DEVELOPMENT OF MATHEMATICAL MEANS FOR ESTIMATION OF ECOLOGICAL AND ECONOMICAL LOSSES FROM POLLUTION OF ATMOSPHERIC AIR IN ZONES OF TECHNOGENIC OBJECTS IMPACT

The article describes the solution of one of the most important problems of rational use of natural resources. Modern mathematical tools for damage estimation, which are caused by atmospheric pollution to natural objects, and also methods for calculation of the cost for their renewal were developed. The solution of problem was divided into 3 stages. At the first stage it was defined basic anthropogenic sources of pollution, was illustrated conceptual behavior of pollutants in the atmosphere emitted by technological stationary point source. Choice of mathematical model that allows to determine the distribution of pollutants concentration in the air in zones of pollution by point stationary sources in the short-term discharges was proved. At the second stage it was developed mathematical tools to determine the level of objects damage, which were in the zone of pollution, depending on the intensity and duration of exposure of technogenic sources. At the third stage it was developed mathematical models to determine the recoverable amount of natural objects depending on their level of damage. Model example of developed means usage was described. Advantages of developed means over existed analogs were noticed

Роль методов локального воздействия на стенки полости и паракавитарную зону в повышении эффективности лечения деструктивного туберкулеза легких

Destructive lung tuberculosis is a heterogeneous group of various forms of the lung tuberculosis (recent, chronic, advanced) which have common features, such as the presence of cavities, a presence of Mycobacteria tuberculosis and they are hard for treatment. Peculiarities of the microcirculation, the fibrous capsule outside the cavity, the caseous and necrotizing layer inside impede medications to reach the inflammation and destruction zone when applied as intranasal as directly into the cavity. Techniques for drug delivery to the perifocal zone (needle-jet injections, intrapulmonary ionophoresis), dénaturation of the cavity’s pyogeneous layer (hydrodiathermocoagulation) and damming of the draining bronchi (blocking of the cavity) allow to increase a number of the destructive cavities closed 23-43.3% more and to eradicate the Mycobacteria tuberculosis 33-47.5% more copared with a complex conservative treatment.Деструктивный туберкулез легких представляет собой разнородную группу форм легочного туберкулеза (свежего, хронического, далекозашедшего), объединенных наличием полости распада (каверн) и бактериовыделением, и является наиболее трудным для излечения. Особые условия микроциркуляции в воспалительно-деструктивной зоне, фиброзная капсула каверны и выстилающий ее изнутри казеозно-некротический слой препятствуют попаданию медикаментов, введенных интравазально (прямо и опосредованно) или внутрикавернозно. В зависимости от формы деструктивного туберкулеза легких методы введения препаратов в перифокальную зону (иголь но-струйные инъекции, внутрилегочный ионофорез), денатурации пиогенного слоя каверн (гидродиатермокоагуляция) и перекрытия дренирующих бронхов (каверноблокация) позволяют повысить закрытие деструктивных полостей на 23-43,3% и добиться прекращения бактериовыделения на 33-47,5% выше, чем при комплексном консервативном лечении

Study of reproductive function in patients with morbid obesity after bariatric surgery

Purpose of the study. To study the effectiveness of bariatric surgeries for reproductive health of patients suffering from morbid obesity.Materials and methods. The medical history of 270 patients suffering from morbid obesity with a violation of the reproductive function was studied. Patients were divided into two groups: 181 of them women, 89 men with a BMI of 45-65 kg / m2. The age of the operated women was from 18 to 58 years old, 7 of them (3.9% of the group of 181 patients) were postmenopausal. Out of 174 patients of 45 - of childbearing age, they complained of a violation of the ovarian-menstrual function. The number of operated men was 89 people aged 18 to 60 years. In the postoperative period, hormone concentrations were studied: testosterone, estrogen, progesterone. The obtained data were compared with the original values. Results. The following signs of clinical improvement of the reproductive system were found: in 36 patients (92%) normalization of the cycle duration occurred. The following group of 31 (91%) patients noted a return to the normal duration of menstrual bleeding. In the last group, menorrhagia disappeared in 11 patients (79%).Treatment led to a normalization of the concentration of hormones studied. Estradiol indicators after a year of the postoperative period decreased to 462 ± 128.4 pmol / l (p <0.01). Similarly, testosterone levels fell to 0.89 ± 0.71 nmol / L (p <0.01). The progesterone content increased to 43 ± 8.3 nmol / l (p <0.01). In 89 male patients with morbid obesity, there was a violation of the background of sex hormones in the form of hypoterosteronemia to 5.34 ± 1.91 nmol / L, hypoprogesteronemia 0.12 ± 0.09 nmol / L and hyperestrogenemia 278 ± 53.8 Pkmol / l. In a laboratory study one year after the operation, the indices were as follows: 1.53 ± 0.92 nmol / L to 5.34 ± 1.91 nmol / L (p <0.01), as did progesterone with 0.12 ± 0 , 09 nmol / l to 2.31 ± 0.83 nmol / l (p <0.01). It is important that the concentration of estradiol 278 ± 53.8 Pkmol / l decreased to 72.3 ± 21.2 Pkmol / l (p <0.01). Discussions. Treatment of patients with both sexes surgically led to a stable, positive result, improving the quality of life. Thanks to bariatric surgery, the patients returned to normal after a certain time, reproductive function was also restored. Reduction of visceral adipose tissue in the patients led to normalization of the hormonal background, which is proved by laboratory tests of blood. And as a consequence of the restoration of reproductive function. The conclusion. Surgical treatment in people with morbid obesity and metabolic syndrome gives good results. Modern surgery allows you to solve problems of infertility associated with excess fat tissue and a broken hormonal background.Цель исследования. Изучить эффективность бариатрических операций для восстановления репродуктивного здоровья пациентов, страдающих морбидным ожирением. Материалы и методы. Изучены истории болезни 270 больных, страдающих морбидным ожирением, имеющих нарушение показателей репродуктивной функции. Пациенты были разделены на две группы: из них женщин 181 человек, мужчин 89 человек с показателями ИМт 45-65 кг/м2 . Возраст оперированных женщин составил от 18 до 58 лет из них 7 пациенток (3,9% от группы 181 пациентки) находились в постменопаузе. Из 174 пациенток 45 - детородного возраста предъявляли жалобы по нарушению овариально-менструальной функции. Число оперированных мужчин составило 89 человек в возрасте от 18 до 60 лет. В послеоперационном периоде изучались концентрации гормонов: тестостерона, эстрогена, прогестерона. Полученные данные сравнивали с первоначальными значениями. результаты. обнаружены следующие признаки клинического улучшения репродуктивной системы: у 36 больных (92%) произошла нормализация длительности цикла. Следующая группа из 31 (91 %) пациентки отметили возвращение к нормальной длительности менструального кровотечения. В последней группе исчезли меноррагии у 11 больных (79%). Лечение привело к нормализации концентрации исследуемых гормонов. Показатели эстрадиола по прошествии года послеоперационного периода снизились до 462±128,4 пкмоль/л (р <0,01). аналогично показатели тестостерона снизились до 0,89±0,71 нмоль/л (р <0,01). Содержание прогестерона возросло до 43±8,3 нмоль/л (р <0,01). У 89 пациентов мужского пола с морбидным ожирением отмечалось нарушение фона половых гормонов в виде гипотестостеронемии до 5,34±1,91 нмоль/л, гипопрогестеронемии 0,12±0,09 нмоль/л и гиперэстрогенемии 278±53,8 Пкмоль/л. При лабораторном исследовании через год после операции показатели были следующими: 1,53±0,92 нмоль/л до 5,34±1,91 нмоль/л (р <0,01), так же увеличивается прогестерон с 0,12±0,09 нмоль/л до 2,31±0,83 нмоль/л (р <0,01). Важно, что концентрация эстрадиола 278±53,8 Пкмоль/л уменьшилось до 72,3±21,2 Пкмоль/л (р <0,01). обсуждения. Лечение больных обоих полов хирургическим способом привело к стойкому, положительному результату, улучшению качества жизни. [10] Благодаря бариатрическим операциям пациентки спустя определенное время приходили к нормальным показателям, репродуктивная функция так же восстанавливалась [7]. Уменьшение висцеральной жировой ткани в организме пациентов приводило к нормализации гормонального фона, что доказывается лабораторными исследованиями крови. И как следствие восстановление репродуктивной функции. Заключение. Лечение хирургическим методом у людей с морбидным ожирение и метаболическим синдромом дает хорошие результаты. Современная хирургия позволяет решать проблемы бесплодия связанные с избытком жировой ткани и нарушенным гормональным фоном

Expanding Paramedicine in the Community (EPIC): study protocol for a randomized controlled trial

BACKGROUND: The incidence of chronic diseases, including diabetes mellitus (DM), heart failure (HF) and chronic obstructive pulmonary disease (COPD) is on the rise. The existing health care system must evolve to meet the growing needs of patients with these chronic diseases and reduce the strain on both acute care and hospital-based health care resources. Paramedics are an allied health care resource consisting of highly-trained practitioners who are comfortable working independently and in collaboration with other resources in the out-of-hospital setting. Expanding the paramedic’s scope of practice to include community-based care may decrease the utilization of acute care and hospital-based health care resources by patients with chronic disease. METHODS/DESIGN: This will be a pragmatic, randomized controlled trial comparing a community paramedic intervention to standard of care for patients with one of three chronic diseases. The objective of the trial is to determine whether community paramedics conducting regular home visits, including health assessments and evidence-based treatments, in partnership with primary care physicians and other community based resources, will decrease the rate of hospitalization and emergency department use for patients with DM, HF and COPD. The primary outcome measure will be the rate of hospitalization at one year. Secondary outcomes will include measures of health system utilization, overall health status, and cost-effectiveness of the intervention over the same time period. Outcome measures will be assessed using both Poisson regression and negative binomial regression analyses to assess the primary outcome. DISCUSSION: The results of this study will be used to inform decisions around the implementation of community paramedic programs. If successful in preventing hospitalizations, it has the ability to be scaled up to other regions, both nationally and internationally. The methods described in this paper will serve as a basis for future work related to this study. TRIAL REGISTRATION: ClinicalTrials.gov: NCT02034045. Date: 9 January 2014. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/1745-6215-15-473) contains supplementary material, which is available to authorized users

High-Energy Laser Ponderomotive Acceleration

A new concept of TeV-range laser ponderomotive acceleration in a plasma is proposed. Particles are accelerated in the point-like scattering by the leading front of the laser pulse, propagating at the group velocity less than the vacuum speed of light. In this scheme, the gain in particle energy is determined by the group velocity and does not depend on laser intensity, which determines the quantum probability of acceleration. The quantum and classical analysis of the scheme proposed is presented. Estimates show that the concept proposed is a promising technique for compact laser acceleration of TeV energy range

The specifics of using nitrates in the treatment of stable angina

Among cardiovascular diseases (CVD), coronary artery disease (CAD) and its complications remain a major cause of death and disability. In Russia, mortality from diseases of the circulatory system account for 56.5% of overall mortality, with about half of cases accounting for CAD [1]. Till now nitrates have been widely used in cardiology though their feasibility and safety are still matters of debate. Stable angina, the basic therapy of which includes nitrates, is the most common clinical form of coronary artery disease