Serum NT-pro-BNP Levels Predict Cardiovascular Events in Acromegaly Patients

Background Acromegaly is associated with an increased risk of fatal and non-fatal cardiovascular (CV) events. Controlling acromegaly decreases, but does not normalize this risk. Brain natriuretic peptide (BNP) assessment is used in the general population for the diagnosis of heart failure and to predict ischemic recurrences and mortality. This is a retrospective, longitudinal, monocenter study that evaluates the role of serum N-terminal fragment of BNP (NT-pro-BNP) for predicting CV events in acromegaly patients. Methods Serum NT-pro-BNP levels were measured in 76 patients with acromegaly (23 males, 57.7±1.5 years), and compared with other predictors of CV events. NT-pro-BNP cut-off value discriminating the occurrence of CV events was determined by ROC analysis. CV events were recorded during a follow-up of 78.6±6.4 months. Results CV events occurred in 9.2% of patients. Mean log(NT-pro-BNP) concentration was higher in patients who experienced CV events than in those who did not (p<0.01) and in patients who died due to CV events than in those who died due to other causes (p<0.01). Based on the ROC curve, a cut-off value of 91.55 pg/mL could predict CV events (OR 19.06). Log(NT-pro-BNP) was lower in surgically treated patients by surgery (p<0.05), and in those cured by neurosurgery (p<0.02). Conclusions High NT-pro-BNP value is an independent middle-term predictor of fatal or non-fatal CV events in patients with acromegaly. According to this parameter, surgically treated patients show lower CV risk than those managed with medical therapy, especially if the disease is cured.

Is there a missing-middle in Australian mental health care?

Objective The term ‘missing-middle’ has been prominent in discourse relating to provision of mental health care in Australia, particularly by proponents of non-governmental youth mental health services such as headspace and related adult services. We investigate whether there is an empirical basis for use of the ‘missing-middle’ term, founded on qualitative and quantitative research. Conclusions Despite the widespread use of the term ‘missing-middle’ for advocacy in Australia, there is a lack of research characterising the epidemiological characteristics of the group. The validity of advocacy predicated on the basis of the ‘missing-middle’ care-gap should be reconsidered. Research, such as systematic service mapping and health needs assessment, is a necessary foundation for evidence-based mental healthcare policy, planning and implementation. Without such research, vital government funds may be deployed to ‘missing-middle’ programmes that may not improve Australian public health outcomes.

Establishment of Novel Genotoxicity Assay System Using Murine Normal Epithelial Tissue-Derived Organoids

Short-/middle-term and simple prediction studies for carcinogenesis are needed for the safety assessment of chemical substances. To establish a novel genotoxicity assay with an in vivo mimicking system, we prepared murine colonic/pulmonary organoids from gpt delta mice according to the general procedure using collagenase/dispase and cultured them in a 3D environment. When the organoids were exposed to foodborne carcinogens—2-amino-1-methyl-6-phenylimidazo(4,5-b)pyridine (PhIP) and acrylamide (AA)—in the presence of metabolic activation systems, mutation frequencies (MFs) occurring in the gpt gene dose-dependently increased. Moreover, the mutation spectrum analysis indicated predominant G:C to T:A transversion with PhIP, and A:T to C:G and A:T to T:A transversion with AA. These data correspond to those of a previous study describing in vivo mutagenicity in gpt delta mice. However, organoids derived from the liver, a non-target tissue of PhIP-carcinogenesis, also demonstrated genotoxicity with a potency comparable to colonic organoids. Organoids and PhIP were directly incubated in the presence of metabolic activation systems; therefore, there was a lack of organ specificity, as observed in vivo. Additionally, PhIP-DNA adduct levels were comparable in hepatic and colonic organoids after PhIP exposure. Taken together, the organoids prepared in the present study may be helpful to predict chemical carcinogenesis.

Polymodeling of time series structures, neighborhood of residuals distribution, wavelet transformation for meso-dynamics assessment

Subject. The article provides the results of meso-dynamics analysis of main twelve industries, based on monthly data for 82 Russian regions, from January 2005 till December 2020. Objectives. The purpose of the study is to address the problem of balanced and stable spatial development of Russia’s regions and Russia, which requires modeling of adequate tools and forecasting nonlinear mesodynamics. Methods. The study follows the econophysics methodology. Results. We consider additive and multiplicative interactions of regular time series components between each other and the residuals, thus expanding the scope of tools application for the variety of considered industries and their models. Using the common and new trend models, we analyze structural changes, introduce the topological measure of proximity to the neighborhood of residuals with heavy-tailed distribution, which is estimated by median values of trends and cycles for regular components. The traditional time series decomposition (by trend, cycle, seasonality, and residual) is supplemented by our unique complex of wavelet transformations, which forms the models of cycles, using auto regression. We obtained representative and time-synchronized analytical estimates of regular components of industries’ dynamics for meso- and macro-indicators of the Russian economy that have higher accuracy than the known results for the accuracy of modeling and forecasting. Conclusions. The offered methodology and tools enable a more adequate analysis of non-linear dynamics of regions’ middle-term development. They help shift to growth point identification, create the atlas of economic industrial cycles, analyze stages of bifurcations and scenario predictive planning.

Factorizing a Quadratic Expression with Reasoning

It is not popularly realized that the factorization of a general quadratic expression basically requires solution to a hyperbola and a line. This fact is conspicuously pointed out and a few solutions to the problem are demonstrated that are scattered in the literature. In the high school level, the coefficients of a quadratic expression are mostly integers, and factorization is performed by the popular method of decomposition of the middle term. In this expository note, we have presented it in a simpler way that shows both insight and reasoning into the problem. Some other methods, namely, Linear Method, Average Method and Difference of two Squares Method are also discussed. Depending on the background, a reader may prefer a particular method to the others. The expository nature and artistry in presentation of the paper are expected to make the learning of the topic amusing and instructive. GANITJ. Bangladesh Math. Soc.41.1 (2021) 15-25

Effect of regional living conditions on middle-term cardiovascular outcomes: data from prospective stage of the ESSE-RF study

Aim. To assess regional living conditions with cardiovascular outcomes based on prospective stage of the Epidemiology of Cardiovascular Diseases and their Risk Factors in Regions of Russian Federation (ESSE-RF) study.Material and methods. We used data from a 3- and 5-year prospective stage of the ESSE-RF study (2012-2013). For initial screening, 16210 people aged 25-64 were included. To characterize the regions of residence, 5 regional indices (RIs) were used. The following endpoints were considered: cardiovascular death, myocardial infarction, stroke, composite endpoint (cardiovascular death + myocardial infarction + stroke). To assess the correlations, generalized estimating equations with nested data structure (individuals in the regions) were used. The studied associations were adjusted for a wide range of potential effect modifiers.Results. There are multiple direct associations of RIs with the likelihood of all endpoints. The exception was the reverse association of Industrial RI with cardiovascular death. The most stable associations regarded Mixed RI, Industrial RI and Socio-geographical RI, with a high RI significance in endpoint development, compared with well-known individual cardiovascular risk factors. Separate associations were noted for Economic RI and Demographic RI.Conclusion. The results indicate a significant contribution of a number of regional living conditions to individual risk of fatal and non-fatal cardiovascular outcomes.

Hypofractionated stereotactic body radiation therapy (SBRT) in pediatric patients: preliminary toxicity results of a national prospective multicenter study

Objectives: While hypofractionated stereotactic body radiotherapy (SBRT) has been largely adopted in the adult setting, its use remains limited in pediatric patients. This is due, among other factors, to fear of potential toxicities of hypofractionated regimens at a young age. In this context, we report the preliminary acute (<3 months from SBRT) and middle-term (3–24 months) toxicity results of a national prospective study investigating SBRT in pediatric patients. Methods: Between 2013 and 2019, 61 patients were included. The first 40 patients (median age: 12 y, range: 3–20) who completed a 2-year-follow-up were included in the present analysis. SBRT was used for treating lung, brain or (para)spinal lesions, either as first irradiation (35%) or in the reirradiation setting (65%). Results: Acute and middle-term grade ≥2 toxicities occurred in 12.5 and 7.5% of the patients, respectively. No grade ≥4 toxicities occurred. Almost all toxicities occurred in the reirradiation setting. Conclusion: SBRT showed a favorable safety profile in young patients treated for lung, brain, and (para)spinal lesions. Advances in knowledge: SBRT appeared to be safe in pediatric patients treated for multiple oncology indications. These results support further evaluation of SBRT, which may have a role to play in this patient population in the future.

The Legal and Trade Effect of the SAA between the Republic of Kosovo and the European Union

The Stabilization and Association Agreement with the Republic of Kosovo is a new chapter in the new institutional and social functioning because it has direct impact on the citizens’ life in our country. The effects of the agreement are not only in trading but those are multiple effects, since they do touch the political stability, the rule of law, democratic governance, economic development, trade exchange, regional economic cooperation, etc. and therefore the relevance of this agreement should not be seen from a single viewpoint, but rather from a wider perspective and we should dedicate more attention to the direct legal and trading issues. This agreement in the short term will create perspective and hope, in the middle term, it will create political stability, whereas in the long term, it will bring economic development, and genuinely trading exchange.