Non-alcoholic fatty liver disease (NAFLD) is the worldwide most common cause of chronic liver pathology, which prevalence strongly correlates with the increasing incidence of diabetes, obesity and metabolic syndrome in the general population. Simple steatosis, the earliest NAFLD stage, usually remains asymptomatic, and appropriate changes in the lifestyle, as well as the diet, can reverse the affected liver into the healthy state. The potential of simple steatosis to progress into severe fibrotic stages and to facilitate carcinogenesis necessitates timely NAFLD detection and risk stratification in community-based healthcare settings. Since their initial discovery a decade ago, extracellular circulating miRNAs have been found in all human biological fluids including blood and shown to hold great promises as non-invasive biomarkers. Normally, intracellular miRNAs participate in the regulation of gene expression, but once released by dying/dead cells they remain highly stable in the extracellular environment for prolonged periods. Therefore, circulating miRNA profiles can reflect the ongoing pathogenic processes in body's tissues and organs, and enable highly sensitive non-invasive diagnosis of multiple disorders. A non-urgent character of the NAFLD-related decision-making justifies the use of chronic liver diseases as an excellent test case for examining the practical utility of circulating miRNAs as biomarkers for longitudinal monitoring of human health. In this review, we summarize the state-of-the-art in the field of early diagnosis of NAFLD using circulating blood miRNAs, and stress the necessity of additional experimental validation of their diagnostic potential. We further emphasize on the potential diagnostics promises of other cell-free RNA species found in human biological fluids.
Given many developing economies depend on primary commodities, the fluctuations of commodity prices may imply significant effects for the wellbeing of children. To investigate, this paper examines the relationship between child mortality and commodity price movements as reflected by country-specific commodity terms-of-trade. Employing a panel of 69 low and lower-middle income countries over the period 1970-2010, we show that commodity terms-of-trade volatility increases child mortality in highly commodity-dependent importers suggesting a type of ‘scarce’ resource curse. Strikingly however, good institutions appear able to mitigate the negative impact of volatility. The paper concludes by highlighting this tripartite relationship between child mortality, volatility and good institutions and posits that an effective approach to improving child wellbeing in low to lower-middle income countries will combine hedging, import diversification and improvement of institutional quality.
Electrocorticography (ECoG) is a standard procedure for the localization of the epileptogeniczone during the surgical treatment of symptomatic epilepsy. The purpose of this study was to evaluate the diagnostic efficacy of intraoperative pre- and post-resective ECoG for the localization of the epileptogenic zone in patients with symptomatic epilepsy associated with supratentorial brain tumors. 1. In the surgical treatment of symptomatic epilepsy associated with intracerebral neoplasm, intraoperative ECG remains a relatively effective method. 2. The effectiveness of intraoperative pre- and post-resection ECoG is affected by factors associated with the performance of neurosurgical surgery (the influence of general anesthetics, mechanical effects on the brain, repeated electrocoagulation), which significantly alter the index of epileptiform activity.
Previous studies have demonstrated altered resting state functional connectivity (rsFC) in patients with post-stroke depression (PSD). It remains unclear whether rsFC is changed at the network level as was shown for major depressive disorder (MDD). To address this question, we investigated rsFC of resting sate networks (RSNs) in PSD.
Eleven subjects with PSD underwent fMRI scanning at rest before and after treatment. The severity of depression was assessed using the aphasic depression rating scale (ADRS). We performed functional network connectivity (FNC) analysis for RSNs, region of interest - FC analysis (ROI-FC) and calculation of brain matter volumes in ROIs overlapping with RSNs and in other brain regions associated with mood maintenance.
We found positive correlation of FNC between anterior default mode network (aDMN) and salience network (SAL) with depression severity before treatment, the latter accompanied by the increase of white matter in the middle frontal and left angular gyri. FNC of aDMN and left frontoparietal network (LFP) decreased after treatment. ROI-FC and the brain matter volumes of several regions of DMN, LFP and SAL also showed a correlation with ADRS or significant change after treatment.
Limitations include small sample size and methodological issues concerning altered hemodynamics in stroke. However, we took complex preprocessing steps to overcome these issues.
Present results of altered rsFC in PSD are consistent with previous findings in MDD. The convergence of results obtained in PSD and MDD supports the validity of rsFC approach for investigation of brain network dysfunctions underling these psychiatric symptoms.
A key component of achieving universal health coverage is ensuring that all populations have access to quality health care. Examining where gains have occurred or progress has faltered across and within countries is crucial to guiding decisions and strategies for future improvement. We used the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) to assess personal health-care access and quality with the Healthcare Access and Quality (HAQ) Index for 195 countries and territories, as well as subnational locations in seven countries, from 1990 to 2016.
Drawing from established methods and updated estimates from GBD 2016, we used 32 causes from which death should not occur in the presence of effective care to approximate personal health-care access and quality by location and over time. To better isolate potential effects of personal health-care access and quality from underlying risk factor patterns, we risk-standardised cause-specific deaths due to non-cancers by location-year, replacing the local joint exposure of environmental and behavioural risks with the global level of exposure. Supported by the expansion of cancer registry data in GBD 2016, we used mortality-to-incidence ratios for cancers instead of risk-standardised death rates to provide a stronger signal of the effects of personal health care and access on cancer survival. We transformed each cause to a scale of 0–100, with 0 as the first percentile (worst) observed between 1990 and 2016, and 100 as the 99th percentile (best); we set these thresholds at the country level, and then applied them to subnational locations. We applied a principal components analysis to construct the HAQ Index using all scaled cause values, providing an overall score of 0–100 of personal health-care access and quality by location over time. We then compared HAQ Index levels and trends by quintiles on the Socio-demographic Index (SDI), a summary measure of overall development. As derived from the broader GBD study and other data sources, we examined relationships between national HAQ Index scores and potential correlates of performance, such as total health spending per capita.
In 2016, HAQ Index performance spanned from a high of 97·1 (95% UI 95·8–98·1) in Iceland, followed by 96·6 (94·9–97·9) in Norway and 96·1 (94·5–97·3) in the Netherlands, to values as low as 18·6 (13·1–24·4) in the Central African Republic, 19·0 (14·3–23·7) in Somalia, and 23·4 (20·2–26·8) in Guinea-Bissau. The pace of progress achieved between 1990 and 2016 varied, with markedly faster improvements occurring between 2000 and 2016 for many countries in sub-Saharan Africa and southeast Asia, whereas several countries in Latin America and elsewhere saw progress stagnate after experiencing considerable advances in the HAQ Index between 1990 and 2000. Striking subnational disparities emerged in personal health-care access and quality, with China and India having particularly large gaps between locations with the highest and lowest scores in 2016. In China, performance ranged from 91·5 (89·1–93·6) in Beijing to 48·0 (43·4–53·2) in Tibet (a 43·5-point difference), while India saw a 30·8-point disparity, from 64·8 (59·6–68·8) in Goa to 34·0 (30·3–38·1) in Assam. Japan recorded the smallest range in subnational HAQ performance in 2016 (a 4·8-point difference), whereas differences between subnational locations with the highest and lowest HAQ Index values were more than two times as high for the USA and three times as high for England. State-level gaps in the HAQ Index in Mexico somewhat narrowed from 1990 to 2016 (from a 20·9-point to 17·0-point difference), whereas in Brazil, disparities slightly increased across states during this time (a 17·2-point to 20·4-point difference). Performance on the HAQ Index showed strong linkages to overall development, with high and high-middle SDI countries generally having higher scores and faster gains for non-communicable diseases. Nonetheless, countries across the development spectrum saw substantial gains in some key health service areas from 2000 to 2016, most notably vaccine-preventable diseases. Overall, national performance on the HAQ Index was positively associated with higher levels of total health spending per capita, as well as health systems inputs, but these relationships were quite heterogeneous, particularly among low-to-middle SDI countries.
GBD 2016 provides a more detailed understanding of past success and current challenges in improving personal health-care access and quality worldwide. Despite substantial gains since 2000, many low-SDI and middle-SDI countries face considerable challenges unless heightened policy action and investments focus on advancing access to and quality of health care across key health services, especially non-communicable diseases. Stagnating or minimal improvements experienced by several low-middle to high-middle SDI countries could reflect the complexities of re-orienting both primary and secondary health-care services beyond the more limited foci of the Millennium Development Goals. Alongside initiatives to strengthen public health programmes, the pursuit of universal health coverage hinges upon improving both access and quality worldwide, and thus requires adopting a more comprehensive view—and subsequent provision—of quality health care for all populations.
Preeclampsia (PE) is a pregnancy-specific syndrome, characterized in general by hypertension with proteinuria or other systemic disturbances. PE is the major cause of maternal and fetal morbidity and mortality worldwide. However, the etiology of PE still remains unclear. Our study involved 38 patients: 14 with uncomplicated pregnancy; 13 with early-onset PE (eoPE); and 11 with late-onset PE (loPE). We characterized the immunophenotype of cells isolated from the placenta and all biopsy samples were stained positive for Cytokeratin 7, SOX2, Nestin, Vimentin, and CD44. We obtained a significant increase in OPA1 mRNA and protein expression in the eoPE placentas. Moreover, TFAM expression was down-regulated in comparison to the control (p < 0.01). Mitochondrial DNA copy number in eoPE placentas was significantly higher than in samples from normal pregnancies. We observed an increase of maximum coupled state 3 respiration rate in mitochondria isolated from the placenta in the presence of complex I substrates in the eoPE group and an increase of P/O ratio, citrate synthase activity and decrease of Ca(2+)-induced depolarization rate in both PE groups. Our results suggest an essential role of mitochondrial activity changes in an adaptive response to the development of PE.
Objective Removal of brain tissue generating pathological high-frequency oscillations (pHFOs) has been related to better seizure outcome than resection of seizure onset zone. However, there is still a lack of understanding what oscillations are to be considered pathological. Methods A female patient (age 53) with 10 year duration of temporal lobe tumor-related epilepsy was admitted to Polenov’s Neurosurgery Institute for tumor resection. The patient underwent a two-staged surgery with subdural implantation of a grid electrode (4 × 5) over the temporal lobe to identify the epileptogenic zone (EZ). During the second stage wideband intraoperative electrocorticography (iECoG) was recorded (up to 500 Hz, sampling frequency 2000 Hz, Mitsar-EEG 202 amplifier). Results Electrocorticographic monitoring data were subjected to visual analysis in traditional frequency range (0.5–70 Hz). Six of 20 electrodes were marked as EZ electrodes. The distance between tumor margin and EZ electrodes reached 1–2.5 cm. Subpial resection of this zone was arranged. During the surgery iECoG data in 0.5–70 Hz frequency band were uninformative, while in 80–500 Hz range bursts of fast ripples (250–500 Hz, 100 μV, extended up to 3 s) were recorded over the marked EZ electrodes. The tumor and EZ were completely resected. Discussion Observed data demonstrate that HFOs coincide with EZ marked during long-term monitoring. The patient is seizure-free for 5 months at the moment, though a more prolonged follow-up is required. Conclusion Wideband iECoG recordings might give us more essential information in case of tumor-related epilepsy. As is shown, fast ripples may be a valid marker of EZ. Significance Pathological HFOs show promise for optimising epilepsy surgery in tumor-related epilepsy.
Objectives: Levels of steroid hormones such as androgens and cortisol exhibit circadian variation, and their fluctuations are related to the sleep-wake cycle. Currently, the functional role of different stages of sleep in steroid hormone secretion remains unclear. The present study aims to explore the effect of slowwave sleep (SWS) suppression on morning levels of cortisol and androgens.
Methods: Twelve healthy male volunteers participated in two experimental sessions: a session with selective SWS suppression during night sleep and a session with regular night sleep (control). SWS suppression was achieved by stimulation using an acoustic tone. Salivary samples were collected in the morning immediately after awakening and again 40 min later. The samples were analysed by liquid chromatography-tandem mass spectrometry for testosterone, androstenedione (Ad), dehydroepiandrosterone (DHEA), 17a-hydroxyprogesterone (17-OHP), and cortisol.
Results: SWS suppression reduced overall SWS duration by 54.2% without significant changes in total sleep time and sleep efficiency. In the session with selective SWS suppression, the average level of morning testosterone was lower than in the control session (p . 0.017). Likewise, 17-OHP was lower in the SWS suppression condition (p . 0.011) whereas the ratio of DHEA/Ad was higher (p . 0.025). There were no significant differences between sessions in cortisol, Ad, or DHEA concentrations.
Conclusions: The effect of selective SWS suppression on morning levels of testosterone and 17-OHP points to the importance of SWS for the synthesis and secretion of androgens. These results suggest that chronic sleep problems, which lead to reduced SWS, increase the risk for the development of androgen deficiency in the long term.
Motor sequence learning is considered the result of the outflow of information following cognitive control processes that are shared by other goal-directed behaviours. Emerging evidence suggests that focused-attention meditation (FAM) establishes states of enhanced cognitive control, that then exert top-down control biases in subsequent unrelated tasks. With respect to sequence learning, a single-session of FAM has been shown to entrain stimulus-dependent forms of sequential behaviour in meditation naïve individuals. In the present experiment, we compared single-session effects of FAM and a computerised attention task (CAT) to test if FAM-induced enhanced top-down control is generally comparable to cognitive tasks that require focused attention. We also investigated if effort, arousal or pleasure associated with FAM, or CAT explained the influence of these tasks on sequence learning. Relative to a rest-only control condition, both FAM and CAT resulted in shorter reaction time (RT) in a serial reaction time task (SRTT), and this enhanced RT performance was associated with higher reliance on stimulus-based planning as opposed to sequence representation formation. However, following FAM, a greater rate of improvement in RT performance was observed in comparison to both CAT and control conditions. Neither effort, arousal nor pleasure associated with FAM or CAT explained SRTT performance. These findings were interpreted to suggest that the effect of FAM states on increased top-down control during sequence learning is based on the focused attention control feature of this meditation. FAM states might be associated with enhanced cognitive control to promote the development of more efficient stimulus-response processing in comparison to states induced by other attentional tasks.
Despite the fact that user-generated data are widely used in medical informatics in general and for revealing side-effects of various pharmaceuticals in particular, recent studies have focused merely on methods of extracting information on side effects from unstructured or semi-structured reviews of specific medications without linking side effects to any outcomes.
In this study we demonstrate how user-generated online content on side effects experienced by patients while taking a pharmaceutical product can be used to do research after the drug has been introduced to the market, thus allowing to complement the results of official clinical studies and market research. In particular, we concentrate on revealing the contribution of various side effects to reported customer satisfaction with Tamiflu, a popular antiviral drug.
Publicly available data from an online platform with reviews from patients are used as an input to the analysis that applies statistical and machine learning methods (multivariate logit models and classification trees) to investigate the relationships of side effects to demographic characteristics and to the overall satisfaction with the medication.
We prioritized side effects of Tamiflu based on the significance of their association with patient’s ratings published at one of the well-known drug discussion forums. Among all types of side effects used in our study, the neuropsychiatric symptoms and body pain are the most influential, followed by skin problems. Specific combinations of side-effects that are associated with low satisfaction were detected.
The proposed analytical approach can help pharmaceutical companies to improve their products and/or medical guidelines associated with their products and figure out fighting which adverse effects should be given a priority from the customer satisfaction perspective.
CONTEXT: Mood disorders are prevalent in people after stroke, and a disorder's onset can exacerbate stroke-related disabilities. While evidence supports the mental-health benefits of participation in exercise and yoga, it is unknown whether such benefits extend to a population with poststroke hemiparesis.
OBJECTIVE: The study investigated whether supplementing exercise with participation in a yoga program would provide further improvements in self-reported symptoms of depression and anxiety in a chronic poststroke population, and it also assessed trial feasibility for future studies.
DESIGN: The research team designed a randomized, controlled pilot trial that included an exercise-only group (EX, control) and a yoga-and-exercise group (YEX, intervention).
SETTING: The study took place at the Centre for Physical Activity in Ageing an exercise rehabilitation and activity center at the Royal Adelaide Hospital in South Australia.
PARTICIPANTS: The participants included 14 individuals with chronic poststroke hemiparesis: eight in the intervention group and six in the control group.
INTERVENTIONS: The YEX group participated in a 6-week standardized program that included yoga in weekly group sessions and home practice in addition to exercise in a weekly group class. The EX group participated only in the group exercise class weekly for 6 weeks.
OUTCOME MEASURES: The research team assessed self-reported symptoms of depression using the Geriatric Depression Scale (GDS15) and symptoms of anxiety and negative affect using the State Trait Anxiety Inventory (STAI). The team based the feasibility evaluation on recruitment outcomes, retention of participants, participants' compliance with the intervention program, and the safety of the intervention.
RESULTS: Changes in depression and state and trait anxiety did not significantly differ between intervention groups (GDS15 P=.749, STAI-Y1, P=.595, STAI-Y2, P=.407). Comparison of individuals' case results indicated clinically relevant improvements in both groups, although members of the intervention group had greater improvements. Participants reported no adverse events, and the study experienced high retention of participants and high compliance in the yoga program.
CONCLUSIONS: This pilot study provides preliminary data on the effects of yoga combined with exercise to influence mood poststroke. It is a feasible, safe, and acceptable intervention, and the field requires additional investigations with a larger sample size.
Population health is one of the most significant human resources which largely determine the progress in the competition, productivity and agricultural economic activity. It has a huge social and economic growth effect in general. It also plays a huge role in village areas which come second in terms of importance after all cities and towns. Over the last decade, there has been a growing research interest in career strategies in medicine among young medical professionals. However, there is little empirical research on young rural doctors’ career strategies in Russia. This study is in line with medical professions studies and rural studies. Young physicians have different career orientations towards learning and practicing medicine. Some of them need more support for their professional development. The study employs the biographical interview method, which allows us to consider the formation of career strategies of young doctors from various conceptual perspectives, such as everyday practices, interactions in work environment, and communication with rural community. The main analytical method was a thematic analysis of young doctors’ narrative stories. Based on those interviews, the article aims to find answers to the following questions: «How to preserve professionalism while working in rural areas?» and «How to devise a career strategy when you enter a rural community?» The empirical base of the study are 40 interviews with young rural doctors from the Leningrad region. When analysing the narrative interviews, two main strategies in forming a young doctor’s career have been found: rural career (focused on life and work in the countryside) and moving strategy (focused on moving from rural to urban areas). Each career type has its own way of positioning oneself as a doctor in a rural community. The received data allows for investigating the career strategies of young doctors based on the thematic analysis of narrative interviews and it can be used to improve the process of young doctors’ integration into working in villages. Our analysis takes account of the strategies young rural doctors use to make a career, their feeling of belonging or non-belonging to the rural community, and different views on rurality. The topics of discussion deal with career choice, working experiences and career opportunities. The study contributes to rural professions studies and medical studies.
The aim of the research was to study the metabolism of iron at patients with co-infection: tuberculosis of the respiratory organs and chronic hepatitis C. Simple randomized research. The main group consists of patients suffering with chronic viral hepatitis C and respiratory tuberculosis (n=71). The control group consists of patients with respiratory tuberculosis (n=128). The main indicators of hemogram, iron metabolism and acute phase proteins were defined. Indicators in the groups were assessed using the nonparametric Mann-Whitney test. Among the patients in the control group, anemia was detected at 25% of the patients. In the experimental group this rate amounted to 26.7%. In the main group, there was a statistically significant difference in the mean volume of erythrocytes, higher values of ferritin, serum iron, and value of saturation of transferrin with iron in per cents. In the case of chronic forms of tuberculosis in the control group, the concentration of hemoglobin decreased, reticulocytosis appeared, serum iron concentration and percentage of saturation of transferrin by iron decreased. In the experimental group, these indicators remained at a high level. The differences in the groups were statistically significant. At patients suffering with chronic v iral hepatitis C and respiratory tuberculosis, a more frequent progression of anemia in chronic form of the disease was detected, followed by a tendency to overload the tissues with iron. At the same time, among patients with chronic forms of tuberculosis and hepatitis, much less cases of anemia appear.