Sepsis? Vs sepsis!

Institutul de Chirurgie „A.Vişnevskii”, Moscova, Federația Rusă, Al XIII-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” și al III-lea Congres al Societății de Endoscopie, Chirurgie miniminvazivă și Ultrasonografie ”V.M.Guțu” din Republica MoldovaConsensul internațional Sepsis-3 (2016) de facto a anulat clasificarea precedentă a sepsisului ACCP / SCCM (Chicago, 1991). Totodată, se păstrează definiția sepsisului ca disfuncție acută a organelor din cauza răspunsului dereglat al organismului uman la infecții de variată natură (bacteriene, virale, fungice), manifestată prin inflamație generalizată (sistemică). Sepsisul nu este considerat ca o nosologie separată, ci ca un sindrom caracterizat prin anumite semne clinice și de laborator nespecifice. Această afirmație contrazice realitățile clinice inerente pacienților cu infecție chirurgicală și principiile de bază ale nosografiei și formulării diagnosticului. S-a dovedit convingător, că sepsisul chirurgical este cauzat de microorganisme (MO) omniprezente. În anumite condiții (numărul MO, care depășește 100.000 pe 1 g de țesut), factorii patogenitici principali - toxinele microbiene și tisulare și citokinele, sunt produse în focarul primar al infecției. Pătrunzând în circulația sanguină, ele determină o reacție citotoxică în cascadă, care duce la dezvoltarea imunodeficienței secundare, efectelor citotoxice, sindromului de răspuns inflamator sistemic (SIRS) și a sepsisului. Este bine stabilită corelația dintre numărul de MO în focarul purulent și activitatea fagocitelor atât în țesuturi, cât și în sângele circulant, precum și efectul direct al acestor indicatori asupra evoluţiei bolii. Dimensiunile suprafeței plăgii, precum și calitatea debridării chirurgicale și închiderea precoce a plăgii au un impact direct asupra rezultatelor tratamentului. Astfel, sepsisul chirurgical este o boală sistemică nespecifică / complicație, care se dezvoltă întotdeauna ca consecinţă a focarului primar al infecției chirurgicale și este de obicei cauzată de OM omniprezente. Principalele criterii pentru diagnosticul sepsisului sunt următoarele: - Focarul primar al infecției (suprafață / volum, inclusiv indicele peritonitei Mannheim); - Focare secundare purulente (singurul simptom patognomonic); - Febră rezistentă; - Bacteriemie persistentă (cel puțin 2-3 culturi sanguine pozitive); - În cele din urmă, SIRS.International consensus Sepsis-3 (2016) de-facto canceled the former classification of sepsis ACCP / SCCM (Chicago, 1991). However, the definition of sepsis as acute organ dysfunction resulting from dysregulation of the human organism response to infections of various nature (bacterial, viral, fungal), manifested by generalized (systemic) inflammation is preserved. Sepsis is not considered as a separate nosology, but as a syndrome characterized by certain non-specific set of clinical and laboratory findings. This statement is contrary to the clinical realities proper to patients with surgical infection, and the basic principles of nosography and formulation of diagnosis. Fundamentally proven that surgical sepsis is caused by ubiquitous microorganisms (MO). Under certain conditions (the number of MO, exceeding 100,000 per 1 g of tissue), main pathogenetic factors - microbial and tissue toxins and cytokines, are produced in the primary focus of infection. Penetrating into the blood flow, they cause a cascade cytotoxic reaction leading to the development of secondary immunodeficiency, cytotoxic effects, systemic inflammatory response syndrome (SIRS) and sepsis. It’s well established the correlation between the number of MO in purulent focus and the activity of phagocytes both in the tissues and in circulation, as well as the direct effect of these indicators on the outcome of disease. The size of the wound surface, as well as quality of surgical debridement and early closure of the wound have a direct impact on the treatment results. Thereby, surgical sepsis is a systemic non-specific infectious disease / complication, that always develops due to primary focus of surgical infection and is usually caused by ubiquitous MO. The main criteria for the diagnosis of sepsis are as follows: - Primary focus of infection (area / volume, including Mannheim peritonitis index); - Secondary purulent foci (the only pathognomonic symptom); - Resistant (remitting) fever; - Persistent bacteremia (at least 2-3 positive blood cultures); - And finally, SIRS

Pathomimia (auto-aggressive syndrome) in purulent surgery of soft tissues

Institutul de Chirurgie „A.V.Vişnevskii”, Moscova, Federația Rusă, Al XIII-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” și al III-lea Congres al Societății de Endoscopie, Chirurgie miniminvazivă și Ultrasonografie ”V.M.Guțu” din Republica MoldovaIntroducere: Patomimia (sindromul Kozins-Dure) - provocarea autoleziunilor de către pacient pentru a trezi interesul și simpatia celorlalți oameni; observată în isterie; este un fel de mitomanie. Material si metode: Lucrarea se bazează pe rezultatele tratamentului a 128 de pacienți (toate femei) la Institutul de Chirurgie „A. V. Vişnevskii” în perioada 1975-1998. Toate femeile au fost internate în spital cu diagnosticul de sepsis sau sepsis cronic. Din cele 128 de paciente, 85 (67%) au fost operate pentru diferite colecţii purulente de la 11 până la 50 de ori, iar 24 (18,6%) - peste 50 de ori. Toate focarele purulente au fost localizate în țesuturile moi pe suprafața anterioară a corpului. Principalele manifestări ale bolii: procese purulente recurente ale țesuturilor moi și ulcerații tegumentare, febră înaltă de lungă durată. Rezultate: Cele mai frecvente modalități de a provoca boala: autoinjectarea fecalelor, urinei, produselor petroliere, perforări și injecții ale pielii și membranelor mucoase cu ace contaminate, agrafe de hârtie etc..., manipulări cu termometrul, consumul medicamentelor care induc febră. Principalele caracteristici diagnostice ale febrei artificiale: femeile aflate în vârstă fertilă, multiplicitatea și localizarea în grup a cicatricilor și focarelor purulente, în zone accesibile mâinilor pacientei, identificarea bacteriilor enterale în focarele purulente, lipsa ritmului circadian al febrei, scăderea rapidă (în câteva minute) a temperaturii fără transpirații, starea generală satisfăcătoare, analizele sângelui nemodificate, recurenţe multiple ale bolii, culturi sanguine negative. Principiile diagnosticului patomimiei: termometria în prezența personalului medical, căutarea unor urme de injecții în zona localizării cicatricilor sau proceselor inflamatorii noi, căutarea obiectelor utilizate pentru acțiuni auto-agresive, examinarea histologică a țesuturilor, consultarea psihiatrilor și teste psihologice. Evidența legală a genezei artificiale a bolii: găsirea obiectelor folosite pentru acțiuni auto-agresive, examinarea histologică cu determinarea celulelor gigante sugestive corpurilor străini în țesuturile afectate, uleiului mineral, fragmentelor de sol și, în final, însăși recunoașterea pacienților. Concluzii: La majoritatea pacientelor cu patomimie a fost constatată o formă isterică sau explozivă de personalitate, depresie nevrotică, psihopatie isterică sau neurastenie. Doar la 4 paciente s-a verificat schizofrenia (2 cazuri) și epilepsia (2). În relațiile zilnice cu pacientele, trebuie de avut în vedere faptul că bolnavul cu boala artificială suspectată are aceleași drepturi ca și ceilalți: confidențialitatea și consimțământul informat. Pacienții cu patomimie adesea înaintează petiţii și procese în instanța de judecată.Background: Pathomimia (Kozins-Dure syndrome) - causing patient lesions to himself in order to arouse the interest and sympathy of others; observed in hysteria; is a kind of mythomania. Methods and materials: The paper is based on treatment results of 128 patients (all women) at the A. V. Vishnevsky Institute of Surgery in 1975-1998. All women were admitted into the hospital with a diagnosis of sepsis or chronic sepsis. Of the 128 patients, 85 (67%) were operated for different purulent collections from 11 to 50 times, whereas 24 (18.6%) - more than 50 times. All inflammatory focuses were localized in soft tissues on the front surface of the body. The main manifestations of the disease: recurrent purulent processes of soft tissues and skin ulceration, prolonged high fever. Results: The most frequent manners of causing the disease: self-injection of feces, urine, petroleum products, punctures and injections of the skin and mucous membranes with contaminated needles, paper clips, etc., manipulations with a thermometer, taking medications that cause fever. The main diagnostic features of artificial fever: women of childbearing age, multiplicity and group localization of scars and purulent focuses in areas accessible to the patient’s hands, cultivation of enteral bacteria from purulent foci, lack of circadian rhythm of fever, rapid (within minutes) decreasing of temperature without sweating, satisfactory general conditions, normal blood counts, multiple relapses of disease, negative blood cultures. Principles of pathomimia’ diagnostics: thermometry in the presence of medical staff, searching for traces of injections in the area of scar grouping or over the new inflammatory site, searching for objects used for auto-aggressive actions, histological examination of tissues, psychiatrist consultation and psychological testing. Legal evidence of the artificial genesis of disease: finding objects used for auto-aggressive actions, histological examination with finding of giant cells suggestive for foreign bodies in the affected tissues, mineral oil, soil fragments, and, finally, recognition of the patient herself. Conclusion: In majority of patients with pathomimia, a hysterical or explosive types of personality, neurotic depression, hysterical psychopathy, or neurasthenia were revealed. Only in 4 patients schizophrenia (2 cases) and epilepsy (2) was verified. In daily relationships with the patient, it should be remembered that the patient with the suspected artificially induced disease has the same rights as others: privacy, confidentiality and informed consent. Patients with pathomimia often impose court complaints and lawsuits

Методы принятия решений в транспортной политике: многокритериальный подход

Transport policy includes various aspects of government regulation of transport and related industries. Decision-making in transport policy must consider a wide range of factors and evaluate options for the consequences of adoption of certain decisions based on various criteria, such as cost, environmental impact, and social effects. Two widely used decision-making tools in transport policy are multi-criteria decision analysis (MCDA) and cost-benefit analysis (CBA).The objective of the study was to select decision support methods for transport policy that consider aspects other than monetary or hardly formalised onesAs a practical experiment, the study selected and ranked projects currently considered promising, per as they correspond to a given target using T Saat/s analytic hierarchy process. Several criteria developed within the framework of the study are proposed for the purpose of applied assessment of the pool of projects and their prioritisation.Application of such criteria and AHP allowed to develop a new applied tool for evaluating projects for subsequent use in the system of state administration of the transport industry. The study concludes that although CBA and MCDA methods have their strengths and weaknesses, the choice of method should depend on the specific context of the project. Транспортная политика включает в себя различные аспек­ты государственного регулирования работы транспорта и смежных отраслей экономики. При принятии решений в транс­портной политике необходимо учитывать широкий спектр факторов и проводить оценку вариантов последствий от тех или иных решений на основе различных критериев, таких как стоимость, воздействие на окружающую среду и социальные эффекты. Двумя широко используемыми инструментами приня­тия решений в транспортной политике являются многокрите­риальный анализ решений (MCDA) и анализ затрат и выгод (CBA).Целью данного исследования является отбор таких ме­тодов поддержки принятия решений в транспортной полити­ке, которые позволяли бы учитывать не только монетарные и трудноформализуемые аспекты.В рамках исследования в качестве практического экспе­римента проведён отбор и ранжирование проектов, рассмат­риваемых в настоящее время в качестве перспективных, на предмет соответствия заданной цели с использованием метода анализа иерархий Т. Саати. Предложен ряд разрабо­танных в рамках исследования критериев для цели прикладной оценки пула проектов и их приоритизации.На примере данных критериев и метода анализа иерархий разработан новый прикладной инструментарий оценки про­ектов для последующего использования в системе государ­ственного управления транспортной отраслью. Исследование приходит к выводу, что хотя методы CBA и MCDA имеют свои сильные и слабые стороны, выбор метода Должен зави­сеть от конкретного контекста проекта

Транспортная политика: теоретическая база и экономические аспекты

The transport policy of the state is an integral part of its economic and spatial policy. The relevance of the clarification of the content of the term «transport policy» is conditioned by the attention of the state to the issues of strategic planning in the field of transport. In Russia, it was clearly evidenced by the approval in 2021 by the Government of the Russian Federation of the updated Transport Strategy of the country until 2030 with a forecast for the period until 2035.The article reviews the definitions of transport policy in the scientific literature: its economic, environmental, technical, geopolitical and other aspects are considered. At the same time, the main emphasis of the study was on the economic factors of transport policy: the materials of economic theories (spatial development and distribution of productive forces), decision theories and methods for assessing the effectiveness of investments in transport infrastructure were considered. The definitions and the range of their application are specified. Also, the components of the transport policy have been established and a range of tools of its implementation has been defined, incl. financial, regulatory, etc. Based on the data obtained, a structure of the relationship between transport policy and economic growth was compiled, social and other components to economic aspects were identified.Транспортная политика государства является неотъемлемой частью его экономической и пространственной политики. Актуальность уточнения содержания термина «транспортная политика» обуславливается вниманием государства к проблематике стратегического планирования в области транспорта. В России очевидным свидетельством этого стало утверждение в 2021 году Правительством Российской Федерации обновлённой Транспортной стратегии страны до 2030 года с прогнозом на период до 2035 года.В статье проведён обзор определений транспортной политики в научной литературе, рассмотрены её экономические, экологические, технические, геополитические и другие аспекты. При этом основной акцент в рамках исследования был сделан на экономические факторы транспортной политики: рассмотрены материалы экономических теорий (пространственное развитие и размещение производительных сил), теорий принятий решений и методов оценки эффективности инвестиций в транспортную инфраструктуру. Уточнены определения и круг их применения. Также установлены составляющие транспортной политики и определён круг инструментов её реализации, в том числе финансовых, регуляторных и других.На основании полученных данных составлена конструкция взаимосвязей между транспортной политикой и экономическим ростом, выделены социальные и иные составляющие экономических аспектов

Plan and procedures for rapid inventory taking at the Research Institute for Atomic Reactors

A major element of a system for nuclear material protection, control, and accounting (MPC and A) is to take the physical inventory of the nuclear material periodically. Physical inventory taking (PIT) includes ensuring that all nuclear material on inventory is included in the facility records and that the measured content of items or containers (or at least a suitable random sample thereof) corresponds to the recorded values. This paper summarizes the existing MC and A system at the RIAR Central Storage Facility, presents a means for achieving enhanced safeguards in nuclear material accounting, and discusses the process of introducing the technology and methodology into the plant operations at RIAR in Dimitrovgrad

The use of maize haploidy inducers as a tool in agricultural plant biotechnology

The discovery of the ability of some mutations to stimulate haploidy during hybridization made it possible to create one of the most promising and sought-after trends in the field of reproductive biology. Haploid inducers created on their basis are capable of increasing the frequency of haploidy up to 15 %. The improvement of the existing haploid inducer lines and the search for new genes that contribute to a high frequency of haploidy are underway. Along with these studies, the field of application of haploid inducers in genetics and plant breeding is expanding. Haploid inducers carrying R1-nj genes for anthocyanin pigmentation of the seed and embryo are able not only to mark the hybrid embryo and identify haploid genotypes, but also to detect genes that suppress the anthocyanin color of the grain, like C1-I, C2-Idf, and In1-D. Depending on their quantity, the phenotypic manifestation of the gene in the seed varies. Haploidy is widely used for accelerating hybrid breeding and obtaining both new maize lines with improved traits and their sterile counterparts. By introducing certain genes into the genome of the improved line, breeders can use the doubled haploid (DH) breeding technology to accelerate the creation of pure lines carrying the desired gene. Haploid inducer maize lines and their tetraploid analogs are used in the selection of rediploid maize lines by their resynthesis from tetraploid genotypes. In 2019, Syngenta Company synthesized a haploid inducer maize line carrying a CRISPR/cas construct capable of simultaneously stimulating haploidy and editing the genome at a specified DNA site. Thanks to this technology, it became possible to improve haploid inducers by introducing various CRISPR/cas constructs into the haploid inducer genome for editing any DNA site. Maize haploid inducers are widely used in doubled haploid wheat breeding. The first experiments showed that the most effective haploid inducer for stimulating haploidy in wheat is maize pollen. Researchers are intensively searching for other ways of using maize haploid inducers in plant breeding

The prospects for using haploinducers in maize breeding

The discovery of spontaneous haploid plants and the development of ways to produce them in in vitro culture have set a new direction important for breeding and for theoretical research in reproductive biology. The frequency of spontaneous haploidy in cultivated plants is extremely low and does not exceed 0.01-0.1%, therefore, the search for sources and donors capable of stimulating haploidy in hybrid combinations is of current interest. Expansion of the search for new sources and donors of the haploinduction trait, the creation of new, more effective haploinducers contribute to the accumulation of scientific information and genetic sources, characterized by a high resource potential for selection and genetic research. The causеs of haploidy are not well understood yet. According to the available information, the genes localized in the qhir1, qhir11, qhir12 regions of chromosome 1 in maize are responsible for this process. The use of genes that stimulate haploinduction in maize in combination with the marker gene R1-nj responsible for anthocyanin coloration of the caryopsis and embryo, as well as genes A1 and B1, which are in control of the entire plant coloration, allowed the creation of haploinducer lines with a frequency of haploid stimulation up to 15%. Phenotypic expression of dominant alleles of the marker anthocyanin coloration genes in different parts of a hybrid plant, as well as in the caryopsis and embryo, contributes to the high-quality selection of haploid kernels in the cob due to the manifestation of recessive alleles of these genes at the haploid level. The presence of anthocyanin synthesis suppressor genes in siliceous maize (C1-I, C2-Idf, In1-D) restricts the use of the R1-nj gene in other representatives of siliceous maize. In order to overcome this problem, studies are underway to create other genotypes of haploinducers, which are not associated with the anthocyanin coloration of the caryopsis, but instead have other marker traits, such as the oil content in the kernel, the absence of ligules in the leaves, and root coloration in seedlings. The use of matroclinous and androclinous types of haploinduction allows breeders to obtain highly homozygous dihaploid maize lines, with both the maternal and paternal genomes. These achievements made it possible to cut five or more times the material and time inputs into the creation of inbred lines and their sterile analogs, accelerate the breeding of new maize hybrids, and signifi cantly improve the quality of seed production in terms of typicality and uniformity. The materials presented in the article should help breeders and geneticists to learn more about the innovative directions and problems of hybrid maize breeding

БОРИС МИХАЙЛОВИЧ КОСТЮЧЁНОК. НАШ УЧИТЕЛЬ

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