Pathological Deviations Research Articles

3D Model Simulation in Preoperative Planning of Complex and Revision Hip Replacement

Complex and revision hip arthroplasty has remained one of the most discussed orthopedic topics in recent years. With the advancement of printing technologies 3D preoperative planning and live model simulation provides us with “hands on” procedures without any risk for the patient. Modern computer technologies present the possibility for preoperative planning of Total Hip Arthroplasty (THA) in digital environment. 3D printing of anatomical models in real size allows accurate assessment of the pathological deviations of the anatomy, precise preoperative planning of the reconstruction and simulation of the operative intervention ex-vivo. We present a series of 3D simulations for planning hip replacement, illustrating the technique, discussing its advantages and disadvantages, in complex primary and revision hip arthroplasty. In the complex and revision surgery of the hip joint, a correct assessment of bone defects is mandatory. Reconstructing the biomechanical parameters – centre of rotation, femoral offset and leg length discrepancy, is also of great significance. The 3D reconstruction with biomodel simulations offers exceptional accuracy in this respect. The method can be an excellent tool for education of surgeons in training and residents.

Angular and torsional malalignments of the paediatric knee joint

Abnormal angular and torsional alignment of the lower extremities during growth are acommon reason for consultation of apaediatrician or orthopaedist. There is often uncertainty about the pathological value of these abnormalities and the need for treatment, even among specialists. In the course of physiological growth and development processes, the axial and torsional alignment of the legs sometimes change considerably and in characteristic patterns. The ability to assess whether abnormal angular or torsional alignments of the lower limb in the course of growth should still be regarded as normal or already as pathological, depending on age and gender, is essential for the treating physician and requires precise knowledge of the physiological development processes and the tolerable limits in all three spatial dimensions. After careful explanation to the frequently concerned parents, arestrictive approach with observation of the spontaneous course of correction on the basis of regular clinical check-ups makes sense in the majority of cases. Pathological deviations from the physiological conditions are rare overall, can be idiopathic or of secondary origin and should be further clarified diagnostically using imaging procedures. As conservative measures are ineffective, pronounced angular and/or torsional deformities of the legs requiring treatment can only be corrected by surgical intervention, even in children and adolescents. The surgical treatment modalities available are varied and differ in terms of their invasiveness and complication profile, depending on the localization, type and severity of the deformity, as well as the age and possible concomitant diseases of the affected child or adolescent.

Revisiting “An Unknown Woman”: A Look at Freud’s Paper Through the Lens of Hans Loewald

In his paper “The Psychogenesis of a Case of Homosexuality in a Woman” (1920), Freud tried to outline a general psychoanalytic approach to homosexuality by recounting the case of an 18-year-old girl sent to him by her father. The case, as told by Freud, makes for awkward reading today. Loewald’s theory of developmental narrative, differentiation, linking, and his notion of parricide as the individual giving voice to one’s self, offers a different lens through which to view it. Although Loewald did not write directly about the issue of homosexuality, in boys or girls, in “The Waning of the Oedipus Complex” he gives voice to the inner processes of separation and linking from parents, leading to mourning, through which the adolescent has to go. In this paper, I offer a reading of the Freud case using Loewald’s theory, which enables us to highlight homosexuality as a variation in the expression of human sexuality, rather than a pathological deviation as Freud implies, and presents the “unknown woman” as struggling with difficulties in mourning.

FETAL ANATOMY OF THE ARTERIES OF THE DORSUM OF THE HAND

Fetal anatomy of the upper extremity in today’s understanding is a set of morphological methods for studying the structure and topography of the structures of its separate areas in human fetuses from the standpoint of the norm and taking into account the forms of individual anatomical variability. Also, in recent decades, microsurgical anatomy has gained intensive development, in particular the hand, which allows studying the structure and topography of small anatomical structures – blood vessels and nerves, muscle tendons, their layer-by-layer relationship in normal anatomical formation, and pathological deviations depending on the needs of microsurgery.The purpose of the study was to fi nd out the sources of blood supply, topography, and branching areas of the arteries of the back of the hand in human fetuses. The study was conducted on the preparations of 18 human fetuses aged from 4 to 10 months using macromicroscopic preparation, injection of arterial vessels, and morphometry.In human fetuses, the arteries of the back of the hand are arranged in two layers. The surface layer of the arterial vessels of the back of the hand, as a rule, is formed by the radial and anterior interosseous arteries, and (or), less often, by the ulnar or posterior interosseous arteries without the formation of arterial arches or nets. The deep layer of the arteries of the back of the hand mostly forms the back carpal arch and is inseparably connected both with the arteries of the superfi cial layer of the back of the hand and with the palmar arterial arches.The arteries of the deep layer of the back part of the hand are mostly (69.5 % of cases) represented by the back arterial arch: 1) radial-i nterosseous; 2) radial-i nterosseous-ulnar; 3) radial- ulnar; in 25 % of observations – with the posterior carpal arterial network. In 5.5 % of cases, the posterior carpal arch or posterior carpal mesh was absent, and duplication of the deep palmar arterial arch was found. Variability of the sources of formation, the degree of development, and the number of dorsal common digital arteries were revealed in human fetuses.Own dorsal digital arteries, except for the arteries of the thumb, as a rule, reach only the level of the middle phalanx of the fi ngers, and then they become thinner, or end in the periosteum or arterial arch-shaped anastomoses of the fi rst interphalangeal joint, or end in the palmar digital arteries, which provide blood supply to the back surface of the distal parts of the fi ngers of the brush.

A comparative study of young wild boars’ and rearing piglets’ health status with regard to the behavioral disorder tail biting in pigs

ABSTRACT This study analyses a potential link of certain pathological findings to tail biting and whether tail biting/necrosis occurs in wild boars. Thirteen young wild boars and 17 rearing pigs were pathologically examined and findings compared by Chi2/t-Tests. Sixty-five tails of wild boars were analyzed pathohistologically. Typical pathological findings in wild boars were linked to parasitic infections, which were not seen in rearing pigs. However, significantly more rearing pigs were affected by parameters linked to gut health (P = 0.05) and rhinitis (P = 0.02). Pathological deviations in tails of wild boars were linked to external parasites. Wild boars are not healthier than rearing pigs (or vice versa). However, causes for diseases differ. The gut seems to be challenged in the rearing pigs. This may be explained by a nutritional challenge due to early weaning and might be linked to the development of tail biting. No evidence for tail biting/necrosis in wild boars was found.

Could cigarette smoke be associated with metaplastic type of meibomian gland dysfunction?

Madam, The meibomian glands are located in the tarsal plates of the eyelids. The diseases involving these glands belong to a broad classification. However, the metaplastic diseases of the meibomian gland are the focus of this letter.1 We intend to propose the possible role of cigarette smoke as an active agent in developing metaplastic type of meibomian gland dysfunction (MGD). A meibomian gland is made up of multiple acini that are arranged around a long central duct. Owing to its vigorous function of producing meibum and maintaining tear film stability, the gland requires a constant turnover and differentiation of cells. Consequently, during this intricate cascade of continuous production and differentiation of cells, even a slight deviation from normality can lead to drastic pathological effects.2 We presume that oxidative stress can produce such a pathologic deviation. One of the most common causes of increased oxidative stress in cells is exposure to cigarette smoke. It has also been experimentally established that cigarette smoke is a well-known inducer of metaplastic changes; especially known to cause squamous metaplasia in the bronchial epithelium.3 Therefore, exposure to cigarette smoke may also be a culprit when the meibomian orifice, owing to its superficial location on the eyelid, is exposed to the components of cigarette smoke. Cigarette smoke contains carbon particles and other toxic compounds that begin the cascade of inflammation and during the attempts of phagocytic elimination of these toxic compounds, inflammatory damage to DNA and proteins can occur.4 The aspect of protein damage and hyperkeratinization in response to increased oxidative stress has already been studied and implicated in the pathogenesis of MGD.2 Furthermore, it has been demonstrated that EGF (Epidermal Growth Factor) is produced in epithelial cells in response to smoke and that further increases the possibility of metaplastic as well as hyperplastic changes.5 Therefore, we suggest that there exists a strong relation between exposure to cigarette smoke and the development of metaplastic meibomian gland dysfunction. Further studies in this regard might help in prevention, as well as newer diagnostic approaches towards MGD especially in populations exposed to cigarette smoke on a regular basis.

A Kinematic Analysis of Wrist and Carpal Function Using Four-Dimensional Computed Tomography Technology: A Dynamic Perspective

An emerging imaging modality, four-dimensional computed tomography, can provide dynamic evaluation of carpal motion, which allows for a better understanding of how the carpals work together to achieve range of motion. The objective of this work was to examine kinematic motion of the carpus through a flexion/extension arc of motion using four-dimensional computed tomography. A convenience sample of 20 uninjured participants underwent a four-dimensional computed tomography scanning protocol through a complete arc of flexion/extension motion. Kinematic changes in motion were quantified using helical axes motion data for each carpal. Rotation angles were compared between bones to identify differences in kinematic motion between bones. The bones within the proximal carpal row, the lunate, scaphoid, and triquetrum, rotate significantly to differing magnitudes at the ends of motion (40° of flexion and 40° of extension). The scaphoid rotates to the highest magnitude, followed by the triquetrum, and lastly, the lunate. The distal carpal row bones rotate to similar magnitudes throughout the entire range of motion. This work describes the kinematics of the carpals throughout dynamic invivo flexion and extension. This study adds to an understanding of wrist mechanics and the possible clinical implications of pathological deviation from baseline kinematics.

Clinical Gait Analysis: Characterizing Normal Gait and Pathological Deviations Due to Neurological Diseases.

This study addresses the characterization of normal gait and pathological deviations induced by neurological diseases, considering knee angular kinematics in the sagittal plane. We propose an unsupervised approach based on Dynamic Time Warping (DTW) to identify different normal gait profiles (NGPs) corresponding to real cycles representing the overall behavior of healthy subjects, instead of considering an average reference, as done in the literature. The obtained NGPs are then used to measure the deviations of pathological gait cycles from normal gait with DTW. Hierarchical Clustering is applied to stratify deviations into clusters. Results show that three NGPs are necessary to finely characterize the heterogeneity of normal gait and accurately quantify pathological deviations. In particular, we automatically identify which lower limb is affected for Hemiplegic patients and characterize the severity of motor impairment for Paraplegic patients. Concerning Tetraplegic patients, different profiles appear in terms of impairment severity. These promising results are obtained by considering the raw description of gait signals. Indeed, we have shown that normalizing signals removes the temporal properties of signals, inducing a loss of dynamic information that is crucial for accurately measuring pathological deviations. Our methodology could be exploited to quantify the impact of therapies on gait rehabilitation.

Updates on the Physiopathology of Group I Metabotropic Glutamate Receptors (mGluRI)-Dependent Long-Term Depression.

Group I metabotropic glutamate receptors (mGluRI), including mGluR1 and mGluR5 subtypes, modulate essential brain functions by affecting neuronal excitability, intracellular calcium dynamics, protein synthesis, dendritic spine formation, and synaptic transmission and plasticity. Nowadays, it is well appreciated that the mGluRI-dependent long-term depression (LTD) of glutamatergic synaptic transmission (mGluRI-LTD) is a key mechanism by which mGluRI shapes connectivity in various cerebral circuitries, directing complex brain functions and behaviors, and that it is deranged in several neurological and psychiatric illnesses, including neurodevelopmental disorders, neurodegenerative diseases, and psychopathologies. Here, we will provide an updated overview of the physiopathology of mGluRI-LTD, by describing mechanisms of induction and regulation by endogenous mGluRI interactors, as well as functional physiological implications and pathological deviations.

Potential Pathogenic Impact of Cow's Milk Consumption and Bovine Milk-Derived Exosomal MicroRNAs in Diffuse Large B-Cell Lymphoma.

Epidemiological evidence supports an association between cow's milk consumption and the risk of diffuse large B-cell lymphoma (DLBCL), the most common non-Hodgkin lymphoma worldwide. This narrative review intends to elucidate the potential impact of milk-related agents, predominantly milk-derived exosomes (MDEs) and their microRNAs (miRs) in lymphomagenesis. Upregulation of PI3K-AKT-mTORC1 signaling is a common feature of DLBCL. Increased expression of B cell lymphoma 6 (BCL6) and suppression of B lymphocyte-induced maturation protein 1 (BLIMP1)/PR domain-containing protein 1 (PRDM1) are crucial pathological deviations in DLBCL. Translational evidence indicates that during the breastfeeding period, human MDE miRs support B cell proliferation via epigenetic upregulation of BCL6 (via miR-148a-3p-mediated suppression of DNA methyltransferase 1 (DNMT1) and miR-155-5p/miR-29b-5p-mediated suppression of activation-induced cytidine deaminase (AICDA) and suppression of BLIMP1 (via MDE let-7-5p/miR-125b-5p-targeting of PRDM1). After weaning with the physiological termination of MDE miR signaling, the infant's BCL6 expression and B cell proliferation declines, whereas BLIMP1-mediated B cell maturation for adequate own antibody production rises. Because human and bovine MDE miRs share identical nucleotide sequences, the consumption of pasteurized cow's milk in adults with the continued transfer of bioactive bovine MDE miRs may de-differentiate B cells back to the neonatal "proliferation-dominated" B cell phenotype maintaining an increased BLC6/BLIMP1 ratio. Persistent milk-induced epigenetic dysregulation of BCL6 and BLIMP1 expression may thus represent a novel driving mechanism in B cell lymphomagenesis. Bovine MDEs and their miR cargo have to be considered potential pathogens that should be removed from the human food chain.

Measurements of the Female Pelvis and the „Artificial Premature Birth“ in the 19th Century – an Object-Centered Study Based on the Collection of the University Women’s Clinic in Würzburg

The collection, measurement and precise mapping of the female pelvis served to investigate the physiological birth process and its pathological deviations. Academic obstetricians considered the narrowed pelvis to be a great challenge, which made childbirth difficult and, in the worst case, endangered the life of mother and child. The article not only examines the obstetric practice of measuring the female pelvis through the scientific research of the Würzburg collection of pelvic preparations and pelvic measuring instruments. Rather, it discusses the ethical problems that arose for academic obstetricians from the measurement values that deviated from the newly defined norm. Closely connected to the history of pelvic research – so the argument – is that of „artificial premature delivery“, which has received little attention in the history of obstetrics.

Extracranial Carotid Artery Aneurysms: 20-Year Experience of Surgical Management

Extracranial carotid artery aneurysm (ECAA) is a rare vascularpathology with reported incidence of 0.2-5.0% of all carotid artery surgical interventions. Most of ECAAs remain clinically asymptomatic, however, they can manifest in neurological symptoms as transient ischemic attack or stroke. The presence of a pulsating formation, swallowing disorders, signs of compression of cranial nerves may beindicative of the aneurysm growth, which is associated with higher risk of thromboembolic complications and less oftenwith rupture. Surgical treatment is a method of choice in symptomatic patients or in cases of the aneurysm growth and includes resection with arterial reconstruction, ligation of the artery or endovascular intervention.
 The aim. To improve the results of surgical treatment of ECAAs.
 Materials and methods. The results of clinical examination, laboratory, instrumental, intraoperative observations were analyzed in 39 patients (35 [89.7%] men and 4 [10.3%] women) with 44 ECAAs, who were admitted to the Vascular Surgery Department of Lviv Regional Clinical Hospital for the period from 2003 to 2022. To conϐirm the diagnosis of ECAA, preoperative instrumental examination included duplex ultrasonography and multispiral computed tomography angiography.
 Results. Etiological causes of ECAAs included: atherosclerosis (79.5%),ϐibromuscular dysplasia (7.7%), trauma (5.1%), previous operations in the neck region (5.1%) and infection (2.6%). The justiϐication of the choice of surgical tactics depended on the localization of aneurysm, concomitant carotid occlusive disease or pathological deviation of carotid arteries. Early results of surgical treatment were evaluated up to 30 days of the postoperative period. The postoperative complications included: transient ischemic attack in 1 (2.6%), ischemic stroke in 2 (5.1%), cranial nerve damages in 4 (10.3%), thrombosis of arterial reconstruction in 2 (5.1%), hematoma of postoperative wound in 4 (10.3%), infection of postoperative wound in 1 (2.6%) cases. Postoperative mortality was 2.6%.
 Conclusion. ECAA is a rare clinical disease that requires an active surgical approach to reduce the risk of ischemic stroke. Reconstructive surgery of ECAAs is a highly effective method of treatment that allows to achieve satisfactory results and prevent the development of severe complications.

UK Biobank imaging adapted for a real‐world memory clinic sample

AbstractBackgroundThe Oxford Brain Health Centre (BHC) provides real‐world research data, aligned with the UK Biobank imaging study (UKB), routinely captured in a clinical service from patients under‐represented in dementia research. In this work we present how we 1) adapted the UKB MRI acquisition protocol to be suitable for memory clinic patients, 2) modified the imaging analysis pipeline to extract measures that are in line with radiology reports and 3) compare measures from BHC patients to the biggest brain MRI study in the world (ultimately 100,000 participants).MethodAdaptations of the UKB acquisition protocol for BHC patients include dividing the scan into core and optional sequences to improve patients’ tolerance. We adapted the UKB structural MRI analysis pipeline to extract quantitative measures from the scans, taking into account the characteristics of a memory clinic population (e.g. high level of white matter hyperintensities, WMH, causing misclassifications in tissue‐type segmentation). We compared the measurements extracted from the scans to visual ratings from radiology reports and to reference distributions derived from UKB data.ResultOf the 108 BHC attendees since August 2020 (average age 78.5 years, range 65‐101 years, 50.9% female), 100 (92.6%) completed the clinical scans, 100 (92.6%) consented to use of data for research, and 69 (63.9%) consented to additional research sequences, demonstrating that the protocol is well tolerated. Modified tissue‐type segmentation improved grey matter volume estimation, which showed stronger correlation with visual ratings of global atrophy after correction (r=‐0.34; p=0.001) than with the original analysis pipeline (r=‐0.31; p=0.002). Correlations between hippocampal volumes and MTA scale (r(L)=‐0.59, r(R)=‐0.71) and between WMH volume and Fazekas scale (r=0.78) were also significant (p<0.001). Because UKB participants are younger than memory clinic patients, additional scans on elderly healthy controls are planned to improve reference distributions to detect pathological deviations. Measures from BHC patients within UKB age range are comparable to those from UKB participants, with several patients falling in the lower percentiles.ConclusionWe adapted UKB research imaging for clinical practice. Current and future work aims to integrate automated quantitative measures in the radiology reports and evaluate their clinical utility.

COMPARISON OF EFFECTS OF FULLERENE C60 AND METHYL METHACRYLATE ON MASS INDEX OF INTERNAL ORGANS IN ANIMALS

In the clinic of orthopaedic dentistry, diseases of the mucous membrane caused by wearing removable dentures occupy a special place because the frequency of their occurrence and according to various authors varies from 15 to 70% of patients. Denture stomatitis is a complication resulting from wearing laminar dentures made of acrylates, which contain residual monomers having a chemical-toxic effect.
 The purpose of the study is to determine the mass coefficient of internal organs in order to assess the toxic effect of C60 fullerene on the body of rats and subsequent introduction of the material into the clinic of orthopedic dentistry.
 Objects and methods. The study was carried out on male rats divided into three groups of six animals each: I group included intact control rats; II group included animals received food with C60 fullerene; III group included animals received injectable methyl methacrylate. Conditionally therapeutic dose of fullerene C60 and methyl methacrylate was 1 ml/kg each. The studied samples were administered to rats through a metal probe every day once a day for 21 days.
 The state of peripheral blood, the functional state of the liver and the mass coefficient of the internal organs of the studied animals enable to evaluate and compare the toxic effect of fullerene C60 and methyl methacrylate.
 Results. The study has shown the introduction of C60 fullerene did not cause visible signs of intoxication and lethal consequences in the experimental animals. No animals of the main group (fullerene C60) and the comparison group (methyl methacrylate) died after the 21-day study. There were also no significant violations of the general condition and behaviour of the animals. The physiological state of experimental rats did not differ from control rats.
 In the group of intact control males, a significant increase in the body weight of rats compared to the initial values ​​was noted by 8% in the 2nd week and by 20% in the 3rd week of observation. In groups of animals that were injected with fullerene C60 and methyl methacrylate, the body weight dynamics as a whole was similar to the body weight dynamics of intact control animals. The obtained indicators point out the absence of a harmful effect of the studied drug on the physiological processes of rats.
 Administration of the nanopreparation did not have a harmful effect on internal organs (liver, heart, lungs, spleen, adrenal glands), with the exception of the kidneys and thymus, where certain changes were observed. The relative mass of the kidneys decreased statistically significantly when fullerene C60 was used, and the mass of the thymus, on the contrary, increased. Despite the statistical differences between the groups, the values ​​of the kidney mass coefficient for the use of the nanopreparation are within the physiological range and cannot be considered critical. An increase in the mass of the thymus against the background of fullerene use probably occurs as a result of the activation of the immune system upon the introduction of the investigated agent. However, hematological studies did not reveal pathological deviations in the leukocyte blood formula and significant activation of immunological processes, so it can be assumed that the increase in thymus mass coefficient is not a consequence of the toxic effect of C60 fullerene.
 Conclusion. The use of Fullerene C60 for 21 days, based on the results obtained, does not have a toxic effect on the organs and systems of male rats, does not cause any intoxication reactions and does not lead to fatal consequences.

Body Weight Distribution and Body Sway in Healthy Female Adults Aged between 51 and 60 Years in Germany—Standard Values

Background: In order to determine possible pathological deviations in body weight distribution and body sway, it is helpful to have reference values for comparison: gender and age are two main influencing factors. For this reason, it was the aim of the present study to present reference values for women between 51 and 60 years of age. Methods: For this study, 101 subjectively healthy female Germans aged between 51 and 60 years (55.16 ± 2.89 years) volunteered and were required to stand in a habitual posture on a pressure measuring platform. Results: The average BMI of this age group was 25.02 ± 4.55 kg/m². The left and right foot showed an almost evenly balanced load distribution with a median load of 52.33% on the left foot [tolerance interval (TR) 38.00%/68.03%; confidence interval (CI) 51.00%/53.33%] and 47.67% on the right foot [TR 31.97%/62.00%; CI 46.67%/49.00%]. The measured median load of the forefoot was 33.33% [TR 21.37%/54.60%; CI 30.67%/36.00%] and that of the rear foot was 66.67% [TR 45.50%/78.63%; CI 64.00%/69.33%]. The median body sway in the frontal plane was 11 mm [TR 5.70 mm/26.30 mm; CI 10.00 mm/11.67 mm] and that of the sagittal plane was 16 mm [TR 7.37 mm/34.32 mm; CI 14.67 mm/18.67 mm]. The median ellipse area was 1.17 cm² [TR 0.29 cm²/4.96 cm²; CI 0.98 cm²/1.35 cm²], the median ellipse width was 0.91 cm [TR 0.42 cm/1.9 cm; CI 0.84 cm/1.02 cm] and its height was 0.40 cm [TR 0.22 cm/0.89 cm; CI 0.38 cm/0.43 cm]. Conclusions: The left-to-right ratio is almost balanced. The load distribution of the forefoot to the rear foot is approximately 1:2. The median body sway values for the frontal and sagittal planes (11 and 16 mm, respectively) agree with other values. The values for the height, body weight and the BMI are comparable to the values of average German women at this age; therefore, the measured values show a presentable cross section of women in the 51–60 age group in Germany. The present data can be used as a basis for women aged 51–60 years and can support the detection of possible dysfunctions as well as injury prevention in the parameters of postural control.

Reference ranges of biochemical blood parameters in juvenile athletes

Reference ranges of blood parameters adapted for young athletes are necessary for proper assessment and timely detection of deviations in the state of health.Purpose. A comparative analysis of the reference ranges of some biochemical blood parameters calculated on a sample of thousands of athletes under 18 years old, members of Russian national teams, versus similar indices of children not engaged in sports obtained in the framework of projects carried out in Canada and in Scandinavian countries.Results. Differences in the width of reference ranges, their minimum and maximum values between the compared groups for several indicators of protein and lipid metabolism, cortisol and testosterone aredescribed. The authors discuss the expediency of further development of reference ranges of blood parameters, which consider sex, age of athletes, and specifics of sports.Conclusion. The specified data on reference ranges of blood indices are necessary for clearer differentiation and objective evaluation of adaptational transformations arising against the background of physical loads, as well astimely detection of pathological deviations in the functional state of juvenile athletes’ organism and prognosis of their further development.

An application of group-based trajectory modeling to define fetal growth phenotypes among small-for-gestational-age births in the LIFECODES Fetal Growth Study

Reductions in fetal growth are associated with adverse outcomes at birth and later in life. However, identifying fetuses with pathologically small growth remains challenging. Definitions of small-for-gestational age are often used as a proxy to identify those experiencing pathologic growth (ie, fetal growth restriction). However, this approach is subject to limitation as most newborns labeled small-for-gestational age are constitutionally, not pathologically, small. Incorporating repeated ultrasound measures to examine fetal growth trajectories may help distinguish pathologic deviations in growth from normal variability, beyond a simple definition of small-for-gestational age. This study aimed to characterize phenotypes of growth using ultrasound trajectories of fetal growth among small-for-gestational-age births. This study identified and described trajectories of fetal growth among small-for-gestational-age births (<10th percentile weight for gestational age; n=245) in the LIFECODES Fetal Growth Study using univariate and multivariate trajectory modeling approaches. Available ultrasound measures of fetal growth (estimated fetal weight, head circumference, abdominal circumference, and femur length) from health records were abstracted. First, univariate group-based trajectory modeling was used to define trajectories of estimated fetal weight z scores during gestation. Second, group-based multi-trajectory modeling was used to identify trajectories based on concurrent measures of head circumference, abdominal circumference, and femur length z scores. Last, how these trajectories were related to patient demographics, pregnancy characteristics, and birth outcomes compared with those observed among appropriate-for-gestational-age controls was described. Of note, 3 univariate trajectories of estimated fetal weight and 4 multivariate trajectories of fetal growth among small-for-gestational-age births were identified. In our univariate approach, infants with the smallest estimated fetal weight trajectory throughout pregnancy had poorer outcomes, including the highest risk of neonatal intensive care unit admission. The remaining univariate trajectory groups did not have an elevated risk of adverse birth outcomes relative to appropriate-for-gestational-age controls. In our multivariate approach, 2 groups at increased or moderately increased risk of neonatal intensive care unit admission were identified, including infants that remained extremely small for all parameters throughout pregnancy and those who had disproportionately smaller femur length and abdominal circumference compared with head circumference. The remaining multivariate trajectory groups did not have an elevated risk of adverse birth outcome relative to appropriate-for-gestational-age controls. Latent class group-based trajectory modeling applied to ultrasound measures of fetal growth may help distinguish pathologic vs constitutional growth profiles among newborns born small-for-gestational age. Although trajectories cannot be fully characterized until delivery, limiting the direct clinical application of these methods, they may still contribute to the development of approaches for separating growth restriction from constitutional smallness.

Cyclic visualization of the respiratory stages in teaching human physiology to english-speaking students

In the course of Human Physiology, students of different specialties learn cyclic processes reflecting the work of the cardiovascular, respiratory, female reproductive systems and sleep as well. Visualization of the cyclic processes is essential for better understanding of the organization and functioning of these systems and finding pathological deviations with formation of defective cycles.&#x0D; The objective of the work is to analyze the application of the visualization of the respiratory stages into the educational process. Dynamics of the physiological processes at various stages of respiration with the help of schematic visual figures allows effective formation of the students’ systemic understanding of the respiratory system functions and its interrelations with the cardiovascular system. These enable to apply the acquired theoretical knowledge while solving clinical situational tasks and formation of professional competence.

Магия белого прогрессора: от глобального каргокульта к новой политической нормальности

The value and institutional core, which legitimized the historical rise and global domination of the West, is increasingly becoming the object of criticism. The initial coordinates of the liberal consensus, which promised humanity a constant rise in the living standards and opportunities thanks to the universality of the models of self-regulating markets and liberal democracies, find themselves under a revision. The background global trends, including those that unfolded in the Western societies, demonstrate the opposite — stagnation or shrinking of the resource base of the majority of the population against the background of the radicalization of economic inequali ty, corporate game that includes “shorting” the cost of labor (global uberization), the formation of elite democracies with limited access that ignore the principles of equality and interests of the majority. As a result, values, practices and institutions that were previously viewed as pathological deviations, institutional traps and something archaic (backwardness), consistently transform into a new global normality. Thus, theories that describe the contours of the global future mainly in non-market, and sometimes in illiberal categories, are gai ning momentum. These theories document new formats for the distribution of public resources, which are not based on markets and democracy, but rather on rent mechanisms, redistributive political regulation and differentiated value for the state of different social groups. The authors argue that, from the economic standpoint, the emerging new normality is associated with the unfolding consensus that citizens are entitled to the basic political rent or other forms of differentiated access to resources that can provide them with decent existence in the face of the gro wing inefficiency of market communications. From the political standpoint, the new normality manifests itself in the potential communitarian turn, based on a set of left-wing, nationalist and populist discourses, united by the resentment idea of returning to the state (which distributes resources) a key role in regula ting radical inequalities in the interests of the majority.

Additional opportunities for using computer technologies in expert analysis of laboratory data

The presented work reflects the author’s algorithm of mathematical processing and possible interpretations of the results obtained when creating expert analytical systems using computer technology. As initial parameters for the construction of neural networks of the second level, it is proposed to use individual results of calculations of the ratios of a number of laboratory indicators capable of forming a single functional cluster (leukogram, indicators of water-electrolyte balance, protein fractions, etc.). Further, using the proposed calculation algorithm and the archive database, structural features in the ′deformation′ of the ratio panel were compared against the background of the growth of each indicator, a matrix table was built reflecting the degree (correlation coefficients, KCr) of the coincidence of the features of the formation of the structure of the obtained panels of the parameters determined in individual observations. At high values of KCr, a conclusion is made about their (determined parameters) unified participation in the mechanism of emerging disorders. Thus, the system allows you to establish a leading complex of associated relationships by changes in the structure of ratios in the selected panel, corresponding to the dynamics of deviation of the target (analyzed) indicator, thereby differentiating the different mechanisms of formation of pathological deviations in this patient, the manifestation and balance of their values in the system-wide response, to evaluate the specific value of the absolute indicator as the final result of such interaction at the time of examination of the patient. The approach used, proposed by the authors, allows us to evaluate not only quantitative relationships, but also the features of the manifestation of the functional properties of the evaluated indicators. All of the above significantly expands the informativeness of the obtained laboratory data, allowing us to build a reasonable paradigm of the connections of the emerging complex of pathological disorders in each individual case. In the list of references, the authors cite publications as concrete examples of the use of the proposed approach in assessing a complex of disorders with different pathological processes using different panels in calculations.