Full-text Version Research Articles

Ambulatory care sensitive diseases/conditions in adult patients. A systematic review

Aim. To summarize the published data on the nomenclature of ambu­latory care sensitive diseases/conditions (ACSCs) in adult patients as one of the tools for a comprehensive assessment of the effectiveness of primary health care (PHC) measures implemented.Material and methods. The study was implemented in 4 following stages: 1 — search for articles by keywords in electronic bibliographic databases; 2 — duplicate elimination; 3 — review of abstracts with an as­sessment for compliance with the inclusion/exclusion criteria, fol­lowed by a search for full-text versions and final selection of pub­lications; 4 — systematization and analysis of data on the ACSCs. Articles published in the period from January 1, 2012 to December 31, 2022 and containing information on ACSC nomenclature were searched in 4 domestic and foreign electronic bibliographic databases (Elibrary, NLM (PubMed), MEDLINE, PreMEDLINE). The PRISMA (Preferred Re­porting Items for Systematic reviews and Meta-Analyses) system was used in the preparation of the systematic review. Systematization of information on the obtained results was carried out in Microsoft Office Excel 2016 spreadsheets.Results. In total, out of 10898 initially found publications, 11 full-text pa­pers describing studies that fully met the inclusion/exclusion criteria we­re admitted to stage 4 and were included in the final analysis. In none of the 11 publications was ACSC nomenclature identical to any other pub­lication included in stage 4 of the analysis. Variability in the total num­ber of ACSCs was noted in each of the assessed papers. In 100% of the analyzed publications, the NCAs included chronic obstructive pul­monary disease/chronic bronchitis, heart failure, diabetes, and hypertension. In 91% (10 publications), the ACSCs included angina pectoris, asthma, iron deficiency anemia, dental and oral diseases, urinary tract infections, acute skin infections, and gastroenteritis.Conclusion. The nomenclature of the ACSCs in different countries is characterized by variability due to demographic, epidemiological, organizational, and other features. The conducted systematic review showed that the nomenclature of the ACSCs has not been defined in the Russian Federation. The data obtained in this work can serve as a basis for initiating a project aimed at developing a domestic nomenclature of ACSCs as one of the tools for a comprehensive assessment of the effectiveness of PHC measures implemented.

Gender-sensitive health indicators for health reporting at the Robert Koch Institute (GBE-GI)-apilot project as part of the Joint Action PreventNCD project

Health reporting (GBE) based on gender-sensitive indicators can provide information on gender inequalities, improve health promotion and healthcare, promote gender mainstreaming, and provide relevant information for gender equality measures. To date, there is no set of gender-sensitive health indicators for Federal Health Reporting at the Robert Koch Institute. As part of the Joint Action Prevent Non-Communicable Diseases, gender-sensitive health indicators are to be identified, evaluated, and integrated into the Robert Koch Institute's health reporting website in apilot project. This is done in three work packages. In ascoping review, the available evidence on gender-sensitive health indicators and theoretical explanations for gender inequality in EU and OECD member states since 2014 will initially be assessed (work package1). Building on this, identified indicators and explanatory approaches will be collated for evaluation and selection in astructured consensus process as part of athree-stage Delphi approach consisting of afocus group discussion and an online survey (work package2). The evaluated indicator set will then be integrated into the Robert Koch Institute's health reporting website (work package3). The results will be disseminated via scientific publications and conference presentations. An English full-text version of this article is available at SpingerLink as Supplementary Information.

Epidemiology of complications in anesthesiology and possible ways of their prevention

Increase in life expectancy in the world leads to an increase in the number of patients with multimorbidity who will require surgical intervention and anesthesia in the future. The desire of specialists to meet the high standards of clinical guidelines when performing medical interventions is often associated with the risk of complications, especially when providing emergency medical care. Complications during surgical interventions and anesthesia can be observed in institutions of any level and when providing care by any specialists.The aim. To assess the main risk factors that can cause complications when providing anesthesia.Materials and methods. The study was conducted in accordance with international reporting requirements for reviews (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). The search was performed in PubMed and Cochrane Controlled Clinical Trials Register. The method of searching by references was used to select the articles. The search strategy did not include limitations of the language, type and date of the article. Inclusion criteria: full-text publications devoted to the influence of risk factors on the incidence of complications when providing anesthesia care. Exclusion criteria: brief summaries; abstracts without a full-text version; publications without key words.Results. The review assessed the most common risk factors causing complications during anesthesia and ways to reduce them.

Hiatal Hernias Revisited-A Systematic Review of Definitions, Classifications, and Applications.

A hiatal hernia (HH) can be defined as a condition in which elements from the abdominal cavity herniate through the oesophageal hiatus in the mediastinum and, in the majority of cases, parts of the proximal stomach. Today, the role of HHs within the complex entity of gastroesophageal reflux disease (GERD) is very important with regard to its pathophysiology, severity, and therapeutic and prognostic options. Despite this, the application and stringent use of the worldwide accepted classification (Skinner and Belsey: Types I-IV) are lacking. The aim of this study was to carry out a systematic review of the clinical applications of HH classifications and scientific documentation over time, considering their value in diagnosis and treatment. Following the PRISMA concept, all abstracts published on pubmed.gov until 12/2023 (hiatal hernia) were reviewed, and those with a focus and clear description of the application of the current HH classification in the full-text version were analysed to determine the level of classification and its use within the therapeutic context. In total, 9342 abstracts were screened. In 9199 of the abstracts, the reports had a different focus than HH, or the HH classification was not used or was incompletely applied. After further investigation, 60 papers were used for a detailed analysis, which included more than 12,000 patient datapoints. Among the 8904 patients, 83% had a Type I HH; 4% had Type II; 11% had Type III; and 1% had Type IV. Further subgroup analyses were performed. Overall, the precise application of the HH classification has been insufficient, considering that only 1% of all papers and only 54% of those with a special focus on HH have documented its use. The application and documentation of a precise HH classification in clinical practice and scientific reports are decreasing, which should be rectified for the purpose of scientific comparability.

Shoulder Injury Incidence and Epidemiology in Youth, High School, and Collegiate Fastpitch Softball Players: A Systematic Review and Future Research Perspectives.

Fastpitch softball is one of the most popular sports in the United States among young female athletes. Softball players regularly subject their shoulders to extreme range of motion and high velocity movements. To date, no systematic review has reported on the epidemiology and incidence of shoulder injuries in softball players. To describe the incidence and epidemiology of softball-related shoulder injuries in youth, high school, and collegiate female softball players. PubMed, Web of Science, and Embase were searched for relevant English language articles from 1980 to 2023. Studies selected based on predefined inclusion criteria. Studies were required to be available full text, in English. Systematic review. Level 4. A preliminary screening was performed based on study title and abstract. In the subsequent screening, the full text versions of the remaining articles were evaluated by 2 reviewers for the fulfillment of the inclusion criteria. A total of 7 articles met criteria for inclusion. All studies evaluated injuries among softball players for at least 1 season. In total, there were 1107 softball-related shoulder injuries reported in the 7 studies included in this systematic review. Of the 3 studies that included a shoulder injury rate, a mean rate of 4.01 shoulder injuries per 10,000 athlete-exposures was calculated. The 2 most common shoulder injuries were shoulder muscle-tendon strains (297) and shoulder/biceps tendinitis (220). High-level prospective studies reporting injury incidence and risk factors among female softball players are extremely limited. Only 2 studies eligible for inclusion in this systematic review were prospective in nature, with neither of these reporting the specific injury rate for shoulder injuries among softball players.

Indigenous access to clinical services along the lung cancer treatment pathway: a review of current evidence.

Lung cancer is a deadly cancer. Early diagnosis and access to timely treatment are essential to maximizing the likelihood of survival. Indigenous peoples experience enduring disparities in lung cancer survival, and disparities in access to and through lung cancer services is one of the important drivers of these disparities. In this manuscript, we aimed to examine the current evidence on disparities in Indigenous access to services along the lung cancer treatment pathway. A narrative literature review was conducted for all manuscripts and reports published up until July 20, 2022, using Medline, Scopus, Embase, and Web of Science. Following the identification of eligible literature, full-text versions were scanned for relevance for inclusion in this review, and relevant information was extracted. After scanning 1,459 documents for inclusion, our final review included 36 manuscripts and reports that included information on lung cancer service access for Indigenous peoples relative to non-Indigenous peoples. These documents included data from Aotearoa New Zealand, Australia, Canada, and the USA (including Hawai'i). Our review found evidence of disparities in access to, and the journey through, lung cancer care for Indigenous peoples. Disparities were most obvious in access to early detection and surgery, with inconsistent evidence regarding other components of the pathway. These observations are made amid relatively scant data in a global sense, highlighting the need for improved data collection and monitoring of cancer care and outcomes for Indigenous peoples worldwide. Access to early detection and guideline-concordant treatment are essential to addressing enduring disparities in cancer survival experienced by Indigenous peoples globally.

Is Ocular Safety in Orthopaedics Overlooked? A Systematic Review of Annual Ocular Radiation Exposure and Protective Measures.

Intraoperative fluoroscopy is increasingly common in orthopaedics, although recent guidelines have reduced the maximum recommended exposure to 20 mSv annually. A systematic review of the literature was conducted to comprehensively assess current adherence to exposure guidelines, identify practice settings at increased risk for exposure, and determine the best practices and personal protective equipment for ocular radiation risk mitigation. In this systematic review we asked: (1) Is the annual amount of eye irradiation received by orthopaedic surgeons below the recommended limit of 20 mSv? (2) What is the effectiveness of leaded glasses in reducing the eye's exposure to radiation? (3) Which imaging setups and operative techniques reduce ocular irradiation? PubMed, Medline, EBSCOhost, and Google Scholar were queried on September 28, 2023, to identify studies assessing intraoperative ocular radiation exposure among orthopaedic surgeons. Studies that measured radiation in or around the eye (such as the bridge of the nose or eyebrows) during orthopaedic procedures were included. Exclusion criteria were duplicate studies, studies that only estimated eye radiation based on the radiation dose recorded at parts of the body distant from the eyes, nonoriginal research, case reports, and articles without full-text English versions available. A total of 393 unique articles were retrieved, and after title, abstract, and full-text screening, 23 dosimetry studies were included, comprising 12 prospective observational studies, 7 phantom models, 1 cadaver model, 2 observational studies, and 1 randomized control trial. Risk of bias was determined via the Methodological Index for Nonrandomized Studies (MINORS) tool. Study quality was generally good to excellent, with noncomparative studies having a mean MINORS score of 14 ± 0 of 16 and comparative studies achieving a mean score of 19 ± 1 of 24, with higher scores representing better study quality. Due to extensive heterogeneity in study design, a meta-analysis was not conducted, with the results rather presented as a narrative summary of key findings. The vast majority of surgeons conducting a variety of orthopaedic and traumatologic procedures were not exposed to a hazardous level of eye irradiation annually, but surgeons who perform a high volume of fluoroscopy-intensive procedures may exceed guidelines. Leaded eyeglasses reduced eye radiation by about 90%, with sport wrap-around glasses offering better shielding than alternatives, although leaded glasses overall were largely underutilized. Positioning mini C-arms in the standard vertical configuration was shown to provide up to a 13-fold decrease in radiation exposure compared with inverted configuration, while standing perpendicular to the fluoroscope further reduced eye irradiation. We found that orthopaedic surgeons who perform a high volume of fluoroscopy-intensive procedures may be at risk of exceeding recommendations on annual radiation exposure, although exposure can be mitigated through various simple strategies. In particular, this analysis found that the use of sport wrap-around leaded glasses, positioning of mini-C arms in the standard vertical configuration, and standing perpendicular to the fluoroscope provide the most effective means of limiting ocular radiation exposure. As ophthalmic radiation exposure presents a potentially important occupational health hazard to orthopaedic surgeons, further investigations of radiation exposure specific to high-volume, fluoroscopy-intensive orthopaedic practices and long-term ophthalmic outcomes will help determine the extent of the potential harm posed by frequent exposure to intraoperative radiation over the span of a career. Level III, therapeutic study.

Impact of Preprocessing Parameters in Medical Imaging-Based Radiomic Studies: A Systematic Review.

Lately, radiomic studies featuring the development of a signature to use in prediction models in diagnosis or prognosis outcomes have been increasingly published. While the results are shown to be promising, these studies still have many pitfalls and limitations. One of the main issues of these studies is that radiomic features depend on how the images are preprocessed before their computation. Since, in widely known and used software for radiomic features calculation, it is possible to set these preprocessing parameters before the calculation of the radiomic feature, there are ongoing studies assessing the stability and repeatability of radiomic features to find the most suitable preprocessing parameters for every used imaging modality. We performed a comprehensive literature search using four electronic databases: PubMed, Cochrane Library, Embase, and Scopus. Mesh terms and free text were modeled in search strategies for databases. The inclusion criteria were studies where preprocessing parameters' influence on feature values and model predictions was addressed. Records lacking information on image acquisition parameters were excluded, and any eligible studies with full-text versions were included in the review process, while conference proceedings and monographs were disregarded. We used the QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies 2) tool to investigate the risk of bias. We synthesized our data in a table divided by the imaging modalities subgroups. After applying the inclusion and exclusion criteria, we selected 43 works. This review examines the impact of preprocessing parameters on the reproducibility and reliability of radiomic features extracted from multimodality imaging (CT, MRI, CBCT, and PET/CT). Standardized preprocessing is crucial for consistent radiomic feature extraction. Key preprocessing steps include voxel resampling, normalization, and discretization, which influence feature robustness and reproducibility. In total, 44% of the included works studied the effects of an isotropic voxel resampling, and most studies opted to employ a discretization strategy. From 2021, several studies started selecting the best set of preprocessing parameters based on models' best performance. As for comparison metrics, ICC was the most used in MRI studies in 58% of the screened works. From our work, we highlighted the need to harmonize the use of preprocessing parameters and their values, especially in light of future studies of prospective studies, which are still lacking in the current literature.

Efficacy and safety of conservative treatment in patients with neurologically intact thoracolumbar burst fractures: a meta-analysis

Objective. To conduct a meta-analysis of studies focused on the conservative treatment of thoracolumbar burst fractures, and to determine the efficacy and safety of this method in the observed group of patients.Material and Methods. The study was performed following PRISMA guidelines. Inclusion criteria for meta-analysis were as follows: availability of full-text version of the article in English or Russian; A3 or A4 type fractures according to the AOSpine classification, or burst fractures of types IIA, IIB or IIC according to the Denis classification, or a direct indication of the presence of a burst fracture without its classification; absence of neurological deficit; age over 18 years; detailed description of treatment outcomes or complications; and a follow-up for at least one year.Results. The meta-analysis included 29 articles describing the results of treatment of 1107 patients. At the time of admission, the following radiographic parameters were calculated for patients: mean kyphotic angle, 13.6 (95 % CI, 10.8–16.5), degree of vertebral body compression, 39.9 % (95 % CI, 27.7–52.0), and the degree of compression of the spinal canal lumen, 41.7 % (95 % CI, 29.2–54.2). A follow-up examination revealed a significant increase in segmental kyphosis by 3%, in vertebral body compression by 3.7 %, and lysis of bone fragments with a decrease in the degree of spinal canal stenosis by 2 times. The incidence of neurological deficit and progression of thoracic and lumbar spine instability was 5.8 % (95 % CI, 4.1–8.1) and 6.5 % (95 % CI, 4.5–9.3), respectively. Recovery of work ability according to Denis scale was as follows: W1 and W2 – 74.7 % (95 % CI, 63.9–83.1); W3 – 14.1 % (95 % CI, 10.2–19.3); and W4 and W5 – 14.8 % (95 % CI, 8.8–23.9).Conclusion. Conservative treatment of neurologically intact thoracolumbar burst fractures can be an effective and safe option if the angular deformity does not exceed 16 degrees and the anterior vertebral body compression rate is up to 52 %. With conservative therapy, a twofold reduction in spinal canal stenosis was observed due to the lysis of bone fragments. The pooled prevalence of radiculopathy or myelopathy with conservative therapy was 5.8 %. Orthopedic intervention due to the progression of instability of the damaged segment may be required in 6.5 % of patients. More than 90 % of patients returned to full-time work following conservative therapy. Comparative studieson the effectiveness of conservative therapy versus surgical treatment should be continued to form clear recommendations for the choice of treatment tactics for patients with uncomplicated fractures of the thoracic and lumbar spine.

Exercise-induced hypertension after aortic coarctation repair: Our experience and a systematic review.

The exact prevalence and clinical significance of excessive increase in blood pressure in response to exercise in patients with repaired coarctation of aorta (CoA) remains unknown. This study aimed to investigate the impact of different definitions of exercise-induced hypertension (EIH) on the prevalence rates in our adult patients with repaired CoA. A systematic review of the available literature was also performed. We retrospectively analyzed exercise test data from adult patients with repaired CoA followed at the national referral center for adult congenital heart disease between 1998 and 2021. The three most reported definitions of EIH in patients with repaired CoA were used for the analysis of EIH prevalence. We also performed a systematic search of the PubMed electronic bibliographic database. Full-text versions of all potentially relevant articles on EIH in CoA were reviewed for relevance. Our registry included 161 adult CoA patients. Complete exercise test results were available in 74 patients (59% male, median age 39 years [range 20-68 years]). The prevalence of EIH in our cohort varied from 24 to 41%, depending on the definition used. We identified eleven eligible articles from 184 publications. The reported prevalence rate of EIH in the studies ranged from 13% to 82%. EIH is common in patients with repaired CoA; however, the rates of EIH vary greatly depending on the definition used. A standardized and uniform EIH definition is needed to accurately assess the prevalence and clinical relevance of EIH in this population.

BANK TECHNICAL EFFICIENCY OF COUNTRY GROUPS: A META-REGRESSION ANALYSIS

Purpose- This study endeavors to examine studies using Data Envelopment Analysis in calculating the banking sector efficiency across country groups and to determine the factors affecting their technical efficiency through meta-regression analysis. Methodology- As of November 22, 2023, relevant works were systematically reviewed using Web of Science, Scopus, and Google Scholar. The literature review employed a comprehensive search encompassing all files with the keywords such as ‘‘technical efficiency (All Field) AND bank (All Field)’’. The research process adhered to the PRISMA guidelines. This study reviewed all studies published between 1932 and 2023 identifying 64599 studies in the initial scan by the author. The author independently scrutinized the titles, abstracts, keywords, text, and references of all manuscripts to mitigate selection bias and reveal whether eligibility criteria were met. Exclusions from the scope encompassed duplicate downloads, papers, books and book chapters, together with studies having low quality scores, no full-text versions, and those that are irrelevant to the subject. Findings- The results of meta-regression analysis revealed that the data collection year of the studies and the income groups of the countries did not have an impact on the mean technical efficiency. The number of banks, number of observations, publication year, and number of countries were statistically significant on the mean technical efficiency estimate. Conclusion- The study further standardized variables and methodological assumptions used in bank sector efficiency studies within country groups through meta-regression analysis. Empirical findings in the literature were combined. This study enhances accessibility to the existing body of knowledge for researchers in the field

Analysis of questionnaires from the perspective of hospitalization risk prediction. Systematic review

One of the key tasks facing the medical community and health professionals is the identification of patients at high risk of hospitalization, including emergency one. Currently, various approaches are used to obtain information about certain predictors in a patient that are as­sociated with an increased hospitalization risk, but there is no consensus on which of them are most effective.Aim. To summarize data from studies that has analyzed the prognostic value of various predictors used in questionnaires or patient surveys associated with an increased hospitalization risk.Material and methods. We search for full-text articles in 8 Russian and foreign electronic databases (Scopus, PubMed, BMC Health Services Research, BMJ Research, Google Scholar, e-library, Oxford Academic, Wiley Online Library), published in the period from January 1, 1993 to January 1, 2023 and containing information about questionnaires on hospitalization risk prediction. The study was carried out in 4 following stages: 1 — search for articles using keywords in electronic databases; 2 — duplicate elimination; 3 — search for full-text versions of articles and their assessment for compliance with inclusion/ exclusion criteria; 4 — data analysis, systematization of hospitalization predictors used in questionnaires.Results. In total, out of 28133 initial publications, 13 full-text papers describing studies that fully met the inclusion/exclusion criteria were admitted to stage 4 and were included in the final analysis. These studies were devoted to the description of 11 questionnaires, their modification or testing. The majority of the articles found (53,8%) were conducted in the United States. When analyzing questionnaires to assess the hospitalization risk, among 61 identified predictors, the following were most often used In questionnaires: "age ≥75 years"; "≥1 hospitalization within one to two years preceding filling out the questionnaire"; "taking ≥5 prescription medications"; "male sex"; "history of diabetes", and "satisfactory/unsatisfactory self-perceived health status". A more detailed analysis of questionnaires to assess the risk of one-year hospitalization among people ≥65 years old found that the following predictors were most often used: "age ≥75 years", "≥1 hospitalization in the period from one to two years before filling out the questionnaire", and "taking ≥3 prescription medications".Conclusion. Evidence is summarized on predictors used in questionnaires on hospitalization risk assessment. Additional research is needed to validate established predictors in the Russian population, their cause-and-effect relationship, and to search for novel predictors influencing the hospitalization risk among the working age and post-working age population.

Congenital Gerbode Defect: A Left Ventricular to Right Atrial Shunt-State-of-the-Art Review of Its General Data, Diagnostic Modalities, and Treatment Strategies.

The congenital Gerbode defect is defined as an abnormal communication between the left ventricle and the right atrium. This review aimed to summarize existing evidence, shed light on the clinical implications, and identify knowledge gaps. The systematic literature search was conducted in the PubMed and Google Scholar medical databases using specifically selected keywords. The inclusion of each publication was assessed according to predefined eligibility criteria based on the PICOM (Population, Phenomenon of Interest, Context, Methodology) schema. Titles and abstracts were screened independently by two authors. Available full-text versions of included publications were reviewed and relevant information was extracted. A total of 78 reports were included. The compilation of all congenital Gerbode defect cases described in the literature revealed a variety of clinical presentations comprising dyspnea, palpitations, growth retardation, and asymptomatology. A suitable multimodal diagnostic approach for newborns consists of auscultation, TTE, and optionally TEE and MRI. Because of its rarity, diversity of findings, unknown pathophysiology, and similarity to more common cardiac diseases, the diagnostic challenge remains significant. To prevent untreated long-term sequelae, early individualized treatment is recommended. Surgical defect closure is preferred to device closure for evidence reasons, although major developments are currently taking place. In conclusion, the congenital Gerbode defect provides a diagnostic challenge for pediatricians to allow early diagnosis and intervention in order to improve patients' quality of life.

Oral health in systemic sclerosis: A scoping review

Background: Limited research on oral health in systematic sclerosis poses a significant challenge for people with systematic sclerosis and health care professionals. We conducted a scoping review to map existing research on oral health–related quality of life in systematic sclerosis across domains including (1) oral manifestations or symptoms, (2) functional consequences, (3) psychosocial aspects, (4) associated patient factors and (5) self-care and management considerations. Methods: We searched MEDLINE, EMBASE, SCOPUS and CINAHL databases to 10 March 2023 for studies on oral health in people with systematic sclerosis. Study data were mapped into pre-specified domains of oral health–related quality of life, subtopics and types of research and reported in tabular form. Results: Of 1460 unique studies reviewed, 91 were eligible and included in the scoping review; of these, 69 (76%) were published as full-text versions, 72 (79%) were from Europe or North America, and 63 (69%) included ⩽50 participants. Only 1 study had >200 participants (N = 382). By domains, 85 (93%) studies reported aspects of oral manifestations or symptoms, with the most common subtopics being oral opening and mandibular function, sicca, periodontitis and soft tissue changes and pathology; 36 (40%) studies provided information on associated patient factors, 23 (25%) on self-care and management, 19 (21%) on psychosocial aspects and 6 (7%) on functional consequences. No studies related to interventions included >50 participants. Conclusion: Most studies on oral health in systematic sclerosis report on manifestations or symptoms, and there are relatively few studies on other important domains. Most studies have been conducted with small samples. Updated systematic reviews should evaluate the quality of existing evidence in domains where enough studies have been done. Large, well-conducted primary studies are needed to address knowledge gaps across domains, including studies that test approaches for supporting oral self-care, improving routine professional care and addressing major disability-causing manifestations.

The role of immunotherapy in the treatment of skin melanoma: a contemporary perspective

Purpose of the study. To evaluate the role and possibilities of various types of immunotherapy in the treatment of skin melanoma, as well as the prospects for its use in clinical practice.Materials and methods. The literature was looked up in the PubMed database. Publication date limit was set from 2018 to 2023. The following keywords were used as search queries: "Melanoma", "Melanoma and immunotherapy", "Treatment of Metastatic Melanoma", "Immunological Factors". Full-text versions were selected. Articles that were based on the subjective opinion of the authors were excluded from the study. For each research found, the following parameters were recorded: treatment method, number of patients, follow-up period, time of relapse-free course, survival rate. No meta-analysis of the data was performed due to the high heterogeneity of the studies. Results. A sufficiently high efficiency of adjuvant therapy with inhibitors of immune response control points in the treatment of BRAF-negative patients has been noted. For this reason, the drug ipilimumab, which appeared among the first, demonstrated its effectiveness. The drug nivolumab gave, according to one of the studies, a 5‑year overall survival rate of 35 %. The use of pembrolizumab was associated with a 5‑year overall survival rate of 41 %. In the 2015 meta-analysis It has been demonstrated that the use of nivolumab, as well as pembrolizumab, provides the best overall survival, and therefore can be included in first-line therapy. The combination of these drugs makes it possible to achieve a good response to therapy in patients with BRAF-positive status (5‑year overall survival rate of 52 %).Conclusion. Melanoma immunotherapy with immune response checkpoint inhibitors is currently the most effective treatment method, especially in cases where it complements surgical resection of the tumor. The most commonly used drugs are nivolumab and ipilimumab, which work more effectively when combined. Thus, the 5‑year progression-free survival rate is 36 %, the overall survival rate is 52 %. Resistance to immunotherapy is an important problem of this type of treatment, the solution of which will help to improve the outcomes of control over the local cancer process and improve the response to therapy. It is possible to find a solution to this problem due to the fundamental study of the molecular biology of the tumor in terms of modeling tumor growth and tumor "escape" mechanisms.

Treatment of Distal Radius Fractures in Elderly Patients:
 A Review

Background. Distal radius fractures (DRF) are one of the most common injuries in the elderly population. Their incidence increases steadily, with epidemiologists predicting further growth. Despite its growing prevalence, the efficacy of surgical treatment for this pathology in elderly patients remains debatable.
 Aim — to determine the optimal method for treating distal radius fractures in the elderly population basing on a comparative analysis of the literature data on various treatment methods, including conservative and surgical ones.
 Methods. A search was performed in PubMed/MEDLINE, Scopus, Google Scholar, and eLIBRARY databases according to the following keywords, their derivatives and combinations in the titles and abstracts: treatment, distal radius fracture, elderly. Initial analysis for meeting the inclusion criteria was performed on the article titles and abstracts, followed by analysis of the full-text articles. The sources with unavailable full-text versions were excluded from the analysis.
 Results. Current epidemiological data were studied, specific aspects of physical examination of elderly patients with distal radius fractures were described, the main treatment methods were determined. The main treatment method remains the conservative one: closed reduction and immobilisation. Open reduction and internal fixation with a volar locking plate has become the leading surgical treatment method in recent decades, replacing such methods as closed reduction and fixation with wires or external fixation. At early follow-up, elderly patients operated on with volar locking plate show better functional results than those who received conservative treatment. However, at long-term follow-up, most studies show no significant differences in functional outcomes after surgical and conservative treatment, despite the differences in radiological data in favour of surgical treatment.
 Conclusion. For the majority of elderly patients, conservative treatment may be the optimal treatment option. Surgical intervention using a volar locking plate may be justified for certain groups of elderly patients, as this method may accelerate rehabilitation after injury.

Balint Orban Memorial Program Abstracts.

Journal of PeriodontologyAccepted Articles MEETING ABSTRACTS Balint Orban Memorial Program Abstracts First published: 23 May 2023 https://doi.org/10.1002/JPER.23-0287 This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as https://doi.org/10.1002/JPER.23-0287 AboutPDF ToolsExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Accepted ArticlesAccepted, unedited articles published online and citable. The final edited and typeset version of record will appear in the future. RelatedInformation

Hygienic efficiency of ultraviolet disinfection of water in centralized drinking and household water supply systems (systematic review)

Introduction. Drinking water supplied to the population must be safe in epidemic terms. However, some viruses and parasites are resistant to the disinfecting effect of traditionally used agents for water treatment. The use of UV irradiation ensures the microbiological safety of water, but there are factors affecting its effectiveness. 
 The purpose of the review was to systematize scientific data on the effectiveness of the use of UV irradiation in relation to drinking water.
 Materials and methods. The search for scientific publications was carried out using literature databases MedLine/PubMed, Scopus, and Science Direct. The total number of publications was one thousand six hundred forty-six. The criteria for including the report in the systematic review were: publications in Russian or English with an available full-text version; samples for the study are water from centralized water supply systems or specially prepared microorganisms; any type of research evaluating the effectiveness of a wide range of doses of UV irradiation against microorganisms.
 Results of the analysis of publications. A systematic review included 17 reports about the effect of UV irradiation on bacteria and viruses. The subject of several studies was the resistance of protozoan cysts and helminth eggs to different doses of UV irradiation. According to the results presented in the publication, pathogenic viruses and bacteria, giardia cysts possess of the least resistance to UV irradiation (100% inactivation). 4 log-inactivation was established for Mycobacteia. E. coli and coliphages demonstrate a wide range of indicators of the resistance to ultraviolet radiation due to the diversity of the studied strains. 
 Conclusion. UV disinfection should be used as an additional method in combination with traditional reagents methods of water treatment. It is necessary to study the effect of UV irradiation on helminth eggs and protozoan cysts.

Counseling in fetal medicine: update on mild and moderate fetal ventriculomegaly.

Ultrasound in Obstetrics & GynecologyAccepted Articles Opinion Counseling in fetal medicine: update on mild and moderate fetal ventriculomegaly D. Di Mascio, D. Di Mascio orcid.org/0000-0002-6560-3393 Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Rome, ItalySearch for more papers by this authorF. D'Antonio, Corresponding Author F. D'Antonio [email protected] orcid.org/0000-0002-7546-8025 Center for Fetal Care and High-Risk Pregnancy, Department of Obstetrics and Gynecology, University of Chieti, Chieti, ItalyCorrespondence to: Prof. F. D'Antonio, Center for Fetal Care and High-Risk Pregnancy, Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy, E-mail: [email protected]Search for more papers by this authorG. Rizzo, G. Rizzo orcid.org/0000-0002-5525-4353 Department of Obstetrics and Gynecology, Fondazione Policlinico Tor Vergata, University of Rome Tor Vergata, Rome, ItalySearch for more papers by this authorG. Pilu, G. Pilu Obstetric Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, ItalySearch for more papers by this authorA. Khalil, A. Khalil orcid.org/0000-0003-2802-7670 Fetal Medicine Unit, St George's Hospital, London, UK Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK Fetal Medicine Unit, Liverpool Women's Hospital, University of Liverpool, Liverpool, UKSearch for more papers by this authorA. Papageorghiou, A. Papageorghiou Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UKSearch for more papers by this author D. Di Mascio, D. Di Mascio orcid.org/0000-0002-6560-3393 Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Rome, ItalySearch for more papers by this authorF. D'Antonio, Corresponding Author F. D'Antonio [email protected] orcid.org/0000-0002-7546-8025 Center for Fetal Care and High-Risk Pregnancy, Department of Obstetrics and Gynecology, University of Chieti, Chieti, ItalyCorrespondence to: Prof. F. D'Antonio, Center for Fetal Care and High-Risk Pregnancy, Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy, E-mail: [email protected]Search for more papers by this authorG. Rizzo, G. Rizzo orcid.org/0000-0002-5525-4353 Department of Obstetrics and Gynecology, Fondazione Policlinico Tor Vergata, University of Rome Tor Vergata, Rome, ItalySearch for more papers by this authorG. Pilu, G. Pilu Obstetric Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, ItalySearch for more papers by this authorA. Khalil, A. Khalil orcid.org/0000-0003-2802-7670 Fetal Medicine Unit, St George's Hospital, London, UK Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK Fetal Medicine Unit, Liverpool Women's Hospital, University of Liverpool, Liverpool, UKSearch for more papers by this authorA. Papageorghiou, A. Papageorghiou Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UKSearch for more papers by this author First published: 19 May 2023 https://doi.org/10.1002/uog.26251 This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi: 10.1002/uog.26251. AboutPDF ToolsExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Accepted ArticlesAccepted, unedited articles published online and citable. The final edited and typeset version of record will appear in the future. RelatedInformation

Aktualisierung zu: Leitfaden zur Vorbeugung, Erfassung und Sanierung von Schimmelbefall in Gebäuden (2017) – Kapitel 6.1 „Nutzungsklassen“

The guidelines published by the German Environment Agency in 2017 on the "Prevention, detection and remediation of mould in buildings" were clarified in two points. First, Chapter6.1 "Utilisation classes" now includes the definition of an "indoor space" in relation to human use. Second, the previous utilisation classIV - which concerned cavities and building components- was removed. These changes avoid misinterpretations and emphasise the hygiene-preventive approach of the guideline. An English full-text version of this article is available at SpringerLink as Supplementary Information.