Prognostic and diagnostic value of the ratio of neutrophils to lymphocytes of patients with diseases of the gastrointestinal tract and liver

The purpose of the  review is to  analyze  the  data  of  the  latest  scientific studies  assessing  the  diagnostic and  predictive  value of the indicator of the ratio of neutrophils to lymphocytes (NLR) in patients with diseases of the gastrointestinal tract and liver. Patients with non-alcoholic  fatty  liver  disease  (NAFLD)  have  the  increased  ratio  of  neutrophils  to  lymphocytes  correlated with the severity of fibrosis and the activity of the disease, and also made it possible to differentiate patients with steatosis and non-alcoholic steatohepatitis (NASH). NLR of patients with liver cirrhosis has shown its prognostic significance in the development  of death, comparable to the MELD and Child – Pugh scales, and in some studies even surpassed them. Contradictory data have been obtained regarding its predictive value at risk of infectious complications in this category of patients. In patients with Crohn’s disease (CD) and ulcerative colitis (UC), an increased value of NLR was associated with the activity of the disease. NLR serves as a predictor of death and a more severe course of acute pancreatitis. In patients with acute appendicitis, NLR has shown its diagnostic significance in identifying its severe forms. NLR has also shown its prognostic value in the development of death among patients with gastrointestinal cancer. NLR serves as a marker of systemic inflammation, which can be calculated using the parameters of the simple clinical bloode test, which is available in everyday clinical practice. The value of NLR is due to its non-invasiveness and low cost. The analysis of the literature showed its predictive and diagnostic value in certain diseases of the gastrointestinal tract and liver.  The higher the indicator under study, the worse the prognosis of the disease and/or life of the patient. However, there is no consensus on the gradation of NLR and cut-off levels fluctuate in various studies, and their results are often contradictory. Also, most studies are retrospective, so it is necessary to conduct major prospective studies in this direction

Changes in the Structural and Functional Albumin Properties in Patients with Decompensated Liver Cirrhosis

Аim: to conduct a comparative analysis of serum albumin's structural and functional properties in decompensated cirrhotic patients by means of spin prob EPR spectroscopy.Materials and methods. The main study group included 70 patients with decompensated liver cirrhosis and ascites. The control group consisted of 12 healthy volunteers, comparable in gender and age, without liver diseases. To assess the structural and functional ability, serum albumin was analyzed by EPR spectroscopy.Results. Albumin levels within reference intervals were found in 37 patients (59.8 %). The native albumin index decrease in cirrhotic patients as the disease progressed with the lowest values in the Child – Pugh C group (p < 0.001). The binding efficiency of albumin decreased in accordance with the severity of cirrhosis with minimal albumin binding capacity in the Child – Pugh C (Me = 25.43 %; n = 30; p < 0.001). The transport activity of RTQ albumin decreased in patients with decompensated cirrhosis, the lowest transport ability was observed in the Child – Pugh C group (Me = 26.09 %). In patients with decompensated disease the detoxification potential was significantly reduced: Child – Pugh B — Me = 44.03 %; Child – Pugh C — Me =17.16 %. Despite the normal values of serum albumin in 72.5% of patients with cirrhosis B and in 26.7% in the cirrhosis C group, only 12.3% in the cirrhosis B group had normal albumin function and in cirrhosis C nо patients had normal albumin function.Conclusion. There were not only serum concentration depletion in cirrhotic patients, but also albumin physiological non-oncotic properties were violated. The severity of these changes increased with the progression of cirrhosis. Our data allow us to raise the question of the need to use the EPR test to determine indications for albumin replacement therapy in patients with cirrhosis and the presence of ascites, even at normal values of its serum concentration

The Role of Correcting Structural and Functional Albumin Properties in Ascites Control in Decompensated Cirrhotic Patients

Аim: to study the structural and functional characteristics of albumin in patients with decompensated cirrhosis, their relationship with ascites; to identify the relationship between improvement in albumin characteristics and regression of ascites.Materials and methods. Fifty patients with decompensated liver cirrhosis and ascites were divided into groups. The first group received standard treatment for cirrhosis, the second — standard treatment and replacement therapy with 20 % human albumin solution at a dose of 200 mL per week for 3 months.Results. The value of the native conformation of albumin and the functional parameters of albumin were significantly lower than in the group of healthy individuals (p < 0.001). With the severity of ascites, the native conformation index (DR), which characterizes the structural usefulness of the albumin molecule, decreased. Median DR for ascites stage I (IAC) was –1.69, II grade — –2.28, III grade — –2.42 (p < 0.05). Replacement therapy with albumin allowed to achieve regression of ascites in 48.4 % of patients, compared with 7.1 % in the standard treatment group. Along with clinical improvement, restoration of albumin structural and functional properties was observed in the albumin group. The mean serum albumin level at which ascites remained in remission for 3 months was 42.11 g/L (p < 0.001).Conclusions and discussion. The structural and functional characteristics of albumin were impaired in patients with decompensated cirrhosis and ascites. The severity of changes in the structural and functional properties of albumin depended on the severity of ascites. The regression of ascites was accompanied by the restoration of the functional and structural usefulness of albumin against the backdrop of albumin replacement therapy. The criterion for stopping transfusion therapy with albumin can be the achievement of a serum albumin level of 42.11 ± 7.04 g/L, DR — 1.05, BE — 73.51 %, RTQ — 75.10 %, DTE — 72.71 %

ANALYSIS OF VACANCIES AND JOB OFFERS FOR DOCTORS IN STATE MEDICAL ORGANIZATIONS OF THE IRKUTSK REGION

The analysis of vacancies and job offers for doctors, especially information on the declared amount of wages and benefits, allows  not only to study the need for personnel, but also to study the level  of motivation of candidates for medical posts. The aim of the study  was to analyze vacancies and job offers for doctors from state  medical organizations of the Irkutsk region. The study was  conducted using the method of continuous statistical analysis of job  offers for physicians posted on the official website of the Ministry of  Health of the Irkutsk region. The public sector of the healthcare  system in the Irkutsk region provides a large number of vacancies  for unemployed doctors and young professionals. Declared in job  advertisements, the salary level of doctors is below the level  reflected in regional state reports on the health of the population and  the organization of health care. There is a lag in the salaries of  medical workers from the average for the region, as well as the  backlog of the Irkutsk region in this indicator from the Russian  Federation. When comparing the municipalities of the region to the  maximum and minimum declared wage levels, it is revealed that the  difference between them is almost fourfold. Although the most  demanded are doctors who provide primary health care, the need for these specialists does not correlate with the level of wages offered to them in vacancy announcements. Fourfold excess of the maximum  declared wage level over the minimum in the municipal formations of the region is not a consequence of taking into account difficult  working conditions in hard-to-reach areas, but is due exclusively to factors of economic nature

Sociological Research of the Adherence of Medical Students to Employment by Specialty Received at a University

Background. A significant number of medical students refuse to work on a specialty obtained in medical universities after its completion or during the first years of professional activity.Purpose of the study: to conduct a sociological study of the adherence of students of a medical university to employment in a specialty received at a university, as well as factors of its motivation.Methods. A sociological survey of graduate students of ISMU was conducted using specially designed questionnaires.Results. It was revealed that more than 5 % of students do not plan to work on the received specialty after graduating from a medical university. Only every fourth respondent after graduation is going to return to his place of permanent residence, one of four intends not to return, and half have not yet decided on the choice of a further place of work and residence. Work with undergraduates about bringing them to the territory of the initial residence is organized by the administration of municipal entities and medical organizations poorly. Meanwhile, the requirements of graduates presented to a potential employer in terms of the level of wages and the creation of conditions for residence and professional activity are not overstated.Conclusion. Working with graduates and taking specific steps to implement their requirements is the most logical option for joint activities of medical universities, health authorities, administrations of medical organizations and local self-government bodies to create favorable conditions for securing young professionals in their chosen field of activity

Formation of Centauro and Strangelets in Nucleus-Nucleus Collisions at the LHC and their Identification by the ALICE Experiment

We present a phenomenological model which describes the formation of a Centauro fireball in nucleus-nucleus interactions in the upper atmosphere and at the LHC, and its decay to non-strange baryons and Strangelets. We describe the CASTOR detector for the ALICE experiment at the LHC. CASTOR will probe, in an event-by-event mode, the very forward, baryon-rich phase space 5.6 < \eta < 7.2 in 5.5 A TeV central Pb + Pb collisions. We present results of simulations for the response of the CASTOR calorimeter, and in particular to the traversal of Strangelets.Comment: 4 pages, 4 figures, to appear in the proceedings of the 26th ICR

Organization of internal control of quality of medical care (Faculty Clinics of Irkutsk State Medical University)

Currently, there is no normative document at the federal level that determines the format of the organization of internal control of medical care quality in a medical organization. The system of standardization in the sphere of public health of the Russian Federation remains incomplete. In this regard, in the multidisciplinary medical organization, innovative approaches have been developed and implemented in the management of the medical care quality and ensuring the safety of medical activities: the development of a number of local regulatory documents; strengthening the expert institute (setting up a department for quality control and safety of medical activities); increasing the role of the internal expertise of the quality of medical care; standardization of medical care; improving the organization of work of middle and junior medical links; strict adherence to the three-stage internal quality control with the obligatory presence of self-control when monitoring the quality of work of medical, middle and junior medical personnel. The authors show the dynamics of the main indicators of the quality of care at the stages before and after the introduction of new approaches to improve the internal quality control of medical care. The presented data testify to the effectiveness and expediency of the proposed measures

Clinical Recommendations of the Russian Scientific Liver Society and Russian Gastroenterological Association on Diagnosis and Treatment of Liver Fibrosis, Cirrhosis and Their Complications

Aim. Current clinical recommendations are intended to supply gastroenterologists, physicians and general practitioners with modern methods for the diagnosis and treatment of liver cirrhosis and fibrosis.Key points. Liver fibrosis develops with connective tissue accumulation in liver in the outcome of various chronic diseases, including alcohol misuse, viral hepatitises, autoimmune and more rare hereditary liver diseases. Liver cirrhosis is the final stage of most chronic diffuse liver diseases. The recommendations present current opinions on pathogenesis of liver fibrosis and cirrhosis, principles of diagnosis, treatment and prevention of their main complications: hepatic encephalopathy, oesophageal and gastric variceal bleeding, acute kidney injury/hepatorenal syndrome, infectious complications (i.a. spontaneous bacterial peritonitis), hyponatraemia, pulmonary complications, etc.Conclusion. Timely diagnosis and adequate therapy in cirrhosis can prevent life-threatening complications and improve the patients’ prognosis and quality of life

CASTOR: A Forward Detector for the Identification of Centauro and Strangelets in Nucleus-Nucleus Collisions at the LHC

Presentation made at the XXVIIIth Symposium on Multiparticle Dynamics, 6-11 September 1998, Delphi and published in World ScientificThe physics motivation for a very forward detector to be employed in heavy ion collisions at the CERN LHC is discussed. A phenomenological model describing the formation and decay of a Centauro fireball in nucleus-nucleus collisions is presented. The CASTOR detector which is aimed to measure the hadronic and photonic content of an interaction and to identify deeply penetrating objects in the very forward, baryon-rich phase space 5.6eta7.2 in an event-by-event mode is described. Results of simulations of the expected response of the calorimeter and, in particular, to the passage of strangelets, are presented

Challenges in QCD matter physics - The Compressed Baryonic Matter experiment at FAIR

Substantial experimental and theoretical efforts worldwide are devoted to explore the phase diagram of strongly interacting matter. At LHC and top RHIC energies, QCD matter is studied at very high temperatures and nearly vanishing net-baryon densities. There is evidence that a Quark-Gluon-Plasma (QGP) was created at experiments at RHIC and LHC. The transition from the QGP back to the hadron gas is found to be a smooth cross over. For larger net-baryon densities and lower temperatures, it is expected that the QCD phase diagram exhibits a rich structure, such as a first-order phase transition between hadronic and partonic matter which terminates in a critical point, or exotic phases like quarkyonic matter. The discovery of these landmarks would be a breakthrough in our understanding of the strong interaction and is therefore in the focus of various high-energy heavy-ion research programs. The Compressed Baryonic Matter (CBM) experiment at FAIR will play a unique role in the exploration of the QCD phase diagram in the region of high net-baryon densities, because it is designed to run at unprecedented interaction rates. High-rate operation is the key prerequisite for high-precision measurements of multi-differential observables and of rare diagnostic probes which are sensitive to the dense phase of the nuclear fireball. The goal of the CBM experiment at SIS100 (sqrt(s_NN) = 2.7 - 4.9 GeV) is to discover fundamental properties of QCD matter: the phase structure at large baryon-chemical potentials (mu_B > 500 MeV), effects of chiral symmetry, and the equation-of-state at high density as it is expected to occur in the core of neutron stars. In this article, we review the motivation for and the physics programme of CBM, including activities before the start of data taking in 2022, in the context of the worldwide efforts to explore high-density QCD matter.Comment: 15 pages, 11 figures. Published in European Physical Journal