Economic analysis of the effectiveness of complex rehabilitation in children with spastic forms of cerebral palsy with injections of botulinum neurotoxin type A and without it

Purpose. Comparative economic analysis of complex rehabilitation of children with cerebral palsy (CP) with and without injections of botulinum neurotoxin type A (Dysport®, BoNT-A). Materials and methods. We clinically followed up 149 children with spastic forms of cerebral palsy (GMFCS II-IV) – 78 boys and 71 girls in the age period from 2 to 14 years (108 children who received intramuscular BoNT-A injections and 41 children who underwent similar complex treatment without it). In the budget impact analysis (BIA) only direct medical costs were taken: the cost of pharmacotherapy BoNT-A, rehabilitation care and surgery. Results. Children with CP of the main group needed surgical correction for the first time by 10.5±2.8 years, 4.6 % (5 children) of them needed repeated 95 % (39 children) of the comparison group during the period of active growth from 10 to 12 years. As a result, the BIA found that the use of the treatment scheme for children with CP using abobotulinumtoxinA will save the budget of 24 744 690 RUB per 100 children compared to standard therapy for 12 years of observation. During the CEA it was found that to achieve 1 % efficiency in children with CP with the use of abobotulinumtoxin A requires 1 854 426 RUB, and to achieve a similar result without BoNT-A — 40 702 271 RUB. Including abobotulinumtoxinA injections in the comprehensive rehabilitation of children with CP would allow to treat additional 14 % children (compared to a treatment without BoNT-A ) with the same budget. Conclusion. It was found that the use of treatment regimens for children with cerebral palsy using the BoNT-A is economically justified. Long-term therapy of children with CP with Dysport® during a 12-year-follow-up has considerably improved clinical outcomes and could provide a saving of 24 744 690 rubles compared with a standard therapy per 100 patients. Considering the register of children with CP in the Tyumen region on 01 January, 2018, the budget savings could account for 5,938,726 rubles a year

PERIBRONCHIAL ADMINISTRATION OF ANTIBIOTICS IN THE INTEGRAL TREATMENT OF PNEUMONIA IN CASE OF ACUTE POISONING

Goal of the study: to improve treatment results of nosocomial pneumonia being the complication of severe acute exogenous poisoning through endoscopic peribronchial administration of anti-bacterial agents.Materials and methods. The analysis included data and treatment results in two groups of patients (71 patients) staying in the emergency care department and suffering from hospital pneumonia as a complication of severe acute exogenous poisoning. Treatment of patients in the compared groups was performed as per the same regimen, anti-bacterial medications were prescribed with the consideration of the drug susceptibility of the causative agents. The difference was the use of the endoscopic peribronchial administration of antibiotics in the main group (41 patients), this technique was not used in the comparison group.Results. Endoscopic peribronchial administration of amikacin to which the isolated causative agent was susceptible, allowed reducing the mortality down to 12/41, 29.0% compared to the group where this method was not used – 13/30, 43.3% (p < 0,05)

Опыт применения комбинированной антитромботической терапии у пациента с острым коронарным синдромом на фоне тяжелого течения коронавирусной инфекции

The paper presents the experience of treating a patient with acute coronary syndrome without ST segment elevation and underlying severe novel coronavirus infection (COVID-19) complicated by polysegmental viral pneumonia and significant respiratory events. Emphasis has been placed on the use of antithrombotic therapy after endovascular treatment. A 56-year-old patient underwent respiratory support (non-invasive face mask lung ventilation followed by high-flow oxygenation), urgent diagnostic coronary angiography followed by percutaneous coronary intervention (balloon angioplasty and stenting of the right coronary artery and anterior interventricular artery). In addition to the etiopathogenetic therapy for coronavirus infection, the patient received combination antithrombotic therapy, including acetylsalicylic acid, prasugrel, FRaMon monoclonal antibodies (single exposure, intraoperatively), sodium enoxaparin. The therapy resulted in normalization of hemodynamic parameters, stable normothermia, absence of catarrhal events, improvement of exercise tolerance. A chest ultrasound imaging showed consolidation events, inflammatory markers significantly decreased, circulatory deficiency events were compensated, anginal pains did not recur. On the 20th day of hospitalization, the patient was discharged home with outpatient follow-up. The use of potent antiplatelet agents such as prasugrel or ticagrelor combined with IIb/IIIa receptor inhibitors and prolonged anticoagulant therapy can potentially improve the outcome of the disease in acute coronary syndrome with underlying severe coronavirus infection. In the presented clinical example, the use of aggressive approaches to the antithrombotic therapy did not lead to the development of significant hemorrhagic or other complications.В работе представлен опыт лечения недостаточности кровообращения сегмента ST на фоне тяжелого течения новой коронавирусной инфекции (COVID-19), осложненной полисегментарной вирусной пневмонией и выраженными явлениями дыхательной недостаточности. Акцент сделан на применении антитромботической терапии после выполненного эндоваскулярного лечения. Пациенту 56 лет, проводилась респираторная поддержка (неинвазивная масочная искусственная вентиляция легких с последующим переходом на высокопоточную оксигенацию), в экстренном порядке выполнена диагностическая коронарография с последующим чрескожным коронарным вмешательством (баллонная ангиопластика и стентирование правой коронарной артерии и передней межжелудочковой артерии). Помимо этиопатогенетической терапии коронавирусной инфекции пациенту проведена комплексная антитромботическая терапия, включая ацетилсалициловую кислоту, прасугрел, антитела моноклональные FRaMon (однократно интраоперационно), эноксапарин натрия. На фоне лечения показатели гемодинамики стабилизированы, достигнута стойкая нормотермия, катаральных явлений нет, толерантность к физической нагрузке увеличилась. По данным УЗИ легких отмечены явления консолидации, значительное снижение уровня маркеров воспаления, явления недостаточности кровообращения компенсированы, ангинозные боли не рецидивировали. На 20-е сут. госпитализации пациент выписан под амбулаторное наблюдение. Использование мощных дезагрегантных средств, таких как прасугрел или тикагрелор, в сочетании с ингибиторами IIв/IIIа-рецепторов и продленной антикоагулянтной терапией потенциально может улучшать исход заболевания при развитии острого коронарного синдрома на фоне тяжелого течения коронавирусной инфекции. В представленном клиническом примере применение агрессивной тактики антитромботической терапии не привело к развитию значимых геморрагических или иных осложнений

ОЦЕНКА РИСКА ОСТАТОЧНОЙ МИОРЕЛАКСАЦИИ ПРИ ЛАПАРОСКОПИЧЕСКИХ ОПЕРАТИВНЫХ ВМЕШАТЕЛЬСТВАХ

The risk degree of the residual curarization was identified for the tracheal extubation under laparoscopic intervention. It is shown by the quantitative neuromuscular monitoring and "total-blind" control under which recovery rate of the neuromuscular conduction and how soon on the operation completion the intensivists perform the tracheal extubation on a routine basis. Выявлена степень риска остаточной кураризации на момент экстубации трахеи при лапароскопических вмешательствах. С помощью количественного нейромышечного мониторинга и «слепого» контроля показано, при какой степени восстановления нервно-мышечной проводимости и через какое время после окончания операции анестезиологи-реаниматологи рутинно производят экстубацию трахеи при лапароскопической холецистэктомии и аппендэктомии

Aquatic community response to volcanic eruptions on the Ecuadorian Andean flank: evidence from the palaeoecological record

Aquatic ecosystems in the tropical Andes are under increasing pressure from human modification of the landscape (deforestation and dams) and climatic change (increase of extreme events and 1.5 °C on average temperatures are projected for AD 2100). However, the resilience of these ecosystems to perturbations is poorly understood. Here we use a multi-proxy palaeoecological approach to assess the response of aquatic ecosystems to a major mechanism for natural disturbance, volcanic ash deposition. Specifically, we present data from two Neotropical lakes located on the eastern Andean flank of Ecuador. Laguna Pindo (1°27.132′S–78°04.847′W) is a tectonically formed closed basin surrounded by a dense mid-elevation forest, whereas Laguna Baños (0°19.328′S–78°09.175′W) is a glacially formed lake with an inflow and outflow in high Andean Páramo grasslands. In each lake we examined the dynamics of chironomids and other aquatic and semi-aquatic organisms to explore the effect of thick (> 5 cm) volcanic deposits on the aquatic communities in these two systems with different catchment features. In both lakes past volcanic ash deposition was evident from four large tephras dated to c.850 cal year BP (Pindo), and 4600, 3600 and 1500 cal year BP (Baños). Examination of the chironomid and aquatic assemblages before and after the ash depositions revealed no shift in composition at Pindo, but a major change at Baños occurred after the last event around 1500 cal year BP. Chironomids at Baños changed from an assemblage dominated by Pseudochironomus and Polypedilum nubifer-type to Cricotopus/Paratrichocladius type-II, and such a dominance lasted for approximately 380 years. We suggest that, despite potential changes in the water chemistry, the major effect on the chironomid community resulted from the thickness of the tephra being deposited, which acted to shallow the water body beyond a depth threshold. Changes in the aquatic flora and fauna at the base of the trophic chain can promote cascade effects that may deteriorate the ecosystem, especially when already influenced by human activities, such as deforestation and dams, which is frequent in the high Andes

Performance of the CMS Cathode Strip Chambers with Cosmic Rays

The Cathode Strip Chambers (CSCs) constitute the primary muon tracking device in the CMS endcaps. Their performance has been evaluated using data taken during a cosmic ray run in fall 2008. Measured noise levels are low, with the number of noisy channels well below 1%. Coordinate resolution was measured for all types of chambers, and fall in the range 47 microns to 243 microns. The efficiencies for local charged track triggers, for hit and for segments reconstruction were measured, and are above 99%. The timing resolution per layer is approximately 5 ns

Performance of CMS muon reconstruction in pp collision events at sqrt(s) = 7 TeV

The performance of muon reconstruction, identification, and triggering in CMS has been studied using 40 inverse picobarns of data collected in pp collisions at sqrt(s) = 7 TeV at the LHC in 2010. A few benchmark sets of selection criteria covering a wide range of physics analysis needs have been examined. For all considered selections, the efficiency to reconstruct and identify a muon with a transverse momentum pT larger than a few GeV is above 95% over the whole region of pseudorapidity covered by the CMS muon system, abs(eta) < 2.4, while the probability to misidentify a hadron as a muon is well below 1%. The efficiency to trigger on single muons with pT above a few GeV is higher than 90% over the full eta range, and typically substantially better. The overall momentum scale is measured to a precision of 0.2% with muons from Z decays. The transverse momentum resolution varies from 1% to 6% depending on pseudorapidity for muons with pT below 100 GeV and, using cosmic rays, it is shown to be better than 10% in the central region up to pT = 1 TeV. Observed distributions of all quantities are well reproduced by the Monte Carlo simulation.Comment: Replaced with published version. Added journal reference and DO

Performance of CMS muon reconstruction in pp collision events at sqrt(s) = 7 TeV

The performance of muon reconstruction, identification, and triggering in CMS has been studied using 40 inverse picobarns of data collected in pp collisions at sqrt(s) = 7 TeV at the LHC in 2010. A few benchmark sets of selection criteria covering a wide range of physics analysis needs have been examined. For all considered selections, the efficiency to reconstruct and identify a muon with a transverse momentum pT larger than a few GeV is above 95% over the whole region of pseudorapidity covered by the CMS muon system, abs(eta) < 2.4, while the probability to misidentify a hadron as a muon is well below 1%. The efficiency to trigger on single muons with pT above a few GeV is higher than 90% over the full eta range, and typically substantially better. The overall momentum scale is measured to a precision of 0.2% with muons from Z decays. The transverse momentum resolution varies from 1% to 6% depending on pseudorapidity for muons with pT below 100 GeV and, using cosmic rays, it is shown to be better than 10% in the central region up to pT = 1 TeV. Observed distributions of all quantities are well reproduced by the Monte Carlo simulation.Comment: Replaced with published version. Added journal reference and DO

Performance and Operation of the CMS Electromagnetic Calorimeter

The operation and general performance of the CMS electromagnetic calorimeter using cosmic-ray muons are described. These muons were recorded after the closure of the CMS detector in late 2008. The calorimeter is made of lead tungstate crystals and the overall status of the 75848 channels corresponding to the barrel and endcap detectors is reported. The stability of crucial operational parameters, such as high voltage, temperature and electronic noise, is summarised and the performance of the light monitoring system is presented

Spin transport and spin torque in antiferromagnetic devices

Ferromagnets are key materials for sensing and memory applications. In contrast, antiferromagnets which represent the more common form of magnetically ordered materials, have found less practical application beyond their use for establishing reference magnetic orientations via exchange bias. This might change in the future due to the recent progress in materials research and discoveries of antiferromagnetic spintronic phenomena suitable for device applications. Experimental demonstration of the electrical switching and detection of the Néel order open a route towards memory devices based on antiferromagnets. Apart from the radiation and magnetic-field hardness, memory cells fabricated from antiferromagnets can be inherently multilevel, which could be used for neuromorphic computing. Switching speeds attainable in antiferromagnets far exceed those of ferromagnetic and semiconductor memory technologies. Here we review the recent progress in electronic spin-transport and spin-torque phenomena in antiferromagnets that are dominantly of the relativistic quantum mechanical origin. We discuss their utility in pure antiferromagnetic or hybrid ferromagnetic/antiferromagnetic memory devices