Thromboemboliás szövődmények COVID–19-betegekben

Összefoglaló. Bevezetés: A koronavírus-2 által okozott fertőzések igen gyakran súlyos, akut légzőszervi károsodás kialakulásához vezetnek, melynek következtében légzési elégtelenség manifesztálódik. A pneumoniák kialakulásának kezdete (2019. december) óta igen sok beteg szorult kórházi kezelésre. A súlyos tüdőgyulladások ellátása során igazolódott, hogy a légzőszervi gyulladásos folyamatok során a betegek jelentős részében vénás, ritkábban artériás thrombosisok alakulnak ki, tovább súlyosbítva a klinikai állapotot. Célkitűzés: A 2020. szeptember és 2021. március közötti időszakban 1590, koronavírus-2 által megfertőzött, tüdőgyulladással szövődött beteget láttunk el osztályunkon. Betegeinkben azt vizsgáltuk, hogy milyen jellegű és arányú a thromboemboliás szövődmények előfordulása. Módszer: Az 1590, koronavírus-2 által fertőzött beteg mindegyikében meghatároztuk a pneumonia súlyosságát; klinikai gyanú eseteiben alsó végtagi Doppler-ultrahangvizsgálatot, valamint komputertomográfiával végzett tüdőangiográfiát végeztünk. Eredmények: A képalkotó vizsgálatok eredményei azt igazolták, hogy a koronavírus-2 által okozott tüdőgyulladással kezeltekben 13%-os gyakorisággal fordult elő mélyvénás thrombosis; akut tüdőemboliát a betegek 17%-ában kórisméztünk. Következtetés: A koronavírus-2 által okozott fertőzésekben elsősorban a tüdőben, de egyéb szervekben is (szív, vese, máj) súlyos gyulladással járó kórfolyamatok alakulhatnak ki, amelyek hatására fokozott thrombosiskészség jelentkezik a gyulladásos és koagulációs rendszer interakciója következtében. A fokozott thrombosishajlam végeredményeként vénás és ritkábban artériás thrombosisok kialakulása súlyosbítja a betegek klinikai állapotát, s kedvezőtlen hatást gyakorol az életkilátásra. Orv Hetil. 2021; 162(43): 1710–1716. Summary. Introduction: The infections caused by coronavirus-2 very often lead to severe, acute respiratory damages, because of which respiratory insufficiency is manifested. As a result, since the development of pneumonias (December, 2019), many patients have required hospitalization. When treating the severe pneumonia cases, it was proved that in a significant number of patients with respiratory inflammatory processes, venous, less often arterial thrombosis occured, making the clinical state even more severe. Objective: We treated 1590 coronavirus-2 infected, pneumonia-connected patients between September, 2020 and March, 2021 at our department. We examined the nature and the proportion of the thromboembolic complications. Method: We determined the severity of pneumonia in the 1950 coronavirus-2 infected patients; when clinically suspected, they had lower limb Doppler ultrasound examination and angiography carried out with computer tomograph. Results: The result of imaging examinations proved that in 13% of cases deep vein thrombosis occured; in 17% of cases acute pulmonary embolia occured with pneumonia caused by coronavirus-2. Conclusion: In coronavirus-2 infected cases, mainly in the lung, but also in other organs (heart, kidney, liver), severe inflammatory disease-processes may occur, as a result of which increased thrombosis tendency shows because of the ineraction of the inflammatory and coagulatory system. As a result of the increased thrombosis tendency, venous and less often arterial thrombosis worsen the clinical state of patients, and have unfavourable effect on life expectancy. Orv Hetil. 2021; 162(43): 1710–1716.

Genetic variants link lower segregation of brain networks to higher blood pressure and worse cognition within the general aging population

The functional architecture of the brain is composed of distinct networks, where higher system segregation, i.e. greater differentiation of such functional networks, is associated with better cognitive performance. Aging and many neurological diseases have been associated with reduced system segregation and thus cognitive impairment. The genetic basis and risk factors of system segregation are largely unknown. Here, we present the first genome-wide association study of fMRI-assessed system segregation in 16,635 UK Biobank participants, identifying nine independent genomic loci. The 66 implicated genes were significantly downregulated in brain tissue and upregulated in vascular tissue. Of major vascular risk factors (Life's Simple 7), blood pressure showed a robust genetic correlation with system segregation. Observational and Mendelian randomization analyses confirmed a unfavourable effect of higher blood pressure on system segregation and of lower system segregation on cognition. Replication analyses in 2,414 Rotterdam Study participants supported these conclusions.

AN ANALYSIS OF THE LIQUID FILMS BREAK-UP USING THE COMPUTER VISION TECHNIQUE

The aim of this paper is to introduce a novel approach for analysing the droplet formation in a transonic flow. The method suggested in this work is based on the combination of the measured data from the wind tunnel by an optical measurement and image processing. A new wind tunnel was developed for the study of the liquid film atomization at high speed flows similar to ones that can be found in steam turbines. The coarse droplets in steam turbines are formed from the liquid films on the blades and inner casings. The coarse droplets formed on the stator blades don´t follow the bulk flow and collide with the following moving blades. These collisions cause erosion and corrosion processes, which have an unfavourable effect on the reliability and the efficiency of the low pressure stages of steam turbines. The tunnel is equipped with a standard instrumentation for the measurement of the flow properties and for the analysis of the size distribution of the droplets. Two measurement methods were used for the measurement of the size of the droplets, photogrammetry and light scattering. In this paper, the image processing of the captured images is discussed. The images were taken by a camera with a telecentric lens. The paper contains an assessment of three image processing methods used for the measurement of the droplet distribution by the light extinction. Moreover, the formation of the droplets is captured on the trailing edge of the profile in the flow. The results bring a new view on the formation of droplets at high speeds.

Assessment of the haematological profile after appendectomy using linear titanium stapler clips: An experimental study in rats

Introduction: The technique of closing the appendiceal stump using linear titanium stapler clips is being used more and more frequently in laparoscopic surgery, despite the good practice in the use of resorbable single endoloop vicryl ligatures and/or the non-resorbable plastic hem-o-lok clips. No light has been shed on potential undesirable effects on the haemathological profile of the use of titanium stapler clips. This experimental study aimed at establishing any possible undesirable effect of linear titanium stapler clips and single resorbable vicryl endoloop ligatures on the blood cells in rats following appendectomy. Methods: A total of 70 adult rats were used, divided into a control group (n = 10), and two experimental groups (n = 30 + 30). The appendices were removed from the rats in the first experimental group using titanium stapler clips and in the second experimental group the appendiceal stump using resorbable endoloop vicryl ligatures was closed. In both experimental groups three sub-groups with ten animals each were formed, from which peripheral blood from a tail vein on days 7, 28 and 60 was removed postoperatively, in order to assess the usual haematological parameters. Stained blood smears were also analysed in order to establish any poikilocytotic erythrocytes present. Results: In the first experimental group, with the titanium stapler clips, more than 25 % neutrophils were found on day 7, which is a significantly different result (p < 0.05) to the control group. In the second experimental group, there were more neutrophils than in the titanium stapler clips group, especially on days 7 and 60 and the results of these two sub-groups differ statistically significantly, p < 0.05. Hypochromia was found in the endoloop vicryl ligatures group, as well as in the titanium stapler clips sub-group on day 28, due to lower haemoglobin values which were significantly different to the control group, p < 0.05. Moderate levels of annulocytes, spherocytes and stomatocytes were found in most experimental groups. Conclusion: The results of this study favour the use of linear titanium stapler clips over resorbable single endoloop vicryl ligatures, because a less unfavourable effect was established on the blood cells of the experimental rats with their use.

Problems and prospects for the development of a public environmental control system

In Russia system of public environmental control is picking up momentum these days. It manages social relations in the field of environmental protection and rational use of natural resources. But it is not unique. It sometimes plays a crucial role, as in the case of diesel spillage in Norilsk in May 2020, but sometimes not. Natural resources have been developed all over the world for centuries with minimal environmental control. This is largely due to the fact that the adverse impact on the environment was not understood and assessed in the way it is now, and at that time the available technologies could not always prevent or control damage to the environment. The result of such unfavourable effect contaminated soils and water, flora and fauna, landscape and many others change. This article is devoted to the issues of improving the system of state and public control of environmental protection.

Effect of Excessive Body Weight and Psoriasis in Women Undergoing ICSI Procedure and State of Health of the Newborn

Excessive body weight and some concomitant diseases, such as psoriasis, accompany women treated due to infertility by intracytoplasmic sperm injection (ICSI). This study is aimed to assess effect of obesity and psoriasis on quality of egg cells, embryos, course of pregnancy, and state of a newborn after treatment with ICSI. A total of 140 women were included into the study (110 healthy women and 30 with psoriasis). Among healthy women, BMI negatively correlated with total recovery rate, total oocyte score, blastocyst formation rate (BFR) and amount and quality of blastocysts (r < 0, p < 0.001). The relationships were similar in psoriasis, however apart from average blastocyst quality (p = 0.17) and BFR (p = 0.352). In healthy patients, BMI negatively correlated with gestational age at delivery (r = −0.444, p = 0.010) and APGAR (r = −0.481, p = 0.005). An excess of adipose tissue exerts an unfavourable effect on female reproductive functions, especially with a simultaneous burden of psoriasis. Excessive body weight is conducive to development of gestational diabetes and shortens the duration of pregnancy. The burden of psoriasis in combination with excessive body weight has an impact on the risk of occurrence of intrauterine growth restriction of foetus. Overweight and obesity negatively affect the state of a newborn, measured using APGAR scale.

The influence of quenching temperature on distortions during the individual quenching method

Purpose: In this paper, the impact of hardening temperature on the quenching distortions which occur during low-pressure carburizing with gas quenching - using the individual quenching method - was analysed. Design/methodology/approach: The reference elements were subjected to carburizing at 980°C, followed by gas quenching at temperatures of 860°C, 920°C and 980°C. The geometrical measurements of the elements were made before and after the chemical treatment and the size of the quenching distortions of their geometrical parameters was determined. Findings: It was demonstrated that a high temperature of quenching has an unfavourable effect on changes in cylindricity and roundness parameters but, at the same time, reduces the size of distortion of outer parameters. Low temperature quenching reduces quenching distortions of cylindricity and roundness parameters while increasing the distortion of outer dimensions. Research limitations/implications: Based on the research and analysis carried out in this work, it was found that the use of lower quenching temperature is justified in economic and quality terms. Practical implications: In the case of the aviation or automotive industry, very high quality of manufactured elements along with a simultaneous reduction of their production costs is extremely important. Maintaining the dimensions of the elements during heat treatment is extremely difficult. The tests allowed to determine the optimal hardening temperature, which brings with it acceptable deformations. Since it is easier to “repair” the outer geometrical dimensions (diameter, thickness), it seems that quenching from lower temperatures is a more favourable process. Originality/value: The conducted tests allowed to determine the most favourable conditions for hardening elements from the automotive industry, taking into account the occurring deformations and their subsequent processing.

Potential value of pretreatment neutrophil-to-lymphocyte ratio in patients with bone sarcomas

Background Increasing evidence indicates the important value of the neutrophil-to-lymphocyte ratio (NLR) in various cancers. In this meta-analysis, we will explore the potential role of pretreatment NLR in patients with bone sarcomas. Methods A systematic literature search of the PubMed, Embase and Web of Science databases for relevant articles was performed with the deadline of December 29, 2019. The hazard ratio (HR) and its 95% confidence interval (CI) were calculated to evaluate the association between NLR and overall survival (OS) in patients with bone sarcomas. Results A total of 1131 patients in 6 studies were included in this meta-analysis. The pooled HR of 2.26 (95%CI: 1.83-2.69, p<0.001) indicated that an elevated NLR had an unfavourable effect on OS. Subgroup analyses showed that elevated NLR was related to poor OS in patients with bone sarcomas, regardless of the type of cancer, ethnicity, sample size (≥200 or <200), the cut-off value for NLR (≥3 or <3), follow-up time (≥30 or <30) and paper quality (NOS scores ≥8 or <8). Additionally, the results of diagnosis analysis suggested that NLR had a relatively high diagnostic accuracy for bone sarcoma patients. Conclusion The results of this meta-analysis suggest that an elevated NLR is associated with poor survival of patients with bone sarcomas. Moreover, NLR had a relatively high diagnostic accuracy for bone sarcoma patients. All these findings suggest NLR might be a promising biomarker in the management of bone sarcomas.

Spotlight on the fetus: how physical activity during pregnancy influences fetal health: a narrative review

Before and during pregnancy, women often aim to improve their lifestyle so as to provide a healthier environment for their developing child. It remains unresolved, however, as to whether physical activity (PA) during pregnancy poses a possible risk or whether it might even have beneficial effects on the developing child. There is increasing evidence that PA during pregnancy is indeed beneficial to maternal physiological and psychological health and that it is generally not detrimental to the fetal cardiovascular system and neuronal function in the developing child. This also led to international recommendations for PAs during pregnancy. In the current review, we aimed to comprehensively assess the evidence of beneficial and harmful effects of maternal PA, including high-performance sports, on fetal development. The different mental and body-based relaxation techniques presented here are frequently performed during pregnancy. We found a considerable number of studies addressing these issues. In general, neither low key, moderate maternal PA nor relaxation techniques were observed to have a harmful effect on the developing child. However, we identified some forms of PA which could have at least a transient unfavourable effect. Notably, the literature currently available does not provide enough evidence to enable us to make a general conclusive statement on this subject. This is due to the lack of longitudinal studies on the metabolic and cognitive effects of regular PA during pregnancy and the wide diversity of methods used. In particular, the kind of PA investigated in each study differed from study to study.

Economic Recession, Informal Sector and Skilled–Unskilled Wage Disparity in a Developing Economy: A Trade-Theoretical Analysis

The paper analyses some selective aspects of economic crises, namely skilled-sector recession, reversed international migration of labour and decline in foreign capital inflow on the informal sector employment and wage rate in developing economies and seeks to explain the non-monotonic effect on the informal sector both across nations and within nation across sectors. In so doing, we develop three-sector General Equilibrium models under two different scenarios which may apply to a large class of emerging market economies. In the first model, we have a traded informal export sector, and the role of the non-traded informal sector in the presence of credit market imperfection is analysed in the second model. Skilled-sector recession produces a favourable (unfavourable) effect on the workers employed in the traded informal sector (non-traded informal sector) due to an induced complementary relationship between the high-skilled export sector and the informal sector. A fall in emigration level of skilled or unskilled worker and a decline in foreign capital inflow hurt the workers in the informal traded sector, while the workers in the non-traded informal sector gain. The results of the paper reflect contradictions of an emerging economy, which is essentially hybrid economics in which capitalist nucleus has a conditional-conditioning relationship with an archaic structure. JEL Codes: F13, J31