Rational Use Research Articles

Impact of coal energy development on the surrounding environmental water resources carrying capacity

In coal mining, water resources are consumed and destroyed. This study focuses on the water bodies in a coal base and analyzes the pollution caused by coal energy development in the area. By examining the current situation of coal energy development and coal industry, combined with the actual conditions in Northern Shaanxi, the detrimental effects of energy development pollution on water resource carrying capacity and the importance of protecting water resource carrying capacity are investigated. The findings indicate that river pollution is significant based on water quality evaluations of the 10 rivers in the coal base. The reservoir in northern Shaanxi has also been contaminated, with serious groundwater pollution observed. Recommendations are made to enhance laws for water resource protection, aiming to support the rational use and optimal allocation of water resources.

Pharmacist's knowledge and attitude towards self-medication practices: a cross-sectional study for the development and validation of questionnaire.

Pharmacists play an essential role in self-medication by providing guidance and counselling services to consumers; hence, it is necessary to assess pharmacists' awareness and attitude towards self-medication to promote responsible self-medication practices. To develop a valid and reliable instrument to assess the knowledge and attitude of pharmacists towards self-medication practices and their role in promoting responsible self-medication. A questionnaire was developed in English after a relevant literature review, which was further administered to a sample of 105 community pharmacists. The reliability of the questionnaire was assessed using the Karl-Pearson correlation and Cronbach alpha statistics. Content validity was evaluated by subject experts. The dimensional structure of items was assessed through exploratory factor analysis and confirmatory factor analysis (CFA). The final questionnaire comprises 27 items for knowledge and attitude with a Karl-Pearson correlation value of 0.896 and Cronbach alpha value of 0.814 (24 items), indicating good internal consistency and reproducibility. Factor analysis identified five factors: namely, (i) attitude towards providing guidance and advice to consumers to promote responsible SMP, (ii) attitude towards shared responsibility for promoting rational medicine supply and use, (iii) knowledge of the advantages and disadvantages of SMP, (iv) knowledge of the definition of self-medication, (v) attitude towards professional competency of a pharmacist as a healthcare provider. CFA results demonstrate good model fit with the value of Chi-square (184.56), CFI (0.937), RMSEA (0.054), and SRMR (0.075). Model validity measures ensure satisfactory validity and reliability. The findings demonstrate a valid and reliable measure for assessing the knowledge and attitude of pharmacists towards self-medication.

Consumption of antibiotics in Brazil - an analysis of sales data between 2014 and 2019

BackgroundAntibiotic consumption is a driver for the increase of antimicrobial resistance. The objective of this study is to analyze variations in antibiotic consumption and its appropriate use in Brazil from 2014 to 2019.MethodsWe conducted a time series study using the surveillance information system database (SNGPC) from the Brazilian Health Regulatory Agency. Antimicrobials sold in retail pharmacies were evaluated. All antimicrobials recorded for systemic use identified by the active ingredient were eligible. Compounded products and formulations for topic use (dermatological, gynecological, and eye/ear treatments) were excluded. The number of defined daily doses (DDDs)/1,000 inhabitants/day for each antibiotic was attributed. The number of DDDs per 1,000 inhabitants per day (DDIs) was used as a proxy for consumption. Results were stratified by regions and the average annual percentage change in the whole period studied was estimated. We used the WHO Access, Watch, and Reserve (AWaRe) framework to categorize antimicrobial drugs.ResultsAn overall increase of 30% in consumption from 2014 to 2019 was observed in all Brazilian regions. Amoxicillin, azithromycin and cephalexin were the antimicrobials more consumed, with the Southeast region responsible for more than 50% of the antibiotic utilization. Among all antimicrobials analyzed 45.0% were classified as watch group in all Brazilian regions.ConclusionWe observed a significant increase in antibiotics consumption from 2014 to 2019 in Brazil restricted to the Northeast and Central West regions. Almost half of the antibiotics consumed in Brazil were classified as watch group, highlighting the importance to promote rational use in this country.

EUROPEAN POLICY OF SUSTAINABLE DEVELOPMENT OF AGRICULTURE: CHALLENGES FOR UKRAINE

Ukraine, despite the damages and losses inflicted on agriculture by Russian large-scale aggression, actively participates in the implementation of the main tasks of the global goals defined by the European strategy for sustainable development. The purpose of the article is to analyze the relationship between the policy of sustainable rural development of the European Union and the possibilities of its implementation in various spheres of life, economic, social, ecological, and institutional to support sustainable rural development in Ukraine. Ukraine is an active participant in the implementation of the system of transfer of knowledge and innovations in the agricultural sector – Agricultural Knowledge and Innovation Systems at the regional level, since the rural population needs to increase its own level of awareness of opportunities and potential risks in conducting economic activities and understanding of rational use of resources. The methodology includes analysis of the report on monitoring progress in achieving the goals of sustainable development in the context of the EU, which are directly related to agriculture or the development of rural areas, directives of the Commission of the European Union, statistical data of the State Statistics Service of Ukraine, primary and secondary sources. The originality of the article lies in the fact that in the article for the first time covers a detailed analysis of the indicators of the goals of sustainable development of agriculture and rural areas and their correspondence to the tasks of the strategy of the common European agricultural policy. The results of the analysis can be used in planning future projects for rural communities or agricultural enterprises to improve their social and economic situation

2024 update: European consensus statement on gene therapy for spinal muscular atrophy

Spinal muscular atrophy (SMA) is one of the most common genetic diseases and was, until recently, a leading genetic cause of infant mortality. Three disease-modifying treatments have dramatically changed the disease trajectories and outcome for severely affected infants (SMA type 1), especially when initiated in the presymptomatic phase. One of these treatments is the adeno-associated viral vector 9 (AAV9) based gene therapy onasemnogene abeparvovec (Zolgensma®), which is delivered systemically and has been approved by the European Medicine Agency for SMA patients with up to three copies of the SMN2 gene or with the clinical presentation of SMA type 1. While this broad indication provides flexibility in patient selection, it also raises concerns about the risk-benefit ratio for patients with limited or no evidence supporting treatment.In 2020, we convened a European neuromuscular expert working group to support the rational use of onasemnogene abeparvovec, employing a modified Delphi methodology. After three years, we have assembled a similar yet larger group of European experts who assessed the emerging evidence of onasemnogene abeparvovec's role in treating older and heavier SMA patients, integrating insights from recent clinical trials and real-world evidence. This effort resulted in 12 consensus statements, with strong consensus achieved on 9 and consensus on the remaining 3, reflecting the evolving role of onasemnogene abeparvovec in treating SMA.

Impact of Land Use Change on Carbon Storage in Urban Agglomerations in the Guanzhong Plain

It is important to study the impact of land use change on terrestrial ecosystem carbon stocks in urban agglomerations for the optimization of land use structure and sustainable development in urban agglomerations. Based on the patch-generating land use simulation (PLUS) model and integrated valuation of ecosystem services and trade-offs (InVEST) model, a simulation was developed that predicted the land use change and carbon stock of the Guanzhong Plain urban agglomeration in 2040 under different scenarios and further analyzed the impact of land use change on carbon stock. The results showed that:① The land use types of the Guanzhong Plain urban agglomeration were mainly cultivated land, forest land, and grassland, which accounted for more than 90 % of the total study area. ② From 2000 to 2020, the carbon stock in the Guanzhong Plain showed a continuous downward trend, with cropland, woodland, and grassland being the main sources of carbon stock in the Guanzhong Plain, and the overall carbon stock declined by 15.12×106 t, with the spatial distribution presenting the distribution characteristics of "high in the north and south and low in the middle." ③ By 2040, the carbon stock would decrease the most under the urban development scenario, with a total reduction of 27.08×106 t, and the least under the ecological development scenario, with a total reduction of 4.14×106t. The research results can provide data support for the high-quality development and rational land use planning of the Guanzhong Plain urban agglomeration.

Non-typhoidal Salmonella contributes to gastrointestinal infections in Morogoro: Evidence from patients attending Morogoro regional referral hospital in Tanzania.

Salmonella is one of the most common causes of food-borne outbreaks and infection worldwide. Non-typhoidal Salmonella (NTS) infections are common and remain a significant public health problem among important bacterial foodborne diseases. The current study aimed to establish the Non typhoidal Salmonella infection and antimicrobial resistance status among selected patients at Morogoro Regional Referral Hospital (MRRH), Morogoro Region, Tanzania, to inform clinical care management and public health interventions. A cross-sectional study was conducted using medical records and samples were collected from hospitalised and outpatients between October and December 2021. A total of 153 participants were enrolled in the study and 132 consented to being sampled. The collected samples were analysed using standard microbiological techniques. The isolates were subjected to molecular genotyping, where Polymerase Chain Reaction (PCR) was performed targeting the 16S rDNA gene. PCR products were then submitted for sequencing to establish phylogenetic relatedness. Antimicrobial susceptibility testing and resistance genes screening were also conducted. The phylogenetic analysis identified two Salmonella serovars; Salmonella Enteritidis and Salmonella Typhimurium. The isolates were from four adults and seven children patients. The isolates were tested against six antimicrobial agents: tetracycline, trimethoprim, gentamycin, ciprofloxacin, ampicillin and cefotaxime. Further antimicrobial assays were performed by screening 10 antimicrobial resistance genes using PCR. Overall, the highest resistance was observed in ampicillin (100%), whereas the lowest resistance was recorded for ciprofloxacin and gentamicin (9.1%). In addition, four (36.4%) of the isolates were resistant to cefotaxime and three (27.3%) to tetracycline and trimethoprim. The isolates also exhibit the presence of resistance genes for sulfamethoxazole 1&2, tetracycline (tet) A&B, Beta-lactamase CTXM, Beta-lactamase TEM, Beta-lactamase SHV, Gentamycine, Acra and acc3-1 in different occurrences. The overall prevalence of Salmonella species in Morogoro region was 8.3% (11/132) with Salmonella Enteritidis and Salmonella Typhimurium being the only serovars detected from adults and children stool samples. Our investigation showed that both children and adults had been exposed to Salmonella spp. However, the occurrence of NTS was higher in children (5.3% (7/132) compared to adults (3.0% (4/132). To stop zoonotic infections and the development of antimicrobial resistance in the community, this calls for Infection Prevention and Control (IPC) and stewardship programmes on rational use of antimicrobials in both health facilities and at the community level.

Development of a nomogram for predicting liver transplantation prognosis in hepatocellular carcinoma

BACKGROUND At present, liver transplantation (LT) is one of the best treatments for hepatocellular carcinoma (HCC). Accurately predicting the survival status after LT can significantly improve the survival rate after LT, and ensure the best way to make rational use of liver organs. AIM To develop a model for predicting prognosis after LT in patients with HCC. METHODS Clinical data and follow-up information of 160 patients with HCC who underwent LT were collected and evaluated. The expression levels of alpha-fetoprotein (AFP), des-gamma-carboxy prothrombin, Golgi protein 73, cytokeratin-18 epitopes M30 and M65 were measured using a fully automated chemiluminescence analyzer. The best cutoff value of biomarkers was determined using the Youden index. Cox regression analysis was used to identify the independent risk factors. A forest model was constructed using the random forest method. We evaluated the accuracy of the nomogram using the area under the curve, using the calibration curve to assess consistency. A decision curve analysis (DCA) was used to evaluate the clinical utility of the nomograms. RESULTS The total tumor diameter (TTD), vascular invasion (VI), AFP, and cytokeratin-18 epitopes M30 (CK18-M30) were identified as important risk factors for outcome after LT. The nomogram had a higher predictive accuracy than the Milan, University of California, San Francisco, and Hangzhou criteria. The calibration curve analyses indicated a good fit. The survival and recurrence-free survival (RFS) of high-risk groups were significantly lower than those of low- and middle-risk groups (P < 0.001). The DCA shows that the model has better clinical practicability. CONCLUSION The study developed a predictive nomogram based on TTD, VI, AFP, and CK18-M30 that could accurately predict overall survival and RFS after LT. It can screen for patients with better postoperative prognosis, and improve long-term survival for LT patients.

Управление горнопромышленными отходами арктических промышленных предприятий: охрана окружающей среды и экономика производства

The problems of mining waste management at industrial enterprises and increasing the economy of production are among the most urgent ones, especially for the Arctic ecosystems, characterized by high sensitivity to external factors and the complexity of recovery. The research was conducted on the example of large industrial corporations directly operating in the Arctic, including PJSC PhosAgro, PJSC MMC Norilsk Nickel, Severstal Resource division of PJSC Severstal and PJSC NOVATEK. The key indicators related to waste management for 20182022 were analyzed. The trend of increasing volumes of mining waste in the Arctic was revealed, while the level of its utilization remained practically unchanged. It is proposed to intensify scientific research in the field of rational use of mining waste and to develop technologies for their processing, taking into account the impact on the Arctic ecosystems. It is suggested to create research and production centers for each industrial enterprise using the experience of the balanced “triple helix” model. It is recommended to actively participate in the Interdepartmental Scientific Council of the Russian Academy of Sciences on the development of the mineral resource base and its rational use, created in 2023, to develop the scientific foundations for the extraction and processing of minerals and accelerate import substitution.

PARENTS’ AWARENESS OF RATIONAL DRUG USE

This study was designed to determine awareness of parents about rational drug use and the influencing factors. The study was completed with 322 parents with children aged 0–18 years who consulted the pharmacy and volunteered to participate in the study. As a data collection tool, a “Descriptive Questionnaire Form” and a “Questionnaire for Awareness of Parents About Rational Drug Use” were employed. The data were assessed using descriptive (number, percentage, and mean) and statistical (t-test, Mann-Whitney U, ANOVA, and Kruskal-Wallis test) methods. It was determined that over-the-counter antipyretics were used by 53.1% of the parents for their children. Parents’ awareness of rational drug use was above the average level (43.17±7.34). The use of over-the-counter analgesics, vitamins, and antibiotics for their children, asking the physician to prescribe medication at each examination, educational background, and employment had an effect on their awareness levels of rational drug use(p

Physicians’ knowledge and preferences regarding pharmacotherapy of pregnant women with respiratory tract infections: research PIKAP

Introduction. The most common extragenital pathology during pregnancy includes upper and lower respiratory tract infections (URTI and LRTI), which, if left untreated, leading to obstetric and perinatal pathology. It is relevant to conduct pharmacoepidemiological studies assessing the preferences of specialists regarding the treatment of pregnant women and attitudes towards vaccination in real clinical practice.Aim. To analyze approaches to pharmacotherapy of URTI and LRTI in pregnant women, evaluate the compliance of prescribed drugs with current clinical recommendations and treatment standards.Materials and methods. The study was conducted from 2018 to 2022 using an anonymous questionnaire method in seven regions of Russia.Results and discussion. A total of 227 physicians from seven regions of Russia were surveyed, with 66.8% being internal medicine doctors and 33.2% obstetrician-gynecologists. This study revealed that physicians’ knowledge regarding the rational use of antimicrobial drugs (AMD) in pregnant women is insufficient. Respondents showed better results in the use of AMD in the treatment of pneumonia, with 78.7% of surveys indicating correct tactics. The worst results were observed in answering the question about the appropriateness of prescribing AMD for URTI, tracheitis, and bronchitis (40.3% to 67.7% of respondents made incorrect choices). Overall, 57.7% of respondents understand the importance of vaccination among pregnant women.Conclusion. The results of the conducted study indicate that the choice of drugs for the therapy of URTI and LRTI, especially AMD, for outpatient treatment of pregnant women in some situations does not fully correspond to the current clinical recommendations in our country. Moreover, it is particularly concerning that some physicians prescribe drugs that are unsafe for pregnant women or lack the necessary evidence base or indications for use.

Microfluidic Electrochemical Integrated Sensor for Efficient and Sensitive Detection of Candida albicans.

Traditional methods for the detection of pathogenic bacteria are time-consuming, less efficient, and sensitive, which affects infection control and bungles illness. Therefore, developing a method to remedy these problems is very important in the clinic to diagnose the pathogenic diseases and guide the rational use of antibiotics. Here, microfluidic electrochemical integrated sensor (MEIS) has been investigated, functionally for rapid, efficient separation and sensitive detection of pathogenic bacteria. Three-dimensional macroporous PDMS and Au nanotube-based electrode are successfully assembled into the modeling microchip, playing the functions of "3D chaotic flow separator" and "electrochemical detector," respectively. The 3D chaotic flow separator enhances the turbulence of the fluid, achieving an excellent bacteria capture efficiency. Meanwhile, the electrochemical detector provides a quantitative signal through enzyme-linked immunoelectrochemistry with improved sensitivity. The microfluidic electrochemical integrated sensor could successfully isolate Candida albicans (C. albicans) in the range of 30-3,000,000 CFU in the saliva matrix with over 95% capture efficiency and sensitively detect C. albicans in 1 h in oral saliva samples. The integrated device demonstrates great potential in the diagnosis of oral candidiasis and is also applicable in the detection of other pathogenic bacteria.

Fungicides, bio-controllers and resistance inducers affect bioactive compounds and oxidative metabolism in bell pepper plants inoculated with Phytophthora capsici

ABSTRACT The rational use of chemical fungicides in chilli pepper (Capsicum annuum L.) for controlling Phytophthora capsici Leo. should include molecules that promote induced systemic resistance in the plant. The study objective was to assess how the application of fungicides, bio-controllers and resistance inducers affects bioactive compounds production and oxidative metabolism in pepper plants when inoculated with P. capsici zoospores. Statistical analyses show significant differences in total flavonoids, total phenols and salicylic acid concentrations in plants treated with Trichoderma harzianum, Acibenzolar-S-Methyl (ASM) and phosphonic acid. In addition, the application of ASM and Bacillus subtilis showed the highest values of antioxidant capacity. On the other hand, ASM application favoured increases in superoxide dismutase and phenyl ammonium lyase activity with values of 4.42 ± 0.016 (units · min−1 · g−1) and 3.90 ± 0.22 U · g−1, respectively. However, hydrogen peroxide production was similar to that of phosphonic acid treatments. Similarly, plants treated with B. subtilis and Metalaxyl-M showed increases in peroxidase enzyme activity with values ranging from 2.86 ± 0.05 to 4.52 ± 0.02 (μmol · [mg protein]−1 · min−1). Likewise, phosphonic acid-treated plants exhibited high catalase enzyme activity with values ranging from 2.38 ± 0.032 μmol H2O2 · min−1 · g−1 to 4.30 ± 0.024 μmol H2O2 · min−1 · g−1. The complementary use of products with biological and resistance-inducing functions could help to mitigate the environmental impacts that occur due to the use of chemical fungicides for controlling P. capsici on chilli pepper.

ED50 of ciprofol combined with sufentanil for fiberoptic bronchoscopy of different patient populations with pulmonary tuberculosis

BackgroundCiprofol is a promising sedative. This study aims to explore the median effective dose (ED50) of ciprofol in inhibiting responses to fiberoptic bronchoscopy in patients with pulmonary tuberculosis (PTB) of different genders and ages when combined with 0.15 μg/kg sufentanil, and to evaluate its efficacy and safety, providing a reference for the rational use of ciprofol in clinical practice.MethodsPTB patients who underwent bronchoscopy examination and treatment at The Third People’s Hospital of Changzhou between May 2023 and June 2023 were selected and divided into four groups using a stratified random method. All patients received intravenous injection of 0.15 μg/kg sufentanil followed by injection of the test dose of ciprofol according to Dixon’s up-and-down method. The initial dose of ciprofol in all four groups was 0.4 mg/kg, with an adjacent ratio of 1:1.1. The next patient received a 10% increase in the dose of ciprofol if the previous patient in the same group experienced positive reactions such as choking cough, frowning, and body movements during the endoscopy. Otherwise, it was judged as a negative reaction, and the next patient received a 10% decrease in the dose of ciprofol. The transition from a positive reaction to a negative reaction was defined as a turning point, and the study of the group was terminated when seven turning points occurred. Hemodynamic parameters, oxygen saturation and adverse reactions were recorded at different time points in all groups. The Probit regression analysis method was used to calculate the ED50 of ciprofol in the four groups and compare between the groups.ResultsThe ED50 of ciprofol combined with 0.15 μg/kg sufentanil for bronchoscopy in the four groups were 0.465 mg/kg, 0.433 mg/kg, 0.420 mg/kg and 0.396 mg/kg, respectively.ConclusionThe ED50 of ciprofol used for fiberoptic bronchoscopy varied among PTB patients of different genders and ages.Trial registrationThe Chinese Clinical Trial Registry, ChiCTR2300071508, Registered on 17 May 2023.

The impact of clinical pharmacists’ intervention on the rational use of intravenous paracetamol vials in Baghdad Teaching Hospital: A case-control study

Paracetamol has been recognized worldwide as a safe and effective agent for relieving pain and reducing fever in many patients. This study aimed to investigate the role of clinical pharmacist interventions in the rational and appropriate use of intravenous paracetamol in surgical patients and the impact of this rational use on hospital costs. A case-control study was conducted on 794 patients (400 in the intervention group and 394 in the control group). The appropriate and rational use of the drug was compared between baseline and post-intervention in the intervention group and between the two groups. The result showed a significant reduction in dispensed IV paracetamol vials after the pharmaceutical intervention (4,151 vials recovered by the intervention), which led to a reduction in the cost (8,302 USD reduction in the total cost). There was a significant reduction in the dose of IV paracetamol, use with or without adjunctive opioid analgesics, frequency of administration, duration of intravenous paracetamol use, daily max exceeding 4 g, and concomitant use with oral paracetamol after applying the clinical pharmacist intervention. In conclusion, the clinical pharmacist plays a vital role in various aspects of healthcare; clinical pharmacist involvement positively impacts the patient’s management plan by improving the optimal and rational use of intravenous paracetamol and decreasing hospital costs.

SELECTION OF OPTIMAL PARAMETERS OF A LIGHTWEIGHT FLAT FLOOR WITH VOIDS MADE OF PLASTIC BALLS

Formulation of the problem. Architectural and construction design of buildings using reinforced concrete has led to an increase in the number of objects with an individual space-planning structure, a rich variety of facade and volumetric solutions. Today the question of the effectiveness of using flat prefabricated monolithic lightweight floors in the construction of multi-storey buildings with individual space-planning and architectural solutions is relevant. In a market economy interest in the issue of rational use of resources, namely the cost of concrete and reinforcement in construction, has sharply increased, which is directly related to attracting investment. As it is known, when designing buildings from prefabricated monolithic reinforced concrete, in contrast to prefabricated concrete, there is greater freedom in adopting the space-planning parameters of the building, and there may also be simpler design solutions, in particular for floors. The constructive solution of floors depends on numerous requirements for the building as a whole and directly for the floor. One of the requirements that influences the attraction of investments is a small material-intensive floor covering with significant spans of buildings of various structural systems. The effective use of lightweight precast monolithic reinforced concrete floors with voids made of plastic balls in construction requires a comprehensive technical and economic analysis of this innovative solution for the precast monolithic reinforced concrete floor structure. The purpose of the article is to perform a technical and economic comparison of various design options for a flat lightweight prefabricated monolithic floor. The influence of floor parameters on the consumption of concrete and reinforcement is considered. Conclusion. As a result of the research, it was established that it is rational to use hollow balls made from recycled materials as a material for making voids from balls in flat floors. Moreover, all studied floor options with spans of 6 m, 7 m, 8 m and void sizes made of balls with diameters of 180 mm, 315 mm and 50 0mm meet the requirements of the first and second groups of limit states.

Tourist Values and Well-Being in Rural Tourism: Insights from Biodiversity Protection and Rational Automobile Use in Al-Ahsa Oasis, Saudi Arabia

In response to the escalating significance of sustainable tourism and the growing global concern for environmental conservation, the current study sought to investigate the intricate dynamics of two pro-environmental behaviors (biodiversity protection and rational car use), personal values (altruistic, biospheric, and egoistic), farm tourists’ well-being, and environmental and activity attachment among farm tourists in the Al-Ahsa region of Saudi Arabia. Employing an online survey, our methodology involved partial least structural equation modeling to unravel the complex relationships among these variables. Based on responses retrieved from 309 farm tourists, results revealed that biodiversity protection significantly influenced altruistic values and the well-being of farm tourists. Additionally, rational automobile use exerted positive impacts on both altruistic and biospheric values. These results underscore the intricate dynamics shaping tourists’ attitudes and experiences in the Al-Ahsa region. The study contributes to the broader understanding of sustainable tourism practices, emphasizing the need for tailored interventions. The positive associations identified highlight the potential for farm tourism experiences to enhance both pro-environmental values and the well-being of tourists, thus offering valuable insights for future research and sustainable tourism initiatives.

Ecological problems of the plant cover of the northeastern slope of Great Caucasus (within Azerbaijan)

Highlight the purpose. Plant cover of our republic, especially forest ecosystems, has lost its original state as a result of the influence of natural and anthropogenic factors. The study of the impact of these factors on biodiversity has been the focus of many experts. The settlement of the studied area since ancient times and the good development of agriculture have caused the degradation and erosion of the forest cover that covers large areas, as well as the vegetation that replaces each other in the altitude zones here. For this reason, the issues of protection and protection of vegetation are distinguished by their relevance. The main goal of our research is to protect the vegetation of forests that have changed their initial state. Objectives. Mountain geosystems of the northeastern slope of the Greater Caucasus are bordered by the Russian Federation to the north, northwest, and west, the Samur-Devachi plain to the east, and the watershed line of the Greater Caucasus Range and Atachay to the south and southeast. Methods. Field studies were organized to solve the issues raised during the research period. Short-term visual observations of the existing geoecological conditions were carried out, from topographic maps and other maps (landscape, vegetation, etc.) of various scales, as well as from 1:25000 scale aerial and space images in the fund of the Institute of Ecology of MAKA, “Google” and “Bing” space images with a resolution of 1 meter in the funds, taken in the visible zone of the spectrum, obtained from various satellites in 2020-2023 and based on the application of SASPlanet, ArcGIS processing programs were used. With the help of these materials, the vegetation degradation and erosion processes of the research area were studied. Results. The northeast part of the Great Caucasus differs from the other mountainous regions for its appropriation features. For a long time appropriation of the investigated zone by the various farming areas caused a serious change in the natural geosystems. Thus, the zones where a hypsometric height of 200-500 m are mainly replaced by agro-complexes, the parts within 500-1800 m turned into a life and rest objects together with the arable and pastures, an irregular use from the summer pastures in cattle-breeding in the zones higher than 1800 m was completed by exposing of the plant cover to transformation. During assimilation, activation of ecological problems like decreased plant productivity, intensification of the erosion process, acceleration of degradation, and so on activates a problem of rational use. Defining importance, sensitiveness of plant cover, and rational use ways as protection, refusal of usage, extensive use of protection, development, extensive use, improvement, and development were determined.

Efficacy of alpelisib (ALP) + fulvestrant (FUL) with rational use of metformin (MET) in patients with HR+/HER2- advanced breast cancer (ABC).

1049 Background: Hyperglycemia (HG) is an on-target effect of ALP, and prophylactic with metformin was shown to decrease the rate and severity of HG. Here we present efficacy and safety of ALP in a large cohort of patients with rational approach to metformin usage based on risk factors of HG. Methods: Patients (pts) with HR+/HER2- PIK3CAmut ABC were treated with ALP 300mg orally and FUL 500mg IM until disease progression or intolerance. The primary endpoints were progression free survival (PFS) and rate of grade 3/4 HG in different risk groups. Pts were stratified to risk groups of HG based on the algorithm (table 1) before starting ALP and received MET for prevention of HG. Results: A cohort comprised 139 pts, median lines of previous treatment in ABC was 3 (1-9): 88% received CDK4/6i, 60% - FUL, and 55% - chemotherapy (77) prior to ALP. The median PFS (mPFS) on ALP - was 7.0 (CI 95%: 5.0-8.9). The risk of HG was assessed in 138 pts: low (47), moderate (46), and high (42) risk, and 3 pts with type 2 diabetes mellitus. Any grade HG was reported in 62% pts, no cases HG G4 were detected. HG G3 was reported in 13% pts; 10% pts required ALP dose reduction to 250 mg due to HG G3; 3 pts (2%) discontinued ALP due to HG. The mPFS in our analysis was longer than in BYlieve trial in cohort C: 7.0 vs 5.6 mo. We suggest that prophylactic of HG allowed maintenance of full dose of ALP in most patients and thus increased the efficacy of ALP. Furthermore, in contrast to the METALLICA trial we distinguished a low risk group (33%) of pts who don’t need the prophylactic use of MET. Conclusions: Rational use of MET in pts with moderate and high risk of HG reduces the frequency and severity of HG, decreases the rate of ALP dose reductions and as a result may increase the efficacy of ALP. Pts with low risk of HG don’t need MET for HG prevention. [Table: see text]

Consensus for antifungal stewardship in China (2024 edition).

Invasive fungal disease (IFD) has become a serious threat to human health in China and around the world, with high mortality and morbidity. Currently, the misdiagnosis rate of IFD is extremely high, compounded with the low quality of prescription antifungals and the high incidence of adverse events associated with IFD treatment, resulting in lengthy hospitalization, low clinical response, and high disease burden, which have become serious challenges in clinical practice. Antifungal stewardship (AFS) can not only significantly increase the early diagnosis rate of IFD, reduce inappropriate utilization of antifungal drugs, improve patient prognosis, but can also improve therapeutic safety and reduce healthcare expenses. Thus, it is urgent to identify key AFS metrics suitable for China's current situation. Based on metrics recommended by international AFS consensuses, combined with the current situation of China and the clinical experience of authoritative experts in various fields, several metrics were selected, and experts in the fields of respiratory diseases, hematology, intensive care units (ICUs), dermatology, infectious diseases, microbiology laboratory and pharmacy were invited to assess AFS metrics by the Delphi method. Consensus was considered to be reached with an agreement level of ≥80% for the metric. Consensus was reached for 24 metrics, including right patient metrics (n=4), right time metrics (n=3), and right use metrics (n=17). Right use metrics were further subdivided into drug choice (n=8), drug dosage (n=4), drug de-escalation (n=1), drug duration (n=2), and drug consumption (n=2) metrics. Forty-six authoritative experts assessed and reviewed the above metrics, and a consensus was reached with a final agreement level of ≥80% for 22 metrics. This consensus is the first to propose a set of AFS metrics suitable for China, which helps to establish AFS standards in China and is also the first AFS consensus in Asia, and may improve the standard of clinical diagnosis and treatment of IFD, and guide hospitals to implement AFS, ultimately promoting the rational use of antifungal drugs and improving patient prognosis.