Exact Criteria Research Articles

On the Necessity of Bulgarian Science Citation Index and the Academic Libraries Possible Contribution: Based on the Varna University of Economics Library (2014 – 2020)

The introduction of new bibliometric indicators for measuring scientific work puts the university and scientific libraries in Bulgaria in the need of creation of databases with citations of professors and scientists in every scientific organization. Each country creates its own citation index. The purpose of the article is to analyse existing bibliographic practises for classifying scientific references and the examine the question for the creation of a National platform to unite them, as well as creating a National Reference Register, in particular one for social studies. It is time for us to decide who will manage the combined citation document resources and how to create a Bulgarian index for scientific citation or a National Citation Index, in general and one for the social studies in particular. Social studies are less represented than the other branches of science, for example, in platforms like Scopus and Web of Science, which are the most influential platforms in the world and publishing and citation in them has more weight in the formation of the minimal national requirements for academic growth. I am using the historical approach and comparative analysis to show the practical experience of countries that have created such Registers and have achieved excellent results. I also offer for discussion a model to build a hierarchical structure for exchange of quoted data. The university libraries need exact criteria which citation to list and how the Bulgarian index for scientific citation in general will be formed, as well as the one for social studies.

Response adaptive designs for Phase II trials with binary endpoint based on context-dependent information measures

In many rare disease Phase II clinical trials, two objectives are of interest to an investigator: maximising the statistical power and maximising the number of patients responding to the treatment. These two objectives are competing, therefore, clinical trial designs offering a balance between them are needed. Recently, it was argued that response-adaptive designs such as families of multi-arm bandit (MAB) methods could provide the means for achieving this balance. Furthermore, response-adaptive designs based on a concept of context-dependent (weighted) information criteria were recently proposed with a focus on Shannon’s differential entropy. The information-theoretic designs based on the weighted Renyi, Tsallis and Fisher informations are also proposed. Due to built-in parameters of these novel designs, the balance between the statistical power and the number of patients that respond to the treatment can be tuned explicitly. The asymptotic properties of these measures are studied in order to construct intuitive criteria for arm selection. A comprehensive simulation study shows that using the exact criteria over asymptotic ones or using information measures with more parameters, namely Renyi and Tsallis entropies, brings no sufficient gain in terms of the power or proportion of patients allocated to superior treatments. The proposed designs based on information-theoretical criteria are compared to several alternative approaches. For example, via tuning of the built-in parameter, one can find designs with power comparable to the fixed equal randomisation’s but a greater number of patients responded in the trials.

Conditions, possibility and priority for admission into inpatient hospice/palliative care units in Japan: a nationwide survey.

Known barriers to admission into inpatient hospice/palliative care units (PCUs) include poor accessibility and stringent conditions for admission. However, the exact criteria are unclear. The aim of this study was to clarify the actual conditions, possibilities and priorities for admission to PCU in Japan. We conducted a nationwide, anonymous, self-administered questionnaire survey to the responsible physicians of all 251 PCUs in 2014. Responses were received from 190 institutions (response rate 76%). The most frequent condition for admission was 'either the patient or the family knows the diagnosis' [86%, 95% confidence interval (CI): 80-90]. For the conditions for admission to PCU, 10-40% fewer facilities answered that the patient's consent or understanding was required compared with those that answered the patient or family's consent was sufficient. Seventy-one percent (95% CI: 64-77) of PCUs answered that either the patient or a family member needed to agree to a do-not-resuscitate (DNR) policy. The factors most likely to result in refusal of admission to a PCU varied greatly. Ninety-four percent (95% CI: 90-97) of PCUs answered that patients who had undergone a long waiting time after applying for admission would be given higher priority, and approximately 50% of PCUs answered they gave priority to their outpatients and inpatients. The findings of this study should be used to modify the system so that appropriate palliative care can be provided to patients who wish to be admitted to PCU.

Intellectual agents of targets in analytical constructing of optimum systems of management of drum mills

Purpose. Justification of the rational use of intellectual agents in forming of the quasi-optimal systems of management furnaces of complexes of type drum mills as observers of complete order. A method of research consists of decision of the best laws management by the mining complexes by the use of methods of the analytical constructing of optimum regulators withthe input in their structures of such essences as intellectual agents as observers of complete order. Results of research. Management by the mining and processing complexes it is perspective to carry out on the basis of the quasi-optimal systems of management. Taking into account properties and sensitiveness of intellectual agents, expediently to include them at the analytical constructing of regulators in the structure of observers of complete order. This increases in accordance with securing functional of quality criterion of exactness of optimum stabilization of rational technology of process of growing shallow in the drum mills. Scientific novelty. A new structure is set of the quasi-optimal system of management by the technological dynamics of drum mills with the asymptotic observer of complete order. Of efficiency of recognition and operative management it is suggested to carry the rise out on the basis of functional possibilities of intellectual agents of targets, as which an observer comes forward of complete order in aggregate with the considered technological processes in the mining and processing complexes. Practical value. Results of researches allow to recommend a rational chart of quasi-optimal management by the drum mills in accordance with the set criterion. In the spectrum of the active power consumable by the drive electric motor technological constituents are selected, which are conditioned by the difficult vibrations of ore mass of filling of drum. Their maximal values are selected ekstremum by detector and are watched by the observer of complete order with the optimum stabilization. This allows to secure intensification of return of the prepared class.

Оценка качества биопсийной морфологической диагностики воспалительных заболеваний кишечника по цифровым изображениям

Introduction. Morphological diagnosis of inflammatory bowel diseases (IBDs) based on endoscopic biopsies remains a rather challenging task and does not always allow the pathologist to make the final conclusion. Difficulties arise due to the absence of a classical morphological picture in biopsy specimens as well as the lack of clinical and laboratory data. These issues may lead to an incorrect interpretation of the detected pathological changes and an erroneous conclusion. The aim of the study was to assess the quality of biopsy diagnosis of IBDs using Internet diagnostic tools, namely, the digitalized histological slides. Materials and methods. We created an Internet platform, which contained 100 scanned images of histologi-cal slides from 70 patients with suspected IBD. Based on our own practical experience and guidelines of international European and British societies of pathology, we arranged a survey. The diagnosis was made on the combined clinical and morphological approach, considering also a complex of clinical, laboratory, endoscopic, and morphological data. The first stage of the survey was anonymous and included a list of 25 questions. Ten pathologists, who agreed to take part in the study, completed the questionnaire. After statistical processing, the results were assessed using a Fleiss' kappa criterion. Results. The comparative analysis of morphological study showed that the participants were able to diagnose accurately only 71% of ulcerative colitis cases and 63% of Crohn’s disease cases. At the same time, the agreement coefficient demonstrated satisfactory values: the Fleiss' kappa was 0.34 and 0.25, respectively. In some cases, the participants found it difficult to perform a differential diagnosis between IBD and other forms of colitis and were not always capable of distinguishing ulcerative colitis from Crohn’s disease. A few of the individual criteria, on which the diagnosis is based, rarely reached agreement above a kappa of 0.5. The participants’ agreement was considered more often as “weak” and “satisfactory”. This is largely due to the fact that we did not discuss the exact criteria for the proposed parameters and that these parameters were divided into four degrees of severity from 0 to 3. Conclusion. The results showed the current discrepancies in the assessment of biopsies in patients with suspected IBD. The developed Internet platform provides additional significant opportunities to improve the quality of morphological diagnosis in ileal and colon biopsies by means of refining the criteria and their assessment in the final diagnosis statement. Keywords: inflammatory bowel disease, colitis, digital pathology

Exploring Issues in Theory Development in Nursing

Theory development in nursing profession continues to raise more debates about critical issues. The present study aimed to explore the critical and contemporary issues and concerns about theory viewed from both the discipline- and professional-related perspectives. This narrative literature review was done in 2020. English articles in the electronic databases of Medline, Scopus, PubMed, CINAHL and Google Scholar were searched using the keywords: concerns, issues, nursing theory development, nursing theory construction, nursing discipline and nursing profession, and literature was retrieved and screened for eligibility. The date limit considered in the literature search was from 2010 to 2019. In the initial search, a total of 179 studies were retrieved and assessed for eligibility; 163 studies were eliminated due to not meeting the exact criteria set, leaving only 16 studies that were finally included in the content analysis. Content analysis method was used to extract our findings. Four themes (issues) emerged and were grouped into two overarching categories of discipline-related issues/concerns and profession-related issues/concerns. The four themes were (1) philosophical issues, (2) issues with validation of nursing theories, (3) multiplicity of nursing theories and divergent practice paradigms of nursing and (4) integration of theory into professional practice. This paper offers a promising premise to reconcile various concerns arising from nurses' attempts to develop, use and test theories. Identification and discussion of these issues should inform the nursing profession to plan activities to resolve or reduce them systematically.

Neurosurgery guidelines for the care of people with spina bifida

Myelomeningocele (MMC) arises from an early neural developmental anomaly and results in a variety of structural abnormalities and associated functional neurologic deficits. As such, neurologic issues are central to virtually all clinical problems. Neurosurgical intervention strives to correct or improve these defects and prevent secondary complications. These interventions include closure of the open myelomeningocele and management (across the life span) of hydrocephalus, the Chiari II malformation (C2M) and tethered spinal cord (TSC). The development of pre-natal closure techniques and reports of improved outcome with in-utero closure (IUMC) have revolutionized the neurosurgical approach to myelomeningocele. Controversies remain surrounding patient selection, maternal risks, technique of IUMC (endoscopic vs. open) and long-term outcomes. However, real gains include reduced rates of hydrocephalus, modestly improved motor capabilities and reduction in C2M morbidity. For many decades, the cornerstone of treatment of hydrocephalus for many decades has been the placement and support of ventricular shunts. Endoscopic third ventriculostomy (ETV) with or without choroid plexus coagulation (ETV/CPC) is an appealing alternate strategy that avoids the morbidity and complications associated with shunts. The exact criteria for ETV-CPC candidacy and best metrics for outcome analysis remain active areas of debate and controversy. Similarly, neurosurgical management C2M, has centered upon the indications and clinical thresholds for performing posterior fossa surgical decompression. Tethered spinal cord management incorporates the diagnosis and surgical management of adhesions formed at the initial closure site, the consequent longitudinal traction related stress on the cord and the resulting neurologic signs and symptoms.

Withdrawal of intensive care during times of severe scarcity: Triage during a pandemic only upon arrival or with the inclusion of patients who are already under treatment?

Many countries have adopted new triage recommendations for use in the event that intensive care beds become scarce during the COVID-19 pandemic. In addition to establishing the exact criteria regarding whether treatment for a newly arriving patient shows a sufficient likelihood of success, it is also necessary to ask whether patients already undergoing treatment whose prospects are low should be moved into palliative care if new patients with better prospects arrive. This question has led to divergent ethical guidelines. This paper explores the distinction between withholding and withdrawing medical treatment during times of scarcity. As a first central point, the paper argues that a revival of the ethical distinction between doing and allowing would have a revisionary impact on cases of voluntary treatment withdrawal. A second systematic focus lies in the concern that withdrawal due to scarcity might be considered a physical transgression and therefore more problematic than not treating someone in the first place. In light of the persistent disagreement, especially concerning the second issue, the paper concludes with two pragmatic proposals for how to handle the ethical uncertainty: (1) triage protocols should explicitly require that intensive care attempts are designed as time-limited trials based on specified treatment goals, and this intent should be documented very clearly at the beginning of each treatment; and (2) lower survival prospects can be accepted for treatments that have already begun, compared with the respective triage rules for the initial access of patients to intensive care.

Feasibility of Biology-Guided Radiotherapy for Pancreatic Tumors: An Assessment of Normalized Target SUV

Biology-guided radiotherapy (BgRT) is a novel method of delivering radiation using emissions from injected radiotracers to provide tracked radiotherapy. Pancreatic tumors in particular may benefit from BgRT given the potential for reducing irradiated volumes and thereby reducing gastrointestinal toxicity. For BgRT to be feasible, there must be sufficient contrast between tumor targets and the surrounding background. We assessed pancreatic lesion contrast using normalized target standardized uptake values (NSUVs) calculated from FDG-PET scans. Patients were identified with IRB approval from our institution (2019-1073). We measured NSUVs on scans from patients with pancreatic cancer before and after induction chemotherapy, which in most cases was FOLFIRINOX or gemcitabine with nab-paclitaxel. Tumors were contoured on PET/CT scans. We calculated the average SUV for two margins around the gross tumor volume (GTV) that did not include the GTV: one for a 5-mm margin and the other for a 10-mm margin. NSUVs were calculated as the SUVmax of the GTV divided by the average SUV of the margin, and then averaged across axial, coronal, and sagittal views. SUVs were measured retrospectively on a GE AW Server 3.2. Since not all PET/CT scans were done with intravenous contrast, the major limitation of this study was identifying the GTV in those patients. Non-parametric Mann-Whitney U and Kruskal-Wallis tests were used to compare NSUV before and after chemotherapy and by tumor location. We scanned tumors in 53 patients with pancreatic adenocarcinoma, 29 at baseline and 28 after induction chemotherapy; 4 patients had scans available at both times. No patient had received pancreatic surgery or radiotherapy. Most tumors were located in the head of the pancreas (33) followed by the body (9), tail (6), neck (3), and uncinate process (2). Before therapy, the SUVmax range was 8.64‒72.25; the mean NSUV was 3.84 (range 1.77‒7.33) for 5-mm margins and 4.05 (1.77‒7.91) for 10-mm margins. After therapy, the SUVmax range was 5.13‒57.43; the mean NSUV was 3.02 (range 1.21‒9.70) for 5-mm margins and 3.28 (1.21‒8.67) for 10-mm margins. Decreases in NSUV after chemotherapy were significant for both the 5-mm (p = 0.001) and 10-mm (p = 0.01) margins. For the 4 patients with evaluable scans before and after induction chemotherapy, the NSUV after induction chemotherapy changed by ‒1.15 for 5-mm margins and by ‒1.12 for 10-mm margins. No differences were observed in terms of tumor location (p>0.05). Although exact NSUV threshold criteria are yet to be defined, using thresholds of 2.5, 3, or 3.5 and a 10mm margin, 86%, 72%, and 59% of pre-therapy patients and 68%, 50%, and 29% of post-induction chemotherapy patients, respectively, would be considered suitable for BgRT. BgRT may be feasible in patients with pancreatic cancer.

Features of proinflammatory cytokine production in patients with allergic rhinitis combined with <i>Helicobacter pylori</i>-associated pathologies

Investigating a role for pro- and anti-inflammatory cytokines in immune and inflammatory response represents one of the most pressing topics in current immunology. There have been accumulated a great body of data regarding the cytokine status during inflammatory processes in gastrointestinal tract. However, many issues remain poorly elucidated. Moreover, most of the studies were mainly aimed at examining biopsy material cytokines collected from various parts of the gastrointestinal tract or gastric juice. Here we present the data on investigating the features of cytokine production in patients with allergic rhinitis combined with H. pylori-associated diseases of the upper gastrointestinal tract. A total of 225 patients aged 18 to 40 years (mean age 29.5±6.74 years) were examined, among which 43 patients suffered from allergic rhinitis, 66 patients had inflammatory diseases of the upper gastrointestinal tract (chronic gastritis/gastroduodenitis), and 69 patients — allergic rhinitis with concomitant inflammatory diseases of the upper gastrointestinal tract. Patients were stratified to various study groups depending on diagnosed allergic rhinitis and H. pylori infection. Serum IL-6 and IL-8 level and complete blood cell count were measured. Statistical significance for difference in parameter frequencies between independent groups was assessed by using Fisher's exact test or χ2 criteria. It was shown that serum IL-6 level in H. pylori-negative patients was within the reference interval with single spikes, whereas its production was markedly increased in patients with H. pylori infection regardless of allergic pathology. Frequency of subjects with elevated serum IL-8 level was comparable between groups of patients with gastrointestinal diseases, but significantly higher than that one in the control group. An interdependence between serum IL-8 level and white blood cell count was found, which is of interest for predicting development of the inflammatory process. Thus, the serum IL-8 level during the upper gastrointestinal tract inflammatory diseases was increased regardless of verified of H. pylori infection and allergic rhinitis, whereas increased IL-6 serum level was observed solely in H. pylori-positive patients.

Síndrome post-implantación: respuesta inflamatoria secundaria a reparación de aneurisma de aorta abdominal

La reparación de un aneurisma de aorta puede iniciar una respuesta inflamatoria sistémica con expresiones clínicas y bioquímicas conocidas como el síndrome post implantación (SPI). A la fecha, no se han logrado alcanzar criterios diagnósticos universales, sin embargo, en los últimos años se ha visto una nueva tendencia a homogeneizar el diagnóstico mediante la asociación directa con los criterios del síndrome de respuesta inflamatoria sistémica (SRIS) utilizando la presentación mínima dos criterios: leucocitosis y fiebre. Su fisiopatología ha evolucionado hacia una consolidación más fuerte alrededor de dos principales promotores: el trombo y el material de la prótesis utilizada. Por otro lado, las repercusiones a corto y largo plazo aún son sometidas a mucho debate y se ha visto un aumento de evidencia que respalda una prolongación en la hospitalización. Esta falta de claridad respecto a efectos adversos a corto y largo plazo genera una incógnita respecto al beneficio del tratamiento y el seguimiento más cercano en pacientes que desarrollen SPI. No obstante, ante la sospecha del mismo y debido a la ausencia de guías en el tema, se contrastan dos estudios novedosos que utilizan antiinflamatorios esteroideos y no esteroides y se exponen las nuevas sugerencias y hallazgos de los casos en donde se desee un seguimiento más cercano.

Automated pressure transient analysis: A cloud-based approach

Pressure transient analysis provides essential information to evaluate the dimensions of injection induced fractures, permeability damage near the wellbore, and pressure elevation in the injection horizon. For injection wells, shut-in data can be collected and analyzed after each injection cycle to evaluate the well injectivity and predict the well longevity. However, any interactive analysis of the pressure data could be subjective and time-consuming. In this study a novel cloud-based approach to automatically analyzing pressure data is presented, which aims to improve the reliability and efficiency of pressure transient analysis.There are two fundamental requirements for automated pressure transient analysis: 1) Pressure data needs to be automatically retrieved from field sites and fed to the analyzer; 2) The engineer can automatically select instantaneous shut-in pressure (ISIP), identify flow regimes, and determine the fracture closure point if any. To meet these requirements as well as to take advantage of cloud storage and computing technologies, a web-based application has been developed to pull real time injection data from any field sites and push it to a cloud database. A built-in pressure transient workflow has been also proposed to detect any stored or real-time pressure data and perform pressure analysis automatically if the required data is available.The automated pressure transient analysis technology has been applied to multiple injection projects. In general, the analysis results including formation and fracture properties (i.e. permeability, fracture half length, skin factor, and fracture closure pressure) are comparable to results from interactive analysis. Any discrepancies are mainly caused by poor data quality. Issues such as inconsistent selections of ISIP and different slopes defined for pre and after closure analyses also contribute to the divergence. Overall, the automated pressure transient analysis provides consistent results as the exact same criteria are applied to the pressure data, and analysis results are independent of the analyzer's experience and knowledge.As data from oil/gas industry increases exponentially over time, automated data transmission, storage, analysis and access are becoming necessary to maximize the value of the data and reduce operation cost. The automated pressure transient analysis presented here demonstrates that cloud storage and computing combined with automated analysis tools is a viable way to overcome big data challenges faced by oil/gas industry professionals.

The Investigation of Simultaneous EEG and Eye Tracking Characteristics During Fixation Task in Mild Alzheimer's Disease.

Alzheimer's disease (AD) is a neurodegenerative disorder that occurs many years before the first clinical symptoms. Finding more exact, significant, and valuable criteria or indices for the diagnosis of the mild form of Alzheimer's disease is very important for clinical and research purposes. Electroencephalography (EEG) and eye tracking biomarkers would provide noninvasive tools for the early detection of AD. Due to the advantages of EEG and eye tracking, in this study, we employed them simultaneously to conduct research on the mild AD. For this purpose, 19 patients with mild AD were compared with 19 gender- and age-matched normal subjects who did not have any history of cognitive or neurological disorders. EEG and eye-tracking data were concurrently collected in both groups in a fixation task. Our results revealed that the total fixation duration was significantly shorter for the AD patients, but their fixation frequency was more than that of the controls. In addition, increased theta power and decreased alpha power were observed in the AD group. Interestingly, there was a statistically significant correlation between fixation frequency and alpha power in the parietal area in the control group. However, this connection was not statistically significant in the AD group. The findings also indicated an elevated coherence in the AD patients in the parieto-occipital area. It is assumed that the AD patients might use the neural compensational processes for the fixation state. This study provides evidence for the simultaneously EEG and eye-tracking changes in the areas, which are involved in the control of the fixational eye movements.

Pharmaceutical care for symptoms of allergy during pregnancy and lactation: rational choice and use of antihistamines

The aim of this study was to conduct a clinical-pharmaceutical evaluation of the rational choice and use of antihistamines during pregnancy and lactation by questionnaire survey. Materials and methods. 95 respondents were questioned by a single specially designed protocol, taking into account the problematic issues associated with allergy symptoms during pregnancy/lactation. Methods applied: systematic approach, standardization, clinical-pharmaceutical, anonymous questionnaire, computer data processing, statistical. Results. It has been established that 71 % of respondents developed symptoms of allergy during pregnancy and/or breastfeeding. Of the 57 women interviewed who reported breastfeeding, only 17 (30 %) had no allergy symptoms. It has been shown that there was no statistically significant difference between the occurrence of allergy symptoms in lactating and non-lactating women (Fischer’s exact criterion was 0.0084; P > 0.05). The most common manifestations of allergy reported by respondents were skin symptoms – 50 %, nose – 43 % and eyes – 16 %. The aforementioned conditions occurred in the first trimester of pregnancy in 26 % of women; during the entire pregnancy – in 25 % and in the II and III trimesters – in 18 %. As the reasons for the allergy symptoms development, 38 % of the respondents reported animal dander; 34 % – pollen of plants; 28 % – household chemicals, 16 % – insect bites and citrus. Regarding the treatment, drugs were prescribed by a doctor only in 39 % of the respondents; 30 % – practiced self-prescribing; 25 % – applied for pharmacist recommendation; 10 % of women used information from the Internet and 4 % – took advice from relatives. Conclusions. As the majority of women surveyed practiced self-treatment (76 %), one third – self-prescription, we consider that the provision of high-quality pharmaceutical care by a pharmacist while dispensing antihistamines to patients with allergy symptoms during pregnancy and/or lactation, including appointment to a physician, is essential for maximizing the effectiveness and safety of pharmacotherapy. Patients should be consulted by specialists (physician, clinical pharmacist, and pharmacist) before taking any medication during pregnancy/lactation.

A study of entity-linking methods for normalizing Chinese diagnosis and procedure terms to ICD codes.

This study aims to develop and evaluate effective methods that can normalize diagnosis and procedure terms written by physicians to standard concepts in International Classification of Diseases(ICD) in Chinese, with the goal to facilitate automated medical coding in China. We applied the entity-linking framework to normalize Chinese diagnosis and procedure terms, which consists of two steps - candidate concept generation and candidate concept ranking. For candidate concept generation, we implemented both the traditional BM25 algorithm and an extended version that integrates a synonym knowledgebase. For candidate concept ranking, we investigated a number of different algorithms: (1) the BM25 algorithm, (2) ranking support vector machines (RankSVM), (3) a previously reported Convolutional Neural Network (CNN) approach, (4) 11 deep ranking-based methods from the MatchZoo toolkit, and (5) a new BERT (Bidirectional Encoder Representations from Transformers) based ranking method. Using two manually annotated datasets (8,547 diagnoses and 8,282 procedures) collected from a Tier 3A hospital in China, we evaluated above methods and reported their performance (i.e., accuracy) at different cutoffs. The coverage of candidate concept generation was greatly improved after integrating the synonym knowledgebase, achieving 97.9% for diagnoses and 93.4% for procedures respectively. Overall the new BERT-based ranking method achieved the best performance on both diagnosis and procedure normalization, with the best accuracy of 92.1% for diagnosis and 80.1% for procedure, when the top one concept and exact match criteria were used. This study developed and compared diverse entity-linking methods to normalize clinical terms in Chinese and our evaluation shows good performance on mapping disease terms to ICD codes, demonstrating the feasibility of automated encoding of clinical terms in Chinese.

Pain in Anterior Knee after Locked Nailing of Diaphyseal Tibia Fractures

The relevance of the study is determined by the high incidence of pain in the anterior knee after the locked nailing of the diaphyseal tibia fracture. The etiology and pathogenesis of this complication remain unclear. Most authors believe that the cause of this complication is a combination of several factors. Material and Methods. The study included 70 patients with consolidated diaphyseal tibia fractures undergone closed blocked nailing through the patellofemoral ligament. The results of the surgery were studied in the time frame of 2 to 4 years (average 36.96±12.05 months). Patients were divided into groups according to the presence or absence of pain in the anterior knee, the type of tibial fractures, the location of the nail in the proximal tibia metaphysis. The evaluation of the outcomes was carried out with the SF-36 questionnaire and the knee X-ray. The significance of differences in the samples was determined by the Pearson’s and Student’s criteria, and Fisher’s exact criterion. Results. The incidence of pain in the anterior knee was 46%. This complication led to a decrease in the patients’ quality of life to a greater extent and in most parameters than in the patient without pain, namely, physical components of health by 10% (p = 0.024), physical activity by 8.8% (p = 0.024), role-based functioning due to physical condition by 14.1% (p = 0.001). The intergroup analysis revealed that the extension of the end of the nail beyond the proximal tibial metaphysis was one of the factors that determeded the development the pain (p0.05). There were differences in the frequency of pain in groups with different depths of immersion of the nail into the proximal metaphysis (p0.05). The closer to the tibial plateau the proximal end of the nail was located, the more often the pain occurred in the postoperative period. In the patients with type C diaphyseal fractures, pain in the knee was much more common than in patients with type A and B fractures (p0.05). Conclusion. The quality of life of the patients with pain in the anterior knee after locked nailing was characterized by a decrease in physical activity and role functioning in society. The main cause of the pain was the projection of the nail beyond the bone borders of the tibial metaphysis or the location of its proximal end in the subchondral area. The type of diaphyseal tibia fracture according to the AO / ASIF classification was a factor that determined the incidence of pain in the anterior knee.

Significance of Clinical Findings of Patients with Placental Abruption

Objective: Placental abruption is an extremely critical complication in pregnant women because it can result in poor maternal and neonatal outcomes. The exact criteria or obvious prognostic factors to diagnose and predict the outcome have not been determined. This study aimed to evaluate the clinical significance of initial findings of patients with placental abruption. Methods: Fifty-six women with placental abruption who delivered at our hospital between January, 2007 and December, 2017 were enrolled in this retrospective study. We reviewed medical records and analyzed the relationship between variable clinical factors and pregnancy outcomes. Results: Patients with unfavorable outcomes (intrauterine fetal death or use of neonatal ventilator) showed a high tendency of having both abdominal pain and vaginal bleeding, or abdominal pain. Neonates delivered in the abdominal pain group showed a significantly lower Apgar score, larger dimensions of placental abruption and higher frequencies of ventilator use than the other group. The results of multivariate logistic regression showed poor prognostic factors of placenta abruption: abdominal pain (odds ratio [OR]=43.3; 95% confidence interval [CI]=1.9-968.9) and vaginal bleeding (OR=23.1; 95% CI=1.7-305.9). Conclusion: Patients with placental abruption showed statistically significant tendencies of having abdominal pain and vaginal bleeding as initial symptoms. Especially, abdominal pain was associated with the poorest outcome. Therefore, obstetricians should make more rapid decisions and carefully monitor patients for improving the outcome of placental abruption when patients have obvious abdominal pain and vaginal bleeding.

INVESTIGATION OF THE INFLUENCE OF THROMBOPHILIC GENES POLYMORPHISM, INCLUDING SERPIN 1 (PAI-I), FII, PROTHROMBIN AND ITGB3-Β INTEGRIN, ON THE FREQUENCY OF STROKE IN ASSOCIATION WITH CONTROLLABLE RISK FACTORS FOR ITS OCCURRENCE

The aim is the analysis of the relationship between the polymorphism of thrombophilic genes, in particular Serpin 1 (PAI-1), F2-prothrombin and ITGB3-α integrin, and the incidence of stroke, as well as the study of factor effects of this polymorphism in association with controlled risk factors (hypertonic disease, smoking, alcohol consumption, diabetes mellitus, obesity, atrial fibrillation). Materials and methods: A total of 134 patients were examined (men accounted for 44.8%, women 55.2%, average age 62.5 ± 2.1). The statistical analysis was carried out using the following criteria: χ2-Pearson, Fisher's exact criterion (reversible), Chuprov's coefficient of conjugation and dispersion analysis (alternative complex). Results: The relationship between the frequency of a specific allele of thrombophilia and the incidence of stroke is absent. The reason for such results can be a significant effect of random factors (hypertension, diabetes ...), a significant variability of risk factors, their different frequency in groups (inter- and intra-group differences), a significant (95%) total effect of these factors. Conclusions:Identification of biochemical or genetic markers of thrombophilic conditions, including polymorphism of the hemostasis system genes, will significantly increase the possibility of adequate pathogenetic treatment and timely prevention of acute cerebrovascular disorders, especially persons of working age, which has great medical and social importance.

Equity, Prudence und Moral Quantity of Action in Samuel Pufendorf’s Legal Theory

The present essay intends to reconstruct the fundamental function of the juridical-formal procedure, carried out by equity in Samuel Pufendorf ’s legal theory, aiming at the adequate application of the positive norm to an exceptional case. To this end, equity conveys the moral contents of the natural law within the positive one, especially if the latter presents gaps or is in contradiction with the former. The essay also examines the characteristics of the equitable judgement, conceived by Pufendorf in the form of the rhetorical syllogism or enthymeme, operating within the moral discipline of prudentia. As such, equity is therefore closely linked to the pufendorfian methodological question if man’s free action is measurable with the exact mathematical criteria or with the most approximate equitable ones. In this methodological context, Pufendorf interprets equity as the criterion for measuring the moral quantity of an action.

Review of Clinical Trials on the Effects of Tai Chi Practice on Primary Hypertension: The Current State of Study Design and Quality Control.

The modulation of Tai Chi in physiological function and psychological status attracts sustaining attention. This paper collected original articles regarding the effects of Tai Chi practice on modulating primary hypertension from 7 electronic databases (PubMed, Excerpta Medica Database, Cochrane Library, Web of Science, Chinese Knowledge Resource Integrated Database, Wanfang Database, and China Science and Technology Journal Database) from their dates of origin to October 1st, 2020. A total of 45 articles were included. The literature analyses have shown that the benefits of Tai Chi practice for blood pressure management have been identified in all of the included 45 studies, and Tai Chi exercise has shown significant efficacy in improving hypertension clinical symptoms and quality of life, compared to the majority of control interventions, though there are also some methodological issues, including small sample sizes, lack of exact randomization methods and quality control criteria, and lack of specific standards used to measure the characteristics of Tai Chi practice. In the future, the inclusion of additional design standards, stricter quality controls, and evaluation measures for the features of Tai Chi practice is required in trials evaluating its effects on hypertension.