Letteratura scientifica selezionata sul tema "629.892 631"

El presente artículo procura arrojar luz sobre veintisiete loci critici de la Soledad primera (1613) de Góngora: vv. 117-120, 153-162, 167-168, 171-175, 182-189, 212-221, 263-266, 291-296, 321-328, 344-349, 374-375, 461-464, 500-502, 573-579, 580-584, 585-589, 598-601, 623-629, 667-668, 701-704, 705-708, 810-811, 812-817, 866-871, 872-878, 895-896, 943 y 1012-1013. A partir de la formidable edición de Robert Jammes (1994), releemos aquí un puñado de lugares de la silva de los campos acerca de los cuales el filólogo confesó que le asaltaban dudas. Acudimos para ello a los gongoristas antiguos (Almansa y Mendoza, Jáuregui, el Abad de Rute, Díaz de Rivas, el anónimo antequerano, Pellicer, Salcedo Coronel, Vázquez Siruela) y también a los modernos (Reyes, Spitzer, Alonso, Orozco, Pabst, Alatorre, Carreira, Sinicropi, Molho, Ly, Poggi, Cancelliere, Romanos, Sánchez Robayna, Lara Garrido, Yoshida, Blanco, Mazzocchi, Micó, Roses, Pérez Lasheras, Ponce Cárdenas, Collins, Tenorio, Matas Caballero, Chemris, Osuna Cabezas, Palomares, Castaldo, Román Gutiérrez, Tanabe, Rojas Castro, Conde, Sandoval...), sin orillar la tradición clásica, la emblemática y el diálogo con el resto del corpus poético de don Luis.

Familial medullary thyroid carcinoma (FMTC) and multiple endocrine neoplasia type 2A syndromes are dominantly inherited diseases caused by activating germline mutations of the RET protooncogene. The majority of these patients carry a germline point mutation affecting one of five cysteine residues encoded by exon 10 (codon 609, 611, 618, or 620) or 11 (codon 634). In a few FMTC families, point mutations involving noncysteine codons in exon 13 (codons 768, 790, and 791), 14 (codon 804), or 15 (codon 891) have been reported. Hirschsprung’s disease is a nonneoplastic disorder associated with RET mutations leading to a loss of function effect. Mutations are identified in 50% of the familial cases and are scattered along the gene. We now report the study of a FMTC family with four affected members and a history of fatal neonatal intestinal obstruction in the sister of the proband. Genetic analysis demonstrated the absence of an usual FMTC mutation and the presence of a germline 9-bp duplication in RET exon 8 in the heterozygous state in all patients with MTC. This new mutation creates an additional cysteine residue in the extracellular cysteine-rich domain of RET. Further studies are warranted to confirm whether this new mutation is causing MTC only or could be associated with Hirschsprung’s disease.

631 Background: Sunitinib remains an important treatment option for mRCC, but the effect of comorbidities/comedications on sunitinib treatment outcomes have not been fully explored. Methods: Data were collated from STAR-TOR, an ongoing real-world registry. Cutoff date for analysis was 19 June 2019. This subgroup analysis assessed the presence or absence of hypertension (HTN), and the use or non-use of statins and proton pump inhibitors (PPIs), determined at the time of entry to the registry. Treatment endpoints were overall survival (OS), progression-free survival (PFS) and objective response rate (ORR). OS and PFS were analyzed by Kaplan-Meier methods. Differences within subgroups were tested using Log-rank test for OS and PFS, and Fisher’s exact test for ORR. Results: 557 sunitinib-treated pts were analyzed; 366 had HTN and 191 did not, 130 used statins and 427 did not, and 165 used PPIs and 392 did not. Median (m) OS (95% confidence intervals) was similar in pts with and without HTN (25.4 [21.1, 31.5] vs 21.5 [15.2, 28.0] months; p = 0.215). mPFS (8.0 [6.5, 9.9] vs 6.3 [5.4, 8.2] months; p = 0.140) and ORR (31.2% vs 30.9%; p = 1.000) were also similar in pts with and without HTN. mOS was similar in pts who used statins vs those who did not (27.8 [20.2, 35.4] vs 24.0 [19.4, 27.3] months; p = 0.884), while mPFS was significantly longer in pts who used statins (9.4 [6.5, 13.6] vs 6.9 [5.7, 8.2] months; p = 0.044). ORR was 37.8% vs 29.0% in pts who did and did not use statins (p = 0.072). mOS was significantly shorter in pts who used PPIs vs those who did not (20.2 [14.9, 28.3] vs 25.7 [22.7, 33.0] months; p = 0.021). mPFS (5.8 [4.6, 8.2] vs 8.0 [6.5, 9.8] months; p = 0.091) and ORR (26.6% vs 33.0%; p = 0.177) were similar in pts who did and did not use PPIs. Conclusions: In sunitinib-treated pts with mRCC in a real-world registry, mPFS was significantly longer and there was a trend toward better ORR in pts who used statins, whereas mOS was significantly shorter and there was a trend toward shorter mPFS in pts who used PPIs. Common comedications may affect sunitinib treatment outcomes in pts with mRCC.

Primary Sjögren’s syndrome (pSS) is known as autoimmune disease characterized by damage to endocrine glands, such as the salivary and lacrimal glands. This study aimed to identify potential biomarkers for pSS using integrated bioinformatics analysis and explore the relationship between differentially expressed genes (DEGs) and immune infiltration. Three pSS datasets (GSE7451, GSE23117, and GSE40611) from the gene expression omnibus database were integrated. All the datasets were processed in R (version 4.0.3). A total of 16 immune cells and 13 immune functions were obtained. The top immune cell and immune function were “activated” dendritic cells and major histocompatibility complex class I. Correlation analysis showed the top correlation among 16 immune cells were B cells and tumor infiltrating lymphocytes, check-point and T cell co-stimulation, respectively. In comparisons of immune score, “activated” dendritic cells (.657 vs 594, P < .001), B cells (.492 vs 434, P = .004), macrophages (.631 vs 601, P = .010), inflammation-promoting (.545 vs 478, P < .001), Type I interferon Reponse (.728 vs 625, P < .001) and so on were higher in pSS than control group. In correlation analysis, the up-regulation of interferon induced protein with tetratricopeptide repeats 1 gene was strongly correlated with Type I interferon response with a correlation coefficient of .87. The receiver operating characteristic curve of 5 genes showed that the area under curve was.891. In the verification model, the area under curve was.881. In addition, disease ontology analysis supported the association between DEGs and pSS. In summary, pSS has a variety of DEGs in immune infiltration, which is worthy of the attention from clinicians.

Objective: In children with RET proto-oncogene mutation, curative treatment of medullary thyroid carcinoma (MTC) is possible by prophylactic thyroidectomy. Recommendations on the timing and extent of thyroidectomy are based upon a model that utilises genotype–phenotype correlations to stratify mutations into three risk groups. Design: We evaluated the long-term outcome (mean follow-up 6.4 years, 15 patients more than 10 years, 26 patients more than 5 years) of operated gene carriers stratified into two risk groups (levels 1 and 2) based on the biological aggressiveness of MTC. Results: In 46 RET gene carriers, prophylactic thyroidectomy was carried out between the ages of 4 and 21 years. Level 1 mutations were harboured by 11 patients (codons 790, 791, 804 and 891). Histology was completely normal in two patients; in seven patients C-cell hyperplasia (CCH) and in two patients T1 tumours were diagnosed. All patients with level 1 mutations were cured. Level 2 mutations were harboured by 35 patients (codons 618, 620, 630 and 634). Histology of these patients showed CCH in 11 patients, T1 tumours in 21, T2 tumour in 1, T3 tumour in 1 and Tx in 1 patient. Histology showed no lymph node involvement. Five patients with level 2 mutations failed to be cured; in two patients, persistence of MTC was diagnosed directly after thyroidectomy and in three during follow-up. In two patients carrying a 634 mutation, other endocrinopathies (hyperparathyroidism and bilateral pheochromocytoma) manifested during follow-up. Conclusions: If prophylactic thyroidectomy is done at early ages, cure rate is high. Timing and extent of prophylactic thyroidectomy can be modified by individual RET mutation.

This paper aims to produce a low profile, wideband, and high gain antenna for chipless RFID tag readers. A miniaturized and wideband printed Log-Periodic Second Series Koch Dipole Array (LPSSKDA) with eleven elements operating over 0.8 GHz-3.2 GHz is designed using the FR4 board. The single LPSSKDA antenna, which acts as the chipless RFID reader antenna having gain between 5.2 and 6.1 dBi and frequency range from 1-3 GHz. A double element of the LPSSKDA antenna is proposed for improving the antenna gain to 6.9-7.9 dBi over the frequency range. The antenna is fabricated to validate the simulation and measurement results in terms of reflection coefficient, radiation pattern, and surface current distribution.

The present article examines the chemical composition of fiber and shive from fiber flax and hemp obtained in Russia under industrial conditions, as well as that of the products of their alkaline delignification. Alkaline delignification was carried out at atmospheric pressure with a 4% sodium hydroxide solution; the chemical composition was determined via wet analysis. The chemical composition of hemp shive from Russian producers was studied for the first time. In the studied objects, the mass fraction of cellulose was found to range from 42.3 to 66.1%, and after alkaline delignification, the yield of products reached 47.0–50.0%. The behavior of fiber flax and hemp fiber is similar during alkaline delignification: cellulose content increases by 1.2–1.3 times, pentosan content decreases by 4.3–6.3 times, and lignin content is virtually the same. The behavior of fiber flax and hemp shive is dramatically different during alkaline delignification. The shive of fiber flax is resistant to alkaline delignification: cellulose content increases by 1.4 times, pentosan content decreases by 4.2 times, and lignin content increases by 1.4 times, which is due to the nature of lignin. Hemp shive is easily alkaline delignified: cellulose content increases by 1.8 times; the content of pentosans decreases by 5.8 times, and lignin content decreases by 2.2 times; the product of alkaline delignification contains cellulose (87.3%), pentosans (5.4%), and lignin (8.2%). The use of hemp shive for chemical and biotechnological transformation is expected to have high prospects.

621 Background: Renal cell carcinoma (RCC), which accounts for about 3% of adult malignancies, is regarded as a major cause of morbidity and mortality. The neutrophil-lymphocyte ratio (NLR) is a simple, reliable, and cost-effective biomarker of systemic inflammation that has been linked to oncologic outcomes in a variety of malignancies. The objective of this study is to determine whether NLR, along with other hematological parameters such as absolute neutrophil count (ANC), absolute lymphocyte count (ALC), absolute eosinophil count (AEC), absolute monocyte count (AMC), monocyte-lymphocyte ratio (MLR), platelet-lymphocyte ratio (PLR), and the Systemic Immune-Inflammation Index (SII; defined as neutrophils counts X platelets counts divided by lymphocyte count), are related to baseline distant metastases and overall survival (OS) in RCC patients. Methods: Clinical data from 203 RCC patients treated at King Hussein Cancer Center (Amman, Jordan) were retrospectively reviewed. We examined the relationship between age, sex, ANC, AMC, ALC, AEC, NLR, MLR, PLR, and SII with baseline distant metastasis and patients’ OS. Results: Of the 203 patients, 97 patients (48.5%) were stage 4 at the time of diagnosis. Univariate analysis showed that patients with high baseline ANC (>5400), AMC (>600), AEC (>120), NLR (>4.36), MLR (>0.33), PLR (>140.44), WBC count (>8.2), SII (>757.7) and low baseline ALC (≤1900) had more baseline metastasis. (p-value: <0.001, 0.007, 0.020, <0.001, <0.001, <0.001, 0.006, <0.001, and 0.004, respectively). On multivariate analysis, patients who had elevated NLR (>4.36) were more likely to have distant metastasis at the time of diagnosis (p-value = 0.0076, odds ratio (OR): 4.45, CI: 1.49–13.33). Moreover, univariate and multivariate analysis showed that patients with elevated NLR (>4.36) were associated with poorer OS (p-value: <0.0001 and 0.0065, respectively). In addition, patients with elevated baseline ANC, AMC, MLR, PLR, SII, WBC count, and low ALC values were associated with poorer OS (p-value: <0.0001, 0.0234, <0.0001, <0.0001, <0.0001, 0.0290, and <0.0001, respectively). Conclusions: The results of this study indicate a substantial correlation between several hematological parameters, including NLR, with the presence of distant metastases at the time of diagnosis and OS. Further research is required to uncover whether these hematological markers may be used to identify patients who are more likely to develop metastases and predict treatment response.

BackgroundT-cell trafficking to the tumor is inhibited via vascular endothelial growth factor (VEGF)-mediated down-regulation of important adhesion molecules on tumor-associated blood vessels and progression of disease on immune checkpoint blockers (ICBs) has been associated with decreased tumor-infiltrating immune cells.1 2 We hypothesized that inhibiting VEGF signaling through its receptor, VEGFR2, would increase intratumoral T cells. Therefore we sought to evaluate the combination of ramucirumab, an anti-VEGF receptor 2 monoclonal antibody, and atezolizumab in patients with advanced-stage, non-small cell lung cancer (NSCLC) patients who have previously progressed on at least one line of ICB. Here, we report on the first twelve patients enrolled on trial.MethodsAdvanced stage NSCLC patients with an ECOG performance status of ≤1 who had previously been treated with ICBs were eligible with no limitation on prior lines of ICB therapy. Patients with untreated brain metastasis, recent hemoptysis, gastrointestinal bleeding or perforation or fistula were excluded. The study was conducted with a two-stage MiniMax design. Peripheral blood and repeated biopsy, when feasible, were collected for correlative analysis.ResultsTwelve patients were enrolled in the first stage of the trial. The median age was 68 (range 47-78), 10 of the patients are female, and 10 had non-squamous histology. Patients had an average of 3.5 prior lines of therapy and 1.6 lines of prior immunotherapy. Overall, treatment was well-tolerated with no grade 3 or 4 adverse events. The most common adverse events were grade 1 or 2 hypertension (35%), nausea (25%) and vomiting (25%). There were no objective responses and 11 patients (91%) achieved stable disease. The median progression-free survival is 3 months with 3 patients (25%) on trial for more than 12 months. The median overall survival (OS) at the time of the latest data cutoff on 9/15/20 is 11.5 months.ConclusionsThe preliminary data from our study showed that combination of ramucirumab and atezolizumab is well-tolerated and associated with prolonged overall survival in a subset of heavily pretreated patients who progressed on prior ICB. The trial is still accruing patients and exploratory analyses are planned.Ethics ApprovalThe study was approved by the Washington University Institutional Review Board.ReferencesDirkx AE, oude Egbrink MG, Castermans K, et al. Anti-angiogenesis therapy can overcome endothelial cell anergy and promote leukocyte-endothelium interactions and infiltration in tumors. FASEB J 2006;20(6):621-630.Herbst RS, Soria JC, Kowanetz M, et al. Predictive correlates of response to the anti-PD-L1 antibody MPDL3280A in cancer patients. Nature 2014;515(7528):563-567.

Simulacó numérica directa de la dispersió turbulenta de plomalls amb flotació en un flux en un canal Alexandre Fabregat Tomás, Tarragona, octubre del 2006
1 Introducció
L'objectiu d'aquest treball és estudiar la dispersió turbulenta de calor en diferents configuracions basades en el canal desenvolupat mitjançant DNS (Direct Numerical Simulations). Aquesta eina ha demostrat ser de gran utilitat a l'hora d'estudiar fluxos turbulents ja que permet, donada una malla computacional capaç de capturar totes les estructures del flux i un esquema que minimitzi els errors i la dissipació numérica, descriure acuradament l'evolució temporal del flux. Permet a més, donada la descripció tridimensional i temporal del flux, determinar amb precisió qualsevol quantitat que seria impossible d'obtenir experimentalment.
En el flux en un canal, el fluid esmou entre dues parets planes, llises i paral·leles separades una distància 2d impulsat per un gradient constant mitjà de pressió. El flux s'anomena desenvolupat quan ja no hi ha efectes de regió d'entrada i la única inhomogeneïtat es troba en la direcció normal a la paret. Sota aquestes condicions, les quantitats promitjades esdevenen estacionàries en el temps.
En aquest treball s'ha validat el codi computacional mitjançant la reproducció d'algunes configuracions de flux prèviament estudiades per altres autors. Els nous coneixements en l'estudi de la dispersió turbulenta de calor s'han obtingut a l'incloure, en un flux totalment desenvolupat en un canal, una font lineal centrada verticalment que provoca l'aparició d'un plomall amb una temperatura més alta que la del flux del fons i que per tant, al tenir una menor densitat, experimenta flotació i es deflecteix. L'amitjanament temporal del flux permet estudiar les diferents contribucions dels diferents termes rellevants en les equacions de transport.
És d'especial interés la comparativa d'aquests resultats amb els corresponents a la formació d'un plomall a partir d'una font lineal d'un escalar passiu.
Per altra banda també s'ha estudiat l'eficiència en paral·lel dels mètodes multigrid en la resolució d'equacions de Poisson. Aquestes equacions són d'especial interés ja que apareixen en el càlcul de la pressió i representen un coll d'ampolla en termes de costos computacionals. Aquest mètode numèric ha estat comparat amb els mètodes de gradient conjugat (anteriorment emprats en el codi 3DINAMICS) en la resolució de diferents problemes comparant els costos en termes de temps de CPU i la seua escalabilitat en la màquina multiprocessador de memòria distribuïda del grup de recerca de Mecànica de Fluids de Tarragona.
2 Descripció matemàtica
Un cop adimensionalitzades mitjançant les escales adequades, les equacions de transport de quantitat de moviment i energia han estat discretitzades sobre una malla desplaçada mitjançant el mètode de volums finits emprant un esquema centrat de segon ordre. La discretització dels termes advectius en els casos amb fonts lineals ha requerit, però, d'un cura especial ja que la no-linealitat d'aquests termes pot provocar oscil·lacions artificials en el camp dels escalars. La difusió numèrica dels mètodes upwind, com el QUICK, ha estat quantificada i comparada amb resultats obtinguts per a esquemes centrats de segon ordre. Les equacions han estat integrades en el temps mitjançant un esquema implícit de segon ordre tipus Crank-Nicholson. També ha estat necessari implementar condicions de sortida per a la temperatura en els casos A i C del tipus no reflectant per tal de garantir la conservació i evitar l'aparició d'estructures artificials en el flux.
3 Descripció física
La figura 1 presenta un esquema del domini computacional corresponent al canal desenvolupat. De l'esquema es desprén que x, y i z corresponen a les direccions principal del flux, la perpendicular i la normal a les parets respectivament. Les configuracions del flux estudiades es troben resumides a la taula 1 on s'indica la resolució de la xarxa computacional, el nombre de Reynolds (basat en la velocitat de fricció ut) i en el casos amb flotació, el nombre de Grashof, la temperatura de referència i la direcció de flotació (la direcció del vector gravetat).
Les dimensions del canal s´on 8pd×2pd×2d en les direccions x, y i z respectivament.
En el cas A la temperatura representa un escalar de manera que el plomall format és passiu, és a dir, no hi ha acoblament entre les equacions de quantitat de moviment i energia. A diferència d'aquest, en els casos B i C totes dues equacions queden acoblades pel terme de flotació. Aquest terme apareix quan les diferències de temperatura en el si del fluid generen diferències de densitat. En el cas B, el canal vertical amb convecció mixta, cada paret del canal es troba a una temperatura constant però diferent. El vector gravetat i la direcció del corrent estan alineades de manera que aquesta direcció continua sent homogènia. En la zona propera a la paret calenta la flotació actua en la direcció del corrent imposada pel gradient mitjà de pressió. En canvi, en la zona propera a la paret freda, la flotació s'oposa al moviment del flux.
El cas C és similar al cas A però en aquesta ocasió la temperatura no es considera un escalar passiu i per tant la flotació acobla el camp dinàmic amb el de temperatures. El vector gravetat actua en aquest cas en la direcció normal. La inhomogeneïtat en la direcció del flux no permet continuar emprant condicions de contorn periòdiques i per tant, al domini presentat en la figura 1, se li ha acoblat una regió auxiliar a l'entrada on es resolen únicament les equacions de quantitat de moviment. Els camps de velocitat i pressió per a un canal totalment desenvolupat obtinguts en aquest domini auxiliar s'empraran com a condició de contorn a l'entrada del domini de computació. No és necessari cap tipus d'interpolació ja que la resolució del a xarxa d'aquest domini auxiliar és la mateixa que l'emprada en el domini de computació.
4 Resultats
Els resultats per a les simulacions presentades en la taula 1 contenen, principalment, els perfils de velocitat i temperatura mitjans així com la intensitat de les fluctuacions. A més, es presenten els perfils de les diferents contribucions dels termes relevants de les equacions de transport amitjanades. Per al cas C, els camps dinàmics i de temperatura no estan desenvolupats. Els perfils mitjans a diferents posicions aigües avall permeten estudiar l'evolució del plomall ascendent a més d'analitzar com la flotació afecta al balanç de les diferents contribucions. La figure 2 presenta el camp mitjà de temperatures per al cas C amb les tres posicions en la direcció principal del flux per a les quals s'han inclòs els perfils.
Finalment, es presenten els resultats corresponents a la comparativa entre els diferents solvers per a una equació de Poisson. Tots els mètodes numèrics han es-
3
Figura 2: Camp mitjà de temperatures per al cas C tat paral·lelitzats mitjançant les llibreries Message Passing Interface. En la figura 3 es presenten com a exemple els resultats (en termes de temps de CPU i speedup) per a la resolució de l'equació de Poisson per al desacoblament de pressió i velocitat en el cas del flux desenvolupat en un canal.
Els resultats de speed-up per als diferents mètodes mostren la baixa escalabilitat del solver multigrid comparat amb els altres mètodes del tipus gradient conjugat. La raó radica en les grans necessitats de comunicació d'un algoritme construït sobre un esquema de relaxació tipus SOR. Tanmateix, multigrid és el mètode numèric que requereix menys temps de CPU per concloure la tasca. El factor respecte als mètodes de gradient conjugat pot arribar a ser de 30 i per tant és el millor candidat per a la resolució d'aquests tipus de problemes.
The main goal of this work is to study the turbulent heat transfer in a developed channel flow using Direct Numerical Simulations (DNS). These simulations solve explicitly all the scales present in the turbulent flow so, even for moderate Reynolds numbers, the discretization grids need to be fine enough to capture the smallest structures of the flow and, consequently, DNS demands large computational resources. The flow, driven by a mean constant pressure gradient in the streamwise direction, is confined between two smooth, parallel and infinite walls separated a distance 2d.
The turbulent heat transport is studied for three different flow configurations.
Some of them are used as benchmark results for this work. The three cases reported can be summarized as:
· case A: Scalar plume from a line source in a horizontal channel.
· case B:Mixed convection with the gravity vector aligned with the streamwise direction (vertical channel).
· case C: Buoyant plume from a line source in a horizontal channel.
In addition, preliminary results for a turbulent reacting flow in a fully developed channel are also presented.
In the case B heat flux results from a temperature difference between the channel walls. The gravity vector is aligned with the streamwise direction and the Grashof, Reynolds and Prandtl numbers are Gr = 9.6 · 106, Ret = 150 and Pr = 0.71 respectively. Close to the hot wall, buoyancy acts aligned to the flow direction imposed by the mean pressure gradient so velocities are generally increased in comparison with a purely forced convection flow. Oppositely, near the cold wall, buoyancy is opposed to the flow and consequently velocities are decreased.
Cases A and C are similar because in both cases a hot fluid is released within a cold background flow through a line source vertically centered in the wall-normal direction located at the inlet. The height of the source is 0.054d. The injected hot fluid disperses forming a hot plume that is convected downstream between the two adiabatic walls of the channel.
The difference between cases A and C lies in the fact that for case A heat and momentum are decoupled and temperature acts as an scalar. Advection and diffusion are the only phenomena responsible for the evolution of the plume. On the other hand, in case C, buoyancy couples heat and momentum and, consequently, the plume floats drifting upward as it advances in the channel due to its lower density. In case C, the streamwise direction is not homogenous because of the coupling between heat and momentum. To guarantee developed conditions at the inlet of the channel it has been necessary to attach a buffer domain just before the computational domain. In this buffer domain, the momentum transport equations for a fully developed channel are solved with the same resolution used in the main domain.
The results of cases A and B have been used to validate the 3DINAMICS CFD code by comparison with data reported in the literature. This code is written in FORTRAN 90 and parallelized using the Message Passing Interface (MPI-CH
library). It uses the second order in time Crank-Nicholson scheme to integrate numerically the transport equations which are discretized spatially using the centered second-order finite volume approach.
The analysis of averaged turbulent quantities and the contributions of the different terms of the time-averaged transport equations is used to show how buoyancy affects the turbulent transport of momentum and heat along the channel.
Finally, following a similar configuration than that of case A, a chemical reactant
A released through line source reacts with a background reactant B following a second order chemical reaction with Damkh¨oler number of 1. Preliminary results for turbulent species transport are also included in this work.
Special attention have been devoted to the discretization of the advective terms to avoid non-realistic values of the variables because of the non-linearities of the transport equations. The conservative non-reflecting boundary conditions have been implemented at the outlet to simulate the convected outflow when the streamwise direction can not be considered homogeneous, as in case C. For homogeneous directions, periodic boundary conditions have been used.
Large grid resolutions (up to 8 million grid nodes for case C including the buffer region) demand important computational resources. A parallel Multigrid solver has substituted the previous conjugate gradient method to solve the Poisson equation in the pressure calculation. This step was the most expensive in terms of CPU costs. The Multigrid method efficiency has been compared with two different versions of the conjugate gradient approach and it has been demonstrated that this method is the most efficient in terms of CPU time although the current algorithmcan be improved to enhance the scalability inmultiprocessor computers.

The analysis of time-delayed dynamics on networks may help to understand many systems from physics, biology, and engineering, such as coupled laser arrays, gene-regulatory networks and complex ecosystems. Beside the complexity due to the network structure, the analysis is further complicated by the presence of the delays. Delay systems are in general infinite dimensional and thus can display complex dynamics as oscillations and chaos. The mathematical difficulties related to the delays hinders the analysis of delay networks. Thus, little is known yet about basic relations between network structure and delay dynamics. It has been shown that networks without delays can be studied efficiently with the generalized modeling approach, which analyzes the stability of an assumed steady state by a direct parametrization of the Jacobian matrix. In this thesis, I demonstrate the extension of the generalized modeling approach to delay networks and analyze networks of delay-coupled delay oscillators, with delayed auto-catalytic growth on the nodes and delayed transport between nodes. For degree-homogeneous networks (DHONs), in which each node has the same number of links, the bifurcation lines that border the stable areas can be calculated analytically, where the topology of the network is described only by the eigenvalues of the adjacency matrix. For undirected networks, the stability pattern in the parameter space of growth and transport delay is governed by two periodic sets of tongues of instability, which depend on the largest positive and the smallest negative eigenvalue. The direct relation between the eigenvalue and the bifurcation lines allows us to predict stability patterns for networks with certain topological properties. Thus, bipartite networks display a characteristic periodicity of tongues. In order to analyze the stability of degree-heterogeneous networks (DHENs), I apply a numerical sampling method based on Cauchy\'s Argument Principle. The stability patterns of these networks resembles the pattern of DHONs, which is governed by the two periodic sets. For networks with sufficiently many links, one set disappears, and the stability of DHENs can be approximates by the stability of a fully-connected network with the same average degree. However, random DHENs tend to be more stable than DHONs, and DHENs with a broad degree-distribution tend to be more stable than DHENs with a narrow distribution. Thus, such networks are more likely to give rise to amplitude death, i.e. the stabilization of an unstable steady state through diffusive coupling. The stability pattern of DHENs can be qualitatively different than the pattern in DHONs. However, for small growth delays, close to the critical delay of the single node system, the bifurcation lines of all DHENs with the same average degree coincide. This, is particularly interesting, because there the stability depends on a global property of the network, which suggests a diverging interaction length. In summary, the extension of generalized modeling to time-delay networks reveals basic relations between the delay dynamics and the topology. The generality of our model should allow to apply these results to a large class of real-world systems.

Abstract Cables, george andrew, pno, kybds, comp; b. Brooklyn, NY, 11/14/44. Studied w. moth., a teacher and amateur pnst.; also att. HS. of Perf. Arts 1958–62; Mannes Coll. of Mus. ’63–5. At age 18, formed Jazz Samaritans w. Steve Grossman, Clint Houston, Billy Cobham. Arr. for East Harlem Protestant church choir ’60s. Worked w. Art Blakey, Max Roach, late ’60s; Sonny Rollins ’69; Joe Henderson ’69–71; Freddie Hubbard ’71–6. Pl. pno. and el-pno. in own trio, Cable Car, in LA mid ’70s. Pl. w. Gabor Szabo, Bobby Hutcherson mid to late ’70s; also w. Woody Shaw; Billy Harper. Worked w. Dexter Gordon at Keystone Korner in SF, Dec. ’76, remain. w. Gordon until ’78. Rejoin. Blakey in ’77 and began an assoc. w. Art Pepper that lasted until the saxist’s death in ’82. Fr. ’80s w. own trio; also w. Bebop and Beyond ’84; in NYC mid ’90s, w. Pete La Roca Sims’ Swingtime; Joe Chambers; others. Cables’ comps. have been rec. by Woody Shaw, Woody Herman, Freddie Hubbard, Bobby Hutcherson. Among the best are “Morning Song” and “Helen’s Song.” Favs: Wynton Kelly, Buddy Montgomery, Hancock, Tyner. Fests: all major. CDs: Cont.; DIW; Steep.; Conc.; w. Bebop and Beyond (BM); D. Gordon (Col.; Steep.); Hubbard (CTI); S. Rollins; J. Henderson (Mile.); Hutcherson (Timel.; Land.); F. Morgan (Cont.; Ant.); Pepper (Gal.; Cont.); Joe Farrell (Cont.); W. Shaw; H. Land (Muse); S. Rogers; B. Forman (Conc.); M. Roach; J. Stubblefield (Enja); C. Rouse (Land.); P. Sims (BN).

Article 13(1)(b) (Information to be provided where personal data are collected from the data subject) (see too recitals 60–61); Article 14(1)(b) (Information to be provided where personal data have not been obtained from the data subject) (see too recital 61); Article 30 (Records of processing activities) (see too recital 82); Article 33 (Notification of a personal data breach to the supervisory authority) (see too recital 85); Article 35 (Data protection impact assessment) (see too recitals 90–91); Article 36 (Prior consultation) (see too recital 94); Article 37 (Designation of the Data Protection Officer) (see too recital 97); Article 39 (Tasks of the data protection officer) (see too recitals 77 and 97); Article 47 (Binding corporate rules) (see too recital 108); Article 52(1) (Independence of supervisory authorities) (see too recitals 117–118 and 120–121); Article 57 (Tasks of supervisory authorities) (see too recital 122); Article 69 (Independence of the EDPB) (see too recital 139).

La Leishmaniasis, son enfermedades infecciosas, transmitida por la picadura del flebótomo o mosquito simúlido hembra, es una patología que infecta al humano en las áreas tropicales y subtropicales, el objetivo del estudio es determinar las características clínicas de la Leishmaniasis en el norte Amazónica de Bolivia, métodos empleados en la Investigacion, es de tipo observacional, de corte transversal, se realizó la observación de datos epidemiológicos de SEDES Pando, en los últimos años, también se realizó la entrevista al responsable epidemiológico de Sedes Pando, los resultados del estudio; la tendencia secular de la Leishmaniasis Pando 2009-2021, el año que más casos se han notificado fue el 2018 con 651 casos, el año 2020 de 622 casos notificados y el año 2015 con 562 casos de Leishmaniasis en este año de 2021 con 310 casos, bajando la curva secular del 2009 al 2021, los casos con mayor incidencia de Leishmaniasis por municipios es el municipio de Bella flor 11, 7% el municipio de Santa Rosa es 8.2%, el municipio de Bolpebra de 5.1%, el municipio de Porvenir con 4.5% y finalmente el municipio de Cobija con 1.3%, el tipo de Leishmaniosis que se han diagnosticado este año, el 83% fueron Leishmaniasis cutáneas y el 17% Leishmaniasis mucosas, en conclusión, los medicamentos utilizados en el tratamiento de la Leishmaniasis, Pacientes diagnosticados, el 90% utilizan Glucantime, el 10% de los pacientes diagnosticados están a la espera del tratamiento de la dosis de Glucantime.

Abstract One of two kinds of penalty (the other being a fine) which the Commission may impose on undertakings and associations of undertakings in the field of general EC competition law, i.e. under Arts. 81 and 82 EC (see Arts. 23 and 24 of Council Reg. 1/2003 of 16 December 2002 on the implementation of the rules on competition laid down in Articles 81 and 82 of the Treaty, OJ 2003 L1/1, which replaced Arts. 15 and 16 of Council Reg. 17, First Regulation implementing Articles 81 and 82 of the Treaty, OJ Sp. Edn. 1959–62, p. 87, as from 1 May 2004). Arts. 23 and 24 of Reg. 1/2003 also apply to competition in the transport sector (which was governed by special provisions prior to 1 May 2004), but separate rules apply in the field of merger control (concentrations) (see further under Competition in transport, Fine, Merger control procedure). Unlike fines, periodic penalty payments are in the nature of coercive measures; their function is to enforce compliance with the law in the future, and not to punish infringements committed in the past (see Cases 2/63 etc. San Michele v. High Authority [1963] ECR 327 at p. 352 per A.-G. Roemer, decided under the ECSC Treaty).

The SJT questions were created following the professional attributes identified from the FY1 job analysis. Questions were written by volunteers at a series of dedicated workshops. The volunteers were not all doctors but should have been familiar with the FY1 role and have worked with junior doctors within the previous two years. The ISFP Project Group employed 89 people to write SJT questions, of whom 69 (77.5%) were senior doctors, two (2.2%) were lay representatives, and the remainder were undeclared. In terms of background, 59 (66.3%) were from a range of acute specialties and 12 (13.5%) from community specialties. This team created a bank of 453 possible questions. These were scrutinized by a team of psychologists who accepted 360 questions as passing this initial stage. A select few writers were asked to moderate all questions to ensure that scenarios were realistic and the terminology was in use across the UK. This group eliminated additional questions, leaving a total of 306. A series of focus groups was then held with foundation doctors who scrutinized the test instructions and up to 20 questions each. They proposed a number of amendments and whittled down the total question bank to 275 items. Once a question bank was established, it was trialled using a panel of subject ‘experts’, i.e. people with similar qualifications to the question writers. Questions survived this process if they achieved a satisfactory level of concordance, i.e. enough experts independently arrived at the same answer under test conditions. A total of 200 questions went forward to be used in the SJT pilots. The SJT model underwent two pilots. The second and larger of these took place in 13 UK medical schools, involving 639 final- year students. Students reported that the content seemed relevant to the Foundation Programme (85% agreed) and that the questions were fair (73.3%). The reasons for understanding how questions are created are to appreciate the following: ● A lot of thought has gone into every question. There should be no ambiguities (unless intended) or ‘tricks’. ● They are written (largely) by senior doctors who are presumably interested in medical training and development.

Abstract Ibrahim, abdullah (Adolphe Johannes Brand aka Dollar Brand), pno, comp, sop sax, fl, cello; b. Capetown, South Africa, 10/9/34. Studied priv. fr. age 7, pl. in church; then self-taught. Listened to Louis Jordan in his teens. First prof. job w. vocal gp. Streamline Bros.; also subbed w. Tuxedo Slickers. As Dollar Brand, pl. w. Willy Max in Capetown 1959; led own gp., Jazz Epistles, w. Hugh Masekela, Makaya Ntshoko, Kippie Moeketsi ’60–1. Moved w. wife, singer Sathima Bea Benjamin, to Zurich ’62. Led trio in Eur. ’62–5. Duke Ellington, who heard him at a club in Zurich, rec. him for Reprise ’63. Pl. at festivals in Juan-les-Pins, Palermo ’63; Montmartre club, Copenhagen ’64–5. Came to the US and app. at NJF ’65. Pl. w. Elvin Jones, also subbed for Ellington on tour ’66, then tour. Eur. w. Don Cherry, Gato Barbieri, M. Ntshoko, Johnny Gertze ’66–8. Stud. w. Hall Overton. Converted to Islam ’68; known by Muslim name fr. mid ’70s. Ret. to Africa ’68, living in Swaziland, Capetown, and Johannesburg ’68–76. Tour. Eur. frequently in mid ’70s, mainly as solo pno.; also w. 10–pc. band ’74. Moved to NYC ’76. Pl. in duo w. Carlos Ward fr. ’76; led own spt. Ekaya fr. ’83. Led perf. of mixedmedia opera, Kalahari Liberation, in Eur. ’82. Much of Ibrahim’s work reflects the influences of South African popular and folk musics, Ellington, and Thelonious Monk. Some of his orchestral work has an impressive African rhythmic sensitivity. Polls: DB critics TDWR ’75. Fests: prod. fests in Swaziland; all major in Eur. fr. ’60s. TV: Eur. TV, incl. apps. w. Danish Radio bb in ’60s and ’70s. Film: mus. for Chocolat ’87; No Fear No Die. CDs: Enja; BL; Japo; Tiptoe; Kaz; Rep. (as Dollar Brand); w. Barbieri (Aff.).

A Hipertensão arterial sistêmica (HAS) é um problema de saúde pública e importante fator de risco para doenças cardiovasculares. A religiosidade/espiritualidade (R/E) são práticas que podem interferir tanto na adesão quanto nas metas terapêuticas de certas doenças. Objetivo: Avaliar o grau de influência da R/E no tratamento de uma doença crônica não transmissível. Método: Estudo realizado no ambulatório de cardiologia de um hospital de alta complexidade (HAC) e uma unidade básica de saúde (UBS). Foram avaliados 240 pacientes segundo escalas acreditadas para avaliação da R/E e adesão ao tratamento. Os pacientes foram separados em grupo com R/E e grupo sem R/E. Resultados: No grupo geral houve predomínio do sexo feminino (68,4%) no grupo com R/E e do sexo masculino (54,1%) no grupo sem R/E (p: 0,006). A cor de pele branca prevaleceu em ambos os grupos com diferença estatística (79,3% x 67%, p: 0,069). Em relação à adesão terapêutica, obteve-se a prevalência de alta adesão tanto no grupo com quanto no grupo sem R/E (82% x 69%, p: 0,026). O grupo com R/E do HAC obteve maior alcance das metas terapêuticas (52,8% x 35,5%, p: 0,033). Já na UBS houve alto grau de adesão em ambos os grupos com diferença estatística (83,3% x 63%, p: 0,011).

Introdução: A infecção pelo papilomavirus humano entre as mulheres que fazem sexo com mulheres ainda é pouco conhecida e escassos estudos apoiam a transmissão sexual entre essa população. Objetivo: Descrever a prevalência e genotipagem de infecção pelo papilomavírus humano entre mulheres que fazem sexo com mulheres. Métodos: Estudo descritivo que incluiu 110 mulheres que declararam fazer sexo com mulheres nos últimos 12 meses, maiores de 18 anos e residentes no interior de São Paulo. Os dados foram obtidos por entrevista e exame físico ginecológico entre janeiro de 2019 e janeiro de 2020. Apesquisa e genotipagem para o papilomavírus humano foi realizada pelo Kit XGEN MULTI HPV CHIP, que possibilita a identificação de 35 genótipos, sendo os de alto risco (16, 18, 26, 31, 33, 35, 39, 45, 51, 52, 53, 56, 58, 59, 66, 68, 73 e 82) e baixo risco (6, 11, 40, 42, 43, 44, 54, 55, 61, 62, 67, 69, 70, 71, 72, 81 e 84). Os dados foram analisados por estatística descritiva. A pesquisa recebeu parecer favorável do comitê de ética local (parecer n. 3.009.410). Resultados: A maioria das participantes se autodeclarava branca (73,6%), não vivia com parceiras (86,4%), recebia penetração vaginal (92,7%) e fazia uso inconsistente de preservativo nas relações sexuais (89,1%). Aproximadamente um terço delas referiu troca de parcerias sexuais nos três meses que antecederam a coleta de dados (32,7%). A prevalência geral de papilomavírus humano foi de 56,4% e os genótipos de alto risco encontrados foram 16,18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 68, 73, 82, e de baixo risco 6, 11, 40, 42, 43, 44, 54, 55, 61, 62, 67, 70, 71, 72, 81. Conclusão: mulheres que fazem sexo com mulheres possuem altas prevalências de papilomavírus humano, com destaque para os genótipos de alto risco encontrados, demonstrando sua vulnerabilidade aos agravos relacionados ao papilomavírus humano.

619 patients with suspected acute myocardial infarction (MI) were randomized to receive either a high-dose short-term intravenous infusion of streptokinase (1.5 MU over one hour) or placebo. In addition, using a “2x2x2 factorial” design, patients were also randomized to receive either oral aspirin (325 mg on alternate days for 28 days) or placebo, and separately randomized to receive either intravenous heparin (1,000 IU/hour for 48 hours) or no heparin. Streptokinase (SK) was associated with a non-significant decrease in hospital mortality (7.7% allocated SI< vs 9.2% allocated placebo) and increase in non-fatal reinfarction (3.6% vs 2.9%). There were significantly more minor adverse events after SK (e.g. hypotension, allergies, bruises or minor bleeds), but no excess of strokes or of anaphylactic shock.Aspirin was associated with fewer reinfarctions (2.9% allocated aspirin vs 3.9% allocated placebo; NS), deaths (6.1% vs 10.5%; 2P<0.04) and strokes (0.3% vs 2.0%; 2P<0.1).Heparin was associated with a decrease in reinfarction (1.9% allocated heparin vs 4.9% allocated no heparin; 2P<0.04), though not in mortality (8.3% vs 8.2%; NS), and with a trend towards more strokes (1.6% vs 0.7%; NS) and more bruising and bleeding (14% vs 11%; NS). To assess reliably the effects of SK and aspirin on major endpoints, several hundred hospitals are now collaborating in a large (about 20,000 patients planned) randomized trial (ISIS-2).

We studied the biochemical composition, nutritive value of the green mass and prepared hay from Ro-manian cultivars of perennial ryegrass, Lolium perenne L. „Mara” and „Măgura” grown in monoculture on the experimental plot of the National Botanical Garden (Institute) “Alexandru Ciubotaru”, Chisinau, R. Mol-dova. Results revealed that dry matter of harvested green mass contained 98-116 g/kg CP, 299-326 g/kg CF, 71-77 g/kg ash, 329-353 g/kg ADF, 546-593 g/kg NDF, 38-40 g/kg ADL, 291-313 g/kg Cel, 217-240 g/kg HC, with nutritive and energy value 60.9-65.3 % DMD, 60.1-64.8 % ODM, RFV=96-108, 12.12-12.45 MJ/kg DE, 9.95- 10.23 MJ/kg ME and 5.97-6.25 MJ/kg NEl. The biochemical composition, nutritive and energy va-lue of prepared hay: 94-110 g/kg CP, 351-385 g/kg CF, 79-82 g/kg ash, 390-423 g/kg ADF, 631-689 g/kg NDF, 46-50 g/kg ADL, 344-373g/kg Cel, 241-266 g/kg HC, RFV=76-86, 11.13-11.61 MJ/kg DE, 9.14- 9.53 MJ/kg ME and 5.17-5.55 MJ/kg NEl. The biochemical methane potential of green mass substrates reached 338-344 L/kg organic matter. The studied cultivars of Lolium perennec could be used in the Republic of Mol-dova for the restoration of degraded permanent grasslands, as a component of the mix of grasses and legumes for the creation of temporary grasslands, the harvested biomass can be used as feed for farm animals or as substrate in biogas generator for renewable energy production.

Abstract Low Salinity Polymer (LSP) injection is a hybrid synergistic enhanced oil recovery (EOR) technique that improves displacement and sweep efficiencies by combining the advantages of both low salinity and polymer flooding methods. Nevertheless, proper design of LSP flooding at field-scale requires a predictive mechanistic model that captures polymer-brine-rock (PBR) interactions. Therefore, this study investigates the impact of water chemistry on polymer behavior in porous media in order to gain a better understanding of the PBR-system. In particular, we examine the effect of salinity and hardness on polymer viscosity and adsorption in dolomite formations during LSP flooding employing our in-house coupled MRST-IPhreeqc simulator. Furthermore, to capture the geochemistry of the LSP process, the MRST-IPhreeqc simulator incorporates surface complexation reactions as well as aqueous, mineral dissolution and/or precipitation reactions. The findings of this study suggest that the 5-times spiked salinity and hardness scenarios are more favorable than those of 10-times spiked salinity and hardness, which were supported by their respective polymer viscosity losses of 75% and 82% for salinity spiking, and 58% and 63% for hardness spiking. Also, the effects of 10-times spiked Ca2+, 10-times spiked Mg2+, and 2-times spiked SO42-on polymer viscosity were studied with estimated viscosity losses of 61%, 61%, and 46%, respectively. The latter signifies the importance of sulfate spiking for reducing polymer viscosity loss while avoiding exceeding sulfate limit for scale formation and reservoir souring. For the effect of salinity on polymer adsorption, it was observed that the increase in salinity from the base case scenario (623 ppm) to 5- and 10-times spiked salinity, results in an increase in the dynamic polymer adsorption from 53 μg/g-rock to 59 and 68 μg/g-rock, respectively. Additionally, comparing the 10-times spiked Mg2+, 10-times spiked Ca2+, and the 2-times spiked SO42- scenarios, the 10-times spiked Mg2+ case resulted in the maximum polymer adsorption (87 μg/g-rock). This is due to the surface complexation reactions of magnesium surface species at dolomite rock surface with polymer molecules forming Mg-polymer surface complexes. In contrast, the calcium and sulfate do not form surface complexes through reactions with the polymer. This indicated that the divalent cation's design might impact the viscosity of the LSP solution, and therefore, it is crucial to carefully consider it when optimizing the LSP process in carbonates. Thus, proper design of LSP flooding at field-scale requires a predictive mechanistic model that captures PBR interactions which is covered in this work.

Abstract The low salinity polymer (LSP) injection is a hybrid enhanced oil recovery (EOR) technique, which synergistically enhances the displacement and sweep efficiencies through compounding the advantages of low-salinity water (LSW) and polymer floodings (PF). While an appropriate LSP-flooding field-scale design typically requires a predictive mechanistic model for capturing the polymer-brine-rock (PBR) interactions, few studies have focused on this issue till date. Therefore, the present study investigates the impact of water chemistry on polymer behavior in porous media using a surface complexation model (SCM), with the purpose of refining our understanding of the PBR-system. In particular, this work examines the effect of salinity and hardness on polymer viscosity and adsorption in dolomite formations during LSP-injection with the use of our in-house developed coupled MRST-IPHREEQC simulator. Hence, to comprehensively capture the geochemistry of the LSP process, the coupled MRST-IPHREEQC simulator included the chemical reactions, such as aqueous, mineral dissolution and/or precipitation, along with the surface complexation reactions. The findings of this study showed polymer viscosity losses of 82% and 63% for the 10-times spiked salinity (6230 ppm) and 10-times spiked hardness (110 ppm) cases, respectively. Thus, the base case low-salinity (LS) brine of 623 ppm was more effective in reducing the risk of polymer viscosity loss for the dolomite model (i.e., viscosity loss of 55%). The polymer viscosity losses calculated for the various potential determining ions (PDIs) concentrations of 10-times spiked Mg2+ (40 ppm) and 2-times spiked SO42- (156 ppm) were 61%, and 46%, respectively. Moreover, investigating the impact of salinity on polymer adsorption revealed that dynamic polymer adsorption increased from 53 μg/g-rock to 68 mg/g-rock and 64 mg/g-rock, when the salinity and hardness were increased from the base case (623 ppm) to 10-times spiked salinity and 10-times spiked hardness cases, respectively. Furthermore, the analysis showed that the 10-times spiked magnesium case exhibited higher polymer adsorption (87 μg/g-rock) compared to the 2-times spiked sulfate case (64 mg/g-rock), which is related to the formation of Mg-polymer surface complexes as a result of surface complexation processes between polymer molecules and magnesium surface species at the surface of dolomite rock. Overall, the surface complexation model has demonstrated that during LSP-injection, the stability of the water-film is enhanced, suggesting a significant alteration in wettability towards a more water-wetting state. This wettability alteration plays a crucial role in increasing oil production. Consequently, our findings underscore the effectiveness of LSP-flooding in enhancing oil recovery processes by modifying the wettability of the reservoir rock surfaces, leading to a more efficient displacement of oil.

Direct generation of optical pulses with duration below 100 fs from cw dye lasers has almost exclusively been limited to the 605–630-nm spectral range. Typically, the use of conventional ring or antiresonant ring cavity arrangements designed to utilize the colliding pulse mode-locking (CPM) effect,1 where counterpropagating pulses meet in a saturable absorber jet stream, is also required. We describe the generation of near transformlimited pulses as short as 55 fs at 675 nm and 69 fs at 583 nm from a linear cavity, synchronously pumped, hybrid cw dye laser which does not require the CPM technique. The laser was pumped at 82 MHz by 650-mW average power, 70-ps pulses from a mode-locked and frequency-doubled cw Nd:YAG laser. The dual-jet resonator was terminated by a two Brewster prism and plane mirror arrangement used to introduce variable intracavity dispersion. Optimal laser performance was achieved by iterative adjustments of the intracavity dispersion and cavity length. Femtosecond pulse generation was obtained using the gain/absorber dye combinations of sulphorhodamine 101/DQTCI and rhodamine 6G/DQOCI and DODCI mix. Average output powers were 35 mW at 675 nm and 55 mW at 583 nm, respectively, for these combinations.

ЦЕЛЬ: изучить параметры компенсации углеводного обмена и связанные с ними факторы у пациентов, проходивших обучение в школах диабета и иных образовательных мероприятиях РООИ «Нижегородская диабетическая лига». МАТЕРИАЛЫ И МЕТОДЫ: проведено анкетирование и оценка гликированного гемоглобина (НвА1с) у 121 пациента с сахарным диабетом 2 типа, обучавшихся в школе диабета или участвовавших в одноднев- ных образовательных мероприятиях РООИ «Нижегородская диабетическая лига». Оценивался анамнез сахарного диабета и его терапии, самоконтроль. Данные приведены в формате M±SD, уровень статисти- ческой значимости принят как р<0.05 РЕЗУЛЬТАТЫ: из 121 обследованного пациента 89% составили женщины, средний возраст 65±11,5 лет; средняя длительность диабета 9±7,0 лет. 68% пациентов получали терапию метформином; 24% - препара- тами сульфонилмочевины; 10% - глиптинами; 7,4% (9 чел.) – глифлозинами; 22% - препаратами инсулина. Тест на гликированный гемоглобин был выполнен у 84 пациентов (69% обследованных), средний уро- вень составил 7,6±1,94%. Доля пациентов с НвА1с >8% была равна 32%, эти пациенты не имели достовер- ных отличий по возрасту (68±10,6 пр.63±13,5 лет, р=0,09) и, закономерно, отличались большей длительно- стью диабета (12±6,7 пр. 7±6,6 лет, р=0,002). Из 11 мужчин НвА1с более 8% отмечался у 9 (82%), тогда как среди женщин такое повышение было зарегистрировано в меньшинстве случаев (26%, р=0,0003). Среди пациентов с уровнем НвА1с более 8% 30% получали инсулинотерапию, тогда как в группе с меньшими значениями инсулинотерапия проводилась достоверно реже (7%, р=0,006). По результатам опросника регулярный самоконтроль не менее 1 дня в неделю проводили 70% паци- ентов, среди них 63% измеряли уровень гликемии как натощак, так и в течение дня. 57 пациентов (69%), проводивших регулярный самоконтроль, сообщили при анкетировании данные о средних показателях гликемии. В наибольшей степени с уровнем НвА1с коррелировал средний показатель гликемии при са- моконтроле в течение дня (R=0.75 p<0.0001), для средней гликемии натощак коэффициент корреляции был меньше (R=0.57 p<0.0001). Доля пациентов, проводивших регулярный самоконтроль, не отличалась существенно между группами, разделенными по уровню НвА1с 8%. При этом у пациентов с высокими уровнями НвА1с при самоконтроле регистрировались высокие значения гликемии – натощак 9,1±2,6 пр. 6,4±1,1 ммоль/л, р<0,0001; в течение дня 12,5±2,4 пр. 8,6±1,1 ммоль/л, р<0,0001. ВЫВОДЫ: среди людей с диабетом 2 типа, принимавших участие в образовательных мероприятиях региональной общественной организации пациентов с сахарным диабетом, плохой гликемический кон- троль отмечался не менее чем в 1/3 случаев. Мужчины с сахарным диабетом в большей степени страдают от низкого уровня знаний и мотивации в отношении сохранения здоровья, при этом имея низкий уровень участия в обучении. Активное привлечение мужчин с сахарным диабетом 2го типа может являться одним из приоритетов в организации обучения. Значительная доля пациентов не осуществляет регулярного самоконтроля гликемии, однако даже при его проведении сохраняется риск плохого управления гликемией, связанный, по-видимому, с инерцией в интенсификации сахароснижающей терапии и игнорированием высоких показателей гликемии по дан- ным самоконтроля.

Introdução: Os Métodos Não Farmacológicos (MNFs) para alívio da dor utilizados durante o trabalho de parto são de cuidado não invasivo que promovem benefícios para a parturiente, proporcionando sua autonomia e participação ativa durante o parto e nascimento. Objetivos: Objetivou-se identificar quais são os MNFs para alívio da dor mais utilizados em gestantes de uma maternidade de alto risco localizada ao noroeste do Espírito Santo e seus benefícios. Material e Métodos: Tratou-se de um estudo descritivo, de abordagem quantiqualitativa, realizado em um hospital de ensino. Os dados foram obtidos através da aplicação de um formulário semiestruturado, realizou-se a gravação das entrevistas e posteriormente foram transcritas na íntegra para análises semânticas das informações. Para avaliação da dor foi utilizada a escala visual analógica (EVA) de dor, sendo esta aplicada antes e após o uso dos MNFs de escolha. Resultados: Os MNFs para alívio da dor utilizados no estudo, foram: banho morno de aspersão, deambulação, musicoterapia, bola suíça, massagem e aromaterapia, sendo o banho morno de aspersão o método de preferência das participantes (89%). Das 100 participantes entrevistadas, 79% evoluíram para parto normal e 29% para cesariana. Das pacientes que tiveram desfecho de parto normal, todas utilizaram algum MNF para alívio da dor, 69% dessas utilizaram de três a seis MNF e 10% utilizaram de um a dois MNF. O segundo MNF mais utilizado foi a deambulação representando 75%. A musicoterapia, massagem e aromaterapia foram utilizadas respectivamente em 63%, 62% e 49% das participantes. A bola suíça foi utilizada por 59% das participantes. A maioria das entrevistadas (53%) teve redução do limiar de dor após a utilização dos MNFs, entretanto 23% das participantes relataram que a dor se manteve da mesma forma antes e após a aplicação do MNF e 24% referiram piora da dor ao utilizar o MNF. Conclusão: Resta admitir que a relevância da utilização dos MNFs e sua importância na atuação da equipe multiprofissional, assim como na assistência qualificada durante o trabalho de parto e parto, podendo mudar a realidade da prática cotidiana, oferecendo uma assistência de qualidade para as mulheres contribuindo assim, no modo de parir e nascer.

ЦЕЛЬ: оценить эффективность бариатрических вмешательств (ПРЖ и ГШ) в достижении ремиссии са- харного диабета 2 типа (СД 2 типа) у пациентов с ожирением. МАТЕРИАЛЫ И МЕТОДЫ: проведено наблюдательное проспективное исследование 64 пациентов (женщин – 37) с ожирением II-III степени (индекс массы тела (ИМТ) ≥35 кг/м2) и сахарным диабетом 2 типа. Пациентам выполняли рукавную гастропластику (РГ, n=42) или гастрошунтирование (ГШ, n=22). Исходно и в течение периода наблюдения (не менее 2 лет) оценивали ИМТ; бариатрическая операция считалась эф- фективной при снижении избыточного ИМТ на 50% и более. Исходно, через 1 и 2 года оценивали уровень гликированного гемоглобина (HbA1c), инсулина, глюкозы венозной крови натощак, рассчитывали индекс инсулинорезистентности (HOMA-IR). Через 2 года после вмешательства оценивали критерии ремиссии СД 2 типа по уровню HbA1c и гликемии натощак. Критериями полной ремиссии сахарного диабета 2 типа после БО считали достижение и поддержание HbA1c до 6,0%, гликемии натощак до 6,0 ммоль/л, частич- ной - HbA1c менее 6,5% и гликемия натощак 6,1-6,9 ммоль/л на протяжении по крайней мере 1 года после операции после полной отмены сахароснижающей терапии. РЕЗУЛЬТАТЫ: средний возраст пациентов составил 41,1±9,8 лет, исходный ИМТ – 45,5±9,4 кг/м2. Гликемия натощак в общей группе составила 7,1±1,1 ммоль/л, HbA1c – 6,9±1,5%. НОМА-IR у пациентов был равен 8,2±5,1, что свидетельствует об инсулинорезистентности. Пациенты в группе РГ (n=42) и ГШ (n=22) были сопоставимы по возрасту, длительности СД 2 типа и исходным характеристикам: ИМТ, глике- мия натощак, HbA1c и НОМА-IR значимо не различались. Через 1 год ИМТ пациентов значимо снизился и составил 33,0±7,9 кг/м2 (р=0,008). Таким образом, через 1 год после вмешательства была установлена высокая эффективность обеих бариатрических операций: потери более 50% избыточного ИМТ достигли 37 из 42 пациентов (88,1%) в группе РГ и у 18 из 21 пациентов (85,7%) в группе ГШ. Оставшиеся пациенты достигли потери избыточного ИМТ через 14-19 месяцев после вмешательства. Через 1 год после вмеша- тельства гликемия натощак значимо снизилась в обеих группах и составила 5,4±1,0 ммоль/л в группе РГ и 5,5±0,8 ммоль/л в группе ГШ (по отношению к исходным значениям р=0,02 и р=0,04 соответственно). HbA1c через 1 год после операции также была ниже и составил 5,5±0,7% в группе РГ и 5,8±0,6% в группе ГШ (p=0,02; p=0,028). HOMA-IR через 1 год после РГ составил 3,7±3,3, после ГШ – 4,6±2,7, что ниже исходных значений (р=0,048; р=0,018). Значимых различий между пациентами после РГ и ГШ по исследуемым пока- зателям через 1 год после вмешательства не выявлялось. Полная ремиссии СД 2 типа через 2 года после операции выявлялась у 39 пациентов в группе РГ (92,8%) и у 18 пациентов в группе ГШ (81,8%). ВЫВОДЫ: выполнение РГ и ГШ у пациентов с ожирением и СД 2 типа оказывает сопоставимый эффект в отношении снижения избыточного ИМТ, гликемии натощак, HbA1c и HOMA-IR в течение первого года по- слеоперационного периода. Через 2 года после вмешательства установлена сопоставимая эффективность РГ и ГШ по достижению ремиссии СД 2 типа у обследованных пациентов.

Introdução: A leishmaniose visceral é uma doença causada por várias espécies de protozoários do gênero Leishmania. Tem apresentação clínica crônica e sistêmica, capaz de afetar vários órgãos internos, principalmente o fígado, o baço e a medula óssea. Sua ocorrência depende da presença de vetores vertebrados (flebotomíneos) e não vertebrados (mamíferos), por isso é uma doença de difícil controle epidemiológico. Objetivo: Identificar a prevalência da leishmaniose visceral no Pará e o principal município acometido dentre os casos notificados no ano de 2019. Material e métodos: trata-se de um estudo epidemiológico descritivo. A análise foi realizada por meio de consulta à base de dados do Sistema de Informações de Agravos de Notificação (SINAN) disponibilizada pelo Departamento de Informática do Sistema Único de Saúde (DATASUS). Resultados: foram notificados 347 casos de leishmaniose visceral no estado do Pará. Das 84 cidades registradas, divididas em 18 microrregiões pelo IBGE, a microrregião de Parauapebas, que possui 4 municípios, liderou o número de casos notificados representando 30% (n=104), com destaque para a cidade de Parauapebas 17,6% (n=61), seguido da microrregião de Marabá 12% (n=42) que contém 3 municípios, com destaque para a cidade de Marabá 11,3% (n=39). As mais microrregiões mais populosas e urbanizadas do estado, representadas por Belém (composta por 3 municípios) e Castanhal (composta por 2 municípios) apresentaram baixa incidência de leishmaniose visceral, correspondendo a 0,03% (n=10) e 0,01%(n=5) respectivamente. A principal faixa etária acometida foi de 1-4 anos 25,64% (n=89), representando 38,20% dos casos, seguida da faixa etária de 20-39 18,7% (n=65). Dos pacientes acometidos 64,3% moravam em zona urbana. Apenas 17,8% (n=62) receberam diagnóstico parasitário. Conclusão: a leishmaniose no estado do Pará está sob controle nas microrregiões mais populosas do estado representadas por Belém e Castanhal, no entanto, há uma maior necessidade de saúde pública voltadas para vigilância, prevenção e controle da leishmaniose visceral na microrregião de Parauapebas e Marabá. Também ressalta-se a necessidade de fortalecer a rede de diagnóstico parasitário desta doença a fim de iniciar precocemente o tratamento adequado.