The current state of Russian agro-industrial complex

The paper analyzes the problems of Agrarian industrial complex (AIC), import substitution in this area and results offood safety program. It is important because AIC ensures food safety of Russia. The main goal of research is to figureout the influence of sanctions and import substitution program on AIC. Natural resource potential of Russia affords togrow the major types of agricultural products except for exotic fruits, berries and nuts. The level of productivity islower than in many developed countries with the same climate. However, one way to help to develop AIC is importsubstitution. In a short term it should be a good method to solve food safety problem. The results of this paper can beused by further researchers to understand strengths and weaknesses of AIC development progra

Analysis of the labor market in Tomsk and Tomsk region

After graduation some people can find a job, but some people can’t find it for a long time. Problems with finding a jobare important for employers and employees. This paper examines an issue of overwhelming importance in Tomsk andTomsk region - unemployment of recent graduates and gives analysis of labor market of Tomsk and Tomsk region.The results of this work show that skilled workers have a higher chance to get a job than the people with highereducation. The results of analysis and advices, which were given in this paper, will help the authorities to solveproblems of labour market in Tomsk and Tomsk region

A superconducting flux-flow oscillator of terahertz range

We have elaborated, fabricated and tested a THz source radiating to open space based on the superconducting flux-flow oscillator (FFO). In this concept, the oscillator is integrated with the transmitting lens antenna based on a slot structure in Nb film with a thickness of ∼200 nm located on the same chip. The slot planar antenna is matched to the oscillator (by input) and to the semielliptical Si lens with a diameter of 10 mm (by output) providing a narrow output beam of THz emission. A harmonic mixer based on the superconductor-insulator-superconductor junction embedded in the "FFO and antenna" integrated structure has been used for the phase locking of the oscillator. Several designs of antenna coupled with the oscillator by microstrip lines have been numerically simulated, and the batches of experimental samples based on Nb-AlN-NbN superconducting trilayers with Rn •A ∼ 20 Ω•μm2 (jc ∼ 10 kA/cm2) have been fabricated and tested. Two different setups were used for experimental study: A THz spectrometer based on the SIS receiver with a high spectral resolution (better than 0.1 MHz) and a Si bolometer. The overall operating range of 250 to 700 GHz is covered by all the developed designs

Liberal transfusion strategy improves survival in perioperative but not in critically ill patients. A meta-analysis of randomised trials

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Non-adrenergic vasopressors in patients with or at risk for vasodilatory shock. A systematic review and meta-analysis of randomized trials

Introduction: Hypotensive state is frequently observed in several critical conditions. If an adequate mean arterial pressure is not promptly restored, insufficient tissue perfusion and organ dysfunction may develop. Fluids and catecholamines are the cornerstone of critical hypotensive states management. Catecholamines side effects such as increased myocardial oxygen consumption and development of arrhythmias are well known. Thus, in recent years, interest in catecholamine-sparing agents such as vasopressin, terlipressin and methylene blue has increased; however, few randomized trials, mostly with small sample sizes, have been performed. We therefore conducted a meta-analysis of randomized trials to investigate the effect of non-catecholaminergic vasopressors on mortality. Methods: PubMed, BioMed Central and Embase were searched (update December 31st, 2014) by two independent investigators. Inclusion criteria were: random allocation to treatment, at least one group receiving a non-catecholaminergic vasopressor, patients with or at risk for vasodilatory shock. Exclusion criteria were: crossover studies, pediatric population, nonhuman studies, studies published as abstract only, lack of data on mortality. Studied drugs were vasopressin, terlipressin and methylene blue. Primary endpoint was mortality at the longest follow-up available. Results: A total of 1,608 patients from 20 studies were included in our analysis. The studied settings were sepsis (10/20 studies [50%]), cardiac surgery (7/20 [35%]), vasodilatory shock due to any cause (2/20 [19%]), and acute traumatic injury (1/20 [5%]). Overall, pooled estimates showed that treatment with non-catecholaminergic agents improves survival (278/810 [34.3%] versus 309/798 [38.7%], risk ratio = 0.88, 95%confidence interval = 0.79 to 0.98, p = 0.02). None of the drugs was associated with significant reduction inmortality when analyzed independently. Results were not confirmed when analyzing studies with a low risk of bias. Conclusions: Catecholamine-sparing agents in patients with or at risk for vasodilatory shock may improve survival. Further researches on this topic are needed to confirm the finding

Awake Fiberoptic Intubation Protocols in the Operating Room for Anticipated Difficult Airway: A Systematic Review and Meta-analysis of Randomized Controlled Trials

Awake fiberoptic intubation is one of the recommended strategies for surgical patients with anticipated difficult airway, especially when concurrent difficult ventilation is expected. We performed the first systematic review of randomized controlled trials assessing different protocols for awake fiberoptic intubation in anticipated difficult airway, including studies investigating elective awake fiberoptic intubation for scheduled surgery; randomized controlled trials comparing different methods for performing awake fiberoptic intubation; and adult patients with anticipated difficult airway. We excluded studies in the nonoperating theater settings, randomized controlled trials comparing awake fiberoptic intubation with other techniques, and studies based on simulation. Primary outcomes were success rate and death; secondary outcomes were major adverse events. Thirty-seven randomized controlled trials evaluating 2045 patients and 4 areas were identified: premedication, local anesthesia, sedation, and ancillary techniques to facilitate awake fiberoptic intubation. Quality of evidence was moderate-low and based on small-sampled randomized controlled trials. Overall, 12 of 2045 intubation failures (0.59%) and 7 of 2045 severe adverse events (0.34%) occurred, with no permanent consequences or death. All evaluated methods to achieve local anesthesia performed similarly well. No differences were observed in success rate with different sedatives. Dexmedetomidine resulted in fewer desaturation episodes compared to propofol and opioids with or without midazolam (relative risk, 0.51 [95% CI, 0.28-0.95]; P = .03); occurrence of desaturation was similar with remifentanil versus propofol, while incidence of apnoea was lower with sevoflurane versus propofol (relative risk, 0.43 [95% CI, 0.22-0.81]; P = .01). A high degree of efficacy and safety was observed with minimal differences among different protocols; dexmedetomidine might offer a better safety profile compared to other sedatives

ДЕФИЦИТ ТИАМИНА И ЕГО КОРРЕКЦИЯ ПРИ КРИТИЧЕСКИХ СОСТОЯНИЯХ

The level of thiamine in critically ill patients can be low due to the loss of fluid, nutrition disorders and increased metabolism. The deficiency of thiamine is associated with reduction of respiratory metabolism, increase in lactate level and hypotension. At present, there are no clear evidence that all critically ill patients suffer from thiamine deficiency and face the risk to develop complications associated with thiamine deficiency. However, there is a certain correlation between progressing of thiamine deficiency and deterioration of the patient's state, though it is to be proved. The efficiency of treatment with thiamine is still being discussed since there is no consensus about the group of patients to be treated, thiamine doses and duration of treatment. For successful diagnostics and prediction of clinical outcomes related to thiamine deficiency, it is necessary to adopt standard methods for thiamine tests and the reference analytic method. Уровень тиамина у больных в критическом состоянии может быть снижен из-за потери жидкости, нарушения питания, повышенного метаболизма. Дефицит тиамина сопровождается снижением аэробного метаболизма, увеличением уровня лактата и гипотензией. В настоящее время нет четких доказательств того, что все больные в критическом состоянии имеют недостаточность тиамина и риск развития тиамин-дефицитных осложнений. Тем не менее существует определенная связь между развитием дефицита тиамина и ухудшением состояния больных, хотя это нуждается в дальнейшем подтверждении. Терапевтический эффект лечения тиамином до сих пор обсуждается с отсутствием консенсуса в отношении групп пациентов, доз тиамина и продолжительности лечения. Для успешной диагностики и прогнозирования клинических исходов, связанных с дефицитом тиамина, необходимы стандартизация методов оценки тиамина и принятие референсного аналитического метода.

A Systematic Review and International Web-Based Survey of Randomized Controlled Trials in the Perioperative and Critical Care Setting: Interventions Reducing Mortality

The authors aimed to identify interventions documented by randomized controlled trials (RCTs) that reduce mortality in adult critically ill and perioperative patients, followed by a survey of clinicians’ opinions and routine practices to understand the clinicians’ response to such evidence. The authors performed a comprehensive literature review to identify all topics reported to reduce mortality in perioperative and critical care settings according to at least 2 RCTs or to a multicenter RCT or to a single-center RCT plus guidelines. The authors generated position statements that were voted on online by physicians worldwide for agreement, use, and willingness to include in international guidelines. From 262 RCT manuscripts reporting mortality differences in the perioperative and critically ill settings, the authors selected 27 drugs, techniques, and strategies (66 RCTs, most frequently published by the New England Journal of Medicine [13 papers], Lancet [7], and Journal of the American Medical Association [5]) with an agreement ≥67% from over 250 physicians (46 countries). Noninvasive ventilation was the intervention supported by the largest number of RCTs (n = 13). The concordance between agreement and use (a positive answer both to “do you agree” and “do you use”) showed differences between Western and other countries and between anesthesiologists and intensive care unit physicians. The authors identified 27 clinical interventions with randomized evidence of survival benefit and strong clinician support in support of their potential life-saving properties in perioperative and critically ill patients with noninvasive ventilation having the highest level of support. However, clinician views appear affected by specialty and geographical location

ЦЕРЕБРАЛЬНАЯ ОКСИМЕТРИЯ В КАРДИОХИРУРГИИ ВЫСОКОГО РИСКА: АКТУАЛЬНОСТЬ И ПРОТОКОЛ КЛИНИЧЕСКОГО ИССЛЕДОВАНИЯ

Cerebral oxymetry is one of the monitoring techniques aimed at the early detection of changes in the brain state. Currently it is being actively introduced into practice, management algorithms for cerebral oxygenation disorders are being developed basing on it, including the ones for cardiac surgeries. Certain data show that this allows decreasing the frequency of post-surgery neurological complications, the duration of patients stay in the intensive care department and general duration of hospital stay. However it is recognized that not all aspects of its using have been provided with the relevant evidence, especially in the respect of cardiac surgical patients with high surgical risk. The main purpose of this research is to draw the attention to the problem and present the protocol of the trial which has been started in our unit. The special emphasis is made on the methodological components of the research, starting with the formulation of research hypothesis, defining finite primary and secondary points, preliminary calculation of sampling and defining statistical analysis methods. We would very much appreciate the feedback from our colleagues and hope that that the other researchers will follow our example when starting big research projects. Церебральная оксиметрия – одна из методик мониторинга, направленного на раннее выявление изменений в состоянии головного мозга. В настоящее время ее активно внедряют в практику, на ее основе разрабатывают алгоритмы коррекции нарушений церебральной оксигенации, в том числе во время кардиохирургических операций. По некоторым данным, это позволяет снизить частоту послеоперационных неврологических осложнений, время пребывания пациентов в палате интенсивной терапии и продолжительность госпитализации. Тем не менее признается, что не все аспекты ее использования получили необходимую доказательную базу, особенно применительно к кардиохирургическим пациентам с высоким операционным риском. Основная цель данной работы – привлечь внимание к проблеме и представить протокол начатого исследования. Особый акцент попытались сделать на методологическую составляющую работы, начиная с формулирования гипотезы исследования, определения конечных первичных и вторичных точек, предварительного расчета объема выборки, определения методов статистического анализа. Будем признательны коллегам за конструктивную критику и рассчитываем, что нашему примеру последуют и другие исследователи, приступающие к большим исследовательским проектам.