THE CHARACTERISTICS OF MORTALITY OF THE POPULATION OF IRKUTSK FROM EXTERNAL REASONS AND SOME DISEASES RELATED ETHYL ALCOHOL CONSUMPTION

To our mind, the population alcoholization is the one of the major medical-social problems in Irkutsk region. According to official statistics it is established that in recent years the average index of incidence with diagnosis of an alcoholism and alcoholic psychosis established for the first time as a whole was higher in Irkutsk region, than in the Russian Federation and Siberian Federal district -1,7 and 1,5 times respectively. Sociological polls of the population of Irkutsk showed that 10 % of adult population and less than 20 % of youth do not take alcoholic drinks only. Abuse of alcohol makes a particular contribution to increase in number of lethal cases from diseases of system of blood circulation and the external reasons (mechanical trauma, suicides). It is not possible to estimate these indexes according to statistical data. The purpose of the real research was studying of a share of deadly outcomes among the population of Irkutsk, associated with ethyl alcohol. The profound personified analysis of mortality of the population of Irkutsk from the external reasons and some diseases (according to the international classification of diseases of the 10th revision) was carried out according to archive of Irkutsk regional bureau of a forensic medical expertise during 2000-2012, in cases when ethyl alcohol was found in cadaver blood. It was established, that the share of acute poisonings with ethyl alcohol makes about 4 % in structure of common mortality of the population of Irkutsk. The share of persons of young age of the dead as a result of an acute alcoholic poisoning makes nearly 20 % in recentyears. The high level of suicide activity of the population of the city interfaced to alcohol intake was revealed. More than 50 % were in an alcohol intoxication of various degree, among the persons prematurely left life. The share of the lethal mechanical traumas, associated with alcohol intoxication, made about a half from all cases of a mechanical trauma. During the 13-year period the decrease of the share of death resulted from cardiovascular diseases, associated with ethyl alcohol, was observed (with 30 to 16 %). Thus among the persons of young age having diseases of cardiovascular system, more than 50 % were at the time of death approach in an alcohol intoxication. The conducted research shows that the actual"hidden" losses of the population interfaced to alcohol intake, are much higher. The alcoholization of the population influences not only formation of losses from acute alcoholic poisonings, but also from the external reasons and diseases against which there was an abuse of ethyl alcohol

Cobalt-based Nanoreactors in Combined Fischer-Tropsch Synthesis and Hydroprocessing: Effects on Methane and CO2_{2} Selectivity

Fischer-Tropsch synthesis: Four types of bi-functional catalysts with cobalt nanoparticles supported on meso- or microporous silicates or aluminosilicates are investigated regarding the obtained CO$_{2}$ and CH$_{4l}$ selectivity under low-temperature Fischer-Tropsch reaction conditions. In situ x-ray absorption spectroscopy results under industrially relevant conditions reveal that strong cobalt-support interactions and oxidized cobalt species are the main factors determining the selectivity depending on the specific support material used. The production of liquid hydrocarbons from syngas (CO and H$_{2}$) via the combined Fischer-Tropsch (FT) synthesis and hydroprocessing (HP) is a promising strategy to provide valuable chemicals and fuels based on renewable feedstocks. High yields of liquid products are essential for industrial implementation since short-chain side products like methane and CO$_{2}$ reduce the overall carbon efficiency, which holds true especially for bi-functional Co/zeolite catalysts. In order to investigate the influence of the support material properties on the methane and CO$_{2}$ selectivities in the combined FT and HP reaction, we synthesized four well-defined catalyst materials with similar cobalt particle sizes. The active material is supported on either meso- or microporous silicates or aluminosilicates. The catalytic properties are investigated in FT experiments at industrially relevant conditions (20 bar, 200–260 °C) and correlated with in situ x-ray absorption spectroscopy results to determine the chemical environment responsible for the selectivity observed. The origin of the high methane selectivity detected for crystalline and amorphous aluminosilicate was mainly traced back to the strong cobalt-support interactions. The high CO$_{2}$ selectivity, observed only for crystalline zeolite materials, is driven by the presence of oxidized cobalt species, while the acidic support in combination with micropores and possible overcracking leads to the observed drop in the C$_{5+}$ selectivity

The model of monitoring of vocational pedagogical competences of professors in secondary vocational education

The relevance of the researched issue is preconditioned by the strategic changes in the secondary vocational education system taking place not only in Russia, but also in majority of industrially developed countries. Provision of the system with qualified pedagogical staff is the leading strategic objective of development of the secondary vocational educational system. Its solution must be based on the justified monitoring system, which objectively represents the condition as well as quantitative and qualitative changes taking place in the educational sphere. The article is aimed at developing, substantiating and approbating the model of monitoring of vocational pedagogical competences of professors in secondary vocational education. Integration of the competence, functional and general pedagogical analysis became the leading approach to research into this problem, which has enabled substantiating the model of monitoring of vocational pedagogical competences of professors in the secondary vocational education system. The article presents results of the theoretical and methodological analysis of Russian and foreign research dedicated to identification of key and emerging competences in various spheres. The competence model of a professor of secondary vocational education has been developed and substantiated as a monitoring basis. The article may be useful to improve the quality of the human resource potential in the secondary vocational education system in Russia, to define current and long-range objectives of its development. © 2016 Andryukhina et al

Vocational pedagogical competencies of a professor in the secondary vocational education system: Approbation of monitoring model

The relevance of the researched issue is preconditioned by the strategic changes in the secondary vocational education system taking place not only in Russia, but also in majority of industrially developed countries. Provision of the system with qualified pedagogical staff is the leading strategic objective of development of the secondary vocational educational system. Its solution must be based on the justified monitoring system, which objectively represents the condition as well as quantitative and qualitative changes taking place in the educational sphere. The article is aimed at approbating the model of monitoring of vocational pedagogical competences of professors in secondary vocational education. Integration of the competence, functional and general pedagogical analysis became the leading approach to research into this problem, which has enabled substantiating the model of monitoring of vocational pedagogical competences of professors in the secondary vocational education system. The competence model of a professor of secondary vocational education has been developed and substantiated as a monitoring basis. Results of model approbation and monitoring tools have been presented. The article may be useful to improve the quality of the human resource potential in the secondary vocational education system in Russia, to define current and long-range objectives of its development. © 2016 Andryukhina et al

CLINICAL NUTRITION INVOLVING A SPECIALIZED PROTEINAND CALORIE-RICH PEDIATRIC MILK PRODUCT FOR ENTERAL FEEDING OF INFANTS WITH PROTEIN-CALORIE DEFICIENCY

Background: Premature infants with extremely low and very low birth weight with a severe overlapping perinatal pathology often feature slower growth rate within the first year of life and require special nutritional support.Objective: Our aim was to study physical development of infants with protein-calorie deficiency in the setting of using a specialized protein- and calorie-rich pediatric milk product for enteral feeding.Methods: We analyzed tolerability and efficacy of clinical nutrition within the framework of a prospective two-month-long case series. We assessed actual children’s diets and the chemical composition thereof. We determined body weight and length, body mass index (BMI), adipodermal flap thickness over the triceps. Anabolic effect of clinical nutrition was assessed on the basis of transthyretin concentration dynamics.Results: The study involved 30 infants with protein-calorie deficiency (7 term infants and 23 premature infants) with a severe perinatal pathology. High tolerability of the formula under analysis was registered in most patients. Termination of functional gastrointestinal tract disorders (posseting, colics, flatulence, constipations) was observed in 23 (87%) patients. In most cases, the use of a protein- and calorie-rich formula as a part of a therapeutic diet helped to satisfy children’s protein demand and improve their weight/length parameters: BMI increased in 19 (72%) children, body weight — in 16 (63%), body length — in 24 (92%), adipodermal flap thickness over the triceps — in all the children (100%). We observed transthyretin concentration increase from 162 (157; 171) in the beginning of the study to 187 (170; 208) mg/l in the end thereof (p = 0.028).Conclusion: A specialized protein- and calorie-rich product for enteral feeding may be used for feeding infants with protein-calorie deficiency born with a severe a perinatal pathology, including premature infants

Морфологические аспекты острого почечного повреждения в кардиохирургии

Summary. The use of endoscopic transsphenoidal access is an effective and safe method for the surgical treatment of pituitary adenomas (PA). In endoscopic transsphenoidal surgeries, there is a need to control intracranial pressure (ICP) for reposition and expansion of the tumor capsule. Currently, the main method for reducing ICP in transsphenoidal surgery is installation of an external lumbar drainage, which is associated with a number of complications.Aim of study. To improve the results of surgical treatment of patients with arterial hypertension using hypertonic saline solution.Material and methods. A clinical and anatomical analysis of material from 27 deceased patients who were treated in the cardiac surgery department of the Institute was carried out. Valve replacement was performed in 11 patients, aortic replacement - 2, valves and aorta - 7, combined operations - 7. The patient’s records, autopsy protocols, results of histological examination of surgical and autopsy material were studied. Already on the next day after surgery, an increase in serum creatinine by more than 25% was noted under the conditions of CBR. Morphological examination of the kidneys revealed acute pathological processes - necrosis of nephrocytes of the convoluted tubules in 59.3% of cases and dystrophic changes in 40.7% of cases against the background of chronic pathology (nephrosclerosis, vascular atherosclerosis, glomerulosclerosis, pyelonephritis, secondary contracted kidney). After coronary angiography with a radiopaque contrast agent (RCA), signs of excretory nephrosis were noted, often with fixation of the RCA in the loop of Henle, with tubulorexis and the formation of cell casts.Резюме. Острое почечное повреждение является частым осложнением у пациентов, перенесших операцию на сердце в условиях искусственного кровообращения (ИК).Цель работы. Улучшить результаты хирургического лечения пациентов с артериальной гипертонией с помощью гипертонического солевого раствора.Материал и методы. Проведен клинико-анатомический анализ материала от 27 умерших, находившихся на лечении в кардиохирургическом отделении института. Протезирование клапанов было выполнено 11 пациентам, протезирование аорты — 2, клапаны и аорты — 7, сочетанные операции — 7. Изучены карты стационарного больного, протоколы вскрытий, результаты гистологического исследования операционного и аутопсийного материала. Уже на следующие сутки после операции в условиях ИК отмечено повышение сывороточного креатинина более чем на 25%. При морфологическом исследовании почек обнаружены острые патологические процессы — некроз нефроцитов извитых канальцев в 59,3% наблюдений и дистрофические изменения в 40,7% случаев на фоне хронической патологии (нефросклероз, атеросклероз сосудов, гломерулосклероз, пиелонефрит, вторично сморщенная почка). После коронарографии с рентгеноконтрастным средством (РКС) отмечены признаки выделительного нефроза, часто с фиксацией РКС в петле Генле, с тубулорексисом и формированием клеточных цилиндров

Primary plasty of an Achilles tendon by plantar muscle tendon (clinical case)

Patient T., 43 years old arrived in clinic with complaints to the pains in lower thir of the right shin, limitation of movements in right ankle joint, inability of using right lower extremity. An. operative treatment was realized in clinic: suture of rupture of Achilles tendon by Cuneo with plastics by the tendon of long plantar muscle. In 4 weeks plaster immobilization was removed, the patient started measured loading of operated extremity with additional cane support. In 6 weeks full load on operated extremity was allowed and the patient returned to work. In 2 months patient received repeated trauma. During the examination local painfulness in the area of operative intervention was revealed. At the palpation it was revealed that integrity of plantar muscle tendon isn't broken. Control MRR of right shin was made: as the result of control examination the injury of plantar muscle tendon wasn't revealed. Immobilization of operated extremity in neutral position of a foot by functional brace was recommended to the patient. Measured, loading with additional additional cane support was approved. In 2 weeks the immobilization was removed, function of operated extremity is fully restored. Conclusion: if proposed method allows to start earlier loadings and. to decrease possibility of repeated rupture of reconstructed plantar muscle tendon in the most active period of rehabilitation

Primary plastics of Achilles tendon by plantar muscle tendon for the prevention of repeated ruptures (experimental research)

The most important requirement to Achilles tendon suture is its ability to hold loading both in postoperative and. in rehabilitation period. The research was aimed, at the comparison of strength of classic intertendon suture of Achilles tendon and. primary plastics of Achilles tendon by plantar muscle tendon. 60 unfixed (cadaveric) Achilles tendons and 60 plantar muscle tendons were used in experimental research. Further parameters were registered: age, measurements of Achilles and long plantar muscle tendons (length, width, thickness). The first step was to determine the tensile of intact Achilles tendon; the second was to determine the tensile double Polyester N 6 suture; the third — to determine tensile of plantar muscle tendon; the fourth — to determine tensile of Achilles tendon reconstructed with, use of proposed method. As the result of the experiment further conclusions were drawn. 1. Force that causes rupture of Achilles tendon decreases with age of a person that proves degenerative theory of Achilles tendon injury indirectrly. 2. Force that causes rupture of intact Achilles tendon (Ме) is 161,0, of double Polyester N 6 suture — 5,0, of tendon of plantar muscle folded up in four is 22,5; of Achilles tendon reconstructed with use of proposed method is 32,0. 3. Tensile of primary plastics of Achilles tendon sutured with use of proposed method is 6.4 times more than tensile of classic suture (Polyester N 6)

ЛЕТАЛЬНЫЕ ИСХОДЫ У БОЛЬНЫХ С ВИЧ-ИНФЕКЦИЕЙ В КРУПНОМ ПРОТИВОТУБЕРКУЛЕЗНОМ УЧРЕЖДЕНИИ КЕМЕРОВСКОЙ ОБЛАСТИ

The aim was to study the causes of death in HIV patients in the Novokuznetsk tuberculosis dispensary in 2016 (population is 550 thousand people; about 2% of population are HIV-positive). Materials and methods: Protocols of all autopsies of HIV-infected patients (n=221) performed in 2016 in the Novokuznetsk tuberculosis dispensary. Results: The mean age of the deceased was 37Ѓ}6,9 years. HIV and tuberculosis (TB) co-infection was in 83,3% of patients (n=184), HIV/TB and other opportunistic or severe somatic diseases – in 10,4% (n=23), non-tuberculous opportunistic diseases – in 6,3% (n=14). The new tuberculosis cases were in 71,1% (n=147), relapses – in 7,2% (n=15), chronic tuberculosis cases – in 21,7% of patients (n=45). Disseminated form prevailed among the cases of respiratory tuberculosis; generalized tuberculosis (3 and more localizations) occurred in 87,0% (n=180), tuberculosis meningitis was found in 17,9% (n=37). Positive fluorescent sputum microscopy was in 72.5%, sputum cultures on Loewenstein-Jensen medium – in 78,3% with HIV/TB. Primary multidrug resistance was detected in 60,7% (including in 5,8% of them with primary extensively drug resistance). Severe opportunistic infections or malignancies were in 9,2% of HIV/TB (n=19) and in 78,7% of non-TB patients (n=11). Data on the CD4 level was known in 68,8% of cases (n=152): the median count was 75,5 cells/μl; 38,9% of new TB cases (n=46) were diagnosed with HIV in time of TB detecting. Antiretroviral therapy was performed only 13% of patients (n=29). Conclusion: There is a need for the optimization of HIV detecting approaches and early initiation of antiretroviral therapy before the appearance of incurable opportunistic diseases, as well as for comprehensive TB prevention.Цель: изучение структуры и причин летальных исходов у больных ВИЧ-инфекцией (ВИЧ-и) в противотуберкулезном диспансере города Новокузнецка за 2016 г. (население 550 тыс. чел., около 2% населения города инфицированы ВИЧ). Материалы и методы: протоколы всех аутопсий случаев смерти больных ВИЧ-и (n=221), выполненных в 2016 г. в противотуберкулезном диспансере г. Новокузнецка. Результаты: возраст умерших был 37Ѓ}6,9 лет. Коинфекция ВИЧ-и/туберкулез (ТБ) была у 83,3% больных (n=184), ВИЧ-и/ТБ в сочетании с другими тяжелыми соматическими или вторичными заболеваниями – у 10,4% (n=23), нетуберкулезные заболевания – у 6,3% (n=14). Впервые выявленный туберкулез был у 71,1% (n=147), рецидивы – у 7,2% (n=15), случаи хронического туберкулеза – у 21,7% (n=45). Среди форм туберкулеза органов дыхания преобладал диссеминированный (83,1%, n=172). Генерализованный туберкулез имел место в 87,0% случаев (n=180), туберкулезный менингит – в 17,9% (n=37). Люминесцентная микроскопия мокроты была положительной у 150 из 207 больных с туберкулезом (72,5%), положительные посевы мокроты на плотные питательные среды – у 162 человек (78,3%). Первичная множественная лекарственная устойчивость составила 60,7% (в том числе первичная широкая лекарственная устойчивость – у 5,8%). Другие вторичные инфекционные или злокачественные заболевания, повлиявшие на исход, имелись у 9,2% больных с ВИЧи-/ТБ (n=19) и у 78,7% больных без туберкулеза (n=11). Сведения об уровне CD4 были у 68,8% человек (n=152): медиана составила 75,5 кл/мкл. У 38,9% умерших от новых случаев туберкулеза (n=46) ВИЧ-и была установлена впервые при выявлении туберкулеза. Антиретровирусная терапия проводилась только 13% больных (n=29). Заключение: необходима оптимизация подходов к выявлению ВИЧ-инфекции, раннему началу антиретровирусной терапии до развития инкурабельных вторичных заболеваний, а также к комплексной профилактике ТБ

Comparison of the results of surgical treatment of patients with Achilles tendon injury at Myerson stage II and III diastasis using plantar muscle flexor tendon

Single-center randomized controlled partially blinded research aimed at the determination of functional results of surgical treatment of patients with Achilles tendon injury of different Myerson stages was carried out in the clinic of Irkutsk Scientific Centre of Surgery and Traumatology. Based on the analysis of surgical treatment of 20 patients with Achilles tendon divided into two groups (with Myerson stage 11 and stage 111 diastasis) we showed the effectiveness of surgical treatment using plantar muscle flexor tendon. We assessed the following criteria: 1) time from the moment of injury, diastasis length, duration of surgery; 2) pain syndrome after the surgery, omission of additional mobility aids and equipment; 3) AOFAS functional results. While the analysis we found statistically significant differences in studied groups by the criteria "time from the moment of injury" and "diastasis length". As the result of the research we found statistically significant differences by "duration of surgery» criterion. In consequence of using plantar muscle flexor tendon as a stabilizing factor at the restoration of Achilles tendon we didn't register the differences between the groups by the level and duration of pain syndrome after the surgery, terms of the omission of additional mobility aids and equipment after the surgery and also in AOFAS functional results