ДОСВІД ЗАСТОСУВАННЯ ТЕЛЕМЕДИЧНИХ ТЕХНОЛОГІЙ НА ПЕРВИННОМУ РІВНІ МЕДИЧНОЇ ДОПОМОГИ

The aim of the work – to highlight the experience of using telemedicine technologies at the educational and practical centers of primary health care of I. Horbachevsky Ternopil State Medical University.The main body. The article adduces examples of the application of telemedicine technologies in the teaching and practical centers of primary health care of I. Horbachevsky Ternopil State Medical University. Telemedicine services that are advisable to implement at the primary level of health care are listed.Conclusion. Created by I. Horbachevsky Ternopil State Medical University educational and practical centers testify to the real possibilities of implementing the Law of Ukraine “On improving the availability and quality of medical care in rural areas” by introducing telemedicine technologies at the level of institutions of primary health care.Мета роботи – висвітлити досвід використання телемедичних технологій у навчально-практичних центрах первинної медико-­санітарної допомоги Тернопільського державного медичного університету імені І. Я. Горбачевського.Основна частина. У статті висвітлено приклади застосування телемедичних технологій у навчально-практичних центрах первинної медико-санітарної допомоги  Тернопільського державного медичного університету імені І. Я. Горбачевського. Подано перелік телемедичних послуг, які доцільно впровадити на первинному рівні медичної допомоги.Висновок. Створені Тернопільським державним медичним університетом імені І. Я. Горбачевського навчально-практичні центри засвідчують реальні можливості виконання Закону України “Про підвищення доступності та якості медичного обслуговування у сільській місцевості” шляхом запровадження на рівні закладів первинної медичної допомоги технологій телемедицини.

Math1 Is Essential for the Development of Hindbrain Neurons Critical for Perinatal Breathing

SummaryMice lacking the proneural transcription factor Math1 (Atoh1) lack multiple neurons of the proprioceptive and arousal systems and die shortly after birth from an apparent inability to initiate respiration. We sought to determine whether Math1 was necessary for the development of hindbrain nuclei involved in respiratory rhythm generation, such as the parafacial respiratory group/retrotrapezoid nucleus (pFRG/RTN), defects in which are associated with congenital central hypoventilation syndrome (CCHS). We generated a Math1-GFP fusion allele to trace the development of Math1-expressing pFRG/RTN and paratrigeminal neurons and found that loss of Math1 did indeed disrupt their migration and differentiation. We also identified Math1-dependent neurons and their projections near the pre-Bötzinger complex, a structure critical for respiratory rhythmogenesis, and found that glutamatergic modulation reestablished a rhythm in the absence of Math1. This study identifies Math1-dependent neurons that are critical for perinatal breathing that may link proprioception and arousal with respiration

A cartilage growth mixture model for infinitesimal strains: solutions of boundary-value problems related to in vitro growth experiments

A cartilage growth mixture (CGM) model is linearized for infinitesimal elastic and growth strains. Parametric studies for equilibrium and nonequilibrium boundary-value problems representing the in vitro growth of cylindrical cartilage constructs are solved. The results show that the CGM model is capable of describing the main biomechanical features of cartilage growth. The solutions to the equilibrium problems reveal that tissue composition, constituent pre-stresses, and geometry depend on collagen remodeling activity, growth symmetry, and differential growth. Also, nonhomogeneous growth leads to nonhomogeneous tissue composition and constituent pre-stresses. The solution to the nonequilibrium problem reveals that the tissue is nearly in equilibrium at all time points. The results suggest that the CGM model may be used in the design of tissue engineered cartilage constructs for the repair of cartilage defects; for example, to predict how dynamic mechanical loading affects the development of nonuniform properties during in vitro growth. Furthermore, the results lay the foundation for future analyses with nonlinear models that are needed to develop realistic models of cartilage growth

Lhermitte-Duclos disease presenting with positron emission tomography-magnetic resonance fusion imaging: a case report

<p>Abstract</p> <p>Introduction</p> <p>Lhermitte-Duclos disease or dysplastic gangliocytoma of the cerebellum is an extremely rare tumor. It is a slowly enlarging mass within the cerebellar cortex. The majority of cases are diagnosed in the third or fourth decade of life.</p> <p>Case presentation</p> <p>We report the case of a 37-year-old Caucasian woman who underwent positron emission tomography-computed tomography with fluorine-18-fluorodeoxyglucose for evaluation of a solitary lung node. No pathological uptake was detected in the solitary lung node but the positron emission tomography-computed tomography of her brain showed intense tracer uptake, suggestive of a malignant neoplasm, in a mass in her left cerebellar lobe. Our patient had experienced two years of occipital headache and movement disorder. Subsequently, magnetic resonance imaging was performed with contrast agent administration, showing a large subtentorial mass in her left cerebellar hemisphere, with compression and dislocation of the fourth ventricle. Metabolic data provided by positron emission tomography and morphological magnetic resonance imaging views were fused in post-processing, allowing a diagnosis of dysplastic gangliocytoma with increased glucose metabolism. Total resection of the tumor was performed and histological examination confirmed the diagnosis of Lhermitte-Duclos disease.</p> <p>Conclusions</p> <p>Our case indicates that increased uptake of fluorine-18-fluorodeoxyglucose may be misinterpreted as a neoplastic process in the evaluation of patients with Lhermitte-Duclos disease, but supports the usefulness of integrated positron emission tomography-magnetic resonance imaging in the exact pathophysiologic explanation of this disease and in making the correct diagnosis. However, an accurate physical examination and exact knowledge of clinical data is of the utmost importance.</p

Principles of early human development and germ cell program from conserved model systems

Human primordial germ cells (hPGCs), the precursors of sperm and eggs, originate during week 2-3 of early postimplantation development(1). Using in vitro models of hPGC induction(2-4), recent studies suggest striking mechanistic differences in specification of human and mouse PGCs(5). This may partly be due to the divergence in their pluripotency networks, and early postimplantation development(6-8). Since early human embryos are inaccessible for direct studies, we considered alternatives, including porcine embryos that, as in humans, develop as bilaminar embryonic discs. Here we show that porcine PGCs (pPGCs) originate from the posterior pre-primitive streak competent epiblast by sequential upregulation of SOX17 and BLIMP1 in response to WNT and BMP signalling. Together with human and monkey in vitro models simulating peri-gastrulation development, we show conserved principles for epiblast development for competency for PGC fate, followed by initiation of the epigenetic program(9-11), regulated by a balanced SOX17–BLIMP1 gene dosage. Our combinatorial approach using human, porcine and monkey in vivo and in vitro models, provides synthetic insights on early human development

Partner notification for sexually transmitted infections in developing countries: a systematic review

<p>Abstract</p> <p>Background</p> <p>The feasibility and acceptability of partner notification (PN) for sexually transmitted infections (STIs) in developing countries was assessed through a comprehensive literature review, to help identify future intervention needs.</p> <p>Methods</p> <p>The Medline, Embase, and Google Scholar databases were searched to identify studies published between January 1995 and December 2007 on STI PN in developing countries. A systematic review of the research extracted information on: (1) willingness of index patients to notify partners; (2) the proportion of partners notified or referred; (3) client-reported barriers in notifying partners; (4) infrastructure barriers in notifying partners; and (5) PN approaches that were evaluated in developing countries.</p> <p>Results</p> <p>Out of 609 screened articles, 39 met our criteria. PN outcome varied widely and was implemented more often for spousal partners than for casual or commercial partners. Reported barriers included sociocultural factors such as stigma, fear of abuse for having an STI, and infrastructural factors related to the limited number of STD clinics, and trained providers and reliable diagnostic methods. Client-oriented counselling was found to be effective in improving partner referral outcomes.</p> <p>Conclusions</p> <p>STD clinics can improve PN with client-oriented counselling, which should help clients to overcome perceived barriers. The authors speculate that well-designed PN interventions to evaluate the impact on STI prevalence and incidence along with cost-effectiveness components will motivate policy makers in developing countries to allocate more resources towards STI management.</p

Development of the cerebellum: simple steps to make a 'little brain'

The authors’ research was supported by grants (R.J.T.W.) from the Biotechnology and Biological Sciences Research Council, Wellcome Trust and a Medical Research Council studentship (M.J.G.)

Expression of Neurog1 Instead of Atoh1 Can Partially Rescue Organ of Corti Cell Survival

In the mammalian inner ear neurosensory cell fate depends on three closely related transcription factors, Atoh1 for hair cells and Neurog1 and Neurod1 for neurons. We have previously shown that neuronal cell fate can be altered towards hair cell fate by eliminating Neurod1 mediated repression of Atoh1 expression in neurons. To test whether a similar plasticity is present in hair cell fate commitment, we have generated a knockin (KI) mouse line (Atoh1KINeurog1) in which Atoh1 is replaced by Neurog1. Expression of Neurog1 under Atoh1 promoter control alters the cellular gene expression pattern, differentiation and survival of hair cell precursors in both heterozygous (Atoh1+/KINeurog1) and homozygous (Atoh1KINeurog1/KINeurog1) KI mice. Homozygous KI mice develop patches of organ of Corti precursor cells that express Neurog1, Neurod1, several prosensory genes and neurotrophins. In addition, these patches of cells receive afferent and efferent processes. Some cells among these patches form multiple microvilli but no stereocilia. Importantly, Neurog1 expressing mutants differ from Atoh1 null mutants, as they have intermittent formation of organ of Corti-like patches, opposed to a complete ‘flat epithelium’ in the absence of Atoh1. In heterozygous KI mice co-expression of Atoh1 and Neurog1 results in change in fate and patterning of some hair cells and supporting cells in addition to the abnormal hair cell polarity in the later stages of development. This differs from haploinsufficiency of Atoh1 (Pax2cre; Atoh1f/+), indicating the effect of Neurog1 expression in developing hair cells. Our data suggest that Atoh1KINeurog1 can provide some degree of functional support for survival of organ of Corti cells. In contrast to the previously demonstrated fate plasticity of neurons to differentiate as hair cells, hair cell precursors can be maintained for a limited time by Neurog1 but do not transdifferentiate as neurons

Tissue engineering of functional articular cartilage: the current status

Osteoarthritis is a degenerative joint disease characterized by pain and disability. It involves all ages and 70% of people aged >65 have some degree of osteoarthritis. Natural cartilage repair is limited because chondrocyte density and metabolism are low and cartilage has no blood supply. The results of joint-preserving treatment protocols such as debridement, mosaicplasty, perichondrium transplantation and autologous chondrocyte implantation vary largely and the average long-term result is unsatisfactory. One reason for limited clinical success is that most treatments require new cartilage to be formed at the site of a defect. However, the mechanical conditions at such sites are unfavorable for repair of the original damaged cartilage. Therefore, it is unlikely that healthy cartilage would form at these locations. The most promising method to circumvent this problem is to engineer mechanically stable cartilage ex vivo and to implant that into the damaged tissue area. This review outlines the issues related to the composition and functionality of tissue-engineered cartilage. In particular, the focus will be on the parameters cell source, signaling molecules, scaffolds and mechanical stimulation. In addition, the current status of tissue engineering of cartilage will be discussed, with the focus on extracellular matrix content, structure and its functionality