Перспективы применения двухэнергетической компьютерной томографии в диагностике мочекаменной болезни и определении химического состава мочевых камней (обзор литературы)

Nephrolithiasis is a pandemic distributed disease that affects 4-20% of the population worldwide and is characterized by a high recurrence rate. Currently computed tomography without contrast remains the gold standard for diagnosis of urolithiasis because of its high accuracy to detect stones, their location and size. However, the modality has limited effectiveness in determination of urinary calculi chemical composition. Recently introduced imaging modality dual-energy computed tomography based on acquiring images at two different energy levels has showed high effectiveness in determination of urinary calculi composition. The review is focused on dual energy computed tomography principles and methods performed on different scanners. Recently published data on the application of this imaging modality in the diagnostic of urinary stone disease for calculi composition determination are analysed. The pitfalls of the method are reviewed. Future perspectives of this technique in urinary stone disease diagnosing will be discussed.Мочекаменная болезнь – пандемически распространенное заболевание, встречающееся у 4–20% мирового населения и характеризующееся высоким уровнем рецидивов. К настоящему моменту “золотым стандартом” диагностики уролитиаза является бесконтрастная компьютерная томография, имеющая высокую эффективность в диагностики наличия, локализации и размера камней, однако обладающую меньшей эффективностью в определении фенотипических характеристик уролитов. Активно развивающийся в последнее время метод двухэнергетической компьютерной томографии, заключающийся в проведении сканирования на двух энергетических уровнях, уже показал высокую эффективность в диагностике состава уролитов. В обзоре рассматриваются основы метода и техники его проведения на различных томографах, приводится анализ имеющихся литературных данных о применении двухэнергетической компьютерной томографии в диагностике мочекаменной болезни для оценки химического состава уролитов. Также приводятся ограничения метода и возможные ошибки, возникающие при проведении двухэнергетической компьютерной томографии. С учетом проанализированных данных оценивается перспективность внедрения метода в диагностику уролитиаза

The sarcopenia and physical frailty in older people: multi-component treatment strategies (SPRINTT) project: description and feasibility of a nutrition intervention in community-dwelling older Europeans.

To access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked DownloadBackground: The "Sarcopenia and Physical Frailty in Older People: Multicomponent Treatment Strategies" (SPRINTT) project sponsored a multi-center randomized controlled trial (RCT) with the objective to determine the effect of physical activity and nutrition intervention for prevention of mobility disability in community-dwelling frail older Europeans. We describe here the design and feasibility of the SPRINTT nutrition intervention, including techniques used by nutrition interventionists to identify those at risk of malnutrition and to carry out the nutrition intervention. Methods: SPRINTT RCT recruited older adults (≥ 70 years) from 11 European countries. Eligible participants (n = 1517) had functional limitations measured with Short Physical Performance Battery (SPPB score 3-9) and low muscle mass as determined by DXA scans, but were able to walk 400 m without assistance within 15 min. Participants were followed up for up to 3 years. The nutrition intervention was carried out mainly by individual nutrition counseling. Nutrition goals included achieving a daily protein intake of 1.0-1.2 g/kg body weight, energy intake of 25-30 kcal/kg of body weight/day, and serum vitamin D concentration ≥ 75 mmol/L. Survey on the method strategies and feasibility of the nutrition intervention was sent to all nutrition interventionists of the 16 SPRINTT study sites. Results: Nutrition interventionists from all study sites responded to the survey. All responders found that the SPRINTT nutrition intervention was feasible for the target population, and it was well received by the majority. The identification of participants at nutritional risk was accomplished by combining information from interviews, questionnaires, clinical and laboratory data. Although the nutrition intervention was mainly carried out using individual nutritional counselling, other assisting methods were used as appropriate. Conclusion: The SPRINTT nutrition intervention was feasible and able to adapt flexibly to varying needs of this heterogeneous population. The procedures adopted to identify older adults at risk of malnutrition and to design the appropriate intervention may serve as a model to deliver nutrition intervention for community-dwelling older people with mobility limitations. Keywords: Energy intake; Nutrition counselling; Nutrition intervention; Protein intake; SPRINTT.University of Helsinki including Helsinki University Central Hospital Innovative Medicine Initiative (IMI) Juho Vainio foundatio

Инфекционные эндокардиты у ВИЧ-инфицированных больных отделения интенсивной терапии

Infective endocarditis (IE) is one of the most common cardiac complications in HIV patients who are intravenous drug addicts. The presence of IE and secondary diseases in immunocompromised individuals usually requires specific diagnostic and therapeutic approach.Aim: Optimizing the diagnosis of IE in patients with advanced HIV/AIDS.Materials and methods We reviewed 429 case records of HIV/AIDS ICU patients using the modified duke criteria for diagnosis of infective endocarditis. Statistical significance (p <0.05) of data was assessed using the χ2 test.Results. 25 patients were diagnosed with IE. The male gender dominated – 68%. Mean age was 38. 60% had stage 4B HIV infection. 68% were ART naive. The medium viral load was 294560 copies / ml, while the medium CD4 count was 218 cells / μl. Fever of >38°C was a key symptom found in all patients. Blood cultures were positive in 60% cases. 80% had a high C reactive protein (CRP), and 44% had CRP levels above 100 mg/l. Procalcitonin (PCT) levels were increased in 52%. Echocardiogram revealed IE in 92%. Pneumonia was diagnosed in 92%. Fatal outcome occurred in 76%. Anemia was a predictor of severe outcome (p<0.002), while patients with leukocytosis had good prognosis (p<0.05).Conclusion. Infective endocarditis is a common complication among HIV IDUs. The most common diagnostic criteria are fever >38°C, pneumonia, anemia, leukocytosis, thrombocytopenia and echocardiographic findings. The levels of the hemoglobin and WBCs could evaluate prognosis of the disease outcome.Инфекционный эндокардит – заболевание, которое в группе ВИЧ-инфицированных потребителей инъекционных наркотиков регистрируется в 1000 раз чаще, чем в общей популяции. Одновременное наличие инфекционного эндокардита и вторичных заболеваний у лиц с иммунодефицитом имеет свои диагностические и терапевтические особенности.Цель. Оптимизация диагностики инфекционного эндокардита у больных ВИЧ-инфекцией на поздних стадиях заболевания.Материалы и методы. Проведен ретроспективный анализ историй болезни 25 ВИЧ-инфицированных больных с инфекционным эндокардитом, проходивших лечение в отделении интенсивной терапии Инфекционной клинической больницы № 2 в 2020 г. Диагноз «Инфекционный эндокардит» устанавливали на основании модифицированных критериев DUKE. Для оценки статистической достоверности (p <0,05) показателей применяли критерий χ2.Результаты. Диагноз «Инфекционный эндокардит» был выставлен 25 больным с ВИЧ-инфекцией. Доминировал мужской пол – 68%, 84% входили в группу потребителей инъекционных наркотиков, Ме возраста – 38 лет, стадия 4В ВИЧ-инфекции – 60%. АРТ не получали 68% больных. Ме вирусной нагрузки – 294 560 копии/ мл, Ме CD4+клеток – 218 кл/мкл. Ведущим симптомом стала фебрильная лихорадка. Положительная гемокультура получена в 60% случаев. Повышение СРБ определено в 80% случаев, выше 100 мг/л – у 44% пациентов. Повышение уровня прокальцитонина (ПКТ) отмечалось у 52% больных, из них у 28% выше 2 нг/мл. По данным ЭХО-КГ диагноз подтвержден у 92% больных. Пневмония была диагностирована в 92% случаев. Летальный исход наступил у 76% больных. Анализ клинико-лабораторных показателей в группах выживших и умерших позволил выявить, что анемия является предиктором неблагоприятного исхода заболевания (p<0,002), а наличие лейкоцитоза – благоприятного (p<0,05).Заключение. Развитие ИЭ у ВИЧ-инфицированных больных наиболее характерно для ПИН. Самыми частыми критериями диагноза являются лихорадка >38°C, пневмония, анемия, лейкоцитоз, тромбоцитопения, эхокардиографические данные. Содержание гемоглобина и лейкоцитов может быть использовано для оценки прогноза исхода заболевания

Reward-dependent plasticity in the primary auditory cortex of adult monkeys trained to discriminate temporally modulated signals

Adult owl monkeys were trained to detect an increase in the envelope frequency of a sinusoidally modulated 1-kHz tone. Detection was positively correlated with the magnitude of the change in the envelope frequency. Surprisingly, neuronal responses recorded in the primary auditory cortex of trained monkeys were globally suppressed by the modulated tone. However, the contrast in neuronal responsiveness to small increases versus large increases in envelope frequencies was actually enhanced in the trained animals. The results suggest behaviorally contingent inhibitory and excitatory processes that are modulated by the probability that a particular signal predicts a reward

The sarcopenia and physical frailty in older people: multi-component treatment strategies (SPRINTT) project:description and feasibility of a nutrition intervention in community-dwelling older Europeans

Abstract Background: The “Sarcopenia and Physical Frailty in Older People: Multicomponent Treatment Strategies” (SPRINTT) project sponsored a multi-center randomized controlled trial (RCT) with the objective to determine the effect of physical activity and nutrition intervention for prevention of mobility disability in community-dwelling frail older Europeans. We describe here the design and feasibility of the SPRINTT nutrition intervention, including techniques used by nutrition interventionists to identify those at risk of malnutrition and to carry out the nutrition intervention. Methods: SPRINTT RCT recruited older adults (≥ 70 years) from 11 European countries. Eligible participants (n = 1517) had functional limitations measured with Short Physical Performance Battery (SPPB score 3–9) and low muscle mass as determined by DXA scans, but were able to walk 400 m without assistance within 15 min. Participants were followed up for up to 3 years. The nutrition intervention was carried out mainly by individual nutrition counseling. Nutrition goals included achieving a daily protein intake of 1.0–1.2 g/kg body weight, energy intake of 25–30 kcal/kg of body weight/day, and serum vitamin D concentration ≥ 75 mmol/L. Survey on the method strategies and feasibility of the nutrition intervention was sent to all nutrition interventionists of the 16 SPRINTT study sites. Results: Nutrition interventionists from all study sites responded to the survey. All responders found that the SPRINTT nutrition intervention was feasible for the target population, and it was well received by the majority. The identification of participants at nutritional risk was accomplished by combining information from interviews, questionnaires, clinical and laboratory data. Although the nutrition intervention was mainly carried out using individual nutritional counselling, other assisting methods were used as appropriate. Conclusion: The SPRINTT nutrition intervention was feasible and able to adapt flexibly to varying needs of this heterogeneous population. The procedures adopted to identify older adults at risk of malnutrition and to design the appropriate intervention may serve as a model to deliver nutrition intervention for community-dwelling older people with mobility limitations