Global Retinoblastoma Presentation and Analysis by National Income Level

Importance: Early diagnosis of retinoblastoma, the most common intraocular cancer, can save both a child's life and vision. However, anecdotal evidence suggests that many children across the world are diagnosed late. To our knowledge, the clinical presentation of retinoblastoma has never been assessed on a global scale. Objectives: To report the retinoblastoma stage at diagnosis in patients across the world during a single year, to investigate associations between clinical variables and national income level, and to investigate risk factors for advanced disease at diagnosis. Design, Setting, and Participants: A total of 278 retinoblastoma treatment centers were recruited from June 2017 through December 2018 to participate in a cross-sectional analysis of treatment-naive patients with retinoblastoma who were diagnosed in 2017. Main Outcomes and Measures: Age at presentation, proportion of familial history of retinoblastoma, and tumor stage and metastasis. Results: The cohort included 4351 new patients from 153 countries; the median age at diagnosis was 30.5 (interquartile range, 18.3-45.9) months, and 1976 patients (45.4) were female. Most patients (n = 3685 84.7%) were from low-and middle-income countries (LMICs). Globally, the most common indication for referral was leukocoria (n = 2638 62.8%), followed by strabismus (n = 429 10.2%) and proptosis (n = 309 7.4%). Patients from high-income countries (HICs) were diagnosed at a median age of 14.1 months, with 656 of 666 (98.5%) patients having intraocular retinoblastoma and 2 (0.3%) having metastasis. Patients from low-income countries were diagnosed at a median age of 30.5 months, with 256 of 521 (49.1%) having extraocular retinoblastoma and 94 of 498 (18.9%) having metastasis. Lower national income level was associated with older presentation age, higher proportion of locally advanced disease and distant metastasis, and smaller proportion of familial history of retinoblastoma. Advanced disease at diagnosis was more common in LMICs even after adjusting for age (odds ratio for low-income countries vs upper-middle-income countries and HICs, 17.92 95% CI, 12.94-24.80, and for lower-middle-income countries vs upper-middle-income countries and HICs, 5.74 95% CI, 4.30-7.68). Conclusions and Relevance: This study is estimated to have included more than half of all new retinoblastoma cases worldwide in 2017. Children from LMICs, where the main global retinoblastoma burden lies, presented at an older age with more advanced disease and demonstrated a smaller proportion of familial history of retinoblastoma, likely because many do not reach a childbearing age. Given that retinoblastoma is curable, these data are concerning and mandate intervention at national and international levels. Further studies are needed to investigate factors, other than age at presentation, that may be associated with advanced disease in LMICs. © 2020 American Medical Association. All rights reserved

LINGUACULTURAL ANALYSIS OF FLORA REPRESENTATION IN SPANISH, MEXICAN, AND COLOMBIAN RIDDLES

This paper is dedicated to the linguacultural, lexical and semantic analysis of Spanish, Mexican, and Colombian riddles about plants. The study of the linguistic worldview perception and its verbalization associated with flora representation in folklore texts is of particular interest. Phytonyms in riddles carry a great semantic load, help to better understand ethnic priorities. Of particular interest are riddles in which ethno-specific features of the Spanish, Mexican, and Colombian linguistic pictures of the world are manifested. Units of culture are revealed in the texts of riddles, firstly, because they contain linguistic elements that are peculiar only to a certain culture, and due to unique ethno-specific elements directly reflect the features of the corresponding linguistic culture. Secondly, in addition to such a direct reflection, cultural units can be transmitted indirectly in texts, through specific structures, which find their expression in the way of describing hidden phytonyms. The lexical and semantic analysis of riddles about the plant world makes it possible to reconstruct the folklore features of phytonyms and, based on the typology of these features, describe plants that are prototypical for linguistic personalities of different Spanish-speaking countries. The analysis of non-standard language explicants of plants allows not only to determine their most relevant features, but also to generalize the metaphorical or metonymic aspect of transfers

Краниоцеребральная гипотермия как метод терапии нарушений температурного баланса головного мозга у пациентов в посткоматозном периоде

Background. Functional outcome in patients after cardiovascular, cerebral or traumatic injuries often remains unfavorable, what needs long rehabilitation and care. Aims. Optimization of chronically critically ill patients treatment using selective craniocerebral hypothermia added to a standard intensive care. Methods. Use of craniocerebral therapeutic hypothermia device «ATG-01» has greater clinical efficacy in mortality rate, CRS-R rate and modified Rankin scale rate, as well as decrease in disability rate. Treatment algorithm with the use of craniocerebral hypothermia device «ATG-01» has greater efficacy in cost- effectiveness analysis. Results. Methods of multipositional SHF- radiothermometry and thermomonitoring, as well as non-invasive craniocerebral hypothermia used in chronically critically ill patients for the first time. Results of our research have showed high efficacy of these methods and let us optimistically estimate the perspective to involve CCH in rehabilitation interventions of such patients. Conclusion. Our results can be used in Intensive Care Units of different medical institutions that provide healthcare to patients with brain damage and common central nervous system diseases that outcome to low level of consciousness.Обоснование. Функциональный исход у пациентов, перенесших сердечно-сосудистые, церебральные и травматические катастрофы, часто остается неблагоприятным, что требует длительной реабилитации и стороннего ухода. Цель - оптимизация лечения пациентов в хроническом критическом состоянии путем селективной церебральной гипотермии в комплексе со стандартной интенсивной терапией. Методы. Применение аппарата краниоцеребральной терапевтической гипотермии «АТГ-01» сопряжено с большей клинической эффективностью в плане уменьшения летальности, улучшения показателей по шкале CRS-R (Coma Recovery Scale-Revised) и модифицированной шкале инвалидизации Rankin, а также увеличения числа пациентов, избежавших инвалидизации. Схема лечения с применением аппарата краниоцеребральной терапевтической гипотермии «АТГ-01» обладает наибольшей эффективностью затрат в рамках анализа затраты-эффективность. Результаты. Методы многопозиционной СВЧ-радиотермометрии и термомониторинга, а также неинвазивной краниоцеребральной гипотермии впервые были применены у пациентов в хроническом критическом состоянии. Результаты исследования показали их высокую эффективность и позволяют оптимистично оценить перспективу введения краниоцеребральной гипотермии в комплекс реабилитационных мероприятий такого рода пациентов. Заключение. Полученные результаты могут быть применены в реанимационных отделениях различных лечебно-профилактических учреждений, оказывающих медицинскую помощь пациентам с повреждениями мозга и наиболее распространенными заболеваниями центральной нервной системы с исходом в низкий уровень сознания

Коррекция нарушений теплового баланса головного мозга в терапии и реабилитации пациентов с церебральной патологией

Temperature monitoring of the brain using radiothermometric technology allows you to assess the imbalance of the thermal balance of the brain, and the technique has shown the possibility and information content of its use in the diagnosis of cerebral lesions. In healthy individuals, at rest, the average temperature of the left (36.74 ± 0.37 ° C) and the right hemisphere (36.64 ± 0.32 ° C). In boxing athletes who received "planned" minor traumatic brain injuries after training sparring, the average temperature of the left (38.4 ± 0.28 ° C) and right temperature (38.2 ± 0.45 ° C), which is significantly elevated. Patients in chronic critical conditions showed a monotonous temperature distribution in the left (36.98 ± 0.18 ° C) and right hemispheres (36.88 ± 0.21 ° C). The temperature heterogeneity of the brain in this category of patients was less pronounced compared with healthy individuals, athletes after sports head injury.Поражения головного мозга весьма часто приводят к нарушениям общего и церебрального теплового баланса, играющим важную роль в патогенетических механизмах вторичных повреждений нейронов. Краниоцеребральная гипотермия позволяет купировать нарушения общего и церебрального термогомеостаза и проявляет выраженные нейропротективные эффекты, что позволяет рекомендовать её применение в составе лечебных и реабилитационных мероприятий. Краниоцеребральная гипотермия, по сравнению с методиками общего охлаждения организма, направлена в первую очередь на понижение температуры мозга, а не внутренних органов, то есть на достижение эффектов нейропротекции. Температурный мониторинг головного мозга с использованием радиотермометрических технологии позволяет оценить нарушения теплового баланса мозга, а методика показала возможность и информативность использования её в диагностике церебральных поражений. У здоровых лиц в покое значения усредненной температуры левого (36,74 ± 0,37°С) и правого полушария (36,64 ± 0,32°С). У спортсменов-боксеров, получивших «запланированные» легкие черепно-мозговые травмы после тренировочных спаррингов, значения усредненной температуры левого (38,4 ± 0,28°С) и правого (38,2 ± 0,45°С), что оказывается существенно повышенным. У пациентов в хронических критических состояниях выявлено монотонное распределение температуры в левом (36,98±0,18°С) и правом полушариях (36,88±0,21°С). Температурная гетерогенность мозга у данной категории пациентов была менее выражена по сравнению со здоровыми лицами, спортсменами после спортивной черепно-мозговой травмы

Global Retinoblastoma Presentation and Analysis by National Income Level

This cross-sectional analysis reports the retinoblastoma stage at diagnosis across the world during a single year, investigates associations between clinical variables and national income level, and investigates risk factors for advanced disease at diagnosis. Key PointsQuestionIs the income level of a country of residence associated with the clinical stage of presentation of patients with retinoblastoma? FindingsIn this cross-sectional analysis that included 4351 patients with newly diagnosed retinoblastoma, approximately half of all new retinoblastoma cases worldwide in 2017, 49.1\% of patients from low-income countries had extraocular tumor at time of diagnosis compared with 1.5\% of patients from high-income countries. MeaningThe clinical stage of presentation of retinoblastoma, which has a major influence on survival, significantly differs among patients from low-income and high-income countries, which may warrant intervention on national and international levels. ImportanceEarly diagnosis of retinoblastoma, the most common intraocular cancer, can save both a child's life and vision. However, anecdotal evidence suggests that many children across the world are diagnosed late. To our knowledge, the clinical presentation of retinoblastoma has never been assessed on a global scale. ObjectivesTo report the retinoblastoma stage at diagnosis in patients across the world during a single year, to investigate associations between clinical variables and national income level, and to investigate risk factors for advanced disease at diagnosis. Design, Setting, and ParticipantsA total of 278 retinoblastoma treatment centers were recruited from June 2017 through December 2018 to participate in a cross-sectional analysis of treatment-naive patients with retinoblastoma who were diagnosed in 2017. Main Outcomes and MeasuresAge at presentation, proportion of familial history of retinoblastoma, and tumor stage and metastasis. ResultsThe cohort included 4351 new patients from 153 countries; the median age at diagnosis was 30.5 (interquartile range, 18.3-45.9) months, and 1976 patients (45.4\%) were female. Most patients (n=3685 {[}84.7\%]) were from low- and middle-income countries (LMICs). Globally, the most common indication for referral was leukocoria (n=2638 {[}62.8\%]), followed by strabismus (n=429 {[}10.2\%]) and proptosis (n=309 {[}7.4\%]). Patients from high-income countries (HICs) were diagnosed at a median age of 14.1 months, with 656 of 666 (98.5\%) patients having intraocular retinoblastoma and 2 (0.3\%) having metastasis. Patients from low-income countries were diagnosed at a median age of 30.5 months, with 256 of 521 (49.1\%) having extraocular retinoblastoma and 94 of 498 (18.9\%) having metastasis. Lower national income level was associated with older presentation age, higher proportion of locally advanced disease and distant metastasis, and smaller proportion of familial history of retinoblastoma. Advanced disease at diagnosis was more common in LMICs even after adjusting for age (odds ratio for low-income countries vs upper-middle-income countries and HICs, 17.92 {[}95\% CI, 12.94-24.80], and for lower-middle-income countries vs upper-middle-income countries and HICs, 5.74 {[}95\% CI, 4.30-7.68]). Conclusions and RelevanceThis study is estimated to have included more than half of all new retinoblastoma cases worldwide in 2017. Children from LMICs, where the main global retinoblastoma burden lies, presented at an older age with more advanced disease and demonstrated a smaller proportion of familial history of retinoblastoma, likely because many do not reach a childbearing age. Given that retinoblastoma is curable, these data are concerning and mandate intervention at national and international levels. Further studies are needed to investigate factors, other than age at presentation, that may be associated with advanced disease in LMICs