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Обстежено 126 пацієнтів (середній вік 60,8 ± 6,2 року) з персистуючою та пароксизмальною формами фібриляції передсердь. Помірні когнітивні розлади діагностовані у 46 (36,5 %) пацієнтів, легкі — у 58 (46,0 %), відсутність когнітивних розладів — у 22 (17,5 %). Аналіз структури когнітивного дефіциту дозволив діагностувати дизрегуляторні порушення у 86,5 % хворих, первинне порушення зорово-просторових функцій — у 13,5 % хворих. Когнітивні розлади залежали від віку хворих, частоти серцевих скорочень, рівня діастолічного артеріального тиску, фракції викиду лівого шлуночка, наявності атеросклерозу судин головного мозку, лейкоареозу за даними комп’ютерної томографії, величини комплексу інтима-медіа загальних сонних артерій. Прогресування когнітивного дефіциту протягом 1 року відмічено у 28,8 % хворих з підвищенням діастолічного артеріального тиску, лейкоареозом та атрофічними змінами головного мозку на комп’ютерній томограмі, збільшенням кінцевого діастолічного розміру лівого шлуночка та збільшенням розмірів комплексу інтима-медіа загальних сонних артерій.

Метою цього дослідження була оцінка зв’язку носійства алелі ε4 гена аполіпопротеїну E (АРОЕ) зі станом когнітивних функцій і атрофічними змінами головного мозку у пацієнтів із фібриляцією передсердь. Усього обстежений 61 пацієнт (середній вік — 64,8 ± 8,2 року) з когнітивними порушеннями різного ступеня вираженості при фібриляції передсердь. Проведено аналіз і наведено результати дослідження впливу генотипу АРОЕ4 на стан когнітивних функцій і вираженість церебральної атрофії за даними комп’ютерної томографії. Встановлено, що носійство навіть однієї алелі ε4 впливало на тяжкість когнітивних розладів, рівень холестерину і ліпопротеїдів дуже низької щільності в плазмі крові. При аналізі морфометричних характеристик встановлено, що у 70,5 % пацієнтів із фібриляцією передсердь і вивченим генотипом АРОЕ когнітивні розлади розвивалися на тлі атрофічного процесу головного мозку. Встановлено кореляційні зв’язки між рівнем когнітивних функцій і морфометричних маркерів підкіркової атрофії в групах пацієнтів з АРОЕ4, що підтверджує провідну роль останньої у розвитку і прогресуванні когнітивного дефіциту. Проведене дослідження дозволяє розглядати АРОЕ4 як фактор ризику когнітивних порушень у пацієнтів із фібриляцією передсердь.фібриляція передсердь; когнітивні порушення; аполіпопротеїн E (АРОЕ)

To determine the effect of prolonged (2 years) antiarrhythmic therapy on cognitive functions of patients with atrial fibrillation, we have examined 117 patients. The condition of patients was evaluated on a number of accepted scales (Mini-Mental State Examination, Global Deterioration Scale, Clinical Dementia Rating) and a battery of neuropsychological tests. In addition, we have determined the genotype of the apolipoprotein E (ApoЕ). The patients were divided into 2 comparable groups in accordance with the characteristics of treatment: 61 individuals treated with beta-blockers (bisoprolol or metoprolol) and 56 — by amiodarone. The findings evidence the benefits of therapy using beta-blockers compared with amiodarone in terms of slowing the progression of cognitive deficit and preventing its transition into the diagnostic category of dementia. The feature of action of beta-blockers was their higher efficiency in patients with cognitive dysfunction with genotype ApoE(4+), i.e. in those, who are at high risk for Alzheimer’s disease.

To determine and compare the incidence and severity of cognitive disorders (CD) in patients of young and middle age with atrial fibrillation (AF), abdominal obesity (AO) and metabolic syndrome (MS) 196 patients were examined. CD, associated with impairment of memory, attention, impaired perception, verbal speed, and еxecutive functions, were diagnosed in 88.3 % of patients with AF and AO, and in 89.5 % of patients with MS. In patients with AF, including combination with AO, predement and severe CD occurred more frequently than in patients with AO and with sinus rhythm. In patients with sinus rhythm and normal waist circumference without cardiovascular disease, moderate and severe CD were not observed. The severity of CD in patients with AF and AO do not depend on structural changes of the carotid arteries and the heart. Risk factors for development of CD in patients of young and middle age with AF and AO were the presence of MS and elevated levels of C-reactive protein in serum. Patients of young and middle age with AF, AO and MS requires assessment of cognitive function for early diagnosis and prevention of CD progression.

Background. The article analyzes the nature of the change in the phenotypic composition of blood lymphocytes, the content of IgA, IgG, IgM, and the fractional composition of immune complexes in patients with ischemic stroke and chronic brain ischemia. The purpose of this study was to investigate the nature of disorders of cellular and humoral parts of the immune system in the acute period of ischemic stroke. Materials and methods. A comparative clinical and immunological examination was performed in 85 patients in the acute period of ischemic stroke (basic group) and 66 patients with chronic cerebral ischemia (control group). To assess cellular immunity, we used the indicators of immunophenotyping of blood cells — the absolute and percentage content of the population of T- and B-lymphocytes, their main subpopulations: T-helper cells, cytotoxic T-cells, subpopulations of natural killers. To evaluate humoral immunity, the contents of the main classes of immunoglobulins (IgA, IgG, IgM) and circulating immune complexes were studied. Results. In the acute period of stroke, an increase in the number of leukocytes (p = 0.028) and a decrease in lymphocytes (p = 0.031), T-lymphocytes (p = 0.002), T-helpers (p = 0.027) and cytotoxic T-lymphocytes (p = 0.045) were observed. There was also a tendency to a decrease in the number of natural killers (p = 0.45). In the humoral immunity an increase in the B-lymphocytes (p = 0.048), dysgammaglobulinaemia due to an increase in IgG level (p = 0.048) and the tendency to hyperfunction of IgA and IgМ (p = 0.05) were observed. Changes in immune status indicators are more pronounced with increasing severity of stroke. Conclusions. These studies demonstrate the involvement of the immune system in a complex set of reactions involved in the development of cerebral accidents., Актуальность. В статье проанализирован характер изменения фенотипического состава лимфоцитов крови, содержания IgA, IgG, IgM и фракционного состава иммунных комплексов у пациентов с ишемическим инсультом и хронической ишемией мозга. Цель исследования: изучить характер нарушений клеточного и гуморального звеньев иммунитета в остром периоде ишемического инсульта. Материалы и методы. Провели сравнительное клинико-иммунологическое обследование 85 пациентов в остром периоде ишемического инсульта (основная группа) и 66 пациентов с хронической ишемией мозга (контрольная группа). Для оценки клеточного иммунитета использовали показатели иммунофенотипирования клеток крови — абсолютное и процентное содержание популяции Т- и В-лимфоцитов, их основных субпопуляций: Т-хелперов, цитотоксических Т-клеток, субпопуляции натуральных киллеров. Для оценки гуморального иммунитета исследовали содержание основных классов иммуноглобулинов (IgA, IgG, IgM) и циркулирующих иммунных комплексов. Результаты. В остром периоде инсульта наблюдали повышение количества лейкоцитов (р = 0,028) и снижение уровня лимфоцитов (р = 0,031), зрелых Т-лимфоцитов (р = 0,002), Т-хелперов (р = 0,027) и цитотоксических Т-лимфоцитов (р = 0,045). Отмечена тенденция к снижению количества натуральных киллеров (р = 0,45). В гуморальном звене иммунитета наблюдалось увеличение В-лимфоцитов (р = 0,048), дисгаммаглобулинемия за счет повышения уровня IgG (р = 0,048) и тенденции к гиперфункции IgА и IgМ (р = 0,5). Изменения показателей иммунного статуса более выражены при увеличении тяжести инсульта. Выводы. Данное исследование доказывает вовлечение иммунной системы в сложный комплекс реакций, участвующих в развитии инфарктов мозга., Актуальність. У статті проаналізований характер змін фенотипового складу лімфоцитів крові, вмісту IgA, IgG, IgM і фракційного складу імунних комплексів у пацієнтів з ішемічним інсультом і хронічною ішемією мозку. Мета дослідження: вивчити характер порушень клітинної і гуморальної ланок імунітету в гострому періоді ішемічного інсульту. Матеріали та методи. Провели порівняльне клініко-імунологічне обстеження 85 пацієнтів у гострому періоді ішемічного інсульту (основна група) та 66 пацієнтів із хронічною ішемією мозку (контрольна група). Для оцінки клітинного імунітету використовували показники імунофенотипування клітин крові — абсолютний і відсотковий вміст популяції Т- і В-лімфоцитів, їх основних субпопуляцій: Т-хелперів, цитотоксичних Т-клітин, субпопуляції натуральних кілерів. Для оцінки гуморального імунітету досліджували вміст основних класів імуноглобулінів (IgA, IgG, IgM) і циркулюючих імунних комплексів. Результати. У гострому періоді ішемічного інсульту спостерігали підвищення кількості лейкоцитів (р = 0,028) і зниження рівня лімфоцитів (р = 0,031), зрілих Т-лімфоцитів (р = 0,002), Т-хелперів (р = 0,027) і цитотоксичних Т-лімфоцитів (р = 0,045). Відзначена тенденція до зниження кількості натуральних кілерів (р = 0,45). У гуморальній ланці імунітету спостерігали підвищення В-лімфоцитів (CD20+) (р = 0,048), дисгаммаглобулінемію за рахунок підвищення рівня IgG (р = 0,048) і тенденції до гіперфункції IgА і IgМ (р = 0,05). Зміни показників імунного статусу більш виражені при зростанні тяжкості інсульту. Висновки. Це дослідження доводить залучення імунної системи до складного комплексу реакцій, які беруть участь у розвитку інфарктів мозку.

Background Mucinous cystic neoplasm of the liver (MCN-L) and intraductal papillary neoplasm of the bile duct (IPN-B) are two different types of mucin-producing bile duct tumour that may complicate the course of pregnancy. To the best of our knowledge, we describe herein the first case of MCN-L with spontaneous rupture during pregnancy necessitating complex surgical treatment. Case summary A 24-year-old woman was initially admitted to another hospital in October 2018 with signs of jaundice (serum bilirubin level 12 mg/dL) and upper abdominal pain radiating to the left shoulder. Initial magnetic resonance imaging (MRI) of the abdominal cavity revealed a multilocular cystic tumour of the liver hilum (37 mm × 40 mm in diameter) located between segments 3 and 4 of the left liver lobe. Six weeks later (December 2018), the patient was found to be 12 wk pregnant and was referred to our institution for further diagnostics and treatment. At admission, a soft, palpable, and tender mass in the left upper abdomen was found. It was determined via MRI (with no intravenous contrast in view of the first-trimester pregnancy) to be a large collection of fluid (19 cm × 17 cm × 10 cm) located close to the liver hilum and below the left liver lobe. The patient did not undergo any diagnostic or therapeutic procedures nor did they have any abdominal trauma in the preceding weeks. The fluid collection proved to be of biliary origin following percutaneous drainage. Therefore, we concluded this was a spontaneous rupture of an MCN-L with the formation of a biloma. The MRI study also revealed the previously found cystic tumour of the liver hilum communicating with the left hepatic duct, which, together with left hepatic duct dilatation, suggested the diagnosis of IPN-B. The follow-up MRI with intravenous gadolinium contrast performed in the second trimester of pregnancy (week 14) showed, in turn, some features of MCN-L, including enhancement of the internal septations within the cystic liver mass. A precise preoperative differential diagnosis between IPN-B and MCN-L was therefore not possible. The patient was submitted to surgery in the second trimester of pregnancy (week 18). Surgery included a cholecystectomy, left hepatectomy, and concomitant resection of the extrahepatic bile ducts followed by anastomosis of the right hepatic duct with the Roux limb of the jejunum. The post-operative period was uneventful and the patient was discharged 8 days after surgery. The histopathological examination of the resected specimen revealed a final diagnosis of MCN-L with low-grade dysplasia and epithelium surrounded by ovarian-type stromal tissue. The patient delivered a healthy baby girl and both remain well at present, after 2 years of follow-up since surgery. Conclusion The differential diagnosis and management of MCN-L and IPN-B may be very challenging, particularly in the setting of pregnancy. When indications for surgery are obvious, the final diagnosis is based on histopathological examination, with ovarian-type stroma being pathognomonic for MCN-L. We believe that the growth of this subepithelial stroma secondary to the high levels of sex hormones produced during pregnancy might have been the main causative factor leading to the tumour rupture with the formation of a biloma in our patient.

Background. A promising direction in modern angioneurology is the study of markers of brain tissue damage in the blood serum of patients in the acute period of ischemic stroke and their comparison with the initial level of neurologic deficit and stroke outcome. As a marker of brain tissue damage, the functions of neuron-specific enolase (NSE) are being actively studied. To evaluate the level of NSE in the acute period of ischemic stroke was the purpose of the work. Materials and methods. The clinical trial included 151 patients (mean age 61.5 ± 8.2 years), who were divided into 2 groups: group 1 consisted of 85 patients with acute ischemic stroke; group 2 — of 66 patients with chronic cerebral ischemia. Plasma NSE level was evaluated in all patients. We analyzed the correlations of NSE with the severity of neurologic deficit according to the National Institutes of Health Stroke Scale, functional activity — using Barthel index, the level of disabi­lity — on the modified Rankin scale, and the severity of cognitive impairment — according to the Mini-Mental State Examination. The relationships between the level of NSE and the survival of patients with ischemic stroke were determined. Results. In patients of group 1, the level of NSE exceeded that of the patients in group 2 by 3.8 times (p, Актуальность. Перспективным направлением в современной ангионеврологии является исследование маркеров повреждения мозговой ткани в сыворотке крови пациентов в остром периоде ишемического инсульта и их сопоставление с инициальным уровнем неврологического дефицита и исходом инсульта. В качестве маркера повреждения мозговой ткани активно изучаются функции нейронспецифической енолазы (НСЕ). Цель — исследовать уровень НСЕ в остром периоде ишемического инсульта. Материалы и методы. В клиническое исследование включен 151 пациент (средний возраст 61,5 ± 8,2 года), которые распределены на 2 группы: в 1-ю группу вошли 85 пациентов с острым ишемическим инсультом; во 2-ю группу — 66 пациентов с хронической ишемией мозга. Всем пациентам определяли уровень НСЕ в плазме крови. Анализировали корреляции НСЕ с выраженностью неврологического дефицита по NIHSS, функциональной активностью по шкале Бартел, уровнем инвалидизации по шкале Ренкина, выраженностью когнитивных расстройств по MMSE. Определяли взаимосвязи между уровнем НСЕ и выживанием пациентов с ишемическим инсультом. Результаты. У пациентов 1-й группы уровень НСЕ превышал показатель пациентов 2-й группы в 3,8 раза (p < 0,001). Установили достоверные различия уровня НСЕ в зависимости от локализации очага ишемии — в бассейне левой средней мозговой артерии и вертебробазилярном бассейне (p = 0,04). У пациентов с тяжелым неврологическим дефицитом уровень НСЕ превышал показатель пациентов со средним и легким неврологическим дефицитом в 1,3 (p = 0,251) и в 2,3 (p = 0,007) раза соответственно. Установили корреляционную связь между уровнем НСЕ и степенью выраженности неврологического дефицита (r = 0,67, p = 0,027), что свидетельствует о прямой зависимости степени ишемического повреждения и неврологических расстройств. У пациентов с тяжелыми когнитивными расстройствами уровень НСЕ превышал показатель пациентов с умеренными и легкими когнитивными расстройствами в 1,2 (p = 0,444) и в 1,9 (p = 0,037) раза соответственно. При оценке взаимосвязи уровня НСЕ с исходом инсульта выявлена тенденция к более высоким показателям НСЕ у умерших (p = 0,083). Определили пороговое значение уровня НСЕ в крови пациентов с ишемическим инсультом — 40 нг/мл. Выводы. Определение НСЕ в плазме крови подтверждает степень повреждения нейронов и является информативным показателем наличия неврологического дефицита у больных с острым ишемическим инсультом. Полученные результаты свидетельствуют о потенциальной роли определения содержания НСЕ в улучшении стратификации риска летального исхода у пациентов с ишемическим инсультом., Актуальність. Перспективним напрямком у сучасній ангіоневрології є дослідження маркерів пошкодження мозкової тканини у сироватці крові пацієнтів у гострому періоді ішемічного інсульту та їх зіставлення з ініціальним рівнем неврологічного дефіциту і наслідком інсульту. Як маркер пошкодження мозкової тканини активно вивчаються функції нейронспецифічної єнолази (НСЄ). Мета — дослідити рівень НСЄ у гострому періоді ішемічного інсульту. Матеріали та методи. У клінічне дослідження включений 151 пацієнт (середній вік 61,5 ± 8,2 року), які розподілені на 2 групи: до 1-ї групи ввійшли 85 пацієнтів з гострим ішемічним інсультом; до 2-ї групи — 66 пацієнтів з хронічною ішемією мозку. Усім пацієнтам визначали рівень НСЄ у плазмі крові. Аналізували кореляції НСЄ з вираженістю неврологічного дефіциту за NIHSS, функціональною активністю за шкалою Бартел, рівнем інвалідизації за шкалою Ренкіна, вираженістю когнітивних розладів за MMSE. Визначали взаємозв’язки між рівнем НСЄ і виживаністю пацієнтів з ішемічним інсультом. Результати. У пацієнтів 1-ї групи рівень НСЄ перевищував показник пацієнтів 2-ї групи в 3,8 раза (p

The aim of our literature review was to describe causes and mechanisms which underlie increased cardiac troponin levels in patients without established myocardial infarction. The widespread introduction of high-sensitivity analyses for troponin determination into everyday practice, which became highest in European countries, has led to a significant acceleration of therapeutic and diagnostic process and improved prognosis for patients. However, there is a downside of high-sensitivity methods: the higher the troponin detection capability, the lower the specificity, which can complicate and/or lead to differential diagnosis errors, especially if clinicians rely on laboratory data alone. An important direction for improving differential diagnosis is to establish accurate mechanisms for increasing the level of troponins in order to evaluate the comparative kinetics of concentration, which should certainly be taken into account for the improvement of rapid algorithms for the diagnosis of acute coronary syndrome. The review deals with the clinical and diagnostic value and mechanisms of an increase in the level of cardiac troponins in conditions not associated with acute coronary syndrome: strokes, aortic dissection, inflammatory myocardial diseases, pulmonary embolism, arterial hypotension, heart fai­lure, takotsubo syndrome, closed chest injury, acute respiratory distress syndrome, chronic renal failure, sepsis, rhabdomyolysis, bleeding from the upper gastrointestinal tract, surgical interventions, physical activity., Цель нашего литературного обзора заключается в описании причин и механизмов, лежащих в основе повышения уровня кардиальных тропонинов у пациентов без установленного инфаркта миокарда. Широкомасштабное внедрение высокочувствительных анализов для определения тропонинов в повседневную практику, которое достигло наибольшего распространения в странах Европы, привело к значительному ускорению лечебно-диагностического процесса и улучшению прогноза пациентов. Однако существует и отрицательная сторона методов с повышенной чувствительностью: чем выше способность по обнаружению тропонинов, тем ниже специфичность, что может затруднить и/или привести к ошибкам дифференциальной диагностики, особенно в том случае, если врачи-клиницисты будут полагаться на одни только лабораторные данные. Актуальным направлением для улучшения дифференциальной диагностики служит установление точных механизмов повышения уровня тропонинов для оценки сравнительной кинетики концентрации, что, безусловно, необходимо учитывать для совершенствования быстрых алгоритмов диагностики острого коронарного синдрома. Обзор посвящен клинико-диагностическому значению и механизмам повышения уровня кардиальных тропонинов при часто встречаемых состояниях, не связанных с острым коронарным синдромом: инсультах, расслаивающей аневризме аорты, воспалительных заболеваниях миокарда, тромбоэмболии легочной артерии, артериальной гипотензии, сердечной недостаточности, синдроме такоцубо, закрытой травме грудной клетки, остром респираторном дистресс-синдроме, хронической почечной недостаточности, сепсисе, рабдомиолизе, кровотечениях из верхних отделов желудочно-кишечного тракта, хирургических вмешательствах, физической нагрузке., Мета нашого літературного огляду полягає в описі причин і механізмів, що лежать в основі підвищення рівня кардіальних тропонінів у пацієнтів без встановленого інфаркту міокарда. Широкомасштабне впровадження високочутливих аналізів для визначення тропонінів у повсякденну практику, що досягло найбільшого поширення у країнах Європи, спричинило значне прискорення лікувально-діагностичного процесу і покращення прогнозу пацієнтів. Проте є і негативна сторона методів із підвищеною чутливістю: чим вища здатність із виявлення тропонінів, тим нижча специфічність, що може ускладнити і/або призвести до помилок диференціальної діагностики, особливо в тому випадку, якщо лікарі-клініцисти будуть покладатися на одні лише лабораторні дані. Актуальним напрямком для покращення диференціальної діагностики є встановлення точних механізмів підвищення рівня тропонінів для оцінки порівняльної кінетики концентрації, що, безумовно, слід враховувати для удосконалення швидких алгоритмів діагностики гострого коронарного синдрому. Огляд присвячений клініко-діагностичному значенню і механізмам підвищення рівня кардіальних тропонінів при станах, не пов’язаних із гострим коронарним синдромом: інсультах, розшаровуючій аневризмі аорти, запальних захворюваннях міокарда, тромбоемболії легеневої артерії, артеріальній гіпотензії, серцевій недостатності, синдромі такоцубо, закритій травмі грудної клітки, гострому респіраторному дистрес-синдромі, хронічній нирковій недостатності, сепсисі, рабдоміолізі, кровотечах із верхніх відділів шлунково-кишкового тракту, хірургічних втручаннях, фізичному навантаженні.

Poisoning is an ongoing problem in clinical medicine. Its frequency increases in proportion to the urbanization of the population and the increase in the consumption of chemicals in the household. In the total number of acute and chronic poisoning, household poisoning prevails, accounting for 90 %. The lion’s share among them is alcohol poisoning and its substitutes. Ethylene glycol poisoning occupies a special place among acute poisoning with alcohol substitutes. According to the statistics, ethylene glycol poisoning occupies the second among intoxications with technical fluids. The availability of ethylene glycol and lack of public awareness about its poisonous properties is a condition for the occurrence of poisoning. The clinical picture of ethylene glycol intoxication is characterized by the development of three successive stages: the first stage — CNS depression (narcotic phase), the second stage — toxic lesions of the heart and the lungs, the third stage — toxic lesions of the liver and kidneys. The article presents a case report of acute ethylene glycol poisoning, gives the results of the diagnostic activities, the dynamics of the clinical manifestations and laboratory parameters, describes the treatment of a patient. The role of hemodialysis therapy in cases of ethylene glycol poisoning is shown, Отравления являются постоянной проблемой клинической медицины. Их частота возрастает пропорционально урбанизации населения и росту потребления химических средств в домашнем хозяйстве. В общем количестве острых и хронических отравлений преобладают бытовые отравления, составляющие 90 %. Львиную долю среди них занимают отравления алкоголем и его суррогатами. Особое место среди острых отравлений суррогатами алкоголя занимают отравления этиленгликолем. Согласно статистическим данным, отравления этиленгликолем занимают второе место среди интоксикаций техническими жидкостями. Доступность и недостаточная информированность населения о ядовитых свойствах этиленгликоля служат условием для возникновения отравлений. Клиника интоксикации этиленгликолем характеризуется развитием трех последовательных стадий: первая — угнетение центральной нервной системы (наркотическая фаза); вторая — токсическое поражение сердца, легких; третья — токсическое поражение печени и почек. Применение всего арсенала средств патогенной и симптоматической терапии, методов реанимации в комплексе с антидотами способно обеспечить наиболее полный терапевтический эффект. В статье представлено описание клинического случая острого отравления этиленгликолем, приведены результаты диагностических мероприятий, динамика клинических проявлений и лабораторных показателей, описано лечение пациента, показана роль гемодиализной терапии при отравлениях этиленгликолем., Отруєння є постійною проблемою клінічної медицини. Їх частота зростає пропорційно урбанізації населення і збільшенню споживання хімічних засобів у домашньому господарстві. У загальній кількості гострих і хронічних отруєнь переважають побутові отруєння, що становлять 90 %. Левову частку серед них посідають отруєння алкоголем і його сурогатами. Особливе місце серед гострих отруєнь сурогатами алкоголю посідають отруєння етиленгліколем. Згідно зі статистичними даними, отруєння етиленгліколем посідають друге місце серед інтоксикацій технічними рідинами. Доступність і недостатня інформованість населення про отруйні властивості етиленгліколю є умовою для виникнення отруєнь. Клініка інтоксикації етиленгліколем характеризується розвитком трьох послідовних стадій: перша — пригнічення центральної нервової системи (наркотична фаза); друга — токсичне ураження серця, легень; третя — токсичне ураження печінки і нирок. Застосування усього арсеналу засобів патогенної і симптоматичної терапії, методів реанімації в комплексі з антидотами здатне забезпечити найбільш повний терапевтичний ефект. У статті наведений опис клінічного випадку гострого отруєння етиленгліколем, наведені результати діагностичних заходів, динаміка клінічних проявів та лабораторних показників, описано лікування пацієнта, показана роль гемодіалізної терапії при отруєнні етиленгліколем.

The issue of increasing the reliability and durability of hydraulic units of closed hydraulic systems of agricultural equipment is considered, due to better cleaning of the working fluid by filtration units. The design of a self-cleaning filter with hydraulic automatic control of backwashing of slotted filtration elements with a counterflow of the working fluid is proposed. A special stand has been developed for simulating the operation of a self-cleaning filter of closed hydraulic systems of agricultural equipment. Experimental studies on a special stand confirmed the efficiency of the proposed design and made it possible to identify its main advantages in comparison with domestic and foreign counterparts. Based on the analysis of transient processes with increased pressure pulsation of agricultural equipment of a closed hydraulic drive, the actual pressure drop at which automatic flushing is triggered was established, compared with the calculated one, in which it was impossible to take into account such real factors as friction in the sealing units, the characteristics of the springs, distortions, tightness of valve pairs, fluctuations in dimensional chains. The most optimal operating mode of auto-washing equipment with a choke diameter of 1.0 mm has been determined. The auto-washing equipment was switched on at a pressure drop of 1.5 MPa (15 atm) and in an improved mode – pressure pulsations with an amplitude of 2 MPa (20 atm) when the auto-wash was turned off decreased in time to 0.12 s. It is noted that the developed self-cleaning filter for closed hydraulic systems of agricultural equipment will improve the reliability and increase the service life of the elements of hydraulic units and the machine itself as a whole.

Chronic fatigue and an impairment of general health-related quality of life (HRQoL) are frequently reported by patients with primary sclerosing cholangitis (PSC). Studies on patients with primary biliary cholangitis (PBC) suggest that, unlike pruritus, fatigue may not be ameliorated by liver transplantation (LT). However, there are few data regarding the assessment of fatigue before and after transplantation in PSC. To investigate the effect of LT on fatigue and HRQoL in patients with PSC, 81 patients with PSC (median age 33 years; 69% men) were prospectively enrolled in this study. The PBC-40 and Short Form 36 (SF-36) questionnaires were used for assessment before and twice after LT. A total of 26 patients who received a transplant for PBC were included as controls. The potential impact of the clinical and laboratory parameters was evaluated by univariate and multivariate analyses. Although in addition to other well-being indexes the median fatigue score improved after LT (P 0.001), a detailed analysis demonstrated that fatigue persists in one-third of patients. A significant fatigue reduction was seen in men (P 0.001) but not women (P = 0.25). Posttransplant fatigue did not depend on concomitant inflammatory bowel disease, laboratory indexes of cholestasis, or disease recurrence. In the multivariate regression model, female sex was the only independent covariate associated with persistent fatigue. In terms of other measures of HRQoL, LT caused a substantial improvement in the majority of SF-36 and PBC-40 domains. Recurrent PSC and unemployment negatively affected the well-being of patients. Patients who received a transplant for PSC had significantly better HRQoL than those patients with PBC. LT improves various measures of HRQoL, but it does not ameliorate fatigue in female patients with PSC.

The article the issue of increasing the durability and reliability of units of closed hydraulic systems of agricultural equipment by ensuring the purity of the working fluid is considered. The analysis of existing systems of filtration of working liquid for the closed hydraulic systems of the agricultural equipment is resulted. It is noted that the basis of the created and implemented filtration systems are filtration installations in pressure mains, including with automatic washing, which provide filtration fineness up to 50 μm, filter elements which have high strength, reliability and are capable of countercurrent washing at working pressure of hydraulic system. The complex system of filtration of working liquid for the closed hydraulic systems of the agricultural equipment is offered. The filtration system of the working fluid provides for the use of filters with backwash and filtration elements with a slit-like brass wire of round cross section. The total length of the filtration gap of one filtration element with a width of 0.05 mm is 40 m The filter provides passive cleaning technology - countercurrent flushing, as the simplest in design, easy to manufacture and sufficiently efficient and cheap. Feature of the filtration installation is a possibility of washing of its filtration elements by a countercurrent of working liquid. The signal for flushing is the occurrence of a pressure drop on the filter, which can be used to judge the degree of contamination and the readings of manometers installed at the inlet and outlet of a closed hydraulic system of agricultural equipment. It is noted that the developed complex filtration system for closed hydraulic systems of agricultural equipment will increase the reliability of control hydraulics at least twice and reduce costly downtime of agricultural machinery due to failure of sealed elements of hydraulic equipment.

Over the past decades, there has been a significant expansion of the treatment options for patients with chronic lymphocytic leukemia (CLL) due to Brutons tyrosine kinase (BTK) inhibitors, which changed approaches in CLL therapy. Ibrutinib was the first BTK inhibitor approved for CLL treatment, but adverse events such as atrial fibrillation and hypertension may limit the use of ibrutinib. In the first head-to-head trial of acalabrutinib and ibrutinib ELEVATE-RR, acalabrutinib was statistically superior to ibrutinib in all-grade atrial fibrillation/flutter (9.4% vs 16.0%; р=0.023). In all-grade arterial hypertension (9.4% vs 23.2%) and grade 3 (4.1% vs 9.1%) acalabrutinib was statistically superior to ibrutinib. Acalabrutinib demonstrated fewer discontinuations due to adverse events (14.7%) vs ibrutinib (21.3%). Based on ELEVATE-RR results acalabrutinib should be considered as a drug of choice among BTK inhibitors for CLL patients, including patients with cardiovascular diseases and risks of cardiovascular diseases.

Introduction The relative resistance of children to severe course of the novel coronavirus infection remains unclear. We hypothesized that there might be a link between this phenomenon and observation from our previous studies concerning an inhibitory or cytotoxic effect of exhaled breath condensate (EBC) on endothelial cell cultures in children. Aim Since we could not find any data on the similar effect caused by EBC in adults, the aim of our study was to evaluate and compare the biological activity of EBC in adults and children in an experimental in vitro model. Furthermore, in order to identify a putative agent responsible for these properties of EBC in children, we attempted to analyse the composition of selected EBC samples. Material and methods The influence of EBC samples on metabolic activity of endothelial cell line C-166 was assessed using colorimetric tetrazolium salt reduction assay (MTT assay). Selected EBC samples were fractionated using size exclusion chromatography and subjected to mass spectrometry analysis. Results Exhaled breath condensates in healthy children, but not in adults, revealed a cytotoxic effect on in vitro cell cultures. This effect was most significant in condensate fraction, which contained a prominent 4.8 kDa peak in the mass spectra. Conclusions Breath condensates of healthy children contain the factor which reveals the inhibitory/cytotoxic effect on endothelial cell cultures. Although the physiological role of this agent remains unclear, its identification may potentially be useful in ongoing research on SARS-CoV-2/COVID-19.

Purpose. To develop a method for synthesizing a fuzzy automatic control system for a shearer drum in terms of coal seam hypsometry basing on the information criterion of the beginning of rock cutting-off by the drum to reduce ash content of the extracted coal. Methodology. Taking into consideration peculiarities of determining a distinct information criterion of the beginning of rock cutting-off by the drum and regularities of its variations during the shearer operation, a fuzzy inference algorithm is developed for a system of fuzzy automatic drum control in terms of seam hypsometry. In this context, rules of fuzzy productions, parameters of the membership functions of terms of the output linguistic variable system, and fuzzy operations are substantiated according to the recommendations of a classic Mamdani fuzzy inference algorithm. Studies are carried out to analyze the efficiency of the proposed fuzzy inference algorithm basing on the introduced relative parameter of the number of effective control actions formed by the fuzzy control system. Simulation modeling makes it possible to perform comparative analysis of the efficiency of the drum control. Findings. In the course of research, an algorithm of fuzzy control of the shearers upper drum in terms of coal seam hypsometry has been developed basing on the determination of direct and inverse transfer from coal breaking near the seam roof by the shearer drum to rock breaking with the help of statistical analysis of the stator power of a cutting drive motor. Originality. For the first time, a method of synthesis of fuzzy automatic control of the drum in terms of seam hypsometry has been proposed. Practical value. The proposed method is the theoretical basis to solve important scientific and applied problem of the automation of the coal shearer drum in terms of seam hypsometry to reduce ash content of the produced coal.

Chronic lymphocytic leukemia/small lymphocytic lymphoma. Clinical recommendations

Introduction. Today, the Joint Institute for Nuclear Research (JINR) is a kind of scientific and technical framework for Ukrainian nuclear researchers who are directly involved in conducting the cutting-edge nuclear physics experiments. Problem Statement. An important aspect of international cooperation for the Ukrainian researchers in the field of nuclear physics and materials science is to consolidate scholarly research, engineering, and financial resources of countries for creating international research organizations and implementing large-scale projects in modern science and technology. Purpose. Analysis of the factors that contribute to the development of nuclear physics and research in related disciplines in Ukraine, involvement of Ukrainian researchers in international research processes, and assessment of the future prospects. Materials and Methods. Analysis of scholarly research trends in the Joint Institute for Nuclear Research (JINR) and review of achievements of Ukrainian researchers, in particular, young researchers, in implementation of international projects in nuclear physics and related disciplines. Results. The background of nuclear physics research in Ukraine, the way of international cooperation development, and its impact on education and training of researchers have been analyzed. The examples of research results of Ukrainian nuclear physicists have been given. The cooperation of Ukrainian R&D organizations and companies with JINR has been shown to have a positive effect on creative and innovative processes, including the development and study of new high-tech materials. Conclusions. Collaboration with JINR gives Ukrainian researchers access to modern methods of physical research and unique equipment at leading international R&D centers, while planning and implementing large-scale experiments in nuclear physics, and enables studying the problems of the Universe. Teachers, students, and schoolchildren from Ukraine have additional opportunities to work with the cutting-edge methods, modern equipment and innovative approaches in the field of science and technology.

AIM. The aim of the study was to assess the epidemiological situation of newly diagnosed HIV infections and AIDS cases and death among AIDS cases in Poland in 2018 in comparison to the changes in preceding years. MATERIALS AND METHODS. Analysis of the epidemiological situation was based on reports of newly detected HIV cases and AIDS cases and the results of the annual survey of HIV testing conducted among the laboratories throughout the country. RESULTS. In 2018 there were 1,209 HIV cases newly diagnosed in Poland (diagnosis rate: 3.15 per 100,000), including 100 among non-Polish citizens. The frequency of newly detected HIV infections decreased by nearly 14.8% compared to the previous year and was higher by almost 6.8% compared to the median in 2012-2016 years. The total number of AIDS cases was 110 (incidence 0.29 per 100,000), and 23 people died from AIDS disease (0.06 per 100,000). New HIV diagnoses were reported mainly among people in age 30 to 39 years (37.8%) and among men (86.8%). Among cases with known transmission route, 77.0% concerned among men who had sexual contact with men (MSM). However, compared to the previous year, there was a significant decrease in the percentage of infected people in all key populations, related to higher risk of HIV infection. In addition, we observe the drop in total number of infected people in 2018 compared to the previous year. Whether these observations represent just fluctuations or a stable tendency, related to decreasing incidence in different key populations can only be assessed in the following years. The percentage of AIDS cases diagnosed at the same time with HIV diagnosis decreased by 4% percent points in comparison to 2017 (from 75.7% to 71.84% of all incident AIDS cases). CONCLUSION. Despite the decreasing total number of new HIV diagnoses overall and among different key populations compared to the previous year, it is too early to conclude that these are the results of positive preventive measures. Still, all actions should be taken to ensure timely linkage to care, considering the growing number of infected people among foreigners residing in Poland, and to improve the low frequency of testing towards HIV in the whole population.

The paper analyzes the energy potential of autonomous power supply based on renewable energy sources in a livestock farm. Based on calculations of the amount of farm waste that act as raw materials for a biogas power plant, the amount of electricity that can be produced from biogas has been determined. The value of electricity generation was also determined when a biogas plant and solar panels are used together in order to fully cover the need for electricity. It has been established that the use of renewable energy sources for autonomous power supply has significant potential for growth, in particular, the generation of electricity by a biogas power plant is calculated according to the minimum indicators for a cattle farm, provides 57% of the required electricity, in addition, there is also thermal energy, which is used for heating farms. The combined operation of the biogas plant and solar panels installed on the roof of the farm allows to cover the need for electricity with a reduction factor of 2.6 solar panels generation. The use of biogas obtained from the waste of a cattle farm and together with solar panels makes it possible to cover the need for electricity with a significant reserve. For a typical farm of 100 cattle, this stock is about 80%. The use of which is possible with the use of energy storage devices and the formation of a biogas reserve. It has been established that the electrical power of a biogas plant, which works in conjunction with solar panels, should be at least the average value of the power consumption to provide autonomous power supply to consumers of the livestock farm, especially in the winter months when solar insolation is minimal.

The most severe and disabling among various types of cerebrovascular accidents are hemorrhages. High mortality in hemorrhagic stroke is due to the possible development of a generalized convulsive syndrome, accompanied by respiratory failure; a cascade of irreversible biological reactions (dislocation syndrome with wedging, ventricular system hemotamponade with the formation of acute obstructive hydrocephalus); the development of complications associated with forced immobilization of the patient or connecting to a ventilator. The diagnosis of cerebral stem strokes is highly relevant due to the increase in their prevalence in the structure of cerebrovascular diseases. With stem strokes, the prognosis of the disease is worse than with strokes of any other localization, which is explained by the location of many vital centers in these structures. The paper highlights the classification and clinical manifestations of hemorrhages in the brain stem, substantiates the feasibility of rehabilitation measures at all periods of the disease. The use of early individual rehabilitation complex treatment can improve the results of therapy of deeply located hematomas, reducing disability and mortality of patients. The article presents the clinical case of a patient with a stem hemorrhagic stroke, in which, against the background of drug therapy and rehabilitation measures developed according to an individual program, self-care skills and working capacity were fully restored. Key words: hemorrhagic stroke (hemorrhage), stem stroke, hemorrhage in pons, rehabilitation

SummaryObjective. Arterial hypertension (AH) is one of the most important risk factors forthe development of chronic vascular brain damage, significant symptoms of which arecognitive disorders.The aim of the research was to study the characteristics of the clinical picture,extracranial haemodynamics, indices of higher brain functions in patients with AH,depending on total cholesterol (TC) plasma level.Materials and methods. Were examined 157 patients (119 males, 38 females) whowere allocated into 3 groups according to the plasma level TC: the first group (n=48)included patients with the mean TC level (7.3±0.7) mmol/L; the second (n=58) group ofpatients with the TC level (5.8±0.8) mmol/L; the third (n=51) – with the TC level(4.7±0.5) mmol/L.Results. It was found that, with an increase in plasma TC level from the desiredlevel to a higher one, patients with AH develop the signs of chronic cerebral ischemia.The daily blood pressure profile is disturbed due to the insufficient degree of nightlydecline. The elastotonic characteristics of the vascular wall of the extracranial arterieschanges with the increase of the asymmetry of blood flow, which is accompanied withneurasthenic disorders of the anxious-depressive type as well as a significant decreasein cognitive functions.Conclusions. The severity of cognitive dysfunction must be taken into account whenconducting preventive measures and assessing the prognosis in patients with AH andconcomitant hypercholesterolemia.

Hairy cell leukemia. Clinical recommendations

Background. Currently, treatment of recurrent / refractory chronic lymphocytic leukemia (CLL) involves the appointment of regimens with innovative drugs, which include ibrutinib and a combination of venetoclax and rituximab. Wherein said combination provides continuing over time high frequency eradication of minimal residual disease. Thereby, this regimen can be canceled if patients do not progress after 2 years from therapy start.The objective of the study was to assess the pharmacoeconomic aspects of therapy with venetoclax and rituximab combination in patients with recurrent / refractory CLL compared with ibrutinib monotherapy.Materials and methods. Analysis was performed by a simulation method from a position of the health care system. In accordance with network meta-analysis results of clinical studies in the recurrent / refractory CLL treatment (MURANO for venetoclax + rituximab combination and RESONATE and HELIOS for ibrutinib), which showed the absence of statistically significant differences in progression-free and overall survival between these treatment options, the cost-minimization method was used in the analysis. In the basic version, the model time horizon is 4 years. The price of venetoclax, rituximab and ibrutinib in the calculation corresponded to that registered (for rituximab – the median of the registered prices) with the value-added tax and the weighted average wholesale allowance taking into account the population in Russia.When analyzing the healthcare system budget impact, the time horizon of the study was 4 years. Therapy with combination of venetoclax + rituximab starting from the first year was suggested in 100 % of newly identified recurrent / refractory CLL patients. In the base case, it was estimated that 100 patients would need therapy every year.In the basic version of analysis, the cost of therapy after progression was not taken into account. In sensitivity analysis, an option taking into account therapy cost after progression, suggesting the appointment of venetoclax in the ibrutinib group and ibrutinib in the venetoclax + rituximab group, was also evaluated. In addition, variants with disease progression were additionally evaluated in 15 % of patients per year in the venetoclax therapy group at the end of the 2-year treatment course, as well as with an increase and decrease in the disease progression rate by 15 % in both comparison groups.As part of the sensitivity analysis, an assessment is made of a 15 % decrease and increase in Venetoclax price, a 30 % decrease in Ibrutinib price compared to registered price and the option with a 3-year study time horizon. When analyzing the budget impact, options with an increase in the number of patients annually identified and requiring treatment by 10, 20, 30 and 50 % were evaluated. Clinical and economic analysis was carried out with a discount rate of 3.5 % per year. A budget impact analysis was performed without discounting.Results. According to the results of cost-effectiveness analysis in the basic version, a regimen including venetoclax can reduce costs by 46.3 % compared with ibrutinib (cost for 4 years per patient is 10.422 and 19.413 million rubles, respectively). Therapy with combination of venetoclax + rituximab in 100 newly identified recurrent / refractory CLL patients annually instead of ibrutinib monotherapy will result in a reduction in therapy costs by 29.0 %, or by 1.579 billion rubles for 4 years per 100 patients starting therapy annually. The sensitivity analysis demonstrated the high reliability of the results. Conclusion. The treatment of recurrent / refractory CLL with a combination of venetoclax and rituximab is comparable in clinical efficacy with ibrutinib monotherapy and can significantly reduce the cost of the healthcare system, and therefore increase the availability of innovative therapy for this group of patients.

Background Cavernous angiomas (CAs) are vascular malformations that may result in stroke. Case Description Herein, we evaluate a CA patient with chronic migraine who experienced 2 documented symptomatic hemorrhages after receiving respective high doses of botulinum toxin (Btx). Conclusions Recently, bacterial lipopolysaccharide has been reported to contribute to CA development through Toll-like receptor signaling, causing hemorrhagic angiogenic proliferation. Lipopolysaccharide and Btx share a common intracellular signaling pathway driving CA development and hemorrhage. Significance of these observations is demonstrated by previous works on plasma molecules showing prognostic associations with symptomatic hemorrhages in human CA, related to the same canonical pathways. Authors suggest careful tracking of the association of Btx and hemorrhage in CA patients.

The significant transformation of employment in terms of its quantitative and qualitative characteristics is a hallmark of the current labor market. Some labor market segments differ in the market condition, growth rates, and the mechanisms of adaptation to change. This article aims at analyzing employment trends in the domestic financial sector in the context of global labor market trends. The research is based on methodological approaches to the employment study of the International Labor Organization and the information of the State Statistics Service of Ukraine. The study found out that in the pre-crisis period, employment in financial activities increased at a faster rate than other types of economic activity. However, after 2008, the trend has reversed. The concentration ratio of employees of the financial and insurance activities in the capital and in economically developed regions is moderate and steadily increasing. A decrease in the intensity of vocational training and advanced training is the negative aspect of the crisis processes in the Ukrainian financial sector.

The processes of producing reactor-grade hafnium are investigated. It is shown that the electron beam melting method is effective for purification of hafnium from metallic impurities. The use of deoxidizing additives makes it possible to purify hafnium from oxygen, and carrying out a vacuum-thermal treatment of the initial charge provides the necessary nitrogen content

The article researches the issue of pursuing the innovative product and price policy based on futures trading. It is specified that under the current conditions of destabilization of the economy, the development and use of efficient forms of financial and economic activity in the sphere of product and price policy is particularly important. It is noted that for countries that implement innovative policies for the development of market economy, futures trading plays an important role in the system of formation of transparent and competitive pricing. It is defined that futures trading is an organized form of trade and acts as a key element of ensuring price equilibrium in the market. It is noted that for successful futures trading its participants cannot avoid mastering the techniques of fundamental and technical analysis of the financial, economic, analytical and exchange activities, studying the risk management issues, etc. Knowledge on this issue can be expanded by no other but consulting companies that will provide qualified assistance in relation to this type of entrepreneurship. Therefore, there is currently a problem regarding the in-depth research of the issues of conducting and providing consulting services for the organization of futures activities as a form of innovative product and price policy. The example of consulting activity in the sphere of futures trading of the exchange broker «Svit Invest» is considered and analyzed. The advantages of using futures trading in the product and price system are determined. Practical proposals on the formation of consulting activities in the system of organization of innovative product and price policy on the basis of futures trading are provided. As a result, it is noted that the use of consulting services in futures trading as an innovative form of economic activity will allow entrepreneurial structures to deepen knowledge on this issue, concentrate resource efforts on the most important tasks of the innovation process and save time and money on additional costs.

The work has determined the possibility of full coverage of the needs for electricity of enterprises under the conditions of joint use of a biogas plant and solar panels on the example of a livestock farm. It has been established that the use of renewable energy sources has a significant potential for growth, in particular, the generation of electricity by a biogas power plant, calculated according to the minimum indicators for a cattle farm, provides more than 50% of the required electricity, in addition, there is also thermal energy that is used to heat the farm. The use of biogas obtained from the waste of a cattle farm and together with solar panels makes it possible to cover the need for electricity with a significant reserve. It has been established that the electrical power of a biogas plant, which works in conjunction with solar panels, should be at least the average value of the power consumption to provide power to the consumers of the livestock farm, especially in the winter months when insolation is minimal. The use of hybrid renewable energy sources based on biogas plants and solar panels makes it possible to significantly increase the efficiency of energy use, subject to the introduction of means for regulating the output of the biogas plant. The developed approaches to tracking the load schedule of a livestock farm that allow for the management of biogas power plants depending on changes in the load with energy storage units, which are needed at the time of starting and synchronizing the biogas plant generators. The use of the proposed method for tracking the load schedule is especially relevant for autonomous power supply systems, since it allows more efficient use of energy resources, in addition, this approach can significantly reduce the storage capacity and form a gas supply. A comparative analysis of the energy balance for daily power supply with various methods of using hybrid renewable energy sources showed the best energy performance when regulating the power of a biogas plant based on monitoring the load curve.

Resume. In this work we introduce the results of examination of 35 patients with neoplasia of distal part of colon. During this examination we use a system of fotodynamic diagnostic SFD.M16-1C2 and a pharmacological drug Hyperflav. Endoscopic examination (video colonoscopy) was doing during 7-9 hours after patients had taken 2 capsules of Hyperflav (8 mg. of hyperycine). From areas which had been fluorescent inducted by photosensibilisation, typical for morphological atypical cells, a biopsy was done. Using of photodynamic diagnostic help us to raise accuracy, sensitivity, specificity of verification of neoplastic processes of mucous membrane of the colon up to 99,8%, 94,9%,94,0% in accordance.

The paper proposes a method of tracking the livestock farm load schedule based on the determination of the required generation capacity depending on the actual load schedule. The use of this method allows the management of biogas power plants based on internal combustion engines, depending on changes in the load without power reserve for the time of possible displacement of technological operations. Unlike the power backup method, there is no additional power loss at the time of the reservation, the possible incorrect switches of electrical equipment that do not correspond to the normalized schedule are excluded, there is work in changing the order of operations and the order of switching on the equipment. The use of the method improves the energy efficiency of the biogas plant and also increases the reliability of the livestock farm's autonomous electricity supply system. The calculations of the use of this method for the cattle farm prove its energy efficiency in the conditions of autonomous electricity supply. Developed approaches to tracking the load schedule of the livestock farm allow for the management of biogas power plants depending on changes in the magnitude of the load without power reserve for the time of possible displacement of technological operations. The use of the proposed method is especially relevant for autonomous power systems. The calculations of using this method for a cattle farm testify to its effectiveness, in particular for a small cattle farm with a herd of 60 valid cows, 11 dry and 29 heads of young animals kept in the winter-stall period, the total saving is 82.8 kW ∙ h day.

Background and Purpose: Brain cavernous angiomas with symptomatic hemorrhage (CASH) have a high risk of neurological disability from recurrent bleeding. Systematic assessment of baseline features and multisite validation of novel magnetic resonance imaging biomarkers are needed to optimize clinical trial design aimed at novel pharmacotherapies in CASH. Methods: This prospective, multicenter, observational cohort study included adults with unresected, adjudicated brain CASH within the prior year. Six US sites screened and enrolled patients starting August 2018. Baseline demographics, clinical and imaging features, functional status (modified Rankin Scale and National Institutes of Health Stroke Scale), and patient quality of life outcomes (Patient-Reported Outcomes Measurement Information System-29 and EuroQol-5D) were summarized using descriptive statistics. Patient-Reported Outcomes Measurement Information System-29 scores were standardized against a reference population (mean 50, SD 10), and one-sample t test was performed for each domain. A subgroup underwent harmonized magnetic resonance imaging assessment of lesional iron content with quantitative susceptibility mapping and vascular permeability with dynamic contrast-enhanced quantitative perfusion. Results: As of May 2020, 849 patients were screened and 110 CASH cases enrolled (13% prevalence of trial eligible cases). The average age at consent was 46±16 years, 53% were female, 41% were familial, and 43% were brainstem lesions. At enrollment, ≥90% of the cohort had independent functional outcome (modified Rankin Scale score ≤2 and National Institutes of Health Stroke Scale score 30% of patients (EuroQol-5D). Patients had significantly worse Patient-Reported Outcomes Measurement Information System-29 scores for anxiety ( P =0.007), but better depression ( P =0.002) and social satisfaction scores ( P =0.012) compared with the general reference population. Mean baseline quantitative susceptibility mapping and permeability of CASH lesion were 0.45±0.17 ppm and 0.39±0.31 mL/100 g per minute, respectively, which were similar to historical CASH cases and consistent across sites. Conclusions: These baseline features will aid investigators in patient stratification and determining the most appropriate outcome measures for clinical trials of emerging pharmacotherapies in CASH.

The increasing awareness of modern consumers regarding the nutritional and health value of food has changed their preferences, as well their requirements, for food products, including meat and meat products. Expanding the knowledge on the impact of food on human health is currently one of the most important research areas for scientists worldwide, and it is also of interest to consumers who want to consciously compose their daily diets. New research methods, such as in silico techniques, offer solutions to these new challenges. These research methods are preferred over food evaluation, e.g., from meat, because of their advantages, such as low costs, shorter analysis times, and general availability (e.g., online databases), and are often used to design in vitro and, subsequently, in vivo tests. This review focuses on the possible use of in silico computerized methods to assess the potential of food as a source of these health-relevant biomolecules by using examples from the literature on meat and meat products. This review also provides information and important suggestions for analyzing peptides in terms of assessing their best sources, and screening those resistant to digestive factors and that show biological activity. The information provided in this review could contribute to the development of new sources of foods as biomolecules important for preventing or treating food-related chronic diseases, such as obesity, hypertension, and diabetes.

BACKGROUND Cerebral cavernous angioma (CA) is a capillary vasculopathy affecting more than a million Americans with a small fraction of cases demonstrating lesional bleed or growth with major clinical sequelae. Perfusion and permeability are fundamental features of CA pathophysiology, but their role as prognostic biomarkers is unclear. PURPOSE To investigate whether perfusion or permeability lesional descriptors derived from dynamic contrast-enhanced quantitative perfusion (DCEQP) magnetic resonance imaging (MRI) can predict subsequent lesional bleed/growth in the year following imaging. STUDY TYPE Single-site case-controlled study. SUBJECTS Two hundred and five consecutively enrolled patients (63.4% female). FIELD STRENGTH/SEQUENCE Three-Tesla/T1 -mapping with contrast-enhanced dynamic two-dimensional (2D) spoiled gradient recalled acquisition (SPGR) sequences. ASSESSMENT Prognostic associations with bleed/growth (present or absent) in the following year were assessed in 745 CA lesions evaluated by DCEQP in the 205 patients in relation to lesional descriptors calculated from permeability and perfusion maps. A subgroup of 30 cases also underwent peripheral blood collection at the time of DCEQP scans and assays of plasma levels of soluble CD14, IL-1β, VEGF, and soluble ROBO4 proteins, whose weighted combination had been previously reported in association with future CA bleeding. STATISTICAL TESTS Mann-Whitney U-test for univariate analyses. Logistic regression models minimizing the Bayesian information criterion (BIC), testing sensitivity and specificity (receiver operating characteristic curves) of weighted combinations of parameters. RESULTS The best prognostic biomarker for lesional bleed or growth included brainstem lesion location, mean lesional permeability, and low-value perfusion cluster mean (BIC = 201.5, sensitivity = 77%, specificity = 72%, P

In following study we examined whether blood arsenic (As) levels combined with specific polymorphisms in MT1B, GSTP1, ABCB1, NQO1, CRTC3, GPX1, SOD2, CAT, XRCC1, ERCC2 can be used as a marker for the detection of colorectal cancer (CRC) among Polish women. A retrospective case-control study of CRC included 83 CRC cases and 78 healthy controls. From each study participant pre-treatment peripheral blood was collected for As level measurement by inductively coupled–plasma mass spectrometry (ICP-MS). We estimated the odds ratio (OR) of the association between blood-As levels and CRC using multivariable unconditional logistic regression models. A low blood-As level (0.27–0.67 µg/L) was associated with an increased frequency of CRC (OR: 3.69; p = 0.005). This correlation was significantly greater when participants carried particular gene variants: CAT, rs1001179-nonCC (OR: 19.4; p = 0.001); ABCB1 rs2032582–CC (OR: 14.8; p = 0.024); GPX1 rs1050450-CC (OR: 11.6; p = 0.002) and CRTC3 rs12915189-nonGG (OR: 10.3; p = 0.003). Our study provides strong evidence that low blood-As levels are significantly associated with increased CRC occurrence and that particular gene variants significantly enhanced this correlation however, due to the novelty of these findings, we suggest further validation before a definitive statement that the combined effect of low blood-As levels with specific gene polymorphisms is a suitable CRC biomarker.

Over the past decade, we have seen a significant change in modern approaches in the first-line treatment of chronic lymphocytic leukemia (CLL). The CLL-10 study data established the FCR regimen as the treatment of choice for younger patients with limited comorbidities, while for patients older than 65 years, the BR regimen is more often considered as less toxic one. According to published data, 46% of patients with newly diagnosed CLL have comorbidities. Moreover, high-risk patients with del(17p) and/or TP53 mutation do not have response on immunochemotherapy (ICT) most often. Thus, about 1/2 of the patients cannot be treated or will not respond to standard ICT regimens. Targeted therapy with Brutons tyrosine kinase (BTK) inhibitors is an important option of the first-line treatment of patients with CLL. Acalabrutinib is a highly selective second-generation BTK inhibitor that does not inhibit EGFR, ITK or TEC targets. Acalabrutinib in combination with obinutuzumab or as monotherapy can be considered as a highly effective and safe option of the first line of CLL therapy. Based on the hight selectivity of the agent, acalabrutinib can be considered as the preferable option for patients who are not eligible for ICT, including patients with commodities, such as cardiovascular diseases or risk factors for their development.

Chronic lymphocytic leukemia (CLL) is the most common type of adult leukemia, with incidence rate of 4: 100 thousand per year, according to European data. CLL remains an incurable disease, with most patients over 60 years old. Immunochemotherapy schemes today remain the standard treatment approach for CLL. The advent of novel molecules expands possibilities of treating this disease. Targeted therapy with small molecule inhibitors of Bruton tyrosine kinase (BTK) occupies an important place in the treatment of patients with CLL, both for first-line therapy and for treatment of relapses. The drug acalabrutinib as a highly selective new generation of BTK inhibitor can be considered as an efficient and safe option for first-line therapy and for treatment of the disease relapse in patients with CLL, especially in patients with comorbidity, including cardiovascular diseases (CDV) or risk factors for CVD.

Highlights • Primary hepatolithiasis is a rare disease in western countries. • Primary intrahepatic stones are associated with repeated attacks of acute cholangitis. • Primary bilateral hepatolithiasis can be managed with partial hepatectomy with an intrahepatic hepaticocutaneous jejunostomy., Introduction Primary hepatolithiasis is a rare disease in western countries and it is associated with repeated attacks of acute cholangitis. Without proper treatment, hepatolithiasis can lead to progressive biliary strictures and secondary biliary cirrhosis. Presentation of case A 40 years old male was admitted due to recurrent cholangitis during the last 18 years. Bilateral primary hepatolithiasis was diagnosed and treated by left hepatectomy with an intrahepatic hepaticocutaneous jejunostomy. There were no postoperative complications and the patient was discharged after 7 days. Discussion The management of patients with primary hepatolithiasis remains a challenging task due to the high incidence of residual and recurrent stones after treatment. Conclusion Primary bilateral hepatolithiasis is a complex disease that can be managed with partial hepatectomy with an intrahepatic hepaticocutaneous jejunostomy.

The article analyzes the approaches to the development of a device for continuous monitoring of electrical parameters of solar panel generation. In the course of the research it is proposed to expand the capabilities of the device in comparison with the existing analogues for more accurate consideration of the main factors that influence the level of electricity generation by solar panels. The proposed device was used to investigate the modes of operation of solar panels type ABI CL P60260. The monitoring results obtained can be used to predict the generation level at the site of installation. The developed approaches to the construction of a hardware-software complex for monitoring the electrical parameters of solar panel generation allow determining the generation characteristics directly at the installation site in given geographical coordinates. In addition, fixing changes in generation depending on weather conditions for a long time, will allow you to get correlation dependencies to predict the level of generation, it is important in the formation of autonomous power supply systems.

Summary Background Genotype–phenotype studies can identify subgroups of patients with specific clinical features or differing outcomes, which can help shape management. Objectives To characterize the frequency of different causative genotypes in congenital melanocytic naevi (CMN), and to investigate genotype–phenotype and genotype–outcome associations. Methods We conducted a large cohort study in which we undertook MC1R genotyping from blood, and high‐sensitivity genotyping of NRAS and BRAF hotspots in 156 naevus biopsies from 134 patients with CMN [male 40%; multiple CMN 76%; projected adult size (PAS) > 20 cm, 59%]. Results Mosaic NRAS mutations were detected in 68%, mutually exclusive with BRAF mutations in 7%, with double wild‐type in 25%. Two separate naevi were sequenced in five of seven patients with BRAF mutations, confirming clonality. Five of seven patients with BRAF mutations had a dramatic multinodular phenotype, with characteristic histology distinct from classical proliferative nodules. NRAS mutation was the commonest in all sizes of CMN, but was particularly common in naevi with PAS > 60 cm, implying more tolerance to that mutation early in embryogenesis. Facial features were less common in double wild‐type patients. Importantly, the incidence of congenital neurological disease, and apparently of melanoma, was not altered by genotype; no cases of melanoma were seen in BRAF‐mutant multiple CMN, however, this genotype is rare. Conclusions CMN of all sizes are most commonly caused by mutations in NRAS. BRAF is confirmed as a much rarer cause of multiple CMN, and appears to be commonly associated with a multinodular phenotype. Genotype in this cohort was not associated with differences in incidence of neurological disease in childhood. However, genotyping should be undertaken in suspected melanoma, for guidance of treatment. What's already known about this topic? Multiple congenital melanocytic naevi (CMN) have been shown to be caused by NRAS mosaic mutations in 70–80% of cases, by BRAF mosaicism in one case report and by inference in some previous cases.There has been debate about genotypic association with different sizes of CMN, and no data on genotype–outcome. What does this study add? NRAS mosaicism was found in 68%, BRAF in 7% and double wild‐type in 25% of cases of CMN. NRAS was the commonest mutation in all sizes of CMN, but was nearly universal in projected adult size > 60 cm. BRAF is often associated with a distinct multinodular clinical/histological phenotype.Adverse outcomes did not differ between genotypes on current numbers., https://doi.org/10.1111/bjd.18747 available online