Course Of Administration Research Articles

Diagnosis of Enteric Fever Cases: Current Challenges of Azithromycin Resistant R717Q Gene in Rajshahi, Bangladesh

Salmonella enterica serovars typhi is a contributing typhoid agent, leading to untreatable infections based upon the rising prevalence of antimicrobial resistance in the said agent. Consequently, the main concern of the health service providers to treat expansively drug-resistant (XDR) enteric fever has been dependent on the only remaining oral drug, Azithromycin, for creating emerging resistance against it. Therefore, a cross-sectional descriptive study was conducted in the Microbiology Department of Rajshahi Medical College, Rajshahi, to identify Salmonella species by Fastidious Antibiotic Neutralization (FAN) method in suspected enteric fever cases along with its antimicrobial susceptibility pattern and molecular detection of Azithromycin resistant R717Q gene. Samples were collected purposively. Regarding the population's age distribution, out of 127 specimens, the predominant 37(29.1%) were found within the age group of 35-44 years. Automated blood culture was found positive in 64(50.39%) population; out of them, Salmonella spp were 38(59.37%) of the population. Among them 29(76.31%) have travel history, took street food 25(65.7%), used tap water for drinking 21(55.2%) and had kancha latrine 24(63.1%). It was found that 18.43% were sensitive and 81.57% resistant to Azithromycin. Azithromycin-resistant Salmonella spp. were detected in 31(81.57%), and among Azithromycin resistant R717Q gene was identified in 9(29.03%). The azithromycin-resistant R717Q gene was identified by conventional PCR. Because of its oral course of administration, Azithromycin is considered the widely used drug in Bangladesh, which is used once on a dose basis a day. In order to contribute to the development of this drug resistance, there could be many reasons, and among them there are the availability over the counter and the imperfectly done treatment. Thus, this study would be helpful to formulate a regional hospital empirical therapy by antimicrobial sensitivity and resistance pattern of the gene for Azithromycin resistance in Rajshahi Medical College Hospital.
 TAJ 2022; 35: No-2: 67-73

STUDY OF THE INFLUENCE OF (Mg, Co) BIS(CITRATO)GERMANATES ON MORPHOLOGICAL CHANGES OF THE LIVER

The search for new and safe drugs has led to a purposeful synthesis of coordination compounds of metals with bioligands based on metals - hermacite (magnesium bis (citrate) germanate), gercocyte (magnesium bis (citrate) germanate). The aim of the study was to investigate the morphological changes in the liver of rats after administration of (Mg, Co) bis (citrate) germanates in subacute and subchronic experiment. Materials and methods of research. The experiment was performed on mature male Wistar rats weighing 180-250 g, which for 28 days and 3 months intraperitoneally administered (Mg, Co) bis (citrate) germanates at doses of 1/40, 1/110 and 1/135 LD50 and studied morphological changes in the liver. Research results and their discussion. The course of administration of compounds at doses of 1/40 LD50 for 28 days was accompanied by dyscirculatory changes in the liver, as well as moderately pronounced dystrophic changes in hepatocytes. In general, more pronounced changes in the tissues of rats were observed under the influence of hercocytes (foci of destruction of liver tissue). The course of administration of doses of 1/40 LD50 for 3 months was marked by more pronounced dystrophic changes in the liver. Subchronic course administration of compounds at doses of 1/110 LD50 was accompanied by minor morphological changes. When comparing morphological changes in rat tissues, cobalt-containing compound had a slightly more pronounced effect. It is noteworthy that toxic effects did not accompany the course of administration of BAS with doses of 1/135 LD50 and liver tissue did not differ from the control group. Key words: (Mg, Co) bis (citrate) germanates, subacute toxicity, morphological changes.

Study of the effect of Unifuzol on cognitive impairment and damage to the hippocampus and cerebral cortex during course administration to rats with bilateral stenosis of the common carotid arteries, causing chronic circulatory failure

To study the effect of Unifuzol (L-arginine sodium succinate) on cognitive impairment, cerebral blood flow, and damage to the tissues of the hippocampus and cerebral cortex during a 10-day course of administration to rats with chronic cerebral ischemia (CCI) caused by bilateral stenosis of the common carotid arteries (CCA). The study was conducted on male rats with CCI caused by bilateral stenosis of the CCA by 60%. 40 days after surgery, rats received Unifusol (21, 42 and 84 ml/kg), nicergoline (10 mg/kg), citicoline (500 mg/kg) or placebo (0.9% NaCl) for 10 days. Next, cognitive impairments were assessed in the Morris Water Maze and the New Object Recognition (NOR) test, as well as the level of motor and exploratory activity in the Open Field test. The level of cerebral blood flow was determined immediately after the CCA stenosis and at the end of the experiment. Animals were euthanized in a CO2 incubator, after which the brain was removed and subjected to morphometric analysis. In animals that were modeled with CCA stenosis, pronounced behavioral and cognitive impairments occurred as a result of a decrease in blood flow in the vessels of the brain and subsequent changes in the tissues of the hippocampus and the cerebral cortex. Intravenous course administration of Unifuzol at doses of 42 and 84 ml/kg to animals with CCI was comparable in efficiency to nicergoline and citicoline, which was expressed in greater preservation of the cognitive abilities of animals in the Morris Water Maze and NOR tests. In the Open Field test, animals injected with Unifusol at doses of 42 and 84 ml/kg performed more acts of motor and exploratory activity than animals from the placebo group, and had a higher level of cerebral blood flow (compared to animals that were injected with citicoline). Based on the results of a morphological study, it was found that the most significant neuroprotective effect was provided by nicergoline and Unifuzol (at doses of 42 and 84 ml/kg). Unifuzol at a course of administration at doses of 42 and 84 ml/kg, comparable to the reference drugs nicergoline and citicoline, reduces the severity of psychoneurological deficit in animals with CCI, comparable to them improves the microcirculation of brain tissues, preventing damage to brain tissues.

Neuroprotective effects of isatin and afobazole in rats with rotenone-induced Parkinsonism are accompanied by increased brain levels of Triton X-100 soluble alpha-synuclein.

Effects of the endogenous neuroprotector isatin and the pharmacological drug afobazole (exhibiting neuroprotective properties) on behavioral reactions and quantitative changes in the brain proteomic profile have been investigated in rats with experimental rotenone Parkinsonism. A single dose of isatin (100 mg/kg subcutaneously on the last day of a 7-day course of rotenone administration) improved the motor activity of rats with rotenone-induced Parkinsonism in the open field test (horizontal movements) and the rotating rod test. Afobazole (10 mg/kg intraperitoneally, daily during the 7-day course of rotenone administration) reduced the manifestations of rigidity and postural instability. Proteomic analysis, performed using brain samples obtained the day after the last administration of rotenone and neuroprotectors, revealed similar quantitative changes in the brain of rats with rotenone Parkinsonism. An increase in the relative content of 65 proteins and a decrease in the relative content of 21 proteins were detected. The most pronounced changes - an almost ninety-fold increase in the alpha-synuclein content - were found in the brains of rats treated with isatin. In animals of the experimental groups treated with "Rotenone + Isatin", as well as "Rotenone + Afobazole", the increase in the relative content of this protein in the brain was almost 60 and 50 times higher than the control values. Taking into consideration the known data on the physiological role of alpha-synuclein, an increase in the content of this protein in the brain upon administration of neuroprotectors to animals with rotenone Parkinsonism may represent a compensatory reaction, at least in the early stages of this disease and the beginning of its treatment.

The China in foreign policy of the US president Richard Nixon administration (january-february 1969)

The article investigates the formation of the foreign policy course of US President Richard M. Nixon on China in January-February 1969. The practical implementation of pre-election initiatives by the administration of President Richard M. Nixon in the Chinese direction in January-February 1969 was studied. There were analyzed reasons, course and consequences of the intensification of Washington's foreign policy strategy toward Beijing during the investigated period. The role of various groups in the American establishment in the process of forming the foreign policy course of the new administration towards China in January-February 1969 is outlined. It describes the specific US foreign policy actions towards communist China at the beginning of Richard M. Nixon's presidential period. Despite the presence in the political, academic, and social circles of the United States of certain attitudes in favor of the recognition of the People's Republic of China as the political reality of international life, the question of the legal recognition of China in the second half of the 1960s constantly moved to the background. The victory of Richard М. Nixon in the presidential election in 1968 was accompanied by a series of changes in the system of geopolitical and military priorities of the United States. The new administration’s more realistic approach to China was due primarily to the fact that Beijing, which renounced its alliances and claimed the role of a «third force», was a strong player in the international arena. Moreover, the policy of Kennedy–Johnson did not justify itself, as China has intensified its foreign policy, and established relations with many countries, including the US allies. At the beginning of the presidency of Richard М. Nixon, in January-February 1969, his administration managed to quickly develop and begin to implement a holistic concept of «new policy» for China. His Chinese policy was inextricably linked to the US foreign policy in Asia and reflected the clash of American and Chinese interests in the region. At the same time, the representatives of the American establishment had a clear idea of how they could influence Soviet-Chinese relations in order to deepen the rift between the USSR and China and what concrete benefits they could derive from this. A number of objective and subjective factors did not prevent the administration of the 37th President of the United States, Richard М. Nixon, radically changing Washington’s Chinese policy. Communist China continued to be recognized as a powerful factor in the US-Soviet dialogue. In spite of this, in the late 60s of the twentieth century, the objective preconditions began to evolve gradually, which promoted the normalization of US-China relations in the future and allowed to resolve most of the controversial issues that ultimately led to the international recognition of the People’s Republic of China by the United States of America.

The policy of the administration of the US President Richard M. Nixon on PRC (March-July 1969)

The article investigates the formation of the foreign policy course of US President Richard M. Nixon on China in March-July 1969. The practical implementation of pre-election initiatives by the administration of the President Richard M. Nixon in the Chinese direction in March-July 1969 was studied. There were analyzed reasons, course and consequences of intensification of Washington's foreign policy strategy towards Beijing during the during investigated period. The role of various groups in the American establishment in the process of forming the foreign policy course of the new administration towards China in March-July 1969 is outlined. It is described the specific US foreign policy actions towards communist China at the beginning of Richard M. Nixon presidential period. Despite the presence in the political, academic and social circles of the United States of certain attitudes in favor of the recognition of the People's Republic of China as the political reality of international life, the question of the legal recognition of China in the second half of the 1960’s constantly moved to the background. The victory of Richard М. Nixon in the presidential election in 1968 was accompanied by a series of changes in the system of geopolitical and military priorities of the United States. The new administration’s more realistic approach to China was due primarily to the fact that Beijing, which renounced its alliances and claimed the role of a «third force», was a strong player in the international arena. Moreover, the policy of Kennedy–Johnson did not justify itself, as China has intensified its foreign policy, established relations with many countries, including the US allies. At the beginning of the presidency of Richard М. Nixon in March-July 1969, his administration was managed to quickly develop and begin to implement a holistic concept of «new policy» for China. His Chinese policy was inextricably linked to the US foreign policy in Asia and reflected the clash of American and Chinese interests in the region. At the same time, the representatives of the American establishment have a clear idea of how they could influence Soviet-Chinese relations in order to deepen the rift between the USSR and China, and what concrete benefits they could derive from this. A number of objective and subjective factors not prevented the administration of the 37th President of the United States, Richard М. Nixon, radically changing Washington’s Chinese policy. Communist China continued to be recognized as a powerful factor in the US-Soviet dialogue. In spite of this, in the late 60’s of the twentieth century the objective preconditions began to evolve gradually, which promoted to the normalization of US-China relations in the future, and allowed to resolve most of the controversial issues that ultimately led to the international recognition of the People’s Republic of China by the United States of America.

The Foreign Policy of US President James E. Carter on the Peoples Republic of China, 1980-1981

The article researches the US foreign policy towards the PRC during the presidency of James E. Carter in 1980–1981. The practical implementation of pre-election initiatives by the administration of the President James E. Carter in the Chinese direction in 1980–1981 was studied. There were analysed reasons, course and consequences of intensification of Washington's foreign policy strategy towards Beijing during the investigated period. The role of various groups in the American establishment in the process of forming the foreign policy course of the new administration towards China in 1980–1981 is outlined. It is described the specific US foreign policy actions towards communist China of James E. Carter presidential period.

Relief of chest pain after SARS-CоV-2 vaccination

A 46-year-old patient consulted a cardiologist complaining of discomfort behind the sternum, which manifested itself in 3 weeks after a mild COVID-19 recovery and had been persisting for about 4 months by the time she consulted the doctor. Echocardiography did not reveal any disturbances in regional and global contractility. It was thickening and hyperechogenicity of the pericardium of the lower-lateral, and lateral areas of the left ventricle without any signs of pathological exudation that attracted attention. A chest X-ray and a test with physical activity were performed. Blood tests did not reveal any abnormality, an increase in C-reactive protein was observed. The patient was diagnosed with chronic non-exudative form of pericarditis associated with COVID-19. A successful treatment was carried out: colchicine 0.5 mg/day, ibuprofen 600 mg 3 times a day. Next time the patient consulted a doctor 3 months later. Against the background of ARVI, typical episodes of low-intensity chest pain repullulated. Echocardiography showed regional exudation and initial signs of impaired diastolic function. A compulsory vaccination with Gam-COVID-Vac was carried out in 4 weeks. The post-vaccination period was accompanied by low-grade pyrexia for 2 days, after which the patient noted the complete disappearance of the heart pain. Echocardiography recorded pericardial layers separation and some improvement in diastolic function. The treatment was not carried out for various reasons. Over the next months, cardialgia did not recur. Check study 3 months after showed no visible exudation into the pericardial cavity, a decrease in hyperechogenicity compared to the records of previous studies was noted. In 8 months after vaccination, the patient suffered another mild COVID-19 with exudative pericarditis recurrence and the involvement of the pleura. Blood tests taken during the 1st week of the disease revealed a characteristic cellular shift (lymphocytosis 38%), as well as an increase in ERS up to 26 mm/h, D-dimer up to 1166 μg/l. CRP was normal. Additional analysis for cardiolipin antibodies, antinuclear factor, rheumatoid factor, cyclic citrullinated peptide antibodies, b2 glycoprotein I antibodies did not reveal any pathology. Transient low-grade pyrexia had been persisting for 3 weeks in evening hours, in spite of the fact that she kept taking 800 mg of ibuprofen per day. By now, the patient continues receiving colchicine according to the planned 6-months course of administration.

TRANSPARANSI PEMERINTAH DESA DALAM PENYELENGGARAAN PEMERINTAH

This study aims to determine: 1) to know the implementation of the principle of transparency, in the Bawan village government in Banama Tingang district Pulang Pisau, 2) to find out the factors that influence the implementation of the principle of transparency in the administration of the Bawan village government in the Banama Tingang sub-district Pulang Pisau. Transparency of governance in the Bawan village through the community’s right to access information is still not optimal because access to information provided to the Bawan village community is still not able to be reached or accessed quickly by the community. Supporting factors: to support transparency in the administration of government in the village, starting from the leadership element, in this case, the village head. The village head of Bawan always provides good support to all employees who carry out their duties well so that the process of implementing transparency in the village of Bawan can run well. Inhibiting factor: In every government administration of course there are obstacles / or obstacles to be faced, as is the case with the Bawan village starting from the budget shortage factor so that there are still many government programs that have not been implemented.

Acute phase protein concentrations following serial procaine penicillin G injections in horses.

Acute phase protein (APP) measurement is used to detect inflammation. Intramuscular (IM) injections could cause tissue injury and induce an acute phase response (APR). To evaluate the effects of IM procaine penicillin G (PPG) injections on APP concentrations in horses. Prospective longitudinal design. PPG was administered intramuscularly to six horses, twice daily, for 5 days. Plasma fibrinogen (FIB), serum amyloid A (SAA), haptoglobin (HAP), creatine kinase (CK), and aspartate aminotransferase (AST) were quantified daily for 5 days before the first injection, during the course of administration, and for 4 days after the final dose. Analytes were quantified every other day for the remaining 16 days. Data were compared using a parametric or non-parametric repeated measures ANOVA and a Tukey's or Mann-Whitney rank sum test, respectively. Significance was set at p < 0.05. CK was increased over baseline (mean ± SD: 200 ± 74 IU/L) on Days 1-6 (p < 0.001 to p=0.02, mean ± SD: 723-1177 ± 355-544 IU/L) and AST was increased above baseline (mean ± SD: 233 ± 58 IU/L) on Days 2-7 and 10 (p < 0.001 to p=0.05, mean ± SD: 307-437 ± 79-146 IU/L). Increased FIB was noted over baseline (mean ± SD: 177 ± 30 mg/dl) on Days 6-8 and 10 (p=0.02 to p=0.03, mean ± SD: 234-252 ± 33-49 mg/dl). SAA was increased above baseline (mean ± SD: 4.7 ± 2.9) on Day 6 (p=0.02, mean ± SD: 113 ± 186 μg/ml). There was no change in HAP. Healthy horses were used, small sample size, and a lack of a negative control group. Serial intramuscular procaine penicillin G (IM PPG) injections may result in increased positive APP concentrations in horses and this must be considered when these test results are interpreted.

Road MAP of National Development Through The V Amendment of The 1945 Constitution

The actualization of the 1945 Constitution of the Republic of Indonesia in the administration of the state, after 23 years of reform or after 4 amendments have been made, it is deemed necessary/important to carry out the 5th amendment. solely on the needs/allegances of the state and it is relevant to the affairs of the life of all Indonesian people. The research method used is normative juridical research considering that what is studied is the result of books and regulations regarding: the ratio of amendments to the 1945 Constitution of the Republic of Indonesia, public participation in constitutional changes, the national development planning system (SPPN), and reconstruction of the state policy model of the main principles of the state. . The basic question related to the current state administration issue is bringing back the State Policy Guidelines to be an important choice? In the course of Indonesia's state administration, it seems that a national development roadmap is urgently needed, in order to realize a good government, and maintain the sustainability of national development (sustainable government) so that the government (President) of the development program becomes a Vision-Mission that must be continued even though the President changes.

Usefulness of Global Longitudinal Strain-Guided Management in Preventing Human Epidermal Growth Factor Receptor 2 (HER2) Inhibitor-Induced Myocardial Damage.

Background: Trastuzumab, an anti-human epidermal growth factor receptor 2 (HER2) monoclonal antibody, is a specific first-line treatment for patients with HER2-positive cancers. Cardiac dysfunction is among the most problematic adverse events associated with trastuzumab. Although regular echocardiographic screening is recommended for early detection of cardiac damage, few reports have investigated the validity of echocardiographic screening in chemotherapy. Therefore, the aim of this study was to determine whether a GLS-guided management approach could reduce cardiotoxicity and discontinuation of trastuzumab chemotherapy. Methods and Results: To evaluate the usefulness of global longitudinal strain (GLS)-guided cardioprotective interventions, we retrospectively analyzed 67 patients treated with trastuzumab who underwent structured echocardiographic assessments before and after 1, 3, and 6 courses of trastuzumab administration. If a >15% relative decrease in GLS was identified, cardioprotective agents were administered. Thirty (44.8%) patients had breast cancer; the remaining patients had salivary gland cancer. The median observation period for the intervention group was 304 days from the initial evaluation. Nineteen (28.4%) patients exhibited a >15% relative decrease in GLS, and consequently received cardioprotective agents. The incidence of trastuzumab discontinuation for cardiogenic reasons was significantly lower among patients receiving GLS-guided interventions than among those not receiving the intervention (2.4% vs. 24.0%; P=0.009). The incidence of a subsequent decline in left ventricular ejection fraction was lower among patients receiving the intervention than among those not receiving the intervention (4.8% vs. 24.0%; P=0.04). Conclusions: GLS-guided cardioprotective intervention significantly decreased the incidence of trastuzumab discontinuation.

Experimental Correction of Homeostasis Changes during Alloxan-Induced Diabetes by Implantation of Islet Cells Cultured in Fibrous TiNi-Based Scaffold.

The use of fibrous scaffolds made of titanium nickelide and carrying islet cells (IC) after a course of alloxan administration was studied in vivo. Scanning electron microscopy showed good adhesion of IC in the pore space of the scaffolds. In 28 days, mature tissue comprising both cellular and fibrous components filled the inner space of the scaffold by 90%. The advantage of intraperitoneal implantation of IC in vitro seeded in fibrous titanium nickelide scaffolds in comparison with injection of IC (6×105 cells) to Wistar rats was demonstrated in the dynamics of pancreatic function recovery (normalization of blood glucose and glycosylated hemoglobin concentrations by day 21 of the experiment), regeneration of the white hematopoietic lineage cells, and lengthening (by 2 times) of the lifespan of animals with alloxan-induced diabetes. Injection of IC improved rat survival by only 40%. Thus, the hybrid tissue-engineered construct (fibrous titanium nickelide scaffold+IC) is biocompatible when administered intraperitoneally, stimulates regeneration in rats with alloxan-induced diabetes, improves blood glucose utilization processes, and restores suppressed leukopoiesis. It is assumed that hepatocytes can be the main target cells of the hybrid tissue-engineering construct.

Effect of benzoyl taurine dipotassium salt on coagulation, hemostasis and vascular activity in the microvasculature of the brain in violation of cerebral circulation

Cerebral circulation disorders (CCD) are one of the most common causes of mortality and disability in the population. Improving the microcirculation of brain tissue is one of the main directions in the treatment and prevention of CCD.Aim of the study was to evaluate the effect of a new derivative of hydroxybenzoic (salicylic) acid on neurological deficit, hemostasis and functional state of arterial pial vessels in the study of prostacyclin-synthetic activity and evaluation of NOmediated endothelial dysfunction in rats under experimental CCD conditions. Material and methods. The experiment was carried out on 50 Wistar rats, which were simulated for CCD by occlusion of common carotid arteries. Within 7 days after the operation, the animals received treatment according to the group: saline, C-60 (N-(3-hydroxybenzoyl)taurine dipotassium salt) and acetylsalicylic acid. After treatment, the activity of the prostacyclin-synthetic system was assessed by the reaction of pial vessels to indomethacin, endothelial dysfunction was estimated by tests with acetylcholine and L-NAME. The parameters of plasma and platelet hemostasis were also studied, and behavioral tests (open field, adhesion test, rotarod, Morris water maze, passive avoidance task) were used to assess neurological deficits in animals. Results. When studying the level of neurological deficit in animals with brain ischemia after a course of administration of the test compound, it was noted that in the treated groups, compared with the control group, there was a significant increase in motor and exploratory activity, improvement in sensory-motor function and coordination of movements (p &lt; 0.05). Also, in the group treated with the salicylic acid derivative, normalization of the parameters of platelet and plasma hemostasis, improvement of the functional state of the vascular endothelium was observed. According to the results of assessing the prostacyclin-synthesizing activity of the endothelium of the cerebral vessels, it follows that the test compound inhibits cyclooxygenase at a level comparable with effect of acetylsalicylic acid. Conclusions. A new derivative of salicylic acid, the dipotassium salt of N-(3-hydroxybenzoyl)taurine, reduces the severity of neurological deficit, improves hemostasis parameters and the functional state of cerebral vessels in rats with brain ischemia in the experiment.

MLC performance prognosis using a degradation model based on trajectory log data from a daily test.

This paper investigates the feasibility of implementing a predictive maintenance program for a multileaf collimator (MLC) based on data collected in trajectory logs (TLs) obtained by conducting a simple daily test, with the aim of minimizing unscheduled downtime. A dynamic field test was designed, and the TLs generated in the course of daily administration in a linear accelerator were collected to evaluate trajectory deviations of the MLC leaves as well as interlocks (COL 420219/20, COL 420207/08) reported by the machine. During this evaluation, we observed that the trajectory deviations of some leaves increased up to a threshold value beyond which certain interlocks began to appear in treatment fields in those leaves. An exponential degradation model was therefore developed to predict this drift and determine each leaf's remaining useful life (RUL). Once the applicability of the model was confirmed, we added a second accelerator equipped with an MLC with the same configuration to validate the model. The model was able to predict certain COL 420219/20 interlocks resulting from primary readout/expected position discrepancies and to estimate each leaf's RUL. In total, 11 cases (8 interlocks + 3 potential interlocks avoided due to service interventions [27.3% of the total]) were detected over 7 days in advance, with no false positive results. Scheduling of service interventions several days prior to MLC failure would therefore be possible. When these types of interlocks were not predicted by the model, they were always generated by leaf motor failure. Consequently, intervention time could also be optimized by directly replacing the motor. During the study period, for these types of interlocks, our approach would have reduced downtime from 35.25 to 4.00h (88.7%) and from 34.75 to 22.83h (34.3%) for each accelerator, respectively. For COL 420207/08 interlocks, which are generated by primary/secondary readout discrepancies, no correlation with leaf trajectory deviation increases recorded in the TLs was found. Throughout the study period, these types of interlocks requiring service intervention, also mainly for motor replacement, represented a downtime of 9.50h for the first accelerator (21.2% of total downtime) and by 4.33h (11.1% of total downtime) for the second accelerator. This study demonstrates that by applying a predictive MLC maintenance program based on information collected in TLs, it is possible to predict certain interlocks and therefore schedule preemptive interventions to avoid their occurrence. This could optimize health-care delivery performance and minimize the loss of treatment sessions.

Final Analysis of Diagnostic Endoscopic Resection Followed by Selective Chemoradiotherapy for Stage I Esophageal Cancer: JCOG0508

Final Analysis of Diagnostic Endoscopic Resection Followed by Selective Chemoradiotherapy for Stage I Esophageal Cancer: JCOG0508

Reestablish immune tolerance in rheumatoid arthritis.

Rheumatoid arthritis (RA) is a chronic progressive autoimmune disease. Despite the wide use of conventional synthetic, targeted and biologic disease modifying anti-rheumatic drugs (DMARDs) to control its radiological progress, nearly all DMARDs are immunologically non-selective and do not address the underlying immunological mechanisms of RA. Patients with RA often need to take various DMARDs long-term or even lifelong and thus, face increased risks of infection, tumor and other adverse reactions. It is logical to modulate the immune disorders and restore immune balance in patients with RA by restoring immune tolerance. Indeed, approaches based on stem cell transplantation, tolerogenic dendritic cells (tolDCs), and antigen-based tolerogenic vaccination are under active investigation, and some have already transformed from wet bench research to clinical investigation during the last decade. Among them, clinical trials on stem cell therapy, especially mesenchymal stem cells (MSCs) transplantation are most investigated and followed by tolDCs in RA patients. On the other hand, despite active laboratory investigations on the use of RA-specific peptide-/protein-based tolerogenic vaccines for T cell, clinical studies on RA patients are much limited. Overall, the preliminary results of these clinical studies are promising and encouraging, demonstrating their safety and effectiveness in the rebalancing of T cell subsets; particular, the recovery of RA-specific Treg with increasing anti-inflammatory cytokines and reduced proinflammatory cytokines. Future studies should focus on the optimization of transplanted stem cells, the preparation of tolDCs, and tolerogenic vaccines with RA-specific protein or peptide, including their dosage, course, and route of administration with well-coordinated multi-center randomized clinical control researches. With the progress of experimental and clinical studies, generating and restoring RA-specific immune tolerance may bring revolutionary changes to the clinical management of RA in the near future.

Sport-Specific Rehabilitation, but Not PRP Injections, Might Reduce the Re-Injury Rate of Muscle Injuries in Professional Soccer Players: A Retrospective Cohort Study.

Platelet-rich plasma (PRP) injections are extremely popular in the management of sports injuries in elite athletes. However, data on the use of various administration protocols of PRP are contradictory. The efficacy of platelet-rich plasma in the treatment of muscle injuries in professional soccer players has to be contextualized within the sport-specific rehabilitation program. Despite the questionable role of PRP, a well-structured rehabilitation program is still regarded as the gold standard. We examined the efficacy of various PRP protocols in the management of muscle injuries in professional soccer players in respect to treatment duration and injury recurrence. A retrospective cohort study. Muscle injuries in professional soccer players (n = 79, height 182.1 ± 5.9 cm, weight 76.8 ± 5.8 kg, BMI 23.1 ± 1.4 kg/m2) from three elite soccer clubs from the Russian Premier League were recorded during the 2018–2019 season. The injuries were graded based on MRI, using the British Athletic Muscle Injury Classification. Treatment protocols included the POLICE regimen, short courses of NSAID administration, and the specific rehabilitation program. The sample group of players were administered PRP injections. The average treatment duration with PRP injection was significantly longer than conventional treatment without PRP, 21.5 ± 15.7 days and 15.3 ± 11.1 days, respectively (p = 0.003). Soccer-specific rehabilitation and obtaining MRI/US before the treatment was associated with significantly reduced injury recurrence rate (p < 0.001). There was no significant difference between the PRP injection protocol applied to any muscle and the treatment duration in respect of grade 2A–2B muscle injuries. The total duration of treatment of type 2A–2B injuries was 15 days among all players. In the group receiving local injections of PRP, the total duration of treatment was 18 days; in the group without PRP injections, the treatment duration was 14 days. In our study, PRP treatment was associated with longer treatment duration, regardless of which muscle was injured. This may reflect the tendency to use PRP in higher-degree injuries. Soccer-specific rehabilitation significantly reduced the injury recurrence rate when compared to the administration of PRP injections. MRI/US imaging before returning to play was also associated with a lower injury recurrence rate. There was no significant difference between the PRP injection protocol applied to any muscle and the treatment duration in treatment of type 2A–2B muscle injuries.

IMPLEMENTASI TUGAS DAN WEWENANG KEPALA DESA BERDASARKAN UNDANG-UNDANG NO 6 TAHUN 2014 TENTANG DESA

Abstract&#x0D; The village is the smallest area within the scope of the government structure, throughout the course of the state administration of the Republic of Indonesia, the village has developed in various forms so that it needs to be protected and empowered to become strong, advanced, independent and democratic so that it can create a strong foundation in implementing governance and development towards village communities as the lowest government unit in Indonesia, its position and authority still raises many pros and cons.&#x0D; &#x0D; This is because the laws governing Regional Government and the new ones have not provided any firmness regarding the duties and authorities of the Village Head.&#x0D; &#x0D; The method used is an empirical legal study. Village administration is a subsystem of the government administration system, so that the village has the authority to regulate and manage the interests of its people. The implementation of village government is inseparable from the implementation of regional autonomy, the village government is the leading unit in service to the community and is a strategic milestone for the success of all programs.&#x0D; &#x0D; Based on this, the formulations discussed in this study are, firstly the implementation of the duties of the village head is vulnerable in realizing the objectives of the village head's authority, and secondly for the supervision of the implementation of the village head's duties which includes all efforts or activities to ensure and direct that the implementation of the tasks or work runs. properly.&#x0D; &#x0D; Keywords: Duties and authorities, Village Head, Law no. 6 Year 2014

Conversion surgery for hepatocellular carcinoma with portal vein tumor thrombus after successful atezolizumab plus bevacizumab therapy: a case report

BackgroundThe treatment of hepatocellular carcinoma (HCC) requires diverse and multidisciplinary approaches. In recent years, new agents with good antitumor effects have emerged for systemic chemotherapy, and conversion surgery (CS) after systemic chemotherapy is expected to be an effective treatment strategy for unresectable HCC. We herein report a case of unresectable HCC with portal vein tumor thrombus (PVTT) in which atezolizumab plus bevacizumab therapy induced PVTT regression, followed by CS with R0 resection.Case presentationThe patient was a 79-year-old man with S2/S3 HCC who was referred to our department due to tumor re-growth and PVTT after two rounds of transcatheter arterial chemoembolization. The PVTT extended from the left portal vein to the main trunk, and it was determined that the resection of the left portal vein would be difficult to perform with R0 status. Based on the diagnosis of unresectable HCC, treatment with atezolizumab plus bevacizumab was initiated. After two courses of treatment, contrast-enhanced computed tomography showed that the PVTT had regressed to the peripheral side of the left portal vein, and R0 resection became possible. The patient developed grade 3 skin lesions as an immune-related adverse event, and it was determined that the continuation of chemotherapy would be difficult. Four weeks after the second course of atezolizumab plus bevacizumab administration, left lobectomy was performed. Intraoperative ultrasonography was used to confirm the location of the tumor thrombus in the left portal vein during the resection, and a sufficient surgical margin was obtained. The histopathological findings showed that primary tumor and PVTT were mostly necrotic with residues of viable tumor cells observed in some areas. The liver background was determined as A1/F4 (new Inuyama classification). The resection margins were negative, and R0 resection was confirmed. There were no postoperative complications. No recurrence was observed as of five months after surgery.ConclusionsCS with atezolizumab plus bevacizumab therapy has potential utility for the treatment of unresectable HCC with PVTT.