Carbonitration of a tool for pressing stainless steel pipes

To upgrade the operational stability of the tool at LLC “Karbaz”, Sumy, Ukraine, carbonation of tools and samples for research in melts of salts of cyanates and carbonates of alkali metals at 570–580 °C was carried out to obtain a layer thickness of 0.15–0.25 mm and a hardness of 1000–1150 НV. Tests of the tool in real operating conditions were carried out at the press station at LLC “VO Oscar”, Dnipro, Ukraine. The purpose of the test is to evaluate the feasibility of carbonitriding of thermo-strengthened matrix rings and needle-mandrels to improve their stability, hardness, heat resistance, and endurance. If the stability of matrix rings after conventional heat setting varies around 4–6 presses, the rings additionally subjected to chemical-thermal treatment (carbonitration) demonstrated the stability of 7–9 presses due to higher hardness, heat resistance, the formation of a special structure on the surface due to carbonitration in salt melts cyanates and carbonates. Nitrogen and carbon present in the carbonitrided layer slowed down the processes of transformation of solid solutions and coagulation of carbonitride phases. The high hardness of the carbonitrified layer is maintained up to temperatures above 650 °C. If the stability of the needle-mandrels after conventional heat treatment varies between 50–80 presses, the needles, additionally subjected to chemical-thermal treatment (carbonitration) showed the stability of 100–130 presses due to higher hardness, wear resistance, heat resistance, the formation of a special surface structure due to carbonitration in melts of salts of cyanates and carbonates

Ocular changes after simultaneous kidney-pancreas transplant

I.V. Vorobyeva1, E.V. Bulava1, L.K. Moshetova1, A.V. Pinchuk2–4 1Russian Medical Academy of Continuous Professional Education, Moscow,&nbsp; &nbsp;Russian Federation 2N.V. Sklifosovskiy Research Institute for Emergency Medical Aid, Moscow, Russian Federation 3A.I. Yevdokimov Moscow University of Medicine &amp; Dentistry, Moscow, Russian Federation 4Research Institute of Public Health Organization and Medical Management, Moscow,&nbsp;&nbsp;&nbsp;Russian Federation Type 1 diabetes (T1D) is one of the most common chronic diseases in young individuals. Diabetic nephropathy, being one of the most dangerous complications of T1D, progresses to end-stage renal disease within 10–15 years in 80%. The simultaneous kidney-pancreas transplant prevents insulin therapy and dialysis, thereby avoiding further progression of complications of diabetes. Normalization of carbohydrate metabolism and resolving of uremia after simultaneous kidney-pancreas transplant are beneficial for ocular structures. This article reviews studies on the pattern of changes in ocular structures in the post-transplant period. The procedure improves peripheral microcirculation of the bulbar conjunctiva and corneal innervation. Most studies demonstrate stabilization and improvement of the course of diabetic retinopathy as illustrated by the reduction in active vascular proliferation, need for retinal laser photocoagulation and vitrectomy. Meanwhile, some studi es failed to reveal any differences in the morphological functional status of the retina in the pre- and postoperative periods.&nbsp;An increase in&nbsp;cataract rate among simultaneous kidney-pancreas transplant recipients receiving immunosuppressant therapy remains a challenge. Keywords: type 1 diabetes, kidney transplant, pancreas transplant, simultaneous kidney-pancreas transplant, diabetic retinopathy, diabetic macular edema. For citation: Vorobyeva I.V., Bulava E.V., Moshetova L.K., Pinchuk A.V. Ocular changes after simultaneous kidney-pancreas transplant. Russian Journal of Clinical Ophthalmology. 2022;22(2):132–136 (in Russ.). DOI: 10.32364/2311-7729-2022-22-2-132-136. </p

Фрагментация QRS-комплексов — перспективы использования в клинической практике

The current article provides a detail review of foreign publications, discussing the opportunities and the benefits of evaluation of the QRS-fragmentation (fQRS) a new electrocardiographic (ECG) parameter in patients with coronary artery disease (CAD). Diagnostic criteria for narrow and wide QRS-complexes are defined. Main results of the comparative and correlation analysis, evaluating fQRS and electrocardiographic (pathologic Q-waves), echocardiographic (left ventricular ejection fraction), angiographic settings are described. There is a discussion of the prognostic role of fQRS in stable CAD as well as in patients presented with acute myocardial infarction. fQRS is an available ECG-marker of local myocardial fibrosis. It seems to be a useful negative predictor in individuals with CAD, indicating an increased risk of life-threatening ventricular arrhythmias and recurrent cardiac events. The presence of fragmented QRS-complexes is associated with an increased in-hospital and long term (overall as well as cardiovascular) mortality. Routine evaluation of fQRS in standard ECG leads does not require additional resources, and will contribute to an improvement in diagnostics and risk stratification of stable CAD as well as myocardial infarction. Assessment of fQRS can be included in noninvasive diagnostic algorithm concerning CAD.Представлен первый русскоязычный обзор основных публикаций, посвященных возможностям и перспективам оценки нового ЭКГ-параметра фрагментации QRS-комплексов (fQRS) у пациентов с различными формами ишемической болезни сердца. Приводятся диагностические критерии fQRS, освещаются результаты сравнительного и корреляционного анализа fQRS с ключевыми электрокардиографическими (патологические зубцы Q), эхокардиографическими и ангиографическими параметрами, подчеркивается негативное прогностическое значение показателя при стабильной ишемической болезни сердца и в случае развития острого инфаркта миокарда. Наличие fQRS в целом ассоциируется с осложненным течением ИБС, высоким риском развития жизнеугрожающих аритмий, повторных сердечно-сосудистых катастроф, ростом общей и сердечно-сосудистой смертности как в краткосрочной перспективе, так и в отдаленном периоде. Авторы считают необходимым обратить внимание на перспективность внедрения метода оценки fQRS в реальную клиническую практику. Определение показателя проводится на основании стандартной ЭКГ, что не требует дополнительных материальных ресурсов и оборудования и в то же время позволяет улучшить неинвазивную диагностику и стратификацию риска у пациентов с атеросклеротическим поражением коронарных артерий на амбулаторном и стационарном этапах

Characteristic of economic indicators of reproduction of fixed capital

The relevance of the topic is needed review and resolve problems of reproduction of fixed capital of industrial enterprises, identification of regularities and peculiarities of its reproduction in conditions of transition to new technological way of life, search of ways of increase of efficiency of formation and development of capital in modern conditions. Long enough for the reproductive processes were considered from the standpoint of attracting investment funds and analyze the dynamics of financial capital, without affecting the issues of reproduction of real capital, the more problems the latest requirements of the modern paradigm of development characterized by the increasing importance of the innovative capacity of enterprises and the economy as a whole. Modern aspects of economic analysis require serious consideration of the problems of the reproduction of capital. In the period of economic reforms in the 80s and 90s the twentieth century, clearly delineated the problems of reproduction of fixed capital of industrial enterprises. Reproductive cycles in this period was carried out in conditions of chronic shortage of investment resources required for sustainable reproduction processes. This defined the urgent problem of physical and moral aging of fixed assets and has created an urgent need for modernization, through the introduction of innovative technologies that meet modern technological paradigms. © Serials Publications Pvt. Ltd

Characteristic of economic indicators of reproduction of fixed capital

The relevance of the topic is needed review and resolve problems of reproduction of fixed capital of industrial enterprises, identification of regularities and peculiarities of its reproduction in conditions of transition to new technological way of life, search of ways of increase of efficiency of formation and development of capital in modern conditions. Long enough for the reproductive processes were considered from the standpoint of attracting investment funds and analyze the dynamics of financial capital, without affecting the issues of reproduction of real capital, the more problems the latest requirements of the modern paradigm of development characterized by the increasing importance of the innovative capacity of enterprises and the economy as a whole. Modern aspects of economic analysis require serious consideration of the problems of the reproduction of capital. In the period of economic reforms in the 80s and 90s the twentieth century, clearly delineated the problems of reproduction of fixed capital of industrial enterprises. Reproductive cycles in this period was carried out in conditions of chronic shortage of investment resources required for sustainable reproduction processes. This defined the urgent problem of physical and moral aging of fixed assets and has created an urgent need for modernization, through the introduction of innovative technologies that meet modern technological paradigms. © Serials Publications Pvt. Ltd

Common pathogenic aspects of diabetic retinopathy and nephropathy. Kidney transplantation and the course of diabetic retinopathy

I.V.&nbsp;Vorobyeva1, L.К.&nbsp;Moshetova1, A.V.&nbsp;Pinchuk2–4, Е.V.&nbsp;Bulava1, Е.P.&nbsp;Delver5, А.А.&nbsp;Belogurov5 1Russian Medical Academy of Continuous Professional Education, Moscow, &nbsp;Russian Federation 2N.V. Sklifosovskiy Research Institute for Emergency Medical Aid, Moscow, Russian Federation 3A.I. Evdokimov Moscow University of Medicine &amp; Dentistry, Moscow, Russian Federation 4Research Institute of Public Health Organization and Medical Management, Moscow, &nbsp;Russian Federation 5National Medical Research Center of Cardiology, Moscow, Russian Federation Epidemics of diabetes and its complications is a global threat to the health of human population. In 2040, the number of patients with diabetes is predicted to rise to 642 million. Diabetic retinopathy and nephropathy are the most dangerous complications. Chronic hyperglycemia is a major factor that determines the development and progression of microvascular complications of diabetes including retinopathy and nephropathy. Key biological pathogenic mechanisms of microvascular complications involve over-production of reactive oxygen species and activation of intracellular signaling pathways and their modulators. OCT angiography is a safe and informative early diagnostic tool to assess vascular retinal abnormalities and to monitor treatment efficacy. Proteinuria was long considered the gold standard to evaluate and monitor kidney functions. However, one-third of patients develop diabetic nephropathy in normal albuminuria. Degradation products of glomerular filtration barrier are thought to be perspective biomarkers of early diabetic nephropathy. End-stage renal disease requires kidney transplantation. In addition to the improvement of uremic syndrome, kidney transplantation favors the course of diabetic retinopathy. Keywords: diabetes, diabetic retinopathy, diabetic nephropathy, optical coherence tomography, OCT angiography, kidney transplantation. For citation: Vorobyeva I.V., Moshetova L.К., Pinchuk A.V. et al. Common pathogenic aspects of diabetic retinopathy and nephropathy. Kidney transplantation and the course of diabetic retinopathy. Russian Journal of Clinical Ophthalmology. 2021;21(2):90–95. DOI: 10.32364/2311-7729-2021-21-2-90-95. <br

SIMULTANEOUS PANCREAS-KIDNEY TRANSPLANTATION: EARLY POSTOPERATIVE COMPLICATIONS

Aim: evaluation of the incidence of early postoperative complications after simultaneous pancreas-kidney transplantation.Materials and methods. The analysis of early postoperative complications after simultaneous pancreas-kidney transplantation is presented in the paper, the most rational diagnostic algorithms, non-surgical and surgical complications’ treatment; the outcomes of the SPKT are reported.Results. 15,6% of patients experienced surgical complications, 12,5% – immunological complications, 12,5% – infectious complications, 6,25% – complications of the immunosuppressive therapy. 1-year patient survival after SPKT was 91,4%; pancreas graft survival – 85,7%; kidney graft survival – 88,6%.Conclusion. The incidence of early postoperative complications after simultaneous pancreas-kidney transplantation remains signifi cant in spite of progressive improvement of simultaneous pancreas-kidney transplantation due to surgical technique improvement, introduction of new antibacterial and immunosuppressive agents. Data, we recovered, fully correspond to the data obtained from the global medical community

Случай успешного лечения АВ-блокады II степени у пациента с гастроэзофагеальной рефлюксной болезнью, ассоциированной с грыжей пищеводного отверстия диафрагмы

Clinical observation of a young patient without an organic pathology of the heart, who repeatedly sought medical help in connection with complaints of episodes of dizziness, lability of blood pressure and pulse numbers, is presented. The medical survey revealed a link between clinical symptoms and progressive retardation of AV conduction (from first-degree AV block to second-degree Mobitz II), and therefore the patient was recommended to be implanted with permanent artificial cardiac pacemaker. To clarify the nature of the conduction disorders, an invasive electrophysiology study was performed, which revealed a proximal AV block due to vagal influences. As the most likely cause of stimulation n. vagus was considered identified in a patient gastroesophageal reflux disease associated with hiatal hernia. Surgical treatment (laparoscopic fundoplication) led to a regression of the clinical and electrocardiographic picture, avoiding the implantation of permanent artificial cardiac pacemaker. The tactic chosen is consistent with the algorithm for managing patients with AV conduction abnormalities (2018 ACC / AHA / HRS Guideline on the evaluation and management of patients with bradycardia and cardiac conduction delay), which involves eliminating potentially reversible causes of bradyarrhythmia before deciding whether to install permanent artificial cardiac pacemaker.Представлено клиническое наблюдение за молодым пациентом без органической патологии сердца, неоднократно обращавшимся за медицинской помощью в связи с жалобами на эпизоды головокружения, лабильность цифр АД и пульса. В ходе обследования была выявлена связь клинической симптоматики с прогрессирующим замедлением АВ-проводимости (от АВ-блокады I степени до II степени Мобитц II), в связи с чем пациенту была рекомендована имплантация ПЭКС. Для уточнения характера нарушений проводимости было выполнено инвазивное ЭФИ, выявившее проксимальную АВ-блокаду, обусловленную вагусными влияниями. В качестве наиболее вероятной причины стимуляции n. vagus рассматривалась выявленная у пациента гастроэзофагеальная рефлюксная болезнь, ассоциированная с грыжей пищеводного отверстия диафрагмы. Хирургическое лечение (лапароскопическая фундопликация) привело к регрессу клинической и электрокардиографической картины, позволив избежать имплантации ПЭКС. Избранная тактика согласуется с алгоритмом ведения пациентов с нарушениями АВ-проведения (2018 ACC/AHA/HRS Guideline on the evaluation and management of patients with bradycardia and cardiac conduction delay), предполагающем устранение потенциально обратимых причин брадиаритмий до решения вопроса о целесообразности установки ПЭКС