Studying Supply Chain and Tourism Cluster Development

Supply chain and tourism cluster are the two important ways to enhance the competitiveness of regions or industries. By discussing the differences and links between the two, this paper concludes that tourism cluster and supply chain carry features of compatibility and symbiosis. The importance of this research paper is determined by the fact that a significant number of tourism clusters established in the territory of the Russian Federation are not always successful as catalysts for the tourism sector development. This study aims to determine methods for conducting research on specialization as a factor in tourism cluster development, taking into consideration the existing research approaches and findings in this area. The systemic, structural, functional and analysis methods were used, along with a general theoretic approach to researching tourism cluster development. The selected methods made it possible to identify approaches to forming the relevant research methodologies. Based on the presented approaches, it is possible to choose research methods and the coherence of research activities in this area, with a view to identify key development indicators for tourism development and various tourism-related processes taking place within the territory of a tourism cluster. The research findings will provide necessary tools and mechanisms for developing tourism clusters based on the diversification of their specialization. The findings of the study are directed at increasing the effectiveness of decisions taken to assess and forecast tourism cluster development and can also be of use to all those interested in this field. The materials of the present study can be used by regional administrations to monitor and make effective management decisions aimed at improving regional tourism development programs. Experts and scholars could also benefit from the findings of this study to analyze and develop projections and to promote topic-related methodological approaches. The article will be of practical value for the specialists in tourism planning, tourism administration and tourism enterprise managers

Pediatric bacteremia and CNS infections associated with <i>klebsiella pneumoniae</i>: molecular genetic characteristics and clinical features

Klebsiella pneumoniae is one of the most significant and life-threatening pathogen of nosocomial infections. This opportunistic microorganism can cause infections of the bloodstream, respiratory tract, urinary tract, skin and soft tissues, inflammation of meninges of the brain and spinal cord, leading to elevated hospital mortality. The purpose of our study was a retrospective analysis of molecular genetic characteristics of K. pneumoniae isolated from blood and liquor samples as well as to describe clinical features in bacteremia and CNS infections. According to the results of assessed clinical data, K. pneumoniae isolates were selected from 64 children suffered from surgical pathology (congenital heart defects — 30%, abdominal pathology — 39%, severe combined trauma — 12%) and somatic diseases accompanied by antibacterial and/or glucocorticosteroid therapy — 14%. The minimum suppressive concentrations of antibiotics were determined by the broth micro-dilution method. Carbapenemases were detected by real time polymerase chain reaction. Virulence genes and capsule serotypes K1/K2 were assessed by multiplex PCR. Biofilms were grown using flat-bottomed polystyrene plates, followed by coloring, fixation, elution and data detection. The population diversity was assessed by multilocus sequence typing. Bacteremia and CNS infections associated with K. pneumoniae were fatal in 25% of cases. A substantial portion of the isolates demonstrated the phenotype of extremely drug resistance (XDR) — 43%, the phenotype of multidrug resistance (MDR) was shown in 16% of the isolates. The blaCTX-M cephalosporinase gene was found in 85% of the strains. The main determinant of resistance to carbapenems was the blaOXA-48 gene (33%); the blaNDM gene was detected in 9% of strains. The combination of blaOXA-48 and blaNDM was found in 7% of isolates. The study of biofilm production showed that moderate ability to form biofilms was shown in 61%, strong — 21%, and weak — 15% isolates. Two isolates (3%) did not form biofilms. The virulence genes entB and mrkD were detected in 100% of isolates, ybtS — in 78%. The iutA gene was found in 18% of the strains. Two isolates showed the presence of the kfu gene. Seven isolates belonged to the K2 serotype. 27 different genotypes were found in K. pneumoniae isolates examined. The most common were: ST307 — 21%, ST395 — 12%, ST48 — 7%, ST39 — 6% and ST29 — 6%. Infections of the bloodstream and central nervous system associated with K. pneumoniae have great importance in clinical practice. This microorganism is able to long persist on biotic and abiotic surfaces, has a wide natural and acquired resistance to antibiotics

Genomic features of resistant <i>Klebsiella pneumonia</i>, isolated from the bloodstream and cerebrospinal fluid of pediatric hospital patients

Introduction. Carbapenemase-producing Klebsiella pneumoniae (CP-Kp), which are international high-risk clones, have become a problem of utmost importance. CP-Kps, adapting to the hospital environment, evolve into convergent pathotypes. Such variants combine traits of two genetic lineages: multidrug resistant (MDR) and hypervirulent. The pathotypes, along with MDR K. pneumoniae, pose an exceptional threat to young patients during systemic infection. The objective of this study is the detailed molecular genetic analysis of MDR isolates of K. pneumoniae detected during the monitoring of resistant Gram-negative bacteria at the National Medical Research Center for Children’s Health in 2014–2021. Materials and methods. Whole-genome sequencing with a subsequent bioinformatics analysis of eight MDR isolates from the bloodstream and cerebrospinal fluid. Results. MDR isolates belonged to 4 sublineages (SL): SL307, SL395, SL29 and SL1198. In the genomes of 6 pangrug-resistant (PDR) isolates, genes associated with resistance to all categories of antibiotics recommended for Enterobacteriaceae therapy were identified. Plasmids were present in all genomes. In 6 isolates, plasmids contained heavy metal ion resistance operons in addition to antibiotic resistance genes. Prophages within the plasmids were also involved in the transfer of resistance genes. The ST395 isolate from the cerebrospinal fluid belonged to the convergent pathotype in terms of resistance and virulence. Comparison of genomes within SLs revealed recombination events in the K- and O-locus regions and the Yersiniabactin operon. Conclusion. Thus, in a sample of resistant K. pneumoniae isolated from bloodstream and cerebrospinal fluid, 6 PDR isolates were detected, one of which belongs to the convergent pathotype ST395

THE EXPERIENCE OF SWITCHING TO THE SECOND TNF INHIBITOR IN A PATIENT WITH SEVERE JUVENILE POLYARTHRITIS AND RESISTANCE TO THE FIRST TNF-BLOCKER

The article presents  a case  of a severe  progressive  course  of polyarticular  juvenile idiopathic arthritis,  debuting  at an early age, refractory to the therapy with methotrexate, cyclosporine, and glucocorticosteroids.  A clinical example demonstrates that switching to the second TNF  inhibitor in the case of developing secondary resistance to the first drug from this group provides restoration of the therapeutic effect and is not accompanied by serious adverse events. Six months after switching to adalimumab, due to the «escape» of the effect of etanercept, the inflammatory changes in the patient were reversed; the volume of movements in the joints increased, and the laboratory parameters of the disease activity were normalized. After 1 year, there was a remission of the disease. The child managed to completely eliminate glucocorticosteroids for oral ingestion. The duration of the joint syndrome remission was 3 years. Adverse events were not serious and did not become a basis for drug withdrawal

PROFESSIONAL WELL-BEING AND RESILIENCE OF DOCTORS AND MEDICAL STAFF

Background. The well-being of doctors and medical staff is vital to their professional activities. Resilience is recognized as a key condition for well-being and is an important factor in socionomic professions. In medical practice, resilience helps doctors and medical staff cope with difficulties and overcome burnout. Purpose. The aim is to study the relationship of well-being in the professional activities of doctors and medical personnel with resilience and conditions supporting it. Methods. A group of 178 medical workers, including doctors, secondary and junior medical personnel, was studied. The resilience scale provided a general indicator of resilience and its components, the WHO well-being scale assessed well-being over the past two weeks. The attractiveness of the profession, the mood it evokes and the satisfaction of the individual with the need for security were evaluated. The relationships between the variables were studied using Spearman correlation coefficients, taking into account the position and multiple regression analysis. Results. Significant positive correlations were found between well-being and general resilience (r = 0,599, p < 0,01), position (r = 0,361, p < 0,01), attractiveness of the profession (r = 0,359, p < 0,01), mood (r = 0,361, p < 0,01) and satisfaction with the need for security (r = 0,159, p < 0,05). Conclusion. Well-being in the professional sphere of doctors and medical personnel is associated with commitment to professional activity, control and risk-taking, attractiveness of the profession, the mood that it causes, satisfaction of the need for psychological security. The results obtained confirm the consideration of resilience as a resource component of the professional well-being of doctors and medical personnel. Strategies for ensuring well-being in the profession should take into account the practices of interventions that stimulate the identified correlates

Aerobiological Monitoring and Metabarcoding of Grass Pollen

Grass pollen is one of the leading causes of pollinosis, affecting 10–30% of the world’s population. The allergenicity of pollen from different Poaceae species is not the same and is estimated from moderate to high. Aerobiological monitoring is a standard method that allows one to track and predict the dynamics of allergen concentration in the air. Poaceae is a stenopalynous family, and thus grass pollen can usually be identified only at the family level with optical microscopy. Molecular methods, in particular the DNA barcoding technique, can be used to conduct a more accurate analysis of aerobiological samples containing the DNA of various plant species. This study aimed to test the possibility of using the ITS1 and ITS2 nuclear loci for determining the presence of grass pollen from air samples via metabarcoding and to compare the analysis results with the results of phenological observations. Based on the high-throughput sequencing data, we analyzed the changes in the composition of aerobiological samples taken in the Moscow and Ryazan regions for three years during the period of active flowering of grasses. Ten genera of the Poaceae family were detected in airborne pollen samples. The representation for most of them for ITS1 and ITS2 barcodes was similar. At the same time, in some samples, the presence of specific genera was characterized by only one sequence: either ITS1 or ITS2. Based on the analysis of the abundance of both barcode reads in the samples, the following order could describe the change with time in the dominant species in the air: Poa, Alopecurus, and Arrhenatherum in early mid-June, Lolium, Bromus, Dactylis, and Briza in mid-late June, Phleum, Elymus in late June to early July, and Calamagrostis in early mid-July. In most samples, the number of taxa found via metabarcoding analysis was higher compared to that in the phenological observations. The semi-quantitative analysis of high-throughput sequencing data well reflects the abundance of only major grass species at the flowering stage

Probiotic Therapy with <i>Lactobacillus acidophilus</i> and <i>Bifidobacterium animalis</i> subsp. <i>lactis</i> Results in Infarct Size Limitation in Rats with Obesity and Chemically Induced Colitis

In this study, we investigated the effect of three different probiotics, namely, a combination of Lactobacillus acidophilus (LA–5) and Bifidobacterium animalis subsp. lactis (BB–12), Saccharomyces boulardii, and Enterococcus faecium L3 on myocardial infarct size in rats with diet-induced obesity (DIO) and chemically-induced colitis (CIC). Potential associations between the effects of probiotics on myocardial ischemia-reperfusion injury and gut microbiome patterns as well as the serum levels of pro- and anti-inflammatory cytokines, lipopolysaccharide, and short chain fatty acids were also studied. Intragastric administration of lyophilized Lactobacillus acidophilus and Bifidobacterium animalis subsp. lactis at a dose of 1.2 × 108 CFU/mL for 15 days resulted in myocardial infarct size reduction in rats with DIO, CIC, and antibiotic-induced dysbiosis. This cardioprotective effect was associated with specific changes in cytokine concentrations, namely reduced levels of IL–1β, TNF–α, IL–2, and IL–8. At the same time, the use of Lactobacillus acidophilus and Bifidobacterium animalis subsp. lactis was accompanied by a significant reduction in lipopolysaccharide level, suggesting normalization of intestinal epithelial barrier permeability. However, the cardioprotective effect of Lactobacillus acidophilus and Bifidobacterium animalis subsp. lactis is not secondary to improved healing of the intestinal mucosa in CIC, as evidenced by the lack of difference in histopathological scores

Современные подходы к ведению детей с острым обструктивным ларингитом и эпиглоттитом

Experts of the Union of Pediatricians of Russia have developed modern guidelines on the management of children with acute obstructive laryngitis and epiglottitis. Croup is the most common cause of acute upper respiratory obstruction in children aged from 6 months to 6 years. Usually respiratory viruses are the pathogenic agents of the disease. The etiological factor of epiglottitis is Haemophilus influenzae type b in the vast majority of cases (&gt; 90%). However, nowadays, epiglottitis caused by this pathogen agent is more common in adults in countries with mass immunization against hemophilic infection. This article considers in detail etiology, pathogenesis, and classification issues. Special attention is given to diagnosis, differential diagnosis, and therapy (via evidence-based approach) of acute obstructive laryngitis in children.Экспертами Союза педиатров России разработаны актуальные методические рекомендации по оказанию медицинской помощи детям с острым обструктивным ларингитом и эпиглоттитом. Круп — это наиболее частая причина острой обструкции верхних дыхательных путей у детей в возрасте от 6 мес до 6 лет. Как правило, возбудителями заболевания являются респираторные вирусы. Этиологическим фактором эпиглоттита в подавляющем большинстве случаев выступает Haemophilus influenzae типа b (&gt; 90%). Однако в настоящее время в странах с массовой иммунизацией против гемофильной инфекции эпиглоттит, вызванный данным возбудителем, чаще встречается у взрослых. В статье подробно рассмотрены вопросы этиологии, патогенеза, классификации. Особое внимание уделено диагностике, дифференциальной диагностике и терапии острого обструктивного ларингита у детей, основанным на принципах доказательности

Современные подходы к ведению детей с внебольничной пневмонией

Experts of The Union of Pediatricians of Russia have developed current clinical guidelines for management of children with community-acquired pneumonia, which were approved by the Scientific and Practice Council of Ministry of Public Health of the Russian Federation in January 2022. Particular attention is paid to the etiological structure, modern classification, diagnostic tests and flagship approaches to antibacterial therapy of community-acquired pneumonia in children based on the principles of evidentiary medicine. Экспертами Союза педиатров России разработаны актуальные клинические рекомендации по оказанию медицинской помощи детям с внебольничными пневмониями, которые были одобрены Научно-практическим советом Минздрава России в январе 2022 г. Особое внимание уделено этиологической структуре, современной классификации, диагностическим исследованиям и основным подходам к антибактериальной терапии внебольничной пневмонии у детей, основанным на принципах доказательной медицины.