The role of multimodal neuromonitoring during anesthesia for ablation of giant endocranial tumors

Catedra de anesteziologie și reanimatologie nr.2, Catedra de anesteziologie și reanimatologie nr.1 „Valeriu Ghereg”, Catedra de neurochirurgie, USMF „Nicolae Testemițanu”, Chișinău, Republica Moldova, Conferința stiințifică „Nicolae Anestiadi – nume etern al chirurgiei basarabene” consacrată centenarului de la nașterea profesorului Nicolae Anestiadi 26 august 2016Material şi metode. În studiu au fost incluse 2 loturi de pacienţi: I lot– 6 pacienţi cărora li s-a administrat anestezie combinată (i/v + pivot inhalator cu sevofluran); lotul II– 5 pacienţi cărora li s-a administrat anestezie totală intravenoasă (propofol+fentanil). Monitoring: TAs, TAd, TAm (invaziv), PVC, echilibru acidobazic, gazos (arteră şi venă periferică, bulbul jugular), electrolitic, acidul lactic, diurezei orară, PESS. Discuţii. În lotul pacienţilor cu anestezie inhalatorie s-a determinat o incidenţă înaltă a depresiei hemodinamice profunde (Tam - 74,3 mmHg, p= 0,02). Tot aici s-a determinat: utilizarea dozelor mai mici de analgetice şi miorelaxante (sol. atracurium bromid 0,35-0,4mg/kg) , trezire mai rapidă, incidenţă mai scăzută a greții şi tremorului postoperator. S-a reuşit efectuarea mai veridică a neuromonitorigului, datorită cantităţii mai mici de miorelaxante utilizate. La pacienţii cu anestezie intravenoasă s-a determinat o stabilitate hemodinamică (Tam - 82,7 mmHg, p ≤ 0,05), hemoragie intraoperatorie nesemnificativă. În lotul dat s-a reuşit efectuarea neuromonitorigului, cu doze obişnuite de miorelaxante (sol. atracurium bromid 0,5 mg/kg). Concluzii. Tehnicile descrise pot fi utilizate pentru neuromonitorizare multimodală în ablaţia de tumori endocraniene. Tehnica de anestezie inhalatorie, respectând farmacocinetica preparatelor, ar putea fi de preferat, din cauza evitării riscurilor de supra - sau sub dozare de medicamente anestezice, oferind o trezire mai rapidă, cu o evaluarea neurologică imediată, care este extrem de importantă.Materials and methods. The study included two groups of patients: I-st group - 6 patients receiving combined anesthesia (i / v + inhaled sevoflurane); II-nd group - 5 patients who received intravenous anesthesia (propofol + fentanyl).Monitoring: sBP, dBP, mBP (invasive), CVP, acid-base, gas (peripheral artery and vein, jugular bulb) and electrolytic balances, lactic acid, hourly diuresis, neurology evoked potentials. Discussion. In the group of patients with inhalation anesthesia was determined a higher incidence of hemodynamic depression (Tam - 74,3 mmHg, p= 0,02). Also it was determined: use of lower doses of analgetics and muscle relaxants (sol. atracurium bromid 0,35-0,4mg/kg), faster awakening, lower incidence of postoperative nausea and tremors. We managed a more accurate recording of evoked potentials due to the small amount of muscle relaxant used. In patients with intravenous anesthesia was determined a more stable BP (mBP - 82,7 mmHg, p ≤ 0,05), less intraoperative bleeding. In the group given was carrying neuromonitorigului managed with dose of muscle relaxant common (ground. atracurium aromide 0.5 mg / kg). Conclusions. The techniques described can be used for multimodal neuromonitoring in ablation of tumor endocranial. Inhalational anesthesia technique, respecting the pharmacokinetics preparations could be preferable because avoid the risks of over - or under dosage of anesthetic agents, providing an awakening faster with immediate neurological evaluation, which is extremely important

Изменения систолической и диастолической фунции правого желудочка у больных ХОБЛ и хроническим легочным сердцем под влиянием длительного лечения престариумом

Catedra Boli Interne nr. 6, USMF „Nicolae Testemiţanu”The results of the complex examination of 40 patients with chronic obstruction pulmonary diseases complicated with chronic pulmonary heart showed up the activation of renin-angiotensin-aldosterone system (rising of renin and angiotensin converting enzyme activity, aldosterone plasmatic concentration). The rising of renin activity and aldosterone concentration correlate with the level of pulmonary hypertension, hypoxemia, structural and functional changes of right and left ventricle. The process of heart remodeling is characterized by increasing of anterior wall thickness and dimensions of right ventricle and right auricle, signs of diastolic (impaired or pseudonormal relaxation) and systolic dysfunction of right ventricle. The administration of inhibitor of angiotensin converting enzyme prestarium in compensated chronic pulmonary heart leads to depression of average pressure in the pulmonary artery, improvement of right ventricle and left ventricle diastolic function, and a tendency to decrease the thickness anterior wall of right ventricle, systolic and diastolic dimensions of both ventricles, dimensions of right auricle. По результатам комплексного обследования 40 больных ХОБЛ, осложненной ХЛС, выявлена активация РААС в виде увеличения активности ренина, АПФ и концентрации альдостерона в плазме крови. Повышение активности ренина и концентрации альдостерона взaимосвязано с уровнем ЛГ, гипоксемии, структурно-функциональными изменениями ПЖ и ЛЖ. Процесс ремоделирования сердца у больных ХОБЛ и ХЛС характеризуется увеличением толщины передней стенки и размеров полости ПЖ и ПП, признакaми диастолической дисфункции по типу замедленной релаксации или псевдонормального типа и нарушения систолической функции ПЖ. Назначение ингибитора АПФ престариума при компенсированном ХЛС через год от начала лечения приводит к уменьшению СрДЛА, улучшению диастолической функции ПЖ и ЛЖ, наблюдается тенденция к уменьшению толщины передней стенки ПЖ, систолического и диастолического размеров обоих желудочков, а также размеров ПП

Современная диагностика легочной артериальной гипертензии

Department of Radiology, Nicolae Testemitanu State Medical and Pharmaceutical University, Institute of Cardiology, Institute of Oncology, ChisinauLucrarea reprezintă o sinteză a cercetărilor actuale din domeniul diagnosticului modern al hipertensiunii pulmonare arteriale. Datele analizate provin dintr-o bibliografie bogată din literatura de specialitate. La etapa actuală, diagnosticarea sindromului de hipertensiune pulmonară arterială se realizează cu utilizarea diferitelor metode: electrocardiografia, ecocardiografia Doppler, radiografia toracică, scintigrafia pulmonară prin perfuzie şi prin ventilaţie, tomografia computerizată, testele funcţiei pulmonare şi cateterizmul cardiac. De asemenea, articolul conţine informaţii practice referitoare la rolul diferitelor metode imagistice în aprecierea patologiei.Представленная работа является синтезом актуальных методов диагностики легочной артериальной гипертензии. Анализируемые данные селектированы из множества литературных источников данного профиля. В настоящее время диагностика синдрома легочной артериальной гипертензии осуществляется с использованием различных методов: электрокардиография, эхокардиография Допплер, рентгенография грудной клетки, перфузионная и вентиляционная сцинтиграфия легких, компьютерная томография, методы функциональной диагностики, катетеризация сердца. Статья также содержит практическую информацию о роли различных методов лучевой диагностики в определении соответствующей патологии

Патогенетическое обоснование приминения Фенспирида в лечении хронической обструктивной болезни легких

Catedra Farmacologie şi Farmacie Clinică, Catedra Boli interne nr. 6, USMF „Nicolae Testemiţanu”The authors show the comparative effectiveness of the long-term use of Fenspirid, Becloforte and Atrovent in 50 patients with chronic obstructive pulmonary disease. In a 6-month program of treatment fenspirid contributed to a 2,6-fold decrease in the intensity of the cough, Becloforte – a 1,9 decrease and Atrovent – a 1,2. The anti-inflammatory therapy had positive effects on the level of pro-inflammatory cytokines that registered a 3-fold decrease in patients who used fenspirid, a 2-fold decrease in patients using Becloforte, and 1,5 decrease with Atrovent. During the long-term treatment with fenspirid VEF1 increased by 35,5%, with Becloforte by 25,4% and by 21,2% using standard therapy.У 50 больных хронической обструктивной болезнью легких изучена сравнительная эффективность длительного примянения фенспирида, беклофорте и атровента. Установлено, что применение фенспирида в течение 6 мес способствует уменьшению интенсивности кашля в 2,6 раза, беклофорте – в 1,9 раза, атровента – в 1,2 раза. Противовоспалительная терапия оказывала положительное влияние на уровень провоспалительных цитокинов, которые уменьшились на фоне лечения фенспиридом в 3 раза, беклофорте – в 2 раза, атровентом – в 1,5 раза. В процесе длительного применения фенспирида ОФВ1 увеличился на 35,5%, беклофорте – на 25,4%, на фоне базисной терапии – на 21,2%

Противовоспалительная терапия в лечении больных хронической обструктивной болезнью легких

Catedra Farmacologie şi Farmacologie clinică, USMF „Nicolae Testemiţanu”The aim of the study was to investigate the effects of Eurespal (Fenspirid) on the clinical manifestations and parameters of inflammation in patients with chronic obstructive pulmonary disease (COPD). The two stages of the study included a 3-week treatment during exacerbation periods and a 3-month outpatient follow-up during clinical remission periods. During exacerbation periods of COPD the researchers observed earlier and more noticeable antitussive and mucolytic action of Eurespal which were associated with the lessening of bronchial obstruction and inflammation, a significant drop of the C-reactive protein level and an increase of total oxidant serum level. Long-term (3 months) treatment with Eurespal led to further positive dynamics of clinical and laboratory indices of inflammation. The results of the study demonstrate that inclusion of Eurespal in complex therapy of COPD increases efficacy of treatment through its anti-inflammatory action during the periods of exacerbation and relative remission.Было изучено влияние эреспала (фенспирид) на клиническое течение и показатели воспаления у больных хронической обструктивной болезнью легких (ХОБЛ). Исследование проводили в 2 этапа: в течение 3 нед терапии при обострении заболевания и на протяжении 3 мес амбулаторного лечения в периоде клинической ремиссии. При обострении ХОБЛ терапия эреспалом оказывала более ранний и отчетливый противокашлевой, муколитический эффекты, сопровождаясь уменьшением обструкции, интенсивности воспаления в бронхах, достоверным снижением содержания С-реактивного белка и увеличением содержания об­щих антиоксидантов в сыворотке крови. Длительное (в течение 3 мес) лечение эреспалом обеспечивало у больных ХОБЛ дальнейшую положительную динамику клинико-лабораторных показателей воспаления. Результаты исследования позволяют считать, что включение эреспала в комплексную терапию ХОБЛ повышает эффективность лечения как при обострении, так и ремиссии заболевания, оказывая выраженное противовоспалительное действие

Optimal microwave control pulse for nuclear spin polarization and readout in dense nitrogen-vacancy ensembles in diamond

Nitrogen-vacancy centers possessing nuclear spins are promising candidates for a novel nuclear spin gyroscope. Preparation of a nuclear spin state is a crucial step to implement a sensor that utilizes a nuclear spin. In a low magnetic field, such a preparation utilizes population transfer, from polarized electronic spin to nuclear spin, using microwave pulses. The use of the narrowband microwave pulse proposed earlier is inefficient when magnetic transitions are not well resolved, particularly when applied to diamond with a natural abundance of carbon atoms or dense ensembles of nitrogen-vacancy centers. In this study, the authors performed optimization of the pulse shape for 3 relatively easily accessible pulse shapes. The optimization was done for a range of magnetic transition linewidths, corresponding to the practically important range of nitrogen concentrations (5-50 ppm). It was found that, while at low nitrogen concentrations, optimized pulse added very little to simple square shape pulse, and in the case of dense nitrogen-vacancy ensembles, with a rather wide magnetic transition width of 1.5 MHz optimal pulses, a factor of 15% improvement in the population of the target state was observed

Random to chaotic temperature transition in low-field Fano-Feshbach resonances of cold thulium atoms

Here, we report on the observation of a random to chaotic temperature transition in the spacing of Fano-Feshbach resonances in the ultracold polarized gas of thulium atoms. This transition is due to the appearance of so-called d-resonances, which are not accessible at low temperatures, in the spectra at high temperatures, which drastically changes thulium's overall resonance statistic. In addition to this statistical change, it has been observed that s- and d-resonances experience quite different temperature shifts: s-resonances experience almost no shift with the temperature, while d-resonances experience an obvious positive shift. In addition, careful analysis of the broad Fano-Feshbach resonances enabled the determination of the sign of thulium's background scattering length. A rethermalization experiment made it possible to estimate a length value of a=144+-38a.u.. This proves that thulium atoms are suitable for achieving Bose-Einstein Condensation

Amicable pairs and aliquot cycles for elliptic curves

An amicable pair for an elliptic curve E/Q is a pair of primes (p,q) of good reduction for E satisfying #E(F_p) = q and #E(F_q) = p. In this paper we study elliptic amicable pairs and analogously defined longer elliptic aliquot cycles. We show that there exist elliptic curves with arbitrarily long aliqout cycles, but that CM elliptic curves (with j not 0) have no aliqout cycles of length greater than two. We give conjectural formulas for the frequency of amicable pairs. For CM curves, the derivation of precise conjectural formulas involves a detailed analysis of the values of the Grossencharacter evaluated at a prime ideal P in End(E) having the property that #E(F_P) is prime. This is especially intricate for the family of curves with j = 0.Comment: 53 page