treated animals with extinguished seizures the striatal synaptotagmin7 mRNA levels (at 12 h after the onset of seizures) were not different from the levels in control animals without seizures, while in rats with attenuated seizures, the upregulation closely resembled kainate seizures-like pattern of striatal upregulation. In the dose of 1 mg/kg, scopolamine did not significantly affect the progression of pilocarpine-induced seizures or pilocarpine seizures-like pattern of striatal upregulation of synaptotagmin7 mRNA. In control experiments, equivalent doses of scopolamine per se did not affect the expression of synaptotagmin7 mRNA. We conclude that here described differential time course and pattern of synaptotagmin7 mRNA expression imply regional differences of pathophysiological brain activation and plasticity in these two models of seizures