Scattering polarization of hydrogen lines in the presence of turbulent electric fields

We study the broadband polarization of hydrogen lines produced by scattering of radiation, in the presence of isotropic electric fields. In this paper, we focus on two distinct problems: a) the possibility of detecting the presence of turbulent electric fields by polarimetric methods, and b) the influence of such fields on the polarization due to a macroscopic, deterministic magnetic field. We found that isotropic electric fields decrease the degree of linear polarization in the scattered radiation, with respect to the zero-field case. On the other hand, a distribution of isotropic electric fields superimposed onto a deterministic magnetic field can generate a significant increase of the degree of magnetic-induced, net circular polarization. This phenomenon has important implications for the diagnostics of magnetic fields in plasmas using hydrogen lines, because of the ubiquitous presence of the Holtsmark, microscopic electric field from neighbouring ions. In particular, previous solar magnetographic studies of the Balmer lines of hydrogen may need to be revised because they neglected the effect of turbulent electric fields on the polarization signals. In this work, we give explicit results for the Lyman-alpha and Balmer-alpha lines.Comment: 15 pages, 6 figure

Perioperative assessment of cardiological risk in non-cardiac surgical interventions

During the postoperative period, cardiological complications occupy the first position regarding morbidity and mortality rates. They depend on various factors such as compromised cardiovascular history and type of surgical intervention, features and type of anesthesia, water balance and postoperative care of the patient. To prevent complications, one should reply two questions: is there a risk of cardiovascular complications in the perioperative period and how to avoid them. The article presents a review of the literature on current views on the perioperative assessment of cardiac risks in patients undergoing noncardiac surgery

Extracorporeal membrane oxygenation in the complex therapy for septic shock in a patient with severe lung damage caused by COVID-19

Extracorporeal membrane oxygenation (ECMO) has been used for more than 20 years in the treatment of severe respiratory distress syndrome. However, ECMO in some categories of patients is not sufficiently covered in the literature, due to a small number of registered cases. This group includes pregnant women and women in labor. During the intensive care of such patients, the entire available range of therapeutic manipulations and measures that can favorably affect the outcome of the disease should be used. We have describe a clinical case of successful ECMO in a patient with novel coronavirus disease (COVID-19) and obstetric sepsis developed in the early postpartum period

Postoperative delirium in elderly patients after thoracic surgery

Background. Postoperative delirium is one of the most severe and common complications of thoracic surgery in elderly patients.Objective. To establish a simple and accurate method for predicting the development of postoperative delirium in patients after thoracic surgery.Material and Methods. We performed an observational cohort study of 303 patients who underwent lobectomy for oncological diseases. The nature of anesthesia and surgical intervention, features of the volume status and hemodynamic changes during the perioperative period were analyzed, laboratory indicators of this period were evaluated.Results. Of 303 patients, 43 (14.2%) developed postoperative delirium. Non-modifiable factors for the development of postoperative delirium included age, history of cerebrovascular accident, alcohol misuse disorder, chronic heart failure, more severe physical status according to the ASA (American Society of Anesthesiologists) Physical Status Classification System. Modifiable factors are the following: the duration of one-lung ventilation, episodes of perioperative hypotension and hypoxemia, the use of opioids, the intensity of the pain syndrome in the postoperative period, and reduced oxygen transport function of the blood. A number of laboratory parameters (blood albumin, blood glucose, leukocytosis), reflecting the degree of surgical stress, may also be useful in postoperative delirium predicting.Conclusion. A prognostic coefficient was compiled with a concordance of 99.9 and Somers' D 0.998. It is equal to the sum of the products: (–3.5367) multiplied by pain intensity on a 10 cm Visual Analogue Scale an hour after surgery; 2.2037 multiplied by the blood albumin level the morning after surgery;    (–4.8151) multiplied by the blood glucose level the morning after surgery

Development of 30-day mortality forecast model in patients after surgical treatment of proximal hip fracture

Introduction Fractures of the proximal femur often occur in elderly and senile patients. Most of them have an unfavorable comorbid background. In this regard, there is a high risk of complications in the postoperative period, which requires the development and implementation of an effective forecasting model in clinical practice designed to take measures to avoid adverse treatment outcomes.Objective To develop a regression model to predict the probability of lethal outcome within 30 days after surgery in patients with proximal femur fracture.Material and Methods A retrospective analysis of inpatient case histories of all patients (n = 1222) with proximal femur fracture treated in our hospital in 2018-2019 was performed. A total of 388 cases were selected for the study.Results After a detailed statistical analysis of the physiological parameters of the patients, four independent factors were identified that increased the risk of death during 30 days following surgery: albumin less than 30 g / l (regression coefficient – 1.742; OR – 5.708, 95% CI – 1.904–17.114, p = 0.002), the presence of diabetes mellitus (regression coefficient – 1.141; OR – 3.130, 95% CI –1.022–9.588, p = 0.046), the presence of acute renal injury (regression coefficient – 3.141; OR – 23.136, 95% CI – 3.886–137.735, p = 0.001), the presence of pneumonia (regression coefficient – 2.130; OR – 8.411, 95% CI – 2.453–28.838, p = 0.001). A regression model for predicting 30-day mortality was developed: the constant regression coefficient was 4.371, the area under the ROC-curve corresponding to the probability of 30-day mortality was 0.841 with 95% CI: 0.732–0.951, model sensitivity and specificity – 78.9 and 81.2%, respectively. After a detailed statistical analysis of the patients' physiological parameters, four independent factors were identified that increase the risk of fatal outcome during the next 30 days after surgery: albumin less than 30 g / l (regression coefficient, 1.742; OR – 5.708, 95% CI (1.904 – 17.114), p = 0.002), presence of diabetes mellitus (regression coefficient – 1.141; OR – 3.130, 95% CI (1.022 – 9.588), p = 0.046), presence of acute renal injury (regression coefficient – 3.141; OR – 23.136, 95% CI (3.886 – 137.735), p = 0.001), presence of pneumonia (regression coefficient – 2.130; OR – 8.411, 95% CI (2.453 – 28.838), p = 0.001). Thereby we developed a regression model to predict 30-day mortality: regression coefficient of the constant was 4.371; area under the ROC curve, corresponding to the dependence of the probability of 30-day mortality, was 0.841 with 95% CI (0.732 – 0.951); model sensitivity and specificity were 78.9 and 81.2%, respectively.Conclusion Aregression model for predicting mortality in patients with proximal femur fractures based on independent risk factors has a sufficient level of sensitivity and specificity. Its application is possible in practical health care institutions, where patients with trauma are treated

Analytic approximations for the broadening of the spectral lines of hydrogen-like ions

Broadband approximate expressions for calculating the broadening of the spectral lines of hydrogenlike ions in a multicomponent plasma are derived taking into account both the influence of the interaction between plasma particles on the distribution function of the plasma microfield and the effect of the microfield dynamics on the broadening of the central component of the spectral line. With the approximate expressions proposed, the calculation of the shape of a given spectral line of a certain ion in a plasma with a given ion composition requires only a few seconds of computer time. The approximate expressions provide a good computational accuracy not only for the central component of the spectral line but also for the spectral line wings

Prediction of perioperative cardiac complications in patients with proximal femoral fracture

Background. Prediction of cardiac complications following orthopaedic and trauma surgery is necessary to improve the quality of treating the elderly patients. Objective. To assess the effectiveness of prognostic scores of perioperative cardiac risk in patients with proximal femoral fracture. Material and Methods. We retrospectively reviewed 918 hospital patients with proximal hip fracture from January, 1 2018 to December, 31 2019. Perioperative cardiac risks were assessed using the Goldman Risk Index, Revised Cardiac Risk Index (Lee Index) and Gupta Perioperative Cardiac Risk Index. Results. Cardiac complications occurred in 7 (0.76%) of 918 patients, 6 (0.65%) patients developed acute myocardial infarction, 1 (0.11%) patient suffered from complete atrioventricular block. Receiver operating characteristic (ROC) curve analysis of the relationship between the time from injury to surgery and cardiovascular complications did not give statistically significant results (AUC (area under a curve) = 0.574, 95% CI (confidence interval): 0.352–0.796). When compared the presence of cardiac complications with the Lee Criteria predictions, significant differences were revealed (p = 0.007), and the Goldman Index data were not statistically significant (p = 0.151). The area under the ROC curve of the corresponding relationship between the prognosis of cardiac complications and the Gupta Index was 0.782 with 95% CI: 0.574–0.991 (p = 0.017), the sensitivity and specificity of the model were 83.3% and 70.4%, respectively. Conclusion. The Goldman Index and Lee Index have no significant value for predicting perioperative cardiac complications in patients with proximal femoral fracture. The Gupta Index has an acceptable level of sensitivity and specificity in predicting cardiac complications

ПРЕДРАСПОЛАГАЮЩИЕ ФАКТОРЫ РАЗВИТИЯ ФИБРИЛЛЯЦИИ ПРЕДСЕРДИЙ У ПАЦИЕНТОВ ПОСЛЕ АНАТОМИЧЕСКОЙ РЕЗЕКЦИИ ЛЕГКИХ

Atrial fibrillation (AF) remains to be one of the most common complications that occur after thoracic surgery; its frequency makes from 4 to 37%. This type of complication can significantly extend the recovery period for the patients after anatomic lung resection and increase the short-term and long-term mortality.Subjects and methods. Data of 183 patients who underwent extensive anatomic lung resections due to malignant neoplasms were retrospectively analyzed. The following was evaluated: the impact of surgery approach (thoracotomy or VATS) and the type of anatomic lung resection, peri-operative fluid balance and severity of pain syndrome as per Visual Analogue Scale on the incidence of AF. Statistical analysis was performed using Student's t-test, non-parametric χ2 test and Mann – Whitney test, as well as a multidimensional logistic regression with standardization of indicators and odds ratio calculation.Results. In the early post-operative period, AF developed in 40 patients. It was found out that with increasing age, the rate of intra-operative infusion and positive fluid balance during the first day of the post-operative period, the risk of post-operative AF went up in thoracic patients. Фибрилляция предсердий (ФП) остается одним из наиболее распространенных осложнений, возникающих после торакальных операций с частотой от 4 до 37%. Данный вид осложнений может значительно увеличить период восстановления пациентов после анатомической резекции легких и повысить смертность как в краткосрочной, так и в долгосрочной перспективе.Материал и методы. Проведен ретроспективный анализ 183 пациентов, которым выполнены расширенные анатомические резекции легких по поводу злокачественного новообразования. Оценено влияние хирургического подхода (торакотомия или VATS) и типа анатомической резекции легких, периоперационного водного баланса и выраженности болевого синдрома по шкале ВАШ на частоту развития ФП. Статистический анализ проведен с использованием параметрического критерия Стьюдента, непараметрического χ2 теста и критерия Манна ‒ Уитни, а также многомерной логистической регрессии со стандартизацией показателей и вычислением Odds ratio.Результаты. У 40 пациентов в раннем послеоперационном периоде возникла ФП. Выявлено, что с увеличением возраста, скорости интраоперационной инфузии и положительного водного баланса в первые сутки послеоперационного периода возрастает риск развития послеоперационной ФП у торакальных пациентов.

Случай ранней реабилитации пациентки с тяжелой формой пандемического гриппа А / H1N1, осложненного пневмонией и острым респираторным дистресс-синдромом

A case of early physical rehabilitation of a female patient with severe pandemic influenza А / H1N1 complicated by pneumonia and acute respiratory distress syndrome (ARDS) is described in the article. Lymphatic drainage of the lower extremities and the lungs and the chest vibration were used in the patient under mechanical ventilation after achieving clinical stability at the day 2 of staying in a ICU. Postural drainage in combination with the chest and the upper extremities vibration in the Sims’ position were used at the day 3. Active physical exercise with a stretch band and cognitive therapy (reading books, listening to music, and occupational therapy) were started at the day 4. At the day 5, the intubated patient took few steps near the bed assisted by a physical therapist and a physician. After extubation, the patient walked every day in the ward and along the hospital corridor under a control of HR, BP, and SaO2. She used breathing techniques (diaphragmatic breathing, resistive breathing) and physical training. The rehabilitation sessions continued up to the hospital discharge.Conclusion. Early physical and occupational therapy was found to reduce a risk of polyneuropathy predictive for unfavorable outcome and can improve the airway clearance with reduction of nosocomial infection risk.циентки с тяжелой формой пандемического гриппа А / Н1N1, осложненного пневмонией и острым респираторным дистресс-синдромом. На 2-е сутки пребывания в анестезиолого-реанимационном отделении (АРО) после стабилизации состояния пациентке на искусственной вентиляции легких (ИВЛ) проведен лимфодренажный массаж нижних конечностей, легких, вибрационные техники в области груди. На 3-и сутки в положении Симса выполнен постуральный дренаж в комплексе с вибрационным массажем спины и верхних конечностей. С 4-х суток начаты активные упражнения с использованием гимнастического эспандера и мероприятия, направленные на улучшение эмоционально-когнитивной сферы (чтение книг, прослушивание музыки, эрготерапия). На 5-е сутки с помощью реабилитолога и реаниматолога пациентка смогла совершить несколько шагов возле постели, находясь на аппарате ИВЛ. После экстубации пациентка каждый день совершала пешие прогулки по палате и коридору АРО под контролем показателей частоты сердечных сокращений, артериального давления, насыщения кислородом артериальной крови, занималась дыхательной гимнастикой (диафрагмальное дыхание, дыхание с сопротивлением), выполняла физические упражнения. Занятия с инструктором по реабилитации носили системный характер и продолжались до выписки пациентки из стационара. В случае ранней физической активизации и реабилитации снижается риск развития полинейропатии критических состояний, которая является предиктором неблагоприятного исхода, улучшается дренажная функция легких, при этом снижается риск вторичной внутрибольничной инфекции

ГИПОАЛЬБУМИНЕМИЯ, ГЛИКЕМИЯ И ЛЕЙКОЦИТОЗ В ПАТОГЕНЕЗЕ РАЗВИТИЯ ОСТРОЙ ПОСЛЕОПЕРАЦИОННОЙ ДЫХАТЕЛЬНОЙ НЕДОСТАТОЧНОСТИ У ТОРАКАЛЬНЫХ ПАЦИЕНТОВ

Acute post-operative respiratory failure is a dangerous complication developing after thoracic surgery.The objective of the study: to assess the potential use of albuminemia, glycemia and leukocytosis as markers of acute post-operative respiratory failure after thoracic surgery.Subjects and methods. A retrospective study was conducted enrolling 300 patients, which were divided into two groups – those who developed acute post-operative respiratory failure (n=150) and those who didn't (n=150). The post-operative level of glycemia and leukocytosis and the degree of albumin level reduction were comparatively analyzed in the early post-operative period.Results. The correlation was found between the degree of reduction of the post-operative albumin level and the ratio of PaO2/FiO2 – the strong inverse correlation (r = -0.9); the strong inverse correlation (r = -0.7) was found between the leukocytosis level and the ratio of PaO2/FiO2; while it was the median inverse correlation (r = -0.7) between glycemia level and the ratio of PaO2/FiO2; and between the degree of the post-operative reduction of albumin and glycemia level, it was the median direct correlation (r = 0.7).Conclusion. The higher levels of peri-operative glycemia and leucocytosis during the first 24 hours after the surgery and more intense reduction of the post-operative level of albumin demonstrate the intensity of stress-reaction to the surgical trauma and make valuable markers of the acute post-operative respiratory failure development in the patients after thoracic surgery.страя послеоперационная дыхательная недостаточность (ОДН) − опасное осложнение после торакальных операций.Цель работы: изучить возможность использования альбуминемии, гликемии и лейкоцитоза в качестве маркеров развития ОДН после торакальных операций.Материал и методы. Выполнено ретроспективное исследование у 300 пациентов, которых разделили на две группы − с развитием ОДН (n = 150) и без нее (n = 150). Провели сравнительный анализ периоперационного уровня гликемии, лейкоцитоза и степени снижения уровня альбумина в раннем послеоперационном периоде.Результаты. Выявлена корреляционная связь между степенью снижения послеоперационного уровня альбумина и соотношением PaO2/FiO2 − сильная обратная (r = -0,9), между уровнем лейкоцитоза и соотношением PaO2/FiO2 − сильная обратная (r = -0,7), между уровнем гликемии и соотношением PaO2/FiO2 − средняя обратная (r = -0,7), между степенью снижения послеоперационного уровня альбумина и уровнем гликемии − средняя прямая (r = 0,7).Заключение. Более высокие уровни периоперационной гликемии и лейкоцитоза в первые послеоперационные сутки и более высокая степень снижения послеоперационного уровня альбумина показывают выраженность стресс-реакции на операционную травму и являются значимыми маркерами развития послеоперационной ОДН у пациентов после торакальных операций