Technology of Supporting Medical Decision-Making Using Evidence-Based Medicine and Artificial Intelligence.

Currently, Medical errors are a serious problem when examining patients. Creating information systems that use the capabilities of evidence-based medicine and artificial intelligence methods will allow the doctor to make an informed and proven decision. In this article, the authors offer a description of an information system that solves the problem of supporting medical decision making based on evidence-based medicine. This is achieved by using artificial intelligence methods. This work was supported by a grant from the Ministry of Education and Science of the Russian Federation, a unique project identifier RFMEFI60819X0278.

Effect of silicon on barley growth and N2O emission under flooding.

The global climate change is related with greenhouse gas emission from cultivated soils - carbon dioxide, methane and nitrous oxide. The emissions of N2O also have negative influence on ozone layer of our planet. The major source of the nitrous oxide is denitrification process in soil, which controlled by specific soil microbe society. The pot experiment with flooding to accelerate the denitrification process and the application of the monosilicic acid as a source of soluble form of Si was carried out with barley. Several forms of nitrous oxide emission (unlimited carbon denitrification and potential denitrification with or without ethylene application) were measured. The obtained data showed that the application of monosilicic acid to brown soil when growing barley under conditions of soil flooding has a significant effect on nitrogen emission and can change the N2O:N2 ratio. The application of the monosilicic acid reduced the uC-D N2O emission, while increased the PD N emission. Generally the application of the water soluble Si decreased the N2O:N2 ratio. We suggested that the presence of monosilicic acid in the system provides a more complete denitrification process with the formation of N2 in the NO3- → NO2- → NO→N2O → N2 reaction sequence, while the deficiency of bioactive Si mainly provides the formation and emission of N2O. Considering that N2 is not a greenhouse gas, we can conclude that application of monosilicic acid to the soil can reduce greenhouse gas emissions and reduce the impact of global climate change on agricultural activity.

Tolerability and blood pressure-lowering efficacy of the combination of amlodipine plus valsartan compared with lisinopril plus hydrochlorothiazide in adult patients with stage 2 hypertension.

BACKGROUND: Most patients with hypertension in the United States and Europe fail to achieve the recommended target blood pressure (BP) of <140/90 mm Hg. Combination therapy is required in approximately two thirds of all patients whose BP is >20/10 mm Hg above the goal. Combination therapy with agents having complementary mechanisms of action, such as a calcium channel blocker and an angiotensin II-receptor blacker, would be a potentially useful therapeutic option. OBJECTIVES: This study evaluated the overall safety profile of combination therapy with amlodipine plus valsartan compared with a combination of lisinopril plus hydrochlorothiazide (HCTZ) in patients with stage 2 hypertension (mean sitting diastolic BP [MSDBP] >or=110 and <120 mm Hg) over the short term (6 weeks). A secondary objective was to evaluate the efficacy of the 2 regimens in achieving BP reduction. METHODS: This was an international, multicenter, randomized, double-blind, active-controlled, parallel-group study. Patients were randomized to receive once-daily treatment with amlodipine 5 to 10 mg + valsartan 160 mg or lisinopril 10 to 20 mg + HCTZ 12.5 rig for 6 weeks. Safety assessments included monitoring of all adverse events, vital signs, and hematology and biochemistry variables. Efficacy variables included the changes from baseline in MSDBP and mean sitting systolic BP (MSSBP), the response rate (MSDBP <90 mm Hg, or a >or= 10-mm Hg reduction from baseline), and the rate of DBP control (<90 mm Hg). The overall rate of BP control (proportion of patients with MSSBP/MSDBP <140/90 mm Hg) was evaluated in a post hoc analysis. Efficacy variables were summarized at each visit and at the end of the study (week 6, applying last-observation-carried-forward methodology) using descriptive statistics for the intent-to-treat population (all randomized patients with a baseline BP measurement and at least 1 post baseline BP measurement). Subgroup analyses of BP changes were performed in prespecified age groups (<65 and >or=65 years) and post hoc in patients with a baseline systolic BP <180 and >or=180 mm Hg. RESULTS: : Of 130 patients who were randomized to treatment, 128 completed the study: 63 in the amlodipine + valsartan group and 65 in the lisinopril + HCTZ group. The majority of patients in both groups were white (amlodipine + valsartan: 59.4% lisinopril + HCTZ: 60.6%) and female (57.8% and 54.5%, respectively). The mean age was similar in the 2 groups (56.5 and 57.6 years), as was the mean weight (85.1 and 82.0 kg). Both regimens were generally well tolerated. Adverse events were mild to moderate in severity, and most were not considered related to study drug. At the 6-week end point, both the amlodipine + valsartan and lisinopril + HCTZ groups had achieved significant reductions from baseline in MSSBP (-35.8 [11.8] and -31.8 [14.7] mm Hg, respectively; both, P < 0.001) and MSDBP (-28.6 [7.7] and -27.6 [8.6] mm Hg; both, P < 0.001). Response rates were similar for the 2 treatment groups (100% and 95.5%), as were rates of DBP control (79.7% and 77.3%). CONCLUSIONS: : The combinations of amlodipine 5 to 10 rug + valsartan 160 mg and lisinopril 10 to 20 mg + HCTZ 12.5 mg were well tolerated and efficacious, and both treatments were associated with achievement of BP goals in the majority of these adult patients with stage 2 hypertension.

Mesophyll cell ultrastructure of wheat leaves etiolated by lead and selenium.

The ultrastructure of mesophyll cells was studied in leaves of the Triticum aestivum L. cv. "Trizo" seedlings after two weeks of growth on soil contaminated by Pb and/or Se. The soil treatments: control; (Pb1) 50mgkg-1; (Pb2) 100mgkg-1; (Se1) 0.4mgkg-1; (Se2) 0.8mgkg-1; (Pb1+Se1); (Pb1+Se2); (P2+Se1); and (Pb2+Se2) were used. Light and other conditions were optimal for plant growth. The (Se1)-plants showed enhanced growth and biomass production; (Pb1+Se1)-plants did not lag behind the controls, though O2 evolution decreased; chlorophyll content did not differ statistically in these treatments. Other treatments led to statistically significant growth suppression, chlorophyll content reduction, inhibition of photosynthesis, stress development tested by H2O2 and leaf etiolation at the end of 14-days experiment. The tops of etiolated leaves remained green, while the main leaf parts were visually white. Plastids in mesophyll cells of etiolated parts of leaves were mainly represented by etioplasts and an insignificant amount of degraded chloroplasts. Other cellular organelles remained intact in most mesophyll cells of the plants, except (Pb2+Se2)-plants. Ruptured tonoplast and etioplast envelope, swelled cytoplasm and mitochondria, and electron transparent matrix of gialoplasm were observed in the mesophyll cells at (Pb2+Se2)-treatment, that caused maximal inhibition of plant growth. The results indicate that Pb and Se effects on growth of wheat leaves are likely to target meristem in which the development of proplastids to chloroplasts under the light is determined by chlorophyll biosynthesis. Antagonistic effect of low concentration of Se and Pb in combination may retard etiolation process.

Biochemistry and cell ultrastructure changes during senescence of Beta vulgaris L. leaf.

The comparative study of biochemical and ultrastructure features in senescing sugar beet (Beta vulgaris L.) leaves was carried out. One group of plants was grown under normal conditions in washed river sand and poured in turn with nitrate-containing mineral solution or water (N plants). Another group of plants, after 1 month of normal growth, was further grown with nitrate omitted in the nutritive solution (defN plants). The starting point of normal leaf senescence in N plants was identified by the maximal content of soluble protein. Soluble carbohydrate pools were statistically constant in senescing N plants, whereas glucose pools varied noticeably. A decrease in the contents of soluble protein and chlorophyll (a + b) in the course of senescing was typical for N plant leaves. The cell membrane in N plant leaves remained mostly intact; the central vacuoles in the leaf cells were large, and their membranes remained intact. The chloroplasts and mitochondria in senescing N plant leaves became swollen. The vesicles that were present in the cytoplasm of N plant leaves were especially large in the oldest leaves. It was concluded that senescing of sugar beet leaves at sufficient nitrate nutrition occurs according to a "vacuolar" scenario. In the case of nitrate deficiency, the content of soluble carbohydrates in defN leaves first reached maximum and then decreased in older leaves; the protein and chlorophyll (a + b) contents were totally lower than those in normal leaves and continuously decreased during the experiments. Chloroplasts in mesophyll cells of defN plant leaves became more rounded; starch grains in chloroplasts degraded and the number and size of lipid globules increased. The multitude of membrane impairments and lots of large vesicles-"crystals" appeared during the experiment. The results showed the controlling action of nitrogen nutrition in the senescing of sugar beet leaves.

Heterodinuclear (Sm, Tb) lanthanide pivalates with heterocyclic N-donors: synthesis, structure, thermal behavior, and magnetic and photoluminescence properties.

Heterobimetallic complexes [SmTb(piv)6(phen)2] (1), [SmTb(piv)6(bath)2]·1.75EtOH (2a·1.75EtOH), [SmTb(piv)6(bath)2]·2EtOH (2b·2EtOH), and [SmTb(piv)6(bath)2]·EtOH (2b·EtOH), where piv is (CH3)3CCO2(-), phen is 1,10-phenanthroline, and bath is 4,7-diphenyl-1,10-phenanthroline, were synthesized and studied by X-ray diffraction. It was shown that complexes 2a·1.75EtOH and 2b·2EtOH have different molecular and crystal structures. Complexes 2a·1.75EtOH, 2b·2EtOH, and 2b·EtOH differ in the structural functions of µ2-piv anions. 2a·1.75EtOH contains two µ2-piv-κ(2)O,O' anions and two µ2-piv-κ(2)O,O,O' anions, whereas 2b·2EtOH and 2b·EtOH have four µ2-piv-κ(2)O,O' anions. According to the mass spectrometry data, the dimeric molecule [SmTb(piv)6] is the major metal-containing component of gas-phase complexes 1, 2a·1.75EtOH, and 2b·2EtOH. The characteristic features of the thermal behavior of these complexes were revealed, and their magnetic and photoluminescence (PL) properties were investigated. A unique feature of desolvated complexes 2a·1.75EtOH and 2b·2EtOH is melting at high temperatures before thermal decomposition. The magnetic properties of 1 and 2a·1.75EtOH are determined mainly by the Tb(3+) ions. The optical properties of these complexes and their homodinuclear analogs were analyzed by photoluminescence, excitation, phosphorescence, and scattering spectroscopy and by lifetime measurements at 77 K and 300 K. As the temperature decreases to 77 K, the PL intensity of Tb(3+) ions in 1 and 2a·1.75EtOH substantially increases by 40 and 100 times, respectively, compared to 300 K. The PL color evidently changes from red at 300 K to bright green at 77 K. Based on these results, the mechanism of intramolecular energy transfer between the ligand levels and Sm(3+) and Tb(3+) ions under UV radiation was proposed.

Structural features of the salt glands of the leaf of Distichlis spicata 'Yensen 4a' (Poaceae).

The epidermal salt glands of the leaf of Distichlis spicata 'Yensen 4a' (Poaceae) have a direct contact with one or two water-storing parenchyma cells, which act as collecting cells. A vacuole occupying almost the whole volume of the collecting cell has a direct exit into the extracellular space (apoplast) through the invaginations of the parietal layer of the cytoplasm, which is interrupted in some areas so that the vacuolar-apoplastic continuum is separated only by a single thin membrane, which looks as a valve. On the basis of ultrastructural morphological data (two shapes of the extracellular channels, narrow and extended, are found in basal cells), the hypothesis on the mechanical nature of the salt pump in the basal cell of Distichlis leaf salt gland is proposed. According to the hypothesis, a driving force giving ordered motion to salt solution from the vacuole of the collecting cell through the basal cell of the salt gland to cap cell arises from the impulses of a mechanical compression-expansion of plasma membrane, which penetrates the basal cell in the form of extracellular channels. The acts of compression-expansion of these extracellular channels can be realized by numerous microtubules present in the basal cell cytoplasm.

Untangling metabolic and spatial interactions of stress tolerance in plants. 1. Patterns of carbon metabolism within leaves.

The localization of the key photoreductive and oxidative processes and some stress-protective reactions within leaves of mesophytic C(3) plants were investigated. The role of light in determining the profile of Rubisco, glutamate oxaloacetate transaminase, catalase, fumarase, and cytochrome-c-oxidase across spinach leaves was examined by exposing leaves to illumination on either the adaxial or abaxial leaf surfaces. Oxygen evolution in fresh paradermal leaf sections and CO(2) gas exchange in whole leaves under adaxial or abaxial illumination was also examined. The results showed that the palisade mesophyll is responsible for the midday depression of photosynthesis in spinach leaves. The photosynthetic apparatus was more sensitive to the light environment than the respiratory apparatus. Additionally, examination of the paradermal leaf sections by optical microscopy allowed us to describe two new types of parenchyma in spinach-pirum mesophyll and pillow spongy mesophyll. A hypothesis that oxaloacetate may protect the upper leaf tissue from the destructive influence of active oxygen is presented. The application of mathematical modeling shows that the pattern of enzymatic distribution across leaves abides by the principle of maximal ecological utility. Light regulation of carbon metabolism across leaves is discussed.