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Alexander Combes,1 Simon McQueen,2 Catalina Alejandra Palma,1 David Benz,2 Scott Leslie,1,3– 5 Paul Sved,1,5 John Boulas,1,5 Arthur Vasilaras,1,5 Chris Rogan,2,5 Ilias Drivas,2 David Robert Eisinger,1 Richard Waugh2 1Department of Urology, Royal Prince Alfred Hospital, Camperdown, NSW, 2050, Australia; 2Department of Radiology, Royal Prince Alfred Hospital, Camperdown, NSW, 2050, Australia; 3RPA Institute of Academic Surgery, Sydney, NSW, Australia; 4Faculty of Medicine, University of Sydney, Sydney, NSW, Australia; 5Department of Urology, Chris O’Brien Lifehouse, Sydney, NSW, AustraliaCorrespondence: Alexander Combes, Department of Urology, Royal Prince Alfred Hospital, 50 Missenden Road, Camperdown, NSW, 2050, Australia, Tel +612 9515 7773, Fax +612 9515 7774, Email combes_08@hotmail.comPurpose: Renal angiomyolipoma (AML) is the most common benign renal tumor. Whilst generally asymptomatic, they can cause life-threatening bleeding. Selective angioembolization (SAE) may be used to treat large symptomatic and asymptomatic AMLs. We aimed to evaluate the efficacy of SAE for symptomatic and asymptomatic renal AMLs and determine characteristics that predict spontaneous bleeding.Patients and Methods: Data were retrospectively collected from a prospectively maintained database from July 2011 to April 2022. Patients were included if AML was > 4cm and they underwent subsequent SAE. Follow-up imaging was analyzed to calculate mean reduction in AML size. Clinical notes were reviewed to analyze lesion characteristics including vascularity, fat content and presence of aneurysm as well as post-procedural complications.Results: 26 patients with 30 AMLs were identified. Interval of follow-up imaging ranged from 1 to 60 months. 25 AMLs were embolized electively with 5 emergency embolizations performed for bleeding. Mean reduction in AML volume was 41% at 3 months (p=0.013) and 63% at 12 months (p=0.007). All 5 bleeding AMLs had a rich vascularity with 60% also having either aneurysms or a low fat content. Complications included post-embolic syndrome (n=9), segmental renal parenchyma devascularization (n=3), acute bleeding requiring re-embolization (n=2), nephrectomy for ongoing bleeding (n=1) and delayed bleeding managed conservatively (n=1). No deterioration in renal function was observed.Conclusion: SAE is an effective procedure for managing symptomatic and asymptomatic renal AML, with minimal significant complications. AML vascularity, fat content and aneurysms may be useful characteristics to assess future risk of bleeding in patients with renal AML.Keywords: selective angioembolization, aneurysm, fat content, tuberosclerosis complex

Gabriel Gallegos,1 Charity J Morgan,2 Garrett Scott,1 David Benz,1 Timothy J Ness1 1Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, Birmingham, AL 35205, USA; 2Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL 35205, USACorrespondence: Timothy J NessDepartment of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, BMR2-208, 901 19 th St. S, Birmingham, AL 35205 Tel +1 205-975-9643Fax +1 205-934-7437Email tness@uabmc.eduBackground: The purpose of this study was to determine whether neuraxial analgesic procedures affect intraoperative hemodynamics and/or postoperative outcomes. Previous studies have examined effects in small samples of patients in highly controlled research environments. This study examined “real-world” data from a large sample of subjects receiving routine clinical cares.Methods: A matched case–control analysis of electronic medical records from a large, academic hospital was performed. Patients who underwent neuraxial procedures preoperatively for postoperative analgesia for abdominal surgery (n=1570) were compared with control patients matched according to age, sex, ASA class and type of surgical procedure. Intraoperative hemodynamic measures, fluids and pressor utilization were quantified. Postoperative outcomes were determined based on the changes in laboratory values, the ordering of imaging studies and admission to an intensive care unit during the seven days following surgery as well as 30-day mortality.Results: Medical records of 1082 patients who received an epidural catheter placement and 488 patients who received a lumbar intrathecal morphine injection were compared with an equal number of matched control patients. Preoperative placement of an epidural catheter for the management of postoperative pain was demonstrated to be associated with significant reductions in mean arterial pressure intraoperatively and poorer postoperative outcomes (more intensive care unit [ICU] admissions, more myocardial injuries) when compared with controls. A similar analysis of preoperatively administered intrathecal morphine injections was not associated with intraoperative alterations in blood pressure and had improved outcomes (less ICU admissions) in comparison with controls.Conclusion: In a “real-world” sample, intrathecal morphine administration proved to be highly beneficial as a neuraxial analgesic procedure as it was not associated with intraoperative hypotension and was associated with improved clinical outcomes, in contrast to opposite findings associated with epidural catheter placement. There should be a careful consideration of elective neuraxial method utilized for postoperative pain control, with the present study raising significant concerns related to the use of epidural analgesia and its potential effect on clinical outcomes.Keywords: neuraxial analgesia, hypotension, perioperative outcomes

Regional markets demonstrate a significant slowdown in economic growth and the Ural region is not an exception. The article examines the specificity of the Ural industrial markets. The methodological basis of the research is neoclassical economic theory looking at the dependence of output on the production factors applied in the context of the production function. The authors perform a quantitative research using the econometric tools and construct several regression models. We use the sales growth rate of the regional industrial market as a resulting indicator. Regressors (factors) are growth rates of salary; investments into fixed capital; own and raised funds allocated for investments into fixed capital; short-term and long-term financial investments. The authors describe the trends in the Ural industries. The results show that there is a correlation between growth rates of the industrial markets and growth rates of salary and own funds allocated for investments into fixed capital. The paper concludes about the necessity for the region to move to a new technological level. At the same time, it is also important to develop traditional industries. The region’s potential is high and, therefore, the synergy in the triad “industry–education–science” can stimulate its growth. In addition, at the moment there is an urgent need for cultivating conditions, especially institutional ones, to form a solid layer of medium-sized business in the Ural region.

The article focuses on issues of economic growth, and eco-efficiency in Russian industrial regions on the example of the Urals Federal District. The study is based on the concept of existing tensions between economic development, and eco-efficiency. The author claims that within this concept an optimum could be found. The purpose of the study is to determine the most optimal industrial growth rate within the Urals Federal District. Industrial production representing 50% of the sectoral gross value added structure is the key factor of economic growth in the researched regions. This basic hypothesis of the study is confirmed by a relatively strong correlation between industrial growth rate and Gross Regional Product growth rate in Sverdlovsk region, Tyumen region, and Chelyabinsk region. As part of the study the author made use of correlation analysis, which confirmed the basic hypothesis of the research, and paired regression analysis, where industrial production growth rate is used as a regressor to build paired regression models. Economic growth is estimated via Gross Regional Product growth rate. For every sector, where the basic hypothesis is confirmed, there is a graphical model illustrating dependence of economic growth (E1), and eco-efficiency (E2) on industrial growth rate. The study discovers optimal industrial growth rate providing development of eco-efficiency in the researched regions. The results of the study can be applied both by scientists or government structures in strategies of regional development taking into account eco-efficiency.

Institutional aspects of business become more and more pertinent. Russian enterprises acts in the environment that is currently imperfect and does not provide comfortable conditions for the growth of small and medium enterprises. Trust is the foundation for construction of a friendly institutional environment, a basic institution required for cooperation between any kinds of subjects. Large enterprises are the core of the Russian economy, they are a stable source of financing the federal budget. Small and medium-sized businesses face two complexities: weak government support and in a business environment characterized by a low level of trust. The purpose of the article is to assess the interrelation of trust indicators in the Russian economy with the main economic indicators using methods of correlation and regression analysis. The parameters of the models are evaluated on the basis of the data of VCIOM (The Russian Public Opinion Research Center) and Rosstat (Russian State Statistics Agency). The main conclusion of the study is the most significant impact on the economy of such a trust indicator as the index of favorable conditions for making large purchases. This indicator can be used for modeling and managing the economic growth in the modern Russian economy.