Успешная сердечно-легочная реанимация с использованием экстракорпоральной мембранной оксигенации (клинический случай)

A clinical case of treatment of a 64-year-old  patient with cardiac arrest is presented. In the complex of resuscitation measures, an automatic chest compression machine was used, and upon admission to the hospital, venoarterial extracorporeal membrane oxygenation was connected as the main method of maintaining effective blood circulation as soon as possible. The interaction of a multidisciplinary team was demonstrated, the features of decision-making when choosing a hemodynamic support  method, the complications that  arose and possible difficulties were described.Представлен клинический случай лечения пациента 64 лет с внезапной клинической смертью. В комплексе реанимационных мероприятий применялся аппарат автоматической компрессии грудной клетки, а также при поступлении в стационар в кратчайшие сроки была подключена вено-артериальная экстракорпоральная мембранная оксигенация как основной метод поддержания эффективного кровообращения. Продемонстрированы взаимодействие мультидисциплинарной команды, особенности  принятия решений при выборе метода поддержки гемодинамики, описаны возникшие при этом осложнения и возможные  трудности

The Science Performance of JWST as Characterized in Commissioning

This paper characterizes the actual science performance of the James Webb Space Telescope (JWST), as determined from the six month commissioning period. We summarize the performance of the spacecraft, telescope, science instruments, and ground system, with an emphasis on differences from pre-launch expectations. Commissioning has made clear that JWST is fully capable of achieving the discoveries for which it was built. Moreover, almost across the board, the science performance of JWST is better than expected; in most cases, JWST will go deeper faster than expected. The telescope and instrument suite have demonstrated the sensitivity, stability, image quality, and spectral range that are necessary to transform our understanding of the cosmos through observations spanning from near-earth asteroids to the most distant galaxies

Опыт работы ПСПбГМУ им. И. П. Павлова по оказанию помощи больным с новой коронавирусной инфекцией: первые итоги и уроки

The constant mutation of the virus and the complicated epidemiological situation in other countries keep the probability of a third wave of the pandemic in the Russian Federation fairly high. It is important to summarize the gained experience as fast as possible to use it appropriately once it is needed.The objective: to analyze the specific parameters of care for critically ill patients with the novel coronavirus infection in Pavlov Multidisciplinary Medical Center.Subjects and methods. This is a result-based report on the work performed by the Infection Center, which was deployed twice in Pavlov Multidisciplinary Medical Center (from 28.04.2020 to 03.08.2020 and from 01.11.2020 to 15.03.2021). Totally, 3,830 patients with SARS-CoV-2 were managed (1,680 patients during the first deployment and 2,150 patients during the second one). In the preparatory period, the operation of the emergency department based on the inpatient emergency medical department (EMD) had been simulated to clarify its staff structure and the procedure for admission, examination, and treatment of patients. Here we compare the organizational approaches during the first and second waves of the pandemic and present the characteristics of the demographic data of the treated patients, the incidence of certain complications, and outcomes.Results. The overall lethality in the Center made 6.2%. Despite the experience gained in the first wave, the results of treatment during the second wave (autumn-winter) did not improve (5.7% died in the first wave and 6.7% in the second one). Lethality in ICU and EMD was 40.0% and 49.6%, in ICU only – 38.5% and 46.9% respectively. A moderate lethality increase in ICU was due to the concentration of critically ill and most critically ill patients. There were 51.4% of patients with comorbidities and 53.5% were above 65 years of age. Refinement and differentiation of tasks performed by departments, simulation of the operation of the Center before opening made it possible to increase the throughput of the medical unit avoiding rush during admission and deterioration the quality of treatment.Conclusion. Certain aspects of the organization of medical care affect the performance of a multidisciplinary medical institution transformed into an infectious diseases hospital. The experience gained under such circumstances can be useful in other emergencies with a large number of victims and patients.Постоянная мутация вируса, сложная эпидемическая обстановка в других странах сохраняют довольно высокой вероятность развития третьей волны пандемии в Российской Федерации. Важно максимально быстро обобщать накопленный опыт в целях его эффективного использования в случае необходимости.Цель: проанализировать особенности системы оказания помощи тяжелобольным с новой коронавирусной инфекцией в многопрофильной клинике ПСПбГМУ им. И. П. Павлова.Материал и методы. Представлены итоги работы инфекционного Центра, дважды развертываемого в многопрофильной клинике учреждения (с 28.04.2020 г. по 3.08.2020 г. и с 1.11.2020 г. по 15.03.2021 г.), принявшего в общей сложности 3 830 больных с новой коронавирусной инфекцией (сначала 1 680 пациентов, затем 2 150). В подготовительном периоде проведено моделирование работы приемного отделения, созданного на базе стационарного отделения скорой медицинской помощи (СОСМП), для уточнения его штатной структуры и порядка приема, обследования и лечения больных. Проведено сопоставление организационных подходов в первую и вторую волну пандемии, представлены характеристика демографических данных пролеченных больных, частота развития некоторых осложнений, исходы.Результаты. Общая летальность в Центре составила 6,2%. Несмотря на накопленный в рамках первой волны опыт, результаты лечения на втором этапе (осень-зима) не улучшились (в 1-ю волну умерло 5,7%, во вторую – 6,7%). Летальность на реанимационных койках в целом составила 40,0 и 49,6% соответственно, непосредственно в отделении реанимации и интенсивной терапии (ОРИТ) – 38,5 и 46,9%. Умеренный рост летальности обусловлен увеличением степени тяжести состояния поступавших пациентов, а в ОРИТ, кроме того, концентрацией больных в тяжелом и крайне тяжелом состоянии, среди которых лиц с сопутствующей патологией было 51,4%, старше 65 лет ‒ 53,5%. Системные решения по уточнению и дифференциации задач, решаемых отдельными подразделениями Центра, с учетом результатов моделирования работы в подготовительный период и неоднородности контингента получавших интенсивное лечение пациентов (расширение роли СОСМП, создание специализированных палат для CPAP-терапии, дифференциация на группы и др.) позволили повысить пропускную способность медицинской организации, не создавая ажиотажа при приеме и не ухудшая качество лечения.Заключение. Аспекты организации медицинской помощи влияют на результаты работы трансформируемого в инфекционный стационар многопрофильного учреждения. Накопленный при этом опыт может быть полезен и в других чрезвычайных ситуациях, сопровождающихся появлением большого числа пострадавших и больных

The James Webb Space Telescope Mission

Twenty-six years ago a small committee report, building on earlier studies, expounded a compelling and poetic vision for the future of astronomy, calling for an infrared-optimized space telescope with an aperture of at least $4m$. With the support of their governments in the US, Europe, and Canada, 20,000 people realized that vision as the $6.5m$ James Webb Space Telescope. A generation of astronomers will celebrate their accomplishments for the life of the mission, potentially as long as 20 years, and beyond. This report and the scientific discoveries that follow are extended thank-you notes to the 20,000 team members. The telescope is working perfectly, with much better image quality than expected. In this and accompanying papers, we give a brief history, describe the observatory, outline its objectives and current observing program, and discuss the inventions and people who made it possible. We cite detailed reports on the design and the measured performance on orbit.Comment: Accepted by PASP for the special issue on The James Webb Space Telescope Overview, 29 pages, 4 figure

Quantitative methods in the study of the phage-antiphage reaction

The following characteristics of antiphage-sera have been defined, and methods given for their measurement: specifically precipitable nitrogen, specific rate of neutralization, neutralizing capacity, precipitating activity, and combining power. The significance and precision of measurement of these characteristics are briefly discussed. The methods have been designed specifically to study equilibria in immune reactions, and the question of the homogeneity of the reactants. The specifically precipitable nitrogen of a coli-phage in crude lysates was found to correspond to less than 10−13 mg per lytic unit. This determination provides an additional method for estimating the size of the infective dose of viruses, which can be obtained in sufficient concentration

Quantitative relationships in the phage-antiphage reaction: unity and homogeneity of the reactants

The applications of methods described in the previous paper reveal small but well-defined differences between the reactivity with coliphage of homologous antisera of different rabbits. These differences show themselves as independent variations in the specific rate of neutralization, the neutralizing capacity, and the precipitating activity, each referred to the same measure of antibody-content. It does not seem necessary to ascribe these differences to variations in the specific immune response, since far more noticeable changes of the same kind may occur during storage of individual sera. By contrast, examination of partially absorbed antisera by the same methods discloses no separation into fractions of differing reactivity. With respect to the properties mentioned, individual antisera behave like homogeneous solutions. This finding is of particular interest with respect to rate of combination of antibody, which might be expected to reflect to a marked degree qualitative differences of any kind. Crude phage-concentrates contain non-antigenic material rich in nitrogen and phosphorus to which phage is reversibly adsorbed. This material is largely eliminated during purification by ultrafiltration. Since the specific absorbing power per lytic unit of crude and purified preparations is the same, it must be concluded that the lytic unit in dilute solutions is a reproducible entity. The purified preparations of Kalmanson and Bronfenbrenner contain considerably more protein than is compatible with any reasonable assumption concerning the average particle-weight of the lytic unit. Since the same is true of the specifically precipitable phage-antigen, the tentative conclusion is drawn that the lytic unit is only one of about 30 similar particles of antigenic substance, assumed from diffusion-measurements to have a particle-weight of 1,500,000. These conclusions are considerably substantiated by the observed combining proportions of phage and antiphage. Thus a single particle of antigen proves on this basis to combine with about 170 molecules of antibody with the latter in excess, to be neutralized by about three, and to be precipitated by about two. Any appreciable departure from the interpretation given the physical data leads to consequences incompatible with the immunologic data. The latter indicate that the isolated material is reasonably pure, and since it contains only traces of phosphorus, the phage does not consist of nucleoprotein. All the known facts may be reconciled with the assumption that the phage consists of small particles (molecular weight about 25,000) of which some 29 are attached to a single molecule of carrier-protein. The data are not compatible, however, with the larger size indicated by electron-micrographs of this phage. Sedimentation-experiments are described which probably indicate the true nature of the visible material. Allowing reasonable scope for error, the absolute rate of the phage-antiphage reaction at 0 C may be expressed as 2 to 10 molecules of antibody per second per phage in a “standard” antiserum 10−5 molar with respect to antibody. This corresponds to a bimolecular reaction-constant of 2 to 10 × 105 mol−1 sec−1 liters. Among four antisera, this is the highest specific rate observed, the range of variation being 4-fold

Factors influencing the rate of neutralization of bacteriophage by the antibody

1. Employing an antiserum prepared against a highly purified preparation of coliphage, we have been able to demonstrate that the specific rate of neutralization of phage by antibody is independent of the absolute phage concentration, that is, a constant proportion of phage is neutralized in a given time regardless of what concentration of phage is actually present. 2. The course of neutralization progresses logarithmically with time, that is, a constant fraction of phage is neutralized in each successive time interval. Deviations are observed only when the reaction is allowed to go to better than 99 per cent of completion. 3. The neutralization of phage by antiphage resembles a (bimolecular) reaction in which two molecules of antibody are needed to neutralize one particle of phage. 4. The logarithm of the proportion of phage remaining active after a given time-interval is proportional to the serum-concentration except in the case of very concentrated serum where more phage remains unneutralized than would be expected. 5. These results may be explained by assuming either that phage suspension consists of particles heterogeneous in their resistance to inactivation by serum, as suggested by Andrewes and Elford, or else by assuming that the bulk of the phage is relatively homogenous, but contains a small fraction (less than 1%) that is arkedly more resistant to neutralization. 6. The reaction of neutralization of phage at 37 C. proceeds at a rate 12 to 14 times faster than at 0 C. (has a Q10 of 2 from 0 to 37 C.) 7. The reaction is relatively indifferent to pH except that below pH 4.5 the rate of enutralization is markedly slowed. 8. Identity of rates of neutralization of small and large particles indicate the probable correctness of the theory that phage of different sizes consists of small active molecules adsorbed to inert carriers of different sizes