Woundary ballistics of biological tissue’s plastic deformation on the model of ballistic plastiline using hollow point and shape-stable bullets

Introduction. Modern military conflicts make many challenges for military surgeons associated with the use of new types of weapons – hollow point bullets. The solution to this problem, firstly, depends on studying the characteristics of the terminal ballistics of such ammunition and comparing the data obtained with the characteristics of traditional weapon. The aim of the work is to conduct experimental modeling of the wound canal and residual wound cavity, which is formed due to plastic deformation from hollow point and non-hollow point bullets. Materials and methods. The studies were carried out on 40 blocks of ballistic plasticine, in each of which one shot was fired from an AKS-74 assault rifle and a ZBROYAR Z-10 carbine. Depending on the type of ammunition, the blocks of ballistic plasticine were divided into 4 groups: Group 1 – 10 blocks into which shots were made with 5.45 mm non-hollow point military cartridges with "PS" bullets with a steel core "7N6"; Group 2 (10 blocks) – 5.45x39 mm cartridges with "V-Max" hollow point bullets; Group 3 (10 blocks) – with cartridges 7.62x39 mm; Group 4 (10 blocks) – cartridges 7.62x39 mm with hollow point bullets of the "SP" type. Results and discussion. Only for a 5.45 mm military cartridge with "PS" bullets, both inlet and outlet bullet holes were detected in all 10 observations. When using non-hollow point bullets, the outer area of ​​the bullet inlet correlates with the caliber of the projectile (1.6 times larger when using 7.62 mm bullets). For hollow point bullets, the caliber of the projectile does not significantly affect the area of ​​the inlet (P < 0.05). The expansive properties of the bullet significantly increase the area of ​​the bullet hole by 14.87-31.2 times compared to non-hollow point ammunition. Increasing the caliber of the non-hollow point bullet leads to a significant increase in the area of ​​the sagittal section of the residual wound cavity in 1.59-2.03 times; whereas the expansive properties of the bullet do not significantly affect either the perimeter or the area of ​​the sagittal section of the residual wound cavity. For non-hollow point bullets, the volume of the residual wound cavity is more correlated with the caliber of the bullet (increases by 3.36 times); whereas for an hollow point bullet, its caliber has a smaller effect on the volume of the residual cavity (increases by 1.37 times). The expansive properties of the bullet affect the volume of the residual wound cavity in two ways: for 5.45 mm bullets the residual wound cavity increases 1.49 times, for 7.62 mm bullets it decreases 1.65 times. The use of hollow point bullets of 7.62 mm leads to greater collateral damage (zone of secondary necrosis, molecular shock) due to the scattering of the kinetic energy of the bullet to the elastic deformation of near-woundary tissues compared to non-hollow point analogues. The use of 5.45 mm expansive bullets leads to the formation of a larger volume of irreversible damage due to plastic deformation compared to non-hollow point analogues. Conclusions. The resulting model of plastic deformation of soft tissues, depending on the type of modern small arms, showed the dependence of the spatial configuration of the inlet bullet hole, residual wound cavity and deformation and fragmentation of the bullet on the caliber of the cartridge and its expansive properties

Recurrent acute pancreatitis prevention by the elimination of alcohol and cigarette smoking (REAPPEAR): protocol of a randomised controlled trial and a cohort study

Background/objectives Acute recurrent pancreatitis (ARP) due to alcohol and/or tobacco abuse is a preventable disease which lowers quality of life and can lead to chronic pancreatitis. The REAPPEAR study aims to investigate whether a combined patient education and cessation programme for smoking and alcohol prevents ARP. Methods and analysis The REAPPEAR study consists of an international multicentre randomised controlled trial (REAPPEAR-T) testing the efficacy of a cessation programme on alcohol and smoking and a prospective cohort study (REAPPEAR-C) assessing the effects of change in alcohol consumption and smoking (irrespective of intervention). Daily smoker patients hospitalised with alcohol-induced acute pancreatitis (AP) will be enrolled. All patients will receive a standard intervention priorly to encourage alcohol and smoking cessation. Participants will be subjected to laboratory testing, measurement of blood pressure and body mass index and will provide blood, hair and urine samples for later biomarker analysis. Addiction, motivation to change, socioeconomic status and quality of life will be evaluated with questionnaires. In the trial, patients will be randomised either to the cessation programme with 3-monthly visits or to the control group with annual visits. Participants of the cessation programme will receive a brief intervention at every visit with direct feedback on their alcohol consumption based on laboratory results. The primary endpoint will be the composite of 2-year all-cause recurrence rate of AP and/or 2-year all-cause mortality. The cost-effectiveness of the cessation programme will be evaluated. An estimated 182 participants will be enrolled per group to the REAPPEAR-T with further enrolment to the cohort

Профілактика мальпозиції імплантів молочних залоз після естетичної аугментаційної мамопластики

Prevention of breast implant malposition (BIM) after submuscular augmentation mammoplasty (SAMP) for hypomastia is an actual problem, as 4.7–5.2 % of women after primary SAMP and approximately 10 % after repeated SAMP require revision surgery due to this complication. The aim. To determine the effectiveness of prevention of BIM after SAMP by choosing the implant volume depending on the physique of women. Materials and methods. In 112 women, the choice of implant volume for SAMP was carried out in accordance with the High Five approach – the comparison group (Group C), in 46 women according to the developed algorithm – the main group (Group M). The algorithm took into account the risk of BIM in women of different physique depending on the implant volume. If a woman insisted on having a larger implant than was calculated, an additional internal bra was created. One year after SAMP, the amount of BIM was assessed according to the developed methodology, according to which BIM was characterised by the percentage increase in the area of the neo-osseous in relation to the area of the prosthesis. The following categories of BIM were distinguished: absent (insignificant) 1.5 % to 6.4 %, mild – 6.5 % to 10.4 %, moderate – 10.5 % to 20.0 %, significant – more than 20 %. Women's body type was assessed by the Pignet’s Index, which distinguished three categories: strong <16, medium 16–25, and weak 26–35. In group M, the maximum possible implant volume with a low risk of BIM was considered to be for women with a weak physique – 360 ml, medium – 430 ml, strong – 650 ml. Results The mean percentage of BIM was significantly lower in group M (7.2±1.8 %) compared to group C (9.1±6.1 %), p=0.036. At the same time, the incidence of significant BIM significantly decreased from 18 (16.1 %) in group C to 2 (4.3 %) in group M, p=0.044. Moreover, patients in group M had BIM that could be classified as moderate, while in group P, 9 (50 %) women had moderate and 9 significant BIM. In the case of additional creation of an internal bra, there was no significant BIM in any case, the average value of this indicator was 6.3±1.6 % (no or mild BIM). Conclusion. The developed personalised approach to the choice of implant volume, taking into account the physique of women, significantly improves the results of SAMP and prevents significant BIMПрофілактика мальпозиції імплантів молочних залоз (МІМЗ) після субмускулярної аугментаційної мамопластики (САМП) з приводу гіпомастії є актуальною проблемою адже 4,7–5,2 %, жінок після первинної САМП і приблизно 10 % після повторної потребують ревізійної операції через це ускладнення. Мета роботи. Визначити ефективність профілактики МІМЗ після САМП шляхом вибору об’єму імпланту залежно від статури жінок. Матеріали та методи. У 112 жінок вибір об’єму імпланту для САМП здійснювався відповідно до підходу High Five – група порівняння (Група П), у 46 жінок за розробленим алгоритмом – основна група (група О). Алгоритм враховував ризик МІМЗ у жінок різної статури (залежно від об’єму імпланту). У разі наполягання жінки на встановленні більшого за об’ємом імпланту ніж було розраховано додатково створювали внутрішній бюстгальтер. Через рік після САМП оцінювали величину МІМЗ за розробленою методикою, згідно якої МІМЗ характеризувалась відсотком збільшення площі неокишені по відношенню до площі протезу. При цьому виділяли наступні категорії МІМЗ: відсутня (незначна) 1,5 % до 6,4 %, легка – 6,5 % до 10,4 %, помірна – 10,5 % до 20,0 %, значна – понад 20 %. Тип статури жінок оцінювали за індексом Піньє, згідно якого видяли три категорії: міцна < 16, середня 16-25, слабка 26-35. В групі О максимально можливим об’ємом імпланту з низьким ризиком МІМЗ вважали: для жінок із слабкою статурою – 360 мл, середньою – 430 мл, міцною – 650 мл. Результати Середній відсоток МІМЗ був достовірно менший в групі О –. Одночасно суттєво зменшилася частота значимої МІМЗ з 18 (16,1 %) в групі П до 2 (4,3 %) в групі О, р = 0,044. Клінічно значима МІМЗ виникла у 20 жінок: в групі О – у 2 (4,3 %), в групі П – у 18 (16,1 %), р = 0,044. З них жінки групи О мали МІМЗ, яку можна кваліфікувати як помірну, тоді як в групі П 9 (50 %) жінок мали помірну та 9 значну МІМЗ. У разі додаткового створювання внутрішнього бюстгальтеру у жінок групи О – 11 (23,9 %), яким, через їх бажання, встановлено імпланти більшого ніж рекомендовано розміру, в жодному випадку не було значимої МІМЗ, середнє значення цього показника становило 6,3±1,6 % (відсутня або легка МІМЗ). Висновки САМП виконана із застосуванням імплантів обмеженого максимального об’му (для жінок із слабкою статурою – 360 мл, середньою – 430 мл, міцною – 650 мл) забезпечує менший середній відсоток величини МІМЗ 7,2±1,8 %, порівняно із стандартним підходом – 9,1±6,1 %, р=0,036 та меншу частоту клінічно значимої МІМЗ 2 (4,3 %) проти 18 (16,1 %), р = 0,044. Додаткове створення внутрішнього бюстгальтеру при САМП асоціюється з низьким середнім значенням МІМЗ – 6,3±1,6

Introduction of antineoplastic drug NSC631570 in an inpatient and outpatient setting: Comparative evaluation of biological effects

The aim of this study is to evaluate the effect of moderate physical exercise and treatment time on the organism's response to NSC631570. The sensitivity of circulating phagocytes to the drug at different times of day was estimated in in vitro experiments. NSC631570 was administered intravenously to healthy volunteers (eleven men, 23 ± 2 years) in a single therapeutic dose in an inpatient and an outpatient setting. Blood samples were obtained before the drug administration, 30 min after the drug injection and every fourth hour throughout the 24 hour period. Biochemical parameters were determined using the hematological analyzer. Flow cytometry was used to evaluate phagocyte metabolism. Treatment of circulating phagocytes with NSC631570 in vitro resulted in an increase in ROS production along with a decrease in their phagocytic activity, most expressed in the morning time. Drug injection to sedentary persons resulted in pro-inflammatory metabolic polarization of circulating phagocytes. Introduction of NSC631570 to active persons was accompanied by a significant increase in phagocyte endocytosis along with a decrease in the daily mean of ROS generation. Significant oscillation (but in the normal ranges) of urea, creatinine, alanine aminotransferase and aspartate aminotransferase after NSC631570 introduction in the outpatient setting was shown during the day. Physical activity interferes with immunomodulatory action of NSC631570 and abrogates pro-inflammatory shift of circulating phagocytes. Biochemical parameters of blood from patients treated with NSC631570 in the outpatient setting must be interpreted cautiously considering the effect of physical activity on some metabolic biomarkers

Antibiotic therapy in acute pancreatitis: From global overuse to evidence based recommendations

Background & objectives: Unwarranted administration of antibiotics in acute pancreatitis presents a global challenge. The clinical reasoning behind the misuse is poorly understood. Our aim was to investigate current clinical practices and develop recommendations that guide clinicians in prescribing antibiotic treatment in acute pancreatitis. Methods Four methods were used. 1) Systematic data collection was performed to summarize current evidence; 2) a retrospective questionnaire was developed to understand the current global clinical practice; 3) five years of prospectively collected data were analysed to identify the clinical parameters used by medical teams in the decision making process, and finally; 4) the UpToDate Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system was applied to provide evidence based recommendations for healthcare professionals. Results The systematic literature search revealed no consensus on the start of AB therapy in patients with no bacterial culture test. Retrospective data collection on 9728 patients from 22 countries indicated a wide range (31–82%) of antibiotic use frequency in AP. Analysis of 56 variables from 962 patients showed that clinicians initiate antibiotic therapy based on increased WBC and/or elevated CRP, lipase and amylase levels. The above mentioned four laboratory parameters showed no association with infection in the early phase of acute pancreatitis. Instead, procalcitonin levels proved to be a better biomarker of early infection. Patients with suspected infection because of fever had no benefit from antibiotic therapy. Conclusions The authors formulated four consensus statements to urge reduction of unjustified antibiotic treatment in acute pancreatitis and to use procalcitonin rather than WBC or CRP as biomarkers to guide decision-making

Discharge protocol in acute pancreatitis: an international survey and cohort analysis.

There are several overlapping clinical practice guidelines in acute pancreatitis (AP), however, none of them contains suggestions on patient discharge. The Hungarian Pancreatic Study Group (HPSG) has recently developed a laboratory data and symptom-based discharge protocol which needs to be validated. (1) A survey was conducted involving all members of the International Association of Pancreatology (IAP) to understand the characteristics of international discharge protocols. (2) We investigated the safety and effectiveness of the HPSG-discharge protocol. According to our international survey, 87.5% (49/56) of the centres had no discharge protocol. Patients discharged based on protocols have a significantly shorter median length of hospitalization (LOH) (7 (5;10) days vs. 8 (5;12) days) p < 0.001), and a lower rate of readmission due to recurrent AP episodes (p = 0.005). There was no difference in median discharge CRP level among the international cohorts (p = 0.586). HPSG-protocol resulted in the shortest LOH (6 (5;9) days) and highest median CRP (35.40 (13.78; 68.40) mg/l). Safety was confirmed by the low rate of readmittance (n = 35; 5%). Discharge protocol is necessary in AP. The discharge protocol used in this study is the first clinically proven protocol. Developing and testifying further protocols are needed to better standardize patients' care

Discharge protocol in acute pancreatitis : an international survey and cohort analysis

There are several overlapping clinical practice guidelines in acute pancreatitis (AP), however, none of them contains suggestions on patient discharge. The Hungarian Pancreatic Study Group (HPSG) has recently developed a laboratory data and symptom-based discharge protocol which needs to be validated. (1) A survey was conducted involving all members of the International Association of Pancreatology (IAP) to understand the characteristics of international discharge protocols. (2) We investigated the safety and effectiveness of the HPSG-discharge protocol. According to our international survey, 87.5% (49/56) of the centres had no discharge protocol. Patients discharged based on protocols have a significantly shorter median length of hospitalization (LOH) (7 (5;10) days vs. 8 (5;12) days) p < 0.001), and a lower rate of readmission due to recurrent AP episodes (p = 0.005). There was no difference in median discharge CRP level among the international cohorts (p = 0.586). HPSG-protocol resulted in the shortest LOH (6 (5;9) days) and highest median CRP (35.40 (13.78; 68.40) mg/l). Safety was confirmed by the low rate of readmittance (n = 35; 5%). Discharge protocol is necessary in AP. The discharge protocol used in this study is the first clinically proven protocol. Developing and testifying further protocols are needed to better standardize patients’ care.Peer reviewe