Extracorporeal membrane oxygenation in the complex therapy for septic shock in a patient with severe lung damage caused by COVID-19

Extracorporeal membrane oxygenation (ECMO) has been used for more than 20 years in the treatment of severe respiratory distress syndrome. However, ECMO in some categories of patients is not sufficiently covered in the literature, due to a small number of registered cases. This group includes pregnant women and women in labor. During the intensive care of such patients, the entire available range of therapeutic manipulations and measures that can favorably affect the outcome of the disease should be used. We have describe a clinical case of successful ECMO in a patient with novel coronavirus disease (COVID-19) and obstetric sepsis developed in the early postpartum period

Medical workers of health care institutions as a risk group for chemo-resistant tuberculosis: analysis of incidence, a clinical case.

The purpose of our study was to analyze the prevalence of morbidity of medical workers of health care institutions and anti-tuberculosis institutions, as well as the analysis of resistance of mycobacterium tuberculosis strains among medical personal of health facilities in the Dnipropetrovsk region. Retrospective analysis for 2015 - 2017 of electronic database of the patients register (TB-manager), outpatient cards and case histories of patients which underwent treatment in pulmonary-tuberculosis and surgical departments of CI «DnepropetrovskRegional Clinical Treatment and Prophylactic Association "Phthisiology"» DRC» was conducted . The incidence of tuberculosis among medical workers in health care institutions of Ukraine remains at a fairly high, stable level (426 cases of tuberculosis in 2016, 389 cases in 2017) on the background of the decrease in the incidence among the general population (59.5 people per 100 thousand population in 2014 and 51.9 per 100 thousand population in 2017 ). In Ukraine among tuberculosis patients – medical workers,  the overwhelming majority are workers of establishments of the general medical network (GMN) - 351 people, while in anti-tuberculosis institutions (ATI) in 2017, 38 cases of tuberculosis were registered. The article presents the clinical case of multidrug-resistant tuberculosis (MDR) in staff member of the pathoanatomical bureau, one of the medical institutions of the city Dnipro

Medical workers of health care institutions as a risk group for chemo-resistant tuberculosis: analysis of incidence, a clinical case.

The purpose of our study was to analyze the prevalence of morbidity of medical workers of health care institutions and anti-tuberculosis institutions, as well as the analysis of resistance of mycobacterium tuberculosis strains among medical personal of health facilities in the Dnipropetrovsk region. Retrospective analysis for 2015 - 2017 of electronic database of the patients register (TB-manager), outpatient cards and case histories of patients which underwent treatment in pulmonary-tuberculosis and surgical departments of CI «DnepropetrovskRegional Clinical Treatment and Prophylactic Association "Phthisiology"» DRC» was conducted . The incidence of tuberculosis among medical workers in health care institutions of Ukraine remains at a fairly high, stable level (426 cases of tuberculosis in 2016, 389 cases in 2017) on the background of the decrease in the incidence among the general population (59.5 people per 100 thousand population in 2014 and 51.9 per 100 thousand population in 2017 ). In Ukraine among tuberculosis patients – medical workers,  the overwhelming majority are workers of establishments of the general medical network (GMN) - 351 people, while in anti-tuberculosis institutions (ATI) in 2017, 38 cases of tuberculosis were registered. The article presents the clinical case of multidrug-resistant tuberculosis (MDR) in staff member of the pathoanatomical bureau, one of the medical institutions of the city Dnipro

Efficacy of Angio-Seal Device for Primary And Complicated Haemostasis: a Multicentre Retrospective Assay

Background. Femoral approach in endovascular surgery remains relevant being, however, associated with the risk of fatal and non­fatal complications. Modern techniques for instrumental haemostasis achieved with the Angio­Seal device (Terumo Corporation, Japan) provide an opportunity to reduce the number of fatal and non­fatal complications. Aim. A multicentre assay of the efficacy and safety of instrumental puncture closure using Angio­Seal devices (Terumo Corporation, Japan) in various settings and clinical situations.Materials and methods. A multicentre retrospective analysis of 1088 use cases of the Angio­Seal device  (Terumo Corporation, Japan) for “primary” and “complicated” instrumental haemostasis after femoral access  has been conducted for the years 2018–2020. The mean patient age was 62.3 ± 11.6 years, including 845 men (78.0%) and 243 women (22.0%). Five centres for routine and emergency endovascular radiology participated in the study.Results. The Angio­Seal device (Terumo Corporation, Japan) demonstrated a high method efficiency, with a  97.0% success rate of “primary” instrumental haemostasis (1055 of 1088 total successful haemostatic  procedures) in various clinical settings. Arterial thrombosis at the approach side had a 3.0% complication rate  (5 of 33 observations), all other complication types associated with haemorrhagic events (8 cases) or device malfunction and damage (20 cases).Discussion. The assay conducted suggests that the incidence of “complicated” instrumental haemostasis  relates to technical drawbacks of the device application that required advance planning. The key identified  prerequisites for a successful Angio­Seal application (Terumo Corporation, Japan) are the alignment of anchor tube­delivery through soft tissue into the vessel lumen and its positioning inside the vessel.Conclusion. The constructive features and instrumental haemostatic technique realised in the Angio­Seal  device (Terumo Corporation, Japan) enable an effective and safe primary sealing of arterial puncture site in 97% cases

Многоцентровой ретроспективный анализ использования устройства «Angioseal» для осуществления первичного и осложненного гемостаза

Background. Femoral approach in endovascular surgery remains relevant being, however, associated with the risk of fatal and non­fatal complications. Modern techniques for instrumental haemostasis achieved with the Angio­Seal device (Terumo Corporation, Japan) provide an opportunity to reduce the number of fatal and non­fatal complications. Aim. A multicentre assay of the efficacy and safety of instrumental puncture closure using Angio­Seal devices (Terumo Corporation, Japan) in various settings and clinical situations.Materials and methods. A multicentre retrospective analysis of 1088 use cases of the Angio­Seal device  (Terumo Corporation, Japan) for “primary” and “complicated” instrumental haemostasis after femoral access  has been conducted for the years 2018–2020. The mean patient age was 62.3 ± 11.6 years, including 845 men (78.0%) and 243 women (22.0%). Five centres for routine and emergency endovascular radiology participated in the study.Results. The Angio­Seal device (Terumo Corporation, Japan) demonstrated a high method efficiency, with a  97.0% success rate of “primary” instrumental haemostasis (1055 of 1088 total successful haemostatic  procedures) in various clinical settings. Arterial thrombosis at the approach side had a 3.0% complication rate  (5 of 33 observations), all other complication types associated with haemorrhagic events (8 cases) or device malfunction and damage (20 cases).Discussion. The assay conducted suggests that the incidence of “complicated” instrumental haemostasis  relates to technical drawbacks of the device application that required advance planning. The key identified  prerequisites for a successful Angio­Seal application (Terumo Corporation, Japan) are the alignment of anchor tube­delivery through soft tissue into the vessel lumen and its positioning inside the vessel.Conclusion. The constructive features and instrumental haemostatic technique realised in the Angio­Seal  device (Terumo Corporation, Japan) enable an effective and safe primary sealing of arterial puncture site in 97% cases.Введение. Бедренный доступ для эндоваскулярных операций сохраняет свою  актуальность, однако его выполнение связано с риском возникновения фатальных и  нефатальных осложнений. Современные технологии аппаратного гемостаза,  достигаемого с помощью устройства «Angioseal» («Terumo Corporation», Япония),  предоставляют возможность снижения числа фатальных и нефатальных осложнений. Цель исследования. Провести многоцентровую оценку эффективности и безопасности аппаратного закрытия пункционного отверстия с применением устройств «Angioseal» в различных условиях и клинических ситуациях.Материалы и методы. Проведен многоцентровой ретроспективный анализ 1088  случаев использования устройства «Angioseal» для осуществления «первичного» и  «осложненного» аппаратного гемостаза после бедренного доступа в период с 2018 по 2020 год. Средний возраст пациентов составил 62,3 ± 11,6 года. Мужчин было 845 (78,0 %), женщин — 243 (22,0 %). В исследовании приняли участие пять центров,  осуществляющих плановую и экстренную рентгенэндоваскулярную помощь.Результаты. Применение устройства «Angioseal» показывает высокую эффективность метода — 97,0 % успеха «первичного» аппаратного гемостаза (1055 случаев из 1088 успешных процедур гемостаза) в условиях различных клинических ситуаций. В  структуре осложнений (3,0 %) — тромбоз артерий на стороне доступа составил 5 случаев из 33 наблюдений; остальные варианты осложнений были связаны с геморрагическими событиями (8 случаев) или отказом/повреждением устройства, наблюдаемым в 20 случаях.Обсуждение. По данным проведенного исследования мы заключили, что случаи «осложненного» аппаратного гемостаза были сопряжены с техническими трудностями применения устройства и требовали заблаговременного планирования. Ключевыми  моментами успешного применения устройства «Angioseal» можно считать прямолинейность прохождения якоря устройства по доставляющей трубке через  мягкие ткани в просвет сосуда и контроль расположения якоря в сосуде.Заключение. Конструктивные особенности и методика аппаратного гемостаза с применением устройства «Angioseal» в 97 % случаев позволяют эффективно и безопасно осуществлять первичное закрытие пункционного артериального доступа

The ATLAS Transition Radiation Tracker (TRT) proportional drift tube: design and performance

A straw proportional counter is the basic element of the ATLAS Transition Radiation Tracker (TRT). Its detailed properties as well as the main properties of a few TRT operating gas mixtures are described. Particular attention is paid to straw tube performance in high radiation conditions and to its operational stability

The ATLAS TRT electronics

The ATLAS inner detector consists of three sub-systems: the pixel detector spanning the radius range 4cm-20cm, the semiconductor tracker at radii from 30 to 52 cm, and the transition radiation tracker (TRT), tracking from 56 to 107 cm. The TRT provides a combination of continuous tracking with many projective measurements based on individual drift tubes (or straws) and of electron identification based on transition radiation from fibres or foils interleaved between the straws themselves. This paper describes the on and off detector electronics for the TRT as well as the TRT portion of the data acquisition (DAQ) system

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