Transformations of organ lesions in hemorrhagic vasculitis

Background. Hemorrhagic vasculitis or Henoch-Schönlein purpura (HSP) is the most common variant of systemic vasculitis in childhood, and peculiarities of the further transformation of the pathological process in adult patients remain unexplored. Objective. To explore the transformation of juvenile HSP, comparing the nature of skin lesions, joints and kidneys of patients in childhood and adulthood. Material and methods. The study included 92 patients (61 men and 31 women on the average age of 27 years, and at the onset of the disease in 11 years). I degree of the activity of the pathological process is determined in 40% of cases, II - in 35%, III – in 25%. Seropositivity by hyperimmunoglobulinemia A occurred in 27% of cases, by the presence of rheumatoid factor – in 21%. At the time of the survey cutaneous syndrome was diagnosed in 55% of patients, the joint – in 45%, kidney – in 71%. There were performed renal biopsy in 15 cases. Results. The cutaneous, joint-cutaneous-abdominal and cutaneous -abdominallyrenal forms of the disease, lesions of the skin, gastrointestinal tract, wrist, ankle and knee joints become more rarely in the course of evolution of juvenile HSP, but exceptionally renal variant of the pathological process, the change of skeletal muscle, liver, spleen are revealed more often. Chronic kidney disease with the kidney failure progression is developed in 12% of patients (in 17% of cases of nephropathy). Sacroiliitis, spondylopathy, tendovaginitis, enthesopathies, epiphyseal osteoporosis, meniscitis of knee joints are arisen. II, III, VI and IV morphological classes of Henoch glomerulonephritis are formed in a ratio of 8:4:2:1 with tubulointerstitial component in all cases. And lymphohistiocytic infiltration of the vascular wall is the unfavorable sign for the prognosis of the disease. Conclusions: In cases of transfer of juvenile HSP in chronic adult form disease often obtain progressive course as regards, first of all, the pathology of the joints and kidneys

Disturbance of the muscoloskeletal system in juvenile ankylosing spondylitis and disease developed in the adulthood (involvement of spine and sacroiliac joints).

Background. Two forms of ankylosing spondylitis (AS) are distinguished: juvenile and adult, depending on debut age of the disease. The diagnosis of juvenile AS (JAS) is one of the most urgent problems in a pediatric rheumatology. The peculiarities of AS course that onsets in childhood and adulthood are manifested by differences in the nature of a spinal column disturbance. At the same time, the evolution of JAS in adulthood remains unexplored. The goals and objectives of research: to study clinical and X-ray symptoms of spondylopathy and sacroiliitis course, to assess their characteristics in the disease that onset in childhood and adulthood. Material and methods. 217 patients with AS (193 men and 24 women) with an average age of 38 years were examined. The fast-progressing course of the disease was detected in 21% of cases, moderate and high degree of activity – in 79% of cases, the ІІ-ІІІ stage in 82%, and polyarthritis – in 65%. JAS was detected in 16% of cases (all boys), among them the third stage occurred twice more likely than among the other patients. Results. The clinical and radiologic signs of spondylopathy and sacroiliitis are observed in 95% and 97% of the total number of AS cases, respectively, among all patients with JAS lumbago was detected 4,3 times more frequently, sciatic muscles hypotrophy – 7,8 times, "the string symptom" - 2,9 times", the calcification of the spinal cord - 2,3 times, whereas the prevalence of spinal column injury, the severity of cervico-spondylopathy and sacroiliitis among patients with the disease debut in the adulthood is significantly greater, and the involvement in the process of the lumbar and thoracic spine are detected correspondingly twice as often and by 19%, occurrence of dorsalgia is 4 times as often, the limitation of body lateral bendover by 59%, while there are ambiguous dispersion-correlation links with extraarticular (systemic) manifestations of the disease, and the high prevalence of a peripheral articular syndrome regarding spondylopathy in JAS is a negative prognosis sign, and for the remaining patients there are indices of the Lansbury index and the index of arthro­pathy progression. Conclusion: the onset of AS in adulthood is a risk factor for the severe course of spondylopathy

NERVOUS SYSTEM LESION IN ANKYLOSING SPONDYLITIS, IN THE DISEASE BEGINNING IN СHILDHOOD AND ADULTHOOD

The incidence of ankylosing spondylitis (AS) in population amounts to 0.3 %, which is significantly more likely to develop at the age of 20–30 years. There are two forms of AS – juvenile and adults, depending on the age of the disease debut. The problem of juvenile AS (JAS) diagnostics is one of the most relevant in pediatric rheumatology, and the evolution of this disease remains unexplored in adulthood. The aim of the study – to learn the frequency and nature of separate clinical signs of CNS and PNS lesions in patients with AS , and to evaluate their special features in the disease beginning in childhood and adulthood. Materials and Methods. 217 patients with AS (193 males and 24 females) with an average age of 38 years were examined. The rapidly progression course is detected in 21 % of patients, moderate and high activity rate – in 79 %, stage II–III – in 82 %, polyarthritis – in 65 %. JAS was noted in 16 % of cases (all boys), in which stage III took place twice as often than other patients. Results and Discussion. Changes in PNS are observed in 4.9 times more often among patients with JAS , and CNS is 2 times less often than in cases of the disease debut in adulthood, moreover among the patients of the 1st group, the severity of CNS disturbance is associated with the involvement of the cervical spine and the prevalence of spondylopathy, PNS is associated with the availability of tendovaginitis, arthritis of the "root joints" (shoulder, hip) and changes in the thoracic spine, while in the 2nd group it is associated with the parameters of the integral index of arthritis activity and the x-ray stage of the disease, with disturbance of "root" and sacroiliac joints, wherein the age of the disease onset affects the development of asthenic vegetative and corticonuclear syndrome, the emergence of radiculopathy, cervicocranialgia and metacarpal canal syndrome, and in the pathogenetic architectonics of the CNS pathology the level of immunoglobulin-A plays a greater role, and in PNS the serum interleukin 1-β contents, which, in addition, in cases of JAC determine the occurrence of cervicocranialgia, and in the remaining observations of AS – the Morton's metatarsalgia. Conclusions. AS with different age of the disease debut is a risk factor for the development of certain symptoms of the CNS and PNS disturbances, which in these groups have their pathogenetic features

Comparative assessment of primary and paraneoplastic gout in lung cancer

Abstract Introduction. Lung cancer (LС) is the most common cause of the so-called paraneoplastic syndrome (PNPS) development, caused by the complex immunoinflammatory, degenerative and vascular distant changes. The risk of LC development is increased in patients with gout which proves the connection between violations of purine metabolism and carcinogenesis. Paraneoplastic (neoplastic) gout is one of the relatively frequent manifestations of LC, but such a relationship of the diseases requires further study. The objective of the study: to compare the clinical and laboratory course of primary gout and disease in the LC patients compared with the tumor process clinical course in the other signs of PNPS presence and to identify risk factors. Materials and methods. 113 patients with gout (97 men and 16 women aged 33 to 79 years) were observed. They were divided into two groups: the first group consisted of 54 patients with primary gout and the second group consisted of 59 patients with paraneoplastic variant of LC. Whereas in the 1st group the ratio of men and women was 26:1, in the 2nd – only 3: 1, and the average age was 50 and 59 years, respectively. The clinical course of gout and tumor process in the 2nd (main) group was compared with that in 199 LC patients with PNPS (comparison group), which was diagnosed in 15.5 % of LC observations. Purine metabolism was assessed by blood levels of uric acid and oxypurinol, their renal clearance, serum activity of xanthine oxidase, xanthine deaminase, adenosine deaminase, and 5-nucleotidase. Results. Paraneoplastic (neoplastic) gout develops in 3.5 % of the LC patients and in 22.9 % of those with PNPS. It differs from the primary (idiopathic) gout by the greater frequency of the disease development in women, the hand joints involvement and the metabolic type of hyperuricemia, but less often observed urolithiasis, peripheral tophi, chronic form of arthritis and the absence of renal type of purine metabolism impairment. Patients with tumorous gout differ from other LC patients with PNPS by the absence of bilateral and median lobe localization of the lung process, but relatively frequent occurrence of Pancoast tumor, high levels of uric acid and xanthine oxidase in the blood. The development of paraneoplastic gout depends on the clinical course of the LC (tumor invasion into the thoracic wall and pericardium, the number of distant organs metastasis) and the power of chemotherapy, the use of alkylating antineoplastic agents and alkaloids. Treatment-associated myelodepression, radiation pneumofibrosis and acute thrombophlebitis development depends on paraneoplastic gout. The presence of gout does not worsen the survival of LC patients with PNPS. LC patients with hyperuricemia (> 420 μmol / l in men and > 360 μmol / L in women) should be prescribed with xanthine oxidase inhibitor - allopurinol in the complex of therapeutic measures. Conclusions. Paraneoplastic gout is a frequent PNPS manifestation in LC, its course has peculiarities compared with the primary gout and is closely related to the tumor process character and the power of chemotherapy, it can determine the complications development in the course of therapeutic interventions. The data presented in the study require further comparative analysis of the other signs of PNPS, comparison of tumor and idiopathic variants of the musculoskeletal system lesion, cutaneous vasculitis and autoimmune systemic syndromes, which might assist in developing of the additional prognostic criteria for the tumor process clinical course, increasing the efficiency of therapy and its control quality

ІНФОРМАЦІЙНА СИСТЕМА (ІС) ДЛЯ ОТРИМАННЯ ТА ОБРОБЛЕННЯ МІКРОСКОПІЧНИХ ЗОБРАЖЕНЬ ЦИРКУЛЮЮЧИХ ПУХЛИННИХ КЛІТИН (ЦПК)

The article presents the structure and implementation of an information system for obtaining and processing microscopic images of the CPC. It is determined that identification of CPC is a complex task, which is practically inaccessible to clinical doctors due to the absence of relevant medical protocols and technological standards for the detection of CPC. The methods of isolation of the CPC are given, and the seven: the technology of separation by morphological features, the method of dividing by density gradient, using centrifugation and subsequent allocation by the OncoQuick technology of the CPC, immune-magnetic methods in which tumor cells interact with antibodies against the markers of CPP with conjugated magnetic particles, after which the cancer cells can be obtained by means of a magnetic field, and their disadvantages. The information system for obtaining and analyzing microscopic images of the CPK, which consists of 4 subsystems: venous blood filtration is developed. Receiving and preprocessing images of the CPC; the formation of images of the CPC and the "intellectual" image processing of the CPC, which, together with the patient's venous blood filtration subsystem, is the basic structural element of information technology for the determination of circulating tumor cells in human blood. The peculiarity of the developed system is the introduction into its structure of the subsystem of "intellectual" image processing of the CPC, which serves as a subsystem of maintaining decision-making and provides almost 100% conformity of the diagnosis to the actual situation, eliminating ambiguity in its interpretation. The problem solving was found, namely, the application of the information system proposed by the authors for the receipt and processing of microscopic images of the MIC for early diagnosis of oncology diseases.В статье приведена структура и реализацию информационной системы для получения и обработки микроскопических изображений ЦОК. Определено, что идентификация ЦОК является сложной задачей, которая практически недоступна клиническим врачам за причины отсутствия соответствующих медицинских протоколов и технологических стандартов выявления ЦОК. Приведены методы выделения ЦОК, а семе: технологии разделения по морфологическим признакам, метод разделения по градиенту плотности с использованием центрифугирования и последующего выделения технологии OncoQuick ЦОК, имуномагнитные методы, в которых опухолевые клетки взаимодействуют с антителами против маркеров ЦОК с конъюгированными магнитными частицами, после чего раковые клетки можно получить с помощью магнитного поля, и их недостатки. Разработана информационная система для получения и анализа микроскопических изображений ЦОК, состоит из 4-х подсистем: фильтрации венозной крови получения и предварительной обработки изображений ЦОК; формирования изображений ЦОК и «интеллектуальной» обработки изображений ЦОК, вместе с подсистемой фильтрации венозной крови пациента представляет собой базовый структурный элемент информационной технологии для определения циркулирующих опухолевых клеток в крови человека. Особенностью разработанной системы является введение в ее структуру подсистемы «интеллектуальной» обработки изображений ЦОК, выполняет функции подсистемы поддержания принятия решений и обеспечивает практически 100% соответствие поставленного диагноза реальной ситуации, исключив неоднозначность в его интерпретации. Найдено решение проблемы, а именно применение предложенной авторами информационной системы для получения и обработки микроскопических изображений ЦОК для ранней диагностики онкологических заболеваний.У статті наведено структуру та реалізацію інформаційної системи для отримання та оброблення мікроскопічних зображень ЦПК. Визначено, що ідентифікація ЦПК є складною задачею, яка практично недоступна клінічним лікарям за причини відсутності відповідних медичних протоколів і технологічних стандартів виявлення ЦПК. Наведено методи виділення ЦПК, а семе: технології поділу за морфологічними ознаками, метод поділу за градієнтом щільності, з використанням центрифугування і подальшого виділення технологією OncoQuick ЦПК, імуномагнітні методи, в яких пухлинні клітини взаємодіють з антитілами проти маркерів ЦПК з кон'югованими магнітними частинками, після чого ракові клітини можна отримати за допомогою магнітного поля, та їх недоліки. Розроблено інформаційну систему для отримання та аналізу мікроскопічних зображень ЦПК, яка складається з 4-х підсистем: фільтрації венозної крові; отримання і попередньої обробки зображень ЦПК; формування зображень ЦПК та «інтелектуальної» обробки зображень ЦПК, яка разом з підсистемою фільтрації венозної крові пацієнта представляє собою базовий структурний елемент інформаційної технології для визначення циркулюючих пухлинних клітин в крові людини. Особливістю розробленої системи є введення до її структури підсистеми «інтелектуальної» обробки зображень ЦПК, яка виконує функції підсистеми підтримання прийняття рішень і забезпечує практично 100% відповідність поставленого діагнозу реальній ситуації, виключивши неоднозначність в його інтерпретації. Знайдено вирішення проблеми, а саме застосування запропонованої авторами інформаційної системи для отримання та оброблення мікроскопічних зображень ЦПК для ранньої діагностики онкологічних захворювань

ІНФОРМАЦІЙНІ ТЕХНОЛОГІЇ І СИСТЕМИ ДЛЯ РАННЬОЇ ДІАГНОСТИКИ ОНКОЛОГІЧНИХ ЗАХВОРЮВАНЬ ЗА РІВНЕМ ЦИРКУЛЮЮЧИХ ПУХЛИННИХ КЛІТИН

Most modern systems and technologies of the automated analysis of medical microscopic images and early diagnostics of oncological diseases are analyzed in the article. The methods and algorithms used for image processing, segmentation, determination of parameters of the object, which are determined manually and require additional knowledge, make it significantly complicated for their practical application in clinical medicine due to insufficient knowledge of medical staff.В статье проанализировано большинство современных систем и технологий автоматизированного анализа медицинских микроскопических изображений и ранней диагностики онкологических заболеваний. Методы и алгоритмы, применяемые для обработки изображений, сегментации, определения параметров объекта, определяются в ручном режиме и требуют дополнительных знаний, это существенно затрудняет их практическое применение в клинической медицине вследствие недостаточного количества знаний у медицинского персонала.Проаналізовано більшість сучасних систем і технологій автоматизованого аналізу медичних мікроскопічних зображень та ранньої діагностики онкологічних захворювань. Методи та алгоритми, що застосовуються для оброблення зображень, сегментації, визначення параметрів об'єкта, визначаються в ручному режимі та потребують додаткових знань, це суттєво ускладнює їх практичне застосування в клінічній медицині внаслідок недостатньої кількості знань у медичного персонал

Shattered pellet injection experiments at JET in support of the ITER disruption mitigation system design

A series of experiments have been executed at JET to assess the efficacy of the newly installed shattered pellet injection (SPI) system in mitigating the effects of disruptions. Issues, important for the ITER disruption mitigation system, such as thermal load mitigation, avoidance of runaway electron (RE) formation, radiation asymmetries during thermal quench mitigation, electromagnetic load control and RE energy dissipation have been addressed over a large parameter range. The efficiency of the mitigation has been examined for the various SPI injection strategies. The paper summarises the results from these JET SPI experiments and discusses their implications for the ITER disruption mitigation scheme

Overview of JET results for optimising ITER operation

The JET 2019–2020 scientific and technological programme exploited the results of years of concerted scientific and engineering work, including the ITER-like wall (ILW: Be wall and W divertor) installed in 2010, improved diagnostic capabilities now fully available, a major neutral beam injection upgrade providing record power in 2019–2020, and tested the technical and procedural preparation for safe operation with tritium. Research along three complementary axes yielded a wealth of new results. Firstly, the JET plasma programme delivered scenarios suitable for high fusion power and alpha particle (α) physics in the coming D–T campaign (DTE2), with record sustained neutron rates, as well as plasmas for clarifying the impact of isotope mass on plasma core, edge and plasma-wall interactions, and for ITER pre-fusion power operation. The efficacy of the newly installed shattered pellet injector for mitigating disruption forces and runaway electrons was demonstrated. Secondly, research on the consequences of long-term exposure to JET-ILW plasma was completed, with emphasis on wall damage and fuel retention, and with analyses of wall materials and dust particles that will help validate assumptions and codes for design and operation of ITER and DEMO. Thirdly, the nuclear technology programme aiming to deliver maximum technological return from operations in D, T and D–T benefited from the highest D–D neutron yield in years, securing results for validating radiation transport and activation codes, and nuclear data for ITER

First-Principles Density Limit Scaling in Tokamaks Based on Edge Turbulent Transport and Implications for ITER

A first-principles scaling law, based on turbulent transport considerations, and a multimachine database of density limit discharges from the ASDEX Upgrade, JET, and TCV tokamaks, show that the increase of the boundary turbulent transport with the plasma collisionality sets the maximum density achievable in tokamaks. This scaling law shows a strong dependence on the heating power, therefore predicting for ITER a significantly larger safety margin than the Greenwald empirical scaling [Greenwald et al., Nucl. Fusion, 28, 2199 (1988)] in case of unintentional high-to-low confinement transition

New H-mode regimes with small ELMs and high thermal confinement in the Joint European Torus

New H-mode regimes with high confinement, low core impurity accumulation, and small edge-localized mode perturbations have been obtained in magnetically confined plasmas at the Joint European Torus tokamak. Such regimes are achieved by means of optimized particle fueling conditions at high input power, current, and magnetic field, which lead to a self-organized state with a strong increase in rotation and ion temperature and a decrease in the edge density. An interplay between core and edge plasma regions leads to reduced turbulence levels and outward impurity convection. These results pave the way to an attractive alternative to the standard plasmas considered for fusion energy generation in a tokamak with a metallic wall environment such as the ones expected in ITER.& nbsp;Published under an exclusive license by AIP Publishing