Optimization of finances into regional energy

The development of modern Russian energy collides with the need for major investments in the modernization and renewal of generation and transmission capacity. In terms of attracting sufficient financial resources and find ways to increase, energy sector profitability and investment attractiveness of particular importance is the problem of investment financing optimizing aimed at minimizing the cost of financing while maintaining financial stability of the power companies and the goals and objectives of Russian energy system long-term development. The article discusses the problem of investment projects financing in power generation from the point of view of the need to achieve optimal investment budget. Presents the author's approach to the investment financing optimization of power generation company that will achieve the minimum cost of resources involved, taking into account the impact of the funding structure for the power generating company financial sustainability. The developed model is applied to the problem of investment budget optimizing, for example, regional power generating company. The results can improve the efficiency of investment in energy, sustainable and competitive development of regional energy systems

Stress-induced diseases of the thyroid gland in Ukraine during hostilities

The aim of the study: to analyze and evaluate the relationship between previous life events of a stressful nature in patients who have surgical diseases of the thyroid gland. Materials and methods. We used the questionnaire method (The Life Experiences Survey Irwin G. Sarason, 1978) of patients before planned surgical intervention on the thyroid gland. The number of positive and negative events that happened to patients during the previous year was evaluated. Results. Among individuals, significantly more adverse events were reported by patients with Graves’ disease (128.0 ± 2.3 points) and proliferative hyperthyroid nodular goiter (105.0 ± 1.7 points) compared to patients treated surgically for euthyroid nodular goiter (53.0 ± 0.7 points of negative events) and thyroid carcinomas (62.0 ± 0.8 points of negative events). Conclusions. It has been proven that stress and negative life events can be triggers for dysfunction and development of thyroid gland diseases. Analysis of a patient survey before thyroid surgery indicated a possible relationship between acute stress and the initiation of Graves’ disease and proliferative hyperthyroid nodular goiter

Organization of sorting and surgery of wounds with soft tissue defects during the joint force surgery

Introduction. The experience of providing medical care during the Anti-terrorist operation in eastern Ukraine showed that in the structure of modern combat surgical trauma gunshot wounds with soft tissue defects are between 64.9-68.2%, of which 36.4-37.5% are small and medium, 28.5-30.7% are large and very large defects.Aim: To improve the results of providing surgical care to the wounded with soft tissue defects by introducing a variety of surgical tactics of wound closure to the medical care levels.Material and Methods. The total array of the study was 2537 wounded with shrapnel, bullet and mine injuries from April 2014 to September 2018. The determination of surgical tactics for closing soft tissue defects was performed at the basis of metric classification taking into account the area, volume and anatomical areas of the lesion.Results. The combination of metric characteristics of wound defects by area, volume with localization of wounds in a single classification allowed the offer of a comprehensive approach to sorting the wounded at the level of medical care and to determine further surgical tactics to close soft tissue defects. In accordance with the sorting and evacuation purposes, the wounded with gunshot wounds to the foot and hand (third zone of injury) were treated in specialised centres to the fourth level of medical care. In the case of medium and large wounds of the thigh, leg, shoulder and forearm, medical care was provided at the second and third levels. And in the case of large and very large wounds of the specified localisation was provided in specialised clinics of the fourth level.Conclusions. The introduction of differentiated surgical tactics in the wounded with soft tissue defects at the levels of medical care has improved functional results: increase the proportion of good from 46.9% to 53.7%, reduce the relative number of unsatisfactory from 18.8% to 11, 6%

Морфологічні особливості печінки статевозрілої собаки

The article describes the features of the macroscopic and microscopic structure of the liver of mature clinically healthy dogs for the use of anatomical, histological and morphometric methods of research. According to the results of organometallic and cytometric studies, the absolute and relative body mass, the volume of hepatocytes, their nuclei and the nuclear-cytoplasmic ratio were determined. Thus, the absolute weight of the liver in the mature dogs is variable and to a certain extent depends on the blood flow to the organ and is 427.4 ± 21.92 g, the relative weight – 2.69 ± 0.1%. Liver of mature dogs is a compact body of flattened form with sharp lower and lateral edges, with deep cuts, dark red color. The histoarhitectonics of the liver of dogs are constructed with connective tissue and parenchyma. The stroma of the organ is formed by a capsule, on top of which is serous membrane. In the area of the gates of the liver, the connective tissue of the capsule penetrates into the middle of the organ, branching and dividing it into lobules. Then it is formed by the hepatic plates by the intraosseous sinusoid capillaries. Liver plates are specific endpoint of the secretory unit of the liver. It has been found that in the microscopic structure of the liver of the dogs, the interstitial connective tissue is poorly developed, therefore the boundaries between the liver lobules are not sufficient. The liver plates behind the microscopic structure have a radial direction from the center to the periphery. The direction closer to the periphery of the particles is less noticeable, since hepatocytes are located in two rows, between which the sinusoidal space clearly appears. Hepatocytes had an irregular, multifaceted form. Their nuclei, which were mainly in the center of the cell, had little clarity of contours of carriel and well perceived color. During microscopic examination of the liver, it is swollen that hepatocytes of the central and intermediate zones are better perceived by color than the cytoplasm of the cells of the peripheral zone of the liver. According to the analysis of our cytomorphometric studies, hepatocytes of dogs have different sizes, which vary in wide range: from small to large. Whereas the average volume of hepatocytes in mature dogs is 964.72 ± 56.003 μm³; the average volume of their nuclei is 105.13 ± 2.02 microns. The nuclear-cytoplasmic ratio of hepatocytes in dogs of this group is 0.128 ± 0.122.У статті за використання анатомічних, гістологічних та морфометричних методів досліджень викладено особливості макро- та мікроскопічної будови печінки статевозрілих клінічно здорових собак. За результатами органо – гісто- та цитометричних досліджень з’ясовано абсолютну та відносну масу органу, об’єм гепатоцитів, їх ядер та ядерно-цитоплазматичне відношення. Так, абсолютна маса печінки у статевозрілих собак мінлива і в певній мірі залежить від кровонаповнення органа і становить 427,4 ± 21,92 г, відносна маса – 2,69 ± 0,1%. Печінка статевозрілих собак компактний орган сплющеної форми з гострими нижнім і бічними краями, з глибокими вирізками, темно-червоного кольору. Гістоархітектоніка печінки собак побудована зі сполучнотканинної строми і зі паренхіми. Строма органа сформована капсулою, поверх якої міститься серозна оболонка. У ділянці воріт печінки, сполучна тканина капсули проникає всередину органа, розгалужується і ділить його на часточки. Останні утворені печінковими пластинками внутрішньочасточковими синусоїдними капілярами. Печінкові пластинки являють собою специфічний кінцевий секреторний відділ печінки. З’ясовано, що у мікроскопічній будові печінки собак міжчасточкова сполучна тканина слабко розвинена, тому межі між печінковими часточками маловиражені. Печінкові пластинки за мікроскопічної будови мають радіальний напрямок, від центру до периферії. Ближче до периферії часточок їх напрямок менш помітний, оскільки гепатоцити розташовувались двома рядами, між якими чітко виявляється синусоїдальний простір. Гепатоцити мали неправильну, багатогранну форму. Їх ядра, які містилися в основному у центрі клітини, мали чітко контуровану каріолему і добре сприймали забарвлення. Під час мікроскопічного дослідження печінки відмічено, що гепатоцити центральної і проміжної зон краще сприймали забарвлення, ніж цитоплазма клітин периферичної зони печінкової частки. Згідно з аналізом проведених нами цитоморфометричних досліджень, гепатоцити собак мають різні розміри, які коливаються у широких межах: від малих до великих. При тім, що середній об’єм гепатоцитів у статевозрілих собак становить 964,72 ± 56,003 мкм³; середній об’єм їх ядер – 105,13 ± 2,02 мкм3. Ядерно-цитоплазматичне відношення гепатоцитів у собак цієї групи складає 0,128 ± 0,122

Conceptual principles of the wounded combatants’ evacuation, suffering military surgical trauma on the medical support levels

Objective. To improve the results of treatment of the wounded persons, suffering a combat surgical trauma, elaborating and introducing of objective scales of the trauma severity estimation into the medical evacuation system while conduction of Antiterroristic operation / Operation of Joint Forces. Materials and metods. Complex medical-statistical investigation was performed, in which 684 wounded persons, suffering a combat surgical trauma were included. Dynamical medical control and determination of the trauma severity degree in accordance to AdTS (Admission trauma Scale) were applied on all levels of medical support. Results. In the beginning of conduction of Antiterroristic operation / Operation of Joint Forces a mortallty have had occurred during transportation of wounded persons in unstable state (more than 9 points) to military-medical clinical centers. The wounded persons in a traumatic shock state were transported on forth level of medical support, what have been considered an organization defect in the help deliver process, which leaded to death of military persons. At the same time an unjustified delay of transportation of servicemen, suffering wounds of the wrist and foot (up to 5 points), on the first and second levels of medical support, leading to development of severe complications, have occurred. Taking into account the above mentioned, the authors have provided a differentiated approach for medical evacuation of wounded persons, suffering a combat surgical trauma, depending on its severity degree. Conclusion. Evacuation of wounded persons, suffering a combat surgical trauma, constitutes an integral part of the medical support system of Antiterroristic operation/Operation of Joint Forces, closely connected with a medical support process during transportation. Medical evacuation of wounded persons with injuries of the vision organ, the wrist and foot must be accomplished urgently to specialized clinic of the fourth level of medical support

The organisation of using videolaparoscopy in military field hospital in conditions of anti-terroristic operations in Easter Ukraine

Ministry of Defense, Kiyv, Military-Medical Clinical Centre of south region, Odessa, Military-Medical Clinical Centre of south region of Ukraine, Odessa, Odessa national medical university, Odessa, Military-Medical Clinical Center of South region, Odessa, Ukraine, 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 MoldovaBackground: Improvement of the medical support for injured in the region of anti-terroristic operation by using endovideo surgical techniques in the hospitals of the 2-3nd Echelon. Methods and materials: In June 2014 mobile military hospital was set up for providing qualified surgical help to warriors in the region of eastern Ukraine. 1460operations (62 laparoscopic) were carried out during first 9 months. Results: We use data of 23 patients suffered under abdomen and pelvis injuries: 18 had missile and gunshot wounds, 5 had closed traumas. Acute diseases of the abdomen cavity were diagnosed 39 patients. The penetrative character of shoot wound was excluded by 6 patients using the diagnostic laparoscopy. Out of 5 patients with closed traumas of abdomen, injuries of internal organs were identified in 2 cases, operations were finished laparoscopically. Suffering from urgent diseases of the abdomen cavity organs, 10 patients underwent the laparoscopic appendectomy for acute appendicitis; 2 persons - the laparoscopic diverticulectomy for Meckel’s diverticulitis; in 3 cases the ovarian apoplexy and haemoperitoneum were detected during the laparoscopy, the laparoscopic resection of ovarium was performed; 1 patient underwent laparoscopy for pancreonecrosis, 20 laparoscopic cholecystectomy for acute calculous cholecystitis; one laparoscopic cholecystectomy for cancer of the pancreas, obstructive jaundice; 2 patients had laparoscopic suturing of perforative ulcers in duodenum. Conclusion: Well-founded approaches of treatment and diagnosis of shoot wounds of abdomen and pelvis by using the video laparoscopic equipment in the field conditions (first time in the Ukrainian history) were performed. Application of the endovideo surgical technics allowed avoiding 20 useless laparotomies

CERN PS laser ion source development

CERN, together with ITEP and TRINITI (Russia), is developing a CO2 laser ion source. The key design parameters are: 1.4 1010 ions of Pb25+ in a pulse of 5.5 ms, with a 4-rms emittance of 0.2 10-6 rad m, working at a repetition rate of 1 Hz. This device is considered as one candidate source for LHC heavy ion operation. The status of the laser development, the experimental set-up of the source consisting of the target area and its illumination, the plasma expansion area and extraction, beam transport and ion pre-acceleration by an RFQ, will be given

Исторические аспекты и современное состояние проблемы применения подкожных кардиовертеров-дефибрилляторов

The review indicates the priority of implantable cardioverter-defibrillators in the prevention of sudden cardiac death. Attention is drawn to the fact that most defibrillators implanted in the world are endocardial systems. The presence of the leads in the heart chambers is associated with a number of specific complications that cannot be prevented. It reduces the function capabilities of the defibrillator and increases the risk of morbidity and mortality. Subcutaneous systems eliminate the need for implantation of the endocardial leads, being preferable for patients with a long life expectancy. The main disadvantages include the impossibility to terminate ventricular tachycardia painlessly because of lack of antitachycardiac pacing and the inability to perform cardiac pacing for bradycardia. To assess the safety and efficacy of subcutaneous defibrillators, large multicenter studies have been conducted and are still ongoing. Their findings have demonstrated that subcutaneous systems are not inferior to traditional endocardial ones according to selected criteria. Recent advances in subcutaneous defibrillators have resulted in their superiority in some functional parameters of these systems over endocardial ones. Devices have a priority for patients with a high risk of infection and vascular access difficulties. Nevertheless, due to known limitations of subcutaneous systems, there are more stringent requirements for the selection of candidates for surgery. Among the entire cohort of patients requiring implantation of any type of defibrillator, there are many candidates for a subcutaneous device, as that can be conditionally equated to a single-chamber endocardial defibrillator, which is implanted in the majority of cases. The likelihood of the need to change in the future the device to a more functional endocardial is defined as low.В работе обоснован приоритет имплантируемых кардиовертеров-дефибрилляторов в профилактике внезапной сердечной смерти. В то же время обращено внимание на то, что большинство имплантируемых в мире дефибрилляторов являются эндокардиальными. Наличие электрода в полости сердца ассоциируется с рядом специфических осложнений, которые невозможно избежать, что, в свою очередь, снижает эффективность функционирования дефибриллятора и повышает риск заболеваемости и смертности. Подкожные системы исключают необходимость имплантации эндокардиального электрода, что является их преимуществом, особенно для пациентов с ожидаемой высокой продолжительностью жизни. К основным недостаткам относятся невозможность безболезненного купирования желудочковой тахикардии методом антитахистимуляции и проведения кардиостимуляции при брадикардии. С целью оценки безопасности и эффективности использования подкожных дефибрилляторов проведены и продолжаются крупные многоцентровые исследования, результаты которых демонстрируют, что подкожные системы не уступают по указанным критериям традиционным эндокардиальным. Прогресс в технологическом совершенствовании подкожных дефибрилляторов приводит даже к превосходству этих систем по отдельным функциональным параметрам над эндокардиальными. Устройствам отводится приоритетная роль в лечении пациентов с высоким риском инфекции и сложностями сосудистого доступа. Тем не менее вследствие известных ограничений подкожных систем требования к подбору кандидатов на проведение операции более жесткие. Среди всей когорты пациентов, нуждающихся в имплантации любого из возможных дефибрилляторов, кандидатов на подкожное устройство немало, так как его условно можно приравнять к однокамерному эндокардиальному дефибриллятору, который устанавливают в большинстве случаев. Вероятность необходимости смены устройства на более функциональное эндокардиальное в дальнейшем определена как низкая

СЕМЬ ВИДОВ ПАРОКСИЗМАЛЬНЫХ НАДЖЕЛУДОЧКОВЫХ ТАХИКАРДИЙ У ОДНОЙ ПАЦИЕНТКИ

The report describes the case of electrophysiological study and catheter ablation of seven types of supraventricular tachycardia in one patient. During radiofrequency ablation for WPW-syndrome three functionated discrete retrograde conductive accessory atrioventricular pathways were documented and were successfully ablated. Further incessant activity of two ectopic atrial focuses was revealed. First localized in upper part of crista terminalis and another – in left superior pulmonary vein ostium. Five months after patient had a recurrence of supraventricular tachycardia. EPI-study demonstrated evidence for retrograde ventriculoatrial dissociation with induction of atypical fast/slow and typical slow/fast atrioventricular nodal reentry tachycardia, wich were successfully ablated. With further observation, rhythm disturbances did not recur.Рассматривается случай проведения электрофизиологического исследования и катетерной аблации семи видов суправентрикулярной тахикардии у одной и той же пациентки. В ходе операции по поводу синдрома WPW было выявлено три дискретных ретроградно проводящих дополнительных предсердно-желудочковых соединения, которые были успешно аблированы. Далее документирована активность двух эктопических предсердных фокусов в области верхних отделов терминального гребня и устья верхней левой легочной вены с успешной их деструкцией. Через пять месяцев у пациентки возник рецидив наджелудочковой тахикардии. При ЭФИ документирована ретроградная вентрикулоатриальная диссоциация. Индуцируется атипичная «fast/slow» атриовентрикулярная узловая реципрокная тахикардия, а после ее успешной аблации и типичная «slow/fast» тахикардия, которая также была устранена. В дальнейшем нарушения ритма не рецидивировали