The Cytoscan (TM) model E-II, a new reflectance microscope for intravital microscopy: Comparison with the standard fluorescence method

The Cytoscan(TM) Model E-II (Cytometrics Inc., Philadelphia, Pa., USA) is a newly developed instrument which functions as an intravital microscope and is small and easily portable. Through the use of orthogonal polarization spectral (OPS) imaging, the Cytoscan Model E-II delivers images of the microcirculation which are comparable to those achieved with intravital fluorescence videomicroscopy (IFM), but without the use of fluorescent dyes. The purpose of this study was to validate the Cytoscan Model E-II instrument against IFM. The experiments were carried out on striated muscle in the dorsal skinfold chamber of the awake Syrian hamster. The following parameters were measured in identical regions of interest in the same animal under baseline conditions and 0.5 and 2 h after a 4-hour period of pressure-induced ischemia: arteriolar diameter, venular diameter and venular red blood cell velocity. Bland-Altman plots showed good agreement between the two techniques for venular red blood cell velocity. As expected, arteriolar and venular diameters as measured by the Cytoscan were on average 5 mum smaller than the values from IFM, since the Cytoscan measures the red blood cell column width and IFM measures luminal diameter. Thus, OPS imaging can be used to make valid measurements of microvascular diameter and red blood cell velocity in tissues. Copyright (C) 2000 S. Karger AG, Basel

Падения в стационаре у пациентов старческого возраста с сердечно-сосудистыми заболеваниями и полипрагмазией

Background. The fall in the elderly is observed much more often than in younger people, and according to statistics the number of people over 65 years who have suffered a fall during the year reaches 30 %, while the probability of injury. Most of the falls in elderly patients does not lead to injury, but the developing at the same time unfavorable psychological discomfort can sharply limit the usual activity, lead to the formation of dependence on outside help, disadaptation in the home and form a fear of a possible fall. Falls, accompanied by the development of trauma, are observed in 10–15 % of cases. The objective was to study the relationship between polymorbidity, polypragmasia and the development of the fall in elderly patients cardiological profile.Results. Polymorbidity prevailed in the group of patients who suffered a fall in the hospital (8.9 ± 2.6 vs 7.5 ± 1.5 in men. 8.5 ± 2.2 vs 7.2 ± 1.6 in women). In patients undergoing a decline, it was also noted, and polypharmacy to a greater extent than cohort patients without falling (9.4 ± 1.9 vs 78.4 ± 2.2 in men. and 9.6 ± 2.7 vs 9.1 ± 2.5 for women). In addition, patients who suffered a fall in the hospital by age were older than patients in the comparison group (86 ± 6 vs 85 ± 5 in men, 87 ± 5 vs 84 ± 5 in women). We also revealed the tendency of the predominance of women in the subgroup of patients with the incidence and development of trauma. Conclusion. Minimizing the amount of drugs received, as the fight against polypragmasy can help reduce the incidence of falls in elderly patients. Введение. Падения у пожилых отмечаются значительно чаще, чем у лиц более молодого возраста. По данным статистики, число лиц старше 65 лет, перенесших падение в течение года, достигает 30 %. Бόльшая часть падений у пациентов пожилого возраста не приводит к травме, однако развивающийся при этом психологический дискомфорт способен резко ограничить привычную активность, привести к формированию зависимости от посторонней помощи, дезадаптации в быту и сформировать страх перед возможным падением. Падения, сопровождающиеся развитием травмы, наблюдаются в 10–15 % случаев. Цель исследования – изучение взаимосвязи между полиморбидностью, полипрагмазией и падением у пациентов старческого возраста кардиологического профиля.Результаты. Полиморбидность преобладала в группе пациентов, перенесших падение в стационаре (8,9 ± 2,6 vs 7,5 ± 1,5 у мужчин; 8,5 ± 2,2 vs 7,2 ± 1,6 у женщин). У пациентов, перенесших падение, также отмечалась полипрагмазия в большей степени, чем у пациентов без падения (9,4 ± 1,9 vs 78,4 ± 2,2 у мужчин; 9,6 ± 2,7 vs 9,1 ± 2,5 у женщин). Кроме того, пациенты, перенесшие падение в стационаре, были старше пациентов группы сравнения (86 ± 6 лет vs 85 ± 5 лет у мужчин; 87 ± 5 лет vs 84 ± 5 лет у женщин). Нами также выявлена тенденция преобладания женщин в группе пациентов с падением и развитием травмы. Заключение. С учетом того, что полипрагмазия является модифицируемым фактором риска падений, минимизация количества получаемых лекарственных средств может способствовать снижению частоты падений у пациентов старческого возраста.

THE FEATURES OF SURFACE PHENOTYPE OF BLOOD LYMPHOCYTES IN THE PATIENTS WITH TUBERCULOSIS

Abstract. Parameters of peripheral blood lymphocytes subpopulations have been studies in the patients with extensive destructive pulmonary tuberculosis caused by drug-sensitive or drug-resistant Mycobacterium tuberculosis before and in the course of specific anti-tuberculosis chemotherapy. It was revealed that in the patients before treatment, a marked immunosuppression takes place, being characterized by decrease of total T-lymphocytes and their basic regulatory and effector subpopulations. E.e., an increase in CD20+-, CD25+- and CD95+cells was observed. The completion of intensive anti-tuberculosis chemotherapy is not accompanied by correction of lymphocyte subpopulations. By contrary, in the patients with drug-sensitive pulmonary tuberculosis M. tuberculosis a sharp increase in CD95+-lymphocytes is registered. After undergoing a full course of therapy a well-noted tendency to normalization of T-lymphocytes (CD3+) quantity, as well as is regulatory populations (CD4+ and CD8+) were found. The level of CD95+-lymphocytes remained increased in the patients with pulmonary tuberculosis caused by drug-resistant M. tuberculosis

Нефрогенная метаплазия с субтотальным поражением мочевого пузыря

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Ис­пользование пероксида водорода выдыхаемого воздуха для оценки эффективности терапии бронхиальной астмы

Exhaled hydrogen peroxide is a marker of airway inflammation. However, its utility for monitoring of asth­ma is still uncertain. The aim of this study was to assess the effect of short-acting β2-agonists and inhaled steroids on the hydrogen peroxide (H202) concentration in expired breath condensate in asthmatic patients. Fifteen patients with moderate atopic asthma were treated with salbutamol as required for 2 weeks followed 12-week treatment with budesonide (Pulmicort Turbuhaler, 400 meg daily). The exhaled H202 concentration as measured using a colorimetric assay (Gallati&Pracht, 1985). FEV1 was assessed using dry spirometer. Airway hyperresponsiveness was considered as a provocative concentration of inhaled histamine causing the 20%-fall in FEV1 (PD20).The H202 baseline level in the asthmatic patients (0.19±0.03 μ‎M) was elevated compared to healthy sub­jects (0.028±0.003, p<0.001). The exhaled H202 concentration did not change during the treatment with salbutamol but it was diminished by Pulmicort Turbuhaler. This was associated with significant improvement in clinical symptom score, FEV1 and PD20 in asthma patients.We conclude that the short-acting β2-agonists do not influence the H202 concentration in the exhaled air condensate of the asthma patients but the inhaled steroids decrease it. This may reflect different anti-inflam­matory activities of these medications.Целью настоящей работы явилось изучение влияния β2-агонистов и ингаляционных стероидов (ИГКС) на концентрацию пероксида водорода (Н2O2) в конденсате выдыхаемого воздуха (КВВ) у больных бронхиальной астмой (БА). Под наблюдением находилось 15 больных атопической БА средней тяжести течения, которые в течение 2 нед получали сальбутамол в режиме "по требованию", а затем в течение 12 нед получали будесонид (пульмикорт турбухалер в дозе 400 мкг/сут). Концентрацию Н2O2 в КВВ изучали спектрофотометрическим методом ("Gallati&Pracht”, 1985). Бронхиальную проходимость (ОФВ1) изучали методом спирометрии. Для оценки гиперреактивности бронхов (ПД20) использовали бронхопровокационный тест с гистамином.Уровень Н2O2 в процессе лечения сальбутамолом (0,19±0,03 мкМ) существенно не изменялся по сравнению с исходным (0,19±0,04 мкМ), а при назначении будесонида достоверно снижался (0,038±0,005). Изменение Н2O2 происходило параллельно с улучшением клинического состояния больных, увеличением ОФВ1 и снижением ПД20.Таким образом, β2-агонисты не влияют, а ИГКС снижают концентрацию Н2O2 в КВВ у больных БА, что, вероятно, отражает их различное влияние на активность воспалительного процесса. Это подтверждает возможность использования Н2O2 в качестве маркера воспаления в дыхательных путях у пациентов с астмой

Падения у коморбидных пациентов старческого возраста при сочетанном применении психотропных и кардиологических лекарственных средств

The article discusses aspects of drug-induced falls in elderly comorbid patients against the background of polypragmasy and also assesses the role of drug interactions that are highly dangerous according to the risk of falling. A drug audit of the obtained pharmacotherapy database was performed in patients with comorbid pathology older than 75 years, in order to identify fall-risk-increasing drugs, ranked according to the degree of risk of falling, their significant interactions and with using the traffic light classification. The data on the analysis of the contribution of psychotropic, cardiological drugs and their combination on the risk of developing a fall in the hospital in comorbid patients of old age against polypragmasy are presented. В статье рассмотрены аспекты лекарственно-индуцированных падений у коморбидных пациентов старческого возраста на фоне полипрагмазии, а также оценена роль сочетанного применения лекарственных средств, отнесенных к высокоопасным по риску падения. Проведен лекарственный аудит базы данных получаемой фармакотерапии у пациентов старше 75 лет с коморбидной патологией на предмет выявления лекарственных средств, отнесенных к высокоопасным по риску падения, ранжированных по степени этого риска согласно светофорной классификации, и их значимых взаимодействий. Представлены данные по анализу исследования вклада психотропных, кардиологических лекарственных средств и их сочетания на риск развития падения в стационаре у коморбидных пациентов старческого возраста на фоне полипрагмазии

Regional development gaps in Argentina: A multidimensional approach to identify the location of policy priorities

Spatial inequalities within Latin American countries have historically attracted the interest ofacademics, policy-makers, and international agencies. This article aims to provide amultidimensional diagnosis of provincial development gaps in Argentina, in order to identifythe location of policy priorities. Therefore, we built a large database, which covers sevendevelopment dimensions, and applied multivariate analysis techniques to overcome someanalytical limitations of previous studies. Results show the stability of provincial developmentgaps between 2003 and 2013 and some heterogeneity within geographic regions. Instead,cluster analysis offers a better classification of Argentine provinces according to theirdevelopment gaps, which can help the government to prioritize the places wheredevelopment policies are strategic.Fil: Niembro, Andrés Alberto. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Patagonia Norte; Argentina. Universidad Nacional de Río Negro; ArgentinaFil: Sarmiento, Jesica Isabel. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Patagonia Norte; Argentina. Universidad Nacional de Río Negro; Argentin

Why Are Outcomes Different for Registry Patients Enrolled Prospectively and Retrospectively? Insights from the Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF).

Background: Retrospective and prospective observational studies are designed to reflect real-world evidence on clinical practice, but can yield conflicting results. The GARFIELD-AF Registry includes both methods of enrolment and allows analysis of differences in patient characteristics and outcomes that may result. Methods and Results: Patients with atrial fibrillation (AF) and ≥1 risk factor for stroke at diagnosis of AF were recruited either retrospectively (n = 5069) or prospectively (n = 5501) from 19 countries and then followed prospectively. The retrospectively enrolled cohort comprised patients with established AF (for a least 6, and up to 24 months before enrolment), who were identified retrospectively (and baseline and partial follow-up data were collected from the emedical records) and then followed prospectively between 0-18 months (such that the total time of follow-up was 24 months; data collection Dec-2009 and Oct-2010). In the prospectively enrolled cohort, patients with newly diagnosed AF (≤6 weeks after diagnosis) were recruited between Mar-2010 and Oct-2011 and were followed for 24 months after enrolment. Differences between the cohorts were observed in clinical characteristics, including type of AF, stroke prevention strategies, and event rates. More patients in the retrospectively identified cohort received vitamin K antagonists (62.1% vs. 53.2%) and fewer received non-vitamin K oral anticoagulants (1.8% vs . 4.2%). All-cause mortality rates per 100 person-years during the prospective follow-up (starting the first study visit up to 1 year) were significantly lower in the retrospective than prospectively identified cohort (3.04 [95% CI 2.51 to 3.67] vs . 4.05 [95% CI 3.53 to 4.63]; p = 0.016). Conclusions: Interpretations of data from registries that aim to evaluate the characteristics and outcomes of patients with AF must take account of differences in registry design and the impact of recall bias and survivorship bias that is incurred with retrospective enrolment. Clinical Trial Registration: - URL: http://www.clinicaltrials.gov . Unique identifier for GARFIELD-AF (NCT01090362)

Improved risk stratification of patients with atrial fibrillation: an integrated GARFIELD-AF tool for the prediction of mortality, stroke and bleed in patients with and without anticoagulation.

OBJECTIVES: To provide an accurate, web-based tool for stratifying patients with atrial fibrillation to facilitate decisions on the potential benefits/risks of anticoagulation, based on mortality, stroke and bleeding risks. DESIGN: The new tool was developed, using stepwise regression, for all and then applied to lower risk patients. C-statistics were compared with CHA2DS2-VASc using 30-fold cross-validation to control for overfitting. External validation was undertaken in an independent dataset, Outcome Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF). PARTICIPANTS: Data from 39 898 patients enrolled in the prospective GARFIELD-AF registry provided the basis for deriving and validating an integrated risk tool to predict stroke risk, mortality and bleeding risk. RESULTS: The discriminatory value of the GARFIELD-AF risk model was superior to CHA2DS2-VASc for patients with or without anticoagulation. C-statistics (95% CI) for all-cause mortality, ischaemic stroke/systemic embolism and haemorrhagic stroke/major bleeding (treated patients) were: 0.77 (0.76 to 0.78), 0.69 (0.67 to 0.71) and 0.66 (0.62 to 0.69), respectively, for the GARFIELD-AF risk models, and 0.66 (0.64-0.67), 0.64 (0.61-0.66) and 0.64 (0.61-0.68), respectively, for CHA2DS2-VASc (or HAS-BLED for bleeding). In very low to low risk patients (CHA2DS2-VASc 0 or 1 (men) and 1 or 2 (women)), the CHA2DS2-VASc and HAS-BLED (for bleeding) scores offered weak discriminatory value for mortality, stroke/systemic embolism and major bleeding. C-statistics for the GARFIELD-AF risk tool were 0.69 (0.64 to 0.75), 0.65 (0.56 to 0.73) and 0.60 (0.47 to 0.73) for each end point, respectively, versus 0.50 (0.45 to 0.55), 0.59 (0.50 to 0.67) and 0.55 (0.53 to 0.56) for CHA2DS2-VASc (or HAS-BLED for bleeding). Upon validation in the ORBIT-AF population, C-statistics showed that the GARFIELD-AF risk tool was effective for predicting 1-year all-cause mortality using the full and simplified model for all-cause mortality: C-statistics 0.75 (0.73 to 0.77) and 0.75 (0.73 to 0.77), respectively, and for predicting for any stroke or systemic embolism over 1 year, C-statistics 0.68 (0.62 to 0.74). CONCLUSIONS: Performance of the GARFIELD-AF risk tool was superior to CHA2DS2-VASc in predicting stroke and mortality and superior to HAS-BLED for bleeding, overall and in lower risk patients. The GARFIELD-AF tool has the potential for incorporation in routine electronic systems, and for the first time, permits simultaneous evaluation of ischaemic stroke, mortality and bleeding risks. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier for GARFIELD-AF (NCT01090362) and for ORBIT-AF (NCT01165710)