Christian Woman\u27s Board of Missions Golden Jubilee

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Difficulties in diagnosing atypical hemolytic uremic syndrome

The paper presents the case of clinical observation of a patient with atypical hemolytic-uremic syndrome (aHUS). aHUS is a disease characterized by an unfavorable prognosis (severe or catastrophic course with rapid development of terminal renal or multi-organ failure). The aim of the study is to evaluate the approaches to differential diagnosis of aHUS in clinical practice.Material and methods. The study was conducted on the basis of the Nephrology Department of Kemerovo Regional Clinical Hospital n.a. S.V Belyaev. The clinical observation of patient D., aged 26 years old, is discussed.Results and discussion. Diagnosing aHUS requires: 1) diagnosing thrombotic microangiopathy (TMA: thrombocytopenia or decrease in platelet count by more than 25 % of original, visceral damage (kidneys, CNS, gastrointestinal tract, heart, lungs)); 2) ruling out HUS associated with Shiga toxin-producing Escherichia coli (STEC-HUS; negative for Shiga-toxin in blood and stool), thrombotic thrombocytopenic purpura (TTP), systemic connective tissue disease, catastrophic antiphospholipid syndrome, HIV infection; 3) assessing the activity of ADAMTS13 (decrease confirms the aHUS diagnosis); 4) proving normal content of complement components C3 and C4 as an additional argument in favor of aHUS diagnosis. At the first stage, the patient was diagnosed with TMA (platelet content 37 x 109/l, hemoglobin content 59 g/l), LDH up to 824 E/l), liver damage (AST, ALT and LDH activity 55, 60 and 824 U/l, respectively), kidney damage (acute renal damage), lungs, heart, and brain damage. At the second stage the following diagnoses were ruled out: STEC-HUS (Shiga toxin in blood and stool was not detected), TTP (ADAMTS13 activity level was 66 %, whereas reference values are 93-113 %, in TTP - below 5-10 %); systemic connective tissue diseases catastrophic antiphospholipid syndrome, HIV infection sepsis. Normal values of C3 (0.9 g/l) and C4 (0.23 g/l) complement components did not rule out the diagnosis of aHUS

An app-, web- and social support-based weight loss intervention for adults with obesity: the 'HelpMeDoIt!' feasibility randomised controlled trial

This is the final version. Available on open access from BMC via the DOI in this recordAvailability of data and materials: The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.Background: Social support has an important role in successful weight loss. The aim of this study was to assess the feasibility and acceptability of an app-, web- and social support-based intervention in supporting adults with obesity to achieve weight loss. Methods: The intervention and evaluation methods were tested in a feasibility randomised controlled trial. Adults in the Greater Glasgow and Clyde Health Board area of Scotland with a body mass index ≥ 30 kg/m2 were recruited and randomised 2:1 (intervention to control). The feasibility and acceptability of the intervention and trial methods were assessed against pre-specified progression criteria, via process, economic and outcome evaluation. Three primary outcomes were explored: BMI, diet and physical activity, as well as a number of secondary outcomes. The intervention group had access to the HelpMeDoIt! intervention for 12 months. This encouraged them to (i) set goals, (ii) monitor progress and (iii) harness social support by inviting 'helpers' from their existing social network. The control group received a healthy lifestyle leaflet. Results: One hundred and nine participants were recruited, with 84 participants (77%) followed-up at 12 months. The intervention and trial methods were feasible and acceptable. Participants and helpers were generally positive. Of the 54 (74%) participants who downloaded the app, 48 (89%) used it. Interview data indicated that HelpMeDoIt! promoted social support from existing social networks to support weight loss. This support was often given outside of the app.Outcomes were compared using linear regression models, with randomised group, the baseline measurement of the outcome, age and gender as predictor variables. These analyses were exploratory and underpowered to detect effects. However, all pre-specified primary outcome effects (BMI, diet and physical activity) had wide confidence intervals and were therefore consistent with clinically relevant benefits. Objective physical activity measures perhaps showed most potential (daily step count (p = 0.098; 1187 steps [- 180, 2555])) and sedentary time (p = 0.022; - 60.8 min [- 110.5, - 11.0]). However, these outcomes were poorly completed. Conclusions: The study demonstrated that a novel social support intervention involving support from participants' close social networks, delivered via app and website, has potential to promote weight loss and is feasible and acceptable. Trial registration: ISRCTN, ISRCTN85615983. Registered 25 September 2014.National Institute for Health Research (NIHR)Medical Research Council (MRC)Chief Scientist Office Social and Public Health Sciences Uni

Results of Monitoring over and Biological Properties of <I>Vibrio cholerae</I> Isolated from Ambient Environment Objects in the Khabarovsk Territory

genotype and a unique MLVA profile. The results of the monitoring indicated that there were optimal for V. cholerae accumulation in surface water reservoirs conditions and it was necessary to enhance measures for cholera prophylaxis in the post-flood period

Anti-Corruption Transformation Processes in the Conditions of the Judicial Reform in Ukraine Implementation

This article analyses the anti-corruption transformative processes triggered by Ukraine’s judicial reform. The subject of the study is the determination of the critical aspects of the success of anti-corruption transformative measures conditioned by the anti-corruption reform in Ukraine. The objectives of the article are to determine the main anti-corruption challenges facing the Ukrainian judicial system and to characterise the main legislative countermeasures. The authors emphasise that a properly functioning system of courts supports the realisation of many development goals – by protecting human rights, resolving social conflicts, and implementing government policy. However, today the judiciary in Ukraine still needs to meet these principles. One of the crucial aspects of judicial reform in Ukraine is undoubtedly the overcoming of corruption, which significantly distorts the independence of judges and the principle of equality. The article is structured as follows: current challenges of the Ukrainian judiciary: corruption and judicial independence (1); the essence of the primary measures of judicial reform (2); the role of the Constitutional Court of Ukraine in curbing anti-corruption measures of judicial reform (3) and the creation of the Higher Anti-Corruption Court as an anticorruption component of judicial reform. The authors formulated two critical factors for the success of judicial reform. The first factor is the presence of political will and coordinated cooperation between the President of Ukraine and the Verkhovna Rada of Ukraine. The second factor is the active participation of the public in initiating and controlling the implementation of reform measures.У цій статті аналізуються антикорупційні трансформаційні процеси, започатковані судовою реформою в Україні. Предметом дослідження є визначення критичних аспектів успішності антикорупційних трансформаційних заходів, зумовлених проведенням антикорупційної реформи в Україні. Завданням статті є визначення основних антикорупційних викликів, що постають перед українською судовою системою, та характеристика основних законодавчих заходів протидії. Автори підкреслюють, що належно функціонуюча система судів сприяє реалізації багатьох цілей розвитку – шляхом захисту прав людини, вирішення соціальних конфліктів, реалізації державної політики. Однак сьогодні судочинство в Україні ще має відповідати цим принципам. Одним із важливих аспектів судової реформи в Україні, безперечно, є подолання корупції, яка суттєво спотворює незалежність суддів та принцип рівності. Стаття структурована так: сучасні виклики українській судовій системі: корупція та незалежність суду (1); сутність першочергових заходів судової реформи (2); роль Конституційного Суду України в стримуванні антикорупційних заходів судової реформи (3) та створення Вищого антикорупційного суду як антикорупційної складової судової реформи. Автори сформулювали два критичні фактори успіху судової реформи. Перший чинник – це наявність політичної волі та злагоджена співпраця між Президентом України та Верховною Радою України. Другим фактором є активна участь громадськості в ініціюванні та контролі за впровадженням реформаторських заходів

ВНУТРИБРЮШНАЯ АЭРОЗОЛЬНАЯ ХИМИОТЕРАПИЯ ПОД ДАВЛЕНИЕМ В СОЧЕТАНИИ С СИСТЕМНОЙ ХИМИОТЕРАПИЕЙ – НОВЫЙ ПОДХОД В ЛЕЧЕНИИ БОЛЬНЫХ РАКОМ ЖЕЛУДКА С ПЕРИТОНЕАЛЬНЫМ КАРЦИНОМАТОЗОМ

The aim of the study was to analyze the immediate and long-term outcomes of pressurized intraperitoneal aerosol chemotherapy (PIPAC) in gastric cancer patients with peritoneal carcinomatosis (PC). Material and methods. The treatment protocol included diagnostic laparoscopy with PCI score assessment and peritoneal biopsy and 4 courses of systemic chemotherapy with XELOX or FOLFOX followed by PIPAC with cisplatin and doxorubicin at 6–8 week intervals. Between the PIPAC cycles patients received systemic chemotherapy according to previous regimen. Each PIPAC procedure included laparoscopy, evaluation of Peritoneal Carcinomatosis Index (PCI) and peritoneal biopsies. Results. 102 (80.3 %) patients had primary gastric cancer with PC and 25 (19.7 %) had peritoneal recurrence of gastric cancer. PCI&lt;10 points was found in 60 (47.2%) patients, PCI 10–18 in 33 (26 %) patients and PCI&gt;18 in 34 (26.7 %) patients. Diffuse type of cancer was diagnosed in 114 patients (89.7 %), intestinal type in 6 (4.7 %) patients and the mixed type in 7 (5.5 %) patients. 127 patients underwent 310 PIPAC procedures. No severe complications and were observed. Pathological response (PRGC score) was evaluated in 72 patients. Partial pathological response (PRGS 2) was achieved in 40 (55.6 %) cases and complete pathological response (PRGS 1) – in 10 (13.9 %). Survival was evaluated in 63 % (n=80) patients who received more than one PIPAC. The median survival was 16.0 months and one year survival rate was 77.9 %. Conclusion. A new approach to the treatment of gastric cancer with PC combining systemic chemotherapy and pressurized intraperitoneal aerosol chemotherapy is a simple and save method allowing improvement of survival of patients with peritoneal dissemination of gastric cancer.Цель исследования – изучить непосредственные и отдалённые результаты применения внутрибрюшной аэрозольной химиотерапии под давлением (ВАХД) у больных с перитонеальным карциноматозом при раке желудка. Материал и методы. На первом этапе, согласно протоколу исследования, пациентам выполняли стадирующую лапароскопию, в ходе которой определяли распространённость перитонеального карциноматоза по шкале PCI с обязательной множественной биопсией брюшины и последующим гистологическим исследованием измененных участков брюшины. Лечение начинали с 4 курсов системной химиотерапии по схеме XELOX или FOLFOX. В дальнейшем больным в условиях торакоабдоминального отделения осуществляли сеансы ВАХД препаратами цисплатин и доксорубицин с интервалом 6–8 нед. Между сеансами пациенты продолжали получать системную химиотерапию по прежней схеме. Каждый сеанс ВАХД включал лапароскопию, повторную биопсию и оценку PCI. Результаты. У 102 (80,3 %) больных был первичный рак желудка с ПК, у 25 (19,7 %) – перитонеальный рецидив. PCI&lt;10 баллов зафиксирован у 60 (47,2 %), PCI 10–18 – у 33 (26 %), PCI&gt;18 – у 34 (26,7 %). Диффузный тип рака желудка выявлен у 114 больных (89,7 %), кишечный тип – у 6 (4,7 %), смешанный тип – у 7 (5,5 %). С 2013 г. 127 больным проведено 310 процедур ВАХД. Тяжелых осложнений и летальности не отмечено. Лечебный патоморфоз был оценен у 72 больных. У 40 (55,6 %) больных отмечен выраженный патоморфоз (PRGS 2) и у 10 (13,9%) – полный патоморфоз (PRGS 1). Выживаемость оценена у 63 % (n=80), получивших более 1 сеанса ВАХД. Медиана выживаемости составила 16,0 мес, 1-годичная выживаемость – 77,9 %. Заключение. Новый подход к лечению больных раком желудка с перитонеальным карциноматозом, сочетающий системную химиотерапию и внутрибрюшную аэрозольную химиотерапию под давлением, зарекомендовал себя как относительно простой и безопасный метод, позволяющий добиться увеличения общей выживаемости у пациентов с диссеминированным раком желудка

РОЛЬ ТРАНСПИЩЕВОДНОЙ ТОНКОИГОЛЬНОЙ ПУНКЦИИ ПОД КОНТРОЛЕМ ЭНДОСОНОГРАФИИ В СТАДИРОВАНИИ РАКА ЛЕГКОГО ПО N-КРИТЕРИЮ

Background: lung cancer is a relevant problem of public health which takes first place among other cancer diseases according to its lethality rate in spite of certain success of chemo- and radiotherapy in combination with surgery. Basic techniques of effectiveness increase are early detection as well as overall examination which aim is detection, morphological verification and comprehensive assessment of the extent of tumorous lesions. Endosonography from esophagus lumen with fine-needle punction is a technique which is only starting to be used as an instrument of specializing diagnostics in lung cancer staging by N-criterion which is critical when deciding on tumor resectability. The following research was carried out taking into consideration few in number data about opportunities of this technique, its role and place in the diagnostic procedure with patients suffering from lung cancer. Research objective: to determine the role and the place of EUS-FNA in the examination procedure of patients suffering from lung cancer with development of lymphadenopathy of mediastinum. Research tasks: to assess the opportunities of EUS and EUS-FNA in visualization and assessment of the type of lymphadenopathy of mediastinum, to carry out comparative analysis of EUS and EUS-FNA effectiveness in comparison to computer-aided tomography and operating material morphological examination data. Results: the sensitivity and specificity of EUS-FNA in verification of lymphadenopathy make 80 per cent and 100 per cent, predicted positive value is 100 per cent, predicted negative value is 88 per cent.Рак легкого - актуальная проблема здравоохранения, по показателю смертности лидирует среди других онкологических заболеваний, несмотря на определенные успехи химиолучевой терапии в сочетании с хирургией. Основными способами повышения эффективности лечения являются ранняя диагностика, а также всестороннее обследование, цель которого - выявление, морфологическая верификация и комплексная оценка распространенности опухолевого поражения. Эндосонография из просвета пищевода с тонкоигольной пункцией (ЭУС-ТИП) - методика, которая только начинает использоваться как инструмент уточняющей диагностики в стадировании рака легкого по N-критерию, критичному при решении вопроса о резектабельности опухоли. С учетом немногочисленных данных о возможностях данной методики, о ее роли и месте в диагностическом алгоритме у пациентов, страдающих раком легкого, было предпринято настоящее исследование. Цель исследования: установить роль и место ЭУС и ЭУС-ТИП в алгоритме обследования больных, страдающих раком легкого с явлениями лимфаденопатии средостения. Задачи исследования: оценить возможности ЭУС и ЭУС-ТИП в визуализации, оценке характера лимфаденопатии средостения, провести сравнительный анализ эффективности ЭУС+ЭУС-ТИП в сравнении с компьютерной томографии (КТ) и данными морфологического исследования операционного материала. Результаты: чувствительность и специфичность ЭУС-ТИП в верификации лимфаденопатии составили 80% и 100%, прогностическая ценность положительного результата (PV+) - 100%, прогностическая ценность отрицательного результата (PV-) - 88%. Заключение: эндоскопическая ультрасо-нография (ЭУС и ЭУС-ТИП) в диагностическом алгоритме позволяет обнаруживать, классифицировать группы лимфатических узлов, морфологически верифицировать характер лимфаденопатии

THE INTERPRETATION OF A LITERARY TEXT THROUGH THE CONSTRUCTION OF CONCEPTUAL FIELDS

The article describes the approach to the literary text through the analysis of the means of the creation of a conceptual field that centralizes its view on a man in his interconnection with the world and other people

Digitalisation of Professional Education: Prospects and Invisible Barriers

Introduction. Nowadays, digital education is one of the priorities of state policy in modern Russia. The Federal Institute for the Development of Education has developed a draft didactic concept of digital education to maximise the potential of digital technology (DT) in vocational training. Nevertheless, while policymakers and education managers are aware of the need to move to a new level of digital technology implementation, there are challenges to this process. The technological resources of educational environment have been increasing intensively in the past decade, and their intensive scientific and pedagogical development is observed. However, little attention is given to the willingness of teachers to work with continuously evolving technological tools.The aim of the research is to identify the barriers, which hinder the professional development of teachers in mastering information and communications technologies (ICT) and digital technologies, as well as some mental attitudes circulating in the society and slowing down the process of digitalisation of vocational education.Methodology and research methods. The present research is based on personal-context and personal-development approaches. In the course of experimental research and two pilot studies, teachers and specialists of professional educational organisations were interviewed (n = 187 people). The methods of questionnaire-based survey, sociological analysis, statistical data-processing tools and Google Forms tools were used.Results and scientific novelty. On the basis of the outcomes of the conducted surveys, the following aspects were analysed: the degree of teachers’ skills formation declared in the professional standard; willingness to implement e-learning, expand the range of ICT and GT included in teaching practice; respondents’ attitudes towards the digitalisation of education and their self-recognition in this process. Clear and invisible obstacles to the process under discussion are identified and sistematised. The found barriers are classified into risk, image and didactic barriers. The recommendations to overcome the barriers are proposed. According to the authors of the present article, it is advisable to introduce a new specialty “digital engineer-teacher” due to the obvious integration of pedagogical and engineering functions into the activities of teachers. Working in one team consisted of a specialist, who designs an effective teaching environment, and a teacher-didactist, will reduce a part of unjustified functional workload of the latter.Practical significance. The materials of the undertaken research have significant implications for further development of perceptions of the essence and content of digital didactics; justification and formation of optimal conditions for digitalisation of vocational education, including psychological and pedagogical adjustment of the system of training and retraining of pedagogical and managerial personnel for the digital economy