Challenges to integrated care for mental disorders in Bulgaria

The rapid rate of population aging and the rising number of people with chronic diseases and mental disorders worldwide and in Bulgaria is a prerequisite for the transformation of episodic fragmented services into integrated care. One of the challenges that psychiatric care in our country is facing is related to the need to improve coordination and communication between the professionals and institutions from the health and social sector. The implementation of integrated mental health care programs will help with the integration of patients with mental disorders, improve their quality of life and overcome their social isolation. The publication uses a documentary and historical method for analysis of publications in the period 1999-2019 on the topic of integrated and psychiatric care

THE CONTRIBUTION OF NURSES IN THE PREVENTION, CONTROL AND COMBAT OF LYMPHEDEMA IN BREAST CARCINOMA - INTERNATIONAL EXPERIENCE

Introduction. Breast cancer (breast cancer) is one of the most frequently diagnosed malignant diseases and among the leading causes of death in women worldwide. This defines it as a disease of great medico-social significance, involving more and more the world scientific community. Along with its medical and socioeconomic psychosocial consequences, patients often develop lymphedema, which is one of the most severe complications after breast cancer treatment.The aim of the present study is to investigate the contribution and functions of the nurse in the process of prevention, control and fight against lymphedema, in mammary gland carcinoma, based on the existing international scientific evidence.Materials and methods. A documentary method was applied. Information retrieved from publications found through a Pubmed search with keywords: prevention, control, lymphedema, breast carcinoma, internationalexperience, nurses, patients, was examined. Information from bibliographic references, specialized literature, statistical data from international and national organizations related to the prevention and treatment of oncological diseases, regulatory documents was also studied.Results and discussion. The analysis of the scientific literature emphasizes the role of the nurse in the prevention of lymphedema, not only as a health professional acting in collaboration with the medical staff, but above all as a professional responsible for the care and education of the patient. This allows nurses to maketheir important contribution to the prevention, control and fight against lymphedema in breast cancer, by identifying patients at high risk of developing lymphedema, implementing the necessary preventive measures, planning and evaluating long-term patient care with mild lymphedema, psychological support, health education and information.Conclusion. Nurses occupy an important place and have a key role in the process of prevention and fight against lymphedema in breast cancer, performing their main functions. They make their high contribution in protecting, maintaining and restoring the health of individuals and their families, taking part in this important process

The Engagement Between MDSCs and Metastases: Partners in Crime

Tumor metastases represent the major cause of cancer-related mortality, confirming the urgent need to identify key molecular pathways and cell-associated networks during the early phases of the metastatic process to develop new strategies to either prevent or control distal cancer spread. Several data revealed the ability of cancer cells to establish a favorable microenvironment, before their arrival in distant organs, by manipulating the cell composition and function of the new host tissue where cancer cells can survive and outgrow. This predetermined environment is termed \u201cpre-metastatic niche\u201d (pMN). pMN development requires that tumor-derived soluble factors, like cytokines, growth-factors and extracellular vesicles, genetically and epigenetically re-program not only resident cells (i.e., fibroblasts) but also non-resident cells such as bone marrow-derived cells. Indeed, by promoting an \u201cemergency\u201d myelopoiesis, cancer cells switch the steady state production of blood cells toward the generation of pro-tumor circulating myeloid cells defined as myeloid-derived suppressor cells (MDSCs) able to sustain tumor growth and dissemination. MDSCs are a heterogeneous subset of myeloid cells with immunosuppressive properties that sustain metastatic process. In this review, we discuss current understandings of how MDSCs shape and promote metastatic dissemination acting in each fundamental steps of cancer progression from primary tumor to metastatic disease

PhysicoMechanical and Physico-Chemical Properties of Bio-Inert Composite Ceramics

Bio-inert ceramics are non-toxic, non-allergenic and non-carcinogenic materials which explain why these are frequently used as orthopedic and dental implants. Unfortunately, these are chemically inert and do not naturally form a direct link with the bone. The research carried studies micro/nanostructure properties and the porosity of the TiO2-Nb2O5 ceramics, used as biocompatible polymer matrix, prepared by different technological regimes. The morphology of the composite samples of TiO2-Nb2O5 was studied using scanning microscopy. The phase identification of the composites was carried by metallographic microscopy. Results obtained show the chemical composition, the technological parameters and the porosity determined, favors formation of sufficiently strong bond between the studied materials and vitreous carbon layers

Comparative Price Analysis of Biological Products for Treatment of Rheumatoid Arthritis

Biological products for treatment of rheumatoid arthritis usually are cost effective for healthcare systems in Europe, but they are huge financial burden due to the high number of patients and the significant budget impact. The expected saving from introduction on the market of biosimilars are significant and are linked to better access and affordability. The aim of this study was to conduct comparative price analysis of biological products for rheumatoid arthritis therapy among seventeen EU countries. The point of view is that of the Bulgarian pricing and reimbursement system and the chosen countries are those from external reference basket for prices comparison at manufacturing level. All authorized biological products by EMA with therapeutic indication rheumatoid arthritis were selected. The access for treatment is evaluated as the availability of the product on the market and the prices level. We assessed the availability of all trade names in the price lists of the observed countries. The prices data was obtained from the official web pages of the responsible institutions up to date December 2017. The results show that four out of all six INNs have authorized biosimilars in EMA. Despite its earlier authorization biosimilar adalimumab is not present in any of the price lists of countries. From all eighteen countries only in Lithuania and Estonia there were no published prices of any of the selected medicinal products. Countries with higher number of biosimilar prices are Spain and France. Differences in manufacturers’ prices of reference biological products in selected countries in comparison with the lowest manufacturer price are higher with 22 to 69% while the retail prices between 62 and 95%. Differences are mostly notable for rituximab, and less notable for tocilizumab. Manufacturers’ and retail prices of biosimilar products were established only for three INNs (etanercept, rituximab, and infliximab). Manufacturers’ prices differ between 26 and 75%, while retail prices differ between 40 and 92% for biosimilars. Comparison of the differences between manufacturer prices of reference biological product and biosimilars shows 36% difference for etanercept, 39% for rituximab, and 31% for infliximab, while at retail level the differences are 11, 86, and 143%, respectively. The limitation of the study is that the prices are the official ones without discounts due to confidentiality and the real prices may be lower. The second limitation is that the methodology for pricing differs in the countries and this could also influence the prices on both levels (manufacturer and retail). Introduction of biosimilars on the national markets led to significant decrease in reimbursed prices paid by public funds and thus might benefit the patients’ access to biological therapy. The decrease of prices after biosimilars entrance on the market is not as notable as for commodity generics

PROX1 is a transcriptional regulator of MMP14

The transcription factor PROX1 is essential for development and cell fate specification. Its function in cancer is context-dependent since PROX1 has been shown to play both oncogenic and tumour suppressive roles. Here, we show that PROX1 suppresses the transcription of MMP14, a metalloprotease involved in angiogenesis and cancer invasion, by binding and suppressing the activity of MMP14 promoter. Prox1 deletion in murine dermal lymphatic vessels in vivo and in human LECs increased MMP14 expression. In a hepatocellular carcinoma cell line expressing high endogenous levels of PROX1, its silencing increased both MMP14 expression and MMP14-dependent invasion in 3D. Moreover, PROX1 ectopic expression reduced the MMP14-dependent 3D invasiveness of breast cancer cells and angiogenic sprouting of blood endothelial cells in conjunction with MMP14 suppression. Our study uncovers a new transcriptional regulatory mechanism of cancer cell invasion and endothelial cell specification.Peer reviewe

Sediment properties as important predictors of carbon storage in zostera marina meadows: a comparison of four European areas

Seagrass ecosystems are important natural carbon sinks but their efficiency varies greatly depending on species composition and environmental conditions. What causes this variation is not fully known and could have important implications for management and protection of the seagrass habitat to continue to act as a natural carbon sink. Here, we assessed sedimentary organic carbon in Zostera marina meadows (and adjacent unvegetated sediment) in four distinct areas of Europe (Gullmar Fjord on the Swedish Skagerrak coast, Asko in the Baltic Sea, Sozopol in the Black Sea and Ria Formosa in southern Portugal) down to similar to 35 cm depth. We also tested how sedimentary organic carbon in Z. marina meadows relates to different sediment characteristics, a range of seagrass-associated variables and water depth. The seagrass carbon storage varied greatly among areas, with an average organic carbon content ranging from 2.79 +/- 0.50% in the Gullmar Fjord to 0.17 +/- 0.02% in the area of Sozopol. We found that a high proportion of fine grain size, high porosity and low density of the sediment is strongly related to high carbon content in Z. marina sediment. We suggest that sediment properties should be included as an important factor when evaluating high priority areas in management of Z. marina generated carbon sinks

The origins and spread of domestic horses from the Western Eurasian steppes

This is the final version. Available on open access from Nature Research via the DOI in this recordData availability: All collapsed and paired-end sequence data for samples sequenced in this study are available in compressed fastq format through the European Nucleotide Archive under accession number PRJEB44430, together with rescaled and trimmed bam sequence alignments against both the nuclear and mitochondrial horse reference genomes. Previously published ancient data used in this study are available under accession numbers PRJEB7537, PRJEB10098, PRJEB10854, PRJEB22390 and PRJEB31613, and detailed in Supplementary Table 1. The genomes of ten modern horses, publicly available, were also accessed as indicated in their corresponding original publications57,61,85-87.NOTE: see the published version available via the DOI in this record for the full list of authorsDomestication of horses fundamentally transformed long-range mobility and warfare. However, modern domesticated breeds do not descend from the earliest domestic horse lineage associated with archaeological evidence of bridling, milking and corralling at Botai, Central Asia around 3500 BC. Other longstanding candidate regions for horse domestication, such as Iberia and Anatolia, have also recently been challenged. Thus, the genetic, geographic and temporal origins of modern domestic horses have remained unknown. Here we pinpoint the Western Eurasian steppes, especially the lower Volga-Don region, as the homeland of modern domestic horses. Furthermore, we map the population changes accompanying domestication from 273 ancient horse genomes. This reveals that modern domestic horses ultimately replaced almost all other local populations as they expanded rapidly across Eurasia from about 2000 BC, synchronously with equestrian material culture, including Sintashta spoke-wheeled chariots. We find that equestrianism involved strong selection for critical locomotor and behavioural adaptations at the GSDMC and ZFPM1 genes. Our results reject the commonly held association between horseback riding and the massive expansion of Yamnaya steppe pastoralists into Europe around 3000 BC driving the spread of Indo-European languages. This contrasts with the scenario in Asia where Indo-Iranian languages, chariots and horses spread together, following the early second millennium BC Sintashta culture

Using imperfect data to validate a model of land change

This paper presents a general technique to validate models that predict changes in landscapes between two points in time. The methodology provides useful information about how the reproducibility of both calibration and validation maps influence the validation process. The reproducibility of a map is the expected agreement between a map that contains error and a theoretically remade map that has the same amount of error distributed independently. Matrix algebra is used to compare three maps: 1) the reference calibration map, 2) the reference validation map and 3) the model\u27s predicted map. This comparison is conducted to validate a model of land change while considering: 1) the reproducibility of the reference calibration map, 2) the reproducibility of the reference validation map and 3) the predictive power of the model. We illustrate this technique by applying it to a study area in Central Massachusetts using the Geomod land change model. Geomod predicts land-use change from 1971 to 1999 among four categories: Built, Forest, Water and Other. Results show that the reproducibility of the calibration map of 1971 must be more than 71% in order for the predicted change in the predicted land-use map of 1999 to be measurable, and that the reproducibility of the validation map of 1999 must be more than 76% in order to detect any signal of land change in the reference map of 1999. If the reproducibility falls below these thresholds, then the model\u27s performance should not be assessed with respect to the imperfect data