Гемостаз в условиях МАРС-терапии и плазмосорбции у больных с печеночно-клеточной недостаточностью

Objective: to comparatively estimate major hemostatic parameters during plasma sorption (PS) and molecular adsorption recirculating system (MARS) therapy in patients with liver cell failure. Subjects and methods: Forty-one patients with liver cell failure were examined. The patients’ condition was rated using the APACHE III, SOFA, MODS, and Child-Pugh scales. As a complex of intensive therapy, all the patients were treated with extracorporeal techniques: MARS therapy in Group 1 (n=17) and plasma sorption in Group 2 (n=24). The patients’ age was 18 to 65 years. Results. MARS therapy, unlike PS, normalizes the parameters of coagulation hemostasis and stabilizes platelet counts within 5 days in the postperfusion period. MARS therapy is the procedure of choice for the treatment of patients with liver cell failure. Mortality was 35.3 and 54.2% in Groups 1 and 2, respectively. Key words: molecular adsorption recirculating system, plasma sorption, acute liver cell failure.Цель работы — сравнительная оценка основных параметров гемостаза при проведении плазмосорбции (ПС) и терапии молекулярной адсорбционно-рециркуляционной системой (МАPC) у больных с печеночно-клеточной недостаточностью. Материал и методы. Обследованы 41 пациент с печеночно-клеточной недостаточностью. Оценку тяжести состояния пациентов проводили по шкалам АРАСНЕ III, SOFA, MODS и Child-Pugh. Все пациенты в комплексе интенсивной терапии получали лечение экстракорпоральными методами — I группа (n=17) (МАР^терапия) и II группа (n=24) (плаз-мосорбция). Возраст от 18 до 65 лет. Результаты. Процедура MAРС в отличие от ПС в постперфузионном периоде в течение 5-и суток обеспечивает: нормализацию параметров коагуляционного гемостаза, стабилизацию количества тромбоцитов. Проведение МАРС-терапии является процедурой выбора при лечении пациентов с печеночно-клеточной недостаточностью. Летальность в I группе составила 35,3%, во II группе —54,2%. Ключевые слова: молекулярная ад-сорбционно-рециркуляционная система, плазмосорбция, острая печеночно-клеточная недостаточность

Plants with genetically encoded autoluminescence

Autoluminescent plants engineered to express a bacterial bioluminescence gene cluster in plastids have not been widely adopted because of low light output. We engineered tobacco plants with a fungal bioluminescence system that converts caffeic acid (present in all plants) into luciferin and report self-sustained luminescence that is visible to the naked eye. Our findings could underpin development of a suite of imaging tools for plants

The Politics of Race and Class and the Changing Spatial Fortunes of the McCarren Pool in Brooklyn, New York, 1936-2010

This paper explores the changing spatial properties of the McCarren Pool and connects them to the politics of race and class. The pool was a large liberal government project that sought to improve the leisure time of working class Brooklynites and between 1936 and the early 1970s it was a quasi-public functional space. In the 1970s and the early 1980s, the pool became a quasi-public dysfunctional space because the city government reduced its maintenance and staffing levels. Working class whites of the area engaged into neighborhood defense in order to prevent the influx of Latinos and African Americans into parts of Williamsburg and Greenpoint and this included the environs of the McCarren Pool. The pool was shut down in 1983 because of a mechanical failure. Its restoration did not take place because residents and storekeepers near the vicinity of the pool complained that by the 1970s, it was only African Americans and Latinos who patronized the pool and that their presence in the neighborhood undermined white exclusivity. For two decades, the McCarren Pool became a multi-use alternative space frequented by homeless people, graffiti artists, heroin users, teenagers, and drug dealers. Unlike previous decades, during this period, people of various racial and ethnic backgrounds frequented the pool area in a relatively harmonious manner. In the early part of the twenty-first century, a neoliberal city administration allowed a corporation to organize music concerts in the pool premises and promised to restore the facility into an operable swimming pool. The problem with this restoration project is that the history of the pool between the early 1970s and the early 2000s is downplayed and this does not serve well former or future users of the poo

Mutationism and the Dual Causation of Evolutionary Change

The rediscovery of Mendel's laws a century ago launched the science that William Bateson called "genetics," and led to a new view of evolution combining selection, particulate inheritance, and the newly characterized phenomenon of "mutation." This "mutationist" view clashed with the earlier view of Darwin, and the later "Modern Synthesis," by allowing discontinuity, and by recognizing mutation (or more properly, mutation-and-altered-development) as a source of creativity, direction, and initiative. By the mid-20th century, the opposing Modern Synthesis view was a prevailing orthodoxy: under its influence, "evolution" was redefined as "shifting gene frequencies," that is, the sorting out of pre-existing variation without new mutations; and the notion that mutation-and-altered-development can exert a predictable influence on the course of evolutionary change was seen as heretical. Nevertheless, mutationist ideas re-surfaced: the notion of mutational determinants of directionality emerged in molecular evolution by 1962, followed in the 1980s by an interest among evolutionary developmental biologists in a shaping or creative role of developmental propensities of variation, and more recently, a recognition by theoretical evolutionary geneticists of the importance of discontinuity and of new mutations in adaptive dynamics. The synthetic challenge presented by these innovations is to integrate mutation-and-altered-development into a new understanding of the dual causation of evolutionary change--a broader and more predictive understanding that already can lay claim to important empirical and theoretical results--and to develop a research program appropriately emphasizing the emergence of variation as a cause of propensities of evolutionary change

Global Perspectives on Task Shifting and Task Sharing in Neurosurgery.

BACKGROUND: Neurosurgical task shifting and task sharing (TS/S), delegating clinical care to non-neurosurgeons, is ongoing in many hospital systems in which neurosurgeons are scarce. Although TS/S can increase access to treatment, it remains highly controversial. This survey investigated perceptions of neurosurgical TS/S to elucidate whether it is a permissible temporary solution to the global workforce deficit. METHODS: The survey was distributed to a convenience sample of individuals providing neurosurgical care. A digital survey link was distributed through electronic mailing lists of continental neurosurgical societies and various collectives, conference announcements, and social media platforms (July 2018-January 2019). Data were analyzed by descriptive statistics and univariate regression of Likert Scale scores. RESULTS: Survey respondents represented 105 of 194 World Health Organization member countries (54.1%; 391 respondents, 162 from high-income countries and 229 from low- and middle-income countries [LMICs]). The most agreed on statement was that task sharing is preferred to task shifting. There was broad consensus that both task shifting and task sharing should require competency-based evaluation, standardized training endorsed by governing organizations, and maintenance of certification. When perspectives were stratified by income class, LMICs were significantly more likely to agree that task shifting is professionally disruptive to traditional training, task sharing should be a priority where human resources are scarce, and to call for additional TS/S regulation, such as certification and formal consultation with a neurosurgeon (in person or electronic/telemedicine). CONCLUSIONS: Both LMIC and high-income countries agreed that task sharing should be prioritized over task shifting and that additional recommendations and regulations could enhance care. These data invite future discussions on policy and training programs