Диагностические маркеры в аспекте развития ВИЧ-энцефалопатии у детей

The aim of the study was to evaluate the diagnostic markers in children with HIV —encephalopathy (HIVE) with varying degrees of severity.Material and methods of research: The study included 260 children (153 boys — 58.85% and 107 girls —41.7%) with HIV-positive status and receiving antiretroviral therapy according to an individually selected scheme for at least 6 months. All children included in the study showed signs of HIV encephalopathy. The activity response was assessed by the concentration of IL-6, IL-10, TNF-alpha, C-reactive protein, C3, C4 components of the complement (immunofelometric analysis).Results: The study of the activity response in children with HIV encephalopathy found that the concentration of TNF —alpha and IL-6 were increased, compared, to the reference values (12.67±0.25 PG/ml and 23.04±0.64 PG/ml, respectively, with reference values of less than 8.1 PG/ml and 7pg/ml, respectively), and the concentration of IL-10 was reduced (5.93±0.10 PG/ml with a reference value of more than 9.1 PG/ml). The study analyzed the predictor significance of various parameters response in the aspect of the development of symptomatic HIV- encephalopathy. A comparative analysis of the concentration markers was performed, and the incidence of symptomatic HIV —encephalopathy was determined depending on the diagnostic concentration of the diagnostic marker. This finding is probably explained by the effector role of systemic inflammation in the development of damage to the Central nervous system.Conclusion. The maximum predictor significance in the aspect of the development of symptomatic HIV -encephalopathy was found in proinflammatory cytokines: an increase in IL-6 concentration above 19.6 PG / ml is associated with an increase in the risk of developing symptomatic HIV encephalopathy by 9.14 times, and an increase in TNF -alpha concentration above 12.5 PG/ml by 4.07 times (p<0.001 for both factors).Цель: оценить у детей диагностические маркеры развития ВИЧ-энцефалопатии различной степени выраженности.Материалы и методы: в исследование были включены. 260 детей (153 мальчика — 58,85% и 107 девочек —41,7%), имеющих ВИЧ-позитивный статус и принимающих антиретровирусную терапию по индивидуально подобранной схеме не менее 6 месяцев. У всех детей, включенных в исследование, были обнаружены признаки ВИЧ-энцефалопатии. Диагностические маркеры интерпретировались по концентрации ИЛ-6, ИЛ-10, ФНО-альфа, С-реактивного белка, С3, С4 компонентов комплемента (иммунонефелометрический анализ).Результаты: изучение маркеров у детей с ВИЧ-энцефалопатией обнаружило, что концентрация ФНО-альфа и ИЛ-6 была увеличена по сравнению с референтными значениями (12,67±0,25 пг/мл и 23,04±0,64 пг/мл соответственно, при референтных значениях — менее 8,1 пг/мл и 7пг/мл соответственно), а концентрация ИЛ-10 — снижена (5,93±0,10 пг/мл при референтном, значении — более 9,1 пг/мл). В ходе исследования был проведен анализ предикторной значимости различных параметров, в аспекте развития симптомной ВИЧ-энцефалопатии. Проведен сравнительный анализ концентрации маркеров, а также определена частота встречаемости симптомной ВИЧ-энцефалопатии в зависимости от диагностической концентрации маркера.Заключение: максимальная предикторная значимость в аспекте развития симптомной ВИЧ-энцефалопатии обнаружена у провоспалительных цитокинов: увеличение концентрации ИЛ-6 выше 19,6 пг/мл ассоциируется с увеличением риска развития симптомной ВИЧ-энцефалопатии в 9,14 раза, увеличение концентрации ФНО-альфа выше 12,5 пг/мл — в 4,07 раза (p<0,001 для обоих факторов)

Left Ventricular Function after Revascularization in Patients with Chronical Coronary Syndromes

Background: The purpose of this study was to determine the dynamics of morpho-functional and myocardial deformation characteristics of the left ventricle after revascularization in patients with chronic coronary syndromes (CCS). Methods and Results: The study included 136 CCS patients of both sexes with stable anginal symptoms [(i) clinical scenario] and asymptomatic coronary artery disease (CAD) at screening [(vi) clinical scenario]. Diagnosis of CCS was performed according to the 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes. All patients underwent the following examinations: assessment of traditional risk factors, physical examination, general clinical and laboratory blood tests, 12-lead ECG, transthoracic echocardiography, two-dimensional speckle tracking echocardiography (STE), and coronary angiography (CAG). The SYNTAX score was calculated retrospectively according to the SYNTAX score algorithm. A total of 100 patients with CCS were enrolled in the main group (MG) and underwent revascularization by PCI with intracoronary stenting using drug-eluting stents. Among the main-group patients, one-vessel, two-vessel, and three-vessel CAD were detected in 36(26.5%), 34(25%), and 30(22.0%) cases, respectively. The comparison group (CG) included 36 CCS patients with hemodynamically non-significant coronary lesions (<50% stenosis). LVEF values were within the normal range in all groups, with the highest value in the CG, followed by the one-, two- and three-vessel lesion groups. LVEF obtained by the area-length method and modified biplane Simpson's method did not differ. The assessment of the contractile function of the LV myocardium was also obtained by assessing the global longitudinal strain (GLS) and global longitudinal strain rate (GLSR). The comparative analysis of the LV myocardial deformation properties in the studied groups showed that less negative GLS and GLSR were found in the three-vessel CAD, followed by the two-vessel and one-vessel CAD groups, and CG. CG demonstrated more negative GLS and GLSR than all MG subgroups. We analyzed the effect of revascularization on the GLS and found no statistically significant differences before and 48 hours after revascularization in all studied MG subgroups and CG. Thirty days after revascularization, GLS significantly showed more negative values in all MG subgroups: -18.12±0.63 versus -17.9±0.4 in one-vessel CAD, -16.13±0.71 versus -15.9±0.4 in two-vessel CAD and -13.91±1.25 versus -13.1±1.1 in three-vessel CAD. In CG with medical treatment only, GLS did not change statistically significantly but had more negative values than in the studied MG subgroups. Analysis of changes in LVEF after revascularization in the MG of patients with one-, two- and three-vessel CAD and in the CG after medical treatment did not reveal statistically significant dynamics. Conclusion: the results indicate the absence of statistically significant changes in myocardial deformation indicators and morpho-functional parameters of the left ventricle in CCS patients 48 hours after revascularization. Thirty days after revascularization, GLS significantly improves, while LVEF remains unchanged. GLS is superior to LVEF in visualizing improvement in LV function after revascularization in patients with CCS

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Background: Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. // Methods: We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung's disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. // Findings: We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung's disease) from 264 hospitals (89 in high-income countries, 166 in middle-income countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in low-income countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. // Interpretation: Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between low-income, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Measurement of the production cross section ratio σ(χb2(1P))/σ(χb1(1P))in pp collisions at √s=8TeV

A measurement of the production cross section ratio σ(χb2(1P))/σ(χb1(1P))σ(χb2(1P))/σ(χb1(1P)) is presented. The χb1(1P)χb1(1P) and χb2(1P)χb2(1P) bottomonium states, promptly produced in pp collisions at View the MathML sources=8 TeV, are detected by the CMS experiment at the CERN LHC through their radiative decays χb1,2(1P)→ϒ(1S)+γχb1,2(1P)→ϒ(1S)+γ. The emitted photons are measured through their conversion to e+e−e+e− pairs, whose reconstruction allows the two states to be resolved. The ϒ(1S)ϒ(1S) is measured through its decay to two muons. An event sample corresponding to an integrated luminosity of 20.7 fb−120.7 fb−1 is used to measure the cross section ratio in a phase-space region defined by the photon pseudorapidity, |ηγ|<1.0|ηγ|<1.0; the ϒ(1S)ϒ(1S) rapidity, |yϒ|<1.5|yϒ|<1.5; and the ϒ(1S)ϒ(1S) transverse momentum, View the MathML source7<pTϒ<40 GeV. The cross section ratio shows no significant dependence on the ϒ(1S)ϒ(1S) transverse momentum, with a measured average value of View the MathML source0.85±0.07(stat+syst)±0.08(BF), where the first uncertainty is the combination of the experimental statistical and systematic uncertainties and the second is from the uncertainty in the ratio of the χbχb branching fractions

Search for strongly interacting massive particles generating trackless jets in proton-proton collisions at s = 13 TeV

A search for dark matter in the form of strongly interacting massive particles (SIMPs) using the CMS detector at the LHC is presented. The SIMPs would be produced in pairs that manifest themselves as pairs of jets without tracks. The energy fraction of jets carried by charged particles is used as a key discriminator to suppress efficiently the large multijet background, and the remaining background is estimated directly from data. The search is performed using proton-proton collision data corresponding to an integrated luminosity of 16.1 fb - 1 , collected with the CMS detector in 2016. No significant excess of events is observed above the expected background. For the simplified dark matter model under consideration, SIMPs with masses up to 100 GeV are excluded and further sensitivity is explored towards higher masses

Search for the X(5568) State Decaying into B-s(0)pi(+/-) in Proton-Proton Collisions at root s=8 TeV

A search for resonancelike structures in the B-s(0)pi(+/-) invariant mass spectrum is performed using proton-proton collision data collected by the CMS experiment at the LHC at root s = 8 TeV, corresponding to an integrated luminosity of 19.7 fb(-1). The B-s(0) mesons are reconstructed in the decay chain B-s(0) -> J/Psi phi, with J/Psi -> mu(+) mu(-) and phi -> K+K-. The B-s(0)pi(+/-) invariant mass distribution shows no statistically significant peaks for different selection requirements on the reconstructed B-s(0) and pi(+/-) candidates. Upper limits are set on the relative production rates of the X(5568) and B-s(0) states times the branching fraction of the decay X(5568)(+/-) -> B-s(0)pi(+/-). In addition, upper limits are obtained as a function of the mass and the natural width of possible exotic states decaying into B-s(0)pi(+/-).Peer reviewe