IMPROVEMENT OF PRODUCTION INFRASTRUCTURE OF THE REGION

The article describes the process of creating a new block-modular boiler house in the town of Kirzhach of Vladimir region which was the result of the interaction of the stakeholders in the process of modernization of heat supply system in this city in the development of public-private partnership in the structure of LLC «Vladimiroblgaz», administration of Vladimir region and the city of Kirzhach and the State Corporation «Fund of assistance to reforming housing and communal services» of Russian Federation

Investigation of interaction femtosecond laser pulses with skin and eyes mathematical model

We present a mathematical model of linear and nonlinear processes that takes place under the action of femtosecond laser radiation on the cutaneous covering. The study is carried out and the analytical solution of the set of equations describing the dynamics of the electron and atomic subsystems and investigated the processes of linear and nonlinear interaction of femtosecond laser pulses in the vitreous of the human eye, revealed the dependence of the pulse duration on the retina of the duration of the input pulse and found the value of the radiation power density, in which there is a self-focusing is obtained. The results of the work can be used to determine the maximum acceptable energy, generated by femtosecond laser systems, and to develop Russian laser safety standards for femtosecond laser systems

Treatment of basal cell cancer in the periorbital area using a pulsed copper vapour laser

An increase in life expectancy in developed countries is inevitably accompanied by an increase in the number of nonmelanoma skin diseases, which are primarily represented by basal cell cancer (BCC) occurring in elderly and old-age patients. The pathogenesis of such diseases is associated both with impaired proliferation and differentiation of the keratinocytes of the epidermal basal layer, as well as with the transformation of the vasculature in the papillary dermis in the vicinity of BCC. In recent years, such conditions have been increasingly treated using CO2 , neodymium, diode and pulsed-dye lasers. In many cases, these devices allow malignant BCC cells to be successfully eliminated. However, the use of near-infrared lasers in the periorbital area is limited due to a higher risk of damaging the organs of the visual system. Therefore, a search for new laser surgery methods that can be used for treating malignant skin tumours seems to be a prospective research direction.Methods. 3 male and 9 female patients diagnosed with primary BCC were treated using a copper vapour laser (Yakhroma-Med). The age of the patients varied from 34 to 77 years. Laser treatment was carried out in one session under the following irradiation parameters: the wavelength of 511 and 578 nm, the average power of up to 3 W and a series of 15 ns pulses. The pause between the pulses was 60 μs, with the exposure time ranging from 200 to 600 ms. The light spot diameter on the skin surface was 1 mm. The follow-up monitoring duration was 24 months.Results. In all the BCC patients, one session of copper vapour laser treatment allowed malignant cells in the disease area to be completely eliminated without relapses during 2 years after the therapy. The duration of skin healing in the irradiated area was 2 weeks in patients under the age of 40 years, compared to 3–4 weeks in elderly patients. After the treatment, short-term side effects, such as a slight edema, erythema and peeling, were observed

COVID‑19 Pandemic: Effect of Specific and Non-Specific Prevention Measures on the Risk of SARS‑CoV‑2 Infection in Employees of Healthcare Organizations

From the very onset of SARS‑CoV‑2 spreading, active involvement in the COVID‑19 epidemic process made the healthcare professionals (HCPs) a vulnerable group with higher risks of contracting the disease, severe course and fatal outcome.The aim. We aimed at studying the impact of specific and non-specific preventive measures on the risk of SARS‑CoV‑2 infection among the HCPs in a large industrial region settings during the COVID‑19 pandemic.Materials and methods. We analyzed the data obtained using 1 905 questionnaires for the personnel of infectious hospitals for treatment of COVID‑19 patients and non-core healthcare facilities in a large industrial region during the COVID‑19 pandemic, 100 questionnaires on adherence of the employees to hand hygiene and antiseptics, the results of the tests for specific IgG to the SARS‑CoV‑2 nucleocapsid (2 200 samples), as well as the results of assessment of viral and bacterial contamination of the outer surface of the personal protective equipment for infectious hospital staff (108 specimens).Results and discussion. In the course of the study, an effect of failure in the implementation of some specific and non-specific preventive measures on an increase in the incidence of COVID‑19 in various healthcare professionals has been identified. The COVID‑19 pandemic once again emphasized the need to save lives and health of the HCPs as socially significant category of citizens under the spread of pathogens with high epidemic potential, applying a complex of specific and non-specific measures that are not mutually exclusive

Тромботическая окклюзия у пациентов с острым ишемическим инсультом

Currently, reperfusion therapy is the main method of treating patients with ischemic stroke (IS). The safety and efficacy of systemic thrombolytic therapy with a recombinant tissue plasminogen activator in patients with IS within 3 hours, and then 4.5 hours after the onset of symptoms of the disease was demonstrated in the NINDS (1995) and ECASS III (2008) studies. In 2018, based on the results of five studies, clear indications were formulated for performing thrombectomy (TE) in patients with IS, which involve the detection of thrombosis of a large stroke-associated artery. Given the continuous growth in the number of the adult population, which constitutes the bulk of patients with IS, information on the prevalence of patients with thrombotic occlusion of cerebral arteries, who are potential candidates for TE, may be important for regional vascular centers.Aim of study. To describe IS patients admitted within the 6-hour “therapeutic window”.Materials and methods. The study included 145 patients with cerebral IS who were admitted within the first 6 hours after the onset of symptoms of the disease. All patients underwent computed tomographic (CT) angiography in order to verify the occlusion of the cerebral artery.Results. In our study, a correlation was established between the NIHSS severity of IS and the likelihood of verification of stroke-related artery thrombosis by CT angiography, but in 32.6% of patients with severe stroke (NIHSS at least score 14), no thrombotic occlusion was detected, and in 13% of patients with a clinic of mild acute cerebrovascular accident (NIHSS no more than 6), on the contrary, thrombotic occlusion was detected. Mortality in patients with verified thrombotic occlusion of the cerebral artery was higher than in patients without it (38% versus 10.5%, p<0.001). Such a significant difference in the mortality rate was due to the initially more severe stroke (NIHSS at admission 17 [10; 23] versus 5 [2; 10], p><0.001) in patients with thrombotic occlusion of a stroke-related artery, as well as a higher incidence of severe swallowing disorders (30% versus 9.5%, p ><0.002), which are a risk factor for pneumonia, as well as a higher frequency of such a comorbid background as chronic kidney disease and atrial fibrillation (30% versus 13.7%, p=0.018% and 58% versus 29.5%, p=0.001, respectively). CONCLUSION 1. Thrombosis of the cerebral stroke-associated artery was detected in 34.5% of patients with ischemic stroke who were admitted within the first 6 hours from the onset of the disease. 2. The main reason for the failure to perform thrombectomy in patients with ischemic stroke admitted within the 6-hour therapeutic window is the lack of verification of stroke-related artery thrombosis using computed tomographic angiography. Due to thrombosis at a different location (other than thrombosis of the internal carotid artery and / or M1 segment of the middle cerebral artery), 10% of patients with verified thrombosis did not meet the currently existing selection criteria for thrombectomy. Keywords: ischemic stroke, reperfusion therapy, cerebral artery thrombosis, cryptogenic stroke>˂0.001). Such a significant difference in the mortality rate was due to the initially more severe stroke (NIHSS at admission 17 [10; 23] versus 5 [2; 10], p˂0.001) in patients with thrombotic occlusion of a stroke-related artery, as well as a higher incidence of severe swallowing disorders (30% versus 9.5%, p˂0.002), which are a risk factor for pneumonia, as well as a higher frequency of such a comorbid background as chronic kidney disease and atrial fibrillation (30% versus 13.7%, p=0.018% and 58% versus 29.5%, p=0.001, respectively).Conclusion. 1. Thrombosis of the cerebral stroke-associated artery was detected in 34.5% of patients with ischemic stroke who were admitted within the first 6 hours from the onset of the disease. 2. The main reason for the failure to perform thrombectomy in patients with ischemic stroke admitted within the 6-hour therapeutic window is the lack of verification of stroke-related artery thrombosis using computed tomographic angiography. Due to thrombosis at a different location (other than thrombosis of the internal carotid artery and / or M1 segment of the middle cerebral artery), 10% of patients with verified thrombosis did not meet the currently existing selection criteria for thrombectomy. В настоящее время реперфузионная терапия является основным методом лечения пациентов с ишемическим инсультом (ИИ). Безопасность и эффективность системной тромболитической терапии при помощи рекомбинантного тканевого активатора плазминогена у пациентов с ИИ в пределах 3 часов, а в последующем 4,5 часа от начала симптомов заболевания была продемонстрирована в исследованиях NINDS (1995) и ECASS III (2008). В 2018 году, основываясь на результатах пяти исследований, были сформулированы четкие показания для выполнения тромбэктомии (ТЭ) у пациентов с ИИ, которые подразумевают выявление тромбоза крупной инсульт-связанной артерии. В условиях непрерывного роста числа взрослого населения, составляющего основную массу пациентов с ИИ, информация о распространенности больных с тромботической окклюзией церебральных артерий, являющихся потенциальными претендентами для выполнения ТЭ, может быть важной для региональных сосудистых центров.Цель исследования. Охарактеризовать пациентов с ИИ, поступающих в 6-часовом «терапевтическом окне».Материал и методы. В исследование включены 145 пациентов с церебральным ИИ, поступивших в первые 6 часов от начала развития симптомов заболевания. Всем пациентам с целью верификации окклюзии церебральной артерии выполняли компьютерную томографическую (КТ) ангиографию.Результаты. В нашем исследовании была установлена корреляция между тяжестью ИИ по шкале NIHSS и вероятностью верификации при помощи КТ-ангиографии тромбоза инсульт-связанной артерии, но у 32,6% пациентов с клиникой тяжелого инсульта (NIHSS не менее 14 баллов) не было выявлено тромботической окклюзии, а у 13% пациентов с клиникой легко протекающего острого нарушения мозгового кровообращения (NIHSS не более 6 баллов), напротив, тромботическая окклюзия была выявлена. Летальность у пациентов с верифицированной тромботической окклюзией церебральной артерии была статистически значимо выше, чем у пациентов без таковой (38% против 10,5%, р<0,001). Столь значительная разница между показателями летальности была обусловлена исходно более тяжелым инсультом (оценка по NIHSS при поступлении 17 [10; 23] против 5 [2; 10], p><0,001, статистически значимо) у больных с тромботической окклюзией инсульт-связанной артерии, а также большей частотой статистически значимых грубых расстройств глотания (30% против 9,5%, p><0,002, статистически значимо), являющихся фактором риска развития пневмонии и такого коморбидного фона, как хроническая болезнь почек и фибрилляция предсердий (30% против 13,7%, р=0,018 и 58% против 29,5%, р=0,001 соответственно). Выводы 1. Тромбоз церебральной инсульт-связанной артерии выявлен у 34,5% пациентов с ишемическим инсультом, поступающих в первые 6 часов от начала заболевания. 2. Основной причиной невыполнения тромбэктомии у пациентов с ишемическим инсультом, поступивших в 6-часовом «терапевтическом окне», является отсутствие верификации тромбоза инсульт-связанной артерии при помощи компьютерной томографической ангиографии. По причине тромбоза другой локализации (отличной от тромбоза внутренней сонной артерии и/или М1 сегмента средней мозговой артерии) 10% пациентов с верифицированным тромбозом не соответствовали существующим в настоящее время критериям отбора для выполнения тромбэктомии. Ключевые слова: ишемический инсульт, реперфузионная терапия, тромбоз мозговой артерии, криптогенный инсульт>˂ 0,001). Столь значительная разница между показателями летальности была обусловлена исходно более тяжелым инсультом (оценка по NIHSS при поступлении 17 [10; 23] против 5 [2; 10], p˂ 0,001, статистически значимо) у больных с тромботической окклюзией инсульт-связанной артерии, а также большей частотой статистически значимых грубых расстройств глотания (30% против 9,5%, p˂ 0,002, статистически значимо), являющихся фактором риска развития пневмонии и такого коморбидного фона, как хроническая болезнь почек и фибрилляция предсердий (30% против 13,7%, р=0,018 и 58% против 29,5%, р=0,001 соответственно).Выводы. 1. Тромбоз церебральной инсульт-связанной артерии выявлен у 34,5% пациентов с ишемическим инсультом, поступающих в первые 6 часов от начала заболевания. 2. Основной причиной невыполнения тромбэктомии у пациентов с ишемическим инсультом, поступивших в 6-часовом «терапевтическом окне», является отсутствие верификации тромбоза инсульт-связанной артерии при помощи компьютерной томографической ангиографии. По причине тромбоза другой локализации (отличной от тромбоза внутренней сонной артерии и/или М1 сегмента средней мозговой артерии) 10% пациентов с верифицированным тромбозом не соответствовали существующим в настоящее время критериям отбора для выполнения тромбэктомии.

A clinical description of two cases of orphan diseases in newborns in the intensive care unit

Clinical cases of the leucinosis and Shwachman-Diamond syndrome at newborns, who were in a serious condition in intensive care unit are described. The clinical picture of diseases and steps of diagnostic search are given. The diagnosis «leucinosis» was made at the age of 2 months that led to belated beginning of specific treatment and adversely affected the disease prognosis. The diagnosis of a syndrome of Shvakhman-Daymond was not established intravital because of rarity of this pathology, weak knowledge of pediatricians and comorbid diseases of the patient.В статье описаны клинические случаи лейциноза(ОМ1М #248600) и синдрома Швахмана-Даймонда (0М1М #260400) у новорожденных, получавших лечение в отделении реанимации и интенсивной терапии. Приведены клиническая картина заболеваний и этапы диагностического поиска. Диагноз «лейциноз» был поставлен в возрасте 2 месяцев, что привело к позднему началу специфического лечения и неблагоприятно отразилось на прогнозе. Диагноз синдрома Швахмана-Даймонда не был установлен при жизни пациента в виду редкости данной патологии, слабой информированности специалистов и наличия у больного коморбидных заболеваний

Высокая суммарная доза облучения улучшает выживаемость больных локализованной формой мелкоклеточного рака легкого: результаты одноцентрового ретроспективного анализа

The overall survival of patients with locally advanced small cell lung cancer who received at least 2 courses of chemotherapy and external beam radiation therapy at a total dose >50 Gy delivered to the primary tumor was retrospectively studied. Patients were dividedinto 2 groups. Patients in the standard treatment group (n=71) were treated to 50–58 Gy total dose. The dose escalation group (n=69) was treated to 60–74 Gy. Accelerated fractionation regimen in radiotherapy was more frequently given in dose escalation treatment group. The 1-, 3- and 5-year survival rates in the dose escalated and standard dose groups were respectively 54 % (95 % CI 42–65 %) and 32 % (95 % CI 23–44 %), р=0,11; 25 % (95 % CI 16–36 %) and 1 % (95% CI 0–8 %), р=0,0003; 17 % (95 % CI 10–28 %) and 0 % (95 % CI 0–5 %) (р=0.0007). The median survival was 14 months (95 % CI 10–17 months) in the dose escalated treatment group and 9 months (95 % CI 8–11months) in patients of the standard treatment group (χ2=16,8, р<0,0001). Multifactorial analysis showed that a total dose of ≥60 Gy resulted in reduction in risk of death (RR 0,57 (CI 0,37–0,88), р=0,012). Radiation dose escalation can result in improvement of local control for patients with locally advanced small cell lung cancer. Prospective randomized studies are required to finally confirm this hypothesis. Проведено ретроспективное изучение общей выживаемости больных Л-МРЛ, получавших не менее 2 курсов химиотерапии и дистанционную ЛТ в СОД не менее 50 Гр на первичный очаг. Больные группы СОДст (n=71) получили облучение грудной клетки в стандартно рекомендованной дозе, в группе СОДэск (n=69) суммарная доза составляла 60–74 Гр по биологическому эквиваленту. Лучевую терапию в режиме ускоренного фракционирования с эскалацией дозы (УГФЭД) чаще применяли в группе СОДэск. Более 1, 3 и 5 лет жили пациенты из группы СОДэск и СОДст соответственно в 54 % (95 % ДИ 42–65 %) и 32 % (95 % ДИ 23–44 %), р=0,11; в 25 % (95 % ДИ 16–36 %) и 1 % (95% ДИ 0–8 %), р=0,0003; в 17 % (95 % ДИ 10–28 %) и 0 % (95 % ДИ 0–5 %) случаях (р=0,0007). Медиана выживаемости в группах составила 14 (95 % ДИ 10–17 мес) и 9 (95 % ДИ 8–11 мес) мес, χ2=16,8, р<0,0001 соответственно. При многофакторном анализе только СОД 60 Гр и выше независимо снижала риск смерти (ОР 0,57 (ДИ 0,37–0,88), р=0,012). Увеличение СОД выше стандартно рекомендуемых 50–58 Гр может привести к улучшению выживаемости больных Л-МРЛ. Окончательное подтверждение этой гипотезы возможно только в рамках проспективного рандомизированного исследования

Five decades of terrestrial and freshwater research at Ny-Ålesund, Svalbard

For more than five decades, research has been conducted at Ny-Alesund, in Svalbard, Norway, to understand the structure and functioning of High Arctic ecosystems and the profound impacts on them of environmental change. Terrestrial, freshwater, glacial and marine ecosystems are accessible year-round from Ny-Alesund, providing unique opportunities for interdisciplinary observational and experimental studies along physical, chemical, hydrological and climatic gradients. Here, we synthesize terrestrial and freshwater research at Ny-Alesund and review current knowledge of biodiversity patterns, species population dynamics and interactions, ecosystem processes, biogeochemical cycles and anthropogenic impacts. There is now strong evidence of past and ongoing biotic changes caused by climate change, including negative effects on populations of many taxa and impacts of rain-on-snow events across multiple trophic levels. While species-level characteristics and responses are well understood for macro-organisms, major knowledge gaps exist for microbes, invertebrates and ecosystem-level processes. In order to fill current knowledge gaps, we recommend (1) maintaining monitoring efforts, while establishing a longterm ecosystem-based monitoring programme; (2) gaining a mechanistic understanding of environmental change impacts on processes and linkages in food webs; (3) identifying trophic interactions and cascades across ecosystems; and (4) integrating long-term data on microbial, invertebrate and freshwater communities, along with measurements of carbon and nutrient fluxes among soils, atmosphere, freshwaters and the marine environment. The synthesis here shows that the Ny-Alesund study system has the characteristics needed to fill these gaps in knowledge, thereby enhancing our understanding of High-Arctic ecosystems and their responses to environmental variability and change

Five decades of terrestrial and freshwater research at Ny-Ålesund, Svalbard

For more than five decades, research has been conducted at Ny-Ålesund, in Svalbard, Norway, to understand the structure and functioning of High-Arctic ecosystems and the profound impacts on them of environmental change. Terrestrial, freshwater, glacial and marine ecosystems are accessible year-round from Ny-Ålesund, providing unique opportunities for interdisciplinary observational and experimental studies along physical, chemical, hydrological and climatic gradients. Here, we synthesize terrestrial and freshwater research at Ny-Ålesund and review current knowledge of biodiversity patterns, species population dynamics and interactions, ecosystem processes, biogeochemical cycles and anthropogenic impacts. There is now strong evidence of past and ongoing biotic changes caused by climate change, including negative effects on populations of many taxa and impacts of rain-on-snow events across multiple trophic levels. While species-level characteristics and responses are well understood for macro-organisms, major knowledge gaps exist for microbes, invertebrates and ecosystem-level processes. In order to fill current knowledge gaps, we recommend (1) maintaining monitoring efforts, while establishing a long-term ecosystem-based monitoring programme; (2) gaining a mechanistic understanding of environmental change impacts on processes and linkages in food webs; (3) identifying trophic interactions and cascades across ecosystems; and (4) integrating long-term data on microbial, invertebrate and freshwater communities, along with measurements of carbon and nutrient fluxes among soils, atmosphere, freshwaters and the marine environment. The synthesis here shows that the Ny-Ålesund study system has the characteristics needed to fill these gaps in knowledge, thereby enhancing our understanding of High-Arctic ecosystems and their responses to environmental variability and change