Off-Target Effects of Antidepressants on Vascular Function and Structure

Depression emerges as a risk factor for cardiovascular disease, and it is thought that successful antidepressant treatment may reduce such a risk. Therefore, antidepressant treatment embodies a potential preventive measure to reduce cardiovascular events in patients with depression. Accumulating evidence indicates that antidepressants have off-target effects on vascular dysfunction and in the early stages of atherosclerosis, which form the basis for cardiovascular disease (CVD) pathogenesis. In this context, we performed a thorough review of the evidence pertaining to the effects of different classes of antidepressant medications on hemodynamic and early atherosclerosis markers. The preclinical and clinical evidence reviewed revealed a preponderance of studies assessing selective serotonin reuptake inhibitors (SSRI), whereas other classes of antidepressants are less well-studied. Sufficient evidence supports a beneficial effect of SSRIs on vascular inflammation, endothelial function, arterial stiffening, and possibly delaying carotid atherosclerosis. In clinical studies, dissecting the hypothesized direct beneficial antidepressant effect of SSRIs on endothelial health from the global improvement upon remission of depression has proven to be difficult. However, preclinical studies armed with appropriate control groups provide evidence of molecular mechanisms linked to endothelial function that are indeed modulated by antidepressants. This suggests at least a partial direct action on vascular integrity. Further research on endothelial markers should focus on the effect of antidepressants on treatment responders versus non-responders in order to better ascertain the possible beneficial vascular effects of antidepressants, irrespective of the underlying course of depression.

Organization of ecologically oriented production management

The article is devoted to the research of theoretical bases of organization of management of ecologically oriented production. The analysis of the financing of environmental protection measures in Ukraine shows a positive trajectory of expenditures on environmentally oriented activities during 2010–2019: total expenditures increased from UAH 13 to 44 billion, or more than 3.3 times. The structure of expenditures is dominated by own funds of enterprises (79 %), funds of state and local budgets – only 2 %. Global improvement of the environment can be achieved only through comprehensive cooperation between the state and enterprises with the support of society. Nature management can be optimized by creating a more advanced management system and introducing new efficient resource-saving technologies. Ecologically oriented activity ensures the observance by enterprises of socio-economic interests under the condition of rational use of natural resources and minimization of anthropogenic impact on the environment. At the same time, sustainable economic growth and stable improvement of financial and economic performance are achieved. The system of environmental production management must be organically integrated into the long-term strategy of enterprise management. The defining priority of ecological production is the target orientation on integration and harmonization of human relations with the environment. We have defined a set of measures for the effective organization of management of environmentally oriented production of enterprises. Among them are the development of environmental policy, compliance with environmental legislation, organizational structure, analysis of indicators and development of environmental programs, formalization of hazardous processes, staff training, document management, monitoring of deviations in environmental management, data accounting, environmental audit and environmental management. Their comprehensive implementation will allow to organize and ensure effective activities that will achieve the optimal ratio of environmental and economic indicators.

P-P08 Towards effective analgesia in acute pancreatitis: a systematic review of randomised controlled trials

Background The optimal analgesic strategy for patients with acute pancreatitis (AP) remains unknown. The present systematic review and meta-analysis aims to compare the efficacy of several analgesic modalities trialled in AP. Methods A systematic search of PubMed, MEDLINE and EMBASE was conducted up until June 2021, according to PRISMA Guidelines to identify all randomised control trials (RCTs) comparing analgesic modalities in AP. The primary outcome measure was improvement in pain scores as reported on visual analogue scale (VAS) on day 0, day 1 and day 2. Results Twelve RCTs were identified including 542 patients. Seven trial drugs were compared: opiates, non-steroidal anti-inflammatories (NSAIDs), placebo, local anaesthetic, epidural, paracetamol and metamizole. A weighted single-arm effects estimate showed global improvement in VAS across all modalities from baseline to day 2. On visual inspection, epidural analgesia appears to provide the greatest improvement in pain scores within the first 24hrs, however at 48hrs it was comparable to opiates. Within the first 24hrs, NSAIDs offered similar pain-relief to opiates, while placebo also showed equivalence to other modalities but then plateaued. Local anaesthetics demonstrated least overall efficacy. VAS scores for opiate and non-opiate analgesics were comparable at baseline and day 1. The identified RCTs demonstrated significant heterogeneity in pain-relief reporting with relatively small datasets per study. Conclusions Given the incidence of AP there is remarkable paucity of level 1 evidence to guide pain management. Epidural administration is most effective analgesic modality within the first 24hrs of AP. NSAIDs are an effective opiate sparing alternative during the first 24hrs.

Irritable bowel syndrome and transplantation of fecal microbiota. Review

Objective — to perform analysis of the literature data as regards the efficacy of the use of fecal microbiota transplantation (FMT) in patients with the irritable bowel syndrome (IBS). Materials and methods. The systematic review of the literature (PubMed, MEDLINE, Cochrane Library) has been performed to assess the results of investigation on the use of FMT in adult IBS patients. Results. Currently, FMT is a safe and highly successful method of treatment for recurrent Clostridium difficile infection, and possibility to use FMT in the treatment of other diseases is under investigation. The results of FMT treatment of patients with IBS are contradictory. A number of authors outline fairly high FMT efficacy when used for the treatment of patients with IBS, refractory to the standard methods: it varies from 36 % to 70 % with a duration of adequate symptoms’ relief up to 1 year. However, other authors indicate that the positive FMT clinical effect lasted from 8 weeks to 3 months, after which there was a gradual recovery of symptoms. At the same time, the researchers noted that mostly often the positive outcome was reached after FMT from donors with a higher number of streptococci in the feces. Still others point out that there was no sustained, at least 50‑point reduction in the severity of IBS symptoms from baseline. Some authors did not reveal the advantages of FMT over placebo control and even reported about the higher placebo efficacy. After data generalization no significant difference was revealed in the global improvement in IBS symptoms in patients receiving donor FM versus placebo. However, the attention is drawn to the relationship between the results of FMT with methodology. Indeed, several studies have shown that placebo capsules were more effective than capsules containing donor feces, whereas FMT from donor stool delivered by colonoscopy was superior to FMF from autologous stool. This may be due to the excipients, containing in the capsulated FMT. A number of researchers also indicated that the use of a super donor is necessary for successful FMT and that the response to FMT is dose dependent. Conclusions. To resolve the issue of the expediency of using FMT in routine clinical practice in patients with IBS, more qualitative controlled studies, involving large cohorts of IBS patients and long‑term follow‑up, are required.

Anatomical and Functional Outcome of Epiretinal Membrane Peeling Surgery

Background: The purpose of this study is to study the anatomical and functional outcome of epiretinal membrane peeling surgery by evaluating the visual outcomes, comparing the pre and post operative macular thickness and functional changes through electroretinogram.Methods: It is a non-randomized, open labelled, prospective study conducted in a tertiary eye care centre. The anatomical and functional outcome of epiretinal membrane peeling surgery was evaluated by comparing the preoperative BCVA, OCT and ERG with post operative results of the same, at 4 & 12 weeks after the surgery in 25 eyes. Results: There was a significant reduction in CFT (p ≤0.05) with marked improvement in vision on follow ups at 4 weeks and 12 weeks after removal of ERM with significant reduction in the macular edema. On post operative ERG, 18 (72%) patients showed global improvement in amplitudes and P1 implicit time as compared to their preoperative value while 2 (8%) patients showed global improvement in amplitude but there was still delay in P1 implicit time as similar to their preoperative value and 4 patients (16%) showed no improvement in global amplitude as well as in P1 implicit time.Conclusions: ERM peeling surgery in selected cases improves visual acuity significantly in majority of the patients. CFT and foveal architecture significantly improves with ERM peeling surgery which also explains the improvement in functional visual acuity. ERG interpretation goes along the improvement in best corrected visual acuity signifying improvement in functioning of macula.

Development of an Efficient Cement Production Monitoring System Based on the Improved Random Forest Algorithm

Strengthening production plants and process control functions contribute to a global improvement of manufacturing systems because of their cross-functional characteristics in the industry. Companies established various innovative and operational strategies and there is increasing competitiveness among them and increase companies’ value. Machine Learning (ML) techniques have become an intelligent enticing option to address industrial issues in the current manufacturing sector since the emergence of Industry 4.0, and the extensive integration of paradigms such as big data, cloud computing, high computational power, and enormous storage capacity. Implementing a system that can identify faults early to avoid critical situations in the line production and environment is crucial. Therefore, one of the powerful machine learning algorithms is Random Forest (RF). The ensemble learning algorithm is performed to fault diagnosis and SCADA real-time data classification and predicting the state of the line production. Random Forests proved to be a better classifier with a 95% accuracy. Comparing to the SVM model, the accuracy is 94.18%, however, the K-NN model accuracy is about 93.83%, an accuracy of 80.25% is achieved using the logistic regression model, finally, about 83.73% is obtained by the decision tree model. The excellent experimental results achieved on the Random Forest model showed the merits of this implementation in the production performance, ensuring predictive maintenance, and avoid wasting energy.

REAC Non-invasive Neurobiological Stimulation for Mitigating the Impact of Internalizing Disorders in Autism Spectrum Disorder

Objectives Allostatic overload occurs when environmental factors become excessive for the individual capacity of neurobiological response and can trigger internalizing disorders. These disorders have a strong impact on individuals with autism spectrum disorder (ASD) and can exacerbate ASD symptoms and deficits. A non-invasive neurobiological stimulation technology, called the radio electric asymmetric conveyer (REAC), has been shown to be effective in improving internalizing disorders and remodeling the individual allostatic response. On these premises, REAC neurobiological stimulation treatments have been introduced for the treatment of internalizing disorders in ASD. The aim of this current research was to retrospectively verify the effects of REAC treatments on motor, cognitive, and behavioral skills and symptoms, assessed using the Autism Profiling Questionnaire (APQ). Methods Data were collected through administration of the APQ to the caregivers of 112 individuals with ASD. The caregivers rated every cluster of the questionnaire with a score based on an evaluation scale ranging from 0 to 10. Results At the 3-month follow-up, the caregivers perceived and rated a global improvement of the individuals with ASD in all clusters. Conclusions This research suggests that the mitigating effects of REAC neuromodulation treatments in relation to the severity of internalizing disorders can enhance the quality of life and the autonomy of individuals with ASD, as shown by the shift in the median values in all 21 items of the APQ toward an improvement in symptoms and skills.

Evaluation of Clonidine Augmentation Therapy for Obsessive-Compulsive Disorder Treatment; a Randomized Clinical Trial

Background: Obsessive-compulsive disorder (OCD) is a common neuropsychiatric disorder worldwide. Inadequate response of OCD patients to a usual agent makes this disorder a great challenge, and recent studies have recommended augmentation therapy as a new choice. Objectives: As traces of noradrenergic dysfunction have been noted in OCD pathophysiology, the current study aimed to assess the efficacy of clonidine augmentation therapy for treating OCD. Methods: This was a randomized clinical trial conducted on 57 OCD patients divided into the two groups of 1-mg clonidine augmentation therapy (n = 28) and placebo group (n = 29). The medication was administered for 12 weeks. Patients’ primary treatment, including SSRIs or clomipramine, continued by receiving the same dose used before participation in this study. The Yale-Brown Obsessive-Compulsive scale (Y-BOCS) and Clinical Global Impression-Severity scale (CGI-S) were used to assess the patients at the start of the study and then at four-week intervals. Drug-related adverse effects and global improvement were assessed and compared between the two groups. Results: The initial CGI scores were 3.89 ± 1.57 and 4.10 ± 1.61 at the baseline and 2.29 ± 1.18 and 3.07 ± 1.51 at the end of the study in the intervention and control groups, respectively. Both groups revealed a significant improvement (P-value = 0.001) with no significant difference between them (P-value = 0.22). The primary Y-BOCS score in the clonidine-treated group was 27.61 ± 8.08 versus 28.69 ± 7.44 in the control group at the baseline, which declined to 20.25 ± 6.08 versus 25.45 ± 7.35 at the end of the study, respectively. Both groups revealed a significant improvement (P-value = 0.001), but there was no statistically significant difference between them (P-value = 0.06). Drug-related complications were not statistically different between the two groups (P-value > 0.05); however, the clonidine-treated patients presented more adverse effects than control subjects. Conclusions: Although the use of clonidine posed no remarkable drug-related adverse effects, it was not superior to placebo considering symptom relief.

360 The Impact COVID-19 Has Had on Paediatric Supracondylar Fractures: A Closed Loop Audit Demonstrating How Compliance to BOAST 11 Guidelines Has Changed in An Orthopaedic Department

Aim Supracondylar fractures of the humerus in the paediatric patient is a common orthopaedic injury. Resultantly, strict guidelines were created by the British Orthopaedic Association of Standards in Trauma 11 (BOAST 11). In 2020, the COVID-19 pandemic, drastically affected the way medicine was practised. This audit aims to highlight, the extent to which compliance with BOAST 11 changed. Method Children with a supracondylar fracture of the humerus (Gartland 2 or 3) were included in this study. Standards from BOAST 11 were selected and the orthopaedic department were audited against these over a period of 2 years. After the first audit cycle, an information booklet was created and distributed to all doctors within the department. At the end of 2020, the department was re-audited, comparing pre-COVID results (2019) with COVID results (2020). Results Compliance improved within five BOAST 11 domains assessed on re-audit. With significant changes in neurovascular status being appropriately assessed and documented in clerking notes (improvement of 28%); and 2mm k-wire being used and documented in operation notes (improved by 23%). However, significant regression in results in patient’s being operated on within 24hours. Conclusions Global improvement of results during the national pandemic in 2020 demonstrates that our department did not compromise patient care despite limited resources but in fact strived for clinical excellence. The reason for a regression in compliance with regards to patients not being operated on within 24hours was likely due to protect paediatric patients from unnecessary stay in hospital, in a strategy to reduce COVID-19 transmission rates.