Study of Etiological Factors of Chronic Pancreatitis Complicated by Biliary Hypertension

During the 2009-2015 time period, 127 patients with complicated forms of chronic pancreatitis (CP) underwent surgical treatment at the Department of General Surgery of the Ivano-Frankivsk Regional Clinical Hospital. CP was accompanied by biliary hypertension (BH) in 39 (30.7%) patients. 14 (11.1%) patients developed BH with concomitant chronic duodenal obstruction (CDO), and in 4 (3.1%) patients a combination of BH+CDO and local venous hypertension (VH) of the vessels in the pancreatobiliary area was found. The analyzed group included 36 (92.3%) men and 3 (7.7%) women at the age of 21 to 60 years. In all 39 patients tubular stenosis of the intrapancreatic part of the choledoch was the morphological substrate of BH due to fibrose-degenerative changes in the pancreatic head; in 9 (23.1%) patients it was combined with cysts of the pancreatic head. In 28 (71.7%) patients, BH had clinical signs (ochrodermia and mucosal icterus, hyperbilirubinemia), and in 11 (28.9%) patients BH was asymptomatic and was diagnosed only by means of ultrasonography (USG) and computed tomography (CT) (tubular stenosis and dilation of the suprapancreatic segment of the common bile duct 0.7 cm to 1.3 – 1.5 cm). In 3 (7.6%) patients, BH was accompanied by the manifestations of cholangitis. All patients with CP complicated by BH underwent surgical treatment. Drainage, resection, and combined surgical interventions were used. In 17 (43.5%) patients CP complicated by BH was the result of acute pancreatitis (1 to 10 years ago), 14 of them underwent surgeries: 2 patients – laparoscopic drainage of the enzymatic peritonitis, 5 patients – laparotomy, drainage of the peritoneal omental sac, abdomen and retroperitoneal space, 5 patients – endoscopic retrograde cholangiopancreatography (ERCP) with drainage of biliary ducts, 2 patients – endoscopic stenting of the pancreatic ducts.  In 4 (10.2%) patients, CP was associated with previous surgeries on the organs of the pancreatobiliary area: 2 patients underwent cholecystectomy due to cholelithiasis, and 2 patients underwent Bilroth II gastrectomy due to duodenal ulcer. In 14 (35.9%) patients their condition was probably caused by cigarette smoking. In 8 (20.5 %) patients, a direct connection between CP and regular alcohol consumption was established. In 7 patients, the causes of CP complicated by BH were not found, and in these cases CP was qualified as idiopathic. Acute destructive pancreatitis is often an etiological factor in the development of CP complicated by BH. BH in case of CP is one of the absolute indications for surgical treatment, and the method of BH correction should be determined individually

Сучасний стан та напрямки розвитку асортименту послуг українських страховиків для роздрібного ринку

У статті розглянуто сучасний стан сектору страхування фізичних осіб в Україні. Ґрунтовно проаналізовано асортиментний ряд страхових послуг, що пропонується громадянам. Розроблено рекомендації щодо поліпшення та подальшого розвитку асортименту страхових послуг для фізичних осіб.In this article the current status of retail insurance sector in Ukraine is viewed. The deep analysis of insurance services assortment row for natural persons is conducted. Recommendations for improvement and further development of insurance services for the retail market are presented.В статье рассмотрено нынешнее положение сектора страхования физических лиц в Украине. Проанализирован ассортиментный ряд страховых услуг, которые предлагаются гражданам. Разработаны рекомендации по улучшению и дальнейшему развитию ассортимента страховых услуг для физических лиц

Effect of Immunomodulating Adjuvant Dzherelo (Immunoxel) in HIV Infected Patients Receiving Standard Antiretroviral Therapy

Open-label, matched-case, comparative trial was conducted in 40 HIV-infected patients to evaluate the adjunct effect of Dzherelo (Immunoxel) on immune and viral parameters. Arm A (n=20) received anti-retroviral therapy (ART) consisting of zidovudine, lamivudine, and efavirenz and arm B (n=20) received ART with Dzherelo. After 2 months total T-lymphocytes increased in ART recipients from 664 to 819 cells/μl (P=0.06), whereas in Dzherelo recipients they rose from 595 to 785(P=0.03). The CD4 T-cells expanded by 57.3% (218 to 343; P=0.002) in the ART arm and by 93.5% (184 to 356; P=0.004) in the Dzherelo arm. The accrual in absolute and relative number of CD8+ lymphocytes in ART and in the Dzherelo recipients was 43.2% (2.7%) and 50.4% (-0.5%) respectively. The CD4/CD8 ratio in Dzherelo recipients increased from 1.495 to 1.940 (P=0.03) but insignificant in the control: 1.418 to 1.613 (P=0.14). Activated CD3+ HLADR+ T-cells increased from 209 to 264 (P=0.02) and from 161 to 348 (P=0.0007) in ART and Dzherelo recipients respectively. No changes in CD20+ B-lymphocytes were seen in the control, but in Dzherelo patients they declined from 509 to 333 (P=0.00008). The proportion of CD3- CD16+CD56+ NK cells was not affected by ART but addition of Dzherelo raised NK cells from 11.2% to 17.1% (P=0.0001). About three-quarters (14/19) of patients on ART displayed decrease in viral load (1718 to 1419 copies/ml; P=0.008), while 95% of patients on Dzherelo had a decrease (1793 to 1368; P=0.001). Dzherelo has a favorable effect on the immune status and viral burden when given as an immunomodulating adjunct to ART

Обґрунтування конструкційних параметрів круглої пилки з комбінованим зубчастим вінцем

As a result of the analysis of the design of a circular saw with a combined toothed crown gear, we found that the method of combining the teeth with carbide plates of various shapes and sizes provides for the time division of the load on the treated material from the cutting forces and consists of the conditional separation of the teeth in the cut with a direct FZ exacerbation along the posterior face, protruding over the general range of cutting, and scrubs that have left and right lateral spine WZ exacerbation along the posterior facet of the tooth. The influence of the structural parameters of the saw with the combination of the FZ/2WZ teeth on the accuracy of longitudinal wood sawing is due to the peculiarities of the formation of propyl, which is divided into two following stages: initially, the perforated tooth FZ cuts the middle part of the chips, forming a mid groove at the bottom of the saw blade, which keeps the saw from the lateral displacement; the following two welding teeth WZ consecutively form the left and right portions of the propylene, expanding the formed groove to the width of the propylene. Known analytical methods for calculating the rigidity of circular saws do not provide the ability to consider the influence of the shape and size of the teeth, so the influence of the projection of the cutting teeth over the cutting circle and their thickness on the working rigidity of the saw was studied using 3D-modeling of the saw and finite element method in Solid Works environment and the dependence in the form of a second order regression equation. As a result of the analysis of the obtained regression equation, it is found that the working rigidity of the saw almost three times greater is the thickness of the saw than the height of the protuberance of the tooth, but rationally increase the stiffness of the saw by increasing the projection of the perforated tooth and reducing the thickness of the saw, as this will reduce the width of the saw. The rational value of the projection of the cutting pin of 1.5 mm is determined, which enables to form a corresponding groove at the bottom of the saw blade, which provides vibration resistance of the saw, and also prevents the saw blades from being displaced in the axial direction. Based on the analysis of the research results, a minimum 2.2 mm saw blade thickness has been determined, which provides the required working stiffness of the saw (J≥150 N/mm) and reduces the overall width of the saw to 3.2 mm. Based on the results of experimental studies on the accuracy of longitudinal sawing boards, it has been established that the saw with substantiated structural parameters of the toothed crown FZ/2WZ ensures the accuracy of sawing up to ±0,5 mm and avoids additional wood losses of about 34 % and electricity up to 20 %.Вплив конструкційних параметрів пилки з комбінуванням зубців FZ/2WZ на точність поздовжнього пиляння деревини пояснено особливостями формування пропилу, що поділяється на два етапи: спочатку прорізний зубець FZ зрізає середню частину стружки, утворюючи паз у дні пропилу, який утримує пилку від бокового зміщення; наступні два зачисних зубці WZ послідовно формують ліву і праву частини пропилу, розширюючи утворений паз до ширини пропилу. За допомогою 3D-моделювання пилки та методу скінченних елементів у середовищі Solid Works досліджено вплив на робочу жорсткість пилки величини виступу прорізних зубців над колом різання та їхньої товщини і встановлено залежність у вигляді рівняння регресії другого порядку. За результатами аналізу отриманого рівняння регресії оцінено вплив кожного чинника та з'ясовано, що підвищення робочої жорсткості пилки до оптимального значення (150 Н/мм) можливе завдяки збільшенню виступу прорізного зубця, оскільки це дає змогу зменшувати товщину пилки. Визначено оптимальну величину виступу прорізного зубця 1,5 мм, яка забезпечує необхідну робочу жорсткість пилки і дає змогу зменшити товщину пилки до 2,2 мм. На підставі результатів експериментальних досліджень встановлено, що пилка з обґрунтованими конструкційними параметрами зубчастого вінця FZ/2WZ забезпечує точність пиляння в межах ±0,5 мм, дає змогу уникнути додаткових втрат деревини (близько 34 %) та електроенергії (до 20 %)

Electrocaloric Response of the Dense Ferroelectric Nanocomposites

Using the Landau-Ginzburg-Devonshire approach and effective media models, we calculated the spontaneous polarization, dielectric, pyroelectric, and electrocaloric properties of BaTiO$_3$ core-shell nanoparticles. We predict that the synergy of size effects and Vegard stresses can significantly improve the electrocaloric cooling (2- 7 times) of the BaTiO$_3$ nanoparticles with diameters (10-100) nm stretched by (1-3)% in comparison with a bulk BaTiO$_3$. To compare with the proposed and other known models, we measured the capacitance-voltage and current-voltage characteristics of the dense nanocomposites consisting of (28 -35) vol.% of the BaTiO$_3$ nanoparticles incorporated in the poly-vinyl-butyral and ethyl-cellulose polymers covered by Ag electrodes. We determined experimentally the effective dielectric permittivity and losses of the dense composites at room temperature. According to our analysis, to reach the maximal electrocaloric response of the core-shell ferroelectric nanoparticles incorporated in different polymers, the dense composites should be prepared with the nanoparticles volume ratio of more than 25 % and fillers with low heat mass and conductance, such as Ag nanoparticles, which facilitate the heat transfer from the ferroelectric nanoparticles to the polymer matrix. In general, the core-shell ferroelectric nanoparticles spontaneously stressed by elastic defects, such as oxygen vacancies or any other elastic dipoles, which create a strong chemical pressure, are relevant fillers for electrocaloric nanocomposites suitable for advanced applications as nano-coolers.Comment: 38 pages, including 10 figures and 2 appendixe

Tájékoztató jelentés az őszi mezőgazdasági munkákról (2015. november 16-i operatív jelentések alapján)

A kiadvány a statisztikáról szóló 1993. évi XLVI. törvény (Stt.) 8.§ (2) bekezdése alapján készült el. Az adatszolgáltatás a Stt. felhatalmazása alapján kiadott Országos Statisztikai Adatgyűjtési Program keretein belül történt. A Nemzeti Agrárkamara (NAK) közreműködésével begyűjtött adatok a őszi mezőgazdasági munkák állásáról adnak tájékoztatást

End-stage heart failure in congenitally corrected transposition of the great arteries:a multicentre study

BACKGROUND AND AIMS: For patients with congenitally corrected transposition of the great arteries (ccTGA), factors associated with progression to end-stage congestive heart failure (CHF) remain largely unclear. METHODS: This multicentre, retrospective cohort study included adults with ccTGA seen at a congenital heart disease centre. Clinical data from initial and most recent visits were obtained. The composite primary outcome was mechanical circulatory support, heart transplantation, or death. RESULTS: From 558 patients (48% female, age at first visit 36 ± 14.2 years, median follow-up 8.7 years), the event rate of the primary outcome was 15.4 per 1000 person-years (11 mechanical circulatory support implantations, 12 transplantations, and 52 deaths). Patients experiencing the primary outcome were older and more likely to have a history of atrial arrhythmia. The primary outcome was highest in those with both moderate/severe right ventricular (RV) dysfunction and tricuspid regurgitation (n = 110, 31 events) and uncommon in those with mild/less RV dysfunction and tricuspid regurgitation (n = 181, 13 events, P &lt; .001). Outcomes were not different based on anatomic complexity and history of tricuspid valve surgery or of subpulmonic obstruction. New CHF admission or ventricular arrhythmia was associated with the primary outcome. Individuals who underwent childhood surgery had more adverse outcomes than age- and sex-matched controls. Multivariable Cox regression analysis identified older age, prior CHF admission, and severe RV dysfunction as independent predictors for the primary outcome. CONCLUSIONS: Patients with ccTGA have variable deterioration to end-stage heart failure or death over time, commonly between their fifth and sixth decades. Predictors include arrhythmic and CHF events and severe RV dysfunction but not anatomy or need for tricuspid valve surgery.</p

Хірургічне лікування хворих з приводу хронічного панкреатиту з біліарною гіпертензією

Проаналізовані результати лікування 25 хворих з приводу фіброзно–дегенеративного хронічного панкреатиту (ХП) з біліарною гіпертензією (БГ), у яких виконана операція Фрея. У 13 (52%) хворих (група порівняння) здійснена класична операція Фрея з формуванням панкреатоєюноанастомозу (ПЄА) на петлі тонкої кишки, виключеній за Ру, у 4 (16%) – операція Фрея з накладанням гепатикоєюноанастомозу (ГЄА). У 8 (32%) хворих застосовано модифікацію операції Фрея, що передбачала формування ПЄА на ізольованому сегменті тонкої кишки, додаткового дуоденоєюноанастомозу з дистальним кінцем сегмента тонкої кишки, холецистектомію, фомування ГЄА бік у бік та міжкишкового анастомозу за Ру (основна група). Для інтраопераційного визначення тиску у позапечінкових жовчних протоках використовували оригінальну методику. Віддалені результати проаналізовані у 13 пацієнтів. В групі порівняння показник фізичного здоров’я (PHs) становив у середньому (42,9 ± 0,9) ум. од., психологічного здоров’я (MHs) – (57,6 ± 1,9) ум. од., вираженість больового синдрому (BP) – (60,3 ± 5,2) ум. од.; в основній групі PHs становив (47,1 ± 1,1) ум. од., MHs – (61,5 ± 1,5) ум. од., BP – (68,4 ± 4,2) ум. од. Запропонована модифікація хірургічного лікування фіброзно–дегенеративного ХП з БГ має переваги, обнадійливі віддалені результати і може бути застосована у лікуванні таких хворих