Хромоколоноскопия как метод улучшения эндоскопического изображения

КОЛОНОСКОПИЯЭНДОСКОПИЯхромоскопияПОЛИПЫМЕТИЛЕНОВЫЙ СИНИ

Reasoning for obligatory preclinical diagnostics of feline chronic kidney disease

Diseases of the urinary system of various etiologies are common in all species of animals and over time, they can lead to the development of chronic kidney disease (CKD) as the progressive process in which renal function gradually decreases over several years. In modern veterinary medicine, there is a problem of a steeply increase in cases of chronic kidney disease in cats. Pathology occurs most often in aged animals, but recent studies have registered cases of chronic renal dysfunction in young ones as well. In chronic kidney disease the kidneys do not work well for a long time, causing a number of changes in the body. Unfortunately, early symptoms are often missed by pet owners and the disease is not noticed for a long time. In most cases, the diagnosis of chronic kidney disease is established only when effective treatment is no longer possible or ineffective and treatment is able to maintain the homeostasis of the body only to a certain extent and for a short time. Undoubtedly, this approach to the diagnosis and treatment of kidney disease requires changes. In view of the fact that the duration of the preclinical stage of CKD can reach several years, the goals of our study were to show the benefits of early diagnosis of chronic kidney disease in cats and the introduction of a new concept of systematic body screening of clinically healthy animals and animals at risk. Also, the goals were to delay the moment of the kidneys compensatory reserve exhaustion and onset of clinical symptoms, which require constant symptomatic and replacement therapy. Reducing the percentage of early mortality of patients and the maximum possible increase in the duration of the preclinical stage of renal pathology were also aimed at. Efforts were also aimed at reducing the percentage of early mortality of patients and the maximum possible increase in the duration of the preclinical stage of renal pathology. Since nephroprotective therapy at the preclinical stage is highly effective in most clinical cases and allows to significantly slow down the progression of any chronic nephropathy, including CKD, there is a need for the formation of innovative diagnostic approaches at the early stages of the disease. It is proposed to conduct a cumulative assessment of the anamnesis in animals from risk groups, monitoring the level of creatinine in the blood serum, complete clinical analysis of urine, ultrasound examination of the kidneys, measurement of protein concentration, since these indicators have not only prognostic value and determine the tactics of treatment, but are also important factors pathogenesis of CKD. Since each parameter will not provide a complete state of the disease, since none of them is 100 % specific, an integrated approach to the early diagnosis of chronic kidney disease is needed for. It is necessary to take into account all the methods listed above, as well as monitoring the condition of the body of animals that have contracted any viral or bacterial infection, or have acute kidney damage, diabetes, hypertension, or metabolic disorders

Wind--Pellet Shear Sailing

A propulsion concept in which a spacecraft interacts with high-velocity pellets and the interstellar medium is proposed. The pellets are slower than the spacecraft and are accelerated backwards as they are overtaken, imparting a forward acceleration on the spacecraft. This maneuver is possible due to the interaction with a fixed medium (interstellar medium, ISM); as the spacecraft travels through the medium, it is able to extract power from the relative wind. This concept relies upon the relative velocities (shear) between the pellet stream and the fixed medium in order to concentrate the energy of the pellets into the spacecraft and is thus termed wind-pellet shear sailing. The equations governing the mass ratio of pellets to the spacecraft and its dependence on the final spacecraft velocity are derived; the critical role of the efficiency of the power extraction and transfer process is identified. Natural sources of energy are considered as a means to accelerate the pellets to velocities of 1000 to 6000 km/s. Techniques for onboard generation of power via electromagnetic interaction with the ISM are reviewed, with a repetitively stroked plasma magnet being identified as a promising approach. The necessity of the spacecraft to detect and track the pellets as they are overtaken dictates the desired properties of the pellets. Pellet pushers (accelerators) on board the spacecraft are also preliminarily explored in their engineering considerations, with electric field accelerators of charged nanometric particles, Lorentz-force accelerated ionized pellets, or expansion of vaporized pellets via a nozzle being highlighted as potential approaches. A preliminary mission profile is defined in which a 500-kg scientific payload is delivered to orbit about alpha-Centauri within 30 years, using wind-pellet shear sailing as the intermediate stage to bring the spacecraft from 2% to 5.5% of c

Results of using the novel method for predicting the development and course of glaucomatous optic neuropathy in POAG

Background: Given that the rates of glaucoma-induced visual incapacitation are steadily increasing, predicting glaucomatous optic neuropathy is important. Purpose: To determine the diagnostic importance of the method proposed for the predicting the development and course of glaucomatous optic neuropathy in primary open-angle glaucoma (POAG) based on SweptSource-OCT-derived morphometric characteristics of the lamina cribrosa and daily intraocular pressure (IOP) in the clinical practice. Materials and Methods: Thirty patients were under observation. At baseline, the risk for the development of glaucomatous optic neuropathy in glaucoma suspects or the risk for disease progression in patients with already diagnosed POAG was assessed using our method. The latter is based on the determination of pressure exerted on the ganglion axons at the level of lamina cribrosa, given the specified IOP value and individual morphometric characteristics of the lamina cribrosa. Patients were divided into three groups depending on their risk levels. A DRI OCT Triton plus swept source OCT system (Topcon, Tokyo, Japan) was used to assess morphometric characteristics of the retina (ganglion cell complex thickness) and optic disc (lamina cribrosa thickness and diameter). The further course of the glaucomatous progression was studied using macular GCL++ characteristics. Results: At month 18, GCC thickness loss was statistically significantly larger in the moderate-risk group than in the low-risk group (p=0.001). In addition, it was statistically significantly larger in the high-risk group than in the low-risk group (p=0.00001) and in the moderate-risk group (p=0.00013). In the low-risk group, mean GCC thickness was 92.90±3.28 μm at baseline and 91.95±3.24 μm at month 18; however, the GCC thickness loss was not statistically significant (p=0.838). Conclusion: First, our method for predicting the development and progression of glaucomatous optic neuropathy in POAG based on SS-OCT-derived morphometric characteristics of the lamina cribrosa and daily IOP level enables determining the risk level of glaucomatous progression, which has been evidenced by the results of a prolonged observation. Second, significant macular GCC thinning was noted in 50% of cases of the high-risk group, even with a normal IOP level. Finally, introduction of the proposed method into clinical practice would enable planning effective glaucoma management aimed at prevention of optic nerve atrophy

Observation of polar cap patches and calculation of gradient drift instability growth times : A Swarm case study

The Swarm mission represents a strong new tool to survey polar cap patches and plasma structuring inside the polar cap. In the early commissioning phase, the three Swarm satellites were operated in a pearls-on-a-string configuration making noon-midnight transpolar passes. This provides an unparalleled opportunity to examine the potential role of the gradient drift instability (GDI) process on polar cap patches by systematically calculating GDI growth times during their transit across the pole from day to night. Steep kilometer-scale gradients appeared in this study as initial structures that persisted during the approximate 90 min it took a patch to cross the polar cap. The GDI growth times were calculated for a selection of the steep density gradients on both the dayside and the nightside. The values ranged from 23 s to 147 s, which is consistent with recent rocket measurements in the cusp auroral region and provides a template for future studies. Growth times of the order of 1 min found both on the dayside and on the nightside support the existing view that the GDI may play a dominant role in the generation of radio wave scintillation irregularities as the patches transit the polar cap from day to night

Intraoperative transfusion practices in Europe

BACKGROUND: Transfusion of allogeneic blood influences outcome after surgery. Despite widespread availability of transfusion guidelines, transfusion practices might vary among physicians, departments, hospitals and countries. Our aim was to determine the amount of packed red blood cells (pRBC) and blood products transfused intraoperatively, and to describe factors determining transfusion throughout Europe. METHODS: We did a prospective observational cohort study enrolling 5803 patients in 126 European centres that received at least one pRBC unit intraoperatively, during a continuous three month period in 2013. RESULTS: The overall intraoperative transfusion rate was 1.8%; 59% of transfusions were at least partially initiated as a result of a physiological transfusion trigger- mostly because of hypotension (55.4%) and/or tachycardia (30.7%). Haemoglobin (Hb)- based transfusion trigger alone initiated only 8.5% of transfusions. The Hb concentration [mean (sd)] just before transfusion was 8.1 (1.7) g dl(-1) and increased to 9.8 (1.8) g dl(-1) after transfusion. The mean number of intraoperatively transfused pRBC units was 2.5 (2.7) units (median 2). CONCLUSION: Although European Society of Anaesthesiology transfusion guidelines are moderately implemented in Europe with respect to Hb threshold for transfusion (7-9 g dl(-1)), there is still an urgent need for further educational efforts that focus on the number of pRBC units to be transfused at this threshold. CLINICAL TRIAL REGISTRATION: NCT 01604083

Therapeutic impact of red blood cell transfusion on anemic outpatients: the RETRO study

BACKGROUND:Patients with cancer or other diagnoses associated with chronic anemia often receive red blood cell (RBC) transfusion as outpatients, but the effect of transfusion on functional status is not well demonstrated. STUDY DESIGN AND METHODS:To estimate the effect of transfusion on functional status and quality of life, we measured 6-minute walk test distance and fatigue- and dyspnea-related quality-of-life scores before and 1 week after RBC transfusion in 208 outpatients age ≥50 with at least one benign or malignant hematology/oncology diagnosis. To account for potential confounding effects of cancer treatment, patients were classified into two groups based on cancer treatment within 4 weeks of the study transfusion. Minimum clinically important improvements over baseline were 20 meters in walk test distance, 3 points in fatigue score, and 2 points in dyspnea score. RESULTS:The median improvement in unadjusted walk test distance was 20 meters overall and 30 meters in patients not receiving recent cancer treatment. Fatigue scores improved overall by a median of 3 points and by 4 points in patients without cancer treatment. There was no clinically important change in dyspnea scores. In multiple linear regression analysis, patients who maintained hemoglobin (Hb) levels of 8 g/dL or greater at 1 week posttransfusion, who had not received recent cancer treatment, and who did not require hospitalization during the study showed clinically important increases in mean walk test distance. CONCLUSIONS:Red blood cell transfusion is associated with a modest, but clinically important improvement in walk test distance and fatigue score outcomes in adult hematology/oncology outpatients