Formation of oxide layers on aluminum, niobium, and tantalum in molten alkali metal carbonates

The electrochemical synthesis of niobium, tantalum, and aluminum oxide nanolayers is studied in the melt of lithium, sodium, and potassium carbonates with various additives to a salt phase in an oxidizing atmosphere at a temperature of 773 and 873 K. A scheme is proposed for high-temperature anion local activation of the process. © 2013 Pleiades Publishing, Ltd

Прогнозирование влияния прямых оральных антикоагулянтов на прямые медицинские затраты у больных фибрилляцией предсердий

Aim. To evaluate clinical-economical effectiveness of direct oral anticoagulants (DOAC) dabigatran, rivaroxaban, and apixaban in comparison with warfarin in atrial fibrillation (AF) therapy.Materials and Methods. Mathematical modeling (tree derivation of solutions) on a temporary 5-year horizon from the medical healthcare system perspective. Methods of clinical-economic analysis: analysis “cost-effectiveness”, “budget impact”, and “the analysis of unseized opportunities”.Results. Total direct costs (DC) were lower by 10.3% when dabigatran was used, by 5.2%, when rivaroxaban was used, and by 10.9%, when apixaban was used in comparison with warfarin. The most significant difference was observed due to different cost of therapy for bleeding complications (in the structure of the costs, it occupied 30-38%). In the group of dabigatran, DC on bleeding complications were lower than in the group of warfarin by 22.0%, in the group of rivaroxaban – by 10.9%, in the group of apixaban – by 36.8%. Besides, in the group of dabigatran, the costs associated with the treatment for ischemic stroke were lower by 28.1% The strategy of the application of DOAC in comparison with warfarin provided more adjusted life years (ALY), complications adjusted life years (CALY), and its lower cost. The application of DOAC saves significant funds. At the same time, the saved funds will provide the purchase of additional modern drugs for patients. The cost-cutting reaches 12% for 5 years and up to 33 patients out of 1000 can receive additional treatment.Conclusion. Due to the prevention of thromboembolic complications in patients that received direct oral anticoagulants, the direct costs can be reduced by 28.1% and due to the prevention of bleeding complications – by 36.8% in comparison with the application of warfarin. Direct oral anticoagulants provide more adjusted life years and complications adjusted life years at a lower cost. Цель. Оценить клинико-экономическую эффективность использования прямых оральных антикоагулянтов (ПОАК) – дабигатрана, ривароксабана, апиксабана по сравнению с варфарином при лечении фибрилляции предсердий (ФП).Материалы и методы. Математическое моделирование (построение дерева решений) на временном горизонте 5 лет с перспективы системы здравоохранения. Методы клинико-экономического анализа: анализ «затраты-эффективность»; анализ «влияния на бюджет»; анализ  «упущенных возможностей».Результаты. Суммарные прямые затраты (ПЗ) при использовании дабигатрана были на 10,3% меньше, при использовании ривароксабана – на 5,2% меньше; при использовании апиксабана – на  10,9% меньше по сравнению с варфарином. При этом наибольшая разница возникала вследствие различной стоимости терапии геморрагических осложнений (в структуре затрат они составляли 30–38%). В группе дабигатрана ПЗ на геморрагические осложнения была меньше группы варфарина на 22,0%, в группе ривароксабана – на 10,9%, в группе апиксабана – на 36,8%. Кроме того, в группе дабигатрана на 28,1% были меньше затраты, связанные с лечением ишемического инсульта. Стратегия применения ПОАК по сравнению с варфарином позволяет обеспечить большее количество сохраненных лет жизни (СЛЖ) и сохраненных лет жизни без осложнений (СЛЖБО) и меньшую их стоимость. Использование ПОАК позволяет сохранить  значительные средства бюджета, при этом сэкономленные средства позволяют пролечить  современными ЛС пациентов дополнительно. Экономия средств достигает 12% за 5 лет, при этом  до 33 больных из 1000 могут быть пролечены дополнительно.Заключение. Прямые затраты в результате предупреждения тромбоэмболических осложнений при использовании прямых оральных антикоагулянтов в сравнении с варфарином могут быть снижены на 28,1%, геморрагических осложнений – на 36,8%. Прямые оральные антикоагулянты позволяют  сохранить большее количество лет жизни и лет жизни без осложнений за меньшую стоимость. 

INVESTIGATION OF STEEL CORROSION RATE IN MOLTEN SALTS USING NEUTRON ACTIVATION METHOD

The paper gives experimental results of investigation of EP-823 steel corrosion in molten salts using neutron activation method. Unoxidized and thermally oxidized in the air to ~12.5 μm thick oxide film EP-823 steel samples, irradiated in IVV-2M reactor to neutron fluence of ~2.9·1017 n/cm2, underwent static corrosion tests in KCl-LiCl and KCl-LiCl-nPbCl2 molten salts at 500 and 650 °С during 24 h. It shows that corrosion and corrosion product transfer to molten salts are selective in terms of steel elements

Clinical features of post-COVID-19 period. Results of the international register “Dynamic analysis of comorbidities in SARS-CoV-2 survivors (AKTIV SARS-CoV-2)”. Data from 6-month follow-up

Aim. To study the clinical course specifics of coronavirus disease 2019 (COVID-19) and comorbid conditions in COVID-19 survivors 3, 6, 12 months after recovery in the Eurasian region according to the AKTIV register. Material and methods.The AKTIV register was created at the initiative of the Eurasian Association of Therapists. The AKTIV register is divided into 2 parts: AKTIV 1 and AKTIV 2. The AKTIV 1 register currently includes 6300 patients, while in AKTIV 2 — 2770. Patients diagnosed with COVID-19 receiving in- and outpatient treatment have been anonymously included on the registry. The following 7 countries participated in the register: Russian Federation, Republic of Armenia, Republic of Belarus, Republic of Kazakhstan, Kyrgyz Republic, Republic of Moldova, Republic of Uzbekistan. This closed multicenter register with two nonoverlapping branches (in- and outpatient branch) provides 6 visits: 3 in-person visits during the acute period and 3 telephone calls after 3, 6, 12 months. Subject recruitment lasted from June 29, 2020 to October 29, 2020. Register will end on October 29, 2022. A total of 9 fragmentary analyzes of the registry data are planned. This fragment of the study presents the results of the post-hospitalization period in COVID-19 survivors after 3 and 6 months. Results. According to the AKTIV register, patients after COVID-19 are characterized by long-term persistent symptoms and frequent seeking for unscheduled medical care, including rehospitalizations. The most common causes of unplanned medical care are uncontrolled hypertension (HTN) and chronic coronary artery disease (CAD) and/or decompensated type 2 diabetes (T2D). During 3- and 6-month follow-up after hospitalization, 5,6% and 6,4% of patients were diagnosed with other diseases, which were more often presented by HTN, T2D, and CAD. The mortality rate of patients in the post-hospitalization period was 1,9% in the first 3 months and 0,2% for 4-6 months. The highest mortality rate was observed in the first 3 months in the group of patients with class II-IV heart failure, as well as in patients with cardiovascular diseases and cancer. In the pattern of death causes in the post-hospitalization period, following cardiovascular causes prevailed (31,8%): acute coronary syndrome, stroke, acute heart failure. Conclusion. According to the AKTIV register, the health status of patients after COVID-19 in a serious challenge for healthcare system, which requires planning adequate health system capacity to provide care to patients with COVID-19 in both acute and post-hospitalization period

ECHOCARDIOGRAPHIC AND LABORATORY MARKERS OF CHRONIC HEART FAILURE: WHETHER IT IS POSSIBLE TO USE THEM IN RHEUMATIC MITRAL DISEASES?

Aim. To find echocardiographic indicators of heart remodelling that improve estimation of heart failure (HF) severity. To evaluate sensitivity of laboratory markers of HF, brain (BNP) and atrial (ANP) natriuretic peptides, in patients with mitral heart diseases of rheumatic aetiology.Material and methods. 100 patients with rheumatic mitral disease and chronic HF (CHF) of I-IV class (NYHA) were examined. Echocardiography was performed in all patients with evaluation of the standard indices to define disease severity. Indices of sphericity, myocardial stress of the left ventricle, etc were also evaluated. BNP and ANB levels were assessed by enzyme immunoassay method.Results. CHF severity had the strongest correlations with atrial sizes, left atrial systolic function and level of pulmonary hypertension. Moderate increase of BNP level in severe CHF (III-IV class) and its rare increase in mild CHF (I-II class) were detected. Significant changes of ANP level were not found. Moderate correlation of BNP level with myocardium mass index, level of pulmonary hypertension and mitral regurgitation was detected.Conclusion. Intensity of heart remodelling in rheumatic mitral diseases is mainly determined by the left atrial area, left atrial systolic function, mitral orifice size, levels of mitral regurgitation and pulmonary hypertension, size and ejection fraction of right ventricle. Normal BNP level does not confirm an absence of CHF or negative prognosis in patients with rheumatic heart disease.</p

IS THERE AN ALTERNATIVE TO EJECTION FRACTION IN INSTRUMENTAL EVALUATION OF CHRONIC HEART FAILURE SEVERITY IN POST-MYOCARDIAL INFARCTION PATIENTS?

Aim. To find echocardiographic indicators of the heart remodeling which provide the best evaluation of chronic heart failure (CHF) severity in post-myocardial infarction patients.Material and methods. Patients (n=100) with CHF related with ischemic heart disease (post-myocardial infarction) have been examined. The CHF severity was assessed by Scale of Clinical State Evaluation (SCSE) in V.Yu. Mareev's modification and 6-minute walk test. The echocardiography was performed with registration of the heart cavities size, left ventricle (LV) myocardium mass, LV asynergy index, LV sphericity index, time of LV isovolumic contraction and relaxation, Е/А ratio for mitral flow, grade of valvular regurgitation and pulmonary hypertension.Results. The maximal correlation values of CHF severity was observed with intensity of diastolic dysfunction, systolic LV size and volume, LV asynergia index, integrated systolic remodeling index, degree of mitral regurgitation. Correlation value of CHF severity with LV ejection fraction was less than this with above mentioned indices.Conclusion. The early echocardiographic markers of CHF were found. These are LV systolic sphericity index, LV integrated systolic remodeling index, LV systolic myocardial stress

Prognosis of the influence of direct oral anticoagulants on the direct medical expenses in patients with atrial fibrillation

Aim. To evaluate clinical-economical effectiveness of direct oral anticoagulants (DOAC) dabigatran, rivaroxaban, and apixaban in comparison with warfarin in atrial fibrillation (AF) therapy.Materials and Methods. Mathematical modeling (tree derivation of solutions) on a temporary 5-year horizon from the medical healthcare system perspective. Methods of clinical-economic analysis: analysis “cost-effectiveness”, “budget impact”, and “the analysis of unseized opportunities”.Results. Total direct costs (DC) were lower by 10.3% when dabigatran was used, by 5.2%, when rivaroxaban was used, and by 10.9%, when apixaban was used in comparison with warfarin. The most significant difference was observed due to different cost of therapy for bleeding complications (in the structure of the costs, it occupied 30-38%). In the group of dabigatran, DC on bleeding complications were lower than in the group of warfarin by 22.0%, in the group of rivaroxaban – by 10.9%, in the group of apixaban – by 36.8%. Besides, in the group of dabigatran, the costs associated with the treatment for ischemic stroke were lower by 28.1% The strategy of the application of DOAC in comparison with warfarin provided more adjusted life years (ALY), complications adjusted life years (CALY), and its lower cost. The application of DOAC saves significant funds. At the same time, the saved funds will provide the purchase of additional modern drugs for patients. The cost-cutting reaches 12% for 5 years and up to 33 patients out of 1000 can receive additional treatment.Conclusion. Due to the prevention of thromboembolic complications in patients that received direct oral anticoagulants, the direct costs can be reduced by 28.1% and due to the prevention of bleeding complications – by 36.8% in comparison with the application of warfarin. Direct oral anticoagulants provide more adjusted life years and complications adjusted life years at a lower cost