Primary Management Strategy Research Articles

Single-Cell Transcriptome Analysis of H5N1-HA-Stimulated Alpaca PBMCs

Avian influenza A virus H5N1 is a highly pathogenic and persistently a major threat to global health. Vaccines and antibodies targeting hemagglutinin (HA) protein are the primary management strategies for the epidemic virus. Although camelids possess unique immunological features, the immune response induced by specific antigens has not yet been thoroughly investigated. Herein, we immunized an alpaca with the HA antigen of the H5N1 virus and performed single-cell transcriptome profiling for analysis of longitudinal peripheral blood mononuclear cell (PBMCs) behavior using single-cell sequencing technology (scRNA-seq). We revealed multiple cellular immunities during the immunization. The monocytes continued to expand after immunization, while the plasma cells reached their peak three days after the second antigen stimulation. Both monocytes and B cells were stimulated by the HA antigen and produced cell-type-specific cytokines to participated in the immune response. To our knowledge, this is the first study to examine the HA-specific immunological dynamics of alpaca PBMCs at the single-cell level, which is beneficial for understanding the anti-viral immune system and facilitating the development of more potent vaccines and antibodies in camelid animals.

Primary care management strategies and COVID-19 related hospitalization: a population-based study

Abstract Background Due to SARS-CoV-2 rapid mutations, the ending of the pandemic is still proceeding at a slow pace and there is the need to strengthen and invest in health systems that avoid hospital overload and its consequences on patients’ health. Most symptomatic infections have mild to moderate respiratory symptoms and patients are managed in the context of primary care. In Italy, literature on COVID-19 outpatients management by general practitioners (GPs) is scarce. This study explores the effect of GP active care and monitoring on COVID-19-related hospitalization in patients in the province of Modena (Italy) and investigates the possible determinants of GP's management. Methods This is a retrospective cohort study of SARS-CoV-2 infected adult outpatients managed by their GPs from March 2020 to April 2021 in the province of Modena (Italy). Data on GPs’ characteristics, management strategies (visits and remote monitoring), patients’ socio-demographic characteristics, and hospitalization were extracted from the GP's electronic medical records and were analyzed using descriptive statistics and multiple logistic regression. Results 46 GPs agreed to participate, and 5340 patients were included in the analyses. 3014 (56%) patients received active daily remote monitoring and 840 (16%) were visited at home. Remote monitoring and home visits were both associated with a reduction of the probability of hospitalization rate of approximately 50% (respectively OR:0.52, 95%CI:0.33, 0.80 and OR:0.50, 95%CI;0.33, 0.78). Preliminary analysis of determinants showed that GPs’ patient load, setting, age, and sex were significantly associated with management strategies. Conclusions Active monitoring performed by GPs was effective in reducing the probability of hospitalization. Primary and hospital care integration can be effective for COVID-19 management. Studies on GPs’ characteristics and patient load and their effect on their ability to care for patients are needed. Key messages • Active remote monitoring and visits performed by Italian general practitioners effectively reduced hospitalization for COVID-19. • Primary and hospital care integration can be effective for COVID-19 management.

Transtibial prosthetic socket fitting: Australian prosthetist perspectives on primary challenges, management strategies, and opportunities for workflow and technological innovation.

Following transtibial amputation, a custom-built socket is the most common interface between the prosthesis and residual limb. Desire from both prosthetists and prosthesis users for improved socket fitting processes have been well documented. However, there is currently limited information available about prosthetists' experiences of how prosthetic manufacturing workflow can contribute to socket fit problems. This study aims to determine how socket fit problems are currently detected and managed by prosthetists and to identify challenges, management strategies, and opportunities for workflow and technological innovation during prosthesis manufacture and socket fitting. Mixed-method (quantitative and qualitative) survey. An online survey was developed and piloted in consultation with members of the Australian Orthotic Prosthetic Association. The final 25-question survey was distributed through their membership database. Mixed methods were used to analyze survey items. Qualitative items were grouped and coded under themes relating to challenges, management strategies, and opportunities. Quantitative data were analyzed using nonparametric descriptive methods. Twenty-three respondents with a range of experience completed the survey. Seven of eight major Australian states/territories were represented. Primary workflow stages presenting challenges with limited strategies/solutions available to the prosthetists were roll-on liner selection, mold or cast modifications, communication with the client, and check socket fitting. Suggested solutions included improved socket-limb interface monitoring technology. This study provides the first insights into prosthetist-identified challenges and limitations at different stages of the socket workflow and presents a starting point for more targeted research into innovation that may assist in these processes.

Use of Calcitonin for Hypercalcemia in a Premature Neonate With Congenital Mesoblastic Nephroma.

We report on a premature neonate (31 4/7 weeks' gestation) who presented with hypercalcemia secondary to congenital mesoblastic nephroma (CMN), the most common type of renal tumor in neonates. Typical presentation includes a palpable abdominal mass or swelling and may include abdominal pain, hematuria, fever, or hypertension. A less common complication of CMN is hypercalcemia of malignancy. Although the primary management strategy for hypercalcemia of malignancy is to treat the underlying disease, there are several agents that can be used as well for acute hypercalcemia including fluids, loop diuretics, corticosteroids, bisphosphonates, and calcitonin. However, there is minimal evidence to guide efficacious and safe treatment selection and dosing as hypercalcemia is a rare complication of this tumor type. This case adds to the current body of literature as only the second case of parathyroid hormone-related peptide-mediated hypercalcemia in a preterm neonate treated with calcitonin and is the first to specify a successful dose escalation strategy of calcitonin for this indication.

Cardiac Surgery-Associated Acute Kidney Injury (CSA-AKI) in Adults and Pediatrics; Prevention is the Optimal Management.

Cardiac surgery-associated acute kidney injury (CSA-AKI) is a significant and severe complication that affects morbidity and mortality. We studied both pediatric and adult patients using the Acute Kidney Injury Network (AKIN) definition. This was an observational retrospective cohort study done at King Abdulaziz University Hospital in Jeddah, Saudi Arabia, and approved by the ethical committee. The exclusion criteria were baseline serum creatinine (SCr) ≥ 4 mg/dL or preexisting renal failure requiring dialysis, reoperation, death within 24 hours postoperatively, and operative mortality or missing data. We included 941 patients in the analysis using statistical software SPSS, version 15.0. Of the total number of patients, 28.68% in the adult group and 20.07% in the pediatric group developed CSA-AKI. Adult risk factors included the age group 60-69 years, cardiopulmonary bypass (CPB), number of grafts, and hypertension. In the pediatric group, CPB, aortic cross-clamping (ACX), and the lower preoperative SCr were the main risk factors Conclusion: Conventional conservative management and preoperative identification of predictor risk factors are essential for preventing CSA-AKI, constituting the primary strategy for optimal management.

Pituitary Adenoma Incidence, Management Trends, and Long-term Outcomes: A 30-Year Population-Based Analysis

ObjectiveTo perform a population-based study of pituitary adenoma epidemiology, including longitudinal trends in disease incidence, treatment patterns, and outcomes. Patients and MethodsIn this study of incident pituitary adenomas in Olmsted County, Minnesota, from January 1, 1989, through December 31, 2019, we identified 785 patients who underwent primary screening, 435 of whom were confirmed as harboring incident pituitary adenomas and were included. Primary outcomes of interest included demographic characteristics, presenting features, and disease outcomes (tumor control, biochemical control, and complications). ResultsAmong our 435 study patients, 438 unique pituitary adenomas were diagnosed at a median patient age of 39 years (interquartile range [IQR], 27 to 58 years). Adenomas were incidentally identified in 164 of the 438 tumors (37%). Common symptomatic presentations included hyperprolactinemia (188 of 438 [43%]) and visual field deficit (47 of 438 [11%]). Laboratory tests confirmed pituitary hormone hypersecretion in 238 of the 435 patients (55%), which was symptomatic in 222. The median tumor diameter was 8 mm (IQR, 5 to 17 mm). Primary management strategies were observation (156 of 438 tumors [36%]), medication (162 of 438 tumors [37%]), and transsphenoidal resection (120 of 438 tumors [27%]). Tumor and biochemical control were achieved in 398 (95%) and 216 (91%) secreting tumors, respectively. New posttreatment pituitary or visual deficits were noted in 43 (11%) and 8 (2%); apoplexy occurred in 28 (6%). Median clinical follow-up was 98 months (IQR, 47 to 189 months). Standardized incidence rates were 3.77 to 16.87 per 100,000 population, demonstrating linear expansion over time (R2=0.67). The mean overall standardized incidence rate was 10.1 per 100,000 population; final point prevalence was 175.1 per 100,000 population. ConclusionPituitary adenoma is a highly incident disease, with prolactin-secreting and incidental lesions representing the majority of tumors. Incidence rates and asymptomatic detection appear to be increasing over time. Presenting symptoms and treatment pathways are variable; however, most patients achieve favorable outcomes with observation or a single treatment modality.

Aggressiveness of Small-Spored Alternaria spp. and Their Sensitivity to Succinate Dehydrogenase Inhibitor Fungicides.

Brown leaf spot of potato is caused by a number of small-spored Alternaria spp. Alternaria alternata sensu stricto, A. arborescens, and A. tenuissima have been reported with increasing frequency in commercial potato fields. Potato cultivars with resistance to small-spored Alternaria spp. have yet to be developed; therefore, the application of foliar fungicides is a primary management strategy. Greenhouse inoculation assays demonstrated that isolates of these three small-spored Alternaria spp. were pathogenic. Significant differences in aggressiveness were observed across isolates; however, there was no trend in aggressiveness based on species. Significant fungicide by isolate interactions in invitro fungicide sensitivity and significant differences between baseline and nonbaseline isolates were observed in all three small-spored Alternaria spp. The ranges of invitro sensitivity of A. alternata baseline isolates to boscalid (EC50 <0.010 to 0.89 µg/ml), fluopyram (<0.010 to 1.14 µg/ml) and solatenol (<0.010 to 1.14 µg/ml) were relatively wide when compared with adepidyn (<0.010 to 0.023 µg/ml). The baseline sensitivities of A. arborescens and A. tenuissima isolates to all four fungicides were <0.065 µg/ml. Between 10 and 21% of nonbaseline A.alternata isolates fell outside the baseline range established for the four succinate dehydrogenase inhibitor (SDHI) fungicides evaluated. In A. arborescens, 10 to 80% of nonbaseline isolates had higher sensitivities than the baseline. A. tenuissima isolates fell outside the baseline for boscalid (55%), fluopyram (14%), and solatenol (14%), but none fell outside the baseline range for adepidyn. Evaluations of invivo fungicide efficacy demonstrated that most isolates were equally controlled by the four SDHI fungicides. However, reduced boscalid efficacy was observed for four isolates (two each of A. arborescens and A. tenuissima) and reduced fluopyram control was observed in one A. alternata isolate. Results of these studies demonstrate that isolates of all three species could be contributing to the brown leaf spot pathogen complex and that monitoring both species diversity and fungicide sensitivity could be advantageous for the management of brown leaf spot in potatoes with SDHI fungicides.

Towards a liquid healthcare: primary care organisational and management strategies during the COVID-19 pandemic - a qualitative study

BackgroundThe COVID-19 pandemic has changed the organisational and management strategies of healthcare institutions such as primary care centres. Organisational culture as well as leadership style are key issues for the success of these institutions. Due to the multidimensional nature of identity processes, it is necessary to explore the changes experienced by health professionals from these perspectives. This study explores health professionals’ organisational and management strategies in primary care settings during the COVID-19 pandemic.DesignQualitative, exploratory study based on the analysis of participants’ accounts within a hermeneutic phenomenologicaly approach.MethodsResearch was conducted in primary care settings in two neighbouring Spanish healthcare regions. The sample included participants with different demographics (gender, age), professional roles (practice managers, general practitioners, paediatricians), employment status (permanent, temporary, zero-hours), and years of experience (under or over ten years’ experience). Data were collected between July and December 2020 through focus groups and in-depth, semi-structured individual interviews.ResultsA total of 53 primary care workers participated in the study, of which 38 were individually interviewed and 15 participated in three focus groups. Of these, 78.4% were healthcare professionals, 49% were female nurses, and 70.5% had more than 10 years of work experience in primary care. Two main themes emerged: “liquid” healthcare and “the best healthcare system in the world”. During the first wave of the COVID-19 pandemic, new, more fluid organisational and management models were implemented in primary care settings, which have remained in place since. Primary care workers’ perceived a lack of appreciation and inclusion in decision-making that risked their alienation and disengagement.ConclusionPrimary care workers’ professional identity became gradually blurred due to shifting perceptions of their professional roles in a context of increasing improvisation and flexible working practices. This affected their professional performance.Trial RegistrationThe study was approved by the Clinical Research Ethical Committee of the Talavera de la Reina Integrated Management Area (CEIm del AGI de Talavera de la Reina in Spain, Hospital Nuestra Señora del Prado, ref: 23/2020).

MP43-11 THE USE AND OUTCOMES OF MEN WITH NCCN FAVORABLE INTERMEDIATE RISK PROSTATE CANCER MANAGED WITH ACTIVE SURVEILLANCE

You have accessJournal of UrologyCME1 May 2022MP43-11 THE USE AND OUTCOMES OF MEN WITH NCCN FAVORABLE INTERMEDIATE RISK PROSTATE CANCER MANAGED WITH ACTIVE SURVEILLANCE Roshan Paudel, Raghav Madan, Ji Qi, Michael Cher, Brian Lane, Arvin George, Alice Semerjian, Kevin Ginsburg, and for the Michigan Urological Surgery Improvement Collaborative Roshan PaudelRoshan Paudel More articles by this author , Raghav MadanRaghav Madan More articles by this author , Ji QiJi Qi More articles by this author , Michael CherMichael Cher More articles by this author , Brian LaneBrian Lane More articles by this author , Arvin GeorgeArvin George More articles by this author , Alice SemerjianAlice Semerjian More articles by this author , Kevin GinsburgKevin Ginsburg More articles by this author , and for the Michigan Urological Surgery Improvement Collaborative More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002609.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: To describe the use of active surveillance (AS), factors associated with the selection of AS, and time on AS for men with NCCN favorable intermediate risk prostate cancer (FIRPC) managed with AS in the Michigan Urological Surgery Improvement Collaborative (MUSIC) registry. METHODS: We calculated the proportion of men with FIRPC that selected AS by year of diagnosis and contributing practice from 2016 to 2020. Selection of AS was defined as both 1) AS listed as the primary management strategy and 2) absence of treatment for at least 12 months post diagnosis. A multivariable logistic regression model was fit to assess for the association of clinical, demographic, and oncological factors associated with AS selection, including the use and result (reassuring [RA] vs. non-reassuring [non-RA]) of confirmatory tests (Genomics, MRI, repeat TRUS, and targeted biopsy). Kaplan-Meier curves were used to estimate treatment free probability for patients on AS in the entire cohort and stratified by patients without, with RA, and non-RA confirmatory test. RESULTS: We identified 2473 men diagnosed with FIRPC from 2016 to 2020, of which 977 (40%) chose AS. Use of AS for men with FIRPC gradually increased from 33% in 2016 to 48% in 2020. Additionally, there was notable variability in the proportion of men with FIRPC at each practice that selected AS, ranging from 17%-56% (Figure 1). In the multivariable model, we noted that increasing age (OR 1.10; 95% CI: 1.08-1.12, p<0.001) and RA confirmatory test results (OR 6.69, 95% CI 5.04-8.85, p<0.001) were associated with the selection of AS, while the presence of GG2 disease (OR 0.19, 95% CI 0.13-0.28, p<0.001) was associated with decreased odds of selecting AS. Of men with FIRPC on AS, 81% were free of treatment 24 months after diagnosis. Stratified by confirmatory testing, the estimated 24-month treatment free probability was 83% for patients without a confirmatory test compared with 87% for patients with RA and 78% for patients with non-RA confirmatory tests. CONCLUSIONS: The use of AS for men with FIRPC has increased from 2016 to 2020, but there is notable variability in the proportion of patients with FIRPC selecting AS by contributing practices. Confirmatory tests may prove valuable in helping to select men and the intensity of surveillance for men on AS. Source of Funding: Blue Cross Blue Shield of MI © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e745 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Roshan Paudel More articles by this author Raghav Madan More articles by this author Ji Qi More articles by this author Michael Cher More articles by this author Brian Lane More articles by this author Arvin George More articles by this author Alice Semerjian More articles by this author Kevin Ginsburg More articles by this author for the Michigan Urological Surgery Improvement Collaborative More articles by this author Expand All Advertisement PDF DownloadLoading ...

Ventricular Tachycardia Burden and Mortality: Association or Causality?

Ventricular tachycardia (VT) is a potentially fatal cardiac rhythm disorder. Implantable cardioverter defibrillators (ICDs) are the primary management strategy for VT and have been shown to reduce the incidence of death but, ICDs do not reduce VT recurrences. Further, mounting evidence indicates that high VT burden, defined as the cumulative number of recurrent VTs or ICD shocks, is associated with an elevated risk of death; however, it is unclear if high VT burden is a cause of death or a marker of severe heart disease. Proposed mechanisms for a causal pathway suggest that multiple VT episodes or potential deleterious effects from ICDs might alter the myocardium of the ventricles to induce worsening heart disease, which might translate to an increased risk of mortality. In this review, we present the evidence to support association and causation hypotheses for the relationship between VT burden and risk of mortality and indicate potential gaps in evidence. Overall, there is insufficient evidence to prove causal hypotheses for the relationship between VT burden and mortality. Consistent definitions for VT burden, randomized controlled trials that assess the relationship between VT burden and mortality, and observational studies that capture VT burden are warranted to investigate if a potential causal relationship exists.

The cutoff of ferritin for evaluation of osteoporosis in patients with Thalassemia Major: A cross-sectional analytic study

Background: This study aimed to assess cutoff of ferritin for evaluation of osteoporosis in patients with Thalassemia Major (TM).&#x0D; Materials and Methods: This analytic cross-sectional study was conducted in17 Shahrivar children's hospital, Rasht, Iran, from November 2017 to November 2018. The inclusion criteria were indicated as the presence of TM in patients aged 12-19 years old with records of their regular visits. The exclusion criteria were noted as the presence of any chronic bone diseases such as osteomalacia or osteogenesis imperfecta, delayed puberty, hypothyroidism, parathyroid dysfunction, renal failure, liver failure, and growth hormone deficiency. Ferritin level was assessed, and bone densitometry was performed for all patients with TM.&#x0D; Results: In this study, 53 females (54.6%) and 44 males (43.4%) were enrolled. Results showed that 36 (37.1%), 49 (50.5%), and 12 (12.4%) patients had a normal bone density, osteopenia, and osteoporosis, respectively. Comparing these three groups showed that despite higher mean serum level of ferritin in TM patients with osteoporosis than patients with osteopenia and normal bone density, no significant statistical difference was noted in these three groups (P &gt;0.05). Besides, the mean ferritin level in patients with abnormal bone densitometry (osteopenia and osteoporosis) was higher than in patients with normal ones. A significant difference was noted between abnormal and normal densitometries (p=0.03). The Area under the Curve for ferritin was 0.708, and the cutoff point was indicated for ferritin was 2006 ng/ml.&#x0D; Conclusion: Regarding the results, there was a high frequency of osteoporosis and osteopenia in teenagers with TM. As bone density abnormality formation is time-consuming, and prevention is the primary strategy for management, it is highly recommended to assess bone mineral density regularly starting from early childhood.

Association Between METS-IR and Prehypertension or Hypertension Among Normoglycemia Subjects in Japan: A Retrospective Study.

AimOur study aimed to investigate the association between the novel non–insulin‐based metabolic score for insulin resistance (METS-IR) index and pre-hypertension (HTN) or HTN in normoglycemia Japanese participants.MethodsThe NAGALA medical examination program at Murakami Memorial Hospital in Gifu, Japan was found in 1994. 15,453 participants enrolled in this program from 2004 to 2015 was included in this retrospective study to explore the association between the METS-IR index and pre-HTN or HTN. Covariates included serum biomarkers and clinicodemographic characteristics. Logistic regression was applied to explore the association between METS-IR level and pre-HTN or HTN.ResultsThis study includes a total of 15453 participants. The prevalence rates of pre-HTN and HTN were 28.55% (4412/15453) and 6.23% (962/15453), respectively. Adjusted for confounding factors in the multivariable logistic regression analysis models, when METS-IR was used as a categorical variable, high METS-IR was significantly associated with both pre-HTN (adjusted odds ratio (OR) = 1.95, 95% confidence interval (CI): 1.61–2.36) and HTN (adjusted OR = 2.12, 95% CI: 1.44–3.11). When METS-IR was used as a continuous variable, each 1 unit increase in METS-IR was associated with a 7% increase in the prevalence of pre-HTN (adjusted OR = 1.07, 95% CI: 1.06–1.08) and with a 13% increase in the prevalence of HTN (adjusted OR = 1.13, 95% CI: 1.10–1.16). Stratified analyses indicated a positive correlation between METS-IR and pre-HTN or HTN in normoglycemia subjects with different characteristics.ConclusionsMETS-IR levels are significantly associated with pre-HTN or HTN in normoglycemia individuals in Gifu, Japan. METS-IR may be used as a monitoring indicator for the development of HTN primary prevention and management strategies in the future, but it still needs more research to confirm.

Available Strategies for the Management of Andean Lupin Anthracnose.

The lupin (Lupinus mutabilis Sweet) is a legume domesticated and cultivated for more than 4000 years by the pre-Hispanic cultures of the Andean zone. Due to its good taste and protein content, the lupin seed contributes significantly to the food and nutritional security of the Andean population. However, lupin is susceptible to diseases, and of these, anthracnose is the most devastating as it affects the whole crop, including leaves, stems, pods, and seeds. This review focuses on available strategies for management of lupin anthracnose from sowing to harvest. Seed disinfection is the primary anthracnose management strategy. Seed treatment with fungicides reduces transmission from seed to seedling, but it does not eradicate anthracnose. Attention is given to alternative strategies to limit this seed-borne pathogen as well as to enhance plant resistance and to promote plant growth. For anthracnose management in the field, integrated practices are discussed that encompass control of volunteer plants, lupin ontogenetic resistance, and rotation of biocontrol with chemical fungicides at susceptible phenological stages. This review covers some local experiences on various aspects of anthracnose management that could prove useful to other the groups focusing on the problem.

Pulmonary Hypertension in Adults with Congenital Heart Disease.

Pulmonary arterial hypertension related to congenital heart disease (PAH-CHD) affects 5% to 10% of adults with CHD and is associated with significant morbidity and mortality. PAH-CHD develops as a consequence of intracardiac or extracardiac systemic-to-pulmonary shunts that lead to pulmonary vascular remodeling through a pathologic process that is similar to other causes of PAH. Eisenmenger syndrome is the most severe phenotype of PAH-CHD and is characterized by severe elevation in pulmonary vascular resistance, with shunt reversal causing hypoxemia and central cyanosis. The primary management strategy for most patients with PAH-CHD is medical therapy, although defect closure is considered in select cases.

Характеристика воспаления центральных отделов носа с учетом вариантной анатомии при респираторной аллергии

Background: in respiratory allergy, a concept of a common respiratory epithelium of the nasal cavity and sinuses allows for a view from a different perspective on the changes of the ostiomeatal complex and central nose. In the individual anatomical variations of the nose, a relationship between the involvement of the ethmoidal labyrinth and the medial maxillary sinuses is suggested. Aim: to assess the effect of variant anatomy on the course of inflammation in patients with respiratory allergy and clinical signs of allergic rhinitis (AR). Patients and Methods: 15 patients (8 men and 7 women, mean age 42±13.2 years) with clinical signs of allergy were enrolled. All participants were divided into two groups. Group 1 (n=8) included patients with AR and the involvement of the ethmoidal labyrinth and medial maxillary sinuses. Group 2 (n=7) included patients with isolated AR (no sinus involvement). All patients underwent nasal and nasopharyngeal endoscopy. Respiratory allergen specific IgE screening panels (ImmunoCap, Phadia) were used to analyze sensitization profile. Sinus and nose anatomy was evaluated by computed tomography. Results: a significant difference of nasal and sinus anatomy was found between the groups. A direct correlation between the deviated septum in its anterior and/or middle portions and inflammation of the ethmoidal labyrinth and central maxillary sinuses was identified. In addition, a weak inverse correlation between the deviated septum in its posterior parts and the inflammation of the central nose was identified. Finally, a tendency towards statistical significance for another anatomical trait, Haller’s cells, was revealed in group 1. Conclusion: these findings should be considered when selecting the primary management strategy, i.e., surgery, allergen-specific immunotherapy or combination thereof. KEYWORDS: allergy, atopy, chronic rhinosinusitis, nasal polyposis, sinusitis, ethmoidal labyrinth, maxillary sinus. FOR CITATION: Grigorieva I.N., Tataurshchikova N.S., Popadyuk V.I. et al. Inflammation of the central nose considering variant anatomy in respiratory allergy. Russian Medical Inquiry. 2022;6(2):62–66 (in Russ.). DOI: 10.32364/2587-6821-2022-6-2-62-66.

Синдром «сухого глаза» при кератоконусе: аспекты этиологии и медикаментозной коррекции

This paper reviews published data on the studies on keratoconus associated with dry eye disease (DED) presentations. Despite the lack of a direct correlation between DED and keratoconus, many studies have demonstrated that keratoconus is associated with DED in more than 80% of cases. The author describes major endogenous and exogenous (inflammatory, immune/allergic, mechanical, neuropathic) factors triggering the development and association of these conditions. Approaches to the medical treatment of disorders resulting from the association of these entities are discussed. The primary management strategy implies tear film and ocular surface protection with tear substitutes based on the sodium salt of hyaluronic acid. In the lack of the effect of tear substitutes or in rigid gas permeable contact lens wearers, gel-based dexpanthenol in high concentrations is recommended. This treatment significantly increases drug bioavailability and prolongs the ocular surface reparation. Scleral contact lenses ensuring intact corneal epithelium and high visual acuity in irregular astigmatism caused by keratoconus are also used for corneal protection and DED therapy. Keywords: keratoconus, keratectasia, dry eye disease, epitheliopathy, tear film. For citation: Averich V.V. Dry eye disease in keratoconus: etiology and medical treatment. Russian Journal of Clinical Ophthalmology. 2022;22(2):122–126 (in Russ.). DOI: 10.32364/2311-7729-2022-22-2-122-126.

The impact of different plant extracts on population suppression of Helicoverpa armigera (Hub.) and tomato (Lycopersicon esculentum Mill) yield under field conditions.

Helicoverpa armigera (Hub.) is a destructive pest of the tomato (Lycopersicon esculentum Mill) crop in Pakistan. Although insecticides are the primary management strategy used to control H. armigera, most of them are not effective due to considerable toxic residual effects on the fruits. Nonetheless, H. armigera is rapidly evolving resistance against the available pesticides for its management. This situation calls upon the need of alternative management options against the pest. Different plant extracts have been suggested as a viable, environment-friendly option for plant protection with minimal side effects. Furthermore, the plant extracts could also manage the insect species evolving resistance against pesticides. This study evaluated the efficacy of different plant extracts (i.e., Neem seed, turmeric, garlic and marsh pepper) against H. armigera. Furthermore, the impact of the plant extracts on growth and yield of tomato crop was also tested under field conditions. The results revealed that all plant extracts resulted in higher mortality of H. armigera compared to control. Similarly, the highest plant height was observed for the plants treated with the plant extracts compared to untreated plants. Moreover, the highest tomato yield was observed in plants treated with plant extracts, especially with neem seed (21.013 kg/plot) followed by pepper extract (19.25 kg/plot), and garlic extract 18.4 kg/plot) compared to the untreated plants (8.9 kg/plot). It is concluded that plant extracts can be used as eco-friendly approaches for improving tomato yield and resistance management of H. armigera.

Resistance of Soybean Genotypes to Anticarsia gemmatalis (Lepidoptera: Erebidae): Antixenosis and Antibiosis Characterization.

Injury by herbivores is a major biotic stress that limits soybean [Glycine max (L.) Merrill] crop production. Among the main soybean insect pests, Anticarsia gemmatalis Hübner is responsible for causing significant economic damage in soybean. The primary management strategy for this insect is chemical control and use of Bt transgenic soybean. Alternative strategies, such as host plant resistance, are considered an efficient and less-aggressive method, especially in association with other strategies as part of an integrated pest management (IPM) approach. In this study, we evaluated 30 soybean genotypes to verify antixenosis expression through oviposition, attractiveness, and food consumption tests. From this, we selected 13 promising genotypes to verify the possible presence of antibiosis. Our results suggest that antixenosis was found in genotypes ‘TMG 133’ RR, ‘TMG 1179’ RR, ‘IAC 19’, ‘IAC 17’, ‘IAC 100’, D75-10169, and IAC 78-2318. By influence on behavior and negative impact on larval viability, antixenosis and antibiosis were indicated for the genotypes IAC 74-2832, ‘IAC 19’, ‘IAC 17’, ‘IAC 100’, and PI 274454. ‘TMG 7062’ IPRO was found to provide antibiosis resistance by negatively affecting larval development and viability. Because of reduced food consumption by larvae, antixenosis was indicated for ‘IAC 24’. These genotypes should be considered in soybean breeding programs focusing on soybean resistance to A. gemmatalis.

Optimizing active surveillance for low-risk prostate cancer: Characterizing provider and patient perspectives.

250 Background: The number of men on active surveillance (AS) for low-risk prostate cancer is rapidly increasing. While AS requires routine clinical exams, labs, imaging, and prostate biopsies, many men do not receive all recommended components. Understanding the perspectives of key stakeholders regarding recommended surveillance is critical to ensuring the optimization of AS as a management strategy. Methods: We conducted in-depth, semi-structured, virtual interviews with a purposive sample of 15 men with low-risk prostate cancer who were on AS as their primary management strategy and their partners, and 15 urologists and 19 primary care providers (PCPs) with experience in AS management between June 2020 and March 2021. We used the Theoretical Domains Framework (TDF), an implementation science framework developed to understand determinants of behaviors and to inform the design of interventions, to guide our interview guide. Questions assessed knowledge, barriers and facilitators, and preferences for provider roles in AS management. Interviews were recorded, transcribed, and deductively coded into TDF domains and constructs. Three independent coders iteratively developed and used a shared coding framework. Participant recruitment continued until data saturation by group. Results: Our study included 15 men (on AS between 1-16 years), 5 partners, 15 urologists (3 female, 5 in private practice, 3 in academic medical centers), and 19 PCPs (9 female, 4 in community practices, 15 in academic medical centers). The TDF domain of “knowledge” and the construct, “barriers and facilitators” were most commonly reported as factors impacting receipt of recommended surveillance across all groups. While urologists were most knowledgeable about AS, PCPs noted limitations in understanding for whom AS is recommended, and what it entails. Patients who had made an effort to research or learn about AS found that this knowledge enabled them to be proactive about receiving all recommended components. Urologists and patients noted several common procedural barriers to receiving recommended surveillance, including pain with repeated biopsies, and becoming lost to follow-up. Patients and PCPs were uncertain about what tests were needed and when. Urologists were concerned about PCP knowledge while PCPs described insufficient communication from urologists as barriers to shared care. Procedural facilitators included electronic medical records (EMR) to remind providers and patients of frequency and timing of tests. Conclusions: Key opportunities for optimizing AS include improving patient and PCP knowledge about the components and delivery of AS, facilitating communication between providers, and leveraging EMR to ensure those on AS are followed. The development of an intervention that combines several of these components will be critical to ensuring men on AS receive the recommended surveillance.

Resistance Gene Pyramiding and Rotation to Combat Widespread Soybean Cyst Nematode Virulence

Soybean cyst nematode (SCN) is an important pathogen of soybean causing >$1 billion in yield losses annually in the United States. Planting SCN-resistant soybean cultivars is the primary management strategy. Resistance genes derived from the plant introduction (PI) 88788 (rhg1-b) and PI 548402 (Peking; rhg1-a and Rhg4) are the main types of resistance available in commercial cultivars. The PI 88788 rhg1-b resistance allele is found in the majority of SCN-resistant cultivars in the north central United States. The widespread use of PI 88788 rhg1-b has led to limited options for farmers to rotate resistance sources to manage SCN. Consequently, overreliance on a single type of resistance has resulted in the selection of SCN populations that have adapted to reproduce on these resistant cultivars. Here we evaluated the effectiveness of rotating soybean lines with different combinations of resistance genes to determine the best strategy for combating the widespread increase in virulent SCN and limit future nematode adaptation to resistant cultivars. Eight SCN populations were developed by continuous selection of a virulent SCN field population (Heterodera glycines [HG] type 1.2.5.7) on a single resistance source or in rotation with soybean pyramiding different resistance gene alleles derived from PI 88788 (rhg1-b), PI 437654 (rhg1-a and Rhg4), PI 468916 (cqSCN-006 and cqSCN-007), and PI 567516C (Chr10). SCN population densities were determined for eight generations. HG type tests were conducted after the eighth generation to evaluate population shifts. The continued use of rhg1-b or 006/007 had limited effectiveness for reducing SCN type 1.2.5.7 population density, whereas rotation to the use of rhg1-a/Rhg4 resistance significantly reduced SCN population density but selected for broader SCN virulence (HG type 1.2.3.5.6.7). A rotation of rhg1-a/Rhg4 with a pyramid of rhg1-b/006/007/Chr10 was the most effective combination at both reducing population density and minimizing selection pressure. Our results provide guidance for implementation of a strategic SCN resistance rotation plan to manage the widespread virulence on PI 88788 and sustain the future durability of SCN resistance genes.