The concept of Less is More medicine emerged in North America in 2010. It aims to serve as an invitation to recognize the potential risks of overuse of medical care that may result in harm rather than in better health, tackling the erroneous assumption that more care is always better. In response, several medical societies across the world launched quality-driven campaigns ("Choosing Wisely") and published "top-five lists" of low-value medical interventions that should be used to help make wise decisions in each clinical domain, by engaging patients in conversations about unnecessary tests, treatments and procedures.However, barriers and challenges for the implementation of Less is More medicine have been identified in several European countries, where overuse is rooted in the culture and demanded by a society that requests certainty at almost any cost. Patients' high expectations, physician's behavior, lack of monitoring and pernicious financial incentives have all indirect negative consequences for medical overuse. Multiple interventions and quality-measurement efforts are necessary to widely implement Less is More recommendations. These also consist of a top-five list of actions: (1) a novel cultural approach starting from medical graduation courses, up to (2) patient and society education, (3) physician behavior change with data feedback, (4) communication training
diagnostic value of US significantly exceeds the clinical examination when scrotal edema has developed. Conclusions. In summary, the Doppler US is a highly sensitive preoperative diagnostic tool for scrotal pain. The sensitivity and specificity of physical examination signs of the acute scrotum in the absence of scrotal edema in children are higher than the US findings, but significantly drops after the onset of scrotal edema. 8. Schalamon J., Ainoedhofer H., Schleef .J et al. Management of acute scrotum in children the impact of Doppler ultrasound.
Цель. Аполипопротеин е (Апое) и параоксоназа 1 (ПОН1) участвуют в регуля-ции уровня липопротеинов крови, как и в их гидролизе и окислении. Мы пред-положили, что индивидуальные аллели генов apoe и PON1, вместе с измене-ниями концентрации данных молекул, вносят вклад в развитие кальциниро-ванного стеноза клапана аорты (КсКА). Материал и методы. Группа исследования включила 108 участников с КсКА и 46 пациентов без признаков стеноза клапана аорты. сывороточные уровни Апое и ПОН1 измеряли методом eLIsA, мутацию Leu28Pro в гене apoe (rs429358) и мутацию Gln192Arg в гене PON1 (rs662) выявляли методом ПЦР sNP-eXPRess электрофореза. Результаты. Повышенные уровни Апое (0,05 vs 0,03 мкг/л, p<0,001) и ПОН1 (4,8 vs 3,4 мкг/мл, p<0,05) были выявлены у пациентов с КсКА. Частоты поли-морфизмов аллелей генов Апое и ПОН1 были одинаковы в обеих группах. Аллель 28Pro гена Апое был ассоциирован с повышенным уровнем липопроте-инов низкой плотности у группы с КсКА (3,9±1,05 vs 3,13±1,08 ммоль/л, p<0,02) и общего холестерина -у контроля (6,2; 6,5 vs 5,11±0,89 ммоль/л, p<0,05). Генотип PON1 не оказывал влияния на обмен липидов при КсКА. Контрольная группа с аллелем 192Gln показала сниженный уровень Апое (0,02 vs 0,05 мкг/л, р<0,01) и повышенную концентрацию в сыворотке ПОН1 (4,1 vs 3,3 мкг/мл, р<0,01). Заключение. у пациентов с КсКА повышен сывороточный уровень Апое и ПОН1; уровень Апое -независимый предиктор кальциноза аорты. Маркеры полиморфизмов Gln192Arg гена PON1 и Leu28Pro гена apoe не ассоциированы с КсКА. CAVs -calcific aortic valve stenosis, IHD -ischemic heart disease, apoeapolipoprotein e, PON1 -paraoxonase 1, LDL -low-density lipoproteins, VLDLvery low-density lipoproteins, HDL -high-density lipoproteins. Aim. Apolipoprotein e (apoe) and paraoxonase 1 (PON1) participate in regulation of blood lipoprotein levels, as well as in their hydrolysis and oxidation. We assumed that individual alleles of the apoe and PON1 genes, along with the changes in concentrations of these substances, contribute to the development of calcific aortic valve stenosis (CAVs). Material and methods. the study group included 108 patients with CAVs and 46 patients without any signs of the aortic valve lesions were determined. the serum apoe and PON1 levels were measured by eLIsA, the Leu28Pro mutation in the apoe (rs429358) gene and the Gln192Arg mutation in the PON1 (rs662) gene were detected using PCR sNP-eXPRess electrophoresis detection scheme.Results. Increased serum levels of apoe (0,05 vs 0,03 µg/l, p<0,001) and PON1 (4,8 vs 3,4 µg/ml, p<0,05) were detected in CAVs patients. the frequencies of allelic polymorphisms of the apoe and PON1 genes were similar in the two groups. 28Pro allele of the apoe gene was associated with increased level of low density lipoproteins in CAVs (3,9±1,05 vs 3,13±1,08 mmol/l, p<0,02) and total cholesterol in the controls (6,2; 6,5 vs 5,11±0,89 mmol/l, p<0,05). the PON1 genotype had no effect on lipid metabolism in CAVs patients. Controls with 192Gln allele demonstrated decreased blood levels of apoe (0,02 vs 0,05 µg/l, ...
Ставропольский государственный медицинский университет 2 Ставропольская краевая клиническая больница МЕДИЦИНСКИЙ ВЕСТНИК СЕВЕРНОГО КАВКАЗА 2014. Т. 9. № 4 Medical news of north caucasus 2014. Vоl. 9. iss. 4 МЕДИЦИНСКИЙ ВЕСТНИК СЕВЕРНОГО КАВКАЗА 2014. Т. 9. № 4 Medical news of north caucasus 2014. Vоl. 9. iss. 4 МЕДИЦИНСКИЙ ВЕСТНИК СЕВЕРНОГО КАВКАЗА 2014. Т. 9. № 4 Medical news of north caucasus 2014. Vоl. 9. iss. 4
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