The assessment of physicians' and senior medical students’ knowledge in the field of communityacquired pneumonia: preliminary results of the KNOCAP-II project (2017-2019)

Внебольничная пневмония (ВП) относится к одной из самых актуальных проблем современной медицины. На сегодняшний день ВП занимает 4 место в структуре смертности (после сердечно-сосудистых, цереброваскулярных заболеваний и злокачественных новообразований) и 1 место среди всех смертей от инфекционных заболеваний. Цель – оценка уровня знаний врачей терапевтического профиля и студентов старших курсов медицинских вузов в вопросах ведения пациентов с ВП. В рамках многоцентрового исследования KNOCAP (полное название проекта – «The assessment of physician and students’ knowledge of community-acquired pneumonia basics») представлены результаты анонимного проспективного опроса по оценке знаний и предпочтений врачей терапевтического профиля и студентов старших медицинских курсов в вопросах ведения пациентов с ВП. По итогам первого периода проекта (2017-2019 гг.) получены и проанализированы результаты анкетирования 588 врачей терапевтического профиля и 394 студентов-медиков из 17 центров России, Украины и Кыргызстана. За основу взят метод анонимного анкетирования, для чего была разработана оригинальная анкета на основании актуальных клинических рекомендаций. Наибольшие сложности вызвали следующие вопросы: сроки проведения повторного рентгенологического исследования при положительной динамике лечения, выбор основного диагностического признака при ведении пациента с ВП, указать типовые ошибки фармакотерапии ВП и выбор стартовой антимикробной терапии у пациентов с факторами риска и без них. В целом исследование показало значимое несоответствие знаний в вопросах ведения пациентов с ВП актуальным клиническим рекомендациям 2010 г. и проектом новых клинических рекомендаций 2018-2019 гг. В настоящее время существует необходимость в повышении уровня знаний и совершенствовании профессиональной деятельности врачей терапевтического профиля и студентов старших медицинских курсов, так как проведенный многоцентровой срез знаний и предпочтений специалистов во многих вопросах выявил их недостаточный уровень для корректного ведения пациентов с ВП. Community-acquired pneumonia (CAP) is one of the most relevant problems of modern medicine. Today, CAP takes 4th place in the structure of mortality (after cardiovascular, cerebrovascular diseases and malignant neoplasms) and 1st place among all deaths from infectious diseases. The aim of the study is to assess the level of general physician’ and senior medical students’ basic knowledge in CAP treatment. The article represents the results of anonymous prospective surveys within the framework of the second stage of KNOCAP multi-centered research project (full name of the project «The assessment of physician’ and students’ knowledge of community-acquired pneumonia basics») aimed at accessing the knowledge and preferences of doctors and students on the fundamental issues in diagnosis and treatment of community-acquired pneumonia. The survey conducted in 2017-2019 involved 588 physicians and 394 students from seventeen Russian, Kyrgyzstan and Ukrainian centers. The method of anonymous questioning was used in this study, for which an original questionnaire was developed on the basis of current clinical recommendations. The following fundamental questions caused the greatest difficulties in the respondents: terms for a repeated X-ray examination in positive dynamics of CAP treatment, the choice of main diagnostic criteria of CAP, the choice of the typical mistakes of CAP treatment, the choice of the initial antimicrobial therapy. In general, the respondents’ knowledge in CAP patients’ management deviates significantly from the current clinical guidelines, as of 2010, and from the new clinical guidelines draft, 2018-2019. Currently, there is a need to increase the level of knowledge and improve the professional activities of therapists and senior medical students, as a multicenter section of the knowledge and preferences of specialists in many issues revealed their insufficient level for the correct management of patients with CAP

Loss-of-function mutations in UDP-Glucose 6-Dehydrogenase cause recessive developmental epileptic encephalopathy

Developmental epileptic encephalopathies are devastating disorders characterized by intractable epileptic seizures and developmental delay. Here, we report an allelic series of germline recessive mutations in UGDH in 36 cases from 25 families presenting with epileptic encephalopathy with developmental delay and hypotonia. UGDH encodes an oxidoreductase that converts UDP-glucose to UDP-glucuronic acid, a key component of specific proteoglycans and glycolipids. Consistent with being loss-of-function alleles, we show using patients’ primary fibroblasts and biochemical assays, that these mutations either impair UGDH stability, oligomerization, or enzymatic activity. In vitro, patient-derived cerebral organoids are smaller with a reduced number of proliferating neuronal progenitors while mutant ugdh zebrafish do not phenocopy the human disease. Our study defines UGDH as a key player for the production of extracellular matrix components that are essential for human brain development. Based on the incidence of variants observed, UGDH mutations are likely to be a frequent cause of recessive epileptic encephalopathy

Geographical and temporal distribution of SARS-CoV-2 clades in the WHO European Region, January to June 2020

We show the distribution of SARS-CoV-2 genetic clades over time and between countries and outline potential genomic surveillance objectives. We applied three available genomic nomenclature systems for SARS-CoV-2 to all sequence data from the WHO European Region available during the COVID-19 pandemic until 10 July 2020. We highlight the importance of real-time sequencing and data dissemination in a pandemic situation. We provide a comparison of the nomenclatures and lay a foundation for future European genomic surveillance of SARS-CoV-2.Peer reviewe

COMPETITIVENESS OF THE BRANCH COMPLEX OF REGIONAL SYSTEM

This article is devoted to questions of an estimation of competitiveness of a branch complex are considered. Also the urgency and the practical importance of the analysis of sector-branch structure of economy of region from positions of state regulation of territorial development is proved

System Analysis and Solution of Energy Efficiency Problems in Machine-Building Production

The article discusses application of system analysis to identify and solve the problems of energy efficiency of machine-building enterprises. The increase in the efficiency of a machine-building enterprise is influenced by many factors, among which tariffs and prices for energy services have a significant impact. The increase in tariffs for these services has a direct impact on the increase in cost. Energy efficiency objectives also include: high energy capacity of products; insufficient efficiency of generation, transportation and distribution of energy resources; low reliability of power supply; insufficient volume or low reliability of information on the energy infrastructure operation. As a result of the system analysis, directions have been identified that enable one to increase energy efficiency, which leads to a decrease in the cost of production, and, consequently, to an increase in the profit of the enterprise. Directions for increasing the energy efficiency of machine-building enterprises can be identified as a result of system studies of the activities of all divisions of the main, auxiliary and service industries. The greatest effect from energy-saving measures is achieved in the process of rational energy consumption, which is advisable to implement at machine-building enterprises. Reduced production output caused by the global economic crisis that began in 2008 and the impact of the 2020-2021 pandemic have resulted in the equipment operation at reduced loads and in off-design modes, which in turn has led to the auxiliary equipment consuming almost the same amount of energy as at nominal performance. This circumstance leads to an increase in costs. A mathematical model has been developed, in which a machine-building enterprise is considered as a set of functional elements and components with a hierarchical structure of connections between them, described in the form of a ‘6-tuple’

Global Blockchain Jurisdiction: Prospects and Features of Use in Russian Realities

© 2020, Springer Nature Switzerland AG. The aim of the work is to assess the prospects for the use of blockchain technologies on a global scale and the comparative legal aspect, especially in the context of the emerging digital society in modern Russia. The widespread use of blockchain technologies is explained by their successful ability to withstand new challenges and threats to the security of mankind as a whole, of distinct people and states. However, during the implementation of this project, one will have to face difficulties in the optimal combination of globalization and regionalization (localization) trends in information management processes. It is necessary to carefully analyze how and where blockchain technologies can be directly applied, and in which areas of the information society they should be limited, or even refrain from their uncritical use. Methodology. The article uses specific sociological and comparative legal method, as well as analysis and synthesis methods. Results. The practice analysis of international relations and the internal Russian situation confirms the priority of using blockchain technologies mainly in the fight against international financial cybercrime and other crimes in the criminal jurisdiction field. The use of blockchain technologies in private law relations is associated with the need to protect economic sovereignty and information security of the country, therefore, it needs careful monitoring and control. Conclusion. The use of blockchain technologies has great prospects on a global scale of development, however, in the process of digital society development, it is necessary to proceed from the continuity of national traditions in the implementation of global innovations

Algorithm for treatment of patients with class II malocclusion rejecting orthognathic surgery [Algoritm lecheniya patsientov s nizhnei retrognatiei, otkazavshikhsya ot kostno-rekonstruktivnoi operatsii]

The aim of this study is to develop algorithms for the treatment of patients with class II malocclusion and incisor protrusion using the combination of bracket system, functional fixed telescopic appliance (FFTA) and skeletal anchorage, which allows to achieve effective dentoalveolar compensation of skeletal forms of class II malocclusion. MATERIALS AND METHODS: Orthodontic treatment of 60 patients with class II malocclusion at the age of 18 to 44 years, using the bracket system, FFTA and orthodontic miniscrews was performed. In order to assess the results of treatment, cone-beam computed tomography were obtained at the beginning and at the end of treatment. RESULTS: As a result of the treatment normalization of lower jaw position, dental position and occlusion were achieved, the lower incisors protrusion was eliminated and the facial profile was improved, reliably confirmed by lateral cephalograms. CONCLUSION: The proposed treatment algorithm proved to be effective for stable correction of skeletal class II malocclusion in patients rejecting orthognathic surgery.ЦЕЛЬ ИССЛЕДОВАНИЯ: Разработка алгоритмов лечения пациентов с нижней ретрогнатией, дистальной окклюзией зубных рядов (ДОЗР) и протрузией резцов с помощью комбинированного применения несъемной ортодонтической техники и скелетной опоры, позволяющих эффективно проводить зубоальвеолярную компенсанцию скелетных форм дистальной окклюзии. МАТЕРИАЛ И МЕТОДЫ: Проведено ортодонтическое лечение 60 пациентов с нижней ретрогнатией и ДОЗР в возрасте от 18 до 44 лет при помощи брекет-системы, функционального несъемного телескопического аппарата (ФНТА) и ортодонтических минивинтов. С целью оценки результатов лечения каждому пациенту проводилось рентгенологическое исследование до и после лечения. РЕЗУЛЬТАТЫ: Было достигнуто улучшение соотношения челюстей по сагиттали, нормализовано положение нижней челюсти, нормализовано положение зубов и смыкание зубных рядов, устранена протрузия резцов и улучшен профиль лица, что достоверно подтверждено данными телерентгенографии черепа в боковой проекции. ЗАКЛЮЧЕНИЕ: Таким образом, разработанные нами алгоритмы лечения позволяют достичь стабильных результатов ортодонтической коррекции скелетных форм ДОЗР у пациентов, отказавшихся от ортогнатической хирургии

Comparative Assessment of The Expansion of The Dentition Using Ligature and Passive Self-Ligating Braces in Combination with Pitts Broad and Early Elastics

Background: The study aimed to analyze the effectiveness of the use of the Pitts Broad and early elastics in the treatment of patients with narrowing and deformation of the dentition. Materials and methods: A comprehensive examination of 46 patients, aged 18 to 30 years, with narrowing and deformation of the dentition was performed. Patients were separated into two groups, depending on the algorithm of treatment: group 1 - using the brackets of passive self-ligation, the Pitts Broad and early short elastics; group 2 - using ligature brackets and archwires Orthos. Results: Biometric analysis of the diagnostic models of the 1st group after treatment showed a significant expansion of maxillary arch between the premolars and molars (a distance between premolars: 39,8 +/- 0,4mm, between molars: 48,3 +/- 0,5mm) and mandibular arch (a distance between premolars: 37,1 +/- 0,5mm, between molars: 46,3 +/- 0,6mm) compared to the data before treatment. Biometric analysis of the diagnostic models of the 2nd group showed that expansion between the molars was achieved on a much smaller extent on both jaws, compared with the 1st group (maxilla: a distance between premolars - 35,7 +/- 0,4mm, between molars 43,5 +/- 0,5mm; mandible: a distance between premolars - 33,2 +/- 0,3mm, between molars - 42,3 +/- 0,5mm). Conclusions: As a result of the study, it was found that the passive self-ligation system in combination with a protocol of the Pitts Broad contributes to the expansion of dentition in aesthetically significant areas (distal regions) at the early stages of treatment. The use of early light elastics provides an early control of the premolars torque, and it allows us to achieve a balanced and wide smile at the end of treatment