Specific Date Research Articles

S48 Rates of Retained Biliary Stents Could Be Affected by Socioeconomic Status and Language Barrier

Introduction: Endoscopically placed common bile duct stents are used for biliary decompression. Studies have reported median patency of plastic stents between 77 to 126 days. It is advisable to remove or exchange these stents within three months of the index procedure to prevent complications such as stent occlusion, dysfunction, migration, and cholangitis. We hypothesized that the risk of retained biliary stents might be high in the underserved population owing to low socio-economic status, language and intellectual barriers, and demographical distribution. Methods: A retrospective study was conducted amongst all patients who underwent ERCP-guided plastic biliary stent placement between January 2016 and December 2021 at our community-based institution. Charts were reviewed to collect demographics, index ERCP, removal/exchange procedure, complications, and follow-up office visits. Retained biliary stents were defined as patients who did not show up for their follow-up ERCP for stent removal (missed stent group) or those who presented for stent removal later than the recommended time frame of 3 months (Delayed stent removal group). Descriptive analysis was performed. Chi-square and Fisher exact tests were used to compare categorical variables and t-tests for continuous variables. Results: A total of 431 ERCPs were performed, out of which 46 (10.7%) patients had retained stents. Fifty percent of the cohort (n=23) were white and 63% (n=29) were females. 10 patients (21.8%) were non-English speakers, and 10 patients (21.8%) were non-insured. 32 (69.6%) of the index ERCPs performed were done in the outpatient setting. Our ERCP reports stated the recommended follow-up time for stent removal for all patients whether performed in the inpatient or outpatient setting. However, 8/14 (57%) of the inpatients did not have these instructions included in their discharge summaries. No statistical significance was seen when comparing missed versus delayed stent removal groups, except for the ERCP location (Table). Conclusion: Socio-economic and demographic factors, including the language barrier and lack of insurance as well as the absence of specific and clear follow-up dates on the discharge instructions from the hospital, could be associated with retained biliary stents. Table 1. - Factors contributing to a higher risk of retained biliary stents Missed n=17 Delayed n=29 P-value Total n=46 Race Non- White 11 (64.7%) 12 (41.4%) 0.127 23 (50%) Sex Female 12 (70.6%) 17 (58.6%) 0.416 29 (63%) Language Non-English 4 (23.5%) 6 (20.7%) 0.821 10 (21.8%) Insurance Non-insured 3 (17.6%) 7 (24.1%) 0.606 10 (21.8%) ERCP location Inpatient 10 (58.8%) 4 (13.8%) 0.001 14 (30.4%) Outpatient 3 (17.6%) 29 (100%) < 0.0001 32 (69.6%)

Bilateral Achilles Tendon Ruptures in the NFL

Category: Sports Introduction/Purpose: Achilles tendon ruptures (ATR) can have devastating results for athletes in the National Football League (NFL). Although NFL athletes who suffer an ATR are successfully treated with surgery and rehabilitation, this potentially career- ending injury has demonstrated a decrease in return to play, playing time, and performance for athletes. With a mean career length of 3.3 years for NFL athletes, the ATR injury and subsequent 9 to 11 month rehabilitation period could adversely limit the impact athletes make both individually and at the team level. Although previous research has examined the effects of a unilateral ATR in athletes, the purpose of this study was to determine the effects of bilateral ATRs on the health, productivity, and career longevity of NFL athletes. Methods: Publicly available online injury data for NFL athletes who sustained bilateral ATRs between the start of the 2007 season and the start of the 2021 season were queried using online news and sports analysis web sources. Inclusion criteria consisted of NFL athletes who sustained two independent, contralateral ATRs and exclusion criteria were NFL athletes who only sustained a single ATR or athletes who subsequently reinjured the same tendon. Specific dates for the first ATR (ATR1), return to play after ATR1, second ATR (ATR2), return to play after ATR2, as well as most recent game played were recorded. NFL preseason, regular season, and postseason (playoff, wild card, Pro Bowl, and Super Bowl) games were used to tabulate the total number of games missed or played. Descriptive and univariate statistics were performed. Results: When analyzing five NFL athletes with bilateral ATRs, mean BMI was 33.4+-4, an average of 5.8+-4 seasons were completed before ATR1, and three athletes currently play. There was a significant decrease in Pro Bowl nominations with each successive ATR (p=0.027). A significant difference was observed for mean age at tendon rupture when comparing ATR1 and ATR2 (27.8+-4 vs 30.4+-4 years, p&lt;0.01). Rehabilitation periods after ATR1 and ATR2 (9.3+-2 vs.10.9+-2 months), as well as number of games missed during rehabilitation periods for ATR1 and ATR2 (9.8+-4 vs.12.8+-6) were not significantly different. The mean time period after returning from ATR2 was 22.0+-16 months, with a mean number of 39.3+-24 games played (Table 1). When analyzing performance metrics of four defensive NFL athletes, forced fumbles was the only defensive metric to demonstrate significant change across ATRs (p=0.02). Conclusion: This case series investigated NFL athletes who sustained bilateral ATRs, demonstrating a significant difference in age at the time of each rupture along with a decreasing trend in the number of Pro Bowl nominations following successive Achilles injuries. Upon analyzing defensive NFL athletes, forced fumbles was the only performance metric that significantly changed across successive Achilles injuries. This case series is the first study to review the effect of bilateral ATRs in NFL athlete performance and further research should be conducted to continue analyzing how these injuries affect the health, productivity, and career longevity of NFL athletes.

Миусский поход воеводы А. П. Салтыкова 1698 года

The article reconstructs the history of the campaign of the Ryazan Razryad Regiment (Discharge Corps) in the North-Eastern Azov Sea area – the most poorly studied operation of the Russian-Turkish War of 1686–1699 based on the archival material. The specific dates of the campaign, the number and composition of the troops participating in it, their exact route is determined. The goals of the military expedition were to protect the region and build a port and a fortress on the northern coast of the Azov Sea. It is shown that the Mius Campaign of 1698 had an exclusively demonstration and colonization value.

Ischemia Modified Albumin (IMA) as a New Biomarker in the Ophthalmology Field: A Brief Literature Review

Purpose:This study aimed to review the potential role of ischemia-modified albumin as a biomarker for diagnostic modalities in the ophthalmology field.Methods:Articles were reviewed without a specific date. A manual search was also performed by reviewing reference lists of meta-analyses and systematic reviews. All articles were reviewed, and a total of 18 articles were selected by the authors.Results:Oxidative stress increases structural and functional damage to proteins in many ocular diseases. The human serum albumin is a major circulating protein with antioxidative and anti-inflammatory properties. Oxidative stress has been shown to be an important part of etiology and pathogenesis in ocular diseases related to ischemia. Biomarkers that are specific to oxidative stress and ischemia-related ocular pathogenesis are needed to provide an extensive understanding regarding diagnosis, monitoring progression, and new potential target treatment. Ischemia-modified albumin (IMA) as a new promising biomarker might be useful in the early detection and treatment of ocular diseases with ischemic pathogenesis.Conclusion:IMA plays an important role in the progression of ophthalmology diseases, such as diabetic retinopathy, hypertensive retinopathy, cataract progression, seasonal allergies, and glaucoma. Further studies are needed to elaborate these results as a consideration in new testing modalities in clinical practice as well as a new target therapy research.

BAŞÇAVUŞ İSMAİL AĞA’NIN BESTELERİ VE MECMUA-I GÜFTE’SİNDEN (BERLIN 3370) TESPİTLER

This lyric book, which is the subject of the article, has been examined with the qualitative research method. The original manuscript of the lyrics book is from the Berlin Staatsbibliothek Ms. or. Fol. It is located at 3370. The manuscript in the library record is 210 pages. The author of the manuscript and the date it was written are uncertain. It has been identified as a work written in the 17th century. A more specific date has not been identified in it. In the first review in this article, it was tried to reveal when the journal was written and by whom it might have been written, using the systematic musicology method. Among the first detected findings, we can count the following: It was seen that two of the 39 makams that make up the index of the manuscript were not recorded in the lyrics. These are sumbule and uzzal chapters. Each page is gold framed. At the beginning of the lyrics, the maqam, the tempo and the composer are often mentioned. Six pages have the new style miniatures of music. Suddenly, when I tried to conclude these and many other determinations as an article, I saw that a research paper by Basher was published in a journal. I removed the general findings from the article I prepared and re-edited my article based on different findings. In this article, the person who wrote the lyrics magazine and the year of its writing were specifically questioned. Among the results found, it was revealed that the author was İsmail Ağa, who died in 1800, and that he might have written his lyric book in the 1780s, for various reasons. The 17th century record in the Berlin library record is not correct, it must be the second half of the 18th century. Among the important findings supporting the determination of the writing date of the journal are the following findings: 1-Majmua was written during the youth of Nasır Dede and the princedom of Sultan Selim III, but none of the makams he invented after 1780. 2- In the journal, there are evicbuse makam compositions from the new makams of the mid-18th century, which Nasır Dede called new that cedid. 3-In comparison with the Hekimbashi journal, which was determined to have been written in 1767, it was seen that some of the same composers were registered as sergeants in the Hekimbashi journal while they were recorded as aghas in the other journal. This finding shows us that the journal no. 3370 was written after 1767. 4-Hizir Agha wrote about his new invention of the musebba usul in his work dated 1777. Hatem of Akovalı stated the name of this new musebba usul in a poem in his Divan. There is a composition in the musebba usul style in this lyric collection. Thus, it is understood that there is a relationship of acquaintance and historical closeness between the writer of the journal and Hızır Agha. Composer and lyric book owner Ebubekir Agha, who died in 1759, and the author of the magazine, Chief Sergeant İsmail Agha, have a familiar relationship, such as being a music student. In conclusion, this article proposes that composer Chief Sergeant İsmail Ağa is the author of Berlin's lyric book in 3370 and that it was compiled in 1780.

Fusion of Different Image Sources for Improved Monitoring of Agricultural Plots.

In the Valencian Community, the applications of precision agriculture in multiannual woody crops with high added value (fruit trees, olive trees, almond trees, vineyards, etc.) are of priority interest. In these plots, canopies do not fully cover the soil and the planting frames are incompatible with the Resolution of Sentinel 2. The present work proposes a procedure for the fusion of images with different temporal and spatial resolutions and with different degrees of spectral quality. It uses images from the Sentinel 2 mission (low resolution, high spectral quality, high temporal resolution), orthophotos (high resolution, low temporal resolution) and images obtained with drones (very high spatial resolution, low temporal resolution). The procedure is applied to generate time series of synthetic RGI images (red, green, infrared) with the same high resolution of orthophotos and drone images, in which gray levels are reassigned from the combination of their own RGI bands and the values of the B3, B4 and B8 bands of Sentinel 2. Two practical examples of application are also described. The first shows the NDVI images that can be generated after the process of merging two RGI Sentinel 2 images obtained on two specific dates. It is observed how, after the merging, different NDVI values can be assigned to the soil and vegetation, which allows them to be distinguished (contrary to the original Sentinel 2 images). The second example shows how graphs can be generated to describe the evolution throughout the vegetative cycle of the estimated values of three spectral indices (NDVI, GNDVI, GCI) on a point in the image corresponding to soil and on another assigned to vegetation. The robustness of the proposed algorithm has been validated by using image similarity metrics.

The reaction of sponsor stock prices to clinical trial outcomes: An event study analysis.

We perform an event study analysis that quantifies the market reaction to clinical trial result announcements for 13,807 trials from 2000 to 2020, one of the largest event studies of clinical trials to date. We first determine the specific dates in the clinical trial process on which the greatest impact on the stock prices of their sponsor companies occur. We then analyze the relationship between the abnormal returns observed on these dates due to the clinical trial outcome and the properties of the trial, such as its phase, target accrual, design category, and disease and sponsor company type (biotechnology or pharmaceutical). We find that the classification of a company as “early biotechnology” or “big pharmaceutical” had the most impact on abnormal returns, followed by properties such as disease, outcome, the phase of the clinical trial, and target accrual. We also find that these properties and classifications by themselves were insufficient to explain the variation in excess returns observed due to clinical trial outcomes.

1342P Pharmacoeconomics in the antineoplastic therapy sector of a public hospital in the Brazilian Amazon aiming at cost minimization: Quantitative analysis

Pharmacoeconomics is characterized by the application of economy in the use of medicines, minimizing financial expenses without compromising treatment. Objective: To draw a guiding diagram for pharmacoeconomics in the oncology sector of a public hospital in the Brazilian Amazon aiming at the Cost Minimization Analysis (AMC), where only costs are subjected to comparisons, since the efficacies or effectiveness of comparable alternatives are the same. Exploratory study, with a quantitative approach, using pharmacoeconomic tools, focusing on sharing schedules on specific dates, optimizing the handling time of related chemotherapeutics, reducing costs and the length of stay of cancer patients in the chemotherapy room (QT) for greater bed turnover and treatment of a greater number of patients. The class A drug of choice was Bortezomib. To perform the tabulation and processing of data, the free software Epidata 3.1 and Microsoft Excel were used. The Integrated Decision Support System (SIAD) software and Action STAT were used for the application of Data Envelopment Analysis (EAD). From July 2017 to May 2018, 74 patients were treated with a total of 201 infusions of QT containing Bortezomib in the protocol, with an average of 4 infusions/cycle, at a cost of R$ 2020.00/bottle. The total expected expenditure was R$109.080. With the actions, 33 bottles were saved and a monetary value of R$66.600 in a period of 9 months, considering individual use per bottle saved. The evolution of the average length of stay (in its respective scale) was observed, and its fall always after the presence of pharmacoeconomics (peaks of low final cost). Affine manipulations are more effective. The p-value < 0.05 for the coefficient of the outcome variable of Final Cost. All tests - Pearson Correlation coefficients, Cluster Analysis, Median, Wilcoxon, Friedman and Kendall's non-parametric hypothesis tests and Generalized Linear Model (p-value <0.05) confirmed the hypothesis that the The presence of pharmacoeconomics has a significant effect on the final cost. With pharmacoeconomics, we were able to apply all resources to ensure the continuous supply of medication as a health instrument.

LEXICAL MEANS OF EXPRESSION OF TEMPORALITY IN THE VERSION OF THE MODERN UKRAINIAN LANGUAGE AT THE END OF THE XIX CENTURY (BASED ON LETTERS FROM VASYL STEFANYK)

Aim. The article is devoted to the analysis of the means that represented lexical temporality in the modern Ukrainian language (in its western version) in the last decades of the XIX century. The purpose of the article is to determine the peculiarities of the functioning of the means of expression of lexical temporality, to classify words with temporal semantics on the material of the epistolary of Vasyl Stefanyk for 1888 – 1898. Methods. The paper uses a systematic approach using the lexical-semantic method of research of language units, the method of continuous sampling. Results. The article presents the lexical-semantic classification of words for the designation of time by two lexical-grammatical parts – nouns and adverbs, and features of functioning of temporal lexemes in the texts of Vasily Stefanyk's letters are revealed. The analysis has shown that all lexical means of temporality expressing can be classified within three microclusters: lexical means with a clear indication on the time of year or day, a specific date, hour and religious holiday; lexical specifiers with chronological semantics without a clear indication of the exact time; a combination of the words of the language different independent parts employed by the author of the letters to point the approximate time or more detailed description of the event time. Scientific novelty. The article for the first time analyzes the specifics of Vasyl Stefanyk's use of words with temporal semantics in letters, lexical-semantic classification of such words through the prism of the Western version of the modern Ukrainian language in the last decades of the XIX century. Practical meaning. The material of the article can be used in further study of the category of lexical temporality in the modern Ukrainian language, as well as in the study of the Galician language at the turn of the XIX - XX centuries.

Blessing of the moon: cultural beliefs, birth timing and child health in Nepal

In many South Asian contexts, specific dates are auspicious and inauspicious for health-related behaviours and outcomes. This study analysed the effect of lunar date-related auspicious beliefs in Nepal on childbirths and neonatal health outcomes. Using the daily birth records from a tertiary maternity hospital, we empirically examined whether births occurred disproportionally around full moon days. We found an average of 10.7 extra births on and before full moon days, with an average of 7.5 extra Caesarean deliveries on full moon days. We demonstrated that births occurring on or before the full moon day have poor neonatal health outcomes. However, a subsample analysis suggested better health outcomes for low-risk mothers and worse health outcomes for high-risk mothers. These findings suggest that low-risk mothers may move their deliveries to auspicious dates with fewer complications than high-risk mothers. The results emphasise the need for additional research to distinguish health service demand from supply influences on birth timing in Nepal.

INFORSAT: AN ONLINE SENTINEL-2 MULTI-TEMPORAL ANALYSIS TOOL SET USING R CRAN

Abstract. Remote sensing via orbiting satellite sensors is today a common tool to monitor numerous aspects related to the Earth surface and the atmosphere. The amount of data from imagery have increased tremendously since the past years, due to the increase in space missions and public and private agencies involved in this activity. A lot of these data are open-data, and academics and stakeholders in general can freely download and use it for any type of application. The bottle-neck is often not data availability anymore, but the processing resources and tools to analyse it. In particular multi-temporal analysis requires stacks of images thus digital space for storage and processing workflows that are tested and validated. Processing image by image is often not a viable approach anymore. Basic tools for multi-temporal analysis are provided via the same web interface, allowing the user to also apply parallel processing for a faster data extraction. A study case over burned areas in the north-eastern region of Italy are reported, to show how the multi-temporal analysis tools provided can be a valid source of data for further analysis. Multitemporal data consisting on the index values of each pixel inside user-defined areas can be downloaded in a spreadsheet that provides the values, the cell ids, the timestamp and the cloud and snow percentage. Also the full-resolution raster with index values that are rendered on screen can be downloaded as GeoTIFF at each specific date.

Photosynthesis phenology, as defined by solar-induced chlorophyll fluorescence, is overestimated by vegetation indices in the extratropical Northern Hemisphere

Vegetation phenology is highly sensitive to climate change, although the data and methods used to estimate key phenological states can influence this sensitivity. Because of its direct relation to leaf photosynthetic carbon uptake, remotely sensed solar-induced chlorophyll fluorescence (SIF) can provide new insight assessing changes in vegetation phenology. Here, we investigated the potential of using a SIF time series product named contiguous SIF (CSIF) to estimate spring, summer, and autumn phenology in the extratropical Northern Hemisphere (>30°N) and compared the results with those based on Moderate Resolution Imaging Spectroradiometer (MODIS) Normalized Difference Vegetation Index (NDVI) for the period 2001–2018. Overall, we found similar spatial patterns in phenological states. However, specific dates of key phenological events differed when using CSIF vs. MODIS NDVI data. NDVI data indicated that the growing season started earlier (by 10.1 days on average) and ended later (11.5 days on average) relative to CSIF data. This implies that actual periods for photosynthetic activity are shorter (by 21.6 days on average) than those estimated from vegetation indices more directly related to changes in canopy structure. These large differences between results from NDVI and that from CSIF suggest that vegetation indices such as NDVI seem to overestimate the period for active photosynthesis over the extratropical Northern Hemisphere. Furthermore, while phenology of the early growing season is dominated by temperature for both NDVI and CSIF data, phenology of the late growing season is mainly controlled by temperature for NDVI but by precipitation for CSIF. Our findings were further confirmed by other SIF (GOME-2 SIF) and vegetation index (MODIS EVI) datasets. Phenology modes in Earth system modelling are often parameterized using leaf unfolding and senescence from either station or satellite observations. Our results imply that canopy structure-based parameterization schemes may have overestimated photosynthesis active period, and thus productivity responses. We conclude that SIF data offers a novel and unique approach for assessing phenological change - one that is more directly tied to the carbon cycle and how it is being influenced by climate change.

Sales Anomaly Detection Using Automatic Time Series Decomposition

This study proposes an automated time series decomposition (ATSD) technique for sales anomaly detection using weekly ice cream sale data from Google Trends with the caption "(Mobile AL-Pensacola (Ft. Walton Beach) FL. In this study, an empirical approach based on automatic time series decomposition (ATSD) was used to detect anomalies in sales data. A historical quantitative weekly ice cream sales data between periods of 9 April 2017 to 3 April 2022 consisting of 261 data points was used. The process for discovering the anomalous sales point includes importing of the necessary libraries, data visualization, construction of the ATSD model, creating the time series components from original data (seasonal, trend, residual), calculating the estimated from the original, and finally, the extraction of the anomalous sales. Anomalies were first discovered during the data visualization stage, which revealed some abnormal sales in mid-2019, late-2019, and early 2020. However, after applying the ATSD, our model detected anomalies with the specific dates of these anomalies. Following the application of the ATSD, our results indicate that the proposed anomaly detection approach can reliably detect anomalies with the dates of these anomalies. Because this technique worked well with our data, we assume it will work with any time series data.

Bookending a Pandemic and Its Impact on Public Libraries: Policy and Announcement Information Provided by Libraries Throughout the Coronavirus (COVID-19) Response

ABSTRACT This study serves as a follow-up on a 2020 study by Wang and Lund that examined the policy changes and announcement information provided by American public libraries during the early weeks of the coronavirus (COVID-19) pandemic, using the same list of libraries as the 2020 study to examine how the COVID response evolved over the past two years. Seven types of information were collected from the public libraries’ websites, with the help of the Internet Archive to collect specific dates: frequency of announcement updates, date of start curbside/pickup services, date of reopening libraries, dates of posting vaccine-related information, dates of removal of COVID-19 related information, and dates of reopening face-to-face programs. The findings indicate that the timing of COVID response updates varied based on factors including the size of the municipality in which the public library is located and the political leaning of the municipality’s voters.

Amerikai-Magyar Ödüsszeia – Avagy a szülőföldtől szülőföldig, a fogadott hazán keresztül: gondolatok Ludányi András Amerikai életutam: A második világháborútól a 21. századig c. könyvéről (2020)

Although the eighty-year-old writer defines the genre of his work as an essay, it is a work that pushes genre boundaries genre, as it is at once an autobiography, oral history in written form, political history, a family novel, and an entertaining read, rich in humorous stories. Ludányi, a documentarist, names specific dates, people and events, thus adding color to the American and Hungarian events of the second half of the twentieth century through his lived historical experiences. His memoir is substantial, rich in personal and historical data, and provides interested readers with a valuable documentary source.

The Preservation of Tracing Paper: A case Study of TRA Archives

Taiwan is located within a subtropical region where the preservation of tracing paper is challenging, given its susceptibility to changes in humidity. Although the National Archives Administration (NAA) currently provides a controlled environment for the repositories of the National Archive, this archive has sustained damage and deterioration due to a legacy of compromised storage and inherent fragility of its contents. Of particular interest are the collective holdings of the Taiwan Railways Administration (TRA), the Ministry of Transportation and Communications (MOTC). Historically, these holdings were originally known as ‘The Railway Department of the Traffic Bureau, under the General Governor of Taiwan’, during Japanese colonial governance. This specific collection dates from 1895 to 1997 and includes over 10,000 engineering drawings. Previously, the NAA had implemented linings to both repair damage and aid in the preservation of the physical archives. However, this study compares this approach with an alternative humidification method using Gore-Tex® to relax and flatten these drawings on tracing paper. The focus of this paper is to evaluate dimensional change as a result of these treatments and to make recommendations in regards to their respective suitability for addressing the condition of the TRA collection.

This Looks Like That There: Interpretable Neural Networks for Image Tasks When Location Matters

Abstract We develop and demonstrate a new interpretable deep learning model specifically designed for image analysis in Earth system science applications. The neural network is designed to be inherently interpretable, rather than explained via post hoc methods. This is achieved by training the network to identify parts of training images that act as prototypes for correctly classifying unseen images. The new network architecture extends the interpretable prototype architecture of a previous study in computer science to incorporate absolute location. This is useful for Earth system science where images are typically the result of physics-based processes, and the information is often geolocated. Although the network is constrained to only learn via similarities to a small number of learned prototypes, it can be trained to exhibit only a minimal reduction in accuracy relative to noninterpretable architectures. We apply the new model to two Earth science use cases: a synthetic dataset that loosely represents atmospheric high and low pressure systems, and atmospheric reanalysis fields to identify the state of tropical convective activity associated with the Madden–Julian oscillation. In both cases, we demonstrate that considering absolute location greatly improves testing accuracies when compared with a location-agnostic method. Furthermore, the network architecture identifies specific historical dates that capture multivariate, prototypical behavior of tropical climate variability. Significance Statement Machine learning models are incredibly powerful predictors but are often opaque “black boxes.” The how-and-why the model makes its predictions is inscrutable—the model is not interpretable. We introduce a new machine learning model specifically designed for image analysis in Earth system science applications. The model is designed to be inherently interpretable and extends previous work in computer science to incorporate location information. This is important because images in Earth system science are typically the result of physics-based processes, and the information is often map based. We demonstrate its use for two Earth science use cases and show that the interpretable network exhibits only a small reduction in accuracy relative to black-box models.

P1511: EFFICACY AND SAFETY OF COMBINATION IRON CHELATION THERAPY WITH DEFERIPRONE AND DEFERASIROX IN PATIENTS WITH Β-THALASSEMIA MAJOR: A SYSTEMATIC LITERATURE REVIEW

Background: Iron overload can occur in patients with thalassemia syndromes because of hyperabsorption and/or frequent blood transfusions. Currently, 3 iron chelators are approved for clinical use: deferoxamine (DFO), deferiprone (DFP), and deferasirox (DFX). Combination iron chelation therapy may be prescribed for patients who do not adequately respond to monotherapy, have increased heart and/or liver iron overload, or have dose-dependent toxicity. It is important to optimize chelation to reduce iron-associated morbidity and early mortality and to improve quality of life. Oral DFP is typically administered as a monotherapy or in combination with DFO or DFX. Combination therapy was approved for clinical use by the European Medicines Agency in 2016; additionally, a recent British Society for Haematology guideline states that DFP+DFX is a highly effective combination therapy, although the safety and efficacy of DFX in combination with other iron chelators is not well established. Aims: A systematic literature review was conducted to evaluate the efficacy and safety profile of combination chelation therapy with DFP+DFX in patients with transfusion dependent β-thalassemia major (TDT). Methods: A systematic search was performed of the Embase and MEDLINE databases to identify trials related to the use of combination iron chelation therapy (DFP+DFX) in patients with TDT. The literature search was conducted in May 2021 and was not restricted to a specific start date. The search strings were established by logical association of appropriate words and MESH terms. The publications were screened based on a priori exclusion and inclusion criteria (eg, case-report exclusion). Results: Eight clinical study publications (7 prospective, 1 retrospective) of 1725 screened articles assessed the DFP+DFX combination for a total of 181 patients (Table). One publication was a pharmacokinetic (PK) study. Of the 7 studies, 6 reported a consistent reduction in at least 1 of the 3 studied endpoints (serum ferritin, liver, and cardiac iron). The PK study reported an additive effect in the total iron excretion in comparison with monotherapy. The adverse events reported with DFP+DFX were consistent with what has previously been reported for DFP or DFX monotherapy; no new adverse events were observed. The most common adverse events across the 7 studies included gastrointestinal symptoms, elevation in alanine aminotransferase and/or aspartate aminotransferase, arthralgia or joint symptoms, an increase in creatinine levels, proteinuria, and red-colored urine. The numbers of patients reported with neutropenia and thrombocytopenia were low (neutropenia, n=7 patients; thrombocytopenia, n=8 patients); agranulocytosis was not observed. Two studies reported serious adverse events, of which 1 (acute cholecystitis) was related to treatment. Image:Summary/Conclusion: This systematic literature review suggests that DFP+DFX combination iron chelation therapy can be a highly effective therapeutic option for improving iron overload, with an acceptable tolerability profile. This review supports the safety and efficacy of the combination, as approved by the EMA. Limitations of this analysis include small sample size and nonrandomization in most studies.

DATING OF TOMBSTONES BY WEAPON IMAGES ON THEM (BASED ON THE STUDY OF STELES OF SULEVKENT CEMETERY)

Experts, who examine Dagestan tombstones, in the absence of a specific date on a tombstone itself or the impossibility of determining it by the content of the inscription or the analysis of texts, use several methods of dating by external elements – by the features of the style (fonts) of texts and by analyzing ornamentation. The subjects of these methods are dated monuments, carefully studied and categorized. Any of these methods is often used separately, the first – by epigraphists, the second – by art historians. Meanwhile, each of them has its drawbacks, and it is clear that the most effective implementation of dating is achieved with their combined application. Another method of dating monuments is to study the objects depicted on them, in particular, weapons. Such studies on Dagestan material have not been carried out yet. As a subject, grave steles of the cemetery of the abandoned settlement of Sulevkent in the Dakhadaevsky district were used, where burials were made at least from the 14th to the middle of the 20th century. Four tombstones depicting sabers and daggers, flintlock pistols and guns, powder flasks and pouches for gazyrs, spears and pikes. The results of the analysis of weapons allowed us to conclude that the monuments belong to the second – third quarters of the 18th century. The dating elements were not only the objects applied to the monuments, but also the absence of certain elements of weapons in the composition of the images. If we exclude images of objects on steles, then all the pieces of monuments under consideration could be dated within a very wide range – from the 16th to the beginning of the 20th century. That is, in certain cases, the analysis of the depicted objects may not serve as an addition to other methods of clarifying or confirming dating, but its only means. The study of weapons as dating elements of tombstones demonstrates that there is a need to study its regional history. In such research, dated tombstones with images of weapons can play an important role. Considering this, it becomes urgent for researchers engaged in identifying monuments to set the task of fixing images of weapon pieces.

Interception Strategies for Managing Exotic Ambrosia Beetles (Coleoptera: Curculionidae) in Nurseries

Interception Strategies for Managing Exotic Ambrosia Beetles (Coleoptera: Curculionidae) in Nurseries