Indicators of cognitive activity of children with laboratory hypothyroidism

The growth rate of a healthy child, the peculiarities of its physical and intellectual development, the formation of reproductive function are largely determined by the state of the endocrine system. Thyroid hormones have a significant impact on the growth and development of the child's organism. Today, attention is focused on the consequences of intellectual disabilities in children with hypothyroidism, as well as the impact of chronic iodine deficiency in the environment on the development of children. Insufficient intake of iodine in the body leads to congenital dysontogenesis of higher mental functions, to the formation, in severe cases, of mental retardation of varying degrees, and, in mild forms - to the borderline or partial disorders of intelligence. The aim is to study the cognitive functions of children with laboratory hypothyroidism. Methods. For a screening study of the intellectual development of school-age children living in geographical areas of Chernivtsi region (Ukraine) with varying degrees of iodine supply, 399 schoolchildren aged 11-18 years were studied, including 194 boys and 205 girls. The main group consisted of children (99) with laboratory hypothyroidism (HL), with thyroid stimulating hormone (TSH) elevation or with diverse complaints and who had been found to have elevated TSH levels during routine examinations. Patients with any kind of systemic disease and/or taking medications were excluded from the study. Diagnosis of HL was based on mild increase of TSH (5-25mIU/L) with a normal fT4 level. Thyrotropin-releasing hormone (TRH) test was also performed in all children. TSH response to TRH stimulation was considered to be normal when TSH levels were between 5-25 mIU/L. The formation of intellectual function was determined using a fragment of the R. Kettel test (adapted modified version of the children's personality questionnaire R. Kettel). Іnclusion сriteria: age 11-18 years, living in the Chernivtsi region, the absence of organic pathology of the CNS and mental retardation, diseases of the eyesight and hearing, for 6 months, all subjects did not receive any treatment with iodine-containing drugs and thyroid hormones. Results. Analysis of the study results showed that children, for the most part, have an average degree of intellectual development (60%). The level of intellectual formation changed in the direction of decreasing with increasing degree of iodine deficiency. Among children with laboratory hypothyroidism, the number of those who had a low level of intelligence was almost twice as high as in children from the comparison group 25 [21.8-27.3] % against 13 [11.8-16.6] %, P < 0.01). Children with laboratory hypothyroidism have a "debt" of 56% of attention, 36% of perception, 26% of motility, and 44% of memory. The pace of operating activities was reduced by 26%. Comparison of TSH concentration, ioduria and thyroid volume with the presence or absence of deficits in certain cognitive functions showed that in children with laboratory hypothyroidism and fine motor skills TSH G level was increased by 90%, thyroid volume by 28% , and with memory loss - 125% and 38%, respectively. Correlative analysis revealed a highly probable positive relationship between moderate strength in prepubertal children between thyroid volume and fine motor skills (r = 0.485, P < 0.01), memory (r = 0.488, P < 0.05) and efficiency (r = 0,321, P < 0,05). Conclusion. Children with subclinical hypothyroidism are characterized by decreased memory, instability of attention and decreased ability to concentrate, impaired fine motor skills, which generally reduces their mental capacity

The results of ultrasound examination of the thyroid gland in children with hypothyroidism

Diseases of thyroid gland (TG) rank first among all endocrine pathologies and remain one of the most difficult problems. According to the statistics of Ministry of Health of Ukraine, the prevalence of hypothyroidism in children does not exceed 0.035%. However, the relatively low rate can be explained by the low level of detection and diagnosis of this pathological condition due to the variability and low specificity of its symptoms. More acceptable for practice are methods of ultrasound diagnosis of the thyroid gland and laboratory examination of the content of thyroid-stimulating hormone in the serum. Aim. To evaluate the results of ultrasound examination of the thyroid gland in children with hypothyroidism. Methods. The results are based on a survey of 94 children with hypothyroidism living in the Chernivtsi region aged 2 to 10 years. An ultrasound examination of the thyroid gland, determination of the level of thyroid hormones (thyroid stimulating hormone (TSH), free thyroxine (fT4) was performed. Statistical analysis was performed using standard methods using the StatSoft software package © Statistica® 6.0 for Microsoft® Windows XP. Results. Analysis of the results of the study showed that in 59.6% of cases (56 out of 94) the diagnosis was made by screening for congenital hypothyroidism, and in 40.4% of cases (38 out of 94) the disease was diagnosed outside the screening. According to the results of our ultrasound, it was found that in 29 patients the thyroid tissue was not visualized in a typical place or its total volume was much less than normal. Of these, in 12 individuals, thyroid tissue was not reliably visualized at the site of TG projection, and in 17 cases was hypoplasia. In 65 patients, the TG was in a typical place, and its volume corresponded to the norm on the surface area of the body. In 85 people, regardless of the state of functional activity of the TG had a heterogeneous echostructure of the thyroid parenchyma), in 9 people the echostructure of the thyroid parenchyma was homogeneous. In thyroid hypoplasia, the level of TSH was at lower values (p <0.05) compared with thyroid dystopia. Conclusion. Sonographic examination of the thyroid gland has a high level of information. In cases of malformations of the thyroid gland there is a more pronounced degree of thyroid insufficiency

Indicators of cognitive activity of children with laboratory hypothyroidism

Abstract. The growth rate of a healthy child, the peculiarities of its physical and intellectual development, the formation of reproductive function are largely determined by the state of the endocrine system. Thyroid hormones have a significant impact on the growth and development of the child's organism. Today, attention is focused on the consequences of intellectual disabilities in children with hypothyroidism, as well as the impact of chronic iodine deficiency in the environment on the development of children. Insufficient intake of iodine in the body leads to congenital dysontogenesis of higher mental functions, to the formation, in severe cases, of mental retardation of varying degrees, and, in mild forms – to the borderline or partial disorders of intelligence

Імовірнісний підхід до визначення допустимих режимів гальмування відчепів на сортувальних гірках

Probabilistic Approach for the Determination of Cuts Permissible Braking Modes on the Gravity Humps / V. Bobrovskyi, D. Kozachenko, A. Dorosh, E. Demchenko, T. Bolvanovska, A. Kolesnik // Transport problems = Problemy transportu/ — 2016. — Vol. 11, is. 1. — P.147—155. — DOI: 10.20858/tp.2016.11.1.14EN: The paper presents the research results of cuts braking modes on the gravity humps. The objective of this paper is developing the methods for assessment of braking modes of cuts under conditions of fuzziness of their rolling properties, as well as selecting the permissible starting speed range of cuts from retardant positions. As a criterion for assessing the modes of target control of cut rolling speed, it was proposed to use an average gap size on a classification track at the established norms of probable exceeding of permissible speed of cars collision and their stop in retarders. As a criterion for evaluating the modes of interval control of cuts rolling speed, using the risk of their nonseparation on the switches was proposed. Using the simulation modeling and mathematical statistics, the configuration of the range of permissible speed of cuts coming out from retardant positions has been set. The conducted researches allow simplifying the choice of cut braking modes in systems of automatic control of cut rolling speed.RU: В статье представлены результаты исследований режимов торможения отцепов на сортировочных горках. Целью статьи является разработка методов оценки режимов торможения отцепов в условиях неопределенности их ходовых характеристик, а также поиск области допустимых скоростей выхода отцепов из тормозных позиций. В качестве критерия для оценки режимов прицельного регулирования скорости скатывания отцепов предложено использовать среднюю величину окна на сортировочном пути при установленных нормах вероятности превышения допустимых скоростей соударения вагонов и остановки их в замедлителях. В качестве критерия для оценки режимов интервального регулирования скорости скатывания отцепов предложено использовать риск их неразделения на стрелках. С помощью методов имитационного моделирования и математической статистики установлена конфигурация области допустимых споростей выхода отцепов из тормозных позиций. Выполненные исследования позволяют упростить решение задачи выбора режимов торможения отцепов в системах автоматического управления скоростью их скатывания.UK: У статті представлені результати досліджень режимів гальмування відчепів на сортувальних гірках. Метою статті є розробка методів оцінки режимів гальмування відчепів в умовах невизначеності їх ходових характеристик, а також пошук області допустимих швидкостей виходу відчепів з гальмівних позицій. Як критерій для оцінки режимів прицільного регулювання швидкості скочування відчепів запропоновано використовувати середню величину вікна на сортувальній колії при встановлених нормах ймовірності перевищення допустимих швидкостей співударяння вагонів і зупинки їх у сповільнювачах. Як критерій для оцінки режимів інтервального регулювання швидкості скочування відчепів запропоновано використовувати ризик їх нерозділення на стрілках. За допомогою методів імітаційного моделювання і математичної статистики встановлено конфігурацію області допустимих швидкостей виходу відчепів з гальмівних позицій. Виконані дослідження дозволяють спростити рішення задачі вибору режимів гальмування відчепів у системах автоматичного керування швидкістю їх скочування

Perioperative Pembrolizumab for Early-Stage Non-Small-Cell Lung Cancer

BACKGROUND Among patients with resectable early-stage non-small-cell lung cancer (NSCLC), a perioperative approach that includes both neoadjuvant and adjuvant immune checkpoint inhibition may provide benefit beyond either approach alone.METHODS We conducted a randomized, double-blind, phase 3 trial to evaluate perioperative pembrolizumab in patients with early-stage NSCLC. Participants with resectable stage II, IIIA, or IIIB (N2 stage) NSCLC were assigned in a 1:1 ratio to receive neoadjuvant pembrolizumab (200 mg) or placebo once every 3 weeks, each of which was given with cisplatin-based chemotherapy for 4 cycles, followed by surgery and adjuvant pembrolizumab (200 mg) or placebo once every 3 weeks for up to 13 cycles. The dual primary end points were event-free survival (the time from randomization to the first occurrence of local progression that precluded the planned surgery, unresectable tumor, progression or recurrence, or death) and overall survival. Secondary end points included major pathological response, pathological complete response, and safety.RESULTS A total of 397 participants were assigned to the pembrolizumab group, and 400 to the placebo group. At the prespecified first interim analysis, the median follow-up was 25.2 months. Event-free survival at 24 months was 62.4% in the pembrolizumab group and 40.6% in the placebo group (hazard ratio for progression, recurrence, or death, 0.58; 95% confidence interval [CI], 0.46 to 0.72; P<0.001). The estimated 24-month overall survival was 80.9% in the pembrolizumab group and 77.6% in the placebo group (P = 0.02, which did not meet the significance criterion). A major pathological response occurred in 30.2% of the participants in the pembrolizumab group and in 11.0% of those in the placebo group (difference, 19.2 percentage points; 95% CI, 13.9 to 24.7; P<0.0001; threshold, P = 0.0001), and a pathological complete response occurred in 18.1% and 4.0%, respectively (difference, 14.2 percentage points; 95% CI, 10.1 to 18.7; P<0.0001; threshold, P = 0.0001). Across all treatment phases, 44.9% of the participants in the pembrolizumab group and 37.3% of those in the placebo group had treatment-related adverse events of grade 3 or higher, including 1.0% and 0.8%, respectively, who had grade 5 events.CONCLUSIONS Among patients with resectable, early-stage NSCLC, neoadjuvant pembrolizumab plus chemotherapy followed by resection and adjuvant pembrolizumab significantly improved event-free survival, major pathological response, and pathological complete response as compared with neoadjuvant chemotherapy alone followed by surgery. Overall survival did not differ significantly between the groups in this analysis