Modern view on the classification of neuroendocrine neoplasms of stomach

Neuroendocrine neoplasms (NEN) of the stomach include a heterogeneous group of neoplasms characterized by different pathogenetic mechanisms, metastatic potential, and prognosis. The incidence of gastric NAN has increased 15-fold over the past few decades. It is necessary to clearly distinguish between well-differentiated neuroendocrine neoplasms (NETs) of the stomach and neuroendocrine cancer (NECs) of the stomach, as well as mixed neuroendocrine-non-neuroendocrine neoplasms. To date, there are three classifications that are used in clinical practice: clinicopathological classification, WHO classification, and UICC TNM classification. It should be noted that over the past five years, these classifications have undergone important changes. In the clinicopathological classification, in addition to the existing three types, a number of authors proposed to add the 4th type (developing as a result of inadequate functioning of the proton pump) and the 5th type (developing in patients who receive long-term therapy with proton pump inhibitors). In the 2019 WHO classification, an important change is the acceptance that well-differentiated NETs can have a high degree of malignancy – Grade III. The main changes in the 8th edition of the TNM classification concerned the differentiation of the M symbol. Thus, to date, the classification of gastric NENs allows us to accurately characterize tumor staging, the pathogenesis underlying their development, and prognosis. They form the basis for choosing an adequate treatment strategy that makes possible to achieve the most favourable result.

Use of different options of anti-inflammatory therapy in patients with severe COVID-19

The aim of the study. To compare the effectiveness of methylprednisolone, dexamethasone and tocilizumab in patients with severe coronavirus disease. Identify the most appropriate treatment option. Materials and methods. Patients of group 1 (n=20) received for anti-inflammatory purposes tocilizumab at a dose of 600–800 mg. Patients in group 2 (n=82) received pulse therapy with methylprednisolone. Patients in group 3 (n=20) received dexamethasone 6 mg / day. Data are presented as M [25–75]. Statistical analysis of the results was performed using the program "Statistica 10". Significance of differences in indicators was assessed using the nonparametric Wilcoxon test. The results were considered reliable at values of p <0.05. Results. The severe course of coronavirus disease with the development of cytokine storm and respiratory distress syndrome is characterized by an increase in markers of inflammation: in group 1 the median CRP was 89.2 g / l, in group 2 – 64.2 g / l, and in 3 – 76.2 g / l, and did not differ significantly between groups (p> 0.05). The level of IL-6 in group 1 was 61.8 pg / ml, in group 2 – 64.6 pg / ml, and in group 3 – 46.5 pg / ml without significant differences between groups (p> 0.05). The level of ferritin in all groups exceeded normal values. Conclusions The most favourable result was obtained when using methylprednisolone: it was possible to reduce the mortality rate to 59.8 %. The relative risk of developing VTE was significantly higher in groups 1 and 3 (RR12 6.8 [2.7–16.8] p12 <0.0001, RR23 0.15 [0.06–0.35] p23 <0.0001), which gives grounds to confirm the presence of anticoagulant activity in methylprednisolone

Innovative Development in the Context of Complementarity

The peculiarities of innovative development in the interaction of economic and social components of the external and internal environment are studied on the basis of a complementary approach, namely the relationship between economic efficiency and social justice, their negative and positive impact on the quality of life and socio-economic development opportunities. As for complementary development, the idea of justice, which currently is an important factor in achieving European living standards and guaranteeing social-economic rights of a person and citizen, plays an important role in reforming all the spheres of public life, democratization of Ukrainian society, and providing Ukraine's integration into the European political and legal space. Complementarity research is becoming relevant at the present stage of global economic development, when the market situation is characterized by a fairly high rate of transformation, and innovation becomes the main competitive factor. The author considers the emergence of the complementarity concept in research works made in various areas (e.g., the concept of institutional complementarity), and also highlights the features of compensatory and supplemental complementarity. Unconditional following global examples without taking into account the state of real socio-economic and institutional structures in a certain state will not give a favourable result from implementing reforms and introducing innovations due to the lack of complementary connections. Therefore, the conditions for the emergence of new institutional changes and the impact of "social elevators" on social development in the long run are analyzed. The presence of complex unresolved problems in the development of our state actualizes the study of the complementary context of innovative development, aimed at rethinking the role of social justice in solving major economic problems. Due to a complementary approach, the economic system will be able to increase such features as adaptability and continuity by developing mechanisms of self-preservation, and will acquire systematic innovative development with a ripple effect.

Pairing function of visual binary stars

ABSTRACT An all-sky sample of 1227 visual binaries based on Washington Double Star catalogue is constructed to infer the initial mass function (IMF), mass ratio, and projected distance distribution with a dedicated population synthesis model. Parallaxes from Gaia DR2 and Hipparcos are used to verify the distance distribution. The model is validated on the single-star Tycho-2 sample and successfully reproduces the observed magnitudes and angular separations. The projected separation distribution follows f(s) ∼ s−1.2 in 102–2 × 103 au range for 1–4.5 m⊙ primary stars. Several algorithms are explored as pairing functions. Random pairing is confidently rejected. Primary-constrained pairing (PCP) and split-core pairing (SCP), the scenarios adopting primary component’s or total system’s mass as fundamental, are considered. The preferred IMF slope is α ∼ 2.8 either way. A simple power-law mass ratio distribution is unlikely, but the introduction of a twin excess provides a favourable result. PCP with f(q) ∼ q−1 is preferred with a tiny twin fraction, models with f(q) ∼ q−1.5 are acceptable when a larger twin excess is allowed. SCP is similar to PCP when a larger slope of the power law is adopted: f(q) ∼ qβ + 0.7.

SAPHO syndrome: the supposed trigger by isotretinoin, the efficacy of adalimumab and the specter of depressive disorder: a case report

Background SAPHO (synovitis, acne, pustolosis, hyperostosis and osteitis) syndrome is a rare autoinflammatory chronic disorder, presenting with non-infectious osteitis, sterile joint inflammation and skin manifestations including palmoplantar pustolosis and severe acne. It could be often misdiagnosed for its heterogeneous clinical presentation. Treatment is challenging and, due to the rarity of this syndrome, no randomized controlled clinical trials have been conducted. Empirical treatments, including non-steroidal anti-inflammatory drugs (NSAIDs), corticosteroids, antibiotics and bisphosphonates and disease-modifying anti-rheumatic drugs (DMARDs) could be quite effective. Anti-tumor necrosis factor-alpha (anti-TNF-α) agents and interleukin-1 (IL-1) antagonists have shown promising results in refractory patients. Isotretinoin, commonly used for severe acne, has been rarely described as possible trigger of osteo-articular manifestations, in particular sacroiliitis. Case presentation The case of a boy, affected by acne fulminans and depression, who presented with sacroiliitis after a 10-week treatment with isotretinoin is presented. After SAPHO diagnosis, NSAIDs therapy was started but the onset of bilateral gluteal hidradenitis suppurativa required the switch to a TNF-α antagonist (Adalimumab) with the achievement of a good control of the disease. Despite specific therapy with sertraline, the patient continued to complains severe depression. Conclusions Our case reports a temporal association between the onset of osteo-articular symptoms and the introduction of isotretinoin, as previously described. However, this timeline is not sufficient to establish a causal role of this drug into the pathogenesis of sacroiliitis. At this regard, further studies are required. The occurrence of hidradenitis suppurativa during SAPHO course supported the introduction of TNF-α blockers with a favourable result, as reported in a few cases in literature. The association between SAPHO syndrome and depressive mood disorders is already reported. Our patient experienced severe depression whose trend seems to be independent from the course of the main disease. Currently, it is not clarified if depression could be considered reactive to the underling disease or if it forms an integral part of the autoinflammatory disorder.

REMEDIATION ABILITY OF MELON GRASS IN A CRUDE OIL POLLUTED SOIL IN A TROPICAL REGION

The aim of this research was to study the effectiveness of a chosen grass (plant) in the remediation of soil contaminated by crude oil. Lemon grass was used in this study to remediate the polluted soil because of its perceived ability to do so. Five wooden boxes were fabricated, and 150kg of soil were introduced to each of them. Four of the boxes were contaminated with different concentrations of crude oil, while two out of these four boxes were amended with cow dung. One of the boxes that served as control was neither contaminated nor amended. Lemon seeds were then planted in all the boxes and allowed to grow for the period of 12 weeks. Analysis were done at the beginning, during and after the plant growth in order to determine the rate of remediation, with particular interest in the TPH (total petroleum hydrocarbon), and few other heavy metals; copper, magnesium, aluminum. Two concentrations of contamination were artificially made (75g and 150g). The TPH, Pb, Zn and Ni contents of the 75g crude oil contaminated soil were 6.784µg/g, 0.485mg/kg, 0.867mg/kg and 0.030mg/kg respectively. It reduced to 6.356µg/g, 0.058mg/kg, 0.560mg/kg and 0.043mg/kg respectively after remediation. The TPHPb, Zn and Nicontents of the 150g crude oil contaminated soil were 9.109µg/g, 0.699mg/kg, 0.851mg/kg and 0.032mg/kg respectively. It reduced 7.713µg/g, 0.059mg/kg, 0.506mg/kg and 0.057mg/kg respectively after remediation. An interesting observation was that, amending the contaminated soil with cow dung gave a favourable result in remediating the contaminants. It took about 80months to remediate TPH to an acceptable level of 0.013µg/g, but over 150months to do the same for an unamended soil. This finding can be applicable in the estimation of time requirement for the remediation of crude oil polluted soil by concerned stake holders.

Dysautonomia secondary to third ventriculostomy successfully managed with midodrine

Hypothalamic lesions can compromise its essential regulatory roles resulting in critical disruption of temperature and blood pressure homoeostasis. We present the case of a 55-year-old woman who had been previously submitted to several neurosurgical procedures aimed at treating idiopathic hydrocephalus. She presented to our department with recurring episodes of hypothermia and wide blood pressure variations, which had been worsening over the last few years. After extensive complementary workup, which excluded new neurological lesions or endocrinological conditions, hypothalamic dysfunction was assumed to be the cause of this syndrome. She was successfully treated with midodrine and on-demand captopril, which resulted in adequate control of her blood pressure. This case highlights the rare and unpredictable consequences of damage to the hypothalamus, depicting the favourable result of a heretofore unpublished medical approach.

Boundary Layer Control of Airfoil using Rotating Cylinder

The requirement for improving the aerodynamic efficiency and delaying the formation of stall over the wing has been of prime importance within the field of aviation. The main objective of the project is to further improve upon these two parameters. The configuration used for analysis consists of a NACA 2412 airfoil of chord length 0.982m with a 64mm cylinder at the leading edge. Analysis is completed using ANSYS Fluent, with a freestream velocity of 10m/s. The aerodynamic characteristics of three configuration bare airfoil, Airfoil with static cylinder and Airfoil with rotating cylinder are tabulated and plotted. The comparison is then followed by pressure and velocity contours to visualize the flow over each configuration. The rotating cylinder configuration shows a improvement in the aerodynamics characteristics. The rotating cylinder configuration gives the most favourable result. This study has a potential application in high lift devices and can be used as stall delaying device

Fuzzy Logic Based Control of Multilevel Inverter for Railway Traction System

This research especially focus on Railway Traction System of Electrical Multiple Units (EMUs) and illustrate the approaching of an Asymmetric Cascaded H-bridge (ACHB) 9-level MLI controlled by the Fuzzy Logic Controller (FLC) to enhance the quality of output by sinking the harmonic contents in the output result. As in the railway, traction system desires high power and voltage for its operation. So it is proficient to utilize recent introduced Multilevel Inverter (MLI) instead of Conventional Inverter. MLI which is discussed here uses two H-bridge modules with unequal DC sources and it is competent to generate multilevel results at output side. Here proposed MLI uses limited semiconductor switches and voltage source. Therefore expenditure and dimensions of the system is condensed. Thus the system effectiveness will enhance. Simulation has done by MATLAB software to authenticate the performance and functional study of proposed MLI. The simulated output shows very favourable result. Comparison has been made between the two (Conventional and Multilevel) power circuit configurations.

P19 Mycophenolate mofetil in paediatric uveitis: an early experience

Background Juvenile idiopathic arthritis (JIA) is the commonest cause of uveitis in children. Uveitis is a significant cause of visual impairment in children with potential complications such as band keratopathy, cataract, posterior synechiae, glaucoma, cystoid macular oedema and a retinal problems. Following the initial treatment with topical and systemic corticosteroids, a wide variety of immunosuppressant agents have been used in the treatment of non-infective uveitis including methotrexate (MTX) and biologic therapy, most of which are administered parenterally. Mycophenolate Mofetil (MMF) is an oral immunosuppressant that inhibits the proliferation of T and B lymphocytes, which has been tried in children with uveitis with mixed results. We started using MMF in children seen in our paediatric uveitis clinic initially as a third line agent when the inflammation is not well controlled despite therapeutic doses of MTX and Adalimumab, as the NHS England Clinical Commissioning Policy does not recommend the use of Infliximab in uveitis not associated with JIA. Buoyed by some favourable result, we have since then used MMF as second line and even first line agent in children with uveitis. Methods Retrospective analysis of the clinical profile of children with uveitis on MMF at a tertiary paediatric rheumatology centre with focus on response to treatment. Results Of the 8 patients who received MMF, six (75%) were girls. Half of them (4/8) had idiopathic uveitis and the rest, associated with JIA. 2/8 patients had MMF as third line agent on top of MTX and Adalimumab, while five of them had it as second line agent on top of Adalimumab due to either MTX intolerance or needle phobia. One patient was started on MMF as first line agent following topical steroids. 6 (75%) of the patients responded/stayed in remission following the addition of/switch to MMF. Conclusion MMF has shown initial promise in the treatment of uveitis in children with uveitis in this small cohort, in line with some existing evidence. It was initially used in patients who were not keen on injections/intolerant to MTX or had failed all existing options. This is a small cohort of patients and we would welcome more research in this area. Conflicts of Interest The authors declare no conflicts of interest.