Multiple endocrine neoplasia type 2A (MEN 2A) is an autosomal dominant syndrome caused by activating germline mutations in the RET (REarranged during Transfection) proto-oncogene. MEN 2A has a strong (>95%) and age-dependent (5-25 years) clinical penetrance of medullary thyroid carcinoma (MTC). Several major studies have analyzed the predictive and prognostic factors for MEN 2A to find indicators that predict the optimal timing of prophylactic thyroidectomy. The aims of this study were to describe all known RET positive MEN 2A patients diagnosed in Norway and to evaluate the clinical course of MTC, as well as its predictive and prognostic factors.
This nationwide retrospective cohort study included data for 65 (14 index and 51 screening patients) out of a total of 67 MEN 2A patients with the RET gene mutation who were diagnosed in Norway since 1974. Data were collected by reviewing patient files. The variables analyzed were genotype, phenotype, preoperative basal calcitonin, age at thyroid surgery, central lymph node dissection and nodal status at primary surgery, number of surgical procedures, and biochemical cure. Of the 65 patients, 60 had undergone thyroid surgery. The median follow-up period was 9.9 years. The patients were divided into pre-RET-and RET-era, which included patients who had thyroid surgery before January 1, 1994, and after, respectively.
In index and screening patients, MTC was found, respectively, in 100% and 45% of cases, central lymph node dissection at primary surgery was done for 64% and 52% of patients, and the median total number of surgical procedures was two (range 1-6) and one (range 1-4). At primary surgery, all patients (n?=?13) with lymph node metastases had preoperative basal calcitonin levels =68?pg/mL, and all patients (n?=?17) without central lymph node dissection and preoperative basal calcitonin
Helicopter emergency medical services are an important part of many healthcare systems. Norway has a nationwide physician staffed air ambulance service with 12 bases servicing a country with large geographical variations in population density. The aim of the study was to estimate optimal air ambulance base locations.
We used high resolution population data for Norway from 2015, dividing Norway into >300 000 1 km×1 km cells. Inhabited cells had a median (5-95 percentile) of 13 (1-391) inhabitants. Optimal helicopter base locations were estimated using the maximal covering location problem facility location optimisation model, exploring the number of bases needed to cover various fractions of the population for time thresholds 30 and 45 min, both in green field scenarios and conditioning on the current base structure. We reanalysed on municipality level data to explore the potential information loss using coarser population data.
For a 45 min threshold, 90% of the population could be covered using four bases, and 100% using nine bases. Given the existing bases, the calculations imply the need for two more bases to achieve full coverage. Decreasing the threshold to 30 min approximately doubles the number of bases needed. Results using municipality level data were remarkably similar to those using fine grid information.
The whole population could be reached in 45 min or less using nine optimally placed bases. The current base structure could be improved by moving or adding one or two select bases. Municipality level data appears sufficient for proper analysis.
Cites: Injury. 2014 Jan;45(1):23-30 PMID 23915491
Cites: Air Med J. 2015 Mar-Apr;34(2):98-103 PMID 25733116
This study considered the possibility of using plant community phytomass for the assessment of soil pollution with heavy metals (HM) from industrial wastes. The three-year-long field experiment was run under the regional natural meadow vegetation; the polymetallic galvanic slime was used as an industrial waste contaminant. It is shown that soil contamination primarily causes decrease of phytomass in the growing phytocenosis. The vegetation experiments determined nonlinear dependence of cultivated and wild plant biomass on the level of soil contamination; it is described by the equations of logistic and Gaussian regression. In the absence of permanent contaminants, the soil is self-cleaned over time. It reproduces phytomass mainly due to the productivity increase of the most pollution-tolerant species in the remaining phytocenosis. This phenomenon is defined as environmental hysteresis. Soil pollution by industrial waste leads to the loss of plant biodiversity. The research shows that the study of the HM impact on ecosystems is expedient given the consideration of the "soil-phytocenosis-pollutant" complex in the "dose-response" aspect. The reaction of phytocenosis on HM showing decline in phytomass leads to serious limitations in the choice of accumulating plants, because the adsorbed HM are rejected through phytomass.
The management of multidrug-resistant tuberculosis (MDR-TB) is strictly regulated in Norway. However, nationwide studies of the epidemic are lacking.
To describe the MDR-TB epidemic in Norway over two decades.
Retrospective analysis of data on MDR-TB cases in Norway, 1995-2014, obtained from the national registry, patient records and the reference laboratory, with genotyping and cluster analysis data. Data for non-MDR-TB cases were collected from the national registry.
Of 4427 TB cases, 89 (2.0%) had MDR-TB, 7% of whom had extensively drug-resistant TB (XDR-TB) and 24% pre-XDR-TB. Of the 89 MDR-TB cases, 96% were immigrants, mainly from the Horn of Africa or the former Soviet Union (FSU); 37% had smear-positive TB; and 4% were human immunodeficiency virus co-infected. Of the 19% infected in Norway, the majority belonged to a Delhi/Central Asian lineage cluster in a local Somali community. Among the MDR-TB cases, smear-positive TB and FSU origin were independent risk factors for XDR/pre-XDR-TB. Treatment was successful in 66%; 17% were lost to follow-up, with illicit drug use and adolescence being independent risk factors. Forty-four per cent of patients treated with linezolid discontinued treatment due to adverse effects.
MDR-TB is rare in Norway and is predominantly seen in immigrants from the Horn of Africa and FSU. Domestic transmission outside immigrant populations is minimal.
Colorectal cancer (CRC) is one of the main causes of morbidity and mortality among all malignant tumors both in the world and in Russia. The purpose of the research was to study the association between diet and the probability of CRC in Perm Krai. The epidemiological analytical case-control study was performed. The questionnaire survey included 191 histologically proved colorectal cancer cases and 200 healthy individuals with excluded CRC by the results of colonoscopy. The surveyed groups were spread evenly by sex, age, ethnicity, place of residence and smoking (p>0.05). The odds to determine the following factors were higher in case group: diet including fried foods (OR=2.45, 95% CI: 1.58-3.80, p
Results of research of mineral composition, content of vitamin C and P, titrable acids, pectinaceous and phenol substances in fresh, fast-frozen (t=-30 °C), and also stored within 3 and 9 months (t=-18 °C) fruits of wild-growing blackberry, cornel, medlar and sea-buckthorn are presented in article. Determination of mineral composition was carried out by flame atomic absorption photometry, vitamin C and pectinaceous substances -by titirimetric methods, phenolic substances and vitamin P - by colorimetric methods. Vitamin C content was minimal in fresh fruits of cornel (6.9±0.3 mg%), amounted to 21.7-32.0 mg% in the fruits of blackberries and medlar and reached 180.1±7.2 mg% in the fruit of sea-buckthorn. Vitamin P concentration ranged from 34.9 (sea-buckthorn) to 180.0 mg% (cornel). Berries of a cornel contained also the greatest number of titrable acids (33.2±1.3 g/dm3), phenolic compounds (243.0±4.8 mg%) and pectinaceous substances (2.91±0.08%). The most significant content of potassium (521±15.6 mg%), calcium (133.2±5.2 mg%), magnesium (62.4±2.5 mg%) and iron (2.81±0.05 mg%) was revealed in medlar fruits. Consumption of 100 g of the studied fruits provides daily requirements of a human body, depending on a species of wild plants: in calcium -for 2-13.3%, potassium - for 7.0-20.8%, magnesium - for 8.1-15.6%, iron - for 5.9-19.2% and in vitamin C - from 5.8-24.6 to 145.7% in the case of sea buckthorn. The applied processing method of conservation - fast freezing (t=-30 °?) of fruits and their long storage (t=-18 °?) is the effective way ensuring high safety of nutrients in them. In the studied berries after 9-months cold storage the safety of vitamin C varied ranging from 55.7 (blackberry) to 76.1% (cornel), and vitamin P - from 81.9 (sea-buckthorn) to 92.8% (cornel). Stability of titrable acids, except for medlar fruits, varied from 84.2% (blackberry) to 94.0% (sea-buckthorn). The safety of phenolic and pectinaceous compounds by the end of 9 months of storage, has averaged 90.6 and 95.6% respectively in comparison with their initial quantity in fresh fruits. The mineral composition was the stablest. After completion of experiment the safety of mineral substances in fruits of wild plants fluctuated from 94.6 to 98.5%. Distinctions in change of biochemical complexes of berries of blackberry, cornel, medlar and sea-buckthorn at fast freezing (t=-30 °?) and storage (t=-18 °?), apparently, are caused by specific features, content of free and bound water, thickness of cellular walls, durability of a thin skin of fruits, as well as by concentration of the components that inhibit the destructive processes occurring at the cellular and molecular level.
This research aims to assess catering arrangements and dietary patterns of children at preschool educational institution and at home. The article analyses catering arrangements for pre-school children (3-7-year-old) from Ekaterinburg, Nizhny Tagil, Kamensk-Uralsky, Vladikavkaz and Krasnoyarsk. Based on menu production records provided by preschool educational institution, and family nutrition questionnaires we have examined their compliance with the nutritional physiological standards. The summarized data on menu production records from preschool educational institutions showed whether they met food basket requirements (net weight), as well as nutritional value requirements (proteins, fats, carbohydrates, calories content). The assessment was carried out in Ekaterinburg, Nizhny Tagil and Krasnoyarsk using Public catering calculations software (version 5) and a proprietary database of childreris food formulae. Childrens food basket assessment in Ekaterinburg and Kamensk-Uralsky revealed underconsumptionof vegetables (17.9-38% decrease), milk (52.7-62% decrease), curd (40.2-45.3% decrease). We have also observed decreased consumption of fruits, including dried fruit, by 31.8%, as well as cereals and legumes by 43% in Kamensk-Uralsky. Macronutrient analysis has shown underconsumption of total carbohydrates (by 19%) and animal proteins. The assessment of children nutrition at home has been carried out using NUTRITEST-IP diagnostic system in Nizhny Tagil, Kamensk-Uralsky, Vladikavkaz and Krasnoyarsk. The results showed overconsumption of most foods except vegetables. Excessive intake of fats and sugars (3.6 and 3.5 fold higher, respectively) accounted for higher than normal energy consumption by children at home. The evaluation has also revealed a significant difference in the consumption of saturated fats, mono - and disaccharides, food fibers and vitamin C by the children from the locations included in the study. The excessive intake of simple carbohydrates was typical for family diets and excessive fat intake was characteristic for child diet in preschool educational institution.
In the present study, the scaling up of Parent Management Training, Oregon Model (PMTO) in Norway was examined by investigating how large-scale dissemination affected the composition of the target group and the service providers by comparing child behavioral outcomes in the effectiveness and dissemination phases of implementation. Despite the larger heterogeneity of the service providers and the intake characteristics of the target group, which are contrary to the expectations that were derived from the literature, no attenuation of program effects was detected when scaling up PMTO. In Norway, a long-term-funded centralized center, combined with an active implementation strategy, seems to have affected the quality of PMTO delivered system-wide in services for children with behavior problems.
Cites: Am Psychol. 2010 Feb-Mar;65(2):73-84 PMID 20141263
Results of an assessment of the actual food of the population in various medicoeconomic zones of the republic (industrial, agricultural, Arctic) by method of the frequency analysis of food consumption are presented in the article. The analysis of control of compliance of quality and safety of foodstuff in the Republic of Sakha (Yakutia), according to requirements of the legislation of the Russian Federation, acts of the Customs union has been made. Decreased consumption of such foodstuff as milk, fish and meat products including products from local food staples and national dishes has been established. The data obtained are medic-biological justification for search of ways of optimization of population nutrition, creation of specialized products with a functional purpose and for the prevention of the states and diseases connected with nutrition violation. They also define innovative development of the republic in questions of biotechnologies of the production of specialized foods for various groups of the population. Results of chemical composition research of the most used wild-growing food plants of Yakutia are given. The questions connected with the nutrition and biological value of the dairy products of a functional purpose with use of wild-growing food herbs and berries of Yakutia are discussed.
Cinnamon contains cumarin, which may be toxic to the liver. EU-regulations standardardize the amount of cinnamon in pastry including cinnamon rolls. The aim of the study was to investigate if cinnamon intake from pastry was associated with toxic or alcoholic hepatitis.
We registered 58 patients with toxic hepatitis, 38 (66%) women and 20 (34%) men with a median age of 51 (range: 32-80) and 53 (range: 18-78) years, respectively. A total of 22 patients had primarily cholestasis and 36 had hepatitis biochemically. The duration of toxic liver disease from admission to normalization of liver enzymes was similar in the two groups (3.5 ± 3.5 vs 3.6 ± 3.5 months). Toxic hepatitis was most often caused by drugs e.g. NSAID (n = 15; 26%), antibiotics (n = 9; 16%), alternative medicine (n = 7; 12%) and Antabuse (n = 5; 9%). We registered eight patients admitted with severe alcoholic hepatitis, five men and three women, median age of 60 (range: 34-67) years. Alcoholic hepatitis was associated with high alcohol intake. None of the patients with toxic or alcoholic hepatitis reported of excessive intake of cinnamon rolls and there was no evidence of cinnamon added to alcohol of alternative medicine products.
Intake of cinnamon from cinnamon rolls is not associated with admission for toxic or alcoholic hepatitis. However, for the diagnosis of toxic liver diseases including alcohol it is very important to have patient information regarding any new drugs, alternative medicine and alcohol intake. Further, other causes of liver diseases should be excluded.