10 research outputs found
Does working memory predict mathematics achievement of children in the primary grades
No full textPresentation given at the Jean Piaget Society Conference (June 2017) held in San Francisco.Not peer reviewedPrimary gradesWorking memor
The performance of Bulgarian food markets during reform
No full textFood policy often depends on markets and markets depend on institutions. But how good do institutions have to be before reforms can be launched? Relying on well timed surveys of agricultural prices and a joint study by the Government of Bulgaria and the World Bank on agricultural market institutions, this paper presents evidence that performance in food markets improved following significant policy reforms in Bulgaria, although public institutions remained weak. This suggests that even though strong institutions are preferred to weak ones, it can be costly and impractical to delay policy reforms until work on strengthening institutions is finished. Still, measured performance varied by place and by commodity, suggesting that markets developed at different tempos and that the distribution of benefits from improved markets was uneven. This points to the need to address the costs of adjustment as policies change. The paper introduces a new approach to measure market performance based on composite-error techniques.Markets and Market Access,Transport Economics Policy&Planning,Economic Theory&Research,Access to Markets,Agribusiness
Molecular pathogenesis of spontaneous abortions - Whole genome copy number analysis and expression of angiogenic factors.
No full textOBJECTIVE
To study two major molecular alterations in spontaneous abortions (SA) with unexplained etiology - fetal genomic anomalies and the endometrial expression of main angiogenic factors VEGFA/VEGFR2 and chemokines SDF-1/CXCR4.
MATERIALS AND METHODS
Whole genome copy number analysis by arrayCGH or Next Generation Sequencing (NGS) was applied for detection of fetal genomic imbalances. The abortive decidua of SA without fetal aneuploidies was further investigated for expression levels of the abovementioned factors using real time PCR analysis. A total of 30 abortive materials were collected from spontaneous abortions after exclusion of known predisposing factors.
RESULTS
In 21 of 30 spontaneous abortions (70%), genomic anomalies were discovered by whole genome copy number analysis. Numerical anomalies were detected in 90% of aberrant cases, and in 10% - structural aberrations were revealed. An increased expression for essential factors of angiogenesis was identified in spontaneous abortions' tissues - 3.44 times for VEGFA and 10.29 times for VEGFR2. We found an average of 14 times increase in the expression levels of SDF-1 and 3.21 times for its receptor CXCR4.
CONCLUSION
We could suggest the occurrence of increased angiogenesis in SA without fetal aneuploidies, compared to the control tissues, which could lead to increased oxidative stress and fetal loss
Spinal anesthesia: comparison of isobaric ropivacaine (5 mg/ml) with isobaric bupivacaine (5 mg/ml)
No full textАдрес за кореспонденция: Д-р Дочка Цонева, дм, Клиника по анестезиология и ИЛ,
УМБАЛ „Александровска”, бул. „Св. Г. Софийски” № 1, 1431 София, e-mail: [email protected] ***** Address for correspondence: Dochka Tzoneva, M. D., Department of Anesthesiology and Intensive Care, University Hospital "Aleksandrovska", Medical University, 1, Sv. G. Sofyiski St., Bg - 1431 Sofia, e-mail: [email protected]Резюме: През последните години нарасна относителният дял на локорегионалните
методи на интраоперативно обезболяване и лечение на болката. Спиналната анестезия (СА) е популярна техника за обезболяване с висока успеваемост, добър профил на безопасност и е широко използвана в клиничната практика. Ропивакаин е нов амиден локален анестетик, синтезиран като чист S-енантиомер. Несъмнени негови достойнства са продължителното действие и възможността да се постигне диференциран сензомоторен блок при по-ниска системна токсичност. Целда се сравнят ефектите на еквипотентни дози изобарен ропивакаин (5 mg/ml) и изобарен бупивакаин (5 mg/ml), приложени интратекално за интраоперативно обезболяване
при възрастни пациенти. 34 възрастни пациенти, планирани за оперативно
лечение под СА по повод ингвинална херния и заболявания в аноректалната област, рандомизирано са разпределени в две групи в зависимост от прилагания локален анестетик: група R (ропивакаин; N = 17) и група B (бупивакаин; N = 17). Оценяваме начало и продължителност на сензорен и моторен блок; сегментно ниво на сензорен блок (дерматом); хемодинамични показатели; нежелани ефекти; време до първо уриниране. Ропивакаин
осигурява спинален блок с подобен клиничен профил както бупивакаин. Началото на сензорния блок е по-бързо, а продължителността 1,2 пъти по-дълга при пациентите в група B. При пациентите в група R по-рядко е наблюдаван пълен моторен блок; възстановяването от СА е 1,2 пъти по-
бързо, а времето до първо уриниране е 1,3 пъти по-кратко, в сравнение с пациентите в група В. Хемодинамичните промени са сходни в двете групи. В ранния постоперативен период нито един пациент не съобщава някакви
оплаквания. Изобарен ропивакаин (5 mg/ml) осигурява еквивалентна СА за операции по повод ингвинална херния и заболявания в аноректалната област с по-бързо възстановяване в сравнение с бупивакаин. Ропивакаин е локален анестетик с добра поносимост, ефективен за интраоперативно
обезболяване с минимално потискане на моторната функция и редуциран потенциал за кардио- и ЦНС токсичност. ***** Summary: Recently, the proportion of loco-regional methods of intraoperative analgesia
and pain management has increased. Spinal anesthesia (SA) is a popular,
widely used in clinical practice technique for analgesia with a high success rate
and good safety profile. Ropivacaine is a new amide local anesthetic, synthesized
as a pure S-enantiomer. Its unquestionable advantages are prolonged action
and the ability to achieve differential sensorimotor blockade with lower systemic toxicity. The aim of the study was to compare the effects of equipotent
doses of isobaric ropivacaine (5 mg/ml) to isobaric bupivacaine (5 mg/ml), administered
intrathecally for intraoperative analgesia in adult patients. Thirty-four adult patients scheduled for inguinal hernia repair and anorectal surgery under
intrathecal anesthesia were randomized in two groups according to the administrated
local anesthetic: group R (ropivacaine; N = 17) and group B (bupivacaine; N = 17). The onset, duration and segmental level of sensory and motor blockade
were examined, as well as hemodynamic variables, side effects, and time
to first void. The results showed that ropivacaine produced spinal anesthesia
with similar clinical profile to bupivacaine. In group R the onset of the sensory blockade was slower with a 1.2 times shorter duration and complete motor block
developed rarer than in the group with bupivacaine. The recovery from spinal block was 1.2 times faster, and the time to void was 1.3 times shorter in patients
who had received ropivacaine, compared with patients in group B. The hemodynamic
changes were similar in both groups. In the early postoperative period no patients reported any complaints. In conclusion, isobaric ropivacaine (5 mg/ml) produces equivalent intrathecal anesthesia for inguinal hernia repair and
anorectal surgery with faster recovery compared to bupivacaine. Ropivacaine is
a local anesthetic with good tolerability; provides effective intraoperative analgesia
with minimal motor function suppression and reduced potential for cardioand
CNS-toxicity
Limb girdle muscular dystrophy 2G in a religious minority of Bulgarian Muslims homozygous for the c.75G>A, p.Trp25X mutation
No full textPrognostic factors for anastomotic insufficiency in elective colorectal surgery
No full textIntroduction: Anastomotic insufficiency is a severe, potentially fatal complication of colorectal surgery. Its frequency, according to different authors, reaches up to 20%. It is related to two main types of risk factors: associated with the patient and associated with the therapeutic approach.Aim: The aim of the study is to determine prognostic factors for anastomotic insufficiency. The collected data from patients operated on for a period of 5 years (2013-2017) in the Second Surgery Clinic, Alexandrovska University Hospital, Sofia, were analyzed.Materials and Methods: A total of 158 patients undergoing elective colorectal surgery have been retrospectively included. These on emergency, non-proven malignancies and with preoperative haemotransfusion were excluded from the study. All patients were evaluated by age, gender, BMI, ASA score, Charlson Comorbidity Score, localization, TNM stage and histological type. The surgical approach and the method of resection were determined. The postoperative period and complications were classified according to the Clavien-Dindo scale. The number of leukocytes, platelets, RDW, CRP and albumin were examined preoperatively, and on the day 1 and day 4, in the early postoperative period.Results: The average age of the patients was 67 (29-87). Of these, 100 (63.3%) were men, and 58 (36.7%) are women. The mean BMI was 27.1 (23-33). A total of 78.9% of the operated patients weree in TNM stage II and III. Histologically, 77.8% were moderately differentiated adenocarcinomas. The mean Charlson Comorbidity Score for the sample was 7.1 (range: 2-13), and the ASA score was 3 (2-4). The rectum was the most common localization - 40.1%, followed by right colon 22.8%, and the sigmoid colon 20.9%. Over the review period, most resections were conventional, with only 15.2% laparoscopic approach. The operations performed were right hemicolectomy - 36 (22.8%), left hemicolectomy -15 (9.5%), segmental resection - 38 (24.1%), total colectomy - 4 (2.5%) resection of the rectum - 44 (27.9%), and other - 21 (13.3%). In 12 (7.6 %) of the patients insufficiency was reported between day 2 and day 3, postoperatively. Five of them were treated conservatively and the other six were reoperated. Seven of the insufficiencies were after anterior resection of the rectum, 2 were after left hemicolectomy, 1 after resection of the sigmoid colon, one was after right hemicolectomy, which had been treated conservatively. The mean postoperative period of patients with insufficiency was 22 days (range: 9-45). For patients without complications, the postoperative period was 9.4 days (range: 4-21) and there was a strict statistical difference (P <0.05). All patients experienced an increase in leukocyte counts postoperatively, albumin drop, increased CRP and ESR. The mean platelet counts depended on the presence of insuffiency.Conclusion: The anterior resection, which is associated with technically more difficult anastomosis and neoadjuvant radiotherapy is a potential risk factor for anastomotic insufficiency. The use of blood parameters in the postoperative period allows early diagnosis of the complication and possible change of the therapeutic strategy
Haematologia
No full text1984 / 1. szám
Dierich, M. P. - Schulz, T.: Physiological and pathological effects of activated complement
Pippard, M. J. - Weatherall, D. J.: Iron absroption in non-transfused iron loading anaemias: prediction of risk for iron loading, and response ot iron chelation treatment in ## thalassaemia intermedia and congenital sideroblastic anaemias
Hershko, C. - Grady, R. W. - Link, G.: Development and evaluation of the improved iron chelating agents EHPG, HBED and their dimethyl esters
Wickramashinge, S. N. - Hughes, M.: Globin chain precipitation, deranged iron metabolism and dyserythropoiesis is some thalassaemia syndromes
Walsh, P. N.: Activation of coagulation factors on the surface of platelets
Tuszynski, G. P. - Walsh, P. N.: Factor V: a platelet cytoskeletal associated protein
Abilgaard, U.: Biological action and clinical significance of antithrombin III
Sas, G.: Hereditary antithrombin III deficiency: biochemical aspects
Nagy, I.: Antithrombin III deficiency: clinical aspects
Eriksen, H. O. - Molke-Jensen, F. - Clemmensen, I.: Plasma fibronection concentration in patients admitted to intensive care unit
Clemmensen, I.: Significance of plasma fibronectin
Pavlov, A. D. - Pashukov, E. N.: Effect of erythropoietin on acetylation and phosphorylation of bone marrow histones
Massaro, P. - Radaelli, F. - Colombi, M. - Bregani, P. - Pogliani, F.: Unusual bone marrow hyperplasia in a case of thalassemia intermedia
Malý J. - Tichý, M. - Bláha, M. - Široký, O. - Vaňásek, J. - Jebavý, L. - Hrnčíř, Z.: A case of "acute" Waldenström macroglobulinaemia
Abstracts
Book Review
ICSH announcement
1984 / 2. szám
Fisher, J. W. - Nelson, P. K. - Belegu, M. - Hagiwara, M. - Beckman, Barbara: Prostanoid activation of erythropoiesis
Radtke, W. - Scheuermann, E. - Desser, H.: Polyamine induced suppression of erythropoiesis in uremia
Pavlović-Kentera, V. - Suśić, D. - Biljanović-Paunović, L. - Milenković, P.: Prostaglandin synthesis inhibitors in erythropoiesis
Walsh, P. N. - Tuszynski, G. P. - Greengard, Judith S. - Griffin, J. H.: The possible role of platelets in bypassing the contact phase of blood coagulation
Bunn, H. F.: Post-translational modifications of hemoglobin
Brock, J. H.: The role of transferrin in lymphocyte transformation
Sablayrolles, M. - Sajcman, H. - Castaigne, J. P. - Labie, D.: In vitro study of ticlopidine as a model of antisickling action of platelet antiaggregant
Frisch, B. - Bartl, R. - Burkhardt, R. - Jäger, K.: Histologic criteria for classification and differential diagnosis of chronic myeloproliferative disorders
Bartl, R. - Frisch, B. - Hoffmann-Fezer, G. - Burkhardt, R.: Lymphoproliferative disorders in the bone marrow: Histologic criteria for classification and staging
Pizzolo, G. - Chilosi, M. - Fiore-Donati, L. - Janossy, G.: Immunohistological analysis of bone marrow involvement in lymphoproliferative disorders. The use of cryostat sections from trephine biopsies
Jacobasch, G. - Holzhütter, H.: Molecular and cellular regulation of pyruvate kinase in red bloods cells
Polasek, J.: Release of multivascular bodies from platelets as observedin SEM
Gallango, Maria L. - Ramírez, M. - Suinaga, R.: Two cases of alpha heavy chain disease in Venezuelans
Ottó, Sz.: Immunofixation electrophoresis: An immunochemical method for testing protein anomalies
Open Forum: Identification of blood group HLA antigens from blood spots and tissues
Lincoln, P. J. - Dodd, Barbara, E.: Experience in the detection of red cell antigens and HLA antigens in bloodstains
Myhre, B. A.: The change in criminalistic methods for bloodstain analysis in California
André, A. - Hoste, B. - Kamenev, L.: Importance of the choice of the means in the study of bloodstains
Pereira, Margaret: ABO and Lewis typing of semen, saliva and other body fluids
Lontai-Santora, S. - Gyódi, E. - Hollán, S. R.: Identification of human lymphocyte antigens (HLA) in a semen stain
Obituary
Abstracts
1984 / 3. szám
Lambertenghi-Deliliers, G. - Soligo, D. - Colajori, E. - Polli, E.: Spleen alterations in hairy cell leukemia: A scanning electron microscopic study
Valbonesi, M. - Montani, F. - Mosconi, L. - Florio, G. - Vecchi, C.: Plasmapheresis and cytotoxic drugs for mixed cryoglobulinemia
Balducci, L. - Hardy, C. - Dreiling, B. - Tavassoli, M. - Steinberg, M. H.: Pure red blood cell aplasia associated with paraproteinemia: in vitro studies of erythropoiesis
Trautsch, Ch. - Reiman, B. - Gerber, G. - Klatt, D. - Ladhoff, A. - Maretzki, D.: Release of microvesicles from erythrocytes during storage in saline-adenine-glucose media
Heilman, E. - Ridderskamp, P. - Weber, M. - Maurer, H. R.: Micromethod for colony growth of erythroid and granulocytic cell colonies in glass capillaries
Merkiel, K. - Prokopowicz, J.: Neutrophil acid phosphatase activity in patients with gastric or rectum carcinoma durign surgical treatment
Kornecki, E. - Tuszynski, G. P. - Niewiarowski, S.: Identification of human platelet membrane fibrinogen receptors by immunochemical techniques
Tzoneva, M. - Mavrudieva, M. - Toncheva, D. - Lalchev, S.: Glucose-6-phosphate dehydrogenase deficiency and Rh factor
Pippard, M. J. - Weatherall, D. J.: Iron Absorption in non-transfused in iron loading anaemias: prediction of risk for iron loading, and response to iron chelation treatment in ## thalassaemia intermedia and congenital sideroblastic anaemias
Announcement
Obituary
1984 / 4. szám
Lombarts, A. J. P. F. - Jagdewsing, J. K. - Bot, Alice G. M. - Leijnse, B.: Sterile, Medium Scale Age Fractionation of Human Red Blood Cells
Berrebi, A. - Talmor, M. - Kluger, Y. - Shtalrid, M. - Vorst, J.: Rosetting Index (E Rosettes/Mouse Rosettes): A Simple Diagnostic and Prognostic Value in CLL
Ulvik, R. J.: Stability of Serum Ferritin in Healthy Subjects
Szmitkowski, M. - Prokopowicz, J. - Siwicka, A.: Inhibition of Granulocyte-Macrophage (GM) Colony Formation by Sera of Patients with Neoplasma of Digestive Tract in the Surgical Treatment
Pajor, A. - Gróf, J. - Menyhárt, J.: Possible Origin of Amniotic Fluid Constituents Influencing Fibrinolytic Activity
Moszczynski, P. - Lisiewicz, J.: Occupational Exposure to Benzene, Toluene and Xylene and the T Lymphocyte Functions
Klener, P.: Today's Treatment of Non-Hodgkin's Lymphomas
Wahlin, A. - Holm, J. - Nyström, L.: Improved Survival in Mulitple Myeloma with Combination Chemotherapy and Plasmapheresis
Dergunova, L. V.: Heterogeneity of B-Thalassemia in Azerbaidzhan
Contents of Volume 17
Author Index
Subject Inde
Author Correction: A deep catalogue of protein-coding variation in 983,578 individuals (Nature, (2024), 631, 8021, (583-592), 10.1038/s41586-024-07556-0)
No full text10.1038/s41586-024-08571-
Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries
No full textEvaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries
No full textBackground: Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods: The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results: A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P < 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion: Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)
