One approach to solve a nonlinear boundary value problem for the Fredholm integro-differential equation

A quasilinear boundary value problem for a Fredholm integro-differential equation is considered. The interval is divided into N parts and the values of the solution to the equation at the left end points of the subintervals are introduced as additional parameters. New unknown functions are introduced on the subintervals and a special Cauchy problem with parameters is solved with respect to a system of such functions. By means of the solution to this problem, a new general solution to the quasilinear Fredholm integro-differential equation is constructed. The conditions of the existence of a unique new general solution to the equation under consideration are obtained. A new general solution is used to create a system of nonlinear algebraic equations in parameters introduced. The conditions for the existence of a unique solution to this system are established. This ensures the existence of a unique solution to original problem

Ethnic identity features in convicted migrants with recidivist behavior: development of tolerance among convicted migrants to other ethnic groups

By the end of adolescence, a person develops ethnic identity that affects their future destiny. The purpose of the study is to analyze formation of ethnic identity features in convicted migrants and development of tolerance among them. In the process of work theoretical research methods have been used. The presence of personal attitudes determines future actions that may be criminal. The increase in the number of convicted migrants who commit crimes repeatedly is characterized by criminalization degree presence, as well as personal and behavioral traits. Ethnic identity in this case has a cognitive component based on criminogenic for a certain benefit. The peculiarities of recidivism manifestation include existence of certain dependencies that link the increase in the severity and rate of crimes committed and increase in the number of convictions, which leads to an increase in recidivism as a result of an increase in crime. The development of tolerance among convicted migrants requires development and implementation of measures aimed at reducing aggression and accepting diversity of culture of other ethnic groups

Bounder solution on a strip to a system of nonlinear hyperbolic equations with mixed derivatives

The system of nonlinear hyperbolic equations with mixed derivatives is considered on the strip. Time variable of the unknown function changes on the whole axis, and the spatial variable belongs to a finite interval. A function, the partial derivative with respect to the spatial variable, is denoted as unknown function, and problem of finding a bounded on the strip solution to the origin system is reduced to the problem of finding a bounded on the strip solution to a system of integro - partial differential equations. The whole axes is divided into parts, and additional functional parameters are introduced as the values of unknown function on the initial lines of sub - domains. For the fixed values of functional parameters, the new unknown functions in the sub - domains are defined as the solutions to the Cauchy problems for integro - partial differential equations of the first order. Using the continuity conditions of the solution on the partition lines, the two - sided infinite system of nonlinear Volterra integral equations of the second kind with respect to introduced functional parameters is obtained. Algorithms for finding solutions of problem with functional parameters are proposed. Conditions for the convergence of algorithms, and existence of bounded on the strip solution of the system of nonlinear hyperbolic equations with mixed derivatives are obtained

STUDY OF EFFECTIVENESS OF SALT INHIBITORS

In this paper, the reasons for the formation of sparingly mineral salt deposits in steam boilers and inhibitors are considered as one of the options for combating this phenomenon

Совершенствование оказания медицинской помощи пациентам с ОНМК с применением стандартов JCI. Первые результаты

AIM OF THE STUDY To compare the dynamics of thrombolytic therapy effectiveness in patients with stroke after the reorganization of medical care using JCI standards.MATERIAL AND METHODS In 2022, a new system for routing patients with stroke at the level of the emergency department was introduced in the Emergency Care Hospital; and 976 patients with the diagnosis of brain infarction were treated. The analysis of the results was carried out by comparing the mortality rates from ischemic stroke, the number of thrombolytic therapies and procedures of mechanical methods of revascularization, as well as the indicators “Door-CT”, “DoorNeedle”, “Door-Opening” for 2021 and 10 months of 2022.RESULTS After the introduction of the new routing system for patients with stroke at the emergency department level, there appeared the first positive results. Thus, the mortality rate from brain infarction in 10 months of 2022 decreased by 5.6% compared to 2021. The number of thrombolytic therapies performed increased by 5.2%, and mechanical revascularization procedures by 1.62% over the same period, while the “Door-CT” indicator decreased by 27 minutes, “DoorNeedle” by 22 minutes, “Door-Opening” by 31.6 minutes.CONCLUSIONS The immediate results of the introduction of the new patient routing system at the level of the emergency department have proved successful, primarily due to the significant reduction in the mortality rate of patients with cerebral infarction by 5.6%. However, the process requires further investigation and has application points for further improvement.ЦЕЛЬ ИССЛЕДОВАНИЯ Сравнить динамику эффективности проведения тромболитической терапии у пациентов с острым нарушением мозгового кровообращения (ОНМК) после реорганизации медицинской помощи с применением стандартов JCI.МАТЕРИАЛ И МЕТОДЫ В ГАУЗ РТ «БСМП» в 2022 г. внедрена новая система маршрутизации пациентов с ОНМК на уровне приемного отделения и пролечены 976 пациентов с диагнозом «Инфаркт мозга». Анализ полученных результатов проводили путем сравнения показателей летальности от ишемического инсульта, количества проведенных тромболитических терапий и процедур механических методов реваскуляризации, а также показателей «Дверь–КТ», «Дверь–Игла», «Дверь–Раскрытие» за 2021 г. и 10 месяцев 2022 г.РЕЗУЛЬТАТЫ После внедрения новой системы маршрутизации пациентов с ОНМК на уровне приемного отделения с применением стандартов JCI имеются первые положительные результаты. Так, летальность от инфаркта мозга за 10 месяцев 2022 г. снизилась на 5,6% в сравнении с 2021 г. Количество проведенных тромболитических терапий увеличилось на 5,2%, а процедур механических методов реваскуляризации — на 1,62% за аналогичный период, в то время как показатель «Дверь–КТ» снизился на 27 минут, «Дверь–Игла» — на 22 минуты, а «Дверь–Раскрытие» — на 31,6 минуты.ЗАКЛЮЧЕНИЕ Непосредственные результаты внедрения новой системы маршрутизации пациентов на уровне приемного отделения являются успешными, в первую очередь за счет значимого снижения летальности пациентов с инфарктом мозга на 5,6%. Однако процесс требует дальнейшего исследования и имеет точки приложения для дальнейшего улучшения

Лапароскопическая передняя эвисцерация органов малого таза с резекцией сигмовидной кишки (клиническое наблюдение)

The clinical observation demonstrates a successful surgical treatment of a 61-year-old female patient K. (body mass index 38.4) diagnosed with locally advanced sigmoid colon cancer protruded into the bladder and uterus (сT4bN2M0) with formation of a colovesical fistula. The patient underwent surgical treatment in the form of laparoscopic resection of the sigmoid colon and supralevator anterior pelvic exenteration with formation of a Bricker conduit. Intraoperative blood loss was 200 ml. Postoperative period was smooth, with fast track rehabilitation; the patient was discharged on day 9. Considering cancer stage, the patient received XELOX as adjuvant chemotherapy for 6 months after the surgery. During a year of follow-up, no signs of disease progression were evident. The patient is fully socially rehabilitated.  В клиническом наблюдении продемонстрировано успешное хирургическое лечение пациентки К. 61 года (индекс массы тела 38,4), у которой был диагностирован местно-распространенный рак сигмовидной кишки с врастанием в мочевой пузырь и матку (сT4bN2M0) с образованием толстокишечно-пузырного свища. Больной было выполнено хирургическое вмешательство в объеме лапароскопической резекции сигмовидной кишки, супралеваторной передней эвисцерации органов малого таза с формированием кондуита по Брикеру. Интраоперационная кровопотеря составила 200 мл. Течение послеоперационного периода гладкое, с применением протокола ускоренной реабилитации; больная выписана на 9-е сутки. С учетом стадии заболевания в течение 6 мес после операции проводилась адъювантная полихимиотерапия по схеме XELOX. В течение 1 года наблюдения данные за прогрессирование основного заболевания отсутствуют. Пациентка полностью реабилитирована в социальном аспекте. 

The Use of the Raabe Aspirator in Intraoperative neurophysiological Monitoring during Decompression and Stabilization Interventions for Degenerative Diseases and Injuries of the Lumbar Spine

Background. Raabe probe is a suction device with monopolar motor fibers mapping capabilities. A number of technical characteristics make it possible to use it for intraoperative neurophysiological monitoring during posterior lumbar fusion surgery.The aim of this study was to analyze our experience of Raabe probe using for intraoperative neurophysiological monitoring during posterior lumbar fusion surgery.Methods. Ninety-eight patients (55 women and 43 men) with degenerative changes and injuries of the lumbar spine were included into the study, mean age – 56.3 ± 12.8 years. Patients underwent the following operations: 85 cases (86.7 %) – spinal roots decompression with fusion by dorsal and ventral implants, 12 cases (12.2 %) – decompression with only dorsal fusion, 1 case (1.0 %) – dorsal fusion without decompression. In all cases intraoperative neurophysiological monitoring control by B. Calancie method with Raabe probe using was performed.Results. With a critical current threshold of 12 mA, the sensitivity of the method is 94 %, the specificity is 97 %. Comparing the thresholds of the M-response at the stage of screw stimulation, no statistically significant differences were found between the groups of true-positive and false-positive results, both for interested (p = 0.09) and intact (p = 0,16) screws. At the stage of the impactor stimulation, the threshold of the M-response in the true-positive group made11.39 ± 7.97 mA, and in the false-positive group – 24.16 ± 8.85 mA (p < 0.05).Conclusion. Raabe probe application for intraoperative neurophysiological monitoring during posterior lumbar fusion surgery show the high sensitivity and specificity. The most reliable sign of pedicle wall breach is a threshold below than 12 mA at the stage of the impactor stimulation

ЛЕЧЕНИЕ БОЛЬНОГО РАКОМ СИГМОВИДНОЙ КИШКИ С СОЛИТАРНЫМ МЕТАСТАЗОМ В ЛЕГКОЕ С ИСПОЛЬЗОВАНИЕМ ЛАПАРОСКОПИЧЕСКОЙ И ТОРАКОСКОПИЧЕСКОЙ МЕТОДИК (КЛИНИЧЕСКОЕ НАБЛЮДЕНИЕ)

A clinical case of a sigmoid cancer patient with solitary lung metastasis is discussed in this article. Use of minimally invasive surgical technologies allowed to perform a simultaneous combined surgery on abdominal and thoracic cavities and improve rehabilitation time and time to systemic chemotherapy initiation. In presented clinical case patient was comorbid with stage III obesity, which was considered as a contraindication to laparoscopic surgery for a long time.В статье описан клинический случай лечения больного диссеминированным раком сигмовидной кишки с использованием мини-инвазивных технологий, позволивших произвести одномоментное комбинированное оперативное вмешательство на грудной и брюшной полости, что способствовало реабилитации пациента в кратчайшие сроки и своевременному началу системной химиотерапии. Особенностью данного случая является наличие у больного сопутствующего заболевания – ожирения III степени, долгое время считавшегося противопоказанием для выполнения лапароскопических операций

Комплексное лечение больных раком прямой кишки с синхронными отдаленными метастазами

Objective: to analyze short-term and long-term outcomes of surgical, combination, and comprehensive treatment in patients with metastatic rectal cancer.Materials and methods. We performed a retrospective analysis of prospectively collected data on the outcomes of rectal cancer patients receiving surgical, combination (surgery + chemotherapy), or comprehensive (chemoradiotherapy + surgery + chemotherapy) treatment in the Department of Proctology at the N.N. Blokhin National Medical Research Center of Oncology, Ministry of Health of Russia, between 1999 and 2015. We assessed overall survival, frequency of postoperative complications, postoperative death rates and frequency of complications associated with chemoradiotherapy.Results. The study included 366patients that were divided into 3 groups according to the treatment strategy. The 2-year survival rate was 83 % in group 3 (comprehensive treatment) vs 40 % in groups 1 and 2. Median survival was 43 months in group 3 compared to 18 and 14 months in groups 2 and 1 respectively. The number of postoperative complications was 19 %, 13.4 %, and 15.1 % in groups 1, 2 and 3 respectively. There was one postoperative death (1.1 %) in group 3.Conclusion. Comprehensive treatment significantly improves overall survival of rectal cancer patients without increasing the risk of postoperative complications.Цель исследования — изучить непосредственные и отдаленные результаты хирургического, комбинированного и комплексного лечения больных метастатическим раком прямой кишки.Материалы и методы. Данная работа основана на ретроспективном анализе проспективно собранной базы данных результатов лечения больных раком прямой кишки, которым проводилось хирургическое, комбинированное (операция и химиотерапия) и комплексное (химиолучевая терапия, операция и химиотерапия) лечение в проктологическом отделении ФГБУ«Национальный медицинский исследовательский центр онкологии им. Н.Н. Блохина» Минздрава России в период с 1999 г. по июнь 2015 г. Исследуемые параметры включали общую выживаемость, частоту послеоперационных осложнений, частоту послеоперационной летальности, частоту осложнений химиолучевой терапии.Результаты. Всего в исследуемые 3 группы вошло 366 пациентов. Общая 2-летняя выживаемость в 3-й группе (комплексное лечение) составила 83 % по сравнению с 40 % в 1-й и 2-й группах, медиана выживаемости — 43 мес по сравнению с 18 мес во 2-й группе и 14мес в 1-й группе, частота послеоперационных осложнений — 19 % в 1-й группе, 13,4 % — во 2-й, 15,1 % — в 3-й. Послеоперационная летальность (1,1 %) зафиксирована только в 3-й группе.Выводы. Комплексный подход лечения позволяет значительно увеличить показатели общей выживаемости больных метастатическим раком прямой кишки без повышения риска послеоперационных осложнений

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p<0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p<0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised